Where I Would Invest (Part 2 of 2) 11/9/12

In my last post, I covered five healthcare areas that I’d be interested in if I was an investor, which I’m not. This post has another seven areas, which started as four but then I got a little carried away.

Care Transitions (Discharge and Readmissions as a Starting Point)

Readmission prevention seems so 2011, but the reality is that technology that helps with transitions in care is necessary to reduce cost and improve the overall quality of care. Coordinating discharge activities, or some subset of those activities, is a good starting point. I think transitions in care don’t have to be overly complicated technologically, at least as a starting point.

axial 
There are lot of companies doing a lot of different things. Some of the ones I know of are:

  • Axial Exchange. Mayo backing and good pilot data, this company is going to do well, though I wish it didn’t water down the message by offering mRemedy mobile apps as its own mRemedy came to Axial with the Mayo investment.
  • Aidin. Coordinating home care, another one well placed with good market entry). 
  • OpenPlacement. Extended care.
  • WellFrame. Mobile interactive care plans. I really like this one the more I think about it.
  • Careinsync. Investment from California HealthCare Foundation.
  • Ginger.io. Acquired Pipette for discharge mobile tools and developers.
  • Cara Health. Personal touch with live phone calls.
  • Care Team Connect. More broad than just readmissions.


Tools to Get Docs Online

When I say online, I’m talking about using the Internet — not a hosted EMR — as an aspect of practice or for professional purposes. This is a space I’m passionate about. It’s a huge opportunity to modernize how doctors practice and interact, both with other doctors as well as with patients and the general public. I think most of the docs using the tools in the short to medium term are technology early adopters, direct primary care (concierge) docs, or docs that do a lot of elective stuff (cosmetics); but, I think usage is going to become more widespread as the physician community evolves and as incentives realign. With all of these services, a big perceived value is in the additional marketing and traffic docs can get from patients and referrals.

sharecare

Some of the big examples, at least in terms of funding and press, are Healthtap (patient/doc Q&A), Sharecare (patient/doc Q&A with more enterprise and brand focus), and Doximity (network for doctors). While these are getting a lot of the attention, there are some others to watch that are more focused.

clearmd

Clear.md is a another example. It enables providers (not just physicians) to create online videos of different topics for patients. The sell is to enable docs to connect with new patients, showcasing knowledge through videos, and also to prescribe buckets of videos to patients and caregivers. It’s a cool idea to me, though I’m not sure how much traction it’s gotten.


Marketplaces

image

There are several kinds of marketplaces, or at least approaches to marketplace, that are starting to get off the ground. I think many of these are likely to merge over time, but will grow initially based on the limited offerings below.

  1. Home health and home care. Several companies are making easier to find, filter, and rate home care providers. Some are targeting users directly and others are targeting discharge planners and case managers.
  2. Appointments. ZocDoc lead in this area, but others, like iTriage, are now offering different approaches to help users find and book the right provider.
  3. Insurance. This is very busy from an investment standpoint with big rounds for companies like Castlight and Simplee, and lots of press for others like CakeHealth. These aren’t really marketplaces at the moment, but I think all will likely be positioned to offer intelligent insurance quotes to people down the road. Also, some, like Castlight, supposedly enable users to see out of pocket costs for certain providers before booking. For dental, I’d have to lump Brighter into here. 
  4. Procedures (usually high deductible or out of pocket). These include imaging and maybe dental. Some startups, like HealthInReach and PriceDoc (which are now one) are trying to build this for users. The value proposition for users is that they can quickly find the best price for services that have wide variation in pricing. I think the challenge is getting users to actually land on and book these procedures. I’d like to see a product that does this through the referring doc.


Connector Apps and Services, Not Portals

Funny story about portals. I was at the Association of American Medical Colleges (AAMC) meeting earlier this week. A med student was displaying some technology and research his school uses. He asked me to describe it.  hesitated, then said, "I feel bad saying this because I think it’s become a bad word in technology, but what you have is basically a portal for your med school, though it is a nice portal," He laughed and said “portal” was the one word he was trying to prevent people from using, but he but agreed it’s how everybody sees it. I actually went to Wikipedia to find a definition for "portal" and got this: "A Web site that brings information from diverse sources in a unified way." With that definition, I was right that it was a med school portal.

Anyway, I’m not really a fan of portals in healthcare because I think they are too broad. Using technology for healthcare access is and will continue to be huge, but it’s not so mainstream or integrated into people’s lives as to require "health portals" to aggregate content and services for consumers. Users go to AOL (or at least my parents used to go there), Yahoo, and even iGoogle (does that still exist?) to check mail, see relevant news, look at their calendar, IM, and maybe a few other things. I don’t think consumers are pining for a health portal to land on. Kaiser may be the exception and I think that’s a result of Kaiser being uniquely placed as the master of all health for its members (payment, scheduling, pharmacy, all med records, all providers).

It may just be a matter of messaging, but I think users want specific features more than a catch-all platform right now, especially if that catch-all platform isn’t really a catch-all because it’s the portal for a PCP or a physician group or a payer or a pharmacy (Kaiser is all of these things). I think consumers want a ZocDoc to schedule appointments, or maybe a Simplee/Cake Health for billing, or a Blue Button, or a weight tracking app/device, or a fitness monitor/tracker. I also think health systems and docs rolling out these services could do better to stagger them, starting with scheduling then adding messaging or med records, and understanding what services are really of value and generate usage and adoption.


Almost Anything Telehealth (sort of related to the previous)

Along very similar lines to apps to connect and get docs online, I like anything that helps docs add virtual services, in the form of telehealth, to their practices. Also similarly to the approaches above, I like simple and focused, both in terms of product and in terms of services offered. Instead of announcing, "We now offer telehealth services!" I think it’s better to launch something specific, like certain types of follow-ups.

americanwell

The big one, American Well, seems more suited for sales to health systems than individual docs and independent practices, but I know it offers platforms for all. I think these solutions can be very simple and, just like the early adopters I listed above (tech-interested docs, direct primary care, elective-heavy), I think these make a lot more sense for certain segments of healthcare today.


EMR Extenders

EMR extenders, a term I seem to be hearing more and more, seem like apps that on top of EMRs. While I think lots of these functions are possible for the EMR to offer itself, it makes a lot more sense for EMRs to add value and innovation with third parties. Some EMRs aren’t going to enable this app store-like model. The ones that do allow it, seeing themselves as the platform instead of the entire ecosystem, are going to be increasingly popular choices. Apple ran out ahead of Android with the growth of its App Store (though Android has caught up) and it was a differentiator for a long time. EMRs can do the same thing.

healthfinch 
One example of an extender is HealthFinch, which offers RefillWizard. RefillWizard is a very specific solution to a very specific problem that saves docs time in the process. It uses EMR data to do its thing, effectively adding RefillWizard to an EMR like adding the Evernote app to your smartphone.

The Next Big EMR

I think there are some candidates on the ambulatory EMR side, but I’m talking about the next contender to Epic and some of the other big boys. This area goes against most of the principles I used to create the rest of the investment list (lots of early money, all enterprise sales, expensive integrations, lots of regulation), but it’s one I just can’t leave out. With the exorbitant cost to license outdated technology, there is a huge opportunity to build something far better, far cheaper, and far more flexible.

I actually think to make this work, a company will have to find a health system that is willing to work with them on it from the start, potently even funding portions of it. When I ask people at health systems why they don’t try this or launch an incubator to do it with a fraction of the money being set aside to consider existing EMRs, the reasons are related to risk and "nobody ever got fired for hiring IBM." That being said, I think it will happen and maybe is already happening.

TGphoto
Travis Good is an MD/MBA involved with health IT startups. More about me.

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