THCB Gang Episode 97, Thursday June 30, 1pm PT 4pm ET

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday June 30 will be THCB regular writer and ponderer of odd juxtapositions Kim Bellard (@kimbbellard); Principal of Worksite Health Advisors Brian Klepper (@bklepper1); futurists Ian Morrison (@seccurve); and fierce patient activist Casey Quinlan (@MightyCasey). I suspect a couple of political issues may just come up given the last week or so in Washington DC.

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

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Quantifying Caregiving: ARCHANGELS CEO Alexandra Drane on The Caregiver Intensity Index

By JESSICA DaMASSA, WTF HEALTH

“Being an unpaid caregiver is the epicenter of Life Sucks Disease,” says Alexandra Drane, Co-Founder & CEO of ARCHANGELS, “but it’s also one of the most glorious, one of the most magnificent jobs we’ll ever have.” So, what’s the trick to managing the “sucky” side of caregiving? Data.

Alex’s company ARCHANGELS has invented the Caregiver Intensity Index, which she describes as a “two-and-a-half minute Cosmo quiz” that helps caregivers quantify the intensity of their caregiving experience and identify the top two things driving that intensity and the top two things alleviating it. The score coming out of this helps caregivers validate the intensity of their experience, offers a framework for communicating about it, and, as Alex puts it, delivers “data that gives them permission to believe” that the stress they are feeling is real. ARCHANGELS then uses the info to crosswalk caregivers to existing resources that can help them manage those intensity-driving challenges – whether they be related to financial stress, workplace stress, relationship stress or otherwise.

Knowing that health plans and employers are starting to “see the light” when it comes to caregiving and its impact on their workforce, Alex and I talk about just how much payers are really willing to contribute to supporting the resources needed to support caregivers and how the data ARCHANGELS is providing is helping demonstrate need and connection to health and well-being. Lots of interesting data points on caregiving in this one – particularly when it comes to mental health and how things have changed through the pandemic. Watch now!

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We Have a Right to Privacy…Right?

BY KIM BELLARD

Well, they did it.  We had a warning they were going to do it, from the leaked opinion in May, but it still was a blow to well over half the country when the Supreme Court struck down Roe v. Wade in its ruling on Dobbs v. Jackson Women’s Health Organization. It didn’t rule that abortion was unconstitutional – as Justice Kavanaugh wrote. “On the question of abortion, the Constitution is therefore neither pro-life nor pro-choice” – but, rather, left it to the “voters,” i.e., the states, to decide.  And, boy, the “pro-life” states have been deciding and are ready to do a lot more deciding.  

There has been lots of outrage, many protests, and calls for the Senate to pass a federal law explicitly granting a right to abortion (although that would require changing the filibuster rules).  Aside from the fact that the Democrats probably don’t have the votes to do that, even if they did, as soon as the Republicans retook Congress and the White House, they’d just repeal it and perhaps pass a law outlawing abortion everywhere.  So it goes.

There are going to be many fights about abortion in Congress and in the states, but I think it’s time for a new strategy.  It’s time to amend the Constitution.  

No, we’ll never get an amendment explicitly granting the right to an abortion – but we might get enough consensus on an amendment explicitly assuring the right to privacy.

Many people are surprised to learn that the Constitution does not include a right to privacy.  It has many rights that Supreme Court has ruled “imply” certain rights to privacy.  It did so in 1965’s Griswold, which for the first time gave married couples the legal right to use birth control.  It similarly did so in 1971’s Eisenstadt (contraception for unmarried couples) and in 2003’s Lawrence (gay sex), as well as, of course, in Roe (1973).  The current Court, though, found the Roe decision had been wrongly decided.  

The Court’s majority opinion, and Justice Kavanaugh’s concurring opinion, took pains to clarify that no other precedents were at stake with this ruling, but the dissenting opinions raised the alarm, and Justice Thomas’s concurring opinion sort of exposed the conservatives’ plan by noting: “In future cases, we should reconsider all of this Court’s substantive due process precedents, including Griswold, Lawrence, and Obergefell [same sex marriage].”

So, after fifty years of believing they has a right to an abortion, America women suddenly are finding out that, well, it depends on where they live.  Some states are not allowing abortions even in the case of rape or incest, perhaps not even if the woman’s life is at stake.  Some states want to restrict women from traveling to other states to get abortions, or to get abortion medications through the mail.

Strange times.

We’re finding that what happens between a woman and her doctor isn’t private; we’re finding that what procedures she may have or what prescriptions she may get isn’t private.  These are matters for the state; HIPAA is not going to protect you.  We’re being reminded that HIPAA only goes so far, and, in our digital age, that isn’t very far.  Women who might have been using, say, a period tracker now have to worry who else can access their data, and what they can do with it.    

But, of course, I say “women” and I’m talking about pregnancy/abortion, but in 2022 all of us should be wondering who might be accessing our health information, for what purposes.  Our digital footprints and fingerprints are everywhere, and third parties are very interested in them, be they for law enforcement purposes or for more mercenary reasons.  

Hospitals recently got caught selling patients’ health information to Facebook, and you’d think both would know better.  Then again, Facebook is still targeting ads to patient groups on its platform, despite having promised several years ago to do better about that.  If you think there are some responsible parties watching out for our health data, I’d like to know who they are.  

It’s not just health data, of course.  We’re already concerned about data privacy generally, especially when it comes to Big Tech (whomever they might be).  A 2021 KPMG survey found that 86% of respondents had a growing concern about their data privacy, and 78% expressed fears about the data being collected.  Congress is supposedly working on the issue (long after the EU passed GDPR), with the American Data Privacy & Protection Act passing a House subcommittee earlier this week, but that’s a long way from actual passage.  

Congress is not going to be our savior.  Some states are trying, such as California, but that’s only going to go so far.  If we want to assure our privacy, and the benefits that accrue from privacy, we’re going to need to go further – much further.  We’re going to need to amend the Constitution.  

Now, I’m not naïve.  In the hyper-partisan country we live in, getting three-fourths of the states to agree on anything seems like an uphill climb.  Just ask proponents of the Equal Right Amendment, which never passed.  The last Amendment that passed (the 27^th) took 202 years, and all it tried to do was delay Congressional salary increases until after the next federal election.  

No, we’re never going to get three-fourths of states to ratify an amendment granting a right to an abortion.  But we might get enough states to ratify an amendment that codifies our rights to privacy more generally, and, if worded artfully, the right to an abortion should be a consequence.  “Pro-life” advocates are not known to be people who are usually willing to compromise, but neither are they people who typically are comfortable with either the government nor Big Tech “spying” on them.  

A right to privacy might be one thing we could all agree on; maybe not all, but perhaps at least three-fourths of us.  

Pro-choice advocates, and I count myself as one, should still be making our voices heard – going to protests, letting our local, state and federal elected officials know our feelings, advocating to strike down laws restricting access to abortions and/or proposing ones that help assure it, and, most importantly, truly voting as though our rights are at stake, because they are.  Those are all necessary actions, but not sufficient.

Anti-abortion advocates have been playing the long game, and Dobbs is its latest success.  The attack on our rights will continue to fit the conservative, evangelical Christian worldview that now drives the Republican party.  The only way to assure them is a Constitutional Amendment.

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor.

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Getting Sick and Going Broke – CVS, Credit Cards, and Crippling Medical Debt

BY MIKE MAGEE

The Medical-Industrial Complex is swarming with grifters. This is to be expected when you build a purposefully complex system designed to advance profitability for small and large players alike. The $4T operation payrolling 1 in 5 American workers is, in large part, a hidden economy, one built by professional tricksters, designed by Fortune 100 firms with mountains of lobbyists, but reinforced as well by friendly doctors and hospitals engaged in petty and small scale swindling who justify their predatory actions as entrepreneurial, innovative, and purposeful means of necessary financial survival.

When lobbyists for high-priced stakeholders get called before Congress, as they did on March 29, 2022 before the House Committee on Oversight and Reform, they make it sound like Americans should embrace the privilege of being screwed over by MIC elite. But as former Kaiser Permanente CEO, George Halvorson, recently reminded, “People are getting bankrupted when they get care, even if they have insurance.”

It’s enough to draw a person back to the early 1950’s when Arthur Sackler helped launch the Medical-Industrial Complex. In fact, our modern day willingness to mask health care cruelty in high-minded language and miscarry  justice is extreme enough to draw one back to June 9, 1954, when Boston attorney, Joseph Welch, hired by the U.S. Army to defend it against accusations of Communist infiltration, said to Sen. Joe McCarthy, “Little did I dream that you could be so reckless and so cruel…You’ve done enough. Have you, sir, no sense of decency at long last?”

Halvorson and others seem to be reaching a similar boiling point, ready to utter to controllers and apologists of the MIC – “Have you not done enough?”

The most recent tipping point comes in the form of a June 16, 2022 KFF poll revealing that more than 100 million Americans, including 41% of all adults, carry significant medical debt, much of it out-of-sight, carried on personal credit cards. Hospitals and doctors have been tapping into the patients cards for payments, leaving patients tapped out, with high interest plastic debt. 1 in 8 now owe more than $10,000, which nearly 20% say they will never be able to pay off.

The problem is accelerating as health insurers have pushed skimpy plans with deductibles that can legally reach $8,700 a year per individual. As I documented with Tenet Health Care Systems and their Conifer Collection System in 2018, the debt business has bailed out poor hospital practices and medical group mismanagement more than once. Now four years later, 58% of collection agency listed debt is medical in nature. One in 10 of the desperate debtors owe money to family members, and collective medical debt now tops $195 billion as of 2019.

As if it couldn’t get worse, the debt (as one might expect) is not spread evenly. Southern states are over-represented due to poor insurance protection laws, lack of Medicaid expansion, and greater presence of chronic disease in their populations. Medical debt is 50% more common in Blacks, and 35% more common in Hispanics, than in whites. If you live in an unhealthy county (measured by high rates of chronic diseases), 1 in 4 have medical debt, compared to 1 in 10 in healthy counties.

Of course, if you are unhealthy in the U.S., you are also in the cross-hairs of direct-to-consumer drug advertising. The practice of pushing medications through TV ads is only allowed in one other nation in the world. 

More than 1 in 3 Americans will fill those prescriptions at CVS, where whistleblower, Alexandra Miller used to work. What is she blowing her whistle about? According to STAT’s uber-pharma investigative reporter, Ed Silverman, her lawsuit contends that “Starting in 2015, CVS allegedly coordinated an effort that relied not only on its SilverScript (Medicare Part D) subsidiary, but also its Caremark pharmacy benefit manager (PBM) and its chain of CVS retail pharmacies to prevent consumers from obtaining low-cost generics because the company profited from making only higher-priced brand-name medicines available to its customers….”

 The kickback scheme involved CVS Health’s Part D plan sponsor, SilverScript; its pharmacy benefit manager, CVS Caremark, and CVS Pharmacies with hidden rewards flowing back and forth as patients credit card debt skyrocketed. As America proceeds headlong into a recession, and the economy becomes bedridden, the ghost of Arthur Sackler is rising from its gilded crypt and whispering, “It is your own health care system that is making you sick and broke.”

Mike Magee, MD is a Medical Historian and Health Economist and author of “Code Blue: Inside the Medical Industrial Complex.“

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American health care leaders are not blameless today

By MATTHEW HOLT

It is a very sad day for America. Roughly 30% of our country is part of a quasi-religious cult. In general these people reject science and the enlightenment. This week the Jan 6th committee has shown they are prepared to use and support any tools or tactics–up to and including the overthrow of the government, in order to get what they want. 

The overturning of Roe vs Wade is the most visible artifact of a 40-year campaign. The campaign was funded by business leaders like the Koch brothers who want to revoke all environmental, labor and rational restrictions on their activities. Using dark money and the passion of religious zealots who want to control women’s bodies and discriminate against anybody who doesn’t believe what they believe, they have turned this nation back to the 18th century, using the Supreme Court as their vehicle.

The biggest of those dominos has now fallen and women’s right to control their own bodies have been taken away in most states. We can assume a nationwide ban (such as happened in Poland) will be coming here soon, maybe as soon as 2025 if the Republicans win the 2024 elections. And note that the rolling coup described by the witnesses at the Jan 6 hearings show that the Republicans are already blatantly taking over the supposedly neutral election process.

But the American health-care system is not blameless. Abortion and other reproductive health services are clearly part of health care. Yet uniquely in this country the provision of the services has not been from mainstream health care institutions. The leaders of our health care organizations, in particular our major hospital systems, have completely avoided delivering these services. They have been more than happy to allow Planned Parenthood and other specialist organizations to provide reproductive care, and have just looked the other way in the debate. 

Worse, many of our religiously affiliated institutions,  particularly those with a Catholic heritage which represent an enormous amount of hospitals in this country, have banned not only abortion but many other forms of reproductive health care such as female sterilization. The Hyde Amendment, ironically named after religious bigot who was an appalling adulterer and hypocrite to boot, bans Federal funding for abortions. That means that private Medicaid plans which now cover most births in this country have never offered a full suite of reproductive health care.

Even in recent weeks when the fate of Roe became clear I have heard nothing from major leaders of hospital systems or health plans about this. Some of the newer provider organizations focusing on women, such as Maven and Tia, have been outspoken, as have many non health care-related employers. But the general silence all major health care organizations in America on this topic has been deafening.

Today there is plenty of shame and blame to go around.

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#HealthTechDeals, Episode 37 | Proximie, Abacus Insights, AI VF, Florence, Cara Care & Newtopia

Jess & I have been out late playing the odds in Vegas at the AHIP conference. This #healthtechdeals has a special appearance from our friend Lara Dodd at Newtopia, and then there are deals for Proximie ($80m), Abacus Insights ($28m), AI VF ($25m), Florence Health ($27m) & Cara Care ($7m) –Matthew Holt

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An Upside Down Future for Healthcare

BY KIM BELLARD

I find myself thinking about the future a lot, in part because I’ve somehow accumulated so much past, and in part because thinking about the present usually depresses me.  I’m not so sure the future is going to be better, but I still have hopes that it can be better.  

Two articles recently provided some good insights into how to think about the future: Kevin Kelly’s How to Future and an except from Jane McGonigal’s new book Imaginable: How to See the Future Coming and Feel Ready for Anything―Even Things That Seem Impossible Today that was published in Fast Company.

I’ll briefly summarize each and then try to apply them to healthcare.

—————–

Mr. Kelly – a founding Executive Editor of Wired (and now “Senior Maverick” there), editor/ publisher of Cool Tools – posits that futurists need to look at the past, present, and future.  “They look carefully at the past because most of what will happen tomorrow is already happening today,” he notes.  “The past is the bulk of our lives, and it will be the bulk in the future.”  

As for the present: 

It is often said that most futurists are really predicting the present. It turns out that the present is very hard to see…So a good futurist spends a lot of time trying to decipher the present and to try to see it through the mask of present-day biases…I sometimes think of “seeing the present” as trying on alien eyes; looking at the world as if I were an alien from another plane.

As for the future, he says, “I find it helpful to unleash the imagination and trying to believe in impossible things…there is an art to believing in impossible things well. It’s more like being open to possibilities, to listening to what is possible.”  

Mr. Kelly suggests trying to picture the “history” of an imagined future, the steps required to get to X in year YYYY, so that we can understand “What kinds of technology and laws and social expectations needed to be in place year by year in order to arrive at that state.” However, he warns: “Most important, the main job is to think about the consequences of X arriving. What would we do if X was true? How do we manage it? How do we regulated it? How does it change us as humans?” 

————–

Dr. McGonigal – a game designer, Director at The Institute for the Future, and co-founder of health app/game SuperBetter – shares five tips for imagining the future:

Take a Ten Year Trip to the Future: “Ten years because that is enough time for society, and your own life, to become dramatically different. It’s enough time for new technologies to scale up and achieve global impact. It’s enough time for social movements to achieve historic victories. It’s enough time for big new ideas to take root, gain traction, and change the world.” 

Be Ridiculous – At First: “Any useful statement about the future should at first seem ridiculous…We need to prepare our collective imagination for “unimaginable” possibilities…If something feels unimaginable, that’s the tip-off that it is an essential future to start thinking about.”

Look for Clues: “To find future clues, you need to develop a way of observing the world in which you spot weird stuff that others overlook.  You must constantly home in on things you haven’t previously encountered, things that make you say, “Huh…strange,” and “I wonder why that’s happening.”

Turn the World Upside-Down: “If your imagination feels stuck in the present, then rewrite the facts of today. Make a list of up to a hundred things that are true today, then flip them upside-down…Turning the world upside-down can help clarify what changes you want in society and your own life.”

Build Urgent Optimism: “Urgent optimism is a highly motivating, resilient mindset made up of three key psychological strengths: mental flexibility, realistic hope, and future power.’

—————–

In healthcare, the past is, for better and for worse, always with us.  For example, the central role of hospitals and doctors is certainly over a century old, that of pharmaceutical companies almost that old; the pervasive presence of employer-provided health insurance goes back to the 1940’s and that of Medicare/Medicaid to the 1960’s.  None of them seems likely to go anywhere anytime soon. 

The present of our healthcare system is, as Mr. Kelly warns, is harder to see.  It has proved dangerously fragile in this pandemic.  It never has offered equal care, or even equal access to care, to everyone.  And, most scary of all, in 2022 it turns out that we still don’t know if most medical treatments work, much less cause harm.  

It’s not a “system” in any meaningful way, and I’m honestly hard pressed to think of for whom it works well; even the people getting ridiculously compensated by it complain.  “Alien eyes” looking at it might not even recognize it as health care, especially considering we keep paying more and more yet are increasingly in worse health.

So we need to think of ridiculous futures, filled with impossible things.  We need to turn healthcare upside-down, as Dr. McGonigal might say.  Ten years isn’t going to be enough; we need to be thinking about 2050, or 2100.  

In my upside-down healthcare world, we don’t have doctors and hospitals.  Care is done at home, supported by assistive/supportive technology and overseen by artificial intelligence.  Health is monitored in real-time and any necessary adjustments are made almost as quickly, such as through the nanobots swimming within us or in the medications/devices we 3D print at home.  Care decisions and treatments are based on evidence, collected and analyzed on an ongoing basis, not on intuition, tradition, or personal preferences.  Technology has lowered costs so much that insurance is not necessary.

We acknowledge that health starts with how we live – what we eat, where we live, what we breathe, how much income we have, how we earn our living, to name a few.  We need massive savings in healthcare to invest in those.  

Where are all the healthcare workers in this future?  I don’t know, but healthcare isn’t supposed to be a jobs program.  It’s supposed to be about maintaining/improving our health.

———-

Sound ridiculous?  Good; that’s how we know we’re trying hard enough.  

I’m going to keep looking for clues to that future, be they improvements in AI, turd robots, or RNA computers – “weird stuff that others overlook,” as Dr. McGonigal says.  I want to be open to the possibilities that healthcare can become, not limited by our expectations about what it is now.

We need more urgent optimism about fixing healthcare.

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor.

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Matthew’s health care tidbits: Is Covid over for the health care system?

Each week I’ve been adding a brief tidbits section to the THCB Reader, our weekly newsletter that summarizes the best of THCB that week (Sign up here!). Then I had the brainwave to add them to the blog. They’re short and usually not too sweet! –Matthew Holt

I am beginning to wonder, is COVID over? Of course no one has told the virus that it’s over. In fact infection rates are two to three times where they were in the post-omicron lull and new variants are churning themselves out faster and faster. We still have 300 people dying every day. But since we went past a million US deaths, no one seems to care any more.

For the health care system, COVID being over means a chance to get back to normal, and normal ain’t good. Normal means trying to get rid of that pesky telemedicine and anything else that came around since March 2020.The incumbents want to remove the public health emergency that allowed telemedicine to be paid for by Medicare, re-enforce the Ryan Haight act which mandates in-person visits for prescribing controlled Rx like Adderall for ADHD, and make sure that tortuous state license requirements for online physicians are not going away. This also means restrictions on hospital at home, and basically delays any other innovative way to change care delivery. Well, it was all so perfect in February 2020!

But there is one COVID related problem that doesn’t seem to be going away. People. They’re just not going back to work and nurses in particular are resisting the pull of the big hospitals. I don’t know the end game here, but there is a clue in the “return to office” data. Basically every large city is below 50% of its office space being occupied and companies are having to figure out a hybrid model going forward, no matter how much Elon Musk objects.

Hospitals aren’t going willingly into the night. The big systems still control American health care, and are prepared to fight on all fronts to keep it that way. But like office workers, nurses and doctors want a different life. The concept of virtual-first, community-based, primary care-led health care has been around for a long while and been studiously ignored by the majority of the system.

If hospitals can’t get the staff and keep losing money employing the ones they have, there will be new solutions being offered to clinicians wanting a different life-style. We just might see a different approach to health care delivery rising phoenix-like from the Covid ashes.

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#HealthTechDeals Episode 36| Sana Health, Sesame, Bardavon, Peerwell, Aidoc

It’s the scandal inside the scandal, and we’ve got the scoop! Check out this episode of Health Tech Deals to learn more about Facebook, health data, and American Hospitals. Is someone stealing someone else’s activity and not getting rewarded for it? What about HIPPAA violations? All these questions and more are answered, along with some new deals: Sana Health raises $60 million; Seasme raises $27 million; Bardavon Health Innovations buys Peerwell; AIdoc raises $110 million.

-Mathew Holt

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THCB Gang Episode 96, Thursday June 16, 4pm ET 1pm PT

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday June 16 are medical historian Mike Magee (@drmikemagee); patient safety expert and all around wit Michael Millenson (@mlmillenson); Queen of all employer benefits Jennifer Benz (@jenbenz); and Suntra Modern Recovery CEO JL Neptune (@JeanLucNeptune), who these days also hosts the Is It Serious podcast.

You can see the video below live (and later archived) & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

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