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Tuesday, January 10, 2017

On the Eve of WinterTech

It's "J.P. Morgan Week" in San Francisco (hashtag #JPM17), amid which I will be covering the Health 2.0 WinterTech Conference (hashtag #WinterTech. Register here).

Where did that year go? My WinterTech 2016 experience.

Interesting article up over at THCB:
JP Morgan Week: Lessons For Investors From the Theranos Story
Jan 10, 2017

Theranos raised $900 million from investors and achieved a market capitalization of nearly $9 billion. Today, its investors may have lost most of their money and the company is pursuing a new strategy. It’s a familiar story to lenders and investors and likely to be hallway chatter today as the 35th Annual J. P. Morgan Healthcare Conference convenes in San Francisco.

Theranos targeted the lucrative blood testing market offering a new technology that allowed labs to do 30 blood tests almost instantly with a single drop of blood. The company began its operations in 2003 with a $5.8 million investment from Draper, Fisher, Jurvetson and other venture funds. By 2010, it had raised $83.4 million more in three follow-on rounds and then scored a reported $633 million investment in 2014 increasing its market value to $9 billion. In those 11 years, the company operated in relative secrecy: its 60-plus patent filings gave clues about its activities while its CEO, Stanford drop-out Elizabeth Holmes, shunned the spotlight...

Stories like Theranos are familiar to every investor and lender gathered in San Francisco this week. All of them have had disappointing results because an organization where they’ve parked capital as debt or equity has failed to meet expectations due to poor execution, or changing market conditions derailed their plan. And some have faced the enormity of challenges like those facing Theranos today in the companies/organizations they’ve funded...

Looming prominently at JPM this week is speculation about the Trump administration’s replacement for the Affordable Care Act...
Yeah. Theranos, ugh. I'll have more to say on them once I've finished reviewing the CMS lab QA assessment.
"Looming prominently at JPM this week is speculation about the Trump administration’s replacement for the Affordable Care Act."
In that regard, everyone might want to read medical economist J.D. Kleinke's recent "out-of-retirement" piece. As he noted on Facebook: "No, I haven't come out of retirement . . . but after all the dangerous and annoying nonsense we heard this week about the ACA, I really had to write this . . . or my head would explode."
Why There Is No Obamacare Replacement — In One Picture

There is no conservative replacement health reform plan for Obamacare — because Obamacare is a conservative health reform plan.

After six years of promising to repeal ‘n’ replace the President’s signature domestic achievement, Republican lawmakers have no coherent alternative to the Affordable Care Act for one good reason: because the Affordable Care Act was once the market-based alternative to a real, not imagined, “government takeover” of health care.

What has always made the ACA a political pariah to Republicans, typified by the bizarre claim by House Speaker Paul Ryan (R-WI) on Wednesday that “Obamacare” has “ruined” and “dismantled” our health care system, is the plan’s namesake — far more than its necessarily complex architecture or any of its actual details, unless you count the details they made up.

And so, if only for kicks, how about some actual historic facts and context about a health reform plan that was actually decades in the making, only three years into full implementation, and on the eve of blind destruction by demagogues who have no idea what they’re taking about.

The chart below illustrates where the ACA sits, ideologically, relative to all other health reform plan models.
This chart places the ACA along a continuum of all serious reform options developed, debated, and discarded or ignored since the 1980s. They are all here: from the single-payer, centrally controlled models popular with those who detest corporations and the corrupting influence of money in medicine — two actual, not imagined “government takeovers of health care” — to a fully free-market, laissez faire model favored by those who detest regulation and the heavy hand of government in medicine...
J.D. rocks. Read the entire post. I first cited him on this blog in 2011 in my post "Use Case."
HIT market failure ... If the state of U.S. medical technology is one of our great national treasures, then the state of U.S. HIT is one of our great national disgraces. We spend $1.6 trillion a year on health care—far more than we do on personal financial services—and yet we have a twenty-first-century financial information infrastructure and a nineteenth-century health information infrastructure. Given what is at stake, health care should be the most IT-enabled of all our industries, not one of the least. Nonetheless, the “technologies” used to collect, manage, and distribute most of our medical information remain the pen, paper, telephone, fax, and Post-It note.

Meanwhile, thousands of small organizations chew around the edges of the problem, spending hundreds of millions of dollars per year on proprietary clinical IT products that barely work and do not talk to each other. Health care organizations do not relish the problem, most vilify it, many are spending vast sums on proprietary products that do not coalesce into a systemwide solution, and the investment community has poured nearly a half-trillion dollars into failed HIT ventures that once claimed to be that solution. Nonetheless, no single health care organization or HIT venture has attained anything close to the critical mass necessary to effect such a fix.

This is the textbook definition of a market failure. All but the most zealous free-market ideologues recognize that some markets simply do not work. Indeed, reasoned free-market champions often deconstruct specific market failures to elucidate normal market functioning. The most obvious examples of such failures (such as public transit and the arts) are subsidized by society at large because such subsidies yield benefits to the public that outweigh their costs. Economists refer to these net benefits as “positive externalities,” defined as effects that cannot be captured through the economic equation of direct cost and benefit...
This year, the health space policy focus -- early on, anyway -- will be on the "Repeal and (not) Replace ObamaCare" battle on the Hill (and on K-Street), along with related fights over Medicare and Social Security. Not that MedTech and Health InfoTech will be exempt from the upshots, (e.g., we see calls for #TrumpleThinSkin to summarily rescind Meaningful Use Stage 3 -- as if that were within his Presidential purview), just that Health IT is relative chump change in the context of the huge pending ACA fight.

Screwing Congress
January 10, 2017, Nicholas Bagley

There’s been a lot of talk about the executive actions that President Trump might take to reshape the Affordable Care Act. Here’s one I haven’t heard discussed: undoing the Hill fix.

Prior to the ACA, members of Congress and their staffers got health coverage through their jobs, just like most Americans. But Congress wanted to signal that it believed in the new exchanges that the ACA created. The ACA therefore sent members and their staffers onto the exchanges. Specifically, the ACA says that “the only health plans that the Federal Government may make available to Members of Congress and congressional staff … shall be health plans that are … offered through an Exchange.”

That left an open question. Could the federal government continue to pay for members’ and staffers’ health plans? Or would they have to pay for their plans out of their wages?

The statute wasn’t entirely clear, so the Office of Personnel Management weighed in. It concluded that the ACA allowed the federal government, as an employer, to purchase exchange plans for members and staffers. That was good news for people who work on the Hill: zeroing out their health coverage would have amounted to an enormous pay cut...

...Mr. Trump, the Hill fix was never illegal. But the ACA gives you the flexibility to undo it. You’ll be president in ten days. Your move.


Yeah, that should be fun. From The New Yorker,
Elizabeth Kolbert

A handy rule of thumb in Washington is that the more pernicious the act, the more high-minded the title. Thus, last week, the House of Representatives approved the Regulations from the Executive in Need of Scrutiny Act of 2017, also known as the REINS Act. The bill would strip the executive branch of the power to issue significant new rules on topics ranging from air quality to food safety. In normal times, such a power grab by Congress would surely face a veto threat from the President, but, of course, these are not normal times.

Under the latest version of the REINS Act, a regulation with “an annual effect on the economy of $100,000,000 or more” could not take effect without congressional approval. In this way, either the House or the Senate could easily scuttle a major new regulation—one that requires food producers to sanitize their tools, for example—simply by doing nothing. “Given partisan gridlock in Congress, this could result in a de facto ban on new public interest safeguards,” Alison Cassady, the director of domestic energy policy at the Center for American Progress, noted in a recent post on the bill.

The ostensible justification for the REINS Act is a fear of executive overreach. However, it’s easy to discern the real—and darker—motive. No agency imposes a regulation with “an annual effect on the economy of $100,000,000 or more” lightly. Such regulations take years to draft and finalize. They’re subject to multiple levels of review, not to mention months of public comment. These regulations also tend to be the sort that have an impact on big corporations, in areas such as energy production, workers’ safety, and lending practices, and, not surprisingly, big corporations often don’t like them...
Interesting. This, though, differs materially from "the Secretary shall" kind of statutory regulations that are a staple of federal legislation. See, e.g., my December post "The Price is Right..."

One more thing to watch.


Almost finished with this book. A very long read, a comprehensive and important look into the critical issues we face at the intersection of science and policy.

Stay tuned. Maybe I'll finish it today. Also have just started this one:

The foregoing will be contextually connected with the three below (as well as a number of others).

I refer to the latter three as "The arc of existence from the Big Bang to the Anthropocene." I may take this rumination over to one of my other blog platforms, maybe Medium.

More to come...

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