It’s the ‘holy grail’ of advice for health tech startups. BlueCross BlueShield of North Carolina’s Chief Strategy & Innovation Officer, Bryony Winn, tells what it takes for digital health and digital therapeutics startups to gain partnership agreements, reimbursement, and possible investment from health plans. How do you figure out how to “align incentives” in a way that perks up a payer’s ears? Bryony gives us some VERY FRANK advice about how startups can bring innovation to BCBS of North Carolina, other Blues plans, or their VC funds (which in this case is Echo Health Ventures where BCBS North Carolina partners with Cambia Health Solutions.) To play the game, you have to know the players. Tune in for more.
It took some doing, but I had finally
made it to Bobby’s home.
It was a rowhome tucked into one of those
little side streets in the city that non-city folks wouldn’t dream of driving
down. As I step in, I’m met by the usual set up – wooden steps that hug the
right side of the wall leading up to the second floor. Bobby certainly hasn’t made it up to the
second floor in some time. At the moment she is sitting in her hospital bed in
the living room. The bed is the focal point to a room stuffed to the gills with
all manners of stuff. At least three quarters of the stuff seems to be food.
Cinnamon buns, Doritos, donut holes, chocolate frosted Donuts, crackers,
Twinkies. The junk food aisle at Wawa would be embarrassed by the riches on
Bobby weighs in at four hundred pounds, 5
foot 5 inches. She has a tracheostomy from multiple prior episodes of
respiratory failure that have required ventilatory support. I’m here at the
request of a devoted primary care physician that still makes home calls. I’ve
looked through the last number of hospital stays. The last few discharge
summaries are carbon copies of each other. Hypoxemic respiratory failure
related to pulmonary edema complicated further by morbid obesity. Time on the
vent. Antibiotics. Diuretics. Home. Return to the hospital 2 weeks later. The
last echocardiogram done was 3 admissions ago. A poor study. Not much could be
seen due to ‘body habitus’.
I sit on the side of the bed trying to acquire my own images of her heart. I talk to her as I struggle. Bobby is 58, the youngest of three sisters, and the only surviving member of the family. Her elder sisters died of respiratory complications as well. They both died with tracheostomies. The conversation is circular. The problem according to Bobby is the tracheostomy. Everything was fine before that. I explain that a prolonged period of time on the ventilator on a prior admission prompted the tracheostomy, and that the multiple recent admissions to the hospital that required a ventilator seemed to validate that decision. She doesn’t waver. Both her sisters died shortly after they got tracheostomies. Bobby thinks the physicians taking care of her sisters had a hand in their demise. “They didn’t care.” “We told them they were sick.”
The American Medical Association (AMA) announced Health 2047, its accelerator and investment fund in 2018. A year later, Andrew Elkind and Stas Sokolin, both Principals at the fund, stop by to get us up-to-speed on the progress the AMA has made so far with its $45 million accelerator fund and $30 million investment fund. What kinds of health tech startups are piquing the attention of this physician-led fund? Get the details behind the Health 2047 investment thesis here!
Today on THCB Spotlights, Matthew chats with Omri Shor, the CEO and Co-founder of Medisafe. Way back in 2014, Medisafe took home the gold at Health 2.0, winning first place at Traction. Since then, their consumer medication management tool has evolved quite a bit. While the app is available for patients with over 6 million users today, they also have folks across the health care continuum partnering with Medisafe to manage the medication journey for their patients. Matthew picks Omri’s brain on how things will continue to evolve, what he’s learned to help people in health care think about the problem of medication management, and how Medisafe fits in with the numerous medication management and chronic disease management tools out there.
One big theme in AI research has been the idea of interpretability. How should AI systems explain their decisions to engender trust in their human users? Can we trust a decision if we don’t understand the factors that informed it?
I’ll have a lot more to say on the latter question some other time, which is philosophical rather than technical in nature, but today I wanted to share some of our research into the first question. Can our models explain their decisions in a way that can convince humans to trust them?
I am a radiologist, which makes me something of an expert in the field of human image analysis. We are often asked to explain our assessment of an image, to our colleagues or other doctors or patients. In general, there are two things we express.
What part of the image we are looking at.
What specific features we are seeing in the image.
This is partially what a radiology report is. We describe a feature, give a location, and then synthesise a conclusion. For example:
There is an irregular mass with microcalcification in the upper outer quadrant of the breast. Findings are consistent with malignancy.
You don’t need to understand the words I used here, but the point is that the features (irregular mass, microcalcification) are consistent with the diagnosis (breast cancer, malignancy). A doctor reading this report already sees internal consistency, and that reassures them that the report isn’t wrong. An common example of a wrong report could be:
Neuroscience startup, NeuroTracker, has a virtual training tool with a proven ability to help improve “cognitive fitness.” Jean Castonguay, co-founder, board member and Head of Global Strategic Partnerships at NeuroTracker, explains the science and clinical validation behind their tech and drops some big name users in the process — Manchester United, German and French soccer teams, US special forces, as well as some of the world’s leading sports concussion rehabilitation clinics. What sets the startup apart from other companies in the mental performance space? How have they shored up their science in the face of Lumosity’s Federal Trade Commission suit against false claims about brain health outcomes? It shook up the industry, and NeuroTracker actually feels it strengthened their business and their value proposition.
Filmed at Bayer G4A Signing Day in Berlin, Germany, October 2019.
It’s great news to read headlines that the average health-insurance premium will drop by 4% next year in the 38 states using federal Obamacare exchanges. As millions of Americans entered open enrollment this year to choose their health insurance plans, it is important to remember that premiums are only one of the ways that we pay for our medical coverage.
many plans lower premiums (paid by everyone) often mean a higher deductible —
or paying more out-of-pocket before insurance coverage kicks in. This burden is
paid only by those who use medical care services.
Deductibles are rising, and so is the number of
Americans enrolled in so-called high-deductible health plans
(HDHPs). Thus, more people with health insurance are being asked to pay
full price for all their care, regardless of its clinical value. Although
it may be better for many people with significant medical needs (and less
disposable income) to avoid plans with high deductibles, more and more people
who receive health insurance through their employer no longer have a choice
except to choose a plan with hefty costs in addition to premiums.
Today on Health in 2 Point 00, Jess is in Las Vegas while I’m all the way in Tokyo for Health 2.0 Japan. In Episode 102, Proteus Digital (finally) announces that they’re running out of money. Does this put the whole category of digital therapeutics at risk? In other news, Seema Verma’s jewelry was stolen and she wants taxpayers to pay her back! How is she going to survive this? And find out what’s going on in Tokyo at Health 2.0 Japan—a whopping 50 startups pitched in a contest yesterday and we’re really seeing the coming of age for this market. —Matthew Holt
AI in medical imaging entered the consciousness of radiologists just a few years ago, notably peaking in 2016 when Geoffrey Hinton declared radiologists’ time was up, swiftly followed by the first AI startups booking exhibiting booths at RSNA. Three years on, the sheer number and scale of AI-focussed offerings has gathered significant pace, so much so that this year a decision was made by the RSNA organising committee to move the ever-growing AI showcase to a new space located in the lower level of the North Hall. In some ways it made sense to offer a larger, dedicated show hall to this expanding field, and in others, not so much. With so many startups, wiggle room for booths was always going to be an issue, however integration of AI into the workflow was supposed to be a key theme this year, made distinctly futile by this purposeful and needless segregation.
By moving the location, the show hall for AI startups was made more difficult to find, with many vendors verbalising how their natural booth footfall was not as substantial as last year when AI was upstairs next to the big-boy OEM players. One witty critic quipped that the only way to find it was to ‘follow the smell of burning VC money, down to the basement’. Indeed, at a conference where the average step count for the week can easily hit 30 miles or over, adding in an extra few minutes walk may well have put some of the less fleet-of-foot off. Several startup CEOs told us that the clientele arriving at their booths were the dedicated few, firming up existing deals, rather than new potential customers seeking a glimpse of a utopian future. At a time when startups are desperate for traction, this could have a disastrous knock-on effect on this as-yet nascent industry.
It wasn’t just the added distance that caused concern, however. By placing the entire startup ecosystem in an underground bunker there was an overwhelming feeling that the RSNA conference had somehow buried the AI startups alive in an open grave. There were certainly a couple of tombstones on the show floor — wide open gaps where larger booths should have been, scaled back by companies double-checking their diminishing VC-funded runway. Zombie copycat booths from South Korea and China had also appeared, and to top it off, the very first booth you came across was none other than Deep Radiology, a company so ineptly marketed and indescribably mysterious, that entering the show hall felt like you’d entered some sort of twilight zone for AI, rather than the sparky, buzzing and upbeat showcase it was last year. It should now be clear to everyone who attended that Gartner’s hype curve has well and truly been swung, and we are swiftly heading into deep disillusionment.
Whether it be from an Apple Watch or a Withings scale, the amount of health data available to provide a glimpse into a patient’s everyday life has grown exponentially in recent years. Unfortunately, the utility of all those data points for healthcare providers has not…at least, not yet! Enter HealthSnap, who’s CEO & Co-founder, Yenvy Truong, aims to make sense of all that health data collected from wearables, sensors, and other medical devices with a “Lifestyle Profile” that provides care providers with a clear-and-concise summary of the data that matters most to understanding the day-to-day health lives of their patients. The early stage startup is gaining traction, with 12 health system partners and over 500 physicians using their tech in clinic today. Learn more about their business model, the Series A round they’re raising, and their scale-up plans in this quick chat with HealthSnap.
Filmed at the HIMSS Health 2.0 Conference in Santa Clara, CA in September 2019.