As of September 2018, the top 10 tech companies in the U.S. had spent a total of $4.7 billion on healthcare acquisitions since 2012. The number of healthcare deals undertaken by those companies has consistently risen year-on-year. It all points to an increasing interest from technology companies in U.S. healthcare, which raises many questions as to what their intentions are, and what the ramifications will be for the health industry.
It also begs the question as to why healthcare has become the latest target of U.S. tech giants. On the surface, they don’t seem like natural bedfellows. One is agile and quick, the other slow moving and pensive; one obsessed with looking forward, the other struggling to keep up with its past.
And yet, it’s true. Apple, IBM, Microsoft, Samsung and Uber have all flirted with healthcare in recent years, from data-collecting health apps and devices to a digital cab-hailing service for medical patients. Two of the most intriguing companies to make movements around healthcare recently, though, are Amazon and Alphabet. Both of them seem to have health insurance, in particular, set in their sights.
A is for: Alphabet, Amazon or Apple
Alphabet is currently the most active investor among large tech companies in U.S. healthcare, according to CB Insights. Via Verily, an Alphabet subsidiary that focuses on using technology to better understand health, and DeepMind, another Alphabet acquisition that deals in artificial intelligence solutions, the tech giant has been exploring how to use AI to tackle disease by using data generation, detection and positive lifestyle modifications. Alphabet has also made substantial investments in Oscar, Clover and Collective Health — companies that all have their eye on disrupting the health insurance sector.
Meanwhile, Amazon raised eyebrows by making its biggest move into healthcare last summer, when it acquired the internet pharmacy startup PillPack. Then, in October 2018, it filed a patent for its Alexa voice assistant to detect colds and coughs. Furthermore, the e-commerce business has been working on an internal project named Hera, which involves using data from electronic medical records (EMRs) to identify incorrect misdiagnoses. And in January of last year, Amazon announced a partnership with Berkshire Hathaway and JP Morgan for an employer health initiative — a thinly veiled tactic to better understand health insurance by using workers as beta-testers with an eye toward expanding into a public market further down the line.
Apple isn’t standing by quietly, either. It was recently announced that they’ve been working with Aetna since 2016 to provide incentives for healthy behavior to their customers through personalized exercise and health tips.
While all three are making strides in the healthcare industry, health insurance, in particular, seems like it may to be a major part of their long-term strategy for Alphabet and Amazon.
Can the tech giants cross the moat?
This isn’t the first time tech-savvy businesses have sized up the U..S healthcare and health insurance industries. They’ve been viewed as sitting ducks for disruption for many years. Unsurprisingly so, too. With their analogue systems, complex strata of silos and out-of-date technology, anyone would think they were primed and ready for digital disruption — that new technologies could help these out-of-date, yet highly lucrative industries, become more streamlined, efficient and customer-centric.
That’s what Better — a mobile experience for healthcare — thought when it was launched in 2013 by Health Hero co-founder and Rock Health mentor, Geoffrey Clapp. The startup struggled from day one with investments and the seemingly monumental task of applying a simple solution to a plethora of problems. Better admitted defeat just two years after it launched.
“We were doing concierge services across all disease states, across anatomic states like a knee surgery or a stroke, and at the same time doing bundled payment services and multiple, different payment structures,” Clapp said in 2016, when looking back at Better. “People may love the product, but they want it to address whatever problem theirs might be. And we talked ourselves into thinking we would have verticals.”
Health insurance is just as difficult a sector to disrupt as other areas of the U.S. healthcare industry, but is less appealing to startups due to the large resources companies need to have before they even enter the market.
Despite their size, capital and ingenuity, making inroads into the healthcare industry won’t be easy for tech companies.
An interesting case study over the past few years has been Oscar Health (which, incidentally, received $375 million in investment from Alphabet last year). Launched in 2012 under the proviso of using technology and customer experience insight to simplify health insurance, Oscar is often seen as the poster-boy of startups disrupting health insurance. However, its journey has been anything but smooth and, despite significant investment, its future is anything but clear.
The company has struggled to compete in the market for individual healthcare, as well as assembling the necessary network of doctors and hospitals. And while Oscar recorded its first profitable quarter in its now seven-year lifespan in 2018, it has a history of hemorrhaging money, including more than $200 million in losses in 2016. If Oscar is the success story of startups disrupting U.S. health insurance, then it’s a stark reminder as to how much of an uphill battle that is.
Of course, Amazon and Alphabet don’t have to worry about losing money in their long-term game plan for health insurance. But they still have to overcome the long list of regulations and pragmatisms that can’t simply be overcome by throwing money at the problem. They won’t automatically succeed on account of their size and resources, as Google learned when it closed the doors of Google Health in 2012, citing that the service “is not having the broad impact that we hoped it would.”
It seems that Alphabet, Amazon et al. have learned from their mistakes, the mistakes of their peers and those of startups like Better. Alphabet isn’t diving in head-first this time around. Instead, it’s tackling specific diseases, partnering with hospitals and applying its vast know-how in AI to combat real problems that affect millions of Americans. And Amazon — via its partnership with Berkshire Hathaway and JP Morgan — is taking the time to better understand the market it hopes to disrupt by taking a close look at its problems on a micro scale.
Grow or die
If the U.S. health insurance industry is indeed so difficult to conquer, it begs the question as to why tech companies are taking another swing at it. The simple answer is revenue.
The U.S. health insurance net premiums recorded by life/health insurers in 2017 totaled $594.9 billion. That’s more than three times Amazon’s 2017 revenue ($178 billion) and more than times that of Alphabet’s ($111 billion).
There’s more to it.
When a business’ annual revenue exceeds $100 billion, it’s sufficiently difficult to find new avenues of meaningful growth. This is problematic for companies like Alphabet and Amazon. Growth and scale are vital for them. Without them, the vultures begin to circle, believing that they’re losing their grip on their ecosystems — and with that, stock prices take a hit.
We’ve already seen the tech giants mitigate this risk by successfully expanding into other verticals in recent years. Whether it’s grocery delivery services, voice assistants or self-driving cars, tech businesses are constantly looking to expand their empires to fresh verticals. Healthcare is simply the next industry to be re-conquered.
Roadblocks along the way
Despite their size, capital and ingenuity, making inroads into the healthcare industry won’t be easy for tech companies, no matter how carefully they approach it. While they may seem to be old hands when it comes to disrupting industries, healthcare and health insurance are different beasts entirely.
For a start, there’s regulation. In order to sell and distribute drugs, there are complex and expensive hoops to be jumped through, overseen by regulatory bodies, including the FDA and the DEA.
There’s always been a question mark over how these companies use the vast swathes of data available to them.
Then there’s data and privacy. Tech giants may believe that technology gives them an upper-hand over the industry’s long-standing incumbents, but tech solutions require access to data that’s also regulated by strict privacy laws — a major barrier to be overcome for those looking to enter specifically into health insurance.
And on top of all of that, the tech companies looking to take on the health insurance would have to navigate the state-based insurance regulatory system. What works in Utah, which is generally regarded as a more lenient state when it come to insurance regulation, may not work in California, which is seen as one of the strictest states.
Privacy, data and universal healthcare
While there may be challenges facing new businesses in becoming major players in the health insurance industry, it would take a brave person to bet against them. If they were to succeed, some of the ramifications might not be appealing to everyone.
For a start, there’s always been a question mark over how these companies use the vast swathes of data available to them. Tech companies have been rocked in recent years by the public turning against them over how their data is used to turn a profit. But what if that data was used to calculate a customer’s insurance premium? It’s feasible that a user’s premium could go down if data shows they live a healthy lifestyle; for instance, they purchase healthy foods, have a gym a membership and track regular workouts through a device.
On the other hand, inactive users shown to buy unhealthy foods and products could see their premiums go up over time.
It’s a genuine concern according to Peter Swire, a privacy expert at the Scheller College of Business at Georgia Tech and the White House coordinator for the Health Insurance Portability and Accountability Act privacy rule under President Clinton. “As far as I can tell, the Amazon website could use its information about the customer to inform its health insurance affiliate about the customer,” Swire says in an interview with Vice. “In other words, I’m not aware of rules that stop data from outside the healthcare system from being used by the health insurance company.”
Tangent: Will tech companies push against a single-payer or universal healthcare system?
I’ll pause a moment to put on my tinfoil hat.
As recently as 2017, Aetna CEO Mark Bertolini stated he’d be open to discussing a single-payer system, “Single-payer, I think we should have that debate as a nation.”
Single-payer or Medicare-for-all are both in the sights of progressive Democrats in Washington. Those fighting for a single-payer health system in the model of countries like the U.K. and Canada are already up against powerful lobbying groups from pharmaceutical and insurance industries. Game theory may tell us that adding the richest companies in the world to that group would surely push the idea of universal healthcare in the U.S. further away from reality.
This is a big, “what if” scenario that plagues me as we consider a future where the tech companies begin to create their own insurance solutions. They definitely would not want the government to come in and replace private insurance.
Let’s remove the tinfoil hat and we can return to the less conspiracy theory-themed conversation.
Better than the status quo
Of course, there’s no evidence to suggest that Amazon, Google or any other tech giant interested in exploring health insurance might use data against its users or lobby against universal healthcare. In fact, if there’s one thing these businesses know, it’s the importance of pleasing as many people as possible. They’re aware, often from personal experience, how damaging negative publicity can be — not just to a particular product or service, but to the whole business. Following nefarious money-making initiatives could destroy any hope of disrupting the health insurance industry before they’ve even begun.
We could imagine that tech companies would approach their solution with their special sauce.
Amazon may bring extreme efficiency, no frills and incredibly fast logistics to their offering. Google or an Alphabet company may come from an AI and predictive approach, wherein every person would have a health assistant backed by a field of specialists. Alphabet machines and kiosks you could drop into for a quick health check. Apple would bring their polished retail experience and love of control to create a vertical solution like what we see from Kaiser Permanente. They’d work to ensure the quality of the experience. Each company would, effectively, serve a different type of consumer.
If they decide to show their hand and go head-to-head with the health insurance industry’s current incumbents, they may do so by positioning themselves as the benevolent alternative that works for everyone in the system and is ultimately better, less expensive and more efficient. According to a 2017 McKinsey study, very few insurers are providing what the American people want from their providers, namely convenience, more incorporated technology, tools that promote health and wellness and greater value for the money.
These are areas where technologists often excel: providing high levels of customer care, improving services and driving down cost, and doing so by incorporating cutting-edge technology. If they can do that with health insurance, then they may well be within a shot of finally delivering on technology’s promise to disrupt an out-of-date industry.
Growth is the lifeblood of these companies, and the health vertical that is ripe for disruption is, coincidentally, vital to our survival. It’s going to be a fascinating battle when it plays out to see whether, like Uber’s cowboy start, tech companies can leapfrog regulation and force the hand of the legislatures with the help of consumer demand.
Respawn will premiere its ‘Star Wars’ game on April 13th
After years of work, Respawn is nearly ready to show what its Star Wars game is all about. Lucasfilm has announced that EA and Respawn will formally reveal Star Wars Jedi: Fallen Order at a Celebration Chicago panel on April 13th. The two are unsurprisingly shy about details, but you’ll meet a Padawan who survived Order 66 (the command to exterminate the Jedi) and experience what it’s like to live in an era where there are seemingly no Jedi left. You can expect “never-before-released” details of the game, Lucasfilm said, which isn’t hard when the game is largely a secret.
Spotify launches in India – TechCrunch
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Just for India, Spotify users who do not pay for a subscription can play any song on demand on mobile. There are also playlists for India and a “Starring…” feature that includes music from Bollywood movies.
“Not only will Spotify bring Indian artists to the world, we’ll also bring the world’s music to fans across India,” said Spotify CEO Daniel Ek.
This isn’t necessarily a precursor to some big action like breaking up a big company or imposing rules or anything like that. It seems more like a recognition that the FTC needs to be ready to move quickly and decisively in tech matters.
Against a backdrop of public backlash and looming federal regulations, the world’s biggest e-cigarette manufacturer has released video of the original thesis presentation that launched the company.
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With the latest improvements, developers can use the machine to solve larger problems with fewer physical qubits — or larger problems in general.
Some thoughts from the former SVP of Walmart’s global e-commerce supply chain.
Cracks are starting to appear in Steam’s armor, threatening to make it the digital equivalent of GameStop — a once unassailable retail giant whose future became questionable when it didn’t successfully change with the times. (Extra Crunch subscription required.)
FTC ruling sees Musical.ly (TikTok) fined $5.7M for violating children’s privacy law, app updated with age gate – TechCrunch
A significant FTC ruling issued today will see video app TikTok fined $5.7 million for violating U.S. children’s privacy laws, and will impact how the app works for kids under the age of 13. In an app update being released today, all users will need to verify their age, and the under 13-year-olds will then be directed to a separate, more restricted in-app experience that protects their personal information and prevents them from publishing videos to TikTok .
In a bit of bad timing for the popular video app, the ruling comes on the same day that TikTok began promoting its new safety series designed to help keep its community informed of its privacy and safety tools.
The Federal Trade Commission had begun looking into TikTok back when it was known as Musical.ly, and the ruling itself is a settlement with Musical.ly.
The industry self-regulatory group Children’s Advertising Review Unit (CARU) had last spring referred Musical.ly to the FTC for violating U.S. children’s privacy law by collecting personal information for users under the age of 13 without parental consent. (The complaint, filed by the Department of Justice on behalf of the Commission, is here.)
But its regulatory issues followed it to its new home.
According to the U.S. children’s privacy law COPPA, operators of apps and websites aimed at young users under the age of 13 can’t collect personal data like email addresses, IP addresses, geolocation information or other identifiers without parental consent.
But the Musical.ly app required users to provide an email address, phone number, username, first and last name, a short biography and a profile picture, the FTC claims. The also app allowed users to interact with others by commenting on their videos and sending direct messages. In addition, user accounts were public by default, which meant that a child’s profile bio, username, picture and videos could be seen by other users, the FTC explained today in its press release.
It also noted that there were reports of adults trying to contact children in Musical.ly, and until October 2016 there was a feature that let others view nearby users within a 50-mile radius.
“The operators of Musical.ly—now known as TikTok—knew many children were using the app but they still failed to seek parental consent before collecting names, email addresses, and other personal information from users under the age of 13,” said FTC Chairman Joe Simons, in a statement. “This record penalty should be a reminder to all online services and websites that target children: We take enforcement of COPPA very seriously, and we will not tolerate companies that flagrantly ignore the law.”
COPPA law, of course, becomes a bit complex to implement for apps like TikTok that sit in a gray area between being oriented toward adults and being aimed at kids. Specifically, apps preferred by tweens and teens — like Snapchat, Instagram, YouTube and TikTok — are often clamored for by younger, under-13 kids, and parents often comply.
But some parents are caught off guard by these apps. The FTC says Musical.ly had fielded “thousands of complaints” from parents because their children under the age of 13 had created Musical.ly accounts.
In addition to the $5.7 million fine, the FTC settlement with Musical.ly includes an agreement that will impact how the TikTok app operates.
It says TikTok is now considered a “mixed audience” app, which means there needs to be an age gate implemented on the app. Instead of locking out under-13 users from the TikTok service, younger users will be directed to a different in-app experience that restricts TikTok from collecting the personal information prohibited by COPPA.
TikTok is also complying with the ruling by making significant changes to its app. It will now restrict under-13 kids from being able to film and publish their videos to the TikTok app. It will also take down all videos from kids under 13.
Instead, the under-13 crowd will only be able to like content and follow users. They will be able to create and save videos to their device — but not to the public TikTok network. Nor can they share videos on the app with their friends if they use TikTok via a private account.
As TikTok already has a large number of younger kids on its app, it will push an app update today that displays the new age gate to both new and existing users alike. Kids will then need to verify their birthday in order to be directed to the appropriate experience.
This is not likely going to have an impact on how many kids use TikTok, however. Kids today already know to lie to age pop-ups so they can enter a restricted app. That’s how they set up accounts on Facebook, Instagram, Snapchat and elsewhere.
However, the move at least puts TikTok on a level playing field with other “mixed audience” apps instead of allowing it to pretend U.S. children’s privacy laws do not exist.
TikTok reportedly has been installed a billion times worldwide, according to recent data from Sensor Tower. The company doesn’t publicly disclose its figures, but the FTC says since 2014, more than 200 million users had downloaded the Musical.ly app worldwide, with 65 million accounts registered in the United States.
The Commission vote to authorize the staff to refer the complaint to the Department of Justice and to approve the proposed consent decree was 5-0. Commissioner Rohit Chopra and Commissioner Rebecca Kelly Slaughter issued a separate statement, shared below:
The Federal Trade Commission’s action to crack down on the privacy practices of Musical.ly, now known as TikTok, is a major milestone for our Children’s Online Privacy Protection Act (COPPA) enforcement program. Agency staff uncovered disturbing practices, including collecting and exposing the location and other sensitive data of young children. In our view, these practices reflected the company’s willingness to pursue growth even at the expense of endangering children. The agency secured a record-setting civil penalty and deletion of ill-gotten data, as well as other remedies to stop this egregious conduct. This is a big win in the fight to protect children’s privacy.
This investigation began before the current Commission was in place. FTC investigations typically focus on individual accountability only in certain circumstances—and the effect has been that individuals at large companies have often avoided scrutiny. We should move away from this approach. Executives of big companies who call the shots as companies break the law should be held accountable.
When any company appears to have a made a business decision to violate or disregard the law, the Commission should identify and investigate those individuals who made or ratified that decision and evaluate whether to charge them. As we continue to pursue violations of law, we should prioritize uncovering the role of corporate officers and directors and hold accountable everyone who broke the law.
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- Watters on felons voting: Dems want to ‘change the rules’ rather than ‘change their message’
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