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The Most Important Thing

By KIM BELLARD

Jack Dorsey has some big hopes for bitcoin.  In a webinar last week, he said: “My hope is that it creates world peace or helps create world peace.”  The previous week Mr. Dorsey announced Square was starting a decentralized financial services (DeFi) business based on bitcoin, joining the previously announced Square bitcoin wallet.  

None of this should be a surprise.  At the Bitcoin 2021 conference in June, Mr. Dorsey said: “Bitcoin changes absolutely everything.  I don’t think there is anything more important in my lifetime to work on.”

I’m impressed that someone with as many accomplishments as Jack Dorsey picks something not obviously related to those accomplishments and decides it is the most important thing he could work on.  So, of course, I had to wonder: what might accomplished people in healthcare say was the most important thing they wanted to be working on?

For many these days, of course, it is the COVID-19 pandemic.  Not much has had a higher priority.  Highly effective vaccines have been developed, COVID-19 treatments have greatly improved, supply chains have been adjusted and readjusted, and countless public health measures have been tried.  Healthcare professionals have worked themselves to extremes.

For others, perhaps, it would be to address the extreme financial hardships the U.S. healthcare system can cause.  A new study in JAMA confirmed what is hiding in plain sight – hundreds of billions of medical debt.   Debt continued to rise despite ACA, especially in states that perversely chose not to expand Medicaid.  Efforts such as requiring hospital “price transparency” have largely failed.  Many large hospital systems continue to sue patients who can’t pay.  These hardships are unfair, immoral, and unique to the U.S.; addressing them should be important.

However, both the pandemic and financial obstacles contributed to, but did not cause, the big health inequities in the U.S. healthcare system.  People of color, people in lower socioeconomic classes, even women all face numerous inequities in the health care they receive and in the health they achieve.   These may reflect broader social inequities, but no one in healthcare should look at these without wanting to address them. 

Digital health has never been hotter. The pandemic reminded people how valuable telehealth can be, and investors are pouring money into digital health at astounding levels – some $19b in the first half of 2021 alone.  We may be in bit of a manic phase right now, but few doubt that digital health is going to be a big part of healthcare’s future. 

Then there’s artificial intelligence (A.I.).  No industry in 2021 can be ignoring it. Some well-publicized mishaps with IBM’s Watson or Babylon Health notwithstanding, A.I. in healthcare has already made impressive strides, such as DeepMind’s recent protein predictions or its successes in imaging.  A.I. is going to be built into our health care in the future, either in a supporting role or directly, and working on it has to be on many people’s wish list.  

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Health Care Needs A Hero

By MIKE MAGEE

Health care needs its heroes.

I came to that conclusion this week through a roundabout route.

First I read Maureen Dowd’s interview entitled “Dara Khosrowshahi, Dad of Silicon Valley”, in which she, with some affection, gives the reader a look behind the scenes at the personal life of the current Uber CEO. At one point, Dowd shares her conversation with Dara’s 20-year-old daughter, Chloe, a Brown student, who wants us to know her father was a seriously good dad. In support of this belief, she reports that “When she was little, her father – a fan of Joseph Campbell…would concoct children’s stories set in faraway kingdoms…”

This, of course, forced me to acknowledge that I didn’t know who Joseph Campbell was. Bill Moyers came to the rescue. His June 21, 1988 interview titled “Joseph Campbell and the Power of Myth — ‘The Hero’s Adventure’”, begins with a clip from Star Wars where Darth Vader says to Luke, “Join me, and I will complete your training.” And Luke replies, “I’ll never join you!” Darth Vader then laments, “If you only knew the power of the dark side.” Moyers asked Campbell to comment.

JOSEPH CAMPBELL: He (Darth Vader) isn’t thinking, or living in terms of humanity, he’s living in terms of a system. And this is the threat to our lives; we all face it, we all operate in our society in relation to a system. Now, is the system going to eat you up and relieve you of your humanity, or are you going to be able to use the system to human purposes.

BILL MOYERS: So perhaps the hero lurks in each one of us, when we don’t know it.

By then, I was aware that Joseph Campbell, who died in 1987 at the age 83, was a professor of literature and comparative mythology at Sarah Lawrence College. His famous 1949 book,  “The Hero With a Thousand Faces” made the case that, despite varying cultures and religions, the hero’s story of departure, initiation, and return, is remarkably consistent and defines “the hero’s quest.” His knowledge of this quest gained him a large following that included George Lucas who was a close friend and has said that Star Wars was largely influenced by Campbell’s scholarship.

Whether health care or technology, unfettered capitalism is more than adept at breeding predatory systems that beg for redemption.  Author Emily Chang spoke to this predilection in her 2018 book, “Brotopia”, describing Silicon Valley types as “secretive, orgiastic, and dark.” Dara Kharowshaki’s  CEO predecessor at Uber, Travis Kalanick, was labeled one of the worst. When Dara took over, New York Times technology expert, Mike Issac asked in 2019, “Can this rational, charming chief without the edge, ego, or cult following of wacky founders succeed in today’s insane economy?”

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Matthew’s health care tidbits

Each week I’ve been adding a brief tidbits section to the THCB Reader, our weekly newsletter that summarizes the best of THCB that week (Sign up here!). Then I had the brainwave to add them to the blog. They’re short and usually not too sweet! –Matthew Holt

In this week’s health care tidbits, we are talking about medical debt. Oh, not all medical debt. No, not that debt being garnished from the wages of health care workers by their own employers. Today we are just discussing the debt that has already gone to collections. Yes, the debt sold off by doctors and hospitals for pennies on the dollars so that debt collectors can hound people until they pay or despair.

This week a Harvard/Stanford team reported that the total in collections is $140 Billion! Way more than anyone thought, Nearly ONE in SIX Americans currently has a medical bill in collections. No prizes for guessing that those most likely to be being pursued are living in the poorest zip codes in the country and even more likely to be in a southern state that never expanded Medicaid.

Glad we are all proud to be American.

#Healthin2Point00, Episode 224 | b.well, Quit Genius, Doktor.se, Sweetch, Kno2, and HealthifyMe

Today on Health in 2 Point 00, Jess and I chat about the staggering medical debt in this country before diving into some more health tech deals. First up on Episode 224, personal health record company b.well Connected Health raises $32 million, bringing their total to $57 million. Next, Quit Genius raises $64 million in a Series C, bringing the digital addiction clinic’s total to $78.6 million, and Swedish telehealth company Doktor.se raises €29.5 million – there are some interesting investors in this one. Sweetch, a Bayer G4A company, raises $20 million for its behavior change app and Kno 2 raises $15 million in a Series A in yet another interoperability play. Finally, Healthify.Me raises $75 million, bringing its total to $100 million – this is like Noom plus exercise in India. —Matthew Holt

Money and Values: For Healthcare Workers, It’s Time They Align

By WYNNE ARMAND and CHRISTIAN MEWALDT

It shouldn’t be controversial to say that promoting the well-being of patients and our community should be at the core of our decisions in health care — even when competing factors exist. Yet we have grown increasingly uncomfortable to realize that we’ve been investing in companies whose products — including fossil fuels — are at the crux of diseases we treat.

In 2018 alone, fossil fuel combustion-produced particulate matter was responsible for an estimated 9 million deaths worldwide, according to a recent publication by researchers from Harvard University and the Universities of Birmingham and Leicester in the United Kingdom. Other health effects are extensive, including increased cardiovascular disease and respiratory illnesses, especially in small children. Fossil fuels are also widely considered a primary driver of climate change, and their combustion contributes to the increased numbers of record heat waves and heat-related deaths, as many US communities are facing this summer.

Our hospitals, as tax-exempt nonprofits, provide us retirement plans in the form of 403(b)s, financial accounts similar to 401(k)s that are offered by for-profit companies. As employees who are eligible for benefits, we are typically automatically enrolled in the retirement savings plan, with contribution limits determined by the Internal Revenue Service (IRS). Recently, we learned that by the end of 2020, of the $35 trillion in US retirement assets, $1.2 trillion were invested in these 403(b) plans, according to Investment Company Institute, the trade association for investment companies.

With healthcare representing the largest sector of employers in the US, with nearly 7 million employees at hospitals alone, our employers should provide us with options for retirement funds that do not contain fossil fuel investments that ultimately undermine our duty to patients.  While retirement finances aren’t our focus during our workdays, the effects of our collective $1.2 trillion investment do appear in clinical settings.

The default choice at our institution, like many, is a target-date fund composed of “passive investments”, i.e. indexed stocks and bonds that rebalance as the employee’s retirement date nears. Most also offer pre-screened mutual funds chosen by the employer’s investment committee, or allow participants to transition retirement funds into a brokerage account to self-manage investments. To choose an alternative investment strategy requires financial know-how and effort, so, unsurprisingly, most of us invest in the default. The largest, most-used are the Vanguard Target Retirement Index Funds, which have an estimated $292 billion invested in fossil fuel companies.

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THCB Gang Episode 63 – Thurs July 22

Episode 62 of “The THCB Gang” was live-streamed on Thursday, July 22nd. Matthew Holt (@boltyboy) was joined by regulars: patient safety expert and all around wit Michael Millenson (@MLMillenson); fierce patient activist Casey Quinlan (@MightyCasey); and futurist Ian Morrison (@seccurve).

We got into it on delta variant, medical debt at $140bn, the NYPD vaccination rate being 20 points below the state average, diversity as structural problem in medical school and beyond, and whether we could give everyone in America concierge primary care (the numbers add up! Almost…)

Then video is below. If you’d rather listen, the audio is preserved as a weekly podcast available on our iTunes  & Spotify channels.

Next week #THCBGang is off on vacation!

Nasdaq’s Dario Health ($DRIO) Does Double Acquisition to Build-out Chronic Condition Care Platform

By JESSICA DaMASSA, WTF HEALTH

The “platform-ization” of chronic condition care continues among digital health companies and Nasdaq-traded Dario Health ($DRIO) has acquired TWO different startups in 2021 alone to augment their core diabetes management offering and keep up. Both wayForward and Upright are now under the Dario Health banner and CEO Erez Raphael reveals the strategy behind the two buy-outs — which cost the company just about $30M each and will add digital behavioral health and musculoskeletal care for chronic pain to the Dario experience.

Erez believes that the promise of digital health and digital therapeutics is hyper-personalization, and that addressing multiple conditions at the same time, in a seamless integration, is the way to deliver on that value prop. But, he’s not alone. Teladoc’s Livongo, Vida Health, One Drop, and Omada Health are well-funded competitors pitching the same promise of integrated virtual care. So, how will Dario Health stand-out? Erez points to the company’s direct-to-consumer beginnings and tech expertise as differentiators – will that be enough in the crowded US employer and health plan market OR is the total addressable market large enough for Dario to grab a significant share? We chat chronic condition care market penetration strategy with one of its few publicly traded digital health companies.

#Healthin2Point00, Episode 223 | Carbon Health, Woebot, Eight Sleep, Aidoc, and OM1

Today on Health in 2 Point 00, Jess has finally reclaimed her Twitter account! On Episode 223, Jess asks me about Carbon Health raising $350 million, this is a big competitor for One Medical with retail clinics plus telehealth. Next, for digital mental health care, Woebot gets $90 million for its mental health chatbot. Eight Sleep raises $76 million working on sleep fitness, with lots of celebrities in this one. Aidoc raises $66 million in a round led by General Catalyst, using AI to analyze medical images for chronic conditions. Finally, real world evidence company OM1 raises $85 million, bringing their total to $170 million. —Matthew Holt

Health Care Should Go (Micro) Nuclear

By KIM BELLARD

I think of hospitals as the healthcare system’s nuclear power plants.  They’re both big, complex, expensive to build, beset with heavy regulatory burdens, consistently major components of their respective systems (healthcare and electric generation) yet declining in number.  Each is seen to offer benefits to many but also to pose unexpected risk to some.

Interestingly, there’s a “micro” trend for each, but aimed towards different ends.

Micro hospitals have been with us for several years.  They usually have only around ten beds, along with an emergency room, lab and imaging.  Dr. Tom Vo, CEO of Nutex Health, says: “We position ourselves between urgent care and a big hospital.”  A micro-hospital Chief Medical Officer admits: “We still partner with our larger hospital partners for patients who might require surgery or intensive care.” 

They’re not trying to reinvent hospitals so much as to support them and offer more convenience to patients.  Not so with micro reactors; they’re looking to revitalize their industry, which is in trouble.

According to the U.S. Energy Administration (E.I.A.), there are 94 U.S. nuclear reactors, at 56 nuclear power plants, in 28 states.  Only one new reactor has gone active in the U.S. since 1996, while almost two dozen are in various stages of decommissioning and only two new ones are under construction.  Overall, the U.S. gets about 20% of its power from nuclear reactors, while 13 countries get at least a quarter of their electricity from nuclear, with France leading the pack at 75%.     

We talk a lot about transitioning away from using fossil fuels to generate electric power, but none of the renewable options currently offers a realistic path towards replacing them.  Nuclear power is the proven alternative, but, as Dan Van Boom wrote in CNET, nuclear power has a PR problem.  No one wants a nuclear power plant in their backyard, no matter how big that backyard is.

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Ginger for Teens Puts “Full-family Approach” to Mental Health Care in Hands of Employers

By JESSICA DaMASSA, WTF HEALTH

Digital mental health unicorn Ginger has just launched ‘Ginger for Teens’ in an effort to help the 1-in-5 teens currently suffering from mental health disorders, amid what’s being called a “teen mental health crisis.” No doubt parents are at their wit’s end searching for care, and Ginger is hoping that its teen-friendly bundle of self-guided content, behavioral health coaching, and video therapy will support a “full-family” approach to mental health care that will help everyone feel a bit better.

Ginger’s Chief Clinical Officer, Dr. Dana Udall, and Adolescent Services Coordinator, Dr. Dena Scott, share their insights on the teen mental health crisis, including the myriad factors they had to consider as they re-tooled Ginger’s offering to meet the needs of this new client base. Ginger for Teens will roll out to all of Ginger’s nearly 650 employer clients by the end of the year, helping teens gain access via their parents’ health plans at work. And beyond Ginger’s employer-sponsored health plan base? Will Ginger for Teens roll out to its health plan clients too? Don’t think we forgot about that first-of-its-kind national contract with Cigna and the potential that partnership could hold to help millions of families nationwide. So, what are the big plans for bringing up the supply-side of teen mental health care? Find out more by tuning in…

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