The a16z Show Healthcare 2026: AI Doctors, GLP-1s, and Insurance Defection
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Jan 27, 2026 
Nikhil Krishnan, founder of Out-of-Pocket who helps people navigate U.S. healthcare, explores why insurance is fracturing and more consumers are paying cash. He digs into AI-driven screening and regulatory tensions, the boom in at-home diagnostics and wearables, and the rise of GLP-1s, peptides, and gray-market risks. Short, sharp takes on how care and choice are shifting.
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Healthcare Rewiring Outside Insurance
- The U.S. healthcare system is reorganizing away from insurance toward cash-pay, proactive care, and navigation tools.
- AI, diagnostics, and memberships are redirecting consumer spending and reshaping care pathways outside traditional insurance.
Do The Premiums-Use Math
- Evaluate insurance value by comparing annual premiums plus deductible against your expected healthcare use.
- If you are low-risk and costs exceed expected benefit, consider cash-pay alternatives but weigh catastrophe risk.
Two Diverging Consumer Cohorts
- Two distinct consumer groups are emerging: proactive, higher-income 'monitored' consumers and lower-income people seeking simpler access and affordability.
- Both want price transparency and agency, but their unmet needs and use-cases differ.