How to Find $100M+ Startup Ideas in Any Market | Counsel Health, Muthu Alagappan

1. 0:00 – 1:26

   Intro

   1. MAMuthu Alagappan0:00

      The Stanford commencement speech was a really exciting time because it marks the end of medical school. One of the things that I think medicine has really taught me is the ability to identify out of twenty patients you may be taking care of, who are the one or two patients that need all your attention right now, and how do you really focus in an outsized way on the couple of problems, in this case, patients, that matter the most. I think being a founder is very similar, where when you're looking across maybe twenty fires of the company, having the ability to figure out what are the one or two that you are most well-suited to solve and contribute to. So it's really a matter of prioritization and of knowing where to really pour your energy into at any given time. I think one piece of advice that's really helpful is where are my unique strengths most suited to have the most meaningful contributions? My name is Muthu Alagappan. I'm a physician by training, but spent the early part of my career as an AI researcher at Stanford, and have spent the last many years building health technology companies. I'm the founder and CEO at Council Health. Council Health is an AI-enabled virtual care company. We're redefining virtual care for the modern era, and our hope is that we can multiply the world's clinical capacity by creating perfect doctors to deliver the highest quality care to the next ten billion people, what many patients describe to us as feeling like they have a doctor in their pocket. We're really excited to announce our twenty-five million dollar Series A co-lead by Andreessen Horowitz, a16z,

2. 1:26 – 4:29

   The Day I Knew I Had to Quit Being a Doctor

   1. MAMuthu Alagappan1:26

      and GV. Growing up, I had a speech impediment where I couldn't say the letter R, and I distinctly remember sitting in class and hoping the teacher wouldn't call on me to read out loud the sections. And I, I actually remember counting the number of Rs in a given sentence to see which sentence I should volunteer to read to avoid, you know, being embarrassed. Later in my life, did a lot of public speaking and speech and debate. And to me, that was mostly a form of building conviction in a growth mindset, and the idea that just because something is broken or doesn't work or isn't the way you want it, doesn't mean that it can't be solved. And in a way, that personal lesson of going from something becoming an impediment to eventually being a strength. So I grew up in Houston, which is the home to the world's largest medical center, another place with some of the best cancer hospitals, teaching hospitals, medical schools. And when you grow up in that environment and you still see cracks in the foundation, you still see misdiagnosis, challenges with access, wait times, diagnostic errors, you start to realize that even the best that we've ever created, the best medical centers, the best hospitals, the best doctors, are still not quite at either the quality or capacity that we need to serve the broader, uh, US and, and global healthcare needs. There's a couple of times where I've felt the way we practice medicine today is just not good enough. And I remember many times being in clinic as a primary care physician, having a patient sit in front of me and explain their problems, and knowing that there is some limitation I have in my memory, my recall, in my ability to connect the dots, that was preventing me from helping this person in the best way possible. Humans, we're working off fallible memory, off logical and cognitive biases. We may be hungry before lunch, and that's making us feel rushed with a particular patient. You're dealing with life or death decisions, patients being rushed in with a heart attack, being alone in the ICU at two AM with a patient whose blood pressure is falling and who is not responding to any medications. How do you comfort a family member who's grieving the loss of their son or daughter? And it felt like all of these were shortcomings. You know, I often felt guilty at the end of each clinic day, realizing that if I had a perfect memory, if I had read every journal article, if I had infinite time, I could help these people so much better than I was. I remember practicing medicine and wanting to have an impact on people, but feeling like that impact was constrained to one patient at a time, one visit at a time. I've been fortunate in my career where I've gone into the depths of both clinical AI and AI research, but also the practice of medicine, having two depths of experience, one in AI, one in medicine. And one of the things I was really excited about when transitioning from clinical medicine into technology was the ability to scale impact, the ability to help people not one at a time, but at a large magnitude, where a single software application, a single new algorithm, a new technique, could suddenly help millions of people or billions of people. And that's what first led me to move away from daily practice in medicine to helping build technology companies that could have this large-scale paradigm-shifting change on healthcare

3. 4:29 – 7:17

   Stop Improving a Broken Idea (Do THIS Instead)

   1. MAMuthu Alagappan4:29

      overall. Many of the AI solutions being worked on in healthcare were improving doctors' capacity by maybe ten percent or twenty percent. But what that actually translates to then is instead of seeing four patients an hour, you're maybe only able to see five patients an hour. And while that is a meaningful improvement, we felt like it wasn't enough to truly make a difference in the access to care, in the quality of care, in how personalized care was. Speeding up doctors by twenty percent wasn't gonna solve that problem. And so we really wanted to go at the root cause of the problem, which is not how do you do administrative work faster, but how do you actually deliver care itself faster, higher quality, more personalized. So we set out on this mission to think in multiples, not percentages. What does it look like to ten X the world's clinical supply? We had a choice of do we wanna build software that tried to practice medicine on its own or one that augmented existing doctors? And we felt really strongly that the right care model here would be one that combined AI with human doctors for supervision and guidance such that you get the best of both worlds. We believe either alone is insufficient. AI-only chatbots have the problem of hallucination, a lack of supervision, and a lack of ability to actually action on the advice they give. And human doctors have the fundamental laws of physics that constrain their ability to see enough patients with enough quality in a given time. We started thinking about our AI augmentation as a sort of Iron Man suit for our clinicians. Imagine a physician that can supercharge their own abilities, you know, essentially obtain these clinical superpowers by using our AI platform. They could suddenly remember every article they've ever read. They could review a patient's chart, even if it's hundreds of pages, within seconds. And the other unique thing about Council is that we built our own physician group in-house. So today, we run and operate a fifty-state medical practice with our own employed physicians. And the reason that's important is it means we control not only the Iron Man suit, but the Iron Men and Women themselves, and we can truly create the best combination of human and AI working together. Many patients describe to us as feeling like they have a doctor in their pocket. I've often tried to make decisions, where are my strengths, was really important to solve some of the hardest challenges ahead in the world of clinical AI. It's because these problems aren't specific to a single domain. They sort of cross over between both domains. It requires you to understand how do doctors do it today, but also requires you to understand the art of the possible with AI. If you only understood one of those two disciplines, you would be fundamentally constrained both in the creativity but also the depth of the types of solutions you could create. We all have different strengths, but where are my unique strengths most suited to have the most meaningful contributions? In startups, this is often called founder market fit, but where are you as a founder best suited to solve a particular market challenge?

4. 7:17 – 9:04

   Choose Only One Important Thing or Achieve Nothing

   1. MAMuthu Alagappan7:20

      One of the things that I've found as a founder is there are always so many fires, so to speak, going on at the company or in the business, and it's really impossible to devote your full attention to all of those fires at one time. And if you try, you end up doing a subpar job across the board. One of the things that I think medicine has really taught me is the ability to identify out of twenty patients you may be taking care of, who are the one or two patients that need all your attention right now, and how do you really focus in an outsized way on the couple of problems, in this case, patients, that matter the most. When building a company like Council Health, there are two themes constantly in tension. One is the medical theme and premise of do no harm, the Hippocratic Oath, and the other is the startup adage of move fast and break things. The idea that only by taking risks and moving quickly can you truly unlock innovation at scale. When building a medical AI care delivery platform like Council, those two things could be at odds, but we found a really elegant way to resolve them. First and foremost, we focus on do no harm. How do we ensure that everything we deploy, every aspect of the care model, not only has physician supervision baked in, but also has been evaluated and tested to be high quality, safe, and at the very least, exceeding the performance of the world's very best doctors. At the same time, because we have an in-house physician group, we're able to safeguard our AI, where we can have our AI take risks, be more innovative in the way the AI is suggesting diagnoses and reviewing the literature, knowing that all of those things will be safeguarded and supervised by a physician in the loop. In that way, we get to enjoy the best of both worlds. We get to make sure the end patient experiences no harm. Yet at the same time, we can have our AI push the boundaries of what

5. 9:04 – 10:45

   The ONE Thing I had to Tell Stanford

   1. MAMuthu Alagappan9:04

      AI is capable of. The world as we know it in healthcare and most industries will probably change fundamentally over the next five years. There's going to be a massive reshuffling of norms and paradigms. The way we interact with a lawyer, a doctor, an accountant, even an investor, will change greatly in the next five years. We even wonder sometimes, will we tell our children in twenty or thirty years about this concept of primary care doctors, and will they look at us with sort of admiration and wonder, uh, at this idea that there was only a single person and they didn't really remember your medical records, and if you traveled, you couldn't really get access to them. And maybe one day that'll all feel a bit, uh, old-fashioned. Not solving perhaps for the next five years, but solving for what the world will look like as a result of this reshuffling. If it's the case that everyone is accessing care via their phone, what does that mean in terms of computational and video needs on a phone? What does that mean for how we structure pharmacies? Don't act like you hit a triple when you were born on third base. While today is a celebration, I think it's also a recognition that in one way or another, we were all born on third base. You know, so many of us are born with so many things that we're fortunate for, that we've been sort of gifted. And in my mind, I view a lot of that as a responsibility to then give back, not just proportionally, but even in an outsized way. And so I think a lot of what motivates me is giving back in a way that feels outsized to what's been given to me in terms of opportunities, in terms of the people I've met, the education I've been able to receive. [outro music]

Episode duration: 10:45