Jul 27, 2022 · 39m · a16z
Two-Sided Networks in Healthcare - a Founder's Playbook
Jay Rughani · 12m spoken Vineeta Agarwala · 5m spoken Doug Hirsch · 4m spoken Iman Abuzeid · 4m spoken Arif Nathoo · 3m spoken Andrew Adams · 2m spoken Thomas Clozel · 1m spoken
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gold bands on the timeline = statements, start to end. Hover to read, click to jump. CC turns on captions
In this Andreessen Horowitz digital health playbook, partners Vinita Agarwala and Jay Rughani join leading healthcare founders to detail the strategic framework for building, scaling, and evaluating two-sided networks in healthcare. The video outlines actionable GTM strategies across both sides of the network, from initial trust-building to long-term defensibility and investor evaluation.
How this conversation actually went
Every chapter scored 0–10 on four independent dynamics. Hover any point for the reasoning behind the score. How this is scored →
The host as informed peer 6.6 Guest teaching 1.6 Guest disagreement 0.2 The host pushing back 0.0
speaking balance: gold is the host, purple is the guest (3 minute bins)
Sharpest disagreement ▶ 33:19 Iman Abuzeid Rejecting Employer Exclusivity Requests
Iman Abuzeid describes pushing back on employer demands for exclusive access to nurse talent, firmly explaining that Incredible Health operates like Switzerland to protect talent choice.
Hardest push from the host ▶ 33:19 Platform Neutrality Policy EnforcementIman Abuzeid outlines denying buyer feature requests that conflict with core platform principles, refusing exclusive deals to preserve multi-sided network integrity.
Biggest teaching moment ▶ 16:25 Doug Hirsch Revealing GoodRx Was Originally a Fake WebsiteDoug Hirsch educates the audience on lean startup execution by revealing that early GoodRx was effectively a manual, fake website that aggregated prices by calling pharmacies directly.
The host holds their own ▶ 35:45 Jay Rughani Explaining Venture Network Evaluation CriteriaJay Rughani demonstrates master-level domain knowledge by articulating the five core criteria (adoption, engagement, retention, efficiency, data access) a16z uses to evaluate healthtech networks.
the scores for every segment, with the reasoning behind each
| Chapter | Topic | The host as informed peer | Guest teaching | Guest disagreement | The host pushing back | Why |
|---|---|---|---|---|---|---|
| Defining Networks and Healthcare's Five Ps | 7 | 0 | 0 | 0 | Hosts Vineeta Agarwala and Jay Rughani outline the foundational taxonomy of two-sided healthcare networks and define the Five Ps framework (Pharma, Pharmacies, Providers, Payers, Patients). Because this is a scripted educational monologue without guests present, host pushback and guest combativeness are zero. | |
| Case Examples: Google and Flatiron Health | 7 | 0 | 0 | 0 | Jay and Vineeta illustrate network concepts using real-world case studies from Google and Flatiron Health, drawing on personal operating experience at Flatiron. The dynamic remains fully host-driven presentation with high domain knowledge. | |
| Three Tailwinds Driving Healthcare Two-Sided Networks | 7 | 0 | 0 | 0 | Vineeta cites key industry metrics including 95 percent EHR adoption and 35 percent of global data generation to explain market tailwinds. This is a solo breakdown by the host displaying deep sector insight. | |
| When to Build a Two-Sided Network and Founder Framework | 6 | 3 | 1 | 0 | Jay presents three structural reasons to build a network and introduces pre-recorded commentary from founders Arif Nathoo, Andrew Adams, and Iman Abuzeid. The founders detail their contrasting strategies on supply vs demand side prioritization. | |
| First Side Playbook: Earning User Trust Early | 6 | 3 | 0 | 0 | Jay frames the takeaway around building initial user trust, introducing clips from Thomas Clozel and Doug Hirsch. Hirsch candidly shares how GoodRx initially launched with a cobbled-together website without requiring user friction like logins. | |
| First Side Playbook: Initial Pricing Strategies | 6 | 3 | 0 | 0 | Jay explores initial pricing and metric tracking through founder stories from Thomas Clozel, Arif Nathoo, Andrew Adams, and Doug Hirsch. Founders discuss optimizing for engagement over immediate revenue and avoiding misleading vanity metrics. | |
| Second Side Playbook: Activating the Second Side and Achieving PMF Again | 6 | 2 | 0 | 0 | The focus turns to activating the second side of the network once first-side PMF is established. Clips from Arif Nathoo, Doug Hirsch, and Iman Abuzeid show how data streams from one side naturally attract or enable products for the second side. | |
| Second Side Playbook: Simplicity in Scaling and Aligning Network Priorities | 6 | 2 | 1 | 0 | Andrew Adams and Iman Abuzeid explain the need to keep scaling mechanics and pricing structures simple. Abuzeid highlights refusing employer requests for exclusivity to maintain platform neutrality for nurses. | |
| Second Side Playbook: Sustaining Growth via Channel Partners and Internal Process | 8 | 1 | 0 | 0 | Jay details a16z's investment evaluation framework across adoption, engagement, retention, efficiency, and data access. The hosts conclude the episode with high authoritative clarity on venture evaluation criteria. |
Statements from this episode (18)
Rughani: Network effects make parallel go-to-market motions easier
“And when one company successfully executes two independent go to market motions in parallel, a powerful network effect kicks in, and each go to market motion becomes easier because the other exists.”
Agarwala: 95% of care providers have adopted electronic health records
“Almost 95% of care providers have adopted electronic health records in the last decade since the HITECH Act in 2009.”
Agarwala: Healthcare delivery generates over 35% of all global data
“Over 35% of all the world's data is actually generated in the process of delivering health care.”
Rughani: Three specific market conditions justify building two-sided healthcare networks
“While two-sided networks can be more complex to execute, founders who choose this go-to-market strategy are typically addressing at least one of three situations in which it can be worth the effort. One, broken data flows between two or more sets of constituen…”
Nathoo: Tech companies building two-sided networks must start with demand
“I think every tech company should start with the demand side.”
Abuzeid: Incredible Health launched supply and demand simultaneously in SF
“So we started with both. We went after supply and demand at the same time, but we stayed geographically very focused, like many other two-sided marketplaces. When we started, we were only live in the San Francisco Bay area.”
Clozel: Owkin Wins Hospital Trust by Focusing on Medicine, Not Data
“We first, we really build this trust by people saying, this is cool. You see medicine, you don't see product, you don't see data, you don't see cash. And it really felt important because we were working with physicians, you know, so I think that the trust was …”
Hirsch: GoodRx spends hundreds of millions of dollars on marketing
“We spend hundreds of millions of dollars in marketing”
Abuzeid: Incredible Health manually onboarded its first 40 nurses without software
“I think the first 30 or 40 nurses we just recruited through our networks, frankly. There was no software, like you said to your point.”
Clozel: Owkin gives hospitals free software and 10% revenue share
“We're going to give you this, you know, technology our platform we're going to help you on the data science side. We're going to have to curate data. No, we also even generate data, single cell data, special transcriptome, really high quality data sets they do…”
Hirsch: Healthcare platforms must optimize for outcomes, not time spent
“Remember I came from the world of social. Like I was at Facebook and Yahoo where time spent was like the God metric. It was like, oh my God, we just care about as many eyeballs and as much time as we can. And it could actually, it's less about time spent. It's…”
Hirsch: GoodRx features 24/7 live nurse chat on drug pages
“We have a program right now where we actually have a nurse, a live, 24 seven nurse chat sitting on a drug page. So you can actually talk to a nurse about the drug.”
Abuzeid: Incredible Health offers free continuing education and salary estimators
“We do offer free continuing education to every single nurse in the country. We have free salary estimators for every single nurse in the country. We have an advice platform or a community built into our apps where nurses can give each other highly personalized…”
Adams: Headway gives away its provider software for free
“We get to give away our software to providers for free.”
Abuzeid: Incredible Health projects 300% to 400% growth this year
“I mean, incredible health grew 400% last year. We're on track to grow another 304 hundred percent this year.”
Abuzeid: Incredible Health rejects exclusivity requests to maintain employer neutrality
“We always say no to those requests. And we explain that we operate like Switzerland, you know, like we're neutral. And we don't have any preference for one employer over the other.”
Nathoo: Healthcare consultants handle last-mile implementation for Komodo Health
“What's happened over time is that our relationship with these consultants has grown to the point where they're the equivalent of a system integrator and in a workflow software setting, meaning that they're the ones that actually carry the last mile often for o…”