Lessons Learned from Amazon’s Entrance into Healthcare

Amazon is the disruptive threat that is considered by many healthcare corporate strategists during their annual planning cycle. Amazon is a threat because they have a demonstrable track record of wringing out the inefficiencies in markets.

The acquisition of Whole Foods terrified the traditional grocery chains — and the market agreed driving down their stock prices the day of the announcement. A year and a half later, Amazon has shown the ability to grow their Prime membership via their Whole Foods channel. They are capturing “big data” shopping habits which will ultimately fuel the pivot to the grocery home delivery market. That is the nightmare scenario for grocery stores looking at becoming the next Borders bookstore.

That transition will be driven by improving the customer grocery shopping experience.

Amazon’s first significant foray into healthcare is the acquisition of PillPack, an online pharmacy company. PIllPack simplifies medication management for consumers by delivering packets with presorted does. A person receives a packet with all of their day’s pills in a single pouch.

The interesting part of the strategy is that they are effectively targeting the small population of individuals that consume the vast majority of prescribed medications.  

The acquisition of PillPack gave Amazon a foothold in all 50 states. This foothold will greatly accelerate its entry in to this regulated space. The stock prices of CVS, Walgreens, and Express Scripts immediately took a hit the day of the announcement. CVS has since launched next-day prescription delivery services in an effort to fend off Amazon’s approach.

Amazon chose this healthcare entry point because of the inefficiency of the current market, as well as the poor customer experience. This approach is in keeping with Amazon’s relentless focus on customer as they transition into new markets.   

It is interesting to revisit the 1999 CNBC interview with CEO Jeff Bezos in light of the above two transactions. That theme is repeated again in the 2018 letter to Amazon shareholders. If you look back at all 23 letters to shareholders, the word customer appears 443 times making it the most common word in all letters.

By contrast, Amazon is mentioned only 340 times.  

How does Amazon achieve their focus on customers without having direct dialogue? Have you ever been able to get someone on the phone at Amazon? Universally, the answer is no.

  • They accomplish this by leveraging their digital platform to observe online behaviors.
  • They experiment relentlessly to improve workflow.
  • They leverage data and AI to anticipate their customer’s needs.  

This sounds like a great model for AngelMD. Our digital platform will scale to 100K physicians by restlessly improving the user experience and anticipating their needs related to insider access to information and education.

Later this year we will be introducing the concept of community leaders focused around specialty groups. Their role will not be to call every physician but rather monitor signups, site traffic, conduct small focus groups, and feed product improvement recommendations to the software team.  

Are you ready to be a part of the future of healthcare? Join AngelMD today to connect with, advise, and invest in early-stage medical startups.

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Healthcare and the Age of Data

This is the fourth in a series of articles where we examine the macro-level trends that support the thesis of our business.

There are so many incredible ways in which big data, artificial intelligence, and machine learning are used behind the scenes to impact our everyday lives. The technologies are frequently used to inform business decisions and optimize operations.

AI, machine learning, and big data have become ubiquitous. You’ve spent years feeding data into your phone, so now it forecasts your commute time. Amazon uses purchase and demographic data, combined with machine learning, to automatically recommend products you might enjoy.

The following excerpt from a Hacker Noon article helps to further explain the concepts:

Artificial intelligence is the technology that allows computers to do things that were once only the domain of humans. For example, computers have always been able to calculate. With AI, they can learn and draw conclusions.

AI can be roughly divided into two disciplines. These are machine learning and deep learning. Machine learning involves the creation of computers and software that can learn from data, and then apply that knowledge to new data sets. Deep learning creates neural networks, designed to resemble the human brain. Deep learning is used to process data such as sounds and images.

AI doesn’t work without data. It consumes data in order to learn. Big data refers to the massive sets of data that are now available for this purpose. These sets of data can be analyzed by machines. This can reveal patterns and trends and facilitate making future predictions.

For healthcare specifically, Medical Economics identified artificial intelligence as the top trend for 2019 in their March 1 article.

Artificial intelligence (AI) technologies should give us great hope for the near future. The technology will enhance, not replace, human efforts. AI promises to alleviate repetitive burdens and provide more accurate tools, so that the medical community can offer better care. Its explosion onto the funding/startup scene is both indicative of its potential and the reason less tech-savvy people feel overwhelmed. 

There is a large greenfield of healthcare opportunities as AI and machine learning are applied to healthcare. HITECH, the Health Information Technology for Economic and Clinical Health act, mandated the use of datasets, which are now being used to feed machine learning and AI.

As one example, HealthPals is an AngelMD portfolio company that leverages big data to help provide population insights. The company’s use of big data allows it to optimize medical, quality, and cost considerations in ways that we have not seen before.

We see significant portfolio investment opportunities in a wide degree of areas that machine learning and AI can impact. Imaging, population health, and even marketing for large healthcare organizations are some of the more obvious choices. But medical billing, EHRs, and medical devices are all ripe for disruption by data as well.

We are just starting to scratch the opportunities for big data and AI in both healthcare and AngelMD. The AngelMD platform benefits from the application of big data and artificial intelligence principles through our Metis Engine. As participation grows on the network, we are able to identify patterns that can be leveraged to grow the membership, inform portfolio choices, and coach portfolio companies to a better, faster exit.  

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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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AngelMD Portfolio Company Saranas Awarded FDA De Novo Designation

The ultimate goal of AngelMD is to facilitate improved outcomes for startups, investors, and ultimately for patients. Today we are proud to share the news that Saranas, an AngelMD portfolio company, has obtained FDA clearance for its Early Bird Bleed Monitoring system. 

A recent study of over 17,000 large-bore transcatheter interventions showed that nearly one in five patients experience a bleeding-related complication. Saranas’ novel early-detection system addresses an unmet need for real-time detection and monitoring of these problems. The company’s last funding raise, in which AngelMD was also a proud investor, allowed for Saranas to submit the De Novo application to the FDA and launch a multi center clinical pilot within the United States.

Saranas originated from the Texas Heart Institute at the Texas Medical Center. Its goal is to provide real-time monitoring without the need for radiation, and at a lower cost than the status quo. 

The Early Bird Bleed Monitoring System is now being piloted across multiple centers to assess its versatility, and to increase patient safety. The company plans to launch the system commercially in selected centers across the US.

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Consolidation – A Boom or Bust for Healthcare Startups

If there has been one overarching theme over the past few years, it is that healthcare delivery systems are consolidating at a stunning pace. As Kaufman Hall reported in January of this year, the average size (in revenue) of the sellers in M&A deals has grown at a compounded annual growth rate (CAGR) of 13.8 percent since 2008. That is to say that, not only are more deals happening, these deals are worth an ever-increasing amount of money.

A more recent trend has been the “merger of equals” when it comes to healthcare consolidation. We’ve seen this in deals like Baylor/Scott & White/Memorial, as well as with Carolinas/UNC, and with Advocate/Aurora. These deals raise all new opportunities for management teams to capitalize on areas of revenue and expense that synergize between the companies.

To further complicate matters, names like Amazon and Apple are now commonplace in healthcare. Cigna’s acquisition of ExpressScripts, CVS acquiring Aetna, and Optum swallowing DaVita are all prime examples of how consolidation is reaching across the industry.

For many startups, and even to investors, this culture of consolidation can lead to uncertainty. It is critical that these companies and their investors have the tools at hand to identify transformative technologies. Ultimately, we’ve built the AngelMD network to be the vehicle by which this identification happens. But reaching even further, the healthacare industry as a whole can rely on AngelMD to be a litmus test for new technologies that can fuel its growth.

How, you might ask? The answer itself is simple. Getting the pieces to work together is the challenge that we meet every day.

Above all else, it’s the network. Our ever-growing base of physician/investors is the ideal network to rapidly identify, score, invest in and advise the very best in healthcare innovation. These members are, more often than not, in senior clinical leadership roles and they are working inside of this rapidly-consolidating landscape. The benefit here is two-fold:

These positions provide a critical level of access which can shorten the startup evaluation process.

Health systems CIOs can leverage the AngelMD network and our Metis AI engine to identify the innovations that best align with the needs of their organization.

For AngelMD, the consolidation of the healthcare industry simplifies the process of identifying potential exits for the best healthcare startups. With over 1,000 startups on the network, we are already pulling from one of the deepest benches in healthcare. Combine that number with our Metis scoring engine and the industry could source the very best ideas that compliment their portfolio while driving revenue growth.

In short, AngelMD is working toward the future. Consolidation doesn’t have to be a scary practice. With the right information, it can be a boom rather than a bust for healthcare startups, their investors, and the companies that buy them.

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