Healthcare Innovation Models and Accelerators

By Clive Riddle, November 7, 2014

Intermountain Healthcare and Healthbox just announced an interesting healthcare innovation collaboration, with their Innovation at Intermountain Healthcare Initiative. Intermountain is the Utah-based health system non-profit juggernaut with 22 hospitals, 185 clinics, 1,100 employed physicians, and the SelectHealth health plan.

A physical structure in Salt Lake City is being constructed next to Intermountain’s flagship medical center to house the initiative, which includes three components:

  1. The Intermountain Foundry which they state “provides a structured framework for help high-potential employee ideas and near-market concepts become commercial businesses.”
  2. Strategic Investments that “will source companies from the broader healthcare ecosystem and develop partnerships that include investment and potential customer relationships.”
  3. The Healthbox Salt Lake City Accelerator, which launched in September in partnership with Health Equity, Zion’s Bank and BD.

Healthbox sees themselves as a “preeminent source of healthcare innovation and drives actionable collaboration between inventors, entrepreneurs and the healthcare industry.” They have operations in five key markets across the U.S., in addition to London and Tel Aviv, and a portfolio of more than 80 active companies and strategic partnerships with more than 30 healthcare organizations.

Speaking of Accelerators, the just released November issue of Healthcare Innovation News addresses the question “how can healthcare accelerators ensure success in their quest to nurture entrepreneurs and support their startup ventures?” in their Thought Leaders’ Corner. Below are three selected responses to this question from their Thought Leader panel.

Tom Olenzak, Director, Innovation at Independence Blue Cross in Philadelphia says “we believe that the key issue facing healthcare innovators is access to customers. The investment of time, expertise and resources by potential customers is critical to help startups turn their innovative ideas into sustainable businesses and products. That’s why we participate in healthcare accelerator programs, such as DreamIt Health Philadelphia. DreamIt Health puts a focus not only on providing funding, but also on the mentorship and access needed to nurture the startups.  I’ve seen firsthand how access to a customer’s point of view, along with business knowledge and data, can have a direct impact on the success of startups. Last year we provided anonymous claims data to the startup Grand Round Table and these data helped the company to solidify its value proposition, helping doctors find appropriate diagnoses faster and reducing the number of unnecessary tests and treatments. The healthcare industry, as we know it, is experiencing dramatic change, and the future of the industry relies on innovative thinking to overcome our biggest challenges. Healthcare accelerators that establish the perfect blend of entrepreneurial coaching and corporate support are the ones that will be successful in developing ventures that push the envelope, and deliver solutions that provide high-quality, affordable care that patients deserve. The future of our industry depends upon innovation, but the opportunities are endless when you embrace partnership and have the right mix of bright minds. Most accelerators help companies grow, but those that provide access to customers and other decision makers breed startups that develop sustainable and scalable solutions to the most pressing challenges.”

Scott Shreeve, CEO at Crossover Health in California says he believes “the challenge for health accelerators is to nurture disruptive ideas and companies yet remain connected to the needs of healthcare providers and payers. Accelerators are good at incubating consumer-focused, digital health innovations. Exciting for sure, but we don’t always see how these isolated innovations bridge the ongoing divide between consumers and providers, and the realities of our current third-party payer system. This is critical in our view because transforming the costs and quality of care won’t be consumer, provider or payer led, but a powerful mix of all three. Crossover Health works with leading employers to deliver primary care services directly to employees via worksite, near-site and virtual care models. We focus on delivering an exceptional patient experience, which not only develops deep patient/provider relationships but also inspires people to take ownership of their health. Innovative provider-led, care delivery and new direct payment models support our experience-centered approach. And, critical to its success are our discovery and adoption of digital health technologies that create new channels of communication, enable population health analytics and facilitate chronic health management in new and different ways. Accelerators can help ensure the success of their startups by making a strong effort to collaborate with equally disruptive providers, who are working with payers that are willing to think differently about health. It’s the responsibility of the accelerator to match different key players together to yield the greatest opportunities and results. By creating a mutual selection process, accelerators can show the power and values of true technology and market disruption.”    

Jason Wainstein, Principal at Deloitte Consulting in Philadelphia shares that “ensuring success is a lofty quest given the nature of accelerators. Not all ideas will pan out. So it’s not about batting 1000; its about providing the best environment to foster the maturation of concept into a viable business. Four dimensions that are critical for accelerator success are: Maintain the right temperature. Many start-ups are focused on building their product/service offering and can benefit from enhanced structure and commercialization cadence, as well as lessons learned from prior startups. Providing a playbook allows the thought leaders to stay focused on building the business. Perfect the role of super connector. One of the greatest values of an accelerator is connecting startups with industry leaders, potential investors and target distribution channels. The top accelerators work relentlessly at building their networks and actively connecting their portfolio companies to these relationships. Be a talent agent. With top talent in high demand, having a network of highly skilled resources that can be brought to bear on short notice can make the difference between success and failure given how aggressively startups must move. Know the white space. There is no shortage of ventures that pop up to capitalize on the hype of the moment, for example, analytics, patient engagement, chronic disease and remote monitoring—like moths to a light. Knowing the white space within these areas and guiding startups to differentiated positions are critical. Otherwise, young companies risk becoming noise in an overcrowded system. Accelerators must treat each startup as a customer, focus on the four dimensions above and be selective in which ideas are brought into the fold based on cultural and content fit.”

Derek Newell, CEO of Jiff in Palo Alto says that “accelerators, by definition, exist to help develop very early stage companies. At this stage, entrepreneurs must transition their companies from a concept phase to a delivery phase. In order to do this effectively, they need to clearly define their value proposition, product and business model. There are two key ways accelerators can support entrepreneurs in facilitating this process.

First, accelerators should connect entrepreneurs to potential customers. Customers validate the product and let companies know they have a commercially viable concept. Talking to customers is the most important thing a startup can do to refine its value proposition. In addition, customers provide critical feedback on product. For the first time, the venture will understand the problem and their target customer’s’ needs at the level of detail necessary to create a meaningful solution for it. Finally, accelerators can help startups figure out their business models early. Many entrepreneurs coming into the healthcare space lack a deep understanding of the complexities and nuances of the industry. Unless the venture is developing a new technology, there is probably a good reason that the solution doesn’t already exist. Within an accelerator, industry experts can help the entrepreneur identify and understand the stakeholders, existing systems and barriers to entry. The forces inhibiting the adoption of the company’s solution could include technology, regulation, operations and/or sunk costs, just to name a few.

By introducing entrepreneurs to potential customers and helping them better understand the healthcare industry, accelerators can help startups navigate this space and support them as they refine their value proposition, business model and product.”


US Healthcare Spending Waste, Unnecessary Cost, and Fraud

By Claire Thayer, November 5, 2014

The United States spends almost $3.8 trillion annually on healthcare – or 18% of GDP. Of this amount, almost one-third of healthcare spending is estimated to be attributed with waste, unnecessary services and fraud. MCOL’s infoGraphoid this week highlights some of the major types of waste, estimated number of unnecessary surgeries, new healthcare fraud investigations and more:

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.


Top Ten Medical Innovations for 2015

By Clive Riddle, October 31st, 2014

The Cleveland Clinic annually announces their take on the Top Ten Medical Innovations that are likely to have major impact on improving patient care in the coming year. They have just released their ninth annual version of this list, selected by a panel of 110 Cleveland Clinic physicians and scientists. With no further adieu, here – verbatim – is their narrative on their compilation of the Top 10 Medical Innovations for 2015:

  1. Mobile Stroke Unit
    Time lost is brain lost. High-tech ambulances bring the emergency department straight to the patient with stroke symptoms. Using telemedicine, in-hospital stroke neurologists interpret symptoms via broadband video link, while an onboard paramedic, critical care nurse and CT technologist perform neurological evaluation and administer t-PA after stroke detection, providing faster, effective treatment for the affected patient.
  2. Dengue Fever Vaccine
    One mosquito bite is all it takes. More than 50 to 100 million people in more than 100 countries contract the dengue virus each year. The world's first vaccine has been developed and tested, and is expected to be submitted to regulatory groups in 2015, with commercialization expected later that year.
  3. Cost-effective, Fast, Painless Blood-Testing
    Have the days of needles and vials come to an end? The new art of blood collection uses a drop of blood drawn from the fingertip in a virtually painless procedure. Test results are available within hours of the original draw and are estimated to cost as little as 10% of the traditional Medicare reimbursement.
  4. PCSK9 Inhibitors for Cholesterol Reduction
    Effective statin medications have been used to reduce cholesterol in heart disease patients for over two decades, but some people are intolerant and cannot benefit from them. Several PCSK9 inhibitors, or injectable cholesterol lowering drugs, are in development for those who don't benefit from statins. The FDA is expected to approve the first PCSK9 in 2015 for its ability to significantly lower LDL cholesterol to levels never seen before.
  5. Antibody-Drug Conjugates
    Chemotherapy, the only form of treatment available for treating some cancers, destroys cancer cells and harms healthy cells at the same time. A promising new approach for advanced cancer selectively delivers cytotoxic agents to tumor cells while avoiding normal, healthy tissue.
  6. Checkpoint Inhibitors
    Cancer kills approximately 8 million people annually and is difficult to treat, let alone cure. Immune checkpoint inhibitors have allowed physicians to make significantly more progress against advanced cancer than they've achieved in decades. Combined with traditional chemotherapy and radiation treatment, the novel drugs boost the immune system and offer significant, long-term cancer remissions for patients with metastatic melanoma, and there is increasing evidence that they can work on other types of malignancies.
  7. Leadless Cardiac Pacemaker
    Since 1958, the technology involved in cardiac pacemakers hasn't changed much. A silver-dollar-sized pulse generator and a thin wire, or lead, inserted through the vein kept the heart beating at a steady pace. Leads, though, can break and crack, and become infection sites in 2 percent of cases. Vitamin-sized wireless cardiac pacemakers can be implanted directly in the heart without surgery and eliminate malfunction complications and restriction on daily physical activities.
  8. New Drugs for Idiopathic Pulmonary Fibrosis
    Nearly 80,000 American adults with idiopathic pulmonary fibrosis may breathe easier in 2015 with the recent FDA-approval of two new experimental drugs. Pirfenidone and nintedanib slow the disease progress of the lethal lung disease, which causes scarring of the air sacs. Prior to these developments, there was no known treatment for IPF, in which life expectancy after diagnosis is just three to five years.
  9. Single-Dose Intra-Operative Radiation Therapy for Breast Cancer
    Finding and treating breast cancer in its earliest stages can oftentimes lead to a cure. For most women with early-stage breast cancer, a lumpectomy is performed, followed by weeks of radiation therapy to reduce the likelihood of recurrence. Intra-operative radiation therapy, or IORT, focuses the radiation on the tumor during surgery as a single-dose, and has proven effective as whole breast radiation.
  10. New Drug for Heart Failure
    Angiotensin-receptor neprilysin inhibitor, or ARNI, has been granted "fast-track status" by the FDA because of its impressive survival advantage over the ACE inhibitor enalapril, the current "gold standard" for treating patients with heart failure. The unique drug compound represents a paradigm shift in heart failure therapy.

Wondering what Cleveland Clinic proclaimed a year ago would be the top innovations for this year? Here was their top ten list from last year:

  1. Retinal Prosthesis System – Early Stage Bionic Eye
  2. Genome-Guided Solid Tumor Diagnostics
  3. Responsive Neurostimulator For Intractable Epilepsy
  4. Direct-Acting Antiviral Oral Hepatitis C Drugs
  5. Perioperative Decision Support System
  6. Fecal Microbiota Transplantation

  7. Relaxin For Acute Heart Failure
  8. Computer-Assisted Personalized Sedation System
  9. TMAO: A Novel Biomarker For Heart Attack, Stroke Risk
  10. B-Cell Receptor Pathway To Treat Blood Cancers

Google Wants to Helpout Your Health

by Kim Bellard, October 21, 2014

I suppose it was inevitable that I'd end up writing something about Google's interest in health, since recent posts have focused on efforts from Facebook and Amazon, as well as the general gold rush for health IT.  Fortunately Google has obliged me by introducing a neat health-related wrinkle on their Helpouts service.

Google's new service pops up an offer to do a video chat with one of their Helpouts physicians when you are doing health-related searches, in case you want more expert opinions and advice.  It certainly beats getting an ad for a pill or a health aid (although I don't imagine Google will stop presenting those as well).

Let's back up.  For those of you not previously familiar with it (and count me among those), Helpouts is a Google service, launched last November, that allows consumers to connect with applicable experts via live video chats. 

The new feature connects the service to search results.  You may not have Google Helpouts top-of-mind when looking for health information, but it's a pretty safe bet that you might use Google search in doing your research.  Pew says 72% of Internet users searched for health information within the past year, with 77% of them starting with a search engine. 

"Google Docs" takes on a whole new meaning now, doesn't it?

The telemedicine aspect of Helpouts is not strikingly new.  What distinguishes Google's effort, of course, that it is pro-active.  It doesn't wait for you to decide things are serious enough to seek out a doctor, but, rather, uses your search activity to trigger the offer of a consult.  I think this will be an important part of our health system's future -- not merely reacting but being proactive.  All these remote monitoring devices are pretty pointless if we don't use them to try to intervene early, instead of waiting for an acute event or an office visit to trigger care.

I have a couple of suggestions, or at least questions, on the new Helpouts feature:

  • It's not clear to me how specific the type of physician available is to the search request.  If you are searching on angina, for example, it'd be nice if you got a cardiologist to talk with rather than a dermatologist.
  • It's not clear to me if the experts are always physicians, or if they triage the experts based on the severity of the information being searched for.  

On the second point, I've written before about personal health assistants -- including Better from The Mayo Clinic -- as well as potentially using AI to provide such a service.  I think it'd be even cooler if Helpouts gave you a personal health assistant, starting with an AI agent and progressing to a specific human team if necessary, with physicians available for the most complex needs.  Maybe that's Helpouts 2.0.

Of course, Google's health interests don't end with the current Helpouts approach.  They are already pushing Google Fit as a way for Android developers to connect their health apps, and it'd be a great next step if Google could tie Helpouts to those apps, using the data mined from them to trigger an offer of a consult -- or an intervention, depending on the urgency of the need.

It'd be even better if you could opt-in your own physician(s) and health system to the Helpouts service instead of relying on Google's set of physicians.  

As long as I'm already trying to come up with more things Google could do in health, I might as well add that I'd love to see them get into the transparency business.  They try to help consumers find the best prices for other goods, and certainly health care can use all the help it can get in this regard.

Google is thinking bigger than these more modest expansions, like their "moonshot" to genetically map a healthy human body, or their new health and well-being company Calico, which has already announced the building of a major research facility.  I like that they are taking the long view, focusing on prevention and cures rather than simply more treatments, but there's still plenty of ways they can help the health care system in the short term as well.

Hmm, Google loves robots: maybe robotic surgery -- or doctors -- is next.

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting


Surveying Physicians on Their Views of the ACA

By Clive Riddle, October 17, 2014

The Medicus Firm, a national healthcare recruiting firm has just released results regarding health reform, from their 11th annual Physician Practice Preference Survey. This year’s survey shows an uptick grades doctors give the Affordable Care Act, but a still overall negative review. 2,272 physicians and advanced practice providers from 19 specialties and all 50 states participated in this year’s survey.

When asked to give the ACA an overall grade, 8.6% awarded an “A”, up from 6.3% last year. Meanwhile, 22.35% graded the ACA an “F” this year, down from 30.2% a year ago.

The survey went on to ask doctors to rate the ACA on specific objectives, such as improving efficiency of healthcare, improving access to healthcare, improving quality of healthcare, and decreasing healthcare costs. Medicus reports that “the best and most improved grades were awarded for ‘improving access to healthcare’, with a resounding 23.4 percent giving the ACA an ‘A’ in this objective, up from 11.8 percent last year. Additionally, 27.11 percent of physicians gave the ACA a ‘B’ for improving healthcare access. Only 13.68 percent of respondents failed the ACA in this category, down from 23.6 percent who gave it an ‘F’ last year for this objective. The objective receiving the lowest grades was ‘improving efficiency of healthcare.’ However, even this category showed some improvement over last year. Only about 7 percent of physicians gave the ACA an ‘A’ for improving efficiency, which is up slightly from 5.6 percent last year. Furthermore, 29.73 percent of physicians gave the ACA an ‘F’ for improving efficiency, which is down from 35.4 percent who gave it a failing grade in this category last year.”

It should come as no surprise that from the onset, physicians would view the ACA negatively. Perhaps it should also not be surprising that some of them would view things more positively once the core of the Act was finally implemented. Jim Stone, President of The Medicus Firm, tells us "Physicians seem to have become slightly more positive about the ACA compared to last year's survey. As of last year's survey, the ACA had not yet been fully implemented, although many aspects of the legislation were already in motion. This year's survey was conducted after the ACA was in full effect for several months, and four years after its passage into law. Unfortunately, the grades on the whole are not very positive, so it's good that there is some improvement in physicians' perceptions of the effectiveness of the ACA."

The Medicus Firm isn’t the only organization surveying physicians on their views of the Affordable Care Act. Physicians Practice Magazine conducts the annual Great American Physician Survey, which this year had 1,311 respondents. Their results, announced in August, included this reform question:
“Which statement best describes your personal feelings about the Affordable Care Act, in terms of its effect on patient access to care: [A] I think it’s been great for Americans (18.9%); [B] I think it’s mostly good, but not all good; and [C] I think it has done a disservice to Americans (39.2%).”

Finally, The Physicians Foundation commissioned Merritt Hawkins, a physician search and consulting firm, to conduct a survey of 20,000 physicians, with the resulting report 2014 Survey of America’s Physicians: Practice Patterns and Perspectives released last month. The survey included a question similar to The Medicus Fund’s grading of the ACA, with Merritt Hawkins finding that “when asked about what grade physicians would give the Affordable Care Act (ACA), 46 percent give a D or F grade. Younger (ages 45 or lower), employed physicians were more inclined to give the ACA favorable marks than older (46 or higher), private practice owners. In fact, 63 percent of younger physicians (ages 45 or lower), would give the ACA a grade of C or above.”