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THCB Gang Episode 99, Thursday July 28

This was a special early in the day edition of #THCBGang. It was at 9.15am PT/ 12.15 pm ET (so if you are coming at 1pm it won’t be live today at the normal time as it’s already happened!). It was part of the Primary Care Transformation Summit which has been running since Monday and continues to the end of Friday. It’s a who’s who of everyone in primary care. You can check out the wider agenda but we were on immediately before the day 3 keynote from head of CMS Innovation, Liz Fowler.

Joining Matthew Holt (@boltyboy) to discuss primary care and more were are WTF Health host & Health IT girl Jessica DaMassa (@jessdamassa); futurist Jeff Goldsmith; & Dan O’Neill (@dp_oneill) who is now at primary care group Pine Park Health.

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

American health care leaders are not blameless today

By MATTHEW HOLT

It is a very sad day for America. Roughly 30% of our country is part of a quasi-religious cult. In general these people reject science and the enlightenment. This week the Jan 6th committee has shown they are prepared to use and support any tools or tactics–up to and including the overthrow of the government, in order to get what they want. 

The overturning of Roe vs Wade is the most visible artifact of a 40-year campaign. The campaign was funded by business leaders like the Koch brothers who want to revoke all environmental, labor and rational restrictions on their activities. Using dark money and the passion of religious zealots who want to control women’s bodies and discriminate against anybody who doesn’t believe what they believe, they have turned this nation back to the 18th century, using the Supreme Court as their vehicle.

The biggest of those dominos has now fallen and women’s right to control their own bodies has been taken away in most states. We can assume a nationwide ban (such as happened in Poland) will be coming here soon, maybe as soon as 2025 if the Republicans win the 2024 elections. And note that the rolling coup described by the witnesses at the Jan 6 hearings show that the Republicans are already blatantly taking over the supposedly neutral election process.

But the American health-care system is not blameless. Abortion and other reproductive health services are clearly part of health care. Yet uniquely in this country the provision of the services has not been from mainstream health care institutions. The leaders of our health care organizations, in particular our major hospital systems, have completely avoided delivering these services. They have been more than happy to allow Planned Parenthood and other specialist organizations to provide reproductive care, and have just looked the other way in the debate. 

Worse, many of our religiously affiliated institutions,  particularly those with a Catholic heritage which represent an enormous amount of hospitals in this country, have banned not only abortion but many other forms of reproductive health care such as female sterilization. The Hyde Amendment, ironically named after a religious bigot who was an appalling adulterer and hypocrite to boot, bans Federal funding for abortions. That means that private Medicaid plans which now cover most births in this country have never offered a full suite of reproductive health care.

Even in recent weeks when the fate of Roe became clear I have heard nothing from major leaders of hospital systems or health plans about this. Some of the newer provider organizations focusing on women, such as Maven and Tia, have been outspoken, as have many non health care-related employers. But the general silence from all major health care organizations in America on this topic has been deafening.

Today there is plenty of shame and blame to go around.

THCB Gang Episode 65 – Thurs September 30

It has been WAY too long and for too many reasons (conferences, travel, a hurricane flooding out 4 East Coast guests) we haven’t got together but #THCBGang is back.

Joining Matthew Holt (@boltyboy) will be fierce patient activist Casey Quinlan (@MightyCasey);  THCB regular writer Kim Bellard (@kimbbellard); ; medical historian Mike Magee (@drmikemagee); and board-certified patient advocate Grace Cordovano (@GraceCordovano).

We opined a lot on the latest machinations in Congress, we talked about access to data (especially images) and we really enjoyed getting in touch with each other for a great hour!

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

Matthew’s health care tidbits, week ending Jun 5

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 week’s health care tidbits, I can’t quite leave the $3.5bn Babylon Health SPAC investor document alone. Yes, it’s crazy but not as crazy as you might think. Essentially it’s saying that it’s going to be a better tech enabled version of Oak Street or Agilon. Babylon has put less effort into the medical group management side of the puzzle than Oak Street or Agilon but it hasn’t done nothing. It’s been running GP clinics in the UK for years and now has two Medicare Advantage networks in California w 52k lives. It only did $79m in rev in 2020 but that was presumably mostly in software. They’re aiming for $320m in rev in 2021 (presumably mostly from the medical groups) & $710m in 2022.

In comparison Oak Street’s forecast is $1.3bn in 2021 and $2bn in 2022. So Babylon is shooting to be 25% of its size. Today’s Oak Street market cap is ~$14,5bn, so 25% of that is close to the $3.5bn Babylon is trying to get investors to pay.

Then there’s the story, which is that the bot tech can reduce all types of patient health spend which will increase the margin. Of course their actual mileage may vary. I do love the chart from their investor prez, which not only assumes that they can reduce medical spend abut also that they get to keep those savings long term. I’m not sure the “Partner” in the chart below will be as convinced.

This was the cause of much hilarity on this week’s #THCBGang.

As I said crazy but not completely crazy. And you never know, maybe better care?

What Will Shape Joe Biden’s Health Care Agenda?

I’m thrilled to have health futurist Jeff Goldsmith back on THCB, and given Biden was only confirmed as President-elect this morning, his article on what to expect is extremely timely!–Matthew Holt

By  JEFF GOLDSMITH

The Trump administration’s health care journey began with a trillion dollar near miss–the failed Repeal and Replacement of ObamaCare- and ended with a full-on train wreck, the catastrophically mismanaged COVID epidemic that will have claimed 300,000 lives by the time he leaves office. After four years of posturing and lethal incompetence, it will be a relief to see caring and professionalism return to the White House health policy under President-Elect Joe Biden.   

Like Inheriting a Badly Managed World War

Like Barack Obama, Joe Biden will be saddled at the beginning of his regime with a damaged national economy. He will also walk in the door to the immediate need to manage the greatest public health catastrophe in a century as well as its economic consequences–a deep and enduring recession. Biden will be inheriting the equivalent of a badly managed World War we are presently losing.

Public health professionals who were marginalized by Trump will be challenged not only to craft coherent policy to contain and extinguish COVID  but also to sell it to a frightened and polarized general public, many of whom reject the need for basic public safety measures.    

Controlling COVID and rebuilding the critical public health agencies–CDC and FDA–that have damaged by political meddling will consume the lion’s share of the administration’s health policy bandwidth in its first year. It will be pressed to address a huge readiness gap–from critical PPE supplies to the development and deployment of testing and tracing capability to public health co-ordination and messaging–for the next pandemic. Increasing the presently inadequate level of public health funding (less than $100 billion a year in a $21 trillion economy) seems inevitable.

The inability of Congress to produce a fall round of COVID relief will create pressure on Biden to take immediate action to help struggling sectors of the economy, like airlines, restaurants and hospitals, as well as further help for the long term unemployed. Only a little more than half of the 22 million jobs lost in the spring have returned by November. Twenty million Americans were stranded by the July expiration of supplemental unemployment benefits as well as countless millions more “free agents” and contractors not eligible for traditional unemployment that are losing coverage at the end of the year. Mortgage, credit card and consumer loan forbearance are ending, and unless Congress acts, acres of rotten credit will turn rapidly into a banking and bond market crisis which the Federal Reserve cannot fix by itself.   

State governments face FY21 deficits equaling $500 billion over the next two years , against a current annual spending base of about $900 billion.  Further assistance to state and local governments will almost certainly include an additional increase in the federal match for Medicaid (FMAP), beyond the 6.2% temporary increase passed in March). Medicaid enrollment will likely top 80 million by mid 2021, almost one-quarter of the US population. Some states will have upwards of 40% of their population on Medicaid by mid-2021.

States laboring under severe revenue shortfalls will be unable to afford the expanded Medicaid program that was part of ObamaCare without a further increase in the FMAP rate.  President Trump and Senate Republicans blamed the state and local government fiscal crisis on profligate Democratic mismanagement, and blocked aid to them during 2020. But Texas, Florida, Georgia and other red states have the same problems New York and California do. 

Serious Fiscal Limitations Push the Health Policy Agenda Away from Coverage Expansion

Barack Obama entered office with a FY08 federal deficit of $420 billion. Joe Biden enters with a FY20 deficit of $3.1 trillion and a baseline FY21 deficit of $1.8 trillion, before adding the cost of the likely additional trillion dollar-plus stimulus package early next year. It will be passed over the dead bodies of Republican Congressional leadership suddenly recommitted to deficit reduction after racking up $8 trillion in deficit spending during the four years they controlled the federal government.

Coverage Expansion via Medicare and Public Option Unlikely

That deficit will significantly constrain a further expansion of health coverage. Not only will “Medicare for All” be off the table. Severe fiscal pressures will cause the new administration to “slow walk” a public option (which would require federal subsidies to implement) and Medicare expansion to people over age 60. These expansions were going to be  controversial and politically costly because they would be fiercely contested by hospitals and other care providers concerned about the erosion of their commercial insured customer base (the source of perhaps 130% of their bottom lines) as well as the use of Medicare as a de facto price control lever. 

By the time Biden addresses the first two problems–COVID and the economic crisis–he will probably have expended his limited stock of political capital and be weakened enough to be unable to take on the large messy issues of health coverage expansion and cost control. The Affordable Care Act exhausted Obama’s store of political capital, by early 2010. His administration’s failure to turn the economy cost the Democrats control of the House of Representatives and 20 (!) state legislatures in 2010.

What Can Biden Do in Health that Does Not Require Federal Spending?

Thus, the focus of Biden health policy is likely to be on items not requiring fresh spending.

Continue reading…

The THCB Book Club!

By JESSICA DAMASSA & MATTHEW HOLT

We are launching a new THCB program! The THCB Book Club (TM) is going to be a discussion with leading health care authors, which will be released on the third Wednesday of every month.

We are kicking off with the new book from Hemant Teneja (VC at General Catalyst who has been writing many big checks lately) and Stephen Klasko (CEO at Jefferson Health System and one of the most unusual hospital system bosses in America). Their book is called UnHealthcare: A Manifesto for Health Assurance which is a how-to for creating a platform for a revolutionary future for healthcare, Taneja said. “Health assurance is an emerging category of consumer-centric, data-driven healthcare services that are designed to bend the cost curve of care and help us stay well.” Sitting in on the interview because we can’t get rid of him we will also have Glen Tullman from Livongo (Just kidding, Glen!). He will weigh in on how this connects with his new idea of Consumer Directed Virtual Care. Matthew may say something about the Continuous Clinic too, and Jessica will keep score of all the crises, Tsunamis, the many ways the health care is broken, and how many zingers Glen & Matthew get in on each other!

We want YOU to read the book in advance and email us questions or comments for us to ask the author(s) before the show. (We record a day or two in advance so please email us or put question in the comments here or on Twitter by the 17th). 

Please go buy the book here (eVersion only $6!)

It should be a lot of fun and very educational! This will be up on THCB on August 19.

In September the author will be Jane Metcalfe with her 2020 book NEO.LIFE

THCB Gang, Episode 19, July 23, 2020

This episode of the THCB Gang included regulars Grace Cordavano (@GraceCordovano) , Deven McGraw (@HealthPrivacy), Ian Morrison (@seccurve), and special guest patient entrepreneur Robin Farmanfarmaian (@Robinff3). We talked about patient experiences, the state of play in health care business, and about new technologies and more. And after tomorrow it gets preserved as a podcast on Itunes & Spotify Enjoy! – Matthew Holt

THCB Gang, Episode 12

Episode 12 of “The THCB Gang” was live-streamed on Friday, June 5th from 1PM PT to 4PM ET. If you didn’t have a chance to tune in, you can watch it below or on our YouTube Channel.

Editor-in-Chief, Zoya Khan (@zoyak1594), ran the show! She spoke to economist Jane Sarasohn-Kahn (@healthythinker), executive & mentor Andre Blackman (@mindofandre), writer Kim Bellard (@kimbbellard), MD-turned entrepreneur Jean-Luc Neptune (@jeanlucneptune), and patient advocate Grace Cordovano (@GraceCordovano). The conversation focused on health disparities seen in POC communities across the nation and ideas on how the system can make impactful changes across the industry, starting with executive leadership and new hires. It was an informative and action-oriented conversation packed with bursts of great facts and figures.

If you’d rather listen, the “audio only” version it is preserved as a weekly podcast available on our iTunes & Spotify channels a day or so after the episode — Matthew Holt

How to Manage Patients in Quarantine, Smartly

By MATTHEW HOLT

Smart Quarantine as the next step to combat COVID-19

As the nation and the world grapple with the impact of the COVID-19 pandemic, there is growing consensus among experts that we need a sustainable system of specific lockdowns, social distancing, and extreme resource provision in terms of labor, ventilators and PPE to arm hospitals and health providers as they deal with the onslaught of patients. Even while some American states start to slowly open up, we need a system that can manage COVID-19 over the coming months and years–especially if this Fall brings a second wave.

Writing in the NY Times on April 7, Harvey Fineberg and colleagues summarized an as yet overlooked issue. There are many patients who may or do have COVID-19, but are not sick enough to need hospital care, or who have been discharged from hospitals. We need to keep these patients away from hospitals but if they shelter in place in their household there is a high risk they will infect their families or housemates. This likelihood is even higher if they are homeless,  incarcerated, or living in other group arrangements.

Instead of sheltering in place at home Fineberg and colleagues suggest those patients enter “smart quarantine” in temporary isolated accommodation, such as hotels or college dormitories, where they can be looked after by medical teams and tested semi-regularly. But whether they are at home or in temporary accommodation, leaving those patients with minimal support to be tested at the end of 14 days is not enough. A significant proportion of them will develop COVID-19 and some of those are going to be admitted to hospital. In addition several patients have been discharged from hospital, but still need to be monitored. We are going to need to be able to closely monitor a significant number of people even while the majority of them will need relatively limited amounts of care.

The good news is that we have had a couple of decades of development of the technologies and services required to both care for and monitor these patients, while keeping the main resources such as ventilators for those in hospitals. Pulling together available technologies and services, we will be able to quickly and accurately manage these patients, ensure their best outcomes, and spare scarce hospital resources. There are seven main components of this process, which I am calling “smart care in quarantine.”

The Process

Upon either a positive test for COVID-19 or a suspicion of those symptoms awaiting testing, patients can be admitted to isolation at home or in, say, empty hotels. 

1. Monitoring equipment. Patients can be given FDA regulated monitoring devices which will work using bluetooth and WiFi (or 4G cellular). The main monitoring tools required are:

  • Pulse Oximeters
  • Thermometers
  • Stethoscopes (with acoustic recording)
  • Weight Scales
  • Video & audio via iPad, phone or computer
Continue reading…

The THCB Gang, Today at 1pm PT/4pm ET

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!

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