01:36:48 · Jordi Hays, Vineeta Agarwala, John Coogan, Casey Neistat
[01:36:48] S0: I'm kind of surprised to hear you calling a vaccine I'm kind of surprised to hear you calling a vaccine a jab. Yeah. But maybe that's just a comment. [01:36:56] S7: What it is. [01:36:56] S1: Yeah. It's like it's like reclaiming [01:36:58] S0: tech bro. Reclaim it. We reclaim tech tech bro, technology brothers. [01:37:02] S1: Yeah. The pharmaceutical industry definitely needs [01:37:04] S7: to replace [01:37:04] S1: the job. [01:37:05] S7: The name of this thing to tech nerds. It just [01:37:07] S0: What about [01:37:09] S7: But you know, you know [01:37:10] S0: Oh, yeah. [01:37:10] S7: So to finish that story out, to make that requires a lot of engineering and a lot of optimization and a lot of so called Silicon Valley style optimization, and so we're seeing that. A company in our portfolio called Orbital Therapeutics announced really exciting data in monkeys, you know, demonstrating that that might be possible for autoimmune disease. [01:37:29] S6: So I [01:37:30] S7: think it goes both ways. Silicon Valley tech is gonna permeate every company whether they're based here or not and whether they're making drugs or not. [01:37:37] S0: Do you think that these sort of early IPOs that drug companies have done historically is a feature or a bug? Like if if we have more developed private capital markets, do you think that like is it even right that effectively retail, uneducated retail could just be taking these like, you know, gambling in the public markets on effectively FDA trials? Or is there a better way?
01:38:06 · Vineeta Agarwala
[01:38:06] S7: There is a huge public market for biotech. The stage at which companies access those markets in the last few years was miscalibrated. And so that's why you see the headlines you're seeing with respect to public biotech stock performance, with respect to public fundraising challenges for companies because they were very far from the clinic. They were very far from generating commercial value. They were very far from demonstrating hard data that they were close to developing a product of value. So I do think the the private markets continue to be to have massive pools of capital in them, and biotech companies will stay private for longer. But, you know, at the same time, we're seeing huge demand and appetite for technologies that work from pharma companies that have a really rich ability to continue to back biotech companies, partner with biotech companies, fund biotech companies, buy biotech companies. So, we partnered up with Eli Lilly on that front and started a whole dedicated fund focused on supporting the biotech ecosystem, and that serves pharma and it serves the biotech ecosystem too. Right? And so there are lots of ways for companies to continue to make progress on those technologies while private until they until they have the metrics that justify justify going public.
01:39:25 · Jordi Hays, Vineeta Agarwala
[01:39:25] S0: That makes sense. You said something earlier around, nursing job vacancies. How do you what's your thesis on how that market evolves in four years? Are we still gonna see, you know, hospital systems unable and and various groups unable to get the nurses that they want? Or do you think that AgenTic systems can can kinda backfill those roles and and they just there there will be more kind of balance in the market. [01:39:53] S7: Yeah. I I hope we also project needing fewer roles. I mean, we are projecting that we're gonna be short over 3,000,000 health care workers just in The United States alone over the next year. Right? So it's a huge number. [01:40:06] S0: And the people so and and and the people making those projections, are they AGI pilled? Are they humanoid robot pilled? Like, I I I it's cool that the FDA has a chief AI officer that feels Mhmm. Important. But anytime I'm like reading into projections, it's more interesting to get a projection or or insight from you given that you're backing all these companies that Hey. I can understand that reality and wanna
01:40:32 · Vineeta Agarwala
[01:40:32] S7: wanna Right. That's a big number. That's based on, you know, the job count know, job that health systems and providers are opening but unable to fill based on the projected increase in health care demand as their population ages. But absolutely, I I hope it's not really that high because there's only, like, 8,000,000 total job vacancies in The US. That's, like, almost half our total job vacancies in health care alone. So we we have to actually decrease our need for those jobs, and we could redirect some of our extremely skilled health care existing workforce from answering phone calls, dropping up pick you know, picking up drop balls, recommunicating the same information to patients, recommunicating the same information between providers who are trying to coordinate. There are a million ways in which our system does not work today, and so I hope that number goes down. But the reality is that, the willingness to try out the agentic solution, whether it's for documentation, whether it's for getting prior auth from an insurance company, or whether it's for actually providing a clinical consult, has never been higher because the reality is today, we don't have the humans to fill those jobs. Wait times are long. Thirty percent of Americans skip care. Like, they skip or delay prescribed care. We're a developed country in which that's happening, and sixty, seventy percent of Americans say, I will see an AI doctor. Like, just give me, I will see one. Like, at least I will engage with one. And in fact, I'm probably gonna engage with one before I engage with a human doctor now. Right? We've all changed our consumer behavior that way almost overnight. It's a pretty remarkable shift that's happening that will, I hope, make us need a lot fewer than than those that, you know, that number of of open jobs.
01:42:18 · John Coogan
[01:42:18] S1: I I I remember what was it? In, like, 02/2008, there was a boom in electronic medical records startups like Athenahealth was one of them. And there was kind of like two waves going on that were kind of adding together and making those businesses work. One is like a technological wave obviously like we had access to cloud databases and cloud infrastructure and better software and so you could actually like put medical records securely in a cloud and so that was obviously like a great business. But then there was also an EHR mandate from the Obamacare legislation I believe. Are there any regulatory tailwinds that are adding on top of, like, the AI technology tailwinds right now in bio or health Yeah. Care
01:43:02 · Vineeta Agarwala
[01:43:02] S7: Absolutely. So there are first of all, I will say, historically, historically, a lot of health care software and technology was adopted because of regulatory incentives and payment incentives. Yep. But for the first time, we are seeing bottoms up adoption of tools and technologies and and an extraordinary NPS of health care software with scribing tools, like those developed by companies like Ambience and Abridge, you know, you know, you know, evidence, access tools like what what OpenEvidence has built. And so for the first time, we're also seeing pull that's just like, hey. This is better. I don't need the government to give me a, you know, a kickback to tell me it's better, but it is better. So that's a separate trend that we're very excited about. But huge regulations are also going to incentivize a better technology infrastructure. So price transparency is a good example. There are clear incentives and penalties for not being able to share transparently your price your pricing cards as a provider, as a payer, and to create that type of open access for patients. And so building that infrastructure layer is gonna be super important. The administration's talked a lot about patient choice. That could be patient choice with respect to how you use your benefit dollar, patient choice with respect to what plan coverage you select. And ICHRA is a good example of a potentially big change in the employer sponsored health care space. So these are all financial rails and incentives. CMMI continues to advance value based initiatives that basically prioritize preventive care and say, hey. At the end of the year, if you save the government a dollar, you save CMS money, dear smart provider who's using technology, you'll make money. Right? So that's a clear financial incentive. It's good for patients. Generally, being out of the health care system, preventing something before it costs a lot of money is good for patients. But the financial incentives and policy incentives do need to, you know, do provide a huge accelerator in our space, and that will continue to be the case.