Thinking about the Government’s Role in Healthcare and Life Sciences Technology Innovation

My personal philosophy of Government is one that takes a long-term view, provides infrastructure and conditions to enable Citizens, and holds the massive responsibility to self-regulate and optimize itself.

I have read four books recently that have really informed my views and inspired me about the role of our Government in Technology:

I want to see Government continue giving Entrepreneurs Access to:

  • Data
  • Policy Makers and Regulators
  • Pilot programs

The Entrepreneurs, Venture Capitalists and Big Tech Giants will build products, fund ideas and get innovation to the people. Government will ultimately set the regulations. Lately, Government has also taken on an increasing role in sponsoring hackathons and innovation challenges (Challenge.gov) to promote adoption of their data sources and generate awareness of their role in the overall tech ecosystem. From the JOBS Act to Patent Reform to Cybersecurity to the Open Data Initiative to the America Invents Act, there are many good examples of progress outlined on Whitehouse.gov.

I also recommend this Recode Decode interview with the U.S. Chief Data Scientist DJ Patil for good examples of how various Government Agencies are using data to iterate on problems.

As I zoom in on Healthcare and Life Sciences I think about:

  • HL7, FHIR and data interoperability
  • Open Data Initiatives and Data.gov
  • FDA regulation, Medical Devices and GxP compliance
  • HIPPA compliance
  • Cures Act
  • Moonshots
  • Why do we allow drug ads?
  • Reproductive rights
  • Medicaid, Medicare
  • ACA impacts and opportunities

There are incredible examples of Government using their scale to make progress such as the Million Veteran Program (Genome study) in which Veterans volunteer their DNA analysis and health information into a massive database for Researchers. Government is also funding technology pilots and new approaches to improving care such as a Mount Sinai paramedicine pilot in which Paramedics consult via telemedicine with Docs and treat the patient in their home without transporting them to the hospital.

I hope our Government continues to build upon the power of open data, collaborate with Entrepreneurs and view Healthcare as a fundamental right for our society and citizens.

The First 90 Days for a Product Manager New To Healthcare

I talk to Product Managers all the time that are considering building products or features that would move them into the Healthcare space. This post is for them.

As you venture into Healthcare, you are embarking on the most TLA filled space imaginable. Talk to other Product Managers that are veterans in the space and you’ll barely be able to follow along. They are not trying to sound smart, it’s simply that the TLAs get ingrained so deep that it takes real effort to not use them.

You’ll also come across a few big topics like:

  • How regulation impacts business models
  • Selling into large Healthcare organizations
  • HIPAA and GxP
  • Healthcare and Life Sciences are very different

I began my first 90 days as a PM in Healthcare on a beach in Florida with my wife and kids on Thanksgiving break. I lounged around reading/listening to these 3 books:

Doing this gave me an understanding of the ACA, Pharma and all of the problems especially in the US Healthcare system. I was beginning to understand some of the TLAs.

My next step was to talk with other Product Managers. I had to ask a lot of dumb questions in these conversations but everyone was super nice and helpful. #givefirst These conversations helped me build a list of news, people, podcasts, blogs, etc that now make up my daily healthcare and biotech information pipeline. On a daily basis I found myself reviewing the Healthcare Top 100 and thinking about the business models of these companies. I subscribed to daily healthcare industry news from Becker’s Hospital Review, STAT and Modern Healthcare. I followed Zdogg and David Chase on LinkedIn. I listened to podcasts from Catalyze.io and a16z.

At this point in my first 90 days I was back in the office, still under a nice “you are still new” grace period and learning from everyone I could. The next step was to talk to Techstars Alumni, Denver-based Founders and friends of mine that are running Healthcare Startups. I had 50 conversations in two weeks and summarized most of them in a shared Box folder the team uses. For a handful of the conversations, I summarized and sent an email to entire team to raise awareness. This quickly established me as the expert for our “Healthcare Startup Developer” persona.

In the first 90 days:

  • Tell stories to build empathy about the people the product is trying to help.
  • Establish yourself as the voice of the customer on your team.
  • Show you are passionate and curious about the problems to be solved and the people you are trying to help.

It’s been one year since I began my journey as a Product Manager in Healthcare. I am once again sitting on the beach over Thanksgiving break pondering our Product Roadmap, Industry trends and reading everything I can about AI in Healthcare, Big Data Analytics use cases, Serverless Compute, how the ACA may change in the next Administration, CRISPR and more.

If you want help with your first 90 days, please don’t hesitate to reach out….and good luck!

Photo Credit: https://unsplash.com/@joaosilas

Thinking about Enterprise Software Startups

I ended up down a rabbit hole of research on Sapphire Ventures thanks to the Origins (Notation Capital) podcast on my flight home from Boston early this morning. Sapphire invests in Enterprise software companies. I got to thinking, if I were to analyze companies in that space with my Product Manager hat on, what would I look for?

These 5 areas came to mind.

1. How will the Product interoperate?

Ex: Zapier, BI fabric, Hybrid Cloud

Is the team thinking about how to move pieces of data around from their app to other apps, from their app to the Enterprise systems, between their Public Cloud and the Enterprise’s on-prem and Dedicated Clouds?

How will insights and raw data from their product be accessible to the Enterprise’s BI Fabric, Data Scientists, etc? How does that strengthen the value of the offering?

2. Where are Users interacting with the Product?

Ex: Mobile, APIs, Slackbots, Echo

Is their product enabling all types of Users to be engaged anywhere? Is extension of the product easy by a Customer Developer via APIs? Is there potential for an Ecosystem to organically grow around the product? Does it feel like a Platform? Is the pretty Mobile app for the on-the-go Sales person just as well thought out as the Developer API?

3. What are the Combinatorial Effects?

Ex: Exongenous Datasets, Data Network Effects

Is the team thinking about combining datasets together to create something new? Does the product have inherent data network efforts? As more people use this, will the value increase?

What two features used together accomlishing something really powerful?

4. What role does analytics play?

Ex: NLP, Computer Vision, Salesforce Einstein

Enterprise data is flowing through the product. How is that data being mined into features? How are signals being extracted using NLP, Computer Vision, Machine Learning, etc? Does the business analysis get smarter the more people use it? Does AI feel like a foundational part of their approach or do they think of it as gimmicky and a nice-to-have?

5. Talk about the Tech Stack

Ex: Microservices, Serverless

Is the team using technologies like AWS Lambda? Do they talk about Reference Architectures and Blueprints? Are they taking a Microservices-first approach?

A few more articles I came across while writing this post:

It’s fun to think this stuff through. I remember the days of meeting with investor after investor while in Techstars and how many of those conversations led to strategy and product improvements.

Healthcare and Life Sciences Corporate Venture Capital

Moving from a background in AI and Developer Tools to Healthcare has required a crash course in healthcare policy, finance, technology and regulations. I’ve always looked to investing trends and analysis to help me better understand a market. Looking at Corporate Venture Capital (CVC) in healthcare and life sciences is a fun exercise.

“over 48% of the top Fortune 100 companies have a corporate VC arm and these corporate VCs have participated in 24% of total deals globally for the past 4 years.” [source]

First, a few basics on Corporate Venture Capital…

Why does the Corporate Venture Group exist?

  • Generate financial returns for Limited Partners (LPs) including parent Corporation
  • Generate revenue for the Corporation
  • M&A channel
  • Licensing, Divestiture, Partnerships
  • Foster Innovation, Identify Global Market Opportunities, funding initiatives that need to exist outside parent Corporation structure

What do Corporate Venture Groups do?

  • Build a Portfolio of Investments that could range from Series A to “evergreen”
  • Build an Ecosystem of Strategic Partners
  • Generate revenue from revenue share deals and equity positions
  • Invest as a Limited Partner (LP) in other Venture firms

So, what’s going on in Healthcare and Life Sciences Corporate Venture funds?

From this CB Insights report, you can see the most active funds include Merck Global Health Innovation Fund, Kaiser Permanente Ventures, Lilly Ventures, Siemens Venture Capital, Pfizer Venture Investments, Novartis Venture Funds, GE Ventures and of course Google Ventures.

Corporate Venture Capital (CVC) in Healthcare

Includes Information Technology, Therapeutics, Diagnostics and Drug Delivery, Diagnostics, Behavioral Health, retail healthcare and rise of consumerism, new provider payment models, delivery of care, implementation of the Affordable Care Act, Data and Analytics.

Kaiser Permanente Ventures

Siemens Venture Capital

Mitsubishi Healthcare

Vesalius Ventures (Vanguard Ventures, Fremont Ventures and Guidant Corporation)

GE Healthymagination

Merck Global Health Innovation Fund

Johnson & Johnson Innovation

Zaffre Investments (BCBS of Massachusetts)

BlueCross BlueShield Venture Partners

MemorialCare Innovation Fund

McKesson Ventures

Cambia Health Solutions

Rex Strategic Innovations

Corporate Venture Capital (CVC) in Life Sciences

Includes Biotechnology, Biopharma, Medical Devices and Diagnostics, Drug Discovery, Pharmaceutical services, Pharma value chain.

Nova Novartis Venture Fund and Novo Ventures

Mitsubishi Life Science

MedImmune Ventures (AstraZeneca)

SR One (GlaxoSmithKline)

Lilly Ventures (Eli Lilly and Company)

Amgen Ventures

Roche Venture Fund

Samsung Ventures

F-Prime Capital Partners (Fidelity Biosciences)

Takeda Ventures

Baxter

Pfizer

Some additional reading:

Making Sense of Corporate Venture Capital

The 117 Most Active Corporate VC Firms Of The Last Year

Digital Health Funding: 2015 Year in Review (Rock Health)

Tencent, Google Capital Invest In Indian Healthcare Startup Practo

Medtronic, Sequoia launch $60M VC fund for Chinese med tech startups

Understanding the portfolios of these Healthcare and Life Sciences Corporate Venture Capital funds, the backgrounds of the Partners, where they are based and what companies they invest in help paint a picture for where things are going.

To learn a bit more about Healthcare technology read There’s a lot going on in Healthcare tech right now.

There’s a lot going on in Healthcare Tech

In 2015, venture funding of digital health companies surpassed $4.3B and accounted for 7% of total VC funding in the US. Deal sizes are growing and the percentage of later stage deals is increasing signaling a maturing in healthcare investments.

In my first six months as part of the Watson Health team, I’ve observed a few trends such as:

Google’s Investment in India will impact Healthcare
Google announced they will train 2M Indians on Android OS and promote internet use among rural women by 2019. In India, 5% of the population has health insurance (“cash for care”) and over 70% live in rural areas without access to quality healthcare (source). No doubt Entrepreneurs and Engineers will be creating major innovations in this space. Related: IBM and Manipal announcement

a16z is talking about Digital Therapeutics
Behavioral change is an area Startups/Developers/Apps have and will continue to embrace. A positive signal is a16z’s movement into this space asVijay Pande talks about in this interview. In this class of app, Email/SMS/Push Notifications/Phone calls are the engagement mechanisms.

VC Investing has increased == Startup activity is very hot
A few months ago Rock Health published their 2015 Healthcare Funding report, a must read. Combine this funding data with a review of new Healthcare products on Product Hunt,new Healthcare companies raising capital on AngelList and scanning Dan Primack’s Term Sheet or any other funding source and you will have a good grasp of the pace.

Regulation continues to provide opportunities
Today, major Health IT spend is in certified electronic health record (CEHRT) technology needed to comply with the federal meaningful use (MU) program, better security systems, and ICD-10 conversion software. Coming soon, additional legislation from the Protecting Access to Medicare Act kicks in mandating “that starting January 1, 2017, physicians ordering advanced diagnostic imaging exams (CT, MRI, nuclear medicine and PET) must consult government- approved, evidence-based appropriate-use criteria, namely through a CDS system.” (source)

Another helpful way to look at the Healthcare VC space is to think about the trends and contrast with VC investments.

Macro-Trends

  • The Consumerization of Healthcare
  • Consolidation of and competition between Hospitals and Integrated delivery systems
  • Strategic Investing (ex: Mayo investing in Helix)
  • Monitoring and Prevention
  • “Obamacare” disruption

Healthcare Funding Categories

  • Health IT Software
  • Digital Health
  • Medical Devices
  • Payer Disruption
  • Biotech

For further reading, I recommend checking out the various portfolio companies from Rock Health, Kapor Capital, SafeGuard, Arsenal and GV. Also checkout the Accelerator programs like Techstars Cedars-Sinai andMore Disruption Please to get a feel for the early stage. CB Insights is always publishing great insights such as this Healthcare IoT market map.

Here’s a brief sampling of some investments I’ve seen recently in these areas:

  • Patient Engagement
  • Prescription Management
  • Healthcare Analytics
  • Genetic Testing
  • Elder Care
  • Life Sciences
  • Medical Devices
  • Nanotechnology
  • Biotech
  • Insurance
  • Gene Therapy
  • Health and Wellness
  • Digital Health
  • Health IT

In Health IT software:

Care Coordination: Patientping, HealthLoop
Payer Management: Oration
Data Analytics: Medivo, BeneStream
EMRs: Elation

In Digital Health we see:

“Communities” like:

  • Health coaches (eating, personal trainers, etc)
  • Community for X
  • Competition
  • Reviews and Ratings
  • Connecting Providers (Patientping), Caregivers to Seniors (Honor)
  • Crowdsourcing data (Human Dx)

“Monitoring” is a huge category including:

  • “smart devices”, watch, smart phones
  • insights, behaviorial analytics
  • personal health and nutrition assistants
  • DNA and other self testing (23andme, Helix, uBiome)

Health and Wellness Platforms like ShareCare, Welltok and Omada Health.

Products like monthly food (Birchbox) and care packages (Citrus Lane).

Content like articles, daily emails and health guides (HealthSherpa)

Dev Tools like HIPPA data stores (TrueVault, Aptible, Catalyze.io) and IoT data streaming (Sense360).

In Biotech we see…

Biorepository, Genetic Analysis, Cellular Models, Regenerative Medicine, Bioinformatic Analytics.

Startups are using new techniques to harden defensibility into their business models such as creating Developer Ecosystems and baking in data network effects. A good example of data network effects at work is Recombine, a genetic testing company. They have built a network of partner clinics that administer its tests; with each new test, Recombine gathers more DNA data which (with appropriate consent) it can run machine learning on to improve its tests and nimbly develop new ones (therefore gathering more data). Recombine uses Machine Learning tools to find and learn patterns in historical data and uses these patterns to generate predictions. Recombine is 4 years old and has raised $3.3M.

I hope this post gets your brain spinning on all of the opportunity and innovation that’s happening in healthcare.

Virtual Agents, ChatBots, Invisible Apps and Conversation Commerce

Since drafting this blog post in Evernote a few months ago, the ChatBot hype has escalated. You will read about Virtual Agents, ChatBots, Invisible Apps, Conversation Commerce, Conversational UIs, Ambient Computing, Bot Stores, Tay and more. Checkout “The Complete Beginner’s Guide to ChatBots” on Medium for tons of examples.

Messaging apps like Kik, WeChat, WhatsApp, Facebook M, Slack and Telegram are integrating ChatBots into their experiences and building Developer tools. Experiences for Shopping, Booking Travel, Dating, Marketplaces and Healthcare are being built by Developers, Startups and Enterprises.

Over the past year since first learning about “Invisible Apps” and ChatBots I’ve been following the thinking of Chris Messina. Chris is a thought-leader on this subject. I highly recommend checking out these three writings/podcasts/lists from him:

After you checkout Chris’s work and get a sense of what’s happening, read on…

Designing for AI, Bots and Invisible Apps

One of the aspects of this I find fascinating is the psychology behind bot interactions. My wife, 7 yr old and 5 yr old and me all say “Thanks Alexa” after “she” does something like sets a timer or plays a song. I think most of us have had interactions in which we’re not sure if we’re talking with a bot or a human.

These articles and podcasts discuss the design, psychology and product management approaches to designing for this new paradigm.

Dev Platforms for Bots

Twilio is totally awesome of course and has been around for a while. We also see startups like Chat Fuel, Layer and Button supporting the new bot type development and technologies like IFFT being leveraged.

Microsoft is also pushing hard in this area by providing a Developer Framework called BotBuilder. And Facebook’s Messenger Platform of course.

Why is this important?

On average, people spend the majority of their time in about 5 apps and interact with about 25 each month. Most experts are predicting a trend in which other interactions beyond apps gradually change the app paradigm that has dominated the past 5+ years. Interacting with notifications, SMS, messenger clients, Siri, Google Now, Cortana, Alexa are all examples of this. Of the experts that predict the “death of apps”, there’s the same amount that predict “ChatBots are hype and apps as we know them are here to stay”.

The “Second Smartphone Revolution” predicts people will bank, shop and interact with their doctor as core mobile experiences. With the mobile phone as the primary device for these important day-to-day interactions, you can imagine how conversational commerce and ChatBot type experiences could play a big role.

Even More Reading

Here’s a few more podcasts and articles I recommend on this topic.

For Me Personally

Some of my favorite user experiences now are coming from apps that interact mostly via SMS including Digit and TripIt.

I feel myself gradually getting very comfortable with alternative UIs like ChatBots and Alexa. I trust the information I’m submitting is being handled correctly, I enjoy interacting outside of a website, email or mobile app and I find myself experimenting with different types of things. A few times a day I have an interaction where I can see how it could and will be improved by a “Invisible App” type experience.

Who knows if ChatBots will be the next best thing since sliced bread, but it’s certainly a cool paradigm that I see as having an important role in our daily lives.

Using Trigger Lists in Product Management

I’m a big fan of “trigger lists”. The exercise of building them and the value they bring to a Mind Mapping or Design process have proved beneficial to me over the years. One of my favorites is David Allen’s GTD Incompletion Trigger List.

Recently, I transitioned from obsessing over providing Developers with APIs that would help them build amazing things with AI to obsessing about Healthcare and how AI can provide better care while lowering costs.

I pounded a Doppio and spent an hour brainstorming this trigger list to help me empathize with Users and better understand Actors in the crazy ecosystem that is today’s Healthcare tech.

I am a…

Healthy person
Cancer survivor
Farmer
Factory Floor Worker
CRO Administrator
CIO
CFO
CEO
Developer
Product Manager
Auditor
Patient
Physician
Nurse
RN
PA
Administrator
Researcher
Daughter
Son
Parent
Community Oncology Clinic
Hospital CEO
CMS Employee
FDA Committee Member

And I have…

Outcome data
Clinical trials
Drug databases
Medical journals
App Store Reviews
Medical Devices
Demographics
Avatars
Full Contact API data
Clinical Trial Participants
Patient data
Lab results
Population data
Reimbursement data
Patent filings
Hunches
Students
Research and Health kit data
Hospital trends
Emails
Tweets
Blog posts
Survey results
Internet searches
Essays
Product reviews
X-rays
Photos
Instagram searches
A list of questions

And I want to…

Find Patterns
Organize my data
Filter my data
Search my data
Understand social media
Build an Android app
Surface correlations
Have access to information

So I can…

Comply with regulations
Stay up-to-date
Collaborate with a Physician
Track my progress
Get credit for a course
Be reminded of an appointment
Find cost savings
Sell an app
Make people healthier
Prove a point
Get reimbursed
Understand health trends
Track my Clinical Trial
Find a Hospital
Research and buy my medication
Predict outcomes
Make more money
Connect data together
Build a treatment plan
Find a Clinical Trial
Predict the Future
Support Meaningful Use
Make evidence-based clinical decisions
Analyze adverse events
Provide better treatment “in the field”

For those familiar with Agile, you’ll recognize the “As a User I want” format of this trigger list.

We all have so much stuck in our heads, try creating one of these trigger lists for something in your world and you’ll be surprised at how it can help.