alex radke

@nikillinit The revenue model & GTM model are the two things I see lacking the most. Few can answer both beyond “we’ll sell to payers”. That’s a channel, not a strategy. Who at the payer? Why do they care? What’s their willingness to pay? Is it repeatable? This is why many stall at <$1-5m

okay - I get a ton of cold DMs about people's healthcare company ideas and get asked for thoughts. I really love the exercise and enjoy riffing with people, seeing what they're building, etc. But my first question is always "what's the business model?" and most people can't answer that. In many cases, people mistake DISTRIBUTION for business model (these people use it the most, we're gonna do partnershps with these companies, etc.) But if you want an actual business, you must do one of two things: 1) You increase revenue for a business (DIRECTLY, not some roundabout way like productivity or reducing absenteeism) or 2) You decrease costs That's it. You need to do one of those two things, it's not rocket science. But awesome products or demos need to be able to do that, and you should at least have a theory from the outset on what the business model is DERIVED from that.

@StuartBlitz This is my number one question to understand when assessing the viability. Most only respond by defining the channel (i.e. payor, D2C, etc.), but then when pressed, can't justify how they would actually sell into that.

I feel like I'm on crazy pills when every health tech deck I see focuses on product/tech when it should focus on GTM. You literally have nothing unless you have a clear and repeatable way to get users and have them pay you.

@BillDA It’s been 15+ years since I’ve done work for the government, but the main things were (1) limited tools/functionality you can use for security/procurement reasons & (2) most are optimized for long-term durability and minimizing maintenance. recreation.gov is a counter ex

Government websites are uniformly terrible Why do we think that is?

@heykayadams The chicken parm pizza at Trattoria Dell'Arte. Flattened chicken cutlet as the crust and a pepperoni pizza on top

What masterful innovation/spinoff am I missing? 🧵

@nikillinit Been seeing this in the ketamine space, where an MSO does the legal, compliance, tech, etc. to enable Psych clinics to offer ketamine therapy

As capital markets tighten - I think you'll see more tech-enabled services companies look towards franchising as a business model instead of trying to own any care with a brick-and-mortar component I've been going down a rabbithole on different kinds of healthcare franchises - big ones include PT, home health, med spas, and urgent care. Here’s an example of Homewell and what their economics + offerings look like > can choose to pay ~$50K upfront with 5% royalty, or $5K upfront and 10% royalty > They give a breakdown of pricing to open one - it can range from $55-$250K all in > They position themselves as helping with the marketing, training the business owners, finding customers in a given area, and succession planning. It’s a little unclear how exactly they do this > They help with vendor discounts across the stack you need open this I would expect more tech-enabled services companies to have a similar approach here - we give you the tech, the brand, recruiting services, help with contracts, etc. and then you pay us fees honestly this might be a better setup than using venture to grow these

@StuartBlitz RFK exiting stage left is the VC partner leaving the meeting

VC’s when portfolio companies ask for a bridge

@xcbarnes @nikillinit Wonder how company's think about this. They could message that they're giving employees choice and give them ICHRA budget that matches their current spend (but lowers YoY increased spend), but then employee now has to pay more to maintain coverage

@Alex_Radke @nikillinit Average exchange rate +18% Average employer insurance +9.5% So the gap in price has shifted ~8% of base cost Seems bearish for ICHRA But you can’t use ICHRA as employee without insurance

With a bunch of people probably moving off Medicaid and exchange plans spiking in price - my guess is you’re going to see a way higher number of people of exiting insurance altogether and jump in cash pay care next year I can imagine that AI care delivery will try to fill this void by offering way cheaper cash visits (with very high patient:doc ratios), maybe things like DPC increase a bit, maybe you see a bit more consumer cash pay shopping But I also think more likely you’re just going to see a ton of people avoid going to the doctor at all and end up in the emergency department or urgent care if there’s a more concerning issue and try to navigate being put on a payment plan

@jspujji Sales

I hired an ex McKinsey consultant to compile all my companies' sales materials. I wanted to see how each company reaches over $20M in annual revenue. He collected: - Recordings of sales calls - Sales scripts - SOPs - Led gen systems - etc 100s of top companies paid me for access to it. Today I'll give it away for free. Comment "sales" to get a copy.

@jonostrower Is the bottleneck Clear? Or is it how many TSA screening lanes are open for Clear vs PreCheck? I’ve had that happen in DIA a few times and it’s always been because there’s far more screening lanes for PreCheck vs Clear.

TSAPre was 8 minutes in a long snaking line starting at 5:31am. Didn’t stick around to see how long it took the person I decided not to get behind for Clear, but it was a lot longer than that and they hadn’t made much progress when I went through the magnetometer.

That’s now three times (twice in a row at @flySEA) that I’ve beaten the Clear line in the regular TSAPre line. The value of @Clear, for which I have happily invested over the last few years, is collapsing rapidly.

@bobbyfijan @girdley @tunguz Or watching a chicken lay eggs and eating them

We owe so much to the early adopters.

@aspiringpeasant It’s also designed for dogs

It's the flow rate of this particular shower, not the "handheld" form factor. Let's not be purposefully dense for outrage clicks please.

@bryce Irmita’s, La Cocina, or Angelica’s in that order

@anothercohen A lot of Ja Rule and Chumbawamba

What do we think is on here?

@buccocapital What’s the best leading indicator for CS that leads to NDR? NPS correlation is questionable, but indexing on increasing NPS leads to over investment in factors that don’t lead to NDR.

(2/2) It’s pretty wild how bloated CS departments have become There will soon be intense scrutiny on what the hell is going on in these departments A lot of activity based on convoluted health scores and NPS Expect there is almost zero correlation to revenue retention

(1/2) Funny memory re: Customer Success in SaaS In a meeting early in my career. Ambitious young lad asks: “How do you see our department growing in the future?” VP of CS (Didn’t have Chief Customer Officers back then) said: “You do realize you work in a cost center, yeah?”

@joshuamschultz Can we see the company meeting doc?

Wrote a guide to working with me a few years ago... Just came across this - still true, if not more so.

@anothercohen At least they don’t charge per page…

Between insurance and myself this doctor probably made $10k in 2018. Also sending credit card details in plain text over email is mad sus

In case you're wondering about the state of healthcare in the US

@patrick_oshag Man’s Search for Meaning by Frankl amazon.com/Mans-Search-Me…

What book legitimately changed your life?

@moseskagan If you could do it over, how would you think about doing it differently?

While my career path was far from the only reason I got divorced, it played a big role. Building a PE shop from $0 AUM, particularly if you're not personally wealthy, is a long, tough slog. Even worse when your close friends are killing it in their careers. You pay a price.

@dvasishtha Same with a Sr Data Analyst role I posted. Too much focus on activity, and not enough on outcomes. Easiest resume screen to look for.

I went through 100+ Sr. PM resumes in the last month and so many were missing initiative outcomes. Nearly all included "product activities" like user interviews, stakeholder mgmt, roadmapping, and prioritizing initiatives but none of that matters if you can't point to the impact