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Measuring the Effectiveness of Cost-of-Care Conversations

By NELLY GANESAN, JOSH SEIDMAN, MORENIKE AYOVAUGHAN, and RINA BARDIN

With support from the Robert Wood Johnson Foundation, Avalere assesses opportunities to normalize cost-of-care conversations through measurement.

With support from the Robert Wood Johnson Foundation, Avalere assesses opportunities to normalize cost-of-care conversations through measurement.

Cost continues to pose a barrier to accessing healthcare for millions of Americans. Research has shown that conversations addressing costs among patients, caregivers, and the clinical team can help build a more trusted relationship between patients and clinicians.

Avalere has partnered with Robert Wood Johnson Foundation (RWJF) since 2015 to work toward normalizing cost-of-care (CoC) conversations in clinical settings, including identifying barriers and facilitators to engaging in conversations about cost. CoC conversations can be defined as discussions that address any costs patients and families might face, from out-of-pocket (OOP) to non-medical costs (e.g., transportation, childcare, lost wages). To that end, Avalere collaborated with the National Patient Advocate Foundation to explore the feasibility of patient-centered measure concepts to support quality improvement, increase satisfaction, and improve outcomes. This issue brief highlights the challenges associated with measurement in this space alongside alternative solutions to encourage CoC conversations in practice.

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Health in 2 Point 00, Episode 153 | GoodRx’s massive IPO, Olive, Bright Health & more

Today on Health in 2 Point 00, Jess is in Jacksonville hanging out with Jackson the dog and trying to replace me with @barkyboy. On Episode 153, we cover the biggest IPO we’ve seen yet—GoodRx—with a valuation of $18 billion, which is more than Teladoc, Livongo, and even Cardinal Health. In other news, Olive gets $106 million bringing their total to $220 million; Olive is a back office automation system using AI for hospitals and this round is practically financed by royalty. Bright Health gets $500 million for their health plan; they’ve raised about $1.5 billion and are planning to expand into more markets. Finally Osso VR raised $14 million in a series A, helping surgeons practice performing surgeries through their VR platform. —Matthew Holt

It’s complicated. A deep dive into the Viz/Medicare AI reimbursement model.

By LUKE OAKDEN-RAYNER

In the last post I wrote about the recent decision by CMS to reimburse a Viz.AI stroke detection model through Medicare/Medicaid. I briefly explained how this funding model will work, but it is so darn complicated that it deserves a much deeper look.

To get more info, I went to the primary source. Dr Chris Mansi, the co-founder and CEO of Viz.ai, was kind enough to talk to me about the CMS decision. He was also remarkably open and transparent about the process and the implications as they see them, which has helped me clear up a whole bunch of stuff in my mind. High fives all around!

So let’s dig in. This decision might form the basis of AI reimbursement in the future. It is a huge deal, and there are implications.


Uncharted territory

The first thing to understand is that Viz.ai charges a subscription to use their model. The cost is not what was included as “an example” in the CMS documents (25k/yr per hospital), and I have seen some discussion on Twitter that it is more than this per annum, but the actual cost is pretty irrelevant to this discussion.

For the purpose of this piece, I’ll pretend that the cost is the 25k/yr in the CMS document, just for simplicity. It is order-of-magnitude right, and that is what matters.

A subscription is not the only way that AI can be sold (I have seen other companies who charge per use as well) but it is a fairly common approach. Importantly though, it is unusual for a medical technology. Here is what CMS had to say:

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THCB Gang Episode 26, 9/24

Episode 26 of “The THCB Gang” was live-streamed on Thursday, September 24th! Watch it below!

Joining Matthew Holt (@boltyboy) were some of our regulars: health futurist Ian Morrison (@seccurve), patient advocate Grace Cordovano (@GraceCordovano), patient & entrepreneur Robin Farmanfarmaian (@Robinff3), health care consultant Daniel O’Neill (@dp_oneill), and patient safety expert Michael Millenson (@MLMillenson). The conversation revolved around the dismantling of the ACA, conservatives causing chaos in the government, the dismissal of pre-existing conditions, and the state of women’s health rights after the passing of RBG. It was both an emotional & impactful conversation.

If you’d rather listen to the episode, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels — Zoya Khan

Minding the Competition: Ginger’s Karan Singh & Russell Glass on Digital Mental Health Investments

By JESSICA DaMASSA, WTF HEALTH

Digital Mental Health startups continue to scale up — in customers, revenues, and investments — as the covid19 pandemic wears on. One of these companies, Ginger, has tripled its revenue this past year, expanded its client base to count more than 200 health plans and self-insured employers, and, for good measure, just added a fresh $50M Series D to their coffers. How much more money can investors put into digital mental health startups? Are things “frothy” in this space, or is investment just “catching up” to meet a latent demand that’s just really been brought to light? And, what is one of this category’s leaders planning to do now that they’re extra flush with cash? (Don’t forget, they’re sitting on a $35M round that closed late 2019…)

Ginger’s co-founder & COO Karan Singh and CEO Russell Glass join us to weigh in on the mental healthcare market’s state-of-play, including the buzz around their own business as both a potential acquisition target and a potential acquirer of additional behavioral health tech. We cover everything from investment to healthcare incumbent’s recent cries for more clinical validation, but my favorite part of this whole interview is when we start talking about the competition and tackle Lyra Health’s recent $100M raise and $1.1B valuation. Tune in around the 15:55-minute mark for some very DETAILED competitive analysis about Lyra-versus-Ginger from Ginger’s own CEO.

As this market gets more crowded, competition heats up, and healthcare consumers receive the benefit of more solutions to access at lower prices, Karan and Russ also help me speculate on what’s ahead, including whether or not they think we’ll see a “digital mental health equivalent” of a massive game-changing-market-moving deal like we saw when Teladoc merged with Livongo to shake up of both the virtual care and chronic condition management spaces.

Congress Is Getting the Transition to Alternative Payment Models Wrong

By TAYLOR CHRISTENSEN

Alternative payment models (APMs) are a hot topic these days, and everyone seems to agree that we need to transition toward them and away from fee for service (FFS). But how should we do it?

First, let’s think about this task as government policy makers would think about it.

They would probably start by saying, “We need to find a way to give incentives to providers and payers to try out these different APMs.” This would be fairly easy to do through Medicare, so they would create some Medicare APM programs and structure them in a way that makes the benefits of joining large enough that lots of providers will want to participate.

And for the sake of uniform provider incentives, they would also want to encourage private insurer-provider diads to start using APMs, preferably ones as similar to the Medicare APM programs as possible. And so they would probably have to offer private insurers and/or providers money to do so.

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WeChat to Many, WeDoctor to Some

By KIM BELLARD

You’ve probably heard about TikTok, especially lately.  President Trump wanted a ban on it, and seems to have endorsed a deal for a U.S.-based version of it.  The hundred million U.S. users, and probably their parents, are undoubtedly watching the sequence of events with mixed amusement and concern. 

But you may have paid less attention to what’s been going on with WeChat, another China-based app.  WeChat was part of the original proposed ban, which a federal judge blocked this weekend, hours before it was due to go into effect (the Commerce Department plans to appeal).  The ban is on “transactions,” which, in WeChat’s case, covers a lot of ground. 

TikTok was overlooked by authority figures for a long time because it was mostly used by young people and mostly for what seemed, to them, to be trivial purposes.  Not so with WeChat; it is deeply engrained in users’ lives, including for their health.  

WeChat is owned by Tencent Holdings, one of China’s internet giants.  It has been described as a “Swiss Army knife” app, able to do many tasks – not just messaging and social networking, but also games, shopping, and payments.  You can order food or book travel.  For many users it is a primary source of news, which is part of the problem. 

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Now Is Not the Time to Forget About the AIDS Epidemic

By SOMA SEN

I keep hearing the voices of colleagues and friends that have been part of the AIDS epidemic compare it to the current COVID-19 pandemic. In fact Dr. Kathy Creticos, Director of Infectious Disease at Howard Brown Health spoke about the politicization of both the pandemics. 

“Here we are in 2020 with this disease that kills people, that we don’t have any treatments for, that we really don’t understand the full manifestation and presentation biology of the virus,” Creticos said In the final segment of an interview with Contagion during International AIDS Society (IAS) AIDS 2020 Virtual Sessions. “We’re really dealing in the same situation as in the HIV epidemic.” 

Her words make me reflect on the levity with which the Raegan administration treated the AIDS epidemic and it’s parallel to the Trump administration’s treatment of the current pandemic. However, she makes an important distinction between the two when she says, “I think a lot of it has to do with the fact that COVID affects everybody, but HIV was certainly perceived as not affecting everybody.”

As an Asian American researcher with more than 15 years of experience in this area, whenever, I bring up the issue of the scourge of HIV/AIDS in our community, the common response both from inside and outside the community is “It’s not a problem in this community.” 

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Health in 2 Point 00, Episode 152 | 2 IPOs, At-Home Care, & Youtube for Employees?

With 2 IPOs this week, On Episode 152 of Health in 2 Point 00, Jess asks me about Amwell’s IPO with a market cap at $5B for its telehealth solutions, Outset Medical’s IPO with a market cap of $1.5B for its kidney dialysis technology, Ready raising $54M for its care at- home platform, Lifespeak getting $42M for its “YouTube” like platform for employee mental health and wellness training program.Matthew Holt

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If I Can Be Safe Working as An ER Doctor Caring for COVID Patients, We Can Make Schools Safe for Children, Teachers, and Families

By AMY CHO

We need to stop arguing about whether schools should reopen and instead do the work to reopen schools safely. Community prevalence of COVID-19 infection helps to quantify risk, but reopening decisions should not be predicated on this alone. Instead of deciding reopening has failed when an infected student or teacher comes to school, we should judge efforts by our success in breaking transmission chains between those who come to school infected and those who don’t. We should judge our success by when we prevent another outbreak. We should pursue risk and harm reduction by layering interventions to make overall risk of transmission in schools negligible. This CAN be done, as healthcare workers all over the United States have shown us. Unlike politics, we should avoid thinking this is a binary choice between two polarized options. At the heart of these decisions about tradeoffs should be the assumption that the education of our children is an essential, public good.

I advocated for school closures in March. We had little understanding of the risks and transmission of COVID-19 and faced massive shortages of personal protective equipment (PPE). The closures were a blunt force instrument but bought precious time to learn and prepare. Pandemic control, by flattening the curve and buying time for discovery of more effective therapeutics, care and a vaccine, remains a critical tool to save lives. But COVID-19 will not be eradicated. We must come to terms with the reality that COVID-19 will circulate among us, likely indefinitely. Shutdowns slow spread but at a great cost, disproportionately paid by vulnerable groups including children, women, minorities, and those with the least financial resources. Getting children safely back to in-person school should be among our highest priorities.

Hospitals never considered closing. As healthcare workers, we cannot physically distance from patients. We watched in horror as hot spots like Bergamo suffered high nosocomial and staff infection rates as they were quickly overwhelmed. In response, we worked tirelessly and collaboratively to protect one another while continuing to provide care.

The good news is that we seem to have learned how to prevent in-hospital transmission of COVID-19. A recent study showed that at a large US academic medical center, after implementation of a comprehensive infection control policy, 697 of 9,149 admitted patients were diagnosed with COVID-19. But only TWO hospital-acquired patient infections were detected. COVID-19 is not “just the flu,” but it isn’t Ebola either. I no longer worry that I will become infected with COVID while working in my emergency department. It is not easy, comfortable nor cheap, but a bundle of universal masking and eye protection, appropriate PPE use, sanitation, improved room ventilation, and protective policies have proven effective at preventing in-hospital outbreaks. 

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