Health tech dispatch: value swings and AI fears

By BEN LEONARD, CARMEN PAUN and RUTH READER

03/30/2023 02:00 PM EDT

ONC head Micky Tripathi warned of AI's risks at the conference. | Ben Leonard

NASHVILLE, TENN. — The mood was a bit muted at the ViVE digital health conference in the Music City this week.

The failure of Silicon Valley Bank rattled the health-tech industry, which already saw an investment downturn in 2022 after a blockbuster 2021 fueled by increased interest in telehealth at the height of the pandemic, Ben reports. Sector executives expect another tough year ahead with industry consolidation and a number of companies that might not survive the downturn.

"Over time, values swing one way or the other. But we tend to settle in the middle," said Lee Shapiro, managing partner at investment firm 7wireVentures. "They’ve swung too low. We had been too high. Hopefully, we’ll reach that happy medium."

At the conference, hosted by the College of Healthcare Information Management Executives and HLTH, attendees honed in on technology to address workforce shortages, a top industry concern.

They also pondered the next steps for virtual care and treatment at home that would lean on technology like monitoring patients remotely and even incorporating face scans into telemedicine to predict disease risk and take vital signs. Executives envisioned "smart homes" equipped with sensors to detect health issues.

The conference comes as the sector is going through a transition period, with the federal government winding down the Covid-19 public health emergency that facilitated access to digital health tech like telehealth and shifted consumer demand.

Policy was also discussed, with some in the industry concerned about the ripple effects of a proposed DEA rule that would roll back eased pandemic rules facilitating virtual prescribing of controlled substances. Smoothing the data-sharing process was also a significant concern.

Micky Tripathi, HHS’ national coordinator for health IT, cautioned that while the industry should be excited about AI's potential, people should have "tremendous fear" about potential safety, quality and transparency issues.

"There are all sorts of issues without appropriate transparency and governance over how these are used at a local level," Tripathi said. "I’m not talking about big picture governance. … Local level, so that users understand what the algorithm is doing."

Elizabeth Fowler, deputy administrator and director of the Center for Medicare and Medicaid Innovation, which tests new payment and delivery models, reflected on how the center has evolved since it was created under the Affordable Care Act, saying she's not sure whether it's lived up to expectations but noted it is making progress.

"We’re past the stage of throwing spaghetti against the wall and planting a lot of seeds," said Fowler, who helped craft the Affordable Care Act as chief health counsel on the Senate Finance committee. "We’re getting closer."

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Investors are less focused on telehealth now, Deloitte found. | Rich Pedroncelli/AP Photo

Digital health investors are looking to more specific areas in mental health, according to a new report from Deloitte.

Venture funding in the sector broadly tempered in 2022 after reaching historic highs in 2021, though it remains above pre-pandemic levels amid rising interest rates.

As that's happened, investors are looking toward mental health for women and the elderly. That's after investors had previously been zeroed in on mental health more broadly and telehealth. Investors are also now honing in on value-based care, the consultancy found.

Investors are also looking to:

— Bolster administrative efficiency

— Strengthen health equity

— Focus on companies with Medicaid patients and social determinants of health, including food and housing

"The shift in focus seems to have resulted in a ‘back to basics’ approach that may continue into 2023," Deloitte's team wrote. "In addition to focusing on growth, innovators may be looking to achieve stability, to help them bridge longer funding cycles, and, potentially, provide meaningful value to their clients."

The consultancy also expects platform-based systems, which lean on partnerships and data, to be more favorable economically amid macroeconomic concerns.

"Whether or not the macroeconomic environment changes in the near future, the health tech sector is expected to continue drawing investors’ attention and driving innovation in health care," Deloitte wrote.

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A midwife in Dakar, Senegal, talks to her patient about cervical cancer screening during a routine consultation. | Clinton Health Access Initiative

Most women who died from cervical cancer globally in 2020 lived in low- and middle-income countries. Catching the disease early is key to ensuring that most women survive it, but most developing countries cannot afford the costs of testing for human papillomaviruses, which cause most cases of cervical cancer.

Those countries rely mostly on a screening method known as visual inspection with acetic acid, which is affordable and accessible but not always accurate. A health worker performs a pelvic exam with a speculum and applies acetic acid — a vinegar-like solution — to the cervix to highlight potential lesions. Then the health provider must decide, based on their experience and training, whether they’re precancerous.

That's where artificial intelligence would come in. The Clinton Health Access Initiative is working with machine-learning experts at Bellevue, Washington-based Global Health Labs to develop an AI tool to help health workers yield a more accurate test result.

The addition of AI would serve as a second opinion, said said Karen Milch Hariharan, senior director for cervical cancer at the Clinton Health Access Initiative. The initiative has been working with partners in Zambia to gather images of precancerous lesions to train the algorithm to recognize them.

The tool is being designed to work offline on a smartphone so it's accessible to health workers in areas with unstable or no internet connection, she said.

"We’re hoping this will be ready in the next two years," Milch Hariharan told Carmen.

Background: The AI tool development is part of a wider effort that led to more than 1 million women in 14 developing countries being screened for cervical cancer over three years. Eighty percent of those who tested positive received treatment.