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QUALITY TALK

A podcast dedicated to advancing better understanding of health care.

Blossoming Genomics, Vertical Integrations, And Better Health

Posted by Jodie Jackson, Jr. on Sep 18, 2018 3:30:00 PM

 

What would Lisa Suennen say?

Lisa is a blogger/podcaster extraordinaire, but those are activities she does “for fun” and to build her personal brand. Her real day job is venture capitalist and head of the healthcare ventures fund for GE Ventures in Silicon Valley, just north of San Francisco.

Lisa-Suennen-headshot-mts

We connected with Lisa after reading her intriguing post, “Genomics Rising, Charlatans Circling,” in the April 4, 2018, online edition of MedPage Today.

Lisa’s is co-host of the Tech Tonics Podcast. Her blog is Venture Valkyrie. She has also authored the book, Tech Tonics: Can Passionate Entrepreneurs Health Healthcare With Technology? The top of her home page has the message, “What would Lisa Suennen say?”

Let’s find out.

Episode 45.
There’s a great hue and cry every time there’s a data breach somewhere, and when someone’s data has been compromised. Yet how many millions of people just willingly spit on a swab and send it off” for DNA testing “to who knows who?”

4:11 – “There’s so much interesting stuff going on” in terms of how the players are changing in healthcare “so I have to find a way to synthesize it for myself.” Lisa agrees that keeping up with the changes is like drinking out of a fire hose.

“The level of cross-over between segments of healthcare that is occurring now is uniquely significant in our industry. There’s a lot to watch; a lot is changing.”


Episode 35 - For health care, disruption is the 'new normal'


5:57 – Are we really changing for the better or just rearranging chairs on the Titanic? In a previous episode of Quality Talk, Primaris CEO Richard A. Royer answered that he’s not worried about a catastrophe. “There are too many people with too much money at stake to let that happen.”

Riverboat steering wheel on exterior wall

Lisa explains that “companies used to stay in their ‘power alley’ in health care. They rarely talked to each other. The lines between those different entities have broken down.”

For examples of the crossover, we’re pulling from her blog, Disruption or deck chair: Healthcare is changing, but will it change for the better?

  • Health System Becomes Drug Company: Tired of what they perceive as price gouging, a group of 300 hospital systems, led by Intermountain in Utah, have banded together to start a generic drug company
  • Tech Companies Become Healthcare Companies: Google, Apple, Amazon. And now FitBit. Fewer middlemen (cost?) Oh by the way, Amazon is also a major seller of private-labeled medical devices and supplies.
  • Medical Device Companies Become Services Companies:  A few years ago, recognizing that if you control the services delivery you can affect what it purchases, Medtronic entered into the business of outsourced management of cath labsand other core clinical operations in a number of hospitals, primarily outside the U.S.   
    young pharmacist suggesting medical drug to buyer in pharmacy drugstoreRetail Pharmacy Company Becomes Medical Device Company: CVS has just announced that it will be developing and selling medical devices, starting with an in-house effort to develop a product for at-home kidney dialysis. (Yessireee, they are going to the FDA with their product (eventually), brought to you by the same folks that sell cheetohs, diapers and makeup while you wait for the pharmacist to fill your scrip.)
  • Retail Pharmacy Companies are Becoming Health Insurance Companies: CVS has been busy. It is also in the process of finalizing a merger with Aetna, one of the nation’s top insurers.  And in response, Walmart has announcedtheir interest in purchasing Humana, yet another leading insurer. VERTICAL INTEGRATION.
  • Insurance Companies are also Becoming Healthcare Providers: obviously the CVS/Aetna merger puts Aetna in the direct mix of being an outpatient provider if they are co-mingled in the CVS mix.  But how about this factoid: UnitedHealth Group now has purchased hundreds of outpatient practices(employing well over 30,000 providers) and outpatient surgery centers (over 1 million procedures per year) and have the ability to serve as much as 70% of the US population. Humana is hot on their heels; rumor has it they are hoping to acquire several hundred outpatient practices in the nearish term (and they have already begun the march in Texas and Florida) and have already acquired a large stake in Kindred Healthcare, a company that provides home healthcare to over 130,000 people. 
  • Providers are Becoming Insurers: hundreds of Accountable Care Organizations, essentially mini-insurance entities, have been formed by providers seeking to take advantage of favorable payment models that have, at least in theory, better profit margins than the hospitals they tend to inhabit. And other provider-owned health insurance companies have been quietly growing.

8:20 – We ask Lisa, “Is this leading towards lower cost?” Her reply: “I personally doubt it. The only way to limit the cost of healthcare is to limit the amount of money to spend on healthcare.” And with an aging population that needs more and more healthcare, “it will be very difficult to turn the clock back on cost.”

Some solutions might be capitation and fixed rates of pay. “I don’t think we’re anywhere close to that.”

There are over 70,000 genetic tests on the market and up to 10 new ones make an appearance every single day. This may be a rate of proliferation that rivals the increased rate of use of the word “blockchain” in Silicon Valley. Yikes.

And worse, like in the early days of the internet, the charlatans are circling.

13:22 – Lisa is watching “innovative ideas, out-of-the-box thinking,” and is intrigued by all the vertical integration. Walmart and Humana, for instance, are teaming to “change the people people access healthcare.” There are highly publicized disruptions such as the Amazon/Berkshire Hathaway/JP Morgan healthcare venture, as well as “micro level” innovation, such as HealthReveal, which is developing ways to save lives and reduce costs  via guideline-directed medical therapy (one form of “precision medicine.”) “There’s a lot of smaller companies trying to solve pieces of this puzzle.”

15:37 – Is this real-life science fiction? What does Lisa say?

“Everything’s sci-fi until it’s normal.” When it comes to genomics, the services offered by companies like 23andme and Ancestry are “interesting” for tracing family lineage, which is “not a medical use.” Then there’s also precision medicine, which “makes all the sense in the world.” But between those two uses, “there’s a lot of grout.”

“There’s a lot of pseudo-science companies out there … Yet people spend a lot of money on this stuff,” she says, adding that regulation will eventually catch up. There are five to 10 new genetic tests that come out every day. “Many of those are not scientifically valid.”

Image of DNA strand against colour background-1

21:48 – Lisa Alderson is co-founder and CEO of Genome Medical Inc., and she has predicted that within five years, every cancer patient will have their genetics sequenced. And in 20 years, everyone will be sequenced at birth. Currently, about 1 million Americans have had their genome sequenced.

Says Lisa Suennen: “It’s becoming standard, and it probably should be, to the extent that we have the science on the medical side to use that data for good and to help people live a healthier life from the get-go.” If in fact everyone is sequenced at birth in 20 years, “How it is protected and how it is utilized is a whole other question … Genomics is blossoming right now. We’re just beginning to see the potential for how it can be used.”

Wrapping up.

  • Lisa also outlines her role as a venture capitalist (23:55): “Look for smart, entrepreneurial people with great ideas. We’re constantly trying to figure out ‘what’s the next new thing?’”
  • Where do social determinants of health fit in with precision medicine and genetic mapping?
  • “We’re not just data points; we’re chemical and biological beings.” The challenge of maintaining the human touch in medicine (27:10).
  • “All of us can try to do the best we can and do the right thing for the patients. If you keep your eye on that ball — making people healthier — ultimately it will drive you to the right place. The drive may be long and circuitous, but it will get you there.”
  • Lisa’s takeaways (37:10). For patients: “Be thoughtful about what you do to contribute to your own healthcare.” For healthcare entrepreneurs: “Let’s really focus on things that make a difference, not on more incremental stuff. It’s important to make a difference.”

Topics: Quality Talk podcast, Lisa Suennen

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