The last time Dawn Sirek's severe asthma put her in the emergency room, she couldn't tell the doctors what happened — she could only gasp for air. Last year her blood-oxygen levels fell so low at times that she lost memory of entire days. Her children were afraid to leave her alone. "I felt like I was dying," said Sirek, a wife and mother of five in Louisville, Kentucky. "When my asthma symptoms were at their worst, I would sit on my bed and remind myself to take the next breath, no matter how shallow or small. I would tell myself, 'Just keep breathing.'"
Sirek, 44, a pediatric trauma nurse, was overwhelmed by adult-onset viral mediated severe uncontrolled asthma. "I got a cold virus that anyone can have. It just never went away and got worse. I was in the ICU for two weeks. It almost killed me. I didn't think I had asthma. But it became very serious very quick. Once the virus was gone, I still couldn't breathe." When she began using real-time medication-tracking technology, things finally turned around. A sensor device developed by Propeller Health was placed on her inhaler and linked to her iPhone through the company's software. The data it compiled about timing and frequency of inhaler doses helped her doctor identify her asthma triggers and tame the extreme symptoms with reminders to be compliant with medications that prevent attacks. As Sirek's pulmonary function rose to near normal levels, her fears fell. "A year ago, I sincerely thought this disease was going to take my life," Sirek said. "Now I have hope that I can control it — not the other way around."
Propeller Health, based in Madison, Wisconsin, is one of nearly a dozen innovative health care technology companies that the California Health Care Foundation (CHCF) is proud to support through its Health Innovation Fund. The fund focuses on program-related investments in companies with the potential to lift the quality and accessibility of health care for low-income Californians — goals at the heart of CHCF's mission. The fund aims to develop innovative technologies that can improve the lives of millions of people, and CHCF is looking to support additional tech and service companies that can do the job. CHCF hopes to provide the spark for Propeller to scale up its products to help the many Californians in the safety-net population who suffer from asthma or chronic obstructive pulmonary disease (COPD).
Building a Track Record
Over the last five years, the CHCF Health Innovation Fund has made 11 such investments (see the full investment portfolio). Our projects typically focus on companies with prototype-ready products and services that are in active use by at least one customer and that have demonstrable customer interest in California. CHCF looks for capital-efficient business models that can be brought to scale and sustained over the long term. The initial investments range from $250,000 to $1 million, and we make follow-up investments as warranted. We're excited about the technologies we help bring to the safety-net population, and we're encouraged by the innovation and passion we see in the health information technology (HIT) and care delivery sectors. (The fund's founder and former leader, Margaret Laws, shared her perspective on its accomplishments in a recent article for the Stanford Social Innovation Review.)
So what kinds of products and services make the cut? CHCF prioritizes funding of projects that improve access to health care by:
- Ensuring low-income Californians have access to coverage they can understand, use, and afford
- Expanding the capacity of safety-net providers to provide timely care by using more effective care teams, innovative services, and technology
- Increasing care options that low-income consumers will find to be more convenient, easier to use, and cost-effective
Similarly, we seek new approaches to advancing the quality of care by:
- Improving the health of mothers and babies by reducing unnecessary medical interventions
- Designing care for people with complex, costly behavioral conditions so that patients' needs are the first priority
- Ensuring patients' end-of-life choices are expressed and honored through the use of advance care planning and Physician Orders for Life-Sustaining Treatment (POLST), as well as expanding access to palliative care
Using these criteria, the fund has collaborated with companies such as CareInSync (since acquired by Hearst Health) for its mobile app that connects care providers. We invested in Swoop, a software-as-a-service (SAAS) platform from healthfinch that facilitates the prescription refill process with clinically based protocols and automated workflows. We funded Omada Health for its online digital health program that helps employers and health plans tackle chronic disease in an engaging, effective, and scalable way. Each of these companies is helping ease health care problems that have a significant effect on California's low-income population.
Whenever we invest in a company, executives agree to participate in an evaluation process to gauge the extent to which the product or service is bringing us closer to achieving our goals. For example, CHCF funded an independent evaluator to conduct a randomized, controlled trial of Propeller Health with a Sacramento area health care delivery system. The study of 495 patients found that monitoring short acting beta agonist (SABA) use with the Propeller Health platform significantly improves asthma control, decreases SABA use, and increases days free of asthma symptoms for patients compared to routine care.
The findings align neatly with Sirek's experience. "With a busy life and demanding career, it is easy to forget the meds," Sirek said. "The app tracks symptoms and helps pinpoint triggers, and I had not been able to do that prior to having the sensors. I can go to the doctor on a good day and show him all the bad days. The information has helped fine-tune my treatment plan. Asthma is a horrible, life-threatening disease that has no cure, but the Propeller sensor and app have become great tools that help improve my daily quality of life."
Beyond providing financial support, CHCF adds value to companies through its involvement with networks of providers, payers, and policymakers in California and through expertise in policy, finance, and reimbursement. CHCF staff members specialize in chronic disease care, health IT, customer engagement, Medi-Cal, care transitions, end-of-life care, and hospital/clinical operations. Trying to navigate the safety-net delivery system can be daunting for an early-stage startup; that first introduction to the right partner can often get the ball rolling in the right direction and save a lot of time and headaches.
Looking for the Next New Thing
So where does our "deal flow" come from, and how do we find out about investment opportunities that might be of interest to the CHCF Health Innovation Fund? We try to cast a wide net by cultivating key elements of our network, including:
- Care providers, payers, other foundations like the Blue Shield Foundation and the Kresge Foundation, as well as organizations like the Center for Care Innovations and the Innovation Learning Network
- Investment leaders such as accelerators, incubators focused on health care IT, corporate venture teams, and angel investment groups
- Our advisory board, which consists of professional investors deeply experienced in the health care ecosystem
We also attend conferences — lots of conferences. In fact, the fund provides grants to conferences that showcase companies and topics relevant to our mission. CHCF was a key sponsor for the HealthTech Conference, held October 27-28, 2015, at the Santa Clara Convention Center. The meeting featured 410 attendees, 48 speakers, and 46 exhibitors discussing a variety of subjects, including digital therapeutics and how to build the right team. This was a great venue where payers, providers, investors, industry leaders, and emerging companies came together to discuss trends, challenges, and solutions in the health tech world, all in a can-do atmosphere that was both pragmatic and passionate.
Anne DeGheest, cofounder of HealthTech Capital, a group of private investors dedicated to funding and mentoring startups focused on the intersection of health care and the computer and mobility worlds, gave a wonderful keynote speech. She talked about how health care providers, payers, and consumers are adapting to the changing ecosystem. See a video of the presentation as well as 10 key takeaways from the conference.
In health care today, there is a lot to keep up with. There are so many moving parts, and the only constant is change. We all have an active stake in the performance of the overall system and our own personal health. At the CHCF Health Innovation Fund, we are excited to play a role in this transition. Through our collective efforts, we can make a difference. So if you hear of entrepreneurs who have a great idea that's poised to revolutionize health care, send them our way — we'd love to talk!
Dawn Sirek is glad the technology arrived in time to help her. "I was having an emergency every day, and now [things have improved so much that] I didn't use my rescue inhaler yesterday," she said. "I want to pass the Propeller sensor out in the emergency room to all our patients. Asthma affects so many families. It would be life changing for a lot of families."