Alejandro Novoa

One key reason why healthcare technologies like AI, telemedicine, and software haven't structurally lowered costs or broadened access for the entire system after decades of experimentation (excluding pure financial engineering of payer contracts) is the limited reimagining of care delivery itself, with asynchronous telemedicine as a notable exception. In the same way that digitizing physical paper failed to exploit the capabilities of a new computing medium for word processing, hosting physician-patient conversations over video does not transform the actual delivery of care. In telemedicine, many of the inputs (e.g., clinician time) and therefore cost structures of in-person care persist, which is why we often see fee-for-service telemedicine companies struggle to achieve economies of scale (i.e., growing revenues non-linearly while growing costs linearly). Until we deconstruct the components of a medical appointment – from intake and triage, to chart review, history gathering, physical examination, diagnosis, treatment, and follow-up – we will continue to be underwhelmed by the disconnect between the transformative potential of these technologies and real-world patient/system impact. I’m optimistic that the emergence of reliable and performant medical AI agents will urge us to perform this deconstruction and redesign the fundamental building blocks of a “medical appointment.”

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I’m worried about the state of venture capital and direct-to-consumer (DTC) healthcare startups. Hims & Hers is the poster child for DTC healthcare at $1.2B proj 2024 revenue and a $3.6B valuation. By most accounts, they have been an outlier success for DTC since bottoming out in May 2022. So why is this bad news for DTC healthcare? Because the market leader (Hims) trades at a 3x forward revenue multiple. And the category leader typically gets a higher valuation multiple than smaller startups. We see this phenomenon in private equity. They “roll up” smaller companies within the same category at a lower multiples just to create one larger platform that trades at higher multiples. Now back to DTC healthcare startups. If Hims commands a 3x revenue multiple, it’s not unrealistic that smaller, unprofitable startups may be valued 1-2x revenue at exit. At 2x revenue, a startup must generate $500M to produce a $1B exit in today’s market (depending on growth and profitability). Series A/B venture capitalists must see a pathway to $1B outcomes. And if the growth-stage investors with billions under management are less interested in DTC healthcare, the future funding rounds necessary for fueling growth are not guaranteed. Juxtapose this against 2017-2022 where DTC could raise Series B-E funding. Let’s take a DTC startup doing $25M after 3-4 years of operations and has already raised a Series A. By most accounts, it would be a phenomenal accomplishment. But today, investors will question the chances of that same company scaling from $25M to $500M revenue in the next 3-4 years with unknown future funding sources from Series B and beyond. You're stuck in VC-funding purgatory. Some of these companies will shut down. Some may sell for 1-3x revenue. And some may try to transition to profitable, cash-flowing businesses. All of which are certainly not the venture-backed goal the founders, investors, and employees often had in mind when first taking capital. I say this all with friends working at or starting DTC healthcare companies, I feel bad for them. I also feel bad for the patients who enjoy those products or services. To caveat (b/c I know people will object), there will be other DTC brands that exit for $1B+ (i.e., Ro). However, they were forged and scaled during a different time period where seemingly endless venture capital was available for DTC healthcare. Now we're in a different time with no end in sight. Thoughts?

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Bag is packed, and I'm heading off to HLTH Europe 🎉 HLTH Vegas was my first taste of the HLTH experience, so expectations are high for what Henry Stoneley and the team have crafted over in Amsterdam. The official agenda is appetising (https://lnkd.in/e3Y87Z8Z), with multiple stages themed around the senses. What am I looking forward to? 🪩 MAIN STAGE 18th: Ali Parsa talking about Babylon and his latest venture. Essential stuff 19th: "Transforming Perspectives on Psychedelics: A Journey Beyond the Trip" fits the tolerant and broad-minded nature of our host city well. 👁 SIGHT 19th: We have "Ghosts in the machine: Empowering healthcare to capitalise on GenAI", "Blinded by AI: The Turing Test live" and "Safekeeping: Is trust AI’s biggest hurdle?" all on the 19th * I'll be appearing on the live Health Tech Talk Show with Lisa B. and Kat McDavitt 👂🏼 SOUND STAGE 18th: Listening to the latest on Mental Health at "Navigating depression: New pathways in mental health"- supporting Erin Sivyer Lee and Team Flow Neuroscience 19th: Having wrapped my head around longevity tech in ArabHealth earlier this year, I'll be checking out "Beyond the Fountain of Youth: Unlocking the secrets of longevity" 20th: The Middle East summit takes over the stage * I'll also be catching up with Christophe Jauquet Mo Zouina and Aline Noizet to record some special Healthusiasm content 👃🏼 AROMA STAGE 18th: ChatGPT and Hospitals? IM IN 19th: Debate time! "This house believes there’s no role for government in healthcare" - I smell smoke... 20th: Data might be the new oil, but not all oils are the same "Goldmine or fool’s gold? Extracting value from health data" 👇🏻 TOUCH STAGE 18th: "Eighths and pains: The ongoing trials and tribulations of cannabis in healthcare" wins for the pun alone - 18th 19th: As a GP, I'll be cheering along to this one: "Undervalued, underinvested: Why keeping primary care as an afterthought costs lives" 20th: My mind was opened by recent talks from ☀️Maneesh Juneja. "Greener, leaner, cleaner: Healthcare's role in global warming" gets my vote 👅 TASTE HLTH do food really well: Survivors BBQ is locked in. 🌍 EVERYTHING ELSE There's the Startup Stage, HealthXL Global Gathering on Monday, AlbionVC mixer, Philips welcome reception, HLTH Networking party, and goodness knows what else. This is Amsterdam after all. 🌶️ For all of my neurospicy sisters and brothers, I'm bringing a wee gift for you. Let's stay hydrated and pace ourselves folks, we have a big week ahead of us! Anushka Patchava MD, MBA Darshak Sanghavi Adel B. Hassan Chaudhury Michael Watts Dr Cos Fantis Rochelle Morris Dr Dom Pimenta M.D. Dr Rizwan Malik Sam Shah Haris Shuaib Dr Harpreet Sood plus many, many more

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How do we use technology and new business models to connect care teams across specialties in service of better patient outcomes at lower cost? Care convergence brings together different clinical disciplines, tech and new payment models to take on the costliest conditions in the system from #diabetes to #dimenia. For me, it offers a new way of … Thinking… Investing in … Paying for… Delivering … Care. What does #CareConvergence mean to you? https://lnkd.in/dhtSs-Qa

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There are many social determinants of successful health outcomes for care-seekers, and I appreciated how the data in this piece tried to examine the intersections between identity factors and socioeconomic indicators. These disparities are multi-faceted and require both public and private organizations to address them in a way that understands the complexity of the issues at hand. #Healthcare #HealthcareDisparities #SocialImpact

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There’s a category we believe is getting too little attention when it comes to AI in healthcare: AI Clinical Documentation Integrity (CDI) While AI ambient scribes and autonomous medical coding solutions have gotten most of the headlines, we’d argue AI CDI is equally impactful when it comes to quality care and accurate billing. For those not familiar, CDI ensures that clinical documentation accurately reflects the patient’s medical condition and the provided care. Historically, CDI was a manual slog, with dedicated CDI specialists, nurses, and physicians painstakingly reviewing patient charts to ensure documentation supported the care delivered. Today, AI is reshaping this landscape. While it’s still early days, we’re seeing three primary approaches to applying AI when it comes to CDI: 1️⃣ CDI + ambient scribing—an AI ambient scribe and AI CDI assistant operate simultaneously, generating comprehensive notes and surfacing codes for physicians to review at the point of care. (Example: Ambience Healthcare’s AutoCDI) 2️⃣ CDI via real-time diagnosis support—diagnoses are suggested at the point of care based on clinical data in the EHR, with auto-generated documentation and audit trails. (Example: Regard) 3️⃣ CDI via an AI-driven post-coding / pre-billing review—the entire patient record is ingested and analyzed against what is coded, surfacing suggestions for revenue and quality opportunities. (Example: SmarterDx) To date, AI in healthcare has focused primarily on administrative use cases. With the increasing adoption of AI CDI solutions, we’re now taking a step closer to clinical workflows. As clinicians get used to AI-suggested diagnoses in the CDI context, it will be interesting to see if this increases their comfort with AI playing a role in clinical care. Here's our working list of AI CDI vendors. Anyone else we should add? • Ambience Healthcare • Brellium • Iodine Software • Regard • Semantic Health • SmarterDx   

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🔄 The Evolution of Healthcare: Navigating the Shift to Value-Based Care Join healthcare leaders Abhishek Shah of TruDoc and Ralph Morales III ŌURA for a critical discussion on transforming care delivery models. As the industry pivots from fee-for-service to value-based care, understand what's working, what isn't, and what's next. Key Discussion Points 📊 Success metrics from early adopters 🏥 Organizational transformation strategies 💡 Scaling challenges and solutions 📈 Real-world outcomes and learnings 🔗 Apply to attend: https://lnkd.in/e_CgHMwC Join the conversation that's reshaping the future of healthcare delivery. #Healthcare #HealthcareInnovation #HealthTech #HLTH

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Key trends and takeaways from HLTH 2024: 1. AI's Evolving Role: AI dominated discussions, with executives acknowledging its potential while also recognizing challenges in accuracy and clinician trust. There's a shift towards focusing on the practical applications of AI, with a call for partnerships to ensure reliable testing and implementation. 2. Infrastructure Focus: Beyond the glitzy AI tools, there's a growing emphasis on the "picks and shovels" needed for healthcare data accessibility, including infrastructure, compliance, and interoperability. Executives believe that improving data flow will facilitate the effective use of AI. 3. Middlemen Under Scrutiny: Pharmacy benefits managers (PBMs) faced criticism for their role in rising drug costs, with discussions highlighting misaligned incentives and the need for transparency in healthcare pricing. 4. Women's Health Spotlight: Women's health initiatives gained attention, particularly following government funding announcements and personal stories shared by advocates. However, investment in women's health remains minimal compared to overall healthcare funding. 5. Interest in Psychedelic Medicine: The potential of psychedelics for treating mental health conditions garnered significant interest, with discussions about funding and research moving forward, especially within the Veterans Affairs system. Executive Takeaways: Leaders from various sectors emphasized the importance of consumer-focused strategies, collaboration, and the need for responsible AI usage. There was a consensus on the critical role of addressing healthcare accessibility, improving patient experiences, and fostering innovations that genuinely enhance care delivery.

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Some VC investors believe that brick and mortar - referring to a physical presence of some kind - should be avoided at all costs. Yet, the track record of clinic and hybrid care businesses in health care indicates otherwise. ==> One Medical (sold for $3.9 billion to Amazon), Oak Street (bought by CVS for $10.6 billion), Lifestance (IPO at $7.5 billion market cap), and PE-backed Premise Health (acquired by OMERS Private Equity for $1.1 billion) If a clinic is indicated as the optimal way to deliver care for that patient population, there are creative ways to build and operate them. Full article below with advice and strategies on how to build and operate hybrid clinics from my teammate Anarghya Vardhana from Maveron, Amir Dan Rubin from OneMedical Group, Steven Eidelman from Modern Animal and more!

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There is a blueprint for success and MDisrupt has the experts to deliver it!

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We're witnessing the next wave of leading companies being within healthcare services & being more "involved" than just writing good code. 🌊 I fundamentally believe it's equally important, understanding on the highest granularity, how healthcare is delivered at the core (in the clinics, hospitals & with doctors). A couple years ago there was a massive focus on digital health, this has shifted to healthcare services, experiencing exponential growth atm, due to the following. 📈 1. Operating within the very heterogenous market of healthcare (in particular primary care) requires to understand and interpret operational nuances (those closest to the problem/market will win) and solve for those very operational topics 🩸 2. Pain to innovate is highest amongst those delivering care, as there is no "continuing as before" (patients jump between services/providers based on availability, that's why digital health only takes off v slowly), doctors can't transition away but are "stuck" with their daily operational problems 😵‍💫 3. Willingness to pay is present, (see point 2.) and doctors can afford to pay for these services (shift from paying for "non-available" staff to software) and lastly it's the largest market (DACH €+550B primary care spend) with everyone being a user at one point, opening up multiple cross revenue streams 💸 4. No payor/insurance fights but a "simple" B2B customer (non of the DTx/reimbursement complexities) and a market with unparalleled retention rates (check CompuGroup revenues over the past 10 years, €1.2B in 2023) ⚔️ 5. Less regulation and increasing emphasis/relaxation on data usage (check Patient Data Protection Act or European Health Data Space) as well as enforced digitalisation throughout the upcoming years (every restaurant needs a modern POS, whilst doctors can still operate pen & paper...) ⚖️ Personally I am very bullish, that within the next 5 years, we'll see the N26/Revolut transformation happening in European healthcare - no flying cars - just better operations, services & experiences on top of existing core medical services. 💯 Thanks for the Eterno Health mention Thomas Hagemeijer - V cool overview! 🙌🏽

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#Niche-focused #ventures in #HealthTech, such as those #targeting #underserved areas or #specific health conditions, offer several benefits. They can address gaps in the #healthcare system, provide specialized care, and #potentially integrate into broader #ecosystems for comprehensive healthcare solutions. For example, #JVEDTECHMedovation, could explore #partnerships with #niche #HealthTech startups to enhance offerings in healthcare #innovation.

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Thank you Saul Marquez for being on "This Week in Pharmacy" --TWIRx In this insightful episode, we sit down with Saul Marquez, veteran of Medtronic and the visionary founder and CEO of Outcomes Rocket, a #podcast and company dedicated to improving healthcare outcomes and driving business success. Outcomes Rocket is a unique shared knowledge hub that brings together healthcare leaders, non-healthcare operators, and investors to discuss and solve pressing healthcare challenges. Key Discussion Points: About Outcomes Rocket: Saul explains how Outcomes Rocket started as a podcast and evolved into a company with a mission to connect healthcare leaders, share best practices, and break down industry silos. By focusing on collaboration and knowledge-sharing, Outcomes Rocket aims to transform healthcare into a more efficient and patient-centered industry. The Power of Connection: Saul dives into how Outcomes Rocket connects healthcare silos, enabling leaders to share knowledge and improve outcomes. By fostering collaboration across the industry, Outcomes Rocket helps bridge gaps and drive positive change in healthcare delivery. Join us as we explore how Saul Marquez and Outcomes Rocket are making a significant impact in the healthcare landscape by fostering a community of leaders committed to improving care and business success. Whether you're a healthcare professional, investor, or entrepreneur, this episode will provide valuable insights into the power of connection and collaboration in healthcare. YouTube Interview here: https://lnkd.in/eEXXRyTz

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Seed. Series A. Series B. C. and D. Suki has grown in size, in revenue, in margins, and in user footprint over the years. I certainly did not imagine life playing out this way when I embarked on this journey in 2017. We tend to write congratulatory notes when we raise rounds. I rather just express gratitude. We are very grateful to all new and existing investors especially Hedosophia and Venrock who led this round. I am even more grateful to the Suki team who is so sincere, and works so hard, and cares so much for the mission. There are so many more to thank. But rounds are not much more than milestones in the larger journey of trying to build something meaningful. AI will one day redo healthcare is practiced around the world. I want Suki to be a part of that story. And to that, we will keep working hard, keep serving our users, and hope that we build a company that users love and employees are proud of. More to come. https://lnkd.in/gzQud4iQ

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💥 New Episode: Second Opinion with Caroline Pearson, Executive Director of Peterson Health Technology Institute (PHTI)! Remember that bombshell PHTI report showing many digital diabetes companies aren't producing meaningful improvements in patient outcomes—and are even driving up healthcare costs?? We had a candid chat with Caroline about how the industry can do better. Some takeaways: 📊 Prove Your Worth: "Digital" isn't a value proposition—it's table stakes. Whether you're driving clinical outcomes or providing patient support, back your claims with evidence and be crystal clear about what you're actually delivering. 🏥 Healthcare is Unaffordable: Caroline talks about the tough trade-offs we make every day due to finite resources. If we’re going to spend healthcare dollars, let’s make sure it’s on something that delivers real value. 🤝 Collaboration is Key: Caroline emphasizes the need for companies to work together—don’t compete when it comes to building evidence. Let’s all push towards better solutions for patients! Check out the full episode here and let us know what you think: ᯤ https://lnkd.in/gUmfWSPq  https://lnkd.in/g7FdqZhs ⏵ https://lnkd.in/gnGH7dpt Turpentine Christina Farr Luba Greenwood, J.D.

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AI in healthcare? LIVEMED Telehealth™’s framework on deploying AI effectively has guided the innovation of VIRTUALIS™ and is fuelling their rapid growth in US telemedicine. It is so refreshing to be supporting a company solving real issues in such an innovative but pragmatic way. #telemedicine #healthcare #virtualcare #healthtech

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Why Isn’t Healthcare More Personalized? ask Robbie Hughes and colleagues in Harvard Business Review. What will it take to make healthcare at least as personalized as our Amazon product recommendations? The advent of the electronic health record, a single source of truth with petabytes after petabytes of data, does not drive personalization, but rather standardization – health care is delivered on a cookie-cutter based approach. Robbie headed health tech start-up company Lumeon that noted from ‘…nearly 20,000 outpatient surgery cases in one health system and found that just under 70% of the patients didn’t need one or more of the standard pre-surgical tests.’  Another study of cancer care pathways found that 65% of cancer patients were treated using one of the standard pathways and 35% were not. I get the need for smart process automation, combining standardization and personalization to create the most effective and responsive care, but how about the needs of the individual patient? We can achieve mass personalization, for sure. https://lnkd.in/e4PWcUqa

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