StartUPDATES: New developments from healthcare startups


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HealCo’s Health System Without Walls (HSWOW) is healthcare’s tele-hybrid solution. Simply put, we’ve merged traditional brick-and-mortar office visits with telemedicine. Here’s how it works:

  • Telemedicine solves many problems in outpatient care, but there are still visits that require physically going to an office.
  • HSWOW tele-hybrid medical offices host licensed providers who supervise all visits remotely, via video call.
  • The brick-and-mortar office is managed by clinical assistants operating at the top of their license

Click this link to fill out a short survey to get involved. Find out more about HealCo at

Eikonoklastes, a preclinical biopharmaceutical company developing next-generation tissue factor immunotherapies for triple-negative breast cancer, has closed an oversubscribed seed funding round.  Working with The Ohio State University Corporate Engagement Office and seed investor CincyTech, the company was formed to advance technology discovered and engineered in the lab of Dr. Zhiwei Hu, MD, PhD, and licensed from the Ohio State Innovation Foundation. CincyTech led the financing. To read more, click here.

Encoded Therapeutics, a precision gene therapy company, has raised $135 million in an oversubscribed Series D financing. The company’s lead asset, ETX101, was granted Orphan Drug Designation (ODD) and Rare Pediatric Disease Designation by the U.S. Food and Drug Administration (FDA) for the treatment of SCN1A+ Dravet Syndrome. GV led the funding round  with participation from Matrix Capital Management, ARCH Venture Partners, Illumina Ventures, RTW Investments, Boxer Capital, Nolan Capital, HBM Genomics, Menlo Ventures, Meritech Capital, Farallon Capital Management, SoftBank Vision Fund 2, and additional unnamed investors. To read more, click here.

Health insurance tech startup Sidecar Health raised $20 million in its most recent funding round. Cathay Innovation led the round, which also included new investors Comcast Ventures, Kauffman Fellows and Anne Wojcicki, co-founder and CEO of 23andMe. Returning investors GreatPoint Ventures and Morpheus Ventures also took part in the round. To read more, click here.

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How four healthcare executives are planning for the future of digital health


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Before the pandemic, many health systems had started to devote more resources to digital health. In the last year alone, Mayo Clinic and Kaiser Permanente hired their first ever chief digital officers.

Since the first Covid-19 cases were reported in the U.S., that role has undoubtedly changed. Technology became an integral part of many health systems’ response to the pandemic – and served as a lifeline to continue to see patients.

At MedCity INVEST, four healthcare executives shared how they responded to Covid-19, and what they see as the future of digital health.

The panelists included:

  • Prat Vemana, Kaiser Permanente’s first chief digital officer
  • Roberta Schwartz, Houston Methodist’s chief innovation officer
  • Eric Spaulding, director of digital customer experience at Highmark Health
  • Aaron Martin, chief digital and innovation officer for Providence St. Joseph Health and managing general partner of Providence Ventures

Innovaccer’s CTO Mike Sutten and MedCity News Editor-In-Chief Arundhati Parmar moderated the panel. Here are some highlights from the discussion:  


Q: What were some of your learnings from your response to the pandemic?

Vemana: Both how consumers adapted to telehealth and virtual care accelerated quite a bit. Earlier, we used to promote telehealth, it was an initiative. Now, it’s here. But the other side is also important from a care team perspective — how they were able to embrace it and adapt.

… The second piece I would say Covid-19 has accelerated is collaboration among different parties. Every conversation required a steering committee and a discussion and whatnot. When I think about what Covid-19 has done, people are learning more toward speed and execution and the ability to have progress over perfection.

Schwartz: I remember in the room we gathered all of our folks who were involved in the Center for Innovation, as well as our IT partners. I just put it out on the table and said, “Tell us every technology that we have that can be turned toward Covid.”

What we realized was all of the ingredients we had sitting out there could pivot just a little bit to help us with the crisis that we had.

… I think what all of us didn’t realize was how quickly adoption could happen. How quickly you could go from 5% to 80% (of visits) on telemedicine. The question that all of us have is when that dust settles, what is the level that’s here to stay for good? What has fundamentally shifted in a period of eight weeks?

Q:   Aaron, (Providence) already had a pretty strong digital presence, so what’s next?

Martin: A few things. One is, I don’t things can stick or accelerate without health systems moving to risk. … We’re on track to do probably 5 million virtual visits this year. That’s a massive number. The problem is, it’s still loaded with friction for both the patient and the provider. So that’s one block of work we’ve got to do.

… We did some math and we said these providers are going to have to do anywhere between three or four video visits an hour to just maintain their income on a fee-for-service RPU basis. And that is just inhuman. We should not have primary care physicians doing fee-for-service work and we’ve got to get to capitation very quickly.

I think that’s actually the core issue. You’ll see us be very aggressive in that space. And also in taking all of the friction out of the process for online scheduling and virtual visits.


Q: What are your thoughts on how to deal with patient privacy at this time when there’s so much collaboration happening?

Spaulding: A lot of it from the customer side is making sure we’re incredibly explicit in what they’re signing up for, whether it’s a bot, making sure every single point of digital interaction they know how to revoke consent, that’s a huge part of it.

The other thing is really working and partnering with our legal and privacy team to look at legislation that’s coming out… being able to do the due diligence to say when do we reasonably expect that this is something that will affect us, and let’s get started now.

Sutten: I think there’s was lot of talk about how the regulation on interoperability will kind of open security (breaches), but in fact, it reduces them. The move to APIs is inherently more secure than batch ASCII files, rarely which even have password protection on them. I think the cloud is inherently more secure, if you think about the amount of people — whether it’s Microsoft, Google or Amazon — that are protecting the perimeter and protecting the services within it.

By the way, we’re now asking members and patients if they would like their data shared, and we’ve never gone to that level before.

These interviews have been edited for content and clarity.

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Telehealth: creating a safe and convenient future of healthcare


In the early 1990s, we heard claims of the World Wide Web changing the future of communication. The internet was a novelty, newly introduced to the world, and just as with any other innovation, people were a little apprehensive. I don’t suppose we can point to a particular event or time in the past three decades when the internet became an integral part of the way we communicate with each other. Today, it’s as easy as pressing a button on your phone because that is all it takes! It’s one tap to FaceTime, or to jump on Zoom for meetings, or to catch up on the events of the world.

For telehealth, the adoption curve is a bit clearer. In a little over six months, life as we know it has been turned upside down. Since the outbreak of Covid-19, many things have changed, including telehealth’s position in healthcare delivery. People are working from home, travel has been restricted, schools and public events have been halted. With over 125,oo0 deaths in the United States and the continued need for testing and personal protective equipment (PPEs), the fear of contracting Covid-19 is understandable.

Amid these events, healthcare has seen a rise in telehealth. The public appetite for healthcare options that offer a safe and convenient method of seeking care has increased and telehealth has been an obvious vehicle. Whether healthcare organizations are ready or not, the era of virtual care has arrived, with telehealth spearheading the change.

Telehealth on the rise
Given how the rapid spread of the Coronavirus is impacting the traditional methods of healthcare delivery, telehealth is now being used much more widely to screen and diagnose patients without risking exposure to the virus. A 2019 survey conducted by M3 Global Research demonstrated that the adoption of telehealth had increased more three-fold: 22 percent of respondents conducted video sessions with patients, up from 5 percent in 2015. Among those who used it, 93 percent agreed that telehealth improved patients’ access to care.

The requirement for social distancing measures is impacting the way hospitals and medical practices manage incoming patients. Even providers who previously did not offer any telehealth services are now gearing up to implement the technology in some form, a move that has been supported by the Centers for Medicare and Medicaid Services (CMS).

The challenges in telehealth and virtual care
Until recently, the key challenges in the widespread adoption of telehealth were geographic limitations and the originating site of care. CMS had restricted Medicare reimbursement to telehealth services that met one of the following three criteria:

  • A site located in designated rural health professional shortage area
  • The program is part of a federal telemedicine project
  • The patient receiving treatment was located in an approved facility such as a provider’s office or a hospital.

The declaration of COVID-19 has led CMS to use waivers to remove these obstacles, at least for now. However, telehealth has other challenges in its way.

A majority of people still lack access to the basic infrastructure that could facilitate a virtual visit. 72 percent of respondents in a survey by the Primary Care Collaborative reported that they have some patients that do not have capabilities for virtual visits and non-stable chronic visits, well-child visits, and developmental assessments are considered least suitable for both phone and video visits. Even on the provider’s side, the technical aspects could be the sticking point for many. Some providers have not invested in the infrastructure that could enable virtual visits is now an added challenge.

Additionally, reimbursement of these services has been a significant challenge. As of 2019, 41 states and D.C. had laws governing reimbursement to telehealth visits in fully-insured private plans, but the laws enacted by states vary. Payment parity, meaning telehealth services covered by private plans have to be reimbursed at the same rate as in-person services, has long been considered a linchpin to nationwide telehealth adoption. The sweeping regulatory changes by CMS declare that providers can bill for telehealth visits at the same rate as in-person visits, which is something to look forward to.

Third, and arguably the most important is the change in the provider-patient relationship in virtual visits. According to a Sykes report on Americans’ perceptions of telehealth during COVID-19, 23 percent of respondents feel uncomfortable speaking with an unfamiliar healthcare provider which presents an opportunity for physicians who chose to adopt telehealth technology to further engage existing patients. For those telehealth providers that primarily handle one-time urgent issues, it’s critical that telehealth providers take the time to plan out their patient’s care journey, and understand their situation to engage with them in a meaningful way.

The road ahead: putting telehealth into action
Hospitals and healthcare systems with a patient-centered approach to care need an effective strategy to communicate with their patients. They have begun to leverage healthcare data platforms that can support secure and real-time virtual visits to reach more patients, triage them quickly and to improve care coordination. Additionally, virtual visits have the potential of saving up valuable and scarce resources during the pandemic. Ramping up telehealth adoption in a planned manner can make a significant contribution to screening, testing and treatment efforts against coronavirus. Even for patients that have medical conditions unrelated to Covid-19, virtual care makes it possible to deliver care remotely, without bringing the risk of virus exposure on either side into the equation.

These are, without a doubt, challenging times for us. Telehealth is far from perfect in the current world and many of the adjustments are temporary. But the reign of Coronavirus will end one day, and just like the internet, telehealth will remain predominant in U.S. healthcare.

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The Healthcare Holy Grail: A health plan’s guide to succeeding with their value-based care strategy



There is broad consensus across the healthcare industry that value-based care (VBC) is a positive step towards achieving the “triple aim” of healthcare: better healthcare experiences and improved health outcomes at lower costs. However, as health plans move towards quality over quantity-based reimbursement models, they are under immense pressure to ingest and operationalize new datasets to properly inform and pay the providers that have transitioned to VBC contractual arrangements. If health plans do not better align their data management, payment management and reporting execution capabilities to enable their VBC contractual arrangements, they run the risk of antagonizing or even losing providers – which will torpedo even the best strategy.

To avoid this outcome, health plans need to retool their VBC execution capabilities to ensure swift provider buy-in and include sustainable access to valuable and actionable data. This lofty goal goes well beyond the triple aim to what I’m now calling the quest for the “healthcare holy grail.”

I’ve noticed three common challenges in implementing VBC contractual arrangements from my conversations with health plans. First, many health plans are taking a reactive approach rather than proactive. For example, as part of a VBC initiative, providers are often promised that they will receive bonus payments at the end of the year. Unfortunately, health plans struggle to analyze the data quickly enough to provide bonuses in a timely manner. Health plans need real-time transaction data to be able to effectively analyze a provider’s adherence to VBC contracts, allow them to “course correct” before they miss quality or financial targets and compensate them accordingly and quickly.

Second, health plans are challenged to offer variations to VBC contracts that are personalized for each provider network and, in many cases individual providers. For example, providers that have different geographic reaches or different measurement strategies require unique contracts. To address this variation, some health plans have built “super spreadsheets” to track hundreds of different contracts. But the reality is these spreadsheets are incredibly complex, time-intensive, resource-consumptive and prone to errors. Simple data inconsistencies can alter entire data sets. This operational model can quickly become unwieldy. Health plans need a more efficient way to track and scale contract variation.  Similarly, plans that have built custom solutions often find themselves boxed into an inflexible model that does not allow the plan to adapt to market trends and state value-based mandates.

Third, health plans that are operationalizing these value-based contracts struggle to make the transition away from the long-embraced fee-for-service model transparent to their providers. Often times, providers who have switched to a fee-for-value model do not know how they are progressing towards their contractual goals and ultimately, bonus payments until the end of year or, at best, months later.

This is too late to course-correct and can cause provider abrasion and frustration. Whether it’s a federal Medicare VBC program, a contract signed with a commercial health plan or an experimental VBC program being driven by a state Medicaid agency, the delay in receiving the required transparency and visibility into a provider’s transition and progress is a challenge. In fact, providers performing services under Medicaid VBC contracts with Managed Care Organizations (MCOs) have complained and appealed directly to the state. The major complaint is regarding the lack of visibility into how they are progressing in their contracts and when, and if, they will receive payments from MCOs.

To address these challenges, health plans can benefit from this roadmap to reach the healthcare holy grail:

  • User Experience: Choose a solution that allows all the required health plan business units and providers to collaborate and experiment as a team on VBC contract development.
  • Solution Velocity: Ensure the solution will scale and provide the rapid deployment and support of contract variation demanded by each provider’s unique characteristics.
  • Process and Data Transparency: Empower providers with the required data transparency needed for success from contract inception through contract

Health plans have already begun their triple aim journey down the path of VBC, but often they are building this initiative on an infrastructure that lacks the needed scale, transparency and efficiency. To reach the healthcare holy grail, health plans must choose solutions that can streamline their data processes and execution capabilities, so providers are efficiently equipped with both the right data to be successful contractually and financially, and most importantly, to ensure patients are receiving the highest quality of care at the right time.

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CVS head of specialty pharmacy sees future of healthcare at home after Covid-19


Mail-order prescriptions are nothing new, but pharmacists have turned to a number of other tools to help patients access their prescriptions during the Covid-19 pandemic.  The head of CVS Health’s specialty pharmacy strategy, Prem Shah, said he expects to see more patients continue receive healthcare at home after the pandemic ends.

Though CVS Health had been building up its arsenal of digital tools before the Covid-19 pandemic, stay-at-home orders forced the pharmacy giant to lean more on them. The company has seen a surge in the use of its support services since the beginning of March.

“We started our journey in the digital space in specialty 5 or 6 years ago,” said Shah, who is executive vice president of specialty and product innovation for CVS Health. “The pandemic has allowed us to really test our capabilities virtually, across the board for the PBM. We quickly realized virtual healthcare and support services were going to be critical with social distancing rules in place.”

For example, the company began offering secure text messaging with a nurse or a pharmacist. CVS Health saw a 30% increase in encounter volume, with some patients asking for help with managing their specialty medication, while others needed help finding supplies beyond the medication itself.

CVS Health also saw an uptick in calls to Accordant nurses, which are trained to help patients with rare conditions. More than a third of the calls were for questions about Covid-19.

Shah said CVS Health had also been working with health plans to help them identify which members face the highest risk from Covid-19, so they could reach out to them and make sure they understood everything that is available to them under their plan.

Looking to the future after the Covid-19 pandemic, Shah expects to see a bigger shakeup in traditional care settings.

“If you were to ask me even three months ago, we would say we have many fragmented sites in which we provide these services,” he said. “One of the things I think you’ll see stick in healthcare… how people think about their healthcare workforce is going to be a little more nimble. You’re not requiring someone to go into a specific setting.”

For example, hospitals have typically been a hub for cancer care. But with the pandemic, CVS Health helped patients that were receiving infusions in a hospital setting transition to in-home care.

“Over time, I think you’ll see care move to patients’ homes,” Shah said.

Telehealth has been another big part of the push to care for patients remotely. But there’s still plenty of room to build on these services.

“The real question with telehealth and these other things has to be how do we improve the quality of care?” Shah said. “The industry needs to push hard, but I do think there’s a better care model.”

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Founder of Microsoft Healthcare comes up with plan to reduce hidden insurance costs


With millions of dollars for health plans tied up in hidden fees and negotiations, Microsoft Healthcare founder Dave Chase sought to tamp down on growing healthcare costs.

He started Health Rosetta with the goal of improving transparency among insurance brokers and help employers keep healthcare costs in check. The company claims it can reduce employers’ healthcare costs by 20% to 50%.

So far, Health Rosetta has already delivered on that promise for some of its clients. The company said it helped Pacific Steel & Recycling reduce its spending from $8 million to about $3.5 million. It also helped Ohio-based Great Lakes Auto cut its healthcare costs by $1.8 million.

A big part of that is carving out unnecessary fees and conflicts of interest and improving primary care benefits.

“It’s a secret hiding in plain sight if you dig in,” Chase said.

But many companies, with overburdened human resources departments, often don’t.

To start, Chase said, companies can take a closer look at the summary plan document that governs their health plan.

“It’s just riddled with unnecessary fees and conflicts of interest. There are things in that boring stuff that can save you a huge amount of money without affecting the members whatsoever,” he said.


Hidden commissions

Another source of hidden cost can stem from undisclosed contracts between brokers and insurance companies. Many self-insured companies turn to brokers to help them design or manage their health plans. But those brokers often receive undisclosed commissions.

According to a report by ProPublica, insurers often pay brokers a commission of 3 to 6 percent of the total premium for employers they enroll. Retention bonuses also serve to keep brokers from shopping around.

“If you maintain 90% of your business with a carrier, you can get a huge bonus,” Chase said. “You have massive conflicts of interest, much of which is undisclosed.”

The solution that Chase proposes is a certification program for health insurance brokers. To participate in the program, they must agree to disclose all of their fees, direct and indirect.  Instead of being paid through insurers, Health Rosetta’s brokers charge their clients a fee, which the company says better aligns them with employers’ interests.

So far, Health Rosetta has trained 170 benefits advisors through the program. Just as LEED certificates became a benchmark for building efficiency, Chase hopes that certifications to improve transparency among insurance brokers will become more commonplace.


Better benefits

The other big piece of Health Rosetta’s plan is restructuring primary care to give patients more time and better communication with their doctor rather than fall back on traditional fee-for-service medicine. That involves screening providers for certain quality metrics, such as how many patients required hospitalization, or quality results for common conditions such as hypertension and diabetes.

Members can be incentivized to go to these facilities by waiving out-of-pocket costs.

“The best way to slash health care costs is to improve benefits,” Chase said. “When you see proper primary care, you have fewer surgeries and ER visits, because people take time to talk to people.”

Chase knows it will take time to make substantive differences in the way people pay for healthcare.

“We know this is a 10-20 year journey, easily,” he said.

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Startup automating healthcare administration raises $51M


Decentralized clinical trial design

A startup building AI tools for health systems closed a $51 million funding round. Olive AI said it plans to use the new funding to further its growth; Olive’s AI assistant is already used at more than 500 hospitals across 41 states, including large systems such as Centura Health and OhioHealth.

Technology venture capital firm General Catalyst, which has backed Livongo and  Oscar Health, led the $51 million funding round.  Previous investors include Drive Capital, and Ascension Ventures and Oak HC/FT, which previously led a $32.8 million funding round in 2018.

In addition to the funding, Olive AI will gain a new board member in Ron Paulus, the former CEO of North Carolina-based Mission Health. Paulus currently serves as an executive-in-residence with General Catalyst. Part of the firm’s strategy is to partner software startups with experienced executives to grow their business.

Columbus, Ohio-based Olive Health uses AI to automate repetitive, error-prone tasks, such as insurance eligibility checks and code matching. For example, Connecticut-based health system Yale New Haven Health previously stated it was using the system to automate prior authorizations.

Olive Health describes its AI, called Olive, as a “digital employee” that is assigned tasks and can provide updates to a manager. It also says the system is EHR-agnostic.

CEO Sean Lane, a software entrepreneur and former Air Force intelligence officer, founded the company in 2012 after he noticed the technology systems used in healthcare were often disconnected from one another.

“The AI workforce is here, and the days of disconnected bots that don’t learn from each other are over,” Lane said in a news release. “The time is now and this investment enables us to accelerate our vision of the internet of healthcare – where when one Olive learns, all Olives learn.  We’re on a mission to radically change the way healthcare leverages and views an AI workforce.”

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The year of healthcare integration


Each year in the healthcare industry we see new ideas and technology rise up to meet society’s needs. In 2019, the healthcare industry saw $2.6B in funding go to virtual care while healthcare policy became more receptive to technological solutions, with 40 states adopting more substantive telehealth policies. These changes were arguably driven by evolving consumer preference for accessible healthcare as 61 million members of Generation Z entered the workforce, and nearly half of the 83 million Millennials shrugged off the traditional model for primary care.

What will it mean for healthcare in 2020? The industry is heading towards a complete integration of virtual healthcare. This year, we will see virtual care become an integral component of healthcare in policy, benefits, behavioral health, consumer experience, and platform consolidation.

The Patient-Consumer
Setting the stage for trends in 2020, it is important to first establish that there is a changing, consumer-driven expectation within the healthcare industry. Consumers are beginning to view virtual care as an integral part of healthcare, as opposed to an alternative.

This year, we will see that virtual care is no longer a separate concept, but a deeply embedded expectation in healthcare. As this happens, health plans and employers will need to think differently about the strategic importance of virtual care for their benefits design.

Policy & Regulatory
In 2019, more than 40 states adopted more substantive telehealth policies. One of these included finalizing the innovative telehealth benefit to Medicare Advantage. This year, I believe that CMS will promote policies that encourage virtual care in value-based models—specifically Medicare Advantage.

Medicare Advantage plans will have more options to enhance their provider networks and improve access to care via telehealth providers. This improved access hinges on CMS expanding the network adequacy criteria to include telehealth as a qualifying visit encounter. Medicare Advantage plans will also be able to improve diagnosis, treatment, and quality outcomes when CMS considers telehealth as a valid risk-adjusted source.

We can already see this trend beginning, as CMS proposes boosting telehealth benefits for certain patients with specialty care needs.

Employer Benefits
Employers have often led the way when it comes to pursuing affordable, accessible virtual care options. A recent survey found that more than half of employees are confident in an employer-provided digital health solution. However, many employers are currently offering multiple point solutions—addressing individual health issues with separate virtual care options.

This year, the industry will see more companies seek all-encompassing solutions to consolidate benefits for their employees and reduce fragmentation in care. We are seeing large companies like Amazon and Walmart roll out innovative virtual primary care options for their employees. These options integrate virtual care into their network as a first stop for medical and behavioral health care, as opposed to providing an alternative for acute care. As CEO of Doctor On Demand, I have seen the impact of deeper employer partnerships and how these models will be prioritized in the coming year.

Virtual Behavioral Care
In 2020, we will see rapid growth in access to and patient utilization of virtual behavioral health care. The demand for behavioral health care is increasing and access is frustrated by a nationwide shortage of in-person behavioral health providers. Millions of Americans are currently waiting for an average of 25 days to schedule a visit with a mental health professional. Virtual care will reverse this trend.

As a convenient, private, and face-to-face video option, virtual care is uniquely situated to meet the needs of consumers seeking behavioral health. Based on my experience as CEO of Doctor on Demand, my prediction is that virtual behavioral health care will become an essential offering for health plans and employers.

Platform Consolidation
While there has been an emergence of point solutions designed around specific conditions and technology modality, these solutions will struggle to maintain market share on their own. This year, the industry will seek to consolidate integrated platforms.

This will move us to create a more seamless experience for doctors and patients, prioritizing usability around both EHRs and referral processes. The integration of platforms will mean better utilization and outcomes for all.

What Does It All Mean?
As virtual care becomes integrated into our various systems, its users will seek solid, outcome-oriented results. Those employing virtual care will want to visualize the utilization rates, tangible health outcomes, real cost savings and quantitative changes in their population over time. This will be true for employers, health plans, and consumers. 

This year, we will see higher expectations placed on receiving results. This data will drive future decisions and the future of virtual care integration.

Photo: Courtney Hale, Getty Images





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Top 5 VR startups in healthcare


Once envisioned as a gaming platform, virtual reality technology has been quickly adopted in the healthcare world. Medical students are using them to brush up on their surgery skills, while surgeons are using them to plan for complex procedures. Some clinicians are studying their use in pain relief. Chemists are even donning the goggles, where they’re used to better visualize molecules in drug development.

It’s still early days for VR in healthcare, but the headsets may soon find their way into operating rooms and clinics. Below, we’ve listed a few startups that have found creative uses for this technology.



CEO: Tej Tadi

Headquarters: Lausanne, Switzerland

Mindmaze uses VR headsets and brain imaging to help stroke victims recover after an injury. Its technology has also been used to relieve phantom pain for amputees. Founded by neuroscientist and engineer Tej Tadi, the company soared to unicorn valuation in 2018, after closing a $100 million funding round. The company said it would use the new funds to expand into new markets, and begin researching the use of its technology for Parkinson’s patients.


Osso VR

CEO: Justin Barad

Headquarters: Palo Alto

Osso VR is combining its software with Oculus Rift headsets to train surgeons and medical students on orthopedic procedures. The company’s founder and CEO, a pediatric orthopedic surgeon, hopes that it will be an effective tool to train surgeons more quickly, making it easier to adopt new procedures in the long run. Osso VR also gives an assessment of users’ surgical skills, with its clients using the technology to get new surgeons proficient enough for hands-on training. So far, the startup has raised $2 million in funding from Signalfire.



CEO: Nissan Eimelech

Headquarters: Israel

Augmedics says its augmented reality headsets can give surgeons “x-ray vision.” Its headsets, which consist of AR glasses and a camera, are used to help surgeons visualize a patient’s spinal anatomy during procedures, making it easier to install spinal implants. Augmedics was founded in Israel, but is entering the U.S. market after it received 510(k) clearance from the Food and Drug Administration in December. The company raised $8.3 million in 2017 from AO Invest, a firm that invests in orthopedics startups.


Surgical Theater

CEO: Moty Avisar

Headquarters: Cleveland

As fighter pilots use simulators to prepare for an upcoming mission, Surgical Theater is hoping to do the same for surgery. The company creates personalized maps for surgeons using data from patients’ CT and MRI scans. Surgical Theater has struck partnerships with several hospitals, including Children’s National Health System and UCSF Benioff National Children’s Hospital. The company raised a $9 million funding round in 2015, led by HTC Corp.



CEO: Eran Orr

Headquarters: Boston

XRHealth is combining two buzzy sectors: telehealth and virtual reality. The startup will open its first virtual reality telehealth clinic in March, which gives patients access to VR apps intended to help with stress, chronic pain and other conditions. While patients use its headsets, clinical staff can see what they’re viewing and adjust the setting remotely. XRHealth also manages the back-end, including insurance billing, and sending clinicians and payers a report on app use. The company says its services are covered by Medicare and most major insurance providers.


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The role of real estate in the future of healthcare


While healthcare finds itself in the throes of a transformation towards value-based population health,  executives are finding inspiration in an unlikely source: the retail industry. This inspiration is helping healthcare leaders bring more convenient and affordable care to patients. In an environment of continued transformation and uncertainty, health systems are learning from the retail industry about how to view patients as consumers and ensure their remote healthcare clinics are optimally located and provide the right mix of services. 

Hospitals are sitting on significant amounts of underutilized real estate following intense M&A activity over the past several years. Adding off-campus clinics in retail settings makes their real estate portfolios even more complex. Real estate portfolios are indeed projected to become more complex as outpatient care and medical office real estate are primed for accelerated growth across nearly all U.S. markets, regardless of potential political and economic headwinds, according to our research. In fact, based on our research, outpatient visitation increased by 25% throughout the past decade and will continue to do so.

As healthcare providers look at 2020, the industry remains in a state of flux. We identified three trends for healthcare companies to stay on top of to enhance the patient experience, improve financial performance and unlock game-changing efficiencies.

The growth of the healthcare economy – and the need for healthcare real estate – is on the rise

The healthcare industry is an undeniable force in the U.S. economy – it is the largest U.S. employer as of 2018, employing more than 13% of the workforce. It is also one of the fastest-growing industries in the U.S. economy. But even as healthcare real estate has grown to more than $1.2 trillion in value and is more diversified than ever, new construction is not keeping pace. For many hospitals and health systems, reconfiguring their footprints to include more outpatient medical offices is the key to meeting new demand, delivering care to more patients safely, efficiently and conveniently.In 2017, healthcare spending grew to almost $3.5 trillion annually, and is anticipated to grow to $5.7 trillion by 2026 – an estimated growth rate of 5.5% each year. Further, the U.S. population is projected to grow by approximately 79 million people by the year 2060 – another factor for recent healthcare economic growth. By 2060, one in four people will be over the age of 65, increasing healthcare spending given the high population of seniors.

Tech pushes more care outside hospital walls  

The evolution of healthcare away from traditional hospital campuses is gaining momentum as new technology has become a key driver in the shift to outpatient care. Healthcare delivery continues to evolve toward a more decentralized model away from inpatient care at hospitals. Healthcare consumers increasingly expect greater availability and a better experience when seeking care. In response, healthcare organizations have developed locations that are easier for patients to access. 

Technology is a key driver in the shift to outpatient locations While patient preferences and financial incentives sparked the shift in procedures from high-cost hospital settings to more cost-effective outpatient locations, new innovations are adding momentum to the trend. 

Many surgeries and medical or diagnostic procedures that once required an inpatient stay can now be performed safely in an outpatient setting, thanks to improvements including minimally invasive surgical procedures—such as laparoscopy and robotic surgery—and new anesthesia techniques that reduce complications and allow patients to return home sooner. 

Payers are also driving the shift. Each year, the Centers for Medicare and Medicaid Services evaluates a list of approximately 1,700 procedures that are designated as inpatient-only. Improvements in medical technologies and surgical techniques are increasing the number of procedures being removed from the inpatient-only list and allowing them to be performed in outpatient settings, further increasing the shift to outpatient procedures. In 2018, six procedures were removed from the inpatient-only list, and in 2019 CMS expanded the list of procedures that can be performed and reimbursed in outpatient surgery centers to include 12 cardiac catherization diagnostic procedures and five ancillary procedures. As technology continues to improve and simplify once complex procedures, this trend is sure to continue. 

Medical offices will continue to be the darling of health systems and investors

In this environment, it is easy to see why outpatient visitation increased by 25% over the past decade – and shows no signs of slowing down. While healthcare-related real estate has grown in general, medical office buildings (MOBs) have emerged as the most popular property type within the niche. With fundamentals that are more cycle-resistant than other more traditional property sectors, this class of buildings has seen investors doubling down, drawn to its stability and bright prospects for continuing strong performance. 

All major healthcare constituents stand to benefit from the growth of medical office real estate, particularly as property investment is no longer dominated by specialty healthcare real estate investment trusts (REITs). In 2014, REITs drove 60% of medical real estate transactions, while hospitals and health systems drove only 16%. Today’s buyer pool is more diversified, with new investors attracted by the sector’s stable growth.

These MOBs account for approximately 10% of the U.S. office sector, but unlike typical offices which are often volatile and cyclical, MOBs offer more consistent and positive income growth compared to other property sectors, making it a more popular niche within the space. 

Medical office sales totaled $10.4 billion in 2018, and today’s buyer pool is better distributed with new investors attracted to the stable growth. From large healthcare systems to small, independent physician practices, these high-credit quality tenants are fueling demand for this growing sector.

The future of healthcare in 2020 and beyond

As healthcare spending is expected to grow by more than nearly $2 trillion in the next decade and reach a projected 19.7% of GDP in 2026, it is even more critical to find and deliver safe, effective care as efficiently as possible. Real estate has an incredibly important role to play in re-imagining a more efficient, convenient, accessible health system

In short: we may not know what the political climate may bring, but one thing is for sure, trend reports are all pointing toward growth regardless of regulatory changes enacted.

Picture: Feodora Chiosea, Getty Images


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