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Category: Health Policy

The THCB Gang Episode 4

Episode 4 of “The THCB Gang” was live-streamed Thursday April 9. You can see it below and it’s also preserved as a weekly podcast available on our Itunes & Spotify channels. Every Thursday at 1pm PT-4pm ET, 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 week, joining me were Jane Sarasohn Kahn (@healthythinker), Anish Koka (@anish_koka), Saurabh Jha (@roguerad), Elizabeth Clayborne (@DrElizPC), and Ian Morrison (@seccurve). A fun and very informative 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

Health Plans Need to Go Farther To Get Us Through the COVID-19 Crisis. Employers Can Encourage Their Cooperation.

Brian Klepper
Jeffrey Hogan

By JEFFREY HOGAN and BRIAN KLEPPER

Among its less appreciated but more worrisome impacts, COVID-19 threatens to destabilize America’s health care provider infrastructure. Patients have largely been relegated to sheltering at home and, to avoid infection, are avoiding in-person clinical visits. The revenues associated with traditional physician office visits have been curtailed. Telehealth capabilities are gradually coming online, but are often still immature. The concern is that many practices will be financially unable to keep the doors open, compromising access and healthy physician-patient relationships.

Health plans have become health care’s bankers, controlling the funding that fuels larger care processes. Health insurance companies and health plan administrators rely on networks of doctors and hospitals to deliver health care services. They also rely on premium payments from employers to administer and pay for health care. In conventional fee-for-service, pay as you go arrangements, providers are paid after they have delivered care services. The stability of this approach, of course, assumes an unhindered flow of patients receiving care.

When the stability of that flow is disrupted, as it has been with COVID-19, physician practices become vulnerable. Solving that vulnerability would give members access to critical services – primary care, specialty care, urgent care and pharmacy coordination – during this epidemic. Without these resources, members will be forced to turn to overburdened hospitals, where they risk increased COVID-19 exposure.

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5 Steps Health Insurance CEOs Must Take to Help with COVID-19

By JEFF LIVINGSTON, MD

Imagine a country where you can not see a doctor. Who will refill your blood pressure prescription, see your sick child, mend your broken arm, deliver your baby, or run the ventilator if you fall victim to Coronavirus? The COVID-19 pandemic created a cash-flow crisis causing mass physician layoffs and closure of medical practices. A world without doctors puts us all at risk. The pandemic is the invisible enemy, and the CEOs of large insurance companies have the tools to help doctors stay in the fight.

Our government, healthcare providers, and individuals are doing our part to flatten the curve of the pandemic. It is time for the insurance industry to take massive action to salvage the US health system.

Practices are closing already. Tenet Health care announced a $250 million dollar reduction effective March 27, 2020. Other large and small health systems are implementing drastic cost-cutting measures. Data reported in USA Today, an estimated 60,000 family practices will close and 800,000 of their employees will lose their jobs by the end of June.  

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Blue Cross NC Chief Medical Officer on “Flipping the Switch” To Telehealth at Parity | WTF Health

By JESSICA DaMASSA, WTF HEALTH

In the early days of the U.S. COVID-19 outbreak, BlueCross BlueShield of North Carolina (Blue Cross NC) stepped up as one of the first health insurance plans to announce reimbursing telehealth visits “at parity” with face-to-face office visits for all providers and specialists. Chief Medical Officer Rahul Rajkumar talks us through the strategy behind that decision to “flip the switch” for telemedicine — which was made in just one meeting (!) – and what metrics and outcomes the Blue plan will be looking at post-pandemic to decide if the switch remains on.

Conversation Highlights:

  • Changing reimbursement policies to cover ALL COVID-19 testing and treatment
  • 6:45 min: The role of virtual care during COVID-19 and reimbursement at parity
  • 11:11 min: How will telehealth be evaluated post-epidemic?
  • 13:58 min: Telehealth innovation, B2B use, remote monitoring (looking to providers to lead the way)
  • 17:25 min: What’s going to happen with healthcare costs in 2021?

For more on how health tech companies in digital health, telehealth, remote monitoring, health data, and more are responding to the COVID-19 crisis, check out the other interviews in this special series at www.wtf.health/covid19.

Patients & Vulnerable Populations Pandemically Left in the Dark

By GRACE CORDOVANO PhD, BCPA

To be honest, the United States blew it on the mask front. From a public health, caregiver and patient safety, as well as community transmission standpoint, we are at least 3 months late to game. Anytime a brand new virus that humanity does not have any immunity to makes an appearance, is highly contagious, starts rapidly infecting people as well as the doctors and nurses caring for them, hospitalizing, and killing them in concerning numbers across the globe, we should enable every proactive safety measure at our disposal.

The first confirmed case of COVID-19 in the US was on January 20, 2020. The general public and the millions of people who are considered at high-risk for complications from COVID-19 were advised that wearing masks in public was unnecessary. Many individuals were shamed and called out for wearing masks in public, being directly blamed for personal protective equipment (PPE) shortages on the front-lines. Meanwhile, hundreds of millions of masks and PPE are exported out of the country by brokers daily. People out in public have been mocked for a spectrum of reasons, being criticized as to why masks were being worn, used to run errands, and for removing them incorrectly. On April 4, 2020, the Centers for Disease Control (CDC) recommended that the general public wear cloth face masks in public where social distancing may be difficult, such as at the grocery store or pharmacy, especially in areas where cases of the infection are high for active transmission.

There has been extensive media coverage of PPE shortages at hospitals on the front-lines of this pandemic. Protecting our doctors, nurses, and all caregivers and first-responders is of utmost priority as we work to fight against COVID-19. As a patient advocate, patient, and carepartner to 2 disabled adults, with multiple family members in the high-risk population, was the call-to-action for the public to wear masks delayed so as to not risk further depleting PPE needed for those directly caring for patients sick with COVID-19?

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Liberal Elite More Deadly Than Coronavirus

By MIKE PAPPAS, MD

As the coronavirus pandemic spreads, millionaires and billionaires, who have been key to oppressing the working class, are trying to position themselves as everyday Americans. We need to understand them for what they are: beneficiaries and key supporters of the capitalist system that helped create this crisis.

My name is Mike. I’m a physician in NYC working on the front lines of the coronavirus pandemic. I’m also a socialist and member of Left Voice.

It was recently reported that a 17-year-old boy in Lancaster, California died suddenly, likely of coronavirus. The boy, who had no previous health conditions, was sick for only a few days. On Friday he was healthy and by Wednesday he was dead. On Wednesday, he went to urgent care as he was not feeling well, but since he had no health insurance, the urgent care center declined to treat him. He was directed to transfer to a nearby hospital, but en route, he went into cardiac arrest. He arrived at the nearby hospital, was revived, but died hours later.

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Sourcing Digital Health for COVID-19? Mount Sinai’s Medical Innovation Lead Has Advice | WTF Health

By JESSICA DaMASSA, WTF HEALTH

As hospitals, health systems, and physician practices look to quickly scale up their digital health, telehealth, and remote monitoring offerings to adjust their delivery systems to the COVID-19 pandemic, what questions should they be asking health tech companies in order to make the right decisions? And, how can these health tech businesses, many of them startups, meet these ready customers half-way?

Ashish Atreja, Chief Innovation Officer for Medicine at Mount Sinai Health System (and also founder of digital health credentialing organization, Node.Health, and platform-builder Rx.Health) leans in with some critical advice at a time when health system sourcing, vetting, and contracting for digital health has never moved so fast.

“This COVID-19 solution you’re gonna bet on can be a catalyst for your entire digital health strategy and platform,” says Atreja, speaking as a health system innovator giving advice to others in similar roles. “There’s no pressure to bet on the right horse, but I think this is a moment of opportunity where you can see what is gonna give you long-term benefit.”

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“Essential Oncology”: The COVID Challenge

By CHADI NABHAN MD, MBA, FACP

One harsh Chicago winter, I remember calling a patient to cancel his appointment because we had deemed it too risky for patients to come in for routine visits—a major snowstorm made us rethink all non-essential appointments. Mr. Z was scheduled for his 3-month follow-up for an aggressive brain lymphoma that was diagnosed the prior year, during which he endured several rounds of intense chemotherapy. His discontent in hearing that his appointment was canceled was palpable; he confessed that he was very much looking forward to the visit so that he could greet the nurses, front-desk staff, and ask me how I was doing. My carefully crafted script explaining that his visit was “non-essential” and “postponable” fell on deaf ears. I was unprepared to hear Mr. Z question: if this is his care, shouldn’t he be the one to decide what’s essential and what’s not?

This is a question we are all grappling with in the face of the COVID-19 pandemic. The healthcare industry is struggling to decide how to handle patient visits to doctor’s offices, hospitals, and imaging centers, among others. Elective surgeries are being canceled and advocates are arguing that non-essential outpatient and ER visits should be stopped. Ideas are flying left and right on how best to triage patients in need. Everyone has an opinion, including those who ironically consider themselves non-opinionated.

As an oncologist, these various views, sentiments, tweets, and posts give me pause. I understand the rationale to minimize patients’ exposure and thus prevent transmission. However, reconsidering what we should deem “essential” has made me reflect broadly on our method of providing care. Suddenly, physicians are becoming less concerned about (and constrained by) guidelines and requirements. Learning how to practice “essential oncology” may leave lasting changes in our field.  

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India’s COVID Conundrum: To Lockdown or Not to Lockdown

By SOMALARAM VENKATESH, MD

 In “Asterix and the Roman Agent”, Julius Caesar deploys Tortuous Convolvulus to cause internal conflict among the Indomitable Gauls. Until then, the only fights the peaceful Gaulish village witnessed were between Unhygienix, the fishmonger and Fulliautomatix, the village smith. The Gauls always stood united against the Roman army and in spite of the occasional free-for-all, would always come together at the end for a boisterous feast. 

In the new millennium, India – like many other countries – has exhibited deep fault lines circumscribing hardened ideologies. It is that time in India’s history that Government’s economic and administrative actions are either inherently partisan, or projected to be divisive by its detractors. If SARS-Cov2 were to be an insidious single-stranded helical malware designed to sneakily break societal monoliths, there couldn’t have been a more opportune time for it than this. This pandemic has become an administrative nightmare. 

The first case of Corona Virus Disease (COVID-19) in India was detected on January 30th. After a lull for the next two weeks, stray reports of COVID-positive cases started from mid-February. A surreal calm descended across the country even as the COVID deaths climbed rapidly elsewhere in China, Italy & Iran. The nation went through a phase of wishful denial & unfounded bravado that tropical heat will protect Indians & that a younger, innately immune population will be somehow spared. 

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Understanding Covid19: How Data From People’s Daily Lives, Flu Outbreak Models Can Help | WTF Health

By JESSICA DaMASSA, WTF HEALTH

In the face of Covid-19, health tech startup Evidation Health is leveraging their relationships with the 4-million people on their Achievement app, the “always on” stream of behavioral data these folks bring to the table via wearables, sensors, and surveys, and everything they’ve learned from years of studying and modeling flu outbreaks to examine the Covid-19 virus in the context of people’s everyday lives.

Evidation’s CEO, Deb Kilpatrick, and Sr. Data Scientist, Ernesto Ramirez, stop by to talk about their company’s efforts for large-scale, frequent symptom surveillance of Covid-19 to add new insights to our understanding of the pandemic and, possibly, even help with making predictions about its spread and severity.

The company is already publishing some of its findings in a weekly report called “Covid-19 Pulse” that is already gleaning insights from a 150,000+ person cohort asked to weigh-in specifically on what they’re doing and how their lives are changing as a result of the pandemic. What’s unique in Evidation’s spin is that they’re adding that critical data from “daily life” that is more or less missed by just looking at the data reported from those who’ve entered the hospital.

“Those folks that are presenting into the medical system — that’s not the full picture of what’s going on,” says Ramirez. “What we need to do is better understand, really, what’s going on at the community level to understand community spread, to understand surveillance efforts, to understand mitigation efforts that may or may not be having impact around the spread of Covid-19.”

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