On Wednesday January 10^th, 2018 I attended the Health 2.0 WinterTech Conference.

WinterTech is a conference with perfect focus on the pulse of digital health investing.

This one day San Francisco symposium, held in parallel with JP Morgan Week, brings together top tech companies, venture capitalists and entrepreneurs to explore the present and future digital health landscape.

Here are my five major takeaways:

1. THREE OR LESS HEALTH TECH IPO’S IN 2018: the venture capitalist panel notes that 2018 will yield less than three health tech IPO’s and over $12 billion in digital health investments.  Digital Health companies historically have not produced outsized IPO returns on the order of LinkedIN, Facebook and Google.
2. TSA PRE-CHECK COMES TO THE FDA: The future of health is a TSA Pre-Check style program for FDA approvals for software as a medical device. Click for additional details,
3. MOST CHRONIC DISEASE IS REVERSIBLE: A panelist cited the National Institute of Health statistic that “86% of disease is lifestyle driven and reversible.” Meanwhile, 185 million Americans have one or more chronic diseases.
4. DIGITAL THERAPEUTICS ARE THE FUTURE, YET 70% OF DOCTORS HAVE NEVER USED THEM: Digital Therapeutics are the use of a dedicated digital device, software, or both for prevention, chronic condition management, etc. According to a presentation by Patricia Mechael, PhD, MHS, 70% of neurologists and 70% of endocrinologists have never used digital therapeutics. Technology has the potential to positively impact health via patient behavior and ownership, improvements in patient care and data driven treatment decisions at the individual patient level.
5. THREE COMPANIES I LOVED:
   1. Parsley Health focuses on the consumer not the insurer. 50 minute patient visits. Nutritional guidance. Advanced testing. The future of healthcare.
   2. Buoy Health is a platform leveraging AI to easily check symptoms and identify the best options for care – before you go to the doctor.
   3. Smart Contacts is the future of vision care. Renew contact lens prescriptions and take an eye exam via your phone. Yes!

A day well-spent. It was absolutely fascinating.

his year’s Vator Splash Health, which took place at Kaiser HQ in Oakland, was Startup focused and well worth the price of admission.

As we’ve come to expect, it featured a very impressive line-up of panelists and speakers dealing with extremely relevant topics ranging from opening remarks (kidding), tackling cancer with technology, to patient-centered healthcare, to telemedicine and patient engagement, to protecting yourself as the founder, to uncovering new data from API’s and platforms, to big picture items, such as the future of healthcare altogether.

There were supercharged Splash competition presentations featuring three of Health Tech finalists creating an opportunity for new businesses to effectively message their product.

Participating vendors were easily accessible; including Bloom Technologies, DocDelta, Lighthouse, from the American Diabetes Association, Lab Sensor Solutions, Carrum Health, and Crediyo.

Event partners included KPMG, SAP Startup Focus, Bread & Butter, Artis, Scrubbed, Stratpoint, and Healthiest.

On the agenda throughout the day were fireside chats with the likes of Helmy Eltoukhy, founder & CEO, Guardant Health and Vator founder/CEO Bambi Francisco.

Other splash talk topics showcased — when software eats bio, funding the science behind healthcare, Who’s financing the digital health ecosystem?, and Are You in Kaiser’s Line of Sight: A Buyer’s Perspective.

Big data was discussed at length, crystallizing the notion that it is the current ability, made accessible by modern technology, to put meaningful patterns together that are deployable that will affect outcomes and achieve objectives.   

An additional topic or two that I was pleasantly surprised by was the acknowledgement by Dave Schulte, Managing Director at McKesson Ventures, of the importance of the virtue of humility, in admitting “not knowing”. Kudos to Dave because this, of course, comes against the backdrop of Silicon Valley’s famed hubris. 

Leading to another interesting point in that, at a minimum, the possibility (if not certainty) exists, that there will be a falling away or clearing of many of the startups and downturn both in investment activity and new business creation.

A sober but fair assessment and reminder of the unavoidable cyclical nature of business that correctly tempers expectations. 

More than simply being a fun event, populated by interesting shakers and market makers, with good,  healthy food (a very pleasant change), it was a phenomenal networking forum and that, perhaps, is its most intrinsic value.

I guess it’s pretty egotistical, but one of the links I’m giving you today is mine.

It’s is a quick read, but really useful; a guest post I did for Catch Your Limit Consulting, a strategic management and marketing firm, called Hate The Plan, Love The Planning. Let me know what you think.

The second one is an article you’ll probably be hearing a lot about. No matter what you think of the content, the question is whether John Mackey, CEO of Whole Foods, should have stepped into the political wasp nest of healthcare. After you read the article, be sure to click the comment tab at the top and scan through some of them. Interesting reading.

And please take a minute to share your favorite business OMG moments for the chance to win a copy of Jason Jenning’s Hit The Ground Running.

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I’ve written a number of posts abut the lack of leadership in healthcare and the resulting problems with links to useful articles. I’ve even managed to discuss them relatively calmly and sans four-letter words—or at least edited them out. (My focus isn’t surprising, since I’m one of the 47 million uninsured.)Three new articles prompt today’s post.

The first was an article, including multiple links to additional information, at Health Care Renewal by Roy M Poses MD. It shines a light on just how little unethical and/or illegal actions impact a career these days.

On September 10th, according to Bloomberg, “UnitedHealth Group Inc.’s former chief executive officer William McGuire agreed to pay $30 million to settle a lawsuit brought against the company and individual defendants over backdated stock options.” But don’t waste your sympathy on Mcguire, who still has around $800 million in stock options to fall back on.

On September 11th, “the Minneapolis Star-Tribune reported Stephen Parente, director of the Medical Industry Leadership Institute in the Carlson School of Management said the school had given him the go-ahead to explore the idea [to be “executive in residence”] with McGuire, former chief executive of Minnetonka-based UnitedHealth Group… “We don’t really care about the stock options.””

How’s that for a great leadership stance?

On September 18th, The Star-Tribune reported that the University of Minnesota is disavowing any plans to make McGuire a faculty member.

Looks like someone with at least a half a brain figured out that having an ethically challenged “executive in residence” wasn’t a good idea.

The second highlights yet another onerous practice of healthcare providers called “balanced billing”—only this one’s often illegal.

“Balance billing most frequently occurs when medical providers participating in a managed-care network believe the plan’s insurer is imposing too deep a discount on medical bills or is taking too long to pay. California, New Jersey, and 45 other states ban in-network providers from billing insured patients beyond co-payments or co-insurance required by the plan. Similarly, federal law prohibits providers from billing Medicare patients for unpaid balances… Many states also shield insured patients from balance billing by out-of-network hospitals and doctors in emergencies, since patients usually don’t control who treats them in those situations.”

Illegal or not, when collectors threaten to trash your credit people pay up. Better to call your State’s Attorney General and scream bloody murder. And if you’re unfortunate enough to live in one of the five states where it’s not illegal maybe you’d better get your network together and lobby for a change.

The third brings us to a new take on managed care.

“Consider what is happening in New England. Blue Cross Blue Shield of Massachusetts, that state’s dominant insurer, and financially struggling Caritas Christi Health Care, its second-largest hospital network, want to switch from a system that charges patients for every medical service to a managed-care-like flat fee per patient. The yearly fee would be adjusted for age and illness…

According to Dr. Stuart Rosenberg, head of a group of 1,400 doctors at Beth Israel Deaconess MedicalCenter in Boston, “70% of U.S. doctors who are specialists would be loath to enroll in a system that emphasizes primary care.

At least a third of those trillions is wasted on unnecessary care, according to the nonprofit Dartmouth Institute and other researchers, and medical experts blame widespread fee-for-service plans. These encourage volume over quality—doctors and hospitals have a financial incentive to perform more and more tests and operations whether they’re needed or not.”

Will it be better? Who knows, but at least they’re trying.

Consistent through all the problems, as well as the barrier to potential solutions, is the MAP (mindset, attitude, philosophy™) of greed and mememe that permeates our society.

In fact, that MAP is the one constant thread I see tying together the debacles on Wall Street, in healthcare, education, religion and a host of other problems.

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Awhile back I wrote several posts (rants?) on healthcare problems and some of the really terrible things that make my blood boil.

Over the last couple of weeks several new article caught my eye and I wanted to bring them to your attention.

1. Following up a February post on doctors and medical researchers extensive conflicts of interest resulting from pharma industry funding and gifts.

Amazingly enough, two industry giants, Pfizer and Zimmer, which manufactures hip, knee, and elbow implants, are concerned about a potential conflict—although not about funding or gifts. This one is about ongoing physician education, often funded by industry players.

“At the center of this controversy are medical communications firms paid by pharmaceutical and device companies to produce physician-education courses. Critics say the manufacturers hire the marketing firms as intermediaries to help them influence doctors’ prescriptions and procedures.”

Gee maybe all the articles, investigations and general negative publicity coupled with a consumer revolt that might force action in Washington are having an effect.

2. It’s disgusting that financial institutions buy the debt of the un/under insured and then charge exorbitant interest rates on it.

Now the light is being shined on a practice that drives one more nail to the inability to buy insurance—assuming that you can even afford it.

“An untold number of people have been rejected for medical coverage for a reason they never could have guessed: Insurance companies are using huge, commercially available prescription databases to screen out applicants based on their drug purchases. … Most consumers and even many insurance agents are unaware that Humana, UnitedHealth Group, Aetna, Blue Cross plans, and other insurance giants have ready access to applicants’ prescription histories. These online reports, available in seconds from a pair of little-known intermediary companies at a cost of only about $15 per search, typically include voluminous information going back five years on dosage, refills, and possible medical conditions. The reports also provide a numerical score predicting what a person may cost an insurer in the future.”

3. We all know how important it is to wash our hands, but many of us are careless about doing it—including healthcare providers.

“Despite recommendations, nearly 60 percent of health-care workers do not wash hands while on duty. … Why? … For one thing, rigorous hand washing is time-consuming. Guidelines advise that we first rinse, then soap for 20 seconds, then rinse again for 30 seconds; after this, we paper-dry our hands and turn the faucet off using the paper towel. For health-care workers, the procedure is supposed to be followed before and after every patient encounter. That means two minutes per patient visit, which adds up to an hour for a doctor who sees an average 30 patients a day, and 2 1/2 hours per shift for an ICU nurse.”

Now, in an effort to force improvement, “Starting in October, hospitals will be penalized for the consequences of unwashed hands: Medicare will no longer pay for complications arising from certain hospital-acquired infections, which in many cases result from poor hand hygiene. This will be a powerful incentive for health executives to improve hand-washing compliance.”

Will it be an incentive? Or will the hospitals just bill the patient for what Medicare doesn’t cover and then sell the receivables to the highest bidder?

4. A possible bright spot—at least for those who work in large companies. It’s on-site medical clinics driven by the very best motivator—vested self-interest.

“[Toyota’s] medical center, which cost $9 million to build in 2007, could save the company many millions over the next decade. Managed by Take Care Health Systems whose business is running medical clinics, the program has helped Toyota slash big-ticket medical items including referrals to highly paid specialists, emergency room visits, and the use of costly brand-name drugs. Plus, there are big productivity gains because workers don’t have to leave the plant and drive to a doctor’s office for routine medical matters. … A recent study by benefits-consulting firm Watson Wyatt Worldwide found that 32% of all employers with more than 1,000 workers either have an on-site medical center or plan to build one by 2009. “We’re talking about a microcosm of health-care reform,” says Hal Rosenbluth, president of Walgreen’s health and wellness division. “Companies can take control and understand their health-care costs.””

In spite of a few bright spots, I honestly believe that the state of healthcare in the US is a mark of shame on the global stage.

What do you think?

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Post from Leadership Turn Image credit: dimshikSorry, I forgot to mention this in the previous post.

I’ve recorded a lot of shows over the years and when I want some company for what I’m doing I pop one in my VCR.

I was watching one recently and realized that there wasn’t even one drug commercial during the entire two hours. It was great.

These days, drug companies spend more than $6 billion a year on direct-to-consumer (DTC) advertising.

I prefer the thrilling days of yesteryear when there was a ban on DTC drug ads, but alas, Congress ditched it.

However, DTC is a real bone of contention for the FDA.

What do you think about drug advertising?

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As most of you know I’ve been writing a series on healthcare, linking to articles detailing the actions of doctors/healthcare professionals, insurance companies and financial institutions. What’s ahppening as opposed to political retoric of what should happen.

But last night I got to thinking.

The stuff the artilces describe isn’t new, it’s been going on for years. Sure, some are new wrinkles, but in general it’s all been around for quite a while.

Why suddenly all these articles? Why is the light being shown and the rocks turned over? What’s different?

Because it’s an election year? Unlikely, this stuff was going on four years ago, but there were no exposés about medical staff not washing their hands or drug companies financial involvement with doctors starting while they’re still in medical school.

So what’s new? What do you think has changed? What’s going on?

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If it’s not doctors ripping off Medicare it’s disability insurers jacking up Social Security’s overhead in the name of increasing their profits.

According to the New York Times, “The Social Security system is choking on paperwork and spending millions of dollars a year screening dubious applications for disability benefits, according to lawsuits filed by whistle-blowers…The insurers are forcing many people who file disability claims with them to also apply to Social Security — even people who clearly do not qualify for the government program.”

The insurance companies use the simplest, tried-and-true approach around to ‘force’ the applications—threatening to or actually cutting off benefits.

How great is the cost?

“…it costs $1,180, on average, to process a single Social Security disability application to the first decision, usually a rejection. If the applicant persists through the first three levels — the initial review, a reconsideration and a hearing by an administrative law judge — the case will cost the system an average of $4,759″

Insurance companies refer 2.5 million disability applicants a year; considering just the basic processing cost that’s nearly three billion dollars. And since they insist on multiple appeals the cost is far higher. Plus, the extra load slows processing for the truly disabled.

Do the whistleblowers have a valid case? Seems likely since the expert witness for the plaintiffs is the former top administrator of the Social Security disability program Kenneth D. Nibali.

One way to stop this practice would be for Social Security to bill the insurance companies for processing costs on meritless claims.

A radical idea that would never get past the insurance lobby.

Think a bill-back would help? Have a better idea?

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Over at Yielding Wealth, Miranda wondered why “universal healthcare” is such a bogyman considering that “Our education system, police force, and even our mail system is socialized…And, of course, one can’t forget socialized capitalism…Society (via taxpayers) provides subsidies for all sorts of companies — profitable Big Oil and Big Ag concerns come immediately to mind. Some would argue that the Federal Reserve itself is something of a socialist institution…” and, of course, the almost done deal of Bear Sterns/JP Morgan/Federal Reserve with us taxpayers holding the bag.

Actually, I think that Miranda hit on the perfect solution—subsidies!

Where ‘universal healthcare’ is steeped in ideology subsidies are embraced.

Better yet, lets make healthcare an earmark, that way every resolution will fly through congress with nary a peep from any direction.

What do you think?

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(Part of an ongoing series)

Those Americans fortunate enough to have medical insurance have long known (if they gave it any thought) that their sensitive medical records are frequently sent overseas for processing right along with most other forms of insurance processing.

Now their bodies are following—paid for by their own health insurance.

“David Boucher, 49, doesn’t fit the usual profile for such medical tourists. An assistant vice-president of health-care services at Blue Cross & Blue Shield of South Carolina, he has ample health benefits. But Boucher recently chose to have a colonoscopy at Bumrungrad International Hospital in Bangkok, mainly to make a point about the expanding options available to Blue Cross customers. And his company happily picked up the $640 tab—a bargain by U.S. standards.”

“”All of the largest U.S. insurers are starting to educate themselves or are putting [offshore] programs in place,” says Jonathan Edelheit, president of the Medical Tourism Assn., an industry group formed just last year. Companies that self-insure are also bombarding Edelheit’s group with requests for information.”

India’s not stupid, they know where the money is, as do many other countries and there are plenty of entrepreneurs who know that medical tourism is definitely a growth industry. One such is Value Medicare that offers “First world care at third world prices.”

The fact that most Indians don’t have access to medical tourism’s palatial care isn’t surprising either, in most countries locals can’t pay what foreigners pay and globally healthcare is a profit center.

One result from all this will be stronger financial returns for insurance companies—premiums based on actual US healthcare costs and payouts based on the price tags in countries with much lower costs—a heart bypass in the US costs $130,000, while it’s $18.5K in Singapore, $11K in Thailand and just $10K in India—all countries where the medical staffs are probably better at hand-washing, too.

Another will be more costs on the backs of the working poor and uninsured who have no options—unlike the poor in India where the state pays for the healthcare they do get.

Would you want to go overseas for a needed procedure?

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