Today on Health in 2 Point 00, Noom launches a mental health offering, Noom Mood, Headspace partners with Waze to offer meditation while you drive, and we have one for the Press Release Hall of Fame where Dario Health announces a major partnership with a major national health plan— but doesn’t say who it is. We have some massive deals on Episode 235: Walgreens launches Walgreens Health, acquires a controlling stake of VillageMD, AND acquires a majority stake of CareCentrix; Intelerad acquires Ambra Health for $250 million; Mindbody acquires ClassPass; and Sprinter Health gets $33 million – even though their business model makes no sense. —Matthew Holt
Christina Liu
#Healthin2Point00, Episode 234 | An M&A and shedloads more money!
Today on Health in 2 Point 00, the word is SHEDLOAD. On Episode 235, Jess and I talk about the scoop on an M&A and shedloads more money in today’s health tech funding climate. First up, Lark gets $100 million, bringing its total to $185 million. How much more money can we throw at a chronic condition management platform? Next, Scottish remote patient monitoring company Current Health gets acquired by Best Buy. TrialSpark raises $156 million, working on developing drugs via their clinical trials software, Twin Health raises $140 million to run clinical trials in silico in “digital twins,” and virtual care GI company Oshi Health gets $23 million. —Matthew Holt
#Healthin2Point00, Episode 233 | Another $2B in deals, including Devoted’s whopping valuation
Today on Health in 2 Point 00, we’re thinking about changing our name to Health in 2 Billion 00. Devoted Health confirmed its $11 billion valuation, bumping it to $12 billion after you count the additional $1.2 billion coming in. Now onto the other 2 billion in deals, BetterUp raises $300 million in a Series C, bringing their total to $569.8 million for performance coaching and resilience training. Honor is growing fast – it raises $370 million ($300M of that is debt), bringing their total to $625M. Elemy, formerly called Sprout, raises $219 million, for children’s behavioral health. Finally, MindMaze raises $125 million, bringing their total to $235 million, working on gamifying digital neurotherapeutics. —Matthew Holt
Medicine is a Moving Missile, Aiming for a Dangerous, Elusive Target
By HANS DUVEFELT
(Desperate times called for desperate measures.)
In the tech world, we have come to expect our devices to become outdated and obsolete very quickly. The biggest tech companies in the world didn’t even exist a few years ago. Bitcoin, a virtual currency which at least I can’t wrap my head around, seems to be more attractive than gold.
I get the sense most people embrace or at least accept the speed of change in tech.
But medical advances that occur rapidly are frightening to many people. Vaccine hesitancy, for example, involves concerns and characterizations like “unproven” and “guinea pigs”.
But can we as a society strive for and reward rapid progress in one area and reject it in another, especially if we feel threatened by outside forces or phenomena – be that a virus, climate change or the collapse of our economy’s infrastructure like supply chains and raw materials.
Tech has its own momentum, more driven by profit motives than altruistism or a desire just to make peoples lives better. Medicine clearly has profit as a driving force, but also a goal of improving life for people. Curing or mitigating disease must rank higher than making life more convenient.
Continue reading…THCB Spotlights: Dan Goldsmith and Jennifer Goldsmith, Tendo
Today on THCB Spotlight, Matthew sits down with Tendo’s CEO, Dan Goldsmith, and President, Jennifer Goldsmith. Tendo is in the patient engagement space, and Jennifer tells us about the vision behind the company – to become that trusted connection between patients, clinicians, and caregivers via software that creates a seamless and consumer-driven experience throughout that care journey. They talk to us about the plethora of point solutions for patient engagement, and how the platform approach that Tendo takes is meant to support a patient’s comprehensive needs without placing the full burden on the patients themselves.
State of Connecticut’s New ‘Episodes-of-Care Health Plan’ Could Be Key to Scaling Value-Based Care
By JESSICA DaMASSA, WTF HEALTH
Signify Health (NYSE: SGFY) has called their approach “Value-Based Care 2.0” and, today, they’ve received an important designation from CMS that could set an exciting precedent for scaling up episodes-of-care, value-based models for the under 65 commercial health insurance market. The plan to receive this important approval as an Advanced Alternative Payment Model (AAPM) is the State of Connecticut’s health plan – a massive plan that covers the State’s 220,000 employees and retirees. To talk about what this first-of-its-kind approval signals for the future of value-based payment models are the State of Connecticut’s Comptroller Kevin Lembo and Signify Health’s CEO Kyle Armbrester.
What’s so important here is the combination of episodes-of-care (which is like value-based care-lite) and the under-65 market (which is not as rich with value-based care case studies as the over-65 Medicare market). That a State government with a massive population of covered lives AND a vested interest in helping keep local hospitals and health systems vibrant economic engines in the community is leading the way on this novel payment model design is significant. And, Comptroller Lembo gives us the details about how he’s viewing it as a win-win – after quite a few battles along the way. To win in health innovation, you’ve got to follow the dollar! Tune into this chat to see where it’s headed as episodes-of-care models get a huge boost from CMS.
#Healthin2Point00, Episode 232 | Cue Health goes public + funding for Stellar, eVisit, & Neuroglee
Today on Health in 2 Point 00, Jess and I are at UCSF – we’ll be providing color commentary for the UCSF Health Awards, so tune in tonight for that. On Episode 232, Jess asks me about more deals including Stellar Health raising $60 million, Cue Health going public (and stealing the HLTH ticket), and eVisit raising $45 million for its telehealth solution. Finally, Neuroglee raises $10 million in an Alzheimer’s play. —Matthew Holt
We Shouldn’t Tolerate Sloppy Allergy Lists
By HANS DUVEFELT
The medication and allergy lists seem like they would be the most important parts of a health record to keep current and accurate. But we all see errors too often.
I think it shouldn’t be possible to enter an allergy without describing the reaction. Because without that information the list becomes completely useless.
The other day I saw a patient who needed an urgent CT angiogram. The allergy list said “All Contrast Materials”, which isn’t even “structured data entry”, and thus not recognized by the computer if my EMR (Me again, Greenway!) would have been clever enough to check for allergies when I order a CT scan.
After a lot of probing, the “allergy” in this case turned out to be a host of nonspecific, chronic symptoms after several lumbar CT myelograms in a short period of time many years ago.
Some people claim to be penicillin allergic because “it never works”. Others list ciprofloxacin or sulfa antibiotics because they get a yeast infection after taking them. Others were slightly nauseous after their first dose of an SSRI like fluoxetine or fatigued after starting gabapentin.
Some symptoms listed as allergies are poorly understood. For example, morphine causes itching in many patients, even skin manifestations like blushing as well as sweating. But this is not usually a histamine mediated symptom, and not an allergy. Other opioids, like hydromorphone, tend to have less risk for itching.
Cough from ACE inhibitors isn’t a true allergy, but we often note that in our allergy lists. People with this side effect can safely be switched to angiotensin receptor blockers, ARBs.
Continue reading…Never Waste a (Design) Crisis
By KIM BELLARD
The Wall Street Journal reported that the American Dental Association (ADA) opposes expanding Medicare to include dental benefits. My reaction was, well, of course they do.
They apparently don’t care that at least half, and perhaps as many as two thirds, of seniors lack dental insurance, or that one in five seniors are missing all their teeth. The ADA prefers a plan for low income Medicare beneficiaries only, although state Medicaid programs were already supposed to be that, with widely varying results between the states.
The ADA is following blindly in the AMA’s opposition to enactment of Medicare, ignoring how fruitful Medicare has turned out to be for physicians’ incomes. It’s all about the money, of course; the ADA thinks dentists can get more money from private insurance, or directly from patients, than they would from Medicare, and they’re probably right.
As is typical for our healthcare system, good design is no match for interfering with the incomes of the people/organizations providing the care.
By the same token, I suspect that the real opposition to “Medicare for All” is not from health insurers but from healthcare providers. Health insurers, a least the larger ones, have done quite nicely with Medicare Advantage, and would probably welcome moving members from those balkanized, largely self-funded employer plans to Medicare Advantage plans.
No, the bloodbath in Medicare for All would be the loss in revenue of health care professionals/organizations missing out on those lucrative private pay rates. As Upton Sinclair once observed, “It is difficult to get a man to understand something when his salary depends upon his not understanding it.” Or, as Guido tells Joel in Risky Business, “never, ever, fuck with another man’s livelihood.”
Very little about our healthcare system has been consciously designed. It’s a patchwork of efforts – legislative/regulatory initiatives, tax provisions, entrepreneurial choices, independent design decisions — and many unintended consequences. We should be less surprised at how poorly they all fit together than that some of them fit at all. Find someone who is happy with our current healthcare system and I bet that person is either making lots of money from it, or not receiving any services from it.
Continue reading…American Primary Care is a Big Waste of Time (When…)
By HANS DUVEFELT
Before Johannes Gutenberg invented the printing press in 1450, books in Europe were copied by hand, mostly by monks and clergy. Ironically, they were often called scribes, the same word we now use for the new class of healthcare workers employed to improve the efficiency of physician documentation.
Think about that for a moment: American doctors are employing almost medieval methods in what is supposed to be the era of computers. Why aren’t we using AI for documentation?
The pathetically cumbersome methods of documentation available (required) for our clinical encounters is only one of several antiquated presumptions in American healthcare. Other inefficiencies, often viewed as axioms, especially in primary care, make the trade I am in chock full of time wasters.
Whereas in most other “industries”, people talk about reach, scale, leverage and automation, primary care is still doing things one patient at a time. The automation in our field is not one where processes happen without human involvement according to preset patterns. Instead, it is an ongoing effort to make medical providers behave in automatic fashion with patients on a one-on-one, one visit at a time basis. The value of one-on-one is when you individualize, give unique advice considering multiple individual parameters; saying “in your particular case”, rather than “everybody should eat a healthy diet”.
Primary care here is wasting time in many ways:
When health maintenance and disease prevention is done by physicians. I keep writing about this, but a standing order to offer pneumonia or shingles shots, diabetes or lung cancer screenings and so many other things to people over a certain age or with certain risk factors can be handled by non-physicians. This would keep the six figure problem solvers doing what only they can do. It would also (a not-so-wild guess) probably double physician productivity.
Continue reading…
