7Wire Ventures is a venture fund that invests in early-stage healthcare companies that are focused on connecting with the healthcare consumer — kind of like one of the most successful companies in its portfolio, Livongo, which went public in 2019. Robert Garber, a partner with the firm, stops by to share his point-of-view on where the consumer health tech market will be headed in 2020, if we’ll see more exits, and whether or not consumer health will be able to gain traction with healthcare’s established players like payers and health systems.
Filmed at J.P. Morgan Healthcare Conference in San Francisco, January 2020
Sometimes you wonder where the line is in health care. And perhaps more importantly, whether anyone in the system cares.
The last few months have been dominated by the issue of costs in health care, particularly the costs paid by consumers who thought they had coverage. It turns out that “surprise billing” isn’t that much of a surprise. Over the past few years several large medical groups, notably Team Health owned by Blackstone, have been aggressively opting out of insurers networks. They’ve figured out, probably by reading Elizabeth Rosenthal’s great story about the 2013 $117,000 assistant surgery bill that Aetna actually paid, that if they stay out of network and bill away, the chances are they’ll make more money.
On the surface this doesn’t make a lot of sense. Wouldn’t it be in the interests of the insurers to clamp down on this stuff and never pay up? Well not really. Veteran health insurance observer Robert Laszewski recently wrote that profits in health insurance and hospitals have never been better. Instead, the insurer, which is usually just handling the claims on behalf of the actual buyer, makes more money over time as the cost goes up.
The data is clear. Health care costs overall are going up because the speed at which providers, pharma et al. are increasing prices exceeds the reduction in volume that’s being seen in the use of most health services. Lots more on that is available from HCCI or any random tweet you read about the price of insulin. But the overall message is that as 90% of American health care is still a fee-for-service game, as the CEO of BCBS Arizona said at last year’s HLTH conference, the point of the game is generating as much revenue as possible. My old boss Ian Morrison used to joke about every hospital being in the race for the $1m hysterectomy, but in a world of falling volumes, it isn’t such a joke any more.
It was a seminal moment in virtual care as Teladoc Health acquired Intouch Health for $600 million, effectively taking its mostly direct-to-consumer telehealth platform directly into more than 2,500 care providers — or, as they say, “from hospital to home.” We caught up with InTouch Health’s CEO, Joe DeVivo, to hear his thoughts on the deal, including what it means for the further advancement of virtual care and for the digital health industry at-large.
Filmed at J.P. Morgan Healthcare Conference in San Francisco, January 2020
In the 1970s, Jean Whitehorse, a member of the Navajo Nation, went to a hospital in New Mexico for acute appendicitis. Years later, she found out the procedure performed was not just an appendectomy – she had been sterilized via tubal ligation. Around the same time, a Northern Cheyenne woman was told by a doctor that a hysterectomy would cure her headaches. After the procedure, her headaches persisted. Later, she found out a brain tumor was causing her pain, not a uterine problem. Like Whitehorse and the Northern Cheyenne woman, thousands of Native American women have suffered irreversible changes to their bodies and psychological trauma that continues to this day. Most medical providers are unaware of our own profession’s role in implementing these racists policies that have direct links to the Eugenics movement.
Eugenics was a “movement that is aimed at improving the genetic composition of the human race” through breeding. From its origin in 1883, eugenics became the driving rationale behind using sterilization as a tool to breed out unwanted members of society in the United States. With the 1927 Supreme Court case Buck v. Bell permitting eugenic sterilization, 32 states followed suit and passed eugenic-sterilization laws. Although the outward use of sterilization declined after World War II because of its association with Nazi practices, sterilization rates in poor communities of color remained high throughout the United States.
What does Glen Tullman, Chairman of Livongo, expect from the health tech market in 2020? Livongo may have started a “race for the exits” in digital health with its 2019 IPO, and Glen says he “wants a healthy, consumer-facing digital health market” to help his own business thrive. Does that mean he anticipates more IPOs from the health tech sector this year? We get Glen’s predictions after we catch up on Livongo’s recent moves to partner with DexCom and test a new pathway to reimbursement via Express Scripts’ Digital Health Formulary.
Filmed at J.P. Morgan Healthcare Conference in San Francisco, January 2020.
This piece is part of the series “The Health Data Goldilocks Dilemma: Sharing? Privacy? Both?” which explores whether it’s possible to advance interoperability while maintaining privacy. Check out other pieces in the series here.
Privacy concerns are on the rise. Over the last couple of years, survey after survey have clearly shown a dramatic rise in overall consumer privacy awareness and concern – driven primarily by the never-ending litany of ongoing data breaches that make the news.
The healthcare industry has been somewhat shielded from
this, seemingly due to the trust that patients extend to their doctors and, by
proxy, the organizations they work with. HITECH and HIPAA legislation have
acted as a perceived layer of safety and protection.
On the heels of a $40M Series B funding round led by Bayer, One Drop CEO Jeff Dachis stops by to hit the highlights about how the digital health platform is touching the lives of 1.6 million users in nearly 200 countries. Focused on chronic conditions like diabetes, pre-diabetes, hypertension, etc. One Drop is unique in the BIG direct-to-consumer business they’ve built through partnerships with Walmart and Apple stores. While Jeff says their growth capital will go toward expanding their heath plan and employer business, there’s also room for growth with Bayer, which could help expand the company’s core operating platform into other therapeutic areas like cardiovascular disease, oncology, and women’s health.
Filmed at Frontiers Health in Berlin, Germany, November 2019.
Artificial intelligence has become a crucial part of our technological infrastructure and the brain underlying many consumer devices. In less than a decade, machine learning algorithms based on deep neural networks evolved from recognizing cats in videos to enabling your smartphone to perform real-time translation between 27 different languages. This progress has sparked the use of AI in drug discovery and development.
Artificial intelligence can improve efficiency and outcomes in drug development across therapeutic areas. For example, companies are developing AI technologies that hold the promise of preventing serious adverse events in clinical trials by identifying high-risk individuals before they enroll. Clinical trials could be made more efficient by using artificial intelligence to incorporate other data sources, such as historical control arms or real-world data. AI technologies could also be used to magnify therapeutic responses by identifying biomarkers that enable precise targeting of patient subpopulations in complex indications.
Innovation in each of these areas would provide substantial benefits to those who volunteer to take part in trials, not to mention downstream benefits to the ultimate users of new medicines.
Misapplication of these technologies, however, can have unintended harmful consequences. To see how a good idea can turn bad, just look at what’s happened with social media since the rise of algorithms. Misinformation spreads faster than the truth, and our leaders are scrambling to protect our political systems.
Today on Health in 2 Point 00, we’re celebrating Valentine’s Day with many new funding deals! On Episode 109, Jess and I discuss Flywire, a payment startup that received not only $120 million from Goldman Sachs, reaching unicorn status, but also acquired the healthcare payments company Simplee which aids the hospital-patient billing process. Headspace raises $93 million, around half of which will be used to build a new ‘Health’ category and the other half to teach meditation. Outset medical raises $125 million for a portable dialysis machine and Iora Health raises $126 million for Series F funding. Finally, I give my take on patient-centric SaaS company Seqster receiving an undisclosed amount from Takeda. –Matthew Holt
Burnout among healthcare professionals is at an all-time
high. Its drivers include longer work hours, the push to see more patients,
more scrutiny by administrators, and loss of control over our practice. We seem
to spend more time with the electronic medical record and less time
face-to-face with our patients.
I have faced burnout personally. My son passed away at the
age of 29, which was beyond painful. At the same time, I felt burdened by the
growing number and complexity of metrics by which I was judged at work. Days in
the operating room and intensive care unit seemed more and more exhausting, and
my patience was becoming shorter and shorter. I was fortunate to have had a long-standing
meditation practice as well as sabbatical time that I used to decompress and
re-evaluate my career. Many of us are not so lucky. More than half of
physicians have serious signs of burnout, and more than one physician commits
suicide every day.
So many of us feel burned out these days because in our
rapidly changing profession we are asked to do more for less and with
inadequate resources. We suffer from exhaustion, self-criticism, and worry
about what will happen next to our practice, our families, and ourselves. If we
want to save our practices, patients, marriages- even our lives, we must
acquire personal resilience.
Fortunately, we can increase our resilience and happiness and reverse burnout by embracing a few simple principles—Gratitude, Acceptance, Intention, and Nonjudgment (GAIN)—that we can put into motion in our everyday lives at the hospital, at home, or wherever we are.