A little more than 20 years ago, the IOM report To Err is Human catalyzed the profession around the realization that our health care system was killing around 98,000 people a year from medical error. I am part of a generation of professionals that learned to adopt systems thinking; to measure, monitor, and improve; and to ultimately improve quality of care.
Today, we face a different set of challenges. Health care is in the midst of a global pandemic, a reckoning with systemic racism, not to mention the great resignation. But also, we face a climate crisis. Are these things connected? Is there something we all can do? The answer is undoubtedly yes, and I write to advocate for climate change to be included on this list of strategic and moral imperatives for health care leaders everywhere.
Last week General Electric announced it was breaking itself up. GE is an American icon, part of America’s industrial landscape for the last 129 years, but the 21st century has not been kind to it. The breakup didn’t come as a complete surprise. Then later in the week Johnson and Johnson, another longtime American icon, also announced it would split itself up, and I thought, well, that’s interesting. When on the same day Toshiba said it was splitting itself up, I thought, hmm, I may have to write about this.
Healthcare is still in the consolidation phase, but there may be some lessons here for it.
For most of its existence, GE was an acquirer, gobbling up companies with the belief that its vaunted management structure could provide value no matter what the industry. This was most famously true in the Jack Welch days, but since those days it has been gradually shrinking itself, spinning off some of its more problematic divisions, like appliances, locomotives, and much of its once-huge financial services business. It will spin off its healthcare business in early 2023 and its renewable energy and power business in early 2024; its aviation business will keep the GE name.
“A healthcare investor wants to invest in healthcare,” CEO Larry Culp explained. “We know we are under-owned in each of those three sectors, in part because of our structure.”
In my course this Fall at the University of Hartford, titled “The Right to Health Care and the U.S. Constitution”, we have concentrated on the power of words, of precedents, and the range of interests with which health has been encumbered over several hundred years.
The topic has been an eye-opener on many levels. On the most basic level, it is already clear that the value of this “right” depends heavily on your definition of “health.”
We’ve highlighted three definitions worth sharing here.
Days after announcing their deal with Walmart, Transcarent’s Executive Chairman & CEO Glen Tullman and meet again (in-person!) to pick up our conversation right where it left off. For the details about the deal, see our last interview; for what the deal signifies for the disruption of the healthcare payer and the ultimate rise of the healthcare consumer, tune in now and take note.
The plot of Transcarent’s story is starting to take shape. Their conflict is with the “big middle” of healthcare where drugs are marked up, care needs pre-authorizations, and docs labeled “this is NOT a bill” are ridiculous artifacts of a payer-first healthcare experience.
“The system behind our healthcare today is working exactly as its designed: for payers. We want to re-design that,” says Glen. “It’s not, ‘how do we get through that better?’ That would be navigating. It’s ‘how do we go completely around that and re-design the experience?’”
Glen talks us through the leverage retailers like Walmart and Amazon really have to help take on non-innovative payers what role Transcarent is playing in all of this, and how startups like GoodRx, Ro, and Capsule who are successfully challenging PBMs are demonstrating that payment model innovation is possible.
And, while we wait for the next big deal to come from ‘healthcare’s best dealmaker, we’ve got some foreshadowing: a quick mention of Oscar Health that registered on my radar as interesting, along with some very specific details about how Transcarent will expand its offering next, looking at MSK, cancer care, behavioral health (particularly for teens), and bringing in more “human voices” for their members to turn to for advice.
Shira Ovide, who writes the On Tech newsletter for The New York Times, had a thoughtful column last week: Tech Can’t Fix the Problem of Cars. It was, she said, inspired by Peter Norton’s Autonorama: The Illusionary Promise of High Tech Driving. The premise of both, in case the titles didn’t already give it away, is that throwing more tech into our cars is not going to address the underlying issues that cars pose.
It made me think of healthcare.
What’s been going on in the automotive world in the past decade has truly been amazing. Our cars have become mobile screens, with big dashboard touchscreen displays, Bluetooth, and streaming. Electric cars have gone from an expensive pipedream to an agreed-upon future, with Tesla valued at over a trillion dollars, despite never having sold a half-million cars annually before 2021.
If we don’t feel like driving, we can use our smartphones to call an Uber or Lyft. Or we can use the various autonomous features already available on many cars, with an expectation that fully self-driving vehicles are right around the corner. Soon, it seems, we’ll have non-polluting, self-driving vehicles on call: fewer deaths/injuries, less pollution, not as many vehicles sitting around idly most of the day. Utopia, right?
Today I saw a patient I have known for years. He suddenly pulled his mask down and said, “I’d like to know what you think I should do about this”.
On his nose was an 8 mm (1/3”) brownish-red flat spot with a crack or scrape through it.
“How long have you had it?”, I asked.
“Oh, a while now” he answered. That is about the least helpful time measurement I know of. I asked him to pin it down a bit more precisely. He settled for about a year. I prescribed a cream and made a two week follow-up appointment for either cryo or a biopsy. It’s probably just an excoriated, premalignant, actinic keratosis.
There was lots of chatter at HLTH 2021 about the fact that healthcare AI unicorn, Olive, showcased its brand-bedecked touring bus on the show floor. Some expressed disdain about whether or not this was really the best use of more than $850M in funding, while others quickly (and literally) jumped on the bandwagon of the company’s quest to go door-to-door to win over hospital-after-hospital with its “Internet of Healthcare” vision. But, to hear CEO Sean Lane talk about it all – including what’s happening at Circulo, the less-than-a-year-old Medicaid plan being built on top of Olive’s infrastructure – the bus might actually be a grand metaphor for a company continuing to “move fast and fix things” despite the typical stop-and-start nature of innovating in healthcare.
Sean gets us up-to-speed on the latest at Olive: its growth (he says the company is “growing by one mid-sized company each month”)… its expanding client base which now also includes more and more payers…and its own new status as a full-service clearinghouse, thanks to its Olive Assures product that instant pays claims to hospitals and completely eliminates the cost of collection associated with these types of payments. And this is just what you can see of the road ahead from the dashboard! On the horizon, is whatever will be built on top of the Olive infrastructure, and Sean gives us insight as to what’s on the itinerary.
Olive launched “The Library” at HLTH, which is a “marketplace” where other tech companies, including competitors, can sell into Olive’s client base any technology – clinical, operational, administrative, or otherwise – that can help automate healthcare. Sean talks about how this marketplace, along with Olive’s recently launched venture fund, are just parts of what they’re doing to build healthcare’s first TRUE platform business. (You’ll have to listen in to hear how he’s defining platform…) So, what’s in store for our legacy “platforms” like EMRs in the future if/when this more open, democratic type of platform thinking takes off? And, what about the first company already being created from scratch on said platform? You can see how passionate Sean is about building Circulo as the “Medicaid Plan of the Future,” and we get into some examples of elements this new plan will offer its members: primary health sites, “Circulators” that bring telehealth into neighborhoods via tricked-out Sprinter vans for those on the other side of the digital divide, and payment model features (zero prior auths, zero denials, payment immediately) that sound a lot like what Olive is enabling in hospitals with traditional payers. There’s a lot to hear in this one!
Today on Health in 2 Point 00, Jess and I talk briefly about Frontiers Health – frontiers.health – a digital health company with a deep therapeutics focus. Kareo and Patient Pop merge to form Tebra and get $65 million dollars from a PE firm. A notable raise from Notable, $100 million in a Series B brings to total up to $119 million. Wellinks gets $25 million in a Series C in the COPD space. Constant Blood Pressure monitoring company Aktiia gets $17.5 million, bringing their total up to $28 million. Aver Inc. rebrands, becoming Enlace Health, and raises 58 million dollars bringing their total up to $111 million. Investment efforts in Enlace were led by Cox Inc., and the relationship between Cox and Enlace seems very tight. -Matthew Holt
A sign of effective ‘merging-and-acquiring’ among innovative healthcare companies? How about a new brand-name? The company known as “Grand Rounds Health and Doctor on Demand,” which merged in March 2021 and quickly acquired LGBTQ+ virtual care company, Included Health, announced that the company would be moving forward as Included Health from here on out. We get into the strategy behind that name-change – and, more importantly, how the integration of the three companies is going – from CEO Owen Tripp.
This quick update covers how the navigation-plus-virtual-care co is prioritizing integration at-scale for millions of members – unlike other growing healthcare companies who Owen says have, “acquired companies, but haven’t put them together.” From member experience, clinician experience, and the business model backing all of this, we get a state-of-play on Included Health, including Owen’s take on the rising popularity of at-risk models among competitors Accolade Health and Transcarent, the legacy relationship the company has with Walmart, and how small/mid-sized employers are increasing area of focus for growth.
General Mark A. Milley, chairman of the Joint Chiefs of Staff, recently expressed grave concern about China’s reported test of a hypersonic missile: “I don’t know if it’s quite a Sputnik moment, but I think it’s very close to that. It has all of our attention.” Maybe it should be, but General Milley may have missed the real 21st-century version of a Sputnik moment: China has claimed huge breakthroughs in quantum computing.
It’s inside baseball to those of us who are neither computer experts nor quantum physicists, but let’s put it this way: the countries/companies that dominate quantum computing will dominate, full stop. Healthcare included.
I won’t pretend to understand quantum computers or try to explain how they work, but they’re to “traditional” computers as those computers are to, say, a calculator, or to an abacus. They’re much faster – like a quantum leap faster – and can quickly do computations that would take even traditional supercomputers centuries to complete, if ever. For example, think you’ve got an unbreakable code? Unless you’ve got the fastest quantum computer, think again.
