Healthcare Handout #58

Everything that happened this week in health tech and business

Here’s a selection of stories we gathered on this week.

Things That Happened

Drugs that may work, and those that don’t. A new study in the Lancet showed hydroxychloroquine and chloroquine multiply the risk of serious heart distress 2 - 3x without also establishing they do anything to treat or prevent COVID-19, so it’d be a bad idea to take it prophylactically if you were thinking of doing something like that.

In the realm of drugs that work, Gilead has donated another 330,000 doses of remdesivir to the United States government, enough to treat 30-55k more patients. Which patients? Doctors are having to decide which patients should receive the drug without data on outcomes, and some, like UPMC, are using a lottery. Some new information arrived Friday night, with a new trial emerging in NEJM showing that remdesivir is successful in shortening recovery time, but with a decline in benefit as case severity increased.

Moderna released some data on Monday showing very early and small data on their coronavirus vaccine. While it was certainly positive, experts, as they are wont to do, urged caution, saying it’s entirely too early and the size of the study is so small that we can’t really derive any sort of reasonable predictions yet. 

The U.S. government, via BARDA, gave $1B to AstraZeneca to develop and distribute a coronavirus vaccine based on research from Oxford University. AstraZeneca is promising to make 1 billion doses of the drug with delivery starting as early as September (clinical proof of efficacy would come later than September).

This only scratches the surface of the drug and vaccine activity around COVID-19, so as always I recommend STAT’s drug & vaccine tracker

Chasing tracing. Apple and Google pressed a button, or whatever it is they do to push OS updates, and released their exposure notification API to the world. This meant that the 22 countries and several states, including Alabama, North Dakota, and South Carolina, who have said they plan on using it can release their apps. 

Some states are forging their own path: Rhode Island hired Infosys to build them a contact tracing app, which someone decided it was a good idea to call ‘CRUSH COVID RI,’ that’ll use location information to establish contact history. Georgia is making an app that lets people log their own contacts, like a journal in your phone, and share them with public health authorities if they so choose.

Getting stamped. Several companies, including Collective Health, Microsoft & UnitedHealth, Castlight Health, and Epic, are getting into the immunity passport business. While those are all focused on employers, ex-Googlers have created the CVKey Project, a non-profit working to create a QR-code based system that’d function as a “health pass” for people who want to go into stores and restaurants, and maybe even office buildings. Meanwhile, there are some pretty big questions about whether immunity passports actually work (due to our lack of understanding around convalescent immunity) and whether they’re a good idea (due to the opportunity they create for human rights violations). 

Primary scare. Primary care practices are in trouble. In a recent survey, 13% of practices said they’re facing the prospect of closing their doors within the next month due to a lack of revenue. This stems from the fact that 50% of the same practices report no income from virtual visits in the last month. Some argue private insurers would be doing themselves a favor by boosting payments to primary care now, to save themselves from having to live in a world without them a few months from now. Many of these practices will sell themselves to health systems at bargain prices, at which point insurance companies will have to pay the higher rates these health systems can negotiate.

Rebound. An analysis shows that outpatient visit numbers are beginning to recover from their April lows, but they’re still 30% lower than normal volume. Commercial labs are also experiencing a resurgence, and once you factor in COVID related activity many are actually operating at above normal capacities. The CEO of Medtronic says his company is gearing up for surgeries to resume after they’ve gotten word from numerous health systems that they’ll be working 7 days a week to make up for lost time. 

Ajit Pain. As part of the CARES Act, the FCC is doling out grants to aid providers with telehealth adoption. For example, Mount Sinai is using their $860K grant to build a remote monitoring app. But the problem is that despite approving $33M in grants thus far across 89 providers, only one has actually received the funds. 

Very well. Telehealth continues to notch big gains, with American Well raising $194M that’ll help them continue being a telehealth company, a winning strategy in the current climate. There’s still room for upstarts like Abridge, which is combining telehealth and natural language processing to produce automated transcripts of visits for both patients and providers. 

Fundamental. The mental health space is having a similarly huge moment. All in the space of this week: Mindstrong, which is targeting serious mental illness with it’s text and video care platform, raised $100M; Tava, a Utah-based mental health startup raised a $3M seed; and Cigna added Talkspace as a covered telehealth offering for 14M members, while Kaiser Permanente made the meditation app Calm, normally $70/year, freely available to all members. 

Down the river. Amazon expanded access to its platform, previously only available to office-based workers in Seattle, to warehouse workers also based in Seattle. Beachhead in care delivery, or just a way to save money with employee care? That’s the question. 

Recalling home. With Emergency Use Authorizations and deliberately relaxed enforcement, the FDA has been letting more products through the approvals process than usual. Stericycle is predicting a follow-on effect in the form of a precipitous rise of medical device recalls later this year. 

Big data. Palantir, the data analytics firm, has been hired by the Department of Veterans Affairs to deploy its Gotham software to “track and analyze COVID-19 outbreak areas and make timely decisions with insight into supply chain capacity.” This software is typically used in law enforcement. They’re also working with the NIH, and have recently secured large contracts around the world, all of it related to helping wring insight of data to fight COVID. 

Studying hard. Fitbit wants to build an algorithm for pre-symptomatic COVID-19 detection using their devices, and they’re launching a study to help them do that. Fitbit users with diagnosed cases are being asked to opt-in using the app. This is their second big study this launched month; they announced a heart study to detect arrythmia. 

CRISPIER. Mammoth Biosciences has agreed to a deal with GlaxoSmithKline to create and distribute a CRISPR-based coronavirus test. They’re targeting a rapid, disposable, and easy to use test that can be used by non-medical personnel and will deliver results even if the patient is asymptomatic. This would be the second CRISPR-based test after Sherlock Biosciences received an EUA for their test earlier this month. 

Things That Started Up

Things To Read

Stephanie Goldberg writes about Medline and how the coronavirus pandemic has dragged this generally muted medical supply behemoth out into the spotlight. 

David Muhlestein, et al write about a study in which they found that more accountable care organizations are actually physician led than those led by hospitals. This contravenes both the common conception of what exactly ACOs are, and the legislation and rules concerning them which tend to consider the needs of hospital-based ACOs over the less dominant, but more numerous physician-led versions. 

Heather Perlberg wrote about how private equity has sunk its fangs into dermatology, turning this lucrative practice area into one even more focused on profits and cash flows. To be fair to the vampiric shadow creatures of private equity, they’re simply magnifying many of the perverse incentives that already existed in the space. 

Lev Facher asked a panoply of experts from the many reaches of healthcare to opine on how our current pandemic will change the industry. They provide predictions on telemedicine, employer-sponsored insurance, nursing homes, scope of practice, drug pricing models, and much, much more. 

Dave deBronkart illuminated us all with a brief glimpse into how FHIR, the universal standard for transferring health data, actually works. If you’ve ever wanted to stroll through the office with the casual confidence of someone who understands how an API works, at least at an armchair level, look no further. 

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Healthcare Handout #57

Everything that happened this week in health tech and business

Here’s a selection of stories we gathered on this week.

Things That Happened

Wonder Drug. Gilead announced they’ve struck a deal with 5 generics manufacturers to make and distribute remdesivir in 127 countries, royalty-free for the duration of the pandemic (not including the U.S., naturally). Gilead hasn’t determined pricing for the United States yet, but STAT asked experts to weigh in with their thoughts on what Gilead could and should charge. 

Meanwhile, in our neck of the woods., following a scattered and mysterious initial distribution, HHS laid out a strategy by which they’ll distribute the thus-far donated drug to state health agencies, who can then in turn decide which hospitals are most in need. The problems continue, however, as doctors are still being forced to ration remdesivir, and must do so with little data-driven guidance on which patients the drug is most likely to help. 

Machine yearning. It’s often hard to tell the interesting AI from the run-of-the-mill ‘we’re saying it has AI to make it sound cooler’ stories. Two worth clipping from this week: Intel and Penn Medicine are collaborating with the NIH to create a new model for identifying brain tumors. What’s most interesting here is they’ll be using a technique called federated learning, which enables the training data to stay securely in one place while the model essentially travels around being trained. It goes a long way towards resolving privacy issues in medical AI applications. 

And Nvidia announced a lot of things this week, but most interesting to us is their Clara Guardian platform, which enables hospitals to run vast networks of distributed edge-AI equipped sensors. If you’re going to have a ‘smart hospital,’ you’ll probably need a platform like this one. Edge AI is particularly cool as it’s specifically engineered to run locally on a sensor, rather than requiring the computing power of a PC or vast network bandwidth. 

That’s a relief. A Kaiser Family Foundation study found that hospital relief funds, distributed by HHS along patient revenue lines, have overwhelmingly benefitted hospitals who see fewer Medicare and Medicaid patients when calculated on a per-bed basis. This could prove troublesome for some hospitals: Sarah Kliff wrote about how numerous hospitals are almost entirely reliant on relief funds at this point to keep their doors open, while others are dipping into investment portfolios to stem losses.  

Meanwhile, the CFO of the Mayo Clinic (one of the hospitals selling off its portfolio in the above story) mentioned in an interview that their projections for 2020 are looking much better after the nation avoided the worst-case-scenario and flattened the curve. If a better-than-expected hospital outlook helps them avoid further relief funds, that could be a good thing as the White House is starting to nudge Congress to require hospitals receiving relief funds to disclose their secret negotiated price lists with private insurance. 

Breathing easier. Fitbit will be shifting production bandwidth to make ventilators. While many ad-hoc ventilators are bare-minimum devices in terms of cost and features, Fitbit is targeting the mid-range on both qualities. Meanwhile, the Trump administration has begun the work of reworking the strategic national stockpile to avoid debacles like this in the future, by doing things like tracking shelf-life and increasing the planned number of days of supply they keep on hand. 

Good news and bad news. One Medical posted their first ever public earnings, revealing deeper losses than expected, but also some optimism in the form of raising projections for the total number of members they’ll have by years’ end. That said, they have pushed some new practice openings back into 2021. And don’t forget that study they commissioned that showed lowered costs per employee when using their system. 

Passport control. A number of companies are starting work on the next stage of the pandemic: getting back to work. Microsoft and UnitedHealth Group are collaborating on ‘ProtectWell,’ an app that allows employers to regularly survey their employees for COVID-19 symptoms. Collective Health announced ‘Collective Go,’ an app that goes a step further by helping employees store antibody test results to demonstrate their immunity to employers. Both are being offered for free to all employers. Also, Epic CEO Judy Faulkner said her company is eschewing a focus on contact tracing to build some sort of immunity passport solution. 

Virtual reality. Telehealth continues to notch progress towards the mainstream. BCBS of Tennessee, which had boosted tele-visit payments to match those of traditional on-site visits during the pandemic, has decided to make those changes permanent. Up in Washington, Premera Blue Cross has gone even further by creating a lower-premium plan where the tradeoff is that patients must use telehealth app 98point6 for all their primary care. Telehealth provider Doctor on Demand has elected to become the first of its kind to offer services permanently to Medicare Part B beneficiaries. And scheduling service ZocDoc has unveiled their own video consultation platform. 

And addiction medicine has been effectively transformed by the lax, pandemic-era rules of telehealth. Physicians in this space are hoping this new way of doing things outlasts the disease as it has helped them take better care of their patients. 

Nursing groans. New York State decided this week to require all nursing homes test their workers twice per week. In response, a group of nursing homes got together to say that, while they think this is a great idea, it’s effectively a logistical impossibility.  In terms of returning to normal, HHS' draft guidelines for re-opening nursing homes (to visitors, mostly) were leaked. Experts responded by saying it’s too soon to consider reopening, while industry complained the guidelines were too vague. 

Abbot and oh, hell no. Abbot announced Tuesday they’d be expanding their capacity for antibody test production, targeting 60 million units in June. This good news lasted all the way until Wednesday when an unreviewed, preprint NYU study showed that Abbot’s tests had a 33%-48% false negative rate. By late Thursday, the FDA issued a warning that Abbot’s tests might be producing false negatives, while Abbot said that practitioners are using the tests wrong. 

Getting testy. CVS said they’re planning to have 1,000 self-swab test sites open across the country by the end of May, with a larger goal of processing 1.5 million tests per month once fully ramped. If leaving your house isn’t your thing, Hims & Hers, the grammatically-questionable startup had their at-home collection kit authorized for use, while LabCorp is expanding their at-home collection to the general public with a physician’s note (it was previously limited to health workers). And if getting swabbed or spitting into a tube don’t sound enjoyable, researchers in the UK are hard at work on a test that uses fingerprint sweat to identify coronavirus infection. 

And finally, New York urgent-care chain CityMD told 15,000 patients who tested positive for COVID-19 antibodies that they’re now immune. Given there’s broad disagreement about the evidence for convalescent immunity, CityMD is getting back in touch with all those folks to let them know they might not be immune after all. Oof. 

Sting like a bee. North Carolina health system Atrium Health is partnering up with Butterfly Network to bring Butterfly’s handheld ultrasound devices to physicians in more than 30 Atrium locations. If you like to geek out on cool tech, the Butterfly iQ device is a fantastic piece of disruptive technology

Go on, Gawande. Atul Gawande made his resignation from the Haven Healthcare CEO job official this week. He’ll stay on as Chairman. 

Drug dealers. While it’s far from surprising that brick & mortar pharmacy chains are seeing an uptick in mail-order business during the pandemic, the 20% growth they’re reporting pales in comparison to some delivery-first pharmacy startups which are reporting 5x growth in new customers. 

Rock n’ enroll. The IRS has given employers leeway to allow their employees to make changes to their health plans outside of enrollment periods. This means adding a family member, changing plans, or dropping coverage altogether. This is cold comfort for the estimated 27 million Americans who have lost access to their employer-sponsored insurance during the pandemic. 

10,000 maniacs. 23andMe announced Wednesday they’re expanding a study into genetic links to COVID-19 severity and susceptibility, and to that end will be recruiting up to 10,000 new participants who have been hospitalized with COVID-19. 

Good enough for the rest of us. In a bid to find creative ways to cope with demand and newfound limitations, providers are turning to consumer tech. Mount Sinai, as part of a partnership with Google, is using Nest cameras to observe and interact with patients. Many providers are utilizing consumer-grade ECG tools like Apple watches and AliveCor devices to provide cardiac readings from afar. 

Return of the King. UnitedHealthcare has filed to return to Maryland’s ACA exchange, perhaps signaling a broader set of moves that’d bring the behemoth insurer back into the individual marketplace fold in a bigger way.

Things That Started Up

Things To Read

Adam Cohen, et al, released a study in which they looked at funding data for more than 1,200 digital health companies from 2011 to 2018. What they found: digital health, like the health system at large, is disproportionately focused on disease management and treatment, rather than prevention and detection. 

Matthew Fiedler and Zirui Song released predictions for the overall cost of patient care for COVID-19, and produced numbers much less catastrophic than other estimates.  They argue that COVID-19 will increase overall projected health costs for 2020, but only by about 1 - 5%. 

Darius Tahir wrote about how public health agencies are heavily reliant on outdated technology like paper records and fax machines. This leads to more mistakes, slower data transfer, and gaps in reporting. 

Robert Langreth looks at Gilead, their lineage in making potent & expensive antiviral drugs, and how they reacted early and quickly to ramp remdesivir production, even before clinical trials assessing effectiveness were complete.

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Healthcare Handout #56

Everything that happened this week in health tech and business

Here’s a selection of stories we gathered on this week.

Things That Happened

Troubled Hospitality. Hospitals are losing a lot of revenue as most normal medical activity remains on pause. Dr. Bob Wachter at UCSF says they’re losing $5M per day, while the American Hospital Association says its member hospitals are losing a collective $50B per month during the crisis. This is leading to widespread staff furloughs and layoffs, with roughly 135,000 hospital job layoffs in April according to BLS data. Some rural hospitals that have recently gone bankrupt are suing the government for admission into the Paycheck Protection Program, which prohibits bankrupt companies from receiving funds, to keep their doors open during the pandemic. 

California hospitals, which have already received $3B in relief funds from the federal government, are asking the state to give them an additional $1B to stave off furloughs and layoffs. Some have pointed out that many hospitals, including some of those in California, have more than adequate cash in their investment portfolios to shore up operations without seeking relief money. One such example: the new investment fund HCA announced this week

One note on those relief funds: a KHN investigation has found that a lot of that government money has ended up at institutions that have suffered recent criminal fines, including one particularly egregious example where an oncology firm that owes a $40M antitrust penalty on June 1 received $67M in bailout funds. 

Cost-sparing. Much of the money that would normally have flowed to hospitals has stayed put with insurance companies, who are weathering the pandemic fairly well. This has led to things like UnitedHealth Group offering 5-20% credits against premiums, and Humana waiving all cost sharing for primary care and behavioral health for its Medicare Advantage plan members through the rest of the year. To add to the instability here is the Robert Wood Johnson Foundations prediction that 25 - 43 million Americans could lose coverage through their employers during the pandemic. 

Also missing: jobs. 20 million Americans have lost their jobs during this pandemic, and healthcare has been experiencing the downturn just the same as many other industries. Within healthcare, dental has been particularly hard hit and comprises 36% of the 1.4 million jobs lost, while 17% come from physician offices. Like we mentioned above, 135,000 of those jobs, roughly 9.6%, have come from hospitals. 

Cease the visits. Some of those elective visits that have evaporated could have longer-term ramifications. A CDC study showed steep declines in the numbers of routine pediatric vaccinations during the pandemic.  Similarly, routine cancer screenings have plummeted 86 - 94% according to a white paper from Epic. 

One more thing that could have serious ramifications: at least 1,099 clinical trials have been postponed. While most of those are delayed, not cancelled, experts suggest that many could be lost due to funding shortfalls and the logistical complications of restarting. 

Party line. Doximity introduced a new video calling feature to their popular Dialer app, which allows physicians to call their patients from a personal phone while the caller ID shows their practice’s number. EHR company DrChrono also unveiled new telehealth functionality, allowing providers to call patients through the EHR using a new mobile app. Given Epic’s recently announced partnership with Twilio to allow in-app video chats, and CVS’ revelation that MinuteClinic telehealth visits in Q1 were up 600% year over year, it’d seem the competitive landscape within telehealth is shifting almost as quickly as adoption is increasing. 

Biblical alliance. Mount Sinai Health Partners and Babylon Health have announced a partnership to bring Babylon’s AI-powered assistant, symptom checker, and telehealth features to patients in New York. You might recognize Babylon as the UK company that has raised $2B in venture capital and made waves by claiming its AI could pass the UK’s general practitioner exam. 

The price is right. Gilead donated their current supply of remdesivir to the federal government, and the government has distributed some of it. Nobody seems to know how they decided whom to give it to, as it doesn’t correlate with the hospitals hardest hit by the virus. HHS issued a release Saturday morning laying out the process for further distributions, which will go to state health departments, who will then distribute to hospitals based on need. 

Gilead is yet to set a price for the antiviral, but ICER has suggested they’d be justified with a price tag as high as $4,500 per treatment course. 

Worth watching. Researchers involved in the long-term Apple Heart Study revealed some numbers from the experiment. They managed to enroll 420,000 participants, and successfully detected 2,200 possible AFib events. Participants, when receiving an AFib alert, were able to launch directly into a video visit with a physician to examine the data, but less than half - just 945 - actually did so. Unrelated to the study, something to watch: physicians in Germany wrote a paper in the European Heart Journal claiming an Apple Watch successfully detected myocardial ischemia in an 80-year-old patient. 

Not letting Apple have all the smartwatch heart study glory is Fitbit, who announced their own broad, long-term heart study this week. 

Human resources. While the promise of massive-scale digital contact tracing has been widely discussed, as plans are coming together to launch efforts in earnest the preference appears to be for analog, human-powered solutions. New York, California, and Massachusetts have already begun hiring armies of contact tracers. This, coupled with a plan submitted last week by a number of notable former federal health officials that argues for human-powered tracing on a national scale, makes it less and less likely we’ll be embracing a digital-first tracing solution. 

This follows a critical report from technologists and epidemiologists saying that Apple and Google’s contact tracing program is effectively more trouble than it’s worth as it creates serious privacy concerns without being all that epidemiologically sound in aiding contact tracing. While states are shunning Apple and Google’s tech for tracing, they aren’t precluding tech partnerships altogether: New York City will be working with Salesforce, who will be setting up a call center and a CRM instance to help contact tracers work more efficiently. 

FDA EUA TBD. The FDA reversed its earlier decision to allow coronavirus antibody tests to be sold without authorization from the administration. They’re now requiring manufacturers to prove they actually work to get an Emergency Use Authorization before they can sell them. 

After NIOSH found that many of the N95 masks being imported from China didn’t actually meet N95 standards, in that they didn’t actually protect the wearers from particulates, the FDA rescinded their approvals for more than 60 China-based mask makers. 

The FAANG’s all here. Big tech wants to help, too. Amazon is directly funding clinical trials for convalescent blood plasma, having AWS launch online donor registries, and delivering at-home COVID tests., the company’s philanthropic arm, is spending $50M to support front-line workers, the WHO, and public health focused data analytics efforts. And Apple contributed $10M to help a small-scale manufacturer scale up the production of at-home sample collection kits. 

Bloomberg took a look at what was going on inside Verily while President Trump was trumpeting that Google (but really Verily) would be coordinating a nationwide testing initiative. Spoiler: they didn’t know what he was talking about. They were targeting a much smaller-scale initiative in the Bay Area, one they successfully stood up, and then charged California an average of $340 per test to complete. 

Tragic heap. Magic Leap, the secretive augmented reality startup that has been around for a decade, raised $2.5B, never found success with a product, and recently laid off around half its workforce, is now pinning its hopes on a $100M investment from a major healthcare company that’d also help the company bring its AR solutions to the surgical suite. Rumor has it, it’s Zimmer Biomet. 

Haven’t a clue. The WSJ reported Friday night that Atul Gawande is in talks to step away from day-to-day management of Haven (the Amazon - Berkshire - JPMorgan joint venture) and take on a more policy and advocacy focused role as Chairman. 

Hacked together. CISA, the Department of Homeland Security’s cybersecurity agency, issued a joint statement with their UK counterpart warning that state-sponsored hackers are targeting healthcare organizations, including pharma and research entities, seeking details about the coronavirus response. This came to fruition relatively quickly as Reuters reported Friday that Iranian hackers targeted Gilead executives with phishing attempts. 

Lab retriever. GoodRx, the company that helps people pay less for prescriptions by comparison-shopping pharmacies, is now applying the same logic to lab testing. Users can now compare pricing for 18 different kinds of tests - including coronavirus tests - across 10 different providers. 

Extra CRISPR. Sherlock Bioscience received an FDA Emergency Use Authorization for a CRISPR-based COVID-19 test, marking the first time the vaunted new technology has been through any FDA review. 

Things That Started Up

  • Owkin raised $25M to extend their Series A. They’re building a virtual lab that allows researchers to more easily and safely share anonymized data sets. 

  • Limbix raised a $9M Series A. They’re building a digital therapeutic for teenage depression that’s deployed via mobile app. They’re also working on a VR delivery device. 

  • Wellth raised a $10M Series A. They’re building a platform for utilizing behavioral economics to incentivize treatment adherence. 

  • LetsGetChecked raised $71M. They’re continuing work on their at home diagnostics services, including antibody and PCR testing for coronavirus. 

  • First Dollar raised a $5M seed round. They’re building a consumer-friendly HSA experience, as well as offering account administration services for employers. 

  • Medable raised $25M. They’re continuing work on their decentralized platform that helps speed up clinical trials through improved data access. 

Things To Read

Taylor Nicole Rogers took a deep dive into how concierge doctors are helping their clients, who pay as much as $10,000 a month, operate outside the healthcare system and get their hands on much-coveted coronavirus tests. 

John Moore makes some predictions around the effect that the COVID crisis will have on various aspects of healthcare including telehealth, physical practice design, health IT, alternative payment models, and more. 

Nikhil Krishnan unpacks classic health-tech business strategies, specifically building patient-centric EMRs and behavioral incentives. 

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Healthcare Handout #55

Everything that happened this week in health tech and business

Here’s a selection of stories we gathered on this week.

Things That Happened

Healthy Decline. An 18% decline in consumer health care spending has been an outsized contributor to the overall decline in GDP we’re experiencing.

Look in to my AI. Google Health built a deep learning tool to detect diabetic retinopathy and rolled it out for live testing in Thailand. While the tool itself proved accurate in detecting the disease, the trial was plagued by issues of image quality and slow internet speeds. 

Retail therapy. UHG’s Optum is reportedly in talks to acquire virtual therapy provider AbleTo for $470M. Optum Ventures has previously invested in the New York based company, which is currently headed by CEO Trip Hofer, an Optum alum. 

Prescription drones. CVS and UPS are partnering to offer drone delivery of prescription medication to residents of The Villages, a 100,000+ resident retirement community in Florida. Glimpse of the future? Perhaps, but it’ll be harder to deploy this sort of service into environments with less centralized control and uniformity.

Home sick. There have been consistent anecdotal reports of declines in hospitalizations for serious acute conditions, and now researchers at Cigna have confirmed them. “Hospitalizations decreased 28% for epilepsy and seizures, 24% for gastrointestinal bleeds, and 22% for aortic aneurysms and dissections. Hospitalizations for acute appendicitis and acute coronary syndromes, which include heart attacks, dropped 13% and 11%, respectively.” While there could be monthly variations at play, that’s less likely as declines have been noted for multiple unrelated conditions. 

Medical Win Ratio. Several major insurers, including Humana, Cigna, and Anthem, have reported their quarterly earnings this week and the story across the board is that they’re largely unaffected by the pandemic. At the same time, AHIP has been lobbying Congress for relief for the industry. 

Telewealth. Teladoc reported earnings this week, and it’d seem they’ve enjoyed the same growth nearly every other telehealth company has seen. Q1 revenue is up 41% YOY, while the 2 million virtual visits they performed represents a 92% increase YOY. And the company is optimistic that this isn’t just a temporary phenomenon; they’re predicting 8 million or more visits in 2020. 

Sleeping-in-place. Withings completed what they’re calling the Lockdown Lowdown Study using aggregate data from their 2 million+ devices to see how their users’ behavior and health has changed during shelter-in-place orders. While the data is surely skewed by the fact that Withings customers would tend to be more active to begin with, there’s a ton of interesting stuff in the report. Some highlights: 

  • Americans have gained, on average, 0.21 lbs

  • Average steps per day has only declined 7% in the US

  • Americans are actually sleeping more

45% Medical Collective Health and One Medical completed a study comparing overall health expenditures for employees using One Medical vs those using traditional primary care. They found fairly significant reductions in spending for One Medical members, with a headline figure of 45% less expense overall. While we should take any study produced by a company with a grain of salt, these results are impressive. 

Testing limits. While commercial labs like LabCorp and Quest Diagnostics are critical to our ability to test at scale for the coronavirus, they too are facing difficulties from the pandemic. Demand for ordinary medical testing has declined significantly, with LabCorp reporting a 50%+ drop. Both companies have furloughed employees. 

Now App-pear-ing. Pear Therapeutics has taken advantage of the FDA’s special temporary rules on digital mental health products to launch their digital therapeutic for schizophrenia. Akili also used this special period to launch their digital therapeutic for children with ADHD. 

Drug Drug Revolution. A bunch of companies are trialing vaccines and treatments for COVID-19. It’s honestly hard to keep track. STAT’s tracker makes it a lot easier. 

Ring ring. Smart ring maker Motiv was acquired and will shift focus away from health tracking via ring to biometric authentication via ring.

Things That Started Up

  • Rome Therapeutics raised a $50M Series A. They're using a machine-learning driven approach to drug development, mining the vast stretches of the human genome that's largely repeating and has been mostly ignored by previous researchers. 

  • SkyCell raised $62M in growth capital. They’re operating a network of climate controlled shipping containers that transport temperature-sensitive pharmaceuticals. 

  • Medici raised a $24M Series B. They’re building an asynchronous telehealth platform that embraces multiple modalities for communication including text, voice, and video chat. 

  • Mojo Vision raised a $54M Series B. They’re developing augmented-reality contact lenses and working towards an FDA Breakthrough Device designation for visual impairment indications. 

  • Particle Health raised a $12M Series A. They’re building a HIPAA compliant API to make sharing healthcare data easy and scalable. 

  • Tomorrow Health raised a $7.5M Seed. They’re building a platform for purchasing home health products and supplies. 

  • Dascena raised a $50M Series B. They’re building algorithmic diagnostics to detect diseases earlier, allowing for earlier intervention in hospital settings. 

  • Vida Health raised $25M. They’re building a platform for connecting health practitioners (nurses, therapists, nutritionists, etc.) with patients coping with chronic conditions. 

Things To Read

Siddhartha Mukherjee comprehensively details the many failures throughout our public health and healthcare systems in preparation and response to the coronavirus crisis. His conclusion: “Everyone now asks: When will things get back to normal? But, as a physician and researcher, I fear that the resumption of normality would signal a failure to learn. We need to think not about resumption but about revision.”

Christina Farr tells the inside story of how teams at Apple and Google worked together to quickly build their contact tracing system tools.

Scott Alexander takes a deep dive into the Amish healthcare system. The Amish pay far less for healthcare per capita than Americans do, but experience comparable results in terms of health and longevity. Nikhil Krishnan analyzed the piece in a series of tweets.

Julie Yoo argues that primary care needs a new operating system. Specifically, it needs a revised technical infrastructure that supports a new mode of unbundled frontline care.

Thanks for reading the Healthcare Handout, a weekly roundup of everything that’s happened in healthcare technology and business.

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Healthcare Handout #54

Everything that happened this week in health tech and business

Here’s a selection of stories we gathered on this week.

Things That Happened

Healthcare Handouts. HHS carved up relief funds, routing $10B to rural hospitals, $10B to hospitals hit hard by COVID-19 cases, and $20B to providers based on net patient revenues (across all payers) from 2018. This is following a touch of controversy as their first round of distributions was based entirely on Medicare billing volumes. 

Under pressure. A new app for the Samsung Galaxy Watch Active2, called Samsung Health Monitor, was approved by South Korean regulators to take  blood pressure readings. The app utilizes the built-in sensors on the smartwatch, and requires calibration before use and every four weeks using a traditional blood pressure cuff. It’s not an FDA approval, but continuous blood pressure monitoring is now a reality.

Getting the leads out. With hospitals facing equipment shortages, some physicians have begun using consumer-grade ECG monitors, specifically the AliveCor KardiaMobile 6 lead, to track patient telemetry. "I don't think this is a complete possible replacement for telemetry, but it can help out in certain situations," one of the doctors said. 

</protest> EHR vendor Epic has officially rescinded their protest over new ONC third-party data sharing rules, remarking that the final versions of the rules satisfy their concerns about patient privacy. Epic stood in fierce opposition to the rules, which compel EHR vendors to make it possible for patients to access their claims and clinical data through third-party applications, even going so far as to recruit their customers to issue a joint statement against the rules. Enforcement of the new rules has been pushed back 6 months into 2021 amid the COVID crisis. 

No Zoom for you. Amwell has launched a new telehealth offering specifically targeted at small to medium sized practices. The platform, Amwell Private Practice, enables physicians to interact with existing patients virtually. Amwell has waived some fees associated with the platform through June. 

Cart before the horse. Major pharmaceutical companies are readying their manufacturing and supply chains to spin up production of COVID treatments. Regeneron is readying its Rensselaer, NY plant for production by moving other drugs to different manufacturing facilities, Moderna is hiring 150 employees to ramp manufacturing,  and J&J is planning to produce 1 billion doses of its experimental vaccine before it’s clinically validated. All of this activity poses serious financial risks for these companies in the event their treatments prove ineffective. 

Rise of the machines. Microsoft launched a ‘plasmabot’ chatbot to help recruit former COVID patients to donate their convalescent plasma. Meanwhile, Verily and Google Cloud teamed up to build a white-labeled chatbot, COVID-19 Pathfinder, for hospitals to utilize to educate their patients about COVID.  

Re-producer. Nvidia has released an AI framework targeted specifically at helping healthcare researchers reproduce machine learning studies. Producing repeated results is a critical step in proving the value of new models, and has been a perennial issue in medical AI research. 

ADH-free. Akili has released their digital therapeutic for children with ADHD following the FDA’s decision to temporarily relax regulations around digital products indicated for psychiatric disorders during the pandemic. It’ll be available for free to children between the ages of 8 - 12, and while Akili has their own vetting process to ensure enrollees are worthy candidates for therapy, there is no physician sign-off required to download the app. 

Video on demand. Novartis acquired digital therapeutics firm Amblyotech, who are developing a video-based approach to treating lazy eye. With some digital therapeutics being operated directly by pharma, and others (like Akili above) going direct to consumer, it’d seem we’re still well awayf from settling on a standard distribution model for these novel digital treatments.

Survey says. Carnegie Mellon researchers found that self-reported COVID symptoms reported via surveys on Facebook and Google correlated by location to cases confirmed via testing. 

Bad money after good. Envision Healthcare is reportedly considering a bankruptcy filing as reduced payment volumes are making it harder to service the $7B of debt incurred as part of their recent leveraged buyout. Perhaps Envision should be more thrifty with their advertising dollars. ProPublica uncovered that Envision and fellow staffing firm Team Health were behind at least $2.2M in spending since February on advertising rallying against legislation that would control surprise medical billing.

Things That Started Up 

  • Aledade raised a $64M Series C. They help independent physicians build and participate in ACOs. They currently partner with 550 practices, representing 7,300 providers across 27 states. 

  • Paige added $5M to their Series B. This makes their total Series B worth $50M. They’re developing computer vision based cancer diagnostics. 

  • H1 Insights raised a $12.9M Series A. They’re aggregating public and private data sources to build a comprehensive database of medical professionals, allowing doctors to communicate with each other, and businesses to find doctors for advertising and clinical trials (but mostly advertising, we can assume).

  • XRHealth raised $7M. They’re developing a VR health platform that is at least initially helping patients rehab from back, shoulder, and neck injuries; relieve stress; and do cognitive training. 

  • RDMD raised a $14M Series A. They’re building a platform for patients with rare diseases to access their medical records and participate in research, and in turn helping drug developers identify those patients with rare diseases. 

  • Unlearn.AI raised a $12M Series A. They’re utilizing machine learning to identify similar patients - ‘digital twins’ - to help run tests and controls in drug clinical trials. 

  • Clever Care Health Plan raised a $20M Series A. They’re planning to create a Medicare Advantage plan that includes holistic and Eastern Medicine. 

  • Biobot Analytics raised $4.2M. They’re building technology to monitor wastewater for public health concerns like opioids, but recently pivoted to measure community levels of COVID-19. 

Things To Read

Lisa Suennen breaks the world of digital health into two epochs: Before Coronavirus and After the Disease. She argues that while funding was plenty in the BC world, profitable digital health ventures were few and far between. This new AD world is their opportunity to become mainstream, successful businesses.

Soleil Shah and Bob Kocher argue that part of the reason our hospitals were so ill-prepared for this pandemic is the complete lack of structural incentives for them to do so. They argue there should be payment incentives to have flexible capacity, as well as the creation of new insurance lines for business interruptions related to pandemics. 

Toyin Ajayi and Iyah Romm, the cofounders of Cityblock Health, wrote a blog post describing how they’ve experienced the pandemic as a startup catering to the health needs of marginalized communities. 

Russell Max Simon, author of the HealthPolity newsletter, wrote a reaction to Marc Andreessen’s “It’s Time To Build” essay, contemplating the question of how Andreessen’s imperative can be applied to healthcare. 

Thanks for reading the Healthcare Handout, a weekly roundup of everything that’s happened in healthcare technology and business.

Want more regular updates on what’s happening in the industry? Visit for all the top stories right now. 

We also offer a daily update email with all the top stories from the day, every evening at 8pm EST. Sign up at

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