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Thanks for the post. The rise of digitally-distributed chronic disease management platforms such as Omada Health has helped revolutionized the way care is delivered in the healthcare system today and has been a key factor in shifting disease management more and more from sites of care such as hospitals and doctor’s offices to the patient’s home, thus taking out significant amounts of medical costs from the system. I think it will be very interesting to see how Omada approaches expanding into other chronic disease categories, such as CHF, which may have less well-defined pathways as compared with diabetes. I wonder how much of their platform could be easily replicated to manage these other diseases? There are some competitors in the market today, such as Vida Health, that have taken the bet that it is relatively easy to target multiple different chronic diseases with the same replicable digital and health coach platform, but I wonder if it is harder in execution than in principle.

Thanks for the post. As Nick mentioned in his post above, I’m also curious as to how you view 23andMe positioned in the broader competitive landscape. The cost of genome sequencing has decreased in recent years and now a whole genome can be sequenced for
under $1,000. This trend has contributed to a large increase in investment in all areas of genomic medicine, including sequencing machines (as well as associated ancillary products), diagnostic and interpretive systems, and targeted therapeutics. Last summer, Allscripts and NantHealth executed cross-investments in one another to create a clinical decision support framework that leverages the specific DNA, RNA and proteomic profiles of patients. These will be integrated with evidence-based guidelines provided by NantHealth’s clinical
pathway, Eviti, as well as the broader clinical patient profile within the Allscripts EMR.
Additionally, at the JPMorgan Healthcare Conference in January, NantHealth CEO, Patrick Soon-Shiong, announced the addition of Independence Blue Cross in Philadelphia to The National Immunotherapy Coalition (NIC) and his Cancer MoonShot 2020 initiative, representing the first CLIA-certified comprehensive DNA/RNA test with quantitative proteomics to receive insurance coverage in a clinical setting. New research by KellySciPub indicates that the core personalized medicine market will be worth over $60bn by 2019. Separately,
Flatiron Health, the leading Oncology EMR and data management company, announced a $175mm third round of funding lead by Roche, bringing the company’s total funding to over $300mm since its inception just four years ago. In parallel with the financing round, Flatiron and Roche entered into a multi-year collaboration to accelerate clinical trials, advance personalized medicine and enhance patient care.

Thanks for the post! Chronic disease management has been shifting more and more from hospitals and doctor’s offices to the patient’s home, facilitated by the rise of digitally-distributed care management platforms such as Omada Health. As such, I wonder if Headspace has the opportunity to help patients with more complex behavioral health issues in addition to helping people like you and me who may just be stressed or burnt out. Behavioral health is a huge challenge and medical cost driver for both providers and health insurers, not just as a standalone disease category but also because it is highly likely to be a co-morbid disease (meaning that patients with chronic diseases such as diabetes or CHF are also likely to have a behavioral health condition as well). In the current healthcare system, it is extremely difficult to seek help for behavioral health conditions, with many solutions being “talk-based” (i.e., revolving around having to talk about your problems with a therapist). I think Headspace’s platform could be very conducive to those patients who do not wish to talk about their challenges with a therapist. If Headspace can show results in this area, it could potentially open doors to getting their services covered by health insurers so that patients who use their services can be reimbursed for the cost of using it.

It is great that Memorial Sloan Kettering is striving to make better use of its data to improve quality and efficiency of care. With all of these initiatives, I wonder what mechanisms it has in place to warehouse its data. With provider consolidation continuing to occur, providers within one overall system will often have multiple different EHR systems in place across the multiple inpatient and outpatient settings that comprise the integrated system. Furthermore, EHRs are just one of multiple data sources that are relevant to providers as they work to improve quality and efficiency of clinical care. To add to the problem, once health systems have implemented an EHR, they must organize, visualize and utilize this data through a healthcare-ready data warehouse infrastructure to identify and act upon the data. As long as healthcare data sits in the various clinical and operational systems (silos), it is not available for analytics.
One company tackling this fundamental problem in data warehousing is Salt Lake City-based Health Catalyst, which has taken a leadership position in the enterprise data warehousing (EDW) market. In the last year, the company announced a 10-year, $100mm agreement with Allina Health as well as long-term relationships with UPMC, Cedars Sinai and Partners Healthcare. I would be curious to understand how Memorial Sloan is tackling this problem.

Great post. As you mentioned, the importance of interoperability among EHR systems is paramount. This administration is extremely focused on the lack of interoperability that exists between most EHRs and with Cerner (Siemens) and Epic, in particular. On average, a single interface between EHRs can cost between $5,000 – $10,000 and hundreds-to-thousands of these interfaces may be required across a large, integrated delivery system. While the ONC has issued a report and is pressuring the EHR vendors to ‘open’ their
systems and eliminate any/all interoperability fees, the duopolies of Cerner and Epic have been slow to
proactively act. In March, HHS Secretary Burwell introduced the Interoperability Pledge, a joint commitment with number of healthcare providers and health IT companies to make patients’ data more accessible and transparent, as well as implement national interoperability practices. The companies who have taken the pledge include Epic, Cerner, Allscripts, athenahealth, and Meditech (which together provide ~90% of the EMRs in the U.S.) and some of the largest private healthcare systems, including HCA, Community Health Systems, Ascension Health, Intermountain, and Kaiser, so we all look forward to seeing improvements in interoperability moving forward.

Thanks for the great post. I think one additional thing to add to the points you make in your post is how GM can drive faster adoption of low-carbon/alternative-fuel cars so that they can become more of a mass-market product rather than a niche one. I think much of that will be tied to developing the necessary supporting infrastructure (e.g., charging and refueling stations for alternative fuel) across the US and making those stations as accessible as traditional gas stations. I would be curious to learn more about how much GM is investing towards that end. In addition, another challenge would be to just change consumer perceptions about how difficult it is to “keep up with” an alternative-fuel car – I know the reason my family has not purchased an electric car is because of perceptions that it’s just harder to manage and to learn how to use. So how can GM and other automobile manufacturers combat those perceptions?

I am very surprised that climate change-related health issues is such a major issue in the US – I guess I’ve never really heard the same level of urgency in talking about lung disease attributed to smog and related issues in the US as I do in China. I am also surprised by the number of states in which the CDC is focusing their BRACE efforts – I have only heard of smog being an issue in the US in the state of California so was surprised to see how many other states were included on the map. I would love to better understand the magnitude of the health problem in the US today, and what people’s attitudes towards climate change-related health issues are. Are people very concerned or do they not see it as a threat? If the population doesn’t perceive this as an immediate threat to their health, I wonder how effective the CDC will be in getting people at a large scale to pay attention to things like the AQI index – I know at least for me, it’s not something that I pay much attention to currently. But I agree with you that to people with sensitive lung problems, it would be very important.

Thank you for the interesting post. I am also very curious to see whether airplane manufacturers actually are able to shift to alternative fuel sources to the extent that automobile manufacturers have given the limitations of what kind of alternative fuel airplanes can use. For example, given the fact that refueling/re-charing in the air or landing in the middle of a flight to refuel/re-charge is not feasible, this limits airplane manufacturers to fuel sources that can sustain the airplane for the hundreds/thousands of miles it travels. So it seems that much of the alternative fuel developed for automobile manufacturers would not work for airplanes, and it would take significant R&D to develop alternative fuel that would work for airplanes.

I think this post is interesting given McDonald’s low-cost position in the fast food industry – they do not have a lot of room to pass on any increase in costs from shifting to more sustainable practices to their consumers. And I’m not sure that McDonald’s cost-sensitive or time-rushed consumers would actually see sustainability as a differentiator when buying from McDonald’s given that the company’s strongest value propositions are its low cost and quick service – sustainability doesn’t really add value in either dimension. So I would definitely have been interested to learn more about how much it would cost McDonald’s to shift to more sustainable practices and how they would plan on absorbing or passing along those costs to their consumers.