I can’t think of a better mission than ensuring Americans receive the healthcare that they are entitled to - not because healthcare is a right but because the terms are what’s spelled out in the explanation of benefits for the plan they, their employer, or the state pays for.
The Claimable story is telling. As long as speculative capital is needed (or perceived) as needed for creditability, in variable the market inertia will win. I don’t see how we can change at scale without changing the terms of capital access and lowering the bar / risk for deployment within the healthcare system for promising solutions to enable better co development.
Thanks, Riaz! You've landed at the same place I have - the capital access terms are upstream of everything else. As long as VC alone is the credibility signal, the optimization function gets set before a founder makes a single product decision. Claimable is Exhibit A.
But the question of what alternative capital structures actually exist for companies in these markets remains undefined. If a company can't get VC backing and can't contort their model to fit the 7-10-year return cycle... what options do they have? Grants? HNW (hello Mark Cuban)? Revenue-based requires revenue, and Steward ownership/PBCs are nice, but they're terms that may not even make it to the table if you can't raise.
You spent years inside a nonprofit MA plan operating at scale. Did the nonprofit structure actually protect the mission in ways that a for-profit with governance protections (dual-class shares, founder control) can't? Or does it create a different set of constraints that are just as limiting?
I’d say not profit status creates different pressures for innovation.
I think if you are a not for profit in a largely for profit market, you’re playing catch up. Competitive markets (particularly inefficient competitive markets like healthcare) require all companies fighting for relevance to operate with a profit mindset. So you’re playing catch up in many ways as it relates to maintaining or building a competitive advantage.
The same MA plan at which I spent time has since radically changed its approach, its structure and the bets it’s placing, while operating the plan as a not for profit. But has it lost its North Star? I bet different people may have different takes.
In my experience, the mission can also be a source of discord as fidelity to it (or the appearance thereof) may prevent the pursuit of certain paths. And there is no metric against which to measure the “mission.” So you can be both right and wrong in the judgements you place, but the baseline assumptions are subjective. Oversight is squishier; strategy can be more amorphous because success is decidedly not profit; accountability is harder to stick. The absence of a measurable standard poses a unique governance challenge that I think you only see or feel in the Board room because it’s not visible. A 990 isn’t the same as quarterly filing.
Finally, I think one of the biggest impediments is time to impact (multiyear) and budget cycles and fee schedules (annual). In our system, the payment rules aren’t any different regardless of tax status.
Really enjoyed this piece.
The Claimable story is telling. As long as speculative capital is needed (or perceived) as needed for creditability, in variable the market inertia will win. I don’t see how we can change at scale without changing the terms of capital access and lowering the bar / risk for deployment within the healthcare system for promising solutions to enable better co development.
Thanks, Riaz! You've landed at the same place I have - the capital access terms are upstream of everything else. As long as VC alone is the credibility signal, the optimization function gets set before a founder makes a single product decision. Claimable is Exhibit A.
But the question of what alternative capital structures actually exist for companies in these markets remains undefined. If a company can't get VC backing and can't contort their model to fit the 7-10-year return cycle... what options do they have? Grants? HNW (hello Mark Cuban)? Revenue-based requires revenue, and Steward ownership/PBCs are nice, but they're terms that may not even make it to the table if you can't raise.
You spent years inside a nonprofit MA plan operating at scale. Did the nonprofit structure actually protect the mission in ways that a for-profit with governance protections (dual-class shares, founder control) can't? Or does it create a different set of constraints that are just as limiting?
I’d say not profit status creates different pressures for innovation.
I think if you are a not for profit in a largely for profit market, you’re playing catch up. Competitive markets (particularly inefficient competitive markets like healthcare) require all companies fighting for relevance to operate with a profit mindset. So you’re playing catch up in many ways as it relates to maintaining or building a competitive advantage.
The same MA plan at which I spent time has since radically changed its approach, its structure and the bets it’s placing, while operating the plan as a not for profit. But has it lost its North Star? I bet different people may have different takes.
In my experience, the mission can also be a source of discord as fidelity to it (or the appearance thereof) may prevent the pursuit of certain paths. And there is no metric against which to measure the “mission.” So you can be both right and wrong in the judgements you place, but the baseline assumptions are subjective. Oversight is squishier; strategy can be more amorphous because success is decidedly not profit; accountability is harder to stick. The absence of a measurable standard poses a unique governance challenge that I think you only see or feel in the Board room because it’s not visible. A 990 isn’t the same as quarterly filing.
Finally, I think one of the biggest impediments is time to impact (multiyear) and budget cycles and fee schedules (annual). In our system, the payment rules aren’t any different regardless of tax status.