How Digital Health is Making a Big Impact on Healthcare
Episode

Matthew Holt, Founder of The Health Care Blog, The Health 2.0 Conference, and President of SMACK.health

How Digital Health is Making a Big Impact on Healthcare

 

A lot is changing in healthcare, and it is for the better.

 

In this episode, our host dissects the current state of American healthcare with Matthew Holt, founder of the Health Care Blog, the Health 2.0 Conference, and president of SMACK.health. COVID was not a good thing to happen. Still, it exposed existing gaps in the American health system and was a catalyst for many changes that brought us closer to digital and equitable healthcare across the country. Matthew gives some insights based on his own experience. What he believes will inevitably happen in healthcare to help improve care for standard and underserved users, especially for patients with chronic and acute illnesses. 

The American healthcare industry has a big problem with users that hold off from using any services to avoid high costs, which counterintuitively, drives up costs and creates insurance issues that need to be addressed with hybrid approaches. Matthew talks about costs, social determinants of health, trust, and data privacy as factors to be considered to implement changes for better health outcomes.

 

Tune in to learn how work is getting done to make changes that will improve the system for many! 

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How Digital Health is Making a Big Impact on Healthcare

About Matthew Holt:

Matthew Holt is an old curmudgeon in the world of health technology. He is best known as the founder of The Health Care Blog (THCB) and the Health 2.0 conferences. He now splits his time between THCB, Catalyst @ Health 2.0, and the SMACK.health advisory service for health tech startups. During his career, he’s spent nearly 30 years in healthcare and healthcare IT as a generalist forecaster and strategist. He’s worked for renowned forecasting (IFTF) and polling (Harris) organizations, conducted several groundbreaking in-depth studies about many aspects of healthcare, and delivered several keynote addresses all over the world.

 

Starting in 2007, Health 2.0 was the leading conference series showcasing frontier technologies in health care. In April 2017 HIMSS bought the conference side of Health 2.0. Catalyst @ Health 2.0 was the other part of Health 2.0 and never went over to HIMSS. It runs challenges for organizations like Robert Wood Johnson Foundation, innovation programs for organizations like the World Bank, markets intelligence services, and it owns the SourceDB which has more health tech companies in it than you can imagine! The Health Care Blog has been a leading source of opinion, news, and interviews about health and health technology since 2003, with 100k visitors or so a month. It also features Matthew’s “Health Tech Deals” videos with Jessica DaMassa which runs down the latest in Digital Health funding, and the weekly #THCBGang live video/podcast where he wrangles a group of health care know-it-alls. The “Policies|Techies|VCs–What’s Next for Health Care” conference, which he runs with Jessica Damassa, was first held virtually in September 2021. It was a “who’s who” of the CEOs of new tech and services companies in health.

 

EHH_Matthew Holt: Audio automatically transcribed by Sonix

EHH_Matthew Holt: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Everyone Hates Healthcare Intro:
For many people today, healthcare feels like we’re behind enemy lines. The system is geared to take care of us, but why do we feel like we’re in it alone? Everyday stories are a powerful way to shine light on the gaps that make it feel this way. I’d like to welcome you to Everyone Hates Healthcare, where we bring you real people’s healthcare stories unfiltered. And now your host, Michael Swartz.

Michael Swartz:
Hey, everybody. Michael Schwartz here and I want to welcome you back to the show. Today, we have Matthew Holt, best known as the founder of The Health Care Blog and the Health 2.0 conferences. He now splits his time between The Health Care Blog, Catalyst @ Health 2.0, and SMACK.health, where he advises startups navigating the healthcare world. With nearly 30 years in healthcare and health tech as a generalist forecaster and strategist, Matthew has worked for world-renowned forecasting and polling organizations, conducted several groundbreaking in-depth studies about the many aspects of healthcare, and delivered several keynote addresses all over the world and now all over Zoom. Many, including myself, consider him one of the greats in the world of digital health. Matthew, I’d like to welcome you to the show. Very excited to be talking to you.

Matthew Holt:
Thank you, Michael, I like that. I didn’t know there was such a thing as a great in the world of digital health. I’m not sure I qualify, but I really appreciate you saying that.

Michael Swartz:
I mean, you’ve been in healthcare way before it was the hottest thing in town, before it was cool. Tell us a little bit about yourself. How did you get into healthcare?

Matthew Holt:
Well, so that’s a funny story, right? So I was typical English kid, went to college in the UK, came out, this is the eighties, because I am old, wandered around the city, the financial, the sort of Wall Street of London, was a complete abject failure, kept on getting fired from jobs, didn’t know what I was doing. And after a few years, I’d been on vacation, there was a woman involved too, San Francisco, it was a nice place, and then I realized, I’m getting nowhere fast doing this, I should find out some other way of going do something else. And I ended up in, ended up getting a Master’s and getting a position, getting a master’s degree at Stanford. In the middle of that, I mean, literally, I was studying Japanese international political economy, I wasn’t studying healthcare stuff at all, but by a random reason I did a term paper on the Japanese healthcare, basically just because nobody else was doing it, no one else was doing sort of international politics and stuff and Japanese car. And this was back in the eighties when the Japanese was, Japan was China. Japan was about to take over the world, not trying to take over the world, and we were all scared of it, right? So anyway, I did stuff with the Japanese healthcare system and then a guy showed up at Stanford, not even the next year, but the next term with some money to study Japanese healthcare. And so I was the only guy who knew anything about it, so I was appended to him and I spent a lot of time there, I extended my stay at Stanford by actually about, nearly by another two years, ended up doing a whole lot of work on American healthcare as part of this project, comparing Japanese and American healthcare, and then I ended up getting a degree in health services research. So I had no intentions of doing this when I went into Stanford, but it all locked out. And then I worked, mentioned those renowned forecasting organizations. I went to the Institute for the Future for five years, which was, and I, when I got there, I was supposed to be sort of the guy to help with their programs, which are looking at the future of healthcare for their customers, who are predominantly drug companies, health insurance companies, hospitals, medical device companies, those kinds of players. And they also, just random, they had a technology forecasting division, which never talked to the healthcare division. But somebody in the technology division had sold a project about healthcare to technology companies, and no one in the healthcare division or the technology division wanted to do it. And they looked at me, well, you’re the idiot who just walked in, you can do it. So I ended up getting involved in looking at technology in healthcare, and that’s back in 1993. And really, I kind of rode the wave of the first iteration of the web, you know, eHealth online and the dotcom boom, and then I sort of kept doing that, and I was in a startup at one point, and I was, and then, later on I was consulting to companies. And then I started the blog called the Health Care Blog, which was about sort of, it still is, it’s still going strong, which is about anything to do with healthcare, health to healthcare business, healthcare policy, experience of doctors. I always had a strong bent towards health technology, and in 2007, 2006, a local news buyer who was doing that, who’s a doctor who was at that stage doing sort of, she’d come out of the drug world and was doing sort of more analysis of new start-ups in healthcare and all the work I was doing on the blog, all the people there said, all the companies I was working with, especially the small startups, say no one else writes about us, no one else cares about it, it’s just you, Matthew. And so I said to him, you know, I have all these companies talking to me and they say, I should do a conference. She said, yes, we should do a conference. And that was basically our business plan and that was the Health 2.0 conference, and that went ten years. We sold it to HIMSS in 2017 and I was pretty successful with our conferences all over the world, and we had, for a long time, we were the place where new health tech companies sort of unveiled themselves. And while that was going on, you know, you mentioned, Michael, this was it a long time for this stuff to become you know, hot and sexy the way it is today. It went, there was a little bit of venture capital in the mid-2000s. It was a decent amount in the nineties and that went away a bit in the 2000s, and then kind of from 2011, ’12, ’13, it started getting more exciting. A couple of companies went public and we were basically following that whole trend. And I think the first conference there were 40 or 50 companies we had on stage out of probably 100 we could have had, and now there’s probably 8 to 10,000 health-type digital companies around, and many of them are huge, they raise huge amounts of money, there’s about 50 or so to the public, it’s a real thing now.

Michael Swartz:
It has just been crazy. And what have you seen with COVID? Have you seen any bump in the venture capital side of things?

Matthew Holt:
Yeah, so I mean, a couple of things happened in COVID. I did a study, so the bit that is called Catalyst to Health … you mentioned in my bio, that is the part of Health 2.0 we didn’t sell, which is like a research consulting program management company. I did a study, a survey of about 200 digital health companies, and ask them a whole bunch of questions about their experience with COVID. And the answer was a couple of things, one is that they all saw big bumps in usage and interest, right? Not a surprise because people couldn’t leave the house, and so they’re looking for more online solutions. And they also all saw much bigger rounds if they were already scaling. So if you’re starting a really early-stage digital health company, it doesn’t matter how sexy and trendy the area is, it’s tough, right? Any really early-stage startup, especially if it’s your first one and just getting going, it’s tough to raise that first round. I mean, I speak, I have lots of CEOs I talk with in that early stage and they’re still taking a long time and they’re still talking to dozens, if not hundreds of venture capitalists and angels, and so they’re already scrambling together to put together that first round. But if you’ve got going, right, if you have raised that first round, you’ve got the first 10, 15, 20 customers or the first few thousand users and you look like you’ve got something going, then there is a ton of money around. And since COVID, since we’ve seen the growth in telehealth and remote monitoring, since COVID, then there has been a ton of not, now when you’re seeing these huge rounds for companies that are scaling fast, where they’re raising 50, 100, 200, 300, some cases more than a million dollars, and seeing a couple of 500 million dollar raises. And that’s really the companies that have kind of got a business model and want to throw gas on the fire. So that’s the biggest difference, I think, is that there is now the emergence of these market leaders and there’s kind of a rush for land grab to become the dominant force and say, direct-to-consumer pharmacy or in telehealth or remote patient monitoring or in mental health or whatever, and raising a lot of money, hiring people, getting out to more clients, acquiring more business has become much more land grab and a sort of mad mad rush that it was sort of three or four years ago, pre-covid.

Michael Swartz:
Yeah, I mean, Covid’s been an interesting one because it just seems like more and more people just all of a sudden are comfortable with technology. And I always give a story of my father. For the longest time, he was not great with technology. He was actually awful with technology. The only thing he knew was like these travel pricing sites. He would always show me the newest and hottest like Good Deal app to get a good hotel, a good flight, but anything else, Uber, all these different things. Well, I wasn’t allowed at his house for about a year and a half, and about a couple of months ago, he finally, him and his wife allow me back into the house, and let me tell you, he had Alexas tied up all over the house. The fridge was controlled by the Alexa. It was, who? I didn’t know who this guy was. And I just see this happening, it’s not something that’s unique to him. Are you seeing that in healthcare? You see more people?

Matthew Holt:
I mean, the healthcare numbers are really quite staggering. So let me give you a story so about, oh, I want to say late 2018, early 2019, sometime around that, The Wall Street Journal had a conference on digital health, and I was in the audience and the conference in San Francisco, and the CEO of Teladoc, Jason Gorevic, was on stage and they had polled the audience. They’d polled the audience and this is the audience at a Wall Street Journal conference on digital health, this is not like random Americans, these are people who are presumably wealthier than average, smarter than average, younger than average who care about digital health. They asked the audience how many of them had ever had an online telehealth visit, and the number was like 33%. And I literally said, so at the end of Jason saying, I, question. … still upset, but Jason looked at me like, Oh God, it’s Matthew. And he went and I went, So, Jason, you know, we’re this incredibly turned-on attuned audience you’d think would care about this would be early adopters and the rest of it. Why is it 32%? Why are we so low? Why the hell is this taking so long? This stuff has been around for ten years now and he waffled his way through it. But in the end, right, covid came to save him and everybody else. So there are a lot of reasons why it was so, the prevalence was so low before, but the predominant reason was, culturally, people didn’t get their care that way, and more importantly, the deliverers of care didn’t deliver it that way. It was always like this weird thing, they had to check the box because the benefit consultants told them they had to have telehealth. But it wasn’t like the mainstream way people saw their doctor. So then you get COVID and you can’t see a doctor, and the only way you can do it is via some kind of telehealth platform. And then the ramp-up in the use of telehealth tools by doctors, and not necessarily in Teladoc in American world, but things like Doximity and Doxy.me, and even just Zoom and FaceTime, right? And even, the ramp-up in that was quick and it was driven by this incredible need because you couldn’t go and see them. So if you look at the data, it’s something like the use within a year was at about 80 to 100 times what it had been in the middle of 2020, had been in 2019. And even after people go back to normal, quote unquote, it’s still like it’s gone down by about half from the peak, but it’s still like 30 to 40 times what it was. So I think that the use of video visits is one thing, and then once you start doing that, once you start saying, okay, we can connect with our patients over synchronous video, then you start thinking about what are the other things we can do? How can we make this a better system for everybody? And then you start thinking about what can we monitor at home? Can we do asynchronous management? Can we do that? Give the patient self-management. And it’s very interesting, if you look at some data, so Crossover Health, which is one of these new-fangled sort of employer-based clinics run by a guy called Scott Shreeve, Crossover Health, they actually acquired a telehealth company from … Parkinson and they sort of now merged all together. And what they say in their data is that for certain things, mental health particularly, it’s not gone back, it’s just all gone virtual, no one wants to go and see a therapist in a clinic setting anymore. They’re just happy to do this at home, they don’t need, it’s just conversation, they don’t need to have any face-to-face. For really intense physical stuff like physical therapy, they find it hard to make that transition, and then for things like just general physician visits, it’s about half and half. What you think is you don’t need to have a physical exam all the time. But what we’re going to see and they’re starting to see is we’re going to see more and more tools enabling a physical exam to be done either at home or in kind of satellite clinics, and shopping malls, and stuff like that. You’re going to see people with all kinds of devices to poke, prod, touch and whatever the individual and more and more of care is going to be delivered by teams of people, you know, part human part robot in bunkers or in call centers, not in the traditional doctor’s office, because the tradicional doctor’s office and clinic and hospital is very inefficient place to deliver care. There’s a lot of travel involved from both sides, there’s a lot of logistics involved. And if you could make that work in a non, you get to people where they are, you’re going to have a, probably you’ll have a better experience, you’ll probably have better outcomes. So we’re in the middle of that. And I think your dad, with the move toward all his Alexas and fridge and stuff being wired is probably very typical. Most people have figured out that you can get closer to a better experience if you are prepared to use technology, and all kinds of people who said that they could only do stuff face to face so finally they don’t have to, right? So to, two areas I know well, that is the change, right? One is venture capital. You always used to say the venture capital say, well, I’m never going to invest in a company that’s more than an hour’s drive away from me so I can go and see them and see the board meeting. And yet over the last 18 months, you’ve seen incredible rounds raised in some cases by people who the venture capitalists have never met, it’s been done on Zoom. And a similar thing for conferences. I mean, I ran a physical conference and I just ran a virtual conference just to mass, my colleague and I who work on the show, Health in 2.0, we put together a conference called Policies, Taxes, VCs, what’s next for healthcare?, and we have 300 people who came to this conference. We had about 100 CEOs and venture capitalists and senior government officials all talking, and it was all done virtually. Some of it was live, some of it was pre-recorded, but, you know, it was a place where people could all get together and come around a sort of virtual fireplace and see a conference. And it’s very different than a face-to-face conference. I’m not sure I like it as much, but it’s certainly something that can be done. So I think that the, that transition, COVID, I’m not saying that it was a great thing that we had COVID, in fact, has been a bit of a disaster for the world that we had COVID, but it has been, not to mention millions of people across the world and all the issues that have come out from it. But it’s really showing people that you could give something, a big shunt, and move it ahead. And don’t forget, Michael, technology is often being given a big shunt by bad things, usually in wars, but pandemics, wars, other crises have moved people quickly towards, you know, using technologies that have been sitting around. And I think this is a big case of it.

Michael Swartz:
No question. It’s opened people’s eyes. So where do you think, based off of your experience, because most of the listeners and myself and you and pretty much everybody, like we’re all healthcare consumers, so let’s focus in on the healthcare consumer, the person who’s actually going and getting care? But where do you think the areas are that you think are going to be the most valuable for us, the everyday American, which also could potentially be winners on the investment side?

Matthew Holt:
You know, I think that probably four main groups of people who are going to find the experience change, right? So the first one is kind of the everyday American middle-class, upper-class consumer who’s been putting up with care from their local doctor’s office and our local health system, and they are going to find a plethora of new options coming to them, either via their employer, direct to consumer or whatever, to do various things that they didn’t have to deal with before. And some of these options are going to come from retail players like Walmart and CVS, some of them are going to come from new players online only like HIMSS and Ro and Lemonade. Others are going to come in the guise of these new mental health companies, but they’re going to be offered options to access care in a way that they didn’t really realize before, and there’s a lot of consumer funding behind that consumer pipeline. So I think that group is going to get a better experience because the current incumbents who in general … in general are big, fat, happy health systems who make their money off their inpatient care of very sick people, and have all these … buying all these feeder systems, these primary care feeder systems into them over the years and have really paid a lot of attention to the experience of those folks. You know, with their entry first, entry to primary care, as long as they can find the ones who they can do the cardiac, get into the cardiac cath lab for to give them a stent or give them a bypass surgery or whatever. They don’t care too much how those people got there, they’re just buying up that supply. They are going to have to realize that that business is usually isn’t good enough because someone like a … medical or an Oak Street health or whatever can give these folks, or a HIMSS or whomever right, can give these people a much better experience and they might lose them. So that’s number one. So that group, I think, is going to have a big, big change. And it’s actually a group of whether you like to call them navigators or not, folks like Accolade and Transparent and Grand Rounds who are going to help direct traffic for those people when they sign up out when they sign up at work through an employer. So that first group, their experience is going to change a lot. Second group whose going to change, I think is the underserved. This may take a little bit longer, but you finally start to see some people saying, how can we deliver care in a better way to people who are sort of the bottom of the totem pole in American healthcare? And so there are a couple of examples of venture-backed companies who are doing pretty well, who are really trying to change the game and how they deal with people on Medicaid and the uninsured. So what I would call it, City Block Health, eventually spin-out from Google, where they’ve raised now 600 million dollars and they’re building these really impressive clinic-based, but in the community-based, tools for basically finding people who have, who are either on Medicaid or uninsured and getting them much, much better continuity of care in primary care. There’s a company called Unite US, which is doing similar things by putting together a network of not just healthcare, but also social services agencies, housing agencies, addiction clinics, all kinds of different food banks and putting them on a network so that the people who use those agencies can get routed around more efficiently and people know what’s going on with them. So I would say that’s an interesting look at the secondary, there is people who have. The third area is people with some kind of chronic illness. You started to see this a bit before the pandemic, but I think this is going to really change over time. I think we’re going to move to a significant home alternate site, nursing home, place of work, place, wherever people are. And then I think we’ll see a significant move towards really comprehensive 24/7 monitoring and management of those people where they are. So you talk about your dad with his Alexa in every room doesn’t take much to say, okay, well, that’s, we had to wire up that house. And you know what? And to some extent, … your dad, sensors all over the place, in his bathroom, in his bed, and elsewhere to track how he’s doing. And this, I think as people age into place, there can be a lot of that. But also the same thing is true of people with chronic illness like diabetes and elsewhere. Right now, we’re just monitoring their blood glucose, but I think we’re going to go much further place. And I call this, I have a slide TedTalk about this, which I call the continuous clinic. But basically, instead of thinking about we’re going to see a patient when they come in once a month or once every two months or when they go into hospital, we’re really going to be on them 24/7 to continuous monitoring, continuous measurement, continuous messaging and continuous measure and continuous management of these individuals, and with the goal of keeping them out of the hospital, keeping them healthy and safe where they are. And included in that will be a lot of coaching. So we’re seeing early days of coaching. Folks like Livongo and Teladoc have been doing some coaching for people with diabetes. Folks like …, like companies like Noom have been doing it for people on diet. Others like Virtua and Vita are doing it as well. But to my mind, you’re going to have a extraordinary amount of like intensive management and interfacing with those people which will improve their lives a lot, but also should reduce healthcare costs because as you know, we’re spectacularly good in America ignoring something until it becomes a crisis, and then we throw all kinds of stuff at it, usually in the emergency room or in hospitals. And we’re, although I wouldn’t say that’s been, that that has been cured as a national trait, the ability now to use that technology and change things is true. And you’re now seeing a lot of money going into specific vertical companies dealing with different types of chronic diseases. I saw a couple of companies, one for epilepsy, one this morning for PCOS, which is a sort of a young woman’s hormonal disease where they basically putting together the entire stack of virtual and real-life care for those people around those conditions. Do they have to manage 24/7? And then if you think about there’s a ton of companies doing this in diabetes, people with back, people with musculoskeletal back pain and knee pain. Other companies are already doing this with heart failure. So I can, you can just see the move towards, let’s identify people who are expensive in the healthcare system and let’s throw resources around them in a way that can give them a better quality of life, by doing this at a 24/7 management. 25, 30 years ago, good buddy, Michael, John Madison was from Moser, just recently out of Kaiser Permanente, but a really smart doctor at Kaiser had him on a panel and he said, you know, the problem with this chronic care is we know what to do, we just don’t know how to do it. And that’s been the issue, right? We’ve known how to treat people with all these chronic illnesses and how you should get them to live healthier lives and have a better outcome. We just haven’t known how to do it at scale, and we’re now starting to get the technology in place to do it at scale. So that’s the third group, the chronic illness Group. And then the fourth group is people who actually need help much more intensively who have got an acute illness. And I think some of that is going to go into the home as well, but also where we’re spending a lot of, we’re starting to spend a lot of time and effort to understand which hospitals and which caregivers and which clinicians and which drugs, which procedures work best for them, and directing traffic to those higher quality areas. So this is kind of the goal of the navigator group that I mentioned earlier. They’re doing a lot of time and effort saying, okay, if I can get, if somebody needs to have this cancer surgery or they need to have this oncology treatment or they need to have this treatment for whatever chronic pain they’ve got, where is the best place to get them to? Because there’s a lot of very average medicine being delivered across the country, and if you could get people to the higher quality medicine, so much better. So I think that’s the fourth group that will have, will see changes form. None of this is going to be perfect. It’s not like tomorrow, I think it’s going to be great and wonderful, but we’re certainly starting to see people segment the population in such a way to say what are the needs of these people and how can we do it? And the good news about American healthcare is that we spend so much money, we waste so much money that if you can do it right the first time and improve people’s quality of life and improve their outcomes, you actually will save a bit of money. So there should be money in the system to pay for this new stuff.

Michael Swartz:
Now, just hearing you talk about it, first thing I think of with the, bringing the care and all the sensors in your house, how do you think you know, with everything, let’s take Facebook, for example. You know, Facebook hasn’t done itself any favors and it’s really shined a light on people wanting ownership of their data. Do you see any concern, do you see any roadblocks of people not wanting all this tracking? And like, how do we protect us, the consumer, that our data is just not out there flying around?

Matthew Holt:
Yeah, I agree. I think that there is a combination of things that are going to help here. So one is there’s a bunch of very activist patients who feel their data has been locked up by the current healthcare system and the law, 21st Century Cures Act is now firmly on their side, right? You can now, it is required that you or your agent be another doctor or whoever it is, can get access to your data. And they’re going to be, there’s a lot of technology and companies starting to be built around that. So I think one question is can I get access to the data that’s mine? Can I get control myself over that data? And the answer is going to be increasingly yes. The next question is, okay, so now I am concerned about someone misusing my data and I’m going to be giving them or giving somebody a lot more data via my, via the sensors in my house and the rest of it. Then people are waking up to that, and I think there is going to be a good deal of business in data security and real data opt-in and opt-out rather than just, you know, let’s give you 27 forms the first time you go to the doctor, you sign them all because you have to and you can’t read them. I think that we’re going to get sort of the management of people’s security data and privacy is in itself going to be a big deal. And the third thing is, I mean, I think we’re getting there, it’s a while. It’s taken a while. I think we get there, but the Facebook effect is people are aware this is an issue, right? If you just willingly hand over all access to your data to people, they can target you. I mean, in all honesty, Facebook targets you in a way that is, on the one hand, pretty inconsequential. Yeah, I’m getting, I mean, in fact, it kind of annoys the crap out of me. The other day I bought some wine for a client and I went on Facebook and like every second commercial was for wine. I said, well, I just bought the wine, so it’s a bit late now. Somehow they told me someone wants to buy wine, right? That doesn’t to me, doesn’t really matter. Obviously, for society, you know, Facebook and some of these algorithmic-based feeds have been targeting people and delivering their messages, which has caused some people say it’s an active crime scene. Unclear to say what bad actors, what other bad actors have been doing on those platforms. But there’s certainly a lot of misinformation, disinformation, etc. around elections and politics and also COVID and all that stuff. I think people are aware of that and I think the companies and organizations and businesses that are doing this sort of in-home management of the care are getting very wary about what they can and can’t do with the data. And I think the regulators are going to be much more on it than they were. So by definition, you are going to have people who are unwilling to do this, don’t want to have monitoring themselves in the house, and what have you, but I think that’s going to be a minority, and for anybody else there will be, I think, more guardianship looking over what’s going to happen than there has been in the past.

Michael Swartz:
Yeah, no, I think it’s trust. I mean, we tend to trust certain brands more than others. So I see really it’s the brands that are trusted that people are going to be comfortable. And I do have a guilty pleasure when it comes to Facebook and my data. I actually go on Instagram not to like people’s pictures, but to purchase things because it knows me better than anybody. Like I’m wearing shoes right now. Some … it had 300 dollars, striped it out, 86. It knew that it would be something I’d be interested in. I’m interested in good deals. So I think it’s this idea of if the brand can build the trust, the convenience and the value it creates can be, make it people much more comfortable with, here you go, giving you access.

Matthew Holt:
Yeah, I mean, I don’t disagree. So I think there is an exchange of value. You can get stuff out of Facebook, Instagram, where you couldn’t before. The fact that they know a bit more about you, sometimes it’s the wine example where they’ve got to be too late and it’s stupid and they’ll have to get smarter about that, and that’s the nicer, the shoes example. They know you’re looking for … shoes and when the deal comes up, they can get you to become a customer. But I think in terms of healthcare data, yeah, there are people on this interesting account, the Medical Quack on Twitter, like Barbara … Last name, but she’s a doctor who’s like completely opposed to the amount of algorithms and code that’s being used to drive traffic. And there’s a lot of people who, there’s a lot of issues with code driving people one way or the other and enforcing current issues maybe now or elsewhere. However, we know about it now in a way that we didn’t before and we’re wise to it, … to it. And we know that, you know, really significant things like civil wars in some countries and military coups, not to mention our 2016 election and the Brexit thing and what’s going with COVID can be driven by these algorithms and by false information. And I think people’s privacy and people’s personal information and how that gets used is something that’s much more top of mind and with the regulators as well. So brands is one thing, but also regulation in healthcare is a highly regulated industry is going to, to my mind, be a bigger deal in the, it’s already a big deal, is going to be a big deal in the future, and I think that will in some ways protect and enhance the good that can be done from this kind of … There’s going to be a lot of invasive monitoring going to be going on, but if it does you good and helps you, I think in general, most people will accept it.

Michael Swartz:
Well, yeah, I mean, it’s healthcare. Healthcare has been such a crazy beast for myself and just most Americans. Do you see anything from the consumer perspective that can help with the idea of like all of a sudden just getting this crazy bill? Like people are staying away from going to the doctor, going to get healthcare just because of the cost. You see stuff, VC companies, verticals that are coming in and helping make it affordable or understandable for the average consumer, just navigating managing healthcare.

Matthew Holt:
This continues to be a really big issue and it’s not going to get better anytime soon, but I see a number of companies that are trying to help, as you mentioned, do some navigation around this, help people understand what they actually owe, what their advocates are, etc., etc. So yeah, I think that is coming slowly. On the other hand, we need to figure out some way of dealing with this in the US, and maybe that’s the particularly American way because, you know, we don’t seem to want to go to the rational way of doing this in kind of single-payer US healthcare system. But we need to figure out some way that people who don’t have money on restriction from getting a care and the things that are still going on in terms of hospitals suing people for like $5,000 and docking their wages and that kind of stuff when those people don’t have any money, you know, that all that crazy shit has got to stop. There are some companies aiming in that area. There’s one called …, which is in that area that some others as well trying to help, some of these navigation companies are trying to help people understand where they should be going, what you’re doing, and what their bills mean. But yeah, the whole thing is still both administratively and bureaucratically messed up on the billing side, and it does need to be changed. I think we need a lot of federal changes in federal regulations and the how things work. But the actual problem that you mentioned, which is … people not going to the doctor because of cost. There are some companies now who are trying to figure that out. And I mentioned the people in the, for the uninsured of the Medicaid, there are a number of companies I mentioned …, there are a number of others who are trying to figure out what can I do to get an affordable or a free experience of these people that’s really going to help them.

Michael Swartz:
Now, do you see any value? So I’m actually, I have insurance. I have an HCA plan, I have virtual primary care, which is 29-15, and it gives me unlimited visits to a primary care, but I also have direct primary care. This whole idea of a single price that gives you a certain amount of services. Do you see any movement in how paying, how the finance is work of healthcare? Because I’ve actually, went to the doctor since being part of this direct primary care both in person and virtual, but do you see any movement in that front? Like is there a change that is happening or that’s needed on the way that insurance works?

Matthew Holt:
Oh, yes, I mean, we need a lot of changes to figure out how insurance works, and there are some new insurance companies, new plans, trying to figure out how they could adjust to that. But, I mean, you get crazy stuff in the current system. I mean, let me give you example some crazy stuff I’m going through right now. So my insurance comes to Blue Cross in Massachusetts because my wife works for a Boston-based company, even though I’m in California. And, so I went for my COVID vaccine and for my COVID test, and in both cases, I didn’t get a bill from the, I don’t even know who the provider was, and I got an EOB from Blue Cross, Massachusetts, and in both cases, they attached a check to it. So I’ve actually got checks, paying me for that. I assume that someone, they were supposed to pay this to the companies and that’s like the bizarrest example, right? I’m in the money, but yes, the other thing is true, I’m clearly, but the inverse to me is true, which is that my the reason I got these checks is because my kid fell off my shoulders in a swimming pool and he cracked his chin on my head and he had to go to the emergency room and got and get four stitches, and the cost of that wiped out my deductible. Now I’m lucky I can afford it, we had like you had an HSA account. But I mean, I was trying to get him to an urgent care center that actually, it was late in the day that all closed, purely because I knew the emergency room, which where we ended up going was just going to cost so much more money. You know, but the issue is we have, to my mind, kind of dicking around with that below the deductible amount, which is what most Americans spend. But the real cost of the system are the people who have chronic illness or really bad accumulate those who are not spending, you know, $1000, $2000, $3000, $4,000 a family a year, but are spending $20,000, $30,000, $40,000, $80,000, $100,000 per family per year, and that’s what we have to get a hold of for our pricing. So I think that direct primary care and the various other new flavors of primary care seems to have the ability and needs to be proven on the big scale, to spend more upfront on primary care and spend less and do a better job of managing people’s use, especially here in hospital care, down the road. If you look at the, either direct primary care guys who are charging concierge fees up front or the people who are doing going at risk in the primary care groups like Iora or Oak Street or others, they seem to be saving money down the road for that, payers and their patients. And I think that frankly, as far as I can tell by my back-of-the-envelope calculations, we could give everybody in America, we may not have the doctors to do it, but we get to give everybody in America access to the right primary care. And so long as they, for in the order of less than a trillion dollars, and as long as that had savings at the back end and reduce care and hospital care and surgery, which I think it probably would do, we’d be better off, and that would give everybody access to really good primary healthcare. So I think that’s the direction we should be heading in, and we’re not going to get there by my Fiat and everyone joining in VIP or one of those companies, but we may get there by a combination of Medicare Advantage and employers and others saying, you know, you’re going to have to go to one of these like you have Michael combo of virtual, or virtual or real direct primary care. And that’s, and we’re going to manage your primary care. We’re not just going to let you be abused by the system and be either be out of sorts or wander around it until you get to what it, wherever you get, which probably ends up being worse for your health and more expensive. So I think over time, we’re going to move in that direction. It’s just going to take a while because the system is currently not set up for that because there is not set up to give you really closely direct primary care. It’s comprehensive direct primary care, except up to give you seven-minute office visits and then shuffle you through to the highest cost provider if they can, if that’s where you’re going to go.

Michael Swartz:
Yeah, it’s interesting because you talk about how there’s cost savings on the back end. It’s, I think there’s two things just from what you say that is important that we target as a society. One is the cost of chronic conditions, but the other is we haven’t been able to see that we’re all about the present. We have such a short-term way of thinking in America. So I think how much of the costs where we stand today is driven by people just not staying healthy, not going to the doctor when they should, holding back, whether it’s because of cost. What are your thoughts on that piece, the cost as it relates like, have we just let it get so out of control that we are a much less healthy country? Or is it just the system has run amok?

Matthew Holt:
Well, it’s both, right? I mean, don’t forget, healthcare is fighting a potentially losing battle with a bunch of other stuff. So if you think about social determinants of health, which really comes down to things like housing, income, education, food, we know that we are on all those fronts fighting a losing battle, things are getting worse, more unequal, worse access, especially down people down at the bottom of the economic ladder are really struggling, all those, a lot of that shows up in the healthcare system. So one thing we ought to do is try and take care of that on a more global societal level. If you get somebody secure, housing is living on the street, they’re much less likely to be spending money in healthcare. If you get, if people get better education, we know people have better education are healthier, it’s a straight, it’s a causal relationship. If we could get people to eat healthier, get people access to healthy food rather than fast food, we know that would improve their life and their lifestyle and eventually work through into healthcare. So I think that stuff’s really big and important and we are making big changes in those areas. You know, they’re going through the first grinding elements of societal change, but agriculture and housing are going to look very different in the future. We’ve seen that change happen in society right now with energy and transportation, right? That shift towards renewable electric power, I mean, that’s gonna be a big change for the next 10, 15, 20 years. So I think those changes are coming, but in terms of saving healthcare dollars in the next couple of years by everyone eating healthier, that’s not how it’s going to work. The reason we spend too much money on healthcare is because of poor diagnosis and poor treatment and by low-quality effective providers. We need to be much clearer about doing the right thing to the patient the first time and that, there is, there are things patients can do to help in that, but a lot of that is getting better information, helping them getting involved in their care. So that’s especially for the expensive stuff, right? Get you, get the best cancer diagnosis, get the right drug, you’re more likely to live, you’re more likely to cost a lot less money than if I have a more effective, and you go through six rounds of chemo or whatever happens to be before you die. So that’s the area where we need the most attention. But the second most and you mentioned this is kind of the people who are on the edge, right? People who are on the edge of chronic illness or on the edge of chronic illness need a lot more help around things like nutrition and elsewhere, and some of this raise the cost, right? We have to make some of these programs free and easy for them compared to expecting them to pay for it and then be putting it off. But also, as you talked about prevention, you need to concentrate the preventive firepower, the support and the help, and the coaching on people who are close to tipping into those expensive categories, close to tipping into poor health. And I think we can do a lot more there in aggressive targeting of people who are, you know, have pre-diabetes or have diabetes and don’t you know, but and don’t quite know how to manage it, but need to be taught how to manage it and a lot of care in that area. So I think that’s what we’re going to head and I think we’ll see a lot more care in different places, including in the home and at work and elsewhere for those kinds of individuals.

Michael Swartz:
So you hit on a point about the everyday American being a better healthcare consumer, making sure that they’re navigating, going to the right doctor. What would you, if you were giving advice to somebody who is just confused like they have to go to a certain doc, like what do people do? Like, what is your advice to whether it’s finding a tool they can use? Like, I’m Michael and I’m an everyday American and I’m confused on how to do something. What would your advice be to me?

Matthew Holt:
Well, we’re not quite there yet, but we do need to have a system of sort of trusted health advisors. Much is the way we’re kind of getting there with a financial advisor. So if you were worried about your retirement, you know, it’s good advice now to say talk to an independent financial professional who is fee-based, who isn’t selling you products that they make money out of it. We want to try and generate that group of people to go and talk to. And there are people who advertise themselves, companies over a thousand as being those folks. And there are now a new generation that is in the financial market, like Wealthfront and Personal Capital, those who are basically managing who are playing that role, right? Whereas in the old days, you know, you talk to a financial advisor, they were selling you the stuff that they were selling the most expensive mutual funds because they were making more money out of it. So we’re still in that sort of phase in healthcare. But you’re seeing the emergence of these direct primary care doctors on some of these online medical groups, especially the ones who are at risk, some of these navigators, patient advocate navigators types, there’s a number of those. I think I would be looking out for those people, those types of organizations. The other thing, especially if I had some kind of illness, specialized illness, is that there is a ton now of access to other family losses on Facebook, but that’s a separate problem to other people who have the same conditions. And there’s a ton of information that patients are sharing amongst themselves. And this has been going on for a while, right? So patients like me and inspire companies like that comes up in my health teams. They’ve been providing these kinds of online forums for more than a decade now, and you can find out a lot about who is good, who’s bad, what works, what doesn’t work. Who are the specialists in this area who really understand it? Especially if you have one of these debilitating and expensive chronic illnesses. So I think those are part of the two areas to hope for, is like what can other patients tell you and what can these more neutral advocates as they expand on the scene come and help you with. But I think in the end it’s like, can you find a primary care doc that you trust who is not connected to a big healthcare system, you don’t think it’s just trying to pass you along, who can spend time with you, and can get to know you holistically? And maybe that comes with in conjunction with a chronic care management organization, or maybe it comes as a part of a bigger primary care group, but that’s kind of where I think I would be going.

Michael Swartz:
That’s interesting. Your comparison to financial advisors and the digital tools in finance, very confusing industry for a lot of people. Finances are tough thing to understand. And you have this whole slew of companies that have really look to make things easier, simpler. Do you see healthcare heading in that direction? Do, and if you do, where do you think we are on making it to where we have the credit Karmas, the Wealthfronts, the Robin Hoods?

Matthew Holt:
Yeah, I’m not sure I put Robin Hood as being somebody who’s on the other side as their consumer, but certainly, you know, if you think about the less, there are companies now on the financial services side, you mentioned Nerdwallet and Wealthfront and some others who are definitely saying we are putting what your grandfather always told you about managing money carefully. We are putting that into action for you in a way that you know, in a way that we’re on your side and we’re making a fee off that, you know. And I think that you can argue that a lot of people are starting to do that in healthcare in various areas. And I like all the most of the medical groups who are in the sort of capitated that risk area whose goal it is to sort of keep, you know, I mentioned crossover and I, or an Oak Street and chairman and those guys, there are many more you know they have the philosophy that their goal and to some extent Kaiser Permanente whether it’s got all the baggage with it, their goal is to keep you healthy for as long as possible and make sure that crazy stuff doesn’t happen to you, but that your conditions and diseases are managed well. And I think that that plus some of the growth of the navigators who improve customer service and get you to quality care quicker. I mean, there’s a lot coming down the street which is good for consumers, good for patients in that area. We know the answer to your question, are we close to being done yet? I mean, no, but then again, financial services isn’t being done. There are still people who are you know, we still have, Wells Fargo was doing opening bank accounts in people’s names. And you have bad actors everywhere and you going to have bad actors in healthcare, but at least we can stop pointing out the Facebook issue around data privacy and targeting. You can point out, people will tell you we can start waving the flag of things that are going wrong and start encouraging people to do the things, the things that are right.

Michael Swartz:
So this is my last question. You being in healthcare since years and years, seeing the evolution from health 1.0 to health 2.0, where do you see healthcare, let’s say fast forward ten years or even seven years? Where do you see, what do you see the healthcare experience for the everyday consumer, for the patient? Where do you see it going?

Matthew Holt:
So I think, you know, I think I’m worried that we’re not going to really fix the insurance issue for, there’s a lot of politics. For the folks at the bottom, and that we won’t have as fast a spread of improving Medicaid and care for the uninsured as I think we ought to have. So I’m worried about that because a lot of that is kind of politics, and pretty American politics has been very, very tricky. But it doesn’t look to me like that we’ve got, if you’re looking for the kind of green New Deal of healthcare, we have the government in place that’s as close to it as we’re going to get structurally for the next five, six, seven, ten years, and we’re nowhere close to doing that. They can’t even agree on the infrastructure bill, which would be advantageous to most Americans, and there are a couple of Democrat holdouts, Democratic holdouts, for reasons that have to do with money and politics and all that stuff. So we’re clearly not getting to where we need to go in that area immediately. But for the majority of Americans who have employer-based care or get care for Medicare Advantage, Medicare or Medicare Advantage, I actually think that we’re going to start to see some of the cream rising to the top of some of these companies. As I said, there’s been a massive amount of venture funding coming into all these different, I mean, we’re talking about $20 Billion so far this year, putting 30 billion this year in venture funding for companies to scale up to provide many of these services we talked about. We’re doing much better with data analytics and data interoperability and data analytics about what works and what doesn’t work. And there’s about a quarter of a trillion dollars sitting on the balance sheets of the major healthcare systems. Many of them are going to use that money to shore themselves up and keep doing what they’re doing, but enough of them, they’re going to stick their nose in the air and sniff which way the wind is blowing and stuff, figuring out how do we change so that we don’t get left behind with these new guys. So think about Mayo, Jefferson Clinic, Jefferson and Philadelphia, a number of others who have explicitly said, we’re going to try and compete with these new guys and we’re going to look at doing this continuous sort of continuous clinic type approach that I mentioned. So my sense is that for seven, ten, seven, ten years out, the healthcare experience and the healthcare quality that most Americans will get will be a lot better than it was. We’ll see a lot more movement towards improvement in the experience, if you like, the branding, the experience, the understanding, the education, and also the actual care quality that gets delivered than we saw the previous 20 years, because we’ve really been putting in place all the building blocks to able to do this. And now I think we’re going to see people actually go and do it. And it wouldn’t surprise me if we get either a large consumer company we know already, whether it’s an Amazon, Walmart, CVS, whomever, or a series of brand new companies coming on board who actually end up delivering the kind of consumer experience that we’ve seen in other industries that this improves other industries. So I think of, I know back in the eighties and nineties, some of the eighties, you bought a car, it was a crapshoot, cars are pretty bad. Over time, the cars improved and improved and improved and now they’re improving again with the transition to electric, right? Whereby you didn’t buy lemons and cars were getting better value and the price didn’t go up too much, but the value of quality continue to consistently improve. That became safer and faster and all those more features, all that kind of good stuff. I think you’ve seen that certainly obviously in the telecommunications computer business, we’re all doing this stuff on Zoom now and using tools that are cheap, that didn’t exist 20 years ago. And I think that it will be a slow evolution, but in the next ten years, that will become much more the norm in healthcare. And people who have good healthcare, bad healthcare experiences won’t have to put up with them. They can go to any number of competitors who will deliver them better healthcare experiences, and they will. So that’s my hope for the next decade. I hope so because a decade’s time I’ll be pushing 70 and I already started to have a user of this stuff and I want it to be better than it is now.

Michael Swartz:
That’s something that I would look forward to. The consumer experience, I mean, it’s been so, so awful, it hasn’t been, it hasn’t had the consumer in mind. So I hope your vision for ten years from now, what healthcare is like rooting for it?

Matthew Holt:
I hope so. I think you have a few more years to go before you’re pushing 70, Michael.

Michael Swartz:
Yeah, no.

Matthew Holt:
It happens to all of us eventually, hopefully. As my old boss used to say to me, you know, … Medicare and Medicaid, it’s not many of us want to become Medicaid patients, but eventually you probably all want to go on to Medicare. Sorry.

Michael Swartz:
Yeah, well, so where can the listeners find you? Where can they follow you? Where can they get your insights?

Matthew Holt:
So I’m pretty easy to find. I’m on Twitter @boltyboy. B O L T Y B O Y. If you go to the Health Care Blog, that’s theHealthCareBlog, one word. Well, healthcare is two words, but in this case, thehealthcareblog is one-word, thehealthcareblog.com, that’s my blog. There’s a lot of people out of that. I have a fairly frequent show on that about twice a week … called Health in 2.0 where we discuss sort of the startup scene. We have a conference, just finished, but you can still take a look at that sort of whatsnexthealthcare.com. So I’m, and then you can Google Matthew on Healthcare you’ll find a lot of random stuff about me there.

Michael Swartz:
Well, thank you for coming on, Matthew. Is there anything you want to leave the listeners with before we sign off?

Matthew Holt:
You know, I think the only thing is to say is that this is still a business in which it’s very hard for somebody new, interesting players to sort of get their heads above the parapet, so it’s known. So if you’re listening to this and you’re interested as a consumer or as a consumer, as a caregiver for relatives or parents or whatever, it does, you go to do a little bit of Googling around, but there are a lot of people on Twitter and on the Internet who are willing to help, who know a lot about this stuff, about this new world of healthcare. And there’s a guy called Sachin Jain, who’s Body-mind these days, the CEO of Scan Health Plan in Southern California. He’s always complaining that we have an innovation layer and an operational layer in healthcare, and the two of them never meet. And it’s my goal, you know, if you’re about to hit the operational layer or as a consumer or a patient, try and find something with the innovation layer who can tell you where to go and who’s doing a better job in operating. That’s what I suggest, is look around a bit, there are people who definitely can and will help, and that’s where you should go first. And look, there’s a lot of things you can do that aren’t great in healthcare, but a lot of people are willing to help.

Michael Swartz:
Love it. And I know the perfect person to reach out on Twitter. So, Matthew, thank you so much for coming, really appreciate it.

Matthew Holt:
Thanks, Mike. It was great fun chatting about it with you.

Michael Swartz:
Thanks, everybody, for listening. See you next week.

Michael Swartz:
Hey listeners, thanks for tuning in to another episode of Everyone Hates Healthcare. If you have a healthcare story, we want to hear it. All you got to do is shoot me an email with My Healthcare Story in the subject line to MyStory@HealthKarma.org. Also, check out all the episode notes, resources, and more ways you can take control of your healthcare. All you got to do is just visit HealthKarma.org/Podcast. While you’re on there, help us out, don’t forget to drop us a rating, a review, and share it with all your family and friends. Can’t wait to see you next week.

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Things You’ll Learn:

  • After the pandemic people are more likely to use and adopt digital tools for their health. 
  • Many technologies and companies are being created around the 21st Century Cure Act, allowing easy access to your health data.
  • People with chronic or acute illnesses are spending between $20,000 to $100,000 per family per year, indicating a problem in costs and insurance.
  • Many of the costs of healthcare are driven by people not staying healthy because they put off their visits or avoid going to the doctor when they should.
  • Healthcare needs to make health advisors more readily available for its users.

Resources:

  • Connect with and follow Matthew Holt on LinkedIn and Twitter.
  • Explore the Policies|Techies|VCs-What’s Next for Health Care Website!
  • Visit the Health Care Blog Website!
  • Follow the Health Care Blog on LinkedIn.
  • Remember to send us your Healthcare Story to mystory@HealthKarma.org with the subject line: “My Healthcare Story”