On Episode 218 of Health in 2 Point 00, it’s a big week in digital health for IPOs. Today Jess asks me about Bicycle Health’s $27 million Series A, bringing the substance use disorder startup’s total to $32.3 million. NexHealth, which is like Shopify for doctors, gets $31 million in a Series B, Stork Club raises $30 million in a Series A, and DrChrono raises $20 million for its EHR. Finally, Pear Therapeutics is SPAC-ing out with a $1.6 billion valuation. As we all know, DTx is my favorite category of health tech so tune in for what I have to say about this one. —Matthew Holt
By MIKE MAGEE
What will be the lasting impact of the Covid 19 pandemic?
We still don’t know the answer to that question in full. But one thing that can be said with some certainty is that it has strengthened the hand of Big Tech and all things virtual. Consider the fact that within the Biden White House administration, 13 senior aides have Big Tech resumes with time spent in firms like Google, Facebook, Twitter, Apple, Amazon, Microsoft and more.
This pandemic-induced scrape with mortality has instigated widely varied responses ranging from existential re-awakenings to explosive entrepreneurship.
In health care for example, health tech start-up’s are altering research, education, care delivery and coordination, data mining, patient privacy and financing.
As we know well from health care, intermingling profit, policy and politics can eventually lead to conflict and recrimination. The current controversy over NIH indirect funding of Shi Zengli’s Wuhan “gain-of-function” viral research through Peter Daszak’s New York based EcoHealth Alliance is a case in point.
But we’ve been there before. In the 1990s, James M. Wilson received a PhD and an MD degree from the University of Michigan, then completed an internal medicine residency at Massachusetts General Hospital and a postdoctoral fellowship at MIT. By 1997, he was one of the leading stars in the new gene-therapy movement, directing his own research institute at the University of Pennsylvania.
The institute focused on adjusting the genes of children born with a hereditary disease called ornithine transcarbamylase deficiency (OTD), which prevents the normal removal of ammonia in the body. Wilson’s experimental technique involved genetic engineering, splicing therapeutic genes into supposedly harmless viruses that, once injected into the body, could carry their payload to defective cells and repair the genetic errors.
Dr. Wilson was attempting to determine the maximum dose of genetically modified material that could be safely injected into affected youngsters. He had enlisted 18 participants, including a teenager named Jesse Gelsinger who had a version of the genetic disease in which some of his liver cells carried the genetic abnormality but other cells were entirely normal. Those who have the full-blown disorder die in early childhood. But with his mosaic, Jesse most of the time felt well, as long as he continued to take 32 pills a day.Continue reading…
By JESSICA DaMASSA, WTF HEALTH
“We have to look at telehealth as an operating system.” Amwell ($AMWL) President & CEO Roy Schoenberg has a way with analogies, and some of his best land in this interview as we get a highly detailed, insider’s perspective about how payers and health systems are rethinking telehealth as a result of their experiences during the pandemic.
Bottom line: The pandemic taught us that telehealth can be used to deliver a much wider variety of healthcare services than just urgent care and, so the whole idea of ‘telehealth’ is changing from healthcare product to healthcare infrastructure. Mental health care, physical therapy, medication management, primary care, and more have all moved to telehealth and, along with that shift, the “rules of engagement” around those services have started to change.
Payers are looking to become the “digital front door” for their members – providing primary care and navigation. Health Systems are increasingly looking to use their own docs for urgent care, rather than outsource that relationship and miss the potential to build trust with local patients. And, in all this, Roy argues that healthcare’s biggest buyers have stopped looking at telehealth as a “product” and, instead, are starting to see the opportunity to “rewrite their future” around a view of telehealth as infrastructure, as one of healthcare’s “foundational systems” intertwined with (and as mission-critical as) their EHRs or claims and eligibility systems.
My favorite analogy starts around the 20-minute mark, when Roy explains this operating system idea by drawing comparison to how individual Microsoft programs (think Word, Excel, Outlook, PowerPoint) would be infinitely less powerful if they were not running on the same operating system and able to easily transfer information. Another good one? How both the buying and provisioning of healthcare is being re-thought digitally, just as online shopping not only changed buying habits but also changed supply chain for retailers. If you’re looking to hear the latest on what’s happening in telehealth post-Covid, learn how things have changed for payers and health systems, AND also want to dip into Amwell’s market positioning a bit, you’ll love this deep-dive.
#THCBGang will feature special guest venture capitalist & massive over-achiever Justin Norden (@JustinNordenMD) from GSR Ventures. Also joining Matthew Holt (@boltyboy) will be regulars, patient safety expert and all around wit Michael Millenson (@MLMillenson); WTF Health host & Health IT girl Jessica DaMassa (@jessdamassa); futurist Ian Morrison (@seccurve); & THCB regular writer Kim Bellard (@kimbbellard)
By HANS DUVEFELT
I have known doctors that cultivated a dependence among their patients by suggesting their health and safety depended on regularly scheduled visits and laboratory testing for what seemed to me stable, chronic conditions. People would come in every three months, year after year, to review cholesterol numbers, potassium levels and glucose or blood pressure logs and have a more or less complete physical exam every time. Patients would also get scheduled for rechecks of ear infections and other simple conditions I always thought patients can assess themselves.
Compare the effort on the part of the physician with that type of practice versus seeing stable patients less often, doing more urgent care, and being more available for new patients. The first approach seems comfortable, possibly complacent, and the second more demanding, but also more satisfying, at least to me. My goal is always to make my patients as independent and self sufficient as they can be. I don’t want them to be dependent on me in an unhealthy way.
It is a matter of temperament, but it is also a matter of stewardship and resource management if we see ourselves as serving the populations and communities around us.
Maybe it is because of my Swedish upbringing and education, but I would feel guilty if sick patients or even relatively healthy people don’t even have access to a personal physician if I were to spend my days over-monitoring stable conditions.
In this medically underserved state, don’t we have a responsibility to consider whether we are getting too comfortable in our chronic care routines? Patients check their own blood pressures and glucose levels. They could get in touch if their numbers worsen. Do we really need to bring them in to make sure they don’t stray when there are people in our communities without access to care?
I sometimes actually use the phrase “I don’t babysit”. I don’t necessarily use the word “empower”, but that is what I always try to do with my patients.Continue reading…
Senior Caregiving Startup Papa: “Hanging Out & Helping Out” Backed by Health Plans & $91M in Funding
By JESSICA DaMASSA, WTF HEALTH
Since it was founded in 2017, “family-on-demand” senior care startup Papa has raised a whopping $91M from a veritable who’s who of health innovation investors. How has this startup that matches “authentically nice people” up with seniors to “help out and hang out” convinced the likes of Tiger Global, Comcast Ventures, and Canaan Partners (and those are just the investors who chipped in for Papa’s $60M Series C round this April) to invest? And, probably more importantly, how has Papa won more than 40 health plans as clients (a number set to triple for 2022) EAGER to foot the bill to provide their members with the support of a Papa Pal?
Founder & CEO Andrew Parker walks us through the business model and what it will and won’t be providing in the near future. Companionship, house help, chatting, and grocery shopping all fall under the purview of a Pal – so does filling non-clinical gaps in care like making annual check-up appointments, picking up prescriptions, and providing telehealth tutorials. Andrew says Pals are like “ninjas for a health plan,” building relationships and trust one weekly visit at a time. With 240 million people that could get access to a Papa Pal either via a Medicare, Managed Medicaid, or even employer sponsored health plan (good employees with aging parents need caregivers…) the potential for growth is tremendous. Will the biz hit a ‘supply’ issue? How long do Pals stick around? As we work to combat loneliness, isolation, and a myriad of social determinants of health issues within a rapidly expanding senior population, find out what Andrew thinks will keep Pals around and the service sticky for seniors, their real families, and their health plans.
By KIM BELLARD
Here’s a question that we don’t often ask: which is the U.S. more likely to accomplish – getting everyone health insurance, or broadband? Hint: it’s probably not what you think.
The health insurance part of it is often debated. We passed ACA, but the number of uninsured stubbornly remains at nearly 30 million, almost 10% of the population. Still, except for residents of those 12 states that have refused to pass Medicaid expansion, everyone in the country has at least access to public or private health insurance, with subsidies available to many.
Broadband hasn’t been around as long a health insurance, but it has become an integral part of our society, as the pandemic proved (ever try remote work or learning without broadband, much less telehealth?). Unfortunately, some 20 million households lack broadband; assuming an average household size of about 2.5, that’s some 50 million people, which is way more than the number of uninsured.
Welcome to the digital divide.
Everyone seems to agree increasing access to broadband is a good goal. It’s part of President Biden’s proposed infrastructure plan, and even many Republicans support some funding towards the goal, as in a recent bipartisan proposal.
We often think about the issue as being a rural problem, similar to the problem of electricity availability in rural areas before the Rural Electrification Act (1936). It’s just hard, or at least expensive, to wire all those vast spaces, those farms and small communities that comprise much of America.
The fact of the matter, though, is that of those 20 million households without broadband, some 15 million of them are urban households. A higher percent of rural households may lack broadband, but, in terms of actual numbers of households lacking it, it is urban dwellers. For the most part, broadband is available in their neighborhood; they just can’t afford it (or don’t see the need).Continue reading…
By TOMER BEN-KIKI
The American people can’t afford partisan politics that increase long-term healthcare costs.
When the GOP came to the table with a $1 trillion infrastructure proposal last week, I was pleased to see that they had increased funding for broadband access to $68 billion.
The President wants $100 billion for broadband expansion, but a meaningful increase before the soft deadline of June 7 was a positive step.
Politics aside, the pandemic made it clear how dependent we are on the issue of broadband internet access.after all, broadband underpinned nearly everything that was done to keep the economy on life-support during the lock-downs.
Without broadband access our ability to deliver education, run most businesses, and (most importantly) deliver healthcare, would have slowed to a glacial pace or – in some cases – ground to a halt.
The fact that the healthcare industry was able to make a lighting-speed pivot to telehealth during the COVID epidemic shows how quickly the government, insurers and providers can respond to deliver needed care. But, that pivot also exposed how social determinants of health, like economic stability and the built environment, still present serious challenges to care delivery for our most vulnerable populations.Continue reading…
Today on Health in 2 Point 00, I haven ‘t been fired yet – so I’m taking over this episode. On Episode 217, there’s been a lot going on in the digital health world, including the biggest IPO in health tech ever with Bright Health’s $14 billion valuation. Speaking of IPOs, 23andMe went public yesterday with a $3.5 billion valuation. Zus Health gets $25 million in a Series A with Jonathan Bush as CEO. Pill Club raises $49 million getting contraceptives to women online, similar to Nurx. Finally Brightline gets $72 million, this is a child mental health company; they take family prep, family counseling psychiatry, and coaching and put it all together. —Matthew Holt
By HANS DUVEFELT
Left to my own devices, I would be selective about when and how much of a physical exam I do: either not at all or very detailed for just those things that can help me make the diagnosis. I have no patience for boilerplate normal exams. Any doctor who uses the term PERRLA (pupils equal, round, reactive to light and accommodation) is probably faking it. First, most of the time this isn’t actually tested completely and, second, even if it’s done correctly, it has no relevance in the majority of chart notes I have found it in. I have actually seen it in office note templates for urinary tract infections!
It is well known that the history makes the diagnosis in the vast majority of cases. But that task – or art, actually – is sometimes relegated to support staff or forced into unnatural click boxes. Because reimbursement until very recently was tied to how many items were asked about and examined, there was a loss of the story, or narrative, of the patient’s illness. And you could get more brownie points by including things that were extremely peripheral to the clinical problem at hand.
EMRs make it easy to produce long office notes with lots of reimbursement and quality scoring points of uncertain clinical value and accuracy.
Specifically, the physical exam has in many instances become a corrupted, fraudulent, one-click travesty of the art and professionalism we swore an oath to hold high when we graduated from medical school.
The pandemic and the rush toward telemedicine made it clear to most people that medical diagnosis, advice and treatment is entirely possible without physical contact. It was just a matter of getting paid for it, or the healthcare industry would have come to a stop, or at least a crawl.
Now that we have admitted that listening, talking and a certain amount of looking or observing can be done without being in the same room, it is time for us to be honest about the value of the physical exam.
Our medical education in universities and tertiary medical centers taught us how to handle complex and baffling cases that had eluded diagnosis in the primary care setting: Start from scratch, assume nothing. This is a method we need to use in select clinical situations.
But in everyday practice that is inefficient and unnecessary. Most of what we see is simple stuff and part of our job is to triage, to know when something seemingly ordinary is or has the potential to be more serious.
We need to know how to do a really good and relevant physical exam when the situation requires it. But we also need to know when that would add nothing and only waste our time and effort.Continue reading…