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This Mother’s Day, Let’s Get Mothers the Health Care Coverage They Need

Mothers deserve more than a day of recognition this year—they deserve the whole month, and more. The pandemic has been particularly hard on women, especially poor women and women of color. 

To demonstrate the appreciation mothers deserve this Mother’s Day, we should get them something they really need: health care. To improve maternal health, we should look to the Medicaid program, long a pathway to accessible, quality health care for low-income Americans. Medicaid is especially important for mothers; it covers close to half of all births in the U.S.

Now, states have the opportunity to do even more for moms.

The American Rescue Plan signed into law in March gives every state the option to extend Medicaid maternity coverage for up to 12 months postpartum, a significant increase from the current limit of just 60 days. Illinois has already announced it will extend postpartum coverage; other states should follow. Extending the guaranteed coverage period will increase access to postnatal care during this ‘fourth trimester’ to ensure that women can access treatment for common conditions like postpartum depression as well as preventing organ prolapse or hemorrhage. Not only mothers will benefit. Parental insurance is associated with better health for children, including a lower risk of adverse childhood experiences.

In addition, the American Rescue Plan offers an opening to expand Medicaid with even more federal funding than is currently available through the Affordable Care Act. The 12 states, mostly in the South, that have not expanded their Medicaid programs are  leaving hundreds of thousands of women without the support they deserve. 

Expanding Medicaid programs will provide robust access to health care to more women and reduce maternal morbidity and mortality, which has reached crisis proportions among many women of color. Black and Indigenous women are more likely than other women to die during pregnancy, childbirth, and the postpartum period. According to the CDC, the maternal mortality rate is 2.5 times higher for Black women than white women. Disparate access and uneven quality of care, higher rates of chronic illness, and racism all play a part in that grim statistic.

The disproportionate burden of maternal mortality and adverse outcomes from childbirth has long-lasting effects on mothers and their children. Black newborns have an increased risk for long-term complications resulting from pre-birth complications. They may also face generational poverty and trauma in the long run if they are born to a mother who dies during childbirth.

Racial disparities in maternal health are getting much-needed attention. Celebrities from Serena Williams to Beyonce have spoken out about their own experiences with maternity complications. The Black Maternal Health Momnibus Act was reintroduced in Congress this past February. The bill would fund community-based services, mental health care, research, and data collection to better understand and improve Black maternal health outcomes. And a major health insurer recently announced its commitment to reducing Black maternal mortality by 50% in five years.

One of the most important ways to reduce Black maternal mortality is by expanding Medicaid. Expanding the Medicaid program works. Fewer moms die. A 2020 study found that maternal mortality rates were lower by 6.65 maternal deaths per 100,000 live births in states that had expanded Medicaid. This effect was concentrated among non-Hispanic Black women, which suggests that Medicaid expansion alleviates some of the disparities in health outcomes for Black women.

Maternal mortality rates were even lower in Medicaid expansion states (by 7.01 maternal deaths per 100,000 live births) later in the postpartum period (more than 42 days after birth). Longer-term postnatal care may have a substantial impact on reducing maternal mortality. And because the majority of the states that haven’t expanded Medicaid are in the South and have a higher proportion of Black residents, Black women will benefit significantly from these Medicaid expansion efforts.

The time for states to act is now. The American Rescue Plan’s incentives for states to expand Medicaid, which provide enhanced federal dollars for two years after expanding, comes off the table as soon as March 2022.  The opportunity to expand postpartum coverage starts in April 2022 and would be available for five years, but we shouldn’t wait—too many mothers are dying unnecessarily.

Mothers everywhere—and the people who love them—also have a role to play. We can all push states to expand their Medicaid programs through our own advocacy. Each state requires its own strategy for Medicaid expansion. Some states can do ballot initiatives, others need the state legislature to act. Organizations like Community Catalyst and U.S. of Care know the local landscapes. The rest of us can support these organizations that help citizens in those states to get it done.

Making sure all mothers in the U.S. have health insurance will take an ongoing effort. It’s more than an election-year issue, and we can provide this critical support now. Mothers deserve no less. 

Rosemarie Day is the Founder & CEO of Day Health Strategies and author of Marching Toward Coverage:  How Women Can Lead the Fight for Universal Healthcare (Beacon Press, 2020).  Follow her on Twitter:  @Rosemarie_Day1

Deborah Gordon is author of The Health Care Consumer’s Manifesto: How to Get the Most for Your Money (Praeger, 2020) and an Aspen Institute Health Innovators Fellow. Follow her on Twitter: @gordondeb

The authors greatly appreciate the research contributions of Allie Dawson, MPH (Consultant at Day Health Strategies) to this piece.

#Healthin2Point00, Episode 205 | Groups, Collective Health, Oura Ring & Ciitizen buys Stella

Today on Health in 2 Point 00, it’s time for the silliness to end, and for Jess DaMassa and I to take digital health deals seriously. Groups gets $60 million from a bunch of famous investors. Oura, they of the tracking ring used by the NBA, gets $100m, and TPA substitute Collective Health gets a whopping $280m from a big Blues plan. And our favorite privacy maven Deven McGraw gets a mention as her company Ciitizen buys interoperability tech company Stella. Did we maintain our serious demeanor? You’ll have to watch to find out but you can probably guess the answer!Matthew Holt

“Necessitous Men Are Not Free Men” – Words to Remember

By MIKE MAGEE

In the second half of the 19th century, Emily Dickinson wrote a short poem that could easily have been a forward looking tribute to two American Presidents – one from the 20th, the other the 21st century.

Dickinson’s poem “A WORD is dead” is hardly longer than its title.

“A WORD is dead

When it is said,

  Some say.

I say it just

Begins to live

  That day.”

She certainly was on the mark when it came to President Franklin Delano Roosevelt’s signature legislation. FDR’s New Deal, extending from 1933 to 1939, ultimately came down to just three words – the 3R’s – Relief , Recovery, and Reform.

He promised “Action, and action now!”  This included a series of programs, infrastructure projects, financial reforms, a national health care program and industry regulations, protecting those he saw as particularly vulnerable including farmers, unemployed, children and the elderly.  And he wasn’t afraid to make enemies. Of Big Business, he said in a 1936 speech in Madison Square Garden, “They are unanimous in their hate for me – and I welcome their hatred.”

But he was also a political realist. And by his second term of office Justice Hughes and his Conservative dominated Supreme Court had begun to undermine his legislative successes and were threatening his signature bill- the Social Security Act. So FDR compromised, and in the face of withering criticism from the AMA, postponed his plans for national health care.

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#Healthin2Point00, Episode 204 | Vida, Headway, & Neuroelectrics, plus RCM acquires VisitPay

Today on Health in 2 Point 00, I am over the moon excited about Chelsea’s Champion’s League semi-final win. But on Episode 204, we have some big deals to cover too. First, Vida Health gets $110 million in a Series D bringing their total to $188 million. Next, R1 RCM acquires VisitPay for $300 million, integrating patient financial engagement into their revenue cycle management offerings. It’s Mental Health Awareness Month, and mental health startup Headway raises $70 million – do they have a chance in that crowded space? Finally, Neuroelectrics gets $17.5 million for their neurostimulation cap helping with epilepsy and depression. —Matthew Holt

THCB Gang Episode 53, Thursday May 6

Episode 53 of “The THCB Gang” was live-streamed on Thursday, May 5 at 1pm PT -4PM ET. Matthew Holt (@boltyboy) was joined by regulars: futurists Ian Morrison (@seccurve) & Jeff Goldsmith; privacy expert and now entrepreneur Deven McGraw  @HealthPrivacy; policy expert consultant/author Rosemarie Day (@Rosemarie_Day1); medical historian Mike Magee (@drmikemagee), & THCB regular writer Kim Bellard (@kimbbellard)

Matthew was celebrating Chelsea’s Champion’s League Semi final win, but the rest of the gang talked about some big picture issues behind public health, COVIUD and health care policy!

The video is below but if you’d rather listen to the podcast. it will be available on our iTunes & Spotify channels from Friday. 

Inside Vida Health’s $110M Series D & Big Push into Digital Mental Health

By JESSICA DaMASSA, WTF HEALTH

It’s another mega-round for a digital health chronic condition management startup, as Vida Health closes its $110M Series D – AND adds a pair of big-name insurers to their cap table. Vida’s Founder & CEO, Stephanie Tilenius, gets into the good news about the funding round, which was led by growth equity fund, General Atlantic, and brought managed care giant Centene (a Vida customer) and multinational insurer AXA into the mix.

Beyond the funding – and the extra “insurance side” endorsement it gives to the virtual chronic condition care space – what’s interesting about Vida now is how its “whole person” approach, which integrates physical health care and mental health care, is very much tilting to mental health these days.

While overall revenue has tripled since last year, Stephanie talks about how the 6000% year-over-year growth for her mental health services has played into that rise, and how the new funding will be used to further expand those offerings.

Does this mean we need to start naming Vida as a competitor to digital mental health companies like Ginger, Modern Health, and Talkspace? And, how does this impact their positioning among the field of other health tech chronic care co’s? For those who may have forgotten, Vida went out the gate with a platform that was designed to treat both the mental-and-physical aspects of chronic disease, while others like Omada and Livongo-now-Teladoc acquired-and-integrated behavioral health providers to augment their physical-first offerings and satisfy customer demands. Will it now prove easier for Vida to scale-up and scale-out, having been built for both “mind and body” from the very beginning? Stephanie’s got her opinion, big plans, and now a treasury to rival those key competitors across both fields of care. Tune in for all the details!

#Healthin2Point00, Episode 203 | Privia goes public, Vocera acquires PatientSafe Solutions & more

Today on Health in 2 Point 00, Jess hardly knows the value of $100 million anymore – is it a salary, is it an entire fund, is it one single round? On Episode 203, Jess and I cover Vocera buying PatientSafe Solutions and Privia going public with a $3.7 billion market cap. Cash-paid healthcare services company Sesame gets $24 million in a Series B, Ceribell gets $53 million in a Series C for its portable EEG, and Summus Global gets $21 million in a Series B providing virtual specialist care. —Matthew Holt

We Are All Designers

By KIM BELLARD

Raise your hand if you had to go through the Hunger Games labyrinth to score a COVID-19 vaccine earlier this year – figuring out which phone number(s)/website(s) to try, navigating it, answering all the questions, searching for available appointments within reasonable distances, and, usually, having to try all over again.  Or, raise your hand if you’ve had trouble figuring out how to use an Electronic Health Record (EHR) or an associated Patient Portal. 

Maybe you thought it was you.  Maybe you thought you weren’t tech-savvy enough.  But, a trio of usability experts reassure us, it’s not: it’s just bad design.  And we should speak up.

“Everyone everywhere: A distributed and embedded paradigm for usability,” by Professors Michael B. Twidale, David M. Nichols, and Christopher P. Lueg, was published in Journal of the Association for Information Science and Technology (JASIST) in March, but I didn’t see it until the University of Illinois School of Information Sciences (where Dr. Twidale is on faculty) put out a press release a few days ago. 

The authors believe that bad design has costs — to users and to society — yet: “The total costs of bad usability over the life of a product are rarely computed. It is almost like we as a society do not want to know how much money has been wasted and how much irritation and misery caused.”

Whatever the numbers are, they’re too high.

As Dr. Twidale said:

Making a computer system easier to use is a tiny fraction of the cost of making the computer system work at all. So why aren’t things fixed? Because people put up with bad interfaces and blame themselves. We want to say, ‘No, it’s not your fault! It is bad design.'”

He specifically referenced the vaccine example: “When hard to use software means a vulnerable elderly person cannot book a vaccination, that’s a social justice issue.  If you can’t get things to work, it can further exclude you from the benefits that technology is bringing to everyone else.” 

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Digital Mental Health Hits Mainstream: Cigna’s Behavioral Health CMO on National Rollout of Ginger

By JESSICA DaMASSA, WTF HEALTH

Cigna is making digital mental health services available to its entire nationwide network of 14 million members, and it’s selected health tech startup, Ginger to deliver the new benefit. Cigna’s Chief Medical Officer for Behavioral Health, Doug Nemecek, and Ginger’s CEO, Russ Glass, stop by to discuss the deal and why Cigna is making such a commitment to expanding its behavioral health offering.

This is about more than just dealing with mental health in the aftermath of Covid; Cigna is actually looking at Ginger’s behavioral health coaching model as preventative. Will other health plans follow suit? Could expanded coverage for lower-acuity mental health services become commonplace? Doug talks about what’s ahead for mental health care from a population health standpoint, and how services like Ginger’s give primary care docs a standard, trusted provider to which they can refer patients when it comes to increasingly common concerns like depression and anxiety. For Russ and Ginger, who talk about using virtual care to right the “supply-and-demand imbalance” in mental health care, what will more than doubling their current client base (from 10 million to 24 million) do to their own ability to provide supply? It’s a moment-of-truth for the business of digital mental health and we’ve got the details!

Some People Don’t Think Like Doctors (!)

By HANS DUVEFELT

This may come as a surprise for people with business degrees:

Doctors don’t really care when a test was ordered. We care about our patient’s chest X-ray or potassium level the very moment the test was performed. We also don’t care (unless we are doing a forensic review of treatment delays) when an outside piece of information was scanned into the chart. We want to know on which day the potassium was low: Before or after we started the potassium replacement, for example.

In a patient’s medical record, we have a fundamental need to know in what order things happened. We don’t prefer to see all office visits in one file, all prescriptions in another and all phone calls in a third. But that seems to be how people with a bookkeeping mindset prefer to view the world. In some instances we might need that type of information, but under normal clinical circumstances the order in which things happened is the way our brains approach diagnostic dilemmas.

Yes, I have said all this before, but it deserves to be said again. Besides, only 125 people read what I wrote about this six weeks ago, while almost 10,000 people read my post about doxepin.

Patients’ lives are at stake and, in order to do our job, we need the right information at the right time, in the order we need it, even if the bookkeepers prefer it a different way.

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