Electronic Health Records Creating A ‘New Era’ Of Health Care Fraud

Derek Lewis was working as an electronic health records specialist for the nation’s largest hospital chain when he heard about software defects that might even “kill a patient.”

The doctors at Midwest (City) Regional Medical Center in Oklahoma worried that the software failed to track some drug prescriptions or dosages properly, posing a “huge safety concern,” Lewis said. Lewis cited the alleged safety hazards in a whistleblower lawsuit that he and another former employee of Community Health Systems (CHS) filed against the Tennessee-based hospital chain in 2018.

The suit alleges that the company, which had $14 billion in annual revenue in 2018, obtained millions of dollars in federal subsidies fraudulently by covering up dangerous flaws in these systems at the Oklahoma hospital and more than 120 others it owned or operated at the time.

The full Kaiser Health News article can be viewed at this link.  

POLLUTION AND HEALTH METRICS: Global, Regional, and Country Analysis- December 2019

Pollution is an enormous and poorly addressed health problem. In October 2017, The Lancet Commission on pollution and health quantified the human toll of worldwide pollution—9 million premature deaths a year. The data for that analysis was from 2015. This report updates those results with the most recent dataset—2017—and also breaks down the results by country, enabling us to rank the best and worst performers in each region.

The new data shows pollution still to be the largest environmental cause of premature death on the planet, killing 8.3 million people in 2017, or nearly one death in seven. These deaths are caused by exposure to toxic air, water, soil, and chemical pollution globally. The results are still conservative, as many known toxins are not included in the analysis. This report draws its data from the Institute for Health Metric’s (IHME’s) 2017 Global Burden of Disease Study.

The full Global Alliance on Health and Pollution report can be found at this link.  

Show ‘Em the Money: Paying Patients to Shop for Affordable Medical Care

After three months of physical therapy, her doctor told her that it was time to get an MRI. She had already paid off her annual deductible, meaning the imaging test would “only” cost her the $150 co-pay. An imaging center near where she worked charged $1500 for the test. Just two miles away, another facility would have just charged only $900 for the same test. She arranged to go to the more convenient location knowing the difference in price would be picked up by her insurance company.

Until…!

She found out she was eligible for a rewards program. She called a rewards advice line and found out that if she chose the less expensive imaging center, her insurance company would send her a check for $400. She’d make money on the deal!

I’ve been describing the kind of program that insurers are increasingly turning to in an effort to incentivize patients to be price sensitive when receiving blood tests, imaging exams, or common procedures. It’s one of the consumer oriented innovations I explore in Sick to Debt (currently ranked one of the top five books authored by people with the last name Ubel).

The full Forbes article can be viewed at this link.  

How Medical AI Can Save Patients From Excessive Exposure To Radiation

AI's potential in medicine has already attracted large amounts of media and public attention. However, some of the specific uses and consequences of AI in the context of health care aren't particularly well known, at least not compared to awareness of the general utility of artificial intelligence.

Some of these uses may be life-saving, and in more ways than one. In recent months, a small number of companies and researchers have begun using AI for the purposes of medical imaging, harnessing machine learning algorithms in order to construct 3D models out of 2D images.

This may seem like a fairly standard employment of AI at first glance, but what's special about this emerging use is that it's focused on avoiding the need for MRI, CT and PET scans. In the case of CT and PET scans, this means that patients aren't subjected to abnormal levels of radiation, which with CT scans at least can result in an increased risk of cancer.

The full Forbes article can be viewed at this link.  

How to bring precision medicine into the doctor's office

Across the globe, researchers devote enormous amounts of time and effort to understand how human genes impact health and billions of dollars are invested. The knowledge of what impact specific genes have on our health has increased tremendously and continues to do so at an amazing pace. Our increased understanding of genes, and how they affect our health, is driving novel methods to halt diseases and new ways of thinking about how medications can be developed to treat diseases.

With all this money and effort being expended, why isn’t the use of your genetic information a standard part of your medical care? As the Kaiser Permanente Fellow to the World Economic Forum’s Precision Medicine Team, I recently had the opportunity to interview leaders from every aspect of Precision Medicine to understand the barriers preventing genetic testing from becoming a standard part of your healthcare.

These interviews suggest that the science behind genetic testing and the knowledge of how genes impact health is far ahead of our ability to make full use of this information in healthcare. Moving genetic testing into your doctor’s office requires a complex set of technologies, processes, knowledge and payments. Though many of the barriers inhibiting this movement were unique and complex, there were some consistent and common themes:

1. The limited expertise in genetics within healthcare systems
2. The lack of sufficient genetic counsellors
3. To successfully embed genetics into your care, doctors need the workflows for genetic testing (receiving results and understanding the impact on their care plans) to become a seamless part of their work
4. Coverage of payments for genetic testing

The full World Economic Forum article can be viewed at this link.  

On the Digital Health Conundrum (Part II)

This is a continuation of the ideas laid out in Part I of this post. In this part, I’ll talk about how to think about changing healthcare and lay out my framework for the kinds of companies that can disrupt it. 

The full article can be viewed at this link.  

On the Digital Health Conundrum (Part I)

For a decade, digital health has been the supposed savior of the healthcare system, coming to drive healthcare into a data-first, low-cost industry worthy of the 21st century. Investors have poured over $30b into digital health since 2011 but what material change can we point to in health care costs or the experience of the average patient? Are there companies that qualify as major disruptors? To me, the answer is no. I call this the Digital Health Conundrum.

The full Medium article can be viewed at this link.  

Hospital execs say they are getting flooded with requests for your health data

Hospitals, many of which are increasingly in dire financial straits, are weighing a lucrative new opportunity: selling patient health information to tech companies.

Aaron Miri is chief information officer at Dell Medical School and University of Texas Health in Austin, so he gets plenty of tech start-ups approaching him to pitch deals and partnerships. Five years ago, he’d get about one pitch per quarter. But these days, with huge data-driven players like Amazon and Google making incursions into the health space, and venture money flooding into Silicon Valley start-ups aiming to bring machine learning to health care, the cadence is far more frequent.

“It’s all the time,” he said via phone. “Often, once a day or more.”

Hospitals have access to vast amounts of people’s health information, including lab and imaging results and medication lists. This data can help software programmers train their systems to recognize patterns that in turn can lead to better care. For example, it can help recognize signs of disease to make a diagnosis. But health systems administrators say it could also be used in unintended or harmful ways, like being cross-referenced with other data to identify individuals at higher risk of diseases and then raise their health premiums, or to target advertising to individuals.

The full CNBC article can be viewed at this link.  

A CT scan costs $1,100 in the US — and $140 in Holland

It’s one thing to understand in the abstract that America has the highest health care prices in the world. It’s quite another thing to see the price of services, from C-sections to MRIs, compared to other health care systems.

The Health Care Cost Institute put out a new report Tuesday showing how the prices paid for medical services by private insurance in the United States stack up against prices in other countries. As expected, American prices are collectively higher than the rest.

But four charts, based on the report, show just how thoroughly the United States is outspending other countries for almost every medical service or prescription drug.

The full Vox article can be viewed at this link.  

Why Big Tech Companies Won’t Solve Healthcare’s Biggest Challenges

With a combined market cap of more than $2 trillion, technology giants Google and Apple are placing big bets on disrupting the $3.6 trillion healthcare industry. 

Earlier in the year, Apple CEO Tim Cook repeated a claim that “there will be a day we look back and say Apple’s greatest contribution to mankind has been in healthcare.” Meanwhile, Google Cloud CEO Thomas Kurian wrote in September that “we can transform healthcare and improve lives.” 

Based on their past innovations (and earnings), there are very few things Apple and Google can’t do. One of those things, I predict, will be transforming healthcare. 

Three announcements last month suggest that Google and Apple stand to make a lot of money on health-related products and services. But none of their recent acquisitions or consumer plays will make a substantial impact where it matters most: On the quality and cost of U.S. healthcare. Here’s why. 

1. Consumer Preferences Are Different Than Medical Needs 
2. No Major Tech Company Is Willing To Accept Medical Liability
3. Tech Companies Will Face Major Data-Ownership Issues Ahead  

The full Forbes article can be viewed at this link.