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Category: Health Policy

Republican Health Policies Disproportionally Harm White Citizens in Their States

BY MIKE MAGEE

As Ive said before, I believe Dr. Ladapo is an anti-science quack who doesnt belong anywhere near our states Surgeon General office, let alone running it. But now that hes been confirmed, its my sincere hope that he and Governor DeSantis choose to focus on saving lives and preventing unnecessary illness instead of continuing their absurd promotion of conspiracy theories and opposition to proven public health measures — but Im not going to hold my breath.”

If you identified these as the words of the former governor, and now Congressman Charlie Crisp, currently running to retake the office he once held, you’d be wrong. These are the words of another state Democrat who is running a distant 2nd in the Democratic primary battle set for this summer.

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Hey, Old Guys!

BY KIM BELLARD

OK, how many of you had on your women-in-power bingo cards that, in 2022, Sheryl Sandberg would be out at Facebook but Queen Elizabeth II would still be Queen?  It’s the Queen’s Platinum Jubilee, marking seventy years on the throne.  She’s getting a lot of love for that tenure, but it makes me think, geez, some people just don’t know when to step away.

Perhaps what sparked my cynicism about the Queen was an op-ed by Yuval Levin, Why Are We Still Governed by Baby Boomers and the Remarkably Old?  Dr. Levin is, of course, referring to the U.S., and he’s spot-on about our governance problem.  But I think the problem goes further: we have too many old people running our companies and major institutions as well.  

Whether it is, say, healthcare, education, or the military, we’re so busy protecting the past that we’re not really getting ready for the future.

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British Doctor Suspended for falsely claiming she was “promised” a laptop. WTF!

BY SAURABH JHA

If forced to choose Britain’s two biggest contributions to civilizations, I’d pick the Magna Carta and the vaguely instructional “fuck off.” If permitted a third, I’d choose “managerialism.” Brits are good at telling others what to do. Managerialism is how the Brits once ruled India. Buoyed by the colonial experience, British managers felt they could rule doctors. 

The new Viceroy, the manager-in-chief, is the General Medical Council (GMC). The GMC is a physician watchdog, funded by doctors, which works for the public good and is answerable to…well, I’ll get to that later. Their relevance rose exponentially when the psychopathic Dr. Harold Shipman, a charming, clinically adept, general practitioner, killed over two hundred patients. Never again, said the managers. They promised to keep the public safe from dodgy doctors with aspirations of Jack the Ripper and Sweeney Todd.

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Virtual Care Regulatory Round-Up: Telehealth & Digital Care ‘State-of-Play’ by Nathaniel Lacktman

BY JESS DaMASSA, WTF HEALTH

Just as HHS extends the Covid-19 public health emergency waivers until July, we kick-off a brand-new monthly interview series about the state-of-play for all things telehealth and digital care policy and reimbursement. Called the WTF Health Virtual Care Regulatory Round-up, we’re partnering with our friends at Wheel to feature health policy experts, lobbyists, health plan folks, and other virtual care experts and insiders who can keep us updated on the changing regulations and what they will mean to those health tech co’s whose businesses rely on virtual care.

Attorney-to-the-stars-of-telehealth, Nathaniel Lacktman, who chairs the Telemedicine & Digital Health Industry Team at Foley & Lardner and is a Board member of the American Telemedicine Association (ATA), kicks the series off for us with an update on those public health waivers and how he is coaching health tech businesses in preparing for the inevitable transition of care that will come when they come to an end.

What will happen to patients who live across state lines from their virtual care providers? What business decisions need to be made to avoid abandoning patients and maintaining continuity of care? Nate’s not bullish on a federal national license, but there are some cases where cross-state patient-provider relationships can continue to exist – they just might not work for everyone’s business model.

And, on the subject of telehealth business models, Nate gives us his take on where he thinks reimbursement will be headed, how policy around virtual prescribing will be impacted post-pandemic (particularly around controlled substances), and whether or not Medicare’s originating site requirement will be put back in place. We also get Nate’s perspective on which virtual care business models seem to be working best among health tech startups and what legal risk those more ‘reckless’ players might be creating for the rest of the field without even realizing it. Great education on virtual care and what’s happening in the space RIGHT NOW. Watch!

Special thanks to our series sponsor, Wheel – the health tech company powering the virtual care industry. Wheel provides companies with everything they need to launch and scale virtual care services — including the regulatory infrastructure to deliver high quality and compliant care. Learn more at wheel.com.

I Want to Believe

BY KIM BELLARD

I know, I should be writing about hot topics like monkeypox or the baby formula shortage, but, c’mon, Congress held hearings last week about UFOs – the first in 50 years!  I mean, I followed Project Blue Book in the 1970’s, watched “The X-Files” in the 1990’s, and have seen UFO videos on YouTube.  If Congress is starting to take UFO’s seriously, how could I not?  

And for those of you who don’t see any possible connection to healthcare (except for those unpleasant alien probes…), let me put it to you this way: by 2050, is it more likely that:

  • We’ll know what UFOs actually are;
  • We’ll have fundamentally reformed the U.S. healthcare system.

I thought so.

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How About This Opportunity, Health Tech Investors? Promoting Contraception vs. Banning Abortion

By MIKE MAGEE

Dr. Linda Rosenstock has an M.D. and M.P.H. from Johns Hopkins, and was a Robert Wood Johnson Clinical Scholar. She is currently Dean Emeritus and Professor of Health Policy and Management at UCLA’s Fielding School of Public Health, but also spent years in government, and was on President Obama’s Advisory Group on Prevention, Health Promotion and Integrative and Public Health.

In the wake of the release of Justice Alito’s memo trashing Roe v. Wade, she was asked to comment about the status of abortion in America. Here is what she said:

The broader the access to proven family planning methods, the lower the unintended pregnancy rate and the lower the abortion rate. We cant underestimate the role of educating and empowering women – and men – about these issues.”

These are not simply the opinions or insights of a single health expert. They are backed up by the following facts:

  1. Since 1981, abortion rates in U.S. women, age 15 to 44, have declined by nearly two thirds from 29.3 per 1000 to 11.4 per 1000.

2. Approximately half of all pregnancies in the U.S. are unintended.  Of those unintended, approximately 40% of the women chose to terminate the pregnancy by abortion – either procedural or chemically induced.

3.  The decline in the number of abortions has coincided with increased access to long-acting reversible contraception, including IUD’s and contraceptive implants. These options are now safe, increasingly covered by insurers, and more accessible to at-risk populations.

4. The increasing inclusion of sex education in middle school and high school curricula has been accompanied by a decline in high school sexual activity by 17% between 2009 and 2019.

5. There were 629,898 abortions recorded by the CDC in 2019. For every 1000 live births that year, there were 195 other women who chose to terminate their pregnancies. Almost half of the 1st trimester abortions are now chemically induced through Plan B-type pills.

What is clear from these figures is that knowledge and access to contraception is the best way to decrease the number of abortions in America.

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Learning from This War

BY KIM BELLARD

There’s an old military adage that generals are always fighting the last war.  It’s not that they haven’t learned any lessons, it’s more than they learned the wrong lessons.  I fear we’re doing that with the COVID pandemic.  

The next big health crisis may not come from another COVID variant; it may not be caused by coronavirus at all.  Even if we learn lessons from this pandemic, those may not be lessons that will apply to the next big health crisis.  

What started me thinking about this is a C4ISRNET interview with Mike Brown, the Director of the Defense Innovation Unit, and DARPA Director Dr. Stefanie Tompkins.  Dr. Tompkins and Mr. Brown are both watching the war in the Ukraine closely.  As Dr. Tompkins says in the interview, the war is a “really good test” about the programs her agency has invested in and/or is investing in for the future.

E.g., Russia has clear advantages in numerical superiority, and in “traditional” weapons like tanks, airplanes, ships, and artillery, but Ukraine has been able to blunt the invasion through asymmetrical warfare, using things that DARPA helped foster, including Javelin missiles, drones, satellite imagery, secure communications, and GPS.  Even Russia’s vaunted cyber capabilities have been overmatched by Ukraine’s own capabilities.  Current DARPA investments like hypersonic missiles and AI are being tested.

I’m comforted that DARPA and DIU are learning in real time what lessons their agencies can learn to help fight future wars, but I’m wondering who in our healthcare system, and who in our governments (federal/state/local), are not just fighting COVID but learning the bigger lessons from it to fight future crises.  

I trust that smarter people than me are looking at this, but here are some the lessons I hope we’ve learned:

Information: it’s shocking, but we don’t really know how many people have had COVID.  We don’t really know how many have it now.  We like to think we know how many have been hospitalized and how many have died, but due to reporting inconsistencies those numbers are, at best, approximations.  

We need early warning systems, like through wastewater monitoring.  We need standardized public health reporting, with real-time data and a central repository in which it can be analyzed.  We need easy-to-understand dashboards that both public officials and the public can access and base their decisions on.  We can’t be building these during a health crisis.

Supply Chains: just-in-time, globally distributed supply chains are a marvel of modern life, bringing us greater variety of products at more affordable prices, but, in retrospect, we should have understood that in a global health crisis they would prove to be an Achilles heel.  Masks and other PPE, ventilators, vaccines and other prescription drugs have all suffered from supply chain issues during the pandemic.  Shortages led to unevenly distributed supplies and higher prices.  

We’re never going back to the days of local production, but we do need to prioritize what things need to be produced regionally/nationally, how that production can scale in time of crisis, and how that production should be fairly allocated.  The mechanisms to do that can’t be built on the fly.

The sick and the dead: Among the many images of the pandemic’s worst (so far) days, some of the most haunting are the ones of hospitals filled to overflowing, with patients on gurneys in hallways, or the refrigerator trucks filled with dead bodies.  Our healthcare system’s capabilities for both were simply overwhelmed – as was the healthcare workforce.

Hospital beds are expensive to build, and expensive to maintain.  We can’t afford a healthcare system that builds them for the worst case scenario.  But we can learn from innovative efforts during the pandemic, like building temporary hospitals that can be expanded or contracted as needed.  

Similarly, there has to be a strategy for dealing with dead bodies during a global health crisis, especially one in which those bodies themselves may carry ongoing risks.  Existing morgues, mortuaries, and even graveyards may not be sufficient.  There needs to be a plan.

Hardest to solve are healthcare workforce shortages.  It’s not easy to train new healthcare workers, and retaining them when they’re stressed beyond belief proved to be a challenge.  In a crisis, we need them all working at the top of the licenses, able to cross workplaces and even state lines, and properly supplied and compensated.  None of those is a “normal” state of affairs for our healthcare system, and all are inexcusable in a crisis.

Telehealth: telehealth seemed to finally gets its day during the pandemic, with relaxed regulation, improved reimbursement, provider adoption, and consumer preference.  It took pandemic to make us realize that making sick, potentially contagious, patients travel to get care is not a good idea.

That being said, now that the pandemic is in a more manageable phase, the bloom seems to be off the telehealth rose, with regulations being reapplied, providers not fully incorporating into their practice patterns, and patients returning to in-person visits.

Hey: it’s 2022.  We have the technology to do telehealth “right.”  Aside from, say, a heart attack or an auto accident, telehealth should always our first course of action.  Our licensing, our reimbursements, and our work flows need to facilitate this – not just to prepare for the next health crisis, but simply as part of a 21st century healthcare system. 

Communication: One of the most unexpected results of the pandemic is the distrust of public heath advice – vilifying public health officials, spurning mitigation efforts like masking or isolation, and spurring on the already-present anti-vaxx movement.  “Science” is seen as in the eye of the beholder. It’s an information war, and health is losing.

We need the tools to fight the health information war more effectively. We need to learn how to communicate more effectively.  We need to reestablish faith in science.  We need responses to a health care crisis to be a health issue, not a political one.  

————

We will be taken by surprise by the next health crisis.  We had plans for a pandemic, but, when it hit, we fumbled every response.  Next time we’ll be expecting another COVID, and, if it’s not, we’ll be caught flat-footed again.  

The current crisis is, to use Dr. Tompkins’ words, a really good test for whether we’re working on the right things for our next health crisis.  I’m not so sure we are.  

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor

ONC Explainer: Micky Tripathi Deep-Dive on Info Blocking, API standardization & TEFCA

By JESS DaMASSA, WTF HEALTH

Micky Tripathi the National Coordinator for Health Information Technology at HHS says this year will be a “transformative” year for Health IT as the decade-long, $40 billion dollar effort to lay an electronic foundation for healthcare delivery heads to the next level. Why is this year THE YEAR when it comes to the digital exchange of health information? Where is federal health IT strategy headed in order to provide the standards and policies health tech co’s need to be able to kick up the pace of innovation?

We get into a SWEEPING chat about the technology and business implications of all the work coming out of ONC, including implementation of those new information blocking regulations, goals for API standardization, and TEFCA (Trusted Exchange Framework & Common Agreement). Micky not only gives the background on the regulations and policies, but also provides some analysis on what they actually mean for those health technology companies trying to do business in-and-around a more digital healthcare ecosystem.

Healthcare Suffers from Patient Bias

By KIM BELLARD

If you went to business school, or perhaps did graduate work in statistics, you may have heard of survivor bias (AKA, survivorship bias or survival bias).  To grossly simplify, we know about the things that we know about, the things that survived long enough for us to learn from.  Failures tend to be ignored — if we are even aware of them. 

This, of course, makes me think of healthcare.  Not so much about the patients who survive versus those who do not, but about the people who come to the healthcare system to be patients versus those who don’t. It has a “patient bias.”

Survivor bias has a great origin story, even if it may not be entirely true and probably gives too much credit to one person.  It goes back to World War II, to mathematician Abraham Wald, who was working in a high-powered classified program called the Statistical Research Group (SRG).

One of the hard questions SRG was asked was how best to armor airplanes.  It’s a trade-off: the more armor, the better the protection against anti-aircraft weapons, but the more armor, slower the plane and the fewer bombs it can carry. They had reams of data about bullet holes in returning airplanes, so they (thought they) knew which parts of the airplanes were the most vulnerable.

Dr. Wald’s great insight was, wait — what about all the planes that aren’t returning?  The ones whose data we’re looking at are the ones that survived long enough to make it back.  The real question was: where are the “missing holes”?  E.g., what was the data from the planes that did not return?

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Dara’s “Hero Quest”: How About Embracing Universal Health Care in America?

By MIKE MAGEE

Joseph Campbell, who died in 1987 at the age 83, was a professor of literature and comparative mythology at Sarah Lawrence College. His famous 1949 book, “The Hero With a Thousand Faces” made the case that, despite varying cultures and religions, the hero’s story of departure, initiation, and return, is remarkably consistent and defines “the hero’s quest.” Bottom line: Refusing the call is a bad idea.

George Lucas was a close friend and has said that Star Wars was largely influenced by Campbell’s scholarship. On June 21, 1988, Bill Moyers interviewed Campbell and began with a clip from Star Wars where Darth Vader says to Luke, “Join me, and I will complete your training.” And Luke replies, “I’ll never join you!” Darth Vader then laments, “If you only knew the power of the dark side.”

Asked to comment, Campbell said, “He (Darth Vader) isn’t thinking, or living in terms of humanity, he’s living in terms of a system. And this is the threat to our lives; we all face it, we all operate in our society in relation to a system. Now, is the system going to eat you up and relieve you of your humanity, or are you going to be able to use the system to human purposes.”

Systems gone awry? Think Putinesque Russia, or Psycho-pernicious Trumpism, or Ultra-predatory Capitalism.

Dara Kharowshaki, the CEO at Uber, who took over the company from uber-bro, Travis Kalanick, is a fan of Campbell’s and understands the journey of a hero – departure, initiation, return. Perhaps that is why he defines “movement” as fundamental to life…adding deliberately the qualifier “movement in the right direction.” In an interview in December, 2021, with Brian Nowak, Equity Analyst, U.S. Internet Industry, for Morgan Stanley, he pushed for corporate engagement in a range of issues including “sustainability, safety, equity, and anti-racism – these are all issues that go to the core of who we are, and our identity.”

How did health care escape that list, especially considering the companies investment in “Uber Health” – a health care delivery service promoting speed, care coordination, privacy, and cost-effective and reliable transport to and from care-giving brick and mortar?

It may have something to do with the fact that Uber has fought tooth and nail to avoid providing health care as a benefit to its drivers. In 2020, the company joined Lyft, DoorDash and other gig companies in throwing $205 million into a lobbying effort in California titled “Yes on 22”.

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