STAT Ebook How Technology Is Shaping Future Health Care

How technology is
shaping the future

of health care
UNDERWRITTEN BY
TA B L E O F C O N T E N T S
01 How Lyft’s growing medical 26 AI could help rid health care

business is trying to close gaps of biases. It also might make
in health care access them worse
07 As health tech flourished, Teladoc 32 When AI is the opposite of

and Livongo saw anopportunity sinister: An MIT researcher is
to ‘accelerate,’ executives say held up as model of how algo-
rithms can benefit humanity
10 Doctors are increasingly using

remote monitoring technology, 36 Remote monitoring is rapidly
raising questions about inclusivity growing — and a new class of
and usability patient-consumer is driving
the shift
20 23andMe’s next challenge:

41 Poll Results: Digital health in the
ensuring its customers can get
time of Covid-19 and beyond
drugs developed withn their data
23 Is the Covid-19 pandemic a

tipping point for digital health?
HOW TECHNOLOGY IS SHAPING THE FUTURE OF HEALTH CARE TABLE OF CONTENTS

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HOW TECHNOLOGY IS SHAPING THE FUTURE OF HEALTH CARE INTRODUCTION

How technology is shaping
the future of health care
Technology is rapidly changing the world of health care for both patients and
providers. Health systems are deploying artificial intelligence tools to diagnose
diseases, predict people’s health risks, and streamline work for clinicians. Remote
monitoring devices — ranging from connected glucose monitors to heart-
monitoring smartwatches — are opening the door to managing disease from
a distance. And telemedicine is booming as patients look for more convenient
ways to access care, a shift accelerated by the Covid-19 pandemic.
Those advances were front and center at this year’s STAT Health Tech Summit,
which brought together researchers, policy experts, and top executives working at
the intersection of health and technology, including leaders from Google Health,
Teladoc, Livongo, 23andMe, and Fitbit.
This e-book includes all of STAT’s coverage of the event, as well as select
coverage of other topics in health tech. Those stories include a look at how
Lyft’s growing health business is trying to close gaps in health care access and
an examination of how AI could reduce existing biases in health care — or
exacerbate them.
Taken together, the stories capture the enormous promise of technology to make
health care more accessible — and underscore the pitfalls that could get in the
way of health tech reaching its true potential.
HOW TECHNOLOGY IS SHAPING THE FUTURE OF HEALTH CARE LETTER FROM OUR EDITOR
How Lyft’s growing medical
H E A LT H T E C H
business is trying to close gaps

in health care access
By Pratibha Gopalakrishna | S E P T E M B E R 1 0, 2020
When Megan Callahan was weighing whether to join Lyft’s burgeoning

health care business two years ago, she was attracted by the idea of being able
to work more closely with patients — and make the process of getting care
easier for them.
Just a few years earlier, Callahan, now the vice president of health care at
Lyft, had been diagnosed with breast cancer. She saw firsthand how much
of a barrier transportation could pose to care.
“That was a moment where I thought, [this] is a problem I can get after, be-
cause I can understand what those patients are trying to deal with,” Callahan
told STAT’s Erin Brodwin on Thursday at the STAT Health Tech Summit.
In the past two years, Lyft has significantly expanded its medical transportation
business, which is designed to help patients get to and from medical appoint-
ments. Callahan also spoke with STAT about how that strategy can help
tackle some of the social determinants that shape a person’s access to care.
HOW TECHNOLOGY IS SHAPING THE FUTURE OF HEALTH CARE ARTICLE 1 | 01

This conversation has been condensed and lightly edited for clarity.
You’re working with some Medicaid providers, including Centene.

What does an insurer get out of this partnership with Lyft?
What we’ve created is a business-to-business platform that allows for a ride to

be called on behalf of the patient or a member without them using the Lyft app.
So the sponsoring organization, whether that’s a Medicaid plan, whether it’s a
health system, arrange the ride for the member, and they pay for the ride for the
member. Medical transportation has been part of the Medicaid benefit since the
program’s inception in the late 1960s. And so when we work with insurers like
Centene, they are used to the traditional [non-emergency medical transportation,
or NEMT] model, which is obviously not based on rideshare.
Typically those experiences are often public transport often loading patients into
a multi-load vehicle so think of like, a van with six to eight people in it. That takes
much, much longer to get to their appointment than it would if they were taking
a direct route… That leads to a tremendous amount of patient dissatisfaction…
The other thing that it does, from a member perspective, is if instead of two
hours to go to a doctor appointment, it’s going to take you four to six hours
because you’re waiting on average one to three hours for your ride to show up
for you. That means that you probably are going to forgo those appointments
because you can’t afford the additional childcare. You can’t afford to take time
off of work. And then you skip those preventative appointments, and often what
happens is those people end up in some kind of an adverse event.
We do have research that shows that actually access to transportation increases

your likelihood of not ending up in the emergency department and not ending
up in multiple days of inpatient visits.

So there is this correlation of actually just physically able, being able to get to
something, and an impact on health outcomes, which I think was a, you know,
probably not something that most of us think about often it’s not something that
probably impacts our lives too often, but obviously I think people can appreciate
the practicality of the problem that we’re trying to solve.
Is there something specific that Lyft adds to the patient transport solution
that other transportation providers are not currently providing?
I would say that the on demand solution is very timely. [With Centene], they
were able to decrease wait times from 28 minutes to seven minutes.
…The way that we all expect now to interact with our life, it is not to sit on a
phone with a call center agent and schedule a ride three days in advance. And
then if something happens… and you have to move your appointment, [you
have] to get back on that phone call with that call center agent again.
So I think that that consumerization and the democratization of the experience is

something that Lyft offers that is far superior to other types of options, and then,
of course, there’s much more behind our product than just the ride. There is a
whole back end infrastructure right around billing and payment and other things
that we believe sets us apart from more traditional options.
How can you overcome patient privacy concerns for substance use disorder
patients whose records are protected by HIPAA and [other federal policies]?
So we actually do a lot within opioid use disorder… A partner of ours announced

the usage of Lyft to determine the impact of rideshare on opioid use disorder and
getting patients to their daily methadone appointments, which are obviously very
fast… So one thing that is to note around Lyft, is that the driver population that
we use for our rides are the same as our general driver population.

The drivers do not know that they are getting a health care ride, and that is by
design. We do not want them to know. So if you get dropped off at a hospital, if
you get dropped off at a point of care, the driver doesn’t know if you’re a patient,
if you’re going in to visit your mother, if you work there, they do not know.
How much of the fleet of Lyft automobiles can accommodate patients

who use wheelchairs?
So, we have wheelchair accessible vehicles, I want to say, in 12 or 15 cities, I

probably have to check to get the correct stat. And we are investigating incorpo-
rating those fleets within the health care product. But one thing I want to point
out for everyone who’s listening because this is a very niche part of healthcare..
[are] the transportation managers. They’re a critical part of this ecosystem. They
are contracted with the health plan. Generally, they are contracted with the state
Medicaid agency. Their job, [if] you’re the patient, [is to] assess you, determine
what your needs are, determine what type of car is appropriate for you.
What do you see at Lyft that you couldn’t see while you were working
at McKesson?
You know, I think one of the things that really attracted me to Lyft was to get
closer to the patient… I was diagnosed with breast cancer towards the end of [my
time at McKesson]. And that also really impacted my decision to come to Lyft,
because at that time — it was 2014 — rideshare wasn’t prevalent. I’m a fairly well
off woman in the health care sector, and I was trying to figure out how I could
get from my home into UCSF to get care for 18 months on an ongoing basis. And
when Lyft called, that was really a moment where I thought, you know, that is a
problem I can get after because I can understand what those patients are trying
to deal with.

There’s a lot of people — I mean think about a Medicaid patient who is a woman
with two children and Spanish-speaking, how she’s going to figure out how to
navigate this. So that’s part of, I think the passion of me and the entire Lyft team.
Tell us more about what Lyft does to address social determinants of health.
Social determinants are really focused on where you live, where you work, where
you play, everything around you. Your ZIP code is is much more predictive of
your health than your health care and even your genetic code. So that incorpo-
rates things like transportation, your job. do you have access to healthy food. All
of those things are really encompassed into social determinants of health.
So Lyft is not only, as transportation, a social determinant of health — it’s also

a conduit to many other social determinants of health. So we focus on a couple
of different things.. We’ve been talking about getting people to care and medical
appointments, and that is obviously one aspect that’s very important. But there’s
other ways that Lyft is playing within the social determinants of health space…
We are very focused on healthy food. We have a grocery access program

where we provide subsidized rides to people in low-income areas to get to the
grocery store in concert with non-profit organizations. Post Covid, we launched
an essential delivery service. We were getting inundated by health systems and
payers and nonprofits looking for ways to get things into the home, whether
that was food banks looking to get food, medical supplies, you name it.
So part of what we’ve done with AmeriHealth in Tennessee is we’ve partnered

with the Second Second Harvest Food Bank and we’re bringing meals into
people’s homes… AmeriHealth is actually paying for the delivery mechanism
for that. We have lots of programs like that.

Another thing that we’re pretty focused on is jobs access. Income inequality
is kind of the umbrella under which any kind of health disparities seems to
emanate from. So we’re very focused on getting… people into job interviews
[and] job programs so that they can hopefully elevate their socioeconomic
position and therefore increase their healthcare. And then I’d say the last
thing that we’re really focused on is last year we partnered with Unite Us,
which is an organization and a platform that’s really focused on with on pro-
viding referrals to community benefit organizations and putting this closed-
loop referral system. And so we are their rideshare partner..
One of the things that I think we have a challenge with is connecting social
determinants of health into our clinical systems and. One thing that is become
very clear to me is that we don’t have a consistent way to pay [clinicians to]
evaluate people for social determinants of health issues [or] barriers that they
might have that preclude them from getting to healthcare. And we don’t have
a good way to code it, and often in healthcare, if you don’t code it, you can’t
measure the effectiveness.
Erin Brodwin contributed reporting.

As health tech flourished,
H E A LT H T E C H
Teladoc and Livongo saw an

opportunity to ‘accelerate,’
executives say
By Elizabeth Cooney @ C O O N E Y_ L I Z | S E P T E M B E R 1 0, 2020
It took a lot of late-night and early-morning Zoom calls plus some socially
distanced in-person meetings to create the first health tech giant, all conducted
during a pandemic and in near-total secrecy. Now that telemedicine provider
Teladoc Health and diabetes coaching company Livongo are moving closer to
clinching their $18.5 billion deal later this year, leaders of both companies say
they’re ready to provide a single solution for care that will satisfy consumers,
providers, and payers.
“We know there’s a lot of waste in health care, but we will trim a lot of that
waste out while also improving clinical health outcomes,” Jennifer Schneider,
president of Livongo, said Thursday at STAT’s Health Tech Summit. “I think
in five-ish years … you’re going to see a different model where the experience
of being a person receiving health care — and that’s all of us — is going to be
convenient. You’re actually going to not hate it.”

To get there, the two companies need to exploit their complementary offerings,
said Jason Gorevic. Currently Teladoc’s CEO, he will be the CEO of the newly
combined company. “The goal here is to provide a single solution that provides
whole-person care, regardless of what the clinical condition is and to really
bring together the very complementary assets of the two companies.”
Teladoc, which went public in 2015, charges subscription access fees to employers
and insurers so that their employees and members can gain access to doctors on
its platform; patients also pay visit fees when they use the service. The company
relies on doctors who are independent contractors, rather than employing
providers directly. More than 70 million people in the U.S. have access to
Teladoc’s platform, and the company has expanded internationally as well.
Livongo, which went public last year, makes most of its money charging em-
ployers and insurers to provide diabetes coaching and monitoring to their work-
ers and members. The company also has growing businesses in other chronic
diseases including hypertension, weight management, and behavioral health.
There’s only a 25% overlap between clients of both companies, Gorevic said,
so there is room to take advantage of the new company’s combined offerings.
Telehealth as a whole has seen a steep rise and later fall in demand for remote
services, tied to the coronavirus pandemic lockdowns earlier this year, followed
by gradual reopening that allowed more in-person medical visits. But Teladoc’s
and Livongo’s business remained steady, Gorevic and Schenider said, because
the chronic nature of many patients’ conditions means their needs stay constant.
Asked if their vision for telehealth to reach more people depended on wide-
spread broadband connectivity, Gorevic said the combined company’s model
can improve care by being an “equalizer,” no matter which neighborhood you
live in or how close you are to the best health care.

“What’s nice is that broadband isn’t required for a lot of the capabilities we can
bring to bear,” Gorevic said. “It’s only an equalizer if people have access to it
and can take advantage of it.”
Looking back at how news of their merger surprised some investors, Schneider
turned to a running analogy.
“Jason sits on the board of New York Road Runners Association and I’m a
runner and racer. And you know that when you’re running fast, you don’t slow
down, you accelerate,” she said. “So from that standpoint, we had a massive
lead, both companies, and it was exactly the time to accelerate, not to sit back.”

Doctors are increasingly using
H E A LT H T E C H
remote monitoring technology,

raising questions about inclu-
sivity and usability
By STAT Staff | S E P T E M B E R 1 0, 2020
Remote monitoring technologies let doctors keep tabs on how you’re doing,
even when you’re nowhere near the doctor’s office.
It’s been touted as a potentially revolutionary development in health care, one

with profound implications for getting tangible, objective data to clinicians, in
real time. And as Mintu Turakhia, a cardiac electrophysiologist who is the
executive director of Stanford’s Center for Digital Health, points out, it’s not
even that new of an idea — cardiologists have been monitoring heart rhythms
with sensors since the 1990s.
That means there’s already reimbursement and training worked out, he said.
But there are still a host of challenges, including inclusive adoption strategies,
better software development, and meeting patients where they are.

STAT’s Rebecca Robbins spoke with Turakhia, who was one of the principal
investigators who led the gigantic Apple Heart study, for STAT’s Health Tech
Summit this week. A transcript of their conversation, lightly edited for clarity,
is below.
STAT’s Rebecca Robbins: You’ve been on the forefront of thinking about

how to integrate health tech into the clinic in a way that that’s careful and
inclusive and evidence-based. So I want to know: What keeps you up at
night? What’s your biggest concern as we rush in to digital health?
Mintu Turakhia: What keeps me up at night is what keeps a lot of people up at

night: How the world is going to change after Covid? And my lens for that is
what we do at Stanford, at our Center for Digital Health: We think about the
future. We run large and seminal clinical trials, and we think about how we’re
going to train the next generation of digital health doctors and leaders.
We’ve seen the pivot to virtual care. We haven’t seen the full pivot to remote
monitoring. But Stanford, for example, went overnight with the flip of a switch
to 90% virtual care. And initially, everybody loved it. Patients loved it. Doctors
loved it. Allied health professionals loved it. And as things went on, we actually
now realize there’s a whole new set of what I’m calling last-mile problems for
digital health.
And so that’s what keeps me up at night: What is the net effect of this? Are we
actually building the right solutions? And do we really know where we need to
go? And hopefully not learn it the hard way. So, for example, in some ways, if
you’re sick, is remote care just delaying the need to go in? Because we haven’t
figured out how to deliver complex care at a distance. And then so related to
that would be: How do we do that? What are the ways that we can do that
synchronously and asynchronously?

And I know another concern that you’ve raised is the question of evidence
supporting these digital health interventions, particularly with respect to
large-scale randomized clinical trials. Could you map out that landscape for
us and what you’d like to see done differently?
I think there’s a discordance or cognitive dissonance in the world of health

tech and digital health with regard to the need for clinical evidence. What’s
interesting is our Center for Digital Health is in the building that formerly
housed Theranos. And so we have this great story to tell about the need for
clinical evidence because we saw how that game played out.
But the interesting issue now is that if you look at the valuations of a phar-
maceutical company — we just heard a great discussion on vaccines or other
drugs — it’s tied to the randomized trial data. It’s tied to the evidence. But if
you look at the valuations of the tech companies, it’s tied really to projections
of revenue, which, in my opinion, are often not grounded in reality with
respect to adoption of clinical evidence.
And so it is important not just to do the observational study or the small pilot
or to have really squishy outcomes of engagement — but to really do the hard
things, to randomize patients, because that’s when you remove the problems
that observational studies are fraught with. And to really look at meaningful
and sustained outcomes, not six-month outcomes, but to go a bit longer. And so
the good news is we’re starting to see that across the board with digital health
trials and interventions.
So a lot of digital health research has historically been focused on the sort
of proverbial cyclist on Sand Hill Road in Silicon Valley. That’s the kind of
very health conscious and often wealthier person who owns lots of pricey
wearables. But your group is trying to expand beyond that population
to develop digital health interventions for Latinx populations, for Black
populations, as well as for gig workers. Could you tell us about that work?

We had a great, fabulous operation here at Stanford, working with Apple and
all of the partners we had for the Apple Heart study. What we learned is that
you open the gates for a study like that — and you have no idea who’s going
to show up. It turned out that over an eight-month period, we enrolled over
419,000 people, all in the U.S. And so there are not likely 419,000 body
hackers out there. There are some.
And when we looked at the trials now published, we saw that we enroll 25,000
people over the age of 65. And many, many people had real, hard comorbidities:
diabetes, hypertension, heart failure, prior heart attack, to name a few. And so
what we realized is, actually, there is adoption. And what we’ve seen in an annual
report that we do in partnership with Rock Health is that digital adoption is real
across the whole U.S. There are barriers, but people are doing this. The problem
is that the products really aren’t clinically facing a wider variety of people. And
so we’re trying to think through where those use cases are. And if you look at the
people who have cell phones, it’s everyone.
And so how do you engage, for example, gig economy workers? We’re going
through a major potential legislation change on how gig economy workers are
viewed, whether they’re employees or contract workers. But that has a lot of
issues around health care benefits, insurance access, health care access. We
know, for example, from a classic study called the London Transport Study and
from studies of New York taxi drivers that they bear high cardiovascular risk
for a variety of reasons. So how can we deliver care where they are? And so one
example we’re working on is hypertension and really trying to design products
that aren’t disintermediating their regular doctor or relationships they may
have with brick and mortar — but are letting that physician use this to guide
and optimize hypertension care. And so that that’s another theme here:
disintermediation and reintermediation of clinicians.

Now, let’s dive into that theme a little bit, because we’ve seen a number of
businesses in the digital health space that have really targeted the employer
market, that have targeted insurers and bypassed that traditional relationship
that patients have with their brick-and-mortar clinician. And you’re trying to
think about digital health tools differently at Stanford. Could you map out
that distinction for us?
We’re in the long haul for digital health — where it really is health and it’s not an
adjacency to regular health. And right now, startups trying to get early revenue,
show viability, a product market fit, understandably react to a health care system
or doctors or practices being too slow to adopt by going around them. And so,
yes, we saw great risk management and great early, mostly observational, though
non-randomized studies of how employees are using these tools. The model that
goes around their doctor completely, to some extent, works because you might
be able to do that for diabetes or cardiovascular risk. But none of that is really
getting back to the doctor in a meaningful way. So it’s not well integrated.
The other area that we’ve seen telehealth take off is transactional health care.
And so that’s an urgent care visit. And now it’s a Covid visit. And there’s a
market for that: a company called Sesame just launched their own marketplace.
And what’s fascinating — I checked out their website this morning — is how
little, in terms of revenue, we’re seeing doctors willing to take for these short
visits. But there’s no continuity. They’re focused, and they’re transactional. And
maybe that’s OK, but it really doesn’t fit into the broader landscape of what you
need for health. And I think that’s the tough, harder problem to figure out, but
the important one.
What’s the path for novel digital measures of health to make it into electronic
medical records where a clinician can see and use them? Are there other
reasonable avenues of getting those measures into the hands of clinicians?

So it’s a great question, but I think of it a little differently. The question is: We can
generate data, how do we get it to people who are trained to look at it? But what’s
more important is that you have some actionable data and you are able to filter
out the data that’s meaningful and actionable.
And I think there’s kind of a tale of two paradigms here: The first paradigm is
you can go to your local big box pharmacy and buy a blood pressure cuff. No
problem. And you can get it on your own. And there’s no manual tool kit on
EMR integration; those have been around before smartphones and before the
internet. There were no issues, and doctors were not saying: Oh my god, we
should not be selling blood pressure cuffs to patients because how do they know
what to do? The same is true of diabetes to the extent that patients manage
their own therapies. So the data — for a clinician to actually want it — have to
be actionable. We really don’t want data that we can’t really use. And so part of
the design spec is to figure that out.
The other use case I think is very mature is remote patient monitoring with
sensors. It’s is actually not a new paradigm. I’m an arrhythmia specialist, and
we’ve been doing this since the 1990s. So there are implantable devices that
transmit to nightstand devices and now cell phones that then go to the cloud.
And that data is filtered and sent back to the clinician in an actionable way.
There’s reimbursement, there’s workflows, there’s even training pathways for
allied professionals to be good at this. And so we don’t see that in the current
landscape of non-implantable devices. And I think that’s what needs to happen.
So EMR integration is certainly important. But you could argue then: How
come we don’t integrate someone’s social media whereabouts on the EMR, too?
The data needs to be actionable; first or foremost, it needs to be presented to the
patient in an actionable way. And then what we’re not seeing is building software
products that are based on disease use cases, heart failure, atrial fibrillation, etc.

So I want to dive in to another audience question, and this one is on the
topic of demographics of the users of digital health. What’s the narrative of
digital health for an aging economy and a potential surge in poor and un-
derserved people covered by Medicaid? Is it different from the narrative for
young people and people with good insurance and access to health care?
It’s a really great question. I don’t think the need is that different. I think that it
really is how we get there and that’s being done in different ways.
So you have a couple of things going on. You have large healthcare systems like
ours at Stanford trying to figure out the whole “make versus buy” argument.
And we’re large enough and we have so many programmers, data scientists,
and a great medical center, but also a great group of faculty and engineering
and everything where we don’t have to buy — we can make and we can handle
it. But that’s not true of everyone. And so some people are going to build their
own stack.
The extreme would be a company like Forward that goes top to bottom and
has not vendorized pretty much anything in their stock of care, including their
sensors. And then the others are going to have to tag on. And then you have the
question: How do you give low-cost health care in really meaningful ways where
you can use the technology?
And so that’s the thesis of Todd Park and his company Devoted Health, for
example. They’re trying to understand: if they build out a stack in a managed
Medicare or Medicare HMO population, how can we reduce costs? So all of
these experiments are happening, and we’ll just see where they shake out. What
I think is not going to work, though, is with a subscription model where you’re
across different platforms and you’re paying for diseases. So, you know, I can’t
go to Netflix to manage my hypertension and then go to Hulu to manage my
diabetes.

That is where something is going to break down. And we’re either going to
need better tech- and health-platform interoperability or consolidation, which
we’re already seeing with companies like Teladoc and Livongo joining forces.
So I want to ask you a little bit more about the Teladoc and Livongo
merger. I’m curious how you see that alignment and the combination of
the two companies fitting in with this paradigm you describe involving
two models: One involves bypassing the traditional health care system
and selling to employers and kind of having your own health care system.
The other model tries to integrate in with a continuous provider that the
patient has a relationship with in-person.
First of all, both companies have been wildly successful at what they do, and
they’ve shown great product market fit and they’ve developed products that work
in those use cases. But what we’re seeing now is this theme, I think, and I’d love
to hear what they say, but, you know, the opportunity for reintermediation. So
you have a great virtual cure platform. And then you have a great set of disease
management tools within a company. And so it makes obvious sense to put those
together. The real question is, you know, how do we envision digital health work-
ing and remote monitoring? Is it going to be a parallel universe that a patient has
kind of almost for their alter ego to health care, but they still anchor to a brick
and mortar physician because they have insurance? I hope not. I think it all
needs to consolidate. And that’s where we see this opportunity of what I think is
reintermediating physicians. So physicians also, you know, may not be working
for a single platform anymore. We have seen over the last 20 years now, basically
health care systems, buying practices and consolidating, which gives them pur-
chasing power. And now we’re seeing an increase of supply with a lot of these
virtual solutions. So now, you know, my hope is that doctors can become free
agents as part of this and really deliver care across many different platforms.

Can you provide insights into how the business model of health care
needs to adapt to benefit from digital innovations?
Many reimbursement policy experts have looked at the various payment pay-
per-performance incentives that we’ve seen, for example, in Medicare. And they
they sometimes work, and they have a small effect, but they often don’t work at
all. So if you want to break this thing and start over, that would be great. But it’s
much easier said than done. That goes all the way down to the fact that in
America, the government cannot negotiate with drug companies.
So, brand-new drugs that get released — there’s a whole suite coming out for
heart failure — are going to cost more in our country versus others. So the
way to get around that has been to show better demonstration of value, for
example, to managed Medicare populations, direct-to-consumer payment,
going to employers to show value. And obviously, everyone is working around
those areas.
But we also have the ability for Medicaid and insurance programs where you
have expansion pools where people can select where they really haven’t matured.
So I think this is a long haul. And I really, truly don’t know how this is going
to change. One major change could be in a post-pandemic world, depending
on where people are with respect to jobs. We’ve seen unemployment numbers
nosedive and start to go up as they may broker their own health care in really
interesting ways. So they may get high-deductible health plans and then hedge
against catastrophic illness with that. But then for the daily stuff — that runny
nose, the sniffles, general wellness checks — they may use low-cost telehealth.

Looking ahead to the post-pandemic world or even in the coming months
to a world that is in the latter stages of the pandemic, as things hopefully
slowly go back to normal, what are you going to be watching for? What
are the themes or trends with respect to remote monitoring technologies
and everything else we’ve talked about today that you’re going to be
monitoring?
So with remote monitoring, there is new reimbursement now, and it’s stable, it’s
working. And we’re seeing a lot of companies try to get in with that. We haven’t
seen major consolidation across different areas. The cardiac stuff is happening
mainly in companies whose core business is is ECG outpatient monitoring. And
so we’ve not seen multiple disease states under a single solution, nor have we seen
a lot of development in great software products that can work asynchronously
between doctors and patients. So I think that will definitely continue.
I’m really looking to see what the traction is of remote monitoring and virtual
visits. We saw virtual visits skyrocket, but in the last quarter the claims have come
down. The number of people has gone down. We’ve seen more face to face. What
does that steady state look like? And can we learn if we’re just going to delay
the inevitable, that you have to come in? Or can we think creatively on on how
we can have complex diagnostics at home? Is it possible to get workers to go
out and do a ECG or echocardiogram or other studies, meeting patients where
they are? And can we scale something like that? Is it possible that patients
can do AI-guided diagnostics themselves in a safe way where they can avoid
coming in and mail things back? So I’m really interested to see how we think
through those ideas and build products around them.

23andMe’s next challenge:
PHARMA
ensuring its customers can get

drugs developed with their data
By Kate Sheridan @ S H E R I DA N _ K AT E | S E P T E M B E R 9, 2020
23andme has long been known as a consumer genetic testing unicorn. But CEO
Anne Wojcicki describes it differently, as “the people’s research company.”
The California-based unicorn is now focused on a partnership with pharma

giant GlaxoSmithKline to discover new drugs using data culled from millions
of 23andMe customers, and Wojcicki said Wednesday at the STAT Health
Tech Summit that she hoped the company’s customers would “feel proud” if
a drug developed with their data reaches the market.
Wojcicki, answering a question from moderator Matthew Herper of STAT,

didn’t outline any specific steps that the company would take to ensure that its
customers could benefit from medications developed with their data. Nor did
she detail how 23andMe would work with GSK on access issues.
Any such decisions are years away, a 23andMe spokesperson later noted, which
should give the company time to figure out a way to ensure its customers benefit.
The first medicine being developed by the partners, an anti-cancer antibody, is
only now starting clinical trials.

“I think there’s a lot to do with the marketing and messaging and actually how [a
drug] is sold that we will be able to address when we’re lucky enough to actually
have that kind of program,” she said.
The experimental cancer drug that entered clinical trials in July “was actually
one of the early programs under Richard Scheller,” Wojcicki noted. Scheller,
23andMe’s former chief scientific officer who was considered an instrumental
figure in the company’s push into drug development, left in July 2019.
In 2018, the company signed an exclusive four-year deal with GSK, with the
option to extend their work an extra year. The companies are working on about
30 drug programs together.
At the time the deal was announced, 23andMe faced some backlash for
providing information distilled from its consumer clients to pharmaceutical
companies. Both companies have argued that they are transparent about how
consumers’ data is used; the press release announcing the deal noted that
23andMe customers would have to opt-in before their de-identified data was
shared with GSK.
“I think what you see is that for people who are really sick, they want to make
a difference. They want to make a difference in their life or they want to make
a difference in the lives of their children,” Wojcicki said on Wednesday. “People
participate all the time in studies at Stanford or with Pfizer or with other groups.
People want to see their information used for good.”
As part of the collaboration, GSK invested $300 million in the genetic testing
company; the companies agreed to evenly split the cost of the work done as part
of the collaboration, which GSK hoped would “improve the probability of R&D
success,” according to its 2018 annual report.

“That focus on genetically validated targets can double the probability of
success,” said GSK’s chief scientific officer Hal Barron, who joined Wojcicki
on the summit panel. “For the same investment, we could get twice as many
molecules out.”
GSK’s $300 million investment was enough to buy 14.5% of 23andMe, which
is still privately held; Wojcicki noted Wednesday that after 14 years, it is “not a
profitable company.”
23andMe’s core business is selling genetic testing packages to people who are
interested in learning more about their ancestry, their predisposition to certain
genetic diseases, or their ability to metabolize certain drugs.
In 2017, the company received clearance from the Food and Drug Admin-
istration to market its tests as a way to detect a select group of hereditary
conditions: Parkinson’s disease, a type of Gaucher disease, several hereditary
blood disorders, and alpha-1 antitrypsin deficiency. Another FDA clearance
followed in 2018 for pharmacogenetic tests, which look for genetic markers of
drug metabolism.
Wojcicki said the company would be “rolling out a number of [pharmacoge-

netics] reports to our customers in the near future.”

Is the Covid-19 pandemic a
H E A LT H T E C H
tipping point for digital health?

By Elizabeth Cooney @ C O O N E Y_ L I Z | S E P T E M B E R 9, 2020
Covid-19 may turn out to be digital health’s tipping point, two Silicon
Valley venture capitalists said Wednesday. The industry’s rapid shift could
be beneficial for patients, providers, and some industry players — but it also
might prove detrimental to companies that swerved toward Covid-19 and
away from the bedrock of their businesses.
“I’ve been worried about all of these companies that have suddenly pivoted
to Covid overnight,” Lisa Suennen, an investor who leads the firm Manatt’s
venture capital fund and its digital and technology businesses, said in a panel
at the STAT Health Tech Summit.
“I feel like every business plan, they crossed out ‘AI’ and wrote in ‘Covid-19,’”
she added.
Suennen said it’s encouraging to see so many health tech companies pitch
in on the Covid-19 response. Tech companies have launched symptom bots,
built digital contact tracing technology, and created new tools to analyze case
data and spot emerging hotspots. But, experts said, a full pivot to Covid-19
— at the cost of their core capabilities in other areas of health tech — might
not be a smart strategy for every company.

“I think if you have to rejigger, redeploy, rehire, and change the internal working
of the company, … you’re going to run into long-term problems,” said Kiersten
Stead, managing partner at Data Collective. “We all know this is a business that
requires a longer-term commitment, so even if you can work on something for 12
months, that’s not necessarily creating value over time.”
Stead said she and many other venture capitalists and investors saw a flood of
companies shift their focus to Covid-19, hoping to address some aspect of the
health crisis. For some companies, Stead saw the effort as “wishful thinking.”
“I think because of the scope, breadth, and speed of a pandemic, unless you
were already working in the space and had a core competency to do whatever
you were proposing to do … we didn’t believe it was a realistic business model,”
she said.
But it’s clear that the pandemic has dramatically accelerated digital health’s
adoption with such speed and volume that it’s difficult to see health care turn-
ing back from tech tools. In some ways, it’s taken 20 years for digital health to
become an overnight success, Suennen said.
That’s easiest to see in telehealth, which has allowed patients to see their doctors
when in-person visits were — and may still remain — inadvisable.
But digital health also extends to remote patient monitoring and synthetic clinical
trials, which combine health records from many patients to test therapies, Stead
said. The growth in those areas could prove crucial for pharmaceutical com-
panies whose patient recruitment efforts for clinical trials may be lagging due
to physical distancing practices.

“The other tipping point — or indicator of one — is the ability of Teladoc
and Livongo to be perceived as such a successful merger,” Suennen said. The
combined company potentially represents “a platform to manage care delivery
in digital health as opposed to a zillion little niche products for your left big toe
and cheek and something else. But all together, it can take care of people more
holistically.”
That strength may outlast the pandemic. “This is not just a stopgap,” Suennen
said about telehealth. “The energy behind proof is growing more and more, as
it should.”

AI could help rid health care
H E A LT H T E C H
of biases. It also might make

them worse
By STAT Staff | S E P T E M B E R 1 5, 2020
Hospitals and health care companies are increasingly tapping experimental

artificial intelligence tools to improve medical care or make it more cost-effective.
At best, that technology has the potential to make it easier to detect and diagnose
diseases, streamline care, and even eliminate some forms of bias in the health
care system. But if it’s not designed and deployed carefully, AI could also
perpetuate existing biases or even exacerbate their impact.
“Badly built algorithms can create biases, but well-built algorithms can actually
undo the human biases that are in the system,” Sendhil Mullainathan, a
computational and behavioral science researcher at the University of Chicago’s
Booth School of Business, told STAT’s Shraddha Chakradhar at the STAT
Health Tech Summit this month.
Mullainathan also spoke with STAT about about the importance of commu-
nication in developing AI tools, the data used to train algorithms, and how AI
could improve care. This conversation has been lightly edited and condensed.

Tell us about what happens when a health algorithm doesn’t work the way
its designed to.
This story is, I think, a really interesting one. … Sometimes AI is sprinkled

around as if it were a magic fairy dust. And I think this story is one that I
would keep in the back of my head whenever you hear the phrase AI. So this
was a project at Google a few years back. This team had built an algorithm to
take chest X-rays and identify disease from the chest X-ray. … And a friend of
mine at that time had been working on interpreting what algorithms see. So
this algorithm had really good performance and they were super excited. And
this friend of mine who works at Google … they had reached out to him and
said, “Oh, so can we can we use your technique? We’re curious, what is the
algorithm looking at?”
And when they did that on a bunch of X-rays, they noticed it was looking in a
particular region. They were like, well, this is odd. So they zoomed in and as they
zoomed in and clarified what was going on in that region, what they saw were
these pen marks. And they’re like, “What is this doing here?” And it turned out
that in their dataset, when radiologists noticed something interesting, they would
put pen marks there. And the algorithm wasn’t identifying disease so much as it
was identifying pen marks.
And you can see how in the data they had, they had what appeared to be a good
performing algorithm because pen marks was associated with disease. But it’s
unlikely to do that anywhere else, especially if what you were thinking was, “Let’s
automate radiologists out of there.” So in a perverse way, the algorithm was
seeing something quite different than by all accounts, it appeared to be seen.
Why does that matter that it caught the pen marks?

Well, it’s very close to a correlation doesn’t equal causation. What you think the
algorithm is doing is detecting disease. Instead, it’s detecting pen marks. So let’s
suppose we had taken this algorithm and then deployed it somewhere else. And
suppose we had said, “Wow, this thing does as well as radiologists. Let’s get
the radiologist out of the system.” OK. But there are no more pen marks now.
And it’s even worse. From this system, this data happened to have pen marks.
There’s lots of systems where they don’t put pen marks. Algorithms pick up on
correlations in the very narrow dataset that they’re given. But those correlations
don’t hold outside of the context in which they’re trained necessarily. So the real
challenge in these data is finding the correlation or finding the signal that is going
to hold outside of the very narrow training context. And what’s particularly weird
about this example that I just want to pause on is that many people think of the
problem in algorithms as being something computational or it needs some fancy
technique. But you’ll notice here it was just almost a communication problem.
Every radiologist knew they put pen marks. Something was broken in the
human communication system that when the data was handed over, they didn’t
say, “By the way, every X-ray that has disease also has pen marks, every X-ray
that doesn’t, doesn’t have pen marks. So you might want to watch out for that.”
Perhaps the best example of your work emerged around this time last year
when you found that racial bias in a commonly used hospital algorithm
was working to perpetuate racial bias in patients who were in that hospital
system. Can you talk to us about that?
This is one of the strangest pieces of research I’ve ever worked on, just because
you rarely have a chance to do something that’s on this scale. So this is a category
of algorithm that, you know, depending on how you count either 60 million or
100 and something million of patients are exposed to.

So it’s care coordination programs [and] you’re trying to decide which patients
should be put into them. Lots of health systems buy an algorithm that will take
their data and will rank patients according to how much care they’ll need in
the coming year.
And the way these algorithms work is they’re just predictive — they say,
“Hey, based on everything I know about you, how much care do you tend to
use? And if you look like you’re going to use a lot of care, let’s put you in these
expensive care coordination programs.” They make a lot of sense. And so
what we did is we said, “OK, let’s take these programs and let’s look at how
they do.” … They do a good job of finding the people who need a lot of care.
And that’s why people buy them.
But the surprise came, as you alluded to, in the racial element of it. When you
looked at how well they did for whites versus Blacks. What you found is at the
same level of illness, Blacks were much lower ranked than whites. To the extent
that if you were to equalize, you would more than double the number of Blacks
being put into these programs. So it’s as if for the same level sickness, Blacks
were given a much lower score.
It’s tempting when you think of algorithms being biased to imagine there’s
something nefarious going on. But when you dug into this, what happened
was another just fairly simple communication error — but very consequential
communication error. So I keep using the words “find the people who need lots
of care.” So what does that mean, care? If we unpack it, there are two ways we
could define care.
We could go to your data. Look at your claims and say, “Oh, here’s a person
who we’ve spent a lot of money on.” Now, that’s the easiest data to get, because
that’s claims data. You can also go and look at care and say, “Oh, this is a
person who ends up being very sick.” … These two are used interchangeably
in health care a lot.

It’s like health as measured by expenditures or health as measured by physio-
logical state. It so happened the algorithm was trained on health as measured
by dollars.
Now, here’s a tragic fact in the United States. Health — physical health and
health as measured by dollars — don’t relate in the same way for Blacks and
whites at every level of sickness. We spend more on whites than we do on Blacks.
So what the algorithm was actually asked to find is expensive patients. Expensive
patients are disproportionately white patients because we spend more on them.
So this subtle miscommunication that crept in and it actually there were there
were six algorithms of this variety and it actually crept in apparently to all of
them. So it’s not as if these people were stupid. It’s not as if you just get better
data scientists. You just get a better team.
I think what’s happening is we’re learning how to take our understanding of

a problem and to put it into code, and recognizing the code is very fragile.
That the data we use, the exact data we use, makes a difference. The exact
variable we use makes a difference. And we haven’t yet learned that ability
to convert the problem in our heads into an AI-ready problem in a way that
doesn’t create problems. … So this is not a negative statement, it’s a part of
this learning process.
How does one develop an AI engine as a closed loop system to detect

those biases and improve upon the accuracy? And how does the impact
of explicit and implicit biases creep into this design?
It is true that a poorly built algorithm will end up embodying the biases that we
have as humans. That’s what we see here, because costs are a biased function of
health. We train on costs and we got this problem. And I think the first line of
defense we have against all of this is just to check.

… I actually think what we’re starting to see in other areas is that badly built
algorithms can create biases, but well-built algorithms can actually undo the
human biases that are in the system. So actually, algorithms are a remarkable
remedy for ourselves. And one of the things that’s missing is that when people
talk about algorithmic bias, they’re looking at the algorithm and the creators
of the algorithm. But they’re forgetting that in many cases that algorithm is
a substitute or an aide to a human and a much older literature on bias is on
human bias and human bias is much bigger, much more intractable, and it is
very hard.
And the nice thing about algorithms is that they sit in a box and we can look
at their behavior, we can tweak them, we can keep working on them. I can’t go
in and tweak what’s inside a doctor’s head. … So algorithms [that are] poorly
designed really are quite a big problem. But they actually offer this amazing
opportunity for us that if we’re careful, we actually can do a lot more good
things with them.
Can you give us an example of when AI can be beneficial?
I don’t know if you’ve ever read this book “The Diving Bell and the Butterfly.”
This is about this guy who basically — to make a long story short — he basically
had to blink. He was trapped in his body. And the only muscle he could you can
move where his eyelids. So you could blink. So you think of how horrific that is.
You just can’t move anything else but your eye. But he wrote this entire book to a
sequence of blinks. They had a whole code …
So why am I telling you this? There is now work that over the last 10 years has
said, wait — for people in that position, we can put EEGs on their head, and
actually read out the brain signal, build an algorithm that translates that brain
signal consistently into their attempt as to where are they looking on a particular
keyboard, for example? Which allows people to basically type with their minds,
which is like science fiction. And it is something that seems unbelievable …

When AI is the opposite of sin-
H E A LT H T E C H
ister: An MIT researcher is held

up as model of how algorithms
can benefit humanity
By Rebecca Robbins @ R E B E C CA R O B I N S | S E P T E M B E R 2 3, 2020
In June, when MIT artificial intelligence researcher Regina Barzilay went to

Massachusetts General Hospital for a mammogram, her data were run through
a deep learning model designed to assess her risk of developing breast cancer,
which she had been diagnosed with once before.
The workings of the algorithm, which predicted that her risk was low, were
familiar: Barzilay helped build that very model, after being spurred by her
2014 cancer diagnosis to pivot her research to health care.
Barzilay’s work in AI, which ranges from tools for early cancer detection to
platforms to identify new antibiotics, is increasingly garnering recognition:
On Wednesday, the Association for the Advancement of Artificial Intelligence
named Barzilay as the inaugural recipient of a new annual award honoring
an individual developing or promoting AI for the good of society. The award
comes with a $1 million prize sponsored by the Chinese education technology
company Squirrel AI Learning.

While there are already prizes in the AI field, notably the Turing Award
for computer scientists, those existing awards are typically “more focused on
scientific, technical contributions and ideas,” said Yolanda Gil, a past president
of AAAI and an AI researcher at the University of Southern California.
“We didn’t have any that recognized the positive impact that AI is having
in our lives.”
With the new award, AAAI aims to counterbalance the widespread messages
of concern circulated in the news media and by other commentators about the
potential negative impacts of AI. “What we wanted to do with the award is to
put out to the public that if we treat AI with fear, then we may not pursue the
benefits that AI is having for people,” Gil said.
With the selection of Barzilay, AAAI’s award committee is honoring work in

health care — widely seen as one of the most promising fields in which AI is
being applied, but also a realm in which plenty can go wrong.
Barzilay has done pioneering work in developing methods for processing

language data, including deciphering dead languages, that earned her a
“genius grant” from the MacArthur Foundation in 2017. But it was after
2014, the year she was diagnosed with breast cancer, that Barzilay began
to focus her attention on health and medicine.
Barzilay’s treatment was successful, and she believes her clinical team at
MGH did the best they could in providing her with standard care. At the
same time, she said, “it was extremely not satisfying to see how the simplest
things that the technology can address were not addressed” — including a
delayed diagnosis, an inability to collect data, and statistical flaws in studies
used to make treatment decisions.

“Going through it and seeing how much one can do really opened my eyes —
I have to contribute,” Barzilay said.
Barzilay said she thinks it’s incumbent not just on the AI community, but also
people outside of it, to turn the abundance of research on AI in health care
into tools that can improve care.
“We have a humongous body of work in AI in health, and very little of it is

actually translated into clinics and benefits patients,” she said.
To try to change that, Barzilay has delved into drug development, building
a machine learning platform that was used to identify a novel antibiotic that
effectively treated a gastrointestinal bug in mice in a study published earlier
this year in the journal Cell.
She’s also co-leading the team developing the AI model for assessing breast
cancer risk that was used on her own mammography data in June. In a study
published last year in the journal Radiology, Barzilay and her team trained,
validated, and tested their model on historical data from about 40,000 women
who were screened for breast cancer. They found that their model could dis-
criminate risk better than an older, widely used risk evaluation tool, known as
the Tyrer-Cuzick model, that relies on breast density to assess risk.
Barzilay’s model appears to have another important advantage: The study

found that a version that incorporated both the mammography data and
traditional risk factors for breast cancer — such as age and family history of
cancer — was equally accurate for white and African American women. By
contrast, the Tyrer-Cuzick tool, developed and validated largely on data from
white women, is less effective in African American women.

An updated version of the model described in the Radiology paper is now being
implemented in the clinic at MGH. People who come in for a routine screening
mammogram automatically have their data analyzed by the model, which spits
out four data points: the woman’s breast density and her risk of developing breast
cancer in the next one, two, or five years.
For now, with the model still in development, only a subset of MGH radiologists
are actually viewing those predictions. They typically do not share the results
with individuals who are screened. (There are occasional exceptions, such as in
cases in which a woman has read about the model in the news media and makes
a specific request to her radiologist to pull up those numbers.)
Another exception was Barzilay, because of her scientific interest and her role
in the model’s development. When she went in to MGH for her most recent
mammogram, she and Constance Lehman — the hospital’s director of breast
imaging who is co-leading the project with Barzilay to develop the model —
pulled up the model’s output and discussed the predictions.
Barzilay doesn’t remember the precise probabilities that the model spit out about
her personal risk of recurrence, but the overall forecast was reassuring: “There
was nothing remarkable there,” she recalled.

Remote monitoring is rapidly
H E A LT H T E C H
growing — and a new class of

patient-consumer is driving
the shift
By Erin Brodwin @ E R B R O D | S E P T E M B E R 1 6, 2020
A cardiac patient in Carlsbad sends their doctor in San Francisco a readout of

their heart rate, courtesy of an Apple Watch. A New Yorker with hypertension
texts with an Alabama health coach about data from their smart blood pressure
cuffs. A person with diabetes snaps a photo of their dinner and uses an app to
predict how it will impact their blood sugar.
Health care is undergoing a monumental shift toward remote patient monitor-

ing — and a new class of patient-consumer is leading the charge, according to
a new STAT report. The transformation — which began years ago as healthy
people moved to optimize wellness and people with chronic conditions pushed
for more convenient care — has taken on a more permanent tone amid the
Covid-19 pandemic.
“Millions of Americans suddenly asked themselves, ‘Can I solve this care need
without showing up in person?’” said Sean Duffy, chief executive officer and
co-founder of Omada Health, a virtual diabetes care provider. “That consumer
expectation change is going to be the thing that writes history the quickest.”

Tech giants and virtual care companies alike are rushing to meet that demand.
For established companies like Apple, Amazon, and Alphabet, the exploding
popularity of health tracking is a boon to their push to make sizable inroads
in health. Those companies are courting the new patient-consumer with a
device-first strategy, transforming their bestselling wearables into health tools
with medical capabilities.
Meanwhile, health tech companies like diabetes care providers Omada Health
and Livongo are taking a platform-driven approach, catering to patients with
remote monitoring programs that connect them with health professionals and
provide useful data.
T H E TAC T I C A M O N G T E C H G I A N T S
Tech companies are starting to chart their path to remote monitoring by trans-
forming consumer gadgets to medical devices, with an eye on clinical evidence.
Apple was the first to enter the space this way, publishing a large and entirely
virtual clinical study of its Apple Watch and embedded electrocardiogram,
or EKG, which records the heart’s electrical signal. The study, which Apple
brought to the Food and Drug Administration as part of its work to get the
watch cleared as a medical device, showed the device could spot the heart con-
dition atrial fibrillation, or A-fib. Fitbit, which was acquired by Google last year,
is following the same path. The company launched a similar virtual study of its
wearable in A-fib in May and plans to present the data to the FDA.
Even Facebook, which has yet to make its own wellness wearable, appears to
be edging toward the heart monitoring space.

In May, the social media giant formed a new team dedicated to health tech-
nology under the leadership of Yale cardiologist Freddy Abnousi and posted
job ads for positions that include an expert in photoplethysmography, the same
type of technology that Apple and Fitbit use for heart monitoring, and an
expert skilled at interfacing with regulators like the FDA.
The tech- and consumer-driven shake-ups are already creating ripple effects
throughout the health care system. Clinicians, for example, are increasingly
being asked to interpret the results of Apple Watch EKGs in patients who are
hesitant to come in for a visit during the pandemic.
“You’re really seeing a shift where it’s consumers and consumer electronics
deciding things more than a doctor deciding which device to use,” said Ritu
Thamman, cardiologist and assistant professor of medicine at the University
of Pittsburgh School of Medicine. “We’re being pushed by the consumers
themselves, and that’s creating the competition and the drive to create the
best user experience.”
Still, by focusing on building out device capabilities — instead of creating

comprehensive virtual health platforms that pair with devices — tech giants
have created a new set of challenges. Without being connected to any sort of
system, it remains unclear how, exactly, the devices will ultimately fit into a
user’s care continuum. If Apple, Fitbit, and other big tech companies intend
for their tools to remain relevant to users’ health for the long term, they’ll
need to start integrating them with platforms that can help guide their care.
“Just because you have a watch that tells you things doesn’t mean you have
remote monitoring. The platforms and the integration need to start,” said
Mintu Turakhia, a cardiologist and executive director of Stanford Medicine’s
Center for Digital Health.

Amazon’s new wearable, called Halo, may be a first step in this direction.
Although the device does not currently have any medical diagnostic capabil-
ities, it lets users share their body fat percentages with clinicians through an
integration partnership with electronic medical record vendor Cerner.
T H E P L AT F O R M - F I R S T P U S H BY H E A LT H T E C H C O M PA N I E S
Virtual care businesses, in contrast to tech giants, are jumping into the health
tracking space with a platform-centric strategy. Companies including Omada, as
well as Alphabet subsidiaries Onduo and Verily, offer care delivery programs that
harness remote monitoring hardware made by other companies and use fleets of
faraway health coaches to help patients interpret and understand their data.
Those devices — which include Bluetooth-enabled weight scales, blood pressure

cuffs, and glucose meters — are connected to the company’s platform, where
clinicians and coaches take a patient’s data, contextualize it, and use it to offer
advice or guide a person’s care. Unlike tech giants and medical device makers
who acquire customers by selling devices, these companies acquire patients by
way of partnerships with employers, insurers, and health plans.
But virtual care companies’ business models often rely on reimbursement or buy-
in from health insurers or employers, meaning their success depends on being
able to consistently demonstrate their effectiveness with research. And while
many of these companies have published small and short term studies, academics
and researchers say larger and more comprehensive research is needed.
“There’s very little clinical trial data” for remote devices, Turakhia said.

The rise of the patient-consumer is also placing new pressures on more
traditional health care players, including established medical device makers.
Industry stalwarts like Philips and General Electric, for example, are being
forced to consider fundamental changes to their business structure aimed at
better serving the patient-consumer instead of the hospital or clinic.
“We are definitely thinking about ways to reach outside hospital walls,” said
Anders Wold, vice president and chief executive officer of clinical care solutions
at GE Healthcare.
Regulators have begun to respond to these changes in recent months with a

mix of temporary and permanent policies geared at making remote monitoring
tools more widely accessible. For example, the FDA introduced a series of
pandemic-era authorizations that increase patients’ ability to use remote health
tracking tools at home, including the EKG-containing Apple Watch and
Livongo’s glucose meters. And starting last year, the Centers for Medicare and
Medicaid Services began reimbursing providers who use remote monitoring
tools with new billing codes explicitly focused on remote health tracking,
including codes that focus on weight and blood pressure.
If those changes are to have real sticking power, however, companies including
tech giants and health tech providers will need to figure out how to make their
devices an established, long-term component of the existing health care system,
rather than simply a temporary or one-off solution.
“There are a lot of consumer devices out there with [FDA] clearance,” said
Turakhia. “But when you’re talking about remote patient monitoring, you’re
really talking about the whole system.”

Digital health in the time of
P O L L R E S U LT S
Covid-19 and beyond

By Mark Lambrecht, Director of the Global Health and Life Sciences Practice, SAS
Emerging tech and digitalization have increasingly shaped innovation and the
pace of change in health care and life sciences. The coronavirus pandemic is
accelerating technology adoption as health care systems and governments work
to slow its spread; health care providers seek to care for patients safely; research-
ers work to keep clinical trials on track; and pharmaceutical manufacturers seek
to maintain the global supply of life-changing therapies and bring vaccines and
treatments for Covid-19 to patients.
In the coming months and years, we will see how innovation born from the
challenges of the pandemic will affect health care and life sciences long-term.
At the STAT Health Tech Summit in September, virtual attendees were
asked about the biggest challenges and opportunities of artificial intelligence
and other new health tech today and in the future.
Wherever you are on your organization’s digitalization journey, AI and

advanced analytics play a critical role in helping you maximize investments
in new tech and get the most insights from your data. Learn more at
sas.com/healthcare or sas.com/lifesciences.
HOW TECHNOLOGY IS SHAPING THE FUTURE OF HEALTH CARE POLL RESULTS | 41

What is the biggest opportunity for AI in
your organization?
Reducing human error

59%
Automation and increased efficiency
Imaging and diagnostics

2%
Extracting insights from data
8%
21%
What new health technology will have the

greatest impact in the next 5 to 10 years?
3%
14%
Nanotech
Wearables
Gene Therapy
30%
Robotic assistance
54%

What technology has been most useful to your
organization during the pandemic?
23%
39% Analytics for forecasting the
pandemic’s impact
Devices to monitor patient outcomes
Digital-first communications strategies

9%
Telemedicine to replace in-person
appointments
30%
What is your greatest challenge in leveraging

new health tech?
9%
Legal concerns
41%
Regulatory hurdles
20%
Relevant expertise
Availability of reliable data
3%

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How technology is

shaping the future

01 How Lyft’s growing medical 26 AI could help rid health care

07 As health tech flourished, Teladoc 32 When AI is the opposite of

10 Doctors are increasingly using

20 23andMe’s next challenge:

23 Is the Covid-19 pandemic a

HOW TECHNOLOGY IS SHAPING THE FUTURE OF HEALTH CARE TABLE OF CONTENTS

Our team includes talented writers, editors, and producers capable of

HOW TECHNOLOGY IS SHAPING THE FUTURE OF HEALTH CARE INTRODUCTION

business is trying to close gaps

When Megan Callahan was weighing whether to join Lyft’s burgeoning

HOW TECHNOLOGY IS SHAPING THE FUTURE OF HEALTH CARE ARTICLE 1 | 01

You’re working with some Medicaid providers, including Centene.

What we’ve created is a business-to-business platform that allows for a ride to

We do have research that shows that actually access to transportation increases

HOW TECHNOLOGY IS SHAPING THE FUTURE OF HEALTH CARE ARTICLE 1 | 02

So I think that that consumerization and the democratization of the experience is

So we actually do a lot within opioid use disorder… A partner of ours announced

HOW TECHNOLOGY IS SHAPING THE FUTURE OF HEALTH CARE ARTICLE 1 | 03

How much of the fleet of Lyft automobiles can accommodate patients

So, we have wheelchair accessible vehicles, I want to say, in 12 or 15 cities, I

HOW TECHNOLOGY IS SHAPING THE FUTURE OF HEALTH CARE ARTICLE 1 | 04

So Lyft is not only, as transportation, a social determinant of health — it’s also

We are very focused on healthy food. We have a grocery access program

So part of what we’ve done with AmeriHealth in Tennessee is we’ve partnered

HOW TECHNOLOGY IS SHAPING THE FUTURE OF HEALTH CARE ARTICLE 1 | 05

Erin Brodwin contributed reporting.

HOW TECHNOLOGY IS SHAPING THE FUTURE OF HEALTH CARE ARTICLE 1 | 06

Teladoc and Livongo saw an

HOW TECHNOLOGY IS SHAPING THE FUTURE OF HEALTH CARE ARTICLE 2 | 07

HOW TECHNOLOGY IS SHAPING THE FUTURE OF HEALTH CARE ARTICLE 2 | 08

HOW TECHNOLOGY IS SHAPING THE FUTURE OF HEALTH CARE ARTICLE 2 | 09

remote monitoring technology,

It’s been touted as a potentially revolutionary development in health care, one

HOW TECHNOLOGY IS SHAPING THE FUTURE OF HEALTH CARE ARTICLE 3 | 10

STAT’s Rebecca Robbins: You’ve been on the forefront of thinking about

Mintu Turakhia: What keeps me up at night is what keeps a lot of people up at

HOW TECHNOLOGY IS SHAPING THE FUTURE OF HEALTH CARE ARTICLE 3 | 11

I think there’s a discordance or cognitive dissonance in the world of health

HOW TECHNOLOGY IS SHAPING THE FUTURE OF HEALTH CARE ARTICLE 3 | 12

HOW TECHNOLOGY IS SHAPING THE FUTURE OF HEALTH CARE ARTICLE 3 | 13

HOW TECHNOLOGY IS SHAPING THE FUTURE OF HEALTH CARE ARTICLE 3 | 14

HOW TECHNOLOGY IS SHAPING THE FUTURE OF HEALTH CARE ARTICLE 3 | 15

HOW TECHNOLOGY IS SHAPING THE FUTURE OF HEALTH CARE ARTICLE 3 | 16

HOW TECHNOLOGY IS SHAPING THE FUTURE OF HEALTH CARE ARTICLE 3 | 17

HOW TECHNOLOGY IS SHAPING THE FUTURE OF HEALTH CARE ARTICLE 3 | 18

HOW TECHNOLOGY IS SHAPING THE FUTURE OF HEALTH CARE ARTICLE 3 | 19

ensuring its customers can get

The California-based unicorn is now focused on a partnership with pharma

Wojcicki, answering a question from moderator Matthew Herper of STAT,

HOW TECHNOLOGY IS SHAPING THE FUTURE OF HEALTH CARE ARTICLE 4 | 20

HOW TECHNOLOGY IS SHAPING THE FUTURE OF HEALTH CARE ARTICLE 4 | 21

Wojcicki said the company would be “rolling out a number of [pharmacoge-

HOW TECHNOLOGY IS SHAPING THE FUTURE OF HEALTH CARE ARTICLE 4 | 22

tipping point for digital health?

HOW TECHNOLOGY IS SHAPING THE FUTURE OF HEALTH CARE ARTICLE 5 | 23

HOW TECHNOLOGY IS SHAPING THE FUTURE OF HEALTH CARE ARTICLE 5 | 24

HOW TECHNOLOGY IS SHAPING THE FUTURE OF HEALTH CARE ARTICLE 5 | 25

of biases. It also might make

Hospitals and health care companies are increasingly tapping experimental

HOW TECHNOLOGY IS SHAPING THE FUTURE OF HEALTH CARE ARTICLE 6 | 26

This story is, I think, a really interesting one. … Sometimes AI is sprinkled