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Category: Health Technology

DALL-E, Draw an AI Doctor

BY KIM BELLARD

I can’t believe I somehow missed when OpenAI introduced DALL-E in January 2021 – a neural network that could “generate images from text descriptions” — so I’m sure not going to miss now that OpenAI has unveiled DALL-E 2.  As they describe it, “DALL-E 2 is a new AI system that can create realistic images and art from a description in natural language.”  The name, by the way, is a playful combination of the animated robot WALL-E  and the idiosyncratic artist Salvator Dali.

This is not your father’s AI.  If you think it’s just about art, think again.  If you think it doesn’t matter for healthcare, well, you’ve been warned.

Here are further descriptions of what OpenAI is claiming:

“DALL·E 2 can create original, realistic images and art from a text description. It can combine concepts, attributes, and styles.

DALL·E 2 can make realistic edits to existing images from a natural language caption. It can add and remove elements while taking shadows, reflections, and textures into account.

DALL·E 2 can take an image and create different variations of it inspired by the original.”

Here’s their video:

I’ll leave it to others to explain exactly how it does all that, aside from saying it uses a process called diffusion, “which starts with a pattern of random dots and gradually alters that pattern towards an image when it recognizes specific aspects of that image.”  The end result is that, relative to DALL-E, DALL-E 2 “generates more realistic and accurate images with 4x greater resolution.”  

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Quickbite Interviews: Force Therapeutics/Xealth & Avia Health

I was at the VIVE conference in Miami last week and caught up with a number of CEOs & execs for some quickbite interviews — around 5 mins getting (I hope) to the gist of what they & their companies are up to. I am going to dribble them out this week.

Up here are Mikayla McGrath, Head of Partnerships at Force Therapeutics & Cynthia Church, Chief Strategy Officer at Xealth–they’re on together discussing their partnership. The other bite is with Cynthia Perazzo, EVP Insights, AVIA Health, who is telling us about the transformation she is seeing among American’s hospital systems. — Matthew Holt

“There Isn’t One Health Plan to Save Them All”: Flume Health’s CEO on New Build-A-Plan Biz

By JESSICA DaMASSA, WTF HEALTH

Two of the most notable payer venture funds, Optum Ventures and Cigna Ventures, just headed up a $30 million dollar Series A funding round for Flume Health, a startup that basically builds “challenger” health plans. How did this go down? Cédric Kovacs-Johnson CEO & Founder of Flume introduces us to his company which offers providers, digital health co’s, brokers, reinsurers, and just about any other healthcare org a tech stack for creating their own hyper-niche, super personalized health plans.

The suite of services to “build-a-plan” includes things like claim processing, payments, enrollment management, digital health point solutions integration, and other API functionality – replacing the traditional TPA with tech and the one-size-fits-all plan with a new opportunity for nichey-ness that can customize coverage for patient populations based on health conditions, location, employer, and so on.

Cédric talks us through the benefit to his target client – the care provider – who, while taking on more risk anyway, may consider building their own plan to capture more premium dollars and gain better control over the end-to-end patient experience. Wait a minute – is all this “Challenger Health Plan” talk just a re-brand of value-based care? I ask point-blank and get a new buzz phrase in return; welcome to the lexicon, “Commercial Advantage.” Lots to unpack in this one including Flume’s rev-gen model and plans for growth – they’re already onboarding one new challenger plan per month!

Quickbite Interviews: 1UpHealth& Cecelia Health

I was at the VIVE conference in Miami last week and caught up with a number of CEOs & execs for some quickbite interviews — around 5 mins getting (I hope) to the gist of what they & their companies are up to. I am going to dribble them out this week.

Up here are are Joe Gagnon, CEO, 1upHealth, a data integrator that works primarily with health plans, and Mark Clermont, CEO, Cecelia Health, a chronic care management company that also runs pharma patient adherence programs. — Matthew Holt

Clarify Health Solutions’ CEO on Data Analytics Startup’s Next Trick: Value-Based Payments Tech

By JESSICA DaMASSA, WTF HEALTH

Turns out, the Clarify Health Solutions story is about a lot more than data and analytics these days. Value-based payments? Acquisition of provider-focused, behavioral science startup Embedded Healthcare? Opportunities in real-world evidence??

Good thing founder & CEO Jean Drouin and I caught up at ViVE 2022. Not only do we get into the backstory of the business, which has built a self-service analytics platform for payers, providers, and life science co’s on top of “one of the largest-ever patient datasets” in the industry, but we also talk about the strategy that’s driving Clarify into the world of value-based contracting and how Embedded Healthcare’s tech will be used to augment and refine that new offering.

Jean talks in detail about his client mix, business model, and the two “healthcare golden rules” Clarify lives by as it scales up its business: 1) figure out how the payment method is going to work and 2) don’t mess with the work-flow.

Quickbite Interviews: Lark & Luma Health

I was at the VIVE conference in Miami last week and caught up with a number of CEOs & execs for some quickbite interviews — around 5 mins getting (I hope) to the gist of what they & their companies are up to. I am going to dribble them out this week.

First two up are Julia Hu, CEO of Lark, a conversational AI program for chronic & behavioral health that works primarily with health plans, and Adnan Iqbal, CEO of Luma Health, a patient messaging system mostly used by providers. — Matthew Holt

Aledade: Mandy Cohen joins, Farzad speaks

Aledade is the “build an ACO out of small independent primary care practices” company. It was founded by former ONC Director Farzad Mostashari and has been growing fast and profitably in the last few years, having raised just shy of $300m. Farzad recently both tweeted out the latest and put up a slide deck about their financial and business progress. Aledade also announced a major star signing in Mandy Cohen, previously Secretary of HHS in North Carolina, who is becoming CEO of a new division called Aledade Care Solutions. I had a wide ranging conversation with both of them about what Aledade has done and what it is going to do, as well as the general state of play in primary care and risk taking–Matthew Holt

TRANSCRIPT (lightly edited for clarity)

Matthew Holt:

Okay, it’s Matthew Holt with THCB Spotlight. I’m really thrilled to have Farzard Mostashari and Mandy Cohen with me. So, both of these two doctors have spent a lot of their time in public, much of their career in public service, Farzad for many years was in New York City, and then later was at ONC. Mandy was at CMS, and more recently, was Secretary for Health in North Carolina. In fact, towards the end of the Obama administration, Farzad was doing venture capitalism in a bar and got given a check and founded Aledade. And the news just recently, was that Mandy, who has just finished her term in North Carolina, is now going to join Aledade and start a new division there. So, I thought we would chat about how Aledade’s doing, what it’s doing, and what it’s going to do in the future and hopefully, yeah.

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Does Digital Health Technology Have a “Famous Trio” in the Making?

By MIKE MAGEE

Yale historian, Frank M. Snowden wisely notes in his 2020 book, “Epidemics and Society”, that “We must avoid the pitfall of believing the driver of scientific knowledge is ever a single genius working alone.”

His insight came to mind this week as I was reviewing the January 11, 2020 Forbes article by Seth Joseph, health tech policy correspondent, titled “What Bubble? Digital Health Funding Year in Review 2021.”

By one measure of success – dollars invested – it’s been a banner year. According to Joseph, there was over $29 billion funded, and 729 digital health US-based startups in 2021. But according to Scott Barclay, Managing Director at Insight Partners, who is quoted generously in the Forbes piece, “digital health is still in its relative infancy.”

This level of churn, passion, and (some might say) financial frenzy is reminiscent of another moment in scientific history – the latter half of the 19th century. Over a few decades, “The Germ Theory” was fleshed out with unprecedented and remarkable human progress following in its wake.

The breakthroughs were not the result of 729 often-repetitive and unoriginal ideas, but rather the work of three successive innovators whose work built on each other, combining innovation, technology and health.

Snowden termed the three “The Famous Trio.”

The first was Louis Pasteur (1822-1895) a chemist with a sharp eye and mind. He had been hired to find a solution for wine and milk that was spoiling too fast. The tools he wielded were mostly observational, including a still primitive microscope. With it, Pasteur was able to identify putrefying microbes as causal but went two steps further. He noted that a heating process killed the microbes and halted the product putrefaction, and tied the microscopic organisms to specific human diseases. With this knowledge, he unveiled a commercial process of serial attenuation of disease-causing microbes that allowed safe inoculation of humans and acquired immunity.

The second of the trio was Robert Koch (1834-1910), a physician 20 years younger than Pasteur. While studying Anthrax at the University of Gottingen, he visualized the large causative bacteria, introduced it into a lab animal, and reproduced the disease. Going one step further, he described resistant spores of the bacteria, identified them in grazing fields, and proved that eating grass laden with spores could spread Anthrax between animals. His careful investigative approach led to the uncovering of the etiology of tuberculosis and to “Koch’s Postulates”, four steps still in place today, which when followed, constitute laboratory-based scientific proof of a theory. Beyond this, Koch was a technology innovator, teaming up with the Carl Zeiss optical company, whose lenses, in combination with specialized tissue stains and fixed culture mediums, allowed Koch to visualize and describe M. tuberculosis.

The third innovator was Joseph Lister (1827-1912), a professor of surgery at Edinburgh.  Thanks to the development of ether and nitrous oxide in the 1840s, pain management intra-operatively was under partial control. Improving techniques and tools helped control blood loss. But post-operative infection remained a persistent and deadly threat. Viewing the work of Pasteur and Koch, Lister recognized the possibility that contamination with microbes might be the cause. In carefully designed studies, employing hand scrubbing, sterilization of tools, and spraying the patient with carbolic acid, rates of post-operative sepsis declined. Other colleagues added sterile gowns, gloves, and masks, merging these added measures with Lister’s support.

 Arguably, the life-saving “Germ Theory” was the work product of complementary insights and serial incremental progress. It might then be reasonable to ask, of the $29 billion funded 729 digital health tech US-based startups in 2021, how many represent additive and progressive insights that might eventually lead to game-changing advances in the health of America?

Scott Barclay appears to be mining this same territory. In Forbes, he says, “The green shoots of the past 10 years are turning into new vibrant ecosystems that are growing, but young. We are early in what may turn out to be a two-decade epoch of super innovative ideas, strong founders with execution experience bringing change to a $4T sector of the economy that has been sclerotic and in many parts oligopolistic. The majority of the largest digital health companies in 2040 public markets have not yet been started.”

Does Digital Health Technology have a “Famous Trio” in the making to link infrastructure, AI diagnostics, and evidence-based health? Who are they, and how do they complement each other?

Mike Magee, MD is a Medical Historian and Health Economist, and author of  “CodeBlue: Inside the Medical Industrial Complex.“

Komodo Health: Chan Zuckerberg Initiative Partnership, Rare Disease Patients, and… IPO Rumors?

By JESSICA DaMASSA, WTF HEALTH

Komodo Health has been catching lots of buzz lately thanks to a recently announced partnership with the Chan Zuckerberg Initiative’s Rare as One Network AND some chatter about a possible upcoming IPO that seems to have come from its own CEO Arif Nathoo. To check what’s true and what’s false, we sat down with Komodo’s President, Web Sun.

What did we learn? Well… a lot. The core of both the CZI partnership and the future of Komodo’s business is their Healthcare Map, which Web says draws together the data of more patients (300M+), across a longer period of time (as long as 6-years for some cohorts) than anyone else in the industry. But, this comprehensive, longitudinal view of the patient journey is only part of Komodo’s usefulness – the other part is how they use that dataset to surface insights.

As Web talks about how all this will manifest itself in the context of rare diseases to benefit the patients who belong to the 60 different advocacy organizations that will now have access to Komodo thanks to the CZI partnership, it’s not only easy to understand how comprehensive data can help rare disease patients, but how this is a metaphor for helping all patients across all manner of healthcare. Shortening the diagnostic journey, better understanding symptom patterns and comorbidities, matching patients to specialists highly experienced and adept at managing their conditions, quickly bridging connections to novel therapies and clinical trial opportunities… how beautiful that this will be offered to patients who need it most. The market potential, however, lies in how it will be scaled-up-and-out to the rest of us – which brings us back to those exit rumors! Tune in to hear what Web has to say about his co-founder’s comments, and how he believes Komodo is differentiated from other big data businesses in the analytics space.

After the Crash

By JEFF GOLDSMITH

These are grim days for innovative healthcare companies.  The health tech and care innovation firms mature enough to make it to public markets have been eviscerated in the ongoing market correction. As of January 29, 2022, high fliers like One Medical (down 83% from peak), Oscar (down 83%), Bright Healthcare (down 85%), Teladoc (down 77% but still selling at 6X revenues!), and AmWell (down 90%) are the tip of a much larger melting iceberg.    The dozens of digital health unicorns (e.g. pre-public companies valued at more than $1 billion) and their less mythical brethren, into which investors poured more than $45 billion during 2020-2021, are sheltering in the comparative safety of VC/Private Equity balance sheets. They are protected from investor wrath until those firms’ limited partners force a revaluation of their portfolios based on the market value of their publicly traded comparables.   

Yet it is the next moves that these innovative firms and their equity holders make that will determine whether these firms realize their full transformative potential or fade into insignificance. The Gartner Group, which tracks the technology industry generally, popularized the notion of the Hype Cycle- a seemingly universal trajectory that tech innovations and the firms that produce them follow (see below).   

                                                    The Gartner Hype Cycle

Everyone seems to focus on the colorful first phase of this cycle- the inflating and deflating part- where an innovation rises on a wave of the adulatory press (and breathless futurist punditry), then crashes ignominiously into the Slough of Despond.  A classic example was the Apple iPhone’s ill-starred great uncle, the Apple Newton, which launched in 1993 and crashed shortly thereafter.

For founders and investors, as well as customers, however, it is the less visible succeeding phases that determine if the innovation survives and the firms that produce them become ubiquitous and indispensable parts of our lives.  The rising initial phase of Gartner’s Hype Cycle is driven by the question “Is it cool”?, mediated by hyperactive media and Internet buzz.    The inevitable crash, on the other hand, is almost always driven by the troublesome real-world question,  “Does the product actually work as advertised?” Analysts, writers, and, most importantly, customers press uncomfortable questions about not only functionality, but also reliability, affordability, stickiness, and “value for money”.

How do firms survive the crash and climb Gartner’s “Slope of Enlightenment”?  This is the unglamorous “pick and shovel” part.  If the sticky “product integrity” issues (does the product actually work?) are resolved, then a host of important questions challenge the firm, its founders, and owners, which answers the crucial question:  whether it is a real business:   

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