Fortnightly Healthtech Update #33

In Taiwan, iWEECARE claims the world’s smallest continuous temperature monitor, and $2.5m in seed funding. 

Plenty has been written about Medicare’s bundled payment experiments (mostly known as BPCI). Much less has been written about how commercial payers have been working on bundles too. A review shows some success, but also points out some things which may be a challenge for Medicare. Namely, that tight coordination and data integration between providers and payers is one of the keys to success. In contrast to that, I can remember an executive from Remedy Partners on a podcast maybe 5 years ago. (Remedy Partners was A VC-funded startup launched to help providers adapt to bundled payments). Apparently one of the early challenges that Remedy had was that communication and data sharing from providers was bad. Just to be clear, to improve outcomes and lower costs over a bundle, the entity carrying the risk (ie. Remedy Partners) has to manage the bundle from start to finish. So, for a knee replacement, that would be pre-hab, surgery, and then 30, 60, or 90 days post-discharge – including all the rehab. In the case quoted by the Remedy exec, patients were being discharged from hospital before Remedy was even informed that the patient was one that should be managed in a bundle. End result, most of the money had been committed, and most of the outcome determined, before Remedy had a chance to intervene and affect either. Healthcare reform…? I don’t think so.

Apparently some parts of the health insurance industry have decided that the COVID-19 pandemic is over. Or at least, UnitedHealthcare and Anthem are stopping the waiver of patient co-pays for telehealth that was introduced earlier in the year. What happens if the second wave hits..? Or did the first wave never end….

A fortnight ago I touched on the somewhat meagre savings from the Medicare Shared Savings Program (MSSP). That’s not to say there aren’t valuable lessons from the program, because there are. The use of data, clinical transformation, financial incentives, preventative healthcare, and population health are all part of the success. My point is that we’re not taking these lessons and applying them rapidly – and more widely – to more providers and more Medicare beneficiaries. We’re moving at a glacial pace, and each year we pay more for healthcare.

Advocating for underserved populations: Is remote patient monitoring the answer? Well, it is if we’re smart about how we use it. As I’ve suggested before, telehealth and virtual care solutions provide a golden opportunity to lower the overall cost of care. And that has to be part of the solution to bringing better healthcare to underserved populations. After all, the reason they’re underserved is probably because there’s less money to be made.

New to me from Phili, RTM Vital Signs. The company is working on a number of possible solutions, but first up is a miniature implantable continuous blood pressure monitor.

Researchers investigate the use of a PPG sensor in a smartphone to measure blood oxygenation and find that it does really rather well.

Hearing tests by smartphone for underserved communities.

Plenty of gushing articles have been written about the potential for consumer wearables to move into the healthcare space. Less virtual ink devoted to the problem of false positives. So now news that the Apple Watch abnormal pulse feature generates 6 false alarms for every genuine situation it catches. That’s frustrating for overworked doctors staring down burnout. But, healthcare CFO’s must be rubbing their hands, it’s all billable. There’s potential for wearables to play a powerful role in preventive medicine, enabling early intervention, reducing the need for later, more expensive interventions. But only if they’re much more accurate and reliable than this.

I touched on the BodyCompass contactless monitoring approach from MIT in issue #32. Over in Switzerland, Sleepiz just received a CE mark for contactless sleep monitoring using millimeter wave technology

Biobeat releases a clinical study that compares its cuffless blood pressure monitor favorably to traditional solutions.

I’ve also written about Clover Health in the past.The company just announced it’s going public with a $3.7bn valuation. I have a bit of an issue with the CEO’s claim that “this is the ultimate healthcare disruptor”. It’s bread-and-butter is serving Medicare Advantage beneficiaries better, so really more incremental improvement than disruptive. That said, the company sees a future in direct contracting to grow quickly. The investor pitch deck is 111 slides. It makes very generous use of white space, and could’ve been done in a third of that. It’s still worth skimming through.

Fortnightly Healthtech Update #32

It’s all good: Medicare ACOs saved $1.2bn in 2019. At least it’s all good until you remember that annual Medicare spend is north of $750bn. I’ll save you the trouble of doing the math, that’s 0.16% shaved off the total budget. We’re eight years into the Medicare Shared Savings Program, Medicare’s primary accountable care experiment. I think it’s fair to say we still have a long way to go.

The other big Medicare value-based payment experiment, bundled payments, is struggling against a headwind too. Major changes coming to bundles and target prices because it’s been bleeding cash so far. This includes a move to make bundles mandatory, instead of allowing providers to cherry pick. A few years ago, Medicare tried to make comprehensive joint replacement (CJR) bundles mandatory. It didn’t end well.

An ultrathin sensor for blood oxygenation, has potential for ear buds among other things, the developers feel. For me though, I think the better applications might lie in better monitoring of chronic conditions. The benefits of SpO2 monitoring for healthy people and wellness applications are not obvious to me. For patients with asthma or COPD though, easier, less obtrusive monitoring to establish baselines and oxygenation during episodes, absolutely.

Also on the wearability theme, porous silicone to allow wearable sensors to transmit sweat.

Should be good for both patients and cost savings, Medicare finalizes new care models for those managing kidney failure. This model encourages home dialysis, which, given how much time dialysis takes, is a massive improvement in quality of life. It’s like giving someone their life back. Note that Fresenius and Davita have almost 7,000 outpatient dialysis centers between them. So a move to home dialysis is a clear existential threat. Fair to say that Fesenius saw the writing on the wall when they acquired NxStage in 2019. 

Another CMS experiment, the ET3 model for emergency services is back on the schedule for January 2021. ET3 aims to provide more flexibility for EMS, moving beyond the typical stabilize and transport to an emergency room. ET3 adds options such as transport to a primary care doc, and providing treatment in place, to the standard EMS charter. The ultimate goal is to deliver a better patient experience at lower overall cost. Note that some providers (such as Northwell) have been doing this for a while as a CMS pilot with good results.

Rita Numerof at Forbes has a point: Why should hospitals get a bailout for a failed business model.

In case you missed it, the MedCity INVEST Digital health virtual conference has come and gone, with some interesting startups showcased. I’d missed that Current Health had relocated its HQ from Edinburgh to Boston. Also missed that it had made significant improvements in form factor and (presumably) comfort, from this to this.

Wellness sleep monitoring has become a niche market over the last few years. Now from MIT, BodyCompass is a contact-less, camera-less solution that uses RF to track body movement and posture during sleep. Designed for the home, but there are applications for this in long-term care and skilled nursing I think. When patients are (mostly) immobile in bed, nurses have to turn them periodically to prevent pressure ulcers. Wearables from companies like Leaf Healthcare have been designed to help nurses track who they need to move, when. That can deliver both better patient care and more productive nursing. No reason off the top of my head why BodyCompass couldn’t provide the same kind of insights.

McKinsey has been writing a lot about healthcare lately, which is probably no coincidence. The latest article is making healthcare more affordable through scalable automation. As you’d expect from McKinsey, it’s well researched, thoughtful, and has data behind it. And the research found plenty of scope for automation, especially in payers. With probably 700,000 people employed in the healthcare insurance industry, that’s a lot of middle class jobs at risk. The Kaiser Family Foundation pushes further, describing a single payer system as a healthcare overhaul could kill 2million jobs, and that’s OK. So estimate a $100k annual cost for a fully loaded employee, that’s an overhead cost of $200bn every year. Or $1,670 per US household if you prefer. That’s a lot of groceries. In reality, incumbents are never going to let those jobs evaporate. Which is where tech innovation and startups come in, deploying technology from the get go in place of admin labor. Direct primary care practices typically avoid insurance, slashing their admin costs. Oscar Health uses a mobile app to cut admin costs, and provide a better customer experience. Amazon is piloting a virtual care first model for its employees. Rock Health has written a longer piece about what it calls next generation providers and payers.