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Category: Health Policy

Will Microbes Finally Force Modernization of the American Health Care System?

BY MIKE MAGEE

Science has a way of punishing humans for their arrogance.

In 1996, Dr. Michael Osterholm found himself rather lonely and isolated in medical research circles. This was the adrenaline-infused decade of blockbuster pharmaceuticals focused squarely on chronic debilitating diseases of aging.

And yet, there was Osterholm, in Congressional testimony delivering this message: “I am here to bring you the sobering and unfortunate news that our ability to detect and monitor infectious disease threats to health in this country is in serious jeopardy…For 12 of the States or territories, there is no one who is responsible for food or water-borne surveillance. You could sink the Titanic in their back yard and they would not know they had water.”

Osterholm’s choice of metaphor perhaps reflected his own frustration and inability to alter the course of the medical-industrial complex despite microbial icebergs directly ahead.

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Take a Tip from Domino’s

By KIM BELLARD

If you’re already thinking ahead to next Sunday’s Super Bowl, you might be thinking about Domino’s, because, as everyone knows, pizza and football go together like mom and apple pie.  I’m thinking about Domino’s too, but not because I’m planning my order.  It’s about their new program to reward customers who do more of their own work.  

Ahem, healthcare: pay attention.

Last week Domino’s announced that customers who picked up their own orders, rather than using delivery, would earn a $3 tip.  Art D’Elia, Domino’s executive president and chief marketing officer, explained: 

It takes skill to get pizza from a Domino’s store to your door. As a reward, Domino’s is giving a $3 tip to online carryout customers who take the time and energy out of their day to act as their own delivery drivers. After all, we think they deserve it. 

The program – Domino’s Carryout Tips – isn’t quite as rewarding as it might sound.  The $3 is actually a credit on your next order, and that credit has to be used by the following week.  There’s a $5 minimum to qualify, and orders have to be online.  The program was announced in time for the expected Super Bowl surge and is scheduled to end May 22.  

But still.  I don’t like waiting for deliveries, I do like pizza, and if I ordered a lot of Domino’s (which I don’t), the $3 tip would be decent discount, even if I had to order even more Domino’s to actually get it.

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Ecology and Technical Advance

By MIKE MAGEE

It is fair to say that the vast majority of Americans know more about viruses today than they did 24 months ago. The death and destruction in the wake of COVID-19 and its progeny have been a powerful motivator. Fear and worry tend to focus one’s attention.

Our collective learnings are evolving. We have already seen historic comparisons to other epidemics. Just search “The 10 worst epidemics” for confirmation. But one critical area which has been skimmed over, and only delicately probed (if at all) is the ecology or “the ecological point of view.”

For those interested, let me recommend “Natural History of Infectious Disease” published in 1972 by Nobel laureate and Australian biologist Sir Macfarlane Burnet and his colleague David O. White.

Chapter 1 begins: “In the final third of the twentieth century, we of the affluent West are confronted with no lack of environmental, social, and political problems, but one of the immemorial hazards of human existence is gone. Young people today have had almost no experience of serious infectious disease…For the first time in history deaths in infancy and childhood are not predominantly from infection.” But a few sentences on, they add this addendum, “Infectious diseases may be almost invisible, but it is still potentially as important as ever it was.”

Americans are all too familiar with the living biologic organism named COVID-19. By now, they know what it looks like, the role of its outer spikes, its nuclear makeup, and genetic alterations that allow the creation of derivative variants and vaccines. But in addition to its biological science, it also has an ecological life as well.

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Spotify, Joe Rogan, and Health Care

By KIM BELLARD

Here’s a sentence I never thought I’d have to write: the most interesting discussion in healthcare in the past week has been about Neil Young versus Spotify.  

For those of you who have not been following the controversy, Neil Young gave Spotify an ultimatum: it could have his music or Joe Rogan, but not both.  “I am doing this because Spotify is spreading fake information about vaccines – potentially causing death to those who believe the disinformation being spread by them.”  Spotify chose Rogan.

Mr. Young was not the first to express alarm at some of the Covid “information” promoted on Mr. Rogan’s podcast, The Joe Rogan Experience (JRE); in December, for example, several hundred scientists from around the world issued an open letter to Spotify specifically about JRE, warning:

By allowing the propagation of false and societally harmful assertions, Spotify is enabling its hosted media to damage public trust in scientific research and sow doubt in the credibility of data-driven guidance offered by medical professionals.

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Matthew’s health care tidbits: #What is insurance again?

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 my health care tidbits this week, I was reminded on Twitter that many Americans really don’t understand health insurance. A spine surgeon no less in this thread (no jokes about arrogance please) was telling me that he was paying ~$8,000 a year ($4,000 in insurance and $4,000 in deductible) before he got to “use” his insurance–which, as his medical costs were low, he never did. Others were complaining that the cost of employee premiums were over $20K. They all said they should keep the money and (presumably) pay cash when they do use the system. It’s true that most people don’t use their insurance. That’s the whole point. When you buy house insurance, you don’t expect your house to burn down. You are paying into a pool for the people whose house does burn down.

In the US we are on average spending $12k per person on health care each year. But spending on most people is way under that and for a few it’s way, way over. If you take the rough rule that 50% of the spending is on 10% of the people then 35 million people account for $2 trillion in spending–that’s ballpark $60,000 each. They are the ones with cancer, heart disease, complex trauma, etc, etc. The rest of us are “paying” our $4,000, $8,000 whatever, into the pool to cover that $60,000.

There are only two ways to lower that cost for the healthy who aren’t “using” their insurance. One is to exclude unhealthy people from that insurance pool, which makes the costs for everyone else much less. We did that for years with medical underwriting and it was nuts because it screws over the unhealthy. Fixing the pre-existing condition exclusions was the only bit of Obamacare everyone agrees on–even Trump. But now we are ten plus years into this new reality, some people have forgotten how bad it was before.

The other way is to reduce the costs in the system and lower that $4 trillion overall. How to do that is a much longer question. But it isn’t much connected to the concept of insurance.

The Social Science of Covid

By MIKE MAGEE

As we enter the third year of the Covid pandemic, with perhaps a partial end in sight, the weight of the debate shows signs of shifting away from genetically engineered therapies, and toward a social science search for historic context.

Renowned historian, Charles E. Rosenberg, envisioned a similar transition for the AIDS epidemic in 1989. He described its likely future course then as a “social phenomenon” with these words, “Epidemics start at a moment in time, proceed on a stage limited in space and duration, follow a plot line of increasing and revelatory tension, move to a crisis of individual and collective character, then drift toward closure.”

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The Tests were a Test

By KIM BELLARD

Raise your hand if you’ve gone out shopping for home COVID tests, only to find empty shelves and signs apologizing for the lack of availability.  Raise your hand if you’ve been able to obtain one, but were surprised at its cost.  Raise your hand if you took one and weren’t quite sure you did it right, or wondered who, if anyone, would be getting the results.

Vox says that the COVID home test reimbursement process “is a microcosm of US health care,” and I think they’ve understated the situation.  Testing has been a microcosm for the US health care system generally.  It was a test, and our healthcare system failed.

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The Covid Vaccine’s PR Crisis: Health Innovation vs the Take-Down Power of Disinformation

By JESSICA DaMASSA

Misinformation and disinformation (intentionally wrong information) have plagued the storyline of the Covid19 vaccine since the early days of its development, creating a healthcare communications crisis that has not only stalled U.S. vaccination rates, but has also raised questions about how medical and scientific experts will ever again win trust across audiences and communications platforms that are becoming increasingly fragmented, and sometimes hostile.

Yesterday, on the two-year anniversary of the first Covid case in the U.S., I sat down with Dr. Carlos del Rio, Professor of Infectious Diseases & Epidemiology at Emory University, and Jon Reiner, Editorial Director at 120/80 MKTG, to check-in on the vaccine conversation and, more generally, what we in the health innovation community can learn from this situation as we attempt to introduce other new medicines, breakthrough technologies, and scientific advances to the world.

Dr. del Rio served as a vaccine expert in a public service campaign that 120/80 MKTG put together called “Just the Facts on Vax,” which sought to combat vaccine disinformation early-on with a series of bite-sized, social-media-ready videos that put infectious disease experts front-and-center to answer common questions about the vaccine. The full campaign can be viewed on 120over80 MKTG’s YouTube channel, but can it still have an impact? And, in the grand scheme of things, when it comes to people’s personal health, evolving medical or scientific information, and a litany of communication platforms that can position nearly anyone as an expert, how do real experts build trust? An interesting – and timely – chat about the power of information and the “trusted expert” archetype in the context of one of the most unique healthcare stories of our lifetime.

The Intersection of 911 and 988: Decriminalizing Mental Health Crises

By BEN WHEATLEY

Effective July 2022, a new three-digit telephone number (988) will become the number to call in the case of mental health emergencies. Currently, 911 serves as the default number for people to call, placing the acutely mentally ill on a direct track toward police involvement. The new system is meant to ensure that every person experiencing a mental health crisis will receive a mental health response instead—help, not handcuffs.

In November 2021, 15 prominent organizations including NAMI (the National Alliance on Mental Illness) and Well Being Trust joined together to reimagine what a crisis response system might look like. Their Consensus Approach included the response to mental health crises, cases of suicidal behavior, and instances of substance use disorder. They argued that “Without a systems approach to transformation, simply implementing a new number to call will have little impact on those who are in need.” 

The Consensus Approach detailed seven critical pillars upon which a new crisis response system could be based, including Equity and Inclusion, Integration and Partnership, and Standards for Care. Pillar #4 stated that “Law enforcement should take a secondary role in crisis response.” This, they said, would be “a paradigm shift” that recognizes mental health conditions as “matters of health care, not criminal justice.” 

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DAOs May Rescue Healthcare

By KIM BELLARD

You may have seen the news that Kaiser Permanente has signed on to be an organizing member of Graphite Health, joining SSM Health, Presbyterian Healthcare Services, and Intermountain Healthcare.  Graphite Health, in case you missed its October launch announcement, is “a member-led company intent on transforming digital health care to improve patient outcomes and lower costs,” focusing on health care interoperability.  

That’s all very encouraging, but I’m wondering why it isn’t a DAO.  In fact, I’m wondering why there aren’t more DAOs in healthcare generally.

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