Jun 14, 2016

The Reordering of Medicine

When you wake up in the morning
You'll have a brand new feeling
And you'll find yourself healing
-Daniel Johnston

The nature of the way we interact - or desire to interact - with medicine and our medical care is starting to change fundamentally. This is less about the unbundling of medicine (which may also be happening) but instead the reordering of it. Stemming from a combination of user desires (driven by the mobile transformation of the last 10 years) and software and device capabilities, the reordering can be seen acutely in some conflicts that are now occurring.

Take just one example: UnitedHealthcare recently decided to make equipment by Medtronic its preferred in-network device for insulin pumps. This is a Medtronic device.


The diabetic community was incensed by this decision. Why? Because alternative device manufacturers had been delivering insulin pumps with different features that users wanted. Like touch screen devices from Tandem or color screens from Animas or Omnipod:

Screen Shot 2016-06-12 at 7.54.54 AM.pngtslim_Hand_View.jpg

Of course, people took to social media to express their feelings: #mypumpmychoice and #accessmatters are just two of the relevant hashtags here.

Underlying this all is the simple idea that “technology is intensely personal.” No longer does technology being personal solely apply to our creative modes of self expression (our cameras, pictures, videos, tweets and Snaps) - it now also applies to how we manage our lives and health. Our phones may not be becoming our new doctors (though I think they can), but they are shifting the ways we interact with and track our health care.

This has the potential to put people at the center of the medical universe (in the same way people have become one center of the media universe).

This isn’t unbundling but more like reordering. Unbundling refers to the phenomenon whereby a market or industry that is tightly coupled, or otherwise concentrated or vertically integrated, is then later transformed when it splits into component parts. The components of healthcare are already fragmented, however. Instead, what is happening may be that the components of medical care are being reordered into something new - patient demanded and patient centric. Defined by the user and user needs.

This isn’t totally new. Jay Parkinson, MD, has been writing about this for years, my favorite quote of his:

People are the CEO of their health, and doctors are just consultants.

What may be new is the technology and services have finally caught up to make this a reality.

And it’s not just insulin pumps, but also many other services. For example, apps to track fertility (like Clue) only indirectly implicate a physician, but for sure help a person collect vital signals about their bodies and health. Parkinson’s very own Sherpaa tackles the problem of the complexity of employer managed healthcare by viewing it as a user experience problem to be solved. Smartphone accessories can now perform tests to detect HIV and syphilis from a finger prick of blood and in just 15 minutes. AliveCor allows you to perform an electrocardiogram at home. Services like Lemonaid and Nurx dramatically simplify the diagnosis experience (and cost) by providing computer-assisted mobile-only medical care directly to users.

This user-centric approach to medicine is also occurring in more b2b oriented services too. Eligible has created an API that enables a healthcare service developer to focus on user experience and not payment and insurance infrastructure (in a similar manner to, for example, Stripe). Lumity uses employee data to help companies provide the best benefits.

USV has, natch, invested in a bunch of these companies, some listed above.  

The thing that ties all these together is putting the user - the consumer of the healthcare - at the center of the universe and building out from there. There are, of course, other vital players in this medical matrix - but this reordering may be the beginning of a user-centric approach that has been largely absent so far at scale. One that feels consistent with trends we have seen in other markets and also one that could result in real change in the economy and society.

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