Healthcare Executives Under Threat of Business Model Disruption

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.

New Studies Seek to Define Clinical Efficacy of Apple Watch

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. 

Voice Technology Helping Patients In and Out of Hospitals

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.

Revolutionizing Healthcare Analytics with Data Lakes

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.

IBM Watson Health and Leading Hospitals Invest $50M to Accelerate AI Development

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.”

Johnson & Johnson Acquiring Robotic Surgery Startup for $3.4B

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 Collaborates with Apple to Bring “Attain” to Plan Members

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.

“What’s Covered”: CMS Launches its First-Ever Patient Facing App

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 Announces Partnership to Deliver Better Health Outcomes

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”.

Your Next Apple Watch May Be Coming From Your Insurer.

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.

Digital Therapeutics’ Promising Start

Pear Therapeutics, a Boston-based digital therapeutic company, rang in the New Year with $64mm in Series C funding from Temasek, Novartis, 5AM Ventures, Arboretum Ventures, and more. This announcement came shortly after reSET-O, their prescription digital therapeutic designed to treat opioid use disorder, became the first software-only digital therapeutic cleared by the FDA. Pear will continue to develop digital therapeutics for Multiple Sclerosis (MS) and Schizophrenia with Novartis. With their recent funding, the “software based disease treatments” company hopes to globalize their reSET products and further fund their other clinical-stage developments.

Pear Therapeutics is not the only digital therapeutic company benefiting from the heightened interest in software as clinical treatment. Last week, Click Therapeutics announced a partnership with Ostuka America to create a new digital therapeutic for major depressive disorder (MDD). The Japanese Pharmaceutical company intends to invest $300mm into the initiative with the goal of delivering evidence-based cognitive therapies to a broader population of patients with MDD.

This wave of investment in digital therapeutics by pharmaceutical companies shows no signs of slowing and indicates a promising future for software-based treatments to become mainstream medicine.

Pfizer and GSK Dominates Consumer Health with Newest Joint Venture

At the end of 2018, Pfizer Inc. and GlaxoSmithKline (GSK) announced their new consumer healthcare joint venture. It promises to deliver stronger sales, cash flow, and earnings growth driven by category leading Power Brands, science-based innovation, and substantial cost synergies. With combined sales of ~$12.7B, the joint venture will become a global leader for Over-the-Counter (OTC) products and position Pfizer and GSK’s Consumer Healthcare Business  to have an OTC market share of 7.3%, the largest in the world. GSK announced this proposed transaction as its strategic plan to strengthen its Pharmaceuticals business and R&D pipeline by scaling GSK Consumer Healthcare within the next three years then separating from the joint venture-- creating two new global companies. By doing so, GSK expects further value for its shareholders and advanced developments in both their Consumer Health and Pharmaceutical businesses.

Alto Pharmacy Raises $50 Million in Series C

Digital pharmacies are on the rise as startups experience a substantial increase in user adoption and investment this year. Capsule, a New York-based digital pharmacy, raised $50mm Series B this past August while Chinese firm Jianke Pharmaceuticals raised a whopping $130mm Series B a month later. More notably, Amazon’s acquisition of PillPack for just under $1B shook the US market and signaled the consumer giant’s strategic plan to enter the wholesale pharmaceutical market. This upward trend for digital pharmacies is showing no signs of slowing down. Alto’s latest funding round continues with this ongoing investment pattern as it closes $50mm in Series C, bringing its valuation up to $73mm.

Led by Zola Global and Greenoaks Capital, the investment will allow Alto to bring its digital prescription service to patients living outside of initial major metro areas in California and expand its product line to include medications for chronic and complex conditions. Since its inception, Alto has partnered with UCSF, Stanford, and One Medical to deliver prescription medicine to over 50,000 patients in San Francisco and Southern California. By providing patients with same-day medication delivery and on-demand access to pharmacists, Alto and other digital pharmacies will only continue to grow and rival traditional retail pharmacy chains.

Walgreens and Humana Talk of Merging. Quip Raises $40mm in Funding

Walgreens and Humana in Preliminary Talks to Merge

With the CVS-Aetna merger closed and big tech companies marching into healthcare, many healthcare organizations are increasingly willing to pursue merger and acquisition activities in order to weather the coming storm. CVS’s competitor, Walgreens, is reportedly in preliminary discussions with Humana to pursue strategic ventures together. The two are considering buying equity stakes in one another as well as expanding on their existing partnership that focuses on senior care. 

In addition to their partnership with Humana, Walgreens has made several deals with LabCorp, Kroger, and Birchbox within the last year as an attempt to combat the CVS-Aetna behemoth by building upon its core competency of being a pharmacy. However, this strategic decision is a problem in today’s healthcare landscape as companies, such as CVS-Aetna, are moving into other verticals to supplement their existing businesses. Nevertheless, as shown by its talks with Humana, it seems that Walgreens has finally caught on and will be making pivotal changes to their business strategy next year. 

---

Dental Care Startup Quip Raises Another $40 million

Quip has had a phenomenal growth year. Earlier this year, the dental startup raised $10 million from Silicon Valley Bank and also acquired Afora, a startup that creates an alternative to traditional dental plans. Quip also recently announced a partnership with Target and will be selling their toothbrushes and toothpaste through the national retailer.

Now, Quip has been equipped with $40mm in funding through the form of equity and debt financing. This influx of money will enable the dental startup to grow its subscriber base by expanding its product line and forming new partnerships with dental care providers. New service launches are also a possibility as Quip sets out to provide its members with a “full-service oral hygiene routine”. A potential dental care platform could emerge from its acquisition of Afora, connecting Quip members with dental providers at a more affordable rate. As one of the most successful personal care subscription services to date, Quip and its electric toothbrushes are here to stay. 

---

DHMP Matchmaking is Happening Next Week on 12/5

Mark your calendars! The Winter 2018 Digital Health Marketplace Matchmaking sponsored by NYCEDC will be held next week on Wednesday, 12/5. We’d like to say thanks to everyone who applied to be a part of the program. We have received over 150 applications from innovators, making this one of our most successful DHMP events. Those selected will have one-on-one meetings with the buyer based on self-identified mutual interest. This half-day of curated matchmaking is a free service of the Digital Health Marketplace, an NYCEDC program focused on strengthening the NYC digital health ecosystem. 

This is a closed event but be sure to follow us on Twitter @catalyst_h20 for live tweets and updates.