Andrea Ippolito has combined her personal experience as a mum struggling with breast feeding, and her professional career as an entrepreneur and engineer at Athenahealth building integrations with EMRs. She’s now the CEO of Simplifed which has built a network of lactation consultants, and much more, and has placed it in the workflow of that most important part of health care — pre and post partum. How did she do it and what’s it like? She told and showed Matthew Holt.
THCB Gang Episode 142, Thursday October 31
Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday October 31 at 1pm PST 4pm EST are patient advocate Robin Farmanfarmaian (@Robinff3); health economist Jane Sarasohn-Kahn (@healthythinker); futurist Jeff Goldsmith: and digital health guru Fard Johnmar (@fardj). Yes, it’s the pre-election special on Halloween!
You can see the video below live (and later archived) & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.
By the way the photo below was THCBGang Halloween 2020. When we all dressed up and Zoya Khan came as me!
Engineers: Heal Thyselves (and Health Care)
By KIM BELLARD
The article I can’t get out of my head is one by Greg Ip in The Wall Street Journal: Crises at Boeing and Intel Area National Emergency.
I’m old enough that I remember when the Boeing 707 took airline passenger travel from the prop age to the jet age. I’m old enough that I remember that we all wanted PCs with Intel chips when companies starting giving office workers their first PCs. I’ve read enough history to know the storied engineering background and achievements of both. I mean, those B-52s that have been the backbone of the U.S. Air Force bomber command for the past 70+ years: those are Boeing planes.
To younger people, though, Being is the company whose doors pop out mid-flight, or which abandons astronauts in space. When they think of Intel – oh, I’m just kidding; when younger people think about chip companies, it’s NVIDIA or TSMC. Intel’s stock is doing so badly it may get kicked out of the Dow Jones Industrial Average.
So, as Mr. Ip says: “A generation ago, any list of America’s most admired manufacturers would have had Intel and Boeing near the top. Today, both are on the ropes.”
He goes on to add:
The U.S. still designs the world’s most innovative products, but is losing the knack for making them.
At the end of 1999, four of the 10 most valuable U.S. companies were manufacturers. Today, none are. The lone rising star: Tesla, which ranked 11th.
Intel and Boeing were once the gold standard in manufacturing groundbreaking products to demanding specifications with consistently high quality. Not any longer.
What is most frustrating, Mr. Ip points out, is: “Neither fell prey to cheap foreign competition, but to their own mistakes. Their culture evolved to prioritize financial performance over engineering excellence.”
As an example, in a Blockbuster-could-have-bought-Netflix parallel, The New York Times reports that Intel could have bought NVIDIA in 2005, but the reported $20b price was considered too expensive. NVIDIA is now worth $3.5 trillion. Whoops.
Boeing’s new CEO, Kelly Ortberg, admits: “The trust in our company has eroded,” and that Boeing needs “a fundamental change in culture.” It doesn’t help that its machinists have been on strike almost 2 months, with the union rejecting Boeing’s latest offer last week. Boeing is slashing some 17,000 jobs, considering selling off its Starliner business, and trying to raise as much as $25b.
Intel has also cut jobs, is trying to beef up its manufacturing through a revitalized foundry business (which some believe Intel should spin off), and has seen its stock crater (down 52% YTD), but CEO Pat Gelsinger vows: “We see the finish line in sight.”
Intel is still waiting for some $8.5b in CHIPS Act funding, “There’s been renegotiations on both sides,” Mr. Gelsinger told The New York Times. “My simple message is, ‘Let’s get it finished.’” But, as former Commerce Department official Caitlin Legacki noted: [There is fear that] Intel is going to take chips money, build an empty shell of a factory and then never actually open it, because they don’t have customers.” Its much-hyped plants in Arizona and Ohio have both faced setbacks.
Meanwhile, the vultures are circling: there are rumors that Samsung and Apple may want to acquire Intel.
The trouble is, which is Mr. Ip’s point, neither has any real domestic competition; if either would fail, it would throw even more of our economy to the mercy of foreign manufacturers (or, in its space business, make the U.S. even more dependent on Elon Musk’s SpaceX). That’s the national emergence he is warning about.
My point with all this is not so much to add another lament about the decline of U.S. manufacturing as to emphasize the decline of the role of engineers. Earlier this year Jerry Useem, writing in The Atlantic, argued: “When the wave of Japanese competition finally crashed on corporate America, those best equipped to understand it—the engineers—were no longer in charge. American boardrooms had been handed over to the finance people.”
Mr. Useem points out that a revitalized GE “is belatedly yielding to the reality that workers on the gemba [Japanese term for the shop floor, where value is actually created] are far better at figuring out more efficient ways of making things than remote bureaucrats with spreadsheet abstractions.” That sounds a lot like what Mr. Ortberg is saying: “We need to be on the factory floors, in the back shops and in our engineering labs.”
So what, you might ask, does this have to do with healthcare?
It turns out that there is something called a healthcare engineer.
Continue reading…THCB Gang — DiME Special Episode 141, Thursday October 24
Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday October 24 at 1pm PST 4pm EST are Digital Medicine Society CEO Jennifer Goldsack, (@GoldsackJen) , the VA’s Cole Zanetti (@ColeZanetti); and the Chief Commercial Officer at Curai Health Nicole Bell (@bellnicolee). There’ll likely be chatter about #HLTH2024 but also a lot of focus on the new announcement about the DiME Seal. Which is not about a those lovable animals that you see basking on rocks or ice flows, I understand…
You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.
“Accelerationalism”: Is Your Money on Altman or Musk?
By MIKE MAGEE
Has America turned into an “Island of Musk?” He seems to be everywhere and nowhere at the same time. As Trump’s new best friend, he’s opened up the gates of Twitter-hell, morphed into a steady stream of crypto-cash, and demonstrated his dance moves alongside Trump at featured venues.
He’s also launched “a robot for every citizen” as part of a cover for sagging expectations for the Tesla Cybertruck, and issued a new round of hollow promises on his Robotaxi scheme. In short, Musk’s ADHD aside, he seems a bit more unhinged than usual.
In contrast, his arch foe, 38-year old OpenAI CEO, Sam Altman, is (if you’re to believe him) almost professorial. In his own words, “Technology brought us from the Stone Age to the Agricultural Age and then to the Industrial Age. From here, the path to the Intelligence Age is paved with compute, energy, and human will.”
Part of the clash revolves around a single word, accelerationalism. Destined to become the 2025 “word of the year,” this label is increasingly assigned to thought leaders in AI who have convinced themselves that AI will soon rule the world, our politics, and the battle field, and therefore “faster is better” is now the mantra when it comes to world-dominating generative AI.
This was not always the case. Back in 2015, when Elon Musk and a young Sam Altman teamed up to launch a non-profit called OpenAI “to benefit humanity,” they both realized that the leased offices were not big enough for two alpha males. But in launching their decade long battle for dominance, they agreed that slow, transparent, and deliberative was better than fast and reckless. Altman wrote at the time, “In an ideal world, regulation would slow down the bad guys and speed up the good guys.”
Back then, Musk famously warned, “Mark my words, AI is far more dangerous than nukes. I am really quite close to the cutting edge in AI, and it scares the hell out of me.” Where Musk was ”in your face,” Altman was “extremely nice and accommodating” which masked a startlingly aggressive underbelly according to those who knew him well. As his former partner in the 2011 start-up “Y combinator”, Paul Graham said, “You could parachute him into an island full of cannibals and come back in five years and he’d be the king.” Sam was 23 at the time.
In February, 2018, Musk jumped ship, apparently disagreeing on strategy with Altman. And then Altman’s board, in an all-out coup, fired him on November 17, 2023. Twelve days later, they were forced to rehire him when major stakeholder, Microsoft, threatened to pull their considerable support. Altman, for his part, displayed a conciliatory tone on Musk’s own X-platform, tweeting on his return “For my part, it is incredibly important to learn from this experience and apply those learnings as we move forward as a company. I welcome the board’s independent review of all recent events.”
On June 7, 2023, 38-year old Sam told his Congressional questioners that money wasn’t his motivator. Rather “I’m doing this because I love it.” Sen Richard Blumenthal swooned, “It’s so refreshing. He was willing, able, and eager.” Altman, playing to the cameras, said, “We think that regulatory intervention by governments will be critical to mitigate the risks of increasingly powerful models.”
Just 9 months later, his Senate supporters were no doubt confused to open the Wall Street Journal and discover the headline, “Sam Altman Seeks Trillions of Dollars to Reshape Business of Chips and AI. Open AI chief pursues investors including the U.A.E for a project requiring up to $7 trillion.”
Continue reading…You’re Not Going to Automate MY Job
By KIM BELLARD
Earlier this month U.S. dockworkers struck, for the first time in decades. Their union, the International Longshoremen’s Association (ILW), was demanding a 77% pay increase, rejecting an offer of a 50% pay increase from the shipping companies. People worried about the impact on the economy, how it might impact the upcoming election, even if Christmas would be ruined. Some panic hoarding ensued.
Then, just three days later, the strike was over, with an agreement for a 60% wage increase over six years. Work resumed. Everyone’s happy right? Well, no. The agreement is only a truce until January 15, 2025. While money was certainly an issue – it always is – the real issue is automation, and the two sides are far apart on that.
Most of us aren’t dockworkers, of course, but their union’s attitude towards automation has lessons for our jobs nonetheless.
The advent of shipping containers in the 1960’s (if you haven’t read The Box: How the Shipping Container Made the World Smaller and the World Economy Bigger, by Marc Levinson, I highly recommend it) made increased use of automation in the shipping industry not only possible but inevitable. The ports, the shipping companies, and the unions all knew this, and have been fighting about it ever since. Add better robots and, now, AI to the mix, and one wonders when the whole process will be automated.
Curiously, the U.S. is not a leader in this automation. Margaret Kidd, program director and associate professor of supply chain logistics at the University of Houston, told The Hill: “What most Americans don’t realize is that American exceptionalism does not exist in our port system. Our infrastructure is antiquated. Our use of automation and technology is antiquated.”
Eric Boehm of Reason agrees:
The problem is that American ports need more automation just to catch up with what’s considered normal in the rest of the world. For example, automated cranes in use at the port of Rotterdam in the Netherlands since the 1990s are 80 percent faster than the human-operated cranes used at the port in Oakland, California, according to an estimate by one trade publication.
The top rated U.S. port in the World Bank’s annual performance index is only 53rd.
Continue reading…The big guys can’t do HLTH right
By MATTHEW HOLT
This is the week where the digital health landscape debunks to the HLTH Conference in Vegas to meet, do deals, listen to superannuated rappers and generally have a great time. Speaking as the guy who ran the digital health conference before HLTH emerged, I remain extremely jealous of how Jonathan Weiner, Rich Scarfo, Jody Tropeano and team have managed to pull 10,000 people together when Health 2.0 never got past 25% of that size! (And I won’t even mention the premium price they charge!).
I have written pretty extensively about how digital health has failed to develop an alternate to the incumbent hospital, specialty & procedure-based system. 90%+ of digital health companies are now desperately trying to get the incumbents to buy their stuff. It’s as if Jeff Bezos in 1998 was going cap in hand to Barnes & Noble asking them to put in his new online ordering system.
But there is something else that HLTH has not been shy in doing, and that is giving a place on the stage for big companies to explain what they intend to do to change the health system. Amazon, Walmart. Walgreens, CVS, Optum and many more have used that premium real estate to explain what they are going to do. And much like the digital health upstarts, the reality has been very different.
Almost all of those companies’ new strategies are in deep trouble.
Amazon was going to build a hybrid telehealth/home based delivery platform. It got up and running and had some sizable employer clients. It also had a strong relationship with Crossover Health which had great worksite clinics. Not hard at all to imagine that becoming a nationwide primary care platform that could take risk and really cut into the business of the incumbent non-profit systems. After all Dave Chase at Rosetta Stone has been preaching this forever. But at the first hint of trouble, Amazon cut & run and bought One Medical. It’s as if their play in grocery was to go mass market but then they decided that they could make more money from the high end Lululemon crowd that shops at Whole Foods. Oh yeah, that was their play in grocery too.
Walmart, Walgreens and CVS were all going to create mass-market primary care, and move to accepting risk primarily from Medicare Advantage. I interviewed Walmart’s then head honcho of health care, Cheryl Pegus, on stage at HLTH two years ago when she waxed lyrical about how Walmart was the answer to the lack of primary care all over the deep South and rural America. The joke was that by the time of that panel she had already quit and was moving to fresher pastures at JP Morgan! Around a year later Walmart declared that it couldn’t staff its clinics, was losing a fortune on each one, and it tossed the whole business.
Walgreens paid a fortune for VillageMD, then even more for Summit Medical (which included CityMD in NYC). At one point in late 2021, VillageMD CEO Tim Barry told me that their main issue was the execution risk of having to open more clinics per week then Starbucks did at the height of its expansion. Walgreens made a minority investment then kept doubling down on its bet. But three years later it has written off the whole amount ($8bn or so) and its stock price is in the toilet. It’s worth less now than doctor network Doximity!
Both of these companies and CVS have shown that it’s really hard just to get the basics right opening clinics in retail stores. That’s despite the fact that most Americans have no primary care doc and can’t get an appointment with a regular one, and that there’s a captive audience walking into their stores every day picking up their meds.
CVS has the added issue of trying to integrate a decent sized insurer into its operations just at the time when the Medicare Advantage gravy train looks like it is running out of steam. CVS’ CEO Karen Lynch took over Aetna recently and then this past week was dispatched to the cheap seats herself. (Don’t feel too bad for her, she’s getting $4m a year to “consult” with the board). Two things have hit Medicare Advantage. First the government is starting to look into risk adjustment upcoding. CVS, you may recall, bought Signify Health, a company specializing in sending nurses into seniors’ homes to perform said upcoding. Secondly, Medicare Advantage plans had surprisingly little information about and control over their members who were being cared for by their non-risk bearing delivery system (which is to say, most of it). They appeared to be totally surprised that post pandemic procedure numbers ratcheted up and were powerless to stop it. Well, Wall Street noticed.
Similar problems have hit Optum, the engine behind United HealthGroup’s profitable growth for the past decade or so. It’s not just the biggest health tech company in America, it’s also the biggest medical group owner—even if CEO and bumbling Englishman Andrew Witty doesn’t seem to know how many doctors it controls. They are being exposed in Stat on a weekly basis for basically semi-frequently causing their doctors to lie about their patients’ health status, just as the Wall Street Journal accuses their associated health plan of inventing diseases and procedures—all to bill the government more. You can argue back and forth but it does appear that the strategy of buying every medical group it can see and provider fracking appears to have hit a bumpy road.
So if the venture-funded digital health upstarts are no longer changing the world, and the big retailers and Optum aren’t setting the world alight, who is taking the upper hand? Well, I expect that intermingled with the ex-pop stars and amazingly beautiful actresses on stage this week (sorry, but I love Halle Berry!), we’ll see a rash of big incumbent non- & for-profit systems. Look at their numbers. Procedures are heading up. ERs are filling up. Operations are profitable or in some cases, very profitable, corporate jets are being bought, and “reserves” –AKA hedge funds–are growing well due to being stuffed full of Nvidia stock.
All of which leads me to believe that sadly HLTH isn’t about the future of health as much as it’s a retread of its past. Still, I’ll catch you at the parties if you’re there….
Matthew Holt is the founder and publisher of THCB
Pete Hudson, Alta Partners & Transcarent Investor (Part 2)
Pete Hudson is one of the OGs of digital health. As an emergency room doc he was fed up with his friends bothering him with their medical problems and he created a tool called iTriage, which helped patients figure out what condition they had, and where to go to deal with it. This was fifteen years ago and we’re now starting to see the evolution of that. Pete is now a venture capitalist and an investor in Transcarent–the sponsor of a new video series on THCB. This is part 2 of our conversation (part 1 is here) and we dive much more into AI and what Transcarent’s Wayfinding tool and other AI like it could do to change health care and the patient experience–Matthew Holt
Chris Darland, Peerbridge Health
Chris Darland is CEO of Peerbridge Health, which is the maker of a “3 lead to 12 lead” EKG patch that can give a better view of overall cardiac health than what’s on the market now–which tend to specialize in AFIB. Chris thinks that the Peerbridge Cor product will lead to a new world where for a much lower price we can have much better data on many more people who are at potential risk for heart disease and much more. I talked with him to discover what’s coming and what the impact might be on the overall health care system. Will we have fewer bypasses and stents? Maybe…Matthew Holt
Pete Hudson, Alta Partners & Transcarent Investor (Part 1)
Pete Hudson is one of the OGs of digital health. As an emergency room doc he was fed up with his friends bothering him with their medical problems and he created a tool called iTriage, which helped patients figure out what condition they had, and where to go to deal with it. This was fifteen years ago and we’re now starting to see the evolution of that. Pete is now a venture capitalist and an investor in Transcarent–the sponsor of a new video series on THCB. We had a long conversation about the evolution of digital health, what went right, what opportunities got missed, and what to expect next. This is part one of our conversation, and allows two guys who were there close to the start of this world to survey what’s happened since–Matthew Holt
