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Five takeaways about the Theranos broo-ha-ha

Oct 16, 2015• 7

By MATTHEW HOLT

You’ve probably seen by now both that the WSJ’s John Carreyrou has run a well researched hit piece on Theranos and that the company, led by wunderkind Elizabeth Holmes, has somewhat muffed its reply. If you haven’t, best thing is to read the Roger Parloff Fortune piece which summarizes the pay-walled piece so you don’t have to do the painful task of sending Rupert Murdoch money. Now in the spirit of FD I need to let you know that we’ve invited Holmes to speak at Health 2.0 twice and her PR handlers have been unbelievably hard to communicate with. They’ve either flat out ignored us or taken forever to turn us down, even though she’s appeared often at (what I at least consider) much less important or relevant venues. I have no idea if she’s badly advised, wanting to stay away from sophisticated health tech audiences, or if her handlers decided that we and our 2,000 strong crowd are just not cool enough for her. Or maybe simply her calendar hasn’t allowed it. Either way I have no first hand knowledge of her or the product–although Elizabeth our invite is still out there! But I do know five things.

1) Lab business decentralizes & democratizes. Whether or not Theranos is lying, cheating, not using its own tech, or its cool stuff just doesn’t work, the trend towards comprehensive, cheap and soon at home lab testing is clear. More than 5 years ago a company called BioIQ was selling at home fingerstick based cholesterol & glucose tests. In the past year the two stage Nokia Sensing XCHALLENGE (of which we hosted stage 1 at Health 2.0 in 2013) has revealed a plethora of companies taking minute quantities of blood, pee or spit and doing complex diagnosis from them. And it’s not stopping there. The next phase is using light and other sensors to diagnose direct from the skin. Whether or not the locus of activity ends up using Theranos at Walgreens or the kitchen table using something else, the dam holding back continuous, cheap multi-faceted testing is going to burst soon.

2) Theranos and Holmes are not the most important thing in health care. There, I’ve said it. While Holmes has talked a lot about revolutionizing health care access and has given lots of transparency into Theranos’ pricing if not its testing technology, what they’re up to is getting easier access to lab tests. I think this is very important and a very good thing, but no one can seriously believe that this is the biggest change in health care. It’s part of a trend towards consumerism. But I’d argue the most important trend in health care is the redesign of chronic care management, on which we spend a shed-load more than lab testing. I may be wrong but if you insert your pet issue here, I’d bet it’s not cheaper lab testing. The media has been a tad snowed by the “youngest female billionaire” and “blonde Steve Jobs” analogies, but even if she runs the field and takes over most lab testing, it’s an incremental change not a huge revolution in health care.

GET Funded Service – What did we learn?

Oct 15, 2015

By PASCAL LARDIER

Part of an EU-funded programme, the GET Funded service targeted European digital health SMEs looking for follow-up investments – typically between 0.5 and 2M € – and was designed to provide them with training, resources and networking opportunities with European investors. In two years, we worked with 50 start-ups, trained and placed over 30 of them on stage to pitch in front of investors. What did we learn?

The GET consortium started by identifying the European investors that were the most active in digital health: about a dozen dedicated funds plus a mix of corporate, health care, technology, and agnostic venture funds. We recruited about 40 we considered as ‘active’, a number that will grow as we witness the creation of new dedicated funds every year. 2015 saw the creation of one in particular that should be interesting to follow: AXA, already ahead of the game in terms of digital health reimbursements, now has a new dedicated investment fund.

Medical Errors, Or Not

Oct 15, 2015• 15

By NORTIN M HADLER, MD

In a recent post, the renowned neurologist, Martin Samuels, paid homage to the degree to which uncertainties create more than just anxious clinicians, they can lead to clinical errors. That post was followed by another by Paul Levy, a former CEO of a Boston hospital, arguing that the errors can be diminished and the anxieties assuaged if institutions adhered to an efficient, salutary systems approach. Both Dr. Samuels and Mr. Levy anchor their perspective in the 1999 report of Institute of Medicine Report, “To Err is Human”, which purported to expose an alarming frequency of fatal iatrogenic errors. However, Dr. Samuels reads the Report as a documentation of the price we pay for imperfect knowledge; Mr. Levy as the price we pay for an imperfect organization of health care delivery. These two posts engendered numerous comments and several subsequent posts unfurling one banner or the other.

I crossed paths with Dr Samuels a long time ago when we were both speakers at a CME course held by the American Geriatrics Society and the American College of Physicians. I still remember his talk for its content and for its clinical perspective. His post on THCB is similarly worthy for championing the role of the physician in confronting the challenge of doing well by one patient at a time. Mr. Levy and his fellow travelers are convinced they can create settings and algorithms that compensate for the idiosyncrasies of clinical care. I will argue that there is nobility in Dr. Samuels’ quest for clinical excellence. I will further argue that Mr Levy is misled by systems theories that are more appropriate for rendering manufacturing industries profitable than for rendering patient care effective.

Key for Health IT Entrepreneurs: Don’t Disrupt the Wrong Thing

Oct 14, 2015• 2

By MICHAEL MILLENSON

Among the 200 demos, 60 exhibitors and more than 100 speakers at the annual Health 2.0 conference on digital health, a critical insight for succeeding in this burgeoning market might have gotten lost in the noise.

The crucial advice came on separate days from two of the savviest digerati doctors in Silicon Valley. Not coincidentally, both Dr. Robert Wachter and Dr. Michael Blumpractice at the University of California, San Francisco (UCSF) Medical Center.

Wachter, an internist, was an early and eloquent advocate of the potential of electronic health records (EHRs) to improve the safety and quality of care. Actual EHR implementation, however, brought not nirvana, but a jarring number of “side effects.” Not least was the way the technology often distracts, confuses and complicates the lives of clinicians, endangering patients in the process.

An October Surprise For Co-Ops

Oct 14, 2015• 3

By LEONARD KISH

Leonard Kish sits down with Julia Hutchins, CEO of the Colorado HealthOP, to talk about the recent surprise when Co-ops were informed the federal government would pay just 12.6 percent of the money they’d requested …

LK: Julia, tell me a little about the history of CO-OPs in general and the Colorado Health-OP in particular. When were they formed? Why were they formed?

JH: The CO-OP program was an important part of healthcare reform. The CO-OPs were part of a bipartisan compromise to ensure that there was competition in the individual and small group insurance markets and to ensure that there was competition on behalf of consumers. CO-Ops have enabled lower costs and more responsiveness to consumers as the market moves from one that was previously medically underwritten to one where anybody can buy health insurance regardless of their health status.

An Interview with InterSystems Clinical Advisor Nelson Le

Oct 14, 2015

By MICHELLE RONAN NOTEBOOM

An interview with Nelson Le, clinical advisor and senior product advisor for InterSystems

Michelle Noteboom: Give me an overview of InterSystems and clarify your role in the company.

Nelson Le: InterSystems is a global healthcare IT company and we have different products that we offer the market. We say that technology is the pathway to making an impact in healthcare. The team that I work on is focused on interoperability and our position is that in order to achieve clinical outcomes and to perform well as a healthcare system, you need to be able to be interoperable and connect all your different systems, your different stakeholders, and all the data that you have regarding your patients and your performance.

My role on the team is clinical adviser. What that means is that I look at our products and solutions, I look at our positioning, and I look at our customer base and figure out how we can use technology to drive strong clinical outcomes.Continue reading…

What Cardiologists Can Teach Economists

Oct 14, 2015• 7

By MICHEL ACCAD, MD

I had the great fortune and pleasure of studying under the late Kanu Chatterjee during my cardiology fellowship at the University of California San Francisco.

In the early 1970’s, Dr. Chatterjee was among the first to understand the benefits of “afterload reduction” for the treatment of congestive heart failure:

Prior to that time, giving medications that could lower the blood pressure was often seen as heretical. In fact, during the 1950’s and 1960’s, the treatment of heart failure sometimes consisted in applying measures to raise the blood pressure and increase the work of the heart.

The “90 Day Contract”

Oct 14, 2015

By TERRY M BENNETT, MD

At age 77, having been through all of the fun and games of dealing with the New Hampshire Board of Medicine, a predatory local Hospital CEO, and other adversaries, nothing should surprise me anymore. But, I am surprised that intelligent, well-educated physicians would sign a “welcome aboard” new employee contract, a contract that allows their employer hospital to fire them without stated cause and throw them, literally, out the door using the security guards to do so, and without even time to clean up their offices.

Most doctors, however, are now hospital employees, and have knowingly or unknowingly, signed exactly such a contract.Continue reading…

Scoring the Surgeon Scorecard

Oct 13, 2015• 4

By MARK W. FRIEDBERG

Mark W Friedberg is a researcher at the RAND Institute and a co-author of the recent RAND analysis of the Surgeon Scorecard. He posted this on THCB in response to Ashish Jha’s post “Misunderstanding ProPublica.”

I don’t disagree at all with the idea that providers should release their own performance data, to the extent that they have it. Free flow of accurate and understandable performance information is inherently good. If the ProPublica Surgeon Scorecard can create pressure for this to happen, fantastic.

But there is no tradeoff between recognizing the serious methodological problems in the Scorecard, improving the Scorecard, and encouraging providers to release their own data. All three can and should be done simultaneously.

Also, for frequenters of this blog, I think it’s important to clarify a few key things about the “RAND critique” (which I authored with individuals from many institutions, all of whom deserve credit for devoting considerable unpaid time to the effort).

1. Nowhere in the critique do we suggest that ProPublica – or anybody else for that matter – abandon efforts to generate and publicize reports that truly reflect provider performance. Far from it. If you look up the authors of our critique, you’ll see that all of us have devoted substantial time and effort to furthering the science and practice of performance measurement and transparency in health care.

Wellness 2.0: Better Health, Better Coverage

Oct 13, 2015• 19

By JIM PURCELL

Just what on earth are businesses thinking? Companies pay too much for poor quality health care coverage. If this were any other business expense, this wouldn’t be tolerated. Yet, expensive, sub-standard healthcare is something U.S. companies roll over and accept. There are many reasons why, all unacceptable.

Fortunately, there’s a path that companies can take now to address healthcare costs: fostering healthier employee lifestyles. This is perhaps the only avenue for immediate action that can lower healthcare costs for both employers and employees while cultivating a healthier, more productive workforce. Your cynical side laughs? Consider this:

“Only private business, not the federal government, can solve America’s epidemic of obesity, chronic disease, and runaway healthcare costs by investing in the health and fitness of their employees,” said Cleveland Clinic CEO Toby Cosgrove in an Affordable Care Act debate panel, a sentiment increasingly echoed inside and outside of healthcare.

Employers must move away from the adversarial, zero sum approach of increasing employees’ share of the cost of coverage to a more partnership-centered model of forging employer/workforce partnerships where both companies and employees support each other’s goals, not just in lowering coverage costs, but by improving health.

Increasing coverage in this day and age? Unheard of! But this is not a pipe dream. If companies are willing to make the investment, on the condition that employees undertake required behavior modifications and achieve positive outcomes, it truly can happen. And though may have heard this before, up to now we’ve not done it right.Continue reading…