The State of Healthcare in 2020 with Nikhil Krishnan
Nov 8, 2020
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Nikhil Krishnan, founder of Out of Pocket, discusses the flaws of the US employer-based healthcare system, comparisons to other countries, investing in the space, dynamics of hospitals, randomized controlled trials, digital therapeutics, EMRs during COVID, and the future of telemedicine.
Employer-based healthcare in the US has flaws and needs changes to provide more flexibility and options for individuals when it comes to choosing their health plans.
The US can learn from other countries with strong government-run healthcare systems to address the challenges of pricing, competition, and affordability in the industry.
Healthcare startups focusing on cash-pay and price transparency, as well as those developing telemedicine workflows and diagnostic tools, present opportunities for innovation and disruption in the industry.
Deep dives
The Intersection of Healthcare and Comedy
Nikhil Krishnan, founder of Out of Pocket, discusses his goal of making healthcare more accessible through the intersection of healthcare and comedy. He utilizes different mediums such as writing newsletters, creating crash courses, and developing novelty products to educate people about the complexities of the healthcare industry. His aim is to demystify healthcare and fix some of the existing problems in the field.
The Challenges of Employer-Based Healthcare
Nikhil dives into the history of employer-based healthcare in the United States. He explains how after World War II, companies offered healthcare benefits as a way to compensate employees due to wage regulations. The government allowed pre-tax dollars to be used for health insurance premiums, which fueled the growth of employer-sponsored healthcare. However, Nikhil highlights the flaws in this system, especially when people lose their jobs and subsequently lose health insurance coverage. He suggests different changes, from providing employees with flexibility in choosing their own health plans, to implementing a public option insurance plan on individual exchanges.
Lessons from International Healthcare Systems
Nikhil explores lessons that can be learned from healthcare systems in other countries. He mentions the presence of government-run healthcare systems in other countries, which allow for a more competitive balance between public and private healthcare options. He acknowledges that the US lacks a strong publicly run healthcare system and highlights the challenges of implementing such a system due to differences in government trust and the pace of change. Nikhil also recognizes the high costs associated with healthcare in the US and the need to address issues with pricing and competition in the industry.
Investing in Cash-Pay and Price Transparency Companies
One area of interest in healthcare startups is companies focused on cash-pay and price transparency. Startups like GoodRx have found success in this space, providing patients and physicians with tools to navigate the relatively competitive cash-pay market. This area presents an opportunity for innovation and disruption, as it addresses the increasing interest in transparency and affordability in healthcare.
Exploring Native Telemedicine Workflows and Diagnostic Tools
Another promising area in healthcare startups is the development of native telemedicine workflows and diagnostic tools. While telemedicine has gained traction, many current solutions simply replicate the traditional face-to-face visit through video. However, startups like Butterfly, which offers portable ultrasound devices, are paving the way for telemedicine to become a core part of healthcare delivery. By integrating telemedicine into the overall care process and building diagnostic tools specifically designed for remote care, these startups are reshaping the future of healthcare.
Nikhil Krishnan (@nikillinit), founder of Out of Pocket, joins Erik on this episode to discuss:
- How employer-based healthcare came to be and how it might change.
- Comparisons of the US healthcare system to other countries.
- His investing thesis in the space and areas he’s bullish on.
- The dynamics of hospitals.
- Thoughts on randomized controlled trials.
- The excitement around digital therapeutics.
- EMRs and their adoption by patients during COVID.
- The state of telemedicine and what the future might hold for it.
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