Friday, April 29, 2016
Thursday, April 28, 2016
Listen app: ResApp diagnoses respiratory ailments
I’m intrigued by an Australian company, ResApp that has developed a smartphone app to diagnose regulatory diseases by analyzing the sound signatures of coughs. The company has just completed an oversubscribed fundraising round, so I guess I’m not the only one who finds it interesting.
I interviewed the CEO, Dr. Tony Keating via email, and his answers are below. Meanwhile, check out the demo for their consumer-facing product.
What is ResApp? from ResApp Health on Vimeo.
Q1. What unmet need does ResApp serve? How big is the need?
ResApp is developing digital health solutions for the diagnosis and management of respiratory disease (e.g. pneumonia, bronchiolitis, asthma, COPD). We estimate that every year more than 700 million doctor visits result in the diagnosis of a respiratory disease within the OECD, in the US the number is 125 million visits. Pneumonia in particular costs the US hospital system $10.5 billion annually. The World Health Organization estimates that nearly 1 million children die of pneumonia in the developing world every year, with a large portion attributed to the lack of availability of a low cost diagnostic tool.
Current diagnosis of these disease is costly and time consuming (consider that an x-ray for pneumonia diagnosis in the US costs more than $200 and can take up to an hour in an emergency department), and there are also many areas where current diagnostic tools are unavailable. Our initial focus is to provide an accurate remote diagnostic capability to telehealth where even the stethoscope is not available to physicians.
Q2. How does the system work?
ResApp’s technology is based on the premise that cough and breathing sounds carry vital information on the state of the respiratory tract. We use machine learning algorithms that analyze the sound of a patient’s cough. Our algorithms are able to match signatures that are within a patient’s cough with a disease diagnosis. An analogy might be how speech recognition algorithms match speech to text, or how Shazam’s algorithms look for signatures in music to identify the artist and title.
Q3. Who came up with the idea? How?
The technology was developed by Dr Udantha Abeyratne and his team at The University of Queensland. Dr Abeyratne and his team have been engaged in the R&D of the technology since 2009. They were initially funded by a grant from The Bill and Melinda Gates Foundation to investigate if mobile phones could be used to diagnose pneumonia in the developing world. The initial idea was to take the latest advances in speech recognition technology and couple them with physicians’ in-depth knowledge of cough and breathing sounds to develop a diagnostic test that could be delivered at low cost to patients in the developing world.
Q4. You started as a telehealth app but are now looking to serve physicians for in-person visits, such as in the emergency room. Why?
Our focus remains on providing a remote diagnostic test to be used alongside a telehealth consultation. However we have seen great interest from physicians for use in in-person visits, such as in the ER. The potential of our technology to provide an instant and highly accurate differential diagnosis of respiratory disease is seen as a way to greatly improve the diagnosis and treatment of their patients. In addition, healthcare payers could potentially realize significant cost savings versus traditional diagnostic tests (such as chest x-ray).
Q5. The app doesn’t require any additional hardware. Is a smartphone really good enough to serve as a medical device?
Our clinical study, run out of two major Australian hospitals, has demonstrated very high levels of accuracy (both sensitivity and specificity) in diagnosis from recordings taken using the microphone on the smartphone. We are simply using the smartphone as an efficient platform for delivering a clinical-quality medical diagnostic device. The FDA has approved over 100 mobile medical apps, including a number that diagnose a disease.
Q6. Your initial focus is on diagnostics. Do you also plan to offer tools for ongoing management?
Yes, our recent fundraising allows us to accelerate our plans to develop tools for ongoing management of the chronic respiratory diseases asthma and COPD. We see an opportunity to potentially measure the severity of these conditions on a more regular basis than what is done today. We also see the opportunity to deliver these management tools to all smartphone users who suffer from these conditions, without the need to purchase additional hardware (or perhaps also just as importantly, without the need to carry a second device).
Q7. What geographic markets are you serving? Are you worried you are spreading yourself to thin?
Our focus is the US telehealth market, although our recent funding extends our US market into the in-person use by a physician. In both of these instances, we are still providing the diagnostic result to the physician, not directly to the patient, so our clinical studies and FDA submissions are essentially unchanged. We have recently seen growth in telehealth, in particular in Europe and Australia and will be working through the regulatory process in those regions in parallel to the US regulatory process.
Q8. What’s to prevent someone else from copying what you are doing?
The university has filed a patent application (which ResApp has a worldwide exclusive license to) describing the method and apparatus of respiratory disease diagnosis using sound. The machine learning algorithms that we use also require a significant amount of high quality clinical data, which we have generated from our multiple clinical studies.
Q9. Anything else to add?
ResApp’s technology, originally developed by a world-class team at one of the world’s leading universities, provides an opportunity to deliver a clinical-quality medical diagnostic test for respiratory disease to everybody who has a smartphone in their pocket. While we’ve talked a lot about the opportunities in the US, Europe and Australia, we must remember that there are also billions of people in the developing world who do not have access to quality healthcare. We have recently partnered with a leading global humanitarian organization to help bring a high accuracy, low cost diagnostic test for pneumonia to those people and to try to reduce the number of children who die from pneumonia and other respiratory diseases every year in the developing world.
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By healthcare business consultant David E. Williams, president of Health Business Group.
from Health Business Blog https://healthbusinessblog.com/2016/04/28/listen-app-resapp-diagnoses-respiratory-ailments/
via A Health Business Blog
Wednesday, April 27, 2016
Good riddance: United finally gives up on ACA marketplaces
United we hardly knew ye
United Healthcare announced that it’s exiting most of the Obamacare insurance marketplaces (aka exchanges) next year. Sound like a familiar story? In fact all the recent news coverage is just a rehash of last November’s announcement that United was probably going to exit.
As I wrote at the time (United pulls out of ACA exchanges: Should we care?), United’s exit is not a huge deal. The company specializes in selling high-priced plans to corporate accounts. In the price-sensitive world of the exchanges, that’s a losing proposition and United wasn’t getting traction.
In January (Like I said: United’s ACA exchange departure is no big deal) I reported on a study that showed that the name brand, high priced commercial players like United were losing out to insurers with a Medicaid managed care background and to mission-oriented Blues plans. United’s departure represents the failure of United, not the failure of the marketplaces. If United says otherwise it’s a sore loser.
Health plans thinking of competing in the marketplaces should say this to themselves a few times before diving in: “Exchange business is price sensitive business. If you can’t compete on price you might as well go home.”
Now, if United were a little more clever and capable it actually could make a play for the exchange business, in a way that would boost its success in the commercial market as well. In particular, there are opportunities to better manage the way specialty care is delivered and paid for, by emulating the approaches used by the most efficient and innovative specialists. This would drive down the overall cost of insurance and improve care for patients. Some astute players in the bundled payments space are starting to figure it out. Somehow I don’t think United will be the one to make it happen.
Image courtesy of Stuart Miles at FreeDigitalPhotos.net
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By healthcare business consultant David E. Williams, president of Health Business Group.
from Health Business Blog https://healthbusinessblog.com/2016/04/27/good-riddance-united-finally-gives-up-on-aca-marketplaces/
via A Health Business Blog
Tuesday, April 26, 2016
Monday, April 25, 2016
Sunday, April 24, 2016
Saturday, April 23, 2016
Friday, April 22, 2016
Thursday, April 21, 2016
Health Wonk Review is up at Health System Ed
Peggy Salvatore has posted the Early Bird Catches the Worm edition of the Health Wonk Review at Health System Ed. She’s taken an interesting approach by posting in the order the submissions were received. You’ll see my post way down at the bottom, which may explain why I’m wormless.
from Health Business Blog https://healthbusinessblog.com/2016/04/21/health-wonk-review-is-up-at-health-system-ed-4/
via A Health Business Blog
Wednesday, April 20, 2016
Tuesday, April 19, 2016
Urgent care billing: Eyebrows raised
An unhealthy discount
My wife was sick a few weekends ago so I took her to the Beth Israel urgent care clinic in Chestnut Hill where they diagnosed her with the flu. Nice modern facility. In network. Convenient parking. You get the idea. Care was good, but slow.
Then a few days ago, I received an Explanation of Benefits (EoB) from my health plan.
One reason to go to urgent care is that it’s more cost effective than the emergency room. In this case BI sent Blue Cross a bill for $1328. Blue Cross marked it down to $365.81, subtracted our co-pay ($35) and deductible ($231.68) and sent BI payment for a whopping $99.13.
In looking at the bill I was most struck by a couple line items. Microbiology/lab was billed at $202.00 and reimbursed at $26.48, or 13%. And Technical Component (maybe for an ultrasound?) was billed at $427.00 and paid at $22.33, or 5%.
Although medical charges (i.e., what’s billed) are known to be detached from reality, I found this EoB particularly galling. How can I explain my visceral reaction, especially to the $427 charge being reimbursed at $22.33?
- If something is billed for $427 but reimbursed at just $22, it seems that BI is overcharging or Blue Cross is underpaying. Or is it both?
- What happens to the poor schlub who’s out of network, or worse, lacks insurance? Is the $427 from rare patients like that –who pay 20x what Blue Cross pays– accounting for more than 100% of the center’s profits?
- Is what I see on the EoB actually the economic reality behind the transaction? Or is BI or my wife’s BI practice being paid a capitated amount for her care and is this bill only meaningful for calculating our cost?
- What is a patient who’s interested in “transparency” and “cost effectiveness” supposed to think? Did we do the right thing by going to urgent care or not? I think it would have been a lot more useful to see a comparison between the actual urgent care visit cost and a hypothetical visit to the ER or physician office
Ok, I’m feeling a little better now.
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By healthcare business consultant David E. Williams, president of Health Business Group.
from Health Business Blog https://healthbusinessblog.com/2016/04/19/urgent-care-billing-eyebrows-raised/
via A Health Business Blog
Monday, April 18, 2016
Sunday, April 17, 2016
Saturday, April 16, 2016
Friday, April 15, 2016
Thursday, April 14, 2016
Wednesday, April 13, 2016
KaloBios bows to the price pressure Gods (I’m quoted)
Pharma bad boy Martin Shkreli, formerly CEO of KaloBios Pharmaceuticals put the company in an uncomfortable spot with plans to jack the price of a drug for Chagas disease.
Today Fierce PharmaMarketing features me in its story explaining what’s going on at KaloBios and the implications for the broader industry. (In Shkreli’s aftermath, KaloBios vows fair pricing. Will others follow its lead?)
The company has really abased itself, essentially putting forward a plan to act like a non-profit. The industry as a whole won’t be following that maneuver! In the story I share my view that pharma has boxed itself in by focusing too much on the cost of R&D. The newer argument that drugs save the system money is a little better, but still not good enough. Overall the industry seems too reluctant to assert that innovation should be rewarded.
I shared my thoughts in a longer piece last week (Is pharma industry too meek on pricing?)
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By healthcare business consultant David E. Williams, president of Health Business Group.
from Health Business Blog https://healthbusinessblog.com/2016/04/13/kalobios-bows-to-the-price-pressure-gods-im-quoted/
via A Health Business Blog
Tuesday, April 12, 2016
The decline of white women’s health
The Washington Post (A great divide in American death: Statistics show widening urban-rural gap) examined death statistics and found that death rates for white women –especially rural white women– have been climbing fast. Key culprits? Self-destructive behavior such as over-eating, opioid abuse, heavy drinking, smoking, and suicide. White women still live longer than other groups, but the trend for them is bad.
According to the Post:
In at least 30 counties in the South, black women in midlife now have a lower mortality rate than middle-aged white women, The Post found. That’s up from a single such county in 1999.
Among them is Newton County, Ga., southeast of Atlanta, where the death rate for black women ages 35 to 54 dropped from 472 per 100,000 to 234. The rate for white women went the other way, from 255 to 472.
The article cites researchers who speculate that new sources of stress are contributing to poor health and higher death rates.
The Post also connects areas with rising white death rates to those supporting Donald Trump’s presidential bid. That makes intuitive sense to me, although I don’t know whether there’s a causal link. What I will say is that those who vote for Donald Trump are going to be disappointed that he won’t be a stress reliever, even if he is somehow elected.
Image courtesy of Ohmega1982 at FreeDigitalPhotos.net
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By healthcare business consultant David E. Williams, president of Health Business Group.
from Health Business Blog https://healthbusinessblog.com/2016/04/12/the-decline-of-white-womens-health/
via A Health Business Blog
Monday, April 11, 2016
Saturday, April 9, 2016
Friday, April 8, 2016
Uber the ambulance chaser
Uber and to a lesser degree Lyft have decimated the taxi industry with a disruptive model that lowers costs, improves service, and identifies the few bad apples among drivers and passengers. Now both companies are venturing into a niche market that’s in need of serious reform: medical transportation.
Some patients need help to get to their medical appointments and Medicaid and Medicare step in as needed to pay for transportation. However, too often a patient is transported in an expensive limo or even an ambulance when a regular car would have been fine. The government recognizes the problem and has taken some steps to clean up the business, but it’s tough going.
I’m not exactly sure how Uber and Lyft will tackle the intricacies of the business, but they are diving in:
- Boston Children’s John Brownstein has helped form Circulation, which will use the Uber network to provide rides to medical visits to seniors and those with disabilities. Medicaid will provide coverage
- In New York, Lyft has been working with the National Medtrans Network on a pilot program
These services will be valuable in their own right because they are likely to reduce costs and improve service. But the downstream value to the healthcare system is even greater: if patients can get to and from appointments more reliably it may well reduce overall medical costs and improve outcomes.
Finally, it’s helpful for patients to have their medical appointments bracketed by state-of-the-art service experiences, since it will encourage patients and maybe medical offices to strive for the same service levels in their medical care. Kind of like how Disney pulls up all customer service in the Orlando area.
Image courtesy of vectorolie at FreeDigitalPhotos.net
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By healthcare business consultant David E. Williams, president of Health Business Group.
from Health Business Blog http://healthbusinessblog.com/2016/04/08/uber-the-ambulance-chaser/
via A Health Business Blog
Thursday, April 7, 2016
Health Wonk Review is up at Population Health Blog
Jaan Sidrov has done us all a favor by hosting a Presidential Politics-Free Health Wonk Review. Thanks, Jaan! My own recent edition may have been a bit too Trumpy.
In place of the candidates we have posts on the Affordable Care Act, mobile health, outcomes, pharma misbehavior, health savings accounts, the minimum wage, drug pricing and more.
Enjoy.
from Health Business Blog http://healthbusinessblog.com/2016/04/07/health-wonk-review-is-up-at-population-health-blog/
via A Health Business Blog
Wednesday, April 6, 2016
Tuesday, April 5, 2016
Vision Zero: The poem
Oops, didn’t see that coming
My father, Allan F. Williams is a renowned highway safety expert, sometimes called the Grandfather of Graduated Licensing. He retired from the Insurance Institute for Highway Safety as Chief Scientist in 2004.
Recently he told me about Vision Zero, a Swedish notion, now popular in the US, that there should be no deaths or serious injuries on the highways. But one problem with this idea is that about three-quarters of people think they are superior drivers and that the highway safety problem is due to the “other” driver.
He wrote a little poem to explain what’s happening on the roads.
Good Driver, Bad Driver
I’m a highly skilled driver, and you are not,
I know, I’ve seen enough of your lot.
You bumble around, get in my way,
Your feeble talents on full display.
Rules of the road are meant for you,
Whereas I can flout them, and often do
I speed, I phone, I drive with flair
And never, ever, make any error
Vision zero is a reality,
With fewer of you and more drivers like me.
Allan Williams, 4/4/16
Image courtesy of Salvatore Vuono at FreeDigitalPhotos.net
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By healthcare business consultant David E. Williams, president of Health Business Group.
from Health Business Blog http://healthbusinessblog.com/2016/04/05/vision-zero-the-poem/
via A Health Business Blog
Monday, April 4, 2016
Sunday, April 3, 2016
Saturday, April 2, 2016
Friday, April 1, 2016
Is pharma industry too meek on pricing?
What were we thinking?
The biopharmaceutical industry has been under attack for some time for the high and rising prices of its products. Pressure has increased recently with the arrival of costly medications for oncology, hepatitis, high cholesterol and more. Expect even further pressure as more specialty drugs are introduced, and then really significant pushback once seriously costly innovations such as gene therapy come online.
I’ve noticed that the pool of people complaining about drug pricing is widening. Now, even doctors are picking up the megaphone. For example, the American College of Physicians (ACP) recently made the case for drug price controls in a position paper. Recommendations include requiring companies to disclose R&D and materials costs, allowing the use of Quality Adjusted Life Years (QALYs) in research funded by the Patient-Centered Outcomes Research Institute (PCORI), having Medicare negotiate prices, enabling reimportation of drugs from lower-priced markets, ensuring that restrictive formularies don’t price patients out of the market by requiring excessive cost sharing, etc.
For all its spending and glitz, the industry’s main lobbyist (PhRMA) hasn’t managed to stave off the attacks. In fact some of its past and current arguments are digging the industry into a deeper hole. Here’s what PhRMA said in response to a MedPage Today inquiry on the ACP position paper:
In an email to MedPage Today, a spokesperson for the Pharmaceutical Research and Manufacturers of America (PhRMA) called the recommendations “far-reaching,” and “driven by the false notion that spending on medicines is fueling overall healthcare cost growth.”
There are a couple of important things the industry is doing wrong:
PhRMA has placed huge emphasis on how expensive it is to develop a drug, and strongly implied that drug prices are based on the costs of R&D. The general public more or less accepted the old $1 billion per drug benchmark, but I’m not sure even the industry believes the $2.6 billion for a new drug figure PhRMA has been using since 2014. And –just like in other industries– manufacturers don’t set prices based on what they spent on R&D.
So while PhRMA may complain about requests for “transparency” on R&D spending –and I agree this information is worthless, not to mention time consuming and expensive to collect– the industry brought the issue on itself.
As the email to MedPage shows, PhRMA’s current argument is that drugs are not driving up total medical costs. In other words, money spent to pay for new drugs is saved elsewhere in the system, for example by reducing hospitalizations, doctor visits or surgeries.
This cost-saving/cost-neutral argument demonstrates to me that PhRMA has not learned its lesson from the failure of its R&D spending-based approach for sympathy. The R&D approach implies a willingness to live with “cost plus” pricing. And the cost-saving argument ignores the possibility that a drug is not just a cheaper alternative to existing approaches but actually a better one. For example, the value of a cure for Hepatitis C extends beyond the financial cost of a liver transplant.
Here are a few suggestions for PhRMA:
- Embrace the concept of Quality Adjusted Life Years (QALY) to measure the value of an intervention. But don’t settle for the arbitrary $50,000 threshold that researchers often use to judge whether a therapy is worthwhile.
- Push back against the ACP and other physician critics of pharma pricing by insisting that the QALY approach be used to measure not just pharma but the work that the rest of the healthcare system does. The QALY concept can be applied to procedures, devices and maybe to hospitalizations and office visits. A lot of what’s done in healthcare today can’t demonstrate any value on the QALY scale, so maybe those things should be eliminated or have their reimbursements cut in order to increase affordability or make room for better interventions.
- Prepare the public for more costly innovations like gene therapy, which have the potential to be transformative for sick individuals but are very expensive. If I or someone else in my family is sick, I want the system to find a way to afford the innovation even if it doesn’t save costs anywhere else.
This is a tricky topic and I’ve just scratched the surface here. But bottom line PhRMA should at least prepare us for the possibility that its members will add to total costs, and that we should be ok with that outcome if the results are good enough.
Image courtesy of Stuart Miles at FreeDigitalPhotos.net
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By healthcare business consultant David E. Williams, president of Health Business Group.
from Health Business Blog http://healthbusinessblog.com/2016/04/01/is-pharma-industry-too-meek-on-pricing/
via A Health Business Blog
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