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Matthew’s health care tidbits: Hospital shooting reveals so much

Each week I’ve been adding a brief tidbits section to the THCB Reader, our weekly newsletter that summarizes the best of THCB that week (Sign up here!). Then I had the brainwave to add them to the blog. They’re short and usually not too sweet! –Matthew Holt

In this edition’s tidbits, the nation is once again dealing with an epidemic of shootings. Now a hospital joins schools, grocery stores and places of worship on the the recent list. I was struck by how much of the health care story was wrapped up in the tragic shooting where a patient took the life of Dr. Preston Phillips, Dr. Stephanie Husen, receptionist Amanda Glenn, 40; and patient William Love at Saint Francis Health System in Tulsa.

First and most obvious, gun control. The shooter bought an AR-15 less than 3 hours before he committed the murders then killed himself. Like the two teens in Buffalo and Uvalde, if there was a delay or real background checks, then these shootings would likely have not happened.

But there’s more. Hospital safety has not improved in a decade or so. Michael Millenson, THCB Gang regular, has made that plain. And that includes harm from surgery. We know that back surgery often doesn’t work and we know that Dr Phillips operated on the shooter just three weeks before and had seen him for a follow up the day before. Yes, there is safety from physical harm and intruders–even though the police got there within 5 minutes of shots being heard, they were too late. But there is also the issue of harm caused by medical interventions. Since “To Err is Human” the issue has faded from public view.

Then there is pain management. Since the opiate crisis, it’s become harder for patients to get access to pain meds. Was the shooter seeking opiates? Was he denied them? We will never know the details of the shooter’s case, but we know that we have a nationwide problem in excessive back surgery, and that is matched by an ongoing problem in untreated pain.

And then there are the two dead doctors. Dr. Husen, was a sports and internal medicine specialist. Obviously there are more female physicians than there used to be even if sexism is still rampant in medicine. But Dr. Phillips was an outlier. He was black and a Harvard grad. Stat reported last year that fewer than 2% of orthopedists are Black, just 2.2% are Hispanic, and 0.4% are Native American. The field remains 85% white and overwhelmingly male. So the chances of the patient & shooter, who was black and may have sought out a doctor who looked like him, having a black surgeon were very low in the first place. Now for other patients they are even lower.

The shooting thus brings up so many issues. Gun control; workplace safety; unnecessary surgery; pain management; mental health; and race in medicine. We have so much to work on, and this one tragedy reveals all those issues and more.

#HealthTechDeals Episode 34 | Carebridge, Nava Benefits, Bicycle Health & LeanTaas

Matthew has been out at the Going Digital Behavioral Health reception meeting all of Jessica’s fans, and discovering what they like about the show! Meanwhile a big funding round for Carebridge ($140m), with more $$ for Bicycle Health ($50m probably not to be spent on bikes) & Nava Benefits ($40m). Plus LeanTaas gets bought by private equity group Bain Capital.

An interview of, err, me by João Bocas

João Bocas is known as “The Wearables Expert” and has been talking, writing and innovating in health tech for a while. Last month he had me on his video series. It was a fun interview in which I talked about Flipping the Stack, the Continuous Clinic, and the slow pace of change in health care! With João’s permission I am reproducing that interview here–Matthew Holt

A deal on AHIP in Vegas!

I’m going to AHIP in Vegas next month and you should come too!

It’s time to be together again. It’s also time to save. Register for AHIP 2022 (formerly Institute & Expo), June 21 – 23 in Las Vegas with code THCB and save. Together, we’ll explore the ideas, innovations, and forward-thinking driving health care’s transformation. Check out the agenda and Register today with code THCB.

Russ Johannesson, CEO, Glooko

Russ Johannesson has been CEO of Glooko since 2018. In that time the diabetes data platform has expanded internationally, made a couple of acquisitions, and added support for digital therapeutics and distributed clinical trials. He brought me up to date with the latest–Matthew Holt

Will Boeglin demos TimeDoc Health

Will Boeglin is CEO of TimeDoc Health. It’s one of a new breed of companies supplying the capability for physician groups and health systems (including FQHCs) to deliver CCM (chronic care management) and RPM (remote patient monitoring). Both of those services are now reimbursed by Medicare, and some private plans, but rolling them out and tracking all that activity–not to mention accounting and billing for it–is non-trivial for practices. That is where TimeDoc comes in. Will started the company as part of a med-school project and just raised $48m to really get it going. He showed me how it worked, and gave an extensive and interesting demo–Matthew Holt

Virtual Care Regulatory Round-Up: Telehealth & Digital Care ‘State-of-Play’ by Nathaniel Lacktman

BY JESS DaMASSA, WTF HEALTH

Just as HHS extends the Covid-19 public health emergency waivers until July, we kick-off a brand-new monthly interview series about the state-of-play for all things telehealth and digital care policy and reimbursement. Called the WTF Health Virtual Care Regulatory Round-up, we’re partnering with our friends at Wheel to feature health policy experts, lobbyists, health plan folks, and other virtual care experts and insiders who can keep us updated on the changing regulations and what they will mean to those health tech co’s whose businesses rely on virtual care.

Attorney-to-the-stars-of-telehealth, Nathaniel Lacktman, who chairs the Telemedicine & Digital Health Industry Team at Foley & Lardner and is a Board member of the American Telemedicine Association (ATA), kicks the series off for us with an update on those public health waivers and how he is coaching health tech businesses in preparing for the inevitable transition of care that will come when they come to an end.

What will happen to patients who live across state lines from their virtual care providers? What business decisions need to be made to avoid abandoning patients and maintaining continuity of care? Nate’s not bullish on a federal national license, but there are some cases where cross-state patient-provider relationships can continue to exist – they just might not work for everyone’s business model.

And, on the subject of telehealth business models, Nate gives us his take on where he thinks reimbursement will be headed, how policy around virtual prescribing will be impacted post-pandemic (particularly around controlled substances), and whether or not Medicare’s originating site requirement will be put back in place. We also get Nate’s perspective on which virtual care business models seem to be working best among health tech startups and what legal risk those more ‘reckless’ players might be creating for the rest of the field without even realizing it. Great education on virtual care and what’s happening in the space RIGHT NOW. Watch!

Special thanks to our series sponsor, Wheel – the health tech company powering the virtual care industry. Wheel provides companies with everything they need to launch and scale virtual care services — including the regulatory infrastructure to deliver high quality and compliant care. Learn more at wheel.com.

Matthew’s health care tidbits: Digital Health is dead (well, not quite)

Each week I’ve been adding a brief tidbits section to the THCB Reader, our weekly newsletter that summarizes the best of THCB that week (Sign up here!). Then I had the brainwave to add them to the blog. They’re short and usually not too sweet! –Matthew Holt

For today’s health care tidbits, the elephant in the room has truely come home to roost, and now it’s landed on the phone wire, it’s close to breaking it. OK, I have stretched that metaphor to death but you’ll get my point. Writing on THCB earlier this month Jeff Goldsmith and Eric Larsen picked up on something I’ve been saying for a while –the fall in valuation of publicly traded digital health companies will have a knock effect on private companies

It took a while–those public companies stock prices started falling from their heights 14 months ago–but in the last month the venture capital scene has gone quiet. The days of sub $20m ARR companies getting mutli-hundred million dollar valuations are over for now. They will be back at some point in the future, as that’s how Silicon Valley has always worked, but it’ll be a while and in the meantime everyone is going to have to figure out what to do in the new world.

The “What to do?” question is getting harder as the data starts to come in, and it’s getting ugly. On the one hand the two fastest growing digital health companies ever have both had their comeuppance. Livongo was a tremendous exit for its investors and ended up trading at 20 times future revenue before it got acquired by Teladoc for $18bn mostly in stock. This quarter Teladoc wrote off much of its investment in Livongo and the whole company is now only worth $5bn. Clearly those “synergies” between telehealth and chronic care management didn’t work. The other rocket ship was Cerebral, which went from nothing in Jan 2020 to by Jan 2022 having over 100,000 patients and thousands of providers on its system as it raised over $300m from Softbank et al. Its aggressive & expensive customer acquisition costs, with its controversial controlled medication prescribing patterns, brought it way too much controversy. Its young CEO is gone, and it’ll be a slow climb back with bankruptcy and collapse the likeliest of outcomes.

But the part of digital health that’s trying to replace the incumbents is not the only place showing ugliness. The technologies and services being rolled out are often not working. Exhibit A is a randomized controlled trial conducted a Univ of Pennsylvania. One set of heart patients was set up with connected blood pressure cuffs, a pillbox that tracked their Rx adherence and lots of coaching help. The others were sent home with the proverbial leaflet and told to call if they had problems. You’d assume many more deaths and hospital readmissions in the second group. You’d be wrong. There were no differences.

So digital health needs to see if it can produce services companies that move the needle on costs and outcomes. The advantage is that they are eventually competing with hospital systems whose DNA doesn’t allow them the ability to let them cross the chasm to the new world. The bad news is that those systems have huge reserves which they can use to subsidize their old world activities.

I’m hoping digital health’s impact in the next 2 years will be as big as it was in the past 2, It’s by no means dead or over, but I am pessimistic.

What Do You Mean, “Innovation”?

BY KIM BELLARD

One of my favorite movies is The Princess Bride. Among the many great quotes is one from Inigo Montoya, who becomes frustrated when the evil Vizzini keeps using “inconceivable” to describe events that were clearly actually taking place. “You keep using that word,” Inigo finally says. “I do not think it means what you think it means.”

So it is for most of us with the word “innovation” – especially in healthcare.

What started thinking me about this is an opinion piece by Alex Amouyel: Innovation Doesn’t Mean What You Think It Does.  Ms. Amouyel is the Executive Director of Solve, an MIT initiative whose mission is “to drive innovation to solve world challenges.” It sees itself as “a marketplace for social impact innovation.”    

In her article, Ms. Amouyel notes that traditional definitions of innovation focus on the use of novelty to create wealth. She doesn’t dispute that view, as long as “wealth” includes the less traditional “community wealth,” which includes “broadly shared economic prosperity, racial equity, and ecological sustainability.” I suspect that innovators like Jeff Bezos or Elon Musk don’t ascribe to that view of innovation.

Ms. Amouyel’s view is: “For me, innovation is about solving problems. And if innovation is about solving problems, what problems you are solving and who is setting about solving them is key.” She notes the multiplicity and difficulty of both global and community-level problems that we face, and urges: “Most urgently, we should zero in on problems that affect the most underserved among us.”

Continue reading…

The Sovereignty Network will help patients make money out of your health data

By HAMISH MACDONALD 

Being a patient has always meant being at the bottom of a trickle-down pyramid in healthcare. Late to get information, our test results, our data, and as for earning the money that our healthcare data is worth – that is something the healthcare industry does without our permission or dues. We are left right out of that.

But what if we made clinical data tools available on your device, so that you could build the most valuable set of healthcare data that exists about you anywhere? What if you owned that particular data set as your personal asset? Well, we think that researchers are going to want access to it – and pay you for that access.

Not only that, how valuable would it be to have the most complete and accurate healthcare data set available about you under your ownership and control? How can you expect a doctor or yourself to reach the best conclusion with incomplete information about your health?!? Frustration, confusion, anxiety and poor health outcomes are often the result.

How The Sovereignty Network empowers you to build your own healthcare data set

Building the most valuable data set about you, for you, is what we have done at The Sovereignty Network. We elevate you as a patient to be a Data Owner. There are 4 easy steps to becoming a Data Owner and earning what your data is worth – and having a complete and accurate set of your healthcare data on hand for your peace of mind.

  1. We have clinically coded simple to answer FHIR and SNOMED CT questionnaires that cover the entire spectrum of your health. We call it “DCPLEG”. By filling out questionnaires in your personally owned and secure profile that represent your Demographic, Clinical, Psychosocial, Lifestyle, Environmental and Genomic data you paint a complete 360 degree view of your health.
  • Where Clinical data sets are also available, such as in the US via the newly implemented Patient API rule, you can also add your clinical data from your healthcare providers. The spread of the FHIR data interoperability standard around the world makes this increasingly feasible to accomplish.
  • Data Researchers are able to sit at their desktop and specify the precise criteria that they are looking for (anonymized, of course) using the same clinical codes that you and others have already filled out in your health profile above. E.g. Age, sex, condition(s), medication(s), procedures, deeper demographic information, environmental, lifestyle, psychosocial markers, etc. Through partners even individual base pairs within a whole genome can be specified. Through the Sovereignty Network they can then make you an offer that you can’t refuse, as it were. If you agree to the offer, only then can they make contact with you with their survey they invite you to complete.
  • We have invented a new class of work we call the “Data Coach” that works rather like the synaptic fluid between joints but here between the Data Researcher and you as the Data Owner. A Data Coach is a vetted healthcare professional / healthcare data expert who verifies on your behalf the specific criteria needed by the Data Researcher. If a Researcher is willing to pay you, say, $100 to fill out a 20-minute survey because you fit their desired set of criteria, you are probably willing to pay some fraction of that to qualified Data Coaches to verify the criteria. (And once verified, criteria likely don’t need to be verified for another Data Researcher).

Turning your data set into licensable income – or donating it to causes you support

Because you and only you own the copy of your healthcare data that you have built – your record, or specific parts of it, is now licensable.

Continue reading…
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