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So - I run a company that does AI agents for pharmacy. We are at Series B now and growing well - series C in 9-12 months given growth. We just acquired a compet

So - I run a company that does AI agents for pharmacy. We are at Series B now and growing well - series C in 9-12 months given growth. We just acquired a competitor of that vendor so very much an insider. First, The technology works, and it scales, but the whole bottleneck is domain expertise and implementation. These are expensive, and hard to scale. We hire pharmacists as project managers, that's how important domain expertise and implementations are. Second, the amount of noise of "Voice AI for <industry>" is incredible. Most of them are completely clueless about the industry & basically "YC-striver" type who can only sell to other yc companies. They fail hard the moment they touch critical functions of the real world. We have hundreds of pharmacies with us now and they mostly successful and happy. Our biggest friction is customers being burned by vendors like this and writing off AI altogether as "not ready".

barbazoo 2mo ago
Make it so the parts that are done by AI are rock solid, until then, they shouldn't be near a customer and be done by humans. Resist the greed!
- lagrange77 2mo ago
  So you want him to make a piece of software that models a probability distribution rock solid.
  - pasc1878 2mo ago
    Yes
  - drdeca 2mo ago
    Maybe “rock solid” could be understood as slightly hyperbolic (though it is metaphorical, so hard to say whether it is really hyperbole), but, it is possible to predict some things probabilistically with a high degree of accuracy. Depending on the task, a high enough degree of accuracy sounds doable, and if it offers a sufficiently convenient fallback to an actual human when it fails, that sounds like it could be quite a bit nicer than navigating a phone tree menu? Classical voice to text combined with NN based voice to text, I would imagine can be highly accurate, and that’s probabilistic.
    - lagrange77 2mo ago
      > could be understood as slightly hyperbolic Of course, you're right. I didn't intend to criticise him. I just think that it's not a good idea to transfer this megatrend to healthcare. Yes, those systems can be highly accurate, but as we all have experienced, this is not a stable or consistent property. A very good model can give you an ingenious answer one minute and an utterly dumb one the next. My guess is that it's simply a consequence of the extremely high complexity of the 'plant' (natural language, language interfacing with the real world), leading to some highly non linear behaviour.
anon7725 2mo ago
> We have hundreds of pharmacies with us now and they mostly successful and happy How happy are their patients?
- gamblor956 2mo ago
  Former patients
- jonathan-adly 2mo ago
  NPS typically improves because no one stays on hold for 20+ mins anymore. People have no ideas have pharmacies work. Pharmacies don't control how much they pay for drug, or how much they get paid. The margins are terrible and you can't hire enough techs to answer the phone at peak call volume. So - most people experience are terrible as they wait on hold for a really long time. EVEN if the AI is a little rough around the edges with relational calls, just solving for transactional calls with no hold is a massive win.
  - deleted 2mo ago
    [deleted]
  - reaperducer 2mo ago
    EVEN if the AI is a little rough around the edges with relational calls, just solving for transactional calls with no hold is a massive win. You keep saying that reducing call time is the "win." It seems like that the only metric you're measuring. If so, your product is a failure, not a success. This is HEALTHCARE. You don't get to do "rough around the edges." You don't get to dismiss edge cases. I also work in healthcare tech. My company doesn't permit such things because people die. I'll write it again because it's a point that tech fetishes can't get into their heads: People die.
    - jonathan-adly 2mo ago
      Do you know what NPS is? That's how the comment started. Patients like it. Because the alternative is to stay on hold for 20+ minutes, and then get it wrong. (Or have no pharmacies except Optum's and Express Scripts). Good for you - I want in the ICU delivering care during COVID as a frontline clinician. You don't get to pull this line.
dylan604 2mo ago
> We have hundreds of pharmacies with us now and they mostly successful and happy. Our biggest friction is customers being burned by vendors like this and writing off AI altogether as "not ready". This is such a great graph. Your company feels successful because your customer is happy yet the rest of the world would be just happy if your company died in a fire. This seems to also be just fine for companies like yours.
- jonathan-adly 2mo ago
  [flagged]
  - jimberlage 2mo ago
    Why were pharmacies viable before? Presumably they didn't lose money for their whole history.
    - 43920 2mo ago
      Most pharmacies are having financial issues basically due to being stuck in the middle of the battle between insurers, drug manufacturers, and PBMs over reimbursement rates, and having the weakest negotiating position of all of the parties. AI probably will save the pharmacies some money, but IMO this will probably cause reimbursement rates to decline further, leaving the pharmacies in the same position as before.
      - taurath 2mo ago
        Weakest negotiating position other than the customers. The funny part is probably a majority of pharmacies are owned by CVS or Walgreens each of which are insurance companies in their own right, and often people with company health insurance will ONLY allow reimbursements through their company pharmacy.
      - Scoundreller 2mo ago
        Tbh, this is most industries. Very few have much of a moat and have some wedge/pressure from their suppliers (land/labor/capital), their clients and competition. Insurance companies and PBMs would probably say the same they have competitors (ie:replaceable) and can’t just pay more for this or that, or reject any cost saving measure available.
laughingcow 2mo ago
Please apologize for making the world a worse place and explain how you will close your company down.
Oras 2mo ago
[flagged]
- Marsymars 2mo ago
  > People tend to compare AI to perfection for some reasons, which is not the case with humans. So I mostly avoid commenting on or pontificating about the value or lack thereof of AI, but the problem I have with companies rolling out "AI for whatever" isn't that sometimes AI gets "whatever" wrong, it's that the companies simultaneous gut the processes around correcting these mistakes. I'm currently dealing with a months-long banking error where the bank has incorrectly linked my credit card account to my wife's account and/or an account of mine in a different region, so it variously doesn't show up in my online account, shows the wrong number, shows the purchases from the wrong account, etc. Every time I call in in a 5-minute rigamarole of: "Please describe what you're calling about." "Representative." "In order to connect to a representative, please describe what you're calling about." "There's an error with my account." "Would you like to know your account balance?" "No, my credit card account is not correctly configured and isn't showing up in my online banking account." "I didn't understand. Please describe what you're calling about." Eventually the bot reaches some failure state and then allows me to wait on hold for an hour to talk to an actual rep. When I eventually get to talk to a rep, I get "Yes, I see that your account isn't correctly configured, I'll submit a back-end ticket and it should get fixed within 5-10 business days." The next week I check my online banking, my credit card still isn't showing up, and I call and repeat the entire process. So yes, it's not AI that's directly causing this Kafkaesque nightmare, but it's AI that's empowered the leaders at every utility/retailer/bank/insurer/etc. that I deal with turn their support systems into this slop.
  - Oras 2mo ago
    I actually made another comment about lack of leadership causing many issues including exhausting dev teams. What you describe is an execution failure not AI, these are basic NLP systems that could be easily configured with some dataset to make them better, but i will make a wild guess that the bank has incompetent manager who was pushing for some numbers to put in a slide to say “I” did this.
artisinal 2mo ago
The pharmacies are happy because you are giving them higher profits. Meanwhile you are royally fucking over the end user with your AI shit. “You are absolutely right! You should indeed not give your 5 year old child 1000 milligrams of ibuprofen per hour”
reaperducer 2mo ago
We have hundreds of pharmacies with us now and they mostly successful and happy. Is your pharmacy one of your customers? Do you use your own product regularly?
areoform 2mo ago
As someone who has worked with companies in the space more than a decade ago, I'm glad that you're doing this! Genuinely love the "embedded not installed" approach. I suspect that applying an aerospace approach of dissimilar redundancy and root cause analysis to this will yield a much better experience for everyone (i.e. you, the pharmacies and the patients) than what would have been possible with humans alone. I've ranted about this before, but medicine as it stands isn't a serious field. And I can say that with a straight face, because medicine has until now, been the only field of modern scientific endeavor (or rather cloaked under modern scientific endeavor) that has fought tooth and nail against gathering more data points for improving understanding. More detail here, https://news.ycombinator.com/item?id=35762650 https://news.ycombinator.com/item?id=35762650 I'm glad that you're doing this!
toss1 2mo ago
Good to see info on how critical domain expertise is for success. I've seen AI used well in a few support situations, and it is great - faster to get to the answer vs a human (usually faster than even getting to a human, which is another issue) When my case can be handled by the automated system, it is great, when it is not, it is usually misery, leading to anger at the customer and whatever company sold them that automated isht. Especially for intelligent knowledgeable users of anything, by the time we call, it is an issue likely to need escalation. So, the one absolutely critical factor for me and everyone I know is: how fast and easy is it to get to a human when we find the automated assistance does not work for our particular issue? It should be "I need to speak to a human now", and the immediate response should be "OK, let me get you one... Hello, this is [person], how can I help?" with the prior transcript already on the human's screen. If this works, it is good because the humans are operating a level up, not having to deal with endless monotonous minutiae, and dealing with interesting issues all day, which means they get good at it and have a better attitude — a win for all. How, and how well do you handle that situation — how close are you to the proper response I described?
GreenVulpine 2mo ago
Starting with your funding and who you've acquired tells me whatever follows is not really worth reading.
MSFT_Edging 2mo ago
> First, The technology works God I would love it if this comment is read out at a hearing about defrauding investors or massively leaking PII
voicedYoda 2mo ago
I've been building agentic voice workflows with nearly 2 decades of healthcare experience. Would love to talk if you're available.
- phatfish 2mo ago
  Please don't.
chrisjj 2mo ago
Serious question. Does your product start each exchange with "I am AI and can make mistakes" like the major LLM chatbots? And if not, why not?

barbazoo 2mo ago

Make it so the parts that are done by AI are rock solid, until then, they shouldn't be near a customer and be done by humans. Resist the greed!

lagrange77 2mo ago
So you want him to make a piece of software that models a probability distribution rock solid.
- pasc1878 2mo ago
  Yes
- drdeca 2mo ago
  Maybe “rock solid” could be understood as slightly hyperbolic (though it is metaphorical, so hard to say whether it is really hyperbole), but, it is possible to predict some things probabilistically with a high degree of accuracy. Depending on the task, a high enough degree of accuracy sounds doable, and if it offers a sufficiently convenient fallback to an actual human when it fails, that sounds like it could be quite a bit nicer than navigating a phone tree menu? Classical voice to text combined with NN based voice to text, I would imagine can be highly accurate, and that’s probabilistic.
  - lagrange77 2mo ago
    > could be understood as slightly hyperbolic Of course, you're right. I didn't intend to criticise him. I just think that it's not a good idea to transfer this megatrend to healthcare. Yes, those systems can be highly accurate, but as we all have experienced, this is not a stable or consistent property. A very good model can give you an ingenious answer one minute and an utterly dumb one the next. My guess is that it's simply a consequence of the extremely high complexity of the 'plant' (natural language, language interfacing with the real world), leading to some highly non linear behaviour.

anon7725 2mo ago

> We have hundreds of pharmacies with us now and they mostly successful and happy How happy are their patients?

gamblor956 2mo ago
Former patients
jonathan-adly 2mo ago
NPS typically improves because no one stays on hold for 20+ mins anymore. People have no ideas have pharmacies work. Pharmacies don't control how much they pay for drug, or how much they get paid. The margins are terrible and you can't hire enough techs to answer the phone at peak call volume. So - most people experience are terrible as they wait on hold for a really long time. EVEN if the AI is a little rough around the edges with relational calls, just solving for transactional calls with no hold is a massive win.
- deleted 2mo ago
  [deleted]
- reaperducer 2mo ago
  EVEN if the AI is a little rough around the edges with relational calls, just solving for transactional calls with no hold is a massive win. You keep saying that reducing call time is the "win." It seems like that the only metric you're measuring. If so, your product is a failure, not a success. This is HEALTHCARE. You don't get to do "rough around the edges." You don't get to dismiss edge cases. I also work in healthcare tech. My company doesn't permit such things because people die. I'll write it again because it's a point that tech fetishes can't get into their heads: People die.
  - jonathan-adly 2mo ago
    Do you know what NPS is? That's how the comment started. Patients like it. Because the alternative is to stay on hold for 20+ minutes, and then get it wrong. (Or have no pharmacies except Optum's and Express Scripts). Good for you - I want in the ICU delivering care during COVID as a frontline clinician. You don't get to pull this line.

dylan604 2mo ago

> We have hundreds of pharmacies with us now and they mostly successful and happy. Our biggest friction is customers being burned by vendors like this and writing off AI altogether as "not ready". This is such a great graph. Your company feels successful because your customer is happy yet the rest of the world would be just happy if your company died in a fire. This seems to also be just fine for companies like yours.

jonathan-adly 2mo ago
[flagged]
- jimberlage 2mo ago
  Why were pharmacies viable before? Presumably they didn't lose money for their whole history.
  - 43920 2mo ago
    Most pharmacies are having financial issues basically due to being stuck in the middle of the battle between insurers, drug manufacturers, and PBMs over reimbursement rates, and having the weakest negotiating position of all of the parties. AI probably will save the pharmacies some money, but IMO this will probably cause reimbursement rates to decline further, leaving the pharmacies in the same position as before.
    - taurath 2mo ago
      Weakest negotiating position other than the customers. The funny part is probably a majority of pharmacies are owned by CVS or Walgreens each of which are insurance companies in their own right, and often people with company health insurance will ONLY allow reimbursements through their company pharmacy.
    - Scoundreller 2mo ago
      Tbh, this is most industries. Very few have much of a moat and have some wedge/pressure from their suppliers (land/labor/capital), their clients and competition. Insurance companies and PBMs would probably say the same they have competitors (ie:replaceable) and can’t just pay more for this or that, or reject any cost saving measure available.

laughingcow 2mo ago

Please apologize for making the world a worse place and explain how you will close your company down.

Oras 2mo ago

[flagged]

Marsymars 2mo ago
> People tend to compare AI to perfection for some reasons, which is not the case with humans. So I mostly avoid commenting on or pontificating about the value or lack thereof of AI, but the problem I have with companies rolling out "AI for whatever" isn't that sometimes AI gets "whatever" wrong, it's that the companies simultaneous gut the processes around correcting these mistakes. I'm currently dealing with a months-long banking error where the bank has incorrectly linked my credit card account to my wife's account and/or an account of mine in a different region, so it variously doesn't show up in my online account, shows the wrong number, shows the purchases from the wrong account, etc. Every time I call in in a 5-minute rigamarole of: "Please describe what you're calling about." "Representative." "In order to connect to a representative, please describe what you're calling about." "There's an error with my account." "Would you like to know your account balance?" "No, my credit card account is not correctly configured and isn't showing up in my online banking account." "I didn't understand. Please describe what you're calling about." Eventually the bot reaches some failure state and then allows me to wait on hold for an hour to talk to an actual rep. When I eventually get to talk to a rep, I get "Yes, I see that your account isn't correctly configured, I'll submit a back-end ticket and it should get fixed within 5-10 business days." The next week I check my online banking, my credit card still isn't showing up, and I call and repeat the entire process. So yes, it's not AI that's directly causing this Kafkaesque nightmare, but it's AI that's empowered the leaders at every utility/retailer/bank/insurer/etc. that I deal with turn their support systems into this slop.
- Oras 2mo ago
  I actually made another comment about lack of leadership causing many issues including exhausting dev teams. What you describe is an execution failure not AI, these are basic NLP systems that could be easily configured with some dataset to make them better, but i will make a wild guess that the bank has incompetent manager who was pushing for some numbers to put in a slide to say “I” did this.

artisinal 2mo ago

The pharmacies are happy because you are giving them higher profits. Meanwhile you are royally fucking over the end user with your AI shit. “You are absolutely right! You should indeed not give your 5 year old child 1000 milligrams of ibuprofen per hour”

reaperducer 2mo ago

We have hundreds of pharmacies with us now and they mostly successful and happy. Is your pharmacy one of your customers? Do you use your own product regularly?

areoform 2mo ago

As someone who has worked with companies in the space more than a decade ago, I'm glad that you're doing this! Genuinely love the "embedded not installed" approach. I suspect that applying an aerospace approach of dissimilar redundancy and root cause analysis to this will yield a much better experience for everyone (i.e. you, the pharmacies and the patients) than what would have been possible with humans alone. I've ranted about this before, but medicine as it stands isn't a serious field. And I can say that with a straight face, because medicine has until now, been the only field of modern scientific endeavor (or rather cloaked under modern scientific endeavor) that has fought tooth and nail against gathering more data points for improving understanding. More detail here, https://news.ycombinator.com/item?id=35762650 https://news.ycombinator.com/item?id=35762650 I'm glad that you're doing this!

toss1 2mo ago

Good to see info on how critical domain expertise is for success. I've seen AI used well in a few support situations, and it is great - faster to get to the answer vs a human (usually faster than even getting to a human, which is another issue) When my case can be handled by the automated system, it is great, when it is not, it is usually misery, leading to anger at the customer and whatever company sold them that automated isht. Especially for intelligent knowledgeable users of anything, by the time we call, it is an issue likely to need escalation. So, the one absolutely critical factor for me and everyone I know is: how fast and easy is it to get to a human when we find the automated assistance does not work for our particular issue? It should be "I need to speak to a human now", and the immediate response should be "OK, let me get you one... Hello, this is [person], how can I help?" with the prior transcript already on the human's screen. If this works, it is good because the humans are operating a level up, not having to deal with endless monotonous minutiae, and dealing with interesting issues all day, which means they get good at it and have a better attitude — a win for all. How, and how well do you handle that situation — how close are you to the proper response I described?

GreenVulpine 2mo ago

Starting with your funding and who you've acquired tells me whatever follows is not really worth reading.

MSFT_Edging 2mo ago

> First, The technology works God I would love it if this comment is read out at a hearing about defrauding investors or massively leaking PII

voicedYoda 2mo ago

I've been building agentic voice workflows with nearly 2 decades of healthcare experience. Would love to talk if you're available.

phatfish 2mo ago
Please don't.

chrisjj 2mo ago

Serious question. Does your product start each exchange with "I am AI and can make mistakes" like the major LLM chatbots? And if not, why not?