Callisto is a non-profit tech company that helps survivors of sexual violence identify repeat offenders. The company was started a few years back by Jess Ladd and Tracy DeTomasi took over as CEO a few years back, It focuses on college campuses where 90% of assaults are perpetrated by repeat offenders, who on average commit 6 offenses. And 90% of assaults are not reported, Callisto is working providing an anonymous solution with Tracey also giving a demo of how it works. This is a tough conversation about a difficult topic.–Matthew Holt
Seriously, Aon, you think weight loss drugs save money?
By AL LEWIS
Last month Aon, the major benefits consulting firm, released a “study” claiming:
A significant opportunity to reduce healthcare costs for employers and enhance overall workforce health through a comprehensive obesity management program that includes GLP-1 medications.
This, of course, is the opposite of what most researchers have shown. And in the immortal words of the great philosophers Dire Straits: “Two men say they’re Jesus, one of them must be wrong.” We’ll shortly see who’s wrong (um, meaning about weight loss drugs) when we dive into the study in a minute. But first, let’s review Aon’s previous analyses.
A brief history of Aon
Aon claimed that Accolade saved 8%, but it looks like they must coincidentally have been absent both on the day that the biostatistics professor explained how control groups work, and also on the day the fifth-grade math teacher explained how averages work.
Then, they claimed that Lyra – which is a mental health company – achieved the following non-mental improvements in the set of patients who had at least one mental health encounter with one of their “220,000 high-quality providers”:
§ A 30% reduction in non-mental health-related ER visits
§ A 30% reduction in generic drug spending
§ A 20% reduction in specialty drug spending
Thanks in part to starting the y-axis at $4000 to improve the optics, Aon also revealed that Lyra achieved a very high “efficiency ratio”:
I can’t object to that finding because – despite three decades in this field, about 100 articles/interviews/quotes/citations including the Wall Street Journal, two trade-bestselling books and one Harvard Business School case study – I still don’t know what an “efficiency ratio” is, other than that has nothing to do with comparing participants to non-participants in a mental health study. Apparently an “efficiency ratio” in healthcare measures how quickly a hospital turns over its inventory. So Aon’s use of the term recalls the immortal words of the great philosopher Bob Uecker: “Juuussst a bit outside.”
When publicly and privately asked to explain any of these things, Aon clammed up. That was likely wise on their part.
Continue reading…Medicaid Should be Abolished. But Not Like This!
By MATTHEW HOLT
A long time ago in a different country, there was a landslide election from a population looking for change. And change they got. Americans had been campaigning for national health care since 1917. There had been failures in 1933 and 1946 and 1961. But in 1965 they got it. Sort of.
But a weird thing happened in the Congress. Out of the political sausage making came a plan that “Cared” for those over 65. While another plan came out that “Aid”ed the poor. (Stole that from the wonderful Adimika Arthur). Weirder still, the Medicare program was and is a Federally-funded program. The Medicaid program was a state-administered program, even though it was at least half funded by the Feds.
That meant that Medicaid was always vulnerable to the whims of states. Of course many states already had demonstrated dismal records in how they treated their poorer and minority populations in the past (think slavery, Jim Crow, KKK, separate schools, drinking fountains, buses…you get the idea).
So while Medicare became the savior program for anyone who made it to 65, and later for those who were disabled or had kidney disease, Medicaid was a program for poor people that then got treated poorly. (Stole that from Jonathan Cohn). And right now in 2025 it is under severe threat yet again.
Before we get to that threat, it’s worth looking at the program. Medicaid has evolved and now covers most nursing home care (for “poor” seniors), care for the disabled, and even pays Medicare Part B premiums for people too poor to pay their own. It also covers health insurance for poor people under 65 and in those states that accepted ACA Medicaid expansion, that’s a considerable number. Of course these are people under an imaginary line that makes them too poor to buy on the exchanges set up by the ACA. And usually Medicaid includes the CHIP program, an insurance program that covers poor children set up under Clinton in 1997.
This chart from the venerable KFF shows that while 75% of people on Medicaid are, poor, under 65, and not classified as disabled, 50% of the money goes to those who are not.
This all results in a bizarro world in which there is one Federal government program for people over 65 and the disabled, and then an entirely different state-based one, which spends 1/2 of its money on people who are over 65 and disabled and who are also in the Federal program. This is plain stupid and always has been.
Of course there is more to it than that.
Continue reading…League Connect Digital Summit is WEDNESDAY
It’s Matthew Holt and I am looking forward to MC-ing the #LeagueConnectDigitalSummit THIS Wednesday May 7.
This one-day virtual event brings together leaders across health care, tech, and consumer experience to explore what it really takes to deliver personalized, digital-first, AI-powered care. I’ll be guiding the day’s key transitions and themes. There’s also strategy & implementation tracks with the likes of Google, Highmark Health, Accenture, Amwell, Deloitte, SCAN, Gainwell Technologies Health, and startups like SimpliFed, Healthily, Linus Health and so many more.
Join me and League for a FREE day of conversations, connection, and actionable insights that move health care forward.
Oh, yes and Moneyball, The Blind Side and Liar’s Poker author Michael Lewis is the keynote.
Glen Tullman, Transcarent
A couple of weeks back Transcarent completed its $630m acquisition of Accolade. But CEO Glen Tullman calls it a merger for a reason because Accolade brings people, products and clients that Transcarent didn’t have. Glen got in deep about Transcarent’s new product set in terms of its AI fueled navigation, primary care, weight management, cancer care and partnerships. Where is it going in terms of more with employers (yes!), Medicare (not yet) and aggressive expansion of services? And what can employers and their employees expect in terms of improving customer service from the health care system? Glen and his team have a big vision, big capital backing, and he is definitely intending to move the needle on care access, quality and cost.–Matthew Holt
Dr. Google Starts Sharing Regular Folks’ Advice As Chatbots Loom
By MICHAEL MILLENSON
“Dr. Google,” the nickname for the search engine that answers hundreds of millions of health questions every day, has begun including advice from the general public in some of its answers. The “What People Suggest” feature, presented as a response to user demand, comes at a pivotal point for traditional web search amid the growing popularity of artificial intelligence-enabled chatbots such as ChatGPT.
The new feature, currently available only to U.S. mobile users, is populated with content culled, analyzed and filtered from online discussions at sites such as Reddit, Quora and X. Though Google says the information will be “credible and relevant,” an obvious concern is whether an algorithm whose raw material is online opinion could end up as a global super-spreader of misinformation that’s wrong or even dangerous. What happens if someone is searching for alternative treatments for cancer or wondering whether vitamin A can prevent measles?
In a wide-ranging interview, I posed those and other questions to Dr. Michael Howell, Google’s chief clinical officer. Howell explained why Google initiated the feature and how the company intends to ensure its helpfulness and accuracy. Although he framed the feature within the context of the company’s long-standing mission to “organize the world’s information and make it universally accessible and useful,” the increasing competitive pressure on Google Search in the artificial intelligence era, particularly for a topic that generates billions of dollars in Search-related revenue from sponsored links and ads, hovered inescapably in the background.
Weeding Out Harm
Howell joined Google in 2017 from University of Chicago Medicine, where he served as chief quality officer. Before that, he was a rising star at the Harvard system thanks to his work as both researcher and front-lines leader in using the science of health care delivery to improve care quality and safety. When Howell speaks of consumer searches related to chronic conditions like diabetes and asthma or more serious issues such as blood clots in the lung – he’s a pulmonologist and intensivist – he does so with the passion of a patient care veteran and someone who’s served as a resource when illness strikes friends and family.
“People want authoritative information, but they also want the lived experience of other people,” Howell said. “We want to help them find that information as easily as possible.”
He added, “It’s a mistake to say that the only thing we should do to help people find high-quality information is to weed out misinformation. Think about making a garden. If all you did was weed things, you’d have a patch of dirt.”
That’s true, but it’s also true that if you do a poor job of weeding, the weeds that remain can harm or even kill your plants. And the stakes involved in weeding out bad health information and helping good advice flourish are far higher than in horticulture.
Google’s weeder wielding work starts with digging out those who shouldn’t see the feature in the first place. Even for U.S. mobile users, the target of the initial rollout, not every query will prompt a What People Suggest response. The information has to be judged helpful and safe.
If someone’s looking for answers about a heart attack, for example, the feature doesn’t trigger, since it could be an emergency situation.
Continue reading…Tom Knight, HealthcareDiversion.org
Tom Knight is the Chairman of HealthcareDiversion.org, a nonprofit that is trying to educate about the topic of drug theft from facilities. This happens both because medical professionals are addicts (and victims themselves) and also because of organized crime and resale. The consequences are awful, with patients receiving water instead of analgesic drugs, getting infections and often dying. And of course there’s a lot of liability and problems for those facilities when these issues are found out. What’s worse is that this problem is rampant. Tom has built a database to show just the tip of the iceberg of the problem. So come on a journey to a terrible health care problem you’ve never thought of that almost certainly affects you–Matthew Holt
Roon – the Demo and Interview
I was a little surprised that in the days of limitless content, AI, and all types of medical information being online a company could raise $15m to create a platform where actual doctors could answer specific questions that patients might have. Vikram Bhaskaran, the CEO is ex Pinterest and knows the consumer world well. Rohan Ramakrishna is a neurosurgeon who is worried about the level of misinformation that he saw showing up in his clinic daily. So Roon is trying to build what might be the impossible, a free personalized (mostly video) guide for health powered by the world’s best experts. They gave me a tour of what they have built so far, and it’s both impressive, ambitious and has a way to go. It’s an interesting demo and it raises some interesting questions about how that knowledge will be shared in the very near future–Matthew Holt
Saving U.S. Manufacturing: Think Biotech, Not Cars
By KIM BELLARD
Amidst all the drama last week with tariffs, trade wars, and market upheavals, you may have missed that the National Security Commission on Emerging Biotechnology (NSCEB) issued its report: Charting the Future of Biotechnology. Indeed, you may have missed when the Commission was created by Congress in 2022; I know I did.
Biotechnology is a big deal and it is going to get much bigger. John Cumbers, founder and CEO of SynBiobeta, writes that the U.S. bioeconomy is now already worth $950Bn, and quotes McKinsey Global Institute as predicting that by 2040, biology could generate up to 60% of the world’s physical inputs, representing a $30 trillion global opportunity. Not an opportunity the U.S. can afford to miss out on – yet that is exactly what may be happening.
The NSCEB report sets the stakes:
We stand at the edge of a new industrial revolution, one that depends on our ability to engineer biology. Emerging biotechnology, coupled with artificial intelligence, will transform everything from the way we defend and build our nation to how we nourish and provide care for Americans.
Unfortunately, the report continues: “We now believe the United States is falling behind in key areas of emerging biotechnology as China surges ahead.”
Their core conclusion: “China is quickly ascending to biotechnology dominance, having made biotechnology a strategic priority for 20 years.1 To remain competitive, the United States must take swift action in the next three years. Otherwise, we risk falling behind, a setback from which we may never recover.”
NSCEB Chair Senator Todd Young elaborated:
The United States is locked in a competition with China that will define the coming century. Biotechnology is the next phase in that competition. It is no longer constrained to the realm of scientific achievement. It is now an imperative for national security, economic power, and global influence. Biotechnology can ensure our warfighters continue to be the strongest fighting force on tomorrow’s battlefields, and reshore supply chains while revitalizing our manufacturing sector, creating jobs here at home.
“We are about to see decades of breakthrough happen, seemingly, overnight…touching nearly every aspect of our lives—agriculture, industry, energy, defense, and national security,” Michelle Rozo, PhD, molecular biologist and vice chair of NSCEB, said while testifying before the April 8 House Armed Services Committee Subcommittee on Cyber, Information Technologies, and Innovation. Yet, she continued, “America’s biotechnology strengths are atrophying—dangerously.”
Continue reading…We Need to Nationalize to Prevent Fraud
By MATTHEW HOLT
Two weeks ago I wrote an April Fool’s piece that claimed that Elon Musk and DOGE were going to nationalize American health care to save some money. That piece was half-joking but full-serious.
If you look at what Musk is complaining about there are two major areas of “waste, fraud and abuse” in government spending.
One is people directly employed by government agencies. Most of the people I’ve ever met in government work damn hard and for much less money than they’d get in the private sector. But you can of course find stories about useless government bureaucrats, who don’t do any work and pad their expense accounts. Those stories are probably about as true as Reagan’s pink Cadillac driving welfare queen in that there is some basis in reality for there being a tiny minority of bad actors, but the politics has far outrun the truth. (BTW that Welfare Queen article by Josh Levin in Slate is remarkable and very long!)
The other major area where Musk claims to be finding fraud is in work contracted out. There are of course lots of types of government work contracted out. If, like me, you’re old enough to remember the Iraq war, you probably are thinking of beltway bandits like Halliburton supplying any number of services to the military. (Remember when the Cheneys were baddies?). Another is the Blue Cross & Blue Shield plans who were the original contractors processing Medicare & Medicaid claims. Funnily enough they couldn’t actually deliver on that so in turn they outsourced it to Ross Perot at EDS and others like ACS, later Conduent. But there’s a ton more across every agency.
Musk & DOGE have been running around in the most ham-fisted way imaginable, axing both actual employees–including 20,000 of the 80,000 working at HHS– and allegedly slashing $150 billion in contracts. Of course on closer examination, many of the “contracts” were already over, or were made up. DOGE has been a pathetic piece of performance art that would be funny if it hadn’t ruined so many careers of people doing great work, or killed so many desperately poor children in poor countries.
The clever people at Brookings, (Elaine Kamarck and Paul Light) in a detailed piece on the topic, came up with an estimate of the ratio between direct employees and contractors.
Continue reading…
