Help With Medicare Costs: What You Need to Know

Low-income Americans on Medicare can get assistance paying their premiums and other expenses. Several states have allowed more people to qualify.

#age-chronological, #content-type-service, #drugs-pharmaceuticals, #elderly, #extra-help, #federal-aid-us, #health-insurance-and-managed-care, #income, #medicare, #medicare-savings-program, #personal-finances, #poverty, #retirement

Medicare Advantage Plans Often Deny Needed Care, Federal Report Finds

Investigators urged increased oversight of the program, saying that insurers deny tens of thousands of authorization requests annually.

#elderly, #health-and-human-services-department, #health-insurance-and-managed-care, #inspectors-general, #medicare, #privatization

Medicare Officially Limits Coverage of Aduhelm to Patients in Clinical Trials

Officials cited data showing the new Alzheimer’s drug has serious safety risks and may not help patients.

#aduhelm-drug, #alzheimers-assn, #alzheimers-disease, #biogen-inc, #centers-for-medicare-and-medicaid-services, #clinical-trials, #drugs-pharmaceuticals, #food-and-drug-administration, #health-insurance-and-managed-care, #medicare

Inside a Campaign to Get Medicare Coverage for a New Alzheimer’s Drug

The Alzheimer’s Association has pushed relentlessly to get broad access to Aduhelm, despite safety risks and uncertain evidence that it helps patients.

#aduhelm-drug, #alzheimers-assn, #alzheimers-disease, #antibodies, #biogen-inc, #centers-for-medicare-and-medicaid-services, #drugs-pharmaceuticals, #elderly, #health-insurance-and-managed-care, #medicare, #united-states, #your-feed-healthcare, #your-feed-science

In Difficult Cases, ‘Families Cannot Manage Death at Home’

Health care researchers argue that hospice facilities could better serve some terminal patients, and ease the burden on exhausted loved ones.

#death-and-dying, #elderly, #hospice-care, #medicare, #united-states, #warraich-haider-j, #your-feed-health, #your-feed-science

Meet the Underdog of Senior Care

The Program of All-Inclusive Care for the Elderly, funded by Medicare and Medicaid, has quietly succeeded in enabling some older Americans to age in place.

#archcare, #elder-care, #elderly, #health-insurance-and-managed-care, #home-health-care, #jersey-city-nj, #medicaid, #medicare, #nursing-homes, #your-feed-healthcare, #your-feed-science

For Older Americans, Some Positive Health News

Three recent developments — incremental and undramatic but encouraging — are likely to improve the lives and health of seniors.

#california, #coronavirus-reopenings, #elderly, #health-insurance-and-managed-care, #hospitals, #medicaid, #medicare, #nursing-homes, #social-security-us, #social-security-administration, #your-feed-healthcare, #your-feed-science

How to Transition Into Retirement

Many older Americans like to ease into being an ex-worker — but you need to think carefully about just how to get there.

#age-chronological, #content-type-service, #labor-and-jobs, #longevity, #medicare, #pensions-and-retirement-plans, #personal-finances, #retirement, #social-security-us, #social-security-administration

Biden’s Hidden Health Care Triumph

Blockbuster enrollments are good news — but will poltiics kill progress?

#american-rescue-plan-2021, #biden-joseph-r-jr, #health-insurance-and-managed-care, #medicare, #patient-protection-and-affordable-care-act-2010, #republican-party, #united-states-politics-and-government

Medicare Will Soon Provide Free At-Home Coronavirus Tests

The announcement came after lawmakers and advocates argued that Medicare recipients had been passed over in the push to require insurers to cover the tests.

#centers-for-medicare-and-medicaid-services, #coronavirus-2019-ncov, #health-insurance-and-managed-care, #medicare, #tests-medical, #united-states-politics-and-government

Voting Rights Bill Dead, Filibuster Alive

The voting rights bill and the filibuster. Also: A Supreme Court ruling; President Biden and Ukraine; Medicare and Covid tests; an American paradox.

#biden-joseph-r-jr, #coronavirus-2019-ncov, #democratic-party, #filibusters-and-debate-curbs, #house-of-representatives, #medicare, #senate, #storming-of-the-us-capitol-jan-2021, #supreme-court-us, #trump-ukraine-whistle-blower-complaint-and-impeachment-inquiry, #trump-donald-j, #ukraine, #united-states-politics-and-government, #vaccination-and-immunization, #voting-rights-registration-and-requirements

Financial Planning for People With Chronic Diseases

Financial planning for people with chronic diseases is complicated and multifaceted. Start by building a team of people to help.

#chronic-condition-health, #content-type-service, #disabilities, #disability-insurance, #drugs-pharmaceuticals, #elderly, #medicaid, #medicare, #national-multiple-sclerosis-society, #pensions-and-retirement-plans, #personal-finances, #retirement

Medicare Proposes to Cover Aduhelm Only for Patients in Clinical Trials

If the preliminary decision is finalized this spring, it would sharply limit the number of patients who use the expensive drug.

#aduhelm-drug, #alzheimers-disease, #biogen-inc, #centers-for-medicare-and-medicaid-services, #drugs-pharmaceuticals, #elderly, #medicare, #your-feed-healthcare

Alzheimer’s Drug Aduhelm Faces Crucial Medicare Decision

Medicare officials are trying to determine whether to cover Aduhelm, which the F.D.A. approved despite unclear evidence that it helps patients.

#aduhelm-drug, #alzheimers-disease, #biogen-inc, #centers-for-medicare-and-medicaid-services, #drugs-pharmaceuticals, #elderly, #medicare, #your-feed-healthcare, #your-feed-science

How to Cope With Medicare’s Rising Costs

A higher Medicare premium in 2022 is just part of the puzzle of health care costs for older Americans. But there are ways to plan.

#aduhelm-drug, #content-type-service, #drugs-pharmaceuticals, #elderly, #finances, #health-insurance-and-managed-care, #inflation-economics, #longevity, #medicare, #pensions-and-retirement-plans, #social-security-us

Senate Clears Last Hurdle to Raising Debt Ceiling

Fourteen Republicans joined Democrats in voting to take up legislation that would pave the way for Congress to raise the debt ceiling by a simple majority vote, skirting a filibuster.

#biden-joseph-r-jr, #democratic-party, #law-and-legislation, #mcconnell-mitch, #medicare, #national-debt-us, #republican-party, #schumer-charles-e, #senate, #united-states-politics-and-government

How Nursing Homes’ Worst Offenses Are Hidden From the Public

Thousands of problems identified by state inspectors were never publicly disclosed because of a secretive appeals process, a New York Times investigation found.

#centers-for-medicare-and-medicaid-services, #coronavirus-2019-ncov, #elder-care, #medicare, #nursing-homes, #regulation-and-deregulation-of-industry, #workplace-hazards-and-violations

Biden Focuses on How Spending Bill Would Lower Drug Costs

President Biden emphasized how the bill would lower prescription drug costs, an issue his administration hopes will build support for the broader package.

#biden-joseph-r-jr, #democratic-party, #diabetes, #drugs-pharmaceuticals, #insulin, #medicare, #senate, #united-states-politics-and-government

Build Back Better Act Would Patch Holes in Health Coverage

Taken together, the provisions in the social policy bill represent the biggest step toward universal coverage since the passage of the Affordable Care Act.

#drugs-pharmaceuticals, #health-insurance-and-managed-care, #law-and-legislation, #medicaid, #medicare, #patient-protection-and-affordable-care-act-2010

Inflation and Retirement: How to Protect Your Savings

With prices rising at their fastest rate in decades, people in retirement or approaching it should take extra care to protect their savings.

#consumer-price-index, #content-type-service, #drugs-pharmaceuticals, #elderly, #inflation-economics, #medicare, #personal-finances, #prices-fares-fees-and-rates, #retirement, #social-security-us, #united-states, #united-states-economy

House Narrowly Passes Biden’s Social Safety Net and Climate Bill

The vote was months in the making for the roughly $2 trillion measure, one of the most consequential bills in decades. Now it faces a difficult path in the Senate.

#american-families-plan-2021, #biden-joseph-r-jr, #child-care, #congressional-budget-office, #corporate-taxes, #democratic-party, #federal-taxes-us, #health-insurance-and-managed-care, #house-of-representatives, #immigration-and-emigration, #law-and-legislation, #mccarthy-kevin-1965, #medicare, #national-debt-us, #pelosi-nancy, #tax-credits-deductions-and-exemptions, #united-states-economy, #united-states-politics-and-government

Dubious $56,000 Alzheimer’s drug spurs largest Medicare price hike ever

Multistory glass building on a tree-lined campus.

Enlarge / Biogen Inc. headquarters in Cambridge, Massachusetts. Biogen Inc. shares soared after its controversial Alzheimer’s disease therapy was approved by US regulators. (credit: Getty | Bloomberg)

Seniors throughout the US will see a hefty increase to their health care premiums next year thanks in large part to Biogen’s Alzheimer’s drug, Aduhelm, which is priced at $56,000 per year and is not proven to be clearly effective at treating Alzheimer’s.

The Centers for Medicare & Medicaid Services (CMS) announced Friday that the standard monthly premium for Medicare Part B will rise from $148.50 in 2021 to $170.10 in 2022, an increase of $21.60 or roughly 14.5 percent. It is the largest increase ever in terms of dollars and among the largest percentage increases in recent years.

CMS officials said Friday that Aduhelm was responsible for about half of the rise in Part B premiums, according to the Associated Press. Though the CMS is still determining how it will cover Aduhelm under Part B, the agency said the prospect of paying for Aduhelm at all required “additional contingency reserves.”

Read 9 remaining paragraphs | Comments

#aduhelm, #alzheimers-disease, #biogen, #cms, #coverage, #fda, #health-care, #health-insurance, #medicare, #premiums, #science

Democrats Reach Deal to Control Drug Prices in Bill

The provision would, for the first time, allow the government to negotiate prices for some medicines covered by Medicare.

#biden-joseph-r-jr, #democratic-party, #drugs-pharmaceuticals, #elderly, #federal-budget-us, #health-insurance-and-managed-care, #house-of-representatives, #inventions-and-patents, #medicare, #pelosi-nancy, #prices-fares-fees-and-rates, #schumer-charles-e, #senate, #sinema-kyrsten, #united-states-politics-and-government, #warren-elizabeth

Democrats Reach Deal to Control Drug Prices in Social Policy Bill

The provision would, for the first time, allow the government to negotiate prices for some medicines covered by Medicare.

#biden-joseph-r-jr, #democratic-party, #drugs-pharmaceuticals, #elderly, #federal-budget-us, #health-insurance-and-managed-care, #house-of-representatives, #inventions-and-patents, #medicare, #pelosi-nancy, #prices-fares-fees-and-rates, #schumer-charles-e, #senate, #sinema-kyrsten, #united-states-politics-and-government, #warren-elizabeth

Why Aren’t More People Comparison Shopping for Health Plans?

Most Medicare beneficiaries don’t compare plans during open enrollment season, and may be paying more, or accepting more restrictions, than they should.

#center-for-medicare-advocacy, #drugs-pharmaceuticals, #elderly, #health-insurance-and-managed-care, #medicare, #your-feed-science

Health coverage would be expanded under the Democrats’ spending plan.

The insurance expansion would offer free private plans to many low-income adults and financial assistance with premiums to higher earners.

#american-families-plan-2021, #democratic-party, #drugs-pharmaceuticals, #elderly, #health-insurance-and-managed-care, #law-and-legislation, #medicaid, #medicare, #united-states-politics-and-government

This May Be Democrats’ Best Chance to Lower Drug Prices

For patients with certain cancers, out-of-pocket spending can exceed $15,000 a year. Legislation could take aim at prices and the amounts Medicare patients are charged.

#drugs-pharmaceuticals, #health-insurance-and-managed-care, #law-and-legislation, #medicare, #prices-fares-fees-and-rates, #united-states-politics-and-government

Biden and Democrats Push for Budget Deal This Week as Rifts Remain

Negotiators were closing in on a deal that could spend around $1.75 trillion, but lawmakers were still haggling over critical disagreements on the sprawling social policy bill.

#alternative-and-renewable-energy, #american-families-plan-2021, #american-jobs-plan-2021, #biden-joseph-r-jr, #democratic-party, #drugs-pharmaceuticals, #federal-budget-us, #global-warming, #high-net-worth-individuals, #house-of-representatives, #manchin-joe-iii, #medicaid, #medicare, #paid-time-off, #schumer-charles-e, #senate, #united-states-politics-and-government

Democrats’ Campaign to Control Drug Prices Nears Collapse

Democrats have made giving government the power to negotiate drug prices a central campaign theme for decades. With the power to make it happen, they may fall short yet again.

#american-action-network, #democratic-party, #drugs-pharmaceuticals, #house-of-representatives, #law-and-legislation, #medicare, #pharmaceutical-research-and-manufacturers-of-america, #political-advertising, #prices-fares-fees-and-rates, #senate, #united-states-politics-and-government

Social Security Cost of Living Increase Will be 5.9 Percent in 2022

The increase, a cost-of-living adjustment that applies to about 70 million Americans, comes as consumer prices have jumped sharply.

#bureau-of-labor-statistics, #consumer-price-index, #elderly, #inflation-economics, #labor-and-jobs, #labor-department-us, #medicare, #social-security-us, #social-security-administration, #united-states-economy

On Concerns About Debt, and Disregard for Climate and Child Poverty

Why don’t those who used to obsess over debt seem to care about the future?

#budget-deficits, #children-and-childhood, #federal-budget-us, #global-warming, #medicare, #national-debt-us, #poverty, #social-security-us, #united-states-politics-and-government

Medicare Expansion Clashes With Health Care for the Poor as Budget Bill Shrinks

Under pressure to cut the bill’s cost, Democrats disagree over whether to offer more benefits to older Americans or to cover more of the working poor.

#democratic-party, #health-and-human-services-department, #health-insurance-and-managed-care, #house-committee-on-ways-and-means, #medicaid, #medicare, #united-states-politics-and-government

Hospitals and Health Care Workers, Overwhelmed by Covid

Burned-out health professionals and overwhelmed hospitals. Also: The child tax credit; counterterrorism; Democrats and taxes; “Medicare for all.”

#brown-sherrod, #child-tax-credits-and-stipends, #children-and-childhood, #coronavirus-2019-ncov, #democratic-party, #federal-taxes-us, #hospitals, #medicare, #parenting, #tax-credits-deductions-and-exemptions, #terrorism, #united-states-politics-and-government, #vaccination-and-immunization

Biden Administration Goes Bigger on Cutting Drug Prices

The administration endorses a proposal for the government to negotiate on prices for all U.S. purchasers, not just Medicare.

#biden-joseph-r-jr, #drugs-pharmaceuticals, #health-insurance-and-managed-care, #medicare, #prices-fares-fees-and-rates, #united-states-politics-and-government

Social Security is projected to be insolvent a year earlier than previously forecast.

Annual government reports on the solvency of the programs underscored the questions about the long-term viability of Social Security and Medicare.

#brooks-lasure-chiquita, #centers-for-medicare-and-medicaid-services, #elderly, #federal-budget-us, #health-insurance-and-managed-care, #medicare, #social-security-us, #united-states-economy, #united-states-politics-and-government

Will Hearing Aids Ever Be Hip?

A new generation of more affordable and stylish hearing aids could help preserve mind, life and limb for millions.

#apple-inc, #bose-corp, #cellular-telephones, #costco-wholesale-corporation, #ears-and-hearing, #elderly, #hearing-aids, #law-and-legislation, #medicare, #wireless-communications

Five Decades Later, Medicare Might Cover Dental Care

In the large budget bill now in Congress, supporters of the measure see a rare opportunity to advance a popular policy.

#federal-budget-us, #health-insurance-and-managed-care, #law-and-legislation, #medicare, #teeth-and-dentistry

Racial Inequities Persist in Health Care Despite Expanded Insurance

A series of studies in an influential medical journal takes a close look at longstanding gaps in medical care.

#black-people, #discrimination, #health-insurance-and-managed-care, #hispanic-americans, #hospitals, #income-inequality, #infant-mortality, #jama-journal-of-american-medical-assn, #medicare, #minorities, #patient-protection-and-affordable-care-act-2010, #pregnancy-and-childbirth, #race-and-ethnicity, #united-states, #whites, #your-feed-science

Getting Old Is a Crisis More and More Americans Can’t Afford

The looming financial crisis for seniors.

#baby-boomers, #elderly, #health-insurance-and-managed-care, #long-term-care-insurance, #medicaid, #medicare

Accel leads Lucid Lane’s $16M round aimed at treating people with medication dependency

Telehealth company Lucid Lane raised $16 million in Series A funding to continue developing its platform that enables real-time intervention for people with medication dependence and substance-use disorders.

Adnan Asar, co-founder and CEO of Lucid Lane, started the company five years ago after watching his wife struggle to stop taking medication she was prescribed following an illness.

There are 40 million people prescribed opioids and benzodiazepines each year, many like Asar’s wife, after surgery or in conjunction with cancer treatment to address acute and chronic pain as well as co-occurring mental health challenges, he told TechCrunch.

However, though the medications work well, out of the number of people prescribed, about 15 million people will continue to use the medication after the prescription runs out. This leads to ballooning healthcare costs with the healthcare system spending $150 billion annually to take care of this population, Asar said.

Lucid Lane’s latest services are aimed toward avoidance of becoming a persistent medication user or addict. They include comprehensive medication taper management for those dependent on opioids, benzodiazepines, alcohol and nicotine, and a medication assisted treatment designed for patients diagnosed with opioid and alcohol substance disorders. The evidence-based treatments are available in more than 25 states.

Its technology utilizes web and mobile-based applications to provide remote patient monitoring and connection to dedicated therapists on a daily basis. A newly developed analytics engine collects health signals from patients to measure symptoms like anxiety, depression, pain levels and withdrawal effects so that the platform and therapists can personalize their treatments. If needed, the engine will connect patients instantly with an on-call counselor.

Over 90% of Lucid Lane patients who start medication tapering safely taper off, while members who are persistent opioid or benzodiazepine users tapered by 50% in six months after they started the process, which is better than Centers for Disease Control and Prevention guidelines, Asar said. Patients also reported improvements in pain, emotional well-being and quality of life.

The Series A funding comes one year after the Los Altos-based company secured $4 million in a seed round. Accel Partners led the Series A and was joined by Battery Ventures, AME Cloud Ventures, Morado Ventures and strategic angel investors. As part of the investment, Eric Wolford, venture partner at Accel, joined the Lucid Lane board of directors.

Asar wasn’t planning for the Series A until later this year, but as the healthcare world was changing around him, venture capital firms began knocking on his door asking when he was raising the next round.

“I met Eric through Battery Ventures, and we had tremendous alignment with passion and mission and it seemed a great fit,” Asar said.

Wolford said he recognized how big of a problem opioid addiction was, that it was a worthy cause, and the size of the market opportunity. “There is something beyond the returns that is compelling, the extent of the problem and the awareness that exists already,” he added.

He also felt that Asar and his team knew the healthcare system and how to introduce technology into it. He mentioned that the industry is complicated to interface with due the complex nature of payers, providers, patients and regulations from state to state. He said that Lucid Lane was embracing the system and working with it.

Wolford was also attracted to the personalized nature of the company’s approach and that it can become the standard of care, taking the pressure off of doctors who want to do right by their patients, but want to prescribe less medication so they don’t become dependent.

“It’s a pressure release value so doctors are appropriately prescribing drugs, are accommodating patients and also providing an intervention to avoid the bad that may start,” he added. “Personalization is what doesn’t exist in healthcare right now, and will help get a person to a state of wholeness and encouragement while also progressing them when they are ready.”

Indeed, things are moving quickly for Lucid Lane. As with the healthcare industry itself, the global pandemic helped adoption of the company’s telehealth platform surge as remote care became more mandatory than a discretionary feature. In addition, Asar said it would have normally taken two years for the company to get into Medicare, but with the government’s updated regulations around telehealth, Lucid Lane is now nationwide with Medicare.

The company has a team of more than 40 therapists across 30 states and will be using the new funding to drive its commercial growth, including building up its sales, business development and product development teams. In addition to a leadership team with experience across the technology spectrum, Lucid Lane also announced that Beau Norgeot, former Anthem clinical AI executive, is joining the company as its chief data officer.

The company is also engaged in peer-reviewed, evidence-based, clinical trials at academic institutions, including Stanford University, the United States Veteran Affairs System and The University of Texas Health System.

“We are the only company addressing the whole spectrum of dependent patients and addicted patients,” Asar said. “Doctors don’t have the time or capability to do this, so we work with them to set a goal for patients to improve their quality of life and reduce their pain.”


#accel-partners, #adnan-asar, #ame-cloud-ventures, #artificial-intelligence, #battery-ventures, #eric-wolford, #funding, #health, #healthcare, #healthcare-industry, #lucid-lane, #medicare, #morado-ventures, #recent-funding, #startups, #tc, #telehealth

Nobody Wants to Live in a Nursing Home. Something’s Got to Give.

America needs more infrastructure for the elderly.

#aarp, #elder-care, #elderly, #green-house-project, #medicare, #nursing-homes

Former Iora Health execs raise $13M to guide seniors through Medicare enrollment

Employers typically offer three options for healthcare insurance. When it’s time to switch to Medicare, particularly Medicare Advantage, there are over 3,500 plans available nationwide, and an average of 30 plans someone can choose from in their particular area. Connie Health is leading seniors through the Medicare maze, helping whittle down those 3,000 plans into a handful of best choices based on care requirements.

The company’s three co-founders, Oded Eran, CEO, David Luna, chief revenue officer, and Michael Scopa, chief growth officer, saw this problem firsthand as executives at primary care company Iora Health, which is being acquired by OneMedical for $2.1 billion.

They started their company in 2019 to develop a Medicare concierge service to assist seniors in easily navigating through those 30 plans to find the right one for them.

“We were coming from the provider side and understood that though healthcare is local, people don’t know the difference in hospitals or the ins and outs of local networks,” Eran told TechCrunch. “Seniors need trust there, and when there are local advisers to meet over the phone or at home, you gain that trust.”

The Boston-based company announced Wednesday it raised $13 million in Series A funding led by Khosla Ventures and Pittango Healthtech to give it a total of $16 million in funding. The company raised $3 million in a seed round back in January 2020, also led by Khosla. The seed and Series A rounds also saw participation by AbstractVentures, Dynamic Loop Capital, Arkitekt Ventures, as well as a group of angel investors, including Hippo Insurance CEO Assaf Wand and Flatiron Health founders Zach Weinberg and Nat Turner.

Image Credits: Connie Health

With 55 million Medicare consumers benefiting from major innovation in Medicare Advantage and value-based care, Kaul saw a large market that was being disrupted by Connie Health. He was especially impressed with the team Eran built and how the company was able to launch during the pandemic and stay nimble.

“The Medicare Advantage space is rich and will continue to grow,” Kaul added. “Technology has not played a big role here, and Oded is going to bring technology in to make the market more efficient.”

Medicare Advantage is the private market part of the insurance program. Eran said the government is trying to drive competition and innovation, so there are a lot of new players coming in to create more plan options, more nuances and to help manage costs better. On the consumer level, this creates a lot of confusion, he added. Potential customers have a hard time making decisions on the latest and greatest options, so they tend to stick with the status quo.

That’s where Connie Health comes in. The company’s technology takes into account the providers someone sees, the medications they are on and the benefits they would like to have, feed those into its model, and based on that, sifts through the thousands of plans available and recommends the best fits.

Four months ago, Connie Health kicked off its consumer platform in Arizona, and with the new investment, also began operating in Texas. Over the next year, Eran expects to move into Illinois, where he is seeing big demographic changes as a lot of people are moving into Medicare and other states. The new funding will also enable the company to branch off to other insurance products.

Within those states, the company’s footprint grew to seven markets, and its local agent base grew 15 times.

“We are going to democratize access to the local agents to help people make these often tough decisions and find healthcare that they deserve and have paid for all of their working life,” Eran said. “We are taking this market-by-market approach because healthcare is in the community.”


#artificial-intelligence, #assaf-wand, #connie-health, #flatiron-health, #health, #health-insurance, #hippo-insurance, #khosla-ventures, #medicare, #oded-eran, #recent-funding, #startups, #tc

Healthcare data sharing: How to improve patient care in the future

Far too often, we see medical mixups and even deaths caused by interoperability obstacles in our healthcare system. In these situations, patients in critical conditions cannot speak to their past medical history in an emergency. Upon their recovery but through no fault of their healthcare providers, they are left footing a massive medical bill or facing other severe financial repercussions. Lack of access to data not only causes these terrible outcomes — it’s also part of the reason why our healthcare costs are nearly 18% of the GDP and growing.

Among the many reasons why healthcare data isn’t more digitally accessible is a very simple one: fear that it will be misused. Patients are scared their data will be used against them. This could happen in a number of ways, the most obvious being the threat that insurance companies will use health data to deny people coverage or that employers will use the data to exclude people when making hiring decisions. That’s why the rules and regulations surrounding health data privacy are so stringent.

So, how can investors advance (and capitalize on) tech development around this issue and help eradicate this fear?

Investors, take note

We know funding for companies in healthcare and digital health has not been a problem — but profitability has. Many of these companies are still struggling financially under a fee-for-service business as required by most insurance companies, Medicaid and Medicare. There are grave inefficiencies in the fee-for-service system: It creates the wrong alignment of interests; doesn’t favor the consumer; is complicated by CPT codes (the numerical codes used to identify medical services and procedures), high copayments and deductibles; and is riddled by waste and abuse.

If the investor community bets on companies that continue to embrace a model that many agree is broken, how can we expect outsized returns?

If the investor community bets on companies that continue to embrace a model that many agree is broken, how can we expect outsized returns? To truly lower costs and reduce inefficiencies, we have to abandon the existing structure and put the customer first.

The key here is to look at companies that are truly trying to solve not just one piece of this puzzle, but those that are attempting to create an end-to-end solution that connects the employer, member, hospital, specialists, pharmaceutical companies, primary care doctors and claims adjusters, powered by digital health data — all while making it more affordable for the consumer.

Keep an eye out for those that are moving away from the fee-for-service structure and focused on employer-driven systems. Employers are properly aligned with patients, as bad health outcomes and financial stress both negatively impact productivity. Employers are also focused on KPIs in their business; they’re used to measuring and tracking results, making them great candidates for data-focused healthcare companies.

Most importantly, in a labor market where companies are clamoring to attract employees, employers will have to work with healthcare technology companies that put a premium on data security because their current and potential employees will demand it.

Innovation over fear

The whole future of healthcare is going to focus on the ability to securely share data. To empower providers and patients to take control of their healthcare journey, we need to build a system of trust that allows the efficient flow of personal healthcare information from stakeholder to stakeholder.

Today, with the way HIPAA works and the requirement to keep data private, that trust has to be in the hands of a provider. Imagine if your primary care physician was the quarterback of your entire healthcare journey. Simply by handling your preventative care, they have a more complete picture.

Even better, preventative care is a major focus when it comes to reducing healthcare costs. If you put the data in the hands of a trusted entity and ensure that each person has access to their full medical history, people are much more likely to grant access at times of need.

The good news? There’s hope

The future is very bright because of technology. The challenge is being able to figure out meaningful ways to utilize and integrate it. Right now, we have a system of incumbency that is disincentivized to embrace new technologies.

Telehealth is a perfect example of how the system can meaningfully change. It took a global pandemic to really be able to break through to a point where telehealth was fully embraced (and covered by insurance). Now, health insurers such as Anthem are actively trying to improve care coordination and interoperability.

Three critical technologies not used in healthcare today could be instrumental in bringing about this change. Ideally, all three will align to usher in a new era of healthcare:

Healthcare telemetry 2.0: Collection of health data on cellular devices

Through our use of social apps and e-commerce platforms on our mobile devices, people have already accepted that our cell phones are constantly collecting data on us and willingly consent to this. Sometimes this function is quite helpful — just look at court cases where detailed location data have provided alibis to suspects.

Anybody with a cell phone is carrying a medical device that counts our steps, tracks our screen actions and is attuned to us as users. So why are we not leveraging this function for optimized care — or at the very least trying to get medical insights out of our device use data?

In the future, the number of times one checks their mobile calendar in a day could be an indicator of early-onset Alzheimer’s in people of a particular age group, as one example. Technologists must continue to push the boundaries of how the computing power in our pockets and purses is used to help us, especially with so much of the groundwork already laid.

Privacy 2.0: Application of blockchain to protect medical information

In just the past six months, we have seen bad actors capitalizing on digital risk to cripple entire industries through data breaches. The Colonial Pipeline hack effectively shuttered gas distribution to a massive portion of the U.S. in a matter of hours. With healthcare data, stewards of the system need to be even more careful. It will be tricky to regulate the privacy and protection of healthcare data, but blockchain technology has proven to be an effective measure in maintaining trust between consumers and data stewards.

Portability 2.0: Ability to securely share information with approved parties

For many people with life-threatening conditions, the simple act of wearing a medical bracelet can make a difference between life and death — but at this point, medical bracelets should be obsolete. Imagine the patient benefits that could come from a next-generation medical “bracelet” that carries a patient’s entire genome, tumor profiles, long-term heart rate trends and more, and can be uploaded instantly in an emergency situation.

Right now, the absence of health record portability creates redundancies that are both expensive and harmful to patients. Doctors spend time and resources rescanning patients, while patients suffer from repeated (and sometimes risky) diagnostics, like blood draws and radiation. Nobody has cracked the code on portability, but effective solutions must navigate tricky regulatory waters while solving for standardization across data sets.

We are already seeing these technologies used in other industries. Apple and Google have turned phones into remote monitoring devices that can easily collect all types of health telemetry data. Cryptocurrency represents billions of dollars in transactions with no breach of trust in various coin exchanges. Uber and Lyft have changed the way we hire, use and pay for transportation. Applying the core technologies used in each of these examples would provide a means for disrupting the current challenges in healthcare. It’s only a matter of time.

History has proven that with innovation, investment and technology, the world has become a dramatically better place. As long as rules and regulations stay out of the way, you can expect that technology will allow us to make enormous leaps forward in the next decade.

Making data secure and meaningful, along with personalized medicine, holds the promise to reduce long-term healthcare costs in the U.S. while improving healthcare outcomes.

#column, #digital-health, #health, #healthcare, #healthcare-data, #healthcare-technology, #insurance, #medical-billing, #medicare, #opinion, #tc, #telehealth

Controversial Alzheimer’s drug could cost US $334B—nearly half of DoD budget

Multistory glass building on a tree-lined campus.

Enlarge / Pedestrians walk past Biogen Inc. headquarters in Cambridge, Massachusetts, on Monday, June 7, 2021. Biogen Inc. shares soared after its controversial Alzheimer’s disease therapy was approved by US regulators. (credit: Getty | Bloomberg)

Concern is mounting over the price of the controversial new Alzheimer’s drug Aduhelm. Advocates, lawmakers, and critics worry in particular about what the drug’s $56,000 per-year list price will do to Medicare. The federal insurance program is available to those age 65 and over, which covers the vast majority of the roughly 6 million adults with Alzheimer’s in the US.

As it stands, the cost of Aduhlem—a doctor-administered intravenous drug—has the potential to eclipse the amount of money Medicare spends on all other doctor-administered drugs and retail prescription drugs combined.

The Food and Drug Administration granted approval of Aduhelm earlier this month, sparking widespread and intense criticism. Experts and industry watchers have called the decision “disgraceful” and “dangerous,” noting that clinical trials of Aduhelm did not clearly show that the drug is actually effective at treating Alzheimer’s. The fact that Aduhelm’s maker, Biogen, set the list price so high only intensified the criticism.

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#alzheimers, #biogen, #drug-approval, #fda, #medicare, #science

New Alzheimer’s Drug Could Cost the Government as Much as It Spends on NASA

The Alzheimer’s treatment will cost $56,000 per patient, and millions may use it. The result: “crazy numbers” for Medicare.

#aduhelm-drug, #biogen-inc, #drugs-pharmaceuticals, #federal-budget-us, #medicare

Democrats Float $6 Trillion Plan Amid Talks on Narrower Infrastructure Deal

Democrats are considering moving unilaterally on a sweeping economic package even as bipartisan talks continue on a smaller infrastructure bill.

#american-jobs-plan-2021, #biden-joseph-r-jr, #budgets-and-budgeting, #federal-budget-us, #federal-taxes-us, #filibusters-and-debate-curbs, #infrastructure-public-works, #law-and-legislation, #medicare, #sanders-bernard, #schumer-charles-e, #senate, #united-states-economy, #united-states-politics-and-government

Mobile dialysis startup eyes human trials in 2022 following encouraging animal study

This past year, three sheep in Canada have been wearing their kidneys on their sleeves. Or more aptly, in jackets on their fluffy backs. 

These three sheep are part of an ongoing animal study run by the Buffalo, New York-based startup Qidni Labs, a company pursuing waterless and mobile blood purification systems. Qidni Labs was founded in 2014, has raised $1.5 million and is currently in the due diligence process leading up to another round of funding. Qidni Labs was also an award winner at the 2019 KidneyX Summit for developing an air removal system for a wearable renal therapy device. 

The jackets are a prototype of Qidni’s mobile hemodialysis machine called Qidni/D. The idea behind Qidni/D is that it will be significantly smaller than a traditional hemodialysis setup and use fewer fluids, allowing patients to be more mobile. 

“We see this device, and this technology, to be a bridge to a blood purification technology that allows the patients to be mobile, although we do not anticipate that to be the first product,” says Morteza Ahmadi, the founder and CEO of Qidni Labs. 

Per the CDC, about one in seven people in the US have some type of chronic kidney disease. Over time, that could progress kidney failure, at which point it’s recommended that patients start dialysis or receive a transplant. That threshold is typically symptom based; people might experience weight loss, shortness of breath or an irregular pulse to name a few symptoms.

There are two major types of dialysis: hemodialysis or peritoneal dialysis. Hemodialysis passes blood through a filter and a liquid called dialysate, whereas peritoneal dialysis inserts fluid into the body, which absorbs toxins, then drains it out. Qidni/D is a hemodialysis machine that can fit into a sheep sized jacket, and uses its own cartridges and gel-based system to cut down on the amount of liquid needed to perform dialysis. (TechCrunch reviewed images of the device). 

In an early animal trial – the results of which have not yet been published in a peer-reviewed journal – the device was able to reduce levels of urea in sheep’s blood at the threshold of an adequate dose of traditional dialysis. TechCrunch reviewed data from the study over Zoom. 

These sheep had no functioning kidneys, and were hooked up to the machine for between four and eight and a half hours. Morteza adds that the data so far suggests that four hours of treatment should be sufficient to cleanse the sheep’s blood. 

This is just one small animal study, so it’s hard to draw massive conclusions from it. It didn’t include an active control arm, for instance, and instead compared the amount of urea and electrolytes removed from the sheep’s blood to published standards from other studies on dialysis. 

The study alone is far from enough to suggest that the technology is ready for market, but those within the company are taking it as a good sign that the design of Qidni’s mobile dialysis machine bears further testing. 

“We can say that in this study, we could replace daily dialysis based on the data,” he says. 

The team will continue to tweak the technology in more sheep-based studies this year, and is aiming to begin human trials in 2022. The overall goal is to file for FDA approval, provided that clinical studies can demonstrate safety and efficacy, by the second half of 2023. 

The kidney treatment landscape is dominated by dialysis, which is an onerous treatment – despite the fact that a kidney transplant, in many cases, could relieve that burden.  

At the moment, far more people with end stage renal disease are on dialysis than receive kidney transplants. The CDC estimates that 786,000 people in the US live with end stage renal failure, of which 71 percent are on dialysis and 29 percent have received transplants. 

The dialysis industry, and in particular Fresenius and DaVita, the two giants that control about 70 percent of the industry, also has a controversial and complicated history of poor performance.

The kidney treatment landscape is also notable because it’s covered by Medicare, however, it remains expensive. Dialysis and transplants make up about seven percent of Medicare’s budget. Because of this complex landscape, startups have been pursuing alternatives like implantable kidneys

Qidni’s current product is not an artificial kidney in that it could live forever in the body of a participant and replace a non-functional organ. Rather, it’s a more mobile take on dialysis. Qidni/D, the blood purification device, is the company’s main focus for the time being. 

That said, Qidni/D  does have some unique elements that may make it as “disruptive” as Morteza hopes it will be. Namely, its small size, and low water requirements. 

During an average week of dialysis treatment, the average person is exposed to about 300 to 600 liters of water, per the CDC. Some of that water is used in the dialysate solution that helps to leach toxins out of the blood. Per Morteza, Qidni/D uses just one cup of water per treatment session, most of which is contained with the dialysate solution. 

“In our understanding, this is probably one of the first times in the world that waterless technology is useful for blood purification over a long period of time in a large animal model,” he says.

Removing the liquid components of dialysis may streamline an already onerous process. Morteza, for one, hopes that this would make at-home dialysis more attainable (fewer stringent water safety requirements) and limit risks of infection (water-related infections sometimes occur during dialysis).

It’s also a small step towards creating an implantable kidney, which would, ideally, not require massive amounts of external fluid – though mobile dialysis remains Qidni’s current focus. The company’s upcoming round will be focused on testing their cartridge technology in small human trials. 

“In this round of funding we would be raising $2.5 million, and that should take us to a point that we can test this technology in a small group of patients, connected to an existing dialysis machine using our own cartridges instead of existing dialysate,” he says. 

It’s ultimately a step towards a machine that functions more like the organ it’s supposed to mimic, though the holy grail for patients is a solution that ends the need for dialysis in the first place. 

#biotech, #buffalo, #dialysis, #health, #infection, #medicare, #medicine, #tc

Lifelong Exercise Adds Up to Big Health Care Savings

People who start to exercise before or during middle age typically save from $824 to $1,874 annually on health care costs after retirement.

#aarp, #age-chronological, #bmj-open-journal, #exercise, #health-insurance-and-managed-care, #medicare

On Medicare and Need Dental Work? Beware a Big Bill.

The traditional version doesn’t cover dental, vision or hearing care. Advocates hope for change under a Biden proposal.

#biden-joseph-r-jr, #ears-and-hearing, #eyes-and-eyesight, #health-affairs-journal, #health-insurance-and-managed-care, #medicaid, #medicare, #prices-fares-fees-and-rates, #teeth-and-dentistry, #united-states-politics-and-government

Social Security and Covid: Why Getting Help Won’t Be the Same

The pandemic abruptly closed the agency’s 1,200 offices, and officials are considering how to move forward. One issue: Without the offices, fewer low-income seniors sought benefits.

#consumer-protection, #content-type-service, #coronavirus-2019-ncov, #coronavirus-reopenings, #elderly, #health-insurance-and-managed-care, #medicare, #retirement, #shutdowns-institutional, #social-security-us, #social-security-administration, #weaver-david