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Matthew’s health care tidbits: Texas is the present future of abortion care

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

In this edition’s tidbits, I have to return to the stunning impact of the Dobbs ruling. We know will happen because it is already happening in Texas where the 6 week law was already being enforced in contravention of Roe v Wade.

Taxpayer money is going to “pregnancy crisis centers” that flat out lie to vulnerable patients about the impact of abortions on their health. Doctors are questioning women who have miscarried–at a moment that is already terrible for them, and women who have miscarried are being denied basic D&Cs–which can kill them.

Don’t get me started on the absolute nonsense being talked–and passed into law –about ectopic pregnancies, of which there are over 130,000 each year in the US, being carried to term. How unlikely is it that an ectopic pregnancy makes it to term with no ill effects? Let me tell you a story. My dad was an OBGYN. He and his anesthetist saved the life of a woman and her baby who somehow had made it to term while being ectopic. During the surgery she needed 12 pints of blood (a normal woman has 7-8 pints in her body) and he considered it the greatest piece of surgery he did in his entire career. He thought that he and the patients were very lucky. So I demand that crazy legislation saying ectopic pregnancies have to be carried to term also mandates that my dad is around to do every single C-Section. Unlikely, as he’s dead, but no crazier than the legislation in Indiana.

Then there’s the impact on telehealth. Most abortions are done using drugs but more and more of the pandemic-era exemptions to prescribing drugs and seeing patients over telehealth across state lines are being withdrawn. Clearly the state-based licensing of doctors is itself ridiculous in an age of online commerce, but despite the DOJ statements the legality of prescribing abortifacients across state lines is very unclear and, as Deven McGraw explained in this harrowing piece on THCB Gang, HIPAA doesn’t protect patient privacy from local law enforcement. So what happens to someone in a state where abortion is banned if they have to go to hospital because of a complication from taking an abortifacient? Trump thinks they should go to jail.

What is clear is that bans on abortion don’t stop abortions. But they do endanger women. And if the pregnancy crisis center stops a woman from getting an abortion, do they help afterwards? Why yes, if you mean by “helping”, they have a celebratory dinner and light a fricking candle.

Matthew’s health care tidbits: Is Covid over for the health care system?

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

I am beginning to wonder, is COVID over? Of course no one has told the virus that it’s over. In fact infection rates are two to three times where they were in the post-omicron lull and new variants are churning themselves out faster and faster. We still have 300 people dying every day. But since we went past a million US deaths, no one seems to care any more.

For the health care system, COVID being over means a chance to get back to normal, and normal ain’t good. Normal means trying to get rid of that pesky telemedicine and anything else that came around since March 2020.The incumbents want to remove the public health emergency that allowed telemedicine to be paid for by Medicare, re-enforce the Ryan Haight act which mandates in-person visits for prescribing controlled Rx like Adderall for ADHD, and make sure that tortuous state license requirements for online physicians are not going away. This also means restrictions on hospital at home, and basically delays any other innovative way to change care delivery. Well, it was all so perfect in February 2020!

But there is one COVID related problem that doesn’t seem to be going away. People. They’re just not going back to work and nurses in particular are resisting the pull of the big hospitals. I don’t know the end game here, but there is a clue in the “return to office” data. Basically every large city is below 50% of its office space being occupied and companies are having to figure out a hybrid model going forward, no matter how much Elon Musk objects.

Hospitals aren’t going willingly into the night. The big systems still control American health care, and are prepared to fight on all fronts to keep it that way. But like office workers, nurses and doctors want a different life. The concept of virtual-first, community-based, primary care-led health care has been around for a long while and been studiously ignored by the majority of the system.

If hospitals can’t get the staff and keep losing money employing the ones they have, there will be new solutions being offered to clinicians wanting a different life-style. We just might see a different approach to health care delivery rising phoenix-like from the Covid ashes.

Virtual Care Regulatory Round-Up: Telehealth & Digital Care ‘State-of-Play’ by Nathaniel Lacktman

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BY JESS DaMASSA, WTF HEALTH

Just as HHS extends the Covid-19 public health emergency waivers until July, we kick-off a brand-new monthly interview series about the state-of-play for all things telehealth and digital care policy and reimbursement. Called the WTF Health Virtual Care Regulatory Round-up, we’re partnering with our friends at Wheel to feature health policy experts, lobbyists, health plan folks, and other virtual care experts and insiders who can keep us updated on the changing regulations and what they will mean to those health tech co’s whose businesses rely on virtual care.

Attorney-to-the-stars-of-telehealth, Nathaniel Lacktman, who chairs the Telemedicine & Digital Health Industry Team at Foley & Lardner and is a Board member of the American Telemedicine Association (ATA), kicks the series off for us with an update on those public health waivers and how he is coaching health tech businesses in preparing for the inevitable transition of care that will come when they come to an end.

What will happen to patients who live across state lines from their virtual care providers? What business decisions need to be made to avoid abandoning patients and maintaining continuity of care? Nate’s not bullish on a federal national license, but there are some cases where cross-state patient-provider relationships can continue to exist – they just might not work for everyone’s business model.

And, on the subject of telehealth business models, Nate gives us his take on where he thinks reimbursement will be headed, how policy around virtual prescribing will be impacted post-pandemic (particularly around controlled substances), and whether or not Medicare’s originating site requirement will be put back in place. We also get Nate’s perspective on which virtual care business models seem to be working best among health tech startups and what legal risk those more ‘reckless’ players might be creating for the rest of the field without even realizing it. Great education on virtual care and what’s happening in the space RIGHT NOW. Watch!

Special thanks to our series sponsor, Wheel – the health tech company powering the virtual care industry. Wheel provides companies with everything they need to launch and scale virtual care services — including the regulatory infrastructure to deliver high quality and compliant care. Learn more at wheel.com.

ATA’s CEO Ann Mond Johnson Takes on the “Telehealth Cliff”

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By JESSICA DaMASSA, WTF HEALTH

The BIG takeaway from ATA’s Annual Meeting is best bottom-lined by ATA’s big boss, CEO Ann Mond Johnson, in this interview: “From an overall perspective, we just don’t want to go over that ‘telehealth cliff.’”

ATA, the re-branded American Telemedicine Association, has not only evolved along with virtual care through the pandemic, but has also been critical in redefining telehealth as modality for healthcare and re-framing access to it as a bipartisan issue that everyone in DC can get behind.

Ann talks through the high-level changes she’s witnessed for telehealth adoption over the past two years and gives us her predictions for what’s going to happen next – particularly when it comes to the business of virtual care, consumer demand, and, most importantly, regulations and reimbursement. Lots happening thanks to ATA’s new affiliated trade organization, ATA Action, which is lobbying to ensure that the waivers that enabled the acceleration of telehealth during the Covid-19 public health emergency become permanent. The time is NOW for health tech co’s to get involved! Tune in to find out how.

Health Care Organizations Must Prioritize Cybersecurity Before Undergoing Digital Transformation

By TRAVIS GOOD

The health care industry is rapidly embracing new technologies. Covid-19 changed the way many industries operate, and healthcare is one industry that was particularly affected by the pandemic. Many health care organizations were already undergoing digital transformations, but Covid exponentially sped up those processes. Health care providers and health-tech companies were forced to adapt to the new normal and change the way they operate. Here are 3 major ways health care has changed in recent times. 

1. Increased popularity of telehealth services:

Covid made telehealth appointments a necessity, but even in a post-Covid world virtual visits are likely to remain a core component of modern healthcare. According to McKinsey, telehealth utilization was 78 times higher in April 2020 than in February 2020. It remained nearly 40 times as popular in 2021 as compared to pre-pandemic levels. 

Research shows that both patients and physicians are fans of telehealth. Many patients prefer the convenience of being able to speak to their doctor from home and physicians feel that offering telemedicine allows them to operate more efficiently. Phone and video-based medical appointments became mainstream in 2020, and they are unlikely to go away anytime soon. 

2. More wearable medical devices with connected ecosystems:

The number of wearable medical devices in use has skyrocketed over the past 5 years. The wearable medical device market is expected to reach $23 million in 2023, a major increase from $8 million in 2017. Gadgets like heart rate sensors, oxygen meters, and exercise trackers are all becoming increasingly popular. Many popular consumer products such as cell phones and smartwatches ship with built-in medical tracking technology.

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Inside Wheel’s $150M Series C: CEO Talks “Long Game” for Stealthy Virtual Care Infrastructure Biz

By JESSICA DaMASSA, WTF HEALTH

Wheel’s CEO Michelle Davey says the white-label virtual care startup’s $150M Series C – led by notable health tech mega-funders Lightspeed Venture Partners & Tiger Global – is “really about the long-game.” We get into the details of this purposeful funding round and what it means for the future of Wheel, as well as the play-by-play analysis of what happened over the past 9 months, since the company closed its $50M Series B. (FYI: Wheel’s total funding is at $216 million to-date.)

Wheel is currently running behind-the-scenes for an undisclosed client list of brands, facilitating 1.6 million virtual visits a year for digital health companies, digital pharmacies, retailers, and, now, even traditional healthcare providers. That number is expected to triple by the end of 2022, and we get into what’s fueling that growth and whether or not Michelle believes that this institutional push toward online care will persist as the pandemic wans and the world continues re-opening.

Armed with this fresh funding, how will three-year-old Wheel continue to differentiate its offering from legacy telehealth infrastructure providers like Amwell and Teladoc? How will it win against their legacy relationships with legacy healthcare providers? Or, is Wheel’s big bet on the continued scaling of what Michelle calls “next generation healthcare”? Wheel has added A LOT of tech to its own infrastructure recently, providing asynchronous options, better clinician matching, more triaging and navigating, and, with this funding, are is now talking about adding “diagnostic services” to round out their service line. What, exactly are we talking about here in terms of business model evolution? Tune in and find out what this stealthy startup is up to!

Meet Wheel: The Mysterious, White-Label Telehealth Startup Bolstering ‘Next-Gen’ Virtual Care

By JESSICA DaMASSA, WTF HEALTH

Stealthy telehealth startup Wheel just closed a $50M series B and CEO Michelle Davey is here to reveal the mystery behind the company’s very behind-the-scenes approach to selling white-label virtual care. The business model is built on a network of clinicians that Wheel has curated and credentialed specifically for virtual care delivery – for a rotating cast of clients, under any brand, at any time. Unlike the market-leading incumbent telehealth co’s that also sell virtual care infrastructure, Wheel does NOT have a patient front door, isn’t angling for one, and is so protective of its clients’ brands that Michelle won’t even name names about who her company is working with. She simply describes her clientele as those in the biz of “next gen” virtual care: retail players, care-plus-pharmacy-delivery startups, asynchronous care providers, labs, remote patient monitoring companies, and so on.

Wheel experienced 300% year-over-year growth — and 1200% growth from Q4-2020 to Q1-2021 — but is it sustainable as the pandemic wans and other plug-and-play telehealth infrastructure services also gain market traction and funding? And, what about the common criticism that telehealth is too transactional and that both patients AND physicians prefer the opportunity to build deeper relationships? Do providers really want to practice for multiple companies at the same time? We get a look inside Wheel’s 90% clinician retention rate to see what else might be satisfying the clinician’s need to connect, and talk about areas for growth now that the company’s received fresh funds.

Healthcare’s New “Operating System”: Amwell’s CEO Says Incumbents are Re-Thinking Telehealth

By JESSICA DaMASSA, WTF HEALTH

“We have to look at telehealth as an operating system.” Amwell ($AMWL) President & CEO Roy Schoenberg has a way with analogies, and some of his best land in this interview as we get a highly detailed, insider’s perspective about how payers and health systems are rethinking telehealth as a result of their experiences during the pandemic.

Bottom line: The pandemic taught us that telehealth can be used to deliver a much wider variety of healthcare services than just urgent care and, so the whole idea of ‘telehealth’ is changing from healthcare product to healthcare infrastructure. Mental health care, physical therapy, medication management, primary care, and more have all moved to telehealth and, along with that shift, the “rules of engagement” around those services have started to change.

Payers are looking to become the “digital front door” for their members – providing primary care and navigation. Health Systems are increasingly looking to use their own docs for urgent care, rather than outsource that relationship and miss the potential to build trust with local patients. And, in all this, Roy argues that healthcare’s biggest buyers have stopped looking at telehealth as a “product” and, instead, are starting to see the opportunity to “rewrite their future” around a view of telehealth as infrastructure, as one of healthcare’s “foundational systems” intertwined with (and as mission-critical as) their EHRs or claims and eligibility systems.

My favorite analogy starts around the 20-minute mark, when Roy explains this operating system idea by drawing comparison to how individual Microsoft programs (think Word, Excel, Outlook, PowerPoint) would be infinitely less powerful if they were not running on the same operating system and able to easily transfer information. Another good one? How both the buying and provisioning of healthcare is being re-thought digitally, just as online shopping not only changed buying habits but also changed supply chain for retailers. If you’re looking to hear the latest on what’s happening in telehealth post-Covid, learn how things have changed for payers and health systems, AND also want to dip into Amwell’s market positioning a bit, you’ll love this deep-dive.

Connection Is Healthcare

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By TOMER BEN-KIKI

The American people can’t afford partisan politics that increase long-term healthcare costs.

When the GOP came to the table with a $1 trillion infrastructure proposal last week, I was pleased to see that they had increased funding for broadband access to $68 billion.

The President wants $100 billion for broadband expansion, but a meaningful increase before the soft deadline of June 7 was a positive step.

Politics aside, the pandemic made it clear how dependent we are on the issue of broadband internet access.after all, broadband underpinned nearly everything that was done to keep the economy on life-support during the lock-downs.

Without broadband access our ability to deliver education, run most businesses, and (most importantly) deliver healthcare, would have slowed to a glacial pace or – in some cases – ground to a halt.

The fact that the healthcare industry was able to make a lighting-speed pivot to telehealth during the COVID epidemic shows how quickly the government, insurers and providers can respond to deliver needed care. But, that pivot also exposed how social determinants of health, like economic stability and the built environment, still present serious challenges to care delivery for our most vulnerable populations.

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Amwell’s CEO Roy Schoenberg on Telehealth as “Healthcare Infrastructure”

By JESSICA DaMASSA, WTF HEALTH

“Telehealth has a much bigger role to play than just carrying out transactions,” says Amwell’s President & CEO, Roy Schoenberg, who joins Jess DaMassa for a sweeping philosophical discussion about how telehealth’s role will continue to evolve through the covid19 pandemic and the changes its forced on the healthcare market. Conversations about telehealth that were once about the value of improving “access to care” are now about the technology’s potential to drive “quality of care.” And Amwell – which says it is a “technology infrastructure company” focused on helping traditional healthcare players transition into digital distribution – is pushing past the old notion that virtual care is merely a “product to get a Z-pak.”

Roy gives us updates on Amwell’s much-buzzed-about partnerships with United Healthcare and Google, the later being focused on how the telehealth co is looking at integrating some of those famous Google technologies (think natural language processing, translation, and geolocation-ala-Maps) into virtual care delivery in a way that sounds like a lot more than just a “switchboard.”

Two other colorful Roy Schoenberg soundbites to tease you into this conversation about the immediate future of telehealth from the leader of one its biggest players: 1) “the notion that we are no longer looking at the home as an illegitimate place of care is drama in in every sense” and 2) “I think the next war-zone, the next place where there’s going to be a lot of heated confrontations and conversations, is state licensure.”