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Theranos

theranos.com

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Re: Theranos

#91

Post by jedc »

ChuckMcM wrote: post #84
justinjlynn wrote: post #10

Theranos is a medical laboratory that appears to have developed new methods of measuring lab values in small sample sizes more quickly. This is interesting because it means that instead of a traditional blood draw with a needle and vial requiring a trained phlebotomist and healthy veins, physicians can use blood collected from a finger stick -- a far less invasive and painful procedure. Additionally, it appears that…

That is a pretty stunning board of directors as well. I don't doubt their CEO can get an introduction to, and lunch with, nearly anyone on the planet.

Fascinating that they're all national security related, except for the ex-CEO of Wells Fargo. I'm honestly curious how that came about...

Re: Theranos

#92

Post by spartango »

justinjlynn wrote: post #24
justinjlynn wrote: post #10

Theranos is a medical laboratory that appears to have developed new methods of measuring lab values in small sample sizes more quickly. This is interesting because it means that instead of a traditional blood draw with a needle and vial requiring a trained phlebotomist and healthy veins, physicians can use blood collected from a finger stick -- a far less invasive and painful procedure. Additionally, it appears that…

With the volumes they're dealing with and the automation they tout I bet they're using integrated microfluidic chips with built in sensor technology. That's so cool and it makes sense given the time they spent in stealth mode since that's a rather new technology and getting it certified must've taken some time. Looking a patents and bingo, they have patents on microfluidic techniques. Awesome. Eventually they might h…

Given that they are going up against massive, automated operations like those of Labcorp and Quest Diagnostics ($9B market cap each), they'll probably need this tech to keep up.

While the thumb-prick and low sample volumes are cool, in the grand scheme of patient care they are somewhat gimmicky. Until doctors request higher-frequency testing, this doesn't pinch that hard. Still cool.

The big sign that they need to be wielding novel capabilities to compete with Quest and Labcorp is the offering of their menu at half of the medicare reimbursement rate. Each of those companies run ~40% gross margins off of medicare reimbursement, so Theranos without novel tech would be running a pretty substantial loss.

Re: Theranos

#94

Post by spartango »

ChuckMcM wrote: post #84
justinjlynn wrote: post #10

Theranos is a medical laboratory that appears to have developed new methods of measuring lab values in small sample sizes more quickly. This is interesting because it means that instead of a traditional blood draw with a needle and vial requiring a trained phlebotomist and healthy veins, physicians can use blood collected from a finger stick -- a far less invasive and painful procedure. Additionally, it appears that…

That is a pretty stunning board of directors as well. I don't doubt their CEO can get an introduction to, and lunch with, nearly anyone on the planet.

This board seems heavily geared to do deals for defense-related applications. That's fine; getting deals with the Armed Forces and VA is feasible and quite rewarding.

What they overtly lack is connections to the healthcare world. I'm surprised they aren't publicly roped into Cleveland Clinic, Mayo Clinic or Kaiser, as they to support novel technologies in this space. I suppose you can argue that the business model is fundamentally incompatible, but I've seen Mayo and Kaiser go in anyway; they can acquire these labs and roll them into operations pretty easily.

Re: Theranos

#95

Post by spartango »

MichaelGG wrote: post #12

Does this mean that I'll be able to walk in and order my own blood tests in the US, without being extorted by a doctor? I see zero reason for me to be forced to schedule time with a doctor, pay her, just for her to "order" tests and have the results sent only to her, and then pay her again to read them back to me. I get regular liver checks due to medication I take. Being able to walk into a lab and download the resu…

This capability depends on your medical care provider in the US. I know that Sutter Health and Kaiser are both providing patients with systems where they can see their lab results on the web, along with all of their medical history. Reaching out to your doctor via email is even included. It works pretty well in my experience (Sutter).

Re: Theranos

#96

Post by spartango »

crassus wrote: post #15
gjkood wrote: post #9

Very interesting people on the Board of Directors. Former heavyweights in the diplomatic, intelligence and military government sectors (George Shultz, Senator Samuel Nunn, Henry Kissinger etc). No big names from the technology or VC space are mentioned however. Something big is brewing.

They'd be dead within the year without some hefty political backing. The FDA does not play nice with novelty, ask any biomedical startup founder.

My experience in the space is that this is a mischaracterization of the FDA, but also misses an important point:

Theranos does not fall under the FDA's mandate in its current form. It is a CLIA-certified laboratory operation, regulated under CDC rules and scrutinized most likely by the College of American Pathologists(CAP). The CLIA/CAP scrutiny is very different from the FDA device/drug process, focusing on protocol and output. Even if they have novel technology, it is often classified as a laboratory developed test(LDT) and falls outside of the FDA's mandate (for now).

Many startups have achieved CLIA-certification without too much difficulty, from Foundation Medicine to Veracyte to Counsyl. It's totally reasonable and doesn't take too long.

Re: Theranos

#97

Post by mr_luc »

spartango wrote: post #94
ChuckMcM wrote: post #84

Earlier quoted context omitted.

That is a pretty stunning board of directors as well. I don't doubt their CEO can get an introduction to, and lunch with, nearly anyone on the planet.

This board seems heavily geared to do deals for defense-related applications. That's fine; getting deals with the Armed Forces and VA is feasible and quite rewarding. What they overtly lack is connections to the healthcare world. I'm surprised they aren't publicly roped into Cleveland Clinic, Mayo Clinic or Kaiser, as they to support novel technologies in this space. I suppose you can argue that the business model is…

Serious question: what economic incentive does the healthcare world have to adopt something like this?

If it's a finger prick, there's less to mark up.

From the outside, it seems like the entire healthcare industry is built on being purposefully inefficient so as to create large costs that they can in turn mark up.

To the VA, inefficiency is a problem. In the healthcare world in general, it doesn't seem to bother anyone.

Re: Theranos

#98

Post by rschmitty »

spartango wrote: post #92
justinjlynn wrote: post #24

Earlier quoted context omitted.

With the volumes they're dealing with and the automation they tout I bet they're using integrated microfluidic chips with built in sensor technology. That's so cool and it makes sense given the time they spent in stealth mode since that's a rather new technology and getting it certified must've taken some time. Looking a patents and bingo, they have patents on microfluidic techniques. Awesome. Eventually they might h…

Given that they are going up against massive, automated operations like those of Labcorp and Quest Diagnostics ($9B market cap each), they'll probably need this tech to keep up. While the thumb-prick and low sample volumes are cool, in the grand scheme of patient care they are somewhat gimmicky. Until doctors request higher-frequency testing, this doesn't pinch that hard. Still cool. The big sign that they need to be…

Low volume samples are important in pediatrics at least (wife a Dr) At the hospital she works all of their samples are low volume already. Plus critical kids get ffrequent samples depending on the level of monitoring needed. For babies you obviously have no choice or they could become anemic. Plus not all kids like seeing a vial fill up.

Re: Theranos

#99

Post by spartango »

mr_luc wrote: post #97
spartango wrote: post #94

Earlier quoted context omitted.

This board seems heavily geared to do deals for defense-related applications. That's fine; getting deals with the Armed Forces and VA is feasible and quite rewarding. What they overtly lack is connections to the healthcare world. I'm surprised they aren't publicly roped into Cleveland Clinic, Mayo Clinic or Kaiser, as they to support novel technologies in this space. I suppose you can argue that the business model is…

Serious question: what economic incentive does the healthcare world have to adopt something like this? If it's a finger prick, there's less to mark up. From the outside, it seems like the entire healthcare industry is built on being purposefully inefficient so as to create large costs that they can in turn mark up. To the VA, inefficiency is a problem. In the healthcare world in general, it doesn't seem to bother any…

It's all about speed and costs. The finger-prick is a distraction; phlebotomy is not a huge deal.

Instead, the important things are the turn-around-time and billed cost. If Theranos can offer 4 hour turnaround and a clinic/hospital cannot (or even get close), they will pay for it because it is good for doctor productivity and patient outcomes. If Theranos can maintain a half-medicare cost structure, that's also good for the provider because they can expand their margins.

Additionally, Theranos might do deals with insurance companies such that they reduce their reimbursements/push providers to use Theranos, which reduces the insurer's costs. The outcomes-case is even more pressing for an insurer these days.

Now, none of these directly translate to lower insurance premiums, but that doesn't mean that there aren't economic reasons to adopt the service.

> From the outside, it seems like the entire healthcare industry is built on being purposefully inefficient so as to create large costs that they can in turn mark up.

This is generally untrue, as much as it is a public perception. The system lacks simplicity and thus comes across as opaque; this is its failing. Its complexity is not malicious, though.

Re: Theranos

#100

Post by mjn »

mr_luc wrote: post #97
spartango wrote: post #94

Earlier quoted context omitted.

This board seems heavily geared to do deals for defense-related applications. That's fine; getting deals with the Armed Forces and VA is feasible and quite rewarding. What they overtly lack is connections to the healthcare world. I'm surprised they aren't publicly roped into Cleveland Clinic, Mayo Clinic or Kaiser, as they to support novel technologies in this space. I suppose you can argue that the business model is…

Serious question: what economic incentive does the healthcare world have to adopt something like this? If it's a finger prick, there's less to mark up. From the outside, it seems like the entire healthcare industry is built on being purposefully inefficient so as to create large costs that they can in turn mark up. To the VA, inefficiency is a problem. In the healthcare world in general, it doesn't seem to bother any…

Kaiser is one example where incentives align, because they're an integrated HMO, running both the insurance and the care side of things. It's kind of like an opt-in single-payer organization. Their model is that they charge you X/month for care, and then everything is billed internally, with Kaiser clinics treating Kaiser plan members. So if they can bring costs down, that helps them; since nobody external is reimbursing for services, there is no advantage to billing expensive tests.
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