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Chasing the (Healthcare) Dream

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Thread starter #1
Hey guys! I'm starting a healthcare company and in the early stages of bringing the final pieces together. In other words, I have everything I need, now it comes down to being the 'surgeon that stitches it all together', if i might make a healthcare quip.

The plan is to start an outpatient clinic that serves the opioid addiction patient population. This requires skillsets and serious effort expended in a number of areas:
  • Regulatory development & licensure: hundreds of pages of inter-connected documents that serve to meet local, state, and federal law requirements to start and operate a healthcare practice. Once built, these do not change drastically over time.
  • Clinical development & ongoing improvement: learning best practices for different disorders and optimizing care outcomes that serve a variety of patients facing similar issues, while also having some unique individual needs that should be addressed as well.
  • Business operations: this is an oft-overlooked area of incredible opportunity. In a business where the majority of your costs are wages, what better place to spend your time than improving their daily workflow for patient care & other admin? Workflow in healthcare is very challenging but also very rewarding. You could build a large consulting business just out of this and not bother with the full clinic development.
  • Personnel staffing & management: healthcare is tricky in finding enough physicians who are willing to switch from their current practice, even if it isn't ideal. The same can be said of other higher-value practitioners like PA's and APRN's. The goal here is to keep everyone very happy by doing more than everyone in the industry - which is pretty easy to do. Most healthcare companies are run by spreadsheet accounting departments it seems.
  • Finance & Vision: although simple finance is needed in the early days, complexity ramps up significantly as you start dealing with multiple business entities, different specialties, different states, separately owned real estate, and the laws that drive each piece forward. A mind for finance structuring can help to navigate these choppy waters. So far, only a few companies have succeeded in this area and they are publicly traded.
  • Ambition: I'd be remiss if I didn't mention this - this is the hardest thing I've done in my life by a good margin. Staring at all the red tape, the rules that have to be addressed one by one, the interconnectedness, the lack of cash flow for a period of time, the problems inherent in getting physicians on board, and hoping your health doesn't fail you for how difficult it can be. It's not for the faint of heart. But this country needs better healthcare and I prefer this to working on Wall Street a million times over. Shaking the hands of people who might otherwise be dead and seeing them have hope, in many cases for the first time in years (even decades for some) has been indescribably rewarding. And so I'm staying on this path.
It seems I have my work cut out for me. Thankfully I'm close to getting started. I meet with the initial team later this week to hammer out some details. I don't want to jinx anything just yet by saying more - but this gives you an idea of what I'm doing. I'll get into talks of funding, physicians, and the final push on my next post.

I might do some videos along with this blog format depending. Onwards and upwards.
 

Gerrit

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#2
I might do some videos along with this blog format depending. Onwards and upwards.
Awesome man great to see you getting ahead with your plans. I would really like to see some videos about this. It would be easy to share as well. Looking forward to more!
 

Teliah Gienger

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#4
Dang Andrew!

You are impressive. I'm very excited to be seeing regular updates from you. What you're doing is honestly really interesting to me seeing as I almost went into the medical field and know that there are a lot of areas that can be better.

:)
 

Kylon

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#5
I know there is some BIG news in regards to this now that is not mine to tell! Either way, freakin stoked for you man. When you're some billionaire health care entrepreneur change maker...we'll have to start like an SD alumni or something haha
 
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I know there is some BIG news in regards to this now that is not mine to tell! Either way, freakin stoked for you man. When you're some billionaire health care entrepreneur change maker...we'll have to start like an SD alumni or something haha
Sounds like you're trying to tempt me into sharing :p

I will say that the most important piece of starting my business fell (nearly) into place this week. I found a physician who is on board and we are now working out details. Barring some unfortunate details with setting a practice up here - it is a possibility since I haven't set up a clinic in Pennsylvania before - I hit a grand slam home run this past week. Especially with the details of how this deal may go down.

I will write a more formal post once we close our arrangement - details and all. But this agreement will allow me to hire approx. 8 people and the economics are great (for both me & the physician). So yes I am very excited. (y)
 

Teliah Gienger

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#9
Sounds like you're trying to tempt me into sharing :p

I will say that the most important piece of starting my business fell (nearly) into place this week. I found a physician who is on board and we are now working out details. Barring some unfortunate details with setting a practice up here - it is a possibility since I haven't set up a clinic in Pennsylvania before - I hit a grand slam home run this past week. Especially with the details of how this deal may go down.

I will write a more formal post once we close our arrangement - details and all. But this agreement will allow me to hire approx. 8 people and the economics are great (for both me & the physician). So yes I am very excited. (y)
I'm so excited to hear about all of it! :) Kylon didn't really share with me what all is happening even...so, I'm stoked to hear your progress!
 
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Thread starter #10
Amazon likes to think of each day as “Day 1”. That no matter where they are as a company, they maintain their attitude as a startup and continue to press forward, never satisfied for customers or competitive position.

Today, I have my first Day 1 of (hopefully many) Day 1’s going forward: I closed a deal to get a physician on board. This allows me to actively building out a healthcare business with all the inputs needed to be to get started. In other words… success! Alas, finally! Success!

As I reflect on today’s progress, I can’t help but be struck with this idea of inflection points – points that, once reached, your business has new capabilities and levers that were previously unavailable:
  • Prior to having a physician, this was a “pitch”
  • Now with a physician on board, this is a pre-revenue clinic
  • Once launched, this is an operational clinic with many channels for expansion
  • Once profitable, this is a scalable model
  • And once we have a base of credibility, this can start to become a new type of healthcare business
It is a race to get to each successful point, as they bring new organizational capabilities. You can start devising plans to accelerate growth or obtain capital through non-traditional channels. You might find high-value people to work with you. And you may even find other businesses interested in what you’re up to.

Each inflection point comes with its own set of challenges. And today I’ve reached arguably the most elusive one.

This is how I look to keep it Day 1 going forward: by asking myself what the next inflection point is. And how can I better leverage my current organization.

Looking forward to the race for the next one: obtaining the license to operate.

And then we’re in business.
 
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Sam

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#11
Amazon likes to think of each day as “Day 1”. That no matter where they are as a company, they maintain their attitude as a startup and continue to press forward, never satisfied for customers or competitive position.

Today, I have my first Day 1 of (hopefully many) Day 1’s going forward: I closed a deal to get a physician on board. This allows me to actively building out a healthcare business with all the inputs needed to be to get started. In other words… success! Alas, finally! Success!

As I reflect on today’s progress, I can’t help but be struck with this idea of inflection points – points that, once reached, your business has new capabilities and levers that were previously unavailable:
  • Prior to having a physician, this was a “pitch”
  • Now with a physician on board, this is a pre-revenue clinic
  • Once launched, this is an operational clinic with many channels for expansion
  • Once profitable, this is a scalable model
  • And once we have a base of credibility, this can start to become a new type of healthcare business
It is a race to get to each successful point, as they bring new organizational capabilities. You can start devising plans to accelerate growth or obtain capital through non-traditional channels. You might find high-value people to work with you. And you may even find other businesses interested in what you’re up to.

Each inflection point comes with its own set of challenges. And today I’ve reached arguably the most elusive one.

This is how I look to keep it Day 1 going forward: by asking myself what the next inflection point is. And how can I better leverage my current organization.

Looking forward to the race for the next one: obtaining the license to operate.

And then we’re in business.
First I've heard of this 'Day 1' mentality! Love it, and your approach to it with your business ?
 

Teliah Gienger

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#12
Amazon likes to think of each day as “Day 1”. That no matter where they are as a company, they maintain their attitude as a startup and continue to press forward, never satisfied for customers or competitive position.

Today, I have my first Day 1 of (hopefully many) Day 1’s going forward: I closed a deal to get a physician on board. This allows me to actively building out a healthcare business with all the inputs needed to be to get started. In other words… success! Alas, finally! Success!

As I reflect on today’s progress, I can’t help but be struck with this idea of inflection points – points that, once reached, your business has new capabilities and levers that were previously unavailable:
  • Prior to having a physician, this was a “pitch”
  • Now with a physician on board, this is a pre-revenue clinic
  • Once launched, this is an operational clinic with many channels for expansion
  • Once profitable, this is a scalable model
  • And once we have a base of credibility, this can start to become a new type of healthcare business
It is a race to get to each successful point, as they bring new organizational capabilities. You can start devising plans to accelerate growth or obtain capital through non-traditional channels. You might find high-value people to work with you. And you may even find other businesses interested in what you’re up to.

Each inflection point comes with its own set of challenges. And today I’ve reached arguably the most elusive one.

This is how I look to keep it Day 1 going forward: by asking myself what the next inflection point is. And how can I better leverage my current organization.

Looking forward to the race for the next one: obtaining the license to operate.

And then we’re in business.
I don't think I've ever heard that concept either...the treat every day like the 1st day concept, but I love it! It's a great mentality to keep when starting a business.

Also, CONGRATS!! Getting someone signed on is incredible! So cool!
 
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I've fully confirmed my model for the early stages and for growth into a mid-sized company. Due to the delay in being able to sign up with insurance, I am able to accept self-pay patients in the interim. This lets me get the flow of working down with my team and accept patients in an area desperately needing attention.

I've always been against the self-pay model, as we have insurance that covers these services. And most physicians will not look to accept insurance, although that is changing. It places an additional economic burden on people trying to recover from the most difficult thing they've faced in their lives.

But with how much help is needed in my area here, I think those self-pay patients will welcome a chance to get some care.

For the medium-term horizon, I have figured out some new ways to expand quickly. I think my model will be a unique one in the country. Very excited to bring it to the light of day.

Also I'm in early talks of adding another prescriber. Progress on the business front is good. Now just to get my regulatory/back-end finished off so I can breathe...
 

Gerrit

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#16
No, it's more of a supply problem - there is not enough treatment. So people, regardless of income, will go for self-pay.

It is more likely to see private insurance accepted than medicaid (low income). But overall there just aren't enough providers.
Forgive my ignorance on the subject. So it would help if more people would become doctors so the supply is increased and the price of medical treatments can drop?
Or is the insurance system like it is now the problem here?
 
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Thread starter #17
Forgive my ignorance on the subject. So it would help if more people would become doctors so the supply is increased and the price of medical treatments can drop?
Or is the insurance system like it is now the problem here?
This is specifically an issue with addiction medicine. There are not enough doctors signing up to help. It isn't a full-time job for them to do addiction - only part time. But many doctors aren't going out of their way for it. Any doctor can do it.

Part of the issue is there are not the right incentives. Or the companies themselves suck. Pay being offered isn't very good. I'm changing that.
 

Gerrit

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#18
Part of the issue is there are not the right incentives. Or the companies themselves suck. Pay being offered isn't very good. I'm changing that.
That is great, I hope you inspireren more people to look ar healthcare your way.
 
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Update:

Today the first money has come in for building the company. This is opposed to money used for salary to get here, which cost me a few percentage points of equity. The wire was initiated maybe an hour ago.

It has been a rough process since leaving my prior venture in October. If you had told me it would take this long, I suppose I would have believed you. I never really had a timeline in mind, I just knew that a lot of work was coming.

As far as updates since I last posted, here are some developments:
  1. Lawyer: I hired a lawyer for formation expertise, and to help me raise money from unaccredited investors. A process that I think is worthwhile to have friends/family along for the ride. It requires extra steps with the SEC (see: rule 504 or 506). I'm not done with it yet, but I am close.
  2. CPA: We have a family friend who helps build healthcare companies and he's been very helpful in getting moving. Knows the tax efficiency of items, and will help me as I operate the company.
  3. State Gov't: Finally heard back on the requirements for the application & licensure. It isn't a nebulous cloud of uncertainty any more. Although I figured out what I needed from online sources, not everything was online. I'm now going through final motions here.
  4. A second prescriber: I have a second prescriber on board. She seems great.
Now just to execute. So close to the finish line here. Which is really the starting line. But for me, the finish line of all this hard work.

"The man who moves a mountain begins by carrying away small stones." - Confucius

The next phase isn't nearly as hard. Managing a healthcare company isn't as difficult as building one. The rest is going to be very fun. ;)
 

Gerrit

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#20
I love your updates man. I feel like a learn every time I read one.
What is a prescriber?
 
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