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Can You Trust Digital Health Firms To Trust You?

By MICHAEL MILLENSON

What kind of health care organization would let a 10-year-old child make an instructional video for patients? And what might that decision teach health tech companies trying to gain the trust of consumers? 

I found myself pondering those questions while listening to Dr. Peter Margolis, co-chair of a National Academy of Medicine committee on health data sharing and stakeholder trust and a speaker at the recent (virtual) Health Datapalooza annual conference. Margolis is also co-director of the Anderson Center for Health Systems Excellence at Cincinnati Children’s, the institution that allowed 10-year old kids with a condition necessitating a feeding tube to create videos showing other children how to insert one. Parents, meanwhile, were recruited to help develop new technology to help their child.

The payoff for this and similar efforts by the shared learning communities Cincinnati Children’s has birthed has been significantly improved outcomes and national renown. But for this type of initiative to succeed, Margolis told me when I visited a few years ago, clinicians and administrators “have to be comfortable with a very different kind of role.” 

As consumers gain access to information once limited to medical insiders, that advice seems increasingly prescient. Federal rules requiring providers to make electronic health data available to patients at no cost take effect April 5.  Meanwhile, voluntary electronic sharing of physician clinical notes is rapidly morphing from the unthinkable to the unremarkable, while apps to make all this data actionable are proliferating. As a result, long-simmering issues related to transparency and trust and are coming to the fore.

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The Paradigm Shift That Wasn’t: The ISCHEMIA Trial

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By ANISH KOKA

A recent email that arrived in my in-box a few weeks ago from an academic hailed the latest “paradigm shift” in cardiology as it relates to the management of stable angina.  (Stable angina refers to chronic,non-accelerating chest pain with a moderate level of exertion).  The points made in the email were as follows (the order of the points made are preserved):

  1. The financial burden of stress testing was significant (11 billion dollars per annum in the USA!)
  2. For stable CAD, medical treatment is critical.  We now have better medical treatments than all prior trials including ischemia. these include PCKS9 Inhibitor, SGLT2-i, GLP1 agonists Vascepa and others
  3. CTA coronaries is by far the most important single test for evaluation of these patients
  4. ” the paradigm of ischemia testing may have come to an end”
  5. For stable angina (not ACS!) in most cases, the decision on revascularization should be based only on symptoms alleviation (as no survival benefit).

The general public should find it interesting, and not a random coincidence that the first point immediately gets to the financial burden of stress testing in a communication that is supposed to assess the level of evidence for the management of coronary artery disease. Imagine a cardiologist enters your exam room to talk about the chest pain you get every time you run up a flight of steps, and starts off the conversation with how much the societal cost of stress tests are.  The cost of care is certainly a relevant concern, especially if it’s to be borne directly by the patient, but it would seem that the decision of whether a therapy is effective or not should be divorced from how much some bean counter decides to price the therapy to generate a certain return on investment.  As such, the discussion that follows will omit any consideration of cost when evaluating the new ‘paradigm shift’ in management of coronary disease that is apparently upon us.

This particular debate boils down to the relevance of diagnostic testing for coronary artery disease.  The traditional approach to testing is a functional test that utilizes the uptake of radioactive isotope injected into a patient during stress and rest conditions to identify mismatches in blood flow in the two states to identify myocardial ischemia.  The amount of ischemia can be quantified as percent of total myocardium, and has been well correlated with prognosis.  Having lots of ischemia typically means a much shorter lifeline than having little or no ischemia.  The accepted paradigm in Cardiology has been to use traditional stress testing to triage patients to ‘conservative’ medical therapy or an invasive approach to bypass or open arteries via stents or coronary bypass surgery. 

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Buoy Health Wins Over Three Health Plans, Turns Symptom Checking into Patient Decision-Making

By JESSICA DaMASSA, WTF HEALTH

Symptom checker startup Buoy Health’s $37.5M Series C caught a lot of attention among health tech market watchers because of the collaborative support the funding round garnered from health plans. THREE payor orgs – UnitedHealth’s Optum, Humana, and Cigna – participated in the round, and co-founder and CEO Andrew Le is here to tell us why.

What’s interesting is how the health tech startup’s model has evolved past “symptom checking” and into patient decision-making to better solve the underlying uncertainty that typically causes a patient to “shotgun into care” that’s often a poor fit clinically AND financially. “If you don’t solve the clinical uncertainty first,” says Andrew, “then nothing else matters.” Health plans, though, are likely also seeing the potential of making sure that their members are routed to the right kind of “covered” care. And Buoy’s big plan is to help that along with a full-on marketplace of curated solutions – think telehealth, digital health apps, digital therapeutics, and so on – that round out the benefit design of a traditional health plan. Suddenly, symptom checking seems a means to a very different end…

#Healthin2Point00, Episode 187 | Redox, Nanit, Innovacer & MindMed

Today on Health in 2 Point 00, Jess makes me pronounce some impossible words while we cover lots of funding deals. Redox has raised $45 million in a Series D, bringing their total up to $95 million. Nanit, another baby monitoring company, raises $25 million in a Series C, Innovaccer raises a $105 million D round, and psychedelic biotech company MindMed acquires digital health company HealthMode. —Matthew Holt

Wiping the Sleep From Our Eyes: The Pandemic Plan Trump Ignored

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By MIKE MAGEE

When awakening from a long sleep, there is a transition period, when the brain struggles momentarily to become oriented, to “think straight.” When the sleep has extended four years, as with the Trump reign, it takes longer to clear the sleepy lies from your eyes.

We are emerging, but it will take time and guidance. This week President Biden and our First Lady showed us the way. As we together observed the startling passage of a half million dead, many needlessly, from the pandemic, the President gave us a crash course on grief. He compared it to entering a “black hole”, and acknowledged that whether you “held the hand” as your loved one passed on, or were unable (by logistics or regulation) to be there to offer comfort, time would heal. “You have to believe me, honey!”, as he is so prone to say.

As important, we saw the First Lady, without fanfare or concious need for attention, at one moment, draw close to him, as she sensed that he was about to be overcome by his own sadness, and place her hand simply on his back, patting him gently, knowing that this was enough to get him through. She, by then, had done this many times before.

And we saw the Vice President and her husband, across from the first couple, there only for support. This was neither a speaking role or super-ceremonial. It was humble. It was supportive. It was human, and far away from a predecessor who for four years had to fawn, and lie, and grovel to satisfy his Commander-in-Chief.

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THCB Gang Episode 44, Thursday Feb 25, 1pm PT – 4pm ET

Joining me, Matthew Holt (@boltyboy), on this week’s THCB Gang were consultant/author Rosemarie Day @Rosemarie_Day1),  Suntra Modern Recovery CEO JL Neptune (@JeanLucNeptune), and health futurist Jeff Goldsmith (@JeffcGoldsmith) and a late add Ian Morrison (@seccurve).

We will also had a special guest who is possibly the most successful corporate venture capitalist in health tech–Merck’s Bill Taranto. He had a decent run last decade– you may have heard of Livongo which he was a big investor in! We talked with Bill about the future of investing, what role investing in digital health has for drug business and what he’s expecting in the big health care realignment. Apparently Merck treasury took all the cash he made with Livongo so he couldn’t give it to us, but he has $500m+ top spend and as he said, “you want a Billion Dollar exit? Put me on the board”

You can see the video below live and the audio will be on our podcast channel (Apple/Spotify) from Friday

Amwell’s CEO Roy Schoenberg on Telehealth as “Healthcare Infrastructure”

By JESSICA DaMASSA, WTF HEALTH

“Telehealth has a much bigger role to play than just carrying out transactions,” says Amwell’s President & CEO, Roy Schoenberg, who joins Jess DaMassa for a sweeping philosophical discussion about how telehealth’s role will continue to evolve through the covid19 pandemic and the changes its forced on the healthcare market. Conversations about telehealth that were once about the value of improving “access to care” are now about the technology’s potential to drive “quality of care.” And Amwell – which says it is a “technology infrastructure company” focused on helping traditional healthcare players transition into digital distribution – is pushing past the old notion that virtual care is merely a “product to get a Z-pak.”

Roy gives us updates on Amwell’s much-buzzed-about partnerships with United Healthcare and Google, the later being focused on how the telehealth co is looking at integrating some of those famous Google technologies (think natural language processing, translation, and geolocation-ala-Maps) into virtual care delivery in a way that sounds like a lot more than just a “switchboard.”

Two other colorful Roy Schoenberg soundbites to tease you into this conversation about the immediate future of telehealth from the leader of one its biggest players: 1) “the notion that we are no longer looking at the home as an illegitimate place of care is drama in in every sense” and 2) “I think the next war-zone, the next place where there’s going to be a lot of heated confrontations and conversations, is state licensure.”

Post Pandemic Re-Entry

By ALICIA MORTON FARLESE

Not in our lifetimes has humanity experienced such a pervasive, profound, and prolonged retreat from “normal lives.” This. Will. Not. Be. Easy. 

While the conversation about the serious negative impact on our behavioral health has started, we also suffer from a scarcity of behavioral health professionals, and equitable access to these essential resources.  

More than ever, we all seem to “get it” and are reflexively more forgiving when we hear that some of us are struggling with the behavioral health consequences of Covid -19 — we’ve all been there to some extent over the past year.  

As a Veteran, I’m accustomed to reintroduction plans, designed with thoughtful consideration, anticipatory preparation, and behavioral health resources for military members (and their families) returning from deployment. As we approach normalcy, a similar reentry will soon begin, yet we’re not talking about what to expect and how our behavioral health needs will be addressed. Where are the post-pandemic re-entry plans? Yes – we want to get back – but just as the military members need level-setting guidance, support, and understanding as they return “home” so do all of us as we begin our reentry. 

Our battlefield has been the isolation, home-schooling, remote working, laid-off, caring-for (and saying goodbye to) loved ones for the last 11 months. It has been the tangled web of emotions: tragic, heartwarming, frustrating, endearing, exhausting and confusing. Emerging from this Nebel des krieges will not be the walk in the park that we hopeful humans imagine it to be.  Now is the time to plan for re-entry. 

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#Healthin2Point00, Episode 186 | Bad jokes about Circulo, Eden Health, Carevive & Loyal

On Episode 186, of Health in 2 Point 00 – I have bad jokes about Olive.ai-related Circulo raising $50m, online/offline clinic Eden Health grabbing $60m, cancer app Carevive getting $18m & provider engagement play Loyal getting $12m. Will Jess DaMassa think the jokes are funny? You’ll have to watch to find out but you can make a pretty good guess!—Matthew Holt

Driverless Cars or Keyboardless EMRs? Which Do We Need Most?

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By HANS DUVEFELT

I love cars and dislike computers.

My car takes me where I need to go, but it also gives me pleasure along the way. I have had it for just about ten years now and I have driven it almost 300,000 miles. It feels like an extension of me. Everything about it is just perfect for the way I drive and the things I need to do with it. From the sumptuously cavernous interior to the rugged all wheel drive features and the studded Finnish snow tires, it takes me pretty much anywhere, anytime. Why anyone would want to travel in a car without the sublime pleasure of driving it is beyond my comprehension.

My computers, on the other hand, are things I avoid whenever I can. My work laptop is an awkward Windows machine. Need I say more? Whatever it does happens stiltedly and unintuitively behind layers of barriers and firewalls that make me sign in again and again until I get to a pathetically clumsy EMR.

My MacBook Pro is slimmer and slicker but it gives me no pleasure to use it, I’m sorry to say.

Every word I have written and published – about as many words as I have miles on my car – has been put down on the virtual keyboard of my iPad. It feels more like an extension of my brain. I use it in bed, by the fireplace, in the barn or on the lawn. I can even talk into it without a microphone or any special software. I touch the screen and magic happens: Apps open, fonts and colors change and the world is at my fingertips, wherever I am.

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