Category: Digital Health

The “move fast and break things” motto might work wonders with consumer products, but a new editorial in npj Digital Medicine makes a compelling case that healthcare needs to flip that paradigm on its head and co-create with clinicians to “sync fast and solve things.”

The editorial argues that healthcare practitioners (HCPs) should play an active role in driving digital health innovation, as opposed to being passively “consulted” so that developers can tout the fact that their product is backed by clinicians.

• The breakneck pace of digital innovation in the wake of the pandemic has outpaced the inclusion of HCPs in the co-creation of new solutions, leading to a fight-or-flight response where clinicians are reluctant to adopt said solutions to defend their traditional responsibilities. Separate research seems to back that up.

• If new tools lack product insight and buy-in from HCPs, they’re significantly more likely to be doomed to clinical irrelevance, as showcased by a recent analysis that found 44% of digital health companies have a clinical robustness score of 0 out of 10.

Although it isn’t an earth-shattering revelation that HCPs have a solid grasp on the exact workflows needed to inform clinically relevant solutions, the authors offer three considerations for shifting from “passive” to “active” co-creation.

• First, financial incentives alone aren’t enough to ensure busy clinicians can engage in meaningful co-creation. The most important incentive that companies can offer clinicians is time, particularly by delivering a product that can optimize workflow efficiency or help deliver quicker treatments.

• Second, the article stresses a need to embed digital health technologies in clinical curricula so that HCPs can learn about not just using these new tools, but also translating their experience into better-informed products.

• Lastly, the authors lay out why there’s a role for regulators to mandate that HCPs participate in digital health innovation, and suggest that payors and legislators consider augmenting their approval processes by requiring HCPs be involved in the development of new solutions to serve as a proxy for their clinical safety and efficacy.

The Takeaway

Healthcare clearly isn’t the best sandbox to “move fast and break things,” but this article is an important reminder that “sync fast and solve things” shouldn’t mean trading clinician input for speed. While passive co-creation might help with the marketing materials, giving clinicians an active role in product development is the only way to ensure their experience is reflected in digital innovation.

It’s rare that a mid-year trend roundup qualifies as the biggest story of the week, but it’s also rare that they’re as stellar as the one that former HHS policy leader Paul Mango just released.

Mr. Mango served juicy takes on three of the biggest trends shaking up the industry:

Trend #1) Payor transformation has been full-speed-ahead as payors seek success in managing beneficiaries with chronic conditions by developing their own disease management platforms (not to mention new arcs of growth help justify their climbing P/E ratios).

• Evernorth is now 80% of Cigna’s total revenue and a whopping 68% of its profit – mostly as the result of its Express Scripts acquisition in 2018. In the first half of the year, Evernorth grew 29% while Cigna as a whole grew 4%.

• United was obviously an early mover into non-health plan assets, but Optum is now the key growth driver for the entire enterprise. United Healthcare remains Optum’s largest client (accounting for two-thirds of its revenue), but Optum now represents 25% of UNH’s total revenue and 49% of its profit (thanks in large part to OptumRx).

Trend #2) Provider tailwinds are adding up as several key performance measures improve simultaneously, including higher volume, increased acuity for inpatients, and lower labor costs. 

• HCA just posted same store revenue up 10% due to a combination of the aforementioned tailwinds. ACA exchange volume was up 46% (total commercial volume rose 12.5%), and contract labor costs were down 25%.

• Even Community Health Systems, whose performance has lagged other national hospital chain operators, saw a 3.2% increase in admissions and a 4.7% bump to same store revenue. CHS axed contract labor costs by 39% year over year.

Trend #3) Medicare Part D upheaval has been emanating from the Inflation Reduction Act, which will take full effect on the 1st of next year.

• Mango boils down the IRA’s impact on Part D as such: it shifted the economic burden from beneficiaries who are heavy consumers of prescription drugs to the payors issuing the plans. 

• Medicare Part D has been around for twenty years and during that time the combination of the beneficiary’s premium and government’s subsidy only rose to $64.28. “The impact of the IRA in one year’s time will cause that to rise to $179.45.

The Takeaway

Where is all this payor transformation heading, especially as providers increasingly view them as competitors? Will health systems sustain their momentum, or is recent performance a reflection of pent-up pandemic demand? All eyes will be on next quarter’s numbers to find out, and you’ll be the first to know when we see them.

The power trio of Mayo Clinic, Epic, and Abridge are joining forces to bring the magic of generative AI to the “scaffolding of the healthcare system” – nurses.

The new solution will work similar to Abridge’s core ambient documentation tools for physicians, but optimized specifically for the unique complexity of nursing workflows.

• Whereas physician conversations usually involve capturing the medical history and patient’s story, nurses are also performing and documenting tasks like vitals collection or turning patients to avoid bed sores.

• This data all ends up in different places within the EHR, and requires a new user experience to work backwards from.

Mayo Clinic nurses are at the center of the collaboration.

• The development team is engaging with them directly to ensure the new solution meets the needs of all nursing and patient care workflows along with regulatory requirements for ambient solutions.

• Nurses will also help prioritize the workflows where the tool will have the highest impact, and will be “instrumental” in designing and testing the overall solution.

Epic’s involvement will allow the tool to integrate seamlessly into its EHR and inpatient nursing workflows, another sign that the company is all-in on quickly advancing its GenAI roadmap.

• It also represents one of the most significant efforts to stem from the Epic Workshop program announced last year, which features third-party vendors co-developing technology with Epic. 

The combination of Abridge’s AI stack, Epic’s development, and Mayo Clinic’s nursing expertise should help accelerate the development cycle, and the health system is looking to get the tool in the hands of nurses before the end of the year.

The Takeaway

Nurses perform a massive breadth of activities in fast-paced environments, and they’re grappling with the same documentation-driven burnout as the rest of the industry. Toggling between patient duties, documentation, and staff communication is a demanding use case for ambient AI, but this team appears to have all the pieces it needs to make it happen.

There’s a comeback brewing for digital health, with Rock Health’s latest funding report showing that the sector is officially on track to beat last year’s investment total.   

US digital health startups raised $5.7 billion across 266 rounds in the first half of 2024, setting a pace that could surpass 2023’s full-year total of $10.7 billion.

Most of the excitement came from early-stage startups. Seed, Series A, and Series B raises accounted for 84% of labeled rounds in H1. The median size of a Series A was $15M (up $3M from last year), driven by big showings from companies like Hippocratic AI and Fabric. 

• Rock Health pointed out that larger Series As have helped AI startups manage costs for training models and acquiring datasets, while also helping others make well-timed M&A (Ex. Fabric’s acquisition of MeMD from Walmart).

Unlabeled rounds started to wane as fewer companies pushed off a valuation haircut or delayed a labeled raise due to not meeting necessary benchmarks. Just 33% of Q2 2024 rounds were unlabeled, down from 47% in Q1 and 55% in Q4 2023.

• This could mark the beginning of a return to a more normal cadence of labeled raises, which Rock Health predicted would be in the cards for 2024.

The most funded value proposition in H1 went to “treatment of disease,” thanks in part to Foodsmart’s $200M raise feeding the $1.1B total. 

• Mental health retained its usual position as the most funded clinical indication, raising $700M as companies like Talkiatry and Brightside managed to attract more investor attention than the surging weight management segment ($300M).

The first half saw three public exits for digital health companies, ending a 21 month drought with stock market debuts for Nuvo (remote fetal monitoring), Tempus AI (precision diagnostics), and Waystar (revenue cycle management).

• Among players still gearing up for an IPO, fewer companies were rounding out their offerings by acquiring the missing pieces, which was chalked up to companies wanting to be conservative with their runway. H1 2024 clocked in at 34 digital health acquisitions, well below half of 2023’s full-year total (83).  

The Takeaway

Resilience seems to be leading to brilliance for digital health founders, with overall funding momentum and fewer transition measures (AKA unlabeled rounds) suggesting the “new normal” is upon us. Although a presidential election and decisions around telehealth flexibilities will have a huge impact on the rest of the year, most signs are pointing toward H2 playing out just as well as the first half.