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Maternal Mortality – Separating Signal from Noise

By AMEYA KULKARNI, MD

When Samuel Morse left his New Haven home to paint a portrait of the Maquis du Lafayette in Washington DC, it was the last time he would see his pregnant wife. Shortly after his arrival in Washington, his wife developed complications during childbirth. A messenger took several days on horseback to relay the message to Mr Morse. Because the trip back to New Haven took several more, his wife had died by the time he arrived at their home.  So moved was he by the tragedy of lost time that he dedicated the majority of the rest of his life to make sure that this would never happen to anyone again. His subsequent work on the telegraph and in particular the mechanism of communication for the telegraph resulted in Morse code – the first instantaneous messaging system in the world.

Mr Morse’s pain is not foreign to us in the 21st century. We feel the loss of new mothers so deeply that, when earlier this year new statistics on the rate of maternal death were released and suggested that American women died at three times the rate of other developed countries during child birth, doctors, patient advocates, and even Congress seemed willing to move heaven and earth to fix the problem. As someone who cares for expectant mothers at high risk for cardiovascular complications, I too was moved. But beyond the certainty of the headlines lay the nuance of the data, which seemed to tell a murkier story.

First at issue was the presentation of the data. Certainly, as a rate per live births, it would seem that the United States lagged behind other OECD countries – our maternal mortality rate was between 17.2 and 26.4 deaths per 100,000 live births, compared to 6.6 in the UK or 3.7 in Spain. But this translated to approximately 700 maternal deaths per year across the United States (among approximately 2.7 million annual births). While we would all agree that one avoidable maternal death is one too many, the low incidence means that small rates of error could have weighty implications on the reported results. For instance, an error rate of 0.01% would put the United States in line with other developed countries.

Surely, the error rate could not account for half the reported deaths, right? Unfortunately, it is difficult to estimate how close to reality the CDC reported data is, primarily because the main source data for maternal mortality is a single question asked on the application for death certificates. The question asks whether the deceased was pregnant at the time of death, within 42 days of death, or in the 43 to 365 days prior to death. While pregnancy at the time of death may be easy to assess, the latter two categories are subject to significantly more error.

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THCB Spotlights: Mike McSherry, CEO of Xealth

Today on THCB Spotlights, Matthew talks to Mike McSherry about Xealth—which is an “X” not a “Z” as in, the missing variable in health. How did Mike end up in health care from Swipe, the touch screen keyboard that is now ubiquitous on all touch screen phones? Find out how Xealth facilitates adoption of a vast range of digital health services by making it easy for providers to prescribe them as well as track engagement levels. Within the complexity of Epic and other EMR systems, how does Xealth fit in?

Will Omada Health be Digital Health’s Next Big IPO? | Sean Duffy, Omada Health

By JESSICA DAMASSA, WTF HEALTH

Sean Duffy, CEO of Omada Health, proves why his company is one of those digital health startups everyone’s watching in the chronic condition management space. Never mind the buzz around their latest massive funding round or Livongo’s IPO, the real story here is Sean’s idea about building a “completely digital” care provider for folks with pre-diabetes, type II diabetes, hypertension, and mental health issues — or, at least that’s the goal for the next decade. What does a “full-stack view of supporting someone’s care look like? How do you get there? Tune in to find out about Omada’s proprietary tech-testing litmus test, “The Sean Duffy’s Mom Test,” and some good advice for other health tech startups about what it takes to win over clinicians with your tech.

Filmed at Health 2.0 in Santa Clara, California in September 2019.

Jessica DaMassa is the host of the WTF Health show & stars in Health in 2 Point 00 with Matthew HoltGet a glimpse of the future of healthcare by meeting the people who are going to change it. Find more WTF Health interviews here or check out www.wtf.health.

Applications for GuideWell’s Scale Up Accelerator Closing Soon!

SPONSORED POST

By CATALYST @ HEALTH 2.0

There are only a few days remaining to apply for GuideWell’s 2020 Accelerator: Aging in Place! The program is seeking innovative, easy-to-use solutions that enable seniors to improve overall physical and emotional wellness, connect seniors to their communities, and increase the affordability and accessibility of health care for seniors that are economically challenged or cared for by a working family member.

10 health technology companies or innovators will have the incredible opportunity to participate in an eight week accelerator program that consists of a two-day kickoff boot camp, followed by weekly mentoring sessions and a series of virtual workshops that focus on challenges in the health care industry (e.g. customer acquisition, regulatory compliance, etc.).The program begins January 23rd, 2020 and will culminate in a curated Investor Matchmaking Showcase at GuideWell’s Innovation Center in Orlando, FL., on March 9th, 2020.

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THCB Spotlights: Todd Clardy, EVP Marketing at Accolade

Today on THCB Spotlights, Matthew interviews Todd Clardy who is the EVP of Marketing at Accolade. Accolade is a company well-known for being in employee/patient advocacy. They’ve created an advocacy model that focuses on creating an outstanding member experience and supporting patients through their whole journey, whether it’s an acute or chronic condition or helping people maintain their health and wellness. Where do Amazon, Google and Haven fit into this space? Find out how many people have got this and how Accolade will be expanding going forward.

Changing EMR – Seamless Continuation, Dreaded Chore or Fresh Start?

By HANS DUVEFELT, MD

At the end of the year my patients and I will start over. That is what changing EMRs does to us. I have mixed feelings about data migration, if it even happens.

I will move into a new virtual environment and my patients will take on slightly different appearances, maybe even alter their medical histories. Some will perhaps be asking me to edit diagnoses that have haunted them since we went from paper to computer records almost a decade ago.

With our first EMR, we scanned in a few things from patients’ paper records – sometimes only a few pages from years or decades of first handwritten and later typed notes. Much got lost, because we were doing something we never really had thought through, and we had to do it with a clock ticking: “Hurry, before the Federal incentives go away”. The Feds wanted EMRs because the vision was that more data would help research and population health and also reduce medical errors.

This time, another factor is pushing us forward: The EMR we have will no longer be supported after a certain date, and for an EMR that requires continuous tinkering in order to do basic tasks consistently, that is an untenable scenario. Only yesterday, I was suddenly unable to send prescriptions electronically and it took the national headquarter’s involvement to get me up and running again.

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Concrete Problems: Experts Caution on Construction of Digital Health Superhighway

By MICHAEL MILLENSON

If you’re used to health tech meetings filled with go-go entrepreneurs and the investors who love them, a conference of academic technology experts can be jarring.

Speakers repeatedly pointed to portions of the digital health superhighway that sorely need more concrete – in this case, concrete knowledge. One researcher even used the word “humility.”

The gathering was the annual symposium of the American Medical Informatics Association (AMIA). AMIA’s founders were pioneers. Witness the physician featured in a Wall Street Journal story detailing his use of “advanced machines [in] helping diagnose illness” – way back in 1959.

That history should provide a sobering perspective on the distinction between inevitable and imminent (a difference at least as important to investors as intellectuals), even on hot-button topics such as new data uses involving the electronic health record (EHR). 

I’ve been one of the optimists. Earlier this year, my colleague Adrian Gropper and I wrote about pending federal regulations requiring providers to give patients access to their medical record in a format usable by mobile apps. This, we said, could “decisively disrupt medicine’s clinical and economic power structure.”

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Now 30M Comcast Members Can Sync their Care Plan with their TV | Carina Edwards, CEO Quil Health

By JESSICA DAMASSA, WTF HEALTH

Quil Health CEO, Carina Edwards, tells us what’s happening at the digital health startup born from the partnership between Comcast NBCUniversal and Independence Blue Cross. The new “baby” is just about a year old. How’s it faring? And how involved are the “parents”? Carina talks about the company’s patient engagement platform that connects via phone, web, and cable TV. That means 30 million Comcast subscribers can sync their TV with their Quil app and literally ‘watch’ their care plan along with their Nightly News. Will Al Roker be making another appearance on Quil soon? This, and all the important questions about their business model and client base are answered here!

Filmed at the HIMSS Health 2.0 Conference in Santa Clara, CA in September 2019.

Jessica DaMassa is the host of the WTF Health show & stars in Health in 2 Point 00 with Matthew HoltGet a glimpse of the future of healthcare by meeting the people who are going to change it. Find more WTF Health interviews here or check out www.wtf.health.

Guerilla Billing – Missing the Gorilla in the Midst

By ANISH KOKA, MD

No one likes getting bills. But there is something that stinks particularly spectacularly about bills for healthcare that arrive despite carrying health insurance. Patients pay frequently expensive monthly premiums with the expectation that their insurance company will be there for them when illness befalls them.

But the problem being experienced by an increasing number of patients is going to a covered (in-network) facility for medical care, and being seen by an out-of-network physician. This happens because not all physicians working in hospitals serve the same master, and thus may not all have agreed to the in-network rate offered by an insurance company.

This is a common occurrence in medicine. At any given time, your local tax-exempt non-profit hospital is out of network of some low paying Medicaid plan or the other.

In this complex dance involving patients, insurers and doctors, Patients want their medical bills paid through premiums that they hope to be as low as possible, Insurers seek to pay out as little of the premium dollars collected as possible, and Doctors want to be paid a wage they feel is commensurate to their training and accumulated debt.

Insurers act as proxies for patients when negotiating with the people that actually deliver healthcare – doctors. Largely, the system works to funnel patients to ‘covered’ doctors and hospitals. Patients that walk into an uncovered facility are quickly redirected. But breakdowns happen during emergencies.

There are no choices to make for patients arriving unconscious or in distress to an emergency room. It suddenly becomes very possible to be seen by an out of network physician, and depending on the fine print of the insurance plans selected, some or none of these charges may be covered.

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THCB Spotlights: Jeremy Orr, CEO of Medial EarlySign

Today on THCB Spotlights, Matthew speaks with Jeremy Orr, CEO of Medial EarlySign. Medial EarlySign does complex algorithmic detection of elevated risk trajectories for high-burden serious diseases, and the progression towards chronic diseases such as diabetes. Tune in to hear more about this AI/ML company that has been working on their algorithms since before many had even heard about machine learning, what they’ve been doing with Kaiser Permanente and Geisinger, and where they are going next.

Filmed at the HLTH Conference in Las Vegas, October 2019.

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