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Chief Strategic Innovation Officer

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates. About Rich Roth:  Mr. Roth leads CommonSpirit Health’s innovation efforts, which seek to create and test novel services, programs, partnerships, and/or technologies – from within and outside of healthcare – that challenge the status quo and have the potential to reduce the cost of care, improve quality, and/or increase access to services. ﻿Working in concert with CommonSpirit Health employees and physicians, Mr. Roth works to anticipate emerging trends and technologies with the goal of incubating, studying, and scaling efforts to improve care.

COVID-19 Updates with Rich Roth

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Founding Dean, Professor of Health Policy

On December 17, 2015, Kaiser Permanente announced the launch of a new tuition-free medical school.1 Explicit in Kaiser&#39;s bold decision is the belief that traditional medical education retards the development of population-based medicine. The Kaiser Permanente Bernard J. Tyson School of Medicine (KPSOM) enrolled its first class of medical students in July 2020.  KPSOM and several other new medical schools are emerging to promote interdisciplinary and interprofessional team-based care. They emphasize chronic disease management, proactive social interventions and health equity. They strive to train doctors to promote health as well as treat disease. These new schools are medicine’s future.  Alarm bells should be ringing loudly in the halls of America&#39;s medical schools. Instead, complacency reigns.  Sounding the Alarm The CDC estimates that the U.S. dedicates 90%2 of its healthcare expenditures to treat chronic and mental health conditions. As chronic disease has proliferated, the healthcare system has treated its symptoms, not its root causes. In the process, healthcare has become too expensive, difficult to navigate and unresponsive to consumer preferences. Today, more Americans fear paying for medical bills than getting seriously ill.3 That is just wrong.  Moreover, consumers confront a massive mismatch between the basic care management and mental health services they need and those the system offers. It is impossible to appreciate why this mismatch occurs without understanding the origins of modern American medicine and its current teaching paradigm.  In Flexner We Trust In the early 1900s, the United States had only a few elite medical schools and institutions. Most physicians were quacks and most hospitals were squalid, unregulated and clinically inadequate.4 In 1908, the Carnegie Foundation engaged Abraham Flexner to survey medical education in the U.S. and Canada. Flexner published his findings in 1910.The Flexner Report promoted the Johns Hopkins training model, which included two years of science education and two years of clinical training, followed by extensive residencies at teaching hospitals. Broad adoption of the Hopkins model transformed American medicine. Its emphasis on evidenced-based care delivery governs healthcare operations to this day.  More than a century after Flexner, medical education prioritizes specialty care and fosters fragmented, hospital-centric, physician-dominated and hierarchical treatment cultures. Aligned medical professionals, including pharmacists, nurse practitioners and physician assistants, rarely practice at the top of their license. Despite the prevalence of chronic disease, current medical education and ongoing training place little emphasis on care management, engagement and social determinants of health. Orthodox medical education simply isn’t getting the job done as chronic disease and skyrocketing costs inflict an increasingly heavy burden on the American people. A New Orthodoxy for Medical Education Medical education is at the epicenter of healthcare transformation. New-era medical schools, like KPSOM, reject orthodox educational models that emphasize rote learning, condition-based care delivery (heroic medicine) and specialized research. Instead, they are developing curricula and programming to meet the broad-based health and healthcare needs of American consumers and communities.  Not surprisingly, “old” and “new” medicine conflict with one another in profound ways. (See more on what Learned Leadership Behaviors are common to Old Medicine, and what new behaviors New Medicine requires <a href="https://www.4sighthealth.com/overcoming-medical-orthodoxy-part-4-retooling-clinicians-for-new-medicine/" target="_blank">here</a>.) While still evolving, &quot;new&quot; medical education seeks to address consumers’ real health and healthcare needs. It incorporates these elements: <ul><li>Practical, applied learning with limited lecture time</li><li>Emphasis on holistic health and well-being for both patients and students</li><li>Longitudinal, collaborative, team-based care</li><li>Community-focused service provision</li><li>Practical training in advanced technologies and data science</li><li>Value-based care delivery</li><li>Openness to innovation</li></ul> New medical education models center on training physicians to prevent, manage and alleviate complex health challenges. Their approaches emphasize engagement, prevention and team-based models for delivering holistic, value-based care.  Conclusion: Reinventing Medical Education In 1910, the Flexner Report standardized medical education for a burgeoning scientific, industrial age. Despite tremendous advancement in medical science since, the American people are sicker than ever. Yet medical education has resisted adaptive change.  Today, physicians trained in the &quot;old&quot; Flexner medicine model enter their profession ill-equipped to meet the day-to-day care needs of patients and communities. That healthcare delivery model will not change until medical education transforms.  No paradigm shift happens without struggle. New, paradigm-busting medical schools are shaking off the burdens imposed by a century of static medical education. They&#39;re training the medical professionals America needs to become a more equitable, productive and healthier nation.   At issue is the extent to which current medical education curriculum, training and institutions can adapt to new-world realities. As American healthcare transitions, new medicine’s behaviors, practices and cultures will displace old medicine. Long live new medicine!  David W. Johnson is CEO of 4sight Health. David Nash MD MBA is the Founding Dean of Jefferson College of Population Health and a full-time Professor of Health Policy; his latest book is “How COVID Crashed the System: A Guide to Fixing American Healthcare” publishing Fall 2022.  Dig deeper on this topic <a href="https://www.4sighthealth.com/the-roaring-20s-then-now-insights-on-healthcares-post-pandemic-future/" target="_blank">here</a>. Opt in for 4sight Health commentaries <a href="https://www.4sighthealth.com/insights/" target="_blank">here</a>.  Read more<a href="https://www.4sighthealth.com/overcoming-medical-orthodoxy-part-1-the-origins-of-dysfunction/" target="_blank">Overcoming Medical Orthodoxy (Part 1): The Origins of Dysfunction</a><a href="https://www.4sighthealth.com/reinventing-medical-education/" target="_blank">Overcoming Medical Orthodoxy (Part 2): Reinventing Medical Education</a><a href="https://www.4sighthealth.com/overcoming-medical-orthodoxy-part-3-forces-disrupting-old-medicine/?utm_source=4sight+Health+Readers&amp;utm_campaign=bf42b1e7d1-CMS+Misdirection_COPY_01&amp;utm_medium=email&amp;utm_term=0_96b6d85309-bf42b1e7d1-" target="_blank">Overcoming Medical Orthodoxy (Part 3): “Old Medicine” Is Showing Its Age</a><a href="https://www.4sighthealth.com/overcoming-medical-orthodoxy-part-4-retooling-clinicians-for-new-medicine/?utm_source=4sight+Health+Readers&amp;utm_campaign=bf42b1e7d1-CMS+Misdirection_COPY_01&amp;utm_medium=email&amp;utm_term=0_96b6d85309-bf42b1e7d1-" target="_blank">Overcoming Medical Orthodoxy (Part 4): Retooling Clinicians for “New Medicine”</a> SOURCES1) https://www.bizjournals.com/sanfrancisco/news/2015/12/17/kaiser-permanente-to-open-its-own-school-of.html2) https://www.cdc.gov/chronicdisease/about/costs/index.htm3) https://www.norc.org/PDFs/WHI%20Healthcare%20Costs%20Coverage%20and%20Policy/WHI%20Healthcare%20Costs%20Coverage%20and%20Policy%20Topline.pdf4) https://www.theatlantic.com/magazine/archive/1910/06/medical-education-in-america/306088/

Overcoming Orthodoxy in Medical Education

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Co-Founder & Chief Medical Officer

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates. About Dr. Michael Le: Dr. Le is the co-founder and Chief Medical Officer of Landmark Health, the nation’s largest provider of in-home, value-based medical care. Dr. Le grew up a small town in western Massachusetts, where he watched his father practice small town medicine, including delivering house calls, black bag in hand, to frail patients in the community. Dr. Le is a passionate advocate for home-based medicine as the best setting of care for complex, chronic patients.  The COVID-19 pandemic has prompted many Americans to crack open their history books in an effort to draw inspiration and comfort from past crises we have confronted and overcome.  The Second World War provides an instructive case study.  To defeat the Axis Powers, we mobilized the full might of our nation’s economic, military and industrial capacity. We overcame the enemy, not just on the battlefield but on the home front as well: we re-tooled manufacturing plants, planted “victory gardens,” and organized scrap metal drives. The home front played a pivotal and enabling role in nourishing, dressing and equipping soldiers on the front lines.  Without the home front, we may have lost the war. A similar dynamic is unfolding as the healthcare system wages total war on COVID-19. Right now, our hospitals are the battlefront—many ICUs and ERs in hotspot areas are bursting at the seams with COVID-positive or presumptive patients. Today, just as we did during the war, we must not overlook the home front. We mean that quite literally: we must bring primary care to the home for our most clinically fragile patients, with the explicit intent of keeping those patients away from hospitals overflowing with COVID-19.  Home-based medicine is not a novel concept: in 1930, 40% of all physician-patient interactions happened in the home. By 1980, fewer than 1% of all primary care visits were house calls. The house call provider, once a cherished figure in the American healthcare landscape, became a victim of the mass industrialization of primary care.  But house calls are making a comeback.  As our nation ages, demand for in-home geriatric care is growing by leaps and bounds, and the volume of home visits is growing rapidly. Modern home-based medicine is advancing quickly and encompasses a broad scope of activities. As home-based physicians, we diagnose and treat medical, behavioral, and social conditions in the comfort of patients’ homes. We manage medications to reduce polypharmacy risk, conduct home safety checks, and facilitate conversations on advance care planning.  Homebound patients benefit disproportionately from access to in-home urgent medical care 24/7: if a frail senior feels short of breath on a Friday evening, or has abdominal pain on Christmas Eve, a home-based provider can be dispatched to the patient’s home to deliver urgent medical care, thereby avoiding an unnecessary trip to the hospital.  Across the country, though, there are millions of homebound seniors who have no access to home-based primary care. This problem is even more acute in the time of COVID-19, when the CDC is—correctly—instructing frail seniors to stay at home because of their susceptibility to the novel coronavirus. This vulnerable population, already socially isolated at baseline, is now even further disconnected from office-based primary care. Many practices are trying to meet this gap by offering telemedicine, which we applaud.  But let’s be frank: telemedicine will never replace the healing hand of a physician, particularly for frail seniors with chronic conditions. At Landmark, we use telemedicine as a complement to (not a substitute for!) in-home medical care, and that reflects the reality of our population: 20% of our patients have cognitive impairment or dementia; 40% has hearing or vision loss; and fewer than one-third owns and can operate a smartphone. Telemedicine won’t suffice for these patients; home-based primary care is the only scalable option standing between these patients and an overflowing ICU. Other players in the healthcare ecosystem have a role to play in promoting access to home-based medicine for frail seniors. CMS could incorporate home-based medicine into its network adequacy rules for Medicare Advantage plans. Health plans, in turn, should develop financial arrangements that reward high-quality, in-home medical care. And acute care facilities can partner more effectively with local house call providers to ensure that patients are safely transitioned from hospital to home.  Now is the time to recognize the vital role of the “home front” in the war against COVID-19. House call providers (both at Landmark and beyond) are racing to patient homes around the clock and across the country. These home visits are providing an essential service not just to these homebound and clinically vulnerable patients, but to the community as a whole. At a time when the nation is struggling with a daunting shortage of critical care beds, we on the “home front” owe it to our colleagues on the ER and ICU frontlines to keep elderly patients out of the hospital and safe in their homes.

How COVID-19 is Changing the Conversation Around Home-based Medicine

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Market Manager, Healthtech & Device

Since its onset, the COVID-19 pandemic has led to a proliferation of mental health conditions ― impacting millions and putting pressure on an already-strained mental healthcare system. At the same time, the landscape for investments in mental health companies continues to evolve to help address new and emerging challenges. Rates of anxiety and depression continue to rise, with 30% of all Americans reporting symptoms of anxiety or depressive disorder in 2022, compared to 11% pre-pandemic.1 For example, employee burnout is hitting alarming new highs, while trends such as <a href="https://www.npr.org/sections/money/2022/09/13/1122059402/the-economics-behind-quiet-quitting-and-what-we-should-call-it-instead" target="_blank">“quiet quitting”</a> highlight the impact of work-related anxieties. Roughly 47 million Americans have quit their jobs since the spring of 2021 in what’s been dubbed <a href="https://www.bbc.com/worklife/article/20220817-why-workers-just-wont-stop-quitting" target="_blank">“The Great Resignation.”</a>2    According to SVB’s latest report, <a href="https://www.svb.com/trends-insights/reports/healthtech-trends-report?utm_source=na&amp;utm_medium=events&amp;utm_campaign=gb-2022-11-ne-ev-na-na-lh-na&amp;utm_content=1pr_na_oc_na" target="_blank">The Future of Healthtech 2022</a>, investment in mental health companies this year is down from 2021’s blockbuster levels — mirroring a broader downtrend in investment from 2021’s record pace — but remains strong and well ahead of 2020 investment, with rising deal sizes, valuations and M&amp;A activity. So far this year, the mental health space has seen promising developments, including improvements in mental healthcare accessibility and prioritization of high-quality mental healthcare for underserved populations. Get a copy of <a href="https://www.svb.com/trends-insights/reports/healthtech-trends-report?utm_source=na&amp;utm_medium=events&amp;utm_campaign=gb-2022-11-ne-ev-na-na-lh-na&amp;utm_content=1pr_na_oc_na" target="_blank">The Future of Healthtech</a>, which provides a detailed analysis on healthtech investments and exits across a variety of subsectors. Venture Capital Investment in Mental Health Companies: Emphasis on Quality Care  Mental health companies are not immune to the market downturn, with investments slowing from 2021 levels this year. However, while the broader healthtech industry saw deal sizes and valuations lower in 2022, mental health companies uniquely saw increases: median deal size in 2022 grew to $10 million from $8 million in 2021 and median post-valuation in 2022 grew to $97 million from $40 million in 2021.3 The development and delivery of mental health services remain ripe for innovation as challenges persist. At the same time, while market size grows (mental health spending in the US is slated to increase to $99 billion in 20284), demand continues to soar. Despite the broader downturn, increasing deal sizes and valuations in mental health demonstrate investor confidence boosted by recent, tangible improvements in mental healthcare, particularly in expanding accessibility. These improvements are partially attributed to the record capital deployed into mental health-focused companies in 2021, enabling them to develop and scale their platforms. Higher quality mental healthcare may also prevent costly inpatient psychiatric visits. Promisingly, the use of inpatient mental health services in 2020 remained <a href="https://www.ebri.org/docs/default-source/ebri-issue-brief/ebri_ib_569_mentalhealth-8sept22.pdf?sfvrsn=12bb382f_4&amp;utm_source=newsletter&amp;utm_medium=email&amp;utm_campaign=newsletter_axioswhatsnext&amp;stream=science" target="_blank">unchanged </a>from 2013 despite a much higher rate of mental illnesses in 2020.5 Accessibility ― a considerable focus in the last three years ― has improved as employer-sponsored mental health support expanded in 2022. Evolving virtual care options also enhanced patient access to providers. Still, access and affordability remain challenging for many, with <a href="https://mhanational.org/sites/default/files/2022%20State%20of%20Mental%20Health%20in%20America.pdf" target="_blank">25%</a>6 of US adults with a mental illness reporting an unmet need for treatment and <a href="https://www.samhsa.gov/data/sites/default/files/reports/rpt35323/NSDUHDetailedTabs2020v25/NSDUHDetailedTabs2020v25/NSDUHDetTabs8-33to8-35pe2020.pdf" target="_blank">46%</a>7 reporting treatment as unaffordable. In 2022, the focus shifted beyond access to high-quality, outcome-based mental healthcare. Tighter financial markets have shifted investment into top-quality mental health companies that deliver quality outcomes and effectively reduce costs.  Preventive care measures are expanding to deliver higher quality care, enabled by virtual care models that allow for more touchpoints with providers. Culturally appropriate mental healthcare services that meet patients’ social, cultural and linguistic needs are growing. For example, the Bronx-based company Health in Her Hue connects Black women to appropriate healthcare providers, including mental health. Shine, acquired by Headspace this year, provides mental health-related activities for many patients with diverse backgrounds and cultures.  Point solutions (companies focusing on a single mental health condition) grew in popularity in 2021 and continue to show promising results. Interestingly, point solutions’ median deal size in 2022 ($12 million) is double that of platform-based business models (companies that focus on more than one mental health condition, $6 million). The focus on single conditions can offer high-quality, specialized healthcare, especially for higher-acuity mental health disorders like treatment-resistant depression or OCD. Brightline, which closed the largest point solution deal this year ($115 million Series C), focuses on mental health for children, teens and their families. Equip Health ($58 million Series B) provides virtual, affordable care for eating disorders, with aims to expand services nationwide this year. Eleanor Health ($79 million Series C) provides a wide range of outcome-based services for substance use disorders.8  Venture Capital Backed M&amp;A in Mental Health  Last year, the mental healthcare industry saw a handful of public exits, including CareSpan, TalkSpace and Highmark Interactive. This year, public market pressures shut the public exit window for healthtech companies. As public markets remain volatile, I expect IPO/De-SPAC activity in the space to remain muted. Instead, private M&amp;A activity is promising this year, with some notable deals spurring the industry. Headspace expanded its platform with two acquisitions this year: Shine and Sayana. As the market becomes saturated with point solutions, I expect more consolidation. As effective and affordable mental healthcare increasingly tops the concerns of patients, employers, investors, payers and providers, investment and M&amp;A activity will remain steady in Q4 2022 and 2023. At SVB we are encouraged by the entrepreneurs leading these companies and how they navigate this increasingly challenging environment. At SVB, we have a pulse on <a href="https://www.svb.com/industry-solutions/global-life-science-healthcare" target="_blank">life sciences and healthcare and believe it its innovators and we are proud sponsors of this year’s HLTH 2022 in Las Vegas, NV. </a> For a deep dive into investment and exit information across healthtech, please read <a href="https://www.svb.com/trends-insights/reports/healthtech-trends-report?utm_source=na&amp;utm_medium=events&amp;utm_campaign=gb-2022-11-ne-ev-na-na-lh-na&amp;utm_content=1pr_na_oc_na" target="_blank">SVB’s The Future of Healthtech </a>report, including detailed analysis across a variety of subsectors such as alternative care, provider operations, clinical trial enablement, wellness &amp; education, healthcare navigation, medication management and spotlights on mental and women’s health.  Resources: 1Anxiety and Depression. https://www.cdc.gov/nchs/covid19/pulse/mental-health.htm. 2 Morgan, K. (2022, August 18). Why workers just won’t stop quitting. https://www.bbc.com/worklife/article/20220817-why-workers-just-wont-stop-quitting. 3,8 The Future of Healthtech. SVB. Retrieved from https://www.svb.com/trends-insights/reports/healthtech-trends-report?utm_source=na&amp;utm_medium=events&amp;utm_campaign=gb-2022-11-ne-ev-na-na-lh-na&amp;utm_content=1pr_na_oc_na4 Fortune Business Insights. (2022, February 23). US Behavioral Health Market Size worth USD 99.40 billion in 2028 | with remarkable 3.6% CAGR. https://www.globenewswire.com/. Retrieved from https://www.globenewswire.com/news-release/2022/02/23/2390169/0/en/US-Behavioral-Health-Market-Size-worth-USD-99-40-billion-in-2028-with-remarkable-3-6-CAGR.html 5 Use of Health Care Services for Mental Health Disorders and Spending Trends. EBRI. Retrieved from https://www.ebri.org/docs/default-source/ebri-issue-brief/ebri_ib_569_mentalhealth-8sept22.pdf?sfvrsn=12bb382f_4&amp;utm_source=newsletter&amp;utm_medium=email&amp;utm_campaign=newsletter_axioswhatsnext&amp;stream=science 6 2022 The State of Mental Health in America. https://mhanational.org/. Retrieved from https://mhanational.org/sites/default/files/2022%20State%20of%20Mental%20Health%20in%20America.pdf  7 National Survey on Drug Use and Health. https://www.samhsa.gov/. Retrieved from https://www.samhsa.gov/data/sites/default/files/reports/rpt35323/NShttps://www.samhsa.gov/data/sites/default/files/reports/rpt35323/NSDUHDetailedTabs2020v25/NSDUHDetailedTabs2020v25/NSDUHDetTabs8-33to8-35pe2020.pdfDUHDetailedTabs2020v25/NSDUHDetailedTabs2020v25/NSDUHDetTabs8-33to8-35pe2020.pdf

SVB's 2022 Healthtech Report Reveals Strong Investment Opportunity in Mental Health

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