#31 - Going on a healthy bender

Collective Health, Oscar Health, and the open health data ecosystem

Things That Happened

I prefer potato chips. A recent job post shows the Apple Health Sensor team is looking for engineers to help build new ASICs, or Application Specific Integrated Circuits. ASICs are ideal for specialized repetitive applications, like monitoring vital signs. 

With rumors swirling that Apple will be building their own health devices (like a blood pressure cuff and a blood glucose meter) it stands to reason they’d want to explore chip architecture that would spread the computational burden of continuous monitoring away from the core processor of the iPhone.

Overall, it’s another indicator that Apple is moving in the direction of making your iPhone into even more of a health-enabled tool. 

All FHIRed up. Google, Salesforce, Amazon, IBM, Oracle, and Microsoft got together at the Blue Button conference and pledged to utilize the FHIR data interoperability standard across their healthcare activities. This is both a minor announcement and a big deal at the same time. Read more blow in Things Worth Understanding.  

Add another “O” to Alphabet. Google’s parent company has invested $375 million in Oscar Health, as revealed by Oscar CEO Mario Schlosser in an interview with Wired. It’s not hard to see why the tech giant is interested in Oscar: they’re arguably the most advanced company at applying technology to the world of health insurance. They’re also doing well financially: while they’re still predicting an overall loss in 2018, they’ve had two profitable quarters

While tech in old-line industries can sometimes be considered a “nice to have” instead of a competitive advantage, I think we’re nearing the point where Oscar will be able to really flex their muscles and show off the flexibility and competitive edge their tech stack gives them. I’ll be looking more into Oscar’s stack and what it enables them to do in a future edition, so stay tuned. 

If you’re the kind of kid who reads ahead, that Wired interview is worth your time. And you can always read their extensive documentation of the Oscar Health business model

Collective Health went on a bender. The California health benefits startup claims to have bent the cost curve for their self-insured employer clients, with an overall decline of 0.3% in medical costs on a per-member basis between 2016 and 2017. Considering the steady growth of medical expenses in this country, it’s notable they were able to actually achieve a decline.

How’d they do it? By helping members access less costly forms of care, and improving administrative processes. Read their in-depth report if you want more than my gross oversimplification. 

Should we be excited? Let’s see if they can repeat the feat next year. And keep in mind that it’ll be far more difficult to enact the same practices with patients not receiving benefits through a self-insured employer. I’ll accept “measured optimism” as the proper level of excitement. 

Best Buy makes a great call. The electronics retailer announced this week a deal to acquire GreatCall, a company that provides devices and in-home technology services targeted at seniors. I’m a big fan of this deal as I think it fits nicely into Best Buy’s strategy, and will also help meet a largely unmet need in healthcare. 

Best Buy’s Geek Squad already provides in-home technology services, and accounts for 10%+ of the overall company’s profits. This sort of low-cost, in-home technology service will enable the wider acceptance of technology for aging-in-place, especially as it relieves the burden of placing and maintaining that technology from caregivers and medical providers. 

With the combination of Geek Squad and GreatCall, Best Buy moves from selling individual devices into a selling a complete service for in-home technology for seniors. As someone who acts as the CTO for his aging parent, I can certainly see the appeal. As will those more firmly in the sandwich generation

It also puts Best Buy in a prime spot for reaping rewards from the rapidly expanding Internet of Medical Things market, which is predicted to be worth $158 billion by 2022. 

Read this piece from Kim Bellard for more. 

Jewish mothers everywhere are ecstatic. NYU announced this week that it will no longer charge tuition for its medical school. It’s hard not to cheer any step in the right direction on the affordability of higher education, but many are dubious of NYU’s 100% scholarship policy. 

Craig Garthwaite@C_Garthwaite

I don't understand people celebrating this move.

If we don't tie this to either more low-income students entering or requiring students to provide a public good after graduation -- what is the benefit here (I mean other than higher average MCATs for NYU)?https://t.co/riBVYqCzjx

August 17, 2018
I’m not sure NYU was motivated by increased MCAT scores (they’re already #3 in the U.S. News Medical School Rankings), but Mr. Garthwaite is correct that without some restrictions around future specialities this won’t have the positive effects we’d hope to see from a no-tuition medical school. Students will graduate without debt, but specialty medicine careers will still pay more than twice what an MD can earn in the shortage areas of family and internal medicine. Future earnings are future earnings, and reducing the debt burden won’t be incentive enough to convince MDs to earn half as much. 

(chart via Medscape)


(And by the way, I’m not joking: my Jewish mother emailed me this story with the subject line “Dr. Krasny?”)

Google wants to be your health coach. The company is reportedly developing a health coach app that goes beyond fitness and uses data about your life habits - when you exercise, when you eat, where you eat, etc. - to help you be healthier through highly-tailored notifications and insights. Details are scant as the project hasn’t officially been announced, but this could be something interesting to watch. 

Things Worth Understanding

This January, Apple first unveiled their health records initiative. It would enable iPhone users with health records at participating institutions to view their records within the Apple Health app on their phone. I argued this was Apple’s statement to the world that, not only were they getting into healthcare, but they were serious about it. 

Within Apple’s health records announcement was a key detail that would cascade throughout the industry. The company famous for its proprietary connectors like FireWire and Lightning would be embracing the open industry standard for transferring health data: FHIR.

Former CTO of the United States Aneesh Chopra hailed the decision as a game-changer, arguing in Wired

It affirms there is one common path to open up electronic health records data for developers so they can focus on delighting consumers rather than chasing records. It encourages other platform companies to build on that path, rather than pursue proprietary systems. And it ensures that the pace of progress will accelerate as healthcare delivery systems respond to the aggregate demand of potentially millions of iPhone users around the world.

Chopra was vindicated when, this week at the Blue Button 2.0 healthcare software developer conference, representatives from Amazon, Google, IBM, Microsoft, Salesforce, and Oracle made a joint statement that their companies would also be fully embracing FHIR. While none of them directly offer an EHR, these companies form much of the underlying technical infrastructure on which the healthcare system runs. While it may have been more critical that EHR giants Cerner, Epic, and Athenahealth signed on to the FHIR standard (which they all have), this announcement essentially seals the deal. FHIR is the future. 

What’s next? 

There are two main reasons that establishing a universal data standard is so important in healthcare. The obvious first reason is ensuring the portability of patient records. One could argue that moving from paper records to electronic records was actually a step backwards in terms of patient data portability as records were being housed in systems that simply couldn’t talk to each other and thus required the creation of PDF/printed versions to transfer. A universal standard ensures that, once EHR elements are standardized, these records will be able to be transferred to any provider in the country. 

While portability is of monumental importance to our health system and will certainly have effects both in the quality and cost of care, it’s not the primary reason the gang of six above were so keen to affirm their devotion to the standard. 

Each of those businesses is firmly focused on developing AI solutions for healthcare. Creating competitive advantage with AI products requires, as I’ve gone on and on about before, proprietary data and high-quality talent. Data is the fuel that drives the AI engine. By setting a standard, these companies can now focus more effort on cultivating that talent and developing technologies rather than worrying about ingesting data in various formats over various protocols. As Aneesh Chopra put it earlier, they can “focus on delighting consumers rather than chasing records.”

But these big companies aren’t the only ones who will benefit. Open standards serve as the foundations of ecosystems, and properly structured ecosystems allow and encourage participation from developers of all sizes. With easier data access, and assurance that the vast majority of healthcare technology platforms are speaking the same language, developers can go to work on creating consumer focused applications to solve niche needs. It’ll be the vibrance of the app store, but able to use live health data to deliver real value. 

Venture capitalist John Doerr argues that we’ll look back on this period in history as an inflection point. "We're going to look back on 2018 and 2019 and say, 'Those were the years of the dataquake.’ Data was required to be interoperable, innovators came together to move us to an app economy."

Travis May, CEO of Datavant, says it’s “a small - yet critical - step towards an open data ecosystem.” As for the ramifications of this small step, he puts it simply: “Establishing an open data ecosystem is essential if the healthcare system as a whole is going to deliver high quality, cost-effective and seamless care for patients.”

Things To Read

“To extract real value from AI,” Alessandro de Fiore writes in the Harvard Business Review, “employees at all levels of the organization need to be empowered to make final decisions aided by AI, and act on them. In short, there needs to be a democratization of judgment-based decision-making power.” As we grapple with the effect that AI is having on healthcare, it’s important to note that simply introducing AI to existing workflows and organizations will limit its effect and benefits. 

"For mHealth apps, user experience may be at odds with accuracy of medical functionality,” says a recent study into the appeal of blood pressure mobile apps that proved inaccurate. Jonah Comstock, writing about the study for mobihealthnews, says “Researchers found that generally, when the app told someone their blood pressure was higher than they expected it to be, they were more likely to give it a lower rating. When it told them their blood pressure was lower than expected, they would give it a higher rating.” This is certainly a phenomena to watch as more user-focused companies enter healthcare. Can you deliver bad news and still have a positive user experience? 

It is not yet time for the obituary (and that time may never come), but the sun is certainly setting on the Golden Age of corporations.” I’m not sure how I came across this seven-year-old blog post from Venkatesth Rao, so if you sent it my way please let me know so I can send you a fruit basket. Rao’s A Brief History of the Corporation: 1600-2100 was a great read while I lay in my tent on Killington Peak this past weekend. While it doesn’t directly address healthcare, Rao weaves a fascinating tale of the interrelationship of business to political power and technological innovation over the course of modern history that will help frame any discussion of the interaction between tech and heatlhcare. I highly recommend it. 

Handout University

How much do you know about AI? This technology is already transforming our world, and will continue to grow both in its complexity and the effect it is having upon our daily lives. There’s no better time than now to get caught up so you can be a part of the conversation. 

Today I’m presenting you with three articles of increasing detail that will help you better understand, and make you more conversant, in the language and concepts of Artificial Intelligence. 


A five minute read - The Difference Between Artificial Intelligence, Machine Learning, and Deep Learning by Calum McLelland

A twenty minute read (with illustrations!) - The AI Revolution: The Road to Superintelligence by Tim Urban 

A forty minute read -Using Artificial Intelligence to Augment Human Intelligence by Shan Carter & Michael Nielsen 

Things I Listened To 

Have you heard the good word of Jeff Tweedy? 

On any given day there’s a 70% chance Wilco will be playing somewhere in my house. This week the album of choice was 1999’s Summerteeth, mostly driven by my desire to hear track “How To Fight Loneliness” over and over again. (spotify)


Thanks for reading. You can always find me at isaac@healthcarehandout.com or on twitter @isaackrasny

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Until next time,

-Isaac