Why did you decide to start another healthcare company, and why this one?
Hari Sundram (WriteWise): Both really good questions. The healthcare system in the U.S. is integrally broken. There’s no shortage of ideas on how to fix it, and it’s frustrating because, like Nathan Hale, I regret that I don’t have more lives to solve these problems. The core issue across commercial health, pharmacy, and Medicare is the misalignment of premiums with actual risk. Premiums are often used to subsidize administrative and vendor-based costs rather than truly protecting against risk.
When we started Verikai, I told my co-founder that all we had to do was throw a match into the forest, and the fire would happen. That’s exactly what happened. We’ve seen small groups of 100 employees transition from being fully insured to self-insured. The universe has changed, and now many options can be leveraged, such as VPC, RBP, and direct contracting.
At the end of the day, the problem in both medical and pharmacy is that people don’t understand the real costs. For example, most don’t know what the cost of a specific drug is in a particular area. That’s the problem. Pharmacy costs are driven by unit cost trends, not utilization. We need to create an environment where it’s profitable to be honest, which has been the hypothesis of every company I’ve started.
What do you mean by making it profitable to be honest?
Hari Sundram (WriteWise): We've created a Per Member Per Month (PMPM) guaranteed platform on the pharmacy side. This means that for any group, consortium, or captive, we inform them what their pharmacy costs will be for the coming year. Both sides—pharmacy benefit managers (PBMs) and employers—negotiate against this guarantee, holding everyone accountable. If costs exceed the guarantee, we're on the hook, creating an honest marketplace.
The challenge is that to be honest and right, you're going to need two miracles. You can't control everything, but you can control the future, and that's why we built this. We have a product called "Essential" for the underinsured population that offers tier one and tier two drugs for $15, with no co-pay or co-insurance. It's bundled with Direct Primary Care (DPC), and you can do whatever you want.
This product sells well in hospital plans. Hospitals get drugs at their hospital price, but employees often use retail pharmacies for convenience, which affects the network. When we underwrite and price it for the hospital, we're never higher than what they're already paying. The spread on generics with traditional PBMs is much higher than a flat price on generics.
Nick Soman (Decent): Mmm, on generics. Yeah.
Hari Sundram (WriteWise): Rip-off, right?
Nick Soman (Decent): Most people think there's less of a rip-off with generics, but I think you just explained why that's not the case.
Hari Sundram (WriteWise): Yeah, if I need more money, I'll just change this one.
What’s your view on brokers in the healthcare industry?
Nick Soman (Decent): I initially thought brokers were part of the problem, assuming they were just trying to rip people off. But I’ve realized some of them are genuinely trying to innovate and improve the system. The challenge is that big insurance companies push the narrative that all brokers are bad while still feeding them business. It’s a tricky situation.
Hari Sundram (WriteWise): Yeah, it’s tough to tell. The stereotype that brokers are dumb is just wrong. They know what they’re doing. But being a true fiduciary, treating the client’s money like your own, is hard when making more money is tied to more expensive deals.
Nick Soman (Decent): That’s why we keep our PPM locked at 35. I’ve told 15 brokers, “No, I won’t change that number,” because consistency matters.
Have You Always Been a Disruptor?
Nick Soman (Decent): You’ve got a reputation for blowing things up—in a good way, of course. Some might call you a mad scientist in healthcare, coming in and doing things very differently. Have you always been like this?
Hari Sundram (WriteWise): I’m not sure what “like this” means, but if some people love you and some people hate you, you’re probably an entrepreneur. In a typical job, everyone either has to like you or not know who you are. But if you’re loved by some and hated by others, entrepreneurship might be your path. You can control your narrative, which is a lot more satisfying.
Nick Soman (Decent): Yeah, you get to be yourself in any context. That’s something I didn’t have when I was working at Amazon.
Hari Sundram (WriteWise): Exactly. We’ve talked about this before. If you’re an entrepreneur and you care too much about what others think, you won’t be very successful. Recently, I was on a call with someone I respect, and she said, “I’m surprised, I heard you were a bit of a jerk.” Honestly, I didn’t know what people thought of me, but it was interesting to hear. The truth is, if you’re trying to disrupt an industry, people will first think you’re crazy. Then, as facts come in, they’ll start to see the opportunity, but fear will also set in. Some people will accept it and scale with it, while others won’t.
Nick Soman (Decent): So, it doesn’t matter if everyone likes you or not, as long as you’re making an impact.
Hari Sundram (WriteWise.com): Exactly. If you’re going to do something disruptive, be passionate about it and be ready for all the challenges that come with it. You’ll face people who don’t understand what you’re doing or why it would work, but it’s up to you to push forward. If the idea works, great—keep going.
Nick Soman (Decent): Like the quote from Satoshi about Bitcoin—if you don’t believe it, I don’t have time to convince you.
Hari Sundram (WriteWise): Dude’s not wrong.
You’re an MD but do not practice anymore. Why not, and would you do it again?
Nick Soman (Decent): I have one last good question for you. You're an MD, do not practice anymore. Why not? And would you consider getting your MD again?
Hari Sundram (WriteWise): You know, Shakespeare says, "To thine own self be true." It’s not just a convenient idiom—it’s a fact. If someone asked me what the primary cause of human misery is, I’d say it’s people not being honest with who they are.
I think a lot of us do things in life for other people—family, kids, spouses, parents—but at some point, we realize that none of those people can live our lives for us. We have to live our own lives. They depend on us to do things for them, but they mistakenly believe that what they want will make us happy. The truth is, we don’t really know.
If I could do it over again, I’d become an entrepreneur earlier. Not to become wealthier or anything like that, but because I would have been happier sooner. It wouldn’t have mattered which industry I chose; I just happened to know enough about healthcare to recognize the issues and problems.
If I had to do it over again, I probably wouldn’t be a doctor. It was an amazing experience with a lot of specialized knowledge and things I can still do and inform others about, which is great. But if you want to do medicine, you have to love it. You have to love taking care of people and be willing to do it for free because it’s truly a taxing and brutal profession.
I don’t practice anymore because I liked it, but I never loved it. I love being an entrepreneur. I’m one of the lucky few that being an entrepreneur worked out well for, but even if it hadn’t, I think that’s the path I would have chosen anyway.
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