As more people die every day from COVID-19 (we
were edging towards 20,000 casualties in the U.S. at the time this article was
written), the answers to what a cure could look like are waiting to be
discovered in EMRs and patients’ homes. We have the technology and business
models to turn this data into insights, but we are stalling… What seems to be the problem?
First this. It’s time to end the illusion that
patients do not pay for healthcare. Whether it is out of pocket, paycheck, or
taxes, U.S. citizens pay for 100% of the healthcare spend. It is indeed their healthcare. It follows logically
from this that patients should be allowed and empowered to lower the cost and
increase the quality of the care they receive. Receiving access to their own
medical records is one important way to accomplish this.
In 2017, when I asked the World Economic Forum
if there is a study on the cost of lack of interoperability in healthcare they
said – “That’s a good idea.”
On Episode 120 of Health in 2 Point 00, Jess asks me about health data sharing company Particle Health raising $12 million in an A round, AliveCor and OMRON partnering in a remote monitoring play for combined EKG and blood pressure monitoring, and Compass Pathways scoring $80 million in a B round for psilocybin therapy for treatment-resistant depression. Also, Optum is reportedly acquiring AbleTo for $470 million which provides behavioral telehealth — looks like they’re slowly putting all the pieces together to become a big virtual Kaiser. —Matthew Holt
It’s amazing that the word “medication” is not mentioned in a recent Morbidity and Mortality Weekly Report from the US Centers for Disease Control and Prevention (CDC). The research states that a staggering 90% of people hospitalized for COVID-19 have underlying conditions, including hypertension, diabetes mellitus and cardiovascular disease, all of which require drug treatments for patients to remain healthy.
Yet nowhere in the report is there mention of how
patients can potentially prevent COVID-19 related health decline through better
medication use for their underlying disease.
Are the COVID-19 hospitalization rates truly caused by the underlying
disease and insufficient use of preventive measures like social distancing? Or
are these underlying conditions unmanaged due to medication optimization issues
placing these patients at higher risk for hospitalizations?
Medication optimization is how the healthcare system
supports the patient from the initial prescription to follow up and ongoing
review. It aims to improve the safety, effectiveness, and affordable use of
prescribed drugs.
The invisible threat enabling the spread of COVID-19
that no one seems to be talking about is that barriers to medication use are
accelerating infections for these high-risk populations. Buried within the “People Who Need Extra Precautions”
section of its website, the CDC states people with high-risk for severe illness
from COVID-19 are “people of all ages with underlying medical conditions,
particularly if not well controlled”. Clearly, optimizing medications is one of
the most important aspects to controlling chronic illness. Optimization
supports patients through medication therapy that aims to improve safety,
effectiveness, and affordable use of prescribed drugs.
When it comes to money back guarantees in health care, it’s
often less about the money and more about the guarantee.
That’s the biggest takeaway shared by two organizations—Geisinger
Health System and Group Health Cooperative of South Central Wisconsin (GHCSCW)—that
separately rolled out closely-watched campaigns to refund patients their
out-of-pocket costs for health care experiences that fell short of expectations.
Both programs started as a way to inject a basic level of
consumerism into a process long bereft of one. In fact, as consumer frustration
over medical costs rise, a money back guarantee has the potential to win back a
dissatisfied public.
But like many experiments in health care, the effort
produced some unexpected results as well. Instead of a rush on refunds,
executives from both systems said their money-back pledge served even better as
a continuous-improvement tool, with patients providing almost instantaneous
feedback to staff who felt newly empowered to address problems.
As healthcare systems around the world grapple with the coronavirus, ‘virtual-first healthcare’ is fast becoming the global response of private and public healthcare systems alike. In Australia, the federal government recently committed to investing $500M to built out its country’s ‘virtual-first’ healthcare infrastructure, so we caught up with Louise Schaper, CEO of the Australasian Institute of Digital Health (AIDH), to find out what that means for telehealth, remote monitoring, and digital health companies looking to capitalize on the market opportunity in Australia.
With a population of 25 million people (roughly the number of people in Florida) and a set of newly-minted reimbursement codes that makes telehealth available to all of them via the government-funded public healthcare system, the appetite for investing in new health tech solutions has grown ravenous.
Says Louise, “Anyone who has solutions that are already market-tested and approved, I’d actually expand your networks globally now. There’s not a section of the globe that hasn’t been impacted by [covid19] and we’re all needing to work out how to deliver healthcare differently.”
As in other parts of the world, the government codes reimbursing telehealth and other virtual-first services are temporary (Australia’s are set to expire September 30, 2020), but organizations like the AIDH, the Australian Medical Association, and others are advocating for their permanence and are optimistic.
The prevailing sentiment is that, like in the US, the benefits of virtual care to healthcare consumers and clinicians are going to be difficult for the government to ignore. Add to that the potential of linking virtual care to the Aussie government’s AUD$2 billion dollar build of its MyHealthRecord system — a centralized, cloud-based EMR that holds the healthcare data of 90% of all Australians — and the prospect grows even more appealing.
Join us as we talk through the basics of the Australian healthcare system and get an insider’s look at the demand for digital health, remote monitoring, and telehealth Down Under.
There are so many
stories about the coronavirus pandemic — some inspiring, some tragic, and
all-too-many frustrating. In the world’s supposedly most advanced
economy, we’ve struggled to produce enough ventilators, tests, even swabs, for
heaven’s sake.
I can’t stop thinking
about infrastructure, especially unemployment systems.
We’d never purposely shut down our economy; no nation had. Each state is trying to figure out the best course between limiting exposure to COVID-19 and keeping food on people’s tables. Those workers deemed “essential” still show up for work, others may be able to work from home, but many have suddenly become unemployed.
The U.S. is seeing
unemployment levels not seen since the Great Depression, and occuring in a matter
of a couple months, not several years. As of this writing, there
are over 22 million unemployed; no one believes that is a complete count (not
everyone qualifies for unemployment), and few believe that will be the peak.
Many unemployment
systems could not manage the flood of applications.
After my posts on telemedicine were published recently, (this one on Manly Wellness before the pandemic and this one after it erupted, on A Country Doctor Writes, then reblogged on The Health Care Blog, KevinMD and many others), I have been asked about my views on telemedicine’s role in the future of primary care.
Things have changed quickly, and a bit chaotically, and there is a lot of experimentation happening right now in practices I work or speak with.
Before thinking about telemedicine in Primary Care, we need to agree on some sort of definition of primary care, because there are so many functions and services we lump together under that term.
Minor Illnesses
Many people think of primary care mostly as treating minor, episodic illnesses like colds, rashes, minor sprains and the like. This is an area that has attracted a lot of interest because it is easy money for the providers, since the visits tend to be quick and straightforward and such televisits are also attractive for the insurance companies if they can keep insured patients out of the emergency room. With the technical limitations of video quality and objective data such as heart rate and rhythm, I think this is an absolute growth area for telemedicine. However, with all the other forms but mostly here, fragmentation of care could become a complicated problem. To put it bluntly, if we still expect a medical professional or a health care organization to keep an eye on reports from various sources, such as hospital specialists, walk-in clinics or independent telemedicine providers, they are going to want to get paid for it.
GuideWell has launched the COVID-19 Health Innovation Collaborative to identify and support solutions that can immediately increase the scope and scale of resources aimed at reducing the complex stress factors COVID-19 is bringing to bear on the U.S. health system.
There will be five categories of focus under
this collaborative, and proposed solutions must directly address at least one
of these categories:
Home-based self-testing solutions for the COVID-19 virus
Virtual, in-home care solutions for at-risk populations that have limited access to health care services
Solutions that reduce risk for health care providers in clinical settings, including approaches for increasing protection of clinical staff
Solutions focused on reducing social isolation due to COVID-19 diagnosis or social distancing
Solutions for delivering food and urgently needed supplies to at-risk populations and households with COVID-19 exposure or symptoms
The COVID-19 Collaborative’s overarching
objective is to source a diverse portfolio of innovative companies that
collectively have the potential to respond to the pandemic in the above
categories. For each category, a cohort of 3-5 companies will be selected to
work together to create a connected, high impact approach to addressing the
program category.
I am writing this blog post (the first after nearly two years!) in lockdown mode because of the rapidly spreading SARSCoV2 virus, the causative agent of the COVID19 disease (a poor choice of a name, since the disease itself is really SARS on steroids).
One interesting feature of this disease is that a large number of patients will manifest minimal or no symptoms (“asymptomatic” infections), a state which must clearly be distinguished from the presymptomatic phase of the infection. In the latter, many patients who will eventually go on to develop the more serious forms of the disease have minimal symptoms. This is contrast to asymptomatic patients who will never develop anything more bothersome than mild symptoms (“sniffles”), for which they will never seek medical attention. Ever since the early phases of the COVID19 pandemic, a prominent narrative postulated that asymptomatic infections are much more common than symptomatic ones. Therefore, calculations such as the Case Fatality Rate (CFR = deaths over all symptomatic cases) mislead about the Infection Fatality Rate (IFR = deaths over all cases). Subthreads of this narrative go on to postulate that the lockdowns which have been implemented widely around the world are overkill because COVID19 is no more lethal than the flu, when lethality is calculated over ALL infections.
Whereas the politicization of the lockdown argument is of no interest to the author of this blog (after all the virus does not care whether its victim is rich or poor, white or non-white, Westerner or Asian), estimating the prevalence of individuals who were exposed to the virus but never developed symptoms is important for public health, epidemiological and medical care reasons. Since these patients do not seek medical evaluation, they will not detected by acute care tests (viral loads in PCR based assays). However such patients, may be detected after the fact by looking for evidence of past infection, in the form of circulating antibodies in the patients’ serum. I was thus very excited to read about the release of a preprint describing a seroprevalence study in Santa Clara County, California. This preprint described the results of a cross-sectional examination of the residents in the county in Santa Clara, with a lateral flow immunoassay (similar to a home pregnancy kit) for the presence of antibodies against the SARSCoV2 virus. The presence of antibodies signifies that the patient was not only exposed at some point to the virus, but this exposure led to an actual infection to which the immune system responded by forming antibodies. These resulting antibodies persist for far longer than the actual infection and thus provide an indirect record of who was infected. More importantly, such antibodies may be the only way to detect asymptomatic infections, because these patients will not manifest any symptoms that will make them seek medical attention, when they were actively infected. Hence, the premise of the Santa Clara study is a solid one and in fact we need many more of these studies. But did the study actually deliver? Let’s take a deep dive into the preprint.
If you are a soccer fan, watching the FIFA World Cup is a
ritual that you don’t ever violate. Brazilians, arguably more than any other
fans in the world, live and breathe soccer—and they are always expected to be a
legitimate contender to win it all. Their expectations are magnified when they are
the host country, which was the case in 2014. Not only did the Germans destroy
Brazilian World Cup dreams, but less than a year after a humiliating loss
on their turf, Brazilians began dealing with another devastating blow: a viral
epidemic. Zika left the country scrambling to understand how to manage the
devastation caused by the virus and grappling with conspiracies theories of
whether the virus was linked to the tourism brought by hosting the FIFA World
Cup.
How did I become so interested in what happened in Brazil five
years ago? Well, social distancing and being mostly at home in the era of
COVID-19 seems to energize reflection. Watching politicians on TV networks blaming
each other and struggling to appear more knowledgeable than scientists makes me
marvel at the hubris. My mind took me back to several prior epidemics that we
encountered from Swine Flu to Ebola, and I couldn’t help but think about the lessons
lost. What did we miss in these previous crises to land us in this current
state where Zoom is your best friend and you are more interested in commenting
on tweets than doing a peer-review? One cannot help but wonder what is so
different about this coronavirus that it has paralyzed the globe.
I decided to take a deep dive into the Zika epidemic in a
hopeful effort to better understand the present public health crisis. I started
by reading Zika: The Emerging Epidemic, by Donald G. McNeil Jr, who also
covers global epidemics for the New York Times. The book is a
fascinating read and offers illuminating parallels to the current failings we
are seeing with national and global health protection agencies during the COVID-19
pandemic.
