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“Alexa, Open Symptom Checker” Gets You This Health Startup’s App | Piotr Orzechowski Infermedica

By JESSICA DaMASSA, WTF HEALTH

One of Europe’s top health tech startups, Infermedica out of Poland just closed a $3.65M funding round for its suite of tools that help patients figure out the best place to go to get care. It’s a patient-routing / symptom-checker with “AI under the hood” that is delivered via an app, chatbot, and voice application for Alexa. (In fact, they “own” the symptom checker that opens when you ask Alexa to “open symptom checker.”) Piotr Orzechowski talks about the full range of ways Infermedica is engaging patients and how they are scaling up their provider facing products as a result of this influx of funding.

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

Doctors Will Vote With Their Patients

By MIKE MAGEE, MD

As Robert Muller’s testimony before Congress made clear, we owe President Trump a debt of gratitude on two counts. First, his unlawful and predatory actions have clearly exposed the fault lines in our still young Democracy. As the Founders well realized, the road would be rocky on our way to “a more perfect union”, and checks and balances would, sooner or later, be counter-checked and thrown out of balance.

On the second count, Trump has most effectively revealed weaknesses that are neither structural nor easily repaired with the wave of the wand. Those weaknesses are cultural and deeply embedded in a portion of our citizenry. The weakness he has so easily exposed is within us. It is reflected in our stubborn embrace of prejudice, our tolerance of family separations at the border, our penchant for violence and romanticism of firearms, our suspicion of “good government”, and –unlike any other developed nation – our historic desire to withhold access to health services to our fellow Americans.

In the dust-up that followed the New York Times publication of Ross Douthat’s May 16, 2017 article, “The 25th Amendment Solution for Removing Trump”, Dahlia Lithwick wrote in SLATE, “Donald Trump isn’t the disease that plagues modern America, he’s the symptom. Let’s stop calling it a disability and call it what it is: What we are now.”

Recently a long-time health advocate from California told me she did not believe that the majority of doctors would support a universal health care system in some form due to their conservative bend. I disagreed.

It is true that, to become a physician involves significant investment of time and effort, and deferring a decade worth of earnings to pursue a training program that, at times, resembles war-zone conditions can create an ultra-focus on future earnings. But it is also true that these individuals, increasingly salaried and employed within organizations struggling to improve their collective performance, deliver (most of the time) three critical virtues in our society.

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Security Crisis of Cardiac Pacemakers Paves the Way for IoT Security Evolution in Cardiology

By INGA SHUGALO

While the healthcare IoT demand forecasts are more than generous, anticipating the market to hit $158.07B by 2022, there is still a certain delay in IoT adoption across the industry. Connected medical devices, especially those that are directly involved in patient care, are adopted cautiously due to potential security vulnerabilities and risks to patient safety.

One of the reasons behind the hesitant adoption of healthcare IoT in cardiology is preexisting concerns about the security of implantable medical devices, such as pacemakers.

The recent pacemaker crisis revealed the vulnerabilities in pacemaker software across several major vendors. If exploited, software vulnerabilities would allow hackers to take over the device and control it fully. The crisis led to device recalls, certain features disabled, and even remote updates cut off completely to avoid unacceptable health risks.

This series of events led to a cautious attitude toward the emerging cardiology IoT. Since we can’t be sure that all exploits and vulnerabilities are eliminated in less advanced systems, are we really ready to take a step forward to more elaborate healthcare software solutions at this point?

The fact of the matter is, cardiology is already taking these steps. The new generation of pacemakers has embedded sensors to monitor a patient’s blood temperature, sinus node rate, breathing, and other vitals. This data is used to flexibly alter the heart rate, slowing or speeding it depending on a patient’s current activity level. They also inherited remote control from their predecessors. Practically, next-gen pacemakers are IoT devices.

Accordingly, the industry can either stigmatize the security concerns or choose to adopt a new perspective, seeing the pacemaker crisis as an opportunity to create a solid platform for unbiased adoption of upcoming connected cardiac devices.

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Health in 2 Point 00 Episode 89 | IPOs, Oscar and Fitbit

Today on Health in 2 Point 00, it’s IPO day! On Episode 89, Jess asks me about the recent IPOs, Oscar Health getting into Medicare Advantage, and Fitbit accuracy in people of color. Jess asks me to weigh in on whether Livongo’s IPO was better than we expected and it’s safe to say that they are growing fast. On the flip side, the “silent” IPO that no one seems to be talking about is Health Catalyst, which is also doing quite well with a $1.6 billion valuation although they are not growing as fast as Livongo is. Next, Oscar Health decided to enter into Medicare Advantage, which is not surprising because that’s where the real money is in the insurance side. Finally, Fitbits and other wearables may not be tracking heart rates accurately in people of color, so what does this mean for the wearables industry—and their potential use for medical purposes? —Matthew Holt

Health Reform Job One: Stop the Gouging! | Part 3

By BOB HERTZ

We Need Legal Assaults On The Greediest Providers!

When a patient is hospitalized, or diagnosed with a deadly disease, they often have no choice about the cost of their treatment.

They are legally helpless, and vulnerable to price gouging.

We need more legal protection of patients. In some cases we need price controls.

In the final part of this series, I discuss how we need to empower patients by allowing them to challenge their medical bills in courts.

Assault Phase Four – Binding Arbitration of Medical Bills

 We must allow patients to challenge their medical bills in expanded ‘Health courts.’

Patients should be able to contest any bill over $250,  especially if they have not given ‘informed financial consent’ to the provider.

Such ‘consent’ would require that if a procedure can be scheduled in advance, it can also be quoted in advance. If the patient requests an estimate, they must be notified in writing at least seven days in advance. This would allow the patient to request a different provider, or to investigate other alternatives. If an estimate is requested but never produced, the patient has no liability. (That will shake up the providers rather quickly.)

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Health Reform Job One: Stop the Gouging! | Part 2

By BOB HERTZ

We Need Legal Assaults On The Greediest Providers!

When a patient is hospitalized, or diagnosed with a deadly disease, they often have no choice about the cost of their treatment.

They are legally helpless, and vulnerable to price gouging.

We need more legal protection of patients. In some cases we need price controls.

Next in this three-part series, I discuss how we could challenge Big Pharma by lessening regulation of generic drugs, having the government take over production and establishing price review boards.

Assault Phase Three – Challenge Big Pharma

Step OneLess Regulation of Generic Drugs

If an off-patent drug has been approved by other first-world nations, this would constitute automatic approval by the FDA.

The price gouging around Epipen would have ended quickly, if new versions of genetic drugs did not require an FDA approval process. We should let reputable drug companies produce whatever generic drugs they want.

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Health Reform Job One: Stop the Gouging! | Part 1

By BOB HERTZ

We Need Legal Assaults On The Greediest Providers!

When a patient is hospitalized, or diagnosed with a deadly disease, they often have no choice about the cost of their treatment.

They are legally helpless, and vulnerable to price gouging.

Medicare offers decent protection — i.e. limits on balance billing, and no patient liability if a claim is denied.

But under age 65, it is a Wild West — especially for emergency care, and drugs and devices. The more they charge, the more they make. Even good health insurance does not offer complete financial insulation.

We need more legal protection of patients. In some cases we need price controls.

‘Charging what the market will bear’ is inadequate, even childish, when ‘the market’ consists of desperate patients. Where contracts are impossible and there is no chance for informed financial consent, government can and should step in.

This series describes the new laws that we need. Very little is required in tax dollars….but we do require a strong will to protect.

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Pending Federal Privacy Legislation: A Status Update

Vince Kuraitis
Deven McGraw

By DEVEN McGRAW and VINCE KURAITIS

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

In our initial blog post of February 20th, “For Your Radar – Huge Implications for Healthcare in Pending Privacy Legislation,” we broadly discussed six key issues for healthcare stakeholders in the potential federal privacy and data protection legislation. We committed to future posts comparing and contrasting specific legislative proposals.  

What’s happened since then? 

Additional bills have been introduced and hearings have been held in both the House and the Senate.  The Federal Trade Commission (FTC) also hosted two days of hearings on the FTC’s Approach to Consumer Privacy.  

The buzz around federal privacy legislation continues, but as of yet there appear to be no proposals or bills that have emerged as the lead bills. 

In the meantime, the clock is ticking.  As we mentioned in our February 20th post, a significant catalyst for federal privacy legislation is the desire of companies covered by the California Consumer Privacy Act (CCPA) to have that broadly-applicable, stringent state law preempted by a more company-friendly federal law.  The CCPA, which sets stringent consent and other requirements for large companies, or companies collecting or monetizing large amounts of consumer data from California residents, goes into effect January 1, 2020 – less than six months from today.  

Is it possible for a legislative body to move quickly on such a controversial topic?  Again, California’s experience may be instructive. The CCPA was passed into law and signed on June 28, 2018, about a week after it was introduced. Lawmakers were in a rush in order to keep a popular and even stricter consumer privacy ballot initiative from being put before the California voters.  (The sponsors of the ballot initiative agreed to withdraw it if the CCPA were enacted by the June 28th deadline.). 

Tech companies held their noses and supported the legislation because changing legislation is easier than changing a ballot initiative adopted by the voters. However, this strategy is not fool-proof.  Although the CCPA has been successfully modified once to address some company concerns and to clarify confusing language, more recent attempts to amend it have failed (modification bills are still pending).  With the deadline fast approaching, and the prospect for further significant modifications to the CCPA looking less likely, the pressure on Congress is reaching a fever pitch.

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Those Digital Health IPOs—Flipping the Stack & Filling the Gap

By MATTHEW HOLT

I’ve been driven steadily nuts by a series of recent articles that are sort of describing what’s happening in health tech or (because the term won’t die) digital health, so I thought it was time for the definitive explanation. Yeah, yeah, humility ain’t my strong suit.

It won’t have escaped your attention that, after five years during which Castlight Health more or less single-handedly killed the IPO market for new health tech companies, suddenly in the middle of July 2019 we have three digital health companies going public. While Livongo, (FD-a THCB sponsor) Phreesia and Health Catalyst are all a little bit different, I’m going to use them to explain what the last decade of health tech evolution has meant.

Don’t get carried away by the precise details of the IPOs. Phressia is already out with a market cap of $845m. Yes, it’s true that none of the three are profitable yet, but they are all showing decent revenue growth at an annual run rate of $100m+ and Livongo in particular has been on a client acquisition and annual triple digit revenue growth tear. It’s also the newest of these companies, founded only in 2014, albeit by buying another company (EosHealth) founded in 2008 that had some of the tech they launched with. Going public doesn’t really mean that the health care market will swoon for them, nor that they are guaranteed to change the world. After all, as I pointed out in my recent somewhat (ok, very) cynical 12 rules for health tech startups, UnitedHealth Group has $250 Billion in revenue and doesn’t seem to be able to change the system. And anyone who remembers the eHealth bust of 2000-2002 knows that just because you get to the IPO, it’s no guarantee of success or even survival.

But just by virtue of making it this far and being around the 1/10th of 1% of health tech startups to make it to IPO, we can call all three a success. But what do they do?

They are all using new technologies to tackle longstanding health care problems.

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Announcing a New Series: “The Health Data Goldilocks Dilemma: Sharing? Privacy? Both?

By ZOYA KHAN

I would like to introduce you to a new ongoing series that THCB will be featuring called “The Health Data Goldilocks Dilemma: Sharing? Privacy? Both?”. It is about time we started talking about health data privacy and policy, and we have just the experts on hand to do so: Vince Kuraitis and Deven McGraw.

The Health Data Goldilocks Dilemma: Sharing? Privacy? Both?” series will cover a whole host of topics that discuss, clarify, and challenge the notion of sharing data and if it should be kept private or made public. On the one hand, sharing health information is essential for clinical care, powering medical discovery, and enabling health system transformation. On the other hand, the public is expressing greater concerns over the privacy of personal health data. This ‘Goldilocks Dilemma’ has pushed US policymakers towards two seemingly conflicting goals: 1) broader data interoperability and data sharing, and 2) enhanced data privacy and data protection.

But this issue is even more nuanced and is influenced by many moving parts including: Federal & State privacy legislation, health technology legislation, policy & interoperability rules, data usage from AI & machine learning tools, data from clinical research, ethical concerns, compensating individuals for their data, health data business models, & many more. 

Fear not, Deven & Vince are here to walk readers through this dilemma and will be providing pieces to help explain what is going on. Most of their discussion & pieces will cover 2 specific affected areas: 1) How are policymakers addressing health data privacy risks, and 2) The impact on business models within the Health Data Goldilocks Dilemma.

We hope you enjoy the series and if you have any pieces to add to it, please email me zoya@thehealthcareblog.com

Zoya Khan is the Editor-in-Chief of THCB & an Associate at SMACK.health

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