5 Interesting Companies I Saw at HLTH

Large conferences are a perfect place to see what companies are working on, and the recently-concluded HLTH conference had its own share of companies touting their strengths and capabilities. Here are a few that I met for the first time or caught up with again after a while (in alphabetical order)

Brook Health
There’s no escaping AI – try as we all did at HLTH – but Brook Health’s plan is to use AI to extend the primary care provider’s relationship to the patient’s home for chronic disease management.

“We encapsulate everything that needs to be done, but we’re doing it under the supervision [of the pcp] such that the patient doesn’t feel, ‘Oh, I got this new entity now that’s trying to form a relationship with me…,” said Oren Nissim, co-founder and CEO of the Seattle-based company.

Nissim claims that other standalone health tech programs that aim to help manage chronic diseases have a retention problem in keeping patients engaged year in and year out.

“Best retention program on the planet right now, about 14, 16, maybe 18 months,” he declared. “So the structure is not just to build the right technology, but read the right deployment mechanism that allows for that relationship to continue and exist beyond the four walls of the clinic.”

Nissim believes that Brook Health has landed on the right formula because it is not functioning as an outsourced entity of the primary care providers. Rather its team of nurses represent the primary care physician. Brook Health is focused on congestive heart failure patients, the vast majority of who are on Medicare. The startup is buoyed by the fact that since 2019 CMS started paying for care at home and codes have been added for reimbursing different care modalities at home. Once Brook Health gets reimbursed for remote care from Medicare, a portion of that also goes to the primary care physician.

Patients at home receive third-party RPM devices and all the data from those gets fed into the patient’s EMR. AI-enabled technology helps Brook Health to ingest multiple different types of data — from the RPM devices as well as those inputted into the app — to determine what kind of nudge patients need to receive to remain on top of their CHF. Patients can receive text messages, in-app communication and even phone calls to keep them engaged.

Aside from the remote care program, Brook Health also runs a preventive care program, and currently 30,000 people are enrolled in the two. Customers include Independent Health, Erie County Medical Center and UMass in Massachusetts. Competitors are companies like Cadence and Snap Health.

Carrum Health
Carrum Health, based in South San Francisco, is all about managing self insured employer’s specialty care costs whether it be surgical care, cancer or behavioral health. CEO Sach Jain was quick to point out that while HLTH is rife with a celebratory atmosphere, the reality of healthcare costs is sobering – it’s projected to grow 8% next year. Carrum Health’s prescription is to partner with health systems and lower costs by bringing value-based care programs to employer-sponsored care.

“We have providers have skin in the game, so they give us a bundle that has a defined set of services included and then providers are accountable for the cost and quality of care they deliver as part of that bundle,” Jain explained.

Recently, the company launched what it bills as the nation’s first value-based care program as it relates to substance use disorder.

“The area of substance use is full of fraud and abuse because 1), there are organizations that are not well set up, but it’s an episode that pays a lot of money and whether the member is actually getting better or not, they are discharged, and after a few days, weeks they come back and then you do the whole thing all over again,” Jain charged. “So this is called washing machine model — wash and repeat — and then you keep on making money on the same patient. So by identifying the organizations that first of all have the right quality of care for these episodes and then making them accountable for the care they’re delivering, that’s what makes this model sustain sobriety.”

In other words, if there is a relapse and the member comes back, the Centers of Excellence taking part in the Carrum Network’s VBC program, have to suffer a financial a penalty or they have to give a huge discount on the relapse.

Carrum Health is working with Hazelden Betty Ford, a provider of addiction treatment, and a couple of other organizations that can’t be identified publicly as part of this program. The first customer, Jain noted, is a Fortune 50 retailer that also couldn’t be named.

But if the company is successful in scaling these programs to many employers, it will be addressing a big and expensive problem. Jain noted that employers pay roughly $35 billion annually on providing substance use disorder benefits to their members.

Genialis
This Boston-based precision medicine company focuses on RNA based biomarkers by blending computational biology and AI. Aditya Pai. the company’s head of business development, said that the company has collected more than 1 million transcriptomic samples globally and trained its algorithms on it. Transcriptome is the complete set of all the ribonucleic acid (RNA) molecules (i.e. transcripts) expressed in a cell, tissue, or organism.

Biomarkers identified by Genialis can expedite drug development, enable new diagnostic testing and improve clinical decision making. One biomarker the company has introduced is the krasID.

“It is able to predict response to and clinical benefit from KRAS inhibitors,” he said noting that there are two drugs currently on the market. “KRAS was considered a non-druggable target. Our mission was to develop a biomarker that in fact looked at all the KRAS biology, every aspect of the KRAS pathway, adjacent downstream, and develop a biomarker that could impact account for all of that diversity.”

What Genialis did was to train the biomarker on the 1-million transcriptomic samples, and then clinically validate it against a patient population that had been treated with one of these drugs that are on the market — that was the sotorasib drug made by Amgen to treat non-small cell lung cancer. What they found was that a patient that scored high on their biomarker — in other words a krasID high patient – had much higher survivability on Amgen’s drug compared with a low krasID patient. Much higher survivability translated to surviving 2.5 times longer than those with a low level.

“The fact that we are able to show such significant stratification, 84% sensitivity with our predictions versus what is available in the market, really renders it as a best in class biomarker that is available in the market,” Pai declared.

Pai noted that several pharma companies including the Swiss firm Debiopharm are customers using the krasID product. The goal is to work with pharma companies developing kras inhibitors and optmize the biomarker to that particular drug and later working with diagnostic companies to create a companion diagnostic product so that clinical trial participants for that drug can be pre-screened to include only those that will likely have a high response to the drug.

But Genialis is also going beyond developing biomarkers for specific targets. Recently, the company announced what it bills as the Genialis “supermodel” that is a combination of multiple validated models of cancer biology serving as a platform technology for pharma companies.

“This is a large molecular model, which is essentially a collection of over a hundred prebuilt validated signatures. And so for any given target, it serves as an AI recommendation engine for any cancer target or drugs that a pharma company is trying to develop biomarkers for ….”

Phenomix Sciences
This company based in Minneapolis and Palo Alto has its roots at Mayo Clinic. It has developed a test called the MyPhenome Test that helps people and their doctors understand why they gain weight and then get treated accordingly. The company’s test gathers behavioral and biomarker data along with a person’s saliva that is then to set to a lab for analysis.

People are stratified into four categories based on their phenotype (a person’s phenotype is determined by both genomic makeup (genotype) and environmental factors): those with a hungry brain, those with a hungry gut, those who have emotional hunger, and finally those who are slow birds. Phenomix Sciences is focusing on the first three types of people.

Patients with a “hungry brain” suffer from abnormal satiation and require more calories during mealtime to reach maximal fullness. If you are diagnosed as one, you will benefit from a low calorie diet “with more dietary fiber in a time restricted fashion is associated with improved appetite sensations, enhanced satiation, and sustained compliance.

Patients with a “hungry gut” have accelerated gastric emptying – the speed at which the stomach empties its contents to the duodenum. That condition can be linked is linked to having lower levels of a hormone called GLP-1. These patients might benefit from a high protein diet with protein preloads to improve GLP-1, accoording to the company.

Finally, people with emotional hunger will most likely benefit from interventions tied to behavior change. Their weight may be controlled and reduced by “structured for goal-setting, self-monitoring, and stimulus control,” according to the company.

The company focused on those 3 phenotypes for a reason – those three happen to be those for which pharma companies have developed drugs, explained Mark Bagnall, CEO of the Phenomix Sciences.

“Once a physician knows you have one of those phenotypes, they can prescribe accordingly,” he said.

He noted that besides drugs there are behavioral and surgical interventions too.

“So it really gives, depending on what type of provider you are, how you are going to intervene with your patient, a really clear picture of the types of things that are good for your patient,” he said. “I think the future of medicine is to personalize medicine based on people’s genetics and other factors.”

I actually took the test myself to see what kind of phenotype I have. I will report back once I have the results.

Truvian Sciences
Theranos may have crashed and burned with a disgraced CEO in jail for duping investors and others, but the idea of using a few drops of blood to determine health status at the point of care continues apace. In the U.S., that effort is being led by Truvian, the San Diego-based biotech company led by CEO Jay Srinivasan.

The ultimate goal is to be able to do the complete annual physical based on just 8-10 drops and through a proprietary instrument, but currently, Truvian is relying on a standard tube of blood (compared to two or three that people provide in a routine annual physical) from which it uses 8-10 drops of blood to draw conclusions. That is not the only area of difference between standard blood draws and the Truvian system.

“So what’s unique about our multimodal platform is we need only one tube or one sort of vial of blood. That’s the first thing,” Srinivasan said. “The second thing is we do believe that over time you may not want to pick phlebotomy because you may not find phlebotomy everywhere. You may not find a phlebotomist everywhere. And so we are also assessing these capillary collection devices,”

From that vial, Truvian analyzes eight drops of blood to report on blood chemistry, lipid and a comprehensive blood count. Currently, Truvian is conducting clinical trials to prove that its instrument works and later it will file for a 510 (k) clearance from the FDA. Srinivasan is also looking for CLIA waiver so that ultimately its propretary instrument can be used without the need to have a medical technician present on site.

Srinivasan added that the company has launched a partnership with Shoppers Drug Mart, a retail pharmacy, in Canada and intends to follow a similar strategy to commercialize in the U.S. And while he wants to bring point-of-care blood testing device to the market, he is very clear on one thing.

“We consciously made a decision that in order for us to build the most robust product that the market can see, we will take known technologies and find a way to miniaturize it, find a way to make it robust and provide the same quality results as sort of the central lab,” Srinivasan said.

The company is currently conducting a clinical trial and hopes to submit the data to the FDA at the end of this year or early next year.

Photo: champpixs, Getty Images