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Ofer Leidner, Happify Health

by MATTHEW HOLT

Happify Health is a online mental health company that is focused almost exclusively on scaling care by offering self-service tech solutions across the patient journey. After R&D starting in 2012, they’ve been scaling since 2017 and now are working with large employers and big health plans. What they don’t do is have their own therapists or psychiatrists. This is an interesting approach and probably much more scalable than many of their competitors. Today they raised $73m more to build out their solutions. I talked to Happify Health’s President, Ofer Leidner about how far they can go with automated self-service. He thinks it’s a long way.

Roblox and Healthcare’s Metaverse

By KIM BELLARD

As neither a gamer nor the parent of a gamer, I’ve been proud that I’ve stayed even mildly in touch with the cultural phenomenon that gaming is.  I’ve written about, for example, the Metaverse, Fortnight, and e-sports.  Still, I somehow managed to be completely oblivious to the existence of Roblox, until they went public this week and was valued at $45b, larger than Electronic Arts (which I had heard of). 

Once again, I think there are lessons for healthcare.

P.J. McNealy, CEO of Digital World Research, described Roblox to NPR as: “Minecraft meets Nintendo, which meets Lego and mobile phones enable a whole bunch of it.”  Whatever the metaphor, Roblox is booming.  It was valued at $4b a year ago, but the pandemic was very, very good for it. 

Half of America children use Roblox.  Two thirds of its users are 16 and younger, and most of them were spending lots of time at home last year.  It is now estimated to have 37 million unique daily users, spending some 30 billion hours on the site last year.  It is available in 180 countries, in 11 languages.

What makes Roblox particularly unique is that it is not a game developer; it is a platform where users develop the “experiences”.  Roblox describes its mission thusly:

Roblox’s mission is to bring the world together through play.  We enable anyone to imagine, create, and have fun with friends as they explore millions of immersive 3D experiences, all built by a global community of developers.

It claims 8 million developers have created 20 million experiences — and that it paid over $300 million to them.  The games are free but users can buy and spend an in-game virtual currency (Robux), which can be exchanged for actual money (Roblox shares 30% of the revenue with developers).  At least one developer made over $1 million in a single year; over 1200 made at least $10,000, with over 300 making over $100,000. 

Mr.  McNealy believes the IPO will allow Roblox significant expansion:

This money will either give them an opportunity to build more content for the for the platform or to go to adjacent platforms like music or partnering with Spotify or movie service.  That’s where this is going to go.

CEO and co-founder David Baszucki isn’t content with the younger market, wondering: “So how do we make it possible for Roblox to connect with everyone in the world?”  Alex Hicks, cofounder of Roblox studio Red Manta, sees such potential, telling Polygon: “Lots of kids already know what Roblox is, but they’re just scratching the surface with the older audience.” 

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The Art of Asking: What Else is Going on?

By HANS DUVEFELT

Walter Brown’s blood sugars were out of control. Ellen Meek had put on 15 lbs. Diane Meserve’s blood pressure was suddenly 30 points higher than ever before.

In Walter’s case, he turned out to have an acute thyroiditis that caused many other symptoms that came to light during our standard Review of Systems.

Ellen, it turned out, was pretty sure her husband was having an affair with one of his coworkers. And, since this wasn’t the first time, she was secretly working on a plan to move out and file for divorce. She admitted she’d always had a tendency to stress eat.

Diane’s daughter had just announced that she was pregnant by a man she wasn’t sure wanted to be around in the long run.

How do we know whether a patient’s subjective symptoms, laboratory values or even their vital signs are caused by their known medical conditions, a new disease or their state of mind?

We are often tempted to proceed down familiar tracks and tackle seemingly straightforward problems with medications: More insulin would take care of Walter’s blood sugar. Ellen could use a couple of months of phentermine. Diane needed a higher dose of lisinopril or perhaps some hydrochlorothiazide.

As Sherlock Holmes said, “there is nothing more deceptive than an obvious fact”.

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#Healthin2Point00, Episode 190 | Forward Health, Cedar, & Babylon

Today on Health in 2 Point 00, primary care appears to have jumped the shark because there is a deal in this episode in which the investors on the round are probably Jess’s favorite group of investors ever. Forward Health raises $225 million in a Series D – there’s Softbank money in this round as well as The Weeknd – but why didn’t they just go public? Patient billing company Cedar raises $200 million, bringing their valuation up to $3.2 billion, although I’m not too impressed by the concept. Finally, Babylon is making inroads into the U.S. from the U.K., buying a California-based provider group. —Matthew Holt

Inside Owlet’s SPAC IPO: From Smart Sock Baby Monitor to Data-Driven Pediatric Healthcare Co

By JESSICA DaMASSA, WTF HEALTH

Oh Baby! Connected digital nursery startup, Owlet Baby Care, just announced their SPAC IPO and intention to take their infant smart sock from baby monitor to FDA-approved medical device. I talk with Owlet’s co-founder & CEO, Kurt Workman, to find out why the baby health tech company (which has raised $48M in venture funding) has decided to take the business public in order to pursue its plans for growth as a pediatric healthcare company caring for baby “from conception to kindergarten.” Kurt gets into the details behind the work Owlet’s team is doing now to get their device FDA-approved in two different ways, and how they’re using Livongo Health’s remote monitoring/data analytics/telehealth model as a precedent for pursuing health insurance reimbursement. There may be lots of market skepticism out there about wearables – particularly socks, and especially with infants – but this deep-dive into Owlet’s vision for data-driven parenting provides a pretty compelling vision for both better and more cost-effective baby care, and the bonus of a better night’s sleep for new parents. Owlet’s calling it an $81 BILLION DOLLAR addressable market, and Kurt believes that it stands alone in terms how its bringing together full-stack connected technology and a consumerized healthcare experience to bridge the gap from hospital to home.

THCB Gang Episode 46, Thursday March 11

THCB Gang featured lawyer & privacy expert Deven McGraw, (@Healthprivacy), Health IT girl and WTF Health Host Jessica DaMassa (@jessdamassa), and policy expert consultant/author Rosemarie Day @Rosemarie_Day1). We’ve had far too many Y chromosomes on lately but also joining Matthew Holt (@boltyboy) for this one will be futurist Ian Morrison (@seccurve) and Fard Johnmar (@fardj), from digital health consultancy Enspektos.

We dove into the health care implications of the new $1.9 trillion stimulus bill, and had a great chat about where health and digital health go next.

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

The Art of Listening: When the Inner Voice Whispers

By HANS DUVEFELT

“I worry, so you don’t have to”, is how I explain to patients when something about their story or physical exam makes me consider that they may have something serious going on.

The worst thing you can do is give false reassurance without serious consideration. And the next worst thing you can do is be an alarmist and needlessly frighten your patient. Finding and explaining the balance between those two extremes is a big part of the art of medicine.

A few times in my career I have struggled with doubt or worry after a patient visit. Did I miss anything, did I order the right test? We all have those moments, but we have personal limits as to how much of such doubt we can handle in the long run.

During my training and early career in Sweden there was more tolerance for physician fallability. Doctors have not been sitting on any pedestals for a couple of generations there. Here, the climate is different: We may not be revered like we were in the past, but if we make errors in judgement, the personal consequences for us can be devastating.

The way to navigate this treacherous territory is first of all to not travel alone. Everything we do is for our patient, so we must maintain a partnership. We are the experts, but we should not make decisions that aren’t shared. I keep coming back to the notion that today’s doctors are guides.

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#Healthin2Point00, Episode 189 | DispatchHealth, TytoCare and Highmark Health

Today on Health in 2 Point 00, we’re wishing Jess a happy belated birthday! On Episode 189, Jess asks me about DispatchHealth raising a massive $200 million Series D, bringing their total up to $403 million, providing in-home urgent care. TytoCare raises another $50 million for their Series D, bringing their total up to $155 million, providing tech-enabled health at home with their device and providers. Finally there’s a partnership with Highmark Health, Google Cloud, Verily, and OnDuo – what’s going on with this lot? —Matthew Holt

Your Health Data May Be a NFT

By KIM BELLARD

I must admit, after I wrote about digital currency last week, I did not expect to be writing about crypto anytime soon. Then I heard about “non-fungible tokens” (NFTs) and got a sense of the hype they were causing — how I could I resist?

There may even be a connection to health care. 

You may have seen the Nyan Cat (pictured below), which is not new; it turns 10 in April.   What is new is that last month its creator “sold” it.  You may be thinking, wait, the GIF is everywhere, anyone can download it, so in what sense could he “sell” it?   

That’s where NFTs come in.  As you may know, “fungible” means that two things can be interchanged; one dollar is just like any other dollar, one bitcoin is like any other bitcoin, one electron is like any other electron.  Non-fungible, then, means the item in question is unique, and this is where the “token” comes in.  Basically, NFTs use digital certificates via blockchain to mark that something is one-of-a-kind, a claim of digital ownership.

Nadya Ivanova, chief operating officer of research firm L’Atelier explained NFTs to The Wall Street Journal:

Think of it like a digital passport that comes with an asset.  They allow for this trust and authenticity to be established in a way that we haven’t been able to do before, whether it’s with physical assets or digital assets.

Artists have been using NFTs for a few years now, and auction house Christie’s is auctioning off the “First Purely Digital NFT-Based Work of Art Ever Offered by a Major Auction House,” featuring the digital artist Beeple (aka Mike Winklemann).  Christie’s promises:

…the buyer receives the artwork file containing a digital signature from the artist and all vital details including time of creation, edition size and a record of any prior sales. These details are permanently attached to the artwork, providing an enduring guarantee of value. 

NFTs have gone beyond art.  The NBA is all over this, with NBA Top Shot selling highlight clips; one of Lebron dunking just went for $200,000.  Maverick’s owner Mark Cuban is a big proponent.  “The tech is real,” he told CNBC. “The impact is real, and permanent.” 

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Kelsey Mellard, CEO Sitka

By MATTHEW HOLT

Kelsey Mellard is CEO of Sitka, one of the emerging companies that’s providing specialty consults online to primary care docs. They’ve been building a specialty care network that can be accessed by asynchronous video, slightly different to some of their competition. Most of their customers are capitated medical groups, like ChenMed, trying to reduce their spend on specialty physician care (as Kelsey calls it the “unmanaged Part B spend bucket”). I asked her how it works, where the company is going (think virtual care integration), and whether it will be needed in the future. (You can guess her answer to the latter!)

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