Docent Health

Service industries like consulting, hospitality, restaurants or the local car mechanic, are judged on experience. Healthcare folks would like to think that it’s all about outcomes but no one would argue that experience is just as important. And most healthcare experiences suck from a patient’s point of view.

Docent Health caught my attention last year in July when they raised a healthy $15M Series A round from big names like NEA and BVP. Their ‘Docent Program’ is an intriguing service approach, to say the least. They offer docents -people who are familiar with the healthcare system, like ex-nurses- to act as a liaison between the patient and caregivers. These virtual and/or onsite docents integrate with the clinical staff to act as a representative of the patient’s anxieties and preferences.

Fair enough. Can’t argue with the benefits of having a personal concierge throughout hospital journey. Building a personal relationship with the patient allows the hospital to create a better brand impression. That kind of word-of-mouth marketing is priceless and spreads fast. Additionally, the learning from one patient’s preferences may be transferable to the next, creating a patient experience-related ‘best practices knowledge base’ that has never existed in traditional health organizations.

But it’s not a panacea. Revitalizing service experience shouldn’t necessarily be about adding more humans into the mix or creating one more layer of touch points. I understand that the current environment doesn’t allow clinicians to have the ideal 1-on-1 time with patients, but adding a new resource into the mix increases the human interfaces through which information has to travel. A new team member gets added to the physician/nursing rounds and the incumbent care team may not like dealing with someone else on their turf. The overall cost goes up too, since someone is ultimately paying for the added cost of docents. Needless to say this added cost will ultimately be handed-off the patient.

If healthcare service experience sucks, the solution should be to fix the fundamental issues (for example overworked caregivers and unhelpful EHRs). It’s the same argument I make against scribe services: fix the EHR user interfaces rather than adding another minion to the mix.

Criticize someone else’s solution is like shooting fish in a barrel. I realize that the current system is straining while waiting for salvation. Docents may be a good-but-temporary fix but tech-enabled services are here to stay. Omada, Livongo, Virta are good examples of how this trend can transform condition-specific care experience and outcomes.

Virta Health

Virta burst on to the digital health scene recently boasting a $37M funding round and a tech-heavyweight CEO Sami Inkinen who previously co-founded Trulia, the online real-estate platform.

Virta is the latest digital health star to follow the trend of what I’m now beginning to identify as tech-enabled care management. Think of it as a healthcare service delivery model where traditional care providers’ interaction with patient is enhanced (in terms of quality and quantity) using modern technology infrastructure like sensors, mobile, machine-learning.

Virta focuses on Type II diabetes management. They offer a dedicated health coach (someone who can help mentor and guide the patient through the health choices they need to make), a personalized nutrition plan and an overall physician supervision of care. All these service experiences are supported by technology that definitely includes a mobile app; and probably includes the needed wearable sensors (for weight, BP, etc. monitoring) along with relevant biomarker tests (like HbA1c).

Diabetes is a complicated multifactorial lifestyle condition that is often made worse with neglect of one/more aspects like exercise, weight, nutrition, mental health, medications, stress, BP, etc. So a comprehensive, closely-monitored program can surely make a difference. And technology is key for scaling services while keeping them personalized. So this kind of solution approach makes sense.

Omada (for diabetes) was an early player in the tech-enabled care management space. Livongo (also diabetes), Lantern (mental health), Hinge Health (musculoskeletal disorders) are some other examples. It’s a good sign to see standardizable niches of healthcare service delivery being scaled up with clever technology use. Of course all this still needs to pass the muster of traditional third-party payment machinery in our healthcare system. Given the accountable care trend I’m optimistic about the viability of such companies as long as they show real outcome improvements.


The idea is certainly not new. Using VR immersion as a part of mental health treatment has been a subject of academic research and debate for a couple of decades. What usually makes news are opinion articles and university research projects.

I’ve seen commercially-oriented companies (like VirtuallyBetter) but none that gave me the impression of a true ‘VR platform for Psychiatrists’. Limbix seems to be the (?)first silicon valley outfit to tackle the workflow, documentation and content needs involved in integrating immersive VR therapy to mental health. Their website is terse, as usual for a startup, so most of this is my gut feel.

Using VR (or AR) to help patients overcome anxiety, phobias and other mental health conditions is in care delivery future. Reminds me of the optimism in late 90s when PACS technology was washing up on the shores of film-based radiology field. Limbix is to be filed away as a representative attempt at a viable digital health niche.

Update: Right after I wrote this, my network pointed to Psius, AppliedVR which look similar.



CaretickerLogoI know nothing more about Careticker than what their spartan website says. But the first time I read it, something clicked. Careticker is a sort of personal (health) productivity app that lets users manage their interaction before, during and after hospital stays. I think that is a great niche.

Except for hypochondriacs, no one likes hospital stays. Most of the anxiety related to a hospital stay can be attributed to the fear of unknown. Patients simply dont know enough about what they need do or what is going to be done to them during that stay. It’s like visiting a foreign country with no map or translation tool. That, is where I think niche context-aware companion apps can help. For common inpatient procedures (like hernia, tonsillectomy, etc.) a focused mobile app that gives patients reminders, education, to-do lists like functionality is  a tremendous value proposition.

Note the word ‘focused’. That’s the key. There are plenty of WebMD, MedlinePlus like generic health information apps that have wide variety of conditions covered. But to make the experience worthwhile the app needs to align all interaction vectors and focus on one intervention (or a group of closely-related conditions/procedures). Take a look at the list of most common procedures performed in US: all of them are candidates for an app. An app to remind patients when to stop eating/drinking for surgery, what to expect during stay, read FAQ posted by surgeon, get a copy of handout/discharge summary, etc. etc.

Back to Careticker. It surprises me that with the fundamentals rooted in an interesting niche, why did they pick a generic, already-crowded-with-apps condition of pregnancy as their first product. To be clear, Ob/Gyn is surely the right subdomain since the majority health-related app user skews to female gender. But a sharper focus (like Caesarean section) may have been smarter. The slightly derogatory name ‘Knocked Up’ doesn’t help either.

There is definitely room for growth in the target market. Especially since outpatient surgeries surpassed inpatient a couple of years ago. For a service like CareTicker, the gamut should run all types of procedures, regardless of care setting. Watch out for more entrants in this space.


People with type 1 diabetes need to take insulin in a similar way their pancreas would produce if it were normal. Older therapy used to be multiple daily injections, which were poor approximation of the insulin need. In Continuous Subcutaneous Insulin Infusion (CSII) or Insulin Pump therapy, a small device delivers a constant stream of rapid-acting insulin through a tiny tube; according to a programmed plan unique to each wearer. Insulin pumps are not automatic but they let patients make immediate adjustments, enabling them to lead a more spontaneous lifestyle.

Companies like Cellnovo represent the key role IT is playing in the evolution of medical devices. UK-based Cellnovo began in 2002 as Starbridge Systems Ltd. to develop a novel micropump with only one moving part that made it smaller, more accurate and less expensive. Somewhere along the line, their conventional medical device transformed into a mobile health offering. It now consists of:

1. Pump: A small, waterproof device that can be easily applied, removed, and repositioned on the body. Also includes a built-in accelerometer that registers and stores user activity data.

2. Handset: A hand-held device that communicates wirelessly to control the pump and sends data to a secure website. User can manage dosage, schedule, log supplemental data like food intake, activities, emotions, etc. through this device. The look-and-feel has been compared to today’s appealing smartphones with icon-driven intuitive graphical display and touch screen ability.

3. Online: Websites customized for various participants that are usually involved in managing diabetes- provider, patient, caregivers, etc. Given the variety of people that can be involved in the care team (primary doctor, dietitian, diabetes nurse educator, eye doctor, foot doctor, endocrinologist, exercise trainer…), communication and coordination is an often under-served part of diabetes management. Seems like Cellnovo Online is an attempt to improve just that.

The overall concept is not new. OmniPod by Insulet Corporation (a public company) has a pump and handset. Big players like Medtronic, Sanofi-Aventis, J&J have shown signs of moving in similar direction. With the February 2011 series B financing round of $48.4 million, Cellnovo also seems to have enough runway in this space. As an interesting aside, combining insulin pumps with Continuous Glucose Monitoring System (CGMS) makes a terrific combo- uninterrupted sensing and coordinated, intelligent drug delivery. OmniPod does this.

Solutions like Cellnovo provide not just a way to deliver therapy, but a novel way to collect detailed data about given patient population. Analyzing aggregate data like that can lead to insights at multiple levels- clinical evidence (EBM), provider performance, population health, etc. An interesting decision fork in this evolution would be whether manufacturers leverage commercial computing hardware like smartphones or create their own (like Cellnovo). The former gives wider reach, while latter provides better, medical-grade control (something that FDA probably mandates).

But the key point in all this is about the future of traditional consumer medical devices. The next-generation devices seem to be less conspicuous, continuously connected, more personalized and come with an integrated online component that becomes the window to interaction with multiple parties (caregivers, friends, insurers…like an evolved, niche form of social networking). The new value proposition doesn’t stop at just a hardware device, but becomes a continuous service for managing chronic disease.

One can argue that managing all chronic diseases requires understanding an ever-changing constellation of information continuously generated by a whole ecosystem of participants. This ever-connected disease management approach that removes the burden of keeping journals and pushes information to healthcare professionals can to be applied to many diseases besides diabetes. I’m sure a number of those are already underway.