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Medicine is a Moving Missile, Aiming for a Dangerous, Elusive Target

By HANS DUVEFELT

(Desperate times called for desperate measures.)

In the tech world, we have come to expect our devices to become outdated and obsolete very quickly. The biggest tech companies in the world didn’t even exist a few years ago. Bitcoin, a virtual currency which at least I can’t wrap my head around, seems to be more attractive than gold.

I get the sense most people embrace or at least accept the speed of change in tech.

But medical advances that occur rapidly are frightening to many people. Vaccine hesitancy, for example, involves concerns and characterizations like “unproven” and “guinea pigs”.

But can we as a society strive for and reward rapid progress in one area and reject it in another, especially if we feel threatened by outside forces or phenomena – be that a virus, climate change or the collapse of our economy’s infrastructure like supply chains and raw materials.

Tech has its own momentum, more driven by profit motives than altruistism or a desire just to make peoples lives better. Medicine clearly has profit as a driving force, but also a goal of improving life for people. Curing or mitigating disease must rank higher than making life more convenient.

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THCB Spotlights: Dan Goldsmith and Jennifer Goldsmith, Tendo

Today on THCB Spotlight, Matthew sits down with Tendo’s CEO, Dan Goldsmith, and President, Jennifer Goldsmith. Tendo is in the patient engagement space, and Jennifer tells us about the vision behind the company – to become that trusted connection between patients, clinicians, and caregivers via software that creates a seamless and consumer-driven experience throughout that care journey. They talk to us about the plethora of point solutions for patient engagement, and how the platform approach that Tendo takes is meant to support a patient’s comprehensive needs without placing the full burden on the patients themselves.

THCB Gang Episode 66 – Thurs October 7

Joining Matthew Holt (@boltyboy)on THCBGang were policy consultant/author Rosemarie Day (@Rosemarie_Day1) ; delivery & tech expert Vince Kuraitis (@VinceKuraitis); and Queen of all employer benefits related issues Jennifer Benz (@Jenbenz)

We dive into the latest machinations in Congress, talked a lit about the practicalities and impacts of vaccination mandates, and had a long discussion about the tech platforms being built out of incumbent health systems.

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.

State of Connecticut’s New ‘Episodes-of-Care Health Plan’ Could Be Key to Scaling Value-Based Care

By JESSICA DaMASSA, WTF HEALTH

Signify Health (NYSE: SGFY) has called their approach “Value-Based Care 2.0” and, today, they’ve received an important designation from CMS that could set an exciting precedent for scaling up episodes-of-care, value-based models for the under 65 commercial health insurance market. The plan to receive this important approval as an Advanced Alternative Payment Model (AAPM) is the State of Connecticut’s health plan – a massive plan that covers the State’s 220,000 employees and retirees. To talk about what this first-of-its-kind approval signals for the future of value-based payment models are the State of Connecticut’s Comptroller Kevin Lembo and Signify Health’s CEO Kyle Armbrester.

What’s so important here is the combination of episodes-of-care (which is like value-based care-lite) and the under-65 market (which is not as rich with value-based care case studies as the over-65 Medicare market). That a State government with a massive population of covered lives AND a vested interest in helping keep local hospitals and health systems vibrant economic engines in the community is leading the way on this novel payment model design is significant. And, Comptroller Lembo gives us the details about how he’s viewing it as a win-win – after quite a few battles along the way. To win in health innovation, you’ve got to follow the dollar! Tune into this chat to see where it’s headed as episodes-of-care models get a huge boost from CMS.

#Healthin2Point00, Episode 232 | Cue Health goes public + funding for Stellar, eVisit, & Neuroglee

Today on Health in 2 Point 00, Jess and I are at UCSF – we’ll be providing color commentary for the UCSF Health Awards, so tune in tonight for that. On Episode 232, Jess asks me about more deals including Stellar Health raising $60 million, Cue Health going public (and stealing the HLTH ticket), and eVisit raising $45 million for its telehealth solution. Finally, Neuroglee raises $10 million in an Alzheimer’s play. —Matthew Holt

The Vaccine Brawl – A Legal Battle in Process

By MIKE MAGEE

The power to mandate vaccines was litigated and resolved over a century ago. Justice John Marshall Harlin, a favorite of current Chief Justice Roberts, penned the 7 to 2 majority opinion in 1905’s Jacobson v. Massachusetts. Its impact was epic.

In 1905, Massachusetts was one of 11 states that required compulsory vaccinations. The Rev. Henning Jacobson, a Lutheran minister, challenged the city of Cambridge, MA, which had passed a local law requiring citizens to undergo smallpox vaccination or pay a $5 fine. Jacobson and his son claimed they had previously had bad reactions to the vaccine and refused to pay the fine believing the government was denying them their due process XIV Amendment rights.

In deciding against them, Harlan wrote, “liberty for all could not exist under the operation of a principle which recognizes the right of each individual person to use his own [liberty]…” 

Of course, a state’s right to legislate compulsory public health measures does not require them to do so. In fact, as we have seen in Texas and Florida among others, they may decide to do just the opposite – declare life-saving mandates (for masks or vaccines) to be unlawful. At least 14 states have passed laws barring employer and school vaccine mandates and imposing penalties in Republican-controlled states already.  

So state powers are clearly a double-edged sword when it comes to health care. 

Questions anyone?

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You Want to 3D Print What

By KIM BELLARD

You know we’re living in the 21st century when people are 3D printing chicken and cooking it with lasers.  They had me at “3D printing chicken.”  

An article in NPJ Science of Food explains how scientists combined additive manufacturing (a.k.a, 3D printing) of food with “precision laser cooking,” which achieves a “higher degree of spatial and temporal control for food processing than conventional cooking methods.”  And, oh, by the way, the color of the laser matters (e.g., red is best for browning).   

Very nice, but wake me when they get to replicators…which they will.  Meanwhile, other people are 3D printing not just individual houses but entire communities.   It reminds me that we’ve still not quite realized how revolutionary 3D printing can and will be, including for healthcare. 

The New York Times profiled the creation of a village in Mexico using “an 11-foot-tall three-dimensional printer.”  The project, being built by New Story, a nonprofit organization focused on providing affordable housing solutions, Échale, a Mexican social housing production company, and Icon, a construction technology company, is building 500 homes.  Each home takes about 24 hours to build; 200 have already been built.

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We Shouldn’t Tolerate Sloppy Allergy Lists

By HANS DUVEFELT

The medication and allergy lists seem like they would be the most important parts of a health record to keep current and accurate. But we all see errors too often.

I think it shouldn’t be possible to enter an allergy without describing the reaction. Because without that information the list becomes completely useless.

The other day I saw a patient who needed an urgent CT angiogram. The allergy list said “All Contrast Materials”, which isn’t even “structured data entry”, and thus not recognized by the computer if my EMR (Me again, Greenway!) would have been clever enough to check for allergies when I order a CT scan.

After a lot of probing, the “allergy” in this case turned out to be a host of nonspecific, chronic symptoms after several lumbar CT myelograms in a short period of time many years ago.

Some people claim to be penicillin allergic because “it never works”. Others list ciprofloxacin or sulfa antibiotics because they get a yeast infection after taking them. Others were slightly nauseous after their first dose of an SSRI like fluoxetine or fatigued after starting gabapentin.

Some symptoms listed as allergies are poorly understood. For example, morphine causes itching in many patients, even skin manifestations like blushing as well as sweating. But this is not usually a histamine mediated symptom, and not an allergy. Other opioids, like hydromorphone, tend to have less risk for itching.

Cough from ACE inhibitors isn’t a true allergy, but we often note that in our allergy lists. People with this side effect can safely be switched to angiotensin receptor blockers, ARBs.

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THCB Gang Episode 65 – Thurs September 30

It has been WAY too long and for too many reasons (conferences, travel, a hurricane flooding out 4 East Coast guests) we haven’t got together but #THCBGang is back.

Joining Matthew Holt (@boltyboy) will be fierce patient activist Casey Quinlan (@MightyCasey);  THCB regular writer Kim Bellard (@kimbbellard); ; medical historian Mike Magee (@drmikemagee); and board-certified patient advocate Grace Cordovano (@GraceCordovano).

We opined a lot on the latest machinations in Congress, we talked about access to data (especially images) and we really enjoyed getting in touch with each other for a great hour!

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.

Never Waste a (Design) Crisis

By KIM BELLARD

The Wall Street Journal reported that the American Dental Association (ADA) opposes expanding Medicare to include dental benefits.  My reaction was, well, of course they do. 

They apparently don’t care that at least half, and perhaps as many as two thirds, of seniors lack dental insurance, or that one in five seniors are missing all their teeth.  The ADA prefers a plan for low income Medicare beneficiaries only, although state Medicaid programs were already supposed to be that, with widely varying results between the states. 

The ADA is following blindly in the AMA’s opposition to enactment of Medicare, ignoring how fruitful Medicare has turned out to be for physicians’ incomes.  It’s all about the money, of course; the ADA thinks dentists can get more money from private insurance, or directly from patients, than they would from Medicare, and they’re probably right.    

As is typical for our healthcare system, good design is no match for interfering with the incomes of the people/organizations providing the care. 

By the same token, I suspect that the real opposition to “Medicare for All” is not from health insurers but from healthcare providers.  Health insurers, a least the larger ones, have done quite nicely with Medicare Advantage, and would probably welcome moving members from those balkanized, largely self-funded employer plans to Medicare Advantage plans. 

No, the bloodbath in Medicare for All would be the loss in revenue of health care professionals/organizations missing out on those lucrative private pay rates.  As Upton Sinclair once observed, “It is difficult to get a man to understand something when his salary depends upon his not understanding it.”  Or, as Guido tells Joel in Risky Business, “never, ever, fuck with another man’s livelihood.”

Very little about our healthcare system has been consciously designed.  It’s a patchwork of efforts – legislative/regulatory initiatives, tax provisions, entrepreneurial choices, independent design decisions — and many unintended consequences.   We should be less surprised at how poorly they all fit together than that some of them fit at all.   Find someone who is happy with our current healthcare system and I bet that person is either making lots of money from it, or not receiving any services from it. 

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