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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.

Sword Health, the Hinge Health S1, and me

By MATTHEW HOLT

The big news in the comeback of digital health is that Hinge Health filed its S1 and is looking to go public soon. I suspect that they’d have preferred to get the IPO done late last year when the AI bubble was expanding rather than deflating, but timing the market is tough! Nonetheless Hinge is almost profitable and at over $350m in revenue at a growth clip of some 75% last year, in terms of a show pony to trot out, it’s about as good as the digital health field has got. The problem is that the last round in 2021 was at a $6bn+ ZIRP-era valuation with Tiger & Coatue paying the idiot price because Teladoc was trading at $15bn market cap then (albeit down from $30bn a year before that!). That is, err, no longer the case. There’s a bunch of weirdness in the IPO structure to pay those guys back, but the main point is that the likely valuation will be in the $1.5-2.5bn range. 

But there’s another problem. And it’s one I have some personal experience with. I must stress that my experience is not with Hinge.

As it happens I did a video interview at Hinge’s booth at HLTH in 2022 when my back collapsed, and I got to try out their Enso device (it helped a bit but not much after the first few minutes using it). I discussed the process with PT Lori Walter and got a quick interview with President Jim Pursely (an old Livongo hand BTW). 

But this past summer I used the services of their main competitor, Sword Health. As far as I can tell the two companies are very similar in their process and services, both with self-service exercises delivered via the smartphone and both moving from remote care from therapists to AI therapists. But I could be wrong. So for this article I am extrapolating from one company to the other to look at the field of MSK digital services overall.

In total, I thought the Sword experience was good as a standalone program. But the problem was that it was standalone.

My problem was with my left knee. I had a lot of knee surgery in 2002-4 as the result of snowboarding into a tree (Hint. If you snowboard, try to make sure you and the board go the same side of the tree). More than 20 years later in 2024 I managed somehow to induce terrible pain in the knee running for a ferry in January, a train in May and an airport shuttle in June. (It seems that travel and my knee disagree). This didn’t stop me strapping up, taking drugs and snowboarding in the 2024 winter season but it certainly slowed me down a whole lot. Around this time there were many reports of people much younger than me getting their knees replaced.

So I thought I should do something about it. My Blue Shield of California plan offers Solera which is an agglomeration marketplace of digital health apps and services. Sword Health is their PT app, so I selected it, enrolled and off I went.

Note that there was zero integration with my PCP, any orthopedic surgeon, any clinical person at the health plan or basically anyone. This was purely patient-driven and managed.

With Sword I had a 15 min intro call on June 6 – then was sent a box containing a generic tablet and six sensors which fit into straps that you attach to your lower and upper legs and arms.

There was a conversation in the app with a PT and then it spat out a selection of exercises for me. The example below is my second exercise session. If you want to check out more, I have put more of the exercise and the chat with the PT here.

Sword suggested, instead of regular 45-60 minute physical PT sessions, that I did four 15 minutes sessions a week. Essentially one every other day.

The end result was that I did eight sessions between June 12 & June 30.

Continue reading…

Linus Health–In-depth demo of cognitive health tool

The decline in cognitive health, especially that leading to Alzheimer’s and other brain diseases, is one of the most feared conditions by patients and their families. It’s also one of the most expensive. But if we can predict it early there are things we can do to prevent or ameliorate it. The issue has been finding an easy and comprehensive way to monitor it as part of primary care. The team at Linus Health has been building a diagnostic solution for exactly that and claims that it’s now the right time to roll it out as part of general primary care. CEO David Bates, John Showalter, Chief Product Officer (a primary care doc) and Alvaro Pascual Leone, a neurologist and Chief Medical Officer, took me through an extensive end to end demo. This is a long and fascinating look at the state of play in neurology diagnosis, and discussion about what the future of brain health looks like. Matthew Holt

Stuart Blitz, Hone Health

Stuart Blitz is COO and founder of Hone Health. He comes from a long career in health tech, notably at diabetes device pioneer Agamatrix. Stuart’s been working on his aggressive social media career, but in the background he co-founded Hone Health in the male health online telehealth/pharmacy space in March 2020 (great timing!). It’s now raised real money ($33m last month), has expanded to the other half of the population (women, too!), and is finding a space for itself in the cash-pay space where HIMS, Roman et al are well known. We had a great conversation about how that space is playing out and what Stuart thinks will work there, and what it means for health care overall–Matthew Holt

Natalie Schneider, Fort Health

Natalie Schneider is CEO of Fort Health, a relatively new entrant into the children’s mental health market. Fort Health’s modus operandi is to partner with (i.e. market via) pediatricians to get them to refer patients. They are delivering integrated care and something called collaborative care…a newer model that has more frequent and shorter interventions and is more affordable. Natalie is concerned that only 20% of current psychiatric care for pediatric patients is currently evidenced-based and measured. Part of their secret sauce is through a partnership with the Child Mind Institute, and they also deliver a series of educational offerings for parents. Fort Health has raised $16m & they’re pursuing a market by market expansion working with those pediatricians starting with New Jersey–Matthew Holt

What would a rational DOG(gi)E do(o)?

By MATTHEW HOLT

DOGE, or Doggie as Kara Swisher has been calling it, has gone from being a meme about Shiba Inus to a crypto scam to a group tearing the Federal government apart.So I thought I would use the title of this piece to make a joke. Like Musk’s humor it’s puerile and not funny. What’s also not funny is what Musk’s team has done to small government agencies, like USAID & CFPB that really help people, not to mention the irrational firing of thousands of government employees that appear to be screwing up the NIH, the National Parks, the FAA and much more. But it’s all got me thinking, what in health care should an effort to quickly rationalize government spending do?

Now I’m not proposing that there’s anything OK with the way Musk and his team have been blundering around the Federal government, telling lies about what it does and indiscriminately firing the people who have the most important responsibilities and then desperately trying to get them to come back. This has been pure ignorance theater, and it would be hilarious if it wasn’t so damaging. Equally importantly the places DOG(gi)E has started are stupid because they don’t spend much money. But the government spends a lot on health care –between two and three trillion dollars, depending on how you count it.

So if you wanted to save some money and potentially change the system, what would you do? First you’d take a deep breath and get some real data, and improve your understanding about what is actually happening. There are some areas in health care where the issues are well understood and the data is clear and there are others where it’s less obvious.

Let’s start with a relatively small one–spending on Federal Employees health benefits. Chris Deacon’s Linkedin posts are a constant source of fun and games, and she has been highlighting screwups in the FEHBP administration for a long time. Essentially the government via the OPM pays lots of different insurance companies to manage Federal employees’ health care. There is very poor oversight of what happens in those programs and when the OPM’s OIG points that out, not much happens. The plans (including Horizon Blues in NJ and BCBSNC and many others) have been caught being sloppy or fraudulent but not much has happened. All DOG(gi)E needs to do is read the report on the audits, or look at what GOA said about $1bn being spent on ineligible members in 2022 and apply their recommendations.

Next let’s get into something that requires a little more investigation. In America we buy (and sell) drugs in a mind-bogglingly complex way.

Continue reading…

Lynda Brown-Ganzert, RxPx

Lynda Brown-Ganzert is CEO of RxPx. The company is the 2022 merger of the company she founded, Curatio, which was a support system for rare disease patients, with RxMx, a complementary service that helped clinicians manage patients on treatment or clinical trials. Lynda says that somehow I inspired the merger! (Although I don’t remember it, nor did she send me my 10%!). Now the company is supporting rare disease patients, funded primarily by pharma, across the globe. Lynda gives a full demo of both the clinician and patient experience–coordinating meds, labs, imaging, appointments, content, symptoms, patient reported outcomes, peer and coach support, and more. And she discusses how a great PE takeover works. (Not all of them are!)–Matthew Holt

George Boghos, Imagine Pediatrics

George Boghos is CEO of Imagine Pediatrics, a company founded out of former CMS Innovation head Adam Boehler’s Rubicon Partners fund. Imagine is a wraparound tech-based service helping some of the sickest kids in America–think kids on feeding tubes, cancer, mental health conditions, autism and more. They provide telehealth and on the ground services (like EMTs) that supplement typical pediatrics offices. the goal is to improve the kids’ and parents’ experience and of course save money on emergency admissions, and hospital admissions. It’s a new idea but one that certainly is having a moment as we need to support families and improve care for kids. And hopefully do it for less money. George told me how it all works. Not simple!–Matthew Holt

VC returns: Well, it’s stock trading…

By MATTHEW HOLT

There’s been a lot of discussion lately about whether digital health is a legitimate place for venture capital. There have been lots of huge failures, very few notable successes (and certainly no “biggest companies in the world” yet), while some real giants (Walmart/Walgreens/Amazon) have come in and then got out of health care.

I don’t have to tell you again that most of the publicly traded digital health companies are trading at pennies on the dollar to their initial valuations. But I will. Look at that chart below.

Heck even Doximity– which prints money (45% net margins!)–is trading at well under its post IPO high. My quick overview is that there are not very many publicly traded companies at unicorn status. With really only Doximity, HIMS and Oscar being very successful. (We can have a separate argument as to whether Tempus and Waystar are “digital health”). And there are many, many that are well off the price they IPOed at. All that at a time when the regular stock market is hitting record highs.

Which makes it interesting to say the least that Define Ventures just came out with a report saying that in general digital health has done well as a venture investment and that it was likely to do even better, soon.

The report isn’t that long and is well worth a read but their basic argument compares digital health venture investments to those in fintech and consumer tech. Essentially it took digital health a lot longer to get to 10% of total venture investment than fintech or consumer tech, but it got there after 2020. Now more than 10% of all VC backed unicorns out there are health tech companies. Yes there was a retrenchment in 2022-3 but health tech investment fell less than other sectors in 2022-3 and is basically back in 2024.

The Define forecast forecast is interesting (it’s the chart below). Define posits that it took 4-5 years after the fintech and consumer tech sectors became 10% of VC dollars for them to start pumping out exits and IPOs. There are 30-50 each in those sectors now, but health tech was ahead of that with 18 exits already in the first 5 years after getting to 10% of VC dollars, and those exits were on average double the size of the fintech/consumer tech exits. (Although to be fair the health tech exits were when the market was higher after 2020)

In fact their analysis is that capital returned was about 10x investment.  You might say, but hey Matthew didn’t you just show me a chart that most of those 18 companies were public market dogs? And you’d be right.

Continue reading…

Ian Morrison

I got the very sad news today that Ian Morrison died peacefully at home yesterday. He had been sick and in hospice for some time but a few months back he told me that he was going for Jimmy Carter’s record. Ian was my first boss in American health care when I worked for him at Institute for the Future and he was as kind and lovely as he was funny and knowledgeable. I was very glad that when I started THCBGang during the pandemic that he was a regular member.

Ian spent decades working with everyone across health care in American and internationally, but as he used to say essentially was paid to insult people. That he did it so humorously and usefully was the reason he kept being invited back. Any Ian Morrison keynote at a big health care conference was both a chance to learn something and laugh hysterically.

He also never ignored the chance to help those trying to make health care fairer and more equitable, serving on the boards of Martin Luther King Jr hospital, the California Healthcare Foundation and many others. He remained a jovial Glaswegian socialist at heart.

Ian liked to say that he went from Scotland where death was imminent, to Canada where death was inevitable, to California where death was optional. Sadly that last crack wasn’t quite true.

My heart goes out to his wife Nora and their children and grandchildren. There’ll be a more formal obituary and a celebration of his life in the days and weeks to come–Matthew Holt