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Senate rejects ObamaCare repeal, replacement amendment

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Senate rejects ObamaCare repeal, replacement amendment

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The Senate rejected a key proposal repealing and replacing ObamaCare on Tuesday night, as senators start a days-long debate on healthcare.

Senators voted 43-57 on a procedural hurdle for the measure that included the GOP repeal and a replace bill, the Better Care Reconciliation Act, as well as proposals from GOP Sens. Ted Cruz (Texas) and Rob Portman (Ohio).
GOP Sens. Susan Collins (Maine), Bob Corker (Tenn.), Tom Cotton(Ark.), Lindsey Graham (S.C.), Dean Heller (Nev.), Mike Lee (Utah), Jerry Moran (Kan.), Lisa Murkowski(Alaska) and Rand Paul (Ky.) voted against the repeal-replace proposal on the procedural hurdle. No Democrats voted for it.
The proposal was the first amendment to get a vote after senators took up the House-passed healthcare bill, which is being used as a vehicle for any Senate action, earlier Tuesday.
But it was widely expected to fail because it needed 60 votes because the Congressional Budget Office (CBO) didn’t analyze either the Cruz or Portman proposal that was packaged in with BCRA.
Tuesday night’s vote doesn’t prevent GOP leadership from offering another repeal and replace amendment, or another version of BCRA.
It could also help GOP leadership get rank-and-file senators on the record, as they try to figure out a path forward.
A vote on an amendment that would repeal much of ObamaCare is expected on Wednesday.
Cruz acknowledged ahead of the late night vote that the amendment wasn’t likely to be approved, but appeared optimistic that Republicans would be able to get to an agreement before a final vote this week.
“I will say the bill before the Senate … is not likely to pass tonight but I believe at the end of the process the contours within it are likely to be what we enact, at least the general outlines,” Cruz said from the Senate floor ahead of the vote.
Cruz said he expects his amendment to end up in the final version of the healthcare bill.
“I believe we will see the consumer freedom amendment in the legislation that is ultimately enacted,” he said.
Sen. Lisa Murkowski (R-Ala.) was greeted by protestors outside the Capitol who chanted “stay strong Lisa.”
Asked whether she would support a “skinny repeal” bill, she said it’s not clear what it would entail.
“I don’t know that any of us have defined what that might be.”
The Texas Republican’s provision would give insurance companies more flexibility on what kind of health insurance plans they provided, as long as they sold some plans that met the ObamaCare requirements.
Portman’s, meanwhile, would aim to lower insurance costs for individuals in Medicaid expansion states, like the Ohio Republicans, but could also apply to other low-income Americans.

The provision would add $100 billion to the bill’s state stability fund to help people who might lose the coverage they got under ObamaCare’s Medicaid expansion. These funds could help cover out-of-pocket costs like deductibles and copays.

Portman said he “worked with the president, vice president and administrative officials” to “improve this bill further to help out low-income Ohioans.”

Would your plan cover John McCain’s treatment?

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https://www.healthinsurance.org/blog/2017/07/25/would-your-plan-cover-john-mccains-treatment/

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The Arizona Senator’s health plan will ensure top-notch glioblastoma treatment, but how would Americans with other health coverage fare?

Last week, we heard the sad news that Senator John McCain has been diagnosed with glioblastoma. McCain had surgery at Phoenix’s Mayo Clinic in mid-July, and it’s expected that he’ll also receive chemotherapy and radiation, along with other potential treatments. Senator McCain has proven time and again that he’s tough as nails, and appears to be facing this latest battle head-on. One thing that he likely has on his side is top-notch health insurance.

McCain is 80, which means he’s presumably been on Medicare for 15 years. Currently serving federal lawmakers are able to obtain employer-subsidized coverage in the Washington DC small-business exchange, and they can have this coverage in addition to Medicare.

How good is McCain’s coverage?

McCain hasn’t said publicly exactly what insurance he has, and his office has not responded to my inquiry. But the most likely scenario is that he has Medicare plus employer-sponsored coverage through the DC exchange – a very comprehensive benefits package.

There are certainly lots of other people who have similar coverage arrangements – either because they’re still working after turning 65, like McCain, or because they receive generous retiree health benefits that supplement their Medicare coverage. For those who don’t, there are private Medicare supplements available that cover virtually all of the out-of-pocket costs associated with Medicare.

But health coverage in the United States is a bit of a mixed bag, with some people having much better coverage than others. A serious illness tends to shine a spotlight on the flaws that exist in some health plans, so let’s take a look at how the average American facing a glioblastoma diagnosis would fare under various health plans.

Employer-sponsored health insurance

Most employer-sponsored health insurance plans provide pretty solid health coverage. According to a 2016 Kaiser Family Foundation analysis, the average deductible for covered workers was about $1,500, and that doesn’t count the 17 percent of covered workers whose plans had no deductible at all.

In addition, the average employer paid more than two-thirds of the total premiums. And the tax exclusion of employer-sponsored insurance premiums amounts to a subsidy that cost the federal government $250 billion in fiscal year 2016.

However, employer-sponsored health insurance is, by definition, linked to employment. A person going through a serious illness like glioblastoma might not be able to continue working, depending on the specifics of the treatment.

As long as the employer has at least 20 employees, the employee will be able to continue the coverage under COBRA for 18 months, even if he or she is unable to work. But COBRA is expensive, as the employer contribution to the premiums and the tax exclusion of the premiums are eliminated. (COBRA premiums are counted as a medical expense for the purpose of itemized medical deductions, but only expenses that exceed 10 percent of your income can be deducted this way.)

Although most employer-sponsored plans provide good coverage, that’s due in part to the ACA. It was not uncommon – particularly in low-wage, high turnover industries – for employers to offer “mini-meds” before the ACA, with exceedingly low benefit caps. (The ACA’s ban on lifetime and annual benefit limits means that these plans are no longer offered to employees.)

A mini-med with a $2,000 or $5,000 annual benefit maximum would not have done much in the face of glioblastoma. Vox reported that just the initial craniotomy to remove a blood clot above Senator McCain’s eye would likely have been billed at more than $76,000. And that was before the cancer diagnosis.

ACA-compliant individual market coverage

The pre-ACA individual market included plenty of solid plans. But dubious coverage also abounded, and regulations varied considerably from one state to another.

The ACA imposed a bevy of regulations on the individual health insurance market, bringing all new (as of 2014) plans up at least a basic minimum standard. Individual major medical coverage can no longer be sold without the ACA’s essential health benefits.

And for those benefits, insurers cannot limit how much they’ll pay during a year or over the course of an insured’s lifetime. (Sadly, another Arizona resident with cancer, Arijit Guha, died in 2013 at age 32. Guha’s health insurance plan had a $300,000 lifetime cap – which is no longer allowed, thanks to the ACA – and his treatment, including chemotherapy that cost $11,000 per session, quickly exceeded that limit.)

Individual-market plans also cannot discriminate against people with pre-existing conditions, either by charging them higher prices or declining their applications (both of those were standard practice in nearly every state prior to 2014). Notably, Senator McCain has a history of melanoma, which would have virtually guaranteed a declined application in the individual market pre-ACA if he had been in need of non-group coverage for some reason.

A person with ACA-compliant individual market coverage would have solid coverage for glioblastoma. The maximum out-of-pocket costs during 2017 would be $7,150, although most plans have out-of-pocket maximums below that threshold. And 57 percent of people who enrolled through the exchanges in 2017 have cost-sharing subsidies, which further reduce the out-of-pocket costs.

The American Cancer Society explains in more detail how the ACA improves access to care for people with cancer. But the short story is that a person facing glioblastoma with a 2017 individual health insurance policy has a much more secure financial safety net than someone with the same diagnosis a decade ago.

Medicaid

Medicaid provides comprehensive coverage. Although the benefits available under traditional Medicaid vary from one state to another, Medicaid expansion coverage is required to include the ACA’s essential health benefits. (The Senate’s Better Care Reconciliation Act – BCRA – would eliminate this requirement after 2019.)

Medicaid has minimal cost-sharing, limited to no more than 5 percent of a family’s annual income.

It’s true that compared with private health insurance and Medicare, fewer medical providers accept Medicaid. But the majority do work with Medicaid. (According to a Kaiser Family Foundation analysis, about 69 percent of office-based physicians accept new Medicaid patients, while about 85 percent accept new privately-insured patients.)

Short-term health insurance

The ACA implemented regulations that apply to virtually all types of health insurance. But some plans are not regulated by the law, including short-term health insurance.

As evidenced by the name, short-term plans are limited in their duration. As of 2017, a short-term plan can last no more than three months, although people who remain healthy can purchase a second short-term plan after the first one ends.

Short-term plans do not cover pre-existing conditions. So if you were to be diagnosed with glioblastoma while covered under a short-term plan, the first thing the insurer would do is go back through your medical records to make sure that you didn’t have any symptoms prior to enrolling in the plan.

Assuming you were healthy before you enrolled, your short-term plan would start to cover your treatments. But you would be facing a looming and inflexible coverage termination date, along with annual and lifetime benefit maximums. Short-term plans vary considerably in quality – some have lifetime benefit maximums of $250,000 or less, while others provide benefits well in excess of a million dollars. In the case of a glioblastoma diagnosis, coverage would end when the policy reached its predetermined end date, or when you hit your benefit maximum – whichever happened first.

Either way, you’d want to hope that you had other coverage already lined up and ready to go at that point. The cancer diagnosis would make it impossible to obtain another short-term policy.

And since a short-term plan is not considered minimum essential coverage, the termination of the short-term policy would not trigger a special enrollment period for individual or employer-sponsored insurance. You would still be able to enroll in a regular individual-market plan, or an employer plan if you’re eligible for one, during regular annual open enrollment. But you might experience a significant gap in coverage, which can be disastrous in the middle of cancer treatment.

A limited-benefit plan

Limited-benefit plans are another category of coverage that’s not regulated by the ACA (despite attempts by the Obama Administration to place some regulations on certain types of fixed indemnity coverage).

Fixed indemnity means that the plan pays a specific dollar amount if the insured has a covered claim. For example, the plan might pay $1,000 per day for hospitalization, or $50 for a doctor visit. There’s no cap on how much the patient has to pay, and these plans often have very low annual and lifetime benefit limits.

So imagine a plan that will pay $2,000 per day for hospitalization, for up to 25 days. It will also pay $2,500 for an outpatient surgical procedure and $2,500 for an inpatient surgical procedure. And it will pay $625 for anesthesia, but it does not cover prescriptions (these numbers are from a real plan currently available in the limited benefit market).

Remember that McCain’s craniotomy – before the glioblastoma was even diagnosed – likely cost $70,000. He was home very soon after the surgery, so if he was hospitalized at all, it wasn’t more than a day or two. A limited benefit plan like the one described above would have paid $2,000 for each day in the hospital (which amounts to zero dollars if the procedure didn’t result in an inpatient stay), $2,500 for the surgery, and $625 for the anesthesia. That would leave a sizeable chunk of the $70,000 bill as the patient’s responsibility.

And all of that is before the treatment for the glioblastoma even begins.

A Cruz Amendment plan

In mid-July, Senator Ted Cruz introduced an amendment to the BCRA aimed at reducing regulations on health insurance plans. The Cruz Amendment, if included in the BCRA, would allow insurers to offer non-ACA-compliant plans as long as they also offered at least one Silver plan, one Gold plan, and one plan that complies with the BCRA’s benchmark standards (58 percent actuarial value).

The non-compliant plans would likely range from decent to terrible, since they would have wide latitude in terms of the consumer protections they’d be able to waive. Essentially, it would be a return to the pre-ACA days when there was more of an “anything goes” approach to health insurance. Plans would be available without essential health benefits, would not have to cover pre-existing conditions, and could be offered with higher out-of-pocket limits than ACA compliant plans.

These plans would likely appeal to healthy people, as they would be less expensive than ACA compliant plans. But a person who seems perfectly healthy can be diagnosed with glioblastoma, at which point the holes in the coverage become glaringly apparent.

What about those who lack McCain’s coverage

In glioblastoma, Senator McCain is facing a fierce battle, and our hearts go out to him and his family. But thanks to McCain’s health coverage, he won’t have to worry about how to pay for his treatment. I’m glad he has that health coverage.

Senator McCain is not alone in his battle. There are more than 12,000 Americans who will be diagnosed with glioblastoma this year. Unfortunately, many of them do not have the level of health coverage that McCain has. Even with the best health insurance, the diagnosis plunges each family into an immensely challenging situation. With lesser – or no – coverage, the challenge becomes even more insurmountable.

Nobody deserves cancer. And nobody deserves to have to fight cancer with less-than-adequate health insurance. With our current medical know-how, we can’t keep everyone from getting cancer. But we can make sure that as many people as possible are covered by high-quality health insurance. We owe it to all the lesser-known John McCains out there to work towards that goal.

That means pushing back against any sort of “reform” that would result in fewer people with insurance. It also means rejecting proposals that would allow junk insurance plans to flood the market, lulling consumers into a false sense of security – until they’re diagnosed with brain cancer.

 

Senate GOP floats scaled-down healthcare bill

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Senate GOP floats scaled-down healthcare bill

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Senate Republicans are considering passing a dramatically scaled-down version of their ObamaCare repeal bill as a way to pass something and set up negotiations with the House, according to GOP aides.

The measure, known as a “skinny bill,” is intended to be something all Republicans can agree on, allowing something to pass and setting up a conference committee with the House.

Aides say the scaled-down bill would likely just repeal ObamaCare’s individual and employer mandates and the medical device tax.

That would be a far narrower measure than the most recent Senate replacement bill, which also scaled down ObamaCare’s subsidies and cut Medicaid.

The consideration of the scaled-down measure is a sign of how much trouble Senate Republicans are having coming to agreement on any more significant bill.

A Senate GOP aide said leadership pitched their office on the scaled-down bill on Monday.

The scaled-down bill is expected to come after votes, which are expected to fail, on both a repeal-only measure and the latest replacement bill.

Republicans would also need to gather enough votes to start debate, and it is still unclear if they have those votes.

Sen. John Cornyn (R-Texas), the No. 2 Senate Republican, floated a conference committee with the House on Monday evening.

“I think if you want to get a result that may be a selling point,” Cornyn said.

ER staffing companies can lead to increased surprise bills

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http://www.healthcaredive.com/news/er-staffing-companies-can-lead-to-increased-surprise-bills/447751/

Dive Brief:

  • The New York Times reported that hospitals are turning more to companies like EmCare, which is one of the country’s largest physician-staffing companies for emergency rooms (ERs), to find ER doctors. Having outside doctors is causing patients to receive more expensive hospital bills because the ER doctors are considered out-of-network.
  • The Center for Public Priorities released a study earlier this year that found surprise billing is a problem that goes well beyond one company, but is an issue across the healthcare system.
  • Also, a new National Bureau of Economic Research study on out-of-network billing for emergency care found that patients who visited in-network hospitals for emergency care received out-of-network physician care 22% of the time. The study authors said: “Because patients cannot avoid out-of-network physicians during an emergency, physicians have an incentive to remain out-of-network and receive higher payment rates.”

Dive Insight:

Part of the issue with surprise billing, also known as balance billing, is thatmost states don’t have laws that protect consumers. Only six states have a “comprehensive” laws that protect against surprise billing, and there are no federal protections against the practice, according to The Commonwealth Fund.

The issue of surprise billing is another example of how the U.S. healthcare system confuses people. Patients who visit in-network hospitals often aren’t able to make sure each doctor working on them is in-network. So, they’re stuck with larger than expected hospital bills later.

Patients don’t like it for obvious reasons, and payors aren’t happy with the higher bills either. The hospital CEO the Times interviewed, Tom Wilbur of Newport Hospital in Spokane, Wash., said switching to EmCare turned out to be a fiasco as confused and angry patients started calling in. “Hindsight being 20/20, we never would have done that,” he told the paper.

A recent Commonwealth Fund study found that 14% of ER visits and 9% of hospital stays were likely to produce a surprise bill. Patients who were admitted to the hospital via the ER were more likely (20%)  to receive a surprise bill.

As health systems look to outside agencies more to fill gaps in coverage, surprise billing is not going away and could even intensify. What’s the solution? The Commonwealth Fund suggested it likely won’t come from Washington given the current toxic political climate — especially when it comes to healthcare. Instead, states will need to take up the issue in an attempt to protect consumers from getting large, unexpected hospital bills that are out of their control.

In Appalachia, Two Hospital Giants Seek State-Sanctioned Monopoly

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http://khn.org/news/in-appalachia-two-hospital-giants-seek-state-sanctioned-monopoly/

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Looking out a fourth-floor window of his hospital system’s headquarters, Alan Levine can see the Appalachian Mountains that have defined this hardscrabble region for generations.

What gets the CEO’s attention, though, is neither the steep hills in the distance nor one of his Mountain States Health Alliance hospitals across the parking lot. Rather, it’s a nearby shopping center where his main rival ­— Wellmont Health System, which owns seven area hospitals — runs an urgent care and outpatient cancer center. Mountain States offers the same services just up the road.

“Money is being wasted,” Levine said, noting that duplication of medical services is common throughout northeastern Tennessee and southwestern Virginia where Mountain States and Wellmont have been in a health care “arms race” for years, each trying to outduel the other for the doctors and services that will bring in business.

The companies now want to merge, which would create a monopoly on hospital care in a 13-county region that studieshave placed among the nation’s least healthy places. The merger’s savings would pay for a range of public health services that they can’t afford now, the companies project. And they are trying to pull it off without Washington regulators’ approval, breaking with hospitals’ usual path to consolidation.

In a typical case, a plan that eliminates so much competition in a market would almost certainly provoke a court battle with the Federal Trade Commission, which enforces antitrust laws and challenges anti-competitive behavior in the health industry.

To avert such a fight, the hospitals are using an obscure legal maneuver available in Tennessee and Virginia and some other states.

Generally known as a Certificate of Public Agreement (COPA), the process works like this: If regulators in Virginia and Tennessee agree that the merger is in the public interest, Wellmont and Mountain States would operate as one company under a state-supervised agreement governing key parts of their operations, including setting prices. The states’ approval would prevent the FTC from challenging the merger under federal antitrust law.

Their decisions could come as soon as this month.

In exchange for approval, Mountain States and Wellmont promise to use money saved from the merger to offer mental health and addiction treatment services and attack public health concerns, such as obesity and smoking — areas previously neglected by the systems that don’t increase hospital admissions and bring in big revenue, hospital officials said

“The question that needs to be asked is whether tight state oversight of a monopoly is better than failed competition,” said Robert Berenson, a health policy expert at the Urban Institute.

Little-Used And Rarely Challenged Mechanism

The federal antitrust exemption made possible under a COPA dates to a Supreme Court ruling in the 1940s used only about a dozen times to allow hospital mergers. One was an hour away from here, in Asheville, N.C.

There’s little scholarly research on COPAs’ results.

Last summer, the FTC dropped its challenge to a merger of two West Virginia hospitals after the state adopted a COPA law and permitted the deal.

In recent years, hospital mergers and acquisitions have created behemoth health systems that have used their status to demand high payments from insurers and patients. Studies by health economists have repeatedly found that consolidation means higher prices.

But the same calculus may not apply here and in other regions where a preponderance of patients are poor or uninsured, officials from both Mountain States and Wellmont say.

While President Donald Trump and Republicans in Congress stress the value of free-market principles in health care, both hospitals argue that in their part of Appalachia the market has led to unnecessary spending, driven up health costs and forced them to focus on services that produce the highest profits rather than meet the community’s most pressing health needs. In this deeply conservative region where death rates from cancer and heart disease are among the nation’s highest, the hospitals say only a state-sanctioned monopoly can help them control rising prices and improve their population’s health.

Without their proposed merger, Levine said, both hospital systems would likely have to sell to an out-of-market chain. That would likely eliminate local control of the facilities and could lead to massive layoffs and the closure of hospitals and services, he said. Together, the two hospital systems employ about 17,000 people.

The FTC, which is urging the states to reject the hospitals’ plan, contends the hospitals could form an alliance or take other steps short of a merger to accomplish the benefits they say one will bring. The agency says the hospitals’ market probably would be no worse off if one chain merged with a company outside the area.

Feds Wary Of Promises

The hospitals are making big promises to sell their deal. They say no hospitals would close for at least five years, although some could be converted to specialized health facilities to treat problems such as mental health or drug addiction. After the merger, all qualified doctors would have staff privileges at all hospitals to treat patients. No insurer would pay lower rates than others. The new hospital system would spend at least $160 million over 10 years to improve public health, expand medical research and support graduate medical education for work in rural areas.

The FTC maintains the hospitals’ pledges are unreliable and dismissed them as having “significant shortcomings, gaps and ambiguities” in an analysis filed with state regulators in January.

Levine said the plan is the best deal for the community given the factors that handicap the hospitals. Those include declining populations and Medicare reimbursement rates that are lower here than other parts of the country because of lower average wages. Another concern is the cost of caring for uninsured people — neither Virginia nor Tennessee expanded Medicaid under the health law, which would have lowered uninsured rates.

“Competition is and should be the first choice, but in an area where competition becomes irrational and there are limited choices, there has to be a Plan B. If not this, then what?” he said.

Blue Cross and Blue Shield of Tennessee, the state’s largest health insurer, is not opposing the hospitals’ combination, a spokesman said. But its counterpart in Virginia, Anthem, hasn’t been persuaded.

“Anthem does not believe that there are any commitments that will protect Southwest Virginia and Northeast Tennessee health care consumers from the negative impact of a state-sanctioned monopoly,” the company said in a statement.

Wanted: Better Job Prospects

The proposed COPA has strong support among large employers in the region, including Eastman, a Kingsport, Tenn., chemical company with $9 billion in annual revenue that employs more than 7,000 people locally. “We get local governance, input and control … and that’s a lot better situation for us,” said David Golden, a senior vice president at Eastman.

Still, walking around Johnson City — the region’s largest city with almost 67,000 people — it’s easy to feel an unease among small employers and residents about a merger. Many worry about possible job cuts.

“Eliminating duplication of services means eliminating people,” said Dick Nelson, 60, who runs a coffee and art shop downtown and has lived here for 27 years. “I don’t care how much health care costs because my insurance will pay it,” he said.

In Kingsport, where Wellmont and Mountain States each has a hospital, Thorp is leery about a merger, too. “It’s an economic move, not an enhancement of medical care,” said Thorp, who runs a newsstand downtown. “We pride ourselves here for having good education and health care. They say there won’t be any services or jobs cut, but if that’s the case then what’s the point of the merger?”

Levine said no place better supports the case for a hospital merger than Wise County in southwestern Virginia, a scenic area with about 40,000 people whose three hospitals all operate below half their capacity. Mountain States and Wellmont each own a hospital in Norton, the county seat with 4,000 residents. Despite few patients, the hospitals still bear hard-to-cut costs for buildings, equipment and adequate staffing levels, Levine said.

On a recent weekday morning, Lonesome Pine Hospital, a Wellmont facility in Big Stone Gap, Va., looked nearly deserted. No volunteers or staffers were visible inside its main entrance and fewer than a fifth of its 70 acute-care beds were being used.

A five-minute drive away, Mountain States’ Norton Community Hospital’s 129 beds are about a quarter filled. Its maternity unit delivers fewer than five babies a week. The hospital offers hyperbaric oxygen therapy — a treatment that pays well under Medicare’s reimbursement rates — to help diabetics heal their wounds. But it has no endocrinologists to help diabetics manage their disease to avoid such complications. Despite a high rate of heart disease in the community, there’s no cardiologist on staff.

Whether a state-sanctioned merger will resolve the incongruities — here or in other poor regions — depends on how firmly regulators hold the hospitals to their pre-merger commitments. If the merger plan gets rejected, Mountain States and Wellmont will resume arch-competitive business practices that do not always put community interests first, said Bart Hove, Wellmont’s CEO.

“It’s about competing for the dollar in any way you can and extracting a dollar from your competition,” Hove said. “You do what you can to drive patients to your hospital.”

Digital Therapeutics: The Future of Health Care Will Be App-Based

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https://www.forbes.com/sites/eladnatanson/2017/07/24/digital-therapeutics-the-future-of-health-care-will-be-app-based/#797cc5b37637

Image result for clinical mobile applications

Last month, healthcare startup Omada Health secured a $50 million C round led by major insurer Cigna, which brings the 5-year-old company’s total funding to over $127 million.  That kind of nine-figure investment isn’t unusual for a company with the next blockbuster drug or game changing medical device, but Omada’s core product is a diabetes-preventing mobile app!  Omada is a leader in one of the hottest new sectors of the app economy: Digital Therapeutics.

Digital therapeutics are a new category of apps that help treat diseases by modifying patient behavior and providing remote monitoring to improve long-term health outcomes.  Depending on the disease, they can encourage patients to stick to diet and exercise programs or help them adhere to drug intake regimes.  Wait a minute, doesn’t that sound a lot like wellness apps?  There are already hundreds of apps that help us manage our workouts or meditate more effectively!

The key difference is that digital therapeutics implement treatment programs tailored to specific ailments, especially major chronic diseases like diabetes, heart disease, high blood pressure, and pulmonary diseases like COPD.  Because patient behavior is so crucial in preventing and limiting the severity of these life-threatening illnesses, the early evidence is that these digital health programs, often combined with human coaching/interaction, can make a significant difference in health outcomes.

To provide hard data of their efficacy (and differentiate themselves from wellness apps), newcomers like Omada have taken a page from the pharma industry and have performed clinical trials with major healthcare networks like Humana.  In recently published research, prediabetic patients that participated in a year-long  Omada-based program lost 7.5% of their initial body weight and showed improved glucose control and decreased cholesterol.

These results are one reason why health insurance firms are among the big investors in the leading startups.  Mobile app-based digital treatment programs can be delivered at massive scale and low cost, and by helping to prevent disease progression, can potentially save insurers billions of dollars.  On the other side of the equation, the prospect of health insurance covered recurring subscription revenues has VC’s salivating.   Omada proved early validation of this prospect when last year it got Medicare to agree to reimburse the cost of its digital diabetes prevention program.

Another reason the insurers are excited about the potential of mobile-delivered health programs is data.  Once clinical trials are complete, most pharmaceutical companies don’t track real-world results for their drugs.  With precise regimes and daily monitoring, digital therapeutics can offer mountains of data that can potentially provide doctors unprecedented insights into patient behavior and create feedback/optimization loops for individual patients.   Enabling patients to take greater control over managing their chronic illnesses and preventing disease progression could yield huge cost savings throughout the entire healthcare system.

Some digital therapeutics is meant to entirely replace medication with behavioral-based treatment, such as apps that use visualization exercises to help insomnia sufferers as an alternative to sleeping pills like Ambien.  Others are designed to work in conjunction with medications by helping patients better manage their treatment regimes.  A company that has taken this approach is Propeller Health, which makes a sensor that attaches to inhalers used by people who suffer from chronic asthma and COPD.  The sensor monitors inhaler usage and provides feedback via a mobile app.  Propeller has partnered with GlaxoSmithKline to create a digital therapy platform to guide patients in using its asthma medications.

Another innovative digital drug adherence platform is the one created by startup Proteus Digital Health.  Proteus has built an ingestible radio tag the size of a grain of sand.  It can be put inside a pill and can send data to a wearable patch on the patient’s torso.  For elder patients managing multiple chronic conditions with an array of daily medications, Proteus’ sensors and the app can send alerts to patients as well as family and primary care providers when a key dose has been missed.  Trials have shown that Proteus’ system has shown reductions in blood pressure among patients taking medication for hypertension.

From these examples, it becomes clearer to see how digital health programs, which can be tailored and optimized for individual patients and delivered at scale via mobile, represent a transformational development in healthcare.  As Andreessen Horowitz partner Vijay Pande calls it, digital therapeutics, by enabling the kind of behavioral meditation which is the only effective way of managing chronic illness, represent a true “third phase” of medicine, after small-molecule drugs and protein biologics.  I predict that someday, apps that help people manage illness and prevent long-term disease will no longer have a special name.  They will just be another form of software on our phones.  More than anything else, the rise of digital therapeutics demonstrates once again the power of mobile computing as the most transformational technology platform the world has ever seen.

12 US cities ranked by cost per square foot to build a hospital

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http://www.beckershospitalreview.com/facilities-management/12-us-cities-ranked-by-cost-per-square-foot-to-build-a-hospital.html?utm_source=Sailthru&utm_medium=email&utm_campaign=Issue:%202017-07-25%20Healthcare%20Dive%20%5Bissue:11297%5D&utm_term=Healthcare%20Dive

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The most expensive U.S. city to build a hospital in is Honolulu, according to a report by Rider Levett Bucknall. In fact, the cost per square foot to build a hospital in Honolulu is about 60 percent higher than in Las Vegas, which has the lowest per square foot hospital construction costs of any city on the list.

For the report, values were based on hard construction costs per square foot of gross floor area.

Here is the range of costs to build a hospital per square foot in 12 large U.S. cities, ranked from most to least expensive.

Please note that some of the costs are equal so there are more than 11 cities listed.

1. Honolulu: $475 to $760 per square foot
2. New York City: $475 to $700
3. Los Angeles: $470 to $700
4. San Francisco: $450 to $650
5. Boston: $400 to $650
5. Washington. D.C.: $400 to $650
6. Chicago: $360 to $630
7. Portland, Ore.: $380 to $525
8. Seattle: $385 to $530
9. Phoenix: $350 to $500
10. Denver: $370 to $455
11. Las Vegas: $285 to $455