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Health in 2 Point 00, Episode 142 | Ginger, Infermedica, Xealth & SOC Telemed

Today on Health in 2 Point 00, Jess and I cover all the deals that got overshadowed by the big news of Teladoc and Livongo’s merger. First up is Ginger, the mental health provider which raised $50 million in a D round bringing their total up to $120 million. Infermedica, an AI enabled symptom checker and triage tool, raised $10.25 million in a series A. Next, Xealth landed a $6 million investment from Cerner and LRVHealth, partnering with Cerner and bringing their digital health prescribing tool to Cerner in addition to its current integration with Epic. Finally SOC Telemed is going public through a “reverse” merger with Healthcare Merger Corp. —Matthew Holt

Why is a 1980 Drill in my 2020 Brain?

By SHVETALI THATTE

Late one evening, a trauma patient, a mother of three, comes through on an ambulance. She’s having trouble breathing, despite the breathing tube lodged in her throat. Dr. Nikhil K. Murthy, the neurosurgeon on the case, assesses the situation and orders a CT, which reveals a ruptured aneurysm, or a burst blood vessel. Excess fluid in the brain is fatal, as the increased pressure deprives the brain of vital oxygen. A sense of immediacy surges through Dr. Murthy as he calls for the necessary supplies to perform a ventriculostomy to drain the blood. He rushes to connect the drill bit, brace the manual drill against his body, and drill a hole in the right place, at the precise angle and depth. With the urgency of the situation blaring in his mind, Dr. Murthy has only his experience, training, and intuition to ensure that he does not drill past the skull and into the brain. The stakes are high, and a woman’s life is on the table. 

Bedside ventriculostomies, like the one described above, are common in the emergency department, as the surgery is often performed in life-or-death situations to immediately relieve fluid build-up in the brain. Dr. Murthy’s experience does not stand alone: countless neurosurgeons have stood in his exact shoes. While Dr. Murthy successfully performed the ventriculostomy, saving the woman’s life, not everyone is as lucky: the complication rate for bedside ventriculostomies in the U.S. stands at an egregious 50 percent

“When that woman was lying on the table, a drill braced against her skull, what she and I both needed was a safer, more reliable tool to perform the surgery.” – Dr. Nikhil K. Murthy 

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Redefining Values in American Health Care

By RICHARD HOEHN, MD

Experts claim we could have been better prepared when the COVID-19 pandemic struck in early 2020. With an annual budget of $400-700 million, the Strategic National Stockpile (SNS) is designed to respond to chemical, biological, and other disasters. Its $8 billion inventory included 13,000 ventilators and a limited supply of personal protective equipment, N95 masks, and medical supplies. This left state and local governments scrambling as the COVID-19 pandemic accelerated and the capacity of many hospitals was overwhelmed.

Faced with immediate and visible death and suffering, leaders took drastic steps to contain the virus, “flatten the curve,” and mitigate economic consequences. Trillions of dollars were allocated to recovery and stimulus packages.

This scenario mirrors our general approach to health care: chronic underfunding of public health followed by high costs and loss of life.

While not as shocking as a sudden pandemic, millions of Americans struggle daily with medical and socioeconomic challenges. Our health care system is designed to care for these patients when they have a problem, not to keep them well. This creates a dichotomy where a minority of the population spends most of the health care dollars and little is invested in the remaining majority

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Health in 2 Point 00, Episode 141 | Teladoc Livongo Merger Special

Today, a special Health in 2 Point 00. Jessica DaMassa asks me about the biggest news in public digital health companies ever: this morning’s merger of Teladoc and Livongo. We discuss the deal, the implications for digital health, what’s next for Continuous Clinics, whether our T-Shirts will become a collectors item, and of course what about our book club on August 19! —Matthew Holt

Post Covid Healthcare is Becoming Like Buying from Amazon Instead of Going to the Mall or Reading an eBook Instead of a Paperback

By HANS DUVEFELT, MD

Now that we are seeing patients via telemedicine or even getting reimbursed for handling their issues over the phone, our existing healthcare institutions are more and more starting to look like shopping malls. 

They were once traffic magnets, so large that they created new developments far away from where people lived or worked and big and complex enough that going there became an all day affair for many people. 

What this pandemic has brought us is a shift in our view of where you have to be in order to get things done. If you can earn your wage remotely and still buy things online when offices and physical stores are shut down, it seemed logical to try to offer healthcare the same way. And most of us have found that it works surprisingly well. 

The analogy with Amazon runs deeper than that. Amazon isn’t just one megaprovider, but also a funnel for many small merchants who sell their products through Amazon. Consumers take advantage of the convenience of this centralized ordering or point of contact with a vast supply network of almost any product that money can buy. But they only give their credit card number to one central contact. 

I don’t follow business literature enough to know if Jeff Bezos chose the name Amazon partly (yes, I know he went through the dictionary) because of a vision of many small contributories coming together into the second largest river in the world. But that is certainly a visual representation of what his business looks like. And “Amazon” ranks higher in the alphabet and sounds a lot catchier than “The Nile”. 

Enter healthcare: Imagine the trusted brand names of our “industry” but without their traditional complete reliance on bricks and mortar places that patients have to visit. 

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Vida Health’s CEO on Scaling Up in the Highly Competitive Chronic Condition Virtual Care Space

By JESSICA DaMASSA, WTF HEALTH

Even before Covid19, virtual care for chronic conditions was a hot and competitive area, with the heat turned up by Livongo Health’s IPO last year and big funding rounds for companies like Omada Health, Virta Health, and One Drop. Another contender in the space, Vida Health, has been best known for taking a “platform” approach to chronic condition management before “platforming out” became the-move-to-make for scaling health tech companies. Their digital health biz actually started out with a “whole health approach” to helping patients manage all their conditions at once, integrating care for diabetes, hypertension, COPD, high cholesterol, mental health conditions, and more from the get-go. Contrast that to some of their biggest competitors, who have adapted to that approach by adding on treatments for co-morbidities as their core businesses evolved.

Is there a benefit to starting out with a holistic care model that those who build it along the way can’t capture? We caught up with Vida Health’s founder & CEO, Stephanie Tilenius, to find out what advantage starting out as a platform play has brought to her business, which just closed a $25M funding round in April and is now available to more than 1.5 million people through employers and health plans.

How will the company scale from here? How will they remain competitive in such a crowded space? Stephanie talks through some of Vida Health’s post-pandemic plans AND how lessons learned from her “previous life” as an exec in Big Tech during that industry’s growth era of the 2000s & 2010s has shaped her thinking about the uptake of technology in healthcare. Not only did Stephanie work at eBay, PayPal, and Google during the birth of the online payment era, BUT she also helped take an online pharmacy company (Planet Rx) public during the dotcom boom.

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Quality Virtual Care Is Within Reach – But Only If We Act Now

By JULIA HU

Though it will be impossible to overstate the devastation that the COVID-19 pandemic is leaving in its wake, we can also acknowledge that it has pushed humanity to creatively adapt to our new, socially-distanced reality—necessity is the mother of invention, as they say. Telehealth is not a new invention, but the necessity of keeping people physically apart, especially those particularly vulnerable to COVID, has suddenly put virtual health care at the center of our delivery system. 

Patients and providers quickly pivoted to at-home care as in-person visits were limited for safety, and use of telehealth spiked early in the outbreak. One survey of over 500,000 clinicians showed that by April—only about two weeks after the first stay-at-home orders were issued in the U.S.—14 percent of their usual number of pre-pandemic visits were being conducted via telemedicine. For many, that involved using unfamiliar technology and a big shift in procedures for providers. Congress recognized the need to support providers through this transition and allocated $500 million for waiving restrictions on Medicare telehealth coverage as part of the emergency funding bill that passed in March. 

But, as restrictions have begun to lift and hospitals and medical offices are beginning to reopen for non-emergent care, we have seen the use of telemedicine start to taper off. The same 500,000 clinicians were surveyed  in June, revealing that telemedicine was used for only 8 percent of the usual pre-pandemic number of visits. Providing quality, virtual health care won’t be as easy as flipping a switch, but we currently have an unprecedented opportunity to carry forward the best version of virtual care and create a more holistic health care system. As we work toward that goal, there are three components our virtual care system needs in order to be sustainable, feasible, and manageable for both patients and providers. 

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The THCB Book Club!

By JESSICA DAMASSA & MATTHEW HOLT

We are launching a new THCB program! The THCB Book Club (TM) is going to be a discussion with leading health care authors, which will be released on the third Wednesday of every month.

We are kicking off with the new book from Hemant Teneja (VC at General Catalyst who has been writing many big checks lately) and Stephen Klasko (CEO at Jefferson Health System and one of the most unusual hospital system bosses in America). Their book is called UnHealthcare: A Manifesto for Health Assurance which is a how-to for creating a platform for a revolutionary future for healthcare, Taneja said. “Health assurance is an emerging category of consumer-centric, data-driven healthcare services that are designed to bend the cost curve of care and help us stay well.” Sitting in on the interview because we can’t get rid of him we will also have Glen Tullman from Livongo (Just kidding, Glen!). He will weigh in on how this connects with his new idea of Consumer Directed Virtual Care. Matthew may say something about the Continuous Clinic too, and Jessica will keep score of all the crises, Tsunamis, the many ways the health care is broken, and how many zingers Glen & Matthew get in on each other!

We want YOU to read the book in advance and email us questions or comments for us to ask the author(s) before the show. (We record a day or two in advance so please email us or put question in the comments here or on Twitter by the 17th). 

Please go buy the book here (eVersion only $6!)

It should be a lot of fun and very educational! This will be up on THCB on August 19.

In September the author will be Jane Metcalfe with her 2020 book NEO.LIFE

Health Insurance Needs to Grow Up

By KIM BELLARD

I’ve been covered by private insurance my entire life.  Even more telling, I worked in the health insurance industry for — gasp! — some thirty years.  It’s not just paid for my healthcare, it’s financed my life.

Today, though, for the first time in my life, I’m covered by public insurance — and I couldn’t be more relieved.  

Now, I’m not going to go all Wendell Potter.  I know many people have their health insurance horror stories, but, sadly, people have them about pretty much every part of the healthcare industry.  I believe most people working in health insurance, like most people working in healthcare generally, sympathize with the people they serve and are just trying to do a good job.  

The problem is that the health insurance model has outgrown the times.  I’ll try to explain some ways how.

Premiums

Once upon a time, most people had employer coverage, and those employers paid all or most of its cost.  Those days are gone.  Employer coverage is still the predominant form of private health insurance, and employers still pay the majority of its cost, but percentage of people with employer coverage continues to drop and the amount they pay for it continues to increase.  

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Health in 2 Point 00, Episode 140 | Heal, Lemonaid, CVS & Sema4

Today on Health in 2 Point 00, Jess helps me celebrate my birthday Kylie Jenner-style. On Episode 140, Jess and I discuss Humana investing $100 million in Heal, Lemonaid raising $33 million in a Series B, CVS Caremark announcing 5 new companies in their digital health platform—4 of which are about weight loss, and perplexing health intelligence company Sema4 raising $121 million in a seed round. —Matthew Holt

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