Amazon’s lessons on building an invention machine; the economics of risk-contracting programs; Twitter subscription

Hello, welcome to this week’s Double Take on product, health tech, and digital media. 

We’ve finally decided to re-design our kitchen this year (hopefully summer). As part of the discovery phase, we organized our project with pictures and measurements in a Notion page to share with designers and contractors. It’s made it so much easier to communicate our plans and get quotes. Vendors were impressed by the format. That’s got me thinking, home renovation is another traditional and opaque industry where consumer experience could be significantly enhanced with modern tools. Any related startups you’ve come across?

One year into the pandemic, self care has been brought to the spotlight quite a bit. Self care doesn’t mean just meditation and “treating yourself”. Making self care tactical means having boundaries with ourselves and with others.

✨ Inspiration

We try to use the talents we do have to express our deep feelings, to show our appreciation of all the contributions that came before us, and to add something to that flow. That's what has driven me.

- Steve Jobs

Now onto the regular programming 👇


💻 Product

  • How to Build an Invention Machine — 6 Lessons That Powered Amazon’s Success. Working Backwards is a new book that shares stories and techniques of how Amazon built its invention machine. Bryar and Carr were ex-Amazon executives who worked with Jeff Bezos and ran large projects such as AWS, Prime Video, and Amazon Music. This review summarizes the 6 main lessons, from going slow to go fast, to taking a contrarian approach of innovating around customer’s needs instead of your skill set, to understanding the input metrics for customer success.

  • Diagnose with data, treat with design. Data alone or intuition alone are not enough to make the right product decisions. Being data-informed means paying attention to objective facts beyond intuition. Data doesn’t always tell you the why. Design intuition helps discover the problem and explore possible solutions. 

  • Shared language over processes. Most companies have a common process that treats all teams in the same way. But different teams and projects are often solving different types of problems in different stages. It’s more important to develop shared language rather than shared processes. Effective teams are able to use a shared language to describe differences in how they work and where they can standardize to add value. 

  • 6 diagrams to explain Product Management concepts. Here are my two favorites. The product manager bottleneck: don’t become a dependency for the team, facilitate meaningful interactions without you. The rock-pebble-sand throughput: plan a mix of large, medium, and small work, so that it allows you to be flexible with shipping value consistently.


📠 Health Tech

  • The low profile IPO of InnovAge makes a great study of the economics of value based care. InnovAge is the largest PACE (Program of All-Inclusive Care for Elderly) provider, ie. nursing home alternative for frail, elderly patients on a capitated-care model. It covers 6600 patients and has 10-15% EBITDA margins, which is quite high for risk-baring providers. Dan O’Neill’s thread highlights how much money lies in these risk-contracting programs. More in the S-1.

  • Digital health consumer adoption report. Rock Health’s annual digital health report shows that more consumers are willing to share their COVID results with the government and their employer compared to sharing their general health data. Consumers are also revealing high preference and satisfaction for virtual care. 

  • Cigna's Evernorth to acquire telehealth company MDLive. Cigna created Evernorth in 2020, a new brand for its health services portfolio. Recall a16z’s recent podcast about payvider stacks that better compete on outcome and cost, here’s an example of the trend. Evernorth buys MDLive, a telehealth provider, to better identify patients in need and make faster referrals. 

  • EHR use in US and non-US health systems. This study (found in Nikhil’s newsletter) looked at EHR use in 348 US health systems and 23 non-US systems. Surprise surprise, US clinicians spend a lot longer in EHRs (90 minutes per day) than other countries (58.3 minutes). Additional discussion with the author on Twitter also pointed out that we over-document in US to minimize denials when dealing with multiple payers.


📣 Media

  • Retro photo app is winning buzz. New photo sharing app Dispo secured $20M series A funding. Co-founded by YouTuber David Dobric, Dispo, short for disposable, wants users to live in the moment. Snap a photo with the app and it has to be “developed” for — hours before it can be shared. Dispo is still in beta (invite only) and tech people are swarming to secure their handles.

  • Twitter’s “Super Follow” creator subscription. Twitter announced a creator subscription during its analyst day, where users can subscribe to creators for a monthly preen and access exclusive content. Screenshots showed an audio space drop-in chat that resembles Clubhouse. It also announced “Communities”, a “Facebook Groups” concept. All this shift is driven by the rising creator economy (and competition) and ambitions to grow revenue.

  • Square acquires majority stake in Tidal for $297M. What’s a financial services company doing with a music streaming service? Jack claims it’s about “finding new ways for artists to support their work”. Umm ok. Are musicians an especially important user group to acquire? Jack and Jay-Z recently also created a bitcoin development fund together. This is all very confusing. 

Thanks for reading! If you liked this edition, hit the 🖤 above, it helps others see it :) Let’s chat more on Twitter.
- Christine