What we’re expecting in 2021, and beyond…

From telehealth to digital trials, customer engagement to healthcare data, Healthware Group outlines the key trends that are expected to shake up digital health this year.

Well, it goes without saying, COVID-19 has resulted in a rapid adoption of digital technologies across all industries, most notably in healthcare. There are several important aspects to these shifts for pharma, biotech and medical device companies, so what can we expect to see over the next 12 months and beyond?

Telehealth keeps maturing and integrates into care pathways

The adoption of telehealth, which was already accelerating pre-pandemic, has been exponentially driven by COVID-19. It’s swept aside several historic barriers to uptake, such as the healthcare professional and patient desire to physically meet, medical guidelines that focus on in-person diagnosis and reimbursement models that discourage remote consultation.

2020 was a psychological and systemic tipping point for telehealth, adoption of which will accelerate in 2021 as it becomes the norm, in the process driving new self-service approaches to medicine and participation-based reimbursement models.

Mental health worsens – digital tools continue to fill the gap

The emotional and psychological wellbeing of the world’s population has been put under tremendous strain because of the COVID-19 pandemic, exacerbating an existing global mental health epidemic.

There is an opportunity to address this at scale with digital tools and techniques, and expand support into just about any therapeutic area through the holistic integration of mental and behavioural health solutions that improve patient care.

Mental health support is key to improving outcomes in chronic diseases and can also provide an invaluable empathetic and psychological component of support for people dealing with other complex medical situations.

When coupled with conversational interfaces and AI, digital mental health solutions are perceived as highly personal by users and open the door for a profound transformation in people’s relationships with digital health tools and how they integrate them into their daily lives.

Clinical trials get more and more digitalised

As study enrolment continues to lag drastically behind target, patient recruitment is set to rely even more on digital marketing to improve its speed and accuracy. These techniques will also need to be applied to screening, interviews and the actual studies themselves, particularly as more trials move towards a virtual, decentralised or hybrid model.

Digital screening of subjects makes their geographical location less relevant, which may make studies more attractive as there is less requirement to travel. And with the support of remote sampling, and growing tools for gathering real world evidence about improved quality of life, the clinical trials of the future can be done faster, with lower costs and on a more decentralised basis.

‘Aging in place’ becomes more commonplace

Aging in place will become more common as the baby boomer generation ages and feels more comfortable leveraging tools like remote monitoring, telehealth and disease management platforms. Living independently will be critical to this age group and digital health tools will be critical in supporting them in this endeavour. The adoption and growth of digital tools is expected to explode as a result. This is certainly evident in the amount of investment in the category.

The inevitable invisibility of digital health

Technology will begin to dematerialise, as has already been seen in other industries, and digital health will increasingly be woven into everyday objects. We’re starting to see this happen through the emergence of smart homes and smart cars (i.e., steering wheels that also measure the driver’s heart rate). As more data is collected passively, there will be more opportunities for integration.

No more ‘business as usual’ for pharma’s customer engagement

Life sciences companies need to rethink their customer engagement paradigms in light of changing customer preferences. Pharma should update the role of the rep from simply delivering a sales message to more of a concierge service model, providing access to – and facilitating the delivery of – meaningful content that physicians want and need. As such, reps will need to be reskilled.

Self-service models for HCPs are also needed in order to provide access to content when and how they want it – as already seen in other industries, the expectation will be for 24/7 access.

While digital-only product promotion was laughed at just a year ago, we’ve already seen the first digital-only blockbuster launch, and we expect this will become a growing trend. Pharma companies will need to continually rethink what works and not be afraid to experiment with solutions they’ve never tried before.

A growing need for digital health proficiency

While 2014 is often quoted as the first year where the majority of working healthcare professionals were digital natives, 2020 was the year when the remaining digital immigrants were forced to travel into the online world. Post-pandemic, online engagement will continue to be commonplace and 2021 will see much broader rollouts of ‘digital’ training for medics (young and old), and all medical societies will have to embrace online learning and digital publishing models. In addition, the subject matter for ongoing disease research will focus even further on COVID-19 comorbidities and the longer-term impact of the virus.

Integration of telehealth strategy into commercial models

Amazon is making a serious global move into healthcare delivery with the acquisition of PillPack, and its recent launch of Amazon Pharmacy. With Amazon Care, it is starting to experiment with virtual health care services, offering them first to its own employees and with plans to expand them to health plans and other employers.

These moves are bringing Amazon closer and closer to a true end-to-end model, similar to the turnkey solutions offered by the likes of Hims, Ro and others in the category with an original focus on conditions with an associated stigma. We’re already starting to see some pharma build end-to-end solutions like this in birth control, and we’re expecting to see these efforts branch out into other disease areas. And beyond building end-to-end solutions like this to drive scripts, we expect pharma to begin approaching telehealth more generally as a potential marketing/sales channel, helping to remove barriers to care, improving online visits and even helping HCPs understand the benefits.

Consolidation of digital health platforms

Digital health platforms will likely see a wave of further consolidations, with a few leading platforms starting to stake out their respective positions across the healthcare spectrum. This trend can be seen as a net positive, in that it will enable digital therapeutic solution developers to concentrate on building the individual vertical products that will live on these platforms.

However, issues around data ownership and sharing will need to be addressed and resolved (by way of regulations) to avoid a situation where solutions that are competitive to platform owners’ own cannot find a way to be listed on them. Price controls will also need to be mandated to avoid the types of ‘access taxes’ currently seen, such as with Apple’s App Store fees on sales charged to app developers (upwards of 30% of sales collected), who have no way to sell their apps directly to iPhone users.

Services to manage and make sense of the health data explosion

We expect to see what we call Health Data as a Service (HDaS). As more solutions and devices generate increasing amounts of health data, there is a greater need to aggregate that data in a useful way for consumers. Consumers want and need tools to make sense of all that data. They also want to ensure they know who has access to that data, and control over where it can flow. So, we expect to see more tools supporting consumers in this way.

We look forward to continuing to contribute to the advancement of digital health and digital transformation across all aspects of the healthcare ecosystem and welcome your thoughts on the above.

About the authors

Roberto Ascione is Healthware Group’s CEO and founder, and a pioneer in digital health and a recognised thought leader, people-inspiring founder, serial entrepreneur and global manager.

 

Gerry Chillè is senior partner at Healthware Group, in charge of its digital therapeutics pipeline strategy and development.

 

Fulvio Fortini is Healthware’s managing director – Italy. With more than 20 years of experience, he is passionate about digital technology and an expert in the health and wellness sector.

 

Petteri Kolehmainen is managing director – Finland, leading Healthware’s Helsinki team, with focus the Nordic and Baltic countries, bringing strong experience in technology and business development.

 

Kristin Milburn is managing director at Healthware Labs, which was launched in New York in 2015 with a mission to accelerate digital health and therapeutic innovation.

 

Ariel Salmang is managing director at Intouch International, a unique joint venture between Healthware Group and the Intouch Group.

 

Paul Tunnah is Healthware’s chief content officer and managing director UK, and a recognised author, speaker and industry advisor with a passion for helping organisations tell authentic stories.

 

If you’d like to learn more about how we think please reach out to [email protected]

About Healthware Group

Healthware is a next-generation integrated consulting group. For more than 20 years it has been offering large companies and start-ups in the life sciences and insurance sectors a unique set of services and expertise in strategic consulting, communication, technology and innovation to drive the digital transformation of health.

The post What we’re expecting in 2021, and beyond… appeared first on .

Hurdle Secures $5M for Digital Mental Health Platform for People of Color

Hurdle Secures $5M for Digital Mental Health Platform for People of Color

What You Should Know:

– Washington, D.C.-based Hurdle raises $5M in seed funding to accelerate its digital mental health platform for people of color.

– Hurdle aims to provide an innovative teletherapy solution for employers and insurers; aims to remove barriers to mental health care for People of Color by rooting its services in evidence-based methods of cultural humility.


Hurdle (formerly Henry Health), a Washington, D.C.-based innovative digital mental health platform company, announced today it has successfully closed a $5 million in seed funding co-led by 406 Ventures and Seae Ventures with participation from F-Prime.  Hurdle leverages technology to cultivate a virtual safe space with culturally intentional content and services that support self-mastery and well-being.

Powering Culturally Responsive Mental Health Care
Services

Hurdle Secures $5M for Digital Mental Health Platform for People of Color
Kevin Dedher, Founder & CEO of Hurdle

According to the American Psychiatric Association, African
Americans often receive poorer quality of care and lack access to culturally
competent care. Only one-in-three African Americans who need mental health care
receive it. Hurdle was founded in 2018 by public health leader Kevin Dedher,
MPH after having suffered his own period of depression where he found the
biggest challenge and barrier to effective care was finding the right therapist
who could truly understand and connect with his life as an African-American.

To tackle these challenges, Hurdle’s digital mental health
platform revolutionizes mental health care for People of Color by creating an
equitable behavioral health service with culturally responsive care and
resources. Hurdle uses a proprietary scientifically validated tool developed by
Dr. Norma Day-Vine, Johns Hopkins professor of Counseling and Human Development
to measure cultural responsiveness and provide appropriate training and
coaching for its therapists. Research shows that therapists whose patients perceive
them as having Cultural Humility deliver meaningfully improved outcomes.

“With depression spiking in Black and minority communities, this year is an inflection point in mental healthcare. The events of 2020 present a unique opportunity for Hurdle to create solutions that work for anyone, but most importantly, for the most underserved populations,” says Kevin Dedner, Founder and CEO of Hurdle. “With this financing, Hurdle will significantly expand its reach and be able to help corporate and payer customers cement their Diversity & Inclusion commitments by providing broader access to culturally-responsive mental health services.”

Hurdle’s suite of services includes:

– Self-care digital apps (daily motivations, mediations,
assessments);

– Wellness workshops (managing stress, cultivating
resilience, coping with grief)

– Teletherapy (individual, couples and group therapy).

Funding Will Expand Platform to Insurers and Large
Employers

Hurdle will use the new capital to strategically scale its evidence-based and tech-enabled platform, designed to support culturally diverse populations’ behavioral health needs. In addition, the company plans to expand its leadership team and solidify its position as the Gold Standard for Culturally Sensitive Teletherapy. 

Hurdle currently accepts Aetna, BlueCross BlueShield, CareFirst, Cigna, Medicare, United Healthcare, and Optum-United Health Group/Optum Behavior Health.  As Hurdle builds operational scale, it will offer its platform directly to more insurers and large employers.


We’re all in this together!

Overcoming Anxiety in the pandemic times!!

The year has been a tough journey for all of us. It has taught us many lessons that are going to stay with us for the whole of our lives. Thus, DelveInsight has decided to take you all on a ride full of experiences – some bitter and some sweet – yet with the power to impact lives positively and assure everyone that “We’re all in this together!”

So, Let’s hear from our COO.

Last year has been so full of stress and anxiety for most of us in some or the other way. I realized the depth of the situation more when I connected virtually with all of my employees on a one-to-one basis where we could not just hear each other voices after so long, but also could feel each other’s emotions. Few were freshers who joined during the pandemic, few who attended the office in person for a few months, and our dear old folks.

Each one seemed to be waiting for this doomsday scenario to end. For most of them, someone in their immediate family, or they appeared to be anxious. And the prolonged situation, without a doubt, made it worse for many. However, connecting helped all of us in more than one way. We could feel that we are not alone, there are similar people out there going through the same and were willing to lend an ear, and extend a helping hand to those who needed it. 

Honestly, this unprecedented situation taught us several things. Now that I turn back and think of it, there is so much to talk on mental health, anxiety and depression. Here, I would take this opportunity to pen down my journey through the situation and share my learnings with you. 

Even though I could not just stop writing about it, still I have tried to keep it crisp and relatable so that I could connect with you. While writing, my intent was to share the information, but my purpose was also to connect with you emotionally.

Just like we can feel happiness, sadness, anger, and anguish. Similarly, anxiety is also a feeling. All of us go through it at one point or another, and it is perfectly normal to feel it. For instance, let us talk about stage-fright. Howsoever well prepared we might be, just before going on the stage and facing the audience, we all feel a bit of nervousness, don’t we?

Similarly, let us rewind to our good old school days. Before a day of any exam, we all feared results. Talking about current times, what about heebie-jeebies that we feel while talking to managers regarding appraisals. By now, I am pretty sure directly, you can relate to what exactly I am trying to say.

So, friends, what exactly is anxiety? Anxiety feels different depending on the person experiencing it. Feelings can range from butterflies in your stomach to a racing heart. You might feel out of control like there’s a disconnect between your mind and body. Or you may have nightmares or panic attacks. And sometimes, painful thoughts or memories resurface that may be beyond your control. You may have a general feeling of fear and worry, or you may fear a specific place or event. If I talk about myself, I hesitate to use the lift, flight or be in any closed space. Symptoms of general anxiety may include:

  • Increased heart rate
  • Rapid breathing
  • Restlessness
  • Trouble concentrating
  • Difficulty falling asleep

Because, ultimately, prolonged anxiety can lead a sane person to experience depression. Knowing anxiety the way I do, I know that we need to work on it. Whosoever can deal with it emerges as a winner, others struggle. Those who struggle, all of their wisdom or intellect fail to help them.

Putting it scientifically, we have two kinds of the nervous system, sympathetic and parasympathetic. The sympathetic nervous system prepares the body for intense physical activity and is often referred to as the fight-or-flight response. On the other hand, the parasympathetic nervous system has almost the exact opposite effect and relaxes the body and inhibits or slows down many high energy functions.

No doubt both are very much required for our existence, but just imagine if all the time, we start gearing up our nervous system? What would happen to our body? Imagine a car is given the amount of petrol needed to reach Chennai from Delhi and it moves just fine if handled with the right gear, functional brakes and accurate acceleration, as required. If we start rushing it by accelerating unnecessarily on the top-most gear – the one which is meant to pull through the steeps, what would happen then? We would finish our fuel halfway through our journey. 

Same happens with our lives. People in early days were calm, peaceful and much contented with what they had; therefore, they did not worry much about anything. They used to remain on their parasympathetic infrastructure, contrary to what happens today when most of us run on sympathetic most of the time, exhausting our energy much too soon. So, friends, activate your sympathetic nervous system for a war-like situation to fight emergency, because do remember your body in that mode cut supplies to all other vital organ and sends its resources more to heart and muscles to fight that situation. Also, do not forget to switch off the machine when the need is over.

Anxiety is the result of worry. Often, we cannot identify the actual reason behind it; however, identifying the cause is as important as addressing the issue itself. Suppose you are not well or tired, you would feel the pain somewhere in the body, you would take proper medicine/rest for that. Similarly, have you ever thought, that if our mind or brain is not feeling that well, how would it notify you?

Yes, it sends apparent signals in sadness, mood swings, and anxiety; we need to pick them fast before it gets more difficult for us. Stop everything and first work on maintaining your mind, because it is the boss of your body and believe me, our mind is just like a small child who also needs a break from the daily stressful, mundane routine. 

Do what you love, sing out loud, listen to some lovely music, chill with friends, meditate, do whatever you love to. It is imperative. Our positivity can help us overcome anxiety very well. This is why we are told to develop hobbies. Hobbies are something where we tend to forget about, but we need to pick them up along with the rest of the things and spend time on what we love, and that brings us back to our real self, which is meant to be cheerful, happy and relaxed.

So, guys, it is OK to be NOT OK. But unfortunately, many of us do not understand this language. Some feel confused, or to be precise, shy about it. Few are not comfortable talking about it to anyone. If we immediately seek medical attention for physical ailments, then why not for emotional/mental stress? Instead, this is more important. It is a massive taboo in a society that needs serious attention. It is high time we start to talk about it.

I will dig deeper into my case. My claustrophobia was well handled by a psychologist. I was able to travel several countries, and each was a separate win for me, travelling for so long in flights, encouraged by my partner who supported me at each level and celebrated all of my small and big wins. 

What I am trying to say is, situations change if we learn to do something about it. If we do not, then our sufferings will continue to pile up. We need to find ways to overcome it.

Now you ask, how? Right? Build a strong network of friends and family, love them unconditionally, strengthen the bond, and the happiness you get in return would not be more comfortable to explain. 

Okay! Stretch your muscles now for a small activity. List down the names of at least 3 people whom you could connect and open your heart without thinking twice at any hour of the day, could share your lows, your weaknesses, in short, you can be your true self.

Keep it in your front-most drawer, and during an emotional emergency, take a look, you are the luckiest if you have even one. Just pour your heart out. If you don’t have any name, for now, become one.

There is sometimes a loop of thoughts which becomes difficult to break.

Few rules to be followed which, I have learnt with experience:

  • Learn to pick the signals your mind sends.
  • Check whether you are running on sympathetic or parasympathetic. For immediate relief, control your breaths because that is the one which gets disturbed first. It gets faster when you are anxious. Close your eyes, sit at a peaceful place, try to slow down its pace for 5 minutes and experience the result.
  • Identify the activity which soothes you, relaxes you. Switch to that when you need. It can be anything… stitching, painting, singing, yoga, dancing… the list is endless.
  • It’s never too late to develop a hobby, which is the best escape route from mundane life.
  • Identify the people with whom you are close, invest in building rich relationships. When I say rich, friends are the richness we all should strive for with all our might. If you have even one who understands you truly, who can listen to you tirelessly, with whom you can be yourself, you have won the world. Talk your heart out, do not give it a thought, express your genuine emotions, and not hesitate.
  • It’s perfectly ok not to be okay, seek medical help if needed, take medicine if advised, shake off the taboo, life is far more precious than these petty things, enjoy it, live it to the fullest.
  • Follow a healthy routine, it elevates the mood. Inculcating the habit to exercise releases endorphin – the happiness hormone- which helps our mind reduce stress.
  • Take a break without applying logic, have fun, this is only one life that we have got. Be yourself.
  • Meditation is one of the most helpful tools, just imbibe it within. Your subconscious mind can do wonders, just keep repeating and reminding it that you are a beautiful soul, powerful soul and perfectly fine. What we say, we ultimately become. Sit quietly by yourself for at least 10 minutes. I am not a meditation expert, just have begun but felt the wonders.
  • Last but not least, become a true friend of someone as you wish for yourself, you never know you might be his/her only trustworthy friend. Believe me, happiness doubles when spread.

That’s all my friend, I won’t say thank you, instead I would express my gratitude for giving your precious time to read, which at the first place empowered me to express myself. 

Signing off.
Preeti Agrawal
COO
DelveInsight

Our COO, Preeti Agrawal, is a market research consultant with around 16 years of experience. She is a science graduate and has done her masters in computer application. Prior to joining DelveInsight, she worked with Toluna (GreenField), Kadence, and Internationallinx. She was actively engaged in client interaction, handling client queries, providing them with feasible solutions & building healthy relationships thereby achieving high customer satisfaction. She has mastered the art of maintaining relationships with customers to achieve repeat/referral business.

The post We’re all in this together! appeared first on DelveInsight Business Research.

The Burden And The Impact Of Mental Health Issues In Today’s Time

Mental health today is a global burden causing a significant number of deaths. It is rapidly increasing and contributing to ill health in both developed and developing countries.  According to Jürgen Rehm et al., “mental and addictive disorders affected more than 1 billion people globally in 2016. They caused 7% of all global burden of disease as measured in Disability Adjusted Life Years (DALYs) and 19% of all years lived with disability”. 

What is mental illness?

Mental health refers to the cognitive, behavioural, and emotional well-being of an individual. Being an essential part of the health, mental health directly correlates with physical health and productivity. Irrespective of the sex, age, gender, socioeconomic group almost all the people are prone to a mental health disorder. Various socioeconomic, biological and environmental factors affect the mental health of an individual. 

What are the risk factors for mental health conditions?

Individual factors – The lifestyle has a direct relation with mental health conditions. The sedentary lifestyle, prevailing medical illness, dependence on substances such as alcohol, cigarettes, and other addictive substances (opioids) increase the risks of depression and anxiety. Similarly, the low self-esteem, obesity,  sexual orientation, cognitive immaturity and difficulties in communicating or interacting with others can also affect mental health. 

Family Factors – Family factors such as conflict, abuse, lack of family support, violence at home, loss of a partner (widowhood), out-of-home care, and the perinatal period contribute to the ill mental health. The family factors such as violence, abuse, and conflicts at home can profoundly impact the young ones.

Social relationships – The lack of social support or cooperation, the ethnic or religious differences, lack of trust and loneliness can trigger the mental health disorder. In recent times it has been observed that social media also influences mental health conditions. People who have experienced cyberbullying or victimization tend to have a higher chance of mental health disorder. In extreme situations, it has even led to suicides. 

Living environment – The living environment comprises factors such as income level, difficulty accessing essential services, experiencing the disaster, exposure to war (particularly among soldiers), ongoing injustice, and discrimination in society may also increase mental health risk. 

Similarly, it has been observed that the mothers and children are the most vulnerable and affected group due to the warlike environment in the country. 

Work and school environment – The working conditions and mental health are directly correlated. The work stress, working conditions, work-life balance, and other factors contribute to the mental health problems if they remain unaddressed. Similarly, difficulties in studies, low performance, or failure at school may also contribute to the young one’s mental health. The mental disturbance at work and school dramatically affects productivity. 

Economic Factors – Mental health problems due to economic factors are more prevalent in the working-age group. Unemployed people are most prone to the mental health disorder. Similarly, huge debt/loan, low income, job insecurity, and impact and fear of the economic crisis (like in the case of Covid-19) on the job also contribute to mental health. 

What are the signs and symptoms of mental health, and how is it diagnosed?

The signs and symptoms of mental health vary from person to person. The various social, economic, and environmental factors over a period of time lead to deteriorating mental health which can be observed through emotion, behaviour, and action. Among multiple factors some of the common sign and symptoms of the mental health includes –

  • Frequent mood change
  • Withdrawal from social life or engagement (such as friends, family and others)
  • Too much dependence on addictive substances such as alcohol or drugs
  • Change in sleeping, eating and other days to day activity
  • Excessive worrying, fear and anxiety
  • Sadness or irritability for an extended period of time
  • Difficulty in understanding and facing people
  • Difficulty to maintain daily activity 
  • Suicidal thoughts.
  • Feeling tired (or low energy) and low physical performance. 

Apart from these, the person might also have hyperactive behaviour, illogical thinking, aggression, confusion, delusions, nervousness and negative thoughts to harm himself and others. Mental health leads to many health complications and difficulties in personal and professional life. Mental health may lead to a change in weight, increase the risk for heart disease, addiction to a specific substance, reduced  ability of the immune system, and may induce self-harm. At the professional level, it might affect relationships with others at home and the workplace. 

There is no medical test to diagnose the mental health of a person. However, the Diagnostic and Statistical Manual of Mental Disorders (DSM) is the most common method used by healthcare professionals in the US and the countries around the world to diagnose mental disorders. DSM is based on specific criteria to identify the symptoms of mental illness in a person. 

What are the most common mental diseases and their treatment options?

Mental disease encompasses a large number of illnesses. Based on the severity and prevalence, some of the most common mental disorders are – 

Depression –  Depression is one of the most common mental disorders in the world. As per the GBD 2017, Disease and Injury Incidence and Prevalence by Spencer L James et al., an estimated 264 million people worldwide are affected by depression. It found that more women are affected by it than men. The depression leads to mood change and certain physical and behavioural changes in the individual. Certain Antidepressants are available in the market to treat Depression.

Schizophrenia According to the World Health Organization, Schizophrenia is a chronic and severe mental disorder affecting 20 million people worldwide. People affected with Schizophrenia are 2-3 times more likely to die early than the general population. Similarly, it is found to be more common among males than females.

There is no cure for Schizophrenia; however, numerous approved drugs are available in the market for initial and maintenance therapy, with the goal of controlling symptoms. Apart from the marketed therapies companies such as GW Pharmaceuticals, Avanir Pharmaceuticals, Minerva Neurosciences, Karuna Therapeutics, and many others are involved in developing therapies for Schizophrenia

Bipolar DisorderAround 45 million people worldwide are affected by Bipolar Disorder. The Bipolar Disorder treatment has two phases: the acute phase and the maintenance phase. To treat Bipolar Disorder, certain medications are approved for acute treatment of depressive episodes. Some of the key companies such as Celon Pharma, Otsuka Pharmaceutical and NeuroRx are diligently working towards developing novel treatment therapies for Bipolar Disorder

Generalised Anxiety Disorder (GAD)The GAD is a long-term condition that leads to constant worry, restlessness, anxiety and other panics in the affected individual. Females are more frequently diagnosed with GAD compared to males.  As per the analysis presented by Delveinsight for the seven major markets of the world (i.e the USA, the UK, Germany, Italy, France, Spain and Japan), the total 12-Month prevalent cases of GAD were 16,606,987 in 2017, based on DSM-V criteria. To address GAD, companies such as BioHaven Pharmaceuticals, Bionomics, Fabre-Kramer Pharmaceuticals, Sage Therapeutics, VistaGen Therapeutics, Forest Laboratories and Allergan are exploring different treatment options.

Obsessive-compulsive Disorder (OCD)According to the NIMH, Obsessive-compulsive Disorder currently affects approximately 1 in 40 adults and 1 in 100 children in the U.S. Similarly as per the World Health Organization’s ‘Depression and other common mental disorders’ report (2017), OCD was included in the ‘anxiety disorders’ category. Biohaven Pharmaceuticals is one of the leading companies working towards the development of therapies to tackle OCD.

Substance Use Disorder, Panic Disorder, Eating Disorders, Post-traumatic Stress Disorder, Personality Disorders, Mood Disorders, Social Anxiety Disorder, and some specific phobias are some of the other common mental disorders prevalent in the world.

Preventative measures for mental health problems 

The social stigma associated with mental disease, limited knowledge about the treatment option and lack of family support are crucial factors that affect the mental health outcome. Over the past few years, significant progress has been made in the diagnosing and treating mental health disorders. The treatment option varies according to the types of condition, its severity and also person to person. Apart from the pharmacological treatments, counselling (psychotherapy), education, social support groups play a vital role in managing mental disorders. In some cases, hospitalisation, admission to the mental health centres, or a need for a private physician may be required. In addition to all these, some complementary and alternative therapies can also be beneficial. 

However, identifying the early warning signs and symptoms, getting medical attention at the due time, and taking care of mental health by incorporating a healthy lifestyle such as regular sleep, healthy food intake, and regular physical activity can significantly reduce the mental health problem. Similarly, addressing the critical socio-economic issues such as nutrition, housing, education, employment, and regular evaluation and monitoring can reduce these diseases’ burden. 

Conclusively, in the coming years, advancements in the diagnosis methodologies, raising awareness about mental health diseases, incremental healthcare spending across the world, and the expected launch of emerging therapies are expected to significantly improve the health outcome for the people affected with mental health diseases.

The post The Burden And The Impact Of Mental Health Issues In Today’s Time appeared first on DelveInsight Business Research.

FCC Unveils 14 Initial Projects Selected for $100M Connected Care Pilot Program

FCC COVID-19 Telehealth Program Providers

What You Should Know:

– FCC announces initial 14 pilot project selected for $100M Connected Care Pilot Program that will support connected care service across the country and focus on low-income and veteran patients.


The Federal Communications
Commission (FCC)
today announced an initial set of 14 pilot projects with
over 150 treatment sites in 11 states that have been selected for the Connected
Care Pilot Program
.  A total of $26.6 million will be awarded to these
applicants for proposed projects to treat nearly half a million patients in
both urban and rural parts of the country. 


Connected Care Pilot Program Background

Overall, this Pilot Program will make available up to $100
million over a three-year period for selected pilot projects for qualifying
purchases necessary to provide connected care services, with a particular
emphasis on providing connected care services to low-income and veteran
patients.  

The Pilot
Program will use Universal Service Fund monies to help defray the costs of
connected care services for eligible health care providers, providing support
for 85% of the cost of eligible services and network equipment, which include:

1. patient
broadband Internet access services

2. health care
provider broadband data connections

3. other
connected care information services

4. certain
network equipment

These pilot projects will address a variety of critical
health issues such as high-risk pregnancy, mental health conditions, and opioid
dependency, among others. Here is the list initial list of healthcare providers
that were selected into the Pilot Program:

Banyan Community Health Center, Inc.,
Coral Gables, FL.
 
Banyan Community Health Center’s pilot project seeks $911,833 to provide
patient-based Internet-connected remote monitoring, video visits or consults,
and other diagnostics and services to low-income and veteran patients who are
suffering from chronic/long-term conditions, high-risk pregnancy, infectious
disease including COVID-19, mental health conditions, and opioid
dependency.  Banyan Community Health Center plans to serve an estimated
20,847 patients in Miami, Florida, 85% of which are low-income or veteran
patients.

Duke University Health System, Durham,
NC.
  Duke
University Health System’s pilot project seeks $1,464,759 to provide remote
patient monitoring and video visits or consults to a large number of low-income
patients suffering from heart failure, cancer, and infectious diseases. 
Duke University Health System’s pilot project plans to serve an estimated
16,000 patients in North Carolina, of which 25% are low-income.

Geisinger, consortium with sites in
Lewiston, PA; Danville, PA; Jersey Shore, PA; Bloomsburg, PA; Coal Township,
PA; and Wilkes-Barre, PA.
 
Geisinger’s pilot project seeks $1,739,100 in support to provide connected care
services and remote patient monitoring to low-income patients in rural
communities in Pennsylvania.  Geisinger’s pilot project would serve an
estimated 1,000 patients and would focus on chronic disease management and
high-risk pregnancies, while also treating infectious disease and behavioral
health conditions.  Through its pilot program, Geisinger plans to directly
connect all participating patients, 100% of whom are low-income, with broadband
Internet access service. 

Grady Health System, Atlanta, GA.  Grady Health System’s pilot
project seeks $635,596 to provide Internet connectivity to an estimated 1,896
primarily low-income and high-risk patients who are unable to utilize video
telemedicine services due to lack of a reliable network connection in
Atlanta.  The program will focus on using connected care services such as
patient remote monitoring and video visits/consults to treat vulnerable
patients with conditions such as congestive heart failure, COVID19,
hypertension, diabetes, heart disease, and HIV. 

Intermountain Centers for Human
Development, consortium with sites in Casa Grande, AZ; Nogales, AZ; Coolidge,
AZ; and Eloy, AZ. 
 Intermountain
Centers for Human Development’s pilot project seeks $237,150 in support to
treat mental health conditions, opioid dependency, and other substance abuse
disorders.  The pilot project plans to serve 3,400 patients in Arizona,
including rural areas, of which 90% are low-income.

MA FQHC Telehealth Consortium,
consortium with 76 sites in Massachusetts.
  MA FQHC Telehealth Consortium’s pilot project
seeks $3,121,879 in support to provide mental health and substance abuse
disorder treatment through remote patient monitoring, video visits, and other
remote treatment to patients in Massachusetts, including significant numbers of
veterans and low-income patients.  The pilot project will expand access to
these services by leveraging program funding to increase bandwidth at its
sites, and to provide patients with mobile hotspots.  This project would
serve 75,000 patients through 76 federally qualified health centers in
Massachusetts, including rural areas, with an intended patient population of
61.5% low-income or veteran patients.

Mountain Valley Health Center,
consortium with 7 sites in Northeastern California.
  Mountain Valley Health Center’s
pilot project seeks $550,800 in support to provide telehealth capabilities and
in-home monitoring of patients with hypertension and diabetes.  Mountain
Valley’s pilot project plans to serve an estimated 200 patients in rural
Northeastern California, of which at least 24% will be low-income patients and
10% will be veteran patients.

Neighborhood Healthcare – Escondido,
Escondido, CA, Neighborhood Healthcare – Valley Parkway, Escondido, CA,
Neighborhood Healthcare – El Cajon, El Cajon, CA, Neighborhood Healthcare –
Temecula, Temecula, CA, Neighborhood Healthcare – Pauma Valley, Pauma Valley,
CA.
  Neighborhood
Healthcare’s pilot project seeks $129,744 to provide patient broadband access
to primarily low-income patients suffering from chronic and long-term
conditions (e.g., diabetes and high blood pressure).  Neighborhood
Healthcare’s collective project plans to serve an estimated 339 patients, 97%
of which are low-income patients, in five sites serving Riverside and San Diego
counties.

OCHIN, Inc., consortium with 15 sites in
Ohio, 16 sites in Oregon, and 13 sites in Washington.
  OCHIN’s pilot project seeks
$5,834,620 in support to lead a consortium of 44 providers in Ohio, Oregon, and
Washington, encompassing 8 federally qualified health centers (FQHCs) serving
rural, urban, and tribal communities.  OCHIN’s pilot project will provide
patient broadband Internet access service and wireless connections directly to
an estimated 3,450 low-income patients to access connected care services,
including video visits, patient-based Internet-connected patient monitoring,
and remote treatment and will deliver care to treat high-risk pregnancy,
maternal health conditions, mental health conditions, and chronic and long-term
conditions such as diabetes, hypertension, and heart disease. 

Phoebe Worth Medical Center – Camilla
Clinic, Camilla, GA; Phoebe Physicians Group Inc – PPC of Buena Vista, Buena
Vista, GA; Phoebe Physicians Group – Ellaville Primary Medicine Center,
Ellaville, GA; Phoebe Physicians dba Phoebe Family Medicine & Sports
Medicine, Americus, GA; Phoebe Putney Memorial Hospital, Albany, GA; Phoebe
Putney Memorial Hospital dba Phoebe Family Medicine – Sylvester, Sylvester, GA.
  The Phoebe Putney Health System
projects seek $673,200 to provide patient-based Internet-connected remote
monitoring, video visits, and remote treatment for low-income patients
suffering from chronic conditions or mental health conditions.  These projects
plan to serve an estimated 4,007 patients, approximately 1,000 of which will be
low-income patients in six sites serving southwest Georgia. 

Summit Pacific Medical Center, Elma, WA.  Summit Pacific Medical Center’s
pilot program seeks $169,977 in support to provide patient-based
Internet-connected remote monitoring, other monitoring services, video visits,
diagnostic imaging, remote treatment and other services for veterans and
low-income patients suffering from chronic conditions, infectious diseases,
mental health conditions, and opioid dependency.  Summit Pacific Medical
Center’s pilot project would serve an estimated 25 patients in Elma,
Washington, 100% of which would be low-income or veteran patients.

Temple University Hospital,
Philadelphia, PA.
 
Temple University Hospital’s pilot project seeks $4,254,250 to provide
patient-based Internet connected remote monitoring and video visits to
patients, including low-income patients, suffering from chronic/long-term
conditions and mental health conditions.  This pilot project plans to
serve an estimated 100,000 patients in Philadelphia, Pennsylvania, 45% of which
are low-income patients. 

University of Mississippi Medical
Center, Jackson, MS.
 
The University of Mississippi Medical Center’s (UMMC) pilot project seeks
$2,377,875 in support to provide broadband Internet access service to patients,
enabling remote patient monitoring technologies and ambulatory telehealth
visits to low-income patients suffering from chronic conditions or illnesses
requiring long-term care.  UMMC’s pilot project would impact an estimated
237,120 patients across Mississippi and serve up to 6,000 patients
directly.  Of these patients, UMMC estimates that 52% would be low-income.

University of Virginia Health System,
Charlottesville, VA. 
 The
University of Virginia (UVA) Health System’s pilot project seeks $4,462,500 in
support to expand the deployment of remote patient monitoring and telehealth
services to an estimated 17,000 patients across Virginia, nearly 30% of whom
will be low-income.  The UVA Health System pilot project will support
patient broadband and information services, including systems to capture,
transmit, and store patient data to allow remote patient monitoring, two-way
video, and patient scheduling. 

KHN’s ‘What the Health?’: On Capitol Hill, Actions Have Consequences

Can’t see the audio player? Click here to listen on SoundCloud.

The reverberations from the Jan. 6 storming of the U.S. Capitol by supporters of President Donald Trump continue. A broad array of business groups, including many from the health industry, are halting contributions to Republicans in the House and Senate who voted against certifying the victory of President-elect Joe Biden. Meanwhile, Republicans in the House who have refused to wear masks or insisted on carrying weapons are being subjected to greater enforcement, including significant fines.

Away from the Capitol, the Trump administration has granted a first-in-the-nation waiver to Tennessee to turn its Medicaid program into a block grant, which would give the state potentially less federal money but more flexibility to structure the federal-state health program for those with low incomes. And in its waning days, the administration is moving to make its last-minute policies harder for Biden to undo.

This week’s panelists are Julie Rovner of KHN, Joanne Kenen of Politico, Margot Sanger-Katz of The New York Times and Kimberly Leonard of Business Insider.

Among the takeaways from this week’s podcast:

  • The decision by industry groups to cut their political contributions to some Republican lawmakers could reshape businesses’ relationships on Capitol Hill. But it’s still not clear if this announcement will affect the vast sums of political contributions that come through PACs and other unnamed sources, as well as individual contributions from corporate officials.
  • The slow start of the covid vaccination campaign points to the tension between the need to steer the vaccine to people at high risk of contracting the disease and the concerns about wasting the precious medicine. Because the vaccines that have been approved for emergency use have a relatively short shelf life, some doses may go to waste if they are reserved for specific populations.
  • The response to the vaccine among health care workers varies widely. In some areas, staffers are eager to get the shots, while in other places, some workers have been hesitant and the shots are going unused. And the federal government has not provided a strong public messaging campaign about the vaccines.
  • The Trump administration’s announcement last week that it would move to convert Tennessee’s Medicaid program to a block grant program is raising concerns among advocates for the poor, who fear that the flexibility the state is gaining could lead to enrollees getting less care, especially since the state will get a hefty portion of any savings it finds in running the program.
  • It may not be easy for the Biden administration to change this decision. Federal officials in recent weeks have been sending states, including Tennessee, letters to sign that could protect the Medicaid waivers they have received from the Trump administration and could serve as a legal guarantee that would require a long, difficult process to unwind.
  • Mental health care may be a casualty of the coronavirus pandemic. As states look to balance their budgets after a year in which revenues were slashed, they may turn to cutting mental health care services provided through Medicaid and other programs.

Also this week, Rovner interviews KHN’s Victoria Knight, who wrote the latest KHN-NPR “Bill of the Month” feature — about an unusually large bill for in-network care. If you have an outrageous medical bill you’d like to share with us, you can do that here.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week that they think you should read too:

Julie Rovner: The Washington Post’s “Young ER doctors Risk Their Lives on the Pandemic’s Front Line. But They Struggle to Find Jobs,” by Ben Guarino

Margot Sanger-Katz: The New York Times’ “Why You’re Probably Not So Great at Risk Assessment,” by AC Shilton

Joanne Kenen: The Atlantic’s “Why Aren’t We Wearing Better Masks?” by Zeynep Tufekci and Jeremy Howard

Kimberly Leonard: Business Insider’s “I Was Offered a Covid Vaccine Even Though I’m Young and Healthy. Here’s How I Did It,” by Kimberly Leonard

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcherGoogle PlaySpotify, or Pocket Casts.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

USE OUR CONTENT

This story can be republished for free (details).

NeuroFlow Secures $20M for Tech-Enabled Behavioral Health Integration Platform

NeuroFlow Secures $20M for Tech-Enabled Behavioral Health Integration Platform

What You Should Know:

– NeuroFlow raises $20M to expand its technology-enabled behavioral
health integration platform, led by Magellan Health.

– NeuroFlow’s suite of HIPAA-compliant, cloud-based tools
simplify remote patient monitoring, enable risk stratification, and facilitate
collaborative care. With NeuroFlow, health care organizations can finally
bridge the gap between mental and physical health in order to improve outcomes
and reduce the cost of care.


NeuroFlow, a Philadelphia-based digital health startup supporting technology-enabled behavioral health integration (tBHI), announces today the initial closing of a $20M Series B financing round led by Magellan Health, in addition to a syndicate including previous investors. Magellan is a leader in managing the fastest growing, most complex areas of health, including behavioral health, complete pharmacy benefits and other specialty areas of healthcare. 

NeuroFlow for Digital Behavioral Health Integration

NeuroFlow works with leading health plans, provider systems,
as well as the U.S. military and government to enhance virtual health programs
by delivering a comprehensive approach to whole-person care through digital
behavioral health integration – an evidence-based model to identify and treat
consumers with depression, anxiety and other behavioral health conditions
across all care settings.

Key features of the behavioral health platform include:

– Interoperability: Seamless EHR and system integrations minimize administrative burden and optimize current IT investments.

– Measurement-based Care & Clinical Decision Support: NeuroFlow enables MBC at scale, keeps the patient in the center of care, and continuously monitors for a consistent connection to critical data and clinical decision support.

– Performance Management & Reporting: Recognize
the impact of your BHI program, monitoring the impact of clinical interventions
on quality and cost of care while recognizing outliers requiring program
adjustments.

– Consumer Engagement & Self-Care: personalized
experience that encourages, rewards and recognizes continuous engagement and
monitoring

Maximize Efficiency, Revenue and Reimbursements

By integrating behavioral health into the primary care setting, increasing screening and self-care plans – NeuroFlow’s BHI solution can reduce ED utilization by 23% and inpatient visits by 10%. 80% of NeuroFlow users self-reported a reduction in depression or anxiety symptoms and 62% of users with severe depression score improve to moderate or better.

Telehealth Adoption Underscores Need for Behavioral
Healthcare

With record growth in telehealth adoption and historic spikes in depression and anxiety due to the ongoing pandemic, workflow augmentation solutions and the delivery of effective behavioral health care have been identified as top priorities in the industry. NeuroFlow’s technology increases access to personalized, collaborative care while empowering primary care providers, care managers, and other specialists to most effectively support patient populations by accounting for and addressing behavioral health. 

“Behavioral health is not independent of our overall health — it affects our physical health and vice versa, yet most underlying behavioral health conditions go unidentified or are ineffectively treated. Most healthcare providers are overburdened, so introducing the concept to account for a person’s mental health in addition to their primary specialty can be overwhelming and lead to inconsistent and inadequate treatment,” said NeuroFlow CEO Chris Molaro. “Technology, when used strategically, can enhance and augment providers, making the concept of holistic and value-based care feasible at scale and easy to implement.”

Strategic Partnership with Magellan

Magellan Health’s network of more than 118,000 credentialed
providers and health professionals are now poised to join NeuroFlow customers
across the country by leveraging the best-in-class integrated data and
analytics platform to meet the rising demand for enhanced mental health
services and support. By partnering with and investing in NeuroFlow, Magellan
has the opportunity to drive further adoption of NeuroFlow’s behavioral health
integration tools and drive collaborative care initiatives with its customers
as well as its vast network of credentialed providers and health professionals
across the country.

Expansion Plans

NeuroFlow will use the Series B proceeds to scale its
operations and support its growth in data analytics, artificial intelligence,
and direct health record integrations. NeuroFlow’s contracted user base has
grown 10x to over 330,000 in support of almost 200 commercial health systems,
payers, accountable care organizations, independent medical groups, and federal
agencies to provide technology-enabled care solutions.


How digital health startups are staying competitive in a fast-growing arena

In an increasingly crowded landscape, digital health startups must figure out what sets them apart. Three startup leaders shared what differentiates their companies from the competition at this year’s J.P. Morgan Healthcare Conference.

2021 – The healthcare changes here to stay

2020 was the year that changed everything, and as the new year begins many are wondering what awaits the world in 2021. Impetus Digital co-founder and CEO Natalie Yeadon reflects on the last 12 months and shares her views on the healthcare, research and digital changes that could be here to stay.

I think it is fair to say that 2020 will not be particularly missed by anyone. Many started the year with big plans, whether for overseas trips, weddings, or industry events, and then the unthinkable happened. While the world first heard of the novel coronavirus in late 2019, it was not until 11 March 2020 that it was declared a global pandemic and it finally sank in just how serious of a threat it was. But how will the world continue to change in 2021?

Major global events

COVID-19 has amplified many of the issues that society was already facing. Although the pandemic has largely taken the media’s focus away from the climate crisis, it has given us a preview of what is to come if we do not stop exploiting the planet and our wildlife. Indeed, 2020 brought new record forest fires and extreme weather events.

In addition, 2020 was the year where social justice (not least in the form of Black Lives Matter protests) was brought into focus. Racial discrimination and bias were also uncovered in healthcare, with stark differences in COVID-19 rates and mortality between different ethnicities in many countries.

COVID-19 has widened the already large class divides seen between white-collar and service workers, with the former typically having the option of working from home and taking the recommended social distancing precautions. Conversely, the latter group is largely being forced to carry on with their work with little protection and low compensation, if they even have a job to go to after many smaller businesses closed their doors.

Public health has been politicised

Somehow, in 2020, wearing a mask to prevent the spread of a highly contagious disease became a controversial and political issue. People were asked to stay home, watch Netflix, and bake sourdough bread to protect those who are vulnerable, yet photos of packed bars and sports stadiums soon emerged and anti-masking protests were held across the world.

Epidemiologists, researchers, and clinicians are now household names, with people like Dr Anthony Fauci and Sweden’s Anders Tegnell drawing their fair share of both praise and criticism domestically and internationally. Countries’ strategies to contain the spread of the virus have been debated and criticised, and it will likely be years before we will be able to say which approaches were “right” and “wrong”.

“On the upside, the pandemic has brought enhanced focus to mental health issues and innovative approaches on how to best address these. If we can keep the momentum going and retain this focus post-COVID, perhaps the stigma around mental health can be lifted and better treatment strategies can emerge”

Mental health focus

The secondary effects on mental health during the pandemic are vast. We are already seeing increased rates of depression and anxiety because of the pandemic, and there are no signs of this slowing down. Women are especially impacted, disproportionately having to take on childcare or home-schooling compared to their male counterparts.

On the upside, the pandemic has brought enhanced focus to these issues and innovative approaches on how to best address mental health. If we can keep the momentum going and retain this focus post-COVID, perhaps the stigma can be lifted and better treatment strategies can emerge.

United global research

Another positive note is that the pandemic has accelerated laboratory and clinical trial collaboration far beyond what has ever been seen before. From the onset of the pandemic, scientists have been openly sharing their data with investigators from other centres or countries. It has also shown that the time it takes to get a drug to market can be substantially reduced when there is enough funding and political will. How this will affect clinical trials and regulatory approvals in the future remains to be seen, but there is reason to be optimistic.

Healthcare goes virtual

Before 2020, telehealth appointments were few and far between, with many clinics not set up for these services. Since then, the growth of telemedicine has been exponential. Another aspect of healthcare that has had to adapt is the way we monitor chronic conditions. Older patients or those with co-morbidities are at higher risk of severe COVID-19, so frequent clinic visits for routine blood pressure measurements are not always feasible. As a result, we have seen a dramatic increase in the interest and uptake of remote monitoring devices such as wearables and mobile health apps. I predict that this is just the beginning of healthcare’s virtualisation and am excited to see what the new year has in store.

Remote work is the future

Another major change in 2020 was of course the sudden move to remote work. For many, it was a 180-degree shift from business as usual. Interestingly, in a Canadian survey, the majority of respondents (55%) expected at least some of the workforce to remain remote in a substantial way after the pandemic is over, while only 17% expected all staff to be onsite five days a week. Further, major companies like Twitter have announced that employees will be able to work from home permanently, signalling a clear change in the way that we do work. While not without challenges, I see remote work becoming a mainstay due to its greater flexibility and convenience for workers.

Virtual events are rapidly improving

Finally, the ways that pharmaceutical and scientific communities attend meetings and events completely changed in 2020. Virtual meetings such as advisory boards and steering committees were already popular before this year but were often accompanied by in-person meetings. We have now seen without a doubt that it is possible to meet the same objectives virtually, often more effectively and at a lower cost.

The biggest change, however, is the way we now attend larger events such as conferences, congresses, and medical education events. There is no shortage of online conference solutions available, but there is still much to improve on. For example, some aspects of in-person events are not always there or are poor substitutes for the real thing.

Ideally, virtual event platforms should be comprehensive so that everything you need is in the same place. The layout, branding, and inclusions should be completely customisable to your needs, and it should come with all aspects of in-person events such as networking, breakout workshops, exhibitor booths, and poster sessions. The good news is that these types of platforms are getting better by the day, and so are the virtual events that they host.

What have we learned from the last year?

The past 12 months have shown that firstly, we live in a highly polarised world where science and public health are up for debate. Secondly, crisis leads to innovation and finally digital health technologies are the future with remote work and virtual meetings here to stay.

Wishing you all a safe, happy, and healthy 2021.

About the author

Natalie YeadonNatalie Yeadon is the CEO and co-founder of Impetus Digital, where she helps life science clients virtualise their meetings and events and create authentic relationships with their customers.

The post 2021 – The healthcare changes here to stay appeared first on .

‘Peer Respites’ Provide an Alternative to Psychiatric Wards During Pandemic

Mia McDermott is no stranger to isolation. Abandoned as an infant in China, she lived in an orphanage until a family in California adopted her as a toddler. She spent her adolescence in boarding schools and early adult years in and out of psychiatric hospitals, where she underwent treatment for bipolar disorder, anxiety and anorexia.

The pandemic left McDermott feeling especially lonely. She restricted social interactions because her fatty liver disease put her at greater risk of complications should she contract covid-19. The 26-year-old Santa Cruz resident stopped regularly eating and taking her psychiatric medications, and contemplated suicide.

When McDermott’s thoughts grew increasingly dark in June, she checked into Second Story, a mental health program based in a home not far from her own, where she finds nonclinical support in a peaceful environment from people who have faced similar challenges.

Second Story is what is known as a “peer respite,” a welcoming place where people can stay when they’re experiencing or nearing a mental health crisis. Betting that a low-key wellness approach, coupled with empathy from people who have “been there,” can help people in distress recover, this unorthodox strategy has gained popularity in recent years as the nation grapples with a severe shortage of psychiatric beds that has been exacerbated by the pandemic.

Peer respites allow guests to avoid psychiatric hospitalization and emergency department visits. They now operate in at least 14 states. California has five, in the San Francisco Bay Area and Los Angeles County.

“When things are really tough and you need extra support but you don’t need hospitalization, where’s that middle ground?” asked Keris Myrick, founder of Hacienda of Hope, a peer respite in Long Beach, California.

People with serious mental illness are more likely to experience emotional distress in the pandemic than the general population, said Dr. Benjamin Druss, a psychiatrist and professor at Emory University’s public health school, elaborating that they tend to have smaller social networks and more medical problems.

That was the case with McDermott. “I don’t have a full-on relationship with my family. My friends are my family,” she said. She yearned to “give them a hug, see their smile or stand close and take a selfie.”

The next best thing was Second Story, located in a pewter-gray split-level, five-bedroom house in Aptos, a quaint beach community near McDermott’s Santa Cruz home.

Peer respites offer people in distress short-term (usually up to two weeks), round-the-clock emotional support from peers — people who have experienced mental health conditions and are trained and often certified by states to support others with similar issues — and activities like arts, meditation and support groups.

“You can’t tell who’s the guest and who’s the staff. We don’t wear uniforms or badges,” said Angelica Garcia-Guerrero, associate director of Hacienda of Hope’s parent organization.

Peer respites are free for guests but rarely covered by insurance. States and counties typically pick up the tab. Hacienda of Hope’s $900,000 annual operating costs are covered by Los Angeles County through the Mental Health Services Act, a policy that directs proceeds from a statewide tax on people who earn more than $1 million annually to behavioral health programs.

In September, California Gov. Gavin Newsom signed a bill that would establish a statewide certification process for mental health peer providers by July 2022.

For now, however, peer respite staff members in California are not licensed or certified. Peer respites typically don’t offer clinical care or dispense psychiatric drugs, though guests can bring theirs. Peers share personal stories with guests but avoid labeling them with diagnoses. Guests must come — and can leave — voluntarily. Some respites have few restrictions on who can stay; others don’t allow guests who express suicidal thoughts or are homeless.

Peer respite is one of several types of programs that divert people facing behavioral health crises from the hospital, but the only one without clinical involvement, said Travis Atkinson, a consultant at TBD Solutions, a behavioral health care company. The first peer respites arose around 2000, said Laysha Ostrow, CEO of Live & Learn, which conducts behavioral health research.

The approach seems to be expanding. Live & Learn counts 33 peer respites today in the U.S., up from 19 six years ago. All are overseen and staffed by people with histories of psychiatric disorders. About a dozen other programs employ a mix of peers and laypeople who don’t have psychiatric diagnoses, or aren’t peer-led, Atkinson said.

Though she had stayed at Second Story several times over the past five years, McDermott hesitated to return during the pandemic. However, she felt reassured after learning that guests were required to wear a mask in common areas and get a covid test before their stay. To ensure physical distancing, the respite reduced capacity from six to five guests at a time.

During her two-week stay, McDermott played with the respite’s two cats and piano — activities she found therapeutic. But most helpful was talking to peers in a way she couldn’t with her mental health providers, she said. In the past, McDermott said, she had been involuntarily admitted to a psychiatric hospital after she expressed suicidal thoughts. When she shared similar sentiments with Second Story peers, they offered to talk, or call the hospital if she wanted.

“They were willing to listen,” she said. “But they’re not forceful about helping.”

By the end of the visit, McDermott said that she felt understood and her loneliness and suicidal feelings had waned. She started eating and taking her medications more consistently, she said.

The small number of studies on respites have found that guests had fewer hospitalizations and accounted for lower Medicaid spending for nearly a year after a respite stay than people with similar conditions who did not stay in a respite. Respite visitors spent less time in the hospital and emergency room the longer they stayed in the respite.

Financial struggles and opposition from neighbors have hindered the growth of respites, however. Live & Learn said that although five peer respites have been created since 2018, at least two others closed because of budget cuts.

Neighbors have challenged nearby respite placements in a few instances. Santa Cruz-area media outlets reported in 2019 that Second Story neighbors had voiced safety concerns with the respite. Neighbor Tony Crane told California Healthline that guests have used drugs and consumed alcohol in the neighborhood, and he worried that peers are not licensed or certified to support people in crisis. He felt it was too risky to let his children ride their bikes near the respite when they were younger.

In a written response, Monica Martinez, whose organization runs Second Story, said neighbors often target community mental health programs because of concerns that “come from misconceptions and stigma surrounding those seeking mental health support.”

Many respites are struggling with increased demand and decreased availability during the pandemic. Sherry Jenkins Tucker, executive director of Georgia Mental Health Consumer Network, said its four respites have had to reduce capacity to enable physical distancing, despite increased demand for services. Other respites have temporarily suspended stays because of the pandemic.

McDermott said her mental health had improved since staying at Second Story in June, but she still struggles with isolation amid the pandemic. “Holidays are hard for me,” said McDermott, who returned to Second Story in November. “I really wanted to be able to have Thanksgiving with people.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

USE OUR CONTENT

This story can be republished for free (details).

Angelini and Arvelle create neurology player with $960m merger

There’s a new player in the neurology and mental health drugs market after Italy’s Angelini Pharma merged with Switzerland’s Arvelle Therapeutics in a deal worth up to $960 million based around the anti-seizure drug cenobamate.

Angelini is an international pharma company that is part of the privately-owned Italian Angelini Group, while Arvelle is focused on bringing innovative treatments to patients suffering from CNS disorders.

The deal gives Angelini an exclusive European license to market cenobamate, a drug being developed for drug-resistant focal-onset seizures in adults.

It is already in the late stages of development and expected to be approved in Europe later this year.

The license covers the European Union and other countries in the European Economic Area, such as Switzerland and the UK. As a result the all-cash deal will see Angelini pay $610 million following regulatory approval of cenobamate, followed by a further payment of $340 million.

Arvelle was founded in 2019 and has been focused on developing cenobamate, which has already been designated as a Promising Innovative Medicine by the UK regulator, the Medicines and Healthcare products Regulatory Agency (MHRA).

It is a small molecule with a dual action, which stimulates the γ-aminobutyric acid (GABAA) ion channel while also inhibiting voltage-gated sodium currents.

Study findings so far have shown cenobamate can produce a significantly greater reduction in median seizure frequency and more patients achieving a 50% or greater reduction in seizure frequency compared to the placebo group.

It is already approved by the FDA as an anti-seizure drug for partial-onset (focal onset) seizures in adults, where it is available under the brand name Xcopri and marketed by SK Biopharmaceuticals, which discovered and developed it.

SK Biopharmaceuticals, a pharmaceutical company listed on the Korea Stock Exchange, announced that it has agreed to sell its 12% stake in Arvelle Therapeutics to Angelini Pharma.

SK Biopharmaceuticals will remain eligible to receive all payments inherited by a license agreement signed between Arvelle Therapeutics and SK Biopharmaceuticals in February 2019.

Revenue share payments due to certain of the Arvelle shareholders will be assumed by Angelini Pharma.

The post Angelini and Arvelle create neurology player with $960m merger appeared first on .

12 Telehealth & Virtual Care Predictions and Trends for 2021 Roundup

Dr. Paul Hain, Chief Medical Officer of GoHealth

Telehealth is Here to Stay in 2021

Prior to the pandemic, telehealth was a limited ad-hoc service with geographic and provider restrictions. However, with both the pandemic restrictions on face to face interactions and a relaxation of governmental regulations, telehealth utilization has significantly increased from thousands of visits in a week to well over a million in the Medicare population. What we’ve learned is that telehealth allows patients, especially high-risk populations like seniors, to connect with their doctors in a safe and efficient way. Telehealth is valuable for many types of visits, mostly clearly ones that involve mental health or physical health issues that do not require a physical exam or procedure. It’s an efficient modality for both the member and provider.

With the growing popularity of telehealth services, we may see permanent changes in regulatory standards. Flexible regulatory standards, such as being able to use platforms like FaceTime or Skype, would lower the barrier to entry for providers to offer telehealth and also encourage adoption, especially among seniors. Second, it’s likely we’ll see an emergence of providers with aligned incentives around value, such as in many Medicare Advantage plans, trying very hard to encourage utilization with their members so that they get the right care at the right time. In theory, the shift towards value-based care will allow better care and lower costs than the traditional fee for service model. If we are able to evolve regulatory and payment environments, providers have an opportunity to grow these types of services into 2021 to improve patient wellness and health outcomes.


12 Telehealth & Virtual Care Predictions and Trends for 2021

Dr. Salvatore Viscomi, Chief Medical Officer, GoodCell

2021 will be the year of patient controlled-health

The COVID-19 pandemic brought the realities of a global-scale health event – and our general lack of preparedness to address it – to the forefront. People are now laser-focused on how they can protect themselves and their families against the next inevitable threat. On top of this, social distancing and isolation accelerated the development and use of digital health tools, from wellness trackers to telehealth and virtual care, most of which can be accessed from the comfort of our homes. The convergence of these two forces is poised to make 2021 the year for patient-controlled health, whereby health decisions are not dictated by – but rather made in consultation with – a healthcare provider, leveraging insights and data pulled from a variety of health technology tools at people’s fingertips.


Bullshit Metrics: Is Patient Engagement Real?

Anish Sebastian, CEO of Babyscripts

Beyond telemedicine

Telemedicine was the finger in the dyke at the beginning of pandemic panic, with healthcare providers grabbing whatever came to hand — encouraged by relaxed HIPAA regulations — to keep the dam from breaking. But as the dust settles, telemedicine is emerging as the commodity that it is, and value-add services are going to be the differentiating factors in an increasingly competitive marketplace. Offerings like remote patient monitoring and asynchronous communication, initially considered as “nice-to-haves,” are becoming standard offerings as healthcare providers see their value for continuous care beyond Covid.


Rise of the "Internet of Healthy Things"

Daniel Kivatinos, COO and Co-Founder of DrChrono

Telehealth visits are going to supersede in-person visits as time goes on.

Because of COVID-19, the world changed and Medicare and Medicaid, as well as other insurers, started paying out for telehealth visits. Telemedicine will continue to grow at a very quick rate, and verticals like mental health (psychology and psychiatry) and primary care fit perfectly into the telemedicine model, for tasks like administering prescription refills (ePrescribing) and ordering labs. Hyperlocal medical care will also move towards more of a telemedicine care team experience. Patients that are homebound families with young children or people that just recently had surgery can now get instant care when they need it. Location is less relevant because patients can see a provider from anywhere.


12 Telehealth & Virtual Care Predictions and Trends for 2021

Dennis McLaughlin VP of Omni Operations + Product at ibi

Virtual Healthcare is Here to Stay (House Calls are Back)

This new normal however is going to put significant pressure on the data support and servicing requirements to do it effectively. As more services are offered to patients outside of established clinical locations, it also means there will be more opportunity to collect data and a higher degree of dependence on interoperability. Providers are going to have to up their game from just providing and recording facts to passing on critical insight back into these interactions to maximize the benefits to the patient.


Sarahjane Sacchetti, CEO at Cleo

Virtual care (of all types) will become a lasting form of care: The vastly accelerated and broadened use of virtual care spurred by the pandemic will become permanent. Although it started with one-off check-ins or virtual mental health coaching, 2021 will see the continued rise in the use and efficacy of virtual care services once thought to be in-person only such as maternity, postpartum, pediatric, and even tutoring. Employers are taking notice of this shift with 32% indicating that expanded virtual health services are a top priority, and this number will quickly rise as employers look to offer flexible and convenient benefits in support of employees and to drive productivity.


12 Telehealth & Virtual Care Predictions and Trends for 2021

Omri Shor, CEO of Medisafe

Digital expansion: The pandemic has accelerated patient technology adoption, and innovation remains front-and-center for healthcare in 2021. Expect to see areas of telemedicine and digital health monitoring expand in new and novel ways, with increased uses in remote monitoring and behavioral health. CMS has approved telehealth for a number of new specialties and digital health tools continue to gain adoption among healthcare companies, drug makers, providers, and patients. 

Digital health companions will continue to become an important tool to monitor patients, provide support, and track behaviors – while remaining socially distant due to the pandemic.  Look for crossover between medical care, drug monitoring, and health and wellness – Apple 

Watch has already previewed this potential with heart rate and blood oxygen monitoring. Data output from devices will enable support to become more personalized and triggered by user behavior. 


Kelli Bravo, Vice President, Healthcare and Life Sciences, Pegasystems

The COVID-19 pandemic has not only changed and disrupted our lives, it has wreaked havoc on the entire healthcare industry at a scale we’ve never seen before. And it continues to alter almost every part of life across the globe. The way we access and receive healthcare has also changed as a result of social distancing requirements, patient concerns, provider availability, mobile capabilities, and newly implemented procedures at hospitals and healthcare facilities.

For example, hospitals and providers are postponing elective procedures again to help health systems prepare and reserve ICU beds amid the latest COVID-19 resurgence. While level of care is always important, in some areas, the inability to access a healthcare provider is equally concerning. And these challenges may become even more commonplace in the post-COVID-19 era. One significant transformation to help with the hurdle is telehealth, which went from a very small part of the care offering before the health crisis to one that is now a much more accepted way to access care.
As the rise in virtual health continues to serve consumers and provide a personalized and responsive care experience, healthcare consumers expect support services and care that are also fast and personalized – with digital apps, instant claims settlements, transparency, and advocacy. And to better help serve healthcare consumers, the industry has an opportunity to align with digital transformation that offers a personalized and responsive experience.


12 Telehealth & Virtual Care Predictions and Trends for 2021

Brooke LeVasseur, CEO of AristaMD

Issues pertaining to the COVID-19 pandemic will continue to be front-and-center in 2021. Every available digital tool in the box will have to be employed to ensure patients with non-COVID related issues are not forgotten as we try to free up in-person space and resources for those who cannot get care in any other setting. Virtual front doors, patient/physician video and eConsults, which connect providers to collaborate electronically, will be part of a broadening continuum of care – ultimately aimed at optimizing every valuable resource we have.


12 Telehealth & Virtual Care Predictions and Trends for 2021

Bret Larsen, CEO and Co-Founder, eVisit

By the end of 2021, virtual care paths will be fairly ubiquitous across the continuum of care, from urgent care and EDs to specialty care, all to serve patients where they are – at home and on mobile devices. This will be made possible through virtualized end-to-end processes that integrate every step in patient care from scheduling, waiting rooms, intake and patient queuing, to interpretation services, referral management, e-prescribe, billing and analytics, and more.


12 Telehealth & Virtual Care Predictions and Trends for 2021

Laura Kreofsky, Vice President for Advisory & Telehealth for Pivot Point Consulting

2020 has been the year of rapid telehealth adoption and advancement due to the COVID pandemic. According to CDC reports, telehealth utilization spiked as much as 154% in late March compared to the same period in 2019. While usage has moderated, it’s clear telehealth is now an instrumental part of healthcare delivery. As provider organizations plan for telehealth in 2021 and beyond, we are going to have to expect and deliver a secure, scalable infrastructure, a streamlined patient experience and an approach that maximizes provider efficiency, all while seeing much-needed vendor consolidation.


12 Telehealth & Virtual Care Predictions and Trends for 2021

Jeff Lew, SVP of Product Management, Nextech

Earlier this year, CMS enacted new rules to provide practices with the flexibility they need to use telehealth solutions in response to COVID-19, during which patients also needed an alternative to simply visiting the office. This was the impetus to the accelerated acceptance of telehealth as a means to both give and receive care. Specialty practices, in particular, are seeing successful and positive patient experiences due to telehealth visits. Dermatology practices specifically standout and I expect the strong adoption will continue to grow and certainly be the “new normal.” In addition, innovative practices that have embraced this omni-channel approach to delivering care are also establishing this as a “new normal” by selectively using telehealth visits for certain types of encounters, such as post-op visits or triaging patients. This gives patients a choice and the added convenience that comes with it and, in some cases, increases patient volume for the practice.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

As we close out the year, we asked several healthcare executives to share their predictions and trends for 2021.

30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Kimberly Powell, Vice President & General Manager, NVIDIA Healthcare

Federated Learning: The clinical community will increase their use of federated learning approaches to build robust AI models across various institutions, geographies, patient demographics, and medical scanners. The sensitivity and selectivity of these models are outperforming AI models built at a single institution, even when there is copious data to train with. As an added bonus, researchers can collaborate on AI model creation without sharing confidential patient information. Federated learning is also beneficial for building AI models for areas where data is scarce, such as for pediatrics and rare diseases.

AI-Driven Drug Discovery: The COVID-19 pandemic has put a spotlight on drug discovery, which encompasses microscopic viewing of molecules and proteins, sorting through millions of chemical structures, in-silico methods for screening, protein-ligand interactions, genomic analysis, and assimilating data from structured and unstructured sources. Drug development typically takes over 10 years, however, in the wake of COVID, pharmaceutical companies, biotechs, and researchers realize that acceleration of traditional methods is paramount. Newly created AI-powered discovery labs with GPU-accelerated instruments and AI models will expedite time to insight — creating a computing time machine.

Smart Hospitals: The need for smart hospitals has never been more urgent. Similar to the experience at home, smart speakers and smart cameras help automate and inform activities. The technology, when used in hospitals, will help scale the work of nurses on the front lines, increase operational efficiency, and provide virtual patient monitoring to predict and prevent adverse patient events. 


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Omri Shor, CEO of Medisafe

Healthcare policy: Expect to see more moves on prescription drug prices, either through a collaborative effort among pharma groups or through importation efforts. Pre-existing conditions will still be covered for the 135 million Americans with pre-existing conditions.

The Biden administration has made this a central element of this platform, so coverage will remain for those covered under ACA. Look for expansion or revisions of the current ACA to be proposed, but stalled in Congress, so existing law will remain largely unchanged. Early feedback indicates the Supreme Court is unlikely to strike down the law entirely, providing relief to many during a pandemic.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Brent D. Lang, Chairman & Chief Executive Officer, Vocera Communications

The safety and well-being of healthcare workers will be a top priority in 2021. While there are promising headlines about coronavirus vaccines, we can be sure that nurses, doctors, and other care team members will still be on the frontlines fighting COVID-19 for many more months. We must focus on protecting and connecting these essential workers now and beyond the pandemic.

Modernized PPE Standards
Clinicians should not risk contamination to communicate with colleagues. Yet, this simple act can be risky without the right tools. To minimize exposure to infectious diseases, more hospitals will rethink personal protective equipment (PPE) and modernize standards to include hands-free communication technology. In addition to protecting people, hands-free communication can save valuable time and resources. Every time a nurse must leave an isolation room to answer a call, ask a question, or get supplies, he or she must remove PPE and don a fresh set to re-enter. With voice-controlled devices worn under PPE, the nurse can communicate without disrupting care or leaving the patient’s bedside.

Improved Capacity

Voice-controlled solutions can also help new or reassigned care team members who are unfamiliar with personnel, processes, or the location of supplies. Instead of worrying about knowing names or numbers, they can use simple voice commands to connect to the right person, group, or information quickly and safely. In addition to simplifying clinical workflows, an intelligent communication system can streamline operational efficiencies, improve triage and throughput, and increase capacity, which is all essential to hospitals seeking ways to recover from 2020 losses and accelerate growth.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Michael Byczkowski, Global Vice President, Head of Healthcare Industry at SAP,

New, targeted healthcare networks will collaborate and innovate to improve patient outcomes.

We will see many more touchpoints between different entities ranging from healthcare providers and life sciences companies to technology providers and other suppliers, fostering a sense of community within the healthcare industry. More organizations will collaborate based on existing data assets, perform analysis jointly, and begin adding innovative, data-driven software enhancements. With these networks positively influencing the efficacy of treatments while automatically managing adherence to local laws and regulations regarding data use and privacy, they are paving the way for software-defined healthcare.

Smart hospitals will create actionable insights for the entire organization out of existing data and information.

Medical records as well as operational data within a hospital will continue to be digitized and will be combined with experience data, third-party information, and data from non-traditional sources such as wearables and other Internet of Things devices. Hospitals that have embraced digital are leveraging their data to automate tasks and processes as well as enable decision support for their medical and administrative staff. In the near future, hospitals could add intelligence into their enterprise environments so they can use data to improve internal operations and reduce overhead.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Curt Medeiros, President and Chief Operating Officer of Ontrak

As health care costs continue to rise dramatically given the pandemic and its projected aftermath, I see a growing and critical sophistication in healthcare analytics taking root more broadly than ever before. Effective value-based care and network management depend on the ability of health plans and providers to understand what works, why, and where best to allocate resources to improve outcomes and lower costs. Tied to the need for better analytics, I see a tipping point approaching for finally achieving better data security and interoperability. Without the ability to securely share data, our industry is trying to solve the world’s health challenges with one hand tied behind our backs.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

G. Cameron Deemer, President, DrFirst

Like many business issues, the question of whether to use single-vendor solutions or a best-of-breed approach swings back and forth in the healthcare space over time. Looking forward, the pace of technology change is likely to swing the pendulum to a new model: systems that are supplemental to the existing core platform. As healthcare IT matures, it’s often not a question of ‘can my vendor provide this?’ but ‘can my vendor provide this in the way I need it to maximize my business processes and revenues?

This will be more clear with an example: An EHR may provide a medication history function, for instance, but does it include every source of medication history available? Does it provide a medication history that is easily understood and acted upon by the provider? Does it provide a medication history that works properly with all downstream functions in the EHR? When a provider first experiences medication history during a patient encounter, it seems like magic.

After a short time, the magic fades to irritation as the incompleteness of the solution becomes more obvious. Much of the newer healthcare technologies suffer this same incompleteness. Supplementing the underlying system’s capabilities with a strongly integrated third-party system is increasingly going to be the strategy of choice for providers.


Angie Franks, CEO of Central Logic

In 2021, we will see more health systems moving towards the goal of truly operating as one system of care. The pandemic has demonstrated in the starkest terms how crucial it is for health systems to have real-time visibility into available beds, providers, transport, and scarce resources such as ventilators and drugs, so patients with COVID-19 can receive the critical care they need without delay. The importance of fully aligning as a single integrated system that seamlessly shares data and resources with a centralized, real-time view of operations is a lesson that will resonate with many health systems.

Expect in 2021 for health systems to enhance their ability to orchestrate and navigate patient transitions across their facilities and through the continuum of care, including post-acute care. Ultimately, this efficient care access across all phases of care will help healthcare organizations regain revenue lost during the historic drop in elective care in 2020 due to COVID-19.

In addition to elevating revenue capture, improving system-wide orchestration and navigation will increase health systems’ bed availability and access for incoming patients, create more time for clinicians to operate at the top of their license, and reduce system leakage. This focus on creating an ‘operating as one’ mindset will not only help health systems recover from 2020 losses, it will foster sustainable and long-term growth in 2021 and well into the future.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

John Danaher, MD, President, Global Clinical Solutions, Elsevier

COVID-19 has brought renewed attention to healthcare inequities in the U.S., with the disproportionate impact on people of color and minority populations. It’s no secret that there are indicative factors, such as socioeconomic level, education and literacy levels, and physical environments, that influence a patient’s health status. Understanding these social determinants of health (SDOH) better and unlocking this data on a wider scale is critical to the future of medicine as it allows us to connect vulnerable populations with interventions and services that can help improve treatment decisions and health outcomes. In 2021, I expect the health informatics industry to take a larger interest in developing technologies that provide these kinds of in-depth population health insights.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Jay Desai, CEO and co-founder of PatientPing

2021 will see an acceleration of care coordination across the continuum fueled by the Centers for Medicare and Medicaid Services (CMS) Interoperability and Patient Access rule’s e-notifications Condition of Participation (CoP), which goes into effect on May 1, 2021. The CoP requires all hospitals, psych hospitals, and critical access hospitals that have a certified electronic medical record system to provide notification of admit, discharge, and transfer, at both the emergency room and the inpatient setting, to the patient’s care team. Due to silos, both inside and outside of a provider’s organization, providers miss opportunities to best treat their patients simply due to lack of information on patients and their care events.

This especially impacts the most vulnerable patients, those that suffer from chronic conditions, comorbidities or mental illness, or patients with health disparities due to economic disadvantage or racial inequity. COVID-19 exacerbated the impact on these vulnerable populations. To solve for this, healthcare providers and organizations will continue to assess their care coordination strategies and expand their patient data interoperability initiatives in 2021, including becoming compliant with the e-notifications Condition of Participation.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Kuldeep Singh Rajput, CEO and founder of Biofourmis

Driven by CMS’ Acute Hospital at Home program announced in November 2020, we will begin to see more health systems delivering hospital-level care in the comfort of the patient’s home–supported by technologies such as clinical-grade wearables, remote patient monitoring, and artificial intelligence-based predictive analytics and machine learning.

A randomized controlled trial by Brigham Health published in Annals of Internal Medicine earlier this year demonstrated that when compared with usual hospital care, Home Hospital programs can reduce rehospitalizations by 70% while decreasing costs by nearly 40%. Other advantages of home hospital programs include a reduction in hospital-based staffing needs, increased capacity for those patients who do need inpatient care, decreased exposure to COVID-19 and other viruses such as influenza for patients and healthcare professionals, and improved patient and family member experience.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Jake Pyles, CEO, CipherHealth

The disappearance of the hospital monopoly will give rise to a new loyalty push

Healthcare consumerism was on the rise ahead of the pandemic, but the explosion of telehealth in 2020 has effectively eliminated the geographical constraints that moored patient populations to their local hospitals and providers. The fallout has come in the form of widespread network leakage and lost revenue. By October, in fact, revenue for hospitals in the U.S. was down 9.2% year-over-year. Able to select providers from the comfort of home and with an ever-increasing amount of personal health data at their convenience through the growing use of consumer-grade wearable devices, patients are more incentivized in 2021 to choose the provider that works for them.

After the pandemic fades, we’ll see some retrenchment from telehealth, but it will remain a mainstream care delivery model for large swaths of the population. In fact, post-pandemic, we believe telehealth will standardize and constitute a full 30% to 40% of interactions.

That means that to compete, as well as to begin to recover lost revenue, hospitals need to go beyond offering the same virtual health convenience as their competitors – Livango and Teladoc should have been a shot across the bow for every health system in 2020. Moreover, hospitals need to become marketing organizations. Like any for-profit brand, hospitals need to devote significant resources to building loyalty but have traditionally eschewed many of the cutting-edge marketing techniques used in other industries. Engagement and personalization at every step of the patient journey will be core to those efforts.


Marc Probst, former Intermountain Health System CIO, Advisor for SR Health by Solutionreach

Healthcare will fix what it’s lacking most–communication.

Because every patient and their health is unique, when it comes to patient care, decisions need to be customized to their specific situation and environment, yet done in a timely fashion. In my two decades at one of the most innovative health systems in the U.S., communication, both across teams and with patients continuously has been less than optimal. I believe we will finally address both the interpersonal and interface communication issues that organizations have faced since the digitization of healthcare.”


Rich Miller, Chief Strategy Officer, Qgenda

2021 – The year of reforming healthcare: We’ve been looking at ways to ease healthcare burdens for patients for so long that we haven’t realized the onus we’ve put on providers in doing so. Adding to that burden, in 2020 we had to throw out all of our playbooks and become masters of being reactive. Now, it’s time to think through the lessons learned and think through how to be proactive. I believe provider-based data will allow us to reformulate our priorities and processes. By analyzing providers’ biggest pain points in real-time, we can evaporate the workflow and financial troubles that have been bothering organizations while also relieving providers of their biggest problems.”


Robert Hanscom, JD, Vice President of Risk Management and Analytics at Coverys

Data Becomes the Fix, Not the Headache for Healthcare

The past 10 years have been challenging for an already overextended healthcare workforce. Rising litigation costs, higher severity claims, and more stringent reimbursement mandates put pressure on the bottom line. Continued crises in combination with less-than-optimal interoperability and design of health information systems, physician burnout, and loss of patient trust, have put front-line clinicians and staff under tremendous pressure.

Looking to the future, it is critical to engage beyond the day to day to rise above the persistent risks that challenge safe, high-quality care on the frontline. The good news is healthcare leaders can take advantage of tools that are available to generate, package, and learn from data – and use them to motivate action.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Steve Betts, Chief of Operations and Products at Gray Matter Analytics

Analytics Divide Intensifies: Just like the digital divide is widening in society, the analytics divide will continue to intensify in healthcare. The role of data in healthcare has shifted rapidly, as the industry has wrestled with an unsustainable rate of increasing healthcare costs. The transition to value-based care means that it is now table stakes to effectively manage clinical quality measures, patient/member experience measures, provider performance measures, and much more. In 2021, as the volume of data increases and the intelligence of the models improves, the gap between the haves and have nots will significantly widen at an ever-increasing rate.

Substantial Investment in Predictive Solutions: The large health systems and payors will continue to invest tens of millions of dollars in 2021. This will go toward building predictive models to infuse intelligent “next best actions” into their workflows that will help them grow and manage the health of their patient/member populations more effectively than the small and mid-market players.


Jennifer Price, Executive Director of Data & Analytics at THREAD

The Rise of Home-based and Decentralized Clinical Trial Participation

In 2020, we saw a significant rise in home-based activities such as online shopping, virtual school classes and working from home. Out of necessity to continue important clinical research, home health services and decentralized technologies also moved into the home. In 2021, we expect to see this trend continue to accelerate, with participants receiving clinical trial treatments at home, home health care providers administering procedures and tests from the participant’s home, and telehealth virtual visits as a key approach for sites and participants to communicate. Hybrid decentralized studies that include a mix of on-site visits, home health appointments and telehealth virtual visits will become a standard option for a range of clinical trials across therapeutic areas. Technological advances and increased regulatory support will continue to enable the industry to move out of the clinic and into the home.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Doug Duskin, President of the Technology Division at Equality Health

Value-based care has been a watchword of the healthcare industry for many years now, but advancement into more sophisticated VBC models has been slower than anticipated. As we enter 2021, providers – particularly those in fee-for-service models who have struggled financially due to COVID-19 – and payers will accelerate this shift away from fee-for-service medicine and turn to technology that can facilitate and ease the transition to more risk-bearing contracts. Value-based care, which has proven to be a more stable and sustainable model throughout the pandemic, will seem much more appealing to providers that were once reluctant to enter into risk-bearing contracts. They will no longer be wondering if they should consider value-based contracting, but how best to engage.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Brian Robertson, CEO of VisiQuate

Continued digitization and integration of information assets: In 2021, this will lead to better performance outcomes and clearer, more measurable examples of “return on data, analytics, and automation.

Digitizing healthcare’s complex clinical, financial, and operational information assets: I believe that providers who are further in the digital transformation journey will make better use of their interconnected assets, and put the healthcare consumer in the center of that highly integrated universe. Healthcare consumer data will be studied, better analyzed, and better predicted to drive improved performance outcomes that benefit the patient both clinically and financially.

Some providers will have leapfrog moments: These transformations will be so significant that consumers will easily recognize that they are receiving higher value. Lower acuity telemedicine and other virtual care settings are great examples that lead to improved patient engagement, experience and satisfaction. Device connectedness and IoT will continue to mature, and better enable chronic disease management, wellness, and other healthy lifestyle habits for consumers.


Kermit S. Randa, CEO of Syntellis Performance Solutions

Healthcare CEOs and CFOs will partner closely with their CIOs on data governance and data distribution planning. With the massive impact of COVID-19 still very much in play in 2021, healthcare executives will need to make frequent data-driven – and often ad-hoc — decisions from more enterprise data streams than ever before. Syntellis research shows that healthcare executives are already laser-focused on cost reduction and optimization, with decreased attention to capital planning and strategic growth. In 2021, there will be a strong trend in healthcare organizations toward new initiatives, including clinical and quality analytics, operational budgeting, and reporting and analysis for decision support.


Dr. Calum Yacoubian, Associate Director of Healthcare Product & Strategy at Linguamatics

As payers and providers look to recover from the damage done by the pandemic, the ability to deliver value from data assets they already own will be key. The pandemic has displayed the siloed nature of healthcare data, and the difficulty in extracting vital information, particularly from unstructured data, that exists. Therefore, technologies and solutions that can normalize these data to deliver deeper and faster insights will be key to driving economic recovery. Adopting technologies such as natural language processing (NLP) will not only offer better population health management, ensuring the patients most in need are identified and triaged but will open new avenues to advance innovations in treatments and improve operational efficiencies.

Prior to the pandemic, there was already an increasing level of focus on the use of real-world data (RWD) to advance the discovery and development of new therapies and understand the efficacy of existing therapies. The disruption caused by COVID-19 has sharpened the focus on RWD as pharma looks to mitigate the effect of the virus on conventional trial recruitment and data collection. One such example of this is the use of secondary data collection from providers to build real-world cohorts which can serve as external comparator arms.

This convergence on seeking value from existing RWD potentially affords healthcare providers a powerful opportunity to engage in more clinical research and accelerate the work to develop life-saving therapies. By mobilizing the vast amount of data, they will offer pharmaceutical companies a mechanism to positively address some of the disruption caused by COVID-19. This movement is one strategy that is key to driving provider recovery in 2021.


Rose Higgins, Chief Executive Officer of HealthMyne

Precision imaging analytics technology, called radiomics, will increasingly be adopted and incorporated into drug development strategies and clinical trials management. These AI-powered analytics will enable drug developers to gain deeper insights from medical images than previously capable, driving accelerated therapy development, greater personalization of treatment, and the discovery of new biomarkers that will enhance clinical decision-making and treatment.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Dharmesh Godha, President and CTO of Advaiya

Greater adoption and creative implementation of remote healthcare will be the biggest trend for the year 2021, along with the continuous adoption of cloud-enabled digital technologies for increased workloads. Remote healthcare is a very open field. The possibilities to innovate in this area are huge. This is the time where we can see the beginning of the convergence of personal health aware IoT devices (smartwatches/ temp sensors/ BP monitors/etc.) with the advanced capabilities of the healthcare technologies available with the monitoring and intervention capabilities for the providers.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Simon Wu, Investment Director, Cathay Innovation

Healthcare Data Proves its Weight in Gold in 2021

Real-world evidence or routinely stored data from hospitals and claims, being leveraged by healthcare providers and biopharma companies along with those that can improve access to data will grow exponentially in the coming year. There are many trying to build in-house, but similar to autonomous technology, there will be a separate set of companies emerge in 2021 to provide regulated infrastructure and have their “AWS” moment.


Kyle Raffaniello, CEO of Sapphire Digital

2021 is a clear year for healthcare price transparency

Over the past year, healthcare price transparency has been a key topic for the Trump administration in an effort to lower healthcare costs for Americans. In recent months, COVID-19 has made the topic more important to patients than ever before. Starting in January, we can expect the incoming Biden administration to not only support the existing federal transparency regulations but also continue to push for more transparency and innovation within Medicare. I anticipate that healthcare price transparency will continue its momentum in 2021 as one of two Price Transparency rules takes effect and the Biden administration supports this movement.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Dennis McLaughlin VP of Omni Operations + Product at ibi

Social Determinants of Health Goes Mainstream: Understanding more about the patient and their personal environment has a hot topic the past two years. Providers and payers’ ability to inject this knowledge and insight into the clinical process has been limited. 2021 is the year it gets real. It’s not just about calling an uber anymore. The organizations that broadly factor SDOH into the servicing model especially with virtualized medicine expanding broadly will be able to more effectively reach vulnerable patients and maximize the effectiveness of care.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Joe Partlow, CTO at ReliaQuest

The biggest threat to personal privacy will be healthcare information: Researchers are rushing to pool resources and data sets to tackle the pandemic, but this new era of openness comes with concerns around privacy, ownership, and ethics. Now, you will be asked to share your medical status and contact information, not just with your doctors, but everywhere you go, from workplaces to gyms to restaurants. Your personal health information is being put in the hands of businesses that may not know how to safeguard it. In 2021, cybercriminals will capitalize on rapid U.S. telehealth adoption. Sharing this information will have major privacy implications that span beyond keeping medical data safe from cybercriminals to wider ethics issues and insurance implications.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Jimmy Nguyen, Founding President at Bitcoin Association

Blockchain solutions in the healthcare space will bring about massive improvements in two primary ways in 2021.

Firstly, blockchain applications will for the first time facilitate patients owning, managing, and even monetizing their personal health data. Today’s healthcare information systems are incredibly fragmented, with patient data from different sources – be they physicians, pharmacies, labs, or otherwise – kept in different silos, eliminating the ability to generate a holistic view of patient information and restricting healthcare providers from producing the best health outcomes.

Healthcare organizations are growing increasingly aware of the ways in which blockchain technology can be used to eliminate data silos, enable real-time access to patient information, and return control to patients for the use of their personal data – all in a highly-secure digital environment. 2021 will be the year that patient data goes blockchain.

Secondly, blockchain solutions can ensure more honesty and transparency in the development of pharmaceutical products. Clinical research data is often subject to questions of integrity or ‘hygiene’ if data is not properly recorded, or worse, is deliberately fabricated. Blockchain technology enables easy, auditable tracking of datasets generated by clinical researchers, benefitting government agencies tasked with approving drugs while producing better health outcomes for healthcare providers and patients. In 2021, I expect to see a rise in the use and uptake of applications that use public blockchain systems to incentivize greater honesty in clinical research.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Alex Lazarow, Investment Director, Cathay Innovation

The Future of US Healthcare is Transparent, Fair, Open and Consumer-Driven

In the last year, the pandemic put a spotlight on the major gaps in healthcare in the US, highlighting a broken system that is one of the most expensive and least distributed in the world. While we’ve already seen many boutique healthcare companies emerge to address issues around personalization, quality and convenience, the next few years will be focused on giving the power back to consumers, specifically with the rise of insurtechs, in fixing the transparency, affordability, and incentive issues that have plagued the private-based US healthcare system until now.


Lisa Romano, RN, Chief Nursing Officer, CipherHealth

Hospitals will need to counter the staff wellness fallout

The pandemic has placed unthinkable stress on frontline healthcare workers. Since it began, they’ve been working under conditions that are fundamentally more dangerous, with fewer resources, and in many cases under the heavy emotional burden of seeing several patients lose their battle with COVID-19. The fallout from that is already beginning – doctors and nurses are leaving the profession, or getting sick, or battling mental health struggles. Nursing programs are struggling to fill classes. As a new wave of the pandemic rolls across the country, that fallout will only increase. If they haven’t already, hospitals in 2021 will place new premiums upon staff wellness and staff health, tapping into the same type of outreach and purposeful rounding solutions they use to round on patients.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Kris Fitzgerald, CTO, NTT DATA Services

Quality metrics for health plans – like data that measures performance – was turned on its head in 2020 due to delayed procedures. In the coming year, we will see a lot of plans interpret these delayed procedures flexibly so they honor their plans without impacting providers. However, for so long, the payer’s use of data and the provider’s use of data has been disconnected. Moving forward the need for providers to have a more specific understanding of what drives the value and if the cost is reasonable for care from the payer perspective is paramount. Data will ensure that this collaboration will be enhanced and the concept of bundle payments and aligning incentives will be improved. As the data captured becomes even richer, it will help people plan and manage their care better. The addition of artificial intelligence (AI) to this data will also play a huge role in both dialog and negotiation when it comes to cost structure. This movement will lead to a spike in value-based care adoption


6 Mental Health & Teletherapy Predictions & Trends to Watch in 2021

The executive team at AbleTo, a technology-enabled provider of behavioral healthcare shares six mental health and teletherapy predictions and trends to watch in 2021.

Trip Hofer, CEO at AbleTo

6 Mental Health & Teletherapy Predictions & Trends to Watch in 2021

1. Measurement and Outcomes

“The healthcare industry has made progress toward increasing access to mental health care and defining what quality care looks like. Now in 2021, the industry needs to focus on how we measure that quality. With mental health becoming an incredibly hot market and so much funding pouring in for new entrants, many leaders are concerned with the lack of rigorous, evidence-based standards for measuring patient outcomes. I share that concern, and want to stress the importance of sound methodologies for demonstrating outcomes.”

2. Market Trends

“The consolidation we saw in mental health during 2020 will continue into next year but I think we’ll see new trends appear too. There’s such a proliferation of investment dollars in the market that we can expect to see some organizations come and go if they don’t produce the expected returns. With so much money flowing into the mental health space, organizations that don’t show evidence-based rigor and good quality clinical care will fade, while those providing sound mental health care will succeed.”

“Provider networks will increase in importance given the shortage of trained behavioral health clinicians. Demand is increasing among patients who need more than an app to address their needs—they need the human connection. With a limited pool of providers, companies will have to compete to attract providers to their network. At AbleTo, we do this by setting ourselves apart on the basis of quality standards of care. That’s very appealing to highly skilled therapists seeking to join a network.”

“In 2021, the industry will need to address the regulatory environment around licensing behavioral health practitioners, as well as the use of remote care. When CMS relaxed cross-state regulations during the pandemic, this made navigating the regulatory framework even more complicated, since the varying licensing rules remain at the state level. We need permanent improvements to regulations so licensed therapists can more easily practice across state lines and meet the growing needs of remote patient populations.”

6 Mental Health & Teletherapy Predictions & Trends to Watch in 2021

Reena Pande, Chief Medical Officer at AbleTo

3. Solution Complexity

“We’ve seen such a promising shift towards focusing on behavioral healthcare. But the wealth of point solutions now available to address behavioral health needs has created an exceptionally confusing environment for payers and employers with some even telling us they have “point solution fatigue.” The fact is that there is no one right point solution. Mental health is not one condition requiring one solution; it encompasses a heterogeneous group of complex conditions that require different interventions. What the industry needs to focus on in 2021 is putting together a solution set that can address the complexity and nuances of mental health. The market needs to be more mindful of this over the course of the next year and avoid trying to oversimplify mental health.”

4. Access and Utilization

“Our payer partners saw a surge in utilization of telehealth broadly at the outset of the pandemic; but while utilization for physical health has lessened, telehealth use for mental health has continued. Given the acceptance of technology as an effective way to deliver mental health care, we expect it to continue into 2021.

This predicted increase in utilization will of course differ by socioeconomic status. Telehealth, like COVID, has laid bare underlying inequities that have long existed in the healthcare system. In 2021, we will see a larger focus on ensuring quality mental health care reaches all populations in need, with greater emphasis on access and cost-effectiveness.”

Naomi Pollock, Senior Director, Clinical
Program Development at AbleTo

5. Relationships

“While technology is driving so much positive change in healthcare and in mental health, we need to remember the value of the human connection. Clinical interventions depend on real people delivering care, and the voices of both patients and providers need to guide our approach to care delivery, including through technology like telehealth or virtual therapy. The relationships that providers and patients create with one another are the key driver of care, and technology should complement that human connection, not replace it.”

6. Clinician Challenges

“We [The industry] need to help our therapists measure the impact of the care they deliver to ensure they’re offering the right interventions to the right participants. This means educating providers around how to measure care outcomes, how to define measurement-based care, and what it looks like both on an individual level and a population level. At AbleTo, we’ve solved that missing piece to support the providers in our network. We need to focus on making this standard across the industry.”

“Our clinicians are facing unprecedented challenges during this pandemic. For months, they’ve been supporting patients struggling with the impacts of COVID while they are living through it themselves—working from home, seeing patients virtually, juggling their own personal and family lives. We need to support our care deliverers amidst this wave of mental health challenges they’re facing, similar to how we support frontline workers and medical practitioners.”

Watch Out For Top Pipeline Therapies Making An Impact In The Bipolar Depression Market

Characterized by debilitating episodes of depression and mood elevation (mania or hypomania), Bipolar depression is an under-recognized and unappreciated phase of bipolar disorder. Since most patients exhibit depression, Bipolar depression gets misdiagnosed with other mental disorders easily. Thus, it is associated with a heavier burden of illness, morbidity, and cost. Even then, there is no cure for it. The present treatment consists of two phases: the acute phase and the maintenance phase. Acute-phase treatment focuses on the management of acute mood episodes (manic, hypomanic, or depressive) while Maintenance-phase treatment prevents recurrences of acute episodes. 

The ultimate goal of treatment is to achieve as high as possible a level of psychosocial function and health-related quality of life. However, a lot of R&D is taking place in advancing the ways mental disorders are dealt with and treated. Key pharmaceutical companies such as Celon Pharma, Otsuka Pharmaceutical, NeuroRx, among others worldwide are profoundly working in fuelling the Bipolar depression market size growth. The Bipolar depression pipeline including Abilify, NRX-100/NRX101, Lumateperone, and Zuranolone are expected to grace the market by 2024, thereby, presenting a promising contribution to the Bipolar depression therapeutics market revenue. DelveInsight estimates that the Bipolar depression market is expected to soar with a CAGR of 16.69% during the study period [2017-30] in 7MM (the US, EU5 (the UK, Germany, France, Italy, and Spain) and Japan). 

Some of the pipeline therapies that are expected to make a positive impact on the Bipolar depression market are:

  1. Lumateperone

Company: IntraCellular Therapies

Lumateperone is an investigational orally available, first-in-class small molecule that provides selective and simultaneous modulation of serotonin, dopamine, and glutamate—three neurotransmitter pathways implicated in severe mental illness. Already marketed under the trade name Caplyta for Schizophrenia in adults, it is in Phase III clinical stage of trials for Bipolar depression. 

  1. NRX-100

Company: NeuroRx

NRX-101 is a proprietary, oral fixed-dose combination of two FDA-approved drugs: D-cycloserine, an NMDA receptor modulator; and Lurasidone (Latuda), a 5-HT2a receptor antagonist. The idea here is the development of a sequential therapy that is a combination of intravenous NRX-100 (ketamine HCL) followed by oral NRX-101. The combination is under Phase III clinical trial for rapid stabilization of acute suicidal ideation and behavior in patients with bipolar depression and phase IIb/III trials for Bipolar Depression in patients with Acute Suicidal Ideation and Behavior (ASIB) and 

  1. Falkieri

Company: Celon Pharma

Falkieri is an esketamine formulation that acts as an NMDA antagonist. Esketamine has received approval from the US FDA in March 2019, under the brand name Spravato, in conjunction with an oral antidepressant, for depression in adults who are not benefited from any other antidepressant. Falkieri is the first such formulation, which targets both unipolar and bipolar treatment-resistant depression. Presently, Celon Pharma is conducting phase II trials in subjects with treatment-resistant Bipolar Depression (TRBD). 

  1. Zuranolone

Company: Sage Therapeutics

Zuranolone is an investigational oral neuroactive steroid (NAS) GABAA receptor positive allosteric modulator (PAM). Administered once-daily, two-week therapy, it is in development for the treatment of the major depressive disorder (MDD) and postpartum depression (PPD). In March 2020, after a Breakthrough Therapy guidance meeting with the US FDA, Sage Therapeutics announced plans to launch three additional studies of its investigational drug zuranolone. Results are expected in 2021.

  1. SEP-4199

Company: Sunovion

SEP-4199 is a non-racemic ratio of amisulpride enantiomers with the potential to be the first benzamide treatment available in the US for mood disorders. It is under phase II clinical trial for Bipolar I depression in the US and Japan, which is being conducted by Sumitomo Dainippon Pharma and Sunovion. Sunovion is working on plans to start phase III studies of the drug.

  1. Abilify

Company: Otsuka Pharmaceutical

Otsuka Holding is currently evaluating Abilify (tablet) in phase III clinical trial as an adjunctive treatment in the treatment of major depressive episodes associated with bipolar I or II disorder. However, the drug is available as a tablet and suspension for injection as a symptomatic treatment for schizophrenia, bipolar I disorder (manic depression), and major depressive disorder. Oral solution and intramuscular injection of Abilify is discontinued in the US.

Besides the emerging therapies mentioned above, candidates such as Latuda (lurasidone), and Vraylar (cariprazine) that are already commercialized in the US, are expected to expand their toefall in other major markets i.e., EU5 and Japan. This shall significantly boost the market size growth for individual geography in the forecasted period (2020–2030). Overall rising prevalence of Bipolar depression also due to a better understanding of the mental disorders are another contributing factor to the promising Bipolar depression market landscape. However, amidst the blinding light, it is to not lose sight of hurdles and snags that lie in the way. Treatment adherence is one of the major issues that physicians and patients struggle with along with the side effects of the ones that might be somewhat beneficial. There exists a high frequency of misdiagnosis when it comes to mental disorders owing to similar symptoms. Further, the inevitable launch of generics of marketed drugs Availability of generics of branded drugs such as Seroquel, Zyprexa. and Latuda is another downside. Without the grain of doubt, medical advancements have helped the world to understand mental disorders clearly, ongoing R&D exploring the use of selective biomarkers, and inclination to find a curative approach to deal with Bipolar depression is expected to uplift the market outlook for a better future. Thus, it is safe to say that the Bipolar depression market is off for a better and promising journey in the coming decade. 

The post Watch Out For Top Pipeline Therapies Making An Impact In The Bipolar Depression Market appeared first on DelveInsight Business Research.

AI-designed serotonin tracker could help develop neurology drugs

A serotonin sensor designed using Artificial Intelligence (AI) could help scientists study sleep and mental health and potentially find new neurology drugs.

The US National Institutes of Health said that the research it had co-funded used AI to transform a bacterial protein into a new research tool.

It is hoped that the protein, which “catches” serotonin molecules and allows them to be tracked, could detect subtle, real-time changes in serotonin levels during sleep, fear and social interactions.

The technique could also be used to test the effectiveness of new psychoactive drugs, according to the US-government funded NIH.

This study in mice was funded by the NIH’s Brain Research Through Advancing Innovative Neurotechnologies (BRAIN) initiative, which aims to revolutionise understanding of the brain under healthy and disease conditions.

It was led by researchers in the lab of Dr Lin Tian, principal investigator at the University of California Davis School of Medicine.

In the study, researchers transformed a nutrient-grabbing Venus-flytrap shaped bacterial protein into a highly sensitive fluorescent sensor that lights up when it captures serotonin.

Tian’s lab builds on the work of scientists in the lab of Dr Loren Looger, Howard Hughes Medical Institute Janelia Research Campus, Ashburn, Virginia, who used traditional genetic engineering techniques to convert the bacterial protein into a sensor of the neurotransmitter acetylcholine.

Tian worked with Looger’s team and used artificial intelligence to completely redesign the protein known as OpuBC to catch serotonin instead.

The researchers used machine learning algorithms to help a computer ‘think up’ 250,000 new designs. After three rounds of testing, the scientists settled on one.

Experiments in mouse brain slices showed the sensor responded to serotonin signals sent between neurons at synaptic communications points.

Further experiments on cells in petri dishes suggested that the sensor could effectively monitor changes in these signals caused by drugs, including cocaine, MDMA and several commonly used antidepressants.

Mouse studies showed the sensor monitored an expected rise in serotonin levels when mice were awake and a fall as mice fell asleep.

They also spotted a greater drop when the mice eventually entered the deeper, REM sleep states.

The post AI-designed serotonin tracker could help develop neurology drugs appeared first on .

Human API CEO Talks Data Privacy Concerns in Employee Wellness Programs

Human API CEO Talks Data Privacy Concerns in Employee Wellness Programs
Andrei Pop, Founder, and CEO of Human API,

A recent BBC article discusses the rise in employee health
tracking via wearable devices and highlights a number of concerns around data
privacy. To try and prevent health tracking schemes from crossing ethical
lines, and eroding trust between employee and employer, some industry figures
believe that organizations need to work with third-party vendors who specialize
in managing wellbeing data. These vendors would hold the data independently
under strict privacy rules, and work with employees directly to change their
lifestyles.

We recently spoke with Pop, Founder, and CEO of Human API to understand how a user-controlled data platform can address privacy concerns surrounding employee wellness programs. Human API delivers a user-controlled health data ecosystem that gives users full control of which enterprises, insurers, and researchers they want to share their data with to learn more about. The company works alongside a number of organizations such as Omada Health and Thrive Global helping them create wellness programs for their employees while keeping their personal data secure.

HITC: In response to the COVID-19 pandemic, how are
employers investing in employee wellness?

Pop: We have seen a number of different initiatives
across the board. Some of the more obvious include offering access to
mindfulness tools, online workouts, fitness apps, or online counseling services
for key issues such as mental health, financial distress, or relationship
difficulties. Others are more inventive, such as tools that encourage employees
to take breaks or ensure they are working in a safe environment at home.

We believe that one of the most important lessons and
reminders for employers during COVID-19 is that employees are the most valuable
assets for any business. Companies that treat their employees as such and
invest in making their teams feel supported throughout the crisis will thrive
in the long run. 

After all, recent studies show that 80% of employees at companies with
developed health and wellness programs feel engaged in their workplace and cared
for by their employers. Modern employees — especially Millennials — are
motivated to join businesses that are committed to their improvement and
progression. While one year ago, this may have meant salary increases and
promotions, through the lens of COVID-19 this also means improving employees’
health and well-being.

Our customers like Thrive Global are actively working with
their employer customers to build additional well-being programs and products
on top of their software platform, to support employee resilience, well-being,
and productivity.

This recognition that healthier, happier employees are proven to be more
creative, productive, and less transient, is driving this increased interest in
wellness initiatives. We believe it will continue to do so well after a vaccine
has solved the immediate threat from COVID-19. Employee well-being is going to
be table stakes in the future for employers who want to attract and retain the
best talent. 

HITC: Has the remote workforce revolution increased
interest in these programs from employers?

Pop: We think about this question a lot since we’re a
virtual-first company by design. Remote working is a trend that has been
accelerated by years due to the pandemic, and our customers are actively
building new wellness solutions to empower employers to take better care of
their people. Wearable devices are now front and center as a way to support
employee wellness, and programs are rapidly emerging to help people stay active
and healthy during these trying times.

Increased interest in wellness solutions to problems
associated with ‘stay at home’ measures — such as a strain on mental health —
is clearly represented in funding data from 2020. A recent report from CB Insights shows that
although wellness applications for general fitness and sleep saw fewer deals
and dollars than they did in the first half of 2019, there has been a spike in
funding for mental health-focused wellness startups. 

During the pandemic, which has been described as a ‘mental
health crisis,’ downloads of consumer meditation and mindfulness apps like Calm
and Headspace have increased significantly. 

We’re also seeing a lot of movement in the enterprise space.
A couple of examples include Spring Health, a service that helps companies
offer their workers mental health benefits, which recently raised $76 million, and MindLabs,
which recently raised $1.8M for its mobile app combining live videos from
mental health professionals leading meditation and mindfulness sessions, with
an EEG headband that measures heart and respiration rates to show how
successful sessions are in reducing stress. 

HITC: What role will user-controlled data platforms play
in working with these enterprises?

Pop: User-controlled data platforms will facilitate
the secure transaction and exchange of fragmented health data to power wellness
solutions, programs, and products, and ultimately accelerate the pace of
innovation for enterprises. Platforms like ours have a vested interest in
earning and keeping user trust, and are able to offer an extra layer of
security and privacy (peace of mind) to end-users. We believe our approach to
enabling data sharing will continue to increase adoption and user participation
in wellness programs and solutions. As we’ve seen in other industries,
companies Uber, and other modern transaction layers that enable trusted
transactions opened the market to new innovations and new consumer behaviors.
Our platform is helping drive enterprise and consumer behavior in a similar way
by accelerating the rise of a consumer health ecosystem that empowers people to
be proactive participants in their own health and well-being. 

HITC: How can employees control their data to solve the
trust issue?

Pop: Through our platform, employees can connect and
disconnect a data source any time they want. They are in full control of which
companies have access to their health data, and we’ll never sell any
identifiable employee health data. Our security policy and protocols are designed
in the best interest of employees (end consumers) to maximize trust,
engagement, and participation. 

HITC: What challenges and trends do you see heading into
2021 and beyond for the user-controlled health data ecosystem?

Pop: Trust remains a big issue, but we find that
people are beginning to be more comfortable with sharing their data while
they’re at home. I believe the biggest challenge to the rise of a new consumer
health ecosystem is how fast industries and enterprises can adapt and innovate.
This is new terrain that companies are learning to navigate and master. We’re
seeing the emergence of a new wellness paradigm to respond to the pandemic, and
we’re excited to help accelerate the trend of empowering consumers to take
control of their own health. As more health data sources come online, our
consumer health data platform will help enable more innovative products and
solutions. There’s a global opportunity and historic moment here to capitalize
on by leveraging the power of wearable technology and health data to transform
consumer well-being.

Health Officials Fear Pandemic-Related Suicide Spike Among Native Youth

WOLF POINT, Mont. — Fallen pine cones covered 16-year-old Leslie Keiser’s fresh grave at the edge of Wolf Point, a small community on the Fort Peck Indian Reservation on the eastern Montana plains.

Leslie, whose father is a member of the Fort Peck Assiniboine and Sioux Tribes, is one of at least two teenagers on the reservation who died by suicide this summer. A third teen’s death is under investigation, authorities said.

Leslie’s mother, Natalie Keiser, was standing beside the grave recently when she received a text with a photo of the headstone she had ordered.

She looked at her phone and then back at the grave of the girl who took her own life in September.

“I wish she would have reached out and let us know what was wrong,” she said.

In a typical year, Native American youth die by suicide at nearly twice the rate of their white peers in the U.S. Mental health experts worry that the isolation and shutdowns caused by the COVID-19 pandemic could make things worse.

“It has put a really heavy spirit on them, being isolated and depressed and at home with nothing to do,” said Carrie Manning, a project coordinator at the Fort Peck Tribes’ Spotted Bull Recovery Resource Center.

It’s not clear what connection the pandemic has to the youth suicides on the Fort Peck reservation. Leslie had attempted suicide once before several years ago, but she had been in counseling and seemed to be feeling better, her mother said.

Keiser noted that Leslie’s therapist canceled her counseling sessions before the pandemic hit.

“Probably with the virus it would have been discontinued anyway,” Keiser said. “It seems like things that were important were kind of set to the wayside.”

Tribal members typically lean on one another in times of crisis, but this time is different. The reservation is a COVID hot spot. In remote Roosevelt County, which encompasses most of the reservation, more than 10% of the population has been infected with the coronavirus. The resulting social distancing has led tribal officials to worry the community will fail to see warning signs among at-risk youth.

So tribal officials are focusing their suicide prevention efforts on finding ways to help those kids remotely.

“Our people have been through hardships and they’re still here, and they’ll still be here after this one as well,” said Don Wetzel, tribal liaison for the Montana Office of Public Instruction and a member of the Blackfeet Nation. “I think if you want to look at resiliency in this country, you look at our Native Americans.”

Poverty, high rates of substance abuse, limited health care and crowded households elevate both physical and mental health risks for residents of reservations.

“It’s those conditions where things like suicide and pandemics like COVID are able to just decimate tribal people,” said Teresa Brockie, a public health researcher at Johns Hopkins University and a member of the White Clay Nation from Fort Belknap, Montana.

Montana has seen 231 suicides this year, with the highest rates occurring in rural counties. Those numbers aren’t much different from a typical year, said Karl Rosston, suicide prevention coordinator for the state’s Department of Public Health and Human Services. The state has had one of the highest suicide rates in the country each year for decades.

As physical distancing drags on, fatality numbers climb and the economic impacts of the pandemic start to take hold of families, Rosston said, and he expected to see more suicide attempts in December and January.

“We’re hoping we’re wrong in this, of course,” he said.

For rural teenagers, in particular, the isolation caused by school closures and curtailed or canceled sports seasons can tax their mental health.

“Peers are a huge factor for kids. If they’re cut off, they’re more at risk,” Rosston said.

Furthermore, teen suicides tend to cluster, especially in rural areas. Every suicide triples the risk that a surviving loved one will follow suit, Rosston said.

On average, every person who dies by suicide has six survivors. “When talking about small tribal communities, that jumps to 25 to 30,” he said.

Maria Vega, a 22-year-old member of the Fort Peck Tribes, knows this kind of contagious grief. In 2015, after finding the body of a close friend who had died by suicide, Vega attempted suicide as well. She is now a youth representative for a state-run suicide prevention committee that organizes conferences and other events for young people.

Vega is a nursing student who lives six hours away from her family, making it difficult to travel home. She contracted COVID-19 in October and was forced to isolate, increasing her sense of removal from family. While isolated, Vega was able to attend therapy sessions through a telehealth system set up by her university.

“I really do think therapy is something that would help people while they’re alone,” she said.

But Vega points out that this is not an option for many people on rural reservations who don’t have computers or reliable internet access. The therapists who offer telehealth services have long waitlists.

Other prevention programs are having difficulties operating during the pandemic. Brockie, who studies health delivery in disadvantaged populations, has twice had to delay the launch of an experimental training program for Native parents of young children. She hopes the program will lower the risk of substance abuse and suicide by teaching resiliency and parenting skills.

At Fort Peck, the reservation’s mental health center has had to scale down its youth events that teach leadership skills and traditional practices like horseback riding and archery, as well as workshops on topics like coping with grief. The events, which Manning said usually draw 200 people or more, are intended to take teenagers’ minds away from depression and allow them to have conversations about suicide, a taboo topic in many Native cultures. The few events that can go forward are limited now to a handful of people at a time.

Tribes, rural states and other organizations running youth suicide intervention and prevention initiatives are struggling to sustain the same level of services. Using money from the federal CARES Act and other sources, Montana’s Office of Public Instruction ramped up online prevention training for teachers, while Rosston’s office has beefed up counseling resources people can access by phone.

On the national level, the Center for Native American Youth in Washington, D.C., hosts biweekly webinars for young people to talk about their hopes and concerns. Executive Director Nikki Pitre said that on average around 10,000 young people log in each week. In the CARES Act, the federal government allocated $425 million for mental health programs, $15 million of which was set aside for Native health organizations.

Pitre hopes the pandemic will bring attention to the historical inequities that led to lack of health care and resources on reservations, and how they enable the twin epidemics of COVID-19 and suicide.

“This pandemic has really opened up those wounds,” she said. “We’re clinging even more to the resiliency of culture.”

In Wolf Point, Natalie Keiser experienced that resiliency and support firsthand. The Fort Peck community has come together to pay for Leslie’s funeral.

“That’s a miracle in itself,” she said.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

USE OUR CONTENT

This story can be republished for free (details).

For Better Patient Care Coordination, We Need Seamless Digital Communications

A recent Advisory Board briefing examined the annual Centers for Medicare & Medicaid Services (CMS) Readmission penalties.  Of the 3,080 hospitals CMS evaluated, 83% received a penalty for payments to be made in 2021, based on expected outcomes for a wide variety of treated conditions. While CMS indicated that some of these penalties might be waived or delayed due to the impacts of the Covid pandemic on hospital procedure volumes and revenue, they are indicative of a much larger issue. 

For too long, patients discharged from the hospital have been handed a stack of papers to fill prescriptions, seek follow-up care, or take other steps in their journey from treatment to recovery. More recently, the patient is given access to an Electronic Health Record (EHR) portal to view their records, and a care coordinator may call in a few days to check-in. These are positive steps, but is it enough? Although some readmissions cannot be avoided due to unforeseen complications, many are due to missed follow-up visits, poor medication adherence, or inadequate post-discharge care. 

Probably because communication with outside providers has never worked reliably, almost all hospitals have interpreted ‘care coordination’ to mean staffing a local team to help patients with a call center-style approach.  Wouldn’t it be much better if the hospital could directly engage and enable the Primary Care Physician (PCP) to know the current issues and follow-up directly with their patient?

We believe there is still a real opportunity to hold the patient’s hand and do far more to guide them through to recovery while reducing the friction for the entire patient care team.  

Strengthening Care Coordination for a Better Tomorrow

Coordinating and collaborating with primary care, outpatient clinics, mental health professionals, public health, or social services plays a crucial role in mitigating readmissions and other bumps along the road to recovery.  Real care coordination requires three related communication capabilities:  

1. Notification of the PCP or other physicians and caregivers when events such as ED visits or Hospitalization occur.

2. Easy, searchable, medical record sharing allows the PCP to learn important issues without wading through hundreds of administrative paperwork.

3. Secure Messaging allows both clinicians and office staff to ask the other providers questions, clarify issues, and simplify working together.  

There are some significant hurdles to improve the flow of patient data, and industry efforts have long been underway to plug the gaps. EHR vendors, Health Information Exchanges (HIEs), and a myriad of vendors and collaboratives have attempted to tackle these issues. In the past few decades, government compliance efforts have helped drive medical record sharing through the Direct Messaging protocol and CCDAs through Meaningful Use/Promoting Interoperability requirements for “electronic referral loops.”  Kudos to the CMS for recognizing that notifications need to improve from hospitals to primary care—this is the key driver behind the latest CMS Final Rule (CMS-9115-F) mandating Admission, Discharge, and Transfer (ADT) Event Notifications. (By March 2021, CMS Conditions of Participation (CoPs) will require most hospitals to make a “reasonable effort” to send electronic event notifications to “all” Primary Care Providers (PCPs) or their practice.) 

However, to date, the real world falls far short of these ideals: for a host of technical and implementation reasons, the majority of PCPs still don’t receive digital medical records sent by hospitals, and the required notifications are either far too simple, provide no context or relevant encounter data, rarely include patient demographic and contact information, and almost never include a method for bi-directional communications or messaging.

Delivering What the Recipient Needs

PCPs want what doctors call the “bullet” about their patient’s recent hospitalization.  They don’t want pages of minutia, much of it repetitively cut and pasted. They don’t want to scan through dozens or hundreds of pages looking for the important things. They don’t want “CYA” legalistic nonsense. Not to mention, they learn very little from information focused on patient education.  

An outside practitioner typically doesn’t have access to the hospital EHR, and when they do, it can be too cumbersome or time-consuming to chase down the important details of a recent visit.  But for many patients—especially those with serious health issues—the doctor needs the bullet: key items such as the current medication list, what changed, and why.

Let’s look at an example of a patient with Congestive Heart Failure (CHF), which is a condition assessed in the above-mentioned CMS Readmission penalties. For CHF, the “bullet” might include timely and relevant details such as:

– What triggered the decompensation?  Was it a simple thing, such as a salty meal? Or missed medication?

– What was the cardiac Ejection Fraction?  

– What were the last few BUN and Creatinine levels and the most recent weight?  

– Was this left- or right-sided heart failure? 

– What medications and doses were prescribed for the patient? 

– Is she tending toward too dry or too wet?

– Has she been postural, dizzy, hypotensive?

Ideally, the PCP would receive a quick, readable page that includes the name of the treating physician at the hospital, as well as 3-4 sentences about key concerns and findings. Having the whole hospital record is not important for 90 percent of patients, but receiving the “bullet” and being able to quickly search or request the records for more details, would be ideal. 

Similar issues hold true for administrative staff and care coordinators.  No one should play “telephone tag” to get chart information, clarify which patients should be seen quickly, or find demographic information about a discharged patient so they can proactively contact them to schedule follow-up. 

Building a Sustainable, Long-Term Solution

Having struggled mightily to build effective communications in the past is no excuse for the often simplistic and manual processes we consider care coordination today.  

Let’s use innovative capabilities to get high-quality notifications and transitions of care to all PCPs, not continue with multi-step processes that yield empty, cryptic data. The clinician needs clinically dense, salient summaries of hospital care, with the ability to quickly get answers—as easy as a Google search—for the two or three most important questions, without waiting for a scheduled phone call with the hospitalist.  X-Rays, Lab results, EKGs, and other tests should also be available for easy review, not just the report.   After all, if the PCP needs to order a new chest x-ray or EKG how can they compare it with the last one if they don’t have access to it?

Clerical staff needs demographic information at their fingertips to “take the baton” and ensure quick and appropriate appointment scheduling. They need to be able to retrieve more information from the sender, ask questions, and never use a telephone.  Additionally, both the doctor and the office staff should be able to fire off a short note and get an answer to anyone in the extended care team. 

That is proper care coordination. And that is where we hope the industry is collectively headed in 2021. 


About Peter Tippett MD, PhD: Founder and CEO, careMESH

Dr. Peter S. Tippett is a physician, scientist, business leader and technology entrepreneur with extensive risk management and health information technology expertise. One of his early startups created the first commercial antivirus product, Certus (which sold to Symantec and became Norton Antivirus).  As a leader in the global information security industry (ICSA Labs, TruSecure, CyberTrust, Information Security Magazine), Tippett developed a range of foundational and widely accepted risk equations and models.

About Catherine Thomas: Co-Founder and VP, Customer Engagement, careMESH

Catherine Thomas is Co-Founder & VP of Customer Engagement for careMESH, and a seasoned marketing executive with extensive experience in healthcare, telecommunications and the Federal Government sectors. As co-founder of careMESH, she brings 20+ years in Strategic Marketing and Planning; Communications & Change Management; Analyst & Media Relations; Channel Strategy & Development; and Staff & Project Leadership.

‘Nine Months Into It, the Adrenaline Is Gone and It’s Just Exhausting’

USE OUR CONTENT

It can be republished for free.

In March, during the first week of the San Francisco Bay Area’s first-in-the-nation stay-at-home order, KHN spoke with emergency department physicians working on the front lines of the burgeoning COVID-19 pandemic. At the time, these doctors reported dire shortages of personal protective equipment and testing supplies. Health officials had no idea how widespread the virus was, and some experts warned hospitals would be overwhelmed by critically ill patients.

In the end, due to both the early sweeping shutdown order and a state-sponsored effort to bolster the supply chain, Bay Area hospitals were able to avert that catastrophe. The region so far has fared much better than most other U.S. metro regions when it comes to rates of COVID infection and death. Even so, with intensive care unit capacity dwindling to critical levels statewide, San Francisco on Thursday issued another drastic order, announcing a mandatory 10-day quarantine for anyone returning to the city who has spent time outside the region.

Amid this fierce second surge, we circled back last week to check in with Dr. Jeanne Noble, director of the COVID response at the University of California-San Francisco medical center emergency department, to get her reflections on the Bay Area’s experience. She explained how even as her hospital has made so many improvements, including recently launching universal testing so that everyone who comes to the emergency room is tested for COVID-19, the lockdown and burnout are wearing on her and her colleagues. The conversation has been edited for length.

Q: How are you doing at UCSF right now? 

We’re OK in terms of our numbers. We have our ICU capacity; today’s numbers are 74% occupied. Acute care is a little bit tighter; the emergency department is seeing an increase in patients. [Editor’s note: As of Sunday, ICU capacity had dropped to 13%.]

We did have a period of time before this last surge where we often had a few days with no COVID patients. That was great. That ended in late September. This morning we have 11 patients on ventilators in the ICU.

I think we’re the first hospital in the state for universal testing. Everyone who comes to the ER gets tested. I’ve been working on this for months, but it’s new this week. Now we have testing, so we don’t have to do so much guesswork.

Q: When we spoke during the week of the first stay-at-home order, back in March, you were very worried. How do things compare now?

The supply [of masks] is just much better than it was back in March. In March, we had furloughed engineers from our local museum, the Exploratorium, making us face shields, and we started a makers lab in the library across the street to make supplies. It doesn’t feel like that this time around. We have a longer horizon.

I think in terms of our COVID care and our hospital capacity, we are fine. But my own sort of perspective on all of this is: When are we going to be done with this? Because even though things are smoother — we have PPE, we have testing — it’s a tremendous amount of work and stress. Frankly, the fact that my children have not been in school since March is one of my major sources of stress.

We’re all working way more than we ever have before. And nine months into it, the adrenaline is gone and it’s just purely exhausting.

Q: Can you tell me more about that, the physical and emotional toll on the hospital staff?

We don’t allow eating in the ED anymore, so we don’t have break rooms. Especially if you’re the supervising doctor, you need to do this elaborate handoff to another doctor if you need to eat. You know, it’s 10 hours into your shift and you want a cup of coffee.

The hassles and the discomforts. Wearing an N95 day after day is really uncomfortable. A lot of us have ulcers on our noses. They become painful.

And the lack of being able to socialize with colleagues is hard. The ED has always been a pretty intense environment. That’s offset by this closeness and being a team. All of this emotional intensity, treating people day after day at these incredible junctures in their lives — a lot of the camaraderie and morale comes from being able to debrief together. When you’re not supposed to be closer than a few feet from one another and you don’t take off your masks, it’s a lot of strain.

People are much less worried about coming home to their families. It hasn’t been the fomite disease we were all worried about initially, worried we’d give our kids COVID from our shoes. But there’s still the concern. Every time you get a runny nose or a sore throat you need to get tested, and you worry about what if you infected your family.

Q: So will you and your colleagues be able to take a break over the holidays?

We’ll see what happens. We’re just now starting to feel like we’re seeing the post-Thanksgiving numbers. But I think that even without having to do extra shifts in the ED, certainly for someone like me doing COVID response, there’s always a huge number of issues to work through. We just got the monoclonal antibodies, which is great, but that’s a whole new workflow.

I think what is going to bother people the most is that we are in lockdown. Kind of longing for that relaxation and time with family that we’re all kind of craving.

Q: It sounds like things are hard, but the hospital is in a relatively good place.

I was deployed to the Navajo Nation and helped with their surge in May in Gallup, New Mexico, and that is much, much harder than what we’ve faced in the Bay Area. In Gallup, at Indian Health Service, they were incredible in just the can-do attitude with way fewer resources than we have here. As of this summer, they had had the worst per capita surge in the country. They redesigned their ED essentially by cutting every room in half, hanging plastic on hooks you would use to hang your bicycle wheel. They hung thick plastic and right there doubled their capacity of patients they could see.

Our tents at UCSF are these blue medical tents with HVAC systems, heaters, negative pressure. They are really nice. There they had what looked like beach cabanas — open walls with just a tent overhead. In March and April they were taking care of patients in the snow. In the summer, it was hot and windy. When I was there, almost every single one of my patients had COVID.

That level of intensity was not something we had to go through in the Bay Area. Not to say that it’s easy [here]; I just told you all the ways it’s hard. But everything is relative. In terms of the COVID landscape, we have been very lucky.

Q: The Bay Area was early to close and has had stricter regulations than many parts of the country. As someone directly affected, what do you think of the response?

I think that we have benefited from early closures, unquestionably, when we did our shelter-in-place in March and probably saved 80,000 lives. It was really a tremendous and a bold move.

We’ve done some things well and other things not so well. We were very late to implement closures in a targeted fashion. Restaurants and dining reopened this summer, and a lot of us couldn’t figure out why indoor dining was open. Why is indoor dining something we need to even be considering when we’ve just barely flattened our curve? It was very predictable that cases would go up when dining happened. And they did.

We need to evaluate what is more important for our society and well-being, and to say what is the risk associated with that activity. Schools are of high social value. And [the closures are] really hard for kids. We’re seeing a lot of adolescents with suicidal ideation brought to the emergency department, which is related to school closure. I would put dining and restaurants as being of minimal social importance and very high risk.

We could have done this better. Closing [down society] when numbers go up is reasonable and that saves lives. But I think we know enough that it should not be an across-the-board closing. I mean, with this latest order, they temporarily closed parks. And we’ve been telling people to go outside. It’s like, what? Are you kidding?

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

USE OUR CONTENT

This story can be republished for free (details).

Poll: Large Majorities Now Say They Wear Masks Regularly and Can Continue Social Distancing for At Least Six Months if Needed, though Republicans Remain Less Likely to Take Such Precautions

As winter sets in and COVID-19 cases and deaths reach records in most parts of the country, more Americans say they wear masks every time they leave home now (73%) than said so in May (52%), a new KFF Health Tracking Poll finds. A small minority (11%) say they wear masks only some of theMore

VHA Innovation Ecosystem Taps MDClone to Leverage Synthetic Data for Faster Healthcare to Veterans

VHA Innovation Ecosystem Taps MDClone to Leverage Synthetic Data for Faster Healthcare to Veterans

What You Should Know:

– Data analytics and digital health company MDClone
announced a partnership with the Department of Veterans Affairs’ (VA) VHA
Innovation Ecosystem to democratize data and provide better, smarter, faster
healthcare to U.S Veterans.

– By leveraging MDClone’s data platform, the VHA is able to tackle this massive problem by securely accessing, organizing, and analyzing the critical health data of Veterans with the use of synthetic data – a breakthrough method pioneered by MDClone.


MDClone,
a digital health
company, and the VHA Innovation Ecosystem, a division of the United States
Department of Veterans Affairs (VA) today announced a partnership to
democratize data at the Veterans Health Administration (VHA). The partnership
will provide unprecedented, secure access to clinical data to better understand
and improve the health of the more than nine million veterans it serves.


Partnership Details

The VHA Innovation Ecosystem aims to empower a wider network of VHA clinical and operational staff to explore data and discover insights that can be used to impact the lives of veterans nationwide. MDClone worked closely on this initiative with Dr. Amanda Purnell, Senior Innovation Fellow at the VHA Innovation Ecosystem, who is part of the Care & Transformational Initiatives (CTI) in the VHA Innovation Ecosystem. This program is specifically focused on testing and refining innovative care models and transformational initiatives that can be meaningfully scaled to impact Veteran care.


Improving Healthcare for Veterans with Synthetic Data


MDClone ADAMS from MDClone on Vimeo.

It’s no secret that Veterans have historically had a difficult time adjusting to normal life following service, which leads to many mental health issues that go unnoticed and un-treated – often leading to homelessness and the tragic loss of lives. By leveraging MDClone’s data platform, the VHA is able to tackle this massive problem by securely accessing, organizing, and analyzing the critical health data of Veterans with the use of synthetic data – a breakthrough method pioneered by MDClone. Synthetic data sets are virtually identical to the original patient data, so there’s no identifying information that can be traced back to individual patients. Synthetic data also has the potential to help the VHA collaborate with external agencies, healthcare providers, and the industry.

Non-technical users can quickly ask important questions, find answers, and take action – dramatically shortening timelines for quality improvement, innovation, and grassroots clinical research. The initial collaboration with MDClone will center around suicide prevention, chronic disease management, precision medicine, health equity, and COVID-19. For example, practitioners can tackle issues like suicide by identifying leading indicators and proactively intervening with patients most at risk.

“The VHA has long been at the forefront of healthcare informatics and the use of data to improve patient outcomes and drive operational improvements,” said Ziv Ofek, Founder and CEO, MDClone. “The selection of MDClone’s unique platform builds upon this tradition. With one of the largest medical databases in the world, the VHA requires enterprise-scale tools to explore data, innovate, and improve patient care. MDClone’s dynamic environment will help VA staff deliver on their mission to provide the best healthcare services to Veterans across the U.S.”


Kaiser Permanente tests referring patients to 6 digital mental health tools

The managed care company picked six mental health apps that it made available to its members over the past two years. It recently published a paper showing patients were more likely to download or use digital health tools when referred by a physician.

Alzheimer’s Inc.: Colleagues Question Scientist’s Pricey Recipe Against Memory Loss


This story also ran on Daily Beast. It can be republished for free.

When her husband was diagnosed with early-stage Alzheimer’s disease in 2015, Elizabeth Pan was devastated by the lack of options to slow his inevitable decline. But she was encouraged when she discovered the work of a UCLA neurologist, Dr. Dale Bredesen, who offered a comprehensive lifestyle management program to halt or even reverse cognitive decline in patients like her husband.

After decades of research, Bredesen had concluded that more than 36 drivers of Alzheimer’s cumulatively contribute to the loss of mental acuity. They range from chronic conditions like heart disease and diabetes to vitamin and hormonal deficiencies, undiagnosed infections and even long-term exposures to toxic substances. Bredesen’s impressive academic credentials lent legitimacy to his approach.

Pan paid $4,000 to a doctor trained in Bredesen’s program for a consultation and a series of extensive laboratory tests, then was referred to another doctor, who devised a stringent regimen of dietary changes that entailed cutting out all sugars, eating a high-fat, low-carbohydrate diet and adhering to a complex regimen of meditation, vigorous daily exercise and about a dozen nutritional supplements each day (at about $200 a month). Pan said she had extensive mold remediation done in her home after the Bredesen doctors told her the substance could be hurting her husband’s brain.

But two years passed, she said, and her husband, Wayne, was steadily declining. To make matters worse, he had lost more than 60 pounds because he didn’t like the food on the diet. In April, he died.

“I imagine it works in some people and doesn’t work in others,” said Pan, who lives in Oakton, Virginia. “But there’s no way to tell ahead of time if it will work for you.”

Bredesen wrote the best-selling 2017 book “The End of Alzheimer’s” and has promoted his ideas in talks to community groups around the country and in radio and TV appearances like “The Dr. Oz Show.” He has also started his own company, Apollo Health, to market his program and train and provide referrals for practitioners.

Unlike other self-help regimens, Bredesen said, his program is an intensely personalized and scientific approach to counteract each individual’s specific deficits by “optimizing the physical body and understanding the molecular drivers of the disease,” he told KHN in a November phone interview. “The vast majority of people improve” as long as they adhere to the regimen.

Bredesen’s peers acknowledge him as an expert on aging. A former postdoctoral fellow under Nobel laureate Stanley Prusiner at the University of California-San Francisco, Bredesen presided over a well-funded lab at UCLA for more than five years. He has been on the UCLA faculty since 1989 and also founded the Buck Institute for Research on Aging in Marin County. He has written or co-authored more than 200 papers.

But colleagues are critical of what they see as his commercial promotion of a largely unproven and costly regimen. They say he strays from long-established scientific norms by relying on anecdotal reports from patients, rather than providing evidence with rigorous research.

“He’s an exceptional scientist,” said George Perry, a neuroscientist at the University of Texas-San Antonio. “But monetizing this is a turnoff.”

“I have seen desperate patients and family members clean out their bank accounts and believe this will help them with every ounce of their being,” said Dr. Joanna Hellmuth, a neurologist in the Memory and Aging Center at UCSF. “They are clinging to hope.”

Many of the lifestyle changes Bredesen promotes are known to be helpful. “The protocol itself is based on very low-quality data, and I worry that vulnerable patients and family members may not understand that,” said Hellmuth. “He trained here” — at UCSF — “so he knows better.”

The Bredesen package doesn’t come cheap. He has built a network of practitioner-followers by training them in his protocol — at $1,800 a pop — in seminars sponsored by the Institute for Functional Medicine, which emphasizes alternative approaches to managing disease. Apollo Health also offers two-week training sessions for a $1,500 fee.

Once trained in his ReCODE Protocol, medical professionals charge patients upward of $300 for a consultation and as much as $10,500 for eight- to 15-month treatment packages. For the ReCODE protocol, aimed at people already suffering from early-stage Alzheimer’s disease or mild cognitive decline, Apollo Health charges an initial $1,399 fee for a referral to a local practitioner that includes an assessment and extensive laboratory tests. Apollo then offers $75-per-month subscriptions that provide cognitive games and online support, and links to another company that offers dietary supplements for an additional $150 to $450 a month. Insurance generally covers little of these costs.

Apollo Health, founded in 1998 and headquartered in Burlingame, California, also offers a protocol geared toward those who have a family history of dementia or want to prevent cognitive decline.

Bredesen estimates that about 5,000 people have done the ReCODE program. The fees are a bargain, Bredesen said, if they slow decline enough to prevent someone from being placed in a nursing home, where yearly costs can climb past $100,000 annually.

Bredesen and his company are tapping into the desperation that has grown out of the failure of a decades-long scientific quest for effective Alzheimer’s treatments. Much of the research money in the field has narrowly focused on amyloid — the barnacle-like gunk that collects outside nerve cells and interferes with the brain’s signaling system — as the main culprits behind cognitive decline. Drugmakers have tried repeatedly, and thus far without much success, to invent a trillion-dollar anti-amyloid drug. There’s been less emphasis in the field on the lifestyle choices that Bredesen stresses.

“Amyloids sucked up all the air in the room,” said Dr. Lon Schneider, an Alzheimer’s researcher and a professor of psychiatry and behavioral sciences at the Keck School of Medicine at USC.

Growing evidence shows lifestyle changes help delay the progress of the mind-robbing disease. An exhaustive Lancet report in August identified a long list of risk factors for dementia, including excessive drinking, exposure to air pollution, obesity, loss of hearing, smoking, depression, lack of exercise and social isolation. Controlling these factors — which can be done on the cheap — could delay or even prevent up to 40% of dementia cases, according to the report.

Bredesen’s program involves all these practices, with personalized bells and whistles like intermittent fasting, meditation and supplements. Bredesen’s scientific peers question whether data supports his micromanaged approach over plain-vanilla healthy living.

Bredesen has published three papers showing positive results in many patients following his approach, but critics say he has fallen short of proving his method’s effectiveness.

The papers lack details on which protocol elements were followed, or the treatment duration, UCSF’s Hellmuth said. Nor do they explain how cognitive tests were conducted or evaluated, so it’s difficult to gauge whether improvements were due to the intervention, to chance variations in performance or an assortment of other variables, she said.

Bredesen shrugs off the criticism: “We want things to be in an open-access journal so everybody can read it. These are still peer-reviewed journals. So what’s the problem?”

Another problem raised about Bredesen’s enterprise is the lack of quality control, which he acknowledges. Apollo-trained “certified practitioners” can include everyone from nurses and dietitians to chiropractors and health coaches. Practitioners with varying degrees of training and competence can take his classes and hang out a shingle. That’s a painful fact for some who buy the package.

“I had the impression these practitioners were certified, but I realize they all had just taken a two-week course,” said a Virginia man who requested anonymity to protect his wife’s privacy. He said that he had spent more than $15,000 on tests and treatments for his ailing spouse and that six months into the program, earlier this year, she had failed to improve.

Bredesen said he and his staff were reviewing “who’s getting the best results and who’s getting the worst results,” and intended to cut poor performers out of the network. “We’ll make it so that you can only see the people getting the best results,” he said.

Colleagues say that to test whether Bredesen’s method works it needs to be subjected to a placebo-controlled study, the gold standard of medical research, in which half the participants get the treatment while the other half don’t.

In the absence of rigorous studies, said USC’s Schneider, a co-author of the Lancet report, “saying you can ‘end Alzheimer’s now and this is how you do it’ is overpromising and oversimplifying. And a lot of it is just common sense.”

Bredesen no longer says his method can end Alzheimer’s, despite the title of his book. Apollo Health’s website still makes that claim, however.

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

USE OUR CONTENT

This story can be republished for free (details).

Fine-tuning telehealth, addressing mental health take precedence for providers in 2021

Telemedicine

As 2020 draws to a close, healthcare providers are strategizing for the new year and the new normal. Providers will need to retool their telehealth efforts and prepare to meet a burgeoning mental crisis, among other issues.

I Found My Secret to Feeling Younger and Stronger. The Pandemic Stole It Away.

Back in early January, before COVID-19 was as familiar as the furniture, I went in for my annual physical. My doctor looked at my test results and shook his head. Virtually everything was perfect. My cholesterol was down. So was my weight. My blood pressure was that of a swimmer. A barrage of blood tests turned up zero red flags.

“What are you doing differently?” he asked, almost dumbfounded.

After all, I’m a 67-year-old balding guy who had spent much of his life as a desk-bound journalist dealing with nasty ailments like hernias (in my 30s), kidney stones (40s) and shingles (50s).

I ruminated over what had changed since my last physical. Sure, I exercise more than 90 minutes daily, but I’ve been doing that for five years. And yes, I watch what I eat, but that’s not new. Like most families with college-age kids, mine has its share of emotional and financial stresses — and there’d been no let-up there.

Only one thing in my life had registered any real change. “I’m volunteering more,” I told him.

I’d been spending less time in my basement office and more time out doing some good with like-minded people. Was this the magic elixir that seemed to steadily improve my health?

All signs pointed to “yes.” And I was feeling great about it.

Then just as I realized how important volunteering is to my health and well-being, the novel coronavirus appeared. As cases climbed, society shut down. One by one, my beloved volunteer gigs in Virginia disappeared. No more Mondays at Riverbend Park in Great Falls helping folks decide which trails to walk. Or Wednesdays serving lunch to the homeless at a community shelter in Falls Church. Or Fridays at the Arlington Food Assistance Center, which I gave up out of an abundance of caution. My modest asthma is just the sort of underlying condition that seems to make COVID-19 all the more brutal.

It used to be that missing even one day of volunteering made me feel like a sourpuss. After almost eight months without it, I’m downright dour.

Science helps explain why.

“The health benefits for older volunteers are mind-blowing,” said Paul Irving, chairman of the Center for the Future of Aging at the Milken Institute, and distinguished scholar in residence at the USC Leonard Davis School of Gerontology, whose lectures, books and podcasts on aging are turning heads.

When older folks go in for physicals, he said, “in addition to taking blood and doing all the other things that the doctor does when he or she pushes and prods and pokes, the doctor should say to you, ‘So, tell me about your volunteering.’”

A 2016 study in Psychosomatic Medicine: Journal of Behavioral Medicine that pooled data from 10 studies found that people with a higher sense of purpose in their lives — such as that received from volunteering — were less likely to die in the near term. Another study, published in Daedalus, an academic journal by MIT Press for the American Academy of Arts & Sciences, concluded that older volunteers had reduced risk of hypertension, delayed physical disability, enhanced cognition and lower mortality.

“People who are happy and engaged show better physiological functioning,” said Dr. Alan Rozanski, a cardiologist at Mount Sinai St. Luke’s Hospital, a senior author of the Psychosomatic Medicine study. People who engage in social activities such as volunteering, he said, often showed better blood pressure results and better heart rates.

That makes sense, of course, because volunteers are typically more active than, say, someone home on the couch streaming “Gilligan’s Island.”

Volunteers share a dirty little secret. We may start it to help others, but we stick with it for our own good, emotionally and physically.

At the homeless shelter, I could hit my target heart rate packing 50 sack lunches in an hour to the beat of Motown music. And at the food bank, I could feel the physical and emotional uplift of human contact while distributing hundreds of gallons of milk and dozens of cartons of eggs during my three-hour shifts. When I’m volunteering, I dare say I feel more like 37 than 67.

None of this surprises Rozanski, who looked at 10 studies over the past 15 years that included more than 130,000 participants. All of them, he said, showed that partaking in activities with purpose — such as volunteering — reduced the risk of cardiovascular events and often resulted in a longer life for older people.

Dr. David DeHart knows something about this, too. He’s a doctor of family medicine at the Mayo Clinic in Prairie du Chien, Wisconsin. He figures he has worked with thousands of patients — many of them elderly — over his career. Instead of just writing prescriptions, he recommends volunteering to his older patients primarily as a stress reducer.

“Compassionate actions that relieve someone else’s pain can help to reduce your own pain and discomfort,” he said.

At age 50, he listens to his own advice. DeHart volunteers with international medical teams in Vietnam, typically two trips a year. He often brings his wife and children to help, too. “When I come back, I feel recharged and ready to jump back into my work here,” he said. “The energy it gives me reminds me why I wanted to be a doctor in the first place.”

I think of my personal rewards from volunteering as cosmic electricity — with no “off” button. The good feeling sticks with me throughout the week — if not the month.

When will it be safe to resume my volunteering activities?

I’m considering my options. The park is offering some outdoor opportunities involving cleanup, but that lacks the interaction that lifts me. I’m tempted to go back to the food bank because even Charles Dinkens, an 85-year-old who has volunteered next to me for years, has returned after eight months away. “What else am I supposed to do?” he posed. The homeless shelter isn’t allowing volunteers in just yet. Instead, it’s asking folks to bag lunches at home and drop them off. Oh, they’re also looking for people to “call” virtual games of bingo for residents.

Virtual bingo just doesn’t float my boat.

Truth be told, there is no one-size-fits-all way to safely volunteer during the pandemic, said Dr. Kristin Englund, staff physician and infectious disease expert at the Cleveland Clinic. She suggests that volunteers — particularly those over 65 — stick with outdoor options. It’s better in a protected space where the general public isn’t moving through, she said, because “every time you interact with a person, it increases your risk of contracting the disease.”

Englund said she’d consider walking dogs outside for a local animal shelter as one safe option with some companionship. “While we do know that people can give COVID to animals,” she said, “it’s unlikely they can give it back to you.”

Meanwhile, my next annual physical is coming right up in January. It’s got me to wondering if my labs will be quite as pristine as they were the last go-round. I’ve got my doubts. Unless, of course, I’ve resumed some sort of in-person volunteering by then.

Last year, an elderly woman staying at the homeless shelter pulled me aside to thank me after I handed her lunch of tomato soup and a turkey sandwich. She set down her tray, took my hand, looked me smack in the eye and asked, “Why do you do this?”

She was probably expecting me to say I do it to help others because I care about those less fortunate than me. But that’s not what came out.

“I do it for myself,” I said. “Being here makes me whole.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

USE OUR CONTENT

This story can be republished for free (details).

Treating Patients with Software: Digital Therapeutics

The 3rd generation pharmaceuticals- Digital therapeutics- have become a much-discussed aspect of MedTech today, as they compete with established drug-based pharmaceutical and biotech products to become therapeutic interventions for many acute and chronic diseases. Currently, many small- and mid-size companies are working to develop, manufacture and launch their software-based therapeutic interventions, while we are observing a significant growth of acquisitions, licensing deals, and collaborations among the big-pharma players, all vying to have a niche in this arena.

As the digital aspect merges across the healthcare ecosystem, digital therapeutics are expected to influence healthcare delivery across the world. Unlike traditional prescription drugs rather than swallowing a pill or taking an injection, patients are treated with software.

Digital Health

Recent years witnessed Digital therapeutics as an emerging alternative to traditional medicine for mental health and addiction treatment. According to the WHO, more than 250 million people suffer from depression and mental health-related problems every day and it is the leading cause of disability and suicides. Although there are reasonably effective treatments for depression available such as the antidepressants, there aren’t enough healthcare resources to treat the growing number of people with depression.

Digital therapeutics utilize digital solutions to change patient behavior and lifestyle, usually with the help of a smartphone and are delivered through an app. Some digital therapeutic products have been successfully used to treat many chronic diseases like type II diabetes, obesity, and depression. With the help of digital therapeutics, healthcare professionals can easily connect with the patient on an online platform and enable personalized and real-time treatment methods.

There are several companies involved in digital therapeutic development, one notable of them being Pear Therapeutics. Pear’s lead product, reSET, is a promising candidate for the treatment of Substance Use Disorder, and was the first DTx to receive authorization from FDA to improve disease outcomes. Pear’s other product, reSET-O for the treatment of Opioid Use Disorder, was the first to receive Breakthrough Designation and was authorized in December 2018. Being FDA approved, these tools are prescribed as cognitive behavioral therapy as an adjunct to outpatient treatment under the supervision of a clinician.  Reset-O is also intended to be used in conjunction with pharmacotherapy.  Pear’s third product, Somryst for the treatment of chronic insomnia, was the first product submitted through FDA’s traditional 510(k) pathway while simultaneously reviewed through FDA’s Software Precertification Pilot Program and was authorized in March 2020.

Companies exploring Digital Therapeutics for Health

Another company active in this space is Akili Therapeutics, which is working to create a niche for themselves by applying gaming principles in healthcare to improve patient clinical outcomes. In June 2020, the FDA permitted the marketing of Akili Interactive Labs, Inc. product EndeavorRx, the first Game-based Digital Therapeutics to improve attention function in children with ADHD.

As the field of Digital Therapeutics is growing, collaborations between digital therapeutic companies, technology and service providers, pharmaceutical manufacturers, academic institutions, and provider groups can lead to the creation of local, regional, and national roadmaps to better operationalize and commercialize digital therapeutics.

The post Treating Patients with Software: Digital Therapeutics appeared first on DelveInsight Business Research.

Cerner, Banner Health, Xealth Partner to Simplify How Clinicians Prescribe Digital Health

Cerner, Banner Health, Xealth Partner to Simplify How Clinicians Prescribe Digital Health

What You Should Know:

– Cerner Corporation today announced with Xealth new
centralized digital ordering and monitoring for health systems, starting with
Banner Health, to foster digital innovation.

– Health systems can prescribe digital therapeutics, smartphones, and internet apps directly within the EHR to address areas such as chronic disease management, behavioral health, maternity care, and surgery prep.


Cerner, today announced it’s building on the recent collaboration with Xealth to offer health systems new centralized digital ordering and monitoring for clients. These capabilities are designed to help health systems choose, manage, and deploy digital tools and applications while offering clinicians access to remote monitoring and more direct engagement with patients. Phoenix-based Banner Health, one of the country’s largest nonprofit hospital systems, is one of the first Cerner clients to use the new capabilities to benefit its clinicians and patients.

Prescribe Digital Therapeutics Via EHR

With the new capabilities, health systems can prescribe digital therapeutics, smartphones, and internet applications to address areas such as chronic disease management, behavioral health, maternity care, and surgery prep. This access to a more holistic view of the organization’s digital health solutions supports the clinical decisions doctors make every day and provides real opportunities to improve medical outcomes and enhance efficiency, meet the increasing demand for telehealth and offer remote patient monitoring.

For example, the new capabilities can help simplify how
clinicians prescribe tools such as mobile mental health apps to monitor anxiety
triggers or a glucose device to help trace blood sugar levels for diabetes
patients.

Digital solutions will be available in a single location in
the electronic health record where health systems can use apps based on
clinical and financial metrics. A wide array of digital health tools is
integrated with Xealth’s offering today and the list is ever-growing. Early
examples of companies that have previously deployed in health systems using
Xealth include Babyscripts, Glooko, SilverCloud Health, Welldoc, as well as
Healthwise Inc., GetWellNetwork and ResMed that have existing relationships
with Cerner.

“As digital tools are increasingly included in care plans, health systems seek a way to organize and oversee their use across the health system. We anticipate the emergence of digital and therapeutic committees to govern digital tool selection similar to how pharmacy and therapeutic committees have historically governed medication formularies,” said David Bradshaw, senior vice president, Consumer and Employer Solutions, Cerner. “Digital health has extraordinary potential to reshape the way we care for patients and, working with Xealth, we are answering the need and helping providers create more engaging and effective patient experiences.”

Why It Matters

Digital health has great potential to make an immediate difference, especially as it relates to automating patient education, delivering virtual care, supporting telehealth, and offering remote patient monitoring. Health systems with a digital health program and strategy in place have the ability to respond faster and more efficiently.

“Now, more than ever, extending care teams to meet patients where they are is critical,” said Mike McSherry, CEO and co-founder, Xealth. “As digital health programs roll out, they should elevate both the patient and provider experience. Cerner building out a digital formulary, with Xealth at its core, is listening to its strong clinician base by delivering tools to enhance patient care, without adding additional steps for the care team.”

Powered by Doctor on Demand, ArcBest Rolls Out Virtual Primary Care Health Plan to its 13k Employees

Powered by Doctor on Demand, ArcBest Rolls Out Virtual Primary Care Health Plan to its 13k Employees

What You Should Know:

– Publicly traded logistics company ArcBest announced its
deal with Doctor On Demand to introduce its virtual-first health plan to its
13,000 employees, who are largely “essential workers” as long-haul
truckers.

– Employees appreciated the convenience and safety of 24/7 virtual care – from their homes, from the road – and ArcBest is now doubling down on virtual care for 2021 – and offering a holistic, virtual-first primary care health plan – one where patients see the same PCP time and time again virtually and can receive many of the same services virtually that they’d typically receive in-person.


Doctor
On Demand
, the nation’s leading virtual care provider,
and ArcBest, a
multibillion-dollar leader in supply chain logistics, announced a partnership
to offer a new Virtual Primary Care health plan benefit to its employees and
their dependents nationwide. The partnership expands on the existing urgent
care and behavioral health services that Doctor On Demand has been providing to
ArcBest since 2017.

Virtual Primary Care Benefit

ArcBest is getting creative in how they deliver healthcare benefits to their thousands of field employees – many of whom are on the road or reside in rural areas throughout the country. As the pandemic hit, it became increasingly difficult or unsafe to seek in-person medical or mental health care, so ArcBest promoted the use of its telemedicine offering of urgent care and mental healthcare.

The new Virtual Primary Care benefit will be available to all 8,000 members who are covered under ArcBest’s medical plan starting December 1st. This benefit comes at a critical time as COVID-19 cases are spiking again, and as the country simultaneously heads into cold and flu season. As a provider of essential freight and logistics services, ArcBest has a large field employee population that operates 24/7, making it challenging to access routine in-person care.

Virtual Primary Care Improves Access to Care

ArcBest believes that investing in this new virtual health
plan upfront will have a major impact on employees’ health long term –
promoting preventative healthcare and driving down long-term costs associated
with employees waiting until their chronic back pain or chronic disease
warrants more costly interventions.

“At ArcBest, we have a unique set of healthcare benefit needs, and Doctor On Demand’s existing urgent and behavioral health care services have been invaluable, especially this year,” said Rich Krutsch, Vice President, People Services at ArcBest. “The pandemic has also prompted us to double-down on our investments in virtual care, and we’re excited to expand our program with Doctor On Demand to include much more holistic, integrated virtual care for our employees.” 

Employees Can Select Primary Care Doctor Through Doctor
on Demand

Eligible ArcBest employees and their dependents will now be able to select a primary care provider through Doctor On Demand and access a comprehensive set of services to support whole-person health, including preventive wellness check-ups, vaccination referrals, nutrition consultations, chronic condition management, and more. Additionally, members are able to continue to see the same physician over time, allowing them to build a consistent, trusted relationship via video.

Pear Therapeutics Raises $80M to Advance Prescription Digital Therapeutics

Pear Therapeutics Raises $80M to Advance Prescription Digital Therapeutics

What You Should Know:

– Pear Therapeutics today announced that it has
successfully closed an $80 million Series D financing led by SoftBank Vision
Fund 2.

–  Pear is the
leader in prescription digital therapeutics and the first company to receive
FDA authorization for a prescription digital therapeutic (PDT) to treat
disease.

– Pear currently has three FDA authorized therapies, reSET, reSET-O and Somryst, for substance use disorder, opioid use disorder, and chronic insomnia, respectively.


Pear Therapeutics,
Inc.
, (“Pear” or the “Company”) today announced that it has successfully
closed an $80 million Series D financing led by SoftBank Vision Fund 21 with
participation from existing investors including Temasek, 5AM Ventures,
Arboretum Ventures, JAZZ Venture Partners, Novartis, CrimsoNox, and EDBI, and
new investors, Forth Management, Pilot House, Sarissa Capital, Shanda Group,
and QUAD Investment Management.

What are PDTs?

PDTs are a new therapeutic class that uses software to treat
disease. Just like traditional medicines, prescription digital therapeutics are
prescribed by a physician and backed by clinical data that has been validated
by the FDA. As a new method of care, they offer patients a wide variety of
benefits, including: increased access to therapies, improved engagement and
adherence compared to face-to-face therapies.

Pear’s FDA Authorized Products

Pear’s products reSET®
and reSET-O® for the treatment
of substance use disorder and opioid use disorder, respectively, are the first
two PDTs to receive market authorization to treat disease from FDA. Pear
recently launched Somryst,
for the treatment of chronic insomnia, its third FDA-authorized PDT and the
third PDT to receive market authorization from FDA. Pear also recently launched
its end-to-end virtual care experience combining virtual doctor visit(s) via
telemedicine provider with PearConnect, the industry’s first patient service
center for PDTs.

The Company’s three FDA-authorized products address large
market opportunities with more than 20 million patients suffering from
substance and opioid use disorders and more than 30 million from chronic
insomnia, in the U.S. alone. These diseases are on the rise as the pandemic has
exacerbated the country’s mental health crises.

Expansion Plans

Pear plans to use the latest round of funding to accelerate
reimbursement coverage for its three commercial products, creating the first
market access pathway in the PDT industry. The Company collaborates with
innovators to build a broad and deep pipeline that has the potential to
redefine standard of care in a range of therapeutic areas, including specialty
psychiatry, specialty neurology, and a host of other non-CNS diseases. Pear has
built the first scalable platform infrastructure to discover, develop, and
deliver PDTs to patients.

“Pear is pleased to welcome our new investors and our new board members. SoftBank Investment Advisers represents an ideal partner to support Pear as we build the digital therapeutics industry,” said Corey McCann, M.D., Ph.D., President and CEO of Pear Therapeutics. “This oversubscribed round of funding will allow us to continue to invest in the launches of our three commercial products to accelerate revenue growth, which we intend to reinvest in our robust pipeline and platform.”

Potential Health Policy Administrative Actions Under President Biden

This brief outlines the potential health policy actions that President Biden could take using executive authority, based on campaign pledges, and actions that would reverse or modify regulations or guidance issued by the Trump Administration.

Creating Future of MedTech Industry with Artificial Intelligence

Artificial Intelligence is a breakthrough technology and has been used tremendously in this data-driven age, leading to a leap forward in the MedTech industry. Artificial Intelligence enrolls the use of advanced machine learning algorithms and fulfills the job, which has been tackled by humans for ages. It has flourished extensively over the past years owing to its versatility in its applications in the industry.

AI in different aspects of MedTech

Artificial Intelligence has the hallmarks of becoming a potent tool in the Healthcare industry by improving the current system by identifying unknown variables, solving fundamental issues, and providing viable solutions. For instance, the shortage of healthcare professionals can be tackled by creating better diagnostic and treatment procedures, integrating solutions developed by physicians worldwide, and providing them seamlessly over a platform accessed by all practicing physicians. This aspect can be seen in some clarity via the NAVIFY tumor board developed by Roche for the oncology therapy area. Unlike most other industries, in MedTech, AI is not confined to sales and operations ends of the value chain. Development in the technology has made it possible for solutions to surface, primarily related to R&D, clinical trials, and diagnostics and treatment, as well as patient management, leading to even more significant innovative potential and promise for AI in the industry.

With the introduction of AI in existing business and services models, the revenue models of medical device organizations are also shifting increasingly, including operating expenditure versus their historical focus solely on capital expenditure.

Key Players in the MedTech

Banyan Biomarkers is one company to be able to market a blood-based diagnostic test in the US market, as it utilizes tech to aid the detection of traumatic brain injuries and concussions. In February 2018, the San Diego-based company was granted a de novo request from FDA for the Banyan Brain Trauma Indicator. The test identifies Ubiquitin and Glial Fibrillary Acidic Protein (GFAP)- 2 brain-specific protein biomarkers- that appear rapidly in the blood of a patient after a brain injury.

Freenome is using AI to develop a colorectal cancer screening application that can learn from its mistakes. In May 2020, Freenome initiated AI-EMERGE, a clinical study for the AI-Genomics blood test has been completed, which collected samples from up to 3,000 patients in the US and Canada.

In April 2018, the FDA approved IDx‘s AI-based diagnostic system for the autonomous detection of diabetic retinopathy, a disorder that can lead to blindness. The IDx-DR solution involves a small robotic camera that takes images of the eye. An AI algorithm then analyses the picture taken from the camera of the patient’s retina and helps decide if a diabetes patient is suffering from retinopathy.

Viz.ai‘s Contact application is a clinical decision support software, designed to analyze CT Scan results, which can notify physicians of a potential stroke in their patients. The application can send a text notification to the specialist if it detects a suspected large vessel blockage through the patient’s scans. The program’s algorithm helps decrease time-lapse as it notifies the specialist during the time of the standard review of images, potentially saving lives. 

Women’s health start-up Ava has combined AI and wearable -two of the fastest-growing segments in MedTech – to develop a fertility tracking mobile device. In May 2018, Ava raised about $30 million in a Series B round.

The start-upstart-up is combining AI and CGM to develop a device known as the iLet biharmonic pancreas system. In May 2018, the firm received IDE approval for a trial, and in December 2019, it received the FDA’s Breakthrough Device designation. The iLet mimics a biological pancreas and consists of a dual-chamber, autonomous, infusion pump. The device is worn on the patients’ body, which contains a biharmonic cartridge in it that carries insulin and glucagon. The device can be configured to inject a specific dose of the hormones into the patient. The device is expected to become a game-changer in diabetes and congenital hyperinsulinism disease areas.

The post Creating Future of MedTech Industry with Artificial Intelligence appeared first on DelveInsight Business Research.

KHN on the Air This Week

KHN correspondent Aneri Pattani discussed how Black faith communities provide support in the face of racial unrest and COVID-19 with Newsy on Thursday.

KHN chief Washington correspondent Julie Rovner discussed President-elect Joe Biden’s plans for health policy and pandemic response with WBUR’s “Here & Now” on Monday. She also discussed the rollout of COVID vaccines with WDET’s “Detroit Today” on Tuesday.

KHN Colorado correspondent Rae Ellen Bichell discussed COVID-19 contact tracing apps with KUNC’s “Colorado Edition” on Nov. 25.

KHN reporter Victoria Knight discussed COVID risks and holiday travel with Newsy on Nov. 24.

KHN senior Colorado correspondent Markian Hawryluk discussed face masks with Colorado Public Radio’s “Colorado Matters” on Nov. 24.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

USE OUR CONTENT

This story can be republished for free (details).

Amid COVID and Racial Unrest, Black Churches Put Faith in Mental Health Care

Wilma Mayfield used to visit a senior center in Durham, North Carolina, four days a week and attend Lincoln Memorial Baptist Church on Sundays, a ritual she’s maintained for nearly half a century. But over the past 10 months, she’s seen only the inside of her home, the grocery store and the pharmacy. Most of her days are spent worrying about COVID-19 and watching TV.

It’s isolating, but she doesn’t talk about it much.

When Mayfield’s church invited a psychologist to give a virtual presentation on mental health during the pandemic, she decided to tune in.

The hourlong discussion covered COVID’s disproportionate toll on communities of color, rising rates of depression and anxiety, and the trauma caused by police killings of Black Americans. What stuck with Mayfield were the tools to improve her own mental health.

“They said to get up and get out,” she said. “So I did.”

The next morning, Mayfield, 67, got into her car and drove around town, listening to 103.9 gospel radio and noting new businesses that had opened and old ones that had closed. She felt so energized that she bought chicken, squash and greens, and began her Thanksgiving cooking early.

“It was wonderful,” she said. “The stuff that lady talked about [in the presentation], it opened up doors for me.”

As Black people face an onslaught of grief, stress and isolation triggered by a devastating pandemic and repeated instances of racial injustice, churches play a crucial role in addressing the mental health of their members and the greater community. Religious institutions have long been havens for emotional support. But faith leaders say the challenges of this year have catapulted mental health efforts to the forefront of their mission.

Some are preaching about mental health from the pulpit for the first time. Others are inviting mental health professionals to speak to their congregations, undergoing mental health training themselves or adding more therapists to the church staff.

“COVID undoubtedly has escalated this conversation in great ways,” said Keon Gerow, senior pastor at Catalyst Church in West Philadelphia. “It has forced Black churches — some of which have been older, traditional and did not want to have this conversation — to actually now have this conversation in a very real way.”

At Lincoln Memorial Baptist, leaders who organized the virtual presentation with the psychologist knew that people like Mayfield were struggling but might be reluctant to seek help. They thought members might be more open to sensitive discussions if they took place in a safe, comfortable setting like church.

It’s a trend that psychologist Alfiee Breland-Noble, who gave the presentation, has noticed for years.

Through her nonprofit organization, the AAKOMA Project, Breland-Noble and her colleagues often speak to church groups about depression, recognizing it as one of the best ways to reach a diverse segment of the Black community and raise mental health awareness.

This year, the AAKOMA Project has received clergy requests that are increasingly urgent, asking to focus on coping skills and tools people can use immediately, Breland-Noble said.

“After George Floyd’s death, it became: ‘Please talk to us about exposure to racial trauma and how we can help congregations deal with this,’” she said. “‘Because this is a lot.’”

Across the country, mental health needs are soaring. And Black Americans are experiencing significant strain: A study from the Centers for Disease Control and Prevention this summer found 15% of non-Hispanic Black adults had seriously considered suicide in the past 30 days and 18% had started or increased their use of substances to cope with pandemic-related stress.

Yet national data shows Blacks are less likely to receive mental health treatment than the overall population. A memo released by the Substance Abuse and Mental Health Services Administration this spring lists engaging faith leaders as one way to close this gap.

The Potter’s House in Dallas has been trying to do that for years. A megachurch with more than 30,000 members, it runs a counseling center with eight licensed clinicians, open to congregants and the local community to receive counseling at no cost, though donations are accepted.

Since the pandemic began, the center has seen a 30% increase in monthly appointments compared with previous years, said center director Natasha Stewart. During the summer, when protests over race and policing were at their height, more Black men came to therapy for the first time, she said.

Recently, there’s been a surge in families seeking services. Staying home together has brought up conflicts previously ignored, Stewart said.

“Before, people had ways to escape,” she said, referring to work or school. “With some of those escapes not available anymore, counseling has become a more viable option.”

To meet the growing demand, Stewart is adding a new counselor position for the first time in eight years.

At smaller churches, where funding a counseling center is unrealistic, clergy are instead turning to members of the congregation to address growing mental health needs.

At Catalyst Church, a member with a background in crisis management has begun leading monthly COVID conversations online. A deacon has been sharing his own experience getting therapy to encourage others to do the same. And Gerow, the senior pastor, talks openly about mental health.

Recognizing his power as a pastor, Gerow hopes his words on Sunday morning and in one-on-one conversations will help congregants seek the help they need. Doing so could reduce substance use and gun violence in the community, he said. Perhaps it would even lower the number of mental health crises that lead to police involvement, like the October death of Walter Wallace Jr., whose family said he was struggling with mental health issues when Philadelphia police shot him.

“If folks had the proper tools, they’d be able to deal with their grief and stress in different ways,” Gerow said. “Prayer alone is not always enough.”

Laverne Williams recognized that back in the ’90s. She believed prayer was powerful, but as an employee of the Mental Health Association in New Jersey, she knew there was a need for treatment too.

When she heard pastors tell people they could pray away mental illness or use blessed oil to cure what seemed like symptoms of schizophrenia, she worried. And she knew many people of color were not seeing professionals, often due to barriers of cost, transportation, stigma and distrust of the medical system.

To address this disconnect, Williams created a video and PowerPoint presentation and tried to educate faith leaders.

At first, many clergy turned her away. People thought seeking mental health treatment meant your faith wasn’t strong enough, Williams said.

But over time, some members of the clergy have come to realize the two can coexist, said Williams, adding that being a deacon herself has helped her gain their trust. This year alone, she’s trained 20 faith leaders in mental health topics.

A program run by the Behavioral Health Network of Greater St. Louis is taking a similar approach. The Bridges to Care and Recovery program trains faith leaders in “mental health first aid,” suicide prevention, substance use and more, through a 20-hour course.

The training builds on the work faith leaders are already doing to support their communities, said senior program manager Rose Jackson-Beavers. In addition to the tools of faith and prayer, clergy can now offer resources, education and awareness, and refer people to professional therapists in the network.

Since 2015, the program has trained 261 people from 78 churches, Jackson-Beavers said.

Among them is Carl Lucas, pastor of God First Church in northern St. Louis County who graduated this July — just in time, by his account.

Since the start of the pandemic, he has encountered two congregants who expressed suicidal thoughts. In one case, church leaders referred the person to counseling and followed up to ensure they attended therapy sessions. In the other, the root concern was isolation, so the person was paired with church members who could touch base regularly, Lucas said.

“The pandemic has definitely put us in a place where we’re looking for answers and looking for other avenues to help our members,” he said. “It has opened our eyes to the reality of mental health needs.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

USE OUR CONTENT

This story can be republished for free (details).

Zoloft enters list of 10 most commonly prescribed drugs in Australia

Increase in women being diagnosed with depression partly behind rise in use

An increase in women being diagnosed with depression is partly behind a significant rise in prescriptions of the antidepressant sertraline – sold under the brand name Zoloft – which is in the list of Australia’s most commonly prescribed drugs for the first time.

On Tuesday Australian Prescriber published its annual list of the 10 most commonly taken drugs – based on standard daily doses for every 1,000 people in the population each day – along with a list of the 10 most costly drugs to government, and the 10 most common drugs by prescription counts.

Related: Why mental health is the legacy-defining fight Scott Morrison can’t afford to lose | Katharine Murphy

Continue reading…

3 Key Solutions to Fighting Stress In the Medical Field

As you read this, doctors are on the frontlines fighting a global pandemic. Lives depend on their skills and expertise, but what often gets overlooked is the fact that doctors are still prone to stress. Sure enough, according to a report by Medscape, more than 42% of physicians across various specialties say they are burnt out. Burnout is still a common occurrence among physicians and it's a matter that practitioners and healthcare institutions should take seriously. After all, doctors are human like us and they deserve a break from their daily challenges. The issue of stress and burnout in the medical field continues to be a critical topic in the midst of the COVID-19 pandemic, so it's important to explore the options that are currently available to people in the medical field. Here are a few key solutions: 1. Creating a culture of collaboration At the organizational level, administrators will need to establish a robust program for engaging the needs of physicians and specialists. Initiatives such as mental health interventions and counselling not only encourages productivity but improves personnel retention. These should also involve physicians in the decision-making mechanisms of the organization. Not all policies are reflective of what's happening on the ground, so giving physicians a place in "higher up" conversations creates a culture of trust and collaboration. This, in turn, simplifies complex processes and leads to better outcomes for the whole organization. 2. Training for bigger roles Indeed, much of the occupational stress that doctors experience stems from a lack of professional support. When you have multiple specialists doing the same tasks without giving them an opportunity to expand their horizons, you risk creating an avenue where job dissatisfaction is rampant. One way to correct this is to invest in job enrichment and build an environment where constant learning is emphasized. This keeps the organization from thinning itself out with only a few specialists capable of handling certain tasks such as administering anesthesia or handling data security. In addition, providing doctors with enough autonomy to apply newly-acquired skills helps enhance productivity and bring innovation to the fore. Through skill development programs and participation in workshops, conferences, and team-building should be considered along these lines. 3. Developing a stress engagement program Work stress interventions are critical to any organization, and that goes for hospitals and clinics. There is always a need to draft a game plan for knowing how to keep physicians and other practitioners engaged and prevent the onset of stress. There are a number of ways you can go about this. For one, you may opt for a more workable shift-rotation scheme. Psycho-physiological needs should also be met, so if your organization is based in Washington, you may recommend a Seattle pain relief clinic or pain management center that’s capable of addressing stress-induced conditions such as fibromyalgia. Stress is rampant in the medical field because practitioners are committed to providing quality life-saving services. Organizations will only need to confront the reality that doctors, nurses, attendants and everyone else down the line require enough support, especially now as healthcare systems are met by unprecedented challenges.

As you read this, doctors are on the frontlines fighting a global pandemic. Lives depend on their skills and expertise, but what often gets overlooked is the fact that doctors are still prone to stress. Sure enough, according to a report by Medscape, more than 42% of physicians across various specialties say they are burned out. 

Burnout is still a common occurrence among physicians and it’s a matter that practitioners and healthcare institutions should take seriously. After all, doctors are human like us and they deserve a break from their daily challenges. The issue of stress and burnout in the medical field continues to be a critical topic in the midst of the COVID-19 pandemic, so it’s important to explore the options that are currently available to people in the medical field. Here are a few key solutions:

1. Creating a culture of collaboration

At the organizational level, administrators will need to establish a robust program for engaging the needs of physicians and specialists. Initiatives such as mental health interventions and counseling not only encourages productivity but improves personnel retention. These should also involve physicians in the decision-making mechanisms of the organization. 

Not all policies are reflective of what’s happening on the ground, so giving physicians a place in “higher up” conversations creates a culture of trust and collaboration. This, in turn, simplifies complex processes and leads to better outcomes for the whole organization. 

2. Training for bigger roles

Indeed, much of the occupational stress that doctors experience stems from a lack of professional support. When you have multiple specialists doing the same tasks without giving them an opportunity to expand their horizons, you risk creating an avenue where job dissatisfaction is rampant. One way to correct this is to invest in job enrichment and build an environment where constant learning is emphasized. 

This keeps the organization from thinning itself out with only a few specialists capable of handling certain tasks such as administering anesthesia or handling data security. In addition, providing doctors with enough autonomy to apply newly-acquired skills helps enhance productivity and bring innovation to the fore. Through skill development programs and participation in workshops, conferences, and team-building should be considered along these lines.

3.  Developing a stress engagement program 

Work stress interventions are critical to any organization, and that goes for hospitals and clinics. There is always a need to draft a game plan for knowing how to keep physicians and other practitioners engaged and prevent the onset of stress. 

There are a number of ways you can go about this. For one, you may opt for a more workable shift-rotation scheme. Psycho-physiological needs should also be met, so if your organization is based in Washington, you may recommend a Seattle pain relief clinic or pain management center that’s capable of addressing stress-induced conditions such as fibromyalgia.

Stress is rampant in the medical field because practitioners are committed to providing quality life-saving services. Organizations will only need to confront the reality that doctors, nurses, attendants and everyone else down the line require enough support, especially now as healthcare systems are met by unprecedented challenges. 


How Care Coordination Technology Addresses Social Isolation in Seniors

How Care Coordination Technology Addresses Social Isolation in Seniors
Jenifer Leaf Jaeger, MD, MPH, Senior Medical Director, HealthEC

Senior isolation is a health risk that affects at least a quarter of seniors over 65. It has become recognized over the past decade as a risk factor for poor aging outcomes including cognitive decline, depression, anxiety, Alzheimer’s disease, obesity, hypertension, heart disease, impaired immune function, and even death.

Physical limitations, lack of transportation, and inadequate health literacy, among other social determinants of health (SDOH), further impair access to medical and mental health treatment and preventive care for older adults. These factors combine to increase the impact of chronic comorbidities and acute issues in our nation’s senior population.

COVID-19 exacerbates the negative impacts of social isolation. The consequent need for social distancing and reduced use of the healthcare system due to the risk of potential SARS-CoV-2 exposure are both important factors for seniors. Without timely medical attention, a minor illness or injury quickly deteriorates into a life-threatening situation. And without case management, chronic medical conditions worsen. 

Among Medicare beneficiaries alone, social isolation is the source of $6.7 billion in additional healthcare costs annually. Preventing and addressing loneliness and social isolation are critically important goals for healthcare systems, communities, and national policy.

Organizations across the healthcare spectrum are taking a more holistic view of patients and the approaches used to connect the most vulnerable populations to the healthcare and community resources they need. To support that effort, technology is now available to facilitate analysis of the socioeconomic and environmental circumstances that adversely affect patient health and mitigate the negative impacts of social isolation. 

Addressing Chronic Health Issues and SDOH 

When we think about addressing chronic health issues and SDOH in older adults, it is usually after the fact, not focused on prevention. By the time a person has reached 65 years of age, they may already be suffering from the long-term effects of chronic diseases such as diabetes, hypertension or heart disease. Access points to healthcare for older adults are often in the setting of post-acute care with limited attention to SDOH. The focus is almost wholly limited to the treatment and management of complications versus preventive measures.  

Preventive outreach for older adults begins by focusing on health disparities and targeting patients at the highest risk. Attention must shift to care quality, utilization, and health outcomes through better care coordination and stronger data analytics. Population health management technology is the vehicle to drive this change. 

Bimodal Outreach: Prevention and Follow-Up Interventions

Preventive care includes the identification of high-risk individuals. Once identified, essential steps of contact, outreach, assessment, determination, referral, and follow-up must occur. Actions are performed seamlessly within an organization’s workflows, with automated interventions and triggered alerts. And to establish a true community health record, available healthcare and community resources must be integrated to support these actions. 

Social Support and Outreach through Technology 

Though older adults are moving toward more digitally connected lives, many still face unique barriers to using and adopting new technologies. So how can we use technology to address the issues?

Provide education and training to improve health literacy and access, knowledge of care resources, and access points. Many hospitals and health systems offer day programs that teach seniors how to use a smartphone or tablet to access information and engage in preventive services. For example, connecting home monitoring devices such as digital blood pressure reading helps to keep people out of the ED. 

Use population health and data analytics to identify high-risk patients. Determining which patients are at higher risk requires stratification at specific levels. According to the Centers for Disease Control and Prevention, COVID-19 hospitalizations rise with age, from approximately 12 per 100,000 people among those 65 to 74 years old, to 17 per 100,000 for those over 85. And those who recover often have difficulty returning to the same level of physical and mental ability. Predictive analytics tools can target various risk factors including:

– Recent ED visits or hospitalizations

– Presence of multiple chronic conditions

– Depression 

– Food insecurity, housing instability, lack of transportation, and other SDOH 

– Frailty indices such as fall risk

With the capability to identify the top 10% or the top 1% of patients at highest risk, care management becomes more efficient and effective using integrated care coordination platforms to assist staff in conducting outreach and assessments. Efforts to support care coordination workflows are essential, especially with staffing cutbacks, COVID restrictions, and related factors. 

Optimal Use of Care Coordination Tools

Training and education of the healthcare workforce is necessary to maximize the utility of care coordination tools. Users must understand all the capabilities and how to make the most of them. Care coordination technology simplifies workflows, allowing care managers to: 

– Risk-stratify patient populations, identify gaps in care, and develop customized care coordination strategies by taking a holistic view of patient care. 

– Target high-cost, high-risk patients for intervention and ensure that each patient receives the right level of care, at the right time and in the right setting.

– Emphasize prevention, patient self-management, continuity of care and communication between primary care providers, specialists and patients.

This approach helps to identify the resources needed to create community connections that older adults require. Data alone is insufficient. The most effective solution requires a combination of data analytics to identify patients at highest risk, business intelligence to generate interventions and alerts, and care management workflows to support outreach and interventions. 


About Dr. Jenifer Leaf Jaeger 

Dr. Jenifer Leaf Jaeger serves as the Senior Medical Director for HealthEC, a Best in KLAS population health and data analytics company. Jenifer provides clinical oversight to HealthEC’s population health management programs, now with a major focus on COVID-19. She functions at the intersection of healthcare policy, clinical care, and data analytics, translating knowledge into actionable insights for healthcare organizations to improve patient care and health outcomes at a reduced cost.

Prior to HealthEC, Jenifer served as Director, Infectious Disease Bureau and Population Health for the Boston Public Health Commission. She has previously held executive-level and advisory positions at the Massachusetts Department of Public Health, New York City Department of Health and Mental Hygiene, Centers for Disease Control and Prevention, as well as academic positions at Harvard Medical School, Boston University School of Medicine, and the Warren Alpert Medical School of Brown University.


New Legal Push Aims to Speed Magic Mushrooms to Dying Patients

Back in March, just as anxiety over COVID-19 began spreading across the U.S., Erinn Baldeschwiler of La Conner, Washington, found herself facing her own private dread.

Just 48 and the mother of two teenagers, Baldeschwiler was diagnosed with stage 4 metastatic breast cancer after discovering a small lump on her chest, no bigger than a pea. Within weeks, it was the size of a golf ball, angry and red. Doctors gave her two years to live.

“It’s heartbreaking,” she said. “Frankly, I was terrified.”

But instead of retreating into her illness, Baldeschwiler is pouring energy into a new effort to help dying patients gain legal access to psilocybin — the mind-altering compound found in so-called magic mushrooms — to ease their psychic pain.

“I have personally struggled with depression, anxiety, anger,” Baldeschwiler said. “This therapy is designed to really dive in and release these negative fears and shadows.”

Dr. Sunil Aggarwal, a Seattle palliative care physician, and Kathryn Tucker, a lawyer who advocates on behalf of terminally ill patients and chairs a psychedelic practice group at Emerge Law Group, are championing a novel strategy that would make psilocybin available using state and federal “right-to-try” laws that allow terminally ill patients access to investigational drugs.

They contend that psilocybin — whether found in psychedelic mushrooms or synthetic copies — meets the criteria for use laid out by more than 40 states and the 2017 Right to Try Act approved by the Trump administration.

“Can you look at the statute and see by its terms that it applies to psilocybin?” Tucker said. “I think the answer is yes.”

Still, the pair admit they’re pushing a legal theory still untested in the courts. “This is untrodden ground,” Aggarwal said.

This month, Aggarwal, who works at the Advanced Integrative Medical Science Institute, known as AIMS, took the first step toward federal authorization of the substance in Washington state and perhaps across the nation. He submitted an application to manufacture psilocybin to the state’s Pharmacy Quality Assurance Commission, which would allow him to grow psilocybin mushrooms from spores at his clinic and administer them for therapeutic use.

Commission members haven’t yet reviewed the application, but Gordon MacCracken, an agency spokesperson, said there “would be a path” for possible license and use — if the application meets the requirements of state regulators and the federal Drug Enforcement Administration.

Currently, psilocybin use is illegal under federal law, classified as a Schedule 1 drug under the U.S. Controlled Substances Act, which applies to chemicals and substances with no accepted medical use and a high potential for abuse, such as heroin and LSD.

Recently, however, several U.S. cities and states have voted to decriminalize possession of small amounts of psilocybin. This month, Oregon became the first state to legalize psilocybin for regulated use in treating intractable mental health problems. The first patients will have access beginning in January 2023.

It’s part of a wider movement to rekindle acceptance of psilocybin, which was among psychedelic drugs vilified — and ultimately banned — after the legendary counterculture excesses of the 1960s and 1970s.

“I think a lot of those demons, those fears, have been metabolized in the 50 years since then,” Aggarwal said. “Not completely, but we’ve moved it along so that it’s safe to try again.”

He points to a growing body of evidence that finds that psilocybin can have significant and lasting effects on psychological distress. The Johns Hopkins Center for Psychedelic and Consciousness Research, launched this year, has published dozens of peer-reviewed studies based on two decades of research. They include studies confirming that psilocybin helped patients grappling with major depressive disorder, thoughts of suicide and the emotional repercussions of a cancer diagnosis.

Psilocybin therapy appears to work by chemically altering brain function in a way that temporarily affects a person’s ego, or sense of self. In essence, it plays on the out-of-body experiences made famous in portrayals of America’s psychedelic ’60s.

By getting out of their heads — and separating from all the fear and emotion surrounding death — people experience “being” as something distinct from their physical forms. That leads to a fundamental shift in perspective, said Dr. Ira Byock, a palliative care specialist and medical officer for the Institute for Human Caring at Providence St. Joseph Health.

“What psychedelics do is foster a frame shift from feeling helpless and hopeless and that life is not worth living to seeing that we are connected to other people and we are connected to a universe that has inherent connection,” he said.

“Along with that shift in perspective, there is very commonly a notable dissolution of the fear of dying, of nonexistence and of loss, and that’s just remarkable.”

The key is to offer the drugs under controlled conditions, in a quiet room supervised by a trained guide, Byock said. “It turned out they are exceedingly safe when used in a carefully screened, carefully guided situation with trained therapists,” he said. “Almost the opposite is true when used in an unprepared, unscreened population.”

Baldeschwiler is one of several AIMS cancer patients eager to undergo psilocybin therapy. Another is Michal Bloom, 64, of Seattle, who was diagnosed in 2017 with stage 3 ovarian cancer. The anxiety of living with the terminal disease is overwhelming, she said.

“It’s as if someone came up to you, put a gun to the back of your head, whispered, ‘I have a gun to your head and I’ll have a gun to your head for the rest of your life. I may pull the trigger, I may not,’” she said. “How do you live like that?”

Research shows that a single six-hour session of psilocybin therapy may be enough to quell that fear, Aggarwal said. “I’m really interested in a right-to-try approach because it’s really what we need for patients right now,” he said.

Under the state and federal laws, to be eligible for “right-to-try” status, a treatment must have completed a phase 1 clinical trial approved by the federal Food and Drug Administration, be part of active clinical trials and in ongoing development or production.

So far, psilocybin ticks all those boxes, Tucker said.

The FDA has granted “breakthrough therapy” status to psilocybin for use in U.S. clinical trials conducted by Compass Pathways, a psychedelic research group in Britain, and by the Usona Institute, a nonprofit medical research group in Wisconsin. More than three dozen trials are recruiting participants or completed, federal records show.

But access to the drug remains a hurdle. Though psychedelic mushrooms grow wild in the Pacific Northwest and underground sources of the drug are available, finding a legal supply is nearly impossible.

Tucker and Aggarwal asked Usona last summer for a supply of the synthetic psilocybin its researchers produce for clinical trials, but so far have received nothing. Penny Patterson, a Usona spokesperson, said there’s been no “definitive resolution” and that conversations are continuing.

The firm’s reluctance may reflect a larger unease with employing right-to-try laws to speed use of psilocybin, said Dr. Anthony Back, a palliative care physician at the University of Washington.

Back supports the use of psilocybin for cancer patients and has even tried the drug to better understand the experience. But he said using psilocybin outside of formal clinical trials might endanger Usona’s ability to get traditional FDA approval. Adverse events may occur that will have to be reported to the FDA, an agency already watching the research closely.

“I can see why they’re hesitant, to be honest,” Back said. “I think right-to-try is an uphill battle.”

Still, Tucker and other advocates say it’s a battle worth fighting. End of Life Washington, a group focused on helping terminally ill patients use the state’s Death With Dignity Act, recently published a policy that supports psilocybin therapy as a form of palliative care. Other treatments for anxiety and depression, such as medication and counseling, may simply not be practical or effective at that point, said Judith Gordon, a psychologist and member of the group’s board of directors.

“When people are dying, they don’t have the time or the energy to do a lot of psychotherapy,” she said.

Baldeschwiler agrees. With perhaps less than two years to live, she wants access to any tool that can ease her pain. Immunotherapy has helped with the physical symptoms, dramatically shrinking the size of the tumor on her chest. Harder to treat has been the gnawing anxiety that she won’t see her 16-year-old daughter, Shea McGinnis, and 13-year-old son, Gibson McGinnis, become adults.

“They are beautiful children, good spirits,” she said. “To know I might not be around for them sucks. It’s really hard.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

USE OUR CONTENT

This story can be republished for free (details).

Family Mourns Man With Mental Illness Killed by Police, Calls for Change

Rulennis Muñoz remembers the phone ringing on Sept. 13. Her mother was calling from the car, frustrated. Rulennis could also hear her brother Ricardo shouting in the background. Her mom told her that Ricardo, who had been diagnosed with paranoid schizophrenia five years earlier, wouldn’t take his medication.

Within an hour, Ricardo Muñoz, 27, was dead. Muñoz, who had a knife, was killed by a police officer in Lancaster, Pennsylvania. The incident has striking similarities to the killing of Walter Wallace Jr. in Philadelphia six weeks later but has received far less national attention.

According to a Washington Post tracker, as of Nov. 18, police had killed 987 people in the U.S. in the past 12 months. Like Muñoz and Wallace, almost a quarter of those people had a diagnosis of a serious mental illness.

Two Sisters, Two Different Calls for Help

Ricardo Muñoz lived with his mother in Lancaster, but earlier on that September Sunday he had been across town at his sister Rulennis Muñoz’s house. Rulennis recalled that her brother had been having what she calls “an episode” that morning. Ricardo became agitated because his phone charger was missing. When she found it for him, he insisted it wasn’t the same one.

Rulennis knew her brother was in crisis and needed psychiatric care. But she also knew from experience that there were few emergency resources available for Ricardo unless a judge deemed him a threat to himself or others.

After talking with her mom, Rulennis called a county crisis intervention line to see if Ricardo could be committed for inpatient care. It was Sunday afternoon. The crisis worker told her to call the police to see if the officers could petition a judge to force Ricardo to go to the hospital for psychiatric treatment, an involuntary commitment. Reluctant to call 911, and wanting more information, Rulennis dialed the nonemergency police number.

Meanwhile, her mother, Miguelina Peña, was back in her own neighborhood. Her other daughter, Deborah, lives a few doors down. Peña started telling Deborah what was going on. Ricardo was becoming aggressive; he had punched the inside of the car. Back on their block, he was still yelling and upset and couldn’t be calmed. Deborah called 911 to get help for Ricardo. She didn’t know her sister was trying the nonemergency line.

The 911 Call

recording and transcript of the 911 call show that the dispatcher gave Deborah three options: police, fire or ambulance. Deborah wasn’t sure, so she said “police.” Then she went on to explain that Ricardo was being aggressive, had a mental illness and needed to go to the hospital.

Meanwhile, Ricardo walked up the street to where he and his mother lived. When the dispatcher questioned Deborah further, she mentioned that Ricardo was trying “to break into” his mom’s house. She didn’t mention that Ricardo also lived in that house. She did mention that her mother “was afraid” to go back home with him.

The Muñoz family has since emphasized that Ricardo was never a threat to them. However, by the time police got the message, they believed they were responding to a domestic disturbance.

“Within minutes of … that phone call, he was dead,” Rulennis said.

Ricardo’s mom, Miguelina Peña, recalls what she saw that day. A Lancaster police officer walked toward the house. Ricardo saw the officer approach through the living room window, and he ran upstairs to his bedroom. When he came back down, he had a hunting knife in his hand.

In video from a police body camera, an unidentified officer walks toward the Muñoz residence. Ricardo steps outside, and shouts “Get the f–k back.” Ricardo comes down the stairs of the stoop and runs toward the officer. The officer starts running down the sidewalk, but after a few steps, he turns back toward Ricardo, gun in hand, and shoots him several times. Within minutes, Ricardo is dead.

After Ricardo crumples to the sidewalk, his mother’s screams can be heard, off-camera. Police made the body camera video public a few hours after Ricardo’s death, in an effort to dispel rumors about Ricardo’s death and quell rioting in the city. The county district attorney has since deemed the shooting justified, and the officer’s name was never made public.

Spotty Care, Dangerous Crises

Across the U.S., people with mental illnesses are 16 times more likely than the overall population to be killed by police, according to one study from the mental health nonprofit Treatment Advocacy Center.

Miguelina Peña said she tried for years to get help for her son.

Among the problems, the family couldn’t find a psychiatrist who was taking new patients, she said. Additionally, Peña speaks little English, and that made it difficult to help Ricardo enroll in health insurance, or for her to understand what treatments he was receiving. Ricardo got his prescriptions through a local nonprofit clinic for Latino men, Nuestra Clínica.

Instead of consistent medical care and a trusted therapeutic relationship, Ricardo got treatment that was sporadic and fueled by crisis: He often ended up in the hospital for a few days, then would be discharged back home with little or no follow-up care. This happened more times than his mother and sisters can recall.

“There was an occasion where a judge was involved, and the judge determined that he should be released home,” Peña said. “And my question is, why would the judge allow him to go home if he wasn’t doing well?”

Immediate Threats and Escalation

Laws in Pennsylvania and many other states make it difficult for a family to get psychiatric care for someone who doesn’t want it; it can be imposed on the person only if he or she poses an immediate threat, said Angela Kimball, advocacy and public policy director at the National Alliance on Mental illness. By that point, it’s often law enforcement, rather than mental health professionals, who are called in to help.

“Law enforcement comes in and exerts a threatening posture,” Kimball said. “For most people, that causes them to be subdued. But if you’re experiencing a mental illness, that only escalates the situation.”

People who have a family member with mental illness should learn what local resources are available and plan for a crisis, Kimball advised. But she acknowledged that many of the services she frequently recommends, such as crisis hotlines or special response teams for mental health, aren’t available in most parts of the country.

If 911 is the only option, calling it can be a difficult decision, Kimball said.

“Dialing 911 will accelerate a response by emergency personnel, most often police,” she said. “This option should be used for extreme crisis situations that require immediate intervention. These first responders may or may not be appropriately trained and experienced in de-escalating psychiatric emergencies.”

The National Alliance on Mental Illness continues to advocate for more resources for families dealing with a mental health crisis. The group says more cities should create crisis response teams that can respond at all hours, without involving armed police officers in most situations.

There has been progress on the federal level, as well. Kimball was happy when President Donald Trump signed a bipartisan congressional bill, on Oct. 17, to implement a three-digit national suicide prevention hotline. The number — 988 — will eventually summon help when dialed anywhere in the country. But it could take a few years before the system is up and running.

Rulennis Muñoz said the family never got to see how Ricardo would have responded to someone other than a police officer.

“And instead of a cop just being there, there should have been other responders,” Rulennis said. “There should have been someone that knew how to deal with this type of situation.”

This story comes from a reporting partnership with WITF, NPR and KHN.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

USE OUR CONTENT

This story can be republished for free (details).

Facebook Live: Helping COVID’s Secondary Victims: Grieving Families and Friends

Can’t see the video player? View the video here.

The coronavirus pandemic has killed more than 246,000 people in the U.S., but it also has left hundreds of thousands of others grieving, and often feeling as if they have been robbed of the usual methods for dealing with the loss. For every person who dies of the virus, nine close family members are affected, researchers estimate. In addition to deep sadness, the ripple effects may linger for years as survivors deal with traumatic stress, anxiety, guilt and regret.

As the holidays approach, millions of people will be experiencing these losses afresh, as well as disruptions to comforting routines and beloved traditions.

Judith Graham, author of KHN’s Navigating Aging column, hosted a discussion on these unprecedented losses and dealing with the bereavement on Facebook Live on Monday. She was joined by Holly Prigerson, co-director of the Center for Research on End-of-Life Care at Weill Cornell Medicine in New York City, and Diane Snyder-Cowan, leader of the bereavement professionals steering committee of the National Council of Hospice and Palliative Professionals.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

USE OUR CONTENT

This story can be republished for free (details).

Long-Term Care Workers, Grieving and Under Siege, Brace for COVID’s Next Round

In the middle of the night, Stefania Silvestri lies in bed remembering her elderly patients’ cries.

“Help me.”

“Please don’t leave me.”

“I need my family.”

Months of caring for older adults in a Rhode Island nursing home ravaged by COVID-19 have taken a steep toll on Silvestri, 37, a registered nurse.

She can’t sleep, as she replays memories of residents who became ill and died. She’s gained 45 pounds. “I have anxiety. Some days I don’t want to get out of bed,” she said.

Now, as the coronavirus surges around the country, Silvestri and hundreds of thousands of workers in nursing homes and assisted living centers are watching cases rise in long-term care facilities with a sense of dread.

Many of these workers struggle with grief over the suffering they’ve witnessed, both at work and in their communities. Some, like Silvestri, have been infected with the coronavirus and recovered physically — but not emotionally.

Since the start of the pandemic, more than 616,000 residents and employees at long-term care facilities have been struck by COVID-19, according to the latest data from KFF. Just over 91,000 have died as the coronavirus has invaded nearly 23,000 facilities. (KHN is an editorially independent program of KFF.)

At least 1,000 of those deaths represent certified nursing assistants, nurses and other people who work in institutions that care for older adults, according to a recent analysis of government data by Harold Pollack, a professor at the School of Social Service Administration at the University of Chicago. This is almost certainly an undercount, he said, because of incomplete data reporting.

How are long-term care workers affected by the losses they’re experiencing, including the deaths of colleagues and residents they’ve cared for, often for many years?

Edwina Gobewoe, a certified nursing assistant who has worked at Charlesgate Nursing Center in Providence, Rhode Island, for nearly 20 years, acknowledged “it’s been overwhelming for me, personally.”

At least 15 residents died of COVID-19 at Charlesgate from April to June, many of them suddenly. “One day, we hear our resident has breathing problems, needs oxygen, and then a few days later they pass,” she said. “Families couldn’t come in. We were the only people with them, holding their hands. It made me very, very sad.”

Every morning, Gobewoe would pray with a close friend at work. “We asked the Lord to give us strength so we could take care of these people who needed us so much.” When that colleague was struck by COVID-19 in the spring, Gobewoe prayed for her recovery and was glad when she returned to work several weeks later.

But sorrow followed in early September: Gobewoe’s friend collapsed and died at home while complaining of unusual chest pain. Gobewoe was told that her death was caused by blood clots, which can be a dangerous complication of COVID-19.

She would “do anything for any resident,” Gobewoe remembered, sobbing. “It’s too much, something you can’t even talk about,” describing her grief.

I first spoke to Kim Sangrey, 52, of Lancaster, Pennsylvania, in July. She was distraught over the deaths of 36 residents in March and April at the nursing home where she’s worked for several decades — most of them due to COVID-19 and related complications. Sangrey, a recreational therapist, asked me not to name the home, where she continues to be employed.

“You know residents like family — their likes and dislikes, the food they prefer, their families, their grandchildren,” she explained. “They depend on us for everything.”

When COVID-19 hit, “it was horrible,” she said. “You’d go into residents’ rooms and they couldn’t breathe. Their families wanted to see them, and we’d set up Zoom wearing full gear, head to toe. Tears are flowing under your mask as you watch this person that you loved dying — and the family mourning their death through a tablet.”

“It was completely devastating. It runs through your memory — you think about it all the time.”

Mostly, Sangrey said, she felt empty and exhausted. “You feel like this is never going to end — you feel defeated. But you have to continue moving forward,” she told me.

Three months later, when we spoke again, COVID-19 cases were rising in Pennsylvania but Sangrey sounded resolute. She’d had six sessions with a grief counselor and said it had become clear that “my purpose at this point is to take every ounce of strength I have and move through this second wave of COVID.”

“As human beings, it is our duty to be there for each other,” she continued. “You say to yourself, OK, I got through this last time, I can get through it again.”

That doesn’t mean that fear is absent. “All of us know COVID-19 is coming. Every day we say, ‘Is today the day it will come back? Is today the day I’ll find out I have it?’ It never leaves you.”

To this day, Silvestri feels horrified when she thinks about the end of March and early April at Greenville Center in Rhode Island, where up to 79 residents became ill with COVID-19 and at least 20 have died.

The coronavirus moved through the facility like wildfire. “You’re putting one patient on oxygen and the patient in the next room is on the floor but you can’t go to them yet,” Silvestri remembered. “And the patient down the hall has a fever of 103 and they’re screaming, ‘Help me, help me.’ But you can’t go to him either.”

“I left work every day crying. It was heartbreaking — and I felt I couldn’t do enough to save them.”

Then, there were the body bags. “You put this person who feels like family in a plastic body bag and wheel them out on a frame with wheels through the facility, by other residents’ rooms,” said Silvestri, who can’t smell certain kinds of plastic without reliving these memories. “Thinking back on it makes me feel physically ill.”

Silvestri, who has three children, developed a relatively mild case of COVID-19 in late April and returned to work several weeks later. Her husband, Michael, also became ill and lost his job as a truck driver. After several months of being unemployed, he’s now working at a construction site.

Since July 1, the family has gone without health insurance, “so I’m not able to get counseling to deal with the emotional side of what’s happened,” Silvestri said.

Although her nursing home set up a hotline number that employees could call, that doesn’t appeal to her. “Being on the phone with someone you don’t know, that doesn’t do it for me,” she said. “We definitely need more emotional support for health care workers.”

What does help is family. “I’ve leaned on my husband a lot and he’s been there for me,” Silvestri said. “And the children are OK. I’m grateful for what I have — but I’m really worried about what lies ahead.”

The Navigating Aging column last week focused on how nursing homes respond to grief sweeping through their facilities.

Join Judith Graham for a Facebook Live event on grief and bereavement during the coronavirus pandemic on Monday, Nov. 16, at 1 p.m. ET. You can watch the conversation here and submit questions in advance here.

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

USE OUR CONTENT

This story can be republished for free (details).

Prayers and Grief Counseling After COVID: Trying to Aid Healing in Long-Term Care

A tidal wave of grief and loss has rolled through long-term care facilities as the coronavirus pandemic has killed more than 91,000 residents and staffers — nearly 40% of recorded COVID-19 deaths in the U.S.

And it’s not over: Facilities are bracing for further shocks as coronavirus cases rise across the country.

Workers are already emotionally drained and exhausted after staffing the front lines — and putting themselves at significant risk — since March, when the pandemic took hold. And residents are suffering deeply from losing people they once saw daily, the disruption of routines and being cut off from friends and family.

In response, nursing homes and assisted living centers are holding memorials for people who’ve died, having chaplains and social workers help residents and staff, and bringing in hospice providers to offer grief counseling, among other strategies. More than 2 million vulnerable older adults live in these facilities.

“Everyone is aware that this is a stressful, traumatic time, with no end in sight, and there needs to be some sort of intervention,” said Barbara Speedling, a long-term care consultant working on these issues with the American Health Care Association and National Center for Assisted Living, an industry organization.

Connie Graham, 65, is corporate chaplain at Community Health Services of Georgia, which operates 56 nursing homes. For months, he’s been holding socially distant prayer services in the homes’ parking lots for residents and staff members.

“People want prayers for friends in the facilities who’ve passed away, for relatives and friends who’ve passed away, for the safety of their families, for the loss of visitation, for healing, for the strength and perseverance to hold on,” Graham said.

Central Baptist Village, a Norridge, Illinois, nursing home, held a socially distanced garden ceremony to honor a beloved nurse who had died of COVID-19. “Our social service director made a wonderful collage of photos and left Post-its so everyone could write a memory” before delivering it to the nurse’s wife, said Dawn Mondschein, the nursing home’s chief executive officer.

“There’s a steady level of anxiety, with spikes of frustration and depression,” Mondschein said of staff members and residents.

Vitas Healthcare, a hospice provider in 14 states and the District of Columbia, has created occasional “virtual blessing services” on Zoom for staffers at nursing homes and assisted living centers. “We thank them for their service and a chaplain gives words of encouragement,” said Robin Fiorelli, Vitas’ senior director of bereavement and volunteers.

Vitas has also been holding virtual memorials via Zoom to recognize residents who’ve died of COVID-19. “A big part of that service is giving other residents an opportunity to share their memories and honor those they’ve lost,” Fiorelli said.

On Dec. 6, Hospice Savannah is going one step further and planning an online broadcast of its annual national “Tree of Light” memorial, with grief counselors who will offer healing strategies. During the service, candles will be lit and a moment of silence observed in remembrance of people who’ve died.

“Grief has become an urgent mental health issue, and we hope this will help begin the healing process for people who haven’t been able to participate in rituals or receive the comfort and support they’d normally have gotten prior to COVID-19,” said Kathleen Benton, Hospice Savannah’s president and chief executive officer.

But these and other attempts are hardly equal to the extent of anguish, which has only grown as the pandemic stretches on, fueling a mental health crisis in long-term care.

“There is a desperate need for psychological services,” said Toni Miles, a professor at the University of Georgia’s College of Public Health and an expert on grief and bereavement in long-term care settings. She’s created two guides to help grieving staffers and residents and is distributing them digitally to more than 400 nursing homes and 1,000 assisted living centers in the state.

A recent survey by Altarum, a nonprofit research and consulting firm, highlights the hopelessness of many nursing home residents. The survey asked 365 people living in nursing homes about their experiences in July and August.

“I am completely isolated. I might as well be buried already,” one resident wrote. “There is no hope,” another said. “I feel like giving up. … No emotional support nor mental health support is available to me,” another complained.

Inadequate mental health services in nursing homes have been a problem for years. Instead of counseling, residents are typically given medications to ease symptoms of distress, said David Grabowski, a professor of health care policy at Harvard Medical School who has published several studies on this topic.

The situation has worsened during the pandemic as psychologists and social workers have been unable to enter facilities that limited outsiders to minimize the risk of viral transmission.

“Several facilities didn’t consider mental health professionals ‘essential’ health care providers, and many of us weren’t able to get in,” said Lisa Lind, president of Psychologists in Long-Term Care. Although some facilities switched to tele-mental health services, staff shortages have made those hard to arrange, she noted.

Fewer than half of nursing home staffers have health insurance, and those who do typically don’t have “minimal” access to mental health services, Grabowski said. That’s a problem because “there’s a real fragility right now on the part of the workforce.”

Colleen Frankenfield, president and chief executive officer of Lutheran Social Ministries of New Jersey, said what staffers need most of all is “the ability to vent and to have someone comfort them.” She recalls a horrible day in April, when four residents died in less than 24 hours at her organization’s continuing care retirement community in northern New Jersey, which includes an assisted living facility and a nursing home.

“The phone rang at 1 a.m. and all I heard on the other end was an administrator, sobbing,” she remembered. “She said she felt she was emotionally falling apart. She felt like she was responsible for the residents who had died, like she had let them down. She just had to talk about what she was experiencing and cry it out.”

Although Lutheran Social Ministries has been free of COVID-19 since the end of April, “our employees are tired — always on edge, always worried,” Frankenfield said. “I think people are afraid and they need time to heal. At the end of the day, all we can really do is stand with them, listen to them and support them in whatever way we can.”

Coming Monday: The Navigating Aging column will look at the grief faced by long-term care workers as COVID-19 cases and deaths mount.

Join Judith Graham for a Facebook Live event on grief and bereavement during the coronavirus pandemic on Monday, Nov. 16, at 1 p.m. ET. You can watch the conversation here and submit questions in advance here.

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

USE OUR CONTENT

This story can be republished for free (details).

NeuroFlow Joins Epic App Orchard for Behavioral Health Integration

NeuroFlow Joins Epic App Orchard for Behavioral Health Integration

What You Should Know:

–  NeuroFlow,
the leader in technology-enabled behavioral health integration, is now
available to healthcare providers through Epic’s App
Orchard marketplace
. NeuroFlow combines provider workflow augmentation
solutions, clinical care dashboards, and a patient-facing application to create
a clinical feedback loop centered around behavioral health.

– Patient generated data including validated assessment
scores, mood and sleep ratings, and journal responses are fed into NeuroFlow’s
provider-facing web platform, which leverages a combination of machine learning
and natural language processing (NLP) from patient journal entries to risk
stratify patients and enhance care coordination efforts.

– The NeuroFlow integration with Epic will
help organizations accelerate their efforts toward integrated care by
facilitating reimbursement for collaborative care codes and optimizing value-based contracts.

– The launch is an encouraging development for health
systems seeking to practice any of a range of collaborative care models, a
clinical approach integrating both the physical and mental health of
patients. Hospitals and health systems using Epic can deploy NeuroFlow to
streamline clinical workflows and scale existing initiatives for measuring and
treating patients’ mental health symptoms.

4 Ways to Combat Hidden Costs Associated with Delayed Patient Care During COVID-19

Matt Dickson, VP, Product, Strategy, and Communication Solutions at Stericycle
Matt Dickson, VP, Product, Strategy, and Communication Solutions at Stericycle

COVID-19 terms such as quarantine, flatten the curve, social distance, and personal protective equipment (PPE) have dominated headlines in recent months, but what hasn’t been discussed in length are the hidden costs of COVID-19 as it relates to patient adherence.  

The coronavirus pandemic has amplified this long-standing issue in healthcare as patients are delaying routine preventative and ongoing care for ailments such as mental health and chronic disease. Emergency care is also suffering at alarming rates. Studies show a 42 percent decline in emergency department visits, measuring the volume of 2.1 million visits per week between March and April 2019 to 1.2 million visits per week between March and April 2020. Patients are not seeking the treatment they need – and at what cost?

When the SARS outbreak occurred in 2002, particularly in Taiwan, there was a marked reduction in inpatient care and utilization as well as ambulatory care. Chronic-care hospitalizations for long-term conditions like diabetes plummeted during the SARS crisis but skyrocketed afterward. Similar to the 2002 epidemic, people are currently not venturing en masse to emergency rooms or hospitals, but if history repeats itself, hospital and ER visits will happen at an influx and create a new strain on the healthcare system.

So, if patients aren’t going to the ER or visiting their doctors regularly, where have they gone? They are staying at home. According to reports from the Kaiser Family Foundation, 28 percent of Americans polled said they or a family member delayed medical care due to the pandemic, and 11 percent indicated that their condition worsened as a result of the delayed care. Of note, 70 percent of consumers are concerned or very concerned about contracting COVID-19 when visiting healthcare facilities to receive care unrelated to the virus. There is a growing concern that patients will either see a relapse in their illness or will experience new complications when the pandemic subsides. 

Rather than brace for a tidal wave of patients, healthcare systems should proactively take steps (or act now) to drive patient access, action, and adherence.

1. Identify Who Needs to Care The Most 

Healthcare providers should consider risk stratifying patients. High-risk people, such as an 80-year-old male with comorbidities and recent cardiac bypass surgery, may require a hands-on and frequent outreach effort. A 20-year-old female, however, who comes in annually for her physical but is healthy, may not require that level of engagement. Understanding which patients are at risk for the potential for chronic conditions to become acute or patients who have a hard time staying on their care plan may need prioritized attention and a more thorough engagement effort. 

For example, patients with a history of mental health issues may lack motivation or momentum to seek care. Their disposition to be disengaged may require greater input to push past their disengagement.  

Especially important is the ability to educate and guide patients to the appropriate venue of care (ER, telehealth visit, in-person primary care visit, or urgent care) based on their self-reported symptoms.  Allowing patients to self-triage while scheduling appointments helps them make more informed decisions about their care while reducing the burden on over-utilized emergency departments.

2. Capture The Attention of The Intended Audience and Induce Action

Once you’ve identified who needs care the most, how do you break through the “information clutter” to ensure healthcare messages resonate with the intended audience? The more data points, the better. It is important to understand the age of the patient, their preferred communication channel, and the intended message for the recipient, but effective communication exceeds those three data points. Consider factors like the presence of mental health conditions, comorbidities, or health literacies. Then, think beyond the patient’s channel of choice and select the appropriate channel of communication (text, phone call, email, paid social media advertisement, etc.), that will most likely induce action. As an organization, also consider running A/B tests to detect and analyze behavior. As you collect more data, determine what exactly is inducing patient action. 

Of note, don’t underestimate the power of repetition. Patients may need to be reminded of the intended action a few times in a few different ways before moving forward with seeking the care they need. Repetition is also shown to decrease no-show rates, a critical metric. Proactive, prescriptive, and tailored communication will help increase engagement. Moving past the channel of choice and toward the channel of action is key.

3. Engage Patients Through Personalized and Tailored Communication 

In addition to identifying the right communication channel, it’s also important to ensure you deliver an effective message.  Communication with patients should be relevant to their particular medical needs while paying close attention to where each person is in their healthcare journey. Connecting with patients on both an emotional and rational level is also important. For example, sending a positive communication via phone, email, or text to lay the foundation for the interaction shows interest in the patient’s wellbeing. 

A “Hey, here’s why you need to come in” note makes a connection in a direct and personalized way. At the same time, and in a very pointed manner, sharing ways providers and health systems are keeping patients safe (e.g., telehealth, virtual waiting rooms, separate entrances, and mandating masks), also provides comfort to skittish patients. Additionally, consider all demographic information when tailoring communications. And don’t forget to analyze if changes in content impact no-show rates. Low overall literacy may impact health literacy and may require simpler and more positive words to positively impact adherence. 

It may sound daunting, especially for individual health systems, to personalize patient communication efforts, but the use of today’s data tools and technological advancements can relieve the burden and streamline efforts for an effective communication approach. 

4. Use Technology to Your Advantage (With Caution)

Once you have developed your communication strategy, don’t stop there.  Consider all aspects of the patient journey to drive action.  A virtual waiting room strategy, for example, can help ease patient concerns and encourage them to resume their care. Health systems can help patients make reservations, space out their arrival times, and safeguard social distancing measures—all while alleviating patient fears. Ideally, the patient would be able to seamlessly book an appointment and receive a specific arrival time, allowing ER staff to prepare for the patient’s arrival while minimizing onsite wait time.

When implemented properly, telehealth visits can also improve continuity of care, enhance provider efficiency, attract and retain patients who are seeking convenience, as well as appeal to those who would prefer not to travel to their healthcare facility for their visit. Providers need to determine which appointments can successfully be resolved virtually. Additionally, some patients might not have the means for a successful telehealth visit due to a lack of internet access, a language barrier, or a safe space to talk freely.

To ensure all patients receive quality care, health systems should make plans to serve patients who lack the technology or bandwidth to participate in video visits in an alternative manner. For example, monitor patients remotely by asking them to self-report basic information such as blood sugar levels, weight, and medication compliance via short message service (SMS). This gives providers the ability to continuously monitor their patients while enhancing patient safety, increasing positive outcomes, and enabling real-time escalation whenever clinical intervention is needed.

It is important we ensure all patients stay on track with their health, despite uncertain and fearful times. Health systems can enhance patient adherence and induce action through the implementation of tools that increase patient engagement and alleviate the impending strain on the healthcare system. 


About Matt Dickson

Matt Dickson is Vice President of Product, Strategy, and General Manager of Stericycle Communication Solutions, a patient engagement platform that seamlessly combines both voice and digital channels to provide the modern experience healthcare consumers want while solving complex challenges to patient access, action, and adherence. . He is a versatile leader with strong operational management experience and expertise providing IT, product, and process solutions in the healthcare industry for nearly 25 years. Find him on LinkedIn.

UnitedHealth must reprocess thousands of illegally denied mental health claims, judge orders

In a trial last year, a federal judge found that a UnitedHealth subsidiary had illegally denied mental health and substance use disorder claims. The same judge has now ordered the payer to reprocess all the claims and reform its guidelines.

How to tackle the mental health crisis that will come with a second Covid-19 wave

To prepare for this next wave, healthcare systems and community mental health organizations must find ways to scale resources to efficiently screen patients for behavioral health conditions, match them with the right resources and then monitor their progress over time

Lundbeck tops Q3 expectations following strong sales of mental health drugs

Denmark’s Lundbeck has beat its expectations in third quarter results, following a strong performance from its portfolio of mental health drugs, although its newly-launched migraine drug seems to have got off to a slow start.

Lundbeck posted quarterly sales of 4.46 billion Danish kroner ($693.39 million), which Reuters noted beat expectations of around 4.39 billion kroner expected by analysts in a poll compiled by Refinitiv.

The performance was thanks to increased sales of its mental health drug Abilify Maintena, which increased 19% in the first nine months of the year compared with the same period last year to 1.729 billion Danish kroner ($270 million).

Sales of its depression drug Trintellix increased 14% to 2.3 billion kroner ($360 million) over nine months.

Another of the company’s mental health drugs, Rexulti (brexipiprazole) for maintenance treatment of schizophrenia saw sales increased by 24% to just over 2 million Danish kroner ($310 million).

The company also has high hopes for its Vyepti migraine drug, although this has only produced sales of 42 million Danish kroner ($6.5 million) since its launch in the US in March.

Lundbeck added Vyepti to its portfolio following its acquisition of Alder in a deal worth up $1.95 billion in September last year.

The last in a gang of four calcitonin gene-related peptide (CGRP) drugs to be approved, Alder decided to develop Vyepti as an intravenous drug that is administered in hospital instead of using pens where patients administer doses themselves.

While the self-administered rivals from Amgen/Novartis, Eli Lilly and Teva that were already on the market at the time of approval may have an advantage in terms of convenience, Lundbeck hopes its IV drug will be more popular with payers.

CEO Deborah Dunsire said that patient feedback about Vyepti had been “strongly positive” and noted its fast onset may also give it the edge over rivals.

Lundbeck upwardly revised full-year earnings before interest and tax (EBIT) to come in between 2 billion crowns and 2.2 billion Danish kroner, up from a previous estimate of 1.8 billion kroner to 2 billion kroner.

 

 

 

The post Lundbeck tops Q3 expectations following strong sales of mental health drugs appeared first on .

Ontrak Acquires Science-Backed, Behavior Change Platform LifeDojo

Ontrak Acquires Science-Backed, Behavior Change Platform LifeDojo

What You Should Know:

– Ontrak acquires LifeDojo Inc, a San Francisco, CA-based
comprehensive, science-backed behavior change platform.

– The acquisition broadens Ontrak’s addressable market
and footprint to lower acuity populations enabling new interventions and remote
patient monitoring.


Ontrak, Inc., a
leading AI-powered
and telehealth-enabled,
virtualized healthcare company, today announced that it has acquired
LifeDojo Inc, a comprehensive, science-backed behavior change platform.
Financial details of the acquisition were not disclosed.

Behavior Change Platform for Consumers and Employers

Founded in 2013, LifeDojo is a platform that makes
transformative life changes possible for members in over 16 countries.
Supported by decades of public health research, the LifeDojo approach to
member-centric behavior change delivers lasting health improvement outcomes,
high enrollment, and better engagement than traditional programs. Clients
include Fortune 500 companies and high-tech, high-growth organizations who use
LifeDojo’s 32 behavior change modules.

COVID-19 Spawns Mental Health Surge

The Journal of the American Medical Association (JAMA) this month reported accumulating evidence of a “second wave” mental health surge that will present monumental challenges for an already greatly strained mental health system and individuals at high risk for mental health disorders such as anxiety, depression, and post-traumatic stress. A June 2020 survey from the Centers for Disease Control and Prevention of 5,412 US adults found that 40.9% of respondents reported “at least one adverse mental or behavioral health condition,” including depression, anxiety, posttraumatic stress, and substance abuse, with rates that were three to four times the rates one year ago.

4 Ways LifeDojo Acquisition Advances Ontrak’s Growth
Strategy

With the coronavirus pandemic rapidly increasing demand for
“telemental” health solutions, the acquisition of LifeDojo is expected to
advance the Ontrak growth strategy in four ways:

First, the acquisition adds a technology-first,
digital business deployed by blue chip customers in the employer space.

Second, LifeDojo enhances Ontrak’s market-leading
behavioral health engagement capabilities for new and existing customers, with
the addition of the LifeDojo digital tools that drive member value and lower
cost. The combination of behavioral health coaching and digital app-based
solutions meets accelerated payer demand for a comprehensive suite of
behavioral health services and solutions.

Third, the LifeDojo platform increases the company’s
addressable market by enabling the creation of lower cost, digital
interventions across behavioral health and chronic disease populations.

Fourth, LifeDojo’s member-facing apps enable remote
patient monitoring capabilities, initially focused on member reported data,
that will feed Ontrak AI capabilities and further personalize Ontrak’s
evidence-based coaching.

“As a public company and leader in virtualized healthcare, Ontrak is uniquely positioned to attract companies, products and technologies that expand our value proposition and footprint with health plan and employer partners. We will endeavor to make additional strategic purchases that expand our addressable market and maximize customer value. LifeDojo and these other intended acquisitions can possibly expand our total addressable $33.7 billion market by up to 100%,” said Mr. Terren Peizer, Chairman and CEO of Ontrak.

For Each Critically Ill COVID Patient, a Family Is Suffering, Too

The weeks of fear and uncertainty that Pam and Paul Alexander suffered as their adult daughter struggled against COVID-19 etched itself into the very roots of their hair, leaving behind bald patches by the time she left the hospital in early May.

Tisha Holt had been transferred by ambulance from a smaller hospital outside Nashville, Tennessee, to Vanderbilt University Medical Center on April 14, when her breathing suddenly worsened and doctors suspected COVID-19. Within several days her diagnosis had been confirmed, her oxygen levels were dropping, and breathing had become so excruciating that it felt like her “lungs were wrapped in barbed wire,” as Tisha describes it.

Vanderbilt doctors put the 42-year-old on a mechanical ventilator, and the next few weeks passed in a blur for her parents, who waited helplessly for the next update about the eldest of their three children.

“That’s when it got really, really bad,” Pam said. “We were not allowed to see her, to go, to talk to her — not anything. I would call. And I might get somebody, and then again I might not.” Later that first week after Tisha arrived at Vanderbilt, Pam reached a nurse. “She said, ‘Ms. Alexander, in all probability your daughter will die today.’ Me and my husband both, we just cried and cried.”

It “was probably more than likely the worst day of my life when the nurse told us that,” Paul said. “She was our first baby, and the first person that I’ve held that was part of me.”

The number of Americans hospitalized with the virus is increasing again, reaching 41,000 late last week, many with a circle of loved ones holding vigil in their minds, even if they can’t sit at the bedside. A decade ago, critical care clinicians coined the term post-intensive care syndrome, or PICS. It describes the muscle weakness, cognitive changes, anxiety and other physical and mental symptoms that some ICU patients cope with after leaving the hospital. Those complications are fallout from the medications, immobility and other possible components of being critically ill. Now they worry that some family members of critically ill COVID patients may develop a related syndrome, PICS-Family.

Studies show that about one-fourth of family members, and sometimes more, experience at least one symptom of PICS-Family, including anxiety, depression, post-traumatic stress disorder or “complicated grief” — grief that is persistent and disabling — when their loved one has been hospitalized, according to a 2012 review article published in the journal Critical Care Medicine. Dr. Daniela Lamas, a critical care physician at Boston’s Brigham and Women’s Hospital, believes relatives and friends of coronavirus patients may be particularly vulnerable.

Hospital rules designed to prevent the spread of the virus have robbed them of the opportunity to sit with their loved ones, watching clinicians provide medical care and gradually processing what’s happening between physician updates, Lamas said. In pre-pandemic times, a nurse “would explain what they had heard [from the doctor] and help them come to terms with unacceptable realities,” she said.

Life Becomes a Daze

The Alexanders could reach a doctor or nurse on most days. But not always, said Pam, acknowledging that “they had a lot to do.” Pam described trying to cope minute to minute, day to day, waiting for the next report from the hospital, wandering from room to room. “You just walk around sort of in a daze. You can’t think about anything else but that.”

Paul struggled with feelings of depression, often retreating to his workshop. “I wouldn’t do anything but sit there and cry, wouldn’t work on nothing, just sit there with my head in my hands.”

Meanwhile, they had become temporary parents to their grandsons, two teenagers who had homework and laundry and kept asking about their mom. Pam tried to shield them as much as possible. “There are a lot of things I just didn’t tell them until it got really bad,” she said.

Being physically cut off from their daughter was the hardest, Pam and Paul said. “I don’t care if I had to put on 40 layers of clothes,” Pam said. “Just to have gotten to go in and touch her and see her would have made a huge difference.”

Even though family members are typically barred from visiting during the pandemic, they can wrestle with guilt that they let a loved one down in his or her time of need, said Jim Jackson, a psychologist and assistant director at Vanderbilt’s ICU Recovery Center.

Without any visual sense of what’s going on, “people often move to worst-case scenarios; they move to catastrophic thinking,” he said. “And why wouldn’t they, because it’s already a hugely serious situation, right? It’s a five-alarm fire and they’re not able to be engaged.”

Seeking Healing

Doctors and nurses can ease the strain on loved ones by updating a designated family member at least once a day, said Judy Davidson, a nurse scientist at the University of California-San Diego and an author of the 2012 Critical Care Medicine review article. Arrange video calls, she suggested, so the family can see their loved one and better picture the room, clinicians and broader hospital environment.

“If we don’t protect them and keep them strong while the person is in the ICU,” Davidson said, “they won’t be strong enough to do the caregiving that’s necessary once the person comes home.”

After a patient does return home, family members may shy away from discussing what they have been through, so as not to burden their still recovering loved one, Jackson said. The ICU survivor may remain silent for similar reasons, he said.

“What tends to happen is they both sort of passively agree not to talk about the elephant in the room, when that’s exactly the best thing to do,” Jackson said.

Tisha — who finally left the hospital May 3 — was stunned by her parents’ appearance the first time she saw them. “They both looked exhausted and I was shocked at the amount of hair that they’d lost,” she wrote in an email. Treatment and damaged lungs have made it difficult for her to talk by phone.

Since then, her parents’ bald spots have begun to fill in, but they haven’t released their worry. Tisha can breathe from only the top of her lungs and needs 24-hour oxygen, Pam said. She’s not strong enough to return to work as a nurse, a job she loved. She no longer has health insurance and can’t afford even the cheapest plan on the Affordable Care Act exchanges. To this day, Tisha doesn’t know where she contracted the virus.

Her parents spend virtually all waking hours at Tisha’s home, about a 10-minute drive from their house, and check on her a few times daily, sometimes more often if she’s feeling poorly, Pam said. “I think, ‘Am I going to come over here and she’s going to be dead from her heart not working?’ It scares me to death because she has bad days and good days.”

Tisha keeps her cellphone handy in case they text or call. “If they call and I don’t answer, it sends them into a panic and they are apt to drive over here to make sure everything is alright,” she wrote.

She’s been attending a virtual ICU survivors support group at Vanderbilt that Jackson helps lead. It’s open to relatives, but Pam was unsure she could handle hearing others’ painful stories as she’s still processing her own. “I don’t mind talking to you about it,” she said, “but sometimes talking about it just sort of gets you in a funk.”

Their church community has provided solace, calling when Tisha was in the hospital and leaving food on the porch. Pam and Paul credit a myriad of prayers from loved ones near and far with bringing their daughter home. “Even the doctors, they really didn’t know why she was still here either, to be honest with you,” Paul said.

He hasn’t stopped fretting about his eldest child. “I still can’t turn it off — it hasn’t turned off,” Paul said. “But every day is a blessing, though.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

USE OUR CONTENT

This story can be republished for free (details).

COVID-19 Pandemic Further Exposes Systemic Racism…

Pandemic Further Exposes Systemic Racism… Healthcare Technology Digital Health
Michael A Greely, Co-Founder & General Partner at Flare Capital Partners

This will be ugly and sad. Racism has cost this country $16 trillion over the last twenty years according to a recent Citigroup report. Much of this loss ($13 trillion) was attributed to discriminatory lending practices and the 6.1 million fewer jobs created as a result, while disparity in wages ($2.7 trillion) and discrimination in housing policies and lost income due to restricted access to higher education accounted for the balance. The report estimates that if these gaps were to be closed, an incremental $5 trillion can be added to U.S. GDP over the next five years alone. Obviously, this does not even begin to account for the extraordinary pain and suffering racism inflicts on our country, much less the dramatic implications to the health and wellbeing for those impacted by racism.

The dramatic increase in unemployment since the onset of COVID-19 has garnered significant attention. While the overall unemployment rate of 7.9% in September is down from the pandemic-high of 14.7% in April, this improvement masks the dramatic discrepancies in rates for minorities; according to the U.S. Bureau of Labor Statistics, white Americans are 7.0% unemployed while the Black unemployment rate is 12.1%. Somewhat jarring, last week Columbia University published an analysis showing that eight million more people are now living in poverty just since the expiration of the Cares Act three months ago, disproportionally hitting minorities.

The story is even more dire when looking at the “True Rate of Unemployment” as defined by the Ludwig Institute for Shared Economic Prosperity which presumes that one needs to earn a minimum living wage of $20,000 to be deemed employed. Under such a definition, Black unemployment is 30.4%, although an improvement from what was seen for the ten years after the Great Recession of 2008.

Source Data: Ludwig Institute for Shared Economic Prosperity; Chart: Axios Visuals

It is estimated that 100.6 million Americans are out of the labor force now, many of whom are from disadvantaged segments of the population. In fact, for those earning more than $60,000 annually, the unemployment rate is a mere 1.0% below where it stood at the onset of the pandemic. For those who make less than $20 per hour (equivalent to a salary of approximately $27,000), the unemployment rate is 17.5% below where it was in February 2020 according to Opportunity Insights. Shockingly, America’s billionaires net worth has increased more than $850 billion since April.

The difference in life expectancy between white and Black Americans is criminally high – nearly five years, even when adjusted for gender, according to the Centers for Disease Control and Prevention (CDC) data. While the underlying causes are complex and fraught with political overtones, this issue is now front and center as the country struggles with the pandemic.

Sutter Health recently published COVID-19 data that attributed the 2.7x increase in hospitalization rates in their hospitals for Black patients versus white patients to, in part, more advanced illness at the time of admission, arguably reflecting a cultural aversion to the healthcare system or challenges around adequate access. CDC data are even worse, tabulating a 5.0x higher rate of hospitalization, 2.3x greater mortality rate, and 3.0x greater infection rate for Black versus white Americans, respectively.  This is particularly troublesome now with case counts spiking 17% just this past week and as winter sets in.

Life Expectancy

The Kaiser Family Foundation (KFF) forecasts that Medicaid roles will increase by 8.4% in 2021; in June there were 67.9 million Medicaid beneficiaries. It is quite clear that the pandemic is hitting minority and less educated segments of the population harder, often because they tend to be front-line essential workers and/or struggle with greater levels of unemployment. McKinsey recently estimated that as many as 10 million Americans will lose employer-sponsored health insurance due to COVID-19 by the end of 2021.

KFF also highlights the discrepancies in private health insurance rates by race: in 2018, white, Black, and Hispanic uninsured rates were 7.5%, 11.5% and 19.0%, respectively, which further exacerbates difficulties for minorities to access effective healthcare. The Affordable Care Act had a dramatic impact over the past decade as uninsured rates in 2010 were 13.1%, 19. 9% and 32.6%, respectively. This year the average family health insurance premium rose by 4% to more than $21,000.

While there is a heightened level of concern about the pace of coronavirus vaccine development, and whether there will be inappropriate political pressures applied to compromise long-cherished safety protocols, the Black community is expressing a particularly high level of skepticism. According to another KFF study, just under 50% of Black respondents would not take a free and safe vaccine, while only 17% would “definitely” do so. While further underscoring long-held distrust of the healthcare system, this phenomenon risks perpetuating the relatively poor health conditions experienced in many of those communities.

Recognizing this and the other numerous challenges introduced by the pandemic, the Healthcare Anchor Network (HAN) of 39 provider systems (many of whom are Flare Capital LPs) reiterated in September that racism is a public health crisis, putting forth a number of steps to chip away at these issues. First and foremost was a commitment to dramatically improve access to testing in underserved communities, as well as more robust inclusive hiring practices and greater spending with diverse suppliers and vendors. 

Importantly, the HAN spotlighted that systemic racism uncouples the public health infrastructure from the private healthcare system, often leading to “generational trauma and poverty.” A profound characterization. A recent Wall Street Journal analysis of CDC data showed a strong link between racism and mental health: in the week following the murder of George Floyd in May, 40.5% of Black adults exhibited symptoms of anxiety and depression (a five-point increase from the week just prior). While somewhat similar to post-traumatic stress disorders, racism is chronic and on-going much like an injury, and should not be considered a disorder. Clinicians have now developed a “Race-Based Traumatic Stress Symptom” scale when evaluating minority patients.

Advances in healthcare technology hold profound promise to improve the health and wellbeing of those most afflicted by racism, particularly during such difficult economic times. According to a provocative analysis by McKinsey (below), many of the most seminal transformative reforms in healthcare have come on the heels of major recessions. Arguably, what has been unleashed on the U.S. economy by COVID-19 may lead to a dramatic restructuring of the healthcare industry, which could usher in a wave of significant innovation to improve conditions for those most disadvantaged.

Entrepreneurship has been one of the great elixirs in the face of such devastating economic conditions and is often looked upon as one approach to reduce economic disparities due to racism. Here, unfortunately, the record is mixed. Given how critical access to capital is, the evidence that racial discrimination compromised many minority groups from accessing emergency funding programs like the Payroll Protection Program (PPP) this past spring is particularly painful. According to the Center for Responsible Lending, 46% of white-owned businesses had accessed bank credit over the past five years (compared to less than 25% for Black-owned businesses) which meaningfully facilitated their ability to secure PPP loans from those same institutions.

Furthermore, a 2016 Federal Reserve Bank study found that only 40% of minority credit applicants secure the full requested amounts of credit when applying as compared to 68% for white-owned applicants. Consistently minority-owned companies pay higher interest rates and have more onerous borrowing terms according to the Department of Commerce’s Minority Business Development Agency. The financial landscape confronting Black-owned businesses is materially more hostile than what white-owned businesses face. Full stop.

Source: Federal Reserve Bank of Atlanta

Rock Health, a leading seed-stage healthcare technology investor (and partner of Flare Capital), recently conducted an extensive diversity survey. These sober findings further highlight the issues around access to capital for minority entrepreneurs. White and Asian founders were nearly twice as likely to backed by venture capitalists; 48% of Black founders bootstrapped their companies versus 25% of white founders. Of the nearly 250 founder respondents in the survey, 12% identified as Black but only a disappointing 5% of the 425 senior executives in those companies were Black. Just over 80% of Black respondents felt that the digital health sector was either the same or less inclusive from when they initially joined the industry. Obviously, much work is still to be done.

Source: Rock Health

These issues are not at all lost on my partners and our firm. Since we started Flare Capital over six years ago, we have been committed to diversity and inclusion. In addition to simply being the right thing to do, it is the best thing for our business. We will make better investment decisions with a broadly diverse set of perspectives and experiences. 

But as inclusive as we felt we were, it is time to do even better. There are systemic causes to these inequities in our industry that we can help address. Over the last four months, we developed a set of new initiatives (summarized below) that we implemented earlier this summer. In summary, we identified two broad dimensions that we are committed to improving upon more equitable access and accelerated career development. Structural challenges exist for many underrepresented entrepreneurs to meet with venture capital firms, much less successfully raise capital. These are fundamental problems that require deliberate, measurable steps from engaging with more diverse founding teams, recruiting more diverse management teams, and partnering with venture firms equally committed to diversity.  



BIPOC = Black, Indigenous, People of Color

We recognize that it will take time and significant effort to address these inequities, and that success will be built, in part, upon many small victories. Arguably, Black Lives Matter is the largest movement in our country’s history. The New York Times recently estimated that between 15 to 26 million Americans likely participated in demonstrations since the death of George Floyd in late May. We are proud to be a part of that movement.


About Michael A. Greely

Michael A. Greely is the CoFounder and General Partner at Flare Capital Partners, a venture capital firm focused on investing in early-stage and emerging healthcare technology companies. Previously, Michael was the founding General Partner of Flybridge Capital Partners where he led the firm’s healthcare investments. Current and prior board seats include Aspen Health, BlueTarp Financial, Circulation, Explorys, Functional Neuromodulation, HealthVerity, higi, Iora Health, MicroCHIPS, Nuvesse, PolyRemedy, Predictive Biosciences, Predilytics, T2 Biosystems, TARIS Biomedical, VidSys and Welltok (observer).

70% Taking Common Antidepressants Suffer Sexual Side Effects

What’s the latest on treating depression with the spice saffron? Years ago, I covered a head-to-head comparison of saffron versus Prozac for the treatment of depression in my video Saffron vs. Prozac, and saffron seemed to work just as well as the drug. In the years since, five other studies have found that saffron beat out placebo or rivaled antidepressant medications.

It may be the spice’s red pigment, crocin, since that alone beat out placebo as an adjunct treatment, significantly decreasing symptoms of depression, symptoms of anxiety, and general psychological distress. Perhaps, its antioxidants played a role in “preventing free radical-induced damage in the brain.” The amount of crocin the researchers used was equivalent to about a half teaspoon of saffron a day.

If the spice works as well as the drugs, one could argue that the spice wins, since it doesn’t cause sexual dysfunction in the majority of men and women like most prescribed antidepressants do. SSRI drugs like Prozac, Paxil, and Zoloft cause “adverse sexual side effects” in around 70 percent of people taking them. What’s more, physicians not only significantly underestimate the occurrence of side effects, but they also tend to underrate how much they impact the lives of their patients.

Not only is this not a problem with saffron, the spice may even be able to treat it, as I explore in my video Best Food for Antidepressant-Induced Sexual Dysfunction. “In folk medicine, there is a widely held belief that saffron might have aphrodisiac effects.” To test this, men with Prozac-induced sexual impairment were randomized to saffron or placebo for a month. By week four, the saffron group “resulted in significantly greater improvement in erectile function…and intercourse satisfaction,” and more than half of the men in the saffron group regained “normal erectile function.” The researchers concluded that saffron is an “efficacious treatment” for Prozac-related erectile dysfunction. It has all been found to be effective for female sexual dysfunction, as well, as you can see at 2:35 in my video. Female sexual function increased by week four, improving some of the Prozac-induced sexual problems but not others. So, it may be better to try saffron in the first place for the depression and avoid developing these sexual dysfunction problems, since they sometimes can persist even after stopping the drugs, potentially worsening one’s long-term depression prognosis.

This includes unusual side effects, such as genital anesthesia, where you literally lose sensation. It can happen in men and women. More rarely, antidepressants can induce a condition called restless genital syndrome. You’ve heard of restless legs syndrome? Well, this is a restless between-the-legs syndrome. These PSSDs, or Post-SSRI Sexual Dysfunctions, meaning dysfunctions that appear or persist after stopping taking these antidepressants, can be so serious that “prescribing physicians should mention the potential danger of the occurrence of genital (e.g., penile or vaginal) anesthesia to every patient prior to any SSRI treatment.” If you’re on one of these drugs, did your doctor warn you about that?

All hope is not lost, though. Evidently, penile anesthesia responds to low-power laser irradiation. After 20 laser treatments to his penis, one man, who had lost his penile sensation thanks to the drug Paxil, partially regained his “penile touch and temperature sensation.” However, he still couldn’t perform to his girlfriend’s satisfaction, and she evidently ended up leaving him over it, which certainly didn’t help his mood. But, before you feel too badly for him, compare a little penile light therapy to clitoridectomy, clitoris removal surgery, or another Paxil-related case where a woman’s symptoms only improved after six courses of electroshock therapy.

Pass the paella!


For more on the spice, check out:

Those drug side effects sound devastating, but depression is no walk in the park. However, when one balances risk and benefit, one assumes that there are actually benefits to taking them. That’s why the shocking science I explored in Do Antidepressant Drugs Really Work? is so important.

What else may boost mood? A healthy diet and exercise:

For more on sexual health generally, see:

What else can spices do? Here’s just a taste:

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

Older COVID Patients Battle ‘Brain Fog,’ Weakness and Emotional Turmoil

“Lord, give me back my memory.”

For months, as Marilyn Walters has struggled to recover from COVID-19, she has repeated this prayer day and night.

Like other older adults who’ve become critically ill from the coronavirus, Walters, 65, describes what she calls “brain fog” — difficulty putting thoughts together, problems with concentration, the inability to remember what happened a short time before.

This sudden cognitive dysfunction is a common concern for seniors who’ve survived a serious bout of COVID-19.

“Many older patients are having trouble organizing themselves and planning what they need to do to get through the day,” said Dr. Zijian Chen, medical director of the Center for Post-COVID Care at Mount Sinai Health System in New York City. “They’re reporting that they’ve become more and more forgetful.”

Other challenges abound: overcoming muscle and nerve damage, improving breathing, adapting to new impairments, regaining strength and stamina, and coping with the emotional toll of unexpected illness.

Most seniors survive COVID-19 and will encounter these concerns to varying degrees. Even among the age group at greatest risk — people 85 and older — just 28% of those with confirmed cases end up dying, according to data from the Centers for Disease Control and Prevention. (Because of gaps in testing, the actual death rate may be lower.)

Walters, who lives in Indianapolis, spent almost three weeks in March and April heavily sedated, on a ventilator, fighting for her life in intensive care. Today, she said, “I still get tired real easy and I can’t breathe sometimes. If I’m walking sometimes my legs get wobbly and my arms get like jelly.”

“Emotionally, it’s been hard because I’ve always been able to do for myself, and I can’t do that as I like. I’ve been really nervous and jittery,” Walters said.

Younger adults who’ve survived a serious course of COVID-19 experience similar issues but older adults tend to have “more severe symptoms, and more limitations in terms of what they can do,” Chen said.

“Recovery will be on the order of months and years, not days or weeks,” said Dr. E. Wesley Ely, co-director of the Critical Illness, Brain Dysfunction and Survivorship Center at Vanderbilt University Medical Center. Most likely, he speculated, a year after fighting the disease at least half of the critically ill older patients will not have fully recovered.

The aftereffects of delirium — an acute, sudden change of consciousness and mental acuity — can complicate recovery from COVID-19. Seniors hospitalized for serious illness are susceptible to the often-unrecognized condition when they’re immobilized for a long time, isolated from family and friends, and given sedatives to ease agitation or narcotics for pain, among other contributing factors.

In older adults, delirium is associated with a heightened risk of losing independence, developing dementia and dying. It can manifest as acute confusion and agitation or as uncharacteristic unresponsiveness and lethargy.

“What we’re seeing with COVID-19 and older adults are rates of delirium in the 70% to 80% range,” said Dr. Babar Khan, associate director of Indiana University’s Center for Aging Research at the Regenstrief Institute, and one of Walters’ physicians.

Gordon Quinn, 77, a Chicago documentary filmmaker, believes he contracted COVID-19 at a conference in Australia in early March. At Northwestern Memorial Hospital, he was put on a ventilator twice in the ICU, for a total of nearly two weeks, and remembers having “a lot of hallucinations” — a symptom of delirium.

“I remember vividly believing I was in purgatory. I was paralyzed — I couldn’t move. I could hear snatches of TV — reruns of ‘Law & Order: Special Victims Unit’ — and I asked myself, ‘Is this my life for eternity?’” Quinn said.

Given the extent of delirium and mounting evidence of neurological damage from COVID-19, Khan said he expects to see “an increased prevalence of ICU-acquired cognitive impairment in older COVID patients.”

Ely agrees. “These patients will urgently need to work on recovery,” he said. Family members should insist on securing rehabilitation services — physical therapy, occupational therapy, speech therapy, cognitive rehabilitation — after the patient leaves the hospital and returns home, he advised.

“Even at my age, people can get incredible benefit from rehab,” said Quinn, who spent nearly two weeks at Chicago’s Shirley Ryan AbilityLab, a rehabilitation hospital, before returning home and getting several weeks of home-based therapy. Today, he’s able to walk nearly 2 miles and has returned to work, feeling almost back to normal.

James Talaganis, 72, of Indian Head Park, Illinois, also benefited from rehab at Shirley Ryan AbilityLab after spending nearly four months in various hospitals beginning in early May.

Talaganis had a complicated case of COVID-19: His kidneys failed and he was put on dialysis. He experienced cardiac arrest and was in a coma for almost 58 days while on a ventilator. He had intestinal bleeding, requiring multiple blood transfusions, and was found to have crystallization and fibrosis in his lungs.

When Talaganis began his rehab on Aug. 22, he said, “my whole body, my muscles were atrophied. I couldn’t get out of bed or go to the toilet. I was getting fed through a tube. I couldn’t eat solid foods.”

In early October, after getting hours of therapy each day, Talaganis was able to walk 660 feet in six minutes and eat whatever he wanted. “My recovery — it’s a miracle. Every day I feel better,” he said.

Unfortunately, rehabilitation needs for most older adults are often overlooked. Notably, a recent study found that one-third of critically ill older adults who survive a stay in the ICU did not receive rehab services at home after hospital discharge.

“Seniors who live in more rural areas or outside bigger cities where major hospital systems are providing cutting-edge services are at significant risk of losing out on this potentially restorative care,” said Dr. Sean Smith, an associate professor of physical medicine and rehabilitation at the University of Michigan.

Sometimes what’s most needed for recovery from critical illness is human connection. That was true for Tom and Virginia Stevens of Nashville, Tennessee, in their late 80s, who were both hospitalized with COVID-19 in early August.

Ely, one of their physicians, found them in separate hospital rooms, frightened and miserable. “I’m worried about my husband,” he said Virginia told him. “Where am I? What is happening? Where is my wife?” the doctor said Tom asked, before crying out, “I have to get out of here.”

Ely and another physician taking care of the couple agreed. Being isolated from each other was dangerous for this couple, married for 66 years. They needed to be put in a room together.

When the doctor walked into their new room the next day, he said, “it was a night-and-day difference.” The couple was sipping coffee, eating and laughing on beds that had been pushed together.

“They both got better from that point on. I know that was because of the loving touch, being together,” Ely said.

That doesn’t mean recovery has been easy. Virginia and Tom still struggle with confusion, fatigue, weakness and anxiety after their two-week stay in the hospital, followed by two weeks in inpatient rehabilitation. Now, they’re in a new assisted living residence, which is allowing outdoor visits with their family.

“Doctors have told us it will take a long time and they may never get back to where they were before COVID,” said their daughter, Karen Kreager, also of Nashville. “But that’s OK. I’m just so grateful that they came through this and we get to spend more time with them.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

USE OUR CONTENT

This story can be republished for free (details).

Impact of COVID-19: 2020 State of Healthcare Performance Improvement Report

Impact of COVID-19: 2020 State of Healthcare Performance Improvement Report

What You Should Know:

– Nearly three-quarters of hospital leaders are either
moderately (52%) or extremely (22%) concerned about the financial viability of
their organizations without an effective treatment or vaccine for COVID-19,
according to a new report from Kaufman Hall entitled, “2020 State of Healthcare
Performance Improvement Report: The Impact of COVID-19”

– One-third of respondents saw operating margin declines
in excess of 100% in the second quarter of 2020 compared with the same period
of 2019.

– This year’s report findings were based on 64 responses
to a survey that Kaufman Hall fielded in August 2020.


Nearly three-quarters
of hospital leaders are either moderately (52%) or extremely (22%) concerned
about the financial viability of their organizations without an effective
treatment or vaccine for COVID-19, according to a new report from Kaufman Hall. One-third of respondents
(33%) saw operating margin declines in excess of 100% in the second quarter of
2020 compared with the same period of 2019.

2020 State of Healthcare Performance Improvement Report: The
Impact of COVID-19
” is Kaufman Hall’s fourth annual survey of hospitals
and health systems on their performance improvement and cost transformation
efforts.

“The challenges brought on by the COVID-19 pandemic have
affected nearly every aspect of hospital financial and clinical
operations,” said Lance Robinson, managing director, Kaufman Hall. “Organizations have
responded to the challenge by adjusting their operations and strengthening
important community relationships.”

Key findings from this
year’s report include the following:

Financial viabilityApproximately three fourths of survey respondents are either extremely (22%) or moderately (52%) concerned about the financial viability of their organization in the absence of an effective vaccine or treatment.

Operating margins. One-third of our respondents saw year-over-year operating margin declines in excess of 100% from Q2 2019 to Q2 2020.

Volumes. Volumes in most service areas are recovering slowly. In only one area—oncology—have a majority of our respondents seen volumes return to more than 90% of pre-pandemic levels.

Expenses. A majority of survey respondents have seen their greatest percentage expense increase in the costs of supplying personal protective equipment. Nursing staff labor is in second place, cited by 34% of respondents as their most significant area of expense increase.

Healthcare workforce. Three-fourths of survey respondents have increased monitoring and resources to address staff burnout and mental health concerns.

Telehealth. More than half of our respondents have seen the number of telehealth visits at their organization increase by more than 100% since the pandemic began. Payment disparities between telehealth and in-person visits are seen as the greatest obstacle to more widespread adoption of telehealth.

Competition. Approximately one-third of survey respondents believe the pandemic has affected competitive dynamics in their market by making consumers more likely to seek care at retail-based clinics.

To download a copy of the report, click on the download
now button below

Were We Mentally Ready for COVID-19? Why It’s Time to Take Behavioral Health Seriously

Were We Mentally Ready for COVID-19? Why It’s Time to Take Behavioral Health Seriously
Dr. Jacob Lazarovic M.D., IMCS Group

As you read this, over 200,000 American deaths have been attributed to the virus. The influx of cases continues, while state and local economies are experiencing hardship, children are shuttered in their homes learning remotely, grown children are moving back home and the “new normal” disrupts nearly all of life’s plans. 

Yet, these issues don’t reveal all the traumas that Americans are experiencing 10 months into the pandemic. The pandemic’s impact continues to be swift and brutal, showing little sign of slowing down. Loneliness and isolation are gripping many American adults, as the nation settles in for a long fall/winter.

Growing evidence supports the notion that this virus is spread through aerosols, that is, person-to-person transmission by means of inhalation of infectious particles. With the onset of colder weather and the approaching holiday season, conditions are rife for spreading the virus. Flu season is imminent and COVID-19 cases are increasing.

While the safest choice is to isolate until the widespread availability of a vaccine arrives (within the next 6-12 months), this is an unwelcome option for some already suffering from “pandemic fatigue” and not really an option at all for others (like those who work outside the home).

Either way, America’s mental health is at risk. According to the CDC, reports of mental health conditions (anxiety, trauma, substance abuse, suicide) have considerably increased during the pandemic with more than 40% of American adults reporting mental health struggles. Frontline healthcare workers are particularly affected, and over 71% have experienced psychiatric symptoms, including depression, anxiety, insomnia, and distress. Even run-of-the-mill loneliness and isolation contribute to substance misuse and disorders, which, by the way, contribute to an increased risk for COVID-19.


Key Ways Mental Health Providers Can Help  

Because mental health threats are now part and parcel of living amid the COVID-19 pandemic, it is important to routinely gauge the health of those close to you, (and this is paramount for those recovering from COVID-19, frontline workers, and first responders.) Consider consulting a mental health provider if you notice any of these characteristics in yourself or someone you know:

– Displaying frequent, uncharacteristic anger, anxiety, irritation; 

– Withdrawing from friends and family;

– Ignoring personal hygiene;

– Engaging in high-risk activities, such as heavy drinking, illicit drug use, or self-destructive behavior;

– Exhibiting feelings of overwhelming sadness, hopelessness, grief, or worthlessness 

Nearly every American is impacted mentally, financially, and emotionally by the pandemic, and even the fortunate few who aren’t already personally affected are feeling the stress of an uncertain future. Mental health providers aim to improve coping skills, relationships, and self-care regimens to reduce anxiety, depression, or other mental illness. From generalized anxiety to neuropsychology related to recovery from COVID-19, behavioral health specialists are equipped to help in a myriad of ways such as these: 

1. Building resilience by introducing coping and stress tolerance activities, such as mindfulness and meditation, or a simple shift in perspective 

2. Shoring up social connections and relationships to serve as a layer of protection and diffusion from life stress

3. Ensuring self-care activities, such as adequate sleep, diet, exercise, and more to sustain mood and self-esteem

4. Delivering grief and loss counseling for those who have suffered acute human losses during the crisis

5. Counseling for substance abuse and addiction

6. Initiating a short intervention using cognitive behavioral therapy techniques

Those with pre-existing mental health issues, including depression, PTSD, social anxiety, agoraphobia, generalized anxiety and major depression, may benefit from an increased intensity in treatment, by frequency or duration.

For survivors of COVID-19 who have had significant cardiac and respiratory complications including prolonged periods of dyspnea (shortness of breath), hypoxemia (decreased blood oxygen levels), and hypoxia (decreased oxygenation of organs), neurocognitive screening and ongoing monitoring of mental status will be helpful.


Advances in Telemedicine 

Recent advances in computer-administered neurocognitive testing have allowed

clinicians to administer psychological and neurocognitive assessment instruments by telemedicine, and there are now many more neurocognitive assessment batteries available to aid in the detection and quantification of neuropsychological functional deficits.

Historically, psychologists, psychiatrists, and L.C.S.W.s have not done virtual sessions with patients, but COVID is changing that, and increasingly insurers are receptive to this practice. The technology, capability, and compliance aspects of virtual appointments were available prior to 2020, but COVID has brought “distance meeting” into the American vernacular. Medical doctors now treat patients via telehealth in numerous instances, and mental health patients can be treated using similar meeting applications.

Telebehavioral health could not be more timely. In the fight against isolation, virtual technology allows human beings to check on one another and meaningfully connect, at the same time allowing people seeking mental health services to receive treatment safely without risking infection from a devastating disease.  

Even as the pandemic presents a common threat like none other we have faced in recent years, it also offers us the opportunity to reach out and check on one another. Everyone is affected in some way by COVID-19, be it the disease itself or simply disruption to our routines and mass anxiety. It’s definitely time to take mental health seriously. Our technology ensures that we do not have to be alone in isolation, and relief may be just a call away. Through mutual understanding and effort, we can focus on the unifying experience of overcoming this crisis.


About Dr. Lazarovic

Dr. Lazarovic, M.D., F.A.A.F.P., has nearly 40 years of medical administration/managed care experience, including 18 years as Chief Medical Officer at Broadspire/CRAWFORD, a global third-party administrator of workers’ compensation, disability, auto and medical product liability claims. Experienced in clinical guidelines, medical cost control and strategic planning, Dr. Lazarovic has conducted and published original research and analytics and presented at multiple industry conferences. Dr. Lazarovic is currently the CMO responsible for the development of advanced, evidence-based clinical applications at MyAbilities Technologies, a medical software and services company in the workers’ compensation and disability sector.  


Sleepless Nights, Hair Loss and Cracked Teeth: Pandemic Stress Takes Its Toll

In late March, shortly after New York state closed nonessential businesses and asked people to stay home, Ashley Laderer began waking each morning with a throbbing headache.

“The pressure was so intense it felt like my head was going to explode,” recalled the 27-year-old freelance writer from Long Island.

She tried spending less time on the computer and taking over-the-counter pain medication, but the pounding kept breaking through — a constant drumbeat to accompany her equally incessant worries about COVID-19.

“Every day I lived in fear that I was going to get it and I was going to infect my whole family,” she said.

After a month and a half, Laderer decided to visit a neurologist, who ordered an MRI. But the doctor found no physical cause. The scan was clear.

Then he asked: Are you under a lot of stress?

Throughout the pandemic, people who never had the coronavirus have been reporting a host of seemingly unrelated symptoms: excruciating headaches, episodes of hair loss, upset stomach for weeks on end, sudden outbreaks of shingles and flare-ups of autoimmune disorders. The disparate symptoms, often in otherwise healthy individuals, have puzzled doctors and patients alike, sometimes resulting in a series of visits to specialists with few answers. But it turns out there’s a common thread among many of these conditions, one that has been months in the making: chronic stress.

Although people often underestimate the influence of the mind on the body, a growing catalog of research shows that high levels of stress over an extended time can drastically alter physical function and affect nearly every organ system.

Now, at least eight months into the pandemic, alongside a divisive election cycle and racial unrest, those effects are showing up in a variety of symptoms.

“The mental health component of COVID is starting to come like a tsunami,” said Dr. Jennifer Love, a California-based psychiatrist and co-author of an upcoming book on how to heal from chronic stress.

Nationwide, surveys have found increasing rates of depression, anxiety and suicidal thoughts during the pandemic. But many medical experts said it’s too soon to measure the related physical symptoms, since they generally appear months after the stress begins.

Still, some early research, such as a small Chinese study and an online survey of more than 500 people in Turkey, points to an uptick.

In the U.S., data from FAIR Health, a nonprofit database that provides cost information to the health industry and consumers, showed slight to moderate increases in the percentage of medical claims related to conditions triggered or exacerbated by stress, like multiple sclerosis and shingles. The portion of claims for the autoimmune disease lupus, for example, showed one of the biggest increases — 12% this year — compared with the same period last year (January to August).

Express Scripts, a major pharmacy benefit manager, reported that prescriptions for anti-insomnia medications increased 15% early in the pandemic.

Perhaps the strongest indicator comes from doctors reporting a growing number of patients with physical symptoms for which they can’t determine a cause.

Dr. Shilpi Khetarpal, a dermatologist at the Cleveland Clinic, used to see about five patients a week with stress-related hair loss. Since mid-June, that number has jumped to 20 or 25. Mostly women, ages 20 to 80, are reporting hair coming out in fistfuls, Khetarpal said.

In Houston, at least a dozen patients have told fertility specialist Dr. Rashmi Kudesia they’re having irregular menstrual cycles, changes in cervical discharge and breast tenderness, despite normal hormone levels.

Stress is also the culprit dentists are pointing to for the rapid increase in patients with teeth grinding, teeth fractures and TMJ.

“We, as humans, like to have the idea that we are in control of our minds and that stress isn’t a big deal,” Love said. “But it’s simply not true.”

How Mental Stress Becomes Physical

Stress causes physical changes in the body that can affect nearly every organ system.

Although symptoms of chronic stress are often dismissed as being in one’s head, the pain is very real, said Kate Harkness, a professor of psychology and psychiatry at Queen’s University in Ontario.

When the body feels unsafe — whether it’s a physical threat of attack or a psychological fear of losing a job or catching a disease — the brain signals adrenal glands to pump stress hormones. Adrenaline and cortisol flood the body, activating the fight-or-flight response. They also disrupt bodily functions that aren’t necessary for immediate survival, like digestion and reproduction.

When the danger is over, the hormones return to normal levels. But during times of chronic stress, like a pandemic, the body keeps pumping out stress hormones until it tires itself out. This leads to increased inflammation throughout the body and brain, and a poorly functioning immune system.

Studies link chronic stress to heart disease, muscle tension, gastrointestinal issues and even physical shrinking of the hippocampus, an area of the brain associated with memory and learning. As the immune system acts up, some people can even develop new allergic reactions, Harkness said.

The good news is that many of these symptoms are reversible. But it’s important to recognize them early, especially when it comes to the brain, said Barbara Sahakian, a professor of clinical neuropsychology at the University of Cambridge.

“The brain is plastic, so we can to some extent modify it,” Sahakian said. “But we don’t know if there’s a cliff beyond which you can’t reverse a change. So the sooner you catch something, the better.”

The Day-to-Day Impact

In some ways, mental health awareness has increased during the pandemic. TV shows are flush with ads for therapy and meditation apps, like Talkspace and Calm, and companies are announcing mental health days off for staff.

But those spurts of attention fail to reveal the full impact of poor mental health on people’s daily lives.

For Alex Kostka, pandemic-related stress has brought on mood swings, nightmares and jaw pain.

He’d been working at a Whole Foods coffee bar in New York City for only about a month before the pandemic hit, suddenly anointing him an essential worker. As deaths in the city soared, Kostka continued riding the subway to work, interacting with co-workers in the store and working longer hours for just a $2-per-hour wage increase. (Months later, he’d get a $500 bonus.) It left the 28-year-old feeling constantly unsafe and helpless.

“It was hard not to break down on the subway the minute I got on it,” Kostka said.

Soon he began waking in the middle of the night with pain from clenching his jaw so tightly. Often his teeth grinding and chomping were loud enough to wake his girlfriend.

Kostka tried Talkspace, but found texting about his troubles felt impersonal. By the end of the summer, he decided to start using the seven free counseling sessions offered by his employer. That’s helped, he said. But as the sessions run out, he worries the symptoms might return if he’s unable to find a new therapist covered by his insurance.

“Eventually, I will be able to leave this behind me, but it will take time,” Kostka said. “I’m still very much a work in progress.”

How to Mitigate Chronic Stress

When it comes to chronic stress, seeing a doctor for stomach pain, headaches or skin rashes may address those physical symptoms. But the root cause is mental, medical experts say.

That means the solution will often involve stress-management techniques. And there’s plenty we can do to feel better:

Exercise. Even low- to moderate-intensity physical activity can help counteract stress-induced inflammation in the body. It can also increase neuronal connections in the brain.

Meditation and mindfulness. Research shows this can lead to positive, structural and functional changes in the brain.

Fostering social connections. Talking to family and friends, even virtually, or staring into a pet’s eyes can release a hormone that may counteract inflammation.

Learning something new. Whether it’s a formal class or taking up a casual hobby, learning supports brain plasticity, the ability to change and adapt as a result of experience, which can be protective against depression and other mental illness.

“We shouldn’t think of this stressful situation as a negative sentence for the brain,” said Harkness, the psychology professor in Ontario. “Because stress changes the brain, that means positive stuff can change the brain, too. And there is plenty we can do to help ourselves feel better in the face of adversity.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

USE OUR CONTENT

This story can be republished for free (details).

Proposed change to Medicaid line extension definition ignores importance of critical improvements in treatments

In comments recently submitted to the administration, PhRMA raised concerns with a number of changes included in the Centers for Medicare & Medicaid Services (CMS) Medicaid proposed rule. Today, we’re diving deeper into CMS’s proposal to vastly expand the types of medicines that would fall under the definition of a “line extension” and how that change threatens future development of needed cures and treatments by establishing a tax on innovation.

Retired NFL Linebacker Overcomes ADHD, Invests in Mental Health Platform Done

October is ADHD Awareness Month, and retired NFL linebacker J.T. Thomas wants people to know that it is okay to get help for the treatment of attention deficit hyperactivity disorder (ADHD). As a person with ADHD, J.T. Thomas knows how important getting help is, and why overcoming obstacles such as stigma, access to care and improper diagnosis are so important.
“Whether competing in the NFL, or in life, many of us feel that we can’t show weakness,” says Thomas. “Unfortunately, this way of thinking has kept millions of adults and children from getting the treatment they need. When I finally sought treatment in 2013, I learned how to turn my ADHD into a strength by better managing it. Getting help was the best thing I ever did.”
J.T. Thomas is advocating for greater awareness regarding diagnosis and treatment options for ADHD because he believes that “knowing and treating” can be life changing. This is what led him and others including David Sacks’ Craft Ventures, Dave Morin’s Offline Ventures and NFL Hall of Famer Joe Montana to invest in ADHD treatment platform Done. Done is the first telehealth platform created specifically for people looking to get help with ADHD.
“I travel a lot, and this makes it very difficult to maintain adherence to traditional, in-person treatment,” added Thomas. “A friend told me about telehealth, and that’s when I found Done. They were focused on ADHD 100%, so I reached out to them and started getting help. I enjoyed the service so much, I asked if I could invest in it.”
Done was founded in 2019 and is led by a 13 person team of former Facebook, Stanford University and Kaiser Permanente professionals. Done, which is making its public debut during ADHD Awareness Month, currently has a team of 25 clinicians available in *11 states.
Done is focused specifically on ADHD because many on the team either have ADHD, or have family and friends with ADHD. As such, Done’s staff fully understands the potential obstacles associated with ADHD.
The primary function for physicians is to enhance health and alleviate suffering. Sadly, in the real world, there are many barriers to the realization of these goals. Medical knowledge alone cannot remove the obstacles, for they are social, political, economic and organizational. This is especially true when it comes to the treatment of ADHD.
“In my career as a psychiatrist, I have been particularly affected by the barriers to care created by the stigma attached to the medical disorders artificially categorized as mental,” states Done Clinical President Dr. David Brody. “The care of all psychiatric disorders is severely affected by this stigma, which takes different forms depending on the specific disorder, but is always destructive. In the case of ADHD, the stigma includes the ideas that it is not real, not severe or serious, and that people seeking treatment for it are drug seeking or looking for an easy way. These stereotypes could not be further from the truth, and that’s why in addition to treatment, at Done we are focused on awareness.”
Done is here to combat these stereotypes, and is working to remove barriers to treatment such as requirements and expectations about frequency of visits, documentation, medication choice and choice of provider. Regulations regarding treatment vary tremendously state-to-state, which is primarily due to the regulatory climate surrounding the medications used for first-line treatment of the disorder. This often forces patients to end treatment, especially if they live far from their provider’s office or have multiple career and family responsibilities.
As a flexible and more affordable platform, Done is well on the way to achieving a more effective and patient-friendly system for ADHD treatment. However, much remains to be “done.”
Priorities for Done include recruitment of additional clinicians for its rapidly expanding organization, improved integration with pharmacies and pharmaceutical manufacturers, improvement of regulations affecting patient care, education of both the general public and the medical community on the reality of ADHD and the falseness of stigmatizing ideas, and streamlining the platform to deal with the roadblocks and inefficiencies that stem from that stigma.
*Done offers services to residents of California, Florida, Hawaii, Indiana, New Jersey, New Mexico, New York, Oregon, Pennsylvania, Texas and Washington.

The post Retired NFL Linebacker Overcomes ADHD, Invests in Mental Health Platform Done appeared first on .

Retired NFL Linebacker Overcomes ADHD, Invests in Mental Health Platform Done

October is ADHD Awareness Month, and retired NFL linebacker J.T. Thomas wants people to know that it is okay to get help for the treatment of attention deficit hyperactivity disorder (ADHD). As a person with ADHD, J.T. Thomas knows how important getting help is, and why overcoming obstacles such as stigma, access to care and improper diagnosis are so important.
“Whether competing in the NFL, or in life, many of us feel that we can’t show weakness,” says Thomas. “Unfortunately, this way of thinking has kept millions of adults and children from getting the treatment they need. When I finally sought treatment in 2013, I learned how to turn my ADHD into a strength by better managing it. Getting help was the best thing I ever did.”
J.T. Thomas is advocating for greater awareness regarding diagnosis and treatment options for ADHD because he believes that “knowing and treating” can be life changing. This is what led him and others including David Sacks’ Craft Ventures, Dave Morin’s Offline Ventures and NFL Hall of Famer Joe Montana to invest in ADHD treatment platform Done. Done is the first telehealth platform created specifically for people looking to get help with ADHD.
“I travel a lot, and this makes it very difficult to maintain adherence to traditional, in-person treatment,” added Thomas. “A friend told me about telehealth, and that’s when I found Done. They were focused on ADHD 100%, so I reached out to them and started getting help. I enjoyed the service so much, I asked if I could invest in it.”
Done was founded in 2019 and is led by a 13 person team of former Facebook, Stanford University and Kaiser Permanente professionals. Done, which is making its public debut during ADHD Awareness Month, currently has a team of 25 clinicians available in *11 states.
Done is focused specifically on ADHD because many on the team either have ADHD, or have family and friends with ADHD. As such, Done’s staff fully understands the potential obstacles associated with ADHD.
The primary function for physicians is to enhance health and alleviate suffering. Sadly, in the real world, there are many barriers to the realization of these goals. Medical knowledge alone cannot remove the obstacles, for they are social, political, economic and organizational. This is especially true when it comes to the treatment of ADHD.
“In my career as a psychiatrist, I have been particularly affected by the barriers to care created by the stigma attached to the medical disorders artificially categorized as mental,” states Done Clinical President Dr. David Brody. “The care of all psychiatric disorders is severely affected by this stigma, which takes different forms depending on the specific disorder, but is always destructive. In the case of ADHD, the stigma includes the ideas that it is not real, not severe or serious, and that people seeking treatment for it are drug seeking or looking for an easy way. These stereotypes could not be further from the truth, and that’s why in addition to treatment, at Done we are focused on awareness.”
Done is here to combat these stereotypes, and is working to remove barriers to treatment such as requirements and expectations about frequency of visits, documentation, medication choice and choice of provider. Regulations regarding treatment vary tremendously state-to-state, which is primarily due to the regulatory climate surrounding the medications used for first-line treatment of the disorder. This often forces patients to end treatment, especially if they live far from their provider’s office or have multiple career and family responsibilities.
As a flexible and more affordable platform, Done is well on the way to achieving a more effective and patient-friendly system for ADHD treatment. However, much remains to be “done.”
Priorities for Done include recruitment of additional clinicians for its rapidly expanding organization, improved integration with pharmacies and pharmaceutical manufacturers, improvement of regulations affecting patient care, education of both the general public and the medical community on the reality of ADHD and the falseness of stigmatizing ideas, and streamlining the platform to deal with the roadblocks and inefficiencies that stem from that stigma.
*Done offers services to residents of California, Florida, Hawaii, Indiana, New Jersey, New Mexico, New York, Oregon, Pennsylvania, Texas and Washington.

The post Retired NFL Linebacker Overcomes ADHD, Invests in Mental Health Platform Done appeared first on .

Lifetime Experiences Help Older Adults Build Resilience to Pandemic Trauma

Older adults are especially vulnerable physically during the coronavirus pandemic. But they’re also notably resilient psychologically, calling upon a lifetime of experience and perspective to help them through difficult times.

New research calls attention to this little-remarked-upon resilience as well as significant challenges for older adults as the pandemic stretches on. It shows that many seniors have changed behaviors — reaching out to family and friends, pursuing hobbies, exercising, participating in faith communities — as they strive to stay safe from the coronavirus.

“There are some older adults who are doing quite well during the pandemic and have actually expanded their social networks and activities,” said Brian Carpenter, a professor of psychological and brain sciences at Washington University in St. Louis. “But you don’t hear about them because the pandemic narrative reinforces stereotypes of older adults as frail, disabled and dependent.”

Whether those coping strategies will prove effective as the pandemic lingers, however, is an open question.

“In other circumstances — hurricanes, fires, earthquakes, terrorist attacks — older adults have been shown to have a lot of resilience to trauma,” said Sarah Lowe, an assistant professor at Yale University School of Public Health who studies the mental health effects of traumatic events.

“But COVID-19 is distinctive from other disasters because of its constellation of stressors, geographic spread and protracted duration,” she continued. “And older adults are now cut off from many of the social and psychological resources that enable resilience because of their heightened risk.”

The most salient risk is of severe illness and death: 80% of COVID-19 deaths have occurred in people 65 and older.

Here are notable findings from a new wave of research documenting the early experiences of older adults during the pandemic:

Changing behaviors. Older adults have listened to public health authorities and taken steps to minimize the risk of being infected with COVID-19, according to a new study in The Gerontologist.

Results come from a survey of 1,272 adults age 64 and older administered online between May 4 and May 17. More than 80% of the respondents lived in New Jersey, an early pandemic hot spot. Blacks and Hispanics — as well as seniors with lower incomes and in poor health — were underrepresented.

These seniors reported spending less face-to-face time with family and friends (95%), limiting trips to the grocery store (94%), canceling plans to attend a celebration (88%), saying no to out-of-town trips (88%), not going to funerals (72%), going to public places less often (72%) and canceling doctors’ appointments (69%).

Safeguarding well-being. In another new study published in The Gerontologist, Brenda Whitehead, an associate professor of psychology at the University of Michigan-Dearborn, addresses how older adults have adjusted to altered routines and physical distancing.

Her data comes from an online survey of 825 adults age 60 and older on March 22 and 23 — another sample weighted toward whites and people with higher incomes.

Instead of inquiring about “coping” — a term that can carry negative connotations — Whitehead asked about sources of joy and comfort during the pandemic. Most commonly reported were connecting with family and friends (31.6%), interacting on digital platforms (video chats, emails, social media, texts — 22%), engaging in hobbies (19%), being with pets (19%), spending time with spouses or partners (15%) and relying on faith (11.5%).

“In terms of how these findings relate to where we are now, I would argue these sources of joy and comfort, these coping resources, are even more important” as stress related to the pandemic persists, Whitehead said.

Maintaining meaningful connections with older adults remains crucial, she said. “Don’t assume that people are OK,” she advised families and friends. “Check in with them. Ask how they’re doing.”

Coping with stress. What are the most significant sources of stress that older adults are experiencing? In Whitehead’s survey, older adults most often mentioned dealing with mandated restrictions and the resulting confinement (13%), concern for others’ health and well-being (12%), feelings of loneliness and social isolation (12%), and uncertainty about the future of the pandemic and its impact (9%).

Keep in mind, older adults expressed these attitudes at the start of the pandemic. Answers might differ now. And the longer stress endures, the more likely it is to adversely affect both physical and mental health.

Managing distress. The COVID-19 Coping Study, a research effort by a team at the University of Michigan’s Institute for Social Research, offers an early look at the pandemic’s psychological impact.

Results come from an online survey of 6,938 adults age 55 and older in April and May. Researchers are following up with 4,211 respondents monthly to track changes in older adults’ responses to the pandemic over a year.

Among the key findings published to date: 64% of older adults said they were extremely or moderately worried about the pandemic. Thirty-two percent reported symptoms of depression, while 29% reported serious anxiety.

Notably, these types of distress were about twice as common among 55- to 64-year-olds as among those 75 and older. This is consistent with research showing that people become better able to regulate their emotions and manage stress as they advance through later life.

On the positive side, older adults are responding by getting exercise, going outside, altering routines, practicing self-care, and adjusting attitudes via meditation and mindfulness, among other practices, the study found.

“It’s important to focus on the things we can control and recognize that we do still have agency to change things,” said Lindsay Kobayashi, a co-author of the study and assistant professor of epidemiology at the University of Michigan School of Public Health.

Addressing loneliness. The growing burden of social isolation and loneliness in the older population is dramatically evident in new results from the University of Michigan’s National Poll on Healthy Aging, with 2,074 respondents from 50 to 80 years old. (It found that, in June, twice as many older adults (56%) felt isolated from other people as in October 2018 (27%).

Although most reported using social media (70%) and video chats (57%) to stay connected with family and friends during the pandemic, they indicated this didn’t alleviate feelings of isolation.

“What I take from this is it’s important to find ways for older adults to interact face to face with other people in safe ways,” said Dr. Preeti Malani, chief health officer at the University of Michigan. “Back in March, April and May, Zoom family time was great. But you can’t live in that virtual universe forever.”

“A lot of well-intentioned families are staying away from their parents because they don’t want to expose them to risk,” Malani continued. “But we’re at a point where risks can be mitigated, with careful planning. Masks help a lot. Social distancing is essential. Getting tested can be useful.”

Malani practices what she preaches: Each weekend, she and her husband take their children to see her elderly in-laws or parents. Both couples live less than an hour away.

“We do it carefully — outdoors, physically distant, no hugs,” Malani said. “But I make a point to visit with them because the harms of isolation are just too high.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

USE OUR CONTENT

This story can be republished for free (details).

Health Care and the 2020 Presidential Election

This side-by-side comparison examines President Trump’s record and former Vice President Biden’s positions across a wide range of key health issues, including the response to the pandemic, the Affordable Care Act marketplace, Medicaid, Medicare, drug prices, reproductive health, mental health and opioids, immigration and health coverage, and health care costs.

Digital Behavioral Health: Addressing The COVID-19 Behavioral Health Crisis

digital behavioral health and addressing the COVID-19 behavioral health crisis
Victor Siclovan, Director of Medicaid Transformation Project at AVIA

Living through a pandemic is stressful and anxiety-inducing. Stay-at-home measures are compounding this stress, resulting in social isolation and unprecedented economic hardship, including mass layoffs and loss of health coverage. Fully understanding the impact of these pernicious trends on overall mental health will take time. However, precedents like the Great Recession suggest that these trends are likely to worsen the conditions driving suicide and substance-related deaths, the “deaths of despair” that claimed 158,000 lives in 2017 and contributed to a three-year decline in US life expectancy among adults of all racial groups.

Even before the emergence and spread of COVID-19, the US was experiencing a behavioral health treatment crisis: 2018 data showed that only 43% of adults with mental health needs, 10% of individuals with SUD, and 7% of individuals with co-occurring conditions were able to receive services for all necessary conditions. 

The treatment gap is staggering, and COVID-19 is exacerbating it: an estimated 45% of adults report the pandemic has negatively impacted their mental health, to say nothing of the disruption of essential in-person care and services. In a similar vein, a recent CDC report has highlighted the staggering and “disproportionately worse mental health outcomes, [including] increased substance use, and elevated suicidal ideation” experienced by “younger adults, racial/ethnic minorities, essential workers, and unpaid adult caregivers.”

Consistent with the CDC report’s findings, the crisis can be felt most acutely by the very workforce that must deal with COVID-19 itself. Hospitals, health systems, and clinical practices – together with other first responders – comprise the essential front line. They bear the burden of their employees’ stress and illness, and must also cope with the many patients who present with a range of mental illnesses and substance use disorder (SUD).

But providers don’t have to face this burden alone: numerous behavioral health-focused digital solutions can support providers in meeting their most urgent needs in the era of COVID-19. Many of these solutions have made select services available for free or at a discount to healthcare providers in recognition of the immense need and challenging financial circumstances. Some solutions also help systems take advantage of favorable, albeit time-sensitive, conditions, enabling them to lay the foundation for broader behavioral health initiatives in the long term. Several of these solutions are described below, in the context of three key focus areas for health systems.

Focus Area 1: Supporting the Frontline Workforce 

Health system leaders need to keep their workforces healthy, focused, and productive during this period of extreme stress, anxiety, and trauma. Providing easily accessible behavioral health resources for the healthcare workforce is therefore of paramount importance.

Health systems should consider providing immediate, free access to behavioral health services to employees and their families and consider further extending that access to first responders, other healthcare workers, and other essential services workers in the community.

Many digital product companies are granting temporary access to their services and are expanding their offerings to include new, COVID-19-specific modules, resources, and/or guidance at no cost. 

Fortunately, the market is rife with solutions that have demonstrated effectiveness and an ability to scale. However, many of these rapidly-scalable solutions are oriented toward low-acuity behavioral health conditions, so it is important that health systems consider the unique needs of their populations in determining which solution(s) to adopt.

The following are several solutions to consider:

Online CBT solutions. These tools are being used to expand access to lower-acuity behavioral health services, targeting both frontline workers and the general population. MyStrength, SilverCloud and others have deployed COVID-19-specific programming.

Text-based peer support groups. Organizations are using Marigold Health to address loneliness and social isolation in group-based chat settings, one-on-one interactions between individuals and peer staff, and broader community applications.

Focus Area 2: Maintaining Continuity of Care 

As the pandemic continues to ripple across the country, parts of the delivery system remain overwhelmingly focused on containing and treating COVID-19. This can and has led to the disruption of care and services, of particular significance to individuals with chronic conditions (e.g., serious mental illness (SMI) and SUD), who require longitudinal care and support. Standing up interventions — digital and otherwise — to ensure continuity of care will be critical to preventing exacerbations in patients’ conditions that could drive increased rates of ED visits and admissions at a time when hospital capacity can be in short supply.

In the absence of in-person care, many digital solutions are hosting virtual recovery meetings and providing access to virtual peer support groups. Additionally, shifts in federal and state policies are easing restrictions around critical services, including medication-assisted treatment (e.g., buprenorphine can now be prescribed via telephone), that can mitigate risky behavior and ensure ongoing access to treatment. 

The use of paraprofessionals has also emerged as a promising extension of the historically undersupplied behavioral health treatment infrastructure. Capitalizing on the rapid expansion of virtual care, providers should consider leveraging digital solutions to scale programs that use peers, community health workers (CHWs), care managers, health coaches, and other paraprofessionals, to reduce inappropriate hospital utilization and ensure patients are navigated to the appropriate services.

The following are several solutions to consider:

Medication-assisted therapy (MAT) via telemedicine. These solutions provide access to professionals who can prescribe and administer MAT medications, provide addiction counseling, and conduct behavioral therapy (e.g., CBT, motivational interviewing) digitally. Solution companies providing these critical services include Eleanor Health, PursueCare, and Workit Health.

Behavioral health integration. Providing screening, therapy, and psychiatric consultations in a variety of care settings — especially primary care — will help address the increased demand. Historically, providers have had difficulty scaling such solutions due to challenging reimbursement, administrative burden, and stigma, among other concerns. Solutions like Valera Health and Concert Health were created to address these challenges and have seen success in scaling collaborative care programs.

Recovery management tools for individuals with SUD. WEConnect Health and DynamiCare Health are both offering free daily online recovery support groups.

Focus Area 3: Leveraging New Opportunities to Close the Treatment Gap

As has been widely documented, the pandemic has spurred unprecedented adoption of telehealth services, aided by new funding opportunities (offered through the CARES Act and similar channels) and the widespread easing of telehealth requirements, including the allowance of reimbursement for audio-only services and temporarily eased provider licensure requirements.

Tele-behavioral health services are no exception; the aforesaid trends ensure that what was one of the few high-growth areas in digital behavioral health before the pandemic will remain so for the foreseeable future. This is unquestionably a positive development, but there is still much work to be done to close the treatment gap. Critically, a meaningful portion of this work is beyond the reach of the virtual infrastructure that has been established to date. For example, there remains a dearth of solutions that have successfully scaled treatment models for individuals with acute illnesses, like SMI or dual BH-SUD diagnoses.

Health system leaders should continue to keep their ears to the ground for new opportunities to expand their virtual treatment infrastructure, paying particular attention to synergistic opportunities to build on investments in newly-developed assets (like workforce-focused solutions) to round out the continuum of behavioral health services. 

COVID-19 has all but guaranteed that behavioral health will remain a major focus of efforts to improve healthcare delivery. Therefore, health systems that approach today’s necessary investments in behavioral health with a long-term focus will emerge from the pandemic response well ahead of their peers, having built healthier communities along the way.


About Victor Siclovan

Victor Siclovan is a Director on the Medicaid Transformation Project at AVIA where he leads work in behavioral health, chronic care, substance use disorder, and Medicaid population health strategy. Prior to AVIA, Victor spent nearly 10 years at Oliver Wyman helping large healthcare organizations navigate the transition to value-based care. He holds a BA in Economics from Northwestern.


Why Hasn’t A More Holistic Approach to Patient Care Become The Norm?

Why Holistic Healthcare Is Worth the Cost

When food production technology made it possible, wheat flour processors started to eliminate the tough exterior (bran) and nutrient-rich core (germ) of the kernel to get at the large, starchy part (the endosperm) only. The bread produced from this process is white and fluffy, and it makes great PB&Js and takes forever to grow mold, but it is almost totally lacking nutritional value.

Nutrition experts eventually pointed this out, of course, after which commercial bakers tried fortifying their bread by adding back essential nutrients stripped out by processing. It didn’t work. While white bread from refined flour is still available, nutrition experts strongly recommend whole grain products as the healthier alternative.

Opposition to this reductionist approach to nutrition is perhaps best captured by the idea of the sum being the whole of its parts: If inputs are lacking, the end result will fall short also.

Each human being is also a sum of parts, and the reductionist approach to healthcare is essential when it comes to advancing many aspects of medicine and healthcare.

“Historically, the invention of the microscope, the defining of Koch’s four infectious disease postulates, the unraveling of the human genome, and even intelligent computers are salient examples of the dramatic benefits of biomedical reductionism,” explained Dr. George Lundberg.

These successes, however, may have convinced many in both the medical community and society at large that reductionism is a necessary, if not sufficient, approach. The numbers say otherwise.

“Classical medical care interventions contribute only about 10 percent to reducing premature deaths compared to other elements such as genetic predisposition, social factors, and individual health behaviors,” Lundberg goes on to say. “Most contemporary medical researchers have concluded that the chronic degenerative diseases of modern Western humans have multiple contributory causes, thus not lending themselves to the single agent-single outcome model.”

Paging Dr. House. It turns out your particular form of genius just isn’t frequently that useful.

And nowhere is the single agent-single outcome model arguably less effective than in behavioral health and chronic disease management. What many in medicine and healthcare now realize is that a vicious cycle of alternating physical and mental ailments are the norm with both chronic illness and long-term mental health challenges.

“Depression and chronic physical illness are in a reciprocal relationship with one another: not only do many chronic illnesses cause higher rates of depression, but depression has been shown to antedate some chronic physical illnesses,” says Professor David Goldberg of the Institute of Psychiatry in London.

It’s an unsurprisingly intuitive conclusion to reach. A man with depression lacks the desire to eat well, exercise, often practice necessary daily hygiene. As his untreated depression deepens, his physical health declines as well. A woman with chronic, untreated pain feels like it will never end and her life is over. Faced with a seemingly unmanageable challenge, she falls into a funk that eventually metastasizes into full-blown depression.

A reductionist approach to these scenarios might be to encourage more exercise or prescribe antidepressants. While both are necessary, neither will likely be sufficient.

So why hasn’t a more holistic approach to patient care become the norm? In a nutshell, because it’s expensive. Chronic illnesses, generally, are the most expensive component of healthcare.

According to a New England Journal of Medicine study, patients “with three or more chronic conditions (43 percent of Medicare beneficiaries) account for more than 80 percent of Medicare health care costs.”

For this expensive, highly at-risk group, holistic care is what actually works.

The NEJM articles conclude that “an intervention involving proactive follow-up by nurse care managers working closely with physicians, integrating the management of medical and psychological illnesses, and using individualized treatment regimens guided by treat-to-target principles improved both medical outcomes and depression in depressed patients with diabetes, coronary heart disease, or both.”

Of course, the regimen included in the NEJM study is expensive—perhaps more so than what qualifies as holistic care now.

But it requires a certain type of twisted logic to argue for holding down costs by rationing care inputs—by reductively treating only just the most obvious health concerns—when this approach invariably leads to readmissions, more office visits, more disability payments, more days of work missed.

Indeed, a reductive approach to accounting—silos of financial impact across the continuity of a life lived—hides the fact that specific healthcare costs are not alone the measure of how chronic illness detracts from both individual life satisfaction and broader societal efficiencies.

The key, then, is to make holistic health both the norm and affordable. How can that be done? By creating initiatives designed to achieve a core set of goals:

Incentivize primary care: In the last two decades, the number of primary care providers (PCPs) available to patients in the United States has decreased by about 2 percent. This may not sound like a lot, but the decline comes as the population has increased, naturally, which means fewer patients have a PCP. As healthcare shifts to pay for performance, not services, the PCP is the natural quarterback of patient care. The country needs many more PCPs, not fewer, and the federal government has an opportunity to use loan forgiveness incentives and other tools to nudge medical school students in that direction.

Embrace technology: Arguably, holistic care only became possible with the digital age. Chronic disease management requires frequent measurement of patient vitals, which is very expensive without wearables and similar digital age technologies. Now, patients can regularly provide data with no clinical intervention, that data can automatically upload to an electronic health record, and that EHR can alert the clinician when results are alarming.

Make poor choices expensive: Perhaps only because smoking has become so socially unacceptable can the cost of cigarettes be so high ($7.16 per pack in Chicago with all taxes) without creating significant protests. But the data is clear that higher costs equal fewer smokers. The same types of behavioral economics programs can also apply to fast food, soda, etc. Yes, people will get upset and complain about the nanny state, but absent some attempt to change behavior, we may want to consider changing the name to the United States of Diabetes.

Reward smart choices: Healthy people use healthcare and insurance less often, which drives down costs. Duh. Combining technology and incentives (avoiding diabetes), Utah’s Intermountain Healthcare engaged almost 1,500 pre-diabetic employees in a program through Omada Health that collectively yielded 9,162 pounds lost. Omada billed Intermountain based on the level of success, and without speaking to specific numbers, Intermountain felt the cost of the program was a wise investment when compared with the costs of diabetes treatment.

These four bullets are probably just the most obvious suggestions, of course. They don’t account for the complexities of the American healthcare system focused on payment models, the profit motive, or what to do with the uninsured, homeless, and devastatingly mentally ill.

But the benefits of holistic thinking when reductionism is inadequate applies to both individual care and the healthcare system as a whole. Public health, for example, takes a holistic approach to communities by looking at how housing, transportation, and education impact general overall health. Where this approach is done well, the benefits are obvious.

Reductionist isolation will always be necessary when identifying specific genes or determining which natural elements are effective in treating disease. But it’s wise to always bring the right tools for the job.

Anthem Expands Relationship with doc.ai to Power Digital Health Offerings

Anthem Refuses Full Security Audit of IT Systems from OIG

What You Should Know:

– Anthem extends the use of doc.ai’s platform and portfolio of privacy-first technologies and artificial intelligence software services to drive the personalization of Anthem’s digital assets and create improved value for users.

– doc.ai’s product offerings are deployed on its cloud-agnostic and zero-trust infrastructure that lets clients like Anthem launch products faster and at lower costs.


Anthem, today announced it is extending its partnership with doc.ai, an enterprise AI platform accelerating digital transformation in healthcare to power its digital health offerings. The expanded relationship extends Anthem’s use of doc.ai’s platform and portfolio of privacy-first technologies and artificial intelligence software services to drive the personalization of Anthem’s digital assets and create improved value for users. Payors, pharma, and providers license doc.ai’s enterprise AI platform that unlocks the value of health data.

Most recently, Anthem licensed Passport, doc.ai’s privacy-first COVID-19 evaluation tool for a safer entry to the workplace, and Serenity, a guided mental health chat companion that helps manage anxiety and depression. In addition, doc.ai’s technology has streamlined Anthem’s ability to create an ecosystem of developers. doc.ai’s product offerings are deployed on its cloud-agnostic and zero-trust infrastructure that lets clients like Anthem launch products faster and at lower costs.

Appoints New CEO and Chief Scientific Officer

In addition to the expanded relationship with Anthem, doc.ai
has announced key executive leadership appointments: Sam De Brouwer, co-founder
has been named its new CEO; Walter De Brouwer, co-founder takes on the newly
created role of Chief Scientific Officer. Dr. Nirav R. Shah, MD, MPH has been
appointed as its first Chief Medical Officer.

Sam De Brouwer, co-founder, and previous Chief Operating Officer has taken on the role of Chief Executive Officer, with a focus on scaling its enterprise offerings. Co-founder Walter De Brouwer has transitioned from CEO to the new role of Chief Scientific Officer where he will focus on vision and will lead research, innovation, and engineering efforts for the company. As doc.ai’s first Chief Medical Officer, Dr. Nirav R. Shah, MD, MPH will lead the clinical focus and medical research of the platform company. These new appointments will join doc.ai’s leadership team alongside current CTO Akshay Sharma and CFO Greg Kovacic.

“What doc.ai has accomplished in a remarkably short period of time is impressive, and I’m excited to join such a talented team,” said Dr. Shah. “Doc.ai has brought cutting-edge technologies to the market that will help break down many of the silos in healthcare, and will ultimately increase the pace of innovation and create pathways to better health outcomes.”

Dr. Shah is a Senior Scholar at the Clinical Excellence Research Center, Stanford University School of Medicine. His expertise spans across the health industry as a member of the HHS Secretary’s Advisory Committee, a Senior Fellow of the Institute for Healthcare Improvement (IHI), and as an independent director for public and private companies and foundations.

He served as Senior Vice President and Chief Operating Officer for clinical operations at Kaiser Permanente in Southern California, where he oversaw the region’s health plan and hospital quality while ensuring effective use of technology, data, and analytics to produce better patient health outcomes. In addition, he served as Commissioner of the New York State Department of Health, where he was responsible for public health insurance programs covering more than five million New Yorkers and led public health surveillance and prevention initiatives.

Digital health firm Lyra enters unicorn territory after fundraising

Digital health startup Lyra Health has raised $110 million in fourth-round financing, raising its value above the $1 billion threshold for the first time since it was founded five years ago.

California-based Lyra provides mental health care services that employers can include in health care plans for their staff, and already features companies like eBay, Uber and Genentech on its customer roster.

Its platform connects employees to mental health professionals and supports them through treatment with coaching, medication management and self-care tools.

The $110 million Series D comes just a few months after a third-round fundraising that brought in $75 million, and brings the total amount raised by Lyra to $292 million.

Lyra says it is now pitching at revenues of around $100 million this year, boosted by what chief executive and cofounder David Ebersman describes as more interest than ever from employers looking to invest in better workforce mental health as the coronavirus pandemic rumbles on.

“In a normal year, companies generally wait until Jan. 1 to launch new health care benefits,” he writes in a blog post published this week which notes that the number of employers covered by its customers had doubled in the past year.  

“This year has been different. Many companies have decided their employees need better mental health services right now.”

Since the start of the COVID-19 crisis, Lyra has added 800,000 members, takings it tally to around 1.5 million.

The Series D was led by Addition and also included Adams Street Partners and existing investors, and the cash injection will be used to invest in new services such as Lyra Blended Care for conditions like depression and anxiety.

Ebersman describes the service as “teletherapy…that pairs video therapy sessions with personalised digital tools based on cognitive behavioural therapy (CBT).”

Blended Care was shown to reduce depression and anxiety symptoms in six weeks in a 385-subject study published in the Journal of Medical Internet Research last month.

“I believe we will look back on 2020 as a turning point in our collective recognition that the mental health status quo is not good enough,” says Ebersman, in a reference to data the company generated with the National Alliance of Healthcare Purchaser Coalitions in July which suggested that  83% of US employees are experiencing mental health issues.

“Too many people in need don’t have easy access to potentially life-changing treatment, “ he adds. The same National Alliance survey of 1,200 workers found that one in four said their employer does not support their mental health at all.

Image by Joakim Roubert from Pixabay

The post Digital health firm Lyra enters unicorn territory after fundraising appeared first on .

Feeling Anxious and Depressed? You’re Right at Home in California.

It’s official, California: COVID-19 has left us sick with worry and increasingly despondent. And our youngest adults — ages 18 to 29 — are feeling it worst.

Weekly surveys conducted by the U.S. Census Bureau from late April through late July offer a grim view of the toll the pandemic has taken on the nation’s mental health. By late July, more than 44% of California adult respondents reported levels of anxiety and gloom typically associated with diagnoses of generalized anxiety disorder or major depressive disorder, a stunning figure that rose through the summer months alongside the menacing spread of the coronavirus.

America at large has followed a similar pattern, with about 41% of adult respondents nationwide reporting symptoms of clinical anxiety or depression during the third week of July. By comparison, just 11% of American adults reported those symptoms in a similar survey conducted in early 2019.

The July responses showed a marked geographic variance, with residents of Western and Southern states, where the virus remains most virulent, registering greater mental distress, on average.

The findings reflect a generalized sense of hopelessness as the severity of the global crisis set in. Most adults have been moored at home in a forced stasis, many in relative isolation. The unemployment rate hit its highest rate since the Great Depression of the 1930s. Thousands of families across California and tens of thousands across the U.S. have lost people to the virus. There is no clear indication when — or even if — life will return to normal.

“The pandemic is the first wave of this tsunami, and the second and third waves are really going to be this behavioral health piece,” said Jessica Cruz, executive director of the National Alliance on Mental Illness (NAMI) California.

The surveys were part of a novel partnership between the National Center for Health Statistics and the Census Bureau to provide relevant statistics on the coronavirus’s impact. In weekly online surveys over three months, the Census Bureau asked about 900,000 Americans questions to quantify their levels of anxiety or depression. The four survey questions are a modified version of a common screening tool physicians use to diagnose mental illness.

Respondents were asked how often during the previous seven days they had been bothered by feeling hopeless or depressed; had felt little interest or pleasure in doing things; had felt nervous or anxious; or had experienced uncontrolled worry. They were scored based on how often they had experienced those symptoms in the previous week, ranging from never to nearly every day. High scores on the anxiety questions indicated symptoms associated with generalized anxiety disorder. High scores on the depression questions indicated symptoms of major depressive disorder.

In both California and the nation, symptoms of depression and anxiety were more pronounced among young adults, and generally decreased with age. For example, nearly 3 in 4 California respondents between ages 18 and 29 reported “not being able to stop or control worrying” for at least several of the previous seven days. And 71% reported feeling “down, depressed or hopeless” during that time.

Interestingly, respondents 80 and older — an age group far more likely to suffer and die from COVID-19 — reported nowhere near the same levels of distress. Just 40% reported feeling down or hopeless for at least several days in the previous week, and 42% reported uncontrollable worry.

Cruz said that may be because young adults are more comfortable expressing worry and sadness than their parents and grandparents, adding that such openness is a good thing. However, even before the pandemic, suicide rates among teens and young adults had been on a yearslong climb nationwide, and California emergency rooms had registered a sharp rise in the number of young adults seeking care for mental health crises.

Some researchers have cited the ubiquitous reach of social media — and with it an increased sense of inferiority and alienation — as factors in the rise in mental health struggles among younger generations. COVID-19 could be exacerbating those feelings of isolation, Cruz said.

The Census surveys also found higher rates of depression and anxiety among those who have lost jobs during the pandemic. Young adults in the service sector have been hit particularly hard by the wide-scale economic shutdowns. In July, the unemployment rate among U.S. workers ages 20 to 24 was 18%, compared with 9% among workers 25-54, according to the U.S. Bureau of Labor Statistics.

Others noted that many other young adults who would normally be immersed in college life are stuck on the couch in their parents’ home, staring at a professor on Zoom, with little social life and no paid work after class.

“Some of the things that generally help improve mood have been more difficult and more challenging now,” said Paul Kim, director of counseling services at the University of California-Davis. “So I think some of our counselors’ work is to help them think through, ‘How is it, for example, you stay socially connected while socially distant?’”

Californians with lower incomes also reported higher levels of anxiety or depression. About 72% of California respondents with household incomes below $35,000 reported “little interest or pleasure in doing things” for at least several of the previous seven days, according to an average of survey results from July 2 through July 21.

“People have had a lot of trouble accessing unemployment benefits — that has not been an easy path,” said Jo Campbell, a therapist and integrated operations director at Hill Country Community Clinic, which provides services to clients, many of them economically disadvantaged, in Shasta County.

Some experts said they worry that the tumble toward depression and anxiety could outlast the pandemic itself, particularly if the economy lapses into a prolonged recession.

“The pandemic will likely have short- and long-term implications on mental health and substance use,” said Laura Pancake, a vice president at Pacific Clinics, one of the largest mental health service providers in Southern California. The pandemic, she added, “has only exacerbated existing challenges that many face, including unemployment, poor health and other barriers.”

Phillip Reese is a data reporting specialist and an assistant professor of journalism at California State University-Sacramento.


This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

USE OUR CONTENT

This story can be republished for free (details).

Lyra Health Reaches $1.1B Valuation After $110M Series D to Meet Demand for Teletherapy

Lyra Health Reaches $1.1B Valuation After $110M Series D to Meet Demand for Teletherapy

What You Should Know:

– Mental health benefits provider Lyra Health raises $110M
in Series D funding, bringing its valuation to $1.1 billion.

– Lyra has grown significantly in 2020. So far this year,
the company has added more than 800,000 new members to the population eligible
to receive Lyra benefits, bringing its total member population to more than 1.5
million. 

– Amid, the COVID-19 pandemic, Lyra is focused on
expanding its enhanced teletherapy offering — Lyra Blended Care — which pairs
video therapy sessions with personalized digital lessons and exercises based on
Cognitive Behavioral Therapy (CBT) principles.


Lyra
Health
, a Burlingame, CA-based provider of mental healthcare benefits for
employers, today announced a Series D financing round of $110 million. Addition
led the round and was joined by Adams Street Partners and existing investors,
including Starbucks chairman emeritus and former CEO Howard Schultz, Casdin
Capital, Glynn Capital, Greylock Partners, IVP, Meritech Capital Partners,
Providence Ventures, and Tenaya Capital. This financing enables Lyra to invest
more aggressively in innovative, tech-enabled mental health treatments; to
partner with more customers; and to expand and diversify its high-quality
provider network.

Accessing and receiving mental healthcare is notoriously
challenging for many Americans today. Cost, social stigma, and navigating the
mental health system make it daunting for individuals to get the care they need.
In addition, only a small fraction of therapists in traditional health plans
are practicing proven methods and accepting new patients.

Founded in 2015, Lyra connects employees to high quality, effective mental health providers, and gives employees the flexibility of in-person care, live video therapy, and digital self-care tools. Lyra’s therapists only practice evidence-based therapies, like Cognitive Behavioral Therapy (CBT), and are available for appointments in just a few days.

Expanded Teletherapy Offering

The company is also focused on expanding its enhanced
teletherapy offering — Lyra Blended Care — which pairs video therapy sessions
with personalized digital lessons and exercises based on Cognitive Behavioral
Therapy (CBT) principles. Lyra Blended Care provides a scalable, tech-enabled
solution optimized for better care quality and clinical outcomes. In July, new
peer-reviewed Lyra research was published demonstrating the effectiveness
of this treatment program for clients with depression and anxiety. The company
plans to continue the expansion of Blended Care to serve Lyra members —
including couples and adolescents — who are experiencing a range of mental
health challenges. Lyra’s solution offers a simple and supportive member
experience, ensures immediate access to care, and prioritizes fast and durable
symptom improvement.

Why It Matters

American workers are experiencing a surge in mental health
challenges as they grapple with historic adversity amid the COVID-19 pandemic,
economic uncertainty, and a national reckoning with racial injustice. Arecent
study
 led by Lyra Health and the National Alliance of Healthcare
Purchaser Coalitions found that 83 percent of U.S. employees today are
experiencing mental health issues.

“Whether you’re dealing with a preexisting mental health condition that has intensified or new symptoms that have arisen during the pandemic, these are challenging times for many people. We are proud to support employers that are prioritizing mental health and will use this new funding to help even more organizations support the mental health and well-being of their most important asset — their people,” said David Ebersman, Lyra Health CEO and co-founder

Recent Traction/Milestones

Lyra has grown significantly in 2020. So far this year, the company has added more than 800,000 new members to the population eligible to receive Lyra benefits, bringing its total member population to more than 1.5 million. Lyra also is on track to surpass a milestone this month by delivering the one-millionth session of care through its exceptional provider network. In the last several months, leading employers in the retail, tech, energy, financial services, and the food and agriculture industries — including Morgan Stanley, Asurion, and Zoom Video Communications — have stepped up to prioritize workforce mental health by partnering with Lyra to offer employees immediate access to proven, evidence-based care from thousands of Lyra providers nationwide. This financing, on top of the Series C round completed earlier this year, positions Lyra to take advantage of the burgeoning market opportunity and the urgent need for better mental health solutions.

Boarding Appointments

The company also announced the addition of Kerry Chandler to its Board of Directors. Chandler is Chief Human Resources Officer at Endeavor, a global entertainment, sports, and content company, and she previously served as a senior executive at Under Armour; Christie’s; the National Basketball Association; ESPN; and ESPN’s parent, The Walt Disney Company. She has also served in human resources leadership roles of increasing responsibility at IBM, Motorola, Exxon, and McDonnell Douglas. Chandler brings an extensive background in human resources operations, strategy, and executive leadership.

The Coronavirus Crisis’ Silent Death Toll: Chronically Ill Patients

The Coronavirus Crisis’ Silent Death Toll: Chronically Ill Patients
Dr. Kayur Patel, Chief Medical Officer of Proactive MD

The impact of the coronavirus crisis is shining a bright light on many of the challenges facing the U.S. healthcare system. 

So much more than a lack of primary care physicians and hospital beds, the all-hands-on-deck approach to combating the spread of COVID-19 has forced patients fearful of engaging with the healthcare system for needs unrelated to the virus to put elective procedures, routine care and timely treatment for chronic or critical conditions on the back burner.

Compounding these issues, fears surrounding visiting the doctor’s office have forced primary care facilities to lay off or furlough clinicians and staff, deferring or skipping clinician salaries in some cases. When it comes to epidemic illness, primary care professionals serve as the first line of defense, preventing patients from flooding emergency rooms and hospitals when they don’t actually need to be there. However, in spite of the need for access to affordable primary care, many primary care practices will not survive the pandemic. 

Despite new CDC guidance showing people with underlying medical conditions like diabetes or hypertension are at increased risk for severe illness from COVID-19, most regular wellness check-ups, cancer screenings, and nonemergency procedures have been put on hold. While COVID-19 is responsible for more than 140,000 deaths in the U.S. alone, experts predict this delay in care for chronically ill patients has resulted in a “silent” death-toll — and one that continues to climb as the world waits for a vaccine.

In the meantime, what can hospitals and clinics in the U.S. do to better serve chronic care patients and ensure no one else falls through the cracks during the pandemic?

Data Analysis

Healthcare generates a lot of data for patient records. It’s crucial that hospitals and medical clinics have the ability to analyze that data to identify and categorize vulnerable patients who are either: 

– high-risk due to potential coronavirus-related complications or

– require regular check-ups because of care related to chronic illness, mental health, or addiction. 

Facing the aforementioned barriers to primary care and treatments, many chronic and crisis care patients are exponentially more vulnerable to the impact of the virus. Even if these patients do not contract COVID-19, the regression that can happen when a condition is not properly managed can be equally dangerous.

Data analysis that allows healthcare providers to stratify patient population risk and engage patients based on care needs provides caretakers the information they need to create personalized treatment plans that ensure the needs of chronic and crisis care patients are not neglected. 

Safe and Continuous Outreach

Healthcare clinics that traditionally rely on in-office visits are now scrambling to provide access to their patients through telemedicine and virtual visits while navigating the challenging new landscape of billing codes and payment rules for these services. Previously derided as less than effective medicine, telemedicine, and virtual visits have become necessary to reduce staff exposure, preserve personal protective equipment (PPE) and minimize the impact of patient surges on facilities.

Because systems have had to adjust the way they triage, evaluate and care for patients through the use of methods that do not depend on in-person services, telehealth, and virtual care services are helping provide necessary care to at-risk patients while minimizing the transmission risk of the virus that causes COVID-19 to healthcare personnel and other patients.

From phone calls and telemedicine appointments to apps, surveys, and regular check-ins, advances in technology empower hospitals and clinics to prioritize relationships that build the foundation enabling continuity of care, even using a new channel to communicate. Through proactive communication with patients about helpful resources and the option for virtual visits, providers can see significant success in their commitment to continued engagement with — and care for — patients.

Dedicated Patient Advocacy

Good patient-provider relationships foster better communication, which drives improved health and wellness. As such, it’s important that hospitals and clinics have ongoing and dedicated patient advocates to reach out to high-risk and chronic care patients. 

By serving as the link between a patient’s care provider and the real world, patient advocates strive to ensure that patients have access to the care and resources they need. Whether that involves access to prescriptions, medical supplies, food, financial assistance, mental health programs, or workforce navigation, care coordination needs to extend beyond simple community referrals. 

In the face of a global pandemic, patients often face complicated decisions concerning their health and overwhelming obstacles to receiving care. Ongoing, dedicated patient advocacy offers guidance that helps patients navigate the complicated health system, ensuring they get the care and support they need throughout the continuing COVID-19 outbreak.

Despite efforts to safely reopen businesses and get employees back to work, the virus itself has not gone away. With practitioners fearing the spread of the disease, patients afraid to keep their in-person appointments and clinicians being redirected to emergency rooms or coronavirus test sites, primary care doctors are seeing their patients far less frequently, and patients are struggling to effectively maintain their health. 

That strain on the primary care system will continue. However, by moving to value-based care models, such as advanced primary care, that leverage data, and analytics to identify and categorize vulnerable patients, facilitate safe and continuous outreach to these patients through telemedicine and other virtual means and have dedicated patient advocates reaching out to high-risk and chronic care patients, hospitals and clinics can continuously serve their most vulnerable patients throughout the duration of the coronavirus crisis.


About Dr. Kayur Patel

Dr. Kayur Patel serves as Chief Medical Officer of Proactive MD. A practicing physician with extensive experience in internal and emergency medicine, his specialty lies in bringing physicians and hospital leadership together in order to convert healthcare challenges into opportunities for growth. He is a nationally-recognized authority and a national speaker on the subject of quality in healthcare. 

COVID-19, Mental Health, and the 2020 Election: A Review of Candidate Platforms

This brief examines where the candidates stand on four key aspects of the nation’s mental health and substance abuse challenges: the opioid epidemic, suicide rates, mental health parity, and mental health workforce. On each issue, the brief summarizes the policy positions of President Trump and former Vice President Joe Biden.

Why International Expansion Must Remain a Priority for Cerner, Epic, Allscripts, MEDITECH

What You Should Know:

Why International Expansion Must Remain a Priority for Cerner, Epic, Allscripts, MEDITECH

– How the top US acute EHR vendors, namely Cerner, Epic, Allscripts, and MEDITECH (+85% share of US acute market in terms of revenues), have progressed on international expansion.


As highlighted below, there is a significant variance amongst the big four in terms of revenue and share of business outside the US. Cerner has by far the highest revenue at more than $650M in 2019, representing 12% of its business. Whilst MEDITECH has considerably lower revenue than Cerner, its international revenue is broadly similar to a share of its total revenue.

By contrast, Allscripts and MEDITECH each has international business that is comparable in terms of revenues, but as a share of overall revenues, international is much less important for Allscripts.

Allscripts’ international revenue was lower than Epic, Cerner, and Meditech in 2018, however, its growth in 2019 enabled it to overtake MEDITECH and become the third largest of the four vendors in 2019.

Main Chart

Cerner

cerner

Cerner’s international revenues fell marginally as a proportion of its total business in 2019 (11.5%, down from 11.9% in 2018), although revenues grew in absolute terms by 3%. This growth was aided by success in Europe, particularly in the UK and Nordics where it won new contracts. Cerner’s overall revenue suffered a 3% decline in 1H 2020 (versus 1H 2019). Despite the impact of COVID-19, its international business witnessed marginal revenue growth (+1%) and rose as a share of its overall business (11.9%) during this period.

Cerner received a significant boost to its international business in 2015 when it acquired Siemens’ EHR business. This provided it with a broad footprint of deployments in DACH (Germany, Austria, Switzerland), Benelux, France, Norway, and Spain. Since this acquisition, the challenge for Cerner had been to migrate the customer base to Millennium. However, this has not happened to date, particularly in Germany and Spain.

Tough market conditions, especially in Germany which already had a highly competitive acute EHR market, was another factor impacting the market growth. The above challenges faced by Cerner were key drivers behind the deal to sell parts of Cerner’s Healthcare IT portfolio in Germany and Spain to CompuGroup Medical (CGM). Cerner will continue to maintain a presence in Spain and German acute markets via its i.s.h.med solution (originally contracted to SAP/Siemens), which was not included in the CGM agreement. i.s.h.med has also provided Cerner a footprint in several other European, African, and Asian countries such as Russia and South Africa.

In other European countries where Cerner has a Millennium footprint it has had more success, and the additional product support and development costs have been less.

Cerner has a substantial UK presence, in part owing to its legacy relationship with BT and the subsequent contracts given out under the largely failed NPfIT program. These customers do use Millennium and the company has grown this business in recent years. To date, Cerner has an installed base of 26 trusts in the UK, up from 22 in 2019, and has had success upscaling these contracts to include products such as HealtheIntent. It has also grown the number of acute trusts served. For example, in 2018 it won contracts with The Countess of Chester Hospital National Health Service Foundation Trust, previously using MEDITECH, and Sandwell and West Birmingham Hospitals. In 1Q 2020, Cerner was selected by two NHS Foundations Trusts (Ashford and St Peter’s Hospital and Royal Surrey) to implement a shared Millennium EHR system, which should support a more coordinated care approach between the two organizations.

Elsewhere in Europe, Cerner expanded its Nordic business recently with large contracts in Region Skäne and Västra Götalandsregionen (both in Sweden) during 2018 and 2019. Cerner was chosen as the preferred EMR supplier for Central Finland (four of 19 sote-areas) and will have the opportunity to expand the contract to other surrounding regions in the mid-long term. However, it lost its Norwegian footprint to Epic when it chose not to bid when the Helse Midt-Norge (Central region) contract was renewed in 2019.

The company has also seen success in the Middle East, particularly in the UAE, Qatar, and Saudi Arabia. However, growth has been more subdued over recent years. In the UAE, it has large contracts with the Ministry of Health and Prevention (MOHAP) and Abu Dhabi department of health (HAAD). Whilst Cerner already has a significant footprint in Saudi, e.g. King Faisal Hospital, the country is still relatively untapped in terms of deployment of digital solutions and offers Cerner a good future growth opportunity.

In Asia Cerner has been successful in Australia, winning state/territory-wide EHR contracts in both Queensland and New South Wales (the only vendor to win two state/territory-wide contracts), and also had success in other states/territories where procurement is decentralized.  Cerner was aiming to add a third centralized Australian contract to its customer base, namely ACT Health (Capital Territory), but was unsuccessful in a head-to-head with Epic, which was selected as the chosen partner in July 2020. Cerner aims to push its PHM solution (HealtheIntent) through its existing state-level contracts where it already has a presence with Millennium.

Most of Cerner’s non-US business in the Americas is in Canada where approximately 100 hospitals are estimated to be using its solution. Here it faces competition from the other leading US vendors such as MEDITECH, Epic, Allscripts, and also local vendor Telus.

In summary, Cerner has broadly made a success of its international business. It tops the market share table in several of its international geographies and it has done this while broadly maintaining the margins achieved with its US business. However, Cerner’s divestiture of the legacy Siemens business in Germany/Spain, and withdrawal from Norway (Central region), will reduce the size of its European business. Cerner also faces an increasing threat from EMEA competitor Dedalus, whose recent acquisitions of Agfa Health’s EHR and integrated care business, and DXC’s healthcare provider business (deal to close in March 2021), could impact Cerner’s position as acute EHR market leader in EMEA moving forwards.

Allscripts

Allscripts

Allscripts’ international revenues witnessed a substantial rise in real terms (up by 34% versus 2018) and as a share of overall business in 2019. This was partly due to a strong performance in the UK with existing customer sales, and new contract wins in New Zealand, Qatar, Philippines, and Saudi Arabia. The impact of COVID-19 on Allscripts’ total revenues was comparatively significant (versus Cerner and MEDITECH), with declines of 9% and 6% respectively in 2Q 2020 and 1H 2020. It is estimated that these declines predominantly impacted North American revenues, whereas international revenues suffered to a lesser extent.

Canada had historically been its largest market outside the US accounting for just under a third of its non-US business, however, its share fell by six percentage points from 2018 to 23% in 2019, largely owing to the growth of its business in the UK and Australia, which are estimated to now be broadly similar in size to Canada.

In Canada, it is a top-five player, but lagging someway behind MEDITECH, Cerner, and Epic in terms of hospital installations. Allscripts continues to steadily grow its Canadian business with a focus on selling added functionality/upgrades to long-standing customers in three provinces (Manitoba, Saskatchewan, and New Brunswick). It aims to expand its Canadian coverage by securing the contract with Nova Scotia province in 2H 2020.

Success in EMEA was mainly driven by wins in the UK, which included two Sunrise clinical wrap contracts along with several added-value solutions for existing client systems. In May 2019, Gloucestershire Hospitals NHS Foundation Trust selected Allscripts to provide a clinical wrap around InterSystems’ PAS. This was rolled out to the entire Trusts’ inpatient wards in March 2020 and represented the fifth clinical wrap around another vendor’s PAS in the UK. In the UK it serves 18 acute trusts (only Cerner, DXC, and SystemC are estimated to serve more).

Much of the company’s UK footprint was built from its acquisition of Oasis Medical Solutions six years ago. However, it has slowly built on this foundation adding new acute trust customers and upgrading many from the legacy Oasis PAS solution to Sunrise and other Allscripts’ solutions such as dbMotion – although perhaps at a slower rate than hoped. Besides the UK and Italy (where it has one Sunrise contract) Allscripts does not have immediate plans for Sunrise expansion in mainland Europe. However, countries that are attempting to implement integrated data-sharing programs (e.g. France, Germany, and Italy), offer Allscripts potential markets for its dbMotion solution.

Allscripts also achieved growth in the Middle East, fuelled by a contract win in March 2020 with Qatar’s Alfardan Medical / Northwestern Medicine for Sunrise. Allscripts has been working on opportunities across Saudi Arabia, UAE, Oman, Qatar, and Kuwait, with different strategies for each country. For example, Oman has a relatively low level of digital healthcare maturity and is being targeted with EMR solutions, whereas relatively mature health markets (e.g. UAE and Qatar) are being targeted with PHM/dbMotion.

Its entry into the Oceania market was also largely via acquisition (Core Medical Solutions in 2016). Core Medical Solutions was a leading player in the smaller hospital and private hospital markets in Australia. Allscripts has added to this legacy with a state-wide Sunrise EHR contract in South Australia (although deployment has not been without its challenges). Sunrise has been implemented in Royal Adelaide Hospital, South Australia Health and Medical Research Center, University of Adelaide, and the University of South Australia.

In 4Q 2019 Allscripts added South Australia’s largest regional hospital network, Mt Gambier, to its coverage. It also had success selling its Sunrise solution outside of this state-wide contract (e.g. Gippsland Health Alliance in Victoria in 2018) and in 2019 its footprint expanded into New Zealand.

In terms of its broader Asian strategy, the company recently split its Asian business into two sub-businesses, ASEAN and ANZ, indicating it sees opportunities beyond its existing Singapore footprint in South East Asia. This has been supported by 2019 wins in the Philippines. In less digitally mature countries, the BOSSNet EHR solution it obtained via the Core Medical Solutions acquisition offers a potential route to offering a more entry-level EHR solution compared to Sunrise.

At just 4.0% of revenues in 2019, international remains a relatively niche business for Allscripts. To some extent the company needs to decide where it wants to take this business. Relying on organic growth in the regions it currently serves is unlikely to move the dial far from this 4.0% figure over the next five years. A significant change is likely only via acquisition, something the company has not shied from in the past. However, should it focus on cementing its position in existing markets or expansion into new? Given it is not a top-two vendor in any of its current geographies outside the US, acquisition to cement its position in existing markets would make more sense than further expansion into new geographies.

Epic

Historically, there have been two major points of entry into new geography for EHR vendors; either through a partnership to gain expertise and ‘localize’ a solution or through the acquisition of a local vendor (as with Cerner and Allscripts earlier). Both have their challenges, with partnerships often being slow to progress and acquisition resulting in the long-term support, and in some instances a significant burden of a legacy solution (e.g. Cerner is still supporting several legacy Siemens EHR solutions nearly six years after announcing its acquisition plans and most of Allscripts’ UK customers are not using Sunrise).

Examples where vendors have taken on large regional projects without sufficient ‘localization’, have often resulted in projects not meeting expectations and negatively affecting both vendors and providers alike. To some extent, Epic has suffered from this with several of its non-US deployments, in particular in the UK (e.g. Cambridge University Hospitals in 2015) and more recently in Denmark (regional contracts in the Zealand region and Capital Region) and Finland (regional contract in the Apotti Region). 

Epic has not made acquisitions to enter its international markets and in all these examples EHR implementations have not met expectations and have either had to be scaled back, delayed, or required a significant amount of remedial action. The main criticism is often not enough ‘localization’ before deployment. That said Epic has had success elsewhere internationally, with less controversy surrounding its deployments in DACH, Netherlands, Middle East, and Singapore. In Canada, it is estimated to be the market leader in terms of revenues and second only to MEDITECH in terms of hospital deployments.

Epic has increased its focus on international expansion in recent years with incremental increases in revenue. However, it needs to improve on implementation/execution or future opportunities may be limited.  The fact it was the only vendor to hit the preselection criteria in Norway for the Helse Midt-Norge contract which it won in 1Q 2019 (replacing Cerner) suggests that progress has perhaps been made on this front.

Historically Epic has struggled to win any Australian state/territory-wide deployments where Cerner, Allscripts, and InterSystems have been successful. However, Epic strengthened its position by winning its first state contract in July 2020 – a $151m deal for the Australian Capital Territory (ACT Health). This was also significant due to it being the first time the Capital Territory had centralized contracting.

MEDITECH

Meditech

At 12% of 2019 revenue, MEDITECH had the highest proportion of non-US sales of all the vendors analyzed in this insight. However, the overwhelming majority of this was from Canada, where it is estimated to be the market leader in terms of the number of hospital installations (although in terms of revenues it is smaller than Epic, Cerner, and Allscripts). Of approximately $60M in non-US sales in 2019, nearly $50M is estimated to have been from Canada. Non-US revenue share was down marginally from 13% in 2018 and in absolute revenues (-7%) due to a fall in Canadian revenues (-8%), whereas revenue from other international markets was marginally up (+1%).

In early 2018 MEDITECH announced the release of its cloud-based EHR, Expanse. MEDITECH has since been rolling out its cloud-based EHR to new customers and replacing its legacy hosted Magic solution for existing customers. This will ease some of the costs and time associated with implementing the solution, which should make it more competitive. In addition, the data hosted on the cloud will make it easier to drive interoperability through a Health Information Exchange, further increasing its attractiveness for provider networks.

Implementation delays caused by COVID-19 contributed toward MEDITECH’s total revenue declining by 3% in 2Q 2020 (versus 2Q 2019). However, a strong international performance in 1Q 2020 (estimated revenue up by c.25%) was driven by new Expanse installations in Canada (including Ontario Mental Health Hospital), leading to 1H 2020 revenues rising by almost 10% (versus 1H 2019).

Approximately 2% of MEDITECH’s business comes from outside North America, a trend that has remained relatively unchanged for several years. As with Epic, Cerner and Allscripts, a significant proportion of its non-American business is in other English-speaking countries, such as the UK/Ireland (22 customers in the UK and 3 in Ireland – mainly public/private sector hospitals), South Africa (24 hospitals) and Australia (72 private hospitals). In the UK it is a second-tier vendor providing EHR solutions to a small number of NHS trusts (low double-digit). Despite a concerted push into the UK, with the acquisition of Centennial (its UK distributor and system integrator) and the official formation of MEDITECH UK in 2018, the number of trusts served decreased with Cerner taking Chester NHS Trust from MEDITECH in 2018.

The company has had considerable success in Africa, selling solutions in 12 countries including Botswana, Namibia, South Africa, Kenya, Nigeria, and Uganda. In September 2019, it partnered with Aga Khan University for a new 2020 deployment of Expanse in South African and Kenya, and subsequent deployment in Pakistan. Contracts in Kuwait and the UAE result in the whole MEA region accounting for a sizable share of its non-North American business.

MEDITECH’s international business mirrors its US business to some extent. It has one of the largest installed bases of hospitals worldwide, but predominantly small hospitals, and often in countries where spend per bed is low; it is also typically not upselling beyond core EHR, meaning that its international revenues, particularly when Canada is excluded, remain small.

Key Takeaways

In Signify Research’s latest global EHR analysis, it was estimated that the US accounted for nearly two-thirds of global EHR sales in 2019, so for these four vendors it must remain the key priority. However, the US is forecast to be one of the slowest growing EHR markets over the next five years as it approaches saturation, particularly for core-EHR products in the acute market. Further, the acute market in the US has now broadly consolidated around these four vendors meaning opportunities for gains in share through replacement is increasingly rare – the long tail has gone.

The geographic expansion offers a potential avenue to drive growth. However, it is not easy and there are plenty of pitfalls. Localizing solutions, acquiring local vendors, displacing local incumbents, aligning products to match government requirements and projects, and putting in place local implementation, project management, and support teams all require significant time and investment. Because of this, the global market remains highly fragmented and market share change is slow. However, for the big four discussed in this insight, ignoring the international opportunity will significantly limit long-term growth; so despite slow and sometimes painful progress, we expect it to remain a priority.


About Arun Gill, Senior Analyst at Signify View

Arun Gil is a Senior Market Analyst at Signify Research, a UK-based market research firm focusing on health IT, digital health, and medical imaging. Arun joined Signify Research in 2019 as part of the Digital Health team focusing on EHR/EMR, integrated care technology, and telehealth. He brings with him 10 years’ experience as a Senior Market Analyst covering the consumer tech and imaging industry with Futuresource Consulting and NetGrowth Consultants.

Led by Mount Sinai, Trellus Health Nabs $5M for Precision Platform for Complex Chronic Conditions

Led by Mount Sinai, Trellus Health Nabs $5M for Precision Platform for Complex Chronic Conditions

What You Should Know:

– Trellus Health secures $5M in seed funding and
collaborates with Mount Sinai to deliver resilience-driven, connected care,
integrating expert clinical and behavioral health for better outcomes.

– The first disease Trellus will tackle is IBD, which is
one of the costliest chronic conditions with a high mental health burden.


Trellus Health, a New York City-based provider of resilience-driven care for people with complex chronic conditions, announced it has raised $5 million in seed funding to transform the way chronic conditions are treated, with an initial focus in Inflammatory Bowel Disease (IBD), including Crohn’s disease and ulcerative colitis. The seed round was led by Mount Sinai Health System (MSHS) and EKF Diagnostics, a global medical manufacturer of point-of-care and central lab devices and tests. Trellus has also entered into an exclusive multi-year contract with MSHS to commercialize its patent-pending GRITT-IBDTM resilience assessment and personalized treatment methodology.

What Is Resilience-Driven Care?

Resilience-driven care incorporates positive psychology
principles into all aspects of chronic disease management, with a focus on
building acceptance, optimism, self-regulation, self-efficacy, and social
support. Proven health benefits of resilience include increased longevity,
cardiovascular, immune, and cognitive function, as well as physical well-being
and reduced risk for depression and anxiety.

Platform for Complex Chronic Conditions, Starting with
IBD

Through its multidisciplinary connected care platform,
Trellus coordinates expert whole-person care, including both clinical and
behavioral health, to improve outcomes and to reduce healthcare costs for
patients, employers, and the healthcare system. The Company leverages its
patent-pending GRITT-IBDTM resilience assessment and personalized treatment
methodology, developed at the Mount Sinai Health System, to support patient
resilience and wellness for better outcomes.

Key features of the platform include:

– Convenient telehealth interactions are coordinated with
in-person visits with local GI providers trained on the latest guidelines for
IBD diagnosis, therapy and medications

– Experienced professional health care team provides care
and coaching to build resilience and help prevent flare-ups with personalized
care plans for symptoms, triggers and lifestyle needs

– 24/7 access to digital tools for expert IBD management,
stress relief, nutrition, and continuous remote monitoring

Why It Matters

According to the CDC, 90% of the U.S.’s $3.3 trillion annual
health care expenditure is for chronic diseases and mental health conditions
with patients suffering from both chronic and mental health conditions costing
twice as much. Despite this, traditional care models fail to address the mental
health aspect of chronic conditions, and access to expert interdisciplinary
care resources to deliver specialist-level care is highly limited. 

The first disease Trellus will tackle is IBD, which is one
of the costliest chronic conditions with a high mental health burden. It
affects 3 million patients in the U.S. (7 million globally) and costing the
U.S. healthcare system over $51 billion a year, according to the ‘Cost of
Inflammatory Bowel Disease: An Initiative from the Crohn’s & Colitis
Foundation 2019.’ Since 2016, the company’s co-founders, Marla Dubinsky,
MD, and Laurie Keefer, PhD, who together bring close to 50 years of experience
managing IBD and serve as co-directors of the Mount Sinai IBD Medical Home,
have integrated resilience-driven multi-disciplinary care into the management
of IBD patients.

“Our research on over 200 IBD patients indicates that more than 70% believe their condition would be better managed if they had support for anxiety or depression,” said Dubinsky, who along with being a co-founder and board member, is also a Professor of Pediatrics and Medicine, Chief of Division of Pediatric Gastroenterology and co-director of Susan and Leonard Feinstein IBD Clinical Center at Mount Sinai. “By personalizing care to address the psychosocial needs of all IBD patients and applying the latest evidence-based clinical approaches, we can help patients achieve disease control and enjoy a significantly improved quality of life.”

KHN’s ‘What The Health?’: Democrats in Array (For Now)

Can’t see the audio player? Click here to listen on SoundCloud.

Democrats have shown a remarkably united front, including on health care, in their socially distant, made-for-TV convention this week. That’s likely due, at least in part, to the physical separation of party members who disagree on issues — this year they cannot chatter on live television — and to the party truly being united in its desire to defeat President Donald Trump in November.

Meanwhile, the coronavirus pandemic continues to complicate efforts around the country to get students back to school, from preschool to college. And the Trump administration’s effort to eliminate anti-discrimination protections in health care for transgender people is put on hold by a federal judge.

This week’s panelists are Julie Rovner of Kaiser Health News, Margot Sanger-Katz of The New York Times, Paige Winfield Cunningham of The Washington Post and Shefali Luthra of The 19th.

Among the takeaways from this week’s podcast:

  • Democrats’ online convention has helped make the party seem unified. But on health policy, divisions remain even though Vice President Joe Biden has agreed to broaden some of his plans, such as lowering the eligibility age for Medicare and agreeing to have federal regulators run a public option plan he is advocating. Progressives in the party still hope to move the debate next year back to establishing a “Medicare for All” system.
  • The heated Democratic primary campaign put a good deal of focus on health policy, including whether to support a Medicare for All system and efforts to make health care more affordable. But the convention rhetoric on health hasn’t focused much attention on that and instead has played up issues surrounding the Trump administration’s response to the coronavirus pandemic.
  • The emphasis on COVID-19 in recent months has also pushed out much of the debate on the issues of high drug prices and surprise bills.
  • As the question of a mail slowdown has enveloped the country, concerns are being raised about mail delivery of prescription drugs, especially for seniors and veterans. Despite anecdotal reports of missed deliveries, most drug industry experts say problems haven’t been widespread.
  • The controversies about reopening schools — both K through 12 and colleges — point to difficulties with the country’s COVID testing program. It is too hard and too expensive for schools to be able to test enough students to guarantee that the virus isn’t spreading.
  • Schools may want to reconsider which age groups they target for returning to the classroom. Since there is little evidence that younger kids spread the virus widely and since they may need the in-classroom experience more, it could make sense to bring them back to school sooner than older students. Plus, older students generally can better handle online classes.
  • Federal health officials have recently warned that the pandemic is having an impact on mental health for many people, raising levels of depression and anxiety. The physical isolation and the economic stresses are fueling much of that.
  • The Trump administration’s rule overturning an Obama administration rule on transgender protections in the Affordable Care Act has been put on hold by a federal judge. But the Obama-era rule had also been put on hold by another judge. So the question is in limbo until higher courts — perhaps the Supreme Court — take up the case.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:

Julie Rovner: The Washington Post’s “Can Dogs Detect the Novel Coronavirus? The Nose Knows,” by Frances Stead Sellers

Margot Sanger-Katz: The Atlantic’s “The Plan That Could Give Us Our Lives Back,” by Robinson Meyer and Alexis C. Madrigal

Paige Winfield Cunningham: Stat News’ “Seven Months Later, What We Know About Covid-19 – And the Pressing Questions That Remain,” by Andrew Joseph, Helen Branswell and Elizabeth Cooney.

Shefali Luthra: KHN’s “Back to the Future: Trump’s History of Promising a Health Plan That Never Comes,” by Victoria Knight

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcherGoogle PlaySpotify, or Pocket Casts.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

USE OUR CONTENT

This story can be republished for free (details).

Why the next blockbuster in mental health might be a video game

David Keene looks at the difficulties faced in treating mental health patients and how digital technologies are changing the game.

In 1919 a young Dwight Eisenhower participated in a cross-country road trip to deliver tanks from Fort Meade in Maryland to San Francisco. Most of the roads on the journey were muddy, rut filled trails, and after 62 days at an average speed of 5 miles per hour, the convoy finally arrived. Forty years later President Eisenhower signed the Federal Aid Highway Act and created the United States’ interstate highway system. Today, the same trip can be easily completed in 4 days.

A highway is a wonderful example of an enabling technology, an underlying, general purpose entity that supports many – sometimes unexpected – innovations. For example, one could argue, that without a high-speed reliable interstate highway system, we wouldn’t have Amazon. Moreover, first mover advantage goes to those who see the maturation of enabling technologies and can build solutions at their intersection at the right moment.

For digital therapeutics, that moment is now.

When I started in the video games industry, computer graphics were – at best – abstract representations of reality. Over the last 20 years, computer and graphics processors have improved astronomically. These improvements — measured by increased transistor count and power efficiency — have allowed for radical increases in graphic fidelity. To put it simply, my mother can’t tell the difference between real life and a computer image anymore. GPU speed and power efficiency has also accelerated machine learning techniques that were unheard of 10 years ago.

Likewise, the availability of high-speed internet has skyrocketed. Spurred on by the intense bandwidth requirements of digital entertainment, the average data rate in the western world has doubled every 18 months, in lockstep with Edholm’s law, the telecommunications equivalent of Moore’s law. Starlink, a network of satellites being launched by SpaceX, is 30% launched, and when complete will provide high speed internet to the entire planet.

“EndeavorRx has become the first ‘prescription video game’ for doctors to utilise, forcing focus for children with ADHD”

In short, society has created machines with photorealistic graphics and machine learning capability, along with a blindingly fast network to connect them. Beyond video games, cat videos, and increased revenue, what else will we spend this tech treasure on?

Mental health disorders affect one in four people, making them a leading cause of ill-health and disability worldwide. Economically speaking, Americans lose approximately $193.2 billion in annual earnings as a result of unmanaged mental illness, and depression alone cost the global market $1 trillion in lost productivity in 2013. According to a 2018 landmark report by the Lancet Commission, the growing mental health epidemic could cost the international economy up to $16 trillion by 2030, with a dramatic impact on productivity and quality of life.

After early wins in the mental health space in the 1950s and 60s with first generation antidepressants and antipsychotics, the industry has struggled to impact mental health at the same rate as other indications. With the exceptions of Spravato and Zulresso, the last major steps forward in the space were SSRIs and SNRIs in the 80s and 90s.

Why is mental health such a “hard attack surface”, to use a hacker’s analogy? The brain is the most complex system in the body, and we are only now starting to understand the complex mechanisms of communication within. It is as if we are standing at the doorway to a vast server farm of computers, but we don’t know the passwords, have only recently discovered electronics, and we don’t yet have a keyboard.

Luckily, our brains already have sensing and effector capabilities, including eyes, ears, a vestibular system to sense the world and many other ways to interact with the outside world. Our brains are highly optimized to use these systems not just as content to reason about, but also as source data to change how we reason, a sort of meta-cognition system.

The human brain is constantly rearranging how it filters, processes and reasons its input. For example, in 1897, George Stratton created a pair of goggles to invert his vision. After wearing them for several days, his brain adapted to the inverted signal from his eyes to his brain, allowing him to function normally and even ride a bike. This year, Akili received FDA clearance for their digital therapeutic for children with ADHD by forcing the brain to adapt with a cleverly designed video game that forces focus. Our brains are capable of responding to training with plasticity.

This makes Akili’s product, EndeavorRx, the first ‘prescription video game’ for doctors to utilise. The game, recommended for children aged 8-12 years old, sees players piloting a small aircraft through a variety of challenging environments.

Due to their rapid development times, low risk and potential for synergistic effects, digital techniques are an ideal add on to existing pharmaceutical pipelines. Many existing drugs and therapies could see an efficacy or adherence boost by adding a digital combination therapy. Soon, integrated digital medicine will be like having a miniature interdisciplinary team accessible 24 hours a day in the patient’s pocket.

In some cases, a combination approach like this will give radically better outcomes. For example, Medically Assisted Therapy (MAT) in Substance Use Disorder (SUD) is more effective than medication intervention alone but is simply unavailable in many areas. A combination digital medicine approach will make high quality, standardised behavioural interventions available for everyone. In other cases, such as the emerging use of psychedelics for SUD or Treatment Resistant Depression, such after-care, as well as pre-care, is critical.

Perhaps now, more than any time in history, all the conditions are ripe for a massive leap forward in mental health. Who will take up the challenge? Who will invest in the basic science? Who will invest in the clinical trials? I would argue that the pharmaceutical industry is the prime candidate for taking up the mantle of taking on mental health with digital medicine. No other industry has the experience, budget, scientific rigour, and established commercialisation pathways to move quickly, ethically and powerfully into this green field of development.

With every required enabling technology now mature, the next leap forward is imminent – and for the hundreds of millions living with debilitating mental illnesses, not a moment too soon.

About the author

David Keene is CEO of IntroSpect Digital Therapeutics, an ATAI Life Sciences Company

The post Why the next blockbuster in mental health might be a video game appeared first on .

Genesis Health Taps Bright.md to Power New Telehealth Offering

Genesis Health Taps Bright.md to Power New Telehealth Offering for Patients

What You Should Know:

– Genesis Health System has signed a partnership agreement
with Bright.md to offer patients in the Quad Cities of Iowa and Illinois access
to its Bright.md’s SmartExam solution.

– The new virtual care offering offers an affordable way to get care for hundreds of low-acuity conditions, mental health, urinary tract infections, and upper respiratory infections including the flu and COVID-19. 


Genesis Health System, today
announced it has selected Bright.md’s SmartExam solution to power its new telehealth offering
as part of an effort to expand its digital health strategy. Patients in the
bi-state region of the Quad Cities metropolitan area and the surrounding
communities of Iowa and Illinois will now have access to another convenient,
affordable way to get care for hundreds of low-acuity conditions.

How SmartExam Works

Bright.md’s care-delivery platform, SmartExam, works like a virtual physician’s assistant. The AI-powered platform automates 90% of a primary or urgent care visit, boosting provider efficiency 15x and increasing the capacity to treat hundreds of patients in a single provider shift. Healthcare systems use SmartExam to deliver treatment for hundreds of conditions, such as flu, pediatrics, dermatology, muscular-skeletal, and behavioral health issues.

By intelligently and automatically combining patient-intake data, interview information, electronic health records, and clinical-workflow integration, the platform enables providers to rapidly diagnose and treat patients with low-acuity conditions, escalating those with more serious conditions to a higher level of care.

Why It Matters

“Demand for virtual care options was growing even before people around the country were asked to stay home due to COVID-19,” said Dr. Kurt Andersen, Senior Vice President, Physician Operations/Chief Medical Officer President of Genesis Health System. “With Bright.md’s innovative telehealth delivery platform and our umbrella of convenient care services, we’re well-positioned to address the situation at hand—for both coronavirus-infected patients and those with other conditions—and be prepared to serve the needs of our patients in a post-COVID-19 landscape.”

The pandemic has shone a light on digital health and in particular telehealth. $5.4 billion has been invested in the digital health sector this year, and analysts predict that telehealth appointments could top $1 billion by year-end. Increased demand for virtual care solutions is fueling this funding frenzy. 

Genesis has offered virtual video visits with their providers since 2015. However, Dr. Andersen and his team recognized the demand for more innovative telehealth tools to complement their current convenient care of services, especially in times of high-demand due to the pandemic. “SmartExam gives Genesis patients another telehealth option and provider’s a greater ability to navigate, triage, and treat patients virtually,” said Dr. Andersen. “And because the automation built into SmartExam streamlines provider workflows, we know our providers will also agree it is a great tool to treat our patients.”