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Will Trump, Congressional Infections Boost Innovations For Covid-19 Survivors?

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By MICHAEL MILLENSON

When powerful politicians confront a life-threatening diagnosis, it can change policy priorities. 

In addition to President Trump and a slew of top aides, five U.S. senators and 15 members of the House of Representatives have now tested positive or been presumed positive in tests for Covid-19 as of Oct. 5, according to a running tally by National Public Radio (NPR).

In that light, the recent burst of coronavirus infections could accelerate three significant innovations affecting every Covid-19 survivor.

1) Post-Covid Clinics

Even seemingly mild encounters with the coronavirus can trigger a cascade of lingering health consequences. While “there is no consensus definition of post-acute Covid-19,” noted an Oct. 5 JAMA commentary, symptoms that have been reported include joint pain, chest pain, fatigue, labored breathing and organ dysfunction “involving primarily the heart, lungs and brain.”

A survey by Survivor Corps, a patient support group, and the Indiana University School of Medicine found that Covid “long haulers” often suffer from “painful symptoms…that some physicians are unable or unwilling to help patients manage.” A similar survey by the Body Politic Covid-19 Support Group concluded that Covid long-haulers face “stigma and lack of understanding [that] compromise access to health care and quality of support.”  

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THCB Gang Episode 28 10/15

Episode 28 of “The THCB Gang” was live-streamed on Thursday, October 15th! Watch it below!

Matthew Holt (@boltyboy) was joined by some of our regulars: communications leader Jennifer Benz (@jenbenz), data privacy expert Deven McGraw (@healthprivacy), CEO of addiction recovery service Suntra Modern Recovery, Jean-Luc Neptune MD (@jeanlucneptune), CEO of Day Health Strategies Rosemarie Day (@Rosemarie_Day1), medical historian & health economist Mike Magee MD (@drmikemagee), policy & tech expert Vince Kuraitis (@VinceKuraitis). The conversation focused on the looming election, the new COVID-19 Surge, Amy Coney Barrett’s hearing, and health care costs rising in the US costs.

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

A War on Science is a War on Us

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By KIM BELLARD

We’re in the midst of a major U.S. election, as well as hearings on a Supreme Court vacancy, so people are thinking about litmus tests and single issue voters – the most typical of which is whether someone is “pro-life” or “pro-choice.”  Well, I’m a single issue person too; my litmus test is whether someone believes in evolution. 

I’m pro-science, and these are scary times.

Within the last week there have been editorials in Scientific American, The New England Journal of Medicine, and Nature – all respected, normally nonpartisan, scientific publications – taking the current Administration to task for its coronavirus response.   Each, in its own way, accuses the Administration of letting politics, not science, drive its response. 

SA urges voters to “think about voting to protect science instead of destroying it.”  They cite, among other examples, Columbia Law School’s Silencing Science Tracker, which “tracks government attempts to restrict or prohibit scientific research, education or discussion, or the publication or use of scientific information, since the November 2016 election.”  Their count is over 450 by now, across a broad range of topics in numerous federal agencies on a variety of topics.   

The SA authors declare:

Science, built on facts and evidence-based analysis, is fundamental to a safe and fair America. Upholding science is not a Democratic or Republican issue.

Similarly, NEJM fears:

Our current leaders have undercut trust in science and in government,4 causing damage that will certainly outlast them. Instead of relying on expertise, the administration has turned to uninformed “opinion leaders” and charlatans who obscure the truth and facilitate the promulgation of outright lies.

Jeff Tollefson, in Nature, warns:

As he seeks re-election on 3 November, Trump’s actions in the face of COVID-19 are just one example of the damage he has inflicted on science and its institutions over the past four years, with repercussions for lives and livelihoods. 

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#Healthin2Point00, Episode 159 | A quiet period?

Today on Health in 2 Point 00, we might be seeing a quiet period in health tech investing with the election coming up. On Episode 159, Jess and I talk about TigerConnect raising $45 million in a Series D, offering a HIPAA-compliant texting service for doctors; UK-based startup Numan getting £10 million, which is another online male health clinic. Next, Nym gets $16.5 million—lots of good investors in this round, this company uses natural language processing to automate hospital billing. Finally, Press Ganey acquires Doctor.com and a company called Binary Fountain. —Matthew Holt

#Healthin2Point00, Episode 158 | Datavant, Mira, Avail & more

On Episode 158 of Health in 2 Point 00, Jess and I talk about Datavant raising $40 million in a Series B for their open health data exchange platform, Mira raising $2.7 million for it’s Costco-esque health insurance alternative, Avail raising $100 million providing telehealth for the OR, ScriptDrop raising $15 million for prescription drug delivery, and Abridge raising $15 million to help patients transcribe doctor’s appointments. —Matthew Holt

Health Professionals Are Tomorrow’s Health Journalists. Here is a Code of Ethics to Guide Us and Trump’s White House Doctor.

By MIKE MAGEE

The patient/health-professional relationship is fundamentally grounded in science and trust, and involves the exchange of compassion, understanding and partnership. The Covid-19 pandemic has challenged this relationship by acutely increasing the nation’s burden of disease, creating new barriers to face-to-face contact, and injecting high levels of fear and misinformation.

Dr. Sean Conley, Trump’s White House physician, in his dodgy and evasive management of legitimate questions from the White House press corps regarding the President’s health, has made matters worse.

As this week’s report on an analysis of 38 million articles on the pandemic revealed, much of the misinformation our citizens have experienced can be traced to a single individual who lacks any health credentials – our own President Trump. Sarah Evanega, the director of the Cornell Alliance for Science and lead author of the report stated, “The biggest surprise was that the president of the United States was the single largest driver of misinformation around Covid. That’s concerning in that there are real-world dire health implications.”

The solution to that specific problem is only one month away – vote him out. But if Trump can be successfully sent packing, how prepared are our health professionals, in the face of these new and complex challenges? A President Biden health reform package will likely include expansion of health care teams, exponential growth of telemedicine, and increasing dependence on reliable information to advance personal health planning.

Today’s modern health professionals are tomorrow’s health journalists. What principles should guide them in their new and expanded role. As a guide, I offer the following:

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Value-based care – no progress since 1997?

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By MATTHEW HOLT

Humana is out with a report saying that its Medicare Advantage members who are covered by value-based care (VBC) arrangements do better and cost less than either their Medicare Advantage members who aren’t or people in regular Medicare FFS. To us wonks this is motherhood, apple pie, etc, particularly as proportionately Humana is the insurer that relies the most on Medicare Advantage for its business and has one of the larger publicity machines behind its innovation group. Not to mention Humana has decent slugs of ownership of at-home doctors group Heal and the now publicly-traded capitated medical group Oak Street Health.

Humana has 4m Medicare advantage members with ~2/3rds of those in value-based care arrangements. The report has lots of data about how Humana makes everything better for those Medicare Advantage members and how VBC shows slightly better outcomes at a lower cost. But that wasn’t really what caught my eye. What did was their chart about how they pay their physicians/medical group

What it says on the surface is that of their Medicare Advantage members, 67% are in VBC arrangements. But that covers a wide range of different payment schemes. The 67% VBC schemes include:

  • Global capitation for everything 19%
  • Global cap for everything but not drugs 5%
  • FFS + care coordination payment + some shared savings 7%
  • FFS + some share savings 36%
  • FFS + some bonus 19%
  • FFS only 14%

What Humana doesn’t say is how much risk the middle group is at. Those are the 7% of PCP groups being paid “FFS + care coordination payment + some shared savings” and the 36% getting “FFS + some share savings.” My guess is not much. So they could have been put in the non-VBC group. But the interesting thing is the results.

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#Healthin2Point00, Episode 157 | The phrase is “Takeout Speculation”!

Today on Health in 2 Point 00, Jess and I gossip about the wild rumor that UnitedHealthcare is acquiring Amwell. On Episode 157, we discuss Lark raising $55 million in a Series C along with a deal with Anthem to be their preferred DPP provider, Medicare Advantage plan Clover going public with a valuation of $3.7 billion, NOCD raising $12 million in a Series A providing specialized CBT and virtual OCD treatment, Cerebral raising $35 million in a Series A for its comprehensive digital mental health offerings, and Express Scripts adding to their digital health formulary with offerings targeting things like women’s health, tobacco cessation, muscle and joint pain, and more. —Matthew Holt

How Can Patients Get Medical Records from a Closed Medical Practice?

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By GRACE CORDOVANO, DEVEN McGRAW, and AARON MIRI

The HIPAA Privacy Rule gives patients the right to copies of their medical records, with rare exceptions. When patients need a copy of their medical records, most start the process by calling their doctor’s office and asking for how to get access. The receptionist or office staff point them in the right direction, whether it’s instructing them to write down their request and sending it to the office, pointing them to contact the medical records or radiology department (if the practice is large enough), or assisting them in setting up their patient portal, if the practice is using an electronic health record (EHR). Being able to connect with a person inside the four walls of medicine is often crucial for many patients and their carepartners who may be unsure of exactly how to request their records.

But what happens to those records when a doctor closes or leaves the practice?

Independent practices close for a variety of reasons. Physicians may merge with a large practice or health system, retire, they may sell or close their practice for personal reasons, they may file for bankruptcy, or they may get sick and die. The COVID19 pandemic has had devastating financial consequences on many small, independent, and rural practices, leading to their consequent closure, acquisition, or merger.

What should patients do when their doctor’s office closes, and they need a copy of their medical records? This is especially challenging when a doctor may not have had an EHR, as is the case with many independent practices as well as more rural settings. On September 26, 2020, a tweet from Cait DesRoches, Executive Director of OpenNotes, inquired about how a family member may get access to medical records from her physican’s practice that closed, triggering a robust conversation that led to the realization that patients and families are not well informed in these circumstances.

Prevention is Worth a Pound of Cure

It can be much more difficult to get copies of records after a practice has closed. Patients should get copies of their medical records as they are generated instead of waiting until they’re needed. HIPAA Privacy Rule guidance states that individuals can get digital copies of digital information (or even digital copies of records kept on paper, as long as the practice has a scanner). Companies are developing tools and services that enable individuals and their care partners to collect, use, and store health records. Request digital (or paper, if that is preferred) copies of blood work, imaging, discharge instructions, and corresponding reports before you leave the practice.

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THCB Gang Episode 27, 10/8

Episode 27 of “The THCB Gang” was live-streamed on Thursday, October 8th! Watch it below!

Matthew Holt (@boltyboy) was joined by some of our regulars: health futurist Ian Morrison (@seccurve), WTF Health Host Jessica DaMassa (@jessdamassa), writer Kim Bellard (@kimbbellard), patient & entrepreneur Robin Farmanfarmaian (@Robinff3), health economist Jane Sarasohn-Kahn (@healthythinker), and fierce patient activist Casey Quinlan (@MightyCasey)! We covered the recent presidential & vice-presidential debates, Trump on steroids, what the future of the ACA looks like, how will virtual care change public health, and more.

If you’d rather listen to the episode, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels — Zoya Khan (@zoykskhan)

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