#39 - Autumn Detection

Highlights and insights from this week in healthcare tech and business

Things That Happened

A new rule for gag rules. There’s a new law on the books that allows pharmacists to inform patients their medications could be cheaper if they don’t use insurance or purchase an approved alternative generic. 

Big smiles. SmileDirectClub, a startup that helps those of crooked-tooth avoid the orthodontist by straightening their teeth using molds that come in the mail, has raised a round of financing at a $3.2 billion valuation. The total US dental expenditure in 2017 was $124 billion, and about $50 billion of that was cash pay. Dental may look like healthcare, but with a lot more consumer agency in payment there’s a more direct path for companies to disrupt the market using improved customer experience as their wedge. 

Athena at auction. Athenahealth is still soliciting bids for the company from a mixture of private equity firms and strategic buyers. The saga began last year when Elliott Management, an activist investor, bought up a 9% stake in the health tech company, followed soon after by the ouster of Johnathan Bush as CEO. For more on this turbulent time for the company and the questionable tactics of Elliott Management read this superlative piece from Sheelah Kolhatkar in the New Yorker. 

AC-A little bit cheaper. Average premiums for individual health insurance coverage on the federal marketplaces are set to decline by about 1.5% next year. Read more before celebrating, however, as this number doesn’t include states that run their own exchanges, and there’s also the huge question of who and what policy is responsible, and if the decline in prices could have been larger if not for a presidential administration hell-bent on picking apart current healthcare regulations. Also, don’t forget that prices have risen significantly overall since 2017. 

DystopiaCare. TNT has ordered 10 episodes of a new reality show were people get their ailments diagnosed by a panel of doctors, and there’s a studio audience for some reason. Welcome to the future. 

You probably already heard. CVS and Aetna got the DOJ’s blessing to merge, so long as Aetna divests their Medicare drug business. 

Things To Read

Young Zhang, a software engineer at Oscar Health, describes a tool his team built to make PDFs searchable for the nurses at Oscar who receive a flood of patient documents daily. This sort of effort - using scarce engineering talent to build an internal tool - speaks to Oscar’s broad product focus. If the product is a top-tier patient experience, then improving nurse’s ability to find relevant information in the 23,000 PDF’s they receive monthly will lead to better patient care, and thus improved patient experience. 

I’ve written before about how Oscar and other new(er) entrants to healthcare are using a tech and product focus to create competitive advantage

“Researchers from the California Department of Public Health found that, from 2007 to 2016, 776 products marketed as dietary supplements contained hidden active ingredients that are unsafe or unstudied.” Rachel Bluth summarizes a recent study in JAMA revealing the questionable status of the FDAs efforts in regulating dietary supplements. It’s reasonable to assert that the FDA can’t possibly screen all of the 80,000 supplements on the market, but then they must do a better job of post-market surveillance when complications from these supplements arise. In many ways it’s a similar problem to the one described in the recent medical device documentary The Bleeding Edge

A study in the American Journal of Medicine examines the financial effects of newly diagnosed cancer on older patients. In short, 42% of patients depleted their life savings fighting the disease. 

“Younger patients… are unwilling to wait a few days to see a doctor for an acute problem, a situation that used to be routine.” Sandra Boodman detailed another thing millennials are shunning: traditional primary care. She wrote this week in the Washington Post about how a sizable portion of millennials don’t have a primary care doctor and instead rely on urgent care and retail clinics when they need to be seen by a medical professional.  

But don’t consider this phenomena in a vacuum: healthcare is exorbitantly expensive, and there’s a shortage of primary care physicians leading to longer wait times and increasing difficulty of even getting an appointment in a traditional practice. Perhaps instead of laying declining interest in primary care at the feet of the population opting to go elsewhere, we should look at the system that’s failing to meet their needs, and charging them a lot to do it. 

“Using DNA testing to determine how well a given depression medication will work with a patient's genetic makeup is becoming a popular approach.” Erin Brodwin surveys the landscape of genetic testing for drug effectiveness and ponders whether these tests are returning enough insight to warrant their high costs. 

Thanks for reading The Healthcare Handout, a weekly update on tech and business in healthcare from Isaac Krasny. Criticize, praise, hire, or otherwise get in touch with Isaac via isaac@healthcarehandout.com, or on twitter @isaackrasny

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