The Health Care Blog – Page 105 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Medicine May Be an Art, but AI May Be Artists

Oct 26, 2021

By KIM BELLARD

Six hundred years ago, Swiss physician/scientist/philosopher Paracelsus disclaimed: “Medicine is not only a science; it is also an art.” Medicine, most people in healthcare still believe, takes not just intelligence and fact-based decision-making, but also intuition, creativity, and empathy. This duality is often cited as a reason artificial intelligence (A.I.) will never replace human physicians.

Perhaps those skeptics have not heard about Ai-Da.

Now, I have to admit, “she” wasn’t on my radar either until recently, when she was imprisoned/impounded at customs by Egyptian authorities on her way to an art exhibit at the Great Pyramids of Giza, where she was scheduled to show her work. Egyptian authorities first objected to her modem, then to the cameras in her eyes. “I can ditch the modems, but I can’t really gouge her eyes out,” said her creator Aidan Meller. After a 10 day stand-off, she was released late last week.

Let me back up. Named in honor of famed 19^th century mathematician/programmer Ada Lovelace, Ai-Da is “the world’s first ultra-realistic humanoid robot artist.” She was created in 2019, and uses AI algorithms to create art with her cameras/eyes and her bionic arms. She can draw, paint, even sculpt, and had her first major exhibit – Ai-Da: Portrait of the Robot — this summer at London’s Design Museum.

The description of her exhibit says:

As humans increasingly merge with technology, the self-titled robotic artist, Ai-Da, leads us to ask whether artworks produced by machines can indeed be called ‘art’…Ai-Da can both draw and engage in lively discussion…These features, and the movements and gestures that Ai-Da is programmed to perform, raise questions about human identity in a digital age.

Her website elaborates:

…current thinking suggests we are edging away from humanism, into a time where machines and algorithms influence our behaviour to a point where our ‘agency’ isn’t just our own. It is starting to get outsourced to the decisions and suggestions of algorithms, and complete human autonomy starts to look less robust. Ai-Da creates art, because art no longer has to be restrained by the requirement of human agency alone.

State-Based Marketplaces 2.0 Part 2: Engines of Innovation, Competition, and Consumerism

Oct 25, 2021

By ROSEMARIE DAY and DAVID W. JOHNSON

Within the current political reality, how can America implement policies that increase access to health insurance while also reducing premium costs and enhancing responsiveness to consumer priorities and needs?

Large-scale healthcare reform appears off-the-table for the Biden Administration. Yet, given the impact of the COVID pandemic on people who have lost (or have worried about losing) their employer-based insurance coverage and the intensifying pressure to reduce overall healthcare costs, solutions that increase health insurance access and affordability have become more important than ever. A significant answer to this complex puzzle can be found at the state level.

Enabled by the Affordable Care Act (ACA) in 2010, state-based marketplaces (SBMs) currently operate in 14 states and the District of Columbia. Another six states operate as SBMs using the federal government’s HealthCare.gov technology platform. Three states, Kentucky, Maine, and New Mexico, will become full SBMs by 2022.

While federal measures to improve insurance access have stalled or been reversed over the past eight years, SBMs have quietly implemented programming modifications for stabilizing local markets that improve the quality and marketability of health insurance offerings to the benefit of consumers.

In Part 2 of our series on marketplace health plan innovations, we examine how SBMs have operated as experimental policy laboratories. They’ve taken their own paths to expand consumer choice, increase access to vital healthcare services, and lower premiums.

The “Secret Sauce” – A Comparison of TSMC and Pfizer

Oct 22, 2021

By MIKE MAGEE

This week’s Tom Friedman Opinion piece in the New York Times contained a title impossible to ignore: “China’s Bullying Is Becoming a Danger To The World and Itself.” The editorial has much to recommend it. But the item that caught my eye was Friedman’s full-throated endorsement of Taiwan’s “most sophisticated microchip manufacturer in the world,” Taiwan Semiconductor Manufacturing Company (TSMC).

TSMC owns 50% of the world’s microchip manufacturing market, and along with South Korea’s Samsung, is one of only two companies currently producing the ultra-small 5-nanometer chips. Next year, TSMC will take sole ownership of the lead with a 3-nanometer chip. In this field, the smaller the better. (For comparison, most of China’s output is 14 to 28 nanometers.)

U.S. Silicon Valley companies like Apple, Qualcomm, Nvidia, AMD, and recently Intel contract with TSMC rather than produce chips on their own. In addition, the key machines and chemicals necessary to produce the chips are willing supplied to TSMC by U.S. and European manufacturers. TSMC’s secret sauce, according to Friedman, is “trust.” As he writes, “Over the years, TSMC has built an amazing ecosystem of trusted partners that share their intellectual property with TSMC to build their proprietary chips.”

“Trust me” is not a phrase often associated with intellectual property. Consider, for example, Washington Post’s reporting the very same day as Friedman’s under the banner, “In secret vaccine contracts with governments, Pfizer took hard-line in the push for profit, report says.” The article reveals documents in a Public Citizen report that confirms that Pfizer has been maximizing their vaccine profits “behind a veil of strict secrecy, allowing for little public scrutiny… even as demand surges…”

As I describe in my book “Code Blue: Inside the Medical Industrial Complex” (Grove 2020), Pfizer’s focus on intellectual property as a commercial weapon has a history that extends back a half-century.

THCB Gang Episode 69 – Thurs October 21 — Alex Drane Special!

Oct 21, 2021

I am so thrilled that as part of my East coast jaunt I got to do another special #THCBGang. This one is with the amazing Alex Drane, CEO of Archangels. Who among other things has almost singlehandedly changed the conversation about SDOH and lots more in this country. And you know that’s true because Jeff Goldsmith has said as much on #THCB Gang many times.

Listen to Alex’s career trajectory as an entrepreneur; how she discovered and publicized the “Unmentionaables“; the good and the bad of her leaving Eliza, and the incredibly important work she is doing with Archangels. All packed into 45 mins!

This is be available as a video below and a podcast on Apple and Spotify from Friday.

We Use Too Many Medications: Be Very Afraid of Interactions

Oct 21, 2021

By HANS DUVEFELT

I happened to read about the pharmacodynamics of parenteral versus oral furosemide when I came across a unique interaction between this commonest of diuretics and risperidone: Elderly dementia patients on risperidone have twice their expected mortality if also given furosemide. I knew that all atypical antipsychotics can double mortality in elderly dementia patients, but was unaware of the additional risperidone-furosemide risk. Epocrates only has a nonspecific warning to monitor blood pressure when prescribing both drugs.

This is only today’s example of an interaction I didn’t have at my fingertips. I very often check Epocrates on my iPhone for interactions before prescribing, because – quite frankly – my EMR always gives me an entire screen of fine print idiotic kindergarten warnings nobody ever has time to read in a real clinical situation. (In my case provided by the otherwise decent makers of UpToDate.)

I keep coming back in my thoughts and blogging about drug interactions. And every time I run into one that surprised me or caused harm, I think of the inherent, exponential risks of polypharmacy and the virtues of oligopharmacy.

You Need a Cyber Team

Oct 20, 2021

By KIM BELLARD

Maybe you, like me, are an Olympics fan (in my case: Summer Games, track & field). Most Americans look forward eagerly to the Super Bowl, while the rest of the world (and, increasingly, many in the U.S.) are waiting for the World Cup. But too few of us are aware that next summer will be the inaugural International Cyber Security Challenge, an esports event that pits teams from multiple countries against each other in cybersecurity skills. The U.S. is sending a 25 person team.

So what, you might say? Well, if you work in healthcare (or any industry, for that matter), or use any kind of digital device, you should care. Ransomware attacks on healthcare organizations continue to proliferate. The Colonial Pipeline cyberattack this past spring illustrated the weakness of other parts of our critical infrastructure, and we’ve all almost certainly had some of our personal data exposed in data breaches.

We’re in a war, but it’s not clear that we have the right army, with the right weapons, ready to fight it. Thus the U.S. Cyber Games.

In “Riding” Abortion, Is Greg Abbott Driving Texas Toward Divestiture?

Oct 19, 2021

By MIKE MAGEE

Texas Governor Greg Abbott has been on a tear lately, and his central theme appears to be “revanchism.” Faced with declining demographics, he is retaliating against enemies and newcomers alike, aligning himself with slippery politicians and vigilantes. As they say in Texas, “He’s on a first-name basis with the bottom of the deck”, and the game he’s playing appears to be “South Africa – 1950.”

The formal establishment of apartheid in South Africa occurred in 1948, though racial injustice had been baked in centuries earlier. Violence and intimidation, embedded in legislation supported by a 15% white minority, led to the creation of the African National Congress (ANC) which launched what they called their “Defiance Campaign.” By 1962, their party had been outlawed, and their dynamic leader, Nelson Mandela, was imprisoned.

And yet resistance continued to grow, inside and outside the country. Religious leaders, like Archbishop Desmond Tutu, took to the street, organizing huge, peaceful rallies. In 1976, images of Black children being attacked and killed in Soweto township during a protest spread like wildfire around the world. 176 died and thousands were injured. In response, the United Nations called on its member states to divest and impose economic sanctions. Only 2 leaders did not. (More on that in a moment.)

Minority rule, oppression, vigilantism, and disenfranchisement are eventually losing propositions as Greg Abbott is learning. A majority of 52% now say his state is moving in the wrong direction. The list of grievances is long and continues to grow. Catholic bishops decried his inhumane handling of immigrant families this year. Baptist minister Rev. Frederick Haynes III spotlighted the Republican legislature’s voter suppression law recently suggesting they were “dressing up Jim and Jane Crow in a tuxedo.” Only 39% approve of his handling of the pandemic, and many Texans find the renewed endorsement of “vigilante justice” for unfortunate women and girls seeking abortions to be a disturbing and dystopian new reality. By the way, 1 in 5 Texans lack health insurance, and Texas is one of twelve Republican-led states that continue to refuse federal offers to expand Medicaid coverage of their citizens.

State-Based Marketplaces 2.0 – Part 1: The Coming Expansion in Access, Affordability, and Value

Oct 18, 2021

By ROSEMARIE DAY and DAVID W. JOHNSON,

The Affordable Care Act (ACA) survived its third challenge at the Supreme Court on June 18, 2021, by a 7-2 vote, signaling that Obamacare is here to stay. With a divided Congress and a Biden administration challenged by multiple urgencies, there is little hope for national legislation to address healthcare’s access, cost, and quality deficiencies comprehensively.

Despite this lack of dramatic progress or sweeping change at the federal level, reformers need not lose hope. Quietly, state-based marketplaces are making health insurance provision more accessible, affordable and effective.

A Biden Administration’s executive order signed in January 2021, reopened the federal health insurance marketplace to individuals seeking to purchase or modify health insurance policies. The fifteen state-based marketplaces (SBMs) followed suit by enacting their own versions of this special enrollment period.

The Administration’s $1.9 trillion American Rescue Plan, enacted on March 11, 2021, includes a narrow but powerful provision that temporarily grants premium subsidies to higher-income Americans and reduces premium costs for lower-income Americans. The “Build Back Better Act” currently moving through the House of Representatives would make these subsidies permanent. It would also provide funding for more experimentation with state-based health insurance affordability programs.

These new policies align with measures undertaken by many SBMs during the past eight years to improve the quality, affordability, and marketability of their health insurance offerings. In this decentralized, real-world way, SBMs have operated as experimental policy laboratories to assess programming modifications for stabilizing local markets, expanding consumer choice, increasing access to vital healthcare services, and lowering premiums.

Walmart Picks Transcarent: Tullman on First ‘Everyday Low Prices’ Offer for Self-Insured Employers

Oct 15, 2021

By JESSICA DaMASSA, WTF HEALTH

Walmart is looking to scale its healthcare business in a brand-new way: setting its sights on self-insured employers. Today the retail giant announced a go-to-market partnership with Transcarent that will make its “everyday low price” prescription drugs and healthcare services available to self-insured employers for the very first time. Transcarent’s Executive Chairman & CEO Glen Tullman drops in to give us the inside story on the deal with Walmart, what it means for the industry, and how it could once-and-for-all ignite the ‘disruption of the payer’ that we’ve been waiting for since JP Morgan, Berkshire Hathaway, and Amazon came together to found Haven.

Transcarent and Glen are hell-bent on re-making the healthcare payment model by eliminating as many middlemen as possible, reshaping the health and care experience along the way. So, what does this partnership with Walmart mean for that mission and for Transcarent? Is this “THE Deal” we’ll look back on as the one that catapulted Transcarent into a new phase of growth? Remember when Glen’s last company, Livongo, shot into the stratosphere after its deal with CVS Health? I ask Glen if he’s running the same play in a much bigger game and finally concede: Transcarent is NOT a healthcare navigator!

#Healthin2Point00, Episode 235 | Walgreens Health + VillageMD & CareCentrix, plus more deals

Oct 15, 2021

Today on Health in 2 Point 00, Noom launches a mental health offering, Noom Mood, Headspace partners with Waze to offer meditation while you drive, and we have one for the Press Release Hall of Fame where Dario Health announces a major partnership with a major national health plan— but doesn’t say who it is. We have some massive deals on Episode 235: Walgreens launches Walgreens Health, acquires a controlling stake of VillageMD, AND acquires a majority stake of CareCentrix; Intelerad acquires Ambra Health for $250 million; Mindbody acquires ClassPass; and Sprinter Health gets $33 million – even though their business model makes no sense. —Matthew Holt