The HLTH conference, a gathering of providers, payers and other attendees working on healthcare innovation, on Monday kicked off its third annual event—virtually.
Technology reporter Jessica Kim Cohen will provide updates and daily observations here throughout the conference.
Wednesday, Oct. 14
CMMI's payment models have improved quality more than cost
Brad Smith, who in January took on the role of director in CMS' Center for Medicare and Medicaid Innovation, said one of his first tasks at the center was reviewing the payment models the center has developed since launching 10 years ago.
That involved analyzing 54 payment models CMMI developed and drawing out lessons.
His team started working on that project early this year, before the COVID-19 pandemic.
Roughly five of the 54 models have saved money, he said, while "a number" of them are in the break-even range. Quality has improved in "quite a few models at a statistically significant level," he said; there aren't any models where quality has gone down.
However, "it takes years for these models to come through and to really understand if they're saving," he noted, so the findings reflect on outcomes from before the past few years.
"These models are complicated—they try to predict prices in the future, they try to evaluate how things are going to change," Smith said. "There's a lot of things that we've learned by going back through these 54 models or so that we're going to be able to leverage going forward."
"My hope is that we'll be able to drive more savings, continue to improve quality," he added.
Why Google invested $100M into Amwell
A Google Cloud executive on Wednesday suggested that their technologies will play a role in emerging telehealth themes, like remote monitoring technologies and artificial intelligence in the coming years.
Aashima Gupta, global director of healthcare strategy and solutions at Google Cloud, suggested healthcare will be tied to people rather than specific places for care and that artificial intelligence and other advancements will support clinician productivity in the future.
"Cloud and technologies like AI will not only shape, but also revolutionize, telemedicine as we know it," Gupta said.
That's why Google in August partnered Amwell, a telehealth giant that went public last month.
Amwell and Google entered into a stock purchase agreement, under which Google invested $100 million into the company in exchange for Class C common stock. As part of the agreement, Amwell will migrate its video performance capabilities onto Google Cloud and the companies are co-developing new capabilities with Google Cloud's AI tools.
Roy Schoenberg, president and CEO of Amwell, said the companies are working together to "reimagine" care with technology, in a way that create a more enjoyable experience for patients.
"For the last 15 years, telehealth … have really tried, as hard as they could, to measure up to be as good as in-person physical care," Schoenberg said. "Telehealth was really trying to imitate, for lack of a better word, what existed before it arrived. Now, we have an opportunity to actually go forward."
U.S. surgeon general to release 'call to action' on suicide, maternal health
U.S. Surgeon General Dr. Jerome Adams on Wednesday said his office will encourage providers to tackle suicide prevention and maternal health in upcoming reports.
More than 700 women die during childbirth each year. More than two-thirds of those deaths are preventable, he said during his keynote speech.
Adams also plans to release a report on oral health, as well as a report on the link between community health and economic prosperity.
The community health and economic prosperity report will discuss how businesses can address health disparities by investing in their surrounding communities, among other strategies.
"Each of these are major public health issues," Adams said.
Adams' announcement follows a call to action on hypertension that he released last week. That marked the first call to action Adams has released since taking on the role of surgeon general in 2017.
Uncontrolled hypertension increases the risk of heart disease and stroke, and contributes to an estimated 500,000 deaths annually in the U.S.
"Our goal with this call to action is to make hypertension control a national priority," Adams said, adding that Black Americans have a higher prevalence of hypertension and tend to develop high blood pressure at a younger age when compared to White Americans.
Verily's Dr. Vivian Lee urges regular COVID testing of asymptomatic people
Dr. Vivian Lee, president of health platforms at Google's sister company Verily Life Sciences, stressed that COVID-19 testing is "critical" to reducing spread of the disease.
"The most important lesson that we're learning really is that it's critical to do regular testing of people who are asymptomatic," she said. "If you're only testing people who are symptomatic, it's already too late."
Verily's employees are tested for COVID-19 weekly, she said. Verily during the pandemic established its own testing laboratory at the company's South San Francisco headquarters to support its testing work, including testing that's involved in the company's internal return-to-work efforts.
Verily has said that the lab is CLIA-certified, meaning it meets federal standards for clinical labs.
Verily also sells a COVID-19 screening and testing program, called Healthy at Work, to employers and universities. Participants in the program use a mobile app to complete daily symptom screening, and, when needed, can schedule COVID-19 testing through mail-in test kits, "pop-up" testing sites set up by Verily or other options outlined by their employer or school.
Lee on Wednesday said some of the university campuses using Verily's program started the school year by testing students twice a week, and scaled down the frequency over time.
"It's been very important when these students have come from all over the country, where there are some significantly higher rates, and you just really want to be sure that they're not bringing that to the campus," she said. "After the first few weeks, I think, then it can kind of settle down to a lower frequency—but those first few weeks are really important."
Tuesday, Oct. 13
Azar on controversial HHS Protect project
HHS Secretary Alex Azar touted the department's controversial HHS Protect database during a keynote address.
"At the beginning of this unprecedented crisis, the federal government largely collected data through customized public health reporting systems that otherwise relied on gathering data from state public health departments," he said. "These customized systems have played incredibly important roles on issues like fighting anti-microbial resistance, but they couldn't provide the kind of flexible reporting we needed."
HHS in mid-July announced that it, rather than the Centers for Disease Control and Prevention, would begin collecting daily COVID-19 information from hospitals through a new database, dubbed HHS Protect. The decision sparked concerns about the integrity of COVID-19 data reporting, as well as several congressional investigations.
Azar on Tuesday said HHS' vision is to gather more data to better target COVID-19 interventions, and to collect that information directly from data that's already being generated during clinical care.
In the long-term, Azar said HHS wants to "eliminate reporting entirely," by leveraging data that's gathered as part of providers' clinical workflows.
That was the thinking that underpinned creation of HHS Protect, he said.
"CDC, the HHS CIO and other leaders across HHS and the administration are already hard at work at moving us toward this goal," Azar said.
As an example, Azar said HHS has shipped 150 million of Abbott's rapid COVID-19 tests to states, nursing homes and other sites. The tests include a companion mobile app that links an individual test to a patient using a QR code. HHS is working with Abbott and state public health entities to see if they can use that system to facilitate case reporting.
"Just imagine that: Between a smartphone app and a cardboard test card with a QR code on it, we have an entire testing and reporting system," Azar said.
Verma: CMS to release details on COVID vaccine coverage
CMS is figuring out a "path forward" to ensure beneficiaries will be able to receive a COVID-19 vaccine without cost sharing from insurers, said CMS Administrator Seema Verma.
"You'll see more from the agency by the end of the month on this issue," she said. "We … want to make sure that all of our rules make it very clear to insurers that we want to make sure that every American can have access to these vaccines. The government's going to pay for the cost of the vaccines."
"Congress has been very clear that they want to make sure that seniors have access to these vaccines with no cost sharing," she said.
Verma also said CMS is working to ensure fees that Medicare pays providers administering COVID-19 vaccines are appropriate, considering the likely "complexities" of a COVID-19 vaccine—such as if it's a multi-dose vaccine or requires complicated storage processes.
Monday, Oct. 12
Teladoc, Livongo have inked first cross-selling agreement
Teladoc Health and Livongo, which in August announced plans to merge in a $18.5 billion deal, have signed their first commercial cross-selling agreement.
GuideWell Mutual Holding Corp., the parent company of health insurer Florida Blue, was already a Teladoc customer for several years, said Teladoc's CEO Jason Gorevic, who will lead the combined company and continue to serve as CEO. It's now signed a contract to make Livongo's diabetes program available to some Florida Blue members, as well.
"It's the first example of why this merger makes so much sense," said Glen Tullman, Livongo's founder and executive chairman, who will have a seat on the combined company's board of directors. "That wouldn't have happened without the connection with Teladoc … Maybe it would have happened in the future, but right now it's going to happen much more quickly."
Teladoc and Livongo executives when announcing the merger in August had highlighted the possibility of cross-selling products among their respective customer bases as a key benefit.
An estimated 25% of Teladoc's and Livongo's current customers already use services from both companies.
The possibility of bringing together Teladoc and Livongo's services is part of Teladoc's vision of "reimagining what primary care should be," Gorevic said."Rather than being a check-up once a year and one or two visits for a sore throat or the flu—and that's really it, and no interactions in between that—this becomes a longitudinal relationship," he said.
HHS to launch BARDA Ventures fund
The Biomedical Advanced Research and Development Authority, part of HHS' Office of the Assistant Secretary for Preparedness and Response, unveiled a venture-capital fund dubbed BARDA Ventures.
"We're envisioning this fund to be a truly venture-style fund that can make quick, agile investment decisions," said Sandeep Patel, director of the division of research, innovation and ventures—also known as DRIVe—at BARDA. "As a nation, we've historically underinvested in the kinds of technologies that are needed to prepare for threats today and tomorrow."
BARDA Ventures, which Patel said will invest in technologies like synthetic biology and early disease-detection tools, will be managed by an independent not-for-profit.
BARDA is still seeking an existing not-for-profit to serve as that managing partner. Once BARDA selects a partner, they will formally launch BARDA Ventures.
The venture capital model will allow BARDA to "respond more quickly with investments," "fortify U.S. influence on the development of critical health security technologies," and "maximize taxpayer value by being able to recycle returns of successful investments," Patel said.
BARDA Ventures will raise additional capital from private investors for the fund.
Congress authorized BARDA to partner with a private not-for-profit to promote development of innovative drugs, medical devices and vaccines—including through investment into companies developing such work—as part of the 21st Century Cures Act.
Amazon Alexa app helps ChristianaCare care for seniors at home
ChristianaCare in Newark, Del., developed an application for Amazon's voice assistant, Alexa, that sends reminders to seniors who are part of the health system's home care program, said Rachel Jiang, head of the Alexa health and wellness team at Amazon.
The voice application—which Alexa calls a "skill"—sends reminders to seniors about physical therapy, medication and wound care, based on care plans determined by the patient's provider.
The program links up with an Echo Show, a voice-controlled Alexa device that includes a screen, so that the patient can review videos of their physical therapy routines.
It's proven particularly helpful during the COVID-19 pandemic, when in-home health visits from providers are less frequent, Jiang said.
The program relies on a voice application ChristianaCare developed as part of a program from Amazon, dubbed the HIPAA-eligible skills program. Amazon launched the program, under which healthcare companies can work with the company to develop Alexa applications that comply with HIPAA, last year.
Atrium Health, Boston Children's Hospital, Cigna, Express Scripts, Livongo and Providence in 2019 were the first participants to develop applications as part of the Alexa program.
ChristianaCare hopes its application for seniors will improve patient activation measures, adherence to care plans and health outcomes, Jiang said.
Race, age, comorbidity data important to evaluate COVID-19 vaccine, FDA commissioner says
The Food and Drug Administration is stressing to COVID-19 vaccine developers that their clinical trials need diverse patient populations.
The diversity includes patients of different races and ethnicities, age and comorbitiies.
"We're going to want to see: What's the safety in different populations? What's the effectiveness in different populations? Because that will shape our decision process," FDA Commissioner Dr. Stephen Hahn said. The FDA's guidance to date says it wants to see at least 50% effectiveness from a COVID-19 vaccine, he added.
The FDA could approve a vaccine for the general population or for a specific population, Hahn said.
"I can't pre-judge that, because I don't know the data," he said.
The Centers for Disease Control and Prevention—with other federal programs like HHS, the Department of Defense and Operation Warp Speed—is developing a strategy for distributing and allocating a COVID-19 vaccine, once it's available. The FDA will hand off data collected from clinical trials, including on effectiveness for various populations, to the CDC to inform those next steps.
The FDA provides advice and technical assistance to all vaccine manufacturers, Hahn added. The agency won't "play favorites with one versus the other," including those developed under Operation Warp Speed.
"There had to be a bright line—a very bright line—between the activities of Operation Warp Speed and the activities of FDA," he said. "We consider Operation Warp Speed to be another developer of a vaccine."
CEO Judy Faulkner on Epic's new research journal
Epic Systems Corp. is harnessing patient data from its EHRs to quickly publish findings in its own research journal, CEO and founder Judy Faulkner said.
Epic Health Research Network is not peer reviewed, but the journal's website says "it's important that good data be availabe sooner, rather than perfect data be available too late."
In May it published one of the earliest studies analyzing the mortality of COVID-19 patients who received mechanical ventilation, Faulkner said. She noted that highly respected journals can take months to review and publish studies.
"Things like mortality rates with ventilators were important to get out right away," she added.
Faulkner also touted Epic's interoperability work, saying providers were hesitant to use its data-sharing tools early on due to compliance concerns.
Today, she said Epic's Care Everywhere, a tool that lets Epic and non-Epic providers share medical records, exchanges more than 6 million records each day, 40% of which are connecting to providers who aren't on an Epic EHR.
Walgreens COO: 'The role of the pharmacist will be quite different'
The healthcare industry should re-evaluate the role pharmacists can play in delivering care to patients, according to Alex Gourlay, co-chief operating officer at Walgreens, arguing that better use of pharmacists would improve community healthcare.
He envisions a future where pharmacists play a larger role in vaccination, testing and treatment, as well as working more closely with primary-care doctors, specialists and nurses.
"The role of the pharmacist will be quite different," Gourlay said. "Many people don't realize pharmacists in America are the second-most educated healthcare professionals, after doctors."
That's part of the vision behind Walgreens' $1 billion investment into primary-care startup VillageMD, under which Walgreens plans to open hundreds of in-store clinics with the startup, where the companies have said Walgreens pharmacists will be an integral part of the care team.
Walgreens has already opened five in-store clinics with VillageMD in the Houston area.
The companies plan to ramp up to 40 clinics by the end of Walgreens' fiscal 2021 and more than 500 within the next five years.
Already, more than one-third of flu shots are administered by pharmacists each year, Gourlay said.
He expects to see 30%-50% more people receiving a flu shot at Walgreens this year amid the COVID-19 pandemic.
But for pharmacists to take on more patient-care responsibilities, "We've got to free them up … from the tasks of yesterday," Gourlay said, pointing to repetitive tasks like dispensing tablets into containers and calling payers as examples. Walgreens is investing in technology that can make those tasks easier for the company's 27,000 pharmacists, he said.
