Posts from hacking healthcare

Abridge

We seed funded a company late last year called Abridge and the company went public yesterday with their iOS and Android apps. Naomi wrote about the investment on the USV blog.

I want to focus on the product because I think it is a game changer for all of us that access the health care system regularly.

The Abridge mobile app (get it here) allows anyone to record a medical visit with a doctor, a nurse, or any other health care professional.

It works like this:

You open the app to see your visit history:

You tell the doctor, nurse, etc that you are going to record the session and hit the record button:

Then you record the session.

When you are done Abridge saves the audio recording of the session and also immediately (in way less than a minute) provides a transcript of the session with the key medical terms called out in bold.

That is me making stuff up this morning. I sure hope I don’t need a knee replacement any time soon.

This is one of those ideas that is so simple and so obvious that you wonder why nobody has done it before.

The team is a combination of physicians and machine learning people from University of Pittsburgh and Carnegie Mellon. It’s a combination of domain experts and technologists who are extremely well suited to make this work and work simply and elegantly.

I would encourage everyone who sees doctors regularly or has a loved one that does to get Abridge on your phones and their phones.

I think it’s a game changer for how we access and understand the medicine in our lives.

A Doctor For Sensitive Issues

Our portfolio company Nurx started out offering birth control prescriptions on a mobile phone delivered to you in the mail. This has been a game changer for many women who live far from a doctor or a pharmacy or live in places where it is not easy to get a birth control prescription.

But they have not stopped there. They added HIV Prep for people who are at risk for HIV and want to protect themselves. And then they added emergency contraception (the morning after pill).

And this week, Nurx added at home testing for sexually transmitted diseases. From that blog post:

The tests offerings include: The Full Control Kit, which tests for gonorrhea and chlamydia (throat, rectal, urine swabs), syphilis, hepatitis C, and HIV (blood sample), and is $75 with insurance or $220 without; The Healthy Woman’s Kit, which tests for gonorrhea and chlamydia (throat and vaginal swabs), trichomoniasis (vaginal swabs), syphilis and HIV (blood samples) and is $75 with insurance or $190 without; The Covered With the Basics Kit, which tests for gonorrhea and chlamydia (urine sample), syphilis and HIV (blood sample) and is $75 with health insurance or $150 without. The goal is to make STI testing easier, more affordable, and with fewer awkward face-to-face interactions with a potentially judgmental lab tech or doctor. The tests are available in 24 states and the District of Columbia.

The idea behind Nurx is that too many people put off going to see the doctor because they are ashamed, it is awkward, or it is inconvenient. And this is particularly true for sensitive issues.

Nurx believes that technology (the mobile phone, telemedicine, logistics, etc) can and will change this for most people and that we can all become healthier as a result. Preventive medicine is the most efficient and affordable kind of medicine and we need more of that in society.

Nurx has grown like a weed over the last two years which tells me that there is a large unmet need for this kind of health care and I am excited to see the Company continue to add more and more services as they grow.

AI and Health Care

David Kelnar sent me this deck that he did on the state of AI. It is very good.

This slide got my attention:

It is interesting, and not totally surprising, that the sector that AI-focused entrepreneurs are targeting more than any other is health and wellbeing.

It seems like there is so much opportunity to improve our collective health and wellbeing with data science and machine learning. This is a big part of our thesis around healthcare at USV.

Healthcare At USV

Over the last five years, we have stepped up our investing in and around healthcare. About 15-20% of the early stage companies we have invested in over our last two fund cycles are working in this sector.

If you look at our current investment thesis at USV, you will see that wellness is one of the key areas of interest for us:

USV backs trusted brands that broaden access to knowledge, capital, and well-being by leveraging networks, platforms, and protocols.

So where in the healthcare sector are we focused?

Rebecca tweeted this out yesterday and I think it is a good articulation of what we find most interesting in healthcare:

Making affordable healthcare more available to everyone seems like the winning formula in this sector.

Take our portfolio company Nurx for example. They make birth control and other important prescriptions and home testing kits available to millions of people who have found them difficult to obtain through traditional channels.

I hope and expect that we will increase our investment in the health and wellness space in the coming years. It is an important sector that has immense challenges, but also immense opportunities.

Audio Of The Week: Reimagining The Well Woman

One of the areas we have been investing a lot in at USV is women’s healthcare (Clue, Modern Fertility, Nurx).

Another interesting company in women’s healthcare, that USV is not an investor in (at least not yet), is Tia, which calls itself “The Women’s Health Clinic.”

In this discussion with the Gotham Gal, the founder of Tia, Carolyn Witte, talks about her inspiration to start Tia and how she has evolved the business over the last couple years.

Creating Surplus

Consumer surplus is the delta between what consumers expect to pay or are willing to pay for an item and what they actually have to pay given market dynamics. A good example of where we are generating a lot of consumer surplus is technology. I would be happy to pay for my email (and do) but I can get it for free from Gmail. A 49″ smart TV sells for about $300 on Amazon. A Samsung Chromebook is $200 on Amazon.

I like to think of all of this “found money” that consumers are getting from technology as the dividend we are getting from the technology revolution. It is also true that technology takes jobs out of the market, and adds them too, and that it may be a zero sum game or worse.

But the truth is many things have gotten a LOT less expensive over the last twenty years and that has made managing the household budget a fair bit easier.

My colleague Nick sent me this chart yesterday. I don’t know where he got it so I can’t identify the source.

What you see from the chart is that wages have increased about 70% over the last twenty years and many things, including housing, food, clothing, and most dramatically technology, have increased less, or have actually gone down in price, creating room/surplus in the household budget.

But not everything has gone down. Health care and education, most notably have increased dramatically.

So it is time to take aim at those sectors. We can do the same with education that we have done with other services. And we will. I feel that healthcare will be a harder lift, but I do think it can be tackled too.

In fact, our current thesis at USV compels us to go after these sectors. So we will.

I am excited about the potential to bring consumer surplus to these sectors and make more room in the household budget in doing so.

Business Model Innovation in Healthcare

Naomi posted some thoughts on changing business models in health care on the USV blog yesterday.

The one that I am personally most excited about is what Naomi calls “change of venue” and within that I like the “virtual primary care” model.

A pure virtual primary model eliminates fixed costs associated with brick and mortar expansion and is able to focus resources on reaching more patients, recruiting more doctors to their platform, and improving the experience for current patients. Payments on a subscription basis allow doctors to get paid more consistently rather than waiting for insurance companies to process claims and paying overhead costs to negotiate reimbursements with their billing offices.

We have portfolio companies executing this model like Nurx and Modern Fertility and we hope to add more.

I value the doctor/patient relationship, but I think there is a lot technology can do to make that relationship less expensive, more engaging, and more convenient (for both parties). And generational changes in doctors and patients are catalyzing and facilitating this transition.

Audio Of The Week: The Changing Nature Of Women’s Healthcare

One of the themes we are deeply bought into at USV in our approach to healthcare investing is the opportunity in women’s health care, particularly providing care to young and healthy women. Our portfolio companies Nurx, Clue, and Modern Fertility are all doing that.

This podcast, which I listened to earlier this week, is a discussion of exactly that opportunity and features Hans Gangeskar, CEO of Nurx, and Carolyn Witte, CEO of AskTia.

The Unbundling Of Health Care

Naomi Shah, one of our analysts at USV, has been doing a deep dive on health care since she joined us this past spring.

She has started to publish a series of blog posts on what she has learned and what she thinks is investable at the intersection of healthcare and consumer tech.

Kind of like putting our playbook on display before we have even implemented it.

But that is how we roll at USV.

At least this way, we get feedback and input on these sector theses which ultimately make them even better.

And we get a lot of incoming pitches from entrepreneurs working in our target areas as a result of making our playbooks public.

She starts off her series with a post on the unbundling of health care and compares it to what has happened in financial services.

Naomi ends this post with this observation:

these observations seem to indicate some unbundling of the existing large, monolithic systems in healthcare towards a more open, local, independent and transparent model, with control residing with individual users. And ultimately, this could change the way healthcare is delivered to consumers.

“A more open, local, independent and transparent model, with control residing with the individual users” sounds exactly what we like to invest in at USV so expect to see more investing in health care from us and more posts from Naomi. You can find her posts on USV.com and/or follow Naomi here.