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Christina Liu

Why I Seldom Recommend Vitamins or Supplements

By HANS DUVEFELT

People here in northern Maine, as in my native Sweden, don’t get a whole lot of natural sunlight a good part of the year. As a kid, I had to swallow a daily spoonful of cod liver oil to get the extra vitamin D my mother and many others believed we all needed. Some years later, that fell out of fashion as it turned out that too much vitamin A, also found in that particular dubious marine delicacy, could be harmful.

This is how it goes in medicine: Things that sound like a good idea often turn out to be not so good, or even downright bad for you.

Other vitamins, like B12, can also cause harm: Excess vitamin B12 can cause nerve damage, just as deficiency can.

Both B12 and D can be measured with simple blood tests, but the insurance industry doesn’t pay for screening. That is because it hasn’t been proven that testing asymptomatic people brings any benefit. In the case of B12, it is well established that deficiency can cause anemia and neuropathy, for example. But here is no clear evidence what the consequences are of vitamin D “deficiency”. A statistically abnormal result is not yet known to definitely cause a disease or clinical risk, in spite of all the research so far, but we’re staying tuned.

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#Healthin2Point00, Episode 220 | Olive’s massive raise, Ro buys Kit, plus funding for Tendo & SWORD

Today on Health in 2 Point 00, I’m cheering England’s win against Germany this week – but Jess keeps us on track with health tech deals. Olive gets another $400 million, bringing their total up to $902 million – with $802 million of that since March 2020. Tendo Systems gets $50 million in a Series A, working on communication between providers and consumers. General Catalyst strikes again, this time in a round with SWORD Health raising $85 million in a Series C, bringing their total to $135 million. This is an MSK company, with a lot of good investors here. Finally, Ro buys Kit an at-home testing company – how does Hims stack up now? And, in case you missed it, Sharecare hits the NYSE today – get the scoop from Jess’s interview with their CEO yesterday. –Matthew Holt

Go Ahead, AI—Surprise Us

By KIM BELLARD

Last week I was on a fun podcast with a bunch of people who were, as usual, smarter than me, and, in particular, more knowledgeable about one of my favorite topics – artificial intelligence (A.I.), particularly for healthcare.  With the WHO releasing its “first global report” on A.I. — Ethics & Governance of Artificial Intelligence for Health – and with no shortage of other experts weighing in recently, it seemed like a good time to revisit the topic. 

My prediction: it’s not going to work out quite like we expect, and it probably shouldn’t. 

“Like all new technology, artificial intelligence holds enormous potential for improving the health of millions of people around the world, but like all technology it can also be misused and cause harm,” Dr Tedros Adhanom Ghebreyesus, WHO Director-General, said in a statement.  He’s right on both counts.

WHO’s proposed six principles are:

  • Protecting human autonomy
  • Promoting human well-being and safety and the public interest
  • Ensuring transparency, explainability and intelligibility 
  • Fostering responsibility and accountability
  • Ensuring inclusiveness and equity 
  • Promoting AI that is responsive and sustainable

All valid points, but, as we’re already learning, easier to propose than to ensure.  Just ask Timnit Gebru.  When it comes to using new technologies, we’re not so good about thinking through their implications, much less ensuring that everyone benefits.  We’re more of a “let the genie out of the bottle and see what happens” kind of species, and I hope our future AI overlords don’t laugh too much about that. 

As Stacey Higginbotham asks in IEEE Spectrum, “how do we know if a new technology is serving a greater good or policy goal, or merely boosting a company’s profit margins?…we have no idea how to make it work for society’s goals, rather than a company’s, or an individual’s.”   She further notes that “we haven’t even established what those benefits should be.”

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Sharecare ($SHCR) Hits NASDAQ Tomorrow, CEO Jeff Arnold on Closing the SPAC IPO

By JESSICA DaMASSA, WTF HEALTH

Sharecare ($SHCR) starts trading on the NASDAQ tomorrow and CEO Jeff Arnold has come back to catch us up on what’s happened since April when we first spoke and took a deep-dive into Sharecare’s population-health-slash-care-navigator-slash-health-security business model. That interview (watch here: https://youtu.be/P6DzFbtiLWg) digs into the $400 million/year revenue model Jeff’s built so far, and now THIS CHAT picks up where we left off — mere hours before Sharecare heads into the public market. valued at just under $4 billion dollars, with ZERO Debt and $400 million in cash to invest in scaling up.

Turns out a lot can happen while you’re waiting for your paperwork to be signed! So what’s new? How about the $50 million dollar private placement Anthem has made into business? Jeff explains how this kind of backing from the country’s second largest health insurance company is not only a win when it comes to securing a customer base, but also how it will likely impact product roadmap. The Anthem investment was closely linked to Sharecare’s January acquisition of health tech startup Doc.AI, which had been working with Anthem on some very payer-friendly tools that will likely be expanded. And speaking of expansion? Jeff’s already made more than a dozen acquisitions to build up Sharecare’s three main verticals over the years– what else could they possibly need now? Tune in for all the last-minute news and numbers before $SHCR pops tomorrow!

#Healthin2Point00, Episode 219 | Health Catalyst acquires Twistle, Hims acquires Apostrophe, & more

Today on Health in 2 Point 00, Jess claims that I am to blame! But for what?? On Episode 219, Jess and I talk about home care software company AlayaCare raising $225 million CAD. Next, Health Catalyst acquires Twistle for $104 million and Hims acquires teledermatology company Apostrophe. Finally, Spiras Health raises $14 million for at-home chronic care management. —Matthew Holt

Did Glen Tullman Just Launch Another New Category? Transcarent the ‘Health Experience Company’

By JESSICA DaMASSA, WTF HEALTH

For those keeping score at home, Glen Tullman is scaling up Transcarent faster than he did Livongo. The startup just closed a $58M Series B, bringing its total funding just shy of $100M. In less than 8 months. What’s the hurry? Have we ordered the balloons for the IPO yet? Glen says he’s out to fix the core problem first, and, in this interview, we get into the details about what that problem statement is all about and you might be surprised.

This is more of a payment model story than anyone may have all initially realized. And, while we may keep trying to put Transcarent into the “healthcare navigator” box or call it a “second opinion service” or a “centers of excellence play,” the truth is that those are all means to achieve a much larger end, which is about redefining the healthcare experience and its payment model for self-insured employers. Remember when Livongo created its own category of care (applied health signals) because they didn’t fit in with what a ‘chronic condition management’ company meant to the market? Well, I think Glen just used this interview to soft-launch a new category of healthcare company here again with Transcarent…

“People always try to put us in a category,” says Glen. “Are you a navigator? No, we’re not a navigator. We do navigation. Are you a health management company? No, we’re not. Are you a supplier? No, we’re not. Are you a PBM? No, we’re not. But we do all of those things to create an experience and that’s why, when you think about it, we’re a health experience company and that’s a new category that no one has.”

I get Glen to talk specifics about what this really means — directly managing healthcare spend for employers in a ‘category-creating’ completely at-risk way – and the examples really do help bring it to life. So does hearing about how he sees Transcarent as completely different than Accolade or Grand Rounds, which are often listed as competitors.

What other trouble do we get into in this 30-minute mega chat? OF COURSE I get his take on this year’s record-breaking investment into health tech, whether or not he thinks we’re in a bubble, and how Amazon, Walmart, and other non-traditional players are going to impact healthcare moving forward. Lots of insights in this one!

Health Tech: Part II –Powering Up The Vision

By MIKE MAGEE

Few can disagree that, in the fog of the Covid 19 pandemic, health technology entrepreneurs have been on a tear. In the first year of Covid’s isolation induced new reality, digital health companies experienced a $21.6 billion investment boost, double that of the prior year, and four times 2016 funding.

By year two, the investment community exhibited some signs of self-restraint by raising a few open ended questions. For example, in early 2021, Deloitte & Touche led a Future of Health panel at the J.P. Morgan Healthcare conference, reporting that “panelists suggested that entrepreneurs need to go beyond products that simply improve processes or solve existing problems.”

Panelists predicted that virtual health delivery services will expand; consumers will demand greater involvement including expansion of  home diagnostics; and investment driven mergers and acquistions will explode – all of which has proven to be true.

Adding push to shove, Deloitte added this final nudge: “Entrepreneurs who define new markets, dominate them with a strategy people can understand, and extract value will likely be the most successful.”

Forty years ago, in the early beginnings of Health Tech, words similar to those above triggered cautionary tones from traditionalists. For example,  Dr. John A. Benson, Jr., then President of the Board of Internal Medicine, stated “There is a groundswell in American medicine, this desire to encourage more ethical and humanistic concerns in physicians. After the technological progress that medicine made in the 60’s and 70’s, this is a swing of the pendulum back to the fact that we are doctors, and that we can do a lot better than we are doing now.”

He accurately described the mood then, and for most of the 20th century, of academic clinicians toward technology, a complex love-hate relationship that has rejoiced and cheered on progress, while struggling to accept and master change in a manner that would avoid driving a wedge between academicians, clinicians and patients.

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#Healthin2Point00, Episode 218 | Bicycle, NexHealth, Stork Club, DrChrono & Pear Therapeutics

On Episode 218 of Health in 2 Point 00, it’s a big week in digital health for IPOs. Today Jess asks me about Bicycle Health’s $27 million Series A, bringing the substance use disorder startup’s total to $32.3 million. NexHealth, which is like Shopify for doctors, gets $31 million in a Series B, Stork Club raises $30 million in a Series A, and DrChrono raises $20 million for its EHR. Finally, Pear Therapeutics is SPAC-ing out with a $1.6 billion valuation. As we all know, DTx is my favorite category of health tech so tune in for what I have to say about this one. —Matthew Holt

Health Tech, Part I: Where We Are Going, Not Just How Fast We Can Get There

By MIKE MAGEE

What will be the lasting impact of the Covid 19 pandemic?

We still don’t know the answer to that question in full. But one thing that can be said with some certainty is that it has strengthened the hand of Big Tech and all things virtual. Consider the fact that within the Biden White House administration, 13 senior aides have Big Tech resumes with time spent in firms like Google, Facebook, Twitter, Apple, Amazon, Microsoft and more.

This pandemic-induced scrape with mortality has instigated widely varied responses ranging from existential re-awakenings to explosive entrepreneurship.

In health care for example, health tech start-up’s are altering research, education, care delivery and coordination, data mining, patient privacy and financing.

As we know well from health care, intermingling profit, policy and politics can eventually lead to conflict and recrimination. The current controversy over NIH indirect funding of Shi Zengli’s Wuhan “gain-of-function” viral research through Peter Daszak’s New York based EcoHealth Alliance is a case in point.

But we’ve been there before. In the 1990s, James M. Wilson received a PhD and an MD degree from the University of Michigan, then completed an internal medicine residency at Massachusetts General Hospital and a postdoctoral fellowship at MIT. By 1997, he was one of the leading stars in the new gene-therapy movement, directing his own research institute at the University of Pennsylvania.

The institute focused on adjusting the genes of children born with a hereditary disease called ornithine transcarbamylase deficiency (OTD), which prevents the normal removal of ammonia in the body. Wilson’s experimental technique involved genetic engineering, splicing therapeutic genes into supposedly harmless viruses that, once injected into the body, could carry their payload to defective cells and repair the genetic errors.

Dr. Wilson was attempting to determine the maximum dose of genetically modified material that could be safely injected into affected youngsters. He had enlisted 18 participants, including a teenager named Jesse Gelsinger who had a version of the genetic disease in which some of his liver cells carried the genetic abnormality but other cells were entirely normal. Those who have the full-blown disorder die in early childhood. But with his mosaic, Jesse most of the time felt well, as long as he continued to take 32 pills a day.

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Healthcare’s New “Operating System”: Amwell’s CEO Says Incumbents are Re-Thinking Telehealth

By JESSICA DaMASSA, WTF HEALTH

“We have to look at telehealth as an operating system.” Amwell ($AMWL) President & CEO Roy Schoenberg has a way with analogies, and some of his best land in this interview as we get a highly detailed, insider’s perspective about how payers and health systems are rethinking telehealth as a result of their experiences during the pandemic.

Bottom line: The pandemic taught us that telehealth can be used to deliver a much wider variety of healthcare services than just urgent care and, so the whole idea of ‘telehealth’ is changing from healthcare product to healthcare infrastructure. Mental health care, physical therapy, medication management, primary care, and more have all moved to telehealth and, along with that shift, the “rules of engagement” around those services have started to change.

Payers are looking to become the “digital front door” for their members – providing primary care and navigation. Health Systems are increasingly looking to use their own docs for urgent care, rather than outsource that relationship and miss the potential to build trust with local patients. And, in all this, Roy argues that healthcare’s biggest buyers have stopped looking at telehealth as a “product” and, instead, are starting to see the opportunity to “rewrite their future” around a view of telehealth as infrastructure, as one of healthcare’s “foundational systems” intertwined with (and as mission-critical as) their EHRs or claims and eligibility systems.

My favorite analogy starts around the 20-minute mark, when Roy explains this operating system idea by drawing comparison to how individual Microsoft programs (think Word, Excel, Outlook, PowerPoint) would be infinitely less powerful if they were not running on the same operating system and able to easily transfer information. Another good one? How both the buying and provisioning of healthcare is being re-thought digitally, just as online shopping not only changed buying habits but also changed supply chain for retailers. If you’re looking to hear the latest on what’s happening in telehealth post-Covid, learn how things have changed for payers and health systems, AND also want to dip into Amwell’s market positioning a bit, you’ll love this deep-dive.

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