BY KIM BELLARD
My heart says I should write about Uvalde, but my head says, not yet; there are others more able to do that. I’ll reserve my sorrow, my outrage, and any hopes I still have for the next election cycle.
Instead, I’m turning to a topic that has long fascinated me: when and how are we going to recognize when artificial intelligence (AI) becomes, if not human, then a “person”? Maybe even a doctor.
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BY SAURABH JHA
If forced to choose Britain’s two biggest contributions to civilizations, I’d pick the Magna Carta and the vaguely instructional “fuck off.” If permitted a third, I’d choose “managerialism.” Brits are good at telling others what to do. Managerialism is how the Brits once ruled India. Buoyed by the colonial experience, British managers felt they could rule doctors.
The new Viceroy, the manager-in-chief, is the General Medical Council (GMC). The GMC is a physician watchdog, funded by doctors, which works for the public good and is answerable to…well, I’ll get to that later. Their relevance rose exponentially when the psychopathic Dr. Harold Shipman, a charming, clinically adept, general practitioner, killed over two hundred patients. Never again, said the managers. They promised to keep the public safe from dodgy doctors with aspirations of Jack the Ripper and Sweeney Todd.
Continue reading…You know what Jess just realized? We haven’t heard my opinion on Cerebral! Scandal! Firings! Intrigue! Legal Issues! Risk! Skyrocketing! Dying! Cerebral offers quite some food for thought. Check out the episode for my opinion on this incredibly fast-brewing story as well as more multi-million deals: Homethrive raises $20 million; Greater Good raises $10 million; Parallel Learning raises $20 million; Cayaba Care raises $12 million; Miga Health raises $12 million.
-Matthew Holt
BY MIKE MAGEE, M.D.
Arthur Sackler continues to demonstrate just how wealthy one can become by advantaging patients and their diseases.
He’s been dead since 1987, but his ghost continues to access your personal health data, pushes medical consumption and over-utilization, and expands profits exponentially for data abusers well beyond his wildest dreams. Back in 1954, he and his friend and secret business partner, Bill Frohlich, were the first to realize that individual health data could be a goldmine. That relationship would still be a secret had it not been exposed in a messy family inheritance feud unleashed by his third wife after Sackler’s death.
That company, IMS Health, was taken public and listed on the NYSE on April 4, 2014, transferring $1.3 billion in stock. I’ll come back to that in a moment. But in the early years, the pair realized that the data they were collecting would multiply in value if it could be correlated with a second data set. That dataset was the AMA’s Physician Masterfile which tracked the identity and location of all physicians in America from the time they entered medical school.
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BY KIM BELLARD
I know, I should be writing about hot topics like monkeypox or the baby formula shortage, but, c’mon, Congress held hearings last week about UFOs – the first in 50 years! I mean, I followed Project Blue Book in the 1970’s, watched “The X-Files” in the 1990’s, and have seen UFO videos on YouTube. If Congress is starting to take UFO’s seriously, how could I not?
And for those of you who don’t see any possible connection to healthcare (except for those unpleasant alien probes…), let me put it to you this way: by 2050, is it more likely that:
I thought so.
Continue reading…BY JESS DaMASSA, WTF HEALTH
What are the BIG questions a BIG healthcare company like CVS Health is trying to answer when it comes to virtual care and creating the healthcare business model of the future? I’ve got Dr. Creagh Milford, CVS Health’s Head of Enterprise Virtual Health, who’s purview covers both CVS Pharmacy (9,000+ stores including 1,100 Minute Clinics) and Aetna, which provides health insurance to 39 million people.
Creagh’s big concern right now: how to weave together existing care models with virtual so 1) the consumer has a single front door and 2) the provider workforce – which includes everyone from pharmacists to primary care docs and beyond – is coordinated and working together. As you’ll hear, there’s a lot of thinking about “pivot points,” or where the patient and provider meet in the virtual-and-in-person ecosystem. The goal is to make those interactions easy and seamless – for both patient and provider alike – and we get into the strategic thinking, clinical operations, and tech underpinnings that are evolving to make those transitions possible.
Long-term, Creagh believes that healthcare consumers have “voted with their fingertips” and that virtual care is here to stay, but as part of a hybrid model in which questions about quality and cost are still being worked out. Will incentives ultimately realign to make virtual care more enticing across the healthcare system? What types of technology will be next to augment the hundreds of thousands of virtual visits a year coming out of Minute Clinic, or happening as part of an Aetna plan benefit? Here’s how one of the biggest healthcare companies in the country is driving virtual care forward. Watch now!
Is Elon Musk going to buy Twitter? Are the telehealth waivers going to be passed forward? Jess and I just waiting waiting waiting. Nothing is happening, so we just reminisce about some stuff over the past days, as well as some of these new deals! Legacy raises $25 million; Ness raises $15 million; NowRX raises $22 million; & Monument acquires Tempest.
–Matthew Holt
It’s Friday 13th, the unluckiest day and many on the stock market were feeling it. But there were some deals. Alan in France raises 183m Euros, HealthMap Solutions gets $25m for kidney care, Icelandic Sidekick Health gets $55m for DTx & Dialogue buys Tictrac for $43m US.
–Matthew Holt
BY JESS DaMASSA, WTF HEALTH
With 61% of American adults reporting a negative behavior change – troubled sleep, changes in diet, increased alcohol consumption, more time on screens, etc. – as a result of the pandemic, AND healthcare payers looking at 2022 cost increases in the range of 8-10%, one has to wonder just how bad our collective health has become thanks to the past two years.
Jeff Ruby, CEO of tech-enabled habit change provider, Newtopia, shares some startling stats about our population’s health, particularly when it comes to those lifestyle-related metabolic disorders that his company is trying to prevent. And, thus, we get into a fiery conversation about condition prevention versus condition management… at-risk payment models versus per-member-per-month models… behavior change versus prescription drugs… and whether or not a biz like Newtopia (running at-risk on goals related to prevention) is better placed or worse off as a result of this population that, though sicker and riskier than before, is showing up in greater numbers to try their program.
It’s clear where Jeff stands with his genetics-plus-behavioral-psychology-based platform, but questions about how to best handle our population’s health as the pandemic wans are still very much up for debate. Even on the public markets – Newtopia was one of the first digital health companies to go public during the pandemic, hitting the Canadian TSX as $NEWUF in March 2020 – investors’ sentiment for virtual care just isn’t what it used to be. Maybe we can apply some behavior change psychology there too? (wink, wink) Though Jeff talks about “uncertainty about how US healthcare works” in the context of the market, it seems like that “uncertainty” is also pervasive in our approach to spending for chronic care – especially now. Are dollars toward prevention dollars that are better spent? A compelling case is made…
BY KIM BELLARD
There’s an old military adage that generals are always fighting the last war. It’s not that they haven’t learned any lessons, it’s more than they learned the wrong lessons. I fear we’re doing that with the COVID pandemic.
The next big health crisis may not come from another COVID variant; it may not be caused by coronavirus at all. Even if we learn lessons from this pandemic, those may not be lessons that will apply to the next big health crisis.
What started me thinking about this is a C4ISRNET interview with Mike Brown, the Director of the Defense Innovation Unit, and DARPA Director Dr. Stefanie Tompkins. Dr. Tompkins and Mr. Brown are both watching the war in the Ukraine closely. As Dr. Tompkins says in the interview, the war is a “really good test” about the programs her agency has invested in and/or is investing in for the future.
E.g., Russia has clear advantages in numerical superiority, and in “traditional” weapons like tanks, airplanes, ships, and artillery, but Ukraine has been able to blunt the invasion through asymmetrical warfare, using things that DARPA helped foster, including Javelin missiles, drones, satellite imagery, secure communications, and GPS. Even Russia’s vaunted cyber capabilities have been overmatched by Ukraine’s own capabilities. Current DARPA investments like hypersonic missiles and AI are being tested.
I’m comforted that DARPA and DIU are learning in real time what lessons their agencies can learn to help fight future wars, but I’m wondering who in our healthcare system, and who in our governments (federal/state/local), are not just fighting COVID but learning the bigger lessons from it to fight future crises.
I trust that smarter people than me are looking at this, but here are some the lessons I hope we’ve learned:
Information: it’s shocking, but we don’t really know how many people have had COVID. We don’t really know how many have it now. We like to think we know how many have been hospitalized and how many have died, but due to reporting inconsistencies those numbers are, at best, approximations.
We need early warning systems, like through wastewater monitoring. We need standardized public health reporting, with real-time data and a central repository in which it can be analyzed. We need easy-to-understand dashboards that both public officials and the public can access and base their decisions on. We can’t be building these during a health crisis.
Supply Chains: just-in-time, globally distributed supply chains are a marvel of modern life, bringing us greater variety of products at more affordable prices, but, in retrospect, we should have understood that in a global health crisis they would prove to be an Achilles heel. Masks and other PPE, ventilators, vaccines and other prescription drugs have all suffered from supply chain issues during the pandemic. Shortages led to unevenly distributed supplies and higher prices.
We’re never going back to the days of local production, but we do need to prioritize what things need to be produced regionally/nationally, how that production can scale in time of crisis, and how that production should be fairly allocated. The mechanisms to do that can’t be built on the fly.
The sick and the dead: Among the many images of the pandemic’s worst (so far) days, some of the most haunting are the ones of hospitals filled to overflowing, with patients on gurneys in hallways, or the refrigerator trucks filled with dead bodies. Our healthcare system’s capabilities for both were simply overwhelmed – as was the healthcare workforce.
Hospital beds are expensive to build, and expensive to maintain. We can’t afford a healthcare system that builds them for the worst case scenario. But we can learn from innovative efforts during the pandemic, like building temporary hospitals that can be expanded or contracted as needed.
Similarly, there has to be a strategy for dealing with dead bodies during a global health crisis, especially one in which those bodies themselves may carry ongoing risks. Existing morgues, mortuaries, and even graveyards may not be sufficient. There needs to be a plan.
Hardest to solve are healthcare workforce shortages. It’s not easy to train new healthcare workers, and retaining them when they’re stressed beyond belief proved to be a challenge. In a crisis, we need them all working at the top of the licenses, able to cross workplaces and even state lines, and properly supplied and compensated. None of those is a “normal” state of affairs for our healthcare system, and all are inexcusable in a crisis.
Telehealth: telehealth seemed to finally gets its day during the pandemic, with relaxed regulation, improved reimbursement, provider adoption, and consumer preference. It took pandemic to make us realize that making sick, potentially contagious, patients travel to get care is not a good idea.
That being said, now that the pandemic is in a more manageable phase, the bloom seems to be off the telehealth rose, with regulations being reapplied, providers not fully incorporating into their practice patterns, and patients returning to in-person visits.
Hey: it’s 2022. We have the technology to do telehealth “right.” Aside from, say, a heart attack or an auto accident, telehealth should always our first course of action. Our licensing, our reimbursements, and our work flows need to facilitate this – not just to prepare for the next health crisis, but simply as part of a 21st century healthcare system.
Communication: One of the most unexpected results of the pandemic is the distrust of public heath advice – vilifying public health officials, spurning mitigation efforts like masking or isolation, and spurring on the already-present anti-vaxx movement. “Science” is seen as in the eye of the beholder. It’s an information war, and health is losing.
We need the tools to fight the health information war more effectively. We need to learn how to communicate more effectively. We need to reestablish faith in science. We need responses to a health care crisis to be a health issue, not a political one.
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We will be taken by surprise by the next health crisis. We had plans for a pandemic, but, when it hit, we fumbled every response. Next time we’ll be expecting another COVID, and, if it’s not, we’ll be caught flat-footed again.
The current crisis is, to use Dr. Tompkins’ words, a really good test for whether we’re working on the right things for our next health crisis. I’m not so sure we are.
Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor
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