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Christina Liu

#Healthin2Point00, Episode 217 | 23andMe goes public, & funding for Zus, Pill Club, and Brightline

Today on Health in 2 Point 00, I haven ‘t been fired yet – so I’m taking over this episode. On Episode 217, there’s been a lot going on in the digital health world, including the biggest IPO in health tech ever with Bright Health’s $14 billion valuation. Speaking of IPOs, 23andMe went public yesterday with a $3.5 billion valuation. Zus Health gets $25 million in a Series A with Jonathan Bush as CEO. Pill Club raises $49 million getting contraceptives to women online, similar to Nurx. Finally Brightline gets $72 million, this is a child mental health company; they take family prep, family counseling psychiatry, and coaching and put it all together. —Matthew Holt

Did Covid and Telemedicine Finally Make the Physical Exam Obsolete?

By HANS DUVEFELT

Left to my own devices, I would be selective about when and how much of a physical exam I do: either not at all or very detailed for just those things that can help me make the diagnosis. I have no patience for boilerplate normal exams. Any doctor who uses the term PERRLA (pupils equal, round, reactive to light and accommodation) is probably faking it. First, most of the time this isn’t actually tested completely and, second, even if it’s done correctly, it has no relevance in the majority of chart notes I have found it in. I have actually seen it in office note templates for urinary tract infections!

It is well known that the history makes the diagnosis in the vast majority of cases. But that task – or art, actually – is sometimes relegated to support staff or forced into unnatural click boxes. Because reimbursement until very recently was tied to how many items were asked about and examined, there was a loss of the story, or narrative, of the patient’s illness. And you could get more brownie points by including things that were extremely peripheral to the clinical problem at hand.

EMRs make it easy to produce long office notes with lots of reimbursement and quality scoring points of uncertain clinical value and accuracy.

Specifically, the physical exam has in many instances become a corrupted, fraudulent, one-click travesty of the art and professionalism we swore an oath to hold high when we graduated from medical school.

The pandemic and the rush toward telemedicine made it clear to most people that medical diagnosis, advice and treatment is entirely possible without physical contact. It was just a matter of getting paid for it, or the healthcare industry would have come to a stop, or at least a crawl.

Now that we have admitted that listening, talking and a certain amount of looking or observing can be done without being in the same room, it is time for us to be honest about the value of the physical exam.

Our medical education in universities and tertiary medical centers taught us how to handle complex and baffling cases that had eluded diagnosis in the primary care setting: Start from scratch, assume nothing. This is a method we need to use in select clinical situations.

But in everyday practice that is inefficient and unnecessary. Most of what we see is simple stuff and part of our job is to triage, to know when something seemingly ordinary is or has the potential to be more serious.

We need to know how to do a really good and relevant physical exam when the situation requires it. But we also need to know when that would add nothing and only waste our time and effort.

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Jonathan Bush Launches Zus with $35M & “Build-Your-Own EMR” Proposition for Health Tech Startups

By JESSICA DaMASSA, WTF HEALTH

Jonathan Bush has “More Disruption Please-d” himself and is back at it with a new company, Zus (get it…like the father of Athena) backed by a $35M Series A led by Andreessen Horowitz, F-Prime Capital, Maverick Ventures, & Rock Health.

“It’s ‘Build-A-Bear’ for EMR, patient relationship management, CRMs…” says Jonathan, and meant to help digital health startups work around incumbent EMR companies by providing a developer kit of components common to the “middle” of a health tech stack — AND a single shared record backend where all Zus clients can land and access patient data.

The intention is to help digital health startups reduce the time and cost of developing their tech by eliminating the redundant, generic aspects of building a healthcare tech stack in the same way companies like Stripe or Twilio have taken the burden out of writing code to process payments or integrate messaging. Zus intends to be the go-to for code used to make an appointment, create a patient profile, connect to a telehealth platform, etc. And the shared record on the back end? Does that make Zus a next-gen EMR company?? Find out more about Zus’s business model, current client list, and why, exactly, Jonathan believes that NOW is the time that the dream of the shared patient medical record is within reach.

Community Health Plans Are Serious: Support Major Federal Action to Reduce Rx Drug Costs

By CECI CONNOLLY

Equal treatment under the law. A foundational pillar of American life. Except when it comes to drug makers who benefit from favorable treatment by the federal government.

For far too long, prescription drug companies have profited immensely under a system that affords them monopolistic powers to set prices devoid of government or public scrutiny.

Even during the pandemic, while much of the economy took a beating, the pharmaceutical industry continued to benefit from the high prices they charge. In fact, 9 of the 10 biggest profit margins recorded last summer belonged to drug companies.

As the nation’s economy sputters back, Big Pharma continues to raise prices and block patient access to lower-cost alternatives. It is beyond time to tame the soaring prices of prescription drugs once and for all.

For years, health care players have skirted around concrete actions to truly impact drug prices. Efforts to cut costs for consumers have translated to higher costs for health plans, resulting in a cost shift instead of a cost reduction. We, as private, nonprofit insurers, believe in the ambition and innovation possible in a free market – but the  market has failed in this instance and it’s time for the government to take action.

That is why the Alliance of Community Health Plans (ACHP) is putting its support behind reforms that can make a real, lasting impact for consumers and the entire health system. For the first time, a national health care payer organization is stepping up and supporting pragmatic and progressive reforms that can truly begin to rein in the price of prescription drugs.

This includes backing the dramatic step to grant the Secretary of Health and Human Services the power to negotiate lower prices for the highest-priced medications for which there is no competition, in addition to other actions.

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Twins For Everyone!

By KIM BELLARD

I have lived my entire life as a twin, and, while it isn’t an unalloyed blessing, on balance I’d recommend it.  Most of you, though, probably aren’t twins and have missed the experience.  Don’t worry: you may still get a chance – with a digital twin. 

It could have profound implications for your health and for healthcare generally.

A digital twin, in case you are not familiar with the concept, is a virtual representation of a physical object.  It is created from data about that physical object, and is fed ongoing data (e.g., via IoT) about it to keep the model accurate. 

The concept is not new, often attributed to Michael Grieves at the Florida Institute of Technology in 2002.  Dr. Grieves saw the value of the concept for manufacturing; for example, GE’s Aircraft Engines has been using them to make their engines safer and more efficient.  Other applications include building maintenance, data centers, and even creating a digital twin of the whole planet.

People have seen the potential of digital twins for healthcare for years.  Back in 2016, GE’s Digital CEO Bill Ruh predicted:

I believe we will have a digital twin at birth, and it will take data off of the sensors everybody is running, and that digital twin will predict things for us about disease and cancer and other things. I believe we will end up with health care being the ultimate digital twin. Without it, I believe we will have data but with no outcome, or value.

We’re not there yet, not nearly, but it’s coming.

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#Healthin2Point00, Episode 216 | Datavant acquires Ciox, plus deals for AllyAlign, Cerebral & more

Today on Health in 2 Point 00, Jess is trying to replace me with the other Matthew Holt. But on Episode 216, I am still around to talk about some deals. First, Datavant acquires Ciox Health in a $7 billion deal, aiming to create the nation’s largest health data ecosystem. Next, Avenue Health is a new company that has just been launched, working on seamless, end-to-end data integration and blockchain, and AllyAlign Health raises $300 million as a new Medicare advantage plan. Finally, Cerebral raises $127 million – this is like a Ro or Hims but specifically for mental health. —Matthew Holt

Why “Radiopharmaceutical” Should be Part of your Healthcare Vocabulary

By JAY T. RIPTON

Not to sound too alarmist, but the radiopharmaceutical industry is on the verge of an explosion. But don’t worry; it’s not the type of explosion one often associates with nuclear materials… I love those movies too! It’s the beginning of a new wave of innovation for the diagnosis and treatment of certain cancers and other diseases.

This new radiopharmaceutical boom quite literally has the life sciences industry in a nuclear arms race of sorts, as companies like Y-mAbs, Novartis and others are pushing through clinical trials for the next blockbuster for the treatment and detection of hard-to-treat diseases like medulloblastoma and metastatic castration-resistant prostate cancer. But all this excitement has many wondering, “what are radiopharmaceuticals anyway?”   

Radiopharmaceuticals are simply a group of pharmaceutical drugs containing radioactive isotopes. They are being used primarily for the treatment and detection of certain types of cancers, but they are also being developed for cardiac disease as well. And what makes radiopharmaceuticals so unique is that they can be targeted to extremely precise areas in the human body.

Although gaining ground with more precision today, this type of therapy actually began in the 1940s with I-131 – which has become an important agent for the treatment of benign and malignant thyroid disease. The development of radiolabeled antibodies began in the 1970s, and Radium-223 dichloride was approved by the FDA in 2013 for the treatment of castrate-resistant metastatic prostate cancer. Lu-177 PSMA is one of several recent developments that are making their way through FDA approvals.

“The radiopharmaceutical industry has actually been around for some time, but today it is at a tipping point,” says SpectonRx president Anwer Rizvi. “Over the next few years, it is estimated that our industry will triple. With more radiopharmaceuticals making their way through clinical trials and FDA approval, we are starting to see more data that highlight their effectiveness. This is why we are now starting to see more life sciences organizations committing real resources to radiopharmaceuticals.”  

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#Healthin2Point00, Episode 215 | Monogram, LetsGetChecked, Transcarent, Lenus, and Ada

Amazon Cares already has customers, Clover has become a meme stock, Transcarent has got a Series B that they closed already, and OneDrop has hit 25 billion biometric data points – what the hell is going on in digital health? Today on Health in 2 Point 00, we still have lots of deals to cover. Monogram, an end-stage kidney disease company, raises $160 million. LetsGetChecked raises $150 million in a Series D – all of these at-home testing companies are getting a push because of COVID. Next, Lenus raises €50M in a Series A, making it the biggest ever single A round in Denmark. Transcarent gets $58 million in a Series B already, and Ada Health raises $90 million for their symptom assessment chatbot. —Matthew Holt

UpHealth Hits the NYSE: CEO & President on SPAC Merger Completion, Virtual Care Competition & More

By JESSICA DaMASSA, WTF HEALTH

Another virtual care company hits the New York Stock Exchange as UpHealth ($UPH) emerges from the combined merger of UpHealth Holdings and Cloudbreak Health with the GigCapital2 SPAC. We’ve got UpHealth’s CEO Ramesh Balakrishnan and President Jamey Edwards here on “Listing Day” to catch us up on the strategic developments and integrations that have occurred since UpHealth’s SPAC IPO was first announced at the end of 2020.

You might remember this deal as the one that brought together six different companies across four of the fastest growing areas of digital health: global telehealth, integrated care management, digital pharmacy, and behavioral health. The story there is still the same, but the value proposition around the combined offering has gelled. UpHealth views itself as a partner to local healthcare providers around the world who need a hand building the integrated digital care model needed to meet growing patient demands and economic realities of a “digitally transformed” healthcare experience. How is this different than what we’re seeing from other publicly-traded telehealth companies like Amwell, Teladoc, and Hims? Or, what about those telehealth-empowered retail giants like Amazon, Walmart, and CVS Health who, like UpHealth, see a lot of upside in the duality of both making care more convenient digitally, while also seamlessly integrating with local in-person care centers? We’ve got all the talk you’ll want about UPH’s positioning, business model, revenue guidance (still $180M-190M for 2021) AND even some client name dropping (Amazon? Really?!) as the stock hits the market.

Bonus: Want to go deeper into this deal? For more on UpHealth, check out our earlier chat with Chairman Chirinjeev Kathuria, Jamey Edwards, and Al Gatmaitan from February 2021. The link is right here: https://youtu.be/50PIVdUjnPU

Hey, How About Starship Earth?

By KIM BELLARD

I missed the job announcement on the company website.  I missed it again when the company posted the job on Linkedin.  I missed it when Eric Ralph tweeted that the posting was “probably the coolest job posting I’ve read in years.”  Fortunately, though, I follow Isaac Kohne (MD, PhD), and I did see his tweet:

Yes, I’m talking about SpaceX.  Yes, the job is for a “Starship Medical Engineer.”  Yes, it’s to help SpaceX’s mission to Mars, whenever that might be.  Who knows, the job might even entail going to Mars, although that’s not spelled out. 

I am not, of course, remotely qualified for such a job.  In fact, I don’t even know anyone who might be.  But I agree with Mr. Ralph that it’s probably the coolest job posting I’ve seen in years, maybe ever.  And I even more agree with Dr. Kohne: it could be an “opportunity to rethink a bigger broken system.”

Hint: I don’t think he’s talking about just the SpaceX mission. 

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