Lucie Ide is a physician running Rimidi, a company helping health systems manage patients with chronic conditions. They extract data from EMRs and transfer this into workflow for care teams, predominantly at ACOs and other risk bearing organizations, but also increasingly with FFS groups using RPM to manage those patients. Their current moves are to continue to extend from their first patient group (diabetes) to all types of chronic patients. We chatted about her company, but also about the wider move (or lack of it) to better manage patients in the US system–Matthew Holt
Rumor Check with Vida Health’s CEO: Buyer Sentiment on Virtual Care, At-Risk Models, Mental Health
By JESSICA DaMASSA, WTF Health
To hear Vida Health’s CEO Stephanie Tilenius talk about what she’s hearing from payers, providers, and employers about at-risk value-based models, the shift to virtual care, and the growing importance of mental health services as a culture-builder for businesses forced into a part-virtual-part-in-office world, you get a sense of how her past work leading the various payments and commerce businesses of Google, eBay, and PayPal probably comes in handy. For example, the shift to virtual care, she says, is, “like the Internet in 1999…It’s happening.”
We get an update on exactly how Vida Health is making it happen themselves, and how they expect their newly expanded at-risk model will help. Vida’s always been fees-at-risk on physical outcomes related to diabetes management, hypertension, etc. BUT the mental health side of their offering (which experienced 6000% growth year-over-year during the pandemic) is now at-risk on outcomes too. With so much happening across the industry to move to value-based models, we deep-dive with Stephanie to hear what she’s hearing from her clients, including client-and-investor Centene and hear about growth in the employer market where she sees a major shift in how employers are thinking about healthcare as the new sexy job perk. “Instead of snacks or transportation or other benefits,” says Stephanie. “It’s all about healthcare.”
Scaling Up One Drop: From Walmart & Apple Stores to Employers & Bayer | Jeff Dachis, One Drop
By JESSICA DaMASSA, WTF HEALTH
On the heels of a $40M Series B funding round led by Bayer, One Drop CEO Jeff Dachis stops by to hit the highlights about how the digital health platform is touching the lives of 1.6 million users in nearly 200 countries. Focused on chronic conditions like diabetes, pre-diabetes, hypertension, etc. One Drop is unique in the BIG direct-to-consumer business they’ve built through partnerships with Walmart and Apple stores. While Jeff says their growth capital will go toward expanding their heath plan and employer business, there’s also room for growth with Bayer, which could help expand the company’s core operating platform into other therapeutic areas like cardiovascular disease, oncology, and women’s health.
Filmed at Frontiers Health in Berlin, Germany, November 2019.
Landmark Results Achieved in Aging and Chronic Disease: Danish Group Extends Disease-free Life by 8 Years
By WILLIAM H. BESTERMANN JR., MD
New Scientific Breakthroughs Can Provide a Longer Healthier Life
Twenty-one years of follow-up comparing usual care with a protocol-driven team-based intervention in diabetes proved that healthy life in humans can be prolonged by 8 years. These results were achieved at a lower per patient per year cost. Aging researchers have been confident that we will soon be able to prolong healthy life. This landmark study shows this ambitious goal can be achieved now with lifestyle intervention and a few highly effective proven medications. These medications interfere with the core molecular biology that causes chronic disease and aging. These same medications will likely produce similar results in patients with congestive heart failure, chronic kidney disease, arterial disease, history of heart attack, hypertension, and angina. Simple medical interventions can extend healthy lifespan today.
Better Chronic Disease Management Can Improve Health and Lower Costs
90% of health care costs come from chronic diseases and aging which are both related. The same biochemistry that causes aging causes chronic disease. Eating processed food, gaining weight, smoking cigarettes, and sitting on the couch accelerate aging and chronic condition development. Those activities switch on genes that should be quiet. Eating real food, avoiding cigarettes, activity, lisinopril, losartan, atorvastatin, metformin, (and spironolactone) are now proven to extend healthy life by 8 years in patients who are at high risk of health catastrophes and early death! These medications all cost $4 a month except for atorvastatin which is $9 a month. The benefits continue even when best practice treatment stops probably because these treatments block signaling from dangerous genes that are inappropriately and persistently turned on.
Progress Will Require Extensive Health System Reengineering
Having better health and reducing health care costs can happen today. Surprisingly, the biggest barrier to progress is our current health care system. It is arranged around catastrophes, organ systems, and hospitals. These concepts are 100 years old. Chronic disease begins decades before the catastrophe, and it is related to aging. Age is the greatest risk factor for a heart attack. The same biochemistry that causes accelerated aging also causes heart attack and strokes. It makes little sense to see a cardiologist for a heart attack and a neurologist for a stroke. They are caused by the same molecular biology. The leading health care systems are beginning to recognize that. The interventions that slow aging and chronic diseases development impact every cell in the body. Every young person who is overweight or smokes has activated genes that make accelerated aging and chronic disease more likely. If these genes are switched on prior to having children, that risk is passed on to the next two generations.
Primary care teams organized to address chronic conditions and more rapid aging will provide lifestyle advice and medication that interfere directly with the biology that is causing the problem. The further upstream these individuals are when identified, the easier it is to slow aging and delay chronic disease onset. The path to better health at lower cost lies in the outpatient setting with primary care teams that are well-versed in molecular biology.
Health in 2 Point 00, Episode 83 | Health 2.0 HIMSS Europe
Today on Health in 2 Point 00, Jess and I are in Helsinki for Health 2.0 HIMSS Europe. In Episode 83, Jess asks me about Roche cheating on mySugr—Roche announced a new partnership with digital diabetes provider GlucoMe, about the new $100 million hospital venture fund in Iowa coming from UnityPoint Health, and about Infermedica’s recent $3.65 million raise for their cool symptom checker complete with an AI chatbot. Stay tuned for more updates from the conference. —Matthew Holt
Young People Need To Turn Out For Their Health
By MERCEDES CARNETHON PhD
This month, we saw historic turnout at the polls for midterm elections with over 114 million ballots cast. One noteworthy observation regarding voter turnout is record rates of participation by younger voters aged between 18 to 29 years old. Around 31 percent of people aged 18 to 29 voted in the midterms this year, an increase from 21 percent in 2014, according to a day-after exit poll by Tufts University.
Surely their political engagement counters the criticism that millennials are disengaged and disconnected with society and demonstrates that millennials are fully engaged when issues are relevant to them, their friends, and their families. Why, then, do we not see the same level of passion, engagement and commitment when young adults are asked to consider their health and well-being?
I have had the privilege of being a member of the National Heart, Lung and Blood Institute-funded Coronary Artery Risk Development in Young Adults (CARDIA) study research team. In over 5,000 black and white adults who were initially enrolled when they were 18 to 30 years old and have now been followed for nearly 35 years, we have described the decades-long process by which heart disease develops. We were able to do this because, in the 1980s when these studies began, young adults could be reached at their home telephone numbers. When a university researcher called claiming to be funded by the government, there was a greater degree of trust.
Unfortunately, that openness and that trust has eroded, particularly in younger adults and those who may feel marginalized from our society for any number of valid reasons. However, the results—unanswered phone calls from researchers, no-shows at the research clinic and the absence of an entire group of adults today from research studies, looks like disengagement. Disengagement is a very real public health crisis with consequences that are as dire as any political crisis.
Continue reading…
Livongo Health adds $20m, Tullman interview
Livongo Health is creating a tech-based service that aims to supersede the glucometer. Headed by former Allscripts CEO (and THCB interview regular) Glen Tullman, it raised another $20m from Kleiner Perkins, DFG & General Catalyst today. I grabbed 10 minutes to talk to Glen Tullman this morning. he had very interesting things to say not only about his business but Cerner, Epic & open systems too.
[youtube]https://youtu.be/4w-pHj91PKM[/youtube]
A Deeper Dive into the Rio Grande Valley
The savings number made for an impressive headline.
But as is often the case, other information had to be left on the cutting room floor. We dive a little deeper into the RGV ACO below:
The Central Role of Information Technology
Dr. Jose Pena, Chief Medical Director of the Rio Grande Valley ACO, emphasizes that one of the first and most difficult tasks for the newly-formed organization was developing an IT infrastructure that would serve their needs. “Using what was there wasn’t really an option,” says Dr. Pena, “so we built our own infrastructure.”
Forgoing a single EHR solution, the Rio Grande Valley now operates on a mix of cloud and office-based systems. The ACO developed software to identify metrics from various EHR systems, migrate that information to the cloud, and view real-time performance of providers. “IT accounted for 40% of our costs,” says Dr. Pena, “but the importance of proper reporting – to our leadership team, and to CMS – was at the top of our list.” The ACO identifies its customized IT system as foundational to its success.
International Classification of Diseases Hampers the Use of Analytics to Improve Health Care
By ANDY ORAM
We are not going to escape the morass of ICD any time soon. As the “I” indicates in the title, the standard is an international one and the pace of change moves too slowly to be clocked.
In a period when hospitals are gasping to keep their heads above the surface of the water and need to invest in such improvements as analytics and standardized data exchange, the government has weighed them down with costs reaching hundreds of thousands of dollars, even millions just to upgrade from version 9 to 10 of ICD. An absurd appeal to Congress pushed the deadline back another year, penalizing the many institutions that had faithfully made the investment. But the problems of ICD will not be fixed by version 10, nor by version 11–they are fundamental to the committee’s disregard for the information needs of health institutions.
Disease is a multi-faceted and somewhat subjective topic. Among the aspects the health care providers must consider are these:
- Disease may take years to pin down. At each visit, a person may be entering the doctor’s office with multiple competing diagnoses. Furthermore, each encounter may shift the balance of probability toward some diagnoses and away from others.
- Disease evolves, sometimes in predictable ways. For instance, Parkinson’s and multiple sclerosis lead to various motor and speech problems that change over the decades.
- Diseases are interrelated. For instance, obesity may be a factor in such different complaints as Type 2 diabetes and knee pain.
All these things have subtle impacts on treatment and–in the pay-for-value systems we are trying to institute in health care–should affect reimbursements. For instance, if we could run a program that tracked the shifting and coalescing interpretations that eventually lead to a patient’s definitive diagnosis, we might make the process take place much faster for future patients. But all a doctor can do currently is list conditions in a form such as:
E66.0 – Obesity due to excess calories
E11 – Type 2 diabetes mellitus
M25.562 – Pain in left knee
The tragedy is that today’s data analytics allow so much more sophistication in representing the ins and outs of disease.Take the issues of interrelations, for instance.
These are easy to visualize as graphs, a subject I covered recently.
Cheeseburger Please, and Make It a Double
Consider that for the last year or so, we have been treated a deluge of entreaties to reduce our salt intake, with the American Heart Association going so far as to claim that daily sodium intake should not exceed 1,500 mg. This puts it at odds with the Institute of Medicine, and now European researchers whose data indicates that the healthy range for sodium intake appears to be much higher.
Our conversation about sodium, much like advice about purportedly evil saturated fats and supposedly beneficial polyunsaturated fats, exemplifies a national obsession with believing eating more or less of a one or a small number of nutrients is the path to nutritional nirvana.
A few weeks back, an international team of scientists did their level best to feed this sensationalistic beast by producing what’s become known since then as the meat-and-cheese study, because it damned consumption of animal proteins.
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The authors correlate cancer mortality with age and protein intake, but they never bother to correlate it with body mass index or waist circumference, the latter of which is an increasingly important measure of body composition. Average waist circumference of the mostly older study subjects was just barely below risk thresholds, meaning that they were fat. Abdominal adiposity induces a damaging pro-inflammatory metabolic state than abets cancer development. Cancer is predominantly a disease of aging with incidence and death rates after age 50 that are 13x greater than before.
