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Year: 2017

Calling all NYC Startups! Digital Health Marketplace is back!

The fourth iteration of Digital Health Marketplace, sponsored by The New York City Economic Development Corporation, in partnership with Health 2.0, is underway! The Digital Health Marketplace connects health technology Buyers and Sellers through curated matchmaking, assistance to facilitate rapid technology adoption, and competitive commercialization awards to encourage piloting and procurement of new digital health technology in NYC.

The past three classes of Digital Health Marketplace has provided over $2M in commercialization awards to innovative NYC health tech startups and their self-chosen healthcare organization pilot partners. This year, a total of $250,000 is available to fund health tech pilots in NYC.

The program helps established healthcare stakeholders, like hospitals and health systems (health tech “Buyers”), de-risk their investments in new technology by simplifying the search for market-ready solutions. At the same time, the program shortens the sales cycle for startups (health tech “Sellers”) by connecting them with relevant, forward-looking Buyers. Buyers and Sellers will be matched based on self-identified interest areas and business needs or abilities once they apply to “Find a Pilot Partner”. Buyers will receive a curated list of startups to choose to meet one-on-one during the half-day Matchmaking Event on April 6, 2017 at the New York Genome Center.

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A Better “Better Way”

Reports coming out of Washington suggest that Republicans may have bitten off more than they would like to chew with repealing & replacing the ACA, with a proliferation of proposals and no consensus on which to support, or how to get the 60 Senate votes needed to turn an eventual consensus plan into law.

There is a general consensus in the GOP to proceed with the budget reconciliation process, but if they pass the bill the House passed in 2015, it will immediately defund plan subsidies and the Medicaid expansion, setting up 25 million or more to lose their coverage right around midterm elections in 2018.

Even a less drastic budget reconciliation bill, for example one that gets rid of the individual and employer mandates by deleting the penalties associated with them, would leave us with a, “zombie ACA”, with everything not budget-related still in place, but malfunctioning with unintended consequences.

All this uncertainty is bad—it’s bad for the government, it’s bad for industry, and most importantly, it’s bad for the tens of millions of confused consumers trying to make informed decisions about how and if they can get health coverage.

Taking a step back

As the saying goes, when you have a hammer, every problem looks like a nail. In this case, when you have a legislative majority, every problem looks like it should be solved by changing the law.

But does that have to be the case? What if Congressional Republicans were to take a back seat and let Tom Price and the Department of Health and Human Services (HHS) begin the process of reforming health reform?

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The RWJF Choosing Care Challenge Offers PokitDok & Vericred APIs

What do you do when your doctor says something serious, like, “Make an appointment with a Cardiac electrophysiologist stat” or “here is a prescription for some XYZ.” A what? And a whom?! “Oh, and you’ll need to get an MRI too.” Well, that’s overwhelming. It’s no surprise that about 20 percent of first-time prescriptions are never filled, according to a 2010 Harvard Medical School study1.

Patients often come to a road block and fail to follow through with doctors’ orders because of perceived financial burdens, or simply because they don’t know where to find what they need. The Robert Wood Johnson Foundation (RWJF) feels that no one should be at a loss for health care services because they don’t know where to go for affordable services. The RWJF Choosing Care Challenge will therefore bring tech-enabled solutions to the forefront of this issue.

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Wellbeing: The Interdependencies of the Body, Mind & Spirit

In 1891, Dr. Luther Gulick proposed a red triangle as the YMCA symbol. In his words, the equal sides of the triangle stood for “man’s essential unity– body, mind and spirit– each being a necessary and eternal part of man, being neither one alone but all three.” True then, and equally true today, it highlights what is missing from most traditional approaches to wellness–the mental, emotional, and spiritual components. Hardly surprising given the remarkable resistance mental illness treatments encounter.

The term “mental illness” usually refers to recognized mental illnesses in accordance with the Diagnostic and Statistical Manual (DSM) published by the American Psychiatric Association. These include depression, anxiety, psychotic disorders, and bipolar disorder. While substance abuse and addictions are not so neatly categorized and are sometimes referred to as “behavioral disorders,” an indeed odd phrasing, we will refer to all such afflictions as “mental health or “mental illness.”

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Non-Alternative Facts About the Healthcare System

The economic fundamentals of healthcare in the United States are unique, amazingly complex, multi-layered and opaque. It takes a lot of work and time to understand them, work and time that few of the experts opining about healthcare on television have done. Once you do understand them, it takes serious independence, a big ornery streak, and maybe a bit of a career death wish to speak publicly about how the industry that pays your speaking and consulting fees should, can, and must strive to make half as much money. Well, I turn 67 this year and I’m cranky as hell, so let’s go.

The Wrong Question

We are back again in the cage fight over healthcare in Congress. But in all these fights we are only arguing over one question: Who pays? The government, your employer, you? A different answer to that question will distribute the pain differently, but it won’t cut the pain in half.

There are other questions to ask whose answers could get us there, such as:

  • Who do we pay?
  • How do we pay them?
  • For what, exactly, are we paying?

Because the way we are paying now ineluctably drives us toward paying too much, for not enough, and for things we don’t even need.

A few facts, the old-fashioned non-alternative kind:

  • Cost: Healthcare in the U.S., the whole system, costs us something like $3.4 trillion per year. Yes, that’s “trillion” with a “T”. If U.S. healthcare were a country on its own it would be the fifth largest economy in the world.
  • Waste: About a third of that is wasted on tests and procedures and devices that we really don’t need, that don’t help, that even hurt us. That’s the conservative estimate in a number of expert analyses, and based on the opinions of doctors about their own specialties. Some analyses say more: Some say half. Even that conservative estimate (one third) is a big wow: over $1.2 trillion per year, something like twice the entire U.S. military budget, thrown away on waste.
  • Prices: The prices are nuts. It’s not just pharmaceuticals. Across the board, from devices to procedures, hospital room charges to implants to diagnostic tests, the prices actually paid in the U.S. are three, five, 10 times what they are in other medically advanced countries like France, Germany, and the U.K.
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The Lifecycle Theory of Saving For Healthcare Needs

Republicans are bickering over whether to repeal the more costly provisions of Obamacare and allow greater flexibility into the health insurance marketplace. Republican lawmakers were shocked… SHOCKED, to discover net beneficiaries of the Affordable Care Act (ACA) like receiving open-ended subsidies worth thousands of dollars – paid for by other people. Lost in the shuffle are the self-employed, small business owners and individuals whose premiums have skyrocketed – and are no longer affordable – so that others can get a sweet deal.

The status quo cannot go on, of course. Premiums are skyrocketing and insurers are pulling out of the market. HealthCare.gov plans are a bad deal for all except for those receiving subsidies and those with significant health problems. Only about 15 percent of exchange enrollees are those paying the entirety of their own premiums, suggesting consumers don’t consider plans a good value. 

In an ideal world, young people would save for retirement, have an emergency fund and save for future health care needs. A mandatory payroll tax dedicated to individuals’ own health care would be the ideal way to fund their future medical needs. Singapore has such a system, called MediSave accounts. Liberals consider personal accounts to be antisocial, since money in one account cannot be diverted to someone else’s medical bills. However, a dose of antisocial behavior would benefit our health care system.

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Diversity in SI Swimsuit Issue is Great But Does it Cross the Line?

Sports Illustrated’s new swimsuit issue is touted as a “diversity issue” intended to celebrate female models of different ages, ethnic backgrounds and figures.  But in featuring plus-size models, does diversity threaten to go too far?

On its face, any movement toward diversity in modelling is admirable – contemporary models of all stripes generally still skew too young, too white and too thin.  And where these models are insufficiently perfect, Photoshop exists to make them even more wrinkle-free, fairer and skinnier.

Luckily, there has been a movement in Europe to rectify at least one of these issues.  Via “skinny model” legislation, France, Italy, Israel and Spain have banned models from working if they are underweight.  In France, penalties for agencies and brands breaking this law range from jail time to hefty fines.  French law also mandates a fine for firms if they fail to clearly note within ads if models have been digitally altered.

From a health perspective, European countries appear to be serious in their attempts to rein in advertisers, designers and photographers.  This is great news –this year’s rookie Sports Illustrated swimsuit model Myla Dalbesio  echoes a concern voiced by many models – that industry-imposed parameters can be arbitrary and demeaning with years of being told that one is “too fat, then too thin”.  Movement toward regulating an industry which, for far too long, has promoted eating disorder-derived emaciated looks such as “heroin chic” deserves oversight and regulation.

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How to Make HSAs Actually Work

First, let me candidly admit that I have no idea if putting Health Savings Accounts (HSAs for short) at the center of the Trump healthcare rework is a good idea. I do, however, have some insights into what made Bush-era HSA plans fail.

Bush-era HSA’s were unavailable to many Americans, because their health insurance companies and employers ultimately made the decision about whether they would be able sign up for an HSA. Many employers elected not to participate in HSA’s by not purchasing health plans that “came with an HSA”.

I was working at the UT School of Biomedical Informatics during the Bush administration’s attempt to deploy HSA’s. I wanted to research and understand how HSA’s would impact the healthcare system, and I knew that the first step was to sign up for one myself. 

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Is DRexit Next?

Sean MacStiofain said “most revolutions are caused… by the stupidity and brutality of governments.” Regulation without legitimacy, predictability and fairness always leads to backlash instead of compliance.

Here’s a prediction for you: If something is not done to stop MACRA implementation, more physicians will opt-out of Medicare and Medicaid than is fathomable.

Once DRexit begins, there will be no turning back.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is destructive to the physician patient relationship because it prevents physicians from prioritizing patient care. MACRA supporters like to point out this legislation was passed with bipartisan support; in reality, it was passed simultaneously with repeal of the Sustainable Growth Rate Formula.

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The Policymaker’s Guide to Options For Replacing the Cadillac Tax

As policymakers debate repealing and replacing the Affordable Care Act (ACA or “Obamacare”), disagreement remains over how to address the ACA’s “Cadillac tax.” Rather than repealing the 40 percent tax on high-cost insurance plans outright, many advocates of “repeal and replace” have proposed replacing it with a limit on the tax exclusion for employer-sponsored health insurance (ESI). Doing so would be a wise choice, and limiting the ESI exclusion would both generate significant revenue to pay for an ACA replacement and help to limit the overall growth of health care spending. In this piece, we discuss some of the options available for replacement. 

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