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Tag: Startups

Lessons Learned from Steve Jobs

I recently spoke with several reporters about Steve Jobs’ impact on healthcare, thanking him for the past 15 years of innovation.   In preparing for those interviews, I reviewed Steve’s career milestones,

In 1997, Apple Computer was in trouble.  Its sales had declined from 11 billion in 1995 to 7 billion in 1997.  Its energies were focused on battling Microsoft.   It had lost its way.

Steve Jobs made these remarks at MacWorld 1997, a few months before becoming Apple’s CEO.  He outlined a simple go forward plan:

1.  Board of Directors
2.  Focus on Relevance
3.  Invest in Core Assets
4.  Meaningful Partnerships
5.  New Product Paradigm

How can we apply these 5 ideas to the work we’re doing in HIT?

It’s clear that Health Information Exchanges across the country are in trouble – CareSpark closed its doors,  the CEO of Cal eConnectresigned, and Minnesota Health Information Exchange ceased operations.

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Lessons from the Carnage in HealthTech

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Recently ZocDoc had a huge funding round demonstrating the success that they are having. There’s a number of lessons learned from ZocDoc’s experience. Unfortunately, many haven’t demonstrated Zocdoc’s wisdom leading to a large number of healthtech failures. A recent study highlights this phenomena. After interviewing 110 digital health entrepreneurs, RockHealth recently released its study Rock Report: State of Digital Health demonstrating the disconnect between the startups getting funding and what many startups are pursuing. This disconnect is the last and most important reason healthtech companies have failed that are detailed below. The following are the top reasons why healthtech companies have failed or had to do major pivots in order to survive:

Lack of Specific Focus or Adoption point
It’s well documented that a lack of focus kills startups whether they are in healthcare or not but it is particularly prevalent in healthcare. The diversity of opportunities in healthcare is so great that it’s tempting to try to solve it all. These startups are ignoring the old saying about how to eat an elephant — one bite at a time. Too many startups are trying to swallow the elephant whole.
Expected consumers to pay
With the exception of weight loss programs, there aren’t many examples of consumers paying directly for health services. Over time, this is likely to change as more of the burden of healthcare costs gets shifted to consumers as was highlighted in a Healthcare Disruption series (see links below). However, I’d be very cautious about any business expecting to have consumers pay in the near-term.

mHealth – Potentially Valuable, But Not Ready For Primetime

mHealth – otherwise known as mobile healthcare – sounds like just what the doctor ordered to help make healthcare delivery cheaper and more effective. And since the Internet today essentially resides in everybody’s pocket, it would seem as though it’s ready to be implemented. But we have what amounts to a “last-three-feet” problem. So I’m not sure mHealth is ready for primetime, mostly because I don’t think our conventional healthcare system is ready or capable of embracing it.

The goal is to have patients wirelessly send appropriate clinical information to their healthcare providers in a timely manner. This would save time-consuming trips to the doctor on their part and, for doctors, ultimately make it easier to retrieve key patient clinical data. Such a system could detect events just before they happen and allow early critical intervention. The problem is that at this point this is just a goal, not reality.

I have looked at a half dozen startups in this space but haven’t made a commitment to fund any of them. In many cases, their technology looks promising, but it isn’t clear how the company would actually generate consistent revenue. Would the healthcare system reimburse mHealth? Would the doctor know how to interpret the flood of real-time data? Would our system drown under a deluge of alerts, many of which resolve naturally? There is a wealth of questions around these issues.Continue reading…

Can Everyone Become a Billionaire?

I’m going to tell you something that Barack Obama doesn’t understand.

And because he doesn’t understand it, our country is wasting hundreds of millions of dollars at a time when we cannot afford to waste hundreds of millions of dollars.

Time and again President Obama has told us how he intends to solve our health care problems: spend money on pilot programs and other experiments; find out what works and then go copy it. He’s also repeatedly said the same thing about education. The only difference: in education we’ve already been following this approach with no success for 25 years.

Still, if the president were right about health and education, why wouldn’t the same idea apply to every other field? Why couldn’t we study the best way to make a computer, or invest in the stock market and do any number of other things — and then copy it?

I want to propose a principle that covers all of this: entrepreneurship cannot be replicated. Put differently, there is no such thing as a cookbook entrepreneur.

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Innovation and Competition

Last year I published a piece called “Beyond Innovation and Competition,” questioning the dominance of those values. Economists celebrate innovation and competition as the main source of future growth. Innovation has become the central focus of Internet law and policy. While leading commentators sharply divide on the best way to promote innovation, they routinely elevate its importance. Business writers have celebrated search engines, social networks, and tech startups as model corporations, bringing creative destruction and “disruptive innovation” in their wake. Maximum innovation is the goal, and competition is billed as the best way of achieving it. Players in the vast and dynamic tech marketplace are supposed to constantly strive to innovate in order to attract consumers away from rivals.

In the piece, I explain how both competition and innovation can be as destructive as they are constructive. There are many social values (including privacy, transparency, predictability, and stability), and companies can compete for profits in ways that erode those values. In an era of inequality and hall-of-mirrors stock market valuations, innovations of marginal or negative impact on society at large can be vastly overvalued by a stampede of fickle investors.

The shortcomings of the innovation and competition story also play out in health information technology. Stimulus legislation in 2009 provided many carrots and sticks for doctors to digitize their recordkeeping systems, ranging from bonuses now to reimbursement haircuts later this decade if they fail to implement the technology. Congress structured the incentives to encourage a competitive and innovative marketplace in health information technology. But many doctors are shying away from implementation, in part because they fear that the fast and loose ethics of the market can’t mesh with a medical culture of constant commitment to quality care.Continue reading…

Getting More Startups Focused on Health

Could it be true? Is venture funding on the mend after it’s collapse in 2008? Some would say that the amount of capital invested is on the rise, and new funding streams are providing an excellent opportunity for startups to start getting funded again. But is this also true for health or healthcare startups?  After leaving Google recently, I have been spending time talking to various startups and VC firms that are interested in health and healthcare apps. I am encouraged by what I see.

There seems to be a handful of seed accelerators and government initiatives focused on stimulating innovation in the consumer and provider health tech space. New incubators like Rock Health and Startup Health, an arm of the Startup America Partnership are trying to encourage attention to this vertical. Other cool platforms such as the Quantified Self movement, ONC’s Investing in Innovations (i2) Initiative, and this week’s impending announcement of the SMArt (Substitutable Medical Apps, Reusable Technologies) Challenge Apps are creating some fresh buzz.  But what I find even more interesting is that broader tech accelerators like YCombinator, and 500 Startups are also starting to fund some health startups (checkout drchrono.com and Evoz).

While I am making my rounds, I cannot help but make a shameless plug for some of my ex Googler friends at 500 Startups. In case you have not heard of them yet, 500 Startups is a $40 million Super Angel investment fund that was founded by former PayPal executive, Dave McClure and Christine Tsai, former Google Marketing pro who ran Google I/O.  They provide early-stage seed funding ($10K to $250K) and have over 140 experienced startup mentors around the world that help with product design and data and customer acquisition. 500 Startups holds a series of events on all kinds of things relating to startup success. In fact, check out the event they are hosting this Saturday, June 25th from 1-6pm called “‘Design a Healthy Startup: Prevent Burn Out.” This event will feature 500 Startup founders and entrepreneurs from HealthTap, EcoFactor, Google, Facebook and Zynga. Demos from cool new startups in the wellness space like Dojo, Habit Labs, and FitSquid, will also be presenting. Read more about the event or sign up to attend this Saturday.

Missy Krasner spent several years helping getting Google Health off the ground, and before that was David Brailer’s right-hand woman at ONC.

Silicon Valley roars back…in healthcare too?

Recently, the Wall Street Journal has been writing article after article about how Silicon Valley is suddenly as hot again as in 1995. And anyone driving into San Francisco these days will have views of the city obscured with big “we’re hiring” billboards from the Groupons, Zyngas, Rockyous, and whathaveyous of the world.

In the past healthcare innovation and startups/new value creation has proceeded independent of that tech-scene and it has been much slower, dominated by buying behavior from giant incumbents who thought NIH stood for Not In Healthcare. But as my colleague and Health 2.0 co-founder Matthew Holt likes to put it: change starts at the edges. And we have seen Health 2.0 start small at the edges with the growth of patient communities, followed by other models connecting patients, payers, and providers in new ways (e.g. American Well, athenahealth, Castlight).

On May 18 SDForum is organizing a one-day event highlighting the change that is afoot in mainstream healthcare as a result of the innovation from the edges reaching the shores (and more) of mainstream health and wellness industries.

I am introducing the first keynote speaker (Holly Potter from Kaiser Permanente) and moderating a panel on one of my favorite topics: how data and innovation in analytics can make treatment and wellness decisions better, and hence create value, for all involved. While 80% of presenting companies are young (from only a few months in existence to 5 years from initial funding), there are also some pioneering established companies (Kaiser Permanente, Safeway, PAMF) who will touch upon topics like:

  • how ONC’s push for ‘data Liberacion’ is one of several forces helping to make health decisions more data-driven
  • how mobile/unplatforms, cloud-computing, and innovative use of analytics create new opportunities to understand patient behavior and introduce new, smart interventions
  • how chronic disease treatment is starting a transformation (funky billboards in LAX not withstanding, Lisa)
  • how new entrepreneurial energy is being backed by more and more funding (Healthtap is one of the companies who recently received funding and who will be on the panel that I moderate, Doximity is another company that fits that bill)

Finally, while some companies in general tech  or consumer markets seem to pursue growth without a business model, this event shows how companies in healthcare who get it right (e.g. Limeade), can grow fast, do good, and become financially viable businesses. Maybe one day the WSJ will report on the exciting IPO window of healthcare technology innovation companies for a change. In the meantime, come and see what the future will look like by hearing from those who are building it now.

Marco Smit is President of Health 2.0 Advisors, the market intelligence arm of the Health 2.0 family.

Who Cares?

The father of a wireless engineer, who made a good living designing mobile devices, contracted a rare and chronic form of athlete’s foot. Over the course of a few months, the father’s condition worsened and eventually he died. Vowing he would make sure that no-one suffered the way his father had during the last few weeks of his life, the engineer set about developing a wireless athlete’s foot detector.

After obtaining the backing of a venture capitalist, he licensed technology from a university spinout that specialised in bio-sensing and embedded it onto a wireless chipset, which he then packaged into a simple mobile device. The athlete’s foot monitor is now on the market and our wireless engineer is talking to a number of healthcare providers, including the NHS.

There are two important things about this story; first it is complete fiction – and  second; anyone who has been involved in the wireless and mobile industry, will have come across real life examples of personal quests masquerading as business plans.

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Year End Pondering

It’s the end of the year – an opportune time to forecast how 2011 will unfold in health care. We are likely to see some surprises, such as the sharply rising importance of primary care physicians.

Here are some predictions about the new year:

More consolidation is on its way in healthcare under Obamacare, which heightens the pressure to improve the efficiency of healthcare delivery. As part of this, more and more healthcare provider groups, even the small ones, will feel compelled to go electronic once and for all.

Valuable new, cost-effective medical tools will begin to become widely embraced. One is telemedicine. Just imagine how much more effective doctors can be if they interact with patients remotely via cameras. The technology exists now, has been successfully used in a number of situations, and it is not expensive.  Soon insurance reimbursement models will permit and remunerate physicians for telemedicine “visits,” and then this will take off.

The use of genetic testing to segment patient populations and better target therapies will be one of the fastest growing segments of healthcare as a new wave of accurate, clinically actionable tests hits the market.

As health reform increasingly kicks in, there will be heightened emphasis on the importance of primary care physicians – a sharp contrast to the elevated importance of specialists for so many years. They will become the linchpins of health care and make more pivotal care decisions as more than 30 million more people enter the healthcare system and require access to them.

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Diffusion of EHR Innovation

No matter what your opinion of Electronic Health Records (EHR) is, you would probably agree that the concept of computerizing medical records represents an innovation of sorts. The spread of innovation, or its diffusion, has been researched and modeled by Rogers[1] as a bell shaped advancement through populations of Innovators, Early Adopters, Early Majority, Late Majority and Laggards (the blue curve in the figure below). At some point during this spread of an innovative solution a Critical Mass of adopters, or Tipping Point, is reached and the innovation is assured widespread diffusion (Gladwell[2]).  Adoption is usually described by an S-shaped curve of adopters vs. time, and the rate of adoption is the slope of the S-shaped curve at any given time (the red curve in the figure).

The Tipping Point occurs right after the rate of adoption assumes its largest value which will be maintained throughout most of the adoption process. It is worth noting that the diffusion of innovation model is not predictive. Many innovations linger and die within the Innovator circle. Another important aspect of the model is that the time variable is not constrained. Depending on the rate of adoption, it may take weeks, months or many years for an Innovation to spread throughout a given population. There is no question that EHR adoption is slowly moving up on the ascending side of a classic diffusion model bell curve, but is it moving fast enough? Is the tipping point visible? Are we there yet?

DiffusionsContinue reading…

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