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Broken System: Halle Tecco on What it Takes to Build Massively Better Healthcare [Replay] · Breaking Precedent

• [00:00:00] Welcome back to Breaking Precedent. This summer, I'm revisiting conversations that continue to shape the way I think, and my episode with Halle Tecco is definitely one of them. [00:00:10] Halle was talking about the future of healthcare long before many people were paying attention. She saw opportunities where others saw complexity and helped build an [00:00:20] entirely new category around health innovation. What I love most about this conversation is that it's not just about healthcare. It's about seeing around [00:00:30] corners, questioning assumptions, and having the conviction to build something before the rest of the world catches up. As healthcare continues to evolve at [00:00:40] a rapid pace, I think you'll find her insights just as valuable today. Here's my conversation with Halle Tecco **Speaker 6:** For wealthy, [00:00:50] lucky individuals, we have one of the best healthcare systems in the world. But for the vast majority of Americans, we have a system that is expensive and hard to access. **Speaker 7:** Hi [00:01:00] everyone. I'm Leah Sullivan, and this is Breaking Precedent. Not only did I found TaskRabbit, one of the pioneers of the gig economy, I'm now a venture capitalist backing the next generation [00:01:10] of rebels. In this podcast, we dive deep into the stories of innovators who are pushing societal boundaries, challenging precedents, and setting new ones in their field. Today my [00:01:20] guest is Halle Teko, founder, investor, and one of the sharpest system level thinkers in healthcare. Halle didn't just start companies. She's challenged the way healthcare [00:01:30] decides who gets care when they get it, and who gets left behind. From founding rock health to backing founders, rebuilding everything from digital health to [00:01:40] longevity, she's been at the center of healthcare's most important inflection points long before they were obvious or fashionable. Now she's putting those lessons into [00:01:50] words in her newly released book, massively Better Healthcare, a clear-eyed argument for why incremental fixes are not enough and why the system needs to be [00:02:00] redesigned around outcomes, trust. And proof. What makes Halle different is that she doesn't just ask, can we build this? She asks, should this exist at all or [00:02:10] who does it actually serve? At a moment when healthcare is overloaded with technology but starved for trust, Halle is pushing the industry to do something [00:02:20] genuinely radical earned belief by proving it works. This conversation is about conviction, timing, and what it really means to break precedent inside one of the [00:02:30] most regulated and most resistant systems on earth. Let's dive in. Halle Techo, thank you so much for being here on Breaking Precedent. **Speaker 6:** [00:02:40] Thank you for having me. It's really fun to be on the other side of the podcasting table. **Speaker 7:** I know. I love your podcast as well and we actually go way, way back. I mean, [00:02:50] when I was running Task Grab and you were at Rock Health and we have lots to catch up on, so I'm excited. **Speaker 6:** Yes, lots of good San Francisco memories. **Speaker 7:** Yes, [00:03:00] absolutely. Wow. To kick things off, I like to start with a little icebreaker, and so here it is. So I know you have [00:03:10] spent. Your career thinking about healthcare as a system, and I'm curious though, what is a moment in your own life, your body [00:03:20] stress, illness, injury, burnout, whatever it was that changed how you think about healthcare more than any other boardroom or sort of [00:03:30] business setting would have. **Speaker 6:** Great question. I would say probably in general, like my upbringing and some of the healthcare experiences I witnessed growing [00:03:40] up in Ohio with some family members that were low income and on Medicaid, and realizing very quickly that we have a system of [00:03:50] haves and have nots, you know, for wealthy, lucky individuals. We have one of the best healthcare systems in the world, but for the vast majority of Americans, we have a [00:04:00] system that is expensive and hard to access. And the fact is where you live, your race, your job, your income, all predict your health outcomes more reliably than any. [00:04:10] Clinical biomarker or genetics. There's actually some data that backs us up. Americans living in the top 1% live on average, seven years longer than people living in the bottom [00:04:20] 50%, and a person living in a small rural county with a median income of. 30,000 can expect to live a full decade less than someone like [00:04:30] you or I, an affluent suburb with a medium income of a hundred K. Wow. Yeah. Uh, and actually I do talk about this in my book and I speak about specific family members and their experiences. [00:04:40] Unfortunately, they're no longer with us, but I talk about how much of our modern healthcare system assumes just a level of engagement, time, literacy, wealth, and support that really. [00:04:50] Isn't evenly distributed, and I won't go into it here. You'll have to read the book. Yeah. But that experience and specifically a specific uncle and his experience in the healthcare system really made it [00:05:00] impossible to ignore for me. And just, you know, learning that engagement in the healthcare system itself is a privilege. **Speaker 7:** I wanna [00:05:10] unpack all of it because there's a lot there. And you know, we met in San Francisco when you had founded Rock Health, which we'll get into. But you know, you mentioned your [00:05:20] upbringing and where you grew up and how you grew up. I'm just wondering if you can kinda take us back, why don't you paint us a picture? What kind of household did you grow up in? What were the [00:05:30] values? Yeah, what were the expectations and how was health talked about in that household? **Speaker 6:** So I grew up in a pretty, I would say. Practical Midwest family. My dad owned a [00:05:40] small manufacturing business that ultimately went bankrupt after nafta. My mom worked the front desk actually at the Cleveland Clinic. We had a household where [00:05:50] responsibility, showing up, getting things done really mattered more than, let's say. Talking about your feelings or optimizing your life. Health wasn't necessarily discussed [00:06:00] proactively. It kind of came up when it had to. If you were sick, you go to the doctor. If you weren't, you really didn't think too much about it. Wellness didn't exist. No one worked out, like no one in my family worked out. [00:06:10] I didn't even work out until I was in my thirties. There was really no language around prevention or mental health. There's literally a photo of me as a baby with Coke in my bottle, which [00:06:20] says a lot about the era and the mindset, but at the same time, I would say that medicine and science and doctors were absolutely trusted. Like we got vaccinated. We [00:06:30] went to all of our recommended appointments. Doctors were seen as authorities, not something to be debated or second guessed, and my family was solidly middle class. So there was never any [00:06:40] issues of getting the care that we needed. And education was also really. Deeply valued. Even though my parents didn't come from academic or professional backgrounds, like I'm a first generation college [00:06:50] graduate. All my siblings were the first generation to graduate college, and also all of us have graduate degrees as well. But the expectation wasn't necessarily to follow a specific path, [00:07:00] but it was really about like. Finding stability in your life? I would just say I grew up kind of trusting institutions like medicine without any like illusion that the system was designed around [00:07:10] comfort or optimization. You know, healthcare was something that you used when you needed it, not something that like you wrapped around your life. Like it wasn't in the day to day. [00:07:20] **Speaker 7:** What about systems in general? I mean, you talked a little bit about education and how important that was. Healthcare system, of course. Did you grow up believing that [00:07:30] systems were meant to be challenged or just accepted? **Speaker 6:** Probably just accepted, but my personality was always pushing back and questioning [00:07:40] why things were the way they were. I always had like a deep desire for fairness. I think coming from a big family with lots of siblings and step siblings as well. I don't know if that's [00:07:50] was part of it, but wanting to make sure that everything was kind of fair. And so I think I just naturally questioned why things were done a certain way and why.[00:08:00] Aren't certain processes and outcomes equally distributed? **Speaker 7:** How many siblings? How big was **Speaker 6:** this family? We're the Brady Bunch. There are four in my family, and [00:08:10] then my dad remarried and I have four step siblings as well. **Speaker 7:** That's incredible. That must be fun for the holidays. Just tons and tons of people. **Speaker 6:** It [00:08:20] is. And I have an only child, so he has lots of cousins, which is great. Nice. And yeah. And you know, I'm not close to all of them. Like I have certain siblings that I spend the most time with and are most [00:08:30] close to, and everybody's kind of spread out around the country and around the world. My sister, I'm closest with lives in Mexico. **Speaker 7:** That's pretty amazing. So that idea of fairness, I could see where [00:08:40] that would come into play with so many siblings and children and family members. When did you realize that? Healthcare wasn't just about medicine, that maybe there was some other [00:08:50] components to healthcare, wellness and other things **Speaker 6:** from a young age. Just seeing people in my family not having the same sort of access as I had consistently throughout my [00:09:00] professional career as well. Getting my MPH was huge. Learning about the social determinants of health from not just like a theoretical standpoint, but like actually looking at the [00:09:10] data and understanding the inequitable outcomes of our healthcare system. I did my MPH at 35, so I went back to school to get it after I had been in the healthcare space for so [00:09:20] long. But it was really there that I was able to very clearly see healthcare as a system, like really see the forest through the trees. And then honestly, I feel like it's every day. [00:09:30] Like there are examples that I hear about or my own, you know, experiences and now I have power and access. I recognize like, oh my gosh, like I was able to see the specialist [00:09:40] because I knew someone high up at the hospital and was able to like call in and get this appointment. I was like, I hate that, that I can pull those lovers, but like I'm going to, because my health, my family's health is very [00:09:50] important. But I think it's just something that's I'm reminded of all the time. **Speaker 7:** It is interesting because it is such a system, it's hard to navigate. I [00:10:00] mean, you have an MPH have studied the system. You've really learned how to sort of play the game. At what point did you feel like [00:10:10] you had to play the game versus. Question the game. Were you always questioning the game as it was sort of laid out on the field? Yeah. **Speaker 6:** I have [00:10:20] not had like a real boss since 2010, so I feel very fortunate that I'm able to kind of call out the game in places. I think a lot of [00:10:30] folks that work in healthcare look around and like see very clearly where there is waste inefficiency and groups that are profiting from [00:10:40] pieces of our healthcare system that. Are worse outcomes for patients and I'm able to like call out those bad actors because I'm not gonna lose my job. I'm not gonna fire myself [00:10:50] for my podcast. I'm not gonna, like I, the universities are very generous with what I say. They don't mind. And if I did get fired, oh well, it's not like that big of a deal. Whereas I think a lot of people within [00:11:00] the healthcare system that work within the healthcare system see it, but don't necessarily have the same sort of privilege to speak up. And so. I'm calling out middlemen that are [00:11:10] driving up prices and I can like call that out and not worry about pissing off those middlemen. But it's also little things like, as you can imagine, healthcare is very, and has always [00:11:20] been very paternalistic and very much driven by men. Even though women make up the majority of the healthcare workforce. If you look at just. Those at the top. It's [00:11:30] mostly men and I have for years and years and years will call out these things and we very early on at Rock Health we're publishing like a Women in health report where we looked at the percentage of women in [00:11:40] leadership positions and like question why given women's involvement in healthcare and being the chief. Caregivers, the chief medical officers of the home, [00:11:50] managing all the healthcare spend. Like why are we underrepresented? Like why are we being kept out? We shouldn't be kept out of any, any industry, but especially healthcare. And so I've had kinda the privilege to like call [00:12:00] out like big conferences, like why are you talking about women's health with all men on the stage, right? Not the first, but one of the first unicorns of women's health was like a male led [00:12:10] women's health company with all male investors. And I just look at that and I'm just like, congrats. I hope you guys do well because we need more solutions to women's health. But that speaks volumes [00:12:20] of where we are in innovation in women's health that a unicorn comes from. You know, it's so hard for women to fundraise and women in women's health. It's like a [00:12:30] double whammy. And so to see that as just like a reminder of how awful it is. So anyways, I'm always like opening my mouth and tired, **Speaker 7:** but I love about you **Speaker 6:** getting tired. **Speaker 7:** I haven't **Speaker 6:** there yet. **Speaker 7:** Well, I [00:12:40] mean, it's interesting to be so deep in your understanding of a system, but to also be outside of it so that you can apply leverage and pressure and you don't [00:12:50] have the same sort of boundaries that others working within the system do. Let's talk a little bit about rock health and how rock health kinda [00:13:00] played into that. What was the goal there for actually kind of breaking into the system? **Speaker 6:** So the story of rock health is [00:13:10] I was getting my MBA and had a really incredible opportunity to intern at Apple in between my first and second year, so my summer internship, and [00:13:20] they hired me to cover the healthcare segment of the app store, which was nascent. It was about a year old at the time. I always say like it has much less to do with my [00:13:30] qualifications to run the healthcare segment as a 26-year-old intern and more to do with how little Apple cared about healthcare at the time. It just wasn't an interesting category. It wasn't moving, it wasn't seeing the [00:13:40] most innovative apps, but **Speaker 7:** little did they know who they were. Hired **Speaker 6:** little, right little did they know they would eventually have, you know, a whole healthcare team. To me like that [00:13:50] really opened up my eyes to the opportunity I knew I wanted to work in healthcare. It was incredible. You know, I sat next to a woman, Linda Kim, who covered gaming. She's still a good friend of mine today. [00:14:00] She's the CEO of match dot com's, like Asia Group, and she was working with like the most incredible developers that were in, in and out of her cubicle. Just like having a [00:14:10] good time using every native feature of the iPhone and the apps that I was working on just were super lame, but I knew. That the market opportunity for [00:14:20] healthcare was a hundred times the size of the opportunity within ads on gaming apps. In terms of like where we were spending our resources and [00:14:30] innovation, like where the founders were spending their time building apps, to me was like all wrong. I felt like, hey, there's an arbitrage opportunity here. We have the biggest industry in the US, makes up almost [00:14:40] 20% of GDP and there's no innovation here. And so it was, you know, to me, just a giant opportunity for. These kind of two worlds to combine. So we, you know, [00:14:50] set out to bring tech people, innovative folks who were using, at the time, mobile was like the biggest, you remember this 2010? **Speaker 7:** I do. Yeah. **Speaker 6:** [00:15:00] Mobile was like the big thing, right? Yeah. And so kind of finding founders who understood product, understood user experience, and then really give [00:15:10] them the support and funding from the healthcare establishment. So our initial investors. Were like the Mayo Clinic and Kaiser Permanente, and they were so excited, like [00:15:20] they wanted to be more innovative and kind of build this bridge to Silicon Valley startups. And so that was kind of like the vision of what we wanted to do was innovate in healthcare, help [00:15:30] make healthcare a better experience for the users or customers or patients, whatever word you wanna use. But also kind of build more efficiency within the healthcare system. Move us [00:15:40] from a place of, you know, 15 minute once a year interactions with the healthcare system to something that's a little bit higher resolution. At the time, no one was doing early stage health tech investing. [00:15:50] There were few folks on later stage, but really no one in Silicon Valley was trying to bring people together in support early stage founders in healthcare. **Speaker 7:** Yep. What were you seeing from these sort of [00:16:00] traditional healthcare providers? What were they getting wrong about startups? In the early days of digital health, **Speaker 6:** yeah, there were so many gatekeepers. [00:16:10] So there were some that got it and that wanted individuals that got it, could see the future, could see the opportunity for technology to transform healthcare, but didn't necessarily have the sort of [00:16:20] environment and structure to make that possible. So even if you found someone within an org, they might be able to write you a little check and support a small group, but really [00:16:30] like enterprise wide. Partnerships were very challenging at the time, and I think the thing that they most got wrong was at not investing early in [00:16:40] kind of the innovation infrastructure that they had to adopt 10 years later at the beginning of the pandemic. So just like a quick, very short history of [00:16:50] what's happened in the last 15 years in healthcare innovation is that health. Systems, clinics, hospitals, technology was forced upon them. We had to create huge government [00:17:00] incentives for them just to use electronic medical records and get off paper in 2010. Right? They did not have the cultural competency to enthusiastically [00:17:10] adopt good technology, and then the pandemic happened five years ago and that changed everything and suddenly they were adopting technology. Faster way than we'd ever seen before. What would normally take [00:17:20] years we were seeing get set up in weeks, and that at the time was mostly virtual care. Mostly remote patient monitoring. **Speaker 7:** And because it was life and death, like they had to do something, **Speaker 6:** they had to, **Speaker 7:** the stakes **Speaker 6:** were just, they were forced [00:17:30] into it. **Speaker 7:** Too high. Yeah. Yeah. **Speaker 6:** And so at the time we're like, well, this is certainly a blip. Like cool, they're doing this. But we kind of assumed they would go back to being technology laggards. Actually the opposite happened. What [00:17:40] happened was these organizations, they strengthened a muscle and built out teams, and they built out these processes and learned that like, you know, technology can be super helpful. And to be fair, [00:17:50] technology has gotten more helpful and there are tools say that didn't exist 10 years ago. So they could argue that they weren't ready, that the technology wasn't ready. Not that they weren't ready, but today, now [00:18:00] we see. See healthcare really leading the way when it comes to like AI adoption. There was a Menlo VC report that came out just a few months ago that showed that healthcare providers were [00:18:10] adopting AI 2.2 times faster than other industries, which is incredible and so exciting to see. I would say I wish they had gotten up to speed faster than they [00:18:20] had, but like at the end of the day, here we are today and I really am so impressed by how dedicated they are to innovation today and how we've kind of normalized [00:18:30] technology to having a place and having a role within our healthcare system. **Speaker 7:** It's pretty amazing with ai because healthcare is one of those industries that [00:18:40] just has so much data. So much data, right? Yes. It's like you think about other industries and you're like, yeah, there's data there, or like maybe we're not collecting it all, but like [00:18:50] healthcare, there's so much data, so the LLMs and the ai, like this industry is ripe for like step function, breakthrough [00:19:00] change, right? In the next, **Speaker 6:** yeah, **Speaker 7:** decade. With ai, it's pretty exciting. **Speaker 6:** I've heard 30% of all data is healthcare data in the world. So absolutely. The problem with it [00:19:10] is that it's very siloed and not all connected, and so that's the next frontier is being able to see, have like one comprehensive data repository, even like with [00:19:20] an Epic, which is the large EHR system. Like you could have an Epic account at one hospital, move across the country. Still use Epic, but it has no [00:19:30] access to your former profile at your last hospital. Like even things like Epic is starting to like at least make it interoperable within their system is improving. But yeah, we have a data [00:19:40] problem within healthcare in that we have. The underuse of data and we also have the misuse of data. So when I say we have the an underuse of data is that we're really not [00:19:50] using the data that we have to its greatest ability to improve healthcare outcomes. When I say we have misuse of data, healthcare data is some of the most valuable data on the black [00:20:00] market. And so we are seeing like. Crazy level breaches within the healthcare system of data. I don't know if you saw the change Healthcare, big news last year that was millions of [00:20:10] dollars ransom holding the data and then God, they finally released it. But like we don't even know if it's still out there and it's very personal data as well, diagnoses that you wouldn't necessarily want out. [00:20:20] So we have both like a cybersecurity issue as well as just like the data's not being used to the extent that it could be. **Speaker 7:** I mean, that kind of feeds into my next [00:20:30] question, which is around the concept of having proof and of being really, really sure in healthcare that something is gonna work. I think healthcare [00:20:40] loves to do pilots. They like to test yes, but like you don't see too many things really get to scale. Can you talk about why that is? **Speaker 6:** Yeah, I [00:20:50] mean, I agree that healthcare loves pilots. A decade ago, I wrote an article for KQED that was like death by pilot because I just saw so many healthcare startups [00:21:00] do pilots that would go nowhere and waste the time. I've talked about that quite a bit. I wouldn't say healthcare hates scale. It's definitely challenging to scale, but it took scale for the incumbents to [00:21:10] get as much power as they have today, especially health plans. Pharmacy benefits managers, but certainly from like the provider side, it's very fragmented. It's very regional, so there's [00:21:20] scale in some places that has been disadvantaged to patients and then not scale in other places where maybe we would have a better experience if there was [00:21:30] some economies of scale there. I think the problem is that we often confuse proof of concept with proof of impact, and then we never do like the hard work of operationalizing the [00:21:40] scale. And a lot of people say. We have an implementation problem, not an innovation problem in healthcare that the problem isn't, that we don't have tools that are helpful, [00:21:50] but that we don't have a way to implement them and we don't have teams to implement them broadly. So, and that kind of goes back to what we were saying earlier with like the cultural friction that you [00:22:00] see in a lot of these like old school healthcare systems. Evidence certainly matters in healthcare more than industries. As you said, like proof, evidence is kind of the term that we use and it's because human [00:22:10] lives are at. Stake and the downside risk is much, much bigger in healthcare. The most famous principle in the Hippocratic Oath is first do no harm. So there's, you know, [00:22:20] reasonable caution when trying new things, but it's led to a culture of not trying anything and just accepting the status quo when we need to change things. But we're, [00:22:30] the path we're on is not sustainable. **Speaker 7:** Yeah. I wanna talk about founders. You meet a lot of founders all the time. Every day you've been an investor. [00:22:40] Talk to me about sort of myths that founders tell you that maybe they still pitch, even though you know it's not true. Are there [00:22:50] things that just keep coming up from founding teams that you just wish we could myth us? Within? **Speaker 6:** Healthcare specifically? **Speaker 7:** Yeah, within healthcare, [00:23:00] yeah. **Speaker 6:** You know, sometimes we think that. There are easy tech solutions when the problem is really regulatory or behavior change, [00:23:10] and those are things that like I wish founders could have a bigger impact on. But there's a ton of regulatory capture within healthcare. One example is I've seen over the years. [00:23:20] So many companies trying to tackle medication adherence and just getting people to take their meds because a lot of prescriptions go unfilled or [00:23:30] people aren't taking them appropriately, and it is really a huge problem. I've seen a lot of physical solutions, people building like futuristic pill boxes to apps that [00:23:40] incentivize you to take it. But the number one reason people don't fill their medication is because the high cost of drugs. And I wanna get excited about some of these solutions and some of them are really cool. I [00:23:50] also, with my public health hat on, look at this of like, if we really want to tackle medication adherence, we need to tackle. The high cost of medications. And so [00:24:00] I think that founders, I wouldn't say something they should unlearn, but something I wish more of them would bring is recognizing that your solution can help [00:24:10] solve one of the many problems within healthcare, but also we need your voice and your advocacy because there's some pieces of it that are going to be kind of beyond your control and your ability to solve, [00:24:20] but. If you become an expert in the problem, then you are well positioned to advocate on behalf of that problem and solve it from a government [00:24:30] level, from the incumbent level, just bringing attention to it. And I think Mark Cuban is like a great example and he's doing this right now, bringing incredible attention to the problem that they're trying to [00:24:40] solve at his new company, cost Plus Drugs. And he's like being very outspoken about some of the intermediaries within healthcare that he thinks are malicious. And then lobbying on behalf of [00:24:50] it. And he's, you know, points out and he's gone to Congress and, and spoken there and he's being an advocate for the problem, which I think more founders need to do. **Speaker 7:** [00:25:00] I think that's such an interesting point because it does seem like it's an industry as a founder, where you can't just focus on your one product or your one [00:25:10] solution. You've really gotta understand the full system and where it fits in. And then, like you said, be an advocate for the whole system of change and for others as well. [00:25:20] Yes. Yeah. **Speaker 6:** Yeah. And ultimately, like if your goal is to. Get people to take their medication, like however that happens, like the way to get there shouldn't [00:25:30] matter. It's like if you are dedicated to this problem, then like, let's look holistically at why does this problem exist and where else do we need change? **Speaker 7:** Yeah. [00:25:40] How do you distinguish between tech that looks really impressive in tech that actually has an impact and changes outcomes. **Speaker 6:** [00:25:50] So, you know, I actually love tech. That looks impressive because healthcare deserves better. But obviously it only matters if it's moving the needle in healthcare, either or we call it started off as the [00:26:00] iron triangle. But now there are four things, but improving outcomes, increasing access, lowering costs, or improving the healthcare experience. And the only thing that you can do is look at the evidence. [00:26:10] The challenge at the early stage is that the evidence is necessarily thin. So what I look for isn't. Perfect data. I look for directional proof, general data of [00:26:20] studies of similar interventions, early signals, consistent with like real world use, not just like ideal conditions. And then obviously kind of the people involved. So much of [00:26:30] it is the people involved and you know this is true for most industries. Are they precise about what they know, what they don't know, and then bringing in kind of the right team and partners to the [00:26:40] table. **Speaker 7:** I mean, that is so interesting because it's like, yeah, wow. These founders, they really have to take on a lot and understand a lot and understand the full [00:26:50] stack and be willing to kind of. Go to bat outside of their key area. I love the comment though, that healthcare deserves better. We deserve these impressive designs. Right? Totally. And really flashy, fancy. [00:27:00] Absolutely, yes. It's interesting though too with venture, right? In venture investing there is this like timeline, right for venture, and if you need the proof and you need the [00:27:10] outcomes, and you need the research, that can take more time. Is that at odds with venture at all, or how do you reconcile that? **Speaker 6:** A hundred percent. Biotech investing has [00:27:20] kind of always been like that, right? Where it takes a lot of time to get through clinical trials. So there are some parts of venture and biotech has always been venture backed. So there are some places [00:27:30] within venture investing that understand these long, risky timelines. But as you know, like with tech investors, they don't necessarily have that same level [00:27:40] of patience because what they're comparing their investments to are these, you know, very. Rapidly growing, easy to pivot products that [00:27:50] can grow very quickly without data you don't need, like the data is how many users are logging in, how many people are paying for it. Like, you know, the sort of KPIs are [00:28:00] quite simple. Whereas in healthcare, the KPIs are going to be a lot longer to generate because sometimes healthcare outcomes take more than a day to to see or, **Speaker 7:** [00:28:10] yeah, **Speaker 6:** you know. Savings is, is in the long run. So it's definitely, it's difficult. But then, you know, I do think that there are a lot of tech investors who genuinely want to do healthcare because, and balance their [00:28:20] portfolio with healthcare investments because they recognize the TAM is really high. They recognize the impact is potentially huge. And so there's like a [00:28:30] mission orientation to investing in healthcare. Just, you know, having to. Manage expectations of growth, and it's really important not to push the [00:28:40] founders in a way that causes them to cut corners. And we've seen this, right? Like I talk about the uBiome case in my book on how that happened, like an otherwise very impressive [00:28:50] team that. Ended up cutting a lot of corners, getting in big trouble with the FBI and are now fugitives on the run. And a lot of that comes down to kind of the pressure from [00:29:00] investors to grow at all costs. So we have some cautionary tales and hopefully that has spooked folks enough that the investors recognize that [00:29:10] we can't take that same grow at all cost mentality to healthcare. **Speaker 7:** What is the most dangerous precedent in healthcare that we still treat [00:29:20] as inevitable? **Speaker 6:** What do you mean by that? **Speaker 7:** I mean like, you know, when you think about what are sort of the table stakes in healthcare, like [00:29:30] the insurance, the regulatory, okay. Like all these pieces that we just take for granted and sometimes feel, I think invisible to a patient or a [00:29:40] consumer, but we just say like, oh, this is just how it is. This is how it's gonna be. Yeah. The **Speaker 6:** entire freaking thing. I mean like, how about the fact that if you show up five minutes late for an [00:29:50] appointment, you. Have to reschedule. **Speaker 7:** That's a really good one. **Speaker 6:** You're likely gonna have to wait an hour for the doctor. Otherwise, I mean, just like **Speaker 7:** a sheer, **Speaker 6:** like **Speaker 7:** that's a really, really good one. Yeah. **Speaker 6:** Imbalance. [00:30:00] I mean, that's just one that I dealt with recently. I will say, you know, going back to the paternalism, which is baked into our system and there's this long. Standing assumption that patients aren't [00:30:10] sophisticated enough to understand their own data, let alone own their own data, their options, or the trade-offs being made on our behalf. I do believe that shows up [00:30:20] everywhere. I am seeing it more generationally. I do think that the younger clinicians are being more partners. I'm seeing this and I don't wanna generalize by age. Does feel like [00:30:30] there's more partnerships with the clinicians that are of a generation that interesting. Knows that their patients are going to be doing their own research anyways. But still, you know, our [00:30:40] data's locked up. We're not able to access, it took laws for us to at least get access to our test results. I mean, they didn't wanna give them to us otherwise. We've just [00:30:50] built a system where information asymmetry is treated as like protective when like in reality it just kind of. Preserves power and kind of keeps patients quiet **Speaker 7:** and [00:31:00] like how much things cost, right? None of us know how much a procedure's gonna cost, how much an X-ray's gonna cost when you go to the er. Like no one knows what anything [00:31:10] costs. And it's not like we can compare costs either and say like, oh, I'm gonna go to this place because I think it's gonna be cheaper or whatever. You know? It's just like there's no transparency. Yeah, **Speaker 6:** there's no [00:31:20] transparency and. Know if you pick up a prescription and the person behind you is picking up the same prescription, like it can be a hundred x price difference. God. So it's not even [00:31:30] just that we don't know the price, but that it swings so wildly from patient to patient. Like one simple law that I would love to see is like having bands [00:31:40] banned with a D on the price change. Like no one can pay more than 10% more than anyone else. Right, because what happens is cash pay, [00:31:50] people that are uninsured are paying the highest price within our healthcare system because they don't have a health plan that's negotiating on their behalf. So the people that probably can afford it the least [00:32:00] are paying the most, and it's completely unfair. Going back to fairness. So that's like one law. I would love to see, like, let's restrict how much a price can fluctuate. It is [00:32:10] worse than going and buying a car because at least going and buying a car, you have like Carfax or Carvana or whatever, you know, you can like go online and know what's like a [00:32:20] normal price and you just really can't do that with healthcare. **Speaker 7:** And it wasn't always that way either, right? In automobiles, like these things evolve, they change, people innovate. It feels [00:32:30] slow to me, I guess, in healthcare, and it's probably because it's regulatory. It has all these extra layers and complexities. I don't know. It feels like a lot. There's a lot of things that need to change. [00:32:40] One of the questions I have for you is around incentives. Okay. So when you think about just the incentive structure, like in a hospital, in a physician's [00:32:50] office with insurance like. With the patients, it feels like incentives aren't necessarily aligned right in a lot of these [00:33:00] systems. Can you talk to us just a little bit about those incentive structures and like where there is misalignment right now? **Speaker 6:** Yeah. Kind of two big pieces. I [00:33:10] think one would be on the payment side. So we enroll in health insurance on an annual basis, so annual enrollment forces, payers and employers to [00:33:20] think on a one year time horizon. So it creates a system where everyone is incentivized to recoup their investment in your health within 12 months. Even though we [00:33:30] know that most meaningful health interventions take years to pay off, not quarters or weeks. That's one big one. And then the other one is paying for outcomes versus [00:33:40] paying for procedures. The example that I give on this in my book is IVF. I had to use IVF to have my child and I actually the most. Profitable patients are those that [00:33:50] actually don't get the outcome they want, and they have to do cycle after cycle. So I was a very profitable patient for my fertility clinic, whereas a patient who can get [00:34:00] pregnant the fastest with the least invasive treatments is going to be the least profitable. So that's just one example. But there are a lot of places within healthcare where the outcomes and what is best for the patient is not what's [00:34:10] best for the bottom line of the provider. And incentives matter. And it says a lot about our healthcare system that. Clinicians are put into positions where they have to [00:34:20] decide how to take payment, and you would hope that it would always be leading to outcomes, but it usually isn't that way. I will say we have had a slow movement to [00:34:30] value-based care, and so there are new models of payments that are based on outcomes, but the problem again, though, goes back to my first problem, which is. It's still [00:34:40] generally annual enrollment, so you still have to kind of see that benefit within a year. So those are things looking at like readmissions. So perhaps your [00:34:50] clinician can help keep you out of a hospital in the short run, but it's not necessarily going to be things like a GLP one, which might take 12 to 24 months to lose the [00:35:00] weight, and then you keep it off. And then we're preventing a heart attack 10 years down the road. **Speaker 7:** Yep. Yep. Fascinating. So let's talk about the book. Your book [00:35:10] is called Massively Better Healthcare. When I saw that you were writing a book, I think on your birthday, you kind of put on Instagram like, Hey, I'm [00:35:20] writing this book. It's my birthday as a gift, you know, will you pre-order? I was like, oh my God, I'm so excited to read this because I know you, I know how thoughtful you [00:35:30] are, and you just had decades of experience. Understanding the system, so I cannot wait to read the book. Talk to us about how the book came about and [00:35:40] why you felt like now was the time to write this. **Speaker 6:** Yeah. And I'm so excited to offline talk to you about your book because it is like having another baby, right? **Speaker 7:** [00:35:50] Yeah. Just like a startup. It's just like a startup. Yeah. **Speaker 6:** Yes. So, you know, over the last 15 years between founding and running rock health, tracking every digital health deal, publishing industry reports, [00:36:00] starting and selling Nat list. Investing in 51 companies, starting a podcast, a blog, teaching over a thousand students at Columbia Business School and Harvard Medical School. Like it took all of that [00:36:10] to make me feel like I was ready. And I was talking to a women's group the other day and I was like, what does that say about imposter syndrome? That I had to like do all of that first before I felt like I was ready. You know, I wanted to [00:36:20] organize and share my key learnings and writing was a really fun way to do that. I love writing. I'd always, I was the editor of my high school newspaper. I've always [00:36:30] just enjoyed storytelling and organizing thoughts and you know, trying to convey information in plain English. And so I had so much fun writing this book. And you know, I think the timing [00:36:40] couldn't be better with new tools like Gen AI combined with healthcare reaching this breaking point that we're facing right now. The stakes are only higher and technology has never been more ready to [00:36:50] tackle this. So that's why now. And I really wanna help the next generation of builders, funders. Leaders kind of have a clearer map than I did. **Speaker 7:** [00:37:00] Amazing, amazing. So what does massively better actually mean? And what does it not mean? I **Speaker 6:** mean it means, and I will say it was one of the [00:37:10] titles that we were toying with was like a hundred x better and okay. Um, my husband who's like very analytical was like, no, 'cause then you need to measure it. Like if you are gonna use a hundred XX better enough, it needs to be. So [00:37:20] anyway, so what I **Speaker 7:** love **Speaker 6:** the to do better, I love it. It's a term we use a lot at rock health, so it kind of has it's genesis and something that we always said there, but it means [00:37:30] meaningfully better for more people, especially the ones that the system currently underserved. So it means better access, better continuity, better alignment between effort and outcome. It [00:37:40] explicitly does not mean incremental optimization of a broken system or continuing to extract or drain value without add, adding any real benefit. **Speaker 7:** Step [00:37:50] function change. I love it. **Speaker 6:** Yes. **Speaker 7:** Very exciting. Yes. Yeah. So who's the book for? Is it for founders, clinicians, policy makers, patients? All of the above. Everyone. **Speaker 6:** Yeah, all of the above. [00:38:00] Awesome. It's for anyone trying to change, yeah. Healthcare from inside or on the edges and like feeling that friction. The tagline is actually The Innovator's guide to Tackling Healthcare's biggest [00:38:10] challenges, and we were very purposeful about choosing the word innovator because we felt like it encompassed. Entrepreneurs as well as entrepreneurs, as well as kind of anyone trying to do things differently. [00:38:20] **Speaker 7:** Yeah, I love that. I mean, it definitely resonates with this podcast too. It's across industries, right? It's about breaking precedent and shifting society in multiple [00:38:30] categories, and yeah, you may not be a founder, but you're an innovator and you may not start a company, but you know you're writing or blogging or push the thinking in a different way. Yeah. So I [00:38:40] just, I love that. **Speaker 6:** Well, as you, I mean, starting companies is overrated. It's so hard. **Speaker 7:** It's so hard and it's probably not usually the way to have the most impact actually. Totally. Right. [00:38:50] When you think about impact and **Speaker 6:** outcomes, I totally agree with that. Yeah. Yeah. I think there's a lot of glory that comes with it, like in the media and we. Lion eyes, [00:39:00] founders, but 95% of startups fail. We don't hear enough stories of those that didn't make it through. And so, yeah, as you said, like it's more likely a good way to spend a lot of [00:39:10] frustrating nights and weekends, um, **Speaker 7:** waste a lot of time and money. No, it's interesting because as I've been thinking about this concept of precedent, right? And what it takes to break [00:39:20] precedent, one of the things that I like really keep coming back to is the idea that. There are no big precedents and there are no small precedents. Like people when [00:39:30] they talk to me about precedent and they're like, oh, but you know, starting a company is such a big precedent that you broke. I'm like, no, no, no, no. Guess what? The biggest precedent I broke was like being the first woman in my family to go [00:39:40] to college. That was a big precedent to break. Right? And it's like the idea of like sizing these things isn't quite right, and I'm not sure I fully have the [00:39:50] language around that yet, and that's what I'm exploring, right, in these types of conversations. But it's like, I think it's more about the ripple effect and the impact that you can have when you're [00:40:00] doing something differently. **Speaker 6:** Absolutely. I mean, so much as you know of successes, timing, **Speaker 7:** yeah. **Speaker 6:** And luck. And so you could spend years of your life working [00:40:10] on something that isn't successful by investors' definition of success. And then five years later, someone else builds something similar and it's wildly [00:40:20] successful. There's so much of that's out of your control that I think founders need to understand that like to me. You know, if you're giving it a go and trying [00:40:30] and earnestly learning about healthcare and taking a stab at making it better, that's awesome. We need more people like you and it's okay if it doesn't fail, as long as it doesn't fail in like a sketchy [00:40:40] way. As long as it's like an honest try. Let's be clear. And actually there's data that shows that. People who try to start a company that does not work out, actually end up better [00:40:50] off than those that don't try at all in terms of their next job. So there was a study, I wish I remembered where the study was, but I did reference it in my book that looked at [00:41:00] the titles. Of thousands and thousands of resumes and they found that those, even if your startup doesn't work out, you will have a more senior title next than someone else and [00:41:10] presumably make more money than someone who didn't try and just kind of linearly grew. So, you know, give it a go. There's, you know, **Speaker 7:** it's, yeah. You gotta go for it. **Speaker 6:** Yeah, go for it. **Speaker 7:** And don't have that [00:41:20] imposter syndrome, right? Like we all do. Yeah. Don't wait, just go for it. What's one idea in the book that you think will make people feel maybe uncomfortable, but you needed to say it [00:41:30] anyway? **Speaker 6:** We like to believe that if the goal is noble, that you will be successful. But the system, the healthcare system is rigged and the incumbents don't all want to play Nice. And I think [00:41:40] that can be uncomfortable because people wanna believe that we're operating in a rational system and a fair system, and that every startup has a chance, but we're not. And the incumbents I see them play mean [00:41:50] all the time. And I actually have a case study in my book about PillPack, where one of the incumbents try to take them down and how they fought that off incredibly well, but. More often than not, [00:42:00] the incumbents win because they can outspend, they can bend policy in their favor. It makes us uncomfortable because we really wanna think that capitalism is fair, but it's not.[00:42:10] **Speaker 7:** Yeah, it is disappointing. **Speaker 6:** Yeah, that's true. It's not a meritocracy. **Speaker 7:** Yeah, it's **Speaker 6:** not a meritocracy. Yeah, it's **Speaker 7:** not. **Speaker 6:** And and these incumbents, their healthcare lobbyists are the [00:42:20] biggest in dc so they're not spending their money outta charity. They're doing it 'cause it benefits their business. **Speaker 7:** Incentives. Incentives, yeah. Yes. Back to that. Right. So for your [00:42:30] readers who are gonna read this book, I can't wait to read it. It's not out yet, otherwise I would've read it for this interview. But after they finish reading, they get to that last chapter, that last page, that last [00:42:40] sentence. They close the book. What do you want them to do? **Speaker 6:** I'm happy that they got through it, and I just learned that they're likely not doing an audio book. I didn't realize this, [00:42:50] but at least for my publisher, I have an academic publisher. They sell the rights to the audio book to someone else, and so it often doesn't happen at the same time because all the. [00:43:00] Secondary publishers that then publish the audiobook need to see the performance of the book to begin with. So I was disappointed to hear that there's not going to be a audiobook, because I do feel like getting to that [00:43:10] last page for some learners is hard. Some people are just like audio listeners. **Speaker 7:** I'm a combo. Like I love reading, love reading. But if I'm driving in the car and I wanna keep going [00:43:20] in a book, all I go back and forth, back and forth, back and forth. Yeah. And the **Speaker 6:** Kindle can do that now. Right. I've heard the Kindle can let you pick up from where you left off, which is incredible. Yeah. Yes. So your [00:43:30] question, so if someone gets to the end of the book Yes. **Speaker 7:** They're gonna get to the end. They're gonna read that last sentence. Yes. I, I hope so. What do you want them to do? **Speaker 6:** Gosh, so many things. I, at a minimum, I [00:43:40] want readers to ask better questions. Notice the dynamics that they might not have recognized before in terms of the incumbents that I've spoken of, the regulatory capture that I have [00:43:50] spoken of, but feel like a greater sense of responsibility for what they're building and how they build it. And if that doesn't happen, then hopefully at least they enjoyed hearing from the case [00:44:00] studies and the founders that I featured. But I, I really hope to equip them with crash course and everything that took me 15 years to learn. **Speaker 7:** I love books [00:44:10] that have that narrative, that have those stories. Because I find that you can just get inspired by what other people are doing and their stories and what they've [00:44:20] built. So I think it's at **Speaker 6:** least, least entertaining. I mean, they're, yeah. Yeah. Right. Nothing else like you. I've worked with hundreds of founders and talked to thousands of [00:44:30] founders, and so the stories are really handpicked to be the ones that I think are the most compelling. Whether it's just like the brutal honesty that the founders are letting me share, but like, I don't wanna give a framework [00:44:40] and rules without. Having an illustration of it. I think it just really helps reinforce ideas and how things work, so yeah. [00:44:50] **Speaker 7:** Awesome. Well, the book is called Massively Better Healthcare, Halle Techo, thank you so much for joining me here. This was such a pleasure. So much fun to catch up and yeah, hear all [00:45:00] your perspectives on healthcare. **Speaker 6:** Leah, thanks so much for having me. This was fun. **Speaker 7:** That was Halle Techo, a rare kind of rebel who understands that in [00:45:10] healthcare trust is harder to build than technology. Her work reminds us that breaking precedent isn't just about disrupting for the sake of it. It's about [00:45:20] redesigning systems that actually serve. So if you're inside a system that feels impossible to change or standing at the edge of one, [00:45:30] asking whether it's worth saving. Let this conversation be your permission slip. You don't need to move fast and break things. You need to move wisely and build what's [00:45:40] next. And if you know someone who's breaking precedent in their own field, I wanna hear their story, you can drop me a note on my website, breaking precedent.com. Until [00:45:50] next time, I'm Leah Sullivan.