THCB Gang was live on Thurs Jan 28. The recording is below.
Joining me, Matthew Holt (@boltyboy) were patient safety expert and all around wit Michael Millenson (@MLMillenson), THCB regular health writer Kim Bellard (@kimbbellard), futurist Ian Morrison (@seccurve), surgeon & innovation dude Raj Aggarwal (@docaggarwal), patient advocate Grace Cordovano (@GraceCordovano), and policy & tech expert Vince Kuraitis (@VinceKuraitis).
The impeachment barely came up but several of us had direct experience of the chaotic vaccine rollout. Lots of speculation about what aspects of shoring up the ACA in the stimulus $1.9bn, and a bunch of discussion and disagreement about whether the lava is cooling in a new data and technology infrastructure on which to build a new health system. A great 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 executive leadership team of UpHealth, the self-described “global digital health super-company” that’s headed toward the public market via a SPAC that’s brought together six companies, 10-years of health tech innovation, and a war chest of $285M dollars, stops by to talk about growth plans and grabbing market share. UpHealth’s Chairman & Founder, Dr. Chirinjeev Kathuria, Co-CEO & President Dr. Al Gatmaitan, and future COO Jamey Edwards talk through what Jamey says is “really a revenue story” about the fastest growth areas of digital health. Global telehealth, integrated care management, digital pharmacy, and behavioral health will be UpHealth’s sweet spots. The newco is positioning itself as a “one-stop shop” for the digital healthcare infrastructure that will support a local healthcare organization in rolling out digital care services and integrating them with their in-person care continuums. This is different than, say, a Teladoc or an Amwell, which in addition to providing infrastructure also have their own tech-enabled medical groups, which can sometimes be viewed as competitive to their customers. The global nature of UpHealth is another differentiator, particularly in how it hopes to ultimately make it possible for highly specialized care from the US to be “exported” to countries abroad AND for lower cost care for lower acuity issues to be “imported” in. With $190M in revenue projected for 2021 – and that’s NOT dependent on integrating the six companies – we talk through areas for potential growth, that aforementioned competitive landscape, and whether or not UpHealth is feeling the pressure to hurry their integration.
David Medvedeff, CEO Aspen RxHealth, tells me about the new role of pharmacists in managing chronically ill patients. Aspen RxHealth has put together a network of independent pharmacists and a tool that allows them to select patients, call them and consult with them for their pharmacy issues. It’s kinda like the original Teladoc model but for pharmacists, while the clients are health plans keen for their patients to avoid problems with polypharmacy. They’ll be doing 200K+ consults this year and just raised $23m.
No copays. No coinsurance. No surprise out-of-network anesthesiologist fees or pre-op imaging bills. Just one, single price (that you see in advance) tells you EXACTLY what you’ll be paying for your surgical care on Carrum Health. Backed by the recent close of a $40M Series A funding round, the health tech startup’s CEO Sach Jain talks through all the ways his company is looking to disrupt how we buy surgical care. Standardized bundle pricing is just the beginning. Carrum requires its Centers of Excellence (and each of their docs) to pass a proprietary 50-point inspection before they can join the platform, AND every surgery must be backed by a 30-day Warranty! How have they convinced providers to jump through these kinds of hoops? With a growing client-base of self-insured employers (Sach says they have several Fortune 100 and Fortune 500 clients) and payment-in-full made to providers upon discharge, the case for additional revenue and zero A/R days is pretty compelling to a health system. And what about the other side of the business model? Tune in to find out why Sach believes Carrum Health’s “marketplace” approach will appeal to the growing base of “activist” employers whose HR benefits administrators are becoming more and more adept at building-their-own healthcare networks.
THCB Gang was held live on Thurs Jan 28 1pm PT -4pm ET. The recording is below.
Joining me, Matthew Holt (@boltyboy) were fierce patient activist Casey Quinlan (@MightyCasey), consultant/author Rosemarie Day @Rosemarie_Day1), THCB regular health writer Kim Bellard (@kimbbellard); employer health expert Jennifer Benz (@jenbenz) & patient safety expert and all around wit Michael Millenson (@MLMillenson).
There was almost nothing to talk about. No inauguration, no riots, pandemic under control via vaccination….oh wait. Actually a lot to talk about with the vaccination rollout, the likelihood of health policy changing in the COVID relief bill, and how the wild world of Gamestop stock trading might impact Digital Health –well we didn’t talk about that but we did talk about employers and what they were going to do!
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.
Episode 39 of “The THCB Gang” will live-streamed on Thursday, Jan 21. You can see it below!
Matthew Holt (@boltyboy) was joined by regulars: futurists Ian Morrison (@seccurve) & Jeff Goldsmith, surgeon and now digital health entrepreneur Raj Aggarwal (@docaggarwal), radiologist Saurabh Jha (@roguerad), and patient advocate Robin Farmanfarmaian (@Robinff3).
Like the nation we took a big collective sigh of relief. We then talked a lot about COVID vaccinations, what the newly (sort of) Dem-led Senate is going to do on stimulus and health care , and we fnished on all that money pouring into digital health, while the stock market goes crazy. It was all good grist for the #THCBGang’s mill.
If you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels
With all due respect to the good intentions of Congress, HHS, CMS, ONC and their dedicated advisors, they are pursuing — and for years have pursued — the wrong approach to achieve medical record interoperability. Endless studies, reports and anecdotal evidence conclude that trying to standardize the way medical records are formatted and kept, and linking provider silos via health information exchanges, doesn’t work! It is far too rigid, complex and constraining, and far too costly. Most importantly, it doesn’t meet care providers’ needs for “total interoperability” — instant access at the point of care to a patient’s COMPLETE medical record from all his or her providers.
Despite having held endless hearings, listening sessions and receiving hundreds of responses to their draft proposals, they continue to ignore reality. Healthcare is dramatically different than banking and travel, the industries they frequently cite as role models. It is perhaps the most massive, complex, diverse and decentralized industry in the country, and requires a very different approach than used in simpler industries. Standardizing record content and formatting simply doesn’t work in healthcare.
Instead of trying to force care providers to accept their pre-conceived technology, they should adopt technology that meets the unique needs of providers. Simply put, they are trying to cut the man to fit the cloth rather than the cloth to fit the man!
Fortunately, there is a simple solution that accommodates the complexities of healthcare and meets the diverse needs of care providers. It focuses on how to MANAGE records rather than how to KEEP them. All we have to do is embrace it!
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.
We did indeed touch on that mob riot in the Capitol. We discussed the impeachment, the inauguration, and virtual JPMorgan AND virtual CES and talked about reparations and reconciliation–and how that might influence the whole world of telehealth and primary care. This conversation was wide ranging and fascinating!
If you’d rather listen, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels
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.
