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Health in 2 Point 00, Episode 152 | 2 IPOs, At-Home Care, & Youtube for Employees?

With 2 IPOs this week, On Episode 152 of Health in 2 Point 00, Jess asks me about Amwell’s IPO with a market cap at $5B for its telehealth solutions, Outset Medical’s IPO with a market cap of $1.5B for its kidney dialysis technology, Ready raising $54M for its care at- home platform, Lifespeak getting $42M for its “YouTube” like platform for employee mental health and wellness training program.Matthew Holt

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If I Can Be Safe Working as An ER Doctor Caring for COVID Patients, We Can Make Schools Safe for Children, Teachers, and Families

By AMY CHO

We need to stop arguing about whether schools should reopen and instead do the work to reopen schools safely. Community prevalence of COVID-19 infection helps to quantify risk, but reopening decisions should not be predicated on this alone. Instead of deciding reopening has failed when an infected student or teacher comes to school, we should judge efforts by our success in breaking transmission chains between those who come to school infected and those who don’t. We should judge our success by when we prevent another outbreak. We should pursue risk and harm reduction by layering interventions to make overall risk of transmission in schools negligible. This CAN be done, as healthcare workers all over the United States have shown us. Unlike politics, we should avoid thinking this is a binary choice between two polarized options. At the heart of these decisions about tradeoffs should be the assumption that the education of our children is an essential, public good.

I advocated for school closures in March. We had little understanding of the risks and transmission of COVID-19 and faced massive shortages of personal protective equipment (PPE). The closures were a blunt force instrument but bought precious time to learn and prepare. Pandemic control, by flattening the curve and buying time for discovery of more effective therapeutics, care and a vaccine, remains a critical tool to save lives. But COVID-19 will not be eradicated. We must come to terms with the reality that COVID-19 will circulate among us, likely indefinitely. Shutdowns slow spread but at a great cost, disproportionately paid by vulnerable groups including children, women, minorities, and those with the least financial resources. Getting children safely back to in-person school should be among our highest priorities.

Hospitals never considered closing. As healthcare workers, we cannot physically distance from patients. We watched in horror as hot spots like Bergamo suffered high nosocomial and staff infection rates as they were quickly overwhelmed. In response, we worked tirelessly and collaboratively to protect one another while continuing to provide care.

The good news is that we seem to have learned how to prevent in-hospital transmission of COVID-19. A recent study showed that at a large US academic medical center, after implementation of a comprehensive infection control policy, 697 of 9,149 admitted patients were diagnosed with COVID-19. But only TWO hospital-acquired patient infections were detected. COVID-19 is not “just the flu,” but it isn’t Ebola either. I no longer worry that I will become infected with COVID while working in my emergency department. It is not easy, comfortable nor cheap, but a bundle of universal masking and eye protection, appropriate PPE use, sanitation, improved room ventilation, and protective policies have proven effective at preventing in-hospital outbreaks. 

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THCB Gang Episode 25 9/17

Joining Zoya Khan (@zoyak1594) on Episode 25 of “The THCB Gang” were regulars patient advocate Grace Cordovano (@GraceCordovano), writer Kim Bellard (@kimbbellard), policy & tech expert Vince Kuraitis (@VinceKuraitis), data privacy expert Deven McGraw (@healthprivacy), and guest Rosemarie Day, Founder & CEO of Day Health Strategies (@Rosemarie_Day1). Rosemary’s book “Marching Towards Coverage” is out now. The conversation revolved around new health technology policies, Medicaid Expansion programs, the 2020 election, and the steps to get to universal health coverage. Oh, and you can take Rosemary’s quiz about what type of a health activist you are!

If you’d rather listen to the episode, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels — Zoya Khan

Doctors Urge Caution in Interpretation of Research in Times of COVID-19

September 9, 2020

To:      

American College of Cardiology

American College of Chest Physicians

American College of Physicians

American College of Radiology

American Heart Association

American Society of Echocardiography

American Thoracic Society

European Association of Cardiovascular Imaging

European Society of Cardiology

European Society of Radiology

Heart Rhythm Society

Infectious Disease Society of America

North American Society of Cardiovascular Imaging

Radiologic Society of North America

Society of Cardiovascular Magnetic Resonance

Society of Critical Care Medicine

Society of General Internal Medicine

Society of Hospital Medicine


Dear Society Leadership:

We are a group of clinicians, researchers and imaging specialists writing in response to recent publications and media coverage about myocarditis after COVID-19. We work in different areas such as public health, internal medicine, cardiology, and radiology, across the globe, but are similarly concerned about the presentation, interpretation and media coverage of the role of cardiac magnetic resonance imaging in the management of asymptomatic patients recovered from COVID-19.

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Kids & Mental Health: Brightline Aims to “Grow Up” Pediatric Behavioral Health Care with Tech

By JESSICA DAMASSA

Despite the fact that kids make up 20% of our national patient population and that their parents are likely just the tech-savvy market of health consumers that most digital health companies are targeting with their own virtual care solutions, very little has been done to use technology to ‘transform’ the way that they take care of their kids. One of the founders hoping to push this market into a growth spurt is Naomi Allen, co-founder & CEO of pediatric behavioral health company Brightline.

From seed to Series A in just 8 months ($25M total funding), Brightline is already looking to scale out its full-stack clinical model to help tackle the behavioral health issues that are often under-diagnosed and under-treated in kids. Naomi says that 75% of all severe mental illness manifests before age 14, but that only 1 in 5 kids will ever even get a behavioral health diagnosis. And more shocking? Of those that are diagnosed, only 1 in 5 of those kids will ever even receive any care.

The supply-and-demand equation is off — stymied not only by a clinician shortage, but by literally poor reimbursement from health plans concerned about the lack of quality metrics, measurements, and processes in pediatric behavioral health despite the prevalence of those kinds of quality guidelines around adult mental health care.

So, how is Brightline going to fix this? Technology, clinicians, coaches. A full-stack clinical model with a “scaffolding” of support for parents built around it using telehealth, digital tools, and, for those health plans, metrics. Tune in to find out more about their business model, what Brightline’s kids are saying, and how you can find their services yourself if you think your child might need help.

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THCB’s Bookclub, September 2020 – NEO.LIFE

By JESSICA DAMASSA & MATTHEW HOLT

The THCB Book Club is a discussion with leading health care authors, which will be released on the third Wednesday of every month.

This month we hosted Jane Metcalfe (Founder of NEO.LIFE) to talk about her 2020 book NEO.LIFE. You can get a copy of it here!

NEO.LIFE is a very unusual book. It’s over 25 very short chapters (ranging from 1 page to 78) which include interviews, concepts, art, science, science fiction, and one short story. All from different authors or groups of authors that are all edited into place by Jane Metcalfe and Brian Bergstein.

The topic is the future of humans! And the loose focus is on biotech, human engineering, and well watch along and get a copy!

You can see the video below (and the podcast version will be in our iTunes & Spotify channels very soon).

In October the THCB BookClub will feature Mike Magee’s book, Code Blue.

Hospitals Must Give Up Power to Save Healthcare

By KEN TERRY

(This is the sixth in a series of excerpts from Terry’s new book, Physician-Led Healthcare Reform: a New Approach to Medicare for All, published by the American Association for Physician Leadership.)

As hospital systems become larger and employ more physicians, healthcare prices will continue to rise and independent doctors will find it harder to remain independent. Hospitals will never fully embrace value-based care as long as it threatens their primary business model, which is to fill beds and generate outpatient revenues. To create a viable, sustainable healthcare system, the market power of hospitals must be eliminated.

Federal antitrust policy is not adequate to handle this task. Even if the Federal Trade Commission had more latitude to deal with mergers among not-for-profit entities, the industry is already so consolidated that the FTC would have to break up health systems involving thousands of hospitals. Such a gargantuan effort would be practically and legally unfeasible.

All-payer Systems

 The government could curtail health systems’ market power without breaking them up. For example, either states or the federal government could adopt “all-payer” models similar to those in Maryland and West Virginia. Under the Maryland model introduced 40 years ago, every insurer, including Medicare, Medicaid, and private health plans, pays uniform hospital rates negotiated between the state and the hospitals.

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Health in 2 Point 00, Episode 151| MDLive (not?) IPOing, DTx Platform for Schizophrenia, & more

We are forgetting about health tech, and celebrating Chicago-oo! Just kidding, today on Health in 2 Point 00, Jess asks me about Truepill getting a 75M Series C after just closing their B, Sana Benefits getting $20.8M, and Decent getting $10M, both of which are in the space of health benefits & insurance for small business have raised funding, MDLive closing a $50M round for their Virtual Primary Care (but weren’t they going public?), Owl Insights getting $15M from Ascension and Blue Ventures, and Boehringer Ingelheim & Click Therapeutics working on a $500M deal together on a DTx platform for Schizophrenia patients. –Matthew Holt

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Healthcare Can Learn From Chess

By KIM BELLARD

Oh, gosh, two of my favorite things are in the news together: Twitch and chess. 

Just kidding.  I barely know what Twitch is, and the last time I played chess was, well, not in this century (and, even then, not well).  But I’m not kidding about their convergence.  Chess has become a big hit on Twitch, especially in these COVID times. 

I figure, if two such seemingly divergent things are meshing, there must be some lessons there, even for healthcare. 

For those of you over, say, fifty, Twitch is an online service that facilitates livestreaming, particularly of gaming.  That is, people watch other people playing games, such Fortnite or League of Legends. 

E-sports, as this is known, have become a big thing; colleges are even giving out scholarships for e-sports.   Major news outlets, such as The New York Times and The Washington Post, reported on Twitch re-signing video game star Tyler Blevins, a.k.a “Ninja,” much as they might have reported an NFL team signing a star player. 

As I write, 2.7 million people are livingstreaming on Twitch.  Its all-time concurrent viewers peak is just over 6 million.  There were 1.6 billion hours watched in August, with over 11 billion year-to-date.  It draws more viewers than network television hits. There are 93,000 live channels at this moment. 

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Will COVID-19 Force The South To Finally Confront Structural Racism Within Their Medicaid Programs?

By MIKE MAGEE

If you would like to visit the meeting place of America’s two great contemporary pandemics –COVID-19 and structural racism – you need only visit America’s Nursing Homes.

This should come as no surprise to Medical Historians familiar with our Medicaid program. Prejudice and bias were baked in well before the signing of Medicaid and Medicare on July 30, 1965.

President Kennedy’s efforting on behalf of health coverage expansion met stiff resistance from the American Medical Association and Southern states in 1960. Part of their strategic pushback was the endorsement of a state-run and voluntary offering for the poor and disadvantaged called Kerr-Mills. Predictably, Southern states feigned support, and enrollment was largely non-existent. Only 3.3% of participants nationwide came from the 10-state Deep South “Black Belt.”

Based on this experience, when President Johnson resurrected health care as a “martyr’s cause” after the Kennedy assassination, he carefully built into Medicaid “comprehensive care and services to substantially all individuals who meet the plan’s eligibility standards” by 1977. But by 1972, after seven years of skirmishes, the provision disappeared.

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