20VC: $5BN in Revenue, 7 to 7,000 Employees in 9 Months, 206,000 Tests in a Single Day: The Craziest Story in Startups: Curative with Fred Turner

Fred Turner is the Founder and CEO @ Curative, one of the wildest stories in tech. Fred scaled a COVID testing business from $0 to $5BN in revenue and took the team from 7 to 7,000 employees in just 9 months. They did over 206,000 COVID tests in a single day and signed contracts in the 100s of $Ms with several of the largest states. Today, Curative is a unicorn health insurance business taking on the incumbents for one of the largest markets in healthcare. AGENDA: 00:00 How Did a Spare-Time COVID Test Become a $5BN Business? 07:00 How Do You Go From Testing Cows to STDs, Sepsis and COVID? 21:00 When Did Fred Realise COVID Was Massive—and How Did Curative Scale to $5BN? 36:00 Why Pivot Into Health Insurance—and What Is Broken About US Healthcare? 40:00 How Is AI Rebuilding Curative—and Which Departments Go to Zero? 45:00 Is SaaS Dead? Why Is Curative Cutting 80% of Its Software Spend? 48:00 Are Legacy Insurers Screwed? What Will Anthropic Be Worth in Three Years? 59:00 Will AI Make Companies Smaller? Which Jobs Will Survive? 1:10:00 Why Nuclear—and Could Subcritical Become Bigger Than Curative? 1:17:00 What Have Marriage and Fatherhood Taught Fred? What Has He Changed His Mind On?

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

  So our chief scientific officer at Curative had, in his spare time, developed a COVID test. Lockdown had just started. Everybody was starting to freak out. There was basically nowhere to get a test.

• 0:10Harry Stebbings?

  What's the single largest contract you signed?

• 0:12Speaker 00

  In the hundreds of millions of dollars. I think our peak day was 206,000 people tested in a single day. And the company went from about seven to 7,000 employees in those first nine months. The total revenue ended up being about $5 billion over a three-year period. We did 2.5 million vaccinations. That was another service we did. We also lost a ton of money on that. That was a terrible business. We're cutting about 80% of our SaaS spend this year. One of our internal meetings, we have a slide of like, when are SaaS contracts due? And whose job is it to tell them that we're not renewing this year?

• 0:43Harry Stebbings?

  How big do you think Anthropic will be?

• 0:45Speaker 00

  I think it could be 10 trillion.

• 0:46Harry Stebbings?

  This is 20 VC with me, Harry Stebbings, and I'm so excited for a freaking wild story today. Fred Turner, co-founder and CEO of Curative. Now, this is an English founder in the valley who scaled a COVID testing business to $5 billion in revenue. Then he had to scale it all back. It did not last post-COVID for obvious reasons. Today, he turned it into a health insurance provider that's worth $1.3 billion. And in the show, he says some pretty wild stuff, like he's going to cancel his $600,000 Salesforce subscription. Sorry, Mark and Salesforce, don't kill me. For a vibe-coded solution they built in a matter of months.

• 1:28Harry Stebbings?

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• 2:09Harry Stebbings?

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• 4:53Harry Stebbings?

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• 5:04Harry Stebbings?

  Brad, I'm so excited for this, dude. You have the most wild story, and I heard it from Justin first and then from Anil. So thank you so much for joining me, man.

• 5:13Speaker 00

  Yeah, thanks for having me.

• 5:14Harry Stebbings?

  Now, I always find it very telling. Entrepreneurs are often kind of compelled either by the fear of losing or by the thrill of winning. If I were to ask you which one drives you more, what would you say it is?

• 5:25Speaker 00

  The thrill of winning. Certainly during COVID with what some of what we built at Curative. I got kind of a taste for the speed at which you can move when everything is like, is behind you and all the momentum is behind you. And I've been chasing that ever since.

• 5:38Harry Stebbings?

  I mean, that is the biggest tailwind that one could have ever expected. We're going to get to that. You actually grew up in the UK and then you moved to Silicon Valley very young, 17?

• 5:48Speaker 00

  19.

• 5:48Harry Stebbings?

  19. Could you have built the business that you did in the UK?

• 5:53Speaker 00

  No, definitely not.

• 5:54Harry Stebbings?

  Why is that?

• 5:55Speaker 00

  I just think the UK doesn't have like some of the kind of infrastructure for startups and investing of like that many people that have kind of done a startup before and then are willing to invest in the next generation, particularly investing in younger people. Like when I found, I tried to raise a venture round in the UK and I couldn't even get meetings. This was when I was like, I was 18, I was in like first year of college and I was doing this startup on the side. I couldn't even get meetings with, I think I got like one fund to take an associate meeting with me. It seemed like people were more investing like purely on credentials. And this was a while ago, right? This was, this was, you know, more than 10 years ago. But it seemed like people were investing just on, oh, well, you came out of this university. So if you, you know, you're an undergrad, like, how could we possibly look at this? This doesn't make any sense.

• 6:40Speaker 00

  Whereas you go to Silicon Valley and it was like, well, what's the possibility here? What could you envision in 10 years if, if everything succeeds? Like, how big a company could this be? And it just, it was a very different mindset that they were optimizing for how to get the best outcome. Rather than, I always felt like in the UK, it was sort of optimizing for like mitigating the worst downstream outcome.

• 7:02Harry Stebbings?

  Yes, how do I not get fired?

• 7:03Speaker 00

  Right.

• 7:03Harry Stebbings?

  Okay. And so we decided to move to the valley. Great. How does, because we go from sepsis detection, no?

• 7:10Speaker 00

  Well, cows to sepsis to...

• 7:13Harry Stebbings?

  Can you just walk me through how we go from cows to sepsis to COVID? Just so I understand this.

• 7:17Speaker 00

  Yeah. So my first company that started...

• 7:19Harry Stebbings?

  I've never said that statement before in a 20 VC episode, by the way.

• 7:23Speaker 00

  There we go. It's a new, a new phrase for you. Yes. So I went from initially cattle testing through sepsis to COVID. So it started off, my first company in the UK, which was called TL Bio Labs at the time, basically sequencing dairy and beef cows to predict various traits about the animal from an early age. So it started off with beef. You can predict that certain cows are going to have more musculature from an early age. And some cows can have too much musculature and then they have trouble giving birth. And so there's like an optimum that you're shooting for. And I found this like completely by chance. I won the UK National Science Engineering Competition, was on TV a little bit. And this farmer reached out to me because he wanted help testing his cows. And he was sending his samples to the Netherlands and it was taking weeks and it was terrible.

• 8:05Speaker 00

  And I initially told him like, I'm not interested in cows. I was interested in human genetics at the time. No, thank you. And then he kind of kept pressing and he like sent me samples with a check attached to the front. And I was like, oh, okay, this is interesting. And so I did the first batch of samples for him and then all of his friends started sending me samples. And so it kind of grew from there. And this was all still in the north of England. I was in the first year of college at the time. We started branching out into dairy and predicting how much milk animals would make. And I tried to raise the first venture round for the company in the UK, didn't get very far. And so ended up going to the US for the US AgTech Investing Conference in San Francisco. It's my first time in the States, never been before. And it was like my last ditch attempt to try and raise some money.

• 8:48Speaker 00

  And I met a bunch of VCs, didn't raise any money, but I did meet a guy who had just finished doing Y Combinator. And he was like, oh, you need to apply to YC. That's what you need to do. You need to move the company to the US. You need to apply to YC. Like, that's the only thing you can do here. And I was like familiar with YC, but I had never applied.

• 9:06Harry Stebbings?

  What year was this?

• 9:07Speaker 00

  This was like the end of 2015.

• 9:10Harry Stebbings?

  Okay.

• 9:10Speaker 00

  Yeah. So I went back to the hotel room and it turned out like the application deadline was six days away. So I was like, all right, it's meant to be. So did the application, you know, got the interview, came back for the interview, and then moved to Silicon Valley for the summer 16 batch.

• 9:24Harry Stebbings?

  Pause. How was the interview? Who was it with?

• 9:26Speaker 00

  Tim, Jeff, and somebody else. It was, I mean, it was all a bit of a blur. It's very fast.

• 9:31Harry Stebbings?

  And then you found out you get in.

• 9:33Speaker 00

  Yes.

• 9:33Harry Stebbings?

  You moved to the valley.

• 9:34Speaker 00

  Moved to the valley. And then it was the same pitch, the same company. We were doing mostly dairy testing at that point. So testing dairy cows to try and predict their milk yield, which for farmers is actually very valuable because they don't make milk until they're 18 months old. And so from day one, all your animals have to have a cough every year to keep making milk. So your herd doubles every year.

• 9:54Harry Stebbings?

  Is this still the same Curative company?

• 9:56Speaker 00

  No, this is a completely different company.

• 9:57Harry Stebbings?

  Okay, I was about to say, God, this is where investing is so difficult. Because if you hear a founder pitching milk yield optimization, and I'm sure it is like logistically a big TAM, I'm sure.

• 10:08Speaker 00

  Well, not big enough. That was the problem.

• 10:10Harry Stebbings?

  Okay.

• 10:10Speaker 00

  Yep. So we did this, went through YC, and we raised a seed round from Andreessen.

• 10:15Harry Stebbings?

  Did a seed round from Andreessen?

• 10:16Speaker 00

  Yeah, their bio fund did our seed round right out of YC. And I don't think they did the TAM calculation. They were like, oh, this sounds interesting. And then they did the round. It was a small round. It was like 1.65 million.

• 10:28Harry Stebbings?

  Chum change.

• 10:29Speaker 00

  It was.

• 10:30Harry Stebbings?

  That's for the coffee.

• 10:31Speaker 00

  It was, you know, for Andreessen, it was like a smaller round.

• 10:34Harry Stebbings?

  Sure.

• 10:34Speaker 00

  And so we kept developing the technology. We had customers. And then we went to go raise an A and then people did do the TAM calculation. And there's about 100 million cows in the US. If you're doing well, you could charge 15 to 20 dollars per test. So even if you assume you could test every cow every year, you'd be at 1.5 billion like total market, which is not enough to do a series A off of. And so what we ended up doing is taking some of the core DNA testing technology that we had developed, pivoting and using that for human diagnostics. And so that was my kind of first foray into healthcare. We actually first launched a high-throughput STD testing lab, which was, and we launched an at-home STD test. It was, that was tons of fun.

• 11:14Harry Stebbings?

  I used to run a lot when I was young and my knees were wonderful. And I used to love how I built this because they would ask the questions like this, which is like, how do you go from like cows and musculature on cows and milk yield optimization to at home STD testing? It doesn't feel that natural a jump.

• 11:33Speaker 00

  Yeah, on the back end, it's more natural, right? All of these things have DNA in them. And so if you're, if you're looking to do better DNA testing, you're just looking for markets where people care more about that. And anything human people obviously care a lot more about are more willing to pay for and are much larger markets. And so we sort of did like a market first approach of, you know, where could there be interesting things? And we narrowed in on antibiotic resistance in STDs as being like a particularly interesting area where they're getting harder and harder to treat because you get more and more antibiotic resistance. And if you're doing the DNA testing, you can predict what the best drug is going to be early, treat with that drug, and then you're not using the most aggressive antibiotics.

• 12:14Harry Stebbings?

  Do we have more STDs than ever?

• 12:17Speaker 00

  Yeah.

• 12:19Harry Stebbings?

  This conversation's pivoting somewhere I so didn't know. But I thought we were having less sex than ever.

• 12:25Speaker 00

  Yeah, but more STDs.

• 12:27Harry Stebbings?

  Wow.

• 12:28Speaker 00

  Yeah.

• 12:28Harry Stebbings?

  That's worrying.

• 12:29Speaker 00

  Yeah. And, and well, it's a while since I looked at the statistics because I've not been doing this for a while now. But when I was like last in this, yeah, the statistics were just kind of a like steady increase and then an increase in resistance. And so it's getting to the point where certain STDs are like harder and harder to treat. And some of them might eventually become untreatable or like you have to be hospitalized to get a certain really powerful antibiotic to treat it, which is crazy. And antibiotic stewardship was the whole thing. And so we did that with STDs and then.

• 12:59Harry Stebbings?

  I so love this conversation.

• 13:01Speaker 00

  And then, and then we found a fascinating market in sepsis. And so sepsis is a disease that kills hundreds of thousands of people a year. It's basically where you get bacteria in your bloodstream. And what kills you is not actually the bacteria, it's your own immune system. So you're not supposed to have bacteria in your blood, right? Your blood is supposed to be sterile. And when bacteria get in there, your immune system kind of freaks out and it triggers this whole downstream cascade where your blood vessels start to leak and all of your organs start failing and it's basically really bad. And that's what kills you is your own immune reaction to the bacteria rather than the bacteria. And so this is, you know, one of the leading causes of death in the US. Often if you're dying from something else, like, you know, you have serious cancer,

• 13:44Speaker 00

  it'll be sepsis that ultimately ends up being what kills you because you get more susceptible to it with other diseases. And so it's leading cause of death, like increasing mortality. It's incredibly expensive, outcomes are terrible. And so we were working on basically a better testing technology where from the earliest date, you could detect these bacteria and what antibiotic they are going to be susceptible to and treat people faster. Because with sepsis, basically every hour that you don't treat somebody is about a 12% increase in mortality. So you want to get the treatment as soon as possible.

• 14:16Harry Stebbings?

  Every hour you don't treat someone is a 12% increase in mortality. Wow.

• 14:19Speaker 00

  Yeah.

• 14:20Harry Stebbings?

  Okay. And so we start this sepsis testing.

• 14:22Speaker 00

  So start the sepsis testing.

• 14:23Harry Stebbings?

  Does it instantly go well?

• 14:24Speaker 00

  No. So this company died at the end of 2019.

• 14:27Harry Stebbings?

  Oh, I'm sorry.

• 14:27Speaker 00

  Yes. So the testing was working great. Prototypes were, you know, pursuing the FDA approval process. We went to do a series B round with, ended up being a strategic.

• 14:38Harry Stebbings?

  So sorry, just so I understand, so we had raised the A from.

• 14:41Speaker 00

  Raised the A.

• 14:41Harry Stebbings?

  And this was same company as this.

• 14:43Speaker 00

  Same company, changed its name from TL Bio Labs to Shield.

• 14:47Harry Stebbings?

  Oh, love it.

• 14:47Speaker 00

  Yeah.

• 14:48Harry Stebbings?

  Good, good single name. Okay. So we go to raise the series B, bigger TAM, sepsis death, more gravitas.

• 14:54Speaker 00

  Yeah, many, many billions of dollars TAM for testing for this. And ended up getting a term sheet from a strategic, large, public diagnostic company. Signed the term sheet, did three weeks of, of work on docs. We were in the second round of docs and then their CEO killed it because it was too competitive with their core products. Meanwhile, we told all the investors that, oh yeah, we've got the lead, we're good to go. Here's the paperwork. And so that was the death of the company. It had, we had about three weeks worth of cash.

• 15:21Harry Stebbings?

  Would you be where you are today though, if that round had come together?

• 15:24Speaker 00

  No, no, because I don't think we would have pivoted as hard into COVID when COVID hit. I mean, it would have probably been easier because we had, at that point, we actually had a lab license. You know, in the US, you need this thing called a CLIA license to run these kind of tests. And we had got one of these licenses over like a painstaking two year process. And then in December of 2019, as part of the wind down, I sold that license to a company in San Diego for $150,000 to pay some of the creditors. And then five months later, acquired a company in Southern California to get the same license for 27 million. So timing is everything.

• 16:00Harry Stebbings?

  Whoa, whoa, whoa, wait, wait. So we're winding down the company and we sell this license for $150,000.

• 16:06Speaker 00

  Which is roughly its market value if there is not a pandemic.

• 16:09Harry Stebbings?

  Totally, yeah, that, cool. Okay. And so we're winding down the company. I want to go chronologically because that's like a while.

• 16:17Harry Stebbings?

  Shutting down the company in 20, now 20, I guess?

• 16:20Speaker 00

  It was, yeah, kind of right at the end of 2019.

• 16:22Harry Stebbings?

  Okay, end of 2019, shutting down the company, strategic, à la Poubelle, fuck that. And then what happens then?

• 16:30Speaker 00

  So then I was kind of looking at what to do next and.

• 16:33Harry Stebbings?

  Were you like personally devastated? This is five years of your life.

• 16:36Speaker 00

  Yes.

• 16:37Harry Stebbings?

  Any lessons for founders, reflections on that?

• 16:40Speaker 00

  It's a lot easier to build a company the second time around. Like there's so many mistakes the first time where you just, you don't know how to do like thing X, like the first time you fire somebody, like how to build a good interview process, how to build a pipeline. Like there's so many things that it's really easy to screw up the first time around. And then when you've seen them go wrong, it's so much easier to build it the second time around. And so like, yes, it's the worst thing in the world to go, you know, to go through is having something you poured all that time and energy into and like, you know, the seven day work weeks and the late nights basically go to zero. But as long as through that you, you learn and you take those lessons and you go solve an even bigger problem. I think, you know, you, you got something out of it.

• 17:19Harry Stebbings?

  Okay. And so this company is like winding down.

• 17:22Speaker 00

  Yep.

• 17:22Harry Stebbings?

  Need to find something else. What happens now?

• 17:24Speaker 00

  Yeah. Originally, the pitch behind Curative was we were going to also solve sepsis, but in a completely different way.

• 17:33Harry Stebbings?

  You're really focused on sepsis.

• 17:35Speaker 00

  A lot of pivots. Yeah. Yeah. So when we were going through all this work with the sepsis diagnostics, one of the things that kept jumping out in the data was when you look at other companies that had tried to do sepsis diagnostics, because we were not the first, a bunch of big pharma companies, like Roche spent a couple of hundred million, Siemens spent a hundred million, a bunch of companies spent a lot of money trying to make better sepsis diagnostics. Kind of this like graveyard of dead sepsis companies. And when you dig into the data, you find this really interesting thing that in academic medical centers, when you try out these new sepsis tests, they work great. And you see much better outcomes and you see, you know, people live longer and it's saving lives. And then you try to replicate that in bigger studies and they fail. And when you dig in and look why, it's when you expand that aperture of who's in the trial

• 18:20Speaker 00

  out of the academic medical center and into community hospitals. What's happening in a community hospital is they're so understaffed, they're so overwhelmed with the volume, particularly in the emergency room, they don't suspect sepsis fast enough. And as I said earlier, it's every hour is 12% increase in mortality. And the intervention that they have to do is actually pretty severe. They basically put a big IV line usually in your femoral artery. They're pumping you full of fluids, they're pumping you full of NAST antibiotics that have bad side effects. So it's a pretty aggressive treatment. If they don't suspect sepsis early enough and jump to that treatment, by the time they get there, it's already too late. And so if you're in a community hospital and it's 2 AM on a Saturday, is there someone on staff that actually suspects sepsis early enough or does it wait until Monday morning?

• 19:05Speaker 00

  And so it doesn't matter if you have a better test if no one ever runs it. And so the original pitch behind Curative is let's take the learnings from an academic medical center and go out to community hospitals and basically build mini hospital in a hospital that just manages their sepsis patients. So whenever they get somebody, you know, we will diagnose them as having sepsis out of the emergency room. We will then take on that patient, they would pay us a fixed fee. So no matter what happens, we're on the hook. If we can drive a better outcome by applying, mostly just getting doctors to follow the instructions, but at scale, then you could drive better outcomes by getting those academic medical center type like clinical results, but helping a community hospital actually do that.

• 19:45Harry Stebbings?

  So what happens then? We, we start that business.

• 19:47Speaker 00

  Start that business, we raised a million dollars of seed money. Justin was the first investor you mentioned at the beginning, Justin Mateen. He came in right as I was shutting down Shield, he was an investor in Shield. And he wanted to put more money into Shield. And I said, no, I, I don't think you should do that. I think that company is, is, you know, is not going to make it unfortunately. But I'm thinking of starting this new thing. And he was like, yes, I'm in. And he didn't even know what it was.

• 20:12Harry Stebbings?

  How much did he put in?

• 20:13Speaker 00

  Put in, I think, $125,000 at a $3 million valuation.

• 20:17Harry Stebbings?

  Wow.

• 20:18Speaker 00

  So he was the first.

• 20:19Harry Stebbings?

  Okay.

• 20:19Speaker 00

  First money in.

• 20:20Harry Stebbings?

  First money in, love it.

• 20:21Speaker 00

  And, and so we had a pilot set up with the first hospital in Wisconsin. This was a clinician that we'd worked with before. He was really enthusiastic. And then we got a call from his assistant saying, this is all on hold and I can't speak to you for at least three months. And we were like, that's really out of character that he wouldn't at least call us or text us or that he's having his assistant. And when we dug in, they were getting ready for this thing called COVID-19, that they were expecting to see the first patient in their hospital. And so that was the first inkling for me of like, oh crap, this is going to be a big thing. This is going to be bigger than people think it is. And so they were shutting down the entire hospital. And so it started off for us as like, okay, well, we can't run our clinical studies. We can't actually launch this product because all the hospitals are in lockdown.

• 21:05Speaker 00

  Maybe we can go help out with this testing thing for a couple of weeks until all of this blows over. And then we'll go back to sepsis.

• 21:12Harry Stebbings?

  And so at that point, we're like, we move into COVID-19 testing.

• 21:15Speaker 00

  Yes, yes. And so it all happened quite quickly from like a lot of me saying, no, no, no, this is not going to be a thing. Like, don't worry about it. Like, just it's.

• 21:22Harry Stebbings?

  What was the moment where you realised? Where were you like, this is substantially going to be a real thing?

• 21:27Speaker 00

  So I was like in my apartment in San Francisco, looking at some data that I think was on Twitter. And I was like, oh crap, if this continues at this rate, like, this is going to be way more substantial than people realise. And so this was probably mid-February. And so then I started to reach out about sort of setting up testing capacity to, well, first of all, we had the problem of finding a lab licence, because I just sold the lab licence. And so we didn't have a lab anymore that was capable of running these kind of tests. We had a test. So our chief scientific officer at Curative had, in his spare time, developed a COVID test. And one of the things they'd done at a previous company is they developed one of these flu tests and just offered it to employees to make them feel better.

• 22:09Speaker 00

  And so he said, hey, can I develop a COVID test? I don't think it'll be very useful, but it might make our employees feel good. And it's like a good training exercise for the team. And so they had worked on through January and the early part of February, a COVID test that they'd been developing, basically in their like spare time, in evenings and in weekends. And so then when everything started to really take off, we actually already had the test. What we didn't have was a lab to deploy it in.

• 22:35Harry Stebbings?

  And so at that point, you then go back to the old one and buy it for 27 million?

• 22:38Speaker 00

  No, so I bought a different lab licence.

• 22:40Harry Stebbings?

  You bought a different lab?

• 22:41Speaker 00

  So we reached out, I reached out to a bunch of people I knew in the Bay Area that had facilities with this kind of licence. Nobody wanted anything COVID related onsite. Nobody wanted anything to do with it. And so I like put it out, I just put out an email to like everybody I know. And there's actually a guy who was in the same YC batch as me, who'd become a VC. And he connected me to a group in LA and they had this licence and they're using it for like sports doping testing. And they were in what I thought was LA. I remember telling Justin, oh, Justin, I'm going to LA. I'll be in San Dimas. And he was like, where the hell is San Dimas? It's like basically very far east of actual LA. It's still in LA County. It's a little city, best known for Bill and Ted.

• 23:25Speaker 00

  You know, it's a little town of like 30,000 people.

• 23:28Harry Stebbings?

  And that's where the lab testing was?

• 23:29Speaker 00

  And that's where the lab was. And so I flew out there to look at that lab. This was from, from San Francisco and to look at one other lab licence that was, I think affiliated with one of the universities. You know, they had a good space, they had this licence and they were doing pretty minimal testing. So they just kind of like a blank slate. And so it started off as a 50/50 JV between Curative and this company that had the lab licence. And we would bring the test, we would bring the expertise, they would bring the licence. And it became pretty clear quite quickly that they didn't have the expertise to scale it up. Like, they were actively getting in the way of scaling it up. So we bought them out.

• 24:07Harry Stebbings?

  And that was the 27 million? Where did you get 27 million from?

• 24:10Speaker 00

  Forward revenue from customers. So we were getting paid, we had our first testing contract, we were doing police and the fire department.

• 24:19Harry Stebbings?

  And so how do you do, you have a chief science officer who's created this brilliant task here?

• 24:24Speaker 00

  Yep.

• 24:24Harry Stebbings?

  And you go to like San Francisco State or Government Council?

• 24:28Speaker 00

  Yeah. So actually, our very first customer was the Sheriff's Department in San Dimas. Well, we did some like private testing for individuals that were paying for the tests. But our first government customer was the Sheriff's Department in San Dimas. And that came about because they got wind that we were setting up a COVID lab, because people were freaking out about it in the town. And so one of their sheriffs reached out to me on LinkedIn and was like, hey, what are you guys doing? And so I connected with him and I explained what we're doing and how it was very safe and how we had this way of deactivating the COVID as soon as it went into the sample. And so there was no live virus on site and we were not presenting a risk to the community. And actually, this was going to be a good thing. And we're going to be hiring a lot of people. And kind of got him on board that, you know, we're doing, we knew what we're doing and we're doing this in a safe way.

• 25:12Speaker 00

  And then he was like, well, we really need testing. And then the fire department wanted testing. And then our first really big contract was the city of LA. And that came about from a tweet. So we had Laura Demming, who was a, you know.

• 25:24Harry Stebbings?

  Yeah, I remember. She's YC and longevity person.

• 25:28Speaker 00

  Exactly. So she, you know, was, was a friend and was trying to basically help with the pandemic. And so she actually drove me down to LA with a car full of PCR machines. So I could like work on a laptop and she helped with a lot of the early development work. And she tweeted, hey, we've got COVID testing capacity. Does anybody want some? And the deputy mayor of LA slid into her DMs and was like, yes, please, we would like to talk about that.

• 25:54Harry Stebbings?

  Wow.

• 25:54Speaker 00

  So that was how our first big contract came about.

• 25:57Harry Stebbings?

  And so you speak to the deputy mayor of LA?

• 26:00Speaker 00

  Yep. And then, so they were doing a pilot. They said, look, we've got a couple of labs. You know, you're going to have to demonstrate this because we were a complete unknown, right? We'd done.

• 26:07Harry Stebbings?

  And COVID wasn't peak ramped now, was it?

• 26:10Speaker 00

  This was like early March. So people, lockdowns had just started. Everybody was starting to freak out. There was basically nowhere to get a test. Unless you were ultra-high risk and in a hospital, there was pretty much no chance you were getting a test. And so everybody was freaking out. This is when everybody was still like cleaning their, you know, supermarket bags with wipes. And nobody knows what's going on. Everything's shutting down. It wasn't so bad on the West Coast, but New York was like, was really bad already by this point.

• 26:37Harry Stebbings?

  And so they're paying ahead of time?

• 26:39Speaker 00

  So the best thing we could get with the city of LA, because they have, obviously, their city, there are certain restrictions, is that they would pay after delivery, that they would pay net one on the invoice. And so we would deliver the tests for a day and then we would send somebody to City Hall the next morning to pick up a cheque for those tests.

• 26:58Harry Stebbings?

  Wow.

• 26:58Speaker 00

  So the tests had been done, they were paying after we delivered them. But it was not, you know, your standard like net 30 or net 60 for a government contract. They were having, we were invoicing them every day for the number of tests they did. And they were having somebody in their finance department, like get us the cheque, because we needed that to pay for supplies, to basically grow out that testing capacity for where they want it to be.

• 27:20Harry Stebbings?

  What's the single largest contract you signed?

• 27:22Speaker 00

  Probably one of the Florida contracts was maybe the largest. So we did a contract with the state of Florida for all of their nursing home testing. I forget what the dollar figure was, but it was, you know, in the hundreds of millions of dollars. They put it out to bid and we won it.

• 27:36Harry Stebbings?

  Hundreds of millions?

• 27:37Speaker 00

  Yeah. But they tested every employee at every nursing home across the state, once a week for a three-month period. And so they did a great job of basically keeping things open, keeping these nursing homes open, keeping visitation, but making sure that the employees of those nursing homes were not spreading COVID to the people in the nursing homes. And so they wanted to test every single employee that was working at those nursing homes and then exclude the people that weren't, that had COVID, so they weren't exposing the residents there. And so we ran this big programme, a bunch of labs, or they put it out to bid. And everybody said, no, that's too crazy. Like, that's impossible. We cannot possibly test that many facilities with that tight a turnaround time.

• 28:19Speaker 00

  Like, this is impossible. And we've been like, yeah, we can, we can do that. We'll make that work. And we delivered it.

• 28:24Harry Stebbings?

  What did you see that others didn't?

• 28:27Speaker 00

  That you have to kind of scale like something like that up from scratch, that the existing labs, like the lab industry in general is a very low-margin industry and it's built on efficiency. You look at the big labs, the Quest and LabCorp, and they are ultra-efficient machines. Like, they're, some of what they do with automation is incredible. But if you're asking them to 10x capacity, that's literally the opposite of what they're built for. They are built for, we will get 1% extra margin by optimising this bit of the process over here so that it is perfectly efficient. And they're really good at that. But if you ask them to 10x that, it really doesn't work. And the mindset isn't there. The people don't know how to scale those kind of things up. All of the supply chain broke down. And so we basically said, okay, start from scratch, throw all of that away.

• 29:09Speaker 00

  Imagine that you're going to have to scale this up to hundreds of thousands of tests a day. Where do you start? And so we built what we called an orthogonal supply chain, which is just basically a fancy way of saying, we don't use the things other people use.

• 29:22Harry Stebbings?

  You sound like a McKinsey consultant specialising in innovation.

• 29:24Speaker 00

  Exactly.

• 29:25Harry Stebbings?

  An orthogonal supply chain. Yeah, great.

• 29:26Speaker 00

  Well, I found that was like a good fancy word that like, you know, was helpful from a sales standpoint.

• 29:31Harry Stebbings?

  Rubber stamp tech, yeah.

• 29:31Speaker 00

  Right. What it basically means is everybody was chasing the same consumables, the same supplies. Everybody was trying to use the same stuff. And if, you know, you can make 1X of that, maybe they can increase to make 1.2X. If everybody's trying to buy that, us also trying to buy that doesn't help. That doesn't net increase the number of tests being done, right? It just makes us all squabble over it. So that's pointless. So you've got to find other ways of doing the testing, using supplies that maybe wouldn't traditionally be used for this kind of testing. So we were sourcing swabs, you know, from other types of vendors that were being used for electronic testing and then sterilising them. We were sourcing, there's this kind of extraction material that you usually use, and magnetic beads is kind of the default standard.

• 30:15Speaker 00

  But there's this other way of doing it with filter plates, which is more scalable because it's basically just glass and plastic. And you can scale that up faster than you can scale up magnetic beads, where they all come from basically two factories in China. And so we're like, okay, well, we should never use magnetic beads because that's not going to scale as a technology. We need to go find vendors who can scale up the plastic and glass manufacturing and partner with them to basically 10x it. And so you kind of approach every single bit of the supply chain that way. You end up with this massive scale. Now, outside of a pandemic, that doesn't work because people don't want 10x more testing than they wanted yesterday. But within a pandemic, you've got to approach it differently. And so we peaked, I think our peak day was 206,000 people tested in a single day.

• 30:54Harry Stebbings?

  206,000 people tested in a single day?

• 30:57Speaker 00

  And that was December of 2020. So that was within eight months from zero, zero to 206,000. And the company went from about seven to 7,000 employees in those first nine months.

• 31:09Harry Stebbings?

  7,000 employees in nine months?

• 31:11Speaker 00

  Yeah. Yeah, it was a, it was a little crazy.

• 31:13Harry Stebbings?

  Do you sleep at all?

• 31:16Speaker 00

  I don't sleep very much, no.

• 31:17Harry Stebbings?

  But in that time, what was the craziest thing that you did?

• 31:20Speaker 00

  I mean, some of the hiring, you know, you have to get licensed people for certain roles, but other, like more administrative roles, you don't need licensed people. And so we would literally, a lot of people wanted to work on the pandemic, which is very helpful. We'd have people like line up in the parking lot, socially distanced, like down the street, and then give them five-minute interview slots and just have somebody sit there with a clipboard and it's like five minutes. And next, just to get the volume of people in the door.

• 31:44Harry Stebbings?

  How much money did you make from COVID testing?

• 31:46Speaker 00

  I think the total revenue ended up being about five billion over a three-year period.

• 31:51Harry Stebbings?

  Five billion? Is that the largest private provider?

• 31:55Speaker 00

  We were, yeah, we were the largest like non-LabCorp and Quest testing company.

• 31:59Harry Stebbings?

  That is extraordinary. What is the margin profile on a COVID test?

• 32:04Speaker 00

  Really good during surges and then really bad not during surges.

• 32:10Speaker 00

  So what we found was when when there is a peak, right? So we get a new variant or it's usually winter was the biggest peak. But then we started having these summer peaks, which was kind of weird. Everybody would run to get tested. And these were all public testing sites. So these were in parking lots. These were the drive through tests. That was what we were doing. So if you went to a drive through testing site, like the biggest one was the Dodgers Stadium site in L A. It was seven lanes of traffic, seven A M. to seven P. M. Seven days a week. They were testing at the peak about 10,000 people a day coming through their cars, getting tested and coming back to the lab. So when you're at peak capacity and you're filling all of the lab's volume, it's very profitable. Then those basically surges subside, right? And you end up back at testing, you know, using 20 or 30% of your capacity.

• 32:55Speaker 00

  All your fixed costs are the same. You're still paying 7,000 to people. Now, you don't have to buy as many consumables, but all of that infrastructure has to be maintained for the surge. And so this is again, where it's like the opposite of the traditional lab industry, where they have a very flat volume. Every year, people do roughly the same amount of blood work as they did last year. Or maybe they do like predictably slightly more, but it's it's within a couple of percentage points. Here, you're kind of building it for that peak capacity. And then during the lulls, like maintaining that capacity is incredibly expensive. And so it was kind of necessary. And this was part of the way it was set up. They increased the price, the reimbursement price that they were paying for these tests because they needed to incentivize the capacity to be built.

• 33:37Speaker 00

  Because if you don't build that peak capacity, then when you have a surge, it all goes horribly wrong and no one can get a test. But that means you basically have to pay to overbuild it because during the dips, you have to have that capacity. You can't just shut it down.

• 33:49Harry Stebbings?

  And you can't build up 7,000 in 24 hours and.

• 33:52Speaker 00

  And so you need to maintain that. And so we would lose a lot of money in every one of the dips, basically.

• 33:58Harry Stebbings?

  Well, you'd actually lose money.

• 33:59Speaker 00

  Yeah, we'd lose money on every test during the dips.

• 34:02Harry Stebbings?

  Oh, wow.

• 34:03Speaker 00

  Yeah.

• 34:03Harry Stebbings?

  So of the 5 billion, how much is profit?

• 34:06Speaker 00

  So after all was said and done, the money that we basically put forward into the insurance business, the health insurance company was about 500 million that we invested into the health insurance business.

• 34:15Harry Stebbings?

  It's absolutely astonishing.

• 34:17Speaker 00

  Yeah.

• 34:17Harry Stebbings?

  Can I ask you, when we saw the vaccines roll out, did you know they were ineffective in the way that they've kind of turned out to be?

• 34:24Speaker 00

  It was not clear at the beginning. And I think also it's it's sort of changed like that when nobody's had any exposure to COVID, being vaccinated probably provides a lot more benefit. Once everybody sort of had COVID a few times, then the vaccines benefit is much less because you've already had it. Also, the variants got weaker and weaker. When we were first rolling them out, I mean, I think in, you know, December of 2020, there was benefit for a lot of people getting the vaccine.

• 34:50Harry Stebbings?

  Did you get vaccinated?

• 34:51Speaker 00

  Yes, we did. We did two and a half million vaccinations. That was another service we did. We also lost a ton of money on that. That was a terrible business.

• 34:57Harry Stebbings?

  Why?

• 34:58Speaker 00

  Because the government wasn't paying enough. We lost money on every single dose. It cost more to administer them than we were getting paid.

• 35:04Harry Stebbings?

  Why did you do it?

• 35:05Speaker 00

  Giving back, a lot of our partners wanted it. So a lot of the partners on the government side we're working with for testing also wanted us to administer vaccinations.

• 35:13Harry Stebbings?

  Was it, this sounds awful, was it a hot, like your business with COVID obviously being eased.

• 35:19Speaker 00

  Yep.

• 35:20Harry Stebbings?

  Completely changes and you have to pivot again?

• 35:23Speaker 00

  Yeah. Well, so that started very early for us because I was convinced this wouldn't last very long.

• 35:28Harry Stebbings?

  But you were always aware it wouldn't last?

• 35:29Speaker 00

  Yes. When we started hiring people at the beginning, we told them this is three months. You have a job for three months. Don't bank on anything beyond three months. This is a three month gig and we're going to shut it all down in three months. So the CFO and now the president of Curative joined at the beginning and for her it was going to be a six month gig. She came out of retirement to help with the pandemic for six months. Now, six years later, she's still here, but it was supposed to be temporary. And every time, you know, a surge, we got through a surge, I was like, all right, that's it. It'll be over now. And then they just kept happening. So we started looking at kind of what comes next, middle of 2020, like really early.

• 36:06Harry Stebbings?

  How did that search for what comes next change? You just started looking at middle of 2020. It's not until end of 22, start of 23, when that actual search is activated into real time plan, correct?

• 36:17Speaker 00

  Yeah, I think we started probably like late 21 is when we got really serious about health insurance. It just took a while to actually get the license.

• 36:24Harry Stebbings?

  Yeah. Why health insurance?

• 36:26Speaker 00

  Well, it wasn't the first idea. We looked at a bunch of other stuff. We looked at other stuff in the lab testing industry. Unfortunately, it's just not that big an industry. And so even like, we had this interesting technology that could theoretically let you do a lot of lab tests, our individual tests today, like as just one single test, which would be scientifically quite cool. But even if you say, okay, I'm going to displace all of LabCorp and Quest, that's about 30 billion of market cap. So that's like the largest company you could possibly build is about 30 billion. That is a big company, but coming out of what we did with COVID, I wanted to build a much bigger company than that. And so there's just not a big enough market in lab testing. So the lab testing was was out. And then we briefly looked at trying to buy a hospital or multiple hospitals.

• 37:11Speaker 00

  We looked at one in Florida and we looked at one in Texas. And the idea was, well, if the hospital is kind of like the whole, the health system becoming the center of where care is delivered, they buy, have bought up a lot of the primary care offices. If you can transform that with technology, can you drive much better outcomes? What we ultimately decided is it doesn't work that well because the payer mix is too broken up. And so as a hospital, your customer is like 50% of the government and then a whole bunch of like split up, smaller insurance plans, and they all want different things and they change their mind every five minutes about what they actually want. And you're trying to like, keep them all happy. So your ability to really change things from the hospital side is quite limited is what we ended up deciding.

• 37:53Speaker 00

  And when you come back to it, like we looked at a bunch of preventative care things, we looked at a primary care chain, everything sort of ends up coming back to the payer. Like the payer is the one that drives behavior in the U. S. Healthcare system. If you are providing the dollars, people will go where the dollars are. If you say, I'm going to pay for this service, people will go do that service. If you say, I'm not going to pay for this, people will stop doing that. And so the payer is the one that's kind of driving things.

• 38:17Harry Stebbings?

  If you could do one thing to change the structure of the U. S. Healthcare system today, magic wand, what would you do?

• 38:23Speaker 00

  I think you have to break up the negotiating into smaller units. Like it's gotten to this point where I think it's it's quite an efficient system as a market when the counterparties are small. When everything gets very consolidated, it becomes incredibly inefficient. So when we look at, for example, health systems, right? So we pay for for care at health systems, some of that care you can get in other places. If we look at how much we pay a primary care doctor who's independent compared to a primary care doctor affiliated with a system, affiliated with a system, they get paid an average double. Same service, you know, same credentials. It's just that this one is part of a hospital system. And that hospital system will use the fact that they have a ton of beds, that they have

• 39:05Speaker 00

  this ultra special surgery center that you need, like we need to have that capacity in our network because some people need to be hospitalized. Some people need those services that if you want to get access to that, you got to pay me double for my primary care doctors. And so when all of the players are small, when you have smaller payers and smaller hospitals, you end up kind of getting to reasonable negotiations. What's happened is you have these massive payers, like the market is ultra consolidated. You basically have like four large players that control the entire market on the payer side. And then you get these ultra consolidated hospital systems because that's the only way for them to survive. If they want to, you know, fight with Blue Cross, the only way to survive is to get really big so they have the negotiating power. And then they just reach these loggerheads where nothing gets done and everybody's overpaying

• 39:50Speaker 00

  for everything and everything's inefficient. And when you have more competition in the market, more smaller payers entering, more, you know, smaller health systems, you start to get like an actual efficient market. When you're just negotiating for like, hey, I have a third of healthcare in the state and I have a third of all of the employees in the state, it's not an efficient market anymore because there's no alternative. You have, you must reach a deal.

• 40:14Harry Stebbings?

  If I am sick, is the best place to be treated in the U. S.?

• 40:17Speaker 00

  Yes, definitely.

• 40:18Harry Stebbings?

  Seriously?

• 40:19Speaker 00

  Yeah, the U. S. Has the access to by far the most cutting edge techniques and facilities and drugs than the rest of the world. And they are willing to spend a lot more in order to preserve life.

• 40:33Harry Stebbings?

  Do you know now that you wish you'd known when you made the pivot into insurance?

• 40:37Speaker 00

  I think I wish that I knew A. I. Was coming. Like the way we designed the business in 2022, when we first started, we had no idea that this wave of A. I. And L. L. M. Was coming. Like we were building a health insurance business because we thought it was a good business to build and we thought it needed to be built. We needed better alternatives in the market for health insurance. And then in the last like 18 months, how we do pretty much everything is now completely different workflow. There's so much, I mean, all health insurance does is like moving bits around, right? Like we don't have a physical product. We give you a little plastic card, but apart from that, our product is that we move bits around in a database that means care is paid for. That's it. And we do a lot of managing, kind of managing a marketplace. We work with the providers to negotiate prices.

• 41:21Speaker 00

  We work with employers to negotiate how much they pay. And then we try to work with employees to keep them healthy. If we can get people to stay healthy, we can avoid the long term downstream cost of care. Essentially, it's marketplace business. And that has been fundamentally like shifted by A. I.

• 41:36Harry Stebbings?

  How's it been shifted by A. I.?

• 41:37Speaker 00

  So much of that back office work, right, has been completely changed by A. I. We now have entire departments that used to be people like rubber stamping things. The first one that went to zero people was our credentialing department where, you know, this is a process that's incredibly labor intensive, where you have to check all doctors that join our network have a valid medical license and aren't being sued for malpractice. And this is, you know, a person going to the medical board website, checking that the license record is there, checking transcripts from their school, checking. Like a database of who's been sued by who and then like rubber stamping. And that used to take us two to three months on average and cost about $50.

• 42:17Speaker 00

  We've now built in-house an agent that runs on Claude that does this end to end. And it goes to the website, it verifies the license, it goes and reads the transcript, it puts it all together, it stamps it for approval. And we're now averaging about 12 hours turnaround time for credentialing somebody and it costs us about 20 cents. And this is like a mind numbing process that payers have to do, which is important. We want to know the doctors in our network, right, are validly licensed to practice medicine. But it's like historically has always been kind of terrible and payers have been bad at it. Right. If you're a doctor and you join a network and it takes three months before you can see any patients, it's just bureaucracy, right? Like they don't, doctors hate that and it's not actually adding the value that it should be adding. It's just creating paperwork.

• 43:02Harry Stebbings?

  How many people did you have in credentialing?

• 43:04Speaker 00

  That one wasn't that large. I think it was like five or six people. We had a few other departments that have shrunk more than that with that.

• 43:10Harry Stebbings?

  What other departments?

• 43:12Speaker 00

  We've seen a lot on the claims side, claims processing, right? It used to be a very manual process where claims comes in and people are like manually tweaking and editing it. And also on the underwriting side, underwriting, you know, the process used to be a broker comes to us with a group, an employer that they're looking to insure. And they ask for competitive bids from multiple different insurance companies. And what that means is basically sending us an email with a bunch of PDFs and spreadsheets attached of who are the employees? What current claims do they have? What's the current insurance look like? And you'd think that over time they would develop like a standardized ish format for how that should run. But no, every single one is like a different spreadsheet format, different PDF.

• 43:52Speaker 00

  And we tried to sort of solve that problem with software and build like universal importers and universal intake. And it like, it kind of worked, but what we found works amazingly is literally to give the files to an agent. Tell it to write Python to get these files into a standardized format. Because they're not very good at parsing files, but they're incredibly good at code gen. And so you can tell it to write a Python script to convert any random file into this known format. And then test it and loop and iterate on your script until it's working. And then you throw away that script. And so it's single use code that never gets used again. You just generate that code one time and then throw it away. And that works so well.

• 44:31Speaker 00

  And so now brokers, providers, employers, when people are sending us files, we always used to like insist, oh, you have to use our standard format for this. And they'd hate it and they'd get mad because somebody's sitting there in a provider office, like manually reformatting these files into our spreadsheet. Now send us whatever you've got, whatever format, it can be scribbles on a napkin. It doesn't matter. The model will figure it out. The model will convert it into our standard format and it will do it in about 15 minutes. And so you build these data ingestion pipelines that used to be hundreds of people sitting, moving spreadsheets around. And it's now a model writing Python code to do that same thing. And then every single time you throw that Python away and start from scratch.

• 45:10Harry Stebbings?

  Dude, I have so many questions to ask on the back of this. The first one is you mentioned that kind of the internal agent build out that you've done for the company and for your specific processes. Do you buy the SaaS is dead theory that we will, why?

• 45:21Speaker 00

  Because I see the number of contracts we're cancelling. Like we just recently cancelled our Salesforce contract because we have an internal CRM that was vibe coded, that is working better, that is managing our process better. Is more integrated into what we're doing. We run our agents inside of it and no, no one was using Salesforce anymore. $600,000 a year, gone to zero.

• 45:41Harry Stebbings?

  How long did it take?

• 45:42Speaker 00

  Two months.

• 45:42Harry Stebbings?

  Is it worth, because the argument back, I always like to do both sides. I'm never, is it worth the engineering hours to vibe code that and then to maintain it?

• 45:52Speaker 00

  The maintenance is definitely one of the most challenging pieces. I agree with that. For most businesses of any reasonable scale, yes, it is worth it. Now, whether they will have the tech resources to do that soon, I think that's like the bigger question. It's kind of when will this happen? But when you build those things custom to your workflow, they work better. Like most of these big, you know, systems, you're paying an administrator, like we had a full-time Salesforce administrator. You're paying people whose sole job is to manage this like archaic software platform. Not that Salesforce is archaic, but you know, we have a few other like internal apps that we were paying for, like industry software. That is taking multiple FTEs to maintain it. You can transition that into one great engineer.

• 46:35Speaker 00

  And then whenever you want a custom feature, you just go build it.

• 46:38Harry Stebbings?

  Absolutely fucking wild. $600,000 a year on Salesforce.

• 46:42Speaker 00

  Yeah. And so we're seeing, you know, there's pockets of software that I think persist because they are more infrastructure based.

• 46:50Harry Stebbings?

  Okay, which persists?

• 46:51Speaker 00

  So we're seeing a lot of backend stuff like, like Sentry, like stuff like that, right? Where it's like kind of become part of your infrastructure. Slack has been like notoriously hard internally for us. Like so many people have built integrations and like workflows that are now working in Slack. I think that while they keep putting the prices up, if they put the prices up too much, then eventually it'll make sense to replace that, but.

• 47:11Harry Stebbings?

  What else is on the chopping block?

• 47:12Speaker 00

  We're cutting about 80% of our SaaS spend this year.

• 47:16Harry Stebbings?

  Wow.

• 47:16Speaker 00

  So we had like in one of our internal meetings, we have a slide of like, when are SaaS contracts due? And whose job is it to tell them that we're not renewing this year?

• 47:25Harry Stebbings?

  Well, you can do it in one fell swoop.

• 47:27Speaker 00

  Yeah. Well, they have renewals. We have to pay them through the renewal.

• 47:30Harry Stebbings?

  Ah, is it all like legacy software like Salesforce, so?

• 47:33Speaker 00

  Some of it's like that. Some of it's like very insurance specific software. So like our claim system, for example, right, is this like massive off the shelf platform that we just migrated to a few years ago. This is again, why like if I'd known AI was coming, we would have probably approached things differently. And it's just, it's very hard to use, like it's hard, their API barely works. It's hard to get the data out of their database. They won't let us manage it, but that's how insurance companies are running things. And so we've built our own claim system completely from scratch in-house. It's now, we've migrated most of the workflows off, will be fully off in July.

• 48:07Harry Stebbings?

  I am a health insurer. You know, other health insurers.

• 48:10Speaker 00

  Yes.

• 48:10Harry Stebbings?

  I do not have the in-house capability potentially technically to build the agentic workforce that you are building.

• 48:18Speaker 00

  Yep.

• 48:18Harry Stebbings?

  Am I screwed?

• 48:20Speaker 00

  I think some of the biggest insurers will struggle. They will not be able to keep up from a margin standpoint with where we can get to with agents. I think some of them do have technical expertise. It's more operational and kind of people ops. If you've built a company of 100,000 people and in order to get this margin improvement, 50,000 of them have to be laid off. Somebody's fiefdom just got a lot smaller. And so they will do it slowly over 10 years. It will happen, but will it happen quickly? No. And will we be able to compete more effectively in the meantime? Yes.

• 48:51Harry Stebbings?

  How do margins change?

• 48:53Speaker 00

  Insurance is a very low margin business. So 85% of your premium that we collect must go out the door to pay for care. So if we get in a dollar, we got to spend 85 cents.

• 49:04Harry Stebbings?

  You have to.

• 49:05Speaker 00

  By law. If less than that goes out the door, we have to give it back to the employer. Which is another thing that's broken about US healthcare, because that drives completely the wrong incentive. Where actually from an insurance company standpoint, if your profit's capped at 15%, the only way to increase profits is to increase total spending, which is not what you want your insurance company incentivized to do.

• 49:24Harry Stebbings?

  Why would I encourage people to go to the gym, eat healthily if actually you're not going to get that back anyway?

• 49:29Speaker 00

  So this was part of Obamacare and it's one of the like, there's some good things in Obamacare, but there was a lot of things I think like the second order consequence was not considered. It sounds like a great PR thing to say we've capped insurance company profits, right? That sounds good, but it's BS.

• 49:44Harry Stebbings?

  It's like capping CEOs like fiscal base pay. Sounds great. Yeah. So let's just pay them 27 million in equity comp and said, that's the reason why we have such egregious comp packages for execs. Cause they kept the salary pay.

• 49:57Speaker 00

  Yep.

• 49:57Harry Stebbings?

  Ridiculous. With that, how's your anthropic cost gone?

• 50:02Speaker 00

  Yes. So I mean, this is one of the, I think the kind of leading indicators for us is that our anthropic cost over the last six or seven months has six Xed every month from, you know, a base of, you know, a couple of tens of thousands of dollars now up to millions of dollars a month. Eventually we're going to have to stop that spending increase because, you know, it'll get unreasonable, but we just keep finding new things to do with it. And then the other thing we found that's been fascinating, we're seeing a lot of areas where it's not that we are necessarily replacing the team. It's that we're repurposing the team and they are now so much more productive. And so one area that has always been like a particularly challenging thing that makes it hard to build a new insurance company is we have to build this network. So the network is all the doctors and all the hospitals and all the people that we have to contract with.

• 50:47Speaker 00

  And there's about 1.2 million of those in the US that you want to have contracted. That ends up being like 60, 70,000 contracts that you have to do. That's just a lot of work to go out, get their attention, do a negotiation, get them to sign an agreement, load all of their data and have them in your network. And this has been one of the biggest like pieces of staying power of the big health plan businesses. Is they built that over a hundred years for Blue Cross and over like 50 years for United Signor and Aetna. And so they did it slowly over a long period of time. If you're trying to from scratch, come in and start a new health plan, you've got to reach out to all of those doctors and negotiate. And so we have a team of about 45 people who do those network contracts and they reach out and they negotiate.

• 51:31Speaker 00

  What we launched earlier this year is an agent called Gwen. And Gwen does the same workflow. You give her basically a lead, hey, there's a primary care office over here. Here's the address and she will go Google it, research them, learn a little bit about their practice. Figure out what other payers are paying them, because there's a lot of this data out there and these transparency files now of how much are they getting paid? Find their email address from Zoom info, reach out to them and then basically ping them repeatedly until they answer her with custom emails. Like, hey, I know about your practice. I know what you're doing, like customized content to them. And then when she gets their attention, negotiate the rates back and forth. Usually over like multiple rounds of negotiation, negotiate and redline the language. And that's another place where we found Python is great.

• 52:15Speaker 00

  These models are terrible editing Word documents. But if you tell them to write Python to edit a Word document, they're great at it. Great hack. And then sign the agreement. So she now signs the agreements with my signature. She'll open up the DocuSign link and then click the button. And it's my signature on that agreement. So this has taken us from doing about a hundred contracts a week to about a hundred contracts a day. Last year, as an entire team, we did 2,300 contracts. So far, in about the last eight weeks, the agent alone has done 3,500. And so what this is letting us do is like that team doesn't go to zero. We've refocused that team to work on these bigger contracts, right? Because some of these deals we can do entirely over email. This agent is email only. And some of these providers will work completely over email to enter into an agreement.

• 52:59Speaker 00

  And actually, how many of them will do the whole thing over email surprised me. There's a lot of millennials, I guess, on the other end that don't want to get on the phone and would rather do the whole negotiation completely electronically, which is fantastic because the model is great at that. But some of them, the bigger hospital systems, the bigger doctor groups, they want to have a phone call, they want to meet in person, they want to learn who we are. And the team now get to spend their time going and having those in-person meetings, going and developing those relationships, working with those bigger groups. And then even when it gets to the paperwork, handing the paperwork off to the model. And then all of the smaller, the individual PCP over here, the small behavioral health provider here, the therapist over here, the agent just gets it done and can sign a contract end to end in a few hours where you wouldn't be able to do that volume with people.

• 53:44Harry Stebbings?

  Given the transformational nature of what you're describing, if Anthropic doubled their price, would it impact your usage? When we look at a lot of the financials of these core businesses today,

• 53:55Speaker 00

  Yeah.

• 53:55Harry Stebbings?

  they are challenged businesses in their current infrastructure and pricing. If they double pricing, would it stay the same?

• 54:01Speaker 00

  If I say yes, I don't want our Anthropic rep to double our pricing.

• 54:06Harry Stebbings?

  But it would.

• 54:06Speaker 00

  It would work, it would be fine, yeah. So it costs with people, it costs us about 1,500 to 2,000 dollars on average to do a contract. The average with Gwen has been about 70 dollars. So it would still work fine. And so that's what we've seen is like partly why the token use has exploded for us.

• 54:22Harry Stebbings?

  Am I being a complete idiot then? But then if they five X their pricing, if you went on the labor displacement theory,

• 54:28Speaker 00

  Yeah.

• 54:28Harry Stebbings?

  it would still work.

• 54:30Speaker 00

  It would still work. What they're betting and what also we've seen is you don't just displace the labor. So here, like I think contracting is a perfect example. We've not said, okay, we're doing 100 a week, so we'll get the agent to do 100 a week. What we've done is said, well, now that we have the agent, we can do 10 times as many contracts this year as we could do last year. So we're going to do 10 times and then we're going to try and do 20 times. And we will just do a lot more volume than you could possibly have done with a human team.

• 54:56Harry Stebbings?

  Everyone's like, oh, I lose my job, lose my jobs. Do you think that's warranted?

• 54:59Speaker 00

  I think for a lot of these back office jobs, yes.

• 55:03Harry Stebbings?

  So how do we determine between I'm just going to do more? A lot of people say with developers, we're not going to get rid of developers. There's an insatiable appetite for more software, better software. How do we determine between functions where we'll do more versus will be replaced?

• 55:17Speaker 00

  So what we've tried to kind of differentiate at Curative is there's like two areas where we're really investing in people. That's technical skills and relationships. Those are two aspects that I don't see going away anytime soon. Is we still have a team that are actually deploying all of this AI. They use a ton of AI in all of their day to day work, right? They're not writing any code anymore, they're not even reading the code anymore. They're deploying all of this with Claude Code or Codex and seeing like incredible results out of like one senior engineer now is so much more productive than they were a year ago that we're investing in having those people. At the same time, there's a side, particularly to health insurance, that is relationship driven, that I don't see as going away anytime soon.

• 55:58Speaker 00

  Ultimately, we ensure a member and that member wants to be able to call and talk to a person. We have a lot of AI they can talk to, the AI is great, they love talking to the AI. But there has to be a person somewhere in the loop. We also work with these provider groups. We have a relationship with that provider group that we're providing a chunk of your revenue. You know, we work with you, you work with us. There's a relationship aspect there that has to be maintained, particularly for the larger groups, by a person. And then on the sales side, we sell through a broker. And that broker wants to have a finalist presentation. They want to go to dinner, they want to go and play golf. And so what we've seen is on the sales side, like that relationship is if anything, more powerful.

• 56:38Harry Stebbings?

  Do you think they still will in five years? A lot of people talk about agent agent transactions and how that changes the process. Do you think we will still have that heavy relationship interpersonal sell in five, 10 years?

• 56:49Speaker 00

  In some aspects, yes. Because I think in some aspects, that's kind of becomes the foundation of trust. And it's like almost the scarce resource, right? Of if you want to do a deal that's important, then you're going to use your scarce resource of people to manage that.

• 57:03Harry Stebbings?

  It's also the bigger the contract, the more important it is to have the whites of the eyes and the trust in the relationship.

• 57:10Speaker 00

  And most of these contracts, right? Most employers, even our smallest employers, it's a million dollar contract at least.

• 57:15Harry Stebbings?

  I always think they're like, when you look at accountants and lawyers and a lot of the people who could be replaced in some of them more simple, especially NDAs or... But you would never not have a law firm do it because if it goes wrong, they're getting fired.

• 57:27Speaker 00

  Yeah, but I think, I think you'll see it work differently though, where, I mean, what we're seeing with Gwen is we had a contract, a standard template contract that was drafted by a law firm. And then we have kind of like guardrails for what Gwen can agree to. But she just redlines it and then signs it. It doesn't go to a law firm for a review. Like we're signing hundreds of these contracts a day. It would be too encumbering, it would be too slow. And they would just be reviewing it with AI anyway. So we kind of trust the agent to do that legal review within certain parameters.

• 57:56Harry Stebbings?

  In three years' time, knowing what you do now about the capabilities that you use it for, how big do you think Anthropic will be?

• 58:02Speaker 00

  A lot bigger than they are today.

• 58:03Harry Stebbings?

  Do you think it could be five trillion?

• 58:05Speaker 00

  I think it could be 10 trillion.

• 58:09Harry Stebbings?

  It's just extraordinary, isn't it?

• 58:11Speaker 00

  Yeah, because I think you just find all these new things that you can do that you just couldn't do before, that it like wasn't possible to do. So Gwen is sending on average 15,000 emails a day. Customized emails to providers that know about their practice, that know about their work. And one of the things we've found is like that relentlessness of the follow-up is what works. A lot of providers will get them on the ninth email. There is no way that a human is going to email them nine times because, you know, people, that's like, you have to kind of have no shame to reach out that many times.

• 58:40Harry Stebbings?

  Johnny has something funny. You mentioned Salesforce. I got Mark Bennie off on the show because I emailed him 53 times, once every week, for a year and a week.

• 58:49Speaker 00

  There we go. Oh, yeah.

• 58:50Harry Stebbings?

  I'm basically an AI model. I lost my personality years ago.

• 58:54Speaker 00

  Very effective AI model.

• 58:55Harry Stebbings?

  That is extraordinary.

• 58:56Speaker 00

  But that works so well in sales and it's, and the best salespeople will do that. But it's really hard to scale that. And you end up getting people that reach out three times and then give up. And when you're trying to scale something up, if you can scale up that relentlessness, that is really valuable.

• 59:11Harry Stebbings?

  So you fundamentally buy the companies will be inherently smaller in the future. And that's why we're seeing layoffs.

• 59:16Speaker 00

  Yes.

• 59:16Harry Stebbings?

  Are layoffs today just an excuse for over hiring in 2021 and 2022?

• 59:21Speaker 00

  I think it's a mix.

• 59:22Harry Stebbings?

  Yeah.

• 59:22Speaker 00

  I mean, I think there's definitely some of that. You know, it's also coming to seeing valuation boosts by doing it. So that's incentivizing maybe bad behavior. But some of it for sure is that these workflows are changing.

• 59:34Harry Stebbings?

  How big are you today?

• 59:35Speaker 00

  We're about 650 people now.

• 59:37Harry Stebbings?

  How big will we be in five years' time?

• 59:40Speaker 00

  In five years, we'll probably be bigger. In the short term, I think we're going to be quite a bit smaller.

• 59:44Harry Stebbings?

  Smaller?

• 59:45Speaker 00

  Yeah. We're not done yet with all of these backend workflows.

• 59:49Harry Stebbings?

  Does that go to 400?

• 59:50Speaker 00

  Somewhere around there.

• 59:51Harry Stebbings?

  Wow.

• 59:51Speaker 00

  There's some aspects of the business that are our clinical workflows. So all of our members get a care navigator who stays with them for their entire journey. And that is just going to grow linearly with our membership. So we want you to have that human point of contact that is available. But the care navigators are now getting significantly more useful because they can actually use the agents to do a lot of the follow-up on their behalf. And they're not having to remember to reach out to this diabetic member every week about X. They can kind of manage it at a population scale. And so there, we're like keeping the same headcount relative to our membership growth, but just letting them do so much more than they could do before.

• 1:00:27Harry Stebbings?

  That's amazing. I was speaking to a major airline where they were saying actually about exactly that, they're like premium CAD customer service, where it's like they're able to give so much more for your recommendations for you and your wife's trip to New York. And everything's so perfected and tailored because all the bullshit that they used to do is gone. And for you as the end consumer, it's amazing.

• 1:00:46Speaker 00

  And the response time, the response time is so much better.

• 1:00:48Harry Stebbings?

  100%.

• 1:00:48Speaker 00

  You get a response back in a few minutes. That's, that's the usual place where we see people ask Gwen if she's an AI, when she responds to your email within five minutes. Because in healthcare, if you get a response same week from an insurance company, you're doing so well.

• 1:01:00Harry Stebbings?

  And people think that I'm an AI because I respond very quickly on email. And to the point where I'm like, no, I just have no life. You said about kind of the different data inputs of like, oh, you can just send us anything now.

• 1:01:11Speaker 00

  Yeah.

• 1:01:11Harry Stebbings?

  I always was like, data cleansing, data structures would be the biggest inhibitor to enterprise adoption of AI. Is that totally wrong bullshit VC?

• 1:01:19Speaker 00

  I think if you approach it in the right way, then the cleanliness doesn't really matter that much because the models are so good at cleaning up the data if you give them the right context. And so that's one of the things we found actually with migrating away from some of these SaaS vendors is we we moved away from Looker. Right? Google's Looker product for visualizations, it's super expensive and we moved to do it in Snowflake. And it's been a lot cheaper, it's worked really well. Part of that migration is moving all of our dashboards and all of the things that fed from Looker would have taken like probably like a year and a whole bunch of engineers and data scientists. We did most of it with an agentic workflow that would spin up, find the next dashboard, figure out how to convert it into what we needed.

• 1:02:03Speaker 00

  And then close it down on the Looker side and boot it up on the other side. And it ended up being like a project for one or two people and it took, it still took a couple of months, but it was a lot more doable because we didn't have to have somebody ingest or like figure out that data. You can just feed that data into a model and let it figure out how to stretch it going forward.

• 1:02:22Harry Stebbings?

  It's just really interesting because I, you know, I often think about what role does not exist today that will be massive in five years' time. And I thought like data cleansing would be one of those roles. If I asked you, what role does not exist today that you think will be very big in five years' time, what would you say?

• 1:02:37Speaker 00

  Agent supervisor.

• 1:02:38Harry Stebbings?

  What does that mean?

• 1:02:39Speaker 00

  One of the things we've found that's been like a bottleneck is when you launch these agent workflows, there's always things that they, you don't want to let it do everything, right? So like with our contracting, our sales workflow, like there's a certain margin threshold where the sales agent can't promise a client that will do it at that margin. But we don't necessarily want it to say no, we want to make a business decision about whether this is the right thing to do for that client. And so you end up generating this like massive list of approval requests that is now much longer than it would have been because you're doing 10 times as much work. So you're now getting, even if you're only getting an approval request 1% of the time, you're still getting 10 times as many as you were last year.

• 1:03:18Speaker 00

  And so one of the things we've found is like, actually, how do you manage all of those exceptions that now become like a really high volume? So we've tried agent supervising agents, which I think works to a degree. And maybe as the models get better as well, you can also have like a more expensive, right? Like if we ever get Mythos and it costs a hundred dollars per million tokens, you probably wouldn't use it for the core workflow, but you could maybe use it as a supervisor. But how you actually manage those agents at scale with like the volume of exceptions that they generate? Because you don't want them just rubber stamping yes or no either way, like you need a more nuanced decision there.

• 1:03:52Harry Stebbings?

  If you were advising your younger brother or sister on how to prepare for that role, what would you advise them to do to be adequately skilled to do that?

• 1:04:01Speaker 00

  I think just play with the models. Like I think a lot of people severely underestimate what they're capable of because maybe they like tried ChatGPT two years ago. Like they're moving so fast and they're so much better than they were even six months ago. That if you're not like relentlessly trying them, then you're going to significantly underestimate. And then also like where they are today is not where they're going to be clearly in a few years. So you've got to skate to where the puck is going to be.

• 1:04:24Harry Stebbings?

  Where will they be in a few years?

• 1:04:25Speaker 00

  Ahead of humans on most capabilities.

• 1:04:28Harry Stebbings?

  Are you excited?

• 1:04:30Speaker 00

  Yes, because I think that opens up so many possibilities, unlimited intelligence.

• 1:04:34Harry Stebbings?

  Are you not worried about in short term societal unrest, labor displacement and what that will do to a hollowing out an inequality increase in the US?

• 1:04:43Speaker 00

  I think that can be dealt with by significant action, whether or not we do that or not.

• 1:04:49Harry Stebbings?

  What significant action would you do to mitigate that?

• 1:04:52Speaker 00

  I think eventually some version of universal basic income.

• 1:04:54Harry Stebbings?

  And you buy that works.

• 1:04:56Speaker 00

  I think we have to build the social structures that give those people purpose and meaning outside of work. Because I don't think that we're going to have, and I also, I don't think that's a bad thing. Like a lot of these mid-level jobs that are being replaced are awful jobs. There are people sitting at a desk with like fluorescent lamps shining at their face, reviewing random paperwork. That's not what people like, you know, when you're little and you say, what do you want to be when you grow up? I want to sit in an office and rubber stamp insurance forms. Like it's not a good job.

• 1:05:24Harry Stebbings?

  I would be worried if my child.

• 1:05:26Speaker 00

  Right. So these are not like, it's not like you're taking some like super aspirational thing away from people. I think these are jobs that will look back and say, God, I can't believe we had people doing that kind of work. That's crazy.

• 1:05:38Harry Stebbings?

  You know, I walk with my mother a lot and I always say, my job is to invest in the things that we say, God, I can't believe we used to do it that way. I said, do you remember, I would never put my credit card on the internet or you'd never find your like husband on the internet.

• 1:05:52Speaker 00

  You'd never get in a stranger's car and have them drive you where you want to go.

• 1:05:55Harry Stebbings?

  What is insane today that will be incredibly, obviously you have your card online, you obviously you meet your partner online. What is insane today that you think will be like obviously in 10 years?

• 1:06:05Speaker 00

  I think empowering agents to do things on your behalf. Like we've seen internally getting the team, I think like Isaac, our CTO and co-founder and I have like trusted the agents faster than most of the team. And we're okay like giving the agent authority to do things. Like it was a big internal dispute getting the agent to sign these contracts. So the agent opens DocuSign and clicks the sign button and it's legally binding and it has my signature on the page. And getting that figured out internally was very, it it took a lot of rounds of convincing people that that was okay and that we can do that. And so I think it will take time for people to trust these agents with stuff like, you know, give it your credit card and let it go book a holiday, right?

• 1:06:49Speaker 00

  Like getting, getting people to trust it acting on your behalf, I think will take longer.

• 1:06:54Harry Stebbings?

  But I'm thrilled that you signed me your house for $12. It was wonderful.

• 1:06:58Speaker 00

  Right, yeah.

• 1:06:59Harry Stebbings?

  Do you worry about the concentration of value when you look at the Mag7 providing 85% of gains here to date in stock markets? And then Anthropic, OpenAI, maybe one or two more. Do you worry about that concentration of value?

• 1:07:13Speaker 00

  I'm quite bullish now because I think a lot of what's going on in AI is going to massively boost earnings in other areas of the economy that have struggled to grow earnings any other way.

• 1:07:22Harry Stebbings?

  Like health insurance.

• 1:07:23Speaker 00

  Like health insurance, like how do you grow health insurance earnings? Where it's been, or you go chase government business and you pay a bunch of lobbyists to get the government to overpay for care. That's all now backfired and all the government business, Medicare and Medicaid is now like a bad business and they're all losing money. Everybody has insurance, so unless you're going to increase the total spending, how do you grow earnings? Well, if you can make it more efficient, so you're not spending 9% of your premium on admin tasks. That's a way you can grow earnings without having to deliver a worse product.

• 1:07:53Harry Stebbings?

  You're in a really good business as well because it's unwaveringly not in the path of the model providers as well.

• 1:07:58Speaker 00

  Yes, they're not going to start an insurance company.

• 1:08:00Harry Stebbings?

  Yeah, I put in the path of like, we're bigly invested in Airwallex, which is like business banking.

• 1:08:04Speaker 00

  Yep.

• 1:08:05Harry Stebbings?

  Anthropic is not going into business banking.

• 1:08:07Speaker 00

  Right.

• 1:08:07Harry Stebbings?

  In Southeast Asia. I would be surprised.

• 1:08:10Speaker 00

  I think things that have some like regulation around them and are like complex industries, yes, they're going to see the advantages of the models, but they're not going to see competition from Anthropic or OpenAI.

• 1:08:21Harry Stebbings?

  I totally get that. When I listen to you, I'm like, Jesus, if I was you, I'd also take a chunk of my money and invest it actively into Anthropic. Can I ask you, have you taken secondaries along the way?

• 1:08:31Speaker 00

  No, no, we haven't sold any secondaries. We did, there was a dividend at the end of COVID, we paid out some. All of the investors got 10x their money back before we started the health insurance company and then they still have their shares today. We haven't sold any secondaries, no.

• 1:08:43Harry Stebbings?

  Are you fucking serious? They got 10x their money back and then they kept the shares?

• 1:08:48Speaker 00

  We didn't have that many investors, but yes, they they all did well.

• 1:08:51Harry Stebbings?

  That is an amazing deal. 10x and then you keep the shares?

• 1:08:56Speaker 00

  Yeah.

• 1:08:57Harry Stebbings?

  What?

• 1:08:58Speaker 00

  Well, I think that's why we've seen them double down, right? It's like they made money with us before. And so, you know, this last round was was led by insiders.

• 1:09:07Harry Stebbings?

  And how big was the last round?

• 1:09:08Speaker 00

  150 million.

• 1:09:09Harry Stebbings?

  What was the price?

• 1:09:10Speaker 00

  1.3 billion.

• 1:09:11Harry Stebbings?

  Wow, nice round actually. Like not too much dilution, enough that it's really impactful cash flows to come in.

• 1:09:17Speaker 00

  Yep.

• 1:09:17Harry Stebbings?

  Wow, dude, that's insane. So can I ask you then personally, I asked this of actually, do you know Josh Browder? He's another Brit in the valley.

• 1:09:24Speaker 00

  Okay.

• 1:09:25Harry Stebbings?

  Phenomenal guy. But like, when you look at your personal allocation today, given our insider access and what we know, is there anything funky that you do with your money?

• 1:09:35Speaker 00

  Outside of curative?

• 1:09:36Harry Stebbings?

  Yeah.

• 1:09:36Speaker 00

  I invest primarily in companies of people that I know and I do very little investing if I don't know the founders.

• 1:09:43Harry Stebbings?

  Does that work well?

• 1:09:44Speaker 00

  It's had mixed results, but some of them are too early to tell.

• 1:09:48Harry Stebbings?

  Best investment?

• 1:09:49Speaker 00

  They're all, they're all a bit too early to to tell.

• 1:09:52Harry Stebbings?

  Do you have any energy investments?

• 1:09:54Speaker 00

  Yes, so there is a company that I co-founded with my wife, Subcritical, in the nuclear fission space. Based on an idea that I had a few years ago that we need more power and that nuclear is a really good way to do this. And it started off actually as looking for an investment. This was like one of my first times I was like, we should find a company that's doing nuclear power. And try and invest in it and see if we can make it go faster. Because I kind of thought, I'm pretty good at making things go faster in really regulated spaces. Like that's kind of what I'm, what I'm good at.

• 1:10:24Harry Stebbings?

  That's your thing.

• 1:10:25Speaker 00

  Yeah, that's my thing. Yeah, everybody's got to have a thing.

• 1:10:29Speaker 00

  And so.

• 1:10:29Harry Stebbings?

  Was that your hook on the first date? Regulated industries, I make it go faster.

• 1:10:33Speaker 00

  Hook on our first date. So after our first date, we both shared our genome files with each other, our VCF. And so she said she'd done this before and the guy thought it was really strange. And we both, oh, we should share our genomes and then, you know, compared and checked that we were compatible. So it was worth having a second date. And we were both totally into that. So we knew it was meant to be. We were compatible by genome. We had two beautiful kids. We knew it was meant to be.

• 1:10:57Harry Stebbings?

  I'm sorry, if you're incompatible by genome, you have like a.

• 1:10:59Speaker 00

  If you both have like the same.

• 1:11:01Harry Stebbings?

  Ginger child?

• 1:11:04Speaker 00

  Well, that was a concern. My brother is ginger.

• 1:11:06Harry Stebbings?

  I'm sorry.

• 1:11:07Speaker 00

  So I carry the ginger gene.

• 1:11:07Harry Stebbings?

  My brother's ginger, too.

• 1:11:09Speaker 00

  Yeah.

• 1:11:09Harry Stebbings?

  Yeah. We don't see him anymore.

• 1:11:11Speaker 00

  Okay.

• 1:11:11Harry Stebbings?

  We took him to the woods and said, run free.

• 1:11:13Speaker 00

  Makes sense. Yeah. So I do carry the ginger gene. And if she had carried the ginger gene, that would have been a deep concern. But she luckily doesn't. And so that was, that was one of the key tests.

• 1:11:22Harry Stebbings?

  You progressed to the second date.

• 1:11:24Speaker 00

  Yes. So we made it to the second date.

• 1:11:25Harry Stebbings?

  What does no one know about nuclear that everyone should know about nuclear?

• 1:11:29Speaker 00

  That it is very safe and that it's not a science or engineering problem. Like, that was when, when we started looking at companies to invest in, that was for me, that the thing that I was sort of disappointed by is everybody was approaching it as if nuclear is this massive engineering challenge. And sure, like, the engineering is hard, it is complicated. But fundamentally, we have built safe nuclear reactors since the 60s. They worked great. The technology has not really changed or progressed since then. We know how to build these. That's not the problem. The problem is that, due to a lot of the anti-nuclear push in the 80s, we have had a regulatory environment that has been incredibly restrictive and difficult to get new nuclear reactors built, particularly in the US, but also worldwide.

• 1:12:15Speaker 00

  There's been this push to say, how do you guarantee that under any possible circumstance, like, once in a million year events, that you will never have anything go wrong? And in traditional nuclear, that is very hard to guarantee. In traditional nuclear, one of the reasons it's difficult, you're basically balancing on this knife edge. So in a reactor, you have what's called criticality, right? Which is where you have to produce enough neutrons each generation that they go off and do exactly one more reaction, and it keeps itself going. If you get too much of that, too many neutrons, it's a bomb, right? It will be a runaway reaction and it will blow up. That's very bad. That's only ever happened once by accident, which is Chernobyl. All the others have been not criticality events. So you don't want that. If it happens not enough, then it just turns off.

• 1:13:00Speaker 00

  So if you go too far below this exact 1.0 threshold, you get no power out. And so you're trying to balance perfectly on that knife edge of exactly 1.0, where you can control it. And that is a hard problem to guarantee. And this is the fundamental issue with nuclear regulation. How do you guarantee that under no possible circumstances will you deviate from that perfect control? And so I was initially pretty disheartened. I was like, well, we're not going to get new nuclear power. This is not going to work. And then I stumbled on this idea of what's called the energy amplifier. And it's not a new technology. It's been around since like the late 80s, early 90s. It was really pushed by a guy, Carla Rubia, who used to be the CERN director. He was a Nobel laureate in physics. And the idea is you always operate below that 1.0 threshold.

• 1:13:44Speaker 00

  So we are designed to operate at 0.97. So that means you never have enough neutrons to keep the reaction going. The reaction will always fizzle out. So no matter what you do, it's going to fizzle out. But normally, that would mean you get no power output. What you do in the energy amplifier is you point a really powerful particle accelerator at that fuel, and that puts in the extra neutrons to drive the reaction forward. But if you turn that accelerator off, all of your energy output just stops. And so you basically have this big on off switch where you can control fission. And you can guarantee that no matter what you do to it, the fission will never run away. Even if you put in 10 times as much power from the accelerator, it will never run away. There's nothing you can do to it to cause it to go critical or to have a criticality accident.

• 1:14:25Speaker 00

  And so it's a fundamentally safer way of doing nuclear fission that is just approaching it from a different angle.

• 1:14:31Harry Stebbings?

  How will the composition of our energy providing change in the next five to 10 years? Like, will nuclear be a demonstrably larger part of energy provision than it is today?

• 1:14:40Speaker 00

  Yes. I think what we're seeing kind of all across the supply chain in nuclear is a push to get more nuclear online. And I think, you know, Subcritical is kind of leading the way there with a faster path to market than any of the other players. But there's a lot of people working on deploying a lot of new nuclear power.

• 1:14:56Harry Stebbings?

  Which current provision will diminish significantly?

• 1:15:00Speaker 00

  I mean, I think any power from coal will mostly go away. I think you're still going to see a lot of gas, just because, particularly in the US. It's cheap, it works, it's fast. But I think coal is going to go away, and then you're just going to see more of everything.

• 1:15:13Harry Stebbings?

  What company will be larger, Curative or Subcritical?

• 1:15:18Speaker 00

  Subcritical, yeah.

• 1:15:18Harry Stebbings?

  Or Subcritical?

• 1:15:19Speaker 00

  That's a great question. Curative has a larger market opportunity, but I think they're both.

• 1:15:24Harry Stebbings?

  Has a larger market opportunity?

• 1:15:25Speaker 00

  Yeah, I think they're both, you know.

• 1:15:27Harry Stebbings?

  And power generation?

• 1:15:28Speaker 00

  Yeah. The US spends, our US employers spend one and a half trillion dollars a year on healthcare, which is, that's our, like, direct TAM every single year.

• 1:15:36Harry Stebbings?

  How much does the US spend on energy?

• 1:15:38Speaker 00

  Through energy that can be addressed through nuclear. It's a similar order of magnitude.

• 1:15:43Harry Stebbings?

  I mean, you chose good TAMs.

• 1:15:44Speaker 00

  They're both, they're both.

• 1:15:45Harry Stebbings?

  From milk yield optimization, I feel like you've really, really taken this.

• 1:15:49Speaker 00

  I figured out the TAM thing. No, they're both like trillion dollar opportunities if we execute right. Yeah.

• 1:15:54Harry Stebbings?

  Wow.

• 1:15:55Speaker 00

  We're also seeing AI on the, on the nuclear side and the design. Because design is like traditionally a thing that is done by a whole bunch of people sitting, doing drawings and mechanical engineering. And the models have gotten really good at that. And so we're seeing that you can do the design with far fewer people using AI to optimize a lot of the design parameters, where historically you might have needed 100 mechanical engineers to design every single nut and bolt and part. You can do it with 20 really good mechanical engineers that are designing the critical pieces, the important pieces, and overseeing the AI on like, oh, well, I need a little bracket that joins this piece to this piece, doesn't need a human to design that.

• 1:16:36Harry Stebbings?

  I was actually meeting a company the other day, which basically said like, you know, the challenge with hardware engineers is they don't often know what software engineering. And the beauty of today is like, we've turned hardware engineers into software engineers overnight.

• 1:16:46Speaker 00

  Yep.

• 1:16:46Harry Stebbings?

  And that's amazing.

• 1:16:47Speaker 00

  But it's another place where we saw like CodeGen as a solution. And I think, you know, this is one of the bets Anthropic made, and they're totally right on. You can generate really good CAD models by having it write Python to make the CAD model. Like, it's not good at, necessarily good at like 3D space visualization or outputting a drawing, right, as, as vectors. But it's really, really good at generating plausible Python code that can draw that part.

• 1:17:10Harry Stebbings?

  It is the most exciting time to be alive in many respects.

• 1:17:13Speaker 00

  Yeah. Well, that's why we ended up starting Subcritical, is I, you know, very busy running Curative, but that was an idea that was just too important to pass up. And there was nobody else. So only one that is under like active construction of those systems is in China, based on a US design from the 2010s that the US stopped working on after Fukushima.

• 1:17:33Harry Stebbings?

  How much money do you need to make Subcritical significant?

• 1:17:36Speaker 00

  Each one of our deployments would be about a billion dollars of construction cost for a 300-megawatt facility. But it's not, you know, it wouldn't be the same, like, you wouldn't raise that as equity. It would be a mix into the plant of equity and debt. It's more infrastructure build financing.

• 1:17:49Harry Stebbings?

  What do you know now about marriage that you wish you'd known at the beginning? Seriously, that, yeah, it's an amazing thing to build a company with your wife.

• 1:17:56Speaker 00

  Yes.

• 1:17:56Harry Stebbings?

  It's a challenging thing as well.

• 1:17:58Speaker 00

  Yes.

• 1:17:58Harry Stebbings?

  How do you make it work?

• 1:18:00Speaker 00

  So I, we're very well matched, I think is one of the things, is we basically never argue. And that's, you know, how I knew very early on that it was meant to be, is we're always on the same page about things. And so it's actually very easy to run a company together, because we're, we usually see eye to eye on like how something should be done.

• 1:18:17Harry Stebbings?

  Fatherhood? You said two kids.

• 1:18:19Speaker 00

  Two kids, two and a half year old and six months.

• 1:18:21Harry Stebbings?

  Anything that you would advise a new father, knowing what you know now?

• 1:18:25Speaker 00

  You should definitely have kids. Don't wait. I mean, I think there's too much like sentiment of people, oh, you know, live your life and wait until you're in your late 30s and then have kids. I think, no, like, have kids early, when you have the energy and can run around and not sleep. And it's one of the best things you'll ever do. You should just get on with it.

• 1:18:44Harry Stebbings?

  Okay. We're going to do a quick fire. Sound good?

• 1:18:47Speaker 00

  Yep.

• 1:18:47Harry Stebbings?

  Dude, that was the most twisting and turning conversation ever, from like the proliferation of STDs to fatherhood and nuclear. I mean, really, we crushed it. Number one, what have you changed your mind on most in the last 12 months?

• 1:19:00Speaker 00

  I think probably a year ago, I have changed my mind that there are workflows that can't be done with the models, with today's models. I think today, the current gen models can do every back office task we have at Curative. It's just a matter of deploying them, like getting them set up, getting them configured, having the right policies. And I think a year ago, I thought there was opportunity. I thought there was things we could do. But I don't think I would have said you could do every single one of our current back office flows.

• 1:19:27Harry Stebbings?

  What one change would you make to Europe if I made you president of Europe in this very strange title, to stay in the race for competitiveness?

• 1:19:36Speaker 00

  You have to have some kind of like burden for passing regulation. There needs to be some penalty. Like, right now, you pass a regulation, that's like, okay, you did a good job. Like, the goal is to pass regulation. There has to be some penalty. Like, if you pass regulation, your country must pay some tax, additional tax for having passed that regulation. Just adding and adding and adding, without like refining what you've got today and like really going and digging in, how is this regulation affecting things on the ground? Like, just more additive regulation is bad. You need to be looking at the effect of what you've done and refining it and iterating on it, and not just trying to add some new landmark regulation.

• 1:20:12Harry Stebbings?

  That's very anti-European, Fred. You're not going to do very, not going to do very well here.

• 1:20:15Speaker 00

  I'm a Texan now.

• 1:20:18Harry Stebbings?

  Mark Benioff said he spent 300 million on Anthropic, equated across the developers that they have. It was actually about 3.8% of developer salary spent on Anthropic. What do you think total percent of developer salary spend will be on Anthropic in three years' time?

• 1:20:33Speaker 00

  Between maybe 2 and 5X would be the, the 2 and 5X salary. I think that's probably.

• 1:20:38Harry Stebbings?

  2 to 5X is the whole salary?

• 1:20:39Speaker 00

  Yeah.

• 1:20:40Harry Stebbings?

  Whoa. So from 3.8% of salary to.

• 1:20:43Speaker 00

  Yeah, because I think the way, I mean, the way we're driving workflows is that you have one senior engineer managing a bunch of downstream agents that are actually doing the work. And then we're now getting to the point where we have like mostly unsupervised agents taking feedback from the team on things, implementing features, and then the engineers are coming in and actually checking that what it built makes sense. So they're becoming more the reviewer and like the architect. And then you have these downstream agents doing the work.

• 1:21:10Harry Stebbings?

  2 to 5, I mean, that's not like 3.8 to 20%, 50%, 50. If it's 50% Anthropic, it's like a $20 trillion company.

• 1:21:18Speaker 00

  Yeah, I think that that's like the workflows will be, is people are, people are going to be deploying more agents than engineers, and they're going to keep the same number of engineers. We're just going to build a lot more.

• 1:21:29Harry Stebbings?

  Just going to message my friend to let me into that new Anthropic round. Message Larry. There we go. What's the kindest thing anyone's ever done for you?

• 1:21:38Speaker 00

  I think when I first was getting started, there were a lot of people that helped make it be possible to move to the US and kind of like made a bet on a kid coming from the north of England to come to Silicon Valley. Like, some of the earliest investors, the guy, Josh Buckley, who, you know, was one of the first guys who invested in us during the YC batch, just because he liked what we were doing and he thought it was, it was cool. But, you know, being willing to kind of take a bet on a kid.

• 1:22:06Harry Stebbings?

  You know Josh is like my best friend.

• 1:22:07Speaker 00

  I didn't know that. I haven't seen him in a while.

• 1:22:09Harry Stebbings?

  Yeah, I.

• 1:22:10Speaker 00

  Oh, say hi to him.

• 1:22:11Harry Stebbings?

  I speak to Josh every single night.

• 1:22:14Speaker 00

  Okay.

• 1:22:15Harry Stebbings?

  Barring, say, Christmas.

• 1:22:16Speaker 00

  All right. Well, he, he invested in cows.

• 1:22:19Harry Stebbings?

  That is unbelievable.

• 1:22:20Speaker 00

  And then STDs.

• 1:22:22Harry Stebbings?

  Oh, you know.

• 1:22:24Harry Stebbings?

  Investor market. That's amazing. I didn't know that, Andros.

• 1:22:29Speaker 00

  Yeah, yeah, he like a month into the Y C batch like came by the lab and was like super supportive of what we're doing. And I think just coming from like the British background, we couldn't even get meetings with investors.

• 1:22:39Harry Stebbings?

  And he was young. I mean.

• 1:22:40Speaker 00

  He was. Yes. But to get, I mean, he'd been through Y C and had a successful company. And it was just awesome to like have someone like that take a bet on what you're doing. Coming from the UK where I was used to like the cold shoulder and no one was interested in what I was building and, you know, no one wanted to take a meeting.

• 1:22:59Harry Stebbings?

  That makes me so happy to hear. Okay, final one. What was the best advice that you've been given?

• 1:23:05Speaker 00

  I think one thing that I have learnt is to always try and get a lot of different perspectives on a problem. I think I I would historically have sort of approached things from like one scientific viewpoint. And sometimes people would say, no, like, take a step back and think about that problem more broadly. And one of the things I learnt during the curative COVID push is we had to bring together a bunch of people from very different backgrounds. We hired a bunch of former military people who were just like incredible at deployment, but they speak a different language. And then we're trying to get them to talk to scientists. And then we hired a bunch of Silicon Valley developers and they all like think about the problem. They're all trying to solve the problem, but they all come at it from like a completely different perspective. And a lot of times I wouldn't have considered

• 1:23:47Speaker 00

  that point of view on doing it. And I think what I found is that the more of those perspectives that you can kind of get on a problem, the closer to grand truth you get. Like, you're never gonna, no, no one of those people is going to give you the grand truth. But if you hear a lot of perspectives, you can kind of get to that grand truth faster.

• 1:24:04Harry Stebbings?

  Fred, that was the most extraordinary show that I've ever done. In breadth, depth, variance of conversation. Thank you so much for joining me and it's so great to do it in person.

• 1:24:15Speaker 00

  Yeah, thanks for having me.

• 1:24:18Harry Stebbings?

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