The Health Care Blog – Page 126 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

The Pain Is In Your Brain: Your Knees Know Next to Nothing

Apr 14, 2021

By HANS DUVEFELT

A “frozen shoulder” can be manipulated to move freely again under general anesthesia. The medications we use to put patients to sleep for such procedures work on the brain and don’t concentrate in the shoulder joints at all.

An ingrown toenail can be removed or an arthritic knee can be replaced by injecting a local anesthetic – at the base of the toe or into the spine – interrupting the connection between the body and the brain.

An arthritic knuckle can stop hurting and move more freely after a steroid injection that dramatically reduces inflammation, giving lasting relief long after any local anesthetic used for the injection has worn off.

The experience of pain involves a stimulus, nerve signaling and conscious interpretation.

Our brains not only register the neurological messages from our sore knees, shoulders, snake bites or whatever ails us. We also interpret the context or significance of these pain signals. Giving birth to a long awaited first baby has a very different emotional significance from passing a kidney stone, for example.

I have written before about how we introduce the topic of pain to our chronic pain patients in Bucksport. Professor Lorimer Moseley speaks entertainingly of he role of interpretation in acute pain and also explains the biochemical mechanisms behind chronic pain.

TREATING PAIN WITH ANALGESICS

Even when we are awake, we can reduce orthopedic pains with medications that work on the brain and not really in our joints. A common type of arthritis, such as that of the knees, is often treated with acetaminophen (paracetamol), nonsteroidal anti-inflammatory drugs (NSAIDS) like ibuprofen or even opioids.

#Healthin2Point00, Episode 198 | Microsoft buys Nuance & lots of IPO rumors

Apr 13, 2021

Today on Health in 2 Point 00, Jess claims to be blameless for the drama between Jonathan Bush and Glen Tullman. On Episode 198, we talk about Microsoft buying Nuance for $16 billion and $3 billion in debt – is Microsoft taking over healthcare, and is this going to slow Nuance down? Cohere Health raises $36 million in a Series B, working on improving prior authorizations between health plans and providers. We wrap up with a lightning round of IPO rumors regarding Privia Health, VillageMD, and Bright Health. —Matthew Holt

To Add is Expected, To Subtract is Design

Apr 13, 2021• 1

By KIM BELLARD

A couple years ago I wrote about how healthcare should take customer experience guru Dan Gingiss’s advice: do simple better. Now new research illustrates why this is so hard: when it comes to trying to make improvements, people would rather add than subtract.

That, in a nutshell, may help explain why our healthcare system is such a mess.

The research, from University of Virginia researchers, made the cover of last week’s Nature, under the catchy title Less Is More. Subjects were given several opportunities to suggest changes to something, such as a Lego set-up, a geometric design, an essay or even a travel itinerary. The authors found: “Here we show that people systematically default to searching for additive transformations, and consequently overlook subtractive transformations.”

In the Lego picture here, for example, when asked how to strengthen the upper platform, most people wanted to add new columns, instead of simply removing the existing column. The researchers note: “The subtractive solution is more efficient, but you only notice it if you don’t jump to an additive conclusion.”

Giving cognitive nudges – like explicitly mentioning the option of deleting something – improved the likelihood that people would come up with subtractive options, but increasing cognitive load (through additional tasks) decreased it. Co-author Benjamin Converse said:

Our Healthcare System Needs More Than Policy Overhaul: It’s Time for Private Sector Innovation to Kick into High Gear for Our Health’s Sake

Apr 12, 2021

By SACH JAIN

Last year I was heading to a meeting on a Fortune 500 business campus and stumbled upon a bake sale. It was odd to see someone selling cupcakes and breads on the grounds of a major corporation, so I inquired. As it turns out, Judy, an employee, was selling baked goods to finance her insurance deductible for spinal fusion surgery.

“Is this what our system has come to?” I asked myself, “Fundraisers for fusions?” If so, our health system is broken.

No matter how you slice it, Americans spend more on healthcare than any other advanced economy, with households responsible for 28% of that spend according to CMS. The Affordable Care Act (ACA) attempted to address long-standing deficiencies inherent in our fractured healthcare system. However, creating an insurance marketplace hasn’t solved the problem of affordability or the reality of limited access to quality providers. The concept is great, but without private sector buy-in it will never succeed.

President Biden is taking long-overdue steps to address some of the ACA’s shortcomings with Executive Orders. During his campaign, he suggested other actions, like capping marketplace premiums at 8.5% for all income levels with the goal of spurring enrollment and strengthening the ACA with an affordable public option. The recently passed $1.9 trillion stimulus package also incorporates an increase in government subsidies to health insurers for covering workers laid off due to COVID-19 and those purchasing their own coverage.

This is a start. But it’s not enough. We can’t afford to waste time waiting for policymakers to negotiate rules that may be overturned when a party majority flips.

Doxepin, a Little Known Super Drug in My Personal Black Bag of Tricks

Apr 9, 2021• 2

By HANS DUVEFELT

A while back I was able to completely stop my mastocytosis patient’s chronic hives, which the allergist had been unable to control.

I did it with a drug that has been on the market since 1969 and is taken once a day at a cost of 40 cents per capsule at Walmart pharmacies.

Hives are usually treated with antihistamines like diphenhydramine (Benadryl). My super drug has a 24 hour duration of effect and is about 800 times more potent than diphenhydramine, which has to be taken every fours hours around the clock.

Histamine is involved in allergic reactions, but it also plays a role in stomach acid production. The allergic response happens mostly through stimulation of Histamine 1 receptors and the stomach acid output is regulated mostly via Histamine 2 receptors. Typical antihistamines are blockers of the H1 receptor, or binding site; they don’t do anything except sit there and prevent the real histamine from attaching and starting the allergic chain reaction. While diphenhydramine sits there for 4 hours, loratadine and the other modern, nonsedating (and less itch-decreasing) antihistamines work for 24 hours. Because there is some overlap between H1 and H2 blocking effects, H2 blockers like famotidine can boost the antiallergy effect of the typical H1 blockers. My mastocytosis patient still had hives on diphenhydramine, loratadine and famotidine combined.

But, wait, there’s more…

Jean Drouin, Clarify Health, on the new data stack.

Apr 8, 2021

By MATTHEW HOLT

Clarify Health has linked (but anonymized) data on about 300m Americans, including their claims, lab, (some) EMR data and their SDOH data. They then use it to help providers, plans and pharma figure out what is going on with their patients, and how their doctors et al are behaving. CEO Jean Drouin, a French-Canadian who incidentally at one point ran strategy for the NHS in London, explained to me what Clarify does, how it’s going to help improve health care, where these data products are going next–and why they needed to raise $116m in March to build it out. Jean thinks about creating a single source of truth, and I asked him a couple of tricky questions about whether his customers would want to know the answer. A fascinating discussion. (Full transcript below)

Matthew Holt:

Hi, Matthew Holt here with another THCB Spotlight. And I’m with Jean Drouin, who has a French Canadian name, but is an American who’s lived in London–a bit like me–who is the CEO of Clarify Health. So Jean, Clarify Health is one of the new startups. You guys raised over a $110 million a couple of weeks back, which I guess is a small round these days considering what everyone else is doing.

Health Tech Deals, on Clubhouse tomorrow (Thursday 8th) at 1 PT/4 ET

Apr 7, 2021

Tomorrow we are taking a break from #THCBGang. Don’t worry it’ll be back with a vengeance next week. Instead, Jess DaMassa & I will host a new show “Health Tech Deals” on Clubhouse

So please join Jess and me in The Health Care Blog’s room for “Gossip, analysis & Sh!talking about digital health funding”.

Tomorrow, Apr 8 at 1:00 PM PDT – 4pm ET on @joinClubhouse. Join us! (And if you need an invite to Clubhouse, let me know)

And it’ll be on our podcast channel (Apple/Spotify) from Friday — Matthew Holt

#Healthin2Point00, Episode 197 | BrightInsight, SteadyMD, CirrusMD, and Cleo

Apr 7, 2021

Today on Health in 2 Point 00, I’m getting my shots soon! On Episode 197, General Catalyst is throwing more money around – $101 million goes to BrightInsight for its digital health insights management platform. SteadyMD raises $25 million bringing its total to $31 million, and CirrusMD raises $20 million in a Series C bringing its total to $47 million. Is there room for more telehealth companies? Finally, fertility benefits company Cleo gets $40 million, bringing its total up to $80 million – this was a hot space last year, what’s going on now? —Matthew Holt

Firefly Health’s CEO & Exec Chairman on $40M Raise & Becoming a “Bloat-less Kaiser”

Apr 7, 2021

By JESSICA DaMASSA, WTF HEALTH

Virtual-first primary care company Firefly Health is becoming a health plan! Backed by a $40M Series B, CEO Fay Rotenberg and Executive Chairman Jonathan Bush stop by to explain how they’re providing “half-price healthcare that’s twice as good.” (Or, as only Jonathan can put it: “we’re a bloat-less Kaiser.”) All kidding aside, some big-name health innovation investors are not only behind this raise (Andreessen Horowitz led, F-Prime Capital and Oak HC/FT dipped back in), but also this idea to wrap a benefit around Firefly’s digitally-driven comprehensive care model. Already in-market, the new benefit-plus-care product is aimed squarely at mid-sized/small, fully-insured employers – shops with 50-500 employees which, right now, have limited options for dramatically changing their healthcare spend or being able to build out their own benefits the same way large self-insured employers can.

Fay and Jonathan get into the details about how they’re extending their “Marie Kondo-ing” of healthcare delivery – which has thus far netted some pretty impressive health outcomes, cost savings, and a 92 Net Promoter Score – into healthcare financing.

BONUS: Tune in around 25:30 and stick around for a few minutes as Jonathan weighs in on the health tech funding boom, how it compares to the EMR arms race days of ole, and whether or not he thinks he can beat Glen Tullman’s $14.5B valuation if/when Firefly goes public. HA!

The Art of the Chart: Documenting the Timeline

Apr 7, 2021

By HANS DUVEFELT

The timeline of a patient’s symptoms is often crucial in making a correct diagnosis. Similarly, the timeline of our own clinical decisions is necessary to document and review when following a patient through their treatment.

In the old paper charts, particularly when they were handwritten, office notes, phone calls, refills and many other things were displayed in the order they happened (usually reverse chronological order). This made following the treatment of a case effortless, for example:

3/1 OFFICE VISIT: ?UTI (where ciprofloxacin was prescribed and culture sent off)

3/3 Clinical note that the culture came back, bacteria resistant and treatment changed to sulfonamide.

3/5 Phone call: Patient developed a rash, quick handwritten addition on left side of chart folder, sulfa allergy. New prescription for nitrofurantoin.