Can chronic disease apps get adopted? Is it as simple as four steps? HBR states the obvious.

“Why Apps for Managing Chronic Disease Haven’t Been Widely Used, and How to Fix It” is an enticing title, and in the Harvard Business Review no less.

Here’s the advice that two Harvard Business School professors have for app developers. First, find an organization–an employer, an integrated health system that includes a payer–that’s willing to pay for your app. Then work the “adopt-diffuse-use-improve” cycle. Get them to adopt it, diffuse it through potential users (as in getting them to try the app), get them to continue using it, and improve the product.

You have to sled through about 500 words of exposition to get to this conclusion, obvious to anyone who’s worked in the field more than a couple of months. And oh, as if these steps were so easy to achieve! There’s the given example of Fitbit buying the Twine Health tracking/coaching app in a bid for a more integrated chronic disease management (CDM) approach–for those who’ve tracked Fitbit, and even the professors, its success remains to be seen. 

There are some nuggets of confirmation useful for presentations, such as you can’t generally sell monitoring apps direct to consumer because managing chronic disease is largely something to be avoided, except for the few with a different attitude, and most believe that insurers should pay for them at least in part. For clinicians, reimbursement and the differential between remote patient monitoring and in-person visits is a big factor.

What’s not mentioned: sustainable pricing that’s low enough for a health system, high enough to support a business; clinicians fitting All That Data into a clinical workflow, much less a patient record in an EHR. 

News roundup: First Stop, GlobalMed, American Well, Avizia, Medicity, Health Catalyst, Allscripts, Welbeing, BenevolentAI

click to enlargeAnnouncements and acquisitions have been multiplying–here’s what’s most interesting.

In companies we’ve recently written about:

Our recent Contributor Bruce Judson, now with corporate telemedicine provider First Stop Health, wrote us enroute to the Government Finance Officials Association conference in St. Louis that FSH achieved triple-digit top-line revenue growth and also achieved an average utilization rate of 52 percent. The formal announcement was made earlier this week at the HLTH conference in Las Vegas (release), where another one of our Contributors, Sarianne Gruber, is attending for Answers Media Company.

GlobalMed, a prior contributor to Perspectives, is offering a lower cost telemedicine alternative to practices with a flat fee starting at $799 per month for three years. Startup costs remain at about $5,000. The starting kit includes a cart, a total exam camera, stethoscope and vitals linked to the organization’s network, and a nurse license. Additional compatible equipment is available at extra cost. We know that a number of comparable telemedicine cart-based kits run upwards of $8,000. It is one of the first public acknowledgments this Editor has seen (but has known for years) that high cost is a major impediment for implementing both telehealth and telemedicine in practices. Health Data Management.

In other news:

Telemedicine and telehealth consolidation continues with American Well’s acquisition of hospital-based telemed/workflow systems provider Avizia. Avizia has a product line of telemedicine carts and workflow software for 40 different specialties, including telestroke and telebehavioral health. The acquisition price was not disclosed. Prior investors in this 2013 Cisco spinoff include Northwell Health, NY-Presbyterian, HealthQuest, and other providers in seven rounds totaling over $23 million. Healthcare IT News

A further sign of consolidation, this time in the crowded health information business, is the Medicity acquisition by Health Catalyst. Health Catalyst is primarily a data analytics and warehousing company while Medicity focuses more on data interoperability and patient engagement for practices, health systems, and HIEs. Medicity was purchased by Aetna in 2011 with much fanfare for $500 million as one of its ‘Emerging Businesses’, rebranded as Healthagen in 2013 [TTA 28 Feb 14] which never quite took off. Out of that unit, what remains are Active Health Solutions and Aetna Accountable Care Solutions, a payer-driven value-based care management company. The amount of the sale was not disclosed but is expected to close in 90 days. Health Catalyst’s CEO Brent Dover served as president of Medicity up to 2013, and both companies are located in Salt Lake City. What is interesting about this sale is that CVS, which is buying Aetna, has no comparable in-house technology. It’s a probable shedding of peripheral or money-losing businesses prior to sale.  HISTalk, MedCityNews

Allscripts continues on its acquisition binge with patient communication and engagement platform HealthGrid. HealthGrid is a mobile app platform that delivers care and education materials traditionally distributed from practices to patients via paper. In January, Allscripts bought practice EHR Practice Fusion for $100 million (a loss to investors) and earlier McKesson’s HIT business for $185 million. It’s a noticeable shift to value-added care tools for this formerly EHR-centric company. Mobihealthnews. 

In UK news:

Welbeing has won Norwich City Council’s Norwich Community Alarm Service (NCAS). It provides a 24-hour, year-round monitoring and response service for over 6,500 adults who are vulnerable or at risk in this part of East Anglia. The press release is on UK Telehealthcare‘s news page. 

BenevolentAI, a UK company using artificial intelligence for drug development, raised $115 million in new funding, mostly from undisclosed investors in the United States, according to Mobihealthnews, for a total funding of over $200 million. The company uses AI to reduce drug discovery time and risk. It does not do its own drug discovery but sells the intellectual property discovered by their AI algorithms, claiming to cut drug development timelines by four years and improve efficiencies by 60 percent compared to pharma industry averages.

Health 2.0 NYC Empowered Patients event rescheduled to 16 May; apply now to the Digital Health Breakthrough Network (NYC)

Empowered Patient 2018: Using Big Data & Technology to Empower Patients & Providers to Make Healthier Decisions
Verywell, 1500 Broadway (at 43rd), 6th Floor (Verywell)–now 16 May

Overview: Big Data is rapidly transforming the healthcare industry – from personalizing content to the patients’ individual needs to making medical diagnoses and outcomes more predictive. The panel of industry experts from various companies ranging from healthcare publishing, research, and technology will discuss how Big Data is enabling this evolution with content, product, and services to democratize health information and provide insights that improve medical care, research, and the overall patient experience. Technology is already making a difference, but raises privacy and ethical issues.

Agenda:
6:00 – Meet, Greet, and tweet with healthy snacks provided by event sponsor: Verywell
6:30–  Panel Discussion
7:15 – Get to know other healthcare innovators in the community

Moderator: Dr. Deepna Devkar, Senior Director, Data Science, Dotdash
Panel:
Marlene Guraieb, PhD – Senior Data Scientist, Oscar Health
Dmitriy (Dima) Gorenshteyn, PhD, Senior Data Scientist, Memorial Sloan Kettering Cancer Center
Rob Parisi, SVP/GM Verywell – This evening’s sponsor and site host is a leading health and wellness site that provides trusted advice for a healthier life to its 20 million monthly unique visitors.
Joy Fennel, Empowered Patient – pilot patient on mymee, a digital therapeutic solution for autoimmune disorders – see www.mymee.com
Libbe Englander, PhD., CEO, Pharm3r, a healthcare analytics company helping improve outcomes with big data

Tickets $15, the snacks and drinks (and crowd) are great. Register and pay here. TTA and Editor Donna are longtime supporters of Health 2.0 NYC and Medstartr, the organizing groups behind this event.

A startup looking for funding? Look no further than the Digital Health Breakthrough Network. Sponsored by NYCEDC and HITLAB, they are in the process of recruiting their fourth class of startups. Eligible companies are early-stage startups (pre-revenue/pre-Series A), based in NYC (50 percent+ of employees), with an innovative digital health technology that presents a novel solution to a significant need in the health marketplace. Applications are open until 15 June. More information here and here.

Health tech founder ousted over alleged ‘acts of intimidation, abuse, and mistrust’: some reflections (Soapbox)

And we thought they were par for the course. Those of us who have worked for company founders, CEOs, and senior execs have learned that some interesting personalities come with the territory, especially in entrepreneurial companies. This Editor has worked for at least one diagnosed ADHD, a bipolar ADHD, another with anger management/impulse control issues, and a gentleman who is now spending a few years in a Federal penitentiary for securities fraud. One of her most memorable CEOs made the cover of Fortune with the caption, “Is this America’s Toughest Boss?” and no, his name was not Donald Trump. (Clue: he was chairman of what was for a time the world’s largest airline conglomerate.)

Of late, there’s been the behavioral quirks of their founders leading to disastrous problems at Uber, Theranos, and Zenefits. It often seems that the more hype, the more sunshine, daisies, puppy dogs, mission, and ‘fab culture’ are on the website, the worse the dysfunctional reality and mistreatment of the troops.

Perhaps no longer. Monday’s very public firing by his board of Ron Gutman, CEO of HealthTap, a digital health all-over-the-map company that now has settled into a members-only patient-doctor mobile health platform, over non-financial behavior may be a first. Mr. Gutman was given the heave-ho by his board after, notably, months of effort. Recode cited a termination letter to him that he “committed acts of intimidation, abuse, and mistrust, and that [he] repeatedly mistreated, threatened, harassed and verbally abused employees.” The coup de grâce: “The toxicity you introduced into the workplace ends now.”

An all-hands memo to employees was more restrained:

After receiving concerning reports by employees about Ron’s conduct as CEO, the Board of Directors hired an outside law firm to conduct an investigation into these allegations. What we learned left us with no choice but to make this change, and we did so after taking the necessary steps from a corporate governance perspective.

The replacing CEO is Bill Gossman, a serial founder and a partner in one of the investors, Mohr Davidow Ventures.

Mr. Gutman has denied it all, stating that he did not abuse employees and that the VCs are in violation of their duties. (FYI, not a whiff here of #MeToo antics.)

Funded to the tune of $38 million by Khosla Ventures, Mayfield Fund, and Eric Schmidt’s Innovation Endeavors, but without fresh funding in five years, the public face of both Mr. Gutman and HealthTap (of which he is the very public face, appearing all over their website still) is one with a very large smile. Mr. Gutman gained some fame from his TED talk and book on the power of smiling. One wonders how the smile is doing today. A frown turned upside down. TechCrunch, Mobihealthnews

Nokia throws in towel on digital health, negotiates Withings sale to co-founder Eric Carreel

Nokia finally gave up on consumer health tech, confirming February reports that they were reviewing strategic options for its Digital Health business. Digital Health was a tiny part of Nokia Technologies and an even tinier part of overall revenue (under .2 percent at €52 million of revenues). The prospective buyer in the exclusive talks is Withings co-founder and former chairman Éric Carreel. “Nokia and Éric Carreel recognize that as an original Co-Founder of Withings, he is best positioned to carry the company forward into its next phase,” a Nokia spokesperson wrote to Mobihealthnews.

Withings sold itself to diversifying Nokia in 2016 for a hefty €170 million, becoming Nokia Digital Health in February 2017. The Withings purchase was positioned as a reverse takeover, with Withings staff taking over Nokia’s fledgling efforts in digital health. But the promised results and impact never took place and Withings faded from view, at least in the Americas.

According to their statement, “The planned sale is part of Nokia’s honed focus on becoming a business-to-business and licensing company.” Other interested buyers include Google’s Nest division and Samsung. The company may also head back to France.  TechCrunch, Mobihealthnews

Confronto Nazionale sul Software in Sanità (National Comparison on Healthcare Software), 4-5 July, Rome

Policlinico Gemelli, Rome, 4-5 July

If you are one of our Readers in Italy or curious about the state of Italian healthcare technology as part of EU developments, 14 healthcare and IT system groups have come together for a meeting on technology innovation. The meeting will examine how health system stakeholders are developing and deploying software that supports the strategic, organizational, operational and clinical processes of service provision. The main discussion will center on sustainability, usability, performance, and interoperability with a focus on the EU’s Horizon 2020 and Italy’s particular situation in (translation) “extreme institutional, managerial and technical confusion. The result of this confusion is the continuous hemorrhaging of economic, logistical and human resources for the functioning of very restricted areas of health that are not interoperable with each other.” There is considerably more information on their website or you may contact the organizer, Koncept Ltd., t. 055 357223, m. 334 7365693, email segreteria@koncept.it

Alerts moving to Thursdays; TTA seeks contributors

Starting this Thursday, TTA updates will be sent to subscribers on Thursdays. This is due to Editor Donna’s new full-time position which has sadly cut down on her writing time. (Oh, for a robot to send to work!).

That being said, we are seeking contributors on an occasional to regular basis to send us articles. If you are an observer of the health care and health tech scene in the US, UK, Europe, Ireland, or in fact anywhere in the world, we’d like to hear from you. Articles can be about conferences, events, R&D, M&A, news, policy, or thoughtful views on developments. The one thing that they cannot do is promote a product or service–in other words, commercial. Email Editor Donna in confidence.

Orangeworm malware running wild in hospitals for three years: multiple reports

Orangeworm hacker group finds easy pickings in hospitals and healthcare. Reports have multiplied in recent weeks of the Orangeworm hacker (or hackers) threatening healthcare organizations, frequently hospitals. Major info security groups have issued warnings: Symantec, Cynerio, BlackBerry, and Rubicon Labs. Symantec’s report states that 39 percent of the victims come from healthcare, with the remainder coming from manufacturing (15 percent), IT (15 percent), and logistics (8 percent), most with ties to the healthcare sector, and suspected vectors for a supply-chain attack.

‘Easy pickings’ include invading the old computer systems and controls prevalent worldwide in healthcare organizations: devices designed to control X-ray machines, MRIs, and even systems that help patients fill out consent forms. Orangeworm accesses IT systems using the Kwampirs trojan, taking advantage of the fact that most hospital IT systems are old, and as we know from the Petya and WannaCry attacks a year ago, their old, unprotected, and unpatched systems are uniquely vulnerable.

The semi-shocking fact is that this has been spreading quietly in healthcare organizations for over three years. The attackers used, according to both Symantec and Bleeping Computer,  malware that infected systems by copying itself across network shares, methods that are considered antiquated and “noisy”. Orangeworm also didn’t change its command and control (C&C) communication protocol over the three years, seemingly unconcerned about discovery.

The attacks appear targeted and coordinated. Speculation is that Orangeworm is a hacker or a small group of hackers targeting the rich information in healthcare records to sell on black markets. 17 percent of the attacks have been in the US, with UK, Germany, the Philippines, and Hungary at 5 percent each.

Symantec’s advice is extensive and detailed here, but can be summed up as: quit using Windows XP based systems, patch and update software and systems, use anti-virus, protect file sharing. Also Digital Health, Information Security Buzz News, Security Intelligence.

‘Deconstructing the Telehealth Industry’ positively, focusing on ‘virtual care’ of older adults

A Big Study must-read. Just published is healthcare-specialized investment banking firm Ziegler’s 28-page update on their 2016 survey of the telehealth industry. Unlike some industry observers who believe that health tech has been ‘next year’s Big Thing’ far too long, with unproven effectiveness and savings, Ziegler believes it’s about to substantially ramp up in investment spending and tech integration.

The study looks forward and goes deeply into the markets. In their view, “We believe the next generation of successful virtual care companies will be those who understand the critical marriage between chronic care management, behavioral health, and social determinants.” Their focus is on the aging (50+) population and their higher risk for developing chronic conditions and the 50 percent/5 percent spread (50 percent of the spending is generated by 5 percent of the population). Their picture is that virtual care will ‘meet patients where they are’ in their daily lives.

The study sees trend confirmation in the adoption of virtual care by health systems (the widest–telestroke and tele-ICU), low-acuity care, and 2019 expansion of Federal reimbursement in Medicare Advantage Plan B with ACOs having more flexibility in telehealth-supported services. Ziegler promotes a change in terminology–‘virtual care’ as the ‘naturally integrated tool used to streamline the complex healthcare ecosystem.” Another difference: they place virtual care in the ‘smart aging continuum’ including its effect on decision makers, payers, care options, aging in place, and residential care.

A strong reference paper our Readers will be referring to for months to come. Deconstructing the Telehealth Industry, Part II (option for printable and viewable PDFs).

The race to develop a blood glucose skin patch monitor speeds up with UCSD pilot

Are thin-film/adhesive patch glucose monitors the thing this year? University of California San Diego Health (UCSD Health)  opened earlier this month a clinical trial of their self-adhesive ‘tattoo’ type glucose monitor. This monitor measures the glucose present in perspiration through two electrodes embedded in the thin adhesive film that apply a small amount of electrical current to make glucose molecules in the skin rise. The clinical trial sampling people with Types 1 and 2 diabetes ages 18-60 with fasting plasma glucose (FPG) > 126 mg/dL, or hemoglobin A1c (HbA1c) > 6.5%. Those in the trial will be comparing their readings from the thin film monitor with a standard glucometer through June 2019. Patients wearing the sensors will receive a minimum of two doses of pilocarpine gel to induce sweat, at fasting and at time points ranging between 15 to 200 minutes post meal. Neither the article nor the clinical trial explain the reading process.

In a Mobihealthnews interview with Patrick Mercier, codirector of UCSD’s Center for Wearable Sensors, the sensor can be produced for under $1, comparable to a blood glucose test strip.

Tattoo-type sensors and strips made the news about two-three years ago in their early stages of development and now are resurfacing with both trials and investment. Sano received $6 million from Fitbit for its combination of sensor and mobile app. The University of Bath has designed a multi-sensor patch that doesn’t need gel to raise a sweat; it measures interstitial fluid located between cells within the body-hair follicles [TTA 24 Apr]. We are rapidly moving towards less-invasive monitoring systems and better diabetes management.

The health tech events of summer: The King’s Fund (London) and Parks Associates (San Diego) (Updated)

Summer is coming, even if it’s difficult to believe that April Showers (or Snow) bring May Flowers. Here’s a preview of two health tech events to put on your calendar later on this year in mid and late summer.

The King’s Fund Digital Health and Care Congress 10-11 July, at their location in London. Content and case studies include creating the right culture for large-scale digital change, using digital technology to improve quality of care, prevention and changing behaviors, population health informatics, tools for self-management, and much more. Speakers include Matthew Swindell of NHS England and the Rt. Hon. Paul Burstow of the TSA. Information and registration are now available here. (Updated this week!) Follow The King’s Fund on Twitter here: #KFdigital18. TTA is a media partner of the Digital Health Congress.

Parks Associates’ 2018 Connected Health Summit: Engaging Consumers will be held 28-30 August at the Manchester Grand Hyatt in San Diego, California. This year will analyze the role of innovative connected health solutions in driving changes in consumer behaviors as well as how healthcare systems, insurers, and hospital networks interact with consumers. Updated: Confirmed keynotes are Deborah DiSanzo, General Manager, IBM Watson Health and–just added–Christopher Weber, General Manager of Uber Health [see this Editor’s thoughts on Uber from last month]. Speaker submissions are open until 1 June–more information is here. Early registration is now open. TTA is a media partner of the Connected Health Summit.

UK-developed non-invasive skin patch monitors blood glucose; a ‘slow-mo’ injection to regulate it

click to enlargeA team from the University of Bath has developed a graphene-based blood glucose sensor that if successfully commercialized could eliminate the diabetic finger-stick. The sensor patch measures the interstitial fluid located between cells within the body-hair follicles–each mini sensor measures an individual follicle, where glucose collects in tiny reservoirs. The sensor patch can monitor every 10-15 minutes for continuous measurement. At this developmental point, readings are not sent to a smartphone. The researchers are focusing on optimizing the number of sensors in the patch, demonstrating successful use over 24 hours, and clinical trials. The University of Bath study with researchers from their Centre for Graphene Science, Centre for Nanoscience & Nanotechnology, and the Department of Pharmacy & Pharmacology, was published in Nature Nanotechnology in March. New Atlas

A possible combination? Treating Type 2 diabetes usually requires medication to regulate insulin. Glucagon-like peptide-1 (GLP1) causes the pancreas to release insulin but has a short half-life. Researchers at Duke University have developed a way to bind GLP1 to a heat-sensitive elastin-like polypeptide which forms a gel-like depot that releases slowly into the body. In early tests with mice and monkeys, the ‘depot’ releases a constant rate of GLP1 for up to 14 days. The slower human metabolism means that this may be a feasible 14-30 day treatment–and translate to the controlled release of other medications. New Atlas

UK health grassroots programs not waiting for the NHS: VR for COPD patient exercise, Now Patient for chronic care management

With the painfully slow adoption of health technology (besides telecare and limited telemedicine) in the UK, it’s heartening to see that there are some ingenious approaches outside the NHS gaining traction. The stories behind these two are interesting and inspiring.

Pulmonary Rehabilitation in Virtual Reality (PRinVR) from Concept Health was developed by a GP in a rural area of South Cumbria. Dr. Muhammad Farhan Amin of the Burnett Edgar Medical Centre on Walney Island in Barrow-in-Furness has many patients with pulmonary and lung problems who need to exercise and do specific breathing exercises. To aid them, he developed a five-step VR assessment and rehab program, It uses only a smartphone and a VR headset to transport a patient to a virtual beach where they can interact in an exercise class. The VR program connected via data to the internet can also tailor the breathing exercises individually and send the exercise record back to the health professional. It’s part of the ‘Better Care Together’ program that provides educational help, coaching on breathing strategies, and nutritional advice. Using VR this way is not new–we have reported on VR-aided rehab for several years going back to Microsoft Kinect and Army Medical–but what is different is its use in specific pulmonary conditions and its development in a very remote area. Dr. Amin’s Concept Health is only a year old, according to LinkedInThe Academy of Fabulous Stuff

On the waterfront in Salford Quays, Manchester, a local digital ad exec father who couldn’t book a GP for his son a few years ago has developed a telemedicine app that has virtual doctor visits and prescribing. Lee Dentith’s Now Healthcare has a private individual service (NowGP) that claims to be Europe’s largest, Now Healthcare (group/corporate), and the free Now Patient which combines pharmacy and the virtual visit. The apps and services have been inspected by the Quality Care Commission (QCC). 

Mr. Dentith told the Manchester Evening News that his market for Now Patient is the 15 million people with chronic care conditions who need regular repeat prescriptions, and noted that GP practices, despite the NHS, are private businesses. Now Patient achieved 60,000 downloads shortly after its October 2017 debut. Their focus is on the individual, group, and private pay market. To date Now has a £4m investment from MediCash in a Series A (Crunchbase). Now aims to have 25 million users on the three platforms. 

Hat tip to Roy Lilley’s NHS Managers newsletter via Steve Hards.

DARPA’s $5.1M contract with Kryptowire to develop passive smartphone health monitoring, predictive analytics

click to enlargeTruly unobtrusive health monitoring on the horizon? The Defense Advanced Research Projects Agency (DARPA) has contracted with cybersecurity firm Kryptowire to develop a health monitoring and analytics app to assess the health and readiness of warfighters (to us civilians–soldiers, sailors, airmen, and Marines) especially in the field. The WASH program–Warfighter Analytics using Smartphones for Health–will use the data from smartphone sensors like microphones, cameras, pedometers, thermometers, and accelerometers (see DARPA illustration, left above). Through sensor-based information, physiological and cognitive symptoms can be captured and analyzed.

Based on their information, most of the assessment will be passive rather than actively diagnostic, and with an emphasis on predictive health and a real-time approach to disease detection and biomarker identification. Part of the challenge will be to filter out the ‘noise’–extraneous information also captured by these sensors on a daily and extraordinary basis. Security, of course, is a major concern. (Where better than to award the app development to a cybersecurity company?)

DARPA is fond of commercializing its technologies (remember something called DARPANET?) so this is planned for commercial release in due time. Usage in clinical trials is an area mentioned. One day we may all be wearing smartphones which unobtrusively monitor our health and positive behaviors. (I’ll leave it to our Readers to say Yay or Nay to this notion.)

The award is for $5.1 million. A development timeframe is not mentioned. Business Wire, DARPA WASH page, HealthcareITNews, Daily Mail (which amusingly tries to paint this as a spy program through an ACLU representative quote).

The Theranos Story, ch. 48: down to 24 employees in a last ditch before bankruptcy

click to enlargeThe ground is next. Theranos is down to its last two dozen employees or less, in a bid to buy a few more months of time before bankruptcy, according to a breaking report in the Wall Street Journal.

The announcement was made by Elizabeth Holmes Tuesday to approximately 125 remaining employees at its downscale Newark, California headquarters. (This Editor wonders if she wore a black turtleneck.) Interestingly, Ms. Holmes remains CEO after settling civil charges with the Securities and Exchange Commission (SEC) while a criminal investigation continues out of the US Attorney’s office in San Francisco. 

The WSJ article from the estimable John Carreyrou (who deserves an old-school Pulitzer Prize for his investigative reporting) recaps Theranos’ fall for those who need it. But…there’s more. Theranos received only $65 million of $100 million promised in their last (ditch) funding from Fortress Investment Group late last year, revealed by Ms. Holmes in an investor email this past Tuesday. The remainder is contingent on Theranos achieving an FDA Zika blood test approval using their miniLab. She stated that this test is still having problems and appealed to investors for yet more funding. The layoffs were designed to keep their cash reserve over $3 million until the end of July, below which Fortress is entitled to seize Theranos’ assets and liquidate them. This, as we have previously noted, is Fortress’ specialty–as now fan dancing is Ms. Holmes’.

According to Mr. Carreyrou’s sources, Ms. Holmes is still living large in basic black. “Until Tuesday, Ms. Holmes still had two personal assistants and two security guards who drove her around in a black Cadillac Escalade SUV, according to the people familiar with the matter.” This Editor wonders what happened after Tuesday. Public transit? A used car for a few thousand?

Theranos and the $900 million in lost investment may have also put a wet blanket on 2017 health tech funding, based on what we’ve learned in Rock Health’s report [TTA 5 Apr]. Other companies with real advances and promise may be paying the price for Theranos’ hype and fakery.

Our 47 past chapters and other Theranos mentions are for your perusal in our pages here

Soapbox: JPM’s Dimon takes the 50,000 foot view on the JP Morgan Chase-Berkshire Hathaway-Amazon health joint venture

Mr. Jamie Dimon, the chairman and CEO of JP Morgan Chase, had a few thoughts about the JPM-Berkshire Hathaway-Amazon healthcare JV for all three companies. You’ll have to fill up the tea or coffee mug (make it a small pot) for it’s an exceedingly prolix Annual Shareholder Letter you’ll have to sled through to find those comments. Your Editor has taken her punishment to find them, towards the end of the letter in ‘Public Policy’. 

They demonstrate what this Editor suspected–an headache-inducing mix of generalities and overreach, versus starting modestly and over-delivering.

  • Point #1 sets up what has gone wrong. Among several, “Our nation’s healthcare costs are twice the amount per person compared with most developed nations.” Under point 2 on how poor public policy happened, an admission that Obamacare fixed little:

Here’s another example: We all know that the U.S. healthcare system needs to be reformed. Many have advocated getting on the path to universal healthcare for all Americans. The creation of Obamacare, while a step in the right moral direction, was not well done. America has 290 million people who have insurance — 180 million through private enterprise and 110 million through Medicare and Medicaid. Obamacare slightly expanded both and created exchanges that insure 10 million people. But it did very little to fix our broken healthcare system and has, in fact, torn up the body politic over 10 years — and this tumult may go on for another 10 years.

  • Point #7 is about fixing the deficit and the ill effects if we don’t. In Mr. Dimon’s view, healthcare is a major part of this through the uncontrolled growth of entitlements, with Medicare, Medicaid and Social Security leading the pack–skipping over the fact that nearly all Americans pay into Medicare and SSI well in advance of any entitlement collection. Healthcare is also an offender through unnecessary costs such as administrative and fraud (25-40 percent),  and six mainly chronic conditions accounting for 75 percent of spending.
  • The experts–specifically, their experts–will fix it! “While we don’t know the exact fix to this problem, we do know the process that will help us fix it. We need to form a bipartisan group of experts whose direct charge is to fix our healthcare system. I am convinced that this can be done, and if done properly, it will actually improve the outcomes and satisfaction of all American citizens.”
  • The generalities continue with
    • The JV “will help improve the satisfaction of our healthcare services for our employees (that could be in terms of costs and outcomes) and possibly help inform public policy for the country.” 
    • Aligning incentives systemwide ‘because we’re getting what we incentivize’
    • “Studying the extraordinary amount of money spent on waste, administration and fraud costs.”
    • “Empowering employees to make better choices and have the best options available by owning their own healthcare data with access to excellent telemedicine options, where more consumer-driven health initiatives can help.”
    • “Developing better wellness programs, particularly around obesity and smoking — they account for approximately 25% of chronic diseases (e.g., cancer, stroke, heart disease and depression).”
    • “Determining why costly and specialized medicine and pharmaceuticals are frequently over- and under-utilized.”
    • “Examining the extraordinary amount of money spent on end-of-life care, often unwanted.”
    • “To attack these issues, we will be using top management, big data, virtual technology, better customer engagement and the improved creation of customer choice (high deductibles have barely worked”).

This Editor has observed from the vantage of the health tech, analytics, payer, and care model businesses that nearly every company has addressed or is addressing all these concerns. So what’s new here? Perhaps the scale, but will they tap into the knowledge base those businesses represent or reinvent the wheel? 

A bad sign is Mr. Dimon’s inclusion of ‘end of life care’. This last point is a prime example of overreach–how many of the JV’s employees are in this situation? The ‘attack’ tactics? We’ve seen, heard, and many of us have been part of similar efforts.

Prediction: This JV may be stuck at the 50,000 foot view. It will take a long time, if ever, to descend and produce the concrete, broadly applicable results that it eagerly promises to its million-plus employees, much less the polity.