Search

The Driver: League recently raised $95 million in a series C funding round led by TDM Growth Partners with participation from Workday Ventures and other unnamed existing investors to scale its consumer-centric healthcare navigation platform. Founded in 2014, League is a medical platform technology company powering next-generation healthcare consumer experiences which has now raised a total of $205M. Through League’s platform, companies ranging from health insurance to medical organizations can create digital patient experiences. These experiences would let patients access telemedicine, personal medical records, and other services. The platform is HIPAA compliant, making it viable for medical use. According to the company, which is based in Toronto and has a presence in Chicago, the new capital will be used to scale the platform. Key Takeaways: Payers, providers, consumer health partners, and employers build on League’s platform to deliver high-engagement, personalized healthcare experiences for consumers League claims its integrated platform creates engagement loops and drives habitual behaviors with customers, resulting in a 12x industry engagement rate and over an 80%-member enrollment rate The digital transformation of the healthcare consumer experience will benefit employers by helping to ensure employees quickly get the services and support that they need. The creation of a single comprehensive, personalized health platform has the potential to result in a much smoother experience for patients hopefully promoting better engagement, improved preventative care to a reduction in costs The Story: League was founded by successful startup founder and investor, Michael Serbinis, who was most recently the CEO of digital reading company Kobo, which was sold to Rakuten. According to an interview in TechCrunch the genesis of League followed a discussion with pharmaceutical entrepreneur and billionaire, Patrick Soon-Shiong, the inventor of Abraxane. In the interview, Serbinis noted that Soon-Shiong “told him that the healthcare system needed to be fixed by someone outside of the industry who was able to take a fresh, consumer-driven approach”. Serbinis added that “most people think about healthcare through the lens of health insurance, i.e., can I do it, can I afford it...the more I learned the more I realized how broken [the system] is.” League’s platform acts as a centralized operating system for employee health benefits. League uses Google Cloud’s healthcare application programming interface to connect a patient’s health information from electronic health records, claims, and wearable devices for an all-in-one consumer healthcare platform. For Payers, League’s digital infrastructure creates an experience that improves engagement by giving members a front door to their programs and services while for Providers, it offers patients the digital experience they’ve come to expect in their everyday lives: easy, seamless, and tailored to their needs. The Differentiators: According to the company, League’s platform harnesses data from electronic health records (EHRs), claims, health and wellness devices, and third-party partners to deliver deeply personalized digital health experiences and create a cohesive, omnichannel experience for the consumer. As noted by Deloitte (and reproduced on the company’s website), “League leverages contemporary technology architectures that support rapid integration, API connectivity and interoperability across different digital point solutions.” League uses FHIR (Fast Healthcare Interoperability Resources) as the data model to support the integration of healthcare data on their platform and to model data that is generated by members as they interact with the platform as it seeks to build an integrated solution for customers and consumers and move them away from point solutions. For example, as patients complete health assessments and pulse checks within their product, their responses are directly mapped to the QuestionnaireResponse resource in FHIR. League claims its integrated platform creates engagement loops and drives habitual behaviors with customers, resulting in a 12x industry engagement rate and over an 80%-member enrollment rate. League notes that it is regularly audited to make sure it complies with security, availability, and confidentiality requirements for managing patient data. League is available to both providers and payers. While there are similar companies proactively venturing into the digitized market for healthcare, League stands firm on its belief that its engagement-focused and consumer-centric platform may be unique in its attempt to close the gaps in care and drive better outcomes all while lowering employee health costs. The Big Picture: League is seeking to move employee benefits from a series of point solutions to an integrated, easy to use, and navigate platform. As noted on their website, employee “benefits are a fragmented ecosystem of expensive point solutions that are difficult for HR leaders to manage, and close to impossible for employees to navigate.” For example, a recent article in the Wall Street Journal noted that the average employee benefits package has anywhere from 16–20-point solution apps that employees must navigate, adding to the complexity of the benefits experience and decreasing engagement. Through League’s platform, companies ranging from health insurers to consumer health companies can create seamless digital patient experiences on a single platform with a single interface. In the words of League CEO Serbinis, “League’s PaaS offering is positioned as the de facto digital infrastructure to build comprehensive healthcare consumer experiences. Providers, payers, consumer health partners, and employers use League’s platform to build unique and differentiated applications that transform healthcare from a patchwork of disparate point solutions to a cohesive experience that just works”. As the digital tools become more prevalent in healthcare and consumers take a more active role in managing their own health, employers will have to ensure that their benefits keep pace with changes in work habits (especially the move to remote work) and desires for greater convenience and navigation. Integrating new tools and technology will play a crucial role as employee benefits programs evolve to meet the needs of workers, many of whom may not actually work in the same physical office or space. League gets $95M for 'digital front door' consumer-centric healthcare platform; League raises $95M in its bid to rule the world of healthcare platforms

Our Take: The striking growth in demand and acceptance for digital health technology presents a way to improve the access and quality of care for the uninsured by further expanding Medicaid with lower administrative costs or expenses. Accumulating data suggests that nationwide Medicaid expansion as part of the ACA would benefit non-expansion states and their patients at lower costs than many opponents have argued. In addition, the increased adoption of healthtech has provided or strengthened the number and types of tools that Medicaid officials have at their disposal to help increase enrollment. Key Takeaways: An estimated 4.1 million individuals would gain health insurance coverage if all states adopt Medicaid expansion, according to the Urban Institute. A recent article in the Archives of Public Health found that digital nudging, similar to that used by employer benefit plans, increased Medicaid enrollment by anywhere from 10%-23%. One study in JAMA found that Medicaid expansion can have a hidden economic stimulus effect with every $100,000 of additional federal Medicaid spending creating employment for 2 workers per year. According to the Journal of Economics, there was a reduction in collection balances of approximately $1,140 for those who gain Medicaid coverage due to the ACA The Problem: According to The Commonwealth Fund Biennial Health Insurance Survey, approximately 12.5% of the U.S. population was uninsured and an additional 21.3% of the U.S. population was underinsured (please see the backdrop for how underinsured is defined). Early on in the pandemic, millions lost their jobs, and consequently, their employer-provided health insurance or their ability to afford other subsidized coverage. While many in this situation who lived in certain states became eligible for Medicaid under their state’s Medicaid expansion, many did not, why? A total of thirty-nine states have adopted Medicaid expansion that became available as part of The Affordable Care Act, however, twelve states including Texas, Florida, Wisconsin, Georgia, and Mississippi decided not to expand their Medicaid programs. As a result, approximately 4.1 million individuals currently lack coverage that they would be able to obtain if all states adopted Medicaid expansion, according to the Urban Institute. In addition, as more data has become available to assess Medicaid expansion, studies have indicated that it both improves outcomes and saves costs where it has been passed. In addition, a number of studies have indicated that digital tools can be used to effectively and efficiently increase enrollment, helping to improve the cost outcomes. For example, according to an article entitled, “Health-Related Outcomes among the Poor: Medicaid Expansion vs. Non-Expansion States”, low-income populations in Medicaid non-expansions states had worse access to care, less preventative care utilization, less medical expenditures, and more out-of-pocket costs compared to those in expanding states. In addition, states like Missouri have employed integrated, online decision support systems to “help individuals purchase private insurance in the marketplace by simplifying information and graphics, developed interactive activities to assess understanding of health insurance, and provided [an] individualized report to ease the selection of a plan that met their financial and healthcare needs” In terms of costs, not only are patients in non-expanding states suffering from the lack of coverage, hospital and state budgets are being strained by costs (which are written off as “uncompensated care” by providers. For example, an article in the Journal of Economics noted that there was a reduction in collection balances of approximately $1140 among those who gain Medicaid coverage due to the ACA”. Correspondingly a JAMA insight article found that “there are spillover benefits for economic well-being” from Medicaid expansion and “for every $100,000 of additional federal Medicaid spending, 2 workers gained a year of employment.” The Backdrop: In 2010 approximately 18% of the U.S. population was uninsured and a large portion was underinsured, leading to the passage of the Affordable Care Act. Underinsurance often impacted the so-called working poor, who often made too much to qualify for Medicaid but too little to be able to pay for health insurance. Many of these were often referred to as underinsured (where their out-of-pocket costs equal 10 percent or more of household income or 5% or more of household income less than 200% of the Federal poverty level ($52,400 for a family of four) not including what they paid in premiums or deductibles. As a result, one key element of the initial design of the Affordable Care Act (ACA) was to effectively require states to increase Medicaid coverage to all U.S. residents with family income at or below 138% of the federal poverty level via the expansion of Medicaid eligibility limits. Following challenges to a significant portion of the law and a variety of lower court rulings, in 2012, the Supreme court ruled that states could not be compelled to expand Medicaid and that Medicaid expansion under the ACA must be voluntary. The Court ruled that it was within states’ rights to decline to participate in the expansion. There were a number of other aspects of the ACA that have been subject to legal challenges but the law remained largely intact. As a result, the ACA includes the private insurance expansion (in part by eliminating pre-existing condition clauses), allows for income-based tax credits for those eligible, depending on federal poverty level, and provides subsidized premiums for the purchase of insurance on state exchanges. Additionally, the dependent provision of the ACA allows children to remain on their parents’ insurance coverage until age 26. While there are multiple parts of the ACA that have contributed to the increase in access to health insurance coverage, expansion of Medicaid led to significantly increased health coverage and reduced racial and ethnic disparities in coverage and access to care for low-income individuals. Implications: Healthcare has increasingly been shown to be an essential good at an individual, local, and federal level. As the COVID-19 pandemic has made clear, individual choices can have broad impacts on the health of their local communities, which in turn can have dramatic effects on the broader economy. Increased healthcare coverage within societies has clear positive impacts on the quality, equity, and efficacy of care and subsequent health outcomes. Accumulating studies show improved access to medical care translates to better health and lower mortality, a benefit for both patients and hospitals alike. Moreover, given the striking increase in the use of telehealth and other healthtech tools during COVID, facilitating more effective and efficient Medicaid expansion goes hand-in-hand with digital health adoption. While efforts to bridge the digital divide and broadband access will have to continue full force, many lower income patients (those who would benefit most from Medicaid expansion) have been shown to embrace digital health tools. For example, two studies cited in a recent Archives of Public Health article found that nudging, similar to that used by employer benefit plans, increased Medicaid enrollment by anywhere from 10-23%. These types of digital nudges can be a very inexpensive and convenient method of outreach for Medicaid plans looking to increase enrollment, “with relatively little expense or administrative burden.” Moreover, with many potential Medicaid beneficiaries likely to be among the working poor who may have difficulty accessing transportation to clinicians or to be unable to take time off work to see providers they are more likely to attempt to avail themselves of technological tools should they be available. However, these tools should not require substantial investment or design by Medicaid authorities, as noted in one study, “simply improving the design and implementation of standard outreach efforts produced durable increases in enrollment that were sometimes even larger than the increases from these more-intensive interventions.” Related Reading: The Benefits of Medicaid Expansion The Far-Reaching Benefits of the Affordable Care Act’s Medicaid Expansion Health insurance enrollment strategies during the Affordable Care Act (ACA): a scoping review on what worked and for whom The Impact of Medicaid Expansion on States’ Budgets Health-Related Outcomes among the Poor: Medicaid Expansion vs. Non-Expansion States

The Driver: Koneksa Health recently raised $45 million series C funding bringing their total capital raised to $70.6M. As noted by the company, Koneksa Health is a healthcare data analytics company that develops end-to-end solutions for remotely collected clinical data to help produce more meaningful data in clinical research by collecting it in real-world settings. Koneksa is founded by Chris Benko, the former VP of Strategic Planning at Merck. The fundraising round was led by AyurMaya with participation from Takeda Ventures, Velocity Capital, McKesson Ventures, Merck Global Health Innovation Fund, Novartis (dRx Capital) Spring Mountain Capital, and Waterline Ventures. The funds will be used to collect more data to support their digital biomarker pipeline (ex: to validate the assessments that the app offers) and to develop a “self-service” platform to allow new users to combine data from different sources into one stored dashboard. Key Takeaways: In one study, Koneksa was able to reduce the number of patients for biomarker validation by 82% Studies show approximately half of clinical study participants drop out of trials before study completion and only 5% of patients participate in clinical trials Koneksa is working to show in-home patient data can provide clinical insight, demonstrating in one study that for every 1,000 steps walked, there was a 26% reduction in hospitalization risk faced by the patients. Koneksa Health has worked with clinical trials at 700 sites. The Story: Chris Benko was responsible for incubating Koneksa Health as part of the Merck Global Health Innovation Fund which he ran, It was his desire to help capture health-related data that can be used to find novel treatments for diseases ranging from neurological diseases to respiratory conditions. He founded Koneksa to develop healthcare software to record patient-generated health data using digital biomarkers, which Rock Health defines as “consumer-generated physiological and behavioral measures collected through connected digital tools.” As Benko noted when the company did its series B fundraising, “digital biomarkers have as much potential to transform the development of new medicines as the molecular, imaging, and fluid biomarkers of the last two decades.” With the use of the Koneksa app, information can be recorded from anywhere, even the patients’ home. The company partners with biotech and pharmaceutical companies to develop biomarkers that can be used clinically to treat patients with different diseases. At the moment, the majority of company capital comes from investors like the ones mentioned earlier. The Differentiators: Koneksa’s software gathers a variety of data through questionnaires about mood, daily activities, symptoms, and combines it with clinical evaluation like movement tests. The end goal is to develop a drug or treatment for several different kinds of health conditions. While Koneksa’s competitors like Songe use tools like vocal screening for spirometry and mental illness analysis, as noted in Tech Crunch, Koneksa is working to turn analog testing scales into digital ones. For example, as noted in Tech Crunch, when testing for Parkinson’s Disease in order to quantify a tremor, “a physician might ask a patient to stretch out an arm and flip their palm upwards and downwards as fast as they can” and watch for subtle changes in speed or shape of that movement. By contrast, “Koneksa’s approach, asks that the patient hold their phone, and perform the same motion using the phone’s accelerometer and gyroscope, record those changes and transmit data to the company’s platform”, which can then be evaluated and “scored” against others by Koneksa’s algorithm. In addition, Koneksa is also focusing on how digital biomarkers can be used to increase the amount of real-world data collected in the trial process and then using this data to help get products to market more rapidly. For example, in a study of asthma patients, Koneksa was able to demonstrate that data collected from at-home devices were comparable to clinical devices but also enabled more frequent data collection requiring fewer participants to collect the required data. That not only makes it cheaper for trial sponsors but more convenient for patients. The Big Picture: Digital biomarkers have significant potential to increase the quality and frequency of data collection for drug discovery going forward, As a result, data collection for many types of trials can go from collecting infrequent, discrete data sets to essentially continuous data sets, empowering improved data quality and even predictive analytics. There is also a positive outlook on user friendliness among patients. In addition, this type of platform may create entirely new sets of valuable health data to help speed the regulatory approval process and boost the efficiency of clinical trials. The more usage this technology gets, the more effective it should be in further research. The application of such real-world devices will also make it easier and more convenient for many groups who were not able to access the current clinical trial system to become more involved and hopefully better represented. However, challenges may arise with such platforms for those who are frail or elderly and may not be technologically literate or for those who may lack access to broadband. While near-term these issues may be addressed by devices that can store and forward the data, over time a more permanent solution will need to be developed. Koneksa’s $45 million round could help make at-home clinical trials a reality, Digital biomarker startup Koneksa scores $45M in Series C funding

Our Take: We need to broaden the use of culturally appropriate tools, expand the use of digital tools as a source of vaccine knowledge and increase representation through broader use of digital clinical trials to improve vaccine acceptance as we move from Pandemic to endemic. While the initial COVID vaccines were developed in under a year, vaccines were not widely accepted for a number of reasons including (but not limited to) the politically infused tradeoffs between personal liberty and public health, confusing communication by public health around various mandates, historic distrust of the healthcare establishment, particularly in communities of color around the safety and efficacy of the vaccine. However, as we move forward we need to do a better job of actively taking into account the social perspectives and cultural backgrounds of underserved communities by utilizing stronger grassroots listening and education campaigns (in the place of mildly informative and effective PSAs). Embracing and changing reimbursement that allows clinicians to do a better job of 1:1 education and care for the disaffected, such as proactive telehealth extension, broader education, and recruitment through digital trials, and leveraging virtual prenatal care would help increase vaccine adoption as we move from pandemic to endemic over time. The Problem: While the first two COVID vaccines to earn emergency use authorization (EUA) in the U.S. were developed in under a year, the approval process itself was shrouded in the fog of politics and then held up as a litmus test of loyalty to political philosophy (and some would argue a political party). For example, there was tremendous pressure on the FDA to grant approval and speed up the pace of its review. In addition, once the vaccines were granted emergency authorization, distribution was plagued by delays and there were initial reports of initial adverse reactions to the shots increasing a sense of apprehension. As a result, there was clear public confusion. Public health authorities appeared to lack the ability to craft a coherent and consistent message as information was imperfect and in a flexible situation. While this persisted, the Biden Administration instituted various government mandates to increase vaccine adoption which simply fanned the flames of the philosophical debate. All the while, efforts to educate the underserved around the factors that contributed to the rapid development of the vaccine were lacking. In addition, challenges surrounding the resistance to the vaccine among many in underserved communities who were healthcare workers, teachers and, students (and thus subject to the mandates) appeared to have been shoved to the side thus creating a backlash. In addition to the mandates, public health officials also enacted incentives to increase vaccination rates which included such things as prepaid debit cards or gift cards to local attractions or establishments. Although these have been successful, they did create a sense of inequality for those who felt like they were doing their civic duty by getting their shots with nothing in it for them. As we move forward, strict regulation on compliance will be an active means of protecting oneself and others by preventing the spread of the virus and it appears there will have to be some consequences for those who choose not to get vaccinated (many European countries have successfully enforced mandates and brought about strong vaccine adherence). However, with the shortage of healthcare workers and with variants like Omicron being highly contagious some sort of COVID vaccine is likely to be with us for some time. ​​ The Background: Assessing a new health threat while keeping the public calm is an arduous and delicate task in and of itself, especially in the digital age where conspiracy theories and fake news are ever present. During this pandemic, poor communication and constant changes in rules and regulations are the main culprits. The Centers for Disease Control and Prevention (CDC) has been highly criticized for failing to be more proactive in its actions against COVID and create a more coherent and consistent plan for protecting the public. During the early phases of the Pandemic, the public received conflicting perspectives and uncoordinated government communications from both state and federal leaders. Many have argued that the CDC is not designed for this role and was poorly equipped to take it on once COVID hit. They have called for the creation of a new public health authority to be responsible for monitoring and alerting the public to risks such as COVID. This is particularly true as the access to and understanding of public health terminology and assessing personal risk is not easily definable for the general population. For example, according to an article entitled “An Analysis of Government Communication in the United States During Covid-19 Pandemic: Recommendations for Effective Government Health Risk Communication”, “conflicts within governmental agencies are key factors that often trigger social disorder, and in the United States, [these] sparked increased societal hostilities between public sectors with different political orientations…[leading to] negative health outcomes (illness, suffering, and deaths) during the COVID‐19 crisis situation.” This was further complicated by a lack of real-time, coordinated public health systems that could help collect and disseminate relevant data. As noted earlier, there is significant distrust in underserved communities based on some historical precedents. This stems from the lack of trust in governing officials, discomfort related to the lack of diversity in clinical trials, and fears of hidden agendas. According to, “The views of ethnic minority and vulnerable communities towards participation in COVID-19 vaccine trials”, “Ethnic minority communities have 10–50% higher mortality risk compared with those of white ethnicity in the UK and USA”, yet were dramatically underrepresented in the vaccine trials as a percentage of total participants. In addition, often accompanying or compounding this vaccine hesitancy in communities of color many women of childbearing age had specific concerns around preterm birth and potential birth defects that were difficult to address early on due to the risk of running trials on pregnant women. However, once the initial safety of the vaccine was established these trials could be run to address these issues. For example, a study in the CDC’s Morbidity and Mortality Weekly Report (MMWR) “found no significant risk or association for preterm births, infants that were born small for their gestational age (SGA), or for those that received a COVID-19 vaccine dose(s) in comparison to unvaccinated pregnant women,” yet many would argue the CDC has not done a good job publicizing this information in terms that are accessible to many and significant misinformation still exists. Nevertheless, many are optimistic about recent developments and the potential for an annual single-dose COVID vaccine that would be effective against a range of variants. However, even with a so-called “single-jab” vaccine, there are likely to be many who will refuse to get even one dose of the vaccine because they question its efficacy. As a result, we have to look at new and alternative vehicles to get the message out and that more effectively combat vaccine hesitancy and misinformation. Implications: To achieve improved compliance with COVID 19 vaccination, policymakers need to take social, cultural, and political perspectives into account in order to better understand and acknowledge the fears of the vaccine hesitant. While significant resources have been poured into rebutting the fears of those anxious about getting the vaccine (and even those opposed to getting the vaccine at all) we need to do a better job of listening and acknowledging those concerns. This is where digital apps and tools which provide culturally appropriate care may play a pivotal role as these solutions cater to minority groups who may be unable to comprehend information due to a language or cultural barrier. Culturally appropriate education, support, and resources on the COVID vaccine, its benefits (and risks) should be addressed and accessible to everyone, especially underserved communities. Interventions such as these that engage with communities in a meaningful way play a key role in not only educating but in helping communities feel heard as their doubts are answered and not simply downplayed. This is where telehealth and other digital tools could play a significant role. With the dramatic increase in telehealth during the Pandemic, communicating with your doctor, typically a family’s most trusted health advisor, became significantly easier and more convenient. Yet a study by the New York University School of Global Public Health found just over ⅓ got their information about the Pandemic from doctors or medical authorities while an almost equivalent amount (29%) got their information from traditional media channels (13.6%), new media (9.8%) and (5.8%) from family, friends, or colleagues. The study noted, “In contrast, those with the lowest level of COVID knowledge preferred informal sources like social media or family and friends.” It is clear that we need to empower and reimburse clinicians to address these issues. At the very least, personal physicians are in a position to address vaccine hesitancy in the context of a patient’s personal history and are in a good position to counter any vaccine misinformation. In addition to a more proactive use of virtual care tools, actively recruiting more participants from underserved communities and enabling more convenient participation in clinical trials by using digital clinical trials would combat myths about side effects and increase the credibility of vaccines. Seeing more information about participation (and possibly even knowing a trial participant) by people who are more representative of the underserved will provide reassurance that getting vaccinated will be beneficial for the average person’s health. Moreover, successful clinical trials with significant BIPOC panel participation can demonstrate that the vaccine is not dangerous and in fact, is effective at preventing patients from contracting or suffering serious illnesses from COVID. This would give the vaccine credibility and help dispel many of the myths and misinformation currently out there. More than anything we need a transparent and thorough breakdown of vaccine-related information and clinical procedures so we can increase vaccine participation as we move from pandemic to endemic. Related Readings: No Jab, No Job? Ethical Issues in Mandatory COVID-19 Vaccination of Healthcare Personnel An Analysis of Government Communication in the United States During the COVID‐19 Pandemic: Recommendations for Effective Government Health Risk Communication The views of ethnic minority and vulnerable communities towards participation in COVID-19 vaccine trials Digital health tools can help with COVID-19 vaccine hesitancy Impact of COVID-19-related knowledge on protective behaviors: The moderating role of primary sources of information

The Driver: Well Dot, Inc., or “Well”, is a healthtech company based in Chapel Hill, NC, and Newton, MA that is founded by Gary Loveman and Dave Werry with a mission to be the world's most effective partner in the advancement of individualized health. They recently raised 70 million in a Series B funding for their consumer-focused health improvement platform which combines leading-edge artificial intelligence, advanced behavioral economic techniques, and on-demand human guidance. The Series B funding was led by Valeas Capital Partners, a recently launched investor-operator firm led by Ed Woiteshek and Rob Little (former Hellman & Friedman colleagues) along with a new investor group of 12 unnamed prominent CEOs and senior managing partners at top-tier private equity firms. Existing investors General Catalyst and partners of Hellman & Friedman also participated in the round.Well plans to use the new money to expand its business with large employers and community health organizations, in addition to growing its direct-to-consumer offerings. Key Takeaways: Well is attempting to be a consumer health platform that proactively delivers a personalized health advancement scale. Live health experts are available for on-demand support to its members to assist in the navigation of health care services. The platform facilitates members’ engagement with personalized actions, incentives, and concierge services to improve their health, instead of using episodic interactions to intervene only when a problem arises. Well offers a wide range of services including preventative care, condition management, and mental health over members’ lifetime and members are given rewards for health milestones achieved. The Story: Gary Loveman (chairman & CEO) and Dave Werry (co-founder, President & COO) established Well Dot on January 2019 in Chapel Hill, North Carolina. According to Well, the company's AI-driven health engine analyzes each member’s health triggers and promotes personalized, achievable steps toward improved health. Gary was previously the EVP of Consumer Health Services at Aetna where he led their efforts in the areas of consumer, data, analytics, marketing, pharmacy, and clinical. Before Aetna, Gary was the long-time Chairman & CEO of Caesar’s Entertainment Company where he pioneered the customer loyalty and rewards program that adapted the use of analytics to influence consumer behavior in the hospitality industry. David was previously the VP of Transformation at Aetna where he oversaw the member-facing capabilities for the enterprise. These areas included Aetna’s digital assets, high-touch clinical services, as well as business units in healthcare payments, benefits enrollment, and population health management. Together, Well was founded to help every individual take control of their health, adding a layer of ease and empowerment to improve a system that’s badly broken while cutting healthcare costs for employers. After decades of healthcare and consumer experience, the founders built Well to deliver personalized, concierge-style health advancement to the masses. According to the company, “they are all-in to deliver for their members — and disrupt healthcare in the process”. In November 2019, the company picked Chapel Hill over Boston for its headquarters after being approved for an incentive package worth nearly $3.9 million. Well now has more than 90 employees across all of its locations and generates $6.38 million in sales. Well works like this: employers sign up to offer the app to employees, and each individual employee can choose whether to opt-in. If an employee opts in Well gets access to some of their health information and uses that to get a sense of what activities or tasks to push to the workers. Well now serves thousands of members across many corporate clients and says they will launch with additional jumbo employer customers in 2022. According to Well, the company is working directly with community health organizations and direct-to-consumer offerings in collaboration with leading consumer brands, providing more avenues for consumers to access Well's digital health platform. Well has not shared any revenue or membership numbers to date however, Werry said the company's next phase is adding more members. According to Ed Woiteshek, of lead investor Valeas Capital Partners, “Well has developed a differentiated and fundamentally unique offering that is proving successful at helping members make meaningful progress on their health and wellness goals”. The Differentiators: Well claims to stand apart amid a crowded marketplace by trying to improve a broken consumer experience for more than 100 million people. According to the company they want to be the first to offer proactive personalized healthcare and services at scale. Whether you want to start sleeping better, managing your health needs, or taking your medications, the app is intended to help users achieve their best health through reminders and rewards through their platform. In addition to the app, users have access to a team of live health guides and nurses who can assist them in reaching their goals as well as the potential to earn rewards for taking “healthy actions”. To help increase your participation in activities, Well utilizes your healthcare provider in an effort to find services and products within coverage of your plan while delivering daily health recommendations. Some competitors such as Unforged focus more on subgroups of the population such as Gen Z with mental health concerns while also charging a subscription fee service. One of Well’s goals is to demonstrate that the time and money that can be saved through the app can outweigh the cons of physically going to see a health professional for the same advice you may receive from one of the live experts or nurses. The Big Picture: Well’s platform and other inexpensive digital tools like it may be paving a new way towards assisting employees on focusing on their own wellness. As digital health has been making inroads into more traditional healthcare delivery during the pandemic, so too should it progress in the ways we address prevention and wellness. With its unique way of utilizing an AI-driven health engine which analyzes each member’s health triggers, it promotes personalized, achievable steps toward an improved health status all while being rewarded for it. Given our sedentary lifestyles, Well’s platform may be most useful to those who need that extra boost of encouragement or those who are confused on how to start on their journey to a healthier lifestyle. In addition, Well’s solution could be helpful for those who could use a little nurturing in making the best choices for themselves. Research has shown that such nudges by employers tend to work. For example, according to an article in Corporate Wellness magazine, “nudging creates a default for people by playing on their subconscious system by winnowing down or outright eliminating options, which in turn, prompts healthier behavior.” In addition to helping employees lead physically healthier lives, services like Well can help with employees mental health. As corporations look to reduce burnout Well is taking the initiative to create sustainable health habits among employees for better health outcomes and lower costs for self-insured employers. Today, about 1,200 people use the Well app which will allow them to drive their own health decisions. Health Improvement Platform Company Well Raises $70 Million

Our Take: Leveraging virtual care is one way to deal with a number of the issues that healthcare’s workforce shortages have brought to light due to the Pandemic. Following huge spikes in demand in almost every part of the country as it deals with COVID, the industry had had to deal with countless labor issues and shortages due to burnout and the overwhelming physical and mental demands placed on caregivers. While healthcare workers are experiencing elevated levels of stress, patients may also experience a different type of stress when it comes to patient quality and overall care. It is important to understand the dynamics of the overlapping crisis we currently face as healthcare professionals quit and the barriers hospitals and Healthcare systems face to catch up. As an alternative, many providers have opted to provide virtual care albeit the future of telehealth is unpredictable. However, the flexibility and convenience that virtual care provides for both the patient and the provider may be here to stay. Key Takeaways: According to the Association of American Medical Colleges (AAMC), physician shortage in the United States is anywhere from 40,800 to 104,900 physicians by 2030 A study conducted by Wheel found that clinician burnout impacts 80% of patients and 1 in 3 patients believe burnout impacts their quality of care Providers have delved into the virtual care world since the pandemic in order to allow for a more flexible and accessible environment for patients If high-value providers no longer pursue in-person care and decide to go on the route of virtual care, patients may follow (where in-person care can be supplanted) to maintain their provider relationship The Problem: The challenges of the pandemic have exacerbated and crystalized labor challenges and the preexisting labor shortages that existed in healthcare prior to the Pandemic. The relatively non-stop confrontation with the Virus and its variants has forced clinicians to work long hours donning layers of PPE often short-staffed due to illness caused by COVID itself as well as employees who refused to comply with vaccine mandates. Consequently, the stresses on clinicians such as the increased administrative burden and inability to focus on patient care have reached a breaking point. For example, issues such as the decline in the supply of nurses and doctors reflecting the retiring of practitioners from the Baby Boomer generation as well as others in the demographics requiring more care left a significant supply-demand imbalance. While demand is high many providers cite insufficient staffing models, insufficient benefits/raises, and lack of flexibility as main concerns along with burnout and the inability to de-stress. This in turn has pushed providers to take a stand as they will no longer tolerate the reduction in their overall quality of life and have chosen to leave the profession or set up virtual practices. In light of the heightened demand during COVID, issues around the healthcare labor shortages have garnered nationwide attention. For example, during the so-called “Great Resignation,” where large numbers of working-age people have simply dropped out of the labor force, approximately half a million healthcare workers have quit since February 2020 according to a recent article in Forbes. Understandably the stress of dealing with a continuous over two-plus years has taken a great toll on clinicians' emotional, and physical health leading to burnout. For many, this has left them with two options–either to step away or go digital. Many have chosen to go digital and work in telehealth or start their own virtual practics which provide flexibility and a work/life balance that many so desperately desire. The Backdrop: Healthcare is a service industry that depends on the dedication and manpower of the individual clinicians and support staff responsible for maintaining the facilities, diagnosing their illnesses, and treating them to care for the lives of patients. A key element in this equation is the hiring and support systems that go into creating a physically and emotionally safe environment for clinicians to operate in where they feel their concerns can be heard and addressed. If not, the burnout and stress associated with working long hours under severe emotional stress, such as those experienced during COVID, can negatively impact the quality of patient care. For example, while the medical profession has long been sought after for its high wages it had also enjoyed significant professional prestige which helped attract a growing labor pool. That may no longer be the case. For example, according to “Amid Rampant Provider Burnout, Marketplace Platform Companies Focus on Clinician Experience” a survey conducted by Wheel, approximately forty percent of respondents would not want their children to go into the field of medicine as it is not worth their time or investment.” In many ways, this may serve as a wake-up call for administrators and public policy officials looking at the causes of the shortage of clinicians as we look for ways to improve the quality of care and lower costs for patients. In addition to the stresses noted above, many practitioners are facing a working environment that is filled with aggression and constant abuse. According to “Nursing Shortages” approximately eight to thirty-eight percent of health care workers are at accelerated risk of facing emotional and physical abuse, which some attribute to insufficient staffing ratios. Following the explosion in digital care during COVID, digital has emerged as an option for many nurses and physicians. Going virtual is a way to create work-life balance and still practice their craft, optimizing the benefits for everyone involved. Many digital and virtual-first solutions are specifically designed to address administrative inefficiencies inherent in current electronic medical record systems (EMRs) and designed to improve information flow for patients and providers. Implications: Addressing the void between provider flexibility and patient care is the future of telehealth. While there is still room for improvement in the delivery of virtual care such as patient privacy and broadband access, virtual platforms have the potential to move healthcare to a more consumer-centric omnichannel experience and address many of the issues of burnout. As noted, newer technologies are specifically designed to address many of the challenges adding to the administrative burdens that clinicians face thereby allowing them to spend more direct time on patient care. In addition, given the number and variety of digital providers, both traditional and non-traditional, doctors and nurses will choose both the type of provider and work schedule that is customized to their needs. Moreover, virtual care will facilitate the use of value-based care by allowing more effective triage of patients into the system, better tracking of care across care settings, and improved analytics (although this will be a function of data sharing and interoperability). Treating patients holistically and funneling them to the proper sites of care should help clinicians work “at the top-of-their” licenses” and focus less on certain types of routine or chronic care which can be handled by other providers in the system or even prevented by higher quality care. Also, as some of the technical hurdles to providing these care delivery mechanisms are addressed, underserved communities and seniors can be given access and training on the technologies, so that virtual care can broaden the scope of care delivery, theoretically increasing provider satisfaction. However, it is important to note that as currently configured there are limitations that come along with virtual care, such as current levels of reimbursement which if left unaddressed following the end of the PHE may discourage the use of virtual care (assuming they revert back to the lower pre-pandemic levels). There are also the issues of patient preference and accessibility and comfort with technology as mentioned, particularly within elderly and underserved communities. Of course, there will be some patients that require “hands-on” procedures or other forms of care that are acute and/or cannot be resolved through a virtual visit. Finally, digital health has the potential not just to reinvent care delivery but many of the tools that can be used or repurposed for education and training of future practitioners which could allow practitioners more options to finish their degrees and ultimately help resolve the current labor shortages. Related Readings: Using Telehealth to Deliver Affordable, High-Quality Care Amid Rampant Provider Burnout, Marketplace Platform Companies Focus On Clinician Experience US Healthcare Labor Shortages Compounded as a Result of the Pandemic Nursing Shortages Domino Effect: Wheel Survey Finds Clinician Burnout Impacts 80 Percent of Patients

The Driver: Casana recently raised $30 million from investors in its series B fundraising round for its smart toilet seat. With this product, the Heart Seat, Casana could change the way we see home health devices. Casana was founded by Nicholas Conn in 2018 after he developed a prototype of the seat during his Ph.D. work at the Rochester Institute of Technology. The product is focused on capturing clinical grade vital signs via heart health monitoring devices that keeps them simple. The fundraising round was led by Morningside Venture Partners and included participation from Matrix Partners, General Catalyst, Outsiders Fund, and a large vertically integrated health care provider. The $30 million in funds are being used to debut the smart toilet seat capable of taking your vital signs. Key Takeaways: Casana’s innovative smart toilet seats may provide an alternative for people to monitor their health easily from the comfort of their homes. The Heart Seat is capable of measuring heart rate, blood pressure, blood oxygenation, and cardiac output. This handy toilet seat would be useful in tracking the vitals of someone with an existing heart condition. The latest fundraiser brings the total capital raised by Casana to $46 million. The Story: Casana was founded to make heart monitoring easier for the millions of people that suffer from abnormal heart conditions. According to CEO Aaron McChord, “Our goal is to be able to monitor a patient’s health more naturally at home, without interruption of their daily routine”. For example, the Heart Seat could be used for an older member of your family such as a grandparent or aunt suffering from hypertension who has memory issues and often forgets to check their blood pressure. With an unobtrusive device like this which requires little effort from the patient for remote monitoring, just having the device in their home would act as a fail-safe and enable continuous monitoring. In fact, Mintu Turakhia, director of the Stanford Center for Digital Health, believes these so-called “ambient devices” represent the next phase of products for the home-health market after wearables. Casana is focused on delivering a product that can make obtaining vitals effortless for both parties, the clinician and the patient. While CEO McChord is hoping that Medicare will agree to pay for the cost of the seat, as well as a monthly subscription for doctors to use the data that is collected, Medicare currently doesn't cover it and there is not a clear-cut payment method in place for the product. However, McChord stated “ I don’t see this being issued as part of remote patient monitoring which is reimbursed by Medicare. The Differentiators: Typically patients get their blood pressure readings when they make an appointment with a doctor or other clinician (or perhaps from a free-standing machine in a grocery or drug store). With the Heart Seat, patients and physicians are getting real-time data on vitals without having to remember anything and with literally no effort. This can potentially take home health monitoring to a new level. Although more recently with the growth in wearables and virtual care, patients can gain readings through wireless blood pressure cuffs or other devices, the patients still need to remember to wear them, charge them and often download the data. With Casana’s product, all you have to do is go to the bathroom and continue with your normal daily routine. While Olive Diagnostics has a similar product that can gather health information by enabling patients to easily gather a urine sample and applying AI insights to it, currently the Heart Seat appears to be less bulky and more natural creating greater ease of use. The Big Picture: Casana’s approach to home health monitoring has the potential to change the lives of many while seamlessly improving their care and monitoring. For example, products like this would be a good fit for older patients with cognitive issues who may forget to check their vitals or charge their devices. In fact, a 2019 study on the use of wearable activity trackers by older adults found that “research based on a general population sample has shown that nearly three-fourths of the participants discontinued using activity trackers after 100 days from the initiation date,” By contrast, with low maintenance easy to use devices like the Heart Seat, physicians will be able to monitor their patients while receiving constant updates. Despite this, one challenge the company has yet to overcome is price and potential reimbursement. Although the company is expected to submit the device to the Food and Drug Administration for approval as a class two medical device in the first half of this year, as noted earlier, it is unclear if Medicare or commercial insurance companies will cover the cost of the product. Nevertheless, products like the Heart Seat may be very useful as seniors look to remain in their homes longer and “age-in-place” or in the senior care space (ex: nursing homes or assisted living facilities). In such institutional settings, monitoring a large volume of patients can be laborious, but the Heart Seat can relieve the effort of manual vital checks from nurses and clinicians. This can improve clinicians’ efficiency, freeing them of the need for routine tasks like taking vitals and giving them more time to work with patients with greater needs. This is especially important in the current environment for healthcare workers, where clinicians are experiencing burnout from COVID and the high administrative burden. Products like these that can help ease the tension and workload by improving efficiency and convenience are sorely needed. Blood pressure monitoring toilet Casana lands $30M,Scoop: Casana nets $30 million to make smart toilet seats

Note: Several weeks ago, our founder, Jeff Englander presented on a panel at the AI Summit NY entitled, “Operationalizing AI in Healthcare-Bringing Analytics and AI Into the Clinical Setting”. One of the topics of the panel was how to increase clinician’s interaction with AI technologies. During the panel, he referenced an article he had written in May of 2018 on “What Steph & LeBron Can Teach Business About Analytics” and how sports demonstrates many practical ways to gain acceptance and integrate analytics into an organization. Given an incredible weekend of playoff football, sorry to all our friends in Nashville, and the number of ensuing debates about sports analytics, we thought it might be timely to reprint it here: As I sat watching the NBA conference finals last night, I began thinking about what I had learned from the MIT Sloan Sports Analytics conferences I went to over the last several years. I thought about how successful sports had been and the NBA in particular in applying sports analytics and what lessons businesses could learn to help them apply analytics to their businesses. Five basic skills stood out that sports franchises had been able to apply to their organizations that were readily transferrable to the business world: 1) intensive focus; 2) deep integration; 3) limited analytic “burden”; 4) trust in the process; and, 5) communication and alignment. 1) Intensive focus - when teams deploy sports analytics they bring incredible focus to the task. One player noted that they do not focus on how to stop LeBron, not even on how to stop LeBron from going left off the dribble, but instead how to stop LeBron from going left off the dribble coming off the pick and roll. This degree of pinpoint analysis and application of the data has contributed to the success and continued refinement of sports analytics on the court, field, rink, etc. 2) Deep integration - each of the analytics groups I spoke with attempted to informally integrate their interactions into the daily routines of players and coaches through natural interactions (the Warriors analytics guy used to rebound for Steph Curry at practice). Analytics groups worked to demystify what they were doing and make themselves approachable. The former St. Louis now L.A. Rams analytics group jokingly coined its office as the “nerds nest”. By integrating themselves into the player’s (and coach's) worlds they were able to break down stereotypes and barriers to acceptance of analytics. 3) Limited analytic “burden” - teams’ data science groups noted given the amount of data they generate it’s important to limit the number of insights they present at any one time. One group made it a rule to discuss or review no more than 3 analytical insights per week with players or coaches. This made their work more accessible, more tangible to players/coaches and helped them quantify the value to the front office. 4) Trust in the process - best illustrated by a player who told the story of working with an analytics group and coaches to design a game plan against an elite offensive player which he followed and executed to a tee. But that night the opposition player couldn’t be stopped and in the player’s words "he dropped 30 on me". The other panelists pointed out that you can’t go away from your system based on short-term results. As one coach noted ‘don’t fail the plan, let the plan fail you…Have faith in the process.” 5) Communication and Alignment - last but not least teams stressed the need to be aligned and to communicate that concept clearly all throughout the organization. As Scott Brooks, at the time the coach of the Orlando Magic noted, “we are all in this together, we have to figure this out together”. Surprisingly, at times communication was paramount even for the most successful and highly compensated athletes. For example, at last year’s conference, Chris Bosh a 5x All-Star and 2x NBA Champion, making $18M a year at the time he was referring to, lamented the grueling Miami Heat practices during their near-record 27-game winning streak in 2013, seemingly despite their success (at the time the 2nd longest winning streak in NBA history). When I asked him, what would have made it more bearable, he said communication, just better communication on what they were trying to do. Clearly, professional sports have very successfully applied analytics to their craft and there are a number of lessons that businesses can copy as they seek to gain broader and more effective adoption of analytics throughout the value chain.

The Driver: This week Wheel raised a $150M series C round bringing its total raised to $216M since the company was founded in 2018, and follows the company’s $50M series B just last May. Wheel’s fundraising round was led by Lightspeed Ventures and Tiger Global with participation from existing investors CRV, Silverton Partners, and Tusk Venture Partners. New investors Coatue and Salesforce Ventures also joined the round. According to the company, it will use the funds to continue to grow headcount, broaden its virtual care platform, particularly in diagnostics, as well as expand its onboarding and educational programs. Key Takeaways: According to the Austin Business Journal, Wheel had twice the number of patent visits in Q4 2021 as it did during all of 2020. According to Wheel internal data, standing up and scaling a virtual care service on your own costs an average of $15MM and takes approximately 15 months. The McKinsey 2020 Virtual Care Study claims that approximately $250B or ~20% of all outpatient, office, and home health spend, could potentially be virtualized. A study by Nuance and HIMSS found that 97% of doctors and 99% of nurses surveyed had experienced burnout at some point in their working life. The Story: According to Forbes, the idea for the creation of Wheel goes back to when CEO and co-founder Michelle Davey was a child and had to undergo over a decade of being “ferried between doctors for her to be diagnosed with an autoimmune condition.” After several stints working in healthcare and recruiting, Davey returned to healthcare to work at a telehealth startup to do recruiting. Thinking her previous recruiting experience would give her a leg up in her new role, she was quickly surprised to learn that it had not. In 2018 this led Davey and her co-founder Griffin Mulcahey to found a matching market for virtual healthcare providers called Enzyme which subsequently became Wheel. According to the firm’s website, Davey and Mulcahey felt that “no one was looking out for those at the center of the healthcare engine: the clinicians on the “front lines” and decided to found Wheel as “the industry’s first model for delivering high-quality virtual care at scale by empowering clinicians and providing new efficiencies for healthcare companies.” According to the company, Wheel helped facilitate 1.3M patient visits in 2021and expects that number to grow by approximately 3-fold by year-end 2022. The Differentiators: Unlike some of its competitors which offer branded virtual care services, Wheel offers a private or “white-label” platform that empowers companies to quickly and easily launch virtual care services on its own by providing them with the appropriate back-end infrastructure and software. In addition, while Wheel is helping traditional healthcare providers like hospitals and physician practices offer virtual primary care services, it is also helping non-traditional players like retailers, pharmacies, and employee benefit programs create their own virtual care programs under their own brand. Wheel claims that using their platform is much more efficient in terms of both time and money than standing up and scaling a virtual care service on your own, which their internal data shows costs an average of $15MM and takes 15 months. Moreover, as we noted in our earlier Scouting Report on Wheel (please see Scouting Report-Wheel: Moving Virtual Primary Care Forward 09/21/21) Wheel has been looking to expand the breadth of its services beyond just virtual primary care for some time and is slated to use some of the proceeds from the round to increase services in labs, and diagnostic care. Interestingly given Wheel’s roots in physician recruitment and staffing, Wheels has a strong background in some of the technical issues involved in scaling a virtual care business. As Davey noted to Forbes about founding the business, one of “the biggest sticking point[s] to scaling digital health startups was understanding the regulations across all 50 states and recruiting licensed clinicians.” Moreover, as noted in our prior article, Wheel continues to experience a strong retention rate of more than 90% even in the face of over 60% growth in its clinician network this past year. Wheel currently has approximately 150 employees (up from 120 in August) and now expects that to increase to 300 by year-end 2022. Wheel charges its customers a base fee for its software and then an additional fee per consultation. The Implications: While Wheel’s last fundraising appeared to be more about the need to keep pace with the explosive growth and market opportunity in digital care created by COVID, this round appears to be more about the transformation to virtual-first care. As CEO Davey noted to MedCity news, in order to move healthcare forward and truly deliver on virtual-first care we need the infrastructure that can deliver “anytime, anywhere” care, which they are helping to create. While the pandemic created a newfound acceptance of digital health, “companies were still struggling to meet their patient’s needs”. However, as Davey notes “the funding puts the company in a strong position to speed the transition from telehealth to virtual first care.” For example, according to the McKinsey 2020 Virtual Care Study “approximately $250B or ~20% of all Medicare, Medicaid, and Commercial outpatient, office, and home health spend, could potentially be virtualized.” Nevertheless, while a great deal of care can be virtualized, virtual first is really about creating a less expensive, more accessible triage point for entry into the system and should begin to enable a true omnichannel experience like consumers experience in most other industries. Davey states, “by leaning on technology, healthcare organizations can more easily triage a patient’s care need and determine the best care setting”. Virtual first brings healthcare much closer to other industries by bringing patient care to the patient at the time and place they desire as opposed to the other way around. Importantly in a time of labor shortages, virtual primary care also provides a mechanism to address the issue of physician burnout, where over 90% of doctors report experiencing at least one symptom of burnout in their lives. By giving them the ability to create their own virtual practice with a much lower infrastructure incidence of burnout can be reduced. While important issues like broadband access and ensuring patients receive culturally relevant care still need to be addressed, virtual first care and technology are changing the nature of healthcare delivery. Wheel Raises $150M in Quest to Move Beyond “telehealth 101” to Virtual-First Care, Wheel Raises $150 Million Series C to Power the Virtual-First Care Revolution, Behind The Screen: Meet The Startup Powering Telehealth

Our Take: Digitizing the healthcare supply chain can bring significant gains in cost-effectiveness for healthcare organizations enhancing their ability to optimize operations while lowering the costs and improving the quality of care in real-time. While a great deal of attention has been focused on digitizing healthcare’s front-end (ex: the patient experience), digital transformation extends into the supply chain as well. In fact, digitizing the supply chain may is a good way for organizations to gain experience and insight into developing digital skills (such as artificial intelligence) before applying them to clinical areas. Key Takeaways: Digitalization increases supply chain networks visibility, enables strategic relationships planning, and uncovers opportunities for establishing new relationships. Prior to the pandemic, 80–90% of active pharmaceutical ingredients for certain drugs were produced almost exclusively in China or India. According to the Institute for Supply Management (ISM), 59-83% of organizations reported an increase in lead times for acquiring supplies since the onset of the pandemic. 88% of healthcare executives identified AI as a critical technology for supply chains in the next three years. The Problem: So far, the healthcare industry has been receptive to digitalization and technological innovations to address complex health problems concerning healthcare access, health equity, and health literacy. Adoption of digitalization within the supply chain will be crucial to success as the industry moves away from fee-for-service reimbursement systems to value-based care, given the need to optimize service delivery, minimize costs and reduce variability in unit costs. At the beginning of the COVID-19 pandemic, the challenges of limited supplies of vaccines, PPE and other medicines exposed the gaps in the healthcare supply chain globally. Healthcare providers and organizations had to reimagine the role of technology and digital solutions in providing and delivering healthcare services. Along with the need to keep patients out of physical facilities, COVID made administrators and policymakers aware of the need to rapidly scale and deliver care where necessary in all fields of healthcare, and not just direct patient care. Supply chain disruptions and its impact on the pandemic response shows the need for adopting deploying innovative digital and technological solutions that strengthen and stabilize the healthcare supply chain. Digitalization of the healthcare industry’s supply chain could change the competitive landscape by reducing costs substantially and turning these skills into a competitive differentiator. The Backdrop: Healthcare organizations’ entire ecosystem is interconnected with the health care industry’s supply chain. In order to optimize cost, minimize errors and foster patient centric care, healthcare organizations are establishing digital supply networks. Digital supply networks have helped the healthcare industry to reduce organization-wide cost through innovative ways of managing resources. By reducing unnecessary variation, digital supply networks reduce the likelihood of poorer outcomes caused by error and variability. The dividends of digitized supply networks include things such as minimized errors, reduced wait times and need for rescheduled appointments all of which could contribute to higher patient satisfaction as well. For instance, hospitals’ investment in electronic inventory tracking allows for automating the inventory replacement process for flagging used or expired inventory supplies as opposed to the costly and time-consuming alternatives of eyeballing or counting. This not only helps manage costs but ensures that supplies will be available for certain types of patient procedures. In addition, with the continued spread of COVID and it’s numerous variants, the manufacturing sector has seen additional stress on the value chains and the need to strengthen them to respond to customer demand. Digital manufacturing technologies such as automation, AI and IoT became a major opportunity for manufacturers to explore. Digitalization is expected to increase the productivity of the manufacturing industry as the prolonged COVID pandemic continues to increase manufacturing costs and shrink the production workforce. According to the Institute for Supply Management (ISM), 59-83% of organizations reported increased lead times in acquiring supplies since the onset of the pandemic. According to “COVID-19 and the health care supply chain: impacts and lessons learned” from the Council of Supply Chain Management Professionals, the pressures experienced during the pandemic impacted testing capability, care coordination, and supply rationing. The United States overdependence on offshore manufacturing of several essential health care items made the pandemic response more challenging. The U.S. struggled to procure enough face shields and masks when countries shut down manufacturing and enforced export bans. For instance, the U.S had a shortage of face masks and a large number of drugs because China manufactured 80% of all face masks and 80–90% of active pharmaceutical ingredients (APIs) are produced in China or India. To address supply chain disruptions, 88% of healthcare executives identified AI as a critical technology for supply chains in the next three years. AI-backed control towers can help an organization gain dynamic visibility across the network, improve predictions on demand changes and disruptions, support inventory management and decision-making to improve patient care. The Implications: With the increased digitalization of the healthcare systems’ supply chain, supply chain cost will reduce and improve provider economics in the face of lower reimbursement levels. An analysis in the International Journal of Environmental Research and Public Health entitled, “Relationships among Healthcare Digitalization, Social Capital, and Supply Chain Performance in the Healthcare Manufacturing Industry” identifies that digitalization has a positive effect on the formation of social capital (ex: networks between groups or individuals that facilitate co-operation within or among groups helping societies to function effectively). Social capital formation within the supply chain would allow efficient delivery of required resources/services that add value to the healthcare manufacturing industry. This added value would improve the performance of healthcare manufacturers and increase visibility of supply chain networks. Digitalization also increases the visibility of supply chain networks by enabling effective planning of strategic relationships and uncovering opportunities for establishing new relationships. Despite the benefits of digitalization, healthcare manufacturing strategic relationships are crucial, as supply chain networks and production processes influence the intended use of output. For example, during the pandemic, the added benefits of AI-enabled supply chains became apparent as they allow real-time, end-to-end visibility, elevated planning and automation, intelligent forecasting, demand sensing and foster a collaborative ecosystem. These services are not only essential for securing timely and accurate information they help in managing the flow of products and services and can also aid in healthcare informatics and predictive analytics. For example, a more digitized healthcare supply chain enlightened by AI might have led to more timely and effective insights about the source and spread of COVID. In order for healthcare companies to establish a supply chain network based on digital manufacturing technology, they need to establish cross-functional teams drawing heavily on patient facing agents such as doctors or nurses to determine the most efficient and effective ways to design and track order flow patterns (doctors and nurses are crucial to identifying real-world bottlenecks and infamous for creating informal solutions). While digitization has the potential of fostering efficient supply chain connectivity and timely resource management, it must be implemented with an eye towards helping improve, not adversely impact, clinical workflows. Related Readings: How Digital Health Care Can Give Providers an Edge. Building a Digital Supply Chain Relationships Among Healthcare Digitalization, Social Capital, and Supply Chain Performance in the Healthcare Manufacturing Industry COVID-19 and the Health Care Supply Chain: Impacts and Lessons Learned Data-Driven Decision-Making: Reinventing Healthcare Supply Chains for the Digital Age

The Driver: Suki.AI is a digital voice-based clinical assistant that uses AI technology to help doctors and healthcare workers with administrative tasks like generating accurate notes. Recently, it raised $55M from March Capital, Philips Ventures, Venrock, Flare Capital, Breyer Capital and inHealth Ventures. Some of the funders are leading figures in technology, healthcare and finance, including the Gaingels Group, Pankaj Patel (ex-chief development officer of Cisco), Andrew Deutsch, M.D., (CEO of RIMA Radiology) and Russell Farscht (former managing director of The Carlyle Group). The San Francisco-based company plans to use its funding to expand its user base through partnerships with health systems and medical groups while increasing employee growth and development. Suki will also add new features that streamline documentation, coding and other administrative tasks for physicians. Key Takeaways: According to Research and Markets’ projection, the global market for healthcare virtual assistants will grow from $1.1 billion in 2021 to $6 billion by 2026. A 2017 Annals of Family Medicine study found that doctors spend almost two hours on tasks related to EHRs for every hour spent on direct patient care. According to a 2019 Medscape survey, 60% of healthcare providers felt that “too many bureaucratic tasks” cause burnout. Suki has lowered physicians’ average time per note by 76%. The Story: CEO and founder of Suki, Punit Singh, a former product manager at Google and ex-CPO at Flip-kart, is not a stranger to creating new products using technology. He got the inspiration for Suki from his experience as a project manager for Google in India, where he helped launch the Google News Archive project. “My stint in India taught me the value of entrepreneurship. One is I wanted to learn and grow from a different perspective and the journey is very different from when you build things from scratch, with nothing except an idea, and build it from there. I also wanted to leverage some of the advantages I had, and more importantly, I wanted to build something that had clear value to society,” he adds. While shadowing doctors and physicians, Singh noticed doctors did not have any technology that reduced their administrative workload, which eventually led to physician burnout. “The doctors are overworked and there are few doctors for a large number of patients. There is no technology, and for every one hour of clinical work they are doing two hours of administrative work,” says Singh. Suki’s app addresses this gap by using natural language processing to transcribe notes. Doctors create clinical notes using the SOAP (subjective, objective, assessment, and plan) method. “Subjective” refers to what the doctor hears from the patient, while “objective” is what they observe. Assessment is what they assess and Plan refers to the next steps. First, Suki writes a clinical note which the doctor can access using a command. Following which, the doctor tells Suki to create a note for a patient. The Suki.Al app then creates the note by using information from the patients’ electronic medical record to populate the note. Apart from note-taking, the app equally allows doctors to insert patients’ notes, which are collated in the overall EMR. By generating detailed clinical documentation, Suki’s technology has reduced physicians’ average time per note by 76% and decreased claim denial rates by about 19% according to the company. Detailed clinical documentation is important for health systems, medical groups’ revenue and also supports hierarchical condition category (HCC) coding integrity required for reimbursement in payment models. While, initially, the app worked as a basic note-taking platform, it now provides other services, including writing diagnostic information, problem-based charting and adding coding information. Doctors can subscribe to the $200 pay-per-month plan on either Windows, iOS, or Android apps and can use the app either on the phone or desktop computer. Currently, Suki, which follows the SaaS (software as a service) model, is used in about 85 healthcare sites in the U.S and also works with EHR companies such as Epic, Cerner, and Athenahealth. The Differentiators: While Suki is not a pioneer in making voice-activated devices that take notes for doctors. Companies like Saykara, Robin Healthcare and Vocera have similar technology. However, Suki is different because it does not have any physical hardware. “We are the only pure software company in this space,” Singh says. That allows it to keep price points low. A human medical scribe can cost between $60,000 and $80,000 per year, while Suki costs an average of $200 each month. This strategy is unique." The software-only design makes transcribing more seamless for doctors because it eliminates the need for setting up a device and also accommodates their need to move around a facility. It is equally cost-effective as healthcare facilities can save money they would otherwise spend on hiring medical scribes which can be quite expensive. The Big Picture: As physicians rise through professional ranks, their workloads follow suit, leading to burnout. The increased workload prevents doctors from spending more time engaging and communicating with patients could influence doctor-patient relationships adversely. A healthy patient-doctor relationship positively affects patients' outcomes. Suki aims to help doctors focus on and engage more with their patients by reducing the time spent on note-taking and other tedious and repetitive tasks. Innovations like Suki that help reduce physician burnout are significant and needed considering the number of physicians that are leaving or thinking of leaving medical practice because of the high administrative burden as well as added stress and trauma experienced during the pandemic. Even without the impact on burnout due to COVID, according to the Association of American Medical Colleges, the U.S. is projected to have a massive shortage of physicians in primary and specialty care by 2034. Although critics have voiced privacy concerns about Suki’s public partnerships with Google Cloud and the Ascension health around Suki software’s ability to listen in on patients’ private non-clinical conversations, the company contends this is not an issue. CEO Singh explains that the software doesn’t passively listen like Alexa, and only begins transcribing notes when the doctor asks for it to do that. He also claims that the software is fully HIPAA-compliant, though engineers at the company do use “insights from the users to train Suki.” AI voice assistance like Suki could help doctors channel countless hours that would have been spent on administrative work focusing on the work they love, caring for the patient. This will help ensure patients receive the quality time and service they deserve. Suki Secures $55M for Voice-Enabled Clinical Assistants to Relieve Physician Burnout, Voice-Based Clinical Assistant Suki Picks up $55M to Fuel Tech Development, Expand Health System Partnerships

How Telehealth Addressing the Opioid Epidemic Telehealth connects geographically dispersed patients to providers and is a promising approach for expanding access and treatment to people with opioid use disorders. Healthcare Startups Mistakes & Lessons Learned While every startup has its own unique set of opportunities and challenges, many tend to repeat a common set of mistakes that can be looked at in a five-part framework: founding, strategy/vision, funding, execution, scaling or growth. Platforms in Healthcare-Series 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. Does AI Always Optimize Healthcare Establishing consistent and flexible frameworks for AI regulation is also key because adaptive AI could drive changes in treatment protocols as models and prediction algorithms become more precise. Coordinating these efforts, not just simply pursuing them, will be a demanding task. Augmented & Virtual Reality Can Finally Impact Healthcare Access and Outcomes Previously, AR, VR, and spatial computing have been used in healthcare on a limited basis, but the broad rollout of 5G communications bandwidth and technologies will allow providers to integrate these technologies more broadly into the delivery network. Big Tech & Retail Disruptors Continue to Run Into Same Challenges in Healthcare The varied nature of healthcare data, the intricate nature of data privacy and security rules such as HIPAA and CCPA, and the often complicated relationships between patients, providers, and payers can make navigating the space difficult at best. Data from Digital Tools is Crucial to Success of Risk-Based Contracting From Implications Para: 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, patient risk management, reducing variation in clinical workflows, and improving patient outcomes at a lower cost. Enhancing Telemedicine Can Close Infant Mortality Gap For many years, the United States has lagged behind other high-income countries in infant mortality statistics due to poor access to prenatal care, chronic disease, and cost barriers to healthcare access, particularly in under-resourced communities. RPM Could Be the Key to Reducing Disparities in Maternal and Infant Care 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. Untangling the Intricate World of Digital Health Regulation For startups to remain compliant they must learn how to navigate the complex web of regulation and guidance and create a system for staying on top of any updates from the appropriate agencies.