GuideWell Podcast: Optimizing the Startup Accelerator Experience

The latest GuideWell Insights podcast features an interview with Nina Nashif, CEO and Founder of Healthbox, and Renee Finley, head of GuideWell Innovation. Partners for the past three years on a new accelerator program in Florida, they share lessons on how to optimize the startup accelerator experience. GuideWell’s Kate Warnock offers the following top takeaways:

  • What makes Healthbox unique
  • If the entrepreneur – or the idea – matters most
  • Why certain applications rise to the top
  • What common pitfalls can sap your startup’s momentum
  • How more women entrepreneurs can connect with funding

While Nina and Renee provide perspective from the top down, we invite you to supplement their counsel with peer advice. Our Startup Survival series features interviews with graduates of the Healthbox accelerator program. Check how Peerfit broke through lackluster product adoption by disrupting their business model. Or how CareSpotter perfected its award-winning pitch. Don’t miss survival notes from health tech’s bleeding edge with eTect. Coming soon, Yo-Fi Wellness explains why your solution designer needs to pay as much attention to the buyer as he or she does to the user.

POV: The Impact of Automation on Medical Decision Making

Untitled-2_inne_4IBM recently announced its planned $1 billion acquisition of Merge Healthcare, a medical imaging company. Through this acquisition, IBM will gain access to millions of medical images that it will use to further develop its advanced analytics platform known as Watson in the hopes of eventually supporting physicians as they make treatment decisions. To what extent could “intelligent” analytic tools, such as IBM’s Watson, impact healthcare providers in the future? Oliver Wyman’s Frank Roberts explores this question:

Today, companies developing “intelligent” analytic capabilities are focused on supporting physicians as they make medical decisions. In the future, however, these capabilities could form the basis for automated diagnostic tools that might eliminate the need for a physician in many situations. Such tools would inevitably disrupt the physician-patient relationship and, in so doing, transform healthcare.

How will patient care be impacted? The impact of automated diagnostic tools on patient care will depend on two factors: the degree of required physical patient contact and the degree of medical decision making complexity associated with an episode of care. Patient care that requires a high degree of physical contact, such as drawing blood, or involves a high degree of complex decision making, such as behavioral therapy, are less likely to be affected by automation than those episodes of patient care which require minimal patient contact and are not medically complex. Our Automation Impact Matrix shows how new medical devices will reduce the need for direct patient contact:

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How big could the impact be? As the infographic below illustrates, “low complexity” codes represented 140 million of the approximately 250 million Medicare Part B enrollee physician office visits in 2013:

Office visit complexity In the not too distant future, some of the medical issues associated with these visits could be resolved without any provider input. A patient who has a rash could be diagnosed with contact dermatitis through diagnostic software and image processing technology. The example of a rash is not just a convenient one – per a recent study by the Mayo Clinic, the most common reason for a visit to U.S. healthcare providers is for skin disorders. This trend towards automated diagnosis of simple medical issues will push care delivery out of traditional care settings and will be a part of the new “front door” to medical care. Here’s how a treatment pathway of the future might look:

Office visit complexity

When will this impact be realized? While it might be tempting to assume that healthcare’s complexity and its unique patient-provider relationship will protect it from the dramatic transformations that have occurred in other industries as a result of automation, recent history illustrates the risk in making such assumptions. Few would have predicted that the widespread adoption of smartphones, for example, would lead to significant disruption of the taxi industry just a decade later.

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Rock Health Video: Omada Health’s Sean Duffy on Designing a Digital Health Company

POV: How Healthcare’s New Front Door is Opening Up Opportunities

surviving-new-front-doorWalgreens, in collaboration with MDLIVE, recently announced an expansion of its telehealth platform to users in Colorado, Illinois, and Washington. The service provides 24/7 access to MDLIVE’s network of U.S. board-certified doctors, and is planned to be available to users in 25 states by the end of 2015. Oliver Wyman’s Josh Michelson and Graegar Smith explain how the expansion illustrates the emerging “new front door” to health and what it means for the market:

For decades, the main front door to the healthcare system has been a provider-centric blend of primary care, specialty care, and the ER.  All bricks and mortar, almost always on the provider’s schedule, and a cold first encounter. In the past few years, providers, retailers, consumer technology organizations, and even payers have been investing in new forms of access and care – with an eye towards offering modalities that are approachable, always available, easy to navigate, lower cost, and transparently priced. Here are some of the new entrances – the new front doors – consumers are using to cross the threshold into the healthcare system today:

  • Next-generation retail care. There has been a steady climb of retail clinics over the past decade with the likes of Walgreens and CVS Health leading the charge (nearly 1900 clinics nationally, up from ~300 in 2007 and ~900 in 2008). But retailers appear to view the organic build of clinics as the starting line. CVS made a splash with the announcement that it would buy Target’s pharmacy and clinic business – and rebrand approximately 80 clinic locations previously operated by Target as part of its plan to operate 1,500 clinics by 2017. Even payers, like GuideWell in Florida, have opened up freestanding retail centers and clinics.
  • Retail setting as a health hub. In addition to the Walgreens partnership with MDLIVE, Rite Aid is collaborating with providers through their Health Alliance to extend care and bring in coaching and other medication therapy management services – all on the provider’s platform. And HealthSpot, a start-up organization, has introduced a kiosk model in retail settings – completely changing the ‘visit to fill’ paradigm through a virtual encounter and a set of diagnostic tools.
  • Virtual convenient care. Companies like Teladoc, MDLive, and AmericanWell are at the forefront of telehealth innovations. More often than not these earlier forays into the medium have been proprietary networks of physicians. Increasingly, however, we are seeing telehealth companies integrate with a provider’s own network of doctors so the virtual visits can leverage existing high trust relationships. One company leading this charge is Carena, which has partnered with the likes of OSF HealthCare in Peoria, IL, INTEGRIS Health in Oklahoma City, OK, and UW Medicine in Seattle, WA, to extend their clinician footprint in local or expansion markets via smartphone, tablet, or computer.
  • Advanced telehealth. Broadband companies are taking telehealth even a step further. For example, Cox Communications, one of the largest broadband and cable providers in the U.S. (and an investor in HealthSpot), recently formed a strategic alliance with the Cleveland Clinic. Called Vivre Health, their shared ambition is to bring healthcare to the home digitally – using the same technology that is transforming consumption of information and web services.
  • Low cost, on-demand primary care. The retail and e-visit setting can be an ideal venue for treating lower acuity episodes, but questions persist about whether individuals with chronic conditions or complex issues warrant higher levels of care. Enter an organization like Walmart. The giant retailer currently has 17 primary care clinics in three states with $40 visits for customers and $4 visits for associates – leveraging learnings from their $4 drug program to make primary care more affordable – potentially at a national scale. Startups like Zest Health and ZocDoc are also helping create ‘spot markets’ by marrying supply with demand for services locally – helping direct patients to same day primary appointments and in doing so reduce system inefficiency.

Over time, we envision a model where ‘new front doors’ are available for unique population and consumer segments – with the power to reshape the traditional PPO network. For example, healthier consumers could be happy relying mostly on a network that includes on-demand access to medical services via telehealth, in-person access via a clinic or kiosk in a pharmacy, and a wrap-around social engagement platform that rewards them for making healthy choices.

A ‘new front door’ can take on greater significance as the healthcare market moves toward value. – Oliver Wyman’s Josh Michelson & Graegar Smith

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Innovation Diffusion: Shawn Ellis on Zest Health’s Smart Concierge

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Zest Health President Shawn Ellis

Today in Chicago the team from Zest Health will be live pitching their solution to WellTech as one of the finalists in the first round of the newly expanded Insight Product Development Startup Competition. Judges from MATTER, Baxter, and Insight Product Development hand-selected promising early stage healthcare innovations to compete for $35K in cash and professional services to further advance their innovations toward commercialization. On the eve of the competition, we caught up with Zest Health President Shawn Ellis, who joined full-time after a stint as entrepreneur in residence, to learn more about his team’s offering:

  • What is the mission of Zest Health? How did you get started?
    Our company mission is simple: we provide access to the information and guidance that health consumers need to Be Smarter and Buy Better when it comes to their healthcare decisions. We stretch consumers’ healthcare dollars further by helping them comprehensively understand their benefits and conveniently access care while optimizing cost, quality, and other consumer preferences. Our origin story is unique in that we were co-founded by successful entrepreneurs and investors with both HIT and consumer innovation expertise: Lee Shapiro and Glen Tullman of 7wire Ventures (formerly of Allscripts) and Brad Keywell of Lightbank (co-founder of Groupon, Echo Global Logistics, and MediaBank, among other ventures). It’s incredibly helpful to have their robust healthcare innovation and consumer perspectives as we’ve built the business.
  • Zest-phonesWhat problem are you working to solve? What is your solution and how does it work?
    Today’s healthcare consumer is responsible for a larger portion of his/her medical cost than ever, but lacks the resources necessary to make truly informed decisions about care. At best, traditional support services offer fragmented assistance with one or two distinct needs. Too often, consumers must synthesize information across multiple sources and navigate the complex care system independently. The burden of healthcare expense is the leading cause of bankruptcy in the US today. Healthcare consumers need help navigating the healthcare system more effectively. Zest has created a Smart Concierge offering that absorbs complexity for consumers and helps them simply understand their benefits and optimally access care. The Smart Concierge is comprised of a personalized consumer-facing application as well as 24/7 support from our live clinical concierge team. We provide comprehensive, integrated support to the individual, including triage, detailed explanation of benefit coverage, real-time tracking of deductible and out-of-pocket progress, the ability to find and schedule in-network care, and visibility to the cost of care that they face. With Zest, consumers can understand and shop for healthcare just as they would any other good or service.
  • Where are you based? How has the area supported your development?
    We’re based in Chicago, IL. It’s an exciting time for the startup community in Chicago, particularly in the healthcare vertical. We’ve been fortunate to join MATTER, which is a community of like-minded entrepreneurs and healthcare leaders focused on driving innovation in health. MATTER has done a great job of leveraging the developed healthcare ecosystem that exists in the Chicago area at large, organizing helpful content and engaging strong mentors with industry expertise who are giving back to startups.

“Consumer centric” solutions shouldn’t necessarily be equated with elegant technology alone. It’s about connecting with consumers in a manner in which they’re comfortable. – Zest Health President Shawn Ellis

Observations on the Internet of Things & Healthy Behavior Change

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Image source: Nest

Wired covered last week how the new Nest app taps into the “Internet of Things” (IoT) to serve as the “command center for all your gadgets” at home. The IoT connected device conceit as it applies to healthcare can be thought of as the capability to link physical, digital, and social assets to create an increasingly full picture of individuals’ habits and changes in behavior. The technology is inspiring new economic partnerships and financial opportunities. Oliver Wyman’s John Coyle, who leads Strategic Information Technology & Operations for Health & Life Sciences, joins with the Health Services team to explore the promise of IoT for health:

Today when we talk about consumer engagement, we wonder at the possibility of driving lasting behavioral change that will help people to live better, and most in the industry are daunted by the possibility of influencing the “non-sick” and unengaged. It is accepted as fact that helping people to do better with the fundamentals of living – eating better, sleeping better, increasing physical and mental activity, and nurturing healthy relationships – are all key to living well and longer. Most further agree that such lifestyle changes would address much of the healthcare costs in the current system.

Helping people to live better and change fundamental behaviors, regardless of level of engagement, is a vision that has yet to be realized. Wellness programs are generally ineffective. Wearable technologies and quantified self “gadgetry” have yet to prove their value. In healthcare organizations, consumer technology programs are often led by marketing teams instead of care teams. Likewise, wellness programs are still evolving their value proposition. Engagement, while generally measured as low, is still used as a proxy for influence. There is a lot of room for improvement in terms of helping people adopt the lifestyles that will help them live well. Yet, we have to believe that deeper understanding of human behavior, enabled by innovation, will make appropriate influence possible.

At first blush, the Internet of Things manifests as the continuing proliferation of smart devices as more of the consumer technology that we do own, from watches to smartphones, now includes health-aware features. Even ordinary “things” like shirts and socks can be enabled to provide health monitoring abilities. Then there are the new categories of devices that are designed to provide constant, passive monitoring of activity and vital statistics, much of which is focused on the active population. Home health technologies like smart scales are also on the rise and are useful for the well and chronically ill alike.

The IoT can unlock our common understanding of people in ways never before possible. Moreover, it can unlock our understanding of an individual in ways that help them to live in a manner that supports their own health goals. – Oliver Wyman’s John Coyle

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Innovation Diffusion: Q&A With Wildflower Health CEO Leah Sparks

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Wildflower Co-Founders Leah Sparks & Kathy Bellevin

Wildflower Health was founded in June 2012 by healthcare and new business strategists Leah Sparks and Kathy Bellevin to deliver a mobile platform that helps health plans reduce medical costs. Their first program guides expecting moms through pregnancy and was featured this week in the Bloomberg article Know Exactly When You Get Pregnant.” Reporter John Tozzi details how insurance companies are turning to such apps to reduce costs by reaching pregnant women sooner. Wildflower just signed a deal this month, he reports, to market its solution to Medicaid agencies across the country through Xerox and its 38 state health-information technology contracts. Below, Sparks shares more on her company’s accelerating growth:

  • What is the mission of Wildflower Health? How did you get started?
    Our mission is to make families healthier with mobile-based programs that connect families to healthcare. We got started when I was actually pregnant with my first child, and I experienced firsthand how people often use the healthcare system for the first time when they start families. Pregnancy seemed like a powerful context for teaching people not just about being healthy but how to use the healthcare system in a smart way. This idea dovetailed with my professional experience. I had started several new service lines at McKesson Corporation, and then at DNA Direct I had sourced and structured the company’s first contracts with healthcare payers.
  • WYhealth+screensWhat problem are you working to solve? What is your solution and how does it work?
    We are helping healthcare payers use mobile-based technologies to better engage the “Chief Medical Officer of the Home,” who is typically a woman, who makes 80% of healthcare decisions and influences health for her whole family. Our first product is Due Date Plus, which engages mom and dad throughout pregnancy to keep women on track with preventive measures and to identify the high-risk pregnancies. The product is unique in that it not only has consumer-engaging mobile features, but also has configurable features for our payer clients so that members can do things like click-to-call health plan nurses or look up in-network hospitals, right on their smartphone.

I hope the future of healthcare sees enough technology advancement that our local pizza place doesn’t have more sophisticated technology than healthcare enterprises. – Wildflower Health CEO Leah Sparks

Innovation Diffusion: Q&A With BioscanR Founder Tracy Ingram

BioscanR Founder Tracy Ingram

BioscanR Founder Tracy Ingram

Tracy Ingram started his company BioscanR in response to the Qualcomm Tricorder XPRIZE Challenge, a $10 million global competition to stimulate innovation and integration of precision diagnostic technologies. He pulled a team together with expertise in medicine, big data, and sensor technologies, and with some early funding and bootstrapping made it as far as the semifinals with his health monitoring solution. The team is continuing to build out their technology and just last week won the  “Best Wow! Factor” award at the WebRTC developers conference. Ingram shares more on their mission below: 

  • What problem are you working to solve? What is your solution and how does it work?
    We are looking to provide solutions to decrease cardiac readmissions. The BioscanR provides real time continuous vital monitoring similar to what is found in an ER, yet our system goes further and evaluates that information to help give an assessment of a broader picture of the patient’s health. The vitals we measure are EKG, pulse, respiration, movement, blood pressure, and weight. Our algorithms take in all this data and compare it to baseline data on human health that sheds light on the chances of readmission. The primary sensor is a Bluetooth patch that is attached to the chest over the heart. It is an FDA-approved Class II medical device that goes for approximately 24 hours on a single charge. The data is transferred to a tablet or phone to collect vitals during the day. BioscanR is a HIPAA-compliant solution providing real time vitals and alerts to medical professionals to assist in early interventions with both text and video messaging. It does this by incorporating wearable FDA-approved technologies to monitor vitals and transmits those through secure channels for professionally trained monitoring, specifically looking for irregularities and/or problems.test1
  • Where are you in the development process? What are your most immediate goals?
    We just released the telemedicine component of the BioscanR last week at the WebRTC conference. We partnered with mobile services provider Forge by Acision for SMS, chat, and video functionality. Our collaboration won the “Best Wow! Factor” award for its integration of vitals and video conferencing that allows medical practitioners to connect from anywhere on any device, without the need of a specialized app. Our immediate goal is finishing our software development kit (SDK) as we have large health organizations interested in including our vitals-monitoring solution in their existing applications.
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ICYMI: WIRED Health 2015 Highlights

WIRED Health 2015 was held April 24 in London, bringing together more than 20 industry-leading speakers plus a selection of startups and growth-stage companies working in the fields of medical technology, software, and services. The event was designed to showcase disruptive thinking and innovation in a range of disciplines, from diagnostics and neuroscience to data-driven healthcare and new material sciences helping to re-build the human body. Speakers included Adam Gazzaley, founding director of the Neuroscience Imaging Center, on how video games are the future of medicine and education; Oxford Nanopore CTO Clive Brown on how his company’s USB stick-sized DNA sequencer will enable an “internet of living things;” and Neuroelectrics’ Ana Maiques on her company’s headgear designed to monitor the brain and help patients recover from strokes, epilepsy, and depression.

Innovation Diffusion: Q&A With Personal Medicine Plus Co-Founder Natalie Hodge

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Personal Medicine Plus CMO Dr. Natalie Hodge

Dr. Natalie Hodge is a board-certified pediatrician and has been serving children for more than 20 years in St. Louis and Paducah, Kentucky. Her experience has given her insight into the difficulties of behavior change and the importance of maintaining a simple strategy to improve health. Along with public health advocate Brandi Harless and tech entrepreneur Jay Campbell, she founded Personal Medicine Plus to help patients create “a personal health feedback loop for real behavior change.” From their headquarters in rural western Kentucky, CMO Hodge shares more about their digital health innovation:

  • What is the mission of Personal Medicine Plus? What problem are you working to solve?
    Our mission is to end lifestyle disease. We are trying to delay onset of diabetes and hypertension in underserved and at-risk populations by changing the behavior of our patients—both teenagers and adults—on an hour-to-hour basis as they go about their day. We are talking about a group of people who rarely have a glass of water, who have never had any veggies to eat aside from French fries, and who are completely sedentary, taking less than 1,000 steps daily.
  • What is your solution and how does it work?blog-screen-pmp
    We use iOS and Android platforms to deliver our software to patients. Physicians or care managers “prescribe” the software and help patients download the software in their offices at the point of care. Once the software is on the phone, this simplifies the conversation and counseling around behavior change. Behaviors are clearly tracked on a dashboard with a gamified interface that’s engaging and fun for patients to use. The goal is to “get your screen to green” by the end of the day. Three health behaviors can affect 80 percent of healthcare costs: Water intake, fruit and veggies intake, and daily steps. Three simple behaviors. Our software flows data from connected health devices to simplify use and reduce user data inputs. It gathers data from home scales, blood pressure cuffs, and blood sugar monitors.
  • What resonates most with patients?
    I tell patients the first step in improving your health behavior is to track your health behavior. Then, I tell them this is health industry software, not a consumer application. I give them my coupon code that identifies my population. And I tell them their use of the software connects to a population health dashboard that I can see, tracking the entire patient group’s every step and their every weight—as well as their nonuse of the software. Patients’ eyes get really big at that point, and I like to use the analogy of the Wizard of Oz behind the curtain, or even “big brother” for parents. This adds in the piece of accountability for patients that is missing when consumers use a pure consumer software play. The messages are: “My doctor daily wants me to do this” and “This is how I’m going to accomplish these goals.”
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