THCB

Categories

Category: Health Tech

How exactly is my lab test co-pay $34.94?

By MATTHEW HOLT

I moved over something I wrote on linkedin, so that it doesn’t vanish. I do this type of thing so you don’t have to & to make Brett Jansen happy I am writing in one line paragraphs.

My question, is how do LabCorp, Brown & Toland and Blue Shield Of California come up with this stuff?

1. I go for my free annual checkup

2. I get blood/lab tests which AFAICT are included in the ACA free checkup.

3. My pre-diabetes is still “pre”. My cholesterol is good!

4. Blue Shield of California puts the claim on its website. The EOB representation says
–total billed $322.28
–In network savings $271.37
(note difference is $50.91)
–Patient responsibility $0

5. Then it has 5 sub-charges for different tests (which I assume total to the $322.28). All have a different price. All say “in network savings” of the same amount. All say Patient Responsibility $0

6. Labcorp sends me a bill. For $322.28. “Adjustments” $287.34. Difference $34.94.

7. I call Blue Shield of California customer service. Its annoying as hell automated system reads me the claim EOB that I can see on the website.

8. After a few minutes of that I hit 0 and get a human eventually. After a loooong time she goes to call Brown and Toland, the IPA that is somehow involved in the lab billing. They tell her that I do indeed owe $35. (26 mins on the call)

9. I ask her why, given they are allegedly free under the ACA, I am being charged for these lab tests. She says that the medical group has sent her the CPT codes and she can tell me which of the 5 lab tests I owe for.

10. (On the Labcorp bill the charges are split up by test [no codes provided], but the “adjustment” is to the total, so there’s no way to tell what the adjustment per test is. Reminder that on the BS site, they all adjust to $0.)

11. But that information is not in whatever documentation the IPA gave her. She goes back to call them AGAIN. Because, yes I am difficult and I did ask her to. Minute 37 at this stage

12. Minute 45. The person from the IPA comes on line. She keeps asking if I want a service or a diagnosis code. But tells me they will review the claim. My guess is that one of these codes doesn’t count as preventative. Eventually she gave me the 5 CPT codes for the tests.

13. The BS rep is still on the call. She chimes in and the IPA rep (who I think is in India judging by accent and bad phone connection) agrees that my lab copay is $50. (BTW the BS rep is clearly American but her phone connection is dreadful too!)

14. After a lot of clarification (OK, me leading the witnesses) they both agree that if the co-pay is $50 but my bill is $34.94, then something is off, and maybe one of the codes has been classified as non-preventative, therefore not free under the ACA.

15 The IPA (Brown & Toland Physicians) rep is going to resubmit this to the claims team. I should get a new EOB. From whom I have no idea. I thank them both for their time and we hang up. 1 hour 4 minutes

I know that wasted more than $34.94 of my time, and certainly way more than that of Blue Shield of California & Brown & Toland Physicians money. But it’s just an indication of how screwed up internal billing and customer service is at these antique orgs!

If you want to follow along, there’s a part 2!

Matthew Holt is the founder, author and publisher of THCB

Ami Parekh & Ankoor Shah, Included Health

Ami Parekh is the Chief Health Officer & Ankoor Shah, is VP, Clinical Excellence at Included Health. I had a long conversation with them about the philosophy of how we are doing population health and how we fix the system that we have today. I’m arguing for more primary care, but Ami restated it and says, you need somone you trust who is an expert who can help you make decisions. And this might not be a human! How do we change the system, and how does telehealth work now and how will it change? Defining health from the person perspective, not the way the health system wants to define it! Matthew Holt

Are the MA(HT)GA crowd going to be proud of themselves?

By MATTHEW HOLT

I have been trying hard to suppress this line of thought but when I woke up in the middle of the night with this piece basically fully formed in my head I couldn’t not write it. Yes I might lose some friends, but someone in health tech has to say this.

Last week a bunch of health tech companies, providers, plans and others went to the White House to an event remarkably called “Make American Health Technology Great Again”. The main organizer Amy Gleason is someone I consider an industry friend. No one can doubt her credentials in wanting to help patients, especially given her daughter Morgan’s medical condition and her awful experience in the health system. The initiatives spelled out–while they are voluntary and based on actions and regulations that are already on the books–will be net net good for American health care, and good for patients. 

Now, almost everything proposed is happening anyway. Anyone in health tech knows that it’s much easier to get health data and to run AI on it than it was in 2020, and it was way easier to get health data in 2020 than it was in 2016. Yes, of course it should be better and easier than it currently is. Yes, it should have happened quicker. Yes, the big provider systems and their main EMR Epic have not exactly bent over backwards to make data access more convenient for patients and innovators. Yes, of course there are too many demands to “send us a fax”. I personally had great fun with a UCSF-affiliated hospital last week, speaking to 5 different people and ending up both emailing and faxing them a referral to get an appointment. I’m pretty sure I’ll be doing the same thing in 2028. 

You can read tons more about the plans, the event and the voluntary agreement from luminaries like Lisa Bari and new dad Brendan Keeler.

But none of that is what is troubling me. What is deeply disturbing is the normalization of the people allegedly in charge of the nation’s health and health tech and the nonchalance and even knee-bending of those who went to the event last week.

Now I wasn’t there, even if several industry friends and clients were. I was at several similar events back in the Obama administration, but what we have seen from this Trump administration is a radical and toxic departure from America’s leadership in health and democracy, and it is not acceptable.

This is encapsulated by the people on the dias, and the actions they have taken.

Trump and his administration have committed so many egregious authoritarian acts that there’s no way to list them all. Just because people voted for him and the Congress and Judiciary is neutered does not obviate the fact that he was – deep breath – convicted of rape and separately found to be lying about mortgages in a civil court; convicted of 34 felonies for essentially tampering with the 2016 election; and impeached twice–once for politicizing America’s foreign policy and once for starting a violent coup. Don’t forget that at the time of the 2024 election he was being–another deep breath–prosecuted for stealing (and presumably selling) state secrets; being prosecuted for vote tampering in Georgia; and being prosecuted for planning the coup on Jan 6. It’s worth pointing out that two countries that have recent experience of dictatorships (Korea and Brazil) have both prosecuted and banned from office the leaders who attempted similar crimes there. (Incidentally I highly recommend you watch I’m Still Here, the Oscar-winning story of one family whose father was “disappeared” under Brazil’s military dictatorship in the 1970s).

Since his return to office, Trump has overseen the greatest direct political corruption ever in this country – you can bribe him directly via his memecoin. He has also overseen the transformation of ICE into an American-style Gestapo. Masked unidentified ICE agents are now snatching people, including both citizens and legal immigrants, off the streets and burying them in concentration camps here and abroad. Don’t forget that many immigrants or first generation immigrants are heading up those health tech companies at the meeting last week, not to mention how many poor, and perhaps undocumented, immigrants are working in our health care system. 

I haven’t even mentioned the impending cuts to Medicaid, the program for the poorest Americans, which will be the result of Trump’s “One Big Beautiful Bill Act”. That is sure to have a terrible effect on patients and on much of the health system, including many health tech companies trying to support Medicaid patients.

I didn’t even mention Epstein! And this is the guy America’s health care community wants to go and politely applaud just because he reads a speech about interoperability?

And it doesn’t stop there.

Continue reading…

Emily & Me–Money Remaking Medicine

The super connector and super intelligent Emily Peters, (who has quite her own patient adventure story–tl:dr GO GIVE BLOOD) and has written several books including Artists Remaking Medicine, is working on another one called Money Remaking Medicine. She invited me on a show called the Positive Deviants Detectives which is kind of a book club called the Health Care Reinvention Collaborative all hosted by the very wise Dawn Ellison. We talked and the audience joined in about the history of money, HMOs and more in health care and whether we can re-fangle it to make the money do the right things. Matthew Holt

Steve Brown, CureWise — AI for patients

Steve Brown is a genuine digital health OG. Starting with video games for kids with diabetes he eventually turned Health Hero into one of the first disease management companies. It was used in the VA to manage patients at home with CHF, diabetes and more and eventually sold to Bosch. Steve left health care for 15 years, but then at the start of this year had his own health issue. Which turned out to be cancer. He turned to AI and has built an amazing early stage patient facing AI doctor, called CureWise. It essentially has turned LLMs into multiple doctors. He gave me a full and fascinating demo. This is clearly the future but it’s also the present for Steve who is patient zero and the first user as well as the CEO. Amazing stuff. — Matthew Holt

Have Some Water – While You Can

By KIM BELLARD

We live on a water world (despite its name being “Earth”). We, like all life on earth, are water creatures, basically just sacks of water. We drink it, in its various forms (plain, sparking, carbonated, sweetened, flavored, even transformed by a mammal into milk). We use it to grow our crops, to flush our toilets, to water our lawns, to frack our oil, to name a few uses. Yet 97% of Earth’s water is salt water, which we can’t drink without expensive desalination efforts, and most of the 3% that is freshwater is locked up – in icebergs, glaciers, the ground and the atmosphere, etc. Our civilization survives on that sliver of freshwater that remains available to us.

Unfortunately, we’re rapidly diminishing even that sliver. And that has even worse implications than you probably realize.

A new study, published in Science Advances, utilizes satellite images (NASA GRACE/GRACE-FO) to map what’s been happening to the freshwater in the “terrestrial water storage” or TWS we blithely use. Their critical finding: “the continents have undergone unprecedented TWS loss since 2002.”

Indeed: “Areas experiencing drying increased by twice the size of California annually, creating “mega-drying” regions across the Northern Hemisphere…75% of the population lives in 101 countries that have been losing freshwater water.” The dry parts of the world are getting drier faster than the wet parts are getting wetter.

“It is striking how much nonrenewable water we are losing,” said Hrishikesh A. Chandanpurkar, lead author of the study and a research scientist for Arizona State University. “Glaciers and deep groundwater are sort of ancient trust funds. Instead of using them only in times of need, such as a prolonged drought, we are taking them for granted. Also, we are not trying to replenish the groundwater systems during wet years and thus edging towards an imminent freshwater bankruptcy.”

As much as we worry about shrinking glaciers, the study found that 68% of the loss of TWS came from groundwater, and – this is the part you probably didn’t realize – this loss contributes more to rising sea levels than the melting of glaciers and ice caps.

This is not a blip. This is not a fluke. This is a long-term, accelerating trend. The paper concludes: “Combined, they [the findings] send perhaps the direst message on the impact of climate change to date. The continents are drying, freshwater availability is shrinking, and sea level rise is accelerating.”

Yikes.

“These findings send perhaps the most alarming message yet about the impact of climate change on our water resources,” said Jay Famiglietti, the study’s principal investigator and a professor with the ASU School of Sustainability. 

We’ve known for a long time that we were depleting our aquifers, and either ignored the problem or waved off the problem to future generations. The researchers have grim news: “In many places where groundwater is being depleted, it will not be replenished on human timescales.” Once they’re gone, we won’t see them replenished in our lifetimes, our children’s lifetimes, or our grandchildren’s lifetimes.

Professor Famiglietti is frank: “The consequences of continued groundwater overuse could undermine food and water security for billions of people around the world. This is an ‘all-hands-on-deck’ moment — we need immediate action on global water security.”

If all this still seems abstract to you, I’ll point out that much of Iran is facing severe water shortages, and may be forced to relocate its capital. Kabul is in similar straits. Mexico City almost ran out of water a year ago and remains in crisis. Water scarcity is a problem for as much as a third of the EU, such as in Spain and Greece. And the ongoing drought in America’s Southwest isn’t going any anytime soon.

Continue reading…

V Bento, Sword Health

I got to interview V Bento the CEO of Sword Health. We had been in a little back and forth on Linkedin but this was the first time we actually had talked. Almost all of their business is in the US in MSK but they have recently added mental health and V is not shy in talking about the other areas they are heading into. They have had some controversial moments. They just raised money at an amount ($4 Bn) higher than larger rival MSK health outfit Hinge Health is trading at on the public market. Then I used it a year ago via Blue Shield of CA, and found it effective but expensive. Finally, there’s a lawsuit from the folks at Aging 2.0 who claim that they are owed equity from an accelerator Sword was part of in the 2010s.

V talked about all of these, specifically about how they are now charging their clients, and why he thinks they are worth their valuation–which apparently has no special terms for general Catalyst which invested at that valuation. He wouldn’t talk about the lawsuit other than to say he was happy with his position. But we had a good discussion and got to hear about their new tech, including their use of AI, and why V is so bullish on the company moving beyond MSK. Matthew Holt

Gen Z Should Give Health Care a Stare

By KIM BELLARD

Last I knew, Gen Z showed its disdain for older generations with a dismissive “OK Boomer.” But that was a few years ago, and now, it appears, Gen Z doesn’t even bother with that; instead, there is what has become known as the “Gen Z stare.” You’ve probably seen it, and may have even experienced it. TikTok influence Janaye defines it thusly: “The Gen Z stare is specifically when somebody does not respond or just doesn’t have any reaction in a situation where a response is either required or just reasonable.”

It’s been blowing up on social media and the media over the last few days, so it apparently has tapped into the social zeitgeist. It’s often been attributed to customer service interactions, either as a worker receiving an inane request or as a customer facing an undue burden.

You can already see why I link it to healthcare.

It’s off-putting because, as Michael Poulin, an associate psychology professor at the University at Buffalo, told Vox: “People interpret it as social rejection. There is nothing that, as social beings, humans hate more. There’s nothing that stings more than rejection.”

Many attribute the Gen Z stare to Gen Z’s lack of social experience caused by isolation during the pandemic, exacerbated by too much screen time generally. Jess Rauchberg, an assistant professor of communication technologies at Seton Hall University, would tend to agree, telling NBC News: “I think we are starting to really see the long-term effects of constant digital media use, right?” 

Similarly, Tara Well, a professor at Bernard College, told Vox: “It’s sort of almost as though they’re looking at me as though they’re watching a TV show… We don’t see them as dynamic people who are interacting with us, who are full of thoughts and emotions and living, breathing people. If you see people as just ideas or images, you look at them like you’re paging through an old magazine or scrolling on your phone.”

Millennial Jarrod Benson told The Washington Post: “It’s like they’re always watching a video, and they don’t feel like the need to respond. Small talk is painful. We know this. But we do it because it’s socially acceptable and almost socially required, right? But they won’t do it.” Zoomer (as those of Gen Z are known) Jordan MacIsaac speculated to The New York Times: “It almost feels like a resurgence of stranger danger. Like, people just don’t know how to make small talk or interact with people they don’t know.”

On the other hand, TikTok creator Dametrius “Jet” Latham claims: “I don’t think it’s a lack of social skills. I just think we don’t care,” which might be more to the point.

ABC News cited some customer service examples that deserved a Gen Z stare: “I’ve been asked to make somebody’s iced tea less cold. I’ve been asked to give them a cheeseburger without the cheese, but keep the pepper jack of it all.” As Zoomer Efe Ahworegba put it: “The Gen Z stare is basically us saying the customer is not always right.”

Ms. Ahworegba doesn’t think a Gen Z stare doesn’t reflect Gen Z’s lack of social skills, but rather: “They just didn’t want to communicate with someone who’s not using their own brain cells.” As some Zoomers say, it is “the look they give people who are being stupid while waiting for them to realize they are being stupid.”

Still, as one commenter on TikTok wrote: “I think it’s hilarious that Gen Z thinks they’re the first generation to ever deal with stupidity or difficult customers, and that’s how they justify the fact that they just disassociate and mindlessly stare into space whenever they are confronted with a difficult or confusing situation, instead of immediately engaging in the situation like every other generation has ever done before them lol.”

Or perhaps this is much ado about nothing. Professor Poulin noted: “To some degree, it’s a comforting myth that all of us who are adults — who’ve gotten beyond the teens and 20s — that we tell ourselves that we were surely better than that.” When it comes to displaying socially acceptable behavior, he says: “This isn’t the first generation to fail.”

———

Interestingly, Gen Z is already skeptical of our traditional healthcare system, as well they might be.

Continue reading…

China Goes “Democratic” on Artificial General Intelligence

By MIKE MAGEE

Last week, following a visit to the White House, Jensen Huang instigated a wholesale reversal of policy from Trump who was blocking Nvidia sales of its H20 chip to China. What did Jensen say?

We can only guess of course. But he likely shared the results of a proprietary report from noted AI researchers at Digital Science that suggested an immediate policy course correction was critical. Beyond the fact that over 50% of all AI researchers are currently based in China, their study documented that “In 2000, China-based scholars produced just 671 AI papers, but in 2024 their 23,695 AI-related publications topped the combined output of the United States (6378), the United Kingdom (2747), and the European Union (10,055).”

David Hook, CEO of Digital Science was declarative in the opening of the report, stating “U.S. influence in AI research is declining, with China now dominating.”

China now supports about 30,000 AI researchers compared to only 10,000 in the US. And that number is shrinking thanks to US tariff and visa shenanigans, and overt attacks by the administration on our premier academic institutions.

Economics professors David Autor (MIT) and Gordon Hanson (Harvard), known for “their research into how globalization, and especially the rise of China, reshaped the American labor market,” famously described the elements of “China Shock 1.0.” in 2013. It was “a singular process—China’s late-1970s transition from Maoist central planning to a market economy, which rapidly moved the country’s labor and capital from collective rural farms to capitalist urban factories.”

As a result, a quarter of all US manufacturing jobs disappeared between 1999 and 2007. Today China’s manufacturing work force tops 100 million, dwarfing the US manufacturing job count of 13 million. Those numbers peaked a decade ago when China’s supply of low cost labor peaked. But these days China is clearly looking forward while this administration and its advisers are being left behind in the rear view mirror.

Welcome to “China Shock 2.0” wrote Autor and Hanson in a recent New York Times editorial. But this time, their leaders are focusing on “key technologies of the 21st century…(and it) will last for as long as China has the resources, patience and discipline to compete fiercely.”

The highly respected Australian Strategic Policy Institute, funded by their Defense Department, has been tracking the volume of published innovative technology research in the US and China for over a quarter century. They see this as a measure of experts opinion where the greatest innovations are originating. In 2007, we led China in the prior four years in 60 of 64 “frontier technologies.”

Two decades later, the table has flipped, with China well ahead of the US in 57 of 64 categories measured.

Continue reading…

Healthcare AI: What’s in your chatbot?

By OWEN TRIPP

So much of the early energy around generative AI in healthcare has been geared toward speed and efficiency: freeing doctors from admin tasks, automating patient intake, streamlining paperwork-heavy pain points. This is all necessary and helpful, but much of it boils down to established players optimizing the existing system to suit their own needs. As consumers flock to AI for healthcare, their questions and needs highlight the limits of off-the-shelf bots — and the pent-up demand for no judgment, all-in-one, personalized help.

Transforming healthcare so that it actually works for patients and consumers — ahem, people — requires more than incumbent-led efficiency. Generative AI will be game-changing, no doubt, but only when it’s embedded and embraced as a trusted guide that steers people toward high-quality care and empowers them to make better decisions.

Upgrading Dr. Google

From my vantage point, virtual agents and assistants are the most important frontier in healthcare AI right now — and in people-centered healthcare, period. Tens of millions of people (especially younger generations) are already leaning into AI for help with health and wellness, testing the waters of off-the-shelf apps and tools like ChatGPT.

You see, people realize that AI isn’t just for polishing emails and vacation itineraries. One-fifth of adults consult AI chatbots with health questions at least once a month (and given AI’s unprecedented adoption curve, we can assume that number is rising by the day). For most, AI serves as a souped-up, user-friendly alternative to search engines. It offers people a more engaging way to research symptoms, explore potential treatments, and determine if they actually need to see a doctor or head to urgent care.

But people are going a lot deeper with chatbots than they ever did with Dr. Google or WebMD. Beyond the usual self-triage, the numbers tell us that up to 40% of ChatGPT users have consulted AI after a doctor’s appointment. They were looking to verify and validate what they’d heard. Even more surprising, after conferring with ChatGPT, a similar percentage then re-engaged with their doctor — to request referrals or tests, changes to medications, or schedule a follow-up.

These trends highlight AI’s enormous potential as an engagement tool, and they also suggest that people are defaulting to AI because the healthcare system is (still) too difficult and frustrating to navigate. Why are people asking ChatGPT how to manage symptoms? Because accessing primary and preventive care is a challenge. Why are they second-guessing advice and prescriptions? Sadly, they don’t fully trust their doctor, are embarrassed to speak up, or don’t have enough time to talk through their questions and concerns during appointments.

Chatbots have all the time in the world, and they’re responsive, supportive, knowledgeable, and nonjudgmental. This is the essence of the healthcare experience people want, need, and deserve, but that experience can’t be built with chatbots alone. AI has a critical role to play, to be sure, but to fulfill its potential it has to evolve well beyond off-the-shelf chatbot competence.

Chatbots 2.0

When it comes to their healthcare, the people currently flocking to mass-market apps like ChatGPT will inevitably realize diminishing returns. Though the current experience feels personal, the advice and information is ultimately very generic, built on the same foundation of publicly available data, medical journals, websites, and countless other sources. Even the purpose-built healthcare chatbots in the market today are overwhelmingly relying on public data and outsourced AI models.

Generic responses and transactional experiences have inherent shortcomings. As we’ve seen with other health-tech advances, including 1.0 telehealth and navigation platforms, impersonal, one-off services driven primarily by in-the-moment-need, efficiency, or convenience don’t equate to long-term value.

For chatbots to avoid the 1.0 trap, they need to do more than put the world’s medical knowledge at our fingertips.

Continue reading…
assetto corsa mods