The tipping point for telehealth just happened. Many ways of doing business will change forever after the experience of the COVID-19 pandemic, and health care, too, will never be the same.
Between the release from some HIPAA requirements announced by President Trump this month, shifts in payor policies, and mandated insurance coverage of telehealth visits, innovation and adoption are taking off like wildfire. As patients and outpatient-based physicians hunker down at home, they are rapidly experimenting, and improving the way care is being delivered remotely.
Our institution, which had no prior program, faced with an imminent shut down of elective activity, developed an enterprise-wide telehealth program in days, rendering hundreds of visits as soon as we launched it. This activity is being replicated all around the country.
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.”
Today on Health in 2 Point 00, we have a no-nonsense April 1st episode—with deals this time! On Episode 115, Jess asks me about Olive raising $51 million for its AI-enabled revenue cycle management solution, Bright.md raising an $8 million Series C for its asynchronous telemedicine platform, and AristaMD raising $18 million for a different sort of telemedicine, eConsults, which allow primary care physicians to consult with specialists virtually. —Matthew Holt
“It’s fair to say that, in Italy, we are doing 10 years of digital health evolution in 10 days.”
Our “man-on-the-street” in Italy (well, man-sheltered-in-place in Italy) Roberto Ascione, CEO of Healthware, reports in on the Covid-19 outbreak and what’s happening with digital health startups, health system partners, and hospitals as Italians continue battling at the forefront of the coronavirus outbreak.
A few weeks ahead of the U.S., there are many things to learn about Covid-19 testing, treatment, outcomes, and timing from the experience in Italy, including some foresight on how pathways for telehealth and digital health continue to evolve as conditions become more serious and the outbreak progresses. (For all you Gretzky fans, this is “skating to where the puck will be” kind of stuff…)
Some navigational guidance on this chat which took place March 26, 2020:
Update on Italian Covid-19 outbreak from health industry insider
10:25 minute mark: Digital Health startup case study, Paginemediche, self-triage chatbot data from 70K Italians, data sharing with Italian government & WHO, telehealth model flipping to give overwhelmed physicians opportunity to triage and “invite” patients based on needs
19:10 mark: How to work with Italian digital health startups to advance Covid-19 work
Today on Health in 2 Point 00, we have a viewer question! For our friends who are wondering what will happen to all the IPOs that were supposed to happen this year, I weigh in on how this crisis will impact IPOs and startup funding. On Episode 114, Jess asks me about the stimulus package granting $117 billion to hospitals and for my thoughts on all the startups coming up with ways to address COVID-19. A few startups that come to mind include Conversa with its virtual care conversation, Coronavirus Health Chats, Biofourmis which is looking for ways to track infected people earlier through its AI-powered arm sensor, and Surveyor Health leveraging its data analytics platform as well. For more on this, check out covid19healthtech.com where my colleagues at Catalyst have put together a resource hub for health tech solutions. —Matthew Holt
Jamey Edwards, CEO of one of the larger in-hospital B2B telehealth startups in the US, Cloudbreak Health, is already seeing changes in the way hospitals are using his company’s telemedicine services in the wake of COVID-19.
From a noted rise in the rate of infectious disease consults, to “quarantine rooms” where telemedicine equipment is cleverly deployed to practice “clinical distancing” to minimize risk to front-line healthcare workers (and also preserve PPE), Jamey talks about what he’s seeing among hospital clinicians and what they seem to need most right now from telehealth providers amid the COVID-19 outbreak.
With changes to licensing regulations, HIPAA policies, and reimbursement changing the very infrastructure around telehealth, will we finally see virtual care become a true part of the healthcare system at-scale?
“One of the hardest things to do in our healthcare system is match cost to acuity,” says Jamey. “I’m not going to say we’ve overvalued the in-person encounter, but we certainly have been very hesitant to step away from it.”
“The fact of the matter is that that’s a bias. And so it’s up to us to look at these biases and say, ‘Well, no. What is the right way to do this?’”
It took a 125 nanometer virus only a few weeks to move American healthcare from the twentieth to the twenty-first century.
This had nothing to do with science or technology and only to a small degree was it due to public interest or demand, which had both been present for decades. It happened this month for one simple reason: Medicare and Medicaid started paying for managing patient care without a face to face encounter.
Surprise! In the regular service industries, businesses either charge for their services or give certain services away for free to build customer loyalty. In healthcare, up until this month, any unreimbursed care or free advice was provided on top of the doctors’ already productivity driven work schedules.
“Health tech providers — this is the make-or-break time. If you can’t prove your value in the next, say, eleven weeks, then you should NOT be in the health care game. It’s time to get serious.”
Bruce Greenstein, former CTO at HHS and current Chief Strategy and Innovation Officer at LHC Group, one of the country’s largest home health care providers, stops by to share what he’s learned about the federal government’s response to the COVID-19 pandemic.
Bruce represented the home health industry during last Friday’s (3/13/20) White House meeting, which culminated in a Rose Garden press conference starring the ‘who’s who’ of American health care, retail, and pharma leadership. (Bruce was the guy who elbow bumped Trump.)
Lots of attention on virtual care and telehealth during that presser, and Bruce weighs-in for our health tech and digital health audience about how they can get involved and what big health care companies like his are looking for in digital solutions right now (LHC Group works with 350 hospitals caring for 100K patients.) And how about those HHS Interoperability Rules that have been basically lost in this news cycle? We get Bruce’s feedback on how HHS did, plus his insider info on the HHS “hack.”
Some guidance to help you navigate this chat. Hot Tip: Open up the transcript in YouTube and navigate to these different breaks in the conversation.
The ‘Trump Bump’ & Gossip from the Rose Garden Press Conference & White House Meetings
8:40 mark — Advice for health tech startups (must-watch)
15:25 mark — Find out what startups can do that would lead Bruce to “put them in Health IT Hell for the rest of their existence”
Dr. Niti Pall has experience working in 41 different health systems around the world in her roles as Global Medical Director for KPMG, Senior Mobile Health Advisor for AXA, and as a General Practitioner in the U.K. With that type of diverse experience across health systems rich and poor, tech-enabled and not, OF COURSE we had to ask which was the best health system ‘hack’ she’s seen so far. The answer takes us to Bangladesh, involves a huge telecom company, and leads to a completely new category of healthcare provider. Is this a model we’ll see Amazon, Apple, Google or other non-traditional healthcare players take up as they head into the health industry? Niti talks about how tech is the underpinning of “proper 21st Century healthcare,” but that’s not all it will it take to overcome global clinician shortages and help consumers feel like they are getting value out of their healthcare dollars worldwide.
Filmed at Barcelona Health Hub Summit in Barcelona, Spain, October 2019.