Trends to watch out for in digital health

Chris:

Hello digital health community, today we're asking WTF is up with health tech by speaking with one of the most prominent voices on the future of health innovation Jessica DeMassa. Jessica hosts WTF health podcast, which stands for what's the future of health. Jessica interviews the who's who of healthcare innovation, researching and analyzing new advances, needs and trends. Jessica has also produced over 200 episodes analyzing digital health tech and funding news with Matthew Holt in health in 2.00 Podcast. And today we're going to talk about the trends in healthcare and her advice to entrepreneurs on how to clearly identify, explain and highlight what's unique about their startups or new products. Jessica, welcome to the pod. We are huge fans. I'm thrilled to have you. Can you  please unbutcher my introduction by telling our audience?

Jessica:

Oh my God, what did the guy like set the bar really high? I'm like, more nervous than our press. Like, I'm not used to being a guest. So yeah, thank you so much. It's such a pleasure to be here. I'm really excited to talk to you. 

Chris:

Yes , so let's dive right in to where you are in WTF health where you have a front row seat to innovation to the future of health innovation. Can you take a moment to talk about WTF health, its inspiration, its mission, and the types of innovators and innovations you look to the future?

Jessica:

Yeah, I mean, so thank you for the question. And the thing with WTF health. So it's like, if you were, WTF Am I right now, right. So it's like, the innovators that I choose to focus on are the people who are trying to drive change in healthcare using technology, or new business models, or new payment models, like kind of rethinking all the things in healthcare that are broken. And so I, I focused on talking to entrepreneurs of all different kinds of startups seed funded, all the way up to those that have gone public. And I'm still watching on the public market, because we're, you know, we're rooting for them. And then the incumbent innovators. So like the folks who are incumbent organizations like pharma companies, or health plans, or provider systems, who are trying to like, Sherpa this stuff in and make it a part of the way that healthcare operates. And then the last group of people I talked to predominantly are investors. So whether they're institutional investors at those kinds of incumbent organizations or they are venture capitalists, we saw private equity investors come into the fold through COVID. It's like, those are the people that I'm talking to kind of get a sense of, you know, what's going on with the technology? What's the plan for changing the way that healthcare is broken? And all the ways? How's it going in terms of uptake? Whether it's, you know, pilots, or actual clients or, you know, whatever? And then, you know, when the investors it is, what are they seeing that's, you know, kind of hot? Or what are they throwing more money at in terms of like, where they see the greatest opportunity for scaling up and, and being like, the next big thing that gets, you know, really baked into the healthcare system in a meaningful way.

Chris:

Right, and you talked about these groups of people that are at the same time rethinking healthcare and what it can and should be. And I know there's some trends of healthcare and health tech, and maybe we could talk about those in really, perhaps as a reference point COVID, in the heart of COVID,posted excitedly about the great unlock of healthcare, saying that the transformation of healthcare that would have taken decades is unfolding right before is right now an accelerated pace. And since then, it really feels like work on almost the other side, fingers crossed of COVID. And calibrating on what it is right now, at a macro level, what has changed in the digital health industry during COVID? And where have we calibrated sense?

Jessica:

I think the biggest thing that has changed was that nobody, broadly speaking, lots of patients, lots of providers, like health systems writ large, those people had really no idea what the use case at a big level for digital health, remote patient monitoring, and virtual care was. And so I think that that, to me, was the big thing that really changed that all of a sudden, everybody kind of knew what a video visit was, it may or may not have, you know, to call it telehealth or whatever, but all of a sudden, people knew what that was and that it was available to them. And so I think that we saw, you know, like it really exposed who had the capability to deliver care in that way. What was going to happen in terms of payment and reimbursement for those types of services. And then like all that stuff, got addressed and at the same time it was like a big opportunity to test the you know, do patients really like this? Is it convenient to change providers like to give care, where are the opportunities? Where are the challenges? As you know, what do we do? So I think that's, I mean, the obvious big thing that changed is that I really think that it put our category of, of virtual care, rpm and digital in to a bigger conversation that was much broader than this niche little healthcare innovation population that had really, you know, we feel like we've been talking about it forever, we're starting to turn some of the incumbents and the investors and stuff onto this space. But it's like, that's just changed the conversation in a really big way on a macro level, and particularly, I think, with patients. So that's one of the big changes. 

The other thing that I think that has kind of happened since is that there was kind of a movement from this focus on okay, health, tech being, you know, strictly driven by the pandemic and the needs of setup ability to see patients. So moving from a virtual care or remote patient monitoring, digital health focus of like health tech, into now I feel like, you know, a couple years through COVID, we're starting to look at like other things that are happening. And so I feel like the way that Health Tech has traditionally been selling itself or organized or whatever has also started to evolve. So one of the things I see as a big macro trend in terms of the way that that has changed is like this whole idea of like, becoming an infrastructure play. Like I feel like before COVID, there really weren't a lot of infrastructure plays. But then as COVID happened, and people needed to stand up telehealth was like, that was companies like wheel or animals started to position themselves as like an infrastructure play with this, we're selling the infrastructure, we don't even want our label on it, you make it yours. And this is how we do it. And they think there are other things that have come into play in that same way. And there's like, there's patient communications platforms that are selling as infrastructure, they don't want to have to be patient, they just want to enable the incumbent to be able to do that, or those that are doing, you know, like different types of pricing or like different types of care navigation or like those, you know, the, the digital front door type stuff, the chaplains, all those is like they started to sell it infrastructure. I think that that's really an interesting way to think about scaling up. The companies that are in our sector, they're technology dominant, but we're incumbents, we're starting to have an issue with things like, what we want to have the relationship with our patients, we want them to know that hospital x. And so I think that that was something that really changed a lot in my mind. I was hearing more and more people refer to their company as being infrastructure and selling in a way that let the incumbent still have that relationship, the brand, name, all that stuff. But where it was their technology that was driving, what was actually changing in terms of the integration of technology and the better, you know, ability to manage and track patients and help them get into the healthcare system the right way, or even just like to facilitate those telehealth visits that needed to happen. 

The other thing that I will say, I think that happened a lot in COVID, is we started to because everybody made investments into virtual care, we started to see this whole idea of omni channel like that was a word that was a word of the year for me like last year, I feel like everybody at Health last year was just that was like on stage over and over omni channel and it was like what had happened then in my mind was it was like, okay, no longer are we just using telehealth video visits or whatever, as a way to, you know, just get through this emergency. Now it's like, okay, I have this other way to sell. And like, suddenly, it became like, Chris, you might be too young for this. But like, when the internet first started, and people were shopping online, there was like a real like hesitancy of like, I know if I can get a credit card in this, how can I do that? Now you can like literally buy something with your face on a phone, like, you know, and don't even think anything about it. It's like, but this was kind of the thing where it's like, you know, as retailers started to adopt that, okay, we can maybe start to sell online, it never became a question of like, are we going to lose our bricks and mortar? It became a how do we have an omni channel model? We're selling a lot, all these different places. And I think that what I feel like we started to see in a lot of the big healthcare organizations, and I'm not just talking about like health systems, or health plans, but even like those retail health, Walmart, Walgreens, some of those CVS starting to look at, like how do we build an omni channel model out that is like, some things are going to be done virtually, or we're going to hope they are, we're at least going to have the option in a real and meaningful way and not like oh, it's a nice to have it. It's buried, like, you know, seven pages deep and you're like member portal and your plan. But then like a meaningful way with this is a front and center way to engage patients. And then I think it's like, they've , they're trying to figure out, you know, how do you blend that together with an on site visit or an in person visit? And what does that look? And so I think, too, we started to see a lot of startups pop up in that space where they were like an Omni channel enablement company. So like those companies that do blood draws mobile or like they tend to do something a little more complicated as far as a wellness check or whatever, and report back and so those are a number of different companies that kind of popped up in that space and got some pretty big funding. because they enable that virtual visit to go a little bit further without requiring somebody to go into the hospital or into the doctor's office. So that whole idea of omni channel I feel like was the other big thing that happens like in the last couple of years through COVID omni channel, I'm like the buzzword girl.

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Chris:

I’m actually glad you brought both of those up. Because I think these in you mentioned these retail providers, like, for example, the Walmarts, the Walgreens, the CVS clinics that Chem meds that are augmenting what they already have with additional physical patient facing models. And a lot of the other things you mentioned, like, okay, mobile nursing, or home care, or blood draws, I think is a part of one of those meta level trends that was forced by COVID. Like this decentralization of healthcare, or I think what a16z Also called the unbundling of the hospital, into care delivery that moves towards these retail like pharmacies, community based virtual at home. Now, that COVID has passed us. You know, do you think that cat is out of the bag forever, like the hospital is forever unbundled and decentralization is here to stay?

Jessica:

That's a great question. Um, no, I don't, I think that there's still a lot of work to be done, like, okay, so like, that unbundling, to me, is like the creation of these other channels, right. So I'm saying omni channel is like, we've got these variety of channels to reach people and to bring them in and whatever, I think that there's some, in some places, the cats out of the bag in the sense that people had to invest in that infrastructure. So there's like, your capital investment in some of this stuff. But the thing that I feel like has not caught up with it yet, where I don't, I can't, in my mind, say that the cat is necessarily out of the bag is that I feel like, what I've been hearing from folks is that it's like the, the workflow processes that need to support that are just not in place. And what I've gathered from it is, particularly on the telehealth side, you know, it's like, just kind of like, like, the first thing I feel like that everybody's looking to  as like one of those things like that would be okay in person or the other channel. 

The other way the hospital is unbundled is by using the virtual visit, is what's going to happen with the emergency regulations that were passed to Lao care to be delivered across state lines by different practitioners not require state licensing, to practice where other video visit is being held. And then also the reimbursement parody. So I feel like until, for me it's like, and this the sentiment I get is that everybody's, like, cautiously optimistic that there will be some changes that don't bring us back to a pre COVID state. But that may not be as generous as what happened as a result of the emergency regulations. But I think everybody's kind of it seems to me, like, I'm reluctant to say that the cats out of the bag completely until we see what happens with that is they feel like there's that holdup on changing workflows, or I had this great interview with Roger Jansen, who's the Chief Digital Health and Innovation Officer at Michigan State University health, healthcare, so our healthcare system, and he's saying that, like, what's been interesting about like, the video visits that they used to have during COVID, their levels of virtual visits have dropped 70%, despite the fact that you can often see a doctor faster, right? Virtually than if you have to come in the office. I'm like, What do you think that's all about you? I'm trying to I'm trying to do the same thing you're doing like it does it and it's a pat on the back or what he said that he thinks the big issue is a behavior change thing, that people are answering the phone, don't think to offer the virtual visit anymore, because they just assume everybody wants to come in behavior change thing, it's a workflow thing. You've never even trained these folks to even ask like, do you want to make that appointment virtually? And come in on this thing? Or do you want to come in in person and wait until they're and it's like, that's such a basic thing, which is some of these, these basic things are not in place? And I feel like there's this waiting that's kind of happening to see what happens with some of those temporary regulations and what some of the decisions are that are made in terms of particularly around reimbursement, because how good of a channel is that omni channel model for you if one of your channels is not generating the type of revenue that you think it should ? 

Chris:

Yeah, absolutely. And I think I want to unpack these policy trends a little bit, maybe in a second, but , just talking about the decision really is decentralization of healthcare, whether that's here to stay. It reminds me of the other movement that happened during COVID, which is the move to remote work in. In particular, I work in remote product engineering, and I feel like that cat is absolutely out of the bag. But I think it is probably much different than healthcare in that the workflows and tools for remote work have always been there. Right. Git lab and many other companies have been remote first for ages. So it's just everyone else getting a taste about life. And then in remote development. You also the end consumers are not part of your workday versus in health. care. They are the centerpiece of the workday. So, yeah, it's,

Jessica:

It's essential. I love that. I mean, I think the more ways that you can provide for people to access health care, the better like I love the direct to consumer piece. I love the virtual visit. I love the virtual visit plus an unsaved thing. I love it. I love the homecare that could be that has a lot of potential I have. I just I think that there's so many different ways to augment what currently exists. And and hope that if like COVID taught us anything is that it's like, there are a lot of different ways to, to do these models. And I think like you know, even if reimbursement doesn't stay at parity, it's like, how can you rethink now that you've, you've practiced it this way, and you had reimbursement for basically it's like we what people always gripe about with digital health or health that we just digitized what was happening in person. And now, you know, made it on video, like it was the same thing. And that's true, even from a reimbursement standpoint, right? But it's like when that goes away, even though we have the practice using the technology, can we figure out now that we've started doing it, we just digitize exactly what we're doing, we get really creative in terms of inventing different types of maybe payment models, or what is this used for? And is it different? Maybe instead of a I don't know, it is like could reimbursement somehow evolve along that way to support the creation of these new channels, not just digitize the old channels, because we were in an emergency and needed to? And I hope that that happens. And I just don't know what exactly enables those of like, really creative mind is really powerful people and the American telehealth Association, Lobby. I have no idea. Like I hope all of us can like rally around that and kind of push for this. Maybe it's the innovators, the entrepreneurs who bring this stuff, and I wasn't. You know, Chris, I was thinking about this as we're talking I'm like, the other thing I really do feel like is that there's the time, the time is right, that this conversation about rethinking what's possible in the payment model, but still playing within like the rules of what's going on. 

And I think that was another thing that I felt like a good COVID Where are we now like in a new trend that has kind of emerged? Is there all these people all of a sudden, who are like asking all these questions about the payment model, and we're actually in like real and meaningful ways, kind of like, yeah, you know why we don't need to be a large self insured employer and use a traditional PBM, one of the big three, we can use like, a navigator company like a right way or a transparent and have them negotiate this for us. And you know what I mean, start to eliminate expenses. So I think people are starting to rethink that there are a couple of different, you know, startup PBMs, that have really emerged and are starting to gain traction. And it's like, that's always been the black box of like health care costs. And so it's like, there's been other things, I think, even within the plan world, you know, we always talk about value based care. There's like value based care light, is like what I like to call her. It's like some of the startup companies or health tech companies are even doing this where it's like, they're taking on risk for certain things against certain KPIs. And they're starting to bundle things together. And like, you're starting to see a little bit more of a movement away from the per member per month, which is like, basically our like fee for service version. And it's like, people are just challenging that in different ways. And so I think the time is right to start thinking about like, like on the value based care thing, it's like, maybe I don't have to go full, all in all risk. What does that look like? If I dial that back? And how, how, how far do I have to dial it back, but I'm still making a meaningful impact. And things are still tied together and reducing costs, but I don't feel like I've taken on too much or has come in over my head, I feel like that's something that's really new, where people are really starting to take a look at novel ways of innovating within the payment model. And I think that is really neat. I think even the direct to consumer movement, we're seeing some of those retail players who are coming, everybody's waiting for like Amazon to do something with prime health insurance, you know, they're building that vertical stack, like, what is he going to? Do? You know what I mean? The $10? Who knows? I mean, there's a lot of there are a lot of CEOs of health tech companies, and I think also quite a few incumbents that I feel like I've spoken with across the ecosystem, no plan provider, pharma who are like, you know, what, like, the direct to consumer thing does have legs for certain things. It's starting to become like, a little bit more adopted, you know, so it's like, I do think that that too, is a unique payment. Because everybody's always like, Well, who would go on here and pay, you know, $30 and not go through their insurance and get this done? I have a high deductible health plan, like I'm never gonna reach that deductible. I have a sinus infection. I'm gonna do a virtual visit, using you know, what are the myriad online pharmacy type businesses that you the doctor, get the prescription called in and then go and pick it up? You know what I mean? i What is that going to do? Am I just not going to anything?

Chris:

Yeah, no, I love that you're highlighting these emerging business models within healthcare. And I think healthcare is one of those complicated industries where the end user is oftentimes not the customer, per se, or the person who's paying the bill. And I think we, yeah.

Jessica:

I have to say this. I had the opportunity, sorry, unless there's a gospel like I talk to these No, no, please, God and the whole world I seriously do. So I was talking to Zachariah Reitano, who's the CEO of ro.co And he has coined the phrase for this direct to patient care model. And so I had this at the ATA annual meeting, fireside chat, talking about direct to patient care models. And it was like, I got to ask him some of those, you know, challenging questions like, because people want to say, oh, it's only for young people, or it's only for, you know, this or that, and it's . patient patients will never pay for their care. And his whole thesis around this is like, maybe not now. But it's like, there are a growing number like their business has grown. And they're not the only one that is in that space, there's a number that are in that space, but they're deliberately the online pharmacy, virtual pharmacy business, and it's like, that is, is really poised to grow . And I do think he's onto something. And his whole thing was like, we know how slow healthcare moves. This is not like, oh, in two years, there's gonna be buying stuff online. But at the same time, it's like there's going to be some steady growth in this pathway, and maybe in 10 years, like that isn't one of those channels in that omni channel model? That's thriving?

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Chris:

Right, yeah and I think there's this emerging mantra that that's the right way to validate a consumer focused digital health product anyways, now. And I think maybe the hesitance from some of these plans, and even providers, is from their experience working with these new products into RPM and the chronic care startup days. And they've started going direct to consumer first, not as the ultimate business model. But as the proof that pinch patients will actually use their invention or their program. Right, and that's because a lot of these providers and payers have been burned by the promise of tech that will improve outcomes and bottom lines for some that no patient wanted to use. And that truth is that gosh patients don't wake up every day wanting to be engaged. So if you're asking them to use or wear something, or do something different, you better be sure that it's organic to their lifestyle and easy to use. And I think entrepreneurs are starting to, by default de-risk this part first, right? Because for us, nobody believes them. And at the end of the day, interventions don't matter if consumers dont  want to see them.

Jessica:

Absolutely, yeah, absolutely. I agree with you. 

Chris:

You talked about Amazon, you've talked about infrastructure. And there are now you know, not just the retails getting in, but the tech titans that are entering in healthcare, it seems like everyone has healthcare. Play between Amazon and building this mystery vertical stack that may or may not go external, Apple, Google, Microsoft is examples. Which of these are interesting to you? They're kind of like platforms as a service, maybe maybe their competitors. Yeah, I mean, are they scary for incumbents or startups?

Jessica:

What do I hear? Or what do I think?

Chris:

I guess both. Yeah.

Jessica:

So this is what's funny is like, I hear more often than not, that these are not scary for incompetence, like I hear. And that the reason, especially if you talk to people who have been in Health Tech for a while, the Matthew Holt of the world, or, you know, some of these folks who have followed this face for a long time, you know, they know that a lot of these companies have, they've made multiple runs at healthcare, and then have like, retreated, and like, you know, like regrouped and then took another run. And so it's like, I think there's a lot of skepticism, I feel like among maybe those of us who are not around for that initial first wave of Health Tech, we might feel like, I think I fall in the more optimistic like, and maybe it's just I'm really rooting for the incumbents to, like, have some kind of competition and be forced to, like, you know, what I mean, to to innovate and adapt some of these things that would make healthcare, you know, reduce admin expense, so that we can just drop the overall health care or improve their processes, digitize and collect data, look at that, and figure out how to improve a workflow faster than not, but do it in a way that's obviously you know, safety risks or whatever. But you know, what I mean, like, I just feel like there might be, there are definitely some things that those organizations have the ability to do, because they are used to working at a faster pace, they are used to taking a little bit more risk. They even took a big risk and what took the big risk of failed in the healthcare the first time they went and now you know, they're regrouping again, it's like, okay, that this didn't work, we're adjusting. We're trying something else. I mean, it's so interesting that it's like, you have like, Amazon cares shuts down, but it's like, then the big news authors like Amazon acquires one article, and it's like, well, wait a minute. Like, okay, we didn't like this model was shaping up. We're gonna just pivot right now and do this. I mean, but I think that that kind of thinking is where the incumbents are gonna get challenged. And I think they shouldn't be afraid of that. And they should also be afraid of the fact that those businesses have an ability to engage consumers with experiences that they love products that they love technology that is ambient and seamless and flowing, the ability to like collect data that they can't even? Yeah, I mean, I only want to talk about the fax machine thing, Chris, I don't want to talk on clinical notes that we have no idea what's going on. You know what I mean? There's so much of that. 

And it's like, I think that there's the threat there too, for them to me is that you have these, these tech titans that just have the ability to think about changing the stuff, they're not afraid to take risks, they bought so much money. And it's like, they have this real, I think ability to maybe reimagine the healthcare experience, because of the fact that they're not, right, in a way that I feel like I'm in a convenience. Like, I used to work for a blues plan. And I was on the innovation team. And that's actually part of the WTF Health founding story, like Kmart in this in the end in a weird way. Because I used to go to these meetings and try to tell people who had been working their jobs doing a great job, but keeping their job was like to improve the status quo and continue to make like revenue that they were like, skyrocketing revenue with a nice happy, your over your percentage increase, it's hard to want to go and like, go through the upheaval of integrating something new and taking on the expense. And we don't even know if it's gonna work. And we've never done it this way. And all my performance metrics as an employee are tied to my goals from last year, which is like a 2% increase in this not like, let's stand something up new and like, completely recreate the payment model. Like, I didn't sign up for that you're gonna say so I think that having thought, when I was in that space, and in the plan that I was at, there's a real interest in innovation, but there's a lot of fear for it. And it's was ironic, and all of this. And like, part of why I started my show, it's like, there's a real need for information about what this technology is how it could be deployed, what that payment model around, it could look like, what's the engagement model with patients and providers and whoever else needs to be involved could look like, and it's like, that's what I tried to do is like, introduce this stuff to people in a very, like, I want, I like  to say like, someone was called me the Oprah of health tech, because I'm just energetic and pretty excited about everything. And I really don't want to try to, I want to ask hard questions like, Okay, well, could this really work? How do you scale it up? Or what's the payment? Is that really gonna work? It's like, I want to make sure that like, I'm asking the hard questions, but in a way where it's like, it's all information speaking kind of educational in the sense that it's like, it's a safe place to learn about the things that maybe you don't quite understand how they're being deployed, and how it all works. So that like, whether you are in an incumbent organization, or another entrepreneur, or just somebody who's innovation, curious, you have the ability to see this stuff, and like, you know, maybe have your mind open, maybe be able to think about, you have that innovation, innovation mindset that you need, where you're saying, not really stop, and then perhaps go and give it a try. And if you're an incumbent, take on the tech companies that might be coming your way.

Chris:

Yeah no, there's so much baggage that stops these large incumbents from actually challenging their own models of thinking and doing things. And you know, it's been shown time and again, that, you know, that  may work or delay for some time. But at some point, if you don't cannibalize your own business, somebody is going to do it for you. And now we have these tech titans and retails from, you know, other industries coming into the market. And it's really, you know, pressing the issue, right, it's like, change now, or these people are gonna change it for you. 

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Jessica:

Yeah and I think the retailers are gonna put a lot of pressure on that. I mean, like, I think the thing that's cool, though, about that is it's like, you know, it's like, the retailers are, they're partnering with incumbents. So it's like, it's not like these guys are leaving them in the dust. It's like, okay, like Walmart in their new UnitedHealthcare deal. 10 years, um, that's a pretty significant deal this decade. I mean, and so that's interesting to me, because it's like, all of a sudden, you've got like this. Walmart UnitedHealthcare. So it's like, you've got the retailer, you've got the plan. Obviously, optum R x, you've got the PBM. And like, what does that look like? That looks just like CVS Aetna. Caremark, right? So it's like, all of a sudden, so it's like, I mean, I think that's gonna be one of those like, forget this like tech titan versus incumbent thing is I want to watch like these retailer Plus plan vertically integrated, like, yeah, do you get our model PBM behemoth, like two giants just going at it. Like that's going to be cool. You think about the price of pricing power, the number of lies, the number of places that those forebrain like, touch, you know what I mean? Like, yeah, it's crazy.

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Chris:

Yeah, yeah. No, I think that is absolutely that competitive advantage that a lot of people are worried about. And then yeah, the other one you talked about is, oh, well, people already use our technology advantage from the Apples and the Googles and such an Amazon Of course. Yeah, it's gonna be fascinating to see how it plays out. But people are still investing very much in these startups that are neither incumbents nor titans from different industries. So let's talk a little bit about funding. Rock Health reported that digital health funding doubled for two years straight, I think peaking at 29 billion last year. But in the first half of this year, we're down to 10 billion. And we've had a lot of inflection points as a planet, in tech and healthcare in particular, from COVID to almost post COVID, war in Ukraine, and this now inflation and potential recession. How would these events in or others impacted Healthcare investment? And where are we at right now?

Jessica:

I mean, I'll give you the gossip of what I'm hearing. So it depends where you're at, and very much. So I mean, I think the general sentiment, which I like, I feel like the general sentiment is like we were so like, excited. I feel like during COVID, and it was like, literally, it was like how people must have felt like when prohibition went into effect, just like the party is like, over there's like a black cloud over us now. It was like the sky is falling. That's it things are over. And I think that might be true In some ways. I think that's a little bit. I feel like it's a little bit overblown, but I really don't think that this is like the, you know, we had our moment and that's it, you'll never hear from us again, these will never be what I'm hearing from a lot of people, generally speaking both on the entrepreneurial side, and on the the investor side is that there's a lot of money out there, like people are like kind of looking for stuff to to fund. And there's a lot of investors who are taking like this, what can I get a good deal on right now? kind of approach to like funding. And so I think like you already know, we're not seeing the types of valuations in rounds that we were saying before, I think there's a lot of good in that, because some of that I think was very overblown. And, yeah. And so I think that that's a good thing. I don't necessarily feel like the doomsday effect on NAT. 

I actually feel like this was kind of the correction that we needed. So that the bubble that everybody talks about doesn't burst, I think that we're what we're seeing, or at least what I feel like we've been seeing, at least through most of 2022 is yeah, there's been a pullback, but it's like, there's still stuff happening, there's still deals that are, you know, and it's like, I think I'm getting a sense from some of the startups it's like, like I keep hearing, it's more difficult to find, to get an A than it is to get a later round, depending on your market traction and what your reputation is who your other investors are. And I'm hearing that like it, there's like a mixed bag on seed funding, like it just seems like investors are hungry to to put stuff somewhere, but it's like, it's like, in theory, there are deals happening, but it's like, it's just it seems like there's kind of like up there. Like, it's like when you know when you have to go shopping, and it's like always for me clothes shopping, and it's like you have money to burn, and you really want to buy and you just don't like anything. It's kind of like that. I feel like it's more like that right now than it is anything because I think I think too, that there was this the artificial thing, not only just like the evaluation piece, but I think that there was just, you know, the obvious trend for a lot of investors that were new to health tech, during COVID. The obvious thing to invest in was virtual care, and mental health. It was like all of a sudden, you know anything about the number of companies in those in those types of spaces, remote patient monitoring, where it's like, this was the obvious thing, like everybody's stuck at home, oh my god, I mean, so it's like this is this category is gonna blow up. And like, there was a particular point in the pandemic, while we're all waiting for the vaccine in some manner of shutdown, depending on where you were in the country is like, that's what a lot of this campaign, those are not at Robin Hood stuff that means stocks. And it's like we're like it used to be in at home, right? We picked our banana bread and like moved on to other hobbies. 

So I think that like what we're seeing now, I think is like that, that some of these investors that were new to Health Tech, I think we stuck them in for life and they're in but they're kind of I think doing that learning of like, okay, I knew that this was big, because this was totally up in the moment, Trent, I still believe in this category, like, what else is there? How do we help, you know, this omni channel enablers or the value based care enablers? Those types of companies that are now going to have to do the infrastructure plays do the jobs and filling in the cracks and getting together the virtual channels and the virtual plus onside, the at home, the with the hospital with the doctor's office, all of that glue that needs to fill in the infrastructure, all that I think that's where, like people are starting to try to figure out what that looks like. And I don't think we necessarily knew what that was before. But I feel like that's kind of like one of the things that has slowed down investment right now in the sense that it's like people are I feel like there's just still kind of like, in some ways, a learning curve with a lot of the investors that jumped into the space before COVID that are sticking around. And I think I mean, I think there's nothing wrong with the quality of startups out there. I just think we've kind of taken a second to figure out like, Okay, we did all this stuff like now what?

Chris:

Yeah, recalibration and rewriting. Yeah, I think in 2021, if you had anything, you know, semi interesting, then it was pretty much a given that you would get a follow on funding round. And so less pressure to let's say, make a sustainable business or prove out that your thing really improves outcomes or adds value. But now 

Jessica:

Everybody became a mental health company that was like a joke for a while, like, there was some business, they did mental health, it seems like mental health, I think it might be a mental health startup right now.

What's interesting about that, is that like, I think what you just said made me think, I think another reason we're not like seeing so much like, so much like deal flow popping right now, is that like, this health tech space was not very big. It's just not. And all that, like, you've just said, like, oh, people got their big rounds. It's like, okay, like, they're still like working on the scale up plan for that round. They've got runway, so a lot of them like they don't need another round right now. And if it doesn't make sense, why would you raise it if you're gonna get a down round? Wait that out? Especially if you funded, that you got funding in the last year or so and you're still scaling up? And you've got a lot of cash in the bank to help you do that? Why would we see more deal flow? I mean, I don't even know how many tech companies that are out there. But I felt like everybody I knew got funny, that's my Oprah moment. Like, I'm gonna fund your own. And you're gonna fund your three funding rounds in one year, like crazy. The norm, multiple companies that did that. I know I had them on the show.

Chris:

Your microphone is the magic wand, right? It's the funding. 

Jessica:

Yeah, that's how it works. I wish, I wish.

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Chris:

Yeah, maybe it's just companies that are kind of stuck in the middle. And they never got to raise their big round, but they were planning on it. And of course, startups within healthcare take much longer to prove out. And as you mentioned, in startups and other industries, it's like, now we have to be patient or go back to school and what it means to try to be default alive until we profounder funding returns. How about the other side, so the end of life of a company, not end of life, the beginning of a new life? So acquisitions? And what have been the trends for acquisition categories? I mean, I guess both through COVID. And then now recently?

Jessica:

Essentially, everybody said this year, and I was one of them, I was like, this is gonna be the year of the acquisition. And I don't even think that we've begun to really even scratch the surface. Like, I think that this is where it's like, you know, depending on how, how far you got with product market fit, you know, client engagement and revenue, like proving out your revenue model, like, depending on how you're doing scaling wise, it's like, we're starting to see right layoffs, and, you know, even people who are trying to take steps to keep the company going, but I think there's going to come a point where some of these startups, it just, you know, it's they don't, they don't work for whatever reason, I do think we're going to see more m&a, and I'm not the only person who thinks this. I've heard this from quite a number of people who are investors, and, you know, it's like, it doesn't. There are still though, you know, there are great companies who are going to acquire them. And I actually think that we're gonna see a lot of like, shuffling together of, you know, health tech startups, you know, some like, I feel like, I mean, I just talked to headspace health, and they just acquired, you know, blink on their name right now that they do like, mental health. With that smile, it's sort of in essence, this guy who was blanking on the name of this, but they do like, they have a mental health self care app that is culturally created with culturally relevant content. So whether it's like LGBTQ or very diversity focused, but you know, headspace was like, they've got this great consciousness, they're stuck with acquisition this year of a smaller company that had a very specific niche solution. So it's like that question of like, I think you're gonna see a lot of like those, you know, the whole point solution, I remember the Wall Street Journal article, and then everybody is now like, oh, point solution platforms is the way that like, that's just like, I don't know, it was like, there is a point there. And I do think that we're gonna see a lot of, you know, the, the mergers and acquisition acquisitions are going to build more of these platforms, or you're going to see them be something like what headspace is done, where they're filling in parts of their own business with acquisitions of their acquisitions this year, where that was that company that just I mentioned, that does the culturally relevant self care and mental health content. 

The other one was one that was just focused on self care and sleep. And so they just don't have those modules in their program. And so they're going to continue to build out and make sensible acquisitions. And there are a number of businesses that have already made acquisitions this year to fill things out. Signifying  health everybody's darling right now a couple acquisitions this year to round out what they had. And you know, it's interesting, you know, how we're seeing that happen. And then what's getting acquired. I feel like I'm, like I said, point solutions that fit into this something bigger. So if you are like a self care asleep app, you go into a bigger mental health solution. Or it could be like smaller telehealth companies getting acquired by something bigger that needs a telehealth infrastructure. Or you're seeing, like, provider groups get acquired by somebody that needs more providers, or I think like in those tech companies there, it's like, their availability. And I always blink on the other company, like, I'm like, Yeah, you're right, like the end of life. Like, they're like that, to me, I'm like, You got it anymore. But they acquired a company that really does like a middle ground type tech thing between them and a health plan to fill in that gap, they're doing it better than availity was able to do it, why buy it, or why build it, when you can buy it and really get like a company that knows what they're doing that's proven or metal in the market has its own client base. Perfect, this is a great acquisition. So I think that's what we're gonna see is a lot of these bigger startups that are very well funded older have a proven revenue model, I think we're gonna start to see them kind of pick up some of these smaller startups that just didn't have a chance to scale yet may have a great business, just we haven't seen them be able to, like have the the time, the money, the capital to prove up their model, for one reason or another, we're gonna start to see them fit into a much bigger offering so that the platforming out of like literally everything.

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Chris:

Right, right and gosh mental health, of course, was forced into the spotlight through COVID. But then, at the same time, it seems like consumers met them at that moment, there were startups and solutions, wellness apps, etc. Are there any other changes or patterns that you've noticed in consumer adoption or readiness for new healthcare technology, or modalities because of the pandemic? And for example, I was around when Google tried their vote the first time around. And the thing is, people just didn't care enough about their health or view technology as a solution to anything outdoors invented. And you know, so it completely failed the first time no one cares about having their at the time health data in one place, because they didn't know how it could possibly impact or trust Google. Do you think any of those under no inhibitions have changed in terms of consumer adoption or trust in technology?

Jessica:

That's tough. Because I feel like there's been like, particularly with Facebook, I feel like that actually, like it kind of went the other way, or there's like, a little bit more distrust. I don't know, I see that in that space. And I'm trying to think if there's anything that I really feel like, has gained more traction as a result of COVID, like, in terms of utilization.

Chris:

But yeah, they're on the other side.

Jessica:

Yeah. You don't even be like, Oh, God, all of those fitness mirrors, I remember there was one week, we were covering the deals of the week. And it was like, literally, it was like three different like, three different fitness mirror companies that got funding, it was like a total of something like $80 million in funding for fitness and yours. I'm like, How does this even happen? In the category that didn't even exist? So I think like, I feel like we are kind of past that part. But you know, I feel like the remote patient monitoring space in one way or another. I feel like, I don't know, people are really hot on that right now. I don't know how hot consumers are with that. But from a lot of the health system, people in particular, that's like a key thing to them. And it's like, I get this whole sense, you know, that health moving into the home, I do feel like that's become more of a thing of like from an ideological shift and may not be like a change in consumer adoption in terms of health tech, but we're care delivered, like looking at the home as a place of care that we never did that before. Now we do like looking at your phone as a place to deliver care. Like that became you know, that that changes you mentioned with virtual care. And I think that the ancillary thing around that, I don't know if the, if that's just being pushed by, you know, folks, that obviously might be a little bit further reach into the home. Or if consumers are really reacting to it in that way or not. I think I mean, Jury's out for me on that, but that would be the one I think that I would say that I feel like, I've always been skeptical of that category, but I feel like more so like now post COVID I feel like I keep hearing a lot more talk about that. Yeah,

Chris:

Absolutely. Because it was the only way to take assessment safely, right for some period of time. And yeah, no, I think RPM is an interesting one where the promise is so great, because physicians can know if there's an exacerbation or a problem, even without you coming into the hospital, but at the same time, that's another category where well, yes, but consumers actually have to wear the thing, right? They have to agree to something that they don't really inherently want, which is to be monitored, and during like for chronic care management, all of these companies sprung up purely to remind people to go ahead and enter their weight to put on the blood pressure cuff. Because it just feels so inorganic, to people to be wearing those. And a lot of the startups that we've talked to seem to have something really interesting going on either, of course, trying to make the devices that they have as easy to wear or transparent as possible, or even AI chips on patches. We've talked to a startup company, or just Ambien, so sensors are put around you in the home, but nothing to wear at all, no phone call to make to remind you to put something honored on a scale. I think those companies are going to be super interesting, because I think the benefits can be clear. But again, patients need to comply with

Jessica:

I'm so skeptical about this space. I just like, it's just , like I said, I keep hearing about it. And I'm like, okay, like maybe because so much of your health in the home thing is a real movement. Like we're seeing the retailer's push there too, right? I mean, signify opposition. So, I mean, I like to see that happen. But like, I'm like you, it's like, I don't know, I don't want to watch, not an Apple Watch and or a ring on my tiny fingers. Like, you know, what are you going to do? And then, you know, people point to like, oh, well, you know, those smart speakers. That's the way that's the way I really article, and I can't remember which one it was, if it was if it was Alexa, or if it was really like you learn within the first 15 minutes of you having that speaker. Whatever commands use, you do in that first 15 minutes. It's like that's 90% of the commands. I mean, it was like 80 or 90% of the commands you will ever use that speaker for like you don't learn a lot of new tricks. Think about it think what's the weather play this music from Spotify. But that's like, it's the repertoire of tricks kind of stopped after a point and doesn't grow very well. And that's something that it's like, it's just there in your room. Right? Like, I don't know. So that space is.

Chris:

Yeah, yeah, no I

Jessica:

Companies, it's like, God, I'll have you on, you could explain to me why it's great. I'll listen, I'm just not so.

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Chris:

Right. Right. And it may not end up being the end consumer that wants the thing. But it could be their kids, right, that want to know that mom or dad is healthy. Or if there's a problem, right? Make sure that somebody is on it, and taking care of them. And I've talked to a couple of startup companies where that is their whole go to market, right? We're not trying to go after, you know, people in home care. But we're trying to go after their kids. Right and offering them this way to know like this whole flipped relationship from childhood. Right, that? No, they're okay, from afar. But yeah, I think it's gonna be fascinating. Certainly none of them have been proven out. You've talked a little bit about policies and policy changes that enabled all these new business models during COVID and may take them back. What are some of those policies that you're watching for? In terms of enabling or disabling business models?

Jessica:

The ones I mentioned before, the ones that are just sort of Top of Mind, it's what happens with telehealth with care delivery, I say lines. What happens with reimbursement around that? What, what's going to happen with Roe versus Wade  returning? You know what I really like? That kind of policy around that going to impact data sharing, because I think there's a great, I guess I'm gonna, I'm one of my one episode of my shows, who's like a HIPAA privacy expert, and it was Deven McGraw. And she explained, she worked for years and HIPAA during both the Obama administration and the beginning of the Trump era. And she was explained because all my data is protected because of HIPAA will not if law enforcement can request it. So this is going to be a policy thing that we might see it play out on a state law, but but the implications for that for a health tech startup is like what's going to count as some of the information that could potentially be used in a court case, that proves that a woman was pregnant, and then all of a sudden was not pregnant and got an abortion? And, you know, so think about like, what kind of data that could include, you know, I mean, it could include everything from like, data from an online pharmacy that shows that there was a process to prenatal vitamins or something, or you know, what I mean, or it could be a period tracking app or like a number of different things where they can pull data, and that could be used, as Devin put it beautifully weaponized, you know, because it can be used in a court of law. But I think her whole point and you guys need to watch this. I'm not a policy expert, and was pointing this out. There's like, there's a lot of different implications depending on what ends up happening around that, that could affect the way that data is shared and the responsibility that a health tech company would have, you know, to comply with the law and also, but, you know, how do you do that and protect your patients and how do you let your patients or your members or whomever your users know that you know if if their request if that Data is requested, you know, because of a, for lawful reason that they have to comply. There's a lot of stuff around that. So it's like, I think those are the big ones that I feel like, are just kind of being talked about right now. I'm sure I'm missing something. But it's like those are the ones that have kind of piqued my interest.

Chris:

Right. And we've talked a lot about these inflection points and changes in health care. But on the flip side, Jeff Bezos shared advice with his portfolio startups, that his secret is to focus on the things that don't change about your business. And I'm curious, what are the things that don't change your habit, or you don't think you're going to change soon within healthcare?

Jessica:

That's hard. What doesn't change in healthcare, I mean, I think the payment model, we got a long way to go before the payment model is gonna change. So I think that like, you know, anything that helps, you know, beef up the fee for service model that is like, you know, really not ever gonna go anywhere. I think value based care is growing, I understand. But it's like, that's still like the majority of the way that healthcare makes its money. So that does not change. So figure out how to get yourself into that. And then I think that some of the other things that are trying to think of like a good one, like a zinger on this one, I think that like people will always want to, people will always want to go in person somewhere. So I do think that like, and we've we're seeing this in the sense that there's a lot of virtual first primary care companies that offer like a site of mental health, and they're operating on their own EMR system in a value based care design, they're starting to take that virtual and build like in person centers, like crossover health as confirmation centers, where you have like an in person, but the small office space or some sort of space and retailer, but there's also the the telehealth that that complements that. So think like, though, there will always be a need to have to go and physically see somebody, and maybe that will change to somebody coming to see you. But there's still going to always be that need for human contact at one point. So I do think that like, you can't say, Okay, we're going to completely move to a virtual care kind of, it's just impossible. I always think that's, you know, it's not going to change, this is awful, but like how people like try to navigate that how consumers try to navigate their health care benefits. Like I think there's always going to be room for like, improvement on like, the IT side, the tech side, the data side of it's like, we're How do I know where to go? Or fits into my plan? How do I know what plan to pick this year? How do I sort through all of this is my doctor in there, you know, at the provider directory issues that are out there. So it's like, I think that's always the stuff that's always gonna, that's never gonna change.

Chris:

Until it's a part of your Amazon Prime, right?

Jessica:

Maybe.

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Chris:

So that was Jeff Bezos’s  advice. But speaking of startup advice, I believe you have a lot to add, as someone who curates startups and innovation trends are a part of and interviews these entrepreneurs. I know you help entrepreneurs and startups on how to build their own brands. How should entrepreneurs explain their ideas, and especially when talking to someone like you that doesn't know them intimately,  an investor and or a potential customer. And you just need to click off the bat

Jessica:

I'd like to do two really great pieces of advice. It's like, ditch your jargon, like ditch, the like high in the sky, like we deliver the right care at the right time in the right place. Are you an app, like I don't even understand what you give me like a disease or like, I have no idea what you're talking about. So it's like, I think that there's like this need to like, kind of bring some of the language that just oh, we're trying to, you know, completely revolutionize healthcare by it's like, okay, just, you know, cut the, the fluffy sensationalism out of it. 

And just I always say, this is the second piece of my advice. Tell me what you do. So that if I was trying to explain this to my mom, like, she's not in health tech, you know, she's not, she's not let me she's not an elderly person. She's, you know, like, she's that consumer that's like, headed toward Medicare, not there yet. But it's like, how would she understand this? Like, if she's, you know, what I mean, she would understand what you're doing with, you know, like, explain it. And like, even something complicated, not necessarily even consumer facing, but if you're like, one of these companies that's doing all sorts of cool stuff with data, you know, it's like some of these like, like a ribbon house or a Komodo halls or like some of these that are doing like really cool, like, amazing stuff with AI and like, predictive analytics and things like that are some of the, you know, clinical trial companies that are helping diversify clinical trials, but you know, having to curate larger audience and do like, decentralized that whole model, but also use AI to find people who are, you know, rare disease and bring them all together, whatever. It's like, how do you explain that to her so that she gets that stuff? Because that's like, if you can figure out how to do that, people understand in your business, you have a really strong jumping off point to continue to tell your story. And you can get into all the ways that that matters and the big pie in the sky visions, which are beautiful, but it's like to open with that. I think  that's a mistake that I often see a lot of startups do is just try to, you know, to talk really big picture real high level cause overs conceptualized and overused jargon that like the normal people won't understand.

Chris:

And you discussed earlier about headspace making this acquisition of a company that kind of contextualizes mental health, culturally contextualized. Is it? And it turns out that okay, this is one of their modules, that headspace just acquired into their portfolio of things they offer. How should entrepreneurs think about what they are in terms of are they just a feature? Or are they a full standalone product? Or are they going to be a platform themselves?

Jessica:

That's a tough one, because you have to really think about this. And it's like, it's like, Yeah, are you a feature in somebody else's thing? Or are you a standalone company? And it's like, and I think it's interesting, because like, you know, you mentioned the chronic condition, startup days, it's like the middle of vongo, oh, Mata Vida Virto, one drop, like arms race of like, what are they going to add to platform out, you know, it's like, what what's going to be next who's going to acquire like hinge or sword and add the MSK thing, and it's like, hidden sword are still there, like, they did they ended up not being that, you know, so it's like, and that was that everybody expected this to become part of a platform to be a feature in a much larger offering. And it didn't, I feel like you have to like, I mean, I think you have to just kind of be really aware of what's going on in the space, and what the players who are a little bit bigger than you are doing, and also what your buyers are saying back to you about what they want. So it's like, if that whole thing is like, we don't want another point solution, or they don't see the value of having a point solution that does x, because it could easily be integrated with a bunch of other stuff, I think you need to start to take that feedback. And, you know, if you keep getting that over and over again, maybe think about what it is that your business really is. And what you need to do to either make yourself more of a standalone, what kind of value you need to be adding, or you know whether or not you do kind of start to think of yourself as maybe a business that hasn't as a successful exit being acquired by somebody.

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Chris:

And so some entrepreneurs are like, good at figuring out what they are right away, some aren't. And some aren't good at explaining it. Some are great, some aren't good at focusing on what they can be. But what are some of the traits that you found of successful entrepreneurs that you've interviewed and gone on to just, you know, crush it? What do you think some of their patterns are?

Jessica:

Um, I feel like they're, I mean, talk about like, generally speaking, one of the things that we're I feel, I always kind of cringe when I hear startup CEOs say this, especially in the early days, and especially if they're not, and they're having a difficult time, like figuring out what they are. And then they start to become everything that every investor that they talked to you says that they want to see. So especially if they're trying to raise around and it's like, well, you're not a platform place. So why don't you become a platform playing cup or ticket, they're trying to get new clients, and new clients are like, Yeah, this is great, we understand that you're focused on this, but if you had that, too, and then it's like, all of a sudden, you're starting to build new modules and expand and it's like, there's this like, I was, it's like, it makes me nervous for them. Because there's a point where it's like, you start to lose what your business does like that. Remember, they Oh, good, great hedgehog concept. Like you start to lose that thing, where I feel like some of the more successful entrepreneurs, they might be flexible on a lot of things but it's like they've got that that core kind of vision that I think kind of carries them through in a way where it's like, they're okay saying you know what, I'm I'm not that I might be open to hearing that I shouldn't be that if I keep hearing it over and over but like right now like No, I'm not that or it's like, you know, kind of having that steadfast like vision but maybe something that is you know, flexible on the details, but solid on that, that long range kind of idea of what what it could become the outcome or impact that you want to make.

The other thing I would say I think about like entrepreneurs from an interview standpoint, my favorite entrepreneurs want to interview are those that are really candid, and are not afraid to say what they think. So this is kind of along the same line. It's like you don't want to you don't want to say something and offend and I'm not saying you have to be offensive and sensational but if you don't like the way that you know mental health care is being delivered and you have some good reason why or like and there's a great company boulder care that does you know, they have a tele a telehealth program for folks who are opioid opioid addicted to help them get through that and it's like you She's passionate about the fact that it's like, this is broken. And I really want to fix it. And it's like to be able to say that I think in a lot of ways and have that passion, I really feel like there's a lot to be gained in terms of not only the success of that company, but just in an interview, like really feeling like that entrepreneur has not only a beat on what's going on, but is really committed and passionate, like, and fired up, but the issue that they're trying to solve, which is like we know, we've said this, healthcare is a long game. So it's like to keep that fire in your belly over the long term, like, you've got to have some fire in your belly. So if it comes across in an interview, I always feel like it's a great trait for an entrepreneur to have

Chris:

Yeah, that's interesting. And maybe it takes that passion to not be tempted away from your core vision. And then yeah, like you said, if you don't focus, you end up building something for everybody, which means it's for nobody at all. 

Jessica:

I like when people, I'll always ask them, Can I ask you about your competition? And like, I always, always, am always fascinated to hear the answer and I'll always do what they say, because I'm not that kind of person to catch anybody. But it's like, I'm okay answering that. But I don't want to mention people by name, or it's like, no, I'm tackling these people head on. I'm tired of being confused and I'd like to hear this again. And you know what I mean? It's like, I love the diversity of answers. That's so cool. But I feel like the best thing you can do in that regard is not pretend that you have no idea what else is going on out there and say like, everybody's doing such a great job. There's room in the market for everybody. Like, there might be but come on. Let's get real. You're thinking about, you know, what would you do to differentiate yourself and how you position yourself? That helps us learn.

Chris:

Yeah. And I'm sure Matthew, if he gets to talk to them, or gets wind of them, holds them accountable to cutting through the BS?

Jessica:

If not, he'll cut through it for them.

Chris:

Yeah, no, I had one very fun interaction. At five with Matthew, where I was very much on my toes to try to explain what we do. Which is not complicated. But yeah. Anyway,

Jessica:

It's interesting how easy it is to fall down that Matthew Holt rabbit hole, especially if it's not happy hour.

Chris:

It was, it  was on a rooftop. Yeah.

Jessica:

I should warn people if you ever see him at a happy hour, and you have a sense that this is not his first or second, I would steer clear because it only goes downhill from there.

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Chris:

Right. Ah  man, but love and admire him? Of course. Yeah, totally. Do you have any other advice for startups? Or where they should get beginning advice? Either yours or incubators, advisors?

Jessica:

No, I have no advice. As far,  do not ask me, I am like, seriously, like a gossip. Like I can tell you what I was talking about, or were hearing but it's like, I'm not I could never do some of the series advising that a lot of these other folks are much more well equipped than I am. Do I do like accelerators, I do feel like there's a lot of value in those if you know what it is that you need from the accelerator and are pretty clear. I'm like finding the right one that can give you what you need. Because they do think they all have their own little like, you know, special sauce. They're almost like an investor, like, you know, there's no problem shopping around for like, you know, we want an investor that helps us, it can help us in a way, not just with funding, but also maybe with relationships or other portfolio companies that are, you know, similar, like, you know, what, I mean, just guidance in that regard. I think accelerators aren't necessarily looked at by early stage startups like that. And it's not because they don't want to wish they don't think they realize that they could or should. And so I think that there's a lot of wealth of knowledge. And there's a lot of great ones that are doing a wonderful job out there. I know, there's a lot of folks who are like, servicing some of these health tech companies, you know, accidents or whatever. I mean, right now, I hate to say this, but there's a dearth of talent that's looking for work, because some of these folks have, you know, unfortunately been laid off. And I can certainly see a lot of those folks doing some advising and helping, you know, grow the next crop of startups. So it's an encouraging to me that they're not leaving the industry. And I think that those are the people if I were, if I were somebody who's looking for an advisor, I'd start to look at, you know, some of the some of the folks that maybe are now looking for work, who have experience in health tech, because a few years ago, there weren't very many of them. And you know, now we have like a class of people. And I hate that they're all that this has happened. But I think maybe one of the positive things could be that, you know, they are looking to advise these younger crop of startups. And it's like, I hope that younger crops as startups start to look for them too.

Chris:

Got it. And so I would love to selfishly ask, as if I'm a startup. And by that I mean, this digital health community and podcast that Bimal and I and the team are building and trying to grow. You have your own very successful community and podcast in WTF. What would your advice be to people like us who want to create content in the digital health space?

Jessica:

Do it ,like do it, do it and make it be yours. Like, I mean, I know my energy is noxious to a bunch of people, but you know what it's what it is. And it's also I think, like, I get very nice messages from people who like it. And so thank you to everybody who supports me and listens and watches and sends me nice notes. I really read everything. I almost always write back with my LinkedIn is my work. So if you get me on LinkedIn, sometimes it's a bad day. But I appreciate all that. And so my advice to you guys would be like, like, yeah, put yourself out there, be yourself, you know, give it a scab. And like, try to think about the stuff that you would want to know, you know what I mean? Like, or you would want to ask or like, what are you curious about? And it's like, more you can kind of, like, you're in this space, what do you like to read about? What do you you know, what gets you going, and it's like, that's the kind of content like, I start to create, like, I'm a payment, innovation junkie, it's like, I will fall for that story every time like, ooh, tell me more like, came from a plan. Of course, I'm gonna love that. You know, it's like, I love like, it's a, I feel like my content, I really just follow my curiosity, which is like, I'm in a very lucky place to do that. And I would encourage anybody else who's creating content to do the same thing. It's like, think about the things that you're curious about the stuff that you like to listen to, then even the style of like, some of the folks that you like, like, I mean, I wish I could do like mob Olara on NPR, and have that great voice are like high visible on marketplace, you know, like, it really gets channeled out. But it's like, I can't it's like, those are the things I enjoy. And it's like, what do I enjoy about them? They're genuine. I feel like I know that. They can make jokes that there's candor, there's like, sometimes running themes throughout and you're like, Oh, I listened to the show forever. And And get this, because I think that's the kind of stuff that makes digital content really great.

Chris:

Oh, well, I do not find you obnoxious , I don't think any of us do. Thank you. No, no, we love your energy. But I obnoxiously  have one last question.

Jessica:

No, you can ask me all the questions you want. But I obnoxiously see,  I've been like the longest guest on your podcast, I'm sure at this I so I need a lightning round .

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Chris:

I mean, given all these things that have changed, and things that may never change, and your perspective on innovation areas, what do you think, which of those is going to be the next big boom in terms of like number of startups or, or potential impact on people's health? 

Jessica:

I've got a couple of answers to this. So I think we're going to, I have this theory, this crazy conspiracy theory about this, like shadow EMR world that's starting to be built alongside the real, like the Cerner and epic world where it's like, there's a lot more like startups that are going into that space, if it's like, and we even think about some of these primary care companies that have built their own EMR, like all of a sudden, it's like, which I feel like we're starting to see like other EMR possibilities kind of emerge alongside and then a lot of other data exchange startups that are taking advantage of some of those new privacy rules that have gone into place, so that you have no privacy rules and start with some of the data sharing rules that have gone into place, and really starting to build out that that side, I think that's going to be a space that is going to just pop because of the fact that all of a sudden, there's this data that wasn't previously available, that we're gonna have our little, our little hands on, and we're gonna be able to algorithm eyes until we run out of questions to ask and predictions to make. And so I think that's going to be a space that was really popping. 

The other thing that I think on that same token, it's, I would like to see that start to become a like, maybe this is further out. But he's like, how we're using some of the tech that we've got to better refine the diagnostic process for certain areas of healthcare. So like, you know, how we're all mental health, right? It's like, could you like how can you refine? How can you get better at doing diagnosis and more quickly getting somebody into the space like with the data that we're starting to collect about certain things, or even when it comes to like some of these the pharma innovations around like digital therapeutics that wrap around a hill or whoever it's like, you have a lot of information now that augments the information that you had in an interesting way. And it's like, can you use some of that to make it easier for somebody to find the right medication faster? Like, or like, you know, get them to a diagnosis with a mental health disorder a little bit quicker? Or? I don't know, I mean, I think there's a lot of potential there for like having like this, this, this front part that helps you not triage or navigate, but it's like, like, how do you enrich that with technology and use the the data in aggregate that we have a bunch of, let's say, people who are using remote patient monitoring device or like, all these chronic condition, digital health startups that have a lot of information about diabetes and weight and, you know, different types of chronic conditions like that. It's like, if you looked at all that aggregate, what could you learn? And how could you slice up our population and maybe provide more targeted treatment to women versus men, or people who are in their 30s ? And I don't know, I mean, like, there's so many ways to start to look at that data that we never even had before. So I like all of that space that really unlocks the potential for taking all that data that is like really just sitting there. and being able to refine it and start to do these things that can really change the way that care is delivered and that patients start to see outcomes. Like I think that's so I love them. So pie in the sky.

Chris:

No, not at all. You know, I hope we can all be positive in these past two years, it's been a tremendous change. And we'll see if we can keep up that pace of change, or whether that's good or bad. 

Jessica:

Still excited I refuse to go down this like, no party is not over and up by any means, we are just nearly like finding an after hours. 

Chris:

Exactly in Digital Therapeutics is one of those. I think our next guests will be a digital therapeutics startup. But so promising in terms of it's been emerging this past couple of years. But the question for all of these companies comes back again, to these business models and policy changes, and how are you going to really make money? Is it going to be from the prescription, the pad or is it going to be from enrollments right through programs with plans and pairs? And, gosh, I'm really hopeful like you are that some of these business revenue model reimbursement things get more supportive or stay supportive of these innovations. But that's our next guest. Jessica 

Jessica:

Oh exciting, I'll tune in for that

Chris:

Oh Gosh please

Jessica:

Send her my way, if you're if it's a good guest

Chris:

Will do, But as far as you're being our guest, Jessica, it's been an absolute pleasure having you on. Thank you. Thank you for catching us all.

Jessica:

Seeing the worst of being interviewed, because it's like, I just yeah, it's like, I'm so much I'm so much more comfortable to be on this other side of it. But thank you for the beautiful facilitation of this conversation. I mean, like, I cannot, these questions were awesome. They were like, they were like, really, I could not have asked for more carefully curated questions that really let me talk about the things I want to talk about. So thank you. Yeah, I feel like I really, again, so excited about so many aspects of the space in case you can tell. And so I appreciate the fact to just kind of throw these ideas out there. Because it's like, when I'm interviewing somebody, I try not to put my opinion out there too much. I think it leaks out sometimes. But I try not to so it's nice to sometimes talk about, it's like me, I'm the worst guest sometimes.

Chris:

No, you're the perfect guest. You're absolutely caring. And I appreciate that and appreciate your sharing of WTF is going on with health. You know, being a role model for us as a podcast and just continuing to be that pulse on what's new and interesting in health.

Jessica:

Thank you so much. That's so sweet, I really appreciate that. I appreciate you having me on and like to all of your listeners. Keep listening to Chris over here. He's doing a great job. It's so fun. So thank you so much for having me. I really appreciate it. 

Chris:

Thank you

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