Today on Health in 2 Point 00, Jess and I are getting in the spirit of things with this week’s Democratic debate. In Episode 87, Jess asks me about Omada Health’s $73 million raise, bringing its total to $200 million, and about what happened with nursing home telehealth startup Call9 shutting down. We turn to politics with Trump telling HHS to have hospitals publish their price list—and it’s unclear that this is even going to make a difference—and to health care coverage in the Democratic debate. —Matthew Holt
DANGER! COURSE CORRECTION ALERT!
By JOE FLOWER
A hot take on healthcare in the Democratic debate: They’re doing it wrong.
Healthcare is not a reason to choose between the Democratic candidates.
They are all for greater access and in some way to cover everyone, which is great.
None of their plans will become law, but if they are elected those plans will become the starting point of a long discussion and legislative fight. The difference in their plans (between, say, Buttigieg or Biden and Warren or Sanders) is more of an indication of their general attitude toward governance rather than an outline of where we will end up.
Democrats are focused on coverage, Trump is on cost.
Around 90% of Americans already have coverage of some sort. Polls show that healthcare is voters’ #1 priority. Read the polls more closely, and you’ll see that it’s healthcare cost specifically that they are worried about.
Democrats seem to assume that extending more government control will result in lower costs. This is highly debatable, the devil’s in the details, and our past history on this is good but not great.
The President, on the other hand, can make flashy pronouncements and issue Executive Orders that seem intended to bring down costs and might actually. It’s highly questionable whether they will be effective, or effective any time soon. Still, they make good headlines and they especially make for good applause lines at a rally and good talking points on Fox.
But, Ms. and Mr. Average Voter will hear that Trump is very concerned about bringing down their actual costs. The Democratic plans all sound to the untutored ear (which is pretty much everyone but policy wonks like you and me) like they will actually increase costs while taking away the insurance that 90% already have in one way or another.
It is important to take care of everyone. But it is a mistake for the Democrats to allow this to become a battle of perception between cost and coverage. Voters’ real #1 concern is about cost, not coverage.
Joe Flower has 40 years of experience in the healthcare world and has emerged as a thought leader on the deep forces changing the system in the United States and around the world.
Can we move on?
By CHADI NABHAN MD, MBA, FACP
Every so often, my cynical self emerges from the dead. Maybe it’s a byproduct of social media, or from following Saurabh Jha, who pontificates about everything from Indian elections to the Brexit fiasco. Regardless, there are times when my attempts at refraining from being opinionated are successful, but there are rare occasions when they are not. Have I earned the right to opine freely about moving on from financial toxicity, anti-vaxers, who has ‘skin in the game’ when it comes to the health care system, the patient & their data, and if we should call patients “consumers”? You’ll have to decide.
I endorse academic publications; they can be stimulating and may delve into more research and are essential if you crave academic recognition. I also enjoy listening to live debates and podcasts, as well as reading, social media rants, but some of the debates and publications are annoying me. I have tried to address some of them in my own podcast series “Outspoken Oncology” as a remedy, but my remedy was no cure. Instead, I find myself typing away these words as a last therapeutic intervention.
Here are my random thoughts on the topics that have been rehashed & restated all over social media outlets (think: Twitter feeds, LinkedIn posts, Pubmed articles, the list goes on), that you will simply find no way out. Disclaimer, these are NOT organized by level of importance but simply based on what struck me over the past week as grossly overstated issues in health care. Forgive my blunt honesty.
The rAIdiologist will see you now
By RIZWAN MALIK, MBBS
The year is 2019 and Imaging By Machines have fulfilled their prophesy and control all Radiology Departments, making their organic predecessors obsolete.
One such lost soul tries to decide how he might reprovision the diagnostic equipment he has set up on his narrow boat on the Manchester Ship Canal, musing at the extent of the digital take over during his supper (cod of course).
What I seek to do in this short paper is not to revisit the well-trodden road of what Artificial Intelligence, deep learning, machine learning or natural language processing might be, the data-science that underpins them nor limit myself to what specific products or algorithms are currently available or pending. Instead I look to share my views on what and where in the patient journey I perceive there may be uses for “AI” in the pathway.
Health in 2 Point 00, Episode 86 | Lightning Round!
Today on Health in 2 Point 00, Jess and I are back from Europe and there is a LOT going on in health tech right now. In Episode 86, Jess asks me about United Health’s big moves, between acquiring PatientsLikeMe and their acquisition of DaVita Medical going through; integrated mental health company Quartet Health raising $60 million; Xealth closing a $14 million round (maybe now they’ll make Epic relevant); Collective Health’s $205 million raise led by SoftBank,; Vida’s $30 million round led by Teladoc (who knows why Teladoc didn’t just acquire Vida); European telehealth company Zava raising $32 million; and finally, Phreesia going IPO (wasn’t Livongo the one to watch?). —Matthew Holt
A Rose by Another Name
By SAURABH JHA, MD
Can we reduce over diagnosis by re-naming disease to less anxiety-provoking makes? For example, if we call a 4.1 cm ascending aorta “ecstasia” instead of “aneurysm” will there be less over-treatment? In this episode of Radiology Firing Line Podcast, Saurabh Jha (aka @RogueRad) discusses over diagnosis with Ian Amber, a musculoskeletal radiologist at Georgetown University, Washington.
Remembering the Real Stakeholders: Patient Privacy Rights Comments to TEFCA Draft 2
By ADRIAN GROPPER, MD and DEBORAH C. PEEL, MD
TEFCA will succeed where previous national health information exchange efforts have failed only if it puts patients’ and families’, and/or their fiduciary agents, in control of health technology. This is the only path to restore trust in physicians, and to ensure accurate and complete data for treatment and research.
As physicians and patient advocates, we seek a longitudinal health record, patient-centered in the sense of being independent of any particular institution. An independent health record is also essential to enhancing competition and innovation for health services. TEFCA Draft 2 is the latest in a decade of starts down the path to an independent longitudinal health record, but it still fails to deal with the problems of consent, patient matching, and regulatory capture essential for a national-scale network. Our comments on regulatory capture will be filed separately.
We strongly support the importance in Draft 2 of Open APIs, Push, and a relationship locator service. We also strongly support expanding the scope to a wider range of data sources, beyond just HIPAA covered entities in order to better serve the real-world needs of patients and families.
However, Draft 2 still includes design practices such as the lack of patient transparency, lack of informed consent, and a core design based on involuntary surveillance. This institution-centered design barely works at a community level and leaves out many key real-world participants. It is wishful thinking to believe that it will work with expanded participant scope and on a national scale.
Today’s Doctors: Colleagues or Free Agents?
By HANS DUVEFELT, MD
My first job after residency was in a small mill town in central Maine. I joined two fifty something family doctors, one of whom was the son of the former town doctor. I felt like I was Dr. Kiley on “Marcus Welby, MD.” I didn’t have a motorcycle, but I did have a snazzy SAAB 900.
Will was a John Deere man, wore a flannel shirt and listened to A Prairie Home Companion. He was kind and methodical. Joe didn’t seem quite as rural, moved quicker and wore more formal clothes. I never could read his handwriting.
They each had their own patients, but covered seamlessly for each other. They were like a pair of spouses in the sense that they answered to each other as much as to their patients. They had to make everything work for the benefit of their shared practice, their shared livelihood. Their mutual loyalty was essential and obvious, although allowing for their differences in temperament and personalities.
Invited to stay on and enter into a partnership, I hesitated. How did I fit in? Could I follow in their footsteps and become an equal partner, covering for them and doing things similarly enough to fit in for the long haul?
Health in 2 Point 00, Episode 85 | Health 2.0 HIMSS Europe Final Thoughts
On Episode 85 of Health in 2 Point 00, it’s our last night in Helsinki. In this episode, Jess asks me about GE selling off Ventures, Neurotrack raising $21 million to detect and track dementia, and Allscripts acquiring ZappRx, a prescribing tool. Also, find out my favorite things from Health 2.0 HIMSS Europe, including a cool pill tracker, Popit, and a great panel on femtech (even though there were not enough men in the room). —Matthew Holt
Is Good, Human-Centered Design in Healthcare Possible? | frog Healthcare Lead Stefania Marcoli
By JESSICA DAMASSA, WTF HEALTH
Frog, the renowned design and strategy firm, has been involved in healthcare for a long time. So, how are they infusing human centered design into the healthcare process? What is frog’s perspective on how healthcare companies can integrate design thinking into their solutions? And most importantly, what does good design in healthcare look like?
Filmed at the Frontiers Health Conference in Berlin, Germany, November 2018.
Jessica DaMassa is the host of the WTF Health show & stars in Health in 2 Point 00 with Matthew Holt. Get a glimpse of the future of healthcare by meeting the people who are going to change it. Find more WTF Health interviews here or check out www.wtf.health.
