What’s Hot in Digital Health? The Venture Capital Perspective

12/11/12Follow @SkipFleshman

The U.S. healthcare market is ripe for technical disruption. Costs are spiraling out of control while quality of service and customer satisfaction continue to go down. The system is opaque, complex and fragmented. Regulation is required but imposes heavy costs. As in other industries before it, the healthcare sector can benefit from technology-enabled efficiency gains that use measurement tools, structured data, analytics, SaaS, faster processing, smartphones and tablets.

At this stage the overall sector, which includes mobile health, electronic medical records (EMR), and Web-enabled health and data analytics, is nascent. I find that entrepreneurs and investors are still apt to openly discuss market trends, business models and partnerships.

I recently organized a dinner for venture capitalists who invest in the digital health sector. The objective was to discuss companies, markets and business models and see how we might collaborate. The guest list was a who’s who of investors in the sector. We had several great conversations but more often came back to the topic of what markets, technologies, and areas are most attractive for investment in digital health. In no particular order, and augmented by conversations I’ve had outside the dinner, here are some of the areas we think are interesting.

Products enabling price transparency: The basic problem here is that a medical test or procedure may be priced dramatically differently in two different clinics situated in the same ZIP code. The consumer, however, rarely has any visibility into these charges until after they receive their bill and they have no idea that they could have had the same procedure done elsewhere at a much lower cost to them. Payers and patients have no mechanism to easily compare procedure costs—but companies like Castlight and Clearcost are trying to create more transparent pricing.

Services for aging population: It is well known that Americans are getting older and suffer more from chronic disease. Although direct care and services for the elderly will consume a significant amount of the money spent in this sector, venture capitalists are keen to find ways to efficiently manage and organize this care. Companies like Proteus Digital Health target compliance and mobile tracking. Care at Hand has a mobile application for home health aides.

Data, data, data (part 1): If patient record data is digitized, and that’s still a big if, it is often stored in disparate locations in different formats, which means it’s hard to use. Much has been written about aggregating, comparing, and analyzing individual medical record data to improve outcomes and help diagnosis become predictive. Although the standards are in place, there is still a long way to go. Practice Fusion is going after storage of EMR while drchrono is helping patients easily access their records and data. Humedica is ahead of the game in analyzing data and using it for very practical purposes.

Data, data, data (part 2): There is a new wave of data generated by users. This comes from mobile phone applications that track movement, mood, or calories consumed; new wearable sensors like Fitbit, Nike Fuel, and larklife; and wirelessly connected scales or blood pressure monitors from Withings. This new type of data, when aggregated and combined with existing EMR, has the potential to help people improve health and well-being. Right now much of this user-generated data is fragmented with few standards, but many companies are opening up their APIs and there are companies attempting to aggregate and connect this data to sources that can do something with it. Genomera is trying to use this data for studies and for pharmaceutical companies, but a bigger play would seem to be exposing this data to payers.

Connecting to consumers: As more and more consumers and healthcare professionals use connected devices to help people maintain healthy lives, pharmaceutical companies, insurance providers, and physicians are beginning to appreciate the ability to connect directly with the patient population. Major organizations are trying to figure out how they can access user-generated data in aggregated and individual form to improve outcomes. They also see value in connecting directly with consumers for engagement and marketing. Ginger.io, Eliza, and Achievemint are all working on solutions in this sector.

Access to healthcare information and services: There is a supply and demand problem between patient needs and access to healthcare (including health information). Appointments are hard to book, doctors are often late, visits are too short, and post-visit follow-up is cumbersome. Companies that are emerging as market leaders are ZocDoc, which helps patients schedule appointments, and HealthTap, which helps patients get their questions answered by doctors online. One Medical Group is also a leader in this space, and MyHealthTeams is a personal favorite.

Tackling readmissions: Hospital Impact reports that one out of every five Medicare patients is readmitted to the hospital within 30 days of being discharged. Medicare has a new policy—called a Readmissions Reduction Program—that docks up to 1 percent of pay for hospitals with high readmission rates. This very real cost of readmissions, estimated at $17.5B/year, is an area that can be addressed in part by technology. Wearable sensors, wireless tracking of vital signs, two-way information flow, and automated discharge plans can all help.

Tools for doctors: Manhattan Research reports that 62 percent of doctors use iPads and over 85 percent use smartphones professionally. Although selling into hospitals can be a cumbersome, lengthy, enterprise sales process, many companies are developing applications and technology that doctors adopt directly. Doximity has created a large social network for connecting doctors and Airstrip is a leader in delivering patients’ clinical data to a doctor’s mobile device. Medigram offers a secure text messaging system for doctors and nurses.

Lowering corporate insurance premiums: As payers’ costs go up, they increase premiums to corporations, and corporations in turn pass along many of these fees to their employees. Payers would likely lower premiums if convinced that a workforce is healthier than the baseline or overall health is improving. Several companies, such as Keas, RedBrick, Bloom Health, and EveryMove are trying to measure employee health and improve it by incentivizing employees to lose weight or stop smoking.

The venture capital community is certainly still looking for companies pursuing FDA-approved therapeutics and devices, but the emerging sector of digital health is continuing to garner attention. Firms that have traditionally invested in both healthcare and IT have a distinct advantage in this converged sector, but we are now beginning to see traditional IT firms investing in companies that are out to disrupt the current healthcare paradigm. A lot of firms lost significant capital in the late 90’s and early 2000’s investing in healthcare IT, which at the time was mostly enterprise software for hospitals. This time around we expect real cost savings and data-driven improved outcomes with several long-standing companies built in the process.

Skip Fleshman is a Managing Partner at Asset Management Ventures, which has invested in Health 2.0 companies such as CardioDx, HealthTap, Lark, Proteus Biomedical, and Maverix. Follow @SkipFleshman

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  • http://www.nurep.com/ Paul

    I would add that “access to healthcare information and services” is posing a problem on the provider to supplier side as well, not just the provider to patient.

    Healthcare reform has caused an in-balance in the supply and demand of medical device information and support to surgeons, which is impacting patient care and increasing healthcare costs.

  • http://twitter.com/ADeGheest Anne DeGheest

    At HealthTech Capital, we focus on the “so what” and have invested in companies that fall in two big categories:
    1. help existing healthcare providers deliver care more cost effectively by leveraging technology like CareInSync to improve communication and collaboration of the care team.
    2. empower the patients to take charge via customized information tools like Wellness FX or MyHealthTeams
    All of those new companies have significant market risk and need to really understand who the stakeholders are and why they will change behaviors or pay for these new products.

  • Mahesh Jain

    Please visit http://curatio.in that meets several of your objectives. Also visit and like facebook page http://www.facebook.com/Curatio.i?ref=ts&fref=ts

  • EMR-Matrix

    Very cool EMR matrix (http://www.emr-matrix.org) has some EMR meets 2.0 features.

  • http://twitter.com/l_scott_brown Scott Brown

    Great article, and mostly spot on. It should be emphasized, however, that investors are still shying away from technologies related to “scary” topics like end-of-life care and patient engagement during critical/end-of-life care situations. Too bad, because that’s one of the spaces where healthcare IT could have the most impact on quality of care, readmissions avoidance, and lowering costs.