2023 Big Ideas in Technology (Part 2) | Summary and Q&A

January 27, 2023
The a16z Podcast
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2023 Big Ideas in Technology (Part 2)


Consumer health tech companies have the potential to become the biggest companies in the world, given the massive size of the healthcare industry. A shift towards value-based care models and the development of a value-based care stack will be crucial in delivering higher-value healthcare and driving innovation in the industry.

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Key Insights

  • 🧑‍⚕️ The healthcare industry is a massive sector that offers significant opportunities for consumer health tech companies to become dominant players.
  • 😨 The transition from fee-for-service to value-based care models is crucial in addressing the inefficiencies and misaligned incentives in the healthcare system.
  • 😨 The development of a value-based care stack will support the implementation of value-based care models, enabling improved patient outcomes and collaboration between payers and providers.
  • 😨 Successful consumer health tech companies will combine deep knowledge of both technology and healthcare to deliver value-driven care and reshape the industry.


at the end of 2022 our team at a16z asked dozens of Partners across the firm to Spotlight one big idea that startups in their fields could tackle in 2023 emerging from this exercise came literally 40 plus builder-worthy Pursuits for the year and that ranged from entertainment franchise games to Precision delivery of medicines small modular reactors... Read More

Questions & Answers

Q: Why haven't large tech companies like Google and Amazon been successful in dominating the healthcare industry?

The healthcare industry requires a deep understanding of both technology and healthcare. Existing tech giants often struggle to navigate the complexities of the healthcare system and lack the necessary expertise to deliver value-based care. Additionally, the fee-for-service model and legacy systems hinder innovation in the industry.

Q: What are the primary challenges in transitioning to value-based care models?

One major challenge is moving away from the fee-for-service mindset and reorienting care models to focus on value from the ground up. This requires a fundamental shift in the way healthcare organizations operate and the adoption of purpose-built approaches that prioritize value over volume. Data aggregation and activation, actuarial modeling, contracting adjudication, and provider ecosystem integration are some key components of the value-based care stack that need to be addressed.

Q: How do consumer health tech companies fit into the shift towards value-based care?

Consumer health tech companies have the potential to transform the healthcare industry by delivering value-based care directly to patients. These companies can leverage technology to improve patient outcomes, enhance the patient experience, and reduce costs. By focusing on preventive care, patient engagement, and personalized health management, consumer health tech companies can drive the transition to value-based care.

Q: How will the development of a value-based care stack support the shift towards value-based care?

The value-based care stack will provide the necessary tools and platforms for healthcare organizations to effectively implement and manage value-based care models. It will enable data aggregation and analysis, actuarial modeling for risk assessment, contract management, and integration with provider networks. The stack will support various buyer segments and levels of technical sophistication, including SaaS platforms, solution marketplaces, and managed service organizations.


In this video, a16z showcases several big ideas for startups in 2023 across various fields. The ideas discussed in this part include the application of AI in credit counseling, the role of technology in improving compliance in the financial industry, the potential of small modular reactors to advance nuclear energy, and the significance of building an advanced space industrial base.

Questions & Answers

Q: What is the big idea around AI in credit counseling?

The big idea is to leverage AI, particularly OpenAI's GPT technology, to drive credit coaching and counseling at a lower cost and without relying on expensive human labor. Credit GPT can deliver high-quality credit counseling and improve financial services on a larger scale, potentially benefiting millions of individuals.

Q: How big is the credit counseling market?

The market size for credit counseling is significant. It includes not only the existing demand for credit counseling services but also the untapped market of people who could benefit from credit coaching but couldn't afford it previously. This includes individuals who are misjudged by the credit system and those who make poor financial decisions. Hence, the potential customer base is much larger than the current number of credit counseling users.

Q: What are the potential risks and challenges in implementing AI-based credit counseling?

One potential risk is the margin of error in AI-driven advice. While AI can perform well in optimizing credit decisions, there might be some errors or challenges that need to be addressed in the beginning stages of implementing AI in credit coaching. However, the belief is that AI technology, such as GPT, can deliver more accurate and beneficial guidance compared to traditional subjective human judgment.

Q: How might regulation affect the adoption of AI in credit counseling?

Regulation plays an important role in the adoption of AI in credit counseling. It is crucial to establish guidelines and standards that ensure the accuracy and reliability of AI-driven credit coaching. While there might be concerns about regulation, the potential benefits outweigh the risks. The goal is to develop incremental solutions and foster confidence in AI technology's ability to provide sound credit advice.

Q: How can AI be applied in other areas of fintech besides credit counseling?

AI can be applied in various areas of fintech. For example, AI can revolutionize customer support by creating a private bank-like experience, providing personalized assistance, and resolving customer issues efficiently. Wealth management is another area that can benefit from AI by offering advice and streamlining financial decisions. The potential for AI to improve and transform different functions in the financial industry is vast.

Q: What is the big idea around compliance in the financial industry?

The big idea is to leverage technology to overhaul compliance processes, making it a competitive advantage rather than a burdensome necessity. The financial industry is heavily regulated and faces challenges in managing compliance across multiple jurisdictions. By adopting software solutions, financial companies can streamline compliance management, manage third-party relationships, and ensure adherence to global compliance standards.

Q: How expensive and inefficient are current compliance processes in the financial industry?

Compliance processes are both expensive and inefficient. Estimates suggest that banks spend around 6-10% of their total revenue on compliance costs. Despite this high investment, traditional compliance solutions often fall short, resulting in fines and penalties for poor compliance procedures. Banks are often reliant on manual processes, leading to bottlenecks and delays. The need for scalable and efficient compliance solutions is critical.

Q: How can technology help improve compliance in the financial industry?

Technology, particularly AI and machine learning, can help automate and optimize compliance processes. By leveraging advanced data gathering and analytics capabilities, companies can streamline customer information, reduce false positives, and enhance the efficiency and accuracy of compliance procedures. The application of technology in compliance can revolutionize the industry and result in better customer experiences, reduced costs, and increased regulatory compliance.

Q: Are there any specific areas within compliance where technology can have a significant impact?

There are several areas within compliance where technology can have a significant impact. One example is enhanced due diligence, where image recognition technology can automate the verification of physical ID documents, reducing the need for manual checks. Additionally, technology can facilitate data sharing and integration, enabling more efficient compliance procedures and better coordination among financial institutions. The scope for technology to transform multiple aspects of compliance is vast.

Q: What is the big idea around small modular reactors (SMRs)?

The big idea is that SMRs can advance the nuclear renaissance by providing a more accessible, efficient, and scalable alternative to traditional nuclear plants. SMRs leverage advanced manufacturing techniques and modular design, allowing for quicker and more cost-effective production. They can be deployed in various locations, making nuclear energy viable for remote communities and even space exploration. SMRs have the potential to reshape the energy landscape and contribute to carbon-free power generation.

Q: How long does it typically take to set up a traditional nuclear power plant compared to an SMR?

Traditional nuclear power plants require significant time and resources to set up, often taking decades. The time-consuming aspect is usually related to site selection, design approvals, and regulatory processes. In contrast, SMRs can be built within a few years, primarily because they require less upfront capital expenditure and have a more streamlined design process. Although there are still regulatory challenges, the time frame for SMR implementation is significantly shorter than that of traditional plants.

Q: What are the main obstacles in the regulatory framework for SMRs?

The regulatory framework for SMRs is still under development, which presents challenges for their widespread adoption. Existing regulatory processes for traditional nuclear plants may not adequately address the unique considerations and characteristics of SMRs. Key obstacles include high approval fees, long timelines, and disputed frameworks for regulation. Lowering fees, accelerating approval timelines, and establishing clear regulatory guidelines specific to SMRs are essential steps to overcome these obstacles.

Q: What are the potential opportunities within the space supply chain and the space industrial base?

The space supply chain and the space industrial base offer opportunities across various sectors. Companies involved in materials, manufacturing, and infrastructure development for space exploration and satellite technology can play a crucial role. The goal is not only to construct advanced rockets and satellites but also to secure and overhaul the entire supply chain, from mining resources to launching infrastructure. Building a robust space industrial base is vital to support national interests, advance technological innovation, and facilitate future ambitious space missions.

Q: Why is being a leader in space crucial for a country?

Being a leader in space is crucial for several reasons. Firstly, space technology drives significant economic activity, as satellites and space-based systems support various industries, including telecommunications, navigation, and weather prediction. Secondly, space dominance provides military advantages, such as advanced surveillance, reconnaissance, and communication capabilities. Thirdly, space exploration opens up new frontiers for resource extraction and energy generation. Being at the forefront of space technology and infrastructure is essential for national security, economic growth, and scientific advancement.

Q: How does space industrialization relate to national power and industrial/military supremacy?

Space industrialization is closely linked to national power and industrial/military supremacy. As space-related technologies play an increasingly crucial role in various sectors, countries that possess advanced space capabilities gain advantages in economic growth, national security, and scientific discovery. The ability to gather resources, conduct Earth observation, and navigate space effectively establishes superiority in areas like commerce, defense, and technological innovation. Space supremacy is a metric for measuring a country's industrial and military power in the modern world.


The video highlights four big ideas for startups in 2023: applying AI in credit counseling, enhancing compliance in the financial industry through technology, advancing nuclear energy with small modular reactors, and building an advanced space industrial base. These ideas demonstrate the potential for innovation and disruption across different sectors, from financial services to energy. By leveraging technology and addressing regulatory challenges, startups can empower more efficient and accessible services while contributing to critical fields such as financial compliance, sustainable energy, and space exploration. The future holds immense opportunities for startups to shape these domains and drive positive change in their respective industries.

Summary & Key Takeaways

  • The healthcare industry is a massive sector, accounting for about 25% of the US GDP. Consumer health tech companies have the potential to dominate the industry and become the largest companies worldwide.

  • Traditional fee-for-service models in healthcare have led to misaligned incentives and bloated costs. Value-based care models, focused on delivering higher-value care, are needed to reshape the industry.

  • The development of a value-based care stack, consisting of various tools and platforms, will support the transition to value-based care. This stack will enable new entrants, such as digital health players and accountable care organizations, to provide value-driven care and improve patient outcomes.

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