Oncology: The 900 Pound Gorilla of Startup Funding

In 2018, startups in the United States raised over $13 billion in capital. Of that, nearly 15 percent (or $1.7 billion) went to oncology-focused companies. On the surface, it’s easy to see why so many investors would want to put their funds toward cancer. Most would consider curing the elusive family of diseases as a moonshot, especially as cases continue to grow at an alarming rate.
But digging deeper, there’s more to the story of why oncology raises so much money, and a host of new technologies have come into play. Let’s dive in and see the details.

Everybody Wants to Rule the World

When thinking about the biggest ideas in medicine, it’s become almost commonplace to say “a cure for cancer.” From students to scientists, pageant contestants to investors. Even former Vice President Joe Biden feels the pull:

“I promise you if I’m elected president, you’re going to see the single most important thing that changes America, we’re gonna cure cancer.”

It’s not a surprising goal. Almost every person can name at least one person close to them affected by the disease. That prevalence means that cancer gets a lot of attention. That attention means that, for better or for worse, oncology is a major talking point.

Talk is Cheap, Cures are Expensive

If you’re a startup that sees your potential funding go toward oncology instead, that talking point is part of the problem. Between individuals, organizations, and the government, cancer gets a huge amount of attention. Some investors, swayed by the noise, choose to pass on other areas and put their money into oncology instead. That bias extends into government funding as well. The National Institute of Health, for example, spends nearly double on the National Cancer Institute as it does its next closest center.

That said, cancer is an epidemic and worthy of the money requied to study, treat, and prevent — if not cure — the diseases. But it’s worth considering whether investors are robbing Peter to pay Paul.

On the Horizon

It’s impossible to talk about cancer in 2019 without also talking about CRISPR. The genetic engineering field is relatively young. CRISPR as a term and dedicated field of study within genetics has only been around since 2002. But the gene editing idea may indeed hold our best chance at curing cancer at its source.

For those not in the know, the Cliff’s Notes version of CRISPR goes something like this: It is a gene editing technology that identifies and “cuts” certain strands of DNA, and then “pastes” replacement DNA in its place. As it relates to cancers, CRISPR should be able to target and remove germline mutations (inherited gene faults) that are tied to cancer growth.

Skirting the Edges

The up side of oncology getting so much attention is that there are many other fields that can work with the cancer while having other areas of cocus as well. Immunotherapy, pharmaceuticals, nanotechnology, and epigenetics are all specialties that see continued attention from oncology. But these fields all have larger umbrellas over them, covering many other areas of treatment as well.

For those who may think that the oncology gorilla is eating too much from the startup funding buffet, there are other fields that can benefit from the attention that cancer commands.

We’d love to hear your thoughts. Are investors ignoring other areas, opting for moonshot oncology treatments? Or does the field deserve even more attention than it gets today? Sound off via your AngelMD profile, and use the #AMDoncology hashtag. Let’s start a discussion.

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The Rise of Patient Engagement

Over the past few years, the term ”patient engagement” has risen in popularity. As payers continue their march toward pay-for-performance models, providers are looking for every advantage. Patient engagement is somewhat of a catch-all phrase that encompasses everything from medication compliance to self-service appointment scheduling (and all points in between). As such, we are seeing a wealth of upstart companies hoping to provide better outcomes for patients and providers.

What Is (And Isn’t) Patient Engagement?

As stated in the introduction, patient engagement is a big umbrella under which many activities will fall. But we should take a look at the existing players in the space to help us narrow things down somewhat. What we found is that two factors have to exist in order for an activity to fall under patient engagement:

  1. The activity must involve both the patient and the provider. Think of a conversation, not a broadcast.
  2. The activity must work toward accountability or understanding.

HIMSS defines patient engagement as “providers and patients working together to improve health.” As a collaboration focused on health information, HIMSS then goes on to define patient engagement through that lens. Everything from text messaging to wearables falls into this category for HIMMS, and much of the talk about patient engagement relies on technology for its success.

The World Health Organization shows one of its focuses on primary care as an area where patient engagement holds promise. As such, WHO tends to start on a more in-person level for engagement. The organization encourages surveys, focus groups, and informal online feedback in order to facilitate mutual accountability and understanding between the patient and the provider.

Conversely, it’s important to note that some other areas of major focus will not fall under patient engagement. EMRs, for example, are not in place to help the patient understand or to make them accountable. Likewise, outreach does not qualify as patient engagement. It is a function of marketing. As such, it does have its own potential for positive outcomes, but again, it lacks the qualifier of patient understanding or accountability.

A Focus on Quality

As much as we would all like to say that every interaction is a quality interaction, that is simply not true. Physicians today have less time to spend with patients, and they have more patients to see with an aging population. Patient engagement is not the entire answer to these problems, but it is an important part of the puzzle.

Letting the market help to guide our vision for patient engagement, we can see areas that are already getting attention. A recent acquisition by Philips aims to help hospitals communicate with patients. The company bought Medumo, which uses texts and emails to communicate with patients about their procedures, with the goals of better compliance and fewer missed appointments.

Hospital conglomerate Banner Health also made news recently. The group has deployed chatbots, powered by LifeLink, in 28 of its emergency rooms. The bots use HIPAA-compliant messaging to inform the patient about their visit, while also feeding submitted information into the hospital’s EMR. The company reports high adoption rates of the chatbots, and improved patient satisfaction ratings across the board for those who use them.

These are just two examples of how patient engagement, with a focus on quality, is moving the needle in today’s market. But a cursory glance at acquisitions headlines shows that the segment is gathering much-deserved attention. By focusing on better patient outcomes, and improved quality metrics, patient engagement has found its niche in today’s healthcare.

Points to Ponder

As we discussed in our recent article on finding success with a medical device company, having predicates and guides is critical. Can the same be said for patient engagement? What areas of expertise are most important for finding success in the segment? What can we learn from the failures in the direct-to-consumer healthcare segment?

How do we overcome patient privacy concerns? It’s safe to say that even most healthcare providers don’t have a full understanding of HIPAA. How can we expect a patient to be more (or even equally) informed? What What areas contain potential pitfalls that must be avoided?

For the healthcare investor, there is an opportunity for faster liquidity than in some other areas. Will we see traditional private equity money being driven into this segment, since it avoids some of the timing concerns that are so relevant with other forms of healthcare innovation?

We will revisit these questions, and more, in an upcoming blog post. For now, we’d love to read what you have to say. Post your thoughts to your AngelMD profile, with the #PEAMD hashtag.

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The Ethics of Investing as a Physician

The past decade has seen a stark increase in the number of private equity firms that are investing in healthcare. On the other side of that same coin are singular investors — or groups of investors — who are looking to diversify their portfolios by investing in healthcare. It only stands to reason that, by investing in what they know best, physicians stand a better chance to beat the odds. But the practice is not without its potential pitfalls, and it is important to know how to avoid them.

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Innovation4Alpha Podcast Se1 Ep1 — Correlation

Welcome to the all new Innovation4Alpha podcast. The goal of Innovation4Alpha is to provide insight and entertainment to the world of healthcare investing. AngelMD CEO Tobin Arthur and SVP of Clinical Investment Operations Jeff Ross, MD lead the discussion, and welcome your feedback.

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Congratulations to Moving Analytics & HeartHero

The American College of Cardiology’s Scientific Session is an annual event that draws physicians, vendors, startups, and subject matter experts from across the United States. For the past two years, AngelMD has had the privilege of hosting the ACC’s Innovation Challenge. The Innovation Challenge pits a pool of startup contestants against one another in a Shark Tank-style pitch competition, where the teams compete for a pool of prizes.

This year’s competition was broken into two categories: Artificial Intelligence, and Digitally-Enabled Medical Devices. Given AI’s rise of importance in healthcare, the ACC wanted to give companies who make heavy use of AI the opportunity to showcase what they have accomplished, and what they’re planning for the future. The teams that were chosen to compete came from the AngelMD network, and were scored not only by AngelMD but also by member-physicians of the ACC.

The Finalists

Artificial Intelligence

  • Care Angel
  • HealthPals
  • Moving Analytics
  • RecoverLINK

Medical Devices

  • GraftWorx
  • Sira Medical
  • cliexa
  • HeartHero

The Winners

Moving Analytics was chosen as the winner from the Artificial Intelligence category. Their pitch showed a strong understanding of the market, its challenges, and a viable way toward solving them.

For heart disease patients, cardiac rehabilitation is a proven method of preventing readmission. Unfortunately, a lack of convenient options for patients means that a mere 15 percent of them ever complete CR programs. Moving Analytics helps hospitals implement virtual CR and secondary prevention programs for cardiac patients. In a value-based care world, where readmission can lead to stiff penalties, it’s critical that patients have access to care that it not only effective, but also considerate of their constraints.

HeartHero was chosen as the winner from the Medical Device category. The company pitched its ultra-portable, affordable, user-friendly AED to the crowd at the ACC.19 Innovation Challenge. A product that can readily save lives, and is available at a lower cost than the status quo was obviously a big hit with the audience.

The use of an AED at the time of an SCA event significantly increases the chance of survival, but currently, AEDs are only used in a small fraction of cases of out-of-hospital SCAs. This gap exists because 70% of out-of-hospital SCA events occur at home, but AEDs are only currently readily available to businesses and institutions. The HeartHero team sees an incredible opportunity to bridge this gap and create a consumer-friendly solution to address these in-home SCA events.

Our congratulations to both teams for their performance, and for winning the Innovation Challenge. Be on the lookout for a full-length article, featuring both companies, that will appear in an upcoming issue of ACC’s Cardiology magazine.

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