Author Archives

Matthew Holt

Iowa Race Questions Logic of Significance of Health Policy Debate

Joe Molloy, health policy, Congressional gridlock


According to the Democrats, their success across the country in the midterm elections has largely been due to the party running on healthcare. Indeed, surveys such as the one conducted by Health Research Incorporated indicated that health was the number one concern for voters during the midterms. In the three states where Medicaid expansion was on the ballot, voters were in favor of it. We’ve been wondering about that, so we took a look at how Iowa voted.

It’s one thing for voters to support healthcare on its own. It’s another for an issue to outweigh all others. Did healthcare really beat every other concern a voter thinks about when picking a candidate during the midterms?

Congressional and Statewide Races

Democrats took 3 of the Iowa’s 4 seats, unseating 2 Republican incumbents. They had a sizeable majority of the votes cast, so things looked good for the Democrats. If the theory holds up, the focus the Democrats kept on healthcare throughout the race would pay off. And it would seem it worked, right?

There’s a big problem here. If Democrats had made gains in Iowa because of healthcare issues, we should expect them to have a pretty resounding victory in the gubernatorial race and in the statehouse.

Continue reading…

Integrating in Health Care: 6 Tools for Working Across Boundaries


Today’s health care providers face the formidable challenge of delivering better, more affordable and more convenient care in the face of spiraling care costs and an epidemic of chronic disease. But the most innovative among them are making encouraging progress by “integrating”—which in this context means working across traditional boundaries between patients and clinicians, health care specialties, care sites and sectors.

The impulse to do so is shrewd, according to our innovation research in sectors from computer manufacturing to education. We’ve found that when a product isn’t yet good enough to address the needs of a particular customer segment, a company must control the entire product design and production process in order to improve it. This is necessary because in a “not-good-enough” product, unpredictable and complex interdependencies exist between components, so each component’s design depends on that of all the others.

Given this, managers responsible for the individual components must collaborate—or integrate—in order to align components’ design and assembly toward optimal performance. IBM employed an integrated strategy to improve performance of its early mainframe computers, and this enabled the firm to dominate the early computer industry when mainframes weren’t yet meeting customers’ needs.

In health care delivery, such integration is analogous to, but something more than, coordinated care. It means assembling and aligning resources and processes to deliver the right care, in the right place, at the right time. This type of integration is a core aspiration of innovative providers leading hot-spotting and aging-in-place programs, capitated primary care practices, initiatives addressing health-related social needs, and other care models that depart from America’s traditional, episodic, acute-care model. How are they tackling it? They’re leveraging very specific tools to facilitate work across boundaries. Here are six of the most common we uncovered in our research:

Continue reading…

Health in 2 Point 00, Episode 60

Today on Health in 2 Point 00, Jess and I report from a hedgehog cafe in Tokyo. In this episode, Jess asks me about Bright Health’s $200 million raise and the significance of Amazon’s new EMR product. We also talk about Health 2.0 Asia-Japan, which is happening right now (December 4-5) in Tokyo, showing us the health care market outside of the U.S. Look forward to hearing from some great speakers at the conference, including John Bass from Hashed Health on blockchain, Fred Trotter on security, David Ewing Duncan on the new wellness and personalized medicine, and Adam Pellegrini from Fitbit. And, of course, Jess will be interviewing just about everyone—including a hedgehog—about innovation for WTF Health —Matthew Holt

The Reality of Bush I on Health Care and Its Lessons for Today


Former President George H.W. Bush may have been every inch the caring individual portrayed in the eulogies of those who knew him, but when it came to health care reform, two words characterized his attitude: Don’t care.

However, compared to Congressional Republicans, Bush was a profile in conservative courage – a lesson with unfortunate parallels to now.

I covered health policy as a reporter for the Chicago Tribune during the Bush years. One strong memory, confirmed by checking original sources, was the presidential debate on Sept. 25, 1988 between Bush and his Democratic challenger, Massachusetts Gov. Michael Dukakis. When Bush was asked what he’d do for the 37 million people without health insurance – about one in seven Americans – he answered that he would “permit people to buy into Medicaid.”

I remember turning from the TV to my wife and saying, “I have no idea what he’s talking about.” Neither, apparently, did anyone else. A Washington Post story that followed, headlined, “Bush’s Mysterious Medicaid Plan” noted that seeking details from the Bush campaign yielded “answers [that] are contradictory.” The story added that “Bush had never publicly mentioned the idea” until the debate.

Continue reading…

You : The App

Kim Krueger is a Research Analyst at Health 2.0 where Matthew Holt is Co-Founder and Co-Chairman.

For evidence of the global Health 2.0 movement, look no further than Health 2.0’s favorite Finnish startup, currently working mostly out of London with plans for expansion into the US. Meet Nelli Lähteenmäki, the Co-Founder and CEO of Fifth Corner (formerly Health Puzzle), makers of the YOU app.

Like many others, Lähteenmäki and her team are working on the tough nut of behavior change in the form of an app that nudges users towards better health with small, incremental steps. The idea is to bridge intention and action, says Lähteenmäki. The Health 2.0 team had a chance to pilot the YOU app in a six-week challenge this past fall, and rather enjoyed tallying healthful tasks like taking the stairs or eating greens for a chance to beat out colleagues. Of course, the Health 2.0 challenge had an equally big stick to go with the carrot of winning, but that’s neither here nor there.

Since then, Fifth Corner has made some big changes, including shifting from an employer-facing business model to a direct to consumer model. It’s a bold pivot at a time when no one has really succeeded with the direct to consumer model in digital health, but Fifth Corner has some strong votes of confidence with new seed funding from London-based venture firm Wellington Partners, and the addition of celebrity chef and healthy food guru Jamie Oliver to the team.

Have a look below to hear more from Lähteenmäki on Fifth Corner’s partnership with Jamie Oliver, how the team will leverage Oliver beyond marketing, and future plans for growth. You can also get a closer look at the stripped down, direct to consumer YOU app here.

Kim Krueger is a Research Analyst at Health 2.0 where Matthew Holt is Co-Founder and Co-Chairman.

Who Owns Patient Data?

Who owns a patient’s health information?

  • The patient to whom it refers?
  • The health provider that created it?
  • The IT specialist who has the greatest control over it?

The notion of ownership is inadequate for health information. For instance, no one has an absolute right to destroy health information. But we all understand what it means to own an automobile: You can drive the car you own into a tree or into the ocean if you want to. No one has the legal right to do things like that to a “master copy” of health information.

All of the groups above have a complex series of rights and responsibilities relating to health information that should never be trivialized into ownership.

Raising the question of ownership at all is a hash argument. What is a hash argument? Here’s how Julian Sanchez describes it:

“Come to think of it, there’s a certain class of rhetoric I’m going to call the ‘one-way hash‘ argument. Most modern cryptographic systems in wide use are based on a certain mathematical asymmetry: You can multiply a couple of large prime numbers much (much, much, much, much) more quickly than you can factor the product back into primes. A one-way hash is a kind of ‘fingerprint’ for messages based on the same mathematical idea: It’s really easy to run the algorithm in one direction, but much harder and more time consuming to undo. Certain bad arguments work the same way — skim online debates between biologists and earnest ID (Intelligent Design) aficionados armed with talking points if you want a few examples: The talking point on one side is just complex enough that it’s both intelligible — even somewhat intuitive — to the layman and sounds as though it might qualify as some kind of insight … The rebuttal, by contrast, may require explaining a whole series of preliminary concepts before it’s really possible to explain why the talking point is wrong.”

Continue reading…

The Problem Is Relative

Numerous studies have shown that the general public has exaggerated perceptions of the health risks they face — as well as exaggerated expectations of the benefit of medical care.

Is it because they’re stupid? No. Instead, the problem relates to how various sources of health information — researchers, doctors, reporters, web designers, advertisers, etc. — frequently frame their messages: using relative change.

“Forty percent higher” and “50 percent lower” are statements of relative change. While they are easy to understand, they are also incomplete. Relative change can dramatically exaggerate the underlying effect. It’s a great way to scare people.

For example, research earlier this year found that women with migraines had a 40 percent higher chance of developing multiple sclerosis. That sounds scary.

But the researchers were careful to add some important context: Multiple sclerosis is a rare disease. In fact, for women with migraines, the chance of developing multiple sclerosis over 15 years was considerably less than 1 in 100 — only 0.47 percent. To be sure, that is about 40% higher than the analogous risk for women without migraines — 0.32 percent — but it’s a lot less scary. More importantly, it’s a much more complete piece of information.

What makes it more complete is the context of two additional numbers: the risk of developing multiple sclerosis in women with and without migraines. Epidemiologists call these “absolute risks.” You and I might call them the real numbers.

Relative change also exaggerate effects in the other direction. It’s a great way to make people believe there has been a real medical breakthrough.

A few years ago a study of a cholesterol-lowering statin drug was hailed for big reductions in heart attacks in people with so-called healthy cholesterol levels. The drug led to about a 50 percent reduction in the risk of heart attack. That sounds like a breakthrough.

But the absolute risks — the real numbers — are sure to look a little different. Why? Because in people with healthy cholesterol levels, heart attacks are rare. To get that context, get the two additional numbers: the risk of heart attack in people taking and not taking the drug.

For people taking the drug, the chance of having a heart attack over five years was less than 1 percent. To be sure, that is about 50 percent lower than the analogous risk for those not taking the drug — less than 2 percent — but it sounds a lot less like a breakthrough.

These absolute risks suggest that 100 apparently healthy people have to take the medication for five years for one to avoid a heart attack. And it’s not even clear from the research — or the federal registry of clinical trials — what kind of heart attack: the kind that patients experience (the bad kind) or the kind that is diagnosed by detecting less than a billionth of gram of a protein in the blood (the not-so-important kind). Add in all the hassle factors of being on another drug (filling scripts, blood tests, insurance forms) and the legitimate concerns about side effects, the use of relative change might now strike you as more than a little misleading.

Whatever the finding — harm or benefit — relative change exaggerates it.

Upon learning this, one of my students likened relative change to funhouse mirrors. If you are thin, there is a mirror that can make you look too thin; if you are heavy, there is mirror that can make you look too heavy.

In the case of relative change, it all happens in the same mirror. It provides a potent combo to promote medical care: exaggerated perceptions of risk and exaggerated perceptions of benefit. Can you imagine a more powerful marketing strategy?

Relative change is not the only culprit in misleading health information, but it is an important one. The good news is that more and more researchers, reporters and editors are on to this game. The bad news is that there is an awful lot of information to police and sometimes it can be hard to even find the real numbers.

That’s where a skeptical, numerate public comes in — one that knows to ask for the real numbers. And, if they can’t be found, one that knows to move on.

H. Gilbert Welch is a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice. He is the coauthor of Overdiagnosed: Making People Sick in the Pursuit of Health. This post originally appeared on The Huffington Post.


The #1 Reason Why Mobile is Critical to the Evolution of Healthcare


Screen Shot 2014-09-16 at 8.54.48 AMWhen you realize that 40% of premature deaths are driven by poor behavior like smoking, alcohol abuse, poor diet and exercise, you have to start asking some hard questions about how to promote better care:

  • How can we make sure people are listening to their doctor’s advice once they leave the office?
  • How do we get people to take their life-saving medications after they’ve been discharged from the hospital?
  • How do we get insight into whether patients’ conditions are deteriorating so that we can make adjustments before they have to make a trip to the ER?

The optimal solutions for these kinds of healthcare challenges encourage patient engagement and incorporate insights. The ultimate tool for this is mobile technology. Why is that?

First, people have already voted with their wallets on which technologies they will welcome into their daily lives – smartphones and tablets.

Second, people are voting for these technologies with their time. A recent study indicated that people check their smartphones 150 times a day on average. Even if you’re on the low end of that average, you’re likely to admit that it is the one tool you use most frequently and find indispensable to your lifestyle.

That’s because you can select the apps you want and customize your smart device to your lifestyle needs, whether it’s for entertainment, news, maps, weather, finance, increasing productivity, etc. You have what you need whenever and wherever you need it. No wonder you’re engaged. So, why should healthcare try to create its own separate engagement tools when people have voted for mobile with their time and money? It shouldn’t. More importantly, it doesn’t have to.

Nowadays, our smart devices have integrated and finely tuned so many technologies that can be applied to healthcare. Some examples include:

1) Phone/Video – to connect to a clinical expert
2) Camera – to take high-resolution images of a wound or skin lesion
3) GPS – to identify a patient’s location on a hospital floor, in their house, or in their community
4) Accelerometer – to track how a patient is moving or not moving
5) Messaging – to send text messages that remind patients how to follow their care plan (i.e. when to take their medicine)
6) Connectivity – to pull information from sensors and wearables to collect biometric data

As importantly, companies like Apple and Google who build the operating systems for most of today’s mobile devices or Samsung, Nokia and LG who actually build many of those devices, are continuously going through the hard part of integrating all the latest great technologies into their products. Apple, for example, will be building biometrics and personal health records into its next generation of operating systems and devices.

The bottom line – people are highly engaged with mobile devices and the innovation opportunities for healthcare are only getting better. The time to leverage mobile for healthcare to engage patients and gain insights is now. Before your competition does.

The (Affordable!) Health Coach in Your Pocket

Vida, a new health coaching app that connects users to coaches and educators for $15/week, launched commercially this week with $5 million in funding from Khosla Ventures and several others, as well as an on stage demo at Code Mobile.

Vida is the latest in a crop of health apps focused on tech-enabled services. The idea is a familiar one at this point, but something that health care has struggled with: how can we keep individuals with chronic illnesses on track between doctor’s appointments? The answer has historically required high-cost, high-touch programs, but now technology is helping those programs scale.

Founder and CEO Stephanie Tilenius and Chief Medical Officer Connie Chen sat down with Matthew Holt to explain how Vida works, how it’s currently being used, and what’s on the road map for the young, San Francisco-based company.

Kim Krueger is a Research Analyst at Health 2.0. 

Matthew Holt Interviews Athenahealth CMO, Todd Rothenhaus

One in a series of interviews that should have been posted months ago, but Matthew Holt is just getting to now.

Nearly 20 years after it was a glimmer in Todd Park and Jonathan Bush’s eye, athenahealth remains the prototypical cloud services company in health care. Todd Rothenhaus, the Chief Medical Officer, has been at athenahealth for 7+ years and leads athenaClinicals (the EHR service). At HIMSS in February 2016, Matthew Holt chatted (at some length!) with Todd Rothenhaus about athenahealth’s platform and the evolution of their products. Check out the interview here:

Priya Kumar is an Intern at Health 2.0, and a student at George Washington University