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Healthcare is Broken... and Funny: Part 2

Written by Andrew Le, MD

PublishedNovember 13, 2021

Welcome to the CEO Corner, where Buoy CEO and Cofounder Andrew Le, MD sits down with industry leaders to chat about the provocative topics of healthcare today. Andrew recently spoke with Nikhil Krishnan, the founder of Out-Of-Pocket. In Part 1, Nikhil shared his observations about the how to understand and fix problems with the healthcare system.

In Part 2, Nikhil reveals his approach to researching deep and wide and suggests ways to make industry conferences better.

This interview has been edited and condensed for clarity.

Andrew Le, MD: I'm curious to know what you read.

Nikhil Krishnan: I don’t have a system in place for choosing what I read. In fact, in terms of running my business, I have very little structure. Frankly, everyone is looking at the same data all the time. You’re eventually going to converge on whatever the popular opinion is if you follow the same signals and data sets.

I enjoy traveling around on the internet. I’ll follow links from Twitter. I'm subscribed to a lot of healthcare newsletters and sometimes dive deeper into interesting leads from those. I also like to digest non-healthcare content. It’s too easy to be isolated in healthcare land.

For example, right now I'm trying to learn about Web 3.0. What does blockchain mean? My roommate's a cryptocurrency person. Sometimes when he talks, I think he’s just making up words. I’m also reading “The Making and Maintenance of Open Source Software” to understand how open source communities actually operate and function.Ideas from those are important to bring to healthcare.

Image courtesy of Block Publisher

One of my favorite books is Catastrophic Care. The author is not from the healthcare industry but had a personal experience with the system. He writes about bringing free-market principles and greater transparency to the healthcare industry. I think it’s important to consider many different lessons and perspectives when it comes to understanding how to fix healthcare.

Long story short, I don't believe in systems. I do random sh*t and read what looks interesting.

Andrew: That reminds me of the Zettelkasten method. It’s a system that helps you store and process knowledge and is based on the work of a very prolific 20th century academic.

Nikhil: He would have loved Roam. It’s a note-taking app that ties different concepts together.

Andrew: Of all the memes you’ve shared, which is your favorite? Residency with the Squid Game?

Nikhil:Yes. I only watched one episode of Squid Game, though. I also really like the Six Stages of Health Tech Grief meme. That hit a nerve for a lot of people. I wrote that one after I'd seen the fifth pitch for a personal EMR startup. I couldn’t hear it anymore. This meme addressed all the questions that kept coming up around health tech. So, if you can answer those questions, I'm happy to chat.

Image courtesy Out-Of-Pocket

Andrew: I saw a few of your tweets about not being very bullish on remote work and industry conferences.

Nikhil: There are some things I say on the internet that I have no idea are controversial. I tweeted that making friends at work helps people get through the hard times, and remote work will make that harder—potentially leading to retention drops at startups. People got really angry about that. Some took it as a personal affront to their remote-first strategy. Other people said they don’t want to make friends at work anyway. Holy sh*t.

Andrew: What is broken about conference culture?

Nikhil: Most conferences are designed for sales and customer success. People are trying to meet customers, and customers are trying to meet potential vendors. The speakers are coached to not say anything too controversial. Speaker panels are like having Netflix on when you're trying to work. Technically it's there, but I'm not here for that.

There's a smaller group of people that does care about the content of the conferences. They're not served well today. That includes people in project management, operations, and engineering roles. They're trying to build stuff, not sell things. There are a lot of cross-company learnings they can benefit from that are not unique to a single company.

Take AWS [Amazon Web Services] conferences. They show people how they built tech stacks using AWS services. Regardless of the industry you're in, you can see how to use that for your use case.

A lot of conferences are overproduced. The most interesting conversations I have about healthcare are in dingy-ass bars. Doing a jankier version of a conference where it feels like you're in a speakeasy would be good.

The last thing I'll say is when you get three people on a panel, they typically agree on everything. I'd like to see more debate formats, with people who are willing to say interesting, opinionated things. I'm chatting with some people now about potentially putting something like this together in the future.

“The most interesting conversations I have about healthcare are in dingy-ass bars.”

Nikhil Krishnan, founder of Out-Of-Pocket

Andrew: I’d like to be at that speakeasy conference.

Nikhil: Just trying to make healthcare a more fun place.

About the participants:

Nikhil Krishnan is the founder of Out-Of-Pocket, which helps people learn about the business of healthcare in plain English and memes.

Andrew Le, MD, is the CEO and cofounder of Buoy Health.