The COVID pandemic has catalyzed an unimaginably rapid adoption of virtual care. Virtual disease management service offerings, and the demand for them, have grown by leaps and bounds. Largely, this is good. Difficult-to-manage chronic diseases are burgeoning, and healthcare is hard (especially in the USA) – we need all the help we can get. This post (briefly) discusses some pitfalls and lessons all health-tech founders should be aware of as we build disease/health management platforms in today’s increasingly virtual, solution-saturated world.
Some background: the onslaught of point solutions and the trend (read: race) towards integration:
There are so, so many products and services that claim to help us manage our health. For diabetes (Omada, Livongo/Teladoc, Virta, Dario, etc.). For musculoskeletal & physical therapy (Kaia, Hinge, Physera/Omada). For behavioral health (Headspace, Lyra, Marigold). The list goes on. Though the nuances vary, most (good) virtual disease management solutions share the same nuts and bolts: telemedicine and easy appointment scheduling; reminders designed to improve medication adherence; remote patient monitoring and/or symptom tracking; strategies that attempt to optimize your behavior (diet, exercise, stress management); an EMR for providers. These services are so standardized that “telehealth infrastructure” (ie. SteadyMD, Wheel) has emerged as a sector of its own.
Is the space increasingly crowded? We think so. But it’s hard to gauge “saturation”. Given the massive market opportunities, there will likely continue to be multiple winners. Problem is, this barrage of point solutions is challenging for everyone involved. Employers/payors struggle to differentiate largely similar products. Patients with multiple diseases find their attention split between two, three, perhaps four separate “full service” health applications. But as everyone clamors for integration of these single-indication solutions, a race has begun in recent years to build an all-encompassing, seamless, one-stop shop that handles diabetes, hypertension, behavioral health, musculoskeletal conditions, and more… and to capture the most market share while doing so.
Advice for new/ early founders:
- Be a big fish in a small pond. Start small and nail a very specific problem or indication. If you’re trying to work on diabetes, hypertension, musculoskeletal care, or mental health, think long and hard about differentiation and defensibility. Tau portfolio company Marigold Health is operating in the crowded mental health space, but their unique product offering (peer support) is a strong differentiator.
- Remote patient management is best if (1) it’s easy and convenient to gather data, (2) the data is accurate, and (3) the data is actionable to the provider. Diabetes and continuous glucose monitors are a good example. Some bad (or tougher) examples? Any situation where an in-person assessment is required by the doctor/ provider. (This remains a challenge with certain mental health conditions).
- Seek to minimize impact upon physician work-flow. Ideally your product will seamlessly integrate with the providers’ EMR (some platforms explicitly require this). The more intrusive it is for the MD, the less likely it is to succeed
- Passive patient data collection is superior to manual, user-entered symptom tracking. You can bet that convenience beats quality 11 times out of 10. Although not passive, Carbon Health’s suite of connected devices (pulse oximeters, blood pressure cuffs, thermometers, glucometers, scales) are certainly easier to use, and more objective, than subjective patient-entered Likert scales/ symptom reports
- Don’t be afraid to push back against “virtual”. We allude to this in our earlier post. Hank, one of our portfolio companies, is a splendid example of this. In their quest to build a community for older adults, Hank decided against a fully virtual model and instead opted to use the app to facilitate in-person meet-ups. The results speak for themselves. Humans are fundamentally social creatures and a screen can only go so far. Don’t forget this truth, especially in healthcare. The best models (like Hank, Carbon Health, etc.) blend virtual and in-person offerings.
As a final thought, let us all as entrepreneurs and investors remember virtual care is not a panacea when it comes to access. A paper in the “New England Journal of Medicine” (one of the most authoritative journals in medicine) shows how moving to telehealth at UCSF meant the most vulnerable populations actually had decreased visits. For all the benefits of virtual care, providing it equitably within our digital divide is very much a work in progress.
Primary author of this article is Kush Gupta, co-authoring with Amit Garg. Originally published on “Data Driven Investor”. Kush is an Associate with Tau Ventures. Amit is Managing Partner and Cofounder of Tau with 20 years in Silicon Valley across corporates, own startup, and VC funds. These are purposely short articles focused on practical insights (I call it gl;dr — good length; did read). See here for other such articles. If this article had useful insights for you, comment away and/or give a like on the article and on the Tau Ventures’ LinkedIn page, with due thanks for supporting our work. All opinions expressed here are from the author(s).
