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Composed of several disparate systems and teams, consolidating data is a significant challenge for many hospitals. Juggling emerging technologies with IoT adoption is causing the attack surface to rapidly expand, while remote administrative and IT workforces only make the environment more complex. Hackers are continuing to relentlessly target healthcare, with ransomware incidents already up a shocking 328%, just in the first half of 2022.

Between these cyber pressures and the growing number of analyst-proposed methods and acronyms being offered to boost security, determining the best cyber strategy for an entire health system can be overwhelming.

Many have turned to zero trust architecture (ZTA) to help. This calls for organizations to embrace a ‘never trust, always verify’ approach by authenticating and vetting users at every access point. It suggests a holistic framework for implementing the most essential security solutions like identity verification and multifactor authentication (MFA) to prevent lateral movement across a network. However, if not done strategically, ZTA can hinder productivity and create unknown in gaps in the security system.

Some healthcare delivery organizations (HDO) utilize a variety of siloed solutions to achieve ZTA, but it doesn’t always create the most efficient or sustainable workflow. Instead, strong integrations between technologies are critical for an effective system that benefits both CISOs and end users. Fortunately, there’s a new analyst term that builds upon ZTA to encourage this: cybersecurity mesh architecture (CSMA).

Extending beyond zero trust, cybersecurity mesh offers a comprehensive, well-integrated foundation for health systems to increase defenses around every digital identity and access point. To understand what led to the development of this concept, let’s look at the biggest changes in healthcare’s cyber environment.

Changes in healthcare’s cyber landscape

Covid-19 enabled cybercriminals to thrive. With hospitals rushing to adjust and support their remote workforces and access for third parties (let alone treat an influx of patients), bad actors started to prey on the vulnerabilities created by a weakened security posture.

The traditional perimeter for how users accessed the network was dissolved. Virtual private networks (VPN) and remote desktop protocol (RDP) used to be effective enough in preventing breaches. But surging ransomware attacks proved that was no longer the case. Hackers began to exploit the vulnerabilities this situation created, with one of their main gateways to access being unsecure third-party integrations. And the problem hasn’t slowed down since then – in fact, 55% of healthcare organizations experienced a third-party breach in the last 12 months.

IoT adoption also grew and became integrated into hospital systems. As users connected to the network from different locations and cloud-based applications, a decentralized environment emerged and brought on new risks that weren’t a factor in the old ‘castle-and-moat’ security strategy. This decentralization created more opportunities for lateral movement across the network, giving hackers the ability to breach digital identities and lay low while looking for the most sensitive assets to attack – like patient information.

This digital environment is surely unsustainable. Although many are taking steps to bolster their security through ZTA, utilizing cybersecurity mesh could take the strategy one step further to provide a stronger and more adaptable framework, boosting defenses from all angles.

What is cybersecurity mesh?

One of the most popular analyst terms in 2022, cybersecurity mesh is a defense method for securing each device and critical access points with their own security perimeter. It builds a foundation of dynamic interoperability in the environment, rather than the traditional security protections of a single perimeter. This lays the groundwork for organizations to build and extend their ZTA.

CSMA should be viewed as an interconnected identity fabric. As healthcare embraces digitalization in the age of ransomware warfare, there’s an urge to implement several protections as quickly as possible. However, there always needs to be a strategic method behind new implementations. In CSMA’s case, the ‘meshing’ of solutions must be cohesive. Between the cloud, on-premises infrastructure, or hybrid environments, CSMA supports and protects digital identities. In addition, it leverages analytics to keep organizations capable of responding quickly in the case of an attack or breach. That in turn provides shared intelligence that triggers actions across several systems.

Although cybersecurity mesh, like zero trust, might be viewed as another buzzword, all organizations, especially healthcare, should consider this method when building a digital identity strategy.

Getting started with cybersecurity mesh

With attacks only increasing, the time to bolster security is now. Gartner estimates that by 2024, in the event of a cyber incident, organizations with CSMA will reduce their financial impact by an average of 90%. To enable healthcare to focus less on the next breach and more on providing patient care, start by answering these questions:

  • What are the most critical access points at your organization? Understanding how and where your most important data is accessed is critical. Build access policies around those points and decide the best authentication methods from there.
  • What is needed to implement ZTA? Determine an outline for achieving ZTA by enforcing an approach that denies trust and makes users verify their identity at every touchpoint. Move away from VPN and RDP to prevent cyber criminals from moving across the organization laterally.
  • Where can analytics be used to monitor and audit user access and behavior? There are many different tools organizations can use for this – from screen-recording privileged access sessions to conducting analysis. This is an effective way to provide insight into how users are interacting with sensitive information. It’s also a simple way to identify any suspicious activity that creates a potential risk for a breach while giving them the tools to prevent one before it’s too late.
  • Have you closely assessed the third parties your business works with? With third-party integrations being a primary access point for bad actors to breach, analyze your connections with all third parties. This improves visibility into their external operations, allowing you to vet their processes and verify external users.

Cybersecurity mesh is an extremely valuable tool for healthcare systems to improve their security and protect their digital identities from all angles. As cyber threats become more sophisticated, taking steps toward cybersecurity mesh could save organizations a lot of time, energy, and money in the long run.

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Sanofi’s scope in genetic medicines is expanding to muscle disorders through a new alliance with a preclinical biotech startup. The pharmaceutical giant is also bringing a key piece for the RNA therapy that partners will develop together for a particular form of muscular dystrophy.

Under the terms of the agreement announced Tuesday, Sanofi will collaborate with miRecule, a Gaithersburg, Maryland-based startup that develops RNA therapies that target and fix a genetic abnormality that causes disease. The alliance covers miRecule’s drug candidate for facioscapulohumeral muscular dystrophy (FSHD), the second most common type of muscular dystrophy. The disease has no FDA-approved therapies.

MiRecule’s technology identifies targets for RNA drugs by analyzing gene sequencing profiles and clinical outcomes from hundreds of patients. Those targets are screened to find the best RNA therapeutic for a subset of patients. The therapies use an antibody to direct RNA to target tissues. The combination of the molecules creates what miRecule calls antibody-RNA conjugates, or ARCs.

FSHD is caused by abnormal expression of the DUX4 protein, which leads to progressive muscle weakness that primarily affects the face, shoulders, and upper arms. The miRecule FSHD program, code-named MC-DX4, is designed to use RNA to eliminate the expression of the DUX4 gene, thereby addressing the underlying cause of FSHD in muscle tissue. The new alliance will pair miRecule’s FSHD drug candidate with an antibody from Sanofi’s proprietary antibody platform.

The agreement gives Sanofi an exclusive license to miRecule’s FSHD therapy. The two companies will collaborate on research through the selection of a lead therapeutic candidate. After that, Sanofi takes over responsibility for the preclinical work to bring the therapy into human testing and subsequent clinical development. Sanofi will also handle commercialization of the product if it secures regulatory approval.

MiRecule is in line to receive an upfront payment and near-term milestone payments that could top $30 million combined, according to the agreement. Milestone payments could bring the biotech nearly $400 million, plus royalties from sales of an approved product.

“We look forward to working with miRecule to bring together our two groundbreaking technologies synergizing in a best-in-class therapy designed to suppress the underlying cause of FSHD. We hope that this will enable patients to live a life free from the debilitating symptoms of the disorder,” Pablo Sardi, Sanofi’s global head of rare and neurologic diseases research said in a statement. “We are excited to embark on this collaboration with miRecule as we work together to bring hope to the FSHD community.”

Sanofi’s RNA moves in the past year have focused mainly on messenger RNA. Last year, the pharmaceutical giant paid formed a new mRNA vaccines unit to expand applications of mRNA beyond Covid-19 vaccines. Months later, Sanofi paid $3.2 billion to acquire mRNA biotech Translate Bio. The $160 million acquisition of startup Tidal Therapeutics brought technology for developing mRNA vaccines for cancer. Sanofi also has an RNA interference therapy in its pipeline through an alliance with Alnylam Pharmaceuticals. That partnered therapeutic candidate, fitusiran, is being developed as a treatment for  hemophilia A and B.

MiRecule started in 2019, supported by the patient and academic communities as well as a grant from the National Institute of Neurological Disorders and Stroke. In addition to muscular dystrophy, miRecule is applying its technology to cancer. The biotech’s most advanced cancer program, MC-30, is in preclinical development for head and neck cancer. That RNA therapy is designed to correct a genetic mutation that leads to resistance to currently available cancer therapies.

Photo: Nathan Laine/Bloomberg, via Getty Images

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During my training as a geriatrician, my colleagues and I would regularly make house calls. One experience in particular sticks with me to this day. A patient had just been discharged from the hospital. He was having difficulty managing his medications and was worried about making mistakes. Upon entering the home, I quickly understood why: there were clusters of pill bottles in nearly every room.

There were meds from the hospital on the dining room table, pill bottles on the kitchen countertops, in the cabinets, and on the living room coffee table. Upstairs, more prescriptions were scattered around the bedroom and in the bathroom. Pills, capsules, tablets, ointments, lotions, patches, droppers – you name it.  I even found old brown-green glass medication bottles from the 1950s. The pile we eventually made on the dining table was three or four feet wide and a foot and a half tall. Working diligently, we focused on disposing of the expired medications, culling the various med lists he had stacked up, and eventually whittled down the active medication list from 20-odd meds down to the 13 or 14 he actually needed.

This is what polypharmacy looks like when it persists over a lifetime, and the experience is all too common among older adults. The average adult between the ages of 50 and 64 is prescribed 13 medications, with that number increasing to 22 for those age 80 and older. Prescriptions for the average older adult come from multiple providers, and they’re often filled at multiple pharmacies. Currently, medication reconciliation only happens at specific, transitional moments in the healthcare journey. Medication management is in dire need of a wider lens and a broader application to reach more patients.

A recent study published in The Journals of Gerontology: Series A found that fewer than 21 percent of people over the age of 65 have received a comprehensive medication review, with low-income patients among those less likely to have received the service. Even though medication reviews have been covered by Medicare Part D plans for over 15 years, 83% of patients were not even aware that their health plan covered this benefit. Where is the disconnect between the benefit and the member?

It’s all in the delivery. The ways in which most medication reviews are currently conducted prohibit many older adults from being able to take advantage of the benefit. Medication management needs to be convenient, accessible, and connected to daily life.

Convenience and access are key

Older adults shouldn’t have to drive to a pharmacy, with a medication list in-hand, for an in-person medication consultation with a pharmacist. It is inconvenient and, for many older adults, inaccessible. For older adults struggling with multiple chronic conditions, those with limited transportation options, or those who may not have convenient access to a pharmacy in their neighborhood, a trip to the pharmacy can be a difficult endeavor.

Outreach over the phone has its limitations, as well. Pharmacists and techs working in call centers typically do not have a relationship with patients, not to mention the difficulty getting in touch with patients over the phone. A pharmacist – or any other clinician, for that matter – is not able to see all the medications in a household. They have a limited view into that person’s life.

Across the industry, the delivery of services is heading into the home. Covid-19 accelerated the movement of healthcare services to the home through the rapid uptake of telehealth and virtual care. Patient preference and technological advancement have kept the momentum going. Patients want these services because they’re easy to utilize.

The gap between patients and medication management, however, is not one that can be bridged completely with ones and zeros. Computers can’t open medicine cabinets. While telehealth services have become a vital piece of the care delivery puzzle, nothing compares to the value of face-to-face time with a healthcare professional. At its core, healthcare will always be a hands-on, human experience. The most convenient, accessible, effective environment to provide services like medication management is in the home.

The kitchen table medication review 

If the healthcare industry can deliver pills to patients’ homes, we should also be able to sit down with them in their living rooms, at their kitchen tables, and help sort through them.

The home is far more accessible and convenient than a trip to the pharmacy. In my experience doing house calls, I found the home a much more efficient site of service for a medication review than a phone call. Being present in the home allowed me the opportunity to get all of my patients’ prescriptions and supplements out in the open and on the table. Sitting at the kitchen table with my patients, I could catalog what they were actually taking and safely dispose of old, unused medications. I could counsel them on safety concerns and drug interactions. Face-to-face, I could build trust.

As a clinician, I can enter my patient’s home knowing them from limited interactions in facilities, or from their health records. But I can leave with a greater understanding of my patient as a person, of their lived environment, and the barriers they face on a day-to-day basis.

People want to be where they’re most comfortable, and healthcare, in recent years, has followed them there. Connecting vital, underutilized services like medication reviews to the daily lives and routines of older adults is the logical next step in the movement of care to the home, and for finally addressing a problem that has confounded the healthcare system and frustrated patients for far too long.

Photo: bong hyunjung, Getty Images

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Immunology drug research has been casting about for better and safer ways to intervene in the inflammation driving autoimmune disorders. The recent FDA approval of a Bristol Myers Squibb plaque psoriasis drug made it the first approved product in a new class of medicines that address a particularly attractive enzyme target. Startup Sudo Biosciences aims to show that its drugs can be best in this emerging class, and it is now out of stealth with $37 million in funding.

The enzyme of interest is tyrosine kinase 2, or TYK2. It belongs to a protein family called Janus kinases (JAKs). Companies such as Pfizer, Eli Lilly, and AbbVie have commercialized JAK inhibitors for a range of autoimmune diseases, but their drugs come with the risk of severe side effects. Last year, an FDA inquiry into the safety of Pfizer’s commercialized JAK drug, Xeljanz, found a higher incidence of cardiovascular problems and cancer, which prompted the regulator to update black box warnings for that drug and other products in the JAK class.

TYK2 is an attractive drug target because, like its JAK cousins, it is also involved in signaling pathways associated with a wide range of immune-mediated inflammatory conditions. However, hitting TYK2 is hoped to offer a safety edge compared to JAK inhibitors. For a TYK2-targeting drug to work, the key is to bind to it without also hitting the other JAK family proteins. Menlo Park, California-based Sudo is now joining a growing group of companies taking a roundabout way to accomplish that task.

The way most small molecule drugs work is by binding to an active site on a target. Sudo’s drug, and other TYK2 inhibitors in the class, are allosteric inhibitors. Rather than binding to an active site, these drugs binds to a different spot that can still provide a desired therapeutic effect. According to Sudo CEO Scott Byrd, his company’s lead programs target the TYK2 pseudokinase domain. Hitting this target avoids also hitting JAK proteins that can trigger side effects.

“By allosterically regulating TYK2 kinase function through binding to the TYK2 pseudokinase domain (JH2 domain), significant improvement in selectivity versus other JAKs can be achieved,” he said in an email. “Increased selectivity provides the advantage of avoiding safety liabilities of agents known to inhibit JAK2 and/or JAK1.”

BMS drug deucravacitinib demonstrated that TYK2’s pseudokinase domain can be successfully drugged by a selective allosteric inhibitor. The September approval of that drug in plaque psoriasis came without the black box warning carried by JAK drugs, but its label does note that cancers were observed in clinical testing. BMS is marketing the pill under the name “Sotyktu.”

Investors are gaining confidence in TYK2 as a druggable target. Days after Sotyktu’s approval, Nimbus Therapeutics unveiled $125 million to fund mid-stage clinical trials of its TYK2-blocking drug in psoriasis and psoriatic arthritis. Ventyx Biosciences followed with a $177 million private placement to fund clinical development of its drug pipeline, including a TYK2-blocking drug.

Not all TYK2 drug research efforts have been successful. Sotyktu failed a Phase 2 test last year in ulcerative colitis. A test in that indication using a higher dose is ongoing. BMS also continues to test the drug in other immune disorders, such as lupus and psoriatic arthritis. The number of drugs vying to join the class is growing. BioCentury counts 11 TYK2 inhibitors in clinical trials, including three that take the dual approach of blocking both TYK2 and JAK1.

Sudo claims its drugs could be best in the TYK2 inhibitor class, but the company isn’t disclosing specifics. Byrd would only say that each of Sudo’s four programs has been designed to fill specific unmet needs unaddressed by known competitors on the market or in development. In indications already addressed by a competitor, Byrd said the goal is to show Sudo’s programs are better. Sudo’s disease targets also remain undisclosed for now, but Byrd said one program is an oral pseudokinase drug.

Though Sudo announced its launch this past week, it was founded in 2020. The company was formed by the life sciences arm of investment firm Frazier Healthcare Partners. In the announcement of Sudo’s launch, Dan Estes, general partner of Frazier Life Sciences, said that the startup emerged from discussions at Frazier that included scientists and others who saw an opportunity to target pseudokinase as a way to treat a range of autoimmune disorders.

Sudo’s Series A financing was led by Frazier Life Sciences and Velosity Capital. Sudo plans to use its new capital to advance the company’s lead drug candidates into human testing. Byrd declined to offer a timeline for reaching the clinic.

Photo by Sudo Biosciences

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From left: Ayush Jain of Revolution’s Rise of the Rest Seed Fund; Ayse McCracken of Ignite Healthcare and INNOVATE Health Ventures; Max Rosett of Research Bridge Partners; and Dr. Hubert Zajicek of Health Wildcatters

When it comes to investment, including healthcare and biotech, companies in the Bay area, Boston and New York tend to get the lion’s share of venture capital. But in recent years there’s been greater attention to investment in companies beyond those regions. The Covid-19 pandemic also played a significant role, as people were forced to limit travel and use Zoom to connect. In a panel discussion at INVEST Digital Health, healthcare and life science investors discussed investment strategies and why they are placing their funding bets in states like Texas, Indiana, Utah and Arkansas.

The panel, Investing between the coasts, moderated by Dr. Hubert Zajicek, CEO, partner and co-founder of Health Wildcatters, offered a window into how investors are finding companies that match their investment theses, even in states that are not thought of as startup hubs. The panel was sponsored by Lyda Hill Philanthropies.

“We were the most active investor in Arkansas last year,” said Ayush Jain, a senior associate with Revolution’s Rise of the Rest Seed Fund. The fund, which was started by Steve Case of AOL fame, has made investments in more than 200 companies in 40 states since 2017.

The video platform Zoom has made an indelible impact towards democratizing investment across the country, according to Ayse McCracken, a founder and board chair with Ignite Healthcare in Houston and president of eNNOVATE Health Ventures. Ignite focuses on women-led digital health and medical device startups, while eNNOVATE invests in a broad array of startups across the continent of Africa.

McCracken said it was one of the unintended consequences of the pandemic.

“[Zoom] has allowed us to connect with entrepreneurs all across the country and all across the world and match them with mentors across the U.S. All of a sudden, we were working with an expanded ecosystem coast to coast, and we were working with startups coming from all across the country. We have eight of the 22 companies [in our latest cohort] that are coming from the Texas market — San Antonio, Austin, Dallas and Houston, which is great. We’d love to see Texas continue to grow. Denver has been another location where we’re seeing a number of entrepreneurs come from, also Minneapolis.”

Max Rosett, a principal with Research Bridge Partners, conceded that Zoom has been useful for connecting with and keeping in touch with portfolio companies in areas that would have otherwise been costly to travel to from his offices in Salt Lake City.

“This is going to sound incredibly trite and yet it’s incredibly real. Now that it’s okay to have board meetings over Zoom, life is much easier,” Rosett said.

Research Bridge Partners, which focuses on life science companies, is trying to chip away at what it refers to on its website as the “geographic misalignment” of venture capital in the Bay area and Boston. It also calls attention to trends among larger venture capital firms of creating lab-to-market systems to advance ideas towards financial liquidity that make it tougher for midcontinent principal investigators to access, because these firms favor  institutional brand and geographical proximity to their offices.

Although everyone is pleased that the worst of the pandemic appears to be over, Zajicek said that in the past two years the accelerator has received a record number of applications from all over the world, which has spurred the development of a hybrid program combining in-person and Zoom-based interactions with startups in its cohorts. It has added an international flavor to its startup portfolio. Add to that the accelerator’s advantageous base in Dallas, in close proximity to an airport with the most direct flights in the country.

“It has flattened the world in non-trivial ways,” Zajicek said.

Health Wildcatters recently moved its offices to Pegasus Park, a 13-floor building that offers lots of space for healthcare and life science startups to work and connect with investors and collaboration partners.

Jain agreed that Zoom can offer a useful complement to in-person meetings and has made it easier to foster relationships with startups. He emphasized the importance of regional startup incubator and accelerator spaces, which frequently host demo days and other events to bring investors and startups together. They can also prove useful for investors from out of town seeking to plug into the regional startup ecosystem.

“If there’s a city that you gravitate towards, whether it’s because of a particular industry strength, or a personal connection, those are factors to leverage when you build relationships in those cities and find deal flow there,” Jain said. “That’s something we lean on a lot. We’re not lead investors. So we rely on finding opportunities to invest in startups, mostly through local regional investors, accelerators, incubators, places like Pegasus Park, where there’s a ton of companies. There’s some institutions in other cities like this. I think finding those and really honing in on them and building relationships is important.”

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Employees

The World Health Organization now considers social determinants of health to comprise the better part of healthcare. This is long overdue, but as pioneers of the population health movement, my colleagues and I consider this an understatement.

We estimate that 80 percent of individual health is due to non-medical factors, including crime, poverty, education and opioid abuse. The silver lining of Covid is that people are finally paying attention to the large-scale social, economic, and environmental issues that impact health outcomes of disparate groups of people — population health — but this is just a start.

An “engine of inequality”

In April of 2020, professors Anne Case and Angus Deaton wrote in The New York Times that the current healthcare system is an “engine of inequality.” Sadly, they got it exactly right. The pandemic exposed the primacy of social determinants in terms of who lives and who does not. Now, we in the healthcare business must ask some very tough questions that have been avoided for far too long. For example, how do we care for populations that may put us at economic risk? How do we stratify care among populations? How do we coordinate care between communities?

In the past, these were considered public health questions. They now fall under the “roof” of population health. The central pillar supporting this roof is composed of epidemiology, behavioral science, and the environment — all of the key tenets of the traditional public health approach. However, there are other pillars, including the quality and safety of the care we deliver, its cost, and public policy considerations.

During the height of the pandemic, the lines for food exceeded the lines for medical help here in Philadelphia. The inherent inequality in our system ensured that the death rate for people of color would be much higher than for others. Covid was a witches’ brew of catastrophe and increased mortality for minority populations.

Post-mortem

While it is too late to declare victory over Covid — and, sadly, we already have another population health crisis on our hands — let’s not wait to recognize the scope and depth of the problems we face. Moreover, let’s address them with the appropriate tools. If our core business is improving health, then let’s reinforce all of those pillars in order to improve the roof over our heads. Of course, this begs yet another question: how are we going to get paid to implement these changes?

Healthcare is a $4 trillion business, and at least $1 trillion of this amount adds no value — except corporate profits. So, one idea could be to redirect those funds to actual healthcare.

Burnout

Aside from a small minority, most doctors feel like outsiders victimized by the healthcare system. Almost 42% of physicians report symptoms of burnout, especially the physicians in critical care, emergency medicine, family medicine, internal medicine, neurology, and urology. I have a daughter who was on the frontlines of Covid as an attending physician. I get it; expecting doctors to heal themselves is simplistic during and after a pandemic.

In contrast, research says that we can reduce burnout if we give providers the opportunity to ameliorate social determinants. Why not allow doctors to write a prescription for food, connect patients to community organizations for help, and mandate behavioral consultations? If we can give providers the tools to help the underserved, burnout decreases. We know doctors aren’t social workers, but they can (and should) be leading the charge to implement the population health paradigm. All they need is a voice and the right tools.

Technology

For example, it’s critical that providers at a minimum have a unique and unified patient record. Especially as we adapt to telehealth and virtual care, organizations need to have a framework that can enable a swift exchange of data among members of care teams. Indeed, population health intelligence is another vital pillar, as well as an important subset of population health that subsumes predictive analytics, augmented intelligence, and artificial intelligence. We can and should be creating a registry of patients with Covid that protects privacy. From the tsunami of data gained, we would glean actionable information about at risk populations. I’m also hopeful that we’ll see digital healthcare that continues to reduce marginal costs. This will enable us to reach much larger populations at a lower cost than ever before.

Strategic shifts

Imagine if we could go upstream to shut off that faucet of disease, rather than constantly mopping up the floor. What if the population of Philadelphia had been healthier pre-Covid? If we had paid more attention to social determinants, we would have been far more proactive. The chance of reducing the unbelievable death rate in minority populations would have been far greater if we had paid attention to obesity, smoking, heart disease, exercise, nutrition, and other “soft” issues. Why didn’t we do this? No one was leading the way, probably because there was no profit incentive.

We know that healthcare is big business, but even more than that, it is the final common pathway to all social determinants. It is constantly reframing what it means to take good care of the population. I firmly believe that we can still establish an exemplary model of population health — a system that promotes inclusion of all factors associated with a patient’s health in order to provide as much comprehensive care as possible.

Photo: marchmeena29, Getty Images

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Many of us first tried virtual care during the pandemic, often because we had no other choice. We connected with our primary care physicians about Covid and other health questions, holding our elbows and ears up to webcams to show where it hurts. This was Virtual Care 1.0, and it was little more than a doctor’s visit via video.

Not only did these early days of “doctors at a distance” meet our needs, but most of us found the experience convenient and time-saving. The vast majority of us are ready to use virtual care on a regular basis, and providers and insurers are poised to build on this wellspring of enthusiasm for telehealth: Virtual Care 2.0 is right around the corner.

Timely, specific, and personal

If you’ve ever stood in the rain trying to hail a cab, you may have wondered “why are there NO taxis?” What you didn’t know was that there were several cabs available at that very moment—just out of sight, just around the corner. The problem wasn’t a lack of taxis, but rather a lack of taxis where and when you needed them. Uber solved this problem by connecting customers and cabs instantly and at the exact location where a ride was needed. As customers and drivers came to understand the power of the model, new uses emerged, including UberEats and other “off-label” errand services.

Uber created a new category of service by leveraging inefficiencies in the transportation system. By creating a marketplace for drivers with idle cars or empty seats, they dramatically increased the convenience and efficiency of transport, while lowering the cost and improving satisfaction. Both drivers and riders have benefited. Uber’s story shows how virtual systems can connect people to real world services—and it serves as a powerful metaphor for the future delivery of healthcare via Virtual Care 2.0.

Not Just an Appointment by Video

Several platforms have emerged that strive to be the Uber of healthcare, but not all are made the same. Most continue to focus on urgent or primary care—replicating a traditional doctor’s visit via video. Such replication fails to leverage the true power of the technology and does little to mitigate megatrends in the healthcare marketplace:

  • Traditional doctor visits contain very little doctor time. The average hourlong appointment contains only 15-20 minutes of care from physicians. The rest of the appointment visit is filled with PA and nurse consultations, vitals collection, clerical needs, and (mostly) waiting. Often the “result” of a visit is a referral to a specialist, where after a long wait for an appointment, the cycle repeats.
  • The US faces a drought of doctors and nurses. As the shortage of health-care workers worsens over the next decade, wait times and scheduling delays will increase, putting patient health at risk. Gains in efficiency and organizational capacity are the only available methods for addressing this shortage in the near term.
  • Healthcare needs are growing. Aging Baby Boomers will burden our healthcare systems for at least the next two decades, and given their financial resources, they are likely to expand the market for innovative geriatric care and lifestyle medicine. To this trend, add a larger, long-term health crisis in America, signified by declining life expectancy. Lastly, Covid-19 is likely only an early example in a future pattern of pandemics.

To address these industry challenges, improve efficiency, build capacity—and deliver better healthcare experiences—Virtual Care 2.0 must leverage patient enthusiasm for tech, exploring and inventing new models. The result will be an utter reshaping of the marketplace towards virtual specialty care.

Specialty care is the core of Virtual Care 2.0

By providing frictionless access to a network of specialist physicians, virtual specialty care can relieve pressure on physicians and speed access to high quality specialists. Assisted by technology that facilitates understanding of medical history and follow-up, virtual specialty care shifts the conversation from urgent care to longitudinal care, including lifestyle medicine. Specialists, connected directly to the patient, attuned to nuance, and supported with powerful information systems, can analyze a patient’s entire journey across any health topic, large or small, common or rare. Here’s how it works:

  1. Employers purchase membership in a virtual care network and provide access as an employment benefit; their employees are now “members” of the network.
  2. Most members first use virtual specialty care because they have a specific health question or concern. When connecting to a healthcare concierge on this first topic, they initiate a relationship with the network that can grow and deepen over time.
  3. The healthcare concierge fields the member’s query and leverages technology to identify a highly-skilled specialist physician.
  4. A consultation with the specialist physician is scheduled within days—and sometimes, hours—of the initial member inquiry. The healthcare concierge may also help the member prepare for the consultation, guiding them to assemble medical records and imagery the specialist might need—and even coaching members to formulate meaningful questions for the physician.
  5. Follow-up conversations are scheduled, introducing the member to the benefits of longitudinal care, lifestyle medicine, and other telehealth opportunities that arise from a sustained relationship with the network.

The efficiency of this model is a win for everyone involved:

  • Patients see the right doctors sooner, which results in better health outcomes. On one network, 52% of patients changed their approach to treatment based on physician guidance gained through virtual specialty care.
  • Employers who offer virtual specialty care as a benefit see a healthier, happier, more productive workforce with fewer sick days. In addition, they see dramatic savings in healthcare costs as a result of quicker, more accurate diagnosis. Specialty care platforms have provided up to $7,150 in average savings per member engagement, resulting in a 3:1 return on investment.
  • Physicians get to spend more time with patients. With the average patient engagement lasting 44 minutes, physicians can spend more time with each patient directly listening and engaging.

Managing the whole journey

Virtual Care 2.0 will restore the human connection between patients and the collective wisdom of the medical community. Using new tools, patients and specialists will collaborate to quickly identify healthcare challenges and map out a journey towards well-being.

Virtual specialty care networks may provide the sort of longitudinal healthcare relationship we haven’t seen since the era of house calls and doctors’ bags—benefiting patients and physicians alike. Employers, who sponsor virtual specialty care for their employees, will see a happier, more productive workforce, higher retention, and reduced costs.

Photo: Feodora Chiosea, Getty Images

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Sanofi’s technology for making natural killer (NK) cell therapies came from an M&A move. The pharmaceutical giant just struck a deal that adds a CRISPR-editing technology to its to toolkit for developing NK cell-based therapies for cancer.

The CRISPR technology is from Scribe Therapeutics, a startup co-founded by CRISPR technology pioneer Jennifer Doudna. Whereas CRISPR’s initial development employed the Cas9 cutting enzyme, Alameda, California-based Scribe’s platform is comprised of gene-editing and delivery tools based on CasX, a protein discovered in Doudna’s lab. CasX is a smaller protein, which makes it a better fit for the in vivo gene-editing applications that are the focus of the startup’s internal research.

Sanofi will apply the Scribe technology to ex vivo NK cell therapies. According to financial terms announced Tuesday, the pharma giant is paying $25 million up front. Development and commercialization milestone payments to Scribe could top $1 billion; Scribe would also receive royalties from sales of any approved products that stem from the collaboration.

NK cells are a type of immune cell endowed with tumor-killing enzymes. NK cells seek out cancer cells to carry out their work, and they have application across many tumor types. Two years ago, Sanofi licensed an off-the-shelf NK cell therapy from Kiadis Pharma that was in preclinical development. The stated goal was to pair that drug with Sarclisa, a Sanofi antibody drug for multiple myeloma.

Months after the licensing deal was announced, Sanofi agreed to acquire the biotech outright for €308 million cash. Sanofi said Kiadis’s NK cell therapies would be developed as standalone treatments and in combinations with the pharma giant’s drugs. Sanofi’s pipeline currently lists one clinical-stage NK program from Kiadis: SAR445419, an off-the-shelf therapy, is in Phase 1 testing for acute myeloid leukemia.

Companies conducting NK cell research are working to bring cell therapy to solid tumors. The first cell therapies, based on engineering a patient’s own T cells, have worked only on blood cancers so far. Frank Nestle, Sanofi’s global head of research and chief scientific officer, said in a statement that his company sees NK cells having applications in both solid tumors and blood cancers.

“This collaboration with Scribe complements our robust research efforts across the NK cell therapy spectrum and offers our scientists unique access to engineered CRISPR-based technologies as they strive to deliver off-the-shelf NK cell therapies and novel combination approaches that improve upon the first generation of cell therapies,” he said.

Scribe emerged from stealth in 2020, backed by a $20 million Series A round of financing. Last year, Scribe closed a $100 million Series B round to finance further development of its technology platform and to advance its pipeline of CRISPR-based therapies for neurodegenerative disorders. The biotech’s neuroscience work previously led to a research partnership with Biogen focused on developing CRISPR-based therapies for amyotrophic lateral sclerosis. In May, the two companies announced that Biogen had exercised its option to expand the collaboration to an additional disease target in gene therapy. That target was not disclosed.

Photo: Nathan Laine/Bloomberg, via Getty Images

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diabetes, diabetics, blocks

Access to quality, consistent care is imperative for patients with diabetes to maintain their health. Having an ongoing care plan is the best way for patients to avoid complications — one of the most common being diabetic foot ulcers, which can lead to the partial or whole amputation of the foot.

The Centers for Disease Control and Prevention’s most recent data on the diabetes-related amputations, from 2016, shows that there were 4.9 lower-extremity amputations per 1,000 diabetic adults in the U.S. Among diabetic people who have had a lower-extremity amputation, more than half may end up having an amputation of the opposite extremity within five years, according to the agency.

The American Diabetes Association announced an initiative last week aimed at tackling this issue. The nonprofit launched the Amputation Prevention Alliance — a three-year effort to decrease the number of diabetes-related amputations in the country — along with five partner organizations.

Those partners include diabetic foot care provider Podimetrics, wound care company Advanced Oxygen Therapy and membership-based medical society Critical Limb Ischemia Global Society, as well as medical device companies Abbott and Cardiovascular Systems.

The majority of diabetes-related amputations are preventable, according to Jon Bloom, Podimetrics’ CEO and co-founder. 

As diabetes advances within a patient, they may experience nerve damage called diabetic neuropathy, in which damaged tissue struggles to heal. Peripheral neuropathy — nerve damage that leads to sores on the feet and legs first — is the most common form of diabetic neuropathy, according to Bloom. The hands and arms can also be affected later, he said.

Patients at risk for diabetic foot ulcers might not even feel a sore forming on their foot. When this is the case, the sore continues to get worse and does not heal well due to increased blood sugar levels, Bloom pointed out. These sores often advance to require diabetic amputation — an issue Bloom said is “simply not talked about enough.”

To combat the public health issue of preventable diabetes-related amputations, the alliance will prioritize patient education about the signs and symptoms associated with diabetic foot ulcers and diabetic neuropathy. It will also work with providers to ensure their patients with complex diabetes have regular check-ups, including appointments with a podiatrist that are focused primarily on foot health, Bloom said.

The Amputation Prevention Alliance plans to advocate for needed policy changes, one example of important legislation being the The Amputation Reduction and Compassion Act. The bill, which was introduced in Congress last year, would provide coverage of peripheral artery disease (PAD) screening for at-risk beneficiaries under the Medicare and Medicaid programs without cost-sharing requirements.

“By expanding coverage for PAD screening, the bill would help prevent vulnerable individuals from developing serious complications from PAD, which can lead to amputation,” Bloom said. “The ARC Act would also prohibit the use of amputation without the completion of testing to determine if alternative options could be utilized to benefit the patient and establish a PAD education program.”

The alliance has also formed a clinical advisory working group to produce recommendations mapping to policy change, clinician education programs and improved patient engagement, according to Bloom. 

The initiative will focus on reaching providers and patients in communities facing disproportionately high rates of amputations and amputated-related mortality, such as the Black and Latino communities. Black people in the U.S. face amputation rates up to four times higher than White Americans, and Latino people are 50% more likely to have an amputation, according to the announcement.

To Bloom, the alliance’s success will be determined by one metric: whether or not it can reduce the more than 154,000 amputations that occur every year in the U.S.

Photo: gustavofrazao, Getty Images

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Healthcare is an industry designed to provide essential services and care for patients to improve their health and well-being. Over generations, the expertise of medical professionals has allowed the industry to continuously innovate and meet the ever-changing demands and needs of patients — ranging from spikes in mental health to safety concerns regarding an in-person doctor’s visit during a global pandemic. Most recently, the Covid-19 pandemic has shown the agility of the healthcare industry to innovate, as we have experienced a surge of medical startups emerging to accommodate new demands and gaps in the industry with digital innovations. There are a number of digital-first methods that improve the healthcare experience for patients, from remote patient monitoring to tech-enabled patient care, virtual reality in the operating room, and more.

As digital health companies solidify their services and technologies as a preference for many, and innovations continue to be developed, it’s critical for healthcare startups to understand the needs of patients and physicians. Companies can hear those important perspectives during innovation development for a successful product or treatment that ultimately propels the healthcare industry.

Improving R&D with the voice of patients and physicians

Many new medical tools and technologies being developed ultimately end up in a doctor’s office, prompting the need for startups to collaborate with physicians during the research and development phase. By engaging physicians in this critical stage, startups can ensure physicians feel confident in adopting and implementing the new innovations within their own practice.

Beyond verifying medical accuracy, physicians can provide exclusive insights to help navigate any number of strategic issues or healthcare challenges that may be unseen to a startup, as well as inform any gaps in a new tool or technology — such as a potential feature or add-on recommendation — based on what they are seeing in the field.

Complementing their medical expertise, physicians also serve as the voice of the patient; with a growing emphasis on tools and technologies being developed specifically for patient use and improved health outcomes, physicians are a valuable asset in informing startups with unique patient perspectives during the R&D phase. Physicians are in constant communication with patients, which provides them with a front row seat to their evolving healthcare needs and desires, as well as feedback or concerns regarding industry innovations at large. With an inside look into what patients need, and the ability to identify consistent trends among patient groups, physicians can share invaluable insights to startups that reflect today’s patient and help optimize new tools or technologies.

Maximizing go-to-market strategies

While the healthcare landscape is known for constant change, these transformations have created a new type of patient. Increasingly, patients are much savvier and more engaged with their personal healthcare journeys; and they are investing the time to become better informed about any health product, tool or treatment. As such, startups should approach their innovations and market strategy with the understanding that patients will do their own research and read the fine print before buying into a new product or technology.

While physicians can ensure medical accuracy during the R&D phase, moving forward these experts can help maximize startups’ go-to-market strategy. Particularly in healthcare, it can be challenging to simplify a new product or technology into layman’s terms without removing any critical medical information pertaining to use. Physicians can help startups identify key messages to include in communication and product materials, as well as common questions or concerns that may arise from patients to include in an FAQ. A physician’s — and startup’s — goal is to help patients, and by enlisting the support of physician expertise, startups can ensure easy-to-understand, transparent, and factual language within their go-to-market strategy to best reach patients.

Fuel startups with leading experts

Often, companies are challenged in sourcing the right expertise for a new project. And as the healthcare digital innovation market continues to grow at a rapid pace, time is of essence — however, startups cannot compromise real science. Thankfully, a national network of expert physicians can be found in one location.

By applying a gig economy model to healthcare innovation, flipMD from GoodRx is lowering the barrier for physicians and businesses to connect and collaborate through an easy-to-use online platform. Whether the latest innovation is in the research and development phase or ready to go to market, the on-demand marketplace for physicians allows startups to remain at the forefront of medicine and conserve their time in identifying the right expertise by posting a job with unique parameters to recruit experts from a broad range of specialties.

In today’s evolving healthcare industry and amid rising consumer demand, it’s important for startups to collaborate with physicians to successfully innovate while staying on track. Discover how to fuel your startups’ momentum by collaborating with expert physicians.

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