Mustafa Sultan, MD

Tomorrow I’ll share how doctors can break into tech (hint: it’s not through job apps) Come join if you literally have nothing better to do on a Saturday luma.com/t3i0vfzx

I thought this was cool -- and we discussed it here @endpointarena - can this help patients? (by driving interest in clinical trials from patients + funding) - does it tackle transparency / incentive problems at the source - risks of anonymous bets + insider knowledge - could this sit as clintech ops inside pharma

Interesting! Is your suggestion to rip out carriers for self-insured employers? And then replace their bundled services with: - employer continues directly taking on risk (with stop loss) - a light touch TPA on top to handle admin - providers contract directly at transparent rates If a 5000 employee company CEO called you and asked where to start - what would you suggest?

The greatest problem in healthcare ? Hospitals, even market dominant hospitals, won’t walk away from the big ins companies that underpay, late pay, clawback, deny claims, waste their time in denial appeals, and require them to pay up to 8 pct of revenue to RCM consultants so they think they are getting what they are owed. Here is the crazy part. The ins companies ARE NOT THE ONES ACTUALLY PAYING THEM on commercial plans. Employers are. 60 pct of employees get their insurance from their self insured employers. The ins carrier is just a middleman that pretends to add value. All the clinical “value” they add, the hospital could do better, for both medical and pharmacy. Most hospitals have no idea whether they make or lose money with their big ins contracts. They are just afraid to lose patient flow. But. They actually know which companies their patients are coming from. They actually know or can find out, how much more the employers are paying the ins company, than what the ins company pays them (the spread, just like in pharmacy ) And to make it worse, those ins companies negotiate their rates as a discount from the “charge master “, which is like WAC in pharmacy. Just a made up list price. Because the hospitals are afraid or too uninformed to walk away from these deals, the hospitals use the inflated charge master prices as the basis to charge uninsured , or out of network , or insured but not covered for their care, at charge master rates. Which of course the patients can’t afford. And it crushes their finances or they go without care I’ll summarize. Employers , and their members , are paying far more than they should to companies they don’t like working with , that effectively rip off both the employer and hospital , and they could eliminate the middlemen if they went directly to to the employer. It’s so simple. Sell your services to the employers that use your services at a price that is less than what nine companies charge for your services and you will make MORE money and employers will save a ton And if they did this, they could dump the chargemaster and reduce the price they bill patients when they are at their most vulnerable But they don’t want to change. And don’t get me started on how much hospitals over pay for drugs and devices because of the GPO deals they do. It’s just stupid. Which in turn leads to the hospital being a bad actor with 340b , facilities fees and afraid of their doctors who demand they pay more for things like glue and implants so they can get vacations. If you are a politician and reading this. Now you know why this is so fucked up and it’s not about capping rates. The insurance companies are smarter than you. They will just move the money to other places. It’s not about giving money to patients. You can’t shop for care from hospitals that are too gutless to walk away from the ins companies that distort all of healthcare economics Go to your local hospitals , particularly those at risk of closing and ask for their profitability by carrier. Fully burdened. Ask how much they spend on RCM and consultants. In many cases they could survive if they ran like a real business and hired execs that could do the work rather than just manage consultants. They could work out contracts in their communities rather than with ins companies and benefit everyone. The middlemen are not needed. Get rid of them

I've been thinking a lot about @OpenAI's acquisition of @tbpn -- and what creators / startup media can learn from it... It's interesting that OpenAI did the acquisition. They're best placed to know that media will be nuked by AI slop. If you think your X feed is bad right now -- wait until 2027. People are already working on strong 'proof of human' checks on media (check out C2PA). I fully expect web browsers will include a toggle to filter out AI-created content from your web xp in the next 12mo. So who will the media winners be in the age of AI slop? I think there are four principles we can learn from TBPN: (1) cult of personality, (2) proof of work, (3) a nod to old media, and (4) cool branding (1) Cult of Personality Look at the top podcasts right now... most of us listen because we like the hosts (i.e., parasocial relationships). @johncoogan and @jordihays are exceptionally likable with v strong chemistry. When's the last time you had those feelings towards AI-generated content? Never (2) Proof of Work John and Jordi turned up every day for 13mo and delivered. That is really really hard. It way surpasses what we're used to (two guys in hoodies on a Zoom call). They focused on 'delighting' their users. You can feel the love that went into each episode (treating media like product vs hitting export to .mp4 on Zoom). Proof of real 'human work' being done is the antithesis of AI slop. (3) A nod to 'Old Media' @a16z's New Media thesis (tl;dr founders skip press, and go straight to your customers) is generally right, but new media players have perverse incentives too. There are lots of founders doing press releases (just with a bit more personality), VCs promoting their portcos / fishing for deal flow etc. TBPN avoided that -- they borrowed old media's editorial independence (i.e., no you can't only shill your new book / product), without 'gotcha' culture or a sense that the hosts are outsiders commenting about something they've never done. AND then they had new media's direct distribution and pro-tech optimism (without becoming a shill vehicle). That's quite hard to pull off. (4) Brand / taste Probably my least developed thought here.. but people just seem tired of blandness. That's one of the problems with AI-generated content. It all reverts to the mean. Having a strong brand identity is exactly the opposite of AI slop. TBPN's brand identity (a broadcast news set with sponsor logos everywhere) was so specific that an LLM (or 'design by committee') could never independently create it. ... and finally what this means for health / life sci media... The same AI-slop pressures are coming for us but we're just less mature. Is there any media in our space which is as good as TBPN, 20VC, etc.? I don't think so (and that includes what I do!). I'd bet that a media brand will be acquired by a major healthtech/life-sci company for the same reasons OpenAI bought TBPN soon ... our media is just v behind at the moment

Thank you, @MustafaSultan @BigPictureMedicine, for having me. It’s always humbling to look back on the journey, and a good reminder of why the work in healthcare continues to matter. Looking forward to continuing the conversation soon! podcasts.apple.com/us/podcast/137…

We are excited to announce that we've raised $20 million in Series A funding led by New Enterprise Associates (NEA), with participation from Sequoia Capital, Blue Lion Global and Neo.

A new era for Co:Helm as we introduce our new name and brand identity — Anterior. We are the AI company built by clinicians for clinicians to transform healthcare administration.

@MarianneBevis @jonronson Thank you Marianne :)

@MustafaSultan @jonronson This was such an engaging conversation.

I very much enjoyed talking with Musty!

@hugospiers @jonronson Agreed

@hugospiers @jonronson Much appreciated — he was a big catch!

This is @jonronson's 'The Psychopath Test' pitch to @iraglass — a book which spent 10 wks on the New York Times Bestseller List ...and also convinced me to join med school wanting to become a psychiatrist. That didn't happen. But it was a pleasure learning how Jon writes.

@julian_donovan @Anchit171 🙏🙏🙏

@MustafaSultan @Anchit171 Absolute monster advice here. Skin in the game.

My friend, currently an F2, is looking to leave medicine and wants to know more about what opportunities there are, e.g. start-ups/consulting, etc. Is anyone able to offer advice / speak with him?

@Anchit171 I have no xp in consulting/IB/big law etc etc But if considering it, I think it's worth watching talks like this to get an idea of what it takes youtube.com/watch?v=RpUJfW…

I'm curious, what was your advice for your friend? My take (general philosophy + tangible steps): Philosophy - It's really hard to just jump out of Medicine without having put in years of work developing a skillset/network. The UK healthtech (et al) market is not super hot, and it's competitive. - for every story about a medic successfully leaving, there are 10 who tried and failed - so I'd view this as a multi-year project, not a quick thing - I had a lot of arrogance thinking that Doctors are massively demand in the private sector, just because we are doctors. Not true. People hardly care. - For your initial move out, I think it's worth picking something healthcare-related. At least you'll have a leg up from your clinical xp Assuming your friend is like most of us at the start, i.e. has no sellable skillset outside of Medicine — options are: - Continue in Medicine and start developing a skillset (can go LTFT). E.g. coding healthcare related projects (you'll have much more advice on this), freelance creative work for agencies/startups, beg/borrow/steal to get internships. You need to create a portfolio/body of work you can point to. Realistically, you need to be able to point to a few things that you have made, examples: coding: I created a 'chatGPT' for primary care demo, I contributed to this public repo, I launched this startup creative: I made this creative work for X startup (can be graphics, video, podcast whatever) internships: I led X project which resulted in at this startup - If interested in consulting, bear in mind that landing a position in the most prestigious firms (MBB) is as hard as getting into Harvard. If you're the Oxbridge/London/AFP calibre of Medic — then sure it's possible. But you'll need to put at least 6 months of dedicated work into this. If you thought F1 was hard, you're about to enter something 2x as intense Join fishbowl, start cold messaging medics who have entered consulting, go to consulting 'open days'. (Caveat: I have no xp in this). - an underrated path is via research. E.g. can do AFP/ACP (or research outside of a formal training programme) and leverage these connections to get startup roles. can also use this to develop useful skillsets (data science/python/stats etc etc). - another path is pharma (e.g. medical liaisons). I have no xp with this though. - If you have no idea what you could do, it's not a bad idea to spend a year on learning about the landscape (@azeemaa100's BiteLabs Fellowship, NHS Clinical Entrepreneur, MBA/MPH/comp sci type masters... Biggest benefit to all of these is network IMO The best piece of advice I received was to get a blank sheet of paper, and write down everything you've achieved in the last few years. Until this piece of paper looks impressive, I think stay in med and start populating this sheet Caveat: Sometimes through raw hustle/grit/bravery — you can fall into opportunities with no skillset. Definitely worth trying this (essential reading: The Third Door), but don't rely on it More essential reading: the Dilbert career advice dilbertblog.typepad.com/the_dilbert_bl… "Capitalism rewards things that are both rare and valuable. You make yourself rare by combining two or more “pretty goods” until no one else has your mix."

@rikrenard Have you been on here? reddit.com/r/overemployed/

Yesterday, I discovered our newly hired account executive was simultaneously working at two companies (Awell + another healthcare SaaS) We obviously terminated his contract immediately, but asked him “Why?”. His reply: I am so efficient that I can do 2 full time jobs in half the time (which wasn’t the case, he was underperforming)💀

@rafael_tiza_f @VamanuAlbert @45graus @cienciasemfim @SpaceToday1 @NEJM_AI @AndrewLBeam @arjunmanrai @hubermanlab Thank you so much Rafael — really means a lot :)

@MustafaSultan @VamanuAlbert @45graus @cienciasemfim @SpaceToday1 @NEJM_AI @AndrewLBeam @arjunmanrai @hubermanlab It's an amazing podcast. Congrats!

🎙️ My 2023 podcast highlights! 🚀 If you're into Science, Technology, AI, and Politics, these are a must-listen: @45graus @cienciasemfim @SpaceToday1 @NEJM_AI @AndrewLBeam @arjunmanrai @MustafaSultan @hubermanlab #Wrapped2023

@VamanuAlbert @rafael_tiza_f @45graus @cienciasemfim @SpaceToday1 @NEJM_AI @AndrewLBeam @arjunmanrai @hubermanlab Thank you! :)

@rafael_tiza_f @45graus @cienciasemfim @SpaceToday1 @NEJM_AI @AndrewLBeam @arjunmanrai @MustafaSultan @hubermanlab Big picture medicine 👏🏻👏🏻👏🏻👏🏻