I’m going to be announcing some big changes on THCB and with my overall services in the next little bit. So to prepare for this, here’s a rather good explanation I did last year in Australia of what I mean by SMACK.health — randomly the interviewer was Jessica DaMassa with whom I now do #Healthin2pt00 — Matthew Holt
Above the Fold
Will Cancer Drugs Ever Be As Affordable As Retrovirals in Low and Middle Income Countries?
In 2014, the majority of international health aid was dedicated to HIV. So, one might reasonably assume that this is the largest health problem facing the world. Yet, HIV only constitutes 4% of the global burden of disease. In 2014, noncommunicable diseases (NCDs) made up 50% of the entire disease burden, but only received 2% of all global health funds.
The disease burden of NCDs is fast outpacing that of infectious diseases. Despite this, the proportion of global health financing dedicated to combatting NCDs has remained constant over the past 15 years at 1 to 2%.
Currently, 32.6 million individuals are living with cancer (diagnosed in the last five years). In 1970, 15% of new cases were in low- and middle-income countries. In 2008, 56% were in low- and middle-income countries. By 2030, this proportion is expected to be 70%. So, not only is the burden of NCDs rising globally, but it is also beginning to disproportionately affect countries with the least resources to deal with them.
But, if NCDs have been steadily increasing in low- and middle-income countries, why has global action not followed suit? Continue reading…
Health in 2 point 00, Episode 24
In this edition of Health in 2 point 00, Jessica DaMassa asks me about enterprise sales (Qventus, Medicity, Health Catalyst), DTC vs Enterprises as a market, the VA allowing nationwide telehealth,, and the TEAP & TEFCA frameworks (that last answer may have overran the 2 minutes a tad!) — Matthew Holt
Mudit Garg, Qventus on the $30m raise
Another day, another $30m round in health tech. On Monday Qventus raised that from Bessemer Partners, with Mayfield, Norwest and NY Presbyterian kicking in too. That brings their total to $43m in so far–not bad for a 75 person company that is in the somewhat obscure space of using AI to improve hospital operations. Qventus sucks in data and delivers operational suggestions to front line managers. Of course given that somewhere between $1-1.5 trillion goes through America’s hospitals each year, there’s huge potential for saving money. And given that most hospitals are being paid fixed cost per case, anything that can be done to improve throughput and increase productivity drops to the bottom line and is thus likely to meet interested buyers. I talked to CEO Mudit Garg about the problem, his company’s solution and what they were going to do next.
The Case For Real World Evidence (RWE)
Randomized control trials – RCTs – rose to prominence in the twentieth century as physicians and regulators sought to evaluate rigorously the performance of new medical therapies; by century’s end, RCTs had become, as medical historian Laura Bothwell has noted, “the gold standard of medical knowledge,” occupying the top position of the “methodologic heirarch[y].”
The value of RCTs lies in the random, generally blinded, allocation of patients to treatment or control group, an approach that when properly executed minimizes confounders (based on the presumption that any significant confounder would be randomly allocated as well), and enables researchers to discern the efficacy of the intervention (does it work better – or worse – than controls) and begin to evaluate the safety and side-effects.
The power and value of RCTs can be seen with particular clarity in the case of proposed interventions that made so much intuitive sense (at the time) that it seemed questionable, perhaps even immoral, to conduct a study. Examples include use of a particular antiarrhythmic after heart attacks (seemed sensible, but actually caused harm); and use of bone marrow transplants for metastatic breast cancer (study viewed by many as unethical yet revealed no benefit to a procedure associated with significant morbidity).
In these and many other examples, a well-conducted RCT changed clinical practice by delivering a more robust assessment of an emerging technology than instinct and intuition could provide.
Alfie Evans and the Medical Ethics of Suffering
Sadly, the case of Alfie Evans came to a close this week, as he passed away in his hospital room surrounded by his parents. The debate over the medical ethics involved goes on.
Ultimately, there are extensive moral, philosophical, and medical issues involved with the policies over these cases. They are complicated, messy, and often times heart wrenching. But let’s put some misconceptions aside to begin with, some propagated by the most extreme and emotional participants in this debate.
Those of us that took issue with the handling of this case for the most part do not believe the doctors involved were evil, murdering individuals. There was no malicious intent from the NHS or physicians involved. I am sure the physicians meant well, from their point of view.
A second point: this was not a case about preservation of resources for the greater good. In this case, the parents had found alternative sources to fund the care they wished for their son. So those arguing that we need to make such decision to prioritize money for those that can be aided the most is largely off target, and not relevant to the case at hand. I also don’t believe that the single payer system of the NHS in England inherently caused their mistakes; I think any system that is blind to its own deficiencies could lead to such mistakes.
That said, what were the issues that were in dispute here?
First and foremost, what was the ultimate intent of the care providers in this specific case? Both sides basically admitted, early on, that Alfie’s prognosis was dire. The reality is this child was likely going to die, and even the experts preferred by the parents readily admitted this in court documents.
Health in 2 point 00, Episode 23
In this start your weekend off right edition, Jessica DaMassa asks me about Andy Slavitt’s new Town Hall venture fund announced at HLTH, the ATHN buyout, Novartis paying Michael Cohen, Trump’s drug price speech & Lyra Health’s $45m raise….all in 2 minutes–Matthew Holt
Trump and Rx Drug Prices: Let the Games Begin
President Trump is scheduled to deliver a major speech on drug prices today. This post is intended to start a dialogue on what he says and proposes.
It’s unclear whether Trump will provide specifics or whether those will be rolled out in coming weeks. As is always the case with Trump, there’s concern he’ll go off script despite apparent careful preparation of the speech.
The speech is reportedly going to coincide with an RFI from HHS on ways to restrain drug prices, building on ideas proposed in the administration’s fiscal 2019 budget request. That sounds like a delay tactic, but we’ll see.
Notably, Alex Azar and Scott Gottlieb, health secretary and FDA Commissioner, respectively, have recently hinted at substantial policy proposals. Azar, for example, has proposed shifting some of the drugs now paid for under Medicare Part B (such as chemotherapy drugs administered in doctors’ offices) to Part D, where private plans would have clout to push for lower prices.
Azar and CMS administrator Seema Verma have also suggested requiring PBMs to share the savings from drug rebates with consumers. Continue reading…
HLTH & Healthcare — My tweetstorm on the HLTH conference
This week was the very flash, very well marketed and apparently rather fun HLTH conference. As you might guess, given I’ve run a somewhat similar conference in a similar space for the past decade and this was the biggest market entrant in years, I was paying alot of attention, even though I wasn’t actually there. So I started writing a few tweets yesterday morning which basically became the equivalent of a blog post–so I made it one here!
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- Since the fuss about & success of #HLTH2018 I’ve been thinking a lot about the role of health tech conferences and in some ways @HLTHEVENT is a perfect metaphor for the health care system as a whole /1
- Bear in mind I co-founded & still am co-chair of @health2con which when it started was regarded as revolutionary & different – so this is tinged with professional envy. Also bear in mind that I was at #ythlive this week so didn’t actually go to Vegas. So grains of salt /2
- What @HLTHEVENT did was convince virtually every CEO who’s ever presented at @health2con @WHCCevents @hdpalooza etc over the past decade to come speak in Vegas at an unknown conference–albeit one that had a ton of money to burn, and great connections via VC @oakhcft /3
- Given the crap I’ve received over the years from certain CEOs who only want to keynote @health2con & were instead asked to be on a panel, or worse were put in a break out, I’m amazed they pulled it off. But they did & it seems all were happy /4
- OK, here’s the metaphor part. Once #HLTH2018 achieved essentially a “health tech co CEO monopoly” (for 4 days in one place), they were able to act like a health system that’s done the same thing with its providers & hospitals (cough cough @UPMC @SutterHealth et al) /5
A Public-Private Partnership to Fix Health Care
The Administration proposal that would enable small employers to band together to purchase health insurance by forming Association Health Plans has several good features. Large companies do pay about 15% less, apples-to-apples, for health insurance than small businesses because they negotiate lower administrative fees, get larger discounts on health care prices and avoid premium taxes and risk charges by self-insuring. Allowing small business to replicate what boils down to volume discounts also appeals politically to many as a market-based alternative to government intervention. Reliance on Association Health Plans could result in substantial volume discounts, but, in the end, would be like paying $10 for a tube of toothpaste that retails for $100, a big discount and a rip-off price.
Even though the largest companies get very deep discounts, there is substantial research showing that their net costs are much higher than everywhere else because we in the United States pay higher prices for health care goods and services. One need to look no further than the benchmark large corporate purchasers who continue to pay about 40% or 50% more than Medicare for the same health care to see how excessive health care prices for private payers are. And this disparity is likely to get worse. While hospitals gobble up other hospitals and doctors’ practices and gain near monopoly market power to raise prices, employers of all sizes remain highly fragmented and, as a result, impotent price negotiators.
A better approach to health care cost containment than Association Health Plans hides in full view. Continue reading…
