#47 - When your heart beats for Facebook

Facebook knows your bpm, ABJ tells all in court, and more...

Things That Happened

It’s still getting worse. Healthcare spending is still growing faster than the economy. See Axios for some good (and depressing) highlights, or find the full report in Health Affairs

And worse. Turns out some popular health apps have been sending data like heart rate readings and women’s period and ovulation schedules straight to everyone’s favorite social network, Facebook. While the initial blow back will be (rightfully) directed at the app developers and Facebook who participated in these illicit and unseemly transactions, the question will turn to the role of the app store. Apple’s recent push to craft themselves as a beacon of privacy will be compromised by the fact that, in this case despite their advertised promises, what you did on your iPhone didn’t stay on your iPhone. 

Discovery Health. Optum took to court a former employee who has joined the Amazon, Berkshire-Hathaway, JP Morgan joint venture out of fear he would disclose their trade secrets. More interestingly, ABJ had to disclose their business plans in open court. “The venture will oversee the $4 billion that Amazon, Berkshire Hathaway, and JPMorgan spend each year on healthcare for their roughly 1 million employees and dependents.” 

The focus will be on managing the benefits of existing employees, but you better believe if they figure out how to bend the cost curve for these 1 million people they’ll start selling the services to other businesses. There’s a fortune to be made in making healthcare cost less than a fortune. 

VAPI. Apple announced the VA will be joining its health records network, allowing 9 million VA patients to move their health records onto their iPhones. For the complete and growing list of participating providers, Apple keeps a list

A Bit Different. Fitbit is moving full-steam ahead on their transition away from being a consumer-focused company and into a health services company that uses proprietary devices to facilitate targeted health programs. The biggest clue this is happening: you can’t even buy their newest device unless it’s through your health plan.

Recoverily. Verily is partnering with a couple of provider networks to help treat patients addicted to opiates and “develop a tech-enabled campus conducive to promoting recovery and addressing the holistic needs of each individual.” The program, dubbed OneFifteen, will be centered in Ohio. It’s yet another collaboration for Verily where they bring technology and money and in exchange reap primary data from the front lines of care. 

Things To Read

“Consumers continue to go digital and are now doing so not just out of curiosity or for general fitness and well-being - but with the intention to address concrete health needs.” Rock Health’s report on digital health adoption in 2018 is a fascinating read for points on telemedicine, data sharing, and the above analysis of consumer usage of digital health tools. 

Since the early days of fitness tracking the question has always been whether these wearables would become clinically relevant. As I noted above with Fitbit’s strategic shift, and with things like the Apple Watch EKG sensor, it seems we’ve turned the corner to where these devices are becoming not just clinically relevant, but tools used by physicians and health plans to help patients manage specific conditions. 

“If these tools are going to be used to determine patient care ... they should meet standards of clinical benefit just as the majority of our drugs and diagnostic tests do.” That’s Ravi B. Parikh, co-author of a paper that calls for tighter standards and regulation of AI in medicine. Axios nicely lays out the different components of an issue that will no doubt be much discussed as technology continues to advance and machines get smarter. 

Here’s an interview with Dr. Sumbul Desai, Apple’s VP of Health, in which she reveals no new information about the company’s plans in health. 

Business Insider got a look at the deck Devoted Health used to divine $300 million from the pockets of venture capitalists without having so much as a single customer. Devoted’s strategy for controlling the cost of care is, in essence, very similar to other extant players in the space. They’ll act as both payer and primary provider, using relatively lower cost front-line care to reduce their policyholders’ need for more expensive specialty and hospital care. It’s actually fairly similar to other innovative primary care outfits like Iora Health, Aledade, et al. The question is whether these companies can implement this intrinsically sensible model before they’re crushed under the weight of VC growth expectations.

“In 2017, Health Care Service Corporation, which oversees Blue Cross Blue Shield plans serving 15 million members in five states, disclosed in its corporate filings that it spent $816 million on broker bonuses and commissions,” Marshall Allen continues turning over every rock in the health insurance industry for his series for ProPublica. This time his target is employer insurance brokers, most of whom are paid by insurers as a percentage of the premiums paid by employers. Yet another player in the health insurance game who benefits when premiums go up. 

And that’s a good summation from James Weinstein, the former CEO of Dartmouth-Hitchcock, of the unifying assumption underlying the strategies of most capitation-driven healthcare companies. Hospital-based care is expensive and oftentimes unnecessary, and removing it from the equation by providing more and better lower cost care can be a recipe for lowering overall costs and earning big profits while bending the healthcare cost curve. 

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

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