Finding PMF in Healthcare (After Tasting it Elsewhere) with Eren Bali and Max Cohen

Hello and welcome to Raising Health, where we explore the real challenges and enormous opportunities facing entrepreneurs building the future of health. I'm Olivia. And I'm Chris. Today's episode is with Max Kowat and Eren Bali. Max co-founded Sprinter Health in 2021 with a mission to engage the unengaged, patients who aren't regularly seeing their providers. by going to their homes and offering free preventative diagnostic services. Eren founded Carbon Health in 2017 to build a modern, tech-enabled healthcare experience, starting with a chain of urgent care and primary care clinics. They are joined by Julie Yu, general partner at a16z Bio and Health. This is the latest addition to our Digital Health Builder Diaries series, which we'll link in the show notes. Max, Eren, and Julie talk about building in the early days of digital health, especially as Max and Eren didn't come directly from a healthcare background.

My approach was just to make sure I knew what the heck I was talking about when I had conversations with them. So there's a lot of studying, a lot of reading, even going into papers and journals and things like that to make sure that I actually understood deeply the stuff that we were talking about. And I think that created some credibility. Someone derogatorily talked about how in the beginning of our company, they said there are some folks that come from tech into healthcare and it looks like they're 2 guys and a hard drive. And that's exactly not what we wanted to be.

They also dive deep on how they found product-market fit, the KPIs they used to track PMF, And how they've seen the investor landscape change.

And I made it forbidden for team to look at other EHRs. I said, if in a product discussion you just take a mere screenshot of some other EHR, you're fired. We opened a small clinic inside the office to learn what the EHR really should be like. And we first built the patient side, which was straightforward because we were all patients ourselves, right?

You're listening to Raising Health from a16z Bio and Health.

So we are here with Max Cohen, CEO of Sprinter Health.

Hello.

And Eren Bali, the CEO of Carbon Health.

Hey.

And this is part of our Digital Health Builders Diaries series. But what's unique about Eren and Max is that they are currently both building in healthcare, obviously, but come to us from outside of healthcare and previously have extensive experience building in the tech space. And so this conversation is going to be all about what that transition has been like, what's been a surprise, what's been unintuitive, where do you guys feel like you have an advantage versus not, et cetera. And hopefully end with a note of optimism about why you guys coming into the space at this moment in time is different than some of the prior generations and waves of tech folks coming into our space and trying to disrupt from within. So let's start with your personal journeys, guys. Tell us about the choice that you made to take the masochistic route of building a company in healthcare after doing it in tech. Max, let's start with you.

Sure. So back in 2010, I was at Google. It actually felt like a little bit of a smaller company because I was at Google in Los Angeles and had a few years years there, enjoyed it, started to get into a little bit of the palace intrigue as the projects got bigger in terms of figuring out how are these going to be budgeted and how are we going to make sure that it doesn't step on anyone's toes. So I started thinking about trying to make a move to a little bit of a smaller company. My wife was 7 months pregnant at the time, so I thought, why not go to a startup? Seemed like a good idea. I got to know the founders of Oculus, and what blew me away was they had a very early prototype of a Samsung Galaxy S4 with a sensor hot glued on the back. And when you put it on your head, it just looked like a phone. little holder, and it was playing a scene from Shanghai, just kind of like a 360 photo, and in the sky was a clip from Avengers. And it just blew me away by how immersive this was. And I thought, this is something I'd be really interested in doing. It was just such an amazing piece of technology that I decided to go there. So went to Oculus as a vice president of mobile. Company got acquired a month later, thanks not at all to me. I was still trying to figure out like what I wanted to order at the cafe, but I got to scale A product from zero up to millions of users with the Samsung Gear VR, then the Oculus Go and the Oculus Quest. That was incredibly rewarding, incredibly educational. I really liked working at Facebook, but I just kind of was thinking I wanted to do something a little bit more meaningful than ads or games. From the ledger of life, I'd been given a lot. I had gotten a good education. I had been working a few places, got lucky with the Oculus acquisition, and I had some personal run-ins with health problems. And so it was something where I felt like I needed to do a little bit more to give back. And so I took a couple of years trying to figure out the exact details and eventually kind of went into healthcare from there.

Amazing. Eren, what about you?

In 2007, I started Udemy in Turkey first. That didn't work, like, moved to United States. And then the second time was like the charm. So we started Udemy, became a successful company, public now. But my transition to Udemy was, Partially from education to healthcare was really twofold. One is I generally thought education, healthcare, housing are just the problems that were not being solved by themselves. It felt like every other area was just automatically getting better, but these 3 were going worse, if anything. And it felt surprising that there were not as much talent going into these fields. But while I was still the CEO, My mom had this just completely unexplained stroke where she couldn't move any part of her body. And I had to take a couple months away from my CEO job and went back to Turkey. My sister's a physician, so she lined up a series of professors to understand what was happening. So we had tons of pages of documents printed. My sister's in nuclear medicine, like a specialist, like a radiologist. So a specialized radiologist. So she had all the MRIs, PET scans, labs, catalog, organize, and we were going from doctor to doctor to understand what was happening. I'm at that point useless, right? Even though I'm a successful tech entrepreneur, in that case, I have zero value there, right? Mm-hmm. But I was just mostly kind of watching it. And one thing I kind of noticed is a lot of the doctors looked at the case in a very similar way visually in their head. They would take notes which were very similar. And my question to my sister was like, they all seem to be doing the same thing. Why doesn't the software already work this way? So I made some sketches in 2013, 2013 about how I would design a healthcare record system in a way that makes sense to doctors. So I kind of showed it to my sister and her feedback was— she then showed me some kind of case journals and presentations like her friends were making in a kind of case conference, like a specialist conference where physicians share cases with each other. I realized like my instincts about how doctors think about this were a lot more aligned because when they shared this with each other in a panel, it is a lot more like how I observed them doing it. So then it actually made no sense that the real technology and how doctors work is just so detached from each other. So I thought I just had no idea what the business of healthcare looks like, but I thought if it's a large enough thing and if I can bring a strong enough technology design edge to it, there must be some business to make here.

Yeah.

In some ways, and I think about this as my founder journey too, like ignorance to some degree really is bliss, right? Like the thing— had I known many of the things that I know now, would I have had the same level of conviction to just jump in blind and build a company from scratch? So in that vein, when you look back, and you guys are obviously still in the thick of it, what— are there specific questions that you wish you had asked deeper before jumping in, and/or people that you wish you had talked to to get their perspective before building what you guys are building today?

From my perspective, I wish I understood the payer landscape a lot better. Healthcare is just so complex in the sense that with general Tech, you have a product. If it's good, you can make money through apps or subscriptions or ads. There's so many ways to do it. There's a lot of VC-backed companies that are all participating in a similar space there. With healthcare, you've got for-profit and nonprofit health systems and payers. You've got patients who are not referred to as consumers, unfortunately. Then you've got providers who are doctors that are making their own decisions. And although I had experienced this like everyone does, the healthcare system, I wish I had built up a little bit more of a knowledge base around how the the business of healthcare works. But at the same time, I didn't have that healthcare network. And I think that spending some time in advance building that up just from a knowledge perspective, but also from a connections perspective, probably would have been advantageous if I had to go back and do this again.

Yeah, that's a good one. How about you, Eren?

I think, honestly, I look at everything I wish I knew back then. And some of them were things people told me, and I just didn't listen. But there are also a lot of things that people told me that I didn't listen. And I'm actually glad I didn't listen. So it's kind of hard to untangle, because I I heard like the mistakes we did, which we realized like when everybody said you should like really think about payers as early as possible, which we didn't take that advice, right? And that turned out to be right advice, but there was like a lot of bad advice, right? So a lot of healthcare entrepreneurs, the feedback was just follow the money, just like look at like a pocket of spending, some arbitrage, and that's how you do the things versus I was a builder. I'm a designer, Developer, that's my nature. I don't like just following the money and look for arbitrage. I like thinking about what problems are the most unique and big to solve and try to go after them. So it is actually like I put sort of takes and because I notice because I take a lot of notes with my meetings and when I look at my old notes, I was like, yeah, people told me that about this thing that we just did wrong 20 times and I still ignored that.

Yeah, again, maybe that was for the better. That's interesting. It's kind of two— you guys have like two sides of the same coin of wanting to or wishing you had known more about payers. And then in your case, maybe having heard about payers, but expressly deciding to not sort of follow some of that advice and try to go more first principles.

Well, I think when you work with domain experts, their first take is often no, because. And when you work with people that are a little bit more ambitious and new, they'll say yes, and. And neither of those is necessarily correct, right? But I think that You need to have a balance at your company of folks who have both those attitudes, and that's the right way to go. And when you're only on one side or the other, it just raises the degree of difficulty.

Yeah.

Actually, let's jump on that. So this notion of building your team. So you guys, again, probably from your past lives, have tremendous networks of folks who have had literally exposure to what best looks like and what great looks like outside of healthcare. And then when you come into healthcare, I certainly had this experience. I think there's a perception that this is an industry that has shitty software. It's super hard to integrate. Things take a lot longer. And so sometimes it's hard to actually get people excited about joining this mission, despite the fact that it obviously has so many personal connections to people, as we were just saying. So tell us about what your experience has been and what your frameworks are for thinking about attracting the best and brightest tech talent to your respective companies, and then also how you balance that with bringing in folks with domain expertise from the industry.

Yeah, so for us, the early engineering design was easy because of the network I already had. But I think because we started from first principles and we were doing a lot of things very differently, whether people thought it was dumb or smart, it was definitely an interesting way to look at this. So I think we had a lot of actually good luck with people who are fed up with the usual healthcare efforts. And so hiring was actually much less of a problem. There was a lot more investor skepticism But employees, like team, really bought into it. Actually, one thing that was surprising to me about healthcare is if you're coming from tech tech, more like pure tech, you think of operators or McKinsey consultants, et cetera, as this kind of a group of people that you make fun of. When you're in healthcare, you realize this whole word operator is really, really important. So those consultants, those smart general purpose people are actually really critical. I just never appreciated how much things like finance and operations really matter until I got deep into healthcare.

You just indirectly complimented Max, the ex-McKinsey consultant there.

It's funny, as a McKinsey consultant, I would take the other view, actually. I saw a video clip recently of Kevin O'Leary, Mr. Wonderful, talking about how consultants will never do anything of consequence, and it comes to mind quite often. But from my perspective, my co-founder was an engineering manager, very much on the tech side. So we had 2 tech people. I'm product, he's engineering. We knew we had to bring a lot of healthcare experience in if we were going to have a shot at making something that could be durable. So we surrounded our— our leadership team was almost exclusively people who came from healthcare. But we found it to be really easy to hire in the beginning because it was one room. So we wanted people that still had the industry experience, but were a little bit newer on that. I would say in the middle levels of scaling, it gets a little bit more challenging to hire because now you're a little bit more interchangeable. There's a lot of companies out there that are between 50 to 400 employees. You're now competing with FAANG more, but you can't pay FAANG rates on things like that. And then I think it gets easier again when you get larger, you have more capital, your equity is priced in a way that makes it a little bit easier. So from the curve of like bringing folks on, I think it's like easy, then challenging, then a little bit easier. If you can keep your team smaller and get more done, you keep your burn lower, gives you more time. There's like so many advantages to that 10 to 15 person company to really find that PMF in the beginning.

How deliberate were you guys about bringing in quote unquote healthcare people? And talk us through that first, you know, traditional healthcare hire, someone who's been on the inside, and how did you guys win them over? How did you guys Convince them to jump on board?

I was deliberate in making a mix of startupy, techie people and healthcare people together. So just always thought about, okay, do we have enough healthcare experience in this area? I think the problem is if you exclusively hire healthcare folks for certain things, in reality, the talent pool is not as strong as technology. That is a reality. But then if you exclusively hire for talent, then you just lack the experience. And the biggest, I think, challenge non-tech people get in healthcare, when I brought them from outside tech to healthcare spaces, outside healthcare to healthcare, is they cannot fathom how bad the fundamental infrastructure is. So they always want to believe there's some other higher-order problem which is missing, which is like, no, no, no, it is actually a fact. It's so bad. You're just Because it's like a 30-year gap in what they're used to. I hired people from fintech. It's just every time I have to explain to people, no, it's not that we have to create this magical solution to solve it. It's just the basic infrastructure is not there. So you have to work on much simpler problems than people usually are used to thinking about. So that is actually the overambitious people from tech sometimes struggle because you're just solving some rudimentary Like connectivity issues.

Well, my approach was just to make sure I knew what the heck I was talking about when I had conversations with them. So there's a lot of studying, a lot of reading, even going into papers and journals and things like that to make sure that I actually understood deeply the stuff that we were talking about. And I think that created some credibility. Someone derogatorily talked about how in the beginning of our company, they said there are some folks that come from tech into healthcare and it looks like they're 2 guys and a hard drive. And that's exactly not what we wanted to be.

So we've talked already about a couple of things that are sort of downsides of working in this industry, whether it be lack of infrastructure, whether it be speed, whether it be desire to embrace innovation, et cetera. What are some examples of things where you've been surprised to the upside about your ability to build a company in this space?

I think this cliché about the healthcare, the market is so big. Like, you actually don't need to own it all to make it a big business, right? If anything, over time, we learned to just like, have a smaller market ambition because even that, like, any slice is big enough versus my other company. Like, we always kind of had to be conscious about how big the market is, right? Then also just one of those like non-cyclical, always there type of problems. You don't have to follow trends. Yeah.

And along those lines, I think that products can actually win in healthcare in terms of the total package. When you build a product that actually creates an ROI for partners, You can get in front of them because they're always looking to improve their operations.

So you mentioned earlier, Eren, that part of the original vision for Carbon was really starting at the EHR layer of how could you build a different clinical workflow that actually mirrors how doctors think versus what we obviously have today, which is largely billing software. And then, you know, Max, obviously I've had a front row seat to you guys building a really impressive tech stack from day one. You guys clearly could, if you wanted to build something, you could. Like, that's very clear based on the DNA of your companies. But how— what's been your rubric for what is worth building versus what is worth taking off the shelf versus what is worth integrating with, et cetera. How have you guys thought through that despite, or I guess given your superpowers of being able to do it all?

For us, the EHR was the most, I would say, controversial decision. So EHRs were these things everybody hated, but also everybody had to use. But also people were complaining that they don't want to use any point solution which is not integrated to their EHR, which means they were going to use EHR anyways. Like, this whole idea that, like, we have to innovate around the shitty EHRs, but we cannot touch them felt weird to me. It was like, there's one thing that everybody spends all their time that is inherently broken and nobody else can fix it, and we all have to just, like, dance around it. Just felt silly. I said, like, we have to start from this part, right? This is, like, the most broken, most important piece. And not only we never used an EHR, And the way I approached it is, okay, we have to build EHR, right? But I don't want to make a slightly nicer looking version of some other bad software. So we said the only way to do this is from the first principle, understand what EHR is, what it does. I actually had no idea what EHRs really looked like, right?

Mm-hmm.

And I made it forbidden for team to look at other EHRs. I said, if in a product discussion you just take a screenshot of some other EHR, you're fired. We opened a small clinic inside the office to learn what the EHR really should be like. And we first built the patient side, which was straightforward because we were all patients ourselves. So we kind of knew what we wanted as consumers. And then we slowly, we just would make debates like, what is the prescription? What is the medication? What is lab? What is vital? How do doctors think about those things? So we started building from the inside out. And the last thing we thought about was billing versus just the opposite. Most companies started building software, and then maybe 20 years later, they think about building a patient portal and e-charting. We built the patient portal first, and then built the charting interface, and then really 3 years later, built the billing side, which I'm glad we did because billing is so ugly. If you start from that, we probably wouldn't have enough motivation to build the rest of it. I feel like having an EHR became sexy again in the last 2 years. It was very unsexy first 4 years or 5 years.

I think because everyone realized what you ultimately realized at the beginning. So, how about you, Max?

From a tech stack perspective, we went with TypeScript, React, serverless, AWS. Very flexible. We can do a lot. My co-founder's fond of saying, don't build a castle in someone else's kingdom. It's kind of a funny mental image to me. I'm like, but nonetheless, for us, what did that mean? It means the core things like routing, logistics, the patient engagement side, the checklisting, our engagement campaign management. That was all stuff that we had to own so that we could have full flexibility over. But we don't need to build everything. So telephony automation, CRM, the experimentation framework that we use, compliance software. There are lots of good products out there. And so it's always easy as a company that has a good tech DNA to say, well, we could just build this better. It's funny, we're talking about EHRs right now. I probably had 2 meetings about that today. Should we build an EHR? Should we buy? And—

You should buy ours.

We'll have to talk about that later. But yeah, so this is the type of thing where you want to make sure that your engineering effort is always going to be limited just from an opportunity cost perspective. Regardless of how big of a company you are. So do the things that are core to what's going to help push your product forward, and then buy the things that aren't.

And tell us about what signal you guys ultimately started to see that proved to you that that was the right decision. Because ultimately, if you're just, you know, building software in a vacuum, obviously you're not going to know whether it's actually having an impact on the business. But I think you guys are far enough along now where you probably have some KPIs in your mind that are like, okay, this is why we made that investment. And how it's manifesting in our competitive advantage. So can you guys share some examples of what that is?

Yeah, so for me, like, I get the product-market fit feel from just random anecdotal events. Like, it's not a number or statistics game for me. So we started in 2016. So we spent first 12 months building the patient app and like some rudimentary EHR for providers to see patients, right? And we were seeing 10 visits a day, like in our clinic inside the offices, like next, like as a lab. But anyway, we had no desire to open clinics at that point. It was just meant to be a lab. And there was this physician named Cesar Jebaharian. He owned 4 urgent care clinics in San Francisco. And he was the official early innovator physician in Silicon Valley. His face was in every digital health startup's homepage as the first customer. He came to our office, and he looked at the software once, which was very rudimentary. We spent maybe three months like working on the EHR only, and he looked at it and said, "Oh my God, I want to use this." And he said, "I can tell." First of all, he said, "There's 80% of the business functionality just is lacking. We'll have to build a lot to make this viable to be used in a data way. But I can tell you guys have never seen other EHRs." That it was a it felt really original to him. But in a way, he liked. He just said, "I can tell that you guys." start from the patient and provider and just are going deeper. And he said, we sat down with this team, meaning one more person, and we just made a list of 300 features we were missing. The one thing about EHRs is that the surface area is so big. And there is no way to really build a good EHR. It's just such a big piece of development. It's like a rabbit hole. The more you get into it, there's no getting out for 6 more years.

At least.

So he just gave us a long list, and in 9 months we powered through all of those functionalities and had his clinics switch to our EHR, the platform we built. So it was really just him just seeing even the early prototype and just actually committing his 3, 4 clinics, a sizable, I don't know, like a $5, $10 million business he owned. Yeah, a couple of clinics. He just fully invested in our software platform. So I think his desire to actually take a bet on this was the biggest signal for PMF for me.

For us, it was around— we didn't want to just have differentiation. We wanted to have durable differentiation. And to do that, you have to run good margins. And the only way you can do that is by cutting costs. Obviously, raising prices, you're going to hit a limit somewhere. So you can't rely on to say, oh, people keep on paying us more for the same service. And so by plugging these pieces together that we had built internally, we actually saw that start to happen. where we saw that, oh, we can actually do more appointments per day, see more patients per month. We can do these types of things and we can do it more affordably. And that also was a little bit of kind of like the North Star for let's— when we're building this, why? Like, what is this doing? Is this making our lives easier? Is it making our sprinters' lives easier? Is it making our patients' lives easier? Who is this for? And so I think kind of asking those types of questions led us to say, these are the types of things that make sense for us to build. Versus for us to buy.

You guys are also sort of indirectly conveying a point of view that is near and dear to my heart, which is around, can you even get credit as a business for just being a software company in healthcare? And you guys are both full-stack businesses right now, which is, you know, you have the benefit of, A, being able to ride existing rails of payment and reimbursement and whatnot to actually get paid for your business, while also manifesting the benefits of your technology. Do you guys agree with that? And do you feel like there is a viable path? Like, had you started again, anew, with just the technology layer of what you guys have built and gone to market with that as a product, if that would have achieved the same level of results that you guys are seeing today?

So I wince every time someone in healthcare says IT. But that's the— that's like a different way of thinking about the technology parts. And so I think it's really challenging if that's all you can do, because even if you have a system, that were you to sell it to Optum or Centene or someone, that could save them hundreds of millions of dollars. How are you going to navigate the interior infrastructure there to be able to get that in place, to be able to get that live? I think it's really hard to just be on the software side to support other partners. When you are full stack, you might be able to get there later because you have such incontrovertible proof that this really does add value. And so I think that as a secondary thing that can help. But if you start— of course, we're biased, right? Because we are Fullstack. But if you started that route, I think it would be a lot of time trying to find the first couple customers, and then it might fail even if the software solution was perfect, but because of an implementation detail. This is why when we work with partners, we try to avoid EHR implementations. I mean, if you can do it outside of the EHR, it's so much better. I just think that these challenges are not going to go away in the next 50 years in healthcare because of the way everyone's constituted.

Mm-hmm. I think my advice generally for healthcare, people who want to sell healthcare, is deployment in healthcare is a big barrier for any kind of software. I think the successful companies are either platforms that are maybe difficult to deploy, but cost a lot of money. So you can just get some momentum. For example, actually EHR type of deployment is heavy, it takes at the minimum 2 months to deploy EHR in a new provider. But it's a large budget item, right? But if your product is cheap, it has to be very fast to deploy. So there's almost like a 2 by 2, there's like a line there. A lot of tools are hard to deploy because they require EHR integration, but they don't have a large utility. So even though it's useful, it's just the customers are not going to pay enough for that to— to take the deployment effort. So I think it's really like you have to find kind of sweet spot, fast to deploy, fast to sell. I think this is the place where a lot of tech entrepreneurs, usually our instinct is we think about a problem and we say, what's the best way to solve this problem? I think the way you have to think about it in healthcare is what is a good enough solution that is going to be fast to deploy?

And part of it is because there's not really this concept of AI takeoff in healthcare. You don't have a product that just suddenly gets self-installed everywhere and can be absolutely huge. And so you're going to have to go through each individual's needs and their concerns. And that's just going to, again, raise the level of difficulty a little bit.

Well, there was— it's called ChatGPT, except all the hospitals shut it off for their employees. So they stifled their own opportunity there. Okay. The other dimension that we haven't touched on yet, which is another huge distinction, I think, between sort of tech, traditional tech and health tech, is venture capital and fundraising landscape. And so, again, as someone who started a company back in the 2010s era and comparing it today, even now, we all think it's still very early, but it was nascent, right? 10 years ago, you could count on one hand basically the number of VCs that were investing in— it was called healthcare IT back then before digital health. And now I think we can all agree that there's relative maturity on the early-stage VC side. But one thing that we certainly observe and that we're doing a ton of work around is what's that next phase, that growth stage? stage market of health tech. I think that's probably the next sort of big bastion of opportunity to really grow with the market as all these early-stage companies that got funded in the last few years kind of grow up. Do you think there do need to be dedicated investors for this particular sector? Do you think there's benefit to having it just be broader tech that's kind of coming into our space or something different?

There's obviously no one-size-fits-all for this. That's the case for pretty much any question you could ask, but specifically for this, I think that that nascency of the market that you were talking about, there's such a long lag between companies that find PMF and then eventually go public that even though 10, 15 years ago, there were a number of great healthcare companies that have gone to success, there's still not enough of them. And so because of that, you need a little bit more of a leap of faith. And if you're not as comfortable with the subject matter, it's going to be harder to take that leap of faith. I know when I was first talking to investors a few months ago, I had to explain value-based care to some of them, and that's probably not a good fit. for someone who would join a future round for us?

We had probably a different, more unique problem because at Carbon Health, my approach wasn't really innovating in healthcare space, to be honest. It was more like there is— I almost did not want to innovate in the form of care, type of care. I just wanted to make the tools and experience a lot better, more like just solve the actual infrastructural problems. So it actually didn't require too much healthcare understanding to Just understand what it is. So I had more luck with the non-healthcare investors, which understood these things are bad, they're big, they need to be improved.

It's funny, I was talking to someone recently. We were having a conversation about how do you value companies, and obviously public market comps are a general way to think about evaluations. And they made the comment that as it turns out, the best comparables for digital health companies right now are still private. So just to close this out, let's There's always a little bit of optimism in this conversation. There's been— and a bit of the tarnished view of tech coming into healthcare has been on the basis of prior generations of entrepreneurs who did come in. What do you guys think is different this time in terms of your ability and your own personal experiences of coming into a space where you had really little to no domain expertise, but have been able to build very complicated businesses in a very complicated industry as quickly as you have? What's different this time?

Well, the advantage is with the general tech industry, there's so many tools, there's so many things that can get you up and running. That applies to us too.

Mm-hmm.

I mean, being able to build out the tech stack that could create actually some differentiation, I think 5, 10 years ago, it would have been a lot longer, a lot harder to do that. We were able to do our first kind of rudimentary routing and logistics system in months and get going and seeing patients and getting feedback and learning what worked and what didn't work. So those general tailwinds, I think, are a good thing. The other thing is that there's been so much investment in the digital health and in the tech-enabled services side that That at least you're not having to explain to these larger partners, like, what the heck is going on here? There are priors. The other thing here is just that, frankly, healthcare has become attractive to a number of people who want to make changes. The quality of folks in it— I'm not trying to say the quality was not good before, but just there's so many top-quality people that want to commit their lifetime to it. And I do think it's a great time to build. And if you're out there thinking about maybe starting something in healthcare, come join, and I'll help you as well.

I think generally the talent in healthcare that comes from technology has really gone up quite a bit, which creates a field where you have other people you can talk to. And some of those people have been successful, so they have trust from healthcare operators. So I think the tech has penetrated in the healthcare space. I think, again, not as much as we want, not as effectively as we want, but I think it has already penetrated. Like, there are various, like, VCs who are trusted by health systems. But it's a big market. We are, like, we have penetrated by 5%, and I think we can get to 30% eventually. So I actually think for healthcare investing, it's like, it is going to be the golden age the next decade or so.

Love it. The future is bright. Thank you guys for sharing your perspectives.

Thank you very much for hosting us.

Thank you, Julie.

Awesome. Thank you for listening to Raising Health. Raising Health is hosted and produced by me, Chris Tatyosyan. And me, Olivia Webb. With the help of the bio and health team at a16z. The show is edited by Phil Hegseth. If you want to suggest topics for future shows, you can reach us at raisinghealth@a16z.com. Finally, please rate and subscribe to our show. The content here is for informational purposes only, should not be taken as legal, business, tax, or investment advice, or be used to evaluate any investment or security, and is not directed at any investors or potential investors in any a16z fund. Please note that a16z and its affiliates may maintain investments in the companies discussed in this podcast. For more details, including a link to our investments, please see a16z.com/disclosures.