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Rcube Health’s ‘Resony App’ Catches Bayer Support for Mental Health DTx for Resonance Breathing

By JESSICA DaMASSA, WTF HEALTH

Digital mental health startups are leaning into the fact that mental health care is not “one-size-fits all” and, as a result, we’re seeing new offerings hit the market that seek to combine typical therapies and their human-plus-machine delivery in novel ways in order to better meet different patient needs. In this interview, we hear about Resony, a digital therapeutic that’s tackling anxiety and stress through a completely autonomous, AI-driven program that brings together resonance breathing and physical relaxation exercises with cognitive behavioral therapy. In other words… working on the physical side of that mind-body connection for the overall benefit of mental well-being.

Resony is just the first DTx coming out of Rcube Health, one of four early-stage startups that have gained the backing of Bayer G4A as part of their Digital Health Partnerships Program Growth Track. CEO and co-founder Ravi Janapureddy introduces us to the business that he’s building on the thesis that true scalability for digital therapeutics in mental health care relies on full automation – no clinical intervention. In a crowded space, how will Resony stand-out as a stand-alone business, instead of a ‘feature’ for a larger, full-service virtual-first mental health care provider? Is this where Bayer might see the opportunity for an “around the pill” or “alongside the pill” approach? Another digital mental health use case to explore!

The need for H.O.P.E: victims of human trafficking need better care from health professionals

BY SARAH BETH

I remember the first time I told a doctor that I was being trafficked. That experience was also the last time I told a healthcare professional. My psychiatrist in an acute inpatient psychiatric hospital heard my story and told me that trafficking only happens in third-world countries and in movies. While this professional was the most ill-informed I ever encountered, they were not the only healthcare workers that did not have the training they needed to identify me. 

I remember tucking my hospital gown between my legs to hide the bruising on my thighs. I remember explaining away cuts and burns. I remember being encouraged by doctors and nurses to report sexual assaults. I remember a psychiatrist telling me I would never get better, so I should stop seeking help. I remember the look in a nurse’s eyes when she knew something was off but did not know how to intervene.

It was that nurse, the one whose instinct told her that something was wrong, that gave me hope. She saw me. When you’ve been through what I’ve been through, you never forget the first person to really see you. She gave me hope that someone could help me, that someone saw me as a person. She gave me hope that someday my life would be different.

For 20 years I was trafficked for sex by a member of my family, and for 20 years I was discharged into the hands of my trafficker, a seemingly good man who was charismatic and kind to everyone in the office. All the while, I remembered the nurse who saw me, and I held onto hope that there were others like her. 

I have heard story after story that mirrors my own: men, women, and children being trafficked, desperately hoping a healthcare worker would spot the signs but being placed back into the hands of their traffickers. The statistics back our experiences. 

Continue reading…

THCB Gang Episode 74, Dec 9

Joining Matthew Holt (@boltyboy) on #THCBGang at 1pm PT 4pm ET Thursday for an hour of topical and sometime combative conversation on what’s happening in health care and beyond were Queen of all employer benefits Jennifer Benz (@Jenbenz); THCB regular writer Kim Bellard (@kimbbellard);  futurist Ian Morrison (@seccurve) and two investor guests — Super smart AI doc from GSR Ventures (@GSRVentures) Sunny Kumar; and the “I make unicorns” King Bill Taranto from Merck GHIF (@BillTaranto).

We got some forecasts and some reviews of the money and the movers in health care this past year, and looked at the world of employment inside and outside of healthcare, RPM and the public vs private financial markets.

The video is archived below. If you’d rather listen to the episode, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels

Health in 2 Point 00, Episode 244 | Transcarent, Suki, Robin, Cerebral, Nomi, and Apti Health

How much longer do we have to wait for Glen Tullman to be on the NASDAQ with Transcarent? In this episode of Health in 2 Point 00, Jess and I discuss several new deals in the healthcare space. Suki raises $55 million, bringing their total up to 95 million; Robin raises $50 million , bringing their total up to $65 million; Cerebral raises $300 million, bringing their total up to $420 million; Nomi raises $110 million ; and Apti Health raises $50 million, bringing their total up to $65 million.

–Matthew Holt

Health in 2 Point 00, Episode 243|Quartet, Ribbon, Lyn Health, Medallion & Safely You

I cough my way through this episode of Health in 2 Point 00 in his original interview sweater. There’s $60m for Quartet (mental health), Ribbon Health gets $43.5m to fix provider lists, Lyn Health reinvents the medical group with $10m (sort of), Medallion gets $30m to fix cross-state line provider credentialing & Safely You gets $30m to use AI to prevent falls in nursing homes. -Matthew Holt

Matthew’s health care tidbits: Athenahealth & Private Equity

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 my health care tidbits this week, it’s time to delve into the private equity firms’ buying and selling of Athenahealth. That’s of course the practice management/EMR firm bought by private equity companies led by Elliot Capital Management–they of the Israeli spy agency dirty tricks division–for roughly $6.5bn in 2018. Many (including me) have wondered how, given it was already doing about $1bn a year in revenue then, Athenahealth could be sold for $17bn three years later. After all it’s hardly likely to have tripled its revenue in a mature market! This comment by “Debtor 23” on @histalk is very instructive:

“Elliott did quite a bit better than 3x on its investment. The original deal was funded with about $4.8B of debt and $1B of equity from the hedge fund sponsors. Add in the acquisition cost of Centricity (call it $500M of equity, $500M of debt) and the equity investors are all-in with $1.5B of equity and $5.3B of debt. They sold off some assets for a total of ~$600M in cash, so net equity in play is $900M. They turned that equity into $11.7B (assuming no interim debt pay down), which is a 13x return. 13x feels ridiculous….but….if you’d invested that same levered-up $6.8B in the Nasdaq (QQQ) on the same timeline (Elliott began buying ATHN in spring 2017)…you could sell today for $18.1B. Absurd as this whole deal sounds, it has actually underperformed the market. This story is more about tech multiple expansion/bubble broadly than it is about improving management or running the business.”

So much like Renaissance and other hedge funds that rely on leverage, essentially Elliott leveraged Athenahealth up with debt to the tune of 80% of its value. So after slashing and burning R&D, selling assets (like the HQ which they apparently got $500m for) they probably got costs down & profits way up. When it was public under CEO Jonathan Bush, Athenahealth never tried to be that profitable. It was always fixated on the next big thing (the last one was building the future state inpatient EMR with Toledo & using the BIDMC tech it bought from John Halamka). That’s one reason its PE ratio was 100+.

So if Elliott can get some sucker to pay up and manages to turn $1bn into $13bn, how do the next greater fools–H&F and Bain Capital–do it? Well they need to layer Athenahealth up with even more debt (as money is currently so cheap) and keep generating enough cash to pay the debt. Of course at that price and with this mature a market it’s going to be super hard to grow the company enough to justify another leap in sales price, but it might be doable to service or even pay down some of the debt and take it for an IPO for a couple of billion more if the market stays nutso. So if H&F and Bain Capital basically shrink their equity portion down to $1-2 billion, and get it to IPO in a year or so for say $20Bn, they will at least double or triple their money. Not quite 13 x but not terrible.

And if it all goes wrong and Athenahealth can’t service the debt? Well the beauty of leverage and debt is that it attaches to the company – not to the PE fund that put it in that position. So all the new owners will have at stake is a reasonably small amount of equity. Of course if the shit hits the fan and Athenahealth goes bankrupt the employees and customers may not be so happy, but who cares about them? (Apart from that hasbeen CEO who got kicked out!)

DNA Storage in a Yottabyte Era

By KIM BELLARD

Did you know we are living in the Zettabyte Era? Honestly, did you even know what a zettabyte is? Kilobytes, gigabytes, maybe even terabytes, sure, but zettabytes? Well, if you ran data centers you’d know, and you’d care because demand for data storage is skyrocketing (all those TikTok videos and Netflix shows add up). Believe it or not, pretty much all of that data is still stored on magnetic tapes, which have served us well for the past sixty some years but at some point, there won’t be enough tapes or enough places to store them to keep up with the data storage needs.

That’s why people are so keen on DNA storage – including me.

A zettabyte, for the record, is one sextillion bytes. A kilobyte is 1000 bytes; a zettabyte is 10007. Between gigabytes and zettabytes, by powers of 1000, come terabytes, petabytes, and exabytes; after zettabyte comes yottabytes. Back in 2016, Cisco announced we were in the Zettabyte Era, with global internet traffic reaching 1.2 zettabytes. We’ll be in the Yottabyte Era before the decade is out.

Continue reading…

Lyn Health Out of Stealth: A Niche Healthcare Navigator for Polychronic Patients

By JESSICA DaMASSA, WTF HEALTH

Straight out of stealth and launching today! Lyn Health is out to provide specific, personalized care for patients with three or more chronic conditions in a way that’s meant to compete with healthcare navigator-advocators like Accolade, Transcarent, and Included Health INSTEAD of the crowd of digital health chronic condition management platforms like Teladoc’s Livongo, Vida Health, One Drop, Omada Health, etc. etc.

With employers and health plans getting increasingly burnt-out on point solutions for chronic care – leading many of those businesses to “platform out” themselves in recent years – will a niche-market navigator really stand-out? Is effective care for polychronic patient populations so specialized that it merits adding a specific, targeted service on top of the more general navigator, primary care provider, or chronic care platform solution that an employer or plan might already have in place?

Lyn Health’s CEO Rick Abbott stops by to introduce us to this seed-funded startup, which has raised $10M (backed by Summer VC) and has already attracted some yet-to-be-named health plan and Fortune 500 employer clients. Rick explains that market need that Lyn Health is aiming to satisfy, and how he’s leveraged what he’s learned about the cost of polychronic care from his past life at Premera Blue Cross into an approach that he believes will work to help employers both reduce spend and improve the day-to-day patient experience of managing multiple chronic conditions. Lyn Health is set-up to deliver care with its own physicians and social workers, connecting with patients in a digital-plus-bricks-and-mortar format. And, as for that business model, we get into the big question: at-risk or not?

Excited to meet this startup on the day of its official launch!

The Healing Power of Even Virtual Human Connection

By HANS DUVEFELT

Almost two years into this new age of varying degrees of self quarantine, I am registering that my own social interactions through technology have been an important part of my life.

I text with my son, 175 miles away, morning and night and often in between. I talk and text with my daughter and watch the videos she and my grandchildren create.

I not only treat patients via Zoom; I also participate, as one of the facilitators, in a virtual support group for family members of patients in recovery.

I have reconnected with cousins in Sweden I used to go years without seeing; now I get likes and comments almost daily on things that I post. I have also video chatted with some of them and with my brother from my exchange student year in Massachusetts 50 years ago.

I have stayed in touch with people who moved away. And I have made new friends through the same powerful little eye on the world I use for all these things, my 2016 iPhone SE.

Members of my addiction recovery group stay in touch with each other via phone or text between clinics. They constantly point out the value of the social network they have formed, even though they only meet, many of them via Zoom, once a week. The literature has supported this notion for many years and is very robust: Social isolation is a driver of addiction.

Continue reading…

WTF Health: Early-Stage Med Device Startup Acorai is Turning Smart Phones into Heart Failure Monitoring Devices

By JESSICA DaMASSA, WTF HEALTH

Acorai is an early-stage medical device startup working with Bayer to improve the way we manage the world’s 65 million patients living with heart failure by using their own smart phones. CEO Filip Peters shows the Acorai device, which is basically an extended smart phone case packed with four different kinds of sensor technologies that work together to measure the pressure inside a patient’s heart, by simply holding their phone against their chest. Of course, the real magic is the algorithm that turns these readings into early detection of a potential incident. How does this stack up against the status-quo way we’re currently caring for these types of patients? Filip says that, right now, the alternative for such monitoring is an IMPLANTED sensor, which many patients aren’t even able to get. As a result, most of the early warning signs of impending heart failure are missed; Acorai’s tech has the potential to be truly revolutionary as it’s able to detect the signs that lead to heart failure hospitalizations up to 30 days in advance.

Acorai has been selected as one of four “Growth Track” companies in Bayer G4A’s Digital Health Partnerships Program, and Filip talks to us about the potential Bayer sees in the daily data stream of information Acorai’s device makes available to cardiologists. A fascinating look at the future of cardiac care!

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