a16z Podcast - Introducing Raising Health: Fireside Chat with Sean Duffy

Episode Date: January 18, 2024

Big news from a16z: Bio Eats World, our sibling show from a16z Bio+Health, is now Raising Health!We’re excited to share Raising Health’s first episode here where Sean Duffy, cofounder and CEO of Omada Health, joins Vijay Pande, founding general partner of Bio + Health.Sean and Vijay discuss the building and growth of Omada, from the early days to now. As the cofounder of one of the original digital health companies, Sean has unique insight into the growth of both the digital health field and the changing venture capital environment. They also talk about the future of AI, how Omada is leveraging AI, and the challenges that might arise with using a technology in a caregiving environment.You can listen to more episodes of Raising Health here: https://link.chtbl.com/IqBoJ2By?sid=a16z11824

I'm never calling ourselves a startup. We were three people, and O'Mada was a digital health company. What needs to happen for an innovation ecosystem to flourish in a way that wasn't there before? Could it be done more effectively or efficiently? Like, look anywhere besides, you know, the U.S. and you find ways that one could. Let's just pretend I was a hired gun CEO brought in today. What would I be doing differently? Day one, great.

Just joined O'Mada. I'm the CEO. What would be the next play? There's a reason that artificial intelligence is a buzzword. artificial empathy is not. Digital health has undergone a remarkable transformation over the past decade, involving from simple health tracking applications to an interconnected ecosystem of solutions that are totally redefining the way we prevent, treat, and manage medical conditions. And today's guest has actually witnessed this entire shift.

Sean Duffy co-founded Omada Health in 2011, with the mission to enable people everyone. to live free of chronic disease. Over the last decade, Sean has actually grown Amata from zero to one million patients, giving him a front row seat into the evolution of the digital health industry. So in today's episode, Sean sits down with A16Benz Bio and Health founding partner, VJ Ponday, for the inaugural episode of phrasing Health, formerly known as By Wheat's World. John and Vijay discussed the building and growth of Amata, how AI is changing the digital health landscape and what the future of the industry will look like as Omada plants a scale

from one to 100 million patients. And if you do like this episode, don't forget to go check out our sister podcast, Raising Health, that again, just relaunched and has some pretty incredible episodes on the docket. In the meantime, enjoy the episode. Hello and welcome. You know us as BioEats World, a podcast at the intersection of BioHealth care and tech. But today, we're evolving to bring you Raising Health. Raising Health is a show for and about the builders who are leading the companies behind the bio and health innovations. In each episode, we'll continue to engage with industry leaders, such as Nobel laureate Jennifer Dowdena, esteemed clinician Carl June, AI pioneer Daphne

Daphne Kohler, and many more. Today's episode is with Sean Duffy. I'm Olivia. And I'm Chris. Sean is the co-founder and CEO of Omata Health. He is joined by Vijay Ponday, founding partner of A16Z Bio and Health. Sean and Vijay celebrated the milestone of Omata achieving 1 million members and looked back to how digital health has evolved since Sean first started raising capital for Omata more than 10 years ago. To be honest, I mean, the last 10 years has been, you know, that scene from Apollo 13 with like the square CO2 cartridge in round hole. We just try to like somehow pull it off with the parts on the ship before, you know, your oxygen depletes, which is your bank account, you know, and startup language.

Maybe because he spent so many years in the wilderness of early digital health, Sean is an optimist about the future of AI. He shared how Amata is leveraging AI today and how the company is shaping its caregiving strategy accordingly. There's a reason that artificial intelligence is a buzzword and artificial empathy is not. And I don't think there is any substitute

for just the human accountability. And in fact, I actually think that maybe in this era of AI, it maybe actually come more valuable, human time, handcrafted goods, like proper human caregivers, that may feel more valuable. So in the same vein, you can leverage not just them, but TIP in augmented support through these models in a way that I think just will transform outcomes and, you know, impact the world. You're listening to Raising Health from A16Z, Bio and Health. Welcome to Raising Health.

The news for 2024 is that BioEats World is getting. and upgrade. We're rebranding as Raising Health. And as our very first guest on Raising Health, it's my pleasure to welcome Sean Duffy, CEO and co-founder of Mata Health. So, Sean, thank you so much for joining. Yeah, VJ, thank you. And thanks for allowing me to be the first, what, an honor. This starts with actually that email that she sent me on. I think it was actually maybe even a tweet that I saw that Amata hit a million patients. That's right. And so that was a huge deal. And I think that made us very sentimental about like all the whole path that you've been through in the path that we've been through it together oh for sure no i mean a million uh you know

we're really proud of it i'm proud of i'm proud of the team uh you know i think it's a it's a lot of people it's big impact and i think if you pull up uh i think it is a statement on where digital health has come from and that it's possible admittedly feel two ways about it i think the the positives are my gosh it took you know so many years of toil to even get to the couple of thousand but then if you compare the million to the task at hand of actually impacting epidemiology and and really, you know, doing what we need to do for the business. We haven't really, really made a dent yet. Kind of told our teams, let's celebrate for 30 seconds and let's go try to get it to 10, 20, 50, and beyond. Well, you make a great point because a million is hitting scale, but in principle

you could get to tens, hundreds of millions and even beyond. How do you view the next steps? How do you get to that type of scale? Well, I think you're at a million, you're on strong foundations. As long as you're serving your members well and you're serving your customers well, It does become slightly easier because we're in a new state in digital health, where it's a little bit more accepted. There's a little bit more trust. We now have, you know, published trials, you know, data, et cetera. So we're staying hungry as possible.

And I think it just shows that the space, though, has progressed a lot. It's still relatively nascent relative to having, you know, the impact that it can and will. So before we get too far ahead of ourselves, actually, I'd love to take us back to the beginning. Sure. So to set the stage, I guess it's 2011, right? And when you started Omada, obviously there's zero patients then. You know, what do that zero to one part of the startup look like? What was that like?

Yeah, so first, just, I mean, I'm here in the, you know, in recent offices speaking with someone who probably is in the same camp, but I've always been pulled between technology and science and healthcare. And originally I thought I had to choose. I had to pick, okay, tech or healthcare. So after undergrad, even though I did my pre-med recs, I worked at Google for a couple of years. I went off to medical school.

I was enrolled in Harvard's MDMBA. You know, through that, came up with the idea from, And really the key reflection was, you know, a statement of where the market was at at the time. I'd be with my tech friends from Google and, oh, my gosh, these like Fitbits, they're going to change health care. My medical school classmates were like, well, where's the level one evidence? What disease are you targeting? And so the idea for Romato was to build a convergence company, one that didn't sacrifice on

technology and, you know, design, but tried to, you know, do so in such a way where it earned, earned the trust of the existing, you know, healthcare market. So that led to the business. And zero to one, it was a, it was a journey. I mean, we were a little ahead of our times. I think when we founded the company, the world kind of didn't know what to do with us. So, yeah, tell us more.

Like, you were a tech company, but you were also a healthcare company. Yeah, no, and I mean, it's in the early days of OMATA, as a, for instance, you'd say hi to, you know, a health plan and say, I want to contract as a provider and like, okay, great, well, where are your clinics? Like, we don't have any. Like, excuse me, where are your clinics? No, no, no, no.

We're a provider. We don't have offices. They're like, well, you can't contract with our network team. It's like a hotel chain without hotels. Yeah, exactly. And so, to be honest, I mean, the last 10 years has been, you know, that scene from Apollo 13 with like the square CO2 cartridge in round hole. We just try to, like, somehow pull it off with the parts on the ship before, you know,

your oxygen completes, which is your bank account, you know, in startup language. Yeah, well, and I made that analogy to the hotel company without hotels. Yes. In a sense, Airbnb, and then there's, you know, fleets without cars and so on. Yep, yep. So it makes sense in that zero to one time, there was probably some surprises. I don't know if there's any no surprises make sense to account. I quickly realized how hard it was to sell into enterprise health care.

Though it was a surprise to me now, it's not surprised at all. And I'll kind of relay that to any tech founder. It's like the key thing was that it was not sexy to be a startup. This was kind of a moment in time where, you know, it's like, oh, my gosh, zeitgeist was that 20-something founder that goes off and builds like a $10 billion company. And you'd be with these health plans. I'm like, I'm never calling ourselves a startup. We were three people.

And Omato was a digital health company. But you had to quickly try to, you know, frame yourself as a, you know, a measured thoughtful business in order to have, you know, success. When you were raising, you were raising probably from tech VCs primarily. And now there are examples of tech biovCs or health tech VCs that are sort of doing both. And actually, you know, it's worth noting that actually A6 and Z investment in a model creates the bio fund itself. How has the sort of investor landscape changed for you? I mean, it's not in day different. Yeah, we were the first major health care investment from Andreessen,

but there were very few conversions funds. And you'd be on the, you know, in the health care kind of fund track. And they're like, well, excuse me. Like, where specifically is your monopolistic IP? And it's going to be just so easy for any health plan to build software. Right. You just don't you just. And that's what they're known for, right?

And then on, you know, you go to the tech side and they're like, how about that budget item for that, you know, million dollar peer reviewed study and the RCT? you're thinking about running. I don't think we need that. Right. And so, you know, and you'd work to kind of, you know, explain and. And I think that was very much sort of in our mind for launching the biofund, you know, which came after the investment in a model that realizing that you were a tech company

and there are other tech companies that happened to be in life sciences or in health care, but were being built like tech companies. And that was the opportunity. Yeah, 100%. Yeah. So any other changes that you've seen to the space? I mean, digital health, I mean, you're very much a pioneer of digital health. That's probably changed over this decade as well. Yeah. I mean, well, so we talked about the investment landscape. I think, you know, equally you've seen drastic differences in both the go-to-market landscape and the talent, the talent landscape.

Yeah, we should take each in turn. Yeah, yeah, yeah. So, I mean, the go-to-market, it's very different. I think there are like more plays. There's still kind of things to be learned. I think if you use Omada as an example, we started targeting self-insured employers that can turn into business with plans. And there's a little bit of emotion now that is slightly more codified. Now, albeit, it's still very, you know, difficult, very capital-intensive.

but it's more of a known thing. And there's been examples. Well, so what makes it difficult? I mean, there's a lot of stakeholders. The buying cycles are really long. You're dealing with not just, you know, HR leaders, but consultants and their plans and their channels. And, you know, it's a very multi-state corporal sales process.

And still a risk-converse environment. But there's a little bit of like a known way to do it. And, you know, when Omada, you know, founded, that was far less so. I mean, you'd seen Castlight work towards selling into employers, but a little bit not the way that O'Mada was doing it. We figured out a way to build through claims. We took our trials to the American Medical Association, got them to issue the first ever digital-specific CPT code,

just literally for billing infrastructure. Now there's many startups that have figured out on the back of that, you know, how to bill through claims and contract, you know, as a provider like we talked about before. So the world has evolved. If I could make one statement that I think is the most, yeah, the most beneficial relative to the go-to-market is buyers better know how to buy.

So how do you make that happen? Well, I mean, it's coming as like a moment, that you're like, well, and I remember in the early days, is, you know, you'd be talking to the network teams and you're like, you know, I'm imagining a world where there's actually specific individuals on a network team focused on your digital provider network. And you just kind of paint this future that could be, but that's not there yet. And then you just kind of work your way to it. And a bit of is learning together with your partners. Like, how do you implement?

You know, what are the claim systems? And then the next one that comes in the door, they're like, oh, we've kind of done this before. And, you know, I remember one experience. It was a health plan, well, related to health plan. So I get a call from a CEO of another digital health company. She's like, okay, I just want to take five minutes to thank you. I'm like, well, why? And he's like, I just, we just did this deal with a health plan, kind of named it.

And they sent over the papers, the contract. And they just forgot to take care of his name out of it all. And I was like, how long did that take it to close? He was like, you know, three months. I was like, well, that took us a year and a half. Yeah. And what that means is, all right, there are plenty of ambitious, digitally forward people in enterprise health care.

But like, there's also. like laid down processes and infrastructure and ways of buying that are pretty solidified. So it takes a little bit of time to like chip at it, morph it, you know, heat it, make it a little bit malleable and then and then kind of lay new foundations on how to just ingest things like Omata. Yeah, once you've retempered that steel. That's right. Exactly.

That's right. It's ready to go. And then you mention something on the talent side too. This changes from everything to current state to kind of the feeder world. And I remember in medical school, it was kind of like me and like, like, two. other people in my med school class who had an entrepreneurial bent. There was a bunch out of what, out of like hundreds? Yeah, 250.

And I restarted the Harvard Medical School like entrepreneurship society. It died. It had died. It had to exist. There was a society of three and then wither on a vine and like, you know, we had to give it CPR and get that thing back going. And now I think that's different. It's like, you know, today's cursive is JavaScript.

There's just more tech fluidity coming out of the, you know, I think the life science is, which speaks to more talent that can appreciate both worlds, which speaks to cultures that can pull the best of both worlds together, which speaks to it's just being easier to build a convergence business. Yeah, I'd love to see this. I don't know, a graph of time and the fraction of med school students who have taken a CS course. Yeah, no, totally right. And it's probably just like growing dramatically.

It's growing dramatically. Well, it's key because like if you really weren't sort of sophisticated on the tech side, you wouldn't be able to handle that side of it. It seems like at least a part of the problem early on was there were just so few people that were conversed in both. And it's funny. It's both like a vision issue that's super important, but it's also like a hiring issue. Because you need, you know, at the end of the day, like you need to be able to pull in incredible skill sets in your organization. And if the language you're using like doesn't communicate that you understand the skills that that person is bringing to bear and you can't just like over a beer like riff on a specific thing in their world, they're not going to join.

I mean, that's, that's one of the reasons why the legacy health services companies have had trouble, you know, hiring talent. They'll put out a role for, like, you know, IT engineer. And, you know, and it's your, in the language and just the appreciation of the skill sets, like, matters. And it's hard to get that if you don't, if you're, if you're not going to want to. They're not going to do it. They're not going to do it. And the same, you know, the same as on the health care side. Like if you're, I mean, if you're just an amazing tech company, you're trying to hire great health care talent, they're like, they don't know.

They don't know what they're doing. know. Well, how's it gone now? Like, how is it hiring sort of the latest crop, like on the MLAI side? Well, you know, it's so much easier because, I mean, specific to that, what's neat is we have just an awesome data corpus. At the end of the day, like, you know, these models are more or less commodities. It's what feeds them that's important. And then, Omata has operated against our users' preferences, which is asynchronous messaging, large part. So, you know, we've got 25 million messages that have flown back and forth between our care teams and our members. Maybe the richest, you know, data,

asynchronous tech data corpus in metabolic care and, you know, LLMs are kind of, they came in a nice time for us. It's a candy store for any kid would love. That's right. So that talent side is fine. But the neat thing relative to the last kind of couple minutes of conversation is now there's a crop of folks that have worked in tech and health care. Maybe we're that a startup that tried to do both but, you know, didn't work out or maybe they're a company that has scaled and they want to, you know, do something different. So there are, there's just actually a rich you know, crop of talent to pull from, it's no longer, you know, everyone trying to steal from Omada for people that are experienced with both. It's kind of a broader set, which is great. I think

it's an amazing thing. Oh, it's a real ecosystem. Well, also 10 years changes all of us. How have you changed? Oh my gosh. I mean, yeah. I mean, I was extremely green when I founded Omada. I was in an MD MBA program, but hadn't done any business side. And I had never hired anybody. I didn't have any managerial experience. I, um, I didn't know what a venture capitalist was, you know, my goal has always been, each year I want to look back at last year, Sean, and just feel a little bit embarrassed. Wow, that's a really unique way to frame it. But embarrassed, is that being hard on yourself?

I think it's purposely, you know, hard because it's like, it's the truth. So I think I have been just a little bit embarrassed about every, every preceding Sean. So the Sean now is very, very different than the vintage, the vintage 2011, Sean. And I mean, you've been on the board of a number of years. I'm sure you've seen it too. Yeah, yeah. Well, actually, now I think about it after you saw. that the thing that most people get embarrassed about is like when you watch yourself on video

or when you listen to yourself, it's actually the fact it's getting embarrassed is not unusual is the fact that you're willing to look at that and look at it in its face. I think that is really takes bravery and is most people don't do that. I think a way to think through the way that I think through it is to think through decisions or mistakes. Like would that have happened with today's, you know, Sean, that misstep that we made, would today's Sean have, you know, fall into that trap. And I think it's a good, it's, I think it's a good mindset. I think similarly I always encourage entrepreneurs to like, especially founders, try to purposely decouple yourself from the founder mind and the CEO mind. How would you differentiate those two?

In fact, sometimes I purposely ask, like, let's just pretend I was a hired gun CEO brought in today. Like, what would I be doing differently? Day one, great, just joined Omada, I'm the CEO. Like, what would be the next play? And then you can similarly ask, what do you think the organization needs from its CEO like next year and beyond? And then that, that like becomes your L&D plan. Also, organizations need sometimes things from their founders, too, which are unique from what they need from their CEOs, presumably. Yeah, that's right. You could reverse it too.

You could reverse it too. And there have been things, I mean, you know, as the org grows, you have to, even as a founder, especially learn how to, like, work with your organization. Because your teams, you know, you have so many bright people and they need to, like, find the energy around. a direction and you have to set the strategy but you know there are there are certain things that you know i think is very helpful with kind of found orientation like you you almost um that optimism doesn't always tend to like carry forward with scale and if there's like new things in the market like for us this whole glp1 landscape or even that you know the generative area landscape those new things like i view it as my job to like just press the organization into into seizing those

yeah to really sort of almost get keep that spirit that you had when you're like 10 people or 30 people. But now to do that scale. You do it at scale, exactly. Any advice you'd give to Sean 21, Sean? That's a good question. I mean, all sorts of tactical stuff. Yeah, yeah. My number one advice to, not just healthcare entrepreneurs, but on the interpros side is put a ton of thought in how you price and package, kind of what you've, what you're buying. That has just so much path dependency. Yeah, and that sounds like a detail, but that's like the core future of your business in a sense. Yeah, I know, it's funny. It's never the strategic stuff that tends to matter as much as the tactical things.

Yeah. And some of them you can read about, and others, like, you know, is it a little on-the-job training. Well, especially if you're creating a field, then there probably wasn't on-the-job training for digital health. Yeah, yeah, it was newer. Yeah, exactly. Well, okay, so let's take us to today. So, and actually, you brought up two great topics. I want to hit AI and GOPs.

Yep. Let's start with the AI side. So you already mentioned that Amata has this huge corpus. You know, what's your take for how AI is going to change Amata? Where do you go with that? Where do you go from here? I mean, the whole team and the engineering team is just giddy with it. And there's yesterday's like AI, which we've been doing, you know, build models and ML models and, you know, recommend resources.

Almost like small ML, small AI versus a large foundation model. Yeah, exactly, versus kind of the generative side. I mean, there's hundreds of ideas on how to best leverage our data. So we're still learning and, you know, and growing. But to give you just some specific examples right now, the, you know, one thing we launched is the ability for our care teams to just see instantly summarized views. of eating history of their members. So what we found is like if they wanted to talk about food, we had a very beautifully structured like view

where they could scroll through the meal patterns, looking at the eating patterns, but they were spending about six minutes, getting the context to be able to craft a message. And so one quick hit was have the model do that. And then they can take that and craft it and craft a note to the member that allows them to just feel more insightful,

more precise and likely more impactful and more efficient. It's like everybody wins in that world. And maybe even more empathetic sometimes. And more, yeah, absolutely, more empathetic. There's like step one for Amada, which is, all right, of these hundred ideas, what are the ones where you have high impact, you know, low regulatory risk? Because there are considerations that you need to think through here.

We're trying to strike that balance of ensuring that, you know, at the end of the day, like people feel the compassion of the amadas. Yeah. You know, services as well as the intelligence where, you know, you've got to have a human to shine through. And so for us right now, we built our care team platform. from homegrown by scratch. So it's about helping to enable our care teams to be authentic humans, to come across that way, do it more efficiently and purr your point.

And, you know, many instances with a little to tee up, perhaps more empathetically. Well, it's really interesting because you sort of alluded to the history of virtual-based care where not having brick and mortar was like kind of crazy, right? And now that's actually, especially post-COVID, it's actually been quite routine. Actually, many of us prefer to some degree. It has its own conveniences and so on. Now you're almost like a different type of virtual because now you're even like the caregivers themselves. It can be. Yeah, that's funny. How far does that go? Does it, are you always going to have caregivers and you're just massively scaling them? Take us five years into the future, like maybe even 10 years in the future. Like, how far does this go?

I mean, it's going to be balanced. I think the, you know, you remember in peak COVID, it was like virtual care, we'll do everything. And I literally felt like the crazy one being like, guys, like biopsies still need to be done. Surgaries. Moles need to be removed. And it'll be the same truth here. I do, there's a reason that artificial intelligence is a buzzword and artificial empathy is not. And I don't think there is any substitute for just the human accountability. And in fact, I actually think that maybe in this era of AI, it maybe actually come

more valuable, like human time, you know, handcrafted goods, like, you know, proper human caregivers, that may feel more valuable. So in the same vein, you can leverage not just them, but TIP and augmented support, you know, through these models in a way that I think just will transform outcomes and, you know, impact the world. Yeah. And, you know, we talked about scaling and we're talking about the million members. Maybe this is how you get there. Yeah. It helps.

Yeah, no question. So it's such a crazy time because we've got AI, like doing this insane thing. And then generally unrelated to AI, but very related to Armada is GLP-1s. You know, like, how does that play into what you're doing in Oman? Yeah, I mean, kind of, I just feel giddy with what's happening here because you've got this two parallel tracks, like just extraordinary technology innovation, extraordinary life science is innovation, like two different silos. And I mean, similar to like the fact that your convergence investor or model is a convergence company, they just hit each other. Yeah. Like right now, you know, right at the moment.

And I think they're both, you know, really have knocked on the doors, you know, of OMATA as a skilled provider that, you know, has not only the data for the generative AI side, but all. also just enough scale to, and enough clinical credibility to capture the opportunity in GLP ones. And, you know, the way I look at them is incredible, I mean, incredible breakthrough. Like, you know, humanity, we should pat ourselves on the back that these exist. Yes. You know, in large part, especially since the data has borne out in type 2 diabetes, I think they'll, you know, generally consider a very safe medicine and hopefully that continues to be the viewpoint. The challenge is GLPs are great at quantity.

What do you mean quantity? A quantity of food. So you can and will lose weight on a GLP without changing anything about the quality of your calories because it will juice the quantity. You just will lose appetite. That's right, you'll lose appetite. So you're dropping your caloric intake

but eating exactly the same foods. The challenge with that is most patients tend to not want to be on these medicines for life even though, you know, I mean, you will find the KOLs that argue that that's the right clinical point of view. Right now that's counter to the patient preference. And then the cost profile is making that for the employers that are covering GLP for obesity, you know, age challenge as well. There are very few that, you know, are thinking, we'll shoot, I'll cover this for life.

So you have this issue where, okay, you've got quantity. Well, what does the quality? And that's where Amada thinks we can really differentiate. If GLPs are quantity, Omata's quality. Because you can use these as almost a behavioral catalyst, help reframe someone's psychology around. can lose weight. This is amazing. And then on that, you're like, well, what are your goals relative to the medicines? Let's do it in a healthy way. Exactly. Well, let's take advantage of this therapeutic window. Yeah. Like, let's figure out some new meals that you can just start to

incorporate. Great, you're losing weight. What are some new activities that you could do now, you know, that you couldn't do otherwise? And then Omada can address some of the clinical, you know, complexities here. I mean, I think that the next issue that is already starting to bubble up is sarcopenia. I mean, you're, you know, because what's happening with these meds, you'll, you'll lose fat and muscle mass, if you do regain, you're going to regain only fat. So there's all these complex body comp questions that are going to require new like, you know, physical activity protocols on top and recommendations and diet and intake to make sure that you're addressing this kind of truth about weight loss generally, not specific to the GOP. Yeah, especially if your

body muscle mass goes down, then your basal metabolic rate goes down. It makes it more likely you're regain. You'll feel hungry. Exactly. Exactly. And if you're only eating, I don't know, is it 1,500 calories, 1,000 calories with these things, whatever small number it is, then every calorie counts, right? Exactly. You know, I mean, OMATA's made some decisions that we're happy about, you know, the first is to launch this like GLP1 care track. Yeah.

You know, we've chosen to not initiate people on the medicines, but just, you know, support them regardless of where the script came from. Yeah. So when we work with our partners who are covering GLPs for obesity, for obesity, kind of a little bit of an all roads lead to Amata strategy, like, look for these to be covered. We want to make sure that you have the life. all support alongside. Given all this that's going on, where do you think this gets us to? Like, what does digital health look like, you know, five, ten years from now? Well, yeah, I mean, for

Vermont, I hope these innovations help us do what, you know, what always has kind of been the most important, which is to have tomorrow's, you know, epidemiologists notice, like, bend and disease curve and have us be a part in that. It's been this weird, weird kind of thing where I feel like every couple of years, you see this, like, report on, you know, diabetes measures, et cetera, and you're like, wow, the nation's gone nowhere. Was that really true? Have we really gone No, or have we gone worse than nowhere? It's part of the fact that anything has gone, you know, a worse direction. You look at we're on a poor trajectory as a country to say the least.

So, you know, I think these innovations help us hit, you know, hit a level of scale that matters. And this is the most acute labor crisis we ever had in the U.S. On the provider side. On the provider side. You talk to the average provider and the C-suite talk, well, what are your challenges? They list, you know, 10, one through eight or labor. You know, we don't have enough practitioners. Right.

So not enough doctors and not enough nurses. Yeah, and I mean, we're not going to have 200,000, you know, primary care clinicians like show up on a tanker. So what does that mean? A, like even outside of what we do, you have to find technologies that give more leverage to every credential, like inter-LLMs. You know, B, what you need is to provide care differently. Like, there is no way that a decade from now, the primary care clinician is going to be point on something like longitudinal diabetes care. So, Omata can come in as a between-visit care provider as an adjunct to primary care. partner and make it such that really what you need to do is route the person to us and we'll handle

that between visit care and take that off your plate which i think is going to be required yeah i mean it's amazing that scaling goes from an aspiration almost to an obligation there is a silver lining i mean this is this is just an extraordinary crisis you know of labor what what is happening is the everyday provider recognizes that there's not you know there's not a solvent and i mean you've have providers that like literally they're like well shoot we've tried almost everything they've bought nursing schools. Right. Right.

I remember. Yeah. Gobbled up nursing schools to try to, you know, build. But there's nothing that's going to be enough. So it's like we have to deliver care differently. What does that look like? Who do we work with to do it? So the shortage is one thing.

Then the other sort of crisis that we all know about is cost. Yeah. So presumably this plays into that as well. Oh, yeah. Yeah, precisely. And oh my gosh, if we just kept the percent of our GDP spent on health care constant, but just use the dollars better, like we've got an embarrassment of riches to put forward, you know, to the country here, relative to the, it's not like, oh, could it be done more

effectively or efficiently? Like, look anywhere besides, you know, the U.S., and you find, you find ways that one could. So, but you kind of need a rock thrown into the lake. Yeah. And there are enough, like, pressure points there that I do think that the silver lining will be, it's, it's kind of hit the fulcrum or it's reinventing the system. Let's paint the picture. So, like, you're dealing with something, which is one of the biggest crises for America, like pre-diabetes, type two diabetes, weight, And it's comorbidities, you know, hypertension and musculoskeletal, all the culmorbidies. So that's, the problem is very clear. And then on top of that, you have the provider problem and the cost problem.

You put in AI and GLPs, it's almost like this wonderful, almost DAX-Machina, like, to the rescue. And no technology to the rescue. It's literally, I'm like, in absence of that plus like, you know, the model layers to tie the room together. Yeah. What happens? It's, you know what I mean? It's like. Well, but then so, then what keeps?

us from the future we're describing? Like, what's in our way? I think it's coming. I genuinely do. I feel more optimistic, you know, than ever. In general, I don't think there's an overnight success. I think that's especially true in healthcare and building a healthcare business. But I think it's coming. Well, what do you think about regulations in this space? I mean, that's one of the reasons why it takes a little bit longer. Especially I say additional regulations for AI, do you see a role for that? Oh, yeah, that's a good question. I mean, I think in that right now, the general basis on how to use gendered AI says like look guide a licensed practitioner so you know we're at that world where you self-driving this analogy like it's driver assisted like you can turn it on we got

to touch the wheel and there's already dr google in play you know yeah and so this is amplifying that but it's still a practitioner's in play yeah exactly and practitioners have regulatory bodies that govern their their work and so on i think there there will be ways to you know create kind of targeted you know regulatory like pathways for hyper specific things that have low patient risk now no other obstacles it feels like the way you're talking it feels like it's inevitable i mean i do i actually do you know i do think it's inevitable again i mean it speaks to the three things that have changed what what needs to happen for an innovation ecosystem to flourish in a way that wasn't wasn't there before you need you need new capital partners there's more folks that understand

you know tech and health care and there's some proof points that you can make money here i mean you need that to create kind of a healthy capital environment. And then secondly, you need like more go-to-market motion models that make it just a little bit easier for the next person. Right. Right. And that's that's critical. And then you need the people.

Yeah. And so, you know, I think you've got the three of those. You know, you've got macro pressures that are requiring, not, you know, innovation is not a, not a vitamin. It's a painkiller, you know, at this point. So I'm very optimistic. You know, again, I think we're still at the beginning. I think the next, you know, the next two decades are just going to be, you know,

extraordinary and we need to make it happen. Well, it's amazing because not only have you co-founded a moderate, basically help co-found this whole ecosystem, right? I mean, that's what needed to be done. Very generous. And thank you for being a partner and Andreessen for being a partner along the way. Oh, no, it's our pleasure. It's our pleasure. Okay, so obviously you think a ton about health care. Like, what do you do for? So I have two kids. I have a four-year-old and a two-year-old gym called Lifetime opened up near my home. And I begged, I would have paid any price to sign out because they have child care for two and a half hours. Oh, wow. It's a deal you can't refuse.

All for you can't refuse. So we've been joking. I'm going to be the best shape of my life because, you know, I mean, you're busy as an entrepreneur and child care, so precious. And the kids love it. So we, we, um, we, um, not lifetime, but we, um, uh, yeah, I got a push notification from Lifetime that said, like, congratulations on your, you know, your 25th visit. Oh, wow. And I looked up how long it had been open. It was like 45 days. That's excellent. Excellent. It's funny. I try to be like similar to Amada. Omada's pragmatic relative to, you know, what fits into your world and what best kind of, you know, fits into your life. You know, you know, fits into your life. life and um uh you know tend to not be overly zealous one way or the other but just try to you know abide by the healthy eating and food habits that makes sense well thank you so much for joining us on raising health you got it and thank you for allowing me to be the the first guest on this new instantiation oh thank you all right take every day thank you for listening to raising health raising health is hosted and produced by me

Tiosian and me, Olivia Webb. With the help of the bio and health team at A16Z, the show is edited by Phil Heggseth. If you want to suggest topics for future shows, you can reach us at RaisingHealth at A16Z.com. Finally, please rate and subscribe to our show. The content here is for informational purposes only, should not be taken as legal, business, tax, or investment advice, or be used to evaluate any investment or security, and is not directed at any investors or potential investors in any A16Z fund. Please note that A16Z and its affiliates may maintain investments in the companies discussed in this podcast. For more details, including a link to our investments, please see A16C.com slash disclosures. Hey, this is Steph again. Just as a reminder, if you did enjoy this episode from our sister podcast, Raising Health,

there is a lot more where that came from. New episodes, just like this, drop every Tuesday with guests just like Sean or AI experts like Dapney Collar, Avivargev, and Andrew Ng. So go follow Raising Health wherever you get your podcasts.