Today on Health in 2 Point 00, it’s IPO day! On Episode 89, Jess asks me about the recent IPOs, Oscar Health getting into Medicare Advantage, and Fitbit accuracy in people of color. Jess asks me to weigh in on whether Livongo’s IPO was better than we expected and it’s safe to say that they are growing fast. On the flip side, the “silent” IPO that no one seems to be talking about is Health Catalyst, which is also doing quite well with a $1.6 billion valuation although they are not growing as fast as Livongo is. Next, Oscar Health decided to enter into Medicare Advantage, which is not surprising because that’s where the real money is in the insurance side. Finally, Fitbits and other wearables may not be tracking heart rates accurately in people of color, so what does this mean for the wearables industry—and their potential use for medical purposes? —Matthew Holt
Health Reform Job One: Stop the Gouging! | Part 3
By BOB HERTZ
We Need Legal Assaults On The Greediest Providers!
When a patient is hospitalized, or diagnosed with a deadly disease, they often have no choice about the cost of their treatment.
They are legally helpless, and vulnerable to price gouging.
We need more legal protection of patients. In some cases we need price controls.
In the final part of this series, I discuss how we need to empower patients by allowing them to challenge their medical bills in courts.
Assault Phase Four – Binding Arbitration of Medical Bills
We must allow patients to challenge their medical bills in expanded ‘Health courts.’
Patients should be able to contest any bill over $250, especially if they have not given ‘informed financial consent’ to the provider.
Such ‘consent’ would require that if a procedure can be scheduled in advance, it can also be quoted in advance. If the patient requests an estimate, they must be notified in writing at least seven days in advance. This would allow the patient to request a different provider, or to investigate other alternatives. If an estimate is requested but never produced, the patient has no liability. (That will shake up the providers rather quickly.)
Continue reading…Health Reform Job One: Stop the Gouging! | Part 2
By BOB HERTZ
We Need Legal Assaults On The Greediest Providers!
When a patient is hospitalized, or diagnosed with a deadly disease, they often have no choice about the cost of their treatment.
They are legally helpless, and vulnerable to price gouging.
We need more legal protection of patients. In some cases we need price controls.
Next in this three-part series, I discuss how we could challenge Big Pharma by lessening regulation of generic drugs, having the government take over production and establishing price review boards.
Assault Phase Three – Challenge Big Pharma
Step One – Less Regulation of Generic Drugs
If an off-patent drug has been approved by other first-world nations, this would constitute automatic approval by the FDA.
The price gouging around Epipen would have ended quickly, if new versions of genetic drugs did not require an FDA approval process. We should let reputable drug companies produce whatever generic drugs they want.
Continue reading…Health Reform Job One: Stop the Gouging! | Part 1
By BOB HERTZ
We Need Legal Assaults On The Greediest Providers!
When a patient is hospitalized, or diagnosed with a deadly disease, they often have no choice about the cost of their treatment.
They are legally helpless, and vulnerable to price gouging.
Medicare offers decent protection — i.e. limits on balance billing, and no patient liability if a claim is denied.
But under age 65, it is a Wild West — especially for emergency care, and drugs and devices. The more they charge, the more they make. Even good health insurance does not offer complete financial insulation.
We need more legal protection of patients. In some cases we need price controls.
‘Charging what the market will bear’ is inadequate, even childish, when ‘the market’ consists of desperate patients. Where contracts are impossible and there is no chance for informed financial consent, government can and should step in.
This series describes the new laws that we need. Very little is required in tax dollars….but we do require a strong will to protect.
Pending Federal Privacy Legislation: A Status Update
By DEVEN McGRAW and VINCE KURAITIS
This post is part of the series “The Health Data Goldilocks Dilemma: Privacy? Sharing? Both?”
In our initial blog post of February 20th, “For Your Radar – Huge Implications for Healthcare in Pending Privacy Legislation,” we broadly discussed six key issues for healthcare stakeholders in the potential federal privacy and data protection legislation. We committed to future posts comparing and contrasting specific legislative proposals.
What’s happened since then?
Additional bills have been introduced and hearings have been held in both the House and the Senate. The Federal Trade Commission (FTC) also hosted two days of hearings on the FTC’s Approach to Consumer Privacy.
The buzz around federal privacy legislation continues, but as of yet there appear to be no proposals or bills that have emerged as the lead bills.
In the meantime, the clock is ticking. As we mentioned in our February 20th post, a significant catalyst for federal privacy legislation is the desire of companies covered by the California Consumer Privacy Act (CCPA) to have that broadly-applicable, stringent state law preempted by a more company-friendly federal law. The CCPA, which sets stringent consent and other requirements for large companies, or companies collecting or monetizing large amounts of consumer data from California residents, goes into effect January 1, 2020 – less than six months from today.
Is it possible for a legislative body to move quickly on such a controversial topic? Again, California’s experience may be instructive. The CCPA was passed into law and signed on June 28, 2018, about a week after it was introduced. Lawmakers were in a rush in order to keep a popular and even stricter consumer privacy ballot initiative from being put before the California voters. (The sponsors of the ballot initiative agreed to withdraw it if the CCPA were enacted by the June 28th deadline.).
Tech companies held their noses and supported the legislation because changing legislation is easier than changing a ballot initiative adopted by the voters. However, this strategy is not fool-proof. Although the CCPA has been successfully modified once to address some company concerns and to clarify confusing language, more recent attempts to amend it have failed (modification bills are still pending). With the deadline fast approaching, and the prospect for further significant modifications to the CCPA looking less likely, the pressure on Congress is reaching a fever pitch.
Continue reading…Announcing a New Series: “The Health Data Goldilocks Dilemma: Sharing? Privacy? Both?
By ZOYA KHAN
I would like to introduce you to a new ongoing series that THCB will be featuring called “The Health Data Goldilocks Dilemma: Sharing? Privacy? Both?”. It is about time we started talking about health data privacy and policy, and we have just the experts on hand to do so: Vince Kuraitis and Deven McGraw.
“The Health Data Goldilocks Dilemma: Sharing? Privacy? Both?” series will cover a whole host of topics that discuss, clarify, and challenge the notion of sharing data and if it should be kept private or made public. On the one hand, sharing health information is essential for clinical care, powering medical discovery, and enabling health system transformation. On the other hand, the public is expressing greater concerns over the privacy of personal health data. This ‘Goldilocks Dilemma’ has pushed US policymakers towards two seemingly conflicting goals: 1) broader data interoperability and data sharing, and 2) enhanced data privacy and data protection.
But this issue is even more nuanced and is influenced by many moving parts including: Federal & State privacy legislation, health technology legislation, policy & interoperability rules, data usage from AI & machine learning tools, data from clinical research, ethical concerns, compensating individuals for their data, health data business models, & many more.
Fear not, Deven & Vince are here to walk readers through this dilemma and will be providing pieces to help explain what is going on. Most of their discussion & pieces will cover 2 specific affected areas: 1) How are policymakers addressing health data privacy risks, and 2) The impact on business models within the Health Data Goldilocks Dilemma.
We hope you enjoy the series and if you have any pieces to add to it, please email me zo**@***************og.com
Zoya Khan is the Editor-in-Chief of THCB & an Associate at SMACK.health
Zeev Neuwirth Reframes Primary Care…Brilliantly
By AL LEWIS
I would urge THCB-ers to read Reframing Healthcare by Dr. Zeev Neuwirth. While much of the territory he covers will be familiar to those of us with an interest in healthcare reform (meaning just about everyone reading this blog), Chapter 5 breaks new ground in the field of primary care.
Primary care is perhaps the sorest spot in healthcare, the sorest of industries. Primary care providers (PCPs) are underpaid, dissatisfied, and in short supply. (The supply issue could be solved in part if employers didn’t pay employees bonuses to get useless annual checkups or fine them if they don’t, of course.)
They are also expected to stay up to date on a myriad of topics, but lack the time in which to do that and typically don’t get compensated for it. Plus, there are a million other “asks” that have nothing to do with seeing actual patients.
For instance, I’ve gone back and forth three times with my PCP as she tries to get Optum to cover 60 5-milligram zolpidems (Ambien) instead of 30 10-milligram pills. (I already cut the 5 mg. pills in half. Not fair or good medicine to ask patients to try to slice those tiny 10 mg pills into quarters. And not sure why Optum would incentivize patients to take more of this habit-forming medicine instead of less.)
This can’t be fun for her. No wonder PCPs burn out and leave the practice faster than other specialties. What some of my physician colleagues call the “joy of practice” is simply not there.
Will Amazon Deliver a Single-Payer Health Care System for the U.S.?
By JOE GRACE
Amazon has quietly put together a syndicate including Berkshire Hathaway and JP Morgan to provide better and more affordable health care for their combined 1.2 million workers.
The joint effort, called Haven, makes sense because many companies of size today are self-insured to provide health care at lower costs. But this is different. Jeff Bezos, Jamie Dimon and Warren Buffett seem to be personally involved in the development of Haven. So, what could they possibility have up their sleeves?
At the same time, many Democrats running for president are promising single payer health care (Medicare For All) as the solution to controlling costs and providing quality health care for everyone. Republicans argue that this is socialism and will result in unacceptable increases in taxes that will ruin our economy.
While politicians debate, Amazon’s real objective may be to create a health care payer to rival all payers with tens of millions of Amazon Prime Members as health plan members.
With Amazon’s buying power, scale and capabilities, the ecommerce giant could create a health payer offering that could render the need for a single payer system moot.
Health in 2 Point 00 | Episode 88, IPO Mania!
On Episode 88 of Health in 2 Point 00, Jess and I talk about all of the IPOs occurring in health tech today. First up is Livongo, with their IPO valuation set at $2 Billion, they have the highest valuation but I wonder if they will be able to grow at the same rate and expand to other sectors to serve their patient populations. Health Catalyst is up next, with their IPO valuation set at $800 Million, it will be interesting to see if they are going to continue down their enterprise play or switch over to SaaS, and last is Phreesia (that has been around longer than the other two) with its IPO valuation set at $500 Million that acts as a front door to the EMR management system- Matthew Holt
Announcing the Robert Wood Johnson Foundation SDoH & Home and Community Based Care Innovation Challenges Semi-Finalists!
SPONSORED POST
By CATALYST @ HEALTH 2.0
Health disparities domestically and globally can often be attributed to social determinants of health (SDoH). According to Healthy People 2020, SDoH are conditions and resources in the environments in which “people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” Examples of these include: resources to meet daily needs (e.g. access to and quality of housing and food markets), educational opportunities, employment opportunities, and transportation. Despite well-established literature on the importance of SDoH, these factors are often overlooked and excluded in health care frameworks.
Concurrently, health services provided in traditional settings such as hospitals and clinics can be expensive and inaccessible. There are a large number of communities, from rural areas to major cities, that are in need of high-quality care. Innovative technologies can mitigate these challenges. Home and community-based care models coupled with digital tools provide the opportunity to serve patients where they feel most comfortable in a cost-effective manner.
In an effort to spur creativity in the SDoH tech environment and improve the landscape of home based care, the Robert Wood Johnson Foundation and Catalyst partnered to launch two Innovation Challenges on Social Determinants of Health and Home and Community Based Care.
For the SDoH Challenge, innovators were asked to develop novel digital solutions that can help providers and/or patients connect to health services related to SDoH. Over 110 applications were submitted to the SDoH Challenge. For the Home and Community Based Care Challenge, applicants were asked to create technologies that support the advancement of at-home or community-based health care. Nearly 100 applications for Home and Community Based Care Challenge were received.
