By KIM BELLARD

Shira Ovide, who writes the On Tech newsletter for The New York Times, had a thoughtful column last week: Tech Can’t Fix the Problem of Cars.  It was, she said, inspired by Peter Norton’s Autonorama: The Illusionary Promise of High Tech Driving.  The premise of both, in case the titles didn’t already give it away, is that throwing more tech into our cars is not going to address the underlying issues that cars pose. 

It made me think of healthcare. 

What’s been going on in the automotive world in the past decade has truly been amazing. Our cars have become mobile screens, with big dashboard touchscreen displays, Bluetooth, and streaming. Electric cars have gone from an expensive pipedream to an agreed-upon future, with Tesla valued at over a trillion dollars, despite never having sold a half-million cars annually before 2021. 

If we don’t feel like driving, we can use our smartphones to call an Uber or Lyft. Or we can use the various autonomous features already available on many cars, with an expectation that fully self-driving vehicles are right around the corner. Soon, it seems, we’ll have non-polluting, self-driving vehicles on call: fewer deaths/injuries, less pollution, not as many vehicles sitting around idly most of the day. Utopia, right? 

This is what Ms. Ovide and Dr. Norton are questioning. Ms. Ovide says: “There’s also a risk that devoting our attention to these technological marvels may give us a pass from confronting a deeper question: How can we make our lives less dependent on cars?”

Making it cheaper, safer, and more convenient to hop in a car, their argument goes, might very likely just make us drive more miles (just as adding/expanding highways has proved to induce demand instead of relieving congestion).  

Ms. Ovide describes some of Dr. Norton’s arguments: 

But Dr. Norton also said that it would be useful to redirect money and attention to make walking, cycling, and using shared transportation more affordable and appealing choices.

Dr. Norton asked us to imagine what would happen if a fraction of the bonkers dollars being spent to develop driverless cars were invested in unflashy products and policy changes.

She concludes: “We know that technology improves our lives. But we also know that belief in the promise of technology sometimes turns us away from confronting the root causes of our problems.”

So it is with healthcare.

Money is flowing into digital health in ways that make the housing market look rational. Every day there are new investment rounds valuing digital health companies you’ve never heard of, and that few of us could distinguish, in the hundreds of millions of dollars. Healthcare, the belief must be, is going to be more digital; we don’t really know exactly how or when, but safer to cover all the bets.

Meanwhile, the big healthcare systems and the big health payors are getting bigger, each gobbling up competitors and new tech-based entrants at ways that Big Tech would recognize. These days, if you’re in healthcare and someone isn’t acquiring or investing in you, you’re doing something wrong.

But, as was pointed out about cars, tech isn’t going to solve the many, many problems that healthcare has. As Nick van Terheyden, MD, tweeted last week:

If you work in healthcare, you know the kind of systemic problems he’s referring to. If you have ever received healthcare, or known anyone who has, you also have probably seen some of them. And if you have the “wrong” insurance status, gender, race/ethnicity, or location, you have undoubtedly experienced them.  

To call our healthcare system a “system” is to overstate the case; it doesn’t work anything like a system. For many people, it doesn’t work at all. It evolved from something smaller, something simpler, and, like evolution generally, it has lots of kludges that serve no evident or useful purpose. The goal of evolution is, after all, survival into the next generation, not efficiency, elegance, or equity. 

Recently, Rasu Shrestha, MD, quoted Atrium Health’s Geoffrey Rose, MD: “A system that needs a navigator, is a system that needs to be redesigned.” What we’re doing in healthcare is adding more and more navigators, especially tech-based ones, instead of redesigning the system.

We can add all the tech we want – and healthcare should have much, much better technology – but that doesn’t necessarily mean people without insurance (or with low-paying insurance like Medicaid) will get the same care. We can apply artificial intelligence and Big Data to many healthcare problems, but, unless we are very careful and very purposeful, that doesn’t mean women or people of color will get the same care, with the same outcomes, as white men. We can build lots of beautiful new buildings but that doesn’t mean the care in those buildings is going to be of the same quality as in the places with the best care.

Even if we gave everyone all the healthcare we could, that doesn’t mean our health would be what it should/could be. If there’s one lesson our healthcare system continues to ignore, medicine is not the same as health. The now-familiar SDoH graphic suggests that only around 20% of our health results from the healthcare we receive.

Dr. Norton wants us to invest in “unflashy products and policy changes,” like zoning changes that encourage us to walk more instead of driving. Similar unflashy products and policy changes would get a bigger bang for our buck than most of our healthcare spending. How do we eat better, get more exercise, have cleaner water and air, etc.?

We’ve built our cities – and our suburbs, and our interstates — around cars (not to mention our parking lots!). Our lifestyles depend on easy access to them. We’re going to see electric cars, autonomous cars, on-demand cars, but unless we rethink our basic attitudes towards driving, we’re not going to achieve the results that we’re hoping for.

The same is true with healthcare. I love technology as much as anyone and am excited about how new technologies can apply to healthcare, but let’s be clear: technology alone is not going to solve the basic problems our healthcare system has. 

Ask the people at Building H or Cityblock how they suggest we might go about solving them. Our health is about our lives, not our health care, and so should our healthcare system.

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor.

By KIM BELLARD

You know we’re living in the 21^st century when people are 3D printing chicken and cooking it with lasers.  They had me at “3D printing chicken.”  

An article in NPJ Science of Food explains how scientists combined additive manufacturing (a.k.a, 3D printing) of food with “precision laser cooking,” which achieves a “higher degree of spatial and temporal control for food processing than conventional cooking methods.”  And, oh, by the way, the color of the laser matters (e.g., red is best for browning).   

Very nice, but wake me when they get to replicators…which they will.  Meanwhile, other people are 3D printing not just individual houses but entire communities.   It reminds me that we’ve still not quite realized how revolutionary 3D printing can and will be, including for healthcare. 

The New York Times profiled the creation of a village in Mexico using “an 11-foot-tall three-dimensional printer.”  The project, being built by New Story, a nonprofit organization focused on providing affordable housing solutions, Échale, a Mexican social housing production company, and Icon, a construction technology company, is building 500 homes.  Each home takes about 24 hours to build; 200 have already been built.

Here’s a video of the process:

No one knows how durable the houses will be over time, but they’ve already withstood a 7.4 magnitude earthquake, something that would have been appreciated, for example, in Haiti.  Most importantly, they’re providing homes for people who might have otherwise been homeless or living in sub-standard conditions.

Brett Hagler, New Story’s chief executive and co-founder, told The Times: “We know that being able to build more quickly, without sacrificing quality, is something that we have to make huge leaps on if we’re going to even make a dent on the issue of housing in our lifetime.”  

“We’re really looking at the biggest opportunities to have both impact and efficiency gains,” New Story co-founder Alexandria Lafci added.  “There is a very significant gain in speed that you get with 3-D printing, without sacrificing quality.”

There are 3D-printed housing projects all over the world, including Austin (TX), Rancho Mirage (CA), and Tallahassee (FL).   The Tallahassee developers boasted: “Make no mistake, these houses are not your average test models. The finished product is far superior in strength, durability, and efficiency.”   

Faster, cheaper, more durable – what’s not to like?

Canada’s first 3D printed house, the so-called Fibonacci House, features curved walls, just because the builders could.  “So now, architectural features that are exciting or adding aesthetics can be done for virtually no cost comparison,” said Ian Cornishin, president of the company that built it.

Here’s their video:

That company, Twente Additive Manufacturing, is now teaming up with non-profit World Housing to build a 3D printed community called Sakura Place.  World Housing’s Don McQuaid says: “Our belief is that technology is going to be the solution for homelessness, and we believe that everyone deserves a home.” 

The Ruler of Dubai is such a big fan that he has decreed that 25% of all construction – not just houses – are to be constructed by 3D printing technology by 2030, “to promote Dubai as a regional and global hub for the use of 3D printing technologies.”  

It’s a new world for construction.  Housing expert Brad Hudson noted: “The housing industry hasn’t changed its overall methods of building homes in the past 50 years.  Innovations like 3D and modular construction will start to gain popularity.”  

So it will be for healthcare.  I’ve written before about the 3D printing of prescription drugs, which offers the intriguing, if not scary, possibility of printing your own meds at home, but that’s just one example of how healthcare is starting to realize 3D printing’s potential.

Scientists at the Israel Institute of Technology have 3D printed a blood vessel network, to support implanted tissue, something that had not been achieved through conventional approaches.  The researchers believe it “is a versatile and adaptable technique that may cement a new path toward fully lab-grown patient-specific tissues.”  

Here’s their video:

We’re not yet at the point of 3D printing human organs for transplants, but we’re close, and in the meantime, we are 3D printing prosthetics.   The NIH says:

3D-printable prosthetics are changing the face of medicine, as engineers and physicians are able to develop prosthetics that are fully customized to the wearer. Consumer 3D printing is leading to an even bigger revolution: “DIY” assistive devices that can be printed by virtually anyone, anywhere.

Imagine that world.  

Some experts think the 3D printing market for healthcare is already a billion-dollar market and will be a $6 billion one by 2030, which seems like not nearly enough.  Where is healthcare’s Ruler of Dubai, demanding 25% of healthcare construction (or manufacturing) using 3D printing by 2030?

3D printing helped lessen the shortage of personal protective equipment (PPE) during the pandemic when demand skyrocketed at the same time supply chains cratered, but not fast enough and not in enough quantity.  Supply chains are again teetering,  but if healthcare organizations have scaled up their 3D printing capabilities to prepare for shortages, I missed it. 

——-

There are really two types of thinking we need to be practicing here. One is what are the things we are doing now that could be done at least as well using 3D printing?  It’s like building houses using 3D printing; they’re not reinventing houses, but they are reinventing how they’re built, in hopes of a faster, cheaper way.  Ideally, it could lead to more affordable houses, and perhaps make a big dent in homelessness.  

E.g., in healthcare, more affordable, better fitting prostheses are made much faster.  

The second is what are the things we can’t do now that could be done with 3D printing?  The work in human organs, tissues, or blood vessels fall into this category, but shouldn’t be the limit of the category.   

It’s easy enough to see how 3D printing may be one of the things that helps us address the problem of homelessness/affordable housing.  How can it similarly help us address the problem of people lacking access to health care/affordable health care?  

Policies|Techies|VCs: What’s Next For Health Care? is the conference bringing together the CEOs of the next generation of virtual & real-life care delivery, and all the permutations thereof. You can register here or learn how to sponsor.

This is a big week. We are one week out and we’ve started pre-recording a few sessions and they’ve been fascinating. Keynotes include government officials from the 3 most important agencies for digital health –Pauline Lapin (CMS), Micky Tripathi (ONC) & Bakul Patel (FDA). But wait there’s more! Keynotes from techies Glen Tullman (Transcarent), Sean Lane (Olive), Jonathan Bush (Zus Health), Jeff Dachis (One Drop) & Andrew Dudum (Hims & Hers). And we’re not forgetting the VCs sprinkled through the program, with a keynote from Andreesen Horowitz’s Julie Yoo.

Please look at the agenda for 20 power-packed panels and over 100 speakers – and then sign up!

Shout out to our sponsors – This week we welcome new Gold sponsor data privacy company Skyflow and new Silver sponsor Amwell. Thanks to both of them for supporting the conference. They join Avaneer Health (our Platinum sponsor) & exclusive Agency sponsor 120/80. Sliver sponsors are Transcarent & Lark . More sponsors are Aetion. Merck GHIF, Crossover Health, Zus Health, Newtopia, Aetion & Big Health! Many of them will have sessions you can catch on the web site.

It’s going to be a great conference–no need to leave your seat as it’s happening virtually September 7-10. Register here!! — Matthew Holt

By KIM BELLARD

By the time you read this, Microsoft may have already struck a deal with the messaging service Discord.  VentureBeat reported two weeks ago that Discord was in an “exclusive acquisition discussion” with an interested party, for a deal that could reach at least $10b.  Bloomberg and  The Wall Street Journal each quickly revealed that the interested party was Microsoft (and also confirmed the likely price). 

Me, I’m wishing that a healthcare company – hey, TelaDoc and UnitedHealth Group, I’m looking at you! – was in the mix. 

Let’s back up.  If you are not a gamer, you may not know about Discord.  It was launched in 2015, primarily as a community for gamers.  Originally it focused on texting/chat, but has widened its capabilities to include audio and video.  The Verge described it: “Discord is a great mix of Slack messaging and Zoom video, combined together with a unique ability to just drop into audio calls freely.”

Zoom meets Slack meets Clubhouse.

As you might infer from the potential asking price, Discord has done quite well.  It has over 140 million monthly users, and, despite having no advertising and offering a free service, generated $130 million in revenues last year (through its “enhanced Discord experience” subscription service Nitro).  OK, it still isn’t profitable, but a December funding round gave it a $7b valuation.

GeekWire gushes:

As of right now, Discord is nearly inescapable in the gaming space. It takes about a minute to open a new public or private Discord channel for any given topic, complete with voice chat, image hosting, and browser access.

The pandemic helped growth, as it did for gaming generally, as well as for services like Zoom, but Discord leaned into the moment and broadened its reach.  NPR says: “What started as a community for gamers has in the past year become a hub for virtually everything: conferences, karaoke, book clubs, group therapy, homework help, sneaker trading andanalyzing Wall Street stocks.” Popular Science believes: “If you’re interested in a topic, there’s almost certainly a subsect of people talking about it on Discord right now.”

Discord CEO Jason Citron told NPR: “You can text chat, voice chat, video chat seamlessly, switch between them on your phone or on your desktop. And it’s great for playing games together, studying homework, hosting an online book club or even a karaoke night.”

He went on to explain:

We surveyed 20,000 of our users and asked them questions like, ‘What is the biggest misconception that people have about Discord?’ The resounding answer was that the biggest misconception is that Discord is only used for gaming.

So in 2020, we relaunched the company to tell the world how people on are doing so much more than playing video games. And with everything that happened with COVID, it dramatically accelerated that transition.

It’s fairly clear why Microsoft wants Discord; it is big in the gaming business through Xbox platform, but weak in the social media space (especially since its efforts to acquire TikTok seem to have petered out).  Microsoft CEO Satya Nadella told Bloomberg recently: “Creation, creation, creation — the next 10 years is going to be as much about creation as it is about consumption and about the community around it, so it’s not creating alone.”

Or, as VentureBeat put it, Microsoft’s objective with Discord is “community, community, community.”  Discord has them and Microsoft wants them. 

While most analyses of Microsoft’s interest focus around the gaming world, Bloomberg sees a broader play:

And as more young people grow up with operating systems, email, chat apps and productivity software from companies like Apple and Google, owning a community popular with that age group could acquaint them with Microsoft in a way their elders have been in the past because of Windows and Office.

This is where I substitute “Microsoft” for TelaDoc, UnitedHealth Group, or other healthcare companies. 

The healthcare world is awash in good feelings about telehealth, convinced that the pandemic has demonstrated that telehealth’s time may finally have come.  More people have tried it, more healthcare companies have embraced it, and more people agree that it is going to play a major part of healthcare’s future.  Virtual care models are exploding, both existing ones like TelaDoc or AmWell and a host of newcomers. 

Patient communities have been around as long as there have been online communities, such as PatientsLikeMe or a host of Facebook-based ones (although the latter not without controversy).  But communities built on a multi-faceted messaging platform, and that is popular with young people – no, we haven’t seen that in healthcare yet. 

People could use Discord to securely message with their physician or other healthcare professionals, or to be part of ongoing or episodic health-related communities. It may not have been designed for healthcare, but 2020 has shown us that Discord could easily be adopted for it.

Christophe Jammet, a managing director at Gather, told Bloomberg: “Microsoft buying Discord would be a really strategic move—it shows that Microsoft understands the power of community in the context of the pandemic.”

Do any healthcare companies understand the same thing? 

Even more important for healthcare, remember that Discord is ad-free, and that Mr. Citron stresses:

From the beginning, privacy has been built into Discord…We believe that people’s data is their data and that people should feel comfortable and safe to have conversations and that their data is not going to be used against them in any way that is is improper.

That’s the attitude we should expect healthcare services to have. 

Microsoft would have many challenges if it were to acquire Discord, especially ensuring that users believe that it would remain agnostic towards gaming platforms and not (overtly) favor Xbox.  Yahoo Finance says: “By continuing to offer Discord as a neutral service, Microsoft could engender more good will from gamers while also getting its name in front of PlayStation and Nintendo players.”

The healthcare version of that could be: “By continuing to offer Discord as a neutral service, UnitedHealth Group could engender more good will from patients while also getting its name in front of CVS/Aetna and Anthem members.”

I have long advocated that healthcare desperately needs to prepare for its future by learning from the gaming world and by figuring out how to appeal to younger people (who may not yet be actively engaged with the healthcare system).  An acquisition of Discord by a healthcare company could accomplish both those goals with one acquisition.

The questions are, though: what healthcare company sees that future — and is prepared to outbid Microsoft for Discord?

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor.

Episode 14 of “The THCB Gang” was live-streamed on Thursday, June 18th. Tune in below!

Joining Matthew Holt were four regulars: health futurist Ian Morrison (@seccurve), writer Kim Bellard (@kimbbellard), MD turned leadership coach Maggi Cary (@MargaretCaryMD), Consumer advocate & CTO of Carium Health Lygeia Ricciardi (@Lygeia), and two guests: Emergency Room MD, IT consultant and so much more Medell Briggs (MedellBriggsMD), and patient advocate CEO of Patient Orator, Kistein Monkhouse (@KisteinM). It was a very thoughtful conversation about patient care, the role of social movements, what to do about structural racism in health care, and what new legislation might come from the federal level. You can watch below right now.

If you’d rather listen to the episode, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels — Zoya Khan

By KIM BELLARD

There’s so much going on.  There’s the coronavirus: It’s now a pandemic!  China can build an entire hospital to treat coronavirus patients in under two weeks!  Or there’s primary care: One Medical’s IPO boomed!  Amazon, Humana and Walmart are testing their versions!  People are flocking away from primary care!  Or, on a completely unrelated note, Tesla wants to disrupt auto insurance too. 

As interesting as all those are, it’s augmented reality (AR) that I want to talk about. 

Stop thinking about Snap Spectacles or Pokémon Go as what you think of when you think about AR.  Stop thinking about the supposed failure of Google Glass.  Start thinking about AR being ingrained in our daily lives.

Facebook CEO Mark Zuckerberg believes “at some point in the 2020s, we will get breakthrough augmented reality glasses that will redefine our relationship with technology.”  He went on to elaborate:

Instead of having devices that take us away from the people around us, the next platform will help us be more present with each other and will help the technology get out of the way. Even though some of the early devices seem clunky, I think these will be the most human and social technology platforms anyone has built yet.

Not surprising, Facebook is rumored to be working, in conjunction with Luxottica, on its own (AR) smart glasses project — code name Orion — that is expected to become available sometime between 2023 and 2025.  CNBC reported: “The glasses would allow users to take calls, show information to users in a small display and live-stream their vantage point to their social media friends and followers,” and have an accompanying A.I. voice assistant.

Apple’s Tim Cook agrees.  “I’m excited about AR,” Cook said, reports Silicon Republic. “My view is it’s the next big thing, and it will pervade our entire lives.”  Apple’s AR headset is expected to launch as early as this year.  Bloomberg reports: “The glasses are expected to synchronize with a wearer’s iPhone to display things such as texts, emails, maps, and games over the user’s field of vision.”

Samsung is also expected to launch AR smart glasses this year, among others, and, of course, Google Glass never really went away, just changed focus. 

But what excited me lately about AR was a report from CES 2020 by Evan Ackerman about what Bosch is doing.  Instead of projecting the AR on a screen or in front of you, it “paints an image directly onto your retina.” 

Now we’re talking.

Here’s the Bosch promotional video, featuring a number of interesting use cases:

Mr. Ackerman was fitted with a customized set of smart glasses, as is necessary, and marveled:

It’s definitely true that for the first 10 or so minutes of wearing the glasses, your brain will be spending a lot of time trying to figure out just what the heck is going on. But after that, it just works, and you stop thinking about it (or that’s how it went for me, anyway.) This is just an experience that you and your brain need to have together, and it’ll all make sense.

Bosch is reportedly less interested in producing consumer products itself than in licensing its Smartglasses Light Drive to other manufacturers as “a complete, ready-to-use solution for smaller, lighter, more stylish smartglasses.”  Mr. Ackerman says “The earliest any such product might be available would likely be 2021. The light drive technology is not inherently super expensive, though, so any consumer smart glasses made with it should be available at a cost comparable to (or cheaper than) other smart glasses systems.” 

Because the image is projected directly into your retina, it is always in focus and works under all lighting conditions.  Others not only can’t see what you are seeing but wouldn’t even know you are seeing anything at all. 

We’ve all experienced being with people who can’t tear their eyes away from their smartphone or other screen.  It is often particularly felt in the healthcare setting, where patients often feel that their physician spends more time looking at the EHR than they do looking at them, and physician burnout is often tied directly to all that screen time.  

The Bosch approach could at least diminish the patient perception, even if physicians are still looking at other information as they talk to them.  

Tim Cook, for one, think this is something AR can help with.  “I think it’s something that doesn’t isolate people,” he said. “We can use it to enhance our discussion, not substitute it for human connection, which I’ve always deeply worried about in some of the other technologies.”  And he is “extremely excited” about tech helping healthcare, noting: “I’m seeing that this intersection has not yet been explored very well.” 

A survey by E-Commerce Times found that only 12% of consumers (actually, heads of U.S. household that have broadband) consider themselves “familiar” with AR, although that is true of a quarter of Millennials and a third of Gen Z households.  Despite the low current familiarity, more than 60% expressed interest in getting information via AR. 

Right now, consumers still think of AR as through smartphones, but as smart glasses get both sleeker and smarter, that should change.  I’ll go a step or two further: just as I’ve long viewed smartphone and other physical screens as transitional, in a world of ubiquitous computing I believe that even smart glasses are transitional. How what devices might be “painting our eyeballs” in such a world, I don’t know, but I’m sure that in twenty or thirty years we won’t all need to be wearing physical smart glasses.   

Healthcare is usually late to technology innovations.  It kept paper-based business records long after other industries, it continues to fail on sharing/transmitting customer information, and usability is often at best an afterthought.  It is dipping its toe into both AR and VR, with some experts predicting AR will grow much faster over the next ten years, but in the case of AR I hope healthcare is a leader, or at least a very fast follower, instead of a laggard.  

Don’t blink or AR might pass healthcare by.  

Kim Bellard is editor of Tincture and thoughtfully challenges the status quo, with a constant focus on what would be best for people’s health.

Has Steve Jobs and his company altered the practice of medicine as significantly as Vesalius, Hooke, Hood and other giants in the field?

A radical supposition perhaps. One that I am not altogether comfortable with. Yet there is no denying the impact of the technologies adopted as a result of his touch.

Medical practitioners these days employ easy to use mobile/connected devices to learn, to stream, to take CME,  or monitor patients, prescribe, ensure compliance, download and consume digital media, or just communicate and collaborate more robustly. Even crowd sourcing solutions to medical conundrums has become a concept mainstream institutions are embracing.

That the world’s data more and more exists in the palm of your hand – instantly accessible from the office to the operating room to any remote corner of the world – is due in large measure to devices and markets either pioneered by or made user friendly by Steve Jobs and Apple.

Heightening the level and rate of electronic exchange does not necessarily mean change for the better in regards to patient care. It is still unclear whether individual patients will enjoy improved diagnosis and treatment as the gradual shift in practice from medical clinician to technician evolves.

Historians will long debate the role of this rock star CEO and his company as they helped shift paradigms in all sectors of our economy – from media to manufacturing to healthcare.

That we are all wirelessly wired in more unforeseen ways everyday is not all due to Jobs and his company. Not by a long shot.

My perception of Jobs’ vision, decision making ability, consumer usability perspective, sense of design, strength of conviction, ability to assemble a great staff, and  relentlessness has propelled him and his firm – coincidentally bearing the same name as the forbidden fruit and as well asBeatle’s record label – to an exalted folkloresque place in corporate America.

I think I forgot communicate in that list, above. Jobs had a unique ability to communicate his vision as well.

I say this not personally owning any Apple products.

I am a late, rather than early adopter, deploying the appropriate tool for the job after the cost curve starts driving downward and market penetration has happened.

I can admire  beautiful design and best in class features and functionality. If I get most of the same for half the price – that is generally the way I go. You are not likely to find me sitting outside on the sidewalk waiting for the latest release at midnight.

But these are my biases.  Clearly there are enough Apple-ites to spur entire Apple store knock-offs in China, and propel the company to #1 on the Market Capitalization Charts – briefly unseating Exxon as the world’s most valued company – worth more than the top 32 banks in the EuroZone!

Not bad for a business started in a garage. For a guy fired from his own start-up.

Perhaps new collaborative techniques enabled by technology his company helps mainstream will sustain his energy and creativity as Jobs transitions to the next phase of his life.

Alex Epstein is currently SVP of Production, Programming and Editorial at ReachMD – a medical information and education service that includes XM160 – the only nation-wide broadcast channel for medical professionals. A graduate of Bennington College and the Yale School of Management, Alex got his start in broadcast TV and radio in Fairbanks, Alaska. His experience includes 10 years in LA writing and producing broadcast and syndicated TV for a variety of high profile outlets. He transitioned to creating corporate, association and educational content and messaging in all its evolving forms after moving to Chicago. His personal blog is Viewser – digital streams of consciousness, where this post first appeared.

By REBECCA FOGG

Hardly a day goes by that I don’t read the term “Disruptive Innovation” cited in relation to health care delivery. This might seem like a good thing, given that our expensive, wasteful, and in some cases frightfully ineffective traditional delivery model is in dire need of transformation. However, the term is frequently misunderstood to refer to any innovation representing a radical departure from an industry’s prior best offerings. In fact, it actually has a very specific definition.

Disruptive Innovation is the phenomenon by which an innovation transforms an existing market or sector by introducing simplicity, convenience, accessibility, and affordability where complication and high cost have become the status quo—eventually completely redefining the industry. It has played out in markets from home entertainment to teeth whitening, and it could make health care delivery more effective by making providers’ care processes, as well as individuals’ own self-care regimes easier and less costly. This, in turn, would reduce the need for both more, and more expensive, interventions over time.

Unfortunately, disruption has been slow to emerge in the health care sector. It’s been thwarted by the broader health care industry’s unique structure, which tends to prioritize the needs of commercial insurers and large employers (who pay the most for consumer care) over those of health care consumers themselves. It also stacks the deck against disruptive entrepreneurs, since established providers effectively control professional licensing requirements, and (along with insurers) access to patients & key delivery partners.

Consequently, most innovation in recent decades has maintained the industry’s status quo. But as Clayton Christensen, Andrew Waldeck and I explained in our 2016 paper, conditions have been improving for disruption in health care delivery, and innovators have been capitalizing on them. At that time, we were particularly encouraged by providers like ChenMed, Iora, Oak Street Health, WellMed and others who were (and still are) developing and scaling potentially disruptive primary care models to help patients better manage complex, chronic conditions over time.

Even more encouraging is the fact that in the two years since we published our paper, disruption appears to be accelerating in health care delivery. Here are four indicators that led me to that conclusion:

1. Health care delivery is attracting diverse and impressive new players. Apple. Google. Walgreens. Amazon. JP Morgan. These are just some of the companies with origins outside health care delivery who’ve very recently entered, or “re-upped,” their strategic commitment to the market. And when such giants of tech, retail, and finance dive into a different market, you know there’s a big problem to solve, and money to be made there. Why does this spell disruption? Because the innovations that ultimately disrupt a market are usually those created by market entrants, vs. historic market leaders.
2. New players are targeting an important, unmet need in the market. These players don’t seek to improve the traditional health care delivery model, which is optimized to address episodes of acute illness or injury with reactive, one-size-fits-all treatments. Their ambitious goal is to create entirely new models. Many are designing them to address the important, unmet market need for continuous and proactive care. Their goal is to help people live the longest, healthiest lives possible. Walgreens’ new partnership with health insurer Humana exemplifies the trend. The companies are piloting primary care clinics in select Walgreens stores, with the explicit strategy of going “beyond addressing acute and immediate health issues” to focus on developing “long-term relationships with patients living with chronic conditions.”
3. New players are shaping innovations to disrupt traditional health care delivery.  Companies entering health care delivery are innovating to make it simpler, more affordable and more convenient. The Amazon/JPMorgan/ Berkshire Hathaway health venture aims to leverage technology innovations toward that end, and Amazon’s extraordinary, tech-driven disruption of brick-and-mortar retailers bodes well for the venture’s success.
4. The global market for population health management solutions is growing fast. Many would-be disruptors are employing “population health management” strategies, which use sophisticated data analytics to identify the major health risks and cost-drivers in a group of patients, and multidisciplinary care teams to work with patients over the long-term to manage their health better and more cost-effectively. Offering yet more evidence that disruption is accelerating in health care delivery, the market research firm MarketsandMarkets predicts that the global market in population health management solutions will be worth over $42 billion by 2021—more than tripling in value from 2016.

While these signs might be viewed as purely positive, Disruptive Innovations are not actually intrinsically good or bad; the nature of their impact depends on the need they are designed to meet, and the stakeholder considered. And indeed, as the force of disruption ripples through health care delivery, many dedicated providers, successful business leaders, talented innovators, and venerated institutions will be forced to change—a process that is as uncomfortable as it can be beneficial and exciting. But where Disruptive Innovation in health care delivery is designed to help Americans live the longest, healthiest lives possible, I believe it’s a win for society as a whole.

Continuing my series of interviews from HIMSS17, is one with Robert Armstrong, CEO of Appstem. Appstem is one of the companies that quietly builds most of those ubiquitous mobile apps branded by health plans, pharma companies and a large number of product companies too. It’s an example of the hyper-specialization going on within technology, as even well funded product companies start to use companies like Appstem to build onto their partner APIs and build out their portfolios. An interesting niche and one that’s a lot more important that you’d think–it’s well worth a listen to Robert to find out more.

Health 2.0 is actively expanding Technology for Healthy Communities and looking for large healthcare organizations and foundations to help support technology adoption at a community level.

Technology for Healthy Communities is a dynamic pilot program designed to catalyze the adoption of technologies in communities. The program fosters the development of sustainable partnerships to address the social determinants of health in the under-served regions that need it the most. Over 200 innovators across the U.S. submitted applications to the program, and through curated matchmaking and access to funding, selected innovators were matched with three participating communities to conduct pilot projects.

Snapshot of the three pilots:

• Spartanburg, SC: ACCESS Health Spartanburg, a non-profit agency primarily working with the uninsured population, is piloting with Healthify to provide community interventions for social determinants of health at the point of care. With support from Spartanburg Way to Wellville and the Mary Black Foundation, the pilot aims to address current pain points in community health care, such as the inefficiency of addressing social needs of patients and helping to make case management easier.
• Jacksonville, FL: The City of Jacksonville and the Health Planning Council of NE Florida, with support from the Clinton Foundation is piloting with CTY to deploy its signature product, NuminaTM. With this technology, bicycle and pedestrian traffic data will be collected to assess current safety conditions and plan improvements in the built environment for residents to be more physically active.
• Alameda County, CA: The Community Health Center Network is piloting with Welkin Health to implement a case management tool that engages members and eases current healthcare worker burden. Together, they will pilot this case management tool in four centers to help community health workers to effectively and efficiently coordinate care.

Due to the high demand from tech innovators and communities, Health 2.0 is expanding the program to new communities, tech startups and organizations who can benefit from technology adoption. By addressing the social determinants of health, the program has the potential to implement unique tech applications and address some of the most important systemic issues at the community level.

Health 2.0 is looking for partners such as foundations, large health systems and corporations who want to support pilots to test innovations in communities, interact with the fastest growing startups in the tech scene, and help create business opportunities for technology companies. Program sponsors will also have the opportunity to address local health needs by bringing exciting, new technologies to under-served regions across the U.S.

The program will focus on tools that support access to a healthy lifestyle, in categories such as:

• Access to healthcare services
• Food insecurity
• Affordable housing
• Behavioral/mental health

If you are interested in partnering with Health 2.0 to help deliver technology to communities, contact patrick@health2con.com to learn about opportunities to support the program.

Alexandra Camesas is a program manager at Catalyst @ Health 2.0