8 ms·

I think people are being a little too hard on the author. Startups in healthcare are hard. Been there, done that, have the t-shirt (literally, that's all that l

I think people are being a little too hard on the author. Startups in healthcare are hard. Been there, done that, have the t-shirt (literally, that's all that left). I even made the same fatal mistake - not identifying who the buyer really is. And when I say identifying the buyer, I don't mean it in that hand-wavey, vague way like "doctors" or "insurance companies". The starting point has to be something like "ophthalmologists in small practices (1-10 doctors) in New England who are trying to acquire new patients through social media." And here's something that's absolutely critical for all engineers trying to build a startup in healthcare to really understand. Healthcare is so alluring because tech people are so idealistic. We think, "Wow, we we can write some code, and then save lives!" And that's sometimes true. But when you are thinking of your customer, revenue model, sales strategy - all that business stuff - the mistake we make is thinking healthcare is different and the same rules don't apply. We think if we can save lives, we can make a business. But the key insight is that you have to take a step back and just treat healthcare like any other for-profit business. Doctors and hospitals care about what generates revenue. Insurance companies want to save money. Pharma companies are looking to advertise to new customers. It's no different than other industries. The psychiatrist's reaction to the sales pitch is the classic thing a doctor will tell when you're not helping their bottom line. As I was reading the post, I could almost predict how she was going to respond. And if you figure that business stuff out, who knows, you might just build a healthcare business that saves a life or two.

wayoutthere 7y ago
From a business standpoint, saving lives can actually be expensive. The longer someone lives, the more healthcare they consume. Health insurance companies are very aware of this, which is why they so frequently deny coverage for various life-saving cancer treatments. If you die while waiting for treatment, not only do they save the cost of the treatment, but also the entire cost of ongoing screening / care during remission.
- omegaworks 7y ago
  This is precisely why we need universal healthcare. The incentive structure of private markets don't properly value human life.
  - folli 7y ago
    Universal healthcare won't help you there, since it also requires a stringent cost-benefit-calculation, e.g. the British system is very (in)famous for this.
    - orhmeh09 7y ago
      Ah, but then you have all these with the ever-increasing demand for profit and the issues caused by that incentive on top of it all. Is that an improvement?
    - DanBC 7y ago
      > e.g. the British system There isn't a "british" system because health is devolved. There are four separate systems, one each for Scotland, Northern Ireland, Wales, and England. > requires a stringent cost-benefit-calculation There are lots of problems with the English NHS, but this is almost never one of them. Unless you have particular examples?
      - philjohn 7y ago
        I'm assuming it's the widely debunked "death panel" talk that was doing the rounds during the ACA debate.
    - philjohn 7y ago
      That is for approving new treatments, not for ongoing lifesaving care, so is an apples to oranges comparison IMHO. The drug needs to have a proven benefit, which usually comes down to how much longer does it give you, if it's only marginally better than the existing treatment, but orders of magnitude more expensive they work with the manufacturer to bring the cost down to where it can be approved. A lot of what was written about the UK system during the ACA debate was outright falshoods or misrepresentations (e.g. the infamous "death panels", whilst ignoring the Kafkaesque nightmare that can be the US system). Tell you what, I'd take the NHS over what you've got any day of the week, as would the vast majority of people in the UK.
- victor106 7y ago
  The longer you live the more monthly premiums you pay, so ideally they do want you to live, but they don't want you to use any healthcare services (or use less services) while you live.
  - harikb 7y ago
    No, the moment you are diagnosed with a chronic or life threatening disease, your premiums no longer cover the medical cost. Otherwise what is the point of insurance. Moreover, many regulations prevent them from raising future premiums. So kicking you off the insurance plan or letting you die is indeed their primary concern
    - jonny_eh 7y ago
      A better way to put it is that health insurers don't want you to get "sick". So anything to prevent that is usually money well spent. That's why vaccines are so easy to get.
    - lotsofpulp 7y ago
      This is incorrect. How can they kick you off the insurance plan? Also, the ACA has provisions to prevent one insurer from having to shoulder the costliest patients via some form of cost sharing with all the others. https://www.cms.gov/CCIIO/Programs-and-Initiatives/Premium-Stabilization-Programs/index https://www.cms.gov/CCIIO/Programs-and-Initiatives/Premium-S...
      - dzdt 7y ago
        > How can they kick you off the insurance plan? They can investigate whether you failed to report any preexisting conditions, or otherwise violated terms of your insurance. Things that would seem to you to be a technicality may be to their lawyers a breach of contract. Do you have a lawyer who is up for that fight? [1] https://www.justice.org/sites/default/files/file-uploads/InsuranceTactics.pdf&ved=2ahUKEwiBhuX28-nmAhUJa80KHVJZDBsQFjAAegQIARAB&usg=AOvVaw1_XJotX5w4-MII4YXJR3yY https://www.justice.org/sites/default/files/file-uploads/Ins...
jimbokun 7y ago
> But the key insight is that you have to take a step back and just treat healthcare like any other for-profit business. Doctors and hospitals care about what generates revenue. Insurance companies want to save money. Pharma companies are looking to advertise to new customers. It's no different than other industries. This is one of the most concise and effective arguments I have read for Medicare-For-All, Single Payer, etc.
- amitmathew 7y ago
  I'm all for removing the broken system we have today, but a single payer system doesn't remove the challenge that the entrepreneur faces - it just changes it. Under single payer, you are now trying to sell to a large government organization, with all the pain and red tape that comes with that.
  - brianpgordon 7y ago
    Presumably the government will be incentivized to try to save lives in a way that simply doesn't exist for doctors and insurance companies trying to make a profit.
    - trileansoftware 7y ago
      What happens in reality in systems like that is that doctors are lectured to avoid prescribing expensive exams, things like MRI or PET scans, even sometimes not telling patients they should do them if they could afford to pay them on their own. And the same goes for drug prescriptions.
  - relaxing 7y ago
    Thanks for refocusing the conversation back on the people that really matter.
  - TheOtherHobbes 7y ago
    Not necessarily. Doctors can still have individual discretion over their choice of IT service provision (etc) under single payer. The only thing single payer does is eliminate insurance company opportunism. It doesn't suddenly convert the entire healthcare system into a dystopian concrete monolith. Although if it did it would make OP's job far easier, because if you could prove there were cost and health outcome benefits on a national scale you would be able to convert the idea into a viable business with a single corporate sales pitch, instead of trying to sell to every doctor individually. In fact the real resistance would come from pharma. Single payer or not, evidence-based prescribing of empirically proven best-in-class drugs would undermine pharma's entire business model.
macspoofing 7y ago
>I think people are being a little too hard on the author. Startups in healthcare are hard. They are hard, but this case isn't really healthcare-related. He tried pitching his product to practices without showing how it could increase their revenue, or decrease their costs. Without that, his product is just another cost-center with some marginal (and ambiguous) healthcare benefits.
angrais 7y ago
Surely you can't leave us hanging? What's the t-shirt look like? :)
Toenex 7y ago
This. Been through two medical device companies that pivoted from clinical trials to product and the major hardships came from not fully understanding the money trail. In the UK the 'Cathedral' of the NHS means that the benefits may not be felt by the your customer.
ljm 7y ago
At risk of identifying myself, I work in this industry (or should I say, I work in the medical field) and yes... it's insane. And of course, you get that privileged peak behind the veil, you get to see how the sausage is made as it were. It is truly humbling because there is no easy solution, there are no unified APIs; you couldn't use them even if there were, because your medical records are highly sensitive. So forget about poking around production to solve a bug, you've got to do it through observability. You can't move fast and break things because your downtime will get the regulators involved, because peoples livelihoods are at stake. You will get official complaints through various official bodies who can and will sanction the business. In short, it's not a fucking joke and it takes a lot more time and a lot more money to do something serious here, and for good reason. Note that I'm not talking about low-key wearables like Fitbits that monitor your pulse, I'm talking about doctors, triage, etc.

wayoutthere 7y ago

From a business standpoint, saving lives can actually be expensive. The longer someone lives, the more healthcare they consume. Health insurance companies are very aware of this, which is why they so frequently deny coverage for various life-saving cancer treatments. If you die while waiting for treatment, not only do they save the cost of the treatment, but also the entire cost of ongoing screening / care during remission.

omegaworks 7y ago
This is precisely why we need universal healthcare. The incentive structure of private markets don't properly value human life.
- folli 7y ago
  Universal healthcare won't help you there, since it also requires a stringent cost-benefit-calculation, e.g. the British system is very (in)famous for this.
  - orhmeh09 7y ago
    Ah, but then you have all these with the ever-increasing demand for profit and the issues caused by that incentive on top of it all. Is that an improvement?
  - DanBC 7y ago
    > e.g. the British system There isn't a "british" system because health is devolved. There are four separate systems, one each for Scotland, Northern Ireland, Wales, and England. > requires a stringent cost-benefit-calculation There are lots of problems with the English NHS, but this is almost never one of them. Unless you have particular examples?
    - philjohn 7y ago
      I'm assuming it's the widely debunked "death panel" talk that was doing the rounds during the ACA debate.
  - philjohn 7y ago
    That is for approving new treatments, not for ongoing lifesaving care, so is an apples to oranges comparison IMHO. The drug needs to have a proven benefit, which usually comes down to how much longer does it give you, if it's only marginally better than the existing treatment, but orders of magnitude more expensive they work with the manufacturer to bring the cost down to where it can be approved. A lot of what was written about the UK system during the ACA debate was outright falshoods or misrepresentations (e.g. the infamous "death panels", whilst ignoring the Kafkaesque nightmare that can be the US system). Tell you what, I'd take the NHS over what you've got any day of the week, as would the vast majority of people in the UK.
victor106 7y ago
The longer you live the more monthly premiums you pay, so ideally they do want you to live, but they don't want you to use any healthcare services (or use less services) while you live.
- harikb 7y ago
  No, the moment you are diagnosed with a chronic or life threatening disease, your premiums no longer cover the medical cost. Otherwise what is the point of insurance. Moreover, many regulations prevent them from raising future premiums. So kicking you off the insurance plan or letting you die is indeed their primary concern
  - jonny_eh 7y ago
    A better way to put it is that health insurers don't want you to get "sick". So anything to prevent that is usually money well spent. That's why vaccines are so easy to get.
  - lotsofpulp 7y ago
    This is incorrect. How can they kick you off the insurance plan? Also, the ACA has provisions to prevent one insurer from having to shoulder the costliest patients via some form of cost sharing with all the others. https://www.cms.gov/CCIIO/Programs-and-Initiatives/Premium-Stabilization-Programs/index https://www.cms.gov/CCIIO/Programs-and-Initiatives/Premium-S...
    - dzdt 7y ago
      > How can they kick you off the insurance plan? They can investigate whether you failed to report any preexisting conditions, or otherwise violated terms of your insurance. Things that would seem to you to be a technicality may be to their lawyers a breach of contract. Do you have a lawyer who is up for that fight? [1] https://www.justice.org/sites/default/files/file-uploads/InsuranceTactics.pdf&ved=2ahUKEwiBhuX28-nmAhUJa80KHVJZDBsQFjAAegQIARAB&usg=AOvVaw1_XJotX5w4-MII4YXJR3yY https://www.justice.org/sites/default/files/file-uploads/Ins...

jimbokun 7y ago

> But the key insight is that you have to take a step back and just treat healthcare like any other for-profit business. Doctors and hospitals care about what generates revenue. Insurance companies want to save money. Pharma companies are looking to advertise to new customers. It's no different than other industries. This is one of the most concise and effective arguments I have read for Medicare-For-All, Single Payer, etc.

amitmathew 7y ago
I'm all for removing the broken system we have today, but a single payer system doesn't remove the challenge that the entrepreneur faces - it just changes it. Under single payer, you are now trying to sell to a large government organization, with all the pain and red tape that comes with that.
- brianpgordon 7y ago
  Presumably the government will be incentivized to try to save lives in a way that simply doesn't exist for doctors and insurance companies trying to make a profit.
  - trileansoftware 7y ago
    What happens in reality in systems like that is that doctors are lectured to avoid prescribing expensive exams, things like MRI or PET scans, even sometimes not telling patients they should do them if they could afford to pay them on their own. And the same goes for drug prescriptions.
- relaxing 7y ago
  Thanks for refocusing the conversation back on the people that really matter.
- TheOtherHobbes 7y ago
  Not necessarily. Doctors can still have individual discretion over their choice of IT service provision (etc) under single payer. The only thing single payer does is eliminate insurance company opportunism. It doesn't suddenly convert the entire healthcare system into a dystopian concrete monolith. Although if it did it would make OP's job far easier, because if you could prove there were cost and health outcome benefits on a national scale you would be able to convert the idea into a viable business with a single corporate sales pitch, instead of trying to sell to every doctor individually. In fact the real resistance would come from pharma. Single payer or not, evidence-based prescribing of empirically proven best-in-class drugs would undermine pharma's entire business model.

macspoofing 7y ago

>I think people are being a little too hard on the author. Startups in healthcare are hard. They are hard, but this case isn't really healthcare-related. He tried pitching his product to practices without showing how it could increase their revenue, or decrease their costs. Without that, his product is just another cost-center with some marginal (and ambiguous) healthcare benefits.

angrais 7y ago

Surely you can't leave us hanging? What's the t-shirt look like? :)

Toenex 7y ago

This. Been through two medical device companies that pivoted from clinical trials to product and the major hardships came from not fully understanding the money trail. In the UK the 'Cathedral' of the NHS means that the benefits may not be felt by the your customer.

ljm 7y ago

At risk of identifying myself, I work in this industry (or should I say, I work in the medical field) and yes... it's insane. And of course, you get that privileged peak behind the veil, you get to see how the sausage is made as it were. It is truly humbling because there is no easy solution, there are no unified APIs; you couldn't use them even if there were, because your medical records are highly sensitive. So forget about poking around production to solve a bug, you've got to do it through observability. You can't move fast and break things because your downtime will get the regulators involved, because peoples livelihoods are at stake. You will get official complaints through various official bodies who can and will sanction the business. In short, it's not a fucking joke and it takes a lot more time and a lot more money to do something serious here, and for good reason. Note that I'm not talking about low-key wearables like Fitbits that monitor your pulse, I'm talking about doctors, triage, etc.