The Health Care Blog – Page 128 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

“I Don’t Do Windows” Says the Maid. “I Don’t Do Machines” Says this Doctor – “But I Do Nudge Therapy”

Mar 29, 2021

By HANS DUVEFELT

The hackneyed windows phrase, about what a domestic employee will and will not do for an employer, represents a concept that applies to the life of a doctor, too.

Personally, I have to do Windows, the default computer system of corporate America, even though I despise it. But in my personal life I use iOS on my iPad and iPhone and very rarely use even my slick looking MacBook Pro. I use “tech” and machines as little as possible and I prefer that they work invisibly and intuitively.

In medicine, even in what used to be called “general practice”, you can’t very reasonably do everything for everybody. Setting those limits requires introspection, honesty and diplomacy.

In my case, I have always stayed away from dealing with machine treatments of disease. But I do much more than just prescribe medication. Since the beginning of my career, and more and more the longer I practice, I teach and counsel more than I prescribe.

I have decided not to be involved with treatment of sleep apnea, for example. It may sound crass, but I don’t find this condition very interesting: The prospect of reviewing downloads and manipulating machine settings is too far removed from my idea of country medicine.

Worse than CPAP machines are noninvasive respiratory assist devises. I won’t go near those.

THCB Gang Episode 48, Friday March 26

Mar 26, 2021

This week (for one week only) #THCB Gang was on Friday. Matthew Holt (@boltyboy) was joined by regulars medical historian Mike Magee (@drmikemagee), Fard Johnmar (@fardj), from digital health consultancy Enspektos, THCB regular writer Kim Bellard (@kimbbellard), and employer health expert Jennifer Benz (@jenbenz). Sadly Casey Quinlan was ill and couldn’t join last minute.

It was an extraordinary week, especially in terms of digital health investment. We talked a bit about that and a lot more about high deductible health plans, whether the filibuster will be busted, and what that might mean for Medicare for all. A wide ranging and big picture conversation!

The video is below but if you’d rather listen to the episode, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

The Drive To Standardize Records: Progress or Chaos?

Mar 26, 2021• 1

By MERLE BUSHKIN

I recently asked my Primary Care Physician’s Medical Records Department for copies of my records covering the last eight months during which I had four office visits, five blood draws, and nine brief email exchanges. I should add that my PCP uses one of the two most popular EMR systems.

To my astonishment, I received 274 pages of digital records (PDFs). I’ve heard of “record bloat” but this was an explosion!

When I analyzed their contents, I found that 59 pages were legitimate documents containing “original” information and data. 22 Pages were Office Notes — or what are often called Progress Notes —applicable to my four visits; 14 were reports of my five blood draws; 23 included my nine email exchanges. In short, they were “normal” — what you’d expect from the number of contacts I had with my doctor and his lab.

But the remaining 212 pages shocked me. They were totally unexpected and, in my opinion, completely unnecessary! They were a slicing, dicing and recasting of the contents of the basic 59 pages! They included 82 pages of “Ambulatory Visit Instructions” (which I was never given), and 62 pages listing my immunizations, meds, problems, procedures, orders, and past medical, social and family histories — all of which are covered in my providers’ Office Notes!

#Healthin2Point00, Episode 194 | Ro, Appriss, Everlywell & Ginger

Mar 25, 2021

We’re swimming in a pool of money, health tech! Today on Health in 2 Point 00, we have over $1 billion and 3 acquisitions in this episode alone. First up is Ro, which just raised $500 million – they’re building quite the big healthcare company; their valuation is roughly double what Hims is trading and their revenue is a little bit more. Next, Appriss Health acquires PatientPing for $500 million and Everlywell acquires both PWNHealth and Home Access Health Corporation. Finally, our friends over at Ginger close another $100 million round. Be sure to tune into Jess’s interview with the CEO Russ Glass for the scoop. —Matthew Holt

Inside Ginger’s $100M Funding & Plans to Scale Value-Based Digital Mental Health Care

Mar 24, 2021

By JESSICA DaMASSA, WTF HEALTH

Digital mental health startup Ginger just closed a $100M funding round on the heels of its biggest growth year yet: tripling revenue in 2020, bringing its employer-client count to 500, and expanding to offer its services to more than 30 integrated health systems and health plans. CEO Russ Glass updates us on what’s next for the company now that it, too, has joined the $1-Billion-Plus club of digital mental health startups.

In a space where competitors are well-capitalized and poised to scale (Don’t forget: Talkspace awaits it’s SPAC IPO, Lyra Health has raised a whopping $475M, and others like Happify Health and Modern Health have just soared past $100M in total funding) Ginger plans to stand apart with a value-based care approach that offers employers a single-priced, fixed fee that gives employees access to Ginger’s entire spectrum of care. Launched during the pandemic, more than 60% of Ginger’s new employer clients have opted for this approach in effort to improve both the quality and cost of care offered to their employees. We dig in to hear more about this model and hear Russ’s predictions for how the supply-and-demand imbalance in mental health will continue to impact us (and the digital mental health market) as the pandemic wans.

Maximizing the Long Term Value of Virtual Care

Mar 24, 2021

By JON BLOOM

The rate of adoption for virtual care and remote monitoring solutions has skyrocketed over the last year as access to in-person appointments has been limited, but despite the uptick, we’re still drastically underutilizing their potential. These solutions often focus on treating a singular episode or chronic condition, when in fact they can open the door to more wide-ranging proactive monitoring and care that can have huge benefits in the long term.

By simply offering a touchpoint for patients to interact with the health care system through solutions like remote monitoring, providers can detect and address all sorts of problems before they escalate and require more intense, expensive interventions, even if the problem isn’t related to the primary purpose of the solution.

The downstream effects of these solutions are significant, both in terms of reducing the financial strain by eliminating unnecessary ER visits and hospitalizations, and in the long-term patient outcomes that are improved by catching problems early.

For example, a study from October we conducted with the Mid Atlantic Permanente Group found that one prevention program for patients at risk of diabetic foot complications also saw reductions in all-cause hospitalizations by 52 percent and emergency department visits by 41 percent. Despite the fact that the subject solution was originally designed specifically to help prevent diabetic foot complications, the touchpoint was able to have a profound impact on overall health and total cost of care.

This follows previous research on other condition-specific remote patient monitoring solutions that showed similar reductions in all-cause hospitalizations and mortality, further supporting the idea that these solutions can have broader impacts than just helping treat the condition they’re designed for.

These findings are especially significant considering many of these solutions, like the one studied in the October research, are often deployed to underserved populations who tend to be less likely to schedule care on their own, whether that be for a well visit or because they’ve noticed a change in their health. By putting devices in their homes and removing the burden of seeking care, we can move toward a future in which patients are able to get the care they need even if they don’t know they need it or don’t know how to get it.

#Healthin2Point00, Episode 193 | Evidation, Komodo Health, Bigfoot Biomedical & Glooko

Mar 23, 2021

On Episode 193 of Health in 2 Point 00, we have another huge day! We catch up on Amazon’s telehealth news before covering more massive deals. Evidation gets $153 million, bringing their total to a whopping $259 million and Komodo Health gets $220 million, bringing their total to $319 million. Bigfoot Biomedical raises $53 million for Type 1 diabetes care, and Glooko raises $30 million for their management system primarily working with diabetes clinics. —Matthew Holt

Nanoparticles On My Mind

Mar 23, 2021

By KIM BELLARD

Nanoparticles are everywhere! By that I mean, of course, that there seems to be a lot of news about them lately, particularly in regard to health and healthcare. But, of course, literally they could be anywhere and everywhere, which helps account for their potential, and their potential danger.

Let’s start with one of the more startling developments: a team at the University of Miami’s College of Engineering, led by Professor ****@***mi.edu“>Sakhrat Khizroev, believes it has figured out a way to use nanoparticles to “talk” to the brain without wires or implants. They use “a novel class of ultrafine units called magnetoelectric nanoparticles (MENPs)” to penetrate the blood-brain barrier.

“Once the MENPs are inside the brain and positioned next to neurons, we can stimulate them with an external magnetic field, and they in turn produce an electric field we can speak to, without having to use wires,” Professor Khizroev explained. A special magnetic helmet would communicate with the MENPs, in real-time.

Other efforts, such as Elon Musk’s Neuralink, have been looking at using implants to achieve the brain-computer interface, but Dr. Khizroev is skeptical of this kind of approach:

Other efforts have used external instruments like microelectrodes to try to solve the mysteries of the brain, but because of its complexity and difficulty in accessing, such methods can only go so far. There are 80 billion neurons in the human brain, so imagine how difficult it would be to attach 80 billion microelectrodes to access every single neuron. The only way to truly tap in is wirelessly—through nanotechnology.

The Art of Clinical Decision Making: Friday Afternoon Dilemmas

Mar 22, 2021• 2

By HANS DUVEFELT

The woman had a bleeding ulcer and required a blood transfusion. The hospital discharge summary said to see me in three days for a repeat CBC. But she had a late Friday appointment and there was no way we would get a result before the end of the day. She also had developed diarrhea on her pantoprazole and had stopped the medication. As if that wasn’t enough, her right lower leg was swollen and painful. She had been bed bound for a couple of days in the hospital and sedentary at home after discharge.

She could still be bleeding and she could have a blood clot. There were no openings for an ultrasound until almost a week later. Normally, with the modern blood thinners, we can just start anticoagulation until the diagnosis of a blood clot can be confirmed or disproven. But you don’t do that when somebody has a bleeding ulcer.

The radiology department solved my dilemma by pointing out that the emergency room can order an ultrasound and the department will call in an on-call technician. So that is where my patient had to go. Her blood count was stable and the ultrasound was negative. So now we just have to hope that lansoprazole, which she had taken in the past, but stopped because she didn’t have heartburn, would be effective.

THCB Gang Episode 47, Thursday March 18

Mar 18, 2021

Joining me , Matthew Holt (@boltyboy), on THCB Gang this week were fierce patient activist Casey Quinlan (@MightyCasey), consumer advocate & CTO of Carium, Lygeia Ricciardi (@Lygeia), THCB regular authors radiologist Saurabh Jha (@roguerad) & cardiologist Anish Koka (@anish_koka), with futurist Jeff Goldsmith on hand to keep us all honest. We started with Casey’s current health journey and Anish’s inability to get vaccines for his clinic — and this moved to a really fun and raucous discussion about whether the public sector can work in health care, whether we need to mandate the vaccine and if America is becoming a failed state! Great stuff!

If you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels