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The White House recently shared its hot take on the “care economy’s” crucial role in supporting labor force participation, stating that “low U.S. fertility combined with an aging population has the potential to generate significant headwinds to economic growth.” As a digital health community, we should pay attention to the pressure cooker of problems associated with the growing numbers of retirees, the lack of babies being born (a.k.a future taxpayers), and the dearth of affordable care for...

After spending a few days this week at another star-studded health care conference - in this case, Fortune Brainstorm Health - I walked away totally convinced about the root problem underlying our health care system. If I had to summarize that in a single word it would be this: Churn. Simply put, we cannot do true prevention at scale if no one is incentivized to keep the patient healthy in the long-term.

If you have read the news, watched cable TV, rode the subway, or been on TikTok in the last six months, you’ve most certainly heard of weight loss drugs like Mounjaro and Ozempic. These “GLP-1” drugs which stand for glucagon-like peptides, have been hailed by celebrities and weight loss influencers as modern medical miracles and as the ultimate solution to our massive obesity epidemic.

My co-author for this post, Leslie Schrock, is the author of a new book called Fertility Rules, published by Simon & Schuster. She also publishes a Substack with a weekly roundup of fertility-related news. So how big is the fertility market really? Well, that’s the question that investors are grappling with as we speak. It’s a difficult one to answer, we think, because the sector today is a bit like the luxury travel market before the introduction of Airbnb.

The day after Tim Peck shut down his company, Call9, he ran the Brooklyn half marathon. Or more accurately, he walked it. If this were a movie, Peck would have crossed the finish line in record time with a look of fierce determination. Instead, Peck felt more defeated, and sleep deprived than he had in a long time. As he walked, he used the opportunity to call family, friends, and angel investors for a series of hard conversations.

2023 was hard. 2024 may be even harder. I am not a big believer btw in sugarcoating. Life has taught me that it’s better to face a hard thing with a plan. If you know what to expect, you’re more likely to get through it unscathed. And that’s not the only benefit to transparency. When we are all collectively facing tough times, we can turn to each other for help. Startup founders right now are struggling the most and could use the support. So let’s get into it. Why might things get worse in 2024?

For years, I’ve seen rampant speculation that when valuations come down (tick) and executives express more interest in selling for the right price (double tick), private equity firms would swoop in to do a bunch of deal-making in digital health. But they aren’t. Or at least, not at the level that I’d expect. So I’ve been probing my private equity investor, analyst and banker friends a lot in recent weeks.

One of the most common problems I have seen in digital health is awareness. That’s a big reason that you’ll hear companies talking about “covered lives,” meaning the number of people eligible to use their service via their health plan or employer, versus the number that actually uses them. That actual numbers of patients who use the service - and not just once for a lark once or twice - is typically very low. Depressingly so. Is that digital health’s fault?