Spotting next generation healthcare opportunities
Written by Marissa Schlueter
Here’s a radical understatement: The last couple years have been tough.
But — at least for me personally — tough times also provide the opportunity for reflection and change. Going into 2022, I have a much better sense of who I am, what I value, how I learn and where I want to be. And that’s as a health tech investor at OMERS Ventures.
I’ve long entertained venture capital as a potential career in the back of my mind. Now feels like the ideal moment. I’m hoping to take my experience with public equity research at Melius Research, as well as private company research at CB Insights to help trend spot and identify the next generation of opportunities in health-tech.
For years, friends and family have joked that I’m a professional student — and they’re not wrong.
My previous roles have relied on my ability to consume large amounts of data, synthesize actionable insights and communicate those learnings to key stakeholders as they evolve. VC gives me a perfect forum to do what I do best in service of finding great founders and helping them build their businesses.
As nerdy as this sounds, I’m genuinely excited to help founders build and refine their financial models, dig into user and company performance metrics, conduct competitive and market landscaping analyses, and identify strategic growth opportunities.
I’ve also come to realize how much I value purposeful, mission-driven work. At the micro level, this affords me the opportunity to really make an impact on entrepreneurs making healthcare better. After all, when they win, we all win.
Why OMERS Ventures (OV)?
I should start by explaining what OV is.
For the uninitiated, OV is the VC arm of OMERS (Ontario Municipal Employees Retirement System), one of Canada’s largest pension plans with around $100B in net assets. With teams in Toronto, London, and Palo Alto, OV makes multi-stage (Series A to C, with the occasional, exceptional Seed) investments in growth-oriented startups across North America and Europe.
The Bay Area investment team, led by Michael Yang, takes a thematic approach to investing within distinct verticals — specifically health tech (myself and Christina Farr), workplace SaaS (Eugene Lee and Justin Ouyang), proptech (Michelle Killoran), and insurtech (led by David Weschler).
As is often the case in venture, people are paramount, and I knew I couldn’t make the jump with just anyone. Specifically, I wanted a team with a strong culture of collaboration, mentorship, and diversity. It was also important for me to join a team that viewed their portfolio companies as valued partners instead of strictly as investments.
Where I’m rolling up my sleeves
Below are just some of the health tech themes, segments, and end markets I look forward to digging into as a VC.
Many of these are personal to me — I’ve either experienced the problem firsthand or have dear friends and family members who have. They also overlap with what I’ve observed (during the last few years at CB Insights) as relatively under-appreciated pockets of opportunity for tech integration and advancement.
If you’re a founder focused on any of these areas, reach out to me at email@example.com — I’d love to learn more about what you’re working on.
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A growing number of startups are using digital technology to productize supplementary health/social services and integrate them into next-gen care delivery models. These wraparound services — which may include coaching, social counseling, dietetics, companionship, peer/community support, navigation, coordination, education, prescription management, transportation assistance, etc. — aim to enable more holistic, personalized, seamless and higher-quality care.
While covering the telehealth space at CB Insights, I saw many point solutions being used for distinct applications/populations, including lifestyle coaching for type 2 diabetes prevention (e.g. Lark Health, Noom), companionship for aging seniors (e.g. Papa), and peer support for recovering addicts (e.g. MAP Health Management, Marigold Health).
But given increased focus on social determinants, shifting consumer expectations, and expansion of verticalized virtual care delivery, I think this trend is in its early innings.
Over the next few years, I expect digitally-enabled wraparound care to become more commonplace and also more comprehensive as next-gen care models emerge for specific demographics (e.g. age, gender, race, socioeconomic status, sexual orientation, etc.) and medical conditions (e.g., cancer, CKD, IBD, HIV/AIDs, etc.).
In the near-term, I’ll be keeping a particularly close eye on the integration of mental/behavioral health and peer/community support into care for patients with rare, complex, debilitating, life threatening, and stigmatized conditions.
Healthcare in the home
In response to the pandemic, many health systems, patients, families, and even clinical trial sponsors/CROs increasingly sought out home-based alternatives for care traditionally delivered in institutional care settings like hospitals and skilled nursing facilities (SNFs). But while the shift to home-based healthcare was accelerated by the pandemic, there are several reasons it could persist.
“Hospital-at-home” (HaH) for acute & post-acute care: A growing body of research supports HaH’s ability to demonstrate material cost savings, reductions in readmissions and lengths of stay, and improvements in clinical outcomes and patient satisfaction ratings. CMS has also signaled a willingness to reimburse for Medicare HaH services during the public health emergency (PHE) with the implementation of the Acute Hospital Care At Home waiver program. Though there are some issues to be sorted out, the program is a move in the right direction from a reimbursement angle and industry stakeholders (Advanced Care At Home Coalition) are aggressively advocating for its extension beyond the PHE.
The startups highly levered to this shift are raising some serious capital: Medically Home just announced a $110M Series D led by strategic investor Baxter International, and last year, DispatchHealth raised $200M in Series D financing at a $1.7B valuation. We’re also seeing M&A activity here: Admedisys picked up Contessa Health for $250M and Best Buy acquired Current Health for $400M.
Extended care for aging and disabled patients: Aging and disabled patients and their families have been shifting away from SNFs in favor of home-based care for the better part of the last decade. The pandemic only accelerated that trend. Though SNF occupancy has bounced back slightly from its all-time low (early 2021), the pace and magnitude suggest we will not be seeing 85%+ occupancy again for quite some time… if ever.
Source: Skilled Nursing News
Decentralized clinical trials (DCTs): During the pandemic, mass decentralization happened out of necessity. But the tech demonstrated valuable benefits: it allowed clinical trial investigators to reach larger, more diverse patient pools, work more efficiently, reduce participant dropout, and generate cost savings for sponsors. Having had that experience, the vast majority of clinical trial sponsors and CROs expect virtual trials to be a big component of their portfolios going forward, with most activities conducted in participants’ homes (according to a McKinsey survey).
Some health tech startups levered to the DCT movement include: Medable (which recently raised $304M in Series D financing at a $2.1B valuation), Castor EDC, ObvioHealth, Curebase, THREAD Research, and Reify Health.
For any/all home-based care programs/paradigms, tech will be absolutely critical to the economics, clinical impact, and patient experience — from identifying eligible participants, to coordinating care, optimizing staffing & logistics, remotely monitoring patient vitals & self-reported symptoms, and more.
Decentralized testing — via point-of-care (POC)/at-home lab tests and smartphone-based screening and diagnostic tools — was a major focus of mine at CB Insights and continues to be an area I believe will see outsized benefits from tech integration and advancement going forward.
While at-home Covid testing may be the most immediately relevant application, the overarching market opportunity for decentralized testing is much more expansive.
We’re already seeing at-home testing solutions tailored for routine screening, high-risk screening (CKD, prediabetes), fertility screening (male & female), low acuity diagnostics (UTIs, STIs, common respiratory viruses, food sensitivities), and even pharmacogenomics (birth control selection).
I expect this list to expand, especially as more care is delivered in the home (acute/post-acute, aging-in-place, clinical trials, etc.) and on the back of some material business developments over the last year or so.
The interest is coming from all angles of the market — we’ve seen: virtual care providers bolting on at-home testing assets (Ro’s acquisition of Kit), at-home testing players acquiring virtual care businesses (23andMe acquiring Lemonaid Health), traditional diagnostics giants getting their foot in the door (BD’s acquisition of Scanwell), and digital infrastructure being built to support the trend (Truepill’s diagnostics launch).
But even beyond at-home testing, there are tremendous opportunities to bring diagnostics closer to the POC — whether that’s in an exam room, at the patient’s bedside, in a community health center, at a retail pharmacy, etc. — because doing so significantly reduces test turnaround time (compared to sending samples out to a reference lab), which in turn can shorten treatment response times, improve patient outcomes, and reduce costs. This is particularly critical for conditions like sepsis and hospital-acquired infections.
Digital pharmacy & DME fulfillment
Digital pharmacies like Capsule, Medly, and Alto have been around for several years but the pandemic really catapulted their growth. The same goes for DTC virtual care/pharmacy fulfillment (“telepharmacy”) companies like Ro, Thirty Madison, Nurx, Pill Club, etc.
Again, I think this phenomena will outlast the pandemic. And so do major tech & retail players: for example, Uber has partnered with ScriptDrop and Amazon and Walmart launched their own digital pharmacy offerings. So, why the optimism?
- The opportunity is massive. According to McKinsey, only 5–10% of the US retail pharmacy market ($460B) happens online. That’s less than half the penetration rate seen in other industries like apparel, consumer electronics, and office supplies. While some drug classes are legally prohibited from being prescribed online (per the Ryan Haight Act), enforcement was relaxed during the PHE and some think we could see a permanent reversal of the law in 2022.
2. Consumers increasingly demand convenience. The proliferation of digital health services during the pandemic has given consumers more power in choosing where/when/how they receive care. And when the choice exists, consumers will always choose the more convenient option, all else equal. Once in place, these expectations are very hard to reverse, and for those reasons I think digital pharmacy/direct-to-patient medication delivery will only grow in demand.
3. More care is happening at home. New opportunities for digital pharmacy will emerge as more care shifts out of institutional care settings and into patients homes. Patients who would normally get their medications on-site at a SNF, for example, now need a different service to fill that gap — for disabled patients or those who no longer drive, digital pharmacy/home delivery is a perfect fit for that.
Another tangentially related area I’m interested in is tech improving durable medical equipment (DME) logistics & fulfillment. Roughly 1 in 4 US seniors rely on DME in some way but getting and maintaining it can be a very confusing and complicated process for those living at home. Companies like Tomorrow Health and Better Health are using tech to improve stakeholder connectivity, optimize supplier matching, streamline order & refill processes, and improve transparency & patient choice.
Caregiver support & empowerment
According to the National Alliance for Caregiving (NAC), a greater proportion of US adults are taking on unpaid caregiving responsibilities each year. In 2020, 21.3% served as a caregiver to a family member or friend compared to 18.2% in 2015. On top of that, a greater proportion are providing care to 2+ people: 24% did so in 2020 vs. 18% in 2015.
The NAC attributes these findings to:
- “The increasingly aging baby boomer population requiring more care
- Limitations or workforce shortages in the health care or long-term services and supports (LTSS) formal care systems
- Increased efforts by states to facilitate home- and community-based services
- Increasing numbers of Americans who are self-identifying that their daily activities, in support of their family members and friends with health or functional limitations, are caregiving
- The confluence of all of these trends” (NAC)
Regardless of the causes, we’re witnessing a “caregiving crunch” that’s only projected to grow more acute in the future. According to Lisa D’Ambrosio, a research scientist at the MIT AgeLab, “shifting demographics will lead to a drop in what’s known as the caregiver support ratio: the number of adults ages 45 to 64 who are available to provide care to those 80 and older. Between 1990 and 2010, the caregiver support ratio hovered at around 7 caregivers per care recipient, but by 2030 the ratio is estimated to decline to 4 to 1, hitting 3 to 1 by 2050.”
Tech is unlikely to solve this problem entirely but it certainly could have outsized impact on low-touch caregiving activities like social engagement/companionship, medication management, care coordination, transportation & meal assistance, etc. DUOS, which emerged from stealth in 2021, is an interesting example as it pairs aging adults with dedicated personal assistants to help with these “social determinants of aging,” leaving high-touch activities to be managed by caregivers.
I’m also interested in businesses looking to support caregivers’ mental health and wellbeing. One company integrating mental/emotional health within a broader suite of caregiver support tools is ianacare, which just recently raised $12.1M in Series A financing.
Contrary to popular belief, palliative care is not synonymous with hospice and isn’t exclusively meant for the very elderly or terminally ill. Though it was originally developed for those purposes, palliative care has evolved into its own medical speciality that caters to people of all ages and all types of serious medical conditions including heart disease, AIDS, MS, stroke, liver disease, and more.
Instead of treating underlying conditions, palliative care teams — a multidisciplinary mix of physicians, nurses, social workers, mental health professionals, and chaplains — focus on alleviating patients’ symptoms and meeting their emotional, spiritual, and quality of life goals. They also serve as critical support systems for patients’ families and caregivers and as care coordinators with patients’ primary physicians. Importantly, unlike hospice, palliative care can be — and often is — delivered alongside curative or life-prolonging treatment.
Studies have consistently demonstrated palliative care’s ability to drive meaningful improvements in quality measures, resource utilization, and costs. As a result, it’s been one of the fastest growing fields in medicine. Between 2000 and 2016, the percentage of 50+ bed hospitals with a palliative care team tripled from just 25% to over 75%.
Despite its growth, palliative care remains underutilized. Roughly 60% of people who would benefit don’t get it. Two of the biggest reasons have been consumers’ lack of awareness and physicians’ hesitation to initiate discussions with their patients. But those things are beginning to change — and demand is rising — in response to the pandemic. Telemedicine has also begun to alleviate some of the access and supply shortage challenges (e.g. Vynca, Devoted Health, Mettle Health).
But as utilization picks up, there will be greater need for other digital health tools to improve patient/family/caregiver education, patient-provider-palliative care team information sharing and communication, symptom management, advance care planning, family grief/bereavement counseling, and more.
Unique solutions for HCP shortages & burnout
Skilled labor shortages and rising burnout have long plagued the US healthcare system but, now with omicron, are growing increasingly more acute by the day. Presently, the healthcare workforce is on the brink of a “Great Resignation,” which could send deleterious ripple effects throughout the entire healthcare system.
Despite all the progress we’ve seen in health tech, in aggregate, these innovations have failed to make a difference on the very people the system depends upon.
Many virtual care companies, for example, claim that they’re helping address HCP shortages, but in my opinion they’re more so reshuffling when/where the available HCPs dedicate their hours. Tech-enabled workflow efficiency gains will only move the needle so far — maybe allowing them to see a few extra patients per day on the margin. To fundamentally address the supply shortage, we need to see more dedicated investment into training and upskilling.
I’m also eager to see tech that improves HCPs’ quality of work life — e.g. by reducing information/tech overload (e.g. Wellsheet), relieving them of documentation duties (e.g., DeepScribe, Suki), providing intuitive clinical decision support, guiding them through difficult conversations, helping them develop stronger relationships with patients, instilling a sense of purpose, etc.
There’s not going to be one fix-all, of course. But hopefully, in time, a confluence of health tech solutions can help turn this ship around.
Provider directories & care navigation
I’ll keep this one short because my colleague Chrissy Farr sums it up nicely in her blog post here.
There’s one thing I’d like to add to her analysis:
Until recently, provider directory and care navigation tech focused mostly on the employer market, but the need for these solutions is becoming increasingly relevant to the masses now that DTC health services are proliferating.
As competition heats up, consumers will grow more discerning of where they’d like to spend their out-of-pocket dollars. Beyond price, DTC providers will be increasingly assessed for things like wait time, cultural competency, ancillary services (e.g. prescription delivery, at-home labs, etc.), patient reviews, etc.
Prior authorizations / utilization management
There are two main types of waste that cost the healthcare system $1.1T annually: administrative waste ($700B) and clinical waste ($445B).
Over the last decade, a lot of time, money, and energy has been spent on addressing administrative waste — understandably, since it’s a bigger piece of the pie — but disproportionately fewer resources have been devoted to tackling clinical waste.
We’re starting to see that change. A growing number of startups are now using tech to improve prior authorization processes and, ultimately, utilization management. Some examples include: Olive, Cohere Health, and Banjo Health.
Medicaid — Investment into Medicaid-focused businesses has historically been limited due to concerns about scalability and profitability. But many of these concerns are actually rooted in misconception. With Medicaid enrollment at record-level highs (almost 25% of the US population) and the rest of the healthcare system “[speeding] up its digital transformation by 10 years,” it’s irresponsible to ignore technology that could make healthcare more equitable, affordable, and accessible for a population that’s long been overlooked and underserved. Cityblock has been a standout for several years now but we’re only just beginning to see other types of Medicaid-focused businesses emerge, like Circulo Health and Waymark.
Specific cultural communities — There’s growing appreciation of the need for culturally competent HCPs and healthcare organizations, with a wave of health tech companies like Hurdle Health, HUED, Health in Her Hue, and Pride Counseling emerging and established players like Grand Rounds/Doctor On Demand (now renamed Included Health) acquiring culturally-competent businesses. Companies that specialize in cultural competency education, training, and credentialing (e.g., Violet) will likely play important roles as this recognition grows.
Children & adolescents — Pediatric health tech businesses have been in vogue recently, but really just in one area: mental/behavioral health. There’s so much else that goes into childhood development that’s not getting much attention. I’d be interested in seeing health tech businesses working on pediatric nutrition/healthy eating, allergy & immunology, endocrinology, reproductive/sexual health, and sleep medicine. I’m also interested in companies working on improving urgent & primary care in school settings.
Women — Again, I’ll leave this one to Chrissy. This is a topic both of us are passionate about so will continue to be a big focus of ours going forward.
Specific conditions & specialties
To avoid going down a million other rabbit holes (I’ll save that for another time…), here’s a short laundry list of specific conditions and medical specialties I want to dig into. None of these are truly uncharted territory from a health tech point of view but they do likely have pockets of untapped opportunity and definitely have areas in need of improvement.
If you’ve got unique experience, perspective, or intel on any of these and how technology could play a bigger/better role in the future, please reach out.
- Mental health beyond generalized anxiety & depression — e.g., OCD, eating disorders, phobias, PTSD, non-suicidal self-injury disorder, bipolar disorder, schizophrenia, etc.
- Substance use disorder and addiction
- Complex chronic disease including autoimmune illnesses like Addison’s disease, Graves’ disease, MS, celiac disease, rheumatoid arthritis, IBD (Crohn’s disease, ulcerative colitis), lupus, psoriasis
- Gastroenterology & metabolic health — e.g., functional GI disorders, pancreatitis, thyroid conditions, metabolic syndrome, etc.
- Neurology — e.g., pain, migraine, peripheral neuropathy, epilepsy, neurodegenerative diseases (Alzheimer’s, Parkinson’s, Huntington’s, ALS), mTBI/concussion, brain aneurysm, stroke
- Pediatric oncology — e.g., solutions to help parents/families to navigate care, communicate with care teams, receive emotional support/counseling, etc.
- Fertility — e.g., businesses aiming to improve the success rate and affordability of fertility care
- Dermatology beyond acne and anti-aging skincare — e.g., melanoma, melasma, eczema, plaque psoriasis, rosacea
- Dentistry/orthodontics (excluding mail-order aligner businesses)
So as you can tell, this is a fairly exhaustive list. And I had to hold myself back from including more. If you’re working in any of these areas, I’d love to hear from you!