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THCB Gang Episode 51, Thursday April 22

Episode 51 of “The THCB Gang” was live-streamed on Thursday, Jan 21. You can see it below! Matthew Holt (@boltyboy) was joined by regulars: futurists Ian Morrison (@seccurve) & Jeff Goldsmith; privacy expert and now entrepreneur Deven McGraw @HealthPrivacy; and digital health guru Fard Johnmar (@fardj). We really dug into vaccines, vaccine passports and what they means for the future of health and society. Great conversation, benefitting a lot from having a fabulous lawyer on the show!

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

Crossover Health’s CEO on Next Move: Private? Public? With a Payer??

By JESSICA DaMASSA

What’s the move for Crossover Health? Looking past the virtual-first primary care co’s $168M Series D, CEO Scott Shreeve gets grilled on the long-game. Is their future private? Or public? As “THE” primary care clinic for Amazon employees, rumors have swirled about a potential acquisition for the better part of a year. But now, with the launch of Amazon Care, does Crossover stand a better chance of being acquired – or being axed? Scott’s explanation of a model that uses small, in-person facilities as “confirmatory centers” to compliment virtual care does sound awfully “Amazon-y,” but it also sounds like a very fundable model for public market investors. A Crossover IPO has also been a long-standing rumor as well, perpetuated by the public market filings of OneMedical, Oak Street Health, and, now, VillageMD. A little extra fuel has been added to the fire by big-money raises among still-private competitors Iora Health and Forward. Does the fact that Crossover’s Series D includes a fresh crop of funders – a group of “crossover investors” no less – that back a wider spectrum of startups and industries foreshadow anything? How about the fact that Crossover is launching a product with a PAYER? What does this new offering, that unites payment model and care model into one market-friendly bundle, foretell about the types of clients Crossover is aiming to serve? Pick this interview apart, health tech friends! All guesses are fair game!

Let’s Build Some LTC Infrastructure!

By KIM BELLARD

Quick now: what’s the biggest single component of President Biden’s infrastructure plan (a.k.a The American Jobs Plan)?   Fixing roads and bridges?  Upgrading the power grid?  Preparing the nation for electric vehicles?  Giving all Americans access to broadband?  Wrong.  If you guessed home and community services, you’ve been paying attention. 

President Biden is proposing $400b (out of some $2 trillion total spending) for this component, compared to, for example, $115b for roads and bridges or $174b to support electric vehicles.  He wants to improve the pay of home care workers, fund more of those jobs, and ensure more people have access to home and community services.

All laudable goals, but not nearly enough, and not spent on the right things.  I worry that we may miss a generational opportunity to fundamentally rethink the infrastructure for long-term care.

Opponents of the Biden plan argue that this part of the program is not “infrastructure” in any normal use of the word, and cynics believe it is more about satisfying the SEIU.  On the other hand, long-term care advocates worry that it doesn’t do anything to improve nursing homes, nor the existing long-term care financing mechanisms.  

No one is happy with our long-term care system, except maybe the people profiting from it.  We spend well over $300b annually on long-term care services, plus billons more in unpaid care, but that doesn’t seem to be money well spent.  Long-term care makes the rest of our messed-up healthcare system look futuristic.  Since 70% of us are likely to require some kind of long-term care assistance during our lifetime, this is an issue we should all care about. 

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The Parallel Realities of Health Care: Ratio and Intellectus

By HANS DUVEFELT

Every patient is unique, with some common basic and measurable features and parameters. For a couple of decades now, healthcare has professed to be patient centered. But the prevailing culture of “quality” (and the reality of getting paid for what you do) has us spending at least half our time documenting for outsiders, who are non-clinicians, the substance and value of our patient interactions. That means our patients get half of our attention and others get half.

But of course, if you really wanted to be patient centered, you’d have to ask what patients actually care about, like their blood pressure or their cholesterol, their anxiety or their sore knees. Their answers may not align with the payers’ priorities. And then what…

Parents raise their children and never have to file any reports on how they do it. I believe clergy can still counsel their parishioners without filing reports. But doctors, nurses, nurses aides and physical therapists are trapped in the tyrannical dichotomy of “If you didn’t document it, it didn’t happen”, which actually forces us to do less for our patients just so we will have time to document what we did do. We are, to varying degree, robotniks in a big, inhumane corporate and federal healthcare billing machine these days.

Perhaps the most striking example of the micromanaging and patient-uncentered mandates we are subjected to is the Medicare Annual Wellness Visit: Miss one thing, like offering HIV screening to 80 year old devout French speaking, monogamous Catholics in Van Buren, Maine and risk getting your payment retracted. But we are not mandated to ask about personal life goals or how to balance seniors’ independence with reliance on their children.

Which is more real? The work we do, face to face or even screen to screen, behind closed doors with our patients, or the EMR documentation we produce as a result of those encounters? I know many providers generate voluminous notes that don’t reflect in any way what happened in the visit. That is where the money is.

Right now I am reading a Swedish book by philosopher Jonna Bornemark, titled (my translation) RENAISSANCE OF THE UNMEASURABLE – battling the pedants’ world domination. Much of it is about how the professions of caring for others have been reduced to protocols and reporting systems that make it harder to do what we were trained and developed a passion for. It talks about how checklists and workflows devalue and discourage the powerful creativity that arises when professionals interact with their unique clients and with each other. She anchors all this in the writings of philosophers Cusanus, Bruno and Descartes. It talks about the unknowable, which is something pedants usually don’t want to think about.

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#Healthin2Point00, Episode 199 | Olive acquires Empiric plus raises by Medable & Papa

Today on Health in 2 Point 00, I air some of my grudges as we get into our deals for the day. In the third extension of their Series C, Medable gets another $78 million bringing their total to $217 million. Olive acquires Empiric Health, expanding into surgical data analytics – where does this fit in with Sean Lane’s five-point strategic plan? Finally, Papa gets a $60 million raise and Anthem, Blackstone and K Health launch a joint venture. —Matthew Holt

Smart Healthcare Platforms Shine a Light On Price Transparency

By MATTHEW DALE

Did you know that as of January 2021, price transparency is being mandated for hospitals? But what exactly does that mean for company healthcare plans, third-party administrators, healthcare sharing organizations, employers, and employees? 

It means U.S. hospitals are now required to provide clear, accessible pricing information online about the items and services they provide in two ways: 1) as a comprehensive machine-readable file and 2) in a display of shoppable services in a consumer-friendly format. 

The Centers for Medicare & Medicaid Services are already requiring hospitals to publicly display their negotiated rates with insurers along with the cash pay price for over 300 shoppable medical services.

For healthcare consumers, this should mean they can shop for the hospital that performs the best knee surgery or other medical procedure for the lowest cost in their area. Unfortunately, the implementation of price transparency has been difficult, to say the least.

The American Hospital Association and other industry groups have spent large amounts of money to block the rule but were unsuccessful. Now, hospitals are trying to get around the rules. A Wall Street Journal investigation found that hundreds of hospitals implemented website code to block search engines from returning results for price inquiries. 

Technically, hospitals are following the price transparency rule, but by deliberately hiding data from search engines or making it nearly impossible to find, consumers are unable to locate a hospital or surgery center they can afford. That’s just one example of how hospitals are avoiding price transparency. The AHA has made it clear they are not happy with price transparency and they’ll do whatever they can to avoid this new rule, but why? 

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THCB Gang Episode 50, Thursday April 15

Well the half-century is up for #THCBGang and it’s been a lot of fun bantering with some of the cognoscenti of health tech, business & policy over most of the last year.

For #50 we had a special guest. Robert Pearl, (@RobertPearlMD) former CEO of The Permanente Medical Group, noted commentator, and author. He joined me, along with regular gang members policy expert consultant/author Rosemarie Day (@Rosemarie_Day1), policy & tech expert Vince Kuraitis (@VinceKuraitis), and Suntra Modern Recovery CEO JL Neptune (@JeanLucNeptune).

There was a little discussion of Robert’s new book Uncaring (although there’ll be more about that on THCB later) and a lot of discussion about his experience at Kaiser Permanente, what went right, what went wrong and why it never traveled nationwide–and what that all means for a new generation of medical groups. And we didn’t forget the vaccine rollout, and even whether it was safe to be on a plane!

You can see the video below live and the audio will be on our podcast channel (Apple/Spotify) from Friday — Matthew Holt

The Pain Is In Your Brain: Your Knees Know Next to Nothing

By HANS DUVEFELT

A “frozen shoulder” can be manipulated to move freely again under general anesthesia. The medications we use to put patients to sleep for such procedures work on the brain and don’t concentrate in the shoulder joints at all.

An ingrown toenail can be removed or an arthritic knee can be replaced by injecting a local anesthetic – at the base of the toe or into the spine – interrupting the connection between the body and the brain.

An arthritic knuckle can stop hurting and move more freely after a steroid injection that dramatically reduces inflammation, giving lasting relief long after any local anesthetic used for the injection has worn off.

The experience of pain involves a stimulus, nerve signaling and conscious interpretation.

Our brains not only register the neurological messages from our sore knees, shoulders, snake bites or whatever ails us. We also interpret the context or significance of these pain signals. Giving birth to a long awaited first baby has a very different emotional significance from passing a kidney stone, for example.

I have written before about how we introduce the topic of pain to our chronic pain patients in Bucksport. Professor Lorimer Moseley speaks entertainingly of he role of interpretation in acute pain and also explains the biochemical mechanisms behind chronic pain.

TREATING PAIN WITH ANALGESICS

Even when we are awake, we can reduce orthopedic pains with medications that work on the brain and not really in our joints. A common type of arthritis, such as that of the knees, is often treated with acetaminophen (paracetamol), nonsteroidal anti-inflammatory drugs (NSAIDS) like ibuprofen or even opioids.

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#Healthin2Point00, Episode 198 | Microsoft buys Nuance & lots of IPO rumors

Today on Health in 2 Point 00, Jess claims to be blameless for the drama between Jonathan Bush and Glen Tullman. On Episode 198, we talk about Microsoft buying Nuance for $16 billion and $3 billion in debt – is Microsoft taking over healthcare, and is this going to slow Nuance down? Cohere Health raises $36 million in a Series B, working on improving prior authorizations between health plans and providers. We wrap up with a lightning round of IPO rumors regarding Privia Health, VillageMD, and Bright Health. —Matthew Holt

To Add is Expected, To Subtract is Design

By KIM BELLARD

A couple years ago I wrote about how healthcare should take customer experience guru Dan Gingiss’s advice: do simple better.  Now new research illustrates why this is so hard: when it comes to trying to make improvements, people would rather add than subtract. 

That, in a nutshell, may help explain why our healthcare system is such a mess.

The research, from University of Virginia researchers, made the cover of last week’s Nature, under the catchy title Less Is More.  Subjects were given several opportunities to suggest changes to something, such as a Lego set-up, a geometric design, an essay or even a travel itinerary.  The authors found: “Here we show that people systematically default to searching for additive transformations, and consequently overlook subtractive transformations.”

In the Lego picture here, for example, when asked how to strengthen the upper platform, most people wanted to add new columns, instead of simply removing the existing column.  The researchers note: “The subtractive solution is more efficient, but you only notice it if you don’t jump to an additive conclusion.”

Giving cognitive nudges – like explicitly mentioning the option of deleting something – improved the likelihood that people would come up with subtractive options, but increasing cognitive load (through additional tasks) decreased it.  Co-author Benjamin Converse said:    

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