#Healthin2Point00, Episode 175 | Haven, Color, RapidSOS & more

Today on Health in 2 Point 00, Jess and I chat about Haven finally closing its doors. On Episode 175, we cover Color raising $167 million growing fast as the major COVID tester in the Bay Area and 23andMe scoring $82.5 million. RapidSOS quietly raised another $51.2 million on New Year’s Eve, Fruit Street Health raises $22 million for chronic condition management, and finally Centene acquires Magellan for $2.2 billion. —Matthew Holt

No Safe Haven to be Found!

By MIKE MAGEE

Can you wrestle a collusive, private, profiteering Medical-Industrial Complex to the ground by throwing more private entrepreneurs at it? Apparently not.

The very public collapse of Haven – the widely heralded health joint venture of Amazon, Berkshire Hathaway, and JP Morgan Chase – is a case in point. After three years, it is unclear whether they were a public-spirited triad trying to bathe efficiency into our bizarre employer-based health insurance scheme, or becoming predatory investors in one of the most profitable segments of our national economy.

When launched nameless in January, 2018, most of the focus was on the three amigos – Warren Buffett, Jamie Dimon, and Jeff Bezos. The linking of hands of the nation’s biggest technology power player, her most revered and respected investor, and her highest ranked financial all star, was impossible to ignore.

What were they up to? No one was quite sure. But there was enough concern about disruption of a sector controlling nearly 1/5 of the American economy that prices of CVS Health, Walmart, Cardinal Health and Express Scripts dove south.

This week, with the announcement of the non-profit joint venture’s collapse, analysts wasted no time piling on. As one said, “Haven had a rocky three years, running up against vague marching orders, a lack of direction, and obstacles inherent to the healthcare landscape.”

But it didn’t start that way. Warren Buffett presented health care that day as “a hungry tapeworm on the American economy.” Jamie Dimon noted that we pay twice as much for poorer quality care than other developed nations. And Jeff Bezos suggested that it was time for PBM’s and insurers to trim their sails.

By the summer of 2018, the three signaled they were seriousby hiring widely acclaimed health leader, Atul Gawande, as their CEO. As Buffett said, “Jamie, Jeff, and I are confident that we have found in Atul the leader who will get this important job done.” It would be another nine months before they could settle on a name for the venture – Haven (as in safe haven for their 1.3 million combined employees).

CNN Business reporter Tami Luhby laid out the stakes at the time. “The expectations are enormous: Gawande has been given a lot of latitude, a lot of time — and most importantly, a lot of money — to curb the ‘hungry tapeworm on the American economy’…”

Gawande had many adoring admirers. Niall Brennan, chief executive of the Health Care Cost Institute, at the time stated, “The cynic in me … wonders if anybody can make a difference. The optimist in me would say that if anybody can make a difference, it’s probably Atul…He’s a god-like rockstar in health care…an incredible visionary thinker and clinician with also a track record of innovation.”

But the plan was fuzzy from the start. Gawande stated with a broad sweep, “The good news is the best results are not the most complicated or expensive. The right care in the right place is often more effective and less costly than what we get today.”

That didn’t threaten the Medical-Industrial Complex much. They’d heard it all before. But his June, 2019 speech at the Aspen Institutewas somewhat alarming. He said, “I think the only way we go is by having us collectively paying into a system that no matter where you’re employed, you have coverage all along the way, and that’s what I think people mean by single-payer. It’s the necessary way to go.”

Gawande set about assembling a first rate executive team, eventually amassing 57 employees in Boston to run the non-profit venture. But when his highly respected chief operating officer, Jack Stoddard, formerly the lead at United Healthcare’s Optum, up and left after only 8 months without explanation, analysts began to ask questions.

Investors became skittish. Some noted that Gawande was splitting his time – still writing for the New Yorker and working as a Harvard based surgeon. Others pointed to an absence of organizational cohesiveness. All three partners were also pursuing independent ventures in the health care space, and were continually running into proprietary roadblocks.

Amazon, in particular, had its own agenda. Their wearable health tracker, Amazon Halo, augmented by Alexa features, was now joined by virtual and in-person Amazon Care clinics for its own employees. Those employees have access to premium priced prescription drugs after the company purchased PillPack for $753 million in June, 2018.

Other analysts noted a lack of momentum. The first market forays – like their new no-deductible insurance policy – was slow to come and not overwhelmingly embraced by the 30,000 JP Morgan employees. There were also rumors that Amazon in particular was about to pull its financial support.

In May, 2020, Dr. Gawande announced his own exit, partially under the cover of more active reporting and commentary necessitated by the growing pandemic. Ultimately, he agreed to serve on President-elect Biden’s coronavirus advisory board.

On January 3, 2021, came the announcement that Haven would cease to exist next month. As one analyst put it, this “is a reminder that the U.S. healthcare sector is incredibly resistant to makeovers…”

And yet, it is useful to ask why none of the Triad seem to have regrets.

Jamie Dimon said, “Haven worked best as an incubator of ideas, a place to pilot, test and learn—and a way to share best practices across our companies. Our learnings have been invaluable.”

Warren Buffett said previously, that this was a “a first step in what is bound to be a long journey.“

And a Bezos spokesperson noted, “The venture’s backers found Haven was a good venue to test new ideas and best practices that could be better implemented individually.”

TIME correspondent Karl Vick, in an article titled “What Happens When Amazon Takes on Health Care”, in February, 2018, wrote:  “The U.S. health care system is the antithesis of Silicon Valley.”

But is it really? Are these three really any different than all the other collusive members of the Medical-Industrial Complex? Or are they simply entrepreneurs seeing a unique business opportunity?

There is a reason why all other developed nations maintain public regulatory oversight and control of their national health care systems. It is because they learned long ago that there is no “safe haven” when it comes to ceding control of health delivery oversight to profiteers.

Mike Magee, MD is a Medical Historian and Health Economist and author of “Code Blue: Inside the Medical Industrial Complex.“

Health Care: Don’t Be Evil

By KIM BELLARD

Google’s corporate motto – written in its original Code of Conduct — was once “Don’t be evil.”  That softened over time; Alphabet changed it to “Do the right thing” in 2015, although Google itself retained the slogan until early 2018.  Some Alphabet employees think Google/Alphabet has drifted too far away from its original aims: they’ve formed a union in order to try to steer the company back to its more idealistic roots.

Parul Koul and Chewy Shaw, two Alphabet software engineers, announced the Alphabet Workers Union in a New York Times op-ed, vowing to live by the original motto, and to do what they can to ensure that Alphabet and its various companies do as well.  They assert: “We want Alphabet to be a company where workers have a meaningful say in decisions that affect us and the societies we live in.”

It’s past time that health care workers, including physicians and executives, stood up for the same thing.

Ms. Koul and Mr. Shaw cite several grievances, including payouts to executives accused of sexual harassment, the firing of a leading AI expert over her efforts to address bias in AI, and company efforts to “keep workers from speaking on sensitive and publicly important topics.”  Doing the work, even doing it well and being well paid for it, is not enough:

We care deeply about what we build and what it’s used for. We are responsible for the technology we bring into the world. And we recognize that its implications reach far beyond the walls of Alphabet.

Their goal is for Alphabet “to be a company where workers have a meaningful say in decisions that affect us and the societies we live in.”  Alphabet, they say, “has a responsibility to prioritize the public good. It has a responsibility to its thousands of workers and billions of users to make the world a better place.” 

Investors may not quite agree.

In an AWU statement, Nicki Anselmo, Program Manager, explained: “This union builds upon years of courageous organizing by Google workers…Our new union provides a sustainable structure to ensure that our shared values as Alphabet employees are respected even after the headlines fade.”

Google’s official response, released by Kara Silverstein, Google’s director of people operations, was predictably bland:

We’ve always worked hard to create a supportive and rewarding workplace for our workforce.  Of course our employees have protected labor rights that we support. But as we’ve always done, we’ll continue engaging directly with all our employees.

So far, slightly over 200 Alphabet employees have signed on, out of some 120,000 employees (and roughly the same number of contractors or temps).  AWU is part of the Communication Workers of America (CWA) but has not had an employee election or ratification from the National Labor Relations Board, and so won’t have collective bargaining rights. 

Veena Dubal, law professor at the University of California, told NYT:

If it grows — which Google will do everything they can to prevent — it could have huge impacts not just for the workers but for the broader issues that we are all thinking about in terms of tech power in society,

I won’t try to predict how successful AWU will be, either in terms of building its membership or influencing Alphabet’s priorities, but I admire the goals.  But if there is an industry in which its employees need to speak up about their organizations’ need to prioritize the public good, it is health care.

Right now, of course, we have healthcare workers putting themselves at risk fighting the pandemic, putting their own health and lives at risk.  It’s admirable, it’s heroic, and it must be commended.  But those efforts can’t mask actions that those same organizations are taking or allowing that aren’t so noble.

In no particular order:

  • Even, or because, COVID-19 vaccines are scarce, we’re already seeing reports about rich or influential people “cutting in line” to get their vaccine early;
  • We want people to get COVID tests, and they’re supposed to be free, but some health care organizations have found ways to include “surprise bills” for them;
  • We’ve seen health care workers silenced, fired or forced to resign for speaking out about poor working conditions or lack of personal protective equipment (PPE) during the pandemic;
  • Health care workers have had to walk off the job over wage and labor condition disputes during the pandemic;
  • We still have hospitals suing patients for unpaid bills, even after promises not to during the pandemic;
  • As bad as the racial disparities are in our health care system normally, they’re even worse with COVID-19, and may further worsen with the vaccine rollout;
  • There are profound gender wage disparities among healthcare workers, and they may be getting worse;
  • While pharma is getting plaudits for its rapid response to develop COVID-19 vaccines, it is also busy further raising prices;
  • Already wealthy, nominally non-profit hospitals are raking in billions of disaster relief funds;
  • Health insurers have done exceedingly well financially during the pandemic.

“Don’t be evil” would seem to apply.

What we need are the health care front line workers and leaders who will stand up and say, this is not good for our patients.  This is not good for our society.  This is when the needs or goals of our organization do not take precedence over the public good.

There are unions in healthcare already, even for physicians, but as a percent of all healthcare workers they have made about as many inroads as AWU has at Alphabet, and over a much longer period of time.  I have mixed feeling about unions generally; while they brought workers many important protections and benefits, they’ve often fallen ended up being more about workers’ insular interests than about broader social priorities.  But sometimes organizing is necessary.

Every health care organization should be, to quote Ms. Koul and Mr. Shaw about their goals for Alphabet, “a company where workers have a meaningful say in decisions that affect us and the societies we live in,” and which “has a responsibility to prioritize the public good.” 

If that is not true of your healthcare organization, if your healthcare organization isn’t committed to “don’t be evil,” then what are you prepared to do about it?

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor.

Olive CEO Sean Lane on 2020’s Big Numbers: 3 Funding Rounds, $450M, & a 5-Point Plan for the Future

By JESSICA DaMASSA, WTF HEALTH

Arguably 2020’s hottest health tech startup, Olive (olive.ai) closed THREE funding rounds this year, totaling $450M and valuing the company at $1.5B. Backed by a “who’s who” of technology, healthcare, and health tech venture capital, Sean Lane, CEO, clues us in about just what makes Olive so damn fund-able. The company boasts a “healthcare AI workforce” that tackles all the back-office processes hospitals use to run their organizations. This is not sexy stuff — filing and tracking insurance claims, ordering inventory, managing suppliers, etc. What’s hot, though, is how Olive is able to automate these tasks (according to Sean, currently many of these processes are handled by spreadsheets and faxes), “learn” as she’s doing it, and create efficiencies and cost savings across all of Olive’s 600+ hospital client-base as she does. Could this be the end of “admin expense” in healthcare? If what Olive is currently doing isn’t enough, we dive deep into Olive’s strategic plan — ALL FIVE POINTS OF IT (!) — to learn what’s next. My favorite? Number 3. The one where Olive starts to INSTANT PAY CLAIMS to completely disrupt hospital cash flow.

#Healthin2Point00, Episode 174 | Cityblock, Elation, Modern Health, LeanTaaS & Well

Today on Health in 2 Point 00, Jess has me weigh in on Cityblock Health’s big raise of $160 million bringing their total up to 300 million to improve health for low-income patients. On Episode 174, Elation, which is Cityblock’s EMR as well as that for some other independent primary care clinics, raises $40 million and working their way into a tough market. Modern Health raises $50 million for the “fourth” pillar of care, providing another mental health platform. LeanTaaS raises $130 million, providing a digital front end for hospitals and smooth out patient access, in contrast to companies like Olive working on the backend. Finally, Well gets $40 million in a Series A using AI and behavioral economics to provide health information and coaching. —Matthew Holt

The Pathway to Health Leads Through Clean Energy Technology

By MIKE MAGEE

Health reporting this week is rightly dominated by the challenging worldwide distribution of the Pfizer vaccine for Covid-19. Bringing the virus to bay is job #1, not only to preserve human life but also our global economy. But this week, on the 5th anniversary of the Paris Agreement, we are reminded that our long term human health, including clean air and water, mitigation of weather-related human disasters, and regulations that lessen our chronic burden of disease, depend as much on energy policy as they do health policy.

Nowhere is this more evident (though largely hidden from sight) than in our planet’s positioning to address global warming. The Paris Agreement, the climate accord signed by 195 nations, was abuptly dismantled by Trump four years ago. But President-elect Biden has signaled that his first order on January 20, 2021, will be to rejoin the agreement.

As Trump patronized his fossil fuel funders, and promised that “we’re going to have clean coal and we’re going to have plenty of it,” the oil and gas industry wrote down the value of its assets $170 billion in the first 6 months of 2020.

Acknowledging as much this past week, a cabal of energy investors, with combined assets of $9 trillion, signaled a shift in their strategy with a pledge to harmonize their investments with net-zero carbon emissions by 2050.

Those investors haven’t suddenly “discovered religion.” No. They’re looking at the numbers.

Clean energy options like solar and wind, combined with the latest battery technology, are now 79% cheaper to produce than US coal production. Investors realize that 90% of the new energy capacity generated worldwide in 2020, as reported by the International Energy Agency, has come from clean energy.

Efficiency, profitability, and technology in clean energy are now aligned. The cost of solar panels has dropped 89% in just the last decade, while wind turbines are close behind with a 59% drop in the same time period. The cost of batteries have declined in tandem by 89% resulting in just a two year horizon before electric vehicles reach cost parity with the venerable fossil fuel guzzling internal-combustion engine.

But what about jobs? The news here is even better. Clean energy is currently generating three times as many jobs as fossil fuels. Solar jobs alone are outpacing overall job growth five-fold.

As Trump was fiddling, American cities and states were quietly adjusting their energy investment strategies. Much of the credit goes to former Vice-President Al Gore, whose leadership in this arena has been tireless and earned him a well-deserved share of the 2007 Nobel Peace Prize.

Al Gore will be highly visible as part of the US delegation in November, 2021, when all signators of the Paris Agreement reconvene in Glasgow, just a 1 hour and 11 minute drive north from the Trump Turnberry Golf Course. But the true celebrity at that historic gathering will be infromation technology.

Gore helped Climate Trace in 2019. As their site describes:

 “In 2019, a group of nonprofits including US-based WattTime and UK-based Carbon Tracker teamed up to apply for Google.org’s AI Impact Challenge with a proposal to monitor all global power plant emissions from space. Google.org not only selected the project for a $1.7 million grant, but also sent a group of seven skilled data engineering and machine learning Fellows to work alongside WattTime and Carbon Tracker for six months to help bring the initiative to fruition.

After the announcement of the Google.org grant, the teams were surprised to immediately hear from over 50 other organizations and scientists around the world offering to help. So they began systematically investigating: Could mixing and matching innovations from various groups improve global emissions monitoring even further? Among the new collaborators was Vice President Gore, who had long suspected that improved global emissions monitoring through satellites and AI held dramatic potential to accelerate climate progress.”

Gore sees the ability to track real-time atmospheric carbon emissions as a “game-changer.” Combined with efficiency, low cost, and jobs, Gore writes, “This precision tracking will replace the erratic, self-reported and often inaccurate data on which past climate agreements were based.”

If you feel Al Gore is overly optimistic, consider the words of thought leader and Silicon Valley entrepreeur, Tony Seba, co-founder of RethinkX, an independent think tank that analyzes and forecasts the speed and scale of technology-driven disruption. Last month in a report titled, “Rethinking Energy 2020-2030: 100% Solar, Wind and Batteries is Just the Beginning”, he stated,

“The implications of this clean electricity disruption are profound. Not only can it solve some of society’s most critical challenges but it will usher in hundreds of new business models and create industries that collectively transform the global economy. When a system generates hyperabundant electricity at a marginal cost close to zero, the potential for new value creation is limitless. This isn’t a problem of overcapacity. This is a Super Power solution.”

Mike Magee, MD is a Medical Historian and Health Economist and author of “Code Blue: Inside the Medical Industrial Complex.“

Bayer G4A Agents of Change: Watch the Panels, Meet the Co’s that Got Deals

By JESSICA DaMASSA, WTF HEALTH

Bayer G4A, the global life science company’s digital health innovation arm, held their splashy “Agents of Change” event last month to not only introduce their latest cohort of health tech partners, but to also demonstrate the pharma co’s commitment to digital transformation. The entire C-suite of Bayer’s Pharma division became a panel itself — marking the first time the full leadership team of a major pharmaceutical company appeared together to talk strategically about tech’s role in shaping the pharma business model of the future. 

The rest of the program’s agenda teased out G4A’s priorities: consumer health, health disparities, women’s health, and investing. Matthew and I both moderated “star-studded” panels with health tech greats: he tackled health tech investment, ridiculous valuations, and advice for startups with a powerhouse crew of investors, while I led my women’s health panel past the usual talk of period-tracking and into a real push for a paradigm shift in thinking about what actually constitutes women’s health data. Rounding out the program were fascinating discussions about health equity and access led by Indu Sabiaya, and a ‘who’s-interviewing-who-here’ fireside about patient-centered tech with OneDrop’s Jeff Dachis and DiabetesMine founder Amy Tenderich, both entrepreneurs with diabetes who have a lot to say about how most tech misses the mark when it comes to grappling with patient needs in everyday life.

And… if you’re curious about what Bayer G4A actually invested in and who they decided to sign partnership agreements with, check out my exclusive WTF Health interviews featuring these companies by way of the playlist below. 

Spoiler Alert: Not a single digital therapeutic. 

What else could there possibly be for a pharma co to invest in? Watch and see. But, so you know a bit about what you’ll be getting into:

  • Caria is women’s health startup focused on menopause 
  • Sweetch is using just-in-time-interventions linked to mobile data to help “outsmart” chronic diseases
  • ONCARE is a care plan content management platform that lets any healthcare provider upload a care pathway that a patient can then follow via an app on their phone
  • Decipher Biosciences is using genomic testing to disrupt the way prostate cancer is diagnosed and treated 
  • Elly is helping improve the quality of life for cancer patients and those with chronic disease by way of educational and motivational content delivered via voice technology

#Healthin2Point00, Episode 172 | MedArrive, PointClickCare, Consejo Sano & FOLX Health

Today on Health in 2 Point 00, we’ve got quite a diverse set of companies to cover. MedArrive, which is Dan Trigub’s company – the former CEO of Uber Health – raises $4.5 million. Jess also asks me about PointClickCare acquiring Collective Medical, connecting data from EMRs in the acute care space into their long term care solution (I interviewed both CEOs on THCB Spotlights here). Consejo Sano quietly raised $17.1 million for their patient engagement and communication solution for the Hispanic community, and FOLX Health raises $4.4 million to provide care to LGBTQIA+ folks. —Matthew Holt

#Healthin2Point00, Episode 171 | Massive deals & a massive IPO

Today on Health in 2 Point 00, we have a huge IPO coming up – JD Health, a Chinese company which has a valuation of $28 billion, could raise up to $4 billion in its upcoming IPO. On Episode 171, Jess asks me about Everlywell raising $175 million in a Series D for at-home testing, everyone’s favorite keto startup Virta Health raising $65 million bringing its valuation to a billion, Olive Health already putting their funding raise to good use by acquiring Verata Health, and dtx company Click Therapeutics raising $30 million. —Matthew Holt

#Healthin2Point00 Episode 170 | Olive, WithMe, Andor & more

Today on Health in 2 Point 00, Jess & I are together in Marin County before Jess sets off! On Episode 170, Jess asks me about Olive raising $225 million following a recent raise as well, WithMe Health closing a $20 million Series B, Andor Health getting an undisclosed amount in a Series A with an investment from M12, Microsoft’s venture fund, Upfront Healthcare raising $11.5 million in a Series B, and Voluntis – which is a publicly traded DTx company in France – raising $7 million. —Matthew Holt

Healthcare on the Edge

By KIM BELLARD

Perhaps you read about, or were directly impacted by, the massive, multi-hour Amazon Web Services (AWS) outage last week.  Ironically, AWS’s effort to add capacity triggered the outage, although apparently was not the root cause.  It’s no surprise that AWS sought to add capacity; it, like most cloud service vendors these days, has seen skyrocketing growth.  Even healthcare has jumped into the cloud in a big way.

But, as the outage reminds us, sometimes having core computing functions done in far-off data centers may not be always a great idea.  Still, we’re not about to go back to local mainframes or networked PCs.  The compromise may be edge computing. 

Definitions vary, and the concept is somewhat amorphous, but goal is to move as much computing to the “edge” of networks, primarily to reduce latency.  PwC predicts: “Now, with the rise of IoT, the centralised cloud is moving down and out, and edge computing is set to take on much of the grunt work.” 

As they describe it:

With edge, instead of pushing data to the cloud to be computed, processing is done by devices ‘at the edge’ of your network. The grunt work is done closer to the user, at an edge gateway server and then select or relevant data is sent to the cloud for storage (or back to your devices).

The oft-cited example is self-driving cars; you really don’t want the AI to wait a single millisecond longer than necessary to make a potentially life-saving decision.  An article in Nextgov pointed out:

Thus, a Tesla isn’t just a next-generation car; it’s an edge compute node. But even with Tesla, a relatively straightforward use case, building and deploying the edge node is just the beginning. In order to unlock the full promise of these technologies, an entire paradigm shift is required.

If this sounds like techy “inside baseball” stuff, think again.  This is a big shift.  Analyst and fund manager Stephen McBride believes edge computing is the “next great tech revolution.”  He says: 

The key takeaway is that edge computing makes the “impossible” possible. Technologies like self-driving cars, IoT, AR, and the commercialization of 5G will never get off the ground without edge computing.

It’s not just Mr. McBride who sees edge computing as a paradigm change.  The 2020 State of the Edge Report calls edge computing “the Third Act of the Internet.  Arpit Joshipura, the General Manager, Networking, Edge, and IOT for The Linux Foundation (which help create State of the Edge) proclaimed: “We stand on the precipice of a profound re-architecting of the Internet called edge computing, which will impact all areas of society.” 

The press release warned:

Where we stand today is at the edge. Today’s Internet struggles to support the newest use cases, particularly those that require real-time and low-latency interactions, not to mention handling connections with billions of devices generating petabytes of data. Only a radical restructuring of the Internet at the edge will solve for these emerging challenges, which will require thousands of companies to invest billions of dollars in new infrastructure.

The report estimates over $700b in capital infrastructure on edge infrastructure and data center facilities over the next decade, with healthcare identified as one of the leading industries that will adopt edge computing.  Mr. Joshipura believes “edge computing will overtake cloud computing” by 2025, which is a pretty bold statement.

More recently, IDC forecast edge computing as being a $251b market by 2024, asserting: “Edge products and services are powering the next wave of digital transformation.”  Healthcare is again cited as one of the impacted industries. 

There are plenty of hardware companies positioning for the edge computing movement, such as Akamai Technologies, Cloudflare, Fastly, or Telefónica, but also software vendors like Google, Microsoft or Red Hat. Earlier this year, Red Hat President and CEO Paul Cormier said:

We can look at the edge as the newest IT footprint, becoming an extension of the data center just like bare-metal, virtual environments, private cloud and public cloud.

The edge is open. The edge is hybrid. And the edge is powered by Red Hat.

Glenn O’Donnell, writing for Forrester in ZDNet, sees 2021 as an “inflection point for edge computing.  He predicts three key developments:

  • Data center marketplaces will emerge as a new edge hosting option – “We see a promising new option emerging that unites smaller, more local data centers in a cooperative marketplace model;”
  • Private 5G will push enterprises to the edge – “Private 5G is here now, and we expect it to fuel edge computing in 2021…2021 will be the inflection for 5G, but it will be private, not public.”  
  • New edge vendors will shave five points off public cloud growth – “As edge computing becomes a “cool” new platform for business computing, it will siphon some of the money that would otherwise have gone to cloud expansion.”

Health care is going to be impacted in a big way.  Most forecasts about the healthcare system of even the near future expect more real-time patient monitoring – the so-called Internet of Bodies (Iob) that includes “an expanding array of devices that combine software, hardware, and communication capabilities to track personal health data, provide vital medical treatment, or enhance bodily comfort, function, health, or well-being.”

We’re not going to get that without edge computing.  As PwC predicts: “5G and edge computing will enable the low-latency, real-time guaranteed conditions necessary to use IoT devices for patient monitoring and at-home care. For rural patients unable to access the care provided in larger metropolitan facilities, this could be a game-changer.”

The future of healthcare is on the edge.

I’m not smart enough to know exactly what edge computing will look like, in healthcare or anywhere else, much less how it works (then, again, don’t ask me how cloud computing or even PCs work!), but I’m smart enough to predict that this is a trend that no industry, especially healthcare, can overlook. 

As the 2020 State of the Edge report warned –not specifically about health care, but definitely including it – “Edge computing is crucial for many industries that currently find themselves in the midst of the digital revolution…It is crucial that industry players respond to these demands—if they don’t they will be substituted for players who can and will.”

Ignore it at your own risk.

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor.

Comcast, Independence BlueCross’s Quil: Fast-Forward Past Video Content to Home Sensors for Seniors

By JESSICA DaMASSA, WTF HEALTH

It’s not just eyeballs that Comcast NBCUniversal and Independence BlueCross’s joint venture, Quil, is after these days. Carina Edwards, Quil’s CEO, paints a compelling picture of the full-scale business model for “health-in-the-home” that her company is enacting. What started out with trusted healthcare content for surgery prep (able to be deployed across a household’s army of devices, including their TV for those 1.3M Comcast Xfinity cable subscribers) is now expanding with more tech and more services to meet the needs of seniors aging-in-place and the fifty million unpaid caregivers looking after them. Ambient, “context-aware” sensors. Voice integrations with smart speakers. And that’s nothing to say of the caregiver-focused programming that addresses everything from caregiver burnout to tackling tough conversations about a range of issues from paying for care to end-of-life wishes. Quil’s pilot of this new senior-focused offering will be rolled out with Comcast’s help this winter, with the full direct-to-consumer commercial launch expected in Q3 2021. As Carina says, “Comcast knows how to pilot technology.” And, Quil has shown its ability to impact healthcare quality measures thanks to studies around its initial surgery-prep offering. Will it be enough to take on others looking to help turn our living rooms into exam rooms? Tune-in around 17:20 to hear just how integrated Comcast and IBX are in the strategy at Quil.

#Healthin2Point00, Episode 167 | Bridge Connector, Togetherall, Solv Health & more

Today on Health in 2 Point 00, the big news is about another COVID vaccine… or is it the collapse of the telehealth and digital health market as we know it? On Episode 167, Jess asks me about Bridge Connector shutting down 2 months after getting a $25.5 million raise, UK-based online mental health platform Togetherall raising $10 million, Cerner partnering with Well Health for provider-patient communication services, Solv Health—the OpenTable for healthcare—raising $27 million, and Springtide raising $18.1 million for its clinic and platform for children with autism. —Matthew Holt

Bayer G4A Agents of Change: Digital Health & the Future of Pharma

By JESSICA DaMASSA, WTF HEALTH

Lots of changes at Bayer G4A: a new investment thesis, new additions to their portfolio, a new Global Head of Digital Health to meet, and a hot new virtual health forum (a free one!) coming up on November 18, 2020. Dominick Kennerson and Sophie Park join us from Berlin, where they’ve got their eyes on the trends shaping the worldwide digital health market. Are pharma companies changing the way they look at digital health companies in the face of the pandemic? Have we gone, well, beyond “beyond the pill”? Dom says Bayer’s been ahead of the curve when it comes to prioritizing digital innovation, and that we’re all going to be “very surprised” in the next 12-18 months about what we see come out of one of the world’s largest life sciences companies. For more clues and additional insight on Bayer’s priorities when it comes to digital health and the future of pharma, give this interview a quick listen then register for G4A’s Agents of Change event. HINT: From the “mad genius” herself…the agenda for the event is Bayer G4A’s roadmap. Bold move!

For more on the Agents of Change event, visit www.g4a.health.

Covid-19, the “Quarantine 15” & Healthcare’s Focus on Weight Management in 2021

By JESSICA DaMASSA, WTF HEALTH

Potential digital health trend for 2021? Weight loss and weight management. Not only has obesity been an “epidemic” of its own for a number of years (40% of U.S. adults are obese, another 32% are overweight) BUT it’s also considered a risk-factor if infected with covid-19 and is a common co-morbidity for a number of chronic conditions. Add to that all the banana bread we’ve been seeing on Instagram and the “quarantine 15” memes that sum up the weight gain brought about by our increasingly sedentary, baked-goods-filled shelter-in-place lifestyles, and you can see where this is likely to go. So, how can health tech help? As healthcare payers and employers look toward weight management as a way to help prevent adverse health outcomes (covid-related or otherwise), we get some advice from Dr. Greg Steinberg, a clinical innovation expert who gained experience piloting novel, health tech solutions for weight management at Aetna. We demystify the relationship between healthcare payers and weight loss solutions, talk about what matters from a cost/value perspective, and, of course, find out what makes for optimal end-user success.

Accolade’s CEO Raj Singh: IPO Backstory & Pop Health Predictions for 2021

By JESSICA DaMASSA, WTF HEALTH

When Accolade went public in July at a $1.2B valuation, the BIG question facing the health tech unicorn pre-dated the covid-19 pandemic and the chaos facing its clientbase of large, self-insured employers: Could they scale? Raj Singh, Accolade’s CEO, tackles the question head-on, buoyed by customer growth that has doubled twice over a fiscal-year-and-a-half and an expanded need for his company’s high-touch, concierge health benefits navigation services. As beleaguered employers struggle with making sure their employees have the health benefits they need to weather the pandemic, Accolade’s focus on making sure that those benefits remain as cost-contained as possible seems to be more attractive than ever. What else is resonating with self-insured employers these days? Raj talks about what will (and won’t) change when it comes to population health management in 2021 and gives us a reality check on whether or not employers and their employees are really using digital health tools like Livongo, Virta, Hinge, Kaia, Ginger, et. al when baked into their benefits ecosystem.

Telehealth, Digital Health Market Update from Europe & Frontiers Health Preview

By JESSICA DaMASSA, WTF HEALTH

Looking for more proof that telehealth has truly become a global trend in healthcare delivery? Our “man-on-the-street” in Italy, Roberto Ascione, CEO of Healthware Group, offers a detailed state-of-play on virtual care uptake across Europe, including how policy-makers, entrepreneurs, and investors are playing much more significant roles in spurning an increasingly “digital friendly” healthcare ecosystem in the wake of covid-19. On the eve of Frontiers Health 2020 — one of Europe’s leading health innovation conferences, of which Roberto is Chairman — we find out how those backing healthcare’s quickly evolving “tele-everything” revolution are planning to come together to push this agenda even further.

Note: Frontiers Health takes place THIS WEEK, on Thursday November 12 and Friday November 13. Check out the full agenda at www.frontiers.health.  Fans of WTF Health get a discount! Just use code FH20WTF25 for 25% off registration fees. See you there!

Health in 2 Point 00, Episode 165 | Centene, Koa Health, Eko and Medically Home

Today on Health in 2 Point 00, there is so much to talk about between the election, the Affordable Care Act, and Pfizer’s COVID vaccine news. On Episode 165, we talk about how this is impacting the markets and cover more deals. ACA darling Centene has acquired Apixio, Koa Health spins out from Telefónica and gets $16.5M in initial funding, Eko raises $65 million in a Series C for their connected stethoscope and ECG, and Medically Home raises $40 million in another continuous clinic play, bringing their total to $65 million. —Matthew Holt

We Need a Digital Identity Framework to Guide the Challenging Transition to Remote Healthcare

By GUS MALEZIS

We don’t often see two Republicans and two Democrats come together to offer solutions to problems. But even at this difficult time in America, I can see bipartisanship in a truly meaningful way. The intensely-challenging issue of digital identity is bringing members of Congress of both parties together.

Most American adults rely on an 84-year-old system of identification — the social security number. But that ID is limited in use, and does not serve us well in healthcare and especially as COVID-19 – beyond the healthcare and safety issues – makes us an ever more digital nation. We are indeed accelerating our national pivot to a digital nation as we, for example,  log on to go to school or work, to buy food, to shop for clothing, or to pay bill and transfer money from a bank account. And, now more so than ever, healthcare is becoming digital, as we seek to navigate a digital world to visit the doctor, to fill a prescription, or to review medical test results. Digital identity presents a major obstacle to a safer and smoothly functioning digital healthcare experience.

As the Coronavirus disrupts our nation, and healthcare delivery turns increasingly digital, on-line fraudsters have not been interrupted; they have simply been given far more opportunity than they might have imagined.

Congressman Bill Foster(D-IL) , has introduced the “Improving Digital Identity Act of 2020,” to make digital identity more secure and data breaches and identity theft less likely. Joining him in sponsoring the bill are another Democrat, John Lagevin (D-RI), and two Republicans — John Katko (R-NY)and Barry Loudermilk (R-GA). These four Congressmen — from far different parts of the American political spectrum — have come together to create a bill that would establish a standard framework for federal agencies to provide digital identity verification, establish a task force on securing digital identities, and create a grant program for states to modernize systems.

This bipartisan effort to protect digital identity can help change for the better millions of lives in the healthcare world. While many of the entities behind this bill are from the financial services world, healthcare needs this bill to become law as much as any sector. Healthcare providers are in desperate need of a more robust, comprehensive digital strategy to address the industry’s unique security, privacy, compliance, and workflow challenges. As important as it is for providers to have a powerful digital ID, it is equally important for patients to have one too, so they can have easy and consolidated access to their health information, and so that doctors can equally see the patient’s complete health picture, regardless if they are treating the patient at the home, the clinic or hospital.

As technology leaders, it is our job to deliver the solutions necessary to meet these complex and growing cybersecurity demands. Having a digital identity framework for all industries, including healthcare represents a giant step forward. With a unified system, we can avoid the security and efficiency gaps of non-cohesive approaches, and we can ensure patient privacy. This is especially important as we plan for the post-pandemic world, which no doubt will only involve more and more remote care – and many other unknowns.

Our goal is to develop a technology solution that works everywhere — in the clinical environment, at home, on any device. After all, healthcare is no longer just in the hospital and the ER – it takes place everywhere, and we need enhanced digital identification that will allow us to access it from anywhere. The technology also has to be simple and easy to use. We cannot afford to further complicate physician workflows and risk exacerbating the national public health problem of physician burnout.

Albert Einstein said, “in the midst of every crisis, lies great opportunity.” With more remote medicine being practiced during the global pandemic, more digital identity failures are exposed. The opportunity — working more remotely and more digitally, with elevated security and privacy during the Covid crisis – is to make vast improvements in healthcare delivery as a whole. That starts with a trusted digital identity framework designed specifically to address and support the unique requirements of healthcare — and its entire ecosystem, including clinicians, patients, external vendors, and non-human entities such as shared mobile and connected medical devices.

We are reaching for these goals, and this legislation will be pivotal. Not only will health care providers benefit from having a trusted digital identity, but indeed all Americans will –  whether they be traversing a healthcare system, depositing a check, or ordering a pizza.  

At this time of stress and pandemic in our country, I am grateful to see four members of Congress come together — two Republicans and two Democrats — in favor of a more secure digital identity for us all.  

Gus Malezis is the President and Chief Executive Officer of Imprivata, a Lexington, Mass.-based healthcare digital identity company.

#Healthin2Point00, Episode 162 | Whoop, Honor, Sidekick Health & more

Today on Health in 2 Point 00, Jess is dismayed at her rising premiums. On Episode 162, Jess and I have more deals to cover. Whoop, which makes a wearable, raises $100 million (including SoftBank money!), bringing their valuation to $1.2 billion. Next, Honor raises $140 million in a Series D and I weigh in on how this tech-enabled home care startup has evolved since it started out. DTx company Sidekick Health raises $20 million for its gamified medication management platform,, and SaaS telehealth platform eVisit gets $14 million—is this any different? Finally, Cricket Health which manages complex kidney diseases early names new CEO Robert Sepucha and raises $15 million. —Matthew Holt

#Healthin2Point00, Episode 161 | Partnerships galore & a new SPAC

Today on Health in 2 Point 00, we have some hot gossip re: Glen Tullman starting his own SPAC. On Episode 161, Jess and I discuss Bind Benefits raising $105 million, BridgeHealth merging with Transcarent and raising $40 million in a Series A, and Loyal raising $12.5 million in a Series A. Jess also asks for my take on a slew of new partnerships between Lyra and Calm, Cigna and MDLive, and Doctor on Demand and CareLinx. —Matthew Holt

Remote Patient Monitoring Sets Up Big Tech to Revolutionize Telemedicine and Healthcare

By JAMES MOELLER

Remote patient monitoring has emerged as the next significant challenge for virtual healthcare and that challenge is creating significant opportunities for many companies largely outside of the traditional healthcare technology marketplace. In particular, it is potentially setting up an opportunity for Big Tech companies like Apple, Google, and Amazon, to revolutionize telemedicine and healthcare similar to what those companies have accomplished in mobile phones, Internet search, and retail.

Next Generation Remote Health Monitoring

Next generation remote healthcare monitoring will likely look much different than anything done before. What is emerging today is the potential for the broad adoption of remote health monitoring devices and systems that leverage consumer wearables, smart home communication systems, and big data to produce holistic views specifically for healthcare providers. The pandemic has thrust telemedicine solutions forward by years if not a decade or more in the short span of three to six months. This is creating an opportunity for remote patient monitoring to provide even better visibility into patients beyond what can be accomplished with basic video conferencing.

But while telemedicine is now becoming more firmly established, remote monitoring seems to still have a long way to go. This is evident in a new report by KLAS Research (a healthcare industry research firm) published on August 27th, where they interviewed 19 executives from 18 healthcare organizations regarding their challenges and solutions during the outbreak of the pandemic. Not surprisingly, telemedicine was the top challenge with 32% of the executives. Overall, though, 84% of the executives indicated that the telemedicine issues were already solved and the remining 16% indicated that the solutions were in progress. However, remote patient monitoring ranked as the second most significant challenge with 26% of the respondents. But furthermore, only 22% of the executives indicated the remote monitoring challenges were solved, with 33% saying it was in progress, and 45% indicating it was completely unsolved. So, a clear opportunity exists.

Big Tech’s Virtual Healthcare Market Leverage

For Big Tech, the leverage into virtual health comes from the ability to offer remote monitoring solutions across wearables, ambient sensors, and smart home communication devices, as well as the capability to apply big data, AI, and machine learning to the information from those devices. Big Tech is even combining these technology solutions with healthcare specific services like telemedicine, prescription drug delivery, and medical testing. Market evidence suggests that Big Tech is already putting these pieces together and using this leverage to expand into the broader healthcare market.

Wearables and Ambient Sensors

Wearables and ambient sensors, and particularly consumer-oriented versions of these products, are a key enabler of next generation remote healthcare monitoring by serving as the principle connection with the individual. Over just the last few years the overall market for wearables has increased significantly and the market demarcations are blurring between traditional medical wearables and consumer health and fitness wearables.

Apple leads the overall wearables market with its Watch, Beats, and AirPod products. Across those product lines the company shipped 29+ million units in Q2 2020 and holds an approximate 30% market share, which is nearly three times the size of its nearest competitor. In addition, the Apple Watch is aggressively pushing into classical medical applications with its ability to measure blood oxygenation levels, its electrocardiogram (ECG) capability, and its ability to detect atrial fibrillation (AFib) as well as other cardiovascular conditions. (5)

Fitbit, which is in the process of being acquired by Google, typically ranks 5th in the wearables segment with a market share of approximately 3%. While Fitbit’s market share has been declining as of late, it would still position Google with an immediate unit shipment customer base (for Q2 of 2020) of approximately 2.5 million as well as its active user base of approximately 30 million.

Not to be left out, Amazon recently introduced its own wristband wearable device for health and fitness tracking called Halo. Its aiming to differentiate in the wearables market by offering capabilities to measure and track body fat, sleep temperature, and emotional state.

Smart Home Communication Devices

Smart home communication devices such as smart speakers and home control systems will also be a key component of next generation virtual healthcare. These systems can serve as communication access points to the Internet for lower power wearables and ambient sensors, and also enable intelligent personal assistant capabilities, such as reminders to take medications, and help in monitoring exercise and other behavioral health aspects.

Amazon is the dominant market leader in smart home communication devices with its Echo Alexa personal assistant, which has estimated 50%+ market share as of January 2020. Amazon was first-to-market with its smart speaker system and continues to augment its capabilities with an ever-expanding array of interactive skills. This includes skills to integrate Amazon’s Ring home security and control system, its portfolio of Alexa wearable devices, and numerous third-party products.

Google has the second position in the smart home communications device market with an approximate 30% market share for its Nest smart speaker products. (8) Recently the company make a $450 million investment in ADT, Inc. with the aim of growing its Nest deployments specifically in the home security market. Google also has a relationship with the Cleveland Clinic that has recently materialized into a capability for its Nest smart speakers that allow users to ask for Cleveland Clinic health tips. This is a perfect example of the virtual healthcare synergies that can be accomplished with smart home communication devices.

Apple is behind the competition in the smart home communications market. The company’s HomePod smart speaker is a distant 4th in market share at only 2.8%. So, while Apple’s Siri assistant has been an integral part of its iPhone for quite some time, the company has yet to make an impact in combining Siri and HomePod for the home market.

Big Data

The big data processing of medical information will become increasingly important as virtual healthcare remote monitoring grows. The ability to analyze the vast amounts of real-time, streaming data to produce trends, correlations, and medical diagnoses can potentially transform how healthcare is applied at both an individual and societal level. Big Tech is uniquely positioned with shear corporate size and technology assets to pursue remote monitoring big data. In addition, Big Tech is already pursuing healthcare data relationships with significant healthcare providers and can leverage those projects into new applications processing remote monitoring data.

In 2019 Google made waves in establishing relationships with both Ascension Health and the Mayo Clinic to partner on the development of digital tools that integrate healthcare data into new patient care models. While the Ascension deal, in particular, raised concerns about patient data privacy, the two relationships will provide Google valuable experience in processing healthcare data that can be leveraged into future remote monitoring data applications.

Apple is leveraging its iPhone and wearables products in its health data initiatives. In 2018 the company introduced a health records app for the iPhone where Apple partners with healthcare providers to deliver a patient’s records to their mobile phone. In addition, Apple has established a variety of research relationships with organization such as Harvard’s T.H. Chan School of Public Health, Brigham and Women’s Hospital, University of Michigan, and others, that focus on cardiovascular projects related to the Apple Watch and hearing projects related to the AirPod earbuds.

Amazon’s principle relationship for health data is with Cerner Corporation, which has an approximate 25% share for electronic health records systems across the entire healthcare marketplace. In 2019, Cerner chose Amazon Web Services as its preferred cloud provider for its healthcare patient data. More recently the companies announced a further collaboration where consumers using Amazon’s Halo wearable can opt-in to share their activity and health data and allow that information to be stored in their patient record in Cerner’s systems. The patient’s healthcare provider can then access and evaluate that information directly in the patient’s records. This is another example of virtual health synergies accomplished via the integrated capabilities of a consumer wearable, health data systems, and a patient’s healthcare provider.

Healthcare Services

As the most straight-forward initiatives toward revolutionize healthcare, Big Tech is also directly entering the healthcare provider and services market, which at a minimum provides a convenient platform to leverage its healthcare technology and data solutions.

In 2018 Apple launched a group of health clinics called AC Wellness for its employees and their families. These clinics are generally focusing on providing primary care but have extended that to also included on-site lab testing and wellness care such as exercise and dietary programs.

Last September Amazon introduced its pilot telemedicine program, Amazon Care, for its employees in Seattle. This service includes virtual primary care as well as home consultations and prescription drug services via Amazon’s PillPack division, a virtual pharmacy Amazon acquired in 2018.

Google’s most recent activity takes a different approach where on August 24th it announced it was investing $100 million in telemedicine provider Amwell. The synergies mentioned in the deal specifically focused on Google’s cloud computing services, but the intersection extends into its data processing and machine learning expertise and can potentially tap into its home personal assistant products for remote monitoring capabilities.

Challenges and Opportunities Ahead

When Big Tech pursues business growth, the companies must think big and look for markets that are ripe to be thoroughly transformed. With the global healthcare market size at more than $8 trillion and new technologies poised to transform how healthcare is executed, a prime opportunity exists. But significant questions remain in terms of the technological solutions, the market competitive and relationship dynamics, and of course, concerns about regulatory and information privacy.

Despite the market positions of Big Tech in wearables, smart home communications, and big data, there continues to be significant venture capital and start-up activity in the technological areas of virtual health that tend to focus on opportunities that Big Tech hasn’t yet pursued. The companies that achieve some degree of success will likely experience a very attractive market to be acquired by not only Big Tech competitors like Apple, Amazon, and Google, but also the leading telemedicine companies like Teladoc Health, Amwell, MDLIve, and SOC Telemed as well as technology-oriented insurers like UnitedHealth Group. From a Big Tech product portfolio perspective, two of the more significant gaps pertain to Apple’s position in smart home communications and Amazon’s position in wearables. In the smart speaker market, Apple’s 4th place position behind Sonos Inc. has led to speculation that Apple might buy Sonos purely to increase its market share. This is very unlikely to happen given Apple’s reluctance to large M&A deals and, more importantly, its recent announcement that it is will stop selling Sonos products in the Apple Store. So, for the moment, Apple looks to be preparing to grow its market share on its own. For Amazon in the wearables market, the situation is similar. There doesn’t look to be any wearable or smartwatch companies that help Amazon’s market position. Even if Amazon were to acquire a company like Garmin, it would only improve its market share by a few percentage points.

The competitive and relationship dynamics of the virtual healthcare market will continue to be very active as broad industry solutions come together. Ultimately, this market is a non-trivial combination of technology, information systems, and healthcare providers. Big Tech has significant positions in many key markets, but lacks considerable exposure to others, most notably in the healthcare provider area. The first six months of the Covid-19 pandemic has thrust telemedicine providers like Teladoc Health, Amwell, MDLive, and SOC Telemed to the forefront and positions them as key parts of future virtual health solutions. Teladoc just recently announced an $18.5 billion deal to acquire Livongo, a company focused on remote monitoring and virtual health services for diabetes and related health issues. Amwell, MDLive, and SOC Telemed are all accessing the public markets to shore up access to capital and the ability to leverage stock as an acquisition currency. So, watch for all these companies to be active acquirers. But for Big Tech there are many more private telemedicine companies that could be acquisition targets to improve Big Tech’s connection to the healthcare provider market. These include companies such as Doctor on Demand, Crossover Health, 98point6, and HealthTap. In fact, Amazon just recently announced a partnership with Crossover Health to provide health services to its employees and health centers near its fulfillment and operations facilities. This could potentially be a precursor to a more significant acquisition opportunity.

Last, but certainly not least, are the concerns over regulatory issues and information privacy. For Big Tech, under the current environment, any initiatives to capture significant portions of the next generation virtual healthcare market are likely to attract even more scrutiny regarding antitrust issues and the companies’ abilities to keep patient information private. But even these challenges are unlikely to deter Big Tech’s pursuit of healthcare. The market opportunity is just too attractive.

Jim Moeller provides business intelligence data analytics consulting services into projects involving strategic planning, competitive analysis, technology assessment, and intellectual property research.

#Healthin2Point00, Episode 158 | Datavant, Mira, Avail & more

On Episode 158 of Health in 2 Point 00, Jess and I talk about Datavant raising $40 million in a Series B for their open health data exchange platform, Mira raising $2.7 million for it’s Costco-esque health insurance alternative, Avail raising $100 million providing telehealth for the OR, ScriptDrop raising $15 million for prescription drug delivery, and Abridge raising $15 million to help patients transcribe doctor’s appointments. —Matthew Holt

#Healthin2Point00, Episode 158 | Datavant, Mira, Avail & more

On Episode 158 of Health in 2 Point 00, Jess and I talk about Datavant raising $40 million in a Series B for their open health data exchange platform, Mira raising $2.7 million for it’s Costco-esque health insurance alternative, Avail raising $100 million providing telehealth for the OR, ScriptDrop raising $15 million for prescription drug delivery, and Abridge raising $15 million to help patients transcribe doctor’s appointments. —Matthew Holt

#Healthin2Point00, Episode 157 | The phrase is “Takeout Speculation”!

Today on Health in 2 Point 00, Jess and I gossip about the wild rumor that UnitedHealthcare is acquiring Amwell. On Episode 157, we discuss Lark raising $55 million in a Series C along with a deal with Anthem to be their preferred DPP provider, Medicare Advantage plan Clover going public with a valuation of $3.7 billion, NOCD raising $12 million in a Series A providing specialized CBT and virtual OCD treatment, Cerebral raising $35 million in a Series A for its comprehensive digital mental health offerings, and Express Scripts adding to their digital health formulary with offerings targeting things like women’s health, tobacco cessation, muscle and joint pain, and more. —Matthew Holt

#Healthin2Point00, Episode 156 | Garage Sale Edition

Today on Health in 2 Point 00, Jess can’t figure out what’s going on with health tech investors. Episode 156 feels like rummaging through a garage sale… First up is mirrors, mirrors, mirrors, with a total of $225 million invested: Tonal gets $110 million, Tempo gets $60 million, and Fiture gets $65 million. Next up is socks; Siren, which makes socks, added $9 million to their B round, which already has $11 million. Our next category is doctors, aka startups from Europe with “doctor” in the name: DrDoctor gets £3 million in an A, HomeDoctor scored €3.7 million, and Your.MD gets $30 million. Finally, we have raccoons! Raccoon.World closes a $900 million seed round to provide physiotherapy in a video game platform. —Matthew Holt

KidsX to Unite Children’s Hospitals & Boost Innovation Investment in Pediatric Digital Health

By JESSICA DaMASSA, WTF HEALTH

Even though kids make up 20% of the total national patient population, investments in startups that use tech to improve their care is, at best, a dismal 1% of the total investments made in digital health and health tech each year. Why is there such a lack of innovation (and investment in innovation) in Pediatrics? Omkar Kulkarni, Chief Innovation Officer at Children’s Hospital of Los Angeles, talks us through the challenges that have so-far stymied a health tech takeover of the pediatric care market and how KidsX is out to change all that. Already, Omkar’s recruited several dozen of the world’s leading Children’s Hospitals and Pediatric care units into KidsX, bringing with them supportive payers and investors who want to add to the collaborative consortium’s ability to drive change into this stretch of the healthcare continuum. These “champions” aim to create more targeted opportunities for startups who want to pilot or co-develop peds-focused solutions with the leading pediatric care providers who will ultimately use them, the payers who will ultimately reimburse for them, and the investors who ultimately will fund scaling them. Startups are currently being recruited until October 7, 2020 to participate in the KidsX accelerator’s first cohort and it’s a pretty sweet deal. The bottom line: Lots of support, no equity take; this is NOT just for early-stage startups and it’s NOT just for health tech. Healthcare incumbents in care delivery orgs, health plans, and pharma companies are also invited to join in, along with those healthcare investors who want early-access to emerging pediatric startups and solutions, or a seat at the table as KidsX plans for its own investment fund.

#Healthin2Point00, Episode 155 | Is UnitedHealth Group taking over the world?

Today on Health in 2 Point 00, Jess and I discuss UnitedHealth Group acquiring DivvyDose for $300 million, which is a knock off of PillPack. Is there anything left for them to buy? We cover many more deals in Episode 155—Noyo raises $12 million in a series A, helping health plans exchange data, Medigate raises $30 million working on cybersecurity for connected devices in hospitals, OnCall raises $6 million helping health systems launch their own virtual care platforms, RapidAI raises $25 million to improve MRI and CT quality using AI to layer those images, and Medefer raises £10 million offering telehealth and referrals to patients within the NHS. —Matthew Holt

Telehealth Reality Check: Who’s Really Going to “Win” the Race to Virtual Care Market Leadership?

By JESSICA DaMASSA, WTF HEALTH

It’s the telehealth market reality check you’ve been waiting for! “Rogue” digital health consultant Dr. Lyle Berkowitz unpacks the numbers and the market potential for virtual care from the unique vantage point of a primary-care-physician-turned-health-tech-entrepreneur with nothing to lose. Having been 1) a clinician, 2) the Director of Innovation at Northwestern Medicine, 3) the founder of a health tech startup (Health Finch) that successfully exited to Health Catalyst, and 4) the former Chief Medical Officer at one of telemedicine’s biggest players, MDLive, few can boast such a wide-reaching, deep understanding of the inner workings of both the innovation and incumbent sides of the virtual care market — AND have a willingness to talk about it all with complete candor!

This is an analyst’s perspective on the telehealth market — with a twist of insider expertise — so expect to hear some good rationale behind predictions about how much care will remain virtual once hospitals and doctor’s offices return to normal, how “real” health system enthusiasm is for building out telehealth capacity to execute on the “digital front door” idea, and whether or not all these well-funded telehealth startups will have what it takes to win market share from traditional care providers.

BONUS on Primary Care: Is this the area of medicine that’s going to be the “battleground” where digital health and virtual care companies will be going head-to-head with incumbents for market share? Lyle says 50-plus percent of primary care “can and should be automated, delegated, virtualized, etc.” and boldly predicts that in 10-20 years we won’t even have primary care physicians anymore. Tune in to find out why starting at the 8:00 minute mark, where we shout out Crossover Health, Oak Street Health, Iora Health, and more.

Telehealth die-hards, don’t think for a second I’d miss this chance to also get some input on Teladoc-Livongo, Amwell, Doctor On Demand, SOC Telemed, the impending IPOs there, digital first health plans, virtual primary care, health systems (who Lyle hopes “don’t shoot themselves in the foot” with their opportunity to jump into the space) and, ultimately, who’s really going to ”WIN” in virtual care moving forward. For this, jump in at 17:00 minutes and hold on!

Change Healthcare’s CEO on Payers, Providers & The New Healthcare Economy

By JESSICA DaMASSA, WTF HEALTH

From his vantage point at the helm of one of healthcare’s biggest IT infrastructure companies, Change Healthcare’s President & CEO, Neil de Crescenzo, has an unrivaled perspective at how covid19 has impacted hospital systems and payers. His business builds the “connective tissue” that not only supports the administrative management and patient engagement aspects of “Big Healthcare,” but it also literally helps those organizations make money, processing about $1.5 Trillion in claims each year. So, what’s he seen so far in 2020? And what’s ahead for 2021? Neil stops by to talk about current challenges facing healthcare provider orgs and payers — and what’s ahead in the “new” healthcare economy where “change” is the only constant. From HHS’s new interoperability rules to telehealth and the more dispersed healthcare system it will inevitably create, we dive into all things future of health including the details behind Change’s two recent health tech acquisitions (each over $200M), what Neil thinks about the Teladoc-Livongo merger, and how digital health startups have an unprecedented opportunity to help expand the healthcare system beyond its traditional footprint.

An Epic Fight for the Metaverse

By KIM BELLARD

 You might have missed it amongst all the headlines about the U.S.P.S., the 2020 elections, and, of course, that little thing we call the pandemic, but Fortnite got kicked off Apple’s App Store (and subsequently Google Play).

I’m not a gamer, but I am fascinated by gaming, because, as Steven Johnson put it, “The Future is where people are having the most fun.” Tim Sweeney, the founder and CEO of Epic Games, Inc., which makes Fortnite, seems to be having a lot of fun. And he thinks the future is the Metaverse.

Healthcare, take note.

The tech giants were reacting to Epic allowing “permanent discounts” on developer fees for in-game purchases made directly, rather than going through Apple or Google. Developers thus avoid the 30% commission charged in those Stores. Mr. Sweeney has been railing about the commission level for some time, leading to the recent decision.

Apple tried to justify its action:

Today, Epic Games took the unfortunate step of violating the App Store guidelines that are applied equally to every developer and designed to keep the store safe for our users. As a result their Fortnite app has been removed from the store. Epic enabled a feature in its app which was not reviewed or approved by Apple, and they did so with the express intent of violating the App Store guidelines regarding in-app payments that apply to every developer who sells digital goods or services.

Epic had, not surprisingly, already gamed this out: it immediately sued both Apple and Google in federal court, charging:

Apple’s removal of Fortnite is yet another example of Apple flexing its enormous power in order to impose unreasonable restraints and unlawfully maintain its 100% monopoly over the” market for in-app payments on iPhones.

Even better, they rolled out a slick ad, its own version of Apple’s iconic 1984 ad attacking IBM:

Mr. Sweeney charged: “We must all choose to fight a painful battle now, or accept an all-powerful middleman with unbounded ambition to extract tribute and limit innovation in the decades to come.”

All this is happening, of course, when regulators in both the U.S. and Europe are eying tech giants warily for monopolistic actions, so kicking off a major app because it wouldn’t say a tribute — umm, “commission” — means they feel there is a lot at risk here. In just three years, Fortnite has accumulated some 350 million users worldwide.

Some view this as just about money, a tech giant battling two bigger giants for more favorite deals. Mr. Sweeney see it as a fight about platforms and exactly what a platform can dictate to its users.

Some view this as just about money, a tech giant battling two bigger giants for more favorite deals.  Mr. Sweeney see it as a fight about platforms and exactly what a platform can dictate to its users.  He tweeted: “We’re fighting for open platforms and policy changes equally benefiting all developers. And it’ll be a hell of a fight!”   

In an interview with Joseph Kim, Mr. Sweeney said:

…they say something is only a platform when the majority of the profit is made by creators rather than the company that built the thing right? Windows is a platform. Gee, is iOS a platform? Not sure.

It should be noted that Epic offers its own platform, Epic Games Store. More importantly, Epic is more than Fortnite; in addition to its Store, it has a game development software (Unreal Engine), the game/social network Houseparty, and this spring hosted a virtual concert watched by more than 12 million people. Mr. Sweeney has made it clear: Epic is gearing up for the Metaverse, which some believe will be “the next version of the Internet.”

The concept of the Metaverse has been around for years — science fiction writer Neil Stephenson is believed to have first introduced it in his 1992 novel Snow Crash — but Mr. Sweeney elaborated on it in his interview with Mr. Kim:

But the Metaverse is going to be some sort of real time 3D social medium where instead of sending messages and pictures to each other asynchronously, you’re together with them and in a virtual world and interacting and having fun experiences which might span anything from purely games to purely social experiences.

The other critical element of the Metaverse is it’s not just built by one mega corporation, right? It’s gonna be the work, the creative work of millions of people who can each add their own elements to it through content creation and programing and design. And the other way of adding value.

Apple, he says, “has outlawed the Metaverse,” since it does not permit “cross-platform ecosystems and games,” something he has pushed for years. The Metaverse, he believes, “It’s going to be from more and more companies and brands connecting their products and services until you have a much, much more open thing that everybody participates in…And so it’s in everybody’s interest to really interconnect and standardize over time.”

Mr. Kim put it to him directly:

JK: And you just want to see competition at every point in the value chain, where every component of the value chain that there’s a healthy competition there. Is essentially… Is that what you’re advocating for?

Tim Sweeney: Yeah, exactly. Healthy competition at every point and facilitated by technical interoperability standards. Right

I think of all this in contrast to healthcare. Oh, sure, healthcare has plenty of middlemen, each collecting its “tribute” and too many of them limiting innovation. But while Mr. Sweeney and others are looking for the next version of the Internet, healthcare hasn’t even gotten to the platform stage, much less platforms with open standards, interoperability, “healthy competition at every point,” and real time collaboration, eventually in 3D space.

Healthcare still works in your grandfather’s economy and uses your parents’ Internet.

Look, I don’t really care if I can’t download Fortnite from either App Store. I don’t have strong feelings about whether 30% is a “fair” commission for Apple and Google. I do wonder what healthcare’s first real platform will be, and worry that, once it comes, it will stifle competition and innovation rather than spur it. I’m all in on cross-platform products and services, with open standards and interoperability, especially for healthcare.

Most of all, I wonder who healthcare’s Tim Sweeney is — fighting to open up today’s “system” and thinking hard about what comes next, whether that be the Metaverse or something else we haven’t imagined yet.

As Mr. Sweeney said:

I think we should all be advocates for the world that we want. If we aren’t forceful and fighting for the world that we want…then we’re going to get a very different world. And by the time it’s set in stone, it’s going to be too late to change it.


Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor.

Health in 2 Point 00, Episode 141 | Teladoc Livongo Merger Special

Today, a special Health in 2 Point 00. Jessica DaMassa asks me about the biggest news in public digital health companies ever: this morning’s merger of Teladoc and Livongo. We discuss the deal, the implications for digital health, what’s next for Continuous Clinics, whether our T-Shirts will become a collectors item, and of course what about our book club next week! —Matthew Holt

Quality Virtual Care Is Within Reach – But Only If We Act Now

By JULIA HU

Though it will be impossible to overstate the devastation that the COVID-19 pandemic is leaving in its wake, we can also acknowledge that it has pushed humanity to creatively adapt to our new, socially-distanced reality—necessity is the mother of invention, as they say. Telehealth is not a new invention, but the necessity of keeping people physically apart, especially those particularly vulnerable to COVID, has suddenly put virtual health care at the center of our delivery system. 

Patients and providers quickly pivoted to at-home care as in-person visits were limited for safety, and use of telehealth spiked early in the outbreak. One survey of over 500,000 clinicians showed that by April—only about two weeks after the first stay-at-home orders were issued in the U.S.—14 percent of their usual number of pre-pandemic visits were being conducted via telemedicine. For many, that involved using unfamiliar technology and a big shift in procedures for providers. Congress recognized the need to support providers through this transition and allocated $500 million for waiving restrictions on Medicare telehealth coverage as part of the emergency funding bill that passed in March. 

But, as restrictions have begun to lift and hospitals and medical offices are beginning to reopen for non-emergent care, we have seen the use of telemedicine start to taper off. The same 500,000 clinicians were surveyed  in June, revealing that telemedicine was used for only 8 percent of the usual pre-pandemic number of visits. Providing quality, virtual health care won’t be as easy as flipping a switch, but we currently have an unprecedented opportunity to carry forward the best version of virtual care and create a more holistic health care system. As we work toward that goal, there are three components our virtual care system needs in order to be sustainable, feasible, and manageable for both patients and providers. 

Patients and providers need a range of services to be available virtually. 

When people talk about virtual care and COVID-19, they are most often referring to a telemedicine experience where a patient interacts with a provider through some type of video conferencing. Those visits are extremely useful for conducting certain types of appointments, including dermatological exams, triaging symptoms to determine best next care steps, and counseling or therapy appointments. 

But, not every virtual care interaction needs to include a video visit with a provider. Asking physicians to keep up a full schedule of virtual visits as they simultaneously work to safely reopen their in-person practices is unreasonable. Physicians are already experiencing some of the highest rates of burnout of any profession, and COVID-19 has only exacerbated that trend. 

Some virtual care, including certain check-up visits or assessments, can be conducted telephonically, giving more flexibility to both patients and providers when video conferencing is not needed. Digital health coaching tools offer another type of virtual care that can help relieve providers from some of that burden by managing patients’ routine care needs in-between either telemedicine or in-person appointments.

This is especially true for chronic condition prevention and management, which requires 24/7 support. Digital coaching can be available at any hour, outside of a physician’s normal 9-5 schedule. It also can help manage symptoms for certain behavioral health issues related to stress or anxiety. 

We need to carry forward the full suite of services that virtual care can provide. This will help physicians better manage their caseloads, give patients access to a variety of services right from their homes, and build more flexibility into our entire delivery system.

Our virtual care system should embrace Remote Patient Monitoring Tools with connected devices.

Remote Patient Monitoring (RPM) allows both patients and providers to access real-time monitoring of key biometrics, such as blood glucose for a patient with diabetes, blood pressure for someone with hypertension, or weight for someone with heart failure. RPM typically uses a connected device, such as a glucose monitor or a blood pressure cuff, that records and sends data. 

RPM benefits physicians by providing them with up-to-the minute information about their patients, alerting them when biomarkers indicate potentially serious issues, and helping them manage their patient population without having to conduct telemedicine or in-person visits. Because RPM is reimbursable through Medicare, it can also help drive revenue for practices, an especially important component for those struggling financially because of reduced patient volumes due to COVID-19.

RPM also benefits patients. It helps ensure that their care is being personalized to their unique health situation, and allows for quick identification and intervention of possible acute or emergent issues. By accessing RPM data, patients can also better understand how their behaviors impact their health. 

Incentive structures, including reimbursement policies, need to be aligned to support these virtual care models.

To sustain quality, virtual care beyond the pandemic, we need to align incentive structures to support its continued adoption. There is much agreement, including among Members of Congress and CMS leadership, that some of the Medicare restrictions on telehealth that were loosened to address the COVID-19 crisis should be permanently extended. Key among them are: allowing providers to provide virtual care across state lines, expanding Medicare and Medicaid reimbursement for a wider breadth of virtual services, and allowing doctors to conduct virtual visits using familiar technology, like FaceTime or over the phone.

Without the certainty that virtual care services will be adequately reimbursed, there is a risk that many physicians will abandon investment in the technology needed to provide those services. We need to act now to make sure that doesn’t happen, and that virtual care becomes an integral part of our larger delivery system moving forward. 

We also have a unique opportunity in this moment to shape our future virtual care system with value-based principles in mind. Aligning incentives between quality and cost can help ensure that virtual services meet the needs of patients, while helping reduce the overall cost of care.

Virtual care will remain especially important as our country continues to face rising COVID-19 cases, giving us the window of opportunity to cement quality, virtual care as a permanent piece of the delivery system. The benefits of building a more holistic system that weaves together virtual and in-person care will extend far beyond the current pandemic. From increasing access for patients, to filling critical gaps in care, to helping providers prioritize their caseloads—virtual services can help shape a better system. But we must act now to bring that vision to life.

Julia Hu is the Founder and CEO of Lark Health.

Health in 2 Point 00, Episode 140 | Heal, Lemonaid, CVS & Sema4

Today on Health in 2 Point 00, Jess helps me celebrate my birthday Kylie Jenner-style. On Episode 140, Jess and I discuss Humana investing $100 million in Heal, Lemonaid raising $33 million in a Series B, CVS Caremark announcing 5 new companies in their digital health platform—4 of which are about weight loss, and perplexing health intelligence company Sema4 raising $121 million in a seed round. —Matthew Holt

THCB Spotlights: Paul Johnson, CEO of Lemonaid

Today on THCB Spotlights, Matthew sits down with Paul Johnson, the CEO of Lemonaid. Lemonaid just closed a $33 million Series B led by Olive Tree Ventures, expanding their direct-to-consumer online services which provide primary care visits as well as pharmacy and medication delivery to your home and launching into more chronic areas of care, such as hypertension, high cholesterol, asthma and type 2 diabetes. Why did they wind up with an Israel-focused lead investor in Olive Tree as a San Francisco-based company? Where is Lemonaid in terms of growth and revenue? And how is Lemonaid differentiating itself against some of the other chronic care management and telehealth companies? Find out how the company aims to provide care for patients holistically and be the first point of contact for patients in seeking healthcare.

Health in 2 Point 00, Episode 132 | Accolade IPO, Somatus, NexHealth, Tatch & more

Today on Health in 2 Point 00, Jess and I cover some big news! Accolade has filed its IPO, so on Episode 132 I give my take on this health care navigation service. We also cover Somatus getting $64 million for chronic kidney disease care, NexHealth raising $15 million, Tatch raising $4.25 million for sleep apnea diagnosis, Simply Speak raising a $1.1 million seed round, and optimize.health raising $3.5 million for its remote monitoring platform. —Matthew Holt

Telehealth’s Missing Link: In the Rush to Implement Virtual Care, What Did CMS Leave Out?

By RAY COSTANTINI, MD

Imagine three months from now when the predicted ‘second wave’ of COVID-19 is expected to resurge and we’re still without a vaccine. Telehealth has become the entry-point to care, widely adopted by patients both young and old. Now, when an elderly diabetic patient wakes up in the middle of the night with a dull ache on her left side and back, she doesn’t ignore the symptom, like she may have during the first COVID outbreak. Instead, she logs online to her local hospital’s website from a cell phone and accesses a simple questionnaire to report her health history and presenting symptoms. The whole process takes just a couple of minutes and she immediately hears back from her health provider with the suggestion to schedule an in-person appointment for further testing to rule out any kidney issues. 

This patient doesn’t become one of the nearly 50% of Americans who delayed care during the initial COVID pandemic. She was able to access care without having to download an application or wait to schedule a virtual appointment during normal business hours. She receives virtual asynchronous care on-demand, coordinated to sync with her electronic health record. The next day, she receives a follow-up call from her primary care doctor to ensure her symptoms were alleviated with the over-the-counter pain medication she was prescribed. 

I applaud the article written by Paul Grundy, MD, and Ken Terry, “Primary Care Practices Need Help to Survive the COVID-19 Pandemic,” in which they called on Congress to make health policy decisions that will provide immediate financial relief for primary care practices. We must mitigate the real risk we face: the highly possible shutdown of our healthcare system. Amid the coronavirus pandemic, the U.S. healthcare system has taken an enormous financial hit and primary care practices have been especially affected and are struggling to survive. As the authors point out, telehealth has taken the spotlight to fill the acute need for an influx of patients needing to access care under social distancing practices. Telehealth can increase access to care, relieve provider burden, reduce costs to systems, and improve patient outcomes. However, this is only possible with on-demand telehealth, or asynchronous care. 

If COVID-19 has a silver lining, it is that forced social distancing has accelerated telehealth adoption by as much as 20 years, according to Deloitte. And while no one is certain when or how the crisis will end, one thing is abundantly clear: widespread use of telehealth is here to stay. Or, as CMS administrator Seema Verma said, “The genie’s out of the bottle on this one.”

That said, in the rush to implement telehealth solutions, CMS and many providers—failed to include asynchronous virtual care as a viable alternative to in-person care. Now though, we have the opportunity to develop a more thoughtful strategy going forward––one that can brace our system at a time when it needs the support.

First, we must establish a broader definition of “telehealth” that includes modalities other than video visits. Non-video forms of virtual care also deliver value for both patients and providers. In some cases, they may go further than video can to increase access and affordability and to protect a patient’s continuum of care. 

Take asynchronous virtual care delivery, for example. 

According to the FCC, approximately 21 million people lack broadband access, which makes video-based telehealth unavailable to large portions of the U.S. Asynchronous telehealth solutions don’t require high-speed internet or even a 4G mobile connection to deliver care. The store-and-forward nature of these platforms means very little data is required to exchange the crucial information needed to provide a complete episode of care.

Asynchronous telehealth platforms that fully integrate into clinical workflows ensure a patient’s electronic health record is intact. This is especially important during times of crisis when a patient seeks care remotely to avoid possible infection. If he or she receives care that isn’t reflected in their record, important information is lost and can impact the quality of care they receive in the future.

Because store-and-forward telehealth platforms boost clinical efficiency by saving provider time over in-person or video visits, they provide cost savings for all involved—healthcare systems, payers, and patients. When some of those savings are passed on to patients, reducing their overall out-of-pocket costs, those patients are less likely to avoid care due to financial concerns that include the threat of surprise bills.  

It is likely, if not inevitable, that how patients access care has been changed forever by COVID-19. Telehealth will continue to play a major part in how patients get care, but virtual care has much more to offer than video visits. Regardless of the modality, if a provider is able to deliver an episode of care that is held to the same standard and quality of in-person care, that visit should be reimbursed at a level that is fair to all parties involved. 

CMS has a real opportunity to help strengthen our injured healthcare system. In addition to patients who have access challenges, providers and systems are struggling financially. If patients put off visits because securing a video or in-person appointment is a challenge, we are going to see fewer ambulatory and non-acute patients, which has an immediate financial impact on systems and could lead to more chronic and emergent conditions that could have been avoided. 

Now is the time for Congress to take action and adjust the CARES Act to include ALL types of telehealth solutions, including virtual care like asynchronous telehealth, and to compensate providers for using it accordingly. These telehealth policy changes should be permanent – our new normal. Perhaps then we will look back at the COVID era as a pivotal time in our nation’s history when healthcare changed for the better. When we considered new entry points to care that are effective, reduce burden on clinicians, and offer more immediate care beginning with triage for patients. It’s the silver lining in this cloudy mess. 

Ray Constantini, MD is the CEO and Co-Founder of Bright.md.