By KIM BELLARD
Not familiar with Schumpeter’s gale? You may be more familiar with the term “creative destruction.” Schumpeter’s “gale of creative destruction” is the inevitable “process of industrial mutation that continuously revolutionizes the economic structure from within, incessantly destroying the old one, incessantly creating a new one.”
We need a Schumpeter’s gale in healthcare.
Continue reading…This is the last THCB Gang of what has been a long, grueling, but enthralling year. And every week (well almost every week) we have had a group from across the health care luminescence to discuss it.
Joining Matthew Holt (@boltyboy) on #THCBGang at 1pm PT 4pm ET Thursday for an hour of topical and sometime combative conversation on what’s happening in health care and beyond will be THCB regular writer Kim Bellard (@kimbbellard); delivery & tech expert Vince Kuraitis (@VinceKuraitis); privacy expert and entrepreneur Deven McGraw (@HealthPrivacy); WTF Health host & Health IT girl Jessica DaMassa (@jessdamassa); and three occasional gang members making very welcome appearances–venture investor & soccer mogul Marcus Whitney (@marcuswhitney); surgeon & startup guy Raj Aggarwal (@docaggarwal); and health economist Jane Sarasohn-Kahn (@healthythinker).
And towards the end of the show we should have our now traditional (or 2nd time) visit from as many other gang members who can make it!
The video will be below but if you’d rather listen to the episode, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.
By IAN MORRISON
I have been studying American healthcare for more than 40 years and I have assembled a large number of one-liners over the years. As we enter 2022, I thought I’d share my 22 oldest jokes and why they still matter.
Coming to America
Gun violence continues to ravage the United States. We have more guns than people. Kids get gunned down in school playgrounds and classrooms routinely. It happened once in Dunblane, Scotland in 1996 when a local shopkeeper walked into Dunblane Primary School and opened fire, killing 16 5- and 6-year-olds and their 45-year-old teacher. It so galvanized public opinion, according to Smithsonian Magazine: “By the end of 1997, Parliament had banned private ownership of most handguns, including a semi-automatic weapons ban and required mandatory registration for shotgun owners”.
Last time I looked, gun violence was the second leading cause of death in children in the US. In America when we have mass shootings all we get are thoughts and prayers.
And when it comes to healthcare as a right, even if we Build Back Better, it won’t be a right for millions of American residents, especially those who are undocumented.
This is one of my oldest jokes and it remains true. In Silicon Valley, where I live, my affluent VC friends want to live forever and are working out and taking supplements to achieve that. In contrast, my British friend Dr. Richard Smith (former Editor of the BMJ) is sitting on the Lancet Commission on the Value of Death. Enough said.
Continue reading…By KIM BELLARD
I recently watched some of the recent Congressional hearings on cryptocurrency, and, boy, if there’s anything funnier than watching experts try to educate most members of Congress on anything crypto-related, it’s probably me trying to explain it. I don’t own any digital assets, still don’t see the point of NFTs, and am not going to buy any real estate in the metaverse.
All that being said, there’s something about Web3 that fascinates me. Knowledgeable people are talking about Web3 “reinventing the internet,” “democratizing” it, giving people more ownership of/control over what they do on it. It’s a counterbalance to how the internet – both the traffic and the infrastructure — has grown increasingly dominated by a few very large firms, such as Google, Facebook, or Amazon.
As the Web3 Foundation declares, Web3 is an internet where:
All that sounds very intriguing to me, especially as someone who has dim views of how healthcare likes to silo information, has placed too little value on patient ownership of their own data, and is rushing to centralize.
Continue reading…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
For my health care tidbits this week, it’s time to bring up the disconnect between the continual collapse of #DigitalHealth stock prices and the continued increase in private sector investment and valuation in the same sector.
All of nine months ago, way way back in March 2021 market leader Teladoc hit a stock price of $308. Last week it hit a low of just under $90. Meanwhile several companies have IPOed or SPACed this year and almost all of them have seen their stock fall dramatically. For example, pioneer online mental health company Talkspace is now at a market cap of under $300m. This week a different mental health company Cerebral which was only founded in January 2020 raised $300m at a private valuation of over $4 billion. Yes they could have bought out Talkspace for that amount! In October Medicare Advantage plan Devoted Health raised money at a $12 billion valuation which exceeded the market cap of rivals Clover, Bright Health and Oscar–each of which has more members.
So what’s going on? Part of this is the wash of money still going into venture funds. Interest rates are historically low, while inflation is picking up, so that money has to go somewhere. Additionally some of the companies that SPACed out were probably unable to get such a good valuation in a private round. But it can’t be that all the 50 or so public companies are lower quality than the private ones. That indicates that either the private valuations aren’t real (because there are so many protections built into the deal for investors), or that the private and public valuations are going to get closer together. There is of course one more possibility–some of the private companies may pursue M&A and buy out some of the public ones. But in any event, this current arbitrage cannot last forever.
It’s not unlikely the public stocks may pick up. But we’ve seen private and public market bubbles before and the aftermath isn’t usually pretty.
By MIKE MAGEE
Warner Vincent Slack, MD, a pioneer of medical informatics, was a Professor of Medicine at Harvard Medical School in the Division of Clinical Informatics. When he died in 2018 at age 85, his memoriam read:
“For over 50 years, Dr. Slack conducted pioneering research on the use of computers in the medical world and was one of the founders of medical informatics. His goal was to empower both doctors and patients by improving the communication between them.”
Followers of Dr. Slack have labored hard over the past half-century to design solutions that will strengthen rather than weaken the bonds of the patient-physician relationship. But as he suggested at multiple points throughout his career, this goal becomes exponentially more difficult if politicians are allowed to “play doctor” with citizens’ lives.
His awareness of the fallout of the Terri Schiavo “right to die” case, beginning a dozen years after his seminal publication of “Patient Power: A Patient Oriented Value System”, likely cast a long shadow on his optimistic vision. The case spanned 15 years, as it rode the poor health and disability of one unfortunate woman literally into her grave with devastating consequences for all concerned.
As the Supreme Court readies itself to serve up opinions in the Texas vigilante and Mississippi abortion cases, the Schiavo case remains a cautionary tale that deserves a careful review. Here’s a quick summary:
Today in Health in 2 Point 00, Jess and I talk about the plethora of notable deals in the Healthcare Space. Bright Health gets $750 million with notable investment from Cigna; Innovaccer gets $150 million, bringing their total up to $375 million; Cadence gets $100 million, bringing their total up to $141 million; Ophelia raises $50 million, bringing their total up to $64 million; and Apti Health raises $50 million, bringing their total up to $65 million.
-Matthew Holt
Joining Matthew Holt (@boltyboy) for an hour of topical and sometime combative conversation on what’s happening in health care and beyond were — medical historian Mike Magee (@drmikemagee); futurist Jeff Goldsmith; fierce patient activist Casey Quinlan (@MightyCasey); and policy consultant/author Rosemarie Day (@Rosemarie_Day1).
Plenty of talk about voting rights, the future of American “democracy” and much more, and we did get back to health care eventually. A great & fun, while important, conversation!
You can see the video below where it’s kept for posterity. If you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels
BY JESSICA DaMASSA, WTF HEALTH
Health tech infrastructure startup, Innovaccer, announced its $150M Series E and newly assigned $3.2B valuation today, and I’ve got CEO Abhinav Shashank with the essential intelligence on how this company is pursuing health IT’s holy grail: the single patient health record.
This is a story of cloud technology’s uptake in healthcare, which has lagged behind other sectors like banking and retail in terms of industry-wide adoption. Abhinav tells us that the “economic incentives” are finally aligned for cloud to really take-off in healthcare, as the technology will be critical to any models where care is longitudinal instead of transactional and a singular view of a patient’s clinical data, labs, scans, and claims will be essential to healthcare organizations taking on more risk.
So what, exactly, does Innovaccer do? What’s the work, and how do they get paid? Who has access to the data they’re landing in the “Innovaccer Health Cloud”? Will patients one-day be able to access this single record themselves? And, what stops Epic or Cerner from just doing this and owning the space outright? No detail left unexplored in this one and – for the benefit of those of us who are not very plugged into the IT underpinnings of the EHR – Abhinav breaks it all down for us in a way that even us non-techie health tech market watchers can understand!
By KIM BELLARD
I’ve finally come to understand why the U.S. healthcare system continues to be such a mess, and I have President Dwight Eisenhower to thank.
I’ve been paying close attention to our healthcare system for, I hate to admit, over forty years now. It has been a source of constant frustration and amazement that – year after year, crisis after crisis – our healthcare system doesn’t get “fixed.” Yes, we make some improvements, like ACA, but mostly it continues to muddle along.
Then I learned about President Eisenhower’s approach to problems:
That’s it! All these smart people, all these years; they didn’t know how to solve the problem that is our healthcare system, so they all took the Eisenhower approach: enlarge the problem. Let our healthcare system get so bad that not addressing it no longer is possible.
If, indeed, there is such a point.
The actual Eisenhower quote is more nuanced than the above version. It was:
Whenever I run into a problem I can’t solve, I always make it bigger. I can never solve it by trying to make it smaller, but if I make it big enough, I can begin to see the outlines of a solution.
I guess we’re not yet at the point when the outlines of a solution are clear (Bernie Sanders notwithstanding).
Instead, we’ve been chipping away at the problem, trying to make it smaller. For example:
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