Here’s a selection of stories we gathered on healthcarehandout.com this week.
Things That Happened
Wonder Drug. Gilead announced they’ve struck a deal with 5 generics manufacturers to make and distribute remdesivir in 127 countries, royalty-free for the duration of the pandemic (not including the U.S., naturally). Gilead hasn’t determined pricing for the United States yet, but STAT asked experts to weigh in with their thoughts on what Gilead could and should charge.
Meanwhile, in our neck of the woods., following a scattered and mysterious initial distribution, HHS laid out a strategy by which they’ll distribute the thus-far donated drug to state health agencies, who can then in turn decide which hospitals are most in need. The problems continue, however, as doctors are still being forced to ration remdesivir, and must do so with little data-driven guidance on which patients the drug is most likely to help.
Machine yearning. It’s often hard to tell the interesting AI from the run-of-the-mill ‘we’re saying it has AI to make it sound cooler’ stories. Two worth clipping from this week: Intel and Penn Medicine are collaborating with the NIH to create a new model for identifying brain tumors. What’s most interesting here is they’ll be using a technique called federated learning, which enables the training data to stay securely in one place while the model essentially travels around being trained. It goes a long way towards resolving privacy issues in medical AI applications.
And Nvidia announced a lot of things this week, but most interesting to us is their Clara Guardian platform, which enables hospitals to run vast networks of distributed edge-AI equipped sensors. If you’re going to have a ‘smart hospital,’ you’ll probably need a platform like this one. Edge AI is particularly cool as it’s specifically engineered to run locally on a sensor, rather than requiring the computing power of a PC or vast network bandwidth.
That’s a relief. A Kaiser Family Foundation study found that hospital relief funds, distributed by HHS along patient revenue lines, have overwhelmingly benefitted hospitals who see fewer Medicare and Medicaid patients when calculated on a per-bed basis. This could prove troublesome for some hospitals: Sarah Kliff wrote about how numerous hospitals are almost entirely reliant on relief funds at this point to keep their doors open, while others are dipping into investment portfolios to stem losses.
Meanwhile, the CFO of the Mayo Clinic (one of the hospitals selling off its portfolio in the above story) mentioned in an interview that their projections for 2020 are looking much better after the nation avoided the worst-case-scenario and flattened the curve. If a better-than-expected hospital outlook helps them avoid further relief funds, that could be a good thing as the White House is starting to nudge Congress to require hospitals receiving relief funds to disclose their secret negotiated price lists with private insurance.
Breathing easier. Fitbit will be shifting production bandwidth to make ventilators. While many ad-hoc ventilators are bare-minimum devices in terms of cost and features, Fitbit is targeting the mid-range on both qualities. Meanwhile, the Trump administration has begun the work of reworking the strategic national stockpile to avoid debacles like this in the future, by doing things like tracking shelf-life and increasing the planned number of days of supply they keep on hand.
Good news and bad news. One Medical posted their first ever public earnings, revealing deeper losses than expected, but also some optimism in the form of raising projections for the total number of members they’ll have by years’ end. That said, they have pushed some new practice openings back into 2021. And don’t forget that study they commissioned that showed lowered costs per employee when using their system.
Passport control. A number of companies are starting work on the next stage of the pandemic: getting back to work. Microsoft and UnitedHealth Group are collaborating on ‘ProtectWell,’ an app that allows employers to regularly survey their employees for COVID-19 symptoms. Collective Health announced ‘Collective Go,’ an app that goes a step further by helping employees store antibody test results to demonstrate their immunity to employers. Both are being offered for free to all employers. Also, Epic CEO Judy Faulkner said her company is eschewing a focus on contact tracing to build some sort of immunity passport solution.
Virtual reality. Telehealth continues to notch progress towards the mainstream. BCBS of Tennessee, which had boosted tele-visit payments to match those of traditional on-site visits during the pandemic, has decided to make those changes permanent. Up in Washington, Premera Blue Cross has gone even further by creating a lower-premium plan where the tradeoff is that patients must use telehealth app 98point6 for all their primary care. Telehealth provider Doctor on Demand has elected to become the first of its kind to offer services permanently to Medicare Part B beneficiaries. And scheduling service ZocDoc has unveiled their own video consultation platform.
And addiction medicine has been effectively transformed by the lax, pandemic-era rules of telehealth. Physicians in this space are hoping this new way of doing things outlasts the disease as it has helped them take better care of their patients.
Nursing groans. New York State decided this week to require all nursing homes test their workers twice per week. In response, a group of nursing homes got together to say that, while they think this is a great idea, it’s effectively a logistical impossibility. In terms of returning to normal, HHS' draft guidelines for re-opening nursing homes (to visitors, mostly) were leaked. Experts responded by saying it’s too soon to consider reopening, while industry complained the guidelines were too vague.
Abbot and oh, hell no. Abbot announced Tuesday they’d be expanding their capacity for antibody test production, targeting 60 million units in June. This good news lasted all the way until Wednesday when an unreviewed, preprint NYU study showed that Abbot’s tests had a 33%-48% false negative rate. By late Thursday, the FDA issued a warning that Abbot’s tests might be producing false negatives, while Abbot said that practitioners are using the tests wrong.
Getting testy. CVS said they’re planning to have 1,000 self-swab test sites open across the country by the end of May, with a larger goal of processing 1.5 million tests per month once fully ramped. If leaving your house isn’t your thing, Hims & Hers, the grammatically-questionable startup had their at-home collection kit authorized for use, while LabCorp is expanding their at-home collection to the general public with a physician’s note (it was previously limited to health workers). And if getting swabbed or spitting into a tube don’t sound enjoyable, researchers in the UK are hard at work on a test that uses fingerprint sweat to identify coronavirus infection.
And finally, New York urgent-care chain CityMD told 15,000 patients who tested positive for COVID-19 antibodies that they’re now immune. Given there’s broad disagreement about the evidence for convalescent immunity, CityMD is getting back in touch with all those folks to let them know they might not be immune after all. Oof.
Sting like a bee. North Carolina health system Atrium Health is partnering up with Butterfly Network to bring Butterfly’s handheld ultrasound devices to physicians in more than 30 Atrium locations. If you like to geek out on cool tech, the Butterfly iQ device is a fantastic piece of disruptive technology.
Go on, Gawande. Atul Gawande made his resignation from the Haven Healthcare CEO job official this week. He’ll stay on as Chairman.
Drug dealers. While it’s far from surprising that brick & mortar pharmacy chains are seeing an uptick in mail-order business during the pandemic, the 20% growth they’re reporting pales in comparison to some delivery-first pharmacy startups which are reporting 5x growth in new customers.
Rock n’ enroll. The IRS has given employers leeway to allow their employees to make changes to their health plans outside of enrollment periods. This means adding a family member, changing plans, or dropping coverage altogether. This is cold comfort for the estimated 27 million Americans who have lost access to their employer-sponsored insurance during the pandemic.
10,000 maniacs. 23andMe announced Wednesday they’re expanding a study into genetic links to COVID-19 severity and susceptibility, and to that end will be recruiting up to 10,000 new participants who have been hospitalized with COVID-19.
Good enough for the rest of us. In a bid to find creative ways to cope with demand and newfound limitations, providers are turning to consumer tech. Mount Sinai, as part of a partnership with Google, is using Nest cameras to observe and interact with patients. Many providers are utilizing consumer-grade ECG tools like Apple watches and AliveCor devices to provide cardiac readings from afar.
Return of the King. UnitedHealthcare has filed to return to Maryland’s ACA exchange, perhaps signaling a broader set of moves that’d bring the behemoth insurer back into the individual marketplace fold in a bigger way.
Things That Started Up
Stellar Health raised a $10M Series A. They’re building a platform to incentivize primary care physicians by paying them directly to perform value-based care-coordination activities.
Ophelia raised a $2.7M seed. They’re building a platform for patients recovering from opioid abuse disorder which helps them stay on top of prescriptions and connect with care coordinators.
Immunai emerged from stealth with $20M raised. They’re building machine learning tech to map the entire immune system, and in turn help develop novel diagnostics and therapies.
Meru health raised an $8.1M Series A. They’re building a digital mental health platform that provides programs and access to therapists for people suffering from depression, burnout, and anxiety.
Lucid Lane raised a $4M seed. They’re building a telehealth platform expressly catering to the needs of those suffering substance abuse and medication dependence disorders.
Carbon Health extended their Series B with an additional $26M raised. They’re using the funds to hire more staff and expand their ability to offer testing during the pandemic.
Things To Read
Adam Cohen, et al, released a study in which they looked at funding data for more than 1,200 digital health companies from 2011 to 2018. What they found: digital health, like the health system at large, is disproportionately focused on disease management and treatment, rather than prevention and detection.
Matthew Fiedler and Zirui Song released predictions for the overall cost of patient care for COVID-19, and produced numbers much less catastrophic than other estimates. They argue that COVID-19 will increase overall projected health costs for 2020, but only by about 1 - 5%.
Darius Tahir wrote about how public health agencies are heavily reliant on outdated technology like paper records and fax machines. This leads to more mistakes, slower data transfer, and gaps in reporting.
Robert Langreth looks at Gilead, their lineage in making potent & expensive antiviral drugs, and how they reacted early and quickly to ramp remdesivir production, even before clinical trials assessing effectiveness were complete.
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