Rock Health puts a kind-of-positive spin on digital health’s ‘annus horribilis’ 2022–a boring 2023

January 13, 2023 | by

Your Editor will be blunt. 2022 was a bucket of cold water, a bursting of bubbles, and generally an annus horribilis (as the late Queen Elizabeth referred to 1992, 30 years prior) for digital health, healthcare tech, and healthcare in general.

Here are the highlights of Rock Health’s 2022 full-year report on digital health funding for US-based digital health companies, published late last week and presented this week at JPM, through the gimlet eye of your Editor: 

Total funding for 2022 was $15.3 billion. There were 572 deals, averaging a deal size of $27 million.

  • 2022 was just over half in activity compared to 2021’s “to the moon”: $29.3 billion over 738 deals averaging $39.7 million.
  • 2022 also barely made it past the pandemic year of 2020 with $14.7 billion over 480 deals averaging $30.6 million.
  • 2022 Q4 fell into a hole: $2.7 billion versus 2021’s $7.4 billion

If 2021 matched prior growth trends instead of the bubble it was, 2022 would have been viewed as flat or slightly down. 

Late stage mega deals fell into the same hole. In 2022, 35 digital health startups raised rounds of $100M or more, compared to 2021’s 88 and even 2020’s 43. 

The Covid-driven investment boom across digital health that characterized 2021 is over. The economy with a 6-8% rate of inflation, energy shortages in much of the world, supply chain disruptions, rising interest rates on money, and the rising possibility of recession led to investor cold feet. It ended the 2019-2021 takeoff and started a down cycle.

Recalibration to a ‘more sustainable run rate’ when it comes to investment

“Disrupting healthcare” may sound good, but it has a spotty track record of success. What’s attractive long term? Incremental transformation within conventional healthcare operations that in this Editor’s view cut time, cost, increase reliability, simplify processes and/or workflows, improve interoperability, reduce operational burden, or improve communication. Preferably, a combination of several of the previous!

D2C startups are particularly vulnerable to the economy–they run hot, multiple companies jump in, and then they’re cold. They have to invest a lot of money to establish a presence with consumers and that money is no longer cheap or available. Some with a decent consumer footprint can focus on B2B entry, though that is a long-buy cycle move.

Most companies will be focusing on the near term, with some of the smarter ones planting some ‘seeds’ for the future

A witty note in their report: “In the current VC climate, strong horses will beat out unicorns…though investors run the risk of betting on the wrong equine.” (Editor’s note–it may be hard to tell the difference. And unicorns have horns that poke bubbles.)

What was hot?

  • Series A deals, the conservative bets of VCs. Yet, in Rock Health’s view, these may be riskier: “investors are more likely to pay more on a risk-adjusted basis for a startup than its later-stage funders, twisting the risk-adjusted valuation upside down.” 
  • In clinical indications, mental health stayed top of the pops. Cardiovascular and oncology rose along with dark horse reproductive and maternal health. What fell? Diabetes.
  • In value propositions (sic), on-demand healthcare and R&D flipped positions from 2021. Dark horses nonclinical workflow, disease monitoring, and care coordination moved into the top 5

And what players had problems? Health systems and the tech giants seeking to move into healthcare and away from ad-based or transactional revenue. As we’ve seen, Amazon dumped Care and is facing scrutiny over One Medical, Alphabet is cutting Verily, and Meta is overall pulling back. Microsoft seems to be concentrating on incrementals and Apple has other concerns over sourcing and patents.

Rock Health’s conclusion is ‘kind-of-positive’. (What, you expected doom and gloom?) “We expect that 2023 will be built up on slow, steady, and maybe even boring strategies for healthcare startups and enterprises alike: managing cash, re-structuring to accommodate revenue volatility, and investing in technology infrastructure.”

Wednesday news roundup: Oracle-Cerner reportedly OK’d by EU, VitalTech RPM raises $14.1 M, Aging 2.0 interoperability challenge, what do rough times mean for investors and startups, employees cause 39% of healthcare IT breaches

May 25, 2022 | by

One regulatory hurdle down for Oracle’s $28 billion Cerner acquisition? The EU has reportedly given an unconditional EU antitrust clearance to Cerner, three sources informed Reuters. The formal announcement will be made 1 June. In the US, the long and winding road of Federal antitrust scrutiny and review began in February by the usual alphabet agencies–DOJ, FTC, and SEC–that show no sign of wrapping up [TTA 11 Feb]. Cerner continues to run into headwinds in its VA EHR implementation including spotty interoperability with the Military Health Service DOD version [TTA 18 May].

In a small confirmation that RPM is on the rise, Texas-based VitalTech raises $14.1 million in a Series B equity raise. The company offers an app-based remote patient monitoring platform for vital signs, med and nutritional reminders for use by home and hospital/acute care. Investors were not disclosed and the total offering has about $2.1 million remaining in unsold equity. Their undisclosed Series A funding dated back to 2019 and funded by Concord Health Partners and Stanley Ventures. SEC filing

The international Aging2.0 organization announced the Global Innovation Search (GIS), an opportunity for innovators around the world to showcase innovations that enable and promote a system-level approach to improving quality, continuity, and efficiency of care through interoperability. The eight finalists will participate in a Care Tech Pitch at OPTIMIZE, Aging 2.0’s annual conference on 21-22 September in Louisville, Kentucky. Applications close 12 June. The GIS is associated with the Louisville Healthcare CEO Council (LHCC) and will require the winner to relocate to Louisville. More information here.

What does this mess of a market mean for healthcare investors, startups, and companies looking for equity or VC investment? Industry figure Lisa Suennen, who has been to this rodeo before, has a POV in her Venture Valkyrie blog that HISTalk has summarized neatly, if not cheerfully. Major points: the downturn in funding will lag the market by 3-6 months, VCs will stuff the cash and wait for deals at lower valuations, few exits mean that portfolion companies will be burning through cash and dependent on existing investors, and there will be less-well-funded companies and funds which will go belly-up. This Editor’s disagreement is only that VCs lag downturns. In 2008, heading marketing in an early sensor-based monitoring company running out of funds, funding became scarce months ahead of the downturn.

39% of healthcare data breaches are caused by employees, according to Verizon’s latest cybersecurity Data Breach Investigations Report–more than any other industry at 18%. Incidents hit an all time high in healthcare, with 849 incidents and 571 breaches last year. 76% of breaches centered on basic web application attacks (attacks against a web-facing app–30%), system intrusions (malware, hacking–26%), and miscellaneous errors (mostly unintentional–21%).  Personal data was nearly 60% of the data compromised, while 46% was medical. Much more in the report. Healthcare Dive

Two NY area events: Mission Physician Transition and ‘Their Big Idea’

June 15, 2018 | by

Tuesday, 26 June: Mission Physician Transition, hosted by Health 2.0 NYC and MedStartr, 6-9 pm, at McCarter & English, 825 Eighth Avenue, NYC

Physicians are increasingly dissatisfied with just being clinicians and want to get involved in healthcare innovation. Similarly, innovative companies need the clinician’s insight into how care actually works in order to create solutions that work for doctors, patients, and all stakeholders in the healthcare value chain. Speakers/panelists to be announced. To register, go through Meetup here.

Thursday, 28 June: Entrepreneur’s Forum–Their Big Idea. Hosted by BioInc@NYMC & iCANny, 5-7 pm, at NY Medical College’s The Café, 19 Skyline Drive, Hawthorne, NY 

Four entrepreneurs present the ideas which they believe could be The Next Big Thing. Moderated by Dan Potocki of Finis Ventures who is experienced in spearheading business development and strategic initiatives for industry-leading data analytics tech startups. Cost: $15 non-members; $12 members, and includes wine and cheese refreshments. Register in advance here.

#MedMo17: the conference, winning startups, Bayer, blockchain, and more

December 6, 2017 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/12/MedMo-header-crop.png” thumb_width=”150″ /]MedStartr Momentum‘s conference last week was extremely well attended, with 260 registrations over the two days at PricewaterhouseCooper’s NYC HQ. It jumped! (Disclaimers: your Editor is one of the hosts and co-organizers; TTA is a media partner) #MedMo17 had about 50-60 total speakers, presenters, and panelists in fast-moving sessions, most 10-15 minutes, with panels clocking under one hour.

What’s always unusual about MedStartr conferences is the mix of topics and people, and not just from NY. There were startups just getting going, successful startups sharing their stories, patient advocates, providers, and investors sharing what they want to see (and not see) before they fund. There was Deborah Estrin from Cornell Tech describing how they nurture graduate student tech entrepreneurs and Maria Gotsch from the Partnership Fund for NYC discussing how they accelerate, partner, pilot, and fund companies coming to market. One sponsor was nearby Newark NJIT’s NJ Innovation Institute–and one of the presenting companies was Uniphy Health (formerly PracticeUnite) that they’ve worked with and helped make successful over five years. Who would have expected a wild discussion about blockchain? Well, here, hosted by media personality/entrepreneur Ben Chodor (HealthTechTalk Live) with panelists ranging from a digital asset hedge fund founder to a patient advocate. For two panels, questions came from ‘the field’ via a Reddit ‘Ask Me Anything’.

Notably, Bayer G4A Generator, coordinated in the US by Aline Noizet, came on board as a sponsor. They came to the right place as they are seeking early-stage companies for Bayer Grants4Apps. In the US, they are seeking new companies developing self-care products: nutritionals/wellness, therapeutics (pain management, seasonal health), personal care (skin, sun, footcare), and self-care in general. Bayer also runs similar programs in Berlin (Accelerator and Dealmaker), Barcelona, Tokyo, Moscow, Singapore, Shanghai, and Italy.

Of the 18 Grand Challenge finalists competing for financing and guidance, the winners were: Population Health–Valisure (online pharmacy pre-screening meds); Wearables/Medical Devices–Alertgy (non-intrusive continuous blood glucose monitoring); Clinical Innovations–eCaring (at-home senior care monitoring), and in Killer Apps, a product that actually kills bad bacteria on the skin–Xycrobe (good recombinant bacteria for dermatological use). Special awards were given to Check with Ellie (breastfeeding questions answered, Momentum Award for growth) and MedAux (patient ed and HIPAA compliant messaging–Crowd Choice Award).

The full conference (Thursday and Friday) is up on video at Medstartr.tv. And in 2018, it will be 29-30 November, so put it in your calendar. Kudos to the MedStartr team, especially Alex Fair. Hat tip also to the NOLA (New Orleans) Health Innovation Challenge 

MedStartr’s ¡Viva La Evolución! evolves on Wed 5 April (NYC)

March 25, 2017 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/11/MedStartr_red_grey_sm.jpg” thumb_width=”150″ /]After an intense and overflow attendance Hospital Innovation Programs Roundtable last Wednesday hosted by NYC’s largest urgent care, CityMD, and with eight speaker/panelists from Mount Sinai, NY-Presbyterian, Northwell, and Startup61/Melbourne Australia Health Accelerator, what could be better than doing it again in two weeks?

Wednesday 5 April’s MedStartr/Health 2.0 NYC presentation on healthcare’s evolution will be a little more relaxed with three panelists so far, but they are rare ‘gets’: Greg Downing, DO is the Executive Director of Innovation at the US Department of Health & Human Services (HHS), an institution much in the news with Federal changes in healthcare. Jay Parkinson, MD, MPH developed the first commercial cloud-based EHR, Hello Health, back in 2008 and founded his current telemedicine company, Sherpaa Health, five years ago. Rich Park, MD is both host and the founder-CEO of CityMD. All have different views of how healthcare is evolving, so it should be both an interesting and full evening. It begins at 6 and wraps up at 9pm, with plenty of networking time.

Tickets are $35. Advance reservations are required due to building security. Ticketing is being done through the Meetup Group Health 2.0 NYC here. If you are not a member, please email MedStartr directly at members@Medstartr.com.

Videos are now online for the 22 March Hospital Innovations program and 1 March’s Rise of the Healthy Machines (#RISE2017). The latter includes keynotes, panels, and the six pitches for the Challenge. December’s #MedMo16 is also online.

TTA is a MedStartr and Health 2.0 NYC supporter/media sponsor since 2010; Editor Donna is a host for this event and a MedStartr Mentor. Check the MedStartr page to find and fund some of the most interesting startup ideas in healthcare.

The mixed picture of health tech investment: a potpourri

March 25, 2016 | by

One picture is generally positive–plenty of opportunity in the aging and ill population, particularly in data integration from various sources, and value-based care. Everyone loves the excitement that a startup with a novel technology or way it can make knowledge more useful brings to the field.  Another picture is one of pitfalls aplenty, from overhyping technology (poster child, Theranos) to overestimating growth, overspending and especially picking the wrong (nervous, impatient) investors at the wrong time, which have left a general patina of mistrust around digital health. There’s also the fact that healthcare is a highly, confusingly regulated, long-cycle business that’s challenged money-wise, whether in the US, UK, Europe or Asia. Some advice to startups contained in these two articles, including from the principals of StartUp Health accelerator (who’ve seen it all), has to do with building trust, finding the right investors, the right advice/advisors, collaboration (though that is difficult with IP), finding proven (affordable) management and a sustainable (and resilient) culture. Underpromise, overdeliver.  TechCrunch, Healthcare Dive

No wonder that investment was flat in 2015, and that much of the news is around acquisitions that rearrange companies and/or offerings. The latest today is Allscripts‘ and GI Partners’ acquisition of behavioral EHR/care coordination company Netsmart for $950 million; Allscripts is moving its homecare business into Netsmart’s CareFabric suite. Kansas City Business Journal, Healthcare Dive  In addition we’ll cite our earlier Mo’ Money article on the $600 million in various digital health investments. UPMC, which had invested in Vivify Health’s telehealth/RPM platform, is spreading $3 million around partly in-house to six health tech projects developed under the Pittsburgh Health Data Alliance. And in an example of Wearables Confusion, investors put $16 million into LifeBeam to develop another DTC ‘holistic’ health wearable (LifeBeam’s origins are sensors for aerospace and defense) while early wrist fitness entrant Pebble has laid off 40 staff in an attempt to refocus on…fitness.

Early-stage companies are also alliancing and merging. Fresh out of Newark and the New Jersey Institute of Technology’s NJ Innovation Institute, the merger of Practice Unite (which knits together secure mobile clinician/patient communications into a customized platform) and Uniphy Health (physician engagement), is an example of complimentary enlargement. This expands care collaboration offerings and shades over into patient engagement if you look at the PHM quadrant here. According to Director/Chief Medical Officer Stuart Hochron, MD (who was a Practice Unite founder), “We’re really pleased with the outcome of this merger. It’s given us the capital and resources that we need to scale.” It’s also good to see that both the founders and the CTO are moving into the new Uniphy Health–and staying in Newark.  Release

HCF Catalyst’s first startup/scaleup accelerators–apply by 27 Nov (Australia)

November 6, 2015 | by

HCF, Australia’s largest non-profit healthcare fund, has started Australia’s first true accelerator for health tech, HCF Catalyst. While accelerators have been around now for the better part of 10 years in the US and UK, they are new Down Under. Both startup and scaleup programs are on offer.

  • Startup: a three-month education/support program with a following three-month incubation program; initial investment of AU$50,000 and a next-round opportunity for up to AU$100,000 from the Slingshot Venture Fund. Qualifying teams should have, to quote their page, an idea that aligns to one of the HCF Catalyst themes, a fantastic team, able to deliver an MVP within three months of starting and global aspirations. See information and apply here.
  • Scaleup: for early-stage companies with business which are in growth mode, this is an access program that includes mentoring and coaching–no funding but access to investors, mentoring, coaching and a ‘demo day’. More information and to apply here.

Partners include Sparke Helmore, PWC, University of Newcastle, Artesian Capital Management and IBM SoftLayer. Hat tip to George Margelis via Twitter and Shawn Larkin, HCF Managing Director on LinkedIn.

Two US events: Health Wildcatters Pitch Day (Texas), mHealth Deep Dive (California)

November 3, 2015 | by

Health Wildcatters Pitch Day: 12 November, Majestic Theatre, Dallas Texas

This Texas accelerator will be presenting its 2015 class of 10 early stage companies in 10 days. Doors open at 2:30pm and the presentations are 3-5 pm. All attendees are cordially invited to the Pitch Day After Party which is a short two-block walk from the theatre at the Health Wildcatters office, 211 N. Ervay Street, 2nd floor. The $10 ticket cost is primarily to defray Eventbrite (having worked with them before!) as it is well-sponsored indeed. More information and registration here. Hat tip to Fiona Schlachter.

Deep Dive: Health/mHealth/eHealth: 8 December, 2825 Lafayette Street, Building 34 (EBC entrance), Santa Clara, California

Shrinking smart devices, sensors, cloud services, connectivity, and an aging population have all created tremendous changes in healthcare and fitness. This half-day deep dive meeting will discuss wireless and mobility solutions, as well as the fixed and fiber side that enables remote radiology and VR tele-surgery through robotic arms. If you are interested in the marriage of startup tech with the health and fitness industries, join in this discussion and networking. It probably pays to be a member as the non-member fee is steep. There are also ‘spotlight tables’ that are discounted 50 percent for pre-revenue startups. Sponsored by the Telecom Council of Silicon Valley. Information and registration. Hat tip to Editor Charles and Mike Clark.

Are we in the midst of healthcare disruption–or not at all?

October 8, 2015 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/02/gimlet-eye.jpg” thumb_width=”150″ /]If you believe we are in the midst of a slow, tidal disruption of healthcare and the ascendancy of patient-centered care–to the point of Topolesque patient ownership–then you will be upset to tears by the contrarian assertions of Dan Munro in Forbes. He maintains that disruption isn’t what we think it is, but (and we cut to the chase here) it’s more like ‘process improvement’ and that it has to be driven by ‘K Street’ (translation: the street in Washington DC where Lobbyists Rule). Technology–patches on the flawed system. Doctors–desperately seeking to pay back their educational loans by picking the most lucrative specialties. (If they survive the internship and residency system without killing a patient or themselves; see The Misery of a Doctor’s First Days)

But..there’s more. (more…)

Accenture projects that 50 percent of digital health startups fail after two years

August 18, 2015 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/08/Accenture-zombie_webready.jpg” thumb_width=”175″ /]Based on historical funding data and analyzing 900 healthcare IT start-ups, Accenture predicts that within two years of life, 50 percent will fail. These ‘zombie startups’, in Accenture’s charming term, burned through $4 bn in funding between 2008 and 2013. An additional $2.5 bn will go to fund digital health in 2015-16.

Does this mean that for the angels to the VCs, a visit to Las Vegas may be more fun? What remains can be mined for gold. There’s a wealth of IP–1,700 patents between the 900 startups analyzed–and experienced people who can be “aqui-hired”. Their solutions, despite failure, can be sound. Kaveh Safavi, managing director of Accenture’s global health care business, said, “Many digital startups that are dying or in danger of failure have developed solutions that can help traditional and non-traditional health care companies achieve their goals.” Mobihealthnews, iHealthBeat, FierceHealthIT. Accenture announcement.

Do startups truly threaten the ‘healthcare establishment’?

May 19, 2015 | by

Or are successful startups fitting into their game? Chris Seper in MedCityNews paints the picture of one side of a quandary. The ‘healthcare establishment’ fundamentally and to its detriment does not understand and is threatened by the startup and innovation process. A startup may begin with an idea which is, in his words, ‘almost always flawed, sometimes deeply’. If the founders are smart, they will test their ideas, validate them and change them appropriately. If not, they will fail. But it is easier for the Establishment to point at the most egregious of the bad ideas and use them to rationalize the status quo.

But being congenital contrarians, we paint the house on the other side of the street. Has the Establishment caught up with–or in some cases, co-opted startups, making them and their funders ‘do their diligence’ and be more cautious before emerging? This Editor would argue yes, and largely for the better.

**The ‘Wild West’ days are over. A few years ago, a truly bad or deeply flawed health tech idea or could easily find funding, because it was all blank slate, new and ‘transformative’.The sexiest hooks were Quantified Self, sleep, employer health incentives, interactive coaching, genomics, app prescribing and (last) wearables. A lot of founders imagined themselves as the Steve Jobs of Healthcare, down to the black turtleneck. Now there is a history of success and failure. The railroads reached the dusty frontier towns.

**There’s now a ‘Startup Establishment’. National accelerators (more…)

Healthcare Innovation Breakfast Series (Dallas, Texas)

February 18, 2015 | by

Having met and been impressed at mHealth Summit by Health Wildcatters [TTA 26 Apr 13], a Dallas Texas-based healthcare accelerator, they are doing some smart marketing in sponsoring a series of local networking breakfasts called The Pulse to connect entrepreneurs, medical professionals, and other innovators from the thriving Dallas healthcare and business communities with healthcare startups. Their launch is Thursday 26 February from 7:30-9am. Coffee and continental breakfast is provided and the cost is an affordable $15. Reserve here. Hat tip to Hubert Zajicek of Health Wildcatters via Twitter

A primer on why startups fail

February 13, 2015 | by

What makes for a successful startup? Or the converse–what are the Elements of Doom for all those Better Mousetraps? Since many of our Readers have Been There, Done That or Considering That, this blog posting by David Skok of VC Matrix Partners (with only minor holdings in healthcare) could be illuminating. Five factors are detailed succinctly and in plain English: market problems (timing, value proposition), business model failure, poor management, running out of cash and product problems. The calculation of CAC (Cost of Acquiring Customer)/ LTV  (Lifetime Value of Customer) with a multiple of CAC:LTV at 1:3-5+ essential. To this Editor, these Elements also apply to later stages. For Entrepreneurs, “Why Startups Fail.” Hat tip to MedCityNews via Twitter.

How startups are being damaged by patent trolls–and turning the tables

September 13, 2013 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/09/TROLLS-1992-008.jpg” thumb_width=”150″ /]In February and for a few months, this Editor was on a tear about the quaintly dubbed patent trolls–primarily (but not always) non-practicing entities (NPEs) which don’t create or market products, but buy up other people’s/companies’ patents and then seek out opportunities to license them. These NPEs target and challenge vulnerable startups and early-stage companies to defend their patents and systems; the suit for royalties, the financial threat, the papers filed, the attorneys called, the money spent and the eventual settlement (or licensing) is in reality just a form of what’s called in Latin America la mordida. It becomes cheaper to settle than to fight–and the cost can be six or seven figures. 

The shots over the bow were in 2012: Bosch’s February lawsuits against Waldo Health, ExpressMD/Authentidate and MedApps (now Alere Connect) [TTA 16 Feb 2012] and then the strange practice of PHR developer/patent accumulator MMRGlobal [TTA 23 Oct 2012] in sending hundreds, perhaps thousands, of letters out to EHR/EMR users to advise them of possible patent violations and demanding licensing. This Editor observed then and during the spring this year that it was only a matter of time that NPEs would pounce on healthcare tech as investment action accelerated. Yet discussions by this Editor with companies in some public venues indicated a certain level of obliviousness to the threat–that there were not enough assets to go after, thus healthcare startups made poor targets–though side conversations with IP specialist attorneys indicated otherwise.

Well, the trolls have reared their fuzzy heads again, uglier than ever, in this drama-laced article in Wired. (more…)

Angels to the rescue in health tech

August 2, 2013 | by

Funding ‘angels’ in the health tech space are increasingly taking on roles that go beyond investing.  Venture-Med Angels has funded 24 companies in seed and Series A rounds, generally at less than $500,000 along with larger syndications, in areas as diverse as Class 1 and 2 medical devices, including diagnostics, as well as mobile health, health IT, telehealth and remote diagnosis. A key problem is in this admission–so many companies have similar products or services. Common to accelerators, the Angels give their help to startups in pitches, achieving milestones and understanding the importance of their intellectual property. From company name to investment, Venture-Med Angels advise startups (Entrepreneurship.com’s eMed/MedCityNews)