It’s been a while but Anish Koka, a one time regular writer on THCB and occasional THCB Gang member, is back publishing up a storm on his Substack channel. You may recall that his political and clinical views don’t always mesh with some of the wooly liberals we feature on THCB (cough, cough, me), but we are delighted to be back publishing some of his pieces–this one is on reimbursement.–Matthew Holt
The subspecialty of Cardiology known as electrophysiology has seen explosive growth over the last few decades in large part because of a massive expansion in the suite of procedures now offered to patients. It used to be that electrophysiologists would spend the majority of their careers implanting pacemakers and defibrillators, but the last 2 decades saw an explosion in electrophysiology procedures known as ablations. Ablations essentially involve burning cardiac tissue in a strategic manner to get rid of arrhythmias that may be afflicting a particular patient. The path humans took from first taking an electrical picture of the heart with a surface ECG to putting catheters into the heart to map and treat dangerous arrhythmias is one of the great achievements of the modern era.
Giants of the field like the recently deceased Mark Josephson essentially created a field by going where no humans had gone before. Dr. Josephson did much of his work in Philadelphia at the University of Pennsylvania publishing seminal papers that lead to a greater understanding and eventual treatment of previously incurable malignant arrhythmias. As is true of all trailblazing work in medicine , there were no reimbursement codes in the beginning , just desperate patients with no place to turn.
The procedures being embarked on were rare and the patients were very complex. The renumeration that was awarded from Medicare was reflective of this. But two things almost always happen once a highly reimbursed procedure code comes on line – technological advances makes the procedure easier, and the population that the procedure is intended for massively balloons.
Home-based healthcare is the stuff of tomorrow – literally. Tomorrow Health just closed a $60M Series B to grow their tech infrastructure biz into what CEO Vijay Kedar hopes will ultimately streamline and optimize how home health is ordered, delivered and paid for. This is the software that *could* be the thing that not only gets patients into home-based set-ups faster (vastly improving upon the up-to-90-minutes it currently takes providers to set-up home care for patients) but also creates a system for all stakeholders to track and monitor patient outcomes with an aim at the much larger, long-term opportunity: to realign incentives on value instead of fee-for-service.
Vijay came out of Oscar Health, meaning there is definitely a payer slant to the way this software is designed and deployed. Payers are Tomorrow Health’s clients, and it offers them a way to organize (or completely create, in some cases) home care networks out of the hundreds of different small, local market suppliers and providers that get medical equipment, skilled and unskilled services, and other in-home care elements to the doorsteps of the patients who need them. For a Geisinger Health Plan or Aetna – two of Tomorrow Health’s marquee clients – the software alleviates the pain of scaling this concept in every market while also providing a way to track what’s happening with the patient and build a “bridge” back into the health system that’s leading the patient care team.
With so many other players working in the home-health space – everyone from retail players like Walgreens/CareCentrix and Best Buy/Current Health to upstarts like Signify Health, Honor, and more – how will this tech stack approach play out against others that are one-stop-shops with frontline care and coordination layered on top? Will these ultimately be Tomorrow’s next clients?? Tune in to find out.
We’ve been duped! Everyone said nothing’s been going on in digital health, but Amazon bought OneMedical! Keep watching for our thoughts and new deals: Cleery raises $192 million; Health Note raises $17 million; Elation raises $50 million; Caraway raises $10.5 million.
This was a special early in the day edition of #THCBGang. It was at 9.15am PT/ 12.15 pm ET (so if you are coming at 1pm it won’t be live today at the normal time as it’s already happened!). It was part of the Primary Care Transformation Summit which has been running since Monday and continues to the end of Friday. It’s a who’s who of everyone in primary care. You can check out the wider agenda but we were on immediately before the day 3 keynote from head of CMS Innovation, Liz Fowler.
Joining Matthew Holt (@boltyboy) to discuss primary care and more were are WTF Health host & Health IT girl Jessica DaMassa (@jessdamassa); futurist Jeff Goldsmith; & Dan O’Neill (@dp_oneill) who is now at primary care group Pine Park Health.
You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.
July 25, 1972 was fifty years ago this week and it is a day that all AP Science journalists know by heart. As Monday’s AP banner headline read: “On July 25, 1972, Jean Heller, a reporter on The Associated Press investigative team, then called the Special Assignment Team, broke news that rocked the nation. Based on documents leaked by Peter Buxtun, a whistleblower at the U.S. Public Health Service, the then 29-year-old journalist and the only woman on the team, reported that the federal government let hundreds of Black men in rural Alabama go untreated for syphilis for 40 years in order to study the impact of the disease on the human body. Most of the men were denied access to penicillin, even when it became widely available as a cure. A public outcry ensued, and nearly four months later, the “Tuskegee Study of Untreated Syphilis in the Negro Male” came to an end.”
The New York Times had an interesting set of op-eds last week under the theme “I Was Wrong.” For example, Paul Krugman says he was wrong about inflation, David Brooks laments being wrong about capitalism, and Bret Stevens now fears he was wrong about Trump voters. Nobody fessed up about being wrong about healthcare, so I’ll volunteer.
I’ve been writing regularly about healthcare for over a decade now, with some strong opinions and often with some pretty speculative ideas. I’ve had a lot to be wrong about, and I hope I will be wrong about many of them (e.g., microplastics). Some of my thoughts (such as on DNA storage or nanorobots) may just be still too soon, but there are definitely some things I’d thought, or at least hoped, would have happened by now.
I was at the AHIP conference in Vegas late last month and caught up with a number of CEOs & execs for some quick bite interviews — around 5 mins getting (I hope) to the gist of what they & their companies are up to. I am dribbling them out –Matthew Holt
I read the Stat News investigative piece “Health care’s high rollers,” by Bob Herman and colleagues, with interest but not much surprise. I mean, is anyone surprised anymore that healthcare CEOs often make a lot of money, and didn’t let a crisis like the pandemic dampen that? As Kaiser Family Foundation’s CEO Drew Altman told them, “Health care has become big business. We have a lot of people making a lot of money in health care, and we still have an affordability crisis in health care.”
I periodically see Twitter threads lamenting how little of that healthcare spending actually goes to physicians, yet people often still blame them for that spending. Physicians make a pretty decent living (an average of $322,000, according to the 2022 Medscape Physician Compensation report), although that compensation depends on specialty, gender, race/ethnicity, and location. But maybe, just maybe, the problem in healthcare is that we’re not paying physicians enough – not nearly enough.
I was at the AHIP conference in Vegas late last month and caught up with a number of CEOs & execs for some quick bite interviews — around 5 mins getting (I hope) to the gist of what they & their companies are up to. I am dribbling them out–Matthew Holt
Next up is Sudheen Kumar, CEO, Health Chain.
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