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Above the Fold

Reflections From the Ukraine

Mar 7, 2022

By MIKE MAGEE

The English translator of Tolstoy’s epic Russian novel, “War and Peace”, Richard Pevear, writes in his introduction, “The book is set in the period of the Napoleonic wars (1805-1812) and tells the interweaving historical events of two very different families of the Russian nobility – the severe Bolonskys and the easygoing Rostovs – and of a singular man reminiscent of the author himself – Count Pierre Bezukhov. It embodies the national myth of ‘Russia’s glorious period’ as Tolstoy himself called it…”

On page 348, in a moment of intense introspection, the very same Pierre broodingly reflects, “What is bad? What is good? What should one love, what hate? Why live, and what am I? What is life and what is death? What power rules over everything?”

Pierre’s mind provides this very dark response, “You will die – and everything will end. You will die and learn everything – or stop asking.”

Matthew’s health care tidbits: The Stupidity Vaccine

Mar 5, 2022

Each week I’ve been adding a brief tidbits section to the THCB Reader, our weekly newsletter that summarizes the best of THCB that week (Sign up here!). Then I had the brainwave to add them to the blog. They’re short and usually not too sweet! –Matthew Holt

For my health care tidbits this week, I think we need a new vaccine. We need one that prevents stupidity.

Look I get that some people don’t think the flu vaccine is effective and don’t think the effects are too bad, so they don’t get one every year. Many people don’t get a vaccine for shingles. But as someone who had shingles long before the recommended age for the vaccine, let me tell you, you’ll wish you had the vaccine should you get it. And even sensible liberal Maggie Mahar a long while back was pretty suspicious of Merck’s Gardasil vaccine for cervical cancer–although since then it’s been replaced both by a more effective updated version and by Cervarix and the long term results are really good.

But since COVID-19 appeared the cultural and ideological identification among most Republicans has been that only wussy liberals take the COVID vaccine. This is stupid and indefensible. Even Donald Trump thinks so! But when he told his cult members that, they booed him! And so the US is stuck on not enough people vaccinated to repel variants or stop ICUs filling up. There are now hundreds of thousands of unnecessary deaths among the unvaccinated with no end in sight.

But this isn’t stupid enough. Now we are seeing senior political leaders attacking vaccines for diseases we’ve had under control for ages. We’ve already seen outbreaks of measles in recent years, including one at Disneyland. Last month 17 Georgia state senators proposed banning school mandates for all vaccines including MMR, chickenpox, DtAP, Hep B, Polio and more. It’s amazing that these people don’t believe in science, yet they are probably happy to use a smartphone or get in an airplane.

Sadly there appears to be no vaccine for stupidity on the horizon

#HealthTechDeals Episode 13: ModMed, Nayya, Sanofi, Dario Health, Ro, Dadi, and Daybreak Health

Mar 3, 2022

Here’s the big question of the day: VIVE or HIMSS or both? Jess and I offer our thoughts on both conferences and which ones we’re going to. Some deals in the past few days: ModMed buys Klara for $200 million; Nayaa raises $55 million; Sanofi and Dario Health have a $30 million deal; Ro acquires Dadi, an in-home sperm testing company; Daybreak Health raises $10 million—Matthew Holt

TRANSCRIPT

Jessica DaMassa:

All right, Matthew Holt, the big question of the day: ViVE or HIMSS or both? Ugh.

Matthew Holt:

Or neither?

Jessica DaMassa:

Hey, that’s the way to do it. It’s the March 3rd episode of Health Tech Deals.

Matthew Holt:

So, Jessica, I thought the big question was State of the Union versus invading Ukraine versus .. No, no, it’s all about ViVE versus HIMSS?

Jessica DaMassa:

ViVE versus HIMSS.

THCB Gang Episode 84, Thursday March 3rd, 1pm PT 4pm ET

Mar 2, 2022

Joining Matthew Holt (@boltyboy) on #THCBGang at 1pm PT 4pm ET Thursday for an hour of topical and sometime combative conversation on what’s happening in health care and beyond will be: fierce patient activist Casey Quinlan (@MightyCasey); patient safety expert and all around wit Michael Millenson (@MLMillenson); THCB regular writer and ponderer of odd juxtapositions Kim Bellard (@kimbbellard); and policy consultant/author Rosemarie Day (@Rosemarie_Day1).

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

Medicare Advantage Poses Challenges to Health Care Cost-Effectiveness and Equity

Mar 2, 2022• 3

BY NIRBAN SINGH AND AMY HELBURN

Introduction

Medicare Advantage (Advantage), originally conceived in 1997 during the Clinton Administration as ‘Medicare + Choice’, has progressively grown and become an established health insurance option for those 65 and older. According to data collected and aggregated by the Kaiser Family Foundation, Advantage has more than doubled in total enrollment between 2010 and 2021. In 2021 alone, 26 million people were enrolled in Medicare Advantage, which is over 40% of the total Medicare beneficiary population. In 2021, 85% of Medicare Advantage growth was concentrated among for-profit health plans, with UnitedHealthCare, Centene, and Humana leading the way.

Overall, the Medicare Advantage market is dominated by UnitedHealthCare, Humana, and CVS Health/Aetna, with this trio responsible for over half of all Advantage beneficiaries.As of October 2020, about 80% of Advantage enrollees directly purchased individual policies, while employer-sponsored Advantage enrollment has been steadily growing, comprising 18.1% of the Advantage market overall in 2020. Analysis from The Chartis Group indicates that half of all Medicare beneficiaries will be enrolled in Advantage plans by 2025, so the trio of existing leaders in providing Advantage plans may continue to innovate and profit immensely while new market entrants may grow their footprint rapidly, in response to growing demand.

#HealthTechDeals Episode 12: Omada Health, Somatus, Qventus, Story Health, and Medibuddy

Mar 1, 2022

In this episode of Health Tech Deals, Jess is back! Where was she? Out in the wilds in Arizona, hiking in mountains. A big shoutout to Ian Morrison for filling in. Some recent deals: Omada Health raises $129 million; Somatus raises $325 million; Qventus raises $50 million; Story Health raises $22.6 million; and Medibuddy raises $125 million.

TRANSCRIPT

Matthew Holt:

Hang on. You’re not Ian Morrison.

Jessica DaMassa:

I’m not.

Jessica DaMassa:

He let me come back.

Matthew Holt:

Hang on, look. And we’re together.

Jessica DaMassa:

We’re together. I went from being completely away and replaced, to being right next to you.

Raspberry Pi Health Care

Mar 1, 2022

By KIM BELLARD

Like many of you, I have been intently following the war in Ukraine, cheering for President Zelensky and the Ukrainian people, while hoping it doesn’t end up in WW3. I thought about trying to write about it, then I saw that Raspberry Pi just turned ten, and I thought, yeah, that’s more my speed.

And, of course, easier to relate to healthcare.

For most of us, a computer is our smartphone, tablet, or laptop. We buy them already designed and built, complete with an operating system and other useful software. There’s an almost unlimited range of other software that can easily be downloaded to run on them. Ease of use is paramount.

This was not always so. If you are of a certain age or have studied the history of computers, you’ll know that in the 1970s and early 1980s, (home) computers came in a kit. You assembled them and figured out what you might want to use them for. Then came Apple and the PC revolution. Our expectations about what computers could do grew as our expectations about what we had to do diminished. Between 2006 and 2011, Eben Upton and his collaborators sought to change this.

DEMO: Medstar Health’s digital front door – featuring b.well Connected Health

Feb 28, 2022

Medstar Health, a big hospital system in the Washington DC area, has been using a selection of digital health tools like Bluestream Health’s telehealth system for a while. Now they are showing to the world their implementation of b.well Connected Health‘s patient interface which as you’ll see is being used to create a digital first experience for their patients, enabling booking of virtual and physical appointments. I spoke with John Lock, Chief Digital Transformation Officer at MedStar Health & Kristen Valdes, CEO of b.well Connected Health, while Cathryna Nieves, AVP, Digital Transformation at MedStar Health gave a full demo of the experience. I don’t often head into the belly of the beast, but it’s very interesting to see how big incumbents like Medstar are working with tech vendors to react to the billions being spent by venture capitalists to create denovo virtual first health services–Matthew Holt

How to Talk to Clinicians: Forget Workflows, Just Tell Us How Things Work

Feb 28, 2022

BY HANS DUVEFELT

Workflows are all the rage with EMR people. But doctors, NPs and PAs are smart. Nothing burns us out as fast or as completely as being told how to do things instead of why. We are not circus animals.

Let me explain:

If we had no professional education at all, we would have clinical workflows memorized instead of clinical knowledge. For example, two weeks after starting an ACE inhibitor like lisinopril, order a basic metabolic profile. That sounds pretty straightforward, but if you add up all the possible clinical workflows we would need if we didn’t know medicine at all, that would be a huge burden – a massive amount of seemingly random and senseless rules.

Pithiatism Redux

Feb 25, 2022

BY MARTIN SAMUELS

Those of us in medicine have all seen the famous painting of the Tuesday afternoon lessons at the Salpȇtrière in Paris in the 19^th century. In Pierre Aristide André Brouillet’s painting, one can clearly see the great professor, Jean-Martin Charcot, holding forth while the patient, Blanche Whitman, is being supported by a tall young man, Joseph Jules Francois Felix Babinski, the Chef de Clinique (the chief resident) and allegedly the favorite to succeed Charcot. He never did as he was failed repeatedly on the exam necessary to become a faculty member at the university by a jealous, xenophobic, anti-immigrant rival, Charles Bouchard. Babinski was born in France and served in the army twice, but his name was Polish as his parents had emigrated to France to escape bias in Poland (sound familiar?). Ironically almost no one remembers Bouchard (his only contribution being the Charcot-Bouchard aneurysm which may be the cause of some intracerebral hemorrhages), but there is no doctor on earth who does not know Babinski’s name. This is one of many reasons why Babinski is my neurological hero.