The Health Care Blog – Page 139 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Two Surgeons—a Veteran and a Newcomer—Talk Fighting COVID Burnout

Dec 18, 2020

By MICHAEL E. LIPKIN and RUSSELL S. TERRY, JR.

Burnout has always been a concern in medicine, and that concern has been amplified by the added stress of COVID-19. Many months into an unpredictable and distressing situation, we have both hung on to our mental health and professional passion by seeking out strategies that work for us. We offer them in two perspectives: veteran and relative newcomer.

Dr. Lipkin: A Veteran’s Perspective

When lockdown began in March, we slowed down my practice for about 6 to 8 weeks, and then returned to full pre-COVID levels. It feels like the uncertainty has affected me most, since it has not been clear if and when things will get substantially better. Everyone is both experiencing and projecting persistent anxiety, stress and uncertainty. Isolation is a problem as well. I no longer have the time or ability to sit down with colleagues and vent over a beer, which was an outlet I counted on to mitigate burnout. At the same time, on a more concrete level, the pandemic has made everything we do incrementally more difficult, which is grindingly stressful. These tips are helping me cope and avoid burnout.

There are so many changes—just accept them. As COVID affects so many areas of practice, there’s a kind of low-grade stress that fluctuates with events. It seems like everything is a little bit harder. We have to shift some patient visits to telehealth and make sure they get COVID tests before surgery. We’re all looking over our shoulders, wondering who’s going to get us sick. There’s always the specter of more shutdowns and how they might affect our livelihoods. Budgets have been cut back, so hiring is frozen and there’s virtually no incremental spending. Everything will stay this way for now, so the best thing to do is accept that we’re going through a tough period and focus on the big picture, rather than the list of irritations.

THCB Gang, Episode 36, Dec 17

Dec 17, 2020

Today’s #THCBGang was an End of Year special. It’ll was a full “Hollywood Squares/Brady Bunch” with nine of us. Michael Millenson @MLMillenson, Deven McGraw @HealthPrivacy, Jessica DaMassa @jessdamassa, Maggi Cary @margaretcaryMD, Robin Farmanfarmaian @Robinff3, Mike Magee @drmikemagee, Rosemarie Day @Rosemarie_Day1, & Marcus Whitney @marcuswhitney all got on to talk about the vaccines, the future of investing in health tech, a little bit about HIPAA, the future of vaccine passports, and more.

Yup we rounded off the year talking about the good, the bad and the very ugly of 2020. And giving our forecasts for 2021. And then a bunch more of the Gang came on at the 50 minute mark to give their hopes for 2021

You can see the video below and it’ll be on our podcast channel (Apple/Spotify) from Friday

— Matthew Holt

Streaming, Baby Yoda, and Healthcare

Dec 17, 2020

By KIM BELLARD

I’ve never seen The Mandalorian. I don’t have Disney+. But I know who Baby Yoda is, and I’m pretty sure Disney is counting on that. Hollywood, in case you haven’t been paying attention, is going through some radical changes. There may be some lessons for healthcare in them.

2020 has been the year of streaming. Moviegoing isn’t entirely dead in the pandemic, but it may be on life support, with major chains like Regal and AMC barely staying out of bankruptcy. “Yes, there is pent-up demand to see movies in a theater,” Hollywood insider Peter Chernin told The New York Times. “But people change their habits.”

Indeed, they do. A new Press Ganey survey found that telemedicine visits shot to 37% of all visits in May, then settled down to around 15% – far above less than 1% pre-COVID-19. Habits do, indeed, change, even in healthcare.

Hollywood has made some startling announcements in the past few weeks that illustrate how swiftly changes are coming to the entertainment industry:

Disney: Disney expects to have 100 new titles – TV shows or movies – each year for the next few years. Disney chairman Bob Iger noted modestly: “The pipeline of original content we’re making is much more robust than originally anticipated.” Of particular note, though, CEO Bob Chapek said, “Of the 100 new titles announced today, 80 percent of them will go to Disney Plus.”

NYT characterized the move as: “Here is a 97-year-old company making a jump to direct-to-consumer hyperspace.” (If you don’t get the reference, you probably didn’t get the Baby Yoda one either).

The strategy appears to be working. Disney said that its year-old Disney+ streaming service already has 87 million subscribers; it had originally projected to reach this number by 2024. Now it expects to reach 260m subscribers by 2024. And those numbers do not include Disney services Hulu (39m) and ESPN+ (12m). Collectively, Disney now expects up to 350m subscribers by 2024.

#Healthin2Point00, Episode 174 | Cityblock, Elation, Modern Health, LeanTaaS & Well

Dec 16, 2020

Today on Health in 2 Point 00, Jess has me weigh in on Cityblock Health’s big raise of $160 million bringing their total up to 300 million to improve health for low-income patients. On Episode 174, Elation, which is Cityblock’s EMR as well as that for some other independent primary care clinics, raises $40 million and working their way into a tough market. Modern Health raises $50 million for the “fourth” pillar of care, providing another mental health platform. LeanTaaS raises $130 million, providing a digital front end for hospitals and smooth out patient access, in contrast to companies like Olive working on the backend. Finally, Well gets $40 million in a Series A using AI and behavioral economics to provide health information and coaching. —Matthew Holt

The Pathway to Health Leads Through Clean Energy Technology

Dec 16, 2020

By MIKE MAGEE

Health reporting this week is rightly dominated by the challenging worldwide distribution of the Pfizer vaccine for Covid-19. Bringing the virus to bay is job #1, not only to preserve human life but also our global economy. But this week, on the 5th anniversary of the Paris Agreement, we are reminded that our long term human health, including clean air and water, mitigation of weather-related human disasters, and regulations that lessen our chronic burden of disease, depend as much on energy policy as they do health policy.

Nowhere is this more evident (though largely hidden from sight) than in our planet’s positioning to address global warming. The Paris Agreement, the climate accord signed by 195 nations, was abuptly dismantled by Trump four years ago. But President-elect Biden has signaled that his first order on January 20, 2021, will be to rejoin the agreement.

As Trump patronized his fossil fuel funders, and promised that “we’re going to have clean coal and we’re going to have plenty of it,” the oil and gas industry wrote down the value of its assets $170 billion in the first 6 months of 2020.

Acknowledging as much this past week, a cabal of energy investors, with combined assets of $9 trillion, signaled a shift in their strategy with a pledge to harmonize their investments with net-zero carbon emissions by 2050.

Those investors haven’t suddenly “discovered religion.” No. They’re looking at the numbers.

Clean energy options like solar and wind, combined with the latest battery technology, are now 79% cheaper to produce than US coal production. Investors realize that 90% of the new energy capacity generated worldwide in 2020, as reported by the International Energy Agency, has come from clean energy.

COVID-19 Symptom Data Challenge Showcase Event — WEDNESDAY 4pm ET!

Dec 15, 2020

After receiving applications from 115 people (across every continent except Antarctica!) and 50 organizations, including 35 academic institutions, the judges have declared DeepOutbreak, a team with members from Georgia Tech, the University of Iowa, and Virginia Tech as the winner of COVID-19 Symptom Data Challenge.

Second place was awarded to K&A, a Russia-based team working with the World Bank and the Higher School of Economics. $75,000 in prizes will be awarded to the winners.

The winners and the other three finalists will present their prototypes at the COVID-19 Symptom Data Challenge Showcase on Wednesday, December 16th, from 4-5:30pm ET. Register here!

The program’s distinguished speakers include

Dr. Tom Frieden, President & CEO of Resolve to Save Lives, an initiative of Vital Strategies & former director of the CDC
Dr. Mark McClellan, director of the Duke Margolis Center for Health Policy
Dr. Farzad Mostashari, CEO of Aledade & former National Coordinator for Health IT at the Department of Health and Human Services, and
Kang-Xing Jin, Facebook’s Head of Health.

Chrissy Farr, Principal and Health-Tech Lead at OMERS Ventures and former technology and health reporter for CNBC.com, will serve as emcee.

The Evernorth Digital Health Formulary & the Disruption of the Digital Health Payment Model

Dec 15, 2020

By JESSICA DaMASSA, WTF HEALTH

Last December, Express Scripts — now a part of Evernorth — became the first PBM to go to market with a digital health formulary. Basically, adapting the vetting, organizing, and pricing functions of a traditional medication formulary to the digital (health) age. Mark Bini, Chief Patient Experience Officer, spearheaded the effort, meant to alleviate the burden faced by Evernorth’s clientbase of 4,000 employers and health plans, who’s HR benefits teams want to make digital health solutions available to the 100+ million members of their health plans, but don’t have a frictionless, repeatable way to do so. As Mark puts it, “if you’ve seen one digital health startup, you’ve seen one.” And, for an HR benefits administrator whose inbox is inundated by digital health companies, the challenge of dealing with different levels of clinical validation, different data needs, different contracts, and, probably, most frustrating, different payment models that are often separated from their health benefit and pharmacy benefits, Evernorth’s Digital Health Formulary eases a real burden. So, a year in… how’s it going? Have Evernorth’s clients bought into more digital health solutions as a result of the formulary? What’s uptake been like among the populations they manage? And, how has this been working out for digital health startups? Mark gives us an update, talks through the details of the selection process, AND reveals what he’s got planned next. Spoiler: The evolution of the Formulary means adding more cohorts of digital health solutions more frequently, increasing the number of digital health solutions covered under drug benefits, getting a beat on longitudinal digital health engagement, and working out how to help consumers navigate all the various health tech options that are available to them.

The Year When Everything Changed: Covid, Self Care and High Tech Innovation In Medicine

Dec 14, 2020

By HANS DUVEFELT

Life as we knew it and medicine as we had viewed it shapeshifted so dramatically in the past year that it is still hard to believe.

Medicine has started to move from an in-person only profession to one that finally recognizes that clinical assessment and treatment have fewer boundaries than people assumed. A patient of mine with newly diagnosed mastocytosis had a productive first consultation with an immunologist hundreds of miles away right from her own living room.

Efficiency increased when we could handle straightforward clinical issues electronically, even over the telephone, and still get paid. We were liberated from the perverted and miserly view by insurers that services not delivered in person should be free, as if fast food restaurants couldn’t charge for food at the drive through.

We delivered more virtual services to allow patients the safety of staying at home and avoiding lobbies, waiting rooms and exam rooms where airborne particles might linger.

Yet, when a primary care or mental health patient is in crisis or a person with new symptoms needs to be evaluated, a video visit is sometimes not enough. Step by step, we improvised screening protocols, not knowing which would be efficient or relevant as we didn’t know quite how the coronavirus behaved and transmitted.

Docs are ROCs: a simple fix for a “methodologically indefensible” practice in medical AI studies

Dec 11, 2020

By LUKE OAKDEN-RAYNER

Anyone who has read my blog or tweets before has probably seen that I have issues with some of the common methods used to analyse the performance of medical machine learning models. In particular, the most commonly reported metrics we use (sensitivity, specificity, F1, accuracy and so on) all systematically underestimate human performance in head to head comparisons against AI models.

This makes AI look better than it is, and may be partially responsible for the “implementation gap” that everyone is so concerned about.

I’ve just posted a preprint on arxiv titled “Docs are ROCs: A simple off-the-shelf approach for estimating average human performance in diagnostic studies” which provides what I think is a solid solution to this problem, and I thought I would explain in some detail here.

Disclaimer: not peer reviewed, content subject to change

A (con)vexing problem

When we compare machine learning models to humans, we have a bit of a problem. Which humans?

In medical tasks, we typically take the doctor who currently does the task (for example, a radiologist identifying cancer on a CT scan) as proxy for the standard of clinical practice. But doctors aren’t a monolithic group who all give the same answers. Inter-reader variability typically ranges from 15% to 50%, depending on the task. Thus, we usually take as many doctors as we can find and then try to summarise their performance (this is called a multi-reader multicase study, MRMC for short).

Since the metrics we care most about in medicine are sensitivity and specificity, many papers have reported the averages of these values. In fact, a recent systematic review showed that over 70% of medical AI studies that compared humans to AI models reported these values. This makes a lot of sense. We want to know how the average doctor performs at the task, so the average performance on these metrics should be great, right?

THCB Gang Episode 35, Dec 10

Dec 10, 2020

Episode 35 of “The THCB Gang” was live-streamed Thursday, Dec 10. You can watch it below.

Matthew Holt (@boltyboy) was joined by not one but two of America’s leading health futurists Ian Morrison (@seccurve) and Jeff Goldsmith; Patient advocate Grace Cordovano (@GraceCordovano); health writer Kim Bellard (@kimbbellard); employer health expert Jennifer Benz (@jenbenz); and surgeon and innovation dude Raj Aggarwal (@docaggarwal).

There was lots of conversation about who is going to pay for what health care. What are big employers going to do. How is the vaccine going to roll out and are we ready? What does it all mean for the future of hospitals, doctors, employers, innovation and more.

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