Can recycling waste be a new business model? I think the concept of recycling waste in healthcare is interesting. An enormous amount of stuff that isn’t even used is discarded simply because there are no entities to check if it’s still usable. Currently redistribution is already happening in shady gray markets via facebook/whatsapp groups with no oversight, or through non-profits that are relatively limited. The dollar amount in drugs is non-trivial. Medicare alone is close to $1B in discarded drugs, and since 2023 manufacturers have to refund CMS if more than 10% of units are discarded. I’m an investor in a company called Medicircle. It takes unused medications from patients that would normally be thrown out, certifies that they’re still good to be used, and then gives it to patients who need it for free. Plans reimburse them for less than they would normally pay for the drug. It’s a win all around! No one is a jerk, which is why they’re not called Medicirclejerk. There are other areas you see recycling too, like surgery supplies. WestCMR, XS supply, RevMed, Hospital Overstock seem to do this by acquiring excess inventory from hospitals and then re-selling it. There’s also a program for pacemakers called My Heart Your Heart to recondition pacemakers from recently deceased patients. I wonder if there are more places where this business model can exist. Durable medical equipment is an area that comes to mind. This happens with diabetes supplies - you’ll see these shady ass flyers posted around NY or weird Craigslist ads. Could a company come in to provide more legit third-party re-certification for other forms of durable medical equipment like CPAP machines, power wheelchairs, unopened diabetes supplies, 60 walkers ordered to a patient in a South Florida fraud ring, etc.? Maybe slightly darker but what about implants? I think re-certification marketplaces can be brought to more parts of healthcare - re-using materials is much more common in other countries. Maybe there’s an ideological conversation about whether patients should be allowed to try these recertified products at lower cost and absorb the risk themselves.

The gray area of medicine is getting pulled forward - things that are interesting in research but not yet implemented in care guidelines/covered by payers. A few reasons: 1) AI tools make it easier to sift through literature at scale, especially for patients. This is allowing them to find experimental things that have promise. 2) Social media makes it easy for people to disseminate tricks and “hacks” that have worked for their health. 3) Cash pay and concierge healthcare has become more popular, with people willing to pay for interventions even if insurance doesn’t cover it. They don’t want to wait a decade until the guidelines are updated. But the quality of papers is extremely variable and designed to be read by humans. Can we build better AI scientists to help assess papers, put research in context at point of use, or even rethink what papers are supposed to publish if you assume an agent is reading it? If you have ideas around this, you should come to our upcoming hackathon with Deerfield Management. We’re giving cash grants and prizes to teams with ideas on how to build AI scientists, and you’ll get mentorship/support to potentially turn this into a company.

We did a hardware hackathon earlier this year and saw some very awesome ideas using robotics and wearables to help patients. For example, here’s a very over-engineered robot that could see when a patient was getting out of bed, spot objects on the floor, and then shine a light and give a warning We think there’s more promise here, that’s why for our upcoming hackathon with Deerfield Management we’re giving cash grants and prizes to teams building with wearables, robotics, and prosthetics. Think perioperative automation, assistive mobility, neuromodulation, patient-facing robot design, and simulation environments. If you’re building something in this area that might improve the lives of patients, doctors, and front-line staff we’d love to help support you.

Thank you to our sponsors that made Knowledgefest possible - very relevant to people building in healthcare! @cloudcruise_app is an AI platform that automates healthcare workflows inside payer portals and EHRs. It turns manual browser and desktop tasks like eligibility checks, prior auths, medical record downloads, and payer enrollment into repeatable, auditable outcomes. Sakura Health is the infrastructure layer for governed AI agents in healthcare, giving teams the primitives to build, evaluate, and deploy agents that work inside EHRs, practice management systems, payer portals, and phone/fax channels. Every agent comes with policy guardrails, audit trails, and human-in-the-loop controls, and specialty practices, digital health companies, and RCM teams already run them across front office, back office, and revenue cycle workflows. @candid_health automates revenue cycle management, ingesting data from any EMR to submit clean claims, reduce manual billing work, and collect more of the revenue providers have earned. Leap is the healthcare company making specialty medicine more affordable and easier to access. We're building modern drug distribution infrastructure for specialty therapy. We bill each drug at its true acquisition cost with no markup, and we pair every patient with a dedicated Care Guide who coordinates treatment, insurance approvals, scheduling, and ongoing support. @SierraPlatform is the leading partner for healthcare agents, already reaching over 50% of U.S. families. Our customers include leading health plans, providers, pharma and medical device companies, digital health companies, and other healthcare platforms. Our agents go beyond answering questions, helping patients understand their coverage and get their medications to proactively closing care gaps and accelerating revenue cycle management. @GetHealthie is the world's leading API-first, ONC-Certified EHR for healthcare delivery outside of the hospital. We provide the powerful infrastructure every scaling organization needs: EHR, scheduling, patient engagement, billing, and more, all accessible via modern APIs and a white-labeled UI. @Vapi_AI is the leading Voice AI platform that gives developers and enterprises control over building, deploying, orchestrating, and managing voice agents at scale. This makes AI voice agents easy to build, safe to operate, and flexible to evolve. @myaccessone , a @phreesia company, is a patient financing platform that enables healthcare providers to offer patients low-interest monthly payment plans, with no credit check, no fees and no impact to their credit score. As a licensed lender, AccessOne accepts 100% of patients and integrates directly with leading EHRs. Providers receive cash acceleration from Day 1, reducing AR days to zero while driving 85% net yield on payment plans. @champ_hq is an AI agents platform for healthcare operations teams. We build AI agents that automate your manual intake, credentialing, eligibility and claims follow up processes.

First part in the series - healthcare companies I think someone should build 1. DME recycling marketplace: A third-party marketplace that re-certifies used durable medical equipment (CPAPs, power wheelchairs, unopened diabetes supplies) so it can be resold legit instead of tossed 2. World's Fair for healthcare: A new World's Fair where people can actually see and touch cutting-edge healthcare tech, like a live Neuralink demo or a Wandercraft exoskeleton. The point is to make people amazed by healthcare again, the way the old fairs did for consumer tech. 3. Instinct for healthcare workers: A personal AI agent built for healthcare employees, with its own login on the org's network, a BAA-covered cloud model, and role-based permissions instead of impersonating you with cached passwords. People are going to use these tools at work no matter what, so someone should build the compliant version.

3 companies collectively worth $6 billion...excited to be doing a happy hour at HLTH with @doximity and @WHOOP If you're going to be there - come join us Tuesday evening, it's gonna be fun

for the next few weeks, I'm going to be writing out healthcare company ideas I think should exist A few I'll write out and send in tomorrow's newsletter - Instinct for healthcare employees - The World's Fair for healthcare - Refurbished DME marketplace You can sign up to get it - and before you ask why I don't start these companies myself...it's because I lack CONVICTION and Out-Of-Pocket is a real business I swear