Month: February 2018

A Health Tech’s Secret Weapon: The People Under The Hood

Feb 20, 2018• 3

By DAVID SHAYWITZ, MD

The recently-announced acquisition of the oncology data company Flatiron Health by Roche for $2.1B represents a robust validation of the much-discussed but infrequently-realized hypothesis that technology entrepreneurs who can turn health data into actionable insights can capture significant value for this accomplishment.

Four questions underlying this deal (a transaction first reported, as usual, by Chrissy Farr) are: (1) What is the Flatiron business model? (2) What makes Flatiron different from other health data companies? (3) Why did Roche pay so much for this asset? (4) What are the lessons other health tech companies might learn?

The Flatiron Business Model

To a first approximation, Flatiron has a model that can be seen as similar to tech platforms like Google and Facebook – delight (or at least offer a useful service to) front-end users, and then sell the data generated to other businesses. For Flatiron, the front-end users are oncologists (mostly community, some academic), and the data customers are pharma companies. In contrast to Google (and also in contrast to the less successful Practice Fusion, recently acquired at a loss), Flatiron doesn’t sell access to front-end users themselves (e.g. through targeted ads), but rather access to de-identified, aggregated clinical information.

Success of this model requires that the Flatiron platform is attractive to oncology practices, who must feel that they’re getting distinct value from it and believe that it helps them fulfill their primary mission of taking care of cancer patients. If this is true, then the Flatiron platform will enjoy continued traction from its current base, and may more easily win over new users (including practices that use a different EMR system, like Epic, but still want access to the Flatiron network and analytics).

CMS Quietly Launches an Offensive Against Direct Primary Care

Feb 19, 2018• 14

By NIRAN AL-AGBA, MD

Our healthcare system is self-destructing, a fact made more obvious every single day. A few years ago, a number of brave physicians who were fed up with administrative burden, burnout, and obstacles to providing care for patients started a movement –known as Direct Primary Care (DPC.) This is an innovative practice model where the payment arrangement is directly between a patient and their physician, leaving third parties, such as insurance or government agencies, completely out of the equation.

The rapidly growing number of DPC physicians have organized into a group called the DPC Coalition (DPCC); suddenly, the Centers for Medicare and Medicaid (CMS) is paying attention. As of February 2018, there are 770 DPC practices across the United States with new clinics opening each week as brave physicians leave the “system” behind, never looking back. Breaking free from the chains of insurance and government, this group is restoring the practice of medicine to its core, a relationship between a physician and their patient.

CMS understands there is a problem with the way Medicare services are being delivered to tax payers; it turns out their idyllic version of “high quality” care is not as affordable as they predicted. All evidence indicates the DPC model is not only capable of generating significant cost reduction, but also saving the federal government billions if administered on a large-enough scale. As fewer physicians accept Medicare and convert to DPC practices, CMS wants a piece of the pie.

Health in 2 point 00, Episode 2

Feb 19, 2018

Here’s the second episode of Health in 2 point 00, hosted by Jessica DaMassa. She asks me as many questions as I can answer in two minutes. Hope you enjoy it! And if you have questions please email them to us or leave them in the comments–Matthew Holt

The Healthcare.gov Rescue and the Hawaii False Alarm . When Good Government Tech Goes Bad.

Feb 16, 2018• 1

By ERIE MEYER

By now, you’ve heard of the Hawaii False Alarm, and about the blowback and blame as people try to sort out how this could have happened. In government circles, however, there have been empathy and knowing cringes. It is the norm, not the exception, that government systems are confusing and hard to use. Horrible mistakes happen when people use clunky government systems — they just usually don’t make the news.

In fact, the last time a government technology failure was so thoroughly plastered across the news was when healthcare.gov failed to launch. At the time, I was working for the Chief Technology Officer of the United States in the White House. It was a difficult, frustrating time — but the media glare and public outrage opened up an opportunity to make some critical progress on changes that government workers had been asking for, for years, to prevent it from happening again. Government design is news right now, so I thought I’d share some thoughts on what people working on this problem could do next.

On Data and Informatics For Value-Based Healthcare

Feb 15, 2018• 3

By SALLY LEWIS, MD

Introduction

Value-based healthcare is gaining popularity as an approach to increase sustainability in healthcare. It has its critics, possibly because its roots are in a health system where part of the drive for a hospital to improve outcomes is to increase market share by being the best at what you do. This is not really a solution for improving population health and does not translate well to publicly-funded healthcare systems such as the NHS. However, when we put aside dogma about how we would wish to fund healthcare, value-based healthcare provides us with a very useful set of tools with which to tackle some of the fundamental problems of sustainability in delivering high quality care.

What is value?

Defined by Professor Michael Porter at Harvard Business School, value is defined as a function of outcomes and costs. Therefore to achieve high value we must deliver the best possible outcomes in the most efficient way, outcomes which matter from the perspective of the individual receiving healthcare and not provider process measures or targets. Sir Muir Gray expands on the idea of technical value (outcomes/costs) to specifically describe ‘personal value’ and ‘allocative value’, encouraging us to focus also on shared decision making, individual preferences for care and ensuring that resources are allocated for maximum value.
This article seeks to demonstrate that the role of data and informatics in supporting value-based care goes much further than the collection and remote analysis of big datasets – in fact, the true benefit sits much closer to the interaction between clinician and patient.

Impact of FHIR + SMART on FHIR

Feb 15, 2018

SPONSORED POST

By HEALTH 2.0

The Future of Data Access in Health Care

The advent of FHIR and SMART on FHIR has been a huge game changer in recent years. FHIR is radically changing the way we think about integration of innovative applications, making it faster, easier and less disruptive to workflow. It has allowed developers to create medical applications, which can be easily integrated into existing systems. SMART on FHIR is a related utility, which allows web apps to run inside a browser so clinicians can use them without leaving the EMR environment.

More than 35 provider organizations have exposed their FHIR APIs. Allscripts has been leading the charge in API adoption for some years now with their plug and play-like platform that developers can build new technologies and applications on top of. Not to be outdone, Epic opened up their API in 2017, thus signaling a refusal to be made obsolete by the more nimble and comparatively newer players.

“The emergence of blockchain, FHIR and other technologies leads to a bigger question. What happens to health care when there is unfettered data access and the monopoly of the user interface goes away?”, said Health 2.0’s Matthew Holt and Indu Subaiya.

Learn about the SMART on FHIR Stack and tools that can be used to deploy world-class applications at Dev4Health on April 30 – May 1, 2018 in Cleveland, Ohio. Join developers, innovative leaders, designers, chief technology officers, chief innovation officers, start-ups, and health tech enthusiasts for two days of strategic networking, idea generation, and innovative workshops – plus live demos some of the newest health tech start-ups. Register today!

2018 Forecast: Another Theranos, Hospital Hiring Slows & Successful HIT Exits

Feb 13, 2018• 3

By BOB KOCHER MD and BRYAN ROBERTS

For what is now an annual tradition, we are once again attempting to be healthcare soothsayers. We are proud to share with you our 10 healthcare predictions for 2018. In 2017, amaz-ingly, eight of our predictions came true.

For 2018, we are betting on the following:

1. Another Theranos

We think at least one healthcare information technology company with an enterprise value of more than $1 billion (not including Outcome Health, which we could not have predicted tanking so spectacularly quickly) will be exposed as not having product results to support their hype. It will also expose embarrassed investors who did not do careful diligence and founders with poor integrity.

2. Hospital hiring slows

After a decade of sustained hiring every month, hospitals will stop. Many will downsize their administrative staffs as admissions continue to slowdown and reimbursement pressures intensify. We expect multiple months with net healthcare job losses which would be the first time this has occurred since the Bureau of Labor Statistics started tracking the data.

3. Successful HCIT exits

After a long wait, and more than $10 billion of venture capital invested in startups over the past five years, we will begin to see successful IPO and M&A exits. These will reassure growth investors to keep pouring money into companies with traction.

4. Amazon does not disrupt PBMs

Despite daily rumors, we think Amazon will not shake up the PBM sector. Instead, Amazon will limit its healthcare market footprint to its existing consumer products and distributing non- regulated healthcare goods to healthcare providers (adopting a B2B and not B2C strategy).

Questioning the Link Between Sports-Related Concussions and CTE

Feb 12, 2018• 9

By JASON CHUNG, PETER CUMMINGS MSc, MD and UZMA SAMADANI

On Jan. 18, an article by Dr. Lee Goldstein of Boston University and colleagues in Brain, a leading neurological journal, was released and touted as proving the link between subconcussive hits to the head and chronic traumatic encephalopathy (CTE) (“Real risk of CTE comes from repeated hits to the head, study shows,” Feb. 4). That same day the CTE advocacy group — the Concussion Legacy Foundation — announced a national campaign called F14G Football to convert all under-14 football into flag football, thereby eliminating tackle football.

The message sent to assembled media and onlookers was that eliminating tackle football for youth is the key to safeguarding the brains and futures of America’s youth.

The truth is not so simple.

The scientific evidence linking youth casual sports play to brain injury, brain injury to CTE, and CTE to dementia is not strong. We believe that further scientific research and data are necessary for accurate risk-benefit analysis among policymakers for two reasons.

First, evidence-based science calls for research to be conducted under generally accepted principles. The case series presented by the Boston University group, primarily due to its ascertainment bias, is weaker than the evidentiary standard sufficient to demonstrate an association or causation and conflicts with pathologic findings in other studies.

CTE pathology in the brain has been shown by British pathologists to be present in approximately 12 percent of normal healthy aged people who died at an average age of 81 years (Ling et al. Acta Neuropathologica). The presence of CTE pathology in the brain on autopsy has not been shown to correlate with neurologic symptoms before death.

To be clear, CTE pathology could be present in a normal person.

The Doctor Squared Movement: An Alternative to Regulatory Burden

Feb 12, 2018• 14

By NIRAN AL-AGBA, MD

The 4th amendment of the U.S. Constitution shields an individual (or business) from unreasonable government intrusion. It is inferred this right extends to ALL people, regardless of profession. Advanced nurse practitioners are independently practicing medicine in 23 states yet are not subject to onerous Maintenance of Certification (MOC) requirements– physicians are not equally protected under the law. Physicians must fight, as one group, against the burden of MOC. We have two choices: become a Doctor Squared (Dr. ²) or join an alternative certification organization such as the National Board of Physicians and Surgeons (NBPAS.)

A Doctor Squared (Dr. ²) denotes one who obtains both an MD and a DNP (Doctor of Nurse Practitioner) degree. This allows independent practice and eliminates the power of MOC. Reviewing a list of affordable DNP programs in the country shows a degree from the University of Massachusetts – Boston DNP program only costs $10,180. Coursework is online, and will take only 3 years if attending part-time. Renewal of an MD license in Washington State costs $697 biannually while DNP license costs $125, putting more money in my pocket. Additionally, the continuing education requirement is different; advanced practice nurses must complete 15 hours annually while physicians need 50 hours annually even though both professions are independently practicing medicine. According to Medscape, malpractice insurance rates are $12,000 yearly (2012) for a family physician, while a family nurse practitioner pays $1200, one-tenth as high. Remember, the cost of MOC for internal medicine is $23,600 every 10 years.

Health in 2 point 00, Episode 1

Feb 12, 2018

We are going to start some new content on THCB in the next few weeks including a lot more video hosted by Jessica DaMassa. And one weekly show will be her asking me as many questions as I can answer in two minutes. Here’s the first crack at it. Hope you enjoy it!–Matthew Holt