Ava Science is a FemTech company best-known for their fertility-predicting wearable device that collects biometric data from a woman’s wrist in order to track ovulation. The device predicts fertility with 89% accuracy (according to published clinical trial data) and is among one of the most well-funded FemTech startups out there, having raised a cumulative $47M. So what’s next? Lea von Bidder, Ava’s CEO, explains the data-driven vision for the company, which is currently one of the few medical device wearables that is approved for collecting digital biomarkers. The startup is eager to capitalize on that first-mover advantage in the women’s health space, and is looking at other ways to use their data. Lea talks through her plans for exploring a full-range of women’s health applications, from non-hormonal birth control to new products that might appeal to women during pregnancy or menopause.
Filmed at HLTH 2019 in Las Vegas, October 2019.
Jessica DaMassa is the host of the WTF Health show & stars in Health in 2 Point 00 with Matthew Holt. Get a glimpse of the future of healthcare by meeting the people who are going to change it. Find more WTF Health interviews here or check out www.wtf.health.
The post Fertility Predicting Wearable Expanding into Birth Control, Menopause | Lea Von Bidder, Ava Science appeared first on The Health Care Blog.
At kitchen tables everywhere, ordinary Americans have been grappling with the arcane language of deductibles and co-pays as they’ve struggled to select a health insurance plan during “open enrollment” season.
Unfortunately, critical information that could literally spell the difference between life and death is conspicuously absent from the glossy brochures and eye-catching websites.
Which plan will arrange a consultation with top-tier oncologists if I’m diagnosed with a complex cancer? Which might alert my doctor that I urgently need heart bypass surgery? And which plan will tell me important information such as doctor-specific breast cancer screening rates?
According to Matt Eyles, president and chief executive officer of America’s Health Insurance Plans (AHIP), insurers over the last decade have made a “dramatic shift” to focus more on consumers. That shift, however, has yet to include giving members the kind of detailed information available to corporate human resources managers and benefits consultants (one of my past jobs).
What’s at stake could be seen at a recent AHIP-sponsored meeting in Chicago on consumerism. Rajeev Ronaki, chief digital officer for Anthem, Inc., explained how the giant insurer is using artificial intelligence to predict a long list of medical conditions, including the need for heart bypass surgery. Information on individual patients is passed on to clinicians.
“The future of care delivery will see physicians, scientists and consumers alike empowered with the most accurate clinical information in real time,” Ronaki declared.
That may be the future, but it’s not the present for the one in eight Americans that Anthem serves today in its various plans, most affiliated with Blue Cross and Blue Shield. Anthem members have to rely on the limited information available in a new mobile app with the gender-vague name of “Sydney” that’s blandly touted as “smart” and “personal.”
As for obtaining a sophisticated cancer consult, an oncologist working with 2nd.MD, which contracts with the top 20 cancer centers in America for virtual consults, related how a man who was diagnosed with advanced cancer had a grim diagnosis offering perhaps a few months to live. But after the consultant, Dr. Charles Balch, directed him to an advanced cancer center, the man showed “an almost complete response” to immunotherapy, Balch said.
Do you know if your health plan offers that kind of service? Who would even think to ask before enrolling?
Meanwhile, as a consultant I’ve seen the detailed information about individual hospitals and doctors that’s available to some insurers. While a few plans do a good job of sharing meaningful data, most settle for limited information posted in a dusty corner of their website.
Given health insurers’ negative image – in one national poll, just 16 percent of respondents believed insurers put people over profits –why don’t health plans highlight these kinds of valuable services? Here’s where consumerism confronts unpleasant realities.
Take cancer consults. While a world-class second opinion may save money in the long run, if everyone who thinks they’re a cancer risk joins your plan, that “adverse selection” among the enrolled population could boost medical expenses.
When it comes to publicizing the use of algorithms to predict illness, the adverse selection problem is complicated by the additional issue of public trust. Even though early intervention can save money, will members believe that a company that gained national notoriety for denying claims for emergency room visits – as Anthem did – has their best interests at heart when it comes to their heart? Other plans have similar trust issues.
And speaking of trust, can members trust that their health plan will risk the ire of doctors and hospitals by publicizing usable data showing that some perform much better than others?
The way to overcome these issues, I believe, is for powerful national employer groups such as the Federal Employees Health Benefit Program to demand detailed disclosures by health plans to consumers. That puts all plans on an equal footing. Plans should answer carefully defined questions in three areas: What will you do to keep me well? What information will you give me about doctors and hospitals? And what resources do you offer in case of serious illness?
It’s important that insurers’ pay members’ bills without bogus bureaucratic barriers. But it’s even more important to give prospective plan members full and complete information about services that might one day save their life.
Michael L. Millenson is president of Health Quality Advisors LLC and adjunct associate professor of medicine at Northwestern University Feinberg School of Medicine. This article originally appeared on Forbes here.
The post Will Your Health Plan Tell You That It Can Save Your Life? appeared first on The Health Care Blog.
I find myself thinking about how being a doctor has come to impact the Christmas Holiday for me over the years. I have written about working late and driving home in the snow and dark of Christmas Eve in northern Maine; I have shuffled Osler’s written words into something that speaks to physicians of our times; I have written about the angst around the Holidays I see in my addiction recovery patients.
This year, my thoughts go to the way Christmas is a time of reconnection for many people. We reconnect with family and friends we may not see as often as we would like, and many of us reconnect with secular traditions dating back to our childhood. Many people also reconnect more deeply with their Christian traditions, the ancient celebration of Hanukkah or the newer one of Kwanzaa.
As a doctor, I think Christmas is a time when individuals are more open toward others, more willing to extend “good will toward men” (Luke 2:14). It can be an opener for future relationships to form or grow, a time to share our humanity in the context of experiencing something larger than ourselves and our everyday existence. It allows us to get a little more personal by sharing something of what we all have in common – the need for togetherness with those we love.
Many people in this country routinely say things like, “have a good weekend”. I’m not sure that is such a universal high point in life. For some, it is a time for dreaded chores, for others a time to muster enough energy for that second job to help pay the bills.
Christmas is a more universal time of feeling celebratory and unselfish, and for me it marks the passage of time as well as the consistency of it. It was my time of awe and delight when I was a child, and now it is that for my grandchildren. As Christmas week culminates in the New Year celebration, it also helps me think about what’s next – for me and everyone in my family.
During the coming weeks, I will make sure to share some of the joy and peace I feel in my own heart with my patients and I will be more than usually sensitive to signals of holiday blues or distress in them.
This is not a time to flaunt what we have – lavish presents, successful relatives, gourmet food, fancy decorations or invitations to fun parties. It is a time to share some simple human warmth in the darkness and bitter cold of the northern Maine winter in a time of divisiveness, strife and unrest.
It is a time of “peace, good will toward men”, of greater openness to others. It is a good time for reconciliation or rekindling of relationships we may have neglected since the last time we wished each other Merry Christmas.
Hans Duvefelt is a Swedish-born rural Family Physician in Maine. This post originally appeared on his blog, A Country Doctor Writes, here.
The post Doctoring at Christmas appeared first on The Health Care Blog.
The question of how much time I spend in front of the screen has pestered me professionally and personally.
A recent topic of conversation among parents at my children’s preschool has been how much screen time my toddlers’ brain can handle. It was spurred on by a study in JAMA Pediatrics that evaluated the association between screen time and brain structure in toddlers. The study reported that those children who spent more time with electronic devices had lower measures of organization in brain pathways involved in language and reading.
As a neurologist, these findings worry me, for my children and for myself. I wonder if I’m changing the structure of my brain for the worse as a result of prolonged time spent in front of a computer completing medical documentation. I think that, without the move to electronic medical records, I might be in better stead — in more ways than one. Not only is using them potentially affecting my brain, they pose a danger to my patients, too, in that they threaten their privacy.
As any practicing physician can tell you, electronic medical records represent a Pyrrhic victory of sorts. They present a tangible benefit in that medical documentation is now legible and information from different institutions can be obtained with the click of a button — compared to the method of decades past, in which a doctor hand-wrote notes in a paper chart — but there’s also a downside.
For one, while they are supposed to maximize the efficiency of documentation, the use of auto-filling “smart” phrases and other techniques designed to save time spent writing notes make them that much more difficult to read. Bloated notes contain limited nuggets of useful information buried within reams of data, where they serve as treasure troves for data miners but as barriers to efficient communication between medical providers.
Aside from the fact that any type of screen time can potentially degrade the structure of my brain, more time spent face-to-screen and less time face-to-face with the patient drains the medical encounter of its essential humanity.
If anyone can disrupt a human connection, it’s the big tech companies. Last month Google announced a collaboration with the Ascension medical system, which operates hospitals across the country. In a blog post, Google stated that they would utilize their cloud computing and artificial intelligence expertise to develop tools that enable care providers to “more quickly and easily access relevant patient information.”
This isn’t new; the announcement followed collaborations between Google and academic medical centers such as Stanford, UCSF, and the University of Chicago.
Leveraging the large patient populations of these institutions, Google has developed technologies that with intersect with patient care in ways ranging from the automatic recognition of words spoken during conversations in the doctor’s office to developing predictive models aimed at preventing unnecessary hospitalizations.These provide enticing solutions to the current drudgery of documentation.
But I am still hesitant to celebrate them. I’m already wary of big tech companies’ using and monitoring consumers’ private data and my concerns are only heightened by the entry of these businesses into the healthcare space.
The collaboration between Google and the University of Chicago, for example, is the focus of a lawsuit claiming that personal health information was shared without the express written consent of patients. Once companies like Google enter into the healthcare space, how do we know they will abide by the rules protecting the personal health information contained in medical records and, more importantly, who would know if they didn’t?
In an age where individuals can be identified from purportedly anonymous DNA samples and imaging algorithms have been used to identify individual faces reconstructed from routine MRI scans , Google’s being adjacent to — if not outrightly inside of — my and my patients’ medical files requires more protections than the Health Insurance Portability and Accountability Act (HIPAA) currently offers.
Back in 1996 the framers of the seminal privacy law didn’t anticipate that people’s activity, financial, and search data would be stored alongside — perhaps even among — our medical diagnoses and symptoms. Questions regarding the provenance, permission, and permanence of the meta-data linking these types of information may not have even been conceived of as it would not have been thought possible that the technology would know us better than we know ourselves.
If HIPAA is insufficient to protect us, it’s probably easier to amend it than stop the steamroller that is big tech. For one, HIPAA should include explicit provisions about separating medical data from what is essentially marketing data. Google is here to make a sale. I’m here to save lives.
Efforts to approach the documentation problem at its source by have been proposed by the Center for Medicare & Medicaid Services, which will implement new requirements for clinical encounters in 2021. While these changes will make electronic medical records easier to manage, it will not make them safer from invasion. We need updated methods to protect all types of medical data and prevent the complete erosion of privacy that has already occurred with other online activities.
Andrew Dorsch, MD, is an Assistant Professor in the Department of Neurological Sciences at Rush University Medical Center in Chicago and a Public Voices Fellow with The OpEd Project.
The post The Intrusion of Big Tech into Healthcare Threatens Patients’ Rights appeared first on The Health Care Blog.
Disruption of the healthcare payment model? We’re IN! Meet Ooda Health a two-year old startup that is working to change the way healthcare is paid for by changing WHEN it’s paid for: BEFORE the patient leaves the hospital or doctor’s office. How can we possibly live in a world without EOBs? We’re dying to find out. Seth Cohen, President & Co-Founder of Ooda Health, talks about the launch of the startup’s first service, Ooda Pay, which just went live with BCBS of Arizona, Blue Shield of California, and care provider, Common Spirit Health. How did it go? We may be closer to disrupting healthcare billing (and it’s paperwork and admin expense) than we thought.
Filmed at HLTH 2019 in Las Vegas, October 2019.
Jessica DaMassa is the host of the WTF Health show & stars in Health in 2 Point 00 with Matthew Holt.
Get a glimpse of the future of healthcare by meeting the people who are going to change it. Find more WTF Health interviews here or check out www.wtf.health.
The post Getting Healthcare Providers Paid in Real-Time. FOR REAL. | Seth Cohen, Ooda Health appeared first on The Health Care Blog.
I recently took care of Rosaria[1], a cheerful 60-year-old woman who came in for chronic joint pain. She grew up in rural Mexico, but came to the US thirty years ago to work in the strawberry fields of California. After examining her, I recommended a few blood tests and x-rays as next steps. “Lo siento pero no voy a tener seguro hasta el primavera — Sorry but I won’t have insurance again until the Spring.” Rosaria, who is a seasonal farmworker, told me she only gets access to health care during the strawberry season. Her medical care will have to wait, and in the meantime, her joints continue to deteriorate.
Migrant and seasonal agricultural workers (MSAW) are people who work “temporarily or seasonally in farm fields, orchards, canneries, plant nurseries, fish/seafood packing plants, and more.”[2] MSAW are more than temporary laborers, though— they are individuals and families who have time and time again helped the US in its greatest time of need. During WWI, Congress passed the Immigration and Nationality Act of 1917[3] because of the extreme shortage of US workers. This allowed farmers to bring about 73,000 Mexican workers into the US. During WWII, the US once again called upon Mexican laborers to fill the vacancies in the US workforce under the Bracero Program in 1943. Over the 23 years the Bracero Program was in place, the US employed 4.6 million Mexican laborers. Despite the US being indebted to the Mexican laborers, who helped the economy from collapsing in the gravest of times, the US deported 400,000 Mexican immigrants and Mexican-American citizens during the Great Depression.
Image from the Bracero History Archive of braceros in California (1959).
Today, there are about who live and work throughout the US, providing crucial labor for the US economy. Unfortunately, as with other exploited minority communities, MSAW have had to withstand from the effects of structural determinants which have ultimately led to poor health outcomes. In fact, 11.4% of MSAW infants versus 8.9% of non-MSAW infants are found to have perinatal medical conditions. This means MSAW infants are almost 30x more likely to experience perinatal medical conditions.
At the forefront of these structural determinants that determine health and wellness is economic stability. The average annual income of MSAW is between $15,000 to $17,499 per person and $20,000 to $24,99 per family. Workers are not paid per hour like many temporary jobs. Instead, they are “… often paid by the bucket; in some states they earn as little as 40 cents for a bucket of tomatoes or sweet potatoes.”[4] To earn $50, farmworkers need to pick about two tons of produce.
How can we tell patients to make their health a first priority when they are doing painstaking work that does not allow them to attain enough economic stability to provide for themselves and their families?
Although their livelihoods are dependent on the cultivation of food, many farmworkers, ironically, are food insecure. The reality that 59% of Indigenous farmworkers in Ventura, CA who said they did not have enough food for their families should give us pause.
Mural created by the Salinas community depicting the impact of pesticides in children.
Another structural determinant of health is dangerous work conditions. For example, pesticide drift exposure is hazardous for MSAW and their families. The relationship between exposure to pesticides on health outcomes in agricultural communities has been the focus of the Center for the Health Assessment of Mothers and Children of Salinas study, a longitudinal cohort study run by the UC Berkeley School of Public Health.[5] The CHAMACOS found that “mothers who lived in close proximity to agricultural operations using the highest percentage of pesticides – the top 1 percent – had an 11 percent increased probability of preterm delivery and a 20 percent increased probability of having a low birthweight baby.”[6] The CHAMACOS study also found that living near farms is associated with respiratory problems in children. The youth who live in Salinas Valley’s agricultural community (a half-mile or less from pesticide application) have “…reduced lung function, more asthma-related symptoms, and higher asthma medication use…”[7] compared to unexposed children. This was found to be the direct result of organic farms using elemental sulfur to control fungal growth of crops and pests.[8]
Infographic of the MSAW health in 2017 from the NCFH.
Finally, access to healthcare is severely lacking for MSAW. . Twenty-two percent of farmworkers have an H2A visa (47% are unauthorized, 31% are US citizens)[9]Employers are not required to provide health insurance under the ACA for H2A because of their temporary status. The ACA only requires that employers let H2A recipients know of the health insurance options they can purchase themselves. California actually expanded federal Medicaid, allowing H2A workers who fall below 138% poverty level to qualify for Medicaid.
Many of these structural determinants impact MSAW patients well before they even step into the examination room. Even so, providers should assist in offering necessary care and advocacy for MSAW patients as well as make it a point to understand these structures in order to have context for conversations about care plans. Clinicians can help MSAW by supporting organizations like Farmworker Justice, Migrant Clinicians Network, and the National Center for Farmworker Health, Inc (NCFH) who work with, by, and for the MSAW community. Providers can join arms with organizations like these to advocate for migrant and seasonal agricultural workers who have been systematically oppressed by structural forces outside of their control. If we don’t, we will be jeopardizing the health of our patients, like Rosaria, whose health and livelihood are dependent on the current system that fails them.
[3] Mexico was not included in migration restrictions that the Immigration and Nationality Act of 1917 set in place for Eastern European, Southern European, and Asian immigrants.
[8] Although elemental sulfur is found in our everyday food, when inhaled, it is results in poor respiratory outcomes.
[9] An H2A Visa given by agricultural employers who anticipate a shortage of domestic workers to bring non-immigrant foreign workers to the US to perform agricultural labor or services of a temporary or seasonal nature
Internist, Pediatrician, and Associate Professor at UCSF, Dr. Le is also the co-founder of two health equity organizations, the HEAL Initiative and Arc Health.
Connie Chan and Brooke Warren are currently interns at Arc Health. Chan is an Economics and Public Health double major and graduate of UC Berkeley. Warren is a Native American Studies major and recent graduate of UC Davis.
This post originally appeared on Arc Health here.
The post A System that Fails Migrant and Seasonal Agricultural Workers appeared first on The Health Care Blog.
What separates successful digital health startups from the pack? John Sharp, Director of Thought Advisory for the Personal Connected Health Alliance (a HIMSS organization) has watched digital health ‘grow up’ over the years as an industry analyst focused on health IT, consumer health, and health tech. Want to know what it takes to win? Who does John think is poised to dominate the digital health space? (Hint: It’s a chronic condition management startup and it’s probably not the one you expect!)
Filmed at the HIMSS Health 2.0 Conference in Santa Clara, CA in September 2019.
Jessica DaMassa is the host of the WTF Health show & stars in Health in 2 Point 00 with Matthew Holt.
Get a glimpse of the future of healthcare by meeting the people who are going to change it. Find more WTF Health interviews here or check out www.wtf.health.
The post What Makes a Digital Health Startup a Winner? | John Sharp, Personal Connected Health Alliance appeared first on The Health Care Blog.
Keep your eyes peeled for OKKO Health, the startup that has created an AI-driven app game to make sure that your eyes are healthy. Founder-and-optometrist Stephanie Campbell explains how the game works to help clinicians to remotely monitor patients with eye diseases that would otherwise require frequent hospital visits to manage; think diabetic eye disease or age-related macular degeneration. Can we really look to gaming as a way for remote patient monitoring? OKKO certainly sees it that way!
Filmed at Bayer G4A Signing Day in Berlin, Germany, October 2019.
Jessica DaMassa is the host of the WTF Health show & stars in Health in 2 Point 00 with Matthew Holt. Get a glimpse of the future of healthcare by meeting the people who are going to change it. Find more WTF Health interviews here or check out www.wtf.health.
The post This Video Game App is Really Remote Monitoring for Eye Diseases | Stephanie Campbell, OKKO Health appeared first on The Health Care Blog.
The
trend toward less invasive procedures, shifting from inpatient to outpatient, has
changed the face of surgery. Industry-changing leaps in technology and surgical
techniques have allowed us to achieve our treatment goals with smaller
incisions, laparoscopy and other “closed” procedures, less bleeding, less pain,
and lower complication rates. As a result, patients who used to require days of
recovery in the hospital for many common surgeries can now recuperate in their
own homes.
Outpatient
procedures grew from about 50% to 67% of hospitals’
total surgeries between 1994 and 2016,1,2 and outpatient
volume is expected to grow another 15% by 2028,3 with advantages for
patients, surgeons, insurers, and hospitals. In my hospital, where bed space is at a premium, my colleagues and
I were able to make a significant impact by switching minimally invasive
surgery for enlarged prostate, also called benign prostatic hyperplasia (BPH),
from inpatient to outpatient.
New
Opportunity with an Advanced Technology
BPH affects
about half of men in their 50s, with the prevalence increasing with age to include
about 90% of men 80 and older.4As a result, BPH surgery makes up a significant
portion of urological procedures in any hospital.
I
have been performing BPH surgery for 11 years. There are several options,
including transurethral resection of the prostate (TURP) and suprapubic
prostatectomy, both of which require hospital stays and bladder irrigation with
a catheter due to bleeding. Another less frequently utilized surgical option for BPH is holmium
laser enucleation of the prostate (HoLEP). HoLEP causes fewer complications and
requires shorter hospitalization.5 Specifically, its postoperative
morbidity is the lowest among BPH surgeries.5,6,7 HoLEP has the
least bleeding, shortest catheter time, and low rates of urinary tract
infection, plus patients are less likely to require additional treatment for
BPH as they age compared to other available therapies.5,6,7
Last
year, my colleagues and I began using a Lumenis 120-watt holmium
laser with MOSES Technology that modulates
the laser pulse, building
on HoLEP’s advantages in a procedure called MOSES laser enucleation
of the prostate (MoLEP). Simultaneously
cutting and cauterizing in a very controlled fashion, MoLEP improves hemostasis
and significantly reduces surgical time and anesthesia use. With these
advantages and very little bleeding after surgery, we found that patients did
not need prolonged irrigation in the hospital. We began to feel comfortable with
the idea of discharging patients after MoLEP surgery – a change we knew would
make a major impact at our hospital
because BPH surgery is so common.
Making the Outpatient Change
Historically,
my hospital had been through many surgical advances and transitions to the
outpatient model. The move must be made with caution each time. Although we
were highly confident in patients’ ability to safely leave the hospital after
MoLEP, we needed to track the success of this approach and identify any areas
for improvement. Thus, we spent several months collecting baseline data on MoLEP
patients who stayed at the hospital overnight.
Reviewing
everything that happened inside the hospital, we saw no reason to keep patients
after surgery unless they had acute comorbidities. Even patients with very
large prostates or those taking blood thinners could safely recuperate at home.
Eight
months ago, we began releasing patients the day of MoLEP surgery and tracking
the outcomes. To date, no MoLEP outpatients have come into the ER with
complications. We are beginning to see positive trends in the data, including
better bladder voiding the day after surgery, which we think may be traced to patients’
tendency to get up and move around at home and the absence of narcotics in
at-home recovery. We have
found that patients who discharge home are more likely to successfully urinate
on their own after the catheter is removed the next day than patients that stay
in the hospital overnight.
Since
we started performing MoLEP, I have discharged over 100 patients home the same day.
We are keeping some patients overnight – specifically those with significant
medical comorbidities, concurrent other procedures, or those who do not meet
discharge requirements.
The Effect on Our Hospital
The
hospital has responded favorably to the same-day discharge. Our level I trauma
center runs near capacity, so it helps that by discharging healthy MoLEP
patients home, we are freeing up hospital beds for more acute patients. The
change has led us to review our outcomes with other surgical procedures and
take steps to shorten hospital stays. My colleagues and I will continue to explore
less invasive surgical techniques that may allow more patients to recover at
home while we focus on more acute cases in the hospital.
Amy E. Krambeck, MD, is the Michael O. Koch Professor of Urology at Indiana University School of Medicine in Indianapolis.
The post Switching to Outpatient Surgery for Everyone’s Benefit appeared first on The Health Care Blog.
