Dr. Venture Capital: Insurance companies are supposed to cover high-quality care for patients. What happens when they dabble in investing?

“The insurance companies [Cigna and Kaiser Permanente] provided Ginger with access to millions of potential users. After its financial investments in Ginger, Cigna began offering no-cost access to Ginger’s behavioral health services in order to improve customers’ overall health and well-being, according to leadership from both organizations. Yes, it is possible that those customers will benefit from the platform. But given that Ginger’s valuation grew in multiples around the same time—at least in part because of the massive influx of customers from Cigna and Kaiser—it’s reasonable to suggest that the insurance company was double dipping. By sending its customers to … Read More

Remote Postdischarge Treatment of Patients With Acute Myocardial Infarction by Allied Health Care Practitioners vs Standard Care: The IMMACULATE Randomized Clinical Trial

“β-Blockers and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACE-I/ARBs) are beneficial after AMI [acute myocardial infarction], and adjustment of these medications to moderate to high doses is recommended in the setting of reduced LV ejection fraction (LVEF) or heart failure. Initiation and adjustment of these medications can be challenging during hospitalization, particularly among patients with borderline or low systemic blood pressure because of an emphasis on shortening length of stay and the challenges in organizing frequent face-to-face visits early after discharge. Telemedicine has enabled the transition from face-to-face care and is set to play a key role in the post–coronavirus disease-19 … Read More

The Treatment of Patients With Unbearable Suffering—The Slippery Slope Is Real

“Physician-assisted death (PAD) is now legal in 9 US states and the District of Columbia and is under consideration in 17 more. Legalization generally follows ballot, as opposed to legislative, initiatives in the setting of extensive marketing efforts by advocacy groups focused on convincing the public that they face a future of unbearable suffering if PAD is not available. Whereas fear of unbearable suffering at the end of life is a commonly expressed concern, most Americans should be able to expect reliable and expert relief of suffering as a result of medical advances in geriatrics and palliative care. The fact … Read More

Let Sleeping Patients Lie, avoiding unnecessary overnight vitals monitoring using a clinically based deep-learning model

“While overnight VS [vital sign] measurements disrupt sleep, they are often indicated and necessary for high-risk and potentially unstable patients. Identifying these patients in a reliable and timely manner is an area of active investigation, with efforts focused on models that vary from single parameter tools to weighted early warning scores and advanced predictive models using machine learning techniques. By contrast, relatively little work has been done to identify the low-risk cohort unlikely to benefit from such care that may, in fact, be harmed by these frequent assessments. Identifying this subset of patients has the potential to enhance recovery, improve … Read More

Insights From Rapid Deployment of a “Virtual Hospital” as Standard Care During the COVID-19 Pandemic

“Hospital at home (HaH), a care model that provides acute hospital-level care in patients’ homes, has been well characterized. Controlled trials and subsequent meta-analyses have suggested the efficacy of HaH, demonstrating noninferior or even superior mortality, readmission, and length of stay outcomes compared with traditional hospitalization for heterogeneous patient populations. [..] Reasons for low adoption include misaligned or lack of financial incentives and challenges inherent in implementing a complex intervention. For example, even when home hospitalization models have been implemented in the United States in study settings or those with aligned payment incentives, low participation rates have been ubiquitous (ranging … Read More

The Case For Mathematical Optimization In Health Care: Building A Strong Foundation For Artificial Intelligence

“Enthusiasm for the potential impact of AI [artificial intelligence] on hospital operations is often based on its impact in other industries. However, non-health care companies invest in AI after having digitized and optimized their operations with a variety of older mathematical methods. In contrast, hospitals may invest in AI while still scheduling patient appointments using fax machines and allocating resources based largely on anecdotal experience. [..] For decades before the advent of modern AI, the operational management of capital, labor, and resources of large manufacturing, retail, airline, and most other large-scale industries were being designed and refined with rigorous methods … Read More

A Framework to Triage Older Adults with Covid-19 to Provide Patient-Centered Care

“[Summary] [..] Our institution developed and implemented a triage framework in the Emergency Department utilizing the Clinical Frailty Scale (CFS) to promote patient-centered care during our Covid-19 surge. A triage clinician assessed 40 patients aged 70 and older from April 7 to May 22, 2020. In addition to recommendations for medication management, fall risk reduction, delirium prevention and advance care planning, the triage clinician directed patients with a CFS of 1-3 to usual care (n=8, 20.0%), a CFS of 4-6 to geriatric co-management (n=6, 15.0%), a CFS of 7-9 to palliative care triage (n=23, 57.5%) and 7.5% (n=3) to both … Read More

Automated Identification of Adults at Risk for In-Hospital Clinical Deterioration

“We previously described an automated early warning system that identifies patients at high risk for clinical deterioration. Detection is achieved with the use of a predictive model (the Advance Alert Monitor [AAM] program) that identifies such patients. Beginning in November 2013, we conducted a pilot test of this program in 2 hospitals in Kaiser Permanente Northern California (KPNC), an integrated health care delivery system that owns 21 hospitals. The system generates AAM scores that predict the risk of unplanned transfer to the ICU or death in a hospital ward among patients who have “full code” orders (i.e., patients who wish … Read More

Reimagining Cardiac Rehabilitation in the Era of Coronavirus Disease 2019

“Cardiac rehabilitation integrates patient education, behavior modification, and exercise. The traditional in-person, center-based cardiac rehabilitation model has been shown to reduce all-cause hospital readmissions by 31% and all-cause mortality by 24% over 1 to 3 years. For patients with a recent acute myocardial infarction, coronary revascularization, or acute heart failure exacerbation, cardiac rehabilitation reduces spending on future hospitalizations by approximately $900 per patient over 21 months. Yet uptake has been disappointing. Even before COVID-19, less than a third of eligible patients attended a single session. Supply-and-demand challenges have impeded uptake, and both must be addressed to expand this life-saving therapy. … Read More

Using DALYs to Investigate Innovations in Care Delivery

On October 27th, the United States Preventive Services Task Force (USPSTF) issued a draft recommendation to extend colorectal cancer screening to individuals 45-49 years of age (Grade B recommendation). Assuming the public comment period does not uncover any surprises, the recommendation will be finalized by the end of the year. The recommendation includes the group’s modeling of benefits and harms with the proposed screening strategy. Compared to our current screening recommendations (screening individuals 50-75 years of age), the new recommendation will add 22-27 additional life-years at a cost of 0.2-2 additional gastrointestinal and cardiovascular complications per 1000 individuals screened. Given … Read More