# The Biggest Company in the World ![rw-book-cover](https://a16z.com/wp-content/uploads/2022/11/Microsite-Featured-Images_Biggest-Company-in-the-World.png) ## Metadata - Author: [[Daisy Wolf]] - Full Title: The Biggest Company in the World - Category: #articles - Summary: Consumer health tech companies have the potential to become the biggest companies in the world. The top five largest companies are consumer companies, and healthcare is a significant industry. While big tech companies like Google, Apple, Facebook, and Amazon are moving into healthcare, they may not win the race to dominate the industry. The current largest healthcare company, UnitedHealth Group, lacks a consumer focus. The future's biggest company in healthcare will be a consumer-centric, tech-native company that prioritizes consumer engagement and reimagines the healthcare experience. There are two paths to achieving this: building a vertically integrated "payvidor" that combines insurance and care delivery, or creating a horizontal consumer marketplace that revolutionizes the way healthcare services are accessed and paid for. - URL: https://a16z.com/the-biggest-company-in-the-world/ ## Highlights - In fact, those massive consumer companies—Google, Apple, Facebook, Amazon (GAFA, for short)—are all working to move into healthcare because they realize the size of the opportunity: a $4 trillion American industry that makes up 20% of US GDP (and growing). This is five times the size of the advertising industry *globally*, which makes up almost all of Google and Facebook’s revenue, and part of Apple and Amazon’s. ([View Highlight](https://read.readwise.io/read/01hxhx8d761qa6hyn17dbr1xs9)) - On the other hand, the world’s biggest healthcare company (the 8th biggest company in the world), UnitedHealth Group (UHG), is not a tech company and is also seriously lacking in the consumer engagement department. ([View Highlight](https://read.readwise.io/read/01hxhx93jp0n9tq2g09dfs4p6y)) - We see two paths to a consumer health startup becoming the biggest company in the world: (1) a vertically integrated path of building a “[payvidor](https://a16z.com/payvidors-unbundled-opportunities-in-healthcare-fintech/)” (a combined payor and provider) that eventually owns most care, and (2) a horizontal path of building a consumer marketplace or infrastructure layer that enables all other care delivery companies. ([View Highlight](https://read.readwise.io/read/01hxhxccrcb8z1a15z39r35sz4)) - In other words, traditional wisdom says there’s no need for a provider or health system to care much about consumer experience since consumers aren’t the ultimate buyers, insurance companies are. Insurance companies tell consumers where they can get care and how much they’ll pay for it, so free market dynamics don’t really exist. ([View Highlight](https://read.readwise.io/read/01hxhxec1c7tmarjdthc30x1fq)) - This is one reason we think the biggest company in the world will be a payvidor—a company that is truly full stack across care delivery and reimbursement—because this enables them to use their insurance product as a distribution channel for their care delivery products. ([View Highlight](https://read.readwise.io/read/01hxj0gyd91sp7nw4r47thkdte)) - Fast forward fifty years, what could this full stack care delivery behemoth look like? It could be a company delivering 90% of healthcare, all through smartphones. This company would allow you to access the world’s best doctors through your phone, integrating human- and software-driven diagnostics, therapeutics, and medication delivery. Hospitals would still exist for surgery and certain diagnostics and treatment, and home health workers would deliver some physical care. But for most healthcare, you’d hop on your phone, just like we do today for 90% of personal finance or commerce (a new norm which itself may have seemed like science fiction twenty years ago). ([View Highlight](https://read.readwise.io/read/01hxj0hrbgakfrmnwmb5cwb2f4)) - We see two major opportunities to become the biggest company through a horizontal healthcare play: one to become the Amazon of healthcare, the other to become the Visa of healthcare. ([View Highlight](https://read.readwise.io/read/01hxj0j81hn88fe7eph4f84jy0)) - In addition, we see an opportunity to radically improve consumer payments, becoming the Visa of healthcare. Most Americans have received a cryptic medical bill in the mail, requiring a phone call or webportal that looks like it’s out of the 1990s to make a payment. Health system consumer collection rates—which hover around [55%](https://www.crowe.com/-/media/crowe/llp/widen-media-files-folder/h/hospital-collection-rates-for-self-pay-patient-accounts-report-chc2305-001a.pdf)—reflect this dismal experience. ([View Highlight](https://read.readwise.io/read/01hxj0z4rsyy289gp9wzx6smcx))