Startup Health Festival

What the Future of Health Looks Like

Health Festival San Francisco

The Health Festival in San Francisco is an annual invite-only two-day gathering of Health Transformers held each year that celebrates boundary-pushing ideas, authentic collaboration, and creativity as elements in health transformation for improving health and wellbeing for billions of lives. This year showcased the latest developments and progress made by startups in eleven Health Moonshots, including Access to Care, Mental Health & Happiness, Longevity, and more.

The event attracted over 2,000+ attendees, 180+ speakers, 100+ healthtech entrepreneurs, CEOs, innovators in Startup Health TV interviews, and 3,000+ meetings. The conference featured guest speakers from big names in technology and rising startups (e.g. Google, Microsoft, Amazon, Calm) who shared their personal anecdotes, perspective on US healthcare, and collaborations that are improving and pushing healthcare forward.

Conclusion

New technology and funding in innovative health solutions are spurring new startups and existing tech players to address pressing global health problems by collaborating and leveraging each other’s strengths to scale impact. This is enabling a transfusion of startups and large technology companies to look holistically at healthcare and add stakeholders to project teams to crack the paradox of technology and adoption in healthcare organizations.

Effectively, healthcare has seen a lot of new technology and solutions for stakeholders involved but historically, adoption has been low to non-existent. Large technology players such as Microsoft and Amazon have recognized this and subsequently gone ahead to implement nurses in their project teams as they touch many points in the healthcare journey and represent different views and perspectives that enable these companies to better solve pain points.

Fireside Chat: How Google Is Using Its Data Trove and AI/ML to Improve Health Outcomes

Moderator, MD & PhD, and Chief Medical Officer at Startup Health, Howard Krein, talked with MD, VP of Google Health, David Feinberg, about how Google is using data to transform healthcare.

Feinberg wasn’t sure at first about transitioning from healthcare to tech by joining Google- he needed convincing that Google was serious about health, that there could be big impact, and that he would have the freedom to treat his team as if they were his own patients.

Krein asked how serious Google is about health and Feinberg said they definitely are, and that Google is a consumer company, which aligns really well in health. He mentioned that 80% of people before an ER visit do a google search around health;

“When you get a new diagnosis, you go to Google, doctors that do (new) procedures go to Youtube to ensure their operations is a success.”

The consumer piece is to make that information better, remove dangerous pieces, (misinformation) and partner with organizations to improving authoritative search.

Krein wanted to know where Google Health sits within the google family. Feinberg said it’s a year old and it’s an umbrella for 3 existing groups; Deep Mind in London, Nest Health in home, and Brain in research.

Feinberg was asked what impact Google health will have on our health. He responded that other technologies entered our world that made life more helpful, for example in knowledge, success, health or happiness. Healthcare however hasn’t made those jumps yet. Feinberg discussed a mammogram study (The UK and US have 43m mammograms a year) of six medical centers where they used ML to compare mammograms with mammograms looked at by physicians. They gave the physicians a head start by giving them access to patient’s earlier mammograms and access to electronic health records, genetic info, and MRI information. Despite this head start results showed:

• 9% decrease in false positives by Google
• 5% decrease in false negatives

The best result was the combination of physicians and AI because separate they both make mistakes. Catching it at stage 1 instead of stage 4 makes a huge impact. In addition to this, Google is getting very good in pattern recognition whereby AI can differentiate gender based on the eye retina of images. They can identify age, blood pressure, cardio risk factors, and Alzheimer’s, with improving accuracy.

Krein brought up the partnership Google has with Ascension and the media stir it caused in terms of data privacy. Feinberg said they want to reach the rich and poor, developed and undeveloped.

Ascension chose them as cloud provider where the information is encrypted in transit and it rest where Google has no access to the information. The only person with the key is Ascension. They also used their G suite and asked if they could do something special with them in 2 hospitals; help organize the health records

What Google did was bring in the tech of search and they created a unified platform for doctors and nurses to search their patients’ individual records through a search bar. To do that Google employees could be exposed to that information, so they needed a business associates’ agreement with Ascension and train Google employees in HIPPA. These agreements relate to the privacy form that refers to third parties (billing, labs, doctor, etc.)

In addition, the search had an auto-complete function for physicians where they auto complete the sentence based on previous notes. (received as huge time saver) Google did not use the data for mining they built the platform using de-identified data and they hope it improves care, lowers physician burn-out, and gives more joy to physicians in treating patients.

Another area for Google health is predictions — doing this for flood and fire but applying this in healthcare. Their team in London developed an app with AI for the rapid response team in the hospital that looked at creatine (kidney) to determine a recommendation is required to go see a specialist. The app had the following results:

• The time of diagnosing acute kidney injury decreased from 4 hours to 14 minutes
• Decreased cost of care with 17%
• 30% less patients have cardiac arrest

Then they used that AI to partner with the Veterans Affairs (VA) and look at the entire patient health record in real time (600K variables per patient) to predict acute kidney injury:

• Resulting in a prediction up to 48 hours before kidney problems surfaced (2 days before any sign of deterioration)

This creates a whole new way of thinking where healthcare is a reactive health system but can move to a proactive system — it’s a step towards changing how patients are treated.

The moderator asked Feinberg what the biggest challenge for roll-out and acceptance is for Google Health. He said its trust. “Technology is amazing, but it has issues and bias is hard to avoid. We can’t do it ourselves; we need partnerships with front line caregivers (doctors, nurses, social workers, home care givers) and we have to make it easy for them to became super caregivers.”

Feinberg said it doesn’t matter how super the tech is, you need cultural sensitivity, affordability, etc. to get there. His team is focused on understanding what people need, especially on the consumer side and create deep relationships on the provider side to wow them and make it easy. He sees medicine moving through the hospitals back to communities.

Fireside Chat: U.S. Department of Health and Human Services (HHS) and kidney disease

Moderator and CEO of Luminary Labs, Sara Holoubek and CTO of the HHS, Ed Simcox, talked about how the HHS is investing in health to lower deaths from kidney disease.

Simcox brought up several statistics to make us aware of the urgency behind kidney disease.

• 1 in 7 Americans are living with kidney disease
• Kidney disease is the 9th leading cause of death
• 1% of entire federal budget every year is spent on kidney disease

Most dialysis spending by Centers for Medicare and Medicaid Services (CMS) is higher than the entire NASA budget and Department of Commerce combined. Dialysis hasn’t seen any innovation since president Nixon signed the End Stage Renal Disease Program (ESRD) in 1972 to help dialysis patients afford treatment. Simcox thought the administration got complacent and comfortable in the system that is providing care. Back then it was seen as a miracle, but nothing changed for over 60 years.

Simcox explained there are a number of reasons why kidney disease is not a top-of-mind concern for people:

1. Its downstream from a lot of other chronic conditions, and cardiac issues and diabetes are contributing to it (many cause type 2 diabetes)

2. The way we paid for progress in the past. Last year the Trump administration signed an executive order to progress the cause called “Advancing American Kidney Health”

3. The lack of prevention and awareness. Many people don’t quite know how to address kidney disease in early stages. Most people who have it don’t learn about it until it’s too late (stage 4 or kidney failure)

4. Kidney transplantation problems. How people are able to get organs and ensure successful transplantation is broken and costs the US economy up to $1.38B since 2017 (Source: https://www.eurekalert.org/pub_releases/2020-02/w-teb020320.php)

The HHS wants to tackle kidney disease with an ecosystem approach for care, patient throughput, the state of science, and how we pay for care.

Panel: The Role of Nurses with Amazon and Microsoft’s Foray into Health

Moderator, Nurse Economist and host of See You Now, Shawna Butler, talked with technology strategist, Lynda Moyer, and National Director of US Health & Chief Nursing Officer of Microsoft, Molly McCarthy RN, and Clinical Operations Leader at Amazon, Kristi Henderson, about the role of nurses in tech companies as they enter the healthcare space.

According to a Gallup poll nurses have been declared the most trusted profession for 18 years in a row (Source: https://magazine.nursing.jhu.edu/2020/01/nurses-are-the-most-trusted-profession-for-18-years-in-a-row/)

Butler asked how tech companies are leveraging trust dividend to think of care in new ways.

Henderson wished it was as easy as finding a new technology solution and ballooning it but unfortunately there’s humans involved and there’s behavior change. Trust is required for getting engagement and you need a trusted partner in that process; someone that listens and understands on the front lines what is being done and how to implement solutions in the best way. Henderson brought up the slogan:

“If you want to make a change you should hire a nurse.”

Butler asked Moyer at her stint at Facebook as strategic partnerships about how her nursing credentials helped her in her role interacting with health communities to provide education and awareness on Facebook. She would often reach out as a nurse to establish that credibility and fiduciary responsibility and to bring those insights back to the team to help with the development of (new) products.

Especially in partnerships to introduce new technologies McCarthy said:

“6.5 years ago, people didn’t think about the cloud, they targeted the IT professional historically and brought in people with experience to have the right conversation beyond the technology or gadgets.”

“Now, Microsoft has nurses in their research groups, areas where they could uniquely add value for behavioral change is operations, mapping out workflows to product development and management; getting those insights from the users to marketing, sales, business development, implementation, and customer success.”

According to Butler most people don’t know what nurses do and understand all the places where they innovate. One of the reasons why trust is so important because on a daily basis nurses are trusted with billions of dollars in pharmaceuticals, technologies, data, and the people that we care for. Butler asked Henderson how she can help customers, clients, and startups that come to her leverage the understanding of how important it is that when people are sharing intimate data how they can build the trust to say it is safe, secure, protected. Henderson said it’s about education and awareness. People don’t really know what nurses do and are capable of, look at the skills and characteristics you need in each individual, go out and seek that. McCarthy added that its smart business as the percentage of nurses in the workforce in the US/ world from a market perspective how nurses can help penetrate the market as designing, developing, and implementing solution in a healthcare environment is very difficult to do without the involvement of nurses.

Butler asked Lynda what some of the specific conditions, populations, process, and procedures are where she had direct contact with the public saying and learn what the needs were to help entrepreneurs focus on particular pain points. Lynda mentioned two areas:

1. Data analytics, bring insights and efficiency from data

2. Patient engagement & behavior change (chronic care)

Butler added the location part where technology is dramatically changing who delivers care, where it’s delivered, and when. Butler asked the speakers what some of the new opportunities are where care can be delivered. Kristi said the patients guide them where care is needed. She elaborated that If they create something in the board room that isn’t informed by users, they will not get the results they want.

Kristi said:

“We have to put it out there, iterate, iterate, and iterate to get it right.”

McCarthy added to the topic and said that Microsoft is moving from sick care to health care because nurses look at healthcare holistically and so they are well positioned to help transition to a preventative model.

Finally, Butler asked how tech companies can best leverage nurses to solve problems in health. Henderson said nurses need to be imbedded in the team from the beginning down to deployment because they represent multiple audiences and viewpoints.

[1] https://magazine.nursing.jhu.edu/2020/01/nurses-are-the-most-trusted-profession-for-18-years-in-a-row/

Fireside Chat: Salesforce’s Plans for Healthcare

Moderator, healthcare & technology reporter at CNBC, Chrissy Farr, talked with MD, SVP & GM for healthcare and life sciences of Salesforce, Ashwini Zenooz, about Salesforce’s involvement in healthcare.

Farr brought up the background of Zenooz and asked if she could elaborate on her experience with working for the Veterans Affairs (VA) and how challenging it was to get telemedicine through at the VA. Zenooz worked across multiple specialties and primary care centers at VA and said that a lot of people don’t move quickly there. Which, according to Zenooz, is okay because the VA does impact so many lives. Before the VA she served the senate and worked hard at trying to get a bill through for telehealth in VA for employees and contractors, which ultimately failed.

So, when Zenooz joined the other side (at VA) it was a top 3 priority of her to get providers inside the VA to practice beyond state lines. It was successful, took some time, and the Trump administration signed an executive order for it.

Farr asked how Zenooz was able to get telemedicine through at VA this time. Zenooz mentioned she has a “kitchen cabinet” of people in her live she calls whenever she has a question about a specialism. She sees these people as mentors whom she respects.

Farr believed Salesforce is trying to take their core product, CRM and apply it to the medical space. She has seen multiple startups where they stick to their core product or do something very ambitious and asked how Salesforce balances that. Zenooz said that people don’t go to tech companies to stay stale. According to Zenooz it makes sense for Salesforce to apply what they know to healthcare. Salesforce has so many years of experience in organizing information and applying that to healthcare makes sense where the health space is fragmented and people are making their own networks trying to fix it, locking people in, and not talking to other networks. ((EHR or other (billing) systems))

To add to that, she said that Salesforce is good at connecting people and things with analytics to make decisions, which worked well in sectors like financial services and retail. Salesforce is for example working with UCSF on a blockchain project pilot for health data because patient data is very important to them, including privacy and security.

Farr entered into a rapid fire where she brought up innovation in AI and asked if AI will replace Zenooz her job. She thought it is silly as when she looks at a case (in radiology) she needed to liaison with 8 different doctors. She sees AI more likely to into imaging where it automates urgency or recommends actions based on the data. In the end no one wants machines to give news without a human telling you. Engaging with people and the ability to understand what’s going on and help patients will help evolve the specialty.

Fireside Chat: The Growth Journey of Calm

Moderator, CEO & Founder at Reinvent, Peter Leyden, talked with Co-CEO & Co-Founder, Michael Acton Smith of Calm, about how Calm has grown since the past decade and the how the societal shift in mental health has played a role.

Leyden took Smith 7 years back in time to explore the environment in which Calm was born.

Smith talked about how the environment was very different; he was in London Soho cooking up ideas and came across a domain name called calm.com, which cost $1m at the time. That made him and his co-founder think about how the world was moving fast and how they could make people calm and slow down.

Smith said the world changed considerably in the past few years, especially the shift in thinking around mental health. “Calm and the product of meditating was previously seen as weird and woo woo,” according to Smith. It was difficult to invest and hire people. This led them to move to California where there are more unusual and embracing people. Nonetheless it wasn’t easy and took several years. Smith looks at the society as an entrepreneur and when there is a shift and peoples’ perception changes to use that in your business to ride the wave with the wind in your sails. From plant-based foods, psychedelics as intervention in mental health. They were there with the mindfulness shift and it helped Calm grow.

Leyden asked Smith if he’s seeing a shift in strategy as Calm evolved and they became a $1B unicorn. Smith said they were tipping points that helped them scale growth;

• The launch of “daily calm” helped build a habit for users
• The discovery of sleep as an opportunity; Calm noticed lots of users had trouble sleeping. At 11pm globally there was a spike in meditation to help drift off to sleep. For this they created mindful stories to help users fall asleep

Leyden pointed out that Calm has celebrity influencers and he wanted to know how Smith got involved in that, the strategy behind it or if it was because of enthusiastic users.

Smith mentioned they are inspired by Nike; they are at the wave of mental fitness and reach people through celebrities that have massive audiences like Nike did. In the past celebrities didn’t want to associate with Calm. As collaboration is a central theme at Startup Health, Leyden asked how important that is for Calm. Smith said he’s a huge fan of collaboration and partnerships as it’s a big driver for business. They have had partnerships with Express Spa, content on AA, Uber, etc.

In terms of growth Smith showed his numbers; 2M paying users and 70M downloads. Smith would like Calm to be the Nike of the mind and become as widespread as a consumer product like Spotify or Netflix. The Calm mission is big and fits a lot of things, so he anticipates making more audio content for areas like fear, smoking addiction, first time parents, etc.

Fireside Chat: How Conversa Helped Northwell Health Deploy Intelligent Patient Communication and Lowered Hospital Readmissions

Moderator, Portfolio Director at Startup Health, Polina Hanin, talked with CEO, Co-Founder & Chairman from Conversa, West Shell the third, and MV, VP of Population Health Clinical Transformation from Northwell Health, Zena Brown, about how Conversa has helped Northwell Health engage better with patients to improve clinical outcomes.

Hanin asked Brown about her experience working with Conversa, her role, and some of the challenges she encountered in partnering with Northwell Health. Brown explained that Conversa delivers automated virtual care using trusted clinically intelligent conversations, and that she has worked with the team for 3 years. Northwell Health has over 8,000 employees across 23 hospitals and her role is two fold:

1. Improve clinical outcomes for patients to do analytics, clinical deployment, and administration of programs
2. Fight readmissions and infections

Brown said they weren’t able to scale in a way that was clinical and reliable at the same time, which is how she met Shell at Conversa. Hanin was curious about how Brown measured the success and she mentioned it was pretty simple as hospitals need to be disciplined because of the federal performance clauses that are required in order to receive money from federal programs. These “STAR” ratings for readmission numbers. Brown needed that readmission numbers to be lower but also wanted to ensure the patient experience for using the Conversa platform would be a triple A rating. According to Shell he reduced the readmission rate by between 40% and 50%.

Shell did this by building Conversa to be timely, relevant, personalized, and asynchronous to deliver a personalized care conversation with patients through their data engine, and act as extension of the care team for Northwell Health. Brown added that the ability to feed back into the system with patient feedback also important. She gave an example the Conversa care team asks conversations that involve the caregiver, but these people don’t know what to look for and don’t know these specific data points.

“It’s not only education but also when checking in with patients to check those boxes Conversa will be asking for to deliver care better.”

According to Brown the biggest benefit of providers using the platform was the fact that they don’t have to worry as much about their patients. Providers can see their dashboard and focus on specific patients in risk groups versus all of them. Providers don’t need to worry about patient status they can see dashboard and focus energy on patients in yellow or red. Getting providers to adopt the technology was not easy, but the key was showing that it was approved by clinical teams and how much patients would benefit from the solution, and not just the technology as a new toy of the month.

Thanks for reading! Feel free to drop a note in the comments for feedback or questions.