The Health Care Blog – Page 137 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

THCB Gang, Episode 37, Jan 7

Jan 7, 2021

Episode 37 of “The THCB Gang” was live-streamed on Thursday, Jan 7.

You can see it below! Matthew Holt (@boltyboy) was joined by regulars: data & privacy expert Deven McGraw, (@Healthprivacy), Patient entrepreneur extraordinaire Robin Farmanfarmaian (@RobinFF3) & consultant/author Rosemarie Day (@Rosemarie_Day1). Balancing them out will be the Y chromosome owners futurists Ian Morrison (@seccurve), Jeff Goldsmith & THCB regular Kim Bellard (@Kimbbellard)

Other than than the Duck Dynasty insurrection & mob riot in the Capitol, the Georgia senate race, most of the world on COVID lockdown, the vaccines, the new Administration, and wishing each other a happy new year, there was little to talk about….

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

RWJF Emergency Response Challenges: The Demos!

Jan 6, 2021

By ELIZABETH BROWN

In mid-June, Catalyst launched the Robert Wood Johnson Foundation Emergency Response Innovation Challenges. These Challenges, one for the General Public and one for the Health Care System, asked innovators to develop a health technology tool to support the needs of individuals as well as health care systems affected by a large-scale health crisis, such as a pandemic or natural disaster.

The Challenges saw a record number of applications— nearly 125 applications were submitted to the General Public Challenge and over 130 applications were submitted to the Health Care System Challenge. Over the course of several months and with the help of experts and industry leaders who evaluated the submissions, these applications were narrowed down to five and then again until only three teams per Challenge remained. These teams were:

Emergency Response for the General Public Finalists:

Binformed Covidata– Binformed is a clinically-driven comprehensive desktop + mobile infectious disease, epidemic + pandemic management tool targeting suppression and containment of diseases such as COVID-19.
CovidSMS– CovidSMS is a text message-based platform providing city-specific information and resources to help low-income communities endure COVID-19.
Fresh EBT by Propel– A technology tool for SNAP families to address food insecurity & economic vulnerability in times of crisis.

Emergency Response for the Health Care System Finalists:

Path Check– Path Check provides privacy first, free, open source solutions for public health to supplement manual contact tracing, visualize hot spots, and interfaces with citizen-facing privacy first apps.
Qventus– Qventus is a patient flow automation solution that applies AI / ML and behavioral science to help health systems optimize resources for Covid, create effective capacity, and reduce frontline burnout.
Tiatros– A mental health and social support platform that combines clinical expertise, peer communities and scalable technology to advance mental wellbeing and to sustain meaningful behavioral change.

These six teams competed in the finals, a virtual pitch event, on November 19th in front of expert judging panels, who evaluated the entries on impact, UX/UI, innovation/creativity, scalability and strength of presentation. (Also re-introduced during this event was Catalyst’s SourceDB, a health tech tracking database – more on that in a separate blog post here!)

In the Health Care System Innovation Challenge, judges awarded first, second, and third place to Qventus, Path Check, and Tiatros, Inc., respectively, with these teams receiving, in order, $25,000, $15,000, and $5,000. However, there was a tie for first in the General Public Innovation Challenge between binformed | covidata and CovidSMS. These two teams split the first and second place prizes and received $17,500 each, and Fresh EBT by Propel in third place received $5,000.

See the demos from all six teams below!

#Healthin2Point00, Episode 175 | Haven, Color, RapidSOS & more

Jan 6, 2021

Today on Health in 2 Point 00, Jess and I chat about Haven finally closing its doors. On Episode 175, we cover Color raising $167 million growing fast as the major COVID tester in the Bay Area and 23andMe scoring $82.5 million. RapidSOS quietly raised another $51.2 million on New Year’s Eve, Fruit Street Health raises $22 million for chronic condition management, and finally Centene acquires Magellan for $2.2 billion. —Matthew Holt

No Safe Haven to be Found!

Jan 6, 2021

By MIKE MAGEE

Can you wrestle a collusive, private, profiteering Medical-Industrial Complex to the ground by throwing more private entrepreneurs at it? Apparently not.

The very public collapse of Haven – the widely heralded health joint venture of Amazon, Berkshire Hathaway, and JP Morgan Chase – is a case in point. After three years, it is unclear whether they were a public-spirited triad trying to bathe efficiency into our bizarre employer-based health insurance scheme, or becoming predatory investors in one of the most profitable segments of our national economy.

When launched nameless in January, 2018, most of the focus was on the three amigos – Warren Buffett, Jamie Dimon, and Jeff Bezos. The linking of hands of the nation’s biggest technology power player, her most revered and respected investor, and her highest ranked financial all star, was impossible to ignore.

What were they up to? No one was quite sure. But there was enough concern about disruption of a sector controlling nearly 1/5 of the American economy that prices of CVS Health, Walmart, Cardinal Health and Express Scripts dove south.

This week, with the announcement of the non-profit joint venture’s collapse, analysts wasted no time piling on. As one said, “Haven had a rocky three years, running up against vague marching orders, a lack of direction, and obstacles inherent to the healthcare landscape.”

But it didn’t start that way. Warren Buffett presented health care that day as “a hungry tapeworm on the American economy.” Jamie Dimon noted that we pay twice as much for poorer quality care than other developed nations. And Jeff Bezos suggested that it was time for PBM’s and insurers to trim their sails.

By the summer of 2018, the three signaled they were seriousby hiring widely acclaimed health leader, Atul Gawande, as their CEO. As Buffett said, “Jamie, Jeff, and I are confident that we have found in Atul the leader who will get this important job done.” It would be another nine months before they could settle on a name for the venture – Haven (as in safe haven for their 1.3 million combined employees).

Health Care: Don’t Be Evil

Jan 5, 2021

By KIM BELLARD

Google’s corporate motto – written in its original Code of Conduct — was once “Don’t be evil.” That softened over time; Alphabet changed it to “Do the right thing” in 2015, although Google itself retained the slogan until early 2018. Some Alphabet employees think Google/Alphabet has drifted too far away from its original aims: they’ve formed a union in order to try to steer the company back to its more idealistic roots.

Parul Koul and Chewy Shaw, two Alphabet software engineers, announced the Alphabet Workers Union in a New York Times op-ed, vowing to live by the original motto, and to do what they can to ensure that Alphabet and its various companies do as well. They assert: “We want Alphabet to be a company where workers have a meaningful say in decisions that affect us and the societies we live in.”

It’s past time that health care workers, including physicians and executives, stood up for the same thing.

Ms. Koul and Mr. Shaw cite several grievances, including payouts to executives accused of sexual harassment, the firing of a leading AI expert over her efforts to address bias in AI, and company efforts to “keep workers from speaking on sensitive and publicly important topics.” Doing the work, even doing it well and being well paid for it, is not enough:

We care deeply about what we build and what it’s used for. We are responsible for the technology we bring into the world. And we recognize that its implications reach far beyond the walls of Alphabet.

Their goal is for Alphabet “to be a company where workers have a meaningful say in decisions that affect us and the societies we live in.” Alphabet, they say, “has a responsibility to prioritize the public good. It has a responsibility to its thousands of workers and billions of users to make the world a better place.”

Investors may not quite agree.

Quality in Healthcare: Cultural Competence, Diagnostic Accuracy or Patronizing Insensitivity?

Jan 4, 2021

By HANS DUVEFELT

I sometimes tell patients “I work for the government”, but sometimes I say the opposite, “I work for you”.

Herein lies a dichotomy that is eating away at primary care in this country, like a slow growing cancer. I suspect everybody is aware of it, but it seems nobody has the inclination to deal with it.

2020 exposed how differently Americans view and prioritize things like personal freedom and public safety. We have also seen how vastly different perceptions of reality suddenly exist about what constitutes medical facts. Alternative facts and fake news are suddenly household concepts.

For years, American healthcare has paid lip service to ethnic and cultural sensitivity, as long as minority opinions or practices don’t clash too badly with the holy cows of western society. We tolerate circumcision in men, but not genital mutilation in women, for example. But we don’t even pay lip service to the majority’s right to direct their own healthcare.

Goodbye, 2020. Hello, 2030

Dec 31, 2020

By KIM BELLARD

2020 is almost over; thank goodness. It has been one of the strangest, and longest, years most of us have ever endured. We’ve all probably known someone who contracted COVID-19; many of us have had lost loved ones from it. Most of us have had to make drastic changes to our lives – masks, social distancing, limits on family visits, eating out, concerts, or trips among them. No, 2020 can’t get over fast enough.

I was struck, though, by a quote I recently read. Loren Padelford, a vice-president at Shopify, told The Wall Street Journal: “Covid has acted like a time machine: it brought 2030 to 2020.”

Gosh, I hope not.

Mr. Padelford went on to explain: “All those trends, where organizations thought they had more time, got rapidly accelerated.” These trends include the shift from physical to online, further decline of cash, and work from home/remote learning. Individuals/families without broadband are being left behind; companies not investing in IT and logistics may not be here in 2030. Healthcare has not been exempt from these trends.

The pandemic has illustrated both the great strengths and the great weaknesses of the U.S. healthcare system. Among the strengths are the courage and professionalism of our health care workers, the innovation that has delivered several vaccines within a matter of months, and the ability to adapt to an existing but underutilized mode of care in telemedicine.

Among the weaknesses, of course, are the lack of planning and coordination that has doomed testing, contact testing, and supply of personal protective equipment; the patchwork quilt of insurance coverage that has left even more without coverage (e.g., due to loss of job based coverage and/or lack of Medicaid expansion); the refusal of many to act in their own best health interests, such as not wearing masks or taking vaccines.

Legislators/regulators may be taking bold actions like throwing money at healthcare organizations, vowing that the COVID testing and vaccines are “free,” and loosening restrictions on telemedicine, but the underlying disfunction in our healthcare system has never been more visible. We don’t test enough or fast enough. We have sick people on gurneys in gift shops, we have dead people in refrigerator trucks, and we still have people crushed by their healthcare bills.

Please, don’t let this be a picture of 2030.

Need to Choose a Doctor? What Does AI Think About the Choices?

Dec 30, 2020

By ZEESHAN SYED

Tens of millions of Americans rely on consumer experience apps to help them find the best new restaurant or the right hairdresser. But while relying on customer opinion might make sense for figuring out where to get dinner tonight, when it comes to picking which doctor is best for you, AI might be more trustworthy than the wisdom of the crowd.

Consumer apps provide us with rich data categories that often take into account preferences, from location to free wi-fi, to help users narrow down choices. Navigating your health insurer’s network of physicians is a different proposition, and some of the popular ranking systems reportedly have significant limitations. Doctors are often categorized by specialty, insurance, hospital, or location, which may be effective for logistics, but fail to take into account a patient’s unique health conditions and say very little about what an individual patient can expect in terms of health outcomes. Research from my company Health at Scale shows that 83% of Medicare patients seeking cardiology care and 88% of cases seeking orthopedic care may not be choosing providers that are highly rated for best predicted outcomes based on each patient’s individual health conditions.

Deep personalization is exactly what physicians, health systems, and insurers need to offer patients to improve outcomes and lower costs across the board. A study using our data recently published in the Journal of Medical Internet Research sought to quantify how consumer, quality and volume metrics may be associated with outcomes. Researchers analyzed data from 4,192 Medicare fee-for-service beneficiaries undergoing elective hip replacements between 2013-2018 in the greater Chicago area, comparing post-procedure hospitalization rate, emergency department visits, and total costs of care at hospitals ranked highly by popular consumer ratings systems and CMS star ratings as well as those ranked highly by a machine intelligence algorithm for personalized provider navigation.

Evaluating President-Elect Biden’s Healthcare Plan | Part 2

Dec 29, 2020

By TAYLOR J. CHRISTENSEN

In Part 1 of this series, I reviewed the relevant context of our post-ACA healthcare system to show why President-Elect Joe Biden’s healthcare plan is perfectly reasonable. In this part, I will critically evaluate that plan to show what he got right and what he got wrong or missed altogether.

Joe Biden plans to get rid of the current limit (400% of the federal poverty level) on who qualifies for health insurance premium subsidies and instead convert it to a flat percentage of income (8.5%), which means anyone whose health insurance is going to cost more than 8.5% of their annual income would qualify for a subsidy. And those subsidies would be more generous, being based on a gold-level insurance plan’s price rather than a silver-level insurance plan. He also plans to create a new government-run health insurance company to offer an insurance plan—a “public option”—on the private market, which would be available to private market health insurance shoppers and some other groups as well.

Ok, now for some evaluation of all that.

First, let me frame how I am going to evaluate Joe Biden’s plan.

There are three problems healthcare reformers are usually trying to solve. They want to (1) increase access to care, (2) decrease healthcare prices, and (3) improve the quality of care.

But if we merge the last two goals into one, we can say they want to (1) increase access, and (2) improve the value of care (Value = Quality / Price). We will take these one by one.

Goal 1: Increase Access

How will Joe Biden’s plan do at increasing access?

There are three things to consider when evaluating access-increasing policies. The first is how many people will be covered. The second is how much it will cost. And the third, almost universally forgotten, is how much it will interfere with efforts to accomplish the second goal to improve the value of care.

Evaluating President-Elect Biden’s Healthcare Plan | Part 1

Dec 28, 2020

By TAYLOR J. CHRISTENSEN

Without the full support of congress behind him, President-Elect Joe Biden will probably not have an opportunity to sign any major system-altering healthcare legislation. But, if Democrats can gain a majority in the senate–either this election cycle or next—healthcare reform will be high on the agenda. Let’s take a critical look at what Joe Biden would push to accomplish.

For this evaluation, I am relying solely on information that Joe Biden has committed to on his official campaign website. He has many pages talking about a variety healthcare issues, such as the pandemic, gun violence, and the opioid epidemic. But the main page that reviews his plans for the healthcare system as a whole is here. Consider giving it a read through first, because what follows will only be summarizing and evaluating the key big-picture components of his plan.

Joe Biden is not pushing for Medicare for All. He instead wants to keep the Affordable Care Act (i.e., the ACA, or “Obamacare”) and fix the parts of it that are not working so well. To understand the rationale of his proposed changes, we first need to review where we are at now with the ACA.

There are many parts to the ACA, but its main thrust was to increase insurance coverage. What kind of numbers are we working with? Below are some 2019 data, rounded for simplicity. And note that I am excluding the 60,000,000 people who are over age 65 and therefore on Medicare.

The under-age-65 people fall into one of four insurance groups . . .

Employer-sponsored insurance (160,000,000 people) if they are lucky enough to work for an employer that provides benefits.

Medicaid (70,000,000 people) if their income is low enough to qualify.

Private insurance from the “private market” (10,000,000 people) if they make too much money to qualify for Medicaid and do not have an employer that provides benefits.

Uninsured (30,000,000 people) if they do not get insurance from their employer, their income is too high to qualify for Medicaid, and they do not want to pay for insurance from the private market.

Remember, those are from 2019, so they are post-ACA numbers. Prior to the implementation of the ACA, the uninsured number hovered around 45,000,000 people. What did it do to reduce the number of uninsured people? There were many ways, but here are the two biggest ways: