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Health Care You Do Not See

By KIM BELLARD

Within a mile from my home in one direction, there are two pharmacies and a primary care office.  In another direction, there’s a multi-specialty physician practice, complete with lab and pharmacy.  And in a third direction, an urgent care center.  Widen the circle another mile, and there are more physician offices, a plethora of other health care professionals, another urgent care, a retail clinic, and an imaging center.  Add a couple more miles and hospitals – plural – to start show up.

I’m not sure that’s a good thing.

Admittedly, not everyone has so many options.  If you live in a rural area or a disadvantaged neighborhood, there may not be so many choices.  Chances are, though, even in those places, whenever you find retail activity, some portion of it is probably healthcare-related.

Retail clinics helped blur the lines between retail and healthcare, and early moves by retail giants like Walmart or Kroger to incorporate first pharmacy, then primary care, into their stores made getting care easier for millions.  All in all, probably a good thing.

Still, though, you know when you’ve gone from shopping for home goods or groceries to getting your healthcare.  You know because there’s more waiting.  You know because there are more forms to fill out.  You know because you don’t know what will happen to you. 

And you definitely know when you are getting health care services.  You get an injection, you take a pill, you have an image taken, your body is invaded by a tube or a scalpel.  That’s why we go, isn’t it?  We go because we fear something may be wrong and we want someone to do something about it.  Advising us to make lifestyle changes is all well and good, although usually not effective; we want some concrete treatment.

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Behind-the-Scenes Look at New Multidisciplinary Healthcare Conference LIFEITSELF

By JESSICA DaMASSA, WTF HEALTH

From Bill Gates to Goldie Hawn, Dr. Fauci and Rochelle Walensky to Astronaut Scott Kelly, and magician Penn Jillette to digital health’s own Dr. Daniel Kraft, new conference LIFE ITSELF (Sept 28-Oct 1) promises an eclectic mix of big thinkers from across tech, business, government, entertainment, and healthcare and a truly unique look at 10 big topics shaping the future of health and wellness.

Created, curated and co-hosted by Marc Hodosh (former owner and creator of TEDMED) and CNN’s chief medical correspondent, Dr. Sanjay Gupta, the four-day discussion is intended to be a mind-expanding, multidisciplinary discourse on healthcare topics that range from cost of care to human longevity. We’ve got Marc here to dish about the agenda as it’s being developed, and we’re lucky he’s willing to share a little bit about some of the surprises he and his team have planned.

Quick word to the wise if you’re interested in attending this one: check it out quick and register ASAP. The event is designed to be intimate to facilitate mixing-and-mingling among speakers and attendees within the iconic Hotel del Coronado and that means space is limited. Tune in to hear more and check out all the details at www.lifeitself.health.

“This Doesn’t Usually Hurt that Much”: Patients With Fibromyalgia Spectrum Disorder

By HANS DUVEFELT

Specialists in orthopedics and general surgery often want us, the primary care doctors, to manage postoperative pain. I don’t like that.

First, I don’t know as much as the surgeons about the typical, expected recovery from their procedures. My own appendectomy in Sweden in 1972 was an open one that I stayed in the hospital for several days for (and nobody mentioned that there were such things as pain medications). I’m sure a laparoscopic one leaves you in less pain, but I don’t personally know by how much.

Postoperative pain could be an indicator of complications. Why would a surgeon not want to be the one to know that their patient is in more pain than they were expecting?

Pain that lingers beyond the postoperative or post-injury period is more up to us to manage. I accept my role in managing that, once I know that there is no complication.

I have many patients who hurt more that most people every time they have an injury, a minor procedure or a symptom like leg swelling, arthritis flare or toothache. The common view is that those people are drug seekers, taking every chance to ask for opiates.

I believe that is sometimes the case, but it isn’t that simple. I believe that people have different experiences with pain. We all know about fibromyalgia patients or those with opioid induced hyperalgesia, but pain is not a binary phenomenon. Like blood glucose, from hypoglycemia, through normoglycemia to prediabetes and all the degrees of diabetic control, pain experience falls on a scale from less than others to more than others.

I reject the notion that pain is a vital sign. When I was Medical Director in Bucksport I discouraged the use of numeric pain ratings. But I did encourage talking about the experience of pain as a subjective, nuanced and very valid consideration. We started a comprehensive pain education module for all our chronic pain patients.

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One Drop’s Minimally-Invasive Biosensor Is Coming (!) & It Nestles Into an Expansive Data Platform

By JESSICA DaMASSA, WTF HEALTH

There’s been a steady drip of announcements coming out of One Drop in recent months about their data capabilities (28 billion biometric data points to be exact), the predictive power of their platform (remember blood glucose predictions and blood pressure insights) and NOW a partnership deal with top-of-the-line smart device manufacturer, Withings. What is this all adding up to? How about some HUGE NEWS?! Rachel Yap Martens, One Drop’s SVP of Commercial Strategy, stops by with a big reveal about the cohesive strategy behind these moves, and how they are all leading to One Drop’s launch of a first-of-its-kind, minimally invasive BIOSENSOR that will bring “continuous health sensing” to the market in the next year or so.

Health tech die-hards will remember One Drop’s acquisition of Sano Intelligence’s sensor technology in April 2020, but that was only the beginning. That sensor tech has been evolved, adapted, and refined, and works by detecting analytes in the body’s interstitial fluid, which – if you look it up – holds important things like glucose, salt, fatty acids, calcium, potassium, magnesium and more. Jump ahead to the 15-minute mark in this interview if all you want to hear about is this, BUT word to the wise: the really compelling part of the sensor is how it will plug right into all the other biometric data collection points in the One Drop ecosystem. Says Rachel, the goal is to help One Drop members “to know what is happening with their bodies right now, to know what is going to happen to their bodies next, and to know how to take action.” Exciting interview!!

#Healthin2Point00, Episode 226 | DomaniRx, Connections Health Solutions, Veda, and Connie Health

Today on Health in 2 Point 00, we have more deals for you! First up, DomaniRx: Anthem, Humana, and a software company SS&C are teaming up to launch a PBM. Connections Health Solutions raises $30 million working on comprehensive behavioral health care, and Veda Data Solutions raises $45 million, bringing their total to $52.2 million, applying AI to provider data. Finally, Medicare navigation platform Connie Health raises $13 million, bringing their total to $16 million. —Matthew Holt

THCB Spotlights: Shahram Seyedin-Noor, GP of Civilization Ventures

Today, Matthew is back with another THCB Spotlight, this time with Shahram Seyedin-Noor, GP of Civilization Ventures. In this interview, Shahram tells us about how he got into venture and what he was doing before that, as well as his thinking around the focus of Civilization Ventures in catering to a new type of life science entrepreneur.

The Rise of the Health Coach: YourCoach.Health on Market Opportunity Between Healthcare & Wellness

By JESSICA DaMASSA, WTF HEALTH

According to the team at YourCoach.Health, health coaching is “the ‘glue’ that’s connecting the $4-trillion wellness economy with the $8-trillion healthcare economy.” And by learning about the growing number of nearly 2,000 health coaches who are engaged in their practice management solution – and the small and mid-sized employers who want to tap into it to provide health coaching to their workforces – its seems like they might be right.

YourCoach’s CEO Marina Borukhovich and COO Eugene Borukhovich walk through the work they are doing to build a platform that both helps health coaches do their jobs better AND find clients within the SMB health benefits market. While “coaching” might often get wrapped around everything from remote monitoring devices and digital therapeutics to care plans for chronic conditions and long-term illnesses, “health coaching” as a credentialed discipline is different.

Marina and Eugene de-mystify the terminology for us, along with the certifications required to be a health coach, the current reimbursement climate for the health service, and where they think the discipline is headed as demand for “human-led, compassion-driven” healthcare booms among both healthcare consumers AND practitioners. A couple little scoops in this one too as we learn about some soon-to-be-released tech features on their platform AND the seed-funded startup’s plans to raise a Series A.

Let’s Meet in the Metaverse

By KIM BELLARD

I really wasn’t expecting to write about the Metaverse again so soon, after discussing it in the context of Roblox last March, which itself followed a look at Epic Games CEO Tim Sweeney’s vision for the Metaverse last August.  But darn that Mark Zuckerberg!

Not many noticed when Mr. Zuckerberg told Facebook employees in June that the company would become focused on building a metaverse, but he got some attention when he expanded on his vision for The Verge in late July.  Then last Monday Andrew Bosworth, Facebook’s head of AR/VR, confirmed a product group had been formed to bring it about.  And, finally, in an earnings call last Wednesday, Mr. Zuckerberg and his executive team couldn’t stop gushing about the importance of the metaverse to the company, and the world.

So, yeah, the metaverse is in the news.  And, once again, I worry healthcare is going to be late to the party. 

I won’t go into too much detail about what the metaverse is; for those who want a deep dive, there’s Matthew Ball’s nine part primer, or you could just read Ready Player One.  Mr. Zuckerberg described it to The Verge as follows: “you can think about the metaverse as an embodied internet, where instead of just viewing content — you are in it.”  In the earnings call, he clarified: “The defining quality of the metaverse is presence – which is this feeling that you’re really there with another person or in another place.” 

Depending on your age/preferences, the concept of “an embodied internet” is either chilling or thrilling.  Maybe both.   

It’s potentially a big deal.  Gene Marks, writing in Forbes, says, “business interactions will forever change.”  The Conversation’s Beth Daley goes further, stating “creating a virtual world for users to interact with their friends and family is not just a fancy vision, it is a commercial necessity.”

It’s not VR, it’s not AR, it’s not 3D internet, although all those may be part of it.  It’s not gaming, it’s not entertainment, it’s not social network, although all of those will be part of it too.  Mr. Zuckerberg promises: “It’s going to be accessible across all of our different computing platforms; VR and AR, but also PC, and also mobile devices and game consoles.”  Not to overstate it, but he sees the Metaverse as the “next generation of the internet.”  Mr. Zuckerberg also described it as “the next computing platform.”

He is openly telling people that the goal is for Facebook to transition to a metaverse company, “within the next five years or so.”  Analysts on the earnings call pressed Facebook to confirm an estimate of a $5b investment, but only got an admission that, yes, the investment was “billions.”

Significantly, for Facebook, Mr. Zuckerberg believes: “this is going to be not something that one company builds alone, but I think it is going to be a whole ecosystem that needs to develop.”   As Mr. Zuckerberg said in The Verge interview, “Hopefully in the future, asking if a company is building a metaverse will sound as ridiculous as asking a company how their internet is going.”

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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?

We are less and less valued for our ability – by virtue of our education and experience – to take general principles and apply them to individual people or cases that aren’t quite like the research populations behind the data and the guidelines. The cultural climate in healthcare today is that conformity equals quality and thinking out of the box is not appreciated. The heavy-handed mandates imposed on our history taking and screening constantly risk eroding our patients’ trust in us as their confidants and advocates. The finesse and sensitivity of the wise old fashioned family doctor is gradually being squeezed out of existence.

The call to primary care medicine, if it isn’t going to pave the road straight to professional burnout, today needs to be a bit like the call to be a missionary doctor somewhere far away:

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Digital Health Investor Larry Leisure’s Picks for the Next Hot Areas for Healthcare VC Investment

By JESSICA DaMASSA, WTF HEALTH

Digital health continues to gain a lot of attention from investors, so we’ve checked in with one to get some perspective on what’s hot (and what’s not) midway through the sector’s largest funding year yet. Larry Leisure, of Chicago Pacific Founders (whose enterprise health benefits company, Jiff, was acquired by Castlight Health) weighs in on the exuberance investors are showing for the health innovation space and whether or not it will last.

Are valuations and funding rounds a little overblown? Are investors concerned about some of the recent complaints of ‘digital health fatigue’ that employers and health plans are starting to vocalize as they wade through an expanding portfolio of point solutions? Larry brings us in on some of the closed-door conversations he’s had with payers and employers about the health tech startup scene, and how their thinking is starting to shift his own ideas about where to place his bets next. Healthcare navigators…care-plus-behavior-change platforms…underserved markets…the digital front door…the end of the per-member-per-month business model and SO MUCH MORE. Love getting a high-level look at the field of play!

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