S3T Dec 29, 2023 - Year in Review: Healthcare, Crypto, AI, the Great Exhaustion, WPA Guides...

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Special Feature: Looking back on 2023: key developments with the biggest implications for the year ahead.

CONTENTS  

• Healthcare: GLP-1s, Telehealth, and increased urgency for change
• Crypto Turnaround: economic and political implications
• AI: Massive hype, then chaos and lawsuits
• The Great Exhaustion & the new role of office space

Healthcare: GLP-1s, Telehealth, and increased urgency for change

Healthcare costs rose in line with inflation in 2023 per this study of the prices of CMS's so called 500 Shoppable Services. Healthcare costs are projected to rise 7% in 2024.

One big cost driver: The discovery that glucagon like peptide-1 (GLP-1) agonists can help address obesity - being heralded as a major scientific breakthrough as the new class of drugs brings both results for patients and disruption to the market. You may have heard of some of these - they go by names like Ozempic, Wegovy. Trulicity. See also:

• Goodrx comparison here with details on how to understand the options.
• Cleveland Clinic medical explanation of how the drugs work, and their side effects.

At the same time, confidence in healthcare fell: In spite of the rising costs, the percent of Americans who believe in the quality of American healthcare fell below 50% in 2023 (The lowest in 2 decades).

Healthcare transformation had mixed success:

• Venture backed healthcare had a rough year. In addition, two trends - retail healthcare, and multi-omic precision medicine - do not seem to have played out as expected in 2023 although solid progress happened on the research fronts. (Also See Slides 12-13 in this presentation for more context and forward looking views on healthcare VC).
• Amazon rolled out a Primary Care Telehealth service. Amazon Prime members can access unlimited 24/7 Telehealth consultations for $9 per month.
• One key development that didn't perhaps as much attention as it deserved: Best Buy Health (yes, the Best Buy you got your TV or laptop from) is quietly moving into a leadership position in home-based care.
• Value Based Care began to be put forward as an enabler for Population Health - an interesting and potentially tricky switch:
  • Value Based Care has been implemented to incentivize providers to drive health outcomes for the specific group of patients attributed to them.
  • Leveraging Value Based Care to drive Population Health in a meaningful way for communities would mean incentivizing providers to drive health outcomes for members of the community who might NOT be attributed to them (or any provider).

As noted by Rita Numero in this recommended opinion piece, the urgency for meaningful healthcare transformation is building.

Crypto Turnaround: economic and political implications

Digital assets and blockchain based projects are clearly back in a bull market hype cycle after suffering through the crypto winter of 2022 and early 2023. The new round of bullish sentiment is perhaps best summed up here by Michael Saylor's remarks here (see excerpt in the callout below):

• Inflation is driving BTC adoption
• Confluence of bullish milestones over the next 6 months: the halving combined with the anticipated ETF approvals the industry hopes will happen in Q1.

Saylor pioneered the use of Bitcoin as a corporate treasury asset, and it will be interesting to see how much Bitcoin and other digital assets return to mainstream use in 2024. I do expect to see some significant new financial innovation emerge in 2024 as blockchain based architectures (and the digital capital and decentralized governance structures they enable) converge with AI.

The wildcard in this will be regulatory clarity, which brings us to the 2024 elections.

If the 2024 elections are close (and many indicators suggest they will be), then political strategist on both sides need to consider the very real possibility that the Democrats are in danger (thanks to a few loud voices that do not represent the broader consensus) of coming down on the wrong side of the crypto debate and handing the Republicans fresh relevance and a set of victories at state and national levels. (Speaking here as a left leaning member of a diverse family which spans the political spectrum).

AI: Massive hype, then chaos and lawsuits

The first half of 2023 saw tech firms and investors alike adopt extremely optimistic views about the utility of GenAI.

Now at year's end, OpenAI is recovering from its organizational meltdown, tech companies are finding it difficult to get returns on their AI investments, and the New York Times just filed a lawsuit against Microsoft and OpenAI for copyright infringement, claiming that its content was used by OpenAI to train its GenAI capabilities. Read the 69 page lawsuit complaint here.

OpenAI has evaded questions about training data, but some researchers found ways to trick ChatGPT into revealing at least some of its training data (one extraction example here).

Forward view: AI is here to stay - it will increasingly just be part of the world's operational plumbing going forward. It will continue to drive disappointment, dilemmas and risks, even as its powers and capabilities continue to improve. In 2024 AI won't likely be the driver of headlines that it was in 2023 except when it poses new problems.

Historic context: Big Tech has a history of appropriating/capturing data and creative work published via social media or web sites and then using this material for their own profit. Using web content to train AI models is not the first case of this pattern:

• Find an asset that isn't protected
• Appropriate it then incorporate it into a product or service
• Wring out big profits

Before GDPR driven reforms, Big Tech did this with personal data as they built their large platforms and billion-dollar business margins: taking advantage of the fact that the legal system had not yet evolved to protect the data and privacy of individuals. It's ethically similar to the historic appropriation of Indigenous lands and resources simply because they happen to not be under the protection of a recognized regime.

The Great Exhaustion & the new role of office space

First the Great Resignation, then the Return to Office wars and now the Great Exhaustion. Cal Newport uncovers evidence that knowledge workers are exhausted due to the drains of constant interruptive digital communication, in some cases made worse by demands (of some employers) for more frequent commutes or travel to the office.

Return to Office (a campaign backed by real-estate interests facing empty downtowns and a severe correction in the commercial real estate market) is being replaced by a hybrid approach that uses corporate space for specific purposes vs the default hub for all work. The issue has driven closer examination of what works for workers and productivity (see Cal Newport's piece above, and the lively Y-combinator discussion here).

Evidence suggests that workers are still navigating how to balance their work and home lives. In practice, even the mildest Hybrid work arrangements mean that more people will have to find ways to work on airplanes, buses and trains, and or participate in calls while driving their cars.

Further Reading

• NBER: Why Working from Home will Stick - review of the tangible benefits of remote work.
• NIH: Leader Perspective on Remote Work - found a link between remote work benefits and the effectiveness of managers.
• Nature's 2021 study on effect of remote work on communication seems to underscore the need for remote workers to be trained in effective collaboration and communication.
• Nature's 2022 publication of the impact of videoconferencing on idea generation noted that as "virtual communicators narrow their visual scope to the shared environment of a screen, their cognitive focus narrows in turn." (So use earbuds, walk around during calls, and limit use of video?).
• Nature's 2023 publication of findings about remote work and innovation suggests that more innovative work is best done in person while more process driven work should be done remotely. Possible time-bias: the research bases its findings on a comparison of how "ground-breaking" different research papers were (but most papers were written before the widespread remote work conditions imposed by the pandemic). If so, not the first instance of a flawed review process for Springer Nature.

Lay of the Land: The WPA American Guide Series

Book lovers will find fascinating travel trivia and deep background on American politics in this little known canon of Americana, now available online.

During the Depression years, the Works Progress Administration (WPA) commissioned a project to write a set of volumes detailing the eccentric and essential things to know about each of the 48 United States that existed at the time.

The project also produced guides to selected regions and cities. The project provided employment for approximately 7,000 writers unable to find work during the great Depression.

Reading and finding the guides

• Read the guides online: Wikipedia keeps a complete list of the state guides with links to their digital versions.
• Buy your own physical set: Here is what the entire physical set looks like (a listing of a set for sale with photos, available as of Dec 2023).

Social and political relevance

If you want to know why US political conflicts evolved the way they did, its good to look at history and where possible the messaging used in official publications: how those in positions of privilege (and those approving what was published) explained things to themselves and to the public.

These books - with their mix of travel tips, trivia and history offer a rare time capsule glimpse into early 20th century mindsets; how writers in "official" publications spoke about the realities of American life in different regions of the country. For example, the Alabama guide opens with cheerful depictions of life in Birmingham under Jim Crow laws.

The books comprise a treasure trove of lore about states and cities, as well as deep background on the attitudes, and character of different regions across US.

Getting Ready for 2024

• 3 Questions that get you ready for the coming week - a weekly quick guided exercise you can do each weekend to sharpen your effectiveness and get the most out of each week.
• Reading List: Setting Goals and Driving Change - List of books offering different angles and insights to fit specific challenges a person is having with setting and achieving goals. Take a look a the short descriptions to see which book might be the best recommendation for you or someone you want to empower.
• Why Change Leadership is the most important skill of the 21st Century - Historically, change leadership and innovation was presumed to be the responsibility of a few rare individuals. Today we are in a very different situation.

Want to learn more? Take the Change Leadership Challenge: The Change Leadership Learning Series is a set of lessons you can go through at your own pace.

Final note for 2023

I hope this message finds you well, as we approach the end of another challenging year! I want to take a moment to express my deepest gratitude and admiration for your unwavering commitment to leading change and innovation. The fact that you take the time to read S3T and put its insights into practices sets you apart as a committed change leader.

The journey of a change leader can be filled with ups and downs, and often uphill battles. But I want you to know that your tireless efforts matter - perhaps to people who may never be able to thank you personally. But you will have made a life changing difference for them. In their quieter moments of reflection, they'll realize, someone must have sacrificed and worked tirelessly to make this possible.

In the challenges you faced this year, every hurdle is a valuable lesson learned. Each setback is an opportunity for growth, and every moment of doubt is a chance to strengthen your resolve. The skills and insights you've gained through your struggles will serve you well in your future achievements.

Thank you again for your commitment in 2023. Know that your work is making a significant difference. Your leadership is a beacon of hope and a catalyst for change.

Looking ahead to 2024, I am confident - and you can be confident as well - that your efforts will bear fruit. Your impact on the community and the world of innovation will continue to grow, and inspire others to follow in your footsteps.

Wishing you a peaceful New Year's weekend, and looking forward to the remarkable achievements that await us in the coming year.

With heartfelt gratitude and warmest regards,

Ralph

Opinions expressed are those of the individuals and do not reflect the official positions of companies or organizations those individuals may be affiliated with. Not financial advice. Authors or guests may hold assets discussed.