Denver’s Digital Health Boom

Medical care is no longer confined to the doctor’s office. Or even, sometimes, to an actual doctor. That iPhone in your pocket now has the capability to diagnose your cough, answer insurance questions, and get you pregnant…or at least help the process along. Digital health (think: smartphones, social networks, and internet applications that provide patients with health information and better access to physicians) encompasses everything from Fitbits to electronic medical records to telehealth—and the trend is booming in Colorado. Employment in the medical device and diagnostic industry alone increased by 10 percent between 2012 and 2016 in the Denver metro area, which boasts the 11th-highest concentration of digital tech workers in the country. Here, we examine the Colorado companies harnessing cutting-edge tech to deliver more personalized treatment to patients all over the world.

Good Behavior

These local companies strive to reduce medical costs (and boost patient care) by curbing your poor decisions.

We have some bad news: You know the ever-spiraling, prohibitive cost of health care? It’s your fault. Well, not yours, specifically—it’s collectively the fault of all patients. Why? Because we make some really dumb decisions when it comes to our health. We smoke, we eat at McDonald’s, we accidentally see doctors outside our networks. Unnecessary emergency room visits alone add $38 billion annually to the national health care bill. But don’t get defensive. Atrocious policymakers and greedy corporations share the blame. Still, if we want to cut costs, one way is to improve our behavior.

Fortunately, digital platforms designed to help individuals make smarter, healthier decisions are all the rage in Colorado. So how are these startups getting patients to be good? With bribes, of course. Welltok, a Denver-based pioneer in health-optimization software, hosts a digital platform called CaféWell that covers everything from resilience training for your mind to daily flossing for dental hygiene. Welltok’s clients are insurance companies, hospitals, and employers who want to goad their staffers or consumers toward specific health goals. The Colorado Division of Human Resources, for one, distributes points to employees who participate in walking campaigns, complete online health assessments, and receive flu shots. If workers accumulate enough points in one year, they get a $240 premium reduction on their health insurance the following year.

RiNo’s Spoke Health, founded in 2016, also doles out rewards, but for making smart decisions about surgeries. For example, the median cost (paid by insurance and patients) for a knee joint replacement in the northeast region of Colorado is $51,900, according to the Center for Improving Value in Health Care; in the Denver region, it’s $23,100. Cost isn’t reflective of quality, so why not travel a few hours to save nearly $30,000? Spoke’s online platform crunches data to find the best surgeons at the lowest prices. Although Spoke’s clients are typically employers or insurance carriers, it interacts directly with consumers by enticing them to choose a less costly, though just as skilled, surgeon with bonuses paid by the employer that go toward out-of-pocket expenses.

Ultimately, though, digital health companies need to know their users to influence them. For that, they rely on big data. Welltok’s CaféWell mines biographic, demographic, and medical data to deliver dizzyingly personal advice to its users. For instance, it will pick up on the fact that your hometown has a high density of fast-food chains and then provide increased support for healthy eating.

Meanwhile, NextHealth Technologies, founded in 2013 in Denver, enables health insurers to sift through client data to identify folks with the greatest opportunity for change. Simple correlation: People who are overweight can reduce their chances of heart disease by shedding pounds. The company also uses analytics to determine the best manner to reach those people—a phone call, mailer, text message, email, or combination thereof—with important information. (An elderly person may respond better to a mailer than a text.) Finally, NextHealth analyzes millions of claims to determine if its communication altered patient behavior. If not, it tries another strategy. Over time, NextHealth learns your preferences, just as Google does. Which, sure, sounds creepy. Thankfully, you’ll have more time to complain about it during your much longer life.

The Price We Pay

• $6,804: Coloradans’ annual per capita spending on health care in 2014—the fifth-lowest in the United States.
• $14.7 billion: Portion of the Centennial State’s health care outlay that went toward hospital care in 2014—the most of any health-related service in the state.
• 6.5%: The average annual increase in health care costs in Colorado from 1991 to 2014, the 18th-highest jump in the country.

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Intelligent Design

A new crop of Colorado-developed smart gear marries innovative software and sleek hardware so you can work out, get healthy and procreate just as Jobs intended.

WINK: A Bluetooth-enabled thermometer records basal body temperature—an indicator of ovulation—so couples know exactly when to get busy with the baby making (or, if you’re on the natural birth control plan, when to just Netflix and literally chill). Wink automatically records the data, which syncs with an app called Kindara; its new features include chat rooms and direct messaging with other Kindara users—because it’s never a bad idea to connect with someone who knows what
you’re going through. kindara.com

GAUGEWEAR: This gadget, developed in part from research by the University of Colorado Boulder, uses a fancy, patented process called radiometric thermometry (it’s like infrared, but can actually gauge the heat inside your body as opposed to only the surface) to measure core body temperature. Worn over the heart, the device can help soldiers and firefighters monitor their temps in intense conditions, as well as protect ultrarunners and other extreme-sport enthusiasts from heat-related sickness, which is one of the top three killers of athletes. gaugewear.com

BAZIFIT: This sensor asks the age-old question: Do you even lift? It attaches to a dumbbell or other piece of equipment to determine whether you should weight up or down. It flashes red if you need to drop weight, blue if you’re right on, or green if you need to add some lbs. (FWIW: Men typically rack too much; women, not enough.) The accompanying app not only tracks your gains toward buff-dom, it also pairs you with an online trainer, who creates workouts for you. bazifit.com

STANDLOGIX: Standing desks are tricky: When do you stand? When do you sit? It’s very confusing. This Arvada startup manufactures a small monitor that attaches to the bottom of desks and sends a gentle reminder through your computer screen when it’s time to get up or sit back down, so you don’t remain sedentary or get fatigued. It sounds simple, but, left to their own devices, Americans with standing desks only stretch their legs a little less than 40 minutes a day, on average. With this device, they stand as much as 3.25 hours a day. standlogix.com

WÜF: Given that we Coloradans just might care more about our dogs’ health than our own, Boulder-based Wüf nailed the market with what it’s billing as the world’s smartest dog collar—yep, a wearable for canines. The Wüf has plenty of features, including an activity tracker that, taking into account age and breed, makes dietary recommendations. getwuf.com

That’s Unreal

Is virtual reality the next big thing in mental health care? – Daliah Singer

A gentle breeze blows across a landscape of lush greens and aquatic blues. Waterfalls flow over rock into a placid lake. I can hear the leaves rustling on the trees. Or so my brain thinks—until I discard the boxy, black headset I’m wearing and blink into the conventional office around me. My happy place only exists on a screen, the backdrop to my virtual reality (VR) guided meditation.

Some say it’s the future of health care—my Zen session is just one of many applications of VR as a treatment strategy. Post-traumatic stress disorder is another relevant realm. The first step in treating PTSD is to determine what triggers an episode. Using VR, a therapist can place a veteran back in a crowded market in Baghdad and pinpoint the sound or action that gives rise to a reaction, then create a responsive treatment plan. Someone with social anxiety can face a crowded VR party in a modern-day version of exposure therapy. Mental health practitioners can get more realistic role-playing experience talking to a suicidal person through a VR training module. “There’s really no end to what this technology can do,” says Matt Vogl, executive director of the National Mental Health Innovation Center (NMHIC), which opened in February 2016 on the University of Colorado Anschutz Medical Campus, with the goal of pioneering solutions to systemic mental health problems.

Although research and clinical validation studies with modern equipment (and large sample sizes) are still in their nascent stages, early efforts are promising. Analysis of VR software that sets pediatric burn patients in a snowy setting while they’re receiving treatment has shown a 25 to 40 percent reduction in reported pain. This past fall, NMHIC launched a pilot with CU’s School of Dental Medicine to determine whether VR can help people with a phobia of getting their pearly whites treated. “We see technology as something that can be a leveler,” Vogl says. “We’re trying to accelerate the pace at which new ideas get out there.”

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Find Your Center

Every empire needs a capital. In Colorado, RiNo’s 180,000-square-foot Catalyst HTI could become the epicenter of the burgeoning digital health sector. Opening in May, Catalyst will be an “industry integrator,” its founders claim. The idea: Amassing a mix of grassroots startups and established businesses under one roof will lead to collaboration that spawns innovation. The facility will boast a co-working floor, four startup accelerators, and traditional office space for big-name powers such as Kaiser Permanente, which will staff a clinic on the ground floor. We caught up with Catalyst president and veteran entrepreneur Mike Biselli (pictured) for his take on the new project.

5280 Health: Why has health care dragged behind other industries when it comes to innovation?
Mike Biselli: Perverse incentives. If you look at how we incentivize our industry, it’s broken. We’re currently in a fee-for-service environment: A physician or a provider gets paid by your insurance whether you get better or not. And that doesn’t work.

How will creating a space in which health care behemoths cohabitate with small startups help fix the system?
Over the next couple of years, health care will move to a fee-for-performance model. Or fee for value, if you will. A lot of the players inside of health care realize they better start coupling themselves with the innovators and the disruptors. If they don’t collaborate and partner with nimble startups, they could be completely dismantled—and quickly. Look what Uber did to the taxi industry.

Which elements of health care can benefit most from digital health?
Where do I start? The big thing is allowing our electronic health records to talk to each other. My health records should follow me wherever I go. Another big piece is that it’s expensive to have patients come into brick-and-mortar facilities. So how do we engage patients through telemedicine and digital connectivity? Trends are showing us that younger generations want that.

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Aid Station

Natural disasters and manmade conflicts create devastating health hazards in developing nations. By becoming the “Amazon of Aid,” the Level Market in Golden hopes to make it easier to deliver humanitarian supplies to those hard-to-reach locales.

Stephanie Cox spent 17 years working in war zones and developing countries, tackling challenges such as boosting water quality, improving sanitation, and advocating for citizens’ access to small-scale agricultural markets. Her experience taught her that while disasters inspire millions to volunteer their time and donate their money, “nobody thinks about how aid supplies get around the world,” Cox says. “It’s an inefficient industry”—one complicated by different languages, infrastructures, and time zones that make it hard for, say, an American NGO to communicate with a manufacturer in Asia. Enter the Level Market, based in Golden. Cox founded the online marketplace in 2015 to be the Amazon of the $140-billion-a-year aid industry. Do-gooders looking to quickly buy and ship products simply click on the company’s website. Here’s how the Level Market is making the world a healthier place.

1. Origin: United States
   • Recipient: Japan
   • Order: 150 packets of Plumpy’Nut, a peanut-based paste used to treat severe acute malnutrition, $50
   • Buyer: Save the Children Japan, a subset of an international NGO that works to protect kids around the world.
   • Purpose: The Save the Children outpost used Plumpy’Nut to demonstrate to supporters that a product does exist that can improve the nutrition of kids ages six months to five years in developing countries.
2. Origin: United Kingdom
   • Recipient: Nigeria
   • Order: Two DelAgua water-testing kits, $2,320 each
   • Buyer: FHI 360, a humanitarian outfit based in Washington, D.C., that organizes and implements health, education, and nutrition programs in more than 60 other countries.
   • Purpose: Part of a program funded by USAID Water and Sanitation (which has improved access to drinking water for more than 7.6 million people as of 2015), the kits evaluated the quality of drinking water at the sources.
3. Origin: India
   • Recipient: Freetown, Sierra Leone
   • Order: 100 DuraNet long-lasting nets (with insecticide), $2.28 each
   • Buyer: Synaptic Street Creative, a marketing company based in Seattle
   • Purpose: Synaptic Street Creative is using the nets as part of a documentary it’s making in Sierra Leone about children with malaria. The film will be shown in public schools in the United States to boost awareness about the disease.

Vital Signs

BurstIQ wants you to profit from your own health stats.
One currency of the future? Health data. BurstIQ, a Denver-based startup founded in 2015, is building an online ecosystem of sorts where you’ll be able to hawk your blood pressure and other medical measurements to parties who want to buy them. Who will be in the market? Consider, say, a medical researcher who needs data from a certain cohort to study blood pressure and would be willing to pay for access to your digits.
The process begins with BurstIQ’s LifeGraph, a free online dashboard that aggregates your health data, from patient records to daily FitBit steps. You’ll be able to share some or all of your LifeGraph with whomever you choose, including a new doctor. But you’ll also be able to advertise it on BurstIQ’s online bazaar to a larger, less personal audience of interested parties. BurstIQ even has its own currency: BiQ Tokens, which are kind of like Bitcoins. Once you’ve collected enough BiQ Tokens in your HealthWallet, you can spend them to buy genetic testing kits, telemedicine services, and other health care products. And the future is nigh: BurstIQ hopes to unveil its marketplace during the first half of this year.

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Going The Distance

Can telemedicine deliver convenience and high-quality care?

Lauren Geraghty knew something was wrong the first time she changed her son Noah’s diaper and found blood in his stool. As he grew older, severe stomachaches and diarrhea pointed to celiac disease—an allergy to wheat—but no one in their hometown of Durango could tell Lauren for sure. Finally, when Noah was 11, his pediatrician recommended that Lauren and Noah meet with Dr. David Brumbaugh, a pediatrician at Children’s Hospital Colorado (CHC) in Aurora, when he visited an outreach clinic in Durango. Brumbaugh performed an endoscopy and confirmed her suspicions; he asked them to visit a CHC dietician to learn how to prepare a gluten-free diet. The problem? The dietician worked in Aurora. “To drive six hours to Denver, get a hotel room, miss school, take three days off work—my family couldn’t afford that,” Lauren says.

To her relief, Lauren and Noah were able to meet with the dietician at their local pediatrician’s office—via video. Telemedicine (connecting remotely with a doctor or other health care provider via the likes of video or text, sometimes for diagnosis and a full treatment plan) carries immense promise for today’s everything-at-your-fingertips consumers. “We invested in telemedicine to bolster the critical missions of the hospital,” says John F. “Fred” Thomas, director of telemedicine at CHC. “That includes reducing wait times, improving relationships with our provider partners, and reaching remote areas.”

So far, not a single CHC patient has balked at receiving treatment through telemedicine, according to Thomas. But a 2016 study in the JAMA Internal Medicine journal, which found that nearly a quarter of the diagnoses in 599 telemedicine cases were incorrect, has elicited some concerns about the accuracy of telemedicine. (Missed, delayed, and incorrect diagnoses typically happen 10 to 20 percent of the time, according to a different study.) The JAMA study examined only one-night stands: telemedicine providers who take your credit card, hear your malady, and bang out a prescription. That sort of siloed service—a far cry from the comprehensive telemedicine practiced at CHC—tainted the concept. “Telemedicine earned a bad name for fragmenting care,” says Dr. Blake McKinney, the co-founder and chief medical officer of CirrusMD, a RiNo-based startup that connects patients and doctors through an online platform.

Unlike swipe-by-night providers, CirrusMD concentrates on the continuum of care by partnering with health care systems, such as Kaiser Permanente Colorado, to serve as the front door or portal for patients. While a patient with the flu might only get a prescription from the telemed provider, the treatment gets recorded in his or her file so Kaiser doctors can refer to it later. For more serious issues, the telemed doc will schedule an appointment with a Kaiser specialist. “CirrusMD doesn’t just do a diagnosis,” McKinney says. “We create a plan.” That way, patients know that convenient care doesn’t turn into careless care.

As for Noah, he’s now absorbing nutrients and growing normally. He’s become a label reader on the lookout for “smoke” or “caramel” flavoring—telltale signs of gluten. But six hours to reach the doctor could’ve been a hardship that kept him from optimum health. “I’m embarrassed to say I wouldn’t have gone to Denver,” Lauren says. Fortunately for Noah, she didn’t have to.

Delivering The Goods

Digital innovation is soaring in the health industry, but it’s not the only technology shaping the future of medicine. Colorado’s 720 bioscience companies and organizations are dreaming up some pretty far-out tech too, including new ways to cure old ailments.

PharmaJet
The Problem: Limited supply of the polio vaccine
The Solution: PharmaJet in Golden makes a needleless, spring-powered syringe called the Tropis that delivers vaccines intradermally (just beneath the skin) rather than into the muscle. Why does this matter? A study by the World Health Organization showed that two 0.1-milliliter doses of inactivated polio vaccine delivered intradermally produce a stronger immune response than a full dose (0.5 milliliter) administered into the muscle. Accordingly, the company is working with the WHO’s Global Polio Eradication Initiative; the group has helped reduce the incidence of polio by 99.9 percent since its founding in 1988, but it’s experiencing a shortfall in its vaccine stockpile.

Mindful Labs
The Problem: Stress
The Solution: Aurora-based biotech startup Mindful Labs works in two ways, combining digital techniques with more traditional scientific methods. First, you sign up (a subscription costs $12 a month) and send in a hair sample. The lab tests the strand to check cortisol levels, which positively correlate with anxiety. (In essence, Mindful Labs quantifies your stress.) The accompanying app then guides you through steps to reduce the anxiety through meditation and other stress-relieving programs. Repeat every month until your anxiety feels under control.

Next Frontier Biosciences
The Problem: Inconsistent doses of MJ
The Solution: Some Coloradans consume marijuana as a substitute for antidepressants. It’s called “microdosing”—taking 0.3 to just under five milligrams as opposed to the state-recommended dose of 10 milligrams for recreational use. The issue, whether you smoke or eat the pot, is
measuring out a consistent dose. Not only do Next Frontier scientists engineer marijuana that delivers the same level of THC every time, but the Denver company’s Verra Wellness brand also packages the pot in nasal mist and sublingual (under the tongue) spray canisters. Both of those areas absorb THC quickly, ensuring you don’t overindulge due to a delayed response.

Let There Be Light

Researchers at the University of Colorado Boulder are using an illuminating new technology to study cancer.
One of the most important medical advancements of this millennium is CRISPR-Cas9, the sci-fi-sounding acronym whose function is a science geek’s dream. In the last seven years or so, researchers showed that scientists could use the molecules comprising CRISPR to easily cut a DNA section from a cell and replace it with a sequence of their choosing. This procedure is called “gene editing,” and its applications range from studying autism to creating drought-resistant crops.

At CU Boulder, Nobel Prize–winning chemist Thomas Cech is using CRISPR to examine the effects of cancer drugs. In most cancers, the enzyme telomerase attaches itself to the ends of chromosomes inside tumors’ cells, enabling the growth to expand and metastasize. Cech has been testing medicines that prohibit telomerase from grabbing onto the chromosome ends, but it was difficult to track the telomerase to know whether the drugs were fulfilling their duty—until CRISPR. With the gene-editing tool, Cech slices off the end of normal telomerase and attaches in its place a molecule that lights up. Under the microscope, Cech tracks the light to see if and how the meds are working. Think of it as a game of following the bouncing ball—one that just might save lives someday.

Applicable Apps (And Other Stuff)

A few of Colorado’s niche digital health innovations to watch.

• Founded by a Lafayette teenager, Myonic Move uses electromuscular stimulation to help people with paralysis move their fingers and elbows…with their minds! It finished third (seriously!) at Lafayette’s Centaurus High School science fair.
• Last year, UCHealth launched LungDirect, developed by Matrix Analytics, at its University of Colorado Hospital in Aurora. The platform (developed for doctors) tracks patients’ pulmonary nodules (spots on lungs) and prompts patients to get the follow-up care they need.
• WhiskerCloud, a Colorado-founded startup that relocated to California, designs cloud-based (read: reliable), personalized websites for veterinary clinics. The good news for pet parents: WhiskerCloud makes it easy to fill out all paperwork online, so you (and Fido) are ready to roll when you arrive for a check-up or emergency visit. And better still for vets, the company manages SEO, keeps watch over online brand reputation, offers high-level web security, and handles social media—so vets can spend more time caring for our furry friends.
• Cliexa-RA helps patients with rheumatoid arthritis communicate with their docs by giving patients a place to log symptoms and then translating that data into a model doctors use to evaluate treatment options. How good is it? A study published in the Journal of Medical Internet Research ranked Cliexa-RA 19th out of nearly 1,000 apps in the world for monitoring RA.
• Method specialists at orthopedic groups and fitness centers test you in person to identify your prime metabolic zone (where you perform best and burn the most fat) during exercise. Then its app tracks your performance and its experts provide personalized workouts and feedback like, “Hey, wuss, do another rep!” Only, they’re nicer about it.
• Wellness Intel collects your vitals and medical history so when you feel sick, the app can make an educated guess about what ails you—and direct you to the proper care facility. You can even enter your insurance info to be sure you end up at an in-network spot.
• Some mental health professionals use sand-tray therapy, a process in which patients build models out of figurines and sand; the activity might hint at the problems patients are facing and help heal the psyche. Virtual Sandtray is the digital version of that technique, for use by mental health professionals with their clients
• Although only in beta, Listen.MD claims its patent-pending artificial intelligence technology will be able to listen in on doctor-patient conversations and automatically fill in electronic media records. Which is important, considering physicians now spend 50 percent of their time performing data entry and only 27 percent of their day with patients, according to the RiNo-based startup.

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Editor’s Note 1/3/2018: A previous version of this article incorrectly characterized WhiskerCloud’s services. We regret the error.