Episode 10 of “The THCB Gang” was live-streamed on Thursday, May 21th
Joining me were regulars: writer Kim Bellard (@kimbbellard), policy expert Vince Kuraitis (@VinceKuraitis), patient advocate Grace Cordovano (@GraceCordovano), radiologist Saurabh Jha (@RogueRad), employer consultant Brian Klepper (@bklepper1), Deven McGraw (@healthprivacy) and a guest, former ONC Consumer head Lygeia Riccardi, now at Carium Health (@Lygeia)! The conversation moved onto the new normal of telehealth, how much things would change in the future, and what the story with testing and opening up would look like. You can see the video below
If you’d rather listen, the “audio only” version is preserved as a weekly podcast available on our iTunes & Spotify channels — Matthew Holt
From the vantage point of our self-quarantined shrunken universes, we cannot see even the immediate future, let alone what our personal and professional lives will look like some years from now.
Factories are closed, luxury department stores are in bankruptcy, hospitals have stopped performing elective procedures and patients are having their heart attacks at home, unattended by medical professionals. New York office workers may continue to work from home while skyscrapers stand empty and city tax revenues evaporate.
Quarantined and furloughed families are planting gardens and cooking at home. Affluent families are doing their own house cleaning and older retirees are turning their future planning away from aggregated senior housing and assisted living facilities.
In healthcare, procedure performing providers who were at the pinnacle of the pecking order sit idle while previously less-valued cognitive clinicians are continuing to serve their patients remotely, bringing in revenues that prop up hospitals and group practices.
As the coronavirus pandemic overtook the tail end of the Democratic primary season, attention rapidly shifted from examining the nuances of the differences between the candidates’ healthcare platforms to simply demanding a response to the pandemic. Beyond addressing the immediate crisis, however, lie many questions about the weaknesses of our current healthcare system, and how we will address them in the long run. These questions should be at the forefront of voters’ minds as we head into the election this fall.
One of the major weaknesses in our system is that we do not have universal healthcare. Importantly, virtually all of the Democratic candidates called for making healthcare a right in the U.S. This is a key first step toward universal healthcare. Their approaches to achieving this varied, however. Bernie Sanders and Elizabeth Warren called for “Medicare for All,” but most of the other candidates, including Joe Biden, have pushed for some kind of public option. The public option has faced criticism that it will simply maintain the status quo. This criticism inspired me to write this blog, because a large-scale public option program could actually help to reshape the US healthcare system and result in improvements in access to care in this country, ultimately getting us to universal healthcare.
Today on Health in 2 Point 00, Jess asks me about Omada Health raising $57 million and then spending $30 million acquiring Physera, Holmusk raising $21.5 million, digital mental health company Meru raising $8.1 million, Noom partnering with LifeScan for digital diabetes care and Alike raising $5 million.—Matthew Holt
If you’re lucky, you’ve been working from home these past couple months. That is, you’re lucky you’re not one of the 30+ million people who have lost their jobs due to the pandemic. That is, you’re lucky you’re not an essential worker whose job has required you to risk exposure to COVID-19 by continuing to go into your workplace.
What’s interesting is that many of the stay-at-home workers, and the companies they work for, are finding it a surprisingly suitable arrangement. And that has potentially major implications for our society, and, not coincidentally, for our healthcare system.
Twitter was one of the first to announce that it wouldn’t care if workers continued to work from home. “Opening offices will be our decision, when and if our employees come back, will be theirs,” a company spokesperson wrote in a blog post. “So if our employees are in a role and situation that enables them to work from home and they want to continue to do so forever, we will make that happen.”
Other tech companies are also letting the work-from-home experiment continue. According to The Washington Post, Amazon and Microsoft have told such workers they can keep working from home until at least October, while Facebook and Google say at least until 2021. Microsoft president Brad Smith observed: “We found that we can sustain productivity to a very high degree with people working from home.”
Back in the early 2000s I was on the board of the California Health Care Foundation and one day the German Minister of Health paid CHCF a visit as part of a learning tour of American healthcare. Mark Smith MD CHCF’s CEO invited me to join the meeting with the minister. She was a delightful person who didn’t speak much English, but because she was accompanied by her handler/translator we managed to communicate just fine. Mark and I tried to explain to the Minister how the American healthcare system worked, and we got to the point in the conversation about the money. The essence of the “game” we described was that commercial insurers (particularly self-insured employers) paid a significant multiple of cost (sometimes in excess of 300% of costs) in order to make the math work for providers. We explained that the game works only if these purchasers paid much higher prices. I don’t speak German, but I think she said: “What The F**k?!”. Exactly.
As we enter the Post COVID world, a key question is: Will healthcare simply restart this game? Or make it even more extreme, in fact, by providers turning to those commercial insurers and self-insured employers to make up the difference for the COVID “Elective Collapse Recession” that has so traumatized provider’s finances including hospitals, specialists, primary care, and dentists leading to job cuts, furloughs, salary reductions and bankruptcies of providers.
A number of recent articles have pointed to how the game works. In particular, the always superb New York Time’s columnist Sarah Kliff’s review of the Mayo Clinic and the other highflying institutions whose excellence is rewarded not by value based reimbursement but by high prices for commercial activity under a relatively benign payor mix (industry code for “don’t see a lot of poor people, uninsured or on Medicaid”).
The great pandemic is wreaking havoc, we are told, because the nation is not testing enough. The consensus from a diverse group that includes public health experts, economists, and silicon valley investors is that more testing will allow the country to restart the economy and do it safely.
The White House has been a mini laboratory for this testing strategy. Everyone who comes into contact with the President and Vice President is tested daily. This is supposedly what allows everyone to sit in meetings together and generally carry out the essential business of the country. But over this Mother’s Day weekend members of the White House spent their time scrambling to track down contacts of Katie Miller, the press secretary of the Vice president who tested positive. And contacts were left unclear about what exactly to do. One official started self-quarantining, while another did not.
If the White House has trouble with a mass testing, and contact tracing strategy, one wonders how this may work nationwide with thousands of new cases per day. While it would be tempting to blame administrative incompetence for the difficulties in the most important household in the land, the real difficulties lies with inherent limitations to tests that need to be understood before getting on the testing bandwagon.
Catalyst @ Health 2.0, in collaboration with the Robert Wood Johnson Foundation, is seeking health technology solutions that can support the needs of the health care system (e.g. providers, government, public health and community organizations, and more) by addressing several obstacles during an emergency such as:
Resource Management: Shortages of equipment, staff, and cash flow
Health Data Exchange: Limited information and access available on patients’ health histories
Training and Communication: Limited training and cumbersome communication between responders and clinicians
Capacity: Limited beds, equipment, and resources and a need to maximize patient flow/throughput
Innovators must submit their tech-enabled solution by June 12th, 2020 at 11:59 PM ET.
Can you create a digital tool that supports the health care system during a large-scale health crisis? Apply today!
Catalyst @ Health 2.0 (“Catalyst”) is the industry leader in digital health strategic partnering, hosting competitive innovation “challenge” events, as well as developing and implementing programs for piloting and commercializing novel healthcare technologies.
We also asked people to rank their concerns about the costs of their care, in five questions that covered cost of care, cost of prescription drugs, cost and availability of insurance, and surprise billing. In the time since we ran the survey, everything has changed in American healthcare. The COVID19 pandemic is filling emergency rooms wherever the epidemic arrives. Bills are likely to be high, for both patients and insurers, and it is still far from clear how they will be paid. Americans are likely to continue to worry deeply about healthcare costs, with good reason, since it’s only in America that someone can go bankrupt due to seeking medical care.
FHIR DevDays, run by Rien Wertheim’s company Firely in conjuncion with HL7, is the premier FHIR event in the world, with editions in the US and Europe. The three pillars for DevDays are Learn, Code and Share. The event runs from 15 to 18 June, 1 to 5 PM EST. This year’s edition will be 100% virtual. Tracks include the ONC and CMS Final Rules and COVID-19 on FHIR. I will be opening and moderating that last track–Matthew Holt.
The Patient Innovator Competition at DevDays US 2020
Have you ever wondered what would happen if patients had access to their data from hospitals, labs and other sources? Some still doubt the value of data at the fingertips of patients. So, we went the extra mile to see how this would look in practice and the results were impressive.
To give some context, every year we run DevDays, which is a semi-annual conference for health data programmers working with FHIR. FHIR is the open and standardized API for healthcare. What APIs have done for other industries, FHIR is doing for healthcare. That is, enabling an app economy: apps for doctors, researchers, payers, even apps for the government and, above all, apps for patients.
A lot of these of these apps are built by EMR vendors, even more by startups, and some by patients. Last year we launched the Patient Innovator Track at DevDays to give patients a voice. The track gives the stage to tech-savvy patients who are taking control of their health using data about their disease and treatment. The track wants to prove a point: access to health data can improve our lives. It also shows the unimagined things people can do with data when their health is at stake.
Four finalists pitched for the Patient Innovator Award. In the end it was John Keyes that blew everyone away. John is a blood disease patient who created a simple app to track his blood count and ongoing test results. The app is called BloodNumbers and it consolidates test data from multiple health care providers, making it easy to view and share results if you want to.
We are looking for more tech-savvy patients, developers and IT experts like John, to apply for this year’s Patient Innovator Track. All you need to do is pitch an app, device or other technology that allows you to use your own health data to improve your wellbeing. The finalists get a free ticket to DevDays US 2020 Virtual Edition where they can learn all about FHIR and connect with the community. The winner gets to walk away with $2,500. On the jury we have Dave deBronkart (“ePatient Dave”) and Grahame Grieve, the founder of FHIR. Check out what Dave wrote about the Patient Innovator Track here.