June 29, 2020

How digital health has changed in the Covid-19 era

Daily Briefing

    On the Radio Advisory podcast, host Rachel Woods spoke with Tom Cassels and Megan Zweig from Rock Health, the first venture fund dedicated to digital health, about how the digital health sphere has changed in response to Covid-19 and what that change means for patients, especially those in underserved populations.

    Rae Woods: Are you tracking any of the factors that might accelerate the adoption of virtual care as a true front door to the delivery system?

    Tom Cassels: Absolutely. The first factor is frankly access, and one thing that just isn't changing is the supply-demand mismatch for specialists, especially in neurology with the aging population, and psychiatry from pediatric to geriatric. Those trends are going to make it absolutely impossible to meet demand if we aren't focusing on the type of virtual care that is not video to video—that is truly asynchronous in nature.

    Woods: You're so right. I actually had a physician leader tell me last year that in order for a patient to get an appointment with a specialist, it would require an act of God. And of course, it's a joke, but that shows you just how bad access was—and that was before Covid-19 created a bottleneck and a backlog of patient appointments that really haven't happened for the last three months.  

    Cassels: You know, it's funny—when I was a young researcher at Advisory Board, the CEO of a large orthopedics group told me the thing she was most proud of was that there was a 30-day wait for the next available appointment. I think that mentality is going to be crushed by folks who embrace virtual care and access that makes sense for human beings. And no offense to that wonderful group, but you're going to be left by the wayside, because people are going to go where they're welcomed.

    Megan Zweig: Also, I want to talk about one access challenge that we are going to need to face when we are transitioning to use of technology as a point of access for care. There are big disparities in terms of access to broadband, access to your tablet, phone, computer, or a private, safe place that you can engage in some of these visits or even the synchronous communication with providers.

    So as country, we need to reckon with not just reimbursing for virtual visits as Medicare/Medicaid, etc., but also recognizing that if somebody doesn't have access to the underlying technology to take part in that visit, it's not going to happen.

    Woods: I could not agree more. When I talk about digital health and telehealth together, I am always a little bit wary of what that transformation means for the vulnerable, the underserved, the rural populations. So, Megan, how can the industry simultaneously push for greater utilization of digital services while also improving health equity?

    Zweig: One thing that we do look for as investors is whether or not the founders have really thought through how they are going to reach different types of populations. Is their solution going to be applicable to more underserved populations? Maybe the Medicaid market, which truly is a really big market that's right for disruption.

    So we work with close partners, such as HealthTech 4 Medicaid, who are really thinking about how we encourage entrepreneurs to better understand the Medicaid market so they can increasingly craft solutions for them. And I remember chatting with the founder of Omada Health, Sean Duffy, about how there are a lot of misconceptions about people's use of technology. There actually isn't huge underutilization of cellphones, for instance, among the Medicaid market. There is just a need to sometimes adapt content into different languages to make sure that it is understood by people of all different educational backgrounds or reading levels.

    You just have to take those design factors into account when you are designing for that market. And it's really thinking through what the challenges of that particular population are, that tends to have—especially when you think about the Medicare market—more co-morbidity and is less likely to be compliant with a particular care plan. Sometimes we kind of want to do the right thing, but it is really hard to find the motivation to do so. And sometimes, these digital tools can tap into that underlying motivation and make the right choice the easy choice for people.

    Cassels: We are very proud of the companies that we have invested in in the last year for their focus, disproportionately, on underserved populations. At the end of 2019, we invested in a company called Arine, who, for a lack of a better term, is a digital pharmacy. They're working with the state of Oklahoma to create a two-way conversation between patients and physicians to understand if medications are really working for them, if they can afford the medications, and what the right medications should be.

    We invested in a company just recently announced, Wellth, which is a technology for improving full care plan adherence using behavioral economics. Its focus is working with state Medicaid plans with FQHCs and with health plans and health systems writ large on how to capture the best way to get a job done when frankly, human nature doesn't act exactly the same for every type of person. So, we feel like that personalization and broad emphasis on who the end users are is something that we love to invest behind.

    Zweig: If we want to see more diverse companies, and companies built for these historically underserved populations, we also need to invest in more diverse founders. We need to see more diversity among investors, and more diversity among the leadership of these enterprise healthcare organizations.

    Historically, we have tracked in the gender equity space very slow movement being made in terms of women's representation on boards, in C-suites, as founders of companies, and as partners in funds. This past year, just 14% of the digital health companies that were funded and based in the United States were led by women. And this year, we really want to broaden our focus and think more about different dimensions of diversity—thinking about race, thinking about ethnicity. We are doing some work that we'll lead with Ivor Horn, who's an incredible leader in this space, to really capture data, because we have the data around gender equity, and the data doesn't exist to just understand broader diversity and health tech. And so we really want to dig into that to understand what barriers are inhibiting these founders from finding funding, finding the right clients, from scaling their solutions, because the talent is out there and we need to find the right bridge to get the capital and non-capital support to them.

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