Another shift in the primary care landscape, Walgreen’s aiming to move away from pharmacy to become a “health and wellness destination” by bringing primary care practice into the store. Mostly targeted on underserved populations, so that’s a win-win. I don’t have the data, but I imagine a growing percentage of prescriptions and OTC meds are now fulfilled by mail order or online. In other words, the traditional pharmacy is a dying business. Better then to evolve and wrap a service layer around your product business.

CMS calls for a renewed commitment to value-based care. Contrast with the acknowledgement that the Medicare trust runs out in 2026 from my last update. And why call for it in a press release…? Medicare and Medicaid combined spend is a trillion dollars a year…don’t write a press release, use your muscle to make it happen.

Or, maybe it is…? CMS proposes to make COVID-19 telehealth changes permanent for home health agencies. I hesitate to say it, but this could be the silver lining to the pandemic. First, CMS makes the reimbursement for telehealth and remote monitoring permanent, so providers start using it routinely. That helps manage the pandemic in the short-term. Most likely, in the medium term, this will cost CMS more, because in-person visits will return at some point. When they do, the healthcare business being what it is, many providers will bill for both remote monitoring and in-person visits if they can do so. But then, as full capitation kicks-in (eg. ACOs) and providers are carrying financial risk, they will see remote monitoring and telehealth as a way to cut costs and keep more money in their pockets. So maybe this is the way we get to value-based care that delivers both better outcomes *and* lower costs. 

Philips partners with Biointellisense for in-home vital signs monitoring. I imagine the big attraction for Philips was the 30 day life of the device. Philips’ recently released in-hospital wearable is fully disposable, and good for up to 5 days. In the home, that shorter life is inconvenient for patients, and also more costly, everything else being equal. Surely no coincidence either that providers get paid for a 30 day remote monitoring period under the reimbursement codes introduced 18 months ago. So, Biointellisense is very smart, because it’s just as important for medtech companies to focus on how they will get paid as it is to deliver clinical value. Deliver a 25 day device when providers get reimbursed for 30 days of monitoring and you’ll find yourself with a dud on your hands.

A first for EarlySense I think, providing patient monitoring for a detox center in Texas. Acute care hospitals, skilled nursing, and long term care are where the company has mostly scored in the past as far as I know.

Can surgery analytics be used for operating room performance enhancement? Of course! But you have to be willing to take action on the insights you get from the data. And that’s usually the hard bit.

Not to beat on insurers any further, but….profits surged at UnitedHealth. The culprit apparently is the cancellation of elective surgeries that is pushing many hospitals to the brink. The fact that hospitals are so dependent on elective surgeries for revenue is another story. A functioning healthcare system just shouldn’t be that way.Amazon tries direct primary care clinics for its employees. As the article notes, not the first company to do this by any means. Some tech companies have been doing this for a long time as “a benefit”. A benefit that also minimizes working time lost to doctors visits. But I think this is a growing trend. There’s a growing realization that primary care via health insurance doesn’t work. There’s no reason that preventative care should go through insurance. First, insurance just adds a margin to something that really isn’t an insurance risk, it’s routine maintenance. Second, insurers have no incentive to spend on preventative care, it’s just a cost to them.

Another glimmer of hope for Medicare ACOs, almost 70% are using, or plan to use, home health agencies. Related to that, some concern that value-based care is going to drive smaller home health agencies out of business. That’s because smaller providers don’t have the resources to adjust to new processes and deal with the reporting burden that comes along with it. That’s unfortunate, but probably necessary. Don Berwick argued a decade ago that healthcare needed to move on from being a cottage industry to become more industrialized. That is more repeatable, more scalable, more efficient. That article is 10 years old, and we’re still mostly waiting for that.

But, on the subject of driving care processes through data, differences in care for the over 80’s having a total hip replacement. Not many as it happens, but good that somebody studied it.

Vitls gets FDA clearance for a 6-day wireless wearable with continuous remote monitoring. Looks like the company is seed funded and runs a very small team. So it’ll be interesting to see what the go-to-market model is, because the company doesn’t seem to have the resources to go it alone..

Not too many startups focus on the less wealthy end of the healthcare business, but here’s one: CityBlock Health raises $54m to bring primary care and behavioral health to low-income communities. Especially important, the company includes a focus on the all important social determinants of health. More on the company’s business model here.