DHW Q&A: The Road to Medication Success With Synapse Medicine

With Clement Goehrs, MD
CEO and Co-founder of Synapse Medicine

In this Digital Health Wire Q&A, we sat down with Synapse Medicine CEO and Co-Founder Clement Goehrs, MD to discuss the challenge of accessing up-to-date drug information and how that data can be used to improve care delivery.

With more medications hitting the market every week, providers face the impossible task of tracking countless new interactions, and software developers don’t have it any easier as they look to equip providers with the right tools for writing safe prescriptions. Dr. Goehrs co-founded Synapse in 2017 to help them do just that, with easy-to-implement UI components making real-time drug data and decision support more accessible than ever.

Can you give the audience a quick introduction to Synapse Medicine and the story arch that brought us to your current solution set?

To put it simply, our mission is to make it as easy as possible to access medication information – wherever it is – and to help providers make the best clinical decisions using that data.

During my time as a physician, I saw first hand how difficult it was to find information for optimizing a prescription, and that we’re also facing a huge public health problem due to people dying from avoidable medication errors. Those are the problems we’re aiming to solve.

And when I say that we’re trying to make drug information easy to find, I mean for our end users (providers, pharmacists, nurse physicians), as well as our clients (usually EHRs, ePrecribers, or telemedicine companies – any type of software company building for clinicians that wants to add a drug information component).

Can you give us a deeper dive into Synapse Medicine’s clinical decision support solution, and walk us through what that user experience looks like?

One of the things that we understood very quickly was that providers don’t want to have multiple tools. That means that if you’re providing some kind of clinical decision support, and you want your end user to have the best experience, you also need to have a seamless integration inside the EHR.

You also have to be able to provide a wide range of tools without making the solution overly complex, and we do that with what we call components. Our components leverage our APIs with a UI layered on top for specific use cases, like drug interactions or side effects. That makes them easy to integrate and customize, but the user doesn’t even notice it’s a third party feature.

To give you an example, if a physician starts a prescription within the EHR, as they begin entering drugs they’ll start to see safety notifications on the side effects, potential interactions, and dosages. All of that is communicated in a way that’s easy to understand. 

No physician wants to see a pile of alerts, but they do want to have info on how to help their patients. So instead of just saying “there’s a severe interaction” like most tools do, we take it a step further by saying “you might want to divide that dose in half to avoid these side effects, and here are the publications supporting that decision.” That explanation is super important.

What are some of the big trends that you’re keeping your eye on, and how do you see them continuing to unfold going forward?

One of the main trends that I’m seeing is that there are a lot of legacy players, very big EHRs and software companies, that aren’t able to innovate at the pace they would like to because they have so much on their plate.

These companies face so many regulatory hurdles and have so many things they need to build, so with all the innovations and AI progress happening every day, more of them have been saying “we can’t keep building every single use case, and we are going to start working with companies that are focused on this specific problem.”

As more EHRs and telehealth companies start to integrate with other players to get the best of both worlds – breadth and depth of features – there’s a big opportunity for the startups working on those use cases.

Has there been anything that surprised you about the recent AI momentum, or as you implemented any new technology into your own platform?

AI is a fundamental part of a lot of what we do, and of course we continue to learn more about it every day. One project that we did with France’s equivalent of the FDA, and probably one of the first healthcare AI projects deployed at that scale, was to help monitor vaccine side effects and other drug interactions on a national level.

As we developed that algorithm, every time we made a major jump in performance, it was never because of the mathematical model. It was always because we ended up back at the data.

We understood the data very well from a medical point of view, and also had physicians on our team that could point out things like why we shouldn’t train the model on certain data. That’s what really enabled most of the fine tuning.

So for the short answer to your question: I’ve been surprised by how much truly understanding your field, and truly understanding your specific use case, is actually what makes AI smarter. It’s not just more data and a bigger model. I think the real progress wiIl come from the AI teams that have physicians and data scientists working together on performance.

What advice would you give to providers or startups that are thinking about improving their own prescribing strategy?

Number one, I would say to think deeply about the end user, about the physicians and the prescribers. That may seem trivial, but that experience is so important, and it’s surprising how often it gets overlooked.

Number two, think about scalability, particularly around adding secure data. What worked for 10 physicians in the beginning might not work as you scale. You’ll probably need better data, and you’ll probably want to do something with that data. If that data isn’t secure from the beginning, you’re going to lose a lot of time if you have to rebuild everything.

That brings me to number three: I wouldn’t recommend doing that by yourself. There are new drugs every week. There’s drug information all over the place, a lot of terminology, and few standards tying it all together. It’s a complex mess, and it would be a mistake to only consider the resources you would need to build it, because it’s maintaining it over time that gets really painful. You can probably avoid a lot of pain by having someone else do it.

For more on Synapse Medicine’s clinical decision support for medication success, head over to their website or reach out to [email protected].

NeuroFlow Picks Up Steam With New Growth Funding

When looking at the movers and shakers in the behavioral health arena, it’s hard not to include NeuroFlow in that conversation – especially after last week’s funding boost courtesy of Concord Health Partners.

The press release definitely leaned into the “unlabeled round” theme, offering neither a Series title nor a dollar value, although it did tag the funding for growing NeuroFlow “to match the increase in demand for its solutions” among health systems, payors, and government agencies.

NeuroFlow had previously raised a total of $57.8M, capital that was used to build out an AI-driven analytics platform that helps providers consistently screen for behavioral health issues, triage patients to appropriate care, and engage them between visits.

  • That platform enables NeuroFlow’s partners to overcome the usual hurdles to adopting an integrated behavioral health model, reducing the risks associated with undiagnosed conditions and helping them get out in front of potential issues before they escalate. 
  • The data collected through that process is then served to providers within their established workflows in the form of decision support, creating a nice feedback loop with the platform’s engagement component while helping create high-touch care journeys.

NeuroFlow’s story over the past year has been about partnership momentum, with a string of new names on the roster like Novant Health, Atlantic Health System, and Emory Healthcare.

  • Growth acquisitions also found a place in NeuroFlow’s playbook, and it recently picked up Capital Solution Design (Behavioral Health Lab) to expand its reach within the VA while gaining some valuable VA-specific EHR integration expertise.
  • The mission behind NeuroFlow is to make mental health a bigger part of physical health, and the latest investment will push that pursuit forward by funding new platform capabilities and quite possibly more strategic M&A.

The Takeaway

The behavioral health segment continues to remind us that it’s one of the most resilient corners of the digital health market, and NeuroFlow’s raise is the latest proof point that these startups can keep securing capital in an otherwise gloomy funding environment. NeuroFlow isn’t offering teletherapy and it’s not delivering care, but it seems to be carving out a nice niche with its “picks and shovels” approach to bridging gaps in the treatment journey for those that are.

What’s Behind the Medicare Slowdown?

Since Medicare coverage first took effect almost six decades ago, the program’s runaway spending has played a leading role in the story of the federal budget. Now, the end of that growth is stealing the spotlight.

An excellent piece in The New York Times highlighted how Medicare’s unsustainable climb reached a turning point in 2011, and for reasons that aren’t exactly clear.

In 2011, Medicare spending per beneficiary (MSPB) reached $13,159, nearly double the level it was at near the turn of the century.

  • If historical growth had sustained beyond that point, we’d currently be sitting at roughly $22,006 MSPB. Luckily, that’s not what happened.
  • Spending leveled out, and we now find ourselves at $12,459 MSPB, a nearly $4 trillion gap compared to previous projections… yet the underlying cause remains a mystery.

The trillion dollar question: what changed? The authors call out obvious shifts in Medicare policy, namely the Affordable Care Act in 2010, and its reduced Medicare payments to hospitals and payors with private Medicare Advantage plans.

  • While ACA was certainly a contributor, most of the reductions are attributed to a category that the budget office calls “technical adjustment,” which describe changes to a wide base of topics such as the expansion of cholesterol and blood pressure medicines.

The NY Times concludes that the true reason for the change is a hard problem that remains unsolved, but the smart folks on social media were quick to pick up where they left off, floating possibilities such as:

  • As MA lives increased, the types of MA plans also improved due to the phasing out of inefficient plan designs
  • Age of death increases stopped around this time, so US citizens aren’t living to older ages with increasingly complicated health issues 
  • The rise of ACOs started in 2012, although we just covered why that factor probably doesn’t account for a huge share of cost reductions

The Takeaway

Savings attribution has always been a fundamental challenge for the healthcare industry, underpinning many of the issues with value-based care and other alternative models. Now that we’ve found ourselves at an inflection point where Medicare spending is slowing but still outpacing the federal budget, the solution to that savings attribution problem will also be what lets us identify the levers that will keep the trend heading in the right direction.

Everything That Washed Ashore at Epic UGM

Epic went with a Castaway theme for this year’s User Group Meeting, and it’s easy to see why considering Tom Hanks would need years on a deserted island to sort through all the new features and partnerships announced at the show.

Luckily for Hanks, we already rounded up all the biggest news from the event, starting with the headline grabber: 

Microsoft and Epic are going all-in on AI. Microsoft CEO Satya Nadella even attended in-person to lay out how the partnership will reshape clinical workflows with generative AI.

  • Ambient clinical note generation powered by Nuance DAX Express 
  • Added in-basket messaging features that auto-generate first-draft responses
  • Rev cycle enhancements that provide coding staff with suggestions based on EHR data
  • New Look-Alikes program that matches patients with unidentified conditions to others with similar symptoms to help inform novel treatments

Epic CEO Judy Faulkner also took the stage in a sweet island explorer / Burning Man costume to share Epic’s overhauled partnership program, which now includes four distinct categories.

  • Cornerstone Partners – tech that serves as the backbone of Epic’s own software (InterSystems, Microsoft)
  • Partners – market leaders in specific areas (Nuance for ambient voice, PressGaney for consumer surveys)
  • Member Services – established integrations providing complementary value 
  • Pals – new category that allows innovative vendors to work closely with its EHR, including Abridge for ambient voice and the just-announced addition of Talkdesk for contact center workforce management

A new app “Showroom” will be the home base for the above partners, replacing the App Orchard that Epic shut down last year. 

  • When Showroom officially launches in a few weeks, it’ll be exclusive to a much more curated cohort of Partners and Pals than the Orchard’s 800+ third-party vendors, a decision that Epic said will help users find the “signal in the noise” and facilitate deeper collaborations. 

The Takeaway

Under the bright lights of an island-themed stage, Epic’s new features look nothing short of transformative, and its newfound willingness to play nice with partners could make a huge impact on nearly all aspects of care delivery. The real question will be whether these enhancements can be deployed as envisioned so that they can live up to their potential. It’s a massive undertaking, but there are countless clinicians that would love if Epic could pull it off.  

Elevance: Hospital Acquisitions Harming Patients

Elevance just published a great report leveraging data from its affiliated health plans to color in the picture that’s been loosely outlined by a few other studies: patients face higher prices and lower care quality after independent hospitals are acquired by health systems.

It’s no secret why a growing number of independent hospitals are getting scooped up each year. Elevance found that operating expenses fell by an average of 6% after an acquisition, about 60% of which can be attributed to personnel reductions.

  • The share of U.S. hospital beds that belong to health systems spiked from 58% in 2000 to 81% in 2020, and a quarter of markets no longer have any independent hospitals.
  • Hospitals inked 20 M&A moves in Q2 alone, opting for consolidation in order to secure additional resources and negotiate more favorable contracts with payors.

That isn’t exactly great news for patients. Independent hospital acquisitions resulted in 5% higher costs for patients with commercial health coverage, and increases ranged from 5% to 8% across top diagnostic categories by volume (Ex. digestive, respiratory, and circulatory). 

  • Elevance also noted that its members receiving cardiac care saw readmissions increase over 10%, and that acquired hospitals with greater staff reductions unsurprisingly experienced a greater increase. Readmissions for Medicare patients with acute non-deferrable conditions saw a more conservative increase of 2-3%.
  • The numbers were a little more vague surrounding access to care, although the study “observed the closure of maternity wards, which were concentrated in rural hospitals.”

What’s the solution? In Elevance’s view, regulators should seek assurances that patients won’t face higher costs following an acquisition, especially considering the efficiency gains for the health system. Regulators might also consider implementing quality standards during the approval process to ensure that readmissions and access aren’t harmed as a result.

The Takeaway

Elevance might have its own reasons for wanting to keep costs down at health systems, but it’s also putting out some credible evidence that suggests hospital acquisitions aren’t doing patients any favors. That said, there are plenty of very real pressures driving hospitals toward consolidation, and reports like this are important for helping policymakers chart the best path forward.

Which Components of CBT Actually Drive Outcomes?

“Cognitive behavioral therapy for X” is the backbone of many mental health startups and digital therapeutics, yet it’s unclear which individual components of CBT actually drive outcomes.

A recent study in JAMA Psychiatry attempted to tackle that question, randomizing 767 adults with depression into cohorts that received some, but not all, of the seven individual components of internet-delivered CBT.

  • Those include: activity scheduling, functional analysis, thought challenging, relaxation, concreteness training, absorption training, and self-compassion training

While internet-delivered CBT resulted in reduced depression at six months (mean follow-up difference in PHQ-9 score: -8.63), the researchers were surprised to find that none of the factors appeared to drive an impact independent of the others.

  • The one exception? Absorption training.

The absorption training module taught individuals to become immersed in what they are doing in the present moment to “improve their direct connection with experience and enhance contact with positive reinforcers.”

  • Patients completed a behavioral experiment where they compared memories of being absorbed versus not absorbed in a task, learned about flow states, and identified activities that make them feel absorbed. 
  • Although statistically significant, the effect of adding this module was still only one-fifth of a PHQ-9 point.

The Takeaway

At least within this study, none of the components of CBT – with the exception of absorption training – significantly reduced depression symptoms relative to their absence, despite an overall average reduction in symptoms. The findings suggest that treatment benefit from CBT probably accrues from factors common to all CBT components (e.g. structure, making active plans), and non-specific therapy factors (e.g. positive expectancy).

Laudio Lands $13M to Tackle Burnout

Workforce management startup Laudio landed a $13M Series B round to tackle labor productivity and burnout, two challenges proven large enough to attract funding in any environment. 

Unlike staffing solutions aimed at adding more people, Laudio helps retain the talent healthcare organizations have already invested in by automating repetitive work and nudging managers toward next best actions.

  • Laudio’s AI-driven software automates tasks such as employee rounding, new hire check-ins, quality audits, and overtime assessments. It also helps with reminders for events like employee birthdays and work anniversaries. 
  • Example: If a nurse has worked several consecutive shifts with new employees, Laudio will alert the manager to reach out and thank them, deliver scheduling recommendations, and suggest follow-ups.

Laudio plans on using the funding to build out its AI capabilities and recommendation engine, while adding more partnerships with health systems throughout the country.

  • Over 20 health systems already use Laudio, and it attributes its early success to its focus on becoming an all-in-one platform for frontline managers, who frequently turn to a variety of point solutions for quality audits and employee engagement.
  • Laudio counts major systems like Novant and UNC Health among its early adopters, and reports that the platform has reduced RN turnover by 26% by driving a single meaningful interaction every month between frontline managers and nursing team members.

The Takeaway

Health systems have been stuck in a vicious cycle of high turnover leading to burned out workers leading to even more turnover. If Laudio can use its Series B funds to prove it can break that chain, it’ll have no shortage of hospitals lined up to streamline the workflows of their frontline managers.

Postponed Care Means Bad News for Payors

The pent-up-demand narrative is back on the menu. Speaking at Goldman Sachs’ Global Healthcare Conference, the CEO of UnitedHealthcare’s Medicare business Tim Noel said that costs are on the rise due to elevated demand for outpatient procedures.

  • “We’re seeing that more seniors are just more comfortable accessing services for things that they might have pushed off a bit like knees and hips.”

That quip sent shares of UnitedHealth Group sliding over 6%, wiping out roughly $29B from the healthcare giant’s market capitalization in one of its largest single-day drops in years.

  • United now expects its Q2 medical loss ratio (percentage of spend on claims versus premiums collected) to be moderately above its full year forecast (82.1% to 83.1%).
  • The stocks of other major Medicare players took a pretty significant sympathy dive, with CVS (-7%) and Humana (-11%) getting the worst of it.

Why is this important? Payors have been enjoying a lull in surgery expenses due to hospital-wary patients postponing care during the pandemic, but that trend might be reversing.

  • Although several surveys have suggested that some of these skipped appointments are lost for good, United’s comments show that Medicare patients are getting back on track.

That’s good news for hospital operators and medical device companies, whose revenue is closely tied to surgery frequency.

  • Shares of hospital operators Tenet Healthcare and HCA Healthcare each jumped on the news, while joint replacement and implant manufacturers like Stryker and Zimmer Biomet climbed around 4%.

The Takeaway

Investors are listening closely for any signs of increased payor costs as patients start catching up on postponed care, and United’s role as the bellwether for the group means that even off-the-cuff comments at conferences are heard loud and clear. While the extent of the pent-up-demand remains to be seen, United seems to think the pressure could start shifting from hospitals to payors in the second half of the year.

Clarify Research: The Kids Are Not Alright

The youth mental health crisis is past the tipping point. The number of mental health hospitalizations among children and young adults doubled between 2016 and 2022, with inpatient stays for anxiety-related issues and eating disorders tripling over the same period.

That’s according to an analysis of claims data for over 24M Americans under the age of 21 in the new The Kids Are Not Alright report from Clarify Health Institute, whose high quality research is matched only by its stellar report titles.

To frame up just how dire the youth mental health crisis has gotten (2016-2022):

  • Clarify found a 124% overall increase in mental health inpatient (IP) hospital admissions
  • A 250% increase in IP admissions for anxiety and fear-related disorders
  • A 221% increase in IP admissions for feeding and eating disorders
  • A 96% increase in IP admissions for depressive disorders
  • A 45% increase in mental health ED visits, including a 74% increase for suicidal ideation, attempts, and other self-harm

Looking at the annual incidence rates between conditions (vs. the utilization stats above), Clarify found a steep climb in new diagnoses for 8 of the 9 leading disorders:

  • Feeding and eating disorders had the highest rate of growth (44%), followed by anxiety and fear disorders (40%), and obsessive-compulsive disorders (38%).
  • Only diagnoses for disruptive and conduct disorders decreased (16%) between 2016-2022, although some volatility in diagnosing was seen at the start of the pandemic (Ex. anxiety conditions saw a 14% decrease in 2020, followed by a 36% YoY increase).

Another interesting slice of the data highlighted the differences in mental health IP utilization by age and sex, showing a particularly tough increase for girls between the ages of 12 and 18.

  • IP admissions for adolescent girls were twice as high as boys in the same age group across the entire time period (27 vs 11 per 1k), with Clarify pointing to ubiquitous social media as a primary contributor.

The Takeaway

If the goal of Clarify’s report was to provide a clearer picture of youth mental health care utilization, it succeeded by highlighting just how bleak the current landscape looks. It’s well known that the pandemic didn’t do younger generations’ mental health any favors, but these statistics are a stark reminder that there’s an urgent need to heed the calls-to-action from groups like these pediatric mental health societies and the Surgeon General.

Mid-Year Digital Health Predictions

The digital health sector has gotten a bit of an ego check since the white hot market at the start of the pandemic. Rising interest rates and a minor banking crisis continue to put a damper on startups’ ability to raise capital, but a mid-year prediction roundup from some of healthcare’s top dealmakers gives a good preview of what might come next as the market cools.

Dudley Baker, Canaccord Genuity. Notable moves: Privia Health IPO, Doximity IPO

  • Since 2020, many startups have sprung up to provide specialized behavioral health and chronic condition management benefits to employers, but the surge in valuations made many of them too expensive to acquire. These companies could have a hard time raising more capital on their own, so Baker expects them to seek out mergers of equals instead.

Claire Pearson, Barclays. Notable moves: Cricket’s merger with InterWell and Fresenius 

  • Pearson sees four areas ripe for M&A centered around new tech capabilities and scale: women’s health, orthopedics, cardiology, and kidney care. Pearson pointed to Cricket’s merger with InterWell and Fresenius as an example of what works in each of these sectors – it combined contracting, providers, and technology under one roof.

Fletcher Gregory, General Atlantic. Notable investments: Included Health, Vida Health

  • Employers weary from working with too many vendors have begun narrowing their focus to companies that can deliver outcomes and lower costs. To make the cut, Gregory predicts that digital health startups working on a single problem are going to have to improve their clinical models in ways that they likely can’t do without combining.

Seth Kneller, TripleTree. Notable moves: KKR’s acquisition of Therapy Brands.

  • Kneller favors companies that are addressing the labor crisis by helping hospitals and health systems become more efficient. Companies using AI to take over tasks like clinical documentation and administrative work look especially attractive to acquirers, but only if they can prove cost reductions for hospitals. 

Karl Palasz, William Blair. Notable moves: Fortive’s acquisition of Provation

  • Companies that employ behavioral health providers to deliver virtual care have struggled to live up to expectations due to a lack of differentiation and the clinician shortage. Palasz has his eye on companies that provide software to niche behavioral health practices, such as substance-use recovery or autism.

The Takeaway

Pending any major economic catastrophe, it seems like the general consensus is that the tide could start turning for digital health M&A within the next few months. Although the IPO market will probably stay limited, the partnerships that are forming now are setting the stage for more M&A in the back half of the year as companies look to combine so they can better weather the tough funding environment.

Get the top digital health stories right in your inbox

You're signed up!

It's great to have you as a reader. Check your inbox for a welcome email.

-- The Digital Health Wire team

You might also like..

Select All

You're all set!