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The Call to Be a Primary Care Doctor

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By HANS DUVEFELT

I suspect the notion of calling in narrower specialties is quite different from mine. Surgeons operate, neurologists treat diseases of the nervous system, even as the methods they use change over time.

Primary care has changed fundamentally since I started out. Others have actually altered the definition of what primary care is, and there is more and more of a mismatch between what we were envisioning and trained for and what we are now being asked to do. Our specialty is often the first to see a patient and also the last stop when no other specialty wants to deal with them.

We have also been required to do more public health, more clerical work, more protocol-driven pseudo-care and pseudo-documentation like the current forms of depression screening and followup documentation. And don’t get me started on the Medicare Annual Wellness Visit. How can we follow the rigid protocol and be culturally and ethnically sensitive at the same time?

We are less and less valued for our ability – by virtue of our education and experience – to take general principles and apply them to individual people or cases that aren’t quite like the research populations behind the data and the guidelines. The cultural climate in healthcare today is that conformity equals quality and thinking out of the box is not appreciated. The heavy-handed mandates imposed on our history taking and screening constantly risk eroding our patients’ trust in us as their confidants and advocates. The finesse and sensitivity of the wise old fashioned family doctor is gradually being squeezed out of existence.

The call to primary care medicine, if it isn’t going to pave the road straight to professional burnout, today needs to be a bit like the call to be a missionary doctor somewhere far away:

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Digital Health Investor Larry Leisure’s Picks for the Next Hot Areas for Healthcare VC Investment

By JESSICA DaMASSA, WTF HEALTH

Digital health continues to gain a lot of attention from investors, so we’ve checked in with one to get some perspective on what’s hot (and what’s not) midway through the sector’s largest funding year yet. Larry Leisure, of Chicago Pacific Founders (whose enterprise health benefits company, Jiff, was acquired by Castlight Health) weighs in on the exuberance investors are showing for the health innovation space and whether or not it will last.

Are valuations and funding rounds a little overblown? Are investors concerned about some of the recent complaints of ‘digital health fatigue’ that employers and health plans are starting to vocalize as they wade through an expanding portfolio of point solutions? Larry brings us in on some of the closed-door conversations he’s had with payers and employers about the health tech startup scene, and how their thinking is starting to shift his own ideas about where to place his bets next. Healthcare navigators…care-plus-behavior-change platforms…underserved markets…the digital front door…the end of the per-member-per-month business model and SO MUCH MORE. Love getting a high-level look at the field of play!

THCB Spotlights: Marta Zanchi, Founder & Managing Partner at Nina Capital

Today on THCB Spotlight, Matthew sits down with Marta Zanchi, who is the founder and Managing Partner at Nina Capital. Nina Capital is a micro venture capital firm in Barcelona, and in this interview, Matthew asks Marta about her decision to move from Silicon Valley to Barcelona and start this fund. Marta talks us through some of the investments they’ve made in the past couple of years so tune in to find out more.

#Healthin2Point00, Episode 225 | Amwell acquires SilverCloud & Conversa – plus more deals

Today on Health in 2 Point 00, we have a deal so big it’s brought me out of vacation just for this episode! Amwell acquires not one, but TWO companies – DTx mental health company SilverCloud Health and chatbot company Conversa Health for a combined $320 million. In other news, mental health company Sondermind raises $150 million, bringing their total to $188 million, and femtech company Elvie raises $80 million, bringing their total to $133.9 million. —Matthew Holt

THCB Spotlights: CJ Wilson, CEO of MyHealth.US

Today on THCB Spotlights, Matthew Holt interviews CJ Wilson, the CEO of MyHealth.US. MyHealth.US provides wearable QR codes for instant access to emergency health information, as well as a digital platform to track your health data and house medical records. CJ shows us some of their offerings and explains how they’re working with unions and schools in NYC along with the company’s future plans for funding and growth.

Mental Health Startup SonderMind Lands $150M to Tackle ‘THE’ Health Issue of Our Generation

By JESSICA DaMASSA, WTF HEALTH

SonderMind closes a $150M Series C funding round co-led by Drive Capital and Premji Invest, and we get CEO Mark Frank’s take on what sets THIS digital mental health startup apart from a pack of very well-funded competitors. SonderMind has its own behavioral health therapists, built its own tech stack, delivers care virtually AND in-person, is covered by some of the biggest health plans in the country — Aetna, Anthem, Bright Health, Cigna, Kaiser, Optum, and United Healthcare. (They can also namedrop health-tech-infamous Board member, Jonathan Bush, in an interview, but that’s beside the point!)

What’s most remarkable – and what Mark says most impressed investors this time around – is not only the health of SonderMind’s business model, but also its balance sheet. This raise marks the bulk of the total $183M the startup has raised to-date, and Mark reveals that they’ve only deployed about half of the $27M Series B funding they received in April 2020 in a round led by General Catalyst. How will such a “capital efficient” business begin to deploy these new funds? We hear Mark’s plans for nationwide expansion and improvements to that tech stack, particularly when it comes to better matching therapists and patients based on expertise and need, and more appropriately measuring process and outcomes. Two areas ripe for more tech integration as the mental health provider tackles what Mark calls THE defining health issue of our generation.

The Most Important Thing

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By KIM BELLARD

Jack Dorsey has some big hopes for bitcoin.  In a webinar last week, he said: “My hope is that it creates world peace or helps create world peace.”  The previous week Mr. Dorsey announced Square was starting a decentralized financial services (DeFi) business based on bitcoin, joining the previously announced Square bitcoin wallet.  

None of this should be a surprise.  At the Bitcoin 2021 conference in June, Mr. Dorsey said: “Bitcoin changes absolutely everything.  I don’t think there is anything more important in my lifetime to work on.”

I’m impressed that someone with as many accomplishments as Jack Dorsey picks something not obviously related to those accomplishments and decides it is the most important thing he could work on.  So, of course, I had to wonder: what might accomplished people in healthcare say was the most important thing they wanted to be working on?

For many these days, of course, it is the COVID-19 pandemic.  Not much has had a higher priority.  Highly effective vaccines have been developed, COVID-19 treatments have greatly improved, supply chains have been adjusted and readjusted, and countless public health measures have been tried.  Healthcare professionals have worked themselves to extremes.

For others, perhaps, it would be to address the extreme financial hardships the U.S. healthcare system can cause.  A new study in JAMA confirmed what is hiding in plain sight – hundreds of billions of medical debt.   Debt continued to rise despite ACA, especially in states that perversely chose not to expand Medicaid.  Efforts such as requiring hospital “price transparency” have largely failed.  Many large hospital systems continue to sue patients who can’t pay.  These hardships are unfair, immoral, and unique to the U.S.; addressing them should be important.

However, both the pandemic and financial obstacles contributed to, but did not cause, the big health inequities in the U.S. healthcare system.  People of color, people in lower socioeconomic classes, even women all face numerous inequities in the health care they receive and in the health they achieve.   These may reflect broader social inequities, but no one in healthcare should look at these without wanting to address them. 

Digital health has never been hotter. The pandemic reminded people how valuable telehealth can be, and investors are pouring money into digital health at astounding levels – some $19b in the first half of 2021 alone.  We may be in bit of a manic phase right now, but few doubt that digital health is going to be a big part of healthcare’s future. 

Then there’s artificial intelligence (A.I.).  No industry in 2021 can be ignoring it. Some well-publicized mishaps with IBM’s Watson or Babylon Health notwithstanding, A.I. in healthcare has already made impressive strides, such as DeepMind’s recent protein predictions or its successes in imaging.  A.I. is going to be built into our health care in the future, either in a supporting role or directly, and working on it has to be on many people’s wish list.  

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Health Care Needs A Hero

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By MIKE MAGEE

Health care needs its heroes.

I came to that conclusion this week through a roundabout route.

First I read Maureen Dowd’s interview entitled “Dara Khosrowshahi, Dad of Silicon Valley”, in which she, with some affection, gives the reader a look behind the scenes at the personal life of the current Uber CEO. At one point, Dowd shares her conversation with Dara’s 20-year-old daughter, Chloe, a Brown student, who wants us to know her father was a seriously good dad. In support of this belief, she reports that “When she was little, her father – a fan of Joseph Campbell…would concoct children’s stories set in faraway kingdoms…”

This, of course, forced me to acknowledge that I didn’t know who Joseph Campbell was. Bill Moyers came to the rescue. His June 21, 1988 interview titled “Joseph Campbell and the Power of Myth — ‘The Hero’s Adventure’”, begins with a clip from Star Wars where Darth Vader says to Luke, “Join me, and I will complete your training.” And Luke replies, “I’ll never join you!” Darth Vader then laments, “If you only knew the power of the dark side.” Moyers asked Campbell to comment.

JOSEPH CAMPBELL: He (Darth Vader) isn’t thinking, or living in terms of humanity, he’s living in terms of a system. And this is the threat to our lives; we all face it, we all operate in our society in relation to a system. Now, is the system going to eat you up and relieve you of your humanity, or are you going to be able to use the system to human purposes.

BILL MOYERS: So perhaps the hero lurks in each one of us, when we don’t know it.

By then, I was aware that Joseph Campbell, who died in 1987 at the age 83, was a professor of literature and comparative mythology at Sarah Lawrence College. His famous 1949 book,  “The Hero With a Thousand Faces” made the case that, despite varying cultures and religions, the hero’s story of departure, initiation, and return, is remarkably consistent and defines “the hero’s quest.” His knowledge of this quest gained him a large following that included George Lucas who was a close friend and has said that Star Wars was largely influenced by Campbell’s scholarship.

Whether health care or technology, unfettered capitalism is more than adept at breeding predatory systems that beg for redemption.  Author Emily Chang spoke to this predilection in her 2018 book, “Brotopia”, describing Silicon Valley types as “secretive, orgiastic, and dark.” Dara Kharowshaki’s  CEO predecessor at Uber, Travis Kalanick, was labeled one of the worst. When Dara took over, New York Times technology expert, Mike Issac asked in 2019, “Can this rational, charming chief without the edge, ego, or cult following of wacky founders succeed in today’s insane economy?”

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Matthew’s health care tidbits

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 week’s health care tidbits, we are talking about medical debt. Oh, not all medical debt. No, not that debt being garnished from the wages of health care workers by their own employers. Today we are just discussing the debt that has already gone to collections. Yes, the debt sold off by doctors and hospitals for pennies on the dollars so that debt collectors can hound people until they pay or despair.

This week a Harvard/Stanford team reported that the total in collections is $140 Billion! Way more than anyone thought, Nearly ONE in SIX Americans currently has a medical bill in collections. No prizes for guessing that those most likely to be being pursued are living in the poorest zip codes in the country and even more likely to be in a southern state that never expanded Medicaid.

Glad we are all proud to be American.

#Healthin2Point00, Episode 224 | b.well, Quit Genius, Doktor.se, Sweetch, Kno2, and HealthifyMe

Today on Health in 2 Point 00, Jess and I chat about the staggering medical debt in this country before diving into some more health tech deals. First up on Episode 224, personal health record company b.well Connected Health raises $32 million, bringing their total to $57 million. Next, Quit Genius raises $64 million in a Series C, bringing the digital addiction clinic’s total to $78.6 million, and Swedish telehealth company Doktor.se raises €29.5 million – there are some interesting investors in this one. Sweetch, a Bayer G4A company, raises $20 million for its behavior change app and Kno 2 raises $15 million in a Series A in yet another interoperability play. Finally, Healthify.Me raises $75 million, bringing its total to $100 million – this is like Noom plus exercise in India. —Matthew Holt

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