Why are telehealth companies treating healthcare like the gig economy?

Why are telehealth companies treating healthcare like the gig economy?

Telehealth has taken off.

Spurred by the pandemic, many doctors in the U.S. now offer online appointments, and many patients are familiar with getting live medical advice over the internet. Given the obvious benefits, many experts have concluded that telehealth is here to stay. “It’s taken this crisis to push us to a new frontier,” said Seema Verma, administrator of the Center for Medicare and Medicaid Services. “But there’s absolutely no going back.”

Now the question is, where are we going? Telehealth has played an essential role during the pandemic, and it could do even more good in the years to come. But we are still in the very early days of its development. And if we are to realize telehealth’s full potential, then we must first reckon with the fact that there are serious flaws in the predominant way it is delivered today– flaws that endanger patients themselves.

Legacy telehealth services like Teladoc and others were built for a time when telehealth was a fringe phenomenon, mostly used to support acute needs like a bad cold or a troubling rash. They largely offer, in effect, randomized triage care. Patients go online, wait in a queue and see the first doctor who happens to be available. These companies market this as a virtual house call, but for patients, the experience may feel more like being stuck on a conveyer belt. Too often, they get funneled through they system with little to no choice along the way.

Insurance companies love this model because it is cheap to operate. But patients bear the cost. Doctors, in this arrangement, get paid to work the assembly line. Every minute they spend listening to patients– learning about their lives, building a personal relationship– is a minute they’re not moving them down the line, seeing the next patient and earning their next fee. The system doesn’t reward doctors for providing care; it rewards them for churning through patients.

As we build telehealth’s future, doubling down on this model would be a worrisome mistake since it is antithetical to how our healthcare system should operate. Healthcare has long been premised on the idea that you should have an ongoing relationship with your local care provider– someone with a holistic, longitudinal view of your health, who you trust to help navigate difficult or sensitive medical issues.

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The randomized triage model breaks this bond and replaces it with a series of impersonal interactions that feel more like the ones you have with an Uber driver– polite but transactional, brief and ephemeral. Healthcare, however, should not be treated in the same way as the gig economy.

As a physician, I am troubled by the prospect of what happens when you scale this model up. Every time a patient gets passed from one doctor to the next, there is a chance that critical information is lost. They won’t understand your baseline mood, your family context or living situation– all critical “intangibles” for informed treatment. That lack of longitudinal data leads to worse outcomes. This is why the healthcare system has long been designed to minimize patient handoffs– and why it would be a mistake for us to choose a telehealth infrastructure that increases them.

What, then, does a better approach look like?

We are at the very dawn of telehealth’s integration into our country’s healthcare system, and I won’t claim to know the full answer. But I do know that patients are far better stewards of their own health than a random doctor generator. A more effective approach to telehealth puts the power in the patients’ hands. Because when we give them choices and then listen to them, patients tell us what they prefer.

Data gathered by my company makes it clear that by a substantial margin, people want to make this decision themselves: 9 out of 10 telehealth patients prefer to schedule an appointment with a provider of their choosing rather than seeing a randomly assigned doctor after waiting in a digital queue.

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Not only that: when given this choice, most patients– about 7 out of 10– make an appointment with a nearby doctor when booking a virtual visit. Patients instinctively know that at some point, they’ll want or need to physically be in the same room with their doctor. And they know that choosing a local provider makes it possible to pick up the conversation in-person right where they left it off online. They don’t want to be forced to choose between telehealth and an ongoing relationship with a trusted provider. And they’re right– they shouldn’t have to.

None of the legacy telehealth companies focus on this imperative. Instead, while the pandemic rages on, they are rushing to scale while their randomized triage model is still viable. And the markets may reward them in the near term for being in the right place at the right time. But long-term value will be derived from listening to, responding to and iterating on what patients want.

Experience suggests patients will reward whoever can give them the most control over their healthcare. That’s where I’m placing my bet, too.

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First blood test to help diagnose Alzheimer’s goes on sale

First blood test to help diagnose Alzheimer's goes on sale

A company has started selling the first blood test to help diagnose Alzheimer’s disease, a leap for the field that could make it easier for people to learn whether they have dementia. It also raises concerns about the accuracy and impact of such life-altering news.

Independent experts are leery because key test results have not been published and the test has not been approved by the U.S. Food and Drug Administration– it’s being sold under more general rules for commercial labs. But they agree that a simple test that can be done in a doctor’s office has been long needed.

It might have spared Tammy Maida a decade of futile trips to doctors who chalked up her symptoms to depression, anxiety, or menopause before a $5,000 brain scan last year finally showed she had Alzheimer’s.

“I now have an answer,” said the 63-year-old former nurse from San Jose, California.

If a blood test had been available, “I might have been afraid of the results” but would have “jumped on that” to find out, she said.

More than 5 million people in the United States and millions more around the world have Alzheimer’s, the most common form of dementia. To be diagnosed with it, people must have symptoms such as memory loss plus evidence of a buildup of a protein called beta-amyloid in the brain.

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The best way now to measure the protein is a costly PET brain scan that usually is not covered by insurance. That means most people don’t get one and are left wondering if their problems are due to normal aging, Alzheimer’s or something else. 

The blood test from C2N Diagnostics of St. Louis aims to fill that gap. The company’s founders include Drs. David Holtzman and Randall Bateman of Washington University School of Medicine, who headed research that led to the test and are included on a patent that the St. Louis university licensed to C2N.

About the test

The test is not intended for general screening or for people without symptoms– it’s aimed at people 60 and older who are having thinking problems and are being evaluated for Alzheimer’s. It’s not covered by insurance or Medicare; the company charges $1,250 and offers discounts based on income. Only doctors can order the test and results come within 10 days. It’s sold in all but a few states in the U.S. and just was cleared for sale in Europe.

It measures two types of amyloid particles plus various forms of a protein that reveal whether someone has a gene that raises risk for the disease. These factors are combined in a formula that includes age, and patients are given a score suggesting low, medium, or high likelihood of having amyloid buildup in the brain.

If the test puts them in the low category, “it’s a strong reason to look for other things,” besides Alzheimer’s, Bateman said.

“There are a thousand things that can cause someone to be cognitively impaired,” from vitamin deficiencies to medications, Holtzman said.

“I don’t think this is any different that the testing we do now” except it’s from a blood test rather than a brain scan, he said. “And those are not 100% accurate either.”

Accuracy claims

The company has not published any data on the test’s accuracy, although the doctors have published on the amyloid research leading to the test. Company promotional materials cite results comparing the test to PET brain scans— the current gold standard– in 686 people, ages 60-91, with cognitive impairment or dementia.

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If a PET scan showed amyloid buildup, the blood test also gave a high probability of that in 92% of cases and missed 8% of them, said the company’s chief executive, Dr. Joel Braunstein.

If the PET scan negative, the blood test ruled out amyloid buildup 77% of the time. The other 23% got a positive test result, but that doesn’t necessarily mean the blood test was incorrect, Braunstein said. The published research suggests it may detect amyloid buildup before it’s evident on scans.

Braunstein said the company wills eek FDA approval and the agency has given it a designation that can speed review. He said study results would be published, and he defended the decision to start selling the test now. “Should we be holding that technology back when it could have a big impact on patient care?” he asked.

What others say

Dr. Eliezer Masliah, neuroscience chief at the U.S. National Institute on Aging, said the government funded some of the work leading to the test as well as other kinds of blood tests.

“I would be cautious about interpreting any of these things,” he said of the company’s claims. “We’re encouraged, we’re interested, we’re funding this work but we want to see results.”

Heather Snyder of the Alzheimer’s Association said it won’t endorse a test without FDA approval. The test also needs to be studied in larger and diverse populations.

“It’s not quite clear how accurate or generalizable the results are,” she said.

 

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Coronavirus infections rising in New Jersey nursing homes: report

Coronavirus infections rising in New Jersey nursing homes: report

Coronavirus infections among nursing home residents are ticking higher in New Jersey as the second wave has taken effect, per a report.

State health records show cases at the Dellridge Health & Rehabilitation Center in North Jersey spiked from two infections in October to seven this week, a local outlet, NorthJersey.com, reported.

The incidence of cases among nursing homes in the Garden State represent just one example of the scene across the country, with one virus-laden nursing home in Kansas even recently losing its federal Medicare funding.

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This state’s coronavirus mitigation tactics “likely” dropped cases, serious outcomes

In late September, Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases (NIAID), told Gov. Phil Murphy the state was well-positioned for the colder months ahead given its low baseline of community spread. Figures from the state health department show new daily cases have gradually been on the rise since then, but are nowhere near the surge seen in April when nearly 4,400 cases were reported on several occasions. 

By Nov. 2, the state had a positivity rate of 6%, which is just above the World Health Organization’s threshold of a 5% positivity rate for two weeks as a guide for reopening. 

New Jersey’s Gov. Murphy won’t rule out another coronavirus lockdown as cases spike 

The outlet reported that facilities in northern New Jersey counties are reporting some of the largest spikes in cases statewide, citing state records. As of Thursday, there were reportedly ongoing outbreaks across 191 nursing facilities, which is a jump from 156 on Oct. 19.

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“We remain hyper-vigilant in our efforts to eradicate COVID-19,” said Family of Care, the health system owning Dellridge, per the outlet. “We have increased our staff testing to twice weekly based on the county positivity rate. We are in daily contact with our Local and State Health Departments of Health.”

However, there was a mistake: Dellridge officials were reportedly removing case numbers off of totals as residents recovered, though a state spokeswoman reportedly said the facility would correct the issue. So far, New Jersey has reported a total of 249,380 coronavirus cases and 14,616 related deaths.

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Medicare finalizing coverage policy for coronavirus vaccine

Medicare finalizing coverage policy for coronavirus vaccine

Medicare finalizing coverage policy for coronavirus vaccine

A senior Trump administration official says Medicare will cover the yet-to-be approved coronavirus vaccine free for older people under a policy change expected to be announced soon

Medicare will cover the yet-to-be approved coronavirus vaccine free for older people under a policy change expected to be announced shortly, a senior Trump administration official said Tuesday.

The coming announcement from the Centers for Medicare and Medicaid Services aims to align the time-consuming process for securing Medicare coverage of a new vaccine, drug or treatment with the rapid campaign to have a coronavirus vaccine ready for initial distribution once it is ready, possibly as early as the end of the year.

It’s questionable under normal circumstances if Medicare can pay for a drug that receives emergency use authorization from the Food and Drug Administration, as expected for the eventual coronavirus vaccine. Emergency use designation is a step short of full approval.

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The administration official said Medicare’s announcement will try to resolve several legal technicalities that could conceivably get in the way of delivering free vaccines to millions of seniors, a high-risk group for COVID-19, the disease caused by the coronavirus. The officials spoke to The Associated Press on the condition of anonymity to discuss a pending regulation.

President Donald Trump and lawmakers of both parties in Congress have spelled out their intention that all Americans will be able to get the vaccine for free. But the official said a series of potential legal obstacles that could get in the way of Medicare payment never got unscrambled. 

Earlier this month, Medicare administrator Seema Verma said her agency was close to resolving the issue.

“I think we’ve figured out a path forward,” Verma said at the HLTH conference, a forum for innovators. “It was very clear that Congress wants to make sure that Medicare beneficiaries have this vaccine and that there isn’t any cost-sharing.”

“Stay tuned,” she added.

The $1.8 trillion CARES Act passed by Congress in March called for free vaccination for all Americans, from seniors covered by Medicare to families with employer-sponsored health insurance.

A White House-backed initiative called “Operation Warp Speed” is pushing to have a vaccine ready for distribution in the coming months. The government is spending billions of dollars to manufacture vaccines even before they receive FDA approval, thereby cutting the timeline for delivery. Officials at the FDA have committed that the program will not interfere with their own science-based decisions. Vaccines that don’t meet the test for approval would be discarded.

States have already begun submitting their plans for vaccine distribution to the federal government. 

Initially, it’s expected vaccines will go to people in high-risk groups such as medical personnel, frontline workers and nursing home residents and staff. Older people are also high on the priority list because their risks of serious illness and death from the coronavirus– which has killed more than 225,000 people in the United States– are much higher. It could be well into next year before a vaccine is widely available.

Medicare’s impending announcement was first reported by Politico.

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CVS, Walgreens to help distribute Covid vaccines to nursing homes

CVS, Walgreens to help distribute Covid vaccines to nursing homes

CVS, Walgreens to help distribute Covid vaccines to nursing homes

The federal government has made a deal with retail pharmacies CVS and Walgreens to help distribute coronavirus vaccine — once one or more gets authorized — to long-term care facilities like nursing homes, federal officials said Friday.

The two drugstore chains are the best place to send out mobile units to vaccinate seniors and other vulnerable people on site, Paul Mango, deputy chief of staff for policy at the Health and Human Services Department, told reporters in a telephone briefing.

“This is a completely voluntary program on the part of every nursing home. This is an opt-in program,” Mango said.

It will be up to the drugstore chains to figure out how to deliver the vaccines, including cold storage requirements and personal protective equipment. The retailers also will have to determine how to collect fees from Medicare, Medicaid or private insurers for administering vaccines, which must be provided to people free of charge, officials said.

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Mango said the Operation Warp Speed team did not have any idea of how many nursing homes would choose to use the retailers. “We are not imposing our solution on anyone,” he said.

Operation Warp Speed is the federal government’s program to rapidly develop a coronavirus vaccine.

Dr. Jay Butler, deputy director of infectious diseases at the US Centers for Disease Control and Prevention, noted that a third of coronavirus deaths in the US have been among residents of long-term care facilities.

“We believe that this plan will be the quickest and easiest way to provide vaccines to long-term care facility residents,” Butler told reporters.

Staff and residents of long-term care facilities are expected to be among the first to get vaccinated.

“We fully anticipate that both Pfizer and Moderna will have data of both safety and effectiveness of their vaccines shortly. We are very encouraged because their clinical trials are going extraordinarily well,” Mango said.

“Part of the reason we are doing this is within 24 to 48 hours of the time the emergency use authorization is authorized, we expect to be putting needles into people’s arms,” Mango said. “This is pre-staging for what we believe will be rapid development.”

The CDC had asked states to submit plans for a vaccine distribution by Friday. Army Maj. Gen. Christopher Sharpsten, director of supply and distribution for Operation Warp Speed, said this plan would help provide centralized management and “ensure there is comprehensive vaccine coverage for the American people.”

“Our goal is to broaden vaccine coverage,” Sharpsten said on the call.

Earlier that Friday, President Trump said seniors would be the first to get any vaccine.

“Seniors will be the first in line for the vaccine. And we will soon be ending this pandemic,” Trump said during a visit to Ft. Meyers, Florida.

Pfizer CEO Albert Bourla said in an open letter posted Friday he thought his company would know whether the vaccine it is testing protects against Covid-19 by the third week in November. Moderna CEO Stephane Bancel has made similar predictions for his company’s vaccine.

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Trump administration set to announce Medicare and Medicaid will cover Covid vaccine

Trump administration set to announce Medicare and Medicaid will cover Covid vaccine

Trump administration set to announce Medicare and Medicaid will cover Covid vaccine

The Trump administration is set to announce as early as this week that Medicare and Medicaid will cover out-of-pocket costs for a potential coronavirus vaccine that is granted emergency use authorization, according to a person familiar with the matter.

Coming days before the election, the move could help President Donald Trump among seniors and lower-income Americans even though top medical experts don’t expect a vaccine to be approved until well after Election Day. In the run-up to the election, Trump had applied intense pressure on agencies to deliver policy wins that might help his reelection, aides said.

Officials have been working for several weeks on changing regulations to allow for Medicare and Medicaid recipients to receive free vaccines.

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It’s not clear whether Trump himself will make the announcement of the rule change, though he is working to appeal seniors during stops in Florida later this week.

Politico first reported the coming changes.

There are currently four US Phase 3 trials of coronavirus vaccines as part of the federal government’s Covid-19 vaccine program, Operation Warp Speed.

Dr. Anthony Fauci, the nation’s top infectious disease expert, said Sunday that experts will know by early December whether a potential coronavirus vaccine is safe and effective, but widespread availability will likely not occur until several months into 2021.

Operation Warp Speed aims to have Covid-19 vaccines moved to administration sites within 24 hours of emergency use authorization or Food and Drug Administration license– with the goal of providing the vaccine free of charge.

“In terms of a principle and an aspiration, it’ll be that no American has to pay for a single dime out of pocket to get a vaccine,” Paul Mango, deputy chief of staff for policy at the US Department of Health Human Services, said back in September.

The federal government already struck a deal earlier this month with retail pharmacies CVS and Walgreens to help distribute the coronavirus vaccine– once one or more gets authorized– to long-term care facilities like nursing homes, with no out-of-pocket costs.

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What you need to know about at-home Covid-19 tests

Is Covid testing on your shopping list?

Costco, a popular wholesale store with locations across the US, has announced that it will sell a direct-to-consumer diagnostic test for Covid-19, joining a growing list of retailers providing diagnostic tests.What you need to know about at-home Covid-19 tests

Kent Sepkowitz writes that even though at-home Covid-19 tests will now be available at a number of retailers, it does not necessarily mean testing will get faster or more accessible.

But there are problems with the program, starting with the cost. The test is not cheap, especially for those looking to test themselves and family more than once. At Costco, the kit costs $129 for the most basic version and $139 for the fancy version that includes video instructions. Federal law mandates that private insurers, Medicare, and Medicaid cover Covid-19 tests without any cost to the patient. Whether they will pay fully for a more bells and whistles program such as that provided by Costco likely will vary plan to plan.

That price is actually cheaper than buying the at-home kit directly from AZOVA, the company that administers the program, which charges at least $20 more. AZOVA is also encouraging pharmacies to offer the kits. In a blog entry titled, “Four ways to generate revenue when you offer Covid-19 testing in your pharmacy and on your website,” lists some tips on how pharmacies can maximize profits, including receiving a $22 to $29 administration fee for in-pharmacy tests and $5 for each test ordered online and conducted at home, noting that “you don’t need to do anything but add a link to your website” to get the five bucks a pop.

As for the speed of the results– sorry, you’ll have to wait at least a couple days. The term “home test” evokes the home pregnancy test approach where the wait for the big reveal is measured in minutes. However, for the Covid-19 test, the “home” refers only to where you collect the specimen, not where you run the test. This is performed by a lab reached by (hopefully) overnight mail.

AZOVA promises a result by email one to three days after receipt of the kit in an approved lab. But there is an additional lag in the time of one to three days for the kit to be delivered to you at home if you order it online. In other words, order on Monday and get your test result at the earliest on Wednesday but as late as the weekend. (Costco advertises a slightly quicker turnaround between ordering the kit and receiving it at your home.) So those who would want to use the test for assurance prior to seeing the family or returning to the office need to plan many days in advance.

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Which Brings us to accuracy. The involved companies claim the test is excellent, with the website advertising 98% sensitivity and 99% specificity, meaning almost every case is detected by the test with very few false positives. But we don’t know how accurate a test really is until people have used it in real life conditions, rather than under perfected lab conditions. OraSure experienced this difference when its home test for HIV, once approved, showed a higher false positive rate than clinical trials had shown.

And that was the good old days, before the Trump administration weakened the process for how lab tests can gain emergency use authorization (EUA) through the FDA. In the name of swiftness, the FDA decided to allow qualified labs themselves to determine whether their test worked. No longer is the company’s data subjected to FDA scrutiny prior to issuing EUA. It is possible therefore that some tests that would not have received FDA emergency authorization six months ago are now receiving a greenlight.

Plus, there is the simple fact that a test is performed today may accurately show no infection, but by the time the result is available– days later– the same person may have become infected. The immediacy of the test result, therefore, is crucial for both personal and public health decisions.

So here we are, eight months into the pandemic and still waiting for an accurate, fast, cheap, readily available test– the game-changer first promised in April. The at-home version in its current form may be helpful for worried families but will not be a game-changer from a public health perspective.

But having several companies trying to solve a problem the Trump administration should have resolved long ago, similar to governments in South Korea, China, Germany and other countries, is a faintly hopeful sign.

The collaborating companies seem to understand that basic principle for controlling the Covid-19 pandemic is the same as for every infectious disease: it is necessary to have a rapid and reliable test to identify who is potentially infectious. Otherwise we are simply trying to swat flies in a pitch-dark room, hitting and missing, missing and hitting, with no hope of knowing anything at all about the effectiveness of our efforts. This single profound limitation more than anything else has led us into America’s historic public health catastrophe.

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Let’s Break Down The Safest Ways To Vote In The 2020 Election

Make your safe voting plan, and stick to it.

Let's Break Down The Safest Ways To Vote In The 2020 Election

Election Day is Here

Americans everywhere are off to the ballots to vote in one of the biggest elections of our lives. The stakes of this year’s election couldn’t be higher, and it’s more important than ever for all eligible voters to make their voices heard this year. We find ourselves amid a global pandemic as we wake up to Election Day 2020, offering its own unique challenges to an already contentious race. The health and safety of voters, poll workers, and volunteers are of the upmost importance as we navigate social distancing during the constraints of polling times. Many might be wondering, “is it even safe to vote this year?” The short answer is yes. There are still ways to vote safely in the pandemic. Let’s break down the three primary methods of voting this year and how safe they are during the age of COVID-19.

Voting by Mail

Voting by mail, also called absentee voting, is going to be the safest choice. Mail-in voting is the act of filling out your ballot at home, and then mailing it to your local elections office to be counted. You can also drop the ballot off at a drop-off location, as many Americans had to do, with the deadline quickly approaching and fears rising of ballots not arriving and, therefore, not being counted in time. The process for voting by mail varies by state- some states are automatically sending mail-in ballots to every registered voter this year, while other states will only send one if you specifically requested it. Mail-in ballots are the safest way to vote in the COVID-19 era. There are no lines, no crowds, no human interaction required and, as a bonus, you can do it from the comfort of your couch!

Early Voting

The second safest way to vote in the 2020 Election is to participate in Early Voting. Many states allow its voters to vote early in-person before Election Day. Early Voting comes with so many benefits: it’s often faster and more convenient than voting on Election Day. And, because you’ll beat those November 3rd crowds, it’s a safer bet in the age of COVID-19.

Voting on Election Day at the Polls

Finally, there’s the option to show up to the polls on Election Day to vote. Voting this way will require extra caution given the pandemic, but if mail-in voting and early voting aren’t options for you, there are concrete steps you can take to make your visit to the polls as safe as possible.

Wear a mask and practice social distancing at all times. Carry hand sanitizer. Pay close attention to posted signs and any instructions you’re given from poll workers. They’re there to keep the lines moving and to make sure everyone stays safe. Try to go during times you think the polls will be less crowded- for example, midday might be less busy than right after 5 p.m. when everyone gets out of work.

Ready, set, vote!

Ultimately, whether you vote by mail, vote early in-person, or vote on Election Day at the polls, have your voice be heard, and do so safely. Take every precaution you can to protect yourself and your community in the process. Together, we can make sure that everyone gets to participate in their democracy safely this year. Make your safe voting plan, and stick to it.

How did you vote this year? Did you feel that voting safety precautions were thorough?

 

Now, more than ever, you’ll want to make sure you’re insured. Your health and health coverage is our priority. Follow the link below to compare plan options and call us at 877-413-1556 with any questions. We look forward to hearing from you!

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7 Tips To Managing Holiday Stress

Parties, shopping, cooking, cleaning, entertaining and unwelcome guests — from Christmas to New Years, the festivities present a dizzying array of demands. For many, the stress of the holidays results in fatigue, insomnia, illness, anxiety and depression, rather than peace and joy. Continue reading “7 Tips To Managing Holiday Stress” »