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When good ideas make bad business

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Re: When good ideas make bad business

#231

Post by achillean »

rossdavidh wrote: post #201
catchmeifyoucan wrote: post #136

I still think this idea is powerful. Not because I believe it transforms healthcare, but because it informs consumers a bit more. That’s what seemed to get you excited in the first place. There are a few paths I see still: a. Assuming you own a database, expose your dataset as an API. Consider possible consumers. Open source it, and monitor the usage. Who’s using that data. b. Cold message a few folks on Linkedin fro…

Another possibility: how many people would be willing to donate a few bucks a month to support it? Call it the public radio model. You won't get rich, but you might pay for upkeep and servers.

Donations are extremely difficult to make work. I tried it after getting decent traction in 2009 and didn't receive a single donation to cover server expenses. I'm guessing with Patreon things have gotten a bit easier but for a business I would highly advise against going down the donations route. In general, small payments also tend to take up a disproportionate amount of your support time compared to larger transactions so you have to be prepared to deal w/ that.

Re: When good ideas make bad business

#232

Post by rconti »

catchmeifyoucan wrote: post #136

I still think this idea is powerful. Not because I believe it transforms healthcare, but because it informs consumers a bit more. That’s what seemed to get you excited in the first place. There are a few paths I see still: a. Assuming you own a database, expose your dataset as an API. Consider possible consumers. Open source it, and monitor the usage. Who’s using that data. b. Cold message a few folks on Linkedin fro…

Yeah, I've gotta wonder how much money it can possibly take per month to keep running, if you stop paying people to add data to it.

Re: When good ideas make bad business

#234

Post by nitwit005 »

war1025 wrote: post #210
nitwit005 wrote: post #204

Earlier quoted context omitted.

Imagine you have a chronic condition, and every month your insurance writes a substantial check for your care. A new treatment comes along that might fix your condition permanently. Surely they'll leap to pay for it? Unfortunately, they probably won't want to. People frequently change insurance, so the most likely outcome is they'll have to pay for an expensive treatment, but never see the savings. This is currently…

Shouldn't it still work out in the aggregate? Assuming people move both in and out of the provider?

Sure, but the decisions get made at the scale of a single company, not the industry as a whole.

For the mentioned new gene therapy treatments, people have been asking congress to come up with a new model for how to pay for treatment. Here's a recent opinion piece by a Louisiana Senator where he lists off the proposals he's heard: https://www.statnews.com/2019/06/12/paying-for-coming-genera...

Re: When good ideas make bad business

#235

Post by enjo »

rjkennedy98 wrote: post #66
leggomylibro wrote: post #9

Oof. The site was practically named after WebMD, and the founder didn't do any market research on that competitor to gauge how viable the business was before quitting their job? This person probably should have known that their main competitor made $0.50/user before they quit their job. Also: >It had been a bit of a working assumption of mine over the past few weeks that if you could improve the health of the patient…

That line stood out to me also. Anyone who feels that the primary goal of healthcare in the US is to improve health outcomes is incredibly naive about how this industry (which is over 20% of the us economy) works. There is only one group in the entire industry which has an incentive to keep people healthy (insurance) and that is the most hated of the bunch!

At Healthify we’ve built a business by aligning positive health care outcomes with the incentives of people paying for healthcare. I think it’s incorrect to say that American healthcare isn’t interested in positive outcomes, it’s just that the systems in place have made it difficult to track and understand those outcomes in the first place.

We just raised a series B and are hiring engineers (very remote friendly)!

Re: When good ideas make bad business

#236

Post by wayoutthere »

uj8efdkjfdshf wrote: post #35

Realistically, while I feel that the author is on the right track with this data driven approach to evidence based medicine, the fact remains that the advantages/disadvantages between drugs within the same class of medicine tend to be negligible compared to drug costs. There are then other specific concerns that must be considered eg pregnancy/breastfeeding, liver failure, kidney failure and often what ends up is tha…

I worked at a company in the early 00s that did exactly this -- natural language processing of medical records for meta analysis. Even when it worked, we couldn't sell it for much. The budget of each study was too low to really build a business around, and the low number of potential buyers didn't help things.

Eventually we pivoted the tech to a B2B SaaS play because it was too hard to sell.

Re: When good ideas make bad business

#237

Post by TheOtherHobbes »

amitmathew wrote: post #203
jimbokun wrote: post #194

Earlier quoted context omitted.

> But the key insight is that you have to take a step back and just treat healthcare like any other for-profit business. Doctors and hospitals care about what generates revenue. Insurance companies want to save money. Pharma companies are looking to advertise to new customers. It's no different than other industries. This is one of the most concise and effective arguments I have read for Medicare-For-All, Single Paye…

I'm all for removing the broken system we have today, but a single payer system doesn't remove the challenge that the entrepreneur faces - it just changes it. Under single payer, you are now trying to sell to a large government organization, with all the pain and red tape that comes with that.

Not necessarily. Doctors can still have individual discretion over their choice of IT service provision (etc) under single payer.

The only thing single payer does is eliminate insurance company opportunism. It doesn't suddenly convert the entire healthcare system into a dystopian concrete monolith.

Although if it did it would make OP's job far easier, because if you could prove there were cost and health outcome benefits on a national scale you would be able to convert the idea into a viable business with a single corporate sales pitch, instead of trying to sell to every doctor individually.

In fact the real resistance would come from pharma. Single payer or not, evidence-based prescribing of empirically proven best-in-class drugs would undermine pharma's entire business model.

Re: When good ideas make bad business

#238

Post by eightysixfour »

Androider wrote: post #212
eightysixfour wrote: post #174

Earlier quoted context omitted.

Or he should try selling it to CVS as a in-the-store tool for OTC products, where his original need came from in the first place.

CVS doesn't care if you buy Tylenol or Advil or which one works better, and makes no additional money depending on your choice of product. In fact, the brands pay CVS for the privilege of being featured on an eye-level shelf vs at the bottom. I think it was a great article. Like it said: To succeed, an offering must create value for all entities involved in the exchange—target customers, the company, and its collabor…

I would absolutely choose one store over another if they had a proprietary tool to tell me which medicine is scientifically most likely to work for my ailment. I cannot stand the massive wall of choices at pharmacies.

Re: When good ideas make bad business

#239

Post by angrais »

amitmathew wrote: post #166

I think people are being a little too hard on the author. Startups in healthcare are hard . Been there, done that, have the t-shirt (literally, that's all that left). I even made the same fatal mistake - not identifying who the buyer really is. And when I say identifying the buyer, I don't mean it in that hand-wavey, vague way like "doctors" or "insurance companies". The starting point has to be something like "ophth…

Surely you can't leave us hanging?

What's the t-shirt look like? :)

Re: When good ideas make bad business

#240

Post by sweeneyrod »

pgsbathhouse wrote: post #214
planetzero wrote: post #209

Earlier quoted context omitted.

"This is precisely why we need universal healthcare. The incentive structure of private markets don't properly value human life." Government-run healthcare isn't a panacea that will 'value human life' any more than the insurance companies. You are still a number in a database somewhere. Most new drugs come out of the US and socialized governments create generics at a fraction of the cost, because they don't have to p…

>Most new drugs come out of the US and socialized governments create generics at a fraction of the cost, because they don't have to put any money into R&D. This is a completely false right-wing talking point. It takes 10 minutes to uncover how just totally bullshit this is. Don't ever repeat again or anything remotely like it (aka the rest of your post). https://www.ncbi.nlm.nih.gov/books/NBK50972/ https://other98.co…

Your second link has a pie chart that claims that pharma companies spend around 200x as much on advertising as clinical trials. Do you believe that is true?
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