TJ Parker launches General Medicine, a healthcare store with transparent insurance pricing in all 50 states

Uh anyway, uh we got a couple other posts, but I think TJ's here. So, should we just bring in TJ and start breaking down the news? Let's do it. Let's bring him in. Welcome to the stream, TJ. How you doing? He's getting the band back together. He's getting the band back together. Let's go. Congratulations. They're back.

Let's go. Keep it going. Keep it going. Two minutes of this. And I have a microphone. I've made a real real upgrade here. I love that you're ready. Podcast guy. Yeah, you went you went all in. I love it. Yeah. Big podcast guy. We turned you. Great to have you. You went from zero to to 100. It's great to be back. Yeah.

Uh give us the news. What's the announcement? What is this company do? I saw the announcement. Bunch of mumbo jumbo. Break it down for me. Uh so the company is called General Medicine. Uh we launched today in all 50 states. So anyone in the US can sign up and use the service.

And the way I think about it is a healthcare store where you can get anything you need in healthcare. Mhm. Um we actually talked about some of these themes a bit a couple weeks back. Um but our general belief is that you should be able to shop healthcare like you shop everything else.

Um, and so that means, you know, if you have if you know exactly what you need, like, you know, you want a certain set of labs or, you know, you need a colonoscopy or you're having kind of ongoing shoulder pain is like an issue I've had that I use the service for.

Um, you can literally search for that problem, fill out a relatively straightforward set of questions and then consult with a clinician. Um, and if what you need is an in-person visit or inerson care, um, or you need to get imaging or any of that done, we make it super seamless to do that.

And I think the probably the most novel thing about the product experience is that you can see personalized insurance pricing for any provider uh, prior to deciding where to get that service. So, for my shoulder pain example, I needed to go get a follow-up X-ray.

And the difference in price between getting the next rate done in Park City versus Salt Lake was $100 versus $500 with my insurance. Wow. Which before when you're making that decision, same same insurance, same insurance difference, same x-ray, uh same actual uh kind of medical group.

They're both kind of inner mountain facilities. Um but a pretty big variance in the actual out of pocket presumably even the same x-ray device like the same technology situation. I think people are making this decision every day, but they literally have no idea. Yeah. There's any sort of differential. Yeah.

So, so the thing that stood out to me is uh when you land on general medicine.

co you see pricing without insurance and that seems uh you know super intentional because you want to just enable people to not one just like speed to care right there's like certain instances where you're like I need to solve this problem as fast as possible.

I don't want to deal with worrying about in network, out network, what all that. Um, and then there's also instances where like something can cost you more by going through insurance. That's correct. Right.

I remember something was going viral uh on X probably a month ago where somebody like their the the ambulance was like much more expensive because they had insurance where if they were just uninsured it would is you know going to cost less.

So, can you talk about kind of that the way that kind of pricing dynamic works and and why you guys decided to to kind of lead with with, you know, showing people that, hey, you can just kind of immediately get these services regardless of of your current insurance situation.

Yeah, I think a probably a useful anecdote is when we built a very similar experience in pharmacy. When you go to kind of Amazon Pharmacy now, you can see cash and insurance kind of headtohead when you're making a purchase decision.

Uh we ended up with a significant amount of folks that were just using cash because either it was cheaper, which I'd say a quarter of the time it was literally cheaper to just not use their insurance just to pay cash. And then a quarter of the time it was moderately more expensive.

Instead of 15 bucks it was 20 or 20 it was 30. But you didn't have to deal with all of the obnoxiousness of using your insurance, right? There was no prior authorizations and to deal with the fact that it was too soon to fill the prescription. Like all these sort of sad past that exist as a byproduct of insurance.

So, I think we'll see a similar dynamic here to your point where sometimes it'll literally be cheaper. Um, and that will happen, I think, a lot more than people would think.

Um, and then sometimes it's slightly more expensive to use cash, but it just is less annoying to deal with having to get it reimbursed and to deal with the upfront prior offs and all those things.

Um, and we think that'll be a I don't know what the right proportion will be for this business, but I think it'll be a much higher percentage than than people would assume. How do you think about the continuum of medical services? because I'm just I'm thinking about the the shoulder injury.

Obviously, there's sometimes when you need an X-ray and you need insurance to pay for that. Sometimes you just need to rest. Sometimes part of health is maybe going to the gym or being on a diet or if you're having problems with sleep, you could need a prescription drug or you could just need some melatonin.

And so, what is the ideal front end to health? Is it I mean I imagine people will go to chat PT they go to WebMD they ask their friends sometimes they go to their doctor prematurely and the doctor just says hey just you know stop eating so much or or hit the gym or something like that.

Um but what is the how will this change and then how do you plan on on being a part of that front end to medicine? I mean, I think the single biggest change here is trying to move healthcare to a much more simple and straightforward transactional experience.

Um, where you can actually transact in the same ways that you transact in retail. I think the over if you think about just the overarching kind of journey for someone dealing with a condition or dealing with some symptoms, they don't know what condition they have.

I think the behavior will be similar to what it is today, which is today they're going to Google and constantly searching for things and trying to figure out what's going on. I think a bunch of that volume will move to chat GPT and other foundation models where it's easy to go from symptom to a likely diagnosis.

I think the problem we solve is post that diagnosis or post having a sense of what your problem is and being able to quickly get what you need, right? Like you like you might need an X-ray, you might need labs, you might need uh you might need an intervention in person. We make that really seamless.

You can transact with us in a normal way. Um, and so I think that is the the sort of novel thing about what we're doing is turning healthcare into really a product catalog um with with super crisp pricing up front. What's the business model going to be?

I think the right mental model is a combination of a first party and third party marketplace, right? So we do have our own medical group. We have our own doctors on staff. Um, we will use them over time for things that are more and more complex where it's not as easy to know kind of right away exactly what you need.

And so you're helping someone navigate that ambiguity. Um and then we both have a set of third party providers that are deeply integrated, mostly specialists, where if you need an immediate specialist consult, we can provide that. Um and then you can literally request to see any provider.

It doesn't matter if we have a relationship with them or not, we can still make that referral, make it we will literally book the appointment for you and we'll show you the again we'll show you like where the best option is for you based on price, quality, whatever things you you care about.

in the the third party sense. It obviously won't be as simple as a traditional marketplace from a monetization standpoint, but it will be of of that ilk, right? Of that flavor of a kind of traditional first party, third party marketplace. Did you guys have an urge to slap an LLM on this thing?

I know it's notably absent from the homepage. I think just like just like my cars, we're like, ah, we're throwing it back to Yeah. Yeah.

I'm cur I'm curious you you you must have gotten a bunch of pitches from people being like hey a lot of people are using chat GBT to diagnose conditions we're going to make a better version of that to me doesn't feel super investable just because chat GPT probably already has full access to PubMed and bunch of you know um other resources but um uh yeah was that a pretty intentional decision to kind of like leave off the site and let people kind of figure out what they need wherever, whether it's Google or WebMD or family, friends, another doctor, etc.

, and then just be the place where they kind of take action. Yeah, that was definitely intentional and definitely something we constantly debate. Um, again, I think the place that Chad GPT and the other foundation models aren't going to go is the stuff we're doing, right?

To go from likely diagnosis to actually transacting. Um, and I think, uh, we'll see how it plays out. I'm a little skeptical that dedicated kind of doctor LLMs will win against the chat GPTs of the world.

We're probably effectively placing a bet here that uh the chat GPS of the world will kind of sweep up that use case for the most part. Um we could be wrong on that for sure.

I mean I think there's a bunch of Yeah, you can you can imagine a world where general medicine is like hey you you know we we think you here's like our read of the situation based on the picture you uploaded or the symptoms you're having.

here's how you take action and actually talk to a specialist to like verify, you know, actually get a get an expert involved that's not just, you know, predicting the next token. Totally. I mean, I think again the right frame here is retail, right?

You're already seeing that exact flow for categories that have this clear kind of product catalog and transactability and doesn't exist in healthcare.

I think we'll have some version of that kind of chat with us and figure out what's going on to help you navigate our store over time, but that's not the bet we're placing. thing the bet we're placing is that uh it's the transaction that the customer ultimately needs and that we can create a a very novel uh experience.

You guys launched in all 50 states. How different is that than the early pill pack days? I imagine that was it kind of a different go to market motion. Yeah, for better or worse it's almost the same.

Um, POPAC took us about 12 months to launch and we were in 32 states I think at launch and then chipped away at the tail over like 6 to9 months I think if I recall and this we're now I don't know 16 18 months in and we're launching in all 50 states.

So on the kind of from a time and uh availability standpoint actually super similar. Can you take me through some of the history of other attempts in this category? I remember using Zachdoc once to find a doctor. Uh I used Wellness FX once to get some labs done.

There's a few different approaches that have been tried in kind of creating the front end the front door to medicine. Um it still feels like one hasn't become dominant. There's a lot of point solutions like if you want hair hair treatment, you go to hair.

com or something and uh you want compounded uh erectile dysfunction medic medicine with GLP-1s in it. You can go to a different website for that. Uh but it probably won't be part of our selection. We debated it. I think we're going to leave it leave it out for now. I want just the the the cocktail cocktail. com.

Can I get four in one testosterone creatine? I want some protein in there. So, throw a 20 milligram aderall XR in there and then mail that to me compounded and uh yeah, just don't I'll pay I'll pay in Cardano actually. Yeah, exactly. BNPL. BNPL with with Cardano. Yeah, that's great.

Uh but yeah, take me through some of the history. Uh you don't need to speak specifically about specific companies, but just the different approaches that have been tried. What worked? What didn't? um why have you landed on and what have you learned that led you to this particular approach?

Yeah, I mean there's a couple vectors there, right? I think the initial thinking for folks trying to build similar stuff was that you'd start in one vertical and go horizontal over time.

That's sort of the Amazon playbook starting in books and then adding categories kind of as there's demand and you have incremental customer uh demand. I think we observed that and have not seen evidence that that approach is successful.

And I think one really different thing about health care is that oftentimes you actually don't know what you need, right, when you're showing up.

And so if you only serve one specific thing, one intervention for that thing, it actually doesn't really serve the customer need in the way that they they they ultimately want.

Um I think if you compare it to kind of booking services with like 3P provider search and you can book an appointment on the site, the thing that we've observed there is that you end up with this um uh selection bias towards providers that have a bunch of availability rather than the best provider for the customer.

And so we're not requiring any level of integration to get you an appointment and get you pricing for any provider. So we don't suffer from that kind of same selection bias. or effectively ambivalent who you want to go see and we can help you figure out who the right person is.

So we we've sort of learned from observing that as well. And then I think the last point I'd make is that um it's novel to have both first party and third party integrated as a seamless thing. That's novel outside of certainly outside of health, you know, in healthcare. It's not as novel outside of healthcare.

Um but by doing that, it allows you to offer a comprehensive experience um and ultimately make it super seamless for the for the customer. Yeah. Um, have there been developments on the legislative side that have allowed this to exist now?

Um, I remember there was some tele medicine rule changes that happened in COVID and kind of stuck around that kind of created a boom there maybe. But could you have built this 10 years ago? I think there's probably two main things that have made this the right time to build this business.

The first is that patient data is much more accessible.

So something novel about the customer experience is when you sign up and you give us very basic demographics, we can go pull your insurance information and pull your full med history and medical record and prepopulate everything in your profile and these in these flows.

That wouldn't have been possible a handful of years ago and that was due to regulatory changes that required companies to open up this data.

And the second is the pricing would not have been possible to do in the ways we're doing it without without LLMs because we're effectively reading your full coverage of benefits and then mapping that to the service that you need and then figuring out where you are in your deductible.

All of that would not have been buildable without the current version of LLM. And so we're not exposing that in like a AI sense, but it does power yeah how we're able to back into what your your pricing ultimately is. That makes a ton of sense.

It does feel like there's huge opportunity for companies that are essentially driven by enterprise AI or AI internal behind the scenes but they don't just need to surface that you don't need to create another text box for someone to chat with that seems like a very deliberate decision but still like you know uniquely enable yeah and if somebody can create the AI doctor that allows you to have a tele medicine visit and you guys are kind of the front end for getting expert care, you could just plug that in.

You don't even necessarily have to develop it.

In terms of I I don't know how familiar you are with how the doctor's office is changing, but there was this drum beat for years in the deep learning community about stop training radiologists m deep learning neural networks focused on image recognition will be able to do it at a superhuman level very very quickly.

Now we're seeing Google V3 generate Hollywood level cinematography. That's pretty generate TJ Parker going on a thousand podcasts in one day. I mean, it's really really good. And so it's actually not real. Sorry, guys. Yeah. Yeah. Yeah. Yeah.

But I I mean when I see the advances in image processing and and generative AI with regard to image, I feel like there has to be an uh there has to be a similar progress happening in the image processing of self-driving cars.

So when I see the the the the chat GPT uh studio Giblly moment happen, that advances my timeline to a self-driving car. Uh, it also should advance my timeline to take a picture of this mole and tell me if it's cancerous.

But is that happening or are these separate uh are these separate um paths in the tech tree or are there just barriers to actual adoption in the medical community or are there uh you know job displacement fears like what's actually going on over there in the doctor's office?

Yeah, it's for sure happening and I think they're as effective as you would imagine they are.

I think the probably the the biggest difference in healthcare and I'm sure it's obvious is that you still have to get the sign off of the dock and there's still a bunch of regulatory overhang that is required to get fully to a diagnosis and certainly at this point to an intervention whether that's a prescription or some other intervention but I think the enablement and the efficiency showing up and I think that'll continue to continue to happen.

Um, you're now you're not a chatp rapper. You're leveraging LLMs though. Are you a fax machine rapper? Uh, we have definitely we'll always be a fax machine rapper. I mean, I I bet I bet I bet that we spent like a third of our dev resources at PPAC for like three years on faxish stuff. Wow.

It's really It's really quite stunning. Let's give it up for the fax machine. One of the greatest one of the greatest ever. Uh, but I mean I imagine that there has to have been like a a B2B SAS company that created like a really great API around fax machines in the last decade. Has that happened?

Are you just standing on the shoulders of giants or are you writing fax machine interop code for We don't even do a build it or buy it. We just always build it. If it's fast, we're we're building. Yeah. Yeah. I imagine you're hiring CUDA engineers totally to develop custom parallel. Yeah.

Part of the 30 plus million is going to you know setting up there's a JV with the UAE and you know setting yeah there's a whole yeah special vector of engineers that will only work on fax machines fax machine we have a lock on that talent pool that's great um I want to talk about go to market um oh sorry but yeah okay one more question here and then I I want to take it another yeah so I mean obviously it's important to drive folks to this uh give us the plug how can people get started Ed, but then uh what's the actual marketing roll out?

Are there partnerships that drive adoption? Am I going to be seeing flyers for your service when I walk into a doctor's office or seeing Google ads? Like how how do you actually plan on getting customers? Yeah. Uh I think this this arc will probably end up following the PPA arc as well.

We're very much a DDC business today and we intend to stay there for a while. Um and so I think if you're searching for any of the things that we offer, we'll show up in those search results like any other uh retail experience. So we'll get quite a bit of demand there.

Um we'll do all the normal kind of DTOC tactics to drive awareness and demand. I think if you influencer partnership yeah exactly really get all the all the key influencers. A lot of lot lot of stunts. A lot of blimps flying. Lot of stunts. A lot of Tik Tok skyriting. Lot of Tik Toks. Yep. Exactly.

Uh but I think if you if you zoom out and look at the PillPack journey, by the time that I left that business, two-thirds of our business was B2B partnerships and B2B driven. Sure. Um, but we feel like to build a novel and great customer experience, you have to start by marketing to the end consumers.

So, we're doing that again here, but we would expect partners over time to help drive demand. I give it two years till Andy Jasse is calling you daily trying to trying to get the band back together again in Amazon.

Um, I got I wanted to go a different direction uh and get an update on on the kind of the fallout from the drug pricing executive order. What what's your kind of updated thinking there? That was only last Monday. Feels like Yeah, it feels like a month ago. Yeah, it does.

Yeah, I don't know if I've seen anything substantive over the last week. Um, yeah, I'd say my take is still roughly my take, but I've not seen any evidence that supports it any more than I had a week ago. So, hard to say. Uh, should we spack NITO uh engineering? Spaxs are back. Spacks. Spacks are back.

much higher margin business for sure. Yeah, Nito Engineering is familyowned started in the 50s car restoration, you know, you know, engineering uh business that TJ's a big fan of. He's wearing a hat, so I had to ask since Spaxs are back, you know, potentially potentially an opportunity there.

Can you talk a little plug is that I produced a documentary about NITO and it's coming out in the fall. So, keep an eye out. We'll have to hop back on TBNN to talk about my documentary. Yeah, I think I saw maybe was there a trailer that already dropped? Okay. Yeah, I saw the trailer. That was cool.

I love that you're mixing, you know, hyper capitalism and, you know, just like postexit, posteconomic, you know, documentary producing, you know, very few can do both. You know, and NITO is not related to the the car garage that you're involved in. Is that right? That is Yeah, it's separate.

That is my car storage business, which is the car business. Yeah. Cool. Um, that's called warehouse. That's my other plug. Warehouse. There we go. Solo house meets like car storage. It's a cool cool concept. Is there a track or where do people take the cars once they're stored there?

We just got like we go on weekly drives. So there's a bunch of places to drive outside of Park City and then there's like a simulators, restaurant, bar, kind of social lounge, that kind of thing. So kind of half social, half car enthusiast stuff. Yeah.

Uh I mean very quickly just on the news because everyone's talking about it. The Johnny IV going from Apple to OpenAI. Uh Nikita was saying it's 100% due to Apple's compensation structure. They can't pay Johnny10 billion. Uh but and you said it's 100% the right take.

But why can't they like like it seems like at this point like maybe they should be paying Tim Cook more. We've been joking about it. He only makes 70 million 60 million a year. Uh and yet he was able to navigate the tariff like war pretty droitly.

Uh it seemed like he probably saved Apple from a $300 billion market cap hit during that fiasco. Uh he doesn't really get to take a slice of that. Is this something that companies should be like set up for going forward or is this just a unique dynamic of the private markets? Like like what's actually going on here?

Yeah, I think it's a fundamental flaw of these large companies is that they're they're designed to reward generalists for the most part. Yeah. Um and there's very little differentiation available on comp. Even if you're at a pretty senior level, you sort of run into these natural comp barriers.

I don't I was less commenting on whether Apple should pay Tim 10 bill should pay Johnny 10 billion, but more commenting like if you bump up against breaking any sort of compensation rule, making an exception, it's incredibly difficult. It's basically impossible.

Um, and I think it's especially odd when you're willing to like there's there's a an incredible willingness to invest in a new thing like well beyond kind of ventures tolerance for capital investment. Totally.

Like billions of dollars a year into the metaverse like super speculative Amazon spending $6 billion on Alexa like super speculative investment. Yep. Um with no disproportionate economics for the person deciding how to make that capital investment. and which I've always thought to be very odd.

Like you could effectively swap out kind of 10 L7s and dramatically change the comp of the VP running that group and that's probably a great investment, but that's just not the sort of mentality at uh most of these large companies. Yeah.

I mean, you you had the kind of canonical founder exited to big tech, moved on pretty quickly experience. Like what was the one thing that you took away from Amazon that was like this is great. I need to port this elsewhere.

Was there anything that stuck out to you as like deeply underrated about those large organizations? Because easy to say, oh, they're slow. Oh, they they, you know, they blah blah blah. But what what was what was actually interesting about uh Amazon in particular or just big tech broadly?

Yeah, I mean Amazon's way of working uh especially the kind of writing culture we definitely have co-opted and I would never um kind of operationally do it a different way. Like I think that is quite effective.

there's like a reasonleness that probably is a little bit, you know, tilted at Amazon, like you're literally writing like your annual budget. Like that there might be things that there's other formats that make sense, but as a general rule, like I think a writing culture is much better than a traditional culture.

Um, I think they're also incredibly good at scaling stuff that works, right? Like they are a machine if they found product market fit, both because there's a deep willingness to invest and because there's a bunch of established mechanisms to scale this stuff.

Um I think that can be inhibitive of building something novel and new right there's like sort of overprocess um and over litigate stuff um early on but the second you have something really working inside of Amazon like they are just masters of of scaling it up. Yeah. This is the same thing with Google.

Ben Thompson was talking about with regard to latest Google IO launch. Like Google launches a ton of demos, ton of products but they never really go anywhere unless it's tied to search. If it's tied to search, they will die before they let that thing not work.

And so, but you can talk all about, oh, they they sunset Google Buzz or circles or flight or this random thing, but like they haven't they haven't sunset shopping. Like, they haven't sunset display. This one's still going. That one's still going. Um, yeah. Yeah. Yeah. Jordan, you have anything else?

Or I think that's it. Uh, the only thing I I'll share it with you now. I just got breaking news. Uh, and TJ will laugh at this, but uh, John really wants the new ZR1. Oh, yeah.

Uh, which which, uh, which which is like probably on the opposite end of like the the spectrum of like cars TJ likes and like doesn't like, but I just got a quote that basically you'd have to pay 100K over MSRP to get one. There's only been 12 delivered so far. So, TBPN is ripping.

It's a small price to pay for American made. Uh may maybe we can flip that around. Uh I So I want an Americanmade sports car. I want something interesting, but it has to be Americanmade. What would you recommend for me for Can it be old? Yeah, it can be anything. Get a Cobra. Cobras are sick. Okay.

Yeah, that might be Do not get a Kit Kart, but like get an OG unrestored Cobra. Those things are sick. Okay, that's good.

Um, I mean, last thing on the the writing culture, do you think that uh Amazon is at risk of being kind of oneshot by these LLMs because you don't actually have to go through the exercise anymore of writing a memo? You can just be like, uh, get me $20 million and I need to hire 25 people.

Justify it like it's an Amazon memo. Boom. And then you just have it. You're just going to drop in all your old memos and be like, update this for Q2, please. Yeah, exactly. I imagine that that kind of destroys the culture potentially. But yeah, it does. There's a real risk there that I hadn't contemplated. Yeah.

Anyway, yeah, I mean, we were recently posting a job posting for an editor and the and and the the job listing was very clearly gener chat GPT generated. And I was like, what prompt did you use? Maybe we should just post that prompt.

And we wound up just posting the prompt and it's like way better because the prompt is way more succinct. It's like you had to give it anything. Ju just give me the bullet points. Don't don't flush it out into two pages. I am I am pretty upset that chat GPT is going to single-handedly ruin M dashes for me.

Oh yeah, for the record was like my favorite punctuation pre-Chat GPT and just ruined. Just totally ruined. Are you a Delve guy too? Were you using Delve a lot? Not really dash. Yeah. Anyway, uh great talking to you as always. Yeah, congratulations. Congratulations on the launch and Elliot.

This is uh I love I love that you guys are getting back together to fix a big uh big problem. It's fantastic. You love to see it. Great having you on. Good to see you guys. Enjoy the rest of the day. See you. Let's tell you about numeral sales tax on autopilot.

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