What I learned this Week: April 21, 2024
If we applied the same root cause analytical rigor to human deaths as the FAA and Boeing do to aviation accident investigation, would we eliminate the $1.9T in healthcare cost of poor nutrition?
Lessons of the Week
I was supposed to testify to the Senate Health Committee on medical-tailored meals on Wednesday. As I was preparing to get on my flight, the hearing was canceled to address the impeachment of the Secretary for Homeland Security. This did free up my Wednesday. So, I caught up with several experts on how to implement medically tailored meals, especially in rural areas. Also, a long threaded rant with our network on WhatsApp.
What I learned this week….
If we want to reduce the $1.9T in healthcare costs of poor nutrition, should we implement a food system that prevents people from ever becoming obese (ex-ante) or one that reverses obesity (ex-post)? These may be dramatically different solutions.
State insurance programs will pay bonuses to private entities that reduce health care costs, like utilities pay ESCOs to save energy or, or CPGs pay for carbon insets. This structure may be a business model for medical tailored meals.
A hoop house, even in a northern climate like Michigan, can produce nutrient-dense vegetables nearly year-round at a profit for 10-12 people/yr. Many hoop houses or greenhouses integrated into row crop operations might ease access to quality food and a better diet for those with A1C > 5.7.
Once your BMI is above 30, from a health cost externality standpoint, it may not matter what technique you use to get it down (Healthy diet, calorie restriction, etc.). The healthcare companies have a much greater profit incentive to own this market than the nutrition companies.
Poor glycemic control (HbA1c ≥ 7%) total costs of care $16,460 ± $10,885
Evolution designed us to consume a wide array of nutrients; figuring out which are best for us is probably hard when many roads lead to Rome.
The rest of the world eats less beef but seeks quality and pays a premium when it does. Should innovative emerging grassland/sustainable beef companies target those markets with quality and differentiated products to get a premium price? A market where plant-based and premium meat coexist but CAFO declines?
The fresh produce industry in the US has steered Americans to prefer fresh and devalue frozen or otherwise processed. Individual quick freezing at the farm, though, may deliver more stable nutrients into the supply chain.
Full body MRIs as a “Worried Well” preventative measure is interesting at $2K/scan. But it may be transformational as the price goes to $0. At what price point is the scan worth more to the patient or as a tool to train AI? (Henrietta Lacks)
If we applied the same root cause analytical rigor to human deaths as the FAA and Boeing do to aviation accident investigation, would we achieve the same safety levels as air travel and increase human longevity?
Some Conclusions
Medical Tailored Meals
I was supposed to give testimony to the Senate Health Committee in Washington, D.C., this week. One of the other witnesses is Erin Martin, who runs a Food RX/Medical Meal program in Oklahoma. Because the hearing was canceled, Erin and I had a chance to bounce around ideas on addressing the healthcare cost of poor nutrition. And perhaps the formation of a larger for profit entity that could improve rural nutrition. Leading to the following thinking…..
As A1C levels climb above 5.7%, each increment of increase has a distinct cost. State health programs under Medicaid and Medicare see no end to increased costs. But are starting to adopt programs to incentivize for-profit entities that reduce A1C.
There are also emerging groups providing medically tailored meals. An example would be a $3k per year program to provide regenerative fresh vegetables to a patient, along with coaching to teach them how to replace processed food with home-cooked meals using the vegetables. The regenerative value is nutrient density and taste. The taste of a proper home-cooked meal replaces some of the desire for processed food. Leading to a better diet and weight loss.
The food is sourced from regional growers, sometimes row crop farmers with extra land, who grow the food for profit and/or as part of their community effort. For various reasons, growers are adding hoop houses and greenhouses to their property, forming an array of regional growers. Some as far north as Michigan and the Dakotas.
These medical-tailored meals can reduce A1C enough to eliminate over $15k-20k of annual healthcare costs. With the .orgs providing these programs at $3k/year and the savings of $15k or more, there is $12k+ of savings and potential profit to anyone that can scale these solutions.
One possible solution would work with a wide range of regional growers to:
Source the vegetables from a range of local farmers
Source the patients from healthcare systems
It would charge $3K per patient for the basic program. And structure an incentive bonus of say $1K+ for each increment of reduction in A1C, creating further profits for the integrator and the the farmers. A1C is not a perfect measure, but serves its purpose for this program. Given the diverse regional nature of the sourcing and the patients, this could be an Uber-like solution with a range of independent contractors providing the produce, organized under a mobile app provided by the integrator who also manages care delivery with the patients.
In time, like Uber and AirBNB, regional providers would form up and drive more scale. Creating more local economic development and productivity. The key value of the integrator would be to establish clear cost benefit to capture the extra premium above the $3K per patient.
Nutrient Density Tech Stack
The “Tech Stack” to nutrient density and Food is Health includes:
Holobiome - Mastering the microbiome
Brightseed - Engineering micronutrition
Holganix - Soil Microbiome
Kula Bio - Nitrogen Fixation
Benson Hill - Genetics
White River Soy - Mini Mill
Edacious - Nutrient density optimization
Bushel - Financial Services and payments
The tech stack will expand to include additional platforms for financial services, human health, and in-silica models for soil, human nutrition, and animal nutrition.
On Substack….
Two startups, Prenuvo and Ezra, offer whole-body MRIs for $2000-$2500. This targets the Worried Well, who want to detect illness before it progresses to a life-threatening condition. If you recall, there was a similar movement around CAT scans in the late 90s that dwindled in time because of false positives. With no other symptoms, an MRI scan also has a high false positive rate that can trigger needless concern in a healthy patient.
But at what price point is the false positive worth it? $1000? $500? Won’t MRI cost continue to decline like all other technology? To date, MRI’s are used to treat people who are sick. If entrepreneurs apply MRIs as a first-line diagnostic, will they quickly learn how to reduce false positives? Is the data collected from these MRIs uniquely helpful and valuable as a healthy control dataset in big data models?
This Weeks Charts
As agriculture productivity continues to climb, will it continue as a commodity, driving down price and cost? Or will agriculture open new markets to extract premium prices in other markets (like food is medicine)?
While there is fast growth in solar and wind, all other forms of energy are also growing.
Opportunities for Livestock
With the continued evolution of animal agriculture, livestock are finding new opportunities as migrant workers to replace labor pools in California.