Healthcare Handout #58

Everything that happened this week in health tech and business

Here’s a selection of stories we gathered on this week.

Things That Happened

Drugs that may work, and those that don’t. A new study in the Lancet showed hydroxychloroquine and chloroquine multiply the risk of serious heart distress 2 - 3x without also establishing they do anything to treat or prevent COVID-19, so it’d be a bad idea to take it prophylactically if you were thinking of doing something like that.

In the realm of drugs that work, Gilead has donated another 330,000 doses of remdesivir to the United States government, enough to treat 30-55k more patients. Which patients? Doctors are having to decide which patients should receive the drug without data on outcomes, and some, like UPMC, are using a lottery. Some new information arrived Friday night, with a new trial emerging in NEJM showing that remdesivir is successful in shortening recovery time, but with a decline in benefit as case severity increased.

Moderna released some data on Monday showing very early and small data on their coronavirus vaccine. While it was certainly positive, experts, as they are wont to do, urged caution, saying it’s entirely too early and the size of the study is so small that we can’t really derive any sort of reasonable predictions yet. 

The U.S. government, via BARDA, gave $1B to AstraZeneca to develop and distribute a coronavirus vaccine based on research from Oxford University. AstraZeneca is promising to make 1 billion doses of the drug with delivery starting as early as September (clinical proof of efficacy would come later than September).

This only scratches the surface of the drug and vaccine activity around COVID-19, so as always I recommend STAT’s drug & vaccine tracker

Chasing tracing. Apple and Google pressed a button, or whatever it is they do to push OS updates, and released their exposure notification API to the world. This meant that the 22 countries and several states, including Alabama, North Dakota, and South Carolina, who have said they plan on using it can release their apps. 

Some states are forging their own path: Rhode Island hired Infosys to build them a contact tracing app, which someone decided it was a good idea to call ‘CRUSH COVID RI,’ that’ll use location information to establish contact history. Georgia is making an app that lets people log their own contacts, like a journal in your phone, and share them with public health authorities if they so choose.

Getting stamped. Several companies, including Collective Health, Microsoft & UnitedHealth, Castlight Health, and Epic, are getting into the immunity passport business. While those are all focused on employers, ex-Googlers have created the CVKey Project, a non-profit working to create a QR-code based system that’d function as a “health pass” for people who want to go into stores and restaurants, and maybe even office buildings. Meanwhile, there are some pretty big questions about whether immunity passports actually work (due to our lack of understanding around convalescent immunity) and whether they’re a good idea (due to the opportunity they create for human rights violations). 

Primary scare. Primary care practices are in trouble. In a recent survey, 13% of practices said they’re facing the prospect of closing their doors within the next month due to a lack of revenue. This stems from the fact that 50% of the same practices report no income from virtual visits in the last month. Some argue private insurers would be doing themselves a favor by boosting payments to primary care now, to save themselves from having to live in a world without them a few months from now. Many of these practices will sell themselves to health systems at bargain prices, at which point insurance companies will have to pay the higher rates these health systems can negotiate.

Rebound. An analysis shows that outpatient visit numbers are beginning to recover from their April lows, but they’re still 30% lower than normal volume. Commercial labs are also experiencing a resurgence, and once you factor in COVID related activity many are actually operating at above normal capacities. The CEO of Medtronic says his company is gearing up for surgeries to resume after they’ve gotten word from numerous health systems that they’ll be working 7 days a week to make up for lost time. 

Ajit Pain. As part of the CARES Act, the FCC is doling out grants to aid providers with telehealth adoption. For example, Mount Sinai is using their $860K grant to build a remote monitoring app. But the problem is that despite approving $33M in grants thus far across 89 providers, only one has actually received the funds. 

Very well. Telehealth continues to notch big gains, with American Well raising $194M that’ll help them continue being a telehealth company, a winning strategy in the current climate. There’s still room for upstarts like Abridge, which is combining telehealth and natural language processing to produce automated transcripts of visits for both patients and providers. 

Fundamental. The mental health space is having a similarly huge moment. All in the space of this week: Mindstrong, which is targeting serious mental illness with it’s text and video care platform, raised $100M; Tava, a Utah-based mental health startup raised a $3M seed; and Cigna added Talkspace as a covered telehealth offering for 14M members, while Kaiser Permanente made the meditation app Calm, normally $70/year, freely available to all members. 

Down the river. Amazon expanded access to its platform, previously only available to office-based workers in Seattle, to warehouse workers also based in Seattle. Beachhead in care delivery, or just a way to save money with employee care? That’s the question. 

Recalling home. With Emergency Use Authorizations and deliberately relaxed enforcement, the FDA has been letting more products through the approvals process than usual. Stericycle is predicting a follow-on effect in the form of a precipitous rise of medical device recalls later this year. 

Big data. Palantir, the data analytics firm, has been hired by the Department of Veterans Affairs to deploy its Gotham software to “track and analyze COVID-19 outbreak areas and make timely decisions with insight into supply chain capacity.” This software is typically used in law enforcement. They’re also working with the NIH, and have recently secured large contracts around the world, all of it related to helping wring insight of data to fight COVID. 

Studying hard. Fitbit wants to build an algorithm for pre-symptomatic COVID-19 detection using their devices, and they’re launching a study to help them do that. Fitbit users with diagnosed cases are being asked to opt-in using the app. This is their second big study this launched month; they announced a heart study to detect arrythmia. 

CRISPIER. Mammoth Biosciences has agreed to a deal with GlaxoSmithKline to create and distribute a CRISPR-based coronavirus test. They’re targeting a rapid, disposable, and easy to use test that can be used by non-medical personnel and will deliver results even if the patient is asymptomatic. This would be the second CRISPR-based test after Sherlock Biosciences received an EUA for their test earlier this month. 

Things That Started Up

Things To Read

Stephanie Goldberg writes about Medline and how the coronavirus pandemic has dragged this generally muted medical supply behemoth out into the spotlight. 

David Muhlestein, et al write about a study in which they found that more accountable care organizations are actually physician led than those led by hospitals. This contravenes both the common conception of what exactly ACOs are, and the legislation and rules concerning them which tend to consider the needs of hospital-based ACOs over the less dominant, but more numerous physician-led versions. 

Heather Perlberg wrote about how private equity has sunk its fangs into dermatology, turning this lucrative practice area into one even more focused on profits and cash flows. To be fair to the vampiric shadow creatures of private equity, they’re simply magnifying many of the perverse incentives that already existed in the space. 

Lev Facher asked a panoply of experts from the many reaches of healthcare to opine on how our current pandemic will change the industry. They provide predictions on telemedicine, employer-sponsored insurance, nursing homes, scope of practice, drug pricing models, and much, much more. 

Dave deBronkart illuminated us all with a brief glimpse into how FHIR, the universal standard for transferring health data, actually works. If you’ve ever wanted to stroll through the office with the casual confidence of someone who understands how an API works, at least at an armchair level, look no further. 

Thanks for reading the Healthcare Handout, a weekly roundup of everything that’s happened in healthcare technology and business.

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