Year: 2017

The Implementer’s Dilemma

Dec 12, 2017• 2

By DAVID SHAYWITZ, MD

One word: implementation.

Increasingly, I’m convinced that the underappreciated challenges of implementation describe the ever-expanding gap between the promise of emerging technologies (sensors, AI) and their comparatively limited use in clinical care and pharmaceutical research. (Updated disclosure: I am now a VC, associated with a pharma company; views expressed, as always, are my own.)

Technology Promises Disruption Of Healthcare…

Let’s start with some context. Healthcare, it is universally agreed, is “broken,” and in particular, many of the advances and conveniences we now take for granted in virtually every other domain remain largely aspirational goals, or occasionally pilot initiatives, in medicine.

Healthcare is viewed by many as an ossified enterprise desperately in need of some disruption. As emerging technologies shook up other industries originally viewed as too hide-bound to ever change, there was in many quarters a profound hope that advances like the smart phone or AI, and approaches like agile development and design thinking, could reinvent the way care is delivered, and more generally, help to reconceptualize the way each of us think about health and disease.

Will CVS-Aetna Merger Lead to “Separate But Unequal” Healthcare?

Dec 11, 2017• 11

By NIRAN AL-AGBA, MD

Last week, pharmacy giant CVS agreed to purchase Aetna this week for an astounding $69 billion dollar sum. The company allegedly plans to reduce health spending by developing an integrated system touted as “a new front door for health care in America.” This merger is actually an acquisition, entailing transfer of ownership. The central aim of an acquisition is to increase market share, expand the scope of services provided, and improve financial stability. CVS hit the jackpot on all three objectives. While Wall Street investors celebrate, many of us knowledgeable in the delivery of healthcare services are wondering who will bear the responsibility for the patients harmed by this experiment?

Aetna has compiled vast amounts of data from 22 million health plan members. CVS provides pharmacy benefits management to nearly 90 million consumers. Together, with 10,000 stores and 1,100-minute clinics already in the CVS network, this acquisition will create a ‘Walmart for Healthcare’. Applying bulk-purchase business strategies to the sale of merchandise is one thing, while providing healthcare services by ‘trial and error’ to human beings is another matter entirely. Bypassing physicians to deliver healthcare by protocol categorically jeopardizes patient safety.

Executives at Aetna-CVS plan to utilize pharmacists and nurses in the evaluation of acute illness and management of chronic disease. If an insurer, drugstore, and pharmacy benefit manager unite as one, it will usher in an era of medical “segregation,” with segregation defined as the isolation or separation of a race, class, or group by enforced or voluntary restriction, by barriers to social intercourse, by separate educational facilities, or by other discriminatory means.

FDA, VCs, Big Ideas, and more at WinterTech

Dec 11, 2017• 1

By HEALTH 2.0

WinterTech is almost one month away, and we’re extremely excited about the final agenda. The 2018 edition of WinterTech will be not only be focusing on the new investment treads in digital health, but will take a in-depth look into the revolution in choice within the consumer landscape and the rapid development of digital therapeutics.

Our jam-packed 1-day conference includes:

Keynote presentation on how to create seamless health care experiences to meet the needs of consumers by Mark Ganz, CEO of Cambia Health.
Panel discussion on the opportunities, roadblocks, and regulations within the field of digital therapeutics by Bakul Patel, Associate Director for Digital Health at the FDA.
Investment Strategies Past and Present: a look into 2017 trends, surprises, and flops. plus predictions for 2018 by VC firms GE Ventures, Canaan, Fifty Years, NEA, and B Capital Group.
Fireside chat between 4 VCs and their CEOs on their relationship and investment models
Access to the Investor Breakfast where start-ups and investors discuss business models and explore portfolios. Start-ups apply here.
Live demos from some of the most innovative companies in the digital healthcare space.

Don’t miss out the hottest digital healthcare event focusing on investment in the space. Register today to take advantage of the early bird rate before prices increase after Friday, December 22nd.

On the Morality of Insurance Premiums

Dec 11, 2017• 17

By ANISH KOKA, MD

As CVS-Aetna merger talks fill the air this Christmas season and experts weigh in on the impact this will have on the economy and consumers alike, I’m sitting at a little desk in a little office contemplating health insurance.

I run a little shop that’s about as far from CVS-Aetna as you can get in the health care space : a solo practice doctor with four full time employees and revenues a little south of $65 billion dollars. I shouldn’t feel too alone. Small businesses account for 99% of US firms and employ almost half of all private sector employees. But knowing my problem is one shared by many provides only partial solace.

Prior to arrival of the ACA, I provided health insurance to everyone through the company. At the time I had 3 full time employees and the insurance broker I worked with got me a quote for $1300 / month. Now, I really didn’t want to be in the providing healthcare business, so when the ACA arrived with its individual market I was happy to facilitate buying health insurance from the exchanges. So initially, I chose to pay for my employees plans on the individual market. I was quickly told by my accountant that paying for my employees insurance in this manner was running afoul of a three letter entity of the federal government called the IRS.

Apparently the individual ACA market premiums were allergic to being deducted in this pre-tax manner. Fine. So I went ahead and paid each employee $6000 per year extra with the understanding that they would use that money to buy health insurance on the individual market.

Hey Watson, Can I Sue You?

Dec 10, 2017• 3

By JASON CHUNG & AMANDA ZINK

Currently, three South Korean medical institutions – Gachon University Gil Medical Center, Pusan National University Hospital and Konyang University Hospital – have implemented IBM’s Watson for Oncology artificial intelligence (AI) system. As IBM touts the Watson for Oncology AI’s to “[i]dentify, evaluate and compare treatment options” by understanding the longitudinal medical record and applying its training to each unique patient, questions regarding the status and liability of these AI machines have arisen.

Given its ability to interpret data and present treatment options (along with relevant justifications), AI represents an interim step between a diagnostic tool and colleague in medical settings. Using philosophical and legal concepts, this article explores whether AI’s ability to adapt and learn means that it has the capacity to reason and whether this means that AI should be considered a legal person.

Through this exploration, the authors conclude that medical AI such as Watson for Oncology should be given a unique legal status akin to personhood to reflect its current and potential role in the medical decision-making process. They analogize the role of IBM’s AI to those of medical residents and argue that liability for wrongful diagnoses should be generally based on a medical malpractice basis rather than through products liability or vicarious liability. Finally, they differentiate medical AI from AI used in other products, such as self-driving cars.

Artificial Intelligence in Healthcare: Lessons from Finance

Dec 8, 2017• 3

By AJAY KOHLI, MD

“We built it and we just let it run. We’re a few dudes in an office and our goal is to keep it running. It does everything we could do, except it’s significantly more powerful and it has completely automated how our work is being done,” casually said the hedge fund manager as he described the process by which nearly $1billion was being managed within his fund.

The ‘it’ is an artificial intelligence (AI) based algorithm that uses complex statistics to analyze variables that went into successful decisions and uses advanced computer programs to keep replicating those decisions. All this, while it continuously learns from – and improves upon – its mistakes as it encounters new variables.

These machine intelligent systems are applying the many different forms of AI and fundamentally changing the financial industry. From applying Natural Language Processing in detecting Anti-Money Laundering and fraudulent financial activity to applying Cognitive Computing to analyze wide varieties of variables in building better trading algorithms and to leveraging Deep Learning to looking at consumer decision patterns and providing personalized ‘chatbots,’ AI is transforming the financial sector.

One of the most noticeable areas where this disruption is taking place is within hedge funds: hedge funds that are transitioning their trading desks to AI backed systems, are already beginning to outperform hedge-funds backed by humans alone. What’s really quite astonishing though is how, in the short span of a few years, how far reaching the results have been.

Hearing about hedgies working with AI researchers to make even more money doesn’t inspire the rest of us to greatness. However, it may be valuable to look a brief historical overview of how the financial industry reached this juncture.

Premium Support: Coming Soon to a Medicare Plan Near You?

Dec 8, 2017• 3

BY ROGER COLLIER

Unnoticed by most of the media, the Congressional Budget Office recently released a report that could profoundly change American seniors’ healthcare coverage.

The report updates a 2013 CBO analysis of the potential impact of switching Medicare to a premium support system. Under such a system private plans would compete with the traditional fee-for-service plan much like today, but with a big difference. Whereas now, for most beneficiaries, Part A is free and Part B requires a modest premium, under premium support the government would pay only up to regional benchmark amounts for Parts A and B together. Seniors choosing a plan (or the FFS option) priced above the benchmark would pay the difference.

The concept isn’t new. Over the past twenty years, various versions have been proposed by bipartisan commissions and—more recently—by Republican budgeters in Congress. What is new is the projected magnitude of the federal budget savings.

Both CBO analyses looked at two options for setting the benchmarks, either as the average of all bids (including the projected FFS cost) for a region, or as the lower of the FFS cost and the second lowest private plan bid. The differences between the projections in the two analyses, four years apart—and the numbers themselves—are huge.

A Clinical Trial By Any Other Name …

Dec 7, 2017• 1

By ARTHUR CAPLAN and KELLY McBRIDE FOLKERS

Mosquito borne illnesses pose a significant threat to human health. In the past several years, drug makers have begun developing vaccines for viruses like dengue, Zika, and chikungunya, all of which pose unique risks to billions across the globe. One of them just went terribly, terribly wrong.

Sanofi Pasteur, the vaccine division of the multinational pharmaceutical company Sanofi, has the problem. In a press release distributed last Wednesday, Sanofi reported that new analysis of long-term safety data for its dengue vaccine, Dengvaxia®, revealed that the vaccine may not be safe or effective for individuals who have had no prior dengue infection. The Philippines was the first country in Southeast Asia to approve the vaccine. It has since been administered to more than 600,000 schoolchildren in three highly-endemic regions of the country in the world’s first public dengue immunization program.

The vaccine received regulatory approval in the Philippines in December 2015, and the school program took effect just over three months later. Numerous local public health officials have claimed that the program was initiated too hastily. Susan Pineda Mercado, the former undersecretary of the Philippine’s Department of Health (DOH), has characterized the program in a Facebook post as “the biggest government funded clinical-trial-masked-as-a-public-health-program scam in the history of the DOH.”

What does the Concorde Tell Us About Healthcare Technology in the 21st Century?

Dec 6, 2017• 8

By JOE FLOWER

I am spending this month in the English Midlands in Stratford-on-Avon hard by the canal, the Bard’s town of quaint half-timbered Tudor pubs with “established 1482” on the plaques, and I am thinking about medical technology. I am here with Jenni to support her older brother as he goes through open-heart surgery and recovery. We have spent hours watching the ICU monitors.

The other night I watched a BBC documentary about the development of the Concorde, the supersonic aircraft. Beautiful plane, impressive technology for the time. Ridiculously expensive. Ultimately abandoned as not easily profitable and of limited use for a limited market.

The designers of the plane were quite proud of it, even as old men talking to the documentary cameras. They well should be, as it was a formidable technological achievement. One of the pilots talked about how many passengers would leave London at 10:30 am, arrive in New York at 9:30 am, conduct a day’s business, then ride the Concorde back to London in the evening, at $8,000 for round trip.

Here is the shocking take-away from the documentary. When they had finished the plane and were shopping it around, a number of countries complained about the noise, the sonic booms it would generate over every inch of its flight path. Eventually they sold zero planes, and the only airlines that put the Concorde into regular service were Air France and British Airways, the national carriers of the two countries that built it. That is not what is shocking. This is what is shocking: This was a surprise to them. The promoters and designers had apparently never considered that people might object to the noise. Never even thought about it.

Nor, it turns out, had they ever fully considered the cost/benefit ratio: Even at very high ticket prices, even at relatively full utilization, even when British Airways was given the planes for £1 each by the British government without having to shoulder any of the vast and deep more-than-decade-long development costs, the Concorde was hard to make a profit from. The crash of a Concorde in Paris in 2000, then 9/11 with its prolonged drop in air travel, spelled the beginning of the end. By 2003 both airlines had withdrawn the entire fleet from service and given up on the beautiful but flawed Concorde.

Secure your seat for live demos on precision medicine delivery at next week’s Tech Summit

Dec 5, 2017

Imagine if you will, a future in which a cancer diagnosis will be treated with a lifestyle change, like a chronic condition. Survivable. Manageable. Like Diabetes. Sure, to receive a cancer diagnosis today does not mean what it meant twenty years ago, but we are also unlikely to reach a point of ever acting casual about the term or the treatment plan.

In the meantime though, the increasing prevalence of personal data collection is driving new approaches in care plans that have a real shot at improving quality of life. The narrative of one’s life can be seen in the data – everything from where you live, what you eat, how you workout, even what you search for on the internet. The sources of such personal data come from places like clinical trials, biosensors, and wearables and is being stored in your Electronic Medical Record.

The sticking point though is the advancement of technological tools to view, aggregate, extract, and analyze relevant data to derive a meaningful plan of attack (er, treatment plan). One interoperable tool that plugs right into the EMR is Cota Healthcare. Pair this with omics data and genome sequencing technology, like 2bPrecise, and physicians are gaining insight into what makes you, you. And thus are better able to customize a bespoke cancer treatment plan, designed for you and only you.

Learn more about how omics data is driving new care plans, and see a live demo from Cota Healthcare andothers at the Technology for Precision Health Summit next week in San Francisco.