Docs fleeing Medicare into direct primary care provides many opportunities for technology to take up the slack and help to grow productivity in healthcare. Better patient access to their records would be one, telehealth and remote monitoring of chronic conditions would be others. For that to happen, the emergency order to reimburse virtual visits the same as to face-to-face – or something like it – would need to be permanent. So interesting insights on the future of value-based care from Dr. Alexander Vaccaro at  Rothman Orthopaedics. I’m inclined to agree, if we want the telehealth boom to continue post-pandemic, push population health and then the providers have a bigger reason to drive out cost.

The pandemic isn’t helping either, as primary care docs see their visits dry up. As the article notes, one option is to be swallowed by a larger health system. We are all wise with hindsight. But direct primary care practices – subscription based, rather than fee for service – have a more stable revenue stream. Direct primary care may potentially get a legal boost, with the IRS proposing that direct primary care be treated as a qualifying expense for some type of flexible spending account. In the meantime though, some PCP’s are lobbying congress for direct financial support.

Open source comes to wearables, with the Open Wearables Initiative releasing a step count algorithm, and sets its eyes on gait.

I almost feel like I should put a disclaimer on this one: Israeli missile maker claims AI tech can predict virus patients’ deterioration. Fair enough, but I wonder how many physicians would agree with the quote “In data science, it doesn’t really matter whether its data from a satellite or blood measurements of a patient. You put data in and you get predictions out.”

Evidence – if it were needed – that providing patients with frequent, actionable health data can lead to better outcomes: FreeStyle Libre Glucose Monitor Reduces Hospitalizations in Diabetes. I’ve personally found this device very helpful. Although not diabetic, I have a sweet tooth and my blood glucose tends to run higher than ideal. With continuous glucose monitoring (CGM), I had real-time feedback on how specific foods affected my body. In the US, this device only available on prescription. Elsewhere, it’s over the counter. Not sure why…Wouldn’t it be better to help people avoid becoming diabetic than merely helping them to manage the condition further down the road? But which is more lucrative I wonder…?

Medicare ACO’s appear to be driving productivity growth, with the percentage of non-physician practitioners growing significantly. Which is good to see, the kind of changes that we should see. 

Binah.ai, the Israeli video-based monitoring group, raises a $13.5m B round. Are comparisons to the Star Trek legendary tricorder helpful? Probably not.

Sensors in clothing might be bubbling, with MIT pursuing a research project. Also from MIT, an update on something we’ve seen before, using wireless signals to monitor vital signs. I do have a bit of an issue with the statement “While healthcare facilities obviously employ a number of different measures to monitor resident and patient vital signs over time…” Theoretically true perhaps, but if it were consistently done well in practice, organizations like the Patient Safety Movement wouldn’t exist.

Video games as therapy: Akili Interactive gets FDA clearance to treat ADHD.

Highly valued startup, Proteus Digital Health, files for bankruptcy protection. There seems to be a lot of surprise about this, I’m not sure why. The majority of VC funded companies never make it at the best of times. Plus, digital health has been a bubble for a couple of years now. Ultimately though, however strong the company may be, healthcare is a supremely tough market to find product/market fit. Because “market” is a complex mash of clinician, patient, health system, and payer. If they don’t all align, it’s a problem. Focused on using sensors to track medication adherence, the first product was a smart version of Abilify. Granted, physicians would love to know that their patients suffering from mental illness are taking their meds. But asking those patients to effectively spy on themselves may have been a tough ask. The added challenge in healthcare is to try and find alignment of financial incentives in a crazy broken reimbursement system. Which begs the question, who on the provider side makes money if patients are more compliant with their meds…? There’s no obvious answer to that for me. So that’s always going to be an uphill battle. Because even if physicians love your product, there still needs to be a way for providers to make money from it in the US. And payers willing to support that, which takes time. In other countries, where delivering care cost-effectively matters, the path may be easier.

On the topic of patient compliance, I’m curious how well the Neopenda neoGuard is tolerated by patients. I’ve worn a few hideously uncomfortable prototype medical watches before, but newborns are at least limited in their ability to complain.

A longer read: It’s time for a new kind of Electronic Health Record, one that is more forward looking.

New to me Siren raises a $12m C round for it’s sensors-embedded-in-fabric monitoring technology. Ultimately, I think approaches like this have huge potential for monitoring chronic conditions in the elderly. Monitoring that is completely unobtrusive, and requires (almost) zero changes in behaviour. Such as sensors in clothing, or radar based vital sign monitoring.

Gotta love low-cost healthcare innovation: Higi raises series B funding of $30m to further it’s kiosk-based preventative care model. Aimed squarely at organizations taking risk for a population (eg. ACOs), the kiosks are free to use. If things look amiss, they can connect the consumer to a clinician. So far, Higi has been used by 62m people. Lowering the cost of preventative care to zero is good for consumers, and good for the provider taking financial risk for a population too. Looks like it’s working for Higi too….

More on accountable care, with COVID-19 set to disrupt the modest progress that has been made with Medicare ACO’s so far. ACOs are, not unreasonably, concerned about the financial impact of the pandemic.

Philips brings a new wearable biosensor to market, with some nimble footwork to address the COVID-19 monitoring opportunity. Compare and contrast with the earlier wearable biosensor here.

A rising tide lifts all boats, so predictably AI in healthcare gets a boost from the pandemic too.

Very early days, but Surrey University in the UK has an implantable sensor that is powered by the body’s movement.

A new clinical study finds that EarlySense is capable of detecting acute pulmonary embolism. 

New to me Vtuls offers 3 months free service to UK care homes, a hotbed for COVID-19 infections for many reasons. Hopefully that offer is as genuine as it sounds and comes with no strings attached – like a 3 years paid subscription tacked onto the free.

Evidence that the direct primary care (DPC) model can drive diabetes care costs lower with good preventative medicine. I think direct primary care will evolve to be a major component of employer-provider healthcare. DPC puts the primary care focus on what primary care should be. Preventative medicine and the management of chronic conditions. And there’s no reason why any of that should go through health insurance. Routine servicing on my car doesn’t go through my insurance. Routine servicing on my body shouldn’t either. For that, the insurer is just adding a layer of admin and taking a margin that consumers really don’t need to give up. So I can see more employers carving out primary care (“direct to employer care”) to work with practices like Iora Health. Some states, such as North Carolina, are clearing the legal path for that.

Will the cost savings be passed onto consumers, or will CVS pocket them: CVS to deliver prescriptions with autonomous vehicles.

A length academic-ish article on why innovation isn’t reducing healthcare costs. The conclusion is we need to innovate for cost-reduction, not innovate for novelty. True, but it’s more than that. Before we get to that step, we need to incentivize cost-reduction.

McKinsey is speculating – and I choose that word carefully – that the telehealth market could grow to $250bn a year, post pandemic. Wisely, McKinsey places a question mark at the end of the article’s title. For good reason in my view. The article has lots of good strategic advice on how practitioners can plan for a telehealth world. And it does also touch on the elephant in the room. Reimbursement. There may be many good clinical reasons for telehealth to grow. Telehealth may be embraced enthusiastically by clinicians. But, if the healthcare industry can bill $1,000 an hour for in-person visits, but can only bill $800 an hour for telehealth, change is going to be very slow in coming. (All numbers made up just to illustrate). Unless telehealth segments and increasingly becomes a direct-to-consumer play, like this example. And if I could do eggs over easy like that I’d be a proud man….

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…