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THCB Gang Episode 48, Friday March 26

This week (for one week only) #THCB Gang was on Friday. Matthew Holt (@boltyboy) was joined by regulars medical historian Mike Magee (@drmikemagee), Fard Johnmar (@fardj), from digital health consultancy Enspektos, THCB regular writer Kim Bellard (@kimbbellard), and employer health expert Jennifer Benz (@jenbenz). Sadly Casey Quinlan was ill and couldn’t join last minute.

It was an extraordinary week, especially in terms of digital health investment. We talked a bit about that and a lot more about high deductible health plans, whether the filibuster will be busted, and what that might mean for Medicare for all. A wide ranging and big picture conversation!

The video is below but if you’d rather listen to the episode, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels. 

The Drive To Standardize Records: Progress or Chaos?

By MERLE BUSHKIN

I recently asked my Primary Care Physician’s Medical Records Department for copies of my records covering the last eight months during which I had four office visits, five blood draws, and nine brief email exchanges. I should add that my PCP uses one of the two most popular EMR systems.

To my astonishment, I received 274 pages of digital records (PDFs).  I’ve heard of “record bloat” but this was an explosion!

When I analyzed their contents, I found that 59 pages were legitimate documents containing “original” information and data.  22 Pages were Office Notes — or what are often called Progress Notes —applicable to my four visits; 14 were reports of my five blood draws; 23 included my nine email exchanges. In short, they were “normal” — what you’d expect from the number of contacts I had with my doctor and his lab.

But the remaining 212 pages shocked me. They were totally unexpected and, in my opinion, completely unnecessary! They were a slicing, dicing and recasting of the contents of the basic 59 pages! They included 82 pages of “Ambulatory Visit Instructions” (which I was never given), and 62 pages listing my immunizations, meds, problems, procedures, orders, and past medical, social and family histories — all of which are covered in my providers’ Office Notes!

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Nanoparticles On My Mind

By KIM BELLARD

Nanoparticles are everywhere!  By that I mean, of course, that there seems to be a lot of news about them lately, particularly in regard to health and healthcare.   But, of course, literally they could be anywhere and everywhere, which helps account for their potential, and their potential danger.

Let’s start with one of the more startling developments: a team at the University of Miami’s College of Engineering, led by Professor ****@***mi.edu“>Sakhrat Khizroev, believes it has figured out a way to use nanoparticles to “talk” to the brain without wires or implants.  They use “a novel class of ultrafine units called magnetoelectric nanoparticles (MENPs)” to penetrate the blood-brain barrier. 

“Once the MENPs are inside the brain and positioned next to neurons, we can stimulate them with an external magnetic field, and they in turn produce an electric field we can speak to, without having to use wires,” Professor Khizroev explained.  A special magnetic helmet would communicate with the MENPs, in real-time. 

Other efforts, such as Elon Musk’s Neuralink, have been looking at using implants to achieve the brain-computer interface, but Dr. Khizroev is skeptical of this kind of approach:

Other efforts have used external instruments like microelectrodes to try to solve the mysteries of the brain, but because of its complexity and difficulty in accessing, such methods can only go so far.  There are 80 billion neurons in the human brain, so imagine how difficult it would be to attach 80 billion microelectrodes to access every single neuron. The only way to truly tap in is wirelessly—through nanotechnology.

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THCB Gang Episode 47, Thursday March 18

Joining me , Matthew Holt (@boltyboy), on THCB Gang this week were fierce patient activist Casey Quinlan (@MightyCasey), consumer advocate & CTO of Carium, Lygeia Ricciardi (@Lygeia), THCB regular authors radiologist Saurabh Jha (@roguerad) & cardiologist Anish Koka (@anish_koka), with futurist Jeff Goldsmith on hand to keep us all honest. We started with Casey’s current health journey and Anish’s inability to get vaccines for his clinic — and this moved to a really fun and raucous discussion about whether the public sector can work in health care, whether we need to mandate the vaccine and if America is becoming a failed state! Great stuff!

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

Glen Tullman’s Return to Digital Health: In-Depth Chat on New CEO Role at Transcarent

By JESSICA DaMASSA, WTF HEALTH

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!

Ofer Leidner, Happify Health

by MATTHEW HOLT

Happify Health is a online mental health company that is focused almost exclusively on scaling care by offering self-service tech solutions across the patient journey. After R&D starting in 2012, they’ve been scaling since 2017 and now are working with large employers and big health plans. What they don’t do is have their own therapists or psychiatrists. This is an interesting approach and probably much more scalable than many of their competitors. Today they raised $73m more to build out their solutions. I talked to Happify Health’s President, Ofer Leidner about how far they can go with automated self-service. He thinks it’s a long way.

Roblox and Healthcare’s Metaverse

By KIM BELLARD

As neither a gamer nor the parent of a gamer, I’ve been proud that I’ve stayed even mildly in touch with the cultural phenomenon that gaming is.  I’ve written about, for example, the Metaverse, Fortnight, and e-sports.  Still, I somehow managed to be completely oblivious to the existence of Roblox, until they went public this week and was valued at $45b, larger than Electronic Arts (which I had heard of). 

Once again, I think there are lessons for healthcare.

P.J. McNealy, CEO of Digital World Research, described Roblox to NPR as: “Minecraft meets Nintendo, which meets Lego and mobile phones enable a whole bunch of it.”  Whatever the metaphor, Roblox is booming.  It was valued at $4b a year ago, but the pandemic was very, very good for it. 

Half of America children use Roblox.  Two thirds of its users are 16 and younger, and most of them were spending lots of time at home last year.  It is now estimated to have 37 million unique daily users, spending some 30 billion hours on the site last year.  It is available in 180 countries, in 11 languages.

What makes Roblox particularly unique is that it is not a game developer; it is a platform where users develop the “experiences”.  Roblox describes its mission thusly:

Roblox’s mission is to bring the world together through play.  We enable anyone to imagine, create, and have fun with friends as they explore millions of immersive 3D experiences, all built by a global community of developers.

It claims 8 million developers have created 20 million experiences — and that it paid over $300 million to them.  The games are free but users can buy and spend an in-game virtual currency (Robux), which can be exchanged for actual money (Roblox shares 30% of the revenue with developers).  At least one developer made over $1 million in a single year; over 1200 made at least $10,000, with over 300 making over $100,000. 

Mr.  McNealy believes the IPO will allow Roblox significant expansion:

This money will either give them an opportunity to build more content for the for the platform or to go to adjacent platforms like music or partnering with Spotify or movie service.  That’s where this is going to go.

CEO and co-founder David Baszucki isn’t content with the younger market, wondering: “So how do we make it possible for Roblox to connect with everyone in the world?”  Alex Hicks, cofounder of Roblox studio Red Manta, sees such potential, telling Polygon: “Lots of kids already know what Roblox is, but they’re just scratching the surface with the older audience.” 

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THCB Gang Episode 46, Thursday March 11

THCB Gang featured lawyer & privacy expert Deven McGraw, (@Healthprivacy), Health IT girl and WTF Health Host Jessica DaMassa (@jessdamassa), and policy expert consultant/author Rosemarie Day @Rosemarie_Day1). We’ve had far too many Y chromosomes on lately but also joining Matthew Holt (@boltyboy) for this one will be futurist Ian Morrison (@seccurve) and Fard Johnmar (@fardj), from digital health consultancy Enspektos.

We dove into the health care implications of the new $1.9 trillion stimulus bill, and had a great chat about where health and digital health go next.

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

THCB Gang Episode 45, Thursday March 4, 1pm PT – 4pm ET

Joining me, Matthew Holt (@boltyboy), on this week’s THCB Gang will be THCB regular writer Kim Bellard (@kimbbellard), medical historian Mike Magee (@drmikemagee),  policy & tech expert Vince Kuraitis (@VinceKuraitis),  patient safety expert and all around wit Michael Millenson (@MLMillenson), and consumer expert and current President of the Medical Board of California, Denise Pines.

Vaccines at warp speed, some “Neanderthal” state governors opening up, but also a pandemic bill passes the house with some health policy implications. Plus lots of fun and games in the world of digital health and startup health plans. We should have something to discuss!

You can see the video below live and the audio will be on our podcast channel (Apple/Spotify) from Friday

Wanna Buy Some Bitcoin

By KIM BELLARD

To healthcare organizations, digital currency is the thing you’re forced to deal with when your systems are held for ransomware.  To the rest of the world, it’s increasingly starting to look like the future.

Tesla caused somewhat of a stir last month when it disclosed that it had bought $1.5b of bitcoin.  It also said it would start accepting bitcoin payments for its cars.  CEO Elon Musk added to the furor, saying: “I do at this point think bitcoin is a good thing. I’m late to the party, but I am a supporter of bitcoin.” 

Most of us are late to the digital currency party. 

Bitcoin’s market cap hit $1 trillion in mid-February, although it now hovers just over $900b, with Ethereum another almost $200b.  Tesla is making more money from its bitcoin investment than from its core businesses.  In the scheme of global financial markets, digital currencies are still small, but are not something any CFO should be ignoring.  

Tesla is not the only major company accepting digital currencies; Overstock, Starbucks and Twitch do, as three wildly different examples.  Twitter is thinking about paying vendors or even employees with bitcoin.  Facebook expects to launch its own cryptocurrency this year. 

I’m not aware, though, of any major healthcare companies accepting or paying with digital currencies.  No Tesla-type breakthroughs in healthcare. 

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