Venture Capital and Digital Health

#TelemedNow Twitter Chat Wednesday, April 21 – 8 PM ET Introduction & Welcome: Ami Bhatt (@AmiBhattMD) Venture Capital and Digital Health

Q1: What are the areas of #digitalhealth that need an inflow of investments to succeed? #TelemedNow

A1 Notable Responses: Stacy Hurt (@stacy_hurt) Education!! How can patient empowerment tools rank first but the #healthliteracy to use them rank last?!? We need to close this gap for effective implementation of the #digitalhealth we want #patients to use #EHR #RPM #TelemedNow Ritu Thamman (@iamritu) Areas of #DiversityandInclusion need more funding since women & minorities have seen less investment overall despite the boom influx of $$ #TelemedNow Need to use technology to scalably connect with ALL types of patients Andrew Watson (@arwmd) #Interop is one area and also fusion of #RPM and video, ie @Amwell/ @VivifyHealth or @TeladocHealth/ @Livongo Make provider use easier, more streamlined. Better analytics. Matt Sakumoto (@MattSakumoto) Anything that connects to "last mile" care (blood draws, RPM, remote exam). AV connection is there, now need to add additional value #TelemedNow Ritu Thamman (@iamritu) This is key! However many big players making it difficult for app based solutions to blossom: Startups have to wait until incumbents show they can’t innovate Andrew Watson (@arwmd) Also a great point @iamritu Do you see this as more hardware related or more operational / UI ? Or maybe I am too myopic here ?? #TelemedNow. Dr. Salim Saiyed (dr_salim_md) existing platform improvements, care desert- broadband , hardware etx Ami Bhatt (@AmiBhattMD) Yes!! important to remember that all #digitaltech needs investing. Video based, audio, and texting! We can close the #digitaldivide with intelligent funding!! Andrew Watson (@arwmd) I also think part of this is creating a better last mile to the doctors, not being critical, but there are some innovative ways we can make this easier and more portable. Especially from home, for mobile solutions. #TelemedNow i’m saying this in general. Dr. Salim Saiyed (dr_salim_md) Chat bots help, but a lot of patients also like to talk. Some of our patient Helpdesk call last over an hour #TelemedNow Matt Sakumoto (@MattSakumoto) Thanks for this update! (I've been quoting 70% Smartphone access, great to see it pushing 80% now!) #TelemedNow Ritu Thamman (iamritu) Will take some time for us to accept but they work! Chatbots can do triage well ( esp empathetic cute ones like a @zoom cat avatar Here’s our new cat Zaara for added cuteness #TelemedNow Irma Raste (@IrmaRaste) Interesting! Somewhat surprising on positive mobile stats, but the #broadband access is still lagging. That gap needs to be closed to bridge the #DigitalDivide. Andrew Watson (@arwmd) And I am not convinced that 5G will be the overall solution for broadband access. I think the towers have to be fairly close together. That’s not going to help rural America. #TelemedNow Sid Kandan (@Sid_Kandan) 100% LTE-M / NB-IoT for vitals transmission with traditional phone calls may work :) #TelemedNow Andrew Watson (@arwmd) And Sid, at some point don’t we want to have wearables that bypass smart phones or hubs? They communicate directly with cellular networks? And they can be functional also when off network ? #TelemedNow @EvanKirstel Sid Kandan (@Sid_Kandan) Excellent question! Would be ideal, but the unit economics and supply chain for cell-modems is too complex to embed directly in devices... ($40/modem vs. >$1 BT chip) That’s why we created an easy step for Bluetooth peripherals with our cellular @VitalsHub #TelemedNow Andrew Watson (@arwmd) We’ve done a lot of work in this area. And I ended up launching a project based on the hub. I still remain optimistic at some point we can commoditize chips to enable direct to network communication. Not just RF IDs / NFC. John Lynn (@techguy) Won't go mainstream until it natively connects via cell. #TelemedNow Morgan Cheatham (@MorganCheatham) one way to bolster health literacy is to meet patients where they are - online. Dr. Google has created health information overload. huge oppty for clinician influencers to act as curators and scientific communicators to help patients access accurate, up-to-date medical info. Ritu Thamman (@iamritu) This is key!!! #misinformation has to be combated by us online as we share data/information as many people get their healthcare info from #socialmedia #TelemedNow Q2: Which are your favorite #digitalhealth companies with top raises that we should keep an eye on? #TelemedNow A2 Notable Responses: Ami Bhatt (@AmiBhattMD) Companies abound. #RPM is a big player. Connecting patients to providers is another. Check out @UpFrontHealth #telemednow Ritu Thamman (@iamritu) The amount of $$$ invested in #digitalhealth was astronomical in 2020 like the $18.5 billion merger of @Teledo & @Livongo (“Teledongo”) #TelemedNow $21.5B raised globally & even smaller M&A like @Bayer $225M acquisition of Care/Of Ami Bhatt (@AmiBhattMD) Great Forbes article on the surge of interest in #digitalhealth #telemednow Dr. Salim Saiyed (@dr_salim_saiyed) Yet to be seen if large companies continue to innovate as smaller nimble , start ups do. Some of that investment is to make money #telemednow Matt Sakumoto (@MattSakumoto) There's actual movement in the #DigitalHealthEquity space. See @UniteUsHQ or @cityblockhealth #TelemedNow Ami Bhatt (@AmiBhattMD) love @cityblockhealth@toyinajayidocis making change happen! @medcitynews Evan Kirstel (@EvanKirstel) Check out @UpHealthInc Ritu Thamman (@iamritu) Certainly They need to recoup their investment & they are entitled to make $$ for all their innovations/hard work #TelemedNow John Lynn (@techguy) I predict a bunch of losers. Actually, that's just the nature of the beast. The market isn't big enough for everyone that's raised all this money to have good exits. #telemednow Industry wise though, we'll be sooo much further ahead. Ritu Thamman (@iamritu) So much competition in this space!!! #TelemedNow #OnlyTheGoodDieYoung Ami Bhatt (@AmiBhattMD) love @cityblockhealth @toyinajayidoc is making change happen! @medcitynews KKJ (@KKJDotai) What would have more impact (A) 2x the investment by another $26Bn (B) FDA free trade zone, patients can opt out of its regulatory control w/ informed consent? Internet innovation is permissionless The only trial endpoint that matters in US is to get the FDA permission slip Ami Bhatt (@AmiBhattMD) The #SPACs have also changed the playing field!! #VentureCapital #PrivateEquity

Sid Kandan (@Sid_Kandan) Speaking of funding, does #telemedNow have any thoughts on the government’s largest investment into Telehealth + Connected devices ($550M)? We broke down the popular solutions and awards here: Irma Raste (@IrmaRaste) According to @Rock_Health's Q1 2021 Funding Report, #DigitalHealth "is all grown up". Q1 was the biggest quarter in digital health funding EVER, dominated by mega deals, with deal sizes of Series A, B & C continuing to trend up. #TelemedNow #Health Q3: What criteria should one use to evaluate a #digitalhealth company/technology for a Series A round of #Funding #VC #AI #RPM A3 Notable Responses: Ritu Thamman (@iamritu) . I this checklist from @peteflint what to show in series A funding #TelemedNow Dr. Salim Saiyed (dr_salim_md) Having #physician #clincian #patients involved since this is #healthcare #telemednow Ritu Thamman (@iamritu) 100 esp since the funding opportunities are increasing #innovation #healthcare #TelemedNow Dr. Salim Saiyed (dr_salim_md) Lots of $$$ hoping to build the next 2.0 #telemednow platform Morgan Cheatham (@MorganCheatham) here’s a few we use.. Morgan Cheatham (@MorganCheatham) Total addressable market (TAM) - healthcare is a ~$4T market that looks a lot more like 4,000 $1 billion dollar markets. Here's a framework for evaluating TAM: Moderator Comments Ami Bhatt (@AmiBhattMD) #TelemedNow here is a Top 50 in #digitalhealth list worth looking at! Forbes: Digital Health’s Banner Year: 2020 Investments And Investor Signals Promising Opportunities In 2021

Q4: As an MD is it better to be the CEO of your own #telehealth company or to hire one? #TelemedNow A4 Notable Responses: Ritu Thamman (@iamritu) I’d hire someone outside for added business acumen #TelemedNow Matt Sakumoto (@MattSakumoto) It depends? I use @chrissyfarr framework on the different types of Chief Med Officers at a startup. #telemedNow Dr. Salim Saiyed (@dr_salim_MD) MD all the way. #physicians know the space & credibility with others. Hire for skills in other rolls you looking in ceo , as #coo or #cio or #cmo #telemednow #MedTwitter #some John Lynn (@techguy) Story Time: my friend did this with a Doctor. Built the product. The doctor himself didn't even use it. Lesson: not all doctors are great at knowing broad market demands and scalable products. Matt Sakumoto (@MattSakumoto) What if the founder is an MD/MBA? #TelemedNow John Lynn (@techguy) Then quextion their execution skills? #telemednow Dr. Salim Saiyed (@dr_salim_MD) #MBA overrated for docs depends on goals #telemednow Ami Bhatt (@AmiBhattMD) I hear this time and again ... #TelemedNow John Lynn (@techguy) MBA is better if you want to get into admin than startup. #telemednow Dr. Salim Saiyed (@dr_salim_MD) #MBA is better for non - docs! Doctors have for centuries ran their own medical practices, clinics, hospitals without MBA John Lynn (@techguy) When you look at how a lot of practices are run, that doesn't support your comment. #telemednow Dr. Salim Saiyed (@dr_salim_MD) Check out @MayoClinic @ClevelandClinic @Intermountain many others run by MD. I’d venture they are run very well John Lynn (@techguy) Exceptions that prove the rule. I'm not saying a doctor can't. Also, hospitals are different than practices. I am saying that just because you've run a practice, doesn't mean you're good at business. I see it over and over again. #telemednow

Moderator Comment Ami Bhatt (@AmiBhattMD) Here are some companies with good backing by @BessemerVP for #TelemedNow to become familiar with: @AbridgeHQ












Q5: Can #telehealth companies make it in this environment without significant VC funding? #AI #TelemedNow #RPM A5 Notable Responses: KKJ (@kkjdotai) Why dont physicians pool together their knowledge and capital and cut VCs out of benefitting from the innovation upside of the space? It’s happening in many tech verticals already. innovation is not properly priced in vs cash in health tech. Healthcare has an innovation problem Shereese Maynard (@ShereeseMaynard) While attractive, that's not likely to happen. Unfortunately, healthcare in the U.S. is a business model, not a care model. And more physicians are embracing VCs as they speak the language of the more successful, sought-after physician. #TelemedNow KKJ (@kkjdotai) Physicians, from their degree/ status seeking phase to clinical phase, follow largely a linear, permissioned career path. Startup innovation is inherently permissionless to be disruptive Which is why the physician bias is to seek a permissioned version of innovation via VC arms Dr. Salim Saiyed (@dr_salim_MD) Yes. Just look at Judy with #Epic a multi billion dollar tech major company without any #vc or loans #telemednow break the models Andrew Watson (@AndrewWatson) I’ve been thinking about this…. Whether or not you need an MBA or a doctor can lead a start up truly depends on the environment in which are innovating. Is it a standalone angel than multiple rounds of funding or under the rubric of an innovator / AMC. #TelemedNow Ami Bhatt (@AmiBhattMD) Where will our #telemedicine advances come from? small companies with VC backing or large companies who shift gears to health @Google @Apple etc ? Davis Liu MD (@davisliumd) Nope. A lot of $ flowing in. It’s a long time to build / see returns and current peer companies heavily funded. Don’t see how it would work now. Probably easier to start now and find funding... Survive long term?! Sid Kandan (@Sid_Kandan) Depends if they're disciplined enough to last. #grit #TelemedNow Andrew Watson (@AndrewWatson) I think smaller companies, will see some very interesting niche solutions I can’t defend themselves against larger mergers. Especially in the monitoring space IMO. Stacy Hurt (@stacy_hurt) I want it to be smaller companies who are more geared towards personalized medicine for #patients but I am afraid it will be the giants #TelemedNow John Lynn (@techguy) Depends on which section. Some #TelemedNow markets, market share is being bought. However, at the edges there are lots of opportunities that don't need vc funding. Matt Sakumoto (@MattSakumoto) Don't forget @AmazonCare! Many 800lb Gorillas in the game #Telemednow Shereese Maynard (@ShereeseMaynard) I'm inclined to agree but along with that inability to compete, will the patient experience suffer? I think so. Large orgs like to produce one-size fits all solutions where smaller orgs tend to build-to-experience. #TelemedNow Ritu Thamman (@iamritu) No need $$ to figure out truly blended care/seamless triage:will give rise to disruptors but they’ll be swallowed by big companies- that use startups to see which products are compelling enough to be piloted by a few customers, then build it as their own #TelemedNow CME Information For #TelemedNow CME - the website to set up an account, register your cell and / or claim CME : If you registered your cell text the code to 412-312-4424 Tonight’s code for 1h of category 1 CME: CUCROR

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