The big news in the comeback of digital health is that Hinge Health filed its S1 and is looking to go public soon. I suspect that they’d have preferred to get the IPO done late last year when the AI bubble was expanding rather than deflating, but timing the market is tough! Nonetheless Hinge is almost profitable and at over $350m in revenue at a growth clip of some 75% last year, in terms of a show pony to trot out, it’s about as good as the digital health field has got. The problem is that the last round in 2021 was at a $6bn+ ZIRP-era valuation with Tiger & Coatue paying the idiot price because Teladoc was trading at $15bn market cap then (albeit down from $30bn a year before that!). That is, err, no longer the case. There’s a bunch of weirdness in the IPO structure to pay those guys back, but the main point is that the likely valuation will be in the $1.5-2.5bn range.
But there’s another problem. And it’s one I have some personal experience with. I must stress that my experience is not with Hinge.
But this past summer I used the services of their main competitor, Sword Health. As far as I can tell the two companies are very similar in their process and services, both with self-service exercises delivered via the smartphone and both moving from remote care from therapists to AI therapists. But I could be wrong. So for this article I am extrapolating from one company to the other to look at the field of MSK digital services overall.
In total, I thought the Sword experience was good as a standalone program. But the problem was that it was standalone.
My problem was with my left knee. I had a lot of knee surgery in 2002-4 as the result of snowboarding into a tree (Hint. If you snowboard, try to make sure you and the board go the same side of the tree). More than 20 years later in 2024 I managed somehow to induce terrible pain in the knee running for a ferry in January, a train in May and an airport shuttle in June. (It seems that travel and my knee disagree). This didn’t stop me strapping up, taking drugs and snowboarding in the 2024 winter season but it certainly slowed me down a whole lot. Around this time there were many reports of people much younger than me getting their knees replaced.
So I thought I should do something about it. My Blue Shield of California plan offers Solera which is an agglomeration marketplace of digital health apps and services. Sword Health is their PT app, so I selected it, enrolled and off I went.
Note that there was zero integration with my PCP, any orthopedic surgeon, any clinical person at the health plan or basically anyone. This was purely patient-driven and managed.
With Sword I had a 15 min intro call on June 6 – then was sent a box containing a generic tablet and six sensors which fit into straps that you attach to your lower and upper legs and arms.
There was a conversation in the app with a PT and then it spat out a selection of exercises for me. The example below is my second exercise session. If you want to check out more, I have put more of the exercise and the chat with the PT here.
Sword suggested, instead of regular 45-60 minute physical PT sessions, that I did four 15 minutes sessions a week. Essentially one every other day.
The end result was that I did eight sessions between June 12 & June 30.
And he tells us why what we have done so far in Medicare Advantage and explains that it doesn’t work because we haven’t got the clinical data easily available via API. (Those in the know knew he was going to say that!). He also thinks that commercial payers may yet be the saviors of ACOs and Medicare Advantage by buying bundled care from providers and making it necessary for them to access the data across the board, and then change overall behavior. And Aneesh is quite optimistic about the new Admin and its MAHA stance. Matthew Holt
This piece is different from the typical “health-care industry” topics covered in this forum.
My Sunday morning routine usually involves getting a cup of coffee and downloading the most recent editions of magazines on my iPad.
The cover of the February 13 edition of Time magazine immediately caught my attention because the title read “OUR CANCER MYSTERY. WHY IT’S NOW STRIKING US SO YOUNG’’. Four people are on the cover: their names, cancer types, and age at diagnosis displayed. 18 to 40. I imagine that the majority of readers might describe their expressions as neutral and composed, their posture calm.
But I see what exists below the restrained surfaces. Something I am all too familiar with. Disbelief. Worry, Bewilderment. Uncertainty. Sadness.
Although overdue, a major news magazine had finally put it out there, front and center. A call to action.
On September 14, 2017, I was standing in a hospital room in Boston, when my previously healthy son, Patrick, then 29, received the shocking news that he probably had stage 4 colorectal cancer, which further tests confirmed. That grave diagnosis came with a bleak 14 percent relative 5-year survival rate. Like the cognitive simulation of Schrödinger’s cat, my beloved son’s life now lay in a sealed box, with a hammer hovering over a flask of toxin. Would it fall, smash the vial, and kill my son? I could only be an observer. I desperately wanted to be the one in the box instead of him.
Fatherhood and medicine are integral to my identity. Throughout the three years during which he received superb care at Dana Farber Cancer Institute, in Boston, I had to be his father first, offering emotional support with love and hope. The physician adviser part was a secondary role.
Despite his indomitable spirit, positivity and best efforts, Patrick took his last breath on September 6, 2020, in his childhood home, Although relieved that his suffering was over, I was caught in immense sorrow, not yet realizing that eventually acceptance would slowly weave itself through the grief, and I would gain a nuanced understanding of “before and after.’’
As I mentioned in my 12/6/2024 piece in this forum, I hadn’t thought very much about early-onset cancer during many of the years that I was in clinical practice and as a physician executive.( I had categorized my experience with bladder cancer at 49 as an anomaly.) But that has changed in the past few years, during which the rising incidence of cancer in younger adults has been, first, in the scientific and medical literature and then sporadically in the broad national news, especially since the summer of 2023. But millions of people still have no idea that this is happening.
Writing is how I express myself best, so in early 2020, I started writing to help myself navigate what was happening to Patrick. As the global phenomenon of early-onset cancers expanded, I felt compelled to tell my son’s inspirational story and raise awareness of early-onset cancer and the need to dramatically expand screening for it. Over three years, I wrote a book titled RESERVATIONS for NINE: A DOCTOR’S FAMILY CONFRONTS CANCER, published earlier this month and timed to CRC Awareness Month. A labor of love and grief, it’s a book about family, love, loss, science and spirituality. Craig Melvin, NBC’s TODAY Show co-anchor, graciously wrote the foreword. Three months after my son passed away, Craig lost his 43-year-old brother to the same disease.
Many books have been written about cancer. From a patient undergoing treatment, to a family member or other caregiver, to a doctor treating a patient, to a researcher looking to change the trajectory of those being diagnosed and treated. But this one is unique. Part memoir and tribute, interspersed with journal entries by my son and others in my family. Part medical saga, the book aims to educate the public about the dangerous global rise in early-onset cancers, and to help provide a roadmap by example of loved ones going through cancer battles, and a call to action to the medical community to get ahead of this crisis.
My son’s life shouldn’t be defined by cancer, but, rather, how he responded to it. Most inspirational was how he became a strong public advocate of screening and funding for cancer research.
I hope that readers of THCB can find the time to share the messages of this book with family, friends and colleagues.
Thank you, Matthew and THCB for providing this forum to present my story.
George Beauregard, DO is an Internal Medicine physician whose experience includes 20+ years of clinical practice as well as leading organizations strategic and clinical initiatives
Four days after emergency surgery and barely able to walk, Heather Sherman flew from Chicago to Washington for first-day-of-work onboarding at the Agency for Healthcare Research and Quality. Fourteen months later, Sherman suddenly became one of the thousands of federal employees summarily dismissed by a weekend email telling them they were “not fit for future employment.”
The trauma of that abrupt ending in mid-February — giving her just a few hours before all access was shut off — still lingers. “This was my dream job,” Sherman told me.
If Sherman were an air traffic controller or nuclear materials expert, her work keeping the public safe would be obvious. But as a mid-level employee with a technical role at a little-known agency in the mammoth Department of Health and Human Services, her curt dismissal and that of an undisclosed number of AHRQ colleagues prompted not even a ripple of news coverage.
Yet what a New York Times editorial decried as a “haphazard demolition campaign” by the Elon Musk-led Department of Government Efficiency, one that is undermining “the safety and welfare of the American people,” applies to agencies like AHRQ and low-profile jobs like Sherman’s just as much as to more high-profile positions.
In complex systems, of which healthcare is surely one, carelessness has consequences.
(Disclosure: I’ve known Sherman for years, and while I serve on AHRQ’s National Advisory Council, I have no inside information. All opinions are my own.)
For Sherman, with two master’s degrees and a Ph.D., the anodyne title of health scientist administrator masks a beyond-the-data devotion to patient safety. A 2023 report by the President’s Council of Advisors on Science and Technology declared patient safety “an urgent national public health issue.” In truth, the urgency is embraced mostly by a small number of individuals determined to drastically reduce the estimated 160,000 Americans perishing each year from preventable medical errors in hospitals.
That death toll is a conservative estimate by the Leapfrog Group. Food and Drug Administration administrator-designate Martin Makary has called medical error “the third-leading cause of death” and estimated a death toll of more than 250,000 Americans.
Saving Lives and Money
Even if the focus is only fiscal — leaving aside the human impact — medical care that causes unintended harm is inefficient and costs money. The potential savings are large: an in-depth examination of medical records by the HHS Office of the Inspector General found that a shocking one-quarter of Medicare patients suffer some level of harm during a hospital stay.
It’s that “inefficiency,” human as well as financial, that Sherman wanted to attack at AHRQ. She proposed an initiative enabling hospitals nationwide to collaborate within a legal framework that promotes candor by protecting their interactions from being discoverable in a malpractice lawsuit. That structure is known as a “patient safety organization,” established by Congress through bipartisan legislation in 2005. The process of ongoing collaboration is known as a “learning health system.”
Sherman recalls reaching out to everyone she knew whose organization was affiliated with a PSO and asking what they needed to meet today’s challenges. “The almost unanimous answer was, ‘We want a place to find solutions, a place to share solutions,’” Sherman said. “‘We want to know what to do.’”
“Any kind of systemic prevention of problems saves money,” she added.
To be effective, however, collaborative problem-solving on a large scale requires more than just setting up Zoom calls and sharing documents. It quickly gets technical; e.g., ensuring that all participants classify and report an adverse event in the same way.
“Classification is the key,” Sherman said. “It’s like a box of different-colored Lego pieces in different sizes. Each Lego is a data element. Everybody has to understand what it means in order to use it.”
Along with her technical expertise, Sherman also brought a determination to expand what information was collected and how it was used; for instance, by bringing in patient and family input. “The law was not meant to exclude reporting of problems by anyone who wasn’t a clinician,” Sherman said. She also planned to utilize qualitative data “to tell a story. You learn a lot more about the nuances of error in the qualitative data.”
To accomplish those ambitious goals, Sherman began seeking buy-in from AHRQ leadership while also planning a national kick-off conference for May. Then, awakening on Saturday morning, Feb. 15, and turning on the TV news, she heard a White House correspondent report that government departments were firing “probationary employees.” Soon afterwards, the dreaded email popped up in her inbox from the HHS personnel office.
“We all knew it was coming,” Sherman said. “We just didn’t know when.”
A Legal Loophole
“Probationary employee” has a different meaning for federal employees than for private-sector ones. In the private sector a probationary period might last a few months, but an employee can typically still be fired “at will” any time afterwards, barring protections related to union membership or illegal discrimination. In federal employment, in contrast, the probationary period before civil service job protections kick in can last one, two or even three years, depending on various factors, and the probationary period can start over even for long-time employees if they’re promoted or switch agencies. Sherman was hired on a two-year probationary period.
Even probationary employees, however, can be fired only for certain reasons. Hence the careful language of the DOGE-driven form letter signed by HHS Chief Human Capital Officer (Acting) Jeffery Anoka that informed Sherman she’d not met “the burden to demonstrate why it is in the public interest” for the government to finalize her appointment. It continued, “your ability, knowledge and skills do not fit the Agency’s current needs, and your performance has not been adequate.”
Excerpt from letter sent to probationary federal employees
“I was very calm that day,” remembered Sherman. “The next day I was a mess.” Questions of what would happen to her work, as well as compensation for unused sick leave and time off, remain unresolved; senior AHRQ managers are also in the dark. “Nobody knows anything, and there’s no guidance,” she said. “I am disheartened and disappointed.”
At the Centers for Medicare & Medicaid Services, a senior manager named Jeff Grant pushed back hard in a letter to Anoka posted on LinkedIn after 82 employees in his group were told they were “not fit for continued employment.” Grant began by announcing he was immediately retiring after 41 years of federal service, emphasizing later that he had served with equal dedication both Republican and Democratic administrations. Grant went on to refute accusations of incompetence by saying the fired workers had not only passed a series of formal reviews with high marks, but the interview process, one in which he was personally involved, allowed CMS to select “truly the best of the best” out of hundreds of resumes.
Moreover, Grant pointedly noted, many of those fired at his Center for Consumer Information and Insurance Oversight were set to work on writing and implementing a new rule announced as a Trump administration priority. That rule, “is projected to save billions in program dollars,” he wrote, “which is the ultimate in government efficiency.”
A Plea For Public Service
On an even more personal note, an “open letter to America from career federal civil servants,” written anonymously to avoid retaliation, poignantly reminded the public, “We are your neighbors, friends and family. … Most of us heeded a call to serve because we love this country and what it represents as much as you and wanted to give back. The hard work we do, we do on your behalf.”
That declaration resonates with Sherman, who said she’s long yearned to work for AHRQ, a small-budget agency with the big-mission task of helping make U.S. medical care better and safer.
“I never wanted to leave AHRQ,” Sherman said. “I wanted to be in this department, in this job, for the rest of my life. I didn’t go into this profession to be rich. I went into this profession to make a difference in people’s lives.”
The “chainsaw” approach favored by Musk continues: the administration has ordered every federal agency to turn in a plan for even more drastic cuts by March 13. The impact of two federal juges’ orders reversing some probationary employee layoffs remains to be seen, particularly since they are being appealed. For Sherman, meanwhile, there are two poignant codas to her career situation. DOGE, the force behind her firing, has been criticized for acting with both joyful cruelty and dubious legal authority. As it happens, Sherman’s undergraduate major was in judicial morality and constitutional democracy.
Meanwhile, although Sherman almost immediately lost all job-related access, her last official day on the AHRQ payroll was March 14. This year, that’s the next-to-last day of Patient Safety Awareness Week.
Michael L. Millenson is president of Health Quality Advisors & a regular THCB Contributor. This piece was previously in Forbes
When most Americans undergo surgery, they expect to recover quickly and return to their normal lives. Few realize that something as routine as a shoulder surgery, a hernia repair, or a mastectomy can mark the beginning of a life-altering opioid addiction. This often-overlooked connection between routine medical care and opioid dependence demands urgent attention.
How Physicians and Hospitals Sustain the Opioid Epidemic
For decades, the pharmaceutical industry has shaped medical education, ingraining the belief that opioids are the best first-line treatment for acute pain. As a result, American physicians prescribe opioids at dramatically higher rates than their counterparts in other countries. A recent study in Annals of Surgery found that after three common surgeries, 91% of U.S. patients were prescribed opioids, compared to just 5% of the global patients.
Hospitals and health systems have also played a significant role in perpetuating opioid dependence. Opioids have long been a convenient and cost-effective solution for acute pain management, readily available and inexpensive to administer. However, the financial incentives for hospitals extend far beyond the initial prescription. The short-term complications of opioid use—such as nausea, constipation, urinary retention, and hyperalgesia—require additional treatments, increasing hospital revenue. Long-term complications, including dependence, overdose, and addiction, further drive profitability through repeat admissions, extended care, and emergency visits. In effect, hospitals and health systems have become financially reliant on opioid-based care, benefiting from both the immediate and prolonged consequences of opioid prescribing.
A study from the University of Michigan/IBM Watson revealed that a single opioid prescription after elective surgery increased healthcare costs by an average of $5,680 per patient per year across all payer types, including Medicare, Medicaid, and commercial insurance. This widespread cost increase affects insurance premiums, employer healthcare spending, and state and federal budgets. Notably, this estimate does not even account for the long-term costs of addiction treatment, which can be 2-16X that cost per patient per year.
The Devastating Impact of Routine Opioid Prescriptions
Each year, over 60 million surgeries are performed in the U.S., leading to the prescription of 45 million new opioid prescriptions per year. But the real crisis lies in what happens next: nearly 10% of all surgical patients remain on opioids long after their recovery should be complete. That means 2-4 million Americans every year are still using opioids beyond 90 days post-surgery.
For aging Boomers, it is impossible not to hear echoes of Apartheid re-emerging with force 3/4 of a century after the battle for social justice here and in far away lands was fully engaged. The Musk assault, disguised as “efficiency” is little more than stealing money from the poor to give to the rich, and widens an already extraordinary income gap.
The assault is large enough to draw condemnation from a dying Pope Francis, forced to remind Trump, Musk and their enablers of the historic Jesus and the tenets of Liberation Theology.
Our college years in the 1960’s were accompanied by chaos and crisis, and guided by fundamental Judeo-Christian values. My college, the Jesuit-led Le Moyne College, was activist to its core. The movement was championed by two priests, brothers Daniel and Philip Berrigan. With the assassinations of JFK, his brother Robert, and MLK; LBJ’s Great Society legislative battles; the Civil Rights movement; and the Vietnam War, America was literally on fire at the time.
It was during this decade as well that a largely student-driven movement emerged to oppose Apartheid in South Africa and rapidly spread worldwide. A seminal feature of that movement was mass education and demonstrations with a goal of creating economic pressure on the leaders of South Africa by divestiture of all stocks and investments that benefited the nation.
I know: you’re pretty proud for being into “wearables” to help monitor your health and other functions. You’ve got some apps on your smartphone. You use a smartwatch. Maybe you’ve tried one of the many iterations of smart glasses, like Google Glass or Meta’s Ray Bans. You were disappointed when Humane’s AI pin bit the dust.
Forget all that. With fiber computing, your clothes can be your wearable.
The fiber computer contains a series of microdevices, including sensors, a microcontroller, digital memory, bluetooth modules, optical communications, and a battery, making up all the necessary components of a computer in a single elastic fiber.
It also has embedded lithium-ion batteries that power it.
MIT has a lab devoted to fiber computing (fibers@mit), led by Professor Yoel Fink, who has been working on it for over ten years. According to its website: “Our research focuses on extending the frontiers of fiber materials from optical transmission to encompass electronic, optoelectronic and even acoustic properties,” with the goal of fibers that can See, Hear, Sense and Communicate.
The lab has had many accomplishments, but the mismatch between the shape of a chip and the shape of a fiber became a problem. Co-lead author Nikhil Gupta, an MIT materials science and engineering graduate student explains the problem:
The decline in cognitive health, especially that leading to Alzheimer’s and other brain diseases, is one of the most feared conditions by patients and their families. It’s also one of the most expensive. But if we can predict it early there are things we can do to prevent or ameliorate it. The issue has been finding an easy and comprehensive way to monitor it as part of primary care. The team at Linus Health has been building a diagnostic solution for exactly that and claims that it’s now the right time to roll it out as part of general primary care. CEO David Bates, John Showalter, Chief Product Officer (a primary care doc) and Alvaro Pascual Leone, a neurologist and Chief Medical Officer, took me through an extensive end to end demo. This is a long and fascinating look at the state of play in neurology diagnosis, and discussion about what the future of brain health looks like. Matthew Holt
A recent report from Moody’s Analytics, by chief economist Mark Zandi, had an eye-opening fact: the top 10% of earners in the U.S. – those who make $250,000 or more – now account for just shy (49.7%) of half of consumer spending. If that strikes you as unusual, you’re right. It is a record since at least 1989. Thirty years ago the comparable percentage was 36%.
“The finances of the well-to-do have never been better, their spending never stronger and the economy never more dependent on that group,” wrote Dr. Zandi. He added: “Wealthier households are financially more secure and thus more able and willing to spend their income. That is, they save less than they would otherwise.”
The rest of us are struggling to hold our own against inflation, not always successfully. It’s why companies like Costco and Walmart are trying to target upscale shoppers, while “value” oriented firms like Big Lots, Family Dollar, or Kohl’s are closing stores or even declaring bankruptcy.
This extreme bifurcation, of course, made me think of healthcare, where – as is famously known – half of all spending is attributable to only 5% of patients. In case you’d forgotten, in healthcare, half the population accounts for 97% of all spending, so the other half accounts for a measly 3%.
Now, you might say, neither of those is surprising: rich people spend more, and sicker people cost more. But somehow neither of those seems right to me.
The answer to a politics ofscarcity is a politics of abundance, a politics that asks what it is that people really need and then organizes government to make sure there is enough of it.
Mr. Klein didn’t coin the phrase “politics of abundance,” but he and Derek Thompson did just write a book on the topic (Abundance) that discusses their thoughts at more length. I have not read the book, but I saw a quote from it that I quite liked: “What is scarce that should be abundant? What is hard to build that should be easy?”
Despite all these shortages or would-be shortages, of course, we manage to spend way more than other countries on healthcare. One can only imagine how much we might be spending if there were no shortages. I take that back: I’m not sure I can imagine.
In the category of things that are scarce that should be abundant, and/or things that are hard to build that should be easy, I’d probably put housing at the top but healthcare as a close second. The trouble is, when we pour more money into healthcare, as we are wont to do, we don’t seem to fill any of our many shortages, much less improve the quality of care or outcomes.
As the artistic director of Out of Hand Theater, an arts organization that promotes anti-racism, social activism and health equity, I believe the recent appointment of Robert F. Kennedy, Jr. (RFK) as Secretary to the Department of Health and Human Services is beyond concerning. RFK is not a doctor, nor is he a scientist, yet he has been very vocal about his vaccine skepticism and has promoted misinformation about vaccine safety. Now, along with the removal of scientific information and warnings from the Centers for Disease Control (CDC) website, RFK’s appointment could lead to major increases in preventable and serious illnesses, outbreaks and deaths.
COVID-19 and its various mutations are still very much part of our daily landscape. According to the World Health Organization (WHO), more than 7 million COVID-related deaths have been reported since 2020 worldwide, nearly 2 million deaths were recorded in 2020 alone. The first vaccines were developed and became available by November 2020 and reported deaths from the last 28 days is 3,872, which is a 98.7% decrease from the onset of the pandemic. Vaccines work and save lives!
Diseases like smallpox and the bubonic plague were wiped out because scientists developed vaccines. Currently, with the “anti-vax” rhetoric being embraced and misinformation being so commonplace, reports of measles went from 4 cases in 2023 to 285 in 2024. Nine of these cases required hospitalization. The affected individuals include six children under four years old, 16 individuals aged 5-17, and two adults over 18 – the numbers rise as the days go by with 124 cases in in Texas in 2025 alone. We cannot and should not be going backwards where medicine is concerned.
Health experts are concerned that increasing nonmedical vaccine exemptions among schoolchildren could lead to more frequent outbreaks. Declining vaccination rates are worrisome as measles can cause serious illness, including hospitalization and brain swelling. I am not a doctor nor a scientist, but I place my trust in the actual doctors and scientists who have the greater good in mind when developing medicines to combat and prevent diseases. Why does this matter to me? Through our Equitable Vaccines program, we use art, information and conversation to encourage vaccine confidence and educate the community about resources so that we can create a healthier community, and we’re proud to have helped deliver 650 vaccines across Georgia. A healthy community is a strong community – and to me, that is the most valuable commodity over what is imported and exported.
As a woman, as a mother, as a human, I worry about our health and our children’s future with RFK Jr leading the Department of Health and Human Services. I implore that all of us contact our local and state representatives to express our concerns over RFK’s Department of Health and Human Services appointment. We cannot go backwards when we have the resources available to us to create a safe and healthy place for every citizen to thrive. We must prioritize our communities’ health and allow proven data to guide our most important decisions that impact those that are most precious to us.
Ariel Fristoe is the Artistic Director at Out of Hand Theater
