Medstar Health, a big hospital system in the Washington DC area, has been using a selection of digital health tools like Bluestream Health’s telehealth system for a while. Now they are showing to the world their implementation of b.well Connected Health‘s patient interface which as you’ll see is being used to create a digital first experience for their patients, enabling booking of virtual and physical appointments. I spoke with John Lock, Chief Digital Transformation Officer at MedStar Health & Kristen Valdes, CEO of b.well Connected Health, while Cathryna Nieves, AVP, Digital Transformation at MedStar Health gave a full demo of the experience. I don’t often head into the belly of the beast, but it’s very interesting to see how big incumbents like Medstar are working with tech vendors to react to the billions being spent by venture capitalists to create denovo virtual first health services–Matthew Holt
How to Talk to Clinicians: Forget Workflows, Just Tell Us How Things Work
BY HANS DUVEFELT
Workflows are all the rage with EMR people. But doctors, NPs and PAs are smart. Nothing burns us out as fast or as completely as being told how to do things instead of why. We are not circus animals.
Let me explain:
If we had no professional education at all, we would have clinical workflows memorized instead of clinical knowledge. For example, two weeks after starting an ACE inhibitor like lisinopril, order a basic metabolic profile. That sounds pretty straightforward, but if you add up all the possible clinical workflows we would need if we didn’t know medicine at all, that would be a huge burden – a massive amount of seemingly random and senseless rules.
Continue reading…Pithiatism Redux
BY MARTIN SAMUELS
Those of us in medicine have all seen the famous painting of the Tuesday afternoon lessons at the Salpȇtrière in Paris in the 19th century. In Pierre Aristide André Brouillet’s painting, one can clearly see the great professor, Jean-Martin Charcot, holding forth while the patient, Blanche Whitman, is being supported by a tall young man, Joseph Jules Francois Felix Babinski, the Chef de Clinique (the chief resident) and allegedly the favorite to succeed Charcot. He never did as he was failed repeatedly on the exam necessary to become a faculty member at the university by a jealous, xenophobic, anti-immigrant rival, Charles Bouchard. Babinski was born in France and served in the army twice, but his name was Polish as his parents had emigrated to France to escape bias in Poland (sound familiar?). Ironically almost no one remembers Bouchard (his only contribution being the Charcot-Bouchard aneurysm which may be the cause of some intracerebral hemorrhages), but there is no doctor on earth who does not know Babinski’s name. This is one of many reasons why Babinski is my neurological hero.
Seqster: The Salesforce of Healthcare?
By JESSICA DaMASSA, WTF HEALTH
It’s not difficult to get Seqster’s CEO Ardy Arianpour fired up, but to get to the details about his business and what he refers to as its “f-ing incredible tech stack,” takes a little doing. Is Seqster a health data analytics company like Clarify Health or Komodo Health, or more of a longitudinal patient health record startup like bWell or Picnic Health?
According to Ardy, these companies would actually make great Seqster clients, and that his tech would serve as the ideal, white-labeled operating system upon which they could engage with patients, collect their data, and examine it alongside EMR data, pharmacy data, social determinants of health data, and even genomic data. While those aforementioned health tech startups might be able to do many of these services themselves, the life sciences companies, health systems, health plans, digital health startups, and non-profit patient registries Seqster does count as clients are using its platform for everything from running decentralized clinical trials to providing patients with a longitudinal single-source medical record.
Ardy breaks down the “operating system” approach Seqster is taking, and how he sees his platform becoming as the “Salesforce of healthcare.” Beyond the specific examples that really bring this concept to life, we talk about what’s ahead for the business, which has raised $23 million in total funding and, interestingly, counts both Takeda Digital Ventures and 23andMe’s CEO and Founder, Anne Wojcicki on its cap table.
Get Ready for (Healthcare) Microgrids
BY KIM BELLARD
We depend on it. Indeed, our daily lives are unimaginable without it. The trouble is, it’s become unreliable. Lives have been lost because it wasn’t performing when it needed to be. It’s built around large facilities that are often decades old. Parts of it don’t communicate/coordinate well with others. Its workforce is aging and burnt out. There is no person or agency charged with ensuring its resiliency. It badly needs to be rethought for the 21st century.
Oh, you thought I was talking about our nation’s power grid? I was talking about our healthcare system.
The parallels are striking, and concerning. They’re huge industries, based on early 20th century approaches, and beset by 21st-century challenges to which they may not be easily adaptable. If we don’t manage their evolution to the 21st century right, we’re dead. Literally.
Continue reading…What Would Newt Do? Making Value-Based Care Victorious
By MICHAEL MILLENSON
Health care’s much-trumpeted transition “from volume to value” care remains more tepid than transformational, according to a new study. Looking at 22 health systems nationwide, RAND researchers found that compensation continues to be “dominated by volume-based incentives designed to maximize health systems revenue.”
Although confusing payment schemes bear part of the blame, there are deeper problems that appeared in sharp relief when I chanced upon a long-ago PowerPoint from a prominent political strategist and early advocate of “data-driven reimbursement.”
I refer, of course, to Newt Gingrich. His recommendations from 2007 about designing transformational change in health care provide a perspective that remains useful today in addressing what is ultimately a political problem. Frankly, value-based care (VBC) advocates perform dismally.
Going Along the Gingrich Roadmap
Back in 2004, Gingrich and I both served on a commission seeking to improve the quality of long-term care. This was during a period when a neutered Newt, out of power, was undergoing a political makeover by championing bipartisan health reform ideas such as electronic health records (EHRs) and evidence-based care. He even shared an award from NCQA with then-New York Sen. Hillary Clinton.
What Gingrich also shared, often, were his thoughts about what was necessary to drive the kind of sweeping alteration of the status quo represented by his leading Republicans to their first House majority in decades. Reviewing that roadmap, it’s not surprising that VBC advocates remain far from their destination.
The journey starts off in the right direction, with VBC advocates following Gingrich’s advice to “focus on large changes.” Trying to upend the way physicians have been paid since Hippocrates made his first house call certainly qualifies. But ambition has to be articulated as part of an organizing and attractive vision.
In 1997, in a book called Demanding Medical Excellence, I summarized the urgency of what we now call value-based care this way:
Tens of thousands of patients have died or been injured years after year because readily available information was not used – and is not being used today – to guide their care….(The health care delivery system) must be restructured according to evidence-based medical practice, regular assessment of the quality of care, and accountability.
In a similar vein, Gingrich in 2007 emphasized “a clear and compelling vision for quality” that would appeal to patients and medical professionals by promising safe care (no preventable deaths or injuries); consistent clinical excellence (appropriate and effective evidence-based care); and clinicians and staff partnering with patients.
Language That’s Bureaucratic, Not Bold
In contrast, the coalition sponsoring last month’s Health Care Value Week positioned transformation as a series of “models” addressing a bureaucratic checklist of health care “challenges.” The same type of language is used by the Centers for Medicare & Medicaid Services.
Continue reading…#HealthTechDeals Episode 11: MindMaze, Memora Health, Ro, PriorAuthNow, and Equip
On this episode of Health Tech Deals, Ian Morrison is pinch-hitting for Jessica DaMassa! Ian and I worked together 25+ years ago, and he’s been sitting in Silicon Valley looking at the American health care system for a long long time. Some deals – MindMaze raises $105M; Memora Health raises $40M; Ro raises $150M; PriorAuthNow raises $25M; Equip raises $58M. Ian also shares his opinions on the American health system and the digital health space–Matthew Holt
TRANSCRIPT
Ian Morrison:
Hi there, I’m Jess DaMassa. Actually, no, Jess DaMassa. Jess DaMassa is a friend of mine and I am no Jess DaMassa. I am Ian Morrison. I am pinch hitting for Jess DaMassa, how could I possibly pinch hit? Matthew told me I had to go and put my kilt on and spruce myself up a bit. But anyway, it’s an honor, a deep honor to be here for the February 18th episode of Health Teach Deals.
Matthew Holt:
So Ian, it’s a Dan Quayle line. No, it’s not the Dan Quayle, it’s the Lloyd Bentsen line about Dan Quayle.
Ian Morrison:
Exactly.
Continue reading…THCB Gang Episode 83, Thursday Feb 17th, 1pm PT 4pm ET
Joining Matthew Holt (@boltyboy) on #THCBGang at 1pm PT 4pm ET Thursday for an hour of topical and sometime combative conversation on what’s happening in health care and beyond will be: futurist Ian Morrison (@seccurve); Queen of all employer benefits Jennifer Benz (@Jenbenz); fierce patient activist Casey Quinlan (@MightyCasey); and & patient safety expert and all around wit Michael Millenson (@MLMillenson)
The video will be below. If you’d rather listen to the episode, the audio is preserved from Friday as a weekly podcast available on our iTunes & Spotify channels
BREAKING: MindMaze Lands Fresh $105M for Digital Neuro-Therapeutics
By JESSICA DaMASSA, WTF HEALTH
You may know the term “digital therapeutics,” but how about the specialized category of “digital neuro-therapeutics”? MindMaze, which has developed a platform approach to creating prescription digital therapeutics for neurological diseases like stroke, Alzheimer’s, and Parkinson’s has just landed $105 million in fresh funding from Concord Health Partners to further advance development of this unique category of pDTx’s.
CEO Tej Tadi, CFO Kevin Gallagher, and Chief Medical Director John Krakauer get us smart on the neuroscience behind MindMaze, their device-plus-gaming interventions, and how they are gaining reimbursement for their brain health and recovery therapies. Each therapeutic is a bit different – MindPod Dolphin, for example, helps patients rehab upper limb motor skills by way of a dolphin-themed gaming experience that incorporates sensors and an anti-gravity vest. The team says there are 10 clinical trials underway across seven indications, with the goal to bring at least three new prescription digital therapeutics to market by next year.
How will this new funding – and a partnership with the American Hospital Association – aid US market expansion for Swiss-based MindMaze? We explore the company’s growth plans, talk about market readiness for digital therapeutics, and even find out the backstory behind how Leonardo DiCaprio ended up on their cap table.
What the Pandemic Taught Us About Value-based Care
By RICHARD ISAACS
You’ll recall that we ran a long piece (pt 1, pt 2) about Medicare Advantage from former Kaiser Permanente CEO George Halvorson earlier this year. Here’s a somewhat related piece from the current head of The Permanente Medical Group about what actually happened there and elsewhere during the pandemic–Matthew Holt
The COVID-19 pandemic has provided important lessons regarding the structure and delivery of health care in the United States, and one of the most significant takeaways has been the need to shift to value-based models of care.
The urgency for this transformation was clear from the pandemic’s earliest days, as shelter-in-place orders caused patient visits to brick-and-mortar facilities to plummet. That decline dealt a financial blow to many fee-for-service health care providers, who are paid per patient visit, treatment or test performed — regardless of the patient’s health outcome.
Prepaid, value-based health care systems, on the other hand, have demonstrated that they are better equipped to respond to a continually evolving health care landscape. Because they are integrated, with a focus on seamless care coordination, and they are accountable for both the quality of care and cost, these systems can leverage technologies in different ways to rapidly adapt to major disruptions and other market dynamics. Priorities are in the right place: the patient’s best interests. Value is generated by delivering the right level of care, in the right setting, at the right time.
Because value-based care focuses on avoiding chronic disease and helping patients recover from illnesses and injuries more quickly, it has the promise to significantly reduce overall costs in the United States, where nearly 18% of gross domestic product was spent on health care before the pandemic — significantly more than comparable countries. That figure rose to nearly 20% in 2020 during the pandemic.
While providers may need to spend more time on implementing new, prevention-based services and technologies, they will spend less time on managing chronic diseases. And thanks to the preventive approach of value-based health care organizations, society benefits because less money is spent managing chronic diseases, costly hospitalizations and medical emergencies.
Value-based organizations drive additional societal benefits. They understand that building trust with patients requires cultural competency — tailoring services to an individual’s cultural and language preferences. During the pandemic, building trust was especially important with underserved communities, where mistrust of health care systems is prevalent.
Continue reading…
