Vital Signs with Jacob Effron and Nikhil Krishnan

This episode features Viren Shetty, Vice Chairman of Narayana Health, discussing how his father founded a cardiac surgery hospital in India 25 years ago that revolutionized healthcare delivery by applying manufacturing efficiency principles to drastically reduce costs while maintaining quality. The conversation explores how Narayana Health scaled from one cardiac center to 19 multi-specialty hospitals across India and one in the Cayman Islands by implementing supply chain optimization, standardization of care, physician specialization, and high-volume operations—enabling them to perform cardiac surgeries at a fraction of Western costs. Shetty discusses the challenges and opportunities of operating in India's largely out-of-pocket healthcare market, the hospital's expansion into insurance and primary care to become a fully integrated provider, their measured approach to AI adoption, and why their high-volume, efficiency-driven model wouldn't directly translate to the US healthcare system despite offering valuable lessons in operational excellence and cost reduction. (0:00) Intro(1:20) Founding and Growth of Narayana Health(2:48) Cost Reduction Strategies in Indian Healthcare(6:04) Challenges and Cultural Shifts in Standardization(8:16) Scaling and Expansion Bottlenecks(14:10) Impact of COVID-19 on Narayana Health(19:15) Medical Tourism and the Cayman Islands(23:03) High Patient Volume in Indian Hospitals(24:29) Exploring Healthcare Ecosystems(25:25) Automating Healthcare Administration(26:39) Challenges in US Healthcare(28:18) Innovative Healthcare Models(30:28) AI in Medicine(33:22) Driving Efficiency in Hospitals(37:48) Opportunities in Indian Healthcare(40:34) Quickfire With your co-hosts: @jacobeffron - Partner at Redpoint, Former PM Flatiron Health @patrickachase - Partner at Redpoint, Former ML Engineer LinkedIn @ericabrescia - Former COO Github, Founder Bitnami (acq’d by VMWare) @jordan_segall - Partner at Redpoint

Walid Mehanna, Chief Data and AI Officer at Merck KGaA, shares insights on scaling AI in the pharmaceutical industry. He emphasizes the importance of a federated approach to AI adoption, focusing on people, processes, and technology. Discussion points include leveraging their internal MyGPT tool for broad AI literacy, overcoming regulatory challenges, and making practical build versus buy decisions. Walid highlights the critical role of AI in drug discovery and the collaboration with startups, emphasizing that AI should enhance human expertise, not replace it.

Joshua Meier, co-founder and CEO of Chai Discovery and former Chief AI Officer at Absci, dives into the transformative role of AI in drug discovery. He explains the evolution through three waves of AI, achieving success rates once deemed impossible. The conversation reveals how AI models think differently from human chemists and the implications of open-sourcing foundational models. Joshua highlights the creativity of AI in generating solutions and discusses key milestones that could redefine the future of pharmaceuticals and biotech.

Elliot Cohen, co-founder of General Medicine and PillPack, dives into the future of healthcare and consumer empowerment. He emphasizes the need for a broad front door to care in 2025 and discusses the challenges faced with pricing transparency. Elliot shares his insights on the PillPack vs. PBMs saga and reflects on lessons learned from building Amazon Pharmacy. He also explores the transformative role of AI in healthcare workflows, highlighting opportunities and hurdles in integrating technology with patient care.

Flashback episode in honor of Hinge Health's IPO this week. In the episode, Jacob and Nikhil sit down with Daniel Perez, the Co-Founder and CEO of Hinge Health, a digital clinic for patients with joint and muscle pain. They discuss Hinge Health’s strategy for selling to employers, how digital health solutions can reach and retain users, the role of software x hardware in disrupting healthcare, and more. (0:00) Intro(2:34) The Evolution of Employer Health Solutions(4:03) Challenges and Strategies in Digital Health(7:07) Focus on Musculoskeletal Care(9:51) Engaging and Retaining Patients(16:17) Marketing and Awareness Strategies(19:31) The Role of Independent Validators(22:27) Clinical Validation and R&D Excellence(23:04) Healthy Competition and Market Differentiation(23:59) Product Superiority and Customer Validation(26:05) Team Dynamics and Tough Decisions(29:49) Future of Hinge Health and Healthcare Automation(31:44) AI and Technology Integration(36:18) Hardware Innovations and Market Impact(39:19) Value-Based Care and Outcome Guarantees(41:14) Regulatory Challenges and Innovation Constraints(43:38) Closing Thoughts and Entrepreneurial Advice Out-Of-Pocket: https://www.outofpocket.health/

Otto Sipe, CEO and Co-Founder of Photon Health, revolutionizes pharmacy experiences by promoting transparency in pharmacy selection. He dives into the challenges of traditional pharmacy models and the transformative role of e-prescribing. The conversation highlights the future of pharmacy benefit managers (PBMs) and the impact of AI on drug pricing. Otto shares innovative approaches to patient care with outcomes-based pricing for GLP-1s, alongside insights into fostering resilience within company culture through creative office decor.

Jacob and Nikhil sit down with Dr. Rushika Fernandopulle. Rushika is the former CEO and Co-Founder of Iora Health, a primary care provider centered around value-based care and Medicare that One Medical acquired for $2.1 billion. They discuss why we’re still in the second inning of value-based care, intersections of tech and healthcare, what it takes for VBC to succeed, and more. [0:00] Intro[0:29] Early Days of Value-Based Care[2:34] Challenges in Commercial Value-Based Care[5:20] Adapting Care Models for Different Populations[13:08] Medicaid and Long-Term Care Issues[16:30] Big Tech's Foray into Healthcare[20:37] Amazon's Healthcare Strategy[21:09] Challenges in Serving Low-Income Seniors[21:43] Innovative Solutions for Patient Transportation[22:16] The Economics of Healthcare Visits[23:22] Building a Custom EHR System[27:34] The Role of AI in Modern Healthcare[33:17] Future of Primary Care and Policy Implications Out-Of-Pocket: https://www.outofpocket.health/

Frank Wu, Co-founder and CEO of Taro Health, shares insights on revolutionizing health insurance with innovative, patient-centered models. He delves into the Direct Primary Care approach that enhances patient-doctor relationships and simplifies payments. The challenges of enrollment and market strategies are discussed, along with the shifting dynamics in InsurTech. Wu also explores the potential of generative AI in transforming healthcare processes while balancing automation with the need for human interaction.

Jacob sits down with Erik Wexler, the President and CEO of Providence. Providence is a non-profit, faith-based health system with 51 hospitals and 1,000 clinics across seven states. They discuss how to think about new AI opportunities with discipline, the value of health system partnerships, programs to support health equity, and more.[0:00] Intro[2:07] Challenges and Opportunities with AI[3:38] Leadership and Organizational Focus[5:30] Whole Person Care and Health Equity[7:23] Financial Challenges in Healthcare[9:25] Collaborations and Partnerships[13:38] Innovations in Healthcare Delivery[15:12] Tech Integration in Healthcare[16:55] Choosing the Right Innovations[17:48] Policy Landscape and Concerns[19:33] Handling Wildfires and Crisis Management[21:59] Commitment to Climate Change and Sustainability[24:14] Health Equity and Community Investment[27:14] Challenges and Successes in Healthcare Innovation[29:18] Future of Healthcare and Final ThoughtsOut-Of-Pocket: https://www.outofpocket.health/

In this conversation, Daniel Perez, Co-founder and CEO of Hinge Health, shares insights from leading a digital clinic focused on joint and muscle pain, with over $800 million raised. He discusses the evolving landscape of employer health solutions and the importance of integrating digital and in-person care for patient engagement. Daniel emphasizes the significance of both software and hardware innovations, AI's role in automating healthcare, and the necessity for guaranteed outcomes amid regulatory challenges. His entrepreneurial advice offers valuable lessons for aspiring founders.