Author Archives: henrykotula

Google Health, the company’s newest product area, has ballooned to more than 500 employees

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https://www.cnbc.com/2020/02/11/google-health-has-more-than-500-employees.html?utm_source=Sailthru&utm_medium=email&utm_campaign=Issue:%202020-02-12%20Healthcare%20Dive%20%5Bissue:25642%5D&utm_term=Healthcare%20Dive

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KEY POINTS
  • More than 500 people now work at Google Health, mostly out of the Palo Alto offices formerly occupied by smart home group Nest.
  • It’s led by former Geisinger CEO David Feinberg, who reports to Google AI chief Jeff Dean, and key players include Google veteran Paul Muret, who runs product, and Chief Health Officer Karen DeSalvo.
  • Former Nest CTO Yoky Matsuoka, who oversaw a small team under Feinberg looking at home-health monitoring, has left the company.

Google’s health care projects, which were once scattered across the company, are now starting to come together under one team now working out of the Palo Alto offices formerly occupied by Nest, Google’s smart home group, according to several current and former employees.

Google Health, which represents the first major new product area at Google since hardware, began to organize in 2018, and now numbers more than 500 people working under David Feinberg, who joined the company in early 2019. Most of these people were reassigned from other groups within Google, although the company has been hiring and currently has over a dozen open roles.

Google and its parent company, Alphabet, are counting on new businesses as growth slows in its core digital advertising business. Alphabet CEO Sundar Pichai, who was recently promoted from Google’s CEO to run the whole conglomerate, has said health care offers the biggest potential for Alphabet to use artificial intelligence to improve outcomes over the next 5 to ten years.

Google’s health efforts date back more than a decade to 2006, when it attempted to create a repository of health records and data. Back then, it aimed to connect doctors and hospitals and help consumers aggregate their medical data. However, those early attempts failed in market and the company terminated this first “Google Health” product in 2012. Google then spent several years developing artificial intelligence to analyze imaging scans and other patient documents and identify diseases with the intent of predicting outcomes and reducing costs. It also experimented with other ideas, like adding an option for people searching for medical information to talk to a doctor.

The new Google Health unit is exploring some new ideas, such as helping doctors search medical records and improving health-related Google search results for consumers, but primarily consolidates existing teams that have been working in health for a while.

Google’s not the only tech giant working on new efforts centered around the health industry. Amazon, Apple, Facebook and Microsoft have all ramped up efforts in recent years, and have been building out their own teams.

Who’s important at Google Health?

In just over a year under Feinberg’s leadership, Google Health has grown to more than 500 employees, according to the company’s internal directory and people familiar with the company. These people asked for anonymity as they’re not authorized to comment publicly about the company’s plans.

Many of these Google Health employees have come over from other groups, including Medical Brain, which involves using voice recognition software to help doctors take notes; and Deep Mind’s health division, which was folded into Google Health back in November of 2018 and has worked with the U.K.’s National Health System to alert doctors when patients are experiencing acute kidney injury.

The business model for Google Health is still a work in progress, but its leadership and organizational structure provided some clues as to the company’s areas of interest.

Feinberg is high up in Google’s internal org chart and has the ear of the top Google execs including Pichai. He reports to Jeff Dean, the company’s AI lead and one of its earliest employees.

Dean co-founded Google Brain in 2010, which catapulted the company’s deep learning technology into medical analysis. Some of the first health-related projects out of Google Brain included a new computer-based model to screen for signs of diabetic retinopathy in eye scans, and an algorithm to detect breast cancer in X-rays. In 2019, Dean took the helm of the company’s AI unit, reporting to Pichai.

Feinberg stood out in interviews for the job because he helped motivate Geisinger to start thinking more deeply about preventative health and not just treating the sick, according to people familiar with the hiring process. During his tenure at Geisinger, the hospital experimented with giving away healthy food to people with chronic conditions, including diabetes. It also pushed for more patients to have genetic tests to screen for diseases before it grew too late to treat them.

Feinberg works closely with Google Cloud CEO Thomas Kurian, who has named healthcare as one of biggest industry verticals for the business as it attempts to catch up with cloud front-runners Amazon and Microsoft.

Another key player at Google Health is Paul Muret, who had been an internal advocate for forming Google Health before Feinberg was hired, say two people who worked there. Muret is a veteran of the company who worked as a vice president of engineering for analytics, followed by video and apps. He’s now listed on LinkedIn as a product leader for “AI and Health,” and people in the organization say he’s in charge on the product side.

The company is now staffing up its team with health industry execs to show that it’s not just a group of Silicon Valley techies tinkering with artificial intelligence.

For instance, Feinberg helped recruit Karen DeSalvo as Google’s chief health officer. DeSalvo, who was the health commissioner of New Orleans, played a major role in rebuilding the city’s health systems in the wake of Hurricane Katrina. Like Feinberg, she’s been a big advocate of the idea that there’s more to health than just health care. She’s pushed for hospitals to consider whether patients have access to transportation services, healthy food and a support system before sending them home.

Google Health has also absorbed a small group from Nest that was looking into home-health monitoring, which would be particularly beneficial for seniors who are hoping to live independently. That group was led by former Nest CTO Yoky Matsuoka, sources say, but she recently left Alphabet, and has reportedly been working as a fellow at Panasonic. Matsuoka co-founded Google’s R&D arm, now called X, in 2011, and worked at Apple in between her stints at Google.

She’s not the only high-profile departure. A top business development leader, Virginia McFerran, who came from insurance giant UnitedHealth Group, has also left the company. To replace her, the team brought over Matt Klainer, a vice president from the consumer communications products group as its business development lead for Google Health.

Some health-related ‘Other Bets’ will remain separate

Google’s parent company, Alphabet, has a number of health-related “Other Bet” businesses that will remain independent from Google Health, including Verily, the life sciences group, and Calico, which is focused on aging.

Recently promoted Alphabet CEO Sundar Pichai stressed that the setup was intentional during the company’s most recent earnings call with investors, implying that Alphabet was not planning to consolidate all of its health efforts under one leader anytime soon.

“Our thesis has always been to apply these deep computer science capabilities across Google and our Other Bets to grow and develop into new areas,” noted Pichai, when describing the company’s work in health.

“The Alphabet structure allows us to have a portfolio of different businesses with different time horizons, without trying to stretch a single management team across different areas,” he continued.

 

President Trump’s budget cuts target Medicaid, Medicare

Posted on by • Posted in 2020 Election Issues, ACA, American Hospital Association (AHA), Health Insurance Coverage Adequacy, Health Policy, Health System, Hospital, Hospital Industry, Medicaid, Medicaid Expansion, Physician, Physician Practice Management, Uncompensated Care • Leave a comment

https://www.healthcarefinancenews.com/news/president-trumps-budget-cuts-target-medicaid-medicare?mkt_tok=eyJpIjoiWVRnM01UZzNaR0V6TTJFNSIsInQiOiJ6aXpsQnNCRjhHdCs4SnN0UytlZnJVUlZUeFdreEZyQ2V6RWE0YklvYmFMOGJnbWpXT3ZHeG0rOHMwNkJPcE9rMUlGb3NzVkpId3NrZHNkZmR2VlZISXZCVGgrbU94cFV3aVlNR1NYamlhazF1R1kzaXd3RXVISm9OSGJoYmVrVCJ9

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Blueprint includes cuts for care in hospital outpatient departments, teaching hospitals and post-acute care providers, AHA says.

President Trump’s proposed $4.8 trillion budget slashes billions of dollars from Medicaid, food stamps and other safety net programs in an attempt to shrink the federal deficit.

Medicaid and the Affordable Care Act see about $1 trillion in cuts over the next decade, according to The Hill. The budget eliminates the enhanced federal match for Medicaid expansion enrollees. An additional $150 billion is expected to be shaved off of Medicaid from the implementation of work requirements, which is expected to result in people losing their healthcare coverage.

The “President’s health reform vision” to ax the Affordable Care Act takes $844 billion over 10 years from the ACA, the report said.

The decrease in federal spending on Medicare would total about $750 billion over 10 years, but that includes shifting two programs out of the budget. After accounting for those changes, the reduction is just over $500 billion, according to CNN. Much of that cut comes from reducing payments to providers.

The budget needs Congressional approval and is not expected to get past a Democratic-controlled House without changes.

House Speaker Nancy Pelosi tweeted: “The budget is a statement of values. Once again, the #TrumpBudget makes it painfully clear how little the President values the good health, financial security and well-being of America’s hard-working families.”

Ways and Means Committee Chairman Richard E. Neal, D-MA, said, “When I saw the President’s proposed budget today, I felt an immense sense of relief – relief that there is absolutely no chance of his ruthless cuts to critical programs ever becoming law. Slashing billions from Medicare and Medicaid will only make it harder for Americans to access the healthcare they need.

Cutting nutrition assistance and Social Security benefits for the disabled won’t enable people to get back on their feet financially.”

Senator Lamar Alexander, R-Tenn said, “Under the Constitution, it is Congress’ job to set spending priorities and pass appropriations bills, and as a member of the Senate Appropriations Committee, my priorities will continue to be making sure our national defense, national laboratories, the National Institutes of Health and national parks have the resources they need. I am encouraged to see the president is calling to end surprise medical billing.”

The budget adds money to the National Institutes of Health. The NIH will invest $50 million for new research on chronic diseases, using AI and related approaches, according to the White House briefing. It adds $7 billion over 10 years to fight opioid abuse and for mental health in the Medicaid program.

WHY THIS MATTERS

Cuts to Medicare and Medicaid mean uncompensated care to providers, or a reduction in the government payments.

The American Hospital Association said, “The budget request, which is not binding, proposes hundreds of billions of dollars in reductions to Medicare and Medicaid over 10 years.”

AHA President and CEO Rick Pollack said, “Every year, we adapt to a constantly changing environment, but every year, the Administration aims to gut our nation’s healthcare infrastructure. The proposals in this budget would result in hundreds of billions of dollars in cuts that sacrifice the health of seniors, the uninsured and low-income individuals. This includes the one in five Americans who depend on Medicaid, of which 43% of enrollees are children.

“In addition to the hundreds of billions in proposed reductions to Medicare, the blueprint includes cuts we strongly oppose for care in hospital outpatient departments, teaching hospitals and post-acute care providers. These cuts fail to recognize the crucial role hospitals serve for their communities, such as providing 24/7 emergency services. Post-acute cuts threaten care for patients with the most medically complex conditions.”

 

AARP, United Healthcare and CVS keep prescription drug prices higher for seniors

Posted on by • Posted in 2020 Election Issues, Generic Drugs, Health Insurance Coverage Adequacy, Health Insurance Industry, Health Policy, High Deductible Health Plans, High Drug Prices, Out of Pocket Expenses, Pharmaceutical Industry, Pharmacy Benefits Management • Leave a comment

https://www.washingtontimes.com/news/2020/feb/11/aarp-united-healthcare-and-cvs-keep-prescription-d/

Illustration on overpriced prescription drugs for seniors by Alexander Hunter/The Washington Times

ANALYSIS/OPINION:

Most folks think of the AARP as a membership organization that gives older Americans discounts on magazine subscriptions and cellphone plans. In fact, those business lines are secondary to AARP’s real source of income, a lucrative partnership with United Healthcare.

AARP partners with United Healthcare to offer health insurance plans to its membership. On its face, there’s nothing inappropriate about this type of affinity branding; the problem is that United Healthcare (and, frankly, other insurance companies) have made some decisions at the expense of seniors and the Medicare program, which should run counter to what a seniors-focused advocacy organization endorses. Recent actions by United Healthcare to limit seniors’ access to less expensive versions of Medicare drugs calls into question whether the AARP is looking out for older Americans or its own bottom line.

During the past three years, President Trump has maintained a laser focus on drug prices, causing pharmaceutical companies to respond in a variety of ways, including reducing or, in some instances, halting altogether annual price increases, pledging responsible pricing for new medications and reducing the price of medicines in certain instances.

For example, last year Eli Lilly launched a half-price version of its insulin drug, Humalog, to address affordability barriers for diabetic patients. Gilead created a subsidiary company in order to offer its two revolutionary hepatitis C products, Harvoni and Epclusa, as “authorized generics” at prices more than 70 percent lower than the identical brand version. In 2018, two companies competing in the cardiovascular space, Sanofi and Amgen, each introduced less costly versions of their cholesterol medications for patients who are unresponsive to statins — at 60 percent below the original price. These are all big wins for Mr. Trump’s jawboning campaign.

But the system is not working: These less expensive versions of innovative drugs are not available to many seniors because of how insurance companies and their negotiators (known as “pharmacy benefit managers” or PBMs) design drug coverage via formularies, particularly in Medicare. A perfect case study is cardiovascular disease, the No. 1 cause of death in the United States: For the past 14 months, in many instances, United Healthcare formulary design kept patients on the more expensive versions of the Sanofi and Amgen cholesterol medicines which came coupled with a high out-of-pocket co-insurance for the patient. Further, CVS (which is merging with insurance company Aetna) admitted to creating barriers for patients by requiring doctors to provide a “documented clinical reason” for prescribing the identical, cheaper version of the same medicine. Today in Medicare, CVS continues to block affordable access to the lower cost versions by not covering these medicines anywhere on their national formulary, effectively dissuading a patient at high risk for a heart attack or stroke from purchasing the medicine prescribed by his/her cardiologist.

Why would insurance companies and PBMs want to keep paying for the more expensive version of an identical drug? The answer lies in the backward way drugs are priced in America. Drug manufacturers set the “list price” of a drug the same way a car dealership lists the price of cars or colleges list the price of tuition. What’s actually paid by an insurer in the final transaction is usually steeply discounted from the starting price by the drug company “rebating” a portion — 40 percent on average, oftentimes more — to the PBM/insurance company (which then pocket it). That negotiation should result in reduced out-of-pocket drug costs for seniors. The problem is that this model results in perverse incentives.

Medicines have high “list prices” because the drug company knows that it will need to provide significant discounts/rebates in order to be listed on a health plan’s formulary. Positive formulary placement = patient access to a medicine. Insurance companies and PBMs like the higher list prices because they profit from both the steep, negotiated rebates and the higher co-insurance the patient pays to the plan. In Medicare, once a patient barrels through the initial drug coverage phase, the federal government picks up 80 percent of a senior’s drug costs, reducing the insurer’s liability. In the end, it’s patients who suffer at the pharmacy counter and in the long run.  

 

 

 

 

30 latest hospital credit rating downgrades

Posted on by • Posted in Credit Quality, Credit Ratings, Health System, Hospital, Hospital Industry • Leave a comment

https://www.beckershospitalreview.com/finance/30-latest-hospital-credit-rating-downgrades.html

OR Efficiencies

The following 30 hospital and health system credit rating downgrades occurred in the past six months. They are listed below in alphabetical order.

1. Altru Health System (Grand Forks, N.D.) — from “A-” to “BBB” (Fitch Ratings); from “Baa1” to “Baa2” (Moody’s Investors Service)

2. Augusta (Ga.) University Health System — from “Baa1” to “Baa3” (Moody’s Investors Service); from “BBB” to “BBB-” (S&P Global Ratings)

3. Bibb County Medical Center (Centreville, Ala.) — from “BBB+” to “BB” (S&P Global Ratings)

4. Boone Hospital Center (Columbia, Mo.) — from “Baa2” to “Ba1” (Moody’s Investors Service); from “A-” to “BBB” (Fitch Ratings)

5. Covenant Health (Tewksbury, Mass.) — from “BBB+” to “BBB” (Fitch Ratings)

6. Delta (Colo.) County Memorial Hospital — from “BB+” to “BB” (S&P Global Ratings)

7. Erlanger Health System (Chattanooga, Tenn.) — from “Baa2” to “Baa3” (Moody’s Investors Service)

8. Excela Health (Greensburg, Pa.) — from “A3” to “Baa1” (Moody’s Investors Service)

9. Fairfield Medical Center (Lancaster, Ohio) — from “Baa3” to “Ba2” (Moody’s Investors Service)

10. Hospital Sisters Health System (Springfield, Ill.) — from “AA-” to “A+” (S&P Global Ratings)

11. Indiana (Pa.) Regional Medical Center — from “Ba1” to “Ba2” (Moody’s Investors Service)

12. Integris (Oklahoma City) — from “A1” to “A2” (Moody’s Investors Service)

13. Mercy Medical Center (Des Moines, Iowa) — from “A” to “A-” (S&P Global Ratings)

14. Methodist Hospitals (Gary, Ind.) — from “BBB” to “BBB-” (S&P Global Ratings)

15. Murray (Ky.) Calloway County Hospital — from “Baa3” to “Ba2” (Moody’s Investors Service)

16. Nicklaus Children’s Hospital (Miami) — from “A+” to “A” (S&P Global Ratings)

17. OSF HealthCare (Peoria, Ill.) — from “A2” to “A3” (Moody’s Investors Service)

18. Parmer County (Texas) Hospital District — from “Baa1” to “Baa2” (Moody’s Investors Service)

19. Princeton (W.Va.) Community Hospital — from “BBB+” to “BBB” (S&P Global Ratings)

20. ProMedica Health System (Toledo, Ohio) — from “Baa1” to “Baa3” (Moody’s Investors Service); from “BBB+” to “BBB” (Fitch Ratings)

21. Regional West Health Services (Scottsbluff, Neb.) — from “BBB” to “BB+” (Fitch Ratings)

22. Sanford Health (Sioux Fall, S.D.) — from “A1” to “A2” (Moody’s Investors Service)

23. South Nassau Communities Hospital (Oceanside, N.Y.) — from “Baa1” to “Baa2” (Moody’s Investors Service)

24. Southeastern Regional Medical Center (Lumberton, N.C.) — from “A-” to “BBB+” (Fitch Ratings)

25. Sparrow Health System (Lansing, Mich.) — from “A1” to “A2” (Moody’s Investors Service)

26. St. John’s Riverside Hospital (Yonkers, N.Y.) — from “B-” to “CCC+” (S&P Global Ratings)

27. St. Luke’s Hospital (Chesterfield, Mo.) — from “A+” to “A” (S&P Global Ratings)

28. Tower Health (West Reading, Pa.) — from “A” to “BBB” (Fitch Ratings); from “A3” to “Baa2” (Moody’s Investors Service)

29. University of Chicago Medical Center — from “A1” to “Aa3” (Moody’s Investors Service)

30. Winkler County Memorial Hospital (Kermit, Texas) — from “AA” to “BB+” (S&P Global Ratings)

 

 

 

Trump budget calls for cutting Medicaid, ACA by about $1 trillion

Posted on by • Posted in 2020 Election Issues, ACA, Health Policy, Medicaid, Medicare • Leave a comment

Trump budget calls for cutting Medicaid, ACA by about $1 trillion

Image result for medicaid cuts

President Trump’s proposed budget includes about $1 trillion in cuts to Medicaid and the Affordable Care Act over a decade, analysts said.

The budget released Monday includes $844 billion over 10 years in cuts from the “President’s health reform vision,” a stand-in for the repeal and replacement of ObamaCare. There are also more than $150 billion in additional cuts from implementing Medicaid work requirements and other changes to the program, which would result in some people losing coverage if they did not meet the requirements.

The cuts drew swift condemnation from Democrats, who pointed out that Trump himself promised not to cut Medicaid, the health insurance program for the poor, during his 2016 campaign.

“I’m not going to cut Medicare or Medicaid,” Trump said in 2015, adding, “Every other Republican is going to cut it.”

“Americans’ quality, affordable health care will never be safe with President Trump,” Speaker Nancy Pelosi (D-Calif.) said in a statement on the budget proposal.

A senior administration official defended the Medicaid cuts, arguing reforms will help preserve the program for people who need it most. “The Budget protects and preserves Medicaid by putting it on a sustainable path, so it can continue to provide vital services to those who need it the most, including children, the disabled, elderly and pregnant women,” the official said.

In contrast to previous years, the budget does not spell out how Trump proposes to repeal and replace ObamaCare. Instead, the budget gives a savings number of $844 billion that could come from any number of possible changes to Medicaid or the health law’s exchanges and subsidies. 

One policy that is specified is that the budget calls for ending the additional federal funding that helped states expand Medicaid to cover more people under the Affordable Care Act, with officials arguing states can step up their spending if they want to expand the program.