Lawrence W. Abrams

My counterfactual to assumption economic institutions can't keep pace with Tranformational AI: Full Stack Inference Providers : @baseten , @modal , @FireworksAI_HQ and others My Taglines: "Turning stateless workflows into stateful capital" "Creating competition for the frontier lab duopoly" "Greatly reducing procurement transaction costs via marketplaces" #econtwitter @econD47

Ads like these from the leading full stack inference provider @baseten will do more to blunt the pricing power of the frontier lab duopoly than the @FTC or the @dojphofficial Yea, startup AI infra market makers

$EVGN worth 10-20x just for its accumulated data to be used to fine-tune other LLM drug discovery models of well funded US startups and public Pharma. Witness $GOOG buying bankrupt Spirit Airlines just for its data. Could also split data buyout into drug discovery and ag chemical discovery . Easily data alone worth 20x current valuation

Markets and price signals deter AI monopolization. It is startup inference providers with LLM price transparent choice routers, not the Chinese, who have turned inference into a commodity, calling into question the sustainability of @AnthropicAI @OpenAI 60% -80% margins. Kudos to @baseten @modal @FireworksAI_HQ @daytonaio With 10+ fast followers, only moat how deep the stack - router, harness, post-training.. cloud sandboxes and VM. Example below of @daytona sandbox pricing

Suggestion for DtC cash pay healthcare: more emphasize on low cost - walk in UTI urine test, followed by fast Dr. video and appropriate antibiotic Rx if positive

Entrepreneurial alert: massive shortage nationwide of Estradiol due to FDA reduced side effects in black box warning that has greatly increasing demand.

#econtwitter There is starting to emerge within economists circles two schools of thought on the ability of economic institutions to adapt to transformative AI (TAI) - what I call “The Stanford School” and “The Hayek School” Below is lede to @DigEconLab recent post announcing new monograph. Here is my reply A counterfactual to @DigEconLab @erikbryn premise that “TAI advances faster than economic institutions can adapt”>> rapid rise in startups success of @OpenRouter @baseten offering auction market design routers-harnesses-post-training low transaction cost competition between frontier LLMs and open weight LLM.

A counterfactual to @DigEconLab @erikbryn premise that “TAI advances faster than economic institutions can adapt”>> rapid rise in startups success of @OpenRouter @baseten offering auction market design routers-harnesses-post-training low transaction cost competition between frontier LLMs and open weight LLM.

A big frustration of users of GLP-1 and other self-injectables is having to refrigerate continually when traveling. The Big 3 #PBMs have no solution. @heyepic is likely to solve that with recently announced Prescription Marketplace via Rx fill routing and re-routing in MyChart at Point of Phone (PoP) See my mock-up>>>

Two sided agentic AI wars in healthcare - PA, upcoding/ downcoding - are about exploiting Grossman - Hart incomplete contracts of a hard to measure granular property rights of a good - healhcare. Is only endgame vertical integration or maybe preserve market but with different goverance — an Ostrom like private collaboration? $UNH #AI #PA #HealthcareAI

My take on @HeyEpic announced Prescription Marketplace: another step toward patient directed healthcare at the Point of Care (PoC) and Point of Phone (PoP) - no question competition for both the Big 3 #PBMs at Point of Sale and @Google Health in ChatGBT @OpenAI @AnthropicAI at PoP

People rightfully are worried @HeyEpic Prescription Marketplace will take up too much time at PoC. Surely, the endgame for Epic is just for the Dr to generate the Rx at PoC at time of visit, then routing choice later at Point of Phone (PoP) via URL internet or Epic app. Also, Epic will build in ability to re-route each refill at PoP, also short term re-route to pharmacy near vacation spot

Talk of ending PA due to zero-sum agentic AI PA wars is mistaken about causal inference in important cases of close therapetic equivalents - e.g. lipid lowering PCSK9 drugs Repatha vs Praulent. The assumption made is the cost-effectiveness causes PA designation by the Big 3 #PBMs. In fact, PA and cost-effectiveness are endogenous to competion for formulary assignments as Pharma competes on rebate % off WAC for for both Tier 2, or at least Tier 3 and avoid PA.

Wonderful time seeing all the Open Studios in the Santa Cruz #California area. No place for irony, denial of self by artists I see.

Set to go live in the summer of 2027, @HeyEpic announcement of an open routing Rx at the EHR Point of Care - to include cash pay mail options like @GoodRx and @costplusdrugs - is another step toward the creation of an @HeyEpic AI centric PBM and GPO. It’s Epic not start-ups offering PMPM model guarantees that is the biggest threat to the Big 3 #PBMs. See my post from 4 months ago.

Include the Big 3 #PBMs in the upcoming battle of 100% pass-through “PMPM Models” I find it instructive to classify such models in terms of PMPM guarantees as (1) the no risk guarantee, (2) the skinny guarantee (3) the sandbag guarantee