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WW (aka WeightWatchers) Is Watching Health Tech & Behavior Change Thinking | Zoe Griffiths, WW

By JESSICA DaMASSA, WTF HEALTH

What’s WeightWatchers, now WW, doing at a health tech conference? Zoe Griffiths, Global Director of Nutrition, talks about what’s next for the company’s 4.5M members worldwide as their “wellness partner” embraces the latest trends and thinking that help make the behavior changes that lead to weight loss easier and more sticky. With the obesity epidemic in full swing, weight management stands on that increasingly blurry line between ‘wellness’ and ‘healthcare.’ How will WW continue to help its members see results?

Filmed at HIMSS/Health 2.0 Europe in Helsinki, Finland in June 2019.

Jessica DaMassa is the host of the WTF Health show & stars in Health in 2 Point 00 with Matthew Holt.

Get a glimpse of the future of healthcare by meeting the people who are going to change it. Find more WTF Health interviews here or check out www.wtf.health

Barbarians at the Gate

By ADRIAN GROPPER, MD

US healthcare is exceptional among rich economies. Exceptional in cost. Exceptional in disparities. Exceptional in the political power hospitals and other incumbents have amassed over decades of runaway healthcare exceptionalism. 

The latest front in healthcare exceptionalism is over who profits from patient records. Parallel articles in the NYTimes and THCB frame the issue as “barbarians at the gate” when the real issue is an obsolete health IT infrastructure and how ill-suited it is for the coming age of BigData and machine learning. Just check out the breathless announcement of “frictionless exchange” by Microsoft, AWS, Google, IBM, Salesforce and Oracle. Facebook already offers frictionless exchange. Frictionless exchange has come to mean that one data broker, like Facebook, adds value by aggregating personal data from many sources and then uses machine learning to find a customer, like Cambridge Analytica, that will use the predictive model to manipulate your behavior. How will the six data brokers in the announcement be different from Facebook?

The NYTimes article and the THCB post imply that we will know the barbarians when we see them and then rush to talk about the solutions. Aside from calls for new laws in Washington (weaken behavioral health privacy protections, preempt state privacy laws, reduce surprise medical bills, allow a national patient ID, treat data brokers as HIPAA covered entities, and maybe more) our leaders have to work with regulations (OCR, information blocking, etc…), standards (FHIR, OAuth, UMA), and best practices (Argonaut, SMART, CARIN Alliance, Patient Privacy Rights, etc…). I’m not going to discuss new laws in this post and will focus on practices under existing law.

Patient-directed access to health data is the future. This was made clear at the recent ONC Interoperability Forum as opened by Don Rucker and closed with a panel about the future. CARIN Alliance and Patient Privacy Rights are working to define patient-directed access in what might or might not be different ways. CARIN and PPR have no obvious differences when it comes to the data models and semantics associated with a patient-directed interface (API). PPR appreciates HL7 and CARIN efforts on the data models and semantics for both clinics and payers.

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Providers Don’t Take Enough Risk to Bend the Cost Curve

By KEN TERRY

Back in 2015, 20 major health systems and payers pledged to convert 75% of their business to value-based arrangements by 2020. Today, more than two-thirds of payments from U.S. commercial health insurers are tied to some kind of value-based model. By 2021, the health plans expect three-quarters of their payments will be value-based.

However, a recent analysis of Change Healthcare data by Modern Healthcare found that the percentage of value-based revenue tied up in upside/downside risk contracts was in the single digits. Among the types of two-sided risk contracts that provider organizations had were capitation or global payment (7.3%), pay for performance (6.5%), prospective bundled payment (5%), population-based payment (5.8%), and retrospective bundled payment (4.1%).

An AMGA survey picked up signs of a recession in risk contracting in 2016. A year earlier, survey respondents—mostly large groups–had predicted their organizations would get 9 percent of revenue from capitated products. In 2016, the actual figure was 5 percent, according to a Health Affairs post by the AMGA’s Chet Speed and the late Donald Fisher.

The authors cited a number of obstacles to the spread of risk contracting, including “limited commercial value-based or risk-based products in their local markets; the inability to access administrative claims data from all payers; the massive administrative burden of submitting data in different formats to different payers; lack of access to investment capital; and inadequate infrastructure.”

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Abu Dhabi’s Looking to Invest in the Future of Health | Abdulla Alii & Dirk Richter, Dept of Health

By JESSICA DaMASSA, WTF HEALTH

Abu Dhabi is looking to diversify its economy and has its sights set on the burgeoning health tech industry. Abdulla Alii & Dirk Richter from the Abu Dhabi Department of Health talk to Jessica DaMassa at Webit in Sofia, Bulgaria where the two are scouting start-ups and established healthcare partners who are interested in helping build a health innovation ecosystem that will augment their country’s traditional oil business.

Filmed in May 2019 at Webit in Sofia, Bulgaria.

Patient Controlled Health Data: Balancing Regulated Protections with Patient Autonomy

By KENNETH D. MANDL, MD, MPH, DAN GOTTLIEB, MPA, and JOSHUA MANDEL, MD

A patient can, under the Health Insurance Portability and Accountability Act (HIPAA), request a copy of her medical records in a “form and format” of her choice “if it is readily producible.” However, patient advocates have long complained about a process which is onerous, inefficient, at times expensive, and almost always on paper. The patient-driven healthcare movement advocates for turnkey electronic provisioning of medical record data to improve care and accelerate cures.

There is recent progress. The 21st Century Cures Act requires that certified health information technology provide access to all data elements of a patient’s record, via published digital connection points, known as application programming interfaces (APIs), that enable healthcare information “to be accessed, exchanged, and used without special effort.”  The Office of the National Coordinator of Health Information Technology (ONC) has proposed a rule that will facilitate a standard way for any patient to connect an app of her choice to her provider’s electronic health record (EHR).  With these easily added or deleted (“substitutable”) apps, she should be able to obtain a copy of her data, share it with health care providers and apps that help her make decisions and navigate her care journeys, or contribute data to research. Because the rule mandates the ”SMART on FHIR” API (an open standard for launching apps now part of the Fast Healthcare Interoperability Resources ANSI Standard), these apps will run anywhere in the health system.

Apple recently advanced an apps-based information economy, by connecting its native “Health app” via SMART on FHIR, to hundreds of health systems, so patients can download copies of their data to their iPhones. The impending rule will no doubt spark the development of a substantial number of additional apps.

Policymakers are grappling with concerns that data crossing the API and leaving a HIPAA covered entity are no longer governed by HIPAA. Instead, consumer apps and the data therein fall under oversight of the Federal Trade Commission (FTC). When a patient obtains her data via an app, she will likely have agreed to the terms and the privacy policy for that app, or at least clicked through an agreement no matter how lengthy or opaque the language.  For commercial apps in particular, these are often poorly protective. As with consumer behavior in the non-healthcare apps and services marketplace, we expect that many patients will broadly share their data with apps, unwittingly giving up control over the uses of those data by third parties.

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Everybody Seems to be an Expert, Except Your Family Doctor?

By HANS DUVEFELT, MD

It’s a funny world we live in. Lots of people make a handsome living, defining their work and setting their own fees and hours with little or no formal education or certification

There are personal and executive coaches, wealth advisers, marketing experts, closet organizers and all kinds of people offering to help us run our lives.

In each of these fields, the expectation is that the provider of such services has his or her own “take” or perspective and offers advice that is individual, unique and as far removed from cookie cutter dogma as possible. Why pay for something generic that lots of people offer everywhere you turn?

So why is it, in this day of paying lip service to “personalized medicine”, genetic mapping, the human biome and psychoneuroimmunology that we expect our healthcare to be standardized and utterly predictable?

And why is it that we are so willing to fragment our care, using convenient care clinics, health apps, specialists who don’t communicate with each other and so on? Does anybody believe it makes sense to have your life coach tell you to have a latte if you feel like it because it makes you happy and your financial adviser scorn you for wasting money, never mind your health coach talking about all those unnecessary calories?

In today’s world, almost all knowledge and information is available, for free, instantly and from anywhere on the planet. But this has not eliminated our need for “experts”. It used to be that we paid experts for knowing the facts, but now we pay them for sorting and making sense of them, because there are too many facts and too much data out there to make anything self explanatory.

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Three Reasons Why 4 of 5 Digital Health Solutions Don’t Make It | Bram Van Leeuwen, Sanofi

By JESSICA DaMASSA, WTF HEALTH

4 of 5 digital health solutions won’t make it to the doctor’s office, and Bram Van Leeuwen, Sanofi’s Lead for Digital Innovation BeNeLux, thinks he knows why. Health tech startups (and their health system advocates) should tune in to find out how they can up their odds of getting their tech integrated into existing points of care. Are there any health systems in the world that have excelled at implementing health tech solutions? Bram’s picked some winners and is sharing best practices.

Filmed at HIMSS/Health 2.0 Europe in Helsinki, Finland in June 2019.

Physicians Should Play a New Role in Reducing Gun Violence

Julie Rosenbaum
Matthew Ellman

By MATTHEW S. ELLMAN, MD and JULIE R. ROSENBAUM, MD

What if firearm deaths could be reduced by visits to the doctor? More than 35,000 Americans are killed annually by gunfire, about 60% of which are from suicide. The remaining deaths are mostly from accidental injury or homicide. Mass shootings represent only a tiny fraction of that number. 

There’s a lot physicians can do to reduce these numbers. Typically, medical organizations such as the AMA recommend counseling patients on firearm safety.  But there is another way to use medical expertise to help reduce harm from firearms: physicians should evaluate patients interested in purchasing firearms. The idea would be to reduce the number of guns that get into the hands of people who might be a danger to themselves or others due to medical or psychiatric conditions.   This proposal has precedents: physicians currently perform comparable standardized evaluations for licensing when personal or public safety may be at risk, for example, for commercial truck drivers, airplane pilots, and adults planning to adopt a child.  Similar to these models, a subset of physicians would be certified to conduct standardized evaluations as a prerequisite for gun ownership. 

As a primary care physicians with decades of practice experience, we have seen the ravages of gun violence in our patients too many times. A 50-year-old man shot in the spinal cord 30 years ago who is paraplegic and wheelchair-dependent. A 42-year-old woman who sends her teenage son to school every day by Uber because another son was shot to death walking in their neighborhood. A teacher from Sandy Hook who struggles to cope with post-traumatic stress disorder.  

Physicians can contribute their expertise toward determining objective medical impairments impacting safe gun ownership. These include undiagnosed or unstable psychiatric conditions such as suicidal or homicidal states, memory or cognitive impairments, or problems such as very poor vision, all of which may render an individual incapable of safely storing and firing a gun. In this model, the clinical role would be limited in scope. The physician would complete a standardized evaluation and offer recommendations to an appropriate regulatory body; the physician would not be the final decisionmaker regarding licensing.  An appeal process would be assured for those individuals who disagree with the assessment.  

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The Efficiency Mandate: To Achieve Coverage, the U.S. Must Address Cost

By MIKE MAGEE, MD

It is now well established that Americans, in large majorities, favor universal health coverage. As witnessed in the first two Democratic debates, how we get there (Single Payer vs. extension of Obamacare) is another matter altogether.

295 million Americans have some form of health coverage (though increasing numbers are under-insured and vulnerable to the crushing effects of medical debt). That leaves 28 million uninsured, an issue easily resolved, according to former Obama staffer, Ezekiel Emanuel MD, through auto-enrollment, that is changing some existing policies to “enable the government agencies, hospitals, insurers and other organizations to enroll people in health insurance automatically when they show up for care or other benefits like food stamps.”

If one accepts it’s as easy as that, does that really bring to heel a Medical-Industrial Complex that has systematically focused on profitability over planning, and cures over care, while expending twice as much as all other developed nations? In other words, can America successfully expand health care as a right to all of its citizens without focusing on cost efficiency? 

The simple answer is “no”, for two reasons. First, excess profitability = greed = waste = inequity = unacceptable variability and poor outcomes. Second, equitable expansion of universal, high quality access to care requires capturing and carefully reapplying existing resources.

 It is estimated that concrete policy changes could capture between $100 billion and $200 billion in waste in the short term primarily through three sources.

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DNA Testing India: Startup Wants to Sequence 20% of World’s Population | Anu Acharya, Mapmygenome

By JESSICA DaMASSA, WTF HEALTH

Not all genetic testing is equal — and neither are the populations that have ready access to them. Anu Acharya founded Mapmygenome in order to fix the inequality in the amount of genetic data available on Indians. Despite being one of the largest populations in the world (20% of the world’s population is Indian), their genomic data only amounts to about 2% of what’s currently being collected and studied. Tune in to find out how this startup plans to scale to become the leading personal genomics company in India.

Filmed at Webit Health in Sofia, Bulgaria, May 2019.

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