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David Medvedeff, CEO Aspen RxHealth, talks about his new model for pharmacists

By MATTHEW HOLT

David Medvedeff, CEO Aspen RxHealth, tells me about the new role of pharmacists in managing chronically ill patients. Aspen RxHealth has put together a network of independent pharmacists and a tool that allows them to select patients, call them and consult with them for their pharmacy issues. It’s kinda like the original Teladoc model but for pharmacists, while the clients are health plans keen for their patients to avoid problems with polypharmacy. They’ll be doing 200K+ consults this year and just raised $23m.

#Healthin2Point00, Episode 181 | SPAC-ing rumors & more deals

Today on Health in 2 Point 00, Jess asks me about Lyra Health raising $187 million — this is their third raise in less than a year — and gets my take on the SPAC rumor for 23andMe, which is valued at $2.5 billion and just raised $82.5 million in December, and the rumor about Ro following Hims & Hers in a SPAC. Sharecare IS planning on “SPAC-ing” and recently acquired Doc.ai, and DarioHealth acquires Upright Technologies for $31 million. —Matthew Holt

One-Price, 30-Day Warranty, Payment at Discharge: Carrum Health’s CEO on Changing How We Buy Surgery

By JESSICA DaMASSA, WTF HEALTH

No copays. No coinsurance. No surprise out-of-network anesthesiologist fees or pre-op imaging bills. Just one, single price (that you see in advance) tells you EXACTLY what you’ll be paying for your surgical care on Carrum Health. Backed by the recent close of a $40M Series A funding round, the health tech startup’s CEO Sach Jain talks through all the ways his company is looking to disrupt how we buy surgical care. Standardized bundle pricing is just the beginning. Carrum requires its Centers of Excellence (and each of their docs) to pass a proprietary 50-point inspection before they can join the platform, AND every surgery must be backed by a 30-day Warranty! How have they convinced providers to jump through these kinds of hoops? With a growing client-base of self-insured employers (Sach says they have several Fortune 100 and Fortune 500 clients) and payment-in-full made to providers upon discharge, the case for additional revenue and zero A/R days is pretty compelling to a health system. And what about the other side of the business model? Tune in to find out why Sach believes Carrum Health’s “marketplace” approach will appeal to the growing base of “activist” employers whose HR benefits administrators are becoming more and more adept at building-their-own healthcare networks.

The Art of Prescribing (Or Not)

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By HANS DUVEFELT

I have learned a few things about prescribing medications during my 42 years as a physician. Some are old lessons, and some are more recent. I thought I’d share some random examples.

First: I don’t like to have to use medications, but when they seem necessary, I choose, present and prescribe them with great care.

CHOOSING MEDICATIONS

Medications are like people. They have personalities. With so many choices for any given diagnosis or symptom, I consider their mechanism of action, possible beneficial additional effects and their risk of unwanted side effects when selecting which one to prescribe. To some degree that goes against today’s dogma.

Blood pressure medications, for example, have what I call an A-list and a B-list. The A-list contains drugs with a proven track record of not only reducing blood pressure, but also actual heart attack and stroke risk. Why we choose from the B-list, the drugs that don’t decrease cardiovascular risk or actually increase it, is a little beyond this simple country doctor’s ability to understand.

ACE inhibitors like lisinopril and diuretics like hydrochlorothiazide are the two recommended first choices in this country. But the A-list also contains amlodipine, a calcium channel blocker and, further down, metoprolol, a beta blocker. I make those less favored A-listers my initial choice in two scenarios:

Amlodipine is my choice when I see a hypertensive patient who prefers a set-it-and-forget-it treatment plan. No bloodwork is required after starting it to monitor for kidney or electrolyte problems, so even if the patient doesn’t come back for a year or more, there is no real risk involved.

Metoprolol, which blocks the effect of the stress hormone adrenaline on the cardiovascular system, is what I talked my own doctor into prescribing for me. That was back in the day, when I was a hard working, somewhat Type A personality with high blood pressure. With the passage of time, life experience, weight loss and my transformative relationship with my Arabian horses, my blood pressure normalized and I didn’t need medication anymore.

Years ago, we all selected blood pressure medications according to the “phenotype” (appearance or general impression) of the patient: metoprolol if intense, hydrochlorothiazide if swollen, nifedipine if cold-handed, lisinopril If naturally hypokalemic (low potassium).

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The Art of Explaining: Starting With the Big Idea

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By HANS DUVEFELT

We live in a time of thirty second sound bytes, 280 character tweets and general information overload. Our society seems to have ADHD. There is fierce competition for people’s attention.

As doctors, we have so many messages we want to get across to our patients. How many seconds do we have before we lose their attention in our severely time curtailed and content regulated office visits?

I have found that it generally works better to make a stark, radical statement as an attention grabber and then qualifying it than to carefully describe a context from beginning to end.

Once a person shows interest or responds with a followup statement or question, you have a better chance for a meaningful discussion. Just starting to explain something without knowing if the person wants to hear what you have to say could just be a waste of time.

Here are some of my typical conversation starters – or stoppers, if you will:

“The purpose of a physical is to talk about stuff that could kill you, more than about symptoms that annoy.”

“Nothing makes a cold go away faster.”

“Urology is about plumbing, nephrology is about chemistry.”

“Most headaches are migraines.”

“Sinus headaches don’t exist in Europe.”

“I don’t care what your blood pressure is today if you’re scared or in pain.”

“A healthy lifestyle is at least as effective as taking Lipitor.”

“We now know that eating fat makes you lose weight.”

“Cholesterol only causes damage if there is also inflammation.”

“Fat free means high in sugar.”

“I don’t believe in vitamins.”

“Osteoporosis happens to every woman around 80, so is it really a disease?”

“You have to treat 35 men for prostate cancer to save one life.”

“You know how many cases of testicular cancer I’ve come across in 40 years? Three!”

“It takes 45 minutes of walking to burn 100 calories, but only 10 seconds to drink them.”

My brief experience as a substitute teacher for junior high school students as well as my many years as a scout leader taught me that you can’t assume you have people’s attention just because you’re standing in front of them. They will give it to you if they believe you have something interesting to say. You often have less than thirty seconds to prove that you do.

Is our medical knowledge alive enough in our minds that we can share it in a quick, easy and captivating way with our distracted patients?

Hans Duvefelt is a Swedish-born rural Family Physician in Maine. This post originally appeared on his blog, A Country Doctor Writes, here.

THCB Gang, Episode 40

THCB Gang was held live on Thurs Jan 28 1pm PT -4pm ET. The recording is below.

Joining me, Matthew Holt (@boltyboy) were fierce patient activist Casey Quinlan (@MightyCasey), consultant/author Rosemarie Day @Rosemarie_Day1),  THCB regular health writer Kim Bellard (@kimbbellard); employer health expert Jennifer Benz (@jenbenz) & patient safety expert and all around wit Michael Millenson (@MLMillenson).

There was almost nothing to talk about. No inauguration, no riots, pandemic under control via vaccination….oh wait. Actually a lot to talk about with the vaccination rollout, the likelihood of health policy changing in the COVID relief bill, and how the wild world of Gamestop stock trading might impact Digital Health –well we didn’t talk about that but we did talk about employers and what they were going to do!

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.

We’re Ready for Mamala

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By DEB GORDON and ROSEMARIE DAY

With the long-awaited inauguration day behind us, America is finally getting something we desperately need: an elected woman in the White House.

On the heels of chaos and violence at the Capitol and after four years of the Trump Administration, we are ready for strong female leadership in the executive branch to help put the country on the right course. In fact, it is long overdue.

Kamala Harris didn’t just need our votes to make history as America’s first female Vice President. To be successful, she’ll need every ounce of our ongoing support as she steels herself to direct threats to her life and faces the challenge, along with President-elect Biden, of healing a deeply fractured nation.

Female leaders around the world have modeled that strong leadership through 2020’s most difficult times. Women have led some of the most effective pandemic responses worldwide. Countries led by women leaders had six times fewer confirmed COVID-19 deaths — and fewer days with confirmed deaths — than countries led by men. New Zealand, Taiwan, Germany, and Iceland — all led by women — are among the coronavirus management success stories.

These women acknowledged the threat from coronavirus rather than underplaying it. They were decisive, and used data and science to drive their decision-making. They took a long-view when designing their response, prioritizing long-term well-being over short-term economic pain. They listened to outside voices to ensure they had the best possible input and solutions for their countries. And they showed empathy. Having a female leader became a symbol of inclusive, open-minded, effective leadership.

And the world took notice, lauding leaders like Jacinda Ardern, who was rewarded with a decisive victory in New Zealand’s October national elections.

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Medable’s CEO: Covid19 Vaccine Will Start Big Pharma’s Era of De-Centralized Clinical Trials

By JESSICA DaMASSA, WTF HEALTH

Covid 19 vaccine development may have mainstreamed questions about how to hasten drug development timelines, but Medable, a health tech startup that offers researchers a way to de-centralize clinical trials, has been working to solve this problem for five years. Freshly funded with a $91M Series C raise, co-founder and CEO Michelle Longmire talks through the benefits of “liberating” clinical trials from academic research centers and sending them onto devices into patient’s homes. Traditionally, drug development processes average more than 10 years, cost millions of dollars, and are limited in the diversity of patients they can recruit because of the heavy focus on the geographic location of the research team conducting the trial. Medable’s digital platform breaks these limitations, reducing drug development timelines and costs by making it easier for researchers to draw study participants from anywhere. More importantly, it makes the novel medicines being tested by the trial available to a bigger, more diverse array of patients. Despite the gains made in 2020 toward the de-centralized clinical trial model (Medable’s revenue shot up 500%), there’s concern that Big Pharma may return to the business processes of old once the pandemic is under control. Does Michelle think last year make enough of an impact to change their business model for good? Find out what’s ahead for the future of pharma.

And You Thought Health Insurance Was Bad

By KIM BELLARD

I spend most of my time thinking about health care, but a recent The New York Times article – How the American Unemployment System Failed – by Eduardo Porter, caught my attention.  I mean, when the U.S. healthcare system looks fair by comparison, you know things are bad.

Long story short: unemployment doesn’t help as many people as it should, for as much as it should, or for as long as it should. 

It does kind of remind you of healthcare, doesn’t it?

The pandemic, and the associated recession, has unemployment in the news more than since the “Great Recession” of 2008 and perhaps since the Great Depression.  Last spring the unemployment rate skyrocketed well past Great Recession levels, before slowly starting to subside.  Still, last week almost a million people filed for unemployment benefits, reminding us that unemployment is still an issue.

Keep in mind that unemployment rates do not tell the full story, as they don’t count those only “marginally attached” to the workforce – people who would like to work but have given up – and counts part-time workers who would like to work full time as “employed.”  The “true” unemployment rate is reckoned to be much worse than the official rate.

Congress has enacted several COVID relief measures, including in late December, to extend duration, amount, and applicability of unemployment benefits, but our unemployment systems remain predominantly state designed and administered.  The shortcomings of these systems have been severely exposed over the past few months: neither the processes nor the actual technologies supporting them proved robust enough for the volume of applicants.  Last December Pew Trusts reported that “unemployment payments were weeks late in nearly every state.” 

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#Healthin2Point00, Episode 180 | Signify Health IPO, OneDrop-Bayer-SCOR Partnership, & more

On Health in 2 Point 00, this time we have Jess tell us about OneDrop, Bayer, and SCOR’s new partnership, creating a chronic condition-specific life insurance policy using OneDrop’s platform and SCOR’s risk predictive engine. On Episode 180, Jess asks me about Signify Health filing for IPO – a real IPO, not a SPAC one, Lumiata getting $14 million working on predictive analytics, and Neuroflow getting $20 miillion in a Series A led by Magellan. —Matthew Holt

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