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Time To Change Course!

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By MERLE BUSHKIN

With all due respect to the good intentions of Congress, HHS, CMS, ONC and their dedicated advisors, they are pursuing — and for years have pursued — the wrong approach to achieve medical record interoperability. Endless studies, reports and anecdotal evidence conclude that trying to standardize the way medical records are formatted and kept, and linking provider silos via health information exchanges, doesn’t work! It is far too rigid, complex and constraining, and far too costly. Most importantly, it doesn’t meet care providers’ needs for “total interoperability” — instant access at the point of care to a patient’s COMPLETE medical record from all his or her providers. 

Despite having held endless hearings, listening sessions and receiving hundreds of responses to their draft proposals, they continue to ignore reality. Healthcare is dramatically different than banking and travel, the industries they frequently cite as role models. It is perhaps the most massive, complex, diverse and decentralized industry in the country, and requires a very different approach than used in simpler industries. Standardizing record content and formatting simply doesn’t work in healthcare.

Instead of trying to force care providers to accept their pre-conceived technology, they should adopt technology that meets the unique needs of providers. Simply put, they are trying to cut the man to fit the cloth rather than the cloth to fit the man!

Fortunately, there is a simple solution that accommodates the complexities of healthcare and meets the diverse needs of care providers. It focuses on how to MANAGE records rather than how to KEEP them. All we have to do is embrace it!

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This is Not Health Care

By HANS DUVEFELT

We use the word health rather loosely in America today. Especially the expression health care, whether you spell that as one word or two, is almost an oxymoron.

Health is not simply the absence of disease, even less the pharmaceutical management of disease. The healthcare “industry” is not the major portion of our GNP that it is because there is a lot of health out there, but the opposite. What consumes so much money and generates so much profit is, of course, sick care. The sicker people are, the more money is spent and earned in this market segment. It is a spiral, and a vicious one.

Health is a naturally occurring phenomenon, a state of perfection. Modern life has corrupted many natural, self-healing biological mechanisms and upended the natural order of things in our bodies – just the way it has altered our environment.

Our bodies are pretty ingenious in their ability to heal. When I crushed my finger in my garage door a few years ago, my disfigured fingertip, bisected nail and contused nail bed slowly regained their original shape, almost like a lizard grows a new tail. Yet in an opposite scenario, a person with scleroderma can lose their fingertip to gangrene without physical injury because of what we call autoimmunity – instead of self healing, our bodies can engage in self destruction. My fingertip could heal perfectly but some people’s skin or stomach ulcers fail to do so.

We intuitively seem to have accepted that, most of the time, nature takes care of itself if we don’t mess with it. And when temperatures rise, forests burn or species go extinct, we are quick to assume our industrial or agricultural processes are the cause.

Yet, we have this head-in-the-sand view of disease that it is a random occurrence, the sudden manifestation of ancient and rare genetic glitches or I don’t know what. The real answer is that much of it is a consequence of what we eat and otherwise expose our bodies to – how we produce and refine food, how we alter its natural properties and how we over- or under-consume basic nutrients.

Functional Medicine asks and answers many of these questions and promises to be the future of medicine. I believe in this, but I also believe that the sick-care industrial complex is powerful enough to severely slow down this revolution. I also believe the food industry will double down its efforts to continue misleading the public.

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Is there a Julie Yoo fallacy?

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By MATTHEW HOLT

Andreesen Horowitz’s digital heath investor Julie Yoo has been building quite the theory of the present and future of health tech. I am going to try to write up a longer response to her but first, please view her presentation on the New Tech Stack for Virtual-First Care — a compelling 8 minute watch. And then have a quick read about how I am (trying to) put her in context.

Her first argument is that the digital services that you need to run health care (things like accounting/revenue management, network management, credentialing, pharmacy, etc, etc.) are getting really good. That means that startup digital heath companies can build services really quickly. No argument there. The second part of her argument is that incumbent organizations will also use these tools (actually already are using these tools) to improve their offerings.

Her argument is somewhere in the middle of three themes I’ve been banging on for a while.

My first argument is that too much VC money has been spent on new tech companies intending to prop up the incumbents and the incumbents by definition can’t change to become the type of virtual-primary care first chronic care management consumer friendly organizations that we need. I called this the Lynne Chou O’Keefe fallacy (which is why Julie wants one of her own!) and wrote it up on THCB about a year ago.

The second is the rather longer theme that I (with Indu Subaiya) have been banging on about called “Flipping the Stack”. The basic idea is that health care services now have the potential to go from an event-driven, encounter-driven acute-care delivery model to one where technology is able to measure, manage, message and monitor patients wherever they are, and that virtual services and physical interventions are layered over the top.

The third is my idea about the “continuous clinic” which is an attempt to describe the activities that an organization needs to run a 24/7 patient management organization. (I’ve presented on this many times but haven’t totally written it up–a version of how it might work for COVID patients is here).

Somewhere in what Julie is doing and in my fumbling towards new models is the idea of what a new health system will do and what it will look like.

Of course the related question is who will be the players? While we have United Healthgroup buying anything that moves and the incumbent hospital systems collectively sitting on an Apple/Google sized mountain of cash reserves, it’s hard to see the current system being changed dramatically by the people running it now.

But it needs to.

If you need to be reminded why, take a look at the comments about half way down in this piece in which a patient blogger Luke O’Neill asked his readers about their relationship with “their” doctor and the health system. And then consider whether we should trust the current incumbents to make that transition.

I’ll be back with more on this next week….

Matthew Holt is the publisher of THCB

THCB Gang Live Episode 38

Episode 38 of “The THCB Gang” was live-streamed on Thursday, Jan 14. You can see it below!

Matthew Holt (@boltyboy) was joined by regulars: medical historian Mike Magee @drmikemagee, policy & tech expert Vince Kuraitis (@VinceKuraitis), Consumer advocate & CTO of Carium Health, Lygeia Ricciardi (@Lygeia), Suntra Modern Recovery CEO JL Neptune (@JeanLucNeptune) WTF Health host Jessica DaMassa (@jessdamassa) &  fierce patient activist Casey Quinlan (@MightyCasey).

We did indeed touch on that mob riot in the Capitol. We discussed the impeachment, the inauguration, and virtual JPMorgan AND virtual CES and talked about reparations and reconciliation–and how that might influence the whole world of telehealth and primary care. This conversation was wide ranging and fascinating!

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

The Cost of Free Speech

By KIM BELLARD

Well, you’d have to say that the past week has been interesting.  It’s not every week that Joe Biden “officially” won the 2021 election, again, as Congress certified the election results.  It’s not every century when the U.S. Capitol is overrun by hostile forces.  And it’d never been true before that Twitter and Facebook banned President Trump’s accounts, or that various tech companies belatedly acted on the threat that Parler poses.  Oh, and we hit new daily records for COVID-19 deaths (over 4,000) and hospitalizations (over 132,000) in case you’d forgotten there is still a pandemic going on. 

Yes, all in all, a very “interesting” week.

I’m going to skip talking about the horror that was the Capitol insurrection, in part because I fear that we’re going to find out more details that will make it clear that it was even worse than we now know.  Similarly, I’m not going to dwell on the shame that Republicans should feel about the fact that two-thirds of their House members still voted to object to certifying the election results even after they’d been forced to flee from the terrorists who sought that very goal with their violence.

Instead, let’s talk about “free speech,” and the social media platforms that helped foster the violence and are now trying to do something about that. 

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#Healthin2Point00, Episode 177 | The biggest funding year for health tech (& more deals!)

We should be celebrating the biggest fundraising year ever for healthcare tech and instead where are we? Not at JP Morgan. Today on Health in 2 Point 00, we chat about the mind-blowingly big numbers for health tech funding this year—Startup Health reported $21.5 billion for the year, Rock Health $14.1 billion. On Episode 177, Jess asks me about Aspen RxHealth raising $23 million in a Series B for their online pharmacy network, Monument getting $10 million for alcohol treatment, Carrum Health raising $40 million for their centers of excellence play, and yet another mental health startup Valera Health raising $4.7 million. —Matthew Holt

The General Public is Meant to be Deceived: The American Food Conspiracy

By HANS DUVEFELT

Everybody knows how to operate smartphones and understands complex modern phenomena, but many Americans are frighteningly ignorant about basic human nutrition.

I am convinced this is the result of a powerful conspiracy, fueled by the (junk) food industry. Here are just a few examples:

Milk has been advertised as a healthy beverage. It is not. No other species consumes milk beyond infancy. Milk based products like ice cream and yogurt are on top of that often sweetened beyond their natural properties.

Fruit juices make it possible to consume the calories of half a dozen pieces of fruit faster than eating just one. Naturally tart juices, like cranberry, are sweetened the same way as soft drinks (high fructose corn syrup), and therefore no healthier than Coca Cola.

Things made from flour—like bread, crackers, boxed and instant cereal, pasta and snacks like pretzels or chips other than plain potato chips—raise blood glucose levels faster than eating table sugar: The breakdown of flour starts in our mouths because of enzymes in our saliva while sucrose doesn’t break down until it reaches our small intestine.

Sugary foods, even candy like Twizzlers, are advertised as “fat free”, which is a relic from the days when fat was believed to be bad for you. Many fats, like those in olive oil, salmon, tree nuts and avocado are extremely healthful.

Another example of tangential descriptions is when flour based snacks are promoted as “baked, not fried”. Flour is bad, no matter what you do with it and, in fact, the presence of fat slows down the blood glucose rise from highly processed carbohydrates.

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Digital Health: Avoiding a Second TechLash!

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By JEFF GOLDSMITH

As John Glaser argued a recent piece in Harvard Business Review, many health care executives seem have been blinded by the shiny object that is digital health. Forgive us for a powerful feeling of déjà vu. Since the last major digital innovation in health, the electronic health record, fell far short of expectations and probably generated a negative return on investment for many care systems, it is worth thinking about to avoid the same fate with this new wave of digital tools.

As COVID raised concerns about the safety of in-person visits to clinics and physicians’ offices, digital health visits soared during the spring. Traditional health care organizations large and small–hospitals, health plans, physician groups–have since struggled to integrate digital technology effectively into their care offerings and management structure. 

In other industries, digital technology acts as a  force-multiplier for the core business–it helps firms make much more efficient use of their workforce, customers’ time and physical capital. Amazon used its cloud-based IT infrastructure and sprawling  digital “catalog” to compress time to customer fulfillment, eliminating the need for customers to visit stores to get what they needed. And by leveraging other firms’ inventories, it reduced the need to purchase, warehouse and physically handle more than half of what they sell. 

Similarly, digital health applications should not be thought of as a “new product”. Indeed, the capability for digital visits and monitoring and digitally enabled remote work has existed (some say, languished)  for almost two decades. Digital health tools should be thought of as force multipliers for the trusted relationships at the heart of healthcare. Clinicians can be in two places at once-  transforming how patients and clinicians interact by removing both time and physical location as constraints. At the same time, telework enables healthcare enterprises to make more efficient use of scarce clinical and administrative person-power,  shrinking their physical capital footprint. 

Achieving savings in clinician time and reduction in overhead were the twin drivers of Kaiser Foundation Health Plans’ successful digital health strategy. Kaiser’s two-decade long investment in virtual care has resulted in more than half of Kaiser subscriber interactions with their caregivers (preCOVID)  being electronic. The savings in reduced clinic time and overhead dropped through directly to Kaiser’s bottom line by minimizing the consumption of resources inside Kaiser’s fixed capitation pool. But you do not need to be fully, or even partially, capitated to reap digital health’s benefits.

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RWJF Emergency Response Innovation Challenges: The Winners’ Interviews

By ELIZABETH BROWN

On November 19th, six teams competed in two virtual pitch events for the finals of two Robert Wood Johnson Foundation Innovation Challenges, one for Emergency Response for the General Public and the other for Emergency Response for the Health Care System.

The teams – binformed | covidata, CovidSMS, and Fresh EBT by Propel for the General Public Challenge and Path Check, Qventus, and Tiatros, Inc., for the Health Care System Challenge – presented in front of expert judging panels, who evaluated the entries on impact, UX/UI, innovation/creativity, scalability and strength of presentation. (You can see the demos for all teams on yesterday’s post here)

binformed | covidata and CovidSMS tied for first place in the RWJF Emergency Response for the General Public Challenge and were each awarded $17,500.

Meanwhile, Qventus was declared the winner of the RWJF Emergency Response for the Health Care System Innovation Challenge and received $25,000.

After they had a chance to catch their breath and enjoy their wins, Catalyst caught back up with the three winning teams – hear the winners’ reflections below:

binformed | covidata – RWJF Emergency Response for the General Public Innovation Challenge Winner’s Interview
CovidSMS – RWJF Emergency Response for the General Public Innovation Challenge Winner’s Interview
Qventus – RWJF Emergency Response for the Health Care System Innovation Challenge Winner’s Interview

Elizabeth Brown is a Program Manager at Catalyst @ Health 2.0

#Healthin2Point00, Episode 176 | Optum acquires Change & deals for Hinge, Liva, and Metronom

Insurgents have stormed the Capitol and we’re still here to talk about health tech deals. On Episode 176, Jess and I discuss Optum acquiring Change Healthcare in a $13.5 billion deal, bringing it back to Jess’s interview with CEO Neil Crescenzo bout what Change Healthcare does with the connective tissue of big healthcare. Hinge gets $300 million in a Series D – this is valued now at $3 billion. Finally Liva Healthcare, which is like European Livongo, raises €24.5 million and Metronom Health gets $22.2 million for yet another CGM. —Matthew Holt

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