Tanay Tandon is CEO of Commure, which is essentially a startup conglomerate which includes the original Commure, Tanay’s company Athelas, ambient scribe Augmedix, the Strongline staff safety product, Memora Health’s workflows and more. HCA, the big for-profit chain, is one of the biggest customers and an investor in Commure. I grabbed Tanay at HIMSS earlier this month to understand what Commure was building and what he thinks co-pilots/auto-pilots can eventually do in the hospital. Tanay’s aiming for a time when the combo of all the products mean doctors don’t have to touch their keyboard. But what does this have to do with the EMR? And what does their major backer, General Catalyst, intend to do with Commure and its other companies? Hopefully after this things are becoming a little clearer!–Matthew Holt
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…Peter Yellowlees, AsyncHealth
Peter Yellowlees MD is CEO at AsyncHealth–this is a new company that is doing the intake interview for a psychiatrist or psychologist session. Peter demos how the AI agent asks questions, how a patient answers in real time. Then after submitting the answers, the AI creates both a full transcript in the back end, and then a summary which the clinician can use in advance of seeing the patient. You’ll see the real time transcript and patient summary. Very accurate and impressive. That saves a significant amount of time in the intake process and helps the patent get to the right type of treatment. It’s early days for Asynch Health, but you’ll quickly get the idea about how this use of AI might change one part of care–Matthew Holt
You Can’t Spell Fair Pay Without AI
By KIM BELLARD
Everything’s about AI these days. Everything is going to be about AI for a while. Everyone’s talking about it, and most of them know more about it than I do. But there is one thing about AI that I don’t think is getting enough attention. I’m old enough that the mantra “follow the money” resonates, and, when it comes to AI, I don’t like where I think the money is ending up.
I’ll talk about this both at a macro level and also specifically for healthcare.
On the macro side, one trend that I have become increasingly radicalized about over the past few year is income/wealth inequality. I wrote a couple weeks ago about how the economy is not working for many workers: executive to worker compensation ratios have skyrocketed over the past few decades, resulting in wage stagnation for many workers; income and wealthy inequality are at levels that make the Gilded Age look positively progressive; intergenerational mobility in the United States is moribund.
That’s not the American Dream many of us grew up believing in.
We’ve got a winner-take-all economy, and it’s leaving behind more and more people. If you are a tech CEO, a hedge fund manager, or a highly skilled knowledge worker, things are looking pretty good. If you don’t have a college degree, or even if you have a college degree but with the wrong major or have the wrong skills, not so much.
All that was happening before AI, and the question for us is whether AI will exacerbate those trends, or ameliorate them. If you are in doubt about the answer to that question, follow the money. Who is funding AI research, and what might they be expecting in return?
It seems like every day I read about how AI is impacting white collar jobs. It can help traders! It can help lawyers! It can help coders! It can help doctors! For many white collar workers, AI may be a valuable tool that will enhance their productivity and make their jobs easier – in the short term. In the long term, of course, AI may simply come for their jobs, as it is starting to do for blue collar workers.
Automation has already cost more blue collar jobs than outsourcing, and that was before anything we’d now consider AI. With AI, that trend is going to happen on steroids; jobs will disappear in droves. That’s great if you are an executive looking to cut costs, but terrible if you are one of those costs.
Continue reading…Sean Bell, Spring Health
Sean Bell is head of new ventures at Spring Health, a very well-funded mental health company. They’ve built a tech platform that its providers (both contractors and FT employees) are on, and spend a lot of time using machine learning to match patients to therapists, to augment the care and also measure the impact of that care. Sean told me about both how Spring Health works and how much its grown, and what new specialized care is being introduced in 2025. He talks quick and we covered a lot of ground including the business of being a highly-valued private mental health company when there are some lower priced public companies out there. Interesting interview — Matthew Holt
Will Trump and RFK Jr. Revive His Covid Pandemic Performance?
By MIKE MAGEE
It has been a collision of past, present and future this week in the wake of Trump’s victory on November 6, 2024. The country, both for and against, has been unusually quiet. It is unclear whether this is in recognition of political exhaustion, or the desire of victors to be “good winners” and no longer “poor losers.”
Who exactly are “the enemy within” remains to be seen. But Trump is fast at work in defining his cabinet and top agency officials. In his first term as President, Trump famously placed himself at the front of the line of scientific experts sowing confusion and chaos in the early Covid response.
His 2024 campaign alliance with Robert F. Kennedy Jr. suggests health policy remains a strong interest. As his spokesperson suggested, his up-front leadership led to a resounding victory “because they trust his judgement and support his policies, including his promise to Make America Healthy Again alongside well-respected leaders like RFK Jr.”
For those with a memory of Trump’s checkered, and disruptive management of the Covid crisis, it is useful to remind ourselves of those days not long ago, and consider if throwing Bobby Kennedy Jr. in the mix back then would have been helpful.
I have been revisiting the Covid pandemics I have prepared for a 3-session course on “AI and Medicine” at the University of Hartford’s Presidents College. The course includes a number of case studies, notably the multi-prong role of AI in addressing the Covid pandemic as it spun out of control in 2020.
The early Covid timeline reads like this:
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…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
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
The Silicon Curtain Descends on SB 1047
By MIKE MAGEE
Whether you’re talking health, environment, technology or politics, the common denominator these days appears to be information. And the injection of AI, not surprisingly, has managed to reinforce our worst fears about information overload and misinformation. As the “godfather of AI”, Geoffrey Hinton, confessed as he left Google after a decade of leading their AI effort, “It is hard to see how you can prevent the bad actors from using AI for bad things.”
Hinton is a 75-year-old British expatriate who has been around the world. In 1972 he began to work with neural networks that are today the foundation of AI. Back then he was a graduate student at the University of Edinburgh. Mathematics and computer science were his life. but they co-existed alongside a well evolved social conscience, which caused him to abandon a 1980’s post at Carnegie Mellon rather that accept Pentagon funding with a possible endpoint that included “robotic soldiers.”
Four years later in 2013, he was comfortably resettled at the University of Toronto where he managed to create a computer neural network able to teach itself image identification by analyzing data over and over again. That caught Google’s eye and made Hinton $44 million dollars richer overnight. It also won Hinton the Turing Award, the “Nobel Prize of Computing” in 2018. But on May 1 2023, he unceremoniously quit over a range of safety concerns.
He didn’t go quietly. At the time, Hinton took the lead in signing on to a public statement by scientists that read, “We believe that the most powerful AI models may soon pose severe risks, such as expanded access to biological weapons and cyberattacks on critical infrastructure.” This was part of an effort to encourage Governor Newsom of California to sign SB 1047 which the California Legislature passed to codify regulations that the industry had already pledged to pursue voluntarily. They failed, but more on that in a moment.
At the time of his resignation from Google, Hinton didn’t mix words. In an interview with the BBC, he described the generative AI as “quite scary…This is just a kind of worst-case scenario, kind of a nightmare scenario.”
Hinton has a knack for explaining complex mathematical and computer concepts in simple terms.
Continue reading…
