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The Driver: HealthMatch, an Australian startup focusing on matching patients with experimental drugs being studied in clinical trials of new therapies, recently raised $7M in Series C funding. The round was led by Folklore Ventures and joined by existing investor Square Peg Capital (who led their Series B round). HealthMatch will use the funding to increase staffing (following layoffs earlier this year) and to broaden services in the U.S. Key Takeaways: There are over 135,000 active clinical trials in the U.S. and a total of almost 430K worldwide according to ClinicalTrials.gov The company notes that based on survey data, 90% of clinical trial participants stated that one of the reasons they chose to participate is to help patients in the future Only about 12 percent of drugs entering clinical trials are ultimately approved by the FDA and reach the market, with those that do not reach the market costing between $1B-$2B on average per a CBO study. On average new therapies take approximately 10 years to reach the market and cost approximately $2.5-$3B to develop. 85% of clinical trial patients reported they felt the kind of care they had during the clinical trial was better than the possible treatment they would have received overall. The Story: HealthMatch was founded by Manuri Gunawardena in 2017 when she was in her final year of studies as a medical student. Having spent that year working in neuro-oncology research she saw firsthand how difficult it was for researchers to locate patients that matched the criteria for certain clinical trials. Manuri saw an opportunity to connect patients to the appropriate clinical trials. In addition, she recognized the potential to increase awareness of other treatment options and connect them to trials or specialists without being limited by geography. Moreover, clinical trials often lack diversity and are plagued by an inability to recruit representative patient samples. This is often because in underserved and underrepresented communities, patients lack access to hospitals and trial centers that are engaged with the appropriate research, increasing the cost of transportation and accessibility for those participants. The objective of HealthMatch is to provide access to patients from all over with the right kind of clinical trials that will pose a benefit to them and inform and show them that they have choices and resources beyond their location and awareness. HealthMatch achieves that objective by focusing on the fact that they are there to guide the patient and help them match with a previously unknown medication trial that could have them on a journey to alleviating or curing them. By focusing on the main point that HealthMatch is there to guide and find that medication that will have them on the journey to a possible cure that will hopefully be the right match for them. But not only to provide that access but to make sure that patients know that there are various alternatives that give them a broad choice that shows them better healthcare options are available with the help of HealthMatch. The Differentiator: HealthMatch’s goal is to facilitate matches and options for patients from all over the world to trials not offered in their own geographic region or country that might be appropriate for their disease. The company has increasingly partnered with pharmaceutical companies to help recruit participants for trials on emerging therapies to study and bring new products onto the market. Work like this has become crucial when an estimated 75% of trials are being paused or halted due to lack of enrollment costing the industry billions of dollars. Through partnerships with pharmaceutical companies like Roche and Abbvie as well as biotechnology companies like Imugene and Earli these companies can now use HealthMatch’s patient information to better design their trials. This includes knowing geographically where they can conduct trials for certain therapies and what types of new treatments are required for patients in need. According to the company, more than 1 million patients have accessed their services and they plan to build on this growth. HealthMatch is a free online service that has an easy-to-understand registration process so all patients have to do is enter the appropriate data to explore which clinical trials might be suited for them. The Big Picture: While the clinical trial process is essential to the testing and approval of new drugs the process has been plagued by issues of recruitment and diversity. For example, according to PharmaVOICE, almost half of patients drop out of trials before a study is completed and less than 5% of patients actually participate in clinical research. Using tools like HealthMatch researchers can expand the number of patients available for trials and help expand the development of lifesaving solutions. In addition, with the average distance for trial participants of approximately 50 miles to trial sites, services like this can increase the ability of patients from underserved communities to access and participate in trials. HealthMatch and others are bridging that gap in underserved and overlooked communities providing them access to potentially lifesaving therapies that they may not have otherwise had. Not only does HealthMatch help patients increase their knowledge about their disease, but it also provides them access to new medications and specialists in the field. Such connections have the potential to both extend and improve the quality of life as well as improve outcomes for the population at large. Clinical trials startup HealthMatch lands $10 million Series C, Clinical trial platform HealthMatch snaps up $7M in Series C funding

The Driver: Plume, a startup whose mission is to serve transgender patients, raised $24 million in a Series B funding. The Series B funding was led by Transformation Capital with additional funding from General Catalyst and Town Hall Ventures. According to the company the funding will be used to expand its services nationwide, make its services more affordable, and move towards accepting insurance. Key Takeaways: 40% of LGBTQ employees remained in the closet at work, while 75% experienced negative interactions related to their identity in the office according to a study by Boston Consulting Group. Estimates state that 60-70 percent of transgender people are taking transition-related hormone pills. It is reported that about 20-40 percent of transitioning transgender people have had gender-related reassignment surgery. Almost 60 percent of trans people living in the inner city and urban areas rely on getting medications outside of the health system. The Story: Plume was founded in 2019 by Doctor Jerrica Kirkley and Doctor Matthew Wetschler who wanted to expand offerings of transgender care, particularly to those living in non-urban areas. In addition, Plume’s goal is to expand access to transgender services like hormone replacement therapy, a treatment that is unfamiliar to many primary care doctors. As noted by Dr. Kirkley, this recent funding will put Plume “on track to reach [its[ goal of increasing access to high-quality, gender-affirming care to patients across the U.S. in both urban areas and coverage deserts.” Trans members of the community require a type of modeled gender-affirmed care which includes unique necessities for each patient. The needs of trans individuals undergoing gender-affirming care go beyond the physical; it requires socio-emotional, legal, and medical. The social aspect is essentially changing from your assigned gender and how you express yourself; the legal being you are legally changing your assigned gender and name; the medical is the non-surgery and surgery-related choices you may or may not opt to undergo. Following its expansion to four additional states in March of this year, Plume claims to be the largest provider of telehealth transgender care in the country. The Differentiator: Plume’s focus is to provide primary health, specialty health, hormone therapy, consultation, and more. Co-founder Jerrica Kirkley wants to help be the change and the differentiator by providing a safe healthcare space for the trans community which is currently dramatically underserved (please see Repairing Disparities in LGBTQ+ Healthcare-The HSB Blog 6/28/22). Users pay a $99 monthly fee and receive telehealth visits, get connected with doctors that have experience treating and caring for transgender patients, prescription refills, lab testing, and monitoring, as well as changes to treatment plans if needed. Plume also provides support groups that offer confidentiality, medical notes for surgery, and doctors that respect your chosen name and pronouns. According to a Pew Research Center study, while less than 2% of the U.S. population identifies as transgender or non-binary, these numbers are significantly higher for those under the age of 30. For example, the study noted that over 5% of Americans between 18-29 identify themselves as transgender or nonbinary. The Big Picture: The founders of Plume are advocates for equal healthcare across the board and believe in providing personalized quality and easily accessible care to the trans community. The digital health team at Plume believes in an equal and affordable space for transgender patients to receive care as easily as the general patient population. This is extremely important as a 2021 study found that almost half of transgender individuals and over two-thirds of transgender people of color experienced discrimination or mistreatment by healthcare providers. Access to such care is extremely important, as there are numerous care deserts with almost 60 percent of trans people living in the inner city and urban areas relying on getting medications outside of the health system. In addition, with an estimated 60-70 percent of transgender people taking transition-related hormone pills, and approximately 20-40 percent of transitioning transgender people having had gender-related reassignment surgery this population is likely to grow over time. Receiving appropriate, informed, and culturally relevant care is especially important given the emotional and social pressure placed on patients. Plume scoops up $24M for virtual transgender healthcare, Plume's wallet blooms: Virtual trans care provider nabs $24M to expand care, payer partnerships

Overview: This week we look at the monetization of healthcare data & in particular, the potential dangers that may arise as more data is generated than ever before and how this data is used. As more patient data is being generated at unprecedented rates and subject to the same consumerization that has changed many industries, it is critical to understand the implications of massive growth without proper regulation and what that means for patients and their privacy. More insight is needed about the development of AI software when it comes to driving the services of organizations that use their analytics to provide transparency to the consumer. These organizations are looking to ensure that analyses are performed with minimal bias with population demographics in mind. The lack of regulation around data privacy raises many concerns about the fair usage and ethical applications of vast datasets collected. These datasets are then processed by AI software which may not operate entirely impartially. Strong projected future growth leaves the potential for stakeholders to reap vast earnings on the basis of the data. Background: With the growth in new technologies such as big data, broadband, and cloud storage, the collection and monetization of data has become big business. For example, according to New Revenue Streams in Health Data Monetization, published by TATA Consultancy Services, the data monetization market is projected to reach a valuation of over $700 billion by 2025. New innovations are constantly advancing the healthcare industry’s collection and monetization, with new revenue streams opening up on the behalf of the data sector which is eager to use these insights both for marketing purposes and to gain a foothold in healthcare as the industry moves towards consumerization. By using data insights to improve existing processes, offering data as a product to businesses, and offering data analysis capabilities as a service, a wide variety of organizations are hoping to gain access to a vast potential profit pool in the coming decades. For example, a study from International Data Corporation and Seagate found that the healthcare data industry is projected to grow up to 36% by 2025, outpacing many other industries. While the practice of monetizing data has existed for a number of years, particularly in consumer industries, the maturation of this industry in healthcare has brought about concerns surrounding its future regulation. In addition, the potential for misuse and theft of patient data, either intentional or unintentional has brought with it the risk that these practices could hurt organizations' reputations and operations. As more and more of patient and healthcare data are being digitized (ex: as data from wearables are being stored in the cloud and providers and payers encourage the use of digital health services) these risks only continue to multiply. Consequently, both traditional players and new entrants have to ensure that they observe both the letter and spirit of the law and are especially sensitive to public perception of how patient’s data is being used and monetized. The lack of clear-cut regulations and patient ownership rights with respect to personal medical data raises questions on the ethical use of this data. Moreover, even when fair usage occurs in line with existing federal policy, potential security risks arise with the absence of accountability. Previous high-profile collaborations in both this country and others, such as that between Google’s DeepMind and the Royal Free NHS Foundation Trust highlight those concerns. In addition, the lack of standards and transparency around the use and applications of artificial intelligence (A.I.) as well as the potential for bias has significant policy implications. There are still many questions that need to be addressed about the industry and if stakeholders can capitalize on this demand, it may open healthcare up to greater monetization and revenue streams than ever before. Lessons Learned: What have been some of the “lessons learned” on modern concerns around the monetization of healthcare data from some of our earlier Our Takes? An increasing number of healthcare organizations are incorporating artificial intelligence and data processing to support decision-making and compute meaning from large, unwieldy data sets. According to the Association for the Advancement of Medical Instrumentation, 77% of organizations already use AI software to inform clinical decision-making, and 66% use AI to yield meaning from large sources of data. The average patient generates 80 megabytes of data in electronic medical records and imaging annually, according to the New England Journal of Medicine. The global healthcare data storage market is expected to grow by more than 16% by 2026 according to a report from research firm Research and Markets. The technology sector is increasingly directing its skills in search and data analytics towards healthcare data but has yet to achieve the success seen in other industries given the uniquely personal nature of healthcare data and limited experience of working in the healthcare industry. Does AI Always Optimize Healthcare? You Need Data Access, Education & Oversight -The HSB Blog 2/8/21 Despite Advances, Data Security Still The Key To Cloud Adoption in Healthcare-The HSB Blog 3/28/22 Big Tech & Retail Disruptors Continue to Run Into Same Challenges in Healthcare-The HSB Blog 3/22/21 Despite numerous efforts that the international, national, and state levels (ex: GDPR, 21st Century Cures, CCPA, etc.), U.S. patients generally continue to have very little control over the usage of their medical data after it has been collected. Of 97 mobile health apps reportedly certified as being clinically safe and trustworthy, 89% were found to transfer information online with 66% of this information unencrypted according to Developments in Privacy and Data Ownership in Mobile Health Technologies, 2016-2019. The article noted that foreign regulations are tougher than those in the U.S. For example, in the European Union, consumers have the right to information about what data will be collected and how their data will be used in contrast to the U.S. where there is no Federal law that informs the consumer about data collection. Many apps are not transparent about how their data is collected, processed, shared, and transferred raising questions as to whether they are actually compliant with existing data privacy laws or not. For example, an article published in Forbes one writer found that 25 out of 36 mobile health apps’ privacy policies had no disclaimer whatsoever concerning how patient data would ostensibly be used. According to HIPAA privacy laws, doctors are allowed to use patient data for research or improving operations. Still, if this data is used to develop a product that can be sold on the private market or make a large profit from, it could fall outside the purview of “healthcare operations” and thus not apply to HIPAA regulations. U.S. healthcare cyber breaches have increased 14% from 2019-2020 with security being the most important concern for 85% of the businesses and organizations working with cloud technologies per the Flexera State of the Cloud report. Despite Advances, Data Security Still The Key To Cloud Adoption in Healthcare-The HSB Blog 3/28/22 How Informed Is Informed Consent? Putting Patients Back In Charge of Their Data-The HSB Blog 8/2/21 Hospital Digital Tools Increase Risk of Cyberattack-The HSB Blog 2/22/21 Even with all the significant advances in AI and machine learning (ML), there is a need to ensure these tools are subject to routine and consistent oversight, audit, and review to detect and avoid bias, increase reliability and ensure fairness in their application. According to a 2020 study entitled, “How Should AI Be Developed, Validated, and Implemented in Patient Care?”, most data processed by AI tools tend to be largely homogenous in terms of patient demographics leading to under-represented populations prevalence being under-represented. This can lead to vulnerabilities around erroneous diagnoses or faulty treatment procedures As noted in an article from STAT News, there is no legal requirement for AI developers to thoroughly document how the AI was developed or ensure the accuracy of its performance, particularly around the processing of demographic data sets. As widely noted during the Pandemic, certain pulse oximeters, a tool used to monitor blood oxygen levels, have been found to provide more inaccurate measurements the darker a patient’s skin. The problem was so widespread it prompted Senators Warren, Booker, and Wyden to send a letter to the FDA requesting a review of the issue. According to the article Extracting and Utilizing Electronic Health Data from Epic for Research, researchers trying to apply AI to identify prescription patterns in certain antipsychotic medications found that 27% of prescriptions were missing dosages even after researchers took steps and statistical methods to address the issue of missing data. Does AI Always Optimize Healthcare? You Need Data Access, Education & Oversight -The HSB Blog 2/8/21 What Clinicians and Administrators Need to Know When Implementing AI-The HSB Blog 9/13/21 Reducing AI Biases in Healthcare: Follow These Four Steps-The HSB Blog 5/17/21

The Driver: Homeward, a hybrid telehealth and in-person care digital health company secured a $50M investment in a series B funding led by Human Capital and Arch Venture Partners and includes participation from General Catalyst, which led Homeward’s series A funding. Glen Tullman and Lee Shapiro both of 7wire Ventures also participated in the round. The proceeds of the funding will be used to expand their offering of high-quality, rural health care to other regions across the country. Key Takeaways: Access to rural healthcare has gotten significantly worse over the past 7 years with over 100 rural hospitals closing from January 2013 to February 2020 per a GAO report. 1 in 5 of the American population lives in rural America, yet rural doctors make up only about 11% percent of practicing physicians. For patients looking to access emergency department services in rural areas where hospitals with emergency departments had closed, the median distance to access hospital services increased by over 20 miles between 2012 and 2018, according to the GAO. Americans living in rural America are more susceptible to premature death from the leading causes of deaths in the country. (Obesity, Diabetes, Heart Disease, Cancer, and more) The Story: Homeward was formed by the former president of Livongo Dr. Jennifer Schneider when she teamed with Amar Kendale formerly the chief product officer of Livongo and Teladoc and Dr. Bimal Shah the former chief medical officer of Livongo. Dr. Schneider has shared that as someone who grew up in rural market America, the mission ofHomeward is personal for her as she experienced firsthand how the lack of access to care or resources for high-quality healthcare impacts those in rural regions. Homeward’s mission is to provide access to primary and specialty healthcare for rural America using a hybrid model. According to the company Homeward will take on full risk for patients and partner with regional Medicare Advantage plans. Homeward’s model is designed to leverage technology and services for both primary care and specialty care by providing a team of health care professionals and experts accessed both through telehealth visits and through mobile care clinics based in rural communities. Homeward will also provide remote patient monitoring of various chronic and acute issues which will alert clinicians when a mobile clinic should respond to signs of escalating medical symptoms or deteriorating chronic conditions. Earlier this year, Homeward secured its first value-based contract with Priority Health for its Medicare Advantage members in Michigan. The Differentiator: Homeward's goal is to completely redesign rural healthcare from the ground up, in the words of co-founder Schneider, we want to "rearchitect" rural healthcare, "we're not reinventing it; we're not throwing everything out.” As noted in a recent Fierce healthcare article, Homeward’s teams conduct physical exams, take vital signs and perform diagnostic tests in order to link patients with community physicians, specialists, and referral resources including appointment coordination. Patients are able to choose from virtual visits, community-based visits, and in-person visits. In addition, in June of this year, Homeward partnered with Rite-Aid to provide services through its vans in parking lots at pharmacy locations in rural communities and plans to roll out this service in Q3 of 2022 in Michigan. Interestingly, Homeward delivers its services using cellular telephone technology for monitoring and telehealth visits which is often more widely available than broadband services. This unique aspect is designed to overcome issues with the so-called digital divide. The Big Picture: Homeward’s commitment is to provide patients living in rural America with hybrid care allowing them to have an in-person visit via Homeward’s mobile visit, followed up with a community-based visit. This is followed by a telehealth visit and referrals for patients that require it. Homeward is helping to address the lack of services and care for the 1 in 5 Americans living in rural communities who often require care and cannot access it. For example, according to a General Accounting Office (GAO) report, over 100 rural hospitals closed from January 2013 through February 2020. Not only does this force Americans living in rural communities to travel hundreds of miles for needed care, but due to the expense and inconvenience, they often delay necessary care. As a result, it is all too common for them to put off routine care such as physicals or diagnostic tests that may reveal their risk of developing chronic diseases, these same tests could also detect diseases they may already be experiencing. In addition, finding specialists to treat the disease can be even more burdensome requiring patients to drive hundreds of miles or many hours just for an initial visit. By contrast with Homeward, people are able to see specialists who will accurately diagnose them and treat them with consistent follow-up care and monitoring, if necessary, thus lowering costs, and improving treatment adherence and outcomes. Moreover, by having routine physicals and other visits earlier, patients can and are more likely to address early signs and symptoms of disease and start making changes to their lifestyle and diet that could positively impact their overall health. With these services, Homeward could improve access, lower costs and improve quality over time. Launched just 5 months ago, Homeward clinches $50M, inks major Medicare Advantage partnership, Homeward Raises $50 Million, Forms First At-Risk Partnership

The Driver: Healthcare and diagnostics startup Senzo announced they raised $2 million in seed funding in July of this year. The funding round was led by BioAdvance, which focuses on investing in life science startups, with participation from Wellness Coaches USA. Senzo is a deep-tech bio-med company that develops testing products. The company has been working on an at-home COVID test, which claims 100% accuracy at ½ the cost of current tests. Senzo is also rolling out its phase 1 testing products for Flu A/B, tuberculosis, HIV, Hepatitis C, and C difficile. The money raised during the seed round will go towards the ALF (Amplified Lateral Flow) COVID testing through regulatory approval and to market. The funds will also be used to increase the manufacturing capacity and improve the development of other at-home testing products. Key Takeaways: Researchers at the University of Sheffield say that Senzo’s at-home Covid test is 100% accurate at ½ the cost of current tests with similar accuracy (~$24 vs $50) The current average time to deliver results for the COVID PCR swab test is 1-2 days from the date of specimen pickup. Some of the at-home rapid antigen tests have an overall sensitivity of roughly 85 percent, which means that they are catching roughly 85 percent of people who are infected with the virus and missing 15 percent. At-home test use peaked in January 2022, with 11.0% (95% CI = 10.7%–11.3%) of the surveyed population reporting at-home test use within the preceding 30 days compared with 2.0% (95% CI = 1.8%–2.1%) in October 2021 and 7.5% (95% CI = 7.1%–8.0%) in March 2022. The Story: Senzo was founded in 2014 by Aron Rachami, Ph.D., and Eli Mohamad. The company was established with the goal of utilizing cutting-edge technologies, with an emphasis on increased sensitivity, to develop portable, point-of-care, and self-testing products. Senzo’s devices use a technology called Amplified Lateral Flow (ALF) which can detect viruses with significantly less viral load then-current technologies. The company’s tests are designed perform precisely, rapidly, and affordably and to be available where medical professionals and patients need them most. Current lab tests, like highly accurate PCR tests for COVID, rely on expensive examinations that require they be sent to a central-lab facility. Senzo is attempting to change the paradigm by bringing testing to the patient at the point of care. By applying insights gained at the point of care, patients may make better choices more quickly, and medical practitioners can spot illnesses earlier, leading to earlier interventions and better treatment outcomes. The Differentiators: While the idea of at-home testing is not new and has become commonplace as a result of the Pandemic, one distinct feature of Senzo’s test is the accuracy they claim to be able to achieve. In a research study conducted by a team of researchers at the University of Scheffield, Senzo’s antigen test took only 10 minutes and accurately detected 25 positive cases and 25 negative cases, demonstrating that the test was able to detect COVID with 100% accuracy. This type of result would place Senzo’s ALF test on par with the current standard for accuracy, a lab-based PCR. Assuming these results are accurate, can be replicated, and are scalable, Senzo will be able to create a testing kit with improved accuracy, and less processing time, which is more cost-effective than their competitors. In addition, during times of crisis or high demand (such as during a public health emergency like COVID) this type of test could potentially reduce the workload of laboratory staff that have to manually process lab specimens and may be needed for other types of testing. The Big Picture: Innovations like at-home testing, necessitated by the Pandemic have permanently altered the face of healthcare and how it is delivered. Along with virtual care services, many are looking at bringing the accuracy of lab-based tests to the home. Solutions like Senzo’s which dramatically improve both accuracy and convenience allow for more timely treatment, less lag time, and improved outcomes. These testing kits can be implemented in the home, nursing facilities, and hospitals for emergency testing. Physicians and staff workers can benefit from testing their patients and receiving early results as well as potentially reducing their own exposure to disease. Innovations like ALF allows the detection of viruses even with a very low viral load which enhances officials' ability to detect public health threats. Being attuned to the earliest signs of a virus and confirming the diagnosis with a test will be a great asset when it comes to dealing with future pandemics and illnesses. Solutions like Senzo’s allow earlier tracking, detection, and treatment of viruses all of which should improve not just individual patients but overall public health as well. It’s the era of at-home health diagnostics and Senzo is finding its flow, Diagnostic startup Senzo raised $2M from local investors to bring its at-home COVID-19 test to market

Overview: Since we have written approximately 75 Our Takes in the last two plus years we thought it might be helpful to take some of the summer to look at “Lessons Learned” from our posts. As such, this summer we will be looking at our lessons learned on the broad range of digital health on topics we’ve written about including Artificial Intelligence; RPM and Virtual Care; Value-Based Care, and Mental Health (among others). This week we look at how digital tools can help mitigate issues such as workforce shortages, burnout, and limited interdisciplinary training among physicians. Background: The shortage of clinical workers in healthcare is a major problem for health systems in the United States. Given the stress of long hours and increasing administrative burdens, combined with the additional shortages and tensions brought on by the Pandemic, worker stress and burnout are running at all-time highs. However, the pandemic also demonstrated the value of digital technologies like wearables, telehealth, remote patient monitoring, and scheduling apps in leveraging existing clinical staff to operate more efficiently and to serve more demanding patient loads more effectively. These changes will not come without their challenges. Nurses and physicians who are at the forefront of implementing these technologies have experienced difficulties in adapting to this new normal in terms of acceptance and training in the use of the technology. Encouraging active engagement by nurses and physicians as well as administrative staff in the realm of technology development and implementation is fundamental for improved performance of these innovations. Moreover, cross-training staff in the use and application of these new technologies can reduce time spent on administrative tasks and increase time spent treating patients. This digital transformation of patient monitoring empowers clinicians to observe, report, and analyze patients' acute or chronic conditions in real time regardless of location. Remote patient monitoring allows healthcare providers to monitor and capture health data from patients for assessment and feedback. Utilizing these digital outputs allows physicians and care teams to get real-time insights into a patient’s status thereby facilitating early intervention, and reducing avoidable hospitalizations, and unnecessary trips to the emergency department. Advancements in remote monitoring and virtual care technology can also positively impact healthcare delivery with a reduction in patient stress by allowing patients to be treated from the comfort of their own homes while eliminating the need for in-person facility visits. This can lead to the reduction of clinician and nurse burnout by giving the clinicians the tools to deliver more targeted care and practice at the top of their license. Clinicians will then be able to give patients a more complete and accurate picture of their longitudinal health profile and how to maintain or improve their health levels. Wearables can also benefit patients as they give a more accurate and continuous view of their health and empower them to automatically record health data such as blood pressure and heart rate which are essential to monitor for the chronically ill, particularly seniors (who often may forget). Lessons Learned: Nurses need to be backed by strong training and technical support in order to enhance the impact of digital health solutions. Despite the many benefits of digital health innovations in nursing practice, nurses have been reluctant to adopt technology because of inadequate support, complicated systems, and technological lapses. Globally, there was a massive increase in nurse shortages and poor retention that only got worse during the COVID-19 pandemic because of the increased health risk and inadequate support. As noted in one study “nurses provide about 80% of care and are described as a link between patients and processes.” The top nursing challenges are nurse retention (61%), nurse recruitment (59%), nurse engagement (35%), and nurse leadership development (33%) per the 2017 Health Leaders Media Nursing Excellence Survey. Lack of nurse leadership poses a major challenge to nurse engagement with digital technology. Empowering nurses is key to enhancing impact of digital health solutions-The HSB Blog 5/17/22 Shifting care from the hospital to the home with digital technology can empower patients and clinicians. Enhanced remote monitoring technology can positively impact healthcare delivery by 1) reducing patient stress and allowing patients to be treated from the comfort of their own homes; 2) limiting expensive and unnecessary visits, like ER visits; and 3) reducing clinician burnout, eliminating unnecessary testing and improving diagnosis by giving them a completer and more accurate picture of their patient's longitudinal health profile. During the pandemic, the use of telehealth skyrocketed but not all organizations’ telehealth platforms have been effective. …Providers need to strategically evaluate both telehealth technologies and the specific demographic, and technological and physical capabilities of their patient population to ensure a fit between the two. Digital Technology Will Shift Care from Hospital to Home-The HSB Blog 3/1/21 Digital tools may be one way to help close the gap in the shortage of clinicians. According to the Association of American Medical Colleges (AAMC), the physician shortage in the United States is anywhere from 40,800 to 104,900 physicians by 2030 A study conducted by Wheel found that clinician burnout impacts 80% of patients and 1 in 3 patients believe burnout impacts their quality of care For example, during the so-called “Great Resignation,” where large numbers of working-age people have simply dropped out of the labor force, approximately half a million healthcare workers have quit since February 2020 according to a recent article in Forbes. The stress of dealing with the continuous over two-plus year Pandemic has taken a great toll on clinicians' emotional, and physical health leading to burnout. For many, this has left them with two options–either to step away or go digital. Leveraging virtual care is one way to deal with a number of the issues of healthcare workforce shortages that were exacerbated by the Pandemic. Virtual Care May Be One Answer to Healthcare’s Labor Shortages-The HSB Blog 1/31/22 Digitizing the supply chain can help reduce clinician burden by reducing the need to track down supplies. Digitalization increases supply chain network visibility, enables strategic relationship planning, and uncovers opportunities for establishing new relationships. According to the Institute for Supply Management (ISM), 59-83% of organizations reported an increase in lead times for acquiring supplies since the onset of the pandemic. 88% of healthcare executives identified AI as a critical technology for supply chains in the next three years. Digitizing Healthcare Supply Chain is Essential for Value-Based Care-The HSB Blog 1/10/22 Virtual care tools can help reduce the shortage of nurses. Hospitals lost approximately 2.5% of their nursing workforce in 2022, resulting in the average hospital losing between $5.2M-$9.0M according to the NSI Solutions 2022 NSI National HealthCare Retention & RN Staffing Report There is predicted to be a shortage of over 500,000 RNs by 2030 with the greatest shortages seen in the South and West, according to one 2018 study. More than 1M registered nurses were predicted to leave the workforce by 2020 according to a 2017 article in Health Affairs, which was taken prior to the extreme stress and burnout of the Pandemic. A number of studies have found that “nurses spend between 26%-41% of their time on documentation activities and that is a major source of what burdens them.” As a result, one study recommends deploying technologies like natural language processing (NLP) to capture and search clinical notes as well as AI-based tools such as predictive analytics, to help risk stratify patients. Virtual Care May Be One Answer to Healthcare’s Nursing Shortage-The HSB Blog 5/10/22

The Driver: CareBridge is a value-based care company for home and community-based services (HCBS) that recently raised an additional $140 million in financing led by venture capital and private equity firm Oak HC/FT and four of the nation's five largest Managed Medicaid plans also having co-invested in the company. The new funding will go towards providing increased community-based home health services for thousands of the Medicaid population suffering from multiple physical and mental conditions and disabilities. The funds will be used to expand CareBridge’s HCBS model for Medicaid and patients shared with Medicare (so-called duals or dual eligibles), with physical and intellectual disabilities across the country, according to the company. Key Takeaways: Joint federal and state Medicaid HCBS spending totaled $92 billion in FY 2018, according to the Kaiser Family Foundation The public share of LTSS spending has grown from just under 65% in 2000 to over 70% in 2020 according to a June 2022 study from the Congressional Research Service. 1 in 4 average adults lives with a disability in America, with 2 out of 5 affecting the elderly 65 years of age and older. An estimated $475.1 billion was spent on LTSS, representing 14.1% of the $3.4 trillion spent on personal health care. The Story: CareBridge was created by the merger of Health Star and Sinq Technologies both of which offered technology in the HCBS space. As noted in the Nashville Business Journal “CareBridge’s services are aimed at assisting low-income seniors, disabled people and others in need of long-term care with daily tasks such as bathing, administering medication and arranging appointments.” These HCBS services are typically covered under what is called Long-Term Services and Supports (LTSS) by Medicaid and include the broad range of paid and unpaid medical and personal care assistance that people may need when they experience difficulty completing self-care tasks as a result of aging, chronic illness, or disability.” CareBridge offers 24/7 clinical support, decision support, data aggregation, and electronic visit verification (EVV). EVV is used to ensure that services are delivered to people needing those services and that providers only bill for services rendered and all state Medicaid agencies were required to implement an EVV solution for Personal Care and Home Health services under the 21st Century Cures Act. According to the company, CareBridge exclusively serves Medicaid and dual-eligible patients who have a physical or intellectual disability and are receiving HCBS. CareBridge’s goal is to provide 24/7/365 services for their patients, family members, and caregivers so they have easy access to a clinician whenever they need one. These telehealth visits will help keep many elderly and disabled patients remaining healthy by allowing them to have regular check-ins and avoid expensive emergency room visits. CareBridge has had success in the Medicaid market and as noted, a number of the plans serving that market have invested in the company. The Differentiator: CareBridge’s focus is to make sure HCBS patients receive optimal care from home. To facilitate this, CareBridge ships a tablet to patients’ homes to allow them to contact their clinicians at any time. In addition, CareBridge deploys a broad team of clinicians for each patient, including physicians, nurse practitioners, social workers, behavioral health specialists as well as pharmacists. In addition to having four of the country’s five largest Medicaid managed care organizations as investors, CareBridge has partnerships with companies like Bayada Home Health Care, one of the largest home health providers with over 325 locations in the U.S. CareBridge provides all-day service and assistance through several types of modes of communication including a mobile app, tablet, or telephone. According to the company, they have grown rapidly from 1,100 full-risk patients in June of 2021 to over 19,000 such patients in June of this year. The Big Picture: An estimated $475.1 billion was spent on LTSS, representing 14.1% of the $3.4 trillion spent on personal health care according to a June 2022 report from the Congressional Research Service (CRS). Moreover, the CRS report notes that “[these] data underestimate the total costs of providing LTSS because they do not capture LTSS provided by family members, friends, and other uncompensated caregivers.” CareBridge’s mission is to provide help to the elderly and the physically and developmentally disabled. With their digital health technology, CareBbridge wants to provide exceptional at-home care for their dual-eligible patients with the help of their broad-based clinical care team which can help address a myriad of needs and facilitate a helpful, trusting, and sound experience. As budget pressures at both the Federal and State levels continue to constrain both Medicare and Medicaid spending it is increasingly important to find solutions that help optimize LTSS spending. This is especially important as the public share of LTSS spending has grown from just under 65% in 2000 to over 70% in 2020. As noted by the company, “by taking risk for the total cost and quality of care for a patient, CareBridge is able to ensure individuals receive the right level of services at home to help prevent unnecessary hospitalizations and ER visits.” Value-based care startup CareBridge clinches $140M to fuel expansion into more states; CareBridge Receives $140M in Financing to Expand Value-Based HCBS Model,Who Pays for Long-Term Services and Supports?

The Driver: Healthie a company building the infrastructure for next-gen digital health companies for virtual care recently raised $16 million in series A funding. The funding round was led by Velvet Sea Ventures with participation from Greymatter Capital, Watershed, Builders VC, and a customer syndicate. Healthie offers a digital infrastructure for next-generation digital health companies that offer virtual first care. The co-founders of Healthie are focusing on providing customers with a template that allows them to customize their care needs and allows companies to provide virtual engagements. Healthie’s CEO Cavan Klinisky stated that the funds raised in this funding round will be used to develop their software platform further. Key Takeaways: Healthie’s clients which include Crossover Health, Plume, and Wellinks have raised around $700 million in VC funds per Business Insider. According to a report from the University of Southern California Sol Price School of Public Policy, 35 million people in the country lack basic healthcare access due to cost and lack of accessibility. According to the Office of the Assistant Secretary for Planning and Evaluation, since the beginning of the pandemic, close to 22% of Americans use telehealth services. Currently, more than 2,000 organizations use Healthie’s services, and the company stores upward of 1.3 million patient records. The Story: Healthie was founded in 2016 by co-founders Cavan Klinsky and Erica Jain. The idea behind Healthie started with cofounder Erica Jain after she witnessed her parents struggle with weight loss but lack access to a comprehensive care team. Her solution to this issue was to create an all-in-one health platform that other companies can utilize for their healthcare business. The platform includes a client portal, electronic records, scheduling, wellness programs, billing options, telehealth and webinars, and cloud-based EHR. As noted by the company, historically these solutions were delivered as separate tools that companies were forced to integrate or build in-house, which is timely and expensive. There are 5 different subscription plans that Healthie offers providers for their healthcare startup. The Starter plan is free and allows for 10 active clients along with the features mentioned above. The other subscription plans are paid annually, but subscription rates are listed per member per month. Subscription prices range from $45/month to $135+/month. The Differentiators: The Covid-19 pandemic has changed the way that people expect to receive healthcare services and Healthie is taking the initiative by supporting the evolving landscape of healthcare. This platform differs from its competitors in that Healthie is not just an electronic medical record but a broad offering where its users can manage patient data, arrange schedules, pay bills, and allow for virtual telehealth visits. Healthie aims to make it possible for anyone to start their own healthcare company by managing administrative and operational functions at cheaper rates than their competitors. Although there are companies such as Athenahealth and Epic that are used for their EMR, Healthie is aimed more broadly than offering just a medical or billing-driven application. The Healthie platform prides itself on its ease of use and affordability for whoever wants to use it. The Big Picture: The co-founders of Healthie recognize the need for advancement and engagement within the healthcare industry. Their proposed solution is aimed to make the startup process for healthcare providers as smooth as possible by taking care of the tedious aspects of running a business. For providers, this means updated electronic databases, telehealth services, billing software, and analytic tools to track how their business is performing. The patients benefit from this as well because they can access virtual appointments and webinars, participate in wellness programs, and access it all easily from a mobile device. While the solution is not the first of its kind, it definitely is an improvement in terms of accessibility, efficiency, and cost-effectiveness for newer startups. While, as noted by the founders, healthcare systems are capable of creating their own electronic health record system, the adoption of the platform has been successful, because their goal sits at the center of provider and customer interaction, housing the business, operational, financial, and health information for customers as the “underlying infrastructure for next-generation virtual care.” Healthie lands $16.5M to build the Stripe for virtual patient care, This startup helps healthcare providers offer better virtual care. Check out the 18-slide pitch deck Healthie used to raise $16 million (subscription required).

Overview: Since we have written approximately 75 Our Takes in the last two plus years we thought it might be helpful to take some of the summer to look at “Lessons Learned” from our posts. As such, this summer we will be looking at our lessons learned on the broad range of digital health on topics we’ve written about including Artificial Intelligence; RPM and Virtual Care; Value-Based Care, and Mental Health (among others). This week we look at healthcare data interoperability and exchange of electronic medical records with a focus on how new digital tools can change current practices, empowering patients and providers alike. The Backdrop: With increased utilization of digital and mobile health tools comes a deluge of data to collect and analyze. As digitization brings increases in the availability and applications of data many patients and providers alike are reporting increased support for such data sharing and demanding better interoperability measures that make their healthcare more efficient and effective. For example, a survey conducted by the Pew Charitable Trusts found that approximately 40% of survey participants reported COVID made them more likely to support data-sharing enabling efforts among healthcare providers and to allow the download of one’s electronic health records (EHR) to their mobile apps. Additionally, between the passage of the HITECH Act in 2009 and 2015, EHR adoption grew from 12% to 72% for hospitals and 22% to 54% for ambulances according to the Office of the National Coordinator for Health Information Technology as government incentives helped drive adoption. More medical data is being generated than ever and there is a need to modernize data processing and sharing to meet this growing demand. However, the inefficiency due to a lack of data interoperability between medical organizations is adding significant additional costs that the industry must bear both financial and non-financial. In terms of financial costs, according to an “Administrative simplification: How to save a quarter-trillion dollars in US healthcare” by McKinsey & Co it may be possible to save over $250 billion annually in healthcare spending by reducing and eliminating wasteful practices with over $100B of that coming from improvements in technology platforms like a centralized, automated claims clearinghouse for insurers. In terms of non-financial benefits, the COVID pandemic was one of the first widespread pushes toward interoperability and data sharing on a national scale and international scale for public health, highlighting the importance of open data standards in collecting and analyzing such a large volume of data rapidly. Panelists at the 2020 World Health Summit concluded that global collaboration and data interoperability has the potential to vastly improve responses to similar events in the future, and sharing health data is necessary to coordinate an effective counter to any public health emergency. However, in an increasingly digitized world, data, privacy, and security cannot be neglected and in fact, must be prioritized. Moreover, not only is it extremely important to preserve patients’ privacy, payers, providers, and others in the healthcare ecosystem must follow both the letter and spirit of the law if they are to maintain patients’ trust. Lessons Learned: What have been some of the “lessons learned” on contemporary issues surrounding health information exchange from our earlier Our Takes? There continues to be a need for digital tools to be developed with an emphasis on interoperability for healthcare payers and providers to standardize practices given the flawed and disconnected nature of healthcare data and the inability to share data easily. According to the Office of the National Coordinator for Health Information Technology (ONC), one of the core issues regarding interoperability is that interoperability is more than just implementing a standard or being able to have two systems exchange data with each other. Healthcare is plagued by the fact that there is no single system of record for interactions with the system and even no single way to identify patients (ex: a national patient identifier). Often data can be lost between systems or very difficult to exchange between systems. For example, while claims data is predominantly financial, clinical systems have to deal with structured data (ex: coding for diagnosis and testing), unstructured data (ex: physician notes in free text fields), and fields involving different storage mediums and signal processing (ex: blood tests, EKGs, etc.). There are now over 350K health-related mobile apps, with almost 90K created in 2020 alone, greatly expanding the amount and types of data available and further driving the need for data access and interoperability. Eliminating Interoperability Hurdles in Digital Health Requires More Than FHIR-The HSB Blog 10/4/21 Promoting data interoperability has the potential to significantly reduce healthcare disparities and empower patients to take control of their own health data. As noted at the Workgroup for Electronic Data Interchange event, studies have shown that minority patients routinely receive inferior care because they may be bouncing between hospitals and clinics and also have higher rates of chronic illnesses like diabetes and hypertension, which research indicates can be better addressed by digital technologies. Having access to digital technology can empower consumers to make better-informed decisions about their health, provide new options for facilitating prevention, and manage chronic conditions outside of traditional healthcare settings. A report by the U.S. Government Accountability Office and the National Academy of Medicine states that increasing high-quality data access and transparency can help developers eliminate bias in data by ensuring the data is representative at larger scales. Without such data access mechanisms, AI tools could be vulnerable to bias from skewed data, which can impact the manner by which decisions are made as well as the quality of these decisions. This would have negative consequences for health equity. Does AI Always Optimize Healthcare? You Need Data Access, Education & Oversight -The HSB Blog 2/8/21 Enhancing Telemedicine Can Close The Infant and Maternal Mortality Gap-The HSB Blog 3/8/21 The creation of digital healthcare platforms to address data interoperability and increase operational efficiency can help healthcare providers exchange data seamlessly and lower costs moving forward. As noted in a 2020 Forbes article healthcare data interoperability solutions can provide the foundation for additional healthcare applications and solutions to be built on. Given the lack of standardization in workflows and custom technology building platforms for software engineers will reduce the cost of custom solutions and support more healthcare innovation. Opportunities for integrating platforms in healthcare, include improving the transferability of patient data to support care coordination, reducing the administrative costs associated with paying for care to reduce overbilling and improving cost accounting to support the transition from fee-for-service to value-based care. It is estimated that $191 billion to $286 billion, or 5% to 8% of total US costs could be saved if interventions to reduce waste were implemented and were successful according to a recent study in Health Affairs, Platforms In Healthcare-Part 1. Platforms Explained-The HSB Blog 11/29/21 Platforms in Healthcare Pt. 3-Healthcare Specific Challenges & Opportunities-The HSB Blog 12/13/21 Data security must remain a top priority as healthcare becomes increasingly digitized both for protection and to ensure access by appropriate parties. All parties need to ensure they have comprehensive policies, procedures, and audits in place to protect patient data, and comply with HIPAA both in terms of the rule of the law and its intent. For example, research done by ONC on individuals’ perceptions of data privacy and security shows approximately two-thirds of respondents remain concerned about unauthorized viewing when data is shared by providers. This will become an even bigger concern as the volume of data grows. One study estimates the global healthcare data storage market is expected to grow at a compound annual growth rate of over 16% between 2019-2026 and will reach over $8B by 2026. Although moving data to the cloud will help increase availability and decrease costs it could pose additional security risks. A 2016 article published by the Institute of Electrical and Electronics Engineers, found additional security and privacy issues when sensitive data belonging to enterprises and individuals are stored and used by services in the cloud. In addition, there are also significant security issues arising out of malware attacks in the cloud which have access to both data and services of many users and also the ability to propagate to many systems over the cloud infrastructure. Many consumer-facing apps have found themselves in the news for exposing user information or undisclosed third-party data sharing, the dramatic increase in the use of mobile health apps during the pandemic has only heightened the security risks according to an article from Business Wire. Despite Advances, Data Security Still The Key To Cloud Adoption in Healthcare-The HSB Blog 3/28/22 Eliminating Interoperability Hurdles in Digital Health Requires More Than FHIR-The HSB Blog 10/4/21Telehealth Could Magnify Inequity For Those Who Lack Access-The HSB Blog 2/16/21 Final Thoughts: COVID dramatically accelerated the use and application of digital and mobile health and with the large volume of data generated and collected by medical providers, the problem of system interoperability and data sharing remains an issue. While recent regulations have put a focus on encouraging interoperability of data and electronic medical records, and the creation of new digital platforms has created ways to speed the development of such systems, healthcare data remains incredibly disconnected and siloed. Alongside this explosive growth in patient data that will increase our ability to improve care and forecast outcomes, comes concerns surrounding data security and privacy which will need to be prioritized. Improving data sharing and interoperability will allow digital and mobile health solutions to fulfill their potential to create new ecosystems that can improve operational efficiency, promote interconnectivity between providers and patients and help tackle historic health disparities. Moreover, this would give patients a greater say and the ability to get involved in and manage their own care which could have meaningful benefits in terms of costs and quality.

The Driver: Medallion recently raised $35 million in Series C funding led by Sequoia Capital who were joined by repeat investors Optum Ventures, Spark Capital, Elad Gil, and Daniel Gross. Also joining this round were Mario Schlosser CEO of Oscar Health, Iyah Romm CEO of Cityblock Health, and Will Gaybrick Chief Product Officer of Stripe. Medallion promises to help healthcare institutions become more streamlined and updated on the administrative level so patient care is improved, patient throughput increases and productivity of administrative staff becomes more efficient Key Takeaways: Healthcare administrative expenses (which include billing, patient enrollment, and insurance claims) are said to represent anywhere from 15-25 percent of the total nation's healthcare spending. Administrative spending also includes other “insurance-related activities” such as licensing healthcare workers (doctors and nurses), background checks on healthcare staff and signing up with different insurers (enrollment/empanelment). The U.S. spends significantly more than other nations on administrative costs, spending twice as much as Canada on administrative costs. Medallion claims to have cut over 250,000 hours (of bureaucratic headaches) since its inception due to the streamlining of the extensive administrative process which can instead be spent on provider care. The Story: Derek Lo, CEO of Medallion founded the company after talking with Zachariah Reitano co-founder and CEO of Ro and discussing how difficult and antiquated the medical licensing, credentialing and certification process was. Following the discussion, he quickly came up with the template to create a process for making this one cohesive unit. His goal was to help healthcare professionals and healthcare organizations by providing operational support to alleviate the arduous administrative process many healthcare organizations face to have doctors credentialed, licensed, and background checks completed. As noted by Medallion CEO Derek Lo to Forbes, “the average time to get to contract with a health insurer or hospital is usually six months at the fastest and can take up to 2 years.” Medallion works on payer empanelment which is when a clinician (ex: doctor or therapist) requests to be a part of a health insurance network in order to accept patients from their networks and be reimbursed by their plans. This process can be very arduous and requires the collection of data from the provider to the insurance company including such things as Drug Enforcement Agency (DEA) and/or Controlled Dangerous Substances certification, provider credentialing criteria (which often differ by payer), etc. Medallion works to decrease the time the empanelment process takes so providers become registered in-network and can start seeing patients faster. Medallion has increased its customer base from 25 at startup to close to 100. Medallion also manages license updates in all 50 states and provides reminders when a provider's license needs to be renewed. They lessen the time it takes to get licensure approved and complete for all provider types from NPs, MDs, RNs, PAsS, LCSWs and RDss, and many more. Payer empanelment under Medallion is more smooth and efficient, they submit the request to the insurance company and make sure the detailed information and files that are required are updated and ready to send. They also make sure the verification process from the insurance company is followed and done correctly as these often vary between companies. This process allows for providers to focus on clinical needs. The Differentiator Medallion is focused on providing and streamlining back-office support to providers in many areas of administration where they deal with inefficient and non-standardized procedures that vary by the state board and the insurance company that often have their own unique set of requirements. This can take significant time and effort to ensure that clinicians are registered, licensed, and credentialed properly and then properly enrolled in health insurance company's networks to make sure that a provider is paid. Medallion bases its costs on the number of medical doctors in a healthcare organization. According to the company they have doubled revenue since November 2021 and now have over 200 customers. Medallion’s goal is to take the burden off its customer base of group practices, health systems, and other health care facilities by doing all administrative work. Systems by Medallion and others can help fill the gap while regulators move toward uniform, standardized benchmarks so providers can fill out a single application and undergo a single process. In addition, by serving virtual primary care practices as well as telehealth and remote patient monitoring (RPM) platforms Medallion is helping ensure that both large and small health care organizations delivering care digitally will be able to meet rapidly the current demands of an ever-growing customer patient base. The Big Picture: There is clearly a need for an answer to the problem of the unnecessary spending in both money and time in administrative or back office spending on healthcare in the U.S. For example, according to the Healthcare Value Hub of Altarum, almost 19% of Medicare Advantage Plan spending and over 12% of Employer-Based Healthcare spending is due to administrative costs. In addition, as noted earlier, the licensing and credentialing process can often take 3-6 months thus slowing the addition of new providers to networks and ultimately leading to fewer people getting the care they need. While some states such as Maryland have programs in place such as all-payer rate setting that helps lower administrative costs, other steps are necessary to reduce the burden. For example, as noted by Altarum, “Standardizing licensure reporting requirements for quality and safety programs and minimum criteria will promote greater uniformity and lower compliance expenses.” Given that efforts like this have been contemplated for many years, tools like Medallion’s can help providers accomplish many of the same things while long-awaited regulatory change takes place. Obviously were that to occur, Medallion and others would have to further differentiate themselves. Healthcare Automation Startup Medallion Raises $35 Million To Go On The Offensive; Credentialing platform Medallion raises $35M and more digital health fundings; This Founder Raised $30 Million To Cut Through The Red Tape Every Health Startup Hates

The Driver: August Health raised $15 million in a Series A funding round led by Matrix Partners and returning investor General Catalyst with participation from Dan Baty, the founder of Columbia Pacific, and Arine Whitman, founder of Formation Capital. August Health’s goal is to apply technology to improve the quality of care for seniors in senior living and has designed a SaaS software system to help digitize patient records. The company feels this will help improve both the care for residents and operations as most senior living communities still rely on paper recordkeeping systems. Key Takeaways: A study by the CDC found that less than 20% of residential care communities use electronic health records (EHRs) leaving over 80% of residential care communities, essentially still relying on paper record keeping. According to a survey by Senior Housing News, 56% of workers in nursing homes and assisted living settings reported feeling burned out at work as a result of the continued response to the Pandemic. Of the senior living communities using record-keeping technology, most were deploying legacy technology typically designed for an adjacent industry according to August Health. Senior care facilities, because of issues with paper-based record keeping, often have trouble tracking things as simple as (for example) how many falls have occurred in their facility. The Story: August Health was founded in 2003 by Co-founders Erez Cohen, Dr. Justin Dr. Schram, and Michael Watts. The co-founders all have prior experience as entrepreneurs with their own companies. Cohen previously founded the company Mapsense which was later acquired by Apple and Dr. Schram was a medical director at Landmark Health which provides home-based medical care to individuals with multiple chronic conditions. During his time at Landmark health, Dr. Schram noticed that most senior living facilities were still using paper-based record-keeping systems. This was not only time-consuming but made finding specific documents difficult especially in an emergency situation. According to Cohen, he and Dr. Schram started visiting communities where Dr. Schram previously had patients and saw an opportunity to support administrators and caregivers by building software that would automate busywork, simplify compliance, and streamline community services. As noted in a recent article in TechCrunch, the two found that “people working at senior care residences often struggle with time-consuming paperwork, including move-in packets, face sheets, emergency binders, medication administration records, and service plans.” As a result, information is not updated across the facility, and having a single “source of truth” is difficult. This has led to the creation of August’s two main products which it currently markets, 1) a move-in-only product that deals with the patient intake process and the move-in-packets described above, and 2) an end-to-end Assisted Living software platform that allows for easier access to resident documents when they need it. Both products are billed on a per active resident per month basis. The Differentiators: August Health's software platform modernizes the functionality of senior living communities by digitizing their resident's records and care coordination. The platform allows for easier tracking of analytics, an online portal for tracking forms, updating information, and compliance tools with built-in reminders to fix outdated information. This solution not only makes accessing resident information easier but also takes stress off the staff members by automating many administrative functions. August Health attempts to differentiate itself by allowing customers to tailor their software to ease of use allowing staff members and residents to find the documentation they need. Moreover, August Health has comprehensive features that allow their platform to integrate everything from resident move-ins to medication management, emergency packets, progress notes and alert charting to a family portal for viewing patient care and billing matter. The Big Picture: August Health’s SaaS platform is very practical for older individuals, incorporating all their needs into one software. This software modernizes senior living facilities by switching the paper records to a digital format, making it easier for providers and staff to keep tabs on their residents. This has become increasingly more important as more patients are being transitioned to post-acute care, and more rapidly. As one study noted “what’s [care that’s] come out of the hospital now was always treated in the hospital years ago, to a large extent. People are coming out quicker. They’re coming out sicker.” In addition, for the residents themselves and for family members, August’s software gives them access to their own records, telehealth appointments, and assistance moving in and out of the facility. As a result, the platform helps improve access, efficiency, communication, and the quality of care for those within the community. For example, in an emergency situation, a staff member can easily pull up a resident's record to see if they have allergies to certain medications without the hassle of going through reams of paper. Moreover by automating records and giving family members and caregivers access (with permission) will free up the time of facility staff who will no longer have to find the information on the paper records. Given the ability to establish a single source of truth and ensure consistent care August’s software has the potential to help significantly improve outcomes and reduce costs. August Health digitizes senior living communities for better care; $18 million tech startup eyes creating efficiencies specifically for assisted living; Over 50% of Assisted Living, Nursing Home Workers Report Burnout; 24% Say They Had Covid-19

OurTake: With investment in the public and private sphere into programs such as the Affordable Care Act, Medicare/Medicaid, and the adoption of services such as Folx Health’s or Plume’s digital care offerings, the lesbian, gay, bisexual, transgender, queer and others (LGBTQ+) community is being empowered with the healthcare tools they need for healthy lives that begin to address historic disparities in healthcare access and outcomes. LGBTQ+ insurance coverage and healthcare discrimination are two significant issues faced by this community which have seen major improvements over the past several years (although this may come under threat with the recent Supreme Court decision overturning Roe v. Wade). Many legislative and court victories have established or upheld a variety of new benefits and protections over the past two decades. Although many of these disparities still persist and more effort will be required from public and private stakeholders to properly deal with these issues, cultural attitudes towards the LGBTQ+ community appear to be changing and broad awareness and support of celebrations such as Pride Month seem to indicate a more promising future. Key Takeaways: 8% of the general population identify as LGBTQ+ according to U.S. Census data. About 20% of LGB and transgender adults respectively lack insurance coverage vs. 12% of the general population according to Jurnal of Public Health Management and Practice Almost 32% of lesbian, gay, or bisexual individuals and 38% of transgender individuals have been diagnosed with a depressive disorder compared to only 16% of the general population according to a New York State Department of Health study. 16% of all LGBTQ+ adults reported experiencing healthcare discrimination according to a 2019 study published in the Health Services Research journal. The Problem: The LGBTQ+ community has long been neglected with regard to the availability of culturally competent healthcare. Struggles persist in achieving widespread coverage sensitive to the unique needs of this group delivered in a non-threatening and non-discriminatory manner. For example, data from an article published in the journal of Public Health Management and Practice indicates that LGBTQ+ suffer from greater health insurance coverage issues than the general population, with 17% of LGBTQ+ adults lacking any kind of coverage compared with 12% of the general population. This disparity is even more apparent among LGBTQ+ adults of color and transgender adults at 23% and 22% without coverage, respectively. Additionally, the prevalence afforded states’ rights in the U.S. policy-making on a national level is disjointed allowing many states to make their own laws that have led to more than half of all U.S. states having no protections for LGBTQ+ inclusive insurance policies. Many more are left with inadequate protections against discrimination based on sexual orientation, gender identity, or both according to a national map of LGBTQ+ healthcare laws and policies by the Movement Advancement Project. Access to insurance coverage and sexual or identity-based discrimination are undoubtedly the paramount concerns that the LGBTQ+ community faces in trying to ensure they receive proper health care and efforts must be taken to address this. Increased investment in health insurance programs such as the Affordable Care Act, Medicare, or other digital health tools from the private sector has made large strides in helping to address coverage issues. Moreover, new legislation must be passed guaranteeing protections to this already vulnerable community that has faced a long history of oppression and inadequate care. The Backdrop: At least 20 million American adults self-identified as LGBTQ+ in 2021, representing nearly 8% of the general population according to U.S. Census data. These numbers have seen considerable increases as more people have gained the confidence to come out publicly as American society has become more accepting of LGBTQ+ individuals, and policies guaranteeing their civil rights have been codified into law. However, many challenges still remain for this community. The overall state of LGBTQ+ health and availability of healthcare in America is still very poor compared to the general population. For example, a 2020 survey conducted by the NYS Department of Health found that nearly 31.7% of lesbian, gay, or bisexual individuals and 37.8% of transgender individuals have been diagnosed with a depressive disorder compared to only 16% of the general population. The study also reported that these same individuals also noted dramatically higher rates of self-reported mental illness, with the study finding that these same individuals reported rates of self-reported mental illness that were almost double the rate of the general population (24%). Additionally, LGBTQ+ youth are well documented to have higher rates of substance abuse than do heterosexual youth, and the LGBTQ+ community has long been targeted by tobacco industry advertising and marketing, with higher rates of tobacco usage as well in comparison to their cisgender, heterosexual peers. There is a clear need for quality and affordable healthcare among the LGBTQ+ community that necessitates further attention and investment in order to address these disparities. Interpersonal discrimination is something that any LGBTQ+ adult will know well, and this problem remains ever-present even while seeking healthcare. 18% of LGBTQ+ adults reported having avoided healthcare due to anticipation of discrimination, along with 22% of transgender adults, while 16% of all LGBTQ+ adults reported actually experiencing discrimination in their healthcare visits according to a 2019 study by the Health Services Research journal. Nevertheless, changing societal attitudes toward LGBTQ+ individuals and recent legislation guaranteeing certain civil rights to these individuals have led to a brighter outlook for the future. A larger part of America is arguably more accepting of LGBTQ+ individuals than ever, and significant resources are being devoted to ensuring continued improvement in the quality of their care from both the public and private sectors. Investment into government-led health insurance programs like the Affordable Care Act and Medicare has indeed led to the expansion of health insurance benefits to cover thousands more of LGBTQ+ Americans. Given recent court rulings relating to qualifying for these programs as well as the Federal recognition of gay marriage, many protections are now codified into law marking significant headway being made in combating discrimination in healthcare. Implications: Recent research into the impacts that increased public and private investment has had on LGBTQ+ healthcare coverage and health outcomes is promising. Affordable Care Act enrollment has been successful in reducing the number of uninsured LGBTQ+individuals. For example, the uninsured rate for LGBTQ+ individuals declined from 34% for low- and middle-income LGBTQ+ adults in 2013 to 26% in 2014 in just the first year of ACA adoption, according to Health Affairs. Similarly, large reductions were seen in states that chose to expand Medicaid coverage, along with substantial improvements in healthcare access. Affordable health insurance options such as these allow the most vulnerable to secure the coverage they need. Guaranteed protection in these public insurance policies can help LGBTQ+ families get the same full family coverage that heterosexual couples are eligible for, including explicit protections on the basis of gender identity and sex stereotypes according to Section 1557 of the Patient Protection and Affordable Care Act. The Office for Civil Rights at the Department of Health and Human Services has also committed itself to investigating and resolve complaints of discrimination regarding LGBTQ+ health care in line with the Biden administration’s commitment to ensuring LGBTQ+ patients can access health care services without fear of discrimination. The private sector is also heavily involved in helping to address these historic disparities, primarily through the deployment of digital technologies and funding of startups dedicated to addressing the needs of the LGBTQ+ community, healthtech has focused on making healthcare more accessible and ensuring it is delivered in a more culturally competent way. For example, Folx Health, a startup offering virtual care to LGBTQ+ patients, received more than $25 million in Series A financing in February 2021 allowing them to expand access to their tools so that employers can now offer services such as virtual primary care and telehealth. In addition, Folx offers hormone replacement therapy for transgender employees, and PrEP which helps fight against the risk of HIV transmitted through sex. Including such services in an employee health plan is a significant step forward for normalizing the inclusion of LGBTQ+ health benefits in employer-sponsored health insurance plans. There are many more companies that offer similar services and could be of immense help to LGBTQ+ individuals in need of accessible and affordable care. Plume, offers a service transgender people can access directly from their phones that allows them to connect with experienced healthcare providers to get hormone replacement therapy services, if medically appropriate, from the comfort of their homes. By reducing the stigma associated with LGBTQ+ specific health issues and making these benefits available through employer-sponsored benefit plans, companies like Folx and Plume will help make this a benefit for all plans. As such, expanding health insurance benefits to include the previously marginalized LGBTQ+ community can go a long way toward addressing LGBTQ+ health disparities, improving mental health, fighting discrimination in healthcare, and improving the attitudes of some caregivers. Related Reading: Sexual Orientation and Gender Identity: Demographics and Health Indicators Discrimination in the United States: Experiences of lesbian, gay, bisexual, transgender, and queer Americans Implications of the COVID-19 Pandemic on LGBTQ Communities Lesbian, Gay, And Bisexual Adults Report Continued Problems Affording Care Despite Coverage Gains Healthcare Laws and Policies Folx Health launches employer offering for LGBTQIA+ care