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Off Our Chests: No Secrets Left Behind

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By CHADI NABHAN

She was a successful corporate lawyer turned professional volunteer and a housewife.

He was a charismatic, successful, and world-renowned researcher in gastrointestinal oncology. He was jealous of all breast cancer research funding and had declared that disease his nemesis.

They were married; life was becoming a routine, and borderline predictable. Both appeared to have lost some appreciation of each other and their sacrifices.

Then, she saw a lump, and was diagnosed with breast cancer. Not any breast cancer, but triple negative breast cancer. The kind that is aggressive and potentially lethal. The year was 2006, and their lives was about to change forever.

This is the story of Liza and John Marshall, who decided after 15 years of Liza’s diagnosis to disclose all, get all their secrets out in the open, and “off their chests”. They did so by writing a book that I read cover to cover and could not put down.

The authors decided to not only share their cancer journey as a patient and a caregiver, but also to share much of their personal and intimate details. They wanted us to know who they are as people, beyond patient and oncologist husband. We got to know how they met, when they met, and how they fell in love from the first sight. We got to know some corky personal details, and as a reader, I felt that I was part of their household. John shares how losing his mother at a young age to lymphoma affected him personally and professionally. We learn that they attend church every Sunday. Both are people of faith and they let us know how their faith helped them during these challenging times. Losing a dear friend to breast cancer took a toll and certainly made them less certain whether Liza’s fate would be any different.

They alternate writing chapters so that we get to know various events and stories from their sometimes-opposing points of view. We get to understand how a cancer diagnosis affects a caregiver, who happens to be a busy academic oncologist with little time to spare in between clinical practice and traveling for his work. At some point, John expresses resentment that all of the attention was being diverted towards his wife -the patient- and that he was left alone with few people caring how he felt and what struggles he was going through.

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Will Google Health Platformize the Electronic Health Record Market?

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Geoffrey Parker
Edward G. Anderson
Vince Kuraitis

By VINCE KURAITIS, EDWARD G. ANDERSON, and GEOFFREY PARKER

The COVID-19 pandemic has accelerated calls for the development of EHR 2.0 (electronic health record 2.0) – the next generation of EHRs with extended platform features and capabilities.

Who will answer this call? While existing EHR vendors have made modest efforts, the door is open for big tech companies and start-ups to develop functionality to envelop and disintermediate current EHRs. We highlight early efforts by Google Health Care Studio, an initiative that has been underway for several years but was only formally named in February 2021. We view Care Studio as having the potential to bring platform functionality to a sector of the healthcare industry known for resistance to change and innovation.

We coin a new term – “EHR Envelopment” to describe novel EHR platform capabilities under development by third parties. By “envelopment,” we mean the entry by one platform provider into another provider’s market by adding functionality and exploiting overlapping user bases. New EHR capabilities threaten to dislodge existing EHRs, e.g. through 1) new user interfaces (UIs) that sit above the current EHR, and/or 2) a focus on new value created by integrating, analyzing, and presenting disparate sources of data.

Through the lens of platform strategy, we focus on the impact that EHR Envelopment initiatives could have on the market for electronic health records for large integrated delivery systems. This market has been dominated by a few vendors for decades, but EHR Envelopment projects have the potential to disrupt EHR market dynamics.

The remaining sections of this essay will address:

  • The Current EHR Market for Health Systems: Ossified
  • Google’s “Care Studio” — What is It?
  • Disrupting and Platformizing the EHR Market
  • Challenges for Google Health
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Teladoc Health’s Mental Health Move: Unite Best of Livongo, Virtual Care in myStrength Complete

By JESSICA DaMASSA, WTF HEALTH

The Teladoc Health-Livongo merger continues to expand Teladoc Health’s virtual care capabilities — this time in mental health. Dr. Julia Hoffman, Head of Mental Health Strategy for Teladoc Health, gives us the inside story on the launch of myStrength Complete, the souped-up, next-gen version of the digital mental health app that Livongo acquired in 2019 and integrated into its “AI-plus-AI whole person health” platform. So, what’s new now that all this is part of Teladoc? Think full-service mental health care, akin to what you might find in a digital mental health point solution, but with more providers… sitting on top of a gold-standard telehealth and remote monitoring infrastructure… and ready-to-move on an outsized opportunity for integration into Teladoc’s virtual primary care offering, Livongo for Diabetes, Livongo for Hypertension, and so on.

myStength Complete is now more than just a smart, cognitive behavioral therapy app; it’s the entry point into an entire mental health care continuum of services. Teladoc Health’s physicians stand ready for telehealth consults alongside a robust portfolio of coaching and self-service mental health care programs that are bolstered by the data-driven “health nudges” made famous by Livongo’s ever-improving AI-AI engine. Looking forward, the data integration strategy has a lot of potential to do a lot of good. Julia talks about how her team is already leveraging learnings from the Livongo products into a better intake process for members, helping them more quickly, easily, and accurately find the type of care they need. This is no small feat, especially when we find out that Teladoc Health consumer survey data shows that about 60% of people seeking mental health care say they have no idea where to start, or what their diagnosis would be. We get into all those survey findings (a little gold mine for those interested in consumer sentiment and digital mental health) and a full “under-the-hood” poking around of myStrength Complete in advance of its July roll-out to employers. This interview is one to watch now for the full details on how Teladoc Health is pushing further into virtual mental health care.

Holograms to the Rescue

By KIM BELLARD

Google is getting much (deserved) publicity for its Project Starline, announced at last week’s I/O conference.  Project Starline is a new 3D video chat capability that promises to make your Zoom experience seem even more tedious.  That’s great, but I’m expecting much more from holograms – or even better technologies.  Fortunately, there are several such candidates.

For anyone who has been excited about advances in telehealth, you haven’t seen anything yet.

If you missed Google’s announcement, Project Starline was described thusly:

Imagine looking through a sort of magic window, and through that window, you see another person, life-size and in three dimensions. You can talk naturally, gesture and make eye contact.

Google says: “We believe this is where person-to-person communication technology can and should go,” because: “The effect is the feeling of a person sitting just across from you, like they are right there.” 

Sounds pretty cool.  The thing, though, is that you’re still looking at the images through a screen.  Google can call it a “magic window” if it wants, but there’s still a screen between you and what you’re seeing.

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#Healthin2Point00, Episode 210 | Babylon acquires Meritage IPA, Ro acquires Modern Fertility & more

This week on Health in 2 Point 00, we’ve got big money, acquisitions, CVS Health starting its own decentralized clinical trials business, AND we’ve got Morgan Health. On Episode 210, Jess asks me about Babylon buying Meritage IPA, looking to add their digital front end to this doctors’ network, and Ro acquiring Modern Fertility for $225 million. Next, telehealth company Wheel gets $50 million in a Series B and digital pathology startup PathAI gets $165 million. Finally, SymphonyRM gets $25 million in a Series B. —Matthew Holt

What Does Your Patient Need to Hear You Say Right Now?

By HANS DUVEFELT

Today a patient told me a cancer doctor had told her husband that he only had a year to live. She was angry, because she felt that statement robbed her husband of hope and she knew well enough that doctors don’t always know a patient’s prognosis in such detail.

“Would you want to know if you only had a year to live”, she asked me.

I thought for a moment and then answered that I probably would want to know. I explained that I would want to make decisions and provisions because I live alone and am responsible for my animals. As I told her, I am well aware that if I dropped dead right now, things would be pretty chaotic for a while.

Two and a half years ago, I wrote a post titled Be the Doctor Each Patient Needs. In it I presumptuously coined the phrase I later put right on top of the sidebar of this blog:

Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.

I still believe we need to be incredibly sensitive to all the verbal and nonverbal clues our patients give us about what they need. In my 2018 post, I used the analogy of being like a chameleon. That’s not the same as being dishonest. It is a matter of knowing that your education and title give you an authority, an opportunity and an obligation to use your position of trust in your patient’s life to say things they need to hear in order to carry on or perhaps to take the first step in a new direction. We all wear the mantle of a superhero in a sense, and we can use this symbol for good. But that carries a responsibility to use our powers wisely.

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Secular Stagnation – An Economic Argument for Universal Health Care Now

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By MIKE MAGEE

John Maynard Keynes, the famous British economist, was born and raised in Cambridge, England, and taught at King’s College.  He died in 1946. He is widely recognized today as the father of Keynesian economics that promoted a predominantly private sector driven, market economy, with an activist government sector hanging in the wings ready to assume center stage during emergencies.

Declines in demand pointed to recession. Irrationally exuberant spending  signaled inflationary increases in pricing, eroding the value of your money. Under these conditions, Keynes encouraged the government and central bank to adjust fiscal and monetary policy to dampen the highs and lows of the business cycles.

Keynesian economics were popularized in America in the 1930’s by a University of Minnesota economist who would go on to become Chairman of Economics at Harvard. For this, he is often referred to as “The American Keynes”, and was highlighted this week in the New York Times by Nobel economist, Paul Krugman, for his association with another tagline, “Secular Stagnation.”

When that economist, Alvin Hansen, first described the condition, he was working on FDR’s Social Security Plan. He defined it as “persistent spending weakness even in the face of very low inflation.”  Krugman’s modern-day description?  “What we’re looking at here is a world awash in savings with nowhere to go.”

Krugman is not the only economist sounding the alarm. Larry Summers, Harvard economist and Treasury Secretary under Bill Clinton, recently wrote, “The relevance of economic theories depends on context.” On the top of his list of current environmental concerns restricting investment and growth is the strong belief that the number of available workers is in steep decline.

Just days ago the CDC added fuel to the fire when they reported a 2020 birth rate in the U.S. of 55.8 births per 1,000 women ages 15 to 44. That was 4% lower than in 2019, and the lowest recorded rate since we started collecting these numbers in 1909. Our lower birthrate is further aggravated by declines in numbers of immigrants and a flattening of the movement of women into the workforce. Add to this the general aging of our population. To put it in perspective, Americans over 80 now outnumber Americans 2 and under.

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#Healthin2Point00, Episode 209 | Funding for Lyra, DrFirst, Jasper Health & Cue Health

Today on Health in 2 Point 00, we catch Jess on the road again! On Episode 209, Jess is shocked at Lyra’s $200 million raise, bringing their total to a whopping $675 million – and their valuation is somewhere in the $4 billion range. What does this mean for the mental health space? Next, DrFirst gets $50 million. They were doing e-prescribing back in the day, what are they up to now? Jasper Health raises $6.75 million for a new play in cancer navigation. Finally testing company Cue Health raises $235 million, bringing their total to $405 million, plus they’ve got some really big federal grants. —Matthew Holt

THCB Gang Episode 55, Thursday May 20 – Ian Morrison is the gang!

Episode 55 of “The THCB Gang” was live-streamed on Thursday, May 20 at 1pm PT — 4PM ET.

This ended up being a special chat. Matthew Holt (@boltyboy) got to talk just with futurist Ian Morrison (@seccurve). A really wide ranging conversation between old friends and a whole lot of fun!

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

What’s the Latest with Evidation Health?

An email interview with the Co-CEO’s of Evidation Health

Over the last few weeks I’ve been conducting a back & forth email interview with Christine Lemke (L) & Deb Kilpatrick (R), the co-CEOs of Evidation Health. They raised $153 million in a Series E back in March (almost a small round these days!) but I wanted to understand a bit more about what the “new” Evidation was doing—Matthew Holt

Matthew Holt: Congrats on the latest funding. Clearly Evidation has evolved since its founding, but focusing first on the clinical trial study aspect, can you explain how the Achievement panel is structured? How was it put together? What are the typical ways that your clients use it, and what is the member experience?

Deb Kilpatrick: Our Achievement platform is the largest virtual connected research cohort in the United States, with more than 4 million users across all 50 states and representing nine out of every 10 ZIP codes. Through the platform, accessible via our app or through a browser, individuals have the opportunity to contribute to ground-breaking medical research in a number of ways: they can connect smartphones, wearables, and connected devices—think Apple Watches, Fitbits, CGMs, etc—that generate heart rate, activity, sleep quality, and other health-related data; they can connect health apps like Strava and MapMyFitness; and they can participate in surveys and provide patient-reported outcomes (PROs) of many forms. 

And they do so with strong privacy protections for both data collection and data use, including use-case specific consents that can be sequential over time. This goes for new Achievers and those who have used the platform for years. And Achievers always have the option to remove themselves from any research project, and/or the platform altogether, at any time.

What do we do with that data? Evidation partners with leading health care companies, including nine of the top 10 biopharma companies in the world, to understand health and disease outside the clinic walls while measuring real world product impact. We’ve conducted virtual trials for almost a decade now, totaling more than 100 real-world studies across therapeutic areas. 

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