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Pandemic State of Mind: Data from Behavioral Telehealth Startup Reveals How We’re Feeling

By JESSICA DaMASSA, WTF HEALTH

“The mental health system was completely broken before COVID. The supply-demand imbalance was wildly upside down. Now, that’s just all exacerbated.”

On-demand mental health startup Ginger has watched usage of their app climb 130% over the last 4-week period. The conversations people are having with clinicians are growing more intense (there’s an internal metric for that) and amid all of this the late-stage startup has re-run its ‘Workforce Attitudes’ survey to find out what’s really going on with the mental health of the employee populations it serves.

CEO Russell Glass dives into some of the findings of that report, which are pretty revealing in terms of understanding how we as a population are dealing with our stress around COVID-19 when we’re seeking professional help with it. Nearly 70% of respondents confessed this was the most stressful period of their career — five times more stressful than the financial crash of 2008 — and there are some surprising differences with how this is all unfolding across gender lines, especially with working from home.

With inbound interest from employers up 4X over the past month, we get Russ’s input on whether or not the demand for telehealth will sustain once the crisis is over and if the temporary regulatory and reimbursement changes will become permanent. Says Russ: “This is like a great experiment of the efficacy of telehealth versus non-telehealth.”

Hiding Our Heads in the Sand

By KIM BELLARD

There are so many stories about the coronavirus pandemic — some inspiring, some tragic, and all-too-many frustrating.  In the world’s supposedly most advanced economy, we’ve struggled to produce enough ventilators, tests, even swabs, for heaven’s sake.  

I can’t stop thinking about infrastructure, especially unemployment systems.

We’d never purposely shut down our economy; no nation had.  Each state is trying to figure out the best course between limiting exposure to COVID-19 and keeping food on people’s tables.  Those workers deemed “essential” still show up for work, others may be able to work from home, but many have suddenly become unemployed.

The U.S. is seeing unemployment levels not seen since the Great Depression, and occuring in a matter of a couple months, not several years.  As of this writing, there are over 22 million unemployed; no one believes that is a complete count (not everyone qualifies for unemployment), and few believe that will be the peak.

Many unemployment systems could not manage the flood of applications.  

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THCB Gang: Episode 6, LIVE 1PM PT/4PM ET, 4/23

Episode 6 of “The THCB Gang” was live-streamed on Thursday, April 23 at 1pm PT- 4pm ET! 4-6 semi-regular guests drawn from THCB authors and other assorted old friends of mine will shoot the sh*t about health care business, politics, practice, and tech. It’s available below and is preserved as a weekly podcast available on our iTunes & Spotify channels.

Our lineup included: Saurabh Jha (@roguerad), Ian Morrison (@seccurve), Kim Bellard (@kimbbellard), Grace Cordovano (@GraceCordovano),Vince Kuraitis (@VinceKuraitis), Brian Klepper (@bklepper1), and a special guest – Alexandra Drane (@adrane, founder of Eliza, Queen of the Unmentionables, CEO of ArchAngels and sometimes Walmart cashier). Lots of great conversation especially around palliative care, patient experience, the real prevalence of COVID-19 and much more.

And if you want to contact Alex about caregiving, here is her Youtube Channel or please email her. — Matthew Holt

Health in 2 Point 00, Episode 118 | Aledade, Medopad, Amblyotech and Yes Health

Today on Health in 2 Point 00, Jess and I talk about HCA now that the real numbers have come out. On Episode 118, Jess asks me about Aledade raising $64 million. Founded by former ONC director Farzad Mostashari, they set up ACOs for independent physician practices and have been doing a lot around COVID-19. Medopad has rebranded as Huma and acquired Biobeats and Tarilian Laser Technologies (TLT); they’ve been doing remote monitoring and have been around for a while. Novartis acquires Amblyotech, a lazy eye digital therapeutic. Finally Yes Health gets $6 million – yet another “we’ll put you on a diet and have coaches bully you” platform. —Matthew Holt

Nursing Students and Educators Must Be Part of a National Public Health Surveillance Strategy

By KAREN JOHNSON PhD, RN

Shortly before our world was turned upside down by COVID-19, I visited Space Center Houston with my family. We marveled at the collective ambition and investment it took to move from space travel being an aspirational dream to setting foot on the moon. I thought about my favorite scene from the movie Apollo 13, when Gene Kranz overhears the NASA Director saying “This could be the worst disaster NASA has ever experienced,” and candidly replies, “With all due respect, sir, I believe this is going to be our finest hour.”

Just months later, our entire planet is on a mission to turn tragedy into triumph. Only this time, Americans have not led the way in proactively translating science into action for the benefit of humankind. Instead, we ignored scientists who warned about the inevitability of a pandemic and now lead the world in most confirmed cases (which, due to our testing debacles, underestimates actual cases). As a public health nurse, this is not a race I want to see us leading. Future outbreaks are all but certain while we wait for a vaccine. Every single one of us must start preparing now, for we will all have a role to play.

To be sure, it is imperative that we all stay the course with current physical distancing efforts to prevent spread, minimize death, and avoid the collapse of our healthcare system and its ability to care for patients with COVID-19 and other life-threatening conditions that do not pause just because of a pandemic. But social distancing cannot be the only public health tool used to bring the pandemic under control. 

Public health experts agree we need a coordinated national public health surveillance strategy that includes widespread testing in order to identify and isolate infected people early (this is crucial given how many contagious people are asymptomatic), contact tracing to figure out who has been exposed to infected individuals, and quarantining everyone who tests positive or has come in contact with an infected person. We must leverage technology to ensure testing provides fast and accurate results, and that we are able to safely and comprehensively track exposures. Without accurate, detailed, and timely data about the epidemiology of COVID-19, we cannot make scientifically sound decisions about how to ease social distancing or ethical decisions about how to equitably allocate scarce healthcare resources to communities of greatest need.

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Even Republicans Want to Outlaw Surprise Medical Billing

By BOB HERTZ

On  April 3, the Secretary of Health and Human Services, Alex Azar, announced that the federal government would pick up the tab for testing and treating all uninsured Americans for COVID-19.

Azar specifically promised that:

a) hospitals would be paid the same prices they receive for Medicare patients; and

b) hospitals which accept the funds would be barred from sending any additional bills to patients.

Did anyone notice the last detail?  This is a Republican, who is promising to protect the vulnerable.

In the coming months, thousands of COVID-19 patients will be routed through a convoluted web of providers. At various points in their treatment. they will be susceptible to receiving out-of-network care — and the staggering bills that often follow.

COVID-19 patients will rarely have the luxury to choose a network hospital, or lab, or specialist. Often, they will need to be treated at any facility that is still open.

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Wait — Robots Work But I Get Paid

By KIM BELLARD

We’re not through the COVID-19 pandemic.  We’re probably not even near the end of the beginning yet.  That hasn’t stopped many pundits to start speculating about how our society (and our healthcare system) are likely to be permanently changed as a result, such as continued reliance on telecommuting and telemedicine.  

OK, I’ll play too: I believe we need to greatly expand the role of robots, and begin something that resembles Universal Basic Income (UBI).  They’re not the only changes that may result, but they are two that should.

Robots

We’ve been seeing robots infiltrating the workforce for many decades, such as in manufacturing but also in many other industries. 

Still, though, as our economy pares down to “essential businesses” during the pandemic, I’ve been alarmed at how many of the jobs remain done by humans.  Not just healthcare workers on the front lines but also all those people doing the cleaning for essential businesses, all those people in the supply chain of food and other vital materials, all those people making deliveries, all those first responders, all those people all those people keeping the power on, the water running, and the internet streaming, among others.  And so on.

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The THCB Gang: Episode 5

Episode 5 of “The THCB Gang” was live-streamed Thursday, April 16 at 1pm PT- 4pm ET! 4-6 semi-regular guests drawn from THCB authors and other assorted old friends of mine will shoot the sh*t about health care business, politics, practice, and tech. It tries to be fun but serious and informative! If you miss it, it will also be preserved as a weekly podcast available on our iTunes & Spotify channels.

Deven McGraw (@healthprivacy), Kim Bellard (@kimbbellard), Grace Cordovano (@gracecordovano), Michael Millenson (@MLMillenson), and Dave deBronkhart (@ePatientDave) all discussed the recent news surrounding COVID-19, and their guesses on how it will impact the landscape of health care; from policy to practice — Matthew Holt

There Will Be Consequences

By KIM BELLARD

Crises — like our current COVID-19 pandemic — force people to come up with new solutions.  They slash red tape, they improvise, they innovate, they collaborate, they cut corners.  Some of these will prove inspired, others will only be temporary, and a few will turn out to be misguided.  We may not know which is which except in hindsight.

I covered some of these in a previous article, but let me highlight a few:

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Flipping the Stack: Can New Technology Drive Health Care’s Future?

By MATTHEW HOLT and INDU SUBAIYA

Indu & I have been talking about Flipping the Stack in health care for about 3 years. 2 years ago we wrote an article for a general hospital audience which appeared in the 2019 AHA SHSMD Futurescan magazine. I was talking about the changes in home monitoring that might come about due to COVID-19 and remembered this article. The one that got published went through a staid editing process. This is the original version that I wrote before which was rather more fun and hasn’t seen the light of day. Until now. Take a look and remember it is 2 years old–Matthew Holt

Over the past twenty-five years most businesses have been revolutionized by the easy availability of cloud and mobile-based computing systems. These technologies have placed power and access into the hands of employees and customers, which in turn has created huge shifts in how transactions get done. Now the companies with the highest market value are both the drivers of and beneficiaries of this transition, notably Apple, Facebook, Amazon and Alphabet (Google), as well as their international rivals like Samsung, Baidu, Tencent and Alibaba. Everyone uses their products every day, and the impact on our lives have been remarkable. Of course, this also impacts how businesses of all types are organized.

Underpinning this transformation has been a change from enterprise-specific software to generic cloud-based services—sometimes called SMAC (Social/Sensors/Mobile/Analytics/Cloud). Applications such as data storage, sales management, email and the hardware they ran on were put into enterprises during the 80s and 90s in the client-server era (dominated by Intel and Microsoft). These have now migrated to cloud-based, on-demand services.

Twenty years ago the web was still a curiosity for most organizations. But consumers flocked to these online services and in recent years businesses followed, using GSuite, AWS (Amazon Web Services), Salesforce, Slack and countless other services. Those technologies in turn enabled the growth of whole new types of businesses changing sectors like transportation (Uber), entertainment (Netflix), lodging (AirBnB) and more.

Fig 1. Growth of Cloud Computing Use (Cisco)
Figure 1. Growth in use of cloud data v s traditional data centers

What about the hospital?

Hospitals and health systems were late comers to the enterprise technology game, even to client-server. In the 2000’s and 2010’s, mostly in response to the HITECH Act, hospitals added electronic medical records to their other information systems. The majority of these were client-server based and enterprise-specific. Even if they are cloud-based, they tend to be hosted in the private cloud environment of the dominant vendors like Epic and Cerner. Of the major EMR vendors only Athenahealth had an explicit cloud-only strategy, and its influence has been largely limited to revenue cycle management on the outpatient side.

However, the hospital sector is likely to move towards the trend of using the cloud seen in other businesses.

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