Week of 2019.12.8

HEALTH POLICY

• Although healthcare is unlikely to solve racism, attendees at a recent symposium for social determinants of health believe health systems could do more to improve the health of their patients outside traditional healthcare settings (e.g., working with at-risk mothers, hiring more patients for healthcare sector jobs, educational opportunities, zoning hearings for liquor stores).
• Online grocery purchasing and delivery services are available in more than 90% of urban food desert census tracts, but only a minority of rural food desert census tracts. If these services could be combined with the US Department of Agriculture’s Supplemental Nutrition Assistance Program, more Americans may be able to get access to healthier foods.

HEALTH INFORMATION TECHNOLOGY

• Express Scripts plans to deploy a digital formulary in January that will include 15 apps to help manage eight of the country’s most common chronic conditions.
• Amazon’s PillPack has integrated with Blue Cross Blue Shield of Massachussetts MyBlue member app to help members manage and fill their prescriptions.
• In a recent USC survey of 1531 American housholds through the Internet sponsored by Blue Cross Blue Shield of Arizona, respondents preferred high-quality interactions with their doctor much higher than digitized services.

MISCELLANEOUS

• The “home” is now a more common place to die in America than the “hospital.” We’re still trying to catch up with Canada and England. This letter to the NEJM editor summarizes some of the challenges that prevent more patients from being allowed to die at home.
• We may need to stop prescribing aspirin for primary coronary disease prevention as this analysis suggests the risks outweigh the benefits for many patients.
• Austin Frakt, the director of the Partnered Evidence-Based Policy Resource Center at the VA Boston Healthcare System, and Aaron Carroll, professor of pediatrics at Indiana University School of Medicine and the Regenstrief Insitute, suggested CPAP machines are good enough to identify sleep apnea episodes and fix them that it might make sense to give them out without a diagnostic sleep study.
• There are a lot of “significant” financial conflicts of interest among federally funded health researchers.

Week of 2019.12.1

HEALTH POLICY

• A meeting in Detroit highlighted the lack of health systems’ engagement with promoting public health policies to improve their patients’ health (e.g., accessible high-quality pre-kindergarten, affordable housing, smoke-free public spaces, and healthy food procurement).
• Food delivery services could help address barriers to access to healthy foods.
• The National Youth Tobacco Survey found over half of high school kids and nearly a quarter of middle-school kids have tried tobacco. Wow.

HEALTH INFORMATION TECHNOLOGY

A recent meta-analysis found that using stand-alone smartphone apps led to significant differences in managing depression and smoking, but not anxiety, suicidal ideation, self-injury, or alcohol use.

MISCELLANEOUS

• One researcher suggests we think about study improvements to patients’ lives as “noticeable” or “valuable” instead of “meaningful.” The language implies differences in how we might measure these improvements moving forward.
• Government officials in Florida are considering US News and World Report rankings to determine hospital reimbursement rates.

Week of 2019.11.24

HEALTH POLICY

• Capping Medicare D payments may be a simpler approach to control out-of-pocket costs compared to other proposals that are being discussed.
• Peter Bach suggests a “too little, too late” (focus on monitoring efficacy after product launch, limit market exclusivity to five years and reduce prolonged high-profit periods) approach to addressing persistently high medication costs.

HEALTH INFORMATION TECHNOLOGY

• Sometimes, a human being beats out a chatbot or artificial intelligence. The Butterball Turkey Talk-Line rolls on.
• Amazon makes a bigger push into healthcare by promoting Alexa as a medication reminder and refill service.
• An individual’s social duty appears to be the strongest predictor of donating personal data. Self-serving motives are negatively associated with donating personal data.

MISCELLANEOUS

• Cognitive behavioral therapy seems to be effective for helping manage anxiety-related disorders up to 12 months after starting treatment, but few studies look beyond that period.
• Woolf and Schoomaker outline the rise in mortality among young and middle-aged adults of all racial groups starting in the 1990s with no easily identified cause or group of causes.
• As the price of drugs continues to rise, interventional pharmacoeconomics funded by payers becomes more viable.

Week of 2019.11.17

HEALTH POLICY

• RAND explores the implications of allowing 50-64 year olds to buy into Medicare.
• The Indiana University Health proposes the Healthcare Economic Efficiency Ratio (HEERO), which features gauging actual spending on patient care against expected spending on patient care as a new measure of healthcare value.
• The Horton Group sponsored a piece in the Minneapolis/St. Paul Business Journal describing the increasingly important role of stop-loss insurance when the Affordable Health Care Act (ObamaCare) removed benefit limits on employer-sponsored health insurance.

HEALTH INFORMATION TECHNOLOGY

• A research group investigated why individuals might donate their medical data. Social duty was the strongest predictor of the intention to donate personal data.
• Avera Care is a healthcare company delivering virtual emergency room physician and nursing support to 179 emergency rooms across 30 states. They’re averaging about 15,000 episodes of care annually.
• A research group tested a probabilistic decision-support system using machine learning that reduced the total number of alerts and increased the perceived value of the alerts delivered.

MISCELLANEOUS

• The Cochrane team reviewed the literature around different HPV vaccine schedules. As you might have guessed, they suggest more long-term studies.
• An author makes an argument that weight lifting captures the best elements of a life well-lived (autonomy, mastery, belonging) without getting caught up in the false notion that achieving some specific result will deliver contentment.
• The CDC released their latest numbers on tobacco use in America. Even though we as a country area using less tobacco (19.7% in 2018), some subgroups (GED holders; serious psychological distress; Medicaid or uninsured; lesbian, gay or bisexual) have much higher utilization rates. 

Week of 2019.11.10

HEALTH POLICY

• CMS posted the latest version of its cost transparency rule on Friday. Here the rule for hospitals and the rule for payers.
• Older adults may require better community conditions (e.g., housing stock, personal care workforce, transportation arrangements, senior food delivery) rather than changing individual behaviors to improve their health.
• Based on the Return on Invested Capital metric, pharmaceutical companies could take a hit to their R&D budgets and still generate higher returns than the average industry.

HEALTH INFORMATION TECHNOLOGY

• A NEJM editorial highlighted the opportunities and challenges of smartwatch-powered studies.
• Robert Pearl suggests that our bias toward blaming technology instead of human performance could be contributing to the death toll secondary to motor vehicle crashes and medical errors.

MISCELLANEOUS

• There are real risks for frail adults undergoing minor procedures. This editorial suggests we should do more to identify a patient’s preferences and goals (e.g., prolong life, relieve symptoms, remain independent) before suggesting these procedures to patients.
• Stop-loss insurance in healthcare is becoming a bigger business. Here’s a brief overview of the concept from the Minneapolis/St. Paul Business Journal.
• A Lancet editorial suggests that systematic reviews might actually be harmful by magnifying the treatment effects from small trials until an adequately-powered trial provides better-quality information.

Week of 2019.11.3

HEALTH POLICY

• A lawyer provides shares some learnings about how to best implement laws to minimize unnecessary vaccine exemptions based on the California experience.
• The drop in hospital admissions may have been due to the overall admission reductions rather than any specific readmission reduction initiative.
• Our tools to identify hospital-acquired infections may be deeply flawed.

HEALTH INFORMATION TECHNOLOGY

• A group of surgeons start using smartphones to track recovery trajectories after surgery.
• CVS is using two-way texting to keep patients with chronic myeloid leukemia out of the hospital.

MISCELLANEOUS

• Group visits with a focus on weight management may improve glycemic control, reduce diabetes medication use and decrease hypoglycemic events.
• And just in case you needed yet another data point about America’s really high healthcare spend and really low return on that investment, here’s a graphic depicting health spending versus avoidable mortality across OECD countries

Week of 2019.10.27

HEALTH POLICY

• A Forbes contributor suggests that physician and hospital prices, not drug companies and health insurance companies, are the major drivers of healthcare spending in America (disclaimer: I work for a large insurance company that also owns a pharmacy benefit manager).
• UCSF developed a screening tool that includes depressive symptoms, alcohol and substance abuse and interpersonal violence to facilitate behavioral health management.
• Sarah Chamberlain, the president of the Republican Main Street Partnership, argues that focusing on prescribing practices would be more effective than dictating drug prices.

HEALTH INFORMATION TECHNOLOGY

• A research team used alternating 10-second on/off cycles off a smartphone to track patient activity before and after surgery to predict post-operative adverse events.
• David Pare, Chief Technology officer for DXC Healthcare and Life Sciences, suggests chief information officers thing beyond implementing electronic medical records and supporting software and consider a broader digital platform to engage different users to leverage each company’s existing data.

MISCELLANEOUS

• The New York City Health + Hospitals used the EAST framework (Easy, Attractive, Social and Timely) to assess and influence behavior change to facilitate more clinical note review by patients.
• John Ioannidis believes the medical press has been highlighting preliminary findings about specific nutrients, foods, or popular diet patterns instead of smoking and obesity, the major drivers of lost health. This misplaced attention is impairing the public’s ability to absorb a few key messages: do not smoke (or quit), exercise regularly, do not eat too much, do not become obese, do not drink alcohol in excess and sleep well.
• Instead of relying on individuals to frame food choices as using self-control to stop “hedonistic consumption,” we may be better served by helping them alter their perceptions of food so that tastiness and healthiness become more positively associated.

Week of 2019.10.20

HEALTH POLICY

• Our current work on exposing drug pricing at the state level may not be identifying the best opportunities to address price gouging.
• Health reinsurance arrangements (HRAs) may provide an avenue to portable health insurance when an individual changes jobs.
• Does promoting healthy habits to extend life increase or decrease a population’s overall risk of dementia? No one’s really sure.

HEALTH INFORMATION TECHNOLOGY

Algorithm-based decision making may require additional education among our citizens to both increase trust in the generated response as well as identifying those instances where algorithms may not be helpful.

MISCELLANEOUS

• Efforts to provide broader government-sponsored insurance may still lead to an increase in private-industry engagement in health insurance functions (e.g., claims processing, anti-fraud activities, call center services).
• Even though patients with acute coronary syndromes and depression do worse than patients with acute coronary syndromes without depression, our current interventions do not seem to be making a meaningful difference in addressing depression in this population.
• One writer’s encapsulates some of Uwe Reinhardt’s best thinking on health policy when reviewing the economist’s last book.

Week of 2019.10.13

HEALTH POLICY

• Next year, Medicare Part D enrollees who had previously reached the out-of-pocket threshold for catastrophic costs ($5100)  will need to pay more out-of-pocket costs ($6350) before qualifying for that coverage.
• Walmart is now mandating employess travel to one of their Centers of Excellence for spine surgery. They didn’t provide any savings estimates.
• The Urban Institute compared eight different proposed reform simulations against current law. Only one (single-payer lite program covering ACA essential health benefits and income-related cost sharing, enrolling all legally present Us residents, prohibiting private insurance coverate and retaining current law Medicad program for long-term services and supports) resulted in a lower overall total cost of care.
• The Affordable Care Act shifted more healthcare costs to the federal government. In the process, the ACA helped reverse the progressive nature of the “healthcare tax.”

HEALTH INFORMATION TECHNOLOGY

• We need more studies that address the limitations and potential safety hazards of patient-facing apps.
• Patient who Google their symptoms may be better patients.
• One research group used deep learning, a form of machine learning, to examine multiple nodules detected on lung CT to predict 1-year lung cancer recurrence risk. The work could be used to personalize monitoring intervals.

MISCELLANEOUS

• Indian tribes are facing an uphill battle to get equal funding for their own healthcare (In 2017, $3332/patient compared to $7789/patient for Medicaid and $12,829/patient for Medicare). Those without casino dollars have even more trouble.
• Two MIT Technology Review writers argue that algorithms can’t simultaneously optimize for two definitions of fairness (“keep error rates the same between groups” and “treat people with the same risk scores the same way”).
• A lot patients might benefit a thorough evaluation for the cause of their gastroesophageal disease (GERD)-like symptoms. Among those who do have PPI-refractory GERD, surgery seems to help.

Week of 2019.10.6

HEALTH POLICY

• Colorado is doing innovative work with its public option proposal to be managed by private entities, setting hospital reimbursement rates as well as a state reinsurance program. While the governor bragged about lower premiums on the individual market, critics suggested the efforts do little to reduce the overall cost of care.
• Massachussetts, a state with some experience with health insurance policy, has struggled to make progress on that same metric.
• California’s governor signed three separate healthcare bills: HIV prevention drugs can now be dispensed without a prescription, pharmaceutical companies can no longer collude to delay lower-priced generics from coming to market (“pay to delay”) and healthcare workers must complete implicit bias training to improve preventable maternal mortality rates among black women.
• JAMA ran a series of editorials around healthcare waste to accompany this article categorizing the types and relative degrees of waste. This editorial focused on administrative complexity and pricing failure, the two most expensive categories of waste by far.
• Other countries with much fewer resources than we have are focused on providing universal health coverage to their citizens.“People ask what keeps me up at night,” [director general of the World Health Organization] Tedros said. “My nightmare is a pandemic flu.” One way to protect against such a pandemic — and against Ebola and other viruses — is to build up health care systems in the most vulnerable countries. Ebola has been spreading in eastern Congo for more than a year. If it suddenly bounces to Europe or Asia, we’ll belatedly realize that our safety in America depends on improving health systems in Congo.”

HEALTH INFORMATION TECHNOLOGY

• Coordinated Behavioral Care finds that consumers still desire basic functions like appointment reminders, medication information, text messages, urgent alerts and appointment scheduling. Given their specific focus, they suggest developing functions for cognitive behavioral thearpy, chronic disease management, peer support, medication management, passive symptom tracking and data collection.
• A group suggested a framework for considering artificial intelligence and medical practice liability. Since our liability laws are focused on the standard of care, providers may face challenges when artificial intelligence algorithms suggest something against the standard of care.

MISCELLANEOUS

• Health systems are starting to invest in local communities to both solve some of their logistical challenges as well as provide incomes to people who may end up being their patients.
• Walmart added kidney transplants to its list of procedures for its Centers of Excellence program. In addition to its recent release of an app aggregating its health and employee benefits with telemedicine, I believe this puts Walmart ahead of Amazon and others vying to be the leading healthcare disruptor.
• Sexually transmitted diseases reached a record high last year. Some blame this on the 40% reduction in CDC funding for STD prevention over the last 15 years.
• On a more optimistic note, David Chokshi, a JAMA editorialist, quotes Johnathan Haidt who thinks about linking communications to one of the five “moral foundations” (harm, fairness, loyalty, authority, and sanctity) when thinking about helping people change their minds about public policy. One of the more interesting tactics Dr. Chokshi suggested was confronting one’s own ignorance about a complicated policy serves to moderate one’s position on that policy. “participants moderated their positions after struggling with an explanation, but not when they were instead asked to enumerate reasons for their policy preferences. Humility in realizing the limits of one’s understanding was a more powerful force for changing minds than rationalization.”

Week of 2019.9.29

HEALTH POLICY

• Gil Welch continues his crusade to fight population-health metrics focused on screening rates that have a low correlation with improving population quality & quantity of life, but have a high correlation with downstream healthcare spending.
• Medicare’s process to accredit organ transplant centers may be leading to unintended consequences.
• CVS gets pushback for its efforts to promote a “quality-of-life years gained” approach to covering medications.

HEALTH INFORMATION TECHNOLOGY

• Blockchain may not be ready to solve healthcare problems.
• Caption Health, a San Francisco-startup, is focused on helping healthcare workers take better images of patients’ hearts using real-time feedback during ultrasounds.
• The VA is defaulting to sharing medical records with participating community care providers.

MISCELLANEOUS

• We keep botching our nutritional messaging. This time, it looks like eating meat isn’t as bad as we had originally suggested.
• Long-term care insurance rates are skyrocketing, challenging the notion we can ever invest in a product with a 30-year (or longer) time horizon.
• Monitoring individuals for lower insurance rates is gaining acceptance in auto insurance. Can health insurance be far behind?

Week of 2019.9.22

HEALTH POLICY – Negotiations between brand-name drug makers and pharmacy benefit managers reduce the rate that generics are added to formularies. – An editorial about the cost-effectiveness of different colon cancer surveillance strategies after polyp detection raises the question of screening some people more frequently when others are not screened at all. – The results of orphan drug legislation do not appear to line up with its intentions. – Why doesn’t flavored tobacco and flavored alcohols get the same scrutiny as flavored e-cigarettes? One writer suggests it may be the differences in youth adoption by class. – The FDA issued some preliminary guidance about what medical apps and software might fall under its scope. HEALTH INFORMATION TECHNOLOGY – Big Tech can learn a lot about you without ever violating HIPAA. – Most artificial intelligence algorithms are optimized to identify a condition or pattern after having access to lots of information. Physician diagnostic work is more iterative with tests being ordered as the result of an earlier test or change in a patient’s clinical condition. This discrepancy may reduce AI’s effectiveness at supporting or replacing diagnosticians. – Health IT companies focused on chronic disease management offer alternatives to healthcare delivered by health systems. – Rand Paul continues to oppose a national patient identifier as a way to protect patients from corporate and government oversight. I personally think his point of view gets dismissed given its unpopularity among health centers and health IT advocates. MISCELLANEOUS – A new regimen to treat tuberculosis is slow to catch on for the usual reasons things are slow to catch on in healthcare. – One writer suggests that corporations can actually work with government to sustain culture change to meaningfully improve the lives of people. – Taking away a older relative’s smartphone may be tougher than taking away their car keys. – Alastair Mactaggart, the California real estate developer financing California’s data privacy efforts, suggests that the right to privacy is being undermined by Big Tech would lose most of their business if that right was enforced.

Week of 2019.9.15

HEALTH POLICY

• There appears to be a disconnect between what older patients expect from their diabetes care targets and what our national groups place in their recommendations.
• The Goverment Accountability Office suggests that CMS’s current efforts to measure quality in healthcare are insufficient to meet the organization’s quality measurement objectives.

HEALTH INFORMATION TECHNOLOGY

• Provider-facing medication cost transparency alerts has some effect on ordering behavior.
• Implementing EMRs seemed to have no effect on condition-specific readmission rates or overall mortality.

MISCELLANEOUS

• Decision aids might be helpful in reducing preference-sensitive surgical procedures appropriately.
• SmileDirectClub develops a blueprint for other health IT start-ups to disrupt healthcare.
• Hoy Health taps into drug vouchers to tap into families across Central and South America.

Week of 2019.9.8

HEALTH POLICY

• As the number of Medicare payment models proliferate, there’s a higher risk that members will be enrolled in multiple programs, reducing the likelihood CMS will be able to determine what programs are most effective.
• Enaging a friend or family member in health behavior change may be more effective than gamification based on competition.
• One writer suggests using population-health metrics in a “Consumer Reports” format to trigger innovation among counties.
• The subscription model to pay for Hepatitis C treatments in Louisiana may only be effective if the model includes a larger paradigm with screening and linkage to care.

HEALTH INFORMATION TECHNOLOGY

Google, Microsoft and others are focused on voice recognition and search to help improve healthcare delivery.

MISCELLANEOUS

• The Electronic Privacy Information Center released a comparison of all privacy legislationin front of Congress.
• Payers might be considered more thoughtful stewards of healthcare dollars if they focused more closely on fraud.
• One New York Times opinion writer suggests Apple’s keynotes are not longer the must-see events they were in our collective memories.

Week of 2019.9.1

HEALTH POLICY

•  Medicare fee-for-service spends a lot more on postacute care than commercial insurers among patients approaching 65.
• A group of economists outline the challenges and opportunities of price caps for health care. I was particularly intrigued by their description of implications pegging caps to some multilple of Medicare prices.

HEALTH INFORMATION TECHNOLOGY

• The New York Times highlighted the privacy challenges of updating the federal government’s health care data sharing rules (two provisions are scheduled to be finalized later this year.
• The CommonHealth group will use the same data interoperability standards to provide medical record sharing on Android devices that Apple owners currently enjoy.
• Planned Parenthood released an app to provide sexual and reproductive health care to over half the country now and a plan to offer the service in all 50 states by the end of 2020.
• Low-impact flooring may be more effective than bisphosphonate infusions to reduce the risk of fractures among the elderly.

MISCELLANEOUS

• Yusuf et al. published their Prospective Urban Rural Epidemiology results tracking over 150,000 individuals in 21 countries over a decade. One finding that stood out for me was the top five risk factors for cardiovascular disease in high-income countries were high non-HDL cholesterol, tobacco use, hypertension, diabetes and abdominal obesity.
• An interesting read about the risks and benefits of vaping, as different entities respond to each other (e.g., vaping may be healthier than smoking cigarettes, e-cigarettes may or may not help patients quit smoking, Michigan bans flavored nicotine to protect their children, the first deaths due to vaping [probably secondary to additives]).
• Charlie Warzel, the New York Times opinion writer heading their Privay Project series, argues that dating apps contain some of the most sensitive information an individual might own. As you might guess, he’s not a fan of Facebook’s push into this space.
• An emergency room physician argues that medical centers’ obsession with placing physicians in triage to reduce wait times adversely affects patient care and costs more money.

Week of 2019.8.25

HEALTH POLICY

• The American Enterprise Institute suggests the federal government should 1) define a set of common and standardized services and interventions and 2) require payers to provide reference-based payments against this set
• Although overall life expectancy in America has decreased, it has actually increased among the college-educated
• The US Preventive Services Task Force looks to expand hepatitis C screening to all adults 18-79
• Walmart is piloting primary care delivery near its physical stores

HEALTH INFORMATION TECHNOLOGY

• Medicare updates its Plan Finder for the first time in a decade with new options for reviewing plans on mobile devices – Alexa may help address loneliness among older Americans
• Electronic medical records could take some tips from aviation safety and consider a “quiet dark” user interface design philosophy instead of “loud bright” one
• Deep learning could help improve the quality of psychotherapy by analyzing utterances during sessions

MISCELLANEOUS

• Two researchers demonstrated how easy it isto dox people using Europe’s GDPR’s ‘Right of Access’ requests
• Sputum eosinophils might be a better way to identify patients with asthma who might respond to inhaled steroids or long-acting muscarinic agents.
• We as an American society may need to rethink the expectation that we will be self-sufficient until we die

Week of 2019.8.18

HEALTH POLICY

• California passed a law (AB 72) in 2016 that pays providers either the average contracted rate or 125% of the Medicare reimbursement rate. Patients are not billed beyond that amount.
• Nicholas Kristof highlighted the value of case managers and social support over incarceration to address the ongoing drug crisis.
• As more rural hospitals close, air ambulances are seen as a bottleneck to efficient transport to a care facility.

HEALTH INFORMATION TECHNOLOGY

• State Farm, the car/home/life insurance company, created an Alexa skill that connects patients with their adult children and caregivers. Data will not be shared across business lines to prevent discrimination against users when it comes to insurance products.
• Remote exercise rehabiliation may be appropriate for some patients after knee replacement surgery. The lead researcher highlighted the need to better understand what patient characteristics might indicate the need for at least some face-to-face encounters during the rehabilitation process.
• At least some leaders on Apple’s health team admit that the division’s primary focus on wellness and prevention, not diagnosis and treatment.
• The ONC’s 5% target for patient portal access inadvertently encouraged providers to ignore patients with challenges accessing online resources.

MISCELLANEOUS

• This week’s Lancet focused on hypertension. This editorial made a strong argument to consider a patient’s overall cardiovascular risk instead of single risk factor (e.g., blood pressure, cholesterol).
• The rise in healthcare facilities owned by Catholic entities curtails services offered to patients needing reproductive health services, LGBTQ care and bias-free care.
• The FDA approved a new treatment for extensively drug-resistant tuberculosis that includes just three drugs: pretomanid, bedaquiline and linezolid.

Week of 2019.8.11

HEALTH POLICY

• Challenges with short-term health insurance plans.
• Publicly available quality measures don’t correlate with individual patient outcomes.

HEALTH INFORMATION TECHNOLOGY

• Text-based apps may increase engagement, but not increase health-promoting behavior.
• Pillpack struggles to compete with Surescripts.
• Providers don’t seem to share medical records with patients as often as they are asked to do so.

MISCELLANEOUS

• Catch a few words from the good Zeke Emanuel.
• Other types of online data may be considered health data.

Week of 2019.8.4

HEALTH POLICY

• CVS-Aetna are developing offerings that threaten the role of providers and hospitals as gateways to obtaining healthcare (including a hypertension and diabetes offering).
• Population health management may be the right thing to do, but it does not guarantee cost savings.
• Home-based cardiac rehabilitation may help address the large numbers of patients who do not receive this service after a myocardial infarction.
• Revealing industry payments to physiciansmay not affect a patient’s decision to choose that physician or, worse, could signal that the physician is a leader in the field.
• Pharmaceutical companies have found ways to use authorized generics to maximize profits after brand-name drugs lose their patent protection.

HEALTH INFORMATION TECHNOLOGY

• Electronic consultations may be appropriate for select conditions meeting specific criteria, but additional research is needed.
• Handheld ultrasonography may change the primary diagnosis in up to 14% of patients. Like all new technologies, questions remain about cost-effectiveness and user proficiency.

MISCELLANEOUS

• A Chinese study found aggressive risk factor control may reduce the risk of patients with pre-diabetes and diabetes from developing cardiovascular events.
• Hatred and aggression are more highly correlated with mass killers than mental illness.
• Nocturnal and 24-hour blood pressure measurements may only add very little marginal value to a single blood pressure measurement when considering death or cardiovascular events.
• Deprescribing anticholinergics may reduce the incidence of Alzheimer disease.
• Nine of the top 15 foundations, as measured by giving, are affiliated with drug makers. This gives the companies both large tax breaks as well as keeping high list prices for their products.

Week of 2019.7.28

HEALTH POLICY

• Therapeutic advancements like CAR T-cell therapy and gene therapies (e.g., Zolgensma) could threaten the Financial Viability Of The Health System.
• Zeke Emmanuel suggests auto-enrollment as an easier method to expand health insurance coverage over any of the proposals coming out of the democratic presidential candidate debates.
• Medicare Advantage plans appear to have multiple challenges including “widespread and persistent performance problems related to denials of care and payment.”

HEALTH INFORMATION TECHNOLOGY

• careMESH built the first national provider directory using the HL7 FHIR standard.
• Rite Aid is teaming up with InTouch Healthto use otoscopes, dermascopes and stethoscopes to increase the value of virtual health offerings
• A group of researchers were able to predict 90% of all acute kidney injuries requiring dialysis up to 48 hours before dialysis using deep learning. Unfortunately, the algorithm generated two false positives for every true positive.
• Earlier this month, Morley and Floridi outline the opportunities and risks of digital health companionship (including promoting some norms, lifestyles and values over others)

MISCELLANEOUS

• Multiple generic drug manufacturers are accused of colluding to charge higher prices
• One New York Times editorial writer suggests a more holistic view to emotional suffering beyond antidepressants

Week of 2019.7.21

HEALTH POLICY

• David Harlow interviews Jeanne Pinder, CEO of Clear Health Costs about challenges providing consumers with price transparency as it is currently defined.
• Richard Horton argues that global health should return its focus on attacking poverty instead of universal health coverage, global health security and climate change.
• Union-owned SolidaritUS Health is delivering value-based care with agreements with employers and providers.
• The Bipartisan Policy Center published an analysis showing savings for Medicare fee-for-service if members with one of 11 conditions received medically-tailored meals.

HEALTH INFORMATION TECHNOLOGY

• Wearables may not be as accurate among people of color, with implications for clinical research and employee incentives.
• CVS starts testing a home-dialysis device.

MISCELLANEOUS

• Acuna, Chesney and Baxter suggest a method for including patient preferences in non-inferiority trials.
• There’s a new algorithm that doesn’t need much to re-identify your de-identified data.
• On a happier note, New York imported a depression intervention from Zimbabwe using lay people to help more people.

Week of 2019.7.14

HEALTH POLICY

• Ramesh Ponnuru from the American Enterprise Institute suggested that our challenges passing a bill for surprise medical bills should reduce anyone’s confidence about our federal government passing any legislation that resembles “Medicare for All.”
• Austin Frakt outlined several challenges to a comprehensive government-led drug-pricing initiative.
• The IRS issued a notice about allowing individuals using Health Savings Accounts with high deductible health plans using services to manage chronic disease without a deductible.
• Drew Altman suggests America would lose its 50-state laboratory to test new interventions if “Medicare for All” became a reality.
• Blue Cross Blue Shield of Massachusetts identified 11.9% savings in medical claims among organizations with Alternative Quality contracts who enrolled in 2011 with measurements through 2016.

HEALTH INFORMATION TECHNOLOGY

• Shoshanna Saxe argues against “smart” cities with arguments that could just as easily apply to the Internet of Medical Things.
• Brian Chen struggles to find value in sleep-tracking devices and apps.

MISCELLANEOUS

In France, e-cigarette use was associated with fewer cigarettes smoked per day, but higher rates of smoking relapse.

Week of 2019.7.7

Health policy

• A review of the Germans’ current process of measuring any new medication’s effectiveness after going to market credited with a five percent reduction in overall drug spending
• A separate review of the Basque Health system and its approach to population health

Health information technology

• California may approve texting between managed Medicaid plans and Medicaid beneficiaries
• A Lancet Digital Health review warning against adoption health information technology without a clear demonstration of increased value

Miscellaneous

• The CDC has documented a decrease in new diabetes cases in America (1.3 million cases in 2017 down from 1.7 million in 2008)
• A new poker-playing algorithm beat the world’s best human poker players, a game with incomplete information (unlike chess or Go)
• A recent publication found that 15 diagnoses accounted for nearly half of all high-severity claims in a database tracking just over a quarter of all malpractice claims in America
• Physicians seem unable to make value-based decisions when they are patients

Week of 2019.6.30

Health policy

• CMS approves five Direct Primary Care models so the organization can contract with providers for a population of beneficiaries’ entire healthcare spending via global capitated payments.
• Barbara Jobst argues for more self-management in chronic disease using outcomes that matter to patients.
• Vonk and Schut describe the changes in the Netherlands health insurance market over time as a method to highlight the conflicts between the insurance logic and the welfare state logic.

Health information technology

Oran and Topol anticipate the rise of the virtualist in the Lancet.

Miscellaneous

• Nathan Heller wrote an insightful piece about the popularity of GoFundMe as a response to rising healthcare costs without a clear solution.
• Back in May, three physicians wrote a Harvard Business Review article about using transparent nudges to help engage clinicians.
• Sarah Jeong, a member of the New York Times editorial board, makes an argument against a data ownership model for personal health information.
• A depressing study found intense exercise did not often result in weight loss often because participants would compensate for the caloric deficit by eating 100 more calories a day (about four bites).

Week of 2019.6.23

Payer space developments

Washington state delivers a public option, but the rate-setting was subject to pressure from multiple constituencies.

Health information technology

• Electronic medical records may be associated with higher performance on process measures, but not outcome measures
• Including patterns of healthcare events may be more informative than tracking individual observations

Health policy

• Medicare’s Hospital Readmissions Reduction Program initial winners appear to be regressing to the mean
• Obesity may be wiping out the gains from tobacco cessation (public health) and statin use (healthcare delivery)
• Allan Goroll suggests that we update the annual wellness exam to be more valuable to patients.

Week of 2019.6.16

Payer space developments

• MDsave offers a bundled payment for multiple healthcare services without engaging payers
• We still can’t agree on the definitions of value-based care or population health
• The National Economic Council updates the Health Reimbursement Arrangement [HRA] rule. Click here for a general description of HRAs.

Health information technology

• Structured forms on mobile devices may be faster and more complete than dictated operative reports
• Emanuel and Wachter argue that behavior change is more important than artificial intelligence in healthcare