“If last year was EUPHORIA…‘We made it! Digital health is relevant!’ This year, it’s a little more panic. More, ‘Are we okay???’” SVB Securities’ Senior Managing Director Stephanie Davis says that she’s been getting asked for a lot of advice this year, so we jump on the bandwagon. Should digital health and health tech be worried? What about exits? What areas of health innovation are still hot? Which are not? And, what the heck is “creative destruction” and why is it her favorite buzz phrase from HLTH 2022?
Stephanie answers all our questions, reassures us of the healthcare market’s resiliency, and offers up some high-level perspective on which “wallet” (payer, pharma, or provider) startups will want to align with to weather the short-term.
It’s time again for me to use my bad back as a case study in why American health care has such crazy incentives.
About a month ago at the HLTH conference in Vegas, over the course of a few hours I developed debilitating leg pain. To quote from my earlier twitter thread on my time in Vegas, “After 3 days of excruciating pain, my wife insisted I went to the ER. The public policy person in me was horrified but we had already spent our deductible, so the cost was actually lower than paying cash for an MRI”
What actually happened was that after 3 days of dreadful pain & inability to walk (including getting myself home from Vegas using multiple wheelchairs, and being that guy who crawls off the plane onto a wheelchair), I got in to see my chiropractor. He said, you need an MRI to figure out what’s wrong with you. The alternatives were
1) Get insurance to pre approve the MRI. His guess was that that would take a few days or more. I actually called One Medical‘s urgent care video line and the PA I spoke to told me that usually insurance would only approve an MRI after I had done 6 weeks of physical therapy.
2) Pay $500 cash for a free standing MRI that could probably get me in during the next few days
3) Go to the ER
Now the “incentives” part of this starts to really matter.
Deena Shakir, General Partner at Lux Capital, shares her take on the market state-of-play for healthcare innovation amid these “tumultuous” economic times. As an investor, Deena has been a passionate advocate for women and children’s health and her fund, Lux Capital, invests broadly in health tech – pre-seed to pre-IPO, from virtual-first care delivery businesses like women’s health clinic, Maven, (on whose Board Deena sits after Lux co-led their $110M Series D) to health tech infrastructure businesses like Commure and Tendo and those working in AI, ML, and robotics.
We get into which types of emerging health businesses Deena thinks are still “hot” despite the downturn, specifically talking about what’s changing in women’s health including current care gaps, health IT infrastructure and its “moment” this year, and how the opportunities in mental health investing are starting look more compelling on the diagnostic side of things.
Overall sentiment: Deena says, “As Venture Capital investors we have long time horizons. We want to invest in things and have a 10-year plus outlook, so it’s actually an incredible time to be doing early-stage investing.” But, what if you’ve sailed past your Series A? Well…tune in to find out what Deena has to say about her experience with later-stage startups and those who thought they may have had an exit planned this year.
Health Gorilla is in the business of health data interoperability and the double-backflip this startup is doing to both make clinical data an easily accessible commodity – while also making sure that access to that data adheres to the privacy rules established by the US government – takes a minute to understand, but is critically important for the future of many health tech businesses.
CEO Steve Yaskin takes on the tough job giving us a brief overview of TEFCA (the Trusted Exchange Framework and Common Agreement) which is meant to establish once-and-for-all a common ground for data interoperability. Then, we get into QHINs – a specially designated group of “qualified health information networks – and how his business is applying for this certification to further build “the bridge” between the public sector and the private sector and what’s needed to achieve compliance for data exchange.
Phew! No wonder this startup has landed nearly $80 million dollars in funding! We talk about the basis for the business model – but, more importantly, the real market need – and find out what’s in store for all of us in the next chapter of data interoperability.
Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday December 15 were patient safety expert and all around wit Michael Millenson (@mlmillenson); policy expert consultant/author Rosemarie Day (@Rosemarie_Day1); writer Kim Bellard (@kimbbellard), consumer expert Lygeia Riccardi (@Lygeia) radiologist Saurabh Jha (@RogueRad), and Olympic rower for 2 countries and all around dynamo Jennifer Goldsack, (@GoldsackJen). It was a full house and lots of fun, with a lot wrapped round the theme of protecting consumers (or not) online.
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.
Along with the implementation of CMS’s hospital price transparency rules in 2021 came a market opportunity for savvy health tech startups able to not only aggregate the massive amount of data coming in from providers and payers, but to actually make it usable for shopping healthcare services or large-scale market analysis for those without a computer engineering degree or background in healthcare economics. Turquoise Health is one of those startups, but what makes the Andreessen Horowitz-backed biz a stand-out from the pack is the extra SAS platform of services it’s building on top of those analytics and compliance products that will, ultimately, offer payers and providers a way to use all that pricing data to better negotiate their contracts with one another. Turquoise Health’s CEO Chris Severn explains the business model and how he plans to ‘platform out’ price transparency to a next-gen rev cycle state that gets us to the holy grail of “upfront, ubiquitous pricing in healthcare.”
Komodo Health’s co-founder & President, Web Sun, has a big challenge for Big Pharma: Kick your “addiction” to the laborious, time-consuming, consultant-led process it takes to get the answers you need to your big data questions.
Komodo itself works with a lot of Big Pharma clients to use its full-stack approach to deliver insights on patient costs and outcomes at-scale – so, what’s up with the tough love??
The answer may have more to do with the news Web shares about how Komodo is starting to evolve its business model from working with Pharma on “applications” that leverage its platform to a model that lets third-party developers access that platform and its capabilities DIRECTLY. Web unpacks what this shift means, and how his team hopes it helps Pharma more cost-effectively invest in research for everything from clinical development and real-world evidence projects to health economics studies and patient outcomes research.
Still not sure how Komodo does its data magic? Web talks us through a great example — a synthetic control arm project (!!!) — Komodo is doing with AppliedVR, and, OF COURSE, what WTF Health interview would be complete without a follow-up on IPO gossip.
The definition of women’s health keeps expanding beyond sexual and reproductive health (finally!) and among those leading the way toward more holistic health for women is virtual pharmacy startup, Thirty Madison, which acquired “Uber-for-birth control” biz, Nurx, at the beginning of this year.
Thirty Madison’s President Michelle Carnahan gives us an update on the integration of the two companies around women’s health, and talks about Thirty Madison’s brand-new mental health offering which will address “mild to moderate” mental health care needs including medication management.
More interesting for those interested in the business of health tech, however, is how Thirty Madison’s business model is starting to evolve from its direct-to-consumer beginnings. Michelle says that just a year ago, 95% of revenue was generated from their D2C efforts. Now, it’s more of a 70/30 split, with enterprise earnings coming in through a variety of mechanisms including accepting insurance on their site, partnering with PBMs, and some special partnerships with incumbents like UnitedHealthcare and CVS Health. Interesting evolution AND interesting partners there…watch to hear more!
Lesson learned: Don’t bet against Glen Tullman. Transcarent’s CEO brings his legendary “paper schedule packet” to our interview to prove the point that he carries Livongo’s first growth chart around with him everyday as a reminder of the number of overnights it takes to build a “overnight success” of a business. As Glen puts it, “When you’re building these companies, everybody remembers where you ended…they don’t remember where you started.”
So, how in the world did we get to this public prove-you-wrong? Catch the conversation that led us there as we talk about Transcarent’s growth two-years in and address the elephant in the room about why there have been so few customer announcements from the employer-focused health and care company. We get a few name-drops here, and also assurance that publicity around some new Fortune 50 and Fortune 100 clients is imminent. Lots of other interesting “build-mode” talk about what else is starting to come together at Transcarent including the “first independent provider network in the country” and more details on the recent Prescryptive partnership which is aiming to rewrite the script on how employers source pharmacy benefits.
This week’s headlines seemingly closed a chapter on the story of medical research criminality in America. Ramesh “Sunny” Balwani, former president and COO of Theranos was sentenced to 13 years in prison for fraud. That’s 2 years more than his former business and romantic partner, Elizabeth Holmes.
White crime criminal defense attorney for all things science tech, Michael Weinstein, took the opportunity to trumpet out a confident message that crime doesn’t pay in Medicine with these words, “It clearly sends a signal to Silicon Valley that puffery and fraud and misrepresentation will be prosecuted, there will be consequences and the end result is potentially decades in prison.”
The smooth talking fraudsters played a good hand for years, buoyed by a Board, asleep at the $9 billion valuation wheel, with the likes of George Shultz, Henry Kissinger, Rupert Murdoch and Larry Ellison. But attorney Weinstein and all associated with Health Tech entrepreneurship would do well to read again a classic piece of health journalism from fifty-six years ago.
On June 16, 1966, the New England Journal of Medicine published an article titled “Ethics and Clinical Research.” Written by a highly respected Harvard physician, Henry K. Beecher, the head of anesthesiology at Massachusetts General Hospital, the article referred to “troubling charges” that had grown out of “troubling practices” at “leading medical schools, university hospitals, private hospitals, governmental military departments (the Army, the Navy and the Air Force), governmental institutes (the National Institutes of Health), Veterans Administration hospitals and industry.”
Beecher then reviewed 50 distinct contemporary American clinical studies with ethical violations judged by standards at Beecher’s own Massachusetts General Hospital.