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THCB Gang Episode 63 – Thurs July 22

Episode 62 of “The THCB Gang” was live-streamed on Thursday, July 22nd. Matthew Holt (@boltyboy) was joined by regulars: patient safety expert and all around wit Michael Millenson (@MLMillenson); fierce patient activist Casey Quinlan (@MightyCasey); and futurist Ian Morrison (@seccurve).

We got into it on delta variant, medical debt at $140bn, the NYPD vaccination rate being 20 points below the state average, diversity as structural problem in medical school and beyond, and whether we could give everyone in America concierge primary care (the numbers add up! Almost…)

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

Next week #THCBGang is off on vacation!

Nasdaq’s Dario Health ($DRIO) Does Double Acquisition to Build-out Chronic Condition Care Platform

By JESSICA DaMASSA, WTF HEALTH

The “platform-ization” of chronic condition care continues among digital health companies and Nasdaq-traded Dario Health ($DRIO) has acquired TWO different startups in 2021 alone to augment their core diabetes management offering and keep up. Both wayForward and Upright are now under the Dario Health banner and CEO Erez Raphael reveals the strategy behind the two buy-outs — which cost the company just about $30M each and will add digital behavioral health and musculoskeletal care for chronic pain to the Dario experience.

Erez believes that the promise of digital health and digital therapeutics is hyper-personalization, and that addressing multiple conditions at the same time, in a seamless integration, is the way to deliver on that value prop. But, he’s not alone. Teladoc’s Livongo, Vida Health, One Drop, and Omada Health are well-funded competitors pitching the same promise of integrated virtual care. So, how will Dario Health stand-out? Erez points to the company’s direct-to-consumer beginnings and tech expertise as differentiators – will that be enough in the crowded US employer and health plan market OR is the total addressable market large enough for Dario to grab a significant share? We chat chronic condition care market penetration strategy with one of its few publicly traded digital health companies.

#Healthin2Point00, Episode 223 | Carbon Health, Woebot, Eight Sleep, Aidoc, and OM1

Today on Health in 2 Point 00, Jess has finally reclaimed her Twitter account! On Episode 223, Jess asks me about Carbon Health raising $350 million, this is a big competitor for One Medical with retail clinics plus telehealth. Next, for digital mental health care, Woebot gets $90 million for its mental health chatbot. Eight Sleep raises $76 million working on sleep fitness, with lots of celebrities in this one. Aidoc raises $66 million in a round led by General Catalyst, using AI to analyze medical images for chronic conditions. Finally, real world evidence company OM1 raises $85 million, bringing their total to $170 million. —Matthew Holt

Health Care Should Go (Micro) Nuclear

By KIM BELLARD

I think of hospitals as the healthcare system’s nuclear power plants.  They’re both big, complex, expensive to build, beset with heavy regulatory burdens, consistently major components of their respective systems (healthcare and electric generation) yet declining in number.  Each is seen to offer benefits to many but also to pose unexpected risk to some.

Interestingly, there’s a “micro” trend for each, but aimed towards different ends.

Micro hospitals have been with us for several years.  They usually have only around ten beds, along with an emergency room, lab and imaging.  Dr. Tom Vo, CEO of Nutex Health, says: “We position ourselves between urgent care and a big hospital.”  A micro-hospital Chief Medical Officer admits: “We still partner with our larger hospital partners for patients who might require surgery or intensive care.” 

They’re not trying to reinvent hospitals so much as to support them and offer more convenience to patients.  Not so with micro reactors; they’re looking to revitalize their industry, which is in trouble.

According to the U.S. Energy Administration (E.I.A.), there are 94 U.S. nuclear reactors, at 56 nuclear power plants, in 28 states.  Only one new reactor has gone active in the U.S. since 1996, while almost two dozen are in various stages of decommissioning and only two new ones are under construction.  Overall, the U.S. gets about 20% of its power from nuclear reactors, while 13 countries get at least a quarter of their electricity from nuclear, with France leading the pack at 75%.     

We talk a lot about transitioning away from using fossil fuels to generate electric power, but none of the renewable options currently offers a realistic path towards replacing them.  Nuclear power is the proven alternative, but, as Dan Van Boom wrote in CNET, nuclear power has a PR problem.  No one wants a nuclear power plant in their backyard, no matter how big that backyard is.

Continue reading…

Ginger for Teens Puts “Full-family Approach” to Mental Health Care in Hands of Employers

By JESSICA DaMASSA, WTF HEALTH

Digital mental health unicorn Ginger has just launched ‘Ginger for Teens’ in an effort to help the 1-in-5 teens currently suffering from mental health disorders, amid what’s being called a “teen mental health crisis.” No doubt parents are at their wit’s end searching for care, and Ginger is hoping that its teen-friendly bundle of self-guided content, behavioral health coaching, and video therapy will support a “full-family” approach to mental health care that will help everyone feel a bit better.

Ginger’s Chief Clinical Officer, Dr. Dana Udall, and Adolescent Services Coordinator, Dr. Dena Scott, share their insights on the teen mental health crisis, including the myriad factors they had to consider as they re-tooled Ginger’s offering to meet the needs of this new client base. Ginger for Teens will roll out to all of Ginger’s nearly 650 employer clients by the end of the year, helping teens gain access via their parents’ health plans at work. And beyond Ginger’s employer-sponsored health plan base? Will Ginger for Teens roll out to its health plan clients too? Don’t think we forgot about that first-of-its-kind national contract with Cigna and the potential that partnership could hold to help millions of families nationwide. So, what are the big plans for bringing up the supply-side of teen mental health care? Find out more by tuning in…

Biden Should Extend a “Public Option” as a Message to “Health Care Royalists”

By MIKE MAGEE

In this world of political theatrics, with Democratic legislators from Texas forced into exodus to preserve voters’ rights, and Tucker Carlson rantings about Rep. Eric Swalwell riding shirtless on a camel in Qatar streaming relentlessly, Americans can be excused if they missed a substantive and historic news event last week.

On Friday, July 9th, President Biden signed a far-reaching executive order intended to fuel social and economic reform, and in the process created a potential super-highway sized corridor for programs like universal healthcare. In the President’s view, the enemy of the common man in pursuit of a “fair deal” is not lack of competition but “favoritism.”

To understand the far-reaching implications of this subtle shift in emphasis, let’s review a bit of history. It is easy to forget that this nation was the byproduct of British induced tyranny and economic favoritism. In 1773, citizens of Boston decided they had had enough, and dumped a shipment of tea, owned by the British East India Company, into the Boston Harbor. This action was more an act of practical necessity than politics. The company was simply one of many “favorites” (organizations and individuals) that “got along by going along” with their British controllers.  In lacking a free hand to compete in a free market, the horizons for our budding patriots and their families were indefinitely curtailed.

Large power differentials not only threatened them as individuals but also the proper functioning of the new representative government that would emerge after the American Revolution. Let’s recall that only white male property owners over 21(excluding Catholics and Jews) had the right to vote at our nation’s inception.

Over the following two centuries, power imbalances have taken on a number of forms. For example, during the industrial revolution, corporate mega-powers earned the designation “trusts”, and the enmity of legislators like Senator John Sherman of Ohio, who as Chairman of the Senate Republican Conference, led the enactment of the Sherman Antitrust Act of 1890.

He defined a “trust” as a group of businesses that collude or merge to form a monopoly. To Sen. Sherman, J.D. Rockefeller, the head of Standard Oil, was no better than a monarch. “If we will not endure a king as political power, we should not endure a king over the production, transportation and sale of any of the necessities of life”, he said.   The law itself stated “[e]very contract, combination in the form of trust or otherwise, or conspiracy, in restraint of trade or commerce among the several States, or with foreign nations, is declared to be illegal.”

Continue reading…

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, Shannon Brownlee and her fellow rebels at the Lown Institute decided to have a bit of fun and compare which non-profit hospitals actually made up for the tax-breaks they got by providing more in community benefit. A bunch of hospitals you never heard of topped the list. What was more interesting was the hospitals that topped the inverse list, in that they gave way less in community benefit than they got in tax breaks. That list has a bunch of names on it you will have heard of!

Given how many of that list run sizable hedge funds and then do a little health care services on the side, perhaps it’s time to totally re-think our deference to these hospital system monopolies. And I don’t just mean making it harder for them to merge and raise prices as suggested by Biden’s recent Executive Order.

#Healthin2Point00, Episode 222 | Funding for Availity, VisiQuate, Truveta, and Bayesian

Today on Health in 2 Point 00, Jess and I cover Availity raising $50 million bringing their total to $200 million and a valuation at over a billion. Revenue cycle management company Visiquate raises $50 million, bringing their total to $70 million. Truveta raises $95 million for its data analysis platform, and finally Bayesian gets $15 million using AI to predict sepsis. —Matthew Holt

The Call to Be a Primary Care Doctor

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?

Continue reading…

THCB Gang Episode 62 – Thurs July 15, 1pm PT- 4pm ET

Episode 62 of “The THCB Gang” will be live-streamed on Thursday, June 17th at 1pm PT -4PM ET. Matthew Holt (@boltyboy) will be joined by regulars futurist Jeff Goldsmith; policy expert consultant/author Rosemarie Day (@Rosemarie_Day1); Suntra Modern Recovery CEO JL Neptune (@JeanLucNeptune); and medical historian Mike Magee (@drmikemagee).

If you’d rather listen, the “audio only” version it is preserved as a weekly podcast available on our iTunes & Spotify channels a day or so after the episode — Matthew Holt

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