The Health Care Blog – Page 176 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

A Full-Scale Assault on Medical Debt, Part 1

Mar 6, 2020• 3

By BOB HERTZ

The recent proposal by Sen. Bernie Sanders to cancel $81 billion of medical debt is a very good start—but it is only a start.

The RIP Medical Debt group—which buys old medical debts, and then forgives them—is absolutely in the right spirit. Its founders Craig Antico and Jerry Ashton deserve great credit for keeping the issue of forgiveness alive.

Unfortunately, over $88 billion in new medical debt is created each year; most of it still held by providers, or sold to collectors, or embedded in credit card balances.

Tragically, none of this has to happen! In France, a visit to the doctor typically costs the equivalent of $1.12. A night in a German hospital costs a patient roughly $11. German co-pays for the year in total cannot exceed 2% of income. Even in Switzerland, the average deductible is $300.

U.S. patients face cost-sharing that would never be tolerated in Germany, says Dr. Markus Frick, a senior official. “If any German politician proposed high deductibles, he or she would be run out of town.”

As Physicians Today, We Must Both Represent the “System” and Disregard it

Mar 5, 2020

By HANS DUVEFELT, MD

Healthcare today, in the broadest sense, is not a benevolent giant that wraps its powerful arms around the sick and vulnerable. It is a world of opposing forces such as Government public health ambitions and more or less unfettered market ambitions by hospitals and downright profiteering by some of the middlemen who stand between doctors and patients, such as insurers, Pharmacy Benefits Managers, EMR vendors and other technology companies.

Within healthcare there is also a growing, more or less money-focused sector of paramedicine, promoting “alternative” belief systems, some of which may be right on and showing the future direction for us all and some of which are pure quackery.

I stand by my conviction that physicians must embrace the role of guide for their patients. If we see ourselves only as instruments or tools in the service of the Government, the insurance companies or our healthcare organizations, patients are likely to mistrust our motives when we make diagnoses or recommend treatments.

Health in 2 Point 00, Episode 110b | Maven, IntelyCare, and New Acquisitions!

Mar 4, 2020• 1

Today on Health in 2 Point 00, we resume our two-part series with part B and bring our promised special guest! Continuing from the first part of Episode 110, Jess and I discuss the women and family health startup Maven raising $45 million in its Series C round with celebrity investment. 1UpHealth, the MassChallenge HealthTech Finalist, raises $8 million; IntelyCare raises $45 million bringing the gig-economy approach to nurse staffing raises, and HealthJoy raises $30 million in Series C funding. The hospital owned ACO umbrella services company Caravan Health acquires Wellpepper, and Sharecare acquires Visualize Health; are these good acquisitions? -Matthew Holt

Still Fighting the Wrong Wars

Mar 4, 2020• 1

By KIM BELLARD

What do the coronavirus and Navy ships have in common? For that matter, what do our military spending and our healthcare spending have in common? More than you might think, and it boils down to this: we spend too much for too little, in large part because we tend to always be fighting the wrong wars.

I started thinking about this a couple weeks ago due to a WSJ article about the U.S. Navy’s “aging and fragmented technology.” An internal Navy strategy memo warned that the Navy is “under cyber siege” by foreign adversaries, leaking information “like a sieve.” It grimly pointed out:

Our adversaries gain an advantage in cyberspace through guerrilla tactics within our defensive perimeters. Once inside, malign actors steal, destroy and/or modify critical data and information.

This is the Navy, after all, that proudly tried to modernize by installing touch screen technology on some of its ships, only to have the disaster that hit the USS McClain. Its vaunted Integrated Bridge and Navigation System was, ProPublica found, “was a welter of buttons, gauges and software that, poorly understood and not surprisingly misused, helped guide 10 sailors to their deaths.” And that wasn’t the only technology-enabled naval disaster in recent years.

Health in 2 Point 00, Episode 110a | Trump at HIMSS20, K Health, and Accolade

Mar 3, 2020

Today on Health in 2 Point 00, Jess is singing as we are finally back with a two-part episode to cover the deals over the past couple weeks! On part A of Episode 110, Jess and I begin with Trump as he is set to speak at HIMSS next week. K Health raises $48 million in its Series C round to focus development on AI-powered primary care. Accolade files for a $100 million IPO and the telehealth language service platform Cloudbreak Health raises $10 million. Finally, Q Bio raises $40 million in Series B funding aiming to open additional centers and enhance the digital health platform. -Matthew Holt

Can Startups Save Primary Care?

Mar 3, 2020• 4

By ANDY MYCHKOVSKY

Today, primary care is considered the bee’s knees of value-based care delivery. Instead of being viewed as the punter of the football team, the primary care physician (PCP) has become the quarterback of the patient’s care team, calling plays for both clinical and social services. The entire concept of the accountable care organization (ACO) or patient-centered medical home (PCMH) crumbles without financially- and clinically-aligned PCPs. This sea change has resulted in rapid employment or alignment to health systems, as well as a surge in venture capital being invested into the primary care space.

Before we get too far in the weeds, let’s first begin with the definition of primary care. The American Academy of Family Physicians (AAFP) defines a primary care physician as a specialist typically trained in Family Medicine, Internal Medicine, or Pediatrics. Some women do use their OB/GYN as their PCP, but these specialists are not traditionally considered PCPs. Now if you’ve gone to your local PCP and noticed that your care provider is not wearing a white coat with the “MD” or “DO” credentials, you are either receiving treatment from a hipster physician, nurse practitioner (NP), or physician assistant (PA). Two of the three professionals are trained in family medicine and can provide primary care services under the responsibility of an associated PCP. At least one of the three has a beard.

The crazy thing is, despite the industries heightened focus on the importance of PCPs, we’re still expecting a shortage of primary care providers. In April 2019, the Association of American Medical Colleges (AAMC) released a report estimating a shortage of between 21,100 and 55,200 PCPs by 2032. Given we just passed 2020, this not that far off. The primary reason for the shortage is the growing and aging population. Thanks mom and dad. Digging into the numbers will really knock your socks off, with the U.S. Census estimating that individuals over the age of 65 will increase 48% over that same time period. Like a double-edged sword, the issue is not just on the patient demand side though. One-third of all currently active doctors will be older than 65 in the next decade and could begin to retire. Many of these individuals are independent PCPs who have resisted employment by large health systems.

The Undercurrents & Subtext of JP Morgan Healthcare 2020 | Luminary Labs, Sara Holoubek

Mar 2, 2020

By JESSICA DaMASSA, WTF HEALTH

Sara Holoubek, Founder & CEO of Luminary Labs, a strategy and innovation consultancy — and the recognized “Queen” of identifying the undercurrents and sub-text of conversations at healthcare conferences — dishes about those undercurrents running just-below-the-surface at JP Morgan Healthcare 2020. Where’s the digital health market headed? Says Sara, “When you see too much bottle service at the parties…that’s when you should watch your back!”

Filmed at J.P. Morgan Healthcare Conference in San Francisco, January 2020.

Hotspotting, Superutilizers, and Avoiding “RTM Traps”

Mar 2, 2020

By THOMAS WILSON PhD, DrPH and VINCE KURAITIS JD, MBA

A recent study in the New England Journal of Medicine reported on the results of a “hotspotting” program created by the Camden Coalition of Healthcare Providers (Camden Coalition). Hotspotting targets interventions at all or a subset of healthcare superutilizers – the 5% of patients that account for 50% of annual healthcare spending.

The results of the study were disappointing. While utilization (hospital readmissions) declined for the hotspotting group, the declines were almost identical in the control group. At least three headlines implied that the conclusion of the study was that hotspotting care management approaches have been proven not to work:

“’Hot spotting’ doesn’t work. So what does?” Politico Pulse

“Reduce Health Costs By Nurturing The Sickest? A Much-Touted Idea Disappoints.” NPR

“Hotspotting” Apparently Doesn’t Reduce Superutilizers’ Readmissions” NEJM Journal Watch

NOT SO FAST!

As we’ll explain, we believe that much of what’s going on here can be explained by one or both of what we call “RTM Traps” (regression to the mean traps).

In this essay, we will:

Define RTM (regression to the mean)
Explain the RTM Traps and how many have fallen into the traps
Suggest how to avoid the RTM Traps

We believe our POV is relevant to clinical, technical, and executive staff in the many organizations focusing on the superutilizer population – hospitals, physicians, ACOs, health plans, community groups, etc.

How Hospital Systems Invest in Digital Health | Brent Stackhouse, Mount Sinai Ventures

Feb 28, 2020

By JESSICA DaMASSA, WTF HEALTH

Savvy health tech startups can learn how the differing investment priorities of venture capital funds and strategic investors (those tied to large healthcare organizations like health plans, pharma companies, and health systems) can impact everything from their capital raise to their ability to gain new clients. Brent Stackhouse, Managing Director at Mount Sinai Ventures, talks about the nuances of investing as a strategic, trying to balance a health system’s inherent aversion to risk with the gusto it takes to place good bets on the future of health. Where does a hospital system find investments? Are they looking for clinical solutions or consumer solutions? Brent shares the details behind Mount Sinai’s investment thesis and talks ‘big picture’ about trends he’s seeing in healthcare investing worldwide.

Filmed at Frontiers Health Conference in Berlin, November 2019.

How eConsults Can Help PCPs Benefit From the Primary Cares Initiative

Feb 28, 2020• 1

By CHRIS JAEGER MD, MBA

The Primary Cares Initiative provides new value-based payment models aiming to enhance the delivery of primary care to promote efficiency and quality while decreasing healthcare costs. In the second part of this two-part series, we explore how eConsults directly support this new initiative across several key metrics.

Introduction

The Primary Cares Initiative aims to enhance the delivery of primary care through value-based payment models. In Part One of this two-part series, we broke down the five payment models offered through this initiative, including two performance-based models (Primary Care First) and three risk-sharing plans (Direct Contracting). Alongside previous programs such as Patient-Centered Medical Home (PCMH), the Comprehensive Primary Care (CPC+) program, and the Medicare Advantage Value-based Insurance Design (VBID), the Primary Cares Initiative represents the most recent push for enhancing primary care within health care systems.

Yet, as programs such as these continue to emphasize primary care providers as a locus of optimal care, the question becomes: how can primary care providers (PCPs) best work within initiatives such as these to enhance care delivery efficiency and effectiveness, and what kinds of services and technologies can support this?