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Hospitalogists,

Welcome to 2026!

What better way to kick off 2026 (can you believe it’s already here? Geez) than a Texas Tech loss deep dive on AI and consumerism in healthcare, 2 of the hottest trends happening in the space right now?

A few months ago I sat down with Elliot Cohen, Co-Founder of General Medicine (formerly PillPack), to talk about why healthcare is finally ready for a consumer revolution (and in sore need of one, really). What followed was a great conversation around the intersection of AI, consumerism, and care delivery. Elliot is super thoughtful and I could tell he cares deeply about this space. I absolutely loved hearing about the conviction he has on these topics. And who better to ask on these topics than a guy that has already walked the walk in the space?

Oh, and a pulmonologist from Nebraska basically applied for a job mid-interview, which was amazing. But more on that later.

By the way - I would REALLY appreciate it if you made one of your New Years’ Resolutions to share Hospitalogy with a friend or colleague. There. Easy - one resolution already checked off the list!! Now you can get started reading Atomic Habits. My brother just bought the workbook for it. What a freak. (Kidding).

Was this email forwarded to you?

BLAKE'S BREAKDOWN

Going deeper on an interesting topic, theme, or trend 

Elliot's healthcare origin story starts at his family's dinner table in Northern California. His mom ran a group of FQHCs, so he grew up hearing debates about who pays for what in healthcare and how payment dynamics translate (or don't) into good care - a foundation that would help form his career.

But the real crystallizing moment came years later, when Elliot was considering whether to join his friend TJ Parker in founding PillPack. Elliot's dad was the prototypical PillPack customer: a multi-medication patient navigating a complex chronic condition. During his early college years, Elliot's father had been diagnosed with anaplastic thyroid cancer, an exceptionally rare malignancy with roughly 200 US cases annually and a survival rate that was essentially a rounding error.

His outlook was so grim that Doctors told him not to bother with treatment. But Elliot's parents took out a second mortgage on their house and moved to Texas for six months so his dad could get a second opinion at MD Anderson. And it turned out to be a life-saving decision as he was diagnosed with CLL, a manageable chronic condition.

How many folks have loved ones with similar experiences, or who have been patients themselves and felt patronized or unheard by our current system?

But here's the most profound part of the story that stuck with Elliot. Years later, when he asked his dad what he wished was different about his healthcare experience, his dad launched into a rant about a mail-order pharmacy in Texas that switched his generic medication to one with a weird coating that was hard to swallow. The pharmacy told him to call his doctor. His doctor didn't understand the issue. Nobody could fix it.

"Those guys. I hate them."

Yeah. Pretty crazy. You might have expected his dad to mention something about…I don’t know…the CROSS COUNTRY move, or the financial implications of taking out a second mortgage. But no - it was this infuriating, uncontrollable, anti-consumer change to his medication.

Elliot described this as a "focusing moment" at PillPack and now General Medicine, honing in on a provocative, yet shockingly simple idea in healthcare: we never design enough for the moments that truly matter to the customer. Healthcare designs around what providers and health systems assume matters and for those stakeholders, and not what actually matters to the person navigating the experience.

The problems solved at PillPack (getting patients to the right medication, coordinating between physicians and payors, creating end-to-end experiences) weren't unique to pharmacy. They were microcosms of the broader healthcare system.

So after selling PillPack to Amazon, casually building Amazon Pharmacy and Amazon Clinic, and taking some well-earned time to ski (no I’m not jealous, why?), Elliot and his co-founders launched General Medicine with $32M in funding and a simple ambition: be the simplest, most delightful place to get access to the best care in the world.

General Medicine's core bet is that healthcare has been missing a consumer layer for decades. Now, the technology finally exists to build one.

When Elliot talks about what General Medicine is, he doesn't reach for healthcare comparisons. He talks about retail. About shopping. The comp isn't One Medical or Teladoc. It's the experience you have buying literally anything else.

"Shopping isn't just price. Shopping is about using whatever criteria matter most to you to find the best product for you," Elliot told me. "In most retail categories, that resolves down to price, breadth of selection, and the quality and convenience with which you can get those things."

Healthcare has none (or very little) of this.

• You can't shop by price because prices are opaque until after you've consumed the service.
• You can't shop by selection because you don't know what your options are.
• You can't shop by quality because quality metrics are buried in academic papers and CMS databases that nobody outside of health services research actually reads.
• You go where your physician tells you to go for the MRI or specialist referral, and they’re usually referring to either a random specialist in that arena they happened to get to know at a medical conference, or someone within the same system.

This dynamic does not solve for quality or the best consumer experience.

So General Medicine is building what Elliot calls a "healthcare store" that lets consumers come in and effectively shop for anything in healthcare. The company thinks about this as a spectrum with two ends:

1. On one end: Simple, low-acuity stuff where ease is paramount. You have the flu, you've already taken a test, you just need Tamiflu. General Medicine can make that streamlined and protocolized while maintaining clinical quality.
2. On the other end: Complex, mystery cases where something is clearly wrong but you don't know what it is or where to start. Elliot shared an example of a 46-year-old woman who went from six-mile daily hikes to barely getting out of bed. She'd seen three or four doctors who kept telling her it was menopause but she knew this wasn't right.

"Every time you show up to General Medicine, we want you to have confidence and to feel comfortable that this really will be the best medicine for you no matter what," Elliot said.

General Medicine believes it can be equally good at both ends of that spectrum. And that's why the name matters. If you tell a consumer you only help with a narrow set of things, you've lost the value proposition. You've put the decision-making burden back on them. No, General Medicine is solving for something much greater. They’re solving for the confusion and anxiety that characterizes every interaction with the healthcare system. Even for experts, healthcare is impossible to navigate. Impossible to understand pricing. Impossible to know if you're getting the best care. Sometimes my friends will ask ME for advice on their health insurance and I’ll tell them straight up “I have no freaking clue but I can kinda tell you what you can and can’t do, oh and here’s what a deductible means.”

Consumer healthcare plays have been tried before. Most have failed. So why does Elliot think the timing is finally right?

He points to three technological shifts that have fundamentally changed what's possible.

• Price transparency files. The regulatory push from the Trump and Biden administrations requiring hospitals and payors to publish negotiated rates has created an entirely new data asset. General Medicine uses this open data to predict what a given service will cost a specific member at a specific provider, something that was essentially impossible 5 years ago. They understand what the member's plan covers, what the provider is likely to bill, and can put those pieces together to show actual prices before the consumer commits. So a predictive price is a pretty cool, innovative, consumer-forward piece of tech.
• Interoperability. The healthcare data infrastructure has matured dramatically over the past decade. When PillPack was trying to do this stuff in the early 2010s, it was fighting against closed systems at every turn. Today, APIs and standardized data exchange mean General Medicine can pull together claims data from payers, clinical data from EMRs, and create a coherent picture of a patient's medical history. When a physician walks into a visit with that context already assembled (why the patient is here, what they've tried, what's in the record) it changes the speed and quality of clinical decision-making.
• LLMs. This is where Elliot's perspective gets interesting, because he's not excited about LLMs for the reasons most healthcare AI companies cite.

"AI agents blur the lines between a generalist and a specialist," Elliot explained. "With a little bit of input from a specialist, we can provide this really high-end level of specialty care without eating up a full slot on the specialist's calendar."

General Medicine uses AI agents throughout the platform, but not primarily for automation. They use them to create what Elliot calls "glue" between different clinical expertise. When General Medicine's care team is working up a patient before sending them to a specialist, they can get rapid specialist input via eConsult. The specialist might spend 30 seconds reviewing the case and providing direction. That curbside consult guides the workup so that when the patient finally sees the specialist in person, they arrive fully prepared rather than starting from scratch.

This brings us to one of the most profound, interesting points I thought Elliot made during our conversation. Most healthcare executives talk about AI as an automation and cost reduction play, and I’ve heard AI as helping everyone ‘work at the top of their license,’ replace or supercharge the human, save the FTE, reduce labor costs. But Elliot thinks that framing fundamentally misunderstands what LLMs actually enable.

"The reason for scalability with AI isn't automation. It's allowing disparate people with disparate sets of expertise to coordinate with each other better."

His canonical example is the rheumatology referral. A patient gets referred to rheumatology, but nobody has done the right workup. No one has ordered the appropriate labs or imaging. So the patient waits six months for the specialist appointment. The rheumatologist shakes their hand, orders a bunch of tests, and tells them to come back in another three to six months once results are in.

General Medicine's thesis is that all of that workup can happen during the six-month wait. And if the results show something urgent, they can get on the phone with the rheumatologist, present the clinical findings, and accelerate that patient into the clinic faster.

The AI isn't replacing the rheumatologist. It's allowing a generalist care team to punch above their weight by having specialist expertise available on demand and enabling proactive, consumer-friendly coordination that was previously impossible because everyone was siloed in their own practices, their own EMRs, or their own workflows.

"LLMs allow all of our teams of specialists and generalists to work together with superpowers," Elliot said. "That's probably the stuff I'm most excited about."

General Medicine operates with three tiers of provider relationships, which you can kind of picture as the earth's core, mantle, and crust. Work with me here.

• The General Medicine core: A tightly aligned physician group that works closely with General Medicine to develop clinical protocols and ensure quality. These are the providers most deeply embedded in the platform.
• The mantle: A looser network of telemedicine and community providers who have deep integrations with General Medicine's scheduling, payment, and care coordination infrastructure. They're part of the platform but not directly employed.
• The crust: Community providers who might never have heard of General Medicine but are in the company's provider directories. General Medicine knows their quality scores, what insurance they take, what services cost, and can help consumers understand the tradeoffs of using any of these options.

This distributed model lets General Medicine offer genuine choice. If you love your current providers and just want help booking and paying, General Medicine can do that. If you want them to interpret results, coordinate specialists, and manage your care journey, they can do that too. If you want to see a specific provider because of a unique subspecialty expertise, they'll help you get there.

On the business model side, General Medicine looks like a normal clinic for the providers in their tightly integrated network. They have their own insurance contracts and bill just like any other provider would. For providers in the community they don't have direct relationships with, they're using open data to predict pricing and facilitate the transaction.

Something I wanted to mention is that General Medicine isn't trying to replace health insurance or work on a parallel health system or anything to that effect. They're just trying to make it easier to use. Elliot's observation is that insurers have spent decades using financial incentives (formulary tiers, in-network/out-of-network) to steer consumer behavior, but the complexity of navigating those incentives creates enormous friction. General Medicine wants to blend all of that into a seamless consumer experience that works whether you're on Medicaid, a high-deductible plan, or paying cash.

For a Medicaid patient, using insurance probably makes sense because copays are low. For someone on an HDHP, there are plenty of services (labs, imaging, certain medications) where cash pricing is actually cheaper. General Medicine can surface those options and let the consumer decide.

One of the things I appreciated about talking with Elliot is his explicit rejection of healthcare paternalism.

When I asked about patient acquisition and how General Medicine breaks into existing referral patterns, Elliot pushed back on the premise.

"There is this idea that you have to be downstream of another provider, but I think that's just a fundamentally paternalistic view. You're making an assumption that the consumer isn't figuring this stuff out on their own."

It’s a great point, and this paternalism is something holding our industry back. Take this data point, for instance: something like 80-90% of healthcare interactions start on Google, and tons of people book through things like Zocdoc. That number is probably even higher now if you include ChatGPT and other foundation models. I mean come on. Loads of people are using AI for healthcare stuff, uploading labs, even using it as their therapist or companion (some folks even want to marry their AI but I digress). Consumer healthcare journeys are already digital and consumer-initiated. There's just been no good destination for that demand.

"That demand is already consumer-centric and already digital," Elliot said. "Nobody has done a great job making it easy for consumers to get from that point to really great healthcare."

And this is when our pulmonologist friend jumped in to the conversation! Dr. Jeffrey Jarrett, a pulmonary critical care physician from Nebraska who had joined the live session, joined us with enthusiastic validation of everything Elliot was describing.

"Patients are so overwhelmed. They see multiple specialists, primary care docs, they have no idea what scans they did where. Yes, the EMRs try to talk to each other, but it's so much superfluous data that you have to spend time fishing through."

Dr. Jarrett talked about the patients who show up with "the binder," comprehensive documentation of everything they've done and everywhere they've been. Those patients are rare. Most people are drowning.

"You're trying to tell people, go do this, do that, get this, get that. And it's kind of like, well, good luck. And you just know people are overwhelmed and they're only gonna do 10% of what you ask."

By the end of the conversation, Dr. Jarrett was asking for the jobs email. I hope he followed up on it! It was simultaneously amusing, exciting, and revealing. Physicians are among the hungriest for care models that let them operate at the top of their license instead of being buried in data entry and care coordination that the system should be handling.

One of General Medicine's most interesting conceptual frameworks is that they're trying to replicate inpatient medicine in an outpatient setting.

That sounds counterintuitive, but hear them out for a sec. In outpatient medicine, everyone is so busy that care feels like lobbing patients over walls. You make a referral and hope for the best. In inpatient medicine, you have a captive audience. The hospitalist becomes your temporary PCP and can coordinate across specialists in real time. Patient presents with a chronic cough? The hospitalist does a curbside with ENT. ENT says it's not them, try GI. That curbside took 30 seconds. Within an hour or two, the hospitalist might have input from four or five specialists and a clear direction for the workup.

In outpatient medicine, that same process takes months or years. You see the PCP, wait for the ENT referral, wait for the ENT appointment, ENT says it's not them, you go back to the PCP, wait for the GI referral, and so on. Each handoff adds weeks or months of delay. And let’s not forget the workup. And new forms. And new patient portals. And the unknown price tag.

General Medicine's care model is designed to compress that timeline. Use eConsults to get specialist input rapidly. Work up the patient properly before the specialist visit. Arrive at the specialist appointment ready for the next step instead of starting from scratch. Provide predictive pricing. Simplify.

When I asked Elliot what needs to go right for General Medicine to succeed, his answer was refreshingly focused on execution rather than external factors.

"I don't think we're dependent on any big external thing that has to go a particular way. People for thousands of years have needed great doctors and great access to care. That's what we're really trying to solve for."

There's broad investor appetite right now for AI and consumer healthcare plays, and General Medicine's $32M raise reflects the enthusiasm. The company is betting that the technology stack has finally matured enough to deliver on promises that consumer health startups have been making (and failing to keep) for over a decade.

Obviously General Medicine isn't the only company chasing this opportunity, but they do have an exceptionally strong pedigree. The longevity and wellness space has seen a flurry of startups targeting the affluent worried well with comprehensive testing and concierge experiences. What differentiates General Medicine's approach is the emphasis on working within the existing system rather than around it. They're not asking consumers to abandon their insurance or pay cash for everything. They're meeting patients where they are and giving them the tools to navigate whatever coverage situation they have.

Still, I will bring up one concern. Healthcare consumerism has a long history of overpromising and underdelivering. The friction in the system is real, and entrenched interests don't disappear just because a startup has good ideas and fresh capital. Making healthcare genuinely shoppable requires solving hard problems across pricing, quality measurement, care coordination, and consumer behavior.

But that's also why efforts like General Medicine matter. The 800-pound gorillas in healthcare (opacity, fragmentation, paternalism) don't get smaller on their own. They require companies willing to take big swings at fundamental problems. Elliot and his team built and sold one successful healthcare company. They spent years inside Amazon building consumer-facing healthcare products. They understand what it takes to deliver a genuinely delightful consumer experience.

Whether General Medicine becomes the company that finally cracks healthcare consumerism or simply moves the Overton window for what's possible, the bet they're making is the right one to make - one I’m a fan of and one I’m cheering on.

The question isn't whether healthcare should be more consumer-friendly. It's whether the technological and regulatory moment we're in actually allows someone to build it. General Medicine is running that experiment in real time.

For those interested in learning more, General Medicine is actively looking for clinicians who want to practice medicine differently. And if you've tried the platform as a consumer, I'd love to hear what you think.

For the founders and investors in the audience: what's your read on whether the shoppable healthcare thesis is finally ready for primetime?

MISCELLANEOUS MADDENINGS

How bout them Longhorns?! Arch’s Heisman campaign begins today (I’m half joking but if we land Coleman in the portal all of you guys are toast).

Reply with your New Years Resolution for you in healthcare and what you want to learn more about! I’m going to slowly start going through email responses over the past few weeks so I’m looking forward to hearing from you guys.

Thanks for the read! Let me know what you thought by replying back to this email.

— Blake  

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