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The EU-Backed Community of Health Innovators Transforming Health | Katharina Ladewing, EIT Health

By JESSICA DaMASSA, WTF HEALTH

Financially backed by the EU, EIT Health is a pan-European network of health innovators and 150+ corporate and academic partners across the continent who pool their assets to support widespread health innovation across Europe. We caught up with Katharina Ladewing, Managing Director for EIT Health Germany, about the group’s priorities, how they enable early and late stage startups to find funding and business partners, and how digital health has been evolving (rapidly) in the EU over the past few years. Wondering what the differences are between the health tech startup ecosystems in Europe versus the US? Katharina shares some of the insights she’s gained after four years watching this space mature.

Filmed at Frontiers Health in Berlin, Germany, November 2019.

Health in 2 Point 00, Episode 108 | OneMedical IPO, Hinge Health, & Humana

Today on Health in 2 Point 00, we’re starting out with a riddle: what’s the similarity between the 49ers Super Bowl performance and digital health? Find out on Episode 108, where Jess and I discuss other news in health tech starting off with another IPO, OneMedical. Now worth more than Livongo at $2.7 billion, this went better than anyone could’ve expected. Hinge Health raises $90 million in a Series C round, offering physical therapy at home and tapping into the loads of waste that goes towards back surgeries. Finally, Humana partners with a private equity company to expand primary care centers, what is the deal with this? —Matthew Holt

To Improve Patient Care, Think Both “Zebras” and Golf

By MICHAEL MILLENSON

Super Bowl Week ended with the San Francisco 49ers and 161 U.S. hospitals having something in common.

Both were publicly penalized, both lost money as a result and both passionately believed the process was unfair. Unfortunately, it’s not easy to decide whether their objections were sensible or sour grapes and, in the case of hospitals, the real-life consequences are not a game.

The penalty that pained the 49ers occurred shortly before halftime of Super Bowl LIV, when offensive pass interference was called on tight end George Kittle. The call negated a big gain that might have enabled the 49ers to take the lead.

Replays showed that the referees – nicknamed “zebras” for their black-and-white striped shirts – were technically correct in their decision. Nonetheless, controversy erupted over whether given other possible penalties called or overlooked, this one deserved a yellow flag.

Hospitals call that kind of context “risk adjustment.” A few days before the Super Bowl, the Medicare program blew the whistle on a group of hospitals having high rates of infection and other patient injuries. The hospitals who are outliers in what are blandly labeled “hospital-acquired conditions” (HACs) suffer a cut of one percent in their Medicare payments over next fiscal year.

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The Digital-First Health Insurance Startup Changing Healthcare in Nigeria | Femi Kuti, RelianceHMO

By JESSICA DaMASSA, WTF HEALTH

RelianceHMO is a Nigerian-based health insurance startup that aims to turn the traditional health insurance world upside-down. CEO Femi Kuti delves into how his company is using mobile phones, telemedicine, data science, and even underwriting (!) to make health insurance cheaper — and more accessible. With more than 1800 hospital partners across Nigeria, RelianceHMO is making a name for itself, but how does it plan to scale throughout Africa? And, what can payers around the world learn from their approach as they seek to make health insurance easy and affordable for Nigeria’s 190M uninsured? We love talking about disrupting payment models in healthcare and after hearing Femi’s story, you’ll understand why.

Filmed at Bayer G4A Signing Day in Berlin, Germany, October 2019.

The Social Context and Vulnerabilities that Challenge Health Care in the San Joaquin Valley of California

By ALYA AHMAD, MD

Call it what you want, white privilege and health disparity appear to be two sides of the same coin. We used to consider ethnic or genetic variants as risk factors, prognostic to health conditions. However, the social determinants of health (SDOH) have increasingly become more relevant as causes of disease prevalence and complexity in health care.

As a pediatric hospitalist in the San Joaquin Valley region, I encounter these social determinants daily. They were particularly evident as I treated a 12-year old Hispanic boy who was admitted with a ruptured appendix and developed a complicated abscess, requiring an extensive hospitalization due to his complication. Why? Did he have the genetic propensity for this adverse outcome? Was it because he was non-compliant with his antibiotic regimen? No.

Rather, circumstances due to his social context presented major hurdles to his care. He had trouble getting to a hospital or clinic. He did not want to burden his parents—migrant workers with erratic long hours—further delaying his evaluation. And his Spanish-speaking mother never wondered why, despite surgery and drainage, he was not healing per the usual expectation.

When he was first hospitalized, his mother bounced around in silent desperation from their rural clinic to the emergency room more than 20 miles from their home and back to the clinic, only to be referred again to that same emergency room. By the time he was admitted 2 days later, he was profoundly ill. The surgeon had to be called in the middle of the night for an emergency open surgical appendectomy and drainage. Even after post-operative care, while he was on broad-spectrum intravenous antibiotics, his fevers, chills and pain persisted. To avoid worrying his mother, he continued to deny his symptoms. Five days after his operation, he required another procedure for complex abscess drainage.

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Autonomous Pharmacy: An Industry Movement to Free Hospital Pharmacists | Randy Lipps, CEO, Omnicell

By JESSICA DaMASSA, WTF HEALTH

From the point at which a medication arrives at a hospital’s receiving dock to the time it’s given to a patient, Omnicell systems are relied on to “store it, package it, barcode it, order it, issue it, and charge it.” Now, CEO Randy Lipps wants to automate ALL OF IT — getting medications from dockside to bedside, without the help of human hands. The Autonomous Pharmacy is not only Omnicell’s bold vision for the future of medication management for hospitals that brings in robotics and software to improve the safety and accuracy of every aspect of the drug delivery process, but as Randy says, it’s an “industry movement” to free the hospital pharmacist from the “basement pharmacy” and allow them to truly practice at the top of their license. Although integrating new tech into healthcare systems is never easy, this CEO says that it’s less the tech — and more the lack of urgency in shifting our mindset as an industry — that’s slowing us down. What exactly needs to change? Bold visions require big plans…

Filmed at the American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting in Las Vegas, December 2019.

Medical Records in Primary Care: Keeping the Story of Phone Calls and Medication Changes with Less than Perfect Tools

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By HANS DUVEFELT, MD

I need the right information at the right time (and in a place that makes sense to me) to make safe medical decisions.

Here’s another Metamedicine story:

In learning my third EMR, I am again a little disappointed. I am again, still, finding it hard to document and retrieve the thread of my patient’s life and disease story. I think many EMRs were created for episodic, rather than continued medical care.

One thing that can make working with an EMR difficult is finding the chronology in office visits (seen for sore throat and started on an antibiotic), phone calls (starting to feel itchy, is it an allergic reaction?) and outside reports (emergency room visit for anaphylactic reaction).

I have never understood the logic of storing phone calls in a separate portion of the EMR, the way some systems do. In one of my systems, calls were listed separately by date without “headlines” like “?allergic reaction” in the case above.

In my new system, which I’m still learning, they seem to be stored in a bigger bucket for all kinds of “tasks” (refills, phone calls, orders and referrals made during office visits etc.)

Both these systems seem to give me the option of creating, in a more or less cumbersome way, “non-billable encounters” to document things like phone calls and ER visits, in chronological order, in the same part of the record as the office notes. That may be what IT people disparagingly call “workarounds”, but listen, I need the right information at the right time (and in a place that makes sense to me) to make safe medical decisions.

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Health in 2 Point 00, Episode 107 | SoftBank Money, Judy Faulkner’s Letter, & Practice Fusion Gossip

Today on Health in 2 Point 00, we have SoftBank Money! I managed to beat Chrissy Farr to this piece of gossip by about 3 weeks, but digital pharmacy startup Alto raises $250 million from SoftBank. Medloop raises 6 million euros doing communication with patients, and mental health startup Spring Health raises $22 million as well. Turning to the EMR drama, I also give a rundown on Judy Faulkner’s letter, and explain the cautionary tale that is Practice Fusion & the Purdue opiate promotion. —Matthew Holt

Ouchie, a Chronic Pain Management App Mapping “Pain Journeys” | Rachel Trobman, Upside Health

BY JESSICA DAMASSA, WTF HEALTH

Not only is ‘Ouchie’ what you say when you’re in pain, but now it’s also what you say when you need to find relief! Rachel Trobman, CEO of Upside Health, introduces us to Ouchie, a remote patient monitoring and treatment tool for chronic pain that patients can download onto their phones. Central to the patient experience of the app is the focus on documenting the patient’s “pain journey” where they answer a series of important lifestyle questions that inform the platform to come up with ways to receive support and other health resources. Not only does this self-reported data help patients identify triggers and patterns that impact their pain level, but it is also a treasure trove of information for physicians who can use it to better (and more quickly) tailor treatment to suit individual needs. The business behind Ouchie, called Upside Health, is starting to take off too and Rachel talks through revenue model, funding, and future plans.

Filmed at Frontiers Health in Berlin, Germany, November 2019.

Why the Centene and WellCare Merger is the Biggest Deal in 2020

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By ANDY MYCHKOVSKY

I feel like the healthcare world just skipped over the $17.3 billion mega-merger between Centene and Wellcare, which just received final regulatory approval last Wednesday. With their powers combined, this new company will create the Thanos of government-focused health plans, hopefully without any of the deranged plans to take over the world. I do get it, 181 million lives are covered by employer-sponsored insurance, between full-risk and self-insured plans. These employer populations have the most disposable income and their HR departments are willing to provide supplemental benefits. However, in my opinion, the future growth of health insurance will be governmental programs like Medicare Advantage (MA), Medicaid managed care, and ACA exchanges. But instead of me telling you this, here is exactly what Centene and WellCare said in a press release to defend the merger:

“The combined company would be the leader in government-sponsored healthcare with increased scale and diversification both geographically and in its managed care service offerings, and enhance access to high-quality services for members. It will offer affordable and high-quality products to its more than 12 million Medicaid and approximately 5 million Medicare members (including Medicare Prescription Drug Plan), as well as individuals served in the Health Insurance Marketplace and the TRICARE program. The combined company will operate 31 NCQA accredited health plans across the country and will have increased exposure to government-sponsored healthcare solutions through WellCare’s Medicare Advantage and Medicare Prescription Drug Plans. It will also benefit from leveraging Centene’s growing position in the Health Insurance Marketplace to new markets. The transaction creates a company with the size and scale to better serve members through enhanced healthcare programs, expanded capabilities and increased investment in technology.”

Simply put, here’s some of quick stats provided at the JP Morgan Healthcare Conference presentation on January 13, 2020:

  • National footprint now serving 1 in 15 Americans
  • Clear market leader in Medicaid managed care and ACA exchange marketplace
  • Dominance serving most complex populations, #1 leader in LTSS and #2 in dual eligible
  • Competitiveness in the Medicare Advantage (MA) enrollment wars
  • $500 million in proposed savings due to annual cost synergies
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