Halfway!

We've officially shared over 50 new startup ideas over the past ten (or so) weeks. That includes contributions from partners at Hustle Fund, Precursor, Venrock, Emergence Susa, along with the founders of Morning Brew, Do Not Pay and more.

To kick-off our second-half, we're doing something a little different. This week's edition is a special collaboration with Nikhil Krishnan and his hilariously insightful publication, Out of Pocket. If you're interested in healthcare (and enjoy laughter), I highly recommend signing up.

As you might have gathered, that means that this week's edition features 5 ideas for founders interested in revolutionizing treatment and care. Even if that's not your focus, I hope you'll find the thoughtfulness of the ideas useful in reframing your process. As a supporter of The Generalist, you get access to an exclusive, additional idea today. You can find it at the bottom of this piece.

Last week

Ethan Batraski's "Documentation as code" was the favorite last time around, just pipping "roving vending machines" and "commerce x community."

It was great to hear from a number of readers interested in the space. If you know of folks building, give me a shout and I'll look to make the connection.

Over the past couple weeks, I've had the pleasure of stumbling across several fun discoveries, a couple of which came from RFS readers! Thanks to those who reached out to share a little of what they're working on. My favorite finds include:

• Podz, an audio newsfeed. I've actually known about this one for a while, but it was only recently launched publicly. While audio's becoming an increasingly competitive space, I've been impressed by the technology undergirding Podz. In particular, they seem to have developed a crack system to extract the most compelling pieces of audio from long form podcasts. As more and more content is created, that curational component could prove very valuable. This was founded by a reader of RFS!
• Showcase, a platform for video organization and search. It's actually a similar value proposition to Podz, though focused on a different medium and customer profile. Essentially, companies are producing more and more video — meeting calls, webinars, tutorials — but that content is pretty hard to search or access. Showcase solves the problem. Another RFS reader building something cool.
• Lendtable, which helps you capitalize on your employee benefits. This is rather genius — Lentable fronts you the money so that you can max out your 401(k) contribution. You then pay back a split of the "profits," over time.

Five ideas...

Real-Time API for Doctor Capacity

ITA for healthcare

Google acquired ITA Software, a company that tracked airline inventories, that would eventually underpin Google Flights. This software let any airline connect their inventory and enabled booking and dynamic pricing through the platform.

Healthcare needs something similar for surfacing real-time provider capacity at a national scale to facilitate efficient appointment booking. Scheduling in healthcare is still a mess. Each provider uses multiple scheduling systems, and no one has a comprehensive view into the overall appointment capacity of a given provider network. We also have an explosion of virtual care and home health companies that require another level of complex resource management and logistics coordination that needs to interface effectively with traditional providers. Creating a universal scheduling infrastructure would enable third-parties/startups to surface live availability in their apps and allow referring providers and consumers alike to utilize capacity more efficiently.

— Julie Yoo, General Partner at Andreessen Horowitz

QVC for digital health

Live-streaming demo sales for DTC medical products

COVID proved two things. One, patients are willing to adopt digital health technology, and two, despite this openness, they remain out of the loop and unaware of which products would best meet their needs.

I think there’s an opportunity to create a QVC-like live-streaming channel that features different healthcare products. The Sales Development Representatives (SDRs) of various startups could come onto the channel and explain their solution’s value. Patient reviews would be integrated, ensuring recommendations did not go unchecked, and the best products rose to the top.

All in all, a solution like this would make discovery more direct and interactive. It could prove especially popular among older generations accustomed to this kind of DTC sales approach.

— Mario Amaro, MD, CEO at DocSpace

Culture-first treatment

Value-based care targeted by ethnicity

Value-based care (VBC) is a healthcare model in which service providers are reimbursed based on the outcomes they achieve. It’s intended to better align the incentives between a healthcare provider like a hospital or clinic and the patient.

I think there’s room to innovate on this model by narrowing the focus area. In particular, I’d like to see a network of VBC primary care providers (PCPs) that focus on specific immigrant communities, bolstering its service accordingly. For example, this network could serve the Indian-American communities in Dublin, OH, the Persian-Americans in Los Angeles, CA, or the Arab-Americans in Dearborn, MI, Somalian-Americans in St Paul, MN, etc. Each center would incorporate relevant religious and cultural practices, impacting the food, ambiance, and presentation of care. Instead of being “culturally sensitive,” this network would be genuinely “culture-first.” The model would simultaneously cater to the caregivers — the first-generation children who will feel comfortable promoting and supporting having their parents be a part of this new community.

— Misha Nasrollahzadeh, Strategic Partnerships Lead at Ribbon Health

Therapy-led primary care

A therapist to quarterback your day-to-day health needs

Behavioral health (BH) still sits outside core primary care. Though access to BH services is increasing, and more primary care startups like OneMed and Tia are offering therapy alongside their primary care services, BH is fundamentally an "add on" service, often accessible only via referral. This feels very contrary to the massive amount of evidence for the mind-body connection and the increasing BH load in the US.

I believe there's an opportunity to re-think how behavioral health is integrated into primary care, where a therapist would be the intake point and "quarterback,” with PCPs and specialists reserved for truly clinical work. There would be several benefits, a major one being the ability to induce, track, and improve behavior change around health, which health-tech has struggled with. There would be more opportunities for "lower licensed" professionals to offer care (like social workers and coaches) and ideally decreased reliance on medication and procedures to address common health aberrations.

This is a big idea in the niche functional medicine and integrative therapy spaces, primarily for people with chronic conditions. But with telehealth and parity laws increasing, there could be a huge opportunity to build a system that expands access to this approach.

— Shohini Gupta, APM at Oscar

CROs of the future

Distributed, therapeutically-specialized clinical research organizations (CROs)

It’s no secret that pre-FDA approval biotech startups are little more than lightweight business and fundraising shells around a (typically outsourced) clinical trial machine. These clinical trial machines, known as Clinical Research Organizations (CROs)‚ are responsible for the vast majority of a biotech startup’s costs and have substantial fixed costs in physical site locations, medical and scientific staff, and payouts to patients. So it stands to reason that any intervention in reducing the cost of clinical trials has to start with the CRO.

As with any business, there are two levers to improving the CRO:

1. Reduction of costs (table-stakes; where most CRO startups focus)
2. Increasing value-add

A “CRO of the future” could innovate on both points.

Concerning cost-reduction, CROs should innovate on the model of distribution. Specifically, they can start to bring trials to patients, eliminate fixed site costs, and build economies of scale by focusing on a particular underserved therapeutic area (e.g., rare diseases; women’s health).

In terms of increasing value, it’s essential to understand that many biotech companies have only one or two shots on goal. They raise capital to try to bring a single compound to market, and if that compound fails in its particular formulation, the business dies. Recognizing this, a modern CRO should support startup partners by identifying other viable indication areas (e.g., dermatology) and formulations, helping them build a case to raise capital for additional, parallel trials. In addition to increasing the revenue of the CRO, this increases the likelihood that any single biotech startup will get the treatment approved, thereby reducing the time it takes for a treatment to get into the hands of patients."

— James Rosen-Birch, stealth startup founder; former Chief of Staff, Roivant Sciences; Sio Gene Therapies

Bonus: CAPTCHA for Health Images

Help tag and annotate de-identified images

One of the big barriers to training ML models is having structured, annotated image datasets. CAPTCHA has been deployed across the internet for security purposes and training datasets for things like autonomous cars. Having a medical-specific CAPTCHA for things like MRIs, CT Scans, Tissue Slides, and so on where physicians tag anomalies or guess the diagnosis could create a valuable, massively labeled dataset. This would need to be on platforms only physicians could access or rely on a verification system to ensure the person tagging is a physician.

This behavior could be incentivized through perks, like discount access to relevant journals.

— Nikhil Krishnan, Thinkboi at Out-Of-Pocket

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Coda

This week's puzzle refers to a common startup mantra. As always, clues available to those that would like them. Just respond to this email.

Just two cryptically-gifted souls cracked last week's more difficult Coda. Serial winner Sid J got there first with Mladen S close behind. Both succeeded in identifying the CEO of Bumble, Whitney Herd. Excellent work in tough conditions.

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