Governors like Andrew Cuomo of New York have discovered the price for inefficiency and conflicts of interest in the face of the COVID-19 epidemic. As he said last week, “No one hospital has the resources to handle this. There has to be a totally different operating paradigm where all those different hospitals operate as one system.”
Our system is marked by extreme variability: a nation of health care haves and have-nots. Yet even when we Americans acknowledge the absurdity of our convoluted system of third-party payers and the pretzel positions our politicians weave in and out of as they try to justify it, reform it, then un-reform it, many still find solace in telling themselves, “Well, we still have the best health care in the world.”
This
crisis in a matter of weeks has revealed the limitations of a conflicted
network built on short-term profiteering and entrepreneurial adventurism. Here
are a few early learnings:
COVID is here. A little strand of RNA that
used to live in bats has a new host. And
that strand is clearly not the flu. New
York is overrun, with more than half of the nation’s new cases per day, and
refrigerated 18-wheelers parked outside hospitals serve as makeshift
morgues. Detroit, New Orleans, Miami,
and Philadelphia await an inevitable surge of their own with bated breath. America’s health care workers are scrambling
to hold the line against a deluge of sick patients arriving hourly at a rate
that’s hard to fathom.
I pause here to attest to the heroic response
of the medical community and the countless more working to support them. At the
time of this writing, despite 368,000 confirmed cases in the United States,
11,000 deaths have been reported. A
horrid number, but still a far cry from Italy with 130,000 cases, and 16,523
deaths, and Spain with 14,000 deaths amidst 140,000 cases. Italy and Spain may be a few weeks ahead of
the United States, but at the moment, Italy and Spain have case fatality rates
(12.5%, 10%) that are multiples of the United States (2.5%). If this rate does
stand, it will be a testament to the tenacity of medical workers toiling under
extenuating circumstances.
With the scale of the tragedy now obvious, the
take from some very smart people is that the people who should have been paying
attention were asleep at the wheel. The
easy target is the bombastic New York real estate developer and current
President of the United States who repeatedly assured raucous campaign crowds
and the nation that the virus was under control before it wasn’t.
The charge is made that the President ignored
warnings and painted a rosy picture of an unfolding crisis in a short-sighted
attempt to preserve the economy and a beloved stock market. He may be guilty of the latter charge, but
the real question relates to ignored warnings.
Where were the warnings? Who was sounding the alarm that was ultimately
ignored?
Indu & I have been talking about Flipping the Stack in health care for about 3 years. 2 years ago we wrote an article for a general hospital audience which appeared in the 2019 AHA SHSMD Futurescan magazine. I was talking about the changes in home monitoring that might come about due to COVID-19 and remembered this article. The one that got published went through a staid editing process. This is the original version that I wrote before which was rather more fun and hasn’t seen the light of day. Until now. Take a look and remember it is 2 years old–Matthew Holt
Over the past twenty-five
years most businesses have been revolutionized by the easy availability of
cloud and mobile-based computing systems. These technologies have placed power
and access into the hands of employees and customers, which in turn has created
huge shifts in how transactions get done. Now the companies with the highest
market value are both the drivers of and
beneficiaries of this transition, notably Apple, Facebook, Amazon and Alphabet
(Google), as well as their international rivals like Samsung, Baidu, Tencent
and Alibaba. Everyone uses their products every day, and the impact on our
lives have been remarkable. Of course, this also impacts how businesses of all
types are organized.
Underpinning
this transformation has been a change from enterprise-specific software to
generic cloud-based services—sometimes called SMAC
(Social/Sensors/Mobile/Analytics/Cloud). Applications such as data storage,
sales management, email and the hardware they ran on were put into enterprises
during the 80s and 90s in the client-server era (dominated by Intel and
Microsoft). These have now migrated to cloud-based, on-demand services.
Twenty
years ago the web was still a curiosity for most organizations. But consumers
flocked to these online services and in recent years businesses followed, using
GSuite, AWS (Amazon Web Services), Salesforce, Slack and countless other
services. Those technologies in turn enabled the growth of whole new types of
businesses changing sectors like transportation (Uber), entertainment (Netflix),
lodging (AirBnB) and more.
Figure 1. Growth in use of cloud data v s traditional data centers
What about the hospital?
Hospitals and health
systems were late comers to the enterprise technology game, even to
client-server. In the 2000’s and 2010’s, mostly in response to the HITECH Act,
hospitals added electronic medical records to their other information systems.
The majority of these were client-server based and enterprise-specific. Even if
they are cloud-based, they tend to be hosted in the private cloud environment
of the dominant vendors like Epic and Cerner. Of the major EMR vendors only
Athenahealth had an explicit cloud-only strategy, and its influence has been
largely limited to revenue cycle management on the outpatient side.
However, the hospital sector is likely to move towards the trend of using the cloud seen in other businesses.
Today on Health in 2 Point 00, Jess and I run through a lot of telehealth investments including Doctor Anywhere raising $27 million, 98point6 raising $43 million, Tyto Care raising $50 million, SilverCloud Health raising $16 million, SteadyMD raising $6 million, and Aktiia raising $6 million. In addition, there’s a company called Air Doctor which matches people when they’re traveling to doctors on the ground which raised $7.8 million despite the inauspicious timing. On the flip side, there have been a slew of layoffs in the space, and Jess and I give our $.02 on Rock Health’s Q1 fundraising report which was just released. Don’t miss our tag-team interview of Livongo’s Glen Tullman, and check out these episodes in podcast form on Spotify and iTunes. —Matthew Holt
The tipping point for telehealth just happened. Many ways of doing business will change forever after the experience of the COVID-19 pandemic, and health care, too, will never be the same.
Between the release from some HIPAA requirements announced by President Trump this month, shifts in payor policies, and mandated insurance coverage of telehealth visits, innovation and adoption are taking off like wildfire. As patients and outpatient-based physicians hunker down at home, they are rapidly experimenting, and improving the way care is being delivered remotely.
Our institution, which had no prior program, faced with an imminent shut down of elective activity, developed an enterprise-wide telehealth program in days, rendering hundreds of visits as soon as we launched it. This activity is being replicated all around the country.
Episode 4 of “The THCB Gang” was live-streamed Thursday April 9. You can see it below and it’s also preserved as a weekly podcast available on our iTunes & Spotify channels. Every Thursday at 1pm PT-4pm ET, 4-6 semi-regular guests drawn from THCB authors and other assorted old friends of mine will shoot the shit about health care business, politics, practice, and tech. It tries to be fun but serious and informative!
This week, joining me were Jane Sarasohn Kahn (@healthythinker), Anish Koka (@anish_koka), Saurabh Jha (@roguerad), Elizabeth Clayborne (@DrElizPC), and Ian Morrison (@seccurve). A fun and very informative discussion about where the COVID-19 crisis is right now and what it’s going to mean both now and in the near future — Matthew Holt
Among its less appreciated but more worrisome impacts, COVID-19 threatens to destabilize America’s health care provider infrastructure. Patients have largely been relegated to sheltering at home and, to avoid infection, are avoiding in-person clinical visits. The revenues associated with traditional physician office visits have been curtailed. Telehealth capabilities are gradually coming online, but are often still immature. The concern is that many practices will be financially unable to keep the doors open, compromising access and healthy physician-patient relationships.
Health plans have become health care’s bankers, controlling the funding that fuels larger care processes. Health insurance companies and health plan administrators rely on networks of doctors and hospitals to deliver health care services. They also rely on premium payments from employers to administer and pay for health care. In conventional fee-for-service, pay as you go arrangements, providers are paid after they have delivered care services. The stability of this approach, of course, assumes an unhindered flow of patients receiving care.
When the stability of that flow is disrupted, as it has been with COVID-19, physician practices become vulnerable. Solving that vulnerability would give members access to critical services – primary care, specialty care, urgent care and pharmacy coordination – during this epidemic. Without these resources, members will be forced to turn to overburdened hospitals, where they risk increased COVID-19 exposure.
Imagine a country where you can not see a doctor. Who will refill your blood pressure prescription, see your sick child, mend your broken arm, deliver your baby, or run the ventilator if you fall victim to Coronavirus? The COVID-19 pandemic created a cash-flow crisis causing mass physician layoffs and closure of medical practices. A world without doctors puts us all at risk. The pandemic is the invisible enemy, and the CEOs of large insurance companies have the tools to help doctors stay in the fight.
Our government, healthcare providers, and individuals are doing our part to flatten the curve of the pandemic. It is time for the insurance industry to take massive action to salvage the US health system.
Fresh off of a press junket that included talking to Jim Cramer on CNBC & hanging with Maria Bartiromo on Fox Business News, Livongo Health’s Glen Tullman stopped by THCB to talk about the impact of #covid19 (& more) on health tech. Jessica DaMassa and Matthew Holt tag-team interviewed him on Weds 8th April. (Full transcript is below the video)
Here is the transcript:
Matthew:
Hi, this is Matthew Holt from The Health Care Blog.
In the early days of the U.S. COVID-19 outbreak, BlueCross BlueShield of North Carolina (Blue Cross NC) stepped up as one of the first health insurance plans to announce reimbursing telehealth visits “at parity” with face-to-face office visits for all providers and specialists. Chief Medical Officer Rahul Rajkumar talks us through the strategy behind that decision to “flip the switch” for telemedicine — which was made in just one meeting (!) – and what metrics and outcomes the Blue plan will be looking at post-pandemic to decide if the switch remains on.
Conversation Highlights:
Changing reimbursement policies to cover ALL COVID-19 testing and treatment
6:45 min: The role of virtual care during COVID-19 and reimbursement at parity
11:11 min: How will telehealth be evaluated post-epidemic?
13:58 min: Telehealth innovation, B2B use, remote monitoring (looking to providers to lead the way)
17:25 min: What’s going to happen with healthcare costs in 2021?
For more on how health tech companies in digital health, telehealth, remote monitoring, health data, and more are responding to the COVID-19 crisis, check out the other interviews in this special series at www.wtf.health/covid19.
