PillPack co-founder Elliot Cohen launches General Medicine, a chat-first healthcare marketplace with full health-history awareness

the entire development cycle from roadmap to release. Uh, we have Elliot Cohen from General Medicine in the Reream waiting room. Next is coming in previously co-founded Pill Pack.

Merry Christmas

with friend of the show.

What's happening?

Merry Christmas. How are you doing? Happy Hanukkah.

Merry Christmas. Thanks for having

holidays. Um,

exactly.

Please, uh, since it's your first time on the show. I mean, we've talked about general medicine before, but introduce yourself. I'd love to get a little bit of your journey, your story, uh, and then I'm sure we can go into a ton of different uh, aspects of the healthcare industry and, uh, and and general medicine generally.

Also, hello TJ.

Oh, yes.

Hope you're watching.

Oh, yeah. I hope so, too.

We love you. Anyways, Elliot,

he was thanks for having me on. He was joking that maybe he would have actually been better for this because he's got the nice Santa beard, you know,

he does have the Santa beard sometimes. Anyway, but dress up, you know, prepared.

It's great to meet you guys. Uh my name's Ellie Cohen. I was one of the other founders of Pillpack along with TJ Parker.

And uh we started that business in 2013. We sold it to Amazon in 2018 and then both of us stayed at Amazon.

Success.

Yeah.

Exactly. Exactly. Yeah. It was like, you know, a month or two and it all just worked out.

Yeah.

Yeah. Uh what's the latest at general medicine? I hear you guys are ripping. Yeah.

But uh would love uh would love for you to share kind of the state of the business.

Business is doing great. Uh we launched in May and since then we just been uh expanding. It's available nationwide. I think it's got the most insurance coverage uh of any provider group in the country. And um and even if we don't take your insurance at our provider group, we can always route you to the right care locally or uh anywhere else. And really we started with uh this uh sort of first touch experience. We wanted to make sure it was as easy as possible to get access to uh immediate care.

And the ambition has always been to build a entry point to healthcare where you should be able to come to us for absolutely anything. And what we're launching today is a new way to do that with a chat that has all of your health history in it. you know, we've been watching I think probably like you guys uh people have been chatting with chatbt and Gemini and others uh about their healthcare and you know it's something like 60 or 70% of probably uh any all adult out there and what we've uh noticed though is that those chats don't go anywhere. they um they aren't connected back into the rest of your care. And so at general medicine, what we've been building is the ability to go from that chat straight into uh into actual care. And all of it is health history aware. So we import all of your records, make it really easy for you to have a conversation with them.

How are you importing records? I feel like my records are all over the place. Sometimes the doctor just hands me a piece of paper, I lose it. Sometimes it's an email. Sometimes there's a web form or web portal that I have access to. Sometimes I went and used some oneoff like you know internet product that I signed up for did some labs have some data over there. It feels very messy. I understand that AI could do cool stuff with it but I feel like I will be very lazy about actually centralizing all the data in my life since it's not ordered.

You need an agent that goes and finds every

Yeah. Yeah. Maybe. But but how do you see actually the the the the most important pieces of health information pulling those in? What's the workflow like? How does the How does the user actually experience this?

We um we have a bunch of elves and uh you tell us. Yeah, they just right out there.

He's going [laughter] to be the gong for the elves. [applause]

We completely lost him on the camera, too. You dodged him completely.

Where am I? Here I am.

There we go. [laughter]

Okay. uh you know that that's the I think we've been willing to wrestle with the complexity of healthare you know that that's the difference of being willing to take people's insurance being willing to embed yourself in the entire healthare system and so yeah you look at what traditional healthcare or sorry tech companies have been doing they've given you these ways to import your records one off and the problem with that's exactly what you said you get one record from one care event um you know when I imported my records uh into general medicine I had stuff going back to 2005 you know more 20 years of records that got automatically imported. And the difference is we're an actual provider group and we're providing real treatment and that gives us the ability to go collect a lot more uh information because it's critical to the way that we provide care. Ultimately, this is the context that we're using that lets us provide this uh this much richer care uh to folks when they come through the front door. So, is the goal for this to be like effectively like passive where even if I'm not immediately seeking like a treatment and I'm just trying to understand my health, maybe I have like shoulder pain and I want to understand that this is some I'm coming to general medicine to just like have a conversation with an LLM and maybe later I come back and I'm like, "Oh, okay. I actually want to pursue treatment now. Whatever whatever I learned, it's not going away or whatever." And then and then you guys can help route it. Is that is that the goal?

I think, you know, honestly, whenever anybody comes in, if you're experiencing shoulder pain, there's always uh advice that we can help support you with that's going to help you figure out when's the right time to seek imaging or when's the right time to go to PT, when's the right time to talk to a clinician about it. And that's the that's the whole point of trying to have the care deeply embedded into the experience is you shouldn't have to just wait to see if it magically gets better or doesn't before deciding to really engage with the healthare system. If it was easy to engage with, you'd do it right away. And that's what we want to enable. Um, actually, I've had foot pain for the last two years. And the connection I had never made in my head, I've been wrestling this with this. I've been talking to doctors about it. I've been exploring it. And when I loaded all this into general medicine, it was the first time I made this connection back to an injury I had in 2005 uh on my on my left foot. And it was the the LM that helped me appreciate that there might be a connection between these two. and it started helping me explore you know what are the different options to figure this out. We decided uh you know one one of the options that came out of that was imaging. Uh I ultimately booked a visit so I could debate whether the imaging was really the right thing or whether PT was the right thing. Since this had been going on for so long we decided my clinician and I decided that uh really jumping straight to imaging was probably the right next step. And the imaging ended up finding these uh cysts in my ankle. And uh I'm a relatively yeah

I'm a relatively educated consumer and I read the report and I didn't really understand it.

You know, you get like that MRI, you log into your portal, you download all this stuff. It's like this really technical language

and I started reading. I just didn't really get it. And I dumped it all into our into general AI and it started explaining it to me perfectly. In fact, uh it was so different though than my understanding of it, I had to give it to one of my buddies who's a radiologist cuz I thought it meant that this was thing was wrong. And he was like, "No, no, it's giving you a perfect interpretation. That's exactly what the radiologist said in the read." And so that I was then able to start exploring with it all of these different pathways. You know, is surgery the right next step? Uh is there a different, you know, less invasive approach? And ultimately, you know, this thing's not going to diagnose me. It's not going to tell me what the right next step in the care is. But being able to have that very exploratory, in-depth dialogue, by the time I get to the actual visit to talk about the different options with the doctor, now I've got this clear idea in my head of, man, there's these three or four different options. I actually don't know which one's right for me, but here are kind of the puts and takes. And just makes it way easier to then have this super rich dialogue with the doctor about which of those pathways is best for me. What what is it like being a a doctor post LLM in general? Like are are do you think patients in general are coming in more informed or more freaked out for no reason? Everyone's been told by a doctor, you know, don't Google it, you know, don't don't don't search and then add Reddit to the end. You just go down a rabbit hole. But I think everybody's experienced at this point of like actually um it can be very empowering to like do research and maybe it has some negative side effects. But in general um I think this is people want information. They want to understand their health and you're never going to stop them from exploring.

I think we're we're pretty clearly on the side of like you want to give people these tools. More more data and information is helpful. You want consumers to be empowered. You know it's their bodies. It's their health. they're the ones who get to make the decision. Uh the clinician should not be a gatekeeper. The clinician should be a guide, a quarterback helping them get to the best care for them. And we think AI is a really critical tool in that process. It helps the consumer understand more upfront so they come to the visit way better prepared to have a really rich dialogue. We also then have a bunch of tools that let us share that conversation in a nicely summarized way with the doctor. So the doctor when you show up, they know what conversation you've been having. they have a sense of that history and what you're interested in exploring in the visit. And so in a 15- 20 minute visit, you can just dive right into the meat of the conversation. You know, you don't have to spend the entire time just ramping up on the history.

How do clinicians see you? Is is do they see you as just like a funnel for business broadly? Like they all want to be on on general medicine um having you uh funnel customers to them. Is there any sort of negotiation that happens? Is all of this just happening sort of by default? Is there optin, opt out? Like what is the relationship between you and the, you know, the radiologist, for example, in that example you gave,

we've got two ways that you could work with us. Um, one is you can join the platform and see patients directly through the platform. And in that scenario, you're getting paid just like you would as part of any health system. You're getting paid for providing care. M uh separately from that we have these really rich uh tools that help us understand the quality and the different services that each physician across the country provides. And so when a customer needs follow-up care um we can help them search very precisely for the exact right care. So to come back to my ankle example you know I can go hunting in that uh in that database for the doctor that is going to be the perfect one to remove this cyst from my ankle. not just a general orthopedist but someone who has experience in that exact surgery and that exact repair. And uh I think this is actually where physicians and consumers are perfectly aligned. Consumers want to get to the exact right doctor for their need as quickly as possible. It's just really hard to know what that is because you didn't go to med school, you didn't go to residency, like you don't have the same expertise. Same thing on the other side. The doctor wants to practice, you know, they want to focus on the patients they're going to be the absolute best at seeing. And today there's just no good way for the consumer to know that they're going to the right doctor for them. And there's no good way for that doctor to say, "Hey, you know, these are exactly the type of patients that I'm going to be really good at. You know, I'm really good at these ankle repairs, but I don't want the knees." There's no way to to filter for that today.

Um, one more question from me and then you can close it out. Um, in terms of like AI and health, uh, we're still, it feels like we're very much in like the abstract era of like maybe it'll cure cancer and it feels like, uh, a couple years ago when in broadly in AI we were like maybe there'll be like an economic explosion. will be growing at 10% GDP and like the economic data at least this year has been like pretty fine like same it's like not bad but also not great and like the unemployment rate just came back and like sort of mixed and like the stock market's doing well but it's not like oh 10% GDP growth um and I'm interested in if you know you know Sachi Nadella said like I'll believe the AI like fast takeoff narrative when I see GDP growing really really fast like what are some of the health metrics that you would look to to to judge in in five years 10 years is AI having a really dramatic impact on health. we've seen, you know, I think everyone has expectations about what's happening with uh the the peptides and GLP-1s, right? And we would expect that if the GLP-1 mission works, uh you'll see obesity rates fall. But is there a broader health metric that you could imagine tracking to understand the impact of what you're doing, but also just broadly like AI in medicine uh having an impact? you you want us to get a metric that's not like Chinese peptide shipments into the [laughter] country.

I mean that one would be probably worth tracking as well. But yeah, I'm just wondering like like what are the highle KPIs for like the we look at a lot of like the health of the American consumer? How much did they spend on Black Friday? What about the the health of the just the health of the American? Like how are we tracking that?

I think we look at this stuff all wrong honestly. Like we spent the last 20 years optimizing for the financial relationship between the doctor and the system. And so all of our health metrics, the way we talk about them, it's all about cost.

I personally, I don't think that's what we should be optimizing for. I think we should be optimizing for the consumer and their enjoyment and their fulfillment that they get out of that experience. So to me, it's, you know, if you want to boil that down as a metric, it's something like net promoter score. Like how much do you love interacting with the system, the healthcare system? And today that's a silly question because the answer is nobody. Nobody loves interact. But that's the craziest thing. Like it's the most it's it's the definition of wealth, right? Like the most important thing that any of us have in our life is probably our own health. We should love interacting with it. We should love engaging with it. And to me, that'll be that's the metric I would look for uh particularly around AI. You know, it has this opportunity to completely shift the way consumers engage with their health and how empowered they are in it and really make them the customer. You know, at the end of the day, I think so much of our health care system today, the consumer is not actually the customer. And our ambition at general medicine is to build a completely new health system where the consumer gets to be the actual customer uh of their own care. And my personal belief is if we do that, we will solve most of the problems in healthcare. Most of the stuff we complain about, it's because the customer is the employer, the customer is the doctor, it's the insurance company, it's the government, it's not the consumer. And I think healthare I think AI has a real chance to shift that back around and make the consumer the center of that.

Drew,

I love it. All comes back to NPS.

It's a final metric. Final boss.

If you think about it like in in times that I've rate like like my NPS score for a company would be like one.

Yeah.

It was like a healthcare related experience, you know?

Sure. like where if you get misdiagnosed or just get bad advice or you get prescribed

a drug that you shouldn't be on or whatever, it's like you're going to time and a lot of that I think is avoidable with just

um

yeah, better better understanding, better more personalization, etc.

Makes no sense.

Anyways, congratulations to the to the whole team. Uh very very exciting and uh

thanks for coming on the show.

Great to have you on.

Hey, thanks for having me. This was great.

I love that.

Have a great rest of your day. We'll talk to you soon.

Goodbye.

So R has weighed in on the word of the year situation. He says the word of the everyone's word of the year is slop. Thus making the word of the year as an article category slop. What do you think? Word of the year still underrated, still room to run.

Does the word of the year as an article c category have motion?

We were trying to Yeah, we were trying to figure out our word. The word that we landed on was motion.

It's uh it's hard to perfectly define.

Yes.

Define. You know it when you see it.

You know when someone has it. You know when someone doesn't have it.

Uh and I just felt like this year

when they are sleeping. You know when they're awake.

You know that who's been bad and good.

Good.

Are you on the motion list?

Are you on the list? [laughter]

Are you on the motion list? This is going to be a boner.

Um,

yeah, it does it does it does feel like everyone everyone sort of landed on this slop thing. Anyway, you you had another story you wanted to run through.

Warner is preparing to tell shareholders

to reject Paramount offer.

Wow. Okay.

Company to recommend existing Netflix deal as soon as Wednesday. So, we'll be looking out for that tomorrow. If you want to participate,

uh, I'm I'm kind of tempted to at least I'm not a I'm not a Warner shareholder. I'm tempted to buy a share. participate just to vote yes or vote no.

No, no, no. I haven't decided yet.

Okay. Okay. You could be swung.

Yeah,

you could be swung. You're a swing.

I want to put the word out.

I'm a single I'm Hey, I'm going to buy some and I'm going to be a single issue voter. Fog horn leg horn.

Bring [laughter] I need a new

I need a trilogy.

I'm going to need a trilogy. I'm going to need a Fogghorn Legghorn trilogy with a lot of Porky Pig on there. I'm going to need uh a a a [laughter] massive cinematic universe all around. you want to hold up the process until you can get