Posted February 15, 2022
"The physician must be able to tell the antecedents, know the present, and foretell the future..." – Hippocrates

Even in today’s modern era of care delivery, this description of a physician’s core responsibilities still resonates. As patients, we hope – and even expect – that our care teams are constantly tracking details of our present health, recognizing signs and symptoms learned from millions of other previously treated patients like us, and using all this data to anticipate what could happen next. In other words, we want “always-on” care.

And yet today, as a physician in 2022, I often lament that I have more real-time insight into the status of my sandwich delivery than I do into the daily health of my patients. Memora Health is changing this, by integrating deeply with our most complex care delivery organizations and building the technology infrastructure needed to transform them into learning health systems that can provide proactive, continuous care.

The status quo for our sickest patients

The U.S. healthcare system today is a confusing paradox. On the one hand, we benefit from access to many advanced therapies and medical interventions. On the other hand, we are forced to navigate a fragmented collection of providers, a checkerboard of non-interoperable technology systems, a high ratio of administrative burden to clinical staffing, and a rising cost of care, which is increasingly borne in part by patients directly. U.S. healthcare expenditures represent nearly a fifth of GDP (a figure substantially outstripping that of other developed countries), and yet we still rank poorly on measures of healthcare access, quality, and preventable mortality.

Buried in these (often overwhelming) realities is an important and actionable data point: patients recall less than half of the recommendations they are given by their care providers, just one week after a clinical visit. This is a staggering statistic.

Most practicing providers would not be surprised by this data at all. We have all felt the anxiety associated with discharging a patient after surgery, knowing fully well that maintaining connectivity with them afterwards will be hard. We have hand-written detailed instructions for our patients on a sheet of clinic printer paper, and tucked them into a patient’s purse pocket, in the hopes that they will refer back to these notes. We have struggled while playing phone tag with a cancer patient a few days after writing a prescription, to make sure they know to expect certain side effects on certain days. These activities simply aren’t scalable, or even reliable. But these same challenges also provide a compelling hypothesis for how we might fundamentally improve our care delivery system going forward: by supercharging providers with modern, consumer-friendly technology that leverages automation to synthesize data from patients and support them continuously.

The new digital tech stack for complex care delivery

Manav Sevak and Kunaal Naik, co-founders of Memora Health, started the company in part due to their own lived experiences as friends and caregivers of a college classmate with a chronic, complex disease. Their friend’s medication regimen was complicated, and they were struck by how little support was available to patients in between episodic clinic visits. Patients with chronic disease have (often predictable) symptoms and questions every single day – so why does our healthcare system address them only sporadically?

Manav and Kunaal are scrappy technologists, and quickly built an early version of Memora’s initial product: a smart communication engine that could continuously remind patients about the medications that they were prescribed, collect patient-reported data, and triage concerns to a care team. Eager to better understand the needs and implementation challenges of their end users and customers, they then went on the road for 6 months, staying at Airbnbs across the country, to speak with clinicians and leaders at one health system after another. Even before the COVID-19 pandemic, they learned that health systems were eager to provide more continuous care outside their four walls, that standardizing evidence-based care delivery remained a frequent challenge, and that the solutions being built by existing technology vendors were cumbersome, and unlikely to leverage cutting-edge machine learning (ML) and natural language processing techniques to be learning from patient data on an ongoing basis.

Then, the pandemic arrived. What were previously stretch goals for health systems with respect to remote patient interaction and provider enablement – suddenly became requirements. And in parallel, the digital health community exploded in size and productivity; new point solutions emerged, seeking to create better, stand-alone experiences for patients, separate from our existing healthcare system. Most touted high-touch patient engagement as key differentiators of their care models, but few offered true evidence-based care journeys that could be trained on years of historical care data (most of which is institutionalized within large health systems). We found ourselves searching for a tech stack that could modernize our largest, most risk-bearing healthcare organizations – and help them care for the sickest, most complex patients who inevitably end up at their doorstep.

As we met with the Memora team (and their customers), the requirements for a new digital tech stack for complex, high-value care delivery came into better focus:

  • An SMS-based (vs app-based), secure, asynchronous patient communication platform 
  • Tight integration with human provider teams for clinical triage and navigation, while ideally producing a net time saving for these teams (e.g., without creating information overload for them)
  • Automation to both push data to patients, and pull new data in (via questionnaires that patients actually answer, connected wearables, and other diverse input streams)
  • Software-enabled care journeys that continue getting smarter over time by learning from the ongoing behavior of patients and providers in the network (vs requiring periodic manual builds)
  • The ability to support patients with high acuity, complex clinical conditions

Memora Health is systematically building enterprise software to deliver all of the above features, with an ever-growing market opportunity as the scale of data and interactions on their service grows (and we are of course all about network effects at a16z!). They bring to their mission a nimble team with profound urgency, commercial hustle, and technical excellence; since we led their last financing, their ML engine is live and seamlessly integrated with the electronic health records and data repositories of dozens of new healthcare organizations. We are proud that Memora has partnered with such a wide array of leading health systems, payors, and life science companies – with whom we will continue to learn and iterate on the future of tech-enabled complex care delivery.

Congratulations to the Memora team on their latest financing – we are thrilled to be backing the company, and are honored to continue serving on their board.