Five Questions: Andreessen Horowitz’s Dr. Vineeta Agarwala

In this series, Digital Health Business & Technology interviews a range of digital health investors, from those who work at venture capital firms and at health system and health insurance venture funds, to individual and angel investors. If you’re interested in participating, email us here. 

Dr. Vineeta Agarwala has an in-depth understanding of the intersections between medicine and venture capital. She serves on the board of the National Venture Capital Association, is a member of the Committee to Visit the Harvard Medical School and School of Dental Medicine and teaches as a clinical assistant professor at Stanford University School of Medicine. She also continues to see primary care patients at Stanford. 

As a general partner at Andreessen Horowitz, she has invested in care management platform company Memora Health, which recently nabbed $30 million from Andreessen and other funders. She also invests in digital health startups Pearl Health, Thyme Care and Waymark.

Agarwala spoke about why doctors get a bad rap when it comes to interest in digital health, her reasons for continuing to practice medicine and more. The interview has been edited for length and clarity. 

You have invested in physician enablement companies like Pearl Health and Memora Health. What interests you about the space?

A big part of my investing thesis is to chase high-cost care. Companies will have an impact and make money if they can change how [providers] deliver care for the patients who already cost the system a lot of money. These patients are going to show up in their local hospital emergency room and at their local primary care physician's office. Those organizations actually have a lot of local connectivity and provide a important [function] in taking care of these patients. But they're not technology-enabled and they're not proactive. They’re not intelligent in the ways that technology could enable them [to be]. They don't have dashboards that tell them, “Jane has severe kidney disease and you actually haven't talked to her for nine months. That means she's a patient who is unfortunately very likely to require more care, decompensate in some way or suffer due to a lack of attention from our healthcare system

That's kind of the approach that Pearl Health is taking: How do you help providers proactively and intelligently infer who needs their attention and who is likely to benefit from outreach?

Once you’ve identified the patients who need attention, you need to help providers do more. That’s where Memora comes in. Every provider wants to do better follow-up, where you’re calling Jane in the morning to tell her there’s a prescription waiting for her at the pharmacy. We can’t do it because we don’t have enough people. We need communication tools that can be proactive.

How do other doctors feel about this enablement technology? 

Candidly, doctors get a bad rap for being anti-tech or too conservative. At the end of the day, you need to meet them where they are. They can't operate with a million extra screens. They can't log into six different apps to deal with their kidney disease patient in a different way than they deal with their heart disease patient. They can't manage the proliferation of tools that has hit them in the last 10 years. But they are extremely receptive to simple unifying technologies. 

Are doctors perceived as anti-tech because of their reportedly negative viewpoints of electronic health records?  

I have a provocative view on that. I think most doctors love the EHR.

Doctors are more burned out by patient messages in their electronic inbox than they are by the sheer work of documentation in an EHR. There’s a real change in how consumers want to interact with the healthcare system. It's a real change in how doctors are spending their time. They're finding that they need to spend hours triaging patient messages after they're done with their clinic [hours]. Some of that is a COVID-induced behavior change in patients.

I just think the narrative that the EHR is driving doctors to quit is false. It’s more that patients are difficult to manage, and we don't have great ways of communicating with patients and finding out what happens after they leave the clinic.  

Why have you continued to practice medicine? 

It's really fulfilling, and it’s a special privilege that I don't take lightly. Does it influence and inform some of my work as a healthcare investor? Absolutely. With some of these [technologies], there's an outsider view and then there's a [provider's] view. What stresses do providers have? What are patients actually struggling with? I think it’s helpful to understand what the real problems are right now. 

What do you want to hear from startups when you first meet with them?

Different factors gain prominence at different stages in a company's life cycle. The team is first and foremost [in importance], and it stays that way through multiple stages of financing. We have to believe that the team can win in the space that they're talking about.

Secondly, regardless of your pipeline … the clinical use case has to resonate. I have to buy it. And I usually try to boil down the whole pitch into figuring out a [potential] patient story, where the technology that you're describing is going to be game-changing. And if I can't get to that … or if it feels like seven other companies could probably do the same thing … I just can't get behind it.