THCB Gang Episode 89, Thursday April 28, 1pm PT 4pm ET

Joining Matthew Holt (@boltyboy) on #THCBGang on April 28 for an hour of topical and sometime combative conversation on what’s happening in health care are: THCB regular writer and ponderer of odd juxtapositions Kim Bellard (@kimbbellard); medical historian Mike Magee (@drmikemagee); patient safety expert and all around wit Michael Millenson (@mlmillenson) & Principal of Worksite Health Advisors Brian Klepper (@bklepper1)

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

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Amwell CEO Roy Schoenberg: Telehealth Tech Is Now Changing Provider & Payer Business Models

BY JESS DaMASSA, WTF HEALTH

Amwell’s ($AMWL) President & co-CEO Roy Schoenberg called it early when he predicted pre-Covid that there would be a paradigm shift for telehealth that would take the technology from “healthcare product” to “healthcare infrastructure.” Now he’s back as (in my opinion) the best kind of market analyst to give us a new high-level take on where telehealth is headed next, how its customers’ demands have changed, and how the public market’s understanding of this technology and its utility in healthcare is starting to evolve.

The bottom line: Telehealth as infrastructure is just the tip of the iceberg. As Roy puts it, “The organizations that we work with now understand that distributing healthcare over technology is part of their future.” And whether it’s payers, health systems, private practices, or even Medicare, the seismic shift Roy sees now is that instead of looking at telehealth as a way to do their old business using new channels, the new channels are being looked at as an opportunity for healthcare organizations to completely remake their old business models. “Technology,” he says, “is being considered a change agent for how healthcare is actually arriving at the hands of its patients.”

So much more ground covered in this big telehealth trends conversation – it’s the PERFECT watch for the week before the American Telemedicine Association’s Annual conference. In addition to an update on the roll-out of Amwell’s new platform Converge (2/3 of the way there) and the integration of its latest acquisitions SilverCloud Health and Conversa Health, you’re going to want to listen in to our little gossip sess about telehealth policy and reimbursement at 17:45 AND our talk about the health tech investment market of privately and publicly traded companies that starts at the 20-minute mark.

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#HealthTechDeals Episode 25: Biofourmis, Reify Health, Nex Health, and Amae Health

In this week’s episode of Health Tech Deals, everyone cheats on each other: Eugene Borukhovich is the guest host replacing Jess! Eugene is cheating on Jim Joyce, while I cheat on Jess; though Jess has cheated on me with Eugene before! Jess is on a cult retreat in Costa Rica, but Eugene and I have some deals to discuss: Biofourmis raises $300 million; Reify Health raises $220 million; Nex Health raises $125 million; and Amae Health raises “several million.”

-Matthew Holt

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CEO Kuldeep Singh Rajput on Biofourmis’ huge Series D raise

You may have thought the days of huge digital health rounds were over. Not quite yet! CEO Kuldeep Singh Rajput talks with Matthew Holt about Biofourmis’ $300m Series D raise. They’re in the business of sensors, digital therapeutics and chronic specialty care (cardiology/oncology) and hospital at home. And as if that wasn’t enough, they have a solid plan for both organic & “inorganic” growth!

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Dara’s “Hero Quest”: How About Embracing Universal Health Care in America?

By MIKE MAGEE

Joseph Campbell, who died in 1987 at the age 83, was a professor of literature and comparative mythology at Sarah Lawrence College. His famous 1949 book, “The Hero With a Thousand Faces” made the case that, despite varying cultures and religions, the hero’s story of departure, initiation, and return, is remarkably consistent and defines “the hero’s quest.” Bottom line: Refusing the call is a bad idea.

George Lucas was a close friend and has said that Star Wars was largely influenced by Campbell’s scholarship. On June 21, 1988, Bill Moyers interviewed Campbell and began with a clip from Star Wars where Darth Vader says to Luke, “Join me, and I will complete your training.” And Luke replies, “I’ll never join you!” Darth Vader then laments, “If you only knew the power of the dark side.”

Asked to comment, Campbell said, “He (Darth Vader) isn’t thinking, or living in terms of humanity, he’s living in terms of a system. And this is the threat to our lives; we all face it, we all operate in our society in relation to a system. Now, is the system going to eat you up and relieve you of your humanity, or are you going to be able to use the system to human purposes.”

Systems gone awry? Think Putinesque Russia, or Psycho-pernicious Trumpism, or Ultra-predatory Capitalism.

Dara Kharowshaki, the CEO at Uber, who took over the company from uber-bro, Travis Kalanick, is a fan of Campbell’s and understands the journey of a hero – departure, initiation, return. Perhaps that is why he defines “movement” as fundamental to life…adding deliberately the qualifier “movement in the right direction.” In an interview in December, 2021, with Brian Nowak, Equity Analyst, U.S. Internet Industry, for Morgan Stanley, he pushed for corporate engagement in a range of issues including “sustainability, safety, equity, and anti-racism – these are all issues that go to the core of who we are, and our identity.”

How did health care escape that list, especially considering the companies investment in “Uber Health” – a health care delivery service promoting speed, care coordination, privacy, and cost-effective and reliable transport to and from care-giving brick and mortar?

It may have something to do with the fact that Uber has fought tooth and nail to avoid providing health care as a benefit to its drivers. In 2020, the company joined Lyft, DoorDash and other gig companies in throwing $205 million into a lobbying effort in California titled “Yes on 22”.

Background: “California, with its estimated 1 million gig workers, has been the largest U.S. market for that type of labor. Officials said the workers were deprived of health care, a minimum wage, job security, and basic protections against discrimination and sexual harassment. So legislators approved Assembly Bill 5 (AB5) in September 2019 to grant benefits to certain classes of gig workers, including Uber and Lyft drivers, by making them employees.”

“Yes on 22” was industry’s counter-response. In their successful drive, where they outspent the opposition 10 to 1, “yes” actually meant “no” for drivers, further cementing their contractor status rather than requiring that they be treated as fully entitled employees. With this bit of trickery, designed by Republican pollster, Bill McInturff, they won by a 59% to 41% margin.

The winners argue that Prop 22 is “preserving flexibility and pairing it with new protections.” In return for the contractor status they had to agree to subsidize health coverage for its California drivers who average 15 to 25 hours a week engaged as drivers or couriers to the tune of 41% of what standard health benefits would have been.

Dara may not be anxious to provide full health coverage to his workers, but he’s right that movement is essential to life – especially if by movement you mean access to health professionals, their institutions, their diagnostic equipment and their therapies. In this arena, Dara is caught in the middle of the “hero’s quest.”

He has passed through phase 1 and “departed” the dark brotopia world, and is currently brushing up against difficult choices within a stormy phase 2 “initiation.”

This has included a rather embarrassing incident that occurred on May 26, 2021, when Uber drivers outside of California received an email (which began with the optimistic opening line “Its a great time to get health coverage,”) announcing that the company would be subsidizing their health coverage, only to learn in a hasty follow-up email that it was all an embarrassing error. It read, “Unfortunately, we made a mistake sending this email to you, as this policy only applies to drivers and delivery people in California. We sincerely apologize for this error.”

Without naming names, Dara has clearly kept his own list of Darth Vaders in Silicon Valley. As he sees it, “Some of them grew up too fast and some of them didn’t take responsibility for their power and I think now they’re being called to reckon… I think the age of ‘I built a platform, I’m not responsible,’ that time is over. And now the question is, what does the responsibility look like? Defining it and putting guard rails around it, I think that’s a healthy thing.”

But his enemies might reply, “You know what else is a healthy thing? Health insurance!”

As Dara himself would admit life’s a journey, and movement toward hero status is filled with bumps along the way. Will he make it to phase 3, a hero’s welcome on his “return?” Earlier this year he said, “Sometimes the system ‘works too well’: I think capitalism has its claws in our democratic societies in ways that has allowed it to overly optimize for its benefit.”

These are tough times to lead – no doubt. Keeping families together, processing fear and worry, expanding opportunity and productivity – all are worthy and essential goals that can only be realized if our citizens have access to health care. That would most certainly be a “move for the better.” So why not get behind universal health care, Dara?

You could be a true hero. As Joseph Campbell stated “Is the system going to eat you up and relieve you of your humanity, or are you going to be able to use the system to human purposes?”

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THCB Gang Episode 88, Thursday April 21st, 1pm PT 4pm ET

Joining Matthew Holt (@boltyboy) on #THCBGang on April 21 for an hour of topical and sometime combative conversation on what’s happening in health care are: patient safety expert and all around wit Michael Millenson (@MLMillenson); digital health guru Fard Johnmar (@fardj); delivery & platform expert Vince Kuraitis (@VinceKuraitis); and a special guest – Alexandra Drane (@adrane) the queen of caregivers everywhere.

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

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#HealthTechDeals Episode 24: Carbon Health, Clipboard Health, Source Health, and Diligent Robotics

Happy 4/20 everybody! Smoking weed live on Health Tech Deals is not to be encouraged, but Jess and I embrace the natural high of discussing the multitude of million-dollar deals in health technology: Carbon Health enters diabetes care; Clipboard Health raises $50 and $30 million; Source Health raises $3 million; and Diligent Robots raises $30 million.

-Matthew Holt

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Has Virgin Pulse’s Acquisition of Welltok Created a New Kind of Care Navigator?

By JESS DaMASSA, WTF HEALTH

Virgin Pulse has been a big name in workplace wellness for a long time – working with health plans and employers (including 25% of the Fortune 500) to provide care navigation, well-being services, health coaching and access to digital health point solutions for years. Yet, it raised some eyebrows at the end of last year when it announced its acquisition of data-driven wellness company, Welltok. So, what happens when one of the biggest names in worker wellbeing suddenly has access to a dataset of 250M healthcare consumers? Virgin Pulse’s CEO Chris Michalak stops by to talk about the value of that data, which he believes will not only turbo-charge Virgin Pulse’s engagement rates, but also provide new ways for the business to serve as a “full-on navigation capability” for employers, plans, and health systems.

As Chris puts it, Virgin Pulse has always been an “engagement company” but the addition of Welltok’s data turns it into an “activation company.” As Virgin Pulse continues to partner up with digital health point solutions, bring digital therapeutics into the fold, and build-out primary care relationships as a lead stream, the platform Chris describes starts to sound more and more like a navigation business that competes with the likes of Accolade or Included Health. Will Virgin Pulse one-day dip into primary care themselves and add their own virtual care providers? Will they build their own digital therapeutics with data derived from that rich Welltok database? We get into the ‘what’s next’ for the business as it integrates its latest acquisition and seeks to win more C-suite attention from employers seeking to better manage their employees’ access to healthcare benefits.

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We Love Innovation. Don’t We?

BY KIM BELLARD

America loves innovation.  We prize creativity.  We honor inventors.  We are the nation of Thomas Edison, Henry Ford, Jonas Salk, Steve Jobs, and Stephen Spielberg, to name a few luminaries. Silicon Valley is the center of the tech world, Hollywood sets the cultural tone for the world, and Wall Street is preeminent in the financial world. Our intellectual property protection for all that innovation is the envy of the world. 

But, as it turns out, maybe not so much. If there’s any doubt, just look at our healthcare system.  

———

Matt Richtel writes in The New York TimesWe Have a Creativity Problem.”  He reports on research from Katz, et. alia that analyzes not just what we say about creative people, but our implicit impressions and biases about them.  Long story short, we may say people are creative but that doesn’t mean we like them or would want to hire them, and how creative we think they depend on what they are creative about.  

“People actually have strong associations between the concept of creativity and other negative associations like vomit and poison,” Jack Goncalo, a business professor at the University of Illinois at Urbana-Champaign and the lead author on the new study, told Mr. Richtel. 

Vomit and poison?  

A previous (2012) study by the same team focused on why we say we value creativity but often reject creative ideas.  “We have an implicit belief the status quo is safe,” Jennifer Mueller, a professor at the University of San Diego and a lead author on the 2012 paper, told Mr. Richtel.  “Novel ideas have almost no upside for a middle manager — almost none, The goal of a middle manager is meeting metrics of an existing paradigm.” 

You’ve been there.  You’ve seen that.  You’ve probably blocked a few creative ideas yourself. 

The 2012 research pointed out: “Our findings imply a deep irony.  Prior research shows that uncertainty spurs the search for and generation of creative ideas, yet our findings reveal that uncertainty also makes us less able to recognize creativity, perhaps when we need it most.  Moreover, “people may be reluctant to admit that they do not want creativity; hence, the bias against creativity may be particularly slippery to diagnose.”

In the new study, participants were given two identical descriptions of a potential job candidate, except that one of the candidates had demonstrated creativity in designing running shoes, but the other in designing sex toys (the researchers note: “the pornography industry plays a significant role in the refinement, commercialization, and broad dissemination of innovative new technologies”).  The participants explicitly rated the latter candidate as less creative, although their implicit ratings showed equal ratings.  

The researchers concluded:

Collectively, the findings strongly support our contention that implicit impressions of creativity can readily form, be differentiated from a traditional explicit measure, and uniquely predict downstream judgment, such as hiring decisions, that might be relevant in an organizational context.

This matters, they say, because: “the findings of study 4 seem to square with real world examples of highly creative people who were ignored until well after their death because their work was too controversial in its time to be recognized as a creative contribution…”

Umm, anyone remember Ignaz Semmelweis?

As the researchers warn: “The results of study 4 merely hint at the possibilities that await in many other embarrassing, stigmatized, or controversial domains within in which people might choose to do their most creative work but that their peers (and creativity researchers) might fear to tread.”  

E.g., if you’ve done your creative work in the health insurance space, that doesn’t necessarily buy you much credibility in the rest of the health care world – or if you’ve demonstrated your creativity in health tech, the rest of the tech world may still doubt your skills. 

——–

Well, at least our patent system, which protects intellectual property and helps fosters innovation, works, right?  Again, not so much. A New York Times editorial charges: “The United States Patent and Trademark Office is in dire need of reform.”  In the current Patent Office system, the Editorial Board asserts, “not only is legal trickery rewarded and the public’s interest overlooked, but also innovation — the very thing that patents were meant to foster — is undermined.”  

If there’s any doubt, just look at the price of insulin, which has been propped up by patent “innovations” that keep its price high after a hundred years.  “When it comes to protecting a drug monopoly,” The Times says, not limiting those monopolies to insulin, “it seems no modification is too small.”

The Patent Office, The Times suggests, needs to ensure that inventions are “truly novel and nonobvious, it must be described in enough detail for a reasonably qualified person to build and use it, and it must actually work.”  It also needs to challenge “bad patents,” such as those from so-called patent trolls, which exist not to innovate but to extort money from actual innovators.  

The U.S. is still, by far, the leader in patents granted, but not in scientific research papers or R&D spending per capita/% of GDP, which makes one wonder what all those patents are for. 

———–

Healthcare desperately needs innovation.  No one can dispute that; not anyone working in it, not anyone receiving care from it, not anyone who has had any exposure to it.  But healthcare also has a lot of middle managers, and middlemen, and, as Professor Mueller said, “Novel ideas have almost no upside for a middle manager.”  

Even worse, healthcare is always teetering on the edge of uncertainty – where’s the funding coming from, how much, what health crisis is coming, what’s the government going to do next?  The forces causing all that uncertainty should be driving innovation, but, as Professor Morrison’s 2012 research also found, “…uncertainty also makes us less able to recognize creativity.”  We have blind spots about what creativity is, who creative people are, and when and how we should incorporate those into our organizations.

Right now, healthcare thinks that EHRs and digital health – whatever that might actually be — qualify as innovation.  That’s enough, it believes; those are forcing change in ways and at pace healthcare is not used to and is not comfortable with. 

Too bad.

It has been said that if your company has an innovation department, it’s not innovative. If it has middle managers deciding which novel ideas get pursued, don’t expect real innovation.  If it is ruling out hiring people who worked on unusual projects (think sex toys), it’s rejecting creativity.  

Your biases against creativity may (not) be showing.

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

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#HealthTechDeals Episode 23; Real, Iris Telehealth, 9am Health, Eko & Duos

In this episode of Health Tech Deals, Jess thinks the music has stopped as Rock Health reports Q1’s funding total being below Q4 2022! No $100m rounds today! But still $37m for Real; $40m for Iris Telehealth; only $16m for 9am Health but lots of Livongo connections; $30m for Eko and $15m for Papa-lookalike Duos

-Matthew Holt

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