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.

I’ve tried to keep Corona-virus free in the last couple of issues. That’s pretty much impossible at this point. However, the good news – if there is any right now – is that some wearables are actually starting to be used to help fight the pandemic. Not just optimistic press releases, but actual usage. So let’s learn about that.

Providence – first in the eye of the storm in Seattle – are using Xealth to help deliver remote patient monitoring. 

The ever inventive Israeli’s are adapting a couple of monitoring systems I’ve not come across before for remote monitoring. EchoCare Technologies uses radar to detect falls in seniors primarily, but also measures respiration rate. Neteera uses a similar idea, but seems to capture a broader range of vital signs.

Also from Israel, Nuvo Group gets the nod from the FDA for its remote pregnancy monitoring for both baby and mom.

Unlikely saviors for desperate times, Alphabet’s Verily has helped to roll out COVID-19 testing in California.

Meanwhile, the Aussie’s have developed a biosensor for real-time tumor tracking. Details on how it works here.

New to me, Tissue Analytics, uses a phone app and machine learning to provide remote clinicians with highly detailed insights into wounds.

I’m shocked by this survey result: 91% of American’s want healthcare price transparency. Did the other 9% not understand the question? Why would anybody not want to know the price of care before treatment…? The answer, most likely, because they have a healthcare plan that costs them little or nothing beyond their monthly premium..

It’s been widely suggested that treating patients in their home would reduce the cost of care, versus a hospital visit. Intuitive really, but still needs to be proven out. Brigham and Women’s in Boston has done that to some extent. Less than 100 patients total, but demonstrating 38% lower cost per episode of care.

Plenty of discussion about the almost complete inability to do contact tracing in the US for COVID-19. Not helped by the fact that in many ways the US acts like a collection of 50 smaller countries – not unlike the dreaded EU! Not to mention the complete lack of integrated health records. But, there is at least now an outline of a policy to tackle that. Policy papers may be irrelevant at this point though, as Apple and Alphabet have announced that they will work together to enable contact tracing. But still plenty of unanswered questions about that project.

Remote monitoring in more than one sense, Biovotion has a COVID-19 related remote monitoring project in remote Australia, Murrumbidgee Local Health District to be exact. Not to be outdone, Caretaker Medical is also setting up for remote monitoring of vitals with Australia’s first virtual hospital. 

Masimo SafetyNet has also been extended to remote-monitoring in the home for suspected COVID cases by St Lukes in Pennsylvania.

CMS requires providers to be compliant with a bundled care protocol called SEP-1. However, there now seems to be evidence that not all elements of the bundle are necessary. Dig deeper though, and it seems SEP-1 might not be based on clinical evidence at all.

Possibly the most classless press release of recent days: MindCotine scores US$230,000 just in time to get at-risk smokers to quit before Covid gets them. Maybe the team at MindCotine just needed to invest a little more of that $230,000 in a better translator, hard to say.

One small step on the road to reasonable med prices, Illinois caps the price of insulin.

There’s a lot of ongoing speculation that the Coronavirus pandemic might finally bring us into the telemedicine era. The FDA has lifted some restrictions on remote monitoring. It’s also temporarily blessed non-HIPAA compliant audio and video. And practicing across state borders. But it’s going to take more than that to make the change stick. It’s going to take alignment of reimbursement rates, as this tweet shows. Certainly as the stock market craters, investors are excited about companies like Teledoc. A bigger opinion piece by Forbes here.

Some wearables are certainly getting a kick in adoption, with the Oura Ring being used to monitor the health of caregivers in a couple of San Francisco hospitals.As far as I can tell, this is a wellness device, not a medical device (ie. not FDA approved). Which probably explains why it’s on caregivers, not patients. That said, the FDA has also relaxed the regs on ventilators manufacturing. Which is fine. If the only choice you have is a possibly iffy vent, or no vent at all, which would you pick? Expect the FDA to relax plenty more rules over the next 12 months. The more interesting thing is how many those changes will stick when we make it through to the other side.

While many industries are looking for the federal government to bail them out as their revenue plummets, ACO’s are looking for help as their costs threaten to explode. Personally, I’m just as interested in seeing what help there will be for families who face bankruptcy because their healthcare insurance cover is so meager.

In news that is probably not COVID-19 related, patient monitoring company Masimo is set to acquire a ventilator company, TNI Medical. As the press release states there is no material impact for 2020, it looks like a longer term play. Masimo’s core business is measuring and monitoring patient oxygenation. Acquiring a product for ventilation is perhaps a move to close the loop between monitoring and therapeutic delivery and deliver a more complete solution.

On that note, I’ve highlighted a lack of continuous patient monitoring as an issue in Cleveland before. Therefore good to see further studies and adoption of solutions to address this need. First, Masimo reports zero deaths or injuries from opioid induced respiratory depression from a 10 year study. In the much smaller control group, sadly 3 deaths occurred. Second, Children’s Hospital of Georgia signs up for Philips’ IntelliVue Guardian to measure early warning scores more reliably, and so improve intervention when needed.

Alphabet’s DeepMind throws its weight behind COVID-19 protein structure folding. Protein folding using spare cycles from home computers has been a thing for over 10 years. That means you can do your bit to tackle COVID-19 and other diseases, sign up here.

Population health is an under-rated discipline – especially in the US where the payer/provider landscape is so fragmented. That may change with the current pandemic, aided by the increased use of consumer wearables. Researchers at Scripps have kicked off a project to do just that. 

This might just be the only COVID-19-free healthcare email you read this week. I wanted to keep it that way, providing a veritable oasis of calm. But that does make it a smidge shorter than usual….Personally, I am very interested to see how this pandemic might change the delivery of medicine. We’re still mostly dependent on in-person visits in the US. But that’s more about how providers get paid than it is about a lack of technology alternatives I suspect.

Phone camera based vital sign measurement from Binah.ai now offered with Burnalong, a fitness app. I’m hoping this isn’t the be all and end all for Binah.ai. Most likely there’s a professional medical application lurking in here too. But working with the consumer market should give the company quick access to lots of data. And that data can be used to refine the underlying AI models to improve accuracy and accelerate product development.

US researchers working on a smart bandage to both monitor the patient and promote healing.

Somatix has an interesting approach to monitoring the elderly as unobtrusively as possible. It uses gestures and hand movements to look for signs of impending trouble. I don’t quite understand why it positions itself as an AI company and not a medtech company, but it does.

I once had a physical therapist friend tell me that women’s pelvic health was a massively under-diagnosed issue. So it’s good to see VaGenie is the winner of Boston Scientific’s Connected Health Challenge.

BioBeat gets CE mark for its wearables that measure blood pressure, cardiac output, stroke volume, oxygenation, and heart rate. This in addition to the FDA clearance granted last year for some parameters. What’s particularly noteworthy is the ability to measure blood pressure off the chest, as well as the wrist.

Lyft simultaneously finds recurring revenue and helps with the social determinants of health. This deal backs onto an existing 3 years deal. It’s great that people are being creative about solving the transportation issue for patients who need it. And presumably, in an accountable care world, providers will actually pay the $20 for the ride if they are going to save thousands in downstream healthcare costs.

A Philips survey reports that 35% of young doctors are overwhelmed by patient data, or aren’t sure how to use analytics. Sounds like we need to re-think physician education.

Researchers find that 3D printing could lead to a better type of silicone wearable.

Some are excited that the federal government has published interoperability rules that *might* allow patients better access to their data. Others are concerned that said rule is a hefty 1,244 pages long.

OK, so I didn’t quite live up to my promise, but it’s a great story that points to the future: Italian hospital 3D prints values it needed for the ICU.