One of the most useful framework in my spiritual journey is
@TheKenWilber
’s:
Wake up — Seeing that there is a higher consciousness
Grow up — Maturing one’s views to be able to hold multiplicity of truths
Clean up — Healing and integrating any shadows (parts in ourselves, and
I BECAME A US CITIZEN TODAY 🇺🇸
This country isn't perfect. But, having lived elsewhere in the 🌎, I don't ever take it for granted that I can say what I want to say, as a woman I can do what I want to do, and I can love who I want to love. I am very proud to be an American.
Speaking of loving whom I love,
@CamillaFHermann
waited patiently for me, in the cold rain, outside the building of the naturalization ceremony (since Covid, friends and family are no longer allowed in) and was the first person I saw as I emerged officially a citizen ❤️
I was surprised by how emotional I felt. Looking around where the oath ceremony took place, there were ppl from everywhere. A beautiful reminder that this country is a place where so many hope to build a better life, like my mom who immigrated with 2 young kids a long time ago.
AI in healthcare doesn’t really exist right now.
It should. It has the potential to meaningfully improve patient outcomes and provider shortages.
A 🧵on why AI companies don’t make it from my vantage point as a digital health investor. 1/
1/
@ACME
’s invested in iconic D2C health companies like Curology, Pillpack, Brightside, & Tia. I ♥️ this space.
I take 1k+ mtgs/yr & invest in ~5 co.
Out of 955 emails,👇 are top reasons why I passed on D2C healthcare startups last year (🧵/18)
TL;DR I like full-stack digital health companies that own care delivery and can use AI/ML to augment what they do vs. AI/ML companies that try to sell to provider groups. Have not seen a company in the latter category be a breakout yet. 12/
An in person conversation I had this week w a major Cerebral investor-
Me: So, how’s Cerebral doing?
🥸: Honestly, it’s a GREAT business.
Me: …
🥸: They’ve beaten projections every quarter.
Me: …
🥸: This stuff will blow over. Look at WeWork! They’re doing so well now.
Me: 🤯
Excited to announce
@ACME
’s new $300m+ Fund IV and my becoming Partner alongside my dear friend & work wife
@alexfayette
.
Here are the things that I’m celebrating today 🧵:
At some point, emptiness practice flips into liveliness practice. There’s nothing to defend anymore, nothing to empty. A thief entering into an already empty home. All sensations and phenomena are welcomed with open arms.
The bar is so shockingly low for VCs that being able to regulate my nervous system and not show up reactive is a massive differentiator in founders' eyes. Wild
At the hospital to start my annual cancer check process. What a visceral reminder of why I invest in healthcare. We all deserve the wealth that is our health.
I've been spending lots of time in digital health and consumer social this year and always get, "??? they're so different." They're not. To me it's ultimately about improving the wellbeing of humans. Healthcare improves the hardware and social improves the software. You need both
Hurdle
#1
: The fragmented nature of US healthcare = pockets of data that company has to painfully get agreements to centralize to even train models. This means interfacing w/ bureaucracies like health systems & unis = months/years of startup burn. 3/
imho
@chrissyfarr
has the smartest
@amazon
x
@onemedical
coverage out there. really singular in her nuanced understanding of what’s going on and Amazon’s broader vision.
I heard someone say this today. I'm not Christian but I find the sentiment beautiful and true: “You should live your Christian values out in the world, because you may be the only Bible someone gets to read.”
Hot take: Cerebral will be a bigger scandal than Theranos when it’s all said and done.
Yes, Theranos is a sensational con man story. But patient impact is much more serious in mental health mis-treatment vs. getting another blood lab bc 1st one was funky.
Cerebral started off prescribing antidepressants, then it found there was more profit in Adderall. Here's the story about how the startup focused on growth, sometimes at the expense of clinical quality. w
@khadeeja_safdar
and
@anfuller
This is assuming employer direct-contracting stay as a model. The company that will likely win is the one that wins national contracts w payors, who can then offer robust mental health packages as part of their plans to their employer clients without creating a separate budget.
Every mental health startup will inevitably pivot to B2B to lower churn.
And due to the crowded market, savvy employers will drive down prices, which will in turn reduce pay for therapists.
OK cool thing about my dear friend and my spouse working together...
I get to see firsthand
@chrissyfarr
absolutely crush it for
@CamillaFHermann
@OathCare
. I've never seen an investor add so much value on recruiting in such a short period of time holy moly.
Demand for mental healthcare in this country is the highest it's ever been yet commercial insurers keep cutting down their reimbursable rates so supply keeps going down. The US healthcare system is so screwed. We all lose (except those making $$$).
Hurdle
#2
: Even once the data needed is acquired, the data itself may be of poor quality and require serious cleaning. Bad data >> bad models = game over. 4/
Hurdle
#4
: Getting adoption in the system is brutal unless you’re also delivering care vertically. The latter is also brutal; you’re essentially building your own provider group and care delivery infrastructure. 7/
One of the things I most appreciate about living in SF is how it’s shattered my inherited East Coast illusion that fancy colleges and degrees matter at all.
The smartest, most capable people I know don’t have them. Some do. There is no correlation.
Women of NYC, Phoenix, LA, & SF...
Drop everything you're doing rn & sign up @ to be your permanent medical home.
I just went in for my annual Well Woman exam. It's the best healthcare I've gotten in my entire life as a woman. A 🧵on why it's so unique:
Hurdle
#5
: Documenting and demonstrating superior clinical outcomes that will win over risk averse providers. If you don’t own your own care delivery stack, you have to convince provider groups to use your application. 8/
There are very, very few healthcare companies that are utilizing AI. And when they say AI, it’s actually just ML.
AI in healthcare doesn’t really exist right now. (It should, and we can go down a rabbit hole another day of why it doesn’t).
Hurdle
#6
: The providers are clinically convinced; but who’s paying? Very few reimbursed by insurance. So either patient pays or providers with already thin margins pay for it. Harder to convince if your value prop is cost savings vs. adding rev. 9/
Side note: I’m writing as I wait for my annual post-cancer check up at a 🏥. Walking into a hospital is a universally vulnerable experience for most humans. Participating in
#JPM22
convos while also viscerally going through patient experience reminds me of what’s important here.
A16Z is leading a $350M (their largest ever) round into Adam Neumann’s new real estate company Flow.
Flow bought 3,000 rental units in S Florida, Nashville, & Atlanta. Business model is unclear, seems like wework for housing + some ownership for renters
What I always forget and have to constantly remind myself (and really the heart of my spiritual practice) is that stories are most powerful when I remember that they are just that — stories. Then I can create while still maintain liberation
Hot take on man’s downfall from Eden: Knowledge from the apple is the addition of prefrontal cortex in sapiens. Emergence of Intellect marks a division from Presence and Wholeness enabled by the conceptual mind, whose powerful ability to tell stories is the very fountain that
Realizing that a thriving relationship is less about dividing household operations “equally” & more trading off of who’s the more resilient one at a given moment & thus can take on more.
In my experience, “equal” has been the ideal but in practice can be static & unrealistic.
My life is complete. I have done what I am meant to do this world. (
@PadmaLakshmi
👋).
World’s best egg sandwich👇
Crispy whites, gooey yolk, melty cheese, bite from green onion, spice from chili oil, nutty whole wheat bread.
Hurdle
#3
: Deciding which application can get venture funding. TAMs for most AI applications in healthcare (not including pharma in this thread) are small bc they provide ancillary services / tooling (e.g. diagnosis assist, workflow automation). 5/
Had such an energizing and beautiful conversation with
@JakeOrthwein
today.
One of the threads we touched on: That awakening isn't a "laddering up" of more and more light absence of dark. Awakening is an expansion and inclusion of both more light and more dark. 🧵
I can’t get this Jewish x Asian menu that I dreamed up out of my head. Time to make it? 🧵 of dishes:
1. Matzoh ball soup with ginger scallion sauce and chili oil.
2. Chopped liver rice balls onigiri 🍙
3. Nigiri sushi rice with smoked salmon & everything bagel seasoning 🍣
You know why good journalism is dying? It’s morphed into PR.
@chrissyfarr
told me how frustrating it was as a reporter to get non-answers from experts when they really are the ones w ground level truth. So now I try to do my small part to say the real thing vs my PR talking pts
Hurdle
#7
: Onboarding, training providers and admins. Does it work seamlessly with their current workflows? Little frictions add up to minimum adoption in the actual field unless it’s something so important that there is a top-down mandate. 10/
We spend so much time running away from the unbearable tenderness of being human even though it is what gives us the most meaning and joy in this short life.
Reality check: The tech people who moved to Texas are wealthy enough that they’re not affected by policies.
Worried about abortion? They have money to travel across states to get the best care. Worried about school shootings? They send their kids to private schools w security.
Our
@7wireventures
hatch company
@caraway_health
is out of stealth w/ a $10.5M financing! What started as an idea we couldn’t shake has culminated in building a generational company focused on college-aged women. A 🧵:
I am a 1st gen immigrant. My mom moved here as a single parent w 2 young kids. Mom worked at my grandma’s hair salon during the day & took college classes at night. She kept a pillow & blanket in the car to nap in btw her shifts & classes.
I’ve lived my whole life, ever since a toddler, w chronic pain. My knees periodically would hurt, like they’re in a lobster cracker.
No prior doc took initiative to look into it. Until today
@Ask_Tia
. My doc listened & ordered labs for what I suspect is juv rheumatoid arthritis
Women of NYC, Phoenix, LA, & SF...
Drop everything you're doing rn & sign up @ to be your permanent medical home.
I just went in for my annual Well Woman exam. It's the best healthcare I've gotten in my entire life as a woman. A 🧵on why it's so unique:
1/ Hot take: The employer direct contract model in healthcare will eventually be less relevant as payors move to offer benefits that were previously fragmented as part of their plans.
Ok in movie / TV scenes where the👮♂️puts the person getting arrested into the back of the police car, they never show seatbelt being put on the handcuffed person. Does that happen in real life??
My mom moved to an entirely new continent with 2 young kids as a single parent with nothing and started from scratch. People can do anything if they put their minds to it.
I’m actively trying to break out my learned helplessness, even when my small actions likely futile.
I moved mtgs to call senators on HR8.
Knowing it’s futile but training myself to act & not numb so when the right opp arises for impact, I’ll have the muscle memory to do it.
Our household lives & breathes digital health. I invest in dh cos. My founder4life
@CamillaFHermann
is building one at
@OathCare
.
Helping parents w their most life-changing experience = constant topic in our home for yrs. Excited to be part of this journey now w
@chrissyfarr
.
Here's my personal take on
@OathCare
from the perspective of being a user desperate for support while pregnant during the pandemic - and later as an investor.
One of the greatest joys of being meat-sacks on this rock hurtling through the abyss of space is sitting out in the sun with the person you love on a nice day
This 👇 why payors can’t implement value based care yet.
@wah__yan
is 💯 right here. Infrastructure that will enable vbc is an area I’d love to invest in.
Over time, the methodologies below have been the most impactful. Each have a lot of crossover impact in other categories (eg Dzogchen really applies to all) but for simplicity:
Wake up — Mahamudra and Dzogchen
Grow up —
@ConsciousLG
with
@DianaChapman
Clean up — Psychedelic
So many of my male friends have asked if there could be a
@Ask_Tia
for men.
The US healthcare system is so bad that even the population that most benefits from its default care design is not getting adequate care.
There is no me without my mom. She’s my hero. It doesn’t matter how often I think about this, it always brings tears to my eyes. I feel them now as I write this.
Access is not enough in this brave new world of digital health; Brightside's commitment to quality sets it apart from everyone else.
Proud to announce our co-leading
@withbrightside
's Series B. We led the Series A just a year before. Why? 🧵
Someone pls report how much the founders and early investors have each sold and gained in secondaries while employees, providers, and patients hold the short end of the stick…
Cerebral, which raised $300 million at a $4.8 billion valuation this month led by SoftBank, changed the status of more than 200 employees, mostly therapists, from salaried to hourly workers in August and made their health insurance contingent on quotas.
Digital applied to mental health…
Pro: Enables greater access in a time of unprecedented need.
Con: Without a relentless commitment to patient outcomes & wellbeing, companies stray & become pill mills to grow revenue. << This is where board governance in startups is critical.
When Covid hit, the fed gov’t relaxed a rule preventing doctors from prescribing controlled substances like Adderall without an in-person visit. Silicon Valley saw an opportunity: diagnosing ADHD online. 🧵
“I'm convinced, I've seen enough, it's time to step back and hand over the keys to Hollywood to
@Chloe_Domont
. It's her world now, I am just another analyst who wants to help her succeed.”
@firstshowing
on FAIR PLAY
@sundancefest
cc
@leopoldhughes
It’s baffling to me that many people eliminate emotions from their decision making. There’s much intelligence to them.
To eliminate them is to narrow one’s set of data points >> incomplete inputs for decision making >> “bad” decisions.🧵
Happy
#InternationalWomensDay
👯♀️
This tweet has since been deleted but it gave me a good laugh and a good reminder how much left there is to do 🤦🏻♀️
The best part of my day today is seeing all of the acknowledgement of how amazing
@chrissyfarr
is. It’s the best feeling when the world sees what I see.
YOU GO GLEN COCO 🚀
(Oh no do I need to explain this to GenZ 👵)
My eternal cc:
@lesliejz
@AlyssaJoyJaffee
@deenashakir
👯♀️👯♀️
Watching
@chrissyfarr
catapult into the world of VC has been amazing. She is the first person to help others with her connection super power. I learn something everything time I spend time with you Chrissy. We are so fortunate that you trusted us enough to join and learn venture!
Doctors who listen seem like a given but it is not for women.
@Ask_Tia
is the best healthcare I have ever received in my life. I am a happy patient of their SF clinic.
Trying out
@Ask_Tia
today! I had such a bad experience seeing a doctor at Kaiser that Tia made sense for me to check out. Women just want doctors to care and listen to them genuinely ya know 💁🏻♀️ We deserve better healthcare!!
10/ The most important factor for a potential investment in D2C digital health is true defensibility. Increasingly that means I’m investing in *a tech company that delivers healthcare vs. a healthcare company that delivers tech.*
Someone asked me the other day what it means to unconditionally love one’s self in the context of a career.
For me, it means that when something “good” happens, I can feel the joy in it and know that it doesn’t mean anything about me. 1/