Oral health: more than a public health challenge, an opportunity for telehealth?

Untreated caries in permanent teeth was the most prevalent health condition in 2010, affecting 35% of the global population, or 2·4 billion people worldwide. In 2010, severe periodontitis was the sixth-most prevalent health condition, affecting 10·8% of people, or 743 million, worldwide.

Worldwide in 2015, dental diseases accounted for US$356·80 billion in direct costs and US$187·61 billion in indirect costs.

Is oral health the next big SDH (Social Determinant of Health)? A focus in this month’s Lancet is the neglect of global oral health. Most of our Readers know that oral self-care can be a challenge with older adults due to physical limitations, finances, and access, but oral  and periodontal disease affects nutrition, is a source of pain, tooth loss, consequent low self-regard, low quality of life, and can lead to other diseases such as sepsis and undiagnosed cancers.

The Lancet’s two articles, Oral diseases: a global public health challenge and Ending the neglect of global oral health: time for radical action (open access, registration required on these links) point out the current allopathic model does not fit the wider societal need,  and come down hard on the social and economic origins (very hard on Western dental practice, the sugar industry, and food providers). However, the articles are light on solutions other than universal health care and community based dental practice. Even in less-developed countries like India and Brazil, practitioners don’t migrate to poor, rural areas. It is true, however, that much of dentistry, at least in the US, has an increasing focus on cosmetic restoration.

Here is a wide-open area for telehealth development. Some areas to explore:

  • Creating wider access to dentistry that treats immediate problems
  • Greater access to proactive dental care, whether dental checkups and to encourage better self-care
  • Connecting rural fixed or mobile clinics staffed by technicians or locally trained staff with dentists for remote screening and scheduling care. 

Hat tip to Leah at The TeleDentists for these articles. The articles are also attached as PDFs here and here.

News roundup: docs dim on AI without purpose, ‘medtail’ a mall trend, CVS goes SDH, Kvedar to ATA, Biden ‘moonshot’ shorts out, and Short Takes

Docs not crazy about AI. And Dog Bites Man. In Medscape‘s survey of 1,500 doctors in the US, Europe, and Latin America, they are skeptical (49 percent-US) and uncomfortable (35 percent-Europe, 30 percent-Latin America). Only 20 percent fess up to actually using an AI application, and aren’t crazy about voice tech even at home. Two-thirds are willing to take a look at AI-powered tech if it proves to be better than humans at diagnosis, but only 44 percent actually believe that will happen. FierceHealthcare

This dim view, in the estimation of a chief analytics and information officer in healthcare, Vikas Chowdhry, is not the fault of AI nor of the doctors. There’s a disconnect between the tech and the larger purpose. “Without a national urgency to focus on health instead of medical care, and without scalable patient person-centered reforms, no technology will make a meaningful impact, especially in a hybrid public goods area like health.” The analogy is to power of computing–that somehow when we focused behind a goal, we were able to have multiple moon missions with computing equivalent to a really old smartphone, but now we send out funny cat videos instead of being on Mars. (And this Editor growing up in NJ thought the space program was there to market Tang orange drink.) HIStalk.

Those vacant stores at malls? Fill ’em with healthcare clinics! And go out for Jamba Juice after! CNN finally caught up with the trend, apparent on suburbia’s Boulevards and Main Streets, that clinics can fill those mall spots which have been vacated by retail. No longer confined to ‘medical buildings’, outpatient care is popping up everywhere. In your Editor’s metro area, you see CityMDs next to Walmarts, Northwell Health next to a burger spot, a Kessler Health rehab clinic replacing a dance studio, and so on. The clever name for it is ‘medtail’, and landlords love them because they sign long leases and pay for premium spots, brighten up dim concourses, and perhaps stimulate food court and other shopping traffic. Of course, CVS and Aetna spotted this about years ago in their merger but are working expansion in the other direction with expanding CVS locations and on the healthcare side, testing the addition of social determinants of health (SDH) services via a pilot partnership, Destination: Health with non-profit Unite Us to connect better with community services. This is in addition to previous affordable housing investments and a five-year community health initiative. Forbes, Mobihealthnews

ATA announces Joseph Kvedar, MD, as President-Elect. Dr. Kvedar was previously president in 2004-5 and replaces John Glaser, PhD, Executive Senior Advisor, Cerner. He will remain as Vice President of Connected Health at Partners HealthCare and Professor of Dermatology at Harvard Medical School. A question mark for those of us in the industry is his extensive engagement with October’s Connected Health Conference in Boston, one of the earliest and now a HIMSS event. ATA’s next event is ATA2020 3-5 May 2020 in Phoenix–apparently no Fall Forum this year.

The Biden Cancer Initiative has shut down after two years in operation. This spinoff of the White House-sponsored ‘moonshot’ initiative was founded after the death of Beau Biden, son of Democrat presidential candidate Joe Biden. Both Mr. Biden and wife Jill Biden withdrew due to ethics concerns in April. According to Fortune, the nonprofit had trouble maintaining momentum without their presence. However, the setup invited conflict of interest concerns. The Initiative engaged and was funded by pharmas and other health tech companies, directly for Initiative support but mainly for indirect pledges to fund research. Most of these organizations do business with Federal, state and local governments. Shortly after the formal announcement, Mr. Biden the Candidate announced a rural health plan to expand a federal grant program to include rural telehealth for mental health and specialized services. Politico   But isn’t that already underway with the FCC’s Connected Care Pilot Program, coming to a vote soon? [TTA 20 June]

And…Short Takes

  • Philips Healthcare bought Boston-based patient engagement/management start-up Medumo. Terms not disclosed. CNBC
  • London’s Medopad launched with Royal Wolverhampton NHS Trust (RWT) in a three-year RPM deal. DigitalHealthNews
  • Parks Associates’ Connected Health Summit will be again in San Diego 27-29 August with an outstanding lineup of speakers. More information and registration here.

And in other news, Matt Hancock holds tight to his portfolio as UK Secretary of State for Health and Social Care in the newly formed Government under new PM Boris Johnson. Luckier than the other 50 percent!

 

 

The magic quadrant matrix strikes again for health tech and investment potential

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2018/05/Medical-social-quadrant-box.jpg” thumb_width=”150″ /]Deceptively simple, the quadrant matrix can make sense out of actions and decisions. As a management tool, it can help you prioritize what is most urgent and important, or how to vary your supervisory/coaching style based on the person’s skill and will levels.

Here we see the magic box used by Krishna Yeshwant, MD, a doctor and investor with GV, Alphabet’s venture firm, to sort out all those Next Revolutions in Health Care. The factors that Dr. Yeshwant uses pertain to the end user’s medical and social needs, often called social determinants of health (SDH). Both are meshed, whether in an active older veteran who lives alone in a rural area but manages his diabetes well, or in a homeless substance user in a city with multiple medical conditions.

Most non-medical entrepreneurs prefer to develop tech and services for people like them with low medical/low social needs, such as virtual doctor apps, concierge primary care, and wellness apps. It’s a crowded quadrant and perhaps is over-served. Those with a medical background appear to gravitate to the diagonal quadrant–high medical/high social needs, such as those targeted to the ‘underserved’ with diabetes or high-need care model management, such as Aledade and Iora Health. Where does the investment money go? Their money goes to companies which have developed high medical need therapeutics such as expensive treatments for cancer, neatly avoiding those complex social factors.

What is missing: innovation in low medical/high social needs. This group is at high risk to move into high medical needs due to their lack of organization and access to/willingness for primary care. This Editor agrees, but if another factor is observed–profitability–this is likely the least potential of the four. So if you want to get Dr. Y’s attention and maybe some moolah from Alphabet…. From his presentation at the HLTH meeting last week in Las Vegas. CNBC.

‘Deconstructing the Telehealth Industry’ positively, focusing on ‘virtual care’ of older adults

A Big Study must-read. Just published is healthcare-specialized investment banking firm Ziegler’s 28-page update on their 2016 survey of the telehealth industry. Unlike some industry observers who believe that health tech has been ‘next year’s Big Thing’ far too long, with unproven effectiveness and savings, Ziegler believes it’s about to substantially ramp up in investment spending and tech integration.

The study looks forward and goes deeply into the markets. In their view, “We believe the next generation of successful virtual care companies will be those who understand the critical marriage between chronic care management, behavioral health, and social determinants.” Their focus is on the aging (50+) population and their higher risk for developing chronic conditions and the 50 percent/5 percent spread (50 percent of the spending is generated by 5 percent of the population). Their picture is that virtual care will ‘meet patients where they are’ in their daily lives.

The study sees trend confirmation in the adoption of virtual care by health systems (the widest–telestroke and tele-ICU), low-acuity care, and 2019 expansion of Federal reimbursement in Medicare Advantage Plan B with ACOs having more flexibility in telehealth-supported services. Ziegler promotes a change in terminology–‘virtual care’ as the ‘naturally integrated tool used to streamline the complex healthcare ecosystem.” Another difference: they place virtual care in the ‘smart aging continuum’ including its effect on decision makers, payers, care options, aging in place, and residential care.

A strong reference paper our Readers will be referring to for months to come. Deconstructing the Telehealth Industry, Part II (option for printable and viewable PDFs).

Is Uber fit to deliver healthcare transport? Healthcare organizations may want to check.

Healthcare-related organizations have codes of conduct pertaining to suppliers. Does Uber meet compliance standards? As we reported a few days ago in our article on the burgeoning area of non-emergency medical transport (NEMT) [TTA 9 Mar], Uber Health’s debut with a reputed 100 healthcare organizations has led this Editor to a further examination of Uber, the organization. Uber has had a hard time staying out of the headlines–and the courts–in the past two years, in matters which might give healthcare partners pause.

  • On 21 Nov, Uber reported that the personal data of 57 million users, including 600,000 US drivers, were breached and stolen in October 2016–a full year prior. Not only was the breach announcement delayed by over a year, but also in that year it was made to go away by Uber’s paying off the hacker. Reuters on 6 December: “A 20-year-old Florida man was responsible for the large data breach at Uber Technologies Inc [UBER.UL] last year and was paid by Uber to destroy the data through a so-called “bug bounty” program normally used to identify small code vulnerabilities, three people familiar with the events have told Reuters.” The payment was an extraordinary $100,000. “The sources said then-CEO Travis Kalanick was aware of the breach and bug bounty payment in November of last year.” The Reuters article goes further into the mechanism of the hack. It eventually led to the resignation of their chief security officer, former Facebook/eBay/PayPal security head Joe Sullivan, who ‘investigated’ it using encrypted, disappearing messaging apps. Atlantic.
  • CEO and co-founder Travis Kalanick was forced to resign last June after losing the confidence of the company’s investors, in contrails of financial mismanagement, sexual harassment, driver harassment, and ‘bro culture’. This included legal action over Uber’s 2016 acquisition of self-driving truck startup Otto, started by former Googlers who may or may not have lifted proprietary tech from Google before ankling. These are lavishly outlined in Bloomberg and in an over-the-top article in Engadget (with the usual slams at libertarianism). Mr. Kalanick remains on the board and is now a private investor.
  • The plain fact is that Uber is still burning through funds (2017: $1bn) after raising $21.1bn and its valuation has suffered. The new CEO Dara Khosrowshahi, who earlier righted travel site Expedia, has a tough pull with investors such as SoftBank and Saudi Arabia’s Public Investment Fund. Also Mashable.

Healthcare and NEMT, as noted in our earlier article, are a strong source of potential steady revenue through reimbursement in Medicare Advantage and state Medicaid programs, which is why both Uber and Lyft are targeting it. The benefits for all sides–patients, practices, these companies, sub-contractors, and drivers–can be substantial and positive in this social determinant of health (SDOH).  

Healthcare organizations, especially payers, have strict codes of compliance not only for employees and business practices but also for their suppliers’ practices. Payers in Medicare Advantage and Medicaid are Federal and state contractors. While Uber under its new CEO has shown contriteness in acknowledging an organization in need of righting its moral compass (CNBC), there remains the track record and the aftermath. Both deserve a closer look and review.

Sustainable transportation models for patient access to care at lower cost

Guest Editor Sarianne Gruber (@subtleimpact) and MovedbyMetrics) returns to the transportation aspect of social determinants of health earlier explored in her article on Veyo [TTA 21 Feb]. New on-demand services provide affordable ‘a to b’ transportation not only which is clean, safe and tailored to the patient’s needs, but also accountable to the health system or provider. A surprise here is that Circulation’s service is not smartphone dependent. 

Circulation, Inc. launched its Non-Emergency Medical Transportation (NEMT) system with just a few hospitals back in September 2016. This game changer company provides on-demand rides with a healthcare transportation platform and an Uber app.  To date, they have expanded significantly with over 30 new clients and ride access in over 25 states. Last week, I had the pleasure to speak with Robin Heffernan, PhD., the co-founder and CEO of Circulation, to learn how they have been able to achieve a successful cost-effective and reliable transportation system for patients and providers. A gently edited version of our conversation follows below.

How has Circulation reduced the cost of a ride with an NEMT system? How will cost savings trickle down?

Heffernan: Our health facility clients are saving costs on the ride component only.  When someone transitions from mostly using taxis to being able to use Uber rides, the cost of that ride is 40 to 50 percent less. We have not yet calculated the bigger total cost savings for our clients. When patients actually make their ride appointment, the savings begin because they are not missing a primary care appointment. Without a scheduled ride, they may decide to take an ambulance the next day to the ER for a basic cough.  I think this is a huge advance for this industry. From day one you are going to achieve significant savings on a pure ride cost basis, get increased patient satisfaction and see your patients actually getting to appointments on time. Health facilities can track for the first time a whole downstream value proposition, and actually tie transportation to appointments to costs like ED utilization. Our solution tracks this component with our clients.

How does Circulation’s transportation model impact value-based care? (more…)

Disrupting the pathways of Social Determinants of Health: the transportation solution

Guest Editor Sarianne Gruber (@subtleimpact) and MovedbyMetrics examines one aspect of social determinants of health, transportation. Social factors have been called the missing links in population health: others are housing, food, finances, and employment. This is not only affordable ‘a to b’ transportation, but also clean, safe and tailored to the patient’s needs. Sarianne interviewed Todd Thomas, then of Veyo and now of Zendrive, a company developing data analytics to make roads safer and to save lives through measuring driver behavior and coaching. Other companies in Veyo’s area are Uber Health and Circulation [TTA 10 Nov].

More and more people are starting to have conversations around the Social Determinants of Health.  And for the first time, the c-suite within healthcare companies are talking about transportation.  People haven’t talked about transportation before because there haven’t been good choices, only poor and expensive service levels. Transportation has always been a low budget item and a cost center. Now people are talking about transportation as a key link in the complete continuum of care. If we are talking about treating the complete person, a huge part of that is making sure they are getting to their treatments on time every time, picking up their pharmaceuticals and shopping to get fresh, clean food. These things make a huge impact in the lives of patients and the members.  It is great that people are becoming aware of transportation and talking about it.Todd Thomas, VP Strategic Business Development at Veyo

Social Determinants of Health, as recognized by the World Health Organization, are the conditions in which people are born, grow up, live, work and age, together with “the systems” that are put in place to deal with illness. Transportation is one of those systems.  In a conversation with Todd Thomas, VP of Strategic Business Development at Veyo, he chronicled how the digitization of this sector broke barriers in Non-Emergency Medical Transportation.  The medical transportation, as Thomas described, was very challenged for decades with the same nationwide providers, all delivering the same levels of service and at the same price.  None had any initiative to adapt to new technologies or evolve their business models.  Medical professionals and companies across the US had come to expect poor service as the norm.  It wasn’t until a couple of years ago when the transportation network companies, the TNCs such as Uber and Lyft, came onboard into the market and really changed transportation in the US and in the world. Thomas contends that what the TNCs did for the transportation world has really turned things upside down, and absolutely raised the level of customer expectations and raised standard of what transportation was going to be.  And ultimately closed a huge care gap for transportation-dependent patients. (more…)