Today on the 52nd episode of Health in 2 Point 00, Jess reports from InsurTechConnect 2018! In this episode, Jess asks Matthew about RockHealth’s $6.8 billion fundraise to date & its $3 Billion raise in Q3, Weight Watcher’s rebranding itself and pushing into the wellness space, and (just in time we might add) Maven, a women’s digital health clinic, series B round of $27 million from Oak HC/FT
Above the Fold
4 Signs that Disruption is Accelerating in Health Care Delivery
By REBECCA FOGG
Hardly a day goes by that I don’t read the term “Disruptive Innovation” cited in relation to health care delivery. This might seem like a good thing, given that our expensive, wasteful, and in some cases frightfully ineffective traditional delivery model is in dire need of transformation. However, the term is frequently misunderstood to refer to any innovation representing a radical departure from an industry’s prior best offerings. In fact, it actually has a very specific definition.
Disruptive Innovation is the phenomenon by which an innovation transforms an existing market or sector by introducing simplicity, convenience, accessibility, and affordability where complication and high cost have become the status quo—eventually completely redefining the industry. It has played out in markets from home entertainment to teeth whitening, and it could make health care delivery more effective by making providers’ care processes, as well as individuals’ own self-care regimes easier and less costly. This, in turn, would reduce the need for both more, and more expensive, interventions over time.
Unfortunately, disruption has been slow to emerge in the health care sector. It’s been thwarted by the broader health care industry’s unique structure, which tends to prioritize the needs of commercial insurers and large employers (who pay the most for consumer care) over those of health care consumers themselves. It also stacks the deck against disruptive entrepreneurs, since established providers effectively control professional licensing requirements, and (along with insurers) access to patients & key delivery partners.
Part 2: Bypassing Prior Authorizations
By NIRAN AL-AGBA, MD
A few weeks ago, I saw a young patient who was suffering from an ear infection. It was his fourth visit in eight weeks, as the infection had proven resistant to an escalating series of antibiotics prescribed so far. It was time to bring out a heavier hitter. I prescribed Ciprofloxacin, an antibiotic rarely used in pediatrics, yet effective for some drug-resistant pediatric infections.
The patient was on the state Medicaid insurance and required a so-called prior authorization, or PA, for Ciprofloxacin. Consisting of additional paperwork that physicians are required to fill out before pharmacists can fill prescriptions for certain drugs, PAs boil down to yet another cost-cutting measure implemented by insurers to stand between patients and certain costly drugs.
The PA process usually takes from 48-72 hours, and it’s not infrequent for requests to be denied, even when the physician has demonstrated an undeniable medical need for the drug in question.
THCB Spotlights: CY5
By ZOYA KHAN
I know we have been bombarding you all with a bunch of videos and announcements, but there are some really interesting pieces of health tech that are launching and events that are happening in the Fall. Today I wanted to spotlight another really cool startup that Matthew met with at #TechCrunchDisrupt18 called CY-5 (pronounced Sci-5, trust me Matthew & I kept calling it C-Y-5). Their company is developing biometric temporary tattoos to track your vitals. Right now their tattoos can measure your heart rate and your inter-cranial pressure. Also, strangely enough, their tattoos are designed and printed onto a special paper that conducts electricity- that means it requires no exterior electricity source to monitor your biometrics! It is all in the design of the product that powers the tattoo. Their focus right now is to test their product out in the elderly population. For all of you out there that can’t get real tattoos, this would look really cool plus it would track your vitals and keep you healthy- double win.
Zoya Khan is the Editor-in-Chief of THCB as well as an Associate at SMACK.health, a health-tech advisory services for early-stage startups.
Another Round of NYC Curated Matchmaking through DHMP!
SPONSORED POST
By JOHN EL-MARAGHY
The New York City Economic Development Corporation and Catalyst @ Health 2.0 are thrilled to announce another round of Digital Health Marketplace matchmaking coming up on December 5th! Since 2013, the Digital Health Marketplace has connected digital health “Sellers” offering technology solutions to a diverse range of healthcare “Buyers” or institutions looking for tech-enabled solutions and partnerships. At the center of the Digital Health Marketplace is the successful curation of needs and solutions that lead to the development of commercialization and the rapid adoption of new health technologies. If you are an early stage startup looking for relevant pilot/commercial partners or a healthcare organization interested in adopting leading technologies, apply for your opportunity to be matched with relevant partners for one-on-one, in-person sales meetings.
Come to the Society for Participatory Medicine conference (Boston, Oct 17)
Join me at the 2nd annual Society for Participatory Medicine (SPM) conference, co-located with the Connected Health Conference at the World Trade Center in Boston. It’s magical and very inexpensive–Matthew Holt
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THCB Spotlights: TestCard
By ZOYA KHAN
A few weeks back, Matthew met with TestCard (another Brit like him) at TechCrunch Disrupt 2018. Greg, from TestCard, spoke to Matthew about how their device can test multiple different illnesses using urine and a clinical grade camera, which then spits out results (almost) immediately on your smartphone. Currently, the device can be used for detecting pregnancy, glucose, STIs, UTIs, and many more diseases. Their focus is on preventative care for patients, so they are working with insurance companies to use their product as a kit to diagnose problems that are prevalent in UK’s population. Not to mention their slogan is “A bit like Theranos, but our flagship products work.”
Zoya Khan is the Editor-in-Chief of THCB as well as an Associate at SMACK.health, a health-tech advisory services for early-stage startups.
Reducing Cancer Care Costs by Comparative and Cost-Effectiveness Research (CER)
Well, it’s time to resume our discussion of Bending the Cost Curve in Cancer Care.
We’ve reached the end of the list, on ideas to reduce oncology costs put forth by Drs. Smith and Hillner in the May 25 issue of the NEJM. Really this 10th and final point intended for oncologists is two-in-one: “The need for cost-effectiveness analysis and for some limits of care must be accepted,” they chart. So doctors should embrace studies of comparative effectiveness and cost effectiveness.
Hard to argue with reason — they’re correct, of course. They write:
… The national imperative is to empower a transparent, acceptable, equitable, politically independent agency for guidance in making tough choices in the public interest so that doctors do not have to make them at the bedside.60 Ultimately, we will have to make decisions based on some criteria, and comparative-effectiveness61 and cost-effectiveness62 analyses are good ways to align resource use with the greatest health benefit.
This sounds great, and is probably right, but I don’t think it’s realistic.
Modeling readmissions
The current intent to judge hospital performance and modify hospital payments based on relative rates of readmissions is not wise. Contrary to President Obama’s characterization that readmitting a patient to the hospital is equivalent to bringing a car back to the mechanic after a repair, rates of readmissions are based on a number of factors, of which a significant portion are services not provided by the hospitals and environmental conditions not controlled by the hospitals.
But let’s put my objections aside and determine how we would model an “appropriate” rate of readmissions. Well, a new article in JAMA* explores existing models, noting that robust models are needed “to identify which patients would benefit most from care transition interventions, as well as to risk-adjust readmission rates for the purposes of hospital comparison.” The article concludes that the capability for doing these things does not yet exist.
In “Risk Prediction Models for Hospital Readmission,” the authors state as their objective: “To summarize validated readmission risk prediction models, describe their performance, and assess suitability for clinical or administrative use.” Their conclusion, after reviewing two dozen such models, was that “Most current readmission risk prediction models that were designed for either comparative or clinical purposes perform poorly.”
Two Former Obama Health Advisors Whistle in the Dark about End of Health Insurance Companies
Ezekiel Emanuel and Jeffrey Liebman, a regular contributor to the New York Times and professor of public policy at Harvard, respectively, say health insurers will disappear by 2020.
In their opening paragraph in a January 30 blog in the New York Times, “The End of Insurance Companies”, they assert:
“Here’s a bold prediction for the new year. By 2020, the American health insurance industry will be extinct. Insurance companies will be replaced by accountable care organizations — groups of doctors, hospitals and other health care providers who come together to provide the full range of medical care for patients.”
They presume this development will leave no room for insurers.
They continue, “A new system is on its way, one that will make insurance companies unnecessary.” The new system, they confidently predict, will consist of accountable care organizations, made up of collaborating hospitals and doctors. ACOs will offer bundled payments. Fee-for-service payments will cease to exist.
ACOs, the two Obamanites imply, will sprout, flourish, and metastasize across the land from sea to shining sea.
Their prediction may be bold, but I believe it is wrong.
