On Episode 193 of Health in 2 Point 00, we have another huge day! We catch up on Amazon’s telehealth news before covering more massive deals. Evidation gets $153 million, bringing their total to a whopping $259 million and Komodo Health gets $220 million, bringing their total to $319 million. Bigfoot Biomedical raises $53 million for Type 1 diabetes care, and Glooko raises $30 million for their management system primarily working with diabetes clinics. —Matthew Holt
The Art of Clinical Decision Making: Friday Afternoon Dilemmas
By HANS DUVEFELT
The woman had a bleeding ulcer and required a blood transfusion. The hospital discharge summary said to see me in three days for a repeat CBC. But she had a late Friday appointment and there was no way we would get a result before the end of the day. She also had developed diarrhea on her pantoprazole and had stopped the medication. As if that wasn’t enough, her right lower leg was swollen and painful. She had been bed bound for a couple of days in the hospital and sedentary at home after discharge.
She could still be bleeding and she could have a blood clot. There were no openings for an ultrasound until almost a week later. Normally, with the modern blood thinners, we can just start anticoagulation until the diagnosis of a blood clot can be confirmed or disproven. But you don’t do that when somebody has a bleeding ulcer.
The radiology department solved my dilemma by pointing out that the emergency room can order an ultrasound and the department will call in an on-call technician. So that is where my patient had to go. Her blood count was stable and the ultrasound was negative. So now we just have to hope that lansoprazole, which she had taken in the past, but stopped because she didn’t have heartburn, would be effective.
Continue reading…#Healthin2Point00, Episode 192 | Happify, 100Plus, Health Recovery Solutions—& Glen Tullman is back
Today on Health in 2 Point 00, we’re back with more deals as promised for our post St-Patty’s episode. On Episode 192, Jess and I have lots to chat about because Glen Tullman is back—he becomes the CEO of Transcarent, a new company which is going direct to employers and doing navigation and telehealth and centers of excellence. Despite the crowded space (especially after this week’s Doctor on Demand and Grand Rounds merger), Glen says there is huge demand from employers. Catch our interview with him on WTF Health. Next, Happify Health gets $75 million, bringing their total up to $123 million. I had an interview with their President Ofer Leidner on THCB Spotlight yesterday, so tune in there to find out about this mental health company delivering automated, self-service care. Finally, two remote patient monitoring companies get funding – 100Plus gets $25 million in a Series A, and Health Recovery Solutions gets $70 million in a C. How are these different and why is there all this money in RPM now? —Matthew Holt
#Healthin2Point00, Episode 191 | Doctor on Demand & Grand Rounds merge, plus more staggering deals
Today on Health in 2 Point 00, it’s St. Patrick’s Day and to top off your green beer we’ve got plenty of green money. First up on Episode 191, the news we’ve been waiting for: Doctor on Demand and Grand Rounds merge. No SPAC here, but this is a real harbinger for the future. Strive Health raises $140 million – this is Google money, looking to reinvent chronic kidney disease care. Social determinants of health startup Unite Us raises $150 million, integrating social services into medical records to address the social determinants. Finally Clarify Health raises $115 million working with population health data for drug companies, hospitals, and health plans. —Matthew Holt
The Art of Asking: What Else is Going on?
By HANS DUVEFELT
Walter Brown’s blood sugars were out of control. Ellen Meek had put on 15 lbs. Diane Meserve’s blood pressure was suddenly 30 points higher than ever before.
In Walter’s case, he turned out to have an acute thyroiditis that caused many other symptoms that came to light during our standard Review of Systems.
Ellen, it turned out, was pretty sure her husband was having an affair with one of his coworkers. And, since this wasn’t the first time, she was secretly working on a plan to move out and file for divorce. She admitted she’d always had a tendency to stress eat.
Diane’s daughter had just announced that she was pregnant by a man she wasn’t sure wanted to be around in the long run.
How do we know whether a patient’s subjective symptoms, laboratory values or even their vital signs are caused by their known medical conditions, a new disease or their state of mind?
We are often tempted to proceed down familiar tracks and tackle seemingly straightforward problems with medications: More insulin would take care of Walter’s blood sugar. Ellen could use a couple of months of phentermine. Diane needed a higher dose of lisinopril or perhaps some hydrochlorothiazide.
As Sherlock Holmes said, “there is nothing more deceptive than an obvious fact”.
Continue reading…#Healthin2Point00, Episode 190 | Forward Health, Cedar, & Babylon
Today on Health in 2 Point 00, primary care appears to have jumped the shark because there is a deal in this episode in which the investors on the round are probably Jess’s favorite group of investors ever. Forward Health raises $225 million in a Series D – there’s Softbank money in this round as well as The Weeknd – but why didn’t they just go public? Patient billing company Cedar raises $200 million, bringing their valuation up to $3.2 billion, although I’m not too impressed by the concept. Finally, Babylon is making inroads into the U.S. from the U.K., buying a California-based provider group. —Matthew Holt
Inside Owlet’s SPAC IPO: From Smart Sock Baby Monitor to Data-Driven Pediatric Healthcare Co
By JESSICA DaMASSA, WTF HEALTH
Oh Baby! Connected digital nursery startup, Owlet Baby Care, just announced their SPAC IPO and intention to take their infant smart sock from baby monitor to FDA-approved medical device. I talk with Owlet’s co-founder & CEO, Kurt Workman, to find out why the baby health tech company (which has raised $48M in venture funding) has decided to take the business public in order to pursue its plans for growth as a pediatric healthcare company caring for baby “from conception to kindergarten.” Kurt gets into the details behind the work Owlet’s team is doing now to get their device FDA-approved in two different ways, and how they’re using Livongo Health’s remote monitoring/data analytics/telehealth model as a precedent for pursuing health insurance reimbursement. There may be lots of market skepticism out there about wearables – particularly socks, and especially with infants – but this deep-dive into Owlet’s vision for data-driven parenting provides a pretty compelling vision for both better and more cost-effective baby care, and the bonus of a better night’s sleep for new parents. Owlet’s calling it an $81 BILLION DOLLAR addressable market, and Kurt believes that it stands alone in terms how its bringing together full-stack connected technology and a consumerized healthcare experience to bridge the gap from hospital to home.
The Art of Listening: When the Inner Voice Whispers
By HANS DUVEFELT
“I worry, so you don’t have to”, is how I explain to patients when something about their story or physical exam makes me consider that they may have something serious going on.
The worst thing you can do is give false reassurance without serious consideration. And the next worst thing you can do is be an alarmist and needlessly frighten your patient. Finding and explaining the balance between those two extremes is a big part of the art of medicine.
A few times in my career I have struggled with doubt or worry after a patient visit. Did I miss anything, did I order the right test? We all have those moments, but we have personal limits as to how much of such doubt we can handle in the long run.
During my training and early career in Sweden there was more tolerance for physician fallability. Doctors have not been sitting on any pedestals for a couple of generations there. Here, the climate is different: We may not be revered like we were in the past, but if we make errors in judgement, the personal consequences for us can be devastating.
The way to navigate this treacherous territory is first of all to not travel alone. Everything we do is for our patient, so we must maintain a partnership. We are the experts, but we should not make decisions that aren’t shared. I keep coming back to the notion that today’s doctors are guides.
Continue reading…#Healthin2Point00, Episode 189 | DispatchHealth, TytoCare and Highmark Health
Today on Health in 2 Point 00, we’re wishing Jess a happy belated birthday! On Episode 189, Jess asks me about DispatchHealth raising a massive $200 million Series D, bringing their total up to $403 million, providing in-home urgent care. TytoCare raises another $50 million for their Series D, bringing their total up to $155 million, providing tech-enabled health at home with their device and providers. Finally there’s a partnership with Highmark Health, Google Cloud, Verily, and OnDuo – what’s going on with this lot? —Matthew Holt
Your Health Data May Be a NFT
By KIM BELLARD
I must admit, after I wrote about digital currency last week, I did not expect to be writing about crypto anytime soon. Then I heard about “non-fungible tokens” (NFTs) and got a sense of the hype they were causing — how I could I resist?
There may even be a connection to health care.
You may have seen the Nyan Cat (pictured below), which is not new; it turns 10 in April. What is new is that last month its creator “sold” it. You may be thinking, wait, the GIF is everywhere, anyone can download it, so in what sense could he “sell” it?
That’s where NFTs come in. As you may know, “fungible” means that two things can be interchanged; one dollar is just like any other dollar, one bitcoin is like any other bitcoin, one electron is like any other electron. Non-fungible, then, means the item in question is unique, and this is where the “token” comes in. Basically, NFTs use digital certificates via blockchain to mark that something is one-of-a-kind, a claim of digital ownership.
Nadya Ivanova, chief operating officer of research firm L’Atelier explained NFTs to The Wall Street Journal:
Think of it like a digital passport that comes with an asset. They allow for this trust and authenticity to be established in a way that we haven’t been able to do before, whether it’s with physical assets or digital assets.
Artists have been using NFTs for a few years now, and auction house Christie’s is auctioning off the “First Purely Digital NFT-Based Work of Art Ever Offered by a Major Auction House,” featuring the digital artist Beeple (aka Mike Winklemann). Christie’s promises:
…the buyer receives the artwork file containing a digital signature from the artist and all vital details including time of creation, edition size and a record of any prior sales. These details are permanently attached to the artwork, providing an enduring guarantee of value.
NFTs have gone beyond art. The NBA is all over this, with NBA Top Shot selling highlight clips; one of Lebron dunking just went for $200,000. Maverick’s owner Mark Cuban is a big proponent. “The tech is real,” he told CNBC. “The impact is real, and permanent.”
Continue reading…
