Believe it or not, Jessica DaMassa and I have been banging out digital health tech & funding news for 200 episodes of this oh-so-cute little show. To celebrate, after several takeover episodes when Jess replaced me with a number of special guests, this time four of the digital health & health care digerati replaced Jess to ask me some oh so serious questions. It’s a special edition with guest appearances from Glen Tullman, Eugene Borukhovic, Lisa Suennen & Ian Morrison, as well as plenty of BS from us two regulars! — Matthew Holt
Don’t want my age revealed…
By LISA SUENNEN & MATTHEW HOLT
Yesterday it was Fortune’s 40 under 40, and a lot of great people, most of whom I thought were much older or at least seem to have been around a while, got listed in the health care section–including Andre Blackman, Ambar Bhattacharyya & Julia Cheek. Lisa Suennen (@venturevalkyrie) and I got into a Twitter exchange about whether we were eligible for the under 40 category or for that matter the category above that. The answer was, amazingly, “no”. Somehow she came out with the line that “we are old”. Knowing her love for 80s pop, I reminded her that this was the inverse of the first line of the Pat Benatar classic “Love is a Battlefield.” Somehow this ended up in us tweeting a new set of lyrics for that song to each other all day. Of course I feel compelled to share them with you. I encourage you to play the video below and sing along!
We are old
Wheelchair to wheelchair we sit….
No Promise ring, yes Depends
Don’t want my age revealed
Before Long
They will all sing our swan song
Scans of our hearts show something wrong
Both of us slowing..
Don’t want my age revealed
Ads begging me to Ro
Then making me pay
Why do my knees hurt so bad?
It would help me to know
Should I stand a different way?
My hip hurts too, I might add
12 Rules for Health Tech Startups
By MATTHEW HOLT
Last week Mark Cuban tweeted out 12 rules for tech startups and Jessica DaMassa challenged a bunch of people to respond for health care. VC and general health care wit Lisa Suennen came out with quite the list (she got to 13) but I thought someone ought to write the real rules…
1. Never start a health tech company if you can sucker someone into giving you a real job
2. When VCs at conferences say raising money isn’t a problem, throw a milkshake at them
3. Never work with a technical co-founder who won’t give you the last M&M in the packet
4. When a clinician wants to quit their job and co-found with you, remember that the good ones could be making $500K a year reading X-rays and be on the golf course at 4pm
5. Do the 50/2 diet. Starve for 50 weeks of the year then eat and drink as much as you possibly can at HIMSS & JP Morgan parties when someone else is paying
6. When the incubator/accelerator/matchmaker says that they “chose you from 700 applicants” remember that there are roughly 700 of them and every company applies to each one
7. When you get the elusive partnership deal with the big hospital system, tech company or corporate, you’re going to expect to work at the speed of the startup and the scale of the corporate. It’ll be the reverse . (I stole this from Michael Ferguson at Ayogo)
8. After your first few clients and funding rounds you’ll be losing money at a exponential rate that matches what you had for revenue on the hockey stick chart in your pitch deck
9. Hopefully you’ll eventually be able to start making the money the health care way, by establishing a monopoly that can arbitrarily raise prices to the moon and stick it to your customers. If not, start prepping for the really big Oscar/Collective/Clover type round.
10. Pray to whatever God you follow that Softbank is still in business when #9 happens.
11. If after a decade or so of slog, you finally get the IPO, or semi decent exit, try to ignore the fact that the Instagram guys sold for $1 billion 11 months after they founded the company
12. Hope that you can disrupt health care, but remember that UnitedHealth Group’s revenue is $220 billion and CMS spends $900 billion a year and they both appear mostly powerless to make anything better.
Matthew Holt is publisher of The Health Care Blog and advises startups at SMACK.health using these principles and a few others too!
TMI, Dude!
If you are a baseball fan like I am, it is not unusual for you to spend time with your fellow sports fanatics comparing statistics. A player’s batting average, on base percentage, runs batted in, earned run average, home run stats and how those compare to their team mates’ stats–all fair game for friendly conversation. The personal analysis of players’ worth doesn’t stop there, as each of them has their height, weight, age and home town displayed on the screen as they step up to bat. Can you imagine if every time you went to work a big Jumbotron screen with all your vital statistics followed you around for all to see. “Look, there’s Lisa on deck. Man, she really is that short.”
Well, you might be horrified to think that the intimate descriptive details of your being might be published and used to compare your value to others, but there is a growing cadre of people who willingly do exactly that despite the complete impossibility that they will ever be found sliding into home plate. In case you have missed it, there is a burgeoning movement built around “self-knowledge through numbers” generally known as “the Quantified Self.” The term Quantified Self refers to the actions that thousands and thousands of over-achievers, narcissists and the insecure are actively undertaking every day, aided by a giant leap forward in sensor and wireless technology, to measure, track and report their vital statistics in the pursuit of living forever, or at least until the Houston Astros win the 2011 World Series in a sweep. FYI if you’re not a baseball fan–that’s going to happen about 3 weeks after hell freezes over.
In a recent article in The Healthcare Blog, Scott Peppet writes:
Human instrumentation is booming. FitBit can track the number of steps you take a day, how many miles you’ve walked, calories burned, your minutes asleep, and the number of times you woke up during the night. BodyMedia’s armbands are similar, as is the Philips DirectLife device. You can track your running habits with RunKeeper, your weight with a WiFi Withings scale that will Tweet to your friends, your moods on MoodJam or what makes you happy on TrackYourHappiness. Get even more obsessive about your sleep with Zeo, or about your baby’s sleep (or other biological) habits with TrixieTracker. Track your web browsing, your electric use (or here), your spending, your driving, how much you discard or recycle, your movements and location, your pulse, your illness symptoms, what music you listen to, your meditations, your Tweeting patterns. And, of course, publish it all — plus anything else you care to track manually (or on your smartphone) — on Daytum or mycrocosm or me-trics or elsewhere.
Indu & Matthew talk Health 2.0 with Lisa & Dave
One of the most insightful and funniest writers in health care is recovering VC Lisa Suennen. With trusty sidekick Dave Shaywitz, she’s been doing Tech Tonics, one of these newly trendy (again) podcasts. And Sunday at Health 2.0 they interviewed my partner Indu Subaiya, and me. Want to know a little more aobut the backstory of Health 2.0? Listen in!
The Hospital That Shall Remain Nameless
Let me start this story by telling you the end: I am just fine. For those of you who like me, there is nothing to worry about and all is well. For those of you who don’t like me, sorry to disappoint you, but you’re stuck with me for a while.
I’m telling you these things—news to make you happy or disappointed, depending on your point of view about me—because this story is about my recent trip to the hospital, an unexpected journey that I wasn’t sure I was going to talk about publicly.
First of all, I didn’t want people calling and fretting and thinking I was suddenly in need of hushed whispers and pats on the head and casseroles. Second of all, I didn’t want people thinking they were finally rid of me and gladly so. But mostly I wasn’t sure I was going to tell this story because I just didn’t want to make a big deal about it. But in the end, I couldn’t help myself. I decided I learned so much on my little stint on the other side of the healthcare desk that I felt I had to share.
It started as a bit of tachycardia, sadly brought on not by a George Clooney sighting, but rather by some anomaly of life which will likely never be known. As my heart started to race faster and faster over a series of hours, and when it became clear that I couldn’t count as high as my pulse was going, I called 911.
Continue reading…
Tales From the Accelerator
I hate to give away all the punch lines from my California Healthcare Foundation report on healthcare accelerators, so you will just have to read it for yourself. However, a few extra tidbits that didn’t make it in are here below (as you can imagine, I can’t be quite as Lisa-ish in a commissioned report as in my blog). Among my many discussions with a myriad of willing report interviewees (thanks to all of you!), I started collecting some funny stories that I have begun to refer to as Tales from the Accelerator Crypt. A few of them are here below for your amusement.
- From an East Coast Economic Development-Focused Accelerator: By far the worst idea pitched to us was from a company that proposed to prevent falls among the elderly with a vest containing an airbag whose deployment is triggered by EEG signals coming from a wearable computer brain interface. It’s probably obvious why this is so insane. Getting beyond who might actually wear such a thing around their home or to bed, can you imagine the number of erroneous deployments from the notoriously unpredictable, noisy EEG signal? If only they had made a video. That same week in the same city, I was amazed to be introduced to a rival company also developing a wearable airbag for accidental falls, but at least this one was triggered by an accelerometer. File under “You know wearables have jumped the shark when…”
- From a University Program in CA: The most awful pitch we had was from a clinician-entrepreneur whose answer to every probing question on commercial viability was “This is going to save countless lives.” It was his answer to every question, clinical to operational to financial. The most entertaining stage moment, however, was when a CEO of a company developing a ‘next generation’ needle-free injector did a live demonstration of his product by injecting himself with saline while up on stage doing his pitch. He unbuttoned his shirt, gave himself the shot and buttoned up again, claiming how painless it was. As he continued to speak, blood pooled and spread from the injection site, down his arm and across his entire white shirt. It was a slow motion disaster. He didn’t recover very well. Needless to say they didn’t win the demo day competition.
Healthcare Accelerators Evolve Towards Specialization
I am excited to announce that the California Health Care Foundation (CHCF) has just published a report, authored by me, about the state of healthcare Accelerators in the U.S. and around the world. For those of you who don’t know CHCF, it is a very large not-for-profit endowment that has a mission to improve the quality, cost and efficiency of healthcare delivered to the underserved populations of California. In so doing, they also provide a very valuable educational service to the overall healthcare community and fund the creation of reports like this one about Accelerators.
The new report, entitled Survival of the Fittest: Healthcare Accelerators Evolve Towards Specialization is available for download HERE.
This report is intended to update the report that CHCF released two years ago entitled “Greenhouse Effect: How Accelerators are Seeding Digital Health Innovation” about the then emerging field of healthcare Accelerators. I would have to say that two years later in 2014, these programs have definitely emerged.
While Healthcare.gov Struggles, A Different Story Plays Out On The Private Exchanges
All eyes are on the hullaballoo created by the challenges at Healthcare.gov and several of the states’ public insurance exchanges. Yet all the while, like in a magic show, attention has been diverted from the real action going on elsewhere. Quietly and in a relatively drama-free way, the private health insurance exchanges are busily taking over the world of insurance and, in my opinion, portend a radical set of changes in how our health insurance system operates.
Several years back, a number of companies began building private health insurance exchanges to initially help companies offload the incredible burden of retiree benefits. Companies such as Extend Health (now owned by Towers Watson), Senior Educators (now owned by Aon), and several others provided a way for large employers to get themselves out of the business (and balance sheet liability) of providing group benefits for retirees, instead providing them with money to purchase their own individual health policies through then small, now large companies. The private exchanges went about the business of building websites that work, call centers that buzz and a wide array of insurance product offerings at various prices. Now, several years later, hundreds of thousands and possibly millions of individuals are out there shopping their little hearts out, choosing their own plans, and dealing with the consequences of high deductibles and the like.
These various private exchanges are now poised and ready to begin serving active employees in 2014 as guaranteed issue (the requirement that all can be insured and no one turned away) goes into effect as a result of the Affordable Care Act. And lest you think this is a small marketplace, you are wrong. In 2008 there were about 120 million total employed workers and just over half of these worked for companies of 500 employees and above (39 million worked for companies with 5000 employees or more). In other words, we are talking about nearly half of American adults and that doesn’t even include the dependents they bring along into their insurance plan.
Interestingly, such large US employers as Walgreens and Petco and DineEquity (parent company of Applebee’s Neighborhood Grill & Bar® and IHOP® restaurants) are all-in on the private exchange program, committing to transfer all of their employees from group plans to the exchange to purchase individual plans come January 2014. The exchanges of Towers, Aon, Mercer, Buck Consultants and a plethora of others are alive and well and open for business at exactly the time when employers are trying to figure out how fast they can reasonably get out of the middle of health insurance administration and run for the hills.
Out of Chaos, A New Beginning
As of last week, the heart of Obamacare is upon us with the opening of the health insurance exchanges (HIXs). And while some think this represents the heart of darkness, it is hard to imagine that anything will stop January 1, 2014 from coming and, with it, a new legal requirement for all Americans to have health insurance.
Ushering in this new world order, the HIXs are essentially a “Match.com” to put people together with insurance products, representing a way that, for the first time, Americans will directly purchase healthcare without the prospect of being denied coverage or having their employers buy on their behalf.
In fact, the new HIXs create a direct relationship between consumers and health insurers in a way that has never existed before, and with that comes the need to fundamentally disrupt traditional methods of delivering health insurance products. Not since the advent of employer-paid health insurance after World War II or the start of the Medicare program in 1966 has there been such a broad-scale opportunity for health system transformation.
There are few markets that are mandated by law to include virtually every single American man, woman and child, making the opportunity particularly juicy to investors. For those entrepreneurs who figure out how to transfer the secret sauce from cheeseburgers that impair health to insurance-related products and services that improve it, the next few years offer an opportunity to turn market confusion into gold.
Among the biggest opportunities are investments in technologies and services that power the new healthcare exchanges. Venture-backed companies, such as GetInsured.com, have emerged to provide the various state-sponsored exchanges with the back-end technology that enable comparison-shopping, financial transactions and enrollment support essential to operating the HIX marketplaces.
But while state and federal healthcare insurance exchanges are the main topic of conversation this week, much of the real action has and will continue to take place in private exchanges serving the large and small employer market, particularly as employers do the math and figure out it may be in their financial best interest to end their role as benefit plan intermediaries.
