How the Religious Freedom Division Threatens LGBT Healthand Science

When Marci Bowers consults with her patients, no subject is off limits. A transgender ob/gyn and gynecologic surgeon in Burlingame, California, she knows how important it is that patients feel comfortable sharing their sexual orientation and gender identity with their doctor, trust and honesty being essential to providing the best medical care. But Bowers knows firsthand that the medical setting can be a challenging place for patients to be candid. That for LGBT people, it can even be dangerous.

"I know from talking with patients that they're often denied services, not just for surgery and hormone therapy, but basic medical care," Bowers says. "I've had patients show up in an emergency room who were denied treatment because they were transgender."

Experiences like these are what make the creation of a new "Conscience and Religious Freedom" division within the US Department of Health and Human Services so troubling. Announced last week by acting secretary of HHS Eric Hargan, the division's stated purpose is to protect health care providers who refuse to provide services that contradict their moral or religious beliefs—services that include, according to the division's new website, "abortion and assisted suicide."

But the division's loose language could leave room for physicians to provide substandard care to LGBT patients—or abstain from treating them altogether. Indeed, in a statement to WIRED, an HHS spokesperson said the department would not interpret prohibitions on sex discrimination in health care to cover gender identity, citing its adherence to a 2016 court order that excluded transgender people from certain anti-discrimination protections.

That's obviously bad for the health and wellbeing of LGBT people, who may feel less comfortable sharing their sexual orientation or gender identity going forward—but it's bad for science, medicine, and policy, as well.

At its core, the new HHS office threatens data and understanding. Collecting facts and figures on sexual orientation and gender identity fills valuable gaps in the medical community's comprehension of LGBT patients and their public health needs, and progress on that front has accelerated in recent years. "Gathering these details has tremendous potential to improve care for LGBT people," says psychologist Ed Callahan, who in 2015 helped orchestrate the addition of fields for sexual orientation and gender identity—aka "SO/GI"—to electronic health records at UC Davis, the first academic system in the country to do so. The more data doctors and policymakers have on LGBT people, the better they can understand the institutional hurdles, social challenges, and public health risks they face as sexual minorities.

The creation of the new HHS division is but the latest development in an ongoing battle over whether and how that data is collected. As of this year, the Office of the National Coordinator of Health Information Technology requires outpatient clinics to use software that collects SO/GI information if they receive federal incentive payments for using government-certified electronic health care records. The Bureau of Primary Health Care requires health centers to report the sexual orientation and gender identity of their patients. And the Centers for Disease Control and Prevention and the Centers for Medicare & Medicaid Services continue to encourage data collection on SO/GI.

"There’s actually been a lot of good work happening at the Veterans Health Administration," says Sean Cahill, director of health policy research at the Fenway Institute, a Boston-based center for research, training, and policy development on LGBT-related health issues. Since 2012, the VA has encouraged the collection of SO/GI data and issued directives that ensure respectful, equitable, culturally competent care for LGBT veterans. And by the end of Obama's presidency, the number of federal surveys and studies measuring sexual orientation had increased to 12, seven of which also measured gender identity or transgender status. "So the good news is that the shift to gathering these data has been underway for several years, and does continue," Cahill says.

But data collection has slowed under the Trump administration. In the past 13 months, surveys collecting data on participation in Older Americans Act-funded programs and Administration for Community Living-supported disability services have removed questions pertaining to sexual orientation and gender identity. In the same time span, numerous political maneuvers have sown uncertainty and distrust throughout the LGBT community. A July 2017 directive from President Trump attempted to ban transgender people from enlisting in the military, and in December policy analysts were presented with a list of banned words—including "transgender"—not to be used in official CDC budget documents.

In short: Under the Trump administration, the country is simultaneously collecting less data and promoting conditions that leave LGBT patients wary of their healthcare providers. "These patients already face significant obstacles to accessing medical care, and I fear implementation of these measures will only make these obstacles worse," says Stanley Vance, a pediatrician at University of California San Francisco and an expert in the care of gender nonconforming youth. "I also worry that these measures will be an institutionalized form of discrimination against patients who have been identified as a sexual minority or transgender who freely come out to their providers or through information previously entered in electronic medical records."

Even when physicians don’t overtly discriminate against gay and transgender patients, negative health care experiences are routine. Many physicians simply don't think to consider a patient's SO/GI—information they can use to not only respect their patients, but screen them for family rejection, which studies show increases the risk for depression, suicide, and high-risk sexual behaviors. Failing to acknowledge a patient's SO/GI can compound the ill effects of social stigma and inaccessibility to care like hormone therapy or gender affirmation surgery. "Across the board, LGBT patients are the group least likely to come back for further care," Callahan says. "And that often happens because of ways they are dismissed as not existing."

Of course, the reality is that LGBT people do exist, they're entitled to equitable services and care, and they deserve to be counted—sometimes literally. "It really shouldn't be political, you know? It shouldn't be a partisan issue," Cahill says. "It's about science and data and providing quality care to all patients."

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Twitter troll opens up after Sarah Silverman responds with kindness

Image: John Salangsang/BFA/REX/Shutterstock

When a troll called comedian Sarah Silverman the C-word on Twitter, she responded with level-headed kindness, finding out he was in a lot of pain and eventually helping him pay for his medical bills.

On Dec. 28, Twitter user Jeremy Jamrozy responded rudely to one of Silverman’s tweets where she was trying to reach out to a Trump supporter in the hope of understanding where they were coming from. Instead of ignoring him or responding angrily, she went in a completely different direction, taking the two down a path that eventually led to her helping him take care of his medical expenses.

Jamrozy, it turns out, has several slipped discs in his spine, and with no insurance and no way to work through the pain, he is unable to cover the costs of fixing it on his own. Along with that, he was dealing with the trauma of an abuse he suffered when he was 8 years old, he told Silverman on Twitter.

After a series of back-and-forth messages, Silverman asked Jamrozy to go to a support group. He agreed to go, and apologized for being rude.

The conversation continued and grew friendlier and friendlier throughout the day, with Jamrozy telling Silverman he enjoys her comedy, is amazed by her love for humanity, and that she’s got herself a fan in him.

As for his back problems, Jamrozy went for a consultation to see what needed to be done to help him get back on his feet. It was not going to be a simple, cheap path to recovery, so Jamrozy started a GoFundMe campaign and Silverman gave him a shout out on her Twitter.

In an interview with My San Antonio, Jamrozy said Silverman offered to pay for his medical expenses. 

With donations coming in from people on his GoFundMe, Jamrozy was inspired to spread that money around to other people who need help in the San Antonio area where he lives.

“I was once a giving and nice person, but too many things destroyed that and I became bitter and hateful,” Jamrozy told My San Antonio. “Then Sarah showed me the way. Don’t get me wrong, I still got a long way to go, but it’s a start.”

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Quartet raises $40M Series C to help healthcare providers collaborate on patient care

Healthcare in America is a mess with no quick solutions and many people aren’t getting the help they need. Created to bridge mental and physical healthcare, New York City-based Quartet Health wants to make life better for patients with a platform that allows providers to collaborate on treatment plans. Currently available in six U.S. markets, Quartet announced today that it has raised $40 million in Series C funding to expand throughout the rest of the country.

All of Quartet’s previous investors returned, including F-Prime Capital Partners and Polaris Partners, which both led the round, Oak HC/FT and GV. It also added a new investor, healthcare investment firm Deerfield Management. This brings Quartet’s total raised so far to $87 million. In addition to expanding its geographic reach (it currently has operations in California, Louisiana, Massachusetts, New Jersey, Pennsylvania and Washington), Quartet will use the capital on its tech platform, hiring for its machine learning team and building its provider network.

The startup was founded in 2014 by chief executive officer Arun Gupta, a former advisor at Palantir Technologies. Gupta wanted to solve inefficiencies in the healthcare system that prevent patients who have chronic health conditions from getting comprehensive medical care. Quartet’s platform makes it easier for primary care doctors to collaborate with mental health professionals, including therapists, on treatment plans, since many psychological conditions have physical symptoms and vice versa. Quartet also uses machine learning to help providers identify potential health issues, while its network of providers allows doctors to make referrals to mental healthcare providers who also use the platform.

Quartet also announced that it is adding three new directors to its board: F-Prime Capital executive partner Carl Byers; Ken Goulet, the former executive vice president and president of commercial and specialities business at health insurance provider Anthem Inc.; and former Rackspace CEO and BuildGroup co-founder Lanham Napier.

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50+ Times American Healthcare System Shocked The Rest Of The World

While the United States has largely considered itself as the greatest country in the world for the last few decades, the statistics tell us that there are areas where things can definitely be improved.

In military might and defence spending the U.S. is undisputedly number one. But in other areas, more important aspects of human wellbeing such as education, life expectancy, happiness, gender and income equality and healthcare, there are more mixed results.

The U.S. healthcare system in particular is a continuing source of bafflement for many, who are accustomed to a degree of protection against the double disaster of poor health followed by financial ruin.

While American hospitals and medical facilities are world class, they are also incredibly expensive and available only to those able to afford them. We at Bored Panda have compiled a list of examples that highlight the inadequacies of the current healthcare system, while polarised politicians continue to argue about their vision for its future. Scroll down to check them out below, and stay healthy over there in America, y’all.

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Jimmy Kimmel brought his adorable son Billy on the show, after his heart surgery

Jimmy Kimmel’s son Billy, who was born with congenital heart disease and who has been at the center of the talk show host’s arguments around U.S. healthcare, had his second open heart surgery last week. So, Kimmel brought him on Monday’s show.

Kimmel has taken time off during Billy’s surgery, instead inviting guest hosts Chris Pratt, Melissa McCarthy, Tracee Ellis Ross andNeil Patrick Harris to keep the seat warm.

Billy’s surgery was a roaring success, and Kimmel thanked the doctors and nurses at the Children’s Hospital LA for his son’s treatment. “Daddy cries on TV but Billy doesn’t,” said a tearful Kimmel during his opening monologue.

Kimmel has been at the forefront of the U.S. healthcare debate recently, slamming the proposed Graham-Cassidy bill for not providing coverage for kids like Kimmel’s son (and rejoicing when it was blocked). On Monday’s show, Kimmel championed the CHIP (Children’s Health Insurance Program), administered by the Department of Health to cover families with modest incomes that are too high to qualify for Medicaid. Kimmel says Congress has failed to approve funding for it this year. He also urges people to enrol for healthcare before the cut-off date on Dec. 15.

Billy has one more surgery planned for when he’s six years old, then he’s done. Go get ’em Billy!

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A prescription for healing the healthcare industry

The year is 1900. Life expectancy is 47 years. Almost all hospitals in the U.S. are nonprofit institutions founded by religious organizations. More people die in war due to infection than in battle.

Fast-forward to today. Healthcare in the U.S. has ballooned into a massive industry worth $3 trillion. The United States spends approximately $9,237 per person for healthcare, roughly three times more than most other first-world countries. And yet, all that spending has not resulted in superior outcomes.

While the graph above is striking enough to spur anyone to immediate action, the implications of this unsustainable growth in expenses and what can be done to stifle it are not as clear.

We can only solve the problems that we can see, and most entrepreneurs don’t have experience working in healthcare, almost by definition. Take the story of John Crowley, who started Amicus Therapeutics after his two children were diagnosed in 1998 with Pompe disease — a severe and often fatal neuromuscular disorder.

In his drive to find a cure for them, he left his job in management consulting and became an entrepreneur. He became founder and CEO of Novazyme Pharmaceuticals in 2000, a biotech startup conducting research on a new experimental treatment for Pompe disease, which he credits as ultimately saving his children’s lives. His story is nicely told in this interview with Tim Ferriss.

Many founders working in healthcare today, like John Crowley, have personal ties to their companies. However, if we have to rely on new healthtech companies being born out of personal frustrations with the status quo, think of how many opportunities will go undiscovered.

I deeply believe the biggest reason we don’t see more entrepreneurs in healthcare is because they don’t understand the problems, and they don’t know where to start.

For all that spending, ($3.2 trillion in 2015) healthcare is largely a neglected and feared investment class — and for good reason. Healthcare is littered with heavy regulation, counter-intuitive payment incentives and deep-rooted politics. It’s far from a free market. Policy wants to move toward a market-based model, but consumers haven’t had a choice in 50 years.

There is strong evidence to show that things are moving in the right direction. Appointed by Barack Obama, Aneesh Chopra — who served as the first Chief Technology Officer of the United States, has accomplished a lot to change the healthcare culture.

He helped launch initiatives inviting innovation in healthcare, such as Open Innovator’s Toolkit, Argonaut Project, Startup America,, Open Data Conference (which I attended and wrote about), the “Blue Button” program and more. Today, as NavHealth chief executive, Aneesh remains focused on a future where health data is unlocked from the vaults of electronic health record companies and is made accessible to patients and innovators to create value.

Some of the biggest opportunities to improve the world exist in healthcare. The more smart people we entice to work on these problems, the better our world will be. Winning in healthcare can be building a billion-dollar company, while also tangibly improving and saving lives.

A few trends that are making healthcare an extremely attractive market right now:

  1. Large and massively inefficient $3.35 trillion market, and growing.
  2. Big regulatory shocks are happening, creating market openings for new players.
  3. The culture is increasingly open to new innovation

Below are a few prescriptions for different facets of the healthcare market. These aren’t solutions that are currently on the market, but hopefully they may inspire a new generation of entrepreneurs to seek their own cures along similar lines.

Rethinking advance care planning

Problem: Only about 30 percent of adults have an Advance Care Plan (ACP) expressing their wishes for end-of-life care; however, having an ACP significantly reduces costs to Medicare and other insurance plans — upwards of 60 percent.

Opportunity: Build a web product that makes it easy for people to create advance directives, easily access them anytime and share them with clinicians or family members. This would give peace of mind to patients and families while saving a significant amount of money for Medicare and other healthcare plans.

In 2011, Medicare spending reached close to $554 billion, which amounted to 21 percent of the total spent on U.S. healthcare in that year. Of that $554 billion, Medicare spent 28 percent, or about $170 billion, on patients’ last six months of life.

Medicine has come a long way in extending our lives, but those extra final months come with a steep price tag. CBS reported that Medicare spent $55 billion on doctors’ and hospital bills during the final two months of patients’ lives, and that “20 to 30 percent of these medical expenses may have had no meaningful impact.”

While patients have every right to dictate their medical treatment in their final days, their family members tend to have a “do whatever it takes” mentality. What they don’t realize, however, is that “doing whatever it takes” has huge costs and consequences of its own. When doctors use ventilators, intravenous fluids, heavy medication and dialysis machines to sustain a patient’s life, that patient often finds their identity and independence all but vanishes as they slowly fade away in a cold, clinical setting.

As our senior population continues to expand at its fastest pace in history, there is a growing need for end-of-life planning services that help patients and their families prepare for their final days. A few early-stage companies are working on facilitation and storage of advanced directives, like MyDirectives and Everplans. Tangentially, companies like Grace are beginning to enter the market, positioning themselves as tech-enabled “concierges” for people planning for, and recovering from, the death of a loved one.

On January 1st, 2016 Centers for Medicare & Medicaid Services (CMS) released a CPT reimbursement code allowing providers to bill Medicare specifically for advanced care planning conversations, making now the perfect time to enter this industry and build something meaningful.

Better post-acute rating and referral system

Problem: Hospitals are fragmented and compartmentalized with few processes for tracking patients beyond their walls. At the same time, our government (CMS) is financially incentivizing hospitals and skilled nursing facilities (SNF) to reduce hospital readmissions and post-acute cost.

Opportunity: Provide hospitals a (software) tool to gain visibility into the patient’s path after they transfer to an SNF/Rehab (and beyond). If hospitals knew which post-acute providers had the lowest readmission rates, they could better direct patients and save money.

This opportunity falls directly in line with healthcare’s shifting philosophy from fee-for-service to value-based care. Hospitals are going to work with post-acute providers that perform the best and most efficient care.

Medicare spends more than $62 billion on post-acute care, or 15 percent of their total budget.

In the future, as patients move from one level of care to another (say from a hospital to a rehab clinic to a SNF and so on), there will be a system for tracking performance of those facilities. Today that doesn’t exist.

A few structural realities make this especially interesting — hospitals have leverage over SNFs because they supply all the referrals. A hospital could make it mandatory for an SNF to use their patient tracking system in exchange for referrals. Once the system is in place, it would act as a feedback loop similar to other rating platforms, like Yelp, Lyft or Airbnb.

Companies like SilverVue are early to market, but there is a lot of work yet to be done and the playing field remains wide open.

Better use of health tracking hardware

Problem: Collecting patient health diagnostic data is a manual process and a lack of data makes it difficult for doctors to turn it into actionable recommendations. The hardware exists and insurance often covers it, but no one has aggregated it and made it easy for doctors to analyze.

Opportunity: Bundle health diagnostic hardware together and build the software to generate simple health reports for doctors.

Most patient-provider interactions occur at the doctor’s office and often have a sense of urgency as the doctor rushes to see as many patients as they can. This is not the ideal time and place to collect data — this time should be spent using the health reports to talk to patients about health suggestions.

Likewise, it’s not always practical for patients to visit doctors for routine diagnostics, especially if the patient has limited mobility or no availability during the doctor’s office hours.

This is where health tracking hardware can play a much bigger role. Patients should be using devices that are specifically tracking the health data relevant for their condition and that data should be seamlessly uploaded to the cloud so software can analyze it and present trends to doctors.

For example, most diabetics take their own blood sugar samples every day, manually. Many of those readings simply vanish and never get recorded. Instead, that data could be communicated back to the patient’s physician or stored in the cloud for future retrieval.

The improvement to patient health with increased adherence and reduction of wasted doctor time is very valuable. The bigger idea down the road is to use this data to detect trends and adverse events before they happen. One notable company, Noteworth, has made significant headway, but lots of opportunity still exists.

Real time logistics tracking within the Hospital

Problem: Health systems struggle with patient logistics inside the hospital. Hospitals struggle with patient delays, mis-staffing providers and general operational challenges.

Opportunity: Tracking the exact location of patients within the hospital walls can help reduce delays, increase department cooperation, prevent disease spread and other far-reaching implications.

Hospitals themselves are hectic environments with many moving parts, so much so that care decisions often fall through the cracks and cause harm to patients. A weighted average of four studies indicates an estimated 210,000 deaths per year are associated with preventable harm in hospitals.

“Nobody is responsible for coordinating care,” said Dr. Lucian Leape, a Harvard health policy analyst, in an interview with Kaiser Health News in 2013. “That’s the dirty little secret about healthcare.”

Large hospital systems are complex, multi-building organizations that could benefit dramatically from technology that helped case managers and directors on the floor get a high-level overview of their staff and patient flow. Tracking locations of clinical workers and patients helps highlight areas of need or surplus in the hospital and optimizes patient flows across the system. Technically, this can be accomplished with beacon technology worn on the back of identification badges and it would disable when people walk outside the hospital.

A cost-effective alternative to the 9-1-1 ambulance

Problem: Ambulances are very binary — there is no middle ground. They are expensive ($2,000 per ride) and often people have to pay a lot of that out of pocket. Many times ambulances go out and find they are not needed, which comes at a huge expense to hospitals.

Opportunity: An app that can be an alternative to a 9-1-1 phone call. The ability to triage and categorize the incoming call, with the ability to upload (pic, video, stream). The idea here is to better triage the incoming incident, assess the need for assistance and possibly offer a lower level/lower cost response team.

While 9-1-1 is an invaluable public health service, it isn’t exactly cost-effective for the patients. According to the U.S. Government Accountability Office, ambulance services cost patients roughly $200 to $2,200+ per use — expenses that often come out-of-pocket if the patient has a high deductible healthcare plan.

In many cases, these services aren’t even required. A 2009 study by the National Association of Emergency Medical Technicians estimated that one in five medical-related 9-1-1 calls were “non-life threatening.” The ambulance shouldn’t be the default option for dispatchers in 100 percent of the medical calls they handle, yet there is no Tier 2 option today.

I believe an opportunity exists to create an Uber-like app platform of “certified” emergency responders throughout a city. These EMTs would receive notifications from 9-1-1 dispatchers regarding an emergency near them. They’d be able to reply confirming or denying their ability to get to the scene fast.

Of course, there are situations where an ambulance is absolutely needed, but a network of low-cost distributed EMTs would be a faster and more efficient way to reach people in need.

Care coordination technology for the public sector

Problem: Lack of technology in caregiver management throughout the public sector results in huge wasted resources that accompany a paper-based operation.

Opportunity: Create a simple process so caregivers can clock into shifts with a mobile app and reliably receive electronic payment.

Each state has unique systems for distributing Medicaid money for home care. In California, In-Home Support Services program (IHSS) is the primary mechanism and they track all hours worked on paper time sheets that get mailed to a factory in Chico, CA for processing.

When 65,000 IHSS time sheets went missing in Los Angeles County after a mail truck mishap in the spring of 2015, thousands of caregivers working for California’s IHSS weren’t paid for weeks or even months.

The gaffe was a mind-boggling demonstration of bureaucratic incompetence, especially in a world where electronic scheduling and payment tools are standard in the private sector of home care.

There exists a huge need for someone to develop specialized tools to help these public programs run more efficiently and at a lower cost.

Anyone who’s worked in the public sector knows just how slow state and federal agencies are to adopt new technologies, which is why there’s a massive need for new tools and workflows to enter this space. Until then, there’s nothing stopping another fiasco like this where thousands of home care workers go unpaid.

Resident scheduling and communication platform

Problem: Tracking resident schedules and communication is frequently managed manually with a paper-based system. Communication among residents is difficult and the system is prone to mistakes.

Opportunity: A scheduling platform specifically for residents would benefit stressed out residents and their attending physicians, as well as lead to better patient care.

Chief residents who are in charge of managing residents struggle with fulfilling availability requests and keeping schedules up-to-date. This makes for frustrated residents (who are already drastically overworked), leading to increased risk of a negative patient experience due to a scheduling mistake.

For Children’s National Health System, which serves 120 pediatric residents covering 30+ sites in different combinations, staff availability and vacation requests are coordinated entirely by hand.

“The situation currently can only be described as a giant and impossible puzzle,” said Amy Fan, MD, resident at Georgetown University Hospital.

There are a few players competing in this space, Medhub and New Innovations, but neither seem to be widely adopted. OhMD — a HIPAA-compliant texting app — is intelligently targeting their marketing efforts towards residents, the youngest and most innovative thinking of all doctors. Eventually they or someone has the potential to grow into a full scheduling platform for residents. The big picture here is getting residents to love your software and then expand to other functions throughout the hospital (doctor to doctor messaging, patient to doctor messaging, nurse scheduling, etc.).

A tool to manage medication reconciliation

Problem: Wrong medication, wrong time, wrong dosage and noncompliance are just some of the major issues for patients taking multiple medications. The detrimental effects and costs of medication mix-ups in the elderly population is a huge problem.

Opportunity: Create a platform of trained people that can go into the homes of seniors and do medication reconciliation (med rec).

Finding a way to ensure patients use their prescription drugs correctly has always been an elusive Holy Grail in the healthcare industry. Dutch researchers estimated roughly 46 percent of all medication-related hospital admissions “were considered potentially preventable.” Another team from Temple University estimated 33 percent of admissions connected to adverse drug reactions were related to “patient noncompliance.”

For many years, the traditional daily pillbox has been the go-to standard for patients looking for an intuitive way to arrange their medication. Companies like TowerView Health and Tricella are developing pill boxes that detect and store patient adherence behavior, while others like PillPack and ZipDrug are developing more intuitive packaging and delivery options to take out much of the confusion of medication management.

But even tools like those largely leave room for error as patients continue to take other old drugs and remain responsible for correctly separating their weekly medication.

I believe an opportunity exists to build a network of low-cost medication reconciliation specialists. These specialists would go into the homes of patients soon after they’ve been discharged from the hospital. They would do a 30-minute audit of the medicine cabinet and make sure the patient or caregiver understands which pills to take at what times. Dispatching would be efficiently handled through the app and specialists would efficiently be able to see about 10 people per day.

If you’re thinking that in-home visits are inefficient and costly, consider that the U.S. spends $20 billion on preventable medication errors and each admission to the hospital costs $9,700 on average. Also consider that leading health systems like Cedars-Sinai and Kaiser Permanente are so desperate to avoid hospital readmissions they are sending nurse practitioners (with salaries of $100,000) into the homes of patients to do med rec. If someone came to hospitals (and progressive payers) offering a managed service with an easy to use technology layer, it could be a game-changer.

Build electronic visit verification 2.0

Problem: Medicaid fraud is a big problem in many parts of the country. Caregivers submit time sheets for shifts they didn’t work, leaving the disabled and elderly home alone.

Opportunity: Electronic Visit Verification (EVV) monitors locations of caregivers, which should significantly reduce fraud. In the last few years, Texas and Illinois mandated the use of EVV technology, which exploded the demand overnight.

In 1996, Michelle Boasten, RN, designed and created the first clinical documentation information system for home healthcare and coined the term EVV.

Two decades later on June 1, 2015, the Texas Health and Human Services Commission mandated that electronic visit verification be used for all home healthcare visits billed to the state. This put a forcing function on the industry to adopt EVV technology and states across the country will likely soon follow by implementing similar EVV mandates.

Regulatory mandates to adopt technology usually create a mad dash to build and sell as fast as possible; I believe that is the scenario here. Being that this area of healthcare doesn’t get a ton of exposure, the competition isn’t very high. There are a few software vendors, CareWatch and myGeoTracking, but this market is still very much up for grabs.

There is an opportunity to build a much better product on the market to manage specific state and federal reporting requirements, use GPS to track caregivers, automate payroll and optimize the matching of staff. All of this would increase the efficiency of the home health agencies, as well as reduce Medicaid fraud by providing detailed evidence of the services provided.

Therapy scheduling

Simple interface for insurance pre-approval

Problem: Insurance reimbursement is vague, confusing, manual and seemingly ambiguous to patients and providers. Patients often don’t know if procedures will be paid for by their insurance or not, which is incredibly frustrating and costly.

Opportunity: Offer a simple tool to private practice providers giving them access to patient copay and deductible information.

Arguably the biggest frustration of running a private practice medical office is dealing with payment. Patients want and deserve simple answers to how much their copay and deductible will be for their procedure, yet this information is notoriously difficult to obtain.

Front desk staff often spend over 30 minutes on the phone calling insurance companies trying to gather this data. It’s a frustrating manual process that can and should be automated.

Real-time eligibility APIs such as Pokitdoc or Eligible allow developers to gain access to health insurance information, but small private practice offices don’t have the capability to integrate these APIs.

A simple SaaS solution that gives private practices access to patient copay and deductibles would save lots of time and money. This is a problem not just for primary care doctors, but dermatologists, dentists and other segments, as well.

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Forward brings its personalized healthcare service to Los Angeles

Forward, the San Francisco-based startup that’s looking to refashion healthcare services in Apple’s image, is expanding with its first location in Los Angeles.

Weaving together a number of Silicon Valley’s favorite healthcare trends, the company’s services combine proprietary, purpose-built medical devices with algorithmically enabled diagnostic tools, and the latest in gene, bacteria and blood tests to provide a holistic view of its patients’ health.

These technologies and services include: unlimited access to its medical staff; baseline screening; blood and genetic testing; wellness and nutrition counseling; and ongoing monitoring from wearable sensors provided at the clinic. Support and access to its AI and 24/7 access to medical staff through the app are available exclusively to anyone who’s willing to pay the $149 per month fee.

At its launch, Adrian Aoun told us about 15 percent of its early users come from underserved communities and had received free membership. Members also get their first month of prescription medicine free through Forward’s onsite pharmacy, which also offers vitamins and supplements.

Forward also plans to offer vitamins and other supplements and wearables through the onsite store, and Aoun said he would like to offer other alternatives, such as acupuncture, in the future.

Opening in a small office on the first floor of the Westfield Century City mall, Forward’s Los Angeles office will contain all of the bells and whistles that brought it so much attention when it opened its first San Francisco location in January.

There are custom-built exam rooms kitted up with interactive, touch-screen displays — part of what the company touts as an integrated, paperless system for new electronic health records.

The centerpiece of the company’s facility is a purpose-built body scanner that collects basic vital signs like temperature, pulse and arterial health, which are then sent to the company’s staff doctors.

Those aren’t the only diagnostic tools. The company also has an app and is rolling out services around fertility and sleep tracking, as well as dermatological and optometry services in its two offices.

Once the scans are completed, doctors then review the results of diagnostic tests with their patients in one of those exam rooms, which is also recording the conversation with voice recognition software that targets key words to help retain the key parts of the conversation and examination.

  1. 20171108-forward-_DEZ3432

    Forward's Los Angeles office
  2. 20171108-forward-_DEZ3453 (1)

    Forward's slogan
  3. bodyscanner

    Forward's proprietary diagnostic scanner
  4. kyson-dana-aug-forward-31

    Forward's tool for examining arterial health
  5. 20171108-forward-_DEZ3508

    A Forward exam room
  6. 20171108-forward-_DEZ3894

    Forward's diagnostic process
  7. kyson-dana-aug-forward-22

    Forward patient kits

This expansion into Southern California marks the next step in the journey that former Google executive Adrian Aoun first embarked on 18 months ago when he started building out the company’s medical devices and first office in a warehouse in San Francisco’s SoMa neighborhood.

An early entrepreneur who first came to prominence through his work building natural language processing software that would enable users to create searches for specific topics, Aoun was one of the original architects of Google’s artificial intelligence strategies and the founder of the company’s urban technology subsidiary, Sidewalk Labs.

Aoun’s attention turned to healthcare after his brother had a heart attack, he says, which led him to confront the inadequacies of the existing system.

“The existing healthcare system was not built for you,” Aoun says. “Their incentives are not to actually make you healthy and they’re certainly not to make this cheaper.”

While Forward isn’t necessarily making healthcare cheaper either, it is planting a flag for making healthcare better, Aoun says. And he thinks that’s the first step to changing the whole system.

“It’s absurd to think that the disruption is going to come from the inside,” he says.

The problem for Aoun is that existing healthcare solutions can’t “scale” because treatment depends on highly skilled medical professionals (and there’s a shortage of those these days).

“We need to figure out how to scale doctors so that they touch more lives… The same way an engineer can scale through software,” he says.

Aoun sees Forward as building the tools that other companies can then use to drive down costs and bring to a larger market the solutions his company is developing.

And, he argues, the Forward price tag isn’t all that expensive. “$149 per month is about half the price of a fancy gym,” he says. “We have to start somewhere.”

While Forward doesn’t talk about its financing, it has secured investments from some of Silicon Valley’s marquee investors and entrepreneurs.

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United Airlines Halts Flights to New Delhi on Poor Air Quality

United Airlines temporarily suspended Newark-New Delhi flights due to poor air quality in India’s capital, and said some extra charges will be waived for passengers forced to reschedule.

“We are monitoring advisories as the region remains under a public health emergency, and are coordinating with respective government agencies,” a United Airlines spokesperson said in response to a Bloomberg query. 

Other airlines were still flying to the national capital and it was not clear if they will follow United Airlines’ move to suspend flights.

Chief Minister Arvind Kejriwal, the leader of Delhi, called the capital a “gas chamber” as thick toxic smog continued to envelop the mega-city of around 20 million people on Sunday. The levels of the deadliest, tiny particulate matter — known as PM 2.5, which lodges deep in a person’s lungs — soared to 676 at 2 p.m. local time, according to a U.S. embassy monitor. World Health Organization guidelines suggest levels above 300 are “hazardous.”

Customers traveling over the next several days should visit the United Airlines website or download the company’s mobile application for updates, the spokesperson said.

The Coming Storm of Climate Change

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    Chili’s Grill & Bar answered a healthcare question and took us all on an educational journey

    Image: Brinker International

    Forget Chili’s dinner for two special—the bar and grill just served us a hot fresh plate of healthcare knowledge in just under 140 characters. 

    Twitter user Colin Gray (@subtlerbutler) went on a tweetstorm on Wednesday about why people should start asking each other information outside of the internet. 

    “There’s this weird thing you can do, where, if you need information from someone, you can ask them instead of the internet,” he wrote. “If you live in the same town, you might be able to see them in person. Who knows! The world is your goddam [sic] oyster.”

    In case no one understood his rant, he decided to include Chili’s restaurant as a prime example of someone to ask, because who doesn’t love or trust Chili’s? 

    Someone decided to humor Gray and ask him what questions he would ask Chili’s. He responded with a serious question about his medical bills and a role the healthcare system plays in paying for his checkups. 

    Chili’s came to the rescue and schooled all of us on the meaning of copays. Who knew a restaurant had so much knowledge on healthcare? No more asking the lady at the front desk what the charges mean.

    “If your deductible hasn’t been met, your copay is how much it costs to simply leave your doctor’s office. They can charge way more later,” Chili’s tweeted.

    After Gray thanked the restaurant chain for answering his question, it didn’t take long for others to ask Chili’s for some advice and have their lives changed forever.

    However, we have to understand the restaurant chain isn’t Wikipedia. Sadly, some answers must remain unsolved. 

    Aside from the advice, some people took to Twitter to show the similarities between Chili’s take on healthcare and our local politicians.

    Chili’s just took their famous slogan “for great American food…think daily” to a whole new meaning. 

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    Take a ‘cell-fie’ using your phone and this small microscope adapter

    Capitol Police remove a demonstrator in a wheelchair from the Graham-Cassidy hearing.
    Image: chip somodevilla/Getty Images

    How do we say this nicely, Senator Cassidy and Senator Graham: everyone hates your dumb healthcare bill. 

    Well, at least a solid majority of Americans do, and pretty much everyone who came to watch the Graham-Cassidy hearing Monday afternoon. Activists from the grassroots disability rights group ADAPT disrupted the hearing multiple times, causing Senator Hatch to briefly recess the hearing and prompting Capitol Police to arrest protestors, some of them in wheelchairs.

    Their protest centered around the large concern that passage of the bill would severely deplete medicaid funding. But many other worries exist about how the bill would not include essential health benefits, cause millions to lose their insurance, and shrink the Obamacare protections for people with preexisting conditions.

    The footage of police forcibly removing the ADAPT protesters is both inspiring and predictably heartbreaking.

    Here is Senator Hatch ordering that the hearing be recessed as protestors in wheelchairs are pulled away by authorities:

    And Senator Cassidy responding with his characteristic charisma, aka a zombie-like yawn:

    Under Graham-Cassidy, at least 1.4 million adults with disabilities would lose Medicaid, per the Center for American Progress. Depending on how deep the cuts go (and what version of the bill we’re looking at) that number could easily climb to 1.8 million. 

    A protestors looks on as other demonstrators are taken out.

    Image: tom williams/CQ-Roll Call, Inc.

    With fewer services, advocates fear that folks with disabilities could be forced back into institutions and otherwise pushed out of the workforce.

    Organizers estimated that the number of arrests today would hover around 100.

    Capitol Police arrest a demonstrator for reportedly disrupting the hearing.

    Image: chip somodevilla/Getty Images

    ADAPT has a long history of disruptive protest in defense of people with disabilities. The group’s grassroots efforts have been instrumental in bringing attention to issues across America for the past 40 years. 

    Capitol police drag a blind protestor out of the hearing.

    Image: chip somodevilla/Getty Images

    This isn’t the first time Capitol Police have thrown activists with disabilities out of a hearing. In June, 43 demonstrators assembled by the organization were arrested outside of McConnell’s office to protest cuts to Medicaid

    Senators McCain, Paul, Collins, and Murkowski have all expressed either opposition or extreme reservations about the bill, which was supposed to be scheduled for a vote sometime this week.

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