Fortnightly Healthtech Update #2

Does the accountable care organization work? Yes!  The ACO model is leading healthcare providers to focus on cost saving through preventative health. Lower healthcare costs, fewer people getting sick, I love that.  Oh, it definitely works – at least it does for Blue Cross Blue Shield of Massachusetts. Or, not so much…. “Why would I ever take away the volume from those two facilities to a lower-cost setting?” The lack of aligned incentives means that some healthcare organizations are going to (understandable) drag their collective feet in the transition to value-based care. Are they playing a smart game, or are they going to be on the losing end ultimately…? Only time will tell. But, I’ll tell you one thing for sure. American’s simply cannot keep paying more and more for healthcare. Basic economics will dictate that, the money’s just not there.  Something will change.

Ben Taub dead patient was unmonitored, found passed out in bathroom. If only there was a way to monitor patients vitals continuously in the hospital and know where they are. Oh wait, there mostly is…the Philips Wearable Biosensor, (full disclosure, I used to be the product manager) gets some recognition for the ongoing pilot at Singapore General Hospital.

While we’re riffing on biosensors, there’s Aseptika diverging from COPD with the, ahh, curiously named BuddyWOTCH, promising continuous blood oxygen, heart rate, respiratory rate and temperature for 7 days.

Not a wearable, but competing hard with them every step of the way, Early Sense notches up another win in post-acute rehab.

Skipping back to payment reform, CMS is proposing a new bundled payment model for radiation oncology, with site neutrality being a key element.  Opponents argue this could interfere with established care models – and here’s me thinking, “But, that’s the whole point….”  Obviously not to jeopardize patient care, but to at least figure out how to provide the same quality care in a lower cost setting.  See note above, basic economics etc, something has to change…

Pampers and Verily introduce the diaper that sends an alert to your phone when a change is required.  Personally, I always found the loud and incessant auditory stimulation from my little ones provided all the alerting necessary.  But, I guess for the ear bud generation, maybe an app is the way to go.  Especially perhaps for a post ear bud generation with hearing loss.

Meanwhile, North of the border, paramedics and remote monitoring are being use to reduce unnecessary ER visits.

I think emerging nations can often signpost the way to lower cost healthcare solutions. Here’s a test for anaemia, jaundice, and oxygen saturation from Indiathat costs less than one US cent.

Potentially great news for diabetics, with coaching linked to real-time blood glucose measurements. Surely so much more valuable to have actionable guidance triggered by real-time feedback to drive long-term behavior change.

Data is everything.  All other things being equal, the people with the most data – and a decent strategy to leverage it – will win in the long term.  That’s why Amazon’s PillPack wants it, and SureScripts would rather not share

And while on the subject of Amazon, Amazon and Cerner were apparently able to detect the onset of heart failure 15 months out.  Couple of immediate questions for me.  First, I’m not a clinician, but is 15 months notice really that significant for heart failure?  Isn’t the condition often brought on by decades of lifestyle choices?  If so, can an individual do anything meaningful in 15 months to avert the inevitable?  Assuming they can, this is great news – as long as you don’t live in the United States.  In countries that truly see the economic value of preventative healthcare, this truly could be great.  In the US, we’re slowly changing reimbursement models (read ACO, or single payer…) so we can actually get to the point where providers are paid for preventing disease instead of merely treating it.   Until then, it’s really just a bit of a machine learning novelty.

Ohhh, I like this – 3D printed heart valves.  Faster, better, cheaper – what’s not to love.

Curavi Health is eyeing up adjacent markets methinks.  Originally focused on bringing telehealth to SNF’s, it’s also now piloted a solution for use in the home.  Makes total sense in context of the an article in my previous update, where ACO’s are bypassing SNFs and sending patients straight home when they can.  And remote patient monitoring has a big fan in New Jersey, with Valley Health System driving readmission rates down to 2%.

Can’t quite decide which is the more impressive part of this announcement, but I think there is something in here somewhere….PhysIQ has ambulatory respiration rate.  But maybe more importantly, has hardware independent respiration rate.  Hmmm.

iRhythm, focused on cardiac arrhythmia detection, reported Q2 revenue 50% higher than last year.  But, the most significant thing in the announcement is CEO Kevin King saying “…our CPT code change application was accepted by the AMA for review…”.  That’s a bigger story than I have time for now, but I’ll try and squeeze out another post soon that gets into the nitty gritty about why that’s so important.

Very intrigued by this really stretchy wearable coming out of a collaboration from many US and Korean universities.  The full scientific paper here for the geeks among you…

Fortnightly Healthtech Update #1

Caretaker Medical is the only (deep breath…) FDA-approved, Bluetooth-enabled, non-invasive blood pressure monitor for hospital use that I’m aware of.  Now adding end-tidal CO2 via a partner, this should help to bring broader appeal.  Note the use of both Wi-Fi and cellular connectivity, which opens up the possibility for monitoring both in the hospital and in the home.  Since Medicare added reimbursement codes for remote monitoring at the start of the year, many more device manufacturers have started to focus on the home.  While accountable care and bundled payments could ultimately drive that change, there’s nothing quite like a good ol’ fashioned reimbursement to get the market moving…

On that note, CMS reports almost 100% growth in the number of physicians taking part in alternate payment models.  And here’s another change driven by the shift to value-based care: Bundled payments often cut costs by discharging patients home rather than to skilled nursing.  That’s perfectly OK – as long as patients are monitored and rehabbed in their homes.

Intermountain Health has been pushing down the value-based care road for some time.  It’s become so adept that it’s spun off Castell as a platform to help other providers down that path.

While financial incentives need to align for change to happen, communications technology also has to be up to snuff for monitoring in the home to become fully widespread.  So, good to see that the UK is pushing ahead with 5G pilots to fully evaluate the potential for rural communities.  Another (vendors) viewpoint on 5G here.

Talking of financial incentives, the FCC is lining up $100m for 3 years of pilots in telehealth and remote patient monitoring.

Also in the UK, using Amazon’s Alexa to dispense medical advice.  The aim is to take the pressure off overworked primary care docs (general practitioners).  Much easier to try that somewhere with a single payer from cradle to grave – the financial incentives simply align.  Much harder in the fragmented world of US healthcare, but I can see accountable care organizations going down this path too.  Every dollar saved is a dollar in the ACO’s pocket….

The FDA gets more interested in monitoring medication adherence.  Measuring adherence is one thing, improving it something else entirely though….

A new study looks at the use of wearables and machine learning for helping people stay on the path to overcome opioid addiction.  Since we know opioid use depresses respiration rate, it might be good to have a sensor to monitor that too. On a similar thread, Jefferson Health is using analytics to spot opportunities to rein in the prescription of opiates, and that’s no bad thing.

Not the first company to try measuring heart rate and respiratory rate using a camera, but Brainworks is new to me.  Philips has been down this path, while Smart Beat has a direct to consumer device for babies.  And you can find an app for heart rate in your phones app store already.  But, in a clinical setting, respiration rate is often a strong early indicator of impending doom.  For me, the biggest potential application for this type of approach is to help keep people with chronic conditions healthy in their homes.