The social determinants of health (SDOH) have rightly become a strong focus in the US in the last couple of years. Insightful then that medical students are poorly trained in nutrition. SDOH is warming up sufficiently that there is an analytics startup focused on just that – called appropriately enough Socially Determined.

The traditional split between providers and payers is fading away, with UnitedHealth buying Vivify for remote patient monitoring. As it’s the Optum division doing the buying, I don’t think this has any role in the payer side of UnitedHealth. But, monitoring patients in the home is a cost containment/reduction play, as providers try to reduce hospital re-admissions. So, most likely RPM is a service that will be offered to providers, and potentially more powerful when integrated with its population health offering.

There’s some rough and tumble in the primary care end of the business right now. There are a number of different business models, each focused on one of the big problems for patients: Timely access to a primary care doc. On one hand, there is the growth of concierge medicine and direct primary care (DPC). It’s hard to put a solid number on that apparently, but it’s there. At the other, budget end of the spectrum, are retail clinics – roughly 6,000 or so of them if Consumer Reports is to be believed. The third approach is telehealth services, such as Teledoc and MDLIVE . And that competitive dynamic has led Walgreen’s to pull back somewhat on in-store clinics. As the article notes, direct-to-consumer (D2C) telehealth has emerged as a serious competitor. And retail clinics have seen explosive growth too, growing 8% in numbers in 2018. Expect a bit of a cull and some M&A in each of concierge medicine, telehealth, and retail clinics before each finds its competitive niche.

This is pretty cool, MedRhythms is getting into trials with hospitals to improve stroke rehab. I first saw this company a couple of years ago when they were part of the Philips Healthworks incubator. Like most moments of pure genius, it’s beguiling in its simplicity, using music to help rewire the brain.

Also a simple idea with potential, a pacifier that analyzes a newborn’s saliva.

I mused last time on the potential liability that will follow the adoption of AI in healthcare. It seems Memorial Sloan Kettering are thinking about it too, but don’t have any more clarity. But then again, AI can help avoid malpractice lawsuits. None of this is going to put the brake on AI funding thought, with Viz.ai scoring $50m from Google Ventures, among others.

Google is lined up to acquire Fitbit for $7.35 a share. That’s a premium on recent trading, but a long way from the circa $50 a share post IPO. Fitbit has been trying to pivot from fitness to healthcare for a couple of years. Makes sense as fitness trackers are a dime a dozen now. Becoming a true medical device though needs a big step up in accuracy, dependability, and reliability. It’s one thing to get pretty good data from most of the people, most of the time. It’s something else entirely to get great data from all of the people, all of the time. Contrast Fitbit’s woes with Apple growing its wearable revenue by 54%. Scroll a little further down in that Apple article though, and you’ll find Withings also trying to expand from consumer devices to professional healthcare. Respectfully, I have to disagree with the CEO of Withings who says “Data is the key to improving nearly every aspect of our healthcare system.” I’ve had this discussion with many people. Data is not the answer. The key to improving healthcare is to pay providers to do what we want them to do – namely deliver better outcomes at lower cost. If we get the financial incentives right, everything else will follow – including the use of insights from data. But unless we change the financial incentives to reward the outcomes we want, all the data in the world isn’t going to change anything.

Many different viewpoints on what the Google/Fitbit deal means btw, including accelerating the pivot to healthcare, Google can’t do hardware, and it’s all about the data.

A new paper-based approach to detecting sepsis – and I don’t mean paper-based records, I mean a sensor made from paper that won an award.

Medicare refines the reimbursement policy on  remote patient monitoring, actually making it more likely to be adopted. This is goodness, major cost and suffering savings here if care models can fall into line and support RPM for chronic care. And that is, after all, dependent on providers being clear on how to make money from it. Something which has been missing from the reimbursement guidelines thus far. Re earlier point on data only being truly useful when the financial incentives are there.

New to me, KnowFalls has a video monitoring solution as an alternative to sitters to help prevent patient falls. As it acknowledges, it’s not the first company to go down this path, but it claims to be more cost effective. Personally, I’m not sure these solutions will ever be widely adopted. For one thing, patient privacy rights in Europe can make video monitoring difficult. Also, many of the elderly patients being monitored will unfortunately be suffering from dementia. The idea of some bodiless voice talking to patients with cognitive difficulties just feels like it could be a very disturbing experience. 

The CEO of Medically Home makes a financial case for treating chronically ill patients at home. What leapt out at me here is that in the US we spend $800bn annually on brick-and-motor hospitals (I haven’t double checked that, and it’s not sourced). Problem is, while we continue to build rooms for hospital beds, hospital CFOs will want to fill them. Isn’t the accountable care organization (ACO) the best way out of this cycle..? Define outcomes standards for managing, say, heart failure. Then it’s up to the ACO to find the most cost effective way to meet those standards for each patient. With of course downside risk if they go over budget.That is something Medicare is pushing for with site neutral payments, but legal obstacles are rightly or wrongly slowing that down.

Here’s Rock Health’s latest report on digital health consumer adoption, the key highlight for me is how patients are willing to share their health data, but few providers are geared up to work with that.

Interesting move for AliveCor as it tries to fend off Apple, starting a partnership with Huami.

Amazon continues to fill out its employee health offering, with the acquisition of Health Navigator.

To wrap up, interesting insight into the impending crisis that is the declining health of millenials. Which is odd, because the preconception I had is that millennials are super focused on being  healthy. Note, this is US millennials, not sure if it applies to other countries too. Either way, it’s not good reading….