Bowie and the JPM Experience

Last week was quite a week. We lost David Bowie and gained another year at JP Morgan. Bowie’s passing was a big topic of discussion at the conference. GenXers and Millenials alike don’t like it when their superstar rock idols die of natural causes, and it made many feel their own mortality. We get so used to things we love that we are shocked when they pass.   Now that’s a metaphor for healthcare business models if I ever saw one.

“Ground Control to Major Tom
Take your protein pills
and put your helmet on”—David Bowie from Space Oddity

If you haven’t ever been to JP Morgan’s Healthcare Conference, it’s hard to convey the level of insanity that goes on. The main event, the conference itself, always occurs in the massively overcrowded and oddly designed corridors of the St. Francis Hotel. Something like 10,000 people attend the actual conference, and access to the hotel is guarded about as closely as El Chapo’s current jail cell. Everyone is in town, helmets on, protein bars at the ready, to hear what those in the know have to impart to those in the want-to-know.

“And all the fat-skinny people, and all the tall-short people, And all the nobody people, and all the somebody people” — David Bowie, Five Years

Outside the conference a whole city within a city amasses, as if it were Fort Lauderdale on Spring Break, with at least 100 million healthcare leaders and hangers on (well it seems like 100 million anyway but it’s probably another 15,000 or so in addition to the JPM 10,000) congregating to participate in a week of gladiator sport. They are all here, the mighty and the willing, to learn, network, do deals, be seen, make an impact, feel an impact, and to create a massive healthcare phantasmagoria worthy of the busiest day at Disneyland (if people wore gray pinstriped suits to Disneyland).

“You wanna be there when they count up the dudes”–David Bowie, Rebel Rebel

Indeed, the conference tends to have an over-representation of the XY chromosome and, as I have written in the past, there is literally no line for the ladies room. But it was actually better this year, in my view. I was moderating a panel at the actual conference and, as I looked out on the room, I saw some real live female people who were not hired models, and that actually surprised me. At virtually every setting I attended there was a better female turnout than in prior years. I’m not sure if it’s due to the pressure to fix the problem or due to an actual increase in women in positions of healthcare power, but whatever it is, it’s getting better. 85 women showed up to a meeting of women venture capitalists. Who knew? Yes, there is still a long way to go, but it gave me hope. And as Annette Bianchi, partner at Vantage Point Ventures reminded me, the JPM Healthcare Conference was originally started by a woman: Annette Campbell White. So there.

“I got a suite and you got defeat”—David Bowie, Young Americans

There is a huge contest for relevance and influence at the JPM experience (I think that’s a better word than “conference” since JPM themselves aren’t responsible for most of what happens outside the St. Francis except inferentially). Many companies save up major announcements for the week and people compete to rent the best hotel suites to impress their clients and colleagues. I found that some hotels had started charging as much as $35 just to SIT IN THEIR LOBBY CHAIRS; restaurants were charging up to $200 minimum to sit at their tables, even if all you wanted was a half hour to talk over coffee and a chance to change the band-aids on one’s blistered feet. I am clearly in the wrong business.

“Chippin’ around
Kick my brains round the floor
These are the days
It never rains but it pours”—David Bowie, Under Pressure

But despite all this ephemera, there is always a ton of action at the conference/experience, and between the breakfast meetings and second breakfast meetings and presentations and cocktail parties and late night dinners and underground events, there is real business to be done and, if you are a healthcare insider, you simply can’t miss this event. I was fortunate in that I had three opportunities to speak at three different events during the week, and thus had a great platform to voice my views among colleagues new and old.

Here are a few highlights from my week:

• At the actual JPM conference I moderated a panel of health data company CEOs to talk about whether and how data could help us solve the dilemmas we face in healthcare. There was a ton of great content from my panel, which included Farzad Mostashari, CEO of Aledade, Deb Kilpatrick, CEO of Evidation, Lonny Reisman, CEO of Health Reveal, Owen Tripp, CEO of Grand Rounds and Jonathan Hirsch, CEO of Syapse. The best moment, however, was definitely the discussion about how Uber could dramatically improve its home healthcare offering by dispatching doctors holding kittens. And of course, there was a memorable exchange when Farzad informed the audience that healthcare companies had pretty much better create a monopoly or die; there was a third choice, do a great job creating value by saving money and delivering quality, but that was drowned out by the other options.

• I walked by what looked like a new health food cafe on Powell near O’Farrell that I hadn’t seen at last year’s conference. I was looking around for the name when I realized it was Walgreens. Yes, that Walgreens, with a fruit counter and a juice bar and all the trappings of some kind of Marin County yoga bar. It left an impression on me, as I definitely think that the big retailers have figured out how to make a great experience for consumers that they are translating to the new front door of the healthcare system. I do not believe that the other big healthcare players are anywhere near them in capturing the hearts and minds of actual people as they go about their lives, healthy or not. It made me wonder why Amazon hadn’t yet purchased a pharmacy benefit management (PBM) company and wiped out the rest of the competition with better technology, logistics and service. Monopoly or die. It may yet happen here.

• At the McKesson Ventures breakfast, the room prominently featured three hilariously cartoonish piñatas in the form of a unicorn, a dragon and a donkey. Each had a hole carved into the top for attendees to insert their nominees for what digital health company was most likely to become a legitimate $1 billion enterprise (the unicorn); which company was actually so great it could return an entire venture fund (the dragon) and which current high flyer was likely to go the

  

  way of the dinosaurs (the “overpriced donkey” aka Unicorpse). (See related article from VC John Backus)

“Turned away from it all
Like a blind man” –David Bowie, Under Pressure

Despite it being a healthcare conference, you don’t really see much actual health or care going on, unless you count the relentless sharing of hangover remedies between unlicensed, self-appointed pharmacist attendees. But this time we actually did see Jonathan Bush, CEO of Athena Health and a former paramedic, drop to his knees and perform CPR on a man who had a heart attack. Of course there was already a crowd around the poor guy, taking pictures, tweeting and generally showing the world our industry’s less-than-optimal skills in patient empathy. It wasn’t until Jonathan showed up and actually helped the guy that hope was restored to the universe.

“How many times does an angel fall?
How many people lie instead of talking tall?”— David Bowie, Blackstar

I think the biggest message from the conference, one that I heard loud and clear, is that a correction is on the horizon. And not just a stock market correction, but a correction in the thinking about all the new solutions that have been coming fast and furiously to the healthcare scene. What needs to be corrected, all seem to agree, is that we need to return to a focus on real, measurable value creation and away from a focus on hype and technology for technology’s sake. Every meeting I led or attended ultimately discussed the importance of proof, of evidence, of efficacy AND cost-efficiency, the need to migrate back towards metrics one can actually count with numbers, not imaginary multiples of bitcoin.  There was definitely a sense that the silly party is over and the serious party needs to begin, particularly in the digital health sector, where buyers have lost interest in the late night TV advertising speak (NEW! IMPROVED! LEMON-SCENTED!) and want only to know how the myriad of so-called solutions are going to actually improve their businesses, stat. You want to know what health plans and provider systems are feeling? Just ask David Bowie:

“Pressure!
Pushing down on me…

It’s the terror of knowing
What this world is about
Watching some good friends
Scream “Let me out!”
Pray tomorrow takes me higher”—David Bowie, Under Pressure

No one knows better than David Bowie how important it is to recognize that change comes and one can’t stop it from happening. The healthcare industry is certainly experiencing its share right now, and it’s mostly a good thing, Much has been debated (for those of you who pay attention to these things) about the actual meaning of these Bowie lyrics:

“Time may change me, but I can’t trace time”—David Bowie, Changes

Here’s what I think they mean. All people (and industries) evolve as the result of experience and the compounded influences of the events that led up to the moment in question. But it’s impossible to go back and precisely track or recapture or change the events and actions and words that led to this moment in time, so stop trying. Just move on with grace, show leadership while you do it, and be one that contributes to the improvement of the system for all.

Happy start to the healthcare year for my fellow JPM experience participants.  It was great to see you and there’s almost enough time to rest up for next year!