Everything you always wanted to know about the Health Care system. But were afraid to ask.
Category: Matthew Holt
Matthew Holt is the founder and publisher of The Health Care Blog and still writes regularly for the site and hosts the #THCBGang and #HealthInTwoPoint00 video shows/podcasts. He was co-founder of the Health 2.0 Conference and now also does advisory work mostly for health tech startups at his consulting firm SMACK.health.
Anyone who follows me knows that I’ve been questioning whether digital therapeutics are real and more importantly whether the people building and trying to sell them are simply trying to replicate the American drug pricing model–patent, protect, prescribe & price gouge. So who better to have this conversation with than the person in charge of explaining and selling the notion of digital therapeutics to the world? Megan Coder is Executive Director of the Digital Therapeutics Alliance. She graciously and bravely agreed to talk to me. Who won the argument? You’ll have to watch to decide, but I found our discussion to be a lot of fun and very interesting and I hope you will too – Matthew Holt
The transcript is below
Matthew Holt:
Hi, it’s Matthew Holt with a THCB spotlight. I’m here with Megan Coder. Megan is the executive director of the Digital Therapeutics Alliance. And we’re here to talk about this thing called digital therapeutics, as to what they are, what the alliance does and whether they really exist and how we should treat them. Megan, thanks for coming on. I know we’ve done a little bit of sparring online and in-person, but I’ve never interviewed you. So I’m looking forward to this. So how are you doing?
Megan Coder:
Good. It’s more fun to spar in-person, but I miss the in-person aspect.
As if one consumer digital health company with an $18.5B exit wasn’t enough, Livongo founder Glen Tullman has decided to give the transformation of healthcare another go – this time as Executive Chairman & CEO of Transcarent. Matthew Holt and I sit down with Glen to hear about the “new kind of experience” that Transcarent is offering self-insured employers and their employees: one focused on providing unbiased information, guidance for accessing high-value healthcare, and an at-risk model that promises to share back the financial benefits associated with better healthcare decision-making.
Could you consider Transcarent an aggregator, a healthcare navigator-PLUS, or is it more like a next-gen health plan that does everything but process claims? Glen talks about how his team was “asked” to jump into providing a better experience for this kind of healthcare service, details what the company needs next, and explains the role of Bridge Health, which merged with Transcarent in October 2020 when the company closed its $44M Series A. Familiar investors, General Catalyst and Glen’s own 7Wire Ventures, have led the funding for Transcarent and we find out if there will be any additional support from the Health Assurance Acquisition Corporation (the SPAC that Glen launched in partnership with General Catalyst’s Hemant Taneja and others) that could potentially provide a vehicle for taking the business public. And, what about Teladoc Health? With a seat on TDOC’s Board, does Transcarent’s commitment to offering “unbiased” direction to the best possible healthcare put Glen into a conflict of interest? This is one catch-up chat you’re not going to want to miss!
Andreesen Horowitz’s digital heath investor Julie Yoo has been building quite the theory of the present and future of health tech. I am going to try to write up a longer response to her but first, please view her presentation on the New Tech Stack for Virtual-First Care — a compelling 8 minute watch. And then have a quick read about how I am (trying to) put her in context.
Her first argument is that the digital services that you need to run health care (things like accounting/revenue management, network management, credentialing, pharmacy, etc, etc.) are getting really good. That means that startup digital heath companies can build services really quickly. No argument there. The second part of her argument is that incumbent organizations will also use these tools (actually already are using these tools) to improve their offerings.
Her argument is somewhere in the middle of three themes I’ve been banging on for a while.
My first argument is that too much VC money has been spent on new tech companies intending to prop up the incumbents and the incumbents by definition can’t change to become the type of virtual-primary care first chronic care management consumer friendly organizations that we need. I called this the Lynne Chou O’Keefe fallacy (which is why Julie wants one of her own!) and wrote it up on THCB about a year ago.
The second is the rather longer theme that I (with Indu Subaiya) have been banging on about called “Flipping the Stack”. The basic idea is that health care services now have the potential to go from an event-driven, encounter-driven acute-care delivery model to one where technology is able to measure, manage, message and monitor patients wherever they are, and that virtual services and physical interventions are layered over the top.
The third is my idea about the “continuous clinic” which is an attempt to describe the activities that an organization needs to run a 24/7 patient management organization. (I’ve presented on this many times but haven’t totally written it up–a version of how it might work for COVID patients is here).
Somewhere in what Julie is doing and in my fumbling towards new models is the idea of what a new health system will do and what it will look like.
Of course the related question is who will be the players? While we have United Healthgroup buying anything that moves and the incumbent hospital systems collectively sitting on an Apple/Google sized mountain of cash reserves, it’s hard to see the current system being changed dramatically by the people running it now.
I was a little surprised to find out that PointClickCare, a Canadian-based EMR that has a big market share in SNFs and long term care was buying Collective Medical, a Utah-based interoperability-sniffer (that’s a term I just made up). Collective specializes in extracting data from acute care EMRs to find where patients have received care (think: ERs), and transmit that information (think: meds & diagnoses) to other providers. (Press Release here). The logic is that the “post acute” landscape is getting more complex and better integrated with the rest of care, and Collective Medical will help get PointClickCare’s SNFs and the hospitals & home care agencies they work with much more accurate tracking of patient movements between them. Given the mess that sector is experiencing with COVID-19 right now, this should be a good idea.
I spoke to PointClickCare’s Dave Wessinger & Collective Medical’s Chris Klomp about the deal. They of course wouldn’t tell me the price, but Blake Dodge at Business Insider sniffed it out and thinks it’s $650m. Moody’s reports that PointClickCare raised $550m in debt to help–although I doubt those cunning Canucks handed over too much of that cash, and they certainly sound like they want to keep the whole Collective Medical team around.
Catalyst @ Health 2.0, supported by professional services firm Wipfli, is launching a survey about the state of Digital Health. We hope to get a comprehensive analysis of the impact of COVID-19 on digital health companies and the rest of the ecosystem. This survey should take under 8 minutes to complete (and probably less). For your time we will get you a copy of the results when they are released. As an added bonus TWO respondents drawn at random who complete the survey will get advertising for their company for 6 months on The Health Care Blog (worth $5,000).
We are interested in hearing from leaders working in digital health companies, or those connected to digital health in health systems, payers, life sciences, consulting or investment companies.
NOTE–None of the data from this survey will be shared by Catalyst @ Health 2.0 (even with our friends at Wipfli) other than as aggregate survey results. So you can be assured that your answers are completely confidential.
Matthew Holt is Co-Chairman of Catalyst @ Health 2.0 & Publisher of THCB
Episode 27 of “The THCB Gang” was live-streamed on Thursday, October 8th! Watch it below!
Matthew Holt (@boltyboy) was joined by some of our regulars: health futurist Ian Morrison (@seccurve), WTF Health Host Jessica DaMassa (@jessdamassa), writer Kim Bellard (@kimbbellard), patient & entrepreneur Robin Farmanfarmaian (@Robinff3), health economist Jane Sarasohn-Kahn (@healthythinker), and fierce patient activist Casey Quinlan (@MightyCasey)! We covered the recent presidential & vice-presidential debates, Trump on steroids, what the future of the ACA looks like, how will virtual care change public health, and more.
If you’d rather listen to the episode, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels — Zoya Khan (@zoykskhan)
Episode 11 of “The THCB Gang” was live-streamed on Thursday, May 27th and you can see it again below
Joining me were three regulars, patient safety expert Michael Millenson (MLMillenson), writer Kim Bellard (@kimbbellard), health futurist Ian Morrison (@seccurve), and two new guests: digital health investment banker Steven Wardell (@StevenWardell) and MD turned physician leadership coach Maggi Cary (@MargaretCaryMD)! The conversation was heavy on telemedicine and value based care, and their impact on the stock-market, the economy and the health care system–all in a week when we went over 100,000 deaths from COVID-19.
If you’d rather listen, the “audio only” version is preserved as a weekly podcast available on our iTunes & Spotify channels — Matthew Holt
Episode 10 of “The THCB Gang” was live-streamed on Thursday, May 21th
Joining me were regulars: writer Kim Bellard (@kimbbellard), policy expert Vince Kuraitis (@VinceKuraitis), patient advocate Grace Cordovano (@GraceCordovano), radiologist Saurabh Jha (@RogueRad), employer consultant Brian Klepper (@bklepper1), Deven McGraw (@healthprivacy) and a guest, former ONC Consumer head Lygeia Riccardi, now at Carium Health (@Lygeia)! The conversation moved onto the new normal of telehealth, how much things would change in the future, and what the story with testing and opening up would look like. You can see the video below
If you’d rather listen, the “audio only” version is preserved as a weekly podcast available on our iTunes & Spotify channels — Matthew Holt
Smart Quarantine as the next step to combat COVID-19
As the nation and the world grapple with the impact of the COVID-19 pandemic, there is growing consensus among experts that we need a sustainable system of specific lockdowns, social distancing, and extreme resource provision in terms of labor, ventilators and PPE to arm hospitals and health providers as they deal with the onslaught of patients. Even while some American states start to slowly open up, we need a system that can manage COVID-19 over the coming months and years–especially if this Fall brings a second wave.
Writing in the NY Times on April 7, Harvey Fineberg and colleagues summarized an as yet overlooked issue. There are many patients who may or do have COVID-19, but are not sick enough to need hospital care, or who have been discharged from hospitals. We need to keep these patients away from hospitals but if they shelter in place in their household there is a high risk they will infect their families or housemates. This likelihood is even higher if they are homeless, incarcerated, or living in other group arrangements.
Instead of sheltering in place at home Fineberg and colleagues suggest those patients enter “smart quarantine” in temporary isolated accommodation, such as hotels or college dormitories, where they can be looked after by medical teams and tested semi-regularly. But whether they are at home or in temporary accommodation, leaving those patients with minimal support to be tested at the end of 14 days is not enough. A significant proportion of them will develop COVID-19 and some of those are going to be admitted to hospital. In addition several patients have been discharged from hospital, but still need to be monitored. We are going to need to be able to closely monitor a significant number of people even while the majority of them will need relatively limited amounts of care.
The good news is that we have had a couple of decades of development of the technologies and services required to both care for and monitor these patients, while keeping the main resources such as ventilators for those in hospitals. Pulling together available technologies and services, we will be able to quickly and accurately manage these patients, ensure their best outcomes, and spare scarce hospital resources. There are seven main components of this process, which I am calling “smart care in quarantine.”
The Process
Upon either a positive test for COVID-19 or a suspicion of those symptoms awaiting testing, patients can be admitted to isolation at home or in, say, empty hotels.
1. Monitoring equipment. Patients can be given FDA regulated monitoring devices which will work using bluetooth and WiFi (or 4G cellular). The main monitoring tools required are:
Matthew Holt talks to David Smith who is working on the Medicaid Transformation Project at Avia, which is looking at how hospitals & health plans can improve health outcomes and in turn, lose less money on Medicaid programs. David talks about the tremendous amount of capital being poured into Medicaid, and how the problem is only getting worse. So the focus of the project is trying to reduce healthcare delivery organizations’ spend on these services. At Avia, they are trying to take the best of model science and the best of digital capabilities to help create more efficient care models for their clients as well as reduce costs.
Zoya Khan is the Editor-in-Chief of THCB and a Strategy Manager at SMACK.health
