HEALTH TRAIN EXPRESS
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Drugmakers including Bristol-Myers Squibb Co (BMY.N), Gilead Sciences Inc (GILD.O), and Biogen Inc (BIIB.O) hiked U.S. list prices on more than 50 drugs on Wednesday, bringing total New Year’s Day drug price increases to more than 250, according to data analyzed by healthcare research firm 3 Axis Advisors. Reuters reported on Tuesday that drugmakers including Pfizer Inc (PFE.N), GlaxoSmithKline PLC (GSK.L) and Sanofi SA (SASY.PA) were planning to increase prices on more than 200 drugs in the United States on Jan. 1. Nearly all of the price increases are below 10% and the median price increase is around 5%, according to 3 Axis. More early year price increases could still be announced. Soaring U.S. prescription drug prices are expected to again be a central issue in the presidential election. President Donald Trump, who made bringing them down a core pledge of his 2016 campaign, is running for re-election in 2020. Many branded drugmakers have pledged to keep their U.S. list price increases below 10% a year, under pressure from politicians and patients.
The United States, which leaves drug pricing to market competition, has higher prices than in other countries where governments directly or indirectly control the costs, making it the world’s most lucrative market for manufacturers. Drugmakers often negotiate rebates on their list prices in exchange for favorable treatment from healthcare payers. As a result, health insurers and patients rarely pay the full list price of a drug. Bristol-Myers said in a statement it will not raise list prices on its drugs by more than 6% this year. The drugmaker raised the price on 10 drugs on Wednesday, including 1.5% price hikes on cancer immunotherapies Opdivo and Yervoy and a 6% increase on its blood thinner Eliquis, all of which bring in billions of dollars in revenue annually. Gilead raised prices on more than 15 drugs including HIV treatments Biktarvy and Truvada less than 5%, according to 3 Axis. Biogen price increases included a 6% price hike on multiple sclerosis treatment Tecfidera, according to 3 Axis.
Good morning, it's Sunday morning, if you are tired of watching the Trump Impeachment Carnival, have your coffee watching this story. (it is a true story)
Insurance companies are supposed to LOWER healthcare costs by fighting inappropriate price gouging, right? WRONG. Here's why.
The story is all too common. Next time your physician orders a test, image or any service from an outside vendor.
A routine doctor's visit for a sore throat brought more than $28,000 in charges for one woman. In our Bill of the Month partnership with Kaiser Health News and NPR, we take a look at unexpected medical costs. The woman’s visit shows even when insurance does cover medical charges, costs can still skyrocket in the long run. David Begnaud reports, and Kaiser Health News editor-in-chief Dr. Elisabeth Rosenthal joins “CBS This Morning” to discuss the findings.
1. Ask how much it will cost
2. Don't believe what he says, because he does not know. If he refers you to one of his staff ask him/her.
Physician burnout: Which medical specialties feel the most stress? An online survey of doctors finds an overall physician burnout rate of 42%, which is down from 46% five years ago. Three new entries in the top six specialties with the highest rates of burnout compared with last year’s edition of the survey provide medical students and residents with new insight into their future careers. The numbers of physicians who report burnout vary greatly between specialties.
In the Medscape survey, the highest percentage of physician burnout occurred among these medical specialties: Urology: 54%. Neurology: 50%. Nephrology: 49%. Diabetes and endocrinology: 46%. Family medicine: 46%. Radiology: 46%.
The lowest rates of burnout were reported by physicians in these medical specialties: Public health and preventive medicine: 29%. Ophthalmology: 30%. Orthopedics: 34%. Psychiatry: 35%. Otolaryngology: 35%. General surgery: 35%.
These findings correlate well with other studies by the AMA, Mayo Clinic and Stanford. Reasons for burnout vary among specialties. Interference with lifestyle and home life. Long hours Unrelenting stress Disappointment with choice of specialty, or mode of practice setting. Physical or Emotional disturbance. Medico-legal issues What has been left out is pre-morbid emotional disturbances, such as bi-polar spectrum disorder, depression, anxiety. The selection of a particular specialty is often secondary or directly attributable to personality type. Social anxiety disorder would lead a physician into a specialty such as a pathology, or anesthesiology. What is burnout? Burnout among physicians was measured using the emotional exhaustion and depersonalization scales of the Maslach Burnout Inventory (MBI), a validated questionnaire considered the criterion standard tool for measuring burnout.28, 29, 30, 31 Consistent with convention,10, 32, 33 we considered physicians with a high score on the depersonalization and/or emotional exhaustion subscale of the MBI as having at least one manifestation of professional burnout.28
Although the MBI is the criterion standard for the assessment of burnout,28 its length and expense limit feasibility for use in long surveys addressing multiple content areas or in large population samples. Thus, to allow comparison of burnout between physicians and population controls, we measured burnout in both groups using 2 single-item measures adapted from the full MBI. These 2 items correlated strongly with the emotional exhaustion and depersonalization domains of burnout measured by the full MBI in a sample of more than 10,000 individuals,34, 35 with an area under the receiver operating characteristic curve of 0.94 and 0.93 for emotional exhaustion and depersonalization, respectively, for these single items relative to the full MBI. Ocam's Razor
The simplest solution is often the correct one. In this case, 3 out of four times one criterion yields a correct answer to the question, In this case, depersonalization, The single question with the highest factor loading on the emotional exhaustion (EE) (“I feel burned out from my work”) and depersonalization (DP) (“I have become more callous toward people since I took this job”)
The model, which gives patients direct access to their doctors and longer appointment times, is proving hard to scale up.
Some people spend $200 a month on the golf course or on a fancy cable TV package, says David Westbrook, a hospital executive in Kansas City, Mo. His splurge? He pays Dr. John Dunlap $133 a month for what he considers exceptional primary care.
Dr. John Dunlap runs a direct primary care practice in Overland Park, Kan., offering patients direct access to him by phone and longer appointment times. The model is similar to concierge medicine.
"I have the resources to spend a little extra money on my health care to my primary care physician relationship," Westbrook says. "Because I have that access — and am very proactive in managing my personal health — I think I'm going to be healthier."
That $133 is in addition to Westbrook's monthly insurance premium, which he still needs to cover whatever Dunlap can't handle in his primary care practice, such as specialist visits, hospital care and more.
For that fee, he has access to "concierge medicine" perks: a long, thorough annual physical exam — lab work included, no waiting room time, same-day appointments. Any other visits during the year cost him $20. His doctor knows him and understands his medical history. If he needs an answer to a question, he can call his doctor's cellphone.
This model is for more affluent people, however, some people will take the extra expense to assure accessibility which has become a major issue for even the insured. Payment for DPC can be made monthly, annually or per visit. Physicians benefit from less overhead, paperwork, billing, and collections. Staffing can be greatly reduced not having to use billers, insurance claims, denials all of which increase overhead, time and expense.
For years, Dunlap took insurance and ran a traditional practice. Now he has about 800 patients who pay him monthly fees directly.
More than 1 in 5 wealthy people pay an extra fee for direct access to their doctor, according to a new poll from NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health. For low and middle-income people, the rates are less than half that.
David Westbrook, photographed in his home in Kansas City, Mo., is a patient of Dr. John Dunlap. He pays $133 per month and gets what he considers exceptional care.
Barrett Emke for NPR
"There are approximately 1,000 [direct primary care] practices in 48 states serving approximately 300,000 U.S. patients," says Sullivan from Harvard, citing the Direct Primary Care Coalition. There's less known about how many patients receive care in true "concierge" practices, Sullivan says. There are also many patients seen at hybrid practices, which charge an extra fee for some of the same perks these other models offer but also bill your insurance, like a traditional doctor's office.
There's a basic math problem here. If doctors see fewer patients, there would need to be many more primary care doctors practicing in this country for this model to be more widespread. And that's a tall order, says Sullivan.
"We have issues with access to primary care in this country. We don't have enough trainees or enough clinicians choosing primary care," she points out. "To have [providers] suddenly hopping over to this model would continue to probably decrease access for patients to primary care."
When you are checking into your doctors' office for the first time, you are handed a HIPAA form. Within that document is legalese describing how your information will be protected....some of the time. Few people read it, skipping to the signature form. Patients skip to the forms about their past and present medical issues
The following is a guest article by Deborah Hsieh, Chief Policy & Strategy Officer at Ciox.
When most of your patients hear “health data rights,” they likely think of HIPAA, or the long forms they rarely read in their doctors’ offices. What they may take for granted is the protections for health data that covered entities must provide.
The Health Insurance Portability and Accountability Act (HIPAA) was passed in 1996 and is the framework on which health data protection has been constructed. The initial intent of the Act was to support the continuation of health insurance coverage and to ensure the security and confidentiality of patient information/data. The regulation fundamentally acknowledged the value of health data and the need for protection.
Where do health privacy rights start and end?
Despite the almost quarter-century that has passed since HIPAA was first enacted, there is relatively limited awareness of health privacy rights beyond compliance and legal experts. News of Google and Ascension’s partnership in November surprised the general public, including legislators, and perhaps exposed that limited awareness. One element many individuals are unfamiliar with is that the same health data that is protected when held by a covered entity – a healthcare provider, healthcare payer or business associate of one of those parties – is not protected if it is held by anyone else.
Almost 25 years have passed since HIPAA was created. Since that time there have been many changes, electronic health records, health information exchanges, telehealth, telemedicine, and remote monitoring to mention a few.
Many of the new companies bringing innovations in digital health are not covered entities or business associates, which means patients have no privacy protections for health data obtained by, shared with and/or created with those companies. As digital health companies and applications become more prevalent and consumers share more of their health data through the applications, consumers must understand their health data rights and how their data is being used so they can make informed choices. In addition to that, without defined protections, someone who is not a covered entity or business associate may also not be held accountable for any breaches of privacy in health data. Based on who holds the data, your patients may not have any recourse.
Protections for health data security are just as critical as those for privacy. In December, the Centers for Medicare and Medicaid Services (CMS) closed access to Blue Button 2.0, as a bug in the code “may be causing certain beneficiary protected health information to be inadvertently shared with another beneficiary or the wrong BB2.0 application.” CMS’s Blue Button 2.0 has been a prime example of the potential of application programming interfaces (API) and increased access to and exchange of health data. That an application created and run by the federal government still suffers from security issues should increase attention to and scrutiny of the security capabilities of other applications accessing health data.
Given this complex landscape, what should you do?
Providers, payers and their business associates should ensure they are abreast of current discussions about healthcare data privacy and security. Administrative actions include a proposed regulation by the Office of the National Coordinator for Health Information Technology related to healthcare data interoperability and exchange and plan to revisit HIPAA. The legislature is also increasing its attention to privacy generally, including for healthcare data. There is great potential for increased access and exchange of health data to improve healthcare delivery; however, there should be recognition and mitigation of the potential challenges to privacy and security, as well as thorough patient understanding.
Finally, healthcare stakeholders should be proactive in helping consumers understand the protections, or lack thereof, for their healthcare data. You can create a more positive consumer experience by educating your patients about their rights and the potential consequences of healthcare data sharing choices.
The important thing for patients to know is you have the right to opt-out of interoperability. Your electronic health record would then be inaccessible to other entities other than your physician. In that situation, you are the owner of your medical data and it cannot be released unless you sign a specific waiver to share it.
Twenty or more years have passed since HIPAA went into effect. It is most likely there will be no improvement. There will always be bugs, hacks, and phishing for your data. In today's world, your data is worth a lot of money. Entities will buy it, and resell it. There are criminal elements and marketing enterprises that are dedicated to creating revenues from your data.
The study finds the data indicates that Medicaid expansion may have prevented between 1,678 and 8,132 deaths from opioid overdoses between 2015 and 2017. For comparison, there were 82,228 total opioid overdose deaths in that time period, the study states.
“These findings add to the emerging body of evidence that Medicaid expansion under the ACA may be a critical component of state efforts to address the continuing opioid overdose epidemic in the United States,” the study states.
Graph of Overdose Deaths per 100,000 population
In this nationwide, population-based study of the association of Medicaid expansion under the ACA with county-level rates of opioid overdose mortality, we found empirical support for adopting and sustaining health coverage expansions as a potential tool for reducing opioid overdose deaths in the United States. Consistent with prior analyses16,27 examining Medicaid expansion and mortality from other causes, we found decreased rates of opioid overdose deaths associated with the adoption of Medicaid expansion. In particular, given 82 228 opioid-related deaths from 2015 to 2017 in the 32 states that expanded Medicaid between 2014 and 2016, our findings suggest that these states would have had between 83 906 and 90 360 deaths in the absence of the expansion, implying that Medicaid expansion may have prevented between 1678 and 8132 deaths in these states during those years.
The observed association between Medicaid expansion and decreased total opioid overdose deaths and deaths involving heroin and synthetic opioids other than methadone is likely in part attributable to the ACA’s inclusion of mental health and SUD services as essential health benefits. Expanded Medicaid eligibility has substantially increased access to these services among the low-income population.10,29 Recent evidence demonstrates that compared with non-expansion states, Medicaid expansion states experienced increases in overall prescriptions for, Medicaid-covered prescriptions for, and Medicaid spending on both MOUDs, particularly buprenorphine and naltrexone, and the opioid overdose reversal medication naloxone.6-8,11,14,30,31,35 Geographic Variation in Opioid and Heroin Involved Drug Poisoning Mortality Rates Introduction An important barrier to formulating effective policies to address the rapid rise in U.S. fatal overdoses is that the specific drugs involved are frequently not identified on death certificates. This analysis supplies improved estimates of state opioid and heroin involved drug fatality rates in 2014, and changes from 2008 to 2014. Methods Reported mortality rates were calculated directly from death certificates and compared to corrected rates that imputed drug involvement when no drug was specified. The analysis took place during 2016–2017. Results Nationally, corrected opioid and heroin involved mortality rates were 24% and 22% greater than reported rates. The differences varied across states, with particularly large effects in Pennsylvania, Indiana, and Louisiana. Growth in corrected opioid mortality rates, from 2008 to 2014, was virtually the same as reported increases (2.5 deaths per 100,000 people) whereas changes in corrected heroin death rates exceeded reported increases (2.7 vs 2.3 per 100,000). Without corrections, opioid mortality rate changes were considerably understated in Pennsylvania, Indiana, New Jersey, and Arizona, but dramatically overestimated in South Carolina, New Mexico, Ohio, Connecticut, Florida, and Kentucky. Increases in heroin death rates were understated in most states, and by large amounts in Pennsylvania, Indiana, New Jersey, Louisiana, and Alabama. Conclusions The correction procedures developed here supply a more accurate understanding of geographic differences in drug poisonings and supply important information to policymakers attempting to reduce or slow the increase in fatal drug overdoses.
The observed association between Medicaid expansion and decreased total opioid overdose deaths and deaths involving heroin and synthetic opioids other than methadone is likely in part attributable to the ACA’s inclusion of mental health and SUD services as essential health benefits. Expanded Medicaid eligibility has substantially increased access to these services among the low-income population.10,29 Recent evidence demonstrates that compared with non-expansion states, Medicaid expansion states experienced increases in overall prescriptions for, Medicaid-covered prescriptions for, and Medicaid spending on both MOUDs, particularly buprenorphine and naltrexone, and the opioid overdose reversal medication naloxone.6-8,11,14,30,31,35
Say you’ve received a brand-new Fitbit for Christmas to get you started in tracking your exercise routine and reach your fitness goals. Great! However, there might be more going on behind the scenes of you keeping fit with the help of technology than meets the eye...
Just like the Jedi Order's Light and Dark side of The Force, health trackers also have contrasting sides akin to the Sith and the Jedi, and you might have unintentionally signed a pact with the dark side already… In hindsight, it might have been a better idea to have asked for a LEGO Millennium Falcon instead...
The Medical Futurist, we’re great fans of wearables (or health trackers) that help you make more informed decisions when it comes to your health. However, we can’t stay indifferent to the potential risks which using these devices entail such as individual tracking, inaccuracies and even supplementing harmful behaviors.
If you were oblivious about the flip side of the health-tracking industry, then join us as we explore the lesser-known, darker side of wearables.
Cyborgs under surveillance
While fitness trackers are practically turning us into cyborgs, they are also increasingly allowing us to be tracked in ways we might not be aware of. In an eye-opening piece published last December, the New York Times showed how, by using only a fraction of location data obtained from a location data company mining that information from various apps, they could track and identify people from military officials to Hollywood stars. A singer whose activities they tracked couldn’t even name the app that might have collected the data used, even though she was careful about limiting how she shared her location.
Find the dots, connect the dots. Even if the data is anonymized, in today's world AI and algorithms will compare data from one source with another, and derive a statistical likelihood that the data is yours.
If you consider that the global number of connected wearable devices is expected to amount to over 1.1 billion in 2022, then you are very likely to be among the owner of such a device that might be giving away your location history to potentially unscrupulous third parties...
For tighter control over the data collected, the same authors of the New York Times article shared 3 quick steps that you can take. These include manually stopping location tracking by apps, disabling mobile ad ID and switching off location sharing in your Google account. Where applicable, you can also set up two-factor authentication on your accounts.
If you’re using a fitness tracker to better monitor and/or attend to a medical condition, you should do so under the guidance of a medical professional. Moreover, any aberrant results you might come across should be cross-checked with a professional.
Unknown to many there are federal guidelines as to how federal funds are spent. The National Academies of Medicine advisory committee released their list of priority areas for medicine whose goals are for 2030. The NAM has provided this list since 1979. Beginning in 1979 and in each subsequent decade, the U.S. Department of Health and Human Services (HHS) has overseen the Healthy People initiative to set national goals and objectives for health promotion and disease prevention. The Healthy People effort also informs public health planning and measurement at the state and local levels.
The HHS Office of the Assistant Secretary for Health charged The National Academies of Sciences, Engineering, and Medicine with assisting in the development of Leading Health Indicators (LHIs) for Healthy People 2030. To accomplish this task, the National Academies convened a consensus committee to provide advice on two components of the Healthy People 2030 effort. The committee was asked to develop (1) recommendations regarding the criteria for selecting LHIs and (2) a slate of LHIs that will serve as options for the Healthy People Federal Interagency Workgroup to consider as they develop the final criteria and set of LHIs for Healthy People 2030. The committee also could identify gaps and recommend new objectives for LHI consideration that meet the core objective criteria. The report Criteria for Selecting the Leading Health Indicators, released in August 2019, responded to part 1 of the charge. The committee’s response to part 2 is found in the present report.
The top one goes to statements about veterans' health care.
President Trump has made 901 false or misleading claims related to health care since taking office three years ago, a Washington Post database shows.
His foremost claim? That his administration single-handedly overhauled care for veterans with the 2018 Mission Act — a measure that does make it easier for some vets to visit private medical providers but is mostly an update of a law signed by President Barack Obama.
His foremost claim? That his administration single-handedly overhauled care for veterans with the 2018 Mission Act — a measure that does make it easier for some vets to visit private medical providers but is mostly an update of a law signed by President Barack Obama.
Trump’s pronouncements on a range of health-care topics — such as preexisting condition protections, the effects of Medicare-for-all and the state of the Affordable Care Act — are among the more than 16,200 false or misleading claims he has made in his three years since taking the oath of office.
The Post’s stellar fact-checking team, which in the administration’s first 100 days started a database for analyzing, categorizing and tracking every suspect statement Trump utters. At the request of readers, they kept it going.
Now the database shows Trump made 8,155 suspect claims in 2019, up from 5,689 claims in 2018 and 1,999 claims in the first year of his presidency.
“In a single year, the president said more than the total number of false or misleading claims he had made in the previous two years,” our colleagues Glenn Kessler, Salvador Rizzo, and Meg Kelly write. “Put another way: He averaged six such claims a day in 2017, nearly 16 a day in 2018 and more than 22 a day in 2019.”
President Trump has made 901 false or misleading claims related to health care since taking office three years ago, a Washington Post database shows.
His foremost claim? That his administration single-handedly overhauled care for veterans with the 2018 Mission Act — a measure that does make it easier for some vets to visit private medical providers but is mostly an update of a law signed by President Barack Obama.
Trump’s pronouncements on a range of health-care topics — such as preexisting condition protections, the effects of Medicare-for-all and the state of the Affordable Care Act — are among the more than 16,200 false or misleading claims he has made in his three years since taking the oath of office.
That’s the tally from The Post’s stellar fact-checking team, which in the administration’s first 100 days started a database for analyzing, categorizing and tracking every suspect statement Trump utters. At the request of readers, they kept it going.
Now the database shows Trump made 8,155 suspect claims in 2019, up from 5,689 claims in 2018 and 1,999 claims in the first year of his presidency.
“In a single year, the president said more than the total number of false or misleading claims he had made in the previous two years,” our colleagues Glenn Kessler, Salvador Rizzo, and Meg Kelly write. “Put another way: He averaged six such claims a day in 2017, nearly 16 a day in 2018 and more than 22 a day in 2019.”
Here are Trump’s top five misleading health-care claims, in order of how frequently he has repeated them:
1. Trump is particularly fond of making bold claims about how the Veterans Affairs Mission Act came about and what it did. Although the Act was passed into law many of its regulations were never implemented. He has claimed the legislation was all his idea. He has suggested Congress couldn’t get the measure approved for 44, 45 or even 48 years. He has made these claims — or iterations of them —113 times, according to the Post database. The actual history of the VA Choice program goes like this: Congress passed the program under Obama as a way of addressing the 2014 scandal in which Veterans Affairs facilities were found to be obscuring long wait times for medical appointments. The program allowed one-third of veterans to get government-paid health care in private settings.
2. Trump has made all sorts of dubious claims about the 2010 Affordable Care Act, calling it “crazy,” “a disaster” and “not working.” He has made such claims 80 times.
3. The president has another favorite overstatement related to veterans’ health care: that a June 2017 measure he signed allowed underperforming VA workers to be fired for the first time ever.
4. Trump’s claims around patients with preexisting health conditions (including one that Glenn gave “Four Pinocchios”) have attracted the most ire from Democrats.
5. This attack — that Democrats want to eviscerate the Medicare program — was popular among Republicans in the 2018 election as they tried to turn the health-care issue to their advantage. Trump has repeated such claims 56 times.
Past approaches to fixing our healthcare system have led to an absurdly complicated and convoluted system based on political motivations - see examples such as the “Affordable Care Act,” which crippled the ability for Americans to gain access to healthcare in the name of health coverage.
The truth is the status quo is broken. Prices and spending levels continue to rise. The healthcare bureaucracy continues to grow. Americans are hurting because of it.
In order to fix our system, we need healthcare freedom.
The Personalized Care Act will put millions of Americans in control of their healthcare choices by expanding Health Savings Accounts (HSAs) - a mechanism necessary to creating healthcare freedom which will allow Americans to personalize their care. Under this bill, funds from HSAs can be used for options such as direct medical care, healthcare sharing ministries, medications, and insurance premiums.
No one should stand in the way of you and your doctor – this includes government and insurance bureaucrats. H.R. 5596, the Personalized Care Act, works to eliminate the growing healthcare bureaucracy by allowing individuals to control their healthcare dollars - tax-free. Healthcare is personal, and Americans deserve a personalized approach.
An analysis of Medicare data has uncovered a startling trend regarding rehabilitation for patients who suffered a cardiovascular event or surgery. Cardiac Rehabilitation Attendance Low Among Medicare Beneficiaries
Matthew Ritchey, DPT, MAn analysis of Medicare data has uncovered a startling trend regarding rehabilitation for patients who suffered a cardiovascular event or surgery.Results of the analysis, which was led by Matthew Ritchey, DPT, MPH, of the Centers for Disease Control Prevention (CDC), indicated less than 1 in 4 eligible patients participated in a cardiac rehabilitation program and just 24% of those who did participate started the program within 21 days of the event or surgery"The low participation and completion rates observed translate to upwards of 7 million missed opportunities in this study to potentially improve health outcomes if 70% of them covered by Medicare who had a heart attack or acute heart event or surgery participated in cardiac rehabilitation and completed 36 sessions,” said Ritchey, a researcher at the CDC’s Division for Heart Disease and Stroke Prevention, in a press release.
In spite of mountains of data indicating the beneficial impact of cardiac rehabilitation on outcomes following cardiovascular events or procedures, improving patient participation and adherence remains a challenge. To assess the progress of programs like the Million Hearts Cardiac Rehabilitation Collaborative, investigators conducted an observational analysis of Medicare Part A and Part B claims data from fee-for-service beneficiaries 65 years and older between 2016 and 2017.
The shocking news is that this is a fully covered Medicare Benefit.
Inclusion criteria included experiencing 1 or more AMI hospitalization, CABG, heart valve repair or replacement, percutaneous coronary intervention, or heart or lung transplant. Patients also needed to be alive for more than 21 days following their qualifying event, have continuous Medicare Part A and Part B enrollment for 12 or more months following the event if they survived to that point, and not be entitled to Medicare benefits due to having an end-stage renal disease. Using these criteria, investigators identified a cohort of 366,103 patients who were eligible for cardiac rehabilitation, of which 89,327 (24.4%) participated in such a program. Further analysis revealed only 24.3% of those who participated began within 21 days of the event or procedure and just 26.9% of participants completed cardiac rehabilitation. Results also indicated participation varied based on the ethnicity of the beneficiary. Participation rates were highest among Non-Hispanic whites, with non-Hispanic blacks being 0.7 times (adjusted prevalence rate [aPR] 0.70; 95% CI, 0.67–0.72) as likely and Hispanics 0.63 times (aPR 0.63; 95% CI, 0.61–0.66) as likely to participate than their white counterparts.
Age also appeared to impact participation rates among beneficiaries. Among those 85 years and older, only 9.8% (aPR 0.57; 95% CI, 0.56–0.59) of eligible beneficiaries participated in a rehab program—compared to 24.8% (aPR 0.93; 95% CI, 0.92–0.95) among those 75 to 84, and 31.7% among those 65 to 74 years old.
Ritchey and colleagues noted multiple limitations to consider when interpreting the results of their analysis. Limitations included being unable to assess referral rates with the use of billing data, clinical information was not available for all patients, investigators were unable to control for factors such as availability of programs, and because only cardiac rehabilitation was assessed results may not be generalizable to Medicare Advantage members or younger patients. Based on the results of their analyses, Ritchey suggests more work is needed to promote and encourage participation in cardiac rehabilitation programs if clinicians seek to maintain the improvements in cardiovascular outcomes seen in recent years.
Despite cardiac rehabilitation (CR) being shown to improve health outcomes among patients with heart disease, its use has been suboptimal. In response, the Million Hearts Cardiac Rehabilitation Collaborative developed a road map to improve CR use, including increasing participation rates to ≥70% by 2022. This observational study provides current estimates to measure progress and identifies the populations and regions most at risk for CR service underutilization.
Despite the importance of CR use to improve health outcomes after a qualifying cardiac event, participation and completion remain low among eligible Medicare FFS beneficiaries. Furthermore, disparities and considerable geographic variability persist. A wealth of guidance exists that identifies the evidence-based strategies that can be used to increase CR use. Hospitals, CR programs, and other stakeholders can consider systematically integrating these strategies into their processes and tracking the effects of their implementation using established quality and performance measures. Continued innovation in the delivery of services may help meet the needs of the groups most underserved, as well as to increase the capacity to provide care for all those who qualify. The findings in this article and future analyses can be used to assess the impact these collective efforts have on achieving national CR utilization goals. There is a serious disconnect between cardiologists, cardiothoracic surgeons, and their patients. Preoperative counseling should include the necessity of post-operative rehabilitation In the cases of open heart surgery chest wall physiology is radically altered due to the opening of the thoracic cavity. For patients in heart failure prior to diagnosis and treatment, it is likely that patients have become de-conditioned due to dyspnea and fatigue. Once treated their body literally has to catch up with a healthier heart/
The next time you call to make an appointment (if your doctor does not offer online booking) a chatbot will handle the call. This appears to satisfy the Turing test. (User cannot discriminate between a computer algorithm and a live person.)
The age of talking algorithms is here.
In 2018, Google stunned the world with the latest feature of the Google Assistant, Duplex, which was able to make an appointment in a hair salon in eerily human-sounding conversational sentences. Chatbots, computer programs or smart algorithms conducting conversation via auditory or textual methods, are becoming more and more popular and widespread. Do you want to know more dad jokes? Read the latest news? Figure out riddles? Plenty of messenger bots offer forms of entertainment.
These features are here now.
Moreover, chatbots are even surpassing into the territory of humans: empathy and feelings. Do you need a friend when you feel lonely? Have a chat with Replika, your A.I. friend to whom you can tell everything about your life. Or talk to Woebot, a little algorithmic assistant aiming to improve mood. It promises to meaningfully connect with you, to show bits and pieces of empathy while giving you a chance to talk about your troubles and get some counseling back in return. Just as a human psychologist does. Do you rather want to get connected to a human coach instantly? Turn to Ginger!
Health Chatbots
Source: www.blog.woobox.com
Chatbots and their place in healthcare
Obviously, there are countless cases where a digital personal assistant or a chatbot could help physicians, nurses, patients or their families. Better organization of patient pathways, medication management, help in emergency situations or with first aid, offering a solution for simpler medical issues: these are all possible situations for chatbots to step in and ease the burden on medical professionals.
Health chatbots are also being used to address specific issues in healthcare. Northwell Health recently launched one to help reduce “no-shows” for colonoscopies, a procedure elemental in colorectal cancer diagnosis. This issue is particularly concerning as 40 percent of less privileged patients don’t follow through with the procedure. The A.I.-based solution is being offered at Long Island Jewish (LIJ) Medical Center and Southside Hospital. Northwell says that personalized chatbot will “encourage patients by addressing misunderstandings and concerns about the exam, delivering information in a responsive, conversational way over email or text”. Researchers will also be able to monitor patient satisfaction, cancellations, no-shows, and successfully completed exams with the app’s use.
In some cases, health chatbots are also able to connect patients with clinicians for diagnosis or treatment, but that is already one step further down the line. The general idea is that in the future, these talking or texting smart algorithms might become the first contact point for primary care. Patients will not get in touch with physicians or nurses or any medical professional with every one of their health questions but will turn to chatbots first. If the little medical helper could not comfortably respond to the raised issues, it will transfer the case to a real-life doctor.
As the number of health chatbots multiplies with incredible speed, we decided to list the most promising ones to have a clue about where the health chatbot industry is heading.
Farewell to some, welcome to others
One would think that artificial “beings” like chatbots would be immune to human beings’ eventuality – death. But some of those virtual chatty beings do seem to share a similar fate to their human companions…
In the last couple of years, we’ve had to bid farewell to some prominent health chatbots. Izzy, the handy period tracking and women’s health bot, stopped to exist. Eva, from Spain-based Bots4Health, who could chat about a wide range of health issues with users followed suit. Even some promising tech like Cognitoys with its dinosaur-shaped A.I. companion toys went off the radar.
We envision a future with chatbots playing a key role in people’s health, we cannot help but feel let down by the “demise” of those virtual health companions. The latter had at their core the noble aim to ease the burden on medical professionals while making patients the point of care. Alas, we’ll have to bid farewell to those bots who left us but we are happy to welcome new ones in this venture as well!
Indeed, health chatbots are on the rise and keep attracting investors. A Crunchbase analysis found that VCs have invested more than $800 million in at least 14 known startups who offer some version of a chatbot with health features.
As such, we decided to update the list of our favorite chatbots relevant in 2020. Say hi to your new health buddy!
1. OneRemission
This New York-based company launched its chatbot with the aim to help ease the life of those involved in the fight against cancer with the information they need.
For cancer patients and cancer survivors, the app empowers them by providing a comprehensive list of diets, exercises, and post-cancer practices, curated by Integrative Medicine experts, so that they don’t need to constantly rely on a doctor. They can, for example, search about the cancer-related risks and benefits of a certain food product.
Should they need the help of a specialist, OneRemission features the ability for users to consult with an online oncologist 24/7.
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Basing itself on the latest scientific research, Youper’s A.I. monitors and improves users’ emotional health with quick personalized conversations using psychological techniques. To further help one improve their emotional health, the app features personalized meditations as well as the ability to track mood and monitor emotional health. As users communicate with the chatbot, it will learn more about them and fine-tune the experience in order to fit their needs
3. Safedrugbot
The idea was born out of a real demand: the developer of the app was asked by a doctor to quickly and easily retrieve information about drugs to which breastfeeding mothers may be exposed. The goal was reached: Safedrugbot is a chat messaging service that offers assistant-like support to health professionals, doctors who need appropriate data about the use of drugs during breastfeeding. Moreover, it provides information about the active ingredients present in the medication and alternative medicines.
Health Chatbots
Source: www.safeinbreastfeeding.com
4. Babylon Health
The British subscription, online medical consultation and health service, Babylon Health, was founded in 2013 and is now valued at more than $2 billion. The company offers A.I. consultation based on personal medical history and common medical knowledge as well as live video consultation with a real doctor whenever a patient needs it.
In the first case, users report the symptoms of their illness to the app, which checks them against a database of diseases using speech recognition, and then offers an appropriate course of action. In the second case, which already goes beyond the usual service of a chatbot, doctors listen and look carefully to diagnose the patient and then write prescriptions or refer to a specialist if required.
The U.K.’s National Health Service (NHS) started to use the chatbot for dispensing medical advice for a trial period in 2017. Nowadays, the collaboration is going strong as the company provides NHS patients near London and Birmingham with digital consultations with doctors (over 700,000 conducted so far). It also plans to extend its service to other cities in the U.K. in the future.
Top Telemedicine Solutions
Source: www.pharmaphorum.com 5. Florence
The chatbot is basically a “personal nurse” in the color blue, and works on Facebook Messenger, Skype or Kik. “She” can remind patients to take their pills, which might be a handy feature for older patients. You just write the name of the medicine in chat, the number of times a day you must take it and at what time. Then, Florence sends you a message in chat every time you must take the pill.
Moreover, Florence can track the user’s health, for example, body weight, mood or period, thus helping them to reach their goals. The chatbot also has the skills to find the nearest pharmacy or doctor’s office in case you need it.
Health Chatbots
Source: www.techcrunch.com
7. Ada Health
Over 1.5 million people have already tried the health companion app, which can assess the user’s health based on the indicated symptoms using its vast, A.I.-based database. We also gave this one a spin in our big symptom checker review and found it to be the one with the most features from those we tested.
Daniel Nathrath, CEO of Ada Health told The Medical Futurist that in the future, “Ada will become a standard diagnostic tool for doctors. That is already the case; users can share their health assessment with their doctor or, in the UK, they can choose to consult with a qualified GP via our Doctor Chat feature. Ada will also become much more of an ongoing health companion, helping patients and doctors to intelligently monitor health data over the long term to enable predictive and proactive care.” Moreover, they have experimented with a voice interface and have trialed using Ada through Amazon Alexa.
Health Chatbots
Source: www.medium.com
8. Sensely
The virtual medical assistant named Molly can assess the patient’s symptoms using speech, text, images, and video. As the user wishes, it can use text or speech to communicate. Based on the gathered data as well as the information fed to its smart algorithm, Sensely interprets the user’s symptoms and recommends a diagnosis.
Molly uses the colors of the triage system, well-known in emergency care to decide about the urgency of a case. In Sensely’s symptom triage it means an assessment of whether self-care is enough or the patient should turn to a doctor. Moreover, it offers a local service discovery and rich resources for self-care.
9. Buoy Health
Reportedly developed by a team of doctors and computer scientists through the Harvard Innovation Laboratory, the company’s algorithm was trained on clinical data from 18,000 medical papers to mirror the literature referenced by physicians. Examples of data include 5 million patients and approximately 1,700 conditions.
You can check your symptoms online or browse in the vast database of Buoy Health to figure out what might be wrong with your health. The chatbot thoroughly asks you about the details of your medical state and offers you various solutions and actionable steps to take.
Health Chatbots
Source: www.cursor.org
10. Infermedica
Infermedica leverages machine learning technology to power the symptom-checker chatbot, Symptomate. The platform runs online and on mobile phones as a chatbot or voice-based application. It assesses the user’s health status and based on the symptoms it sets up a possible diagnosis and gives actionable recommendations. In 2017, Infermedica conducted three million diagnostic interviews with patients and the company doubled its monthly recurring revenues in 2018.
Health Chatbots
Source: www.youtube.com
11. GYANT
GYANT is a health chatbot that asks patients to understand their symptoms and then sends the data to doctors who provide diagnoses and prescribe medicine in real-time. The service is available on Facebook Messenger or Alexa, but the team plans to release it on every messaging platform soon. In addition, they not only provide help for English-speaking patients, but GYANT can speak to users in Spanish, Portuguese or German. GYANT is an Amazon Alexa skill and can be enabled here
In March 2019, the company reported that it prompted over 785,000 people in Latin America to successfully complete a pre-diabetes screening. Following this, more than 174,000 at-risk people from low-income populations participated in treatment with weekly glucose checks at local pharmacies.
Health Chatbots
Source: www.healthcare.digital 12. Cancer Chatbot
is a helpful resource for cancer patients, caregivers, friends and family on Facebook Messenger. The chatbot offers plenty of resources for patients from chemo tips and tricks to free services. It provides resources for caregivers to ease the burden of caring and making their lives easier. Moreover, it offers friends and families advice on what to say and how to help cancer patients best. It’s a sophisticated and well-thought-out solution. The website offers a number of turnkey chatbots that can be purchased online.
Health Chatbots
Source: www.ihadcancer.com
As the health chatbot market is buzzing, no one could collect every one of them as the next day; new ones will appear on the horizon. That also shows what bright future chatbots have in healthcare and how broad the scope is where they can lend a helping hand to both patients and physicians. Do you know about any exciting health chatbot innovation? Let The Medical Futurist know on its Twitter, Facebook or LinkedIn channel!
Like many tech companies, digital or otherwise, healthcare is a tempting target for business opportunities. Google is one of these examples. About five years ago Google had an online form of EHR called Google Health. It failed to get traction and was eventually downgraded and removed from the market place. Now Alphabet was created to be the umbrella company for many related products. Their present success in health IT is the new Apple Smartwatch 5. The device actually has been tested and approved by the Food and Drug Administration. This is no small feat.
What if we looked at all the moves, tech giants are taking in healthcare?
Microsoft, Amazon, Apple, and Google – the „big four” for healthcare?
In September 2017, Microsoft announced the launch of its new healthcare division at its Cambridge research facility, to use its artificial intelligence software to enter the health market. Only in two months, the FDA cleared the first medical device accessory for Apple Watch, Alivecor’s Kardiaband. A few months earlier, Apple had also launched an initiative called the Apple Heart Study in partnership with Stanford Medicine. Moreover, in December 2017, Tim Cook & Co. announced the development of an advanced heart-monitoring feature for future versions of its smartwatch. The latest news in January 2018 was that Apple is bringing health records to iPhones. After all these steps, is it so far-fetched to think that Apple might soon turn Siri into a medical chatbot that alerts you if something is wrong.
No other company in the Silicon Valley is investing so heavily in healthcare-related companies as Alphabet’s venture arm, GV (formerly known as Google Ventures) does.
Since it raised its first fund in 2009, it has backed nearly 60 health-related enterprises. Their portfolio is very diverse ranging from genetics to telemedicine. GV invested in 23andme, the most well-known direct-to-consumer genetic testing company with one of the biggest DNA databases in the world. In addition, Google has stakes in Oscar Health, the New York-based venture disrupting health insurance; Doctor on Demand, a telehealth company helping people talking to physicians from afar; Flatiron Health, a company building a data platform dedicated to oncology or Impossible Foods developing plant-based meats and cheeses. Of course, Amazon doesn’t want to lag behind. But Jeff Bezos is rather attracted to retail and pharmacies. According to CNBC’s news in January 2018, the Seattle-based giant hired one of Amazon’s most high-profile hires to date in health, Martin Levine. He could be joining the tech giant’s internal healthcare group known as 1492, which is testing a variety of secretive projects. Amazon acquired Pillpack, an innovative online pharmacy note for its unique system of dosing packets, for each dose and time of day. Some analysts even regard Amazon’s favorite digital assistant, Alexa as the future’s possible digital doctor. Amazon, Berkshire Hathaway, and JPMorgan Chase also announced a partnership to cut health-care costs and improve services for their US employees.
These four companies have tremendous wealth and are highly liquid with vaults filled with cash. They have tremendous potential to build things with usable interfaces. Many physicians complain that standard EHR vendors would benefit if Apple redesigned their EHR GUIs,
None of these predictions are weird. Some are already operational. The unknown factor is will the market accept and support a business model for the long term. A number of very good AI applications have come and gone.
To be successful in a highly competitive and reducing reimbursement environment any app must demonstrate utility and a return on investment with significant savings.
