Category: Uncategorized

The Simpson’s Explain Healthcare

Jan 4, 2022

By KIM BELLARD

Happy New Year! We’re starting 2022 full of hope and renewed optimism. Oh, wait; not so much. We’re not only still in a pandemic, the Omicron variant is the most infectious one yet. Daily cases are setting new records. Our hospitals are full again. Our beleaguered healthcare workers – the ones who haven’t already thrown in the towel – are at their breaking points. Two years in, and we still don’t have enough tests. We’re in the greatest public health crisis in a century, yet our legislators are taking power away from public health officials, and their angry constituents are forcing many of those officials to quit. We have effective vaccines, but millions still refuse to take them.

The Simpsons – especially, Homer — has the right word for this: D’oh!

Fall Risk: It’s All in Your Head

Jan 3, 2022

By HENRY MAHNCKE

More than one in four senior citizens fall each year, making it the leading cause of both fatal and non-fatal injuries in older adults. Anyone with a loved one at high risk of falls can tell you it creates constant worry and curtails many of life’s pleasures. And, if that loved one has fallen and broken a hip, too many of those caregivers can share the oft-told tale of how that break was the beginning of the end.

As our population grows and ages, the costs of this widespread risk multiply. However, recent breakthroughs in the science of brain health demonstrate that we could be taking relatively low-cost, highly scalable, steps to reduce these risks.

Rooting For Schumpter’s Gale

Dec 28, 2021

By KIM BELLARD

Not familiar with Schumpeter’s gale? You may be more familiar with the term “creative destruction.” Schumpeter’s “gale of creative destruction” is the inevitable “process of industrial mutation that continuously revolutionizes the economic structure from within, incessantly destroying the old one, incessantly creating a new one.”

We need a Schumpeter’s gale in healthcare.

Not Just Token Tokens

Dec 21, 2021

By KIM BELLARD

I recently watched some of the recent Congressional hearings on cryptocurrency, and, boy, if there’s anything funnier than watching experts try to educate most members of Congress on anything crypto-related, it’s probably me trying to explain it. I don’t own any digital assets, still don’t see the point of NFTs, and am not going to buy any real estate in the metaverse.

All that being said, there’s something about Web3 that fascinates me. Knowledgeable people are talking about Web3 “reinventing the internet,” “democratizing” it, giving people more ownership of/control over what they do on it. It’s a counterbalance to how the internet – both the traffic and the infrastructure — has grown increasingly dominated by a few very large firms, such as Google, Facebook, or Amazon.

As the Web3 Foundation declares, Web3 is an internet where:

Users own their own data, not corporations
Global digital transactions are secure
Online exchanges of information and value are decentralized

All that sounds very intriguing to me, especially as someone who has dim views of how healthcare likes to silo information, has placed too little value on patient ownership of their own data, and is rushing to centralize.

Matthew’s health care tidbits: #DigitalHealth valuations

Dec 20, 2021

Each week I’ve been adding a brief tidbits section to the THCB Reader, our weekly newsletter that summarizes the best of THCB that week (Sign up here!). Then I had the brainwave to add them to the blog. They’re short and usually not too sweet! –Matthew Holt

For my health care tidbits this week, it’s time to bring up the disconnect between the continual collapse of #DigitalHealth stock prices and the continued increase in private sector investment and valuation in the same sector.

All of nine months ago, way way back in March 2021 market leader Teladoc hit a stock price of $308. Last week it hit a low of just under $90. Meanwhile several companies have IPOed or SPACed this year and almost all of them have seen their stock fall dramatically. For example, pioneer online mental health company Talkspace is now at a market cap of under $300m. This week a different mental health company Cerebral which was only founded in January 2020 raised $300m at a private valuation of over $4 billion. Yes they could have bought out Talkspace for that amount! In October Medicare Advantage plan Devoted Health raised money at a $12 billion valuation which exceeded the market cap of rivals Clover, Bright Health and Oscar–each of which has more members.

So what’s going on? Part of this is the wash of money still going into venture funds. Interest rates are historically low, while inflation is picking up, so that money has to go somewhere. Additionally some of the companies that SPACed out were probably unable to get such a good valuation in a private round. But it can’t be that all the 50 or so public companies are lower quality than the private ones. That indicates that either the private valuations aren’t real (because there are so many protections built into the deal for investors), or that the private and public valuations are going to get closer together. There is of course one more possibility–some of the private companies may pursue M&A and buy out some of the public ones. But in any event, this current arbitrage cannot last forever.

It’s not unlikely the public stocks may pick up. But we’ve seen private and public market bubbles before and the aftermath isn’t usually pretty.

“Playing Doctor” – A Cautionary Tale From Health IT Pioneers.

Dec 17, 2021

By MIKE MAGEE

Warner Vincent Slack, MD, a pioneer of medical informatics, was a Professor of Medicine at Harvard Medical School in the Division of Clinical Informatics. When he died in 2018 at age 85, his memoriam read:

“For over 50 years, Dr. Slack conducted pioneering research on the use of computers in the medical world and was one of the founders of medical informatics. His goal was to empower both doctors and patients by improving the communication between them.”

Followers of Dr. Slack have labored hard over the past half-century to design solutions that will strengthen rather than weaken the bonds of the patient-physician relationship. But as he suggested at multiple points throughout his career, this goal becomes exponentially more difficult if politicians are allowed to “play doctor” with citizens’ lives.

His awareness of the fallout of the Terri Schiavo “right to die” case, beginning a dozen years after his seminal publication of “Patient Power: A Patient Oriented Value System”, likely cast a long shadow on his optimistic vision. The case spanned 15 years, as it rode the poor health and disability of one unfortunate woman literally into her grave with devastating consequences for all concerned.

As the Supreme Court readies itself to serve up opinions in the Texas vigilante and Mississippi abortion cases, the Schiavo case remains a cautionary tale that deserves a careful review. Here’s a quick summary:

Theresa Marie Schindler was born in a Philadelphia suburb on December 3, 1963.
Terri married her husband, Michael in 1984 and moved to Florida to be close to her parents.
On February 25, 1990, suffering from an eating disorder, she collapsed in the lobby of their apartment, was resuscitated, and hospitalized.
Her husband, Michael, was made legal guardian on June 18, 1990. Two physicians independently declared her in a “permanent vegetative state.” A gastric feeding tube was inserted.
In mid-1993, Michael signed a Do Not Resuscitate (DNR) order.
In May 1998, he filed a petition to remove the feeding tube.
The parents challenged the removal in court and lost. The tube was finally removed on April 24, 2001.
The parents charged Michael Schiavo with perjury, and a judge ordered the tube reinserted 2 days later.
On September 17, 2003, the appellate judge ordered the feeding tube removed for a second time.
Operation Rescue/Right to Life extremist Randall Terry began daily public demonstrations at the care facility.
The Florida legislature passed “Terri’s Law”, allowing Gov. Jeb Bush to order the feeding tube surgically reinserted for the third time.
On May 5, 2004, “Terri’s Law” was declared unconstitutional.
Senator Mel Martinez’s (R-FL) political career was damaged irreparably when memo’s revealed he played politics with the issue.
Senator Bill Frist’s hopes for the presidency went up in smoke on March 17, 2005, when he declared on the Senate floor, “I question it (vegetative state) based on a review of the video footage which I spent an hour or so looking at last night in my office.”
President Bush transferred the case to Federal Courts. The Federal Court agreed with prior State Court Appeals.
Terri Schiavo’s feeding tube was removed a final time on March 24, 2005. She died at a Pinellas Park hospice on March 31, 2005.

Health in 2 Point00, Episode 245| Bright Health, Innovaccer, Cadence, Ophelia, and Apti Health

Dec 16, 2021

Today in Health in 2 Point 00, Jess and I talk about the plethora of notable deals in the Healthcare Space. Bright Health gets $750 million with notable investment from Cigna; Innovaccer gets $150 million, bringing their total up to $375 million; Cadence gets $100 million, bringing their total up to $141 million; Ophelia raises $50 million, bringing their total up to $64 million; and Apti Health raises $50 million, bringing their total up to $65 million.

-Matthew Holt

The Eisenhower Principle

Dec 14, 2021

By KIM BELLARD

I’ve finally come to understand why the U.S. healthcare system continues to be such a mess, and I have President Dwight Eisenhower to thank.

I’ve been paying close attention to our healthcare system for, I hate to admit, over forty years now. It has been a source of constant frustration and amazement that – year after year, crisis after crisis – our healthcare system doesn’t get “fixed.” Yes, we make some improvements, like ACA, but mostly it continues to muddle along.

Then I learned about President Eisenhower’s approach to problems:

That’s it! All these smart people, all these years; they didn’t know how to solve the problem that is our healthcare system, so they all took the Eisenhower approach: enlarge the problem. Let our healthcare system get so bad that not addressing it no longer is possible.

If, indeed, there is such a point.

The actual Eisenhower quote is more nuanced than the above version. It was:

Whenever I run into a problem I can’t solve, I always make it bigger. I can never solve it by trying to make it smaller, but if I make it big enough, I can begin to see the outlines of a solution.

I guess we’re not yet at the point when the outlines of a solution are clear (Bernie Sanders notwithstanding).

Instead, we’ve been chipping away at the problem, trying to make it smaller. For example:

Employer-sponsored health insurance tax preference (WWII)
Hill-Burton Act (1946)
Medicare/Medicaid (1965)
Federal HMO Act (1973)
Stark Physician Self-Referral Law (1989)
DGRs (1983) & RBRVS (1992)
CHIP (1997)
Medicare Modernization Act (2003)
Affordable Care Act (2010)

The need for H.O.P.E: victims of human trafficking need better care from health professionals

Dec 10, 2021

BY SARAH BETH

I remember the first time I told a doctor that I was being trafficked. That experience was also the last time I told a healthcare professional. My psychiatrist in an acute inpatient psychiatric hospital heard my story and told me that trafficking only happens in third-world countries and in movies. While this professional was the most ill-informed I ever encountered, they were not the only healthcare workers that did not have the training they needed to identify me.

I remember tucking my hospital gown between my legs to hide the bruising on my thighs. I remember explaining away cuts and burns. I remember being encouraged by doctors and nurses to report sexual assaults. I remember a psychiatrist telling me I would never get better, so I should stop seeking help. I remember the look in a nurse’s eyes when she knew something was off but did not know how to intervene.

It was that nurse, the one whose instinct told her that something was wrong, that gave me hope. She saw me. When you’ve been through what I’ve been through, you never forget the first person to really see you. She gave me hope that someone could help me, that someone saw me as a person. She gave me hope that someday my life would be different.

For 20 years I was trafficked for sex by a member of my family, and for 20 years I was discharged into the hands of my trafficker, a seemingly good man who was charismatic and kind to everyone in the office. All the while, I remembered the nurse who saw me, and I held onto hope that there were others like her.

I have heard story after story that mirrors my own: men, women, and children being trafficked, desperately hoping a healthcare worker would spot the signs but being placed back into the hands of their traffickers. The statistics back our experiences.

Health in 2 Point 00, Episode 244 | Transcarent, Suki, Robin, Cerebral, Nomi, and Apti Health

Dec 9, 2021

How much longer do we have to wait for Glen Tullman to be on the NASDAQ with Transcarent? In this episode of Health in 2 Point 00, Jess and I discuss several new deals in the healthcare space. Suki raises $55 million, bringing their total up to 95 million; Robin raises $50 million , bringing their total up to $65 million; Cerebral raises $300 million, bringing their total up to $420 million; Nomi raises $110 million ; and Apti Health raises $50 million, bringing their total up to $65 million.

–Matthew Holt