Could Private Companies Build the Public Health Infrastructure that America Desperately Needs?

Eren Bali
January 16, 2021
4 min read

This week, we started working closely with the Los Angeles Fire Department, CORE (Community Organized Relief Effort), and the Los Angeles Mayor’s Office to vaccinate 10,000+ people per day, provide digital vaccination cards, and collect and integrate the necessary data with state and local registries.

This wasn’t the initial plan. In fact, we weren’t involved until this past week, when we heard that the City of L.A. was struggling with another technology product. The government didn’t know it yet, but we’d already built the solution that would come to the rescue.

From our experience delivering high-quality clinical care at a low operating cost, we had figured out that a large-scale vaccination effort would require substantial technological lift. Anticipating that this could be a challenge for the public sector, we tried to contact state and federal governments to offer our help, but the response was always a “don’t worry, we’ve got it” attitude.

Then, around Christmas, we realized that all the vaccines were being shipped to local counties, but the counties had been left to figure out everything else by themselves. It was disappointing, but unsurprising, that there were no centralized systems being built to manage this process.

In response to the demo, they asked us, “Can you go live in two days?” 34 hours later, we launched the registration page.

Anticipating a breakdown, we decided to divert all of our product resources to building an end-to-end system that would help local government operations. We were taking a risk here because no one was asking for our help — yet.

Then, on January 9, we contacted the City of L.A. about the tech problems we’d heard they were having. We learned that the technology they were using was crashing, creating a huge source of friction for the amazing frontline people. We offered to show them a demo of something that might help.

Within hours, we were presenting what we’d designed to the Mayor’s office and the teams that were running the vaccination effort.

As soon as they saw our demo, they were shocked to see a comprehensive, elegant solution built precisely for what they were doing. The government had never posted an RFP for vendors to build something; instead, we had anticipated their need and built what was required without asking for permission.

In response to the demo, they asked us, “Can you go live in two days?”

34 hours later, we launched the registration page. Over the next week, we started deploying the rest of our platforms one by one.

Where We Are Now

Within a few days, we deployed the system that’s now running the process from end to end:

  • We’re queuing patients based on risk factors, scheduling appointments, and collecting all the necessary information.
  • We’re managing the workflow that allows frontline workers to vaccinate tens of thousands of people every day with minimal overhead.
  • Our customer support, billing, and data science teams are helping oversee the operation both centrally and on the ground.
  • We’ll be doing everything else after the visit — reminding patients to schedule their second dose, providing digital vaccination cards, screening for side effects, and integrating all this data with state vaccine registries.
  • Soon, we’ll also be staffing most of the clinical teams administering the vaccines.

Now, the LA fire department and the hundreds of volunteers working with CORE can focus on what they’re best at, which is helping people on the ground.

It’s fair to say the local government has been very appreciative of our help. We have been able to reduce the chaos and increase throughput significantly.

This is Repeatable

Thanks to this experience, we’re launching a new experiment within Carbon: a public health division. I’m envisioning a team staffed with great product managers, engineers, data scientists, and designers, as well as people who deeply understand the challenges of local governments.

This will be different from the usual government vendor model. Typically, governments publish some requirements in an RFP, and vendor companies respond to them and try to win the project. We’ll be working the other way around: we’ll try to anticipate what the government will need in terms of public health efforts, and start building the software and technology that we would build if we were running public health. Then, we’ll pitch the products to the government, showing them what we think they’ll be able to use. We’ll supplement our technology with services (customer support, data, operations oversight, etc.) that we can spawn more quickly and cheaply than they can.

In my experience, there are a lot of competent people involved in government, both in rank and file. They’re keenly aware of their needs, but the setup of the government makes it difficult to execute. All we need to do is have a team that can actively engage with people in local governments and ideate with fewer boundaries.

We know there are certain privatization efforts that have gone wrong, most notably private prison systems. We plan to study those and design a culture that constitutionally avoids making the same mistakes.

If you’re an idealistic technologist who wants to work for the public good, but you’re afraid of not being able to produce output at the pace you’d prefer, then drop us a line. This might be an interesting middle-ground for you, where you’ll be able to work in a faster-paced setting while making a direct impact on public health.

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Eren Bali

Eren Bali is the co-founder and CEO of Carbon Health. Eren leads the Carbon Health team toward his vision of democratizing healthcare and making high-quality care accessible to everyone.


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