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THCB Gang Special: Episode 138, Thursday 30 November 2023 with Jen Goldsack

On #THCBGang today we have a special solo episode with Olympic rower for 2 countries and Digital Medicine Society CEO Jennifer Goldsack, (@GoldsackJen) joining Matthew Holt (@boltyboy). It’s at at 1pm PST 4pm EST on Thursday November 30. Find out about what DiME is and does, and what projects it is pushing forward in the future of health tech.

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

Health Innovation & Data: Five Common Missteps (and How to Interrupt Them)

By MARIE COPOULOS

I’ve had the great fortune of spending much of my career at the intersection of health care innovation and the underlying data that drives new models.

For those of us who’ve worked in this space for a long time, there’s a certain pattern recognition that comes with this work that is often immediate and obvious – both in terms of really cool developments but also gotchas. “Ah, you’re stumbling here. Everyone does that.”

The challenge, I’ve found, is that these ‘gotchas’ that can be so visible to the folx who’ve worked in health tech for the past few decades can be counterintuitive in the business and even met with resistance. Why?

I’m going to focus here on pattern recognition, with the goal of highlighting common stumbling blocks and, critically, ways you can interrupt them if you see them.

Pattern #1: Lacking a Clear-Eyed View of Market Data Gaps
Key Question: Do you understand how the market you’re in informs your ability to measure your work and use data to drive insight?

For those of you building models that change the status quo – this is for you. By nature these innovations break from existing care and financial models with the goal to improve them. We need this in health care. However, it’s common to overlook the fact that breaking with the status quo also breaks with the ways that we capture and serve up health data.

To this end, don’t assume you will be able to measure and show success, and that the data you need must be out there. The true differentiator is for both to align. Design with intention.

If you’re at the stage of thinking about a productized solution to a health care problem, then it is also the right time to look at the market with a lens toward data availability. In your problem space, what’s the data set you’re likely to lean on? Is it sufficient?

If the answer is that the data is not available or notoriously problematic in your market space for the problem you’re solving, this merits a pause. Can you find a way to survive in this reality? Can you create the data set you need? Can you adjust what you’re doing in some way to align with what is available? Is qualitative feedback ok?

Pattern #2: Accumulating Non-Technical Roadblocks Key Question: Do you have a good handle on the non-technical challenges impacting your data business?

A decade ago I would have approached this question differently. Technical challenges were often paramount as we tried to figure out how to solve the basics. Today, however, it’s often the opposite, in that business challenges are more likely to slow down technical progress than the other way around.

Continue reading…

Amazon Can Still Surprise Me

By KIM BELLARD

It’s Cyber Monday, and you’ve probably been shopping this weekend. In-stores sales on Black Friday rose 2.2% this year, whereas online sakes rose almost 8%, to $9.8b – over half of which was via mobile shopping. Cyber Monday, though, is expected to outpace Black Friday’s online shopping, with an estimated $12b, 5.4% higher than last year. 

Lest we forget, Amazon’s Prime Day is even bigger than either Cyber Monday or Black Friday.  

All that shopping means lots of deliveries, and here’s where I got a surprise: according to a Wall Street Journal analysis, Amazon is now the leading (private) delivery service. The analysis found that Amazon has already shipped some 4.8 billion packages door-to-door, and expects to finish the year with some 5.9bn. UPS is expected to have some 5.3bn, while FedEx is close to 3bn – and – unlike Amazon’s numbers — both include deliveries where the U.S. Postal Service actually does the “last mile delivery.” 

Just a few years ago, WSJ reminds us, the idea that Amazon would deliver the most packages was considered “fantastical” by its competitors. “In all likelihood, the primary deliverers of e-commerce shipments for the foreseeable future will be UPS, the U.S. Postal Service and FedEx,” the then-CEO of Fed Ex said at the time. That quote didn’t age well.

Amazon’s growth is attributed in part to its contractor delivery program, whose 200,000 drivers (usually) wear Amazon uniforms and drive Amazon-branded vehicles, although they don’t actually work for Amazon, and a pandemic-driven doubling of its logistics network. WSJ reports: “Amazon has moved to regionalize its logistics network to reduce how far packages travel across the U.S. in an effort to get products to customers faster and improve profitability.”

It worked.

But I shouldn’t be surprised. Amazon usually gets good at what it tries. Take cloud computing.  Amazon Web Services (AWS) in its early years was considered something of a capital sink, but now not only is by far the market leader, with 32% market share (versus Azure’s 22%) but also generates close to 70% of Amazon’s profits

Prime, Amazon’s subscription service, now has some 200 million subscribers worldwide, some 167 million are in the U.S. Seventy-one percent of Amazon shoppers are Prime members, and its fees account for over 50% of all U.S. paid retail membership fees (Costco trails at under 10%). There’s some self-selection involved, but Prime members spend about three times as much on Amazon as nonprime members.

The world’s biggest online retailer. The biggest U.S. delivery service. The world’s biggest cloud computing service. The world’s second largest subscription service (watch out Netflix!).  It’s “only” the fifth largest company in the world by market capitalization, but don’t bet against it. 

I must admit, I’ve been a bit of a skeptic when it comes to Amazon’s interest in healthcare. I first wrote about them almost ten years ago, and over those years Amazon has continued to put its feet further into healthcare’s muddy waters.

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How Patient Activation Made It Possible to Thrive with Kidney Disease

By DAVE WHITE

It had been 10 years since I’d seen a doctor when I arrived at the Emergency Room at George Washington University Hospital in October 2009. I was able to climb the first flight of stairs, but after I froze on the second, they brought me in on a wheelchair.

That was the first time I heard the dreaded words, “Your kidneys aren’t working.” I was put on dialysis immediately, and my life transformed into a series of tests and procedures. But even after three weeks at the hospital, it didn’t sink in that there was no cure.

I checked most risk factors for kidney disease: I ate the wrong foods, smoked more than a pack of cigarettes a day, drank too much beer, and didn’t exercise much. But the biggest risk to my health was not getting regular check-ups. I didn’t think I needed them, or that I had a part to play in my own health.

I hated going to dialysis three times a week. Since I could no longer work, the $20 cab fare each way was an expense my wife and I struggled to afford, so I skipped often. When a nurse warned me that if I missed three sessions in a row I would have to be dialyzed at the hospital, I decided this meant I could get away with one session a week.

The care plan I received from my providers called me “non-compliant” seven times. I felt they had written me off as a lost cause and saw no point in working with them either.

Finally, I was called into a meeting with six nurses, social workers, and clinic staff. When I said I skipped dialysis because money was tight, the charge nurse said, “We’re going to get you resources for transit and help you plan good meals.”

I was shocked – I didn’t know how support services worked. The nurse continued “But you have to do your part or you’re not going to be around much longer.”

No one had said this in such blunt terms before. I left the room, went home, looked at myself in the bathroom mirror, and said, “They’re right. You can do better. You have to do better.”

Fourteen years later, I am lucky to be alive to see the Centers for Medicare and Medicaid Services (CMS) include measures that place the patient’s voice at the center of clinical care. CMS has recognized that supporting patient activation, building a person’s knowledge, skills, and confidence around managing their health, and addressing social needs is critical to helping people like me get the support we need to get and stay healthy.

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Engage with Grace

Alex Drane started this movement in 2008 & named it Engage with Grace. What are your loved one’s wishes at the end of life? Are you with them this Thanksgiving weekend? This one slide can help you start the conversation

(We Don’t) Trust The Science

By KIM BELLARD

I know the A.I. community is eagerly waiting for me to weigh in on the Sam Altman/OpenAI dramedy (🙄), but I’m not convinced this isn’t all a ploy by ChatGPT, so I’m staying away from it.  A.I. may, indeed, be an existential issue for our age, but it’s one of many such issues that I fear we’re not, as a society, going to be equipped to handle.

Last week the Pew Research Center issued an alarming report Americans’ Trust in Scientists, Positive Views of Science Continue to Decline. Now, a glass half-full kind of person might look at it and say – no, it’s good news!  Fifty-seven percent of Americans agree science has a mostly positive impact on society, and 73% have a great deal or a fair amount in confidence in scientists to act in the public’s best interests.  For medical scientists it was 77%. Only the military (74%) also scored above 70%. That’s good news, right?

The glass half-empty person would point to the downward trend in just the past few years: at the beginning of the pandemic (April 2020) the respective percentages were 87% (scientists), 89% (Medical scientists), and 83% military.  The faith in them has continued to drop since.  Things are trending in the wrong direction, quickly.

If the glass was half full, it’s spilling now.

About a third (34%) of the public thinks that the impact of science on society has had an equally positive and negative impact, while 8% think science has had a mostly negative impact. Again, the trend has been negative since the pandemic; the 57% who think science has a positive impact was 73% in January 2019. That’s alarming.

The skepticism about scientists and the value of science has increased generally but is more pronounced among Republicans and those without a college degree.  E.g., only 61% of Republicans have a fair/great amount of confidence in scientists, versus 85% in April 2020 and versus 86% of Democrats now.  Fewer than half (47%) of Republicans think science has had a mostly positive impact on society, versus 70% on January 2019.

In the supposed most developed country in the world, 39% of Americans think the U.S. is losing ground in science achievement versus the rest of the world, and only 52% even agree it is important for the U.S. to be a world leader in scientific achievements.  10% didn’t think it was important at all. Young people, surprisingly, were most skeptical.

I wonder what they do think it is important for us to be the world leader in.

The problem may be that a third thought developments in science were changing society too quickly (43% among Republicans).  They want their new iPhones, they like fast internet speeds, they demand the latest treatments when they get sick, but somehow they don’t connect those to science.

I think about this when I read about the Texas board of education fighting about how science is taught in Texas schools.

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TOMORROW: ZS Impact Webinar on Digital Health

Join ZS’s Ahmed Albaiti with me, Matthew Holt, author and founder of The Health Care Blog, as we discuss the considerations and approaches that policy experts, regulators, clinical leaders and the venture capitalist community can take to affect a future for connected health technologies.

Date: Wednesday, November 22, 2023

Time: 12:00 PM Eastern Standard Time

Duration: 30 minutes

Register here

Orange, Green, and Red – The Colors of Tribalism

BY MIKE MAGEE

As Thanksgiving Day approaches, let’s give thanks for the study of history, in part because it reminds us that Trumpian words like “vermin” have been used before and serve to alert the human race that we have entered danger zone

One President who understood the power of words more than many others was FDR. When he structured up “a series of programs, public work projects, financial reforms and regulations…to provide support for farmers, the unemployed, youth and the elderly”, he memorably packaged the plan under the label, The New Deal.”

Seizing alliteration in 1933, he further defined his new policies as the 3 Rs – Relief, Recovery, Reform”, promising “…action, and action now.”

When his enemies began to coalesce against him in 1936, he chose his words carefully in the public defense. Seizing the largest venue he could find at the time –Madison Square Garden – he stood tall and erect, supported by heavy leg braces, and declared defiantly, They are unanimous in their hate for me – and I welcome their hatred.”

With a heavy dose of humility and learned wisdom, he rose again eight years later, on January 11, 1944, fifteen months before his death, and delivered the State of the Union Address as a Fireside Chat from the Oval Office in the White House. 

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Paul Jaglowski, Feedtrail

Feedtrail is one of a new breed of customer experience companies. Most health care experiences are captured in paper surveys that end up in H-CAPS and Star ratings. These are very important for how providers and plans get paid but probably don’t actually reflect what happens very well and give very poor feedback to organizations and staff about what’s actually going on. They also don’t give a chance for patients to directly give positive feedback to staff who do a great job–which likely helps them feel good about their work. Feedtrail is working to fix all that. I got a full demo and explanation from founding CEO and chief strategy officer Paul Jaglowski–Matthew Holt