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Can Democracy Survive In The Absence of Health Care Security?

By MIKE MAGEE

In my course this fall at the President’s College at the University of Hartford, we began by exploring the word “right” at the intersection of health care services and the U.S. Constitution.  But where we have ended up is at the crossroads of American history, considering conflicting federal and state law, and exploring Social Epidemiology, a branch of epidemiology that concentrates on the impact of the various social determinants of health on American citizens.

What makes the course timely and relevant is that we are uncovering a linkage between health and the construction or destruction of a functional democracy at a moment in America’s history when our democracy is under direct attack.

This was familiar territory for Eleanor Roosevelt. She spent the greater part of World War II creating what she labeled in 1948 “Humanity’s Magna Carta” – aka the “Universal Declaration of Human Rights (UDHR.)

Embedded in the declaration was a much broader definition of health. It reads “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The Marshall Plan, for reconstruction of war torn Germany and Japan, embodied these principles, and successfully established stable democracies by funding national health plans in these nations as their first priority.

Although our nation signed the UDHR, it carried no legal obligations or consequences. In fact, the U.S. medical establishment’s bias was to embrace a far narrower definition of health – one that targeted disease as enemy #1. They believed that in defeating disease, health would be left in its wake.

In contrast, neighboring Canada took the UDHR to heart, and as a starting point asked themselves, “How do we make Canada and all Canadians healthy?” Where our nation embraced profiteering and entrepreneurship, leaving no room for solidarity, Canada embraced the tools of social justice and population health.

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Breaking Up is Good to Do

By KIM BELLARD

Last week General Electric announced it was breaking itself up. GE is an American icon, part of America’s industrial landscape for the last 129 years, but the 21st century has not been kind to it. The breakup didn’t come as a complete surprise. Then later in the week Johnson and Johnson, another longtime American icon, also announced it would split itself up, and I thought, well, that’s interesting. When on the same day Toshiba said it was splitting itself up, I thought, hmm, I may have to write about this.

Healthcare is still in the consolidation phase, but there may be some lessons here for it.

For most of its existence, GE was an acquirer, gobbling up companies with the belief that its vaunted management structure could provide value no matter what the industry. This was most famously true in the Jack Welch days, but since those days it has been gradually shrinking itself, spinning off some of its more problematic divisions, like appliances, locomotives, and much of its once-huge financial services business. It will spin off its healthcare business in early 2023 and its renewable energy and power business in early 2024; its aviation business will keep the GE name. 

“A healthcare investor wants to invest in healthcare,” CEO Larry Culp explained. “We know we are under-owned in each of those three sectors, in part because of our structure.”

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How Unhappy are Patients with Info Coming from Providers, Payers? Pega’s Survey Shows It’s Not Good

By JESSICA DaMASSA, WTF HEALTH

Is this a big surprise? Even during Covid, Pega’s annual 2,000-person Patient Engagement Survey shows that 63% of patients are unhappy with the communication they receive from their payers and providers. Which begs the question… just how bad was it before? (Answer: 86% unhappy– yikes!)

Pega’s VP of Healthcare & Life Sciences, Kelli Bravo, has run this survey three years and counting and drops in to share the highlights (if we can really call them that) of the survey results and how she thinks enterprising young health tech startups can capitalize on the opportunity to help.

For those in the business of trying to talk to patients — which is all of us — let’s look at this as a wake-up call. Let’s stop speaking “health care” and start using language everyone can understand about their care, what it will cost, and what all the options really are. Pega is attempting to do its part in that department, and we get an update on how they’re fairing at helping to make healthcare feel more like retail. The rise of the healthcare consumer is a real thing. Now, with new data to back up claims about what they’re demanding in terms of how they prefer to be talked to and communicated with.

Click to see the data and report on Pega’s site.

What is the “Right” to Health Care Worth? It Depends

By MIKE MAGEE

In my course this Fall at the University of Hartford, titled “The Right to Health Care and the U.S. Constitution”, we have concentrated on the power of words, of precedents, and the range of interests with which health has been encumbered over several hundred years.

The topic has been an eye-opener on many levels. On the most basic level, it is already clear that the value of this “right” depends heavily on your definition of “health.”

We’ve highlighted three definitions worth sharing here. 

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WTF Health: Transcarent, Walmart & The “Re-making” of Healthcare Payers: Glen Tullman on the Power of Big Retail

By JESSICA DaMASSA, WTF HEALTH

Days after announcing their deal with Walmart, Transcarent’s Executive Chairman & CEO Glen Tullman and meet again (in-person!) to pick up our conversation right where it left off. For the details about the deal, see our last interview; for what the deal signifies for the disruption of the healthcare payer and the ultimate rise of the healthcare consumer, tune in now and take note.

The plot of Transcarent’s story is starting to take shape. Their conflict is with the “big middle” of healthcare where drugs are marked up, care needs pre-authorizations, and docs labeled “this is NOT a bill” are ridiculous artifacts of a payer-first healthcare experience.

“The system behind our healthcare today is working exactly as its designed: for payers. We want to re-design that,” says Glen. “It’s not, ‘how do we get through that better?’ That would be navigating. It’s ‘how do we go completely around that and re-design the experience?’”

Glen talks us through the leverage retailers like Walmart and Amazon really have to help take on non-innovative payers what role Transcarent is playing in all of this, and how startups like GoodRx, Ro, and Capsule who are successfully challenging PBMs are demonstrating that payment model innovation is possible.

And, while we wait for the next big deal to come from ‘healthcare’s best dealmaker, we’ve got some foreshadowing: a quick mention of Oscar Health that registered on my radar as interesting, along with some very specific details about how Transcarent will expand its offering next, looking at MSK, cancer care, behavioral health (particularly for teens), and bringing in more “human voices” for their members to turn to for advice.

Tech Can’t Fix the Problems in Healthcare

By KIM BELLARD

Shira Ovide, who writes the On Tech newsletter for The New York Times, had a thoughtful column last week: Tech Can’t Fix the Problem of Cars.  It was, she said, inspired by Peter Norton’s Autonorama: The Illusionary Promise of High Tech DrivingThe premise of both, in case the titles didn’t already give it away, is that throwing more tech into our cars is not going to address the underlying issues that cars pose. 

It made me think of healthcare. 

What’s been going on in the automotive world in the past decade has truly been amazing. Our cars have become mobile screens, with big dashboard touchscreen displays, Bluetooth, and streaming. Electric cars have gone from an expensive pipedream to an agreed-upon future, with Tesla valued at over a trillion dollars, despite never having sold a half-million cars annually before 2021. 

If we don’t feel like driving, we can use our smartphones to call an Uber or Lyft. Or we can use the various autonomous features already available on many cars, with an expectation that fully self-driving vehicles are right around the corner. Soon, it seems, we’ll have non-polluting, self-driving vehicles on call: fewer deaths/injuries, less pollution, not as many vehicles sitting around idly most of the day. Utopia, right? 

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CareCentrix CEO on Walgreens Taking Majority Stake, How Post-Acute Care Will Fair in Retail Health

By JESSICA DaMASSA, WTF HEALTH

The same day Walgreens announced its $5.2B investment in VillageMD to snag a majority stake in the growing primary care clinic, it ALSO revealed it had made a $300M investment in CareCentrix that scored 55% of that company and another opportunity to expand its reach beyond the pharmacy – this time into the home.

CareCentrix’s CEO John Driscoll takes us behind the deal, which lands Walgreens into the world of post-acute care (home nursing, hospital discharge recovery, home infusion, palliative care, etc.) which he describes as the “long-form sexy-cool” segment of the healthcare market that’s not only worth $75B annually now, but that’s also set for massive growth over the next 20 years.

Walgreens is clearly seeing the opportunity John’s seeing, particularly when it comes to positioning its pharmacies as “local health distribution and support centers” – hubs that leverage both the trust patients have in their pharmacists and the frequency with which they visit a Walgreens store compared to a doctor’s office or hospital. In the Walgreens Health strategy, what’s the vision for how CareCentrix and VillageMD will ultimately work together to take care of these regular Walgreens customers? Will post-acute care fair as well as primary care when it comes to a retail distribution channel? And, of course, we HAVE to go behind the scenes on the deal itself and ask John what we were all wondering: Why didn’t Walgreens just acquire both VillageMD and CareCentrix outright??

Behind the Mask

By HANS DUVEFELT

Today I saw a patient I have known for years. He suddenly pulled his mask down and said, “I’d like to know what you think I should do about this”.

On his nose was an 8 mm (1/3”) brownish-red flat spot with a crack or scrape through it.

“How long have you had it?”, I asked.

“Oh, a while now” he answered. That is about the least helpful time measurement I know of. I asked him to pin it down a bit more precisely. He settled for about a year. I prescribed a cream and made a two week follow-up appointment for either cryo or a biopsy. It’s probably just an excoriated, premalignant, actinic keratosis.

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Update from Olive: CEO Sean Lane on Putting $850M+ Funding to Work

By JESSICA DaMASSA, WTF HEALTH

There was lots of chatter at HLTH 2021 about the fact that healthcare AI unicorn, Olive, showcased its brand-bedecked touring bus on the show floor. Some expressed disdain about whether or not this was really the best use of more than $850M in funding, while others quickly (and literally) jumped on the bandwagon of the company’s quest to go door-to-door to win over hospital-after-hospital with its “Internet of Healthcare” vision. But, to hear CEO Sean Lane talk about it all – including what’s happening at Circulo, the less-than-a-year-old Medicaid plan being built on top of Olive’s infrastructure – the bus might actually be a grand metaphor for a company continuing to “move fast and fix things” despite the typical stop-and-start nature of innovating in healthcare.

Sean gets us up-to-speed on the latest at Olive: its growth (he says the company is “growing by one mid-sized company each month”)… its expanding client base which now also includes more and more payers…and its own new status as a full-service clearinghouse, thanks to its Olive Assures product that instant pays claims to hospitals and completely eliminates the cost of collection associated with these types of payments. And this is just what you can see of the road ahead from the dashboard! On the horizon, is whatever will be built on top of the Olive infrastructure, and Sean gives us insight as to what’s on the itinerary.

Olive launched “The Library” at HLTH, which is a “marketplace” where other tech companies, including competitors, can sell into Olive’s client base any technology – clinical, operational, administrative, or otherwise – that can help automate healthcare. Sean talks about how this marketplace, along with Olive’s recently launched venture fund, are just parts of what they’re doing to build healthcare’s first TRUE platform business. (You’ll have to listen in to hear how he’s defining platform…) So, what’s in store for our legacy “platforms” like EMRs in the future if/when this more open, democratic type of platform thinking takes off? And, what about the first company already being created from scratch on said platform? You can see how passionate Sean is about building Circulo as the “Medicaid Plan of the Future,” and we get into some examples of elements this new plan will offer its members: primary health sites, “Circulators” that bring telehealth into neighborhoods via tricked-out Sprinter vans for those on the other side of the digital divide, and payment model features (zero prior auths, zero denials, payment immediately) that sound a lot like what Olive is enabling in hospitals with traditional payers. There’s a lot to hear in this one!

Woman’s Health Startup Pollie Wins Bayer G4A’s Attention With Female-Focused Chronic Condition Play

By JESSICA DaMASSA, WTF HEALTH

Forget being pigeon-holed as a “femtech” company! VERY early-stage women’s health startup, Pollie, is taking an integrated care approach to complex chronic conditions that either just affect women, OR impact women differently or disproportionally than men. Think not only about conditions caused by hormone imbalances like PCOS (polycystic ovarian syndrome) or endometriosis, but also auto-immune disorders and digestive disorders that present differently or more frequently in women.

Co-Founder and CEO, Jane Sagui, drops by to talk us through the platform Pollie is building (and I mean, building-as-we-speak) which will ultimately teach women how to manage their chronic conditions via a highly-personalized program that includes all possible treatment management solutions, from pharmaceuticals to lifestyle-based treatments like diet and exercise. The company is currently piloting a version of their solution with a cohort of PCOS patients, but, has grand plans to expand their multi-modality pill-plus approach into other categories of women’s health that are NOT reproductive system related. Their biz has already caught the eye – and some investment dollars – from Bayer, as the company is one of four that’s been selected for this year’s Growth Track within G4A’s Digital Health Partnerships Program.

Jane gives us the details behind Pollie: their business, the pilot, the round they’re currently raising, and the types of partners they’re seeking as they evolve their offering. What’s also exciting? An early-stage bet from a big pharma co like Bayer that signals a future for women’s health care that may (finally) be about MORE than just reproductive health.

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