Accelerating Science-Driven Reimbursement For Digital Therapeutics In State Medicaid Programs

“For evidence-based, prescribed digital therapeutics to reach the most vulnerable populations, they need to be reimbursable by Medicaid. [..] One example is WellDoc, an FDA-cleared digital therapeutic that has been shown to improve outcomes for patients with Type 2 Diabetes, leading to cost savings for employers and health plans. Another example is the FDA-cleared digital health platform Propeller Health, an evidence-based platform for asthma and chronic obstructive pulmonary disease (COPD). There are also digital therapeutics earlier in the FDA-clearance pipeline with growing literature demonstrating reproducible clinical effect. One example is Cognoa, an evidence-based FDA breakthrough-designated company that focuses on diagnosis … Read More

Perspectives of VA Primary Care Clinicians Toward Electronic Consultation-Related Workload Burden: A Qualitative Analysis

“Improving our understanding of clinician-level perceptions regarding e-consultation is important for informing program implementation and adoption, and ensuring that e-consults facilitate delivery of high-quality care. Prior evaluations demonstrated that primary care clinicians and specialists believe that e-consults may improve communication between clinicians. Primary care clinicians and specialists across several health care systems have reported that use of e-consultations increases the efficiency of care and reduces appointment burden for patients. [..] In a 2018 study, primary care clinicians working in safety-net clinics described e-consultations as “increased administrative burden, broadened clinical responsibility, and restructuring of specialty care delivery.” A perception among primary … Read More

A Moment with Duke’s Dori Steinberg: On Nutrition Beyond Calories and Health at Every Size

“[Question] What are you working on right now that you’re excited about? [Steinberg] Our team is developing a behavioral intervention focused on improving intuitive eating and diet quality using digital health tools (apps, video coaching, APIs) to improve blood pressure. Most notably, we were purposeful in not focusing on calories or changing one’s weight in this project. I am excited to offer people something that can improve health independent of changing body size or weight. Reducing weight stigma is something I aim to work on more in future projects. [Question] Who’s doing something that you admire in healthcare today, and … Read More

A Moment with Gina Merchant: On Shiny Objects and Technology’s Path to Meaningful Behavior Change

“[Question] What’s the biggest barrier to getting things done in your line of work? [Merchant] The biggest barrier I face, and observe others facing, is being asked to play by a set of rules and a culture handed down by the tech industry, which does not transfer well to the health tech industry. For example, product timelines are often too short to bring an effective product to market (and despite lip service to iteration, products often remain unchanged year over year). Also, the right combination of experts and leaders are often missing seats at the table; there isn’t enough investment … Read More

Gilead’s Covid-19 Drug Is Mediocre. It Will Be a Blockbuster Anyway.

“the F.D.A.’s decision to grant the drug full approval — which means the company can now begin broadly marketing it to doctors and patients — has puzzled several outside experts, who say that it may not deserve the agency’s stamp of approval because it is, at best, a mediocre treatment for Covid-19 [remdesivir..]. “I think most people think that because a drug is F.D.A. approved, that means it must work,” said Dr. Aaron S. Kesselheim, a professor of medicine at Harvard Medical School who studies the drug industry. He and other researchers recently found that less than one-third of new … Read More

Comparison of Community-Level and Patient-Level Social Risk Data in a Network of Community Health Centers

“no clear standard has emerged on how to implement social risk screening, nor how clinicians can or should use social risk information to adjust patient care or make referrals to community resources. Moreover, some have questioned the benefit of integrating social risk screening into primary care, raising concerns about the additional burden of adding more required data collection to already busy primary care practices and the limited resources available to address identified social risk factors. [..] relying solely on community-level data to understand the social context of an individual patient and/or to guide patient-level interventions poses a risk of ecological … Read More

Where Health Improvement Lags in Recent Decades—Pain and Mental Health

“The health of the US population has improved enormously in many areas but been stagnant in others. The biggest success may have been improvements for people with cardiovascular disease. Major cardiovascular events are declining in incidence, and cardiovascular disease risk factors are better controlled than they used to be. There are many elements behind this good news, the 2 most important being pharmaceuticals to treat cardiovascular disease and public health efforts to reduce smoking. Other areas of health in which there have been major improvements include lung cancer (associated with reduced smoking), breast cancer (stemming from improved treatment), and colorectal … Read More

No-Fault Compensation for Vaccine Injury — The Other Side of Equitable Access to Covid-19 Vaccines

“Wealthy governments that have invested in vaccine candidates have made bilateral agreements with developers that could result in vaccine doses being reserved for the highest-income countries — a phenomenon known as “vaccine nationalism” — potentially leaving people in poor countries vulnerable to Covid-19. The response to vaccine nationalism has been the creation of the COVAX Facility, an international partnership that aims to financially support leading vaccine candidates and ensure access to vaccines for lower-income countries. Seventy-nine higher-income countries are COVAX members. Their governments will help support 92 countries that couldn’t otherwise afford Covid-19 vaccines. [..] Equally important is offering companies … Read More

Constructing the Modern American Midwife: White Supremacy and White Feminism Collide

“US exceptionalism in maternity care is marked by the lack of midwives as primary providers. Out of 100 births, only 10 to 12 will be attended by a midwife – and 9 out of 10 of these midwives are white. Yet globally, most childbearing women are attended to by midwives, only turning to an obstetrician if serious complications arise. According to WHO and The Lancet, midwives could help avert roughly two-thirds of all maternal and newborn deaths, while providing 87% of all essential sexual, reproductive, and maternal health services. Midwifery is one of the most ancient of traditions and professions … Read More

Effective interventions for potentially modifiable risk factors for late-onset dementia: a costs and cost-effectiveness modelling study

“[Abstract methods] we searched PubMed and Web of Science from inception to March 12, 2020, and included interventions that: successfully targeted any of nine prespecified potentially modifiable risk factors (hypertension, diabetes, hearing loss, obesity, physical inactivity, social isolation, depression, cigarette smoking, and less childhood education); had robust evidence that the intervention improved risk or risk behaviour; and are feasible to enact in an adult population. We established when in the life course each intervention would be delivered. We calculated dementia incidence reduction from annual incidence of dementia in people with each risk factor, and population attributable fraction for each risk, … Read More