Kind: captions Language: en Lockdowns had just started. Everybody [music] was starting to freak out. There was basically nowhere to get a test. So, our chief scientific officer had in his spare time developed a COVID test. I think our peak day was 26,000 people tested in a single day. I'm so excited for a freaking wild story today. Fred Turner, co-founder and CEO of Curative. This is an English founder in the valley who scaled a COVID testing business to $5 billion in revenue. Then he had to scale it all back. [music] It did not
last postcoid for obvious reasons. Today, he turned it into a health insurance provider that's worth $1.3 [music] billion. And in the show, he says some pretty wild stuff. And the company went from about 7 to 7,000 employees in those first 9 months. We did 2.5 million [music] vaccinations. That was another service we did. We also lost a ton of money on that. That was a terrible business. We're cutting about 80% of our SAS spend this year. What's the single largest contract you signed? >> Ready to go.
>> [music] >> Brad, I'm so excited for this. Dude, you have the most wild story and I heard it from Justin first uh and then from Anil. So, thank you so much for joining me, man. >> Yeah, thanks for having me. >> Now, I always find it very telling entrepreneurs often kind of compelled either by the fear of losing or by the thrill of winning. If I were to ask you which one drives you more, what would you say it is? >> Uh, thrill of winning. I feel like during um certainly during co with what
some of what we built at curative, I got kind of a taste for the the speed at which you can move when everything is like is behind you and all the momentum is behind you and uh I've been chasing that ever since. >> I mean that is the biggest tailwind that one could have ever expected. We're going to get to that. You actually grew up in the UK and then you moved to Silicon Valley very young. 17. >> Uh 19. >> 19. Okay. Could you have built the business that you did in the UK? >> No, definitely not.
>> Why is that? >> I just think the UK doesn't have like some of the the kind of infrastructure for um for startups and investing of like that many people that have kind of done a startup before and then are willing to invest in the next generation. Particularly investing in younger people. like when I found I tried to raise a venture round in the UK. Um, and I couldn't even get meetings. This was when I was like I was 18. I was in like first year of college and I was doing this startup on the side
and I couldn't even get meetings with I think I got like one fund to take an associate meeting with me. [laughter] >> Naturally, it went very far. >> Yes. And and so it just it seemed like people were more investing like purely on credentials. And this was a while ago, right? This was this was, you know, more than 10 years ago. But it seemed like people were investing just on, oh well, you came out of this university. Um, so if you, you know, you're an undergrad, like, how could we possibly
look at this? This doesn't make any sense. Whereas you go to Silicon Valley and it was like, well, what's the possibility here? What could you envision in 10 years if if everything succeeds? Like, how big a company could this be? And it it just it was a very different mindset that they were optimizing for how to get the best outcome rather than I always felt like in the UK it was sort of optimizing for like mitigating the the worst downstream outcome. >> Yes. How do I not get fired, >> right?
>> Yeah, I totally get that. Um [laughter] that's pretty funny. Um okay. And so we decide to move to the valley. Great. Um >> how does because we go from sepsis detection. No. Well, cows to sepsis to >> Can you just walk me through how we go from cows to sepsis to co just so I understand this? >> Yeah. So, my first company that >> I've never said that statement before in a 20 VC episode, by the way. >> There we go. It's a new a new phrase for you. Yes. So, um I went from initially
cattle testing uh through sepsis to to co. So it started off my first company in the UK which was called TL Biolabs at the time basically sequencing dairy and beef cows to predict various traits about the animal from an early age. So it started off with beef you can predict that certain cows are going to have more musculature um from an early age and some cows can have too much musculature and then they have trouble giving birth and so there's like an optimum that you're shooting for um and I found this
like completely by chance. I won uh the UK National Science Engineering Competition and um like was on TV a little bit and this farmer reached out to me because he wanted help testing his cows and he was sending his samples to the Netherlands and it was taking weeks and it was terrible. And I initially told him like I'm not interested in cows. I was interested in human genetics at the time. Um like no thank you. Um and then he kind of kept pressing and he like sent me samples with a check attached to the front and I was like oh
okay like this is interesting. And so I did the first batch of samples for him and then all of his friends started sending me samples. And so it kind of grew from there. And this was all still in the north of England. I was in the first year of of college at the time. Um and uh we started branching out into dairy and predicting how much milk animals would make. And I tried to raise uh the first venture round for the company in the UK. Didn't get very far and so ended up uh going to the US for the US ACT investing conference in San
Francisco. It's my first time in the States, never been before. Um, and I was like my last ditch attempt to try and raise some money. And I met a bunch of VCs. Didn't raise any money, but I did meet a guy who had just finished doing Y Combinator. And he was like, "Oh, you need to apply to YC. That's like that's what you need to do. You need to move the company to the US. You need to apply to YC. Like that's the only thing you can do here." Um, and I was like familiar with YC uh but had never applied.
>> What year was this? This was like the end of 2015. >> Okay. >> Yeah. So, I went back to the hotel room and it turned out like the application deadline was 6 days away. So, I was like, "All right, it's meant to be." So, did the application, you know, got the interview, came back for the interview, uh, and then moved to to Silicon Valley for the summer 16 batch. >> Paul, so how was the interview? Who was it with? >> Tim, Jeff, and somebody else. Yeah, it was I mean, it was all a bit of a blur.
It's very fast. >> And then you found out you get in. >> Yes. >> You moved to the valley. moved to the valley and then it was the same, you know, pitch the same company. We were doing uh mostly dairy testing at that point. So testing dairy cows to try and predict uh their milk yield, which for farmers is actually very valuable because they don't make milk until they're 18 months old. And so from day one, all your animals have to have a cough every year to keep making milk. So your herd doubles every year.
>> Is this still the same curative company? >> No, this is a completely different company. >> Okay. I was about to say, god my this is where investing is so difficult because like if you hear a founder pitching milk yield optimization [laughter] and I'm sure it is like logistically a big town I'm sure >> well not big enough that was the problem. >> Yeah. So so we did this went to YC and we raised a seed round from Andre >> a seed round from Andre. Yeah, their their bio uh fund uh did our seed round
right out of YC. Um and I don't think they did the TAM calculation. >> Um >> they backfound us. >> Credit to you. >> Yeah, they they were like, "Oh, this sounds interesting." And they did the round. It was a small round. It was like 1.65 million. So >> chum change. >> It was for the coffee. >> It was, you know, for for Andreason, it was like a smaller round. >> Sure. >> Um and so we kept developing the technology. We had customers. Uh, and then we went to go raise an A. And then
people did do the TAM calculation and there's about 100 million cows in the US. If you're doing well, you could charge 15 to $20 per test. So even if you assume you could test every cow every year, you'd be at 1.5 billion like total market, which is not enough to do a series A off of. And so what we end up doing is taking some of the core DNA testing technology that we had developed and pivoting and using that for human diagnostics. And so that was my kind of first foray into healthcare. Uh we actually first launched a high
throughput STD testing lab. Um yeah, which was and we launched an at home STD test. It was that was tons of fun. [laughter] >> I don't I used to run a lot when I was young and my knees were wonderful. Uh, and I used to love how I built this cuz they would ask the questions like this, which is like, how do you go from like cows and musculature on cows and milk yield optimization to at home STD testing? [laughter] Like, it doesn't feel that natural a jump. >> Yeah. On the back end, it's more
natural, right? All of these things have DNA in them. And so, if you're if you're looking to do better DNA testing, you're just looking for markets where people care more about that. and anything human people obviously care a lot more about are more willing to pay for and are much larger markets. And so we sort of did like a market first approach of, you know, where where could there be interesting things and we narrowed in on uh antibiotic resistance in STDs as being like a particularly interesting
area where they're getting harder and harder to treat because you get more and more antibiotic resistance. And if you're doing the DNA testing, you can predict what the best drug is going to be early, treat with that drug, and then you're not using the most aggressive antibiotics. >> Do we have more STDs than ever? >> Yeah. Yeah. >> [laughter] >> This conversation's pivoting somewhere. I didn't expect but I thought we were having less sex than ever. >> Yeah, but more STDs.
>> Wow. >> Yeah, >> that's worrying. >> Yeah, it is. And and well, it's a while since I looked at the statistics because I've not been doing this for a while now. Um but when I was like last in this Yeah. The statistics were just kind of a like steady increase and then an increase in resistance. And so it's getting to the point where certain STDs are like harder and harder to treat and some of them might eventually become untreatable or like you have to be hospitalized to get a certain really
powerful antibiotic to treat it which is crazy. Um and so antibiotic stewardship was a whole thing. And so we did that with STDs [snorts] and then [laughter] I love this conversation keep. And then [clears throat] and then we found a fascinating market in sepsis. Um and so sepsis is a disease that kills hundreds of thousands of people a year. It's basically where you get bacteria in your bloodstream. And what kills you is not actually the bacteria. It's your own immune system. So, you're not supposed
to have bacteria in your blood, right? Your blood is supposed to be sterile. And when bacteria get in there, your immune system kind of freaks out and it triggers this whole downstream cascade where your blood vessels start to leak and all of your organs start failing and it's basically really bad. And that's what kills you is your own uh immune reaction to the bacteria rather than the bacteria. And so this is, you know, one of the leading causes of death in the US. Often if you're dying from something
else, like if you know, you have serious cancer, it'll be sepsis that ultimately ends up being what kills you. Um because you get more susceptible to it uh with other diseases. And so it's leading cause of death, like increasing mortality. It's incredibly expensive. Outcomes are terrible. Um and so we were working on basically a better testing technology where from the earliest date uh you could detect these bacteria and what antibiotic they are going to be susceptible to and treat people faster because with sepsis basically every hour
that you don't treat somebody is about a 12% increase in mortality. So you want to get the treatment as soon as possible. >> Every hour you don't treat someone is a 12% increase mortality. >> Yeah. >> Okay. And so we start the sepsis testing. >> So start the sepsis testing. And so this >> does it instantly go well? >> No. So this company died at the end of 2019. >> Oh, I'm sorry. >> Yes. So, uh, we went to the testing was working great. Prototypes were, you
know, pursuing the FDA approval process. We went to do a series B round, uh, with ended up being a strategic. >> Sorry, just so I understand. So, we raised the A from A and it's still the same company as this milky. >> Same company. Yeah. It changed its name from TL BABs to Shield. >> Oh, love it. Good. It's a good single name. Okay. So, we go to raise the series B, bigger TAM, sepsis, death, more bigger >> TAM gravitas. Yeah. Many many billions of dollars TAM uh for testing for this
and ended up getting a term sheet from a strategic uh large public diagnostic company. Signed the term sheet, did three weeks of of work on docs. We were in the second round of docs and then their CEO killed it because it was too competitive with their core products. Meanwhile, we told all the investors that, oh yeah, we've got the lead. We're good to go. Oh, here's the paperwork. And so, uh, that was the death of the company. It had, we had about 3 weeks worth of cash. >> Would you be where you are today,
though, if that round had come together? >> No. No. Cuz I don't think we would have pivoted as hard into CO when CO hit. Um, I mean, it would have probably been easier cuz we had at that point, we actually had a lab license. So, you know, in the US, you need this thing called a clear license to run these kind of tests. And we had got one of these licenses over like a painstaking two-year process. Uh, and then in December of 2019, as part of the windown, I sold that license to a company in San Diego for $150,000
uh to pay some of the creditors and then 5 months later acquired a company in Southern California to get the same license for 27 million. So, timing is everything. >> Whoa, whoa, whoa, wait, wait. So, we're winding down the company and we sell this license for $150,000, >> which is it roughly its market value if there is not a pandemic. >> Totally get that. Cool. Okay. And so, we're winding down the company. I want to go chronologically cuz that's like a wild [laughter] number like flies in
shutting down the company in 20 now 20 I guess. >> Uh it was Yeah. kind of right at the end of 2019. >> Okay. End of 2019. Shutting down the company strategic alle [ __ ] that. [snorts] Um >> and then what happens then? So then I was kind of looking at what to do next. Um, and >> were you like personally devastated? This is five years of your life. Yes. Any lessons for founders? Reflections on that? >> I think it's a lot easier to build a company the second time around. Like
there's so many mistakes the first time where you just you don't know how to do like thing X, like the first time you fire somebody, like how to build a good interview process, how to build a pipeline. Like there's so many things that it's really easy to screw up the first time around. And then when you've seen them go wrong, it's so much easier to build it the second time around. And so like, yes, it's the worst thing in the world to go, you know, to go through is having something you poured all that
time and energy into and like, you know, the 7-day work weeks and the late nights basically go to zero. But you learn as long as through that you you learn and you take those lessons and you go solve an even bigger problem, I think, you know, you got something out of it. >> Okay. And so this company is like winding down, >> need to find something else. What happens now? >> Yeah. So originally the pitch behind curative uh was we were going to also solve sepsis but in a completely
different way. [laughter] >> You really focused on really. [snorts] Yeah. So when we were going through all of this work with the sepsis diagnostics, one of the things that kept jumping out in the data was when you look at other companies that had tried to do sepsis diagnostics because we were not the first. A bunch of big pharma companies like Ro spent a couple hundred million. Um Seaman spent a hundred million. A bunch of companies spent a lot of money trying to make better sepsis diagnostics. So it's kind of this like
graveyard of dead sepsis companies. And when you dig into the data, you find this really interesting thing that in academic medical centers when you try out these new sepsis tests, they work great and you see much better outcomes and you see, you know, people live longer and it's saving lives. And then you try to replicate that in bigger studies and they fail. And when you dig in and look why, it's when you expand that aperture of who's in the trial out of the academic medical center and into community hospitals. What's happening in
a community hospital is they're so understaffed, they're so overwhelmed with the volume, particularly in the emergency room, they don't suspect sepsis fast enough and as I said earlier, it's every hour is 12% increase in mortality. And the intervention that they have to do is actually pretty severe. They basically put a big IV line usually in your femoral artery. They're pumping you full of fluids. They're pumping you full of nasty antibiotics that have bad side effects. So, it's a pretty aggressive treatment. But if they
don't suspect sepsis early enough and jump to that treatment, by the time they get there, it's already too late. And so if you're in a community hospital and it's 2 a.m. on a Saturday, is there someone on staff that actually suspects sepsis early enough or does it wait until Monday morning? And so it doesn't matter if you have a better test if no one ever runs it. And so the original pitch behind curative is let's take the learnings from an academic medical center and go out to community hospitals and basically build
mini hospital in a hospital uh that just manages their sepsis patients. So whenever they get somebody you know we will diagnose them as having sepsis out of the emergency room. We will then take on that patient. They would pay as a fixed fee. So no matter what happens we're on the hook. If we can drive a better outcome by applying mostly just getting doctors to follow the instructions but at scale then you could drive better outcomes um by getting those academic medical center type um like clinical results but helping a
community hospital actually do that. >> So what happens then we we start that business >> start that business we raised uh a million dollars of seed money. Uh Justin was the first investor you mentioned at the beginning Justin Matine. Uh he came in uh right as I was shutting down Shield. He was an investor in Shield. Um and he wanted to put more money into Shield. And I said, "No, I I don't think you should do that. I think that company is is, you know, is not going to make it unfortunately, but I'm thinking of
starting this new thing." And he was like, "Yes, I'm in." And he didn't even know what it was. >> How much did he put in? He >> put in, I think, $125,000 uh at a $3 million valuation. Wow. >> So, he was the first >> First money in. >> First money in. Love it. >> Um and and so we had a pilot set up with a first hospital in Wisconsin. This was a clinician that we'd worked with before. He was really enthusiastic. And then we got a call from his assistant saying this is all on hold and I can't
speak to you for at least 3 months. >> Huh. >> And we were like, that's really out of character that he wouldn't at least call us or text us or that he's having his assistant. And when we dug in, they were getting ready for this thing called CO 19 that they were expecting to see the first patient in their hospital. And so that was the first inkling for me of like, oh crap, this is going to be a big thing. This is going to be bigger than people think it is. And so they were shutting down the entire hospital. And
so it started off for us as like, okay, well, we can't run our clinical studies. We can't actually launch this product because all the hospitals are on lockdown. maybe we can go help out with this testing thing for a couple of weeks until all of this blows over um and then we'll go back to sepsis. >> And so at that point we're like we've move into CO 19 testing. >> Yes. Yes. And so it all happened quite quickly from like a lot of me saying no no no this is not going to be a thing like don't worry about it like just it's
>> What was the moment where you realized like where were you like this is substantially going to be a real thing? So, I was like in my apartment in San Francisco looking at some data that I think was on Twitter. Um, and and I was like, "Oh crap, if that if this continues at this rate, like this is going to be way more substantial than people realize." And so this was probably midFebruary. Um, and so then I started to reach out about sort of setting up testing capacity uh to well, first of all, we had the problem of
finding a lab license cuz I just sold the lab license. [gasps] This was the 150 grand you just sold. >> So just sold the lab license and so we didn't have a lab anymore that was capable of running these kind of tests. We had a test. Um so our chief scientific officer at at Curative had in his spare time developed a COVID test. And one of the things they' done at a previous company is they developed one of these flu tests and just offered it to employees to make them feel better. And so he said, "Hey, can I develop a
COVID test? I don't think it'll be very useful, but it might make our employees feel good, and it's like a good training exercise for the team. And so, they had worked on through January and the early part of February a COVID test that they'd been developing uh basically in their like spare time in evenings and in weekends. And so then when everything started to really take off, we actually already had the test. What we didn't have was a lab to deploy it in. >> And so at that point, you then go back
to the old one and buy it for 27 million. >> No. So I bought a different lab license. you bought a different lab. >> So, we reached out I reached out to a bunch of people I knew in the Bay Area that had facilities with this kind of license. Nobody wanted anything COVID related on site. Nobody wanted, you know, anything to do with it. And so we um I like put it out I just put out an email to like everybody I know. Um, and there's actually a guy who uh was in the same YC batch as me um who had become a
VC and he uh connected me to a group in LA and they had this license and they were using it for like uh sports doping testing and they were in what I thought was LA. I remember telling Justin, "Oh, Justin, I'm going to to LA. I'll be in Sand Deas." And he was like, "Where the hell is Sand Deas?" It's like basically very far east of actual LA. It's still in LA County. It's a little city uh best known for uh Bill and Ted. It's a little town of like 30,000 people. >> And that's where the lab test
>> and that's where the lab was. And so I flew out there to look at that lab. Uh this was from uh from San Francisco. And to look at one other lab license that was I think affiliated with um with one of the universities and you know they had a good space, they had this license and they were doing pretty minimal testing. So they just kind of like a blank slate. And so it started off as a 50/50 JV between Curative and this company that had the lab license. And we would bring the test, we would bring the
expertise, they would bring the license. And it became pretty clear quite quickly that they didn't have the expertise to scale it up. Like they were actively getting in the way of scaling it up. Um and so we >> What did you do? >> We bought them out >> and that was that was the 27 million. Where did you get 27 million from? >> Uh forward revenue from customers. So we were getting paid. We had our first testing contract. We were doing the uh police and the fire department. >> And so how do you do you have the chief
science officer who's created this brilliant task kit? >> Yep. >> And you go to like San Francisco state or government. >> So this is mostly Yeah. And so actually our very first customer was the sheriff department in Sand Demos. Well, we did some like private testing for individuals that were paying for the tests. But our first, you know, government customer was the sheriff's department in Sand Demus and that came about because they got wind that we were setting up a CO lab because people were
freaking out about it in the town. And so one of their sheriffs reached out to me on LinkedIn and was like, "Hey, what are you guys doing?" Um, and so I connected with him and I explained what we're doing and how it was very safe and how we had this way of deactivating the COVID as soon as it went into the sample and so there was no live virus on site and we were not presenting a risk to the community and actually this was going to be a good thing and we're going to be hiring a lot of people and kind of got
him on board that you know we're doing we knew what we're doing and we're doing this in a safe way. And then he was like, "Well, well, we really need testing." And then the fire department wanted testing. And then our first really big contract was the city of LA. And that came about from a tweet. Um, so we had uh Laura Deming >> who was a >> Yeah, I remember she's YC uh longevity. Yeah, exactly. So she um you know was was a friend and would trying to basically help with the pandemic. And so
she actually drove me down to LA with a car full of PCR machines um so I could like work on a laptop and she helped with a lot of the early development work and she tweeted, "Hey, we've got CO testing capacity. Does anybody want some deputy mayor of LA slid into her DMs and was like, "Yes, please. We would like to talk about that." >> So that was how our first big contract came about. And so you speak to [laughter] the deputy mayor of LA. >> Yeah. And then so they were doing a pilot. They said, "Look, we got a couple
of labs. You know, you're going to have to demonstrate this." Because we were complete unknown, right? We' done >> And co wasn't peak ramps now, was it? This was >> This was like early March. So people lockdowns had just started. Everybody was starting to freak out. There was basically nowhere to get a test. Like you unless you were ultra high risk and in a hospital, there was pretty much no chance you were getting a test. So everybody was freaking out. This is when everybody was still like cleaning their
um you know supermarket bags with wipes and nobody knows what's going on. Everything's shutting down. Um it wasn't so bad on the West Coast, but New York was like was really bad already by this point. >> And so they're paying ahead of time. So the best thing we could get with the city of LA because they have obviously their city there are certain restrictions is that they would pay after delivery but they would pay net one on the invoice. And so we would deliver the tests for a day and then we
would send somebody to city hall the next morning to pick up a check for those tests. >> So the tests had been done. They were paying after we delivered them. Um but which was not you know your standard like net 30 [laughter] or net 60 for a government contract. They were having we were invoicing them every day for the number of tests they did and they were having somebody in their finance department like get us the check because we needed that to pay for supplies to basically grow out that testing capacity
for where they wanted to be. >> What's the single largest contract you signed? >> Probably one of the Florida contracts was maybe the largest. So we did a contract with the state of Florida for all of their nursing home testing. Um I forget what the dollar figure was, but it was, you know, in the hundreds of millions of dollars. And so we were the they put it out out to bid and we won it. >> Hundreds of millions. >> Yeah. They tested every employee at every nursing home across the state once
a week for a 3-month period. And so they did a great job of basically keeping things open, keeping these nursing homes open, keeping visitation, but making sure that the employees of those nursing homes were not spreading COVID to the people in the nursing homes. Um, and so they wanted to test every single employee that was working at those nursing homes and then exclude the people that weren't uh that that had COVID so they weren't exposing the uh the residents there. And so we ran this big program, a bunch of labs or they put
it out to bid and everybody said, "No, that's too crazy. Like that's impossible. We cannot possibly test that many facilities with that tight a turnaround time. Like this is impossible." And we bid. We're like, "Yeah, we can we can do that. We'll make that work." Um, and we delivered it. What did you see that others didn't? >> That you have to kind of scale like something like that up from scratch that the existing labs like the lab industry in general is a very low margin industry and it's built on efficiency. You look
at the big labs, the Quest and Lab Corpse and they are ultra efficient machines. Like they're some of what they do with automation is incredible. But if you're asking them to 10x capacity, that's literally the opposite of what they're built for. they are built for we will get 1% extra margin by optimizing this bit of the process over here so that it is perfectly efficient and they are really good at that but if you ask them to 10x that it really doesn't work and the mindset isn't there the people
don't know how to scale those kind of things up all of the supply chain broke down and so we basically said okay start from scratch throw all of that away imagine that you're going to have to scale this up to hundreds of thousands of tests a day where do you start and so we built what we called an orthogonal supply chain which is just basically a fancy way of saying we don't use the things other people use >> sound like a Mackenzie consultant specializing in innovation an orthogonal supply chain yeah great
>> well I found that was like a good fancy word that like you know was helpful from a sales >> stand what it basically means is everybody was chasing the same uh consumables the same supplies everybody was trying to use the same stuff and if if you know you can make 1x of that maybe they can increase to make 1.2x. If everybody's trying to buy that, us also trying to buy that doesn't help. That doesn't net increase the number of tests being done, right? It just makes us all squabble over it.
>> So that's pointless. So you got to find other ways of doing the testing using supplies that maybe wouldn't traditionally be used for this kind of testing. Um, so we were sourcing swabs, you know, from other types of vendors that were being used for, you know, electronic testing and then sterilizing them. we were sourcing. There's this kind of extraction material that you usually use and magnetic beads is kind of the default standard, but there's this other way of doing it with filter plates which is more scalable because
it's basically just glass and plastic and you can scale that up faster than you can scale up magnetic beads where they all come from basically two factories in China. And so we're like, okay, we should never use magnetic beads because that's not going to scale as a technology. we need to go find vendors who can scale up the plastic and glass manufacturing and partner with them to basically 10x it. And so you kind of approach every single bit of the supply chain that way. You end up with this massive scale. Now, outside of a
pandemic, that doesn't work because people don't want 10x more testing than they wanted yesterday. But within a pandemic, you got to approach it differently. And so we peaked, I think our peak day was 26,000 people tested in a single day. >> 206,000 people tested in a single day. And that was December of 2020. So that was within eight months from zero zero to 26,000. So and the company went from about 7 to 7,000 employees in in those first nine months. >> 7,000 employees in 9 months. >> Yeah. [laughter]
>> Yeah. It was it was a little crazy. >> Do you sleep at all? I mean >> I don't sleep very much now. >> But like in that time, what was the craziest thing that you did? Um, I mean some of the hiring, you know, you have to get licensed people for certain roles, but other like more administrative roles, you don't need licensed people. And so we would literally a lot of people wanted to work on the pandemic, which is very helpful. We'd have people like line up in the parking lot um, socially distanced like
down the street and then give them five minute interview slots and just have somebody sit there with a clipboard and it's like 5 minutes and next just to get the volume of people um, in the door. >> How much money did you make from co testing? I think the total revenue ended up being about five billion over a three-year period. >> Five billion. Is that the largest private provider? >> We were Yeah, we were the largest like non-labcest testing company. >> That is extraordinary. What is the
margin profile on a co test? >> So really good during surges and then really bad not during surges. [laughter] Um, so what we found was when when there was a peak, right, so we get a new variant or, you know, this usually winter was the biggest peak, but then we started having these summer peaks, which was kind of weird. Um, everybody would run to get tested. Um, and these were all public testing sites. So these were in parking lots. These were the drive-through tests. That was what we were doing. So if you went to a
drive-through testing site, like the biggest one was the uh Dodger Stadium site in LA. It was seven lanes of traffic, 7:00 a.m. to 7:00 p.m. 7 days a week. So they were testing at the peak about 10,000 people a day coming through their cars getting tested and coming back to the lab. So when you're at peak capacity and you're filling all of the labs volume, it's very profitable. Then those uh basically surges subside, right, and you end up back at testing, you know, using 20 or 30% of your capacity. All your
fixed costs the same. You're still paying 7,000 to people. Now you don't have to buy as many consumables, but all of that infrastructure has to be maintained for the surge. And so this is again where it's like the opposite of the traditional lab industry where they have a very flat volume. Every year people do roughly the same amount of blood work as they did last year or maybe do like predictably slightly more, but it's it's within a couple of percentage points. here you're kind of building it for that peak capacity
and then during the lulls like maintaining that capacity is incredibly expensive and so it was kind of necessary and this was part of the way it was set up they increased the price the reimbursement price uh that they were paying for these tests because they needed to incentivize the capacity to be built because if you don't build that peak capacity then when you have a surge it all goes horribly wrong and no one can get a test but that means you basically have to pay to overbuild Because during the dips you have to have
that capacity. You can't just shut it down, right? >> And you can't build up 7,000 in 24 hours in >> and so you need to maintain that. And so we would lose a lot of money in every one of the dips basically. >> Well, you would actually lose money. >> Yeah. Yeah. Yeah. We would lose money on every test during the dips. >> Oh wow. >> So of the five billion, how much is profit? So after all was said and done, the money that we basically put forward into the uh insurance business, the
health insurance company was about 500 million that we invested into the health insurance business. >> It's absolutely astonishing. >> Can I ask you when we saw the vaccines roll out, did you know they were ineffective in the way that they've kind of turned out to be? It was not clear at the beginning and I think also it's it's sort of changed like that when nobody's had any exposure to co being vaccinated probably provides a lot more benefit once everybody's sort of had co a few times then the vaccines benefit is much
less because you've already had it also the varants got weaker and weaker uh when we were first rolling them out I mean I think in you know December of of 2020 there was benefit for a lot of people getting the vaccine >> did you get vaccinated. >> Yes, we did that. We did 2 and a half million vaccinations. That was another business. >> Why? >> Um because the government wasn't paying enough. We lost money on every single dose. It cost more to administer them than we were getting paid. So
>> why did you do it? >> Uh giving back. A lot of our partners wanted it. So a lot of the partners on the government side we're working with for testing also wanted us to administer vaccinations. >> Was it sounds awful? Was it a hard like your business with co obviously being eased >> completely changes >> and you have to pivot again. >> Yeah. And so that started very early for us cuz I wasn't going to last very long. >> You were always aware it wouldn't last.
>> Yes. When we started hiring people at the beginning, we told them this is 3 months. You have a job for 3 months. Like don't bank on anything beyond 3 months. This is a three-month gig and we're going to shut it all down in three months. Um, so the the CFO and now the president of Curative joined at the beginning and for her it was going to be a six-month gig. [laughter] Um, she came out of retirement to help with the pandemic for 6 months. Now 6 years later she's still here. But um, it was supposed to be temporary and every
time you know a surge we got through a surge I was like all right that's it. It'll be over now. And then they just kept happening. [laughter] So, we started looking at kind of what comes next middle of 2020, like really early. Um, yeah. >> How did that search for what comes next change? You just started looking at middle of 2020. It's not until end of 22, start of 23 when that actual search is activated into real-time plan. Correct. >> Yeah. I think we started probably like late 21 is when we got really serious
about health insurance. It just took a while to actually get the license. >> Yeah. Why health insurance? >> Well, it wasn't the first idea. We looked at a bunch of other stuff. We looked at other stuff in the lab testing industry. Unfortunately, it's just not that big an industry. And so even like we had this interesting technology that could theoretically let you do a lot of lab tests that are individual tests today like as just one single test, which would be scientifically quite cool. But even if you say, okay, I'm
going to displace all of LabC and Quest, that's about 30 billion of market cap. So that's like the largest company you could possibly build is about 30 billion which that is a big company but coming out of what we did with co I wanted to build a much bigger company than that and so there's just not a big enough market in lab testing um so the lab testing was was out and then we briefly looked at trying to buy a hospital um or multiple hospitals we looked at one in Florida and we looked at one in Texas and the idea was well if the
hospitals kind of like the the health system becoming the center of where care is delivered, they buy have bought up a lot of the primary care offices. Um, if you can transform that with technology, can you drive much better outcomes? What we ultimately decided is it doesn't work that well because the payer mix is too broken up. And so, as a hospital, your customer is like 50% the government and then a whole bunch of like split up smaller insurance plans. and they all want different things and they change
their mind every 5 minutes about what they actually want and you're trying to like keep them all happy. So your ability to really change things from the hospital side is quite limited is what we ended up deciding. Um and when you come back to it like we looked at a bunch of preventative care things we looked at a primary care chain everything sort of ends up coming back to the payer like the payer is the one that drives behavior in the US healthare system. If you are providing the dollars people will go where the dollars are. If
you say I'm gonna pay for this service, people will go do that service. If you say I'm not going to pay for this, people will stop doing that. And so the payer is the one that's kind of driving things. >> If you could do one thing to change the structure of the US healthcare system today, magic wand, what would you do? >> Um, I think you have to break up the negotiating into smaller units. like it's gone to this point where I think it's it's quite an efficient system as a market when the counterparties are small
when everything gets very consolidated it becomes incredibly inefficient. So when we look at for example health systems right so we pay for for care at health systems some of that care you can get in other places if we look at how much we'd pay a primary care doctor who's independent compared to a primary care doctor affiliated with a system affiliated with a system they get paid an average double same service you know same credentials it's just that this one is part of a hospital system and that hospital system will use the
fact that they have a ton of beds that They have this ultra special surgery center that you need like we need to have that capacity in our network because some people need to be hospitalized, some people need those services that if you want to get access to that, you got to pay me double for my primary care doctors. And so when all of the players are small, when you have smaller payers and smaller hospitals, you end up kind of getting to reasonable negotiations. What's happened is you have these massive payers like the market is ultra
consolidated. You basically have like four large players that control the entire market on the payer side and then you get these ultra consolidated hospital systems because that's the only way for them to survive if they want to, you know, fight with Blue Cross. The only way to survive is to get really big so they have the negotiating power and then they just reach these loggerheads where nothing gets done and everybody's overpaying for everything and everything's inefficient. And when you have more competition in the market,
more smaller payers entering more, you know, smaller health systems, you start to get like an actual efficient market. When you're just negotiating for like, hey, I have a third of healthcare in the state and I have a third of all of the employees in the state. It's not an efficient market anymore because there's no alternative. You h you must reach a deal. >> If I am sick, is the best place to be treated in the US? >> Yes, definitely. >> Seriously. Yeah. Yeah. We have the US has the access to
by far the most cutting edge techniques and facilities and drugs than the rest of the world and they're willing to spend a lot more. >> What do you know now, sorry, that you wish you'd known when you made the pivot into insurance? I think I wish that I knew AI was coming because I think like the way we designed the business in 2022 when we first started, we had no idea that this wave of AI and LLM was coming. Like we were building a health insurance business because we thought it was a good
business to build and we thought it needed to be built. We needed a better alternatives in the market for health insurance. And then in the last like 18 months, how we do pretty much everything is now a completely different workflow. And we there's so much I mean all health insurance does is like moving bits around, right? Like we don't have a physical product. We give you a little plastic card, but apart from that our product is that we move bits around in a database that means care is paid for.
>> That's it, right? And we do a lot of managing kind of managing a marketplace. We work with the providers to negotiate prices. We work with employers to negotiate how much they pay and then we try to work with employees to keep them healthy. If we can get people to stay healthy, we can avoid the long-term downstream cost of care. Essentially, it's marketplace business. Um, and that has been fundamentally like shifted by AI. But when we first started building, we didn't know that was coming
>> by AI. >> So, so much of that back office work, right, has been completely changed by AI. There's we now have entire departments that used to be people like rubber stamping things. Um the first one that went to zero people was our credentiing department. Um where you know this is a process that's incredibly labor intensive where you have to check all doctors that join our network have a valid medical license and aren't being sued for malpractice. And this is, you know, a person going to the medical
board website, checking that the license record is there, checking transcripts from their school, checking like a database of of who's been sued by who, um, and then like rubber stamping. And that used to take us two to three months on average and cost about $50. We've now built in-house an agent that runs on on Claude that does this end to end. and it goes to the website, it verifies the license, it goes and reads the transcript, it puts it all together, it stamps it for approval. Um, and we're now averaging about 12 hours turnaround
time for credentiing somebody. And it cost us about 20 cents. And so this is like a mind-numbing process that payers have to do, which is important. We want to know the doctors in our network, right, are are validly licensed to practice medicine. Um, but it's like historically has always been kind of terrible and payers have been bad at it, right? If you're a doctor and you join a network and it takes 3 months before you can see any patients. It's just bureaucracy, right? Like they don't Doctors hate that and it's not actually
adding the value that it should be adding. It's just creating paperwork. >> How many people did you have in credentiing? >> That one wasn't that large. I think there was like five or six people. We had a few other departments that have shrunk more than that with the >> What other departments? We've seen a lot on the claims side, claims processing, right, is used to be a very manual process where claims comes in and people are like manually tweaking and editing it. Um, and also on the underwriting
side, underwriting, you know, the process used to be uh a broker comes to us with a group, an employer that they're looking to insure and they ask for competitive bids from multiple different insurance companies. And what that means is basically sending us an email with a bunch of PDFs and spreadsheets attached of who are the employees, what current claims do they have, what's the current insurance look like. And you'd think that over time they would develop like a standardized format for how that should run, but no,
every single one is like a different spreadsheet format, different PDF. And we tried to sort of solve that problem with software and build like universal importers and universal intake. And it like it kind of worked, but what we found works amazingly is literally to give the files to an agent, tell it to write Python to get these files into a standardized format because they're not very good at parsing files. But they're incredibly good at codegen. And so you can tell it to write a Python script to
convert any random file into this known format and then test it and loop and iterate on your script until it's working. And then you throw away that script. And so it's single use code that never gets used again. and you just generate that code one time and then throw it away. Um, and that works so well. And so now brokers, providers, employers, when people are sending us files, we always used to like insist, oh, you have to use our standard format for this. And they'd hate it and they'd get mad cuz somebody's sitting there in
a provider office like manually reformatting these files into our spreadsheet. Now send us whatever you've got, whatever format. It can be scribbles on a napkin, it doesn't matter. The model will figure it out. The model will convert it into our standard format. and it will do it in about 15 minutes. And so you build these data ingestion pipelines that used to be hundreds of people sitting moving spreadsheets around and it's now a model writing Python code to do that same thing and then every single time you
throw that Python away and start from scratch. >> Dude, I have so many questions to ask on the back of this. The first one is you mentioned there kind of the internal agent buildout that you've done for the company and for your specific processes. >> Do you buy the SAS is dead theory that we will >> Because I see the number of contracts we're canceling. >> Like we we just recently canceled our Salesforce contract because we have an internal CRM that was built, you know, was vibe coded, that is working better,
that is managing our process better, um is more integrated into what we're doing. We run our agents inside of it and no one was using Salesforce anymore. $600,000 a year. >> Gone to zero. How long did it take? >> Two months. >> Is it worth because argument back I always like to do both sides. I'm never Is it worth the engineering hours to vibe code that and then to maintain it? >> The maintenance is is definitely one of the most challenging pieces. Um I agree with that. I think for most businesses
of of any reasonable scale, yes, it is worth it. Now whether they will have the tech resources to do that soon, I think that's like the bigger question is kind of when will this happen? But when you build those things custom to your workflow, they work better. Like most of these big, you know, systems, you're paying an administrator. Like we had a full-time Salesforce administrator, right? You're paying people whose sole job is to manage this like archaic software platform. Not that Salesforce is archaic, but you know, we have a few
other like internal apps that we were paying for like industry software that is taking multiple FTEEs to maintain it. You can transition that into one great engineer and then whenever you want a custom feature, you just go build it. >> Absolutely [ __ ] wild. [laughter] $600,000 a year on Salesforce. >> Wow. And so we're seeing, you know, there's pockets of software that I think persist because they are more infrastructure based. >> Okay. Which persist? >> So we're seeing a lot of backend stuff
like uh like Sentry like stuff like that, right? Where it's like kind of become part of your infrastructure. Um Slack has been like notoriously hard internally for us to like too many so many people have built integrations and like workflows that are now working in Slack. Uh, I think that while they keep putting the prices up, if they put the prices up too much, then eventually it'll make sense to replace that. But, um, >> what else is on the chopping block? >> We we're cutting about 80% of our SAS
spend this year. >> So, we have like in in one of our internal meetings, we have a slide of like when when are SAS contracts due and whose job is it to tell them that we're not renewing this year? >> Well, you can do it in one fell swoop. >> Well, they have renewals. We have to pay them through the renewal. Ah, is it all like legacy software like Salesforce though? >> Some of it's like that. Some of it's like very insurance specific software. Um, so like our claim system for
example, right, is this like massive off-the-shelf platform that we just migrated to a few years ago. This is again why like if I'd known AI was coming, we would have probably approached things differently. >> Um, and it's just it's very hard to use. Like it's hard. Their API barely works. It's hard to get the data out of their database. Uh, they won't let us manage it. It's it but that's how insurance companies are running things and so we've built our own claim system completely from scratch in house that's
now uh we've migrated most of the workflows off will be fully off in July >> I am a health insurer you know other health insurers >> yes >> I do not have the in-house capability potentially technically to build the agentic workforce that you are building >> am I screwed [laughter] >> I [snorts] think some of the biggest insurers will struggle because they they will not be able to keep up from a margin standpoint with where we can get to with agents. I think some of them do
have technical expertise. It's more like operational and kind of people ops. If you've built a company of 100,000 people and in order to get this margin improvement 50,000 of them have to be laid off, somebody's fift just got a lot smaller. And so they will do it slowly over 10 years. It will happen. But will it happen quickly? No. And will we be able to compete more effectively in the meantime? Yes. >> How do margins change? >> Insurance is a very low margin business. So 85% of your uh premium that we
collect must go out the door to pay for care. So if we get in a dollar, we got to spend 85 cents. Have to [clears throat] by law. >> If less than that goes out the door, we have to give it back to the employer. Which is another thing that's broken about US healthcare because that drives completely the wrong incentive where actually from an insurance company standpoint if your profit's capped at 15% the only way to increase profits is to increase total spending which is not what you want your insurance company
incentivized to do. >> Why would I encourage people to go to the gym eat healthily if actually I'm not going to get that back anyway? So, this was part of Obamacare and it's one of the like >> there's a lot of >> there's some good things in Obamacare, but there was a lot of things that I think like the second order consequence was not considered. It sounds like a great PR thing to say we've capped insurance company profits, right? That sounds good, but it's BS. >> It's like capping a CEO's like fiscal
base pay. Sounds great. Yeah. So, let's just pay them 27 million in equity compens. That's the reason why we have such egregious comp packages for exacts cuz they cap the equ the salary pay. Ridiculous. With that, how's your anthropic cost gone? [laughter] >> Yes. So, I mean, this is one of I think the kind of leading indicators for us is that our anthropic cost over the last like six or seven months has 6xed every month from, you know, a base of, you know, a couple of tens of thousands of dollars now up to millions of dollars a
month. and it just keeps eventually we're going to have to stop that spending increase because you know it'll get unreasonable but um we just keep finding new things to do with it. And then the other thing we found that's been fascinating we're seeing a lot of areas where it's not that we are necessarily replacing the team. It's that we're repurposing the team [clears throat] and they are now so much more productive. And so one area that has always been like a particularly challenging thing that makes it hard to
build a new insurance company is we have to build this network. So the network is all the doctors and all the hospitals and all the people that we have to contract with. And there's about 1.2 million of those in the US that you want to have contracted. That ends up being like 60 70,000 contracts that you have to do. That's just a lot of work to go out, get their attention, get them like do a negotiation, get them to sign an agreement, load all of their data and have them in your network. And this has
been one of the biggest like pieces of staying power of the big health plan businesses is they built that over 100 years for Blue Cross and over like 50 years for United Sign. And so they did it slowly over a long period of time. If you're trying to from scratch come in and start a new health plan, you've got to reach out to all of those doctors and negotiate. And so we have a team of about 45 people who do those network contracts and they reach out and they negotiate. What we launched earlier this
year is an agent called Gwen. And Gwen does the same workflow. You give her basically a lead. Hey, there's a primary care office over here. Uh here's the address. and she will go Google it, research them, learn a little bit about their practice, um, figure out what other payers are paying them because there's a lot of this data out there and these transparency files now of how much are they getting paid. Find their email address from Zoom Info. Reach out to them and then basically ping them repeatedly until they answer
her with custom emails like, "Hey, I know about your practice. I know what you're doing." Like customized content to them. Uh, and then when she gets their attention, negotiate the rates back and forth, usually over like multiple rounds of negotiation, negotiate and redline the language. And that's another place where we found Python is great. These models are terrible at editing Word documents, but if you tell them to write Python to edit a Word document, they're great at it. Great hack. Um, and then sign the
agreement. And so she now signs the agreements with my signature. She'll open up the docyign link and then click the button and it's my signature on that agreement. And so this has taken us from doing about a 100 contracts a week to about 100 contracts a day. And the last year as an entire team we did 2,300 contracts. So far in about the last 8 weeks the agent alone has done 3500. And so what this is letting us do is like that team doesn't go to zero. We've refocused that team to work on these bigger contracts, right? Because
some of these deals we can do entirely over email. This agent is email only. And some of these providers will work completely over email to enter into an agreement. And actually, how many of them will do the whole thing over email surprised me. There's a lot of millennials I guess on the other end that don't want to get on the phone um and would rather do the whole negotiation completely electronically, which is fantastic because the model is great at that. [snorts] But some of them, the bigger hospital systems, the
bigger doctors uh doctor groups, they want to have a phone call. They want to meet in person. They want to learn who we are. And the team now get to spend their time going and having those inerson meetings, going and developing those relationships, working with those bigger groups. And then even when it gets to the paperwork, handing the paperwork off to the model and then all of the smaller the individual PCP over here, the small behavioral health provider here, the therapist over here, the agent just gets it done and can sign
a contract end to end in a few hours where you wouldn't be able to do that volume with people. Given the transformational nature of what you're describing, if Anthropic doubled their price, would it impact your usage? When we look at a lot of the financials of these core businesses today, >> yeah, >> they are challenged businesses in their current infrastructure and pricing. >> If they double pricing, would it stay the same? >> If I say yes, I don't want our anthropic rep to double our pricing. [laughter]
>> But it would >> it would work. It would be fine. Yeah. So, it costs with people, it cost us about $1,500 to $2,000 on average to do a contract. Um, the average with Gwen has been about $70. So it would still work fine. Um and so that's what we've seen is like partly why the token use has exploded for us. >> Am I being a complete idiot then? But then if they 5x their pricing if you went on the labor displacement theory, >> it would still work. >> It would still work. I think what
they're betting and what also we've seen is you don't just displace the labor. So here like I think contracting is a perfect example. We've not said okay we're doing 100 a week so we'll get the agent to do 100 a week. What we've done is said, "Well, now that we have the agent, we can do 10 times as many contracts this year as we could do last year. So, we're going to do 10 times and then we're going to try and do 20 times and we would just do a lot more volume than you could possibly have done with a
human team." >> Everyone's like, "Oh, I lose my job. Lose my jobs." Do you think that's warranted? >> I think for a lot of these back office jobs, yes, because >> So, how how do we determine between I'm just going to do more? >> Yeah. A lot of people say with developers, we're not going to get rid of developers. There's an insatiable appetite for more software, better software. >> That side I do agree with. I think >> how do we determine between functions where we'll do more versus we'll be
replaced. >> So what we've tried to kind of differentiate at curative is there's like two areas where we're really investing in people. That's technical skills and relationships. Those are two aspects that I don't see going away anytime soon is we still have a team that are actually deploying all of this AI. They use a ton of AI in all of their day-to-day work, right? They're not writing any code anymore. They're not even reading the code anymore. They're deploying all of this with cloud code or
codecs. Um, and seeing like incredible results out of one senior engineer now is so much more productive than they were a year ago that we're investing in having those people. At the same time, there's a side particularly to health insurance that is relationship driven that I don't see as going away anytime soon. Ultimately, we ensure a member and that member wants to be able to call and talk to a person. We have a lot of AI they can talk to. The AI is great. They love talking to the AI, but there has to
be a person somewhere in the loop. We also work with these provider groups. We have a relationship with that provider group that we're providing a chunk of your revenue. You know, we work with you, you work with us. There's a relationship aspect there that has to be maintained particularly for the larger groups by a person and then on the sales side we sell through a broker and that broker wants to have a finalist presentation. They want to go to dinner. They want to go and play golf and so what we've seen is on the sales side
like that relationship is if anything more powerful. Do you think they still will in 5 years? A lot of people talk about agent agent transactions and how that changes the process. Do you think we will still have that heavy relationship interpersonal cell in 5 10 years? I think on in in some aspects yes because I think in some aspects that's kind of becomes the foundation of trust and it's like almost the scarce resource right of if you want to do a deal that's important then you're going to use your
scarce resource of people to manage that as almost like >> it's also the bigger the contract >> the more important it is to have the the whites of the eyes and the trust in the relationship >> and and most of these contracts right most employers even our smallest employers is it's a million-doll contract at least. >> I always think they like when you look at accountants and lawyers and a lot of the people who bluntly could be replacing some of the more simple especially NBAs or
>> but you would never not have a law firm do it because if it goes wrong they're getting fired. >> Yeah. But I think I I I think you'll see it work differently though where I mean what we're seeing with with Gwen is we had a contract a standard template contract that was drafted by a law firm and then we have kind of like guardrails for what Gwen can agree to. But she just redlines it and then signs it. She doesn't it doesn't go to a law firm for review. Like we're signing hundreds of
these contracts a day. It would be too encumbering. It would be too slow and they would just be reviewing with AI anyway. So we kind of trust the agent to do that legal review within certain parameters. >> In 3 years time, knowing what you do now about the capabilities that you use it for, how big do you think anthropic will be? >> A lot bigger than they are today. >> Do you think it could be 5 trillion? >> I think it could be 10 trillion. >> Bugger. [ __ ] [laughter]
>> Is just extraordinary, isn't it? >> Yeah. because I think you just find all these new things that you can do that you just couldn't do before that it like wasn't possible to do. So Gwen is sending on average 15,000 emails a day. Customized emails to providers that know about their practice, that know about their work, and one of the things we found is like that relentlessness of the follow-up is what works. A lot of providers will get them on the ninth email. There's no way that a human is
going to email them nine times because you know people that's like you have to kind of have no shame to reach out that many times. >> Do you want to hear something funny? You mentioned Salesforce. I got Mark Benny off on the show cuz I emailed him 53 times [laughter] once every week for a year and a week. >> There we go. >> I'm basically an AI model. I lost my personality. >> Very effective AI model. >> That is extraordinary. >> But that works so well in sales and it's
and and the best sales people will will do that. But it's really hard to scale that and you end up getting people that reach out three times then give up. >> And when you're trying to scale something up if you can scale up that relentlessness like that is really valuable. >> So you fundamentally buy the companies will be inherently smaller in the future and that's why we're seeing layoffs. >> Are layoffs today just an excuse for overhiring in 2021 and 2022? >> I think it's a mix. Yeah,
>> I mean I think there is definitely some of that and you know it's also companies are seeing valuation boosts by doing it. So that's incentivizing maybe bad behavior but some of it for sure is that these workflows are changing. >> How big are you today? >> We're about 650 people now. >> How big will we be in 5 years time? >> Well, in 5 years we'll probably be bigger. In the short term I think we're going to be quite a bit smaller. >> Smaller? >> Yeah. We're not done yet with all of
these backend workflows. >> How does that go to 400? >> Uh somewhere [clears throat] around there. >> There's some aspects of the business that are are clinical workflows. Uh so all of our members get a care navigator um who stays with them for their entire journey and that is just going to grow linearly with our membership. So we want you to have that human point of contact that is available. But the care navigators are now getting significantly more useful because they can actually
use the agents to do a lot of the follow-up on their behalf and they're not having to remember to reach out to this diabetic member every week about X. They can kind of manage it at a population scale. And so there we're like keeping the same headcount relative to our membership growth, but just letting them do so much more than they could do before. >> That's amazing. I was speaking to a major airline where they were saying actually about exactly that that like premium care customer service where it's
like they're able to give so much more for your recommendations for you and your wife's trip to New York and everything's so perfected and tailored because all the [ __ ] that they used to do is gone and for you as the end consumer it's amazing >> and the response time the response time is so much better >> you get a response back in a few minutes that's that's the usual place where we see people ask Gwen if she's an AI is um when she responds to your email within 5 minutes because in healthcare. If you
get a response same week from an insurance company, you're doing so well. >> And people think that I'm an AI because I respond very quickly on email and to the point I'm like, no, I just have no life. [laughter] >> You said about kind of the different data inputs like, oh, you can just send us anything now. I always was like data cleansing, data structures would be the biggest inhibitor to enterprise adoption of AI. Is that totally wrong [ __ ] VC? I think if you approach it in the right
way, then the cleanliness doesn't really matter that much because the models are so good at cleaning up the data if you give them the right context. And so that's one of the things we found actually with migrating away from some of these SAS vendors is uh we we moved away from Looker um right Google's Looker product for visualizations. It's super expensive. Um and we moved to do it in Snowflake um and it's been a lot cheaper. It's worked really well. Part of that migration is moving all of our dashboards and all of the things that
fed from Looker would have taken like probably like a year and a whole bunch of engineers and data scientists. Uh we did most of it with an agentic workflow that would spin up, find the next dashboard, figure out how to convert it into what we needed and then close it down on the Looker side and boot it up on the other side. And it ended up being like a project for uh one or two people. And it took it still took a couple of months, but it was a lot more doable because we didn't have to have somebody
ingest or like figure out that data. You can just feed that data into a model and let it figure out how to structure it going forward. >> It's just really interesting cuz I you know I often think about what role does not exist today that will be massive in 5 years time. And I thought like data cleansing would be one of those roles. If I asked you what role does not exist today that you think will be very big in 5 years time, what would you say? agent supervisor. >> What does that mean?
>> One of the things we've found that's been like a bottleneck is when you launch these agent workflows, there's always things that they you don't want to let it do everything, right? So, like with our contracting or our sales workflow, like there's a certain margin threshold where the sales agent can't promise a client that we'll do it at that margin, but we don't necessarily want it to say no. we want to make a business decision about whether this is the right thing to do for that client.
>> Um, and so you end up generating this like massive list of approval requests that is now much longer than it would have been because you're doing 10 times as much work. So you're now getting even if you're only getting an approval request 1% of the time, you're still getting 10% or 10 times as many as you were last year. And so one of the things we found is like actually how do you manage all of those exceptions that now become like a really high volume. So we tried agents supervising agents which I
think works to a degree and maybe as the models get better as well you can also have like a more expensive right like if we ever get mythos and it costs $100 per million tokens you probably wouldn't use it for the core workflow but you could maybe use it as a supervisor but how you actually manage those agents at scale with like the volume of exceptions that they generate um because you don't want them just rubber stamping yes or no either way like you need a more nuanced decision there. >> If you were advising your younger
brother or sister on how to prepare for that role, what would you advise them to do to be adequately skilled to do that? >> I think just play with the models. Like I think a lot of people severely underestimate what they're capable of. um because maybe they like tried ChatGBT two years ago [snorts] and and it like they're moving so fast and they're so much better than they were even six months ago that if you're not like relentlessly trying them then you're going to significantly underestimate and then also like where
they are today is not where they're going to be clearly in a few years. So you got to skate to where the puck is going to be. >> Where will they be in a few years? >> Ahead of humans on most capabilities. >> Are you excited? [laughter] Yes, cuz I think that opens up so many possibilities like unlimited intelligence. >> Are you not worried about in the short term societal unrest, labor displacement and what that will do to a hollowing out an inequality increase in the US? >> I think that can be dealt with by
significant action whether or not we do that or not. >> What significant action would you do to mitigate that? >> I mean, I think eventually some version of universal basic income. >> Really? >> Yeah. and you buy that works. >> I mean, I think we have to build the social structures that give those people purpose and meaning outside of work because I don't think that we're going to have and I also I don't think that's a bad thing. Like a lot of these mid-level jobs that are being replaced
are awful jobs. They're people sitting at a desk with like fluorescent lamps shining at their face reviewing random paperwork. Like that's not what people like, you know, when you're little and you say, "What do you want to be when you grow up?" I want to sit in an office and rubber stamp insurance forms. Like it's not a good job. >> I would be worried if my child. >> Right. So these are not like it's not like you're taking some like super aspirational thing away from people. I think these are jobs that we'll look
back and say, "God, I can't believe we had people doing that kind of work. That's crazy." >> You know, I I walk with my mother a lot and I always say my job is to invest in the things that we say, "God, I can't believe we used to do it that way." I [laughter] said, "Do you remember? I would never put my credit card on the internet or you'd never find your like husband on the internet. >> You'd never get in a stranger's car and uh and have them drive you where you want to go. >> What is insane today that will be
incredibly d obviously you have your card online, obviously you meet your partner online. What is insane today that you think will be like obviously in 10 years? I think empowering agents to do things on your behalf. Like we've seen internally getting the team I think like uh Isaac our our CTO and co-founder and I have like trusted the agents faster than most of the team and we're okay like giving the agent authority to do things like it was a big internal dispute getting the agent to sign these contracts. So the agent opens Docu Sign
and clicks the sign button and it's legally binding and it has my signature on the page. And getting that like figured out internally was very it took a lot of rounds of convincing people that that was okay and that we could do that. And so I think it will take time for people to trust these agents with stuff like you know give it your credit card and let it go book a a holiday, right? like getting getting people to trust it acting on your behalf I think will take longer >> but I'm thrilled that you signed me your
house for $12. >> Uh do you worry about the concentration of value when you look at the Mag 7 providing 85% of gains here today in stock markets and then anthropic open AI maybe one or two more. Do you worry about that concentration of value? I'm quite bullish now because I think a lot of what's going on in AI is going to massively boost earnings in other areas of the economy that have struggled to grow earnings any other way. Like if you're health insurance, >> like health insurance, like how do you
grow health insurance earnings? Well, it's been or you go chase government business and you pay a bunch of lobbyists to get the government to overpay for care. That's all now backfired and all the government business, Medicare and Medicaid is now like a bad business and they're all losing money. Everybody has insurance. So unless you're going to increase the total spending, how do you grow earnings? Well, if you can make it more efficient so you're not spending 9% of your premium on admin tasks, that's a
way you can grow earnings without having to deliver a worse product. >> You're in a really good business as well cuz it's like unwaveringly not in the path of the model providers as well. >> Yes, I not going to start an insurance company. in the past like we're big invest in wallets which is like business [clears throat] banking like anthropics is not going into business banking >> in Southeast Asia [laughter] >> I would be surprised I think things that have some like regulation around them
and are like complex industries yes they're going to see the advantages of the models but they're not going to see competition from anthropic or open AAI >> I totally get that when I listen to you I'm like Jesus if I was you I'd also take a chunk of my money and invest it actively into anthropic um can I ask you have you taken secondaries along the way? >> Uh no, no, we haven't sold any secondaries. We did uh there was a dividend at the end of co we paid out some uh all the investors got uh 10x
their money back uh before we started the health insurance company and then they still have their shares today. >> We haven't sold any secondaries now. >> Are you [ __ ] serious? They got 10x their money back and then they kept the shares. >> We didn't have that many investors but yes they they all did well. >> That is an amazing deal. [laughter] 10x and then you keep the shares. Yeah. >> What? >> Well, I think that's why we've seen them double down, right? It's like they made
money with us before and so, you know, this last round was was led by insiders. >> And how big was the last round? >> 150 million. >> What was the prize? >> 1.3 billion. >> Wow. Nice round actually. Not too much dilution. Enough that it's really impactful cashwise to come in. >> Wow, dude. That's insane. So, can I ask you then personally? I asked this actually, do you know Josh Browder? He's another Brit in the valley. Okay. Um, a phenomenal guy, but like when you look
at your personal allocation today, given our insider access and what we know, >> is there anything funky that you do with your money >> outside of of curative? Yeah, >> I invest primarily in companies of people that I know and I do very little investing if I don't know the founders. >> Does that work well? It's had mixed results, but some of them are too early to tell. Some of them are the best investment. they're all they're all a bit too early to to tell. [laughter] >> Do you have any energy investments?
>> Uh, yes. So, there is a company that um I co-founded with my wife, Subcritical, that is um in the nuclear fision space. So, this was based on an an idea that I had a few years ago that um we need more power and that nuclear is a really good way to do this. Uh and it started off actually as looking for an investment. This was like one of my f first times I was like we should find a company that's doing nuclear power and try and invest in it and see if we can make it go faster. Um because I kind of thought
I'm pretty good at making things go faster in really regulated spaces. Like that's kind of what I'm what I'm good at. >> That's your thing. Yeah, that's my thing. You know, everybody's got to have a thing. >> And so, >> is that your hook on the first date? Regulated industries make a good first hook on our first date. So, after our first date, we both shared our genome files with each other, our VCF like um and so she said she'd done this before and the guy thought it was really
strange and we both were like, "Oh, we should share our genomes and then, you know, compared and check that we were compatible so it was worth having a second date." And we were both totally into that. So, we We knew it was meant to be. We were compatible by genome. >> We have two beautiful kids, so we uh we knew it was meant to be. >> I'm sorry. If you're incompatible by genome, you have like a >> If you both have like the same >> You have a ginger child. >> Well, that was a concern. My brother is
ginger. So, I carry the ginger. >> My brother is ginger, too. Yeah. >> We We don't see him anymore. We took him to the woods and said, "Run free." >> Makes sense. Yeah. [laughter] So, I do carry the ginger gene. And if she had carried the ginger gene, that would have been a deep concern. but she luckily doesn't. And so that was that was one of the key tests. >> You progressed to the second date. >> Yes. So we made it to the second date. >> What does no one know about nuclear that
everyone should know about nuclear? >> That it is very safe. I think and that it's not a science or engineering problem. Like that was when when we started looking at companies to invest in that was for me that the thing that I was sort of disappointed by is everybody was approaching it as if nuclear is this massive engineering challenge. And sure like the engineering is hard. It is complicated. But fundamentally we have built safe nuclear reactors since the 60s. They work great. The technology has
not really changed or progressed since then. We know how to build these. That's not the problem. The problem is that due to a lot of the anti-uclear push in the 80s, we have had a regulatory environment that has been incredibly restrictive and difficult to get new nuclear reactors built particularly in the US but also worldwide. Uh there's been this push to say how do you guarantee that under any possible circumstance like once in a million-year events that you will never have anything go wrong. And in traditional nuclear
that is very hard to guarantee. In traditional nuclear one of the reasons it's difficult you're basically balancing on this knife edge. So in a reactor you have uh what's called criticality right which is where you have to produce enough neutrons each generation that they go off and do exactly one more reaction and it keeps itself going. If you get too much of that too many neutrons it's a bomb, right? It will be a runaway reaction and it will blow up. That's very bad. that's only ever happened once by accident,
which is Chernobyl. Um, all the others have been not criticality events. Um, so you don't want that. If it happens not enough, then it just turns off. So if you go too far below this exact 1.0 threshold, you get no power out. And so you're trying to balance perfectly on that knife edge of exactly 1.0 where you can control it. And that is a hard problem to guarantee. And this is the fundamental issue with nuclear regulation. How do you guarantee that under no possible circumstances will you deviate from that perfect control?
And so I was initially pretty disheartened. I was like, well, we're not going to get new nuclear power. This is not going to work. And then I stumbled on this idea of what's called the energy amplifier. And it's not a new technology. It's been around since like the late ' 80s, early 90s. It was really pushed by a guy Kar Rubia who used to be the CERN director. He was a new uh Nobel laurat in physics. And the idea is you always operate below that 1.0 threshold. So we are designed to operate at 0.97.
So that means you never have enough neutrons to keep the reaction going. The reaction will always fizzle out. So no matter what you do, it's going to fizzle out. But normally that would mean you get no power output. What you do in the energy amplifier is you point a really powerful particle accelerator at that fuel and that puts in the extra neutrons to drive the reaction forward. But if you turn that accelerator off, all of your energy output just stops. And so you basically have this big onoff switch
where you can control fision and you can guarantee that no matter what you do to it, the fision will never run away. Even if you put in 10 times as much power from the accelerator, it will never run away. There's nothing you can do to it to cause it to go critical or to have a criticality accident. And so it's a fundamentally safer way of doing nuclear fision that is just approaching it from a different angle. How will the composition of our energy providing change in the next 5 to 10 years? Like will nuclear be a
demonstrabably larger part of energy provision than it is today? >> Yes, I think what we're seeing kind of all across the supply chain in nuclear is a push to get more nuclear online. Um and I think you know Subcritical is kind of leading the way there with a faster path to market than any of the other players. Uh but there's a lot of people working on deploying a lot of new nuclear power >> which current provision will diminish significantly. >> Um I mean I think any power from coal
will will mostly go away. I think you're still going to see a lot of gas just because particularly in the US it's cheap, it works, it's fast, but I think coal is going to go away. Um and then you're just going to see more of everything. What company will be larger, curative or subcritical? >> Subcritical. Yeah. >> Or subcritical. >> That's a great question. Um, curative has a larger market opportunity, but I think they're both >> has a larger market opportunity. >> Yeah. I think they're both, you know,
>> power generation. >> Yeah. The uh US spends or US employers spend $1 half trillion dollars a year on healthcare, which is that's our like direct TAM every single year. >> How much does the US spend on energy? through energy that can be addressed through um through nuclear. It's a similar order of magnitude. >> I mean, you chose good ts. >> They're both they're both yield optimization. I feel like you've really really taken this >> I figured out the TAM thing. [laughter]
No, they're both like trillion dollar opportunities if we execute right. >> [ __ ] >> Wow. We're also seeing AI on the on the nuclear side in the design >> because design is like traditionally a thing that is done by a whole bunch of people sitting doing drawings and mechanical engineering >> and the models have gotten really good at that. And so we're seeing that you can do the design with far fewer people using AI to optimize a lot of the design parameters where historically you might
have needed a hundred mechanical engineers to design every single nut and bolt and part. You can do it with with 20 really good mechanical engineers that are designing the critical pieces, the important pieces um and overseeing the AI on like well I need a little bracket that joins this piece to this piece that doesn't need a human to design that. I was actually meeting a company the other day which basically said like you know the challenge with hardware engineers is they don't often know what software
engineering and the beauty of today is like we've turned hardware engineers into software engineers overnight. >> And that's amazing. >> Well, it's another place where we saw like codegen as the solution and I think you know this is one of the bets anthropic made and they're totally right on. You can generate really good CAD models by having it write Python to make the CAD model. like it's not good at necessarily good at like 3D space visualization or outputting a drawing um right as as vectors but it's really
really good at generating plausible Python code that can draw that part. >> It is the most exciting time to be alive in many respects. >> Yeah. Yeah. Well, that's why we ended up starting Subcritical is I you know very busy running curative but that was an idea that was just too important to pass up and there was nobody else. So uh the only one that is under like active construction of those systems is in China based on a US design from the 2010s that the US stopped working on after Fukushima.
>> How much money do you need to make subcritical significant? >> Uh well each one of our deployments would be about a billion dollars of construction cost for a 300 megawatt facility. So it's but it's not you know it wouldn't be the same like you wouldn't raise that as equity. It would be a mix into the plant of equity and debt. So, it's a different kind of it's more infrastructure build financing. >> What do you know now about marriage that you wish you'd known at the beginning?
Seriously, like it's an amazing thing to build a company with your wife. >> It's a challenging thing as well. >> How do you make it work? >> So, I we're very well matched, I think, is one of the things is we basically never argue. And that's, you know, how I knew very early on that it was meant to be is we're always on the same page about things. And so it's actually very easy to run a company together uh because we're we we usually see eye to eye on like how something should be
done. >> Fatherhood. You said two kids. Two kids. Two and a halfyear-old and 6 months. >> Anything that you would advise a new father knowing what you know now? >> You should definitely have kids. Don't wait. I mean I think there's too much like um sentiment of people. Oh, you know, live your life and wait until you're in your, you know, late 30s and then have kids. I think no, like have kids early when you're have the energy and can run around and not sleep and it's one of the best things you'll ever
do. You should just get on with it. >> Okay, we're going to do a quick fire. Sound good? >> Dude, that was the most uh twisting and turning conversation ever from like the proliferation of STDs to fatherhood and nuclear. I mean, really, we crushed it. What have you changed your mind on most in the last 12 months? >> I think probably a year ago I have changed my mind that there are workflows that can't be done with the models with today's models. I think today the current gen models can do every back
office task we have at curative it's just a matter of deploying them like getting them set up getting them configured having the right policies and and I think a year ago I thought there was opportunity I thought there was things we could do but I don't think I would have said you could do every single one of our current back office flows >> what one change would you make to Europe if I made you president of Europe in this very strange title to stay in the brace for competitiveness. >> Uh you have to have some kind of like
burden for passing regulation. There needs to be some penalty. Like right now you pass a regulation that's like okay you you did a good job. Like the goal is to pass regulation. There has to be some penalty. Like the if you pass regulation your country must pay some tax additional tax for having passed that regulation. just adding and adding and adding uh without like refining what you've got today and like really going and digging in how is this regulation affecting things on the ground like just
more additive regulation is bad. You need to be looking at the effect of what you've done and refining it and iterating on it and not just trying to add some new landmark regulation. >> It's very anti-European Fred. You're not going to [laughter] do anything. You're not going to do very well here for a reason. I mean, you know, I'm a Texan now. Um, uh, Mark Benio said he spent 300 million on Anthropic. Equated across the developers that they have, it works out to be about 3.8% of developer salary
spent on Anthropic. What do you think total percent of developer salary spend will be on anthropic in 3 years time? >> Between maybe two and 5x be the two and 5x salary. I think that's probably >> 2 to 5x is the whole salary. >> Whoa. So from 3.8% 8% of salary to >> Yeah. Because I think the way I mean the way we're driving workflows is that you have one senior engineer managing a bunch of downstream agents that are actually doing the work. And then we're now getting to the point we have like
mostly unsupervised agents taking feedback from the team on things, implementing features, and then the the engineers are coming in and actually checking that what it built makes sense. So they're becoming more the reviewer and like the architect. And then you have these downstream >> doing the two to five. I mean that's not like 3.8 to 20% [laughter] 50%. If it's 50% anthropics like a 20 trillion >> Yeah. I I think that that's what the workflows will be is people are people are going to be deploying more agents
than engineers and they're going to keep the same number of engineers. We're just going to build a lot more. >> Going to message my friend to let me into that new anthropic round. [laughter] Just message Larry. [snorts] There we go. Uh, what's the kindest thing anyone's ever done for you? >> I think when I first was getting started, there were a lot of people that helped make it be possible to move to the US and kind of like made a bet on a kid coming from the north of England to come to Silicon Valley. some of the
earliest investors. Um the guy Josh Buckley who, you know, was one of the first in guys who invested in us during the YC batch just because he liked what we were doing and he thought it was it was cool. But, you know, being willing to kind of take a bet on a kid, >> you know, Josh is like my best friend. >> I didn't know that. I haven't seen him in a while. >> Yeah, I I say hi to him. >> I I speak to Josh every single night. >> Okay. uh barring say Christmas. >> All right. Well, he he invested in cows.
>> That is amazing. >> And then STDs. [laughter and snorts] >> Oh, you know, investor Mark. That's amazing. I didn't know that on Josh. >> Yeah. He like a month into the YC batch like came by the lab and was like super supportive of what we're doing. And I think just coming from like the British background, we couldn't even get meetings with investors >> and he was young. I mean, >> he was Yes. But to get I mean he'd been through YC and like had a successful company and it was just awesome to like
have someone like that take a bet on what you're doing. Coming from the UK where I was used to like the cold shoulder and no one was interested in what I was building and you know no one wanted to take a meeting. [laughter] >> That makes me so happy to hear. Okay, final one. What's the best advice that you've been given? I think one thing that I have learned is to always try and get a lot of different perspectives on a problem. Um I think I I would historically have sort of approached things from like one scientific
viewpoint and sometimes people would say [clears throat] no like take a step back and think about that problem more broadly. And one of the things I learned during the curative co push is we had to bring together a bunch of people from very different backgrounds. We hired a bunch of former military people who were just like incredible at deployment, but they speak a different language. And then we're trying to get them to talk to scientists. And then we hired a bunch of Silicon Valley developers. And they all
like think about the problem. They're all trying to solve the problem, but they all come at it from like a completely different perspective. And a lot of times I wouldn't have considered, you know, that point of view on doing it. And I think what I found is that the more of those perspectives that you can kind of get on a problem, the closer to ground truth you get. Like you're never gonna no not one of those people is going to give you the ground truth. But if you hear a lot of perspectives, you
can kind of get to that ground truth faster. >> Fred, that was the most extraordinary show that I've ever done in [clears throat] breadth, depth, uh, variance of conversation. Thank you so much for joining me and it's so great to do it in person.