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A Conversation with Shaye Mandle, President and CEO, the Medical Alley Association

April 16, 2018
by Pamela Tabar
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Shaye Mandle

Breaking down healthcare’s information siloes has become a mission for Shaye Mandle, president and CEO of the Medical Alley Association in Minneapolis, one of the largest medical technology consortiums in the country. Under Mandle’s tenure, the consortium has evolved into a 650-member conversation on how to overcome technology barriers and meld the interests of all healthcare sectors. Unlike many industry groups, the Medical Alley deliberately courts members from across the spectrum of healthcare, including payers, providers and vendors.

Editor’s note: Why is the Medical Alley Association nicknamed the “Silicon Valley of the Midwest?” Read Healthcare Informatics’ profile of the innovation group in Part 1 of this two-part piece.

The cloud-based world and the dramatic rise in consumerism in healthcare seem to have stamped an expiration date on proprietary platforms, making cross-sector collaboration more important than ever. The best way to solve healthcare’s technology challenges and innovate, Mandle says, is to bring every aspect to the same table.

Healthcare Informatics recently spoke with Mandle about emerging innovations, industry trends and the surging impact of digital health.

How would you describe the culture change in healthcare IT these days?

Clearly, there are a lot of big healthcare players that have their own impact on the market. Until about three years ago, those proprietary lines drove almost everything. Part of the reason for the Medical Alley Association and its activities is to encourage that shift in the market. There's a real value shift happening now, and it involves some significant underlying cultural changes in perspective. We’re seeing a new emphasis on getting to know what the consumer needs and wants, and how to engage them in their own health.

How is the digital health movement changing the way companies need to think about consumers?

A lot of these larger, more established companies, particularly device companies, have been the major players in healthcare for a long time, but their relationship hasn’t traditionally been with the actual consumer. They’ve typically targeted the physician expert and clinical data/ IT sides of the equation.

But as consumers become more and more educated, these device companies are going to see a change to a more consumer-focused realm. We’ll see it happening with the payers, too. It's not just about convincing the hospital to buy your product anymore. It's also about who’s using it and what that experience is like.

What types of convergence do you see on the near horizon?

One of the things that will be interesting over the next few years is the convergence of what’s happening in Silicon Valley, which is known for great consumer service, and what’s been going on in the legacy healthcare space. I think we’ll see those worlds starting to come together.

From our vantage point, we're seeing a lot of interesting healthcare expertise migrating into higher tech and into the consumer interface realm. But while we consider the demands of consumers and their connection to healthcare, we also need to bring the healthcare expertise to get it all done in a way that is both compliant with legal and regulatory parameters and can produce results in a systematic shift.

How is the value-based purchasing world changing business intelligence?

The definition of business intelligence is really expanding now. The importance of data collection continues to grow, but we're definitely in a period now where it’s also about the ability to apply that data and create information that is actionable.  Then there’s what I call the “soft business intelligence” side—it’s data-driven, but it’s more about what intelligence is relevant to the emerging definitions of value, and how that data translates across legacy platforms. There are still so many inhibitors to getting to where everybody ultimately needs to be.

What are some of the innovations heating up?

Personalized medicine is really hot. “Pharmacos” are working on clinical decision support tools that will allow for prescriptions that are based on your genetic makeup instead of guessing which medication will work best. Mental health is another place where we're seeing some interesting work. One company is developing wearables that can capture behavior patterns and what the body is doing during episodes of various mental health disorders to allow for better data collection. Then the therapist can use that when talking with the patient.

I’m also very interested in virtual reality and artificial intelligence, because I think the most important component of fixing healthcare ultimately will be about the ability to change behavior patterns. I think there are plenty of questions about where those applications are in development, but an AI/VR clinical support technology platform could get individual consumers to engage in better behavior, better adherence to their prescriptions and therapies and better manage their health through the life cycle. If we can make that happen, then I think most of the conversations we have today about healthcare challenges will be easily managed. 

Learn more about technology innovation and digital health at the Healthcare Informatics IT Summit in Minneapolis, June 13-14, 2018.


2018 Raleigh Health IT Summit

Renowned leaders in U.S. and North American healthcare gather throughout the year to present important information and share insights at the Healthcare Informatics Health IT Summits.

September 27 - 28, 2018 | Raleigh


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Town Hall Ventures Close First Fund at $115 Million

September 20, 2018
by David Raths, Contributing Editor
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Adds Landmark Health, Bright Health, Strive Health to Portfolio

Town Hall Ventures, an investment firm built to address the healthcare challenges of the most vulnerable Americans, has closed its first fund at $115 million.

The founding partners — Trevor Price, Andy Slavitt, and David Whelan — announced the firm’s formation on May 7, 2018, at the HLTH Conference in Las Vegas. Their goal is to help build companies to improve care in Medicare, Medicaid, and risk-based care, and in addressing complex conditions and social determinants of health.

The fund and its limited partners represent multiple large nonprofit health systems and payors, along with entrepreneurs, executives and investors. 

Town Hall also disclosed investments in three companies:

• Landmark Health LLC, which provides home-based care to high-acuity Medicare, Medicaid, and Dual Eligible populations who are frail and chronically ill. Landmark’s new CEO, Nick Loporcaro, was recruited by Trevor Price and Oxeon Partners, and the company is backed by General Atlantic and Francisco Partners.

• Bright Health Inc., a technology-enabled health insurance plan that is built in partnership with leading health systems. Bright’s CEO is Bob Sheehy, former CEO of UnitedHealthcare, and the company is backed by NEA, Bessemer Ventures, and Flare Capital Partners.

• Strive Health LLC, a leading provider of chronic kidney disease solutions, focused on transforming healthcare and patients’ lives through early engagement, comprehensive coordinated care, and expanded treatment options. The company's co-founder and CEO is Chris Riopelle. The concept for the business was developed with the co-founders inside the Oxeon Venture Studio and backed by lead investor NEA.

Existing investments include:

• Cityblock Health Inc., which provides primary care, behavioral health, and human services to address unmet health and social needs in urban populations.

• Somatus Inc., which provides treatment and new models of care for patients with chronic kidney disease and end-stage renal disease.

• Welbe Health LLC, a provider of integrated medical and social services to frail seniors who qualify for PACE. 

• Aetion, Inc., a provider of real-world analytics and evidence to help biopharma companies and payors better understand how drugs work in the real world to enable value-based care.

Town Hall also announced that Ann Hickey has joined the firm as a vice president. She previously worked at Audax Group, Oak Hill Capital Partners, Castlight Health, and, most recently, Archimedes Health Investors.

Town Hall is led by Andy Slavitt, former Administrator of the Centers for Medicaid and Medicare Services (CMS) and Group Executive Vice President of Optum; Trevor Price, Founder and CEO of Oxeon Holdings – the parent company to Oxeon Partners, a retained executive search firm – and Oxeon Ventures, an investment firm and venture studio; and David Whelan, Managing General Partner of predecessor firm Oxeon Ventures and former General Partner and CFO of investment firm Accretive LLC.

 

 

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At Partners HealthCare, Bringing Digital Transformation to Clinical Care

September 18, 2018
by Rajiv Leventhal, Managing Editor
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Last spring, Partners HealthCare, founded by Brigham and Women’s Hospital (BWH) and Massachusetts General Hospital, and California-based software company Persistent Systems, announced a strategic collaboration to develop a new industry-wide open-source platform with the goal of bringing digital transformation to clinical care.

Indeed, with the digital platform, Partners’ leaders hope to enable greater exchange of information across healthcare providers everywhere, and make available open source applications to any health system. At the time of the 2017 announcement, officials said that the co-developed digital platform will be based on Substitutable Medical Applications & Reusable Technologies (SMART), an open, standards-based technology platform along with Fast Healthcare Interoperability Resources (FHIR). “The platform will enable provider systems across the country to rapidly and cost effectively deploy industry-leading best practices in clinical care across their ecosystems,” according to the announcement.

Healthcare Informatics Managing Editor Rajiv Leventhal recently spoke with Sandy Aronson, executive director of information technology at Partners Healthcare, about this collaboration, its specific goals and outlook, and how things have come along so far. Below are excerpts of that discussion.

What would you say is the greatest significance behind this collaboration?

I have been at Partners for about 15 years, and the first 13 of those years were primarily focused on the clinical use of genetics and genomics. In that space, we created a suite of applications that was architected differently than health IT applications are typically architected. These were applications that helped with the generation of interpreted reports for genetics and genomics sequencing test results. So, where normally in health IT applications you create a transaction system and then try to bolt a knowledge base on top of it to the extent you can, we decided to architect this in the opposite way.

We built a knowledge base that deeply modeled the tests that a laboratory offers, the genes that are covered by that test, variants known to exist in these genes, variants that are learned over time, and the state of knowledge linking those variances to clinically relevant facts—so disease states, drug response, drug efficacy, etc. So we built this deep knowledge base and built a transaction system on top of it, and made a rule that you can’t report out test results unless you keep the knowledge base up-to-date and consistent with your test results. And that enables you to automate the generation of reports.

But as a result, we wound up with this continually-updated knowledge base, so based on that we created what would now be a SMART on FHIR app that plugs into the EHR [electronic health record] and provides clinicians with alerts if something new and potentially clinically relevant is learned about a variant previously identified in one of their patients. So it created this notion of a knowledge base alert being interjected into clinical care.

We studied this and found that clinicians liked it, but the rate at which this learned was dependent on the number of transactions that flow through the system, because that’s how geneticists would gather the data that would enable them to improve their assessment of variants. So we registered this as a medical device, distributed it outside of Partners, and networked the different instances together, so it could learn not just based on our volume, but other folks’ volume as well. Ultimately, we sold that to Sunquest [Information Systems]. The thing we feel was most important was creating this infrastructure that facilitated new clinical processes and captured, shared, and federated data in a way that enabled learning to care.

After having done that, we took a step back and said OK, what should we do next? The infrastructure we built was very specific to issues where genetics and genomics are the major components to deciding what to do for a patient. So we wanted to look at all of the things that made that infrastructure hard to do, and build a platform to make it easier to build things like GeneInsight [an IT platform company owned and developed by Partners], and then distribute that platform, so that in addition to building examples of a similar infrastructure, others can build those examples, too. We wanted that platform to make it easier to distribute apps that are created by different folks in different organizations, ultimately with the goal of networking those apps together.

We are at a unique point in time where you have these new data types coming online that can be helpful to the care delivery process, you have algorithmic-based medicine starting to come into use, both machine learning-based and not, and you have people looking at transformative ideas on how to alter clinical processes where in order to incorporate these new data types and incorporate algorithmic-based approaches to care, you need new kinds of IT support in order to enable these transitions to occur. And that creates an opportunity, not only related to the specific transitions, but also to start collecting data for specific clinical problems in a much finer-grained way that lays the groundwork for these networks that can build the data that’s required to underlie continuous learning processes.

All of this is happening in a time with incredible cost pressure in healthcare, which does constrain internal investment but also makes organizations far less resistant to change. The goal here is to fundamentally enable clinicals to evolve their practices, their care, new data, ideas, and techniques in ways they haven’t done in the past.

Sandy Aronson

And how are you working with Persistent Systems on this, specifically?

We are building this platform together. The platform is called HIP, or health innovation platform, and the platform itself will be open-source, and it sits on top of the current clinical IT ecosystem. You interface it to underlying systems, and then it handles things like some aspects of security, authentication, and HIPAA, but also access to data as well as incorporating shared algorithms.

The goal is having different places hook up the platform, and once it is hooked up, it should create a uniform surface on top of the platform so that apps built on top of the platform become more shareable and distributable. We are now focused on both building the platform and building certain apps. And the apps get interjected to the EHR as SMART on FHIR apps.

Can you give some examples and details of the apps that are being built?

One example is that we have been working with BWH’s cardiology [department] on this program that they have, where if you look at heart failure, which affects about 2 percent of the population and has a very high mortality rate with a great deal of costs associated with it, there are guidelines that have been shown to really be helpful, yet very few people are treated in a way that actually adheres to guidelines. And that’s because the process of getting them to guideline-based care involves this drug selection and titration process that requires a lot of interaction, some of which can make patients unconformable.

But as it turns out, you can instantiate a process where you use patient navigators to take patients through this drug selection and titration process, interacting with them far more frequently than a cardiologist would ever be able to, to get them to guidelines. It’s a data-intensive process. So we are providing support for that program through the HIP platform today and we are really focused on deepening that support.

What are your goals in the next 12 to 24 months regarding this partnership? What would you like to see happen?

The ideal world is that our group and Persistent Systems will continue to add more capabilities to the platform, and that the platform is reducing costs. So many clinicians have ideas on how to fundamentally improve care but they can’t put those ideas into use without these kinds of IT interventions.

One thing I hope is that this will continuously reduce the cost of building those interventions and as a result, our team, and others, too, will develop more of these apps. We hope to see some cross-institutional adoption of apps built here and elsewhere, that the sharing will begin at the app level and ideally, in two years or so, we will be having real conversations about how we can get the networking between apps really going.


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Cigna to Invest $250M in Venture Fund with Eyes on Healthcare Startups

September 17, 2018
by Rajiv Leventhal, Managing Editor
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Cigna, the Connecticut-based health services company, has announced the launch of Cigna Ventures, a corporate venture fund focused on investing in promising healthcare startups and growth-stage companies.

Cigna has specially committed $250 million of capital to Cigna Ventures to invest in transformative and innovative healthcare companies “that are unlocking new growth possibilities in healthcare and will bring improved care quality, affordability, choice, and greater simplicity to customers and clients,” officials said in a press release.

Cigna Ventures is particularly focused on companies across three strategic areas: insights and analytics; digital health and retail; and care delivery/management. Officials say the venture fund was created to help Cigna identify, assess and sponsor early-stage innovation ideas that warrant deeper exploration through focused pilot and test-and-learn activities with the goal of realizing meaningful business value.

“Cigna’s commitment to improving the health, well-being and sense of security of the people we serve is at the front and center of everything we do,” Tom Richards, senior vice president and global lead, strategy and business development at Cigna, said in a statement. “The venture fund will enable us to drive innovation beyond our existing core business operations, and incubate new ideas, opportunities and relationships that have the potential for long-term business growth and to help our customers.”

As an article in Bloomberg noted, “Health insurers have been starting venture-capital arms to find new ideas to improve their businesses and generate financial returns. UnitedHealth Group Inc., the biggest health insurer, said in November that its Optum unit was creating a venture arm with $250 million in funds. Humana Inc., Kaiser Permanente, and a group of Blue Cross and Blue Shield insurers all have venture units.”

According to officials, the venture fund builds on Cigna's existing venture activity, including collaboration with five venture capital partners and an equal number of existing direct investments. These include leading the C1 round of financing with Omada Health, investments in Prognos, Contessa Health, MDLIVE and Cricket Health.

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