Here’s a selection of stories we gathered on healthcarehandout.com this week.
Things That Happened
Troubled Hospitality. Hospitals are losing a lot of revenue as most normal medical activity remains on pause. Dr. Bob Wachter at UCSF says they’re losing $5M per day, while the American Hospital Association says its member hospitals are losing a collective $50B per month during the crisis. This is leading to widespread staff furloughs and layoffs, with roughly 135,000 hospital job layoffs in April according to BLS data. Some rural hospitals that have recently gone bankrupt are suing the government for admission into the Paycheck Protection Program, which prohibits bankrupt companies from receiving funds, to keep their doors open during the pandemic.
California hospitals, which have already received $3B in relief funds from the federal government, are asking the state to give them an additional $1B to stave off furloughs and layoffs. Some have pointed out that many hospitals, including some of those in California, have more than adequate cash in their investment portfolios to shore up operations without seeking relief money. One such example: the new investment fund HCA announced this week.
One note on those relief funds: a KHN investigation has found that a lot of that government money has ended up at institutions that have suffered recent criminal fines, including one particularly egregious example where an oncology firm that owes a $40M antitrust penalty on June 1 received $67M in bailout funds.
Cost-sparing. Much of the money that would normally have flowed to hospitals has stayed put with insurance companies, who are weathering the pandemic fairly well. This has led to things like UnitedHealth Group offering 5-20% credits against premiums, and Humana waiving all cost sharing for primary care and behavioral health for its Medicare Advantage plan members through the rest of the year. To add to the instability here is the Robert Wood Johnson Foundation’s prediction that 25 - 43 million Americans could lose coverage through their employers during the pandemic.
Also missing: jobs. 20 million Americans have lost their jobs during this pandemic, and healthcare has been experiencing the downturn just the same as many other industries. Within healthcare, dental has been particularly hard hit and comprises 36% of the 1.4 million jobs lost, while 17% come from physician offices. Like we mentioned above, 135,000 of those jobs, roughly 9.6%, have come from hospitals.
Cease the visits. Some of those elective visits that have evaporated could have longer-term ramifications. A CDC study showed steep declines in the numbers of routine pediatric vaccinations during the pandemic. Similarly, routine cancer screenings have plummeted 86 - 94% according to a white paper from Epic.
One more thing that could have serious ramifications: at least 1,099 clinical trials have been postponed. While most of those are delayed, not cancelled, experts suggest that many could be lost due to funding shortfalls and the logistical complications of restarting.
Party line. Doximity introduced a new video calling feature to their popular Dialer app, which allows physicians to call their patients from a personal phone while the caller ID shows their practice’s number. EHR company DrChrono also unveiled new telehealth functionality, allowing providers to call patients through the EHR using a new mobile app. Given Epic’s recently announced partnership with Twilio to allow in-app video chats, and CVS’ revelation that MinuteClinic telehealth visits in Q1 were up 600% year over year, it’d seem the competitive landscape within telehealth is shifting almost as quickly as adoption is increasing.
Biblical alliance. Mount Sinai Health Partners and Babylon Health have announced a partnership to bring Babylon’s AI-powered assistant, symptom checker, and telehealth features to patients in New York. You might recognize Babylon as the UK company that has raised $2B in venture capital and made waves by claiming its AI could pass the UK’s general practitioner exam.
The price is right. Gilead donated their current supply of remdesivir to the federal government, and the government has distributed some of it. Nobody seems to know how they decided whom to give it to, as it doesn’t correlate with the hospitals hardest hit by the virus. HHS issued a release Saturday morning laying out the process for further distributions, which will go to state health departments, who will then distribute to hospitals based on need.
Gilead is yet to set a price for the antiviral, but ICER has suggested they’d be justified with a price tag as high as $4,500 per treatment course.
Worth watching. Researchers involved in the long-term Apple Heart Study revealed some numbers from the experiment. They managed to enroll 420,000 participants, and successfully detected 2,200 possible AFib events. Participants, when receiving an AFib alert, were able to launch directly into a video visit with a physician to examine the data, but less than half - just 945 - actually did so. Unrelated to the study, something to watch: physicians in Germany wrote a paper in the European Heart Journal claiming an Apple Watch successfully detected myocardial ischemia in an 80-year-old patient.
Not letting Apple have all the smartwatch heart study glory is Fitbit, who announced their own broad, long-term heart study this week.
Human resources. While the promise of massive-scale digital contact tracing has been widely discussed, as plans are coming together to launch efforts in earnest the preference appears to be for analog, human-powered solutions. New York, California, and Massachusetts have already begun hiring armies of contact tracers. This, coupled with a plan submitted last week by a number of notable former federal health officials that argues for human-powered tracing on a national scale, makes it less and less likely we’ll be embracing a digital-first tracing solution.
This follows a critical report from technologists and epidemiologists saying that Apple and Google’s contact tracing program is effectively more trouble than it’s worth as it creates serious privacy concerns without being all that epidemiologically sound in aiding contact tracing. While states are shunning Apple and Google’s tech for tracing, they aren’t precluding tech partnerships altogether: New York City will be working with Salesforce, who will be setting up a call center and a CRM instance to help contact tracers work more efficiently.
FDA EUA TBD. The FDA reversed its earlier decision to allow coronavirus antibody tests to be sold without authorization from the administration. They’re now requiring manufacturers to prove they actually work to get an Emergency Use Authorization before they can sell them.
After NIOSH found that many of the N95 masks being imported from China didn’t actually meet N95 standards, in that they didn’t actually protect the wearers from particulates, the FDA rescinded their approvals for more than 60 China-based mask makers.
The FAANG’s all here. Big tech wants to help, too. Amazon is directly funding clinical trials for convalescent blood plasma, having AWS launch online donor registries, and delivering at-home COVID tests. Google.org, the company’s philanthropic arm, is spending $50M to support front-line workers, the WHO, and public health focused data analytics efforts. And Apple contributed $10M to help a small-scale manufacturer scale up the production of at-home sample collection kits.
Bloomberg took a look at what was going on inside Verily while President Trump was trumpeting that Google (but really Verily) would be coordinating a nationwide testing initiative. Spoiler: they didn’t know what he was talking about. They were targeting a much smaller-scale initiative in the Bay Area, one they successfully stood up, and then charged California an average of $340 per test to complete.
Tragic heap. Magic Leap, the secretive augmented reality startup that has been around for a decade, raised $2.5B, never found success with a product, and recently laid off around half its workforce, is now pinning its hopes on a $100M investment from a major healthcare company that’d also help the company bring its AR solutions to the surgical suite. Rumor has it, it’s Zimmer Biomet.
Haven’t a clue. The WSJ reported Friday night that Atul Gawande is in talks to step away from day-to-day management of Haven (the Amazon - Berkshire - JPMorgan joint venture) and take on a more policy and advocacy focused role as Chairman.
Hacked together. CISA, the Department of Homeland Security’s cybersecurity agency, issued a joint statement with their UK counterpart warning that state-sponsored hackers are targeting healthcare organizations, including pharma and research entities, seeking details about the coronavirus response. This came to fruition relatively quickly as Reuters reported Friday that Iranian hackers targeted Gilead executives with phishing attempts.
Lab retriever. GoodRx, the company that helps people pay less for prescriptions by comparison-shopping pharmacies, is now applying the same logic to lab testing. Users can now compare pricing for 18 different kinds of tests - including coronavirus tests - across 10 different providers.
Extra CRISPR. Sherlock Bioscience received an FDA Emergency Use Authorization for a CRISPR-based COVID-19 test, marking the first time the vaunted new technology has been through any FDA review.
Things That Started Up
Owkin raised $25M to extend their Series A. They’re building a virtual lab that allows researchers to more easily and safely share anonymized data sets.
Limbix raised a $9M Series A. They’re building a digital therapeutic for teenage depression that’s deployed via mobile app. They’re also working on a VR delivery device.
Wellth raised a $10M Series A. They’re building a platform for utilizing behavioral economics to incentivize treatment adherence.
LetsGetChecked raised $71M. They’re continuing work on their at home diagnostics services, including antibody and PCR testing for coronavirus.
First Dollar raised a $5M seed round. They’re building a consumer-friendly HSA experience, as well as offering account administration services for employers.
Medable raised $25M. They’re continuing work on their decentralized platform that helps speed up clinical trials through improved data access.
Things To Read
Taylor Nicole Rogers took a deep dive into how concierge doctors are helping their clients, who pay as much as $10,000 a month, operate outside the healthcare system and get their hands on much-coveted coronavirus tests.
John Moore makes some predictions around the effect that the COVID crisis will have on various aspects of healthcare including telehealth, physical practice design, health IT, alternative payment models, and more.
Nikhil Krishnan unpacks classic health-tech business strategies, specifically building patient-centric EMRs and behavioral incentives.
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