Reinventing the doctor - week 3

Bambi Francisco Roizen · August 2, 2019 · Short URL:

Keith Rabois (Founders Fund), Dr. Michael Abramoff (IDx), Dr. Arif Nathoo (Komodo Health) and more

Welcome to "Reinventing the doctor" - week 3, my weekly curation of news and information around the Internet that's relevant to our topic. We'll be discussing how technology is changing the role of the doctor at our upcoming salon at UCSF in San Francisco. 

Join us on 9/12 and you'll meet me, my co-hostess Dr. Archana Dubey (Global Medical Director, HP) and my co-host Mark Goldstein (Chairman, UCSF Health Hub). 


This week, rather than dive into the news, I wanted to first highlight some of our esteemed speakers. We're excited to have them spearhead the conversation, which we hope all our guests will partake in. These salons are designed to be interactive so we encourage everyone to engage and participate!

Here's our speaker list:

Keith Rabois, Partner, Founders Fund

 Keith needs no introduction. As a Silicon Valley veteran, Keith can talk to any topic, and importantly provide a 50,000-ft perspective. He started as a lawyer and then operator at PayPal and Slide. He then became a VC at Khosla Ventures, and now Founders Fund. That's why Keith joins us to talk about the "Big Picture: How will doctors engage with patients in the future? Why are US health outcomes worse than other countries if we have the best doctors in the world?  Would “Medicare for All” improve care? Keith is a conservative contrarian, so it will be a riveting discussion given the makeup of most of the Silicon Valley crowd. Keith has talked publicly about how data will improve outcomes. One company doing this already is IDx, whose founder will be one of our speakers as well!

Dr. Michael Abramoff, Founder and CEO of IDx.  

In April 2018, IDx received FDA approval to market the first autonomous diagnostic system. It is an Artificial Intelligent device to detect diabetic retinopathy without the need of a physician to provide input. Diabetic retinopathy, which affects 30 million people in the US, is when high levels of blood sugar can affect the retina and lead to blindness. "Nothing in the healthcare system, in terms of reimbursement, was prepared for it, because everything in that system is built around physicians and nurse practitioners making decisions. Autonomous AI makes the clinical decision by itself, so we had a giant hurdle to cross,” said Dr. Michael Abramoff, in an interview with MD&DI. How is IDx reinventing the doctor? The FDA says that IDx-DR is the first device authorized to provide a screening decision without the need for a specialized doctor to interpret the image or results. Founded in 2010, IDx has raised $52 million from notable VCs, such as 8VC and Optum Ventures. 

Dr. Arif Nathoo, Founder & CEO of Komodo Health

Komodo Health, as I wrote about last year, "sits on an exponentially-growing rich repository of hundreds of billions of data points aggregated from hundreds of sources and stitches together a high-quality tapestry of 300 million people profiles across hundreds of different therapeutic conditions." This is a value add as medical information that's not shared results in at best redundant tests at worst, inferior care that results in poor outcomes. How does Komodo reinvent the doctor? By seeing what's happening across silos, Komodo can equip healthcare providers with tools for screening and treatment. As Arif has said to me, "providers are diagnosing at the point of suspicion maybe a year into the disease, or worse yet - 20 years." Komodo is also making inroads in early screening of highly at-risk patients for rare conditions, such as hereditary ATTR amyloidosis (hATTR), which affects 10,000 people in the US. Founded in 2014, Komodo is backed by Felicis Ventures and McKesson Ventures.

Dr. Sunita Mishra, CEO of Providence Express Care 

Express Care facilities handle same-day or walk-in appointments for low-acuity services, such as the common cold, strep throat, minor burns and UTI. The facilities are opened from 8 am to 8 pm and open most of the week, depending on the area. Express Care is part of Providence St. Joseph Health, a non-profit health system, which operates in five states and has 27 hospitals and 35 non-acute facilities. Some of the Express Care clinics are inside a Walgreens drugstore as a way to connect locals or customers with Providence doctors. How is Express Care reinventing the doctor? They're creating new venues and access points for doctors to provide care outside of the clinic or hospital. 

Dr. Ian Tong, Chief Medical Officer, Doctor on Demand

 The consumer telehealth services market was $300 million in 2018 and is expected to reach $470 million by the end of 2025. Among the leading companies in this space is Doctor On Demand, which was founded in 2013 and has since raised $161 million in venture financing. Doctor On Demand connects patients, with or without insurance, to board-certified physicians, licensed psychologists and psychiatrists 24/7/365 via video visits. This helps consumers get care without having to utilize other more expensive alternatives, like the emergency room. Some studies show that telehealth is savings between $19-$100-plus per patient visit.  Back in 2015, we heard founder Adam Jackson early on at one of our Vator events talk about how telehealth would reduce costs. (Doctor on Demand at Splash Health 2015).  

Scott Barclay, Partner, DCVC

Scott focuses on Data Collective's "Computational Care" thesis. What does this mean? As he told us in our Meet the VC series, "I think the future of computing data means bringing these capabilities closer to the healthcare patient and to the empathetic human that touches a patient. This may take place in some of our most complicated clinical environments where our loved ones are vulnerable, like an ICU (intensive care unit), or this may be something consumerist that pushes intelligence closer to our daily life." Some investments he's led include Karius, which leverages genomics, machine learning and proprietary processes to enable hypothesis-free infectious disease (ID) testing; Medical Informatics, a female-led early special team doing deep compute on top of the ICU – historically, a “firehose” environment of health data left unused – now captured, standardized and made usable for true learning and Swift Medical, a company that applies machine vision to the smartphone at the bedside for wound care.

Join us at this event. We'll have more speakers to announce in the coming weeks.  


In the meantime, brush up on relevant news on the topic. 

Anthem and K Health team up

Insurer Anthem in July teamed up with K Health to create a cobranded app for Anthem members to chat with a doctor for less than a copay. The toll will also give Anthem members access to K Health's tool that shows how doctors have diagnosed patients in the past.

Read more.

Doctor on Demand and Humana

Insurer Humana tapped Doctor on Demand to provide virtual doctor visits for nothing. The new service called On Hand is available to Humana members. The service is "$0 copay for doctor visits using Doctor on Demand and a $5 copay for common labs and prescriptions."

Read more. 

Bernie Sanders and billing

During the Democratic debates, Sen. Bernie Sanders said cost savings can come from the wasted resources that go toward admin costs, like billing. "On the Medicare for all, the hospitals will save substantial sums of money because they're not going to be spending a fortune doing billing and the other bureaucratic things that they have to do today," said Sen. Sanders at the debate.

One study showed that doctors spend about three hours a week dealing with billing-related matters, according to a study in Health Affairs. Including the medical support workers and admins who support the doctor, there was an additional 55 hours, bringing total costs to $68,000 per year per physician. In another study at in JAMA, billing activities accounted for 3 percent of revenue for surgical procedures. At the high end, 25 percent of emergency department visits revenue went toward billing costs. For primary care physicians, billing accounted for 15 percent of revenue.  

Read more

(Image sources: Thetimes, signal.nfx, theopthamologist, Medium)

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Bambi Francisco Roizen

Founder and CEO of Vator, a media and research firm for entrepreneurs and investors; Managing Director of Vator Health Fund; Co-Founder of Invent Health; Author and award-winning journalist.

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