We are back from HLTH, and there is no doubt that it's THE conference of the year in the digital health industry. We could catch up with friends at our booth and make new ones over the four days of the conference. We assisted exciting discussions of different niche topics and listened to top-notch leaders share their insights. Now back at the office, our team put together all these main takeaways from the talks:

Mental health

Mental health is one of the biggest problems Americans face, and providing care is still highly challenging. Dr. Satish Singh, Jeff Weness, and Saad Shah spoke about pharma's role in scaling mental health safely and shed light on the issue that comes from expecting people to know what they don't know. We know little about this topic, making it extremely difficult to identify what we need. It's not just one gateway, one pathway, that will give people the correct care. We need to explore different solutions and treat each problem uniquely and personally.

A study shows that just providing care to someone with behavioral problems can lower medical and pharmacy costs by 16% in 15 months and 28% over 27% months. These numbers reflect that we are just at the beginning of affordability and that connecting and measuring what we do can bring tremendous outcomes.

Also, Jay Shetty, Chief Purpose Officer of Calm, and David Ko, CEO of Calm, shared in "The Body. The Mind. The Future of Whole Health" conference some interesting statistics and insights about mental health and how the industry will evolve in this sense:

• ¼ people you know are struggling with their mental health.
• If we know that treating the mind is as important as treating the body, why don't we do that? Because the system is not set up that way. There are not enough professionals and mental health resources today to treat all the people that do ask for help. There are over 123 million Americans who have no access to the mental health resources that are out there today. In the 3,000 counties in the U.S., 60% don't have a psychiatrist, and two-thirds of all primary care physicians can't get one of their patients to see someone if they're having a mental health issue.
• People look at their phones 262 times per day, that's once every five and a half minutes. Our attention is on our phones, causing us stress, pain, and anxiety. But we can't expect people to move away from these habits that have been built up over time. So, we need to transfer the habit of using technology in a way that adds to our lives and our health.
• Workplaces need to start the conversation of mental health and provide the tools for a culture of growth and progression inside the company. We all want to know that we're not alone.
• How will the mental health area continue to evolve? We need to bring the ecosystem together because it is very fragmented and will continue to get more fragmented. Where are all these people going to go when they start raising their hands when we can't support the people who are raising their hands today? This is where technology will have to play a big part in the solution.

Investing in Patient: V.C.s advice

Top industry leaders building and raising in this environment over the next several quarters shared some interesting advice at the "Investing in the Patient: What Technologies are V.C.s Interested In" Conference:

• Vijay Patel: Focus on overgrowth. Understand the model they're trying to put forward vs. the number of markets you're trying to enter.
• Ulili Onovakpuri: if you are selling to a provider or looking for an investment for a provider, keep your economic model simple.
• Chris Bischoff: Focus on the pathway to decent unique economics.
• Christine Brocato: know your business, know your numbers, and try to keep cash in the bank.
• Kelsey Maguire: Be clear about what you're building and why you are building it.

Women's health and Tech

Priyanka Jain, Co-Founder and CEO of Evvy, shared her insights on the future of women's health and Tech at the "The Power of Personalized Health and Nutrition Conference”.

Key takeaways:

• For the funding world, we are just at the very beginning of what will end up being a very massive Market.
• It starts with giving people access to information on their own bodies, providing them with a scientifically sound education, and then really doing the research and the work that it's going to take to move our Healthcare System to one that works for all of us.
• The key step is to create new data sets, given the amount of white space in our understanding of female health conditions. When you actually bring much more big data around this problem, you find out it's far more complex than it seemed. For example, "what we call bacterial vaginosis today is probably 40 different things (...), but we'll never get there if we don't build the data".

Advices for healthcare founders

Also, Mario Schlosser, John Driscoll, Jordan Nof, Julie Yoo, and Julia Hu discussed "Pivot or Spiral: Remaining Agile as a Founder" and shared some exciting advice and thoughts for founders in this industry:

• In healthcare, you have to plan for the long term. "Plan as if your business is gonna last forever but lead as if you're going to be measured on your leadership tomorrow." Don't postpone people, culture, or purpose.
• Employees always know more about the company than they think, and the outside world weighs less. If you don't communicate clearly internally, people can't make sense of what's happening, and that's usually when companies do poorly.
• Build trust, a strong team, and culture, and invest in authentic communication upfront. The market is unpredictable, so it's really important to have your internal situation strong to fight the crisis.
• Fall in love with facts and not your vision: when you have to pivot, you have to pivot. Build assuming that the market, the world, isn't going to develop the way you think necessarily, so build a foundation that gives you flexibility in whatever you build. If you fall in love with something that really isn't where the world is, it will not work. Use facts, focus, and have a good feedback cycle.
• Having a record of the pivots you've done in the past and scripting out a tangible plan for the future with your management team is crucial.
• We are all being forced to focus on this industry. You should decide clearly where to place your bets and discard the rest to let others go for it.
• Communicate immediately after you announce that pivot with each individual in the company and where they stand. Same on the investor side. Thus, the importance of having longitude and a relationship, and continuous communication with your board.

Big Tech

Big Tech is a huge buzzword in the healthcare industry, and Tomas Kurian, Chief Executive Officer of Google Cloud, shared in the "Why Healthcare Needs Big Tech Conference” some key priorities regarding this issue to make the most out of it:

1. Shifting care from just being done in the inpatient setting in a hospital to an outpatient setting and increasingly for chronic diseases even at home.
2. Improving the digital interface people use to find information and access care.
3. Helping organizations use their data and new tools like data science to understand how to deliver care better. And what kinds of care are needed.
4. We are increasingly seeing digital tools as a vehicle to improve accessibility to health care for people who may not be in the United States or even globally.
5. Shifting from fee-for-service to value-based and using technology to facilitate it.

Also, cyber crimes continue to grow and accelerate as data becomes more and more critical in healthcare. But, rather than having every company learn and have excellent cyber expertise, just simplify how they can operate securely by putting the information into the platform and keeping it secure there. Some of Google's good practices Kurian shared:

• When organizations run on a cloud, allow them to do so securely and protect them from various threats that continue to merge.
• Provide them with tools to protect them from Human errors. Allow people to measure and manage their security posture so they know whether they are running in a secure configuration. You must make cyber risk something you can measure, manage, and audit.
• Have advanced capabilities.

Integrated care systems

One of the significant issues in healthcare today is definitely health equity. It was wonderful to learn from David Grandly, Innocent Clement, Christian Egle, and Dr. Nabil Chehade how developing integrated care systems can enable seamless health for everyone.

Some key takeaways:

Innocent Clement: "The most important thing in healthcare, no matter how great the solution or the technology is, if people cannot access it, then it's a big problem." He emphasized that not everyone has access to technology and that healthcare cannot be for just a group of people. Providing health coaches, devices, and a plan to serve the whole population should be a super intentional priority.

Christian: He explained how much impact he could see in his last projects by changing the organizational structures of his clients and focusing on integration.

David: Alignment of investments to solve health equity issues is crucial. He highlighted the importance of digital equity and how in healthcare, we believe that Tech allows us to engage with people in ways that face-to-face interactions won't. It will improve patient experience, bring better outcomes, and lower costs, but the issue is that not everyone is joining the digital journey. Many organizations relate it to the "digital divide" and say that access to devices and broadband will be the magic bullet, which is not true.

"Health literacy is one of the components of digital literacy, specifically, comfort, accessibility, how user interfaces are designed for people who have visual impairments, cognitive impairments, the elderly, how we use people's data and how transparent we are about that, how privacy is protected, how we face digital issues… this is the complexity of digital equity and the things we need to address if we want to move the needle."

Dr. Nabil: He explained how we need to push healthcare systems to adopt value base contracting, and by reaching that, the incentive on the health system side will be to do right by the patient. "If we get to that equation, everything else will flow easier.

"Expensive care is no care." "It's not care if it's not for everyone."

Elizabeth Fowler also spoke about this issue in her talk: Innovation and the Ideal Health system. She defined a high-performing delivery system for both patients and providers as one that achieves equitable outcomes through high-quality and affordable patient care. For patients, it's all about better results and a better experience, and for providers, one that allows them to focus on taking care of patients instead of paperwork, organization, etc.

Consumer-Centric Benefits

Moreover, Joan Harvey, Abir Sen, Noah Lang, and Ashok Subramanian talked about another huge buzzword in the healthcare industry these past years: Customer Centric Benefits. Here are some interesting thoughts they shared about the industry:

Noah Lang | Co-Founder & CEO | Stride Health

• If you can guarantee the cost of something for someone, it's an exponentially better experience consuming healthcare than we've ever had before.

Abir Sen | Co-founder, Chairman, and Co-CEO | Gravie Inc

• We see in the market a disaggregation of the supply side of healthcare. Somebody will need to reaggregate that back in a way that makes sense for every consumer, not in a one-size-fits-all way but in a way that is relevant to every consumer.
• About a trillion dollars are spent on the commercial side of Healthcare in America, but 90% of that benefits less than 10% of the employees. So in a real sense, employees don't have health insurance when they need it the most.

Ashok Subramanian | Founder/CEO | Centivo

• Every employee needs access to a health plan that covers at least 90% of their expenses (also known as Actuarial value). How do you then achieve that?

1. Making it a strategic goal that we are going to have an affordable health plan
2. Not getting there by call shifting but by partnering with providers who have embraced value-based care to bring down the total cost of care order of magnitude 20 to 30%.
3. Address the natural tension when you work with a subset of providers by ensuring access.

• Tailored benefits package design. Every self-funded employer has to embrace some truths:

1. If you are a self-funded employer, you are a purchaser of Health Care, not an insurance purchaser. As a purchaser of Health Care, it is your responsibility, now aided by the transparency regulations that came with the Consolidated Appropriations act, to know how much health care costs where your Workforce resides. There are major differences and costs.
2. If you are committed as an organization to offering an affordable health plan, over the long term, it will hurt you in the war for talent.

At the end of the conference, these experts shared exciting predictions on how the market will evolve in the following five years:

• Joan Harvey: it will be all about access. Today, we talk about what consumers want and the ability to provide care and networks when we have 30% of the nurse population retiring and quitting. We will grapple with this as an industry and country and how we create access at war to extend access.
• Abir Sen: Part of the problem for the healthcare system is these zero-some games that exist up and down, and the two areas where it's calcified and leads to less than an optimal outcome are the way providers' networks work and the way pbn's work. So, in the next five years, we will see a redefinition of how provider networks work, and that'll probably happen a little later than the Pbn issue that is happening today, and that world is getting blown up.
• Noah Lang: Five years from now, we'll continue seeing an unbundling of benefits, and I'm very hopeful that we'll see better plan design and better consumer choice. We'll Bloom over the next five years.
• Ashok Subramanian: Every American will have a personal care team that they relate to predominantly virtually.

Digital Health's Financial Future

One of the conference's most exciting and expected panels was given by Michael Yang, Cheri Mowrey, Missy Krasner, and Jonathan Bush, who discussed the future of digital healthcare finance.

Firstly, Michael Yang, Managing Partner at OMERS Ventures, gave interesting advice for founders to adapt to the industry's climate: This is a rat race. We're all running, and we've overcorrected. It's a survivor at this point, and there are a lot of great businesses that were in the middle of being birthed and created and scaled, and now you're going to have to recalibrate to play the long game.

Next year, it's going to get worse before it gets better. We're not at that trophy yet, and it might not be the next quarter or the quarter after that. It's only going to get bumpier from here. We need consolidation to move the needle; small things will not make it.

Also, benefits communications is a problem that has yet to be solved. It's compounded with all the proliferation of solutions, and an H.R. benefits department could be better. Here it's an opportunity...

Also, Cheri Mowrey, Head of U.S. Healthcare and Investment Banking at Morgan Stanley, affirmed that investors need to see in companies that are going to be in the public market going forward. Based on what we've seen in the history of digital health, this industry is a pendulum; it swings and will swing back the other way again. It's just a matter of time. I think in the near term, Public Market investors will need to see the certainty of business models. They're going to do much more diligence in the future waves of IPOs and digital health. That was part of the challenge we saw over the last two years; there was so much coming to market that nobody could spend much time doing due diligence on these companies. So profitability is definitely near term.

By 2024 we will see an IPO window starting to open up to give us some good news. The most likely companies that will be in the public markets if they attempt in 2023 will be profitable, lower growth companies with real stability in their business models and strong management team until economics. So hopefully, we'll get one or two under the public markets, if not more, at the end of 23.

Also, Chari shared that they want to see more platforms, point solutions, and care coordination in the public market. A great opportunity, she affirms, is the need for a platform for coordination of care with the family, the patient, and all the clinicians involved in the patient's care.

Still, Missy Krasner, Venture Chair at Redesign Health, shared her point of view on this matter as well. She affirms that after the pandemic, we are in a market correction, but it's actually a good correction. We're going to see companies getting good deals valuations; you have to be a company with a great business model and strong unit economics. It's no longer days of no profit, just investing in the team and a concept.

At Redesign health, they are still on target to launch 100 companies by 2025, they are not slowing down. They know healthcare as a system and industry are pretty lethargic regarding innovation and launching companies. We see a huge amount of activity with new buyers, but providers and health systems are really in trouble right now. They've operated in the red during covid. They need to transform. Health Systems and hospitals will not be able to compete with big Tech, and retailers are trying to remodel consumer-centric primary care. There are lots of really new and interesting ideas in virtual primary care and Specialty Care. There are buyers out there, whether it's IPO or M & A, to buy or build into new markets, but now, there's inorganic growth. Companies need to keep going cash conserve.

Also, Missy shared her desire to have an Omni Channel experience and reinvent insurance, access issues, and innovate insurance as an opportunity for founders.

Finally, Jonathan Bush, Founder, and CEO of Zus Health, shared another opportunity: clearing mechanisms. You need either standard tools or market mapping tools.

Barriers and opportunities of the whole care delivery model (from the patient's side)

Tom Bianculli, Peter Durlach, Erica Olenski Johansen, and Shannon Connor Phillip mentioned at the Reimagining the In-Person Patient Experience Conference the following:

• The biggest barrier is that we are used to doing things the way we have always done them. There is a significant lack of incentive in this sense.
• 10% of deaths could be avoided by removing medication errors, so the opportunity is to eliminate preventable errors.
• We have the data; the opportunity is to use and transform it into insights to remove friction in the medical processes, improve outcomes and prevent future conditions.
• There is a duality between improving patient experience and re-thinking how to create operational benefits.
• The main opportunities come from incorporating conversations with caregivers and patients into the board-level decision-making tables to improve the patient experience.

Pharma strategy

Despite all the challenges healthcare faces, Jorge Cancela, Ofer Leidner, and Jason Hawbecker gave a truly inspiring talk about how our industry is reaching maturity and working together.

They expressed that every niche inside healthcare is thinking about value-based care, bringing better outcomes, and facing the same challenges. So working collaboratively with different partners will be crucial to achieving success.

As for pharma, the most effective strategy comes from value-based care models, the quadruple aim, and having a user-centric approach. "We need to go top of the funnel to improve the experience."

AI in Healthcare Storm

In addition, John Halamka, President of Mayo Clinic Platform and Mayo Clinic, commented on the A.I in the healthcare industry.

Some strong stats he shared where:

• 65% of hospitals in this country will have a negative margin in 2022. Hospitals are having challenges with Staffing, supply chain, general cost, and reimbursement.
• The Miss rate for humans visualizing endoscopy images: 20%

Also, he affirms we will have a new class of digital divide: the algorithmically underserved. He explained that clinicians in our country today make decisions based on anecdotes and experience; "Oh, I've seen five patients like that. But five patients like that may not give you enough data or evidence to make the right decision. So if we are to pick an algorithm to help us augment our decision-making, we better understand how well that algorithm works. When you pull a new algorithm, you have no idea if it's good or bad, appropriate or not biased. So, the solution is to democratize access to the knowledge we've accumulated. If we're going to solve some of the societal problems first, we need to help the algorithmically underserved.

But how are we going to get data from patients without EHR data? We need to help the algorithmically underserved novel sources of data and approaches. Heterogeneity of patient types and patient geographies and experiences, and you could even use the term exposome.

If we really want to serve the algorithmically underserved, we need more than 10 million de-identified records (distributed Data Network). No one has to give up their data, and no one has to lose control of their data. It's de-identified, cloud-containerized, and Federated. So organizations in industry and Academia can work across multiple organizations without having to centralize or really remove the data across a firewall or an international border, making it a whole lot easier from a HIPAA, gdpr, China, Brazil, and Israeli data residency perspective.