My Reaction to Fred Wilson’s 2015 Healthcare Predictions

My blog post ticker has me sitting at three YTD so I will need to start cranking out more posts to hit my goal of 52 this year.

One post I have had on my list since January was to provide my thoughts on Fred Wilson‘s post about What is Going to Happen in 2015 and, more specifically, his healthcare predictions:

11/ the health care sector will start to feel the pressure of real patient centered healthcare brought on by the trifecta of the smartphone becoming the EMR, patients treating patients (p2p medicine), and real market economies entering health care (people paying for their own healthcare). this is a megatrend that will take decades to fully play out but we will see the start of it in 2015.

Let’s unpack this:

the health care sector will start to feel the pressure of real patient centered healthcare

According to a FICO survey, 80% of smartphone users want to interact with their provider online. I certainty agree with Fred’s prediction here and  believe we are already seeing the entire healthcare industry react to increased patient demand for digital health services.

brought on by the trifecta of the smartphone becoming the EMR

I see the trend of the EMR moving into patients’ hands playing out over the next 10 years as new ways to verify identity over the Internet become more mainstream, such as block chain. Patients will come to expect to own their online profiles and the data associated with them.

patients treating patients (p2p medicine)

Fred mentions these are megatrends that will take years to play out. I think this one is the farthest off (10+ years) because clinical judgement is deeply engrained in our healthcare system in order to ensure clinical quality and patient safety. Over the next five years, I think it is more likely that we will see software tools that will make clinical judgement more accessible to patients. With that said, I have seen examples of patients with rare conditions diagnosing and treating themselves because clinical judgement is lacking.

and real market economies entering health care (people paying for their own healthcare)

We have seen direct-to-consumer markets (where providers accept payment outside of insurance directly from patients) forming over the last decade with retail care and more recently with virtual care and concierge services. I imagine Bitcoin and other peer-to-peer payment models will also drive down the cost for providers to offer these services. This is definitely a megatrend driven by patients taking on the burden of their healthcare costs and reimbursement models shifting from fee-for-service to value-based.

Overall, I think Fred is on track with his predictions. The two megatrends I am most excited about over the next 3-5 years are patient centered care (brought on by patient demand for digital health services) and new market economies forming (brought on by patients taking on the burden of their healthcare costs and the transition from fee-for-service to value-based reimbursement).


Collaboration = Innovation

I just finished listening to Walter Isaacson’s book The Innovators: How a Group of Inventors, Hackers, Geniuses and Geeks Created the Digital Revolution on Audible. The book walks the reader (or listener) through the many innovations of the digital revolution.

Isaacson’s theme and my major takeaway from the book is that the digital revolution cannot be traced to one person. From Steve Jobs to Robert Noyce to Alan Turing to Ada Lovelace, the digital age came about and continues to grow by building on the innovations that came before it.

Isaacson points to collaborative environments with a diversity of people and skill sets like Bell Labs and MIT as models that fostered key innovative breakthroughs during the infrastructure period of the digital age.

Over the last 40 years, I believe Silicon Valley has served as the collaborative environment that has fueled the latest innovations (chips, e-commerce, web 2.0, mobile devices/apps, social, sharing economy, etc).

Today, you can see how the ecosystem is using Facebook and mobile devices/app stores to push new innovations forward. There also appears to be a renaissance of the lab concept with app development shops popping up such as Kevin Rose’s North.

So what’s next? My guess is the next set of innovations (5+ years) will be built on top of today’s innovations: Uber, wearables, drones, Oculus and Bitcoin. Regardless, Isaacson would argue they will come from collaborative environments that feature diversity of people and skill sets. I tend to agree with him.


Blogging in 2015

One of my 2015 goals is to blog once a week so when January 1, 2016 rolls around I can look back and see 52 posts over the course of the year. Three weeks in to 2015 and I only have one post…I have some work to do.

My objective in blogging once a week is primarily to share what I am thinking about and find interesting right now in my life/career arc. I also think it will help me improve my writing skills by forcing me to write a compelling post every week that people will find funny, interesting and worthwhile.

To pay homage to Mark Suster, I am blogging for the hell of it. My posts will be stream of consciousness and are not meant to last forever. I will be wrong and I expect my opinions will change over time as I get more data/experience. I hope you enjoy my forthcoming 52 posts (now 50 posts) and find them worth your time.

My Life

Top Ten Experiences of 2014

Welcome to my fourth annual post highlighting my top ten experiences of the past year. I was inspired to start this post after noticing a shift in society to value experiences over material goods.

2014 saw less travel – evidenced by my Delta miles being a piddly 7,000. This means 2015 will not be blessed with Platinum status so I’ll be at the back of the plane and boarding in Zone 3 with the rest of you.

To all my friends and family who didn’t make the list this year or disagree with your placement, remember there is always next year. Cheers to another great year and for what 2015 has in store.

10. Ran the Torchlight 5K


My sister Ellie and I ran a 5K through downtown Minneapolis in July. Thanks to the countless times running around Lake of Isles, I finished with a time of 21.30! The actual race was brutal, but drinking the free Mich Goldens with Ellie at the finish line was very rewarding. Look for us to bump up to a 10K in 2015.

 9. Hog Roast / Camping with Friends

pocket lake

I went on two camping trips during the summer of 2014.

The first was to attend the Hog Roast at my friend Ryan’s cabin on Pocket Lake (picture above). Side note: Ryan and another friend Mike recently launched an organic grab-and-go eatery in the Minneapolis Skyway called SIMPLS, check it out. The Hog Roast has been an annual tradition for the last four years and has somehow alluded the Top Ten list thus far. Nothing beats eating some slow cooked hog, playing yard games and getting the crew together for some fun in the great outdoors.

The second camping trip was with my friends Riley, Megan and Karla. It was a great trip except we had one casualty: Riley’s left flip flop. Despite my valiant attempt to save it, it will never be seen again. Sorry about that bud.

8. Moved into a New Apartment


I moved into an apartment near Lake of the Isles in the Lowry Hill/Uptown area. It’s small and has some character, but has a great location – its proximity to downtown gave me the opportunity to bike to work during the summer. I also want to formally go on record with my claim as the fastest biker on a Nice Ride in the Twin Cities. Challengers please take a number.

7. Ice Fishing

ice fishing

2014 was the year I finally became a true Minnesotan: I went ice fishing and hunting.

Riley and I went ice fishing with our good high school buddy Chad. Riley fit in well with his ’80s moon boots and JanSport hat (pictured above). Despite his best efforts to scare all the fish away with this outfit, we did catch some fish..or was that each others lines?

6. Hunting


Part two of me becoming a Minnesotan was going hunting for the first time. My college buddy Derek and his family graciously took me in for the weekend and introduced me to the hunting culture in Wadena, MN. From filling our thermoses with coffee at 5am to stopping by the VFW for a nightcap, I enjoyed every minute of it including shooting my first buck. If anyone wants some venison, I have a very full freezer.

5. Virtual Care Inflection Point


Zipnosis had white-hot growth in 2014 driven by patient demand for new virtual access points. We are now powering virtual care with several health system partners across the country, have a great team and are poised to make a strong push in 2015.

4. Jerry Seinfeld

Jerry Seinfeld

Karla and I got to see my favorite comedian Jerry Seinfeld at the Orpheum theater in January. Seinfeld is my favorite show so of course I spent the whole show laughing as Jerry brought his act into the current age of cell phones, social media and the Internet. Seeing him live, you can really appreciate his humor and the amount of time he invests in his craft. I wrote about how Jerry spends years writing and tweaking his jokes to get the perfect reaction from the audience here.

3. Sailing on Lake Harriet



Since I moved to the Uptown area, I wanted to take advantage of my proximity to the lakes by buying a buoy on Lake Harriet for my dad’s sailboat. After spending 20 years in my parent’s garage, the sailboat was finally able to stretch its legs on the cool blue water of Harriet. I built my confidence as a sailer through changing winds, different weather conditions and the occasional 747 flying overhead. The experience wasn’t always perfect as we had to devise strategies to prevent the boat from turtling during storms, cleaning up after the ducks and rowing a half mile each direction to and from the buoy. Overall, it was a great summer spending time with my dad and family that convinced me there is nothing better than the wind in your sail and the sun dancing across the water.

2. Golf Trip to Whistling Straits and Erin Hills in Wisconsin




The Bash Bros / Good Ol’ Boys crew really outdid ourselves by playing 63 holes over four days at Whistling Straits (host of the 2004, 2010 and 2015 PGA Championships) and Erin Hills (future host of the 2017 US Open) in Kohler, Wisconsin.

Whistling Straights sits atop bluffs overlooking Lake Michigan with panoramic views that rival my 2013 golf experience at Torrey Pines. Erin Hills is nestled in between the corn fields of the Wisconsin heartland. These courses were challenging and really tested both your mental and physical toughness. The Good Ol’ Boys ran away with the title, but if I could have hit every shot as my caddy recommended then it would have been a different story…

1. Ski Trips

ski trip 2014

Karla and I made our way to Colorado in February and December for some skiing at Copper Mountain, Breckenridge and Loveland.

We were very fortunate to have perfect conditions for both trips with fresh powder each day. We got absolutely dumped on with 22 inches of snow over 2 days during our trip in December. Karla has yet to see the sun and blue sky in Colorado so she is hoping for that in 2015 and I am hoping for more 22 inch powder days.

Honorable Mention

WWE Elimination Chamber at Target Center


I am not a big wrestling fan, but when 15 of my friends booked a suite to watch the WWE’s Elimination Chamber pay-per-view event, I couldn’t say no. Daniel Bryan’s YES! chant really was pretty incredible.


Identifying Big Breakthrough Ideas

Marc Andreessen discusses how his venture capital firm Andreessen Horowitz identifies big breakthrough ideas in the YouTube video below.

He explains that big breakthrough ideas are not predictable and may seem nuts, but so do all the crazy ideas that will never amount to anything. So how do you identify them? Andreessen Horowitz “tilts into the radical ideas” by having a prepared mind, which means reading broadly about as many things as you can. Then when they meet with an entrepreneur, they enter into a zen like state with perfect humility and ask the entrepreneur to teach them about their idea. He explains the reason really big breakthrough ideas appear nuts is because if they weren’t nuts than a big company would already have done it.

Andreessen contrasts this with the “top-down” approach of how other venture capital firms identify big ideas. He explains that the partners draw a map at the beginning of the year with boxes that represent product categories within each market. Then they go out and try to find the best company possible to put into each box. If they have names in each of the boxes at the end of the year then it was a good year.

I really like Andreeseen Horowitz’s approach to identifying big breakthrough ideas.


What’s a Good Sales Methodology for a Saas Company?

Mark Cranney of a16z recently published an excellent post titled “If SaaS Products Sell Themselves, Why Do We Need Sales?” In the post, Mark outlines his sales process to qualify a customer as answering three questions:

1. Why Buy Anything?

2. Why Buy From Your Company?

3. Why Buy Now?

Here’s his process:

These questions are also the first three phases in Mark Suster’s PUCCKA methodology:

Pain – Why buy anything?

Unique Selling Proposition – Why buy me?

Compelling Event – Why buy now?

Champion – Employee of your customer who is leading the internal “selling” effort

Key Players – Other stakeholders who need to sign off

Aligned Purchasing Process – Customer has budget, resources and approval process to make the buying decision

We use Mark Suster’s methodology at Zipnosis. I like the additional phases of Champion, Key Players and Aligned Purchasing Process because these can all be land mines that can kill a deal, so they should be qualified as quickly as possible before investing heavily into the deal.

If you are looking for a good sales methodology, you really can’t go wrong with the first three questions/phases identified by the Marks.


Can EMRs Move From Enterprise To Cloud?

Embed from Getty Images


Jonathan Bush, the CEO of athenahealth, was interviewed by Jim Cramer on Mad Money last night. Bush describes athenahealth as a cloud-based electronic medical record (EMR) that can take advantage of the network effects of having all their customers on the same version of software. Athenahealth’s biggest competitor, Epic, is an enterprise software EMR that deploys a unique piece of software or ‘island’ for each customer. The result of enterprise software is no portability of data or continuity of care from one implementation to another.

Bush goes on to say they have 5-6% of doctors on their platform. Athenahealth’s market cap is currently $4.72 Billion which means the back of the napkin EMR market estimate is roughly $100 Billion (noting that some of this is already built into their current valuation). The biggest challenge for athenahealth to get more of this pie is the switching cost creates a barrier for health systems and physician groups that have invested in $100 million Epic implementations.

So how do athenahealth and cloud-based EMRs win? Cramer touches on it in the interview which is I think it needs to be driven by patients demanding better portability of data and continuity of care across the spectrum of care delivery.

Hopefully we can see cloud-based EMRs catch fire like we have seen in the broader technology industry over the last 10 years because there are real benefits that can be realized by health systems/physicians and patients.