Digital Health is Underfunded

digital health is underfundedOverall venture capital funding made a sharp decline in the last two quarters amid worries (justifiable or not) of a bear market and a funding bubble in technology investments. In contrast to the tech market, however, digital health funding continues to grow at a record pace. According to Rock Health, $4.5B was invested in digital health in 2015 (an increase from $4.3B from 2014) and $981 million has already been invested in the first quarter of this year. It seems on pace to be another stellar year, which is remarkable considering what is going on in other sectors.

Many are skeptical about the investment potential of healthcare technology investments and have been wary to enter the market (perhaps especially so with all the negative media that companies like Theranos and Zenefits have attracted). Additionally, regulatory barriers and the longer timeline needed with healthcare innovations tend to scare potential investors away.  But anyone familiar with the sad state of technology in healthcare can see, even with the record-breaking investments thus far, that there continues to be an enormous untapped opportunity in healthcare–greater, I believe, than in any other sector.

Digital health is vastly underfunded.

Technology is taking over most of our personal and professional lives with indispensable apps, wearables, and other connected devices and software. At home, we have smart appliances, lighting, thermostats, security systems, media systems, and even smart cars. And we have Siri, Cortana, and Alexa doing our bidding. But in healthcare, we’re still in the Stone Ages in terms of technology. Communication via faxes, for example, is still common between hospitals and doctors offices. There are small glimmers of hope, such as patient portals, higher-functionality EMR systems, and telehealth services, but the fact is that we are still a far cry from the ideal vision for healthcare, which includes a seamless cloud-based network of devices and software that can track and record a vast spectrum of patient information, the ultimate goal being the use of computational technology to help prevent, predict, diagnose, and yes, even treat disease. Ultimately, collecting information on large populations of patients could have profound impact through public health measures that can prevent disease and thereby reduce healthcare costs. This can only be accomplished with a wide-spread network of software and devices, that includes electronic health records, wearables, devices based in the hospital, office, and at-home, and with telehealth capabilities. In addition, there are too few companies working to collect, store, manage, and interpret health data.

There is still a lot that needs to be done.

According to MarketResearch.com, the healthcare “internet of things” (IoT) is expected to reach $117B by the year 2020. The fact is, the full potential of digital health won’t be seen until every hospital and doctor’s office and home is connected via cloud-based devices and software and with the development of machine learning platforms that can make sense of the reams of health information.

It is a little challenging to think of all of this in the abstract, so here are a few examples of the potential of the healthcare IoT. Imagine that a spike in certain population health data (like temperature) is detected in a region of the country that alerts public health officials to early to a disease outbreak that can then be contained to prevent an epidemic. Imagine that a change in an individual’s biometric data alerts that person to seek medical care, detecting a life-threatening disease, like cancer, early and improving the chances of cure. Imagine chronic health conditions like diabetes are monitored routinely and continuously with real-time blood glucose levels, with immediate adjustment by doctors of insulin dosages, thereby preventing hospitalizations due to uncontrolled diabetes, and also preventing long-term diabetic complications, such as kidney disease.

These are only a few examples.  There are countless other opportunities in healthcare.

In addition to the opportunity to improve healthcare delivery, there is the opportunity to improve the quality of care through tools that provide greater communication and transparency of information with patients and improve care coordination between the providers of those patients. And by changing the focus of medical care to prevention and early diagnosis of disease, there is the opportunity to decrease the outrageous cost of healthcare as well, by decreasing the need for excessive medication, surgery, unnecessary visits, and hospitalizations. According to the Commonwealth Fund, in the US we spend an outsized proportion of our GDP on healthcare versus other countries. Other developed countries spend between 8.8%-11.6% to our 17% of GDP, related in part to better-connected health IT networks.

It’s hard to fathom how much digital health tech is needed to serve a US population of 318 million and a global population of 7 billion, but one thing is certain: the market is huge.  We should stay bullish on health tech investments now, and probably for a long while to come.

 

How Jonathan Bush Plans to Build the Health Care Internet

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Jonathan Bush, the high profile CEO of athenahealth, has a grand vision of the future of health care and it involves building a “health care Internet.” In this world, primary care physicians are power brokers, connecting and referring patients to a cloud-based network of super-specialists that can care for patients regardless of their geographic proximity.

Primary care physicians will be able to find specialists anywhere in the country, even the world, with highly specific skills and knowledge for their most complex patients.

Patients will have the advantage of being cared for by doctors who have treated hundreds of patients just like them, instead of by doctors who may only see patients with their specific disorder a few times in their careers.

It sounds compelling, but in our currently disjointed system, it seems like a distant dream. Bush, in a keynote interview at the Digital Healthcare Summit in Boston, admits, “We’re sort of Star Wars 1 here in health care … So, ok, the market doesn’t work so well in health care, but what we want is a network.”

Moderator Brandon Hull challenged Bush a bit. At the conference, Bush shared a music video parody that ridiculed EMRs. Hull noted the video’s message that, “Doctors hate EMRs … The last I looked, you’re in the business of selling EMRs.” Bush agreed that what we currently have is far from what we want and pointed to the lack of a coordinated vision on the part of the government as a key factor.

He cited the rush to tie physicians and hospitals to electronic health record systems without supporting infrastructure as one of the reasons for the lack of interoperability. To get to his vision of a fully functioning software enterprise system, Bush recommends taking a hard look at our current situation. “With everything in life, the first thing that you want to do if you really want to live fully is to stare vividly and unflinchingly for a very long time at the awkward reality of your current situation and then you can look off to your right and see a beautiful world that you wish you were in.”

Considering the current tech challenges in health care, Bush takes a sympathetic stance on the plight of doctors. During the talk he shared the image of a painting that he takes inspiration from, called “The Doctor” by Sir Luke Fildes. In it, a pensive doctor sits at the bedside of an ill child. “This guy, to me, is on the edge of his humanity…” he shared. “And what I believe is that digital health represents the wicking away of the things … that don’t require this level of presence is the job of the cloud and is the job of technology.”

It’s a beautiful vision, but is it realistic or even attainable?

The brutal truth about health care today is that the pensive doctor now has a large computer screen between her and her ill patient. Bush admits that we’re far from the vision currently and admits that doctors’ documentation work has become “life-sapping.” His long-term vision, however, is to make this work automated and routinized, so that doctors can be more fully present for patients.

Bush notes with irony that currently 12 million faxes are sent between the IT systems of health care providers despite the overwhelming adoption of electronic health records throughout the health care system. Bush attributes the stimulus of the ACA with the wide but ineffective adoption of EMRs. Speaking of the stimulus, in his usual colorful manner, he said, “What did Keynes say? If you pay a 100 guys to dig a hole and another 100 to fill the hole, at least you get the ball rolling.” According to Bush, despite requiring the collection of meaningful use data, the government has built no infrastructure to actually receive and measure it. He went on to discuss how regulations just add additional complexity to the system, which when worked around, create “ridiculous absurdities” and additional bureaucratic drag.

Still, he feels there is plenty of room for innovation, which is reflected in the creation of athenahealth’s innovation arm, called MDP, or More Disruption Please. Through MDP, athenahealth provides investment and support to start-ups and entrepreneurs who share their connected health vision. “We think of health care as a few trillion dollar industry. It’s thousands of a couple of billion dollar markets, all masquerading as one thing … My thought with MDP is that what we need is thousands of companies with no cost of sale, no cost of implementation, that are very results oriented, maybe they almost morph between a vendor and a provider, and they kind of come together and focus on these thousands of industries and get a 10x return because you don’t have to put very much in and the cost of sale, of implementation, is so low because you have this backbone to plug into an app store, if you will, that you can start verticals.”

Besides improving care of individual patients with a powerful network of providers, Bush feels the health care Internet can also create a new opportunity to study diseases. Under our current system, it is difficult to get enough patients with certain diseases in one place in order to conduct a study with high enough power, but that could change with enhanced technology. He also sees an opportunity to better address population health, not just in those with chronic disease – which is a focus currently due to the high costs of care of these patients – but ultimately other groups of patients as well, and the ability to do this at scale.

One regulatory shift that Bush seems to favor is the emphasis on fee-for-value versus fee-for-service. He argues that risk-bearing creates a rich market with a large number of buyers and sellers, competitively innovating cheaper and better solutions. His hope, through MDP, is to help create this rich health care ecosystem. He asserts that it’s not athenahealth’s objective to build or be the storefront for all of these businesses, but rather to simply encourage their development.

This long-view of health care and investment in MDP places athenahealth ahead of the hundreds, if not thousands, of other EMR providers. It shouldn’t surprise anyone if someday the much-sought-after and elusive health care Internet is ultimately hosted on servers built by Jonathan Bush and athenahealth.

 

This article was originally published by Healthegy.

GV’s Approach to Healthcare Investing: An Interview with Dr. Krishna Yeshwant

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Please note:  This article was originally published on TechCrunch.com.

Healthcare investments — in particular, investments in digital health — are booming, and don’t seem to be slowing down. According to CB Insights, digital health funding hit nearly $5.8 billion in venture funding last year, surpassing the previous record of $4.3 billion in 2014.

One of the top venture firms, GV (previously known as Google Ventures), recently came out with their year in review, revealing that more than one-third of their investments are in the life sciences and healthcare. (They currently have $2.4 billion under management.) “I can think of no more important mission than to improve human health and global quality of life,” CEO Bill Maris said in a recent announcement.

One of the strengths of the GV life science and health investment team is having a diverse mix of PhDs and MDs as investors, including general partner Dr. Krishna Yeshwant. Yeshwant continues to practice internal medicine part-time at Brigham and Women’s Hospital in Boston, and credits that with helping to keep him in touch with the challenges facing healthcare.

I recently sat down with Yeshwant to talk about GV’s investment strategy.

Yeshwant started his career, interestingly, studying computer science at Stanford. From there, he helped found two tech companies, which were eventually acquired by Hewlett-Packard and Symantec. He could have successfully continued on his path in tech, but decided instead to go to medical school after his father became ill and needed a cardiac bypass. “I remember just being in the hospital thinking this is just messed up. There are so many areas for improvement,” he said.

He went on to pursue an MD-MBA at Harvard. During this time, he became involved in a lot of medical-device work, and even started a diagnostics company. This work eventually led him to work with Bill Maris at Google Ventures.

Thus far, one of GV’s largest investments has been with Flatiron Health, an oncology-focused technology company based in New York City. According to Yeshwant, the concept was developed by two former Google employees who received support from GV. “Flatiron is basically integrating EMR’s (electronic medical records) in the outpatient and hospital setting,“ said Yeshwant, “and it provides data back to physicians as well as aggregating data to aid with discovery and help with regulatory processes.”

Others have also recognized Flatiron’s enormous potential. Flatiron recently announced they received $175 million in Series C funding from Roche Pharmaceuticals. In addition to the funding, Roche plans to be a subscriber to Flatiron’s software platform. Their hope is to use the platform to identify and bring innovative treatments to market faster.

Yeshwant strongly believes in the need for more tech solutions in healthcare like Flatiron Health. “There’s a fundamental need for infrastructure. A single disease type of lung cancer is actually lots of diseases. Other more complex diseases are going to need more data sets, multisite trials, and we need to create infrastructure for that,” he said.

It’s hard to argue with him on that point. Massive amounts of biometric data are being collected in healthcare right now, but there aren’t nearly enough tools for storage, communication and analysis of that data. There’s a great deal of opportunity for healthcare startups that can specialize in data management and analysis.

Three such companies in which GV has invested in this space are Metabiota, which provides risk analytics to prevent and reduce epidemics; Zephyr Health, which uses global health data and machine learning to provide treatment insights to pharma and medical device companies; and DNAnexus, a company that helps companies store their genetic information.

“Once you’re in a world where you can scale up and down your computational analysis, you can ask lots of simultaneous questions of your aggregated data sets and that’s well suited to the cloud environment,” said Yeshwant. “We invest heavily in those spaces.”

Besides software-based companies, GV is investing in a diverse range of other types of companies in healthcare and the life sciences. One such area is the genomics space. Thus far, GV has made major investments in Editas, a CRISPR gene-editing company; 23andMe, which offers chromosomal analysis to consumers; and Foundation Medicine, a company that offers genomic analysis of various cancers.

Yeshwant also feels one of the biggest challenges (and opportunities) in healthcare is helping healthcare organizations shift from fee-for-service to fee-for-value. “That’s the direction we’re going,” he said. “How do we migrate big systems in that direction? That’s the fundamental question.”

GV therefore has made some significant investments in companies that are shaking up the traditional provider model, including the telemedicine company Doctor on Demand and the innovative primary care provider, One Medical Group. “Anything you can do to move healthcare from a high cost setting to a low cost setting is generally going to be successful in that model,” said Yeshwant. “Telemedicine is a good example of that. We have a company called Spruce Health which is essentially asynchronous care. Value based care is a big area for us.” (Spruce Health is a platform for dermatologic care.)

Yeshwant hinted that future projects may be in the areas of population health and chronic disease management, investment in companies that engage consumers directly and possibly even some work in women’s health. One thing’s for sure: We can expect more exciting things to come in 2016 and beyond for GV.

 

 

Walgreens: Investing in the Power of the Patient

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Thanks in part to Affordable Care Act reforms and the rise of digital health, patients now have more skin in the game, more health care tools at their disposal, and more information than ever before to take charge of their own health.

Dr. Harry Leider, CMO and Group VP of Walgreens, speaking on a panel at last week’s Digital Healthcare Innovation Summit in Boston, said health care providers must find a way to adapt to the schedules and demands of patients, who have more say over how their health care dollars – and their time – are spent.

“Traditional providers are learning that they [patients] are not willing to take a half-day off from work, figure out what to do with their kids, to get routine care,” he told the panelists. “People are busier, the information technology has made it easier to get solutions without having to spend a half-day somewhere.”

It’s no surprise, then, that pharmacy retailers are placing big bets on consumer-facing health care opportunities.

In the past few years, the pharmacy-services giant CVS Health has made big investments in this area, dropping tobacco sales, expanding its MinuteClinics, and also establishing a drug ad-herence program. Now with Walgreens’ recent announcement of its $9.4 billion acquisition of Rite Aid Pharmacies, it has effectively overtaken CVS to become the leader with 46.5% of the market to CVS’ 30.9% share.

But Walgreens is looking to get bigger on the back end as well. Also, just this week it announced an upgrade to their mobile app which improves its functionality and also expands their telehealth services to 25 states (previously available in only 5 states). Walgreens’ other health care investments hint at its level of commitment, including its partnership with controversial laboratory services company Theranos and a recent announcement that it has partnered with health information tech giant Epic to install that firm’s electronic health record software across all of its health care clinics.

Walgreens is banking on its huge presence to provide easy and convenient access to the next generation of health care consumers. “Everybody knows Walgreens,” Leider said. “We have 8,300 stores, 25,000 pharmacies, and over 1,000 nurse practitioners in our clinics.” He also emphasized that half of Walgreens are located in ethnically diverse areas, with a large number of especially high-risk populations, which gives them a unique opportunity to influence health care outcomes. “Take the average diabetic patient. Diabetes is an epidemic in our country, but especially among diverse populations. First of all, a diabetic, if they’re lucky, sees a primary care doctor two to three times a year. The average diabetic comes to our pharmacy counter 20 times a year. So the opportunity to provide systems that can solve problems is greater because of this.”

Walgreens has started a digitally supported Healthy Choices Program, which rewards consum-ers for walking, weighing themselves, logging blood pressure and blood glucose levels, commit-ting to smoking cessation, and setting other health goals. In addition, it offers digital health coaching, pharmacy checks, and even virtual doctor visits.

Roughly 800,000 people have signed up, Leider said. About 500,000, of those patients are sharing their personal health data with Walgreens. What the company has found thus far from its collection of these data is that engaged users (who are actively tracking their weight) lost an average of 3.3 pounds more than non-engaged users and 1 out of 6 lost more than 10 lbs. In addition, Walgreens found that its engaged users have overall healthier behaviors and better drug adherence.

Still, he’s not a blind advocate of digital health: “I don’t think digital health alone can solve the problems you’re talking about.” Leider insists that Walgreens is not trying to usurp the tradition-al establishment but rather be a resource to providers. “We really see ourselves as supporting traditional providers and adding value to the ecosystem. We’re not gearing ourselves up to do primary care,” he said. “So our strategy really is to provide a low-cost option for care and to partner with health systems and providers.”

Going forward, Dr. Leider would like to see a greater transition to value-based care. “Despite what everybody’s saying, most providers are still trying to keep the beds full and have the most number of visits. So, for all this tech to be funded and sustainable, it’s got to be the right envi-ronment to really reward people for staying well.”

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This article was originally published at www.digitalhealthcaresummit.com.  

Don’t Count Out Theranos

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The past few weeks haven’t been easy for Theranos, the pioneer hoping to make blood diagnostics a whole lot easier.

A scathing account by The Wall Street Journal, followed by some troubling documents released by the FDA, armed critics of the upstart start-up. The company clearly needs to counter these charges and demonstrate efficacy of its tests and the soundness of its business model.

However, change isn’t easy even in an industry like blood testing, which must be disrupted. We are literally still drawing vials and vials of blood for laboratory tests. This procedure seems only a shade better than the days of medical bloodletting with leeches. Also, these tests are notoriously expensive and have slow turnaround times.

What if Theranos CEO Elizabeth Holmes is on to something here?

What if her vision of easier, faster and cheaper blood testing is really possible? Wouldn’t we all like to see that? Blood testing is a very fundamental aspect of medicine and improving the current antiquated process has the potential to truly transform health care in a big way. Imagine how many more people might be compliant with their blood tests with this type of testing. Imagine how much faster we’d get results in critical situations, and how many lives might be saved. Imagine how much we could save our very wasteful and expensive health care system by making this process cheaper.

Before you say it’s impossible, let’s remember that the FDA did approve one of Theranos’ tests via its nanotainer technology, a test for the herpes simplex virus (HSV). That is an impressive feat, and quite frankly, I’d really like to see what other tests Theranos has been able to do via its tiny nanotainers. According to Holmes, the firm has something on the order of 120 tests submitted for approval with the FDA. Squash them now and the world may never know.

The media frenzy circling Theranos is unfortunate, and we should all hope it won’t kill off something that could really transform health care for the better. We shouldn’t be trying to protect the status quo in our dysfunctional health care system. Instead, we should be less hasty to judge Theranos.

Let’s keep in mind when we read media reports that there are a lot of stakeholders embedded in the health care industry – from equipment makers to laboratories to walk-in clinics and pharmacies – that might like to see Elizabeth Holmes fail. Some of these players currently own the market. That means they dictate the availability, the turnaround times, and yes, the price of these tests. Sure, maybe they could innovate also, but there’s inherently less motivation when you’re already a market leader. How about we introduce some competition to drive prices down and introduce more motivation to innovate?

Theranos, admittedly, has a lot of work to do. It is trying to disrupt the entire laboratory industry, while currently having just one FDA-approved test. I’m hoping more of its technology will meet FDA approval. In the meantime, it makes business sense to offer venous blood draws. If the company wants to capture enough of the market, it needs to offer the full spectrum of services to customers, be it using its proprietary technology or the industry standard.

As for Holmes, I can’t blame her for being protective of her nascent company. Unfortunately, people tend to be suspicious of things they don’t know much about, so that approach is not going to work anymore. Her challenge in the coming months will be how to effectively share more information with the media and increase transparency, now that she and Theranos are much more in the public eye.

There’s reason for optimism, not paranoia, about Theranos. Let’s allow some room for its visionary leader to carry out her ambitions. Maybe, just maybe, she’s on to something that can change health care, and the world, for the better.

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Conflict-of-interest disclosure:

I have no financial or other ties to Theranos or Elizabeth Holmes. My biases include wanting to see positive health care change and more women leaders. The opinions I’ve expressed here are my own and not those of any of my employers or affiliates.

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This article was originally published at www.digitalhealthcaresummit.com.

Investing in Problem-Solving, Not Product: PureTech’s “Proactive” Approach

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Step into the sixth floor offices of PureTech Health in downtown Boston and you may feel that you’ve dropped into a rabbit hole and right into a lush wonderland of wall-to-wall greenery. It’s a surprising interior for the otherwise nondescript office building on the heavily trafficked Boylston Street.

But the unique décor might provide a clue about how this innovative company, run by CEO Daphne Zohar, operates. Referred to as an intellectual property (IP) commercialization company, one of a rare breed seen in the U.S., it licenses and develops health tech and life sciences patents from academic and independently-run labs. The model is common in the U.K.–PureTech Health went public on the London Stock Exchange this past May, raising nearly $200 million—but is radically different from how typical biopharma or venture capital firms operate.

“We start with the problem–take obesity or other disorders, like schizophrenia, ADHD–where we feel like there really isn’t a very good way to address it, and we bring together a network of 50 plus experts from around the globe, people who have really thought deeply about this problem and others who may be in slightly different disciplines,” explains Julie DiCarlo, PureTech’s SVP of Communciations and Investor Relations. “They look at the problem from different perspectives and start vetting potential technologies or science to address it. So it’s really different than a company that might say, ‘Here’s a really cool technology that we want to invest in.’”

After the think tank identifies potentially useful innovations, PureTech tests the concepts to see if previously reported results are reproducible. DiCarlo adds, “From there, we might find that there’s one that really stands out as a really potentially exciting and game-changing opportunity and if it passes all of our rigorous tests, we’ll start a company around it.”

This process of search and discovery has lead to the founding of some of the most innovative healthcare-focused companies, with diverse treatments ranging from drugs and biologics, to devices and digital health.

Akili Interactive Labs develops video game therapies for treating cognitive disorders, which have been found to improve cognitive ability and executive function among the elderly. In the future, Akili hopes to also develop treatments for those suffering from disorders like ADHD, autism and depression.

Vedanta Biosciences hopes to treat autoimmune and infectious diseases by modulating a patient’s microbiome. At this stage, Vedanta is isolating specific strains of organisms in order to learn which combinations result in particular, desired phenotypic expressions and outcomes.

Gelesis has developed an oral hydrogel capsule for the treatment of obesity (and related disorders, such as diabetes) which works mechanically, causing early satiety and decreased appetite, before dissolving and being eliminated by the body.

Tal Medical is working on a tabletop medical device (modeled like a much smaller MRI machine) that has been shown to rapidly reverse depression through neurostimulation. A single treatment with the device has been found to have an effect equal to four to six weeks of traditional pharmacologic treatment.

PureTech has 12 companies currently in their portfolio with a goal to add an additional one to two each year. Although each is independently-run, they are all majority-owned by PureTech, sometimes for the long-term. This approach allows for more flexibility than at a typical life sciences or VC firm. These companies have the potential to become completely independent, be sold to larger biopharmas, develop partnerships with other healthcare organizations, or may be retained by PureTech to continue growing the company’s product lines.

Executive Vice President of Science and Technology Erik Elenko calls PureTech’s approach “100 percent proactive.” “Think about a typical entrepreneur who has one technology and they [sic] get really excited about it but there could be 10 others out there. We’re reaching out to people, we’re not having companies come and pitch us…The key is that you start with a problem and come up with a solution, rather than investing in a technology which may or not be useful.”

The company also draws on a large, interdisciplinary panel of experts—including outside experts in addition to members of its own scientific advisory board—who look at complex healthcare problems from a multitude of angles. Among the most valuable and in-demand consultants are those working in digital health. According to Elenko, healthcare and IT have radically different cultures and “different ways of approaching the world,” so finding individuals that have connections in both worlds is invaluable in solving today’s complex healthcare challenges.

PureTech has ambitious plans for the future.

“If you look at our fundamental goal, it’s to solve the most difficult healthcare problems that exist through interdisciplinary and unexpected solutions,” shared Elenko. “Success is getting therapies to market for patients, reaching more patients through partners and helping patients by looking at their toughest problems.”

This article was originally published on MedTech Boston.


Cool Startup: RubiconMD

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Primary care practice stands on the precipice of radical transformation as emphasis shifts from offering volume-based to value-based care. Look no further than the recent Supreme Court ruling to see that the ACA and its mission are becoming further cemented into the U.S. healthcare system. The goals are lofty: higher quality and greater access to healthcare at a lower cost. For most, it’s hard to imagine what this healthcare landscape will look like in the future.

But Gil Addo, the CEO and founder of the NYC- and Boston-based healthcare startup RubiconMD, seems to know. His novel vision of the future involves shaking up the traditional model of primary and specialty care practice in medicine.

A Yale and Harvard Business School graduate, Addo’s experience as a consultant and in commercializing innovation has included industry stints at both large and small tech and biotech companies. In early 2013 he met co-founders Dr. Julien Pham, a physician formerly on faculty at Harvard Medical School, and Carlos Reines, another Harvard MBA.

As of December 2014, they have raised over $1.4 million funding and support from major investors, including athenahealth and Waterline Ventures.

We sat down with Addo recently to talk about this innovative company and discuss his plans for the future.

Tell us about what you do at RubiconMD.

RubiconMD is meant to enhance access and bring appropriate specialist expertise into the primary care setting. The patients will see their primary care providers and whatever the issue is–if it is outside the PCP’s expertise and results in a referral—the physician can upload any relevant information, such as images, labs, and studies, and ask questions. We figure out who the most appropriate specialist is and then route the case to them so that they can respond within a few hours.

That’s the crux of the entire interaction. It’s a clinician-to-clinician electronic consult.

How did you get the inspiration to start RubiconMD?

I was very interested in this problem of enhancing access and wanted to find a way to solve it. I had a personal experience that motivated me to take this on. I had a grandmother who had to travel thousands of miles to Boston for treatment of a brain tumor, and then back and forth for all the follow-up. Why couldn’t her local provider oversee her care with appropriate support? There had to be a better way.

I traveled to India and looked at different healthcare delivery models and found that better way. There they have an extreme version of what you see everywhere: the appropriate expertise is in a concentrated area and people are everywhere else, so they bring the appropriate expertise into community health centers.

I started iterating on that model and borrowed things from other settings until I arrived at a solution that fit the U.S. healthcare market. RubiconMD allows increased access to the right specialist and brings that expertise into the primary care setting, to the front line.

How did you figure out if this might be something that primary care physicians would actually be interested in?

Once we figured out that the idea made sense at a system level, we had to figure out if this was a solution that physicians would use. Julien brought his clinical expertise and introduced the idea of “curbside” interaction, an informal and natural way that physicians interact with each other. We were able to validate the model on a small scale and see that physicians would actually use it and find value.

We ran a larger scale pilot to see if this would save people money. We used two large clinics with a panel of specialists and ran it across 15 or so specialties. The findings have been remarkably consistent.

  • In a third of the time, this support avoids a specialist visit. This has been consistent across all deployments and different populations.
  • Another third of the time this process improves the referral. You’re able, even though you’re referring, to send along the appropriate labs and studies and waste less time. And you make sure the patient goes to the right specialist.
  • For the remaining third of the time, it’s peace of mind. It validates what you were going to do.

The cost savings is from improving care outcomes and avoiding duplicate and inefficient use of resources. Almost $300/per opinion is saved, aside from other benefits such us reducing wait time and avoiding ancillary costs to patients.

Is this billable to insurance?

It is not. Right now, we work with value-based organizations incented to provide high quality primary care in the most affordable way possible who see this as a way to extend their capabilities, provide better and more timely care in the primary care setting and avoid unnecessary services.

Payers show interest, as this is a great tool to enhance outcomes and reduce costs while improving patient satisfaction.

What are the challenges that you’re having? 

No shortage of challenges. We focus on the sphere of healthcare that is value-based and incented to provide high quality care at the lowest cost. But U.S. healthcare still has a very large fee-for-service component and the biggest challenge is that we’re dealing with so many groups fighting themselves. It’s a system in transition. We’re trying to bring this into that environment and show them how we help them transition. It’s tough but enough of the market has moved and enough changes in primary care have happened that we have been able to gain momentum quickly.

What are your next goals, short-term and long-term?

Short term, we want to continue better servicing our customers, provide better tools to meet their needs and fit even better into workflow. We’re obsessed with enhancing workflow and not making additional work — providing a tool that syncs with the way physicians want to practice medicine.

Long term, we’re focused on the idea of democratizing medical expertise. As our longer-term vision, we want this to be the default. We want people to think of RubiconMD as the way to get high quality consults more efficiently and locally so that there’s no barrier for clinical expertise.

This article was originally published at MedTechBoston.com.

Cool Startup: GenoSpace

daniel meyer

Healthcare is drowning in a deluge of data. Decision-makers must somehow make sense of a heterogeneous array of information — demographic, clinical, patient-generated, treatment and outcomes data. The latest waves of information also include data from mHealth and genomic sources. It’s not hard to imagine that many in the healthcare industry suffer from information overload and struggle with a bit of ‘analysis paralysis.’ How can organizations make sense of all this big data and actually harness it to improve healthcare and outcomes?

One company helping answer this question is GenoSpace, an ambitious genomic and health data management startup based in Cambridge, Mass. Its current chairman, John Quackenbush, and CEO, Mick Correll worked together in the Center for Cancer Computational Biology at Dana Farber before co-founding the company in 2012. Contracts with notable customers like the Multiple Myeloma Research Foundation (MMRF) and PathGroup funded GenoSpace before the first round of outside funding in 2014.

It was around that time that GenoSpace hired Daniel Meyer, an entrepreneur with a background in venture capital, as Chief Operating Officer. According to him, it was GenoSpace’s ability to attract high-quality customers early on (a rarity for most early-stage companies in life sciences) that convinced him to join. Recently, we sat down with Meyer to learn more about how GenoSpace helps healthcare organizations make sense of all the big data.

Tell us about what you do at GenoSpace.

When you’re dealing with genomics and other biomedical data, there are a variety of different users and reasons for their use. So you could have an institution that has users engaged in research, clinical development, lab medicine and clinical care. They have different software application needs that cut across the same or similar data sets. One of the things we try to do is develop the tools, the interfaces and the experience that will enable all of those different people to get the most from the data.

Could you go over your major offerings?  

We have three primary categories of offerings: analysis and interpretation of a single assay result together with phenotypic and other clinical data, interactive analysis of data from many individuals as a group, such as from a large observational study (where we really excel is when a customer has integrated demographic, clinical, genomic, treatment, outcomes and other data) and enabling patients to directly report and interact with their data. We’ve created software applications and web-based sites for patients to upload their data, track their results and better understand their condition. Although we have a core competency in genomic data, we do not only deal with genomic data.  Research and clinical care rarely rely solely on a single data type.

Now that Obama has announced the Precision Medicine Initiative expanding genomic study, do you also expect your work to expand?

We think it’s a fascinating announcement and those are the types of initiatives we support. One of the interesting things is that we have customers right now solving many of the problems that the initiative will face. For example, we have been working with Inova, a healthcare system based in Northern Virginia that serves more than two million people per year in the metro DC area. They have been collecting a rich set of whole-genome sequencing data together with structured clinical data on thousands of people. Their data management and analysis needs map directly to those of precision medicine initiatives like the one announced by the White House.

I’d imagine that you’d have greater demand on the private side.  

We have spent most of our time there. Our first clinical lab customer, PathGroup, is delivering industry-leading molecular profiling across a wide geographic footprint, including to some big cities in their coverage area and also smaller cities and towns.  Our ability to help them bring academic-quality medicine to community oncology is a huge impact. Roughly 85% of oncology patients are treated in a community setting. If you’re only deploying in major cities with academic medical centers, you’re missing out.

What are your next plans? Any new projects or goals?

We are  looking to expand to different customer use cases. That can be in terms of the therapeutic indication, such as rare diseases, neurologic or cardiac disease. But it can also be integrating different kinds of data. We have a lot of experience working with demographic, diagnostic, treatment and outcomes data together with genomic results, and there are more opportunities to expand.

Are you also working on using machine learning to do predictive analytics?

We think about that a little differently. There’s supervised analysis, the user asking questions and getting answers about the data, and there’s unsupervised analysis. For many of our customers, they’re not looking for a black box. Our goal is not to replace molecular pathologists, but to work hand in hand with them to make sure their work is better, more operationally efficient and more sustainable, particularly if it’s a commercial entity.

That last piece is underappreciated by a lot of folks. We do a lot of work in genomics and in precision medicine and there’s a lot of science and advanced technology. All that work is lost in most settings if you don’t deliver it properly. You have to understand the science and the innovation, but also how to get it in the hands of people who can impact patients. That’s a big part of what we do.

Any final thoughts?

One of the fun things about being here is we have folks with a lot of different capabilities—in software engineering, interactive design, data science, etc. For a lot of the interesting problems that people are trying to solve in medicine, it takes that interdisciplinary team approach as opposed to a whole bunch of people with the same type of experience.

To learn more about GenoSpace, visit their website at genospace.com or follow them on Twitter at @GENOSPACE.

This article was originally published on MedTech Boston.