Decoding Healthcare Innovation

In this episode, Carrie, Rebecca, and Adam discuss: 

• Why digital health startups need to calculate ROI 
• What types of organizations to consider targeting as customers
• What range of ROI Adam sees digital health companies produce
• How to supercharge success by creating value pathways

Key Takeaways: 

• When you’re pitching to a CFO, they’re going to be looking for the answer to two questions: 1.) Are you going to bring my organization more revenue? 2.) Are you going to reduce the overall cost structure across my organization? You need to have a clear cut answer. CFO’s tend to be calculation-oriented people. 
• There are five types of organizations you can target as customers: 
  • Health plans
  • ACOs (Accountable Care Organizations)
  • Hospitals
  • Employer groups 
  • Self-insured employers
• The ranges of ROI for digital health companies can go as low as 2x to as high as 20x or 30x, depending on the estimates that are used. 
• Create value pathways. Think about how your digital health company is going to lead to potential overall additional revenue or additional savings for your clients. Write it out and add it into your demo. 

“Pricing is a bit of an art but I’m a believer that ROI should be driving what your pricing is.” - Adam Block

Connect with Adam Block: 

Website: https://www.charmeconomics.com/ 

LinkedIn: https://www.linkedin.com/in/adameblock/ 

Learn more from Carrie and Rebecca: 

Healthcare Insights (a monthly deep dive into specific topics for innovators): https://nixongwiltlaw.com/healthcare-insights

Telehealth/Virtual Care Mgmt Update (a biweekly LinkedIn newsletter tracking legal and policy changes across the nation): https://www.linkedin.com/newsletters/telehealth-virtual-care-update-6901900767960068096/ 

Website: https://nixongwiltlaw.com/ 

Carrie on LinkedIn: https://www.linkedin.com/in/carrienixon/ 

Rebecca on LinkedIn: https://www.linkedin.com/in/rebeccagwilt/

NGL on LinkedIn: https://www.linkedin.com/company/nixon-gwilt-law/ 

In this episode, Carrie and Rebecca discuss: 

• What a minimum viable revenue model is
• What 5 questions they ask every new revenue model client
• Why healthcare business rules are different from every other industry
• Why determining a revenue model must include designing a compliant business arrangement
• What happens when your revenue model is noncompliant 

Download the checklist here: https://bit.ly/3TxMKCN

Find the episode transcript at our website: https://nixongwiltlaw.com/dhi-podcast/ 

Key Takeaways: 

• The first question you must ask is, “what are you selling”? For example, a vendor of RPM is often selling software, devices, and clinical services in the form of management services. 
• Identifying who your customers are or what revenue streams you have available is a key step in figuring out what the available payment mechanisms are. You may have more options than you think.
• In healthcare, designing a compliant business arrangement is key to capturing revenue without getting yourself in trouble. Noncompliance is a revenue risk.
• Consider what documents you need to make the arrangement viable.There may be more than you think due to the complexity of the healthcare industry.

“If you’re using those non-compliant business arrangements to capture the revenue, that revenue down the road may be clawed back from you.” - Carrie Nixon

Learn more from Carrie and Rebecca: 

Healthcare Insights (a monthly deep dive into specific topics for innovators): https://nixongwiltlaw.com/healthcare-insights

Telehealth/Virtual Care Mgmt Update (a biweekly LinkedIn newsletter tracking legal and policy changes across the nation): https://www.linkedin.com/newsletters/telehealth-virtual-care-update-6901900767960068096/

Website: https://nixongwiltlaw.com/ 

Carrie on LinkedIn: https://www.linkedin.com/in/carrienixon/ 

Rebecca on LinkedIn: https://www.linkedin.com/in/rebeccagwilt/

NGL on LinkedIn: https://www.linkedin.com/company/nixon-gwilt-law/ 

In this episode discover: 

• How to apply experiences from other industries to healthcare
• Why you need to focus on customer experience in healthcare 
• How to navigate the challenges of working in the home health space
• What the advantages are of being missions oriented

Key Takeaways: 

• Being in varied and different roles or industries gives you the unique opportunity to provide your learnings from those roles and apply them to your current ones. Learn the industry as fast and as deeply as you can and inject your experiences.
• Other companies treat their customers as guests, but it’s different in healthcare. It’s time for companies to step up and make healthcare a more personalized, pleasant, and convenient experience. 
• There are certain challenges that come with a home-based healthcare service like Sprinter Health. Some of them are hiring qualified people, managing their time, and dealing with the challenges each city presents. 
• Being mission-oriented will help the company navigate through rapidly changing times and prevent people from being distracted by “shiny objects” that appear along the way. 

“Being mission-oriented, and always keeping your eye on what you're trying to achieve is super important. In this market where things are changing and innovation is happening, if you have that kind of North Star guiding your decisions, it is incredibly helpful to navigate…”- Seema Otoya

Resources: 

Connect with Seema on LinkedIn: https://www.linkedin.com/in/seemaotoya/ 

Company website: https://www.sprinterhealth.com/ 

Careers at Sprinter Health: https://jobs.lever.co/SprinterHealth 

Learn more about Care at Home on the Nixon Gwilt Law blog: https://nixongwiltlaw.com/care-at-home 

Learn more from Carrie and Rebecca: 

Healthcare Insights (a monthly deep dive into specific topics for innovators): https://nixongwiltlaw.com/healthcare-insights

Telehealth/Virtual Care Mgmt Update (a biweekly LinkedIn newsletter tracking legal and policy changes across the nation): https://www.linkedin.com/newsletters/telehealth-virtual-care-update-6901900767960068096/ 

Website: https://nixongwiltlaw.com/ 

Carrie on LinkedIn: https://www.linkedin.com/in/carrienixon/ 

Rebecca on LinkedIn: https://www.linkedin.com/in/rebeccagwilt/

NGL on LinkedIn: https://www.linkedin.com/company/nixon-gwilt-law/ 

In this episode, you will discover: 

• A simple definition of a value-based enterprise 
• Why are Value-Based Enterprise arrangements very well suited to digital health companies? 
• How Value-Based Enterprises reward teamwork between organizations

Key Takeaways: 

• A value-based enterprise or VBE, is essentially a regulatory construct that permits substantial freedom in how organizations can pay providers for services. That freedom is gained in exchange for adhering to certain requirements around the relationship between the parties and how providers participate in value-based care initiatives. 
• Digital health companies come from the tech world, and the tech world is all about subscription-based revenue. Payment based on a capitated model is one of the explicitly contemplated types of payment systems within the value base enterprise exception. Digital Health Companies have a leg up on other businesses because they're working within that capitated framework.
• The promise of value-based enterprises is that they really reward the organizations that are able to get together and work as a team. The government has recognized this and has built constructs that allow people to dip their toes in the water and explore to see how it works and maybe build something better. 

“I discovered a lot of things that I think make value-based enterprises very well suited to digital health companies. They have a leg up on other businesses because they work within that capitated framework. A lot of the benefits that come with being a tech-oriented business can carry over into that quality accountability type world.” - Luis Argueso

Resources: 

Website: https://www.inhealthadvisors.com/ 

LinkedIn: https://www.linkedin.com/company/inhealth-advisors/ 

Twitter: https://twitter.com/inhealthadvice 

Learn more from Carrie and Rebecca: 

Healthcare Insights (a monthly deep dive into specific topics for innovators): https://nixongwiltlaw.com/healthcare-insights

Telehealth/Virtual Care Mgmt Update (a biweekly LinkedIn newsletter tracking legal and policy changes across the nation): https://www.linkedin.com/newsletters/telehealth-virtual-care-update-6901900767960068096/ 

Website: https://nixongwiltlaw.com/ 

Carrie on LinkedIn: https://www.linkedin.com/in/carrienixon/ 

Rebecca on LinkedIn: https://www.linkedin.com/in/rebeccagwilt/

NGL on LinkedIn: https://www.linkedin.com/company/nixon-gwilt-law/ 

In this episode you will discover: 

• The food allergy and treatment landscape
• Protein design opening a new landscape of treatment possibilities
• Shifting from investing to the operational side of startups and navigating the world of biotech as a female CEO

Key Takeaways: 

• The treatment for food allergy is difficult because it requires a balancing act between efficacy and safety. This is because food proteins that are needed to train the body to reduce its allergic reactions are often also the cause of allergic reactions. 
• Through breakthroughs in protein design, Ukko has shown that it is possible to isolate the two parts of a protein and create a new one that can be used for more effective and safer immunotherapy, essentially removing the harmful part of the protein and keeping the part that trains your body to reduce its allergic reaction. 
• The best thing that VCs can do is to experience the operational side, it makes you a much better VC on so many levels. It shifts your empathy and your understanding of what the CEO is going through. If you make the move from VC to founder, you will have great tools that will also make you a better fundraiser. 

“I think that the best thing VCs can actually do is experience the operating side. There's something about understanding the roller coaster, the experience, the day to day of this person who just walked into your room - this is their blood, sweat and tears.” - Anat Binur

Resources: 

Website: https://www.ukko.us/ 

LinkedIn: https://www.linkedin.com/in/anatbinur/ 

Twitter: https://twitter.com/abinur 

Learn more from Carrie and Rebecca: 

Healthcare Insights (a monthly deep dive into specific topics for innovators): https://nixongwiltlaw.com/healthcare-insights

Telehealth/Virtual Care Mgmt Update (a biweekly LinkedIn newsletter tracking legal and policy changes across the nation): https://www.linkedin.com/newsletters/telehealth-virtual-care-update-6901900767960068096/ 

Website: https://nixongwiltlaw.com/ 

Carrie on LinkedIn: https://www.linkedin.com/in/carrienixon/ 

Rebecca on LinkedIn: https://www.linkedin.com/in/rebeccagwilt/

NGL on LinkedIn: https://www.linkedin.com/company/nixon-gwilt-law/ 

In this episode you will discover: 

• What is a patent? 
• How soon should you invest in patent protection? 
• What you need to know about design patents for digital companies
• What the advantages founders gain from talking to a patent attorney 

Key Takeaways: 

• A patent gives you the right to exclude others from making, using, selling, or importing your invention. It is a defensive measure to make sure that your work is protected. 
• Invest in patent protection for your idea before publicly disclosing it without a confidentiality agreement so that you won’t risk losing your rights. Once you disclose your invention publicly, you’ll have one year to file for a patent. 
• Creating an interesting graphical user interface for an app, for example, can be protected under design patents. That’s a way for companies to protect the user interface for some applications. 
• Anybody can file a provisional application with the PTO, but it’s still more advantageous to talk to a patent attorney since they will make sure that the claims are as broad as possible to cover all possible different iterations. 

“USPTO is a ‘first-to-file’ system. So it's not necessarily first to invent, it's whoever's in the door first.  So if they are about to disclose it at a trade show, or to prospective investors, then they want to make sure that their patent is in the office.” - Giordana Mahn


Resources: 

Fish & Richardson Attorneys Author IAM Article "Neglect Begets Opportunity in Femtech IP": https://www.fr.com/insights/thought-leadership/articles/fish-richardson-attorneys-author-iam-article-neglect-begets-opportunity-in-femtech-ip/ 

Protecting Your Femtech IP(Webinar): https://www.fr.com/insights/webinars/protecting-your-femtech-ip/ 

The Basics of Design Patents(Webinar):
https://www.fr.com/insights/webinars/the-basics-of-design-patents/ 

Successful Patent Strategies for Digital Health and Digital Therapeutics(Webinar): 
https://www.fr.com/insights/webinars/successful-patent-strategies-for-digital-health-and-digital-therapeutics/ 

Fish & Richardson: https://www.fr.com/ 
LinkedIn: https://www.linkedin.com/in/giordana-mahn-32832212/ 
Women Of Wearables: https://www.womenofwearables.com/ 


Learn more from Carrie and Rebecca: 

Healthcare Insights (a monthly deep dive into specific topics for innovators): https://nixongwiltlaw.com/healthcare-insights
Telehealth/Virtual Care Mgmt Update (a biweekly LinkedIn newsletter tracking legal and policy changes across the nation): https://www.linkedin.com/newsletters/telehealth-virtual-care-update-6901900767960068096/ 
Website: https://nixongwiltlaw.com/  


Carrie on LinkedIn: https://www.linkedin.com/in/carrienixon/ 
Rebecca on LinkedIn: https://www.linkedin.com/in/rebeccagwilt/
NGL on LinkedIn: https://www.linkedin.com/company/nixon-gwilt-law/  

In this episode, you will discover: 

• How interactive patient care will impact the future of healthcare 
• How vendors can be successful in the digital health space 
• What technologists and innovators should keep in mind 

Key Takeaways: 

• The pandemic accelerated the growth of the digitalization of healthcare. Healthcare providers need to look into leveraging technology that will reduce the burden of work for nurses and staff so that they could focus on what is important. 
• Missing information is a huge reason for stress both for patients and providers. Anything you could do to fill the gaps in information ensures a better overall experience for the patient and improves the outcome, possibly helping them recover more quickly. 
• It’s impossible to be good at everything, but there is always one thing that you’re great at. As a vendor, apply this mindset by focusing on one specialization that will make you preferable to a feature or functionality that might already be established. 
• People who are great at developing technology and creating solutions should never lose sight of the human element. Another thing to keep in mind is that new technology only works if it is ingrained in the culture and that there’s adoption of how it’s going to work in the organization. Lastly, keep it simple. 

“What's happening with digital technology is we are looking for the ability for us to create force multipliers that reduce the burden of work for nurses and clinical staff that allow them to focus on what's really important, and that's taking care of patients’ medical clinical needs.” - Dave Bennett

Resources: 

Website: https://pcare.com/ 

Dave Bennett on LinkedIn: https://www.linkedin.com/in/staywellbennett/ 

Learn more from Carrie and Rebecca: 

Healthcare Insights (a monthly deep dive into specific topics for innovators): https://nixongwiltlaw.com/healthcare-insights

Telehealth/Virtual Care Mgmt Update (a biweekly LinkedIn newsletter tracking legal and policy changes across the nation): https://www.linkedin.com/newsletters/telehealth-virtual-care-update-6901900767960068096/ 

Website: https://nixongwiltlaw.com/ 

Carrie on LinkedIn: https://www.linkedin.com/in/carrienixon/ 

Rebecca on LinkedIn: https://www.linkedin.com/in/rebeccagwilt/

NGL on LinkedIn: https://www.linkedin.com/company/nixon-gwilt-law/ 

In this episode, you will discover: 

• Why price transparency is important
• How to understand the impact between a $0 option and a $250 option in the moment of decision
• How data transparency impacts patient access and health equity 

Key Takeaways: 

• Moving to a more consumer-directed and consumer-focused model means focusing on creating more transparency on the area of pricing. By bringing this information upstream, we will be able to build trust between the patient and the provider. 
• The difference between a $250 drug and a $0 drug can be meaningful to a lot of people. Providing this option isn’t impossible, it’s only a matter of getting the right answer to the right decision-maker when those things are happening. 
• Consumer-driven healthcare is the most important health equity issue to solve. Half of America can’t incur $1,000 of unexpected expenses without financial ruin. Providing information to the right people can go a long way in contributing to the solution. 

“Things that we can automate, we should automate.” - Kyle Kiser

Resources: 

Website:  https://arrivehealth.com/ 

LinkedIn: https://www.linkedin.com/in/kyle-kiser-68ba218/ 

Learn more from Carrie and Rebecca: 

Healthcare Insights (a monthly deep dive into specific topics for innovators): https://nixongwiltlaw.com/healthcare-insights

Telehealth/Virtual Care Mgmt Update (a biweekly LinkedIn newsletter tracking legal and policy changes across the nation): https://www.linkedin.com/newsletters/telehealth-virtual-care-update-6901900767960068096/ 

Website: https://nixongwiltlaw.com/ 

Carrie on LinkedIn: https://www.linkedin.com/in/carrienixon/ 

Rebecca on LinkedIn: https://www.linkedin.com/in/rebeccagwilt/

NGL on LinkedIn: https://www.linkedin.com/company/nixon-gwilt-law/ 

In this episode, you will discover: 
How continuous touch can help patients’ health improve continuously 
What the similarities and differences are between the EU and the US in the healthcare space 
Why healthcare companies should focus on preventive healthcare 
What Petter recommends for EU companies that plan to expand to the US

Key Takeaways: 
Remote therapeutic monitoring codes came about with the belief that continuous touch with a patient during the course of their needs for exercise and therapy is going to help them progress instead of backsliding. This part of the process needs to be reimbursed to make sure that it is continually done and that the patient’s well-being continuously improves. 
The US and EU face similar challenges. Both markets don’t have a strong focus on preventive healthcare, focusing more on improving reactive measures. One difference is that the EU is very good at building innovation but is not good at supporting companies’ transition to adaptation which is why many EU companies migrate or expand to the US.
Both the US and the EU market have a lot of incentive to focus on prevention: an aging population leading to a high prevalence of chronic diseases, rapidly increasing healthcare costs, and how diet, sleep, alcohol, and tobacco usage account for 90% of the total health determinants. 
Find the right regulatory and compliance partners because that is the hardest thing for a startup coming overseas to navigate through. Massive amounts of time, energy, and money can be saved by partnering with experts. 


“We're focusing on providing the best possible care for the patients while also solving a big problem for the providers, which has been that they don't have the right tools, energy, or the time to focus on prevention. They're stuck focusing on reactive treatments, which are fine, but it's not where the future is at.” - Petter Aasa


Resources: 

Website: https://www.vitala.health/en/home 
LinkedIn: https://www.linkedin.com/in/petter-aasa-103245a9/ 



Learn more from Carrie and Rebecca: 

How NGL helps International Companies Enter the US Healthcare Market: https://nixongwiltlaw.com/international
Case Study: https://nixongwiltlaw.com/case-study-antidote-health
How NGL Helps DTx Companies Find a Path to Commercialization: https://nixongwiltlaw.com/digital-therapeutics 
Healthcare Insights (a monthly deep dive into specific topics for innovators): https://nixongwiltlaw.com/healthcare-insights
Telehealth/Virtual Care Mgmt Update (a biweekly LinkedIn newsletter tracking legal and policy changes across the nation): https://www.linkedin.com/newsletters/telehealth-virtual-care-update-6901900767960068096/ 
Website: https://nixongwiltlaw.com/  
Carrie on LinkedIn: https://www.linkedin.com/in/carrienixon/ 
Rebecca on LinkedIn: https://www.linkedin.com/in/rebeccagwilt/
NGL on LinkedIn: https://www.linkedin.com/company/nixon-gwilt-law/  

In this episode you will discover: 

• What’s driving healthcare’s shift toward globalization 
• How companies can learn from the world around them
• What big thing international healthcare companies are grappling with 
• Why it is crucial to demonstrate ROI 

Key Takeaways: 

• There’s a shift in healthcare innovation towards globalization. This can be seen from the changing requirements in Europe and how UK companies consider engaging a bigger market. 
• Healthcare companies have to keep an eye on what they can learn from what’s already been built around the world in order for them to provide faster, easier, and generally better care for patients. 
• Reimbursement is the biggest thing that they don’t understand. They know they don’t understand it and they don’t know where to start. That’s why a lot of them are looking for support in order to get better insight into how they will get paid. 
• Provide a value proposition or an ROI presentation that the customer is going to care about. View everything that you do through the lens of a provider. Focus on solutions that already have clinical data and develop more clinical data based on an ROI that’s going to drive adoption. 

“If there's not a pathway to demonstrating an ROI that a system cares about, then it's not worth spending time or energy to do it in this market. Keep growing where you are and come back when the timing is different, or when you have more data to show this particular ROI, because that's what the customers are going to care about.” - Emily Reiser

Resources: 

Website: https://www.tmc.edu/ 

LinkedIn: https://www.linkedin.com/in/emilyreiser/ 

More on the ROI of Digital Health in Episode 36: https://nixongwiltlaw.com/dhi-podcast/2022/10/2/understanding-digital-healths-roi-with-adam-block

Learn more from Carrie and Rebecca: 

Healthcare Insights (a monthly deep dive into specific topics for innovators): https://nixongwiltlaw.com/healthcare-insights

Telehealth/Virtual Care Mgmt Update (a biweekly LinkedIn newsletter tracking legal and policy changes across the nation): https://www.linkedin.com/newsletters/telehealth-virtual-care-update-6901900767960068096/ 

Website: https://nixongwiltlaw.com/ 

Carrie on LinkedIn: https://www.linkedin.com/in/carrienixon/ 

Rebecca on LinkedIn: https://www.linkedin.com/in/rebeccagwilt/

NGL on LinkedIn: https://www.linkedin.com/company/nixon-gwilt-law/