One of Google's top doctors explains how its coronavirus response is feeding into its long-term plans to reinvent how people get health information
We spoke with Karen DeSalvo, Google's chief health officer, who's in charge of a clinical team at Google making products for clinicians and consumers. She said many of Google Health's coronavirus projects, like tracking and answering people's health-related questions, are part of broader strategy around users' "discover to action pathway." Google wants to aid people's health-related searches, in other words, whether it's answering a simple question about symptoms or booking a telehealth appointment. Visit Business Insider's homepage for more stories.
It's been 20 months since Google's health efforts got revamped, and nearly a quarter of that time has been spent amid a pandemic. The team started when Dr. David Feinberg, the former CEO of Geisinger Health, joined Google in January 2019. From there, Feinberg as the head of Google Health brought together scientists, engineers, and managers from across Google in an effort to get many of the trillion-dollar company's healthcare projects under the same roof. When the coronavirus pandemic started rolling across the US in March, the young team had to speed up projects that were only ideas — all while steering real people towards testing sites, hospitals, online appointments, and whatever else they came to Google for. In the months since, Google Health's projects are taking on a theme that's baked into the team's broader healthcare strategy, Dr. Karen DeSalvo, Google's chief health officer, told Business Insider. Whether it's through YouTube, Maps, Google Assistant, or simply Google.com, the tech giant wants to guide consumers on their healthcare experience wherever and whenever they come into contact with the company. For those that ask Google for local testing sites, in other words, the goal is to actually get them to one. For those looking for doctors, the goal is to set up an appointment. Internally, the team calls it the "discover to action pathway," DeSalvo said. Read more: We found the 18 leaders at Google who are deciding the future of the tech giant's healthcare business "We want to make sure we're thinking about the kinds of questions people are coming to us with, and how we can help them navigate that experience," she said. It's a key part of Alphabet's overall goal as well. During Alphabet's earnings in July, CEO Sundar Pichai told investors there's been an enormous effort across search and product teams to provide locally relevant information about coronavirus in more than 70 languages in 200 countries. "I'm looking at different types of user journeys and making sure each of them is getting deeper and better," Pichai said on the call. "So for example in Google, as people have started coming for more health-related information, how is that experience working?" Read more: 11 tech chiefs, analysts, and bankers in healthcare reveal how Amazon, Microsoft, and Google have used the coronavirus to make new inroads in the $3.6 trillion industry
Google is flagging relevant health information based on your search terms DeSalvo said Google is well aware of its responsibility to uplift information that's credible, especially amid a pandemic. Her job is to lead a clinical team at Google Health tasked with making products for clinicians and consumers, she said. As one of Google's top doctors, DeSalvo also advises the rest of the company about health and coronavirus on a case by case basis. Prior to Google, she was New Orleans' health commissioner after Hurricane Katrina and helped the US Department of Health and Human Services respond to Zika and Ebola outbreaks. "My experiences in public health, and in science and in medicine, are that it's really hard to get the right information to people," she said. In response to people asking questions about COVID-19, the disease caused by the novel coronavirus, Google Health designed a self-assessment for coronavirus with health agencies around the world. It's triggered by certain search terms, and the results give people an idea of whether they should see a doctor or get tested.
It rolled out a similar screener for mental health in May, as Americans struggled to grapple with their new realities. Thoughts of suicide nearly doubled compared to the year before, and anxiety and depression increased more than fourfold in the last year. Prompted by soaring demand for telehealth, Google's health unit also sped up development for a "virtual care feature" that launched in April. If medical professionals are able to do phone or video visits, Google can now say so in a little blurb reading "Get online care" in their normal search results on Google.com and maps. It links to sites like Mount Sinai's telehealth services in New York, which has options for doctors' appointments. A second aspect of the feature displays names of telehealth companies with links and price information when people search for things like "immediate care" in Search and Maps. That's not available everywhere in the US yet.
Other search upgrades show people active testing sites, credible health information on YouTube, and how to find guidance from their local health department, DeSalvo said. "We're trying to get the world's health information available for consumers where it matters," including for depression, anxiety, diabetes, and coronavirus, she said. Google's work helping people navigate their healthcare is still in its early days DeSalvo cautioned that Google Health's consumer-facing work is still early. For now, the group's machine learning is much farther along, with some devices already being used to make medical diagnoses faster and more accurate. Another huge coronavirus project has been Google's contract-tracing program with Apple, which isn't related to user searches. Four US states and 16 countries or regions are using it to tell people if they've likely been exposed to coronavirus, according to the company. Ultimately, however, some industry leaders think Google could become a kind of Expedia for doctors' visits, per Business Insider's interviews. One of Google Health's oldest projects helps doctors search medical records, and obviously the tech giant's long history started with a humble search engine. Read more: The man who helps hospitals and clinics move to Google's cloud shares how the coronavirus pandemic is shaping its healthcare push The larger company has asked Google Health specifically to think through how it can improve the world's health, which involves direct work with consumers — not just the providers who care for them, DeSalvo said. "If we're going to really make a difference in the lives of people's health, we have to do that by addressing not only tools and support for carers, but we have to do that as much as we can directly to consumers and other parts of the system," DeSalvo said.Join the conversation about this story » NOW WATCH: Why Pikes Peak is the most dangerous racetrack in America
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Microsoft's healthcare strategy is all about the cloud. 2 executives lay out how it's taking on Google and Amazon as tech giants push deeper into the $3.6 trillion healthcare industry.
Summary List Placement Microsoft's healthcare strategy is all about Azure, a web-based service and money-making machine....Summary List Placement Microsoft's healthcare strategy is all about Azure, a web-based service and money-making machine. Microsoft uses Azure to build, store, and manage companies' data, sites, and mobile apps. As of June, the tech giant made more than $50 billion from Azure and other internet businesses like Office 365 and LinkedIn year-over-year, the company said during earnings. Long-term, the tech giant has the potential to make $140 billion in revenue from Azure alone, according to 2019 estimates by Bernstein. The total addressable market for infrastructure and platform services, Azure's bread and butter, is between $900 billion and $1.2 trillion, the report said. Microsoft doesn't break out how much money it makes from selling the cloud to healthcare companies. But it's been going after the healthcare industry for the better part of 25 years, and it's increasingly using Azure to do so. Its latest endeavor is Microsoft Cloud for Healthcare, a package that combines Teams and other web-based tools for health systems and doctors. The package is available for purchase on October 30. Other industries will soon get their own cloud kits, Tom McGuinness, a vice president at Microsoft Healthcare, said. "Satya and the entire leadership team are looking for ways that we can contribute to the pandemic response," he told Business Insider, referring to Microsoft CEO Satya Nadella. In several respects, the US healthcare system wasn't ready to handle, and still hasn't solved, a series of emergencies caused by the coronavirus outbreaks, starting with shortages in protective equipment for healthcare workers. Big tech firms helped fill in the gaps and started investing heavily in technology propelled by remote care. Google just poured $100 million into Amwell, the world's second largest telehealth company. Amazon is betting big on wearables with its new Halo device, and Apple's new watch has health components that could aid more clinical research. Microsoft for its part is trying to own the underlying infrastructure of the way hospitals do business. With virtual care taking off, Microsoft said a big part of its healthcare strategy lies in using Azure to tackle some of the industry's biggest problems, like clinician burnout and disconnected medical records. Meanwhile its reputation on security, privacy, and transparency makes it a good partner for the transition, David Rhew, Microsoft Healthcare's chief medical officer, said. "We're extremely transparent in terms of our desire to not monetize data," Rhew said. Microsoft connected Teams with health systems' electronic health records Already, healthcare providers are turning to Microsoft Teams for virtual visits. In July alone, doctors and other people in healthcare conducted 46 million meetings with Teams, Nadella said during an earnings call. They use the Zoom-like app for virtual visits with patients and, soon, administrative tasks. For the new cloud package, Microsoft engineers got Teams to connect with Epic's electronic health records and a transcription tool ("DAX") made by Nuance Communications. That means that while physicians do online appointments, they can see patients' full histories and talk to them without worrying about taking notes, McGuinness said. "We've all been in an exam room, physically where our poor physicians are typing the conversation as quickly into the EMR as possible," he said. "And that's tough on the patient. It's tough on the physician." After the visit, doctors can approve the clinical note generated by DAX. Then it's put directly into the patient's medical record. Rhew thinks the impact of the tool could be dramatic. Early adopters of DAX have seen 50% to 75% reductions in time for clinicians to document in the EHR, plus an increase of 88% of physician satisfaction in terms of documentation, Rhew said, citing internal research. "For me as a clinician, I can tell you there's been a significant amount of burnout among my peers and what drives a lot of that burnout is documentation into the electronic health record," he said. Finding new ways to use tech in the hospital Microsoft's virtual strategy isn't just about video appointments. Over the course of the pandemic, the tech giant made a lot of traditional care, like booking sick patients, more remote. But CIOs like Providence St. Joseph Health's B.J. Moore and UPMC's Ed McCallister said that such technologies adopted during the emergency will continue to power their strategies. Microsoft repurposed its AI-driven chat bots to work for coronavirus, for example, which health systems used to triage potential patients. To date, they've delivered 500 million messages in more than 26 countries, Rhew said. That tech is powered by Azure, along with text notifications, reminders, and links to join appointments — all newly available through the cloud offering. "It's much easier for a patient to be part of one health care system and then have a virtual visit with a second consult somewhere else," McGuiness said. "And I think more so than even in the past, that raises the bar for data fluidity." Microsoft is connecting disparate devices and systems It all comes down to Microsoft's intense underlying technology, which uses codes called APIs designed with standards called FHIR to get computers talking to each other. Insiders call that communication "interoperability," and it's a big part of why healthcare CIOs are starting to favor Microsoft over the other big cloud providers, one tech chief told Business Insider in July: its healthcare services all work together. Compare that to Amazon Web Services, which is cheaper, but requires more programming. While the 21st Century Cures Act and recent rules passed by the Centers for Medicare and Medicaid drive health systems to adopt better data function, Microsoft is positioning itself as their go-to partner for the new plumbing. "Interoperability is like a building block. It's a critical building block that allows us to be able to exchange important information between different systems of record and allow us to be able to view and act on it real time," Rhew said. Join the conversation about this story » NOW WATCH: Why babies can't eat honey
American Well is looking to raise $488.5 million as it goes public. We pored over the 196-page filing to find 5 crucial details about the telehealth giant's plans to change how you get healthcare.
Summary List Placement American Well, a telehealth giant and rival to Teladoc, filed to go public...Summary List Placement American Well, a telehealth giant and rival to Teladoc, filed to go public on August 24. On Tuesday, the company said it's setting its public offering price between $14 and $16 per share. That values Amwell at $3.3 billion based on outstanding shares. As part of the IPO, Google's cloud division is investing $100 million. We read the 196-page filing and spoke with Google Cloud's head of healthcare sales to find 5 critical details about the companies' plans. Visit Business Insider's homepage for more stories. Telehealth company American Well on August 24 filed to go public in what's become a huge year for companies that deliver healthcare over the internet. Amwell said in a Tuesday update to its filing that it's looking to set its public offering price between $14 and $16. At the midpoint of that range, they're looking to raise $488.5 million, according to the company, which values Amwell at $3.3 billion, based on Amwell's outstanding shares. Lockdowns in the wake of the coronavirus pandemic have made Amwell's services newly relevant to people who need mental healthcare, physical therapy, prescriptions, and a whole host of other medical needs from the safety of their homes. It comes on the heels of rival Teladoc making an $18.5 billion bid for Livongo, a chronic care company, the biggest deal that digital health has ever seen. It's sending ripple effects through a market that insiders are saying is ripe for more huge deals and initial public offerings. As part of Amwell's IPO, Google is making a $100 million investment in Amwell at the IPO price. Through the arrangement, Google's cloud business will host Amwell's technology and partner with the company in all-things-healthcare. It's not typical for Google Cloud to make investments of this nature, according to the company. But Chris Sakalosky, its head of healthcare sales, said telehealth's rapid growth during the pandemic set off a "light bulb moment" that has Google reimagining its work in the $3.6 trillion healthcare industry. The two companies have plans to make the disconnected healthcare industry more connected through devices in people's homes, data analytics, and machine learning to lighten doctors' adminsitrative loads, he told Business Insider. They're also going to market each other's services to their respective client bases. Founded in 2006, the Boston-based Amwell works with 55 health plans, which support 36,000 employers and include more than 80 million people, as well as 150 of the nation's largest health systems. It's paid primarily through subscription fees and set-up costs when providers and health systems pay to use Amwell's technology to run their own virtual shops. Amwell also conducts separate doctors visits through its giant medical group, wherein patients pay for online visits in primary care, mental health, and other areas. Amwell's S-1 filing provides a detailed look at its financials, risks, and vision for the future. Here are five takeaways from the filing. Read more: Telemedicine startups have raised hundreds of millions as the coronavirus puts them to the test. Meet the 12 startups forging a new path for healthcare. Amwell is riding a coronavirus wave that won't last forever With the recent surge in telehealth visits around the globe, many are wondering how long it can last after doctors' offices reopen and lockdowns ease. Amwell conducted a record 912,000 medical visits in April, with daily visits increasing 1,279% since the same time last year, the filing said. But monthly visit volume has already dropped since then, hitting 540,000 in June, though that number was still a 592.3% increase year to date. When Teladoc reported earnings last month, CEO Jason Gorevic told Business Insider that volume growth stabilized in late May at roughly 40% higher than it was before outbreaks, even in states where coronavirus is relatively under control. Amwell didn't provide estimates like that in the filing, but said it's expecting a similar trend. Prior to coronavirus, Amwell's revenue was increasing steadily — from $113.9 million in 2018 to $148.9 million in 2019. Amwell's revenue for the first six months of 2020 was $122.3 million, up from $69 million over the same period in 2019. Amwell's losses deepened in the first half of 2020 to $113.4 million, compared to $41.6 million in the second half of 2019. "While the COVID-19 crisis is a unique event, we believe that utilization of the Amwell Platform will remain at higher levels after the crisis versus levels previously forecasted before the crisis," the S-1 said. Read more: 6 reasons why the telehealth boom is here to stay, according to the CEO of $16 billion Teladoc Amwell's customers are conducting significantly more visits in 2020 In February of 2020, right before the pandemic hit the US, the majority of Amwell's visits —roughly 57% — were run by Amwell's medical group, a huge network of contracted doctors that can see patients directly over the site or take them from hospitals that are too busy to use their own staff, according to the S-1. Now, visits run by the medical group have dropped off to roughly 22% in June, and the vast majority of total active providers don't work for Amwell, but rather the health systems or health plans that Amwell contracts with. It's a significant transition in the company's core business towards partnering with providers to build their own telehealth solutions, rather than essentially taking away appointments and the reimbursement that accompanies them. It's opening up the doors to a $12.4 billion business among health plans and providers, per Amwell's estimates. Institutional customers also pay subscription fees to use Amwell's tech, creating a steady revenue stream that's less dependent on temporary circumstances like coronavirus. But large clients are a longer and more complicated play than routine, independent visits, in some ways. Amwell said that most of its revenue comes from customers, such as hospitals, that purchase access to the telehealth platform. Those contracts are typically three-year deals and require a lot of upfront investment on Amwell's part, the filing said. So the company needs its providers to stay customers for a while in order to win back its initial costs. Read more: 10 healthcare startups that could be M&A targets after Teladoc's record-breaking $18.5 billion deal for Livongo More than 20% of Amwell's business comes from Anthem Amwell derives a lot of its business from a small group of clients, the S-1 said. Its largest, Anthem, accounted for 22% of its revenue in the first half of 2020. In 2018 and 2019, its 10 biggest customers by revenue accounted for 48% and 44% of Amwell's total, respectively. That means there's a big risk to Amwell's business if they lose any number of top buyers, particularly Anthem. Google Cloud Sakalowsky told Business Insider it intends to market their services to current cloud customers, and new ones in pitches. Notably, Amwell's business from health systems accounts for a smaller chunk of its revenue, despite working with 150 health systems that represent 2,000 hospitals. In the first half of 2020, subscription fees from health systems clients accounted for 19.3% of Amwell's total revenue, down from first half of 2019, when health systems accounted for 25% of the company's total revenue. Regulatory risks remain Amid the pandemic, regulators did away with a lot of rules that telehealth providers normally had to follow and increased their reimbursement from Medicare and Medicaid. While people in Washington seem on board with telehealth, these temporary measures still aren't written into law, Amwell said in its S-1. "Although the COVID-19 pandemic has led to the relaxation of certain regulatory and reimbursement barriers, it is uncertain how long the relaxed policies will remain in effect," the S-1 said. "And there can be no guarantee that once the COVID-19 pandemic is over that such restrictions will not be reinstated or changed in a way that adversely affects our business," it said. The silver lining for Amwell in the event that regulations are reinstated is that its HIPAA-compliant and its medical group doesn't perform Medicare consultations, according to the document. That means a return to the status quo could technically benefit Amwell insofar as less secure telehealth platforms are edged out of the marketplace, sending more customers to Amwell, it said. Amwell is working with Google to go beyond video visits Google and Amwell's partnership extends beyond a normal cloud contract. Amwell is pushing into home care through some of its hardware, like TV Carepoint, that allows patients to access healthcare at home or in their hospital rooms. The company is also investing in remote patient monitoring, advanced analytics, lab services, drug delivery, and various applications of machine learning, the S-1 said. Part of the idea is that Amwell has to make more technologies if it wants to stay ahead of the curve in telehealth, a market where rapid change and "short product lifecycles" can make services irrelevant almost instantaneously, Amwell said in the document. That's where Google comes in. Working with patients in their homes opens up doors to increase access to care as well as the types of care that providers can deliver, like managing chronic conditions. Google's tech, like Healthcare API, can connect devices and data together to accomplish things like this. "To meet patients in their homes, to meet patients when they're remote and to work across that fusion of the digital and the physical, we think that's the area where bringing our technologies together will come to the forefront quite quickly," Google Cloud's Sakalosky said.Join the conversation about this story » NOW WATCH: What it takes to become a backup dancer for Beyoncé
THE RISE OF GENETIC TESTING IN HEALTHCARE: How leading genetic testing companies like Ancestry and 23andMe are carving into healthcare with the promise to fuel more personalized care
Insider Intelligence publishes thousands of research reports, charts, and forecasts on the Digital Health industry. You...Insider Intelligence publishes thousands of research reports, charts, and forecasts on the Digital Health industry. You can learn more about becoming a client here. The following is a preview of one Digital Health report, The Genetic Testing in Healthcare Report. You can purchase this report here. Since the first human genome was sequenced in 2003, the genetic testing market has evolved rapidly alongside consumers' interest in how their genetic makeup affects their health. The human genome was sequenced — or read in its entirety — for the first time in 2003 after more than 20 years of work and nearly $5 billion was put into the National Institutes of Health's (NIH's) Human Genome Project — which marked a huge step in helping scientists and medical researchers understand how genes and gene interactions impact disease development and progression. In the ensuing decades, genetic information catapulted into mainstream healthcare, driven largely by the rapid decline in cost for DNA sequencing technology.DNA testing firms like Ancestry and 23andMe broke onto the genetic testing scene via direct-to-consumer (DTC) tests, and consumers have flocked to their products seeking to gain insights into their individual health risks. Ancestry and 23andMe both offer cheaper, but less comprehensive, DNA testing — their products come at a price point between $100-$200, which is likely more enticing to average consumers than higher-cost tests that explore the entire, or a larger portion of, the genome. Of the 26 million global consumers who took a DNA test in 2019, Ancestry and 23andMe tested 25 million. This marks a meteoric rise in consumer adoption over the course of the 2010s: In 2015, for example, fewer than 1.5 million global consumers had taken at-home genetic tests. The ability to provide genetic tests at a lower cost has opened up new opportunities in preventative medicine. For example, chronic illness accounts for 90% of the US' more than $3.7 trillion of annual healthcare spending — and healthcare stakeholders are actively looking for ways to assess population health risks and intervene earlier. Genetic testing is an attractive proposition for healthcare players that want to paint a picture of an individual patient's health risks — and use that information to help guide care plans that could mitigate the development or progression of a condition and steer drug development for more precise medications. In this report, Insider Intelligence will examine the industry forces that have helped evolve genomic information from a consumer novelty to a transformative healthcare technology. We outline how some of the key players in the genetic testing space have altered their business models to appeal not only to consumers but also healthcare players across the industry, including health systems and pharma companies. We provide a glimpse at what's next for the implementation of genomic information — namely, the barriers that are holding genetic testing companies back from reaching new customers, including how the coronavirus pandemic could impact growth in the space. The companies mentioned in this report are: 23andMe, Almirall, Ancestry, Apple, Calico, Color, Diploid, Genelex, GlaxoSmithKline, Google, Helix, Illumina, Invitae, Jungla, LunaPBC, Mayo Clinic, Microsoft, MyHeritage, NorthShore University Hospital , Novartis, Ochsner Health, Pfizer, PWNHealth, Salesforce, Stanford Medicine, TrialSpark, Verily, Veritas, and YouScript. Here are some key takeaways from this report: The use of at-home, direct-to-consumer genetic tests skyrocketed during the 2010s, but has been tapering off over the last couple of years. The slowdown in the DTC market has catalyzed genetic testing companies to veer into healthcare — teaming up to give legacy healthcare players access to rich sets of data that could guide care and treatments, which could help boost customer bases. Health systems can add genetic testing into care regimens to gain a more comprehensive image of patients' health risks. Payers can front the costs of tests for their members, the results of which could empower them to take proactive approach to care management and reduce costs in the long-run; and drug-makers can unlock troves of genetic data in order to design more precise medications. Myriad barriers are still holding back genetic testing companies from cementing their position in the healthcare industry, including privacy and accuracy concerns, the inability of healthcare professionals to operationalize genetic data, and a continued drop in consumer interest. The coronavirus pandemic and accompanied economic slowdown could weigh on genetic testing companies further, as consumers will likely put off nonessential purchases like genetic tests, and healthcare companies may focus resources and time on initiatives more directly related to the virus and recouping lost revenue. In full, the report: Provides an overview of the ways in which prominent US genetic testing companies are using their products to edge deeper into the healthcare landscape. Highlights how leading telehealth vendors have reacted to a sudden, rapid uptick in adoption of their services. Outlines how legacy healthcare players — including health systems, payers, and drug-makers — are leveraging genetic testing companies' products to make use of insights into genetic variants. Identifies the barriers that genetic companies are staring down that could hinder growth and adoption. Interested in getting the full report? Here's how you can gain access: Join other Insider Intelligence clients who receive this report, along with thousands of other Digital Health forecasts, briefings, charts, and research reports to their inboxes. >> Become a Client Purchase the individual report from our store. >> Buy The Report Here Are you a current Insider Intelligence client? Log in and read the report here.Join the conversation about this story »