Today on Health in 2 Point 00, Jess and I get festive for the holidays. In this episode, Jess asks me about Walgreens and its new partnership with FedEx for next day prescription delivery and with Verily to help patients with prescription adherence. She also asks me about blockchain startup PokitDok getting its assets acquired by Change Healthcare. Lots of job changes are happening as well. Amy Abernethy, the chief medical officer at Flatiron Health, was named Deputy Commissioner of the FDA. Rasu Shrestha, who was previously at the University of Pittsburgh Medical Center, is the new chief strategy officer of Atrium Health. Finally, Zane Burke, who recently stepped down as president of Cerner, was just hired as Livongo’s new CEO, while Glen Tullman remains executive chairman of the company. Dr. Jennifer Schneider was also promoted from the company’s chief medical officer to president. We have one more episode of Health in 2 Point 00 for 2018, so be on the lookout for our year-end wrap-up. —Matthew Holt
In less than one week, the Health 2.0 8th Annual Fall Conference will feature over 200 LIVE demos, 150 speakers, on over 60 panels and sessions focused on innovative solutions within health care technology. Indu Subaiya, CEO & Co-Founder of Health 2.0 interviewed Adam Pellegrini, VP of Digital Health of Walgreens ahead of his appearance at the 8th Annual Health 2.0 Fall Conference. Adam will be participating in the Monday main stage panel “Consumer Tech and Wearables: Powering Healthy Lifestyles.” In this interview, Adam gives insight into Walgreens innovative API creating the seamless user experience.
Indu Subaiya: So you are leading up a number of very exciting initiatives at Walgreens in terms of digital health. Let’s begin by talking a bit about the API program and the developer ecosystem that you’ve built.
Adam Pellegrini: Absolutely. So Walgreens has been offering a very robust API program for quite some time – this idea that our stores in the online space should be really an omni-channel user experience. If you think about our stores, our stores actually have a lot of partners that actually have products in the stores.
So really, our API program is really about partners. It’s about bringing and facilitating the digital ecosystem together via API. So for us in the Health API space, it’s about how do we help all of these different apps leverage the ingredient technologies that Walgreens has created to create a seamless friction as user experience.
IS: You mentioned that the Health API has drawn a lot of members within the Health 2.0 community. Can you tell us a little bit about some partners there and how this is then connected to your Balance Rewards program?
AP: GenieMD is actually one of our partner apps that leverage our Refill by Scan, our personal health app that goes on both Androids and iPhones. And some of that could be really convenient and add a value to their app by embedding the API that we have for refilling prescriptions, the Refill by Scan.
All eyes are on the hullaballoo created by the challenges at Healthcare.gov and several of the states’ public insurance exchanges. Yet all the while, like in a magic show, attention has been diverted from the real action going on elsewhere. Quietly and in a relatively drama-free way, the private health insurance exchanges are busily taking over the world of insurance and, in my opinion, portend a radical set of changes in how our health insurance system operates.
Several years back, a number of companies began building private health insurance exchanges to initially help companies offload the incredible burden of retiree benefits. Companies such as Extend Health (now owned by Towers Watson), Senior Educators (now owned by Aon), and several others provided a way for large employers to get themselves out of the business (and balance sheet liability) of providing group benefits for retirees, instead providing them with money to purchase their own individual health policies through then small, now large companies. The private exchanges went about the business of building websites that work, call centers that buzz and a wide array of insurance product offerings at various prices. Now, several years later, hundreds of thousands and possibly millions of individuals are out there shopping their little hearts out, choosing their own plans, and dealing with the consequences of high deductibles and the like.
These various private exchanges are now poised and ready to begin serving active employees in 2014 as guaranteed issue (the requirement that all can be insured and no one turned away) goes into effect as a result of the Affordable Care Act. And lest you think this is a small marketplace, you are wrong. In 2008 there were about 120 million total employed workers and just over half of these worked for companies of 500 employees and above (39 million worked for companies with 5000 employees or more). In other words, we are talking about nearly half of American adults and that doesn’t even include the dependents they bring along into their insurance plan.
Interestingly, such large US employers as Walgreens and Petco and DineEquity (parent company of Applebee’s Neighborhood Grill & Bar® and IHOP® restaurants) are all-in on the private exchange program, committing to transfer all of their employees from group plans to the exchange to purchase individual plans come January 2014. The exchanges of Towers, Aon, Mercer, Buck Consultants and a plethora of others are alive and well and open for business at exactly the time when employers are trying to figure out how fast they can reasonably get out of the middle of health insurance administration and run for the hills.
Walgreens has been ordered to pay $1.44 million in a lawsuit brought against it for a violation of the Health Insurance Portability and Accountability Act (HIPAA) by one of its pharmacist employees. While this may not sound like a big deal, this case represents only the second time HIPAA has been successfully used this way in court and it could have serious repercussions on the health care system.
The story begins when a Walgreens pharmacist looked up the medical records of her husband’s ex-girlfriend, whom she suspected gave her husband an STD. Apparently she found what she was looking for and told her husband about it, who then sent a text message to his ex and informed her that he knew all about her results.
The ex did not appreciate this, and told the Walgreens pharmacy about what happened. At some point after that, the pharmacist accessed the ex’s medical records again, and eventually the ex filed a lawsuit against Walgreens, claiming it was responsible for the HIPAA violation because it failed to properly educate and supervise its employee.
Walgreens argued what the pharmacist did fell outside of her job duties and therefore it was not responsible for the breach. The judge and jury disagreed, and the jury decided Walgreens was responsible for 80% of the damages owed the plaintiff (so I guess that means the total judgement for the plaintiff was $1.8 million). Walgreens has already said it will appeal.
As I said above, it may not sound like a big deal, but it potentially is.
Although HIPAA has a mechanism by which health care providers can be subject to federal civil and criminal penalties for violations, conventional legal wisdom says HIPAA does not allow for a “private cause of action”, meaning a private individual cannot sue a health care provider for breaching their medical privacy.
Or at least that’s how HIPAA used to be interpreted, before Neal Eggeson, the enterprising young attorney who successfully argued the only two cases in which HIPAA has been used in this fashion, came along.
Walgreens, the country’s largest drugstore chain, announced on April 4th that its 330+ Take Care Clinics will be the first retail store clinics to both diagnose and manage chronic conditions like asthma, diabetes, high blood pressure, and high cholesterol. The Nurse Practitioners (NPs) and Physician Assistants (PAs) who staff these clinics will provide an entry point into treatment for some of these conditions, setting Walgreens apart from competitors like Target and CVS whose staff help manage already-established chronic illnesses or are limited to testing for and treating minor, short-lived ailments like strep throat.
A one-stop shop for toothpaste, prescription drugs, and a diabetes diagnosis? The retail clinic phenomenon has its appeal: it allows patients convenience and better access to care through longer hours and more locations than our health care system now provides. Walgreens leaders bill their latest offering as a complementary service to traditional medical care. They envision close collaboration with physicians and even inclusion in Accountable Care Organizations, according to reporting by Forbes’ Bruce Japsen (though it’s not clear how the retailer would share the financial risk or savings in such a model).
And three were created by a pharmacy chain.
Walgreens’ move into shared savings is many things: unusual, eye-catching, a sign of the times.
But it’s not surprising, observers say, as the pharmacy chain has been cultivating a broader strategy to ramp up its role in frontline care. And through a handful of new programs, Walgreens already has “demonstrated … the valuable role our pharmacists can play working with physicians to meet the triple aim” of improving patient outcomes and satisfaction while cutting health costs, spokesperson Jim Cohn told me.
“ACOs are the next step.”
Target, Walgreens and CVS have recently started medical clinics in their stores. Opening up these “retail clinics” seems both potentially profitable and, at first blush, somehow pushes the lines on our tradition view of where medical services should be located. Giving the concept of retail clinics some thought might reveal store-based providers to be convenient and cost-effective, or alternatively full of conflicts of interest and potential harms. Should we be worried about retail clinics turning into the Walmart of medicine?
The retail clinic industry appears to have grown rapidly over the last few years. Most of these clinics are run by three large chains–Target, Walgreens and CVS–but there are also a mix of smaller providers branching out of existing chains like the Mayo Clinic. Their primary use seems to be the treatment of acute “urgent care” conditions such as symptomatic treatment of upper respiratory tract infections (lots of sore throats), or providing simple preventive care such as vaccinations. Most patients who visit these retail clinics will see a nurse practitioner. According to a recent study that tracked the growth of these clinics from 2007 to 2009, there was a four-fold rise in the number of these clinics, such that there are now over 1,200 retail clinics that see almost 6 million visits per year.
Walgreens is being sued by customers who are not happy that their prescription information – even though it has been de-identified – is being sold by Walgreens to data-mining companies.
The data privacy and security concerns surrounding the transfer of de-identified data are significant. To “de-identify” what is otherwise protected health information under HIPAA, some outfits will simply strip data of 18 types of identifiers listed in federal regulations. However, the relevant regulation (45 CFR 164.514(b)(2)(ii)) also provides that this only works if “the covered entity does not have actual knowledge that the information could be used alone or in combination with other information to identify an individual who is a subject of the information.” Thus, the problem with this approach is that, these days, nobody can disclaim knowledge of the fact that information de-identified by removing this cookbook list of 18 identifiers may be re-identified by cross-matching data with other publicly-available data sources. There are a number of reported instances of this sort of thing happening. The bottom line is that our collective technical prowess has outstripped the regulatory safe harbor.
Is this the basis of the lawsuit brought against Walgreens? An objection to trafficking in health information that should remain private? No. The plaintiff group of customers is suing to share in the profits realized by Walgreens from trading in the de-identified data.Continue reading…
about the social life of health information and the internet’s power to
connect people with information and with each other. Living with
chronic disease is associated with being offline – no surprise. What’s
amazing and new is our finding that if someone can get access to the
internet, chronic disease is associated with a higher likelihood to not
only gather health information but to share it, to socialize around it.
my talk around two examples of how health care can either take advantage
of patients’ shared wisdom (and innovate) or ignore it (and fail).
innovation example was CureTogether’s crowd-sourced migraine findings: 147 treatments were evaluated
and ranked according to their effectiveness and popularity, with some
surprising results. My fail example was taken from Diana Forsythe’s
classic essay, “New Wine, Old Bottles.” Designers of a migraine
information resource asked a single doctor what he thought patients
should know, rather than going directly to the patients. Not
surprisingly, the number one question asked by newly diagnosed migraine
sufferers was not addressed: Am I
going to die from this? Ridiculous to a doctor, but
essential to a patient.