Bio Journal Club; Drugging the Undruggable; and Healthcare, Unbundled

Announcing Bio Journal Club

This month, we kicked off our new a16z Podcast show Journal Club, with Bio Journal Club (hosted by Lauren Richardson, PhD, who joins us from PLOS Biology). Bio Journal Club curates scientific breakthroughs, and why they matter from our vantage point at the intersection of biology and technology. Our inaugural episode covers two topics but multiple research papers: (1) identifying new antibiotics through a novel machine-learning based approach and the implications for pharma; and (2) characterizing the protein structures of the coronavirus causing the COVID-19 pandemic, and what we can learn from it for therapeutics and more.

Listen to the first episode here.

Drug discovery in the age of coronavirus

Developing new drugs is a herculean task. Traditional drug discovery and development often takes years, even decades, and there are entire categories of drugs so elusive we call them “undruggable.” But that might be changing: in this article, general partner Vijay Pande argues that drug development in the age of COVID-19 and beyond might look very different, as an engineering approach and new technological tools transform this process to be faster, more efficient, and more successful. And in this episode of the a16z Podcast, general partner Jorge Conde, Vijay Pande, and Hanne Tidnam discuss with Jay Bradner, President of Novartis’ R&D institute, NIBR, how a whole new world of targets and medicines we once thought was impossible is emerging today.

Healthcare has left the building...

In some ways, the healthcare system of the future will look like science fiction—therapies that are algorithms, medicines made for you from your own engineered cells and genes, sensors continuously and passively monitoring your health all around you. But in others ways, it just might look a lot like the past. This presentation by Jorge Conde, first given at the 2019 Oliver Wyman Health Innovation Summit, first tracks the evolution of modern healthcare and the rise of the giant healthcare institution, from doctors making housecalls and apothecaries grinding out homemade medicines, to the centralization of specialized equipment and knowledge. What does the healthcare system of the future look like—only hastened by COVID-19—when healthcare leaves the hospital, medicine leaves the pill bottle, and one day, we may not even need symptoms to tell us we’re sick?

Watch this video (or read the article) here.

... And primary care is getting unbundled.

Primary care was set up to be the “front door” of the healthcare system. COVID-19 has shown us pretty clearly that as a front door goes, it’s broken. But just the same way that the impact of COVID-19 is exposing the fractures in our system and shining lights on innovation in other areas, general partner Julie Yoo argues in this article that we’re going to see an acceleration of a new operating system for primary care. Primary care in the future will better serve users by verticals or demographics; allow more access at different points in the care delivery spectrum; and use new tools to finally set primary care up properly for success.

Building momentum for virtual care

The past few weeks have seen more movement in virtual care adoption, incentives, and regulation than the past several years combined. We’ve talked about how the COVID-19 pandemic has created a staggering demand for virtual care across the board, from primary care to specialist settings like oncology. But how do we maintain this momentum so virtual care sticks even when patients can safely return to the clinic?

More regulatory changes will be required. We’ve already covered the recent HHS Interoperability Final Ruling and its expected impact on increasing accessibility and portability of health data. But COVID-19 has forced other temporary regulatory adjustments too: support from CMS and some commercial payors to reimburse virtual care at parity with in-person visits; relaxed restrictions around the technology tools used to provide virtual care, the services it can be used for, and the geographical areas in which it can be offered; and funding and stimulus measures from the FCC and others to lower the barrier for adoption of virtual care technologies. Though some of these are still just temporary, they are key catalysts; to sustain this momentum, we need continued adoption to drive clinical impact, bottom-up advocacy, and top-down regulation.

More trends building momentum for virtual care:

• New patterns of behavior created and reinforced: The rapid increase in the adoption of virtual care tools has so far anecdotally seen high satisfaction rates for both patients and providers across a wide range of demographics.
• Virtual medicine as a critical resource isn’t disappearing: An expected prolonged “return to work” period for clinics and patients means that we’ll likely need virtual care to plug a critical gap well beyond the initial peak of the pandemic.
• A window for demonstrated impact: This period of elevated adoption plus relaxed restrictions is a powerful opportunity for demonstration of the impact of virtual care models. Showing that these models can drive high value care—a product of both clinical outcomes and cost of care—on top of a positive patient experience will be critical for durable policy change.

In this unique moment, CMS and other commercial payors are actively discussing more permanent changes around regulation in the space. All signs point to virtual care being here to stay.

Justin Larkin is an investing partner on the Bio + Health team, focused on healthtech, including care delivery and horizontal infrastructure.

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