Next Things First

Health 2.0 From a Diabetic’s Perspective by charlottegee

Last night I came across this post on Read Write Web and had to pass it along. We’ve been talking about Health 2.0 for a while now on Next Things First—what will become of all these start-ups, do people really use the sites and gadgets and widgets (and do these actually improve health outcomes), important things Health 2.0 companies forget.

Well, Richard MacManus (in New Zealand) offers an incredibly informative perspective: Health 2.0 Through the Eyes of a Diabetic. He covers consumer web applications, online platforms to connect health professionals, medical records, portals, search tools, blogs and more. His post is certainly chock full of great information and resources for those people with diabetes, but also provides some interesting perspective for companies to consider regarding what patients want/need out of Health 2.0 offerings. (Personal note: Reading Richard’s post made even the cynic in me feel very “safe” in a way—if I’m ever diagnosed with diabetes or something similar. It is quite reassuring to know that all of these communities/resources are out there, many of them being tried and tested, ready and waiting.)

Other posts of note from the Read Write Web site:

How Technology Can Improve The U.S. Health Care System

Microsoft HealthVault and Google Health – The ‘Coke and Pepsi’ of Online Health

Health 2.0 and The New Economics of Aggregation

(Lots more, too.)

Posted by CharlotteGee

From Techno Tuesday

From Techno Tuesday


Quick Read: Seattle HealthTech Meetup by charlottegee
November 25, 2008, 3:05 pm
Filed under: innovation, seattle market | Tags: ,

The iMedExchange blog recently posted a writeup of the first “Seattle HealthTech Meetup”—featuring none other than Faultline Ventures founder (and Next Things First creator) Rob Coppedge. The event focused on how Seattle can become “a more vibrant and effective hub of healthcare technology … the advantage of Seattle’s entrepreneurial spirit and focus on innovation.” Rob also highlighted the fact that “Seattle is not as risk averse as some other cities currently thought of as healthcare hubs such as Nashville and Louisville.” Fourteen different regional health care companies attended.

Rob will be posting more thoughts on all of this soon. For now, see the post at iMedExchange.

Posted by CharlotteGee

Constancy of Change (from Jory Caulkins) by charlottegee
November 24, 2008, 11:07 am
Filed under: economy, venture capital | Tags: ,


My dad will be very excited that I worked this phrase into some sort of professional usage.

Private equity over the past five years (and perhaps more, excluding a short stint in the 90s) has been synonymous with gargantuan LBO deals. Deals in which excessive liquidity in the system allows for large amounts of leverage, and financially engineering a very attractive return given consistent cash flows. Since the dot-com implosion, these mega-deals have overshadowed the rest of the private equity asset class, especially venture capital and early stage strategic growth equity.

With the recent and inevitable credit crunch came the fall of many of these giant deals. But I do not think private equity is dead … its face is just changing. There is a fundamental difference between the environment necessary for these mega-deals to prosper, and that necessary for value-adding venture and growth investors to prosper.

Buyout shops need leverage in order to financially engineer their profitability. This means they need willing creditors, and ultimately liquidity. Unfortunately, these occur in cycles, and we are on a down cycle.

In contrast, venture investors and growth equity investors rely substantially less (if at all) on leverage for returns. Instead, they target disruptive innovation that can change established business processes and rely on the support of risk-tolerant capital partners to fuel their growth with a combination of equity and specialized value added. However, with many institutional investors so invested in buyout funds, I wonder how long it will take traditional fund investors to make a change in their asset allocation to fuel the next wave of venture capital funds.

This means that if you do believe that “there is nothing constant but change” (as I do after years of hearing it from my father), then you ought to be pretty excited about the opportunity set for venture and growth equity investors, especially relative to other current private equity opportunity sets.

Submitted by Jory Caulkins
Morgan Stanley, Mergers & Acquisitions

The Wall Street Journal on Obama’s “Emerging Health Care Plan” by charlottegee
November 20, 2008, 12:59 pm
Filed under: health policy, medicaid/medicare | Tags: ,

The opinion piece in today’s Wall Street Journal—The Obama Health Plan Emerges—is certainly worth a read. The closing sentences can give you a quick idea of the article’s overall tone:

Either Senator Baucus and President-elect Obama are making promises that can’t possibly be kept. Or they’re not being honest about their plans for U.S. health care.

The usual statistics are cited, along with a brief rundown of the mess we’re in … the “slow-motion catastrophe,” and a review of the Baucus and the Obama plans. The author(s) eventually conclude that the “public option” (an insurance program managed by the government and modeled after Medicare that will compete with private plans) will not work, and then “Congress will deal with the problem by capping overall spending and rationing care through politics (instead of prices) — like Canada does today.” And it’s funny, because those words can scare a lot of people to death.

Full opinion piece: The Obama Health Plan Emerges

Corresponding WSJ Health Blog post: Insurers Will Sell Plans to All Comers — If Everyone Must Buy In

Posted by CharlotteGee


Beyond the Partners Health Article: Looking at the Bigger Picture (From Howard Luks, MD) by charlottegee
November 19, 2008, 4:46 pm
Filed under: innovation, quality, wellness | Tags: , ,

The recent article in the Boston Globe regarding the perceived inequity of payments to the Partners system by local payors serves as notice on where the press and perhaps the public is going to come down on this issue. In the article, the authors assumed their conclusion and skewered Partners. I believe the authors missed a huge opportunity to explore the bigger picture. One of the more glaring problems I have with the article is that the authors begin with the assumption that institutional compensation (in medicine) is linked to quality.

Health care (medicine) is big business, the largest the world has ever known. The “average” successful hospital’s margin is 2%-2.5% at best. The payors are only interested in managing shareholder value and revenues and the effect of reimbursement on their valuation. How can the authors of the article find fault with Partners and their ability to negotiate from a position of strength, while they note that other local institutions are struggling and running in the red even prior to the enormous cuts that will come down from the state over the next quarter? How can they fault Partners’ quest for a profit to fund the next generation of technological advances, capital improvements and to fund care for the indigent and under-insured? Another interesting consideration is how the reporters gained access to the fees paid to institutions. There is NO transparency in this space. Confidentiality agreements between payors and institutions are SOP—which leaves one to imagine who wanted this article published in the first place.

The bigger picture that was not explored by the reporters is measuring quality and somehow tying quality measures to compensation. Measuring “quality” is a burgeoning practice (industry) that is trying to define and align itself in this highly fragmented and well-entrenched space. The definition of *success* and *quality*is the first of many roadblocks that exist. Is it a length of stay issue? Complication rate issue? Quality of life issue? Mechanical issue (healed rotator cuff in a patient who remains in pain)? Which of the overlapping systems are we referring to: the environmental level, the level of the health care organization, or the interface between clinicians and patients? There are numerous opportunities that exist within existing industry standards and industries that are just starting to emerge to enhance/streamline/incentivize (and profit from) the focus on *quality*.

A small, but certainly not exhaustive list of opportunities that exist are in various areas of the health care system:

Enabling rapid advances in health care: The need for federal, state and local governments to come together and guide reform platforms.

Health care delivery redesign: In order to provide safer, more reproducible, higher *quality* care, the environment in which health care is delivered needs to change. This will need to address, amongst other issues, management practices, workforce capability, work design and organizational safety culture.

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The Politics of Health Care by charlottegee
November 19, 2008, 11:11 am
Filed under: politics | Tags:

Yesterday the Los Angeles Times had a nice piece on the state of health care and its role in the political landscape (or is it the other way around?). The article provided a good overview of where we are now and what may or may not happen, depending on some part on the usual political activities (like the latest PhRMA ad campaign). Here are some of the more interesting snippets:

  • Hospitals and physicians are increasingly worried about the escalating burden of newly unemployed workers being thrown onto the rolls of the uninsured.
  • Liberal advocacy groups see the Treasury Department’s $700-billion commitment to banks and other financial institutions bolstering the case for a similar investment to help sick Americans get medical care.
  • Still unresolved are important details about the cost of a new system, provisions for increasing quality and a mechanism for compelling businesses and people to participate.
  • “We have a huge financial problem in this country,” said Joe Antos, a healthcare scholar at the conservative American Enterprise Institute, who called the idea that bold action would save money on healthcare “completely ludicrous.”
  • “If you don’t fix healthcare, healthcare expenses are going to make this banking bailout deal look like a rounding error,” [Sen. Ron] Wyden told physicians, business leaders and healthcare industry leaders gathered for a meeting today in Los Angeles.

Read the entire article: Political temperature may be just right for healthcare overhaul

And … what do you think of this?: DASCHLE TO HEAD HHS

Posted by CharlotteGee


The Week in Numbers by charlottegee
November 14, 2008, 12:38 pm
Filed under: week in numbers | Tags:

Installment #4:

80% in U.S. worry about medical bills

Cleveland Clinic doctors pick Top 10 innovations in medicine

Fewer Than 12% of Hospitals Use Electronic Health Record Systems

The percentage of heart-surgery patients who received standard treatment to prevent blood clots ranged from 59 percent to 96 percent at Seattle-area hospitals

Test showed that Google’s tool highlighted flu outbreaks about two weeks faster than the CDC’s tracking

By 2020, Burrill estimates the most common pharmaceuticals will be memory drugs

New Blues VC Fund Aims to Improve Healthcare, Has $116 Million to Invest

Turns out C. diff is infecting more than 1 in 100 inpatients, a nationwide survey just found

Interoperable PHRs Could Save $19B Annually, Study Finds

Posted by CharlotteGee