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Ciitizen Acquired By Invitae: Empowering Patients To Take Charge of Their Care Ciitizen Acquired By Invitae: Empowering Patients To Take Charge of Their Care Services like Ciitizen’s can centralize a patients' complete medical history and improve a practitioner’s ability to view a patient holistically, hopefully resulting in improved diagnosis, treatment, and outcomes. TytoCare Remote Medical Examination Device Maker Raises $50M Scouting Report-TytoCare Remote Medical Examination Device Maker Raises $50M TytoCare is hoping to change the way people perceive healthcare to one focused on wellness and preventive care all the while taking advantage of the shift in the way people acquire healthcare as a result of COVID. Oxygen: AI-Based, End-to-End, Virtual-First Primary Care Oxygen: AI-Based, End-to-End, Virtual-First Primary Care “Virtual-first” will …allow EHRs and other systems to incorporate the appropriate data and analytics so they can be analyzed and applied within clinical practice and workflows. Caresyntax: AI-Based, Real-World Evidence to Improve Surgical Outcomes & Reduce Risk Scouting Report-Caresyntax:AI-Based,Real-World Evidence to Improve Surgical Outcomes & Reduce Risk Caresyntax’s technology allows hospitals to better optimize the use of the surgical suite and help them “achieve increased workflow efficiency, patient safety, and surgical performance.” Wheel: Moving Virtual Primary Care Forward Wheel: Moving Virtual Primary Care Forward [Wheel] is also helping non-traditional players like retailers, pharmacies, and employee benefit programs create their own virtual care programs under their own brand. Redox Raises $45M in Series D to Grow Data Integration Platform Scouting Report-Redox Raises $45M in Series D to Grow Data Integration Platform Redox’s cloud-based platform simplifies integration and scaling for software developers looking to build applications for healthcare providers. DexCare Software for Same Day Care Coordination & Management Raises $20M DexCare Software for Same Day Care Coordination & Management Raises $20M DexCare, an AI-powered platform that manages and schedules patient care, promises to support the increased patients’ consumption for healthcare to match the novel demand for ambulatory and telehealth services simultaneously. Caremerge: Improving Collaboration & Care in Senior Living w/Clinical Engagement Software Caremerge:Improving Collaboration & Care in Senior Living w/Clinical Engagement Software Caremerge helps healthcare providers improve accuracy in data collecting, develop a better longitudinal care record and ensure better care delivery and diagnostics. Clearing: Addressing Non-Addictive Pain Management Clearing: Addressing Non-Addictive Pain Management [Clearing’s solution] should reduce barriers in accessing pain management treatment plans for people of color and women and result in improved care at lower costs. Bastion Health: A Reproductive and Prostate Care App for Men Scouting Report-Bastion Health: A Reproductive and Prostate Care App for Men By creating a safe space for men to get discreet reproductive healthcare services, Bastion Health helps address men’s ability to monitor their health and hesitancy in seeking healthcare.

This is the 3rd in a series of articles on Platforms in Healthcare (please see our previous two pieces here: Platforms In Healthcare-Pt, 1 Platforms Explained-The HSB Blog 11/29/21 & Platforms In Healthcare-Pt. 2 What It Takes to Build A Successful Platform Bus.-The HSB Blog 12/6/21) for more background on technology platforms and the characterics of successful platforms. Please note that the list of potential sectors where platforms could make sense in healthcare, nor the examples given are meant to be exhaustive. Our Take: The U.S healthcare system could achieve the Triple Aim of improving patients’ experience, reducing cost, and improving population health by applying elements of a successful platform strategy in healthcare​​. Healthcare platforms have the potential of addressing care coordination issues in healthcare and support the transition to value-based care. However, addressing unique healthcare industry challenges like limited data standardization and system compatibility is crucial for establishing maturity and achieving network effects. Building a successful platform business requires an understanding of successful platform strategies, long-term minded investors, a strong team with the ability to work and collaborate across platforms to deliver superior products and execution, and a well thought out roadmap that empowers a clear understanding of how the platform will deliver more efficient workflows. Key Takeaways: Administrative spending accounts for about one-quarter of the total cost of care delivery in the U.S. according to McKinsey. According to a study in Health Affairs, an estimated $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 successfully. A study by McKinsey found that ,it may be possible to save at least $250 billion annually in health care spending (perhaps more) by reducing/eliminating waste in health care then redirecting these funds elsewhere. The Problem: The platform business model has helped startups in different industries to achieve success with high valuations and returns on investment. Creating successful platform companies is extremely challenging, especially early on in their development, as it requires attracting users and customers that can generate enough value to attract even more users and begin the process of generating network effects. This initial hurdle is referred to as the “cold start” problem. The “cold start” problem is worth understanding because network effects, which refers to increasing product or service value relative to the increase in the size of the customer or user base, is the force that underlies platform companies gaining competitive advantage (ex: as social media platforms attract more users the value of being on the same network as friends and family grow dramatically, often leading to exponential growth for the network). However, those looking to build platforms in the healthcare industry must be aware of unique barriers that could delay the development of network effects and they need to be prepared to deal with the challenges they present. Some of these barriers include the fragmentation of healthcare software products, the intricate web of healthcare data privacy and security governance regulations, and the extremely risk-averse (some might say hyper-cautious) purchasing behavior in healthcare information technology. For example, one of the major elements behind this risk-averse purchasing behavior in healthcare IT procurement departments is what is known as software lifecycle management. Software lifecycle management is the process whereby upgrades or entirely new installations of software products are initially tested, installed in systems, and updated for future versions. Due to the complex web of healthcare data security and privacy laws (HIPAA, HITECH, GDPR, CCPA, etc.) healthcare IT, departments are extremely concerned about the potential that any new installation or upgrade could lead to a security weakness or cause instability in a particular organization’s infrastructure. Despite this healthcare IT investment and software procurement require expansion to better evaluate the risk for cybersecurity, software update release cycles, and software integration with existing systems in an organization. In part, this is a reflection of healthcare organizations’ investment priorities. For example, healthcare consistently ranks as one of the lowest industries in terms of the percent of overall budgets spent on IT, relative to other industries. So if the industry is serious about creating a more patient-centered experience with new technology and in the process speeding the adoption/development of new solutions this will have to change. For example, they will need to commit more resources (either personnel or equipment,) to mitigating risks through software testing and auditing potential security vulnerabilities in order to increase the pace of software update release cycles. For platform businesses, this implies that they will have to take a number of steps to help ensure and demonstrate the data integrity, cybersecurity, and privacy precautions they will take with any data encountered from any client’s system. These include: 1) Being able to specify and limit the number of data elements it will need to interact with as part of a client’s IT system; 2) Being able to explain and document the lifecycle of any data once it leaves an organization’s system; 3) Being transparent about security testing and procedures for any software and updates; and, 4) Focusing on the ability to integrate with existing installed software and hardware and being able to demonstrate that path. For healthcare IT organizations, managing software issues like frequent software updates, avoiding critical system failures and data breaches, is crucial for patient safety, preventing harm caused by medical errors, and improving the quality of clinical care. For example, system failures in healthcare settings can cause issues as broad as making medication errors in an intensive care unit to having the wrong data collected from ambulatory services and sent to the billing department. For the healthcare system to embrace platforms and for them to achieve their potential, the reliability of platforms is essential. While many people may point to other industries such as finance as examples of where platforms have been embraced more rapidly and successfully than healthcare, integrity, and security are critical in the healthcare industry as any error literally could mean the difference between life and death. Background: Translating the elements of successful platform companies into a healthcare platform could be challenging due to barriers that are unique to the healthcare industry cited above and the interactions between payers, providers, and patients. Examples of such interactions include the payment for completed medical procedures, referrals of patients to out-of-network specialists for specific procedures as well as patients increasing expectations of higher-quality, more integrated service delivery from both providers and payers (ex: the consumerization of healthcare). As noted in the first two articles in this series, platforms have certain unique characteristics and inherently require certain factors and elements to achieve success (please see: Platforms In Healthcare-Pt, 1 Platforms Explained-The HSB Blog 11/29/21 & Platforms In Healthcare-Pt. 2 What It Takes to Build A Successful Platform Bus.-The HSB Blog 12/6/21). Nevertheless, we feel platforms hold great potential in the healthcare industry, particularly around the areas of system integration and health data interoperability, two areas that have long plagued the fragmented healthcare industry. While the Centers for Medicare and Medicaid Services has recently established and enacted policies to foster improved data integration and interoperability between insurance companies and provider systems (through such vehicles as FHIR and HL7), to improve claims processing and patients’ access to health data, these remain in their infancy and much work remains to be done. Other opportunities for integrating platforms in healthcare include; Improving the transferability of patient health data to support care coordination, Reducing the administrative costs associated with paying for medical care to reduce overbilling, Improving cost accounting to support the transition from fee-for-service to value-based care. Implications: In the U.S, curbing the rising healthcare cost while delivering quality care has long been a difficult and intransigent issue to solve. Healthcare innovators and new startups are interested in addressing these issues by fundamentally changing the way patients access care and pay for medical services. Along the same line, they have been working to enable providers to deliver quality healthcare services that improve health outcomes. Healthcare platforms could be an abundant source of solutions that help reduce cost and deliver quality healthcare by increasing the efficiency of interactions between stakeholders. For instance, the consumerization of the healthcare system in the U.S aims to improve the patient experience via better customer service, improved access to care, and lower costs (ex: Cured, Medisafe). Propelled by the accelerated pace of digital adoption during COVID, most healthcare platform companies are exploring ways to leverage virtual care to improve patients’ experience by making care more accessible, either virtually, in-office, or in their homes. Platforms in healthcare could also be used to improve the healthcare applications infrastructure. Companies that build products used by healthcare software developers simplify product development or integration into systems by providing templates for common use-cases, such as APIs, data queries, and standard data formats used. Platforms that support software developers will develop a competitive advantage by reducing the costs for developing healthcare applications especially as the developer community grows and economics of scale take effect (ex: Redox, Zus Health). While, many large incumbent technology companies have developed “out-of-the-box” solutions that are compliant with current healthcare data standards, for many of the reasons cited above it is important that platform companies focus specifically on building infrastructure for healthcare systems. While the existing standards for healthcare data are evolving as the existing conversation for data interoperability continues, it appears additional solutions will be needed to bridge this gap. Improving the coordination of provider-to-provider interactions also seems like a fruitful area for the application of platform technology (ex: Caremerge, ConsejoSano). This is particularly important for specialty care and post-acute process, and very important in the care of high-risk populations, such as patients with chronic disease and multiple health conditions. For example, referrals of patients to different care settings, such as when they transition from an acute-care hospital to a post-acute facility can lead to a lack of consistency in care and coordination between providers. In addition, referrals from primary care providers to out-of-network specialists often lead to patients leaving that organization’s network of providers (so-called “patient leakage”) leading to large revenue losses for many providers. This is due to the fact that many primary care providers never follow on referrals and many patients never even make an initial contact with the specialist that they were referred to. For example, according to Fibroblast it can reduce nearly one-fifth of a system’s revenue per year and some systems can lose as much as half a billion dollars per year in business that goes out of network. Platforms could enhance provider referrals especially when providers could help coordinate the referrals and fill in any holes in specialty care via the addition of a virtual practice or telehealth. Network effects on provider-provider platforms could reduce costs related to specialist care, create a competitive advantage, and promote improved continuity of care for managing complex health conditions. Moreover, another area that is ripe for the application of platforms is in enabling the access and portability of consumer records across systems, providers, and payers (ex: Health Gorilla, Validic). As noted above, the move towards healthcare consumerization is well underway and as a result, consumers are going to expect the same ease of access, transfer, and portability of their own personal health records as they do in data in other areas of their life. Consumers have become used to getting data of many kinds, when and where they want it, on whatever device they want it. Healthcare information exchanges and healthcare platforms that enable better sharing of patient data for patients and providers will increase patient satisfaction, coordination of care, adherence, and potentially aid in the detection and treatment of disease. These types of data repositories could empower better analytics, population health management and even have applications in clinical research (ex: trial recruitment from disease databases, the building of digital twins for genomic research). However, it will be doubly important that healthcare platforms pursuing these areas take significant and visible precautions to ensure the cybersecurity and privacy of patients’ data for them to succeed. Ultimately, healthcare platform companies have many market opportunities to pursue. By enabling more efficient workflows, platforms will contribute to the transition to value-based healthcare and consumerization of healthcare. Platforms for healthcare infrastructure will provide more efficient developer resources to build healthcare software applications. Health systems will equally benefit from health platforms interventions focused on achieving the Triple Aim of improving health outcomes, reducing cost, and improving patient experience. Related Reading: Waste in the US Health Care System Administrative Simplification: How to Save a Quarter-Trillion Dollars in US Healthcare Radical Interoperability in Healthcare: Measuring the Impacts on Care, Cost, and Growth

The Driver: Recently, Kala Health raised $75M in Series C funding with plans to use the funding towards a partnership with Luna On-Demand Physical Therapy. They also plan to make their solution available to more patients through employers and health plans in the US and expand into national reimbursement systems in Europe. Investors in the round include Optum Ventures, Idinvest, 3VC, Balderton Capital, Heartcore Capital, Symphony Ventures, and A Round Capital. Kaia Health, a digital therapeutics company for musculoskeletal (MSK) care, is collaborating with Luna to offer Kaia Health members in-person physical therapy in addition to virtual therapy sessions. Kaia’s digital health platform uses computer vision technology to help members track exercise through their smartphone. Kala members have the option of scheduling physical therapy appointments or video visits with physical therapists. Key Takeaways: Kaia's app was featured in a randomized control trail published in Nature, entitled "App-based multidisciplinary back pain treatment versus combined physiotherapy plus online education: a randomized controlled trial" One in five American adults experiences chronic pain, costing nearly $300 billion annually in lost productivity. According to the World Health Organization, about1.71 billion people have musculoskeletal conditions worldwide. Kaia Health is the largest musculoskeletal (MSK) care platform worldwide with over 500K users across the globe. The Story: Konstatin Mehl and Manuel Thurner, established Kaia Health in response to their personal struggles with chronic pain conditions. This inspired the desire to develop an innovative solution that would eliminate the obstacles that prevent patients from getting effective and cost-efficient treatment in a timely manner. On many occasions, people who suffer from chronic pain resort to prescription drugs and only get referred for high-quality treatment when it is too late. Late treatments eventually lead to higher costs and avoidable invasive treatments like orthopedic surgery (for MSK) or lung transplantations for chronic obstructive pulmonary diseases (COPD). The co-founder’s vision for Kaia Health is to enable patients to achieve cost-effective and sustainable treatment interventions promptly. Kaia Health’s app offers evidence-based pain management exercises that include daily movement exercises, relaxation exercises, and knowledge modules that patients can use at their convenience. Kaia also has a personalized daily training program that uses AI technology and a front-facing camera of the smartphone to aid the user in properly executing the modeled exercise routine. The technology has an audio feedback feature that tells users whether they are doing the exercises correctly and how adjustments they can make. “Kaia Health uses Motion Coach technology that delivers results without having to rely on cumbersome sensors or expensive hardware. Motion coach features real-time, automated exercise feedback and objective function assessment. It uses a strong basis of clinical evidence including one of the largest randomized control trials of its kind, great traction in multiple markets, and a team of motivated and dedicated followers which the company refers to as “Kaianeers.” Currently, Kaia’s Motion Coach technology uses computer vision technology to help patients track their exercises through a smartphone, works with most iOS and Android devices, even without an internet connection, but can only track 2D motion. Kaia is working towards developing a 3D musculoskeletal model. Furthermore, the app’s algorithm uses the patient's input and feedback in creating personalized training plans that match the user's condition and physical aptitude. Users have the option of adjusting the challenge level, the length and the number of rounds of the exercises. Funding for Kaia Health’s services is available through most employer-based health plans. Its partnership with Luna has expanded its patient offerings to include in-person physical therapy by licensed therapists. Patients are not required to have prescriptions before they can begin accessing therapy services. After scheduling and getting matched with a therapist the patients work with the same therapist for every session. In between sessions, the patient’s therapist can prescribe exercises or treatment regimens and answer any questions through the Luna app. Luna accepts most forms of health insurance, including Medicare however, they also offer a self-pay option that costs $125 per visit. The Differentiators: Kaia Health is one of the few self-service digital therapeutics companies that have a clinically validated MSK digital pain therapy. In addition to offering online services, Kaia through its partnership with Luna will now offer its users an in-person service option or both. According to both companies, this will allow patients to see the same therapist at each appointment, which the companies believe will improve continuity of care between Kaia’s digital offerings and in-person care. Furthermore, unlike its competitors, Kaia’s computer vision technology is a software-only approach and doesn’t require any additional sensors or hardware for patients to be able to use the system. Kaia Health also offers round-the-clock therapy on the app with an option for Luna’s licensed therapists to provide at-home care outside traditional business hours (from 6:30 AM-9:30 PM). Consequently, patients don't have to wait for availability or long hours in doctors’ offices. The Big Picture: Kaia Health and Luna’s collaboration increases access to care by making both online and in-person therapeutic care available to patients thereby increasing its appeal to a broader potential user base. For example, by providing users with both remote and in-person options it helps accommodate the needs of the elderly or disabled who may have gone through orthopedic trauma and may not be able to access in-person care as often as they would like or need to for optimal recovery. Digital physical therapy, either by itself or in combination with in-person physical therapy could also reduce the cost of care through early pain detection and eliminate the need for expensive medications and invasive procedures due to conditions that have deteriorated or gone untreated. By having therapists come to the patient Kaia facilitates a wide range of treatment options (in office, virtual and in-home) and makes receiving physical therapy easy and accessible as well as aiding in transitions of care. For example, prior to the collaboration, when a patient received virtual therapy and needed extra care requiring in-person therapy the patient would need to find a doctor unconnected to the Kaia network and potentially unfamiliar with the app. Now with the collaboration, they can just switch to Luna’s services while remaining on the Kaia health app. Kaia Health & Luna may also help patients to save thousands of dollars on unnecessary medication and invasive surgeries by engaging them in their MSK treatment journey earlier, possibly aiding in the detection of pain points early on and thereby saving money on additional medications and treatments. Also, through continuous therapy from the privacy of their home or workplace, patients may be able to avoid invasive surgery. By using a holistic evidence-based approach Kaia can potentially save patients time, money, and unnecessary pain. Kaia Health Adds In-Person Physical Therapy Through Partnership, PharmaShots Interview: Kaia Health's Konstantin Mehl Shares Insight on the Funding to Transform the Treatment for MSK and COPD

Our Take: As an increasing number of companies attempt to transition from a product to a platform business model or sometimes combine elements of both, now more than ever it is critical for companies to understand the elements that make up a successful platform business and what can be learned from them. While several of the world’s most valuable companies are dominant online platforms that have successfully created digital communities and market spaces for people to interact and transact, it is far from an easy feat to create. Moreover, McKinsey predicted in its report, “Winning in Digital Ecosystems” that digital platforms will mediate over 30% of global economic activity by the year 2025 but noted only 3% of established companies have adopted an effective platform strategy. As the platform economy continues reshaping the global economy, companies are contemplating the viability of leveraging the platform business model to their industry’s advantage, making it essential to understand the foundations of such models. Key Takeaways: Between 1992 and 2015, 209 platform organizations failed, with an average survival rate of about 5 years. According to McKinsey, digital platforms will mediate over 30% of global economic activity by 2025 yet only 3% of established companies have adopted an effective platform strategy. Forbes Insights survey (2017) reported that 31% of organizations in North America and Western Europe have adopted platform thinking. Anaconda, an open-source platform of 27M Python data scientists, has seen a total of approximately 10 billion downloads of its software library packages as of Spring 2021. The Problem: As noted in “The Power of Platforms” by Deloitte, traditional supply/demand distribution approaches are based on what are called “push-based approaches” whereby producers “simply made an efficient batch size of what they sold and foisted it onto the marketplace. This of course meant investing effort into anticipating what the customer demand might be, using that to create a sales forecast, and then procuring the right resources and people to produce the appropriate quantity of goods.” By contrast, platform-based approaches to supply/demand facilitate and empower so-called “pull-based approaches” whereby producers “reorient operations such that nothing happens until actual demand signals are received from real buyers.” However, companies in diverse sectors are adopting the platform business model to tap into its pull-based approach and profitability without adopting the competitive strategies that make platform companies successful. Some existing companies, aiming to either grow or even survive, focus more on replicating platform success and less on the power dynamics and risks associated with platform markets. However, success is not easy, according to a report entitled “The Evolution of the Global Digital Platform Economy: 1971-2021”, over 200 platform organizations failed between 1995 and 2015, with an average survival rate of only about 5 years. As the authors note “a platform often requires underwriting one side of the market to encourage the other side to participate. But knowing which side should get charged and which side should get subsidized may be the single most important strategic decision for a platform”, hence managers attempting to build platforms can “misprice” one side of the platform when underwriting the market. In addition, the authors also conclude that although several reasons account for some companies’ inability to leverage the platform model effectively, the wide knowledge gap is the most prominent reason. Many company managers do not understand how platforms operate and compete because it differs from the traditional supply-driven market. In addition, having an experienced platform leader does not guarantee a platform company’s success, especially if the company applies ineffective strategies or limits access to the platform. For example, in the 1980s, Steve Jobs struggled with creating a platform that was open enough for connecting Apple customers to the company’s software producers. Google Health, despite having an experienced platform leader, failed because it focused on healthcare consumers instead of healthcare providers (please see the Our Take blog “Lessons Learned: Big Tech Stumbles in Healthcare Again, Google Health Closing-The HSB Blog 8/30/21” for more detail). Ultimately, for platform businesses, determining which side of the market to emphasize is a crucial element of success. Unlike supply-side markets where external forces are considered threatening, understanding when to either include or remove ecosystem value is fundamental to platform strategy. The Backdrop: In 2017 Forbes conducted a survey showing that 31% of organizations have adopted what is called “platform thinking”. As noted by Erich Joachimsthaler in “What is Platform Thinking”, the concept of “platform thinking changes how we connect with consumers or customers.” Business functions like “marketing, communications, and selling [become] about connection – engagement and interaction, and creating a gravitational force that pulls consumers in, and that empowers them.” In an MIT Sloan Management Review article entitled “How to win at the Platform Game” the authors highlight three strategic elements that are pivotal for platform businesses: Business models built around subscription-based software as a service. Models built around marketplaces that connect many buyers and sellers. Combining a and b with data and machine learning models. For example, Amazon, which is perhaps the most successful platform company in the world and one of the world’s largest cloud services providers, has aggregated users from multiple industries (sometimes supplying the cloud infrastructure for competitors in parts of its business), has a straightforward cloud infrastructure, and many credible use cases. Amazon started by generating high value with an online bookstore and gradually expanded to other adjacent markets or markets with similar competitive dynamics where it felt it could create an advantage. According to the Harvard Business Review article entitled “Pipelines, Platforms and the New Rules of Strategy'' most successful platforms start with a high value generating single interaction before moving to adjacent types of interactions. This explains Amazon’s moves to integrate itself into every value chain by owning its customer interactions, amassing large amounts of data, and managing users' experience. The article also notes that network effects are central to the execution of every successful platform. A more robust network enhances supply and demand matches, leading to richer data that leads to improved matching (please see, Platforms In Healthcare-Part 1. Platforms Explained-The HSB Blog 11/29/21 for more on network effects). For example, in 2007, Apple was generally not considered a threatening player in the cell phone manufacturing market compared to the major cell phone manufacturers at the time (ex: Samsung, Nokia, and Motorola), even though it had innovative designs and new capabilities. The company’s fortunes changed in the cell phone market when Apple began to think of the iPhone as a connector rather than solely as a mobile communications product. By adopting this approach, Apple built a platform business that generated 92% of global profits by 2015. Conversely, a study of more than 250 failed platform companies found that the most prominent reasons for failure generally fell into 4 categories: 1) poor timing,2) dismissing the competition prematurely, 3) absence of trust between users and partners, and 4) mispricing on the wrong side of the market. Implications: A Deloitte Insights article on “Digital Platform as a growth lever” outlined fundamental questions that leaders must consider when transitioning to a platform business model. These questions include: Does the business align with a platform-based business model? Are there enough influence points on the platform to connect disparate parties? Are transitioning or new businesses able to develop a trust-based relationship with other partners on the platform? Does the business have the capabilities to build and sustain a platform? Apart from evaluating the viability of the platform business model with an existing or new business, companies also need to balance decision making with strategy formulation, process, and technology. The most important decision is determining the customer type. For a healthcare digital platform, the consumers include both patients and providers because often gaining provider/clinician buy-in can be crucial for gaining patients’ trust. Apart from platform offerings themselves, the supporting capabilities associated with the platform should not be underestimated and should be given due consideration. Healthcare organizations that intend to build healthcare platforms need to consider and envision the added benefits that the platforms can potentially provide to both customers and partners and their value proposition. Another noteworthy point is that while many corporate leaders believe platform models are only applicable for business-to-consumer models (B2C), platforms are increasingly more useful for business-to-business models (B2B). According to Laure Claire Reillier, a former senior executive at eBay Euro and author of “Platform Strategy: How to Unlock the Power of Communities and Networks to Grow Your Business”, the business-to-business model is currently showing the most activity. Incorporating both models within the healthcare platform could mean better-targeted services at lower costs. While a great deal of focus has been on B2C platforms there is great potential for B2B platforms in software development, provider asset management, and service optimization. Building a successful healthcare platform requires patient centricity, powerful analytic capabilities to read and interpret data meaningfully, and seamless data management. The evolution of information technology has reduced the cost of computing power storage and communication and made platform building and scaling cheaper and more straightforward. In addition, continued efforts in B2C healthcare platforms could allow for better communication, care coordination, and outcomes for patients. Developing effective healthcare platforms holds a promise of taking the stress off providers and expanding the range of services offered to facilitate improved patient care. When used properly, healthcare platforms foster an improved doctor-patient relationship due to much-needed improvements in the level of communication, convenience, and responsiveness. As noted, both B2B and B2C platforms present the healthcare industry with opportunities to either grow services or make them more efficient as they look to address the increasingly complex health and healthcare problems of diverse populations. Related Reading: Digital Platform as a Growth Lever The Platform Economy Pipelines, Platforms, and the New Rules of Strategy The Evolution of the Global Digital Platform Economy: 1971–2021 How to Win at the Platform Game

The Driver: AppliedVR recently raised $36 million from F-Prime Capital, JAZZ Venture Partners, Sway Ventures, and SVB Ventures bringing the company’s total funding to $71 million. The L.A.-based company plans to use the investment to conduct more clinical trials, launch EaseVRx’s in the market, and expand to other areas. AppliedVR uses virtual reality technology for managing chronic pain, acute postoperative pain, and anxiety. The company’s technology consists of a virtual reality headset with visual and audio programs that deliver cognitive behavioral therapy for treating pain conditions. To date, AppliedVR has conducted clinical trials on over 60,000 patients in 240 hospitals and 1,500 patient homes to help patients ease acute pain either during or after surgery. Key Takeaways: According to Modor Intelligence, the pain management market was valued at approximately $65B in 2020, and is expected to grow to $87B in 2026, a 4.85% CAGR. 66% of the patients who watched VR programs reported at least a 30% reduction in pain Chronic pain affects nearly one-third of Americans and has a total cost about $635 billion each year According to the CDC, on average, 115 Americans die daily from opioid overdoses. The Story: According to CEO and founder, Matthew Stout, AppliedVR was originally created as a tool to facilitate a better understanding of human decision-making by LRW at a top market research firm. After meeting with top VR researchers, Stoudt gained a better understanding of the role of virtual reality in helping people deal with their behaviors, emotions, and decisions. His realization of VR’s potential as a powerful cognitive tool gave rise to the idea of deploying it in dealing with anxiety, chronic pain, and depression. AppliedVR is useful for alleviating all manner of pains, from labor pains during childbirth to the discomfort experienced by patients undergoing cancer treatment. Using the company’s technology, virtual reality creates a 3D environment using a combination of advanced software, hardware, and design. Users can interact with the environments displayed in the VR headsets and engage with different visuals, sounds, and even sensations. The AppliedVR set comes with a Samsung smartphone, a Samsung VR device powered by Oculus, a headset, cables, and instructions. The VR content consists of a set of pre-installed medical apps, games, and animations, so once the user turns on the headset, they can start to use the system immediately. The smartphone’s use is limited to checking out the VR app on the phone or accessing Wi-Fi. Research has shown that people who use VR therapy have decreased levels of pain activity in the five regions of the brain associated with pain. The company notes that Dr. Brennan M. Spiegel and his research team at the Cedars-Sinai Medical Center have worked with AppliedVR for years and treated hundreds of patients with VR therapy. A study conducted by Dr. Brennan’s team to assess pain levels using VR found that the use of VR on hospitalized patients significantly reduces pain compared to a control distraction condition. Furthermore, an experiment in an article entitled “Virtual Reality for Management of Patients in Hospitalized Patients: Results of a Controlled Trial”, concluded that patients had a 13% drop in pain scores of 100 patients that watched a 15-minute nature video with mountains, running streams, and soothing music in the background. AppliedVR treats chronic pain by ​​capturing the mind’s attention and blocking pain signals from reaching the brain. The tactile and sensory feedback produced by AppliedVR’s system signals the patient’s neurotransmitter mechanisms that reduce pain. AppliedVR is currently working with Medicaid, Medicare, and other insurance networks for reimbursement, but they are yet to set any pricing plans. The Differentiators: Similar companies like Vicarious Surgical have FDA breakthrough status just like AppliedVR’s technology. However, Applied VR’s EaseVRx product is the first and only FDA-approved at-home virtual reality pain treatment used to treat chronic lower back pain and fibromyalgia and sets AppliedVR apart from comparable organizations. The FDA gave EaseVRx a “breakthrough device designation” for treating fibromyalgia and chronic lower back pain. The breakthrough device designation speeds up the development and review of new medical devices. In developing EaseVRx, AppliedVR conducted an important clinical study of 179 participants with chronic lower back pain that helped it to get FDA approval. Half of the participants were given an EaseVRx headset to watch immersive 3-D programs daily for 8 weeks and the other half were given headsets to watch routine nature scenes as a placebo. At the end of treatment, 66% of the patients who watched VR programs reported at least a 30% reduction in pain, compared to 41% of the patients in the placebo group. The Big Picture: Chronic pain and chronic pain management have long been an issue in the U.S. For example, according to Modor Intelligence, “the pain management market was valued at approximately $65B 2020, and it is expected to grow to $87B in 2026, with a CAGR of 4.85% over the forecast period. In addition, in the US, the misuse of prescription pain medication has led to an opioid overdose crisis. According to the Center for Disease Control and Prevention, the annual economic burden of prescription opioid misuse in the United States alone is approximately $78.5 billion. The estimated amount includes healthcare costs, addiction treatment, criminal justice involvement, and lost productivity. AppliedVR’s technology offers an alternative to chronic pain management while eliminating the need for prescription pain medication and instances of misuse. Apart from AVR’s potential in averting the opioid overdose crisis caused by pain prescription misuse, it is also more cost-effective. According to a Journal of Managed Care & Specialty Pharmacy study, the total cost of prescribed pain medication in the US is $17.8 billion. It also eliminates the need for costly and painful surgeries because VR therapy is a non-invasive treatment. In terms of inclusiveness, AppliedVR is user-friendly for people with disabilities because it is a hands-free device. Consequently, a wider range of patients, especially patients with limited mobility, can utilize and benefit from AppliedVR therapy. Notwithstanding the benefits of AppliedVR, there is still room for improvement. In the EaseVRx clinical trial, about 20% of participants reported discomfort with the headset and nearly 10% reported motion sickness and nausea. While these are common side effects from using VR headsets, it is worth addressing to improve the user’s experience. AppliedVR might help several people manage their chronic pain and anxiety with the proper training, price adjustments, and improved technology. AppliedVR Raises $36M, Pursues FDA Clearance of First Digital Therapeutic, AppliedVR scores $36M for Virtual Reality Pain Management. AppliedVR’s EaseVRx scores FDA De Novo Clearance for Treating Chronic Lower Back Pain

Our Take: The digital health industry is increasingly moving to platform solutions, with many different healthcare solutions likely to start converging into platform products, leading to more innovation and overall improvement of healthcare industries. While companies that buy and sell healthcare technology products both stand to benefit from this trend by having an integrated, more comprehensive set of tools available to solve their business needs, it is even more important for these platform developers to consider the many constraints that the market dynamics of the healthcare industry creates for new entrants. Key Takeaways: According to SaaS consulting company Formotus, surveys suggest that the price range for developing an enterprise mobile app is generally in the range of $100,000 to $500,000. The IQVIA Digital Health Trends reports notes there are currently over 350K health-related mobile applications available to consumers with more than 90K added in 2020 alone. According to Zus Health there are 4000 companies building heatlhcare registration apps alone. The average employer benefits plan has 18 stand alone health and wellness apps as part of its benefits offerings. The Problem: Exciting market opportunities exist in narrow market segments that have high customer demand and low competition. Peter Thiel, a well-known investor and serial entrepreneur, recommends startups to focus their efforts on areas that can come up with innovations that are significantly better than existing solutions. This is due in part to the fact that incumbents often fear changing the status quo or embracing innovation since it entails fear and risks of the unknown in processes such as operations and purchasing behavior both of which have helped them to develop a competitive advantage. Nevertheless as strategists such as Thiel and Clayton Christensen have recommended, to be significantly better, there needs to be a drastic improvement in reducing cost, increasing value, and/or the quality of the user experience. For industries that are associated with complex problems, including healthcare, education, government services, successful companies have often targeted reducing the cost and complexity of reaching the market for their customers. There are large market opportunities to improve the value and quality of products in these industries. Although the healthcare industry has large market opportunities, it is highly regulated with legal and regulatory requirements that could constrain companies with innovative solutions. New entrants need to recognize and prepare for these constraints during product development. For example, new medical software often can produce diagnostic results faster and more accurately than existing diagnostic methods, however, generally, it will still need to go through rigorous testing with regulatory authorities such as the FDA for patient safety and clinical effectiveness before it will be able to be sold into the marketplace. For industries that are fragmented such as healthcare, there are typically fewer opportunities to form long-lasting competitive advantages due to competitive pressures from new entrants, changing needs from customers, and cost pressures from suppliers. Platform companies can help overcome some of the competitive and regulatory issues that constrain innovation and provide a way to increase user value through network effects. Network effects describe how an additional user added to the platform will increase the economic value of the platform in a self-reinforcing loop causing more people to be added to the platform. An example of this is social media platforms, where having only one user on the platform would bring negligible value, but by contrast, enticing a larger number of users to join the platform initially will generate additional content that will keep users engaged, retained, and cause them to suggest their friends and associates join the platform thereby repeating the cycle. Viral user growth and user-generated content in social media platforms attract advertisers because of high user engagement and attention in the application to view advertisements. Companies develop a competitive advantage by reducing costs for customer acquisition (by leveraging existing users as referral sources) and creating high switching costs to prevent users from using alternative substitutes (ex: when the vast majority of one’s friends are on a particular social network). Initially, these products often require stable cash flow generation and long-term investment as early-stage platform products need to develop enough value on their early versions to retain and grow their user base to create and leverage network effects. For healthcare technology and enterprise software products, it is important to consider how risk-aversion must be overcome for companies to purchase a new innovative product. Developing platforms in digital health can help emerging companies in healthcare overcome existing barriers in areas such as systems integration, data security, and interoperability by effectively creating a roadmap for product developers to follow. The Backdrop: Platform models can be divided into two different categories, value exchange platforms, and innovation ecosystem platforms. Value exchange platforms encompass platforms like those in the so-called sharing economy, such as Uber and Airbnb, and other multi-sided marketplaces, such as Etsy and Angi. Innovation ecosystem platforms encompass developer tools for building infrastructures, such as Stripe and Amazon Web Services, and app stores, such as the Apple App Store and the Microsoft Store. The platform models that will be covered in this will be focused on the innovation ecosystem category. Platforms that fall in the innovation ecosystem category are critical to the advancement of the underlying infrastructure for an industry. For example, Stripe started with creating code to simplify payment processing for developers. Stripe then expanded their platform to encompass multiple areas of financial technology to make management of e-commerce and payments from new startups to public companies. Building upon these successes, the company now states its mission is to build the economic infrastructure for the internet. Building tools that lay the foundation for a new approach to industry infrastructure and supports developers will enable more product development, which will result in more innovation and a more mature ecosystem with better solutions. Similarly, a non-software example would be how the development of user-friendly 3D rendering software and inexpensive 3D printers contributed to a growth in rapid prototyping and DIY movement for so-called “makers” that support the use of open-source software in creating new devices electronics, robotics, 3-D printing, App stores that have a large market share with hardware devices are the Apple App Store, Google Play Store, Microsoft Store, and Amazon App Store. App store platform models allow software companies to control the distribution of third-party applications and digital content for hardware devices. For example, the Apple App Store’s revenue model has two main revenue streams, revenue from developers to publish their mobile applications on the app store, and commissions from developers when users purchase apps, and make in-app purchases. Platforms that can sustain their network effects can create what is referred to as a “flywheel effect” where growth compounds on previous growth eventually leading to extremely large and continuous gains in scale. This flywheel effect is what makes competitive advantages more resilient as initial first-mover advantages can contribute to lower costs from economics of scale in purchasing and operations, more revenue from exponential gains in customers and low customer acquisition costs, with more efficient distribution channels. Implications: Understanding customers and regulatory requirements are important considerations for organizations that are building platform companies in heavily regulated industries like healthcare, as healthcare providers (ex: hospitals and physicians) are subject to legislation such as HIPAA, HITECH, the 21st Century Cures Act, Anti-Kickback, and Stark Laws as well as numerous other regulations around the privacy and security of personal health information (PHI). These regulations for data privacy, security, and compliance can limit the ability of new entrants to gain traction in the industry by increasing the difficulty of developing products. The complexity of understanding the requirements rewards industry veterans that are able to develop solutions that can work within the existing regulatory framework. When compared to more consumer-focused retail and media, the differences in user dynamics and data privacy add an additional layer of complexity for building platform products in regulated industries. Regulated industries tend to have long sales cycles with risk-averse purchasing behavior. New startups require long-term investment horizons and sufficient financial capital to have enough resources to test products with customers and learn how to integrate their solutions into existing business processes. In healthcare given the many regulations around data privacy and security, data access and data storage can often be fragmented with different types of data residing in different systems in the organization. For example, in healthcare, there is structured and unstructured data that includes handwriting from doctors’ notes, lab results, images from radiology reports, and claims processing, which makes it difficult to create broad end-to-end solutions that would encompass a patient’s entire longitudinal record. End-to-end functionality is also hard to accomplish on a larger scale throughout an organization, even if it is able to be accomplished on a smaller scale since data if often siloed within departments. Interoperability is a barrier limiting how data from multiple systems can be integrated together for analysis. As noted earlier, healthcare data interoperability solutions being developed by companies such as Validic and Redox can provide the foundation for additional healthcare applications and solutions to be built on. Another characteristic of complex user dynamics is the lack of standardization in workflows. Custom technological solutions are expensive due to the complexity of system integration and limited standardized compliance requirements for interoperability. Building platforms for software engineers will reduce the cost of custom solutions and support more healthcare innovation. Zus Health and Health Gorilla are two of the multiple companies working on platform products for developers to reduce the cost associated with customization for healthcare applications. There is a large opportunity for the growth of platforms in healthcare if sufficient platform products that build critical infrastructure can reduce costs for innovating and delivering value to customers. This opportunity is similar to how enterprise cloud computing led to the reduction in infrastructure costs for server management and web hosting, which in turn led to more innovation. There are many reasons to remain optimistic about the future value of healthcare platform companies in improving healthcare delivery when the barriers to innovation can be overcome. Related Reading: The Art Of Pitching A Platform Business In Healthcare Why 'Ecosystems' Will Be the 2020 Leading Health Care Buzzword The Power of Data Network Effects

The Driver: ShiftMed recently raised $45 million in funding from Panoramic Ventures, HealthWorx, Blue Heron Capital, Motley Fool Ventures, and 3TS Capital Partners. ShiftMed is a startup mobile health company that connects medical providers with health care workers. Since its establishment in 2021, ShiftMed’s goal is to connect hospitals, assisted living providers, home-based care agencies, and nursing facilities with nurses looking for available shifts. Due to the current shortage of nurses across the country, the app has been a useful tool to connect doctors with nurses and other home-based healthcare workers. While the Virginia-based company started in 10 markets it has now increased to 56 markets across the United States. Key Takeaways: The U.S. Bureau of Labor Statistics projects the need for 1.1 million new RNs by 2022 for expansion and replacement of retirees, and to avoid a nursing shortage. In 2021, ShiftMed has hired more than 10,000 nurses so far with a combined time of more than 1 million hours caring for patients. More than 3,600 U.S. health care workers perished in the first year of the pandemic, according to a study by The Guardian and KHN. The Annual State of Nursing Report showed that almost 50% of US nurses are considering leaving their jobs over the next two years. The Story: In 2014, Todd Walrath had founded HomeCare.com which is a mobile platform that connects care providers to families seeking at-home care services. This later inspired Walrath to start ShiftMed in 2018. Both companies deal with shortages of healthcare workers and earning livable wages. These issues have made it nearly impossible for healthcare facilities to provide quality care for patients. The COVID-19 pandemic has only exacerbated these issues. Most nurses have left their jobs due to burnout, safety concerns, and the fact that they are not treated well. This leaves many vacant positions in hospitals and other health facilities. ShiftMed works to connect providers with nurses to fill those vacancies. ShiftMed allows Nurses (CNAs, LPNS, and RNs) to use their smartphones to control their entire work schedule. This includes selecting shifts, rate of pay, managing credentials, and getting paid right after their shift. The app enables families, hospitals, assisted living providers, home-based care agencies, and nursing facilities to reach the maximum amount of staffing while simultaneously giving healthcare professionals an opportunity to make their own schedule with shifts at the time and location of their choosing. ShiftMed has a national database of nurses across 700 locations in the US with more than 6 million nurses. There are more than 60,000 fully credentialed nurses available everyday to cover shifts at healthcare facilities. The Differentiators: In addition to offering more flexible scheduling, ShiftMed also offers unique payment models that allow nurses to receive their paychecks earlier, giving them added financial independence. For example, ShiftMed offers what are known as Next Day Pay and Guaranteed Shifts. With Next Day Pay, nurses can receive their paycheck the next day instead of waiting until the end of the week. In addition, healthcare workers can work a shift and receive 50% of their gross earnings within 24 hours of their withdrawal request and ShiftMed will even transfer these payments directly to their bank account for free. Through Guaranteed Shifts, nurses will still be paid for the entirety of their shift even if that shift has been canceled by the healthcare facility. By allowing nurses to pick up shifts at different hospitals, ShiftMed gives nurses the freedom to explore different locations and see which facility and/or organization may be the best fit for them. If a nurse likes a certain location, they can choose to pick up shifts at that location repeatedly which also allows patients to have consistent care with a familiar face. ShiftMed offers flexibility with nurses choosing their own schedules which typically is not found with dedicated nursing shifts at a single facility. The Big Picture: The rise of the COVID pandemic led to dramatic surges in infections across the U.S., spikes in hospital utilization, and long hours for overworked nursing and clinical staff. All of this led to a significant increase in burnout among overworked nurses leading to a shortage of nurses and other front-line staff in hospitals. This was compounded during COVID by the lack of PPE and nurses feeling unsafe and unappreciated from the constant pressure and anxiety of having to work in difficult conditions. For example, Michelle Thomas, a registered nurse, and manager of the emergency department at a hospital in Tucson, Arizona, resigned three weeks after reaching her breaking point. As noted in a recent article from NPR entitled, “Hospitals Face A Shortage Of Nurses As COVID Cases Soar”, “There was never a time that we could just kind of take a breath, I hit that point ... I can't do this anymore. I'm so just tapped out." After experiencing less than ideal working conditions and going through emotional turmoil, Thomas, like many other nurses, decided to leave her job. The burden of COVID has only contributed to what already was moving toward a nationwide shortage of nurses in America. Services like ShiftMed that work to connect hospitals, clinics, at-home agencies with nurses looking for both part-time and full-time shifts make the system more flexible. In addition, while staffing services like ShiftMed will not alleviate shortages when the entire healthcare system is overtaxed, when there are sporadic or geographic shortages, services like ShiftMed can help allocate nursing resources to where they are most in demand. Moreover, the convenience of being able to work as much or as little as you want, whenever you want will likely entice nurses who have retired or whose other responsibilities may prevent them from returning to work full time, and it has the potential to alleviate some of the nursing shortage. Nurse Staffing Platform ShiftMed Raises $45M to Fill Provider Needs on-Demand, Meet The Disruptors: Todd Walrath Of ShiftMed On The Three Things You Need To Shake Up Your Industry

Our Take: The increase in the use of telehealth and remote patient monitoring tools by elderly populations during the COVID pandemic has created a unique opportunity for health technologies and solutions to transform the health and healthcare of the aging. For example, according to an article in Health Evolution entitled “Digital health making a surprising impact for older patients” prior to the pandemic only 20% of adults 65 and older had reported using a health app, and 4% of adults 65 and older had participated in a telehealth visit. However, post-pandemic, over 90% of adults 65 and older reported using virtual care for the first time, and 60% of seniors reported embracing technology during the pandemic. This is crucially important in enabling the elderly to maintain independence and age in place as approximately 85% of older adults have at least one chronic health condition, and 60% have at least two chronic conditions, according to the Centers for Disease Control and Prevention. Not only did the pandemic lead to significant improvement in the elderly population’s receptiveness to digital health solutions and adoption of digital technology to access healthcare services, but it also increased digital health solutions and investor focus on the delivery of care and support services for the elderly population. Shifting abruptly to digital health was a difficult transition as a great many seniors were separated from the support system that assisted them with navigating technology. On the positive side, the dramatic shift to telehealth forced many seniors to acquire or improve their digital skills in order to carry on with their usual healthcare activities like doctor’s appointments or ordering their medicines which were now happening with the assistance of technology. Key Takeaways: According to the UN Report on Aging 2020, there are 727 million persons aged 65 years and over globally, and this number is projected to double by 2050. Pre-Pandemic only 20% of adults 65 and older had used a health app, and 4% of adults 65 and older had participated in a telehealth visit. Post-Pandemic 92% of adults 65 and older reported using virtual care for the first time during the pandemic, and 60% of seniors embraced technology more during the pandemic. Goldman Sachs estimates that digital health technologies can reduce US healthcare costs by about $305 billion, partly through adoption among older people looking to lower their expenses. The Problem: As we age, naturally we increasingly prone to falling ill and are more susceptible to chronic illness resulting in increased spending on healthcare treatments. According to the UN Report on Aging 2020, there are 727 million persons aged 65 years and over globally, and the number is projected to double by 2050 increasing the demographic in need of care. Research has shown an association between the ability of seniors to live independently have reduced healthcare costs and lower mortality risk. Digital health technologies that offer support for the elderly to manage their healthcare and live on their own could reduce mortality risks, especially for seniors with limited support networks.. Before the pandemic, the investments and solutions for the elderly were few compared to the need for several reasons. These include limited understanding of the technology needs of the elderly, the tendency to prioritize the more tech-savvy populations, and the elderly’s preference for in-person care. At the onset of the COVID-19 pandemic, stringent lockdown measures and the need to keep people safe from potential infection led to the separation of older populations from their families and support systems. To contain the spread of the pandemic, healthcare services were mainly accessible remotely and therefore digital health solutions and technology became an integral part of healthcare for everyone, including the elderly. While the elderly tried to navigate the new normal by adopting digital health solutions it became increasingly apparent that most of the existing solutions were not specifically designed to meet their needs including the need for solutions that address needs most often found in this population like hearing and vision loss. According to Rock health’s report, 9 in 10 Americans found it challenging to obtain, process, and understand basic information and services needed to make appropriate health decisions, and the older adults struggled more than their younger counterparts. Before the pandemic, only 20% of adults 65 and older used a health app, and 4% had used telehealth services. However, following the pandemic, a striking 92% of adults 65 and older reported using virtual care for the first time, during the pandemic, and 60% of seniors embraced technology more during the COVID-19 pandemic. The Backdrop: Despite the rapid increase in the number of health-focused digital solutions, the elderly population was largely ignored. The increased adoption of digital health solutions caused by the pandemic’s disruption of healthcare delivery has forced solution vendors to rethink their assumptions and led to the design of more customized solutions targeted at meeting the needs of the elderly population. A BMC Geriatrics article (2021) classifies digital health technologies for the elderly into the following four categories: Gerontechnology: Digital tools targeted for supporting the aged in living healthier lives. Intelligent assistant technology that helps patients with dementia or age-related cognitive disabilities. Digital health solutions that are designed for the general population but with features customized to serve the needs of the elderly. Other Digital Health solutions that generate data that support the implementation of assistive functions like self-monitoring medication adherence, and calorie consumption. In addition, the forced adoption of technology that occurred during the pandemic has helped many older adults overcome their reluctance to use digital health particularly for follow-up and routine visits, though many still prefer in-person care for diagnostic care and specialized treatments. A study conducted in Switzerland aimed at recording digitization for the elderly saw that generally the elderly had a positive attitude towards digital health technology. The sample study identified certain values older adults attached to digital health technologies including, improved communication and care coordination, risk reduction for safety concerns, and fostering their autonomy. Nevertheless, in the same study, they also expressed concerns about privacy, cost reimbursement, and the lack of human contact. Implications: Empowering the aged to maintain some level of independence, also referred to as healthy aging or aging-in-place, is one of the ways nations are looking at caring for an aging population while addressing the increased socio economic impact of that care. In addition to helping reduce the cost associated with institutionalizing elderly populations, many studies have demonstrated that seniors can live healthier more emotionally fulfilling lives by remaining in their own homes with sufficient support systems. As alluded to by Dr. Mike Devoy, Bayer’s Chief Medical Officer in an interview, realizing the full potential of innovative digital solutions and technologies for the elderly hinges greatly on empowering older people to self-manage their health and be equipped to make better health decisions. The increased adoption of telemedicine, telehealth, remote care, and other digital solutions promises more autonomy, reduced cost, and better treatment outcomes for the elderly. Digital health solutions like at-home monitoring devices could eliminate the need for costly nursing home care and cut down unnecessary hospital visits. In a 2015 report entitled, ”The Digital Revolution comes to the US healthcare” Goldman Sachs estimated that digital health technologies can reduce US healthcare costs by about $305 billion, partly through adoption among older people looking to lower their expenses. Optimizing the advantages of digital health for the elderly would require addressing the issues that prevent them from accessing or utilizing them. These solutions must be simple to use, adapted to the visual, hearing, and tactile needs of seniors, and generally with fewer processes to enhance usability. Integrating patient engagement technology and visual explanations to improve health literacy and provide technology support could enhance the elderly population’s user experience and satisfaction. In addition, given seniors are generally living on a fixed income and many may be struggling with living costs, affordability is equally important to avoid excluding the elderly from accessing much-needed healthcare services. Digital health is the future of healthcare particularly as healthcare delivery moves out of facilities and closer to patients, hence health technologies need to be customized for seniors to ensure that they can access care where and when they want and take full advantage of imminent advancements in healthcare systems. Related Research: Digital Health Interventions for Healthy Aging: A Qualitative User Evaluation and Ethical Assessment How Seniors Got Lost in the Digital Health Revolution Data Dive: Digital Health Making a Surprising Impact for Older Patients Three Questions: Mike Devoy on how Digital Health Solutions can Help People Age Better The Future of Aging Technology and Care

The Driver: Bastion Health is a digital health startup company that focuses on providing prostate and reproductive healthcare services for men. In early November, the company received $2.2M in seed funding from the Werth Family Investment Associates and recently launched the first comprehensive app-based telehealth platform for men’s health. Since its establishment in 2020, Bastian Health’s goal is to provide comprehensive and accessible health care for men that empowers them to better manage their health from the comfort of their homes. While the company’s services are only currently offered in Florida, they plan to use this round of funding to expand across the country. Key Takeaways: Prostate cancer is the most common cancer for men (after skin cancer) with about 1/3 of men experiencing moderate to severe symptoms by age 60, and about 1/2 of men experiencing those symptoms by age 80. According to a 2017 study male sperm count in men has fallen by over 50% in 40 years. 50% of men have prostate issues after the age of 45 years CDC research has found that 35% of couples experience infertility, where a male issue is identified in combination with a female factor while in about 8% of couples, a male factor is the only cause found. The Story: Reza Amin and Khashayar Dashti, co-founded Bastion Health in response to the gap in finding comprehensive health tools and resources for men. They developed Bastion Health to fundamentally change men’s healthcare which they described as underserved and to help remove the stigma around conversations about men’s health. Amin and Dashti’s vision is to foster a more proactive approach to health care for men as most men are less inclined to be proactive about their health and in seeking healthcare. They also hope to address men’s reluctance to seek healthcare for reproductive matters due to embarrassment by providing a comprehensive and accessible digital clinic where they can discreetly get the care they need. This is particularly important because most often the burden of infertility lies heavily on women even when the man might have health issues. “You can find a lot of solutions for female reproductive health, and that’s good, but it’s also putting more pressure on women,” Amin says. “We believe that any reproductive issue is not a man versus woman problem; it’s a couple problem. So men should take responsibility, and we are designing this product for responsible men who want to really be part of this process.” The app is designed to offer lifestyle tracking, education, and telehealth visits with a network of doctors and medical providers. After signing up on the Bastion Health website, patients can schedule appointments, receive lifestyle planning tips, prescriptions, and even referrals if they need to see a doctor in person. The Differentiators: Although prostate cancer is the most common cancer in men after skin cancer, yet it is often untreated. Bastion’s plans help overcome some of the obstacles to treatment by offering plans that are affordable, convenient, and easy to comply with. For example, Bastion Health has two prostate telehealth packages that cost $150 and $750. The $150 service includes a comprehensive assessment as well as Benign Prostatic Hyperplasia (BPH) diagnostics for men. This service comes with prostate-specific antigen tests and results, urinalysis tests and results analysis, comprehensive BPH assessment reports, and lifestyle guidance. For $750, Bastion offers a prostate treatment plan which includes a 12 month BHP management plan. This package includes all of the features of the assessment plan with additional personalized clinical treatment plans, prescriptions, supplements, lab tests (for additional fees) as well as treatment progression trackers, and updates. Similar to prostate treatment, infertility in men often goes undiagnosed and is poorly treated. To help facilitate treatment, Bastion has also developed a patented smartphone diagnostic technology for the app that provides men with fast medical test results for male fertility from the privacy of their homes. It requires the patient to load a semen sample onto a disposable testing grid, which then processes the result on the phone. The technology then produces an analysis of the user's sperm count, sperm motility, fructose, and pH levels, which are all important for analyzing male reproduction and health. Bastion’s smartphone technology enables it to offer two reproductive telehealth packages for men at a cost of $225 and $500. The initial package costs $225 includes an assessment and consists of semen analysis tests and results, genetic tests and results analysis, fertility assessment reports, and lifestyle guidance. A more comprehensive reproductive treatment plan is available for $500 and includes a 4-month at-home plan. Bastion’s services are direct-pay as they do not take insurance. However, they accept payment via Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA). The Big Picture: With the COVID-19 pandemic, several digital health innovations have come to the forefront with niche solutions for different demographics. Bastion Health’s focus on men's health is a welcome development that could foster better reproductive health and overall better health outcomes for men. For example, epidemiologist Shanna Swan cites evidence that male fertility has been declining for years and may soon reach a point that could impact a couple’s ability to conceive. In her book Countdown, Swan cites a 2017 study that showed that male sperm counts in the Western world had decreased over half between 1973 and 2011. According to the study, if the current pace of decline in sperm count continues, the grandchildren of Western males could possess sperm counts below the level considered suitable for reproduction. By creating a safe space for men to get discreet reproductive healthcare services Bastion Health, helps address men’s ability to monitor their reproductive health and hesitancy in seeking healthcare. Moreover, it enables a broader discourse on the issues of reproductive and prostate healthcare for men, which is often undiscussed among men. Making access to reproductive health care services more convenient could help lower the costs of healthcare by providing the path to earlier treatment and intervention. In addition, it could help reduce the instances of emergency department overuse caused by delayed care or non-adoption of preventive care measures. Student Startup Gets $2.2M Investment to Bring Men’s Reproductive Health Ecosystem, Testing to Life, Men’s Health Startup Bastion Health Launches to Offer Reproductive, Prostate Care

Our Take: Direct service contracting and other value-based care models are dependent on and require significantly greater data points to enable evaluation and management of actuarial risk. As a result, this opens up more direct need and broader market opportunities for digital health tools like remote and virtual care products. For example, virtual care products that track patients' conditions in their homes and even on the go help providers achieve patient adherence and compliance with treatment protocols to facilitate risk-sharing modes. This in turn allows providers and payers to contain costs based on clinical outcomes. The data points enabled by digital tools are crucial elements to supplement the episodic clinical data that most members of the healthcare ecosystem have if we are going to successfully move from a fee-for-service to a value-based care healthcare system. High quality, granular patient outcome data, cost accounting, and benchmarks, are the core requirements before new workflows can be used for value-based care. Key Takeaways: According to HCP-LAN, approximately 40% of Medicare fee-for-service payments, 30% of commercial payments, and 25% of Medicaid payments are in some form of value-based payment arrangement. CMS has a goal of having all Medicare fee-for-service beneficiaries in a care relationship with “accountability for quality and total cost of care” by the year 2030 According to research from Avalere, on average, physician-led ACOs produced almost 7 times the amount of Medicare savings per beneficiary than hospital-led ACO. CMS estimates that approximately 70% of Medicare beneficiaries were enrolled in either a Medicare Advantage plan or attributed to an ACO in 2020. The Problem: Value-based healthcare describes a set of solutions that have been pursued over the last few decades to improve healthcare quality, improve health outcomes, and reduce healthcare expenditure. The transition from fee-to-service to value-based care requires several factors to be considered, such as data interoperability between providers and payers, reimbursement policy that incentivizes supporting chronic and high-needs populations, and tools for provider systems to deliver healthcare at lower costs. Many early models to control costs (such as the HMO models of the 1990s) used risk-adjusted payment models to have provider systems deliver services and achieve specific clinical outcomes for their patient population at pre-negotiated or capitated costs. Capitated payments and other risk-adjusted plans allow provider systems, such as hospitals, to bear financial risk and utilize historical benchmarks to contain the cost of delivering care. Historical cost benchmarks for clinical outcomes are used to reduce cost growth and to provide forecasting for potential revenues if specific clinical and cost targets are achieved. The requirement of cost benchmarking depends on data quality of the measures used for cost accounting and the clinical measures related to health outcomes. However, with the increased use of digital healthcare tools such as virtual care and remote patient monitoring post-COVID, new entrants in virtual care can empower the transition to two-sided risk (where providers share in both savings and cost-overruns vs. a benchmark) and empower the transition to value-based care. While this will need to be accompanied by an improved level of cost-accounting for providers to track the resources needed to deliver clinical care as well as improved data collection and data analytics around clinical performance data for benchmarking and forecasting, these additional data points lay the groundwork for much more precise models of patient care. In addition, these tools will give providers and payers the data needed to deal with the administrative complexity required to financially model cost and revenues, that underlie such risk-sharing arrangements. The data quality needed to adequately price risk-adjusted models for value-based care is significant and may in fact be a barrier to entry for new entrants and incumbents who don’t embrace the level of patient tracking enabled by digital tools. Virtual care and the broad set of digital tools available to improve patient care are necessary to deliver better patient engagement and better health outcomes. For new entrants interested in direct service contracting and similar risk-sharing arrangements, these tools when used properly (i.e., with appropriate data privacy and security safeguards) may prove to be a competitive advantage. The Background: In late October The Center for Medicare and Medicaid Innovation (CMS Innovation Center or “Innovation Center”) released an updated strategic plan. Included in that strategic plan was the goal of having all Medicare fee-for-service beneficiaries in a care relationship with “accountability for quality and total cost of care” by the year 2030. While the long-term future of CMMI’s Direct Contracting model is uncertain, it does appear that it will be here to stay for the foreseeable future as Next Generation ACOs were allowed to join the second cohort of direct contracting organizations for the year beginning January 1st. Medicare’s Direct service contracting is one of the newer models that have been released in 2019 by the Center for Medicare & Medicaid Innovation (CMMI) to reduce expenditures and to improve the quality of care for Medicare beneficiaries. The Global and Professional Direct Contracting (GPDC) Model was released in April 2021, and builds on previous efforts made in value-based care from the Medicare Accountable Care Organizations (ACOs), Medicare Shared Savings Program (MSSP), and the Next Generation ACO (NGACO) model. Direct service contracting poses a unique market opportunity for new entrants in virtual care to participate in a risk-sharing arrangement with Medicare. The opportunity for direct service contracting would enable participating providers to decide whether to take on the full-risk or partial risk for the risk-sharing arrangement. The main benefit of direct service contracting is better cash flow in the risk-sharing process when compared to previous ACO arrangements. The cash flow is more flexible and allows the provider to invest in resources needed for cost-containment. When the model formally launched in April 2021, the participating 53 eligible direct contracting entities (DCEs) included VillageMD, Oak Street, and Iora. In addition to the direct contracting model, CMMI is looking at expanding and redesigning the use of other holistic care solutions such as Accountable Care Organizations (ACOs). While the success of ACO models has been mixed, CMMI continues to believe they hold promise and research indicates their potential. For example, according to the American Journal of Managed Care, from 2010-2015, ACOs were led by hospitals and health systems, whereas now since 2015, ACOs are increasingly led by physician groups. In 2018, ACOs led by physician groups represented 45%, hospital-led represented 25%, and joint-led ACOs represented 30% of all ACOs. This shift to an increase in physician group-led ACOs indicates a market pressure that corresponds with a need for primary care physicians to play a larger role in cost containment of healthcare expenditures. According to research, physician-led ACOs are better, compared to hospital-led ACOs, at achieving savings and improving quality scores despite having less access to financial resources, less experience managing risk, and less advanced technology systems. According to research from Avalere, on average, physician-led ACOs produced almost 7 times the amount of Medicare savings per beneficiary than hospital-led ACO. Implications: Digital health solutions will play a vital role in transitioning to a value-based care model, by providing better data and analytics for cost-containment, managing patient risk, reducing variation in clinical workflows, and improving patient outcomes at a lower cost. These digital care tools are broadly defined encompasses tools related to telehealth, remote patient monitoring, patient engagement, and software that supports continuity of care for the patient experience. Direct service contracts, accountable care organizations, and other similar risk-sharing arrangements from the CMMI create a market opportunity for new products and services to enable existing ACOs and providers to bear more risk through virtual care. These models create an opportunity for new entrants by increasing the flexibility of the benefits design and patient care initiatives that can be offered, such as telehealth, and by expanding the range of organizations that can participate. With CMS estimating that approximately 70% of Medicare beneficiaries were enrolled in either a Medicare Advantage plan at attributed to an ACO in 2020 and a goal of having all Medicare fee-for-service beneficiaries in a care relationship with “accountability for quality and total cost of care” by the year 2030 the detail and depth of patient data underlying patient care will be increasingly important. In addition, organizations that are able to master the collection, refinement, and correlation of patient data with best practices and outcomes as well as those that help empower the standardization, interoperability, and transfer of health data will create sustainable competitive advantage going forward. Related Reading: Innovation Center Strategy Refresh CMS Innovation Center at 10 Years — Progress and Lessons Learned Value-Based Care Physician-Led Accountable Care Organizations Outperform Hospital-Led Counterparts Value-Based Care Emerges as Must-Have for Investors

The Driver: Health in Her Hue (HHH) is a digital health startup company that connects black women and women of color to culturally aligned and racially sensitive healthcare providers. The platform aims to reduce racial health disparities by using technology, media, and the community to equip black women with adequate information to advocate for themselves and improve their health outcomes. In the fall, Health in Her Hue raised $1M in a pre-seed round. Investors in this round include Seae Ventures, The Genius Guild Greenhouse Fund, Unseen Capital, and Female Founders Alliance. Also included in this round are angel investors Pipeline Angels, BLXVC, and Bedua Partners. The company intends to use the funds to build its platform to help Black women and women of color easily access culturally sensitive healthcare providers, health content, and community. Key Takeaways: According to a study in the Annals of Emergency Medicine, Black patients were significantly less likely than white patients to receive analgesics for extremity fractures in the emergency room (57% vs. 74%), despite having similar self-reports of pain. One in five Black Americans prefer a provider of the same race or ethnicity A 2005 report from the National Academy of Medicine (NAM) noted that the poverty in which black people disproportionately live doesn’t account for the fact that Black people are sicker and have shorter life spans than white peers. Although Black Americans make up approximately 13% of the U.S. population only 5% of American physicians are Black. The Story: HHH co-founders CEO Ashlee Wisdom and Chief Product Officer Eddwina Bright started the company to address the impact of systemic racism on the health outcomes of black women and women of color. While working in a healthcare setting Wisdom experienced microaggressions that impacted her health adversely. She also observed the impact of social factors and disparities on the health outcome of black women and women of color. Her personal experience and research spurred the vision of creating a safe space for black women to access adequate and proper treatment by culturally competent healthcare providers. By Hearing and Understanding these women’s unique Experiences, The company hopes to foster health equity by closing the gap in health literacy and interventions while addressing racial health disparities. According to the U.S. Census and the Association of American Medical Colleges, there are about 40 million Black Americans and only about 5% of U.S. physicians are Black The ratio of Black patients to doctors is disproportionate and limits patients who would prefer treatment from a doctor of the same race or ethnicity. More than one in five Black Americans prefer a doctor of the same race or ethnicity. By providing a platform featuring over 1000 culturally sensitive healthcare providers including doctors, doulas, midwives, lactation consultants, therapists, and nutritionists, Wisdom hopes to connect black women to providers of color. Although doctors of color are not exempted from having biases, the goal of HHH is to connect patients with doctors who listen and deliver care that is culturally sensitive. Providers can sign up on the website, list their practice and patients can enter their location to find doctors nearby. HHH plans to add telehealth services to its current offerings, and develop a new platform and membership experience within the following year. This membership will offer women customized care support through tailored content, consultations, and care recommendations. While its app is still in the beta testing phase, HHH’s website offers workshops, events, and easy-to-follow courses to educate black women about their health for free. The Differentiators: According to the CDC, Black women have the highest maternal mortality rate in the U.S. While the high maternal mortality rate is attributable to several factors, a consistent concern amongst black women is that their concerns are mostly dismissed or overlooked by health providers. For example, in a report, The National Academy of Medicine stated that “racial and ethnic minorities receive lower-quality health care than white people—even when insurance status, income, age, and severity of conditions are comparable.” In addition, a December 2020 article in JAMA found that many medical programs lack cultural competency as well as diversity and inclusion training within their curriculum leaving medical professionals ill-prepared when treating patients of other ethnicities. HHH is attempting to address this issue by connecting patients with doctors who can understand and address their cultural and ethnic needs. HHH’s goal is to provide a pioneering platform that connects providers of color for black and other women of color. In helping to create a safe space where black women and women of color can access health literature, attend events discussing health, and connect with medical providers of color, HHH helps address concerns of women of color over disparate treatment. This platform contributes to the reform efforts to foster health equity in the U.S. with services that address biases both within and outside the healthcare delivery system. With its base in New York City, HHH hopes to help women from underserved minority groups and women of color take control of their own health. The Big Picture: The observed disparities and inequities at the onset of the pandemic has fueled a much-needed focus on social determinants of health; especially the role of demographic characteristics such as race. As noted in the National Academy of Medicine’s 2002 report “Racism and Health Inequity Among Americans”, the inequities that worsen minorities' health conditions are “the result of a combination of social factors that influence financial access and receipt of appropriate care.” HHH’s platform could further open up the discourse on the healthcare of minorities, especially women of color in America. HHH’s provision of culturally competent information and treatment could also reduce instances of poor health outcomes and avoidable deaths caused by wrong diagnoses or poor health-seeking behavior caused by fear of discrimination. As described by Keisha Ray, an assistant professor at the McGovern Center for Humanities and Ethics in Texas, “When we look at patient testimonies, particularly from Black women ... we’re seeing that they are hypersexualized and that if they have some sort of illness or pain, that it's presumed to be likely self-inflicted in a sense that they did something wrong.” Furthermore, improved access to culturally competent information could also equip women of color to be better advocates of their health and help them in making more informed health or healthcare decisions. Health in Her Hue is a welcome development for addressing poor health outcomes attributable to implicit bias and prejudices in healthcare delivery. References: Health In Her You; Health in Her Hue- Improving Healthcare for Black Women; New health app offers resources, information for women of color

Our Take: Digital health solutions like remote patient monitoring devices are developing broad-based solutions for maternal-child health disparities by addressing both social determinants of health and clinical gaps. Close monitoring after delivery is life-saving for mothers because almost 50% of maternal morbidity and death happens after delivery. In addition, following the pandemic, healthcare providers have adopted remote patient monitoring devices for prenatal and postpartum care as a necessary precaution for keeping pregnant mothers and newborns away from exposure to illness and preventing the spread of the COVID virus. Key Takeaways: Preterm birth and its complications are the second largest contributor to infant death in the U.S. and preterm birth rates have been increasing for five years. According to the March of Dimes 2020 Report, 7M women of childbearing age live in maternity care deserts and 50% of U.S. counties lack a single obstetrician. Medicaid covers 42% of all births and is the largest payer for maternity care in the US. Association of Maternal and Child Health Programs was awarded $4 million to promote telehealth services, remote pregnancy monitoring, and delivering trauma-informed perinatal and behavioral health care. The Problem: The United States has the worst maternal mortality rate of any developed country especially when one considers the amount the U.S. spends on per capita care. About 900 women die each year during pregnancy or delivery, or within a year of delivery-related causes, and the preterm birth rate among Black women is 50% higher than the rate among all other women. According to the Commonwealth Fund, the maternal death ratio for Black women (37.1 per 100,000 pregnancies) is 2.5 times the ratio for white women (14.7) and three times the ratio for Hispanic women (11.8). In addition, mothers in rural communities equally have challenges in accessing quality maternal healthcare services due to hospital closures, workforce shortages, and social determinants of health gaps. Certain counties are referred to as maternity care deserts because maternity healthcare services are either limited or absent. According to the March of Dimes 2020 Report, 7 million women of childbearing age live in so-called “maternity care deserts” (defined as communities where access to maternity health care services is limited or absent). A number of factors all contribute to the divide in maternal health, these include racial distrust of the healthcare system and healthcare information, poor access to healthcare information, a shortage of healthcare providers for maternal and child care, particularly those with similar racial and ethnic backgrounds. For example, according to Healthcare IT News, over one-third of women reported that they don't make it to all of their prenatal visits and about 50% of U.S. counties lack a single obstetrician or gynecologist. This is of particular concern given the American College of Obstetrics and Gynecologists (ACOG) recommends an average of 12-14 prenatal care appointments, and that is for women with low-risk pregnancies. Moreover, women in underserved communities often have to make tradeoffs such as unpaid time away from work, caring for loved ones, or lack of transportation, all of which increase the cost and inconvenience of being able to make an appointment. The inability to keep scheduled appointments could lead to complications and possibly easily preventable deaths. In addition, Medicaid is the largest payer for maternity care in the United States and as a result a key player in ensuring quality maternal and perinatal healthcare coverage. Medicaid and its reimbursement policies have a significant impact on current maternal care protocols as well as enhancing maternal and perinatal health outcomes. Not surprisingly, as the public health program for people with low incomes, women in Medicaid, are reported to have a higher rate of births reported as low birth weight compared to women that are privately insured. While remote patient monitoring and other digital tools hold great potential in improving access to coverage and care they have not been broadly adopted. For example, prior to the pandemic, only 21 States permitted Medicaid reimbursement for remote patient monitoring, and since the onset of the pandemic, only 8 more states have included reimbursement for remote patient monitoring in their Medicaid programs. ​​The Backdrop: Digital health solutions for maternal and child care whose adoption was spurred on by COVID have improved access to timely care for mothers in diverse communities by allowing healthcare providers to meet mothers where they are. Since COVID would expose mothers to potential disease it made it difficult for pregnant mothers to comply with appointments and needed care. This lead to a significant increase in telehealth and remote patient monitoring for delivering maternal and child care. According to BMC Pregnancy and Childbirth, 36% of women reported using telemedicine for prenatal appointments during the pandemic, and 71% of new and expectant mothers reported being worried about exposure to COVID from in-person prenatal visits. Remote patient monitoring is likely to remain a significant factor in prenatal and maternal care following the pandemic. For example, in May 2020 the U.S. Department of Health and Human Services awarded $4 million to the Association of Maternal and Child Health Programs especially to promote telehealth services, remote pregnancy monitoring, and delivering trauma-informed perinatal and behavioral health care. In addition, in November 2020 The Connected Maternal Online Mothering Services (MOM) Act was introduced in the U.S. Senate to establish Medicare and Medicaid coverage for telehealth programs that monitor the health of expectant mothers (the bill has not yet passed). Implications: Remote patient monitoring as a healthcare delivery method has tremendous potential to be beneficial to providers, patients, and healthcare systems. Among other things, it could improve access to care, help generate additional data, improve patient, provider communication, reduce cost, and empower patients' in the management of their own care. Health information generated from using remote patient monitoring devices may help reduce pregnancy-related deaths by improving prenatal care and addressing some of the causes of maternal mortality. Preeclampsia and eclampsia, which is the most common cause of maternal mortality, have been successfully prevented by using the records from remote monitoring devices for postpartum hypertension surveillance. A 2019 study evaluating postpartum text-based remote blood pressure monitoring found that texting was a potentially innovative way of reducing disparities in accessing postpartum care. Premature babies and babies that have a low Apgar test score (typically performed on a baby at 1 and 5 minutes after birth and indicates how well the baby tolerated the birthing process (the 1-minute test) and how well the baby is doing outside the mother's womb (the 5-minute test) may indicate that the babies require around the clock care. Some studies have shown that these babies can benefit from remote patient monitoring devices that allow health providers to monitor them from the comfort of their homes. At the UVA Children's Hospital, they found that babies did much better in the home environment. Thus, after consultation with the doctor, babies were monitored from home with an iPad, NG tube, a scale, and other devices, and the data collected was stored in the UVA’s Epic EHR. By generating digital touchpoints remote patient monitoring facilitates a quicker transition of care outside the hospital in addition to reducing the number of in-person maternal care visits. For example, Babyscripts is one of a number of virtual maternal care platforms that combine a mobile app and remote patient monitoring devices to create solutions to address both user and provider gaps. Its remote patient monitoring device has helped reduce prenatal in-person visits schedules and generated digital touchpoints in real-time that generated more data than is usually captured in the hospital. When the data points are unusual the trigger system alerts the provider to respond in a timely manner or alter care plans as needed to avert avoidable complications. Babyscripts services also extend to providers of prenatal or postpartum care to support care coordination and reimbursement. This exemplifies the rounded approach of digital health solutions with remote patient monitoring components and its impact on improving healthcare efficiency care. Furthermore, it enables shorter in-patient stays and avoidable emergency department (ED) utilization which reduces the cost of inpatient services. Remote patient monitoring has the potential to address health disparities and barriers to care by ensuring that women in underserved communities get access to routine check-ups and prenatal visits thereby improving quality and outcomes. The sustainability of remote patient monitoring for maternal and prenatal care will depend to a large extent on the continuity of policies adopted during the public health emergency which increased use and the amount of reimbursement for remote care. Should these be adopted we believe they will show a substantial return on investment as well as declines in maternal and infant mortality. Related Readings: Telemedicine for Prenatal Care: A Systematic Review Telehealth Offers Relief for Prenatal Care and Newborn Health Medicaid Coverage of Pregnancy Care Delivered via Telehealth Maternal Telehealth Has Expanded Dramatically During the COVID-19 Pandemic Improving Perinatal Care in the Rural Regions Worldwide by Wireless Enabled Antepartum Fetal Monitoring: A Demonstration Project