To Beat COVID-19, We Need A Modern Approach to Public Health Data

To Beat COVID-19, We Need A Modern Approach to Public Health Data
Ed Simcox, Chief Strategy Officer at LifeOmic

The COVID-19 pandemic, which has taken 270,000 American lives to date, has shined a light on another crisis — the U.S. currently has no standardized system for reporting public health data. Health departments all over the country resort to using paper, fax, phone, and email to transmit and receive critical information, and essential healthcare workers are spending precious time retyping data into systems from printed reports and PDFs.

At the heart of this lack of a centralized infrastructure for reporting public health data is the 10th Amendment of the U.S. Constitution, which says, “The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.” Because of this amendment, the federal government — including the CDC — is not able to mandate that states, providers, or public health entities use a centralized reporting mechanism for managing all public health data. Further, the 10th Amendment also allows states to set up their own IT systems independently of other states and the federal government. The CDC then has to beg for data that sits in bespoke, disparate information systems in each state and territory.

Congress has tried three times in the last fourteen years to fix the issue. In 2006, it passed the Pandemic and All Hazards Preparedness Act (PAHPA), which required the CDC to establish the near-real-time, electronic, nationwide, public health data-sharing capability. Four years later in 2010, the U.S. Government Accountability Office (GAO) reported that not even the most basic planning steps were taken to establish the network. 

Then in 2013, Congress passed the Pandemic and All Hazards Preparedness Reauthorization Act (PAHPRA), which unsuccessfully called for a near real-time interoperable public health data exchange network. Finally, just months before the current pandemic, Congress passed the Pandemic and All-Hazards Preparedness and Advancing Innovation Act (PAHPAI), and our need for such a system is now greater than ever.

An Interoperable Public Health Data System

The U.S. Department of Health and Human Services (HHS) needs to lead the creation of a modern public health data approach on behalf of all public health agencies throughout the country, including the CDC. HHS was given $1 Billion for public health data infrastructure modernization in the recently passed CARES Act.

A modern approach to public health data would cost a fraction of that and must consist of three things: the creation of a gateway to link and securely move data between public health entities, the adoption of and adherence to widely accepted health data standards, and the creation of a cloud-based data hub for transparent analysis and reporting of data.

Creation of a Data Gateway

Data must be complete, timely, and accurate. A single federal data gateway would allow for the secure, two-way flow of data between all of the components of the public health ecosystem. The idea is not to create new, custom systems as we have done in the past, but to create a single gateway system at the federal level that stitches all existing data systems together using modern application programming interfaces (APIs). Such a system will allow data to timely flow between jurisdictions and up to the CDC so that we can collectively inform public health decision-making and public policy. 

We should leverage recently adopted interoperability standards to connect data from existing Electronic Health Records (EHR) and insurance claims systems wherever possible to avoid duplicate entry of data by essential workers.

Adoption of a Standardized Data Model

We need to encourage state and local health organizations to use and promote a standardized approach to collecting data at the points of care, testing, and immunization. 

Fortunately, the public health data interoperability challenge can be solved by supporting the private sector’s move to a standardized data model for healthcare data. Congress spent billions of taxpayer dollars over the past several years incentivizing healthcare providers to adopt electronic health record systems and data interoperability standards, most recently as part of the 21st Century Cures Act, which just saw its regulations go into effect this year. Healthcare providers are busy preparing to accommodate the Cures Act’s updated standards and requirements. The federal government should eat its own dog food by adhering to the same standards when creating the new gateway.

The two main standards to pay attention to are Fast Healthcare Interoperability Resources (FHIR) and the United States Core Data for Interoperability (USCDI). Major IT and EHR companies like Google, Amazon, Microsoft, IBM, Oracle, Salesforce, and Cerner have pledged to support these standards meaning they can immediately begin supporting a new gateway and helping America’s public health system quickly modernize. 

A Cloud-Based Data Hub

Once the data is available, flowing, and standardized, we need a national, cloud-based data hub to begin gaining insights from COVID infection rates, vaccinations, and many other key indicators important to recovering from the pandemic.

Led by HHS with support from OMB and the White House, this new system could be set up within months. There are well-known tools and virtual computing environments that could be put to use right away. A modern data hub would benefit not only the federal government but also the research community and academia, as these organizations play very important roles in helping us further understand and respond to the pandemic.

Most importantly, such a hub would provide transparency and accountability, giving confidence in the data being reported by providing independent reproducibility of conclusions from data analysis.


About Ed Simcox

Ed Simcox is the chief strategy officer of LifeOmic, the creator of LIFE mobile apps, JupiterOne cloud compliance and security operations software, and the Precision Health Cloud platform in use at major medical and cancer centers. Prior to joining LifeOmic, Ed served as the Chief Technology Officer (CTO) at the U.S. Department of Health and Human Services (HHS), the largest civilian government agency in the world. He led efforts at HHS to effectively leverage data, technology, and innovation to improve the lives of the American people and the performance of the Department’s 29 agencies and offices. While CTO, he also served as Acting Chief Information Officer at HHS, where he oversaw the Department’s IT modernization efforts, IT operations, and cybersecurity


HHS Awards Funds to Increase Data Sharing Between HIEs & Immunization Registries

HHS Launches EHR Innovations for Improving Hypertension Challenge_HHS Funded Health Care Innovation Award Projects to Watch

What You Should Know:

– The ONC today unveiled a series of investments to improve
the sharing of health information related to vaccination.

– The new investments will provide opportunities to track
vaccination progress, help clinicians contact high-risk patients, and help
identify patients due to receive the second dose of the vaccine.


The U.S. Department of Health and Human Services
acting through the Office of the National
Coordinator for Health Information Technology (ONC) today
announced a
series of investments to help increase data sharing between health information
exchanges (HIEs) and immunization information systems. These
projects will build on and expand ONC’s Strengthening the Technical Advancement
and Readiness of Public Health Agencies via Health Information Exchange (STAR
HIE) Program by helping communities improve the sharing of health information
related to vaccinations. Through these collaborations, public health agencies
can get additional help tracking and identifying patients who have yet to
receive their second dose of a COVID-19 vaccine and better identify those who
may be high-risk who have not yet received a vaccination.

In addition, ONC will also award funds to the Association of
State and Territorial Health Officials (ASTHO) and CORHIO, the Colorado
Regional Health Information Organization, to support immunization related
health information exchange collaborations.

“These CARES Act funds will allow clinicians to better access information about their patients from their community immunization registries by using the resources of their local health information exchanges,” said Don Rucker, MD, national coordinator for health information technology. “Through these collaborative efforts public health agencies and clinicians will be better equipped to more effectively administer immunizations to at-risk patients, understand adverse events, and better track long-term health outcomes as more Americans are vaccinated.”

Tracking Vaccination Progress

The new investments will provide opportunities to track vaccination progress, help clinicians contact high-risk patients, and help identify patients due to receive the second dose of the vaccine. It will also help provide a statistically and clinically robust way to measure vaccination outcomes. In collaboration with HIEs, the ability to individually correlate every patient who has received the vaccine with all of their clinical data both pre-and post-vaccination could offer more detailed insight into any adverse events and long-term health outcomes than is currently possible.

Increasing Data Collaboration Between HIEs & Immunization
Registries

There are currently 63 immunization information systems
across the United States, one in each state, eight in territories, and in five
cities. They are funded in part by through the Centers for Disease Control and
Prevention’s National Center for Immunization and Respiratory Diseases (NCIRD).
Currently, there are approximately 100 health information exchange
organizations in the United States reaching an estimated 92 percent of the U.S.
population, according to the Strategic Health Information Exchange Collaborative,
the national trade association for HIEs.

IoMT Is Improving Patient Access: We Must Avoid Creating New Barriers

The Internet of Medical Things (IoMT) is changing the face of healthcare and has the potential to significantly improve patient access as well as system efficiencies. The adoption of telemedicine, for example, spurred on by the Covid-19 pandemic, has spread rapidly.  Forrester revised its forecasts to predict that virtual care visits in the United States will soar to more than one billion this year—including 900 million visits related to Covid-19 specifically. Likewise, in the United Kingdom, 40% of doctor’s appointments now consist of phone or video calls.

Even before the pandemic, the adoption of IoMT was already growing rapidly, with the market valued at US$44.5 billion in 2018 and predicted to reach US$254 billion in 2026. There are more than 500,000 medical devices on the market, helping to diagnose, monitor, and treat patients – and more and more of these can, and are, becoming connected – not to mention innovations yet to enter the market. The connected medical devices segment specifically is expected to exceed $52 billion by 2022.

The COVID-19 Effect

The COVID-19 pandemic has changed the healthcare landscape more than any other single event in recent memory. The urgent and widespread need for care, coupled with the challenge of physical distancing, has accelerated the creation and adoption of new digital technologies as well as new processes to support their adoption and implementation across healthcare. The MedTech industry is emerging as a key apparatus to combat the virus and provide urgent support.

A simple example demonstrating the potential benefits of IoMT can be seen even within a hospital setting, where monitoring COVID-19 patients is costly in terms of time and PPE (personal protective equipment) consumption, since simply walking into a patient’s room becomes a complex process. IoMT technologies enable medical devices to send data to medical practitioners who can monitor a patient’s condition without having to take readings at the bedside. The same technologies can enable patients who do not require hospitalization to be safely monitored while remaining at home or in a community setting. 

From the patients’ perspective, many are embracing virtual healthcare as an alternative to long waits or having to go to a clinic or hospital altogether. And given the growing number and scope of connected medical devices and services, such as remote patient monitoring, therapy, or even diagnosis, there will be even more options in the future.  

Catalyzed by the pandemic, the IoMT genie is fully out of the bottle, and it is unlikely to go back. 

Increasing Access

This is good news for healthcare and good news for patients and families. Patient access is improving as telehealth, supported by connected devices to enable the collection of health-related data remotely, is helping to lift barriers. This increase in accessibility has the potential to improve the convenience, timeliness, and even safety of access to healthcare services for more people in more places. 

IoMT is lifting geographic barriers that have impeded access to healthcare since its very inception. Individuals with transportation or mobility challenges will no longer need to travel to receive routine care if they can be safely monitored while at home. Historically underserved rural or remote communities can gain access to medical specialists without needing to fly or drive great distances, while services can be delivered more cost-effectively. 

Furthermore, with fewer clinic or hospital-based appointments required for routine monitoring of patients who are otherwise doing well, doctors would be able to concentrate their in-person time and clinic resources on those most in need of care. 

The capacity for specialized medicine enabled by IoMT could also have a dramatic impact. The vast quantities of health data becoming available (with the requisite permissions in place), can enable sophisticated AI-driven health applications that can, for example, predict complications before they occur, better understand the health needs of specific populations, or enable stronger patient engagement and self-care. These models can also equip healthcare practitioners with better sources of information, ultimately leading to better patient outcomes.

Navigating Barriers

That said, while technology capabilities expand, innovation must take into consideration the needs of all the stakeholders within healthcare – from patients and caregivers to healthcare practitioners to administrators and payors/funders. Internet access, infrastructure, and comfort with technology, for example, can pose significant barriers for patients and health practitioners alike. 

One approach is to minimize the technological burden facing end-users. Devices should be user friendly and “ready to go” right out of the box, taking into consideration the circumstances and abilities of the potential range of users (patients and practitioners alike). Relying on the patient’s home Wi-Fi to provide connectivity is not ideal from either a usability or security perspective – not to mention availability and affordability. It is better for medical devices to have a cellular connection that can be immediately and securely connected to the network from any location, while also being remotely manageable to avoid burdening the user with network and setup requirements, or apps to download. 

Another barrier is the concern that both patients and healthcare providers have about security and data privacy risks. According to the 2016 edition of Philips’ Future Health Index, privacy/data security is second only to cost in the list of top barriers to the adoption of connected technology in healthcare across the countries surveyed.  

The Cybersecurity and Infrastructure Security Agency, FBI, and U.S. Department of Health and Human Services have warned of cybercrime threats against hospitals and healthcare providers. The WannaCry ransomware attacks affected tens of thousands of NHS medical tools in England and Scotland. The enthusiasm in rolling out new digital health solutions must not overlook security principles or create systems that rely on ad hoc patches.

One way of meeting the stringent security requirements of healthcare is to ensure that connected medical devices have security literally built into their hardware, following the most recent guidelines set out by the GSMA for IoT security, including the GSMA IoT SAFE specifications. In accordance with this globally relevant approach, connected devices have a specially designed SIM that serves as a mini “crypto safe” inside the device to ensure that only authorized communication can occur.

Similarly, new medical devices and software that are difficult to implement or cannot communicate with other systems such as electronic health/medical records risk being “orphaned” in the system or simply not used.  The latter is a matter of both developing the necessary integrations and ensuring the appropriate access and permissions are managed. More easily said than done, fully integrated systems take time, and some of the pieces may be added incrementally – the key is that the potential to do so is there from the beginning so future resources can be invested in enhancements rather than replacements. 

Early Collaboration is Key

Accessibility and usability must be designed right into IoMT solutions from the outset, and the best way of ensuring that is for developers and healthcare stakeholders to have plenty of interaction long before the product enters the market. Stakeholders are many and healthcare systems are complex, so innovators can look to startup accelerators and other thought leaders to help navigate the territory. The time and effort spent by innovators and healthcare stakeholders in collaborating is a sound investment in the future, ensuring that technology is designed and then applied in meaningful and equitable ways to address the most pressing issues. 

The telehealth genie, powered by IoMT, is indeed out of the bottle and is set to revolutionize healthcare. By ensuring that IoMT technologies are developed and implemented with security, accessibility, and ease of use for all stakeholders as priorities, we can make sure that the full benefits of this new dawn can be enjoyed by all. 


Heidi Sveistrup, Ph.D. Bio

As the current CEO of the Bruyère Research Institute and VP, Research and Academic Affairs at Bruyère Continuing Care, Heidi Sveistrup, Ph.D. is focusing on increasing the research and innovation supporting pivotal transitions in care; meaningful, enjoyable and doable ways to support people to live where they choose; and creating opportunities to discover and create new approaches to identify, diagnose, treat and support brain health with individuals with memory loss. Fostering new and supporting existing collaborations among researchers, policymakers, practitioners, civil society and industry continues to be a priority.


Elza Seregelyi Bio

Elza Seregelyi is the Director for the TELUS L-SPARK MedTech Accelerator program, which offers participants pre-commercial access to a secure telehealth platform. L-SPARK is currently working with its first cohort of MedTech companies. Elza has an engineering and entrepreneurship background with extensive experience driving collaborative initiatives.


Why Hospitals Should Act Now to Create Clinical AI Departments

Why Hospitals Should Act Now to Create Clinical AI Departments
John Frownfelter, MD, FACP, Chief Medical Information Officer at Jvion

A century ago, X-rays transformed medicine forever. For the first time, doctors could see inside the human body, without invasive surgeries. The technology was so revolutionary that in the last 100 years, radiology departments have become a staple of modern hospitals, routinely used across medical disciplines.

Today, new technology is once again radically reshaping medicine: artificial intelligence (AI). Like the X-ray before it, AI gives clinicians the ability to see the unseen and has transformative applications across medical disciplines. As its impact grows clear, it’s time for health systems to establish departments dedicated to clinical AI, much as they did for radiology 100 years ago.

Radiology, in fact, was one of the earliest use cases for AI in medicine today. Machine learning algorithms trained on medical images can learn to detect tumors and other malignancies that are, in many cases, too subtle for even a trained radiologist to perceive. That’s not to suggest that AI will replace radiologists, but rather that it can be a powerful tool for aiding them in the detection of potential illness — much like an X-ray or a CT scan. 

AI’s potential is not limited to radiology, however. Depending on the data it is trained on, AI can predict a wide range of medical outcomes, from sepsis and heart failure to depression and opioid abuse. As more of patients’ medical data is stored in the EHR, and as these EHR systems become more interconnected across health systems, AI will only become more sensitive and accurate at predicting a patient’s risk of deteriorating.

However, AI is even more powerful as a predictive tool when it looks beyond the clinical data in the EHR. In fact, research suggests that clinical care factors contribute to only 16% of health outcomes. The other 84% are determined by socioeconomic factors, health behaviors, and the physical environment. To account for these external factors, clinical AI needs external data. 

Fortunately, data on social determinants of health (SDOH) is widely available. Government agencies including the Census Bureau, EPA, HUD, DOT and USDA keep detailed data on relevant risk factors at the level of individual US Census tracts. For example, this data can show which patients may have difficulty accessing transportation to their appointments, which patients live in a food desert, or which patients are exposed to high levels of air pollution. 

These external risk factors can be connected to individual patients using only their address. With a more comprehensive picture of patient risk, Clinical AI can make more accurate predictions of patient outcomes. In fact, a recent study found that a machine learning model could accurately predict inpatient and emergency department utilization using only SDOH data.

Doctors rarely have insight on these external forces. More often than not, physicians are with patients for under 15 minutes at a time, and patients may not realize their external circumstances are relevant to their health. But, like medical imaging, AI has the power to make the invisible visible for doctors, surfacing external risk factors they would otherwise miss. 

But AI can do more than predict risk. With a complete view of patient risk factors, prescriptive AI tools can recommend interventions that address these risk factors, tapping the latest clinical research. This sets AI apart from traditional predictive analytics, which leaves clinicians with the burden of determining how to reduce a patient’s risk. Ultimately, the doctor is still responsible for setting the care plan, but AI can suggest actions they may not otherwise have considered.

By reducing the cognitive load on clinicians, AI can address another major problem in healthcare: burnout. Among professions, physicians have one of the highest suicide rates, and by 2025, the U.S. The Department of Health and Human Services predicts that there will be a shortage of nearly 90,000 physicians across the nation, driven by burnout. The problem is real, and the pandemic has only worsened its impact. 

Implementing clinical AI can play an essential role in reducing burnout within hospitals. Studies show burnout is largely attributed to bureaucratic tasks and EHRs combined, and that physicians spend twice as much time on EHRs and desk work than with patients. Clinical AI can ease the burden of these administrative tasks so physicians can spend more time face-to-face with their patients.

For all its promise, it’s important to recognize that AI is as complex a tool as any radiological instrument. Healthcare organizations can’t just install the software and expect results. There are several implementation considerations that, if poorly executed, can doom AI’s success. This is where clinical AI departments can and should play a role. 

The first area where clinical AI departments should focus on is the data. AI is only as good as the data that goes into it. Ultimately, the data used to train machine learning models should be relevant and representative of the patient population it serves. Failing to do so can limit AI’s accuracy and usefulness, or worse, introduce bias. Any bias in the training data, including pre-existing disparities in health outcomes, will be reflected in the output of the AI. 

Every hospital’s use of clinical AI will be different, and hospitals will need to deeply consider their patient population and make sure that they have the resources to tailor vendor solutions accordingly. Without the right resources and organizational strategies, clinical AI adoption will come with the same frustration and disillusionment that has come to be associated with EHRs

Misconceptions about AI are a common hurdle that can foster resistance and misuse. No matter what science fiction tells us, AI will never replace a clinician’s judgment. Rather, AI should be seen as a clinical decision support tool, much like radiology or laboratory tests. For a successful AI implementation, it’s important to have internal champions who can build trust and train staff on proper use. Clinical AI departments can play an outsized role in leading this cultural shift.  

Finally, coordination is the bedrock of quality care, and AI is no exception. Clinical AI departments can foster collaboration across departments to action AI insights and treat the whole patient. Doing so can promote a shift from reactive to preventive care, mobilizing ambulatory, and community health resources to prevent avoidable hospitalizations.

With the promise of new vaccines, the end of the pandemic is in sight. Hospitals will soon face a historic opportunity to reshape their practices to recover from the pandemic’s financial devastation and deliver better care in the future. Clinical AI will be a powerful tool through this transition, helping hospitals to get ahead of avoidable utilization, streamline workflows, and improve the quality of care. 

A century ago, few would have guessed that X-rays would be the basis for an essential department within hospitals. Today, AI is leading a new revolution in medicine, and hospitals would be remiss to be left behind.


About  John Frownfelter, MD, FACP

John is an internist and physician executive in Health Information Technology and is currently leading Jvion’s clinical strategy as their Chief Medical Information Officer. With 20 years’ leadership experience he has a broad range of expertise in systems management, care transformation and health information systems. Dr. Frownfelter has held a number of medical and medical informatics leadership positions over nearly two decades, highlighted by his role as Chief Medical Information Officer for Inpatient services at Henry Ford Health System and Chief Medical Information Officer for UnityPoint Health where he led clinical IT strategy and launched the analytics programs. 

Since 2015, Dr. Frownfelter has been bringing his expertise to healthcare through health IT advising to both industry and health systems. His work with Jvion has enhanced their clinical offering and their implementation effectiveness. Dr. Frownfelter has also held professorships at St. George’s University and Wayne State schools of medicine, and the University of Detroit Mercy Physician Assistant School. Dr. Frownfelter received his MD from Wayne State University School of Medicine.


Death by Ransomware: Poor Healthcare Cybersecurity

Death by Ransomware: Poor Healthcare Cybersecurity
Babur Khan, Technical Marketing Engineer at A10 Networks

If hackers attack your organization and you’re in an industry such as financial services, engineering, or manufacturing your risks are mostly monetary. But when it comes to healthcare cybersecurity, not only is there significant financial jeopardy, people’s health and wellbeing are also at risk so the stakes are much, much higher.

According to the Department of Health and Human Services, there has been an almost 50 percent increase in healthcare cybersecurity data breaches between February and May 2020 compared to 2019. This is thought to be a result of the COVID-19 pandemic distracting the industry due to the sweeping changes required, putting extra pressure on already inadequate healthcare cybersecurity measures. 

Why Are Hackers Attacking Healthcare?

If there’s one thing hackers like, it’s a target that’s “soft” and large, complex organizations in industries that have been slow to adopt and then secure digital technologies are precisely that, soft targets. These organizations usually have broad and mostly poorly defended “attack surfaces,” which provide hackers with many routes to enter and through which they can not only exfiltrate data but also compromise services and hardware.

Healthcare, in general, is one of the most visible and softest targets. Successful hospital cyber-attacks usually cause significant disruption of patient data and routine workflows such as scheduling patient medication, resources management, and other essential services. These hospital cyber-attacks can easily result in what is euphemistically called in healthcare “bad outcomes” … these “bad outcomes” include injury and death.

How Does Healthcare Think About Cyber Risks?

A study by the security consulting firm Independent Security Evaluators concluded:

One overarching finding of our research is that the industry focuses almost exclusively on the protection of patient health records, and rarely addresses threats to or the protection of patient health from a cyber threat perspective … In summary, we find that different adversaries will target or pursue the compromise of patient health records, while others will target or pursue the compromise of patient health itself.

The report argues that protecting patient records has been most of the focus of healthcare cybersecurity planning, and organizations often view threat actors as being “unsophisticated adversaries” such as individual hackers and small hacker collaborations. ISE argues that this framework ignores the potential of far more sophisticated hospital cyber-attacks from political hacktivist groups, organized crime, terrorists, and nation-states who are all highly motivated and well-funded and “As a result, a multitude of attack surfaces are left unprotected, and attack strategies that could result in harm to a patient are not considered.”

The Universal Health Service Hospital Cyber-attacks

In September 2020, Universal Health Services a hospital and health care network with more than 400 facilities across the United States, Puerto Rico, and the United Kingdom, found itself under attack by the Russian “Ryuk” ransomware. This wasn’t the first hospital cyber-attack on UHS. Security firm, Advance Intel’s Andariel intelligence platform, reported that trojan malware-infected Universal Health Services throughout 2020.

UHS has not officially confirmed the details of the attack but reports by UHS employees indicate the attack was the result of a successful phishing expedition. The attack disabled computers and phone systems and forced the hospitals to revert to using paper-based systems to continue operations. Affected network hospitals also had to redirect ambulances and move surgical patients to other unaffected facilities.

As is usually the case with large, complex organizations, cleaning up and restoring the system was neither simple nor quick and a UHS press release on October 12, 2020, announced: “… we have had no indication that any patient or employee data was accessed, copied or misused.” It also stated that operations were mostly back to normal after a total of 16 days. Given that downtime for enterprise security breaches cost upwards of $1,000,000 per day or more this attack will have dealt a serious blow to UHS’ bottom line. Whether UHS paid the ransom is not known.

Cyber Attacks and Murder

When a cyberattack happens to any organization, there are always consequences but when healthcare ransomware is involved there’s a real risk of loss of life. In the case of UHS, there were unconfirmed rumors of four patients dying because doctors had to wait for lab results delivered by couriers instead of by electronic delivery. While those, so far, appear to be just rumors, there is one known case of a patient dying directly due to a hospital ransomware attack.

The University Hospital Düsseldorf (UKD) in Germany suffered a ransomware attack on September 10, 2020. The attackers exploited a vulnerability in the Citrix ADC that had been known since January but the hospital, unfortunately, had not got around to implementing the fix.

As a result of the attack, the hospital immediately announced that “The UKD has deregistered from emergency care. Planned and outpatient treatments will also not take place and will be postponed. Patients are therefore asked not to visit the UKD – even if an appointment has been made” and patients were routed to alternative medical facilities.

The demand note delivered by the hospital ransomware showed that the intended target was not in fact the University Hospital Düsseldorf but rather Heinrich Heine University. The German police contacted the hackers via the instructions in the ransom note dropped by the malware and explained the mistake after which the hackers withdrew their demand and provided the decryption key.

Unfortunately, one patient with a life-threatening illness was diverted to a distant hospital after UKD was deregistered as an emergency care facility. The additional hour’s travel may have been the cause of the patient’s death. On September 18, 2020, German prosecutors launched an official negligent homicide investigation which, if confirmed, would make the patient’s death the first known case of death by hacking.

Protect Critical Systems from Malware

The key to defending your systems from malware and phishing is monitoring and examining all network communications. Now that encryption is becoming the norm for all internet communications, looking “inside” of message streams requires new approaches and technologies so that embedded threats are caught and handled before they can escalate into disasters.


About Babur Nawaz Khan
Babur Nawaz Khan is a Technical Marketing Engineer at A10 Networks, a leading provider of secure application services and solutions. He primarily focuses on A10’s Enterprise Security and DDoS Protection solutions and holds a master’s degree in Computer Science from the University of Maryland, Baltimore County.


2020’s Top 20 Digital Health M&A Deals Totaled $50B

Teladoc Health and Livongo Merge

2020’s Top 20 Digital Health M&A Deals Totaled $50B

The combination of Teladoc Health and Livongo creates a
global leader in consumer-centered virtual care. The combined company is
positioned to execute quantified opportunities to drive revenue synergies of
$100 million by the end of the second year following the close, reaching $500
million on a run-rate basis by 2025.

Price: $18.5B in value based on each share of Livongo
will be exchanged for 0.5920x shares of Teladoc Health plus cash consideration
of $11.33 for each Livongo share.


Siemens Healthineers Acquires Varian Medical

2020’s Top 20 Digital Health M&A Deals Totaled $50B

On August 2nd, Siemens Healthineers acquired
Varian Medical for $16.4B, with the deal expected to close in 2021. Varian is a
global specialist in the field of cancer care, providing solutions especially
in radiation oncology and related software, including technologies such as
artificial intelligence, machine learning and data analysis. In fiscal year 2019,
the company generated $3.2 billion in revenues with an adjusted operating
margin of about 17%. The company currently has about 10,000 employees
worldwide.

Price: $16.4 billion in an all-cash transaction.


Gainwell to Acquire HMS for $3.4B in Cash

2020’s Top 20 Digital Health M&A Deals Totaled $50B

Veritas Capital (“Veritas”)-backed Gainwell Technologies (“Gainwell”),
a leading provider of solutions that are vital to the administration and
operations of health and human services programs, today announced that they
have entered into a definitive agreement whereby Gainwell will acquire HMS, a technology, analytics and engagement
solutions provider helping organizations reduce costs and improve health
outcomes.

Price: $3.4 billion in cash.


Philips Acquires Remote Cardiac Monitoring BioTelemetry for $2.8B

2020’s Top 20 Digital Health M&A Deals Totaled $50B

Philips acquires BioTelemetry, a U.S. provider of remote
cardiac diagnostics and monitoring for $72.00 per share for an implied
enterprise value of $2.8 billion (approx. EUR 2.3 billion). With $439M in
revenue in 2019, BioTelemetry annually monitors over 1 million cardiac patients
remotely; its portfolio includes wearable heart monitors, AI-based data
analytics, and services.

Price: $2.8B ($72 per share), to be paid in cash upon
completion.


Hims & Hers Merges with Oaktree Acquisition Corp to Go Public on NYSE

Telehealth company Hims & Hers and Oaktree Acquisition Corp., a special purpose acquisition company (SPAC) merge to go public on the New York Stock Exchange (NYSE) under the symbol “HIMS.” The merger will enable further investment in growth and new product categories that will accelerate Hims & Hers’ plan to become the digital front door to the healthcare system

Price: The business combination values the combined
company at an enterprise value of approximately $1.6 billion and is expected to
deliver up to $280 million of cash to the combined company through the
contribution of up to $205 million of cash.


SPAC Merges with 2 Telehealth Companies to Form Public
Digital Health Company in $1.35B Deal

2020’s Top 20 Digital Health M&A Deals Totaled $50B

Blank check acquisition company GigCapital2 agreed to merge with Cloudbreak Health, LLC, a unified telemedicine and video medical interpretation solutions provider, and UpHealth Holdings, Inc., one of the largest national and international digital healthcare providers to form a combined digital health company. 

Price: The merger deal is worth $1.35 billion, including
debt.


WellSky Acquires CarePort Health from Allscripts for
$1.35B

2020’s Top 20 Digital Health M&A Deals Totaled $50B

WellSky, global health, and community care technology company, announced today that it has entered into a definitive agreement with Allscripts to acquire CarePort Health (“CarePort”), a Boston, MA-based care coordination software company that connects acute and post-acute providers and payers.

Price: $1.35 billion represents a multiple of greater
than 13 times CarePort’s revenue over the trailing 12 months, and approximately
21 times CarePort’s non-GAAP Adjusted EBITDA over the trailing 12 months.


Waystar Acquires Medicare RCM Company eSolutions

2020’s Top 20 Digital Health M&A Deals Totaled $50B

On September 13th, revenue cycle management
provider Waystar acquires eSolutions, a provider of Medicare and Multi-Payer revenue
cycle management, workflow automation, and data analytics tools. The
acquisition creates the first unified healthcare payments platform with both
commercial and government payer connectivity, resulting in greater value for
providers.

Price: $1.3 billion valuation


Radiology Partners Acquires MEDNAX Radiology Solutions

2020’s Top 20 Digital Health M&A Deals Totaled $50B

Radiology Partners (RP), a radiology practice in the U.S., announced a definitive agreement to acquire MEDNAX Radiology Solutions, a division of MEDNAX, Inc. for an enterprise value of approximately $885 million. The acquisition is expected to add more than 800 radiologists to RP’s existing practice of 1,600 radiologists. MEDNAX Radiology Solutions consists of more than 300 onsite radiologists, who primarily serve patients in Connecticut, Florida, Nevada, Tennessee, and Texas, and more than 500 teleradiologists, who serve patients in all 50 states.

Price: $885M


PointClickCare Acquires Collective Medical

2020’s Top 20 Digital Health M&A Deals Totaled $50B

PointClickCare Technologies, a leader in senior care technology with a network of more than 21,000 skilled nursing facilities, senior living communities, and home health agencies, today announced its intent to acquire Collective Medical, a Salt Lake City, a UT-based leading network-enabled platform for real-time cross-continuum care coordination for $650M. Together, PointClickCare and Collective Medical will provide diverse care teams across the continuum of acute, ambulatory, and post-acute care with point-of-care access to deep, real-time patient insights at any stage of a patient’s healthcare journey, enabling better decision making and improved clinical outcomes at a lower cost.

Price: $650M


Teladoc Health Acquires Virtual Care Platform InTouch
Health

2020’s Top 20 Digital Health M&A Deals Totaled $50B

Teladoc Health acquires InTouch Health, the leading provider of enterprise telehealth solutions for hospitals and health systems for $600M. The acquisition establishes Teladoc Health as the only virtual care provider covering the full range of acuity – from critical to chronic to everyday care – through a single solution across all sites of care including home, pharmacy, retail, physician office, ambulance, and more.

Price: $600M consisting of approximately $150 million
in cash and $450 million of Teladoc Health common stock.


AMN Healthcare Acquires VRI Provider Stratus Video

2020’s Top 20 Digital Health M&A Deals Totaled $50B

AMN Healthcare Services, Inc. acquires Stratus Video, a leading provider of video remote language interpretation services for the healthcare industry. The acquisition will help AMN Healthcare expand in the virtual workforce, patient care arena, and quality medical interpretation services delivered through a secure communications platform.

Price: $475M


CarepathRx Acquires Pharmacy Operations of Chartwell from
UPMC

2020’s Top 20 Digital Health M&A Deals Totaled $50B

CarepathRx, a leader in pharmacy and medication management
solutions for vulnerable and chronically ill patients, announced today a
partnership with UPMC’s Chartwell subsidiary that will expand patient access to
innovative specialty pharmacy and home infusion services. Under the $400M
landmark agreement, CarepathRx will acquire the
management services organization responsible for the operational and strategic
management of Chartwell while UPMC becomes a strategic investor in CarepathRx. 

Price: $400M


Cerner to Acquire Health Division of Kantar for $375M in
Cash

Cerner announces it will acquire Kantar Health, a leading
data, analytics, and real-world evidence and commercial research consultancy
serving the life science and health care industry.

This acquisition is expected to allow Cerner’s Learning
Health Network client consortium and health systems with more opportunities to
directly engage with life sciences for funded research studies. The acquisition
is expected to close during the first half of 2021.

Price: $375M


Cerner Sells Off Parts of Healthcare IT Business in
Germany and Spain

2020’s Top 20 Digital Health M&A Deals Totaled $50B

Cerner sells off parts of healthcare IT business in Germany and Spain to Germany company CompuGroup Medical, reflecting the company-wide transformation focused on improved operating efficiencies, enhanced client focus, a refined growth strategy, and a sharpened approach to portfolio management.

Price: EUR 225 million ($247.5M USD)


CompuGroup Medical Acquires eMDs for $240M

2020’s Top 20 Digital Health M&A Deals Totaled $50B

CompuGroup Medical (CGM) acquires eMDs, Inc. (eMDs), a
leading provider of healthcare IT with a focus on doctors’ practices in the US,
reaching an attractive size in the biggest healthcare market worldwide. With
this acquisition, the US subsidiary of CGM significantly broadens its position
and will become the top 4 providers in the market for Ambulatory Information
Systems in the US.

Price: $240M (equal to approx. EUR 203 million)


Change Healthcare Buys Back Pharmacy Network

2020’s Top 20 Digital Health M&A Deals Totaled $50B

Change
Healthcare
 buys
back
 pharmacy unit eRx Network
(“eRx”),
 a leading provider of comprehensive, innovative, and secure
data-driven solutions for pharmacies. eRx generated approximately $67M in
annual revenue for the twelve-month period ended February 29, 2020. The
transaction supports Change Healthcare’s commitment to focus on and invest in
core aspects of the business to fuel long-term growth and advance innovation.

Price: $212.9M plus cash on the balance sheet.


Walmart Acquires Medication Management Platform CareZone

2020’s Top 20 Digital Health M&A Deals Totaled $50B

Walmart acquires CareZone, a San Francisco, CA-based smartphone
service for managing chronic health conditions for reportedly $200M. By
working with a network of pharmacy partners, CareZone’s concierge services
assist consumers in getting their prescription medications organized and
delivered to their doorstep, making pharmacies more accessible to individuals
and families who may be homebound or reside in rural locations.

Price: $200M


Verisk Acquires MSP Compliance Provider Franco Signor

2020’s Top 20 Digital Health M&A Deals Totaled $50B

Verisk, a data
analytics provider, announced today that it has acquired Franco Signor, a Medicare Secondary Payer
(MSP) service provider to America’s largest insurance carriers and employers.
As part of the acquisition, Franco Signor will become part of Verisk’s Claims
Partners business, a leading provider of MSP compliance and other analytic
claim services. Claims Partners and Franco Signor will be combining forces to
provide the single best resource for Medicare compliance. 

Price: $160M


Rubicon Technology Partners Acquires Central Logic

2020’s Top 20 Digital Health M&A Deals Totaled $50B

Private equity firm Rubicon Technology Partners acquires
Central Logic, a provider of patient orchestration and tools to accelerate
access to care for healthcare organizations. Rubicon will be aggressively driving Central Logic’s
growth with additional cash investments into the business, with a focus
on product innovation, sales expansion, delivery and customer support, and
the pursuit of acquisition opportunities.

Price: $110M – $125 million, according to sources


Billions in Federal Provider Relief Funds Have Been Distributed. Now Come Auditing and Compliance.

Anna E. Stevens, CPA, is the Partner-in-Charge of Health Care Services at Weaver,

Of the $175 billion in federal Provider Relief Funds (PRF) allocated to healthcare providers, $125 billion has been accepted by hospitals and healthcare providers. The cash infusion was designed to cover costs related to COVID-19 related care. These targeted payments were earmarked for preventing, preparing for, and responding to the Coronavirus, solely for reimbursement of healthcare-related expenses or lost revenue directly attributable to COVID-19

Early on, providers who received PRF funds had to accept or reject the money without information about reporting and auditing requirements. However, Health and Human Services (HHS), the administrator of all PRF funds, has since established reporting and auditing requirements to ensure proper compliance. 

Thousands of hospitals and other providers have received and accepted payments from the Provider Relief Fund. As they begin to consider financial reporting and audit requirements, some will find themselves in unfamiliar territory.

Historically, under most circumstances, only non-federal government agencies and nonprofit organizations have been subject to audit requirements under the Single Audit Act. However, Health and Human Services (HHS) recently clarified that for-profit entities that expend  $750,000 or more of Provider Relief Funds during the entity’s fiscal year will be subject to an audit as described in section 75.216 of HHS’s adoption of the Uniform Guidance

Reporting requirements

Recipients will report the use of their funds in two categories. The first allows the recipient to report any healthcare-related expenses due to COVID-19 that were not reimbursed from another source. The second is for any PRFs received in excess of the healthcare-related COVID-19 expenses. The entity may be allowed to attribute funds in the second category to lost revenue.

Healthcare-related expenses may include supplies, equipment information technology, and facilities. Allowable general and administrative expenses could include rent, insurance, personnel, fringe benefits, lease payments, and utilities. Lost revenue is allowed up to the difference in 2019 and 2020 net patient service revenue.     

The HHS reporting system also will require certain non-financial data. Demographic information will include the reporting entity, the tax identification number, the national provider identifier, the fiscal year-end date, and the federal tax classification. Recipients will need to provide, by quarter, personnel metrics, patient metrics, and facility metrics. The personnel metrics may include labor by category, hires and rehires, and terminations. Patient metrics will require information such as a number of patient visits, patients admitted, and resident patients. 

If there was a change in ownership for the reporting entity, certain details around the acquisition or divestiture must be disclosed. Finally, the entity should disclose whether it is subject to a Single Audit and whether the auditors have selected PRF to be within the scope of the Single Audit.

The reporting system will become available to recipients in early 2021. Recipients that have expended all funds prior to Dec. 31, 2020, may submit one report. If a recipient has expenditures subsequent to Dec. 31, 2020, a second and final report will be required.

HHS will continue to provide information and updates in webinars and FAQ guidance leading up to the reporting deadlines.

What should healthcare organizations be doing to prepare?

Preparation should begin now. When it comes to expenditures, healthcare organizations should stick to the fundamentals of the purpose of the funding and document, document, document.  

1. Follow accounting policies and procedures and retain records for COVID-19 expenses.

– As much as possible, stick to your policies and procedures and document any changes as a result of COVID-19. Manual processes are most likely to be affected.  Communicate procedural changes to staff.

– Retain records for COVID expenses as if any of these expenses could be subject to audit because they could.  Good record keeping will reduce the possibility for claw-back of funds.

2. Maintain internal controls over compliance.

– Document any changes in internal controls caused by COVID-19 funding.  Know what your review and approval process is, who is responsible, and how it is documented.

– Focus on internal controls in these key areas: payroll, non-payroll, and procurement. Payroll should include time and effort reporting requirements for all staff being paid with COVID-19 funding.  For non-payroll expenditures, purchase orders should reference COVID and be adequately supported by third party invoices or the like. For procurement ensure federal procurement requirements are being followed.  Noncompetitive procurements should be well documented.

3. Understand compliance requirements 

– Assign a Program Director to oversee the expenditures of the federal funds. Program Directors need to obtain an understanding of the grant(s) and the compliance requirements to ensure the entity is able to comply.  

– With an influx of new money, be sure to obtain the necessary documentation from your granting agency: Also, keep an eye on your expenditures of federal awards.  Keep in mind the $750,000 threshold for triggering a third-party audit.

Provider Relief Fund money was intentionally distributed to create as little disruption as possible for healthcare providers as they work on the front lines of this crisis. However, as providers continue to accept these funds, they can help reduce future headaches by keeping current and future reporting and audit requirements in mind.


Anna E. Stevens, CPA, is the Partner-in-Charge of Health Care Services at Weaver, a Texas-based national accounting firm.

AHRQ and Google Pilot New Tool to Help Patients Plan for Medical Visits

AHRQ and Google Pilot New Tool to Help Patients Plan for Medical Visits

What You Should Know:

– Built-in collaboration with the Agency for Healthcare Research and Quality (AHRQ), Google is piloting a new tool to help patients plan for medical visits.

– The new Google visit planning tool makes it easy for
patients and those who care for them to privately list and prioritize their
questions in preparation for a medical visit.

– The suggested questions, developed by AHRQ as part of its “Questions are the Answer” initiative, is designed to get people thinking about their goals and priorities for the visit.


Today, Google announced it is piloting
a new online tool to help patients plan for medical visits as part of an ongoing
collaboration with  Agency
for Healthcare Research and Quality
 (AHRQ), part of the U.S.
Department of Health and Human Services.

How It Works

The new Google visit planning tool is built on the same
evidence behind AHRQ’s QuestionBuilder app. The new tool will make it easy for
patients and caretakers to develop a visit plan by selecting from
evidence-based questions like, “What is this test for?” as well as adding their
own questions. When people use Google to search for a healthcare provider, they
will have the option to create their own private visit plan. Once completed,
patients can print or email the visit plan and bring it to the doctor’s office
to help them remember important questions they want to ask. In addition, the
visit plan also includes a reminder of things patients should bring to the
visit, like a list of current medications, recent lab results, and their insurance
card.

Private & Secure

The tool does not gather any personal health information or
store any of the information that is entered into the tool. People have the
option to print or email their visit plan, and people can use this tool without
signing into a Google account.

Why It Matters

“Patients who prepare for medical visits by prioritizing their questions, strengthen their role as members of their own health care team,” said Jeffrey Brady, M.D., M.P.H., a preventive medicine physician and Director of the Center for Quality Improvement and Patient Safety at the AHRQ. Dr. Brady added, “This helps clinicians maximize their time with patients so they can better address their most critical health needs. Clinicians appreciate that healthcare can be more efficient, effective, and higher quality when they work together with patients.”

Availability

This tool is currently in the pilot phase and is only available to a limited number of people in the United States and will expand to more users over time.

HHS Taps CVS Health for Pilot to Administer COVID-19 Therapy to Patients At Home & Long-Term Care Facilities

HHS Taps CVS Health for Pilot to Administer COVID-19 Therapy to Patients At Home & Long-Term Care Facilities

What You Should Know:

– Today, CVS Health was selected by HHS, as part of
Operation Warp Speed, to pilot the administration of a limited supply of
bamlanivimab, a monoclonal antibody therapy, with eligible COVID-19 patients
at-risk of severe infection or complications resulting from the virus.

– Under this pilot, Coram, the specialty pharmacy and
infusion care business of CVS Health, will administer the intravenous therapy
in patients’ homes or long-term care facilities to help meet the growing demand
for these new treatments.

– The pilot will be available in Boston, Chicago,
Cleveland, Los Angeles, Milwaukee, Minneapolis and Tampa, and their surrounding
communities starting Thursday, December 3.


CVS Health was selected today by the U.S. Department of Health and Human Services (HHS), as part of Operation Warp Speed, to pilot the administration of a limited supply of bamlanivimab, a monoclonal antibody therapy, with eligible COVID-19 patients at risk of severe infection or complications resulting from the virus. The selection underscores the role of CVS Health as a diversified health services company and expands work underway with HHS and Operation Warp Speed as CVS Health also prepares to administer COVID-19 vaccines

COVID-19 Therapy Pilot Details

Under this pilot, Coram, the specialty pharmacy and infusion
care business of CVS Health, will administer the intravenous therapy in
patients’ homes or long-term care facilities to help meet the growing demand
for these new treatments. Coram and its more than 800 certified and highly
trained nurses across the country are a prime example of how CVS Health offers
diversified health services to transform health and meet people where they are
– whether in normal times or during the ongoing pandemic. 

Details of the pilot include:

– Coram will begin administering 1,000 doses of monoclonal
antibody therapies for the treatment of COVID-19.

– The pilot will be available in Boston, Chicago, Cleveland,
Los Angeles, Milwaukee, Minneapolis and Tampa, and their surrounding
communities starting Thursday, December 3. Following the pilot, Coram will
scale this solution to additional markets in areas of greatest need.

– To be eligible, and in accordance with the therapy’s
Emergency Use Authorization (EUA), patients must not be hospitalized, be within
10 days of symptom onset, at least 12 years of age or older, weighing at least
40 kilograms (or 88.2 pounds), and at high risk for progressing to severe
disease and/or hospitalization.

– There is no out-of-pocket cost to the patient for this
care.

Why It Matters

As COVID-19 rates surge in many parts of the country, Coram
also has worked to help keep patients out of inpatient and hospital settings
altogether, alleviating pressure on the health care system and preserving
important hospital resources for the most critical patients. Since early
in the pandemic, Coram has partnered with hospitals to safely
transition eligible infusion patients home to help ensure hospital bed capacity
to treat COVID-19 patients. Importantly, today’s announcement also expands the
integral role of CVS Health on the front lines in the fight against COVID-19.
This includes work underway with HHS and Operation Warp Speed to administer
COVID-19 vaccines when available, as well as a national COVID-19 testing
infrastructure, which has enabled the company to perform more than eight
million tests across more than 4,300 retail testing locations and onsite at
workplaces and campuses around the country since the start of the
pandemic. 

“Patients can rest assured they are receiving the best care possible through Coram in the safety and comfort of their own home or long-term care facility, and Coram is poised to continue to meet shifting health care demands as the importance and value of home-based care will undoubtedly outlive the pandemic,” added Prem Shah, Pharm.D., Executive Vice President of CVS Specialty and Product Innovation. “This established and experienced clinical service further demonstrates CVS Health’s unique ability to touch all aspects of a person’s health to make their experience more accessible and affordable.”

Lean on Your Connected Community of Care in Times of Crisis

Is Your Community Ready to be Connected?
Dr. Keith Kosel, Vice President at Parkland Center for Clinical Innovation (PCCI)

We’ve all experienced crises in our lives. They may be personal in nature (e.g., involving our interpersonal relationships), organizational (e.g., relating to our employment or retirement income), or nature-made (e.g., floods, tornados, or the COVID-19 pandemic). When crises hit our communities, the impacts can be widespread and far-reaching. Healthcare providers and community-based organizations (CBOs) are called upon to provide more rapid and extensive care and support to the community than is otherwise the norm. A well-established and highly functioning Connected Community of Care (CCC), as is the case here in Dallas, Texas, can provide a tremendous strategic and tactical advantage over non-connected peers.

Since 2014, the Parkland Center for Clinical Innovation (PCCI) has led an effort to bring together several large healthcare systems and a number of regional social-service organizations such as food banks, homeless assistance associations, and transportation service vendors, along with over 100 smaller CBOs (i.e., neighborhood food pantries, crisis centers, utility assistance centers) and area faith-based organizations to form the Dallas CCC. Over time, civic organizations, such as the Community Council of Greater Dallas, Dallas County Health and Human Services (DCHHS), and select academic institutions have begun to participate in various community-wide projects under the Dallas CCC umbrella.

Central to the success of the Dallas CCC are the partnerships that have been formed between the CBOs and a number of local healthcare systems (Parkland Health & Hospital System [Parkland], Baylor Scott & White Health, Children’s Medical Center, Methodist Health System, and Metrocare Services), clinical practices, and other ancillary healthcare providers serving the Dallas metroplex. These partnerships have proved essential in building a truly comprehensive and functional network aimed at improving both the health and well-being of Dallas residents.

Connecting these various entities and forming a two-way communication pathway is an electronic information exchange platform termed Pieces™ Connect, which allows for real-time, two-way sharing of information pertaining to an individual’s social and healthcare needs, history, and preferences. The information exchange platform is the glue that holds the physical network together and provides one of the mechanisms to disseminate information from public health and healthcare entities to social service providers in the community. It allows the individual community resident, via the CBO, to become better informed about important health issues, such as routine vaccinations or preventive care, such as social distancing and proper mask usage during a pandemic.

Until recently, the primary mission of the Dallas CCC focused on addressing residents’ social determinants of health (SDOH) issues through providing community resources (e.g., food assistance, housing, transportation) to improve the lives of Dallas County residents. While this mission has become even more critical during the COVID-19 pandemic, the work of the Dallas CCChas also evolved to include identifying COVID-19 sites within the County and directing community outreach efforts to help stem the rapid spread of the virus.

The Dallas CCC has provided an innovative model of community governance and cooperation to impact the consequences of the COVID-19 outbreak. From the first days of the pandemic, PCCI has been working with Parkland and DCHHS to help reliably identify and quantify the geographic location and incidence rates of positive COVID-19 cases within Dallas County. This problem is especially challenging when considering vulnerable populations and the transitory nature of these residents in inner-city communities.

Working with data provided by DCHHS, the Dallas-Fort Worth Hospital Council, and CBOs, PCCI built a series of dynamic geo-maps that were able to identify, at the neighborhood and block level, the location of hotspots of positive COVID-19 cases as well as attendant mortality rates. In addition to flagging at-risk patients and populations, the model continues to be used by public health and civic leaders to establish locations for testing sites within the city of Dallas based on COVID-19 incidence and community needs.

With the establishment of the hot-spotting, the next step was to get that information, along with general infection prevention protocols, in the hands of local CBOs to help raise awareness and slow the spread of the virus.  With the aforementioned information in hand, public health workers have been able to develop targeted communications and tactical strategies to improve containment efforts through community-wide awareness and educational messaging.

By connecting local CBOs and faith-based organizations with public health workers and clinicians, the Dallas CCC is facilitating effective contact tracing and the implementation of care plans for high-risk individuals in a more efficient and scalable manner.

The value of the CCC communication network linking healthcare providers and CBOs cannot be underestimated, as it represents a highly effective and efficient mechanism to disseminate leading practice information aimed directly at high-risk populations. We have seen first-hand that communications delivered to community residents through familiar food pantries, homeless shelters, and places of worship are much more effective than community-wide public information campaigns broadcast via radio or television.

This increased effectiveness is based on the fact that many of these at-risk individuals frequent the CBOs on a regular basis for essential services and these individuals know and trust the CBO staff delivering the information. From one-on-one conversations to displaying infographic posters and take-away educational leaflets, CBOs provide a ready avenue to communicate with at-risk individuals in the communities they serve.

As mentioned, early work in Dallas County is beginning to demonstrate the value of CCC in facilitating contact tracing. In this case, the challenge is not simply identifying the location of positive COVID-19 cases but having the ability to connect those cases to other individuals within the neighborhood or community who may have come in contact with the infected individual, all while working in an environment where individuals frequently move from one location to another. Having a well-established communication system at the local neighborhood level can be extremely helpful in identifying contacts and potential contacts.

It is well-known that many individuals in impoverished, underserved neighborhoods are reluctant to speak with individuals they don’t know or trust, especially if those individuals are affiliated with government agencies, no matter how well-intentioned the agency personnel may be. Staff members at local faith-based organizations and CBOs frequented by these vulnerable residents are a highly effective resource for identifying inter-personal relationships and connecting with those individuals, which is something that has proved challenging for public health staff when working outside of a CCC environment. In Dallas, CBOs, public health, and civic staffers, as well as medical student volunteers have all been partnering to help facilitate the contact tracing process with positive results.

CCC’s can materially improve the health and well-being of a community’s residents, especially in times of crisis. The take-away lesson is clear. If you already have a CCC, lean on it to help you through crises impacting your community. If you don’t have a CCC, now is the time to begin the process of establishing one in your community. Even with the challenges that the current pandemic is generating, it is possible to begin building your CCC.  Start small and gradually increase the CCC’s scope and scale; don’t be in a rush to grow. The most important thing is to take the plunge and begin the journey!


About Dr. Keith Kosel

Dr. Keith Kosel is a Vice President at Parkland Center for Clinical Innovation (PCCI) and is the author of “Building Connected Communities of Care: The Playbook for Streamlining Effective Coordination Between Medical and Community-Based Organizations,” a guide that brings together communities to support our most vulnerable. At PCCI, Keith is leveraging his passion for – and extensive experience in – patient safety, quality, and population health by focusing on understanding social determinants of health and the impact of community-based interventions in improving the health of vulnerable and underserved populations.

ASN, HHS Launches KidneyX COVID-19 Kidney Care Challenge

ASN, HHS Launches KidneyX COVID-19 Kidney Care Challenge

What You
Should Know:

– The HHS and
the American Society of Nephrology announces the launch of the COVID-19
Kindey Care Challenge.

– The $300k
challenge aims to identify and share these frontline solutions so all
communities can benefit. Winners will receive $20,000 each in recognition of
their solutions.


The U.S. Department of Health and Human Services (HHS)
and the American Society of Nephrology (ASN) launched the KidneyX COVID-19 Kidney
Care Challenge
 . The $300,000 challenge invites eligible entities
or individuals to submit demonstrated solutions that reduce the transmission of
coronavirus among people living with kidney disease and/or reduce the risk of
kidney damage among people who contract the virus.

Challenge
Overview

The COVID-19 Kidney Care
Challenge seeks to identify replicable solutions from providers, staff,
patients, and caregivers and share them across healthcare communities. KidneyX
is particularly interested in demonstrated solutions that consider the patient
experience and could be implemented without requiring significant effort,
expertise, money, or other resources.

These solutions may be
applied in a range of settings — such as dialysis centers, clinics, hospitals, homes,
and transport. Solutions may address, but are not limited to:

– Data collection and
dissemination.

– Patient management and
monitoring.

– Education, training, and
communication.

– Supply chain and
resource management.

– Care setting logistics.

KidneyX is particularly
interested in solutions that consider the patient experience and could be
implemented without requiring significant time, expertise, money, or other
resources. Solutions that reduce the impact of the COVID-19
pandemic on communities facing existing health disparities are encouraged.

Why It Matters

The 37 million Americans living with kidney disease are at increased risk of severe illness from COVID-19. And acute kidney injury — sudden loss of kidney function — affects 20-40% of COVID-19 patients admitted to intensive care. The pandemic is exacerbating existing health disparities and social determinants of health, as kidney disease disproportionately affects low-income communities and people of African American, Asian, Hispanic, Latin American, Native American, or Pacific Islander descent. Individuals and organizations on the front lines have responded by quickly developing or adapting solutions for safely delivering kidney care during the pandemic.

“COVID-19’s heavy impact will be felt for decades to come, drastically intensifying inequities within the American healthcare system,” said KidneyX Steering Committee Chair Dr. John Sedor. “The COVID-19 Kidney Care Challenge, alongside KidneyX’s ongoing work, offers us a way to potentially improve outcomes for patients in the near term — as well as help set innovation roadmaps for the health challenges of the future.”

Evaluation Criteria

The judging panel will
assign up to five points for each of the criteria below, for a maximum of 20
points.

Impact: The confidence in the solution to reduce
SARS-CoV-2 transmission among people with kidney disease and/or reduce the risk
of kidney injury/disease among people who contract COVID-19.

Feasibility: The ease with which the solution could be
implemented, considering factors such as time, expertise, money, or other
resources required.

Adaptability: The extent to which the solution could be
adapted for other people or used in other care settings and/or geographies.

Ingenuity: The degree to which the submission offers a new
solution, demonstrates an improvement on an existing solution, or applies an
existing solution in new ways.

Entrants are invited to submit their solutions via an online
submission form
. The submission form asks entrants to provide an overview
of the solution; available data to demonstrate the solution has, or could have,
a positive impact; and additional information to assess how the solution may be
implemented in other settings.

Challenge Timeline

Round 1 of the challenge
is now accepting solutions until December 4, 2020. Round 2 will be open to
eligible entrants from Round 1, as well as new eligible entrants who did not
enter the first round; the second round will accept solutions from December 9,
2020 to January 20, 2021. The judging panel will recommend winners from both
rounds to receive $20,000 each in recognition of their solutions.

Innovaccer Unveils Risk Adjustment Solution For Improved Coding Accuracy

Innovaccer Launches Risk Adjustment Solution For Improved Coding Accuracy

What You Should Know:

– Innovaccer unveils new risk adjustment solution to help providers better segment their population to refine the risk scoring process and improve coding accuracy and efficiency, thereby improving performance on risk-based contracts.

– The solution utilizes Artificial Intelligence (AI) and
Natural Language Processing (NLP) to make risk predictions.


Innovaccer, Inc., a
leading healthcare
technology
company, has launched its Risk Adjustment
Solution
. Leveraging Innovaccer’s industry-leading, FHIR-enabled Data
Activation Platform, providers can better segment their population to refine
the risk scoring process and improve coding accuracy and efficiency, thereby
improving performance on risk-based contracts. The solution utilizes Artificial Intelligence
(AI)
and Natural Language Processing (NLP) to make risk predictions. By
improving care management workflows, Innovaccer works to help all members of
the health team care as one.

Addressing End-to-End Risk Adjustment

Innovaccer’s solution is designed to address end-to-end risk
adjustment needs by allowing providers to use actionable insights on dropped
codes and suspected codes across various risk models. The solution works with
the Centers of Medicare & Medicaid hierarchical condition categories
(CMS-HCC), Department of Health and Human Services hierarchical condition
categories (HHS-HCC), and the Chronic Illness and Disability Payment System
(CDPS), helping providers improve coding accuracy.

Segment Patient Population Based on Risk Scores

Providers can identify codes that can be integrated into the
EHR using simple
steps through advanced risk adjustment analytics. Innovaccer’s platform can
also segment the patient population based on risk scores available through
historical data and provide dashboards to identify details related to Risk
Adjustment Factor (RAF) and risk capture trends. Providing curated insights to
risk coders prevents them from having to switch between multiple screens,
reducing the time spent on coding processes.

“Innovaccer’s Risk Adjustment Solution caters to all risk management needs through one seamless platform. It is AI and NLP ready, and by leveraging the platform’s smarter workflows and actionable insights, providers can decrease time spent on risk-related coding by up to 40%. The solution helps providers to refine the risk scoring process and improve coding accuracy and efficiency for improved performance on risk-based contracts,” says Abhinav Shashank, CEO at Innovaccer.

3 Telemedicine Security and Compliance Best Practices

3 Telemedicine Security and Compliance Best Practices
Gerry Miller, Founder & CEO at Cloudticity

The coronavirus pandemic accelerated telemedicine exponentially as patients and doctors switched from in-person visits to remote consultations. Health providers rapidly scaled virtual offerings in March and April and traffic volumes soared to unprecedented levels, with practices “seeing 50 to 175 times the number of patients by telehealth than before the outbreak,” according to McKinsey. By early August, the U.S. Department of Health and Human Services expanded the list of allowable telehealth services in Medicare and there was an executive order supporting permanent telehealth provisions for rural areas.

But the surge in telemedicine adoption comes with a host of cybersecurity risks and regulatory compliance requirements unique to the healthcare sector.

As telemedicine traffic increases, so does the volume of hacking attempts. Recent cybersecurity news indicates healthcare organizations are top targets for cyberattacks and “providers remain the most compromised segment of the healthcare sector, accounting for nearly 75 percent of reported breaches.” The consequences are chilling: “The average cost of a healthcare data breach is $7.13 million globally and $8.6 million in the United States.

Further, whenever patient information is involved, HIPAA compliance is required. While HHS temporarily suspended pursuing HIPAA penalties on providers for “good faith provision of telehealth during the COVID-19 nationwide public health emergency,” such permissiveness will not last.

Luckily, most telemedicine providers can utilize managed services and cloud infrastructure to keep pace. Here are some best practices to meet IT compliance and cybersecurity demands for telemedicine.

Telemedicine Compliance Best Practices

Compliance should be viewed as a real-time process that drives security. Telemedicine tools and technology should therefore reflect significant expertise with all healthcare regulations (HIPAA, HITRUST, HITECH), with compliance functions permeating processes. Recommended compliance best practices include:

1. Automate Remediation

Healthcare applications cannot offer high reliability if every potential compliance problem is remediated manually; there’s just too much that can go wrong and never enough staff to address it when needed. The solution is to automate everything that can be automated, and rely on people to handle exceptions or potential violations that don’t impact reliability. Cloud-based services can integrate AI and operational intelligence to automatically remediate anomalies when possible, present recommendations to operations staff for cases that cannot be resolved automatically, and present clear choices such as:

·         Do Nothing: Take no action, delete ticket after [x number of days]

·         Fix Now: Implement the recommended actions immediately

·         Schedule: Perform the recommended actions during the next maintenance window

This approach speeds resolution and decreases service disruptions, and improves the reliability of telemedicine delivery. The automated response also plays a critical role in security (which will be discussed shortly).

2. Perform Formal Risk Assessments

Understanding the risk level and specific risk issues are critical components for an effective compliance plan. Many providers of healthcare services underestimate their level of risk, in part because it is difficult to quantify. The HHS has published guidance in its Quantitative Risk Management for Healthcare Cybersecurity, which offers insight. There are also cloud solutions that can aid the process. Cloud services providers such as Amazon Web Services (AWS), Microsoft Azure, and Google Cloud offer automated security assessment services that help improve the security and compliance of applications deployed on their cloud hosting platforms. They can generally assess applications for exposure, vulnerabilities, and deviations from best practices. A good inspection service should highlight network configurations that allow for potentially malicious access, and produces a detailed list of findings prioritized by level of severity.

3. Reduce Attack Surface

To provide secure access to sensitive information, hybrid architectures supporting telemedicine applications need a virtual private network (VPN) gateway between on-premises and cloud resources. However, developers, test engineers, remote employees, and others who need access to cloud-based protected health information (PHI) may bypass a VPN gateway by either cracking open the cloud firewall to allow direct unencrypted internet traffic or using peering connections. To prevent such potential exposures, secure desktop-as-a-service (DaaS) solutions provide an elegant way to allow cloud-based access to PHI without exposing connections or records. A DaaS is generally deployed within a VPC providing each user with access to persistent, encrypted cloud storage volumes using an encryption key management service. No user data is stored on the local device, which reduces overall risk surface area without impeding development capability.

Telemedicine Security Best Practices

While the full scope of cybersecurity strategies is beyond the scope of this article, here are three best practices that telemedicine providers can use bolster their security profile:

1. Deploy Proactive Network Security

Modern cyber threats have become steadily more sophisticated in evading traditional security measures and more devastating once they penetrate network perimeters. For that reason, telemedicine providers need a highly proactive, multilayered approach to prevent malware-based outages, theft of intellectual property, and exfiltration of protected health information (PHI).

A combination of network anti-malware, application control, and intrusion prevention systems (IPS) is recommended. Such proactive solutions are generally bundled in managed cloud services that should automatically detect suspicious system changes in real-time, isolate and quarantine affected resources, and prevent the spread of exploits by locking down any server whose configuration differs from the installed settings.

2. Encrypt Data Storage

Data encryption is the last line of cyber-defense for PHI and other critical information. Even if an attacker can penetrate the perimeter and proactive network security and exfiltrate data from the provider, those data are useless to the hacker if encrypted. It’s good practice to encrypt all web and application servers running on cloud instances using a unique master key from a key management service when creating volumes.

Encryption operations generally occur on the servers that host cloud database (DB) instances, ensuring the security of both data-at-rest and data-in-transit between an instance and its block storage. For additional protection, you can also opt to encrypt DB instances at rest, underlying storage for DB instances, its automated backups, and read replicas.

3. Harden Operating Systems

Both Microsoft Windows Server and Linux are ubiquitous operating systems in telemedicine. They are also both attractive targets for cybercriminals because they provide complex capabilities, frequently remediate vulnerabilities, and are so common (increasing attackers’ chances of finding an unpatched system). Hackers use OS-based techniques such as remote code execution and elevation of privilege to take advantage of unpatched operating system vulnerabilities. Hardened images of Windows Server and Linux virtual machines (VMs) should be used, employing default configurations recommended by the Center for Internet Security (CIS). Such hardened images make gaining OS administrative extremely difficult, and coordinate well with proactive security bundles described earlier.

Additional resources for telemedicine compliance and security are available from the American Medical Association (AMA), the US Department of Homeland Security, the U.S. Department of Health and Human Services, and HITRUST.

 While these best practices are targeted primarily at telemedicine companies, they can also be applied to a wide range of healthcare providers and organizations delivering vital services in the face of 2020’s dramatic swings in demand.


About Gerry Miller

Gerry Miller is the founder and chief executive officer at Cloudticity. He is a successful serial entrepreneur and healthcare fanatic. From starting his first company in elementary school to selling his successful technology consulting firm in 1998, Gerry has always marched to his own drummer, producing a series of successes. Gerry’s first major company was The Clarity Group, a Boston-based Internet technology firm he founded in 1992. Gerry presided over seven years of 100% aggregate annual growth and sold the company in 1998 when it had reached $10MM in revenue.

He was recruited by Microsoft to become their Central US Chief Technology Officer, eventually taking over a global business unit and growing its revenue from $20MM to over $100MM in less than three years. Gerry then joined ePrize as Chief Operating Officer, where he grew sales 38% to nearly $70MM while improving operating efficiency, quality, and both client and employee satisfaction. Gerry founded Cloudticity in 2011 with a passion for helping healthcare organizations radically reshape the industry by unlocking the full potential of the cloud.

Bridge Connector Lands $25.5M to Expand Healthcare Integration Platform

Bridge Connector

What You Should Know:

– Bridge Connector raises $25.5 million in Series B funding to advance interoperability layer for healthcare organizations as demand for integrated health data intensifies during COVID-19 pandemic.

– The investment will support the growth of Destinations,
the company’s new integration-platform-as-a-service (iPaaS) that connects
health data systems using use-case-based interoperability blueprints to speed
integrations with major vendors.


Bridge Connector,
a Nashville, TN-based interoperability company changing the way health care
communicates, today announced it has raised $25.5 million in Series B funding led
by Axioma Ventures. The round was also joined by all existing investors,
including veteran investor Jeff Vinick, and brings Bridge Connector’s total
funding to over $45 million.

COVID-19 Underscores Growing Demand for Integrated Health
Data

The last decade has seen an explosion of digital health platforms and the U.S. health care system has taken incremental steps toward achieving interoperability between them. In March, the Department of Health and Human Services (HHS) issued new rules that force formerly closed vendor solutions to become interoperable.

However, the COVID-19 pandemic has exposed the urgent need for data liquidity as healthcare providers across the country have struggled to share essential patient information and provide comprehensive care via remote delivery methods such as telehealth. In the face of the pandemic’s disproportionate effect on minority communities, the industry has also recognized the critically important role that social determinants of health — the environments in which we are born, live and work — play in our overall well-being and the need to make this information available to health care providers.

A True Interoperability Layer for Healthcare

Founded in 2017, Bridge Connector provides a suite of vendor-agnostic integration solutions and a full-service delivery model, helping health care vendors, providers, and payers more easily share data between disparate systems, such as electronic health records (EHRs) or patient engagement solutions. The company’s technology is designed to democratize health care by allowing organizations of any size to equitably connect data systems and empower care teams with the most accurate patient data in real-time. Unlike other health care interoperability vendors, Bridge Connector’s unique approach does not lock customers into a forced data model or proprietary APIs, instead of employing a vendor-agnostic integration layer that works across data models without the need for standardization.

The investment will further support the company’s increasing
market share in healthcare interoperability and growth of Destinations, a new
integration-platform-as-a-service (iPaaS) that connects health data systems
using use-case-based interoperability blueprints to speed integrations with
major vendors.

Recent Integrations with Key HIT Stakeholders

The new funding comes shortly after Bridge Connector finalized various collaborations with some of the most influential stakeholders in health IT, including Epic, Allscripts, and Salesforce, as well as other system integrators such as MuleSoft. Those collaborations represent calculated steps toward creating a centralized hub of integration solutions for all data platforms that any health care provider or payer can access. The average hospital today uses approximately 16 disparate electronic health records platforms that limit data sharing within the walls of a single hospital, let alone between separate hospitals.

Analysis: July Health IT M&A Activity; Public Company Performance

– Healthcare Growth Partners’ (HGP) summary of Health IT/digital health mergers & acquisition (M&A) activity, and public company performance during the month of July 2020.


While a pandemic ravages the country, technology valuations are soaring.  The Nasdaq hit an all-time high during the month of July, sailing through the 10,000 mark to post YTD gains of nearly 20%, representing a 56% increase off the low water mark on March 23.  More notably, the Nasdaq has outperformed the S&P 500 (including the lift the S&P has received from FANMAG stocks – Facebook, Amazon, Netflix, Microsoft, Apple, Google) by nearly 20% YTD. 

At HGP, we focus on private company transactions, but there is a close connection between public company and private company valuations.  While the intuitive reaction is to feel that companies should be discounted due to COVID’s business disruption and associated economic hardships facing the country, the data and the markets tell a different story.

While technology is undoubtedly hot right now given the thesis that adoption and value will increase during these virtual times, the other more important factor lifting public markets is interest rates.  According to July 19 research from Goldman Sachs,

“Importantly, it is the very low level of interest rates that justifies current valuations. The S&P 500 is within 4% of the all-time high it reached on February 19th, yet since that time the level of S&P 500 earnings expected in 2021 has been pushed forward to 2022. The decline in interest rates bridges that gap.”

Additionally, Goldman Sachs analysts also estimate that equities will deliver an annual return of 6% over the next 10-years, lower than the long-term return of 8%.  Future value has been priced into present value, and returns are diminished because the relative return over interest rates is what ultimately matters, not the absolute return.  In short, equity valuations are high because interest rates are low. 

What happens in public equities usually finds its way into private equity.  To note, multiple large private health IT companies including WellSkyQGenda, and Edifecs, have achieved 20x+ EBITDA transactions based on this same phenomenon.  From the perspective of HGP, this should also translate to higher valuations for private companies at the lower end of the market.  As investors across all asset classes experience reduced returns requirements due to low interest rates, present values increase across both investment and M&A transactions. 

As with everything in the COVID environment, it is difficult to make predictions with certainty.  Because the stimulus has caused US debt as a percentage of GDP to explode, there is an extremely strong motivation to keep long-term interest rates low.  For this reason, we believe interest rates will remain low for the foreseeable future.  Time will tell whether this is sustainable, but early indications are positive.

Noteworthy News Headlines

Noteworthy Transactions

Noteworthy M&A transactions during the month include:

  • Workflow optimization software vendor HealthFinch was acquired by Health Catalyst for $40mm.
  • Sarnova completed simultaneous acquisition and merger of R1 EMS and Digitech.
  • Payment integrity vendor The Burgess Group acquired by HealthEdge Software.
  • Ciox acquired biomedical NLP vendor, Medal, to support its clinical data research initiatives.
  • Allscripts divests EPSi to Roper for $365mm, equaling 7.5x and 18.5x TTM revenue and EBITDA, respectively.

Noteworthy Buyout transactions during the month include:

  • HealthEZ, a vendor of TPA plans, was acquired by Abry Partners.
  • As part of a broader wave of blank check go-public transactions, MultiPlan will join the public markets as part of Churchill Capital Corp III.
  • Also as part of a wave of private equity club deals, WellSky partially recapped with TPG and Leonard Greenin a rumored $3B transaction valuing the company at 20x EBITDA.
  • Edifecs partnered with TA Associates and Francisco Partners in another club deal valuing the company at a rumored $1.4B (excluding $400mm earnout) at over 8x revenue and 18x EBITDA.
  • Madison Dearborn announced a $410mm take private of insurance technology vendor Benefytt.
  • Nuvem Health, a provider of pharmacy claims software, was acquired by Parthenon Capital.

Noteworthy Investments during the month include:

Public Company Performance

HGP tracks stock indices for publicly traded health IT companies within four different sectors – Health IT, Payers, Healthcare Services, and Health IT & Payer Services. Notably, primary care provider Oak Street Health filed for an IPO, offering 15.6 million shares at a target price of $21/ share. The chart below summarizes the performance of these sectors compared to the S&P 500 for the month of July:

The following table includes summary statistics on the four sectors tracked by HGP for July 2020:


About Healthcare Growth Partners (HGP)

Healthcare Growth Partners (HGP) is a Houston, TX-based Investment Banking & Strategic Advisory firm exclusively focused on the transformational Health IT market. The firm provides  Sell-Side AdvisoryBuy-Side AdvisoryCapital Advisory, and Pre-Transaction Growth Strategy services, functioning as the exclusive investment banking advisor to over 100 health IT transactions representing over $2 billion in value since 2007.

COVID-19 Underscores Why Certain Aspects of the American Healthcare System Should Change Forever

Medsphere CEO Talks Affordable Healthcare IT and Future of EHRs
Irv Lichtenwald, President & CEO of Medsphere Systems Corporation

In the late 1940s, the United Kingdom was busily reassembling country and what remained of the empire in the aftermath of World War II. Among many revelations, the war had convinced Britain’s leaders of the need to provide healthcare for all in the event of calamity upending the basic functions of a civilized society. With that, the UK’s National Health Service (NHS) was born.

In 2020, all perspectives about quality and the time it takes to see a provider aside, the NHS remains quite popular among UK citizens and is an enduring source of national pride.

With the United States in the midst of its own upheaval, it’s for a related question: Might the current COVID-19 situation give rise to significant changes to the American healthcare system? 

Virtually no one thinks the correct answer is ‘No.’ Things will change. The question is how and to what extent. The healthcare system in place in the United States now is dramatically more complex than that in use by Britons after WW II. There are so many moving parts, so many things that can break. 

So, in which aspects of the current American healthcare system are we likely to see changes after COVID-19 is dealt with?

Telehealth: Someone always benefits in a catastrophe. In this case, that someone may be Zoom shareholders.

From 10 million daily users in December, Zoom rocketed to 200 million in March and nearly 300 million a month later. Much of that was healthcare related. 

Of course, Zoom is not the only direct beneficiary of coronavirus as venerable meeting platforms like WebEx and Skype, among others, have also experienced dramatic growth.

Hospitals and health systems were incrementally implementing telehealth services prior to the coronavirus outbreak, but there was no sense of urgency that accompanies a rapidly spreading virus. Since then, the federal government, states and insurance companies have allocated funds and rewritten regulation to expand the use of telehealth. 

But there are more telehealth related-issues to address, some of which have thorns. Service and payment parity across insurance companies is an issue. If telehealth is going to be a regular component of healthcare, technology gaps will have to be addressed, especially in rural areas. 

This is something the federal government recognizes. The White House recently drafted an executive order oriented around improving rural health by expanding technology access, developing new payment models and reducing regulatory burdens. The EO tasks the secretaries of health and human services and agriculture to work with the Federal Communications Commission to “develop and implement a strategy to improve rural health by improving the physical and communications healthcare infrastructure available to rural Americans.” But until Congress gets involved and provides funding for something like this, it will probably never get out of the proposal phase. 

In fact, there are enough concerns—parity, technology gaps, added costs—associated with telehealth to wonder if it will endure after coronavirus is in the rear view. Enough about telehealth benefits both providers and patients for it to stick and proliferate, but that could also be said about any number of healthcare initiatives that seem to languish for lack of coordination and political will. 

Health Insurance: This is where the NHS analogy is the most relevant. Many millions of workers are furloughed or simply laid off with the impact of COVID-19 on frontline jobs like restaurant worker, massage therapist and barista. Those who had insurance through work may not have it anymore, leaving them doubly vulnerable—no coverage, no income—to illness or accident. 

Mass unemployment episodes reveal, each time, the weakness in the patchwork employment-based healthcare insurance system we’ve sort of made peace with for decades. Sure, Medicaid exists to fill the gaps, but it may make sense to render Medicaid unnecessary, especially since its value is questionable in particular states.

“You notice the number of band-aids that Congress is having to apply to help people who have lost their jobs,” said former CMS Administrator Don Berwick, MD. “What we have now is a whole series of band-aids and special measures. What if instead, we just had universal health insurance?”

What if, indeed. Will COVID-19 be the straw that burns the bridge of employer-based health insurance, to mangle a metaphor? That may depend on how long the pandemic lasts, who is president sometime after November 3 and how much damage is done to the national fabric before economy and society start a process of repair.

Payment Models: For years now, hospitals have been in the middle of slow shift from fee-for-service care to value-based care and alternative payment models. That transition didn’t happen quickly enough to prevent most hospitals from falling into a financial chasm. If elective procedures are a big part of revenue, it follows that revenue will fall if those procedures disappear. 

To be fair, the hit to hospital finances has been catastrophic enough—more than $200 billion in losses over four months, according to the American Hospital Association—that federal government support would have been necessary even if a full pay-for-quality model had been in place.  

But the pandemic spotlights the downside of treating essential services like healthcare as though they are mere services one selects or rejects. And it exposes the folly of not making sure everyone has insurance coverage (a payer) when the individual costs for COVID-19-related hospital admission can range from $20,000 to $88,000. 

End-of-Life Care: According to one analysis, 42 percent of COVID-19 deaths have occurred in nursing homes or assisted living facilities. The families of those unfortunate souls who’ve died while in a facility have generally endured the agony of saying goodbye outside a window or over a video link. It’s hard to believe, after COVID-19, that the assisted living industry will continue as before. 

“The crisis surely will lead nursing home administrators to reconsider the way patients are cared for,” says Modern Healthcare. “Among the ideas Harvard’s [Professor David] Grabowski believes will get a longer look in the wake of the pandemic are using telemedicine services, creating specialized Medicare Advantage plans for the homes and pursuing smaller settings.”

Perhaps. And perhaps a son or daughter that remembers coronavirus will simply choose not to risk everything by putting their parent in a home. Could enough of them make such a decision that the industry contracts? Is forced to take quality care more seriously? Attracts more serious federal regulation? 

As the deaths mount, it’s hard not to give every option serious consideration. 

Supply Chain: These days we’re bickering in public and on social media (looking at you, maskless Karen throwing food in Trader Joes) about whether or not masks should be mandated. Look back with me  to February, however, and you’ll fondly recall concerns about there being enough masks at all. 

Back then we learned that the United States had exactly one mask manufacturer, and that all other masks are sourced from overseas. That it takes longer to get stuff from China than from Amarillo creates obvious potential problems when a crisis hits, but it also pits hospitals and government entities against one another and guarantees that the winner will pay more for supplies than they would in less-critical times. 

It also creates weird, unnecessary scenarios that could be avoided using coordination and leadership. The governor of Maryland, for example, used his wife’s connections to South Korea (her country of birth) to secure 500,000 coronavirus tests, which he then put in an undisclosed location and protected using national guard troops. 

What’s the remedy? 

Modern Healthcare has called for a national supply chain czar, which in other times may have just been the head of FEMA. The suggestion, however, highlights the need for a coordinated central clearing house where supplies can be ordered, managed and dispersed based on need. 

Individual hospitals, clinics and health systems can also help themselves by using a robust supply chain software system that keeps track in real time of available supplies, covers all ordering systems and methodologies, and reacts swiftly to certain thresholds. 

The uniquely unfortunate aspect of the American political system among western democracies is that, for the most part, it responds to the demands of special interests. Think about your local representative. Chances are good the shouts of specific business interests are ringing in his or her hears so loudly that little else is audible. 

As such, there is a significant danger that the American healthcare system will return, post-COVID-19, to the same dynamic it had when the virus arrived, which will be unfortunate. What we need post-pandemic is not necessarily specific changes to hospitals, clinics, insurance companies, etc., though they could be part of an overall solution. What will be necessary is an examination of where every aspect of the healthcare system overall, inasmuch as there is one, didn’t do its job.   

Disasters are social sodium pentothal that, while active, force groups of people to take an honest look at their failures. Once the disaster is passed, however, there is a danger that Upton Sinclair’s maxim—“It is difficult to get a man to understand something when his salary depends upon his not understanding it”—will rule the day. 

No one hopes for more dramatic damage to the American economy and social fabric, but the irony is that necessary change sometimes only comes when reality is undeniable, as in a shellshocked Britain instituting the NHS. If COVID-19 doesn’t shock us sufficiently into making substantial changes to the healthcare system, it’s a pretty safe bet the same disaster will occur again.

Talis Awarded $25M NIH Contract for Point-of-Care COVID-19 Testing

Talis Awarded $25M NIH Contract for Point-of-Care COVID-19 Testing

What You Should Know:

– Today, Talis Biomedical Corporation announced it has
been awarded a $25M contract from the National Institutes of Health (NIH) as
part of Phase 2 of its Rapid Acceleration of Diagnostics (RADx) initiative as
well as another $100 million in additional financing.  

– The new funding will be used to scale manufacturing for
the launch of the Talis One™ diagnostic platform that provides rapid and highly
accurate detection of COVID-19 at points-of-care in 30 minutes or less.

– The Talis One System is a fast, easy-to-use, solution
that brings testing out of the lab and to the point of care. The technology
provides healthcare professionals with an entire clinical lab in the palm of
their hand and is intended for use in non-laboratory settings, such as
physicians’ offices, urgent care clinics, elder care/assisted living
facilities, cancer treatment and dialysis centers, and potentially the
workplace.


Talis Biomedical Corporation,
a company dedicated to developing high-performance point-of-care diagnostic
tests for infectious diseases, today announced that it has secured a $25
million contract from the National Institutes of Health (NIH) for Phase 2
of its Rapid Acceleration of Diagnostics (RADx) initiative. Additionally, the
company has completed an additional financing of $100 million to scale
manufacturing for the launch of the Talis One™ diagnostic platform, which
provides rapid and highly accurate detection of COVID-19 at the
point-of-care. 

Accurate Point of Care COVID-19 Testing

 Today, patients are
often forced to endure days of waiting for lab results.  As a result, doctors may initiate unnecessary
isolation or empirical treatment based on incomplete information. This approach
is costly and can be harmful to patients. With COVID-19 cases
on the rise in many areas across the country, there is a tremendous need for
access to testing, especially in vulnerable populations where the spread of
COVID-19 infection can be devastating.   The Talis One System is a molecular diagnostic
platform developed to enable rapid, highly accurate point-of-care testing for
infectious diseases such as COVID-19.

Talis One COVID-19 Assays

The Talis One assays are based on a proprietary, highly
optimized nucleic acid isothermal amplification chemistry to achieve
exceptional test performance much faster than traditional PCR. The system is
designed for use in non-laboratory settings, such as physicians’ offices,
urgent care clinics, elder care/assisted living facilities, cancer treatment
and dialysis centers, and potentially the workplace.

COVID-19 is the first infectious disease that the Talis One
System will support. Future infectious disease indications may include assays
for other respiratory infections, such as influenza, as well as sexually
transmitted infections (STIs) and other infections impacting women’s health.
The Talis One instrument can be managed remotely and sends test results to a
cloud database for secure transmission, storage and review. Results are
available in 30 minutes or less.

“We are extremely proud that the NIH selected Talis,
out of a field of 600 applicants, to be among the first teams to move to the
final phase of the RADx initiative. This important funding will accelerate the
commercialization of our Talis One System for the detection of COVID-19.
Additionally, we are pleased to have the continued support of our investors,
who share our excitement about the significant impact the Talis One System can
deliver as a fast and reliable diagnostic testing platform for life-threatening
and life-altering infectious diseases,” said Brian Coe, Co-Founder and
Chief Executive Officer of Talis.

“In response to the significant need for rapid, highly
accurate testing solutions to help combat the pandemic, we were able to utilize
our Talis One System, which we have been developing for clinical use in women’s
health, to quickly develop an assay for SARS-CoV-2, the novel coronavirus that
causes COVID-19. We are particularly focused on serving vulnerable populations,
such as those in elder care facilities or patients with impaired immune
systems. With the support of the NIH RADx program and proceeds from the new
financing, we are confident that we will be able to accelerate our goal of
making rapid diagnostic testing widely available,” added Coe.

NIH Support

The Talis One COVID-19 assay project is supported by the
RADx program and has been funded in whole or in part with Federal funds from
the National Institute of Biomedical Imaging and Bioengineering, National
Institutes of Health, Department of Health and Human Services, under Contract
No. 75N92020C00010.

Walgreens to Invest $1B in VillageMD to Open 500 to 700 Full-Service Doctor Offices

Walgreens to Invest $1B in VillageMD to Open 500 to 700 Full-Service Doctor Offices

– Walgreens will invest $1 billion in
equity and convertible debt in VillageMD to open 500 physician-led primary care
clinics in more than 30 U.S. markets in the next five years.

– VillageMD and Walgreens also recently announced the
availability of Village Medical telehealth providers on Walgreens Find Care™,
which is an online platform that connects patients with a wide range of health
services.


Walgreens
Boots Alliance, Inc
. and VillageMD
announced today that Walgreens will be the first national pharmacy chain to
offer full-service doctor offices co-located at its stores at a large scale,
following a highly successful trial begun last year. This expanded partnership
will open 500 to 700 “Village Medical at Walgreens” physician-led primary care
clinics in more than 30 U.S. markets in the next five years, with the intent to
build hundreds more thereafter.

Here are five things to know about the landmark deal:

1. The clinics will accept a wide range of health insurance options and offer comprehensive primary care across a broad range of physician services. Additionally, 24/7 care will be available via telehealth and at-home visits. More than 50 percent will be located in Health Professional Shortage Areas and Medically Underserved Areas/Populations, as designated by the U.S. Department of Health and Human Services.

2. This rollout follows a trial with five in-store clinics in the Houston, Texas area, which produced very strong results after opening last November including high patient satisfaction, with Net Promoter Scores over 90.

3. Most of the full-service clinics will be approximately 3,330 square feet each, with some as large as 9,000 square feet. They will optimize existing space in the store, which will also still provide a vast range of retail products to customers.

4. Under the terms of the new agreement, WBA will invest $1B in equity and convertible debt in VillageMD over the next three years, including a $250M equity investment to be completed today.

5. Of WBA’s investment, 80 percent will be used by VillageMD to fund the opening of the clinics and build the partnership, including integration with Walgreens digital assets. WBA will hold an approximately 30 percent ownership interest in VillageMD at the completion of the investment.

 “In the U.S., we spend $4 trillion per year on healthcare, over 85 percent of that is tied to patients with chronic diseases. To improve our healthcare system and reverse the trajectory of health spending, we must meet the needs of all patients. This partnership allows us to unleash the power of primary care doctors and pharmacists, enabling them to work in a coordinated way to enhance the patient experience,” said Tim Barry, chairman and CEO, VillageMD. “The results of our initial pilot clinics highlight that these outcomes are infinitely achievable.”