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Matthew’s health care tidbits: Hospital shooting reveals so much

Each week I’ve been adding a brief tidbits section to the THCB Reader, our weekly newsletter that summarizes the best of THCB that week (Sign up here!). Then I had the brainwave to add them to the blog. They’re short and usually not too sweet! –Matthew Holt

In this edition’s tidbits, the nation is once again dealing with an epidemic of shootings. Now a hospital joins schools, grocery stores and places of worship on the the recent list. I was struck by how much of the health care story was wrapped up in the tragic shooting where a patient took the life of Dr. Preston Phillips, Dr. Stephanie Husen, receptionist Amanda Glenn, 40; and patient William Love at Saint Francis Health System in Tulsa.

First and most obvious, gun control. The shooter bought an AR-15 less than 3 hours before he committed the murders then killed himself. Like the two teens in Buffalo and Uvalde, if there was a delay or real background checks, then these shootings would likely have not happened.

But there’s more. Hospital safety has not improved in a decade or so. Michael Millenson, THCB Gang regular, has made that plain. And that includes harm from surgery. We know that back surgery often doesn’t work and we know that Dr Phillips operated on the shooter just three weeks before and had seen him for a follow up the day before. Yes, there is safety from physical harm and intruders–even though the police got there within 5 minutes of shots being heard, they were too late. But there is also the issue of harm caused by medical interventions. Since “To Err is Human” the issue has faded from public view.

Then there is pain management. Since the opiate crisis, it’s become harder for patients to get access to pain meds. Was the shooter seeking opiates? Was he denied them? We will never know the details of the shooter’s case, but we know that we have a nationwide problem in excessive back surgery, and that is matched by an ongoing problem in untreated pain.

And then there are the two dead doctors. Dr. Husen, was a sports and internal medicine specialist. Obviously there are more female physicians than there used to be even if sexism is still rampant in medicine. But Dr. Phillips was an outlier. He was black and a Harvard grad. Stat reported last year that fewer than 2% of orthopedists are Black, just 2.2% are Hispanic, and 0.4% are Native American. The field remains 85% white and overwhelmingly male. So the chances of the patient & shooter, who was black and may have sought out a doctor who looked like him, having a black surgeon were very low in the first place. Now for other patients they are even lower.

The shooting thus brings up so many issues. Gun control; workplace safety; unnecessary surgery; pain management; mental health; and race in medicine. We have so much to work on, and this one tragedy reveals all those issues and more.

THCB Gang Episode 95, Thursday June 9

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday June 9 were THCB regular writer and ponderer of odd juxtapositions Kim Bellard (@kimbbellard); fierce patient activist Casey Quinlan (@MightyCasey); Principal of Worksite Health Advisors Brian Klepper (@bklepper1) & Queen of all employer benefits Jennifer Benz (@jenbenz)

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

#HealthTechDeals Episode 32| Hint Health, Moxe Health, uMotif, Fairtility, Circles

Shots have been fired. Hear the crickets? Maybe it’s the chirping from health technology twitter, particularly on the lack of deals? NO! That sound you hear is the stunning silence from our epic burns this episode. Shoutout to our new sponsor AHIP – check out the AHIP Conference 2022 taking place in Las Vegas! Common (the rapper) will be there. Tickets are $100 off with code THCB. Some deals: Hint Health raises $45 million; Moxe Health raises $30 million; uMotif raises $25 million; Fairtility raises $15 million; Circles raises $16 million.

An interview of, err, me by João Bocas

João Bocas is known as “The Wearables Expert” and has been talking, writing and innovating in health tech for a while. Last month he had me on his video series. It was a fun interview in which I talked about Flipping the Stack, the Continuous Clinic, and the slow pace of change in health care! With João’s permission I am reproducing that interview here–Matthew Holt

THCB Gang Episode 94, Thursday June 2

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday June 2 were regulars Grace Cordavano (@GraceCordovano); patient safety expert and all around wit Michael Millenson (@mlmillenson); and policy expert consultant/author Rosemarie Day (@Rosemarie_Day1). Gun control, hospital quality and much more all came up and were interlinked. Quite the conversation.

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

Russ Johannesson, CEO, Glooko

Russ Johannesson has been CEO of Glooko since 2018. In that time the diabetes data platform has expanded internationally, made a couple of acquisitions, and added support for digital therapeutics and distributed clinical trials. He brought me up to date with the latest–Matthew Holt

THCB Gang Episode 93, Thursday May 26 1pm PT, 4pm ET

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday May 26 were medical historian Mike Magee (@drmikemagee); Suntra Modern Recovery CEO JL Neptune (@JeanLucNeptune); and fierce patient activist Casey Quinlan (@MightyCasey). Plenty of conversation about guns as a public health crisis, and also much about data use, data reidentification and controversy there.

You can see the video below live (and later archived) & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

#HealthTechDeals Episode 31| Homethrive, Greater Good, Parallel Learning, Cayaba Care, Miga Health

You know what Jess just realized? We haven’t heard my opinion on Cerebral! Scandal! Firings! Intrigue! Legal Issues! Risk! Skyrocketing! Dying! Cerebral offers quite some food for thought. Check out the episode for my opinion on this incredibly fast-brewing story as well as more multi-million deals: Homethrive raises $20 million; Greater Good raises $10 million; Parallel Learning raises $20 million; Cayaba Care raises $12 million; Miga Health raises $12 million.

-Matthew Holt

Matthew’s health care tidbits: Digital Health is dead (well, not quite)

Each week I’ve been adding a brief tidbits section to the THCB Reader, our weekly newsletter that summarizes the best of THCB that week (Sign up here!). Then I had the brainwave to add them to the blog. They’re short and usually not too sweet! –Matthew Holt

For today’s health care tidbits, the elephant in the room has truely come home to roost, and now it’s landed on the phone wire, it’s close to breaking it. OK, I have stretched that metaphor to death but you’ll get my point. Writing on THCB earlier this month Jeff Goldsmith and Eric Larsen picked up on something I’ve been saying for a while –the fall in valuation of publicly traded digital health companies will have a knock effect on private companies

It took a while–those public companies stock prices started falling from their heights 14 months ago–but in the last month the venture capital scene has gone quiet. The days of sub $20m ARR companies getting mutli-hundred million dollar valuations are over for now. They will be back at some point in the future, as that’s how Silicon Valley has always worked, but it’ll be a while and in the meantime everyone is going to have to figure out what to do in the new world.

The “What to do?” question is getting harder as the data starts to come in, and it’s getting ugly. On the one hand the two fastest growing digital health companies ever have both had their comeuppance. Livongo was a tremendous exit for its investors and ended up trading at 20 times future revenue before it got acquired by Teladoc for $18bn mostly in stock. This quarter Teladoc wrote off much of its investment in Livongo and the whole company is now only worth $5bn. Clearly those “synergies” between telehealth and chronic care management didn’t work. The other rocket ship was Cerebral, which went from nothing in Jan 2020 to by Jan 2022 having over 100,000 patients and thousands of providers on its system as it raised over $300m from Softbank et al. Its aggressive & expensive customer acquisition costs, with its controversial controlled medication prescribing patterns, brought it way too much controversy. Its young CEO is gone, and it’ll be a slow climb back with bankruptcy and collapse the likeliest of outcomes.

But the part of digital health that’s trying to replace the incumbents is not the only place showing ugliness. The technologies and services being rolled out are often not working. Exhibit A is a randomized controlled trial conducted a Univ of Pennsylvania. One set of heart patients was set up with connected blood pressure cuffs, a pillbox that tracked their Rx adherence and lots of coaching help. The others were sent home with the proverbial leaflet and told to call if they had problems. You’d assume many more deaths and hospital readmissions in the second group. You’d be wrong. There were no differences.

So digital health needs to see if it can produce services companies that move the needle on costs and outcomes. The advantage is that they are eventually competing with hospital systems whose DNA doesn’t allow them the ability to let them cross the chasm to the new world. The bad news is that those systems have huge reserves which they can use to subsidize their old world activities.

I’m hoping digital health’s impact in the next 2 years will be as big as it was in the past 2, It’s by no means dead or over, but I am pessimistic.

THCB Gang Episode 92, Thursday May 19 1pm PT, 4pm ET

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday May 19 are delivery & platform expert Vince Kuraitis (@VinceKuraitis); policy expert consultant/author Rosemarie Day (@Rosemarie_Day1); & back after a long absence dangerous radiologist Saurabh Jha (@roguerad). Some great conversation about digital health, Roe v Wade, rural care and a deep dive into Saurabh’s trip to Nepal to deliver radiology tech to Everest Base Camp!

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

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