Healthcare consumerism is on the rise and individuals now expect convenience in each step of their care experience. Digital pharmacies like Medly are taking advantage of this shift. The New York City-based startup provides same-day delivery of prescription medications. Providers can send prescriptions to the Medly platform then patients book a time for home-delivery. Founded in 2017, the company is headquartered in Brooklyn and serves customers in the greater New York and New Jersey area. Medly recently announced a new Series A funding round led by Greycroft for an undisclosed amount. Following the footsteps of their competitor, Capsule, the startup plans to use the infusion of funds to expand its services throughout the US. Medly believes that through humanizing their service and free same-day delivery, they will be differentiated from their competitors.
With the US in the midst of the opioid epidemic, healthcare stakeholders are leveraging technology to create alternative sources of pain relief. Recently, the FDA granted De Novo clearance for a prescription nerve stimulation device called IB-Stim. Developed by Innovative Health Solutions, the device is a single-use electrical nerve stimulator that reduces functional abdominal pain for adolescents and teens with irritable bowel syndrome. It is placed behind the patient’s ear and emits a low-frequency pulse that stimulates cranial nerves to provide pain relief. This isn’t the first time the FDA has provided marketing authorization for a digital health tool to target the opioid crisis and pain management. In recent years, the FDA cleared the NSS-2 BRIDGE, a device used to reduce symptoms of opioid withdrawal and the Electro Auricular Device for use in acupuncture. Neurological medical devices offer the possibility of safer alternatives to pain management.
Although house calls evoke flashbacks to the 1900s, startups like DispatchHealth and Heal are making a case for them in this tech-enabled world. Both startups reimagine traditional house calls with mobile technology that allow patients to request on-demand care. In this care delivery model, the clinician arrives at the patient’s home within two hours and focuses on common health concerns like the flu, UTIs, stomach viruses, respiratory conditions, etc. The dispatched clinician then shares detailed notes to the patient’s primary care provider to ensure care is coordinated and no information is lost.
In 2018, Heal raised $27M in Series A funding and has steadily expanded its service area and partnerships. While Heal continues to build on their company, DispatchHealth announced this month they have gained $33M in growth capital financing. DispatchHealth also added Kaiser Permanente (Colorado) to their list of health insurers, which includes Medicaid, Medicare, Cigna, Aetna, and more. The new investment will allow DispatchHealth to extend its service area coverage and develop new partnerships. With the ever growing consumer demand for healthcare at home, we can expect startups like Heal and DispatchHealth and house calls to become more prominent.
The ability to communicate and be understood is a privilege that is often taken for granted. For those who suffer from neurological conditions such as ALS, multiple sclerosis, traumatic brain injury, and Parkinson’s disease, impaired speech limits how they can express needs and engage with those around them. However, with the advancement of voice-enabled tech and artificial intelligence, Google AI seeks to empower those with speech impairments by improving a computer’s ability to understand diverse speech patterns.
Project Euphonia, part of the AI for Social Good program, uses specialized software to turn recorded voice samples into a spectrogram, or a visual representation of the sound. Common transcribed spectrograms are used to "train" the system to better recognize less common types of speech patterns. Those with severe disability or nonverbal individuals also benefit from this project given that Google’s personalized AI algorithms are simultaneously working to detect facial movements and gestures. Euphonia can then take actions such as generating spoken commands to Google Home or sending text messages. The ultimate goal of this initiative is to support people with impaired speech and empower them to communicate freely and effectively.
Health care insurers are increasingly using wearables to engage and monitor the health and wellness of their members. For example, Aetna’s Attain and UnitedHealthcare’s Motion programs incentivizes beneficiaries to perform tasks designed to improve their health. Oscar Health’s new partnership with smartwatch app maker Cardiogram takes a different approach by improving access to care for those at risk of developing chronic conditions. Oscar Health is able to more effectively manage the health of its members through early disease detection by leveraging Cardiogram’s clinically proven artificial intelligence technology.
Oscar beneficiaires will be able to download and use Cardiogram Care on their smartwatch for free. After uploading the necessary insurance information, each user will be monitored for signs of diabetes and atrial fibrillation. If symptoms are detected, users will need to take further tests to confirm the diagnosis. If a previously undiagnosed condition is confirmed, the app will be able to refer the user to in-network physicians. As wearables slowly become more prevalent, having a clinical workflow leveraging smart devices can have dramatic implications on how we access care in the future.
Millions of Americans across the country do not have adequate access to healthy foods. For example, those living in low income neighbourhoods, communities of color, and rural areas often do not have a nearby supermarket stocked with nutritious, affordable, and high quality foods. In an effort to remove such transportation barriers, Lyft will be expanding its Grocery Access Program to more than a dozen cities in the US and Canada over the next year. The ride-share platform will be partnering with local organizations and nonprofits to provide low-income families in food deserts with discounted rides to the grocery store.
The expansion of the program helps Lyft maintain a competitive edge over its rival Uber in healthcare. Lyft’s Concierge service, which gives hospital administrators the ability to book NEMT for patients, came out two years ahead of Uber’s similar service, UberHealth. Now Lyft has once again gained a first mover advantage by being the first to roll out a grocery service. With payers seeking to mitigate costs associated with poor nutrition, we can see Lyft forging crucial partnerships and leveraging its platform to treat the growing health inequity in the US.
The rapid digitization of healthcare is enabling the advancement of technology solutions aimed at providing quality home-based care for patients. One notable example is the Portuguese startup SWORD Health. The company provides patients suffering from musculoskeletal disorders with a digital physical therapy solution. Each patient is given a wearable motion tracking device, an AI-powered digital therapist, and a clinical portal where caregivers can track their progress. The company published two studies in the Journal of Medical Internet Research and Nature Scientific Reports last month, showing its digital therapy platform is more effective than standard rehabilitation at helping patients recover from total knee arthroplasty.
SWORD Health recently announced it successfully raised $8M in Series A funding, indicating continued investor interest in their AI-powered platform. The funding round was led by Khosla Ventures with additional participation from several unnamed angel investors. It plans to use the investment for further clinical validation, improving product engineering, and expanding its footprint in North America. Khosla Ventures founder Vinod Khosla states SWORD Health’s “end-to-end technical approach enables exponentially more efficient delivery of care to patients and payers.” By providing accessible and effective care to patients at home, SWORD Health’s digital platform may be a huge disruptor of the physical therapy landscape.
Israel is a center for healthcare innovation, with 500 digital health startups and a world-class healthcare system. Researchers are leveraging the country’s interoperable EHRs for analysis. They can easily obtain data since EHR systems at different hospitals throughout the country are able to talk to one another.
According to Siman-Tov, director general of Israel’s Ministry of Health, de-identified patient data is enabling researchers to “generate insights and identify patterns that can later be implemented in decision support systems.” For example researchers from Clalit, the largest healthcare system in the country, have used medical records to identify patient populations with adrenal failure at risk of further degradation. In addition to furthering preventative medicine at a population-level, researchers plan to leverage the data in support of advancements in personalized medicine. Last year, Israel’s government approved a $276M investment in digital health in hopes of commercializing their medical databanks. Having already attracted the interest of many stakeholders, Israel continues to solidify its position as a leader in digital health innovation.
Digital health startups raised $8.1B from investors in 2018. However, with the exception of Roche’s $2B purchase of Flatiron Health and Amazon’s $1B acquisition of PillPack, there has been a lack of significant exits within the digital health landscape. In the past, many IPOs came from companies with business models familiar to Wall Street. For example, Veeva Health and AthenaHealth have a business model focused on selling cloud-based software while Fitbit focuses on selling devices.
Unlike in previous years, digital health companies planning to IPO have business models that emphasize combining technology and services. Livongo is a provider of chronic disease management services bundled with a blood glucose meter. It has hired Morgan Stanley, Goldman Sachs, and J.P. Morgan Chase to manage their IPO. According to Marc Albanese, senior director of research at CB Insights, “there hasn’t been a true digital health IPO,” putting a bit of pressure on Livongo. Undoubtedly, Livongo’s IPO performance will set the tone for how similar companies are received by Wall Street.
The increasing popularity of fertility trackers and other women-focused tech has spurred the growth of reproductive health companies with a digital focus. For example, Natural Cycles, the first birth control app to be CE-certified as a contraceptive in Europe, raised $30M in Series B funding back in 2017. Ava, maker of an ovulation tracking bracelet, also raised $30M in Series B funding early last year. NextGen Jane, a startup seeking to make it within the increasingly competitive reproductive health space, closed a $9M Series A funding round earlier this week. Leading the round was Material Impact. Additional investors include Access Industries, Viking Global Investors, and Liminal Ventures. NextGen Jane is planning to mail kits to women with a tampon they can send back and have analyzed. The Oakland, California-based startup will use the influx of cash to further its scientific dataset and prepare for a 2020 product launch. By providing women with accessible methods to understanding their reproductive health, NextGen Jane and other femtech startups will only continue to grow in the coming years.
Healthcare executives are increasingly worried about business model disruption due to the influx of new entrants, processes, and technologies into the healthcare industry. According to Change Healthcare’s 9th Annual Industry Pulse Survey, 13.3% of 185 healthcare leaders believe that innovations in care delivery will lead to potential advancement within the industry and 11.1% believe that refinement of customer experience will create disruptive change. Other potential disruptors include supply chain innovations (9%), launch of vertical one-stop healthcare companies (8%), and advances in artificial capabilities (7%). However, the survey findings also suggest that healthcare leaders are increasingly embracing healthcare technologies. Thirty percent of leaders indicate that EHRs are their leading source of clinical data and another 30% of respondents say that analytics are “extremely effective” or “very effective” at increasing workflow productivity.
Health systems are also jumping into the digital age, with patients portals employed by 73% and telehealth solutions employed by 54% of all surveyed respondents. Twenty percent of respondents indicate they currently use machine learning and 51% plan to employ the technology in the future. Interestingly, the survey reveals a marked lack of attention toward cybersecurity. Even while 40% of healthcare leaders see cybercrime as a potential risk, 38% answered that there are “too many competing priorities” to warrant the level of attention that cybersecurity needs. Nevertheless, the threat of disruption has charged healthcare leaders to intensify its commitment to combating new market entrants.
Preliminary results from the Apple Heart Study show the potential health benefits of wearables. Researchers from the Stanford University School of Medicine partnered with Apple to conduct a virtual observational study with more than 400,000 participants. The study used the Apple Watch’s irregular rhythm notification (IRN) system to detect atrial fibrillation (AFib). The results showed 0.5% of participants received irregular rhythm notifications. For those who were notified, 21% received and wore an ECG patch. Of those, Afib was confirmed 34% of the time. The positive predictive value of the overall study was 71%, however, this increased to 84% for the subgroup who also used an ECG patch. It should be noted that the study has not yet been published in a peer-reviewed journal.
Johnson & Johnson’s HEARTLINE Study aims to build on the Apple Heart Study. Announced back in January, the virtual clinical trial will enroll 150,000 Americans 65 years and older to detect AFib and collect outcomes data. Participants will be randomized to either receive the Apple Watch 4 or no watch at all. Compared to the Apple Heart Study, one key technical design difference allows the HEARTLINE Study to draw a clearer connection between AFib observance and confirmation. Instead of waiting for an ECG patch to be mailed to the participant, the ECG app on the user’s Apple Watch 4 will be engaged once the “IRN software detects five out of six consecutive irregular rhythms each lasting one minute.” Both the IRN software and the ECG app are FDA cleared for AFib detection. Although the clinical efficacy of wearables is far from conclusive, the innovative use of virtual clinical trials will likely be commonplace in the future with the continued proliferation of consumer-driven health technologies.
With the proliferation of devices such as the Google Home and Amazon Alexa, consumers have increasingly become accustomed to using voice technologies to send and receive information. Livongo, a chronic conditions management platform, has recently announced the launch of a new voice tool feature for its users. It is called "Cuff to Cloud" and is powered by Amazon Lex and Polly. It allows Livongo users to upload their blood pressure readings through a voice-enabled cellular blood pressure monitoring system. By running the data through the company’s AI+AI engine, users will receive personalized “health nudges” such as suggestions to reduce their sodium intake.
Hospitals are also evaluating the use of voice technologies to decrease inefficiencies and improving patient satisfaction. Cedars-Sinai is currently running a 100-hospital room pilot to assess the capabilities of a patient-centered voice assistant platform. Each room is equipped with an Amazon Echo run by Avia (an Alexa-powered platform). In addition to the standard Amazon Alexa features, patients can request help through the device. If the request is not answered in a timely manner, Aiva automatically sends it up the chain of command to notify the relevant personnel. By moving patient interaction into the 21st century, Cedars-Sinai hopes that a smart room will have a positive impact on patient satisfaction for both patients and nurses. Adrienne Edwards, an early user of the platform, praised the smart addition to her room. Feeling lonely, she asked the smart device, “Alexa, will you be my friend?” The device responded, “Of course we could be friends. You seem very nice.”
From personalized health recommendations to expediting patient-provider communication flow, voice technology is rapidly gaining traction among the patient population. What’s left to see is how fast can the technology be adapted to healthcare-specific settings with an inherent focus on patient privacy.
The use of artificial intelligence, voice recognition, and other modern solutions in healthcare organizations is fast becoming a reality. Hospital systems such as Thomas Jefferson University Hospital are quickly embracing these new technologies to increase patient satisfaction and experience. However, impressive patient-centered innovations require a solid technical infrastructure on the back-end to sustain long-term growth and stability. One type of data architecture, commonly known as data lakes, is a clear solution to this problem.
Modern healthcare organizations are able to pull data from Internet of Things sensors, social media feeds, website activity, in addition to electronic health records and other patient data. While data warehouses have traditionally been used to store current and historical data in an organized manner, they are unable to capture the vast amounts of raw data generated by modern technologies. This is where data lakes step in. Unlike the structured manner of a data warehouse, data lakes act as a central repository of unstructured, semistructured, and structured data to pull in vast amounts of information in real time. Everything from surgical systems to general ledgers and payroll can be pulled into a data lake, making them prime for experimentation. Organizations can load a variety of data types from multiple sources and quickly engage in ad hoc analysis, according to Kelle O'Neal, founder and CEO of management consulting firm First San Francisco Partners.
As more and more healthcare organizations look to data lakes as a viable solution for their data storage needs, it is important to understand the benefits of the architecture. Arizona’s Phoenix Children’s Hospital has pulled a variety of data from 40 healthcare systems into its data lake. Not only has this created a culture shift towards a data-driven approach to problem-solving, but it has also generated a number of practical solutions, such as algorithms for more accurate dosing. New York’s Montefiore Health System uses its “multi-sourced, tagged data to support artificial intelligence and deep learning.” As the transition towards value-based care continues, it can be incredibly beneficial for healthcare organizations to understand and implement data lakes in order to leverage data in support of clinical and operational decisions.
While artificial intelligence is a buzzword within the healthcare industry, there is a lack of real-world solutions aimed at ameliorating major public health issues. To spur the advancement of AI technology for the healthcare industry, IBM Watson Health has announced a 10-year, $50M investment in research collaborations with Brigham and Women’s Hospital, the teaching hospital of Harvard Medical School, and Vanderbilt University Medical Center.
A key area of focus will be studying how AI can utilize electronic health records and claims data to address public health issues such as precision medicine, health equity, and patient safety. Additional research will be conducted to explore the physician and patient user experience with AI technologies. The collaboration will combine IBM Watson’s expertise in artificial intelligence with the “best health informatics researchers in the world,” in hopes of accelerating the development of real-world AI-solutions “to improve the utility of the EHR and claims data to address major public health issues.”
The highly lucrative robotic surgery sector is showing signs of continued growth as big name firms and investors pursue strategic investments in the $90B market. Early last week, Johnson & Johnson (J&J) announced plans to spend $3.4B in cash to acquire Auris Health, in addition to milestone payments of up to $2.35B. Auris Health is best known for being founded by the forefather to robotic surgery Frederic Moll. It gained FDA approval in March 2018 for its Monarch platform, a robot-assisted diagnostic and therapeutic bronchoscopy tool that will be able to perform lung biopsies.
The pharmaceutical and consumer products giant aims to leverage the acquisition to bolster its robotics program as well as to complement its existing pulmonary hypertension pharmaceutical program. However, some analysts have voiced concern over the acquisition due to the large premium paid. Last valued at $2.2B, Auris Health currently only has one product approved for lung biopsies. Nevertheless, future product launches and synergies with existing J&J programs could provide additional long-term value to the acquisition.
Aetna is the latest health insurance provider to partner with Apple in hopes of capitalizing on the Apple Watch 4’s incredible health monitoring capabilities. The launch of its new app Attain, gives Aetna beneficiaries the ability to track and be rewarded for healthy behavior. Unlike existing wellness programs, such as United Healthcare’s, the value of Attain is its focus on personalizing each individual’s experience. Apple Watch users will be able to receive personalized health goals, recommendations, nudges, and rewards. Attain incorporates user-provided medical data and data collected by the Apple Watch to make each suggestion.
Aetna enrollees have the option of receiving an Apple Watch 3 directly from the insurance provider or paying out of pocket for the Apple Watch 4. Users can pay back the price of the device over 24 months by accomplishing fitness goals and receive other benefits like corporate gift cards. While only 250,000 to 300,000 slots in the program are currently available, Aetna is planning on rolling it out to all of its 22.1M members.
Although Aetna’s collaboration with Apple allows the insurance provider to provide enrollees with personalized health recommendations, there is a concern among users about sharing private health information. In light of the various breaches in privacy by several tech giants over the past couple years, Apple has stated it will not access any data identifying an individual and Aetna has said it will not use the data to make coverage decisions. Nonetheless, this new initiative by Aetna marks the start to a widespread adoption of personalized medicine.
The Centers for Medicare and Medicaid Services (CMS) has launched its first ever consumer facing mobile application. The app “What’s Covered”, is available both on iOS and Android for all Original Medicare beneficiaries. Users will be able to search for medical products and procedures to determine their coverage. With more than 65% of Medicare users online, the app aims to provide accurate answers to many of the inquiries that the CMS receives. The service is part of a larger CMS initiative called eMedicare. It focuses on modernizing Medicare to help beneficiaries access their claims data by providing APIs to third-party software developers. In addition to the app, eMedicare also includes several web-based solutions, including price transparency tools, information on the differences between Original Medicare and Medicare Advantage, and intuitive surveys on the user experience of these tools.
Walgreens and Microsoft have announced a seven year strategic partnership. It aims to combine Microsoft’s technical expertise in cloud computing and AI technology with Walgreens’ extensive customer reach, location volume, and outpatient healthcare services. The two companies have committed to a research and development investment comprised of funding, subject matter experts, technology and tools, as well as possible joint innovation centers focused on key markets. Moreover, Walgreens will pilot 12 store-in-store “digital health centers” focused on selling healthcare-related hardware and devices. By leveraging each others core specialties, the partnership will “deliver new innovations, greater value and better health outcomes in healthcare systems across the world”.
After months of anticipation, Apple has released a software update enabling the echocardiogram feature on its Apple Watch Series 4. In addition to measuring the heart’s rhythm, the wearable includes a fall detection sensor that automatically notifies emergency services if a fall is detected. With the inclusion of such features, Apple seeks to partner with private Medicare plan providers to subsidize the cost of the watch for senior citizens. Apple hopes its health-focused tech can be used for preventative care. Apple CEO Tim Cook further touts Apple’s conviction to allow users to proactively manage their own health data, which he states will be Apple’s “most important contribution to mankind.”
While such claims reflect upon the industry’s optimistic mindset of healthtech advancement, it is important to note the security and privacy implications such tech will have on our society. Where will our health data be stored and how will consumers access their own information? Most importantly, how will insurance companies utilize this data? As we continue to accelerate the implementation of health tech into our lives, we should keep these questions in mind.