00:00hi I'm Hannah and welcome to the a 16z
00:02podcast our bio fun team often wonders
00:05if one day in the future we might be
00:07shocked that we once relied only on
00:09something as backwards and often toxic
00:11as pills for diseases like diabetes
00:12depression PTSD so then what's the
00:17could it be digital therapeutics this
00:19episode on digital health includes Omata
00:21health CEO Sean Duffy a 16 Z partner
00:24Vijay Pandey and is moderated by our own
00:27well Elliott a maybe we'll start with
00:29what is digital health it's a pretty
00:31overuse term it means different things
00:32for different people so when people say
00:35it what do we mean yeah you know it's
00:36interesting if you look at what software
00:38that had healthcare implications was
00:40called before it was usually some
00:42amalgam of health or n health or health
00:45IT and I think at large software
00:48entrepreneurs started to latch on to
00:50digital health because it felt fresher
00:52frankly I captured more well especially
00:55there was there's something different we
00:57were talking about before and so that's
00:59why we needed a term most the time
01:01people think of didja health where it's
01:02software driving right software is
01:03leading the strategy not a secondary
01:05right that's really the next generation
01:07of software in healthcare where software
01:09has to be a solution to make the big
01:12change versus kind of a second order of
01:15operations to make something real yeah
01:17the way I see it especially is that
01:19software allows us to do something new
01:21in it scale what's a good example of
01:24that I think there's a whole host of
01:26companies that are kind of capitalizing
01:28on this next era of how software can
01:30empower outcomes in a whole host of new
01:32ways we're really shooting to deliver a
01:34clinical outcome through software you
01:35can think about the traditional
01:37breakdown for how we think about
01:38healthcare as being DX and rx you know
01:41and so the RX here at digital
01:43therapeutics but there's also in a sense
01:46digital diagnostics the ability to be
01:48able to use machine learning in other
01:49areas to really propel Diagnostics in
01:51new ways as well and in digital adjuncts
01:53where it's digital is a complement to
01:55something that could be a you know a
01:57drug it amplifies the outcome that
01:59you're working to achieve I think
02:00historically when people thought about
02:02you know the therapeutics or their
02:03devices are the diagnostic industries it
02:05was if there's physical right it's the
02:07it's the small molecule that gets the
02:09outcome right and you you know you
02:11figure that out you test it it works you
02:13and that's what you use and now because
02:16so many people are using software and
02:17brand-new ways and you can learn how to
02:19guide therapies and guide people with
02:21software that's core to the outcome
02:23which is a whole that's a brand new
02:25thing for the industry at large the
02:26interesting thing here is that you know
02:28we've seen this before in a sense and
02:30that the in the 80s with the origin of
02:33biotech and protein biologics yeah we
02:35already went through oh you know I know
02:37what a drug is drugs are small molecule
02:39this protein thing that's weird I mean
02:41the protein thing that'll never be a
02:42drug and you can list all these reasons
02:44why it'll be a problem this is something
02:46agreed there there's there's truth there
02:48but actually protein biologics are a
02:49huge part of how people live these days
02:51oh for sure and it took it took the
02:52industry a while to evolve to
02:54accommodate there were a whole host of
02:55new you know regulatory pathways that
02:58had to be created there is a you know
02:59commercialization pathways manufacturing
03:01pathways ways to inject and administer
03:05the medications there's this entire
03:06surrounding ecosystem that had to emerge
03:08to commercialize about a large so this
03:10is really the third wave there's small
03:11molecules biologics this is the new
03:13format of therapeutics so let's talk
03:15about are we actually talking about
03:17versus small molecules and biologics are
03:20we talking about replacing some of these
03:21pills do some of these therapies work
03:24what sort of diseases do they work best
03:26in you know when we think about this
03:28space there are some things that I
03:30really imagine digital therapeutics
03:32making a huge impact in anything that's
03:34behavioral in nature that when you talk
03:37about PTSD depression anxiety sleeping
03:41issues and especially something like
03:43type 2 diabetes these are behavioral
03:45problems for which our behavioral
03:46solution is very natural you know I can
03:49imagine that there will be things for
03:50which digital therapy just don't make
03:51any sense like it's hard for me imagine
03:53what an antibiotic looks like but the
03:55reason why is that antibiotics fit the
03:58standard Western model really well
03:59bacteria and mice is very similar
04:01bacterium people the antibody kills the
04:03bacteria it all just makes sense
04:04whereas PTSD in mice versus an alum of
04:07humans it's hard for me to know where
04:08that actually that makes even any sense
04:10to be talking about that and so for
04:12behavioral problems of behavioral
04:14solution is very natural well yeah I
04:15completely agree and it's you know it's
04:17I think it's very hard to find someone
04:18who doesn't agree that software
04:19experiences move behavior I mean that's
04:21the you know any good product designer
04:23core is kind of a behavioralist now
04:25software and using a combination of
04:27social experiences people you know
04:29devices curriculum content you know
04:32timelines goals all of that allows these
04:35approaches to actually scale in a way
04:38that you might imagine a traditional
04:40drug could scale where it's reliable
04:41it's reproducible you can deploy
04:43overnight anywhere how do you know it's
04:45effective there's a reason why digital
04:47therapeutics has a right to the term
04:50therapeutic and in my mind it's because
04:52one can assess its efficacy in exactly
04:56the same way you would a drug so you
04:57could take a drug for a given behavioral
04:59disorder and then you can compare that
05:01in efficacy to digital therapeutic and
05:04in a sense if no one told the the
05:06doctors which was which the rest would
05:08look the same it's just you're assessing
05:09the disorder over time and and so that's
05:12the part I think that's particularly
05:13intriguing is that we can assess
05:14efficacy using basically identical
05:16metrics have they been head-to-head
05:18comparisons against existing
05:20pharmaceutical products in the original
05:22diabetes prevention program trial they
05:24actually looked to see if these programs
05:26delivered in person would be better than
05:29drugs that they hypothesized to work and
05:31they were that you know a program
05:34delivered far more efficacy in diabetes
05:37risk reduction then an actual drug now
05:39finally I would have thought the digital
05:41therapeutic would be maybe just a little
05:42worse than a drug like you think of a
05:44drug is like a really powerful thing and
05:46then that's compared to software but the
05:47irony is that I can imagine ten years
05:49from now people would be like what would
05:50you expect I mean you wouldn't expect
05:52this small molecule that we didn't have
05:53like this sense for how all the human
05:56brain works in understanding behavior
05:58from a semental molecular biological
06:00sense how could a small molecule do as
06:02well compare it to something that
06:03directly gets at the behavioral problem
06:05oh for sure and you might even imagine
06:06that when drugs were commercialized if
06:08there's nuances to the medication that
06:10require behavioral support you know
06:12maybe the pills really big and it tastes
06:14bad maybe you have to eat it with you
06:16know something that's high in fats maybe
06:18it has to be the exact time of day or it
06:19doesn't work you know any element that
06:21behavior is required as part of the drug
06:23therapy you could imagine that it would
06:26be viewed as laughable to not have a
06:28digital companion experience with the
06:30medicine well well that goes to a
06:31question I think in malinka was getting
06:32at earlier which is are these
06:34replacements or they supplements
06:36some cases there may not be a
06:38behavioural drug that has any sort of
06:41efficacy and there's certainly examples
06:43of our or the efficacy is fairly minimal
06:44and then some cases where I could
06:46imagine synergies out there like
06:47antibiotics you brought up early yeah
06:49right that's that's a classic example
06:50where a lot of people don't comply in
06:52the right way with antibiotic medicine
06:54what's changed in the last few years to
06:55make all this possible you know I think
06:56one is just the spread of Technology
06:59right some of the biggest levers you can
07:02pull on behavioral elements have to do
07:03with you know social interactions you
07:05know goal setting peer support and you
07:07know people are more comfortable
07:08engaging in different in new ways
07:10through web and mobile and that's kind
07:11of how people are living their lives now
07:13in front of their screens so you can
07:15meet them right where they are
07:16I think those two elements and needing
07:18the ability to measure and use data
07:20science to improve are really enabling
07:22this transformative new wave in you know
07:25in behavioral medicine it's also
07:26intriguing I think culturally people are
07:28very comfortable texting and you
07:30actually might be much more comfortable
07:31texting a stranger than you would be
07:33talking to them face-to-face those
07:35technological changes have engendered
07:36cultural changes as well you can measure
07:39the inputs and the outputs at the same
07:42time which is traditionally very very
07:43hard in the healthcare system what does
07:45that allow you to do well as you to
07:46improve and that's one important nuance
07:48in this space if you're building a
07:50cardiometabolic med you've got it you
07:52lock it down it's a small molecule like
07:54done right cool in digital that's not
07:57the case you can constantly evolve
07:59personalized tailor improve you know
08:01create kind of the next chapter of how
08:02you create really almost like you know
08:04personalized Bayville medicine and you
08:06can do that through measurement yeah I
08:08mean you look at what we don't we've
08:09amassed about eleven and a half million
08:11weight readings it's the largest
08:12longitudinal data set of these sorts of
08:13programs in the world and if you make
08:15sure that every single user in your
08:17program you're learning from to make it
08:19better for the next you actually
08:20increase the innovation velocity as you
08:22grow as a company now you wouldn't have
08:23that in traditional kind of classics at
08:26classical you know drug device or mint
08:27yeah and you have an interesting barrier
08:29to entry that is far superior than
08:32something like patents something you put
08:34in the oven you know you set a timer you
08:35hear Daniel great I'm done yeah well
08:37that's not that's just not the reality
08:38of the space it needs to constantly
08:39improve and the barrier and the
08:41competitive differentiation is all the
08:43nuanced details and how you deploy
08:45actually remember you're telling me when
08:47you're able to change the notification
08:47frequency and how that affected health
08:50outcomes our program occurs on a
08:52timeline and that gives you every single
08:53week a new chance to try something new
08:55and different and you can really adjust
08:57it appropriately on demographic
08:59considerations and know if it's working
09:00and see who is working for who think of
09:02them as internal randomized controlled
09:04trials where we reduce the latency with
09:06which we gave people feedback on the
09:08food after they entered it in that
09:10section of the program were that's most
09:11relevant and just that latency reduction
09:13you know you see a lift in the
09:14engagement and then at 16 weeks we saw
09:16like a point three four percent
09:17improvement in weight loss outcomes what
09:19are some of the more surprising things
09:20that you found through some of these
09:22efforts one is kind of interesting the
09:23question is what can people who are
09:25viewed as less tech-savvy engaged would
09:28this work for older people I was a
09:29question we you know we got a lot early
09:31on and until we'd done work in 65 plus
09:34it was kind of a hypothesis for us too
09:36we weren't sure it turns out that age
09:39the older you are the the better you
09:42actually do which is a little bit
09:43counterintuitive you know I think the it
09:44would be easy to think well digital of
09:46course young people are gonna do a young
09:47people gonna do better but people 65
09:49plus they engage more you know with
09:51their peers and the groups they're you
09:52know they're they're more dialed in to
09:54the program it's you know it's really
09:55fascinating and you know we think that
09:57that the combination of two reasons one
09:59is building tech that's easy to use
10:02right mixed with the reality that you
10:04know I think as you age in life you're
10:06just more in tuned with your health and
10:08you kind of your healthcare goal so that
10:10was one that was really counterintuitive
10:11but it's still very new it's it's
10:13difficult for those in the traditional
10:15healthcare system to wrap their mind
10:16around this they don't completely get it
10:18what are the worries that you've seen
10:20from people in the system I remember
10:21reading about the American Medical
10:23the head of the AMA put out a statement
10:25calling digital health technologies
10:28digital snake-oil which I thought it was
10:30a fairly interesting statement what do
10:32you think about yeah I mean that's a
10:33fascinating example because that became
10:35a talking point you know quite quickly
10:37and was picked up by media you know the
10:39AMA have used digital health the digital
10:41sacral but if you actually look at that
10:42in context of what they were saying
10:44it's very sound and AMA is not against
10:46you know digital health digital health
10:48that's going to and be embraced by the
10:50digital by the enterprise healthcare
10:52community needs to publish evidence you
10:54need to show the effectiveness
10:56otherwise it you know could be snake oil
10:58right it could not work it needs to
11:00abide by guidelines you know what makes
11:01sense clinically for the person it just
11:04needs to be done in a way that actually
11:05delivers a result which increasingly
11:08companies are doing traditional medicine
11:11had it's a long history of dealing with
11:12snake oil on its own in traditional
11:14medicine you have to go through clinical
11:16trials it's hard to have large end
11:19that's what makes drugs so expensive in
11:20part and instead on the on the digital
11:24therapeutic side you can be running the
11:26equivalent RCT Zoe's randomized clinical
11:27trials all the time with super huge end
11:30but that of course then puts the onus on
11:32on on those having digital therapeutics
11:35to make the case in the consumer world I
11:36mean we have the equivalent of snake oil
11:37everywhere oh it's just Ottawa for a
11:39wedding was at this amazing spa in you
11:42know walk in and they're like oh this
11:43pool it's gonna take all the toxins out
11:45of your body there will continue to be a
11:47need for evidence for evidence
11:49generation for digital health companies
11:51in a way that has traditionally been
11:53viewed as acceptable which is
11:54peer-reviewed publications I mean that's
11:56kind of the currency du jour of gaining
11:59clinical acceptance and it's you know
12:00it's not one it's many digital has to do
12:02that as well so the traditional
12:04healthcare system is is entirely based
12:06on face to face interactions with pcps
12:08between PCBs and patients or what do you
12:11think about the concern that we're
12:12losing something here by by you know
12:14reducing the amount of that face to face
12:16interaction well I think you know face
12:18to face is a you know a proxy for
12:21feeling supported and cared for by a
12:23person which with modern technology can
12:26be done on the other end of an internet
12:28I think the systems where people are
12:29included as part of the core offering
12:31are scaling in better ways then people
12:35believe they could ten years ago and I
12:37think the next era of how individuals
12:40can interact with the healthcare system
12:41at our level or third primary care level
12:44will be through feeling cared for and
12:46feeling that there's people kind of
12:49rootin for them and looking out for them
12:50doesn't have to be in person also I
12:53think whenever anything is new that's
12:55different than way we do things we tend
12:57to concentrate on what is lost in the
13:00difference rather than what's games
13:01there are people who actually would
13:03prefer yes type of interaction yeah I
13:06agree in addition to creating really
13:10for users you can actually add
13:11efficiency and efficacy because you can
13:14use data to help the people that are
13:15part of it right so suggestions based on
13:18data analytics and data science of what
13:20the behaviors of our participants are
13:21expressing so your team of you know
13:23people you make them smart right you
13:25know give them superpowers with software
13:27and that actually enables a better
13:28experience it's kind of what you what
13:30well you know I'm curious how far we can
13:33push software so for some companies in
13:36this space have human coaches or human
13:38participants and software really scales
13:40another approach would be to have pure
13:43software where even the coaching is done
13:45algorithmically and you know with all
13:47the excitement about
13:48AI it's intriguing to think how far we
13:51can go I mean oh it's yeah it's funny I
13:53mean in our space the answer I'd give
13:54would be not too dissimilar to what Marc
13:56Andreessen said on a panel at Stanford
13:57with AI or it's like you know someone in
13:59the audience act hey Marc you know if a
14:01is coming up why isn't there an AI
14:02investor and Marc's response was if that
14:05does happen I want to in dreesen to be
14:08the entity and the firm that figures it
14:11yes yet when you look at the majority of
14:13the complexity in scaling and all the
14:15challenges in building a business a lot
14:17of it's very very people forward and
14:20relationship forward and it's all those
14:21those kind of softer kind of tougher
14:24elements that right now the worlds of AI
14:26is not equipped to address and I you
14:28know I feel that same way with us like
14:29if if we can if there were ever a world
14:32where you know a a software-only an AI
14:36only approach could coach you in the
14:38right way toward positive health
14:39I want Amada to be the company that
14:41figures that out but right now you know
14:43color me a little skeptical that would
14:44that the world's ready for that do you
14:46think AI will be will make a difference
14:47in this digital health world where do
14:48you think you would yes I mean we talked
14:50a lot about what that might look like
14:51for our you know our company you might
14:53imagine a couple of permutations one is
14:55like yeah you could personify it like
14:57almost like a little robot that's a
14:58group member mm-hmm right you know make
15:00it kind of cute and it contributes and
15:01sometimes when it's you know so when
15:03it's when it's off it doesn't cross the
15:04uncanny valley closer to r2d2 exactly
15:09close to r2d2 because you can't you've
15:11got a like its first principles of like
15:13social interaction yeah or Eliza like
15:15how does that make you feel
15:15yeah so let's go back to humans then for
15:19a little bit because I actually
15:20fundamentally do believe that in order
15:22for us to have better health
15:24careful largest of people we absolutely
15:26do need to scale up humans providers
15:29doctors human doctors with software we
15:32are we have a shortage it's very clear
15:34so what are the challenges you've seen
15:36in in terms of scaling up humans using
15:39software well it's interesting
15:40primary care of tomorrow will be so
15:42different than primary care of today you
15:44know it's very tough to take an existing
15:46health care system that's incredibly
15:48people based and start from scratch with
15:50it if you designed with a vision that
15:53this is how you want to use this
15:55confluence of tech and software from
15:57ground zero it makes a little easier
15:59than on the other side trying to
16:00retrofit like a thirty thousand person
16:03like health system to do that I know
16:04this because of a real interesting point
16:06what do you think about startups
16:07innovating within the existing
16:08healthcare system versus being
16:09completely outside well it's funny I
16:11mean I would actually say that we're we
16:13sit we deliberately have pointed
16:14ourselves toward fitting in with the
16:16existing healthcare system just in a
16:18digital way right we want referrals so
16:20we want the existing healthcare system
16:22to send us participants or to get
16:23participants from employers plans
16:26understanding what is the current
16:29reality of the healthcare system and
16:31knowing how you can latch on to that is
16:32really important for entrepreneurs in
16:34this space and you know you have to take
16:37an approach of ramping the learning
16:39curve and embracing the complexity even
16:41though there's a lot of it ya know it's
16:42interesting to think about what was
16:44coming computation will scale existing
16:47things and we'll see a lot of that you
16:48could imagine how machine learning
16:50applied to radiology
16:51could be almost like a grammar spell or
16:53checker for radiologists and how they
16:56can see so many more images they could
16:57see before and I think before we talk
17:00about replacing doctors at all that
17:02doesn't make any sense when we could be
17:03accelerating them exactly and having
17:05them do so much more I'm pretty sure
17:07we'll see that first just like you don't
17:09think a word process over the grammar
17:11checker it's gonna replace a writer
17:13on the other hand it could be that the
17:15real transformative changes are in areas
17:18where human being can't even do that or
17:20all right now so my favorite example is
17:22looking at a genome like a human being
17:24can't look at the all the different
17:25snips or something like that in just
17:27like AHA that's a team 7a therefore
17:29we're gonna give you this drug instead
17:31of that drug you know that's not
17:33something human beings really are good
17:34at and they may never be good at it
17:37competitions perfect for it I think
17:38people who are really future forward are
17:41not thinking of primary care as a
17:42discipline anymore it's more of a
17:44concept hmm all right it's you know like
17:46all Doc's used to be primary care Doc's
17:47150 years ago then then you got some
17:50specialties and you know the amount of
17:52information that medicine had so quickly
17:54outpaced the ability of any one person's
17:56brain to absorb it and software is
17:59really good at now and everything so you
18:02just have to connect it with the person
18:03to help guide their judgment and layer
18:05on the human instinct well and on top of
18:06that we've been talking i think
18:08implicitly about a sort of a us or at
18:10least first world approach to healthcare
18:13and there's a lot more of the globe than
18:15just the US and you know when i think
18:17about other countries like india india
18:20you know has billion ish people
18:22apparently a half a million doctors
18:24mm-hmm so you know ratio is pretty scary
18:27and a lot of doctors are primary care
18:29doctors and Aika Majan for them having a
18:32competition radiologist on call could be
18:36something that could really further
18:37propel them to be able to help more
18:39people and especially the intriguing
18:40thing about computation here is that
18:43it's not just an average radiologist it
18:44could be the best radiologist given and
18:46so what you could see in the third world
18:48is something very much analogous to what
18:50happened with telephones I can imagine
18:52leapfrogging in in countries like this
18:54that don't have the infrastructure we
18:55have now and that they would have an
18:57even greater benefit to moving quickly
18:59into this future yeah and I mean I agree
19:01I think that'll that'll start to happen
19:03in certain kind of pockets especially
19:04pockets where the current existing
19:06healthcare in the u.s. might be just
19:08slightly uncomfortable with like how
19:09different something is you mean you see
19:11that drones right you see Ito you see
19:13I'm countries across the world who
19:14recognize challenges and design kind of
19:17regulatory frameworks to better support
19:18kinda new and different things Venkanna
19:20leapfrog it we often think about human
19:23nature's being slow to adopt change but
19:24that and medicine in general has that
19:27reputation because you know it's charged
19:29with human life and you don't want to do
19:31any harm but I could see this this
19:34approach of just enhancing doctors is a
19:36way to sort of naturally work in and and
19:38and in time it would be be one of these
19:40things where I think we wake up 10 years
19:42later and it's just all there you know
19:44as a practitioner I think that when done
19:46right man this makes you feel awesome
19:49the doctor yeah we're in a primary care
19:51crisis care system like there's not
19:52enough to go around so much of what you
19:54do is like maybe not the best use of
19:56your brain and if all the sudden like
19:58you're surfaced with the areas where you
20:01just feel on a day-to-day basis that you
20:03can make the most impact you have a much
20:05more fulfilling profession yeah
20:07absolutely my friends that go into the
20:08profession they go there to save people
20:11yeah not to do paperwork or not to that
20:14make sense so let's maybe let's shift
20:15over a little bit to the
20:17commercialization aspects what I've been
20:19the major challenges that you think
20:21companies in this space would face yeah
20:23I mean I guess not too dissimilar to the
20:25reference point in biologics it's just
20:27new we always tried to get reviewed and
20:29have discussions with P and D committees
20:31that you know health tons of pharmacy
20:33and therapeutics committees or the
20:34people who valuate gonna new services
20:36for clinical benefit you know sometimes
20:38the entities can think of you is
20:40software and like oh well this is a
20:41you're a vendor you're a vendor of
20:43software for us it's not quite like that
20:46and so that's yeah that's been a
20:48constant bit of evangelism where it's
20:50like here's how to think of us right so
20:51that's kind of a classic thing and then
20:53you know the other there's just a lot of
20:54brass tacks like you know tactical
20:57considerations of like how to even
20:58operate and work with each other so you
21:00gotta got to get in a room together and
21:01figure out how to use their existing
21:03infrastructure to do this in a different
21:05way as a for instance prices on outcomes
21:08I think digital companies are better
21:10equipped to do that because they're
21:11better able to measure their impact in
21:13order to do that using the existing
21:14healthcare system you gotta set it up in
21:17an interesting way and use
21:18fee-for-service billing but done in an
21:20outcomes-based way and you find the
21:21early customers that you figured out
21:22with them and then they're on the next
21:24calls with the other health plan so
21:26here's how we set up all right and then
21:28it just you know it starts to spread so
21:29it happens it happens organically but it
21:30is wind in your face when you're so
21:32unique like you don't really fit into
21:34any box it's tempting to sort of put a
21:36lot of effort and thinking about does it
21:37work and the efficacy and those are all
21:39important things but I think the part
21:41that often people don't think enough
21:44about is also is there gonna be a huge
21:46ROI for your customers and so you know
21:49you want to be able to ideally go after
21:51not just the wellness space but
21:53something where you're having a really
21:54material impact on the cost of
21:57healthcare or the quality of care or
21:59ideally both yeah I mean early on
22:01the enterprise healthcare can be tough
22:03because it's a very appropriately
22:04risk-averse buying market I mean yet
22:06they want to make sure to do right by
22:08their members their patient's etcetera
22:09so the areas where we found our early
22:11adopters were just clinical evangelists
22:13I mean we've got a reality across the
22:14globe where preventable chronic disease
22:16is killing more people worldwide and
22:17infectious the epidemiology is frankly
22:19scary and you'll find evangelists
22:21medical directors and health plans you
22:23know in providers that have such
22:25conviction that we're heading in the
22:27wrong direction clinically for their
22:29patients that they'll willing to make a
22:30bet on something you know if it's new or
22:32neat so you just eating you kind of have
22:33to find them and then learn with them
22:36before you can bring you know what
22:37you've got to a more broad set of
22:39customers actually you brought up
22:41prevention briefly and this is something
22:42I want to dig into a little bit people
22:44often talk about healthcare today as
22:45sick care right we take care of people
22:47when they say we don't try and keep them
22:48healthy and something of a general trend
22:50I've noticed with some of these software
22:51companies in the healthcare space are
22:52that they really enable a prevention
22:54first health care system is that
22:56something you've seen as well what do
22:58you think about that yeah I know it's
22:59funny the a piece of me always think
23:01that's a little bit of an
23:03I mean vaccines are preventive you know
23:06the US has something called the US
23:08Preventive Services Task Force which is
23:09one of the most illustrious like
23:11positions as an internal med or primary
23:13care med like doctor to sit on that
23:15evaluates preventive services you know
23:17mammographies preventive trainings
23:18preventive we don't see all the lives
23:20that were saved that's right from
23:21Jackson you don't see it it is true that
23:23the u.s. health care system is a little
23:25bit more like reactive I mean we're
23:26built to address kind of acute problems
23:28and reimburse for each new problems you
23:30prevent the progression and slow the
23:32progression you know it's not like we
23:34enroll people with no risk factors into
23:36our program I mean we you know we
23:37sometimes called the tipping point
23:38population where they're already warning
23:40signs like this is the right moment
23:41clinically to intervene versus earlier
23:44but I think you know I think software
23:45and data helps you do that you just have
23:47to fit in the same sort of framework
23:49that the rest of prevention doesn't us
23:50also I think there's a big opportunity
23:52for changes that reflect the desire for
23:55value-based versus fee-for-service if
23:58you think about capitalism you're
23:59thinking about psychology human nature
24:01people will optimize within the rules
24:03you give them and if you're paying for
24:05services you probably get a lot of
24:07services if you're paying for value
24:08that's the best chance to get value if
24:10there's any one thing that I would like
24:13to see is to preserve the value
24:15based approach this would have the
24:17greatest impact on changing things and
24:19both in terms of quality care and
24:21decreasing cost decreasing cost is such
24:23a nightmare and and obviously we all
24:26care about value we're still very early
24:27on at this intersection of health care
24:29bio and software what do you think the
24:30next few years look like it'll be a lot
24:32of infrastructure building I think the
24:34you know more companies are gonna
24:36continue to realize that evidence is
24:39gonna be important in this space I think
24:40you'll continue to see a real leverage
24:43of using data science to adapt and
24:45personalize as companies get volume we
24:47will continue to see a push for
24:49alchemist based pricing you've got plans
24:50across the country asking drug companies
24:53to do it asking device companies to do
24:55it asking their providers to do it I
24:56think that'll continue and then the next
24:58leap that I think really is the
25:00transition even closer to clinical
25:02settings for digital right where it's
25:05not often that a clinician or a
25:06practitioner things so I'm going to
25:07prescribe or refer to digital I think
25:10that's changing I would have one thing
25:11which is that I think about where we're
25:14gonna be in 10 years it's something
25:16where machine learning and AI will have
25:18crept in so much that we wouldn't even
25:20have thought about so if you think about
25:22even just where we were ten years ago
25:23and you could bring someone straight
25:25into the future you show them your the
25:27apps on your phone with automatic face
25:29recognition and the huge possibilities
25:32that we have that are just things that
25:33we just routinely think about I think
25:35those will be deeply embedded in all
25:37these different spaces because it's
25:39basically coming along the ride with all
25:40the other technological advances that
25:42we're having and so the real question is
25:44how can we sort of accelerate that
25:46change and how can we get there faster
25:49and I think one of the the key things
25:51that we're seeing is as emergent
25:52properties of having software pushing
25:55this is the driving feature and that was
25:57as Shaun said I think that's what's new
25:59and I think that's what's important all
26:01right thank you very much everyone I
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