Category: Health Tech

Digital Health: Avoiding a Second TechLash!


As John Glaser argued a recent piece in Harvard Business Review, many health care executives seem have been blinded by the shiny object that is digital health. Forgive us for a powerful feeling of déjà vu. Since the last major digital innovation in health, the electronic health record, fell far short of expectations and probably generated a negative return on investment for many care systems, it is worth thinking about to avoid the same fate with this new wave of digital tools.

As COVID raised concerns about the safety of in-person visits to clinics and physicians’ offices, digital health visits soared during the spring. Traditional health care organizations large and small–hospitals, health plans, physician groups–have since struggled to integrate digital technology effectively into their care offerings and management structure. 

In other industries, digital technology acts as a  force-multiplier for the core business–it helps firms make much more efficient use of their workforce, customers’ time and physical capital. Amazon used its cloud-based IT infrastructure and sprawling  digital “catalog” to compress time to customer fulfillment, eliminating the need for customers to visit stores to get what they needed. And by leveraging other firms’ inventories, it reduced the need to purchase, warehouse and physically handle more than half of what they sell. 

Similarly, digital health applications should not be thought of as a “new product”. Indeed, the capability for digital visits and monitoring and digitally enabled remote work has existed (some say, languished)  for almost two decades. Digital health tools should be thought of as force multipliers for the trusted relationships at the heart of healthcare. Clinicians can be in two places at once-  transforming how patients and clinicians interact by removing both time and physical location as constraints. At the same time, telework enables healthcare enterprises to make more efficient use of scarce clinical and administrative person-power,  shrinking their physical capital footprint. 

Achieving savings in clinician time and reduction in overhead were the twin drivers of Kaiser Foundation Health Plans’ successful digital health strategy. Kaiser’s two-decade long investment in virtual care has resulted in more than half of Kaiser subscriber interactions with their caregivers (preCOVID)  being electronic. The savings in reduced clinic time and overhead dropped through directly to Kaiser’s bottom line by minimizing the consumption of resources inside Kaiser’s fixed capitation pool. But you do not need to be fully, or even partially, capitated to reap digital health’s benefits.

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#Healthin2Point00, Episode 176 | Optum acquires Change & deals for Hinge, Liva, and Metronom

Insurgents have stormed the Capitol and we’re still here to talk about health tech deals. On Episode 176, Jess and I discuss Optum acquiring Change Healthcare in a $13.5 billion deal, bringing it back to Jess’s interview with CEO Neil Crescenzo bout what Change Healthcare does with the connective tissue of big healthcare. Hinge gets $300 million in a Series D – this is valued now at $3 billion. Finally Liva Healthcare, which is like European Livongo, raises €24.5 million and Metronom Health gets $22.2 million for yet another CGM. —Matthew Holt

THCB Gang, Episode 37, Jan 7

Episode 37 of “The THCB Gang” was live-streamed on Thursday, Jan 7.

You can see it below! Matthew Holt (@boltyboy) was joined by regulars: data & privacy expert Deven McGraw, (@Healthprivacy), Patient entrepreneur extraordinaire Robin Farmanfarmaian (@RobinFF3) & consultant/author Rosemarie Day (@Rosemarie_Day1). Balancing them out will be the Y chromosome owners futurists Ian Morrison (@seccurve), Jeff Goldsmith & THCB regular Kim Bellard (@Kimbbellard)

Other than than the Duck Dynasty insurrection & mob riot in the Capitol, the Georgia senate race, most of the world on COVID lockdown, the vaccines, the new Administration, and wishing each other a happy new year, there was little to talk about….

If you’d rather listen, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels

#Healthin2Point00, Episode 175 | Haven, Color, RapidSOS & more

Today on Health in 2 Point 00, Jess and I chat about Haven finally closing its doors. On Episode 175, we cover Color raising $167 million growing fast as the major COVID tester in the Bay Area and 23andMe scoring $82.5 million. RapidSOS quietly raised another $51.2 million on New Year’s Eve, Fruit Street Health raises $22 million for chronic condition management, and finally Centene acquires Magellan for $2.2 billion. —Matthew Holt

No Safe Haven to be Found!


Can you wrestle a collusive, private, profiteering Medical-Industrial Complex to the ground by throwing more private entrepreneurs at it? Apparently not.

The very public collapse of Haven – the widely heralded health joint venture of Amazon, Berkshire Hathaway, and JP Morgan Chase – is a case in point. After three years, it is unclear whether they were a public-spirited triad trying to bathe efficiency into our bizarre employer-based health insurance scheme, or becoming predatory investors in one of the most profitable segments of our national economy.

When launched nameless in January, 2018, most of the focus was on the three amigos – Warren Buffett, Jamie Dimon, and Jeff Bezos. The linking of hands of the nation’s biggest technology power player, her most revered and respected investor, and her highest ranked financial all star, was impossible to ignore.

What were they up to? No one was quite sure. But there was enough concern about disruption of a sector controlling nearly 1/5 of the American economy that prices of CVS Health, Walmart, Cardinal Health and Express Scripts dove south.

This week, with the announcement of the non-profit joint venture’s collapse, analysts wasted no time piling on. As one said, “Haven had a rocky three years, running up against vague marching orders, a lack of direction, and obstacles inherent to the healthcare landscape.”

But it didn’t start that way. Warren Buffett presented health care that day as “a hungry tapeworm on the American economy.” Jamie Dimon noted that we pay twice as much for poorer quality care than other developed nations. And Jeff Bezos suggested that it was time for PBM’s and insurers to trim their sails.

By the summer of 2018, the three signaled they were seriousby hiring widely acclaimed health leader, Atul Gawande, as their CEO. As Buffett said, “Jamie, Jeff, and I are confident that we have found in Atul the leader who will get this important job done.” It would be another nine months before they could settle on a name for the venture – Haven (as in safe haven for their 1.3 million combined employees).

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Health Care: Don’t Be Evil


Google’s corporate motto – written in its original Code of Conduct — was once “Don’t be evil.”  That softened over time; Alphabet changed it to “Do the right thing” in 2015, although Google itself retained the slogan until early 2018.  Some Alphabet employees think Google/Alphabet has drifted too far away from its original aims: they’ve formed a union in order to try to steer the company back to its more idealistic roots.

Parul Koul and Chewy Shaw, two Alphabet software engineers, announced the Alphabet Workers Union in a New York Times op-ed, vowing to live by the original motto, and to do what they can to ensure that Alphabet and its various companies do as well.  They assert: “We want Alphabet to be a company where workers have a meaningful say in decisions that affect us and the societies we live in.”

It’s past time that health care workers, including physicians and executives, stood up for the same thing.

Ms. Koul and Mr. Shaw cite several grievances, including payouts to executives accused of sexual harassment, the firing of a leading AI expert over her efforts to address bias in AI, and company efforts to “keep workers from speaking on sensitive and publicly important topics.”  Doing the work, even doing it well and being well paid for it, is not enough:

We care deeply about what we build and what it’s used for. We are responsible for the technology we bring into the world. And we recognize that its implications reach far beyond the walls of Alphabet.

Their goal is for Alphabet “to be a company where workers have a meaningful say in decisions that affect us and the societies we live in.”  Alphabet, they say, “has a responsibility to prioritize the public good. It has a responsibility to its thousands of workers and billions of users to make the world a better place.” 

Investors may not quite agree.

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Goodbye, 2020. Hello, 2030


2020 is almost over; thank goodness.  It has been one of the strangest, and longest, years most of us have ever endured.  We’ve all probably known someone who contracted COVID-19; many of us have had lost loved ones from it.  Most of us have had to make drastic changes to our lives – masks, social distancing, limits on family visits, eating out, concerts, or trips among them.  No, 2020 can’t get over fast enough.

I was struck, though, by a quote I recently read.  Loren Padelford, a vice-president at Shopify, told The Wall Street Journal: “Covid has acted like a time machine: it brought 2030 to 2020.” 

Gosh, I hope not.

Mr. Padelford went on to explain: “All those trends, where organizations thought they had more time, got rapidly accelerated.” These trends include the shift from physical to online, further decline of cash, and work from home/remote learning.  Individuals/families without broadband are being left behind; companies not investing in IT and logistics may not be here in 2030.  Healthcare has not been exempt from these trends.

The pandemic has illustrated both the great strengths and the great weaknesses of the U.S. healthcare system.  Among the strengths are the courage and professionalism of our health care workers, the innovation that has delivered several vaccines within a matter of months, and the ability to adapt to an existing but underutilized mode of care in telemedicine. 

Among the weaknesses, of course, are the lack of planning and coordination that has doomed testing, contact testing, and supply of personal protective equipment; the patchwork quilt of insurance coverage that has left even more without coverage (e.g., due to loss of job based coverage and/or lack of Medicaid expansion); the refusal of many to act in their own best health interests, such as not wearing masks or taking vaccines

Legislators/regulators may be taking bold actions like throwing money at healthcare organizations, vowing that the COVID testing and vaccines are “free,” and loosening restrictions on telemedicine, but the underlying disfunction in our healthcare system has never been more visible.  We don’t test enough or fast enough.  We have sick people on gurneys in gift shops, we have dead people in refrigerator trucks, and we still have people crushed by their healthcare bills.

Please, don’t let this be a picture of 2030.

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Need to Choose a Doctor? What Does AI Think About the Choices?


Tens of millions of Americans rely on consumer experience apps to help them find the best new restaurant or the right hairdresser. But while relying on customer opinion might make sense for figuring out where to get dinner tonight, when it comes to picking which doctor is best for you, AI might be more trustworthy than the wisdom of the crowd.

Consumer apps provide us with rich data categories that often take into account preferences, from location to free wi-fi, to help users narrow down choices. Navigating your health insurer’s network of physicians is a different proposition, and some of the popular ranking systems reportedly have significant limitations. Doctors are often categorized by specialty, insurance, hospital, or location, which may be effective for logistics, but fail to take into account a patient’s unique health conditions and say very little about what an individual patient can expect in terms of health outcomes. Research from my company Health at Scale shows that 83% of Medicare patients seeking cardiology care and 88% of cases seeking orthopedic care may not be choosing providers that are highly rated for best predicted outcomes based on each patient’s individual health conditions. 

Deep personalization is exactly what physicians, health systems, and insurers need to offer patients to improve outcomes and lower costs across the board. A study using our data recently published in the Journal of Medical Internet Research sought to quantify how consumer, quality and volume metrics may be associated with outcomes. Researchers analyzed data from 4,192 Medicare fee-for-service beneficiaries undergoing elective hip replacements between 2013-2018 in the greater Chicago area, comparing post-procedure hospitalization rate, emergency department visits, and total costs of care at hospitals ranked highly by popular consumer ratings systems and CMS star ratings as well as those ranked highly by a machine intelligence algorithm for personalized provider navigation.

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Health in 2 Point 00 — with no video!


Due to @jessdamassa being lost in America and my totally crap internet in the Sierras, there is no #HealthIn2Point00 this week.

So I’m going to write out a few things we would have said:

1. @OscarHealth raises another $140m and files to IPO. SPAC or no SPAC, a bunch of these startup health plans are going to try to get out the door while the window is open! 420,000 members ain’t a lot–I mean there are 5-6 Medicaid plans bigger than that in CA alone! I still predict someone big buys them but whether pre- or post crash I don’t know.

2. @LyraHealth is raising another $175m (apparently). That’s the 3rd trip to the well THIS YEAR! Mental health is sexy these days. Just how many online mental health cos can make it? I think Lyra needs to use these $$ for automated self-service tech, cos psychiatrists don’t scale, and they currently sell themselves as having a better network than anyone else.

3. @kyruus buys @HealthSparq (from @Cambia). No $$ announced. Unclear why a company that makes $$ routing patients to doctors within systems (& prevents “leakage”) needs a transparency tool that explains who’s charging what. But maybe an overall pivot to serving health plans?

4. @h1insights raises $58m (total is over $70m). It’s a database of doctors sold to drug companies to help them better target their marketing. Good to know that in the new world of health tech, helping big pharma push pills is a reliable way to make bank.

OK, so that’s what I would normally have covered in 2 mins on #HealthIn2Point00 yes, it’s much better with @jessdamassa on video and running the show while poking fun at me. Hopefully the internet works next week! #MerryChristmas2020

Olive CEO Sean Lane on 2020’s Big Numbers: 3 Funding Rounds, $450M, & a 5-Point Plan for the Future


Arguably 2020’s hottest health tech startup, Olive ( closed THREE funding rounds this year, totaling $450M and valuing the company at $1.5B. Backed by a “who’s who” of technology, healthcare, and health tech venture capital, Sean Lane, CEO, clues us in about just what makes Olive so damn fund-able. The company boasts a “healthcare AI workforce” that tackles all the back-office processes hospitals use to run their organizations. This is not sexy stuff — filing and tracking insurance claims, ordering inventory, managing suppliers, etc. What’s hot, though, is how Olive is able to automate these tasks (according to Sean, currently many of these processes are handled by spreadsheets and faxes), “learn” as she’s doing it, and create efficiencies and cost savings across all of Olive’s 600+ hospital client-base as she does. Could this be the end of “admin expense” in healthcare? If what Olive is currently doing isn’t enough, we dive deep into Olive’s strategic plan — ALL FIVE POINTS OF IT (!) — to learn what’s next. My favorite? Number 3. The one where Olive starts to INSTANT PAY CLAIMS to completely disrupt hospital cash flow.


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