Telemedicine is still underutilized says Harvard JAMA Study

A recent study led by researchers at Harvard Medical School analyzed claims data from Optum plan data over the last few years, concluding that telemedicine adoption has still yet to take off  – in rural areas. The tip here is the assumption that telemedicine was designed to administer care in hard to reach rural areas.

While there are more state mandates that require coverage of telemedicine as a care option, it is important to note that patients do understand that there is a mix such as  primary care, urgent care and acute care options. This is especially true for consumers who live in urban areas.

So what can be the reason for low adoption in rural areas. Perhaps it has to do with comparing degree of trust in urban vs rural areas. Rural patients may prefer in person interactions as more trusting and may not be as comfortable with relaying private medical information over video.

Much more importantly, is that perhaps consumers are not even aware of the services. Sometimes poor adoption can be improved by better technology integrations – enabling consumers to access such services where they already access other services whether in person or technology bases. This bring telemedicine partnerships in mind such as American Well with Philips, Teladoc with CVS Minute Clinics, MDLive with Walgreens. Although time will tell if the above integrations are the most effective ones for the targeted population.

 

 

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$240B revenues for United Health in 2019

UnitedHealth Group said revenues will hit between $243 billion and $245 billion in 2019. Year-to-date, profits are up 29 percent to $8.9 billion when compared to the first nine months of 2017. Excerpt pulled from the this Becker Hospital Review article.

That’s the magnitude of the health care industry for payers. And the payer pie will only get larger as consolidation such as recent – Aetna/CVS continues.

 

Nokia divests Withings, it’s Health business

Nokia is selling its Withings digital health business back to the original founder. Withings famous for its connected health devices such as WiFi enabled body scales, fitness trackers and baby monitors has only been part of Nokia for 2 years. According to the Verge, Withings products weren’t making enough money for Nokia in its short time under their watch. Just last year, the company announced a write-down of $164 million on the assets.

It is not clear the fate of Withings going forward especially in a very competitive and low margin B2C/hardware business. One indicator to watch for this sector is share price. Fitbit, a market leader is trading at about $6 a share and Jawbone just went out of business.

P&G acquires Merck’s consumer health business

In a continued trend, pharmaceutical companies are offloading their low margin consumer health divisions to focus on high risk, high reward prescription drug discovery business. German based Merck found a partner in Cincinnati headquartered P&G to sell it’s consumer health business, which features OTC products such as Neurobion, Femibion, Nasivin, Bion3, Seven Sea for muscle, joint, back pain and mobility. Products we don’t hear much about, because they are primarily sold in Europe, South America and APAC.

The acquisition will strengthen P&G’s consumer health business, where health currently makes up 1 out of every 8 products in sales, complementing brands such as Vicks, Pepto-Bismol, Crest and Oral-B.

It was less than 10 years ago since P&G divested it’s prescription drug discovery business. With this acquisition, it aims to dominate in retail consumer health by expanding scale, portfolio and category.

World Medical Innovation Forum: Insights on AI from healthcare leaders

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Ziad Obermeyer MD, Assistant Professor, Harvard Medical School during First Look session

The World Medical Innovation Forum in Boston just wrapped after three days of insights on artificial intelligence in health care. While it didn’t disappoint in respect to buzzwords as is expected in AI conferences, it was the quality of the participants and their views on AI in health care workflows that made it notable. Here are twelve quotes directly from healthcare leaders.

On AI as a capability and adding immediate value

We realized having great medical devices is not enough, we need to connect them and make them interoperable. We operate on Adaptive Intelligence rather than Artificial Intelligence. Frans Van Houten. CEO, Philips

You will need to have capability to process structured (EHR) and unstructured (genomics) data, we can say we are more advanced in AI due to our work in oncology  – aiding in virtual recruiting in clinical trials. Amy Abernethy, MD, PhD. CMO/CSO, Flatiron Health

Knowing about the range of products being developed now, in 5 to 10 years time, there will not be a single decision made in healthcare and medicine not influenced by AI. John Kelly, PhD. SVP Cognitive Solutions and Research, IBM

30-45% of each provider’s day is wasted in non-care related activities, AI can improve healthcare and reduce burnout. Peter Durlach. SVP Health Care Division, Nuance

On data generation and interoperability

We need to remove any remaining friction between insurers and providers when it comes to sharing data, we need free flow of information. Patrick Conway, MD. CEO, BCBSNC

Some doctors don’t want to be paid electronically. They are still sending paper faxes.  Roy Beveridge, MD. CMO, Humana

Pharmaceutical companies are sitting on mountains of data on clinical trials. This data is still underutilized. Jackie Hunter, PhD. CEO, Benevolent AI

On data security, privacy and consent

When thinking of AI innovation, two considerations  – medical requirements on devices as well as consumer privacy and security. Jigar Kadakia. CISO, Partners HealthCare

Facebook says we got consent from you. But then you don’t really know you signed consent. Consent needs to be clear  – in healthcare. Noga Leviner. CEO, Picnic Health

On quality and trust of all these AI algorithms 

How are we going to address quality. How is that algorithm performing and how does that impact health outcomes? Seth Hain. Director, Analytics and Machine Learning, Epic

There’s a difference between Big data and AI. Big data has informed and enabled’. What has AI done in drug development? Dr Thomas Lynch. EVP, R&D Bristol Myers Squibb

Garbage in, Garbage out. We have to de-toxify the data. Carl Kraenzel. CISO, IBM Watson Health

 

EHR Data interoperability: Apple, Google, CMS and FHIR

Data interoperability is the flavor of the month. Everyone is working on it.

Different EHR providers mean ‘proprietary data’ and impact to revenue hence naturally system A can’t talk to system B when patient changes health plan, provider or employer benefits

Apple may be bringing disruption with its consumer play.

Apple launched its Health Records platform with over a dozen partners.

While about 40 health systems are now primed to sharing their medical records with patients through the iPhone Health Records app is impressive, what’s particularly interesting is Apple’s bet that consumers will be empowered to share this data with an ecosystem of digital health apps (developers) on their phones and providers and drive their own insights.

This is particularly a new approach with EHR portability which is usually system led rather than consumer led.

To make this all possible, the industry had to agree to one standard – Fast Healthcare Interoperability Resources (FHIR). This then serves as a connector to read and port data to/from from an EHR. Apple’s partners include top tier systems such as NYU langone Health, Stanford Medicine, The University of Chicago Medicine and John Hopkins hospital.

While Apple is pursing a B2C play, Google continues it’s domination in B2B via acquisitions.

Google’s Apigee (acquired in 2016) has apparently been working with several healthcare companies, including Walgreens, Kaiser Permanente to build links between data streams connecting existing data sets in disparate systems and finding new ways to ingest data from other sources. It’s strategy is to build an ecosystem of developers that are native to Apigee’s API.

There isn’t much data yet on adoption except in the single payer UK NHS where Deepmind (another acquisition) and Google’s AI arm has rolled out a number of limited hospital rollouts of it’s Streams app.

With use of the Apigee API, come storage requirements. Apigee sits under Google’s relatively new Cloud division so naturally it’s aim is to sell cloud services to these organizations to catchup up to Amazon’s Web Services and Microsoft Azure.

Lastly, the government has taken a stand to accelerate interoperability. Championed by White House advisor Jared Kushner, CMS debuted blue button 2.0 in March. The premise is patients should have access to their medical data wherever they go throughout their lifetime. As such it is requiring health plans to share data on Medicare participants. CMS requirements include requiring providers to update their systems to ensure data sharing, allowing patient’s data to follow them after they are discharged from a hospital and streamlined documentation and billing for providers.

As data becomes a commodity, non differentiated EHR incumbent providers such as Epic, Allscripts, Cerner will have to revisit their business models due to competitive new entrants and reduced revenue.

Facebook and the healthcare sector

Considering the launch of a Bayer campaign back in 2016 reported by Fierce Pharma, Facebook has been building teams that sell pharma ads to the health care sector. While still in the early stages, it is no secret that Google built those teams years ago to sell account management and ad targeting for big pharma and life sciences firms.

Google got clever however. It long invested in Google (Cloud), one of the fastest growing business segment in enterprise. With Amazon (Web Services) and Apple (Electronic health records rollout on its devices), Facebook is far behind the GAFA set in the health care industry. The recent Cambridge Analytics data privacy breach is a set back for the company in rollout of any new enterprise platforms (Workplace by Facebook) and patient data analytics experimentation, especially considering HIPAA privacy regulations. Workplace by Facebook reportedly has signed up over 10,000 organizations in a very short time and is possibly the medium to enter the industry. By working with healthcare providers on collaboration and predictive analytics tools, it may be the route to compete in the already crowded telemedicine market.

Time will only tell if the company can build products that expand beyond other people’s data and the advertising model.