Tech-Enabled Care Delivery | Scaling Access & Elevating Outcomes at Greater Efficiency

Session Focus

Berke opened by describing Mass General Brigham Ventures as the intramural venture capital function for the system, with a mission to maximize the impact of MGB invention and discovery for patients and public health. His formulation: ROI means return on innovation.

His metaphor for the institution’s intellectual property was an underground oil reserve, with the job being to extract it in a way that produces return for the investors funding the process. However inventive a technology is, it cannot touch a patient until it reaches the market, commercialization is the route there, and venture companies are the vehicles built to travel that road.

The fund invests across what he called the five Ds: drug, device, diagnostics, delivery and digital, comprising 65 portfolio companies. The three panelists represent the health tech center of that portfolio.

His framing question, which he called the inventive leap: each panelist is a founder, so what convinced them, and then convinced investors, that a new company was needed in an area already served by centers of excellence, and why could the incumbents not do it themselves?

Why the Incumbents Could Not Do It: Payment

Clay Johnston MD, PhD described Harbor Health as a payvider, a new version of Kaiser, and explained why that model needed rebuilding.

His background is research rather than clinical care. After most of a career at UCSF, he started a medical school in Austin from scratch, his first startup experience, built around a specific question: could healthcare be built better, and could an academic medical center be better aligned with society’s interests? That meant care promoting health rather than sick care, and attention to resource consumption rather than only the cutting edge.

After eight years he could demonstrate better care, better outcomes and dramatically reduced costs. The problem was that he could not get paid for it. Insurers were not going to change how they did business, which meant it would not scale, and scalability was the entire purpose.

His assessment of academic medicine was not dismissive. Institutions like Mass General and UCSF have important societal functions and genuinely drive the frontier. But most care is not happening at that frontier. Most care is controlling hypertension, treating depression and engaging people to keep them healthier, none of which is a major focus of academic medicine, and all of which loses money universally in the current system.

His conclusion: only by taking the dollars at the top, the insurance dollars, can the incentives be arranged so the whole thing works better. Berke added the underlying dynamic, that there is a great deal of cross subsidy in the system.

Building a Safety Net in Serious Illness

Mihir Kamdar MD described Tuesday Health as a value-based, in-home palliative care company, and himself as a palliative care physician of nearly 20 years, all of it at Mass General.

He set out the problem in terms anyone can recognize. The last one to two years of life facing serious illness is incredibly challenging, with physical symptoms and emotional distress affecting caregivers and families, alongside repeated admissions and readmissions. A quarter of Medicare expenditure occurs in the last year of life.

His research at Mass General showed that involving palliative care early improves the experience for patients and families and reduces unnecessary, unimpactful expenditure. He corrected a common misconception directly: palliative care is not hospice. It sits upstream, can begin one to two years before death, and can be delivered alongside curative treatment.

His framing of why that matters: someone with six weeks who believes they have six years will choose very different care, and much of the high-intensity care delivered does not translate into improvement.

Two barriers blocked community access. In a fee-for-service model, spending an hour and a half at a bedside does not bill like a seven-minute epidural steroid injection, which he can also perform, making the work hard to sustain or grow. And the workforce does not exist: roughly 5,000 palliative care specialists nationally, against an estimated 80 to 90 million people needing some form of palliative care by 2050.

The technology response came from his own clinical frustration. Cancer-related pain affects 70 percent of people with advanced cancer and drives about half of oncology admissions. He would treat a patient’s pain, see them return four weeks later, and find the wheels had come off.

The team built an app functioning as a virtual nurse, checking in multiple times a week. Issues it could resolve through education were handled there; others escalated to a nurse who reached out, replacing a call line where a patient might spend 45 minutes hoping for a callback.

They did not know it would work. The randomized controlled trial showed significant symptom improvement and almost a 70 percent reduction in hospitalizations, which he called wonderful and surprising.

He noted the field context. At the time, digital tools were being aimed at diabetes, heart failure and wellness, and nobody was thinking about serious illness. This was the first proof of concept that technology could keep people at home by identifying issues early.

The team explored licensing and partnering before ultimately founding the company. Berke drew the parallel to InStride: scientific founders created a meaningful evidence base for the eventual customers and referrers, and that evidence was the primary asset enabling a company formed through an institutional license.

When Demand Exceeds What an Institution Can Serve

John Voith described InStride Health as treating children, teens and young adults with complex anxiety and OCD, with an unusual scope of enrollment: not only the patient but the whole family, including parents and caregivers, plus the school and the pediatrician. The three-person care team is a pediatric psychiatrist, a therapist and an exposure coach. Families in crisis enter care and graduate once the patient is in remission, typically between four and ten months later.

The care model originated inside the Mass General Brigham system at McLean Hospital, where his two clinical co-founders built it over seven years, producing strong clinical outcomes, a substantial academic literature establishing effectiveness, and profound family gratitude. It had effectively established a brand of its own, with families relocating from around the world to Boston for access.

The reasons it had to leave were all consequences of that success. A 12 to 24 month waiting list. Families required to relocate to Boston. And a primarily self-pay, very expensive offering out of reach for most families, because commercial insurance does not pay for systems-based treatment of the kind described, including parental involvement in care.

Key Takeaways

1. Better outcomes at lower cost did not scale, because the payment model would not follow. That gap is what produced a payvider.

2. Most care is not at the frontier. Hypertension control and depression treatment lose money universally in the current system.

3. A quarter of Medicare spending falls in the last year of life, which is the size of the palliative care opportunity.

4. Palliative care is upstream of hospice and compatible with curative treatment, a distinction the panel took care to make.

5. A virtual nurse app cut hospitalizations by almost 70 percent in a randomized trial, in a population digital health had ignored.

6. Institutional success can force a spinout. Waiting lists, relocation and self-pay pricing were what pushed a proven McLean model out.