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Everyone Is Having the Wrong Healthcare Debate

By STEVEN MERAHN, MD

In 1807, in an effort to spite the British and French for shipping interference (and forced recruitment of American citizens into military service), the United States Congress passed an Embargo Act, effectively shutting down trade with these two countries. Britain and France quickly found other trading partners; the US, then limited in our capacity to sell products outside our borders, was left with a devastated economy and a gaping hole in our face. It took only weeks before Congress passed a loophole; they repealed the act within 15 months of its passing. It was a great lesson in unintended consequences.

Today, ignoring history, both Republicans and Democrats seem to spar continuously around healthcare: whether the message is about tearing down the Affordable Care Act or about some version of Medicare (For-All, For Whoever Wants It, For America, or For Better or Worse), both parties are terribly wrong.

Assuming the social imperative for healthcare is to eliminate preventable morbidity and disability (and associated costs) and improve (or sustain) quality of health of all our citizens (in order to help as many of them as possible remain productive, contributing members of society), another approach to ‘universal care” would be to flip the figure/ground relationship for our current efforts: instead of developing better payment systems, let’s develop and commit to a universal clinical operating framework that ensures that every member of society has the same opportunity to optimize their health status.

“Centralizing” the methodology around a universal model for how we plan for care, and allocate resources to ensure care plan goal achievement, would be far more valuable to society than centralizing the sources of funds to pay for care, because then we’d know what we’re paying for.

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Health in 2 Point 00 Episode 92, Takeover Edition | Louise Schaper, HIC 2019 Australia

Today on Health in 2 Point 00, we have another takeover edition! On Episode 92, Jess talks to Louise Schaper, CEO of the Health Informatics Society of Australia (HISA) at HIC 2019. Louise’s key takeaway from the conference is that health tech in Australia is focused on humanity and improving outcomes for all people. Jess also asks Louise about the Australian Digital Health Agency’s MyHealthRecord, an online summary of individuals’ health information. It’s got a great participation rate with 90% of Australians opted in, but it’s not being utilized as much as it could be. Finally, Louise debunks some of the chatter around HealthEngine’s data scandal in which they were caught sharing health data with law firms. The thing is, the press has sold it as if they have full access to your medical data and has sold that, but that’s not the case.

The Rebellion of the Buyers

By JOE FLOWER

Did you catch that headline a few weeks back?

An official of a health system in North Carolina sent an email to the entire board of the North Carolina State Health Plan calling them a bunch of “sorry SOBs” who would “burn in hell” after they “bankrupt every hospital in the state.”

Wow. He sounds rather upset. He sounds angry and afraid. He sounds surprised, gobsmacked, face-palming.

Bless his heart. I get it, I really do. Well, I get the fear and pain. Here’s what I don’t get: the surprise, the tone of, “This came out of nowhere! Why didn’t anyone tell us this was coming?”

Brother, we did. We have been. As loudly as we can. For years.

Two things to notice here:

  1. What is he so upset about? Under State Treasurer Dale Folwell’s leadership, the State Health Plan has pegged its payments to hospitals and other medical providers in the state to a range of roughly 200% of Medicare payments (with special help for rural hospitals and other exceptions). In an industry that routinely says that Medicare covers 90% of their costs, this actually sounds rather generous.
  2. What is the State Health Plan? It’s not a payer, that is, an insurer. It’s a buyer. Buyers play under a different set of rules and incentives than an insurer.
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How a Value Focus Could Change Health Care

By BRIAN KLEPPER, PhD

How will the drive to health care value affect health care’s structure? We tend to assume that the health care structure we’re become accustomed to is the one we’ll always have, but that’s probably far from the truth. If we pull levers that incentivize the right care at the right time, it’s likely that many of the problems we think we’re stuck with, like overtreatment and a lack of accountability, will disappear.

A large part of getting the right results is making sure that health care vendors have the right incentives. All forms of reimbursement carry incentives, so it’s important to align them, to choose payment structures that work for patients and purchasers as well as providers. Fee-for-service sends exactly the wrong message, because it encourages unnecessary utilization, paying for each component service independent of whether its necessary and independent of the outcomes. Compare US treatment patterns to those in other industrialized nations and you’ll find ours are generally bloated with procedures that have become part of practice not because they’re clinically necessary but simply because they’re billable.

By contrast, value-based arrangements are really about purchasers demanding that health care vendors deliver better health outcomes and/or lower cost than what they’ve experienced under fee-for-service reimbursement, and the payment structure often asks the vendor to put his money where his mouth is, at least where performance claims are concerned. In a market that’s still overwhelmingly dominated by fee-for-service arrangements, one way for a vendor to get noticed is to financially guarantee performance. Integrated Musculoskeletal Care, a musculoskeletal management firm based in Florida, guarantees a 25% reduction in musculoskeletal spend on the patients they touch. This typically translates to a 4%-5% reduction in total health plan spend, just by contracting with this vendor, a compelling offer in an environment that makes it hard for upstarts to get market traction.

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Selling Your EMR Startup to Apple…Then Leaving Apple to Start-up Again | Anil Sethi, Ciitizen

By JESSICA DaMASSA, WTF HEALTH

Anil Sethi had the health tech exit every startup dreams about: a buyout by Apple. Not content to ride that unicorn into the sunset, Anil’s back at it with his new startup Ciitizen, which is another take on better a patient health record. What’s different? Why come back? Tune in for more and this and Anil’s great advice for other health entrepreneurs.

‘I Apologize for What You Are About To See’

By HILARY HATCH, PhD

The growing movement to include the patient voice in medicine through Motivational Interviewing, patient-reported outcomes, social determinants of health and shared decision-making

One day in 2011, as a part of my research on ways to improve patient-provider communication about health behaviors, I was shadowing Dr. G., a talented young internist with a cheerleader demeanor. He marched through 12 afternoon patient appointments with confidence and purpose. But when he saw the name of the last patient on his schedule, he turned pale, faced me and said, “I apologize for what you are about to see.”

I must have looked confused. He repeated, “I apologize for what you are about to see.”

We walked into the exam room. I’m not sure either one of us knew what to expect. The patient, a white, obese man, was seated, doubled over. He had a wad of paper towels jammed in his mouth. He threatened to pull out his own, presumably abscessed, tooth. He refused to see a dentist because he had no dental coverage, no money and no one to borrow money from. He said he would use pliers to pull his tooth, but stayed put, rocking in his seat. At the computer, the young doctor’s white-knuckled hand gripped his mouse. Click. Click. Click. He searched the patient’s chart aimlessly for help. Alerts kept popping up about the patient’s missing A1C results. It took two minutes, but it felt like 20.

Dr. G. left the room and came back a few minutes later. He gave the patient the name of a dentist who would see him at no cost. I suspected Dr. G. had called the dentist and said he would pay for the appointment out of his own pocket. The patient hugged Dr. G. He only wanted help, and Dr. G. wanted to help. The tension was resolved for the moment.

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Health Data Outside HIPAA: The Wild West of Unprotected Personal Data

Deven McGraw
Vince Kuraitis

By VINCE KURAITIS and DEVEN McGRAW

This post is part of the series “The Health Data Goldilocks Dilemma: Privacy? Sharing? Both?”

“…the average patient will, in his or her lifetime, generate about 2,750 times more data related to social and environmental influences than to clinical factors”

McKinsey analysis

The McKinsey “2,750 times” statistic is a pretty good proxy for the amount of your personal health data that is NOT protected by HIPAA and currently is broadly unprotected from sharing and use by third parties.

However, there is bipartisan legislation in front of Congress that offers expanded privacy protection for your personal health data. Senators Klobuchar & Murkowski have introduced the “Protecting Personal Health Data Act” (S.1842). The Act would extend protection to much personal health data that is currently not already protected by HIPAA (the Health Insurance Portability and Accountability Act of 1996). 

In this essay, we will look in the rear-view mirror to see how HIPAA has provided substantial protections for personal clinical data — but with boundaries. We’ll also take a look out the windshield — the Wild West of unprotected health data.

Then in a separate post, we’ll describe and comment on the pending “Protect Personal Health Data Act”.

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WeightWatchers Acquired This Health Tech Startup That Helps Kids Lose Weight | Kurbo, Thea Runyan

By JESSICA DaMASSA, WTF HEALTH

Kurbo just became a wholly owned subsidiary of WW (aka WeightWatchers) with its app that helps kids lose weight. Co-founder Thea Runyan explains how the digital health solution is changing unhealthy lifestyles for teens and kids everywhere and talks about her company’s successful exit to the weight loss giant.

Filmed at HIMSS/Health 2.0 Europe in Helsinki, Finland in June 2019.

HardCore Health Podcast| Episode 3, IPOs, Privacy, & more!

On Episode 3 of HardCore Health, Jess & I start off by discussing all of the health tech companies IPOing (Livongo, Phreesia, Health Catalyst) and talk about what that means for the industry as a whole. Zoya Khan discusses the newest series on THCB called, “The Health Data Goldilocks Dilemma: Sharing? Privacy? Both?”, which follows & discuss the legislation being passed on data privacy and protection in Congress today. We also have a great interview with Paul Johnson, CEO of Lemonaid Health, an up-and-coming telehealth platform that works as a one-stop-shop for a virtual doctor’s office, a virtual pharmacy, and lab testing for patients accessing their platform. In her WTF Health segment, Jess speaks to Jen Horonjeff, Founder & CEO of Savvy Cooperative, the first patient-owned public benefit co-op that provides an online marketplace for patient insights. And last but not least, Dr. Saurabh Jha directly address AI vendors in health care, stating that their predictive tools are useless and they will not replace doctors just yet- Matthew Holt

Matthew Holt is the founder and publisher of The Health Care Blog and still writes regularly for the site.

Are Radiologists Prepared for The Future?

By ALEX LOGSDON, MD

Leave your bias aside and take a look into the healthcare future with me. No, artificial intelligence, augmented intelligence and machine learning will not replace the radiologist. It will allow clinicians to.

The year is 2035 (plus or minus 5 years), the world is waking up after a few years of economic hardship and maybe even some dreaded stagflation. This is an important accelerant to where we are going, economic hardship, because it will destroy most radiology AI startups that have thrived on quantitative easing polices and excessive liquidity of the last decade creating a bubble in this space. When the bubble pops, few small to midsize AI companies will survive but the ones who remain will consolidate and reap the rewards. This will almost certainly be big tech who can purchase assets/algorithms across a wide breadth of radiology and integrate/standardize them better than anyone. When the burst happens some of the best algorithms for pulmonary embolism, stroke, knee MRI, intracranial hemorrhage etc. etc. will become available to consolidate, on the “cheap”.

Hospitals can now purchase AI equipment that is highly effective both in cost and function, and its only getting better for them. It doesn’t make sense to do so now but soon it will. Consolidation in healthcare has led to greater purchasing power from groups and hospitals. The “roads and bridges” that would be needed to connect such systems are being built and deals will soon be struck with GE, Google, IBM etc., powerhouse hundred-billion-dollar companies, that will provide AI cloud-based services. RadPartners is already starting to provide natural language processing and imaging data to partners; that’s right, you speak into the Dictaphone and it is recorded, synced with the image you dictated, processed with everyone else to find all the commonalities in descriptors to eventually replace you. It is like the transcriptionists ghost of the past has come back to haunt us and no one cried for them. Prices will be competitive, and adoption will be fast, much faster than most believe.

Now we have some patients who arrive for imaging, as outpatients, ER visits, inpatients; it does not matter the premise is the same. Ms. Jones has chest pain, elevated d-dimer, history of Lupus anti-coagulant and left femoral DVT. Likely her chart has already been analyzed by a cloud-based AI (merlonintelligence.com/intelligent-screening/) and the probability of her having a PE is high, this is relayed to the clinician (PA, NP, MD, DO) and the study is ordered. She’s sent for a CT angiogram PE protocol imaging study. This is important to understand because there will be no role for the radiologist at this level. The recommendation for imaging will be a machine learning algorithm based off more data and papers than any one radiologist could ever read; and it will be instantaneous and fluid. Correct studies will be recommended and “incorrectly” ordered studies will need justifications without radiologist validation.

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