Category: Uncategorized

Connected Health Predictive Analytics: A Long Road Ahead

Dec 1, 2018

By Joseph Kvedar, MD

We’re spending a lot of time at the Center for Connected Health (CCH) these days thinking about and experimenting with algorithms. It’s part of our general interest in micro-segmenting the population and creating unique, engaging health messaging for each individual that will keep them on the path to better health. Healthrageous is working fast and furious on this as well. Of course, we’re not the only ones. A number of other labs and firms are on the same journey. The vision is compelling.

However, today when you get health related messages from your insurer or another source, they are typically public health focused. Stop smoking! Get your mammogram! Get your flu shot! These three messages illustrate the challenge. I’ve been the recipient of all of them recently. I’ve never smoked, clearly do not need a mammogram and was vaccinated for influenza in early October.

I always thought our friends on the consumer web side were doing better. The first time you experience Amazon’s or Netflix’s recommendation engines, they tend to raise eyebrows. Over time, the experience is less salient. And let’s face it, it’s got to be easier to guess which type of movie I might want to watch or a book that might interest me than to predict what a really engaging health-related message might be.

At CCH we’re in the middle of an interesting trial funded by the McKesson Foundation, where we collect three types of data (a measure of readiness to change, ongoing activity data and location data) and use an algorithm to generate motivational messages based on these variables. It’s ongoing now, so I don’t know how it will turn out, but we’re excited about the possibilities. Still, it’s only three variables and only one (activity level) is continuous. My instinct is that we have a long journey ahead of us.

The Return of Conservative Medicine

Dec 1, 2018

By Kenny Lin, MD

Forty years ago, Dr. Jack Wennberg and colleagues at Dartmouth Medical School published the first of a series of groundbreaking studies of medical resource utilization and practice variations that would eventually become the Dartmouth Atlas of Health Care.

They found huge variations in how often elective surgeries such as tonsillectomies were performed in different parts of New Hampshire, even in neighboring cities and counties.

These geographical variations could not be explained by differences in the demographics or health of patient populations, and outcomes in areas with more surgeries per capita were no better, and sometimes worse, than in those with fewer surgeries. Subsequent studies identified similar unwarranted variations in many other procedures and treatments paid for by Medicare, leading to a consensus among policymakers that the U.S. health system spends hundreds of billions of dollars each year on medical care (termed “waste”) that has no health benefits and often harms patients.

To my profession’s credit, physician organizations are finally taking unprecedented steps to confront the problem of waste in medicine. The American Board of Internal Medicine Foundation’s Choosing Wisely campaign, which asks each partnering group to identify 5 commonly performed tests or treatments that should be questioned by physicians and patients, has signed up more than 50 specialty organizations to date, with more to come in the next several months.

This week, screening and diagnostic experts from all over the world gathered at Dartmouth to discuss strategies for Preventing Overdiagnosis, a problem that is largely created by physicians looking too hard for diseases with imperfect tests that lead to many false positive results and more invasive procedures, such as biopsies. (Even if the tests themselves were perfect, they are often performed in patients who could not possibly benefit from the results, such as patients with terminal cancer.)

But if the problems of medical waste and overdiagnosis are familiar to doctors, most patients are still in the dark about the basics. Continue reading…

You : The App

Dec 1, 2018

By KIM KRUEGER & MATTHEW HOLT

Kim Krueger is a Research Analyst at Health 2.0 where Matthew Holt is Co-Founder and Co-Chairman.

For evidence of the global Health 2.0 movement, look no further than Health 2.0’s favorite Finnish startup, currently working mostly out of London with plans for expansion into the US. Meet Nelli Lähteenmäki, the Co-Founder and CEO of Fifth Corner (formerly Health Puzzle), makers of the YOU app.

Like many others, Lähteenmäki and her team are working on the tough nut of behavior change in the form of an app that nudges users towards better health with small, incremental steps. The idea is to bridge intention and action, says Lähteenmäki. The Health 2.0 team had a chance to pilot the YOU app in a six-week challenge this past fall, and rather enjoyed tallying healthful tasks like taking the stairs or eating greens for a chance to beat out colleagues. Of course, the Health 2.0 challenge had an equally big stick to go with the carrot of winning, but that’s neither here nor there.

Since then, Fifth Corner has made some big changes, including shifting from an employer-facing business model to a direct to consumer model. It’s a bold pivot at a time when no one has really succeeded with the direct to consumer model in digital health, but Fifth Corner has some strong votes of confidence with new seed funding from London-based venture firm Wellington Partners, and the addition of celebrity chef and healthy food guru Jamie Oliver to the team.

Have a look below to hear more from Lähteenmäki on Fifth Corner’s partnership with Jamie Oliver, how the team will leverage Oliver beyond marketing, and future plans for growth. You can also get a closer look at the stripped down, direct to consumer YOU app here.

Kim Krueger is a Research Analyst at Health 2.0 where Matthew Holt is Co-Founder and Co-Chairman.

WSJ to Biotech: “You’re All Going To Die.” Thanks – Now Let’s Keep Fighting.

Dec 1, 2018

By David Shaywitz, MD

Friday’s WSJ features a brutally – I mean brutally — frank article about the dismal state of biotech financing. There are few revelations (certainly not for those readers of this column who I know follow the space closely), and unfortunately, few patches of sunlight. This clip from Play It Again, Sam pretty much captures the tone.

The crisis in financing is having a chilling effect on biomedical innovation. As discussed in my last column, the main problem in our industry is that the sheer cost of drug development has become almost prohibitively expensive, effectively pricing almost everyone but the largest companies out of the market.

While my Forbes colleague Matt Herper suggests this could represent a disruptive opportunity for ultra-lean start-ups, I don’t think this is true in practice. For a start-up or small company, figuring out how to run trials in an extremely capital-efficient way isn’t a competitive advantage, it’s table stakes – it’s what gives you a shot on goal, or maybe two. Given the intrinsically high likelihood of failure, long-term survival requires the ability to advance a portfolio of products through clinical development, something that typically only fairly large companies can afford to do.

The broader challenge is how can you achieve disruptive innovation in a highly-regulated industry?

One approach is to avoid regulation – this is one of the reasons so many digital health companies are pursuing consumer health – they hope to avoid the regulatory morass that has so dampened progress in the medical products industry. As I’ve noted before, it will be interesting to see how this works out – I’ve see a lot of cutsie apps out there, but not much that seems likely to deliver measurable improvements in patient health (i.e. improvements that would be meet the sort of standards both demanded by drug regulators and expected by physicians).

Many Ways of Skinning a Statistical Cat

Nov 30, 2018

By SAURABH JHA MD

In this episode of Firing Line, Saurabh Jha (aka @RogueRad), has a conversation with Professor Brian Nosek, a metaresearcher and co-founder of Center for Open Science.

They discuss the implications of this study, which showed that there was a range of analytical methods when interrogating the database to answer a specific hypothesis: are soccer referees more likely to give red cards to dark skinned players? What is the significance of the variation? Does the variation in analysis explain the replication crisis?

Listen to our conversation at Radiology Firing Line Podcast.

Consumers are Dishing On Healthcare Experiences—Be Part of the Conversation

Nov 29, 2018• 1

By KARYN MULLINS

Consumers aren’t taking their healthcare providers’ words for it anymore. They’re taking charge and leading a digital revolution where individuals have the power to make their own educated decisions about care.

According to the Healthcare Consumer Insight & Digital Engagement report by Binary Fountain, a leading online reputation management platform, 51 percent of people who have a physician share their personal healthcare experiences via online ratings, review sites and social media.

Once shared, this information is immediately available to the entire world with just the click of a button. And people are taking full advantage of this. In fact, 80 percent of respondents in the 2018 Customer Experience Trends in Healthcare report by Doctor.com have used the internet to make a healthcare-related search in the past year. Another 81 percent said they read reviews about a referred provider.

Consumers’ accessibility to detailed, personalized experiences could make or break medical sales companies. Unfortunately, if these trends aren’t addressed appropriately, medical sales teams around the country will feel the impact.

By further empowering the general public, medical sales leaders can give their teams the tools needed to excel in the field. Here’s how:Continue reading…

EMRs, APIs, App stores & all that: More data

Nov 28, 2018• 5

By MATTHEW HOLT, with OLIVIA DUNN & KIM KRUEGER

Today I’m happy to release an update to some unique data about a pressing problem–the ability of small health tech vendors to access data from the major EMR vendors and integrate their applications into those EMRs. For those of you following along, in 2016 when Health 2.0 first ran this EMR API survey, we confirmed the notion that it’s hard for small health technology companies to integrate with the EMR vendors. Since then the two biggest vendors, Epic & Cerner, have been much more aggressive about supporting third party vendors, with both creating app stores/partnership programs and embracing FHIR & SMART on FHIR.

In 2018, we conducted a follow-up survey to see if these same issues persisted and how much progress has been made. In this report, we break down the results of the 2018 survey and compare them to the results of our 2016 survey. As in 2016, survey response rates weren’t great, but in this year’s survey we asked a lot more questions regarding app store programs, specific resources accessed, troubling contract terms and much more. And if you look at the accompanying slides, we also pulled some juicy quotes.

The key message: In 2016 we said this, The complaint is true: it’s hard for smaller health tech companies to integrate their solutions with big EMR vendors. Most EMR vendors don’t make it easy. But it’s a false picture to say that it’s all the EMR vendors’ fault, and it’s also true that there is great variety not only between the major EMR vendors but also in the experience of different smaller tech companies dealing with the same EMR vendor.

In 2018, things are better but not yet good. A combination of government prodding (partly from ONC implementing the 21^st Century Cures Act, partly in the continued growth of pay for value programs from CMS), fear of Apple/Google/Amazon, genuine internal sentiment changes at least at one vendor (Cerner), and maturity in dealing with smaller applications vendors from three others (Allscripts, Athenahealth, Epic), and the growth of third party integration vendors like Redox and Sansoro, is making it easier for application vendors to integrate with EMRs. But it’s not yet in any way simple. We are a long way from the all-singing, all-dancing, plug-in interoperability we hoped for back in the day. But the survey suggests that we are inching closer. Of course, “inching” may not be the pace some of us were hoping to move at.

All the data is in the embedded slide set below, with much more commentary below the fold.

Health 2.0 EMR API report 2018

It’s getting better but….EMR Vendors are still a bottleneck
Continue reading…

Saying No to the Drug Crisis

Nov 27, 2018• 15

By BRIAN KLEPPER

In a recent essay, VIVIO Health’s CEO Pramod John guides us through four sensible drug policy changes and supporting rationales that could make drug pricing much fairer. Reading through it, one is struck by the magnitude of the drug manufacturing industry’s influence over policy, profoundly benefiting that sector at the deep expense of American purchasers. As Mr. John points out, the U.S. has the world’s only unregulated market for drug pricing. We have created a safe harbor provision that allows and protects unnecessary intermediaries like pharmacy benefit managers. We have created mechanisms that use taxpayer dollars to fund drug discovery, but then funnel the financial benefit exclusively to commercial interests. And we have tolerated distorted definitions of value – defined in terms that most benefit the drug manufacturers – that now dominate our pricing discussions.

The power of this maneuvering is clear in statistics on health industry revenues and earnings. An Axios analysis of financial documents from 112 publicly traded health care companies during the 3rd quarter of 2018 showed global profits of $50 billion on revenues of $636 billion. Half of that profit was controlled by 10 companies, 9 of which were pharmaceutical firms. Drug companies collected 23% of the total revenues during that quarter, but retained an astounding 63% of the profits, meaning that the drug sector accounts for nearly two-thirds of the entire health care industry’s profitability. Said another way, the drug industry reaps twice the profits of the rest of the industry combined.

Health Care-Related Public-Private Partnerships Will Likely Become the Norm in 2019

Nov 26, 2018• 3

By MARY SCOTT NABERS

The United States ranks number one in the world for health care spending as a percentage of GDP. That sounds great… but, for instance, Texas ranks only 11th worldwide when it comes to performance. That’s because of access to care.

The country’s health care rankings are likely to get worse as 673 rural hospitals in the U.S. are at risk of closing. Here’s what has happened: the need for care greatly outpaces available funding, especially for public hospitals. Something must be done.

If public funding is no longer available, alternative funding can be secured in numerous ways. The simplest way to access alternative funding is through a public-private partnership (P3) engagement. However, alternative funding for public hospitals, health care clinics and university medical centers can be found from other sources as well. Finding funding is not a problem when private-sector investors, large equity funds, pension programs, asset recycling and EB5 programs all stand ready to invest in public-sector projects.

Moving to a P3 health care model would allow hospitals to secure immediate funding and utilize private-sector expertise and best practices while transferring all risks. The launch of health care P3s would also ensure new construction, new jobs and hundreds of additional health care options for people.
Continue reading…

Young People Need To Turn Out For Their Health

Nov 23, 2018• 7

By MERCEDES CARNETHON PhD

This month, we saw historic turnout at the polls for midterm elections with over 114 million ballots cast. One noteworthy observation regarding voter turnout is record rates of participation by younger voters aged between 18 to 29 years old. Around 31 percent of people aged 18 to 29 voted in the midterms this year, an increase from 21 percent in 2014, according to a day-after exit poll by Tufts University.

Surely their political engagement counters the criticism that millennials are disengaged and disconnected with society and demonstrates that millennials are fully engaged when issues are relevant to them, their friends, and their families. Why, then, do we not see the same level of passion, engagement and commitment when young adults are asked to consider their health and well-being?

I have had the privilege of being a member of the National Heart, Lung and Blood Institute-funded Coronary Artery Risk Development in Young Adults (CARDIA) study research team. In over 5,000 black and white adults who were initially enrolled when they were 18 to 30 years old and have now been followed for nearly 35 years, we have described the decades-long process by which heart disease develops. We were able to do this because, in the 1980s when these studies began, young adults could be reached at their home telephone numbers. When a university researcher called claiming to be funded by the government, there was a greater degree of trust.

Unfortunately, that openness and that trust has eroded, particularly in younger adults and those who may feel marginalized from our society for any number of valid reasons. However, the results—unanswered phone calls from researchers, no-shows at the research clinic and the absence of an entire group of adults today from research studies, looks like disengagement. Disengagement is a very real public health crisis with consequences that are as dire as any political crisis.
Continue reading…