Forward Health raises $225M from investors including The Weeknd as it looks to expand nationwide

Primary care startup Forward Health is looking to expand its tech-powered, personalized healthcare model across the U.S., and will use a new $225 million Series D raise to help make it happen. The new capital comes from Founders Fund, Khosla Ventures, SoftBank, Mark Benioff – and recording artist The Weeknd – among others. I spoke to Forward Health co-founder and CEO Adrian Aoun about his company’s plans for this fresh capital, and we also chatted briefly about how The Weeknd got involved.

Forward, which currently operates clinics in select U.S. markets including LA, New York, Chicago, SF and Washington, D.C., has a number of distinguishing features, but most notable are likely its tech-first approach that includes a full biometric assessment upon first visit, and its business model, which eschews insurance providers altogether and instead works based on a single flat membership fee.

Aoun and his co-founders created Forward Health with the idea of building a healthcare business that’s aligned with its customers in terms of incentives, which is why they sidestepped insurance altogether. That’s led to a focus on customer service and long-term patient relationships and outcomes, which Aoun says are stronger because they’re not bound by an individual’s relationship with their employer, for instance, which is often the case when an employer foots the bill for healthcare via company-provided insurance.

“The average person in the Bay Area is with their employer for about two and a quarter years,” Aoun told me. “So your employer is kind of sitting there thinking, if you get the flu, you’re missing three days of work – I’m out some money.” That means they’ll do things like institute programs to remind employees constantly to get their annual flu vaccine, and do other things to make that happen like provide on-premise shots. But Aoun says they’re optimizing for short-term outcomes, not long-term health – because that’s where their incentives tell them to optimize.

Image Credits: Forward Health

But when long-term healthcare programs, like lifestyle shifts that can lessen the potential of truly dangerous outcomes like heart disease and cancer, come into play, an employer who expects you to stick around for a few years at most is far less incentivized to want to fund that. Forward Health, which aims to attract subscribers and, for lack of a better term, minimize churn, actually is incentivized to make those long-term outcomes positive for everyone who comes through the door.

That’s part of why one focus with this new funding is to debut new doctor-led programs tailored to treating conditions that individual patients might be predisposed to – like heart health, if heart disease runs in your family, or specific types of cancer, if there’s a history of that, for instance.

“We’ve got our [in-clinic] body scanners, our blood tests, our gene sequencing – we basically collect on the order of about 500 biometric data points,” Aoun said. “The idea is you and your doctor then figure out which which kind of programs make sense for you based upon those.”

For example, Aoun says he’s actually at fairly high risk for developing heart disease, so there’s a Forward program that includes doing a heart risk analysis, blood tests, and regular at-home monitoring of key risk factors like blood pressure and weight. Another program for cancer prevention includes measures designed to help lessen the risk of contracting the top five cancers in terms of prevalence — so Forward created a dermatoscope for that, which is essentially a skin scanner to map out an individual’s moles and skin features and alert them of any changes.

This builds on work that Forward began at the outset of COVID-19 — its ‘Forward at Home’ program, which includes sending patients home with specialized sensors for remote care. Another specialized program tailored to COVID-19 actually offers monitoring specific to the disease in order to track a patient’s progress safely.

“We’re now launching programs for all the top diseases to help you get ahead of them,” Aoun said. “And whatever kind of programs you’re using, you walk away with plans that are tailored to you, again, to counsel you not only on the potential risks for the things like the cancer and heart disease, but also to be proactive, with guidance from diet, to exercise, to stress, and to sleep, etc.”

The programs are supported by Forward’s 24/7 worldwide care support team, which subscribers can access via their mobile app. It’s also complemented by the check-ins with your physician via the ‘Forward at Home’ in-home virtual visits.

Image Credits: Forward Health

While Forward is already rolling these out, it has plans to continue to develop new ones, and it’s also monitoring results in order to understand how they’re working for users, and will be sharing that data once it has collected a significant sample. I asked Aoun how Forward can scale this kind of personalized care – especially now that the startup plans to open additional locations in other parts of the country.

Basically, Aoun said that Forward approached it as an engineering problem. He argues that most solutions in healthcare see the fundamental issue as a labor problem — but trying to scale that, with the salaries that medical professionals command, and the limited availability of skilled talent, makes no sense. Especially because consumers are naturally looking for improvements in their standard of care over time, in the same way they expect improvements in the products they buy or services they use.

Rather than relying on a chain of increasingly specific medical professionals to address individual health risks and needs, Aoun said Forward identified that there’s a massive amount of overlap in preventative care courses of action. The Forward team focused on breaking the fundamental elements down into what equate roughly to reusable Lego blocks, which can be recombined with relative speed and repeatability to produce a program that’s nonetheless tailored to an individual’s needs.

Combined with Forward Health’s longitudinal approach to care, these programs and their recombinant nature should prove a good dataset from which to assess how a direct, client-focused primary care model affects overall health.

And, because I promised, I’ll leave you with how Aoun says The Weeknd got involved in the Series D.

“He literally just walked by one of our locations, and walked in and was like, ‘This is awesome,’ and then asked a friend, who asked a friend, who asked a friend to get connected,” he told me.

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TikTok parent ByteDance joins patent troll protection group LOT Network

LOT Network, the non-profit that helps businesses of all sizes and across industries defend themselves against patent trolls by creating a shared pool of patents to immunize themselves against them, today announced that TikTik parent ByteDance is joining its group.

ByteDance has acquired its fair share of patents in recent years and is itself embroiled in a patent fight with its rival Triller. That’s not what joining the LOT Network is about, though. ByteDance is joining a group of companies here that includes the likes of IBM, the Coca-Cola Company, Cisco, Lyft, Microsoft, Oracle, Target, Tencent, Tesla, VW, Ford, Waymo, Xiaomi and Zelle. In total, the group now has over 1,300 members.

As LOT CEO Ken Seddon told me, the six-year-old group had a record year in 2020, with 574 companies joining it and bringing its set of immunized patents to over 3 million, including 14% of all patents issued in the U.S.

Among the core features of LOT, which only charges members who make more than $25 million in annual revenue, is that its members aren’t losing control over the patents they add to the pool. They can still buy and trade them as before, but if they decide to sell to what the industry calls a ‘patent assertion entity,’ (PAE) that is, a patent troll, they automatically provide a free licence to that patent to every other member of the group. This essentially turns LOT into what Seddon calls a ‘flu shot ‘ against patent trolls (and one that’s free for startups).

“The conclusion that people are waking up to is, is that we’re basically like a herd, we’re herd immunization, effectively,” Seddon said. “And every time a company joins, people realize that the community of non-members shrinks by one. It’s like those that don’t have the vaccination shrinks — and they are, ‘wait a minute, that makes me a higher risk of getting sued. I’m a bigger target.’ And they’re like, ‘wait a minute, I don’t want to be the target.’”

ByteDance, he argues, is a good example for a company that can profit from membership in LOT. While you may think of patents as purely a sign of a company’s innovativeness, for corporate lawyers, they are also highly effective defense tools (that can be used aggressively as well, if needed). But it can take a small company years to build up a patent portfolio. But a fast-growing, successful company also becomes an obvious target for patent trolls.

“When you are a successful company, you naturally become a target,” Seddon said. “People become jealous and they become threatened by you. And they covet your money and your revenue and your success. One of the ways that companies can defend themselves and protect their innovation is through patents. Some companies grow so fast, they become so successful, that their revenue grows faster than they can grow their patent portfolio organically.” He cited Instacart, which acquired 250 patents from IBM earlier this month, and Airbnb, which was sued by IBM over patent infringement in early 2020 (the companies settled in December), as examples.

ByteDance, thanks to the success of TikTok, now finds itself in a situation where it, too, is likely to become a target of patent trolls. The company has started acquiring patents itself to grow its portfolio faster and now it is joining LOT to strengthen its protection there.

“[ByteDance] is being a visionary and trying to get ahead of the wave,” Seddon noted. “They are a successful global company that needs to develop a global IP strategy. Historically, PAEs were just a US problem, but now ByteDance has to worry about PAEs being an issue in China and Europe as well.  By joining LOT, they protect themselves and their investments from over 3 million patents should they ever fall into the hands of a PAE.”

Lynn Wu, Director and Chief IP Counsel, Global IP and Digital Licensing Strategy at ByteDance, agrees. “Innovation is core to the culture at ByteDance, and we believe it’s important to protect our diverse technical and creative community,” she said in today’s announcement. “As champions for the fair use of IP, we encourage other companies to help us make the industry safer by joining LOT Network. If we work together, we can protect the industry from exploitation and continue advancing innovation, which is key to the growth and success of the entire community.”

There’s another reason companies are so eager to join the group now, though, and that’s because these patent assertion entities, which had faded into the background a bit in the mid- to late-2010s, may be making a comeback. The core assumption here is a bit gloomy: many companies seem to assume we’re in for an economic downturn. If we hit a recession, a lot of patent holders will start looking at their patent portfolios and start selling off some their more valuable patents in order to stay afloat. Since beggars can’t be choosers, that often means they’ll sell to a patent troll if that troll is the highest bidder. Last year, a patent troll sued Uber using a patent sold by IBM, for example (and IBM gets a bit of a bad rap for this, but, hey, it’s business).

That’s what happened after the last recession — though it typically takes a few years for the effect to be felt. Nothing in the patent world moves quickly.

Now, when LOT members sell to a troll, that troll can’t sue other LOT members over it. Take IBM, for example, which joined LOT last year.

“People give IBM a lot of grief and criticism for selling to PAEs, but at least IBM is giving everybody a chance to get a free license,” Seddon told me. “IBM joined LOT last year and what IBM is effectively doing is saying to everybody, ‘look, I joined LOT.’ And they put all of their entire patent portfolio into LOT. And they’re saying to everybody, ‘look, I have the right to sell my patents to anybody I want, and I’m going to sell it to the highest bidder. And if I sell it to a patent troll and you don’t join LOT — and if you get sued by a troll, is that my fault or your fault? Because if you join LOT, you could have gotten a free license.’”

#airbnb, #bytedance, #cisco, #flu, #ford, #ibm, #instacart, #intellectual-property-law, #lawsuit, #lot-network, #lyft, #microsoft, #monopoly, #oracle, #patent, #patent-law, #patent-troll, #software, #tencent, #tesla, #triller, #united-states, #vaccination, #vw, #waymo

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Replace legacy healthcare staffing with a vertical marketplace for workers

Over the last several months, we’ve seen dramatic swings in the demand for healthcare across the country. While hospitals in some cities were overwhelmed by an influx of COVID-19 patients, others sat empty — and in many cases experienced financial distress — as patients postponed elective surgeries and care for non-life-threatening matters. Cities went from relative safe zones to dangerous hotspots and back again within a matter of a few months.

This “COVID-19 whipsaw” has brought into focus a problem that has long been simmering in healthcare: The movement of labor is highly inefficient. We need a new paradigm in healthcare labor markets.

The pandemic has exposed systemic vulnerabilities

Early in the pandemic, many clinicians moved across state lines to answer Governor Andrew Cuomo’s calls for help in New York, only to be told upon arrival that their contracts had been canceled because the hospitals had overestimated their need. The imbalance of nurse and physician labor across states, which existed well before the pandemic, reached a terrifying apex during the height of the pandemic. In some parts of the country, clinicians were being furloughed or laid off, while in others they were stretched to their full capacity working around the clock to save lives. With each month came new hotspots — New York, Detroit, Miami, Phoenix, Los Angeles — and with each new hotspot a near disaster caused by a shortage of healthcare workers.

The marathon of addressing COVID-19 has imposed severe stress, depression and anxiety on our nation as a whole, with our healthcare providers at the epicenter. Clinician burnout was a serious issue even before COVID-19, but it has only gotten worse in recent months, especially for those working in geographic hotspots.

Healthcare workers across the country have found themselves delivering care for a high volume of acutely ill patients, often with severely limited supplies of personal protective equipment (PPE), magnifying their own risk. Many have watched colleagues fall sick and even die, while others have been asked to ration patient care. Multiple studies have highlighted increased instances of depression, anxiety, insomnia and psychological distress amongst frontline workers, and some clinicians have even taken their own lives.

Challenges with the legacy staffing model

Prior to the pandemic, our healthcare system had long dealt with seasonal and geographic differences in healthcare demand. Flu season, for example, causes more demand for healthcare in December than July. Florida experiences more demand for care in February than June because snowbirds migrate from the northeast in the winter and bring their healthcare needs with them.

In the past, temporary or contingent workers — travel nurses, per diem nurses and locum tenens doctors — helped to balance supply of labor with the seasonal and geographic peaks and troughs in demand. Staffing agencies worked with these temporary clinicians to match them with opportunities at hospitals, ambulatory surgical centers, long-term care facilities and other providers. Many people don’t realize that temporary clinicians are an important part of the healthcare workforce. Estimates are that supplemental staffing accounts for more than 30% of total nursing hours in the U.S.

Staffing agencies, however, cannot scale for pandemic scale events because they are using outdated tools and processes. Recruiters at staffing agencies make phone calls and send emails to communicate with the clinicians who are frequently annoyed by inconvenient and unwanted solicitations. More importantly, these tools are not fast enough when we experience sudden unpredicted spikes in different geographic areas like those in the past six months.

Outdated regulations are partly to blame. Licensure for nurses is handled state-by-state, which creates obstacles that prohibit nurses from working in states where they are not licensed. There are approximately 35 states that are part of a licensing compact that offers mutual recognition, but many of the largest states and those hit hardest by the early days of the pandemic — like California, New York and Washington — are not part of the compact. In California, it takes six weeks on average to get a license for an out-of-state nurse, a number that has not budged even as the state’s COVID-19 cases have skyrocketed.

Some states that are not part of the compact have used executive actions or emergency declarations to allow nurses to cross state lines, but many of those are now expiring and were never meant to be a long-term solution. The pandemic has highlighted the need for new regulations as part of the solution described below that allow for a more fluid movement of clinicians across state lines. Are patients and diseases in California really that different from the patients and diseases in Texas such that we need different regulatory standards and license requirements in each state?

The solution: A vertical marketplace for healthcare workers

We need to move beyond the antiquated staffing agency model to facilitate a more rapid response, a better clinician experience and more efficient matching. The good news is that we are starting to see companies addressing this problem with a software-centric model: the vertical labor marketplace. Some examples of these marketplaces include Trusted Health and Nomad Health.

Like StubHub, the company I started 20 years ago, these marketplaces use the power of the internet to connect supply with demand. In the case of these healthcare labor marketplaces, the clinicians make up the supply while the hospitals and other care facilities make up the demand. Rather than scouring the job boards for individual hospitals or fielding calls from recruiters, clinicians can see all available positions that meet their skills and experience, along with compensation and other job details. They can check the marketplace when it is convenient without getting inundated by phone calls or emails.

Clinicians can use the marketplaces to come in and out of the labor pool as they wish. This helps to reduce stress and increase work-life balance before burnout sets in. Some nurses might choose to leverage the marketplace to move to Florida in the winter to serve the snowbirds while others may choose to take the summer off and work during flu season. The marketplace also creates financial opportunities for underutilized clinicians by better allocating their labor to geographies and hospitals that need them. Hospitals and other providers benefit from these simple-to-use cloud-based marketplaces that allow them to quickly ramp up capacity when they need it most.

The system needs more contingent workers

In the staffing agency paradigm, when an independent hospital experiences a spike in demand it must work with a staffing agency to bring in temporary clinicians quickly. A multihospital health system has the advantage of being able to move clinicians from lower demand hospitals to a sister-hospital that is experiencing an unexpected peak. A widely adopted national marketplace would theoretically have an even greater advantage because its broader visibility across more hospitals would allow it to move resources from hospitals with excess capacity to those with the highest demand, even if the two hospitals are unaffiliated.

There have been heroic doctors and nurses who have volunteered to move to areas with the highest demand. However, hospitals and health systems are not incentivized to lend out their doctors and nurses to nonaffiliated hospitals. Therefore, the solution requires more clinicians to be in the contingent workforce (like travel and per diem nurses). If the mix between contingent nurses and permanent nurses were 70/30 instead of 30/70, peaks and troughs would be more easily handled since a larger percentage of the resources would be shared across a larger network of hospitals. The marketplaces would have an even greater impact on our society because they would be able to allocate even more resources to the hospitals with the most acute needs.

There are two possible sources of additional contingent workers. First, permanent healthcare workers may decide to terminate their affiliation with a single hospital or health system in favor of contingent work because they are attracted to the flexibility. Second, workers in other industries may choose to enter the healthcare industry because it provides more options for contingent work. Regardless of the path, an expansion of the supply of contingent healthcare workers is a necessary part of the solution.

A side benefit: Stronger financial health for our hospitals

During the pandemic, patients across the country chose to postpone many elective surgeries and non-life-threatening procedures because they were scared of contracting the virus at the hospital. As a result, hospitals lost revenue from profitable elective procedures. Because hospitals have huge fixed costs (salaries are a big component), the government has provided tens of billions of stimulus money for hospitals in financial distress.

In addition to all the other benefits described above, a more widely adopted vertical labor marketplace for healthcare workers would provide relief to hospitals by shifting a larger portion of clinician labor from a fixed cost to a variable cost. Hospitals would have a smaller number of permanent employees and a larger number of temporary contingent workers. When demand drops, hospitals would use fewer contingent clinicians. When demand rises, they could tap into the marketplace to bring on more capacity.

A marketplace approach to America’s healthcare and its clinicians is long overdue. While the pandemic magnified our current system’s vulnerabilities, they have been there all along. By leveraging the technology and marketplace paradigm that has made so many other industries efficient, we can improve not only our healthcare system and clinician quality of life, but also our hospitals’ bottom line. Let’s galvanize the collective distress COVID-19 has created and use it to pioneer a more efficient model for all.

* Craft is an investor in Trusted.

#column, #covid-19, #flu, #health, #health-care, #health-systems, #healthcare, #national-health-service, #novel-coronavirus, #nursing, #opinion, #policy, #tc

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As pandemic rages out of control, CDC head warns of darker times this fall

A serious man in a business suit puts on a surgical mask.

Enlarge (credit: Getty Images / Pool)

If seasonal influenza roars back this fall while the COVID-19 pandemic is still raging, the combined weight of the diseases could cause US healthcare systems to collapse, the head of the Centers for Disease Control and Prevention warned Tuesday.

The grim warning comes as COVID-19 is spreading out of control in many areas of the country, which is now seeing upwards of 60,000 new cases a day.

I am worried,” CDC director Robert Redfield said in a live interview with Howard Bauchner, editor-in-chief of the medical journal JAMA. “I do think the fall and the winter of 2020 and 2021 are going to be probably one of the most difficult times we’ve experienced in American public health.”

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#cdc, #covid-19, #flu, #healthcare, #infectious-disease, #influenza, #masks, #public-health, #sars-cov-2, #science

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Cue Health raises $100 million to speed development of rapid, portable COVID-19 diagnostics

San Diego-based startup Cue Health has closed a $100 million Series C funding round, including participation from Decheng Capital, Foresite Capital, Madrone Capital Partners, Johnson & Johnson Innovation, ACME Capital and others. The funding will be used to help Cue finish up development, validate and scale production of its Cue Health Monitoring System and test cartridges, including test kits designed to diagnose COVID-19, which are currently being reviewed by the U.S. Food and Drug Administration (FDA) for emergency use authorization.

Cue has been developing its connected, portable lab to provide on-site care including molecular diagnostic tests since its founding a decade ago. The company also secured a $13 million contract in March specifically targeted towards development of a portable point-of-care COVID-19 test. Cue co-founder and CEO Ayub Khattak says that this pandemic has only re-emphasized the need for its product, which is primarily aimed at providing rapid, simple-to-use diagnostics that can be implemented quickly by a wide range of frontline workers in a variety of settings.

Concurrently with its EUA process for the Cue COVID-19 test, the company is also finishing up validation of the results for its influenza A and B tests, which will be used to submit to the agency for final approval of those tests as well. Its tests would provide at-home molecular based testing, with a connected results platform that can immediately provide diagnostics to certified healthcare providers within 20 minutes, unlocking a new level of remote care.

In total, Cue has $30 million in contract from the U.S. HHS’ Biomedical Advanced Research and Development Authority (BARDA) across its efforts both for flu testing and for COVID-19 diagnostics.

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New coronavirus research suggests vaccines developed to treat it could be long-lasting

A new study from Italian researchers suggests that the SARS-CoV-2 coronavirus, which is the cause of the COVID-19 pandemic currently causing a global health crisis, is relatively slow to mutate – meaning that any effective vaccine that is developed to prevent people from getting infected should be broadly effective across geographically separated populations, and over a relatively long period of time.

The research, conducted by two independent teams working separate from one another, including scientists at the “Lazzaro Spallanzani” National Institute for Infectious Diseases (IRCCS) in Rome and the Forensic Division of the Department of Biomedical Sciences and Public Health (DSBSP) at Ancona University Hospital, performed genetic sequencing tests using tech developed by Thermo Fisher Scientific on samples of the virus taken from Italian patients. They then compared these samples to a reference genome that was sequenced from a sample of the virus taken from the original Wuhan outbreak some two months prior.

The differences between the two virus samples was very small, speaking in terms of genetic variation – only five new variants appeared in the later Italian samples, which is an early indication that the SARS-CoV-2 coronavirus remains fairly stable even over the course of a long train of transmission across multiple individuals and populations.

This is heartening news, especially given that other coronaviruses can be quick to mutate. Consider the standard seasonal flu: it essentially constantly mutates, which is why each year a new flu vaccine is developed, with researchers essentially racing the clock to anticipate which newly mutated strains will pose the greatest threat in each flu season, adapting the inoculation and urging the public to get their updated shot.

Other viruses either mutate very slowly, or don’t mutate at all, and the coronavirus that leads to COVID-19 appears to be among the former. In addition to this Italian study, work done by John Hopkins University and other health science researchers around the world have supported this view. An endeavor by a UK consortium to more comprehensively track mutations over time should provide an even clearer view.

As far as the COVID-19 pandemic goes, this new support for the theory that the virus behind it is a slow-moving one in terms of its genetic makeup is very good news indeed. Any vaccine is still likely at least a year way, but this research at least suggests that when it does arrive, it’ll be effective broadly, and for at least a few years at a time.

#coronavirus, #flu, #health, #medicine, #pandemic, #rome, #science, #tc, #united-kingdom, #viruses

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Amazon Care to provide delivery and pick-up of at-home COVID-19 test sample kits in Seattle trial

Amazon is going to be working with a new research initiative backed in part by the Gates Foundation that will distribute at-home coronavirus assessment kits, and then deliver the collected samples to FDA-approved test facilities. Amazon Care, the health arm formed by Amazon initially for internal employee care, will be handling the delivery of the kits, as well as transportation of collected samples to the test labs, as first reported by CNBC.

While the FDA updated its guidance just a few days ago to specifically exclude at-home testing from the Emergency Use Authorization that is in place to enable broadened private lab testing of potential COVID-19 cases, the arrangement with the Seattle Coronavirus Assessment Network (SCAN) and Amazon Care bypasses use of the traditional mail or package delivery network. The Amazon Care drivers who are doing the test kit drop-offs and deliveries are specifically trained in proper handling of sensitive medical materials, and the SCAN project is for a limited research endeavor undertaken in order to help “understand how coronavirus is spreading in the Greater Seattle area.”

Availability of kits will be limited, but will include the kind of swab testing that is being conducted at drive-through testing facilities in the U.S. Should a sample test positive for COVID-19, the person who provided the sample to SCAN will be contacted by a healthcare worker for next steps, including advice on how to seek treatment and prevent transmission.

SCAN is the result of a partnership by Seattle & King County’s Public Health department, as well as a team of hospitals and health organizations that created the Seattle Flu Study, a similar project meant to study the spread of the traditional seasonal flu within the community. The research and data modeling work done for that study have been adapted to the study of COVID-19, and the flu study has been put on hold while researchers focus on the pandemic instead.

#amazon, #amazon-care, #coronavirus, #covid-19, #fda, #flu, #food-and-drug-administration, #gates-foundation, #health, #seattle, #tc, #transportation, #united-states, #viruses

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