“[Data analytics company Embold Health chief executive officer Daniel Stein:] In the larger health care policy discussions, Medicare and Medicaid and other government programs get a lot of attention. But as you noted, most working Americans get their coverage through their employer. All in, about 165 million Americans are getting coverage through their employer. It’s a tough job to provide health coverage for your employees. Not only do you have to worry about things like cost and quality, the usual types of pressures that a purchaser has, but coming through this global [Covid-19] pandemic, employers were focused for a long … Read More
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“The lack of palliative care resources and shifting patient needs due to improvements in cancer therapeutics highlight the need for less resource-intensive and more patient-centered palliative care models. Moreover, the historical model of a referral system that relies on oncologists to identify patients with cancer who may benefit from early palliative care remains inadequate. [..] In stepped care, all patients receive care for their condition, but with a minimum of required contact with a specialty-trained clinician. More intensive treatment with the clinician is reserved for patients who do not benefit sufficiently from the less intensive therapies. A key element of … Read More
Excerpt – For a growing number of doctors, A.I. chatbots — which can draft letters to insurers in seconds — are opening up a new front in the battle to approve costly claims, accomplishing in minutes what years of advocacy and attempts at health care reform have not. [..] Doctors are turning to the technology even as some of the country’s largest insurance companies face class-action lawsuits alleging that they used their own technology to swiftly deny large batches of claims and cut off seriously ill patients from rehabilitation treatment. Some experts fear that the prior-authorization process will soon devolve … Read More
“In January 2024, the pharmaceutical company Eli Lilly launched LillyDirect, a service that includes a direct-to-consumer pharmacy and a referral network of in-person and telehealth clinicians. These tools are intended to add new options for patients to access the company’s drugs, including its newly approved antiobesity drug tirzepatide (Zepbound). [..] LillyDirect is similar to several pharmacies that cut out insurers and PBMs [pharmacy benefit managers] and allow patients to purchase drugs at discounted cash prices. These include pharmacies introduced by major retail companies like Walmart, Costco, and Amazon, and independent pharmacies like the one named for its billionaire cofounder Mark … Read More
From the article abstract: “[Objective] [..] We developed machine-learning models to detect CKD [chronic kidney disease] without blood collection, predicting an eGFR [estimated glomerular filtration rate in ml/min/1.73 m2] less than 60 (eGFR60 model) or 45 (eGFR45 model) using a urine dipstick test. [Materials and Methods] The electronic health record data (n = 220 018) obtained from university hospitals were used for XGBoost-derived model construction. The model variables were age, sex, and 10 measurements from the urine dipstick test. The models were validated using health checkup center data (n = 74 380) and nationwide public data (KNHANES data, n = 62 945) for the general population in Korea. [Results] The … Read More
“At a 1992 conference on birth control, an official on the F.D.A.’s fertility and maternal health drugs advisory committee, Philip Corfman, noted that the birth control pill is safer than aspirin, which is available over the counter. The F.D.A. subsequently announced plans to convene a hearing to consider moving oral contraceptives over-the-counter. It was believed that this would greatly expand access to birth control by bypassing doctors, to whom millions of Americans then — as still now — had little access. But, as the historian Heather Munro Prescott has recounted, the hearing was canceled at least partly because of criticism from … Read More
“When Roe v. Wade was decided in 1973, a group of 100 U.S. professors of obstetrics and gynecology predicted that teaching hospitals would emerge as leaders in compassionate abortion care, creating outpatient clinics to meet the demand for legalized abortion. But most hospitals did not embrace abortion provision; many of them in fact adopted policies that were more restrictive than was legally required. Freestanding clinics instead emerged as the primary provider of abortion care, and this siloing was further reinforced by stigma, threats of violence, and the exclusion of abortion coverage by major health care payers. In 2020, hospitals accounted … Read More
“Commensurate with the rise in telehealth has been a proliferation in publications assessing the cost, experience, efficiency, safety, and unintended consequences of telehealth. Many publications aim to answer the “Goldilocks question”: what is the right amount of telehealth that optimizes its benefits while minimizing potential problems? The right dose of telehealth needs to balance (1) concerns by payers and policy makers that it will increase cost and cause unintended consequences (eg, misdiagnosis or duplicative care) and (2) the desire of its proponents who want to allow clinicians to use it as they see fit, with few restrictions. [..] To date, … Read More
Excerpt – Mr. [CEO of Capital Caring Health who is now the nation’s largest non-profit hospice and advanced illness provider Tom] Koutsoumpas is eager to correct misconceptions about hospice care. “People think it means you’re giving up and going home to die. But we find that with good symptom management and the support of family, patients often do better and live longer,” he says from Capital Caring’s offices in Falls Church, Va. President Jimmy Carter, for example, is still with his family, after announcing in February that he would forego additional medical care to spend his remaining days in hospice at … Read More
Excerpt – Orexo, which made almost all of its $60 million in 2022 revenues from U.S. sales of Zubsolv, a drug used to treat opioid use disorder, earned negligible income from its three software-based treatments in the first quarter of the year. On the company’s earnings call, CEO Nikolaj Sørensen attributed this to the company’s ongoing difficulty securing reimbursement for digital therapeutics. [..] Orexo’s new, careful approach is a stark contrast to the bullish tone the company took when it first dove into digital therapeutics in 2019 and 2020. At the time, Orexo was sitting on millions in Zubsolv profits … Read More