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matthew holt

Livongo CEO Glen Tullman’s Advice for Startups

Sep 10, 2018

By JESSICA DA MASSA, WTF Health

If you’re a health tech startup, should you be building for your exit? Does that really lead to the greatest possible success for your business…if you know how to get out?

Here’s some advice from someone who should know. Glen Tullman is ‘the guy’ who took Allscripts public via a wildly successful IPO in the late-90s. He’s now the CEO of Livongo, a chronic condition management startup that rang in 2018 with a $105M mega-round raised internally among its current pool of investors – at more than two times the company’s previous valuation.

When I caught up with Glen earlier this year, it was just after his round closed, the company acquired Retrofit, and rumors had started swirling about Livongo going public. Needless to say, our conversation turned toward ‘the exit’ and I had the chance to ask what he would tell other startup founders about going IPO. What comes next is a passionate discourse about what it takes to not only exit – but raise and scale – a startup in healthcare. For being a money guy, Glen is no sell-out; young startups would be wise to take his two cents and invest them.

Get a glimpse of the future of healthcare by meeting the people who are going to change it. Find more WTF Health interviews here or check out www.wtf.health. Filmed at HLTH in Las Vegas, May 2018.

Physician Well-Being: Lessons From Positive Psychology

Sep 7, 2018• 2

By SANJ KATYAL

The absence of burnout does not equal wellness. While the focus on physician burnout as an epidemic is finally gaining more attention, we may be missing a larger issue. Most physicians are not burned out. We are able to function. We get through our days, make it to some of our kids’ activities and even manage to go out to dinner on the weekends. We survive the work week as we look forward to our next vacation. We do this because that is what we have always done. We put our heads down and do our work. We often project ourselves past the next exam or to the next stage of our lives to help us get through the stress. We become masters of delayed gratification. We develop the mindset of “I’ll be happy when…” I get into medical school or match into a good residency spot or make partner or have enough money to retire etc…Along the way, we may have some bright spots – falling in love, having kids, taking great vacations. We may even reward ourselves for our hard work with a new car or nicer house. We deserve it. But deep inside, “something is missing”. We have achieved most, if not all of the goals we have set for ourselves. Yet despite our hard work, many of us remain unfulfilled with our careers and often with our lives. What is it that we need? A better job with more money? A different car? A different title? Better vacations?

I have struggled with these questions and many more. How do I stop wanting what I don’t have and start wanting what I do have? How can I fully enjoy the present while also preparing for a better future? How can I spend quality time with my kids while they are still around? How can I have a career that uses all of my potentials? Of all the questions that I’ve asked myself, the most important one was this – How can I learn to flourish and not just function?

Fortunately, I found answers in the relatively new field of Positive Psychology which is the scientific study of human flourishing. Unlike traditional psychology which alleviates distress and moves a patient from a -8 to a 0 or +1 (if they are lucky), positive psychology focuses on a patient that is functioning at a +1 and tries to move them to a +8 on the flourishing scale. We need both areas of focus. There are many people that are functioning well by most standards but are nowhere near their potential level of fulfillment.

Disrupting the Cholesterol Test: Finnish Startup Nightingale Health

Sep 6, 2018• 1

By JESSICA DA MASSA, WTF Health

Today’s cholesterol test is about to be disrupted. Nightingale Health, a five-year-old startup based out of Finland, has built a better blood test that – among other things – is about to disrupt the cholesterol test of today.

Their blood test collects 50 times more biomarker data than the standard test – boasting a 20% better prediction rate for diabetes and cardiovascular disease – and they’re offering it at the same price point as the existing industry standard. Why does this matter? Well, for clinicians, researchers, or those working on new drug development, the Nightingale test is not only offering an unprecedented amount of metabolic data, but it’s an unprecedented amount of AFFORDABLE metabolic data that can impact the health care cost curve as far as the eye can see.

What’s more – and this has gotten investors’ blood pumping – they haven’t even fully realized the full potential of their panel. Listen in as Kristiina Tolvanen talks with me about the company’s priorities to build their evidence base and find out what else their biomarker analysis platform can potentially displace. Freshly funded with a $30M round – and a very prestigious partnership with the UK Biobank to analyze 500,000 blood samples – this is one to watch.

Filmed at Upgraded Life Festival in Helsinki, Finland, June 2018. Find more interviews on health and technology here or check out www.wtf.health.

Health in 2 Point 00, Episode 48

Sep 6, 2018

Jessica DaMassa asks me about Cricket Health’s $24m raise for kidney disease services, Rx.Health from Mount Sinai and a whole bunch of big money in little China. All in 2 minutes–Matthew Holt

Is Universal Health Care Socialism?

Sep 5, 2018• 7

By ETIENNE DEFFARGES

The November midterms elections are approaching, and one of the major topics is health care. Democrats are campaigning on retaining Obamacare, in many cases advocating that we move towards universal health care.

That would be pure socialism, retort Republicans, who would rather repeal the Affordable Care Act as they attempted in 2017, even if this leads to 20 million Americans losing coverage.

Is Universal Health Care Socialism?

Only if we believe that every other developed market-based economy in the world is socialist since the U.S. is the only one without universal coverage. We spend almost $10,000 per year per capita on health care, about twice as much as most developed countries. However, in terms of major health outcomes, such as infant mortality or life expectancy, we are laggards. In a recent OECD survey, we ranked 27th out of 35 countries in life expectancy. Japan spends about $4,000 per year per capita in health care, yet the average Japanese has a life expectancy of 84 years, versus 79 for the average American. Why?

Every developed country other than the U.S. has had universal care for decades. While Prussia’s “Iron Chancellor” Otto Von Bismarck implemented the first universal care system…in 1883, our health care history is a patchwork of partial reforms, an inefficient collage of private and public institutions. We first tied health insurance to employment in 1946, because business and conservative opposition would not allow universal coverage; then added Medicare in 1965 so that our seniors would have coverage after they retired; then Medicaid, a different one for each one of our fifty states; Continue reading…

Health in 2 Point 00, Episode 47

Sep 5, 2018

Jessica DaMassa asks me about Patrick Soon-Shiong and his Verity hospital chain going bankrupt, whether Peerfit can justify its $8m raise, and who I’m going to see at TechCrunch Disrupt this week–Matthew Holt

Can CMS’ Proposed ACO Changes Really Help Medicare Beneficiaries?

Sep 4, 2018• 3

By REBECCA FOGG

Earlier this month, the Centers for Medicare and Medicaid Services Administrator Seema Verma proposed bold changes to Medicare’s Accountable Care Organizations (ACOs), with the goal of accelerating America’s progress toward a value-based healthcare system—that is, one in which providers are paid for the quality and cost-effectiveness of care delivered, rather than volume delivered.

CMS has created a number of ACO programs over the last six years in an effort to improve care quality and reduce care costs across its Fee-for-Service Medicare population. In a Medicare ACO, hospital systems, physician practices and other voluntarily band together and assume responsibility for the quality and cost of care for beneficiaries assigned to them by Medicare. All ACOs meeting quality targets at the end of a given year receive a share of any savings generated relative to a predetermined cost benchmark; and depending on the type of ACO, some incur a financial penalty if they exceed the benchmark.

According to CMS’ recent analyses, ACOs that take on higher financial risk are more successful in improving quality and reducing costs over time. So one important objective of CMS’ proposed changes is to increase the rate at which ACOs assume financial risk for their beneficiaries’ care.

Health in 2 Point 00, Episode 46

Aug 29, 2018• 1

Jessica DaMassa asks me about single payer polling high, big VC for women’s pelvic floor digital therapeutic Renovia, 23andme cutting off API access to its data, plus guest mentions for Shafi Ahmed and Glen Tullman. All in 2 minutes (more or less!)–Matthew Holt

Prior Authorizations: Will They Become Damocles Sword?

Aug 28, 2018• 29

By NIRAN AL-AGBA MF, FAAP

In July 2009, the family of Massachusetts teenager Yarushka Rivera went to their local Walgreens to pick up Topomax, an anti-seizure drug that had been keeping her epilepsy in check for years. Rivera had insurance coverage through MassHealth, the state’s Medicaid insurance program for low-income children, and never ran into obstacles obtaining this life-saving medication. But in July of 2009, she turned 19, and when, shortly after her birthday, her family went to pick up the medicine, the pharmacist told them they’d either have to shell out $399.99 to purchase Topomax out-of-pocket or obtain a so-called “prior authorization” in order to have the prescription filled.

Prior authorizations, or PAs as they are often referred to, are bureaucratic hoops that insurance companies require doctors to jump through before pharmacists can fulfill prescriptions for certain drugs. Basically, they boil down to yet another risky cost-cutting measure created by insurance companies, in keeping with their tried-and-true penny-pinching logic: The more hurdles the insurance companies places between patients and their care, the more people who will give up along the way, and the better the insurers’ bottom line.

PAs have been a fixture of our health care system for a while, but the number of drugs that require one seems to be escalating exponentially. Insurance companies claim that PAs are fast and easy. They say pharmacists can electronically forward physicians the necessary paperwork with the click of a mouse, and that doctors shouldn’t need more than 10 minutes to complete the approval process.

Comprehensiveness is Killing Primary Care

Aug 24, 2018• 20

By HANS DUVEFELT, MD

Dr. Hans Duvefelt

In most other human activities there are two speeds, fast and slow. Usually, one dominates. Think firefighting versus bridge design. Healthcare spans from one extreme to the other. Think Code Blue versus diabetes care.

Primary Care was once a place where you treated things like earaches and unexplained weight loss in appointments of different length with documentation of different complexity. By doing both in the same clinic over the lifespan of patients, an aggregate picture of each patient was created and curated.

A patient with an earache used to be in and out in less than five minutes. That doesn’t happen anymore. Not that doctors and clinics wouldn’t love to work that way, but we are severely penalized for providing quick access and focused care for our well-established patients.