Future of Home Health

The COVID-19 pandemic has been an unprecedented catalyst for change, revealing how much we can achieve from the comfort of our own homes. A world of remote work, e-commerce, and digital communication was swiftly brought into focus, and the domain of healthcare is no exception. The emergence of home healthcare is a pivotal chapter in this transformation, backed by breakthrough telehealth technologies, sophisticated platforms for doctor-patient interaction, and a new, patient-focused approach.

Join us as we delve into the future of home healthcare, examining its possibilities, addressing its challenges, and envisioning its trajectory. We were honored to host Sandra Van Trease; Sathya Elumalai, CEO of Aidar Health; Alicia Chong Rodriguez, CEO of Bloomer Tech; and Dr. Adam Wolfberg, Chief Medical Officer of Current Health. These thought-leaders shared their unique insights and perspectives on the immense potential of delivering comprehensive healthcare services from home.

Immerse yourself in this fascinating conversation, which paints a vibrant picture of a future where quality healthcare is not a distant destination, but a service that comes to your doorstep.


iSelect Deep Dive: Home Health

Tom Bunn: I Select Fund is not soliciting investment or providing investment advice in any way whatsoever. This presentation is general industry research based on publicly available information. I select is an early stage venture capital firm in St. Louis focused on early stage companies in food, agriculture, and health.

I select invest at the forefront of innovation, seeking emerging problems, solutions and technologies. Isec uses these deep dive presentations not only as a way to better engage with and understand new science and technology, but also engage with the experts and entrepreneurs who drive and change innovation in their respective fields.

Good morning everybody, and welcome to I select Steep Dive webinar series. My name is Tom Bunn, an associate on the I Select Ventures team, and I’m excited to walk you through today’s discussion. For those new to these webinars, I select is an early stage venture capital firm in St. Louis, Missouri, focused on early stage companies in food, agriculture, and health.

Isec invests at the forefront of innovation, seeing emerging problems, solutions and technologies in their infancy. And we use these deep dive presentations not only as a way for us to better engage with and understand nuisance science and technology, but also do engage with the experts and entrepreneurs we’re driving change and innovation in their respected fields.

One theme that we’ve been researching is home health. The past two years have pulled what feels like a decade’s worth of interest, demand, and innovation for home health forward telehealth, which is just one aspect of home health grew 63 x during the pandemic, and today almost 80% of the US population has used telehealth.

The pandemic aside, latent demand for home health has been increasing just by virtue of the astronomical rise in healthcare costs, particularly for hospital stays and ER visits combined with an aging population that wants to age with dignity in their own homes and improving sensor technology. We have a perfect storm to reimagine where and how healthcare gets delivered.

For these reasons, home health is of increasing interest to, I select. I’ll give some brief introductions, then I’ll give a very brief background. We have some great introductions. I want to short circuit my comments and get right to the experts, and then of course, we’ll have some time for conversation in q and a.

So with that, let me introduce today’s attendees and experts and entrepreneurs. And I’m delighted that they could join us and, deeply appreciative that they co time. To share their expertise with us we have Alicia Chung Rodriguez. Alicia is an engineer and inventor who is the founder and c e o of Bloomer Tech.

She designs wearable technologies that can allow for personalized healthcare, particularly in the treatment of cardiovascular disease in women. She was named a TED Fellow in 2021. Secondly, we have Satia. Satia is the founder and c e o of I D A R, health and Healthcare Executive with 15 plus years of experience.

In improving the quality and safety of healthcare. He’s been featured in 200 plus media publications and holds a dual master’s degree in public health and an MBA in healthcare management from Johns Hopkins University. Thirdly, Sandra Ventre. Sandra was the group president at BJC Healthcare until her retirement in 2020.

She was also the president of BJ C’S Accountable Care Organization from its establishment in 2012. Prior to work with bjc, Sandra served as president and c e o of the insurer, UniCare. Which was a wellpoint Health Network subsidiary. She also served as the c o and c f O of Right Choice Managed Care the parent company of Blue Cross Blue Shield of Missouri.

She’s actively involved as a board member for a number of healthcare organizations as well. Finally, we have Dr. Adam Wolfsberg. Adam is an obstetrician a runner and a writer based in Boston. Adam, is the Chief Medical Officer at Current Health. He leads the clinical team and conducts research improving healthcare for patients with chronic disease.

Adam’s first book, fragile Beginnings, was published in 2013 and dives into the complex world of newborn intensive care. He is written for the Atlantic Slate, the Wall Street Journal, the Boston Globe Magazine, and other publications. So let’s get into it. As I mentioned in the introduction there’s currently a perfect storm for, home health technologies, a number of macro trends to really allow home health technologies to make their mark take these headlines as a jumping off point and, a framing of some of the problems that our entrepreneurs and experts.

Are, helping to solve today. Starting from the top here, according to the c d c, 90% of the nation’s 3.8 trillion in annual healthcare expenditures are for people with chronic and mental health conditions. So this is an astronomical number that 3.8 trillion represents about 17% of G D P and growing.

Some analysts say that’s closer to 19% in 20 21, 20 22. So it’s a huge number that, that. Is focused on chronic disease which is really different than the episodic care in hospitals that, that the, that hospitals specialize in. Additionally, as we all know, the pandemic accelerated remote care like nothing else ever has.

People are now comfortable with it. About 80% of the US population has now experienced the telehealth visit, and increasingly payers are getting more comfortable with it as well. Hospital home. The hospital home waiver. Reimbursed hospital at home programs at parody to traditional care within the, four walls of a hospital.

And hopefully that’s something we see continue. Also according to data published by the Association of American Medical Colleges the US could see a shortage of between 37,100 24,000 physicians by 2034. That’s primary and specialty care physicians. That are on the precipice of a, steep shortage.

Additionally, as we all know, the aging population is going to put increasing pressure on our healthcare resources. People are living longer. Many chronic diseases are also age related diseases. One stark projection related to, chronic and age related diseases is the number of people living with Alzheimer’s in the US is expected to increase from 6 million today to almost 13 million by 2050.

And finally, sensors are, not only ubiquitous, but increasingly powerful and sensitive. They’re only gonna get more sensitive, more powerful, and and stealth. Which is a great segue to our first entrepreneur who is developing a stealth sensor in bloomer tech. Alicia, can you tell us a little bit about what you’re doing at Bloomer Tech and, why it’s so important?

Alicia CHong Rodriqueh: Yes. Hi Tom. Thank you for having me. I’m really happy to join this panel. So hello everyone. My name is Alicia, I’m founder, and CER as background is in electrical engineering computer science, and. Back at m I t I met my co-founders and we had many personal stories that we shared with each other. Some of them including I am very proudly named Anisia after my grandma who dedicated her life to women’s health as an obstetrician back in a time when women were rarely allowed to, obtain medical degrees and, we lost her to a heart attack when I was only 13 years old. And then when, one of my co-founders was 12 she was waiting at school for her mom to pick her up from school. And that didn’t happen because her mom, who was a 44 year old physician, suddenly died from a stroke. And the these stories are unfortunately very common and for us it is very shocking that 30 years that 15 years later, sorry, there’s over 30 years of evidence that shows that there’s sex differences in cardiovascular diseases and strokes, and yet it’s like none of the tools that we have today or the technologies are tailored.

For the specific differences that have been already identified between men and women. So we thought, okay, now everyone’s building all of these solutions around AI and machine learning. And I had been part of the m i t Computational Cardiovascular Research group. That’s where I, I did my thesis and I had access to some of the world’s biggest data sets in the world.

So when you see data sets like Framingham or Grace, and you realize that hey, only one in every four clinical trial participants. Are female. It’s, pretty shocking because you’re building algorithms based on those data sets and, for us and with, all of the evidence of algorithmic biases and all of these technical challenges that you face because of the quality and the type of the data that you’re collecting.

We, thought we could do something about it, and that’s what we decided to, go after. We’ve been working very hard to, build one of the most comfortable devices that can collect data in a fast way for women, and we’ve created a and patented textile. Sensors that are medical grade, so they look and feel just like any other type of clothing and they can integrate seamlessly.

Into a everyday bras. So we into, to what Tom was saying, it’s a sales device because you don’t even realize that it’s there. It doesn’t have a screen or, anything. It just looks and feels like any other ordinary bra. But now it collects extraordinary data. Right data that can be used for better early detection that can be used to, titrate medication because women metabolize drugs, differently.

It can be used for, a lot of different conditions and, diseases that we, are seeing people facing today. So it that’s basically what, we’re doing and why we’re doing it, and we can discuss further as the panel goes through.

Tom Bunn: Great. Thank you Alicia. Just a, couple questions right off the bot bat.

Can you talk about the sensitivity of the sensors and what, you think is as the near term clinical utility? What, sort of disease indications. Or other ailments are, you initially going after?

Alicia CHong Rodriqueh: Yeah, so there’s, a couple of things there. We’ve done early feasibility studies at the MIT Clinical Research Center when we compared our sensor for a traditional hal a not a ter, sorry, A traditional e ecg, hospital ECG device.

And in terms of sensitivity, it we, had a 92% a similar signal. We, had a protocol where there’s motion and there’s different things in terms of, giving stress to the sensors, and ours actually performed better. It was 92% similar, but the rest, diet percent, that was different. Ours was performing better, and we are doing other studies because we’ve designed it in a way where we take into account the differences that, that men and women have in, the physiology for the interpretation of the data, but also in the design of the device and how we reduce all of these.

Issues that other manufacturers are not taking into consideration that cause. Are sources of noise or lower yield in these devices because women have breast tissue or they have a different lifestyle and needs that haven’t been considered in the divi, in the sign of other devices that can be attached like stickers, for example.

Or that can have wires, that babies can pull. Different, things like that have been considered in the design of our, device.

Tom Bunn: Great. And I, understand you’re also targeting a, consumer pathway as well. Can you talk about the, plan you have for the split strategy between helping healthcare organizations and going direct to consumer? Curious how you’re thinking about that dual pronged approach.

Alicia CHong Rodriqueh: Yeah so, for us it is very key that we focus on the medical grade quality of our device. We want to be able to, get better and better because we, right now, we can collect the traditional a biomarkers like you have listed here, electrocardiogram, respiratory rate, heart rhythm, right? But, we’re a continuous monitor.

We con collect a lot of data over time. If you think about it in one day, we collect a over 500 megabytes of data per patient. That’s, a lot of data. And eh, this means that we’re not like a picture that, just that snapshot in time. We work more like a video, right? So we, foresee that we’re going to able to help make decisions, predict predictions.

In a better way over time. So we do have identified some of the digital biomarkers that we’re going to be able to give consumers once we’re ready for that consumer. A population. We are first focusing on monitoring a patients that already have been diagnosed and or have a high risk of heart disease and stroke.

Tom Bunn: Fantastic. We have we’ll have, I’m sure some more questions towards the end. But Alicia, thanks for walking us through what you’re up to at, Bloomer Tech. In an interest of time. Want to move on to Satia at, iar r IDAR. Forgot to show this infographic on Lilly. The the product that Alicia and Bloomer Tech are developing here.

But Satia, can you give us an, update an overview on, Idar and, what you’re working on?

Sathya Elumalai: Absolutely. Thanks so much, Tom, for this opportunity. I’m Saia, I’m the founder and c e O of AR health. R is a digital medicine company where we aim to reimagine today’s standards for chronic disease management, digital medicine, and aging in place.

Our mission is to actually design and deliver evidence-based digital medicine tools and interventions to improve the quality of life of patients with chronic condition and also empower them. To make sustainable behavior changes. It all really started my mom, she was diagnosed with the diabetes almost 15 years ago, and then hypertension.

But we all, everybody thinks right. Diabetes and hypertensions are really common conditions today. People just take it for granted. Which also what happened in my mom’s mother’s case where that led to actually, now she has chronic kidney disease and, it’s being, it’s brutal to be a caregiver because you have to measure every drop of water and every gram of salt because of her fluid restriction and salt restricted diet.

Which is where. There was always this frustration, right? To find a solution that is not measuring only one aspect or just the primary condition, but also something that can measure an individual’s overall health. And we, me and my co-founders they were looking into where we can. Collect hundreds and thousands of health information from an individual and at least help use that data to map somebody’s health every single day.

Which is what led us to build this device. This is this is our device, a small handle device. It’s more like a breathalyzer. The user holds a device and place it in the mouth and breathe through it normally for 30 seconds. At the end of 30 seconds, they perform lung function tests, essentially taking a deep inhale and forcefully exhale twice.

Essentially. Today our device measures the user’s temperature, blood pressure, E C G, oxygen saturation, pulses rate, respiratory rate, respiratory flow morphology. Heart rate variability, and lung functions. It provides a more holistic view of an individual’s health every single day. And this device is also sends that they’re using 4g, so it has a chip within iot technology.

Somebody doesn’t have a smart device, they could still use the device. And it also, the device also has communication capability so you can actually interact with it if required. The best part about it is like after almost six years of working on it we finally f d a cleared CE mark approved i o certified md, SAP certified and HIPAA compliant and GDPR compliant.

Why I mentioned all those things is primarily when we started, we didn’t want it to really. Look into another consumer gadget or another technology, but we wanted something that is very simple to use at the same time it is medical grade. We’re fortunate that we got all those 10 plus parameters, f d a cleared today, and we are using this technology and our enterprise platform to help manage patients with chronic conditions and also work with pharmaceutical partners of pharmaceutical companies.

To help use that data to actually help improve their drug efficacy. Look at the effectiveness of a medication, look at toxicity, tolerability, and various other things which is very integral to manage somebody’s health. And then also the key factors. It’s. It’s not like in any, other device.

It’s not like one off where we start like getting to a point. But in this case, because of the device actually goes in the mouth, it has access to breath and saliva, which in turn gives access to many other biological indicators of health. So right now we are working on, already start working on the next versions of the device, which includes other biomarkers, breadth, and saliva based which will also go through validations.

And hopefully we’ll have at least a version every year. In the next few years. So my, co-founder calls it, it’s more like a check engine light for humans, which is what we are trying to achieve. So that at least spend one minute of your day to get a comprehensive health assessment. So I’ll probably stop here.

I know there’s some questions, but happy to tell you a little bit more about the tech and, also

Tom Bunn: the business. Great. First question comes to mind Satia is What the disease indications you guys are, focusing on with these with the health systems and also with the the pharmaceutical side.

Can you talk about the ideal situations for which this technology is, suited?

Sathya Elumalai: Absolutely. I think because of this barometer and there are a lot of people just always more interested on the respiratory side. So we also focusing on asthma and C O P D but also working on certain initiatives with heart failure and c KD or chronic kidney disease.

So those are the four ind Conditions and indications that we are working on from a pharmaceutical company perspective. There are a lot of applications from the oncology side, which we are exploring right now. So we, because the, value of measuring all these parameters is really critical in, in almost all the conditions, so we can expand into others, but right now it’s primary focus is respiratory.

Tom Bunn: Got it. Do you see a market for for direct to consumer in-home wellness or is that not something you guys are focused on at this point?

Sathya Elumalai: No, I think we definitely wanted to expand our capabilities. I think direct to consumers would be a great opportunity for us, but I think we also need to build our capabilities to support scaling into direct to consumers.

So we are really looking into that next year. This year we are more focused on our current

Tom Bunn: efforts. Sure. And can you describe at a high level some of the, pharmaceutical partnerships, if you can?

Sathya Elumalai: Yeah, I think we, we signed a major pharma partnership where we are really looking into building our technology as, a digital companion tool for asthma patients.

I think they are the first device that can not only just look at asthma, but also. Other overlapping conditions like, for example, C O P D. We’re working with our pharma partner to really leverage our technology to help predict an exacerbation at a very early stage and, prevent hospitalization, but also help guide them through their care journey and an offer.

Superior value to some of the products pharma, our products that are out there. We, are putting in both our technology and platform to help enable that kind of an interaction between the patients and the the users or the participants or patients.

Tom Bunn: Got it. And one of the obvious positive attributes of this is it’s, a one stop shop for all these biomarkers, right?

Can you talk about. The kind of the, biomarkers that you think are the most unique that give you a unfair advantage in, this market and, why that particular biomarker is unique and the development that you had to do to to, put those all under one roof.

Yeah, I think

Sathya Elumalai: For us, we definitely went, did not go into the path of okay, let’s put in like 10, 10 things. But these were done through like user studies where we looked into today poly chronic condition is a new normal. Most people have at least two or three chronic conditions. So we looked into what are the factors that are essential for them and.

What are something that needs to be measured at the same time? And compared to measuring one or two parameters continuously, what we saw is like measuring everything at the same time offered superior value and insights and a broader picture. So one, looking into our, end of the system where we can see everything at the same time, we can look into false positives and then also pick up false negatives.

So some of the parameters that you look into, like for example, blood pressure is, a key indicator. Not a lot of people have that. And also from respiratory flow morphology, which is more like a unique fingerprint for individuals. So we can do a lot of analysis with just the respiratory flow morphology that we measure.

In addition to that we, have a couple of other breath based capabilities that are currently in our in our device, which we, once we get our F D A clearance, we will actually really report those as well. Those are the key things that are going to make it indispensable.

Tom Bunn: Awesome. Really cool technology.

Satya, thanks for joining us. Again, we’ll have some more questions at the end as time allows, but thank you very much. Absolutely. Thanks. Next up, Dr. Adam Wolfsberg from Current Health. Adam, can you talk to us about, current? I know you’re a bit Senior to some of these other startups you’ve been current has, been around for a bit and has is now a Best Buy company.

Curious kind of what current health is up to and how you think about your, core value proposition at, current.

Dr. Adam Wolfberg: Thanks and, I’m not sure we’re senior. I think we just got acquired.

Tom Bunn: Yeah, that’s the wrong use of words there.

Dr. Adam Wolfberg: So current health enables healthcare providers to take care of patients in the home.

And Tom, if you go to that slide this sort of covers what we do. The At our core, we’re a data platform and we enable the collection of vital signs, patient information and other data from the patient in the home. Make it available to healthcare providers remotely to manage that care and then integrate it into the electronic health record and, other systems.

We have, we do have our own proprietary wearable that streams continuous vital signs, heart rate, respiratory rate, oxygen saturation step count and, skin temperature. But we are increasingly becoming device agnostic recognizing that patients and their providers wanna select. The vital sign monitoring devices that are most appropriate.

And so we accept data from those devices as well. That is from f d a cleared highly reliable medical devices as well. We provide connectivity in the home because we want to be available to patients in all locations irrespective of their. Whether or not they have a smartphone, whether they have internet in the home, whether they have English as a first language.

We’re very focused on enabling the, crossing of health equity barriers. And we wrap this with, services, we’ll deliver the technology. We’ll pick up and clean the technology. We have a nursing team that will monitor vital sign data. And so as you can imagine, we end up powering a number of clinical programs, including the hospital at home.

Programs that are part of the C M S Hospital at Home Waiver admission, readmission prevention, chronic disease programs, population health programs. We also work with large pharmaceutical organizations to enable their decentralized clinical trials. And, we were privileged to be part of a couple of the COVID vaccine trials.

Supervising the safety of, patient participants during that process. In terms of the organization we were founded by a couple of guys in Scotland in 2015, and the, company pivoted a, few times before landing on the home based monitoring environment. The r and d team is in Edinburgh.

The center of our commercial operation is in Boston. And it turned out that we were a good fit for the. The vision of the Best Buy health organization to be part of their ecosystem. And the company was acquired, current Health was acquired in November. And so we’re in really the early days of beginning to be integrated into that, that broader Best Buy health ecosystem.

Best Buy Health has a, suite of products and services that, that enable care in the home. They have an active aging business, for example, that provides services and fall detection and connectivity to seniors in the home. We also have caring centers that, that reach out to patients on behalf of payers and providers and, We at large reach about a million patients in any given in any given month.

So we’re excited to be part of that broader organization and see a lot of opportunity in, allowing patients to receive health services where they want, when they want them. But it was a to your point Tom, it was a little bit early in Current Health’s journey. We were not expecting to be acquired.

Literally six months after we rate a large B round. But it’s been a perfect fit and we’re really excited about that process.

Tom Bunn: Great. Thank you. Adam. You mentioned a million patients per month. Is that just on, is that just on the Best Buy side, or can you give a sense of kind of the, scale, the patient, how much, how many patients you’re touching in general through all of your partnerships?

Dr. Adam Wolfberg: Yeah, so that, that’s largely Best Buy. So if you go online, if you go into a store you can buy the lively suite of products. And that’s a variety of different devices. That have fall detection and a single button that connects the consumer to a caring center where someone who’s exquisitely trained will help solve their problem, whether they did infect, fall and they need emergency services.

It’s a per service, or whether they needed to be connected, for example, to a a licensed social worker who can help solve problems of food insecurity, loneliness. Transportation even access to care. We have a new partnership with a telehealth physician company to, to provide access to care through these programs.

And then that suite of services becomes more and more complex, reaching current health at the top of the complexity spectrum. And we serve about 20,000 patients on any given day across about 60 health systems. In the us, across the NHS in the uk and through a handful of global pharmaceutical partners.

Tom Bunn: Terrific. I’ve heard you listened to a podcast a couple days ago, and I heard you say that 75% of Americans live within 15 miles of a Best Buy, and you were explaining the customer service, the great customer service. Component that Best Buy has curious if you can how you think the integration’s going.

Obviously the part of the customer service is on the Geek Squad side. Do you see the Geek Squad coupling or beginning to have n nurse practitioner capabilities, or how do you see the great customer service that’s been. Established already in Best Buy’s historic business with, this new Best Buy Health side?

Yeah, it’s a great

Dr. Adam Wolfberg: question. And I, would say that where there’s real synergy between current health philosophy and Best Buy’s philosophy is in that, sort of customer interaction. I, have the personal experience of current health, of having both outsourced our level one technical support and outsourced our.

Clinical Nurse triage service failed to provide a level of service that we thought our patients, our clients, patients deserve. And so brought them in house and built two in-house W2 teams to provide that service. So like I, I know what good looks like and I know what bad feels and and, Best Buy is the same way.

And I, think. You, of course you run into the, dichotomy between really high quality, well-trained customer support, patient support, and the demand to provide a cost effective solution perhaps offshoring it. And I think that where we and, Best Buy see things is that, the un unless it’s incredibly high quality it, just doesn’t serve the business.

And when we bring together our approach and the Geek Squad and these caring centers and I’ve visited them myself and listened to these calls it’s a great, it’s a great approach. It, may not be the most cost effective approach, but it’s, a great approach.

Tom Bunn: Great. And the website mentioned some, pretty astounding outcomes data on readmissions ER visits.

I was hoping you could expand on some of those and what, you’re seeing in terms of kind of the, clinical utility and from a different view, the cost savings to, your customers.

Dr. Adam Wolfberg: Sure. I’m. I’m not exactly the sort of target physician demographic of, current health cuz I practice obstetrics.

But I have plenty of experience of having the patient who for example, the patient with preeclampsia after delivery, who’s on the cusp. Is it safe to send them home? Is it not safe to send them home? Can we have a, can we have insight into their blood pressure as we continue to titrate their medication?

Or, and the, instinct of any. Any well-intentioned physician is to keep the patient around so you can keep an eye on them and make sure that, they will genuinely be safe when they go home, and to give them a connected set of devices that allows for supervision through telehealth interaction enables early discharge.

We see it again and again where patients are. Are really ready to go, but they need a little more surveillance. And so we enable that prompt discharge. And naturally that’s cost effective. You have to have the right payment mechanism. And for hospitals that are paid on a day-to-day basis it, doesn’t work necessarily.

They don’t wanna send discharge that patient. For hospitals that have tons of capacity, they may not be in a super rush to get patients out these days value-based care is, more and more reality and, particularly in urban areas where capacity has been a, major problem, we’re seeing that really resonate from a cost reduction perspective.

Tom Bunn: Great. Last question is just around how you discount the probability of the permanent regulatory or the reimbursement change as you’re close to all this. Curious how you’re thinking about when, if, what that discount looks like for that, that parody of reimbursement for hospital at home type of care.


Dr. Adam Wolfberg: so for, those who aren’t familiar with it, there’s a c m s waiver in place right now that essentially allows a very quick path for hospitals to stand up these hospital home programs where if they provide. Genuine hospital level care to patients who meet inpatient criteria in the home. They can re be reimbursed to parody, which has allowed a lot of hospitals to stand up these very acute programs pretty quickly.

And the question is, how long does this waiver stick around and what, follows it? And I, have a a couple thoughts on it. First of all, I think that we’ve seen really great outcomes and potentially, Better outcomes as patients are cared for outside of a facility where nosocomial infection’s a big deal and patient satisfaction is super high.

We certainly see that in our NPSs floors. It seems to me implausible that the hospital home program is gonna simply go away. We’ve made too much progress. We’ve shown too much impact. I can’t imagine it’s gonna go away. Is it gonna get paid at parody? I can’t imagine it would be, honestly. If it’s the same the incentives end up being wrong.

But is it paid at 80 cents? Is it paid at 90 cents on the dollar? That’s what I imagine. I think the other issue that we’re gonna need to address is what about the problem of creating reimbursable bed days that don’t have any state-based regulations? The, certificate of need programs don’t necessarily apply to hospital at home beds, and we know that building beds and building facilities can simply balloon costs just by building them.

Here in Boston, for example mass General Brigham is in this sort of regulatory and, public relations campaign. Fight against a variety of, public interest folks who are just worried about the cost of care if, mgb builds a big new facility on the South Shore. These are really common state level challenges, and c m s is gonna have to think about that when they start authorizing virtual services that are expensive.

Tom Bunn: Fantastic. Adam, thank you for joining us. Again, I’m sure we’ll have some questions towards the end but wanna switch, switch gears a little bit. We have Sandra Vane who was former president of BJ C Healthcare, as well as the bjc A C o. Obviously lived through a inflection point with the beginning of the, Covid pandemic.

Sandra Curious. How you get to get a little bit of your background and, how you think of some of these emerging home health technologies wearing both your your health system hat as well as your, payer hat.

Sandra Van Trease: Yeah. Thanks, Tom. Good Morning, good day to everyone. Pleased to be here.

And thank you for the panelists. I’ve learned a lot about each of your innovations and they’re very exciting. My background as Tom has mentioned most recently Past 16 years or so was with BJC Healthcare in St. Louis. We’re a integrated 15 hospital integrated organization. We are affiliated with Washington University Medical School here in St.

Louis. And I had the opportunity to do a number of innovative things frankly, which was. Very crystallized as it relates to the topics that we’re talking about here today. Prior to my stent on the provider side, I spent 10 plus years on the payer side serving as president and or c e o or some suite C-suite.

Role in blue Cross Blue Shield and in one of the wellpoint companies, as Tom mentioned. So I I bring to this a payer and a provider perspective and was particularly focused on the integration of those two. Sectors of healthcare, frankly, because one being the financing and one being the proviso of care.

It’s, exciting that we can, that we continue to look for ways to solve not only clinical risk challenges, but also those financial risk challenges. And happy to be here, Tom. Thank

Tom Bunn: you. Great. Thank you Sandra. Really appreciate it. So curious to get your. Perspective on the biggest opportunity that you see from a provider perspective here for not only this, area in general specifically perhaps focusing on the, entrepreneurs we just heard from what you think the biggest opportunities are as from your experience on the provider side and, how you would go about digging at some of these opportunities.

As a case in point with some of the, technologies and companies we’ve had, We’ve heard today.

Sandra Van Trease: Yeah. Yeah. And the pandemic really crystallized and focused providers, I would tell. I would say like nothing that we’d ever seen in our lifetimes before. And safety, of course, was paramount.

Safety of the teams, safety of the patients. There were a lot of organizations that made decisions to stop providing not what they were, was deemed non-emergent care. It was a critical component of, the last couple of years. It was a difficult one. One thing it taught most providers, and I’m sure that Dr.

Wilford could also support this is when we start to focus on something and you have a laser-like focus, which the pandemic required. Things get solved. And my example in terms of its applicability here is the virtual care the, telehealth, telemedicine. We’ve been working on that for several years to launch that in a meaningful, scalable way.

We got it done in three weeks because we had to, it was the only way we were going to see certain patients. And Tom indicated earlier, You said that, people are getting comfortable with it in terms of the statistics? We not only did the patients become comfortable with it, but importantly the providers had to learn how to do this.

This was not something that they normally did and and so they had to get comfortable with it. So we’re not only teaching patients, but we’re also teaching those who prescribe and provide the care. It did, of course, elevate the concerns relative to the patients. We were not able to see all of these people that you’re talking about with chronic conditions.

How do you stay connected and frankly, what would c m s and the other payers allow us to do? That emergency use order and emergency orders that, Dr. Wilfork talked about was critical and how it get, how it plays out in the future is also critical. I completely agree. It’s unlikely that we are going to continue these reimbursements at the parody level but I also agree is hard.

It’s gonna be hard going back because. To the point about what’s the opportunity for, from a provider standpoint, Tom? All providers are focusing on demonstrating en enhanced outcomes. Reduction of readmissions, avoiding unnecessary emergency room visits, and they’re struggling on the staffing side with having clinicians home health clinicians that go visit people in the market.

There’s not enough people and the workload is too, much. So how do you deploy technologies that can integrate with a health system’s clinical records? I think and be trusted by the providers. That interest will continue to grow. We just have, to figure out how to make that happen.

Tom Bunn: Interesting. One, one question your comments sparked is, just about patient sentiment and Whether or not reimbursement gets billed at parody going forward. That seems to be an open question the patient’s sentiment side do have, from any of your experience have you found that patients receiving telehealth or home health kind of implicitly think that their care is, less than or not as beneficial as receiving care within the four walls of a hospital or?

How do you think the patient sentiment, obviously many patients are touching telehealth for the first time over the last two years, but how is, how do you think patient sentiment stacks up and do they think they’re getting parody of care?

Sandra Van Trease: Yeah. I, think it’s a valid question that all of the entrepreneurs, the innovators need to think about.

And I would probably say it depends not to evade it, but I think that the patient, the consumer journey, the customer journey is one that everyone needs to think about. Because the journey for a 35 year old female with two kids, perhaps it may be a different journey than the 78 year old gentleman who’s retired and, is used to a certain type of relationship with their provider.

I do think it does depend. And I think it, is innovators are well served to think about the patient journeys and create scenarios because if, I were talking to Satya and Alicia specifically and I, wanna know who really gets specific about who your target market is, right?

How does the patient interact with something in this techno technological space? Are they savvy? What do they have at home? So how do you position this really to solve that problem from the consumer patient’s perspective? And then on the flip side, frankly you gotta think about it from the provider side too, Tom.

It’s a workflow issue for most providers. Not only a finance question, but it’s a workflow. There’s a lot of data, as both Alicia and Satia said, there’s a ton of data. And that’s being transmitted by the patient to the provider. What do they do with it? It can be overwhelming and the patient has an expectation.

Is my experience that because this, these data are available, the provider knows it as quickly as they do and they perhaps have an expectation that is one of a very quick response. Some providers are comfortable with that. Some providers are

Tom Bunn: not. Got it. Great. Thank you. Wanna switch gears a little bit.

Sandra if, you were being pitched these companies tomorrow wearing your, BJC president hat what would be, what’s the most important thing? What’s the most important question? Perhaps you just alluded to it, but would love to hear what you think the most important thing is and, then perhaps to get some, responses from our entrepreneurs on the call today.


Sandra Van Trease: I

do think it’s a bit about how what is the target and, I have probably multi-factored questions. Who buys this? How does it get to the end user? What triggers the end user to get it? And in front of all that, of course is what is the problem from a provider’s perspective.

I’m the provider. What problem are you trying to solve? Can you really articulate the problem that you’re solving my problem? And then how does it get to where it needs to go? As I alluded to it’s a workflow question. So we might we might just stop there and, see what their thinking is in terms of really crystallizing the problem statement from a provider’s perspective, and then how it gets deployed in, into the workflow.

Dr. Adam Wolfberg: I can be the first Guinea pig here. And I think it’s a really interesting question and what I would say is how I started is that current health, for example, enables providers to take care of patients in their home. I would admit to you that, some of the challenges that we encountered were not what I thought.

So I’ll give you an example. I remember pitching a large health system on a hospital at home program. And I went and talked about our technology and essentially said, however you want to deploy your hostile at home program, we will support you. We will do whatever it is. You just tell us how you wanna do it.

And we lost that deal. Because the, another one of our competitors went in and said listen, we have a very strong point of view on how you should deploy your hospital at home program. We will guide you every step of the way, and that’s what the health system wanted to hear. And since then we have developed deep clinical expertise in how you deploy these novel virtual programs.

We’ve built, as I said, services around that in terms of nursing, in terms of logistics in terms of. Ancillary services that are not core to our platform, like phlebotomy and infusion services because our partners were going down this road with us together. We, initially thought they were the experts and we would enable it, but we learned that together we had to be the experts and that’s how we had to solve some rather novel problems at a very difficult time in our public health history.

Sathya Elumalai: Definitely I wanted to piggy back on what a Adam said. I think most of the customers or like providers are interested in a single solution that can be end-to-end in a way so that they they wanted to know who’s accountable for this patient’s health. Oftentimes a lot of technology companies today go and say, okay, we can provide this amazing solution, but then.

What happens if there’s something that comes out of it which is for example, companies like Current Health and others have done a really good job of kind of tying everything together. The other thing is really from a privacy perspective, I think we. Patients are really concerned about their privacy.

So what we are doing to help improve privacy and, definitely improving the clinical decision making process, right? So you’re getting all these data that’s great. And then I can see the patients, but. How will I visualize what is right and at what time point we need to get the data.

So that’s where it is. It’s very important to put levers in place so that physicians are informed. But when there is an absolute need and there is another layer of support that is always required, both from a patient as well as provider perspective I think. There are a lot of codes right now available to remotely managed patients.

So a lot of companies are leveraging that. So that’s understood. Most most companies have taken that approach of getting some revenue or shared revenue from providers. But what one thing that companies or organizations. Need to really focus on is to actually see what is the long-term value.

And, today there is a huge shortage of healthcare providers or, staff. So is this solution gonna solve my problem of healthcare shortage? It’s also something that is very important to address as we are talking to health systems.

Tom Bunn: Fantastic.

Alicia CHong Rodriqueh: I, can keep in, in, in a different way because I think one of the things that, that everyone alluded to ties in with the fact that for us we, do focus. Significantly on women having a cardiac event. And after a cardiac event, the average cost typically can be, or the biggest problems that, that providers want to, not have is the fact that she can have a recurring episode.

And after a cardiac event there’s, an average of $1 million of costs. On female patients because their outcomes are poorer, right? So we, know that, and we know that 75% of these can actually be prevented. There’s studies that show that it could have been prevented. So using. Home health and remote monitoring tools, right?

Like I, I think there, there are ways where the fact that when we’re in the hospital, we have a team of clinicians, when we’re outta the hospital, we’re on our own right. And that home health is enabling this transition. And everything that Adam has shared, eh, here is, very exciting, right? Because it’s, that transition that you are not alone at home either.

You, are able to. To life without disconnecting. But at the same time, feeling that, eh, sense of, trust eh, with your healthcare and getting that back into the healthcare system is really important because I, think our, devices do have to do a lot of work to give trust to the providers by providing that medical grade quality where they can use it for decision making, eh, at the same time.

We need to be comfortable and easy to use with the patients. Which is why our device looks unlike any other medical device you’ve typically seen, right? Like it looks like something you would find in your closet, not in your hospital. Eh we, do. We, have made an effort so that our users can be, feel very comfortable by wearing it each day because it’s something they’re, they have been used to most of their life, right?

So it, it doesn’t change their daily habits. It, ties into what they’re already used to. And I think home health is making that transition so that you can make those lifestyle changes alongside with, your care providers and disincentivizes. The, providers and the payers because they can actually reduce the biggest problem, which is a recording episode.

Tom Bunn: Great. Thank you Alicia. And looks like we have a question from the audience. They ask how is this going to impact the business model of academic medical centers in terms of clinical care and research trials? How do you see this landscape changing? What are the threats to these new models of care?

I dunno if anyone wants to take that one.

Alicia CHong Rodriqueh: I would definitely like to start, but I think people are going to say amazing things in this one. I just would say that decentralized clinical trials are really happening. They’re bringing real world evidence and it’s, just very exciting to see how.

Different medical device companies, the big ones, and pharma companies have been interested in our product because we can help them retain and recruit patients to these decentralized clinical trials patients that they were before. A to, to Sandra’s point, like a 36 year old mom of two kids will have a harder time participating in a clinical study unless it’s decentralized.

So we’re, opening the doors. In a way that is unprecedented, which is exciting.

Sandra Van Trease: Yeah. I and, I’ll just add I think there are so many benefits to clinical trials and, all that that, that, does tell us, but I think we’re, a number of these kinds of organizations like, we’re hearing from today. Can help is to take it to the next level. There, there are downsides for clinical trials and Alicia alluded to, them.

We all know them generally, we have We, we exclude certain populations from these trials for variability reasons. And as such, the outcomes of those clinical trials while leading us into evidence-based care, which is critical may not be as applicable to a patient like me. And so I, look towards the future where, The the inclusion in clinical trials of more real world patients will continue to, be supported and evolve to get better outcome data.

Tom Bunn: Great. Thanks Sandra. We have a question about cost of these devices. Alicia and Satia can you comment on, the cost curve and what this will be at scale and, as opposed to the current PRI price today?

Sathya Elumalai: Yeah, I can jump in. I think for us we, are pricing it more as, a SaaS model right now, so we are integrating the device cost into it.

But happy to talk offline about whoever wants to reach out. Definitely wanted to discuss more about the pricing. Great.

Tom Bunn: I know we’re at the, top of the hour here. I’m conscious of our very generous guest time. I want to thank our guests for joining us. As a reminder to those in attendance, we host these calls roughly once a month, alternating between topics in food and ag and healthcare.

My colleague David Yoakum will be hosting one. We’ll be announcing that shortly in the next coming weeks on some topic. A fascinating topic in food and ag, I’m sure. And we will email you the details of that. So again, thank you to our guests today and thank you to those in attendance, and we will see you next time.

Everyone. Have a great day. Thank

Sathya Elumalai: you, Tom. Bye-bye. Thanks. Bye-bye. Thanks everyone.


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