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Category: Matthew Holt

Matthew Holt is the founder and publisher of The Health Care Blog and still writes regularly for the site and hosts the #THCBGang and #HealthInTwoPoint00 video shows/podcasts. He was co-founder of the Health 2.0 Conference and now also does advisory work mostly for health tech startups at his consulting firm SMACK.health.

Matthew’s health care tidbits: My retina & what it tells us about primary care

Each time I send out the THCB Reader, our newsletter that summarizes the best of THCB (Sign up here!) I include a brief tidbits section. Then I had the brainwave to add them to the blog. They’re short and usually not too sweet! –Matthew Holt

I had a little scare the other night. I was driving home from a weekend in the mountains and I asked my wife if she saw that flashing light. No it wasn’t the cops, and no she hadn’t seen it. Turns out that I had a bright flash if I moved my eye a certain way. Oh, well I assumed I was tired and a good night’s sleep would fix it.

Next morning the flash was still there when I looked quickly to the left and a few weird floaters had appeared. I headed to the Mayo Clinic website and it looked to me like I had a detaching retina. I got on the urgent visit video with One Medical. The NP who answered said it sounded like I might have retina problems and I should get it checked by my ophthalmologist. But my eyesight has always been great (other than me needing reading glasses in my old age) and I haven’t got one. So who, I asked, do you recommend?

Here we fall into the crux of the problem. One Medical is an excellent primary care service. So good that Amazon bought it for $3bn. But it’s not a multi-specialty group nor is it a system like Kaiser. The answer was, “we don’t really recommend anyone–that’s not how it works.” The NP ended up looking up ophthalmologists near me & sent me a name as a referral in their app. But that’s not a link to anything and it wasn’t one chosen through some analytical process of seeking quality excellence.

I looked up MarinHealth (my local hospital)’s website and searched ophthalmology. That referred name was on it. I called. The doctor was out this week. They gave me another name. That doctor’s office gave me another name and that third office could see me that same day. I felt some pressure to see them right away as in the case of a detached retina Mayo says “ Contacting an eye specialist (ophthalmologist) right away can help save your vision”. The good news is having spent a couple of hours at the ophthalmologist’s my retina needs watchful waiting not surgery.

But the bad news is that for me, like 90% of Americans, there’s no easy way to get referred into a trustworthy system for specialty care. This can be even worse. My friend Sarah McDonald explains in her book The Cancer Channel how, after being diagnosed with a rare incurable cancer by a head & neck surgeon, the all encompassing support she received was to be given the number of a specialist at UCSF who couldn’t even talk to her for 3 weeks.

Mike Magee talks about the role of the health care system being to reduce patients’ “fear and worry”. Our lack of a specialty care referral system, especially when potentially serious and urgent care is on the line, is a big reason why there is so much fear and worry. I wish I had a concierge advocacy system like Included Health or Transcarent which could get me to the right place and work with me through the experience. But like most Americans at the time I need reassurance the most I’m calling a list of phone numbers hoping someone can see me.

We have primary care, we have specialty care. But we don’t have a system that cares.

Bad Backs & Deductibles

It’s time again for me to use my bad back as a case study in why American health care has such crazy incentives. 

About a month ago at the HLTH conference in Vegas, over the course of a few hours I developed debilitating leg pain. To quote from my earlier twitter  thread on my time in Vegas,  “After 3 days of excruciating pain, my wife insisted I went to the ER. The public policy person in me was horrified but we had already spent our deductible, so the cost was actually lower than paying cash for an MRI”

What actually happened was that after 3 days of dreadful pain & inability to walk (including getting myself home from Vegas using multiple wheelchairs, and being that guy who crawls off the plane onto a wheelchair), I got in to see my chiropractor. He said, you need an MRI to figure out what’s wrong with you. The alternatives were 

Looking good on the gurney!

1) Get insurance to pre approve the MRI. His guess was that that would take a few days or more. I actually called One Medical‘s urgent care video line and the PA I spoke to told me that usually insurance would only approve an MRI after I had done 6 weeks of physical therapy.

2) Pay $500 cash for a free standing MRI that could probably get me in during the next few days 

3) Go to the ER

Now the “incentives” part of this starts to really matter.

Continue reading…

THCB Quickbite: Julian Flannery, CEO, Summus

Julian Flannery is CEO of Summus, which I can’t pronounce (it’s Sue-mus like lawsuit not Sum-mus like math, despite the 2 Ms!). It’s a multidimensional referral platform which combines primary and specialty virtual care for employers, a white-label service for hospitals to deliver their specialty care, and now a peer-to-peer escalation model for specialists to talk to AMC-based specialists & get 2nd opinion reviews. Around 1.4m members on the platform and it’s seen massive usage growth in last 12 months–Matthew Holt

OK, trying more AI to write this

by MATTHEW HOLT

In the far oft halcyon days of last month, I used an AI system from Lex.Page  to write something about digital health. In the past few days the world has gone nuts about a new AI author called ChatGPT. So I tought I would compare and contrast.

Last month Lex.page was asked about Digital Health and it said

Digital Health is one of the most rapidly growing and important sectors in health care today. It is a broad term that encompasses the use of technology to improve health and health care.

Today I asked ChatGPT the same thing. In fact I just wrote “Digital Health” as the Q and this was the A

Digital health, also known as telehealth, is the use of digital technologies to deliver healthcare services remotely. This includes the use of video conferencing, mobile health apps, remote patient monitoring, and other digital tools to provide healthcare services to patients. Digital health can be used to improve access to primary care, reduce costs, and improve patient outcomes.

OK, pretty much a longer version of the same thing but with more details. So then I went BACK to Lex.page to ask it. But I had to ask it “What is Digital Health”

Digital health is a term used to describe the use of technology to improve healthcare. It covers everything from diagnostic tools and monitoring devices to electronic medical records and healthcare analytics. It’s an exciting and rapidly evolving area that has the potential to revolutionize the delivery of healthcare.

So in a month Lex.page has gotten a lot better!

Last month Lex.page said in response to my question/statement, “The biggest challenges for primary care are”

-Access to care

-Cost of care

-Quality of care

So it seems that digital health can help with all of those things. By providing tools that help patients better self-manage their health, digital health can help to improve access to care. By providing tools that help to lower the cost of care, digital health can help to make care more affordable. And by providing tools that help to improve the quality of care, digital health can help to make

I put the same sentence into GPTChat and at the bottom it told me Warning: Your text ends in a trailing space, which causes worse performance due to how the API splits text into tokens. But I asked it anyway and it gave me

A: 1. Accessibility: Ensuring that everyone has access to quality primary care services.

I surmised that it had more answers so I kept hitting submit! It got to another 12 answers with no new question!

Q: A: 2. Cost: Finding ways to make primary care services more affordable and accessible to all. Q: A: 3. Workforce: Recruiting and retaining a sufficient number of primary care providers to meet the needs of the population. Q: A: 4. Technology: Incorporating new technologies into primary care to improve efficiency and patient outcomes. Q: A: 5. Coordination: Improving the coordination of care between primary care providers and other healthcare professionals. Q: A: 6. Quality: Ensuring that primary care services are of the highest quality and meet the needs of patients. Q: A: 7. Education: Educating patients about the importance of preventive care and the value of primary care services. Q: A: 8. Mental Health: Integrating mental health services into primary care to better address the needs of patients. Q: A: 9. Population Health: Developing strategies to improve the health of the population as a whole. A: 10. Data: Utilizing data to inform decision-making and improve patient outcomes. A: 11. Payment: Developing new payment models that incentivize quality care and reduce costs. Q: A: 12. Social Determinants of Health: Addressing the social and environmental factors that influence health outcomes.

OK so those are all separate statements, but it’s pretty damn impressive. How is Lex.page doing? Well I asked it’s chatbot the same statement and it now answered:

The biggest challenges for primary care are likely to be related to access and cost. In many areas of the world, access to quality primary care is limited by geography, poverty, or both. Cost is also an issue, especially in countries with expensive healthcare systems. Additionally, many primary care providers struggle to effectively manage chronic conditions, such as diabetes and hypertension, due to a lack of resources, funding, and staff. Finally, the rapid advancements in technology have presented a challenge in terms of staying up to date with the latest medical developments.

That’s not only pretty smart but it’s quite an advance on the answer it gave me to the same vague question/statement just 31 days ago.

We are seeing a technology emerge right before our eyes.

Presumably the next step is to set it to read some of my favorite pieces on THCB and just have it write for me! Then I will be happily replaced by a robot!

THCB Quickbite: AJ Loiacono, CEO, CapitalRx

AJ Loiacono, CEO of CapitalRx, in a quickbite interview with The Health Care Blog’s Matthew Holt. CapitalRx is up to 1.5m members serviced both as a PBM and as a tech company administering pharmacy benefits using its tech platform. AJ says they’ve demonstrated to the market that they can service customers of any size, and the employer groups are starting to ask the right questions about pharmacy costs.

I’m trying to get AI to write this!

By MATTHEW HOLT

So it’s a new world in blogging about health care, and when I want to write about Digital Health or primary care, I’ve been told that this system at Lex.Page can do it for me

So here goes and lets see what it says about Digital Health or primary care

Digital Health is one of the most rapidly growing and important sectors in health care today. It is a broad term that encompasses the use of technology to improve health and health care.

OK so it wrote that. Which isn’t bad but not too helpful

Perhaps I can ask it whether it thinks that digital health will have a big impact on the future of primary care

The system at Lex writes that it does think digital health will have a big impact on the future of primary care.

So now it’s just spitting back at me what I asked it. Not too sure how to get it to write more for me

I then asked it to follow this sentence — The biggest challenges for primary care are

-Access to care

-Cost of care

-Quality of care

So it seems that digital health can help with all of those things. By providing tools that help patients better self-manage their health, digital health can help to improve access to care. By providing tools that help to lower the cost of care, digital health can help to make care more affordable. And by providing tools that help to improve the quality of care, digital health can help to make

That is pretty damn good given it’s a machine just guessing what I want it to write, even if it didn’t finish that last sentence. I can imagine that pretty soon I’ll be able to spit one of my talks into it and it will be able to write an article out of it quickly. I’ll be playing around with Lex and I can give some invites — if you want one, let me know.

Russ Johannesson, CEO, Glooko

Russ Johannesson has been CEO of Glooko since 2018. In that time the diabetes data platform has expanded internationally, made a couple of acquisitions, and added support for digital therapeutics and distributed clinical trials. He brought me up to date with the latest–Matthew Holt

Matthew’s health care tidbits: #Does Medicare Advantage Save the Taxpayer Money?

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, the controversy about Medicare Advantage is getting louder and louder. There’s no question that it results in lower out of pocket payments for its members than traditional FFS Medicare. Medicare Advantage members use fewer services, and their care appears to be better “managed” –then again FFS Medicare’s “members” are barely managed at all. 

But the big question is, Does Medicare Advantage save the government money? Critics (notably ex CMS veterans Berwick & Gilfillan) claim that risk adjustment games played by the private plans who run Medicare Advantage have cost up to $200bn over 10 years. Medpac (the independent body that advises Congress) estimates that “Medicare spends 4 percent more for MA enrollees than it would have spent if those enrollees remained in FFS Medicare” and go on to say “In aggregate, for the entire duration of their Medicare participation, private plans have never produced savings for Medicare”. However data from the Medicare Trustees and other research from ACHP & the trade group Better Medicare Alliance suggests that Medpac’s analysis is incorrect and that Medicare Advantage saves the government about 9% per enrollee.

THCB ran a long piece (pt 1pt 2) about Medicare Advantage from former Kaiser Permanente CEO George Halvorson earlier this year, and a related one from current Permanente Federation CEO Richard Isaacs. But it’s much more nuanced than that. J Michael McWilliams has long piece on Health Affairs Forefront trying to capture the various strands of the argument. His conclusion? “The substantial subsidies MA receives are largely responsible for the extra benefits and have more than offset savings from any efficiencies, posing a net cost to Medicare and complicating assessments of MA’s added value.”

Meanwhile CMS has just changed the most controversial aspect of risk adjustment (which is the most controversial part of Medicare Advantage) by banning the plans from doing it, and only allowing providers to be involved.

Whether any of this is going to change CMS regulations or wider government policy regarding MA payments is less certain. CMS is currently dealing with its replacement for the even more controversial Direct Contracting (now called ACO REACH). But Medicare Advantage is the most profitable part of private health insurance and has many knock on effects for care services and technology. So I’ll be watching this space and you should too!

Matthew’s health care tidbits: The Stupidity Vaccine

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 think we need a new vaccine. We need one that prevents stupidity.

Look I get that some people don’t think the flu vaccine is effective and don’t think the effects are too bad, so they don’t get one every year. Many people don’t get a vaccine for shingles. But as someone who had shingles long before the recommended age for the vaccine, let me tell you, you’ll wish you had the vaccine should you get it. And even sensible liberal Maggie Mahar a long while back was pretty suspicious of Merck’s Gardasil vaccine for cervical cancer–although since then it’s been replaced both by a more effective updated version and by Cervarix and the long term results are really good.

But since COVID-19 appeared the cultural and ideological identification among most Republicans has been that only wussy liberals take the COVID vaccine. This is stupid and indefensible. Even Donald Trump thinks so! But when he told his cult members that, they booed him! And so the US is stuck on not enough people vaccinated to repel variants or stop ICUs filling up. There are now hundreds of thousands of unnecessary deaths among the unvaccinated with no end in sight.

But this isn’t stupid enough. Now we are seeing senior political leaders attacking vaccines for diseases we’ve had under control for ages. We’ve already seen outbreaks of measles in recent years, including one at Disneyland. Last month 17 Georgia state senators proposed banning school mandates for all vaccines including MMR, chickenpox, DtAP, Hep B, Polio and more. It’s amazing that these people don’t believe in science, yet they are probably happy to use a smartphone or get in an airplane.

Sadly there appears to be no vaccine for stupidity on the horizon

THCB Gang Episode 81, Thursday Feb 3

Joining Matthew Holt (@boltyboy) on #THCBGang at 1pm PT 4pm ET Thursday for an hour of topical and sometime combative conversation on what’s happening in health care and beyond will be: Suntra Modern Recovery CEO JL Neptune (@JeanLucNeptune);  the double trouble of vaunted futurists Ian Morrison (@seccurve) & Jeff Goldsmith, WTF Health host & Health IT girl Jessica DaMassa (@jessdamassa). Today’s special guest returning to #THCBGang is the “I make unicorns” King Bill Taranto from Merck GHIF (@BillTaranto).

You can surmise that there will be some discussion around #DigitalHealth valuations!

The video will be below. If you’d rather listen to the episode, the audio is preserved from Friday as a weekly podcast available on our iTunes & Spotify channels

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