Silicon Valley types like to talk about disrupting things. But health care doesn’t want to be disrupted.
I get it. Who wants to see their medical care taken over by a bunch of techies willing to cut corners in their insatiable quest for growth? If Theranos’ Elizabeth Holmes had continued to operate her business without oversight, who knows how many people would have been hurt?
Lately, I’ve been feeling that it’s time for us to move on from the narrative that a bunch of brash newcomers are moving into the health tech space and willfully harming people because they don’t respect the rules. To be sure, there are bad actors in health tech, just as there are in any sector. Instead, it’s time to consider a more nuanced alternative to this story.
Digital health has matured a lot in the past decade. Since I’ve been involved in the space as a journalist — and now as an investor — the largest tech companies have gone through multiple iterations of success and failure in health care. A generation of entrepreneurs has similarly been humbled by health care. But they’ve also wised up to its complexities. More often than not, I meet founding teams of health tech companies these days with a practicing physician and an entrepreneur at the helm, working collaboratively.
This isn’t amateur hour, and it hasn’t been for quite some time.
It’s 2021, and companies like One Medical, Livongo, Grand Rounds Health, and Omada Health have been at it for close to a decade or longer. In that time, those who entered the space from tech have become seasoned health care operators in their own right.
“We’ve learned the hard way what not to do,” Tom Stanis, founder of virtual medicine startup Story Health, told me. Stanis previously ran software at Verily, Alphabet’s life sciences arm, before making the leap to start a company.
Stanis says he still sees health tech engineers in his network making the mistakes they’ve always made. They often start out by confusing “medicine and health care,” he explains, meaning they’ll often go deep on trying to understand a metabolic pathway or an organ system before realizing that health care is about “systems and people and how it all works together.”
But he also sees more technologists spending time talking to a variety of clinical experts and not being afraid to ask dumb questions. For that reason, when Stanis started his new company, he brought on cardiologist Ashul Govil as a co-founder. It was important to him to find someone who still practices medicine, ideally one who treats diverse patient populations.
We’re seeing a spate of Silicon Valley types succeeding because they bring a fresh perspective to medicine, not in spite of it. Likewise, not all doctors will succeed at innovating in health tech just because of their clinical training, particularly if they aren’t willing to collaborate with product and operations teams. Medicine is notoriously hierarchical, which doesn’t translate well to the flatter world of tech.
What digital health companies are doing better than ever before is finding ways to marry the two disciplines.
It’s not easy. The two cultures can be like oil and water. But the cohort of startups that have been around for a while have implemented techniques that work, thanks to a lot of trial and error. Manish Shah, the founder and CEO of PeerWell, one of my company’s portfolio companies, describes it as “translational thinking,” meaning the art of applying solutions from one domain to another.
Take Omada Health, which is using digital tools to help patients with chronic illnesses. Omada was started by former Google employee Sean Duffy, who dropped out of medical school to move into the business world. His company focuses on preventing diseases like diabetes rather than managing them once they become uncontrolled. Those people often fall through the cracks in our current “sick care” system.
Dr. Carolyn Jasik, the company’s chief medical officer, told me in a Zoom chat about an interaction she had with a colleague who had joined from the e-commerce brand Everlane. This employee, Krista Bangsund, questioned Jasik about a front-end application she had put together for Omada’s patients. Jasik, relying on her clinical training, had written out about 100 questions that might have taken hours for a user to complete. Bangsund pushed back and the two worked together to figure out what information was really necessary. They eventually figured out a clinically sound way to reduce friction and improve the user experience.
Another example: Remember Ginger.io, the digital health startup that spun out of the Massachusetts Institute of Technology in 2011? The initial product was focused on using smartphones to diagnose mental illness. It was a cool idea, but a challenging one to scale. Eventually, the team came around to the idea that instead of selling to providers, they needed to become one. So in 2018, the founders recruited Russell Glass, an experienced technologist who previously worked in product at LinkedIn.
Notably, Glass had zero background in health care before joining Ginger (by that time, the company had decided to drop the “io”) as CEO. What he did right is to approach the space with humility. After lots of calls with medical experts, he realized Ginger could help solve what he described to me by phone recently as a “massive supply and demand imbalance problem.” In other words, a ton of patients and far too few providers to care for them.
That insight led Ginger to build a website and app that connect patients with coaches and licensed therapists. Ginger is now used by some of the largest employers in the country, offering mental health services to tens of thousands of employees.
Because Glass was new to health care, he was able to leave his assumptions at the door. And this part is key: He surrounded himself with a team of clinicians to guide the development of the product, but stayed true to training from consumer tech.
So while there may still be some folks in tech who believe they can transform health care on their own or automate away doctors, I rarely come across them anymore. And many folks in the health tech world share that view.
“I am approached a lot by people with tech backgrounds who are tired of their career generating ad revenue and want to work in a mission-driven field,” Dr. Dena Bravata, a clinical adviser to digital health companies, shared with me. “Sometimes you see a disregard for expertise, but there are others who are super thoughtful and are willing to partner with clinicians very early on.”
So when companies fail, let’s not jump to the conclusion that a bunch of tech people messed it up because of their arrogance. Or worse, constantly remind potential innovators that the space is too hard or too complex. By doing so, we may be putting off entrepreneurs who might do a lot of good.
And let’s be real: Our health care system isn’t perfect. In fact, it’s failing on many levels. We’re facing an obesity epidemic, ever-rising costs for lifesaving medicines, life expectancy that’s declining, a poor track record on maternal health, a massive prevalence of mental illness, millions of people experiencing chronic pain — and to top it all off, we’re in the midst of a pandemic.
As Malay Gandhi, head of strategy at digital health startup Benchling and an angel investor told me recently, great leaders can build teams in any industry regardless of their expertise. Health care today isn’t solving many problems well, particularly when it comes to preventing disease versus prescribing a pill or procedure. So there may be a whole new generation of talent that can move in and focus on that. Or maybe the next success story in digital health will come from an individual who has experienced these shortcomings first-hand and envisions a better path forward.
Rather than being gatekeepers, it’s time we hear from these new voices.
“The system is failing a lot of people as it stands today,” said Gandhi. “So why not shift to more open-minded rhetoric?”
Christina Farr is an investor at OMERS Ventures specializing in health technology. Before that she was a journalist at CNBC, Reuters, and Fast Company.