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Tag: Matthew Holt

Chakri Toleti, Care.ai

Chakri Toleti is an occasional Bollywood film producer (you can Google that) and also the CEO of Care.ai–one of the leading companies using sensors and AI to figure out what is going on in that hospital room. They’ve grown very fast in recent years, fundamentally by using technology to monitor patients and help improve their care, improve patient safety and figure out what else is needed to improve the care process. You’ll also see me doing a little bit of self-testing!–Matthew Holt

What’s behind all these assessments of digital health?

By MATTHEW HOLT

A decent amount of time in recent weeks has been spent hashing out the conflict over data. Who can access it? Who can use it for what? What do the new AI tools and analytics capabilities allow us to do? Of course the idea is that this is all about using data to improve patient care. Anyone who is anybody, from John Halamka at the Mayo Clinic down to the two guys with a dog in a garage building clinical workflows on ChatGPT, thinks they can improve the patient experience and improve outcomes at lower cost using AI.

But if we look at the recent changes to patient care, especially those brought on by digital health companies founded over the past decade and a half, the answer isn’t so clear. Several of those companies, whether they are trying to reinvent primary care (Oak, Iora, One Medical) or change the nature of diabetes care (Livongo, Vida, Virta et al) have now had decent numbers of users, and their impact is starting to be assessed. 

There’s becoming a cottage industry of organizations looking at these interventions. Of course the companies concerned have their own studies, In some cases, several years worth. Their  logic always goes something like “XY% of patients used our solution, most of them like it, and after they use it hospital admissions and ER visits go down, and clinical metrics get better”. But organizations like the Validation Institute, ICER, RAND and more recently the Peterson Health Technology Institute, have declared themselves neutral arbiters, and started conducting studies or meta-analyses of their own. (FD: I was for a brief period on the advisory board of the Validation Institute). In general the answers are that digital health solutions ain’t all they’re cracked up to be.

There is of course a longer history here. Since the 1970s policy wonks have been trying to figure out if new technologies in health care were cost effective. The discipline is called health technology assessment and even has its own journal and society, at a meeting of which in 1996 I gave a keynote about the impact of the internet on health care. I finished my talk by telling them that the internet would have little impact on health care and was mostly used for downloading clips of color videos and that I was going to show them one. I think the audience was relieved when I pulled up a video of Alan Shearer scoring for England against the Netherlands in Euro 96 rather than certain other videos the Internet was used for then (and now)!

But the point is that, particularly in the US, assessment of the cost effectiveness of new tech in health care has been a sideline. So much so that when the Congressional Office of Technology Assessment was closed by Gingrich’s Republicans in 1995, barely anyone noticed. In general, we’ve done clinical trials that were supposed to show if drugs worked, but we have never really  bothered figuring out if they worked any better than drugs we already had, or if they were worth the vast increase in costs that tended to come with them. That doesn’t seem to be stopping Ozempic making Denmark rich.

Likewise, new surgical procedures get introduced and trialed long before anyone figures out if systematically we should be doing them or not. My favorite tale here is of general surgeon Eddie Jo Riddick who discovered some French surgeons doing laparoscopic gallbladder removal in the 1980s, and imported it to the US. He traveled around the country charging a pretty penny to  teach other surgeons how to do it (and how to bill more for it than the standard open surgery technique). It’s not like there was some big NIH funded study behind this. Instead an entrepreneurial surgeon changed an entire very common procedure in under five years. The end of the story was that Riddick made so much money teaching surgeons how to do the “lap chole” that he retired and became a country & western singer.

Similarly in his very entertaining video, Eric Bricker points out that we do more than double the amount of imaging than is common in European countries. Back in 2008 Shannon Brownlee spent a good bit of her great book Overtreated explaining how the rate of imaging skyrocketed while there was no improvement in our diagnosis or outcomes rates. Shannon by the way declared defeat and also got out of health care, although she’s a potter not a country singer.

You can look at virtually any aspect of health care and find ineffective uses of technology that don’t appear to be cost effective, and yet they are widespread and paid for.

So why are the knives out for digital health specifically?

And they are out. ICER helped kill the digital therapeutics movement by declaring several solutions for opiod use disorder ineffective, and letting several health plans use that as an excuse to not pay for them. Now Peterson, which is using a framework from ICER, has basically said the same thing about diabetes solutions and is moving on to MSK, with presumably more categories to be debunked on deck.

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THCB Gang Special: Episode 138, Thursday 30 November 2023 with Jen Goldsack

On #THCBGang today we have a special solo episode with Olympic rower for 2 countries and Digital Medicine Society CEO Jennifer Goldsack, (@GoldsackJen) joining Matthew Holt (@boltyboy). It’s at at 1pm PST 4pm EST on Thursday November 30. Find out about what DiME is and does, and what projects it is pushing forward in the future of health tech.

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

Joanna Strober, CEO, Midi Health

Women’s health in their mid-life has been very poorly treated. No one has been managing all of women’s health, and almost no one has been delivering hormone replacement therapy since a now debunked 2002 study. Midi is a new company with protocols for many conditions, and it has been training NPs to deliver the care (because no one has been training them!). CEO Joanna Strober explained how Midi is providing care in 14 states now and will be in all 50 next year, and how Midi is delivering virtual and comprehensive care to women–many of whom do not have access to any other type of regular care. They just raised another $25m from GV (Google) & others–Matthew Holt

Robin Berzin, CEO & Founder, Parsley Health

Robin Berzin used to work with me at Health 2.0 , as well as combining her medical training with lots of media production and other work. Fast forward a decade and Robin has left the rest of us in the dust. She’s now the Founder and CEO of Parsley Health, which is a really innovative primary care++ clinic that is based on the foundations of functional medicine, and is having tremendous success treating and transforming the lives of thousands of patients who were not getting what they needed from the traditional health care syste,. Now Parsley is aggressively moving into the employer market. I caught up with Robin at the recent HLTH conference.–Matthew Holt

THCB Gang Episode 137, Thursday October 26

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday October 26 at 1pm PST 4pm EST were delivery & platform expert Vince Kuraitis (@VinceKuraitis); author & ponderer of odd juxtapositions Kim Bellard (@kimbbellard); futurist Ian Morrison (@seccurve); and our special guest was Kat McDavitt(@katmcdavitt) President of Innsena.

The video is below. If you’d rather listen to the episode, the audio is preserved from Friday as a weekly podcast available on our iTunes & Spotify channels

Fay Rotenberg, CEO, Firefly Health

Fay Rotenberg is CEO of Firefly Health, which is an advanced virtual primary care group (a bastardized phrase she hates). That means they are both providing virtual care, with an integrated care and health plan coverage model, and are also a risk-bearing medical group working with other payers. They adjust the model using health guides, MDs, NPs, etc. and they help their patients manage their in person experience with specialists, labs, imaging, etc. — they have 1900+ partners nationwide who will actually know the patient is coming, and is integrated into Firefly’s model. Clinical outcomes are great, and costs are 12-15% lower, yet they have 5,000 members per MD. Maybe it really is the 21st century Kaiser?

THCB Gang Episode 136, Thursday October 5

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday October 5 at 1pm PST 4pm EST were delivery & platform expert Vince Kuraitis (@VinceKuraitis); author & ponderer of odd juxtapositions Kim Bellard (@kimbbellard) and policy expert consultant/author Rosemarie Day (@Rosemarie_Day1).

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

THCB Gang Episode 135, Thursday September 28

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday September 28 at 1pm PST 4pm EST are futurist Jeff Goldsmith: author & ponderer of odd juxtapositions Kim Bellard (@kimbbellard); and patient safety expert and all around wit Michael Millenson (@mlmillenson).

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

Shiv Rao, CEO demos Abridge

Abridge has been trying to document the clinical encounter automatically since 2018. There’s been quit a lot of fuss about them in recent weeks. They announced becoming the first “Pal” on the Epic “Partners& Pals” program, and also that their AI based encounter capture technology was now being used at several hospitals. And they showed up in a NY Times article about tech being used for clinical documentation. But of course they’re not the only company trying to turn the messy speech in a clinician/patient encounter into a buttoned-up clinical note. Suki, Augmedix & Robin all come to mind, while the elephant is Nuance, which has itself been swallowed by the whale that is Microsoft.

But having used their consumer version a few years back and been a little disappointed, I wanted to see what all the fuss was about. CEO Shiv Rao was a real sport and took me through a clinical example with him as the doc and me as a (slightly) fictionalized patient. He also patiently explained where the company was coming from and what their road map was. But they are all in on AI–no off shore typists trying to correct in close to real time here.

And you’ll for sure want to see the demo. (If you want to skip the chat it’s about 8.00 to 16.50). And I think you’ll be very impressed indeed. I know I was. I can’t imagine a doctor not wanting this, and I suspect those armies of scribes will soon be able to go back to real work! — Matthew Holt