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Will Boeglin demos TimeDoc Health

Will Boeglin is CEO of TimeDoc Health. It’s one of a new breed of companies supplying the capability for physician groups and health systems (including FQHCs) to deliver CCM (chronic care management) and RPM (remote patient monitoring). Both of those services are now reimbursed by Medicare, and some private plans, but rolling them out and tracking all that activity–not to mention accounting and billing for it–is non-trivial for practices. That is where TimeDoc comes in. Will started the company as part of a med-school project and just raised $48m to really get it going. He showed me how it worked, and gave an extensive and interesting demo–Matthew Holt

How About This Opportunity, Health Tech Investors? Promoting Contraception vs. Banning Abortion

By MIKE MAGEE

Dr. Linda Rosenstock has an M.D. and M.P.H. from Johns Hopkins, and was a Robert Wood Johnson Clinical Scholar. She is currently Dean Emeritus and Professor of Health Policy and Management at UCLA’s Fielding School of Public Health, but also spent years in government, and was on President Obama’s Advisory Group on Prevention, Health Promotion and Integrative and Public Health.

In the wake of the release of Justice Alito’s memo trashing Roe v. Wade, she was asked to comment about the status of abortion in America. Here is what she said:

The broader the access to proven family planning methods, the lower the unintended pregnancy rate and the lower the abortion rate. We cant underestimate the role of educating and empowering women – and men – about these issues.”

These are not simply the opinions or insights of a single health expert. They are backed up by the following facts:

  1. Since 1981, abortion rates in U.S. women, age 15 to 44, have declined by nearly two thirds from 29.3 per 1000 to 11.4 per 1000.

2. Approximately half of all pregnancies in the U.S. are unintended.  Of those unintended, approximately 40% of the women chose to terminate the pregnancy by abortion – either procedural or chemically induced.

3.  The decline in the number of abortions has coincided with increased access to long-acting reversible contraception, including IUD’s and contraceptive implants. These options are now safe, increasingly covered by insurers, and more accessible to at-risk populations.

4. The increasing inclusion of sex education in middle school and high school curricula has been accompanied by a decline in high school sexual activity by 17% between 2009 and 2019.

5. There were 629,898 abortions recorded by the CDC in 2019. For every 1000 live births that year, there were 195 other women who chose to terminate their pregnancies. Almost half of the 1st trimester abortions are now chemically induced through Plan B-type pills.

What is clear from these figures is that knowledge and access to contraception is the best way to decrease the number of abortions in America.

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BREAKING at ViVE: Jenny Schneider on Launch of New Biz, Homeward

by JESSICA DAMASSA, WTF HEALTH

BREAKING! Livongo-famous Jenny Schneider stops by to talk to us first, on-site at ViVE in Miami, about the brand-new business she’s just launched today to “rearchitect” rural health and care. Called Homeward, the startup is coming out with a $20 million Series A backed by General Catalyst, and a novel model that will integrate virtual-and-in-person primary care and cardiology care for Medicare beneficiaries in rural markets. We get into the business model, care model, some shocking statistics about just how dire the market need is, AND all the gossip about the old friends she’s bringing into the business with her. PLUS: Bonus dishing on Glen Tullman’s new business Transcarent, and what connection Homeward might have to the SPAC that Jenny co-founded with Glen, Hemant Teneja and Steve Klasko of General Catalyst. Coming at you fast with this one!

Does Digital Health Technology Have a “Famous Trio” in the Making?

By MIKE MAGEE

Yale historian, Frank M. Snowden wisely notes in his 2020 book, “Epidemics and Society”, that “We must avoid the pitfall of believing the driver of scientific knowledge is ever a single genius working alone.”

His insight came to mind this week as I was reviewing the January 11, 2020 Forbes article by Seth Joseph, health tech policy correspondent, titled “What Bubble? Digital Health Funding Year in Review 2021.”

By one measure of success – dollars invested – it’s been a banner year. According to Joseph, there was over $29 billion funded, and 729 digital health US-based startups in 2021. But according to Scott Barclay, Managing Director at Insight Partners, who is quoted generously in the Forbes piece, “digital health is still in its relative infancy.”

This level of churn, passion, and (some might say) financial frenzy is reminiscent of another moment in scientific history – the latter half of the 19th century. Over a few decades, “The Germ Theory” was fleshed out with unprecedented and remarkable human progress following in its wake.

The breakthroughs were not the result of 729 often-repetitive and unoriginal ideas, but rather the work of three successive innovators whose work built on each other, combining innovation, technology and health.

Snowden termed the three “The Famous Trio.”

The first was Louis Pasteur (1822-1895) a chemist with a sharp eye and mind. He had been hired to find a solution for wine and milk that was spoiling too fast. The tools he wielded were mostly observational, including a still primitive microscope. With it, Pasteur was able to identify putrefying microbes as causal but went two steps further. He noted that a heating process killed the microbes and halted the product putrefaction, and tied the microscopic organisms to specific human diseases. With this knowledge, he unveiled a commercial process of serial attenuation of disease-causing microbes that allowed safe inoculation of humans and acquired immunity.

The second of the trio was Robert Koch (1834-1910), a physician 20 years younger than Pasteur. While studying Anthrax at the University of Gottingen, he visualized the large causative bacteria, introduced it into a lab animal, and reproduced the disease. Going one step further, he described resistant spores of the bacteria, identified them in grazing fields, and proved that eating grass laden with spores could spread Anthrax between animals. His careful investigative approach led to the uncovering of the etiology of tuberculosis and to “Koch’s Postulates”, four steps still in place today, which when followed, constitute laboratory-based scientific proof of a theory. Beyond this, Koch was a technology innovator, teaming up with the Carl Zeiss optical company, whose lenses, in combination with specialized tissue stains and fixed culture mediums, allowed Koch to visualize and describe M. tuberculosis.

The third innovator was Joseph Lister (1827-1912), a professor of surgery at Edinburgh.  Thanks to the development of ether and nitrous oxide in the 1840s, pain management intra-operatively was under partial control. Improving techniques and tools helped control blood loss. But post-operative infection remained a persistent and deadly threat. Viewing the work of Pasteur and Koch, Lister recognized the possibility that contamination with microbes might be the cause. In carefully designed studies, employing hand scrubbing, sterilization of tools, and spraying the patient with carbolic acid, rates of post-operative sepsis declined. Other colleagues added sterile gowns, gloves, and masks, merging these added measures with Lister’s support.

 Arguably, the life-saving “Germ Theory” was the work product of complementary insights and serial incremental progress. It might then be reasonable to ask, of the $29 billion funded 729 digital health tech US-based startups in 2021, how many represent additive and progressive insights that might eventually lead to game-changing advances in the health of America?

Scott Barclay appears to be mining this same territory. In Forbes, he says, “The green shoots of the past 10 years are turning into new vibrant ecosystems that are growing, but young. We are early in what may turn out to be a two-decade epoch of super innovative ideas, strong founders with execution experience bringing change to a $4T sector of the economy that has been sclerotic and in many parts oligopolistic. The majority of the largest digital health companies in 2040 public markets have not yet been started.”

Does Digital Health Technology have a “Famous Trio” in the making to link infrastructure, AI diagnostics, and evidence-based health? Who are they, and how do they complement each other?

Mike Magee, MD is a Medical Historian and Health Economist, and author of  “CodeBlue: Inside the Medical Industrial Complex.“

After the Crash

By JEFF GOLDSMITH

These are grim days for innovative healthcare companies.  The health tech and care innovation firms mature enough to make it to public markets have been eviscerated in the ongoing market correction. As of January 29, 2022, high fliers like One Medical (down 83% from peak), Oscar (down 83%), Bright Healthcare (down 85%), Teladoc (down 77% but still selling at 6X revenues!), and AmWell (down 90%) are the tip of a much larger melting iceberg.    The dozens of digital health unicorns (e.g. pre-public companies valued at more than $1 billion) and their less mythical brethren, into which investors poured more than $45 billion during 2020-2021, are sheltering in the comparative safety of VC/Private Equity balance sheets. They are protected from investor wrath until those firms’ limited partners force a revaluation of their portfolios based on the market value of their publicly traded comparables.   

Yet it is the next moves that these innovative firms and their equity holders make that will determine whether these firms realize their full transformative potential or fade into insignificance. The Gartner Group, which tracks the technology industry generally, popularized the notion of the Hype Cycle- a seemingly universal trajectory that tech innovations and the firms that produce them follow (see below).   

                                                    The Gartner Hype Cycle

Everyone seems to focus on the colorful first phase of this cycle- the inflating and deflating part- where an innovation rises on a wave of the adulatory press (and breathless futurist punditry), then crashes ignominiously into the Slough of Despond.  A classic example was the Apple iPhone’s ill-starred great uncle, the Apple Newton, which launched in 1993 and crashed shortly thereafter.

For founders and investors, as well as customers, however, it is the less visible succeeding phases that determine if the innovation survives and the firms that produce them become ubiquitous and indispensable parts of our lives.  The rising initial phase of Gartner’s Hype Cycle is driven by the question “Is it cool”?, mediated by hyperactive media and Internet buzz.    The inevitable crash, on the other hand, is almost always driven by the troublesome real-world question,  “Does the product actually work as advertised?” Analysts, writers, and, most importantly, customers press uncomfortable questions about not only functionality, but also reliability, affordability, stickiness, and “value for money”.

How do firms survive the crash and climb Gartner’s “Slope of Enlightenment”?  This is the unglamorous “pick and shovel” part.  If the sticky “product integrity” issues (does the product actually work?) are resolved, then a host of important questions challenge the firm, its founders, and owners, which answers the crucial question:  whether it is a real business:   

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Rooting For Schumpter’s Gale

By KIM BELLARD

Not familiar with Schumpeter’s gale?  You may be more familiar with the term “creative destruction.”  Schumpeter’s “gale of creative destruction” is the inevitable “process of industrial mutation that continuously revolutionizes the economic structure from within, incessantly destroying the old one, incessantly creating a new one.”  

We need a Schumpeter’s gale in healthcare.

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BREAKING: Innovaccer CEO on Healthcare Cloud Startup’s $150M Raise & $3.2B Valuation Announced Today

BY JESSICA DaMASSA, WTF HEALTH

Health tech infrastructure startup, Innovaccer, announced its $150M Series E and newly assigned $3.2B valuation today, and I’ve got CEO Abhinav Shashank with the essential intelligence on how this company is pursuing health IT’s holy grail: the single patient health record.

This is a story of cloud technology’s uptake in healthcare, which has lagged behind other sectors like banking and retail in terms of industry-wide adoption. Abhinav tells us that the “economic incentives” are finally aligned for cloud to really take-off in healthcare, as the technology will be critical to any models where care is longitudinal instead of transactional and a singular view of a patient’s clinical data, labs, scans, and claims will be essential to healthcare organizations taking on more risk.

So what, exactly, does Innovaccer do? What’s the work, and how do they get paid? Who has access to the data they’re landing in the “Innovaccer Health Cloud”? Will patients one-day be able to access this single record themselves? And, what stops Epic or Cerner from just doing this and owning the space outright? No detail left unexplored in this one and – for the benefit of those of us who are not very plugged into the IT underpinnings of the EHR – Abhinav breaks it all down for us in a way that even us non-techie health tech market watchers can understand!

Tech Can’t Fix the Problems in Healthcare

By KIM BELLARD

Shira Ovide, who writes the On Tech newsletter for The New York Times, had a thoughtful column last week: Tech Can’t Fix the Problem of Cars.  It was, she said, inspired by Peter Norton’s Autonorama: The Illusionary Promise of High Tech DrivingThe premise of both, in case the titles didn’t already give it away, is that throwing more tech into our cars is not going to address the underlying issues that cars pose. 

It made me think of healthcare. 

What’s been going on in the automotive world in the past decade has truly been amazing. Our cars have become mobile screens, with big dashboard touchscreen displays, Bluetooth, and streaming. Electric cars have gone from an expensive pipedream to an agreed-upon future, with Tesla valued at over a trillion dollars, despite never having sold a half-million cars annually before 2021. 

If we don’t feel like driving, we can use our smartphones to call an Uber or Lyft. Or we can use the various autonomous features already available on many cars, with an expectation that fully self-driving vehicles are right around the corner. Soon, it seems, we’ll have non-polluting, self-driving vehicles on call: fewer deaths/injuries, less pollution, not as many vehicles sitting around idly most of the day. Utopia, right? 

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Medicine May Be an Art, but AI May Be Artists

By KIM BELLARD

Six hundred years ago, Swiss physician/scientist/philosopher Paracelsus disclaimed: “Medicine is not only a science; it is also an art.”  Medicine, most people in healthcare still believe, takes not just intelligence and fact-based decision-making, but also intuition, creativity, and empathy.  This duality is often cited as a reason artificial intelligence (A.I.) will never replace human physicians.

Perhaps those skeptics have not heard about Ai-Da

Now, I have to admit, “she” wasn’t on my radar either until recently, when she was imprisoned/impounded at customs by Egyptian authorities on her way to an art exhibit at the Great Pyramids of Giza, where she was scheduled to show her work.  Egyptian authorities first objected to her modem, then to the cameras in her eyes.  “I can ditch the modems, but I can’t really gouge her eyes out,” said her creator Aidan Meller.  After a 10 day stand-off, she was released late last week

Let me back up.  Named in honor of famed 19th century mathematician/programmer Ada Lovelace, Ai-Da is “the world’s first ultra-realistic humanoid robot artist.”  She was created in 2019, and uses AI algorithms to create art with her cameras/eyes and her bionic arms.  She can draw, paint, even sculpt, and had her first major exhibit – Ai-Da: Portrait of the Robot — this summer at London’s Design Museum.

The description of her exhibit says:

As humans increasingly merge with technology, the self-titled robotic artist, Ai-Da, leads us to ask whether artworks produced by machines can indeed be called ‘art’…Ai-Da can both draw and engage in lively discussion…These features, and the movements and gestures that Ai-Da is programmed to perform, raise questions about human identity in a digital age.

Her website elaborates:

…current thinking suggests we are edging away from humanism, into a time where machines and algorithms influence our behaviour to a point where our ‘agency’ isn’t just our own. It is starting to get outsourced to the decisions and suggestions of algorithms, and complete human autonomy starts to look less robust. Ai-Da creates art, because art no longer has to be restrained by the requirement of human agency alone.  

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#Healthin2Point00, Episode 232 | Cue Health goes public + funding for Stellar, eVisit, & Neuroglee

Today on Health in 2 Point 00, Jess and I are at UCSF – we’ll be providing color commentary for the UCSF Health Awards, so tune in tonight for that. On Episode 232, Jess asks me about more deals including Stellar Health raising $60 million, Cue Health going public (and stealing the HLTH ticket), and eVisit raising $45 million for its telehealth solution. Finally, Neuroglee raises $10 million in an Alzheimer’s play. —Matthew Holt

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