Jessica DaMassa asks me about the biggest IPO in Digital Health ever, the Platform vs App question and what was Seema Verma tweeting about during #HDPalooza. All in 2 minutes–Matthew Holt
As you may have noticed, we are picking up the focus on new tech companies here on THCB. Much of this is happening as I have a little more time to examine and work with startups as I’m no longer running the Health 2.0 conference day to day. Some of it comes from our new partnership with Jessica DaMassa and her WTF.Health series. But don’t worry, we are continuing to be the place to find great opinion pieces about the health care system as a home (This is an “add” not an “instead”)
Today I have an interview about an interesting new company I’m getting to know called Bluestream Health which is essentially a second generation telehealth video platform. Brian Yarnell is the President and I spoke with him about his company, and what makes their technology different. Brian will be at the ATA conference net week (while I’ll be at Dev4Health!) — Matthew Holt
There are buoys, far out in the ocean, that bob in the waves and signal, through satellites, when the surf will rise at Mavericks on the California coast, or when the tsunami will hit.
Healthcare in the U.S. is a hollow economy, inflated, impossible, all over patches and gimcracks and work-arounds puffed up on clouds of hot air generated by sweaty, dedicated crews of policy panjandrums and podium pundits burning forests of acronyms. True, that’s just looking at the bad side. But this bad side goes all the way around.
Will it pop? Will it undergo catastrophic exothermal deformation? Is it the Hindenburg nearing Lakehurst? This could be.
Look, this is the 21st Century. Whatever its name, catastrophic deformation, restructuring, “disruption,” or “creative destruction,” this is normal for businesses, industries, entire sectors. We have talked and whined and freaked out about massive change in healthcare since we had a peanut farmer in the Oval Office, and it hasn’t happened. Not really. Trust me, I was there, I watched it not happen. Nothing like the video stores, big-box malls, and Fotomats whose husks litter the landscape like the yonquerías of Baja. Nothing like Eastern Airlines, Western Airlines (“The only way to fly”), Northwest Airlines, Pacific Southwest with its dayglo go-go-booted stews, PanAm, and all the others whose logos adorn the Electras, L-1011s, 727s and Constellations parked wingtip to wingtip in the Mojave.
Healthcare has planetary inertia, gas giant inertia. It snacks on cost-cutting schemes like DRGs and Certificate of Need commissions and just gets bigger. It downs slices of GDP — 12 percent, 15, 18, 19 — and just gets bigger. Right through recessions, reforms, budget cuts. It’s Hungry Mungry. Its extraordinary resistance to deep transformation, compared to other industries and sectors, makes us ask why. What is holding it together? And makes us ask: What would do it? What would puncture this hollow, makeshift gas envelope?
2018 has brought renewed attention to high and rising employer health care costs, especially among employees. Teacher strikes across the country, motivated in part by rising health costs that have essentially canceled out small yearly raises, demonstrate the impact of these cost increases, which impact workers in all sectors of the economy. Over the last five years, the employer share of health care costs for family coverage increased by 32%, while employees’ share increased 14%. Average premiums have almost tripled since 2000.
Taking action is imperative. However, no single group can drive change of its own, not even giants like Amazon and JP Morgan. The total number of employees at most organizations represents a very small number of the commercially insured population. A critical mass of employers is needed to drive change, and should include an often overlooked and underused group: state employee health plans.
State employee health plans are frequently the largest commercial plans in the state; in 18 states, they cover more than 10% of the privately-insured population. Their members are often spread across the state, giving the plan a footprint in every major market. State employees have than double the median tenure of private sector employees and are often insured through retirement, making it more financially viable for the state to make long-term investments in employee health. States often have regulatory flexibility to try new initiatives, and their transparency requirements allow state employee health plans to signal to the market their future direction and leverage publicly shared information in negotiating reforms.
As state funded plans, they are also under pressure to run efficiently, with many succeeding. Nevada’s plan runs almost 10% leaner than comparable commercial plans while still reimbursing providers competitively. While running a lean plan limits some plan flexibility and management options, it offers an example for how plans can operate at the lowest possible cost.
The opioid crisis has devastated countless families and individuals across the United States and abroad. What once started as a quiet concern has become a full-blown epidemic, requiring the full support and attention of the healthcare and tech communities to address it.
From the Surgeon General’s August 2016 letter on Opioid Addiction:
“I am asking for your help to solve an urgent health crisis facing America: the opioid epidemic. Everywhere I travel, I see communities devastated by opioid overdoses. I meet families too ashamed to seek treatment for addiction. And I will never forget my own patient whose opioid use disorder began with a course of morphine after a routine procedure.”
I remember when visiting a city required paper maps and often actual guidebooks. Today, I tap on a map app on my phone, enter my destination, and review options for getting from point A to point B. In recent years, these applications have expanded to integrate ride-sharing, bike-sharing, and public transit information. Map apps provide two key real-time data points to help me compare the different options: the time it will take to get to my destination and the cost.
Behind those data points are elegant algorithms that analyze traffic patterns and conditions, as well as the real-time data exchange between multiple apps through modern, REpresentational State Transfer (RESTful) application programming interfaces (APIs). What makes our smartphones so powerful is the multitude of apps and software programs that use open and accessible APIs for delivering new products to consumers and businesses, creating new market entrants and opportunities. There is nothing analogous to this app ecosystem in healthcare.
ONC’s interoperability efforts focus on improving individuals’ ability to control their health information so they can shop for and coordinate their own care. While many patients can access their medical information through multiple provider portals, the current ecosystem is frustrating and cumbersome. The more providers they have, the more portals they need to visit, the more usernames and passwords they need to remember. In the end, these steps make it hard for patients to aggregate their information across care settings and prevent them from being empowered consumers.
Walmart (WMT) is in talks with Humana (HUM) about a relationship enhancement, possibly an acquisition. The two already know how to work together in alliances (narrow pharmacy network, marketing collaborations, points programs). If a new structure is needed, WMT and HUM must be considering a major expansion of scope or a set of operating models where contributions are difficult to attribute and reward (e.g. joint asset builds). What is on their minds? Beyond any interim incremental moves, what could be the endgame?
Catching convergence fever
Horizontal combinations among the top five health plans have arguably reached the regulatory “permissible envelope.” But provider combinations continue apace, enhancing ability to execute on value-based care to be sure, but also increasing negotiation leverage relative to payers. Further, Amazon’s (AMZN) interest in healthcare is gaining momentum but the specific goals are still mysterious, leaving many incumbents to imagine red laser dots are on their foreheads.
Accordingly, health plans are seeking defensible terrain in convergence combinations: CS & Aetna (CVS-AET), Cigna & Express Scripts (CI-ESRX), Anthem’s PBM insourcing and growing attention to CareMore (United Healthgroup [UNH] has been ahead of the curve as usual: but their recent SCA and DaVita medical group acquisitions have clarified for the market the scope of its ambitions for OptumCare). Of course, each of these moves just contributes to the uncertainty about the new competitive paradigm, driving more land grabs in response. I view the WMT-HUM discussions as part of these developments.
Jessica DaMassa asks me as much as she can about health & technology in just 2 minutes. In this episode there’s a lot of things not happening including, Amazon not supplying hospitals, and women CEOs not getting funded–Matthew Holt
WTF Health – ‘What’s the Future’ Health? is a new interview series about the future of health and how we love to hate WTF is wrong with it right now. Can’t get enough? Check out more interviews at www.wtf.health.
Lots of chatter lately about the disparity between men and women in health tech – both in and out of the the start-up space. I’m pulling together new interviews for a WTF Health ‘Special Report’ on women in health tech (stay tuned) but had a chance to have two great conversations on the topic while at #HIMSS18.
VEDA Data Solutions CEO Meghan Gaffney Buck talks about what it’s like to be a female founder in AI – raising millions and pushing new tech in a space usually dominated by guys. Find out what a ‘Mike Fest’ is and be sure to listen until the end for the good news about a trend she’s seeing in female-run investment funds.
Then, listen to Susan Williams, founder and CEO of Agency Other, on how women in our industry are starting to come together for world domination through orgs like Healthtech Women, a non-profit dedicated to such doings. Susan just launched the group’s newest chapter in one of the most eclectic healthcare markets in the country, Los Angeles, and also weighs in on what the health tech scene is like in Hollywood.
Jessica DaMassa asks me all about health & technology, in just 2 minutes, featuring venture rounds for Kyruus, Parsley Health, Livongo buying RetroFit, the RWJF AI challenge from Catalyst @ Health 2.0 and a ridiculously long explanation of where the @boltyboy twitter name came from…–Matthew Holt