The THCB Gang Episode 3, (LIVE Today at 1PM PT/4PM ET)

Each week an episode of “The THCB Gang” (this was Episode 3) is streamed live here (below) and is also preserved as a weekly podcast and available on our Itunes & Spotify channels a day or so later. Each week 4-6 semi-regular guests drawn from THCB authors and other assorted old friends of mine will shoot the shit about health care business, politics, practice, and tech. It tries to be fun but serious and informative!

This week, joining me were Deven McGraw (@healthprivacy), Kim Bellard (@kimbbellard), Vince Kuraitis (@VinceKuraitis), Michael Millenson (@MLMillenson), Brian Klepper (@bklepper1), Grace Cordovano (@gracecordovano) & Daniel O’Neill (@dp_oneill). It was an argumentative discussion about the developments around COVID19 and what we should pay attention to next week — Matthew Holt

Health Catalyst: Dale Sanders on what’s next for analytics & big data

One of the more interesting guys in health tech is Dale Sanders who’s been data geek/CIO at multiple provider organizations (InterMountain, Northwestern, Cayman Islands), was in the nuclear weapons program in the US Air Force back in the day, and now is the product visionary at Health Catalyst. Health Catalyst is a very well-backed date warehousing and analytics company that has Kaiser, Partners, Allina and a host of other providers as its customers and investors (and has been a THCB sponsor for a while!). I’ve interviewed CEO Dan Burton a couple of times (here’s 2016) if you want to know more about the nuts and bolts of the company, but this chat with Dale at HIMSS17 got a tad more philosophical about the future of analytics–from “conference room analytics” to “embedded decision support.” I found it great fun and hope you do too!


Blog Notes

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The World in 2016: MACRA, a New Era For Meaningful Use and (Yet More) Political Change to come

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THCB is pleased to introduce the 2016 Healthcare Town Hall, a special online feature brought to you in partnership with Health Catalyst. This is an experiment. The idea is to open up an ongoing dialogue around the issues that are transforming healthcare in the second decade of the 21st Century.  

We’re kicking things off with an online panel featuring THCB Editor John Irvine and the HealthCatalyst leadership including Dale Sanders, John Haughom and Bryan Oshiro. 

John Irvine: Let’s start with the recent decision at CMS to transition from the Meaningful Use the program to a new program that will be a component of MACRA.  A lot of people were extremely surprised with the news that Meaningful Use is going away. The follow up development, of course, is that CMS has agreed in principle to a new set of core clinical quality measures that will change the way doctors are evaluated. I’m hearing a lot of positive feedback about the Meaningful Use decision. Reactions?

Dale Sanders: I was surprised, yes. As I think you know, I’ve spent a lot of time in Washington. I know how government works. People in government generally do not reverse themselves, unless it is very clear that there is no other available option. That’s Washington 101. Read into that what you will.  It’s far easier to allow a program to keep on going than to admit that something isn’t working or that it has outlived it’s usefulness. I think a lot of people are missing the fact that It took political courage to do that.  I will say that I was one of the first to publicly call for the suspension of Meaningful Use, and you guys posted the blog that I wrote about it. At Northwestern, we published a one page policy entitled, “Principles of EMR Utilization” that was written and endorsed by our physicians, facilitated by me when I recognized that our EMRs were being used for little more than a multi-million dollar word processor. That one-page document is all we needed to achieve the same concepts as Meaningful Use. The last time I counted, the Meaningful Use regulations totaled over 350 pages. In typical fashion, the government turned a good concept into a mess. So, I’m cautiously optimistic that we are going to return to common sense.

Continue reading…


And the Stars Looked Very Different Today

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“This is Major Tom to Ground Control
I’m stepping through the door
And I’m floating in a most peculiar way
And the stars look very different today
For here
Am I sitting in a tin can
Far above the world
Planet Earth is blue
And there’s nothing I can do”

Space Oddity. HD (YouTube.) THCB
With thanks to @jlschuster827

Health 2.0 WinterTech–Health Tech Investing at #JPM16


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Health 2.0’s WinterTech conference is today January 13. It features leaders from Venrock, Canvas, Grand Rounds, Doximity, Livongo, Omada Health, Maverick Capital, GE Ventures, Kaiser Permanente and more. It’s the only event dedicated to health tech and investing during the health investment mecca, JP Morgan Week, WinterTech will bring together the top tech companies, investors, entrepreneurs, policy makers, and more to explore investing in the health tech landscape.

Online sales are sold out but we have released a few seats that you can buy on site.

Key sessions will address New Clinical Tools and Platforms, the Convergence of Life Sciences and Health Tech, the New Consumer Health Ecosystem and more. Additionally, there will be exclusive one on one interviews with top influencers such as Vinod Khosla, Founder, Khosla Ventures; Bryan Roberts, Partner, Venrock; Owen Tripp, CEO, Grand Rounds; Glen Tullman, CEO, Livongo Health; Sean Duffy, CEO, Omada Health and Rebecca Lynn, Co-Founder & Partner, Canvas with “her” CEO Jeff Tagney, Doximity along with a keynote from Jonathan Bush– CEO and Co-Founder, athenahealth.

Along with key speakers, Health 2.0 is famous for its incredible selection of LIVE demos, and this year you’ll see; Redox; Bigfoot Biomedical; Propeller Health; Lyra Health; Outset Medical; LifeQ; Accordion Health; dacadoo; physIQ & Jiff

Top investors will join us to discuss business models, examine trends, and explore portfolios and meet startups. This year we will have:GE Ventures; Novartis dRx Capital; Maverick Capital Ventures; Ziegler; World Bank Group/IFC Venture Capital; Kaiser Permanente Ventures; and many more.

We hope to see you there!!

Matthew’s Issues & Charities at end 2015, start 2016

Every year (well almost) I write a letter to friends and contacts about which charities I give to and which issues I support, and recently I’ve been posting it on THCB–hey I own the joint so who’s going to stop me!. Here’s this end/start year edition–Matthew Holt

Yes another year with a Matthew issues letter nearly missed but not quite. I’m poolside in Maui winding down as much as possible when on a vacation with little kids and I’ve missed getting this out for end 2015 but because of the weekend 2016 isn’t really here yet, and I’m finally hammering out my end of year news, gossip, charities and issues letter. A couple of weeks ago someone asked me how the new year was shaping up, and I told them I was about ready for 2012….and I still feel the same way. I seem to spend more time reading articles on the habits of productive people than actually being one …thanks Buzzfeed!

If you don’t know, this is a letter I write mostly to myself about what happened in what’s now last year and what I should do about it–in terms of making charitable donations while it’s still 2015, although I must confess that I sometimes give money on Jan 1-2 and claim it on my taxes for the year before, so I hope the NSA isn’t sharing this email with the IRS. People do ask me about it every year, sometimes in advance, so hopefully it’s not a waste, and if you don’t care then hit delete, or go onto the next fascinating Facebook article on 15 celebs that look gross after plastic surgery, or whatever….and I love comments on the blogs/Facebook/Twitter or by email, so please let me know what you think.
The main stuff is the issues below, but quick update on me and mine. Aero (1), Coco (4) and Amanda (unspecified) still continue to interrupt my attempts to waste my life away. Amanda says that my appeals for a diaper changing robot are unnecessary as Aero only has about 2,000 changes to go. She does say though that I might soon need one, Health 2.0 had a great year with our biggest ever crowd in Santa Clara plus 2 other successful conferences in the US plus others in Europe (Barcelona) Korea, Latin America  (São Paolo) and Japan, where I had great fun this November. I also snuck in a trip to Finland to talk about Health 2.0 (12 mins of fun here) at the wonderful SLUSH conference and had a cold plunge after a sauna, leading to my most viewed and commented Facebook video post ever! (Thanks to my host Pekka Sivonen). Thanks to everyone who worked for, volunteered at, spoke at or came to a Health 2.0 conference. 
In addition due to the work of  my long suffering partner Indu Subaiya, and our New York team led by Graeme Ossey & Jen David we now have a really vibrant business running challenges and pilots, including a huge new project for the World Bank exposing hospitals in India to new technology. You can also very occasionally see me write on The Health Care Blog which I own while John Irvine manages it (well sort of!!)
But this email isn’t about that, it’s about about issues, charity and politics—I missed end of 2013 but 2014’s was pretty good, so much of this is a minor update. If you want to see the past editions here’s 20122011 2010 20092008 and you can search back to 2002 (first one was either 2000 or 2001 but either way it was pre-Blogger so I dont have a copy!), As ever, this letter is about my views and suggestions for donations about health care, poverty in developing world, poverty at home, torture, drug prohibition, and other stuff…. And as I said earlier comments/insults are welcome
Health care & (poor) women’s & kids care
The affordable Care Act is finally established, having survived yet another crazy attack in the Supreme Court. And in the most expensive and inane way basically 10 more million Americans have health insurance than did before. But before you criticize, realize that this was the best that could be done given the insane politics of America and that, other than the disgraceful refusal by many southern Republican governors to expand Medicaid in southern states leaving many of the very poor uncovered, almost everyone now has the chance to be in the system–including those  people who had health conditions who were previously left to go broke or die. America hasn’t done entirely the right thing yet, but we are getting there.
What sadly has come into focus this year is the desperate attempts to attack women’s access to health care. If you’re a woman– especially a young or poor one who needs access to contraceptives, mammograms, cervical cancer screening, sexually transmitted disease testing, and all kinds of health procedures including safe abortions, it’s become the mission of mainstream Republicans to stop you getting them–using disgusting, deceitful, and downright illegal methods. And that’s as polite as I can say it. So my biggest bump in funding this year went to the one organization that consistently not only campaigns for but actually provides reproductive health services (including contraception, STD testing, counseling, pregnancy support and, yes, safe abortions), Planned Parenthood. I cannot believe that men want to live in a world where women cannot get these services, although I guess the evidence shows enough do….especially in Texas, Louisiana, Indiana and many more.

Finally Coco’s first pediatrician, the amazing Nadine Burke Harris just got a big grant to study the impact of Adverse Childhood Events.. Worth checking out some information about that here (no donation required!) 

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What Does it Mean When We Say a Treatment “Works?”

flying cadeuciiMaking a decision requires you to compare tests/treatments that have been contrasted in researh studies to see if one over another results in improved chances of good outcomes. In a sense, medical decision making is a competition. To assess the competition, you compare the chances of outcomes, or results from groups of people taking different options. The comparison is a simple subtraction in the amounts of outcomes that occur in each studied group.

Subtracting results in a difference that is either a benefit (if better for you) or a harm (if worse for you). For nearly all decisions, however, the test/treatment that is better for disease outcomes (benefit) is worse for complications (harm). Comparing, then, results in the following possibilities:

The chances of outcomes associated with the condition you have and the tests/treatments available will be the same for all options. In this case, chose the cheapest option.

The chance of outcomes associated with the condition you have will be less with one option. That option provides added benefit

The chance of a complication caused by the test/treatment that adds benefit for the disease outcomes will be greater (harm).

Since the test/treatment that is better for you in terms of the disease you have will be, simultaneously, worse for you in terms of complications caused by that test/treatment, a trade-off of benefit and harm is required.

Hence, the definition of “works” is that:

A test/treatment works when you feel there is more to gain from the greater chance of better disease associated outcomes than there would be to lose from suffering the complications caused by your chosen treatment.

So, medical-decision-making is a competition between options and there is always some good to be balanced against some bad.

The balance of good and bad from your perspective is what makes one treatment work over another.

Robert McNutt, MD is a board certified internist in Clarendon Hills, Illinois. He is a Professor at Rush Medical College of Rush University.


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