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Don’t Underestimate Doctor On Demand – CEO Hill Ferguson on the Era of ‘Tele-Everything’ Healthcare

By JESSICA DaMASSA, WTF HEALTH

JUST before the Teladoc-Livongo merger was announced, I had a chance to catch up with Doctor on Demand’s CEO, Hill Ferguson. The future for telehealth, he said, is “bright green” — and I’m pretty sure it’s looking even greener now! Doctor On Demand has stood out among telehealth companies for being particularly early on virtual primary care and it sounds like they’re going to continue developing that line of business — in which they have key partnerships with Humana and Walmart — with the $75M series D funding they just received.

Add to that a brand-new, first-of-its-kind telehealth program for the Medicare Part B population, and crazy consumer-focused type UX features like same-day scheduling for behavioral mental health care (yes, that’s right, dynamic scheduling for healthcare is here, folks!) and you can start to see how DOD is strategizing to pull away from the pack.

With the competitive landscape shifting, especially after Teladoc-Livongo, how does Hill view the onslaught of new entrants like digital health companies who added telehealth in reaction to the COVID-19 pandemic, or potential unicorns like Ro or HIMS, who are focused on tying the prescription drug business into virtual care delivery? It’s the insider insight you’ve been waiting for in this era of ‘tele-everything’ healthcare.

Take Your Mom to Work

By KIM BELLARD

If you are a working mom, or married to one, or simply know one, you know that it is tough to balance a job and raising a child even under ideal circumstances.  Even if she has a supportive spouse, chances are that it is the mom who ends up providing the most child care, and whose career it impacts the most.

But, of course, these are not ideal circumstances.  Prior to the pandemic, women had made great strides in the workforce; more women had payroll jobs than men, for example (although they continued to be paid less for them).  Those gains quickly came crashing down once the pandemic hit.  It is believed to be the first time that job and incomes losses have hit women harder than men.  Some are calling our pandemic-driven economic downturn a “shecession” as a result.   

That’s bad enough, but the even bigger danger is that the pandemic could set back women’s careers for a generation. 

recent study by Collins, et. alia confirmed what most might have guessed: in the wake of the pandemic, women are more likely than men to have reduced their work hours to take on additional child care responsibilities due to school/daycare closing — four or five times as much.  

The study found that:

Scaling back work is part of a downward spiral that often leads to labor force exits—especially in cases where employers are inflexible with schedules or penalize employees unable to meet work expectations in the face of growing care demands.  

We are also concerned that many employers will be looking for ways to save money and it may be at the expense of mothers who have already weakened their labor market attachment.

Even more worrying, lead author Caitlyn Collins, a professor at Washington University, says: “Our findings indicate mothers are bearing the brunt of the pandemic and may face long-term employment penalties as a consequence.”  

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The Need for Measuring Clinician-Patient Cost-of-Care Conversations

By MORENIKE AYOVAUGHAN, NELLY GANESAN, EMMY GANOS, and JOSH SEIDMAN

It is no surprise that beyond COVID-19 health risks, the pandemic has also caused significant disruption to the lives of everyone in America. It has caused exacerbating financial pressures and ongoing job losses. An estimated 42 million people have lost their job since March 2020, which has increased the number of uninsured. The loss of coverage has the potential to yield catastrophic healthcare costs for those seeking care during the period.

It is no surprise that beyond COVID-19 health risks, the pandemic has also caused significant disruption to the lives of everyone in America. It has caused exacerbating financial pressures and ongoing job losses. An estimated 42 million people have lost their job since March 2020, which has increased the number of uninsured. The loss of coverage has the potential to yield catastrophic healthcare costs for those seeking care during the period.

While the pandemic has exacerbated coverage challenges, it also highlights gaps that existed long before the outbreak. Prior to COVID-19, average out-of-pocket costs were on the rise with an estimated 24% of Americans spending over $1,000 per year on direct medical care and surprise medical billing. The pandemic-induced economic disruption reinforces the need for physicians and patients to embrace conversations regarding cost in the clinical setting; avoiding such discussion may result in patients foregoing care and not realizing their options.

Patients should be able to rely on their clinicians to help them understand the costs of their care, including losses associated with the time away from work and transportation expenses for visits. Our past research, and the research of others, has demonstrated that these conversations are valued and can be impactful in helping patients understand their options to address concerns upfront. And yet, the concept of having a Cost-of-Care (CoC) conversation is merely optional. These conversations are not typically supported with access to price information, nor are they consistently viewed as a routine part of practice. Cost conversations are not consistently documented, lack standardization, and structure. Furthermore, physicians have not adequately been trained to address CoC conversations with their patients.  

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How to Pandemic-Proof Our Healthcare Payment System

By AISHA PITTMAN and SETH EDWARDS

The pandemic has focused many policymakers’ attention  on strategies to make the healthcare system better. The obvious answer is one that we know is efficacious, if perhaps not the sexiest: value-based care.

The current healthcare payment system – built around the fee-for-service (FFS) model in which healthcare providers are reimbursed for the quantity versus quality of care – required $175 billion in bailouts and temporary modifications to remain whole during the crisis, a stance that’s unsustainable for both providers and payers.

The Centers for Medicare & Medicaid Services (CMS) admitted as much with its renewed national commitment to value-based care in late June: The movement to value is happening now.

The worth of value-based care models has long been detailed, from more coordinated care to lower costs. In fact, a recent survey conducted by our organization Premier Inc. found that healthcare providers in alternative payment models (APMs) were better positioned to respond to COVID-19 and support reopening plans through the rapid deployment of telehealth, care management and data analytics. These are the types of population health capabilities the industry must focus on spreading – and incenting – in the near future.

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Health in 2 Point 00, Episode 142 | Ginger, Infermedica, Xealth & SOC Telemed

Today on Health in 2 Point 00, Jess and I cover all the deals that got overshadowed by the big news of Teladoc and Livongo’s merger. First up is Ginger, the mental health provider which raised $50 million in a D round bringing their total up to $120 million. Infermedica, an AI enabled symptom checker and triage tool, raised $10.25 million in a series A. Next, Xealth landed a $6 million investment from Cerner and LRVHealth, partnering with Cerner and bringing their digital health prescribing tool to Cerner in addition to its current integration with Epic. Finally SOC Telemed is going public through a “reverse” merger with Healthcare Merger Corp. —Matthew Holt

Why is a 1980 Drill in my 2020 Brain?

By SHVETALI THATTE

Late one evening, a trauma patient, a mother of three, comes through on an ambulance. She’s having trouble breathing, despite the breathing tube lodged in her throat. Dr. Nikhil K. Murthy, the neurosurgeon on the case, assesses the situation and orders a CT, which reveals a ruptured aneurysm, or a burst blood vessel. Excess fluid in the brain is fatal, as the increased pressure deprives the brain of vital oxygen. A sense of immediacy surges through Dr. Murthy as he calls for the necessary supplies to perform a ventriculostomy to drain the blood. He rushes to connect the drill bit, brace the manual drill against his body, and drill a hole in the right place, at the precise angle and depth. With the urgency of the situation blaring in his mind, Dr. Murthy has only his experience, training, and intuition to ensure that he does not drill past the skull and into the brain. The stakes are high, and a woman’s life is on the table. 

Bedside ventriculostomies, like the one described above, are common in the emergency department, as the surgery is often performed in life-or-death situations to immediately relieve fluid build-up in the brain. Dr. Murthy’s experience does not stand alone: countless neurosurgeons have stood in his exact shoes. While Dr. Murthy successfully performed the ventriculostomy, saving the woman’s life, not everyone is as lucky: the complication rate for bedside ventriculostomies in the U.S. stands at an egregious 50 percent

“When that woman was lying on the table, a drill braced against her skull, what she and I both needed was a safer, more reliable tool to perform the surgery.” – Dr. Nikhil K. Murthy 

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Redefining Values in American Health Care

By RICHARD HOEHN, MD

Experts claim we could have been better prepared when the COVID-19 pandemic struck in early 2020. With an annual budget of $400-700 million, the Strategic National Stockpile (SNS) is designed to respond to chemical, biological, and other disasters. Its $8 billion inventory included 13,000 ventilators and a limited supply of personal protective equipment, N95 masks, and medical supplies. This left state and local governments scrambling as the COVID-19 pandemic accelerated and the capacity of many hospitals was overwhelmed.

Faced with immediate and visible death and suffering, leaders took drastic steps to contain the virus, “flatten the curve,” and mitigate economic consequences. Trillions of dollars were allocated to recovery and stimulus packages.

This scenario mirrors our general approach to health care: chronic underfunding of public health followed by high costs and loss of life.

While not as shocking as a sudden pandemic, millions of Americans struggle daily with medical and socioeconomic challenges. Our health care system is designed to care for these patients when they have a problem, not to keep them well. This creates a dichotomy where a minority of the population spends most of the health care dollars and little is invested in the remaining majority

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Health in 2 Point 00, Episode 141 | Teladoc Livongo Merger Special

Today, a special Health in 2 Point 00. Jessica DaMassa asks me about the biggest news in public digital health companies ever: this morning’s merger of Teladoc and Livongo. We discuss the deal, the implications for digital health, what’s next for Continuous Clinics, whether our T-Shirts will become a collectors item, and of course what about our book club on August 19! —Matthew Holt

Post Covid Healthcare is Becoming Like Buying from Amazon Instead of Going to the Mall or Reading an eBook Instead of a Paperback

By HANS DUVEFELT, MD

Now that we are seeing patients via telemedicine or even getting reimbursed for handling their issues over the phone, our existing healthcare institutions are more and more starting to look like shopping malls. 

They were once traffic magnets, so large that they created new developments far away from where people lived or worked and big and complex enough that going there became an all day affair for many people. 

What this pandemic has brought us is a shift in our view of where you have to be in order to get things done. If you can earn your wage remotely and still buy things online when offices and physical stores are shut down, it seemed logical to try to offer healthcare the same way. And most of us have found that it works surprisingly well. 

The analogy with Amazon runs deeper than that. Amazon isn’t just one megaprovider, but also a funnel for many small merchants who sell their products through Amazon. Consumers take advantage of the convenience of this centralized ordering or point of contact with a vast supply network of almost any product that money can buy. But they only give their credit card number to one central contact. 

I don’t follow business literature enough to know if Jeff Bezos chose the name Amazon partly (yes, I know he went through the dictionary) because of a vision of many small contributories coming together into the second largest river in the world. But that is certainly a visual representation of what his business looks like. And “Amazon” ranks higher in the alphabet and sounds a lot catchier than “The Nile”. 

Enter healthcare: Imagine the trusted brand names of our “industry” but without their traditional complete reliance on bricks and mortar places that patients have to visit. 

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Vida Health’s CEO on Scaling Up in the Highly Competitive Chronic Condition Virtual Care Space

By JESSICA DaMASSA, WTF HEALTH

Even before Covid19, virtual care for chronic conditions was a hot and competitive area, with the heat turned up by Livongo Health’s IPO last year and big funding rounds for companies like Omada Health, Virta Health, and One Drop. Another contender in the space, Vida Health, has been best known for taking a “platform” approach to chronic condition management before “platforming out” became the-move-to-make for scaling health tech companies. Their digital health biz actually started out with a “whole health approach” to helping patients manage all their conditions at once, integrating care for diabetes, hypertension, COPD, high cholesterol, mental health conditions, and more from the get-go. Contrast that to some of their biggest competitors, who have adapted to that approach by adding on treatments for co-morbidities as their core businesses evolved.

Is there a benefit to starting out with a holistic care model that those who build it along the way can’t capture? We caught up with Vida Health’s founder & CEO, Stephanie Tilenius, to find out what advantage starting out as a platform play has brought to her business, which just closed a $25M funding round in April and is now available to more than 1.5 million people through employers and health plans.

How will the company scale from here? How will they remain competitive in such a crowded space? Stephanie talks through some of Vida Health’s post-pandemic plans AND how lessons learned from her “previous life” as an exec in Big Tech during that industry’s growth era of the 2000s & 2010s has shaped her thinking about the uptake of technology in healthcare. Not only did Stephanie work at eBay, PayPal, and Google during the birth of the online payment era, BUT she also helped take an online pharmacy company (Planet Rx) public during the dotcom boom.

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