Introduction:
Startup Health Now is a weekly show showcasing entrepreneurs, innovators, and investors transforming healthcare. Stephen Krein, CEO and Co-Founder of Startup Health, and Unity Stokes, President and Co-Founder, are on a mission to improve global health and well-being through investments in health moonshots. Vinod Khosla, a legendary entrepreneur, investor, and technology fan, founded Khosla Ventures.

Vinod Khosla’s Involvement with Startup Health:
Fourth conversation with Vinod Khosla, who first visited Startup Health in 2014. Vinod’s previous insights and vision have shown to be timeless. Excitement about the upcoming conversation.

A Year of Transformation:
A year ago, the Startup Health Festival marked the beginning of a global pandemic that transformed the healthcare landscape. As a society, our limitations were determined by our beliefs rather than our abilities.

Covid Impact on Healthcare System:
Healthcare system became more adaptable and receptive to experimentation. Rapid vaccine development showed what’s achievable when preconceived limitations are challenged.

Vision for the Future:
Overcoming artificial categories such as specialties within healthcare. Leveraging AI for 80% of healthcare tasks, enhancing efficiency and precision. Innovation will focus on verticalized care, addressing specific conditions like diabetes, mental health, and musculoskeletal issues. Remote care has immense potential, enabling cost-effectiveness and learning health systems that continuously improve.

Entrepreneurs, Innovators, and Investors in 2021:
Marginal implementation of technology is being replaced by true innovation. Verticalization will promote innovation by targeting parts of healthcare budgets and significantly reducing costs. Patients can expect better and more affordable care as a result of these changes. This will usher in a decade of verticalization across healthcare, transforming care delivery and cost structures.

Technology Advancements in Digital Health:
The pandemic has accelerated the adoption of exponential technologies in healthcare. Digital health funding has grown significantly, from $2 billion in 2011 to $20 billion in 2020.

Investment Growth and Adoption:
The potential for 10x investment multiple in digital health is significant due to its vast market size. Rapid payback and increased investment are expected in the healthcare sector. Adoption of digital health technologies can be categorized into incremental improvements within existing systems and radical innovations that disrupt care models.

Radical Innovations and Business Models:
Companies like Livongo and AliveCor exemplify radical innovations by establishing new verticals in chronic care. Changing the cost of diabetic care by 10x through innovative business models can lead to higher rewards.

Long-Term Perspective and Payoffs:
Valuable things in technology and business often require a long-term perspective and investment in core technologies and learning. Short-term gains may be easier to achieve but may not be as interesting or impactful.

Vision for 2030:
Khosla envisions a transformative healthcare landscape by 2030, with significant improvements in the level of care compared to today.

Collaboration in Innovation:
Innovation often happens outside legacy systems, but collaboration can be effective at later stages of scaling, not for early-stage innovation.

Experts and Radical Innovation:
Vinod Khosla emphasizes that radical innovation requires out-of-the-box thinking, and relying on experts can slow down the process or hinder radical ideas. Experts’ questions and perspectives can be valuable to good entrepreneurs, who should consider them without compromising their unique viewpoints.

Fusion Effort Example:
Khosla draws an example from fusion energy, where a small startup like Commonwealth Fusion, leveraging ideas from a global collaboration, might surpass trillion-dollar efforts due to its ability to take risks and pursue radical ideas.

Tesla and General Motors:
Using the example of Tesla, Khosla argues that seeking advice from traditional players in radical innovation could lead to mediocre results, like the EV1, instead of groundbreaking advancements like Tesla’s electric cars.

Healthcare Innovation:
Khosla warns that taking advice from healthcare providers in radical healthcare innovations might result in incremental improvements, like a Prius, rather than transformative advancements akin to Tesla.

Eliminating Symptom-Based Medicine:
Current healthcare focuses on treating symptoms rather than addressing underlying causes. This approach is ineffective as most diseases begin long before symptoms appear. Khosla advocates for eliminating symptom-based medicine by 2030.

Changing the Practice of Medicine to the Science of Medicine:
Healthcare should transition from tradition-based medicine to a science-based approach. This involves using measurable biochemical changes to diagnose diseases early. Current medical practices rely on historical data and clinical studies, which are limited.

Implementing a Learning Health System:
Khosla proposes a learning health system where every patient interaction contributes to an AI system. This system would benefit all patients, not just those of individual physicians. Data from patients would be used to improve the care pathways for all.

Regular All-Omics Testing and Full-Body Imaging:
Khosla predicts all-omics tests and annual full-body imaging will be standard by 2030. These tests would provide a comprehensive overview of a patient’s health. Early detection of diseases would allow for timely interventions.

AI-Based Analysis of Complex Biomarkers:
A vast number of biomarkers would require AI-based analysis due to their complexity. AI algorithms would interpret complex data patterns, aiding in disease diagnosis. Complex systems theory and science would be essential in understanding these intricate systems.

Revolutionizing Healthcare through Digitalization:
Digitalization and remote healthcare offer cost-effective solutions. Scaling physician capacity by 80% can address healthcare shortages.

AI-Assisted Primary Care:
CureEye’s AI-assisted primary care model reduces physician workload. AI can diagnose patients, reducing the need for physical examinations. Potential for free primary care through AI-based systems.

Oncology as an Ideal Discipline for AI:
Oncology is well-suited for AI implementation due to its structured data. Invitation for entrepreneurs to explore AI-based oncology solutions.

Stanford vs. Rural India: A Vision for the Future:
AI-powered healthcare in rural areas can surpass expert care in developed countries. AI’s continuous learning advantage over traditional medical education.

Accelerated Physician Load Reduction:
Curai’s goal of reducing physician load by 1% monthly. Exponential impact of sustained load reduction.

Upscaling Healthcare Professionals:
Progress in upscaling nurses and PAs has been insufficient. Autocatalytic effect of sufficient complexity and component pieces. Exponential adoption once critical mass is reached.

Real-Time Health Data Revolution:
LabCorp’s million users generate 100,000 ECGs daily. Real-time, contextually rich data transforms healthcare.

Autocatalytic Systems:
Vinod Khosla believes that healthcare will experience an autocatalytic system phenomenon in the next decade due to the increasing diversity of talent and components.

Silicon Valley’s Mindset:
Silicon Valley fosters a culture of risk-taking and innovation. This mindset, coupled with the diversity of talent, allows for radical ideas to be pursued relentlessly.

Moonshots and Incremental Innovation:
Moonshots involve taking significant risks with the potential for transformative outcomes. Incremental innovation involves safer, gradual advancements. The choice between moonshots and incremental innovation depends on the entrepreneur’s goals and risk tolerance.

Investor Matchmaking:
Entrepreneurs should choose investors who align with their goals and risk appetite. Different types of investors are suited for different levels of risk-taking and ambition.

Innovation in Healthcare:
Khosla asserts that true innovation in healthcare should focus on improving patient care through radical transformations. He emphasizes the need for entrepreneurs to prioritize patient-centric solutions over incremental changes. Verticals like chronic care outside of traditional healthcare systems can facilitate radical innovation.

Global Health and Investing:
Vinod Khosla expresses disappointment in investors’ limited focus on global health opportunities despite the potential of billions of people outside the field of billing codes. Lack of alternative options makes emerging markets attractive for radical innovation in areas like mental health. Traditional healthcare systems and billing codes can limit large-scale innovation.

Sources of Inspiration for Innovation:
Khosla emphasizes the value of failure and learning from numerous failed attempts. He recommends reading “Loonshots” and books by Eric Topol for insights on innovation in healthcare. Khosla mentions his experiences with Larry Page, Sergey Brin, Elon Musk, and Jeff Bezos as sources of inspiration.

Innovation and Expertise:
Khosla observes that major innovations often come from individuals outside of the expert realm. He cites examples from retailing, media, space, and technology where radical innovations came from non-experts. Expertise can limit thinking and constrain what is seen as possible for innovation.

Vision and Long-term Thinking:
Khosla stresses the importance of long-term vision in building a successful company, rather than focusing solely on short-term business plans. The mindset and vision of a $0 billion company differ significantly from a $0 million company. He emphasizes the need to build human resources aligned with the long-term vision while establishing revenue and stability.

Conclusion:
Khosla’s insights highlight the potential of global health and the value of diverse perspectives in driving innovation. His emphasis on long-term thinking and learning from failures provides valuable guidance for entrepreneurs and investors.

Assembling Innovative Teams:
Strong teams are critical in building successful companies, whether they are billion-dollar ventures or multi-billion dollar enterprises. Entrepreneurs should seek diverse expertise, but not be limited by conventional wisdom or industry norms.

Visionary Leadership:
The entrepreneur should possess a clear vision for disrupting norms. Leadership should question established practices and think according to first principles rather than relying solely on experience-driven reasoning.

Collaboration with Experts:
Experts can contribute specific technical skills, but entrepreneurs should maintain their visionary direction. Elon Musk’s approach to integrating expertise from the automotive industry while maintaining his own vision provides a valuable model.

Deep Science and Entrepreneurial Mindset:
While the role of deep science in innovation is still debated, the entrepreneurial mindset often prevails. Immunotherapy, for example, is a complex field where the entrepreneurial mindset and vision drive successful innovation.

Future of Healthcare:
The future of healthcare holds immense possibilities for innovation in the next decade. Investors and entrepreneurs should be optimistic about the bright future of healthcare.