Dec. 15, 2025

80 I The $91 Million Nobody Measured: eConsults and Specialty Access (HLTH)

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Overview:

We dive into the journey of Jomo, whose three decades in healthcare have been dedicated to improving access, with a special focus on LA County’s transformative eConsult system. We explore how this tool slashes specialist wait times from months to days for underserved populations, discuss the concept of “return on value” as a fuller measure of healthcare innovation, and reflect on the tension between profit, impact, and equity.

Our conversation highlights the ways technology can lift the baseline for vulnerable patients, outlines the collaborative benefits for specialists and PCPs, and considers how public health systems can better articulate their true value—beyond just financial ROI. We wrap with excitement about new data showing $91 million in annual value generated and a call to drive broader recognition of health tech’s role in democratizing care.

Three Takeaways:

Addressing Access Inequities in Both Urban and Rural Populations
The conversation highlighted that healthcare access barriers aren’t just a rural problem; even in resource-rich settings like downtown LA, low-income patients face immense hurdles. The solution doesn't just serve rural North Dakota, but also the urban poor—demonstrating the shared structural challenges across geographies.

Shifting Specialist Engagement through Technology
Jomo underscored the win-win value proposition for specialists: eConsults remove the loser-incumbent dynamic often present in tech rollouts. Specialists are able to respond to more cases efficiently, get compensated for asynchronous consults, and expand their reach, sometimes across state lines due to loosening regulations.

The Moral Tension between Profit and Mission in Healthcare Innovation
Both Raj Sundar and Jomo tackled the discomfort around profit-driven healthcare startups—recognizing both justified suspicion of profiteering at the expense of the vulnerable, and the reality that profit and altruism can co-exist if properly harnessed. They advocate for embracing mission-aligned entrepreneurship instead of rejecting all profit.

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