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America, the intolerant

BY ANISH KOKA

Historically, the great tension between liberty and authority was between government as embodied by the ruling class and its subjects.  Marauding barbarians and warring city-states meant that society endowed a particular class within society with great powers to protect the weaker members of society.  It was quickly recognized that the ruling class could use these powers for its own benefit on the very people it was meant to protect, and so society moved to preserve individual liberties first by recognizing certain rights that rulers dare not breach lest they risk rebellion.  The natural next step was the establishment of a body of some sort that was meant to represent the interests of the ruled, which rulers sought agreement and counsel from, and became the precursor to the modern day English parliament and the American Congress.  Of course, progress in governance did not end with rulers imbued with a divine right to rule being held in check by third parties.  The right to rule eventually ceased to be a divine right, and instead came courtesy of a periodical choice of the ruled in the form of elections.  The power the ruled now wielded over those who would seek to rule lead some to wonder whether there was any reason left to limit the power of a government that was now an embodiment of the will of the people.

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One Person’s Trash…

BY KIM BELLARD

Gosh, so much going on.  Elizabeth Holmes was finally sentenced.   FTX collapsed.  Big Tech is laying off workers at unprecedented rates, except TikTok, which should, indeed, be cautionary.  Elon Musk’s master plan for Twitter remains opaque to most of us. Americans remain contentedly unworried about the looming COVID wave

With all that to choose from, I want to talk about space debris.  More specifically, finding opportunity in it, and in other “waste.”  As the old saying goes, one person’s trash is another person’s treasure, so one person’s problems are another person’s opportunities.  

And, yes, there are lessons for healthcare.

Getting to space has been one of humankind’s big accomplishments. We’re so good at it that earth’s orbit has become a “graveyard” for space debris – dead or dying satellites, pieces of rockets, things ejected from spaceships, and so on.  Space is pretty big, but the near-Earth debris is getting to the point when avoiding it becomes an issue for the International Space Station and other orbiting objects.  

Scientists now fear that climate change will impact the upper atmosphere in ways that will cause space debris to burn up in it less often, making the problem worse. 

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When Push Comes to Shove: The AMA v. Dobbs. Part 2.

BY MIKE MAGEE

On November 8, 2022, five days after the 2022 Midterm elections, the AMA raised its voice in opposition to Republican efforts to promote second class citizenship for women by exerting public control over them and their doctors intensely private reproductive decisions. At the same time they sprinkled candidates on both sides of the aisle with AMA PAC money, raising questions whether their love of women includes active engagement or just passive advocacy.

Trump and his now MAGAGA (“Make America Great and Glorious Again”) movement has now returned to center stage. With the help of Senate Majority leader McConnell, Christian Conservatives had packed the Supreme Court with Justices committed to over-turning Roe v. Wade. And they did just that.

On June 24, 2022, a Supreme Court, dominated by five conservative Catholic-born Justices, in what experts declared “a historic and far-reaching decision,” Dobbs v. Jackson Women’s Health Organization, scuttled the half-century old right to abortion law, Roe v. Wade, writing that it had been “egregiously wrong,” “exceptionally weak” and “an abuse of judicial authority.”

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When Push Comes to Shove: The AMA v. Dobbs. Part 1.

BY MIKE MAGEE

Should anyone present know of any reason that this couple should not be joined in holy matrimony, speak now or forever hold your peace.”     Book of Common Prayer, Church of England, 1549

Last evening Trump rose from the ashes and declared it was time to “Make America Great and Glorious Again” (MAGAGA).

This past week, five days after the Midterm elections, AMA President, Jack Resnick, Jr., MD, raised his voice from the podium at the AMA Interim Meeting in Hawaii with the AMA’s own version of a call to action:

But make no mistake, when politicians insert themselves in our exam rooms to interfere with the patient-physician relationship, when they politicize deeply personal health decisions, or criminalize evidence-based care, we will not back down…I never imagined colleagues would find themselves tracking down hospital attorneys before performing urgent abortions, when minutes count … asking if a 30% chance of maternal death, or impending renal failure, meet the criteria for the states exemptions … or whether they must wait a while longer, until their pregnant patient gets even sicker…Enough is enough. We cannot allow physicians or our patients to become pawns in these lies.”

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Is Care Navigation Healthcare’s Next ‘Gold Mine’? Quantum Health’s Move to Win Over Larger Employers

BY JESSICA DaMASSA, WTF HEALTH

One-to-watch as a potential health tech IPO this year is care navigator Quantum Health, and I’m talking to CEO Zane Burke about both their breaking new product launch AND the key differences between Quantum and the increasingly competitive field of other employer benefits advocacy-based businesses like Accolade, Rightway, and Transcarent.

Private equity backed, two-decades old, and EBITA positive, Zane says Quantum Health is delivering an ROI of “over two-and-a-half to one” to its client roster of 450 top large, self-insured employers and saving more than 14% on all healthcare costs over time. The new product – Quantum Health Access – is a streamlined, more flexible version of the soup-to-nuts Complete Care offering capable of yielding these results, and it’s being offered to give the largest of employers (those big enough to be working with multiple health plans, for example) a way to start out with Quantum’s data-driven navigation tools without a total overhaul of their current benefits situation.

Zane explains Quantum’s “real-time intercept tool” and how it not only helps engage high-utilizers in an employer’s plan (aka those who spend more than $10,000 in claims), but how 85% of the time it catches them on their care journey before they’ve spent a thousand dollars – creating an early opportunity to provide better routing and, ultimately, reduce overall costs. The upside for Quantum? “Employers have long thought of the carriers as this is their responsibility, but the carriers are really maximizing around their siloed system to pay a claim, do the disease management, get you off the phone and into somebody else’s queue,” explains Zane. “Our model is, ‘hey…every single one of those interactions is a gold mine.’”

We get further into the details around the new Quantum Health Access product, and, more importantly, what Zane sees as Quantum’s key point of differentiation against Accolade, Rightway, Transcarent, and the rest. Tune in around the 20-minute mark to hear this bit and to find out what Quantum’s doing with provider data that makes “everybody else that talks that game” look like they are just playing “Pick Up Sticks.”

Our Plants Should Be Plants

BY KIM BELLARD

It seems like most of my healthcare Twitter buddies are enjoying themselves at HLTH2022, so I don’t suppose it much matters what I write about, because they’ll all be too busy to read it anyway.  That’s too bad, because I was sparked by an article on one of my favorite topics: synthetic biology.  

Elliot Hershberg, a Ph.D. geneticist who describes his mission as “to accelerate the Century of Biology,” has a great article on his Substack: Atoms are local.  The key insight for me was his point that, while we’ve been recognizing the power of biology, we’ve been going about it the wrong way.  Instead of the industrialization of biology, he thinks, we should be seeking the biologization of industry.

His point:

Many people default to a mindset of industrialization. But, why naively inherit a metaphor that dominated 19th century Britain? Biology is the ultimate distributed manufacturing platform. We are keen to explore and make true future biotechnologies that enable people to more directly and freely make whatever they need where-ever they are.

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The Dangers of EMR-Defaulted Prescription Stop Dates

By HANS DUVEFELT

It happens in eClinicalworks, I saw it in Intergy, and I now have to maneuver around it in Epic. Those EMRs, and I suspect many others, insert a stop date on what their programmers think (or have been told) are scary drugs.

In my current system all opioid drug prescriptions fall into this category. For a short term prescription that might perhaps be a good idea but for a longer-term or occasionally needed prescription it creates the risk of medical errors.

In Epic there is a box for duration, which is very practical for a ten day course of antibiotics. If I fill in the number 10 in the duration box, the medication falls off the list after 10 days. This saves me the trouble of periodically cleaning up the list.

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THCB Gang Episode 106, Thursday November 10

After an early Fall hiatus, THCB Gang is back!! Joining Matthew Holt (@boltyboy) for #THCBGang on Thursday November 10 were medical historian Mike Magee (@drmikemagee); futurist Jeff Goldsmith; THCB regular writer and ponderer of odd juxtapositions Kim Bellard (@kimbbellard); and policy consultant/author Rosemarie Day (@Rosemarie_Day1). You can imagine that elections were on our collective minds.

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.

Virtual Care Regulatory Round-Up: Ro’s Z Reitano & Virtual-First’s Power to Control the Care Journey

by JESSICA DAMASSA, WTF Health

“What happens when there is a massive shift of where the beginning of a journey occurs…that sort of affords the opportunity for everyone after that to be disintermediated.” So says Zachariah “Z” Reitano, co-founder & CEO of Ro, arguably one of the most successful OG virtual-first care companies which has been providing telehealth-plus-testing-plus-pharmacy-delivery (and now a whole lot more) via its Roman and Rory brands since 2017.

As health tech companies – and now, more and more incumbent orgs and retail health providers – evolve their own “omnichannel” strategies, we talk to Z about Ro’s direct-to-patient care model, and what we can learn from its successful operation and expansion as one of the first “digitally native” healthcare providers.

To Z, the technology is just an enabler to a larger shift in how people are ultimately gaining more control over their health. Technology can turn luxuries into commodities, he says, and, at Ro, that’s translating into a concept they’re calling “goal-oriented healthcare,” which is basically providing the “luxury” of giving a patient what they want, when they want it; easily, conveniently, and affordably.

In short, Z explains: “Patients come to us, and they say what they want to achieve: ‘I want to lose weight…I want to have a child…I want to improve my mental health…I want to improve my skin…I want to have better sex.’ And then, we help them from beginning to end in the most convenient and effective way possible.”

The role of digital in all this is critical. It allows for costs to be stripped out, for providers to be able to practice at the top of their licenses, and for data to be shared between provider and patient asynchronously (aka conveniently.) But, it sounds like what’s most exciting about ‘virtual-first’ to Z is the “first” part – having the opportunity to initialize the relationship with the patient, then “raise the standard of where we guide people afterwards, and have the opportunity to disintermediate and really heavily influence the entire patient journey.”

Oooohh – can’t hear enough about this! Tune in to find out more about how Z sees virtual-first care as changing patients’ relationships with the healthcare system AND, because we had to talk a little policy too, get his thinking on how barriers like state licensure that are often looked at as constraints to ‘virtual care at-scale’ might also be evolving to help enable that shift.

* 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 www.wheel.com.

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