Leslie Asanga

We just released our H1 2024 Digital Health funding summary. https://lnkd.in/gAZY64tp H1 2024 Digital Health funding closed at $12.4 billion invested across 719 deals. - Q2 2024 is outperforming Q1 by 34% ($7.1 billion vs. $5.3 billion)! - Digital Health funding has shown sustained investor confidence. Funding in Digital Health in North America is up 14% to $9.5 billion. Investment in Europe is down 10% to $1.52 billion, while funding in APAC dropped by 7% to $1.17 billion. - Partnerships in Digital Health are flat in the first half at 1,730. NVIDIA has been the strongest corporate partner in H1 2024 - 96 M&As, 8 bankruptcies, 5 delistings from the stock market and 3 relistings from NASDAQ to OTC market. The full report will be available for free next week. Feel free to comment and share if you want to receive a copy prior to our official launch 😊 Galen Growth | Insights You Can Trust #funding #digitalhealth #investments #partnerships

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The Morisky Medication Adherence Scale-8 (MMAS-8) is an ideal barometric measure for assessing medication adherence among patients due to its reliability and consistency over time. Connect with me for more information and if you want to integrate this tool within your own EHR or digital platform for RPM, telehealth or DTx. Your patients deserve to know their adherence score and an opportunity to improve it over time. 1. Validity and Reliability: The MMAS-8 has been extensively validated in various patient populations and healthcare settings, demonstrating strong psychometric properties. Its reliability makes it a dependable tool for consistently measuring medication adherence among patients over time. Healthcare providers can trust the accuracy and consistency of MMAS-8 scores when assessing adherence levels. 2. Comprehensive Assessment: The MMAS-8 assesses multiple dimensions of medication adherence, including forgetfulness, carelessness, and intentional non-adherence. By capturing these various aspects of adherence behavior, the scale provides a comprehensive understanding of patients' medication-taking patterns. This comprehensive assessment enables healthcare providers to identify specific barriers to adherence and tailor interventions accordingly. 3. Easy Administration and Interpretation: The MMAS-8 is very easy to administer and interpret, making it practical for use in clinical practice. The scale consists of eight simple questions that patients can quickly respond to, minimizing burden on both patients and healthcare professionals. Scoring and interpreting MMAS-8 results are straightforward, allowing for efficient assessment of medication adherence during routine clinical visits. 4. Longitudinal Monitoring: Due to its reliability over time, the MMAS-8 can be used for longitudinal monitoring of medication adherence among patients with chronic conditions. By administering the scale at multiple time points, healthcare providers can track changes in adherence behavior, evaluate the effectiveness of adherence interventions, and identify trends or patterns that may require intervention adjustment. This longitudinal approach facilitates proactive management of adherence-related issues and supports continuity of care. 5. Predictive Value: Research has shown that MMAS-8 scores are predictive of various clinical outcomes, including treatment response, disease progression, and healthcare utilization. Patients with high MMAS-8 scores (indicating good adherence) are more likely to achieve therapeutic goals and experience positive health outcomes compared to those with low scores. By using the MMAS-8 as a barometric measure, healthcare providers can identify patients at risk of poor outcomes early on and intervene to improve adherence and prevent complications.

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A whirlwind of activity last week at the America's Physician Groups conference. Lots of solid insights shared by health system leaders. Some notable thoughts: +++ Artificial intelligence is intelligent in different ways: By now, we all know ai has a diverse set of use cases, incorporated in different applications and tools. But there are fundamental differences in how the intelligence itself is brought to life. Examples include: - Predictive AI, used to forecast future outcomes by leveraging historical data. Shout out to UCLA’s CKD/ESRD early intervention protocol (Joycee Berin) and Diagnostic Robotics’ intelligence care post-dicharge journeys (Kira Radinsky) - Protocolized AI, used to automating a user’s administrative load by using a set of detailed, pre-defined rule sets. Thanks to ARC for sharing their experience using Elaborate 's automated outpatient lab summaries (Manish Naik) - Generative AI, used to create new content. Great overview of ambient documentation at MGB as well as Cedars’ Sinai talking through its medical ontology model powering acute triage (Caroline Goldzweig) Across system leaders and experts, there was clear agreement that the first step to implementing intelligence intelligently is defining the ‘jobs to be done’. That way, internal and external stakeholders are clear on what they're solving for when they architect the solution.  +++ Scaling AI takes time and rigorous observation: Market leaders describe a phased pilot approach that allows clinicians to build confidence and system leaders to measure ROI before deploying systemwide. Loved hearing Rebecca Mishuris outline MGB’s novel approach of piloting two solutions against one another, to pressure test implementation, workflow, and value creation. +++ Proving ROI continues to be challenging: Lots of vendors using lots of different metrics to prove value, but the majority of leaders agreed that estimating the ROI of these new tools today is part science, part art. Demonstrating the ROI of the “soft” metrics around provider burnout and retention seemed to be a big opportunity, especially for investment in more efficient primary care and PCP wellbeing. After all, PCPs drive referrals to specialty-level care (and higher reimbursements) for health systems. Appreciated Anurang Revri's overview of how working team setup can also impact ROI estimates. +++ Value-based care = tools + humanity: VBC will require not only implementing tools to support clinical documentation, risk capture, upcoding, etc, but also humanizing interactions to engage patients. Countless examples, but one that made me smile was a depression focused chat bot responding in the following interaction: - Context: post-discharge check in Bot: Hi Freida, how are you feeling today after your surgery?  Patient: I’m having a tough time, am in a lot of pain.  Bot: Well, it can’t be that bad, I’m sure it will get better with a positive mindset!    🤣 🤣 🤣 Can't wait for next go-around!

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Digital Health Acquisitions # 107 - # 108: Week of July 14th - 20th, 2024 Digital health M&A cooled off slightly last week with just two deals announced. 108: Commure acquired Augmedix in an all-cash deal valued at $139M. Augmedix, a company that previously went public through a SPAC transaction, was initially listed through a reverse merger with Malo Holdings Corp. in 2020 before listing through a traditional IPO on NASDAQ in 2021. This acquisition marks a significant move for Commure, as it aims to enhance its healthcare technology offerings by integrating Augmedix's capabilities in medical documentation and workflow automation. 107: The German/Dutch company Apothera GmbH / MYA Health acquires Disapo.de Apotheke B.V. from Europe's omnichannel premium beauty chain Douglas Group. Apothera has its main office in Berlin, Germany but operates its online pharmacy through Mya Health B.V. in Amsterdam, Netherlands. This acquisition is a strategic play to strengthen Mya Health's online pharmacy presence and reach a wider customer base. While deal activity slowed down, the digital health industry continues to evolve rapidly. What are your thoughts on the current M&A landscape? Did I miss a deal last week? Galen Growth | Insights You Can Trust #DigitalHealth #Mergers #acquisitions

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Unfortunately, I think many DTC virtual clinics + cash-pay, mail-order pharmacies have a tough road ahead. This is all about the mismatch between the VC investment thesis (5-10x valuation increase from latest round) and what is likely a realistic exit outcome for this archetype right now. We know what best-in-class looks like for a DTC virtual clinic + cash-pay, mail order pharmacy: Hims & Hers Health worth $4.6B. They've seen strong investor interest lately, especially related to their GLP-1 compounding initiative. Hims' full year 2024 guidance is $1.20-1.24B in revenue. That represents a 3.7x forward revenue multiple. The challenge is that many smaller DTC virtual clinic + cash pay, mail-order pharmacies raised significant funding in 2020-2022 and now have high exit expectations. Once you raise significant VC funding (series a and beyond) and dilute the cap table, it's really hard to pivot to a sustainable, cash-flowing business. For example, after an angel, pre-seed, seed, and series a round, the founders may own ~50% or less of the company. By this time, there's already a formalized board in place with $1B+ exit expectations. Now if we were talking about DTC skin care, frozen food, or clothing, there's a tried and true pathway to exit the business to a $100B+ conglomerate CPG brand for 8-9 figures like Unilever, P&G, PepsiCo, Nestle, LVMH, or Coca Cola to name a few. The problem is that unlike traditional CPG, DTC health is much smaller and younger. Instead of P&G (worth $398B) or Unilever (worth $143B), the largest acquirer may be Hims at $4.6B. And now that Hims is publicly traded, they may prefer an acquisition that is net income accretive at a reasonably low multiple (1-2x revenue). And they also would have to believe it's not a product/service they could do internally. The $100B+ players in healthcare like UnitedHealth Group, CVS, McKesson, or HCA don't appear to be interested in acquiring niche DTC virtual clinics + cash pay, mail-order pharmacies at this time. Especially hard when their cash yields 5% risk free and the market optimizes for earnings per share. DTC is not their core business and given their mature revenue scale, adding 8 figures of revenue does little. Now the holy grail for these DTC virtual clinics + cash pay, mail-order pharmacies is either a) go public; or b) get bought by a consumer juggernaut that likes healthcare (aka: Amazon). The only issue with Amazon is given the recent dept consolidation news, seems like they're still digesting PillPack and One Medical. The other option of IPO'ing is hard because bankers want to see a $1B+ valuations. If we use Him's 3.7x forward revenue multiple, another DTC virtual clinic + cash pay, mail-order pharmacy needs ~$270M annualized revenue w/ similar margins. That's brutally hard to achieve that scale when growth-stage private funding has dried up for DTC. But this is just my two cents. And I could be wrong, wouldn't be the first or the last time. Thoughts?

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I’m worried about the state of venture capital and direct-to-consumer (DTC) healthcare startups. Hims & Hers is the poster child for DTC healthcare at $1.2B proj 2024 revenue and a $3.6B valuation. By most accounts, they have been an outlier success for DTC since bottoming out in May 2022. So why is this bad news for DTC healthcare? Because the market leader (Hims) trades at a 3x forward revenue multiple. And the category leader typically gets a higher valuation multiple than smaller startups. We see this phenomenon in private equity. They “roll up” smaller companies within the same category at a lower multiples just to create one larger platform that trades at higher multiples. Now back to DTC healthcare startups. If Hims commands a 3x revenue multiple, it’s not unrealistic that smaller, unprofitable startups may be valued 1-2x revenue at exit. At 2x revenue, a startup must generate $500M to produce a $1B exit in today’s market (depending on growth and profitability). Series A/B venture capitalists must see a pathway to $1B outcomes. And if the growth-stage investors with billions under management are less interested in DTC healthcare, the future funding rounds necessary for fueling growth are not guaranteed. Juxtapose this against 2017-2022 where DTC could raise Series B-E funding. Let’s take a DTC startup doing $25M after 3-4 years of operations and has already raised a Series A. By most accounts, it would be a phenomenal accomplishment. But today, investors will question the chances of that same company scaling from $25M to $500M revenue in the next 3-4 years with unknown future funding sources from Series B and beyond. You're stuck in VC-funding purgatory. Some of these companies will shut down. Some may sell for 1-3x revenue. And some may try to transition to profitable, cash-flowing businesses. All of which are certainly not the venture-backed goal the founders, investors, and employees often had in mind when first taking capital. I say this all with friends working at or starting DTC healthcare companies, I feel bad for them. I also feel bad for the patients who enjoy those products or services. To caveat (b/c I know people will object), there will be other DTC brands that exit for $1B+ (i.e., Ro). However, they were forged and scaled during a different time period where seemingly endless venture capital was available for DTC healthcare. Now we're in a different time with no end in sight. Thoughts?

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Extending the reach of HIPAA to "health apps" is a good thing. This rule should clamp down on the release, sharing, and even selling of consumer health data to data brokers, social media, etc. However, my view is that these top-down rules shouldn't be necessary if digital health companies subscribed to a set of data stewardship principles that are greater than the laws and regulations on the books. Of course, that's never going to happen, but a boy can dream. The first rule is that every actor in the chain of custody of patient/participant data is a steward of that data. We have a duty to only collect your information with your permission and use it for very specific purposes that the patient/participant agrees is permissible. This is a good rule and I hope it thins the herd of bad actors. #datasecurity #hipaa https://lnkd.in/gkGz6ZhY

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👍 In the first half of 2024, U.S. digital health startups secured $5.7 billion across 266 deals, showing a strong rebound after years of slowed investment, according to Rock Health. With early-stage deals driving the momentum, the sector is on track to surpass funding totals from 2019 and 2023. https://bit.ly/4cCRy2W Via Healthcare Dive #digitalhealth #digitalhealthfunding

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Q1 2024 was big for Digital Health, with $1.1B in VC funding. A large portion came from major deals like $126M for Transcarent and $108.8M for Rightway. Despite some challenges in digital therapeutics and telehealth, investments in general care ($213.4M) and health benefits navigation ($140.7M) are promising. Read what’s driving the shift from direct-to-consumer to enterprise telehealth models here: https://ow.ly/uNYs50SpXGh

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Should you sell your practice to a VC-Backed MSO Startup? tldr: - new VC-backed startups are forming MSOs to roll up independent practices - The pitch is physicians receive early liquidity from the roll up and are granted ESOP shares that can be used for retirement - Problem is the use of ESOPs with independent practices is not a new concept and has been used with large group practices since the 70's - ESOPs do not grant full ownership and in order for the shares to be valuable for retirement, the practice needs to run the same if not better post roll up - With VC-backed startups being primarily operated by non-physicians with zero clinical or medical practice experience, the likelihood of this happening is extremely low making the entire concept high risk However, there is a viable path for continued ownership + liquidity for independent practices. Check out the article to learn more. ⤵ https://lnkd.in/gmGvTYwP

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“The average American over 65 sees 28 doctors in their lifetime. 14 prescriptions are written per American per year.” - Good Energy by Casey Means, MD and Calley Means In 2022, according to CMS.gov the U.S. spent $4.5 trillion on healthcare. Yet Americans are declining in their vitality, health, and well-being at a rapid rate. This concerned me enough, as well as through personal experience, to become a certified integrative health coach. I’ve been fortunate to study with Institute for Integrative Nutrition, and have had access to learn from some of the most extraordinary experts in the industry. Along my journey I discovered Casey Means, MD and her work with Levels. If you are interested to learn more about metabolic health, how critically important it is for overall health and what you can do personally to improve your health and well-being, do get a copy of the book “Good Energy”. It may contribute to helping you improve your health, or even save a life. #health #energy #wellbeing Audible

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I always read Rock Health's digital health reports as they give a nice pulse feel for what is happening in the digital health funding space. Good to see funds raised in H1 2024 suggest funding in the sector seems to have stabilized at 2023 levels. Its no surprise the report emphasis the buzz around AI and healthcare. There have been clear winners in the AI healthcare space in the area of process and cost optimization and the R&D space. The impact of AI in care and treatment delivery is so far much more muted. One area I never though to look at AI was in its ability to bring together multiple healthcare pathways and digital point solutions into a more holistic seamless experience for the patient. There is a clear trend away from using stand alone digital health point solutions, and could AI address this challenge by facilitating the efficient integration of disparate processes and technology into unified care programs. I can see this happening with digital health products but this will be more tricky to do with physical care programs involving clinicians and HCPs. “AI is helping us combine multiple parts of the care journey, across all care experiences. In the future, benefits navigation, clinical guidance, and care delivery won’t be delivered by separate companies or point solutions within the healthcare ecosystem. They’ll be features that work in concert within products, and they’ll happen in under 90 seconds for a seamless patient experience.” – Glen Tullman, CEO, Transcarent and Managing Partner, 7wireVentures

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Galen Growth | Insights You Can Trust just published its executive summary of its analysis of the #digitalhealth ecosystem performance in the first 6 months of 2024 - Read the key trends and insights here

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💯agree with Dr. Mehta and to quote her: Healthcare is broken, and those that are in it understand why. Patients need - and deserve - quality health care. This requires safe staffing practices, skilled clinicians who can feel good about what they do, and insurance companies that pay their bills. We can’t have a system where insurance companies can get away with record profits while finding more and more reasons not to pay for care and eroding away at the heart of healthcare. You cannot scale your way out of America’s healthcare problem. You actually need to fix the incentives, regulate insurance companies, pay clinicians appropriately, prioritize clinician well being and retention, and focus on the patient. The days of paying lip service to physicians leaving medicine and physician burnout are numbered. Supply and demand forces will necessitate real solutions that move the needle.

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What a deal! $29 to message your provider!? $49 for a virtual visit!? Well, I guess it's a deal compared to traditional health systems which charge.... $39+ per message $75+ per telehealth visit Or, you can get UNLIMITED virtual (text messages, email, video) visits with a DEDICATED care provider through HealthBar for $16/mo. Dedicated means it's the same person (think clinician in your family feel) nearly every time and it's someone how UNDERSTANDS you and will actually LISTEN! Or, you could just keep letting your workforce use healthcare haphazardly like this and hope your costs go down... probably not going to happen :) #healthcare #business #hr #insurance #benefits #ceo #cfo #virtualhealth

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One key reason why healthcare technologies like AI, telemedicine, and software haven't structurally lowered costs or broadened access for the entire system after decades of experimentation (excluding pure financial engineering of payer contracts) is the limited reimagining of care delivery itself, with asynchronous telemedicine as a notable exception. In the same way that digitizing physical paper failed to exploit the capabilities of a new computing medium for word processing, hosting physician-patient conversations over video does not transform the actual delivery of care. In telemedicine, many of the inputs (e.g., clinician time) and therefore cost structures of in-person care persist, which is why we often see fee-for-service telemedicine companies struggle to achieve economies of scale (i.e., growing revenues non-linearly while growing costs linearly). Until we deconstruct the components of a medical appointment – from intake and triage, to chart review, history gathering, physical examination, diagnosis, treatment, and follow-up – we will continue to be underwhelmed by the disconnect between the transformative potential of these technologies and real-world patient/system impact. I’m optimistic that the emergence of reliable and performant medical AI agents will urge us to perform this deconstruction and redesign the fundamental building blocks of a “medical appointment.”

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https://lnkd.in/erNTTJGG *Have you noticed that you haven't been able to buy e-books directly from Amazon on your Android-powered devices recently? * The reason is simple: we are at Google's mercy as it determines how apps in its ecosystem are used. * Google and Apple hold tremendous power in determining whether or not these apps are used in their ecosystem. At the snap of a finger, they can deny you apps that you have been very used to for many years. *The EHR ecosystem also has a similar marketplace for digital health apps. The government's interoperability mandate forced these app ecosystems upon EHR companies to ensure the appropriate data flow between digital health entities for better patient care. *Epic has the largest market share of EHR software in the US and recently penalized one of the digital health companies in its "app store", Particle Health. Epic stated that they cut off data access to the startup because it used health data for non-treatment purposes. *Digital health 360 Degrees lens; *Although this sounds very much like a way to prevent misuse, there is more to this kind of incident than meets the eye or the brain as I scratch my head out of concern. *With EPIC's market share and the power to delete others at will, the question is: Does EPIC also use patient data for treatment purposes all the time? Who is there to ensure EPIC is also compliant with all the use cases of patient information? *These are all shrouded in secrecy; we can only guess what it is based on all the algorithms EPIC has produced with patient data. *It's easy to hit the little guy heavily if they don't "comply" while you indulge in the same data gluttony. #EHR #digitalhealth

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We're underestimating how physicians will build and access software in the future and we're 100% underestimating how this will impact independent practice. By now I'm sure you've seen the Claude 3.5 Sonnet demos and all of the use cases or application non technical folks are building with 1-3 line prompts. Even Jensen Huang, CEO of Nvidia made a controversial comment on the future of coding, “It is our job to create computing technology such that nobody has to program. And that the programming language is human, everybody in the world is now a programmer. This is the miracle of artificial intelligence,” This is absolutely true, and if there's one area where this will have the biggest impact on society, it will be healthcare. The reason for that is that physicians and clinicians have NOT been included in the design of healthcare technology over the last 20ish years, leaving them to practice in systems designed by non-clinical people. Claude 3.5 offers a glimpse into the future of independent practice. Physicians will be able to design, build, and launch AI applications as needed without requiring developer support. In the future, I envision independent practices hiring their own AI Agent developers who can not only build these applications, but also integrate them into their practice operations infrastructure to create the ultimate practice management system. What application would you build if this were possible today? ----- Hi, I'm Dr. Mario Amaro, Founder and CEO Ease, and I talk about all things starting, running, and growing a private practice with AI. Follow me, if you are planning to start one or are currently figuring out creative ways to grow one. #PrivatePractice #SelfEmployment #HealthcareOnLinkedin #HeyEase #IndependentTogether #Fintech #Infrastructure #AIinHealthcare #CareDelivery

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