Dear friends, 

In JC’s Newsletter, I share the articles, documentaries, and books that I enjoyed the most in the last week, with some comments on how we relate to them at Alan. I do not endorse all the articles I share, they are up for debate. 

I’m doing it because a) I love reading, it is the way that I get most of my ideas, b) I’m already sharing those ideas with my team, and c) I would love to get your perspective on those. 

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💚 Alan

We are starting this edition of the newsletter with an announcement.

I’m very happy to announce the release of my book, "De l’assurance maladie au partenaire bien-être". 💚
I share my vision of a preventive and personalised health system, centred around each citizen.

The book comes out this Friday and is available for pre-order here.

Let's dream about what our health experience could look like in a few years, and let's build it together! 

💡Must-read

👉 The Best Leaders are Feedback Magnets — Here’s How to Become One  (First Round Review)

➡️ Excellent set of tips to share feedback.

• Your colleagues already have feedback for you. They’re just not saying it aloud. They’ve had thoughts like, “Sarah NEEDS to stop saying ‘um’ so much in meetings,” or “Ugh! Here I go again, working with Mike, who’s never gotten a deliverable to me on time,” or “Once again, I have no idea WTH this person is trying to say.” Their unspoken impressions contain precious insights — if only you could get them to communicate those impressions out loud.

​​➡️ Pushing a culture of feedback that scales especially when you have many newcomers is really hard. It is worth investing in and showing a lot of examples. 

• Unfortunately, people typically don’t volunteer that kind of feedback unless they’re forced to put it into a performance review. In fact, they actively avoid giving it because it makes them uncomfortable. They’re afraid it’ll sound impolite, or that you’ll get angry with them, or that they’ll lose some kind of social standing with you. They feel awkward. And they’re great at making excuses for not speaking up: 

  • “I’m not the right person to tell them this.”

  • “I’ll have time to tell them later.”

​➡️ I bet you all had this experience at least once. 

• All feedback is good feedback. That doesn’t mean you should act on everything others think you should do — but rather that you should give careful thought to every piece of feedback you receive to see if it rings true.

• Even unfair feedback usually has at least some truth to it. If you’re able to triage it appropriately and respond gracefully, you’ll get better faster than people whose egos are fragile.

  • “What about this feedback could be true?”

​➡️ That is really hard but important. When you receive feedback, you should only ask “Tell me more? What else?” And just keep hitting those two.

• Assume good intent and follow up with gratitude. Remind yourself that the person giving you the feedback is taking a risk by giving you their honest take.

➡️ Really easy to forget. 

• Thank them in the moment — and most crucially — be sure to follow up to thank them again later.

• Reflect on the feedback you’ve received. Resist the urge to push back. Instead, thank the feedback giver and set aside time to reflect on the feedback you’ve received. Once you're in a clear state of mind, you can decide how to respond and evaluate whether you agree with the feedback. Follow up with the feedback giver to share your reflections.

• Narrow the question. Instead of asking vague questions like, "Do you have any feedback for me?" or "How can I improve?" ask specific questions to unearth truly constructive feedback. A narrow question reduces the mental burden for your colleagues to identify how you can improve. It also gives them permission to share candid feedback because they’re telling you about something that you’ve already identified as a potential problem.

  • How can I exceed expectations?

  • How can this deliverable be 10% better?

  • What would make you “love” this instead of just “like” it?

  • Was I saying “like” too much in the meeting?

​​➡️ This is one of the most useful tips. Very specific questions really help get significantly better feedback. 

• When stakeholders hesitate to give me honest feedback, I ask them to rate my performance or idea on a scale of 0-5. They rarely say “5”. Then I follow up by asking what I could have done differently to make it a 5?

• Swap “feedback” for “advice.” “Feedback” is a loaded term. Not only do you tighten up when you ask for “feedback,” so does the feedback giver. Swapping it out for “advice” is more inviting and indicates you value your colleague’s counsel.

  • “Do you have any advice on how I can improve on X?”

➡️ A question I often ask some people I work with: “Do you have any advice on how I can improve as a CEO? What did you think when I did X?”

🏯 Building a company

👉 Brain Food: Thinking Time, Information Acquisition, and Doing Obvious Things (NewsletterHunt)

• "Your skill in decision-making is directly proportional to your quality of information acquisition. So, how good are you at making decisions? How good are you at acquiring information?" — Shopify CEO Tobi Lütke (FS )

👉 How Ruth Porat Tamed Google’s Spending Binge (The Information)

• While financial targets differ by company, generally speaking, if X bets can’t generate a roughly 20% internal rate of return over 10 years, they get cut, current and former executives say.

➡️ Interesting data point.

👉 Ro Nagpal - Twilio: Messaging, Margins, and Markets (Join Colossus)

• He saw the birth of AWS and the idea that you could take really complicated infrastructure and turn it into code. I like to think about this idea of turning complexity into code

➡️ Turning complexity into something simple is always super powerful. 

• SmileDirectClub. They help you align your teeth, they mail you these kits, customers were having trouble finding certain locations. So what they did is they started sending customers text message reminders. They added a picture of the storefront. That drove 25% better attendance of appointments, which is the ROI is through the moon.

➡️ Can we do that for Alan Map?

• 10 years from now, you're probably going to have a much more durable growth rate than a business that sold seats because the usage keeps going.

➡️ Selling on usage is powerful. Loss ratio + membership fee is one way of doing it. 

• A great lesson from Twilio is you need to make it very easy for your buyer to look smart to their boss. And if you can do that, you will have them for life.

➡️ How can we do that more for HRs? To look smart to their CEO? To their employees?

🗞 In the news

📱Technology

👉 OpenSea: The Reasonable Revolutionary (ReadtheGeneralist)

• OpenSea seemed to take an alternate approach, charging fees and running lean. As late as August of 2020, the company had just seven employees.

➡️ On the importance of doing big things while running lean.

• Users could cook up profile pictures using composable elements like eyes, a mouth, and accessories. Such as Ethmoji 

➡️ Can we do the same with our Alan marmot?

• Over August and September, Finzer and company averaged $220 million a month in fees.

➡️ Impressive.

• A number of decentralized players have emerged over the course of the last year, of which Rarible is the most established. It’s also an interesting case in that the project began as a centralized entity that raised $16 million in venture funding before it declared its intention to become a DAO. As part of that transition, Rarible issued a token in the summer of 2020. $RARI could be earned by using the project’s platform and also granted governance rights.

• Rarible launched a token for the sake of launching a token and didn’t think deeply about token economics.

• To their credit, OpenSea operates a customer portal where users can propose improvements and vote on previous submissions. The list is long

➡️ Should Alan have a customer portal to have features from members in a structured way? 

👉 DAOs: Absorbing the Internet (Readthegeneralist) 

• DAOs rely on a decentralized framework in which workers, users, and other stakeholders have true ownership of the entity.

• DAOs are group chats, and communities

• DAOs are — or can be — a lot more than just a Discord channel with a native token. Rather, they are entities geared towards a shared purpose: the creation of value.

• DAOs are hard. Even at the best of times, it’s extremely difficult to coordinate large groups of people to orient towards a common

• Ownership : Rather than concentrating ownership into the hands of founders and investors, DAOs distribute ownership to a variety of stakeholders in an ecosystem, including contributors, users, strategic partners, vendors, and so forth.

• Essentially, DAOs are owned by the people who create value in them.

• DAOs empower a broad ecosystem to take action and create value on its behalf.

• The expectation of radical transparency.

• All work is grounded in the pursuit of a larger purpose, of which the upside is shared.

• Radical transparency of this kind incentivizes collaboration over competition, and empowers individuals to take ownership over their work because of their deep understanding of organizational context.

➡️ Distributed ownership, radical transparency, some stuff we know. :) 

• Aragon, Orca, Tribute, and Colony. 

• A simple way to think of them is as a crypto-native version of Stripe Atlas — they allow DAOs to get off the ground. That includes things like membership management, treasury tooling, and infrastructure for governance.

➡️ No code tools.

Some tools:

• Tools like Collab.Land make it easy for DAOs to ensure that access to private chats on Discord is granted only to those that meet token requirements. Other widely used bots include MEE6 and Statbot.

• For example, Coordinape’s “Circle” product allows DAO contributors to “gift” a limited number of GIVE tokens to those they believe are are bringing value to the organization.

• Snapshot has exploded in popularity by providing an easy to use and cheap governance participation method. Essentially, DAO contributors can head over to their organization’s Snapshot page, see the topics up for vote, and weigh.

🏥 Healthcare

👉 HTN Weekly Health Tech Reads 11/21 (Health Tech Nerds)

• Teladoc hosted its investor day (Link)

  • Slide 35: Teladoc highlights the financial advantages of landing & expanding employer client relationships. It sees an opportunity to expand a 10k life employer from $130k a year in revenue to $527k a year in revenue by adding products.

  • Slide 75: BetterHelp, Teladoc's D2C mental health brand, is growing quite quickly in 2021.

• Talkspace announced the departure of its two co-founders amongst a daunting set of challenges the organization appears to be facing.

  • The company is struggling mightily with submitting claims to payors.

  • It's also wild to see that Talkspace has B2B relationships covering 75 million eligible lives, but it has only ~61k active users at the end of Q3, with B2B users consisting ~32k of that. That equates to 0.04% penetration of their B2B covered lives.

• Ro sees a big opportunity in the weight management space, pre-ordering $30 million worth of a new weight-loss pill Plenity.

👉 CVS to Close 900 Stores Over Three Years, Push Online Business (The Information)

• Pharmacy retailer CVS on Thursday announced that starting next spring it will begin closing 900 of its more than 9,000 stores over the next three years as the company looks to drive more of its business online.

👉 A healthcare renaissance: Cleveland Clinic former president and CEO Toby Cosgrove 

• I don't think we're going to see much more vertical integration between acute care centric hospital systems and payors. From 2015 to 2017, there were on the order of 43 attempted vertical mergers, either hospital company acquiring a payor or launching a de novo payor, or a payor acquiring the hospital system. You fast forward to late 2017 and 39 of those 43 health plans were not profitable. 

• If you look at the vertically integrated payor-providers now like Kaiser, Geisinger, or Intermountain— the average age of their health plan is 41 years old. It took more than a generation to figure out how to reconcile competing factional interests between hospitals, physicians, and payors, and figure out the complex science of risk-bearing capital and actuarial judgments.

• The other vertical integration is ambulatory integration. Are we going to see greater aggregation of physician practices? I think this is one of the most consequential shifts over the last 19 months. Seventy-one percent of our nation's 950,000 physicians are now employees, and 50% are employed by hospitals. We’ve been seeing this corporatization of American medicine for a long time.

➡️ Is there a similar trend in France?

• I do think you're going to see a commodification trend of many of the undifferentiated telehealth platforms. The question is what you put on top of the platform. Virtualized primary care or verticalized solutions around diabetes, for example?

• Mental health is the singular area that has not come back down to earth from the virtual experience. Sixty per cent to 70% of visits are still virtual.

 ➡️ Interesting data point.

👉 French people want to change their healthcare system (JDD) 

• The French healthcare system faces many challenges:

  • 1️⃣ A fragile system: 76% of French people believe that the healthcare system is "weakened" or "in distress", an observation shared by 86% of healthcare professionals 

  • 2️⃣ An unequal access to healthcare: 41% of French people have already had to give up a medical consultation because they could not find a health professional and 36% because of financial reasons.

  • 3️⃣ A topic not sufficiently addressed: 70% of French people think that health issues are not discussed enough by the candidates in the presidential campaign.

• French people aspire to a change in the system, notably by:

  • 1️⃣ Increasing the number of healthcare professionals: 89% of French people want to hire more health professionals.

  • 2️⃣ Reducing inequalities in access to care:  81% of French people want to "implement measures to reduce inequalities in access to care between territories".

  • 3️⃣ Investing in prevention: 75% of French people believe that "reorienting our health care system towards more prevention" should be a priority for candidates.

• We need to re-think our healthcare system. If you want to join the debate, pre-order my book on the topic 👉 here.