Today marks the beginning of the 8th annual Healthcare IT Week. Healthcare IT Week was started and continues on as a collaborative forum for public and private healthcare constituents to discuss the value of health information technology (health IT) for the U.S. healthcare system.
It is amazing to see how far health IT has come over the last 10-15 years. It has its own week! If, a decade ago, you told people that health IT would be a core focus of investors, entrepreneurs and everyone else in healthcare, the energy produced from the eye rolling alone could power the lights on the Las Vegas Strip for a month. The basic sentiment back then was this: Why would anyone invest in, think about, care about health IT when the consumer Internet was rocking and companies selling online dog food could get started on Monday and sold on Friday for a bull mastiff’s weight in gold?
Today it is quite clear that healthcare IT is a hugely significant part of any success we are having and will continue to have in transforming our healthcare system from one where 30% of cost and care is wasted or the result of error to one where value reigns supreme. We do not believe anyone rational would now argue that healthcare IT is non-essential to improving the quality, productivity, efficiency, cost and outcomes we produce in our healthcare system, although the path is not always smooth.
And it’s about time. Technology has been used to optimize and redefine virtually every key industry except healthcare. Manufacturing has gone from human assembly lines to robotics; banking has gone from tellers to home banking; travel has gone from agents with brochures to Travelocity; and yet in many ways, the fundamental practice of medicine hasn’t changed in decades.
The U.S. Bureau of Labor Statistics came out with its June jobs report this week and, consistent with usual trends, healthcare jobs are booming. In June 2013 there were approximately 20,000 new healthcare jobs in the U.S., ¾ of which were in the ambulatory care sector and ¼ of which were in hospitals. Healthcare jobs represented 10% of all new jobs created this month.
The June growth in healthcare jobs matches up to the average 19,000 new healthcare jobs we have seen created in each of the prior months of 2013 and the 12% job growth we have seen over the last five years. In a country where new jobs are viewed as even better than baseball, apple pie and mom herself, these new jobs should elicit a huge round of applause, or at least a stadium style wave, right?
Or should they?
Change the channel and a different set of policy makers, employers and industry experts will tell you that the only way to save our economy from ruin is to cut healthcare costs. Cutting healthcare costs means making the people who work within the system vastly more efficient, eliminating unnecessary medical care (and thus reducing the labor that goes along with it), and helping empower consumers to do things for themselves, including taking a more active role in reducing their own demand for healthcare services and, in some cases, doing at home what they might previously have used the healthcare system to do (e.g., diagnostics, home care, etc).
Two weeks ago I had the good fortune to be invited back to the South by Southwest Conference (SXSW) to participate as a judge of a digital healthcare start-up competition. SXSW, which takes place in Austin, TX, is historically an indie music gathering that has evolved into a massive mainstream music conference as well as a monumentally huge film festival, like Sundance times twenty. There are literally hundreds of bands and films featured around town. There has now evolved alongside this a conference called Interactive that draws more than 25,000 people and focuses on technology, particular mobile, digital, and Internet.
In other words, SXSW has become one of the world’s largest gatherings of hoodie-sporting, gadget-toting nerd geniuses that are way too square to be hip but no one has bothered to tell them. Imagine you are sitting at a Starbucks in Palo Alto, CA among 25,000 people who cannot possibly imagine that the rest of the world still thinks the Internet is that newfangled thing used mainly for email and porn. SXSW is a cacophonous melting pot of brilliance, creativity, futuristic thinking, arrogance, self-importance, ironic retro rock and roll t-shirts and technology worship. One small example: very hard to get your hands on a charger for anything other than an iPhone 5 because, seriously, who would have anything else?
Patient monitoring outside the hospital has been a hot topic (and also a not so hot topic) for the past 15 years.
Starting back in the late 1990s with companies like Health Hero Network, a company whose products for patient home monitoring are still in use today, company after company has sought to bring a successful product to market. The holy grail: finding an easy, non-intrusive, and continuously reliable way to predict patients’ potentially serious medical problems when it is early enough to do something about them and prevent an acute and expensive episode of illness. Some of the newer companies are focused more on the wellness and tracking side of the equation, such as helping individuals see progress from an exercise or other preventive/health-inducing regimen.
So far this whole area has been a very tough nut for businesses to crack in the US in particular. While some studies have shown great positive effect, others have not. Insurance payment for these programs has been spotty at best and non-existent at worst; most of the current vendors are stuck in pilot hell without significant long term and widespread commitments from payers. There is a belief, veracity unknown as yet, that the proliferation of risk-based entities such as Accountable Care Organizations will change this and lead to broad adoption of ambulatory patient monitoring tools, angels will sing and a large number of hospitalizations and rehospitalizations will be avoided. That may be true, but remains to be seen.
So I read an article the other day about a new company called Rap Genius. The company consists primarily of a website that relies on crowdsourcing to explain rap lyrics to the masses who are not down with the urban vibe (aka, people over 30). The company takes lyrics such as these from Kanye West’s Gold Digger….
“She was supposed to buy your shorty Tyco with your money
She went to the doctor got lipo with your money
She walking around looking like Michael with your money.”
…and explains that they mean, to wit: The ex-wife was supposed to buy your baby some toys with the child support money but instead spent it all on so much plastic surgery that she looks like Michael Jackson (presumably before he died―my edit).
Here’s another example: Nelly’s song Grillz gets explained thusly: “Got 30 down at the bottom, 30 more at the top, all invisible set in little ice cube blocks” refers to the fact that Nelly is wearing “grillz” aka jewelry worn over the teeth, which are worth $30,000 on the top and another $30,000 on the bottom, with diamonds set right into the gold. So now you know.
According to the article about the $15m investment that venture fund Andreesen Horowitz put into Rap Genius, the company’s goal is to “annotate the Internet” and, beyond rap music, “the company is slowly spreading to other categories such as literature, political speeches, and science papers.” Let me just digress for a moment and say that the website I would love to see is the one that turns political speeches into rap lyrics―wouldn’t it be sublime to see Joe Biden and Paul Ryan speak jive?
While the evolution of the digital health ecosystem has seemed at times almost painfully contrived, it now appears to have reached the point where it requires but a few sprinkles of magic fairy dust to be truly alive.
The basic idea behind digital health is pretty clear: we can (and must) do health better, and technology should be able to help,
There’s also an ever-increasing amount of support for early-stage innovators in this space. A remarkably large number of digital health incubators have sprung up around the country, as Lisa Suennen captured with characteristic verve in a recent Venture Valkyrie post.
On top of this, a slew of corporate VCs have now emerged – many from payors, but some from communication companies, and even a few from big pharmas such as Merck – all keen to invest strategically in the digital health space.
Deliberately, many of these large corporations also represent likely buyers for the products or services that will be produced, so it really does seem like an example of the savvy external sourcing of innovation.
So we’re good, then – right?
Well, not so fast.
It turns out that many high profile VCs continue to eschew this space, other than perhaps an occasional investment or two. The reason? As one extremely well-regarded VC – with extensive healthcare experience – told me yesterday, “I haven’t seen a viable business model yet.”
Translation: how do you make (serious) money here? Where’s the revenue?
This week I had the occasion to be at UCLA for a very interesting meeting (more on that in a future post). As I arrived at LAX to return my rental car, I drove past a huge billboard at the corner of 96th Avenue and Airport Blvd (just across from the Renaissance Hotel) that made me do a double take. The billboard, said in gigantic white letters on a red background: “This year thousands of men will die from stubbornness.”
Naturally, my first thought was this: Why thousands? If men can die from stubbornness, aren’t they all doomed? If stubbornness is the proximate cause of death, we are looking at a wipe-out of society on a pretty imminent basis. The bad news: no more future generations. The good news: no one will hassle us women about buying too many shoes and all the top-paying private equity jobs will soon be available.
So figuring that I had misread this billboard, I actually made a U-turn and drove past it again (not sure what made me do it: alarm or wishful thinking). What I noticed on my second pass was the very fine print, which said, “Learn the preventative medical tests you need. AHRQ.gov.”
The billboard is apparently part of an U.S. Government Agency for Healthcare Research and Quality Department ad campaign targeted to get men to stop avoiding the doctor and to go and get the medical screening tests recommended each year, such as those for cholesterol, diabetes, high blood pressure, cancer and other illnesses.Continue reading…
A few weeks ago I wrote a post about the unbelievable cost associated with Alzheimer’s disease and how large a population it is likely to affect. According to an op-ed piece written by Sandra Day O’Connor, among others, it is estimated that by 2050 approximately 13.5 million Americans will be stricken with Alzheimer’s, up from five million today, and that the cumulative price tag for treating Alzheimer’s, in current dollars, will be $20 trillion. In contrast, remember that the cost of our ENTIRE healthcare system today is around $2.4 trillion.
This week there was a follow-up piece in the NY Times entitled, “Tests Detect Alzheimer’s Risks, but Should Patients Be Told?” The article described how new diagnostic tests have become available that make it possible to detect early Alzheimer’s and, more interestingly, to predict more accurately one’s likelihood of getting Alzheimer’s in the future. The focus of the article was the moral and ethical dilemma presented by the availability of this knowledge.
Since there is no known treatment for Alzheimer’s and none on the short term horizon, physicians with knowledge of a patient’s Alzheimer’s risk are put in an interesting spot. If they tell their patients the bad news, it may have a profound negative effect on their psyche and lead to debilitating depression; if they don’t tell, they are withholding information that might enable a person to prepare their life more effectively to deal with the oncoming challenges. As the article so well articulates:
“Modern medicine has produced new diagnostic tools, from scanners to genetic tests, that can find diseases or predict disease risk decades before people would notice any symptoms. At the same time, many of those diseases have no effective treatments. Does it help to know you are likely to get a disease if there is nothing you can do? “
The Cleveland Clinic recently published an annual Top 10 list of what their leadership believes to be the most significant advances in medicine in each of the last five years. In 2007-2008 all of the items on the top 10 lists were either medical devices, clinical diagnostics,pharmaceutical or biotech products. These sectors were basically the Beatles of medicine, while healthcare information technology was more like the indie group Florence + the Machine: intriguing, but not likely to be called out on the Billboard Top 10 (or make Cleveland’s own Rock and Roll Hall of Fame) in the immediate future.
Interestingly, healthcare information technology (HIT) applications began to sneak their way onto the Cleveland Clinic Top 10 list over the last two years. In 2009-2010 HIT barely made it, coming in at number 10 in both years. In contrast to all previous years, however, there it was. HIT had made it to the list representing 10% of what one of the nation’s most prestigious medical institutions calls the most significant up-and-coming technologies that can have the biggest impact on health care. In 2011 HIT was number 6 with a bullet, moving HIT well up the Top 10 list.
I think it is fair to say that most people in the know about the healthcare field agree that the strategic application of HIT is essential to moving the quality, efficiency and efficacy of our healthcare system forward. However, it is particularly gratifying to see an organization such as the Cleveland Clinic broadening their view of what constitutes the most profound developments in our healthcare system.
In the last several weeks I lost my phone (recovered), my iPod (gone) and even a piece of jewelry (I am pretty sure the cat is guilty). I was at the airport when I couldn’t remember where I parked my car for long enough to wonder if I actually did drive myself there. (Don’t judge me; I know you do it too.)
All of us are prone to losing objects and forgetting appointments and struggling for that word on the tip of our tongue that we definitely should know. Sometimes we even forget the names of people who live in our house just for a second; admit it: how many times have you called your child by the dog’s name?
Those momentary lapses of memory can be amusing or frustrating, but they usually don’t slow us down much. We laugh it off and say, “wow, I must be getting old” and move on to the next task. An op-ed I read recently in the NY Times, however, made me realize we don’t long have the luxury of humor when it comes to this issue.
Authored by Supreme Court justice Sandra Day O’Connor (ret.), Nobel Laureate neurologist Dr. Stanley Prusiner and Age Wave expert Ken Dychtwald, and entitled The Age of Alzheimer’s, the article pointed out these astonishing facts:
Starting on Jan. 1, our 79-million-strong baby boom generation will be turning 65 at the rate of one every eight seconds. That means more than 10,000 people per day, or more than four million per year, for the next 19 years facing an increased risk of Alzheimer’s. Although the symptoms of this disease and other forms of dementia seldom appear before middle age, the likelihood of their appearance doubles every five years after age 65. Among people over 85 (the fastest-growing segment of the American population), dementia afflicts one in two. It is estimated that 13.5 million Americans will be stricken with Alzheimer’s by 2050 – up from five million today.Continue reading…