Jas Tiwana
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highlights · 283
Integrating physicians into product teams is not just a nice to have, it’s a need to have.
Is There a Doctor on the Plane? - MedCity Newsgetting patient buy-in by building trust in the patient-physician relationship is the single most valuable tool in our toolbelt to truly help someone achieve their health goals.
Is There a Doctor on the Plane? - MedCity NewsThis means not only understanding the clinical indication of prescribing a specific medication, but also understanding all the steps of the process that would actually allow a patient to be adherent to treatment.
Is There a Doctor on the Plane? - MedCity NewsGreat product teams are driven by systems thinking, viewing components as part of a whole rather than in isolation to better understand things like causality, downstream effects, and feedback loops.
Is There a Doctor on the Plane? - MedCity Newswhere to set the accepted risk threshold and what the steps are that you need to take to get to that threshold.
Is There a Doctor on the Plane? - MedCity Newser, and how to test hypotheses in order to produce a product roadmap that will dictate what and when products or features will be built.
Is There a Doctor on the Plane? - MedCity Newswhat risks need to be mitigated now vs. later,
Is There a Doctor on the Plane? - MedCity Newswhat’s market signal vs. noise
Is There a Doctor on the Plane? - MedCity NewsEvery product team creating for the healthcare space needs to have a clinical expert deeply embedded in their organization to drive use case definitions, articulate pain points, define value, inform implementation, and perhaps most importantly, uncover problems or risks ahead of build.
Is There a Doctor on the Plane? - MedCity Newshealthcare is a very complex and intricate system with multiple players, all with different value drivers and using different technology and tools
Is There a Doctor on the Plane? - MedCity NewsIn a world where health tech is often trying to build the airplane while flying it, I hope there’s a doctor on that plane.
Is There a Doctor on the Plane? - MedCity NewsIn a world where health tech is often trying to build the airplane while flying it, I hope there’s a doctor on that plane.
Is There a Doctor on the Plane? - MedCity NewsIn a world where health tech is often trying to build the airplane while flying it, I hope there’s a doctor on that plane.
Is There a Doctor on the Plane? - MedCity NewsIt’s hard to change healthcare. But the hard is often what makes things great. If something was easy, someone would have done it already. Difficulty creates defensibility.
Primary Care Innovation Doesn't Work – Here's WhyFor innovation to increase in healthcare, the cost to build and distribute healthcare products has to approach zero
Primary Care Innovation Doesn't Work – Here's WhyIn the past 3 years, over 1,000 digital health companies have wasted millions of dollars building the same features. Once they’ve built those features, GTM is notoriously challenging.
Primary Care Innovation Doesn't Work – Here's WhyThere is little defensibility in incrementalism. Incremental innovation is a commodity. It favors incumbents with distribution. It favors superior process optimizers. It favors economies of scale.
Primary Care Innovation Doesn't Work – Here's WhyAI isn’t the right way to productize healthcare (I’ll share a better way in coming months).
Primary Care Innovation Doesn't Work – Here's Whydistribution will matter more than accuracy. As tends to be the case in healthcare, incumbents win.
Primary Care Innovation Doesn't Work – Here's WhyAI tools are already becoming commoditized in care delivery
Primary Care Innovation Doesn't Work – Here's WhyMost of the time, the doctor knows the correct course of action. And the cases which are diagnostic odysseys are the very cases in which a statistical AI system is least likely to work.
Primary Care Innovation Doesn't Work – Here's Whythe process of diagnosis takes a minority of a doctor’s time. The majority of it is in history taking, testing, empathizing, explaining treatment plans, and managing chronic disease.
Primary Care Innovation Doesn't Work – Here's Whycompanies have been too obsessed with AI diagnosis, which misses the forest for the trees for several reasons.
Primary Care Innovation Doesn't Work – Here's WhyExpertise remained a scarce resource. It
Primary Care Innovation Doesn't Work – Here's Whyt proved challenging to simultaneously solve the trilemma of cost, quality, and access without material care model innovations.
Primary Care Innovation Doesn't Work – Here's WhyUltimately, value-based care became a game of optimizing the traditional model of care and gaming the billing/coding system
Primary Care Innovation Doesn't Work – Here's WhySecond, the scarcity of high-quality doctors means that it’s harder to reduce costs as you take on more patients
Primary Care Innovation Doesn't Work – Here's WhyMedicare populations, the government reduces value-based payments if providers are extracting excessive rents
Primary Care Innovation Doesn't Work – Here's Whyas soon as margins get too large, competition or the government forces margins back down.
Primary Care Innovation Doesn't Work – Here's WhyThe kicker is that cohort margin expansion doesn’t continue forever — it asymptotes, as is the case with all competitive service-led markets. The reason for this is two-fold.
Primary Care Innovation Doesn't Work – Here's WhyThe value-based payment model rewarded companies for keeping patients healthy. To simplify, the idea was that a company gets paid $1,000 for a patient, and then they bear all the costs associated with that patient’s healthcare. If they keep the patient healthy, out of hospital, and off expensive medications, they pocket the savings. But if the opposite happens, they bear the cost of care
Primary Care Innovation Doesn't Work – Here's WhyUltimately, reimbursement matters in healthcare.
Primary Care Innovation Doesn't Work – Here's WhyIt was never about “what is best for patients” and rather it was about “what is best for retention and economics”
Primary Care Innovation Doesn't Work – Here's Whycompanies had to battle incentivized to have patients visit less to reduce costs versus the incentive to have patients visit more to improve retention
Primary Care Innovation Doesn't Work – Here's WhyProvider shortages made it challenging to maintain quality with scale.
Primary Care Innovation Doesn't Work – Here's WhyTo acquire customers and reduce churn, these companies had to provide an exceptional service.
Primary Care Innovation Doesn't Work – Here's WhyWhilst high CACs can be justified by strong retention, the problem is that retention was the opposite. If patients didn’t receive $100-$200 of value each month, there was the threat of churn.
Primary Care Innovation Doesn't Work – Here's WhyAcquisition is hard and retention harder
Primary Care Innovation Doesn't Work – Here's WhySince revenue is mostly fixed by the reimbursement model, tech-enabled primary care became a game of operations optimization rather than quality improvement.
Primary Care Innovation Doesn't Work – Here's Whyhard for companies like One Medical to compete with incumbents that can cross-subsidize primary care with more expensive services.
Primary Care Innovation Doesn't Work – Here's Why75% of health networks operate their primary care business at a loss
Primary Care Innovation Doesn't Work – Here's Whymany digital health companies fight over the same customers
Primary Care Innovation Doesn't Work – Here's Whyunlike your old-fashioned primary care clinics, tech-enabled clinics have two entirely new line items, which are zero-sum and commoditized.
Primary Care Innovation Doesn't Work – Here's WhyVirtual-first care companies haven’t improved margins at the operating profit line. In fact, they haven’t even improved incremental margins — in many cases we’ve seen inverse operating leverage.
Primary Care Innovation Doesn't Work – Here's Whyprice, you charge less per member, but clinician salaries are fixed, which definitionally compresses gross margins.
Primary Care Innovation Doesn't Work – Here's Whyquality, the key was to let doctors spend more time with patients. Moving from 30 patients per day to 15 patients per day helped with customer acquisition, retention, and engagement, but ate into economics.
Primary Care Innovation Doesn't Work – Here's Whyaccess, you have to operate with a surplus of doctors to meet spikes in patient demand, which worsens gross margins.
Primary Care Innovation Doesn't Work – Here's Whythese companies compete on either (a) access, (b) quality, or (c) price, which are all inimical to unit economics.
Primary Care Innovation Doesn't Work – Here's WhyVirtual-first fee-for-service care has struggled to expand gross margins.
Primary Care Innovation Doesn't Work – Here's Whyinsurance companies are looking out for themselves, not for their partners.
The Madoff of Digital Health: How Lies and SEC’s Code of Silence Killed Babylon and Caused Investors $1.5 Billion.