Things I find interesting: Week of 7/17

Week 2 of this little side project to keep track of things I’ve been reading & finding interesting in health tech is coming in a little early this week as I’m taking off to hike the Appalachian Trail for a week. More next week!

News:

  • Medi-Cal has had one child in the past few years whose medical expenses have been in the $15 million — $21 million range annually. And the bottom 50% of Medi-Cal members accounted for 7% of total costs. At Harken we didn’t have anyone nearly this expensive, but we did have a sicker, more costly population than our actuarial model anticipated. As the article notes, these ‘outliers’ in terms of medical spend are often just complex conditions that are going to be expensive, so CM/DM efforts and other initiatives aren’t going to be able to reduce costs that much. It’s hard for an insurance market to function if you can’t pool that risk across other people who cost less… Link. (There is also similar, and really good, read on the topic from a parent in Iowa with a son who has hemophilia, where a hemophiliac cost BCBS >$12 million last year. Link.)
  • Amir Rubin had a cup of coffee at Optum and is now leaving for One Medical. Rapid national expansion, as mentioned in the article, over the next few months doesn’t make a ton of sense to me. Then again Rubin is leaving Optum where they are expanding clinics like crazy which might have given him a blueprint. That article makes it sound like he’s going to position it as more of a workplace clinic so maybe it makes more sense going down that route vs the concierge medicine route. Link.
  • Impact Health raised $13 million from Techstars / Foundry Group to build a marketplace for helping consumers select insurance plans. Currently serving around 59,000 users, the company hopes to grow to 350,000 users by year end. Wonder about the cost of acquistion vs lifetime value of a user with this… I assume they are pitching the long term vision as using the buying decision to get a hook into a user to start influencing other healthcare decisions. Link.
  • Gravie raised $14 million. They also do a marketplace for plan selection but sell through employers. Targeting employers brings a different set of challenges / opportunities than Impact Health, but clearly there’s interest in the helping consumer shop market. Gravie currently is serving 900 employers and 62,000 individuals. Oh yeah… and go Minnesota startups! Link.
  • I had no idea there was a French health insurance startup called Alan, let alone what the health insurance industry is like in France. The name alone makes me think they’re a European clone of Oscar… apparently they’re also expanding to life insurance. The pictures of their app and ID card look nice. Link.
  • Whatever the GOP is doing with regards to healthcare today is probably dumb. Thats all on that.

Opinions:

  • WSJ has a good deep dive on use cases for digital health management apps. It’s interesting how little they focus on financials / cost savings of these apps though. Ultimately that is what’s going to drive adoption of these tools — insurers implementing them as CM/DM tools. Of course figuring out the clinical use case is necessary to drive the ultimate outcomes, but the financial outcomes are both critical and difficult to demonstrate (note that the only financial data discussed in the piece is related to Omada, which not surprisingly is the furthest along in terms of adoption). The real sweetspot for tools like this is in entities that bear financial risk and control the last mile for members from a care delivery perspective while having low enough member churn to demonstrate long term savings… Link.
  • This Politico piece on how hospitals have benefited from the ACA is a fascinating read. It also the kind of stuff that makes me a bit sick to work in health care. Everyone knows it’s unaffordable. Health systems blame insurers. Insurers blame health systems. Everyone profits. Around and around we go. Link.
  • Sansoro’s Dave Levin on a future model for how to think about hospitals bifurcating into two types — one that is highly specialized to treat the super sick / complex, and one that functions unlike any ‘hospital’ today. Of course there is a lot of disruption that needs to happen to get to this view of the future, so who knows when we’ll get there. Then again days go slow and years go fast. Link. (And again… go Minnesota startups!)
  • A good read on a Hospital Sisters Health System in Illinois and their efforts to promote virtual care with their patients. Tons of interesting stats here — systems are going to have to get smarter at this kind of stuff as the industry becomes more consumer focused. Most surprising stat to me? Patients average a 12 minute wait for a 20 minute virtual visit. That seems… off. Link.

Data:

  • New CDC report out on Type 2 diabetes prevalence in the US. 34% of the entire US population has pre-diabetes. Dang. Link.
  • Dropbox link to a bunch of great health care research studies with a health policy bent. Link.
  • Still debating whether I pony up the $5 for this study, but it links retail clinics to reduced low-acuity ER visits in New Jersey and estimates $70 million of savings annually. Why can’t all studies just be posted free on dropbox links somewhere?! :( Link.

Random life stuff:

  • A helpful reminder that life is short and work can be all consuming if you let it be. I am particularly succeptible to that and need to remind myself to maintain balance in life. Link. (And the Wait but Why article linked in that on the tail end of life and how much time you have is also really great. Link.)
  • I am embarking on some side projects post Harken while doing some thinking about what is next. I suppose this in and of itself is something of a side project. Anyways… I found this read on the importance of side projects to be really interesting. Link.
  • One of the other side projects in life I am working on is learning d3.js (I think data viz is fun and a lot of healthcare data could use a good storytelling layer on top of it via data viz). So I’ve been going through this tutorial for d3.js and found it particularly helpful. It looks like its part of the ongoing education for Square employees… which is super freaking cool on their part. Link.