This week, One Medical (Nasdaq: ONEM) will be the first “next-generation” primary care company to enter the public markets. Others have been growing quietly–but steadily–under a wave of private financing (Oak Street, Iora, Firefly, ChenMed, Forward, Cityblock, arguably Oscar) or have been acquired (CareMore, acquired by Anthem). I’m a big believer in redesigning health care delivery and applying novel financial models and technology to improve the way patient’s receive care, and One Medical’s pioneering role in this space is worth dissecting.

With a wave of brick-and-mortar (read: low gross margin) startups facing questions about their SaaS-multiple IPO valuations (e.g. WeWork…


Under the seemingly harmless guise of consumer marketing, the tech industry has begun developing end-to-end solutions for medical conditions. Big Pharma should be paying attention.

While the biggest news leading up to JPM 2019 is the $74B Bristol-Myers Squibb — Celgene merger, venture capitalists have not-so-quietly poured over $600M in startups, e.g. Simple Health, Hims, Ro, Nurx, and Thirty Madison, shifting generic drug prescribing, delivery, and user experience to a full-stack model more akin to San Francisco direct-to-consumer (D2C) startups than traditional East Coast biopharma giants.

Here’s how these companies work. Consumers pay a fixed rate for an online ‘visit’…


Allogene’s founders sold their first CAR-T company, Kite Pharma, for $12 billion. After launching the biggest biotech IPO of 2018, will version 2.0 be even better?

Source: Celgene

Last week, Drs. James Allison and Tasuku Honjo received the 2018 Nobel Prize in Medicine for their seminal work discovering the role of negative immune regulation for cancer therapy. Their work, along with many others in the field, led to the creation of checkpoint blockers, CAR-T therapies, and new modalities still under development, and also sparked a paradigm shift in how physicians and scientists approach the treatment and management of cancer.

One of the…


How a Google investment and vertical integration strategy at Oscar Health create and capture winner-take-all dynamics in Primary Care.

Source: Bloomberg

Last month Oscar Health Insurance raised a $375M strategic investment from Alphabet, uncovered in an incredibly thorough interview. This immediately raised questions about the round size, valuation, sustainability, and growth strategy.

Naturally, Oscar’s round size and corresponding valuation (and lack thereof) received the most attention.


How Amazon’s logistics backbone, Whole Foods, PillPack, and Echo are primed to tackle the prescription drug market.

On the back of record Q2 2018 profits separate from its core retail business, Amazon can afford to undercut its competition’s prices to expand its moat while simultaneously putting capital to work in new verticals. The company’s acquisition of PillPack isn’t its first major investment into pharmacy, and unlikely to be its last.

When compounded with Amazon’s existing logistics infrastructure, business units, online retail market share, and most notably, new modalities of enabling purchases (Echo, Go), Amazon’s jump into the pharmacy business resembles…


What do you get when you combine Atul Gawande’s expertise with three firms that hold a combined market capitalization of $1.6 trillion?

Amazon, Berkshire Hathaway, and JP Morgan Chase (ABC) announced last Wednesday that Dr. Atul Gawande will serve as CEO for their unnamed health care venture first publicized in January.

“I’m thrilled to be named CEO of this healthcare initiative, I have devoted my public health career to building scalable solutions for better healthcare delivery that are saving lives, reducing suffering, and eliminating wasteful spending both in the US and across the world. Now I have the backing of…


By Nisarg Patel

Image: Shawn Hempel/shutterstock.com

The staccato, ephemeral blips of an EKG monitor are no match for the deafening crunch of potato starch meeting tooth enamel. So naturally, the first thing I noticed about Cindy when I walked into her hospital room was the family-sized bag of Lays in her hands.

Cindy (not her real name) was suffering from congestive heart failure (CHF); the muscles in her heart were too weak to effectively pump blood through her body. The bag of chips was just one of the snacks that her husband bought from a nearby convenience store minutes before I arrived to…


By Nisarg Patel

Image: Alexander Supertramp/shutterstock.com

The first pediatric patient I saw was in 2010, while I was still a college student scurrying after attendings within the pale eggshell walls of a greater Phoenix hospital. The kid wasn’t much younger than I was, either 14 or 15, but he was just moody enough that I felt like 18-year-old me was old and gray in comparison.

The boy was suffering from bipolar disorder, but, despite instruction from his physicians and nudging from his parents, refused to take his medications. I couldn’t help but notice that throughout the visit, where I stood quietly in the…


Novel gene editing technologies and lean manufacturing processes could unleash the potential of CAR-T in both blood and solid tumors, but with hundreds of potential drugs in development, who wins?

Source: MSKCC

Fundamentally, the advent of CAR-T signaled a paradigm shift in drug development from molecules and biologics to living cells.

While biochemists have spent thousands of hours optimizing small molecule chemotherapies over the last century, today’s molecular biologists are meticulously tweaking the genetic code of living immune cells to maximize their therapeutic potential and miminize their toxicity in the fight against cancer.

In this analysis, I cover:

  • A brief overview on…


Walmart is devising a novel market strategy around the unbundling and consumerization of health care critically distinct from both Amazon and CVS Caremark.

In the last week, reports that Walmart is in merger talks with Humana, a health insurer with a $37B market cap, and looking to buy PillPack, an online pharmacy, for just under $1B make Walmart look more like an integrated health care delivery system with every passing day.

On top of Walmart’s existing health care offerings, these two acquisitions would functionally give Walmart the following:

  1. Risk-aligned health insurance plans that incentivize the expansion of low-cost retail primary…

Nisarg Patel

Resident Surgeon at UCSF. Biopharma and healthcare investor @BessemerVP. Cofounder @memorahealth. Alum @ycombinator, @broadinstitute, @harvardmed. Views my own.

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