Out-of-Pocket’s Nikhil Krishnan uses memes, humor to explain industry trends


Tucked into one of Nikhil Krishnan’s recent newsletters is a photograph of Hillary Clinton glancing distressingly at a kitchen in a public housing unit, a visit paid while she was on the 2016 presidential campaign trail. Krishnan gave the visual the tongue-in-cheek caption: “Home health startup actually visiting a patient’s home for the first time.”

The meme was part of his guide to emerging health care business models, one of the latest editions of Krishnan’s free online newsletter Out-of-Pocket. More than 20,000 readers turn to Out-of-Pocket to learn about the business of health care and read analyses of new industry trends. Krishnan’s pitch is that he makes a complex business easy to understand—and fun, thanks to a healthy dose of memes that illustrate stubbornly nonvisual topics like self-insurance and electronic medical records.

“I do think I’m marginally funny, and that bar in health care is very low,” he said.

Krishnan got into health care by accident. He studied sustainable development as an undergraduate at Columbia University but pivoted to tech by the time he graduated in 2014. His first job was as an analyst for CB Insights, a market intelligence platform that tracks private companies and publishes analytical, sector-specific newsletters on startups.

The startup world appealed to Krishnan, who had by then started a couple of his own fledgling ventures. During high school he customized shoes and sold them online. He also helped graduating seniors sell their Texas Instruments TI-89 graphing calculators to younger calculus students (retail price: $130).

At CB Insights, he was charged with producing data-driven reports about digital health and biotech companies. He faced a steep learning curve but used it to his advantage, sharing his findings in a newsletter and building a readership of 90,000. He did the same on Twitter, where he now has more than 44,000 followers.

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