All posts by David White

Digital Health, Healthcare, Healthcare Reform

Fortnightly Healthtech Update #23

It’ll be interesting to see Startup Health’s next analysis of where the VC money went in Q2. My guess would be telehealth: Carbon Health lands $23m for a partly virtual offering.

As if enough opioids weren’t prescribed already, Practice Fusion got busted for taking payments from a pharmaceutical company to build a pain alert tool to encourage physicians to provide more. 

Atul Gawande is no longer CEO of Amazon-JP Morgan-Berkshire Hathaway health startup Haven. If any kind of sea change happens in the US healthcare industry – and we need it to – it’s going to come from outsiders. But I’m not discouraged by this change. Is being CEO of this venture the best contribution Atual Gawande can make to changing healthcare? Probably not, because being CEO is about far more than having a vision and a medical background. 

More consumer tech pressed into COVID-19 monitoring: Mount Sinai deploys Google Nest cameras for remote monitoring. The bad boys of big tech are helping in other ways too, with Amazon involved in multiple COVID-19 related projects.

While the cost of care keeps going up, the lack of competition means hospitals can keep passing on the cost of their inefficiency: 88% of the days first surgery is delayed. I’m guessing if most of the first surgeries are delayed, so are all the others that day. Because if OR’s aren’t running at a high utilization, then we have another problem all together.

I mentioned Tissue Analytics a couple of issues ago. It just got swallowed by a specialist EHR vendor Net Health. That’s OK, but Net Health is owned by private equity groups. I’m not thrilled about private equity getting involved in healthcare. Lack of transparency is a big problem driving healthcare costs higher. Private equity just adds another layer of obscurity since their financials aren’t public at all. Bloomberg has a nice piece that digs deeper into some of the consequences of PE’s move into the healthcare industry. Where there’s a fat margin to be found, private equity goes. If anything, private equities’ growing presence in the healthcare industry is a sure sign that the healthcare industry is more divorced than ever from the practice of medicine.

In a COVID-19 related development, Banner Health introduces virtual waiting rooms and chatbots to its appointment check-in process. Which is great, but I have to wonder: If the healthcare industry was as competitive as it could be, innovations like this might have happened long ago, purely as a way to gain a competitive business advantage.

As the pandemic makes temperature monitoring desirable, so vital sign monitoring companies are looking to fill that hole in their solutions where necessary: Current Health partners with VivaLNK to do just that.

BreatheVision is about to start a trial of its respiration rate monitoring device at the Sourasky Medical Center’s Ichilov Hospital.

Pakistan brings female doctors who are out of the workforce back into action for remote monitoring.

A possible biosensor from A&M University to help gout sufferers.

VitalConnect gets to work with BARDA (the Biomedical Advanced Research and Development Authority) on a COVID-19 monitoring solution.

As the pandemic forces changes to healthcare access, so the spotlight has returned once again to the lack of interoperability restricting access to patient data. It’s been a basic competitive strategy of the software industry forever. If you’re already the dominant player, the best way to retain and grow your customer base is to make it hard for customers to migrate to a competitor’s system. That includes locking up the data. That works until somebody else big has a more open approach and can change that. Like Apple. Because Apple’s growth path is to expand the number of consumers using its devices. The growth path for EHR vendors is to expand the number of hospital systems usings their software. Patients aren’t even in the equation. For Apple, letting customers carry their medical records around on their phone grows customer loyalty. For dominant EHR vendors, open access to data is not in their best interests…

Digital Health, Healthcare, Healthcare Reform

Fortnightly Healthtech Update #22

Really not sure how I feel about this, Primary care needs a new operating system. Especially when the article is written by a venture capitalist…? OK, I do know how I feel about it. It’s not the number of billing codes that’s the problem. Maybe the fact that there are billing codes at all for primary care is the problem. Just focus on delivering preventative care at a fixed rate, problem solved. Whether it’s direct primary care, some form of capitation etc. is less important. A bit like the model proposed by the Pacific Business Group on Health.

After years of desperately slow adoption of telehealth, now the barriers are really dropping. To move things along, CMS agreed early in the pandemic to expand reimburse for virtual visits. Now, some providers are pushing for audio-only visits to be added into the mix. I think we used to call those telephone calls.

New to me, Stasis is providing COVID-19 remote monitoring in India.

Pivots everywhere you look, Chicago’s Neopenda is trying crowdsourcing to help pivot to the US market from the initial target of Africa.

Also new, a collaboration in Belgium makes a play for COVID-19 remote monitoring. In my experience, 6-sided collaborations rarely end well. Just too many cooks. I hope to be proved wrong in this case…

Not much of a looker perhaps, but LifeSignals receives the CE mark for its wireless vital signs monitoring wearable.

Tech experts: Widespread adoption of telemedicine, remote monitoring ‘here to stay’. No not really, not in the US at least. In Western Europe and other places where the aim is decent healthcare at the lowest possible cost, sure. In the US, technology adoption in medicine is decided mostly by lobbyists, lawyers, and accountants haggling over reimbursement policies. People who practice medicine are a poor second sadly. So unless the COVID-19 related temporary telehealth reimbursement policies (see above) are made permanent, telehealth will fade again just as quickly as it blossomed. Despite strong use cases like this, checking in with seniors at home.

More nimbleness from the federal government, flexing Medicare reimbursement rules as hospitals reconfigure to provide more capacity to counter the pandemic. Perhaps more renowned for rapidly adapting to a crisis, the US air force is adapting a monitoring solution used in the field for COVID-19. While on that thread, the DoD is working with PhysIQ for similar reasons.

Hackathon at Cornell gives birth to a smart facemask that also monitors vitals.

A bit of a change in direction/maturing of strategy for AliveCor. Originally marketed as a direct-to-consumer ECG device, the company has also gained traction with healthcare professionals. Notably in the UK, where lifetime cost of care from cradle to grave is a driver. Now, AliveCor partners with Medable for home use with clinical trials.

Also on heart health, I remember seeing this as a research project a couple of years ago, nice to see it getting funded. Bemis Manufacturing leads investment round in NY startup’s in-home cardiac testing device. The beauty of this is the monitoring is unobtrusive – and pretty much unavoidable, so helping with patient compliance. With sensors built into the toilet seat, you’re pretty much guaranteed to get a measurement once a day.

For a longer read, the redoubtable McKinsey maps out the journey for healthcare providers through COVID-19 and beyond.

Digital Health, Healthcare, Value Based Care

Fortnightly Healthtech Update #21

The state of Illinois partners with OSF and Southern Illinois School of Medicine team up to monitor some COVID-19 patients at home. But before you get too excited, it’s pretty low tech.

While COVID-19 obviously makes some healthcare providers overburdened, some might struggle to survive: Almost half of primary care practices may have to close in a month due to lack of patients/revenue. Which could allow cash buyers to pick up the assets at fire sale prices, and that often drives up costs for consumers. On the other hand, here’s a viewpoint that it might ultimately send primary care docs down the direct primary care/concierge medicine path instead. For more on that, keep scrolling…

Good to see the federal government can still move apace when it feels the need: The FCC funds 6 hospital telehealth programs within days of application. 

Is consumer health tech more trouble than it’s worth? A high false alarm rate and lack of robust connectivity is a problem for Owlet. Being open that your device is not a medical device doesn’t matter. It might get you off the hook legally, but new parents who can splash $300 for a monitoring device are going to have high expectations. Being accurate/connected *only* most of  the time isn’t going to cut it.

Binah.ai’s solution for measuring vital signs automatically via camera is being trialed in Montreal.

Necessity is the mother of invention: Mount Sinai in New York adapts an existing stroke solution for remote monitoring of COVID-19 patients. Also adapting existing solutions to the pandemic, the eCart algorithm for early detection of patient deterioration is being fine-tuned.

Sensium gets a COVID-19 bump monitoring quarantined travellers arriving through Heathrow airport.

Could coronavirus derail the decades-long shift to value-based care? Could it derail it…? No “could” about it, it’s nailed on that it will. Coronavirus has already derailed absolutely everything else about “normal” that I can think of, so it’s pretty much guaranteed. Exhibit A: CMS is delaying the new payment model for ET3. There’s no doubt in my mind that we’re entering a new era for US healthcare. We’re a nation where so much of healthcare spend is via employer-subsidized insurance. And suddenly so many people have lost that benefit – and their income – however much we might whine about the cost of healthcare ordinarily. And everyone downstream of that cozy employer-employee relationship is going to lose healthcare revenue too – insurers, big pharma, PBMs, providers – everyone. Something is going to change. It’s a period of destruction, but will it be creative destruction? Maybe this will be a pivotal moment for direct primary care.  Similar thoughts here.

A sharp idea straight out of the University of Washington, using machine learning to distinguish a genuine cough from noise.

Digital health funding broke all records in Q1, according to Rock Health. It’s going to be really interesting to see how much the pandemic affects the rest of the year. I expect funding will drop overall, but anything that supports healthcare-remote-anything might find itself caught up in a funding boom.

Researchers in The Netherlands determine that AliveCor may be just as effective for managing blood pressure remotely as in-the-flesh visits to a clinic. Which leads us neatly into….

A couple of developments coming out of MIT. I think this is a development of a project I first saw maybe three years ago, using wireless signals to measure vital signs for COVID-19 patients at home. And further out still, embedding sensors into clothing to measure vitals continuously.

Is AI really better than physicians at diagnosis? I have two thoughts on that. First, AI’s diagnostic skills are still improving at a much faster rate than human docs. Second, AI is – or will be – cheaper. And that, in countries that have a strong focus on total cost of care, is going to be what drives adoption.

The long read: The history of telemedicine, how it came to be, how it promised to break down socio-economic barriers, and how it seems destined to be a tool for the wealthy. Really, it’s a good read, my description doesn’t do it justice. If nothing else, it highlights the tension between those that see the practice of medicine as a public good, and those that see it more as an opportunity for profit.

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Fortnightly Healthtech Update #20

I’ve tried to keep Corona-virus free in the last couple of issues. That’s pretty much impossible at this point. However, the good news – if there is any right now – is that some wearables are actually starting to be used to help fight the pandemic. Not just optimistic press releases, but actual usage. So let’s learn about that.

Providence – first in the eye of the storm in Seattle – are using Xealth to help deliver remote patient monitoring. 

The ever inventive Israeli’s are adapting a couple of monitoring systems I’ve not come across before for remote monitoring. EchoCare Technologies uses radar to detect falls in seniors primarily, but also measures respiration rate. Neteera uses a similar idea, but seems to capture a broader range of vital signs.

Also from Israel, Nuvo Group gets the nod from the FDA for its remote pregnancy monitoring for both baby and mom.

Unlikely saviors for desperate times, Alphabet’s Verily has helped to roll out COVID-19 testing in California.

Meanwhile, the Aussie’s have developed a biosensor for real-time tumor tracking. Details on how it works here.

New to me, Tissue Analytics, uses a phone app and machine learning to provide remote clinicians with highly detailed insights into wounds.

I’m shocked by this survey result: 91% of American’s want healthcare price transparency. Did the other 9% not understand the question? Why would anybody not want to know the price of care before treatment…? The answer, most likely, because they have a healthcare plan that costs them little or nothing beyond their monthly premium..

It’s been widely suggested that treating patients in their home would reduce the cost of care, versus a hospital visit. Intuitive really, but still needs to be proven out. Brigham and Women’s in Boston has done that to some extent. Less than 100 patients total, but demonstrating 38% lower cost per episode of care.

Plenty of discussion about the almost complete inability to do contact tracing in the US for COVID-19. Not helped by the fact that in many ways the US acts like a collection of 50 smaller countries – not unlike the dreaded EU! Not to mention the complete lack of integrated health records. But, there is at least now an outline of a policy to tackle that. Policy papers may be irrelevant at this point though, as Apple and Alphabet have announced that they will work together to enable contact tracing. But still plenty of unanswered questions about that project.

Remote monitoring in more than one sense, Biovotion has a COVID-19 related remote monitoring project in remote Australia, Murrumbidgee Local Health District to be exact. Not to be outdone, Caretaker Medical is also setting up for remote monitoring of vitals with Australia’s first virtual hospital. 

Masimo SafetyNet has also been extended to remote-monitoring in the home for suspected COVID cases by St Lukes in Pennsylvania.

CMS requires providers to be compliant with a bundled care protocol called SEP-1. However, there now seems to be evidence that not all elements of the bundle are necessary. Dig deeper though, and it seems SEP-1 might not be based on clinical evidence at all.

Possibly the most classless press release of recent days: MindCotine scores US$230,000 just in time to get at-risk smokers to quit before Covid gets them. Maybe the team at MindCotine just needed to invest a little more of that $230,000 in a better translator, hard to say.

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Fortnightly Healthtech Update #19

One small step on the road to reasonable med prices, Illinois caps the price of insulin.

There’s a lot of ongoing speculation that the Coronavirus pandemic might finally bring us into the telemedicine era. The FDA has lifted some restrictions on remote monitoring. It’s also temporarily blessed non-HIPAA compliant audio and video. And practicing across state borders. But it’s going to take more than that to make the change stick. It’s going to take alignment of reimbursement rates, as this tweet shows. Certainly as the stock market craters, investors are excited about companies like Teledoc. A bigger opinion piece by Forbes here.

Some wearables are certainly getting a kick in adoption, with the Oura Ring being used to monitor the health of caregivers in a couple of San Francisco hospitals.As far as I can tell, this is a wellness device, not a medical device (ie. not FDA approved). Which probably explains why it’s on caregivers, not patients. That said, the FDA has also relaxed the regs on ventilators manufacturing. Which is fine. If the only choice you have is a possibly iffy vent, or no vent at all, which would you pick? Expect the FDA to relax plenty more rules over the next 12 months. The more interesting thing is how many those changes will stick when we make it through to the other side.

While many industries are looking for the federal government to bail them out as their revenue plummets, ACO’s are looking for help as their costs threaten to explode. Personally, I’m just as interested in seeing what help there will be for families who face bankruptcy because their healthcare insurance cover is so meager.

In news that is probably not COVID-19 related, patient monitoring company Masimo is set to acquire a ventilator company, TNI Medical. As the press release states there is no material impact for 2020, it looks like a longer term play. Masimo’s core business is measuring and monitoring patient oxygenation. Acquiring a product for ventilation is perhaps a move to close the loop between monitoring and therapeutic delivery and deliver a more complete solution.

On that note, I’ve highlighted a lack of continuous patient monitoring as an issue in Cleveland before. Therefore good to see further studies and adoption of solutions to address this need. First, Masimo reports zero deaths or injuries from opioid induced respiratory depression from a 10 year study. In the much smaller control group, sadly 3 deaths occurred. Second, Children’s Hospital of Georgia signs up for Philips’ IntelliVue Guardian to measure early warning scores more reliably, and so improve intervention when needed.

Alphabet’s DeepMind throws its weight behind COVID-19 protein structure folding. Protein folding using spare cycles from home computers has been a thing for over 10 years. That means you can do your bit to tackle COVID-19 and other diseases, sign up here.

Population health is an under-rated discipline – especially in the US where the payer/provider landscape is so fragmented. That may change with the current pandemic, aided by the increased use of consumer wearables. Researchers at Scripps have kicked off a project to do just that. 

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Fortnightly Healthtech Update #18

This might just be the only COVID-19-free healthcare email you read this week. I wanted to keep it that way, providing a veritable oasis of calm. But that does make it a smidge shorter than usual….Personally, I am very interested to see how this pandemic might change the delivery of medicine. We’re still mostly dependent on in-person visits in the US. But that’s more about how providers get paid than it is about a lack of technology alternatives I suspect.

Phone camera based vital sign measurement from Binah.ai now offered with Burnalong, a fitness app. I’m hoping this isn’t the be all and end all for Binah.ai. Most likely there’s a professional medical application lurking in here too. But working with the consumer market should give the company quick access to lots of data. And that data can be used to refine the underlying AI models to improve accuracy and accelerate product development.

US researchers working on a smart bandage to both monitor the patient and promote healing.

Somatix has an interesting approach to monitoring the elderly as unobtrusively as possible. It uses gestures and hand movements to look for signs of impending trouble. I don’t quite understand why it positions itself as an AI company and not a medtech company, but it does.

I once had a physical therapist friend tell me that women’s pelvic health was a massively under-diagnosed issue. So it’s good to see VaGenie is the winner of Boston Scientific’s Connected Health Challenge.

BioBeat gets CE mark for its wearables that measure blood pressure, cardiac output, stroke volume, oxygenation, and heart rate. This in addition to the FDA clearance granted last year for some parameters. What’s particularly noteworthy is the ability to measure blood pressure off the chest, as well as the wrist.

Lyft simultaneously finds recurring revenue and helps with the social determinants of health. This deal backs onto an existing 3 years deal. It’s great that people are being creative about solving the transportation issue for patients who need it. And presumably, in an accountable care world, providers will actually pay the $20 for the ride if they are going to save thousands in downstream healthcare costs.

A Philips survey reports that 35% of young doctors are overwhelmed by patient data, or aren’t sure how to use analytics. Sounds like we need to re-think physician education.

Researchers find that 3D printing could lead to a better type of silicone wearable.

Some are excited that the federal government has published interoperability rules that *might* allow patients better access to their data. Others are concerned that said rule is a hefty 1,244 pages long.

OK, so I didn’t quite live up to my promise, but it’s a great story that points to the future: Italian hospital 3D prints values it needed for the ICU.

Digital Health, Healthcare, Healthcare Reform, Medtech, Value Based Care

Fortnightly Healthtech Update #17

Lengthy article on the evolution of mobile phones for digital phenotyping (ie. continual data collection of the individual). 

CareSignal (formerly Epharmix) gets funding from customers and others for remote patient monitoring. The beauty is, it’s a relatively low-tech solution that can be used by many diverse patient populations with different conditions. See studies on COPD, diabetes, and mental health. Often, simple really is better.

The direct primary care model continues to evolve with Clove Health claiming to be the first legally incorporated as a public benefit corporation getting to work in Florida. More on that style  of incorporation here. Citizen Health is heading down a similar path.

I touched on the ongoing battle over patient access to their own data. Apparently the federal government has started hitting providers with fines if they make it difficult for patients to get their data.

From Imperial College London, using sound to detect vital signs allows a device to penetrate layers of clothing.

Medicare builds on the mixed success of ACOs to create the Direct Contracting model for the next stage of value based care. There’s also the Primary Care First model, now due sometime next year. Also, a fresh study of Medicare ACOs finds that much of the cost variation comes from the use of out-of-network primary care docs.

More Medicare, the CJR program was controversially introduced as a hip and knee replacement bundle a few years ago. Controversially because it was a mandatory bundle introduced because providers didn’t sign up for the similar voluntary program with sufficient enthusiasm. Now CMS wants to extend it for another 3 years, and add in outpatient settings too. Which makes sense because it will drive the cost down, all other things being equal.

A new design to make better, cheaper biosensors for fluid analysis. Quite honestly, it works in ways I don’t fully comprehend, but hopefully it means something to some of you…

More healthcare reform, CMS picks 205 EMS services for the experimental ET3 model. The intent of ET3 is mostly to help people with chronic conditions get treated in their homes, avoiding the personal discomfort and stress of perpetual trips to the ED. It also should save Medicare money on avoidable ED visits too. To do that, ET3 allows EMS to get reimbursed for other services, not just transport. This potentially opens up another route to market for medtech vendors in applications like remote patient monitoring.

Wearables and machine learning start to show real promise: PhysIQ and VitalConnect study shows promise for predicting hospitalizations for heart failure patients. We’re already seeing machine learning breaking into imaging. I think continuous patient monitoring also has real potential. There’s a big need to determine baseline vital signs for individual patients, rather than just using generic values. I think machine learning might have the potential to usher in more adaptive algorithms that can help to reduce the long-running over alarming problem.

Apple leans hard into atrial fibrillation. A new collaboration with J&J makes the Apple Watch available for $49 to seniors who take part in a study. This could be a win for everybody: Seniors who avoid a potential stroke through the early detection of afib, cardiologists who get more business, and obviously Apple. Presumably J&J has some meds for managing afib in its portfolio too. And Medicare could win, since stroke care is reckoned to cost $40bn a year.

Sepsis has been a silent killer for a long time. A new study finds a stunning growth of 40% among Medicare beneficiaries who were hospitalized. Digging deeper into the economics, the same study finds the total cost of treating sepsis to be much higher than previously thought – over $23bn for inpatient care alone.

At the other end of the age scale, Children’s Hospital of Philadelphia has developed a new algorithm for detecting pediatric sepsis.

A new potential tool in the opioid crisis, a wearable to detect opioid induced respiratory depression (OIRD) in the community. Developed by Altair Medical in Scotland, I’m interested to see how this develops and works in practice. There are definitely challenges in current opioid addiction treatment that this could address. (For podcast fans, Freakonomics has a good two-parter on the crisis and current approaches). Also, equal parts tragic, genius, and sheer practicality, a number of communities are training kids to administer Narcan. Note, OIRD is still a major problem for post-surgical patients too, where hopefully the patients location and time to rescue are more predictable, so potentially more effective overall.

Simple early warning scoring is still an undervalued (and under adopted) practice for catching patient deterioration early. One hospital system in the UK dropped cardiac arrests by 75% by capturing vitals at the bedside with iPads and calculating the early warning score automatically. 

An unfortunate reminder that technology alone can’t change anything: WellSpan Health York Hospital gets cited for failure to respond to a patient in distress. It seems even thought the patients falling heart rate and oxygenation levels were noted for at least 20 minutes, nursing staff failed to intervene.

Digital Health, Healthcare, Healthcare Reform, Value Based Care

Fortnightly Healthtech Update #16

Walmart moves into radiology, opening a clinic in Calhoun Georgia with x-ray facilities. Which is a nice lead in to will big retail disrupt healthcare more than big tech?

Profusa’s Lumee tiny oxygen sensor gains a CE mark. Intended for conditions such as peripheral artery disease, the device operates for 28 days, clinical study here.

Apple highlights it’s healthcare presence in its earnings release, claiming 100% of F500 companies in the healthcare sector use Apple. Which sounds impressive, but when you think about it, that’s a small number. You might even be able to count those companies on the fingers of one hand. 

Medicare’s bundled payment isn’t perfect, it rewards doctor’s who take lower risk patients. Really would be nice if it worked the other way around perhaps.

The legal fight over price transparency continues. Meaningful transparent hospital pricing would lead to meaningful competition among hospitals. Competition among hospitals would lead to lower prices. Hence, the AHA is obliged to fight it on behalf of its members. But the American Academy of Family Physicians is not.

On the theme of overpaying, Medicare paid $7.8bn for insulin. If it paid the same prices as another federal government department (the VA) it would only have paid $3.4bn. That is just one of many examples of Medicare overpaying because of a lack of political will.

Verily partners up with Santen for vague eye are projects.

Continuous vital sign monitoring in hospitals is becoming a thing at glacial pace. (See Isansys in the last post). This study compares the performance of devices from EarlySense, Sensium, VitalConnect, and Masimo. In summary, all are accurate for heart rate, some better than others for respiratory rate.

The lack of continuous monitoring still hits the broader headlines occasionally. In this case,  Cleveland area hospitals are highlighted for their tardy adoption following the tragic loss of a patient in 2016. 

Also continuous monitoring, continuous monitoring of urine for the early detection of kidney problems from Serenno Medical.

Virta Health – treating diabetes the old school way with diet – has been running a pilot with the VA for a year.

Scientists in Korea have developed a biosensor test for the early detection of Alzheimer’s.

An opinion piece from a Professor at Stanford University School of Medicine, outlining how a simple market segmentation would improve healthcare delivery. In practice, I think market forces are already doing this to some extent. The reasonably wealthy/reasonably healthy are starting to adopt concierge medicine, or direct primary care. But, I can’t figure out how direct primary care is going to work for the chronically ill. The direct primary care model often touts unlimited primary care access as a benefit. But, unlimited access to a primary care doc is just like having unlimited paid time off. It only works if you don’t take the “unlimited” literally. And that won’t apply to many chronically ill people with multiple comorbidities of course. And if that mild criticism wasn’t enough for you, Molly Osberg well and truly shreds direct primary care – the comments are definitely worth a read too.

Oh, and Iora Health, one of the pioneers for direct primary care, just closed $126m in funding.

Apple finds itself squaring up to Epic and assorted hospitals in the fight to allow patients to easily access and share their healthcare data. Epic and friends voice concerns about patient privacy. But, dig deeper. Allowing Apple access to health records is a long-term threat to Epic’s dominant position in the EMR business. And, as noted above (on price transparency), hospitals aren’t keen on competition either. Preventing people from easily moving their data from one provider to another is just one more way to lock in a patient’s revenue stream. Which is really unfortunate. Because, if consumers had better access to quality data, better access to pricing, and could easily move their health records from one provider to another, hospitals that delivered greater value to consumers would ultimately thrive. And those that did not would either raise their game or wither and die. Everybody wins – except sucky hospitals.

Also in the EMR connectivity game, Innovaccer raises $70m to create longitudinal patient records to support the transition to value-based care. I imagine it will find “patient privacy concerns” to be a challenge too. 

Caretaker Medical of finger-cuff blood pressure fame, adds ECG via a partnership with VivaLNK. Ditto VitalConnect, partnering with CorVitals to add arrhythmia detection.

Researchers in New South Wales come up with a superior algorithm for early detection of sepsis.

Machine learning is steadily making inroads into the diagnostic space. PhysIQ adds a patent to estimate cardiopulmonary function from wearables.

Challenging assumptions or a little Christmas humor…Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial.

Digital Health, Healthcare, Healthcare Reform, Value Based Care

Fortnightly Healthtech Update #15

An industry analysts pretty jaded view of the state of innovation and meaningful change in healthcare from the JP Morgan Healthcare Conference.

Isansys claims a small deployment down under as the world’s first hospital-wide wireless monitoring install. If you know a better claim to first, please let me know….

The internet of insecure things…..GE has a problem with the security of its patient monitors.

Hips and knees are falling out of favor with participants in Medicare’s bundled payment program. Two reasons are given. First, providers have wrung all the excess cost out of the bundle – primarily by cutting skilled nursing for rehab. Second, the shift to outpatient surgical centers might increase the risk. As noted in the last fortnightly, this saving has been achieved without a drop in quality. Good news is, providers are moving onto more complex bundles. Let’s hope they don’t lose their shirts.

For a well-sourced read on – well, just about everything wrong with US healthcare – thank the American College of Physicians. One of the observations is that an eye-watering 31% of US healthcare spending goes on admin. A number that is so high in my view because of the massive fragmentation of both providers and payers. That complexity just needs so many administrators to coordinate everything – and often still dropping the ball in my personal experience. How can we cut that admin overhead that we all pay…? One way is single payer (aka Medicare For All). Another might be direct primary care with healthcare cost sharing ministries.

More on what the US could learn about universal healthcare from other countries here.

And One Medical, a direct primary care startup, has filed for an IPO. Direct primary care for the price of a latte a week…

And yet more on new primary care models here.

The personal health wearables business has another casualty with UnderArmour dropping out.

Plenty of players (eg. Isansys above), but precious little adoption: VivaLNK elbows its way into the wireless vital sign monitoring market.

As does BioIntelliSense, with FDA clearance for a 30 day patch to monitor vitals in the home. The home use and 30 day life position the BioIntelliSense BioSticker squarely in the “readmission prevention” market, so it should appeal to many hospitals. Not clear to me if the device is semi-reusable, but that would help to keep the unit costs down if that’s true. Most interestingly, the company is pursuing a subscription model, with sensors provided free to providers.

Evidence that Medicare is overpaying docs for post-surgical follow-up that never happens. On the face of it, this could be an argument against bundled payments. But it’s not. Bundled payments pay for outcomes. If a doc decides they can achieve a perfect outcome without burdening the patient with unnecessary follow-up visits, good luck to them. Let them keep the extra, because the total price of that bundle should be cut by a fraction each year to encourage innovation in clinical practice.

McKinsey has a piece on what hospital care will look like in 2030. It’s mostly a rosy picture for patients – mhealth apps that avoid hospital visits altogether, online appointment booking, no waiting rooms (just-in-time visits), walls that change color to reflect or enhance a mood etc. It’s all good – but overlooks the obvious question. Why would our healthcare industry pay for any of that when they don’t get reimbursed for it in turn? And hospital visits aren’t going to dry up anytime soon while the American Hospital Association spends $26m a year on lobbying. Unless we push really hard on the ACO model and make sure value-based care fulfills its promise. Better outcomes at lower cost.

Tangential I know, but US life expectancy actually increased for the first time in four years. But only by a month. Lower death rates from cancer and opioid overdoses are the reason.

Alphabet’s Verily playing catchup with Apple, adds FDA cleared irregular heartbeat capability. Although Verily is more focused on clinical trials than Apple is on the face of it.

Allegheny Health Network reports both good financial and clinical outcomes by adopting a faster test for sepsis that gives results in just 90 minutes. Aiming to better that, researchers in Switzerland are working on a sepsis test that can be completed in 15 minutes.

Digital Health, Healthcare, Healthcare Reform, Value Based Care

Fortnightly Healthtech Update #14

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A glasses-attaching wearable to monitor eating habits – because I’m pretty sure we all lie to our calorie counting apps at least some of the time…. 

CMS loosens up the purse strings to try digital health for moms-to-be and kids with complex needs.

Some positive results for the Medicare bundled payment experiment, lower costs for hip and knee replacements with no loss of quality. The study doesn’t see any change with other bundles though (there are 48 possible bundles in total). That doesn’t surprise me – and it’s not necessarily a bad thing. By far the most popular bundle with hospitals was hips and knees. Basically, it was a very low risk way to get into the bundled payment game – a relatively simple, repeatable procedure. So, the reason why we’re not seeing savings with other bundles yet could just be a lack of volume for providers to learn from.

Not an option for those that sleep in the buff, smart pajamas for monitoring vitals and sleep patterns.

Boston/Paris based Cardiologs picks up $15m in funding for its afib diagnostics algorithm. Abstract for a clinical study here.

Ah, the tensions of the journey to value-based care….BCBSMN tries to steer patients to out-patient clinics for lower cost care. Hospitals that stand to lose out, sue.

Why aren’t patients electronically accessing their medical records? Because – IMO – there’s rarely anything to be gained by doing so….I can go to my docs portal, I can login, I can see my data, and then…so what, there’s nothing useful to do with it.

VC’s clearly think bundled payments are here to stay, sinking an extra $27m into Aver. They might be right, unless we all go down the ACO path instead. Or just pull the plug on value-based care.

More potential lawsuit woes for Apple, being sued for patent infringement by Masimo. The basis seems to be that instead of licensing the technology, Apple hired key people away. Quite a nifty strategy if you can pull it off actually.

Is digital health failing before it’s even really got started…? Maybe. The good news is a Stanford Medicine survey finds that the vast majority of docs see value in self-reported health data. The bad news…a third are looking for help on how to use AI. So that’s a big fail right there.  Docs really shouldn’t need to know how the algorithm works, unless they want to get into research.

Israel-based Clew raises a B funding round for it’s AI-based platform for predicting patient deterioration. 

Can AI reverse the ‘unsustainable’ trajectory of spine care? In a word, no. Because spine surgery rarely brings much benefit.

Interesting use of Fitbit’s to track the spread of flu.

Payers and providers are squaring up to each other on how to address surprise bills. I’m honestly not confident this will help. The problem isn’t surprise medical bills. The problem is just medical bills. I’m mindful of this case from a couple of years back, where a woman begs people not to call an ambulance because she couldn’t afford it.

Rock Health reports that digital health funding dropped a little to $7.4bn in 2019, Still the second highest funding year on record though.

Masimo to acquire some assets from NantHealth, basically a device integration play. 

The Camden Coalition has previously been seen as a great success in addressing the high cost of high utilizers. Unfortunately, that no longer seems to be true.

Enrollment in Medicare’s MSSP program is stalling as CMS tries to get ACO’s to take on actual financial risk earlier. Meanwhile, it’s reported that one of Medicare’s other ACO programs (Next Generation) saved Medicare $184m in 2018. That’s good, but bear in mind the total budget for CMS is $1.2tn….