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Nikhil Krishnan Profile picture
@nikillinit
Jun 26, 2020 • 3 tweets • 2 min read • Read on X
everybody shut the fuck up and don't ruin this for me Image
do anything to grow that subscriber base #hustle #entrepreneur #growthhacking Image
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More from @nikillinit

Nikhil Krishnan Profile picture
Jan 3, 2023
some interesting stuff in this report about the No Surprises Act and all the disputes around out of network billing

There’s a massive spike in number of disputes filed, and so far only 4% of them have reached a payment determination
Unsurprisingly there seems to be admin issues - the biggest one being figuring out whether an issue goes through the federal process or the state-based one

It costs like $4M per quarter to deal with these disputes
-Seems like most of the people starting the dispute process are either RCM companies, staffing companies, or consulting firms. Texas has way more dispute filings than any other state
Read 4 tweets
Nikhil Krishnan Profile picture
Nov 17, 2022
our conversation with @bobkocher the GOAT has so many good opinions per second of conversation I actually had to go back and re-read the transcript a couple of times

some parts I particularly liked:
some of the interesting things he found in the initial mckinsey study mapping out costs

-supply induced demand
-having multiple payers created less net admin spend than believed
-cross-subsidization lead to costs going down one place yielding costs going up somewhere else Image
how the first wave of ACOs were more work than just raising prices, and colocating specialists + PCPs for interesting payment models basically asked PCPs to do more work and take specialist $$, which specialists/hospitals aren't a fan of

independent PCPs seemed to do better Image
Read 5 tweets
Nikhil Krishnan Profile picture
Apr 10, 2022
someone asked me the other day what I thought the main issues in healthcare were

there's obviously an infinite list, but I tried to come up with a list that I thought were thematic across the industry

(add your own major ones in the replies)
Principal-Agent Problem: The buyers and the users in healthcare are usually not the same people, and the two entities usually have different priorities (e.g. price vs. experience).
Reliance on Cross Subsidization: Someone has to pay. Frequently the less profitable “mandated” business lines are propped up by increasing the price of the higher margin business lines to balance out.
Read 11 tweets
Nikhil Krishnan Profile picture
Mar 30, 2022
an excellent read on FQHCs (Federally Qualified Health Centers) in alternative payment programs

FQHCs are the backbone of care in a lot of lower-income communities, and the article goes through some specific examples of programs states run/FQHCs are in

commonwealthfund.org/publications/2…
it’s clear that data report is a massive problem here.

States or MCOs need to give these FQHCs the data they need to accurately forecast costs + members, and the FQHCs need to be able to ingest and interpret that
The FQHCs in these programs can do more interesting at-home stuff like home colon-cancer screenings, at-home blood draws, etc which they're typically not incentivized or able to do without having upfront/guaranteed capital
Read 6 tweets
Nikhil Krishnan Profile picture
Mar 29, 2022
this is probably the best and most honest writeup I’ve seen about how health systems think about building new solutions vs. becoming customers of external ones. It gives a 9 item assessment and two examples as demonstrations.

nature.com/articles/s4174…
also contains all the reasons why selling to hospitals sucks

-Reliance on EMR vendors to build tools whene
ver possible, and if not then ask internal devs.
-need for proof points from other systems before bringing it internally
-hospitals requiring custom solutions for as many things as possible an asking the vendor if they can do it

-thinking about vendor ROI primarily in the form of increased utilization or more $ per patient

-need a champion + department that will eventually oversee X solution
Read 4 tweets
Nikhil Krishnan Profile picture
Sep 29, 2021
when I started doing some early stage healthcare investing I thought I had to have industry related theses to guide me

having founder theses is much more important at the early stage esp since the business is going to change so much anyway (this is prob obvious to others)
one thing I've been trying to hone-in on are founder archetypes I particular enjoy working with. Three in particular I love

1) Extremely fast learners - people that are new to some problem but can get at the "existential questions" that the field struggles with
2) Teachers - these are people that absolutely love the subject they're working in and love telling people about it + explaining it in terms appropriate for the audience they're speaking to (and usually emphasize mentor cultures at their own companies)
Read 7 tweets

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