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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.

Flipping the Stack: Can New Technology Drive Health Care’s Future?

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By MATTHEW HOLT and INDU SUBAIYA

Indu & I have been talking about Flipping the Stack in health care for about 3 years. 2 years ago we wrote an article for a general hospital audience which appeared in the 2019 AHA SHSMD Futurescan magazine. I was talking about the changes in home monitoring that might come about due to COVID-19 and remembered this article. The one that got published went through a staid editing process. This is the original version that I wrote before which was rather more fun and hasn’t seen the light of day. Until now. Take a look and remember it is 2 years old–Matthew Holt

Over the past twenty-five years most businesses have been revolutionized by the easy availability of cloud and mobile-based computing systems. These technologies have placed power and access into the hands of employees and customers, which in turn has created huge shifts in how transactions get done. Now the companies with the highest market value are both the drivers of and beneficiaries of this transition, notably Apple, Facebook, Amazon and Alphabet (Google), as well as their international rivals like Samsung, Baidu, Tencent and Alibaba. Everyone uses their products every day, and the impact on our lives have been remarkable. Of course, this also impacts how businesses of all types are organized.

Underpinning this transformation has been a change from enterprise-specific software to generic cloud-based services—sometimes called SMAC (Social/Sensors/Mobile/Analytics/Cloud). Applications such as data storage, sales management, email and the hardware they ran on were put into enterprises during the 80s and 90s in the client-server era (dominated by Intel and Microsoft). These have now migrated to cloud-based, on-demand services.

Twenty years ago the web was still a curiosity for most organizations. But consumers flocked to these online services and in recent years businesses followed, using GSuite, AWS (Amazon Web Services), Salesforce, Slack and countless other services. Those technologies in turn enabled the growth of whole new types of businesses changing sectors like transportation (Uber), entertainment (Netflix), lodging (AirBnB) and more.

Fig 1. Growth of Cloud Computing Use (Cisco)
Figure 1. Growth in use of cloud data v s traditional data centers

What about the hospital?

Hospitals and health systems were late comers to the enterprise technology game, even to client-server. In the 2000’s and 2010’s, mostly in response to the HITECH Act, hospitals added electronic medical records to their other information systems. The majority of these were client-server based and enterprise-specific. Even if they are cloud-based, they tend to be hosted in the private cloud environment of the dominant vendors like Epic and Cerner. Of the major EMR vendors only Athenahealth had an explicit cloud-only strategy, and its influence has been largely limited to revenue cycle management on the outpatient side.

However, the hospital sector is likely to move towards the trend of using the cloud seen in other businesses.

Continue reading…

12 Rules for Health Tech Startups

By MATTHEW HOLT

Last week Mark Cuban tweeted out 12 rules for tech startups and Jessica DaMassa challenged a bunch of people to respond for health care. VC and general health care wit Lisa Suennen came out with quite the list (she got to 13) but I thought someone ought to write the real rules…

1. Never start a health tech company if you can sucker someone into giving you a real job

2. When VCs at conferences say raising money isn’t a problem, throw a milkshake at them

3. Never work with a technical co-founder who won’t give you the last M&M in the packet

4. When a clinician wants to quit their job and co-found with you, remember that the good ones could be making $500K a year reading X-rays and be on the golf course at 4pm

5. Do the 50/2 diet. Starve for 50 weeks of the year then eat and drink as much as you possibly can at HIMSS & JP Morgan parties when someone else is paying

6. When the incubator/accelerator/matchmaker says that they “chose you from 700 applicants” remember that there are roughly 700 of them and every company applies to each one

7. When you get the elusive partnership deal with the big hospital system, tech company or corporate, you’re going to expect to work at the speed of the startup and the scale of the corporate. It’ll be the reverse . (I stole this from Michael Ferguson at Ayogo)

8. After your first few clients and funding rounds you’ll be losing money at a exponential rate that matches what you had for revenue on the hockey stick chart in your pitch deck

9. Hopefully you’ll eventually be able to start making the money the health care way, by establishing a monopoly that can arbitrarily raise prices to the moon and stick it to your customers. If not, start prepping for the really big Oscar/Collective/Clover type round. 

10. Pray to whatever God you follow that Softbank is still in business when #9 happens.

11. If after a decade or so of slog, you finally get the IPO, or semi decent exit, try to ignore the fact that the Instagram guys sold for $1 billion 11 months after they founded the company

12. Hope that you can disrupt health care, but remember that UnitedHealth Group’s revenue is $220 billion and CMS spends $900 billion a year and they both appear mostly powerless to make anything better.

Matthew Holt is publisher of The Health Care Blog and advises startups at SMACK.health using these principles and a few others too!

Exponential Medicine

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By MATTHEW HOLT

After only maybe 5 years when I’ve been away running a conflicting conference in some other part of the world I finally get to go to Exponential Medicine the next 4 days. I met Daniel Kraft way back before he was famous, and his conference grew from being a week long academic session in an airline hangar in Mountain View to being a mega 4 day bash at the Hotel Del Coronado in San Diego (partly aided by TEDMED abandoning the venue and heading off in its own strange direction post billionaire buyout–well done Mark Hodash despite the lawsuit and yes I am jealous!).

Anyway, it’s going to be lots of fun. There’s plenty of people from my Health 2.0 world presenting. Lonnie Rae Kurlander, ePatient Dave, heck even John Halamka has been tempted off the farm — although I suspect Dave will have him in a headlock about access to his BIDMC data pretty quick).

Then there’s the surgeons and the weirdos. I leave Shafi Ahmed & Stefano Bini to decide which category they’re in, although whatever John Brownstein says I do owe him a nice bottle of scotch. Anyway, check out the program and if you haven’t bought yourself a ticket or bribed your way in, don’t worry it’s all being live streamed and Jessica DaMassa from WTF Health will as ever be interviewing anyone who doesn’t get out of the way quick enough.

So if you’re there I’ll be milling around not doing much, so say hi. And otherwise follow along here and @boltyboy

Cats & Dogs: Can We Find Unity on Health Care IT Change?

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By MATTHEW HOLT

Today we have a humming economy and insane politics. In early 2009 we were in economic meltdown and were about one week into the sanest, soberist Administration and even Congress over many recent decades. In February 2009 they passed a stimulus bill that had a huge impact on the health IT market (and still does). At that time there was much debate on THCB about what the future of health IT policy should look like and how the stimulus “Meaningful Use” money should be spent. My January 2009 summary of that whole debate introduced the notion of “Cats and Dogs in health IT”. They’re still around today. We’re reprinting it here as part of our 15-year THCB birthday party–Matthew Holt
 

Those of you paying attention for the past few days might have noticed on the one hand a sense of optimism and unity as Barrack H. Obama, somewhat somberly, began his presidency.

Meanwhile, over the past few weeks the fur has been flying among the electrons on THCB while some very knowledgeable and opinionated health care wonks and geeks have been battling it out about what exactly we should be doing in terms of federal health care IT spending.

Given that even among you smart THCB readers this may be all a little perplexing, I’m going to try to try to make what I hope are some elucidating comments to put this argument in context. I’m doing this partly because I’m perplexed too, but also because I think that there is some hope for a middle road.

First the basics: As sometime THCB contributor & uber-CIO John Halamka makes clear in this excellent post about The Greatest Healthcare IT Generation, some $20 billion of the soon to be passed “spend it as fast as you can” stimulus package is going to be targeted towards health care IT. Now, that’s by no means the biggest part of the $800 billion or so package, and it’s not even the biggest part of the health care spending in the bill. Nearly $87 billion or so is going to support Medicaid, although that will mostly will be replacing cuts being forced on states.

Continue reading…

Why Hillarycare failed…and what we need to learn from that failure

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By MATTHEW HOLT

In July 2005 George W Bush had relatively recently won a Presidential election in which the Republican won the popular vote (something that will likely never happen again) & the Republicans controlled all three branches of Government. Those of us liberals at the bottom of a dark trench were wondering if and how we’d get to health reform. So in another reprint to celebrate THCB’s 15th birthday, here was my then take on what went wrong in 1994 and what would happen next–Matthew Holt     

There are lots of versions about what killed the 1993-4 health care reform effort.  Hillary Clinton has now decided that the problem was the lack of incrementalism in her plan.  Last week the New York Times said that since becoming a Senator:

“She has deliberately avoided the major mistake she made as first lady, namely trying to sell an ambitious plan to a public with no appetite for radical change. <SNIP>. She summed up her approach in the first floor speech she delivered in the Senate about four years ago, when she unveiled a series of relatively modest health care initiatives. “I learned some valuable lessons about the legislative process, the importance of bipartisan cooperation and the wisdom of taking small steps to get a big job done,” she said, referring to the 1994 defeat of her health care plan.”

On the other hand, some people are still claiming victory for the plan’s defeat even if they were at most modest bit players.  Here’s what one fawning bio says about former New York Lt Governor Betsy McCaughey

“A 35-year-old senior fellow named Elizabeth McCaughey…wrote an article for The New Republic on what she discovered in a close reading of the 1,431-page document containing the Clinton Health Care Plan: Namely, that it would put every citizen in a single government-operated HMO. That one article shot down the entire blimp, and Betsy McCaughey became a 35-year-old Cinderella. One of the richest men in America chose her as his wife, and George Pataki made her lieutenant governor of New York.”

Ignoring the fact that McCaughey spent her time thereafter putting poor New Yorkers into those HMOs she so despised, and then went off the deep end en route to divorce from Pataki, the rich guy, and reality (not necessarily in that order), it’s not really true that one article in The New Republic can be quite that influential. (Sorry Jon!).  Even if the overly geeky Clintonistas in the White House did feel that they had to come out with a point by point rebuttal. And anyway, the article only came out in January 1994 by which time the die was more or less cast the other way. Again we have to look elsewhere for the explanation.

If you want to go back and spend a few minutes wallowing in the era of trial balloons and secret task forces, there’s a very interesting time line of the whole process on the NPR website, as well as a briefer information over at the Clinton Health Plan Wikipedia site.Continue reading…

SMACK.Health–Getting Clear on the Concept

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I’m going to be announcing some big changes on THCB and with my overall services in the next little bit. So to prepare for this, here’s a rather good explanation I did last year in Australia of what I mean by SMACK.health — randomly the interviewer was Jessica DaMassa with whom I now do #Healthin2pt00 — Matthew Holt

THCB Exclusive–Trump appoints Holt to run VA

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By THCB STAFF

Today Donald Trump pulled a big surprise. He changed the much criticized appointment for his new VA head from over-effusive physician Rear Adm. Ronny Jackson to well known lefty health blogger Matthew Holt. When asked why he wanted Holt to run the VA Trump said, “Look, I’m pretty smart and I’ve appointed now only the best people like John Bolton and Mike Pompeo to run our foreign policy. If I appoint someone else I like, how can I fire him quickly? That Holt guy seems to hate me, and he’s never stayed in one of my hotels, so he’s perfect for the VA–I hear that the accommodation is a bit rough, not exactly a ten.”

When THCB asked Holt why he agreed to take the job running the VA, he suggested that it had a lot to do with his English roots. “As most of my followers know I grew up in England and like the concept of everyone suffering together in a government funded and provided socialized National Health System. The VA and its fellow traveler the DOD is the only health system like that in America and it’s a brilliant place to start”. When asked about his likely future polices for the VA, Holt suggested that massive expansion was the key initiative. In a written statement, his VA spokesman noted “Given the utter lunacy of the Trump Administration and the crazy warmongers now running the show, the chances of total war versus North Korea and Iran are very high. So essentially everyone in the country will soon be called up to the military, which means that soon eventually everyone will be a Veteran. And if Trump loses in 2020, by 2021 we’ll be at war with the Russians so either way my theory pays off.”

Holt was on the Charlie Rose show last week when he told Rose about his philosophy for the future. “When everyone in the country is part of the VA, we can shut down that ineffective and expensive private health system, and instead everyone can get their care the way I think is best. And if they don’t like it Rasu Shrestha will send them their records using the Lighthouse Blue Button Carrier Pigeon system, and we’ll give them a row boat to head to Nepal or somewhere.

When TCHB reached him for comment, Cato health spokesman Michael Cannon said, “if you are going to expand this universal health care stuff, you might as well give it a real go. Lucky for me, I have bone spurs…”

Health in 2 Point 00, Episode 8

It’s the end of #HIMSS18 where Jessica DaMassa asks me the end of term questions, while the exhibit hall is being torn down around us. We’ll be back to our weekly schedule next week–Matthew Holt

Health in 2 point 00, Episode 7

More from HIMSS18, it’s episode 7 in which I  get to give a shout out to UPMC, OneView HealthCare, Echo Ventures, & GE Ventures who funded patient travel to HIMSS via the Society for Participatory Medicine. And to HIMSS itself which for the first time let patients in for free. Jessica DaMassa asking the questions and thanks to @HealthTechDan from Digital Health Today for running the camera–Matthew Holt

Matthew Holt’s EOY 2017 letter (charities/issues/gossip)

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Right at the end of every year I write a letter summarizing my issues and charities. And as I own the joint here, I post it on THCB! Please take a look–Matthew Holt

Well 2017 has been quite a year, and last year 2016 I failed to get my end-of-year letter out at all. This I would like to think was due to extreme business but it probably came down to me being totally lazy. On the other hand like many of you I may have just been depressed about the election–2016 was summed up by our cat vomiting on our bed at 11.55 on New Years Eve.

Having said that even though most of you will never comment on this letter and I mostly write it to myself, I have had a few people ask me whether it is coming out this year–so here it goes.

2017 was a big year especially for my business Health 2.0. After 10 years my partner Indu Subaiya and I sold it to HIMSS–the biggest Health IT trade association and conference. And although I used to make fun of HIMSS for being a little bit staid and mainstream, when it came to finding the right partner to take over Health 2.0’s mantel for driving innovation in health technology, they were the ones who stepped up most seriously. From now on the Health 2.0 conferences are part of the HIMSS organization, and Indu is now an Executive Vice President at HIMSS. I’ll still be very involved as chair of the conferences and going to all of them but will (hooray!) be doing a lot less back office & operational work. (Those of you in the weeds might want to know that we are keeping the Health 2.0 Catalyst division for now at least)

That does mean that next year I will have a bit more time to do some new things. I haven’t quite figured out what they are yet but they will include a reboot of (my role at least) on The Health Care Blog and possibly finally getting that book out of the archives into print. But if you have any ideas for me (and I do mean constructive ideas, not just the usual insults!) then please get in touch. You can of course follow me on Twitter (@boltyboy) to see what I’m thinking with only modest filtering!Continue reading…

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