Monthly Archives: July 2015

Corridors

This idea of corridors has occurred to me over the last few months. I know of no references for the way of thinking that I will try to describe here. I am sure these references exist, but I do not know where they are.

Applications of Corridors
Corridors have application in law, and its sister concept of regulation; in design, and its subset applications of architecture, landscape architecture, interior design, and fine arts, such as drama, art, music, and dance; in policy, and its subset applications of corporate policy, or global, national, regional, and local policy (bodies of legislation and accompanying case law and precedent is a broad variant on this idea); in education, when schools ask students to specify a major, to join a department, or to specialize in a field; and in careers, when individuals define their own professional corridors, e.g. in engineering, software design, medicine, law, business, etc.

The Core Idea of Corridors
The core idea is this: productivity is a function of well-designed corridors. Design a corridor that is too narrow, and productivity is stifled. Design a corridor too wide, and productivity suffers from too many permutations and combinations of possibilities.

If any given project is vague, then the progress of the project managers is limited as they attempt to find a path forward that makes sense. Once found, a clear path forward leads to progress in leaps and bounds. If the path forward is not found, among a myriad of possibilities, then project teams flounder and are frustrated.

Corridors in Law
A law is a corridor hammered out by the legislative body. Designed well, a law specifies the corridor by which activity is “legal”. And conversely, a law specifies which activity is “illegal”. Along with the idea of illegal comes the the sanctions applied to those unfortunate enough to be caught doing something illegal.

Corridors in Regulation: the Sister Concept to Corridors in Law
A regulation reflects the desire of a law-making body to avoid making the law itself too narrow (where the language of the law effectively gets into counter-productive micro-management). It reflects the delegation of authority from the law-making body to an agency. The agency is charged with coming up with “regulations’ that define the tactics of the law. Done well, regulations always remain within the corridors outlined in the law. They reflect the intention of the law, and are an executional element of the law. Done poorly, regulation stray beyond the corridors outlined in the law, and can serve to confuse the public and frustrate the law-makers.

An example of Corridors in Law and Regulation: Social Security
FDR is known for making Social Security the law of the land. The US Congress, in adopting Social Security, effectively defined a corridor for aging in the US. From its adoption forward, older citizens who qualify for Social Security are entitled to a “safety net” of income. Because Congress recognized that this entitlement would require dynamic adjustment over time, it authorized the Social Security Administration to publish regulations that would tactically implement, and to adjust over time, the intentions of the law.

Corridors in Design
Creatives focus. The really great ones define corridors for their work. The corridors are broad enough to be highly motivating to the creative – who yearns for freedom of thought and expression. At the same time, they are narrow enough to allow the creative to be highly productive, by applying and reapplying their creative concepts within a relatively narrow scope.

An example of Corridors in Design: Steve Jobs and Apple
An example is Steve Jobs and Apple – a brilliant example of choosing a corridor for creativity and productivity. Apple defined the personal computer as their corridor – with stunning success. As they achieved preeminence in this field, Apple was able to see a larger corridor, which the world now sees as the ipod, iPad, iPhone, and – now – the iWatch. Are these new consumer appliances different than a “personal computer” – the corridor of the original vision? I would argue that they are not different: they are applications of the personal computer corridor, brilliantly subsuming appliances from other corridors into the corridor of personal computing.

Corridors in Policy
I mentioned that policy is an area where the notion of properly chosen, well-defined corridors can lead to high productivity. Corporate, Global, National, Regional, and Local Policy-Makers must constantly struggle to define corridors within which citizens and institutions within their sphere of influence must operate.

Urban Policy as an Example of Corridors in Policy
Take urban policy as an example. Urban design policies found in comprehensive plans and zoning ordinances. These plans and regulations reflect policies about where a given city wants to grow. How much growth should be in industrial, commercial, and residential ? Where are the geographies slated for each? Where does mixed-use fit? What procedures allow for changes over time?

Corridors in Education
Education is probably the most classical application of the example of a “corridor”. It is impossible to know everything. So educators attempt to guide students in narrowing their field of study. An undergraduate education might well define “liberal arts” or “engineering” as a corridor of study. A graduate program might define “public administration” or “mechanical engineering” as a corridor. Unfortunately, however, there are far too many examples of students getting lost in a corridor as large as “liberal arts”. Out of frustration parents and students alike may well force a narrower corridor. Chosen well, such a narrower corridor, e.g. history, can focus the mind and increase productivity and creativity. At the same time, there are far too many examples of those who define an educational corridor that is too narrow, e.g. automotive mechanics.

Example of Corridors in Education
90%+ of US students follow a corridor path that is well-known. They might, for example, take liberal arts as an undergraduate, and major in a science, social science, language, or fine arts. But US students may well have the sites set on graduate school, and so they stay very broad in undergraduate courses so they do not limit their choices in graduate school. A law or medicine graduate student does well to stay broad in undergraduate classes. The medicine corridor in graduate school would naturally expect more science course. The law corridor in graduate school would be inclined to expect high proficiency in writing and communication and analysis as an undergraduate.

Corridors in Careers
What is my career path? Virtually everyone struggles with this question. It is a corridor question and brings with it the same perils of other corridor choices. Choose a corridor that is too narrow, e.g. cost accounting, and the person runs a real risk that opportunities will rapidly fall outside the chosen corridor. The result will be career confusion, as job choices can be endless, and dead-end job choices are everywhere. At the same time, choose a career corridor that is too broad, e.g. systems design, and the person runs a real risk that no employers trusts that the applicant is qualified for a specific job that is available.

Example of Corridors in Careers
Sales is a reasonably common example of a career corridor filled with endless possibilities, and yet it is very specific in the eyes of an employer. “Show me proof that you can sell”, they might say. And with that proof, they may well not care if they have proof that the person can sell a specific widget or software or product or service.

Neuroscience of Walking in Nature

NYT reports on Stanford studies about the “Subgenual” Prefrontal Cortex activity associated with “brooding” and mitigating brooding via walking in nature:

NYT on How Nature Changes the Brain

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Then the scientists randomly assigned half of the volunteers to walk for 90 minutes through a leafy, quiet, parklike portion of the Stanford campus or next to a loud, hectic, multi-lane highway in Palo Alto. The volunteers were not allowed to have companions or listen to music. They were allowed to walk at their own pace.

Immediately after completing their walks, the volunteers returned to the lab and repeated both the questionnaire and the brain scan.

As might have been expected, walking along the highway had not soothed people’s minds. Blood flow to their subgenual prefrontal cortex was still high and their broodiness scores were unchanged.

But the volunteers who had strolled along the quiet, tree-lined paths showed slight but meaningful improvements in their mental health, according to their scores on the questionnaire. They were not dwelling on the negative aspects of their lives as much as they had been before the walk.

Arivale Launches LABS company

“Arivale” Launched and Moving Fast. They launched last month. They have 19 people in the Company and a 107 person pilot – but their plans are way more ambitious than that.

Moreover: “The founders said they couldn’t envision Arivale launching even two or three years ago.”

Read on ….

This is an important development: the well-being movement is picking up even more steam with Silicon Valley money. The move here is toward “scientific wellness”.

Note that the “L” in MARVELS stands for “LABS”, and is intended to represent this area of scientific wellness that stems from blood, urine, stool, microbiome, and exhalation monitoring, as well as genomics.

The “L” in MARVELS is now fully covered by this firm (as well as by Theranos, which has been covered in prior blogs). I think of Arival as a a one-stop-shop for LABS.

“Arivale plans to blend comprehensive, cutting-edge genetic analysis with personal coaching — giving participants specific ways to take action to improve their overall health, meet their personal goals and minimize their long-term risk of disease.”

“The 19-person startup has spent the past year working with Hood’s Institute for Systems Biology to pilot a scientific wellness program with a group of 107 people — the “pioneers,” as the company calls them — who gave blood, urine and saliva samples at quarterly intervals, used fitness trackers, and talked regularly with a dietician who served as their coach, helping them understand their genetic tests and identify specific actions to take.”

The background is this:

Arivale just closed their Series B funding round, and now have $40 mm in capital. So Lee Hood, the founder of Amgen, is looking to “create the future of wellness” – directed at creating a new field called “scientific wellness”.

Interesting to note that Maveron is in this Series B round. That is Howard Schultz’s VC firm.

Here is the article:
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Geekwire Article on Arivale
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Dr. Lee Hood’s scientific wellness startup Arivale raises $36M to improve health through genetics

A new startup in Seattle wants to be the Google or Microsoft of a new industry called scientific wellness, and now it has some serious cash to do so.

Co-founded by renowned genetics pioneer Dr. Lee Hood, Arivale today announced that it raised a $36 million Series B round led by Arch Venture Partners and Polaris Partners, with participation from Maveron. Total funding for the company, which publicly launched last month in Seattle, now stands at almost $40 million.

As we detailed in June, Arivale plans to blend comprehensive, cutting-edge genetic analysis with personal coaching — giving participants specific ways to take action to improve their overall health, meet their personal goals and minimize their long-term risk of disease.

The 19-person startup has spent the past year working with Hood’s Institute for Systems Biology to pilot a scientific wellness program with a group of 107 people — the “pioneers,” as the company calls them — who gave blood, urine and saliva samples at quarterly intervals, used fitness trackers, and talked regularly with a dietician who served as their coach, helping them understand their genetic tests and identify specific actions to take.

“I think many came in quite skeptical of whether it would really do anything,” Hood told GeekWire on Monday. “But almost everyone said that this, in one way or another, had really transformed their own personal health objectives.”

Lee Hood and Maveron co-founder Dan Levitan chat at Arivale’s launch event last month. Hood has started his fair share of successful biotech companies, including the likes of Amgen, Applied Biosystems, Rosetta, and about a dozen others. But he said he’s never had an easier time raising money for a company than with Arivale. In fact, Hood said the potential success for the company is “unlimited.”

“Virtually everyone in Silicon Valley and Seattle recognize that this is a really big, encompassing idea,” he said. “Frankly, I think this company could be larger and more transformational than any I’ve been associated with in the past.”

While there are other companies launching in this new wellness industry, Arivale CEO and co-founder Clayton Lewis said that his company has a series of differentiators, from the way it understands your genome sequence to how it regularly conducts tests — blood, saliva, urine, gut microbiome — to measure change over time.

“We start with a wellness focus as opposed to giving you a set of data,” Lewis said. “We focus on how we help optimize current health and how to avoid disease.”

Perhaps even more important are Arivale’s personal coaches, who help Arivale participants take concrete steps based on their test results and goals.

“It’s our secret sauce,” Lewis said. “They take this very complex data set with the support of a physician and scientists, come up with three or four actionable recommendations, and then help you succeed in achieving those recommendations.”

The founders said they couldn’t envision Arivale launching even two or three years ago. But now people are paying more attention to wellness and prevention as healthcare costs are being transferred back to consumers.

“Interest in staying healthy is accelerating,” Lewis noted. “We also see that people tend to be unsatisfied with solutions brought to market today.”

At the outset, Arivale will charge $2,000 per year for each participant, but Hood said he expects the cost of the required testing to come down over time as economies of scale kick in. For example, he thinks that within eight years, it will cost 10 times less to map a human genome than it does today.

“It’s when and how those declines in cost will come,” Hood added. “I’m quite confident that over this period, there will be striking decreases.”

Arivale plans to launch in San Francisco this fall and will expand across the country next year. Three days after Arivale’s launch event in Seattle last month, the company had 140 people wanting to sign up to join the program. Now, it has more than 1,000.

“One of the most exciting things about this company is the idea that it is the opening shot in creating a whole new industry of scientific wellness,” Hood said.

Money from the $36 million Series B round will be used to recruit new users, pay for clinical tests, and bring on up to 30 employees by the end of 2015.

Arivale also today revealed its 10-person Scientific Advisory Board, which includes the following individuals:
• Frances Arnold, PhD, California Institute of Technology
• George Church, PhD, Harvard Medical School
• Robert C. Green, MD, MPH, Brigham and Women’s Hospital and Harvard Medical School
• Jim Heath, PhD, California Institute of Technology
• Lee Hood, MD, PhD, Institute for Systems Biology (chair)
• Ed Lazowska, PhD, University of Washington
• Larry Smarr, PhD, University of California, San Diego
• Ralph Snyderman, MD, Duke University
• Bonnie Spring, PhD, Northwestern University
• Eric Topol, MD, Scripps Research Institute (uncompensated)

“They have enormous expertise in a whole variety of areas,” Hood said of the board. “They are going to help Arivale invent the future of wellness.”

CVS Well-Being Focus – Update

This update about CVS is from today’s NYT:

Strategic Summary:

CVS is placing a very big bet, and my guess is it is right:

That the future consumer of health care in the US will:
– rarely have a primary care physician
– have “high deductible” insurance (so they will be very tough buyers)
– demand services closer to home (convenience is a premium)
– demand services with great frequency of visits (shorter waits, no hassle)
– value convenient treatment for routine illnesses, basic screenings and vaccinations.

So these consumers still need a “front end” to the health care system that allows them to get what they need, when they need it – when it is routine. They also want to crisis services, and other backend services – arranged when the need arises. They think CVS is the answer to those consumers. They want to be the one-stop shop for those consumers.

Their push to retail clinics can be seen in their 900 MinuteClinics and plan to have 1500 by 2017. A typical CVS clinic staffed by nurse practitioners sees 35 to 40 patients a day; those patients pay $79 to $99 for minor illnesses and injuries, and most insurance plans are accepted. Analysts estimate each clinic typically brings in $500,000 a year..

And … just a few months ago …they bought all of Target’s 1900 pharmacy locations. Assuming that some of these become clinics, there could there be even more retail clinics in the future.

So they want to be the one-stop-shop for a consumer’s health, with a front end that is both behind the counter (traditional pharmacy) and in-front-of-the-counter (the store with lotions and magazines and diagnostic equipment etc).

On the back end, they want to best prices for everything that is health-oriented. They also are partnering with Rush University in Chicago to make sure that more-critical needs are serviced properly.

Highlights:

– The Company started in 1963 as Consumer Value Stores (Lowell, Massachusetts)
– CVS under CEO Larry Merlo (who came to CVS when they acquired People’s Drug) has moved aggressively to rebrand the company as a health company. This move began in 2004, when they bought Eckerd Drug.
– They now have 7800 stores, and 900 “MinuteClinics” within their stores …. and plan to have 1500 soon.
– “Its MinuteClinics diagnose and treat patients, and its pharmacies dispense medicine to more than two million prescriptions a day. It negotiates the price of medicines and helps 65 million people navigate drug coverage under their insurance plans.”

Last year, the company changed its name from CVS Caremark to CVS Health.

Acquisitions history is:

2004: The shift toward health care started in 2004, when CVS acquired Eckerd Stores and Eckerd Health Services, giving CVS a foothold in administering drug benefits to employees of big corporations and government agencies.

2006: CVS acquired MinuteClinic, a pioneering in-store health clinic chain that was offering treatment for routine illnesses, basic screenings and vaccinations.

2007: $21 billion merger between CVS and Caremark, which gave birth to the country’s leading pharmacy benefits manager.

2012: CVS struck a deal with the medical products distributor Cardinal Health to form the country’s largest generic drug sourcing operation.

2012: $2.1 billion acquisition of Coram, a business that allows CVS to dispatch technicians to patients’ homes to administer pharmaceuticals through needles and catheters.

2015: In May, it paid $12.7 billion to acquire Omnicare, which distributes prescription drugs to nursing homes and assisted-living operations.

2015: In June, CVS announced it would buy Target’s pharmacy and clinic businesses for $1.9 billion and left open the possibility of pursuing further deals. Once the Target deal closes, CVS will operate about 9,600 retail stores, or about one out of seven retail pharmacies, according to Pembroke Consulting.

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Article begins here:

How CVS Quit Smoking and Grew Into a Health Care Giant

Michael Gaffney’s throat was scratchy for days, and lemon tea was not helping. So he dropped into a MinuteClinic above a CVS store in Midtown Manhattan on a lunch break. Within minutes, a nurse practitioner tested him for strep throat (negative), suggested lozenges and a regimen (ample fluids, no spicy food), collected a co-payment ($25 cash) and sent him on his way.

“That was quick,” said Mr. Gaffney, 26, an account executive for Indeed.com, who, like millions of Americans, does not have a primary care physician, even though he is covered by health insurance. He has been meaning to find a doctor since moving to New York last year, but his sore throat did not seem serious enough to warrant what was sure to be a time-consuming search and a long wait for an appointment.

The CVS MinuteClinic, on the other hand, was just blocks away from his office. “I waited longer for my bagel this morning,” he said.

With 7,800 retail stores and a presence in almost every state, CVS Health has enormous reach. And while shoppers might think of CVS as a place to pick up toothpaste, Band-Aids or lipstick, it is also the country’s biggest operator of health clinics, the largest dispenser of prescription drugs and the second-largest pharmacy benefits manager. With close to $140 billion in revenue last year — about 97 percent of that from prescription drugs or pharmacy services — CVS is arguably the country’s biggest health care company, bigger than the drug makers and wholesalers, and bigger than the insurers.

Even before the Affordable Care Act created millions of newly insured customers in the almost $3 trillion health care industry, CVS saw that there were more profits to be made handling prescription drugs than selling diapers. But while its transformation from drugstore to health care company began a decade ago, CVS has more recently taken on a new advocacy role, that of a public enemy of cigarettes.

Last year, CVS became the first major pharmacy chain to stop selling tobacco, a business that brought in $2 billion a year. And on Tuesday, CVS said that it would resign from the United States Chamber of Commerce after revelations that the chamber and its foreign affiliates were engaged in a global lobbying campaign against antismoking laws.

Its stand against smoking has allowed CVS to make alliances with health care providers and rebrand itself fully as a health care company. But with smoking rates on a steady decline, and cigarettes sales slumping, CVS also saw that future profits lie not with Big Tobacco but in health and wellness.

Taking the high road for health has its challenges. For one thing, it means new competitors in a rapidly changing industry. And, for a major retailer with tens of thousands of products on its shelves, it leads to an uncomfortable question: If we cannot sell cigarettes, what does that mean for potato chips?

Road to Growth

The Consumer Value Store started as a scrappy discount health and beauty outlet in Lowell, Mass., in 1963. Four years later, the small chain opened its first in-store pharmacies, and those became the core of the company — and its growth — for years. Larry Merlo, the chief executive, is a pharmacist by training and came into the company when it bought People’s Drug, a drugstore chain based in a suburb of Washington.

In a phone interview, Mr. Merlo spoke mostly in corporate platitudes, but when the conversation turned to the subject of pharmacists, he spoke passionately about pharmacists’ role in delivering health care.

“Hypertension, diabetes, osteoporosis,” he said. “It’s the same story — people don’t take their medication as prescribed.”

Pharmacists, who see patients more frequently than doctors do, can make sure patients stay on their drug regimens, he said, keeping them out of the hospital and saving the health care system billions of dollars down the road.

“I think back to my own personal experience,” he said. “Sometimes, it’s as simple as answering questions to get people to stay on their prescription therapies.”

Mr. Merlo said the company stood out in the breadth of products and services it offered: Its MinuteClinics diagnose and treat patients, and its pharmacies dispense medicine to more than two million prescriptions a day. It negotiates the price of medicines and helps 65 million people navigate drug coverage under their insurance plans.

The shift toward health care started in 2004, when CVS acquired Eckerd Stores and Eckerd Health Services, giving CVS a foothold in administering drug benefits to employees of big corporations and government agencies. Two years later, CVS acquired MinuteClinic, a pioneering in-store health clinic chain that was offering treatment for routine illnesses, basic screenings and vaccinations. CVS also expanded its very profitable specialty pharmacy business, which focuses on expensive drugs to treat complex or rare diseases like cancer or H.I.V.

Then in 2007 came the $21 billion merger between CVS and Caremark, which gave birth to the country’s leading pharmacy benefits manager. Three years ago, CVS struck a deal with the medical products distributor Cardinal Health to form the country’s largest generic drug sourcing operation. It followed up with a $2.1 billion acquisition of Coram, a business that allows CVS to dispatch technicians to patients’ homes to administer pharmaceuticals through needles and catheters.

The acquisitions keep coming. In May, it paid $12.7 billion to acquire Omnicare, which distributes prescription drugs to nursing homes and assisted-living operations. Just weeks later, CVS announced it would buy Target’s pharmacy and clinic businesses for $1.9 billion and left open the possibility of pursuing further deals. Once the Target deal closes, CVS will operate about 9,600 retail stores, or about one out of seven retail pharmacies, according to Pembroke Consulting. Last year, the company changed its name from CVS Caremark to CVS Health.

The growth of CVS comes at a time when the way Americans get access to and pay for health care is evolving quickly. Surveys show that many of the estimated 30 million people who gained insurance coverage last year under health care reform do not have a primary health care physician or do not use one. Many, too, opted for high-deductible health plans and are expected to become picky with the dollars they spend, and less tolerant of the opaque pricing that is still the industry’s norm. And consumers in general are starting to demand more convenient, on-demand access to health care, closer to home.

In that fast-changing world, CVS’s strategy is to be a one-stop shop for health care.

“Say you have diabetes, and you go into a pharmacy to get your insulin, how great is it if, in the same aisle, there’s a cookbook for people with diabetes?” said Ceci Connolly, managing director of PwC’s Health Research Institute. “And maybe there’s some foods that are already approved for you, and a place to check your feet, and a clinician to check your eyes,” she said.

“Consumers are saying: I want all of that at a place near my house that’s open on Saturdays, when it’s convenient for me. I want that place to post prices. It’s in CVS’s interest to pull in more and more pieces of that puzzle.”

A typical CVS clinic staffed by nurse practitioners sees 35 to 40 patients a day; those patients pay $79 to $99 for minor illnesses and injuries, and most insurance plans are accepted. Analysts estimate each clinic typically brings in $500,000 a year, representing just a fraction of CVS’s revenue. Still, the clinics are an important part of the company’s health care proposition.

Other retailers are also getting into the business. The number of retail clinic sites grew to 1,800 locations nationwide in 2014 from 200 in 2006, though they still represent just 2 percent of primary care encounters in the United States, according to a report published this year by Manatt Health, a health advisory practice, and the Robert Wood Johnson Foundation. But CVS is by far the leader. Walmart, which charges just $40 a visit, has fewer than 100 clinics, compared with the more than 900 in CVS’s portfolio. Walgreens, the second-largest, has half as many clinics as CVS. And CVS plans to add more, reaching 1,500 by 2017, the company has said.

Whether these clinics provide the best kind of care is a question sometimes raised by doctors in more traditional practices, like Robert Wergin, president of the American Academy of Family Physicians and a doctor in Milford, Neb.

“These retail clinics, they’re run by competent folks, and they probably have some role to play,” he said. “But you’re being seen at a clinic next to the frozen food section by a stranger. And if you go back for a follow-up, you’re going to get seen by someone else.”

For employers and insurers, however, the clinics offer a way to reduce costs for noncritical conditions. A study by researchers at the RAND Corporation estimated that more than a quarter of emergency room visits could be handled at retail clinics and urgent care centers, creating savings of $4.4 billion a year.

Reducing health care spending, however, may turn out to be complicated.

“You might imagine that they keep people out of E.R., so that’s one way you could save money,” said Martin Gaynor, professor of economics and public policy at Heinz College, Carnegie Mellon University. “On the other hand, just because they’re more convenient, people might go and obtain care in circumstances where they otherwise would not have sought care.”

CVS might have more sway reducing health care costs in its role as a middleman between drug companies and patients with drug benefits. The company is expected to start shifting the balance between end users on one hand, and drug manufacturers and wholesalers on the other.

CVS and other large dispensing pharmacies — Walgreens, Express Scripts, Rite Aid and Walmart — made up about 64 percent of prescription-dispensing revenue in the United States in 2014, according to Pembroke Consulting. That year, CVS was also the leading provider of specialty drugs in North America, with $20.5 billion in revenue, representing 26 percent of the total market.

“Scale is a big factor in pharmacy,” said Joseph Agnese, senior equity analyst at S&P Capital IQ. “There’s a lot of pricing pressure from drug manufacturers and one way for retailers can come back at them is to become larger, and become a more significant purchaser of drugs.”

Dr. Gaynor of Carnegie Mellon said, however, that cost reduction varied greatly by type of drug. “If there’s a drug that is very important for CVS to carry, and there are no alternatives, they aren’t going to have a lot of negotiating power,” Dr. Gaynor said. “But of course, the bigger CVS gets, the more they can move product, the more important it becomes.”

The company’s size also creates significant competition issues, says David A. Balto, an antitrust lawyer and former policy director at the Federal Trade Commission who often represents independent pharmacies. CVS’s ownership of Caremark could restrict consumers’ access to rival pharmacies, he said, and CVS’s acquisition of Omnicare, already a dominant player in long-term care, could reduce competition in that industry.

“There are tremendous concerns when you see someone becoming so terrifically large,” Mr. Balto said. “The acquisitions might conceivably be efficient, but whether those efficiencies are passed on to consumers really depends on the level of competition in the market.”

Quitting Cigarettes

Helena B. Foulkes, who leads CVS’s retail business, swept past the sales counter at a newly renovated CVS in downtown Manhattan. Where cigarette packs once lined up in neat rows, now there were nicotine gum and patches to help smokers quit. (There are no e-cigarettes either, much to the chagrin of that industry, which had hoped CVS would embrace its products as a lower-risk alternative.)

Ms. Foulkes, who lost her mother to lung disease, leads the retail business, which is starting to change to fit the company’s health care bent better.

The move to forgo $2 billion in annual tobacco sales has bolstered CVS’s health care bona fides. The White House lauded CVS’s move. “Thanks @CVS_Extra, now we can all breathe a little easier,” Michelle Obama wrote in a Twitter post. The praise seemed to give Mr. Merlo a jolt of confidence. At a TEDx talk this year in Winston-Salem, N.C., he declared: “CVS kicks butts across the U.S.”

“When we exited the tobacco category, it was the most important decision we’d made as a company,” Ms. Foulkes said. “That decision really became a symbol both internally and externally for the fact that we’re a health care company.”

It also made economic sense. Adult smoking rates have dropped to 18 percent in 2014, from 43 percent in 1965, according to the Centers for Disease Control, and experts predict that rate to dip below 10 percent in the next decade. Ditching cigarettes allows CVS to trade a small — less than 2 percent of revenue — and shrinking part of its business for an instant enhancement of its credentials in the faster-growing health and wellness space.

In October, CVS announced that its Caremark arm would require some of its customers to make higher co-payments for prescriptions filled at pharmacies that still sold tobacco products — in effect driving more traffic to the now tobacco-free CVS pharmacies. While that move encourages pharmacies to quit selling tobacco, it also raised the ire of an antitrust law research firm, which called the announcement “a smokescreen” that masks higher costs for those who fill prescriptions at competing pharmacies.

“CVS’s use of its market power to bludgeon consumers and rivals into ending tobacco sales is not a legitimate form of competition,” the American Antitrust Institute said in a statement. It has urged the Federal Trade Commission to investigate.

In general, CVS’s new anti-tobacco stance has helped it forge affiliations with regional hospitals. Before CVS went tobacco-free, negotiations with local health systems were awkward, Mr. Merlo said during a recent analyst conference call.

“That question would always come up — ‘You guys sell tobacco products, don’t you?’ — and that literally sucks all the energy out of the room,” Mr. Merlo said. But since the company stopped selling tobacco, he said, “We’ve been able to accelerate partnerships with leading health systems across the country.”

A new partnership with Rush University Medical Center in Chicago will involve patient referrals and shared electronic health records. Anthony Perry, vice president for ambulatory care and population health at Rush, said that traditional health care providers and companies like CVS could be natural allies.

“Take people with high blood pressure. That’s the type of thing you manage steadily over time, and you work on things like diet and exercise, and lifestyle changes, and if those things don’t work, you get into the world of medications,” he said. “What we asked was: If we’re going to do a series of visits with somebody, might they be able to do some of that closer to home?”

The flip side, he said, is that CVS can refer people with more serious ailments, but no primary care doctor, to Rush. “So CVS can now say: You need to see a primary care doctor, and we can connect you.”

The anti-tobacco stand has had other effects. Notably, the company has had to start thinking about other unhealthy items on its shelves. If it is a company that promotes health, can it also sell sugary sodas and candy bars?

The downtown Manhattan store where Ms. Foulkes walked the aisles is one of 500 locations that CVS is remodeling to emphasize healthy fare.

“I was in Long Island the day after the tobacco announcement, and I ran into a store manager who said: ‘I’m so proud of the company,’ ” she recalled. “But he also said, ‘I’m hearing customers now saying, why don’t you have healthier food?’ ”

“Customers quickly made the leap. They expected more from us,” she said.

Ms. Foulkes pointed to a prominent snack corner at the front of the store.

“What you’ll see in our stores are brands that convey healthy without being overly edgy. It’s Chobani yogurt, it’s Kind bars, it’s lots of proteins and nuts,” she said. “Health for the masses.”

At this point, there are no plans to stop selling high-fat or high-sugar snacks, still a big part of CVS stores’ sales. But they might be harder to spot.

When asked where the Oreos were, she smiled. “You’ll find them, but you’ll have to look for them.”

Digital Health Update

With thanks to:

Storyofdigitalhealth.com Resource List

Digital Health Organizations, Institutes, Centers – NEW!

United States

UCSF Center for Digital Health Innovation
UCSF Clinical and Translational Science Institute (CTSI)
Harris Center for Precision Wellness
Duke Global Digital Health Science Center
Scripps Translational Science Institute (STSI)
National Center for Advancing Translational Sciences
Canada

Canada Health Infoway
Scotland

Digital Health & Care Institute

Digital Health-focused VC Funds

Most Active in 2014

Kleiner Perkins Caufield Byers – 7
Khosla Ventures – 7
Sequoia Capital – 6
Andreessen Horowitz – 6
First Round Capital – 5
Venrock – 5
Bessemer Venture Partners – 4
Data Collective – 4
Norwest Venture Partners – 4
SC – 4
Founders Fund – 4
True Ventures – 4

Most Active in 2013

Khosla Ventures – 9
Andreessen Horowitz – 9
General Catalyst Partners – 7
Norwest Venture Partners – 7
Kleiner Perkins Caufield Byers – 6
Maverick Capital – 6
Sandbox Industries – 6
The Social Capital Partnership – 6
Venrock – 6
Founders Fund – 6
Excel Venture Management – 5
Aberdare Ventures – 5
SV Angel – 5
Most active in 2012

Qualcomm Ventures – 5
Aberdare Ventures – 5
Merck Global Health Fund – 5
West Health Investment Fund – 4
NEA – 4
BlueCross BlueShield Venture Partners – 3
Council Capital – 3
Khosla Ventures – 3
Top 12 Venture Capital Firms Funding the 50+ Market – StartUp Health

Organizations & Companies Running Digital Health Prizes, Challenges, and Code-a-Thons

University of Utah’s Sorenson Center for Innovation and Discovery

Games4Health Challenge
Aetna Foundation

Healthier World Innovation Challenge: – $4.5 Million Challenge to Accelerate Digital Health Innovation
U.S. Department of Health and Human Services

ONC “Market R&D Pilot Challenge”, A New Prize Challenge to Catalyze Health IT Innovation
2020Health

AXA PPP Health Tech & You Awards
XPRIZE

Qualcomm Tricorder XPRIZE
Health 2.0

Re-imagining Consumer Health With Windows 8 And Healthvault Challenge
Novartis Thalassemia App Challenge
RWJF Hospital Price Transparency Challenge
Blue Button Co-Design Challenge
Other Innovation Catalysts

Luminary Labs
Innocentive
Kaggle
angelMD
HealthXL
Philadelphia Health IT Circle
Various Grants

National Space And Biomedical Research Institute (NSBRI) Industry Forum Grant (from NASA’s grant fund) SMARTCAP – Accel 2013
Gates Foundation’s Grand Challenges in Global Health
Gates Foundation’s Records for Life RFP
US Government

Grants.gov
FedBizOpps.gov (FBO)
NIH Reporter

Rumi favorite

This being human is a guest house.
Every morning a new arrival

A joy, a depression, a meanness,
Some momentary awareness comes
As an unexpected visitor.

Welcome and entertain them all!
Even if they’re a crowd of sorrows,
Who violently sweep your house
Empty of its furniture,
Still, treat each guest honorably.
He may be clearing you out
For some new delight.

The dark thought, the shame, the malice;
Meet them at the door laughing,
And invite them in.

Be grateful for whoever comes,
Because each has been sent
As a guide from beyond.

-RUMI

Africa Grid lags economic growth

New York Times reports…and here is the essence:

Nigeria’s leaders have promised a stable power supply since the end of military rule in 1999, spending about $20 billion and dismantling the state National Electric Power Authority, better known as N.E.P.A. — and widely derided as “Never Expect Power Always.”

Yet the country’s power generating capacity has remained virtually unchanged, about six gigawatts for a country of 170 million. The United States, with 310 million people, has a capacity of more than 1,000 gigawatts

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Here is what keeps hope alive:

Post on Elon Musk and his powerwall factory

Note Musk is in record that his real vision is to sell battery factories….like the factory he is building in Nevada.

—————–

For Many in Africa, Lack of Electricity Is Barrier to Growth

JULY 1, 2015

JOHANNESBURG — In the darkened and chilly parking lot of a mall, a suburban family huddling around a shopping cart shared a snack on a Friday evening out. After finding their favorite restaurant closed because of a blackout, Buhle Ngwenya, with her two sons and two nephews, settled for meat pies from one of the few stores open in the mall.

“It’s like death, this load shedding,” Ms. Ngwenya, 45, said, referring to the blackouts imposed by South Africa’s state utility to prevent a collapse of the national electricity grid.

With winter here in South Africa, the worst blackouts in years are plunging residents into darkness in poor townships and wealthy suburbs alike. The cutoffs have dampened South Africa’s economy, Africa’s second biggest, and are expected to continue for another two to three years.

Despite a decade of strong economic expansion, sub-Saharan Africa is still far behind in its ability to generate something fundamental to its future — electricity — hampering growth and frustrating its ambitions to catch up with the rest of the world.

All of sub-Saharan Africa’s power generating capacity amounts to less than South Korea’s, and a quarter of it is unproductive at any given moment because of the continent’s aging infrastructure. The World Bank estimates that blackouts alone cut down the gross domestic products of sub-Saharan countries by 2.1 percent.

The crippling effect on sub-Saharan Africa was recently on display in Nigeria, which overtook South Africa as the continent’s biggest economy last year.

Nigeria’s electrical grid churns out so little power that the country mostly runs on private generators. So when a fuel shortage struck this spring, a national crisis quickly followed, disrupting cellphone service, temporarily closing bank branches and grounding airplanes.

The power shortages and blackouts have cast a harsh light on elected officials, causing rising anger among voters for whom reliable electricity was supposed to be a dividend of democracy and economic growth.

Experts say that the appointment of politically connected officials with little industry expertise at the South African state utility, Eskom, has led to mismanagement just as it has at other state-owned enterprises.

“It’s not only a symbol of failure when the lights go off,” said Anton Eberhard, an energy expert and a professor of management at the University of Cape Town. “It’s experienced directly by people. If you’re about to cook or if your child is studying for an exam the next day and your lights go off, people feel this very directly. There is a very concrete and dramatic expression of failure.”

The demand for power in Africa has become a major international issue. China has taken the lead in financing many power projects across the continent — mostly hydroelectric dams, but also solar power plants and wind farms. Private companies from Asia, the United States and Europe are also supplying power to an increasing number of countries.

China has taken the lead in financing many power projects across the continent, and independent power producers are now supplying some countries with electricity.

President Obama, in a visit to Africa two years ago, highlighted the importance of improving the continent’s power supply with a $7 billion initiative called Power Africa. The American government, partly through entities like the Millennium Challenge Corporation, is focusing on improving the electricity infrastructure in several countries, including Ghana, Malawi and Tanzania.

But investments and changes in the electricity sector on the continent have yet to yield significant gains, and experts predict that it will take decades before sub-Saharan Africa enjoys universal access to electricity.

In his inaugural address last month, Nigeria’s new president, Muhammadu Buhari, said that his nation’s attempts to overhaul its electricity sector “have only brought darkness, frustration, misery and resignation among Nigerians.” He singled out unreliable power service as the biggest drag on his country’s economy.

Nigeria’s leaders have promised a stable power supply since the end of military rule in 1999, spending about $20 billion and dismantling the state National Electric Power Authority, better known as N.E.P.A. — and widely derided as “Never Expect Power Always.”

Yet the country’s power generating capacity has remained virtually unchanged, about six gigawatts for a country of 170 million. The United States, with 310 million people, has a capacity of more than 1,000 gigawatts.

“Most companies don’t have four hours of power a day from the national grid,” said Akpan Ekpo, the director general of the West African Institute for Financial and Economic Management in Lagos, Nigeria’s commercial capital. “If they do, they’re lucky.”

Most of the $20 billion spent to overhaul the power sector is believed to have gone into the pockets of corrupt officials, Mr. Ekpo said.

“With the advent of democracy, we were promised constant power, or at least improved power,” he added. “But much to our surprise, things have only gotten worse. In some middle-class parts of Lagos, people are lucky if they now get 30 minutes of power a day.”

Yet the country’s power generating capacity has remained virtually unchanged, about six gigawatts for a country of 170 million. The United States, with 310 million people, has a capacity of more than 1,000 gigawatts.
“Most companies don’t have four hours of power a day from the national grid,” said Akpan Ekpo, the director general of the West African Institute for Financial and Economic Management in Lagos, Nigeria’s commercial capital. “If they do, they’re lucky.”
Most of the $20 billion spent to overhaul the power sector is believed to have gone into the pockets of corrupt officials, Mr. Ekpo said.
“With the advent of democracy, we were promised constant power, or at least improved power,” he added. “But much to our surprise, things have only gotten worse. In some middle-class parts of Lagos, people are lucky if they now get 30 minutes of power a day.”
South Africa’s recent history of electrification is more complicated, and it has been the subject of fierce debate as the current blackout crisis has dragged on for several months.
In the last years of apartheid, before a democratic government was elected in 1994, electricity reached only a third of South African households, few of them black.
Under the African National Congress — whose leaders have governed ever since, often promising free electricity and other services as part of the nation’s new democracy — 85 percent of households now have electricity, a remarkable accomplishment by any standard.
President Jacob Zuma has forcefully rejected any blame for the energy crisis. The strain on the grid, he said, resulted from the burden of bringing light to millions of black households without power under white-minority rule.
“It is a problem of apartheid, which we are resolving,” he said this year.
But energy experts say that these households, many of them low-income, consume little electricity. Instead, they said, the shortages result from frequent breakdowns at aging plants and, most critically, the delayed construction of two new facilities.
As far back as 1998, a government report warned that without new capacity, the country would face serious power shortages by 2007. A year later, in 2008, South Africa suffered its first rolling blackouts.
South Africa, which has the continent’s only nuclear power plant, has around half of sub-Saharan Africa’s power generating capacity, roughly 44 gigawatts. Still, the power cuts contributed to a recent drop in economic growth and a spike in unemployment to 26.4 percent, the worst level in a dozen years.
The rolling blackouts have affected everyone from giant gold mining companies and manufacturers to small businesses and individuals.
South Africans are now buying up generators, rechargeable lights and gas burners. They plan their days and evenings around scheduled blackouts by the utility. Dominating South Africa’s list of popular app downloads are ones that alert smartphone users to the impending start of a cutoff in their neighborhood or the risk of one as load shedding across the nation increases from Stage 1 to Stage 2 or Stage 3.
To Ms. Ngwenya, who was sharing meat pies with her family in the parking lot, load shedding was not only about electricity. She blamed the African National Congress, the party that liberated South Africa and has steered its course ever since.
“I always supported the A.N.C.,” said Ms. Ngwenya, who grew up in Soweto, a black township outside Johannesburg, but now lives in a wealthy suburb. “However, when it comes to load shedding, I don’t know. It’s not normal coming to a mall and carrying a torch like this man here,” she said, pointing to another consumer shrouded in darkness.
“For me, this is the biggest failure of the A.N.C.,” she added. “We even have a name for it, load shedding. Why don’t they say blackout once and for all?”
In Sandton, a Johannesburg suburb with gated communities and sumptuous malls, Junior Nji, 38, walked out of a well-lit Woolworth’s in an otherwise dark mall. His wife had just sent him a text message with the news that their neighborhood had gone dark and not to bother getting groceries.
“Load shedding boo,” she had written him, using a term of endearment. “This can’t be life.”
That morning, Mr. Nji said, he had finally decided to buy a diesel generator for his house, and workers had come to prepare for the installation. But Mr. Nji, an architect, was holding off on plans to move to a bigger office because of the extra costs of equipping it with a generator. He had been planning, he said, to hire an additional architect and a draftsman.
He texted his wife: “Then let’s go out somewhere. That Chinese restaurant might just be O.K.”

NantHealth Update

Allscripts invests $200M in Soon-Shiong’s NantHealth in software integration deal (updated)
By NEIL VERSEL
Post a comment / 61 Shares / Jun 30, 2015 at 1:33 PM
Patrick Soon-Shiong
Dr. Patrick Soon-Shiong
Electronic health records vendor Allscripts Healthcare Solutions has bought a 10 percent equity stake in NantHealth, the health IT arm of Dr. Patrick Soon-Shiong’s empire, for $200 million, while another Soon-Shiong company has bought $100 million worth of stock in Allscripts.

The deal, announced Tuesday, extends a partnership first disclosed in March, in which the two companies agreed to share technology in developing more personalized cancer treatments.

Chicago-based Allscripts paid cash for its 10 percent stake in NantHealth, the two companies said. Soon-Shiong bought into Allscripts via his personal investment vehicle, NantCapital, part of his burgeoning NantWorks conglomeration.

The Los Angeles Times reported that the cross-investment, which values Culver City, Calif.-based NantHealth at $2 billion, closer to a planned initial public offering later this year. “We feel we have one or two transactions to accomplish, then we will initiate the public offering that we anticipate will happen probably within this year,” Soon-Shiong reportedly told the Times.

NantHealth and Allscripts said that they would jointly integrate their software via application provider interfaces, including placing dashboards to NantHealth databases and analytics engines into Allscripts EHRs. For example, NantHealth will make its Eviti cancer-specific clinical decision support technology available through Allscripts front ends, NantHealth President Robert Watson said in an interview with MedCity News.

The two companies also plan on developing several specific pieces of technology: an ontology and industry standard for cross-clinical usage of a NantHealth-developed test known as GPS Cancer (GPS stands for genomic-proteomic sequencing); invitations for GPS Cancer sequencing delivered to specific patients through Allscripts’ FollowMyHealth portal; and a new product for accountable care organizations that promotes semantic interoperability.

“We believe that our GPS Cancer test should become a standard of care,” Watson said. It takes the kind of access to hospitals and cancer centers that Allscripts has to make it happen, Watson explained.

The test is more comprehensive than others on the market, Watson said, in that it takes into account the full genome and full exome, not just a small subset of pairs.

In a press release, Allscripts President and CEO Paul Black said:

“We’re taking an important step forward in our strategic partnership that fully aligns our resources and furthers Allscripts’ strategy to invest in new technologies that can revolutionize service to hospitals and physicians. Under the leadership of Dr. Soon-Shiong, NantHealth is pioneering extraordinarily innovative, personalized healthcare solutions that will empower more efficient and effective clinical decisions. We’re confident that our joint efforts will help Allscripts lead the way in our vision of delivering open, integrated and precision-based medical solutions to physicians and patients

============== Prior Blog Post =======

NantHealth Update
Remember Dr. Patrick Soon-Shiong and NantHealth?

He is the LA billionaire I met in 2013. I was saying “watch him make his next move” in 2013 when he came to Coke and showed a vision of how he wanted to revolutionize health care. I drove in a car with him to see if he could use some of his genomic knowledge to help my friend John Farrell live (it was too late but he really tried hard and I came to respect him as a physician and oncologist).

His vision them was for a revolution in health care based on breathtaking new genomic understandings, including how genes changed over time, combined with revolutionary new home appliances that would record cloud-based data relevant to your personal health, e.g. a scale that recorded weight and pill bottles that recorded compliance with medications.

In any event ….

Take a look at his investors – – – $320 million so far, from elite players:

I’m reminded of what Dr. Patrick Soon-Shiong is doing with NantHealth, which is a lot more opaque other than the approximate $320M of private equity money invested to date by Sovereign Wealth Fund, Kuwait Investment Authority, Verizon, Celgene, Blackberry, and Blackstone.