Posts from health care

Health Care’s Inflection Point

The Gotham Gal looked up from her laptop yesterday and said to me “I’m seeing a ton of health care deals right now.” I looked up from my Kindle app and nodded.

Mary Meeker’s slide deck addressed this is bit. Here are a few of the big points from it:

Healthcare is now $2.8 trillion in the US, which represents 17% of GDP

Healthcare is being consumerized

Healthcare is being digitized

Digital Health Venture Investment was $1.9bn in 2013 (out of a total of $24bn)

I listed health care as one of four “sectors” in my LeWeb talk last fall and when asked recently what excites me most, I mentioned the “mobilization of health care”.

The Gotham Gal has been making a bunch of these kinds of angel investments this year. She’s closed two and has a third in her pipeline. That’s somewhere between 25% and 33% of her investment activity right now. As Mary’s data shows, digital health is approaching 10% of all VC activity.

At USV, we’ve been looking hard at this sector but have only made one investment so far, in HumanDX. Albert explained the investment thesis behind HumanDX here.

We’ve made a few other offers but got outbid pretty badly on them. There is a lot of heat around this sector right now.

We are looking for networks of users, patients, doctors, and other stakeholders in our health care who can transform the way health care is delivered. We only have one game plan at USV and look to play it in every market opportunity we see.

I am pretty certain the intersection of the Internet and mobile, the digitization of the health care system, and a desire for people to take more control over their health is going to be one of the biggest investment opportunities we will see in my lifetime. And its game on.

Open Source and Our Government

A couple days ago, I saw a tweet by Henry Blodget and replied:

I am really upset by the problems with Leaving aside all the issues with Obamacare, and I hope and pray this discussion does not downgrade into a debate about that, I am very excited about the potential of marketplaces and marketplace economics on the price, availability, and transparency of healthcare insurance. It is way too complicated to buy healthcare insurance today and it costs way too much. The Internet and the power of marketplace economics has the potential to change that.

But our government has badly botched the construction of and is now proposing a tech surge to fix it. More people, more money, and more promises thrown at a badly broken process. This will end about as well as Afghanistan and Iraq.

I'd like to suggest another way. Open source the project, or at least all the components that easily lend themselves to open source. I think that some of it may already be open sourced. But instead of hiring an army of contract developers who will cost us so much money, harness an army of volunteers, who are likely better engineers, who will do the work for free.

That's what is increasingly done by technology companies and so much of the software that runs the web these days is open source. Why can't the software that runs our government be open sourced too? If you think this is a good idea, you can sign this petition. I signed it yesterday.

There is a lot going on in this area. My colleague Nick posted this link on today. GitHub now has a "subgit" on government projects. That's awesome and I hope we see the codebase show up there soon.

Withings Scale

As I've gotten into my 50s, something has occurred that has never been an issue for me, I've put on some weight. Nothing earth shattering but enough to get me focused on my weight for the first time ever.

So in the spirit of "you can't manage what you can't measure", I decided to get a scale. And because my friend Naveen is such a fan of the Withings scale, I went for that.

The Withings scale is a thing of beauty. It is sleek and looks great in my closet.

The scale measures your weight, body fat %, pulse rate, temperature, and CO2 levels in your home.

It connects to the wifi in your home and communicates with the Withings app on your iPhone and Android. You never have to connect anything to anything. The data flows over the air from scale to phone. The app provides a timeline of your key stats and gives you goal settings for them.

It's geek and chic at the same time. I'm into it and thought that some of you might be as well. Like most things, it is available at Amazon.


There are all sorts of wellness apps for mobile. Some record how much you workout. Some record how much you eat. And so on and so forth. In the aggregate, I think wellness is a great category for mobile. Your phone is a watchdog and a reminder and recommender. I think wellness apps can and will make a difference in living healthier lives.

But there aren't many wellness apps that are focused on the impact of mobile phones on our health. There are a number of things that mobile phones bring into the equation that may not be good for us. Listening to loud music on our headphones may be harmful to our hearing. Texting while driving, biking, or walking may be harmful to us and others. And then there's the issue of the radiation that mobile phones produce.

This last issue is where Tawkon has been focused. Tawkon is a bunch of smart Israeli scientists and engineers who have built algorithms that run on a mobile phone and predict the amount of radiation your phone is emitting in real time (and over time). They've been around for a few years and they have correlated their algorithms with real laboratory testing to insure that their predictions are accurate.

I met with the founder, Gil Friedlander, last week and during our meeting I downloaded Tawkon to my Android phone. I've been using it since. Most of the time it just runs in the background and I forget it is there. But every once in a while, it wakes up and alerts me to take the phone away from my head, put it on speaker, or put on a headset.

On friday afternoon, I was in my apartment where I get poor reception, and I was doing a few conference calls. In each case, Tawkon alerted me to the fact that I should not do the call without a headset and I took  the advice.

Tawkon also aggregates my radiation exposure and phone activity over time and keeps a record of it. This is what last week looked like for me:


You can also track family members so you can be a nagging spouse or parent. I suggested that the Gotham Gal download Tawkon for that exact reason.

Unfortunately Tawkon is not available on iOS. Take what you want from that fact. So I can't get my kids on Tawkon as much as I'd like to. I really can't understand why Apple would not approve a wellness app like this but iOS is Apple's world and they can decide who gets to play in it and who doesn't.

As with any app that runs in the background, I've been concerned about its impact on battery life. I look at what apps are using battery regularly and have not seen Tawkon on that list and I also have not noticed any difference in battery life since I have installed Tawkon. Of course, I've only been using it for a week so I can't say with 100% confidence that this is not an issue.

Here's a picture of me in the meeting with Gil practicing good cell phone hygiene. I have one of those handsets in my office and my home. I use them all the time.

Fred on headset

Tawkon is available on Android and most Blackberry phones. You can also put it on jailbroken iPhones. Give it a try and let me know what you think. 

The Rise Of Consumer Centric Healthcare

Nearly three years ago, we talked about Consumer Centric Healthcare here at AVC. I keep coming back to this central idea:

a guiding principle of any reform should be to put the consumer, not the insurer or the government, at the center of the system.

So when I read this morning in the NY Times that medical costs have been leveling off over the past few years, it got my attention.

I particularly like this part of the Times article:

Many experts — and the Medicare and Medicaid center itself — point to the explosion of high-deductible plans, in which consumers have lower premiums but pay more out of pocket, as one main factor. The share of employees enrolled in high-deductible plans surged to 13 percent in 2011 from 3 percent in 2006, according to Mercer Consulting.

I’m a huge fan of high deductible plans and think that they, along with some sort of health savings account that rolls over unused account balances, is a big step in the right direction to put consumers in control of their own medical expenses and decision making.

There are other things that would be part of a comprehensive consumer centric approach, including wellness incentives (ideally driven by self monitoring/reporting technology), accountable care, and efforts around education and transparency so consumers can make their own decisions. Clearly the Internet can make big contributions in all of these efforts.

It is ironic that consumers are starting to take control of their own medical spending at a time when our country and our courts are debating the wisdom of a large expansion of our government’s role in our medical care. It reminds me of the adoption of the open source model in software at the same time as the government’s case against Microsoft. Guess which one had the bigger impact?

None of this should suggest that I am against providing for those who cannot afford their own care. We can and should do that. But there is a difference between the funding mechanism and the decision mechanism in health care. The latter should be in the hands of the consumer as much as possible in order to restrain health care costs and maintain/improve the quality of care in this country.