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Category: Health Policy

RWJF Challenge: Health Care Emergency Tech

SPONSORED POST

By CATALYST @ HEALTH 2.0

Catalyst @ Health 2.0, in collaboration with the Robert Wood Johnson Foundation, is seeking health technology solutions that can support the needs of the health care system (e.g. providers, government, public health and community organizations, and more) by addressing several obstacles during an emergency such as:

  • Resource Management: Shortages of equipment, staff, and cash flow
  • Health Data Exchange: Limited information and access available on patients’ health histories
  • Training and Communication: Limited training and cumbersome communication between responders and clinicians
  • Capacity: Limited beds, equipment, and resources and a need to maximize patient flow/throughput

Innovators must submit their tech-enabled solution by June 12th, 2020 at 11:59 PM ET.

Can you create a digital tool that supports the health care system during a large-scale health crisis? Apply today!

Catalyst @ Health 2.0 (“Catalyst”) is the industry leader in digital health strategic partnering, hosting competitive innovation “challenge” events, as well as developing and implementing programs for piloting and commercializing novel healthcare technologies.

Americans Are Worried About the Cost of Their Healthcare (and they have good reason)

By CASEY QUINLAN, HELEN HASKELL, BILL ADAMS, JOHN JAMES, ROBERT R. SCULLY, and POPPY ARFORD

Last year, the Patient Council of the Right Care Alliance conducted a survey in which over 1,000 Americans answered questions about what worried them most about their healthcare. We asked questions about access to care, concerns about misdiagnosis, and risks of treatment, which we reported on in our last THCB piece about the What Worries You Most survey.

We also asked people to rank their concerns about the costs of their care, in five questions that covered cost of care, cost of prescription drugs, cost and availability of insurance, and surprise billing. In the time since we ran the survey, everything has changed in American healthcare. The COVID19 pandemic is filling emergency rooms wherever the epidemic arrives. Bills are likely to be high, for both patients and insurers, and it is still far from clear how they will be paid. Americans are likely to continue to worry deeply about healthcare costs, with good reason, since it’s only in America that someone can go bankrupt due to seeking medical care.

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It’s Not About Tradeoffs

By MICHEL ACCAD

It is tempting to oppose the harmful effects of COVID-related lockdown orders with arguments couched in terms of trade-offs. 

We may contend that when public authorities promote the benefits of “flattening the curve,” they fail to properly take into account the actual costs of imposing business closures and of forced social distancing: The coming economic depression will lead to mass unemployment, rising poverty, suicides, domestic abuse, alcoholism, and myriad other potential causes of death and suffering which could be considerably worse than the harms of the pandemic itself, especially if we consider the spontaneous mitigation that people normally apply under the circumstances.

While I have no doubt that lockdown policies can and will have very serious negative consequences, I believe that the emphasis on trade-offs is misguided and counterproductive.  It immediately invites a utilitarian calculus: How many deaths and how much suffering will be caused by lockdowns?  How many deaths and how much suffering will occur without the lockdowns? How exactly are we to measure the total harm?  What time frame should we consider when we ponder the costs of one option versus the other?

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How Will COVID-19 Change the Health Care Balance of Power?

By KEN TERRY

In any economic disaster, the largest, best-financed organizations have a natural advantage over smaller, cash-strapped organizations. The bigger entities have a greater ability to withstand economic downturns, while the small ones can quickly go out of business because they lack the financial reserves needed to tide them over.

In the roughly 2 ½ months since the COVID-19 pandemic began sinking its hooks into America, the pertinence of this business axiom has been amply illustrated. Small companies across the country are desperate to reopen so they can survive, while many large corporations are seeing their stock prices soar. Most healthcare systems are not for profit, so they don’t issue stock; yet bigger hospitals are not suffering as much financially as smaller and rural hospitals are. Even though the large hospitals’ losses from elective surgery bans have been higher, they have much deeper reserves and greater access to bank lines of credit.

Physician practices have been hit disproportionately by the pandemic. Most practices have switched to telemedicine visits as patients have shunned in-person encounters and the offices have tried to protect their staffs. But the revenue from virtual encounters has not come close to making up for the loss of revenues from office visits that, in many cases, include lab tests and/or minor procedures.

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Keep Petri Dishes in the Lab

By KIM BELLARD

COVID-19 is changing the landscape of our healthcare system, and, indeed, of our entire society, in ways that we hadn’t been prepared for and with implications that we won’t fully grasp for some time.  As we grapple with how to reshape our healthcare system and our society in the wake of the pandemic, though, I worry we’re going to focus on the wrong problems.  

Take, for example, nursing homes, prisons, and the meatpacking industry.  

Anyone who has been paying attention to the pandemic will recognize that each of these have been “hot spots,” and have been called “petri dishes” for coronavirus (as are cruise ships, but that’s a different article).  These institutions aren’t the only places where masses of people congregate, but they seem to do so in ways that create fertile territories for COVID-19.  And that’s the problem.

We knew early on that nursing homes were going to be a problem.  We knew COVID-19 was a problem in Wuhan, but that was far away — until a few cases emerged in late February in a skilled nursing home in King County, Washington.   We know now that these were not the first cases, nor the first deaths, but we were stunned by how quickly it spread in that facility.  By mid-March experts were already calling nursing homes “ground zero,” and that has been proven right.  

It is now estimated that as many as a third of all U.S. coronavirus deaths have come from nursing home residents or workers.  That is (as of this writing) almost 30,000 deaths, and over 150,000 cases.  

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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
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We Need to Fix COVID-Damaged Care Sites and Give the Country Better Care and Universal Coverage in the Process

By GEORGE HALVORSON

The COVID crisis has shown us clearly that major portions of the American care system are extremely dysfunctional and some are now badly broken. We need to put in place a cash flow for American health care that can help our care sites survive and ultimately thrive, and we need to put that approach to save the sites in place now because a vast majority of hospitals and medical practices are badly damaged and some are financially crippled and even destroyed by their response to the crisis.

We have learned a lot in the COVID crisis that we need to use now in building our next steps and our collective response to the crisis.

The COVID crisis has shown us all that our care sites do not have good patient data, do not have good patient linkages, usually do not have team care of any kind in place, and most are so dependent on current piecework fee volumes from patients that they quickly collapse financially when that volume is interrupted.

We should be on the cusp of a golden age of care delivery that uses all of the best patient support tools to deliver continuously improved care — and we now know that the piecework way we buy almost all of our care today will keep that golden age from happening for the vast majority of American patients for the foreseeable future until we change the way we buy care.

We need to buy care in a way that both requires the use of those tools and rewards caregivers and care teams when they use them.

We need a dependable cash flow for care to anchor that process.

We are unlike most of the rest of the industrialized world in not having a dependable cash flow now to buy care. We rely on a hodgepodge and mishmash of unlinked, unaligned and uncoordinated payment sources now and that lack of coordination in payment creates a vast and damaging lack of coordination in the delivery of care.

We can make a huge improvement in that entire process and we can give our health care system a stable and functionally useful future cash flow by becoming a much more highly skilled purchaser of coverage and care. We need a flow of money to make that happen.

We actually can create that flow relatively quickly and fairly easily by imposing a payroll tax on every employee that exactly copies the approach we use now for our Social Security payroll tax process and then using that money in a health care purchasing pool to buy health coverage for every person who is not on Medicaid.

The numbers work.

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After COVID-19, What Next? A Recovery Blueprint for Health System Leaders

By JAMES GARDNER

Is the beginning of the end in sight? Perhaps. After much stress and strain, many experts believe we’re seeing early signs of a COVID-19 plateau in some states and cities. Everything could change tomorrow, but healthcare leaders should be preparing now to reopen their shuttered operating rooms and get back to business. 

When restrictions loosen, lost days and weeks could have dire implications for health systems already weakened by months of deferred and canceled elective procedures. These surgeries — joint replacements, tumor biopsies, gallbladder removals, and cosmetic procedures, for instance — underpin the economics of hospitals and physician groups. Delay some of these surgeries for too long and patient care can also suffer. Essential? Absolutely.

Unfortunately, healthcare leaders will be reopening their doors to a world unlike anything they’ve seen before. Aren’t we all seeing our personal health through a new lens?

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Is Covid-19 the Argument Health Data Interoperability Needed? | WTF Health

By JESSICA DAMASSA, WTF HEALTH

“This pandemic highlights why we need that free flow of healthcare data. So that we can make better decisions sooner.”

In the way that Covid-19 has proven the utility of telehealth as a means for health systems to reach their patients, has the pandemic also become the final argument for healthcare data interoperability? Has this pandemic been the worst case scenario we needed to make our best ‘case-in-point’ for why U.S. healthcare needs a national health data infrastructure that makes it possible for hospitals to share information with one another and government health organizations?

Interoperability advocates have been clamoring for this for years, but Dan Burton, CEO of data-and-analytics health tech company, Health Catalyst, says this public health crisis has likely created an inflection point in the interoperability argument.

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Can AI and radiographs help in resource-poor areas for the fight against COVID-19?

Pooja Rao
Tarun Raj
Manoj TLD
Preetham Srinivas
Bhagarva Reddy

By POOJA RAO, TARUN RAJ, BHARGAVA REDDY, MANOJ TLD, and PREETHAM SRINIVAS

In March 2020, we re-purposed our chest X-ray AI tool, qXR, to detect signs of COVID-19. We validated it on a test set of 11479 CXRs with 515 PCR-confirmed COVID-19 positives. The algorithm performs at an AUC of 0.9 (95% CI : 0.88 – 0.92) on this test set. At our most common operating threshold for this version, sensitivity is 0.912 (95% CI : 0.88 – 0.93) and specificity is 0.775 (95% CI : 0.77 – 0.78). qXR for COVID-19 is used at over 28 sites across the world to triage suspected patients with COVID-19 and to monitor the progress of infection in patients admitted to hospital

The emergence of the COVID-19 pandemic has already caused a great deal of disruption around the world. Healthcare systems are overwhelmed as we speak, in the face of WHO guidance to ‘test, test, test’ [1]. Many countries are facing a severe shortage of Reverse Transcription Polymerase Chain Reaction (RT-PCR) tests. There has been a lot of debate around the role of radiology — both chest X-rays (CXRs) and chest CT scans — as an alternative or supplement to RT-PCR in triage and diagnosis. Opinions on the subject range from ‘Radiology is fundamental in this process’ [2] to ‘framing CT as pivotal for COVID-19 diagnosis is a distraction during a pandemic, and possibly dangerous’ [3].

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