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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

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 doingMatthew 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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Death, Taxes — and Paperwork

By KIM BELLARD

Tuesday, in case you missed it, was the deadline for filing your 2020 federal taxes (it was postponed  from its usual April 15 date due to “the unusual circumstances related to the pandemic”).  Nothing, Benjamin Franklin famously said, is certain but death and taxes, but if you live in the United States, you might add the inevitability of paperwork involved with both (and with healthcare in general). 

The question is, does it have to be as bad as it is? 

A Washington Post op-ed by Helaine Olen argues that tax filing could, and should, be much simpler.  A March article in The Conversation by Beverly Moran, a tax expert at Vanderbilt, agrees.  Both make the point that, for most of us, the IRS could do the work for us. 

Ms. Olen asserts:

The thing is, filing taxes just doesn’t have to be this hard. In 36 countries, the nation’s tax agency sends eligible residents a pre-filled return, and asks them to sign if they agree with the amount that’s indicated is owed or should be credited to them. Japan does this. So do Sweden, the Netherlands, Spain and others.

Professor Moran has slightly different numbers, but makes the same point.  She adds that our tax system is 10 times more expensive than in other major economies.  This should not be a surprise; collectively, we spend close to $200b annually on IRS paperwork, taking some 6 billion hours of our time along the way. 

You’d think that all this time and money spent on tax filing would at least give us an efficient tax system, but the opposite is true.  The last time the IRS took a look, for tax years 2011-2013, the “tax gap” – the estimate between taxes owed and taxes paid – was $441b annually, some 16% of tax liability.  IRS Commissioner Charles Rettig told Congress last month that the number might actually be over $1 trillion annually now, due to new kinds of wealth creation and more sophisticated tax avoidance. 

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Komodo Health’s CEO on $220M Series E & What’s REALLY Happening with Big Data in Healthcare

By JESSICA DaMASSA, WTF HEALTH

You know all that “magic” that machine learning is meant to bring to seemingly lackluster healthcare data and our limited understanding of it? Komodo Health’s co-founder & CEO Arif Nathoo demystifies the wizardry of one of our favorite buzz phrases, “The Algorithm,” and gives us a colorful overview of how his startup is making data useful to the way payers, health systems, and pharma co’s study populations at-scale. Komodo’s raised $314M to-date, closing a MASSIVE $220M Series E backed by Tiger Global Management, Casdin Capital, ICONIQ Growth, Andreessen Horowitz, and SVB Capital in April, and after hearing this enthusiastic explanation of what they’re working on – and the market potential for it – we understand why.

At its most simplistic, Komodo is using de-identified healthcare claims data as a base from which to learn how patients flow through the healthcare system. Other data sets are brought in and layered onto that “patient-flow, dollar-flow” claims trail in effort create a new vantage point for seeing what’s happening within the system, at a population level. That insight can then be used to predict patient behavior and provide evidenced analysis for how the system can be improved. Don’t worry: Arif provides lots of detailed examples and talks through exactly what kind of data can (and currently can’t) be pulled into the mix. If you want to get smart on the “Big Data” opportunity in healthcare and how it’s going to be impacting the future of care delivery and virtual care delivery, this is one chat you won’t want to miss!

“Tell Me More”

By HANS DUVEFELT

Words can be misleading. Medical terms work really well when shared between clinicians. But we can’t assume our patients speak the same language we do. If we “run with” whatever key words we pick up from our patient’s chief complaint, we can easily get lost chasing the wrong target.

Where I work, along the Canadian border, “Valley French” expressions tripped me up when I first arrived. The flu, or in French le flu (if that is how you spell it – I’ve never seen it in writing) is the word people use for diarrhea. Mal au cœur (heart pain) doesn’t mean angina or chest pain, but heartburn, a confusing expression in English, too.

But even if we are all English speaking, clinicians need to be careful not to assume common words mean the same to everyone.

I have seen many patients complain of anxiety, but not actually be worried about anything. A number of bipolar people have used the word anxiety when, in my personal vernacular, they are really describing pathological restlessness. I once had a patient complain of “nerves” but not have a worry in the world except for his hereditary essential tremor, which he assumed was a sign of untreated anxiety.

People often resist my labeling their symptom as chest pain, insisting that I am wrong about the location and the character of their discomfort. Instead, they might insist it is indigestion or prefer pressure, tightness or heaviness in their throat, epigastrium or even between their shoulder blades. “Chest pain is shorthand for all that”, I tell them.

I hear people use the word dizzy for a gnawing feeling in their epigastrium, and nauseous for a sense of early satiety after eating.

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Will Virtual Care Platforms (VCPs) Become Healthcare’s Mega-Platforms?

Seth Joseph
Vince Kuraitis

By VINCE KURAITIS and SETH JOSEPH

Let’s start with a pop quiz. Take 15 seconds to look at the list below, asking yourself the question “What do all these have in common?”

  • address books
  • video cameras
  • pagers
  • wristwatches
  • maps
  • books
  • travel
  • games
  • flashlights
  • home telephones
  • cash registers
  • MP3 players
  • Day timers
  • alarm clocks
  • answering machines
  • The Yellow Pages
  • wallets
  • keys
  • transistor radios
  • personal digital assistants
  • dashboard navigation systems
  • newspapers and magazines
  • directory assistance
  • travel and insurance agents
  • restaurant guides
  • pocket calculators

The commonality is that all of these were disrupted by smartphones and their operating system (OS) platforms — Google Android and Apple iOS.

Let’s consider a healthcare comparison. Ask yourself, “What do all these have in common?”

  • Primary care
    • Urgent care
    • Office visits
  • Hospitals
    • Inpatient
    • Outpatient
    • ER
  • Specialist access
  • Behavioral health
  • Diagnostics
  • Patient portals
  • Home health services
  • Medication administration\
  • Preventive care
  • mHealth apps
  • EHR functionality/apps, e.g.,
    • Scheduling & check in
    • Billing
    • eRX
    • Medication management
    • Referral management
    • Care planning
    • Care coordination
    • Social care
    • Patient education
    • Patient communications

The commonality is that all of these are potentially disruptable by Virtual Care Platforms (VCPs).

In this essay we ask the question “Will virtual care platforms become healthcare’s mega-platforms?” We believe the potential for such a scenario is strong. We describe and assess parallels between the evolution of the duopoly smartphone operating system (OS) market and the emerging virtual care platform market. Our intent is to describe a plausible scenario for the future – not to make a prediction.

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