Jay Parkinson MD, MPH
@jayparkinson
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Digital health OG. Founded Hello Health (2008). Founded Sherpaa (in 2012 & acquired by Crossover in 2019). Currently: CMO of Sana Benefits
Colorado, USA
Joined February 2008
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I paid off my med school loans today. I went to Penn State and graduated with $280k in debt, just from med school. My tuition doubled between my first and second year, which coincided with Penn State merging with Geisinger. There’s no way to fight that. 1/
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Healthcare in the US is not one $4T industry. It’s about 200 regional industries. This is quite possibly the most misunderstood concept in health tech.
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I'm thrilled to announce that Crossover Health has acquired Sherpaa and I've joined Crossover to lead the design and development of the platform that powers the most seamless virtual and physical care experience the world has ever seen.
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The craziest thing about all healthcare conferences is that the same handful of leaders speak at all of them and say the same thing over and over and all I can think is this is such a huge industry, surely, there’s got to be more diverse voices and expertise. Yet, there isn’t.
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I really hate that the term Virtual Primary Care has been co-opted by telehealth companies as a euphemism for a 10 minute video chat between strangers who can never connect again. That's not primary care.
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On my drive to JFK today, my Lyft driver told me he moved to NYC from Kathmandu 21 years ago. Over the years, he paid off his house in Queens and his 22 year old daughter is in her 2nd year of a 7 year undergrad/med school program in NYC. What an inspiring guy. Made my day.
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Smallpox killed 300M people just in the first 75 years of the 20th century before it was fully eradicated by a worldwide vaccination effort. Vaccines. Antibiotics. Clean water. Triumphs of humankind. Feeling all public healthy now that I’m 2 weeks post jab
#2
.
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Anytime I hear about healthcare blockchain startups, I think about how healthcare hasn't even yet adopted email.
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GoodRx, Hims, etc aren’t healthcare. They’re marketing companies capitalizing off symptoms of bad, inaccessible, confusing healthcare.
1/ Hims & Hers the latest to show how explosive the revenue growth can be in consumer healthcare.
2018: $27M
2019: $83M
2020E: $138M
While improving GMs from 29% to 71%.
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Life update! I’m doing a new thing! Real stealthy. But it ticks off my 3 criteria of what I want to spend the next epoch of my life tackling:
✅ Scalable, online care
✅ Avoiding US healthcare BS
✅ Not funded by VCs or PE
More to come in Q1 2022…until then, lotsa London!
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How to build a sustainable digital health company: lessons I've learned in the last year at Sherpaa.
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Life update! About 4 weeks ago, I left Crossover after working with them for 2 years post Sherpaa acquisition. I’m taking a break. It’s not forever, just for now. But here are some thoughts as I head into this much needed clearing of the mind.
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We’ve been mum and have to be mum, but Crossover’s Care Model is the future and today we get to announce our partnership with Amazon to pioneer the future of healthcare together. Online, in-person, anytime— care for Amazon employees and their families.
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First trend: hospital networks buying up and employing doctors. Second trend: insurance co’s buying up and employing doctors. Will doctors ever realize their inability to organize means they will forever be pawns in the business of healthcare?
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Big life update! My new company is live! For the last 15 years, I've spent time, money, and a little bit of my soul building new online and physical care models. Now, I can help architect your company's tech-enabled, human-powered care model. Let's chat?
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A healthcare company started by a friend of mine was recently acquired for $26M. He and 2 other angels funded it. He owned 80% of the company. That’s the same outcome as him exiting with 10% of a $200M VC-funded company.
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EMRs can’t be fixed. The business side of healthcare hires EMRs to maximize revenue via inflated data. Doctors want to hire EMRs to minimize fluff & maximize insights. Those are diametrically opposed & EMRs can’t fulfill both expectations simultaneously.
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Innovation in healthcare is not only hard, it’s damn near impossible. I never thought of that as a ban on innovation, but you can’t really call it anything else.
Baumol's cost disease doesn't happen by accident. Labor productivity can't rise if the state bans innovation, as it does in healthcare, education, and housing.
Try using AI to automate, say, medical imaging — and see how much the state interferes.
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I love Amazon’s RxPass, but can’t stop thinking about how little the average person knows, and therefore has the energy to care, about how they can optimize their personal medical spend. Medical financial literacy is the epitome of confusing.
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Hearing that many physician practice visits are down as much as 70%. Also hearing that there’s 12 hour waits for video visits. Lesson 1: All businesses that depend on physical visits prob won’t survive. Lesson 2: Video visits simply change the location of the waiting room.
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It’s 2001. Apple has a genius idea. 1000 songs in your pocket. There’s just one problem. The average person listens to songs 2.7 times per year. The iPod, iPhone, Apple Music, Spotify. Not enough use cases to disrupt the local CD shop. That’s the digital healthcare dilemma.
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If digital health co's want to truly revolutionize healthcare, they'd all agree on:
1: One single sign on protocol
2: Interoperability between services
Today's online care is more siloed than traditional care and everybody seems to think this is fine.
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Slack meets an EMR meets a project management tool because that pneumonia is a 3 week project to be managed by you and your team. That’s the product we’re building at Crossover. We need a rockstar clinical informaticist. If you’re that person, let’s talk.
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There have been 3 misguided approaches to digital health over the last 7 years:
1: One condition wonders (when you raise $100M for one condition)
2: Gig-working docs who power these services (no upside for the docs)
3: Go big or go home (forced fast growth in a glacial industry)
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As of now, Sherpaa is available for everyone, not just companies. Join the world's first online medical practice.
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Instead of trying to study and understand the value of telehealth, we should be trying to study the value of the physical exam and mandatory in-person conversations.
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Hey everyone. After 16 years in Brooklyn, in February I moved to San Clemente, CA to join Crossover Health. So much good on so many levels.
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I hope healthtech becomes blacklisted by VCs. The industry isn't Snapchat or TikTok. Healthcare needs a different investment vehicle than VC. It moves at a snail's pace and history shows us that the majority of these VC-funded companies IPO and then tank.
Digital health has gotten a lot of negative attention. We need to slow it down. Invest smart, not fast, double down on fundamentals. Growth at all costs was never going to work.
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The older I get the less I want to have strong opinions about things I used to have strong opinions on. Everybody is winging it. Most are genuinely trying to do their best. It’s hard and rare to be successful. Just keep giving your all and be positive toward each other. ✌️
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Wild how expensive, time-consuming, & exhausting it is to be on the bleeding edge of healthcare. You put in all the thought, hard work, & grind for 11 years. Then all your work is eventually copied because Amazon recognizes it's just a marketing problem they can solve.
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Big Life Update: I've never seen anything like Nabla and I'm happy to be a part of our mission to power this next era of healthcare— primarily online and augmented by GPT-3 and our own medically-trained LLM.
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From 2007 to 2022, digital health startups existed because dreamers wanted healthcare to be fundamentally different/better. That era is over. Going forward, digital health startups will exist to make the mind numbing inefficiencies of US medical care a tad bit more efficient.
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If you’re investing in making a beautiful, lean, cost-effective primary care experience, know that 75% of health systems have little to no interest in you. They’re cool with terrible.
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With one Apple Shortcut, Vivian takes the Apple Watch fall detection concept and makes it quickly applicable to almost any emergency or self-preservation situation. Awesome.
So I made an iOS 12 Shortcut called “Mayday” to automatically text people for help in an emergency.
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The best evidence for people not caring who their doctor is (give me someone, anyone) nor caring about a relationship with their doctor is the massive rise of urgent care centers. They hire new docs fresh out of residency, there’s lots of churn, and they’re chock full.
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Wild to think that many digital health co’s would kill for 100 new patients a week and a new urgent care center in a neighborhood hangs up their shingle and does that in the first week. And those places don’t even know what CAC/LTV is.
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One day you wake up and everything around you exists to maintain complexity and not add value.
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This thread wins the day.
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To assume you’ll win as an entrepreneur by creating the best mouse trap in healthcare is a fatal error. The gold standard is the status quo. If the GS is a procedure, we’re prob the best in the world. If the GS is a service, near the worst. Yet the worst is fiercely defended.
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Telehealth will never take off until payors are 100% agnostic to the method of communication and the value communication brings to managing the health issue. Literally, the same value can often be delivered in a one sentence asynchronous update as a 15 minute office visit.
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Healthcare costs stem from the 95% of care downstream from primary care. It’s not from pink eye and sniffles. In order to have a real impact on healthcare, primary care needs to be “anytime, anywhere, for anything” first responders who are cost-conscious and data-enabled.
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Digital health conferences are for geeks like me. It’s the same folks attending all of them. So if the audience is the same, why are the speakers and panelists all the same? It’s insulting to attendees and it’s an admission there’s not enough interestingness in the space.
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I take photos almost every day with with my Hasselblad. I figure all this healthcare talk needs to be broken up by little beautiful somethings. This is from this weekend in Telluride.
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Yeah it’s called my last 12 years.
I ain’t bitter. It might be a disadvantage to me, but a massive advantage to our culture as folks like us give the world a glimpse of what’s to come and light a bit of 🔥 under healthcare’s 🍑.
Recently heard that there’s a thing in health tech called “first mover disadvantage.”
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My hot take on the Amazon news today…there’s no big integrated genius strategy. They purchased ONEM and it’s going to continue operating as is, just like their Whole Foods purchase, but with essentially no marketing costs to drive new ONEM subscribers because of Prime.
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“If you can’t be part of the solution, there’s good money in being part of the problem.”
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The magnitude of road blocks in healthcare for doing anything but the status quo is mind blowing. So many levels.
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There are ~7,000 urgent care centers that do ~350k visits per day in America. Urgent care does 1.1M visits in 3 days, which is what the telemedicine “leader” TelaDoc does in one year. Good luck VCs! This ain’t Snapchat!
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I try to "don't believe the hype" for a while but I do believe that digital health service co's founded prior to GPT will feel like the 90s and those with GPT at their core will feel and operate like the future. It's gonna get wild folks. Can't wait to see it.
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This is one of the best articles I've read in a while. Imagining what something could be.
http://t.co/zwhHUjDgr7
http://t.co/HABRqEg05t
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I've been a bit AWOL these last few months, but I'm incredibly excited about what we've been doing here at
@crossoverhealth
. Gotta stay mum for a bit, but dreams of re-engineering the care process (at scale) with an enabling biz model are finally getting realized. Stay tuned...
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It’s downright scary how few ideas healthcare systems have to improve anything in healthcare. No vision and no political will to actually deliver on the few ideas they do have. There are some pockets of innovation, but as a whole, it’s dire.
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@KaseyKlimes
Once sprawl happens, it’s impossible to transform that into interesting walkability. With walkability, you get great cities. NYC was the only city in America subject to geographic constraints just before the invention of the car. Pre-car+the elevator = perfect storm.
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Climbed three 14ers this weekend. And on the top of Mt Lincoln (14,266 feet), we ran into this lovely beast.
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Big life update! I've joined Sana as their Chief Medical Officer. A full scope online care model deeply integrated into Sana's health plan? Seems like a match made in heaven no?
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There are only two groups in America actively trying to force change in American healthcare. VCs and entrepreneurs. Every other organized entity is fighting change. And because there’s no American Patient Association, nobody’s fighting for a better American healthcare.
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Every med student and resident should know that if you have the courage to think differently, there will always be a home for you somewhere in this industry and it’ll be the most rewarding thing you’ll ever do. Trust me.
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In the minds of consumers, they hear telehealth and they hear a cheap 10 minutes with a stranger. They don’t hear that it should be like managing a project at work over time using online and in-person communication with a known team of highly competent people.
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One of the most insightful things I’ve heard is
@sacjai
saying at a private event speech “Literally nobody cares about your care model.” That hit me hard. I always thought that everyone cared about a different and better experience. But only a few wonks know enough to understand.
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If you’re a shop, you sign up for Shopify, customize with a few plugins, and you’re off. In healthcare, you Frankenstein 8 platforms together and pray nothing breaks in the tech stack powering your $120M VC-funded service. Meanwhile, where’s your IP? You’ve outsourced everything.
Here's our market map - and of course, we appreciate any thoughts you may have on gaps & companies we missed.
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Livongo doesn’t leverage physicians. Instead, it’s a structured digital experience powered by health coaches, cutting out the doctor altogether. Disease management like this will be the future and that’s quite likely a very good thing.
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I joined Twitter in Feb 2008. Back then, the physician peanut gallery said things like “doctors shouldn’t be on social media— it’s unprofessional.” Now look at this place. The number of docs using twitter is so inspiring.
#MedTwitter
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Primary care is playing in that “we’re not specialists” space. And over time, generalists typically get disrupted. Primary care in 20 years will likely be replaced by clinical condition project managers taking direction from specialists.
@thogge
Yes, that's how VC seems to be playing out. It's a natural evolution; the same thing happened in private equity, hedge funds, law firms, ad agencies, talent agencies, management consulting firms, and on and on. Scale and specialization both work; the middle is dangerous ground.
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Currently building my 4th "EMR." Once you have the basics out of the way (user types, IDP, etc.), the first feature I build is asynchronous messaging. Once you have a communication channel that documents the care, you can deliver almost all care.
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Pretty proud of this. Sherpaa is now the primary care go-to for two health plans in America. That means on the back of your insurance card, it says “PCP co-pay $35” and “Sherpaa co-pay $0.” Giving ppl easy access prevents inappropriate usage & strategically directs in-person care
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There is a huge misconception found in most people outside of the health industry— people think that there are many scientists studying all aspects of health, especially diet and “things that are good for me and things that aren’t.”
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Here’s a link to my slides from yesterday’s keynote I gave in Sydney. It’s all about Primary Care 3.0.
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As someone who graduated with $280k in med school debt in 2002 and will pay ~$1,000 per month until I’m 65, this is one of the most inspiring initiatives I’ve ever seen. Kudos NYU.
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It says a ton about the quality of the tech and the Nabla team that an organization as big and reputable as Kaiser would choose Nabla to power this unprecedented new era of AI-augmented care delivery.
We're thrilled to announce a groundbreaking partnership with Kaiser Permanente, bringing Nabla Copilot to 10,000 physicians across Northern California!
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I bet 98% of people in America could care less about having a better healthcare experience. Once you admit this, I believe the fight gets easier and less frustrating. It took me 10+ years to admit that my passion didn’t always translate. I’m good now.
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Hey guys let’s just make it so you can email with your doctor. That’d solve 90% of the problem right then and there. Then you don’t have to use all the buzzwords and try to make healthcare appear as if it’s operating in the 21st Century.
Integrated Health Model Initiative from AMA is focused on structuring
#pghd
patient generated health data in common ways — very important & exciting! Includes patient goals, emotions, data from devices
#health2con
#standards
#Interoperability
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That’s a feature, not a company.
The hardest part of digital health isn’t the tech, it’s getting contracts and creating real businesses.
My two big takeaways from not attending JPM this year.
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This is what I assume will eventually happen with the commodity transactional telehealth companies, if they ever reach sufficient traction. Docs will realize they’re just gig workers being taken advantage of, and finally organize their own service via commodity technology.
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I’m all for understanding the Social Determinants of Health, but this trend toward startups saying they’re tackling SDoH means not only are they trying to fix healthcare, they’re also trying to fix poverty, food literacy, mental health, etc. Healthcare’s hard enough, no?
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In July, Sherpaa went from a VC-funded co to a profitable, independent co. I've been mum, but here's the story.
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Would rather know the combined revenue, not the valuation. Then, we could divide the $4T annual healthcare spend by these revenues and see where we are.
These are all the unicorn ($1B+) digital health companies.
Crazy to think most these companies didn’t exist even 5-10 years ago.
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What if every doctor, upon making an order, saw the cost of the order and the “ROI.” The result of this $500 order contributes to a diagnosis in only 5% of situations. This $10 order contributes in 80% of situations.
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All virtual first companies are leveraging gig worker rando doctors. Relationship-based virtual practices have more economically in common with office practices. But precedent is race to the bottom gig working economics. Virtual first won’t take off until relationships>randos.
One of the things virtual-first plans don’t consider is the benefit of an actual, continuous relationship with your doctor. Why not? Insurance Featuring Virtual Visits? The Pros and Cons of a New Twist in Health Plans | Kaiser Health News
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I take Claritin every day and I buy a 365 day supply once a year. Bought it at CVS yesterday for $54.99. Checked Amazon and it was $10.99. Love how Amazon is slowly and surreptitiously tackling the generic world making it so cheap they don’t even have to play the insurance game.
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Now that every ICD-10 diagnosis has a well-funded startup I predict that the grand plan is Bezos comes along in 3 years time and buys every single-serving startup at a steep discount and rolls up all 10,000 siloed platforms into one master platform and saves US healthcare.
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For $5,000 I can be featured as “One of the 20 Most Influential Leaders in Healthcare 2018.” It’s both sad and obvious that this is how these things work. For the record, I passed.
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This is my new best friend, Roux. His official name is Roux Barkinson. He’s 14 weeks now and he’s the best social distancing friend I could imagine. And should you feel the need to follow his Instagram adventures, rouxbarkinson is where you’ll find him.
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Big announcement today. Comcast will be the first major Crossover client to go live with the new Crossover Platform/care model my team has been designing and building over the last year.
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Telehealth could offer so much more in pandemics. But it needs to be asynchronous and locally connected, not one time video chats with strangers who aren’t plugged in to local care.
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If you’re a virtual care co & you need an EMR & you think you can use a traditional one, it won’t work. Traditional EMR architecture is built around documenting and billing for physical visits expecting zero comms in between visits. They lock you into a process not built for you.
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Seeing the convos from health conferences on twitter makes me think 2 things. Since I became active in 2007, the conferences are flashier due to markedly more VC funding. But what people are talking about is almost entirely unchanged. Hot concepts cycle in and out and back again.
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When you take VC money, you resign your company to only 3 options— go public, get acquired, or go broke. Two years ago this month, Sherpaa became that ultra-rare 4th option— get investors to resign from the board, restructure the company, operate profitably, and grow sustainably.
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At Sherpaa, we cared for ~50k people over our 8 years and had ~500k episodes of care. Our messaging was "start with Sherpaa first" so these were everyday primary care concerns. 80% of the 500k never needed to be seen in-person. That is real world data, not claims analysis.
🚨New Second Opinion🚨
I teamed up with
@seanduffy
to analyze how many of the 9k+ Category I CPT codes are "clinically feasible" for virtual care vs. brick & mortar. Spoiler alert: It's v. few.
So what should be the right balance going forward?
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“Consumers won’t pay for digital health” is too elementary. Instead:
“Consumers will pay for convenience when purchasing something they don’t expect their insurance to cover”
and
“Consumer’s won’t pay outside their insurance for services they expect their insurance to cover.”
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As a rule, the more consolidation in healthcare, the less likely for meaningful innovation. Incumbents preserve and grow shareholder value. They don’t meaningfully disrupt themselves. Healthcare must cost 50% less, not 4% more with wider profit margins.
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Still one of my favorite insights of my career— we should treat our patients’ health conditions as projects to be managed.
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When I think about designing a care model, I think People, Props (tech+physical), & Processes. The tech enables a superior process. And my primary “person” I design for is the care team. If you give the care team super powers, patients see magic.
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I met a physician founder yesterday who built an entirely online practice with 20 providers to $5m in AR, traditional FFS insurance, bootstrapped. I haven’t seen that before and I’m very encouraged by this.
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When you’re selling 10 minute buckets of time via video, and all of a sudden you get 100x the volume, you get a digital waiting room of over 12 hours then a missed call due to “unknown caller” and you gotta jump back in the queue again.
Asynchronous care solves this problem.
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If your doc said "the main way we talk is messaging + photos + phone and only in-person visits when needed," life would be so much easier.
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I met
@nikillinit
for dinner last week when he was in Denver. I tried to get him to come to the mountains but he “hates nature.” He also said my online persona (grumpy) is wildly different from my IRL (“gregarious”). Been IRL buds for years. I’m gonna be online gregarious now.
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Would those who don’t want to wear a mask be cool going into surgery with a surgeon who didn’t believe in masks?
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Public health depts say, for COVID-19 testing, “work with your healthcare provider.” This is so out of touch with reality:
50% of us say we don’t have a PCP
25% say we do, but don’t know their name.
And 25% have a real relationship.
What about the 75% w/o a relationship?
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Why is the trend in VC investing in Value Based Care tech when, 10+ years in, the vast majority of care is still fee-for-service w/o any signs that this will change? Magic doesn’t make things happen.
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