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Post Covid Healthcare is Becoming Like Buying from Amazon Instead of Going to the Mall or Reading an eBook Instead of a Paperback

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By HANS DUVEFELT, MD

Now that we are seeing patients via telemedicine or even getting reimbursed for handling their issues over the phone, our existing healthcare institutions are more and more starting to look like shopping malls. 

They were once traffic magnets, so large that they created new developments far away from where people lived or worked and big and complex enough that going there became an all day affair for many people. 

What this pandemic has brought us is a shift in our view of where you have to be in order to get things done. If you can earn your wage remotely and still buy things online when offices and physical stores are shut down, it seemed logical to try to offer healthcare the same way. And most of us have found that it works surprisingly well. 

The analogy with Amazon runs deeper than that. Amazon isn’t just one megaprovider, but also a funnel for many small merchants who sell their products through Amazon. Consumers take advantage of the convenience of this centralized ordering or point of contact with a vast supply network of almost any product that money can buy. But they only give their credit card number to one central contact. 

I don’t follow business literature enough to know if Jeff Bezos chose the name Amazon partly (yes, I know he went through the dictionary) because of a vision of many small contributories coming together into the second largest river in the world. But that is certainly a visual representation of what his business looks like. And “Amazon” ranks higher in the alphabet and sounds a lot catchier than “The Nile”. 

Enter healthcare: Imagine the trusted brand names of our “industry” but without their traditional complete reliance on bricks and mortar places that patients have to visit. 

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The THCB Book Club!

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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

Health Insurance Needs to Grow Up

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By KIM BELLARD

I’ve been covered by private insurance my entire life.  Even more telling, I worked in the health insurance industry for — gasp! — some thirty years.  It’s not just paid for my healthcare, it’s financed my life.

Today, though, for the first time in my life, I’m covered by public insurance — and I couldn’t be more relieved.  

Now, I’m not going to go all Wendell Potter.  I know many people have their health insurance horror stories, but, sadly, people have them about pretty much every part of the healthcare industry.  I believe most people working in health insurance, like most people working in healthcare generally, sympathize with the people they serve and are just trying to do a good job.  

The problem is that the health insurance model has outgrown the times.  I’ll try to explain some ways how.

Premiums

Once upon a time, most people had employer coverage, and those employers paid all or most of its cost.  Those days are gone.  Employer coverage is still the predominant form of private health insurance, and employers still pay the majority of its cost, but percentage of people with employer coverage continues to drop and the amount they pay for it continues to increase.  

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COVID herd immunity: At hand or forever elusive?

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By MICHEL ACCAD, MD

With cases of COVID-19 either disappeared or rapidly diminishing from places like Wuhan, Italy, New York, and Sweden, many voices are speculating that herd immunity may have been reached in those areas and that it may be at hand in the remaining parts of the world that are still struggling with the pandemic.  Lockdowns should end—or may not have been needed to begin with, they conclude. Adding plausibility to their speculation is the discovery of biological evidence suggesting that prior exposure to other coronaviruses may confer some degree of immunity against SARS-CoV2, an immunity not apparent on the basis of antibody seroprevalence studies.

Opposing those viewpoints are those who dismiss the recent immunological claims and insist that rates of infections are far below those expected to confer immunity on a community. They believe that the main reason for the declining numbers are the behavioral changes that have occurred either under force of government edict or, in the case of Sweden, more voluntarily. What’s more, they remind us that the Spanish flu pandemic of 1918-1919 occurred in 3 distinct waves. In the summer of 1918 influenza seemed overcome until a second wave hit in the fall. Herd immunity could not possibly have accounted for the end of the first wave.

The alarmists may have a point.  However, recent history offers a more instructive example.

Until early 2015, epidemiologists considered Mongolia to be exemplary in how it kept measles under control. In the mid-1990s, the country instituted a robust vaccination program with low incidences of outbreaks, even by the standards of developed countries. In the early 2000s, it adopted a 2-step MMR immunization schedule and, after 2005, its vaccination rates were upwards of 95%. From 2011 through 2014, not a single case of the virus was recorded, leading the WHO to declare measles “eradicated” from Mongolia in November 2014.  

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Robert Wood Johnson Foundation Innovation Challenges Blog Post Announcing Semi-Finalists

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SPONSORED POST

By CATALYST @ HEALTH 2.0

The novel coronavirus (COVID-19) has underscored the need for efficient and innovative emergency response. Major health organizations, such as the American Hospital Association, have provided resources that can be utilized for organizational preparedness, caring for patients, and enabling the workforce during the pandemic.

As COVID-19 brought to light the lack of emergency response preparedness in the health care system, the Robert Wood Johnson Foundation (RWJF) and Catalyst saw an opportunity to highlight digital health’s potential to support health care stakeholders and the general public. RWJF and Catalyst partnered to launch two Innovation Challenges on Emergency Response for the General Public and Emergency Response for the Health Care System. 

The Emergency Response Innovation Challenges asked innovators to develop a health technology tool to support the needs of individuals as well as health care systems affected by a large-scale health crisis, such as a pandemic or natural disaster. The Challenges saw a record number of applications— nearly 125 applications were submitted to the General Public Challenge and over 130 applications were submitted to the Health Care System Challenge. 

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Too Many Small Steps, Not Enough Leaps

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By KIM BELLARD

I was driving home the other day, noticed all the above-ground telephone/power lines, and thought to myself: this is not the 21st century I thought I’d be living in.  

When I was growing up, the 21st century was the distant future, the stuff of science fiction.  We’d have flying cars, personal robots, interstellar travel, artificial food, and, of course, tricorders.  There’d be computers, although not PCs.  Still, we’d have been baffled by smartphones, GPS, or the Internet.  We’d have been even more flummoxed by women in the workforce or #BlackLivesMatter.  

We’re living in the future, but we’re also hanging on to the past, and that applies especially to healthcare.  We all poke fun at the persistence of the fax, but I’d also point out that currently our best advice for dealing with the COVID-19 pandemic is pretty much what it was for the 1918 Spanish Flu pandemic: masks and distancing (and we’re facing similar resistance).  One would have hoped the 21st century would have found us better equipped.

So I was heartened to read an op-ed in The Washington Post by ReginaDugan, PhD.  Dr. Dugan calls for a “Health Age,” akin to how Sputnik set off the Space Age.  The pandemic, she says, “is the kind of event that alters the course of history so much that we measure time by it: before the pandemic — and after.”  

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Can Community Be a Medicine?

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By ARAS TOKER

Analysis on peer accountability focused community building efforts in making lifestyle changes through digital therapeutic programs

Before we jump ahead to the medicine piece, what the heck does a community even mean? In the past, communities were more likely associated with a group of people living in the same physical location such as a neighborhood, school, or a town. I remember my neighborhood soccer community very well, for instance. Instead of being born into or trying to fit in, community is something we choose for ourselves and express our identities through. With the advancement of accessing the high-speed internet globally, today’s community has no physical or geographical boundaries.

Community builder Fabian Pfortmüller brilliantly explains the difference between communities and other groups. He asserts that unlike project teams or companies who are optimizing for external purposes (collective goals); communities optimize for internal purposes (the relationship and the shared identity). His definition of a community deeply resonated with me and the communities that I had the opportunity to build.

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Pfortmüller’s definition of community
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Stop Rolling Back Expanded Practice Licenses for Nurse Practitioners

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Dallas Ducar
Katie Wolf

By DALLAS M. DUCAR, MSN, PMHNP-BC, RN, CNL and KATIE WOLF, MBA

We’re not in Kansas anymore. Kansas has rescinded an executive order that dramatically empowered and expanded its healthcare workforce as COVID-19 cases soared.  In the best interest of patients now and in the future, other states must not follow Kansas’ example.

The story of coronavirus is far from over in the United States and the impacts to our healthcare systems continue.  America’s clinical workforce began this battle at a deficit and, in certain states, continues under those conditions. For years, studies outlined shortages of medical doctors and predicted gaps to worsen over time. Prior to the presence of COVID-19, a contentious debate emerged as to how to address the deficit of physicians. Nurse practitioners (NPs) lobbied for broader clinical autonomy to help bridge this gap. At present, rapid influxes of critically ill patients have strained our healthcare systems to a breaking point laying bare the resource constraints in our healthcare system. 

Alex Azar, the Secretary of Health and Human Services responded to this need by sending a letter to governors to expand the 290,000 NPs in the United States, bolstering our provider workforce during this time of crisis. Empowering NPs to independently treat patients  has needlessly been a long-standing point of contention in healthcare. Increasing the breadth of NP autonomy makes sense in the face of COVID-19.  Wisely, since the start of the pandemic, the number of states allowing NP autonomy jumped from 22 states to 48.  This structural change to healthcare is long overdue and should remain in perpetuity.  However, at the end of May, Kansas became the first state to expire this expansion of NP authority.  

NPs are independently licensed and trained to diagnose and prescribe medications and treatments. This role grew organically out of the field of nursing, to provide holistic and patient-centered care to their communities. Nurses become nurse practitioners by choice, honing their skills through years of training at patients’ bedsides, and are part of the most trusted profession in the United States. 

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Collective State Action Is Needed to Fight This Pandemic Right Now

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By KEN TERRY

As COVID-19 cases soar across the country, the federal government has lost control of the situation. Amid the Trump Administration’s happy talk and outright dismissal of the crisis, the U.S. is experiencing a forest fire of contagion and hospitalizations, and an upsurge in COVID-related deaths has already begun.

Other countries like Taiwan, South Korea, Germany, Australia and New Zealand have controlled their outbreaks, which is why their COVID-19 infections and deaths have been minimal or trending downward in recent months. To replicate those nations’ strategies of testing, contact tracing and quarantining, the U.S. Congress would have to appropriate about $43.5 billion, according to one estimate. But as we know, Senate Republicans won’t pass such a bill without Donald Trump’s prior approval—and that’s unlikely as long as his main focus is on reopening the economy.

We can hope that electoral victory by the Democrats in November will change this equation, but Joe Biden won’t take office until January if he wins. Meanwhile, the coronavirus is chewing up America. We can’t afford to wait six months to blunt the impact of this horrible disease. However, there is a solution that doesn’t depend on federal leadership: states can form compacts that would form the basis for collective action to get us out of the trap we’re in.

Interstate compacts are very common in the U.S. Various pacts cover everything from clean water and clean air to medical licensure, mental health and interstate transportation. For example, under the Middle-Atlantic Forest Fire Protection Compact, which includes Ohio, West Virginia, Virginia, Pennsylvania, New Jersey, Delaware, and Maryland, member states assist one another in fire prevention and suppression and firefighter training.

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Healthcare Should Get Into Some #GoodTrouble

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By KIM BELLARD

As hopefully most of you know, Rep. John Lewis, civil right icon and longtime member of Congress, died this past Friday.  Rep. Lewis was often described the “conscience of Congress”  – perhaps a low bar in today’s Congress but important nonetheless — for his unwavering commitment to social justice.  I have always been struck in particular by one of his quotes:

Rep. Lewis must have been heartened by the fact that, in 2020, plenty of people are, indeed, making noise and getting into good trouble, necessary trouble over issues that he cared deeply about, like Black Lives Matter and voting rights.  There are others who are better able to write about those people and that trouble.  So I’d like to talk about his call to action with respect to healthcare.

If you are working today in healthcare — especially in the United States — or, for that matter, someone getting healthcare or having a loved one get it, then you should be making some noise and getting into good trouble, because our healthcare system most definitely makes it necessary. 

It should come as no surprise that we’re not very happy with our healthcare system, rating it lower than do citizens in most other developed countries.  And for good reason: it’s the world’s most expensive while delivering sub-par health results and leaving tens of millions without financial protection.  Even our physicians don’t like it.  Even our latest, best effort for improving the sorry state of our healthcare system — the Affordable Care Act  – is under risk of repeal due to a lawsuit brought by 18 states and backed by the Trump Administration.  

Every day, too many of us suffer in the healthcare system, ranging from waits to indignities to critical mistakes, and some face financial ruin due to the care — whether good or bad.  Most of us suffer in silence, or only complain to our friends and family.  We don’t see a lot of mass protests about the pitiful state of our healthcare system, and I have to wonder why.  

We have to stop being so passive.

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