Each week an episode of “The THCB Gang” (this was Episode 3) is streamed live here (below) and is also preserved as a weekly podcast and available on our Itunes & Spotify channels a day or so later. Each week 4-6 semi-regular guests drawn from THCB authors and other assorted old friends of mine will shoot the shit about health care business, politics, practice, and tech. It tries to be fun but serious and informative!
This episode of “The THCB Gang” is up here as a video (you could also see it live at 1PT/4ET every Thursday) and it’s also preserved as a weekly podcast and available on our Itunes & Spotify channels a day or so later. Each week 4-6 semi-regular guests drawn from THCB authors and other assorted old friends of mine will shoot the shit about health care business, politics, practice, and tech. It should be fun but serious and informative!
This week, joining me was Michael Millenson (@MLMillenson), Grace Cordovano (@GraceCordovano), Vince Kuraitis (@VinceKuraitis), Brian Klepper (@bklepper1) Ian Morrison (@seccurve) & Anish Koka (@anish_koka). A fun and argumentative discussion about where the COVID-19 crisis is right now and what it’s going to mean both now and in the near future — Matthew Holt
Starting today we are going to create a new live show on THCB that will be preserved as a weekly podcast. I’m calling it The THCB Gang. Each week 4-6 semi regular guests drawn from THCB authors and other assorted old friends of mine will shoot the shit about health care business, politics and tech. It should be fun but serious and informative!
To kick off this week, joining me I’ll have Saurabh Jha (@roguerad), Jane Sarasohn Kahn (@healthythinker), Deven McGraw (@healthprivacy) & Kim Bellard (@kimbbellard). Join us at 1pm PT and 4pm ET right here! Hopefully if I don’t screw up too badly we will repeat this every week at the same time with a variety of guests! — Matthew Holt
Update, just added Ian Morrison (@seccurve) to the gang!
Since the COVID-19 pandemic became very real for all of us a couple in the US a couple of weeks ago, our team at Catalyst @ Health 2.0 has been working on a way to support the wider health tech community.
We have created a list of information on innovators who are working to address the COVID-19 pandemic. In order to maximize our response efforts to the coronavirus outbreak, we are collecting information on specific solutions for COVID-19 issues from digital innovators in several categories like telemedicine, artificial intelligence, and disaster preparedness. Our resource hub includes information on health technology developments, as well as news and interviews. We are by no means the only ones doing this and we are doing this cooperatively with HIMSS, Startup Health, Chilmark, HealthXL and others.
Our goal is to have as comprehensive and searchable a list as possible of these solutions. Today we are making our first effort live. Please come look at the site at covid19healthtech.com and please give us your feedback. In particular if you or your organization is working on a response to COVID-19 or you have expert insights on how to address the outbreak, please tell us about it!
We hope to greatly expand the number of companies and organizations we feature in the coming days, and look forward to working with the wider health tech community to all do what we can to improve health care as much as we can in these very trying circumstances
Indu Subaiya & Matthew Holt are the co-founders of Health 2.0 LLC
Since Saturday’s Nevada primaries, confusion seems to be reigning about how Bernie Sanders seems to be winning. Time (and not a lot more of it) will tell who actually ends up as the Democratic nominee. But the progressive side (Bernie + Warren) is doing much better than the moderate side (Biden/Butt-edge-edge/Klobuchar) expected, while we wait to see how the Republican side of the Democratic primary (Bloomberg) does in an actual vote. The key here is the main policy differential between the two sides, Medicare For All.
Don’t get too hung up in the details of the individual plans, especially as revealing said details may have hurt Elizabeth Warren. But do remember that there is one big difference between Sanders/Warren and the moderates. It comes down to whether everyone is in the same state-run single payer system (a modified and expanded version of Medicare) or whether the private employer system is left as it is, with expanded access to something that looks like Medicare (the public option) for everyone else. Note that no Democrat wants to stand pat on Obamacare “as is”. Everyone is way to the left of what Obama ran on in 2008 (or at least what he settled for in early 2009).
I recently took care of Rosaria, a cheerful 60-year-old woman who came in for chronic joint pain. She grew up in rural Mexico, but came to the US thirty years ago to work in the strawberry fields of California. After examining her, I recommended a few blood tests and x-rays as next steps. “Lo siento pero no voy a tener seguro hasta el primavera — Sorry but I won’t have insurance again until the Spring.” Rosaria, who is a seasonal farmworker, told me she only gets access to health care during the strawberry season. Her medical care will have to wait, and in the meantime, her joints continue to deteriorate.
Migrant and seasonal agricultural workers (MSAW) are people who work “temporarily or seasonally in farm fields, orchards, canneries, plant nurseries, fish/seafood packing plants, and more.” MSAW are more than temporary laborers, though— they are individuals and families who have time and time again helped the US in its greatest time of need. During WWI, Congress passed the Immigration and Nationality Act of 1917 because of the extreme shortage of US workers. This allowed farmers to bring about 73,000 Mexican workers into the US. During WWII, the US once again called upon Mexican laborers to fill the vacancies in the US workforce under the Bracero Program in 1943. Over the 23 years the Bracero Program was in place, the US employed 4.6 million Mexican laborers. Despite the US being indebted to the Mexican laborers, who helped the economy from collapsing in the gravest of times, the US deported 400,000 Mexican immigrants and Mexican-American citizens during the Great Depression.
On Episode 101 of Health in 2 Point 00, there are some scandals and competitors brewing in the health tech space! Jess and I discuss Outcome Health’s investigation and charge by the FBI for $1 billion in fraudulently obtained funds; Mint’s founder starting Vital, a new EHR company, to reinvent the overall EHR experience (even though I believe it is currently one of the toughest markets to enter into); Amazon launching Amazon Transcribe Medical which will be a tool medical professionals can use to dictate their notes and streamline them into EHR systems; and Wellframe raising $20 million to advance digital health management. If you are in Japan, catch me at Health 2.0 in Tokyo, Japan where they will be showcasing new health tech startups in the space or if you are in Vegas, go hang with Jess at the American Society of Hospital Pharmacies conference! Last but not least, Guidewell launched its Aging in Place Accelerator that is looking for startups in the senior health tech space (applications are due December 8th). — Matthew Holt
Today is Health in 2 Point 00’s 100th Episode and we are reporting from Frontiers Health in Berlin! Jess and I talk about Google & Ascension’s deal to move all of their information and data onto Google Cloud, however, they are currently facing backlash over data privacy issues and are being investigated by HHS’ Office for Civil Rights. Apple released some new research on EKGs, carrying out a clinical trial on 400,000 people, I didn’t think their results were that interesting, but their ability to reach that many people for a clinical trial was impressive and may open up new doors in research for recruiting participants using Apple products. At Frontiers Health, Noom, a nutrition startup focusing on managing chronic care conditions, announced that they are looking to do $235M in revenue by this year, which is big news considering Livongo (which IPOed this year) did $165M in revenue. We also take a moment of silence for Bernard J Tyson, CEO of Kaiser Permanente, who was an active leader for equity in health care and a leading black executive for the community. Rest in Peace – Matthew Holt
Forced absence from gun violence has created a literal and metaphorical void in schools across our country that may impact students and staff for decades to come. The students are referred to as “Parkland kids,” “Sandy Hook students,” or “Columbine survivors.” These labels are sadly reflective of a new reality for American schools, as students, teachers, and staff no longer feel safe. America’s students feel vulnerable as the facade of schools as a safe place is no longer true. The Center for American Progress recent report revealed that 57% of teenagers now fear a school shooting.
Often, perpetrators of gun violence leave a trail of “red flags” for years, as they are troubled youths. This was the case in the Parkland shooting. Tragically, multiple agencies failed to respond to the signs the troubled young man was leaving, including specifically writing online that he aspired and planned to be a school shooter.
In the aftermath of the Parkland, Florida tragedy, parents and school districts turned to security experts demanding a plan of action. Sadly, the information provided was substandard and lacked evidence to support the strategies as efficacious. Lives weigh in the balance and there is no more tolerance for guessing.
Research is needed to guide the creation of evidence-based frameworks for school communities to address prevention as well as protection. Threat assessment teams are a strategy to assess for potential threats, but more importantly is that an intrinsic safety network is woven into the fabric of the educational system. Exposing the root cause of the contagion of violence impacting our youth is key.
The system is unstable. We are already seeing the precursor waves of massive and multiple disturbances to come. Disruption at key leverage points, new entrants, shifting public awareness and serious political competition cast omens and signs of a highly changed future.
So what’s the frequency? What are the smart bets for a strategic chief financial officer at a payer or provider facing such a bumpy ride? They are radically different from today’s dominant consensus strategies. In this five-part series, Joe Flower lays out the argument, the nature of the instability, and the best-bet strategies.
Cost. Get serious control of your costs. Most providers I talk to are dismissive. “Yeah, yeah, you’ve been saying that for 10 years. We’re on it, believe me.” But I don’t believe them. Observation of the industry makes it clear that most healthcare providers have not gone after costs with nearly the ferocity of other industries. Some providers that I have worked with and interviewed over recent years have gotten their full cost of ownership down to a level where they can survive on Medicaid rates (that’s not a typo, I mean Medicaid) and build bigger, stronger systems at the same time. They have proven it can be done. But this is far from the industry norm. In the new competition, getting your costs seriously down is not the way to win. It’s just the price of admission. In the new competition, any entity that can deliver any particular service at a lower price will steal that business from you. You need to be that entity.
Overtreatment and waste. Do a deep and honest analysis of how much of your book of business is actually not effective, not necessary, does not deliver value or satisfaction to the customer—because that book of business is likely to wither away under alternative financing arrangements. Keep in mind that among various studies, the low estimate of how much of healthcare delivers no real value to the customer (an estimate by doctors about their own specialties) is 20%. The high end (in a PricewaterhouseCoopers study) is 54.5%. Most studies and estimates cluster around 35%.
Abandon monopolistic practices. An “all system” fee-for-service contract hidden from public scrutiny is smart, but not wise. It may help this year, maybe next year, but in the longer run it creates vulnerability to political attack, legislation, and lawsuits, and also to shifts in the market. A semi-monopoly position allows you to charge a premium for your products, but it locks you into that ability to charge a premium. As the market shifts and finds ways around paying high prices, you will find that you will be forced to compete at the lower prices, but you will not have developed the partnerships, the strategies, and the product lines to do that. If there is no competition in your area, then compete with yourself to forestall lower-cost competition developing.
Birth your competition. The growth area in the new healthcare competition will be: “How to cut into the hospital’s bottom line by keeping people out of the hospital.” The most competitive business models in healthcare will be in the business of cutting off hospitals’ revenue streams upstream. Get into this business model, even if you are a hospital. Especially if you are a hospital. Get into this business and get better at it than any potential competition. Create high-performance bundled programs with deeply managed costs well below the industry median. Get into contracts with large buyers for particular niches in which you give financial and quality performance guarantees. If you can’t guarantee that you can drop the cost and improve the quality, you will lose that business to someone else who can show that track record and give that guarantee.
Put yourself into all the business models that are disrupting you, such as outpatient clinics, community clinics, mobile vans, mini-hospitals, stand-alone emergency departments, onsite clinics, personalized management of complex cases, direct-pay primary care and others. Make these businesses able to compete for market share by unshackling them from hospital pricing and facilities fees.
Risky? Sure, but you do not want to end up being just the super-expensive job shop at the end of the line that every single customer and buyer is making every effort to avoid.