From the Internet of Things to the Internet of the Body

As Managing Director of Healthcare at GE Ventures, Leslie Bottorff invests in healthcare industry startup companies—with a preference for medical technologies and emerging business models. Her 15 years of venture capital investing experience includes her roles as managing director at ONSET Ventures, and investments and board seats at Sadra Medical, which was sold to Boston Scientific; Spinal Concepts, which was sold to Abbott Labs; Neuronetics; Relievant; and VisionCare Ophthalmic.

Earlier in her career, Bottorff spent 19 years in operating roles at large andventure- backed companies including Medtronic’s CardioRhythm division, Embolic Protection (acquired by Boston Scientific), Nellcor (now Covidien), Ventritex (now St. Jude), Menlo Care (acquired by J & J), and GE Healthcare. She has also served on advisory boards or as guest faculty at several universities including Purdue, Stanford, and UC Berkeley.

TEDMED: What’s the most remarkable innovation you are seeing in health tech or medicine, and what is driving it?

Bottorff: We’re seeing tremendous innovation in personal monitoring and in therapies for a wide variety of diseases. Combining therapies, diagnostics and digital communications is creating a more effective systems approach to patient care management. This means helping patients who are in the hospital or coming out of the hospital, living at home with chronic diseases as well as helping people who are not ill, but taking steps towards preventative care.

This is analogous to the emergence of the Industrial Internet, which GE is a major proponent of. This convergence of personal monitoring technology and advanced wireless communication is a pretty big opportunity for what I’ll call, the “Internet of the Body”. This convergence is going to be the driving force behind the advances we are seeing today.

In addition to personal monitoring, another area of remarkable innovation is noninvasive technologies to treat and diagnose conditions related to the nervous system. We’ll be able to take advantage of some of the electronics and connectivity that is now available. As one example, GE has a brain initiative being led by our Healthymagination unit.

TEDMED: What’s the most important factor for entrepreneurial success inhealth tech—and is that different from your own key to success?

Bottorff: It’s important for entrepreneurs to embrace innovation throughcollaboration and not think they have to be experts in everything to bring the many pieces of the puzzle together themselves. This is a multi-functional area. You have to recruit a strong multidisciplinary team and maintain focus. This industry is being re-invented as we speak; nobody’s got the formula. So it’s important to maintain focus and persevere to understand the needs of your target customer. Those factors are very synergistic to GE’s. We also need to stay focused, and we also need to innovate, which is why we stay close to the new thinkers and innovators. In a young and small company, you can be agile and you succeed or fail in much faster cycles than a large company. At GE, we think the best way to focus on what’s next and what’s coming is to partner with entrepreneurs and startups. We aim to help accelerate their growth and help them commercialize their ideas to really move the needle. At the same time, they may have the problem that they’re not able to scale, get big, or get reach. That’s the kind of thing we can help them with and one of the many reasons why we feel like it’s so important for us to collaborate.

TEDMED: For entrepreneurs with needle-moving ideas in global health, what are the keys to finding collaborators and supporters across specialties, industries, and geographies?

Bottorff: We’re an infrastructure company that has global reach and global distribution. We see ourselves partnering with all sorts of external partners, including startup companies with great ideas for products and business entities in many of the countries we’re based in. Having operations in 170 countries, we can take the innovations that are going to be most appropriate to the right markets and geographies and help an entrepreneur do that parsing—to ask if their product is a fit for the infrastructure of a given market. So we can say to entrepreneurs, “Let’s talk about how we can help you most, because you don’t have the scale to get all markets .”

TEDMED: In 2020, you’re asked to give a TEDMED talk about the biggest transformation you helped bring about in your field. What is it?

Bottorff: GE would love to play an important leadership role in coordinating what will be an end-to-end system that delivers on the promise, and not just the hype of  “Digital Health”.

A lot of people have grand visions of how Digital Health is going to transform and improve healthcare, and that is exciting. But, getting from point A (where we are  now) to point B (the ideal future vision) is trickier than coming up with a grand vision. It’s going to require a lot of cooperation with a lot of parties and GE intends  to be right in the middle of it to help make it happen. The transformation between now and 2020 or 2030 will be remarkable.

The Hive 2014: The Next 10 Startups

As promised, today we’re announcing 10 more breakthrough startups that will join the TEDMED Hive 2014. This September 10-12 in Washington, DC and San Francisco, each will share their products and ideas for progress in health and medicine with our Delegates. Visit TEDMED.com for fascinating background info on these newly announced entrepreneurs, and to revisit the 10 startups announced last week.

Screen Shot 2014-06-12 at 3.55.54 PMScreen Shot 2014-06-12 at 3.56.09 PMScreen Shot 2014-06-12 at 3.56.22 PMToday, we’re also getting to know Hive Curator Sumbal Desai, Associate Chief Medical Officer for Strategy and Innovation at Stanford Hospital and Clinics, via our weekly Q&A blog series. She shares insights on how healthcare is reshaping itself to fit consumers’ digital expectations.

We’ll release more Hive startups next week.  Until then, follow the latest news @TEDMED.

Q2 Checkup: What Is Shaping Digital Health Innovation in 2014?

By Aman Bhandari

With 2014 halfway behind us, it’s time for a bi-annual look back at digital health innovation so far.  What have been our major influencers?

Six months is a very short time span in which to say anything is shaping a sector, but it’s also a good time frame for a snapshot. It wasn’t until I started thinking about what’s happened recently that I realized how dizzying the activity has been across the spectrum and potentially at scale. This is critical. In this year alone we are seeing some of the biggest players make bets and shifts, from the Office of the National Coordinator for Health Information Technology (ONC) to Apple, which means the digital health ecosystem will be impacted, and it could happen at scale.

-1First, look at the activity and record levels of venture funding in the digital health space; $700M in Q1 2014 alone, an 87% year over year increase according to Rock Health. This recent Harvard Business Review piece nicely summarizes why the time to be in digital health is now. There has (finally) been some chatter that we are approaching bubble territory in digital health, and while that may be true, there are at least three areas of optimism thanks to the infrastructure and ecosystem evolving at all levels: Continued Federal activity, Fortune 500/Wall Street involvement, and diversified venture funding.

1. Federal Government: Continued Data Liquidity Push
The federal activity from this year is across the board. Some highlights that will challenge entrepreneurs to develop a continued drive for enhanced data and information liquidity with an improved consumer experience over the long run include the following:

  • ONC releases 10 year interoperability vision
  • ONC re-organizes and creates an API committee. This wouldn’t have happened as recently as two years ago.
  • Medicare announces an historic data release of physician payment data revises other data related guidelines, potentially opening more access to commercial entities
  • FDA Open Data releases millions of files to entrepreneuers in a more accessible format
  • Healthcare.gov helps enroll millions of people

2. Digital Health at Scale: Fortune 500 Involvement

Following on CMS data transparency efforts, some of the largest health insurers, including Aetna, United Health and Humana, announced they will release payment data to consumers. And speaking of consumers, technology companies including Intel, Samsung, and Apple have entered in a big way, and it’s clear that wearables have gone mainstream. The Fortune 500 are paying attention and are also forming collaborations across silos, such as the Apple Epic and Mayo partnership, including:

  • Intel’s $100M+ acquisition of Basis
  • Samsung’s $50M digital health fund + S Health launch
  • The Apple Health Kit
  • Health insurance giants making payment data public

3. Startup Diversification & Investment: New Entrants

The third signal flare from 2014 to watch is the increased diversity of players including some who haven’t been as involved previously. This includes investments this year from venture funds Social+Capital and Andreessen Horowitz (a16z). Some of the new entrants are driving record amounts of funding and are bringing greater assets to bear.  Here are some highlights of startup activity:

  • Flatiron Health had one of the largest series B rounds in the digital health space ($130M)
  • Omada Health gets $28M series B lead by a16z
  • Better raises $5M from Social+Capital
  • Nant Health receives $100M from the Kuwait Investment Authority
  • 16 digital health acquisitions to date

Digital health innovation is still the wild West, admittedly, and there are many hurdles. What’s clear is that these three areas have backing from actors who can scale and bring on the best talent in the world. They’re creating a robust ecosystem that is shaping innovation in digital health. Across the board, there is a larger theme taking shape of capturing, aggregating and democratizing access to data, which is spurring entrepreneurial activity and the consumerization of health. In addition, novel cross-silo partnerships are forming. Collaboration across the health and tech sectors is no longer an option; it is a necessity if we are going to drive meaningful change in healthcare.

Which three things would you point to as harbingers for 2014?   TMIcon

 

Aman Bhandari has worked in corporate, non-profit and government organizations. He formerly worked for Todd Park, the US CTO, at the White House, where he helped to launch a variety of global and national health policy initiatives at the intersection of health IT, data, and innovation. He also co-launched the Health2.0 code-a-thon and developer challenge series. Follow him @GHideas.

 

TEDMED COO, Shirley Bergin, says over-50 crowd are real winners at AARP @50+ LivePitch

Finalists at the AARP Health Innovation @50+ LivePitch in Boston last week included a lab-quality DIY diagnostic kit and a smart phone that can tell when it’s user is getting a bad case of the wobbles.

Clearly, this is not your mother’s health technology, said TEDMED COO Shirley Bergin, who was one of the judges for the event.

““There really is something to the idea that today’s 50-year-old is yesterday’s 40. The way this group thinks about technology is sophisticated, from invisible sensors to wearable technology. They’re definitely ready to participate in a productive way,” she said.

Photo: Christopher Sherman/AARP

Photo: Christopher Sherman/AARP

The judges chose Lift Labs as their winner, which makes a spoon that automatically and unobtrusively prevents those with tremors from spilling food, an advance very much geared toward life quality.

The audience choice was Careticker, a web based program that helps caregivers track activities to earn incentives and to connect with other caregivers.

“Careticker is very focused on what I thought was a big theme; we’re living longer and taking care of those we love for longer periods of time,” Bergin said, adding that health tech innovation for this crowd seemed to center on needs-based items for an audience that was very much on the move.

“The psychographics of a 50-plus today is one of a very active individual, not somebody who’s thinking they’re on the last journey of life. They want to take advantage of all the world has to offer, and look for technology that facilitates an active lifestyle and promotes a good quality of life,” she says.

Shirley Bergin Photo: Christopher Sherman/AARP

Shirley Bergin Photo: Christopher Sherman/AARP

In a couple of weeks, TEDMED will begin releasing the names of startups joining its own innovation showcase, the TEDMED Hive.  After reviewing the hundreds of Hiva applicants, the AARP contestants and those at SXSW, at which she was also a tech innovation judge, Bergin says the market seems to be shifting to a more mature phase of implementation and commercial viability.

For example, while you’re still seeing startups focused on big data, it’s more focused about how that data is going to enable you to take care of yourself, manage a chronic disease or facilitate some improved state of being.  How is all of that data going to improve our health?

Entrepreneurs are also coming to terms with a venture capital pool that is finite, she says, and are delivering more sophisticated business model presentations; still mission-based, but with an eye as to how the work will scale commercially. One thing that might help:  joining forces.

“Startups are trying to approach solutions from different angles, so I hope there will be more awareness that other people are addressing the same problems. My hope is that those are going to be more collaborations as well as innovations,” Bergin said.

A startup health incentives app shows users the money

The human brain is a marvel, but it does a pretty lousy job of weighing long-term hazard avoidance versus immediate gratification. C’mon, if we were really thinking clearly about consequences, would anyone start smoking? Finish the entire bucket of Kentucky?

But what if someone gave you money to put down the cigarette?  Ah, that might change things.

Achievemint is betting on it. The startup app, part of a platform developed by Activity Exchange Inc., awards points for behaviors like a gym workout or nutritious food choice that can translate directly into merchandise or even cash. The platform has some 170,000 users. Achievemint gains by aggregating data anonymously for customers.

The company’s end target, though, is insurers, who stand to gain from improving preventive behaviors now that the Affordable Care Act put an end to pre-existing condition restrictions. In this scenario, users accrue discounts on their insurance premiums of up to 30 percent.

Mikki Nasch, Achievemint’s CEO, says most insurer wellness programs as yet have a poor track record of inspiring behavior change over the long run, with little research as to what actually motivates an audience and a general lack of truly targeted messaging. Instead, Achievemint aims to push age- and language-appropriate information relevant to a user, marketing health as a product one might actually like to buy.

Nasch dismisses gadgets and group competitions as interventions one might flirt with, but rarely marry.

“The whole notion of gamification and health undermines the intelligence of the consumer, to be frank. We don’t all rush to a reward portal every day to see how we’re doing against our five friends,” she says.

Money in one’s pocket is a different story.

“The way the ACA is written is very smart, because it incentives the payers to incentivize their populations. Regardless of what you want to do as a payer you’ve got to give those discounts intelligently, because if you discount the wrong 30 percent you’re going to lose your shorts,” Nasch says.

Patricia Meisner, co-founder and CEO of ActualMeds, also bemoans the difficulties of engaging patients.

“Today, there’s not a strong payment model or market model where consumers are used to paying for their own healthcare. They’ll buy their own running shoes but they won’t buy their own healthcare management tool,” she says.

Care managers, though, have all sorts of reasons to look for help, from avoiding risks to better outcomes and reduce costs. To those ends, ActualMeds is a web-based platform that helps them collect patient data and manage medications for those with chronic diseases. It provides medication reconciliation on demand at point of care and seamlessly combines medication information from the electronic health records, prescription claims, and structured patient interviews.

The company began life as NIH-funded research at the University of Connecticut, focusing on Medicare’s high-risk patients with seven or more medications to manage. Medicare’s way of helping ensure compliance involved matching patients with a random pharmacist for review, which brought in less than desirable results and low engagement rates.

“ActualMeds did not set out to disrupt that market model; we set out to change it entirely. You don’t need a clinical pharmacist to do all this. We can do a tool that aggregates the best possible medical history,” Meisner says.

ActualMeds also aims to provide a virtual safety net of reminders for areas that often escape attention, like over-the-counter meds.

“Acid inhibitors are powerful pharmacologic agents, as are antihistamines. And I want to go on records as saying statins will be next. People self medicate with these like crazy. Older patients will take things to help them sleep and they end up falling down. That’s the stuff no other claims database is going to give insight into,” Meisner says.

ActualMeds was part of the New York Digital Health Accelerator program (run by the New York eHealth Collaborative, another TEDMED 2013 Hive company), and recently won the 2014 Venture+Forum contest at the annual HIMSS conference. They’re currently working on a number of pilots on various facets of the platform, including testing its structured interviews for home visits and primary care, with results checked by case managers or clinical pharmacists.

Catalyst is an ongoing series about health innovation, focusing on companies from the TEDMED Hive.  For more information and to apply for the Hive 2014, click here.

Great American health startups, not from garages

Sure, a lot of great ideas came out of American garages, but with enough imagination, moxie and determination, they can be teased out of virtually every setting.

Take these products and projects from the TEDMED 2013 Hive companies, for example.

iMPaK Health makes an ultra low-energy Bluetooth enabled device, about the size of a credit card, supporting products that monitor medication adherence, pulmonary function, activity and sleep. Functions run the gamut from simple to complex – recording symptoms, measuring pulmonary function or analyzing a drop of blood. The company is an offshoot of Meridian Health, a not-for-profit hospital system based on New Jersey, which started developing the products after pondering how to help patients monitor their own conditions in ways that meshed with the workflow of the Meridian health system.

“We realized that the companies that were out there didn’t understand health care that well. They had no real idea of what health systems were looking for in terms of costs, return on investment, and ability to scale easily. They didn’t understand that patients don’t want to feel sick. A lot of the devices made to be placed in the home were modified hospital versions of existing technology,” says Meridian Health Director of Consumer Technology and Service Development, Sandra Elliott.

Screen Shot 2014-03-21 at 7.48.59 AMInstead, iMPak aims to increase patient engagement over time and to aid in prevention when possible with inexpensive, easy to use tools.

“How do we get people to own their health now, and at the same time take those patients who are at the ‘Oh, Crap’ moment in the hospitals, and put them back on a different track when they’re in the community? It’s not just about the tools and what the information is telling us; it’s about helping people change their behavior,” Elliott says.

Tiffany Wilson Karp, Executive Director of the non-profit Global Center for Medical Innovation (GCMI), works to help medical device innovations coming out of academic centers in the Southeast ramp up to market. Health devices are a tough field for a startup, not only with normal new business pressures but also with the mandates of prototypes and clearing FDA approvals.  A device can’t raise money until its proven clinically and commercially viable, and that can’t be proven until it’s manufactured in a cleanroom, an area designed to reduce environmental pollutants.

Project partners Georgia Tech, Piedmont Hospital, the Georgia Research Alliance and St. Joseph’s Translational Research Facility collaborated to open GCMI in 2012. It’s based in a 12,000-square-foot facility near Georgia Tech. The idea is to help innovators, from the Southeast at least initially, navigate what Karp calls the “little pockets and ecosystems” of the medical device commercialization process, and to gather the intelligence needed to see the process through.

“It takes a village to get something from a concept to the patient. It’s an intersection of science, engineering, business and law. Everybody speaks a different language, yet need to carefully coordinate to get something to market that’s safe,” Karp says.

The fine print is seen to by a network of intellectual property, regulatory and quality systems advisors, and the bottom line by investors already flocking to the center.

While products are of necessity hush-hush, Karp says results include supporting one company from going to a team of two to their FDA clearance and CE approval in about 18 months, a process that can take years.

“The medical device industry is hard, messy and expensive. The underlying reason that drives innovation is the patient. You ask anybody in this industry why they do it, and they say, ‘Every day when you go to work you’re working on something that’s going to affect somebody’s life and quality of care,” she says.

The positives of HIV testing: A tale of two cultures

Last week, we hosted a live online discussion about essential community building blocks for breaking the links between poverty and poor health outcomes. And the need to think creatively is perhaps strongest in local HIV/AIDS prevention initiatives. Cultural pressures, health myths, and access issues can hamper engagement and progress and yet, two campaigns are making strides.

The Many “Reasons” to Get Checked

Putting a positive spin on HIV testing for young men at high risk for the disease may be a daunting task, but culturally poignant messages may go a long way towards selling the value of getting checked.

Manuel Rodriguez manages the “Reasons” program for the non-profit development strategy organization FHI 360.  Reasons is a messaging campaign that aims to get Latino men who have sex with men to undergo testing for the HIV virus.  It comprises social media outreach, print, t.v. and online advertisements, and presence at gay pride events, and currently focuses on cities with many members of the target population, including Miami, Los Angeles and New York.

 

“We all have a reason for getting HIV tested,” the ads say, including words like love, life, family and pride.

Rodriguez says Reasons aims to touch on the strong sense of community in the Latino culture, which holds whether one is a first-generation immigrant or has lived in the U.S. for decades (Rodriguez was born in Caracas,Venezuela.).

“We incorporate family and friends, and the importance of protecting your partner. Mom is a very big figure in Latino culture, so some of the messages are, ‘I’ll do it for my mom to make sure I’m going to be there for her,” Rodriguez says.

Another hallmark of the effort is its positive, not punishing, slant.

“We see this as a new way to communicate because it comes from a positive and empowerment framework, instead of, ‘You must do this, because you do that.’ It’s more of a value-driven proposal.  ‘You can control it.  You can prevent it.’

“As a person, your value as a member of a family and your community is health. To be there for them is to take control of your health,” he says.

Rodriguez says impact of the year-old program is measured so far in the millions of online website views and by a big bump in social media interactions since the program launched. The program has conducted strategic online listening activities to fine-tune campaign messages. Some findings include that some Latino gay and bisexual men see testing as the right thing to do, and they go as far as to share Instagrams of their test results as a badge of honor — negative results, because a positive test result still carries a stigma in Latino culture; one that Rodriguez has worked to mitigate throughout his career in public health communication.

Though Reasons has a defined target audience, Rodriguez says that its themes may turn out to be not so specific after all:

“We think at the end of all these Pride events and local mobilization, we’re going to have a story to tell. And we’re going to find out that these will be universal themes that unite us all.”

Taking Pride in Resilience

Another FHI360-managed program, Testing Makes You Stronger, is aimed at African-American men with male partners. According to Cornelius Baker, Acting Director of the HIV/AIDS Unit, Testing reflects a common ethos in the black community of ‘that which doesn’t kill you, makes you stronger.’

“It’s the messages one gets by growing up in an African American family; that of resilience, that you can survive through tough things,” Baker says. “It’s also very much that sense of pride, of having a respect of agency for the community.  People want to live well; they want to survive.  What we have to do is create an environment of support for that, and give people the tools to be able to benefit themselves,” he says.

Baker says his organization gathered input from community leaders, advocates and the Testing target audience — more than 400 black men in five cities — before embarking on the campaign.  There is also a campaign for African-American women, Take Charge: Take the Test.

Both programs are funded by the Centers of Disease Control and Prevention, which also lends its scientific and technical expertise to governments and agencies worldwide to help stop the spread of HIV.  (For more on how global health strategies are applied locally, join TEDMED’s special World Health Day Google Hangout on April 7.)

BUSTED: What are the top five preventive health myths?

You can get the flu – or worse — from a vaccine. Only old folks get strokes and heart attacks. Calories in, calories out. X-rays cause cancer. Sleep eight hours a night and drink eight glasses of water a day. Skip the sunscreen on a cloudy day. Take a multivitamin every day, just to be on the safe side. An apple a day keeps the doctor away. Exercise more to lose weight.