U.S.

Healthcare 101
Health Tech Spring 2024
April 23, 2024

FI.co | #FIWorldwide

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Agenda

1. Welcome / Introductions (5 min)

2. Hotseat (40 min)

3. Presentation (45 min)

4. Q&A / Close (30 min)

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Mentor Presentations

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Mentor

Dominique Kim
Co-Director, Founder Institute, Health Tech Program
Dominique Kim is a health care industry operator, strategist, public health professional,
and consultant. She has led and scaled quality improvement programs at large health and
payer systems nationwide including Partners Healthcare, Kaiser Permanente, and Blue
Shield of California. Dominique’s pivot to health tech has included directing UC Berkeley’s
School of Public Health and directing the Founder Institute’s Health Tech Program; she
especially enjoys mentoring and forging multi-sectoral partnerships.

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Mentor

Lisa A. Sherwin
CEO Sherwin Advisors | Advisory Board Member | FI Mentor
Before launching her own consulting company- Sherwin Advisors- Lisa acted in various VP
roles from Population Health to Technology Standardization while also serving on the
Advisory Board at the University of Vermont in the Woman in Leadership Program. Lisa is a
seasoned healthcare executive with over 20 years of experience in organizational
development, strategic planning, operational and financial management, with numerous
roles driving health care solutions including but not limited to
Price Waterhouse Coopers and Accenture.

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Mentor

Jenn Knoop
VP, BoomerBaby
Jenn Knoop Koblick has worked in the Bay Area for over 20 years, providing unique
solutions in the complex insurance industry and specializing in self funding, alternative
HRA arrangements, PEO's and Trust products. Jenn also has International
experience in the insurance market including the health sector.

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 Hotseat

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U.S. Healthcare

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Health Care Ecosystem Stakeholders
• Providers (hospitals, physicians, therapists, FQHC clinics, others)
• Payers (Health insurers, government, employers)
• Suppliers / Manufacturers (Pharmaceutical, biotech, medtech companies)
• Pharmacy Services (PBM/PBA, Specialty Pharmacy/Infusion, Distributors)
• Regulators
• Government (oversight)
• Services & Technology (Payment services, brokers, data analytics, software)
• Health Information Networks and EHR Vendors
• Life Science Companies
• Community Based Providers and Coordinating Entities (e.g. CBOs, UniteUs)
• Business competitors- Walmart, Omada, Google, Amazon

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Stakeholder Map
• Payers
• Providers
• Suppliers
(Manufacturers)
• Pharmacy Services
• Regulators
• Government

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Flow of Funds in U.S. Health Care

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Who Pays for Care

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Financing
Structure-
Public & Private

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Climate
• The Need- Providing High Quality, Personalized Care
• Stormy winds:
• Inflation (Other industries impacting health care costs)
• Workforce Challenges
• Shifting Market
• Regulatory Pressures
• Potential Economic Downturn
• All players being asked to do more with less
• Payers, Providers, Life Science Companies
• The “winning innovators” will be the ones who adopt a digital-first
mindset and invest in the right capabilities

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Cost- Health Spend as Share of GDP

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Cost- Per Capita Spending on Health Care

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Contributors to Spending, by Service Type (2021)

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2026 Projections- Follow the $

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8 Healthcare Trends
2024

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 1. Value Based Care
● Shift from volume to value; long but steady journey
● CMS will continue to drive the trend toward value-based (VB) care.
● CMS will continue to drive the trend toward value-based care nationwide
through innovative alternative payment models driving VB care
● The # of MA enrollees covered by the 69 MA organizations (MAOs)
participating in the VBID Model in 2024 will increase by 47% in 2024 compared
to 2023.

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What IS Value-based care (VBC)?
• TIES the amount health care providers earn to the results of the care
they deliver to patients, measured by quality, cost and equity
• INTENDS to correct the misaligned incentives of the U.S. fee-for-service
system and improve results from our high-cost health system
• AIMS (value-based care programs) to hold providers more accountable
for improving patient outcomes while granting flexibility in how to do it
• MEASURES value via cost, outcomes, experience (Triple Aim)

Source: Commonwealth Fund, “Value-based-care-what-it-us-why-its-needed”, Feb, 2023, Commonwealth Fund 21

Quintuple Aim- The Gold Standard for Value

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What does VBC look Like?
doing more with less in primary care
home health
consumer technology
data and digital platforms
technology innovation
care coordination
improved utilization
alternative sites of care
broader set of decentralized but partnering providers and payers cost optimization
measures
value based payment models
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 2. Artificial Intelligence (AI)
AI can streamline operations, accelerate research
discoveries, improve risk and disease identification, and
facilitate more informed clinical decisions.

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 Artificial Intelligence (AI)
Applications:
● Drug development (boosting efficiency, precision, safety (NFX report))
● Reducing administrative costs (scheduling software, task optimization)
communication w/ patients, visit documentation, virtual health care assistants)
● Advanced data analysis: Organize unstructured data; recognize patterns from
massive volumes of data, predict future phenomenon, make brand new insights
(generative vs. content-based)
● Diagnostic imaging, genomics into data, early detection, personalized
diagnostics &. immunotherapies)

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Surge in AI-Enabled, FDA Approved
Devices since 2015

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 3. Leveraging Data
● 97% of all hospital produced data goes unused each year.
● That’s changing as health ecosystems leverage data / AI
● Examples: (note: not ALL use AI!)
■ GE Healthcare & Vanderbilt University: Immunotherapy responses + genomic, tumor &
imaging data using AI powered apps → Treat
■ NASA style mission control command centers - Hospitals using to manage capacity,
safety, quality and wait-time issues
● Data interoperability is key (=the ability of two or more systems to exchange
health

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 4. Data Protection and Privacy
● Cyberware attacks doubled from 2016-2021
● Health systems getting more serious, policymakers getting tougher as biometric
and AI-driven tech grows fast and furious
● In 2023 Section 524B Amendment of the FD&C Act, ‘Ensuring Cybersecurity of
Devices’ happened*

*Office of the National Coordinator for Health Information Technology, The Path to Interoperability, 2013
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 5. Preventative Healthcare
● Heightened awareness of importance of early detection and lifestyle
management in reducing chronic disease risk.
● Technologies: wearable devices and mobile health apps will play crucial role
in monitoring

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 6. Shrinking Workforce
● 54% of healthcare / pharmaceutical employees exited the industry
between April 2020 and April 2022 (McKinsey)
● Clinicians cite poor emotional health and burnout as reasons

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 7. Digital Health
● Digital Health continues to expand
● Cuts costs for health care provider systems
● Telehealth Shifting to High Value Care (longitudinal data vs. 1-off visits)
● Care at Home: Urgent care, women’s health, virtual hospital, behavioral health
● Privacy Flags: Policies growing to support privacy
● Consumer facing tech products- ChatGTP, BingCo-pilot etc, will fuel digital
health innovations
● FOUNDERS: Who is YOUR customer?

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 8. Care at Home
● Primary care, urgent care, women’s health, behavioral health, weight loss
● In 2021 Kaiser Permanente and the Mayo Clinic had already estimated that 30%
of patients admitted to hospitals in the US had conditions eligible for in-home
care.
● Cost cutting incentive to reduce ER / hospital visits
● "The US Centers for Medicare & Medicaid Services (CMS) launched the Acute
Hospital Care at Home waiver in 2021.
(Translation? Virtual hospital care is happening in 37+ states!)

https://www.s3connectedhealth.com/blog/hospital-at-home-medical-devices-to-provide-healthcare-anytime-anywhere
https://homehealthcarenews.com/2023/11/cms-acute-hospital-care-at-home-waiver-delivers-promising-results/
“Healthcare delivery is following in the footsteps of the retail
industry, which was once brimming with massive
department stores and shopping malls, and which
gave way to consumer preferences for convenient
locations and digital shopping capabilities.”
(Price Waterhouse Coopers [PwC])

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Health Systems Investing in Tech (2023)

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Providers are
Investing in
Digital!

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 Funding
● Funding all time low in 2023- likely to rise in 2024
● Companies w/ edge - positive data now emerging -high quality and improved
access from "robust clinical models with good unit economics and can scale"
(seeds planted 2021)
 Thank you!
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