Fay Rotenberg is CEO of Firefly Health, which is an advanced virtual primary care group (a bastardized phrase she hates). That means they are both providing virtual care, with an integrated care and health plan coverage model, and are also a risk-bearing medical group working with other payers. They adjust the model using health guides, MDs, NPs, etc. and they help their patients manage their in person experience with specialists, labs, imaging, etc. — they have 1900+ partners nationwide who will actually know the patient is coming, and is integrated into Firefly’s model. Clinical outcomes are great, and costs are 12-15% lower, yet they have 5,000 members per MD. Maybe it really is the 21st century Kaiser?
Above the Fold
“Doomscrolling” – Call the doctor!
by MIKE MAGEE
Exactly 1 year ago, mental health experts alerted the medical world to their version of an assessment scale for yet another new condition – “doomscrolling.”
As defined in the article, “Constant exposure to negative news on social media and news feeds could take the form of ‘doomscrolling’ which is commonly defined as a habit of scrolling through social media and news feeds where users obsessively seek for depressing and negative information.”
No one can deny a range of legitimate concerns. Faced with continued background noise from the pandemic, add global warming, renegade AI, and the Republican Congress. And now, the devastating attacks on Israel and growing instability in the Middle East. It is no wonder that we can’t turn off the Instagram feed.
With real challenges like these, our troubled world needs her doctors and nurses to stay focused more than ever on their primary professional missions – managing health and wellness, sickness and disease, fear and worry, and yes, now “doomscrolling.”
John J. Patrick PhD, in his book Understanding Democracy, lists the ideals of democracy to include “civility, honesty, charity, compassion, courage, loyalty, patriotism, and self restraint.” The 4.2 million registered nurses and 1 million doctors in America are agents of democracy.
Regrettably, they are already being drawn away from patients by three powerful forces.
- Corporate Dislocation – To assure maximum reimbursement, doctors and nurses are routinely asked to prioritize time and contact with data over time and access to patients.
- Health Technology and AI Substitution – Rather than engineering solutions to expand real-time patient contact, most innovations are further distancing patients from healthcare professionals.
- Legislative Intrusion – Complex medical decisions, long entrusted to the patient-health professional relationship to negotiate, are being transferred to ultra-conservative legislators.
We live under a constitutional and representative democracy, as do two-thirds of our fellow citizens in over 100 nations around the world. The health of these democracies varies widely. The case for democracy emphasizes its capacity to enhance dignity and self-worth, promote well-being, advance equal opportunity, protect equal rights, advance economic productivity, promote peace and order, resolve conflicts peacefully, hold rulers accountable, and achieve legitimacy through community-based action.
One of the challenges of democracy is to find the right balance in pursuing “the common good” which has dual (and often competing) arms. One arm is communitarian well-being and the other, individual well-being.
Continue reading…CMS’s Policy on Mental Health Therapists Will Work
By JON KOLE
Nearly 66 million Americans are currently enrolled in Medicare, a number that will likely swell towards 80 million Americans within the next seven years. These are our mothers, fathers, aunts, uncles, grandparents and friends – and, maybe, you.
A significant portion of these millions of people need mental health services – and, yet, many face long wait times or aren’t able to find a therapist at all. On average, Americans have a waiting period of 48 days before receiving mental health care. At present, two notable provider groups – Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs), which summed to approximately 415,000 in 2021 – have not been eligible to provide psychotherapy for people with Medicare.
Currently, Medicare only approves psychologists and masters-level Licensed Clinical Social Workers (LCSWs) to provide therapy to Medicare recipients. In July, CMS proposed policies that would significantly increase access to mental health services by adding MFTs and MHCs into the ranks of Medicare-eligible providers. At a time where access to mental health services is acutely limited, it is startling that such a large pool of providers with advanced specialized degrees are not allowed to provide care.
There are many similarities between LCSWs and MFT/MHC training. In addition to an undergraduate degree, LCSWs, MFTs and MHCs have completed a two-year Master’s program, which is then followed by two years of supervised clinical practice prior to taking a licensure exam in their relevant discipline. Once they pass that test, they are able to practice independently in a wide range of settings.
Adding these trained professionals to the roster of available providers is a meaningful step to improve access to mental health services for Medicare members.
Improving access is not just about getting to a provider, though, t’s also about getting connected to one that a patient can feel safe with, connected to, and build a strong working rapport with. According to AAMFT, the satisfaction rate among patients engaged in care with a MFT is exceptionally high, with nearly 90% reporting an improvement in their emotional health after receiving treatment.
One key element in patient-provider connection is allowing options for demographic matching. Studies have shown that when patients from ethnic/racial minority backgrounds are able to connect with providers who share similar demographics, they report better health outcomes and increased satisfaction with the care provided. In one analysis, data gathered from Black caregivers showed 83 percent felt that having a mental health provider of the same race and ethnicity was important, citing themes like relatability, diversity in cultural experiences and the overall patient experience.Adding MFTs and MHCs has the potential to improve demographic matching, given that these are more diverse groups than PhDs or LCSWs.
Given the overall supply-demand imbalance, which is only predicted to get worse, the time is now to ensure that the entire qualified mental health labor force is able to work with Medicare recipients. The CMS proposal would do that.
Continue reading…Alex Katz, CEO, Two Chairs
Two Chairs has an interesting model. Their concept is to find the right therapist for you, and they actually start a patient off with a therapist who diagnoses AND directs in a session, separate from the one who treats. Once the “right” match is made, the patient gets set up with a therapist and the results have been pretty good in terms of the patient coming back–one of a number of things Two Chairs measures rather intently! CEO Alex Katz explained the model and the business–Matthew Holt.
The Future of Digital Health: How UX Design is Shaping the Industry
By PARV SONDHI
As the digital health world continues to expand, more and more people are turning to apps to manage everything from diabetes and obesity to depression and anxiety. People rely on these apps for their physical and mental health, so it’s crucial that product developers ensure a safe, effective, and engaging experience for them. Healthcare experts agree.
A team of researchers and health system leaders recently introduced a new framework called “Evidence DEFINED” for evaluating digital health products. This framework offers hospitals, payers, and trade organizations a precise set of guidelines to assess the validity and safety of a digital health product. It also gives digital health companies good benchmarks to work from.
As digital health companies create new products in the space, they should keep specific points in mind — from user experience design to considerations for data privacy. While clinical outcomes will always reign supreme, the framework suggests that patient experience, provider experience, product design, and cost effectiveness can’t be discounted.
Here are a few critical considerations that product delivery teams should plan for when creating digital health apps.
Clear navigation
First things first: a user won’t use an app that’s hard to navigate. To help people stick to their health goals, developers need to create apps that are intuitive and easy-to-use. When a user logs onto an app, they want to find the content they need immediately and be guided through the experience step by step.
A lot of different people use health apps, and not all of them are tech-savvy. Health apps need to be accessible to all demographics, including people of various ages who speak different languages. It’s also important to remember that digital health apps can be used across multiple platforms, so the navigation should remain clear when switching between devices.
While navigation might seem like a no-brainer, it’s often overlooked when designing for digital health.
Continue reading…Interview with Oxeon CEO, Sonia Millsom
Sonia Millsom is the relatively new CEO at Oxeon, which became the dominant executive search (headhunter) firm in digital health over the past decade or so. The company was built by Trevor Price and team. Sonia discussed the transition to her leadership, the other things Oxeon does (venture studio, relationship to TownHall Ventures), and the state of the employment market in digital health. TL:DR on that, it’s slowed but they are doing a lot of work and still growing.–Matthew Holt
GoodWill’s Lessons for Health Care
By KIM BELLARD
The New York Times had an interesting profile this weekend about how Goodwill Industries is trying to revamp its online presence – transitioning from its legacy ShopGoodwill.com to a new platform GoodwillFinds — in the amidst of numerous other online resellers. It zeroed in on the key distinction Goodwill has:
But Goodwill isn’t doing this just because it wants to move into the 21st century. More than 130,000 people work across the organization, while two million people received assistance last year through its programs, which include career navigation and skills training. Those opportunities are funded through the sales of donated items.
Moreover, the article continued: “Last year, Goodwill helped nearly 180,000 people through its job services.”
In case you weren’t aware, Goodwill has long had a mission of hiring people who otherwise face barriers to employment, such as veterans, those who lack job experience or educational qualifications, or have handicaps. As it says in its mission statement, it “works to enhance the dignity and quality of life of individuals and families by strengthening communities, eliminating barriers to opportunity, and helping people in need reach their full potential through learning and the power of work.”
As PYMNTS wrote earlier this month: “Every purchase made through GoodwillFinds initiates a chain reaction, providing job training, resume assistance, financial education, and essential services to individuals in need within the community where the item was contributed.”
I want healthcare to have that kind of commitment to patients.
Healthcare claims to be all about patients. You won’t find many that openly talk about profits or return on equity. Reading mission statements of healthcare organizations yield the kinds of pronouncements one might expect. A not-entirely random sample:
Cleveland Clinic: “to be the best place for care anywhere and the best place to work in healthcare.”
Continue reading…Interview with Infermedica CEO, Piotr Orzechowski
At the HLTH conference I talked with CEO of Infermedica, Piotr Orzechowski, and also had a quick word with VP of Marketing Marcus Gordon. Infermedica has been around over a decade, and has been a slow burner in the symptom checker and patient digital front door market. But now it has a lot of clients and deals and its API is hiding behind several big names including Optum & Microsoft. Piotr graciously let me butcher his name, and still told me about how their model works and how LLMs will change it.–Matthew Holt
There Needs to Be an “AI” in “Med Ed”
By KIM BELLARD
It took some time for the news to percolate to me, but last month the University of Texas San Antonio announced that it was creating the “nation’s first dual program in medicine and AI.” That sure sounds innovative and timely, and there’s no question that medical education, like everything else in our society, is going to have to figure out how to incorporate AI. But, I’m sorry to say, I fear UTSA is going about it in the wrong way.
UTSA has created a five year program that will result in graduates obtaining an M.D. from UT Health San Antonio and a Master of Science in Artificial Intelligence (M.S.A.I.) from UTSA. Students will take a “gap year” between the third and fourth year of medical school to get the M.S.A.I. They will take two semesters in AI coursework, completing a total of 30 credit hours: nine credit hours in core courses including an internship, 15 credit hours in their degree concentration (Data Analytics, Computer Science, or Intelligent & Autonomous Systems) and six credit hours devoted to a capstone project.
“This unique partnership promises to offer groundbreaking innovation that will lead to new therapies and treatments to improve health and quality of life,” said UT System Chancellor James B. Milliken.
“Our goal is to prepare our students for the next generation of health care advances by providing comprehensive training in applied artificial intelligence,” said Ronald Rodriguez, M.D., Ph.D., director of the M.D./M.S. in AI program and professor of medical education at the University of Texas Health Science Center at San Antonio. “Through a combined curriculum of medicine and AI, our graduates will be armed with innovative training as they become future leaders in research, education, academia, industry and health care administration. They will be shaping the future of health care for all.”
Dhireesha Kudithipudi, a professor in electrical and computer engineering who was tasked with helping develop the university’s AI curriculum, told Preston Fore of Fortune:
In lots of scenarios, you might see AI capabilities are being very exaggerated—that it might replace physicians and so forth. But I think our line of inquiry was guided in a different way, in a sense how we can promote this AI physician interaction-AI patient interaction, bringing humans to the center of the loop, and how AI can enhance care or emphasize more patient centric attention.
OK, fabulous. But, you know, computers have been integral to healthcare for decades, especially the past 15 years (due to EMRs), and we don’t expect doctors to get Masters in Computer Science. We’re just happy when they can figure out how to navigate the interfaces.
To be honest, I was expecting more from UT.
Continue reading…Nabla CoPilot– the new ambient EMR note taker that snagged Permanente
I got up super early on a Sunday (in Vegas no less!) to meet Delphine Groll, COO and Alexandre Lebrun, CEO of Nabla. I have heard directly from doctors a lot about their CoPilot product being adopted as a less expensive version than Nuance or Abridge, and wanted to see what the fuss was about. They gave me a demo of their ambient AI medical note taker and it is very impressive–you’ll see a little bit of my demo and the resulting note in the interview. They were a little shy on Sunday to tell me about their relationship with the Permanente group but between Jay Parkinson and Fierce Healthcare, the beans are well and truly spilled now, and they are apparently soon to be available in every Permanente region. I suspect because of that the integration with Epic that Alexandre mentioned will be full speed ahead!–Matthew Holt
