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An Epic Fight for the Metaverse

By KIM BELLARD

 You might have missed it amongst all the headlines about the U.S.P.S., the 2020 elections, and, of course, that little thing we call the pandemic, but Fortnite got kicked off Apple’s App Store (and subsequently Google Play).

I’m not a gamer, but I am fascinated by gaming, because, as Steven Johnson put it, “The Future is where people are having the most fun.” Tim Sweeney, the founder and CEO of Epic Games, Inc., which makes Fortnite, seems to be having a lot of fun. And he thinks the future is the Metaverse.

Healthcare, take note.

The tech giants were reacting to Epic allowing “permanent discounts” on developer fees for in-game purchases made directly, rather than going through Apple or Google. Developers thus avoid the 30% commission charged in those Stores. Mr. Sweeney has been railing about the commission level for some time, leading to the recent decision.

Apple tried to justify its action:

Today, Epic Games took the unfortunate step of violating the App Store guidelines that are applied equally to every developer and designed to keep the store safe for our users. As a result their Fortnite app has been removed from the store. Epic enabled a feature in its app which was not reviewed or approved by Apple, and they did so with the express intent of violating the App Store guidelines regarding in-app payments that apply to every developer who sells digital goods or services.

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Health in 2 Point 00, Episode 143 | Lumeon, Nurx, Thirty Madison, & More

On Episode 143 of Health in 2 Point 00, we have all the alphabets in the raising series represented ;)! Jess asks me about Lumeon raising a $30M Series D for their care orchestration centers, Nurx raising a $22M Series C to develop out its online pharmacy presence, Thirty Madison getting $47M and Johnson & Johnson is an investor this round, Bodyport closing an $11.2 M Series A for their weighing scale platform that can detect early cardiovascular disease, and Kumanu raising a $3M Series A to grow out its platform that helps people figure out their lives’ purpose.

Be sure to check out our talk from the 7 competitor CEOs to Teledoc & Livongo who weigh in about the $19B merger. If you want to join our book club, we are reading UnHealthcare: A Manifesto for Health Assurance, which is a how-to for creating a platform for a revolutionary future for healthcare, by Hemant Teneja (VC at General Catalyst) and Stephen Klasko (CEO at Jefferson Health System). We will have a video on our discussion with the authors which will be published on the 3rd Wednesday of every month! —Matthew Holt

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Crossover Health: The Amazon Deal, Primary Care & The Rise of the ‘Health Activist’ Employer

By JESSICA DaMASSA, WTF HEALTH

“Next-gen” healthcare might just be getting its start in primary care. So says Crossover Health’s CEO, Scott Shreeve, who laughingly channels Justin Timberlake and says he’s “bringing sexy back” to it too. With Walmart launching its own Healthcare Super Centers, Walgreens partnering with VillageMD in a $1-billion-dollar three-year deal, and some soaring post-IPO stock prices for OneMedical and Oak Street Health — it appears he’s onto something. And, hopefully, it’s something big that’s borne from Crossover’s recent partnership deal with Amazon. Will this be the tech giant’s next foray into healthcare? We’ve got the analysis on Amazon, Scott’s insider insights on what’s next for the primary care market, AND some phenomenal perspective on the “rise of the ‘Health Activist Employer’” as healthcare’s “most innovative payer.”

Health Insurers Ride High for Now, But Watch What’s Coming Next

By KEN TERRY

In the strangest healthcare business story of 2020, the major health insurance companies are thriving despite—or because of—the pandemic. As the second quarter reports of United, Anthem, Cigna and other insurers reveal, their COVID-19-related costs were outweighed by the sharp drop in claims for other healthcare services.

As a result, the second quarter operating gain for Anthem, one of the largest national carriers, jumped 65% from the prior-year period, while the portion of its premiums spent on member benefits dropped to 78%. The earnings of UnitedHealth, similarly, vaulted 98% as the percentage of its premiums spent on health care fell to 70.3%. Such a low “medical loss ratio” has probably not been seen since the 1990s.

At the same time, the big insurers’ membership has been rising, but not among workers covered by employer-sponsored plans. Commercial insurance members served by United, for example, fell by 270,000 to 26.8 million, following a drop of 720,000 in Q1. In contrast, the number of people in United’s Medicaid managed care plans rose by 330,000.

These trends track with the short-time fallout of the pandemic. Families USA reported that 5.4 million workers who lost their jobs from February to May also lost their health insurance. Another study predicted that by the end of 2020, 10.1 million people will lose employer-based insurance tied to someone in their household.

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Healthcare Sings The Non-Profit Blues

By MICHAEL TURPIN

Powers once assumed are never relinquished, just as bureaucracies, once created, never die.

Charley Reese

As we ponder the 100 day count down to the Presidential Elections, the rhetoric and ranting swirling around the best solution for our nation’s healthcare crisis, is hitting decibel levels not heard since the passage of the Affordable Care Act.  As with any major entitlement legislation, there are commendable elements, inefficiencies, and a host of unintended consequences. The current administration’s obsession with repeal while the ranks of uninsured people grow, begs the question, “what is the blue-print for expanding coverage and reducing waste, fraud and abuse while increasing transparency, quality and overall public health.  Answer: There is no plan and if there was, it would fall well short of achieving many of these objectives given the deeply entrenched stakeholder who actually do not benefit if the cost of healthcare declines.  It a classic NIMBY response: “I’m all for reform as long as I maintain my role and revenue in whatever solution is proposed.”. 

The Affordable Care Act is a solid foundation to build a 2.0 version of a solution to solve for the uninsured and to act as a catalyst for market reforms that will either reshape the misaligned incentives and embedded inequities in our current system or it will lead to voters demanding the expansion the role of Medicare and Medicaid.  70M adults and children are covered under Medicaid – including those who benefited by the passage of the ACA.  Approximately 55M are covered under Medicare resulting in 125M covered under some form of state or federal aid. 155M receive coverage through employers. 

Its estimated by the Economic Policy Institute that 29.8M individuals who received coverage as a result of ACA expansion would lose coverage if no legislation replaced it.  Add in the severe economic dislocation arising from Covid-19 that could result in an additional 14M unemployed and you could see a worst case of uninsured swell from a current 27M to as high as 70M according to Policy Advice, a non-profit industry watch dog.

So how can you change the current market to drive reforms without a legislated intervention?  It starts by enforcing laws already in place and challenging regulators to do their jobs – ensuring that we minimize waste, fraud and abuse.  As of 2020, the average annual cost of family health coverage has eclipsed the cost of a mid-sized economy car. We must tackle the affordability problem by reducing the number of intermediaries who extract profits from the delivery system but do not play properly in the sand box of regulation that is often poorly monitored. We must demand transparency and deconstruct expensive bureaucracies only inflate the cost of care without improving it. It’s impossible to moderate the cost of healthcare without reducing the size of the pie and those feeding on it.

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I Cured My Patient, But What Was His Diagnosis?

By HANS DUVEFELT

He cancelled his followup appointment because he was feeling fine. He didn’t see the point in wasting a Saturday to come to my clinic when he had lawns to mow and chores to do.

Less than two weeks before that he was sitting on the exam table in my office, again and again nodding off, waking up surprised every time his wife prodded him. The stack of printouts from the emergency room illustrated all the normal testing they had done.

He had experienced a brief episode of numbness in the left side of his face and felt tired with just a slight headache. When I saw him the headache was a bit more severe in the back of his head and down the right side of his neck. But his neck wasn’t stiff.

His blood sugar was 87, normal for most people, but this man had a history of diabetes although his blood sugars had steadily improved over the past year. I told him to stop all his diabetic medications although I don’t think he took notice. His wife said she would make sure he stopped them.

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Teladoc & Livongo — The Health Techerati Weigh-In

Six competitor CEOs and one ex-CMO discuss the biggest-ever digital health merger

By JESS DAMASSA & MATTHEW HOLT

It was the news that stunned the world of health tech. And us! So we had seven of Teladoc and Livongo’s biggest competitors weigh-in on what the merger means for telehealth, digital health, the future of health care delivery–and their businesses! You’ll hear from the CEOs of Omada, Ginger, One Drop, Vida, Lark & Cloudbreak, with some spicy commentary from Lyle Berkowitz who was, until recently, CMO at MD Live. From reaction to the merger to speculation about how this will impact the future of digital health funding, fasten your seat belts for some impactful and fun infotainment about all the implications of the deal.

THCB Gang Episode 21

Episode 21 of “The THCB Gang” was live-streamed on Thursday, August 13th! Watch it below.

Joining Matthew Holt (@boltyboy) today are some of our regulars: policy & tech expert Vince Kuraitis (@VinceKuraitis), MD turned leadership coach Maggi Cary (@MargaretCaryMD), patient advocate Grace Cordovano (@GraceCordovano), and Consumer advocate & CTO of Carium Health Lygeia Ricciardi (@Lygeia). It was a great conversation surrounding the patients’ role in all the technology being deployed, how providers can work to close the gap in care, and whose duty is it really to ensure a person is “healthy”. Give it a listen below if you missed the live show

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

The Story of an American Mask Distributor

By SAURABH JHA

Seven weeks before President Trump declared COVID-19 a federal emergency heralding the economic lockdown, Jesse’s customers began cutting their orders. Jesse sells garments and cotton, imported predominantly from India, to wholesalers and retailers, big and small, in malls across the North East corridor.  His business had a good January. December was like any December. But February was different.  His customers, reassuring him that it wasn’t personal, were predicting a falling demand for their products because of COVID-19. They may be over reacting, but better shortage than glut, they felt.

Jesse, who has no medical background, had heard of a virus which quarantined cruise ships, but nothing seemed foreboding back in February. He had tuned out the President, who was being his usual clownish self. It was business as usual in Manhattan, where he lives. He received reassuring messages from public health figures about the novel coronavirus. New York City’s mayor was particularly upbeat, urging New Yorkers to mingle with even more vigor.

Jesse didn’t know how to reassure his customers. A week later, more customers cancelled their orders. By middle of February, the orders halved. Being a businessman, not philosopher, it mattered not to him why his customers had seemingly overestimated COVID-19’s threat. What mattered is that they had. Since his business operated on small margins, the reverberations could be substantial. The first order of the day was reducing the output of his factory in India which was running on all cylinders.

The second order of the day was survival. If his customers’ fears came true, his business would be destroyed. Jesse had no qualms accepting government bailout. But this was long before the federal government announced relief for businesses. The virus had yet to strike Italy. COVID-19, like Chengiz Khan, seemed to prefer the eastern perimeters of the Silk Road.

In his culture, Jesse Singh is an American Sikh hailing from the Punjab – there’s a simple rule. When customers don’t want a certain product, find something else to sell. His family motto is that you should love the act of selling, not the product being sold (the motto sounds better when said by a Punjabi in Punjabi).  

Another Punjabi rule, technically not a rule but part of their cultural RNA, is that Punjabis don’t sit idle. During the partition of the subcontinent, thousands of Sikhs arrived at Delhi train station hungry, battered, penniless, and homeless, after losing their homes and families to the mobs. After feeling sorry for themselves for a couple of days, they started selling tea and biscuits on the railway platforms.

If the panic from coronavirus could shut old businesses it surely could open new ones, Jesse thought. A soaring demand for personal protective equipment (PPE) seemed obvious. Since N-95 supply was regulated, he threw his weight behind surgical masks, believing that they’d be demanded by healthcare workers and eventually the general public. He decided to import a small batch on a trial basis.

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Don’t Underestimate Doctor On Demand – CEO Hill Ferguson on the Era of ‘Tele-Everything’ Healthcare

By JESSICA DaMASSA, WTF HEALTH

JUST before the Teladoc-Livongo merger was announced, I had a chance to catch up with Doctor on Demand’s CEO, Hill Ferguson. The future for telehealth, he said, is “bright green” — and I’m pretty sure it’s looking even greener now! Doctor On Demand has stood out among telehealth companies for being particularly early on virtual primary care and it sounds like they’re going to continue developing that line of business — in which they have key partnerships with Humana and Walmart — with the $75M series D funding they just received.

Add to that a brand-new, first-of-its-kind telehealth program for the Medicare Part B population, and crazy consumer-focused type UX features like same-day scheduling for behavioral mental health care (yes, that’s right, dynamic scheduling for healthcare is here, folks!) and you can start to see how DOD is strategizing to pull away from the pack.

With the competitive landscape shifting, especially after Teladoc-Livongo, how does Hill view the onslaught of new entrants like digital health companies who added telehealth in reaction to the COVID-19 pandemic, or potential unicorns like Ro or HIMS, who are focused on tying the prescription drug business into virtual care delivery? It’s the insider insight you’ve been waiting for in this era of ‘tele-everything’ healthcare.

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