Peter Winarsky

"Digital health is no longer the future; it is the present, reshaping our healthcare landscape in real-time." Excited to be part of the UCSF Digital Health Hub Foundation's Quarterfinalist Party! As a past board member, I'm honored to celebrate the outstanding quarterfinalists. As we reflect on the state of digital health in 2024, it's evident that the COVID-19 pandemic has fundamentally transformed healthcare delivery. The rapid adoption of telemedicine during the crisis has become a permanent fixture, with over 60% of physicians continuing to utilize this technology. The sprint towards smarter healthcare, catalyzed by necessity, has shattered preconceptions about digital-first health experiences. Virtual care is no longer a stopgap but an integral part of a seamless, anytime, anywhere health ecosystem. 🌍 We're witnessing the rise of B2B2C models in remote consultations, with companies like Teladoc Health and Amwell partnering with insurance providers to integrate their services into health plans. Public sector collaborations, like eConsult Health 's partnership with the NHS in the #UK, underscore the potential for remote consultations to enhance efficiency and accessibility at a national level. The digital health landscape is evolving rapidly, with advancements in remote consultations, mental health support, at-home diagnostics, and patient monitoring. AI and generative AI transform care delivery, making it more efficient, personalized, and patient-centric. 🤖 Yet, challenges remain. While venture capital funding for digital health has stabilized after the pandemic boom, it remains below its 2021 peak. Sectors like digital therapeutics face reimbursement hurdles, and we've seen major players like Walmart and Optum close telehealth businesses. Looking ahead, we anticipate further consolidation in digital health, driven by acquisitions to create broader ecosystems encompass telemedicine, mental health, and other specialized services. As healthcare leaders, we must leverage these digital advancements to improve access, enhance patient outcomes, and drive efficiency in our healthcare systems. The future of healthcare is digital, and the time to embrace this transformation is now. Congratulations to all the finalists! 🎉 Looking forward to the grand finale at #HLTH2024 in #LasVegas! 🙌 By the way, the pink drink that we were holding was delicious—and nonalcoholic! The Digital Health Hub Foundation - Digital Health Awards #HealthcareInnovation #DigitalHealth #UCSFHealthHub #Networking #HealthTech #Entrepreneurship #LasVegasFinale Walter Greenleaf, PhD Daniel Kraft, MD Unity Stoakes StartUp Health University of California, San Francisco UCSF Innovation Ventures American Association for Precision Medicine (AAPM) WISE World Investors & Entrepreneurs Society #AAPMhealth #aapm_health

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Hot take on a lot of early-stage digital health companies out there: You're not a tech company. Most tech-enabled care companies I've seen over the past two years are only tech-enabled in the sense that they use telehealth as their delivery mechanism for care. There are exceptions to this, of course - companies who build computer vision and applied AI tools to better the doctor-patient experience, companies who build tooling around risk scoring and stratification to enable more personalized medicine, companies who build truly novel intakes to better route patients to the appropriate care, etc. These companies have real technology chops and, if they sell it right to the market, can get credit for this from investors. But if you're truly a telehealth provider, you need to realize now that the goal post has shifted dramatically from 2021 and you're going to be valued at maturity at something like 3x EBITDA. That's profit. Not revenue. Throw a revenue multiple out the window. That's not the world we live in if you're a virtual doctor's office. Think of how that impacts venture math. If you're raising a seed round at $15M post-money (or $12M pre-money), it means you'll have to generate something like $150-200M in annual EBITDA to be a fund returner for your seed investors. Maybe even more with dilution, since telehealth businesses are not traditionally capital efficient and will likely need to raise material additional capital to reach that scale. You need to be ridiculously profitable (probably on $800M-$1B in annual revenue since you're likely going to be a 40% gross margin business). Here's the good news: you can set yourself up well (and probably be a contrarian founder relative to your peers), by talking about EBITDA growth and how you can grow into a fund-returning outcome based on realistic mature market comps. This will stand out for the investors you're pitching, even at the early stage. This is how you can beat the malaise of the tech-enabled care market. Focus on the right metrics and the right type of growth. You don't have to have all the answers (no founder does), but you need to make sure the ship is headed in the right direction. A focus on profitability for "tech-enabled care" (*ahem* telehealth) businesses is a good first step.

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Some VC investors believe that brick and mortar - referring to a physical presence of some kind - should be avoided at all costs. Yet, the track record of clinic and hybrid care businesses in health care indicates otherwise. ==> One Medical (sold for $3.9 billion to Amazon), Oak Street (bought by CVS for $10.6 billion), Lifestance (IPO at $7.5 billion market cap), and PE-backed Premise Health (acquired by OMERS Private Equity for $1.1 billion) If a clinic is indicated as the optimal way to deliver care for that patient population, there are creative ways to build and operate them. Full article below with advice and strategies on how to build and operate hybrid clinics from my teammate Anarghya Vardhana from Maveron, Amir Dan Rubin from OneMedical Group, Steven Eidelman from Modern Animal and more!

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M13 is thrilled to lead the Series A in RadiantGraph which is focused on personalization in healthcare. As we continue to invest in early stage companies it is abundantly clear that the biggest indicator of success is the founder and his or her ability to execute on their vision of the future. In this case, I don't think I have seen much better founder-market fit than we have with founder and CEO Anmol Madan. We believe in his vision: in order to have the best patient outcomes in healthcare we need increased personalization and AI is the breakthrough to get us there. Anmol started one of the pioneering digital health companies Ginger and then was Chief Data Scientist at Livongo and Teledoc. He has done it all: early stage, late stage, public company. And he deeply understands the nuances of the healthcare market from all angles which is critical for success. While there are many players building healthcare-specific AI capabilities, RadiantGraph is focused on outcomes: The platform is already processing personalization models for more than 3.5 million people, despite launching just last year. Excited to partner with my friend Adam D'Augelli and the great True Ventures again and Morgan Blumberg who has been deep in the healthcare market with me for many years. More on our thesis in the blog below. https://lnkd.in/evDDmC3W

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Someone broke down the estimated costs of a $15 Sweetgreen salad. We need these cost graphics for digital health to help future founders. Especially for tech enabled cos, the greatest cost is labor. Much of the "value created" is in curation and matching, which means the gross margins are reliant on labor arbitrage. Pay someone $X, but get paid $X+Y% per visit. The challenge with healthcare is that you often have to pick one of two business models: 1. specialized, low volume, high cost, low gross margin % 2. generalized, high volume, low cost, high gross margin % I'd argue founders should focus on gross dollars over the lifetime of the customer (like Jeff Bezos said) instead of gross margin %'s, but we'll leave that for another time. The challenge is that many tech enabled digital health cos have high cost of goods sold (labor) and moderately high product, design, and engineering budgets. We must build differentiated solutions for patients, clinicians, and clients to be out incumbents, however, we're realizing that companies are ultimately valued on the discounted value of future cash flows. And the high SG&A costs at most organizations might be inbalanced to the unit economics of the business. I'm not sure the math pencils out for everyone unfortunately. But I'm just a guy on the internet, would love to hear the thoughts from those smarter than I (you!). Comment below. --- p.s. I have no idea the accuracy of the graphic and not an investor in Sweetgreen. Cheers. Credit: David Crowther

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Platforms are in, point solutions are out as the healthcare AI category leaders come into focus this year. In conversation with Shelby Livingston at Endpoints News, I shared: 1. Why AI-first companies have the greatest platform potential and heuristics for identifying these opportunities at the earliest stages, 2. How companies are differentiating through co-development and distribution partnerships with leading healthcare institutions, and 3. Strategies for navigating anemic budgets and constrained market sizes through business model innovation such as AI-enabled services and pay for performance models Read more here: https://lnkd.in/dJWqv_zC Bessemer Venture Partners Abridge #healthcare #lifesciences #AI #generativeAI

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We conclude differently that Bigs aren’t getting it right so -give up on innovative care delivery. Nope. 35m get their primary care +msk/behavioral and more at work for free or near free. Direct care,called near site or onsite is offered at jumbo employers in much of the F100 and its doubling every 30 months. NPS scores are 88-98 in direct care. World class status. Excerpt Walgreens paid a fortune for VillageMD, then even more for Summit Medical Group . At one point in late 2021, VillageMD CEO Tim Barry told me that their main issue was the execution risk of having to open more clinics per week then Starbucks did at the height of its expansion. Walgreens made a minority investment then kept doubling down on its bet- three years later it has written off the whole $8bn and its stock price is worth less now than doctor network Doximity. Both of these companies and CVS have shown that it’s really hard just to get the basics right opening clinics in retail stores. That’s despite the fact that most Americans have no pcp and can’t get an appointment with a captive audience walking into their stores every day picking up meds. CVS has the added issue of trying to integrate a decent sized insurer into its operations just at the time when the Medicare Advantage gravy train is running out of steam. CVS’ CEO Karen Lynch took over Aetna, a CVS Health Company recently and then this past week was dispatched to the cheap seats herself. (Don’t feel too bad for her, she’s getting $4m a year to “consult” with the board). Two things have hit Medicare Advantage. First the government is starting to look into risk adjustment upcoding. CVS, you may recall, bought Signify Health, a company specializing in sending nurses into seniors’ homes to perform said upcoding. Secondly, #MedicareAdvantage plans had surprisingly little information about and control over their members who were being cared for by their non-risk bearing delivery system (which is to say, most of it). They appeared to be totally surprised that post pandemic procedure numbers ratcheted up and were powerless to stop it. Well, Wall Street noticed. Similar problems have hit Optum the engine behind UnitedHealthGroup’s profitable growth for the past decade or so. It’s not just the biggest health tech company in America, it’s also the biggest medical group owner—even if CEO and bumbling Englishman Andrew Witty doesn’t seem to know how many doctors it controls. They are being exposed in Stat on a weekly basis for basically semi-frequently causing their doctors to lie about their patients’ health status, just as the The Wall Street Journal accuses their associated health plan of inventing diseases and procedures—all to bill the government more. You can argue back and forth but it does appear that the strategy of buying every medical group it can see and provider fracking appears to have hit a bumpy road. https://lnkd.in/gzT25DcN

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Bag is packed, and I'm heading off to HLTH Europe 🎉 HLTH Vegas was my first taste of the HLTH experience, so expectations are high for what Henry Stoneley and the team have crafted over in Amsterdam. The official agenda is appetising (https://lnkd.in/e3Y87Z8Z), with multiple stages themed around the senses. What am I looking forward to? 🪩 MAIN STAGE 18th: Ali Parsa talking about Babylon and his latest venture. Essential stuff 19th: "Transforming Perspectives on Psychedelics: A Journey Beyond the Trip" fits the tolerant and broad-minded nature of our host city well. 👁 SIGHT 19th: We have "Ghosts in the machine: Empowering healthcare to capitalise on GenAI", "Blinded by AI: The Turing Test live" and "Safekeeping: Is trust AI’s biggest hurdle?" all on the 19th * I'll be appearing on the live Health Tech Talk Show with Lisa B. and Kat McDavitt 👂🏼 SOUND STAGE 18th: Listening to the latest on Mental Health at "Navigating depression: New pathways in mental health"- supporting Erin Sivyer Lee and Team Flow Neuroscience 19th: Having wrapped my head around longevity tech in ArabHealth earlier this year, I'll be checking out "Beyond the Fountain of Youth: Unlocking the secrets of longevity" 20th: The Middle East summit takes over the stage * I'll also be catching up with Christophe Jauquet Mo Zouina and Aline Noizet to record some special Healthusiasm content 👃🏼 AROMA STAGE 18th: ChatGPT and Hospitals? IM IN 19th: Debate time! "This house believes there’s no role for government in healthcare" - I smell smoke... 20th: Data might be the new oil, but not all oils are the same "Goldmine or fool’s gold? Extracting value from health data" 👇🏻 TOUCH STAGE 18th: "Eighths and pains: The ongoing trials and tribulations of cannabis in healthcare" wins for the pun alone - 18th 19th: As a GP, I'll be cheering along to this one: "Undervalued, underinvested: Why keeping primary care as an afterthought costs lives" 20th: My mind was opened by recent talks from ☀️Maneesh Juneja. "Greener, leaner, cleaner: Healthcare's role in global warming" gets my vote 👅 TASTE HLTH do food really well: Survivors BBQ is locked in. 🌍 EVERYTHING ELSE There's the Startup Stage, HealthXL Global Gathering on Monday, AlbionVC mixer, Philips welcome reception, HLTH Networking party, and goodness knows what else. This is Amsterdam after all. 🌶️ For all of my neurospicy sisters and brothers, I'm bringing a wee gift for you. Let's stay hydrated and pace ourselves folks, we have a big week ahead of us! Anushka Patchava MD, MBA Darshak Sanghavi Adel B. Hassan Chaudhury Michael Watts Dr Cos Fantis Rochelle Morris Dr Dom Pimenta M.D. Dr Rizwan Malik Sam Shah Haris Shuaib Dr Harpreet Sood plus many, many more

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Had a blast diving into Amir Dan Rubin's extensive healthcare career on Vital Signs. Amir previously served as the CEO of One Medical and Stanford Health Care, was an EVP at United/Optum and is now the Founding Managing Partner at Healthier Capital. Our conversation spanned payer-provider integrations, lessons learned from leading One Medical, applications of generative AI, and more. Some highlights: ⚡Combining care models We talked a lot about the One Medical/Iora combination. Amir argues that just because two care delivery approaches may occupy the same physical location (e.g., a clinic), that doesn’t mean they necessarily need to conform to the same economic model. For instance, One Medical and Iora were able to combine effectively despite the former being a membership model and the latter being global capitation. Amir emphasizes that much of the overhead resources (e.g., front desk staff, phlebotomy) can be shared across models. ⚡How One Medical uses generative AI to improve efficiency One Medical allows members to message the care team, and then uses NLP to read the message, figure out its content, and triage it to the appropriate team member. Amir is excited about leveraging internal knowledge graphs to get around hallucinations. This approach can point to relevant internal data in helping compose responses, creating more trust and accuracy in the outputs. ⚡Behind the Amazon acquisition One Medical was interested in expanding its direct to consumer offering. However, they recognized that customer acquisition was costly, which is why partnering with Amazon Prime’s existing membership base made sense for them. Amir explains how at their core, both Amazon and One Medical are all about using technology and logistics to create an excellent customer experience. An awesome conversation ranging from health system innovation to startup strategy to health tech investing! Listen to our full episode below: Spotify: https://spoti.fi/3Wrbnol Apple: https://apple.co/3XWOomb

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In case you missed it, last week the Coalition for Health AI (CHAI) released a draft consensus framework for responsible health AI. Developed with input from over 100 contributors representing a diverse network of healthcare stakeholders, this guide proposes actionable evaluation criteria throughout the AI lifecycle—from identifying use cases to deployment and monitoring. Key examples outlined in the guide include: • Predictive EHR Risk Use Case (Pediatric Asthma Exacerbation) • Imaging Diagnostic Use Case (Mammography) • Generative AI Use Case (EHR Query and Extraction) • Claims-Based Outpatient Use Case (Care Management) • Clinical Ops & Administration Use Case (Prior Authorization with Medical Coding) • Genomics Use Case (Precision Oncology with Genomic Markers) The draft framework is open for public review and comment for the next sixty days. Please use this form to submit feedback: https://lnkd.in/eYughFYC Kudos to the CHAI team led by CEO & President, Dr. Brian Anderson, MD, on this milestone. Eric Horvitz Jennifer Goldsack John Halamka, M.D., M.S. Michael Pencina Micky Tripathi Nigam Shah Suchi Saria Troy Tazbaz #healthcare #ai #artificialintelligence #generativeai https://lnkd.in/e7VRv6fD

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Exciting news from Monica Chopra, Jeffrey De Flavio, MD, Samantha Adelberg, and the rest of the Auxa Health team as they officially announce their $5.2M Seed round. The team's deep industry expertise and drive for change have led them to solve critical infrastructural friction to providing quality healthcare and adoption of value-based care. Auxa's AI benefit navigation platform is simplifying the complexities of healthcare by streamlining all of the fragmented and siloed data and information to make it actionable in real-time for healthcare organizations. For the 70% of Americans who aren't getting access to the health and social care benefits they deserve, Auxa's solution will be pivotal in enabling equitable care. We're thrilled to partner with co-investors Zeal Capital Partners, AlleyCorp, Laconia, and Chaac Ventures on this journey and look to share many more milestones ahead. Cc K50 Ventures, Ryan Bloomer, Daniel Vásquez, Nick Talwar, Stefanie Ng https://lnkd.in/dPDY7-Db

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There is a blueprint for success and MDisrupt has the experts to deliver it!

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Suggestions on selling health and wellbeing innovations into large employers. - There are plenty of needs to be met and 𝐩𝐥𝐞𝐧𝐭𝐲 𝐨𝐟 𝐢𝐧𝐧𝐨𝐯𝐚𝐭𝐢𝐨𝐧 𝐧𝐞𝐞𝐝𝐞𝐝. - We need to fix the fundamentals and there is a 𝐠𝐫𝐨𝐰𝐢𝐧𝐠 𝐫𝐞𝐚𝐝𝐢𝐧𝐞𝐬𝐬 𝐭𝐨 𝐛𝐞 𝐛𝐨𝐥𝐝. - Think about how your idea 𝐡𝐞𝐥𝐩𝐬 𝐭𝐡𝐞 𝐩𝐞𝐨𝐩𝐥𝐞 𝐩𝐚𝐲𝐢𝐧𝐠 𝐟𝐨𝐫 𝐚𝐧𝐝 𝐫𝐞𝐜𝐞𝐢𝐯𝐢𝐧𝐠 𝐜𝐚𝐫𝐞. ____________________ 𝘚𝘰𝘭𝘷𝘦 𝘵𝘩𝘦𝘪𝘳 𝘱𝘳𝘰𝘣𝘭𝘦𝘮𝘴 𝘰𝘧 𝘣𝘦𝘵𝘵𝘦𝘳 𝘤𝘢𝘳𝘦 𝘢𝘵 𝘭𝘰𝘸𝘦𝘳 𝘤𝘰𝘴𝘵 𝘢𝘯𝘥 𝘵𝘩𝘦 𝘥𝘦𝘮𝘢𝘯𝘥 𝘸𝘪𝘭𝘭 𝘣𝘦 𝘵𝘩𝘦𝘳𝘦. ____________________ Thoughtful post Elizabeth Mitchell, thank you. Christina Farr, HLTH Inc.,  Purchaser Business Group on Health (PBGH). Manatt, Phelps & Phillips, LLP, I M Human. #wellbeing #strategy #vulnerability #connection #belonging #psychologicalsafety #innovation #humanresources #leadership #culture #whatinspiresme #learnings #imhuman

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In case you missed it, my fellow co-founder, Senan Ebrahim, MD, PhD, recently spoke with Startup Savant about our mission at Delfina. As U.S. maternal health outcomes continue to fall behind those of other high-income countries, I’m proud to share how we are working to change that at Delfina. Together with Senan Ebrahim, MD, PhD, and Ali Ebrahim, PhD, we are committed to revolutionizing pregnancy care and improving health outcomes for expectant mothers globally.
 We aim to make equitable and accessible care a reality, especially for Black pregnant patients facing higher mortality rates. Despite the challenges of merging AI with healthcare, the positive feedback from our users drives us to believe that technology and compassion can transform maternal health.
 Read the full article here: https://lnkd.in/eu6eW8Sq

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Jeremy Knibbs and I caught up with Paul Wilder Bri Buch and Gurpreet (G.P.) Singh for a chat yesterday as we are watching the US interoperability journey with interest post the 21st Century Cures Act. We had the pleasure of Paul joining us at our Wild Health Cloud Summit in Sydney in 2022 for an armchair chat about what happens when you legislate to share health data using a stick and not a carrot. We were curious to see how things were tracking. CommonWell Health Alliance recently partnered with ELLKAY a nationwide leader in healthcare connectivity to support data exchange to 200 million patients across a network of 34 000 provider organisations in preparation for the next stage of their interoperability journey (TEFCA) the Trusted Exchange Framework and Common Agreement. The numbers seem mind boggling to us in Australia. Whilst Australia's population is a fraction of the US, we have not yet cracked the interoperability nut despite throwing billions $$ at the problem so we thought we would take a deeper dive on the US journey and our own as one of the themes at our WildHealth Summit in Melbourne on October 22nd. The program will be live next week and it’s one of our best yet! ( Watch this space!) As we can see from the Epic versus Particle dispute there is a lot we need to be across on our own journey to interoperability and a lot we can learn to avoid the same scars. #interoperability #datasharing #connectedcare

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AI has made good design more important than ever in healthcare. Why? Model performance alone doesn't guarantee clinical or financial value. A model can deliver a robust insight/output (accurate, reliable, complete, etc.), but clinician-users may struggle to use or integrate it in a real-world setting. As healthcare AI systems become compound machines, these design challenges amplify. Here are two simple examples: • AI systems that do not integrate seamlessly into EHRs, PACS, or pathology viewers may drive differential rates of utilization/adoption across sites, privileging some patients to a given algorithm without an underlying clinical rationale. • Imagine a model recommending a "next best step in care" that is not provided at a given hospital (e.g., due to lacking resources or infrastructure). Contextual and human factors can have a greater influence on whether the value of an AI intervention is realized, even when in silico model performance is compelling. There are two near-term opportunities here: 1) Healthcare AI model benchmarking should encompass "end-to-end systems," capturing nuances around system design, user experience, workflow integration, and ease of adoption. 2) It's time for AI-first design in healthcare – made possible by revisiting the unique capabilities of AI systems and their emergent behaviors to interrogate what new user experiences are possible. What are your favorite examples of AI-first design? #healthcare #ai #artificialintelligence #generativeai

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While there are numerous pros and cons to consider when raising a seed round, I generally agree with Gary Tan’s assessment: companies succeed when they create products that solve problems and meet customer needs, not because of the size of the check VCs write. I understand the frustration for VCs who have been raising larger seed-stage funds and need to deploy more capital per deal, but I support the founder’s decision to limit dilution early on. My advice to founders is to stay strong, be bold, hustle and take a chance on yourself, if you can solve customer problems, the same VCs who are upset about your decision to raise and dilute less during the seed round will come knocking on your door. #startups #founders #dilution #believeinyourself #venturecapital https://lnkd.in/gdmKsUje

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One conversation we should be having more, especially in healthcare: is this an AI problem or a policy problem? A big challenge in American healthcare stems from the reality that our healthcare strategy changes with every administration. Throwing AI at problems that are well-addressed by policy innovation (e.g., AI for payer-provider RCM war) feels like a gross misallocation of resources. Solution sets are rarely zero sum – in truth, most problems will require policy, tech, and human interventions, but it's worth asking ourselves whether AI is the best solve when we have a multitude of options.

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The most talked about AI x Medical startup Abridge is working to rescue doctors from the never-ending admin grind (which causes burnout and less patient face-time). Abridge's AI listens to patient visits and generates precise medical notes, slashing the clerical workload. Now, doctors can focus on what truly matters: patient care. Major health systems like Yale and Emory are already on board and raving, calling it "life-changing" and "magical." 🔷 A big reason --> Payback of the scribe tool is easy to measure. It supports 14 languages including Haitian Creole, Brazilian Portuguese, and Punjabi. An ongoing criticism of generative AI is that it still has few substantive business applications. This seems to quash that. Question: is a dedicated medical LLM needed to be successful in the space? Or will the huge foundational models (GPT-4o, Google, and Meta) ingest a plethora of medical notes and kill the competition with performance? We're dealing with a fast and furious pace, and today's edge may not be relevant tomorrow. Competitors include Microsoft-owned Nuance Healthcare , Ambience Healthcare, Nabla and Suki. I'm excited to continue to see this field revolutionized. 🌟 #AI #MedTech #Abridge #HealthTech

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