Telehealth Opportunity or Telehealth "Parity"?

Health Alert: Telehealth Opportunity or Telehealth “Parity”?

(A version of this column, with hyperlinks, was published by Forbes.)

Telehealth provides a great opportunity to reduce costs and improve quality in U.S. health care. It uses information technology to eliminate distance within the system. A subset of telehealth is telemedicine, which allows physicians to consult patients over the phone, by text, or video.

Take a couple of obvious examples: Telepsychiatry, whereby a patient undergoing talk therapy has a session with his psychiatrist over the phone instead of having to go to the doctor’s office; or e-prescribing, whereby a patient can describe symptoms over the phone or send a photo (of, for example, a rash) and the doctor can prescribe immediately (if appropriate).

Most people tend to categorize these as “no-brainers.” If we paid for our own care directly, these and many other examples would have long since taken off. However, because payment for medical care is dominated by health insurers and government, these innovations have been stifled. Third-party payers impose obstacles because they fear paying fraudulent claims.Nevertheless, telemedicine is growing.

First, Do No Digital Harm: Regulating Telemedicine

(A version of this Health Alert was published by Forbes.)

Telemedicine, whereby physicians use email, phone, text, or video for prescribing and consultations, is growing rapidly. Seeking to encourage faster uptake of telemedicine, many well-intentioned parties are prodding Congress to take actions which will likely have harmful unintended consequences.

So far, Congress has done well. With respect to regulating actual devices, the 21st Century Cures Act, passed by the House in 2015 with overwhelming bipartisan support, is forward thinking. If passed into law, the policies it would implement would lead to a responsible and responsive regulatory environment for mobile health apps.

However, there are other areas in which a Congressional take-over would do more harm than good. In recent testimony to the House Energy & Commerce Committee’s Subcomittee on Commerce, Manufacturing and Trade, I encouraged Congress to First, Do No Digital Harm. Two of the most important areas of risk are federal interference in the practice of medicine and how Medicare pays for telemedicine.

Digital Health Funding Defies Expectations

Investors have not had their fill of digital health deals, according to new fundraising reports from Rock Health and Startup Health, two outfits which have led the digital health revolution and produce complementary reports on how much capital is flowing into the sector. While other sectors have wobbled recently, digital health (which was only defined as a market five or six years ago) continues to attract venture capital.

Read the entire column at Forbes.

Is Telehealth Another Health Care Silo?

When we say health care operates in silos, we mean a patient’s cardiologist, psychiatrist, and general practitioner have no idea what each other are doing. Or that the individual departments in a hospital have no idea what each other are doing. Or your new family doctor has no idea what former doctors did to you, and you have to fill in a sheet on a clipboard in the waiting room with decades-old information you barely remember or even understood when former doctors told you.

“Connected care” is supposed to break down these silos. Is telehealth doing it? Probably not.

Read the entire column at Forbes.

Connected Care Cuts Costs, But Can It Overcome Inertia?

“Connected care” refers to a large and growing portfolio of digital tools, from video consultations with psychiatrists to in-home sensors passively detecting when a senior falls to devices that measure diabetics’ blood glucose and send messages to their families’ or doctors’ smartphones when intervention might be needed.

Beyond Electronic Heatlh Records, uptake of connected health is very low. According to a recent report:

• Less than half (45 percent) of patients receive even the traditional telephone appointment reminders.
• Only one in five (21 percent) have access to online appointment scheduling with their doctors.
• Fifteen percent use email to communicate with their provider.
• Just 14 percent have 24/7 access to medical advice.
• Fewer than one in ten (9 percent) receive reminders by text.
• Only a small percentage (3 percent) are able to send a photo of a medical condition over email.
• Just 2 percent have access to video visits.

Even more discouraging are physicians’ attitudes: Fewer than half believe telemedicine (delivering care over the phone or video) is an important evolution in the practice of medicine, while almost one third belief it is “not worth the hype.”

Read the entire column at Forbes.

Explaining The Fall (And Possible Rebirth) Of Doctors' House Calls

House calls used to make up 40 percent of U.S. doctors’ visits in the 1940s, before going into decline in the 1960s. These days, they comprise less than one percent of consultations. Many believe that more house calls would increase quality of care at low cost, which led Medicare to launch an “Independence at Home” demonstration project for seniors with multiple chronic conditions in 15 states. Starting in 2012, the project has had promising results.

This invites the question: Why did house calls decline?

Read the entire column at Forbes.

21st Century Cures Passes U.S. House

This morning, the U.S. House of Representatives passed (344-77) the 21st Century Cures Act. This is a monumental achievement, designed to fundamentally restructure the Food and Drug Administration and thereby reverse the staggering decline of productivity in medical research and development.

Read the entire entry at NCPA's Health Policy Blog.

Rock Health: $2.1 Digital Health Funding in Q2

Rock Health has published its account of 2015 Q2 funding of digital health ventures. According to Rock Health, funding so far this year is keeping pace with 2014.

What is especially interesting about Rock Health’s report is that it compares venture funding of digital health to other areas and concludes that digital health is growing at a significantly faster rate than other areas, especially biotech and medical devices.

Digital Health Market is Maturing

StartUp Health has published its analysis of 2015 Q2 digital health funding. Covering a somewhat broader portfolio than Mercom Capital does, StartUp Health reports $1.7 billion in new funding.

By far the biggest deal discussed in the report was Zenefits’ $500 million raise. Zenefits, I get. The deal I don’t get is Oscar, which comes a distant second with $145 million raised. Oscar is the only health insurer in America that actually wants to enter Obamacare’s exchanges. What are they thinking? I can’t figure it out, but Goldman Sachs is an investor, and it’s not a good idea to bet against Goldman Sachs.

The report also notes that there have been some significant IPOs in digital health, providing liquidity and some transparency in valuations.

Telehealth Has Best Funding Quarter Ever

Venture funding of health IT deals in 2015 Q2 amounted to $1.2 billion in 138 global deals, according to Mercom Capital Group. This was smaller than 2014 Q2, which saw $1.7 billion raised in 159 deals.

However, telehealth and mobile health continue to blow the doors off.

Read the entire entry at NCPA's Health Policy Blog.

Net Neutrality Versus Your Health

(A version of this Health Alert, which is co-authored by Roslyn Layton, was published by iHealthBeat. Roslyn Layton is a PhD fellow at Aalborg University’s Center for Communication, Media & Information Studies and vice president of Strand Consult.)

The Federal Communications Commission’s recent decision to regulate the Internet with the same law that was created for “Ma Bell” before World War II has plenty of implications for the health innovation economy. The era of “permission-less innovation” may be coming to an end as the FCC will scrutinize telemedicine applications and other broadband-enabled health care services because they involve connectivity. If Congress can act quickly to rein in the FCC, a disaster can be averted.

Read the entire Health Alert at NCPA's Health Policy Blog.

Teladoc Fights Back

This blog noted a few weeks ago that telehealth is facing headwinds. Teladoc, a Texas-based provider of telemedicine services, was being stifled by the Texas Medical Board.

Now, Teladoc has filed both an Initial Public Offering (IPO) and a lawsuit against the Texas Medical Board on antitrust grounds.

Read the entire entry at NCPA's Health Policy Blog.

Telehalth Faces Headwinds

We’ve cheered the telemedicine compact written by the Federation of State Medical Boards, and hoped that it would lead to a rapid collapse of the barriers facing telehealth providers’ ability to provide services across state lines.

Unfortunately, some medical societies and states are unwilling to move with the times.

Read the entire column at NCPA's Health Policy Blog.

Here's What Electronic Health Record Interoperability Looks Like (Not)

NCPA recently released an Issue Brief questioning the federal government’s dominance of health information technology, especially electronic health records (EHRs). Our conclusion came from the failure of the federal government to bring about so-called interoperability between EHRs. Jonathan Bush, CEO of Athenahealth, a provider of EHRs, illustrates how appalling this failure has been:

Read the entire column at NCPA's Health Policy Blog.

Licensing Out-of-State Doctors: Half of Medical Boards Perform Poorly

Telemedicine embraces technologies as diverse as surgeons operating robots remotely, radiologists reading scanned images remotely, or psychiatrists conducting therapy sessions via videoconference. A new research article in the Telemedicine and E-Health Journal shows how difficult state regulatory barriers are making it for doctors to practice effective telemedicine.

Read the entire column at NCPA's Health Policy Blog.

Get the Federal Government Out of the Electronic Health Records Business

In 2009, the federal government decided that doctors and hospitals were slow to take up electronic health records (EHR).  Isn’t everyone fed up with filling out forms and having his or her medical records filed in manila folders?  So the feds decided to dish out $30 billion to pay doctors and hospitals to install EHRs credentialed by a new government agency, the Office of the National Coordinator of Health Information Technology (ONC).

By July 2014, $25 billion of these payments had gone out the door.  Unfortunately, results indicate that this federal spending has perverted the natural adoption of EHRs, and may have even lowered the quality of care.

Read the entire article at The American Thinker.

FDA Regulation of Mobile Health Apps Is A Real Threat

Do you want the Food and Drug Administration (FDA) to regulate your smartphone? Many in the booming digital health industry are indifferent to the risks of the FDA regulating apps as medical devices. As I noted in a recent Health Alert, the FDA’s current doctrine is to allow most new apps onto the market without regulation. However, this openness is defined only in rules written by the FDA itself, not legislation. Rep. Marsha Blackburn and others in Congress have proposed to amend the law to prevent the FDA from overreaching.

Entrepreneurs and patients who think that the FDA’s current posture is eternal should be aware of a campaign to regulate apps for health. Here’s a recent article from Mother Jones:

Read the entire article at NCPA's Health Policy Blog.

Digital Health Venture Funding Doubled in 2014

If it hasn’t happened to you already, it will soon: Your doctor, employer, health insurer, friend, or colleague will recommend you try a new smartphone app to keep you healthy. Apps are just one example of the fast growing area of digital health, which refers to applying digital technology that has changed so much of our lives to the healthcare industry.

Two recent reports show how important digital health is becoming, and how fast. StartUp Health, a New York-based accelerator, and Rock Health, a San Francisco-based accelerator and seed fund, have independently reported that funding for new digital health ventures in the United States doubled in 2014.

Read the entire column at Forbes.

The U.S. Regulates Health Technology Under A Law Signed By Gerald Ford

1976: The United States celebrated the bicentennial of our independence; Jimmy Carter was elected president; young men wore bell bottoms and middle-aged ones wore leisure suits; advertising encouraged women to smoke Kool cigarettes. And the Food and Drug Administration (FDA) first regulated medical devices.

Although we fantasized about having Captain Kirk’s communicator or Dr. McCoy’s tricorder, nobody would have known what to do with an actual smartphone or tablet, had they existed in those days. Today, increasing numbers of us use them to keep track of medical information, to remind us to take our meds or do countless other tasks important to our health. In 2013, the Apple app store had 97,000 mobile health apps, and over 60 percent of physicians were using tablets.

And yet, the FDA is still regulating these 21st century technologies under legislation passed when Wings’ Silly Love Songs topped the pop music charts. It’s past time for Congress to amend the Food, Drug and Cosmetic Act to clarify the FDA’s regulatory authority over these new tools for our health.

Read the entire column at Forbes.

Health Technology Forum Meet Up in Washington, DC on December 11

Colleagues,

I would like to invite you the Health Technology Forum Meet Up in Washington, DC, on December 11, from 6-9 p.m.

Our December 11 Meet Up will address the theme of Clinical Evidence in mHealth.

We have three speakers confirmed so far:

• Sandeep Pulim, MD, Chief Medical Information Officer of @Point of Care,  a new business incubated by StartUp Health which provides a streamlined practice-based tool to allow for the delivery of content at the clinician’s fingertips at the time it is acutely needed, built on IBM's Watson cognitive technology.

• Anand K. Iyer, Phd, MBA, Chief Data Science Officer of WellDoc, a healthcare company that uses technology to improve disease management outcomes and reduce health care costs. Dr. Iyer previously PRTM Management Consultants' Wireless Solutions practice where he helped companies in both the commercial and government sectors capitalize on the convergence of three mega trends: Internet ubiquity, emerging wireless technologies and innovative business models. He is a pioneer in the realm of Telematics and Telemedicine, where he has developed and launched several initiatives with OEMs to transition their basis of competition from a product-base to a service-base.

• Michael Slage of LiftOffHealth, the DC-area'a only incubator/accelerator focused exclusively on health care. LiftOffHealth will be welcoming its first class of entrepreneurs soon. If you have a new business idea you do't want to miss his presentation! Mr. Slage has over two decades of experience building new healthcare businesses.

More speakers will be announced soon. Your nominations are welcome.

To learn more, and RSVP, become a member of the Health Technology Forum: DC Meet Up, which takes only a few clicks of the mouse..