In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
As the COVID-19 pandemic continues to impact society worldwide, the scientific community is racing to understand SARS-CoV-2, the novel coronavirus that causes the disease, and respond by developing diagnostic and therapeutic approaches to combat it. Among the most powerful tools being used is CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats), a gene-targeting and gene-editing technology based on the mechanism that bacteria naturally use to fight viruses.&nbsp;
CRISPR has enabled an efficient, precise and affordable way to manipulate and edit genomic DNA and RNA, completely unlocking a new frontier for biological engineering. Well before the COVID-19 pandemic, researchers had begun to use CRISPR to find new ways to cure diseases, including cancer, blindness and Alzheimer&rsquo;s disease; develop more sustainable methods for producing fuel; and improve food crops to better feed the growing global population.&nbsp;
In nature, CRISPR plays an important role in microbial immunity. By understanding the mechanism that bacteria naturally use to fight viruses, the research community and biopharma industry are now applying CRISPR-based genome engineering to the following potential solutions for COVID-19:
Rapid Diagnostic Tests
Scientists and companies are using CRISPR to detect the RNA of SARS-CoV-2 in patient samples, developing diagnostic tests that are more efficient than the standard polymerase chain reaction (PCR) diagnostic tests now in use for COVID-19 testing, which must be conducted in sophisticated centralized labs by trained technicians. Supplementing PCR tests with CRISPR-based approaches could broaden access to COVID-19 diagnostic testing, a key strategy for stopping the transmission of the virus. The availability of such testing will be critical as we transition out of a complete shelter-in-place mode.
Treatments
Understanding how a pathogen operates at the host-pathogen interface is critical to developing new treatments. To that end, researchers are using the genome-editing power of CRISPR to shed light on how SARS-CoV-2 interacts with the proteins in human cells and then generate appropriate cell models. As described in a recent <a href="https://www.nature.com/articles/s41586-020-2286-9">Nature</a> publication, these cell models could lead to faster discovery of a potential new treatment or an existing drug combination that could lead to a potential treatment. Furthering this approach, therapeutics developers are leveraging the <a href="https://pharmanewsintel.com/news/gsk-vir-use-crispr-artificial-intelligence-to-find-covid-19-cure">convergence of technologies</a> including CRISPR and artificial intelligence to rapidly advance discovery and development programs in innovative ways.
Vaccines
Researchers are utilizing CRISPR technology to develop a <a href="https://bioengineering.stanford.edu/new-genetic-method-using-crispr-eliminate-covid-19-virus-genomes-cells" data-saferedirecturl="https://www.google.com/url?q=https://bioengineering.stanford.edu/new-genetic-method-using-crispr-eliminate-covid-19-virus-genomes-cells&amp;source=gmail&amp;ust=1596829900842000&amp;usg=AFQjCNF6vl-jP7dlkFAfLmro3ZJs5dhvTg">genetic vaccine</a>. This approach involves using CRISPR to precisely target, cut and eliminate SARS-CoV-2 and its genome to stop the virus from infecting cells in the lung.&nbsp;
Collaboration as an engine to advance COVID-19 research&nbsp;
With SARS-CoV-2 transmission continuing on a global scale, it is more critical than ever that scientists have access to innovative tools that can enable rapid and accurate research. As an example, the team at Synthego, a genome engineering company that leverages machine learning, automation and gene editing to build platforms for science at scale, has been working hand-in-hand with the CDC, MIT&rsquo;s Broad Institute, UCSF and others in government, academia and industry to help accelerate research being conducted by scientists in the trenches.&nbsp;
Inspired by the work that our collaborators are pursuing, Synthego developed COVID-19 specific tools designed to help enhance the speed and effectiveness of the development of rapid diagnostics and treatments. These tools include bioinformatically designed custom Cas13 guide RNA collections that can be used for individual or multiple gene knockouts to develop diagnostics for SARS-CoV-2 and algorithmically-designed multi-arrayed CRISPR single-guide RNA (sgRNA) gene knockout libraries targeting 330 human genes that interact with SARS-CoV-2 proteins. These libraries can be used to investigate the molecular mechanisms of SARS-CoV-2 to identify drug combinations of enhanced efficacy, as described in this recent <a href="https://www.biorxiv.org/content/10.1101/2020.03.22.002386v3" data-saferedirecturl="https://www.google.com/url?q=https://www.biorxiv.org/content/10.1101/2020.03.22.002386v3&amp;source=gmail&amp;ust=1596829900842000&amp;usg=AFQjCNGuRRKWTyfXq80G_dBgqdPDrwAMbw">publication</a>. Additional contributions have been focused on supporting the development of critical reagents for novel CRISPR-based COVID-19 point-of-care diagnostics including the <a href="https://www.stopcovid.science/" data-saferedirecturl="https://www.google.com/url?q=https://www.stopcovid.science/&amp;source=gmail&amp;ust=1596829900842000&amp;usg=AFQjCNEEgTVKoe1q_JNHpq1b3cXB1d3R0g">STOPCovid protocol </a>and the <a href="https://sherlock.bio/sherlock-biosciences-receives-fda-emergency-use-authorization-for-crispr-sars-cov-2-rapid-diagnostic/" data-saferedirecturl="https://www.google.com/url?q=https://sherlock.bio/sherlock-biosciences-receives-fda-emergency-use-authorization-for-crispr-sars-cov-2-rapid-diagnostic/&amp;source=gmail&amp;ust=1596829900842000&amp;usg=AFQjCNGl8tas5aVeTi78x7td0fhACOmQrg">Sherlock&trade; CRISPR SARS-CoV-2 Rapid Diagnostic</a>, which received Emergency Use Authorization (EUA) from the FDA in May.&nbsp;
The unprecedented innovation taking place in the biopharma industry, academia and government in response to the COVID-19 pandemic today will provide a foundation for improving human health tomorrow. The current scientific efforts are representative of a paradigm-shifting movement in the life sciences &ndash; one in which the convergence of multiple technologies, the speed of information flow, and the rapid programmability and agility of technologies such as CRISPR will fundamentally change how research and development is approached and conducted. As society emerges from shelter-in-place orders, the scientific discoveries enabled by CRISPR-based genome engineering are poised to continue to drive innovation. Using the latest transformative tools, technologies and approaches, the scientific community is able to address both the challenges of today and those of the future.&nbsp;
<div></div>
<div>About Jason Steiner:</div>
<div>
Jason Steiner, Ph.D., Chief Strategy Officer at Synthego, leads the company's business strategy and partnerships efforts to enable academic institutions and biotech and pharmaceutical companies to leverage Synthego&rsquo;s gene engineering platform to accelerate the research, discovery, and development of next-generation therapeutics, including genetic and cellular therapies. Before Synthego, Steiner spent several years in the clinical genomics space commercializing liquid biopsy technologies in reproductive genetics and oncology at Natera.
He holds a doctoral degree in materials science engineering from the University of California, San Diego, where his research focused on the development of nanoparticle delivery systems for therapeutics and diagnostics in oncology.
</div>

The Role of CRISPR Technology in the Development of COVID-19 - Rapid Diagnostic Tests and Treatments

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates. 
HLTH Team: First off, can you both explain your partnership and what brings you two together today?
Megan Callahan: Thanks for having us, it&rsquo;s great to be with you. Let me start by giving you some background on what Lyft is doing in the healthcare space. Since 2016, we&rsquo;ve partnered with health systems, health plans and their transportation managers to ensure patients have access to reliable rides to their medical care. Every year, almost four million people miss a medical appointment due to a lack of transportation and these individuals are disproportionately poorer, older, people of color and people with chronic illnesses or disabilities.&nbsp;
Medicaid plans have traditionally relied on non-emergency medical transportation (NEMT) to address this problem. But traditional NEMT services have significant challenges, often requiring rides to be scheduled days in advance with wait times ranging anywhere from 60 minutes to three hours. Many forward-thinking health plans, like Amerigroup, are looking to rideshare as a more accessible and reliable alternative. We&rsquo;ve been working with Amerigroup Tennessee since August 2019 to improve access to care. I&rsquo;ll let Robert talk about why they decided to work with Lyft.
&nbsp;Robert Garnett: Thanks Megan. For us, this really started from a member quality and access standpoint. Prior to working with Lyft, missed or cancelled trips were the largest driver of member grievances and complaints. While we enjoy a great relationship with our NEMT provider, Tennessee Carriers, there are certain types of rides where additional capacity through on-demand transportation can make a huge difference in closing access gaps and improving overall NEMT quality. In working with TennCare, our state Medicaid agency, Tennessee Carriers and Lyft, Lyft has really helped close the transportation access gap. We&rsquo;ve seen that reflected in our data with a 90% decrease in transportation-related member grievances, a 50% increase in quality gap closures and a 44% increase in primary care physician (PCP) visits. That last metric is huge &mdash; Lyft has actually made it easier for our members to access primary care. Before, when someone wasn&rsquo;t feeling well and had to schedule a ride three days in advance, that delay in seeking care meant they may end up in an emergency room or urgent care as a result. We&rsquo;ve made it easier and faster for members to meet with their doctors and ultimately stay healthy.
We started with a 12-month pilot in Shelby County, the most populated Medicaid county in the state of Tennessee. Given early successes, we&rsquo;ve moved to quickly scale the Lyft pilot statewide.&nbsp;We&rsquo;ve really started to see some impressive developments and we are excited to launch this service statewide and see what we can do beyond Shelby County.&nbsp;
HLTH Team: Switching to the current pandemic, why is NEMT even more crucial now? What makes it particularly challenging under these circumstances?&nbsp;
Megan Callahan: The entire healthcare system has been under stress since March, but people still need access to essential health services. Whether it&rsquo;s dialysis, chemotherapy, or prenatal appointments, we&rsquo;ve postponed or delayed essential medical care for many individuals. This is particularly important for Medicaid members who often can&rsquo;t afford other forms of transportation on their own. The populations that we generally serve are vulnerable groups &mdash; chronically ill, immunocompromised or older adults that live independently. Traditional forms of transportation like public transit or multi-load shuttle vans can be dangerous given the lack of social distancing. Riding with Lyft can help limit exposure, at least until we get a vaccine or have more widespread testing and contact tracing. I think all of those reasons make NEMT particularly important right now, and Lyft as a part of the solution to ensure people can get to essential medical care.&nbsp;
&nbsp;Robert Garnett: Megan hit that very clearly. While we&rsquo;ve seen a huge shift towards telemedicine and have expanded reimbursement policy at the state level to cover that, there are certain services that require in-person visits. If you think about dialysis services, for example, it&rsquo;s not really something that you can do remotely beyond the initial consultation. We recognize that for many individuals, it&rsquo;s simply not possible to stay home and miss their medical appointments. It&rsquo;s been extremely helpful for us during COVID-19 to have those Lyft rides as a safer form of transportation for members.&nbsp;
HLTH Team: Do you see patients delaying routine care visits due to fear of contracting the virus during transit? How are you easing those fears?
Megan Callahan: Our hypothesis is that many folks are delaying care, particularly if they&rsquo;re in a vulnerable population or fear going into a healthcare facility. There was a fascinating survey recently from Kaiser Family Foundation, which showed that 53% of those with poor health or a chronic condition have put off medical care in the last three months. Rob, would you agree with that?
Robert Garnett: We&rsquo;ve seen a ton of data on this. Folks are still going in for services they deem critical, but if there&rsquo;s an option to forgo an elective procedure, many states and federal entities have advised to do so or shift to a digital setting. Many individuals still don&rsquo;t feel comfortable accessing care.
At Amerigroup, we&rsquo;ve conducted a member outreach and check-in program, where we have case managers reach out to our most vulnerable members. We&rsquo;ve used predictive analytics to identify about 17,000 members and our associates make calls to check-in on them and ensure they have access to necessary community resources. There was a lot of fear expressed by these members about using mass transit or a traditional van ride. So, we certainly know there&rsquo;s a preference to have a safer transportation option for going to and from the doctor&rsquo;s office when that&rsquo;s necessary.&nbsp;
HLTH Team: I imagine you easing those fears by directing a lot of patients to Lyft. On the Lyft side, how have you been ensuring the cleanliness and safety for both your riders and your drivers during this time?
Megan Callahan: That&rsquo;s been a huge conversation and big undertaking for Lyft, not just on the healthcare side but for our general rider population. We view ensuring the health and safety of our communities, both our drivers and our riders, as a top priority. We&rsquo;ve been anchored to the CDC guidelines and launched a health and safety program on June 1st that requires riders and drivers to do five things. First, both must wear face masks in the vehicle. Second, they have to certify that they do not have COVID-19 or any related symptoms. Third, sit only in the back seat. Fourth, keep the windows rolled down. Last, have drivers sanitize the vehicle.
Last week, we also announced we&rsquo;ll be making partitions available to all drivers in the coming months. By the end of July, we will have made tens of thousands of partitions available to U.S. drivers for free, aiming to cover more than 50% of rides in select markets. And later this summer, partitions will be available for all drivers to purchase through our new online storefront designed to give drivers easy and affordable access to PPE, cleaning supplies and face masks.
We think that those steps are necessary to ensure cleanliness and safety, and of course with appropriate social distancing by having people sit in the back seat, we believe that helps us get patients safely to their appointments. I&rsquo;d like to commend our healthcare partners &mdash; their role in rolling out our health safety program is not insignificant. We have to instruct every patient and member that they must wear a face covering before they get into the vehicle. There has been a lot of collaboration across all of our partners to make that happen.&nbsp;
HLTH Team: Have state regulatory barriers eased or changed during the pandemic to further provide NEMT options to patients?&nbsp;
Megan Callahan: I can speak to the Medicaid side. At the start of this pandemic, states began to recognize that incorporating Lyft into their NEMT programs was very important for members. Since March, we&rsquo;ve worked with four new Medicaid agencies and our partners in Florida, Illinois, South Carolina and Indiana to add rideshare into NEMT. For context, in early 2019 rideshare was not formally a part of any Medicaid NEMT program. Altogether, we&rsquo;re now in 14 states plus the District of Columbia and are supporting up to 29 million people every year get to and from their medical appointments. That&rsquo;s a huge shift in a relatively short period of time. I&rsquo;m really proud of the Lyft team that has shouldered our market entry and made Lyft a viable option for millions of Medicaid members across the country.&nbsp;
Robert Garnett: When COVID-19 really picked up, I can&rsquo;t tell you how thankful and happy we were to work closely with TennCare, our state Medicaid agency, which was essential in turning rideshare into a reality within Tennessee. We really have a great state partner that was willing to work with us, with Lyft and with our transportation vendor to facilitate a pilot. It made us far more prepared when COVID-19 really started to take hold because of the issues that arose. We were having 2-3 hour daily touchpoints with TennCare and it was reassuring to know we had this additional capability to leverage Lyft to supplement our existing NEMT services, particularly in light of social distancing protocols. That is directly attributed to the fact that we had the additional capabilities from Lyft and a highly engaged and innovative state partner in TennCare.
HLTH Team: Do you expect these regulatory changes to remain even after the pandemic? Also, has this crisis highlighted flaws in the current regulatory structure?
Megan Callahan: I do think that they will stick. I think the value proposition that Robert just pointed out is very strong. The new states that we&rsquo;ve worked with have created permanent ability to use rideshare, or are actively working on creating permanent pathways. In general, a lot of these Medicaid regulations are a sign of the times in which they were written, often quite some time ago. We spend a lot of our time talking to agencies about how to modernize their NEMT programs. At the times that these regulations were written, they did not contemplate rideshare models where you didn&rsquo;t own the car and a driver wasn&rsquo;t an employee. Everything is predicated on older business models.&nbsp;
Just to give you a concrete example, some states require drivers to write down the odometer number at the beginning and end of the ride. Obviously, with technology today and certainly with the real-time of tracking and transparency that Lyft brings to the table, we don't have to do that anymore. We can tell you exactly how much time a driver took and if it was the optimal route. That&rsquo;s a huge value-add for Medicaid with respect to decreasing fraud, waste and abuse. We&rsquo;re in the midst of an extraordinary opportunity to modernize transportation in a way that not only improves the member experience, but also can decrease overall costs for Medicaid programs, which I think is really important.&nbsp;
HLTH Team: Are you seeing a major shift to in-home care? How are you supporting this shift through any new programs or partnerships?&nbsp;
Robert Garnett: When you refer to at-home care, which includes telemedicine, absolutely. I&rsquo;ve been a big proponent of telemedicine for a long time and it&rsquo;s had a big &ldquo;coming soon&rdquo; sign for the last ten years. There has been a lot of excitement and energy about it for quite some time. I think it&rsquo;s safe to say that it has taken off more in these past two months then it has in the past few years. It&rsquo;s absolutely here to stay, but I think how much will depend on state regulatory environments, similar to your last question on NEMT. How states adapt to the consumer is important &mdash; it&rsquo;s a first for many members. But now that you have consumer demand for it given the current pandemic, it&rsquo;s really pushing telemedicine to the forefront.
Megan Callahan: From a Lyft prospective, we&rsquo;re very supportive of digital-first models and I would echo everything that Robert said about telemedicine. What&rsquo;s interesting for us is how much COVID-19 accelerated not only telemedicine but delivery services for vulnerable populations in their homes. The amount of interest we&rsquo;ve received from payers and providers about how Lyft could support their members and patients was overwhelming.&nbsp;
Amerigroup was one of those partners and we quickly accelerated our delivery work, which was on our product road map for this year but we moved it up to meet the moment. Now, for example, we&rsquo;re working with Second Harvest Food Bank in Tennessee and Amerigroup to deliver food to those who face food insecurity. We&rsquo;re very proud of that program. Consider all of the other ways that Lyft can bring an on-demand network to deliver food, prescriptions and other essential items. We&rsquo;re supporting the at-home experience and believe it&rsquo;s here to stay.&nbsp;
HLTH Team: Wonderful! For both of you, any last thoughts &mdash; reflecting on the past few months or just overall hope you have for the future?
Megan Callahan: You know, I think that COVID-19 has been the great revealer in exposing the many challenges in the American healthcare system, and it has also been the great accelerator. Between emergency easing of regulations, ingenuity in the marketplace and flat-out need to help people, I think you saw the healthcare industry lay the groundwork for executing ideas that have been around for some time. I think we&rsquo;re going to have an interesting time coming into 2021. We&rsquo;ll all be challenged to keep up with the pace of change and figure out how we can get to the future faster.&nbsp;
Robert Garnett: I think the term Megan used, acceleration, I absolutely agree with. We&rsquo;re in conversations at the state level around the social determinants of health (SDOH), where we are looking at member assessments and other key metrics. To even think about having a conversation about paper-based assessment, for example, seems almost foreign since everything now has really shifted to digital-first.&nbsp;
I would also highlight the program Megan mentioned around food as another example. We heard from our members about food insecurity and quickly implemented a program with Lyft to ensure their needs were being met. It was odd to think that if they were using Lyft in their personal life, they would accept using a mode of&nbsp; transportation in their &ldquo;healthcare life&rdquo; that isn&rsquo;t as convenient or flexible. There was a contrast to how consumers were receiving services in their personal lives versus healthcare. We&rsquo;ve had to bridge that gap over the course of the current pandemic, and we&rsquo;re very proud of what we&rsquo;ve accomplished for Tennessee&rsquo;s Medicaid members.

About Megan Callahan:
Megan Callahan is VP of Healthcare at Lyft Business, which works with thousand of organizations to move people they care about &mdash; from employees and customers, to patients, travelers, and more. Together, we design transportation experiences and programs that make the ride matter. Megan oversees the strategy and operations of Lyft Business&rsquo; thriving healthcare business.
Before joining Lyft in 2017, Megan served as Chief Strategy Officer and member of the Executive Leadership team at Change Healthcare. She was a primary architect of the merger that created Change Healthcare, during her tenure as senior vice president of corporate strategy and business development for McKesson Technology Solutions. Megan has an Masters of Public Health from UCLA and volunteers at the San Francisco Homeless Prenatal Program.

About Robert Garnett:
Robert Garnett serves as President, Amerigroup Tennessee, which is part of the Medicaid Central Region and Government Business Division at Anthem, Inc. As President, he is responsible for the strategic, fiscal, regulatory, and operational leadership of the health plan. In his role, he is also responsible for building and managing state and local relationships and fostering new growth and strategic opportunities within Tennessee&rsquo;s TennCare Medicaid program. Amerigroup Tennessee provides Medicaid managed care services for approximately 400,000 members as a part of the TennCare program for the state of Tennessee, which includes TANF, LTSS, ABD/SSI and ECF (IDD) services. Prior to his promotion to President in 2018, Mr. Garnett served as the Chief Operating Officer and previously the Director of Medicaid State Operations, leading all day to day health plan operations and execution, customer service, quality management, and regulatory oversight from 2014 to 2018. Prior to joining Amerigroup Tennessee, he served in a similar operational leadership capacity for Amerigroup Georgia from 2011 to 2014. In addition to these roles, Mr. Garnett supported South Region Medicaid with business development &amp; implementation, and strategic operational strategy. Prior to his roles supporting Medicaid in the Central and South Regions, Mr. Garnett participated in Amerigroup Corporation&rsquo;s Executive Leadership Development Program (LDP) and served in multiple Business Analysis roles supporting IT and Enrollment services.

The Importance of Rideshare During COVID-19 

HLTH Content Director, Jody Tropeano interviews Manisha Gulati, Chief Operating Officer,&nbsp;Clarify Health and Bhash Parasuraman, Vice President and BU Lead, Rare Disease Patient &amp; Health Impact,&nbsp;Pfizer . They&nbsp;both recently presented on a HLTH GoLIVE series webinar called &ldquo;Rearchitecting the drug launch model.&rdquo; The discussion zeroed in on the incentives of regulators, payers, providers, and patients, which are often at odds with each other when it comes to drug launches.

Rearchitecting the Drug Launch Model

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
About Trevor Martin:
Dr. Trevor Martin, Co-founder and CEO of Mammoth Biosciences, is leading the company with the mission to democratize access to CRISPR and affordable and effective diagnostics that enable individuals to better understand their health. To make his vision a reality, Trevor partnered with CRISPR discoverer and pioneer, Jennifer Doudna, and her two recent Ph.D. researchers, Janice Chen and Lucas Harrington along with fellow Stanford Ph.D., Ashley Tehranchi. Since its founding, the team has built the world&rsquo;s next generation CRISPR platform and the world&rsquo;s first CRISPR-based diagnostics platform capable of detecting any biomarker or disease with DNA/RNA. To do so, Mammoth has raised $23M from lead investor Mayfield and other influential institutional and angel investors including Tim Cook, Brook Byers, Bob Nelsen, and Jeff Huber.
Trevor kicked off his career in science at Princeton, where as an undergraduate student in Molecular Biology, he began his research career in the university&rsquo;s Storey Lab. In his time there, he conducted independent research in quantitative biology and was ultimately awarded the top honor for his senior thesis in molecular biology. After Princeton, Trevor went on to complete his Ph.D. in Biology at Stanford University, combining techniques from statistics and genetics and developing methods around mapping the determinants of quantitative traits in both humans and microbes. In addition to having taught multiple courses in statistics at Stanford, Trevor has penned educational guides for university courses across the globe. His work has been featured in outlets like FiveThirtyEight and The Atlantic, and he has been featured on Forbes&rsquo; 30 Under 30 list in 2018.

COVID-19 Discussion with Trevor Martin

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
About&nbsp;Richard Saynor:&nbsp;
Richard Saynor is Chief Executive Officer (CEO) for Sandoz, a global leader in generic and biosimilar medicines. Mr. Saynor has more than 20 years of pharmaceutical leadership experience in branded and generic medicines across established and emerging markets. He leads with the purpose to pioneer access for patients, and is committed to developing and commercializing high quality, affordable medicines that address unmet medical need.&nbsp;&nbsp;&nbsp;
Richard Saynor joined Novartis from GlaxoSmithKline (GSK) Pte. Ltd., where he spent nine years in a variety of leadership roles across therapeutic areas and geographies. He most recently served as senior vice president of classic and established products as well as commercial and digital platforms. He was responsible for &pound;10bn of post-patent products covering a number therapy areas (respiratory, allergy, urology, anti-infectives, CNS). Previously he held the roles of senior vice president and global head of established products and senior vice president of classic brands and generics for Europe, Japan, and the emerging markets and Asia-Pacific (EMAP) region. Prior to that, Richard Saynor held commercial operations leadership roles at Sandoz, serving as Region Head of Asian Markets, and as Region Head of Asia-Pacific, Latin America, Canada and Turkey.&nbsp;
Richard Saynor earned his Bachelor of Pharmacy from the University of Bradford in the United Kingdom. He is a member of the Royal Pharmaceutical Society in the UK, and served on the board of GSK India from 2018 to 2019. However, he will tell you that his most important role is that of husband and dad.&nbsp;

COVID-19 Discussion with Richard Saynor

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
Over the last few weeks, countries including Japan, New Zealand and some in the EU <a href="https://www.nytimes.com/2020/06/12/travel/reopening-europe-caribbean-virus.html">have begun to reopen</a> after months-long battles with COVID-19. Guided by data, bars, restaurants, and even sports stadiums are <a href="https://hosted.ap.org/kernradio/article/d47ede495574d8096e73074bcc16cc40/fans-savor-return-stadium-sport-virus-free-new-zealand">refilling with patrons</a>. The United States too, is beginning to reopen, but unfortunately, the approach here in America is being largely guided by optimism more than evidence.&nbsp;
Far from a successful elimination of the virus, like <a href="https://www.nytimes.com/2020/06/08/world/australia/new-zealand-coronavirus-ardern.html">New Zealand</a>, more than 20 states have seen <a href="https://www.washingtonpost.com/nation/2020/06/13/coronavirus-live-updates-us/">increases in their average daily new coronavirus cases</a> compared to previous weeks. Some states, including Arizona, Arkansas, North Carolina, Texas and Utah, continue to reopen despite seeing <a href="https://www.reuters.com/article/us-health-coronavirus-usa/record-spikes-in-new-coronavirus-cases-hospitalizations-sweep-parts-of-u-s-idUSKBN23L0JB">record numbers of hospitalizations</a>.&nbsp;
Private organizations cannot wait or rely on a coordinated, national response to COVID-19. More than 120,000 Americans have lost their lives, yet there is still no coordinated national testing program. Regardless, cities and states across the country are feeling the pressure to reopen, despite health risks, as double-digit unemployment rates continue to threaten a new recession. Economic concerns have taken priority over health concerns, but it&rsquo;s not a tradeoff we need to make. To start, we need widespread testing, and that&rsquo;s a huge opportunity for employers.&nbsp;
In carefully balancing the needs and appropriate level of risk for their business and their people, employers can help facilitate widespread testing in order to move America closer to where we need to be. Testing is a critical piece that can&rsquo;t be overlooked. Our own data and <a href="https://osf.io/s23tx/">protocols for testing</a>, created in collaboration with researchers from major universities, shows that the chances of missing a COVID+ employee with basic measures such as temperature checking is <a href="https://www.statnews.com/2020/06/02/optimism-not-evidence-driving-americas-return-to-work-strategy/">greater than 86%</a>. With PCR testing, that number drops to as low as 2%. By confirming that workers are not infected with COVID-19, employers can effectively reduce health risks in their workplace and communities.&nbsp;
When workers are healthy, <a href="https://www.wsj.com/articles/healthy-workers-are-more-productive-study-finds-1502219651">they are more productive</a>. It&rsquo;s an obvious, but crucial link as employers have a direct economic incentive to ensure the health of their employees even in the best of times. During a global pandemic, in which a coordinated government response has fallen flat, employers can take a leading role in testing their workforce. The impact of workplace illness is amplified since it may prompt an employer to shut down their workplace to curb spread. Along with the economic benefits, companies also have moral and social obligations to the communities in which they serve.&nbsp;
Fortunately, employers have led throughout this crisis. In the crucial days before state governments issued stay-at-home orders, countless businesses across the country began implementing their own responses; adopting remote work policies and deploying safety and sanitation processes for essential workers who couldn&rsquo;t work remotely. This leadership likely saved countless lives by helping slow the transmission of COVID-19.
Companies can continue to lead by adopting proper methods. With broad testing for COVID-19 among workforces, businesses can make it clear who is safe to return to work, especially when <a href="https://www.acpjournals.org/doi/10.7326/M20-3012">40 percent or more of transmissions are spread asymptomatically</a>.&nbsp;
Of course, employer-led testing programs are not one-size-fits-all. A tech company with the infrastructure to support remote work will have different needs than a manufacturing plant or a university. Hesitation to implement testing and compliance programs is understandable, but the sooner employers begin preparing for, and implementing, appropriate return-to-work testing plans, the faster they can safely get people back to work and help slow the nationwide economic skid.&nbsp;
At Collective Health, we&rsquo;re building on seven years of experience administering health plans and population health programs to help support this effort with Collective Go: a comprehensive and adaptive solution to help reduce risk and facilitate safer workplace reentry. Collective Go uses a dynamic protocol to provide organizations with a product and a series of measures supporting testing, workplace safety guidance, screening, and risk assessment.
We&rsquo;ve been encouraged by the initiative we&rsquo;ve seen employers take across the country to do their part in helping combat COVID-19. However, it&rsquo;s imperative that employers continue to follow the latest epidemiological data in crafting their plans. Absent a widely distributed vaccine, employees will need ongoing testing as they are continuously exposed to new potential carriers. Evidence-based approaches, like the one we&rsquo;ve created with Collective Go, are key to meaningfully reducing the risk of COVID-19 in workplaces and in our communities.
While we&rsquo;ve seen progress in our collective fight against COVID-19, the virus remains active and in some areas of the country, more so than ever. Until we&rsquo;ve truly eradicated the virus, the country and its businesses will need to adapt to this new reality. Employer-led testing programs will be key to doing so in a safe, responsible, and productive manner.&nbsp;

About Dr. Rajaie Batniji:
Dr. Batniji uses his background as both a physician and political economist to create a better, data-driven, and more efficient health insurance experience. He provides direction on Collective Health&rsquo;s partnerships with healthcare providers and networks and oversees Collective Health&rsquo;s analytics teams, and employee health management programs.He received his doctorate in International Relations (Political Economy) from Oxford University, an MD from UCSF, and BA and MA degrees from Stanford University.

Employers Can Lead For a Safe Reopening

The management of chronic conditions, such as diabetes, asthma and congestive heart failure, have long required judicious oversight and management from a savvy healthcare provider, along with - in many cases - daily actions on the part of the patient, to execute the evidence and guideline-driven instructions of their healthcare providers to remain in the &ldquo;safe zone.&rdquo;&nbsp; Provided the trust behind this arrangement is maintained, there&rsquo;s the usual cadence of physician office visits - say 3-4 times per year - when the physician-patient team can check in on progress and make any required course corrections.&nbsp; And in more dire situations, or in ones where new variables may be introduced (e.g., the initiation of insulin for a patient who is naive to the drug and to injections as a whole), that frequency of interaction between the patient and provider may increase in order to maintain a safe health trajectory.
COVID-19 has turned this paradigm on its head.&nbsp; For months now, patients cannot see their healthcare providers in the usual manner, as offices may have been either closed or imposed restrictions for emergency visits only.&nbsp; In some counties in the US and in some countries globally, this persists today.&nbsp; And that&rsquo;s not all.&nbsp; COVID-19, apart from its immediate impact on the continuity of care in chronic condition management, has further uncovered underlying and systemic problems in healthcare.&nbsp; As mentioned, the patient-provider cadence of meetings has been interrupted. While telemedicine services can help to address this issue, COVID-19 has further uncovered societal disparities in the basics required for telehealth to even work.&nbsp; Access to reliable high-speed internet, smartphone use and provider practices equipped with telehealth technology are barriers for telehealth in underserved communities.&nbsp; Security and privacy are risks with the rapid introduction to telehealth. When the first wave of tele-consults due to COVID-19 constraints manifested, many shifted to and adopted tools. Adding to the complexity, , some of these tools faced significant challenges as it related to ensuring privacy and security. &nbsp; So while the healthcare community was scrambling to deal with the new impositions of COVID-19, many &ldquo;holes in the bucket&rdquo; were discovered.
The truth is no one has ever experienced anything like this, and certainly not since the pandemic in the early 20th century.&nbsp; It could take well over a year to develop a vaccine, and even though Dr. Anthony Fauci - the respected and renowned Director of the NIH National Institute of Allergy and Infectious Diseases and arguably, one of the world's top 5 virus pandemic experts - recently expressed cautious optimism about a vaccine by the end of the year, is that the only solution? Do we sit still in the interim?
Enter stage left -&nbsp; Innovation.&nbsp; There is an incredible opportunity for innovation to unlock alternate strategies to help cope with these impositions of COVID-19 on chronic conditions and that too, well beyond our pandemic has subsided. We are beginning to witness this &nbsp;through telehealth and the increase in virtual care. On March 27, 2020, the Coronavirus Aid, Relief and Economic Security (CARES) Act was enacted into law. Amongst other things, the bill provided a further expansion of telehealth services. <a href="https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/telehealth-a-quarter-trillion-dollar-post-covid-19-reality">McKinsey recently surveyed consumers</a> and unearthed that 11% of US consumers used telehealth in 2019 versus a whopping 46% who are using telehealth today due to COVID-19 altering healthcare visits and breaking that continuity of care. This&nbsp; can only help so much until it faces the foundational constraints we&rsquo;ve already mentioned.&nbsp; How do we take this a step further?&nbsp; What else can be done with digital technology and more importantly, the data it generates therein.
First, some somber statistics about how dire the risk is for those who suffer from chronic conditions in the midst of COVID-19. According to <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6924e2.htm?s_cid=mm6924e2_w">CDC case surveillance in the US</a>, people with chronic conditions are 6 times more likely to be hospitalized and 12 times more likely to die from COVID-19. Diabetes is one of the most common underlying health conditions accounting for 30% of cases.&nbsp; That&rsquo;s nearly three times the normal incidence of Type 2 diabetes in the US! <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144611/">What experts now believe</a> is chronic inflammation, immune response impairment, and potential direct pancreatic damage is the association between COVID-19 and diabetes. The <a href="https://www.medscape.com/viewarticle/931470">most recent study published </a>examines specific characteristics before and at the time of hospital admission, which predict worse outcomes among people with diabetes.&nbsp; One of the key conclusions:&nbsp; BMI is a major risk factor. This research determined one in ten people with diabetes hospitalized for COVID-19 die within a week. Thus, chronic conditions must be a part of this conversation and we must move beyond just telemedicine in order to address the problem.
The advent of digital health and digital therapeutics - those digital health solutions that generally meet a higher level of rigor associated with evidence, claims, randomized control studies, FDA clearance, cybersecurity certification and clinical workflow integration - has been accelerated by evidence-driven health apps, wearable technology, and advanced sensors.&nbsp; These digital health solutions are already impacting chronic disease management in ways that both traditional care and telemedicine cannot solve alone.&nbsp; Add to that advanced, artificial intelligence and machine learning techniques that can be used to turn patient-generated health data from those who suffer from chronic conditions into behavior patterns which inturn, can aid in the response to their condition amidst this unprecedented pandemic.
Digital health solutions can analyze patterns in heart rate, blood pressure, blood glucose, physical activity, weight, sleep, medication adherence, diet, age, gender, you name it.&nbsp; This data can be both self-entered, and also brought-in via a series of technology-enabled (e.g., BLE, NFC, etc.) protocols, to take out the &ldquo;adoption and engagement friction&rdquo; associated with manual data entry. &nbsp; In one quick move, digital health improves what we refer to as the four &ldquo;V&rsquo;s&rdquo; of data:&nbsp; Variety, Velocity, Volume, and Veracity.&nbsp; The variety is the data patterns mentioned above.&nbsp; The velocity is near-real time, and the volume therefore is high. &nbsp; With trusted sensor integration, or even integrations with labs and EMRs, the veracity of the data is increased.&nbsp; All of these contribute to perhaps the most important &ldquo;V&rdquo; - the fifth one:&nbsp; Value.
So what can we do with this data?&nbsp; We can run primary analysis, to address basics like &ldquo;what&rsquo;s the pattern for a male vs. a female, younger vs. older, tech-savvy vs. non-tech savvy person, etc.&nbsp; That primary analysis is facilitated by tools such as Tableau, Microsoft Power BI, R and others, where data vectors can be input, cleansed (according to data governance best-practices) and then plotted to inform on &ldquo;patterns of interest.&rdquo;&nbsp; These patterns can be a good event (such as a patient remembering to take their medication) or a bad event (such as a low blood sugar value for a diabetic or rapid weight gain for a patient with the onset of CHF).&nbsp; Then, add to this the more advanced statistical pattern recognition techniques of clustering (as an example, K-nearest neighbor (K-NN)), or discriminant functions (as an example, linear discriminant functions) whereby the data isn&rsquo;t just answering &ldquo;what&rdquo; event happened, but more importantly, &ldquo;why&rdquo; it happened.&nbsp; Once a pattern is discovered, probabilistic and predictive models can then be used to understand &ldquo;when&rdquo; such an event may occur again.&nbsp; There are predictive models - the likes of Gaussian, Bayesian, Markov and others - that can be used to predict the trajectory of a patient.&nbsp; And finally, these data then fuel adaptive models, which apply machine learning algorithms to &ldquo;fine-tune&rdquo; and adapt the model to track, trace and predict a patient&rsquo;s pathway based on the data they are entering.&nbsp; The output of such analysis can inform providers to then apply their clinical training to guide the patient to the best therapy pathway.&nbsp; Without the data and advanced algorithms, the provider will have little to go on, but their ability to optimize the treatment pathway for the patient is illuminated by data and analytics.
Welldoc has used such techniques to predict the onset of hypoglycemia, develop models that isolate feature usage within the digital health solution that are predictive of a successful pathway, and continued persistence of engagement to ensure the patient remains in the &ldquo;safe zone.&rdquo;&nbsp; All of this while not being able to physically or virtually &ldquo;see&rdquo; their healthcare provider.
What we learned through our research is early identification of individuals at risk of either succeeding or failing with a specific therapeutic pathway.&nbsp; Leveraging data and advanced analytics associated with digital health can therefore increase the efficacy of telehealth services to be more patient and condition-specific.
We can apply these methods to COVID-19 too and learn clues from patients who are suffering to better inform our response. What are good and bad symptoms that impact the onset or recovery? It&rsquo;s important to note that this can be very individualistic. Hypothetically, we may discover that an unrelated medication mitigates progression for many patients, but the taking of certain actions can have a completely different effect for two different individuals.&nbsp;
The bottom line is digital health solutions offer hope and can help us address this conundrum when a doctor&rsquo;s office is empty and patients can&rsquo;t leave their homes. Remote capture of real-time data coupled with predictive analytics are key during this pandemic and beyond.
The capability exists to remotely monitor critical health conditions, predict future outcomes and utilize data analytics to help drive the course of patient actions to a more healthy future.&nbsp;

Role of AI and Machine Learning in Chronic Disease Management During COVID-19

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.

About Stacy Lindau, MD:
Dr. Stacy Lindau, MD, MAPP, is NowPow&rsquo;s founder and Chief Innovation Officer, a practicing physician and tenured professor at the University of Chicago. She is an experienced principal investigator with 15 years of continuous funding from federal sources, including the National Institutes of Health (NIH), the Center for Medicare and Medicaid Innovation and the Agency for Healthcare Research and Quality. Her scientific work is published in the highest impact medical literature and she is internationally known as an expert in women&rsquo;s and population health across the life course. Stacy earned her medical degree from Brown University and a master&rsquo;s degree in public policy from the University of Chicago where she was a Harris Child and Family Fellow. She was a Robert Wood Johnson Foundation Clinical Scholar (and served on the National Advisory Committee) and is an Aspen Institute Health Innovation Fellow and serves the Health Innovators Fellowship Board of Overseers. She has a BA from the University of Michigan Honors College in secondary education and political science and worked in broadcast journalism at Dow Jones and Company&rsquo;s Wall Street Journal TV. Dr. Lindau is also president of MAPSCorps, a nonprofit community asset mapping organization that has employed more than 2,000 youth in 6 urban and rural geographies.

COVID-19 Discussion with NowPow

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
Healthcare Must Adapt and Embrace Digital Health to Survive
The COVID-19 pandemic has had a tremendous impact in the United States and around the globe. It has taken too many lives and disrupted too many more, including by postponing or preventing medical treatment. The fragility it has exposed in our healthcare system must be addressed in order to restore public confidence. In some ways we have started already. In a matter of weeks, we&rsquo;ve seen a decade&rsquo;s worth of growth in the adoption of telehealth and other digital health tools, as hospitals and clinics scramble to keep serving patients. Blue Cross Blue Shield of Massachusetts reported recently that the number of telehealth claims it received per day went from about 200 in February to more than 38,000 in May. In some cases the rapid adoption of virtual care was made possible by leveraging previous investments in then underutilized telehealth platforms. However, much of the recent mobilization occurred through general consumer/business video platforms such as FaceTime and Zoom, the use of which was liberated by the temporary relaxation of outdated regulations.
For this recent shift to make a permanent impact, however, and truly improve the lives of patients, we need to think and communicate clearly about how these technologies can be used effectively in a post-COVID world. I see three essential ways that digital health technologies will have to adapt in order to continue providing real benefits to providers and patients.
Serve the Neediest
Telehealth has been widely adopted during the pandemic for the simple reason that it allows doctors and patients to consult without the risk of infection. It has also allowed physicians to reach underserved communities, many of whom are at greater risk for COVID-19 complications, and manage milder cases of the virus remotely, freeing up hospital beds for the sickest patients.&nbsp;
But when the pandemic has ended, those applications will abate as well. When they do, digital health technology risks becoming little more than a convenience for those who could visit a provider&rsquo;s office but prefer not to. Telehealth offers much more value to people who have great difficulty reaching a doctor&rsquo;s office because of disability, advanced age, remoteness or some other significant obstacle. At the same time, it is these very populations that are often limited in their ability to access and navigate modern smartphones, computers, and connected devices. Extending these technologies to the populations that need them most should become our paramount goal, achieved not just through the design of appropriate software and hardware, but through empathetic support services which can bridge this divide and address health disparities.&nbsp;
Emphasize the Benefits to Quality of Care
Similarly, we need to more fully communicate the vast functional value of telehealth. During the pandemic, its simplest expression &ndash; enabling people in remote locations to see each other and converse in real time &ndash; has been tremendously valuable. But if we are to make continued progress, we need to convince providers and patients that telehealth is much more than conducting medical appointments by videoconference.
Technologies like remote patient monitoring, tracking apps and algorithms that make sense of longitudinal patient data can do much to increase the quality and effectiveness of healthcare. Many of these applications have been employed ingeniously during recent weeks out of necessity. For example, during Italy&rsquo;s initial COVID outbreak, Roche created an app in collaboration with a startup, clinicians and patient advocacy groups to monitor patients remotely and set up virtual doctor&rsquo;s visits at a time when hospitals and clinics were overwhelmed. Others have developed chat bot assessments, self-monitoring tools and analytics tools to support COVID patients and manage demand for services. A paper published online May 5 in Diabetes Technology &amp; Therapeutics described how two patients with type 1 diabetes, one newly diagnosed, were successfully treated at home for diabetic ketoacidosis during the pandemic thanks to the availability of continuous glucose monitoring systems. These tools have value far beyond COVID, but for it to be widely realized the healthcare system will have to recognize the full potential of digital health.
Protect Patients and Their Data
We must also remember that the digital health experiments of recent weeks required loosening regulations and reimbursement policies. Medicare coverage has been expanded for telehealth services, HIPAA rules have been suspended for communication by phone and videoconference and restrictions on practicing medicine across state lines have been loosened to make remote care more feasible.
Some of these regulations may have been unnecessary in the first place, but not all of these rollbacks should remain in place after the crisis has passed. We need good regulations for digital health that make sense during normal times as well as crisis, allow the introduction of new digital biomarkers and therapeutics into a trusted system for validation, and enable the transmission and use of patient data while maintaining privacy and security. Data is the lifeblood of modern medicine, and managing it responsibly is of utmost importance.&nbsp;
The overnight explosion in the adoption of digital health tools due to COVID is a welcome silver lining to what has been a difficult and tragic few months for healthcare. The pandemic has exposed many weaknesses, among them our inability to collect, analyze, and act on data as quickly and effectively as we should. We can and must do better, and one way to make progress is to move digital healthcare forward with the needs of patients in mind.
It seems likely that the vast majority of people who have ever visited a doctor remotely did so for the first time in the last few weeks. This is a rare chance to transform that brief introduction into a long-term relationship. If we do not think carefully today about how to use digital tools effectively and communicate their value in a post-COVID world, we risk losing the momentum this unique historical moment has provided us.
For more information on digital health, click <a href="https://www.roche.com/about/business/diagnostics/value-of-digital-health.htm">here</a>.
*********************************************************************

Pravene Nath - Global Head of Digital Health Strategy, Personalized Healthcare&nbsp;
Pravene is responsible to launch digital health products and ensure strong acceptance and adoption by healthcare systems (including physicians, hospitals, payers, and patients) - and ultimately deliver the full potential of these digital tools to patients.
Prior to Roche, Pravene worked at Mindstrong Health, where as the Chief Product Officer and SVP of solutions and healthcare operations, he was in charge of building teams to launch Mindstrong's digital biomarker, patient engagement, telehealth, and care management products. He also oversaw the build-up of Mindstrong's inside sales team, customer support operations, and payor/provider implementation teams. Before that, Pravene was the CIO and CDO for Stanford Health Care and Stanford University School of Medicine, where he oversaw 600 employees and a $200 million operating budget deployed across digital health strategy, healthcare analytics, enterprise information technology, product development, and physician and nursing informatics. While there, he led the efforts to develop and launch the Stanford MyHealth mobile apps that reached 320,000 subscribers within 3 years.&nbsp; He received Becker's Healthcare's CIO Leadership Award and Stanford was designated by US News as the Most Connected Hospital.&nbsp; Prior to his time at Stanford, Pravene was the Chief Medical Information Officer for NYU Medical Center in New York, where he oversaw all enterprise EHR and physician/nurse informatics programs.

COVID-19 Updates with Pravene Nath

To the HLTH Community,&nbsp;
In our last communication to the HLTH community, we stated that during this period of dynamic change, you can depend on us, to be honest, responsive and transparent. Our top priority is to ensure the safety of our attendees and uphold the values of the health community that we serve. &nbsp; After critical and thoughtful consideration, and with the support and guidance from our <a href="https://www.hlth.com/hlth-matters/blog/An-Update-from-the-CEO-of-HLTH" title="Advisory Committee" target="_blank" data-saferedirecturl="https://www.google.com/url?q=https://www.hlth.com/hlth-matters/blog/An-Update-from-the-CEO-of-HLTH&amp;source=gmail&amp;ust=1592585872477000&amp;usg=AFQjCNGWasL7eUocycdlQwkj0TlT0FqjdA" rel="noopener">Advisory Committee</a>, we have made the decision to transition HLTH 2020 to an entirely virtual event. <a href="https://www.hlth.com/virtual" title="HLTH VRTL 2020" target="_blank" data-saferedirecturl="https://www.google.com/url?q=https://www.hlth.com/virtual&amp;source=gmail&amp;ust=1592585872477000&amp;usg=AFQjCNF5rt-FRKdzCzNsu5_AVSHwFDc_Nw" rel="noopener">HLTH VRTL 2020</a> will take place, October 12-15, 2020. The year everything changed - we are facing a global health pandemic, a cultural crisis and will have one of the most important Presidential elections of our time. Now more than ever, it&rsquo;s essential for us to gather together to spark true change and discuss the impact that this past year will have on the industry going forward. We&rsquo;re developing a brand-new virtual agenda that will focus on the history-altering events of 2020 that have affected our hearts, minds, and forced us to question our current policies and business models. <a href="https://www.hlth.com/virtual/agenda-overview" title="HLTH VRTL Agenda" target="_blank" data-saferedirecturl="https://www.google.com/url?q=https://www.hlth.com/virtual/agenda-overview&amp;source=gmail&amp;ust=1592585872477000&amp;usg=AFQjCNH9o7KSyY8U_aMWltmZ0XQBfkciRw" rel="noopener">See the agenda overview here</a>. While we may not be able to meet in person this fall, you can still expect an exceptional virtual experience, bringing together leaders from across the health ecosystem to help solve some of the industry&rsquo;s largest problems and to bring to life some of the most promising opportunities to improve health.&nbsp; You&rsquo;ll be able to attend sessions from top health &amp; political leaders, listen to startup pitches, meet with key solutions providers and sponsors, and build new partnerships and connections through 1:1 networking opportunities; including our virtual <a href="https://hlth.com/virtual/hosted-buyer" title="Hosted Buyer program" target="_blank" data-saferedirecturl="https://www.google.com/url?q=https://hlth.com/virtual/hosted-buyer&amp;source=gmail&amp;ust=1592585872477000&amp;usg=AFQjCNE58E4R13O2TnRO89xf40Hi_GyIcA" rel="noopener">Hosted Buyer program</a>, <a href="https://hlth.com/virtual/funding-founders" title="Funding Founders program" target="_blank" data-saferedirecturl="https://www.google.com/url?q=https://hlth.com/virtual/funding-founders&amp;source=gmail&amp;ust=1592585872477000&amp;usg=AFQjCNGaQXwyYr_uNXLC-c3_cw5nu6vtOw" rel="noopener">Funding Founders program</a>, and <a href="https://hlth.com/virtual/table-talks" title="Table Talks" target="_blank" data-saferedirecturl="https://www.google.com/url?q=https://hlth.com/virtual/table-talks&amp;source=gmail&amp;ust=1592585872477000&amp;usg=AFQjCNHgsENYVkSeSxiQsZeoyKTXVfr7lQ" rel="noopener">Table Talks.</a> Also, get ready to be surprised with some amazing entertainment! We&rsquo;re so excited for you to see what we have in store. Right now, our mission has never been more important and we're so excited for the potential that a virtual experience has to bring us all together in new ways. We can&rsquo;t wait to be able to connect virtually with you all.
- The HLTH Team

HLTH 2020 Has Gone Virtual

Q&amp;A with Paul Roma
In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
HLTH Team: As a business leader, how are you setting priorities and managing your organization through these unprecedented times?
COVID-19 has disrupted everyone. As a business leader, I need to make sure that we&rsquo;re taking care of our employees and clients. Many people are working from home, maybe they&rsquo;re juggling taking care of kids or parents, they could be struggling with stress or anxiety. Our clients are wrestling with the same issues we are. It&rsquo;s more important than ever for employees to be flexible and stay connected &ndash; with each other and with clients.&nbsp;
I&rsquo;m proud of the way our teams have stepped up to support our clients, partners and communities. IBM is aligning with needs across industries to help address business continuity, security risks, supply chains, remote workforces, and of course, supporting health and human services. IBM has several initiatives to help companies prepare their workforce for the new normal. For example, <a href="https://www.ibm.com/products/return-to-workplace-advisor">IBM Return-to-Workplace Advisor</a> helps employers monitor data and make evidence-based decisions about when to return to the workplace.
HLTH Team: What&rsquo;s the role of advanced technology in a pandemic? How is it helping patients right now?
Patients have a lot of important questions right now. For example, people might ask their providers how they can tell if they have COVID-19, or where they can go for testing. They might need to check coverage with their health plans or employers. Or they might need unemployment or food assistance from government agencies. People are flooding healthcare and human services organizations with these questions at the same time some call centers are managing their own remote work situations.
Organizations can use AI to help connect people to the answers and resources they need. This is especially important during times of crisis. Conversational AI can help these organizations answer common questions about COVID-19. We&rsquo;ve shared some examples in a <a href="https://newsroom.ibm.com/2020-04-02-IBM-Offers-Watson-Assistant-for-Citizens-to-Provide-Responses-to-COVID-19-Questions">news release</a> about how government and healthcare organizations around the world are using Watson Assistant for Citizens to help answer people&rsquo;s questions quickly and accurately.
HLTH Team: What are some other ways advanced technology and AI are helping organizations with COVID-19 response efforts?
One important way AI is being used by health systems is to help providers on the front lines. AI can help surface the information providers need &ndash; such as evidence-based drug and disease information &ndash; at the point of care. They can make more informed decisions if they have access to the latest evidence. We&rsquo;ve given free access to <a href="https://www.ibm.com/products/dynamed-and-micromedex-with-watson">DynaMed and Micromedex with Watson</a> to help providers with access to high-quality content about drugs and diseases, including COVID-19.
Life sciences companies are working hard to find a way to prevent, contain and treat COVID-19. It&rsquo;s a challenge to work under this timeline, because clinical development is a long process. One of IBM&rsquo;s key initiatives is to help accelerate discovery around COVID-19, and there are a number of efforts underway &ndash; including our high-performance computing consortium.&nbsp; We are also offering IBM Clinical Development free of charge to eligible research teams focused on COVID-19. We&rsquo;ve been able to help sponsors get several COVID-19 trials running across 35 different sites. One example, Bionical Emas, published a <a href="https://bionicalemas.com/case-study/covid-19-pneumonia-case-study/">case study</a> about how it was able to set up a clinical trial on COVID-19 in five business days.&nbsp;
Employers are using advanced tech to make better decisions, too. Right now, employers are deciding about when employees can return to the workplace. They have to do it in a way that protects employee health while balancing the needs of their customers and clients. Lots of factors come into play for each worksite. Local COVID-19 infection rates, employee symptoms and health risk factors, local regulations, company policies&hellip;and these factors keep changing all the time. As I mentioned earlier, IBM is working to help employers support their employees in the new normal. <a href="https://www.ibm.com/products/return-to-workplace-advisor">IBM Return-to-Workplace Advisor</a> fits into that effort, as it&rsquo;s designed to help employers and employees look at all of these data sources together and determine how best to proceed for their organizations.
As one final example, public health officials are looking to technology to help mitigate the spread of COVID-19 as states ease social distancing rules. Contact tracing can help case workers identify clients who have been infected and follow-up with anyone who might have been exposed. These are powerful capabilities to help slow the spread of the disease.&nbsp;
HLTH Team: How has COVID-19 affected advanced technology adoption?
In the race to respond to COVID-19, I think we have seen some acceleration around digital transformation and the adoption of things like telehealth, as well as advanced technologies, AI and blockchain.
Here&rsquo;s just one example: a blockchain-powered network is helping address medical supply shortages. Many of us have heard of how COVID-19 has exhausted supply chains for things like masks, gowns or other equipment needed. Other companies have stepped up to mass produce some of these items &ndash; but before hospitals and state agencies can purchase from them, they have to, first, identify these new suppliers, validate they are a trusted supplier, and be able to see what they&rsquo;ve got in their inventories, real-time. To help with that, IBM launched <a href="https://www.ibm.com/blockchain/solutions/rapid-supplier-connect">IBM Rapid Supplier Connect</a>, which is designed to help government agencies and healthcare organizations find and onboard new vendors.
Advanced technologies, cloud, AI, blockchain are all proving to be useful tools in the COVID-19 crisis. I expect healthcare will continue to use them to solve our toughest challenges.
About Paul Roma:
Paul Roma is the Global General Manager for IBM Watson Health, an organization helping to lead the transformation of health around the world by applying next-generation technologies, such as data, analytics, AI and hybrid cloud, to address the most pressing health challenges globally. Watson Health partners with the greatest minds in the healthcare world &ndash; including Memorial Sloan Kettering, Mayo Clinic, the Broad Institute of MIT and Harvard among others in life sciences, health plans and tech &ndash; to research, develop, train and test our technologies.

COVID-19 Updates with Paul Roma

As coronavirus cases in many parts of the country decline and states and cities slowly begin to reopen, they are learning that the way out of a lockdown is even more difficult than the way in. For employers looking to reopen worksites, and employees needing reassurance it&rsquo;s safe to return, even the most well-considered government plans provide just the broad-stroke safety standards and conditions to be met -- addressing whether and when, not so much how. Such plans can be largely summed up with a few words: proceed with caution.
So, what are employers to do? How can they thoughtfully &ldquo;balance life and livelihood&rdquo; rather than view it as a trade-off, as Bryony Winn, senior vice president, Chief Strategy and Innovation Officer at Blue Cross NC, asked in our recent HLTH panel on the &ldquo;<a href="https://www.youtube.com/watch?v=AGDR1fItGjM">The Resilient Workplace</a>&rdquo;? As we consider a safe-return strategy, how can we learn from our recent successes and failures protecting the health and safety of those essential workers who never stopped going to workplaces. As Lorna Friedman, MD, global health lead for the multinational client group at Mercer, reminded us in the same panel discussion, &ldquo;millions of people don't have the choice. They are at work, they are essential workers, so they're not &lsquo;returning.&rsquo;&rdquo;
With a vaccine still 18 to 24 months out, according to <a href="https://www.nytimes.com/interactive/2020/04/30/opinion/coronavirus-covid-vaccine.html">best-case scenarios</a>, it&rsquo;s clear there is no silver bullet solution on the horizon. Employers need to look instead to layering a set of strategies that will together enable them to manage and reduce risk while prioritizing employee privacy and trust.
#1. Manage risk with a &ldquo;combination therapy&rdquo; Any successful strategy must begin and end with multifactored screening and rigorous adherence to proven safety measures. In a recent <a href="https://www.newyorker.com/science/medical-dispatch/amid-the-coronavirus-crisis-a-regimen-for-reentry">New Yorker essay</a>, Atul Gawande likened such an approach to a &ldquo;combination therapy,&rdquo; where each element has its limitations but the resulting &ldquo;cocktail&rdquo; is effective. First, employees need to be able to self-screen daily for recent COVID19 testing results and symptoms to determine who can safely come to the workplace and who needs to seek care or stay home with ongoing support and clinical guidance. Since early February, when we incorporated the Center for Disease Control and Prevention&rsquo;s COVID19 guidelines into Buoy&rsquo;s AI-based health assistant, 624,000 interviews have been completed, helping people to self-screen for COVID19 symptoms and be rapidly triaged to the best next steps.
For employee screening to be effective against asymptomatic spread, however, it needs to also address exposure risk -- whether people have encountered anyone at close quarters who has tested positive or experienced symptoms -- along with other situational and occupational factors that might contribute to heightened risk. For both employee and employer, the goal of such multi-factored screening isn&rsquo;t and can&rsquo;t be to eliminate risk entirely; the goal is to mitigate and minimize risk through continuous data gathering and analysis.
Employees cleared for return must then adhere to the now-standard trio of CDC safety protocols: rigorous hygiene measures, required face masks, and social distancing. As we&rsquo;ve learned, none of these is easy to implement and enforce -- especially in a busy workplace -- but all are effective in reducing exposure risk.
#2. Safeguard employee privacy and trust No safe-return strategy can come at the expense of employee privacy, nor succeed without a foundation of trust and shared decision-making. Already, there have been <a href="https://www.nytimes.com/2020/05/11/technology/coronavirus-worker-testing-privacy.html">reports</a> of employers using screening technology, temperature checks, and surveillance measures in ways that may violate privacy and disempower workers. At Buoy, when we expanded our platform to offer employers a Back with CareTM solution, we put privacy first, ensuring that none of the health information provided by the employee in the screening process is shared with their employer -- only the overall risk category they fall into.
Building trust begins with giving employees a sense of control and partnership in creating a plan with their employer, rather than having one imposed on them. By self-reporting any symptoms or recent exposure, employees can feel empowered and gain a better understanding of their own risk levels.&nbsp; By applying protocols consistently and fairly and communicating outcomes and progress frequently, employers can rally employees around a shared vision for a healthy and productive workplace.
#3. Tap real-time data to drive decision-making For any employer, the task of safely reopening is a daunting one, with a dizzying number of variables to manage. On a daily basis, they need to assess risk stratification across their employee populations to understand who is cleared for on-site work, who must work from home, who to send for testing, and more. For larger companies with multiple offices in diverse geographies this can be like assembling a puzzle from shape-shifting pieces.
Employers also need to align this risk profile data against business needs on a continuous basis in prioritizing certain roles for re-entry over others. And they must determine the most strategic allocation of limited resources. For example, if they only have access to 100 COVID19 tests but have 1,000 employees, which 100 should get the tests? To make informed decisions, employers will need access to real-time data, dashboard-level visibility, and the ability to model scenarios and choose the best course of action.
#4. Stay nimble and adaptable We are living in a moment of pervasive uncertainty. As we begin the national experiment of reopening -- with some states exercising more caution than others -- we may see new spikes or a second wave of the virus emerge. We are learning more about the virus itself, the actual scale of infection, and the relationship between antibodies and immunity. In response, we can be certain that clinical guidelines will continue to evolve, as will federal and state regulations and standards. Employers must be ready to adapt and respond in real-time to these fluid conditions to stay productive while keeping employees safe and healthy.
This next phase of re-entry will be anything but easy. There&rsquo;s no playbook for employers to follow and no guarantees of success. But the capabilities we develop and habits we take on now can serve us well over the long haul. Those employers that navigate this transition well will emerge stronger for it, with a culture of mutual caring and trust that can carry them through other challenges that lie ahead.

A Four-Part Strategy for Safely Returning to the Workplace

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.

About Acacia Parks:
As Chief Scientist at Happify Health, Acacia&rsquo;s research focuses on digital methods for managing and treating depression and anxiety, as well as chronic health conditions. Her passion lies at the intersection of research and regulatory strategy for digital therapeutics. She received her B.A. in Psychology from Reed College, and her Ph.D. in Psychology from the University of Pennsylvania, where her graduate research helped build the foundation for research on bringing mental health interventions to the general public. Prior to joining Happify Health, Acacia was an Associate Professor of Psychology at Hiram College.
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COVID-19 Discussion with Acacia Parks

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
I&rsquo;ve heard it said that some of the best marriages show their true strength when faced with adversity. In the face of COVID-19, this clearly rings true as we witness unprecedented and extended partnerships and collaborations to fight what has been defined as &ldquo;our generation&rsquo;s greatest war.&rdquo; I have been both inspired and humbled by all the leaders willing to pivot, dig deep, think outside the box, and put aside our individual company goals in the spirit of one shared goal &ndash; to conquer COVID-19.&nbsp;
This &ldquo;new normal&rdquo; has created new rules and new ways to partner. As we develop innovative solutions to solve for COVID-19 and to help prevent a future pandemic, I believe we&rsquo;ll look back on the partnerships forged during this trying time as a key part of the equation. In particular, these significant components of working together will steer our success:
Fast Moving Relationships Are Good: Yes, we&rsquo;ve all experienced partnering in health care. Yet, think about how long it took for some of these partnerships or extended agreements and projects to emerge. Today, just as COVID-19 took off at an alarming rate, so has the speed of alliances forming to stop its progression. In our collaboration with Amgen to discover and develop neutralizing antibodies targeting SARS-CoV-2 to potentially prevent or treat COVID-19, we started work immediately with a verbal handshake.&nbsp; It&rsquo;s not about economics. It&rsquo;s about saving lives. We are not the only companies forging ahead in this fashion. A new standard has been established, recognizing there is no time to waste.&nbsp;
Remain True to Who You Are Individually and Together: Every one of us is stretching the potential of innovation to fight this new enemy. However, we will only win if we stay true to our existing and collective strengths. At Adaptive, we believe the key to diagnosing and treating disease lies within our immune system - nature&rsquo;s most finely tuned diagnostic and therapeutic. We spent the last 10 years building a unique platform that can read and translate the immune system. Over two years ago, we formed a partnership with Microsoft to map population-wide immune responses to diseases at scale. When COVID-19 hit, we didn&rsquo;t have to pivot. We were immediately able to apply our platform to advance solutions for the pandemic. As infectious and debilitating as COVID-19 is to society, the immune system sees it as it would any other disease and our platform works in the same way. Whereas others are focused on the virus itself, we have extended our partnership with Microsoft to focus on the immune response to the virus from people who have contracted COVID-19 or have been exposed.&nbsp;
Commit to the Long Haul: As health leaders, we&rsquo;ve all worked together to solve issues of the day while planning for tomorrow. However, among the extraordinary challenges of COVID-19, the importance of playing the long game becomes even more critical.&nbsp; We need to constantly understand how what we are solving for today will also benefit us in the future -- to manage and prevent COVID-19 and potentially future pandemics.&nbsp;
For example, there are many unanswered questions and challenges on the testing front today. Through our partnership with Microsoft, we recently announced <a href="https://immunerace.adaptivebiotech.com/">ImmuneRACE</a> &ndash; a virtual clinical study to develop a new diagnostic based on patients&rsquo; immune responses. With two types of tests currently available, we see the need for a third kind of diagnostic test &ndash; one that we believe can give a more accurate picture of a patient&rsquo;s COVID-19 &ldquo;status&rdquo; that could help contribute to reopening society and potentially better manage and contain the virus long-term.&nbsp;
Everyone Can Be a Partner:&nbsp; Unfortunately, COVID-19 is anticipated to become &ldquo;part of life&rdquo; for the foreseeable future. What we are doing today can - and should - impact how it is managed for years to come. That&rsquo;s why half the battle in the war with COVID-19 will be our willingness and ability to share information with each other. This war will not be won alone. Individual companies, public health organizations, academic researchers and government entities must work collectively towards diagnostics, treatments and vaccine solutions.
I am encouraged by the traction here. From worldwide efforts in the U.S. and beyond, we are seeing less competitiveness and more collaboration to share research and information. If anything is going to silence the open source vs. proprietary research debate, it will be COVID-19. At Adaptive, we are proud to commit that the de-identified data we uncover with Microsoft about the immune response to the virus will be freely available to any researcher, public health official or organization around the world via an open data access portal.&nbsp;
Our collective &ldquo;end game&rdquo; is to advance solutions for COVID-19. As we do, I know we are also advancing how we partner and collaborate for an even greater impact on the overall health of patients and society for years to come.

Partnering Our Way Out Of COVID-19

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.

Before coronavirus, our country was experiencing its own silent mental health epidemic. <a href="https://www.cdc.gov/mentalhealth/learn/index.htm">One in five</a> adults experience some form of mental illness each year and, as <a href="https://pediatrics.aappublications.org/content/early/2020/05/08/peds.2019-1536?utm_source=STAT+Newsletters&amp;utm_campaign=a4d4393b19-MR_COPY_01&amp;utm_medium=email&amp;utm_term=0_8cab1d7961-a4d4393b19-151683053">new data</a> highlights, pediatric mental health visits to the ED increased 60% between 2007-2016. With this year&rsquo;s Mental Health Awareness Month coinciding with a global pandemic and the highest <a href="https://www.nbcnews.com/business/economy/u-s-economy-shed-record-20-5-million-jobs-last-n1202696">unemployment rate</a> since The Great Depression, I can&rsquo;t help but share the concern of experts and agencies anticipating an <a href="https://www.washingtonpost.com/health/2020/05/04/mental-health-coronavirus/">unprecedented</a> mental health crisis.&nbsp;
So many of us are experiencing isolation and loneliness, job loss, and anxiety from social and economic upheaval. For those already living with mental health issues, however, the <a href="https://www.kff.org/health-reform/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/">compounding effects</a> of this crisis can be devastating. My heart goes out to those who have experienced loss during this pandemic but have been unable to say their goodbyes or find comfort in traditional rites of mourning. I worry about frontline <a href="https://www.buzzfeednews.com/article/scaachikoul/coronavirus-frontline-workers-depression-mental-health">healthcare workers</a>, many of whom are experiencing anxiety, depression, and PTSD &mdash; even <a href="https://www.nytimes.com/2020/05/19/health/pandemic-coronavirus-suicide-health.html?utm_campaign=KHN%3A%20Daily%20Health%20Policy%20Report&amp;utm_source=hs_email&amp;utm_medium=email&amp;utm_content=88150954&amp;_hsenc=p2ANqtz-8Q0d6w2a9PKz8u56phXbB2EazQYpfp3m1boTKYdcEBStLs-bBTfrz4NPkesO-O3q517aOWig3MBlrar8gmr8VIQ-0TeQ&amp;_hsmi=88150954">suicidal thoughts</a> &mdash; from exhausting shifts tending to the sick and dying. There is also growing concern that individuals and populations with more acute mental health disorders (e.g., the homeless) are <a href="https://khn.org/morning-breakout/going-without-life-saving-therapy-social-distancing-orders-complicate-mental-health-care-crisis/?utm_campaign=KHN%3A%20Daily%20Health%20Policy%20Report&amp;utm_source=hs_email&amp;utm_medium=email&amp;utm_content=88150954&amp;_hsenc=p2ANqtz-8Q0d6w2a9PKz8u56phXbB2EazQYpfp3m1boTKYdcEBStLs-bBTfrz4NPkesO-O3q517aOWig3MBlrar8gmr8VIQ-0TeQ&amp;_hsmi=88150954">forgoing care</a> due to social distancing orders.
The pandemic is making it clear that we can't neglect or isolate behavioral health but must instead see it as integral to caring for the whole person. <a href="https://www.medicalnewstoday.com/articles/324030#Anxiety-and-depression-similar-to-smoking">Studies</a> have shown time and again how deeply intertwined mental and physical health are. In some cases mental health directly impacts physical health, whether due to chronic stress on the body or engaging in risky behaviors. Behavioral health challenges also make it more difficult for people to adhere to care and treatment plans. Not only is addressing behavioral health crucial to people&rsquo;s total wellbeing; it&rsquo;s also essential for containing runaway costs to the system. A <a href="https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/returning-to-resilience-the-impact-of-covid-19-on-behavioral-health?cid=other-eml-alt-mbl-mck&amp;hlkid=a67e715c4e74404b9ce3ee39619c9f48&amp;hctky=11790988&amp;hdpid=77fd8c2c-9522-4c29-8841-c63419bf1ecf">McKinsey analysis</a> of national insurance claims data found that 60% of overall medical expenditures are driven by the 23% of members who have mental or substance use disorders.
As a physician and technology leader, I see behavioral health &mdash; and its integration into a whole-person approach to care&nbsp; &mdash; as an area ripe for innovation. These four strategies to address the U.S.&rsquo;s rising demand for behavioral health are top of mind for me:&nbsp;
<ul>
<li>Increase access. The digital front door has expanded the access point for patients to get the care they need&mdash;and the same holds true for behavioral health. Traditional healthcare providers can leverage technology capabilities such as AI-driven chat bots, virtual assessments and triage, and virtual care appointments to help reduce barriers to entry for patients seeking care and services for mental and behavioral health &mdash; a challenge that has long plagued the healthcare system. We can also expect startup digital health companies such as TalkSpace to continue to grow by democratizing access to behavioral health services (they&rsquo;ve reported a 65% uptick in clients since mid-February) .&nbsp;</li>
</ul>
<ul>
<li>Support and engage patients. Healthcare providers offering behavioral health services can stand up online communities for patients seeking resources, advice, and support from others who may be experiencing similar issues. Organizations can also proactively engage behavioral health patients on digital journeys to ensure they are routing patients to the support they need, when they need it.</li>
</ul>
<ul>
<li>Facilitate better care coordination between care teams. Care coordination is vital, especially in transitioning patients from physical to behavioral health services. Organizations can use a connected platform to drive visibility and collaboration across care teams to ensure that no patient slips through the cracks.</li>
</ul>
<ul>
<li>Strengthen preventative measures for vulnerable populations. Social Determinants of Health (SDoH) factors, such as limited access to food, safe housing, and job security, can lead to prolonged stress and trauma in vulnerable populations. Organizations can bolster their community prevention efforts by risk-stratifying populations based on SDoH data. This information can be used to prioritize community partnerships that help alleviate these stressors and to conduct outreach that will help connect vulnerable groups to the care and services that they need.</li>
</ul>
Even as we begin to recover, re-open and emerge from the worst of the pandemic, the realities of this crisis will only begin to settle in &mdash; likely exacerbating an already wide gap between the supply and demand for behavioral health services in the U.S. (especially in <a href="https://www.cnn.com/2018/06/20/health/mental-health-rural-areas-issues-trnd/index.html">rural</a> areas). Now, more than ever, we need to enlist the power of technology to help the industry better scale and integrate behavioral health services to reach more people in need.

About&nbsp;Ashwini Zenooz, MD:
Ashwini M. Zenooz, MD is currently the Chief Medical Officer and SVP for Healthcare and Life Sciences at Salesforce. Dr. Zenooz was most recently the Chief Medical Officer at the Department of Veterans Affairs (VA) overseeing the national EHR modernization program. She has also held senior policy development and operational roles including serving as Deputy for VA Health Policy and Services, Legislative Health Policy Fellow with U.S. Senator Richard Blumenthal, Committee Staff on U.S. Senate Committee on Veterans Affairs, and Chief of Imaging Services. Dr. Zenooz received her MD in the Medical Honors Program at the University of Florida. She completed radiology residency at Henry Ford Health System and an Abdominal Imaging fellowship at Massachusetts General Hospital. Dr. Zenooz is board certified in radiology and continues to practice medicine today.&nbsp;

Enlisting Technology to Address the Looming Behavioral Health Crisis

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
As we know, the highest-risk groups for COVID-19 are made up of people who are 65 and older and people living with chronic conditions. Hypertension, diabetes, obesity, and other preventable chronic conditions make people susceptible to the most severe forms of COVID-19.&nbsp; Of course, the virus doesn&rsquo;t affect everyone in the same way, but the general trend is that older people are at higher risk of the worst consequences of the disease. If they have underlying conditions, including preventable ones, that risk is compounded.
The trend has seemed to hold consistent even among younger people. The young people who have contracted COVID-19 and experienced the most severe consequences seem to be those who were less healthy before the virus struck. However, younger adults who contract COVID-19, particularly those who lack underlying conditions, typically have demonstrated greater resilience. They often report &ldquo;feeling a little off&rdquo; and then return to normal.
People in our communities of color are also bearing a disproportionate brunt of COVID-19 infection. This is no doubt correlated, at least in part, to the fact that they suffer disproportionate rates of lifestyle-related diseases.
Yet, independent of COVID-19, the evidence is clear that, if you help individuals at risk of physical inactivity, obesity, diabetes, cardiovascular disease and other non-communicable diseases to adopt and maintain healthier lifestyles &ndash; engage in regular physical activity,&nbsp; follow healthy nutrition practices, manage stress, and sleep better &ndash; you can&nbsp; functionally slow the aging process.&nbsp; So, it&rsquo;s at least imaginable that a population of individuals 65 years old and above whose health markers show them to be biologically younger would be at somewhat reduced risk for the most severe forms of COVID-19 or any future pandemic.&nbsp;
So, what if we viewed healthy lifestyle coaching and support as an adjunct piece of the epidemiological preventive puzzle for future respiratory-viral pandemics? I&rsquo;m not talking about specific, individual immunity against COVID-19 or any other virus &ndash; although there is evidence to suggest that participation in regular, moderate amounts of physical activity can help enhance general immune function. &nbsp; But, consider how a population made up of healthier and more active individuals, might present the virus with a more resilient opponent, at the population level, among those infected.&nbsp; For instance, evidence overwhelmingly shows that exercise boosts mood and reduces levels of anxiety and depression. When people are dealing with any type of condition, if we can enhance their mental outlook, then their health outcomes tend to be better. Exercise has a role in boosting resilience both physiologically and psychologically.&nbsp;
To take the idea a step further, what if we didn&rsquo;t just promote active, healthy choices but actually invested in making them possible and accessible to all people regardless of race and socioeconomic status? &nbsp; Tomorrow&rsquo;s public-health strategy will, of course, endeavor to reduce the likelihood of individuals being exposed to a virus or contagion. But, future strategies should also include ongoing lifestyle behavior change, delivered at scale, to reduce the severity of the consequences of viral outbreaks like COVID-19 for those individuals who contract it.
I would like to see public health and epidemiology invite physical-activity and healthy-lifestyle promotion to their table. I believe we all could work together to equitably empower people to adopt healthier lifestyle behaviors on a population scale, and do it in the name of pandemic readiness, not as a way to address COVID-19-like maladies from an immunity standpoint, but as an adjunct tool to help with more effective management of the risks associated&nbsp; with battling such an illness.&nbsp;
It is my hope that evidence-based programs that are demonstrated to help people adopt and maintain healthier lifestyles, and those individuals who are qualified to deliver such interventions, can be part of the conversation around promoting optimal population health. When the worst of COVID-19 is past, public health should become better funded, better understood, and even more looked to as an essential part of the overall strategy that steel us against threats similar to what is so disrupting our lives today. Empowering people to be more physically active, eat more healthfully, better manage their stress and sleep routines, and live overall healthier lifestyles is a logical piece of that puzzle.

<div>About Cedric X. Bryant:</div>
<div>As President and Chief Science Officer, Cedric X. Bryant, Ph.D., FACSM, stewards <a href="http://acefitness.org/" target="_blank" data-saferedirecturl="https://www.google.com/url?q=http://acefitness.org&amp;source=gmail&amp;ust=1590183997454000&amp;usg=AFQjCNFi-IRnLq83l9In1GSnovKeQSlW4Q" rel="noopener">ACE</a>'s development of strategies to deliver exercise-science and behavior-change education in ways that are engaging and compelling, recruiting more people to become exercise professionals and health coaches and equipping them for growth in their respective fields. He's responsible for driving innovation in the area of behavior-change programming, overseeing the development of programs that <a href="http://acefitness.org/" target="_blank" data-saferedirecturl="https://www.google.com/url?q=http://acefitness.org&amp;source=gmail&amp;ust=1590183997455000&amp;usg=AFQjCNHbFOm-qB34EJdIodT6-aNuoj-00g" rel="noopener">ACE-Certified Professionals</a>&reg; can utilize to help people adopt and sustain healthier lifestyles. Furthermore, he leads ACE's exploration of how science-based programs and interventions appropriately integrate into healthcare and public health. Dr. Bryant is also responsible for ensuring the scientific accuracy of ACE-commissioned studies, publications and all other materials that ACE creates. He represents ACE as a national and international presenter, writer and subject-matter expert, and highly sought-after media spokesperson. Finally, Dr. Bryant shares his expertise as a member of the Institute of Medicine's Obesity Solutions Roundtable, the National Association of Physical Literacy's Advisory Board, the Prescription for Activity Task Force's Leadership Council and Executive Committee, Exercise Is Medicine's Credentialing Committee and the International Consortium for Health &amp; Wellness Coaching's Council of Advisors. He earned both his doctorate in physiology and master's degree in exercise science from Pennsylvania State University, where he received the Penn State Alumni Fellow Award, the school's highest alumni honor that is given to select alumni who are considered leaders in their professional fields. Dr. Bryant and his wife, Ginger, are avid golfers and the proud parents of four physically active young men.</div>

A More Resilient Opponent for the Next Pandemic

In recent months, the nation has watched in awe as tens of thousands of nurses have raised their hands to go to the frontlines of the COVID-19 pandemic, putting themselves at great risk in order to help overwhelmed hospitals. Even now as the rate of cases starts to slow and the country looks to get back to some semblance of normality, the effects of the pandemic continue to linger for clinicians who have had to ration care, watch their colleagues fall sick and care for severely ill patients.&nbsp;
As a former ER nurse who spent nearly a decade working in Level-1 trauma centers, I have witnessed this first hand. The memories of traumatic patients from my time at the bedside still linger even years later. And as a nurse executive, sending nurses to the front line brought stress, anxiety, and sometimes even tears.&nbsp; The gravity of this situation really hit home, as it did with many of my colleagues who share my growing sense of alarm at what will likely be the long-term negative impact on the mental health of our nursing workforce.&nbsp;
New data shows the toll COVID-19 has taken on nurses&rsquo; mental health&nbsp;
In an effort to better understand how the pandemic has impacted nurses, my company, <a href="https://www.trustedhealth.com/">Trusted Health</a>, recently conducted a survey of 1,425 nurses across all 50 states, two-thirds of whom were providing direct care to COVID-19 patients. What we found was startling.&nbsp;
The nurses in <a href="https://assets-global.website-files.com/5c5b66e10b42f155662a8e9e/5eac7f8885c94fd16ca2f898_mental-health-survey-2020.pdf">our study</a> reported a 30% decrease in their mental health since the pandemic hit, rating their current facility an average of 4.8 (on a scale of 1 to 10) in terms of the support it provided related to their mental health and well-being. When asked how they think that the healthcare industry prioritizes and supports nurses&rsquo; mental health and well-being as a whole, nearly 95 percent said they felt that it was either not a priority, or if it was a priority, that there were inadequate measures in place to support it.
How the industry needs to change&nbsp;
What makes these results particularly noteworthy is that awareness of the issue of burnout and its adverse effects on patient outcomes has been <a href="https://www.ajmc.com/journals/ajac/2019/2019-vol7-n2/making-an-evidencebased-case-for-urgent-action-to-address-clinician-burnout">widespread</a> within the healthcare industry, and there have been a series of efforts -- some very high profile -- to address it. And yet, our data shows that nurses largely see this as lip service.&nbsp;
So where is the disconnect? I believe it stems from the fact that the solutions have largely been at the surface level and have put the onus on nurses themselves to manage their own mental health and well-being.&nbsp; In order to address this issue and prevent an onslaught of COVID-19-related mental health issues, we need to focus on meaningful changes, in particular:&nbsp;
<ol>
<li style="font-weight: 400;">Close the academic-practice gap. We need to rethink the way that we educate nurses. Newly licensed RNs often find that their schooling hasn&rsquo;t prepared them for the structural realities of being a nurse, such that <a href="http://rnworkproject.org/">one-third ultimately leave their first post within two years.</a> We need to integrate skill-building around wellness and stress management into the curriculum for undergraduate and graduate programs. From there, Continuing Education Units (CEUs) can build on that foundation, offering additional relevant content around mental health and well-being.</li>
<li style="font-weight: 400;">Accompany wellness programs with large-scale structural changes. <a href="https://www.the-hospitalist.org/hospitalist/article/121385/leadership-training/promoting-health-healthcare-employees">Nearly 90 percent of hospitals</a> have some kind of employee wellness program, but overall participation remains low. I believe this is in large part because they fail to address the root of the problem via meaningful system-wide changes. One such change &ndash; and perhaps the most important &ndash; is an effective staffing system. No amount of gym discounts or healthy snacks can compensate if nurses are working excessively long hours, have unsustainable patient assignments, or aren&rsquo;t able to take a break during the day.&nbsp; Additionally, evidence suggests the industry-standard 12 hour shift also leads to burnout and patient safety issues.</li>
<li style="font-weight: 400;">Institute support programs tailored to nurses&rsquo; specific needs. While the type of basic counseling that is generally provided through an Employee Assistance Programs is sufficient for some needs, nurses who are working in high-stress units like the ICU or ED often require more comprehensive support. Nurses need an ecosystem of options that includes access to crisis support, cognitive-behavioral skills building, and mindfulness techniques. As one example, Trusted Health and The Ohio State University&rsquo;s College of Nursing<a href="https://news.osu.edu/new-partnership-supports-nurses-on-the-front-lines-of-the-covid-19-crisis/"> recently launched a program in this vein</a> &ndash; staffed by nurses, for nurses. <a href="https://www.physiciansupportline.com/">Similar programs for physicians</a> have also recently sprung up in response to the pandemic.&nbsp; This peer-to-peer relationship has been shown to be effective in getting people to open up and catalyze healing&nbsp; in other high stress jobs like the military, law enforcement and fire fighting.</li>
</ol>
Parting thoughts
A growing chorus of voices from the frontline have begun to speak out about the effect of COVID-19 on clinician mental health. Last week, Dr. Tsion Firew, an emergency medicine doctor based in New York, wrote <a href="https://www.cnn.com/2020/05/06/opinions/help-before-its-too-late-firew/index.html">a harrowing op-ed</a> in which she underlined the struggle she and her colleagues now face:
&ldquo;Medical professionals are indeed heroes, but we are also human. Many of us are suffering beyond anything we are able to articulate and the weight of this moment is heavy upon our shoulders. Heed our call. The front line of this pandemic needs mental health resources and emotional support to process the destruction we cannot prevent, we cannot fix.&rdquo;
COVID-19&rsquo;s legacy for healthcare is still being written. I for one hope that those of us who work in the industry will use this moment, when the eyes of the world are upon us, to come together to find meaningful solutions to help the millions of selfless healthcare professionals who have risked their lives to save ours.&nbsp;

About Dan Weberg:&nbsp;
Dr. Dan Weberg is an expert in nursing, healthcare innovation and human-centered patient design with extensive clinical experience in emergency departments, acute in-patient hospital settings and academia. He currently serves as the Head of Clinical Innovation for Trusted Health, the staffing platform for the healthcare industry, where he helps drive product strategy and works to change the conversation around innovation in the healthcare workforce.
Prior to joining Trusted, Dan spent seven years at Kaiser Permanente, where he held executive roles in nursing innovation, research, and technology strategy across eight regions, 38 hospitals, and 60,000 nurses. He was also part of the founding faculty for the new Kaiser Permanente School of Medicine.
Dan is on the faculty at The Ohio State University College of Nursing and multiple innovation fellowship programs. He previously taught on nursing innovation and leadership at Arizona State University. He is on the editorial board for Nursing Administration Quarterly and has authored two dozen peer-reviewed articles and two textbooks, including Evidence Based Innovation Leadership for Health Professions and Leadership in Nursing Practice.
Dan earned his Bachelors in Nursing, and was in the first cohort to graduate from the Masters in Healthcare Innovation program at ASU, as well as the first-ever graduate of the PhD in Healthcare Innovation Leadership program at ASU. His clinical background is in Emergency and Trauma nursing at Level 1 trauma centers in California and Arizona.

The Looming Mental Health Crisis in Nursing

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
The ongoing health crisis has heightened the importance of our mission at AliveCor to deliver accessible personal ECG technology to those who need it most. People with chronic conditions are more likely to develop severe symptoms if they are diagnosed with COVID-19. Throughout the pandemic, this demographic has faced more health challenges than ever. Some are in the hospital being treated for coronavirus, while others are learning to navigate telemedicine in order to stay on top of their heart health.
As business leaders in healthcare, it&rsquo;s crucial during this time that we remain focused on providing care to those who are most vulnerable&mdash;remotely or otherwise. As the pandemic hit, our team at AliveCor knew that we had to come together and shift our approach in order to provide critical care for those in need right now. Whether it was something simple, like adjusting our logistics to ensure we had the necessary supply of devices, or something more complex, like building entirely new workflows to support the implementation of our devices by front-line care providers, we had to be both flexible and quick to respond. While learning to navigate this surreal state of the world can be daunting, I&rsquo;ve learned from prior recessions that these difficulties are less overwhelming when you hone in your efforts and outline a roadmap to anchor your team.
<ul>
<li>Accept the challenge and adapt. What was once planned the day before can shift overnight in a recession. That state of flux is not something we have control over, but we can control how we respond. Recently, the <a href="https://www.fda.gov/regulatory-information/search-fda-guidance-documents/enforcement-policy-non-invasive-remote-monitoring-devices-used-support-patient-monitoring-during">FDA issued guidance</a> to expand the availability and use of remote patient monitoring in the wake of COVID-19. For AliveCor, that meant initiating a rapid and nimble response to further expand our offerings, while remaining steadfast in our commitment to our core demographic. Almost overnight, we adapted our workflow to offer a service to healthcare professionals that measures the QTc interval in COVID-19 patients using data from KardiaMobile 6L, our six-lead personal ECG. The QTc measurement is a critical piece of heart rhythm data that can be used to help identify negative side effects of medications being used to treat the virus, such as hydroxychloroquine and azithromycin. This service, offered for the duration of the COVID-19 emergency, provides our already strained healthcare system with resources to effectively manage patient care.</li>
<li> Remember, we&rsquo;re in this together. Across the healthcare industry we&rsquo;ve seen the FDA, as well as the private and public sectors, come together to address the pandemic head on. Like <a href="https://www.projectbaseline.com/study/covid-19/">Alphabet&rsquo;s Verily,</a> which launched a website that identified testing areas, and <a href="https://www.businessinsider.com/explore-coronavirus-maps-made-from-facebook-google-apple-user-data-2020-4">Facebook, Apple, and Google</a> using their data to help identify outbreaks. Or our team at AliveCor, who has expanded strategic partnerships with global healthcare leaders&mdash;such as OMRON, Medable, and ERT&mdash;to improve access to remote care for patients and to assist the continuation of important clinical trials. These collaborative efforts are crucial to ensure that we&rsquo;re not only addressing the COVID-19 crisis directly, but also leveraging each other's strengths to improve business strategies and ultimately assisting our customers, patients, and healthcare professionals alike.</li>
<li>Remain focused on the goal. Our mission at AliveCor has always been to provide life-saving cardiological services to those who need it most&mdash;and that&rsquo;s something we won&rsquo;t budge on. While our approach and strategies to fulfill this vision may have evolved because of the pandemic, we remain committed to our mission in everything we do. As we increased the presence of KardiaMobile 6L in hospitals to help fight COVID-19, we equally expedited enhancements to our enterprise platform, making it even more valuable for healthcare providers. Our team also continues to progress the new services and product offerings planned for this year, which will provide people with a way to monitor heart health like never before.</li>
</ul>
The COVID-19 pandemic has forced us all to recognize a new normal that will significantly alter how we do business, provide and receive healthcare, interact with each other, and more. But by accepting the challenge, working together, and keeping our focus, we can learn to shift and evolve with the changes coming not only during the pandemic, but beyond it as well.

Remaining Nimble in the Uncertain COVID-19 Era

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
About&nbsp;Nimesh Jhaveri:&nbsp;
Nimesh is president of Health Mart Pharmacy and senior vice president, McKesson Pharmaceutical Solutions and Services. In his role, Nimesh is responsible to provide visionary and strategic leadership that ensures growth and stability for the 5,000+ Health Mart Independent Pharmacy franchise. He oversees Health Mart field operations, support operations, strategy, and business development.
Nimesh joined McKesson in 2018. Previously, Nimesh led healthcare services for the Walgreen Co., where he spent 29 years in various leadership roles leading business development for pharmacy practice design, automation and technology, pharmacy operations, human resources and corporate operations.&nbsp;During this time, he drove the creation of market leading technology and design, earning numerous patents granted by the United States Patent and Trademark Office.

COVID-19 Discussion with Nimesh Jhaveri, MBA, R.Ph.

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
When my son Aki graduated from university a couple of years ago, he asked me what advice I could give him as he started out in professional life. I told him: &ldquo;Be quick on your feet, learn fast and be ready to adjust. One of the shortcomings of being human is that we all have biases that cloud our decision making, but what can help us to move forward together is the ability to listen to multiple perspectives, to analyze and to adapt.&rdquo; Fast forward to today, as we face the unprecedented challenges caused by the spread of coronavirus, we need adaptability more than ever. In order to find innovative and scalable solutions to rapidly emerging demand, we have to reflect on how we do things.
Necessity is the mother of invention. One thing about a crisis is that the constraints it causes can give us a laser-sharp focus on clear and present needs. When European fashion houses shut down production at their factories earlier this year, <a href="https://www.harpersbazaar.com/uk/fashion/g31973958/fashion-brands-coronavirus/">many pivoted instead</a> towards designing and producing hospital masks, gowns and hand sanitizer. And they did it in weeks instead of months. A crisis also means that there&rsquo;s simply not enough time to use traditional sequential approaches to innovation &ndash; in which you move in a linear way from an idea, through research, design and various concepts, right up to the final launch. Instead, all of these stages need to happen in parallel and the resulting propositions continuously improved through data feedback loops.&nbsp;
Fast, adaptive innovation requires <a href="https://www.wired.com/insights/2014/01/platform-thinking-approach-innovation/">platform thinking</a>. A platform approach creates an environment in which propositions are consistently evolved over time. The architecture is highly modular and takes into account the fact that the modules &ndash; such as memory, CPUs, sensors or cameras &ndash; may evolve rapidly and can be easily substituted with better versions as they come along. Modules can be re-combined to address emerging needs and software opened up with standard interfaces that abstract the underlying modules. This allows new functionality to be developed in parallel by different parties and deployed at a faster pace. &ldquo;<a href="https://en.wikipedia.org/wiki/A/B_testing">A/B testing</a>&rdquo; can applied to fine-tune the proposition to user needs. With &ldquo;<a href="https://docs.microsoft.com/en-us/azure/devops/learn/what-is-devops">DevOps</a>&rdquo; changes can be deployed overnight from the Cloud into connected systems.
If products are assembled as a series of modular components that run together, it&rsquo;s possible to drive both quality and agility to adapt to short-term requirements while maintaining a consistent long-term strategy. This approach recognizes that innovation occurs on different layers at different speeds: so-called &ldquo;<a href="https://www.gartner.com/en/documents/3297020/pace-layered-application-strategy-and-it-organizational-">pace layering</a>&rdquo;. At Philips, platform thinking has helped us to move to a much more agile model in which the majority of our innovations run in parallel and leverage existing assets and capabilities. Since the outbreak of the coronavirus, this model has helped us to rapidly address the needs of hospitals and patients around the world.&nbsp;
A large part of that agility has come from iterating on proven solutions. Like the fashion houses, which need to quickly react to changing tastes, we have tapped into our innovation capabilities to address new needs during the outbreak. For example, a multi-disciplinary team, deeply experienced in respiratory care, created <a href="https://www.philips.com/a-w/about/news/archive/standard/news/articles/2020/20200414-philips-introduces-new-philips-respironics-e30-ventilator-to-help-free-up-icu-units-in-wake-of-covid-19.html?src=search">a new ventilator</a> in just two weeks which can immediately be mass produced to treat hospitalized COVID-19 patients both invasively and non-invasively. It&rsquo;s an alternative for where fully featured, critical care ventilators are not available [1].
We also used an existing Cloud solution to create and rapidly deploy an <a href="https://www.philips.com/a-w/about/news/archive/standard/news/articles/2020/20200415-philips-launches-national-portal-for-digital-exchange-of-covid-19-patient-data-in-the-netherlands.html?src=search">online portal</a> that allows Dutch hospitals to seamlessly share relevant patient information with one another. Since its launch on March 28, 95% of Dutch hospitals have used the portal. Similarly, we are working with various hospitals to add biosensors to our patient monitoring platforms. Hospitalized COVID-19 patients can be monitored continuously yet remotely, reducing the number of times nursing staff need to enter the patient&rsquo;s room. The aim is to reduce the risk of its nurses being infected with the coronavirus. In a <a href="https://www.philips.com/a-w/about/news/archive/blogs/innovation-matters/2020/20200403-going-virtual-to-combat-covid-19.html">virtual care model</a>, patients wearing biosensors can be continuously monitored at home, providing better control over the patient population and less pressure on acute care facilities.&nbsp;
For hospitals, a platform-based approach can help optimize and scale up or down as needed. The spread of coronavirus is causing surges of demand right across the care continuum, from diagnosis, acute care and treatment through to home care. Let&rsquo;s take diagnostic capabilities as an example. Right now, CT images are one of the most reliable ways to diagnose suspected COVID-19. But if the patient is scanned in a hospital where the radiologists are overloaded, a digital exchange can enable the scan to be shared with any available radiologists in the system&rsquo;s network to help balance the load. In the future, we could see this extended to include other diagnostic platforms too, for example by adapting the capabilities of a <a href="https://www.philips.co.uk/healthcare/sites/lumify">handheld ultrasound</a> device to help triage patients at the point of care.&nbsp;
A core element of this kind of platform is the insights it can deliver by interpreting the associated data. One of the enormous challenges of new infectious diseases with a high mortality rate such as COVID-19 is that doctors need to base potentially life-and-death decisions on very little information. We&rsquo;re working with some of the leading healthcare providers on the development of a diagnostic dashboard that could help nurses and doctors to support the clinical decisions for the patient in front of them by integrating up-to-the-minute data about the disease with the patient&rsquo;s personal medical history, in a similar way to a GPS system that reroutes a car to find the quickest journey to its destination.&nbsp;
In a much broader sense, platform thinking applies to leadership too. As the world struggles to contain the effects of the coronavirus, we need leaders from all sectors to work together. No single country or organization has all the answers. It&rsquo;s a fragile world out there right now. Our global societies will only be strong enough to beat this outbreak if we support one another, learn and adapt together.
[1] Philips has received Emergency Use Authorization (EUA) for the device for use only during the COVID public emergency. Status of EUA requests can be found on the FDA website. The Philips Respironics E30 is not FDA cleared or approved.
About Jeroen Tas
Jeroen&nbsp;Tas is the Chief Innovation &amp; Strategy Officer and member of the Executive Committee at Royal Philips

Why Healthcare Leaders Should Consider Platform Thinking for Fast Adaptive Innovation to Combat COVID-19

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
As the COVID-19 pandemic continues, one thing has become clear: we&rsquo;re in for a long ride. The coronavirus outbreak will have a lasting impact that our country we&rsquo;ll be addressing for years to come.
Over the past weeks, the pandemic has shed light on a wide range of inadequacies in our U.S. healthcare system - from hospital beds and PPE, to a well-resourced workforce of frontline clinicians to combat the virus itself. In many cases, the problems that are coming to light are problems we&rsquo;ve had all along, but appear more obvious today because of our current crisis. And as tens of millions of Americans deal with the mounting anxiety that comes with uncertainty--as well as the depression that can accompany social isolation--it&rsquo;s clear that mental healthcare in our country is among those problems.&nbsp;&nbsp;
Increased Distress
Our system was already reeling from the strain of <a href="https://www.bloomberg.com/news/articles/2019-06-20/latest-suicide-data-show-the-depth-of-u-s-mental-health-crisis">rising suicide rates</a>, <a href="https://www.nimh.nih.gov/health/statistics/major-depression.shtml">growing numbers</a> of people reporting at least one major depressive episode, and <a href="https://adaa.org/about-adaa/press-room/facts-statistics">tens of millions</a> suffering from anxiety. And just as <a href="https://www.sciencenews.org/article/coronavirus-why-african-americans-vulnerable-covid-19-health-race">health disparities related to COVID-19</a> have had a disproportionate impact on communities of color, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3928067/">mental health disparities</a> have created barriers for racial and ethnic minorities, who are less likely to have access to high quality treatment.&nbsp;
Though social distancing is crucial for containing the spread of the coronavirus, we are starting to see a dramatic increase in mental health needs--both in those already seeking mental health services, as well the general population. We can think of this in two ways: those without previous mental health symptoms are developing them, and those with existing diagnoses are likely getting worse. For many, initial qualms about social distancing have evolved into grief about being displaced from family and friends, or losing loved ones to the virus itself. Financial stress has evolved into job loss and despondency about when things will get better. While the peak in the bell curve of COVID-19 cases may be in sight, the mental health peak has yet to come -- and when it does, it will likely have a long tail.&nbsp;
Gaps in the System
Unfortunately, most individuals who are suffering will not have the chance to successfully obtain mental support, due to large gaps in the U.S. healthcare system which existed long before the onset of COVID-19:&nbsp;&nbsp;
<ul>
<li>Lack of access: 50% of U.S. counties don&rsquo;t have access to a single mental health provider within the county, and wait times exceed 4 weeks on average.</li>
<li>Poor quality: 70% of Americans with behavioral health conditions are not getting effective mental healthcare.&nbsp;</li>
<li>Fewer providers entering the field: Estimates pre-COVID-19 showed that by 2025, the gap for mental health providers was estimated to be 250,000.&nbsp;&nbsp;</li>
</ul>
The COVID-19 pandemic is both exposing and exacerbating these challenges. We are now seeing many of the country&rsquo;s therapists and psychiatrists closing their doors. Most have not been trained to provide telehealth services, which means they may not feel comfortable transitioning from brick-and-mortar practice to online office. Those who have made the shift to provide online care are likely booked out weeks or months in advance.&nbsp;
Short and Long-term Solutions
With a supply-and-demand imbalance that has only grown more pronounced during COVID-19, we need both short-term and long-term solutions.&nbsp;
In the short term, mental health providers should seek training on how to provide telehealth services, and invest in hardware and software that will enable them to do so. The barrier to entry has come down, and clinicians don&rsquo;t need to be IT experts to migrate their practices online. To address healthcare disparities in the long-run, graduate training programs should develop robust curricula around telehealth services, so that incoming students are trained and mentored on best practice from the beginning of their career.
We know there is a huge appetite for such novel approaches. In a <a href="https://www.businesswire.com/news/home/20200409005169/en/New-Data-Ginger-Shows-70-Percent-Workers">recent survey</a>, 70% of people who used a technology-based mental health service for the first time did so to deal with COVID-19 stress, with 48% of them trying it because their regular counselor had moved to online sessions.&nbsp;
While the transition can feel foreign to many clinicians, virtual care, supported by the right technology infrastructure, can provide an incredibly powerful platform to better balance workload, reduce administrative burden, and support providers to practice at the top of their licenses. I know, because I've made the transition myself.&nbsp;
But moving care online is not enough in itself. To provide services to those who need it most--and those with fewest resources--we need to expand our idea of what mental health support looks like. New modalities that focus on prevention can be effectively leveraged to meet the needs of a broad population. Behavioral health coaching, particularly when paired with clinical services in a telehealth setting, is key in distributing care across groups. Coaches can help people face tough situations and learn skills like mindfulness, which is a highly effective tool for self-management.
The government also plays an important role here. The telehealth industry has historically suffered due to complex regulation around cross-state licensing and reimbursement, which has significantly impeded widespread adoption by consumers and clinicians. Fortunately, as a result of COVID-19, we&rsquo;ve seen positive developments at both the state and federal level, which have reduced some of these barriers. Though we&rsquo;re headed in the right direction, these changes shouldn&rsquo;t be temporary. State and federal partnerships should foster continued innovation in telehealth, and further push to dismantle systems which prevent people from accessing much needed care. Both our patients and providers have never needed this more.&nbsp;
Our already overburdened mental health system has been easily broken by COVID-19. The coronavirus pandemic is causing new mental health problems, but--more importantly--exposing the problems our system has had all along. Upgrading our tools, training, and infrastructure will be essential to providing sustainable care for those who need it most. Though these upgrades have been a long time coming, there&rsquo;s no time like the present to take action.&nbsp;
About Dana Udall:&nbsp;
Dana Udall is the Chief Clinical Officer at Ginger, an on-demand mental health company

COVID-19 is the Tipping Point for Mental Healthcare in America: How the Coronavirus Finally Shed Light on our Broken System 

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.

COVID-19 Discussion with Jon Cohen, MD

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
About Rich Roth:&nbsp;
Mr. Roth leads&nbsp;CommonSpirit&nbsp;Health&rsquo;s innovation efforts, which seek to create and test novel services, programs, partnerships, and/or technologies &ndash; from within and outside of healthcare &ndash; that challenge the status quo and have the potential to reduce the cost of care, improve quality, and/or increase access to services.
Working in concert with&nbsp;CommonSpirit&nbsp;Health employees and physicians, Mr. Roth works to anticipate emerging trends and technologies with the goal of incubating, studying, and scaling efforts to improve care.

COVID-19 Updates with Rich Roth

COVID-19 has brought enormous uncertainty to our personal and professional lives. While we continue to adapt to this new normal and struggle with the anxieties brought about by the coronavirus, we want to reassure you that HLTH remains a reliable partner. HLTH is privileged to be a part of the health ecosystem and in this very personal business, we succeed together&mdash;or not at all.&nbsp; We have been humbled by the dedication, bravery and humanity demonstrated by the community we proudly serve.&nbsp;
HLTH 2020 Event Updates During this period of dynamic change, you can depend on us to be honest, responsive and transparent. We recognize the responsibility and significance that comes with hosting HLTH in 2020, given the event is scheduled three weeks before the presidential election and would be the first industry gathering of senior leaders across the health ecosystem since the pandemic began.&nbsp;
We have convened an Advisory Committee of recognized public health experts to help us make the best decision possible about HLTH 2020, guided only by the facts. We anticipate a final decision in the coming weeks and will communicate that with you immediately. We are grateful to the members of this esteemed Committee for stepping forward despite their own very busy schedules. They include:
<ul>
<li>Dr. Amy Abernethy, Principal Deputy Commissioner and Acting CIO, FDA</li>
<li>Dr. John Brownstein, Chief Innovation Officer, Boston Children&rsquo;s Hospital; Professor, Harvard Medical School&nbsp;</li>
<li>Dr. Farzad Mostashari, Co-Founder &amp; CEO, Aledade Inc; former National Coordinator for Health Information Technology, HHS</li>
<li>Dr. Kavita Patel, Primary Care Physician, Mary's Center, The Brookings Institution, Former Director of Policy for the Office of Intergovernmental Affairs and Public Engagement in the White House&nbsp;</li>
<li>Andy Slavitt, Founder &amp; Board Chair United States of Care; former Acting Administrator of CMS</li>
<li>Dr. Leana Wen, Visiting Professor, George Washington University Milken School of Public Health; former Baltimore City Health Commissioner&nbsp;</li>
</ul>
Your Investment in HLTH We are taking several measures to preserve your investment in HLTH:
<ul>
<li>In the event HLTH 2020 is not able to take place as scheduled, we will transfer all sponsorships to HLTH 2021 and registrations to any event in the future, as well as work through options for an appropriately scaled virtual event.</li>
<li>We have designed the 2021 event and will work with sponsors on space holds until we have a clear direction for this year&rsquo;s event. Our sales team will be reaching out to each of our sponsors in the coming days.</li>
<li>We launched the HLTH Matters GoLIVE Webinar series this week, bringing together subject matter experts in conversations about technologies, innovations and partnerships that will shape healthcare in the years ahead. Learn more about how to get involved: <a href="https://www.hlth.com/go-live-webinars">hlth.com/go-live-webinars</a></li>
<li>HLTH remains committed to working toward gender parity in healthcare leadership.&nbsp; We are pleased to announce the relaunch of CSweetener, a virtual mentorship program for women aiming for the c-suite. CSweetener, a HLTH Foundation program, is looking for new mentors, mentees and partners interested in sponsoring mentorships for mid/senior-level employees and key recruits. Visit <a href="https://csweetener.org/" target="_blank" rel="follow noopener">csweetener.org</a> to learn more and get involved in the community!</li>
</ul>
On-Site Safety for 2020 &amp; 2021 The safety of HLTH&rsquo;s attendees is our top priority. We will remain continuously engaged in safety evaluations and planning and keep you updated. Some of the measures we have already adopted include:
<ul>
<li>Communicating closely with our partners, who are working with Infectious Disease Specialists on cleaning and disinfecting conference facilities and hotel rooms.</li>
<li>Posting sanitation stations in venue foyers, meal rooms and all public and back of house restrooms.</li>
<li>Partnering with the onsite staffing company for measures to deliver as many touch-free options as possible including all onsite staff wearing gloves and door opening service offered throughout the venues.</li>
<li>Working with catering teams to include chef-attended stations and individually plated items as part of food and beverage service (self-service stations will be unavailable).</li>
<li>Digital swapping of business cards via HLTH&rsquo;s mobile app.</li>
<li>Establishing social distancing in general session seating and enabling proper distancing on the exhibit floor and in public spaces, in accordance with our Advisory Committee, local authorities and in conjunction with our hotel partners.</li>
<li>Continuing to confer with our Advisory Committee on best practices in order to hold a safe event.</li>
</ul>
COVID-19 Support A new section of the HLTH website has been created to share <a href="https://www.hlth.com/covid-19">COVID-19 resources and information</a> from experts across various sectors.&nbsp; We are continuously updating this resource with blog &amp; video interviews, news, volunteer opportunities, and health and wellness offerings for individuals and healthcare workers.
As we navigate this together, you can count on HLTH to make responsible decisions that respect the value of our relationships, the depth of our connections and the true meaning of health care.&nbsp;
Be well,
Jonathan Weiner Founder and CEO HLTH

An Update from the CEO of HLTH

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
Each day hundreds of thousands of courageous and selfless health care workers &ndash; including doctors, nurses, cafeteria support, environmental services, administrative and support staff &ndash; step into gowns, pull on gloves and adjust masks over their faces as they prepare for another grueling round with COVID-19. This personal protective equipment (PPE) is their best line of defense against the virus; yet, it is in short supply across the United States and the world.&nbsp;&nbsp;
There are many reasons for this. For example, our supply is limited. Much of our PPE is made in China &ndash; including respirators, masks, gloves, disposable gowns and goggles &ndash; and they are only now ramping back up production following the COVID-19 outbreak in that country. Many hospitals also have had a hard time securing PPE due to supply chain challenges and competition with other organizations that are also working to procure PPE.
And, our demands are high. Due to testing limitations, hospital staff need to wear full protective gear and treat each patient as if they have COVID-19. In addition, the number of COVID-19 cases across the country continues to rise. Both result in the need for extraordinary amounts of PPE.&nbsp;
This is playing out at hospitals around the country. <a href="https://abcnews.go.com/Politics/internal-memos-chief-surgeon-york-presbyterian-hospital-revealed/story?id=69735650">New York-Presbyterian Hospital</a> estimated in March that while they normally use 4,000 non-N95 masks a day, they were consuming 40,000 of those masks each day and that number would reach 70,000 as they hit their peak. One hospital leader that responded to the Health and Human Services Office of Inspector General&rsquo;s National Pulse <a href="https://oig.hhs.gov/oei/reports/oei-06-20-00300.pdf">Survey</a> shared that before COVID-19, the hospital normally used around 200 masks per day; that number jumped to 2,000 by late March.&nbsp;
More than three months into the pandemic, supply simply cannot keep up with demand. And, while hospitals are working to protect health care workers on the front line of COVID-19, the reality is that many health care providers and organizations still lack sufficient supplies of professional, medical-grade PPE.&nbsp;
The PPE picture is not all grim, however. Many of its most pressing issues are being addressed directly right now, and the AHA has been working with Congress and the Administration to secure more PPE and the funding and private sector support to ramp up production and get the right supplies in the field.
AHA is supplementing this effort with <a href="https://www.100millionmasks.org/2020-04-07-calling-any-volunteer-engineers-or-innovators">the 100 Million Mask Challenge</a>. Originally launched by <a href="https://washington.providence.org/">Providence</a>, in Washington state, the Challenge now calls on manufacturers, the business community and individuals nationwide to coordinate their efforts to rapidly produce PPE on the large scale needed by our nation&rsquo;s caregivers.&nbsp;
Since scaling this initiative nationwide, over 200,000 visitors have visited AHA&rsquo;s expanded website, many of which have been manufacturers downloading specifications to make masks, face shields and gowns that will allow them to produce PPE quickly and effectively.&nbsp;
We&rsquo;ve been so inspired by those that have stepped up and joined forces to ensure our front line health care workers have the PPE they need. For example, in Idaho, <a href="https://www.ktvb.com/article/news/health/coronavirus/boise-state-3d-printer-faces-shields-coronavirus-help-hospitals/277-f5825c82-f6f3-4105-94ec-6fc43a74a2f5">Boise State University</a> is using its 3D printer to assemble face shields for local hospitals.&nbsp;
Schools in <a href="https://kfor.com/health/coronavirus/schools-encouraged-to-donate-cleaning-supplies-to-hospitals-nursing-homes-amid-covid-19-pandemic/">Oklahoma City</a> have donated surplus medical supplies, like hand sanitizer, masks and disinfecting wipes to nursing homes and hospitals. <a href="https://www.bicycleretailer.com/industry-news/2020/03/23/cycling-manufacturers-answering-call-switch-production-face-shields-masks#.XpXsC9NYY2x">Cycling manufacturers</a> and a number of <a href="https://www.cnbc.com/2020/03/26/coronavirus-retailers-make-masksgowns-for-healthcare-workers.htmls">clothing retailers</a> are also producing PPE to protect our health care work force. We recently even received close to $200,000 in contributions from the <a href="https://www.bobbleheadhall.com/">National Bobblehead Hall of Fame and Museum</a> due to strong sales of their Dr. Anthony Fauci and Dr. Deborah Birx bobbleheads.&nbsp;
Individuals are pitching in, too, such as a 7 year-old Missouri boy, the son of a nurse, using a 3D printer to make hundreds of adjustable head bands that hold protective masks in place more securely. From every corner of society, people are demonstrating a desire to help keep our health care workforce safe.
As AHA grows the 100 Million Mask Challenge, we are developing new ways to make sure PPE gets to where it is needed. In recent weeks, we launched <a href="https://www.health-equip.com/">HealthEquip</a>, an app that matches those wanting to donate PPE with hospitals that need it most. We also continue to help hospitals navigate the PPE challenges by vetting non-traditional <a href="https://www.ahrmm.org/covid-19-resources-non-traditional-suppliers-offering-ppe-and-other-critical-supplies">suppliers</a> offering PPE.&nbsp;
The challenge of full PPE protection for all of our courageous front line COVID-19 responders will not be solved overnight. But Americans are focused on this as never before, and when our nation sets a goal as urgent and necessary as this one is, you can bet we will achieve it.&nbsp;&nbsp;

About Priya Bathija:<a href="mailto:100MillionMasks@aha.org"></a>
Priya Bathija is vice president, Strategic Initiatives at the American Hospital Association. In this role, she leads the AHA&rsquo;s efforts to guide hospitals and health systems as they promote affordability by improving quality and decreasing cost. In addition, she leads the organization&rsquo;s work on maternal and child health, social determinants, and its exploration of innovative delivery and payment system reforms that will allow vulnerable urban and rural communities to ensure access to essential health care services.&nbsp;
Formerly, Ms. Bathija served as the AHA&rsquo;s point person for inpatient payment and rural hospital issues and as the AHA&rsquo;s liaison to MedPAC. Prior to joining the AHA, she practiced health care law and served as hospital counsel for MedStar Georgetown University Hospital and MedStar Washington Hospital Center in Washington, D.C., and associate general counsel at ProMedica Health System in Toledo, Ohio.
For more information on the 100 Million Mask Challenge, please visit 100MillionMasks.org or email <a href="mailto:100MillionMasks@aha.org">100MillionMasks@aha.org</a>

Answering the Need for Personal Protective Equipment

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
We&rsquo;ve now seen how coronavirus and its disease, COVID-19, revealed a most dire learning: how ill-prepared many environments are to control the spread of infection. The struggle to accommodate a highly infected populace has forced decisions about who gets what, and where, and how &ndash; a debate we shouldn&rsquo;t and hopefully will never have again. I&rsquo;ve found myself thinking about what can be learned and how people like me &ndash; designers &ndash; can take action to help safeguard against future health crises.&nbsp;
Reimagine the physicality of healthcare facilities&nbsp;
Right now, we&rsquo;re grappling with the physicality of our healthcare facilities. Hospitals have not been designed for situations in which there are more patients to treat than medical staff can attend to. Moving forward, we&rsquo;re going to challenge ourselves to think more efficiently about proximity in future hospital builds, from the moment one enters the lobby &ndash; patient, staff and visitors alike &ndash; to the waiting areas, to treatment rooms, to hospital beds and beyond. We&rsquo;ve already gotten a head start on this one.
Recently, ICRAVE led design strategy for the interior and public spaces of Memorial Sloan Kettering&rsquo;s new&nbsp;<a href="https://www.mskcc.org/locations/directory/david-koch-center-cancer-care-at-msk?utm_source=yext&amp;utm_medium=local&amp;utm_content=gmb">David H. Koch Center for Cancer Care</a>&nbsp;in Manhattan. This 750K sq. ft. facility is a microcosm of what all public spaces are experiences in this COVID era: it houses patients who are very susceptible to infection as well as caregivers and doctors who are not. When we began planning in 2014, we examined the standard process of checking into a hospital and how a person is required to navigate the facility to reach their final destination; there were roughly 18 checkpoints to move from the lobby entrance to a doctor&rsquo;s care. This revealed countless exposure points for patients and a number of spaces built for very narrow uses. Our goal became to eliminate unnecessary touch points not just to make the overall experience more positive, but also for&nbsp;the hospital&nbsp;to&nbsp;become part of a person&rsquo;s care instead of yet another stressor.&nbsp;
Achieving this wasn&rsquo;t about moving walls; we had to lean into tech to design more flexible spaces. &ldquo;Waiting areas&rdquo; needed to adapt to a patient&rsquo;s day to day needs as their treatment progressed. At this facility, that meant creating three new typologies of waiting areas called Activation, Restoration and Recreation, each of which held a unique set of choices and experiences for the patient. In order to make treatment efficient, the facility assigns each patient with RTLS&nbsp;technology so that they can be located and alerted when needed. Meaning, patients could roam more freely between floors and typologies depending on their needs, instead of being captive on one floor or neighboring other ill patients in an overcrowded waiting area.&nbsp;
In the future, the physicality of hospitals can become more nimble&nbsp;and change from use to use &ndash; spaces can become treatment areas, clinics,&nbsp;or&nbsp;ORs if needed, instead of being fixed office space or waiting areas.&nbsp;
Use a tipping point to create behavioral change&nbsp;
From grabbing the same door handles as countless others, to fishing out sugar packets out of shared tins at the coffee shop, to merely sharing an elevator, we&rsquo;ve witnessed how everyday habits unwittingly put us at risk. So, it should also remain true that changing these habits, in small, incremental ways, can actually be an important part of keeping our healthcare environments clean as the day unfolds.&nbsp;
Getting people to change behaviors that can have a huge impact on the cleanliness of a shared space &ndash; like a hospital lobby or waiting area &ndash; is very challenging, but key. For example, changing behavior around handwashing to make it a central task could occur by putting a handwashing station right at the front entrance of a facility, or by installing a soft audio cue or blinking light that prompts people to use that station, and makes it obvious when they have not. At most hospitals, clinicians and caregivers are already aware of the importance of handwashing and do so instinctively, but visitors and outsiders need retraining. This is the Koch Center&rsquo;s own tipping point: just as the world is doing now with self-quarantine, self-isolation and social distancing measures, people are acutely aware that they&rsquo;re not protecting themselves; rather, they&rsquo;re protecting the most vulnerable people from harm.
Another example is motivating people to better care for their surroundings. Families that spend all day in a waiting area as their loved one is in surgery may throw their shoes up on a couch or allow food wrappers to accumulate throughout the day &ndash; two common actions that allow germs to build. How can we dissuade this behavior? Some hospitals solve for this by keeping areas pretty bare, but we&rsquo;ve done the opposite at a few of our healthcare projects, by designing spaces that are more homey. The thinking is that if people feel truly at home somewhere &ndash; as if they are waiting in someone&rsquo;s living room &ndash; they will treat it better and keep it cleaner.
Leverage technology to its full potential
A decade ago, my team first introduced food ordering via iPads at JFK Airport; it was revolutionary in that it allowed travelers to enjoy pre-boarding meals anywhere in the terminal, which meant people were less likely to stay in gate hold areas and more evenly disperse throughout the airport, a crucial shift in reducing crowd density and the spread of germs. Now, I wonder: why aren&rsquo;t we just ordering directly from our own phones, instead of on devices that thousands of people touch in a day&rsquo;s time? And why, especially in a clinic or hospital, isn&rsquo;t this true?
Technology might be the simplest yet most-overlooked solution to creating safer, cleaner spaces. For decades we&rsquo;ve understood its promise to be life-changing, but we haven&rsquo;t yet meaningfully integrated technology into the everyday healthcare spaces, and how we interact with objects, surfaces, and each other there. Tech is breaking ground in how we diagnose and treat patients, but it has not been integrated into the built healthcare environment with any urgency or sophistication.&nbsp;
Build new environments through strategic design
A future hospital can be designed with all contagion areas in mind: unclean air, droplets living on bed frames and medical equipment.&nbsp;
Solutions could involve air filtration systems above every bed area; beds themselves could be made from copper, an antimicrobial surface; monitors and other medical machines could be housed within waterproof, self-cleaning surfaces. In the future, your doctor won&rsquo;t be able to &ldquo;disable&rdquo; a patient&rsquo;s room&rsquo;s red light check to green until they&rsquo;ve washed their hands for 20+ seconds.&nbsp;
Further, the need for spaces like the Javits Center in New York, and Central Park itself, to be turned into makeshift hospitals signals an obvious demand for more buildings to be structurally designed with flexibility in mind. How much time could be saved if we could easily transform any of the near-or-fully empty office buildings in our cities, into makeshift hospitals, simply through a re-shift of their interior walls and rotating floors?
Solutions like these require airtight partnerships between teams like mine &ndash; experience strategy and design &ndash; as well as hospital administrators, facilities, operations, IT and medical. But, they are very much within reach and show how good design can keep us safer and healthier.

About Lionel Ohayon:
Lionel Ohayon, is the founder and CEO of ICRAVE, a leading design firm based in New York City that solves business challenges through strategy and design. Since launching ICRAVE in 2002, Ohayon has grown the studio into an internationally renowned practice that drives clients' bottom line by designing spaces as experiences that capture people&rsquo;s attention. Ohayon works with Fortune 500 companies, top developers and other retail innovators to create award-winning work spanning healthcare, airports and air travel, hospitality and entertainment, and mixed-use residential.
Ohayon is passionate about fostering creativity in the world around him. Outside of the office, Ohayon donates his time and resources to Performance Space 122, a not-for-profit arts organization and one of the longest standing venues dedicated to contemporary performance art in New York City. He lives in Manhattan with his wife and three children. Ohayon graduated from the University of Waterloo School of Architecture.&nbsp;

Learning from COVID-19: 4 Ways to Start Designing the Future of Healthcare Now

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.

With the hope that the COVID-19 surge may be beginning to transition into a rolling recovery phase, it is time to begin to define what healthcare will look like on the other side of this crisis.
Let&rsquo;s first align on a few core truths. These of course have been well known by health industry &ldquo;insiders,&rdquo; but the crisis revealed them more broadly:
1. Nurses, doctors, and all other care providers are heroes.&nbsp; We are forever indebted to the bravery and personal sacrifices that these clinicians, much like our military, make on behalf of the communities they serve.&nbsp;&nbsp;
And yet, the tools our healthcare heroes have at their disposal barely touch the surface of what is possible.
2. Hospitals are the most essential of essential businesses.&nbsp; In the face of a pandemic, a popular sentiment that we have too many hospital beds is debunked, and every hospital is thought of as &ldquo;critical access.&rdquo;&nbsp;&nbsp;
This means it is even more necessary that we reimagine financial models and create new operational efficiencies to ensure long term viability.
3. Scaled adoption of digital health is a societal imperative. Social distancing, capacity limitations, growing needs of vulnerable populations, ongoing chronic conditions, and the need for in-home care have decisively made the business case for an array of transformational, modern solutions.&nbsp;&nbsp;
Digital represents the key to arm our clinicians with the transformational tools and advantaged insights worthy of superheroes. Digital represents the answer to supercharge the business of healthcare to align clinical success with financial success and operate with the efficiency of the most successful Fortune 500 companies.
And yet, with so much noise around digital health, how do industry leaders separate the wheat from the chaff? Where do you focus first?
To address the surge, many health systems have scaled adoption of critical digital tools in two-weeks time, a process that may otherwise have taken two years. We know that one of the biggest barriers to wider adoption of digital health tools is to experience it for the first time. Obviating that challenge has resulted in sea-change of consumer and provider expectations for the simplicity and convenience of foundational solutions like telehealth visits, virtual triage, chatbots and remote monitoring.
Looking ahead to optimize recovery and successfully transition to a new normal, prioritization and focus on durable solutions is critical. Newly deployed innovations must be optimized. For example, one of AVIA&rsquo;s health system members is filling available openings in virtual visits through an automated outreach program to about 3,500 patients that reminds them to measure and report their temperatures twice daily.
Many other digital capabilities essential to the future of healthcare delivery will range from accelerating reactivation surgical and ambulatory services, addressing behavioral health, cash management and financial modeling, clinician burnout, consumerism, etc.
This is digital health&rsquo;s long-anticipated transformational moment. Whether you are a provider or solution company, the question is: &ldquo;Are you IN or are you OUT?&rdquo;
Sure, everyone will say they are IN, but what does that really mean?&nbsp; There will be winners and losers as we move into different phases of this crisis.&nbsp; How do you adapt to ensure you end up on the right side of history?
Can a hospital or health system invest in digital to better serve a community that relies on it for care and innovation while, at the same time, addressing its own organizational financial crisis?
Here are the related key questions for which hospitals and health systems need focus and clarity:
<ul>
<li>What digital capabilities are needed to support our organizational strategic initiatives?</li>
<li>How can we internally align and assess where we stand and benchmark with our peers?</li>
<li>How do we prioritize what to do now, later, or not at all?</li>
<li>How do we build a business case for investment and what are the metrics we should use to measure value?</li>
<li>Where can we better leverage the digital tools we already own?</li>
<li>How can we understand the context for solution landscapes and compare relevant products?</li>
<li>How can we de-risk product selection and accelerate a scaled deployment?</li>
</ul>
To help answer these questions and catalyze awareness, assessment, and adoption of impactful digital solutions, AVIA and the American Hospital Association have launched a new tool, the <a href="https://www.aha.org/center/aha-digital-pulse">AHA Digital Pulse</a>, free for all AHA members to learn, internally assess, and compare digital capability benchmarks with peers. There are two Pulses available right now: one on digital readiness and response to COVID-19; and another on what capabilities are needed for the Digital Front Door to enable more streamlined and efficient access to care.&nbsp;
The AHA Digital Pulse is hosted on the industry&rsquo;s platform for digital transformation, <a href="https://connect.avia.health/signup">AVIA Connect.</a> This platform enables providers to not only assess their digital capabilities, but also share best practices and experiences at a time when quick access to insights is so urgently needed.
Together, we will effectively and efficiently navigate through this crisis and emerge with an accelerated, improved journey to realize the future of health.
About Bruce Brandes and Andy Shin:&nbsp;
Bruce Brandes is the General Manager, Digital &amp; Partner Network at AVIA. AVIA is the nation's leading digital transformation partner for healthcare organizations. Andy Shin is the Chief Operating Officer for the American Hospital Association&rsquo;s Center for Health Innovation. The AHA Center for Health Innovation is leading hospital and health system transformation and accelerating innovation at scale.

Digital Health’s Transformational Moment: Are You In or Out?

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
Long before COVID-19 was part of our reality, my Co-Founder Taylor Justice and I set out to design a system that would bridge the gaps between social care and healthcare, an infrastructure to ensure that people&rsquo;s needs were met holistically across communities&ndash;not in a siloed, fragmented way. We initially created Unite Us in 2013 to help veterans and their families transition back to civilian life, simplifying care coordination and service delivery for providers and ultimately the people seeking those services. Since then, our community-driven work has organically expanded into the healthcare industry, working with partners all over the country to address critical social needs so that people&rsquo;s health improves. Little did we know then how relevant and critical this integrated model would support communities around the country respond to the pandemic and ensure that the most underserved, vulnerable people do not slip through the cracks. Unite Us was built for this.&nbsp;
The COVID-19 crisis has laid bare an undeniable fact: the people hardest hit are those who already lacked resources, had limited access to quality social and clinical care, and in some cases are one paycheck(or worse) away from putting food on the table or paying the rent. <a href="https://www.pewsocialtrends.org/2020/04/21/about-half-of-lower-income-americans-report-household-job-or-wage-loss-due-to-covid-19/?utm_campaign=2020-04-">Study</a> after study show that the people who are suffering the most both medically and economically during the pandemic are the ones who were underserved before it hit.&nbsp;
In the past several weeks, <a href="https://www.cnbc.com/2020/04/30/us-weekly-jobless-claims.html">more than 30 million people</a> filed unemployment claims. Many Americans are turning to safety net benefits programs like Supplemental Nutrition Assistance Program (SNAP), which was already servicing 36 million Americans by the end of 2019. With a limited supply of providers and services to meet this record volume of applications, more Americans will suffer. Prior to the COVID-19 crisis, about 44 million Americans had no health insurance, and over 38 million people were <a href="https://www.census.gov/library/publications/2019/demo/p60-266.html">living in poverty</a>. These numbers will continue to climb as the unemployment rate skyrockets.&nbsp;
The fact is, the fight against this virus is not only happening in hospitals, but throughout individual communities across the country. Americans are strongly urged to physically distance themselves from others at a time where they need to be connected more than ever, especially to health and social care providers for the essential services they need.&nbsp;
We&rsquo;ve observed our healthcare systems lament not being better prepared for this crisis. But this medical crisis foreshadows what we&rsquo;ve known since we launched Unite Us: we need national, comprehensive public health infrastructure that sufficiently serves both medical and social needs. We also need sufficient and sustainable funding for community organizations, nonprofits, and other agencies who are on the frontlines meeting people&rsquo;s social needs, just as the doctors, nurses and healthcare workers in the hospitals are on the frontlines meeting their medical ones.&nbsp; In short, we must elevate social care to the same priority level as health care.&nbsp;
Fortunately, Unite Us was able to seamlessly adapt to remote work, continuing to engage at a deep level with both our health and social service partners, identifying what they needed from us and adjusting to provide solutions, even while physically distant.&nbsp;
Here&rsquo;s a high-level view of what we&rsquo;ve been up to:
<ul>
<li>We are building Rapid Response Networks that we stand up in shorter periods of time. In just a few weeks, we launched <a href="https://nyc.uniteus.com/">Unite NYC</a> in collaboration with <a href="https://www.healthsolutions.org/">Public Health Solutions </a>&nbsp;and <a href="https://www.air-nyc.org/">AIRnyc</a> that includes CBOs from all over New York City to help those hardest hit by the pandemic. That grassroots community network is growing daily.</li>
<li>We&rsquo;ve added COVID-19 screening tools into our existing partners&rsquo; workflow, so that they can readily assess and address social needs arising directly from the pandemic.</li>
<li>We&rsquo;ve also added a COVID-19 exposure assessment that allows our partners to appropriately direct people to the care they need, helping to redirect people away from hospitals and to the proper local resource if in fact they&rsquo;ve been exposed, but aren&rsquo;t critically ill.</li>
<li>We have accelerated the growth of our networks while ensuring that we support every organization&rsquo;s adjustment to their service offerings throughout the crisis.&nbsp;</li>
</ul>
While the need for an immediate response to COVID-19 is crucial in the short term, we also need to think about what a post-pandemic world will look like - and execute on that now.&nbsp;&nbsp;
Here are some action steps we can take:
<ul>
<li>Direct stimulus and relief funding equitably to the non-profit sector, to CBOs who are struggling to keep their doors open in the very communities who need the most help.</li>
<li>Develop a national, comprehensive public health infrastructure that brings together partners from ALL sectors&ndash;non-profit, healthcare, insurance, government and business&ndash;who can work collaboratively towards a service delivery system that is inclusive, fair and sustainable for the long haul.</li>
<li>Shift mindsets to recognize that social care must be valued equally to healthcare if we are ever to truly build healthier communities across this country.</li>
</ul>
For over seven years, Unite Us has been strategically building the technological infrastructure to allow for secure information sharing between community network providers, enabling them to send and receive electronic referrals, and track outcomes together to ensure people are getting the care they need. Sending people into a service black hole without accountability will never transform care delivery, nor lead to healthier people and communities. Only when we can track outcomes, identify gaps in services and direct funding to where it&rsquo;s needed most, will we start to see impactful, systemic change.&nbsp;
We will be dealing with COVID-19&rsquo;s impact for the foreseeable future. We know--and have always known--that the power of a connected community and care coordination is absolutely critical for immediate recovery efforts, the ability to stabilize, regroup and heal, and finally, to be prepared for inevitable future health crises. As a nation, we need to invest in communities to ensure that people can get back on their feet. A far-reaching infrastructure needs to be part of that investment.

About Dan Brillman:
Dan Brillman, CEO and Co-Founder of Unite Us, graduated from Yale University in 2006 and worked in finance and consulting before joining the Air Force Reserves as a combat pilot, where he still serves today. After earning his MBA from Columbia Business School in 2012, Dan worked in venture capital in NYC, where he focused on investing and technological innovation until co-founding Unite Us in 2013. He is a recipient of the Jefferson Award for Public Service and was recently added to Business Insider&rsquo;s &ldquo;30 People Under 40 Changing Healthcare.&rdquo;&nbsp;

Immediate Response and Long-Term Solutions in the Face of COVID-19

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
About&nbsp;Roy Schoenberg, MD:&nbsp;
Roy is President and CEO of American Well Corporation where, a decade ago, he introduced the technology that brokers on-demand Telehealth visits between patients in need and available providers. Since its rollout in 2008, the American Well Eco-system was joined by over 200 of the nation&rsquo;s largest payers, health systems, employers, retailers and, through them, reaches millions of Americans.
Prior to American Well, Roy was the founder of CareKey Inc. and served as Chief Internet Solutions Officer at TriZetto, following its acquisition of CareKey. In 2013, Roy was appointed to the Federation of Medical Boards&rsquo; task force delivering landmark guidelines for the &ldquo;Appropriate use of Telehealth in Medical Practice&rdquo;. Roy is the 2014 recipient of the American Telemedicine Association Industry award for leadership in the field of Telemedicine.

COVID-19 Discussion with Roy Schoenberg, MD

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
As the industry focuses heavily on the COVID-19 pandemic, the health science community is working overtime to conduct research that will lead to treatment, vaccine, and better diagnostics. Here at Elsevier, we continue to update our <a href="https://www.nbcsports.com/washington/capitals/hockey-teams-bachelor-contestants-according-very-good-thread-predators?fbclid=IwAR2p50l5DaeQp5_dEoL7Zu2DKdntLNFRWYl1AfiTRRhJbhHU95Qhp7J641w">Novel Coronavirus Information Center</a> to help public health authorities, researchers and clinicians contain and manage this disease. From research papers, data sets, patient care plans, and clinical decision support tools, these resources are available for free to the health science community, clinicians and patients around the world. As an extension of this effort, we also recently launched our <a href="https://elsevier.health">COVID-19 Healthcare Hub</a> as a free resource to aid frontline healthcare workers managing the current coronavirus health crisis and the <a href="https://www.elsevier.com/clinical-solutions/coronavirus-research-hub">Coronavirus Research Hub</a>, which provides a suite of best-in-class tools for researchers and data scientists to freely access.&nbsp;&nbsp;
The importance of free access to research
In the past four months, we have seen the research community change focus rather quickly to themes relevant to COVID-19. This is all part of a larger trend that we are seeing in infectious disease research. Over the past decade, research publications on emerging infectious diseases has grown at an <a href="https://www.elsevier.com/connect/infographic-global-research-trends-in-infectious-disease?dgcid=_EC_PR">average rate of 6.9% annually</a>.&nbsp;
We also know that following an outbreak of a disease, there is a sharp spike in disease-specific publications. This is evidenced by a rise in publication counts following outbreaks of SARS, Influenza A (H1N1), Ebola and Zika virus. We can expect to see that for COVID-19 as well. Suffice it to say, there is a lot of research available that could help inform a response to the evolving pandemic &ndash; and it is clear that the research community is hard at work and eager to access information like this.
As a member of the health science community, I believe it is Elsevier&rsquo;s duty to do everything in our power to support the urgent global effort to understand, contain, and eradicate this new virus. This is why Elsevier, and many other publishers, have signed the Wellcome Trust&rsquo;s <a href="https://wellcome.ac.uk/press-release/sharing-research-data-and-findings-relevant-novel-coronavirus-covid-19-outbreak">statement</a> that calls for research findings and relevant data to be shared rapidly and openly to inform the public health response and help save lives. This is why we have worked quickly to pool all available information in one place on our coronavirus resource hub. Ultimately, science does not happen in isolation; it requires timely collaboration and knowledge sharing.&nbsp;&nbsp;&nbsp;
Using AI to sort through data&nbsp;
You may be asking, with this growing amount of data and research, how do we expect our busy clinicians to sort through and break the information down into actionable next steps? This is where artificial intelligence can shine, as it sorts through thousands upon thousands of journals and databases to expertly curate relevant peer-reviewed papers. This technology also allows researchers to comb and surface real-time clinical trial data. But, how does this ultimately impact patient care?&nbsp;
Research impact on patients&nbsp;
When looking at the direct impact of research on patients, first we must look to past infectious disease outbreaks, such as SARS, Influenza A (H1N1), Ebola and Zika virus. Through the research completed during and after these outbreaks, the health science community discovered new approaches to treat and curb the spread of diseases. As we are problem-solving for the current situation with COVID-19, many are looking to past successes, and in some cases, even failures, to apply learnings to the challenge at hand. Ultimately, this can accelerate the speed of discovery for successful treatments, vaccines, and diagnostics for the novel coronavirus.&nbsp;&nbsp;
Right now, we need any and all research findings on every aspect of this virus. This will help us improve diagnosis, offer urgently needed treatment possibilities and enable a greater understanding of the pathogen itself and its evolution. This has become especially clear in the last few months, as we have seen a rapid response from public health organizations to advance various treatments, vaccines and diagnostics based on existing data and new research results. As we move forward, research will also provide insight into the long-term effects of the treatments, vaccines and the virus itself, as we have little knowledge of this currently. Eventually, as the global community recovers from COVID-19, we can use our learnings to improve outcomes for future outbreaks.&nbsp;
COVID-19 has had a massive global impact, with extreme economic disruption, strain on local and global public health resources and, above all, human health. As we work together in the fight against this pandemic, we must remember that the fundamental first step rests in research.&nbsp;

About John Danaher, MD:
John Danaher, MD, MBA, is Global President of Clinical Solutions at Elsevier, a global business focused on improving patient outcomes and reducing unnecessary healthcare costs through advanced clinical decision support and clinical process improvement. Before joining the Clinical Solutions group, John was President of Education (Nursing and Health Education) at Elsevier.&nbsp;
Prior to joining Elsevier, John was President of the Schools of Health Sciences and Nursing at Kaplan University. He brings a great depth of experience in digital media in health care and education from his time at Kaplan, Discovery Communications, and as Executive VP of WebMD. John has deep domain expertise and a successful track-record in managing health information businesses. His experience, in both government and the private sector, extends beyond the US and into global markets, including assignments and experience with Japan, Pakistan, the UK and Australia.
John received his medical degree from Dartmouth Medical School and is Board Certified in Internal Medicine. He received his MBA from Stanford University and earlier in his career was Resident &amp; Chief Resident in Internal Medicine at Stanford University Medical Center. John has served on diverse corporate and not-for-profit boards, community organizations, teaching faculties and fellowships, including a White House Fellowship.

The Fundamental First Step to Fighting COVID-19: Research

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates. 
About Farzad Mostashari, MD:&nbsp;
Farzad Mostashari, MD is founder and CEO of Aledade, which partners with independent practices, health centers and clinics to build and lead Accountable Care Organizations (ACOs) anchored in primary care. Dr. Mostashari has spent his career at the forefront of health care policy and health information technology. He is the former National Coordinator for Health IT at the Department of Health and Human Services, and served as a distinguished expert at the Brookings Institute&rsquo;s Engelberg Center for HealthCare Reform. Prior to his work at the Office of the National Coordinator, he founded the NYC Primary Care Information Project, which equipped 1,500 physicians in underserved communities with electronic health records. He has spoken and written extensively on issues affecting health IT, Accountable Care Organizations, and health care policy and delivery. He has been published in the New York Times, the Journal of American Medical Association, and Health Affairs, among others. Dr. Mostashari received his MD from Yale University School of Medicine and his Masters in Population Health from Harvard T.H. Chan School of Public Health.

COVID-19 Discussion with Farzad Mostashari, MD

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
About&nbsp;Mario Schlosser:&nbsp;
Mario Schlosser is the CEO and co-founder of Oscar, a health-insurance start-up that is using technology, design, and data to help humanize and simplify healthcare. Previously, he co-founded the largest social gaming company in Latin America, where he led the company&rsquo;s analytics and game design practices.
At Bridgewater Associates, Mario developed analytical trading models as a Senior Investment Associate. Prior to Bridgewater, he worked as a consultant for McKinsey &amp; Company in Europe, the U.S. and Brazil. As a visiting scholar at Stanford University, Mario wrote and co-authored 10 computer science publications, including one of the most-cited computer science papers published in the past decade, in which he developed an algorithm to securely compute trust in randomized networks.

COVID-19 Discussion with Mario Schlosser

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
Keith, the 63-year-old father of an Aetion colleague, was managing his COVID-19 symptoms for two weeks at home, seemingly successfully. Then he suddenly took a turn for the worse. He was the last patient at his New York hospital to qualify for compassionate use of remdesivir.&nbsp;
My sister&rsquo;s friend Jim, a healthy 49-year-old, was hospitalized for COVID-19 treatment for over a month. He participated in a randomized trial, and his care included ventilation, extracorporeal membrane oxygenation, hydroxychloroquine, a statin, tocilizumab, and maybe remdesivir.&nbsp;
Max, my colleague&rsquo;s 15-year-old son, experienced COVID-19 symptoms in the form of a nasty rash on his toes. His doctor advised him to wait and see.&nbsp;
And there are others: my college friend T.J. self-quarantined; my friend&rsquo;s husband Gavin didn&rsquo;t realize what he had until after he recovered. The list of people I know who have or have had this virus goes on.
Who&rsquo;s next? And how on earth will their doctors know which treatment is best for whom&mdash;and when? (Also, why is everyone I know who has had a COVID-19 diagnosis male?)&nbsp;&nbsp;
I&rsquo;m not sure. But I&rsquo;m certain that it&rsquo;s critical we look to real-world data (RWD), right now, for answers.&nbsp;
RWD represent our daily lives as captured by sources like health care claims, EHRs, labs, and wearable devices. These sources provide a rich and current&mdash;with as few as two- to three-day lag times&mdash;view of patient experiences. Looking at data collected in uncontrolled settings helps shed light on practice patterns and outcomes for people in different demographics and with various comorbidities. Dr. Scott Gottlieb, who&rsquo;s on our Board, has made a point to say that while these data won&rsquo;t be the sole basis of assessing and authorizing potential COVID-19 interventions, they are an important adjunct.
With the right level of scientific rigor, we can transform these data into real-world evidence (RWE), evidence that is credible enough for conclusions on treatment safety and effectiveness. Moving rapidly but no less rigorously means using Aetion Evidence Platform&reg; to consistently apply principled database epidemiology concepts; to quickly run and rerun analyses as data accrue; and to support transparency and replicability of results.&nbsp;
Naturally, we are not alone in looking to RWD for answers to address the COVID-19 crisis. We&rsquo;re pleased to join with the Reagan-Udall Foundation for the FDA and Friends of Cancer Research in an effort, <a href="https://www.focr.org/covid19">Covid-19 Evidence Accelerator</a>, to combine forces (and data) and efficiently resolve key questions about COVID-19. It&rsquo;s through this kind of cross-industry collaboration with data providers, government, academia, and health systems that we&rsquo;ll deliver insights to the people who most need them.
For definitive insights without delay, our biopharma and payer partners are also using a COVID-19 specific solution we developed with HealthVerity. The <a href="https://www.aetion.com/covid">Real-Time Insights and Evidence</a> system enables evidence on treatment utilization and outcomes in a rapidly evolving landscape. Through the integration of data&mdash;data that are simultaneously current and complete&mdash;into a Covid-ready evidence platform, researchers can create a system of studies to respond in real-time to COVID-19 (and its knock-on effects). All of this will become increasingly helpful as we consider outbreak scenarios in the fall.
I&rsquo;m grateful to share that Keith, Jim, Max, T.J., and Gavin are all breathing normally again. I&rsquo;m grateful to all who are helping advance RWE to accelerate safe and effective treatments for many more COVID-19 patients.&nbsp;
Lastly, especially, I&rsquo;m grateful to the scientists that will lead us to the other side of this crisis, as they help the world understand, manage, and treat disease.


About Carolyn Magill:&nbsp;
Carolyn is the CEO of Aetion, the digital health company delivering the platform that turns real-world data into the regulatory-grade evidence needed to inform health care&rsquo;s most critical decisions: which treatments work best, for whom, when, and how much we should pay for them. &nbsp; Before Aetion, Carolyn held leadership roles at three companies central to the shift from volume to value in health care. As CEO of Remedy Partners, she led the premier company for bundled payments software and services. As Executive Vice President of Payer Strategy and Operations at Evolent Health, she led the team responsible for establishing value-based contracts on behalf of health systems and provider-led health plans. During her four year tenure, Evolent progressed from start-up through IPO to become a major force in health systems embracing population health. &nbsp; For the preceding eight years, Carolyn served in leadership positions in the Medicare and Medicaid businesses of UnitedHealth Group. Her roles included Chief Operating Officer of its Community and State plan in New Jersey, and the national Vice President of Medicare Special Needs Plans, supporting people with multiple chronic illnesses and limited incomes. &nbsp; Carolyn has an undergraduate degree from Harvard University and an MBA in health care management from the Wharton School of Business at the University of Pennsylvania. She serves on the board of the Center for Health Policy Development, and of Parity.org, an organization that aims to close the gender gap at the highest levels of business. She also serves on the Entrepreneurial Council of United States of Care, a bipartisan nonprofit focused on improving access to quality health care.

COVID-19: The Critical Role of Real-World Evidence Made Real

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
"Physicians think they do a lot for a patient when they give his disease a name." &ndash; Immanuel Kant
Moving Beyond the Diagnostic Moment for COVID-19
We know the ancient Greeks feared Agea, Ascelapius and Thanatos, three gods capable of bringing pain, illness and death. But what they feared most was a concept &ndash; &ldquo;agnostos.&rdquo;&nbsp; The most fundamental fear human beings have always had, and the one that pain, illness and death inevitably lead us to, is <a href="https://www.sciencedirect.com/science/article/pii/S0887618516300469#!">the fear of the unknown</a>.
As a cancer surgeon, I was constantly amazed at how patients accepted bad news with equanimity &ndash; either an initial diagnosis or even a poor prognosis &ndash; when it was tactfully presented. They often told me that they felt empowered by understanding what they were up against, and that a great deal of their anxiety had been the fear of not knowing. They were therefore relieved by finally having more information, even if it wasn&rsquo;t optimal.
I used to think of this as my former patients needing to &ldquo;name the beast,&rdquo; which would then empower them over it somehow.&nbsp; My ruminations were influenced by growing up in Texas, where I learned some Native American tribes <a href="https://www.psychologytoday.com/us/blog/whats-in-name/201107/names-and-identity-the-native-american-naming-tradition">have a tradition of keeping sacred names given by the shaman secret</a>, to avoid empowering their enemies.
However, only telling my patients they had &ldquo;lymphoma&rdquo; was insufficient. It was sharing a diagnosis along with a plan of treatment and likely outcomes, along the way answering questions like, &ldquo;What are my chances, doc?&rdquo;, that helped to alleviate their fear of the unknown. &ldquo;Naming the beast&rdquo; for them required considerably more than just a name.
We are in the real-time midst of a generation-defining event as we deal with the COVID-19 disease worldwide. In time, this will become nothing more than a notable historical event, like the Black Death or the 1918 influenza outbreak. However, despite the wishful thinking of some politicians, it will not go away &ldquo;like magic&rdquo;; we will be actively managing this disease for quite some time, at least until a successful vaccine is developed and deployed worldwide.
Although it seemed apparent early in its course that the aged or those with significant underlying medical conditions were at high risk for contracting the virus and experiencing a severe course, these determinants have proven to be unnervingly imprecise. A significant number fall seriously ill and die with no obvious &ldquo;risk factors.&rdquo; So, while we are increasingly able to tell individuals whether or not they are infected with SARS-CoV-2 using a variety of diagnostic tests, and soon whether or not they have been previously infected via serology, we are not fully &ldquo;naming the beast.&rdquo; A great deal of fear of the unknown persists, and there are ramifications.
We know there is <a href="https://www.nature.com/articles/nrg3114.epdf?no_publisher_access=1&amp;r3_referer=nature">genetic predisposition to some infectious diseases</a> and their manifestation. As examples, genes have been identified that suggest more likely progression to AIDS with HIV, contraction of tuberculosis, severe manifestations of malaria and the spontaneous clearance of Hepatitis C virus. Many <a href="https://covid19hg.netlify.app/">investigators around the world are racing</a> to see if genetic signatures can predict how someone will react to SARS-CoV-2 infection &ndash; either by examining single genes, such as <a href="https://jvi.asm.org/content/early/2020/04/16/JVI.00510-20">those coding for the human leukocyte antigens</a>, or measuring the combined contribution of many different gene variations.&nbsp;
Another approach is to look beyond genes<a href="https://www.nature.com/articles/s41591-019-0665-2"> to the actual proteins they express</a> to predict whether or not someone will follow an asymptomatic, mild or severe COVID-19 course. Although genes can be very informative, their expression does not change over time. However, the human proteome &ndash; consisting of ~20,000 basic structures and likely innumerable altered ones &ndash; &ldquo;turns over&rdquo; about 40,000 times during a human being&rsquo;s life. The dynamic nature of proteomic evaluation can add things like environmental exposures, age, drug exposure and behaviors to the analysis of human biology, as genes are not all that is involved in an individual&rsquo;s &ldquo;biologic fate.&rdquo;
Using such approaches to further &ldquo;name the beast&rdquo; for individuals can help alleviate the fear of the unknown associated with SARS-CoV-2 infection as we await a vaccine and effective treatments. They can also help determine who most needs the emerging vaccine and treatments, which will undoubtedly take some time to be widely accessible even after they are proven in laboratory and clinical studies.&nbsp;&nbsp;
And what about the conundrum of putting people back to work without it seeming like a potential death march? At full strength, the U.S. workforce numbers more than 160 million, and if only five times more than the current number of individuals who have tested positive actually have had COVID-19, that means that only 5 million are likely to be immune (once we have a serology test to prove it). Relying only on infection survivors simply doesn&rsquo;t work for economic recovery: Uninfected and unvaccinated people must also go back to work.&nbsp;&nbsp;
The way to restart the world&rsquo;s economy is not to put millions of lives at undue risk, but to put people back into the workforce that have little chance of severe COVID-19 disease proven by genomic and/or proteomic analysis and good medical science data. Let&rsquo;s fully name and emasculate the COVID-19 beast even as we work to definitively defeat it.


About Roy Smythe:&nbsp;
Roy Smythe, M.D., joined SomaLogic in November 2018 as Chief Executive Officer. Originally trained as a thoracic surgeon and physician-scientist,
Dr.&nbsp;Smythe subsequently gained highly diverse experience and expertise across many areas of cutting-edge healthcare, technology and translational medicine.
Dr. Smythe came to SomaLogic from Royal Philips, where he served as Chief Medical Officer for Strategy and Partnerships. Before joining Philips, he served as Chief Medical Officer at Valence Health, a Chicago-based healthcare company. He held the same title previously at AVIA, a healthcare technology accelerator.

COVID-19 Updates with SomaLogic

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
Private Medical Founder &amp; Managing Partner&nbsp;<a href="https://www.linkedin.com/in/drjordanshlain/" rel="follow">Dr.&nbsp;Jordan Shlain</a>&nbsp;is a practicing primary care&nbsp;doctor, a digital health entrepreneur, a writer, and respected thought leader.

COVID-19 Discussion with Dr. Jordan Shlain

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.

Hear that silence? It's the sound of a planet that's been brought to a screeching halt by a tiny pathogen. Who would have believed only a few months ago the surreality of record reduction in global GDP, oil prices nosediving to below zero for the first time in history, or 22 million Americans filing for unemployment benefits in the space of a few weeks*. We&rsquo;re living in a moment that&rsquo;s going beyond anything seen in most people&rsquo;s lifetimes.
The world as we know it is being changed by COVID-19, both on an institutional and personal level. Take for example the biggest institution of them all - the government. If the prime role of any government is the protection of the security of its nation, then the very definition of that security has just been challenged. The U.S. has lost more people to COVID-19 than to the wars in Vietnam, Iraq and Afghanistan, and to all terrorist attacks on its soil including 9/11, combined. No government will be able to ignore the warnings that our real security challenge is not just &lsquo;a war but a virus&rsquo; and not just &lsquo;missiles but microbes&rsquo;.
While our institutions will change, each of us individually has already changed in so many ways. My experience of COVID-19 has been punctuated by the loss of my father. He survived partisan wars, radical movements, political internment and revolutions, and yet lost the battle against this unseen tiny organism. A fit, healthy man in his early 90s, he was a humanitarian, an entrepreneur, an engineer and my best friend. Just before he went into the ICU, he asked to speak to my children, his grandchildren. He told them this crisis would pass, like every other. But he also told them we should never forget it, and they must emerge wiser. Our people individually, and our society collectively has paid too high a price to return to business as usual.&nbsp;
So, where do we go from here in healthcare?
The pandemic has exposed our &lsquo;unhealthy&rsquo; shortcomings&nbsp; Even before COVID-19, we faced supply shortages in healthcare, that meant our industry only served a minority of the world&rsquo;s population. Half of humanity, according to the World Health Organization, does not have access to basic healthcare, and 5 billion people cannot even dream of getting access to any kind of surgery.&nbsp;
In 2016, the WHO reported that we were 5 million healthcare professionals short, and things are getting worse. By 2030, the world would have a deficit of 18 million healthcare professionals. And here we are. COVID-19 has exposed it all. Einstein used to say &ldquo;the definition of insanity is doing the same thing over and over again and expecting a different result&rdquo;. I am going to be controversial here. The old methods of healthcare, with all its best intentions, have failed us and we cannot go back. The good news is that many governments, medical professionals, health systems and innovative businesses across the world have already acknowledged this and are working together to uncover new solutions.
New technology is the new normal It&rsquo;s been remarkable to see how we&rsquo;ve all adapted to the current situation. Healthcare has adapted faster than most thought possible to meet our needs. Only a few months ago, something as mundane as telemedicine was considered &lsquo;a radical new technology&rsquo;. Now, it&rsquo;s commonplace. But this crisis has also exposed its shortcomings. A doctor behind a phone is as expensive, and as much in short supply as one sitting in a clinic. The same is true with many other promising solutions. So how can we use technology to safeguard our health?
The answer is to forget about the means and focus on the needs. This is the moment we discovered that it&rsquo;s not about the technology but its application in solving the root cause of a problem. Some healthcare systems are already learning from this, and proactively thinking of new ways of harnessing innovation to solve their foundational problems of scarcity of clinical resources and unpredictability of disease behaviour.&nbsp;&nbsp;
How need-driven innovation can protect our health systems For Babylon, this pandemic has shown us what we can do. At the time of significant surge in demand and shortage of clinical resources, we built a COVID-19 Care Assistant solution to give every person the most appropriate care by the most appropriate resource, while safeguarding our clinicians for the patients who need them most.&nbsp;
We created a disciplined digital funnel that gives information and reassurance to large numbers of patients who are seeking it. An AI tool to allow people to find their most probable causes of any symptoms and help them decide to self-isolate if necessary. Care plans based on the latest information, digital monitoring throughout recovery, the option to chat with a trained professional if more help is needed, 24/7 remote consultations with a doctor when required. And it speedily refers patients into hospital, only when necessary.&nbsp;
This system allows the same number of frontline staff to help a much greater number of people, all whilst making sure that people get the care they need. Our service now covers 8% of England&rsquo;s population and is being launched to millions of members in the US and Brazil. Already we&rsquo;re seeing that around 80% of people who use it don&rsquo;t actually need to speak to a clinician &ndash; that&rsquo;s a huge release valve for any clinical resource.
The simple rethinking of solutions like this will result in meaningful change, making healthcare more affordable and accessible to people everywhere, including the billions who were previously being left behind. It is time these solutions are applied to assist with significant challenges, such as management of chronic conditions, from diabetes to mental health. Now that we have seen what can be done in meeting one crisis, there is no excuse to ignore the chronic crisis that we have been struggling with before this one.&nbsp;
Changing attitudes can help change healthcare Accelerating advancements in technology and biology is about to melt into air all that we know in healthcare. A perfect storm is brewing that will merge the new discoveries in quantum computing, AI, mixed reality, robotics, organ reconstruction, genetic engineering and synthetic biology, to help us shape new possibilities hitherto unimaginable. For the first time in history, it is possible to dream of making quality healthcare accessible and affordable for every person on Earth.
But science and technology by itself won&rsquo;t transform healthcare. What is required is a change in attitude. Each and every one of us is responsible for that change. These are dark and difficult times. We cannot let it go to waste, and must learn from these challenges where we can. People all around the world have paid far too heavy a price for us to go back to the way it was before. It is our obligation to those who have suffered not to return to our old ways, but to reshape for the better all that we do.
References
*<a href="https://hub.jhu.edu/2020/04/16/coronavirus-impact-on-european-american-economies/">The Hub at John Hopkins, 16 April 2020</a>

How the Pandemic Will Change Healthcare

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
About Ed Simcox:
Ed Simcox is the chief strategy officer of LifeOmic, the creator of LIFE mobile apps, JupiterOne cloud compliance and security operations software and the Precision Health Cloud platform in use at major medical and cancer centers. Prior to joining LifeOmic, Ed served as the Chief Technology Officer (CTO) at the U.S. Department of Health and Human Services (HHS), the largest civilian government agency in the world. He led efforts at HHS to effectively leverage data, technology and innovation to improve the lives of the American people and the performance of the Department&rsquo;s 29 agencies and offices. While CTO, he also served as Acting Chief Information Officer at HHS, where he oversaw the Department&rsquo;s IT modernization efforts, IT operations and cybersecurity.
HLTH Team: What are your short and long term projections for how COVID-19 will progress in the US?&nbsp;
Ed Simcox: From the models I have seen, I think we have encountered the top of the curve - peak infection rates and mortality rates - this past week in several states. There are some states that haven&rsquo;t seen peak infection and mortality, but I believe that most, if not all, states will have peaked by the first week of May. These are just predictions and as we know, the best models have required adjustment along the way.
Moving forward, it is going to be critical for us to remain vigilant. As we move into the recovery phase, we need to adjust our approach and add new tools to the public health toolbox.
To be successful and avoid another serious wave, we need better, faster, and more accurate testing; widespread contact tracing; and better data reporting mechanisms for public health.
While we have widespread diagnostic testing, we need to quickly move the entire testing process out to the edge of the healthcare system, where the patients are, to improve response time. Rapid diagnostic tests or RDTs are tests that are run at the point of care and return results much quicker than lab-based tests - typically while the patient waits. To date, there have been accuracy issues with COVID RDTs, but these tests will continue to improve.
We also need to introduce quick, accurate, widespread serologic testing ASAP and before we significantly ease restrictions. These tests determine whether patients have built up immunity to COVID-19.&nbsp;
Just as importantly, we need a better, more streamlined way to capture data about each patient and their test result and send this data to public health. There are major gaps today in the way we report cases and investigations. This limits public health&rsquo;s ability to make important, timely decisions.
Thirdly, contact tracing will be very important to keep infection rates low in the future. This is the process of contacting those who have come into contact with contagious individuals so they can be tested and quarantined if necessary to prevent further spread. The standard way to conduct contact tracing is to hire and train thousands of people on the process and have them call or visit each individual. We won&rsquo;t be able to totally avoid this manual process, but we can certainly streamline and expedite contact tracing using technology and do it without violation of people&rsquo;s privacy.&nbsp;
Finally, once the dust settles, I hope that we take a breath and examine our public health data infrastructure. Our public health laws need to be modernized to reflect our connected, data-driven world. I would encourage Congress to form an independent commission to look at all aspects of our response but especially as related to the collection and transmission of mission-critical data.&nbsp;
HLTH Team: You spent a lot of time with the health innovation and tech communities across the US when you were at HHS. Have you been in touch with those communities, and how are they both dealing with and responding to the current crisis?
Ed Simcox: I&rsquo;ve been humbled and proud of the response from the health-tech sector in the U.S. in the past few weeks. I&rsquo;ve participated in multiple hackathons and collaborative efforts to bring disparate data sets together to serve the common good. I&rsquo;ve witnessed companies jumping in and helping states solve complex data and computing issues without asking for contracts or knowing if they will get paid for helping.&nbsp;&nbsp;
Necessity is the mother of invention and innovation. I first saw the impact of rapid, sector-wide innovation in response to the opioid epidemic. It was a virtual call to arms that yielded so much great insight which fueled important policy changes to combat opioid addiction and mortality. The response I&rsquo;m seeing to COVID-19 is orders of magnitude greater. I recently counted over sixty hackathons on the subject, and I&rsquo;m sure there are many more. These hackathons will yield significant, long-term benefits as well as commercial opportunities for many companies bent on making a difference.&nbsp;
I have also seen two large healthcare providers historically resistant to sharing data recently share valuable data with states and other organizations. I hope other provider organizations realize how impactful that is and continue to open their data while also caring for patient privacy.&nbsp;
HLTH Team: You mentioned you think we need to examine our public health data infrastructure. What specifically needs to be done and how long do you think it will take?
Ed Simcox: First, we need to continue implementing the 21st Century Cures Act. I was canceling flights because of COVID-19 the day ONC was rolling out their rules. I immediately thought of how the impending pandemic could negatively impact the rollout of the 21st Century Cures Act rules, which our industry so desperately needs to finally crack through issues that have prevented us from improving health outcomes and lowering healthcare costs.&nbsp;
I was recently on a call with a sophisticated, large hospital system that could not run simple analytics to determine which patients were presenting at their hospitals with COVID-19 symptoms. Nor could they identify registered patients more at risk for serious illness due to known factors like severe obesity. Another hospital I know didn&rsquo;t have a way to generate a report of the ethnicity of its COVID patients when requested by the state. These providers are being hamstrung by their technology. There are easy-to-use, sophisticated tools that can answer important questions with data, but they are of limited or no use until we address data access and blocking.&nbsp;
I encourage HHS to stick to its deadlines for EHRs and providers to implement improvements. The benefits are undeniable after what I&rsquo;ve seen during this pandemic. We should speed up, not slow down.&nbsp;
We also need to go back to the basics and examine our public health data infrastructure in the United States. We have a disparate, antiquated, and piecemeal public health data infrastructure. Bespoke data systems are being created by each state that don&rsquo;t speak to one another or to the CDC. Providers are literally hand-writing on printed CDC COVID forms and faxing them.&nbsp;
Federal, state, and local public health officials are doing an incredible job with what they have, but the antiquated infrastructure gets in their way. We need to look at examples from highly-regulated industries like banking to help reimagine things for the future. There are well-known ways to handle the timely exchange of data in disparate, federated environments where trust is paramount.
HLTH Team: Privacy is a big concern right now. There are tech companies sharing data about their users to try to help in response efforts, but this is raising privacy concerns. How do we balance serving the greater good with an individual&rsquo;s right to privacy?&nbsp;
Ed Simcox: Privacy for health data is paramount and must be protected. However, there is a lot that can be done with patients&rsquo; data that doesn&rsquo;t identify them. Just as important as privacy is trust. Trust is the currency of the health-tech industry, especially for companies with apps that are collecting data on consumers. Beyond caring for the legality of sharing users&rsquo; data, we have to be careful not to violate the precious trust relationship with our users. But trust can be protected through transparency: getting users&rsquo; consent for new, secondary uses of their data. We can explain in plain language the &ldquo;what&rdquo; and &ldquo;why&rdquo; for new data uses. Give them a chance to opt-in. Most of the time, people want to be a part of crowd-sourcing efforts if they believe they are contributing to the greater good.&nbsp;
HLTH Team: The HLTH community is mostly executives across the health ecosystem - what steps could they take to contribute to the solution?&nbsp;
Ed Simcox: Share as much of your data as you can. Get your developers and data folks participating in hackathons, collectives, consortia, and the like.&nbsp; Most importantly have a voice about the ongoing importance of improving data sharing and interoperability across the health ecosystem.&nbsp;
HLTH Team: What do you think we can learn from the current crisis that can benefit our healthcare system in the future?
Ed Simcox: I think we will see an awakening of Americans who have been rarely mindful of their health status. People are startled to learn that their chronic conditions can be the difference between living or dying from this virus. We will likely see a higher degree of self-empowerment and interest in health and wellness. People&rsquo;s newfound curiosity about their health will lead them to look for ways to become more health-literate, which will further &ldquo;consumerize&rdquo; healthcare. We will see a continued blurring of the lines between wellness and medicine which will help us move upstream to better treat the root causes of illness such as diet and life habits.
We have known that telehealth is effective at scale and provides many benefits to our health system, such as improving health equity, increasing access to care, and addressing the shortage of medical specialists. Our main problem has been that we weren&rsquo;t able to pay providers for using it with patients. With CMS and private payers now reimbursing for virtual care at scale, it&rsquo;s my hope that it becomes mainstreamed and that neither public nor private payers try to put the genie back in the bottle after we&rsquo;ve recovered from the pandemic.

COVID-19 Updates with Ed Simcox

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
About Dr. Robin Berzin:
Dr. Robin Berzin, MD is the founder and CEO of Parsley Health. A Summa Cum Laude graduate of the University of Pennsylvania, Robin completed medical school at Columbia University&rsquo;s College of Physicians and Surgeons, and trained in Internal Medicine at Mount Sinai Hospital in New York City. She has also trained in functional medicine with the Institute for Functional Medicine. In 2011 she co-founded the physician communication app Cureatr and currently advises numerous startups in healthcare and wellness. Robin founded Parsley Health in order to make whole-body, transformative medicine accessible to everyone through better services and smart technology.
HLTH Team: Can you explain how antibody testing for COVID works?&nbsp;
Dr. Robin Berzin: Antibody testing works by detecting whether the specific types of antibodies in your blood match those that correlate with the virus responsible for COVID-19 (the SARS-CoV-2 antigen).
Antibody testing is the only known way to detect if you&rsquo;ve had exposure to the virus in the past. For COVID-19 antibody testing, there are three different subclasses of antibodies that can be used including immunoglobulin M (IgM) which indicates active infection, immunoglobulin (IgG) which indicates recovery after an infection and immunoglobulin A (IgA) which indicates respiratory infection.
Antibody testing, in general, is not new. It is routinely used to check for things like HIV and chickenpox. But it&rsquo;s important to note that not all tests are created equal.&nbsp;
Antibody tests that only look at only one or two of the subclasses of antibodies such as only IgG or only IgM are not as comprehensive as those that test for all three classes (IgG, IgM, IgA), and therefore those tests might miss detecting an infection. Furthermore, many low-quality rapid tests have flooded the market, leading WHO to make a blanket <a href="https://www.who.int/news-room/commentaries/detail/advice-on-the-use-of-point-of-care-immunodiagnostic-tests-for-covid-19">recommendation against their use</a> until their quality has been validated.&nbsp;
HLTH Team: What is the accuracy of the tests i.e. any false negatives/positives? If someone tests positive for having had COVID, what does that mean for them in terms of immunity?
Dr. Robin Berzin: Every test and every vendor or lab will have a different specificity and sensitivity -- and with FDA&rsquo;s loosening of regulations around these tests, it&rsquo;s important for consumers and doctors to individually evaluate the quality of specific test they intend to use.&nbsp;&nbsp;
The test that Parsley Health has selected tests for all three subclasses of antibody: IgM, IgA, and IgG. Our test is 97.14% sensitive, 98.36% specific, which means for every 100 people that have been exposed to the virus, 97 of them will get a positive result. With this specific test the likelihood of a false negative is low.&nbsp;
But there is more to making a diagnosis than sensitivity and specificity. Doctors also need to know the prevalence of a disease in the population, since that influences how they trust and interpret the results. That&rsquo;s one of the arguments for scaling up antibody testing: it will establish the disease prevalence. This is also the primary reason it&rsquo;s important to work with a doctor to interpret antibody test results.
At this time, it remains unknown how long IgG antibodies will remain in the body and if they will protect people against getting infected again (like they do with chickenpox). The WHO has warned that we don&rsquo;t yet know if antibodies protect against getting COVID-19 twice, but as we do more antibody testing we anticipate clearer answers.&nbsp;&nbsp;
HLTH Team: When do you expect that antibody testing will be rolled out on a larger scale?&nbsp;
Dr. Robin Berzin: Antibody testing will only be sustainable at a national level when a high-quality self-administered finger prick test is scientifically validated or FDA approved. This type of test will allow people to collect samples at-home, using methods commonly used by diabetics to check their blood-glucose levels. People who want to be tested will still need to work with their doctor to ensure that testing is completed in the proper window of exposure for the test to offer accurate results, but high-quality finger-prick tests will reduce some of the logistical hurdles while increasing scale.
Right now, the only way to do the COVID-19 antibody test while keeping an eye on quality control is to require the blood sample to be drawn by a licensed phlebotomist under doctor&rsquo;s orders. To limit the potential spread of COVID-19 and respect &ldquo;stay at home&rdquo; orders, the best way to do that is to utilize mobile phlebotomy services, which come to patient&rsquo;s homes to draw the sample. This mobile phlebotomy model is higher cost and not as easily scalable as an at-home finger prick test.
HLTH Team: Where will people be able to get these tests?
Dr. Robin Berzin: Parsley Health is currently offering COVID-19 antibody tests to members in the state of California, where mobile phlebotomy services are robust and enough PPE is in supply for safe sample collection. Our tests are only available via doctor&rsquo;s orders, through a trusted CLIA-certified and CAP-certified lab, and we hope that other companies will follow the same model to ensure that the tests used are high quality and that the appropriate testing windows are targeted. We hope to scale our testing capabilities nationwide as soon as a high-quality FDA-approved finger prick test is available.&nbsp;&nbsp;
HLTH Team: Will different testing sites be using different tests or all the same?
Dr. Robin Berzin: Different companies will be using different tests -- and some will be more precise than others. What is available and where will change quickly as the FDA approvals change. The key things you should look for are: doctor ordered tests that look at at least two antibodies for accuracy (IgM, IgG) and ideally all three (IgM, IgG, and IgA), and make sure that you are doing the test in the appropriate window after exposure (at least 5 days). Lastly, it&rsquo;s important to ensure quality sample collection, that the lab that is processing the sample is reputable, and that the sample is collected in the safest circumstances possible.&nbsp;
HLTH Team: How were the tests able to receive FDA approval so quickly? What is the clinical evidence behind them?
Dr. Robin Berzin: This is where things get complicated and it&rsquo;s important to understand the nuance. Under emergency circumstances -- such as a pandemic -- the FDA is able to approve the use of tests by consumers prior to receiving an official FDA stamp of approval. That&rsquo;s what&rsquo;s happening right now with COVID-19 antibody tests.&nbsp;
What this means is that doctors can now prescribe COVID-19 antibody tests that have been validated (meaning enough tests have been collected to be statistically true) and after testing has been conducted the labs can submit to the FDA to review that validation.&nbsp;&nbsp;
Currently <a href="https://www.fda.gov/medical-devices/letters-health-care-providers/important-information-use-serological-antibody-tests-covid-19-letter-health-care-providers">FDA recommends</a> that health care providers continue to use antibody blood tests to identify who may have been exposed to the virus. But the onus of responsibility sits with health care providers to understand &ldquo;the limitations of these tests and the risks to patients and the community if the test results are used as the sole basis to diagnose COVID-19.&rdquo;
With this in mind, results from antibody testing should not be used as the sole basis to diagnose or exclude SARS-CoV-2 infection or to inform infection status. A doctor must clinically interpret the test and make a recommendation on care and whether follow-up testing is needed.
All of this will become clearer as more testing and FDA reviews are completed over the coming weeks.&nbsp;
HLTH Team: Will there be any costs incurred to the patients receiving the tests? Will they be billed through insurance?&nbsp;
Dr. Robin Berzin: Like the early days of COVID-19 swab testing, insurance companies haven&rsquo;t quite caught up with the latest testing. Many tests going on right now are not covered by insurance yet, but we are hopeful that insurance companies will soon cover these tests without co-pays so that anyone who thinks they may have COVID can quickly and affordably get a test.&nbsp;
HLTH Team: Any misconceptions out there that you want to clear up about the antibody tests?&nbsp;
Dr. Robin Berzin: Testing is critical to understanding your own health and helping to slow the spread of COVID-19 infection. The more we get community testing out into the world, the faster we can help slow the spread of the disease. Knowing who and who has not mounted an antibody response is critical to our understanding of disease progression. While we don&rsquo;t know if antibodies translate to immunity, these early tests, particularly the comprehensive antibody test like the one we offer at Parsley Health, will be part of the way that we learn about the virus and how to ultimately defeat it.

COVID-19 Updates with Parsley Health

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
About Sean Duffy:
Sean is certain that behavioral medicine is at an incredible tipping point of innovation, thanks to technology and design. He holds a BS in Neuroscience from Columbia University, was an MD/MBA candidate at Harvard, and formerly worked for Google and IDEO.

COVID-19 Discussion with Omada Health

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
Nancy Brown is Chief Executive Officer of the American Heart Association. Serving as CEO since 2008, Nancy has elevated the AHA as a global leader in heart disease and stroke science innovation.
Robert Harrington, MD, is President of the American Heart Association and chairman of the department of medicine at Stanford University.

COVID-19 Discussion with The American Heart Association

Last year, US investments in health technology topped $7.4 billion, according to Rock Health. While the novel coronavirus might have stalled investments across all industries, we expect this pause will be temporary. But we also anticipate that post-COVID-19 investors may follow an investment path that is different than the one they were on before the virus broke out. The pandemic has helped highlight the importance of health technology, which is suddenly front and center economically, politically, and socially.
Prior to the COVID-19 crisis, the Deloitte Center for Health Solutions interviewed executives from 15 health care and non-health care venture capitalists (VCs) and corporate venture capital (CVC) firms. We also<a href="https://www2.deloitte.com/us/en/insights/industry/health-care/health-tech-investment-trends.html"> analyzed funding and investment data for health tech innovators</a>. Among the main investor groups, we expect CVCs will likely be under most pressure in the short term to curtail investment. It is too soon to know where future investment dollars will flow once we move past the current crisis. However, we expect to see a continued emphasis on health technology, particularly virtual health.
Removal of regulatory hurdles could change future investments
Some US start-ups in the virtual health space have seen a recent surge in activity in response to increased demand and more relaxed regulations. Although the technology to conduct<a href="https://www2.deloitte.com/us/en/insights/industry/health-care/virtual-health-care-health-consumer-and-physician-surveys.html"> virtual doctor visits</a> has existed for decades, regulatory and financial barriers have often hindered adoption.
In response to the novel coronavirus, some regulatory hurdles have been removed&hellip;at least temporarily. On March 27, the White House enacted the $2 trillion Coronavirus Aid, Relief, and Economic Security (CARES) Act. Along with $100 billion in emergency funding for hospitals and other provider groups, the new law opens the door wider for virtual health. For example, patients who receive at-home dialysis won&rsquo;t be required to have an in-person assessment to qualify for telehealth services. Moreover, the law also allows federally qualified health centers and rural health clinics to offer telehealth services to Medicare beneficiaries at a rate comparable to in-person visits. The law also provides $200 million &ldquo;to provide telecommunications services, information services, and devices necessary to enable telehealth services.&rdquo;&nbsp;
The US Department of Health and Human Services (HHS) temporarily eased some regulations to make it easier to conduct virtual health/telehealth. On March 17, the US Centers for Medicare and Medicaid Services (CMS) said that a 1135 waiver would allow Medicare to pay for office, hospital, and other virtual-health visits. As of March 29, CMS had expedited waivers for 34 states. In addition, the HHS Office of Inspector General (OIG) announced that clinicians could reduce or waive cost-sharing for virtual health visits paid through federal programs. Prior to the waiver, Medicare could only pay for virtual health visits in a limited number of circumstances, such as when a patient is in a rural setting.
While the loosening of certain restrictions might be temporary, we expect adoption could continue to grow even after the COVID-19 emergency has passed. Demand from clinicians and consumers could cause some restrictions to be removed permanently. In the near-term, we anticipate that adoption of virtual health will accelerate in an uncoordinated, haphazard way. But over the longer term, it will likely become the new normal. Adoption might be episodic based on geography, speed to market, funding, and the type of technology being introduced. As investment strategies emerge in this new normal, investments in virtual health technology could grow if it is able to validate its potential.&nbsp;&nbsp;
Incumbent players could eye new partnerships
As virtual health and other digital-health technologies have become more integrated into life, work, and culture, many health care organizations have developed their own internal investment strategies. Our research pointed to a trend of collaborations and partnerships&mdash;rather than acquisitions&mdash;between incumbent players and companies from the outside. Incumbents include hospitals and health systems, health plans, medical-device manufacturers, and pharmaceutical companies. Non-traditional participants include technology firms, large retailers, and other consumer-focused industries. These organizations are looking to accelerate change in the health sector. Consider these two examples from our recent paper on investment trends:
<ul>
<li>&nbsp; Merck: The corporate venture arm of Merck invests globally in companies with proven technology or business models. Its aim is to increase revenue and enhance value creation. The Merck Global Innovation Fund (GHI) has focused its investments on health tech&ndash;centered companies and platforms.1 It has more than 40 digital health investments and $500 million in evergreen funds. Merck GHI&rsquo;s investments have concentrated on four major areas: therapy planning, care management, e-clinical trials, and health analytics and AI. Merck GHI&rsquo;s strategy is concentrated on investments that have current revenue, are almost profitable, and that pursue growth capital.</li>
<li>&nbsp; The BlueCross BlueShield Association (BCBSA): The corporate venture arm of the association invests in emerging companies that align with its corporate strategy. The nation&rsquo;s 33 Blues companies have pledged more than $575 million across three funds to invest in companies that are focused primarily on health technology. BlueCross BlueShield Venture Partners is focused on long-term strategic partnerships to drive revenue and distribution while simultaneously promoting innovation across the industry.</li>
</ul>
What might lie ahead? It&rsquo;s worth noting that the uncertain economy could change or delay investment strategies. However, the temporary or permanent removal of regulatory hurdles could accelerate investments in virtual health and other digital technologies. Even before the outbreak, health care and life sciences companies were migrating toward a more digitized world that is guided by consumer preferences. Patients who had a positive experience with virtual health during the pandemic might help drive further adoption. Moreover, increased digitization is likely to change how therapies are provided, how clinicians practice, how health plans pay for care&hellip;and where investors place their bets.&nbsp;
&nbsp;
This posting originally appeared on the Deloitte Center for Health Solutions &ldquo;<a href="https://www2.deloitte.com/us/en/blog/health-care-blog.html">Health Forward Blog</a>.&rdquo; Copyright &copy; 2020 Deloitte Development LLC. All rights reserved.&nbsp;&nbsp;
Endnotes
<ol>
<li>Deloitte, Health tech investment trends: How are investors positioning for the future of health?, March 12, 2020</li>
</ol>

About Peter Micca:
Partner with 30 years of experience serving a broad array of clients in all sectors of the healthcare, technology and life sciences industries. Including; significant experience with health technology organizations, software as a service (SaaS) organizations, pharmacy benefit management, clinical and diagnostic operations, emerging growth and private equity financed organizations in life sciences, health technology and services.
Experience applying a deep knowledge of industry sector business issues regarding the emerging trends surrounding consumerism, convergence, cost considerations, emerging regulatory and compliance issues and consolidation.

COVID-19 Could Alter and Even Accelerate Health-Tech Investment Strategies

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community the most up to date facts and updates.&nbsp;
About Josh Golomb: Josh Golomb is CEO of Hazel Health, a healthcare company offering all children access to healthcare through in-school virtual medical clinics. Hazel partners with schools to improve student health and decrease absenteeism by providing students with instant access to a network of doctors for a speedy diagnosis and care plan. Josh is an experienced senior executive, having co-founded new healthcare enterprises and presided over several large organizations, fostering tremendous growth. As former CEO of direct primary care startup Paladina Health (acquired by NEA), he has proven success in developing forward-thinking healthcare organizations while delivering exceptional clinical and financial results.
HLTH Team: How is telemedicine assisting with the COVID-19 crisis?
Josh Golomb: We are seeing a complete transformation in the role of telemedicine. For years there has been a huge gap between the public&rsquo;s interest in telemedicine which exceeds 60%, and actual utilization, which was typically below 10%. The COVID-19 crisis is demonstrating the value of virtual, most notably by minimizing the strain on the healthcare system by keeping those with mild cases of COVID-19 at home and out of hospitals. This approach is helping physicians identify and treat non-emergency health issues, and instruct patients to stay home when they can, in order to keep clinic and hospital resources available to those who need it most right now.&nbsp;
HLTH Team: How is the rapid shift toward utilizing telemedicine affecting the quality of digital health platforms?
Josh Golomb: Wider adoption of telemedicine is driving primary care providers to shift toward conducting high quality virtual visits. It also provides an opportunity for everyone in the healthcare community to work together and develop the most robust protocols for care. Digital health technologies that were once faced with skepticism around their effectiveness are quickly becoming strong platforms with rigorous standards.&nbsp;
At Hazel, we have been recruiting experienced family practices and pediatricians to deliver care, many of whom were initially weary of telemedicine. From the beginning, we&rsquo;ve approached care with the mindset that we wanted to develop the protocols and practices to have the most rigorous pediatric clinical practice. We are excited to share what we have learned with the hard working physicians that are now practicing this new form of care for the first time.&nbsp;&nbsp;
HLTH Team: How are families coping with school closures?
Josh Golomb: School closures have had a monumental impact on all families as schools play a central role in communities well beyond education. Many working parents rely on schools for child care and do not have jobs that allow them to work remotely. Families also rely on schools to feed their children - The National School Lunch Program provides free meals to more than <a href="https://nces.ed.gov/blogs/nces/post/free-or-reduced-price-lunch-a-proxy-for-poverty">30 million</a> children each year. Schools are also often a crucial health resource. At Hazel, 50% of the families we work with tell us they do not have a primary care physician. These families often rely on a school nurse as their primary source of healthcare. With schools closed, many families are left without options other than the Emergency Room. For these families, school closures threaten a key lifeline of support.&nbsp;&nbsp;
Thankfully, we are seeing incredible leadership from our school partners working around the clock to ensure families receive vital services. School Districts are finding creative ways to get families the services they need - from food and supplies to wifi access and computers to enable families to connect from home. Many school nurses are still supporting families remotely, helping to ensure that their students can still get treatment for pink eye, a key medication refill, or other non-COVID-19 treatments that families still need for their kids. We are doing our part to introduce telemedicine as a healthcare resource in our communities.&nbsp;
Last week, one of our school nurse partners reached out to help with a family in need remotely. Their child had asthmatic symptoms, but had no primary care provider. The family was planning to head to the Emergency Room, which would put them at risk for COVID-19 transmission. We were able to connect our provider to the student and get them the care they needed. We were proud of our ability to support the family, but know that we were only able to play this role because of the deep trust that school had built with the family.&nbsp;&nbsp;
HLTH Team: How is Hazel supporting families during this time?
Josh Golomb: Hazel works closely with school districts and local health authorities to ensure that families have easy access to the most up-to-date information available on COVID-19. We&rsquo;re working with our school partners, families, and legislatures to offer Hazel&rsquo;s services at the designated &ldquo;resource outposts&rdquo; they&rsquo;ve made available to families at this time.&nbsp;
Hazel is also now allowing students and families to access medical advice and treatment by Hazel doctors from home. Students in Hazel&rsquo;s partner districts are able to meet virtually with doctors, who can provide medical expertise, prescriptions, and clarification on how to stay safe. As schools close and students are forced to stay home, Hazel is enhancing our platform and responding to the call to serve families in need. We also believe that an integrated platform that supports children across school and home will be a huge support to families.&nbsp;&nbsp;
We&rsquo;re proud to be doing our part to help the underserved communities being hit hardest by COVID-19, and helping to mitigate the strain on the healthcare system by keeping families out of the hospital when possible and providing them with the care they need.&nbsp;
HLTH Team: What are your thoughts on some state governments looking to open school back up in May? Do you think that is too soon? What are the benefits/risks?&nbsp;
Josh Golomb: Each state has different needs, and strategies to contain need to be made on local levels. Each state is taking the necessary precautions to do what they need, and schools have been amazing community leaders throughout these challenging times.
HLTH Team: Have you noticed an increased need for mental health support for K-12 students during this time? Are there enough resources out there in regards to mental health for this age group?&nbsp;
Josh Golomb: Anxiety and depression have been <a href="https://www.researchgate.net/publication/12189974_The_age_of_anxiety_Birth_cohort_change_in_anxiety_and_neuroticism_1952-1993_Journal_of_Personality_and_Social_Psychology_79_1007-1021">on the rise</a> for K-12 students since the 1950s. Now more than ever, students need mental health support as they are growing up in an uncertain time. With <a href="https://www.fda.gov/consumers/consumer-updates/fda-dont-leave-childhood-depression-untreated">11% of children</a> diagnosed with depression by the time they are 18, schools have the ability to offer instrument support as this is where students are spending the majority of their time. We&rsquo;re currently working on a mental health support offering at Hazel so that we can provide the resources school leaders need to support K-12 mental health. Our hope is that as health care evolves with telemedicine, these services can be more widely implemented for the benefit of schools and children everywhere.&nbsp;
HLTH Team: What advice would you give to parents with children with special health needs who may not be able to access the same level of care right now and where telehealth may not be enough?&nbsp;
Josh Golomb: Telehealth has proven to be a leading solution for equitable, quality care, but we recognize it is not a one-size-fits-all solution. The needs of every family are different, so there will be instances where families need to seek differing or more substantial levels of care. Our recommendation is to seek local community resources in order to access the best resources for a given situation. Schools are a great place to start, as district leaders have their finger on the pulse of what is available in each community.

COVID-19 Updates with Hazel Health: The Impact on K-12 Students

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
HLTH Team: I read the Scott Gottleib and team piece that they put out about achieving containment and the various phases for easing social distancing. In your opinion, what does phase one/phase two/phase three look like and how do we get there?
Andy Slavitt: So, there's no question that the social distancing and the hashtag #stayhome is working. It&rsquo;s probably not working quite as well as it works in other countries, but it&rsquo;s probably harder in a liberal democracy, and it&rsquo;s harder because we were a little bit less prepared. You know it's going to be this phase one social distancing that&rsquo;s going to do a few things. It's going to spare our hospitals and our hospital workers from an overload. And it's also going to give our scientists time to develop therapies and better testing protocols and allow us to catch up with things.
I think what was smart about Scott's piece was that it focused on not the timeframe but what the conditions on the ground have to be like in order to move forward. And, you know, I think you focus on the rights and the things so it's a good road map, which is to say we need the ability to test and track and trace, and be able to contain the outbreaks.
We need to be in a position to protect the most vulnerable people who will want to avoid getting it and we're going to have to adjust some of our habits and some of our patterns. So I think it was a fairly decent road map back. And well, you know, we'll have to figure out how that can happen regionally and how we can ramp testing into a much more kind of scalable form before we can do that. So there's a lot of work to be done, I don't think we're quite ready at the end of April, but I think, you know, it would be great if we can get there by the beginning of June.&nbsp;
HLTH Team: Do you think by June we&rsquo;ll have the ability to rapid test?
Andy Slavitt: We've been working a lot on that. We're making about a million tests a week. We need to at least get to three and half a million a week. And, and even then I think that doesn't make it ubiquitous. I think we can probably get to a million and a half a week in the next few weeks, then I think we start to run into different further supply chain issues that are the ones we're still facing, but we can optimize. How well we solve that problem is going to depend on how fast we get there. But we're not going to do it everywhere because we'll do it in places where we have this reasonably well under control. I think we could conceivably have tests to do it and I also just don't think the public is going to be able to wait much longer than that, so we're going to sort of have to do the best we can. The Southeast hasn't even begun to see the worst of it yet, that's going to really start hitting the Southeast really hard much in the way that it&rsquo;s hit the Northeast.
HLTH Team: Do you think that the New York metro area will, when all is said and done, still far surpass other metro areas with their numbers? Or do you think there are other metro areas who didn't react fast enough and will be worse off than New York?
Andy Slavitt: I mean, New York's been a costly six days. New York and California we're kind of roughly on the same track. Governor Newsom in California acted about six days earlier. And that has pointed the curb, and it's proved to be an enormous difference. There's something that says cities like New York, take a city like Hong Kong, can't contain this but, but obviously if you don&rsquo;t in a city of this size, you end up with what you have.&nbsp;
So I think from an absolute numbers standpoint I don't think anything will approach New York thankfully. But from a relative standpoint, I think we're going to see a lot of tragedy in New Orleans and we&rsquo;re already starting to see it in the black community. We're going to see that, I think Texas and Florida are very concerning, Georgia is very concerning.
So, you know, relative to those population sizes, I think we're going to see some really bad events but hopefully, you know, their political leaders and their infrastructure learn some of the lessons that they didn't learn at the beginning.
HLTH Team: With most of our team living in New York City, we watch the Cuomo daily briefings, and it seems like there's a lot of regional plans happening, and maybe not one cohesive plan across the whole country. So, with that, where do you think that the federal government has taken the right steps, where do you think they have not taken the right steps, and do you think there's a chance for them to get on the right path from here?
Andy Slavitt: You know I think their biggest issue has been that they've just been late. So, you know, when you start late, you know we&rsquo;ve all been late with things before. And you work the weekend, you can catch up, you can stay up late nights, you can catch up. But when you're late with something that's growing exponentially, that's just not possible. It's like swimming after a speedboat that&rsquo;s 15 feet away from you and by the time you get 15 feet the speedboat is 100 feet away from you. You're just not able to catch it. So the consequence of being late has been that the rest of the world was buying up masks and testing materials before we were even in the game.
We were just, you know, caught completely unprepared. And there was a little bit of denialism that was going on. I think that's changed. I think the problem now is more organization than it is of anything else. You know, the states and the hospitals have to be the people on the ground executing. But the federal government can really help by the role it plays. It can set one for example, one standard national price for a ventilator, instead of having the Governor's bidding each other on ventilators. It can coordinate the movement of ventilators and staff and resources from one location, one hot spot to the next. It can coordinate the public health workforce by having public health workers moved from one place to the next. So I think there are good people inside the administration. It's almost like they&rsquo;re playing hero, like &ldquo;hey we just got 3000 ventilators to a hospital, aren&rsquo;t we great?&rdquo; Or to the city or whatever, as opposed to, and you know, that is great. I mean you have to do that at the beginning, but you have to also put that on a sustainable path and we have that skill inside the government, it's in military operations, it&rsquo;s not in the places that we're using it. And FEMA is used to responding to regional disasters. And they're very good at it. There&rsquo;s a lot they can do. Same with the army corps.
So we just need more organizational leadership that I think we would get if we put military ops in more of a leadership role, more of a structure. And then, I think you know the federal government needs to just be more transparent. Biding not selected facts, not hopeful facts, not a different set of facts every day, but the same consistent pieces of data, good or bad for the public is the kind of leadership that's required. I think Cuomo has done a nice job of that in his briefings. I think some of the other governors certainly have as well.
So, you know, I&rsquo;m not trying to sound critical because it's a hard thing. It's a hard problem. But that's where I think we could really use more leadership at the federal level.
HLTH Team: With many health policies, specifically around telemedicine, being changed or just relaxed during this time, and proving to be pretty successful, do you think that these changes will remain for good or will they revert back to how they were before the crisis?
Andy Slavitt: Well, I think the bigger issue is, we may not have primary care doctors and specialists, after this disaster if we don't do something about it. We have to do a lot more to keep those practices in business. We&rsquo;ve seen 40 to 50% declines in patient flow and revenue and these particularly small practices, they don&rsquo;t keep a lot of cash on hand. And a lot of the money that's been put forward is being put forward for hospitals. So that's going to be a real issue. Telemedicine helps both them and it helps patients. I think, you know, the opposition to telemedicine before is still going to be there, which is that if you're in Pennsylvania, you're licensed in Pennsylvania. If a doctor in another state can practice in your state, through telemedicine, it takes business away. So, telemedicine I think has good potential to stay. But the real&nbsp;liberalization that allows a lot of telemedicine to occur, because it can cross state borders, you know, I think there's still going to be opposition to that. I&rsquo;m not saying it&rsquo;s right, I&rsquo;m just saying it doesn&rsquo;t automatically go away.
HLTH Team: How about the transparency that I think we've all wanted in healthcare for a long time that is actually happening now? At least in New York, they're sharing resources across public and private systems and have one central database that they're working off of now, do you think these changes will remain after the crisis?
Andy Slavitt: For data and analytics, I think so. I mean, If you look at what happened after 2004 with Vioxx, you know, they created a sentinel capability to look for signals around people who were having heart conditions and taking Vioxx. And then they left that system in place called the sentinel system so that you could look for drug safety issues by looking at whole sets of data in the population. I do think public health will help us think about why these things matter. Interoperability, it sort of mattered to a lot of people and in ways that are too abstract to explain oftentimes. People can say well I'm worried about privacy or it costs money to do this or I want to keep my data, this way or that way. When you have a real scare like this it's an opportunity for people to see why we can build assets that can really help us.
HLTH Team: I just read the playbook that United States of Care put out for a rapid COVID response at a city-level. Can you share a little information on that and what you guys are hoping for there?
Andy Slavitt: First we wrote something for Congress which was the five priorities that Congress needs to take care of. And we've had a number of opportunities to talk to Congress about that. Secondly, we have put together for states, and we'll continue to put together for states, a set of what are the best practices and kind of rapid response center and resource center as people are trying to set up and move to the next stage and next wave. So I think United States of Care has focused a lot on how to help those best practices spread, how to capture the things that are really helping and how to make that kind of thing work.
HLTH Team: Do you think there will be multiple waves of the virus? And if there are multiple waves, will the next one be worse, better, just about the same as this?
Andy Slavitt: There will be multiple waves. I did a call several nights with scientists and homeland security folks, and others just kind of talking about things and one person said that there can be as many as 40 or 50 different waves. Which is kind of crazy to think about but, you know, a lot of this just depends on the sort of sociological issues about like how much you can open up, when, and so forth. I think I'm worried, along with many others that, you know, we started to see some good numbers flattening the curve. There's a lot of political pressure to open up, we do it before we have the kind of testing in place we need and then we still see second outbreaks.
You still get Singapore in the last few days, we're talking now in April, 8 or ninth or whenever we're talking, in Singapore which has been very successful, is now just seeing a dramatic increase because they have started to open up again. So there's no silver bullet, right, there's no happy place where we can say oh let's just open up and everything's great again. It will be a tough process. And you know, we'll have to find a middle zone that's comfortable.
HLTH Team: How do you think that health industry professionals, startups, and entrepreneurs can help right now? How is this changing the startup landscape in health?
Andy Slavitt: Look, figuring out how to care for people who are most vulnerable to COVID-19 is going to be like an enormous challenge and therefore opportunity. Whether that's social services, medical care, text based services or obviously telemedicine. But finding ways to take in, you know, an isolated population, social work, mental health. So, I think that there's a whole litany of things that are going to become an even more important part of what get done every day.
Secondly, mental and behavioral health and addiction are going to be really important areas. I just read a paper that someone just sent me on what happens with sustained exposure to trauma. And it's pretty clear cut that this is going to feel a lot like PTSD for a lot of our healthcare workforce, and maybe a lot of others.
And the levels of anxiety and with, normally if you have a crisis or some kind of a healthcare crisis, or a financial crisis (we have both), you have your friends and your support structure to rely on. Here, you have those two things, and you can&rsquo;t see the people who help you get through all these things, so it's a really difficult period of time to manage. It's not like anything we've had to manage before.&nbsp;
So, you know, my view, just startups, has always been the same. If you're solving a big important problem, you&rsquo;re probably headed in the right direction. If you're focusing on a problem that was important yesterday or seemed important yesterday, but it's not important now, you have to ask yourself if it still makes sense to focus on that problem. And to me it's not a matter of &ldquo;just waiting it out&rdquo; it's a matter of saying, is what I'm doing going to be as valuable and be valuable again in the future and you have to be very very honest with yourself. Entrepreneurs are good at being in love with their own products, services and with our investors I think that there's going to be a different set of IDs then yeah and then I think there's always people who are starting businesses to exploit the opportunities. Those can succeed for a time, but they tend not to be long lasting in my view. I'm sure people will find opportunities to exploit here, but I don't think those are going to be the kinds of things that will make good lasting businesses that people should invest in.
HLTH Team: That&rsquo;s a good point on mental health. I saw Patrick Kennedy tweeted an article by Ben Miller earlier today calling mental health &ldquo;the epidemic within the pandemic&rdquo; which was well put. Anything&nbsp;else that you think our audience needs to know right now?
Andy Slavitt: I mean, you know, there's this interesting phenomenon in healthcare where health insurers are getting fat and health care providers are getting really low on cash, for good reason. There's a huge decrease in demand for services and you know a lot of places that have stopped with any elective procedures. So, I think health insurers should really take it to heart what their obligation is in a time like that. It's not just to reward shareholders because of this, it's actually I think to sustain the care provider community in a way that will keep care coming for the long term. So, I would like to see health insurers, for example, advancing payment care providers and saying here's what we paid you the last six months, we're going to pay you this for the next six months, to keep you in practice, and then we're going to, you know, over time we're going to, if you continue to deliver high quality results to patients we&rsquo;ll make that right but we'll keep you going. I worry instead we'll see people exploiting the situation buying up practices shuttering. And I think that becomes a forever restructuring of our healthcare system in ways that I don't think we want.&nbsp;
HLTH Team: That's a good point. Where do you think pharma plays a role in this. I know, obviously people are wondering if there is treatment that gets approved or vaccine, what will the price be on those? Will they make it affordable to all? Will they donate it, in some cases, do you think we'll run into a pricing issue?
Andy Slavitt: Someone's going to have to pay to have the vaccine made available to everybody or the vaccine doesn't do any good. There's probably some help from the federal government. You know, likewise with therapies, pharma successfully got rid of any language in the first bill that would have done anything to make sure the price was affordable of a vaccine or trial so I don't think people will necessarily change their stripes, but we value the work of the scientists inside the pharma companies a great deal. We want that. We want them inventing, we want them helping.
What we don't want is them taking drugs that have been on the market forever and look like other drugs and just inflating those prices unnecessarily. So, I don't think anybody shouldn't have a problem with rewarding the companies that create great therapies and good vaccines. But I think what we should be doing is saying all the people that take insulin every day or our blood pressure medication every day and make sure that those prices remain affordable to people, or we're going to lose a lot of people that we shouldn&rsquo;t

About Andy Slavitt:
During his decades-long career as a private sector healthcare technology leader, including as group executive VP for Optum, Andy Slavitt drove some of the most significant and successful initiatives in healthcare, impacting millions of Americans as well as the shape of the healthcare system.&nbsp;&nbsp;He was the former Acting Administrator of the Centers for Medicare and Medicaid Services under President Obama. Prior to that he was the Group Executive Vice President of Optum, and before that a healthcare tech founder and entrepreneur. He currently serves as Board Chair of United States of Care, a Senior Advisor to the Bipartisan Policy Center and is a columnist for USA Today and JAMA and is a frequent commentator on MSNBC, CNN, Fox and CNBC. He attended University of Pennsylvania and Harvard Business School.

COVID-19 Updates with Andy Slavitt

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
About Dr. Michael Le:
<a href="https://www.linkedin.com/in/michael-le-a0830030" rel="follow">Dr. Le</a> is the co-founder and Chief Medical Officer of Landmark Health, the nation&rsquo;s largest provider of in-home, value-based medical care. Dr. Le grew up a small town in western Massachusetts, where he watched his father practice small town medicine, including delivering house calls, black bag in hand, to frail patients in the community. Dr. Le is a passionate advocate for home-based medicine as the best setting of care for complex, chronic patients.&nbsp;
The COVID-19 pandemic has prompted many Americans to crack open their history books in an effort to draw inspiration and comfort from past crises we have confronted and overcome.&nbsp;
The Second World War provides an instructive case study. &nbsp;
To defeat the Axis Powers, we mobilized the full might of our nation&rsquo;s economic, military and industrial capacity. We overcame the enemy, not just on the battlefield but on the home front as well: we re-tooled manufacturing plants, planted &ldquo;victory gardens,&rdquo; and organized scrap metal drives. The home front played a pivotal and enabling role in nourishing, dressing and equipping soldiers on the front lines.&nbsp;
Without the home front, we may have lost the war.
A similar dynamic is unfolding as the healthcare system wages total war on COVID-19. Right now, our hospitals are the battlefront&mdash;many ICUs and ERs in hotspot areas are bursting at the seams with COVID-positive or presumptive patients.
Today, just as we did during the war, we must not overlook the home front. We mean that quite literally: we must bring primary care to the home for our most clinically fragile patients, with the explicit intent of keeping those patients away from hospitals overflowing with COVID-19.&nbsp;
Home-based medicine is not a novel concept: in 1930, 40% of all physician-patient interactions happened in the home. By 1980, fewer than 1% of all primary care visits were house calls. The house call provider, once a cherished figure in the American healthcare landscape, became a victim of the mass industrialization of primary care.&nbsp;
But house calls are making a comeback.&nbsp;
As our nation ages, demand for in-home geriatric care is growing by leaps and bounds, and the volume of home visits is growing rapidly. Modern home-based medicine is advancing quickly and encompasses a broad scope of activities. As home-based physicians, we diagnose and treat medical, behavioral, and social conditions in the comfort of patients&rsquo; homes. We manage medications to reduce polypharmacy risk, conduct home safety checks, and facilitate conversations on advance care planning.&nbsp;
Homebound patients benefit disproportionately from access to in-home urgent medical care 24/7: if a frail senior feels short of breath on a Friday evening, or has abdominal pain on Christmas Eve, a home-based provider can be dispatched to the patient&rsquo;s home to deliver urgent medical care, thereby avoiding an unnecessary trip to the hospital.&nbsp;
Across the country, though, there are millions of homebound seniors who have no access to home-based primary care. This problem is even more acute in the time of COVID-19, when the CDC is&mdash;correctly&mdash;instructing frail seniors to stay at home because of their susceptibility to the novel coronavirus. This vulnerable population, already socially isolated at baseline, is now even further disconnected from office-based primary care.
Many practices are trying to meet this gap by offering telemedicine, which we applaud.&nbsp;
But let&rsquo;s be frank: telemedicine will never replace the healing hand of a physician, particularly for frail seniors with chronic conditions. At Landmark, we use telemedicine as a complement to (not a substitute for!) in-home medical care, and that reflects the reality of our population: 20% of our patients have cognitive impairment or dementia;&nbsp;40% has hearing or vision loss; and fewer than one-third owns and can operate a smartphone. Telemedicine won&rsquo;t suffice for these patients; home-based primary care is the only scalable option standing between these patients and an overflowing ICU.
Other players in the healthcare ecosystem have a role to play in promoting access to home-based medicine for frail seniors. CMS could incorporate home-based medicine into its network adequacy rules for Medicare Advantage plans. Health plans, in turn, should develop financial arrangements that reward high-quality, in-home medical care. And acute care facilities can partner more effectively with local house call providers to ensure that patients are safely transitioned from hospital to home.&nbsp;
Now is the time to recognize the vital role of the &ldquo;home front&rdquo; in the war against COVID-19. House call providers (both at Landmark and beyond) are racing to patient homes around the clock and across the country. These home visits are providing an essential service not just to these homebound and clinically vulnerable patients, but to the community as a whole. At a time when the nation is struggling with a daunting shortage of critical care beds, we on the &ldquo;home front&rdquo; owe it to our colleagues on the ER and ICU frontlines to keep elderly patients out of the hospital and safe in their homes.&nbsp;

How COVID-19 is Changing the Conversation Around Home-based Medicine

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
HLTH Team: &nbsp;Can you tell us a little bit about your past experience working at the CDC?
David Van Sickle: Between 2004 and 2006, I was an Epidemic Intelligence Service officer at the Centers for Disease Control and Prevention in Atlanta. As part of the Air Pollution and Respiratory Health Branch, I provided epidemiological support to the National Asthma Control Program, and investigated the health effects of a variety of environmental exposures, including chlorine gas in South Carolina, carbon monoxide in Florida, and ambient ozone among student athletes in Georgia. I also helped establish emergency illness and injury surveillance in coastal Mississippi and New Orleans after Hurricanes Katrina and Rita.&nbsp;
HLTH Team: How do you feel the CDC&rsquo;s response has been so far to COVID19? What can we expect from them moving forward into later stages of the pandemic&rsquo;s progression?
David Van Sickle:&nbsp;I hope and expect a lot more public-facing leadership and activity from the agency. It has been weeks since CDC has held a media briefing. As others have noted, it is past time for them to assume leadership and command of the situation, prepare a national strategy, and mobilize every necessary resource required to slow and then turn things around.&nbsp;
Part of the problem is that we&rsquo;re demanding a return on investment we have failed to make in public health. Year after year, the CDC has had to make do with less. It is hard to overstate how valuable those investments -- at federal, state and local levels -- could be today. Compared to the U.S., the experience of coronavirus in countries with strong and prepared public health infrastructure could not be more different. There are no shortcuts, unfortunately.&nbsp;
HLTH Team: What is unique about COVID19 from a respiratory disease perspective? What makes it particularly dangerous?
David Van Sickle:&nbsp;Across the world, we&rsquo;ve seen coronavirus create a significant unmet need for life support ventilators. During my time at CDC, I responded to a train derailment in South Carolina that caused the release of approximately 60 tons of chlorine gas, sent hundreds to the hospital, and demonstrated the potential for even local disasters to overwhelm healthcare delivery. At the time, and in response to concerns stemming from September 11th, the Department of Homeland Security developed a set of National Planning Scenarios, published in 2006.&nbsp;
This document highlighted a number of catastrophes that would require access to many more ventilators than would otherwise be available. The scenarios included chemical terrorism, such as the deliberate release of chlorine gas from a railcar in an urban area, and a return of pandemic influenza. We&rsquo;re now confronting circumstances clearly anticipated by this work and finding ourselves dangerously unprepared.&nbsp;
HLTH Team: How has digital health stepped up to the plate in slowing the spread and helping to triage patients?
David Van Sickle:&nbsp;We&rsquo;ve seen digital health companies respond with a range of solutions, from diagnosis to treatment. A wide variety of tools are available to help people better understand coronavirus and COVID-19 screen themselves for the disease and locate where to get tested. Telehealth platforms have played a central role in helping people to consult remotely without having to visit a clinic, which has helped to minimize unnecessary impact on health systems.&nbsp;
Companies such as Big Health and Omada have worked quickly to make their digital health tools available to people affected by the pandemic, with the goal of minimizing mental health consequences. At the same time, CMS has implemented new guidance to clarify and encourage the adoption and reimbursement of digital health and remote monitoring.
At Propeller, we&rsquo;ve been collaborating with health system partners to help them adopt digital health for asthma and COPD. With clinics focused on COVID cases, and many in-person appointments cancelled, a digital health tool like Propeller can help them provide preventive care without a clinic visit, freeing up resources to meet the need of people with asthma and COPD who need immediate attention and the emerging demands of COVID patients.&nbsp;
HLTH Team: What makes those suffering from chronic disease at high risk and how can digital health help protect that particular population?
David Van Sickle:&nbsp;The clinical epidemiological data suggest that individuals with preexisting conditions tend to do worse when infected with coronavirus. This includes people with chronic lung disease such as asthma and COPD. Current guidance from the American Thoracic Society and the AAAAI, as well as GINA, recommends that people with respiratory disease continue to take their daily preventive medication during the COVID-19 pandemic.&nbsp;
Patients who adhere to their medications, and whose symptoms are well managed, may have fewer concerns about symptoms of chronic lung disease being associated with COVID-19. Patients with well-managed symptoms are also less likely to seek acute respiratory care at healthcare facilities and emergency departments, which decreases the risk of incidental exposure to SARS-CoV-2 and allows healthcare providers to focus attention on patients with other critical needs.&nbsp;
This is where digital health comes in. Patients who use a digital health platform to manage their asthma and COPD are proven to adhere to their medication regimen more closely, and experience fewer serious symptoms.&nbsp;
The good news is that since the COVID-19 outbreak began to ramp up in January, our data shows that people with asthma and COPD have been 14.5 percent more adherent to their medication, with the steepest increases occurring in the last two weeks of March. This indicates that patients are taking expert recommendations on adherence seriously and prioritizing their preventative health with the help of a digital health tool.&nbsp;
HLTH Team: How has state and federal governments best utilized tech during this pandemic? Where do you see tech becoming an even more important piece of the solution moving into the next several months?
David Van Sickle:&nbsp;We think&nbsp; the use of technology in the ongoing care of chronic disease will surge due to COVID-19. With federal reimbursement now in place to support remote patient monitoring and management, we can expect routine visits -- designed to assess patient status and make necessary adjustments to treatment -- to move online.&nbsp;
Because digital health tools can monitor patient well-being at a distance, it will be easy for providers to make evidence-based decisions on patient care by looking at digitally collected data. With these changes, it should be possible to lead more people to minimally-burdensome treatments that truly control symptoms and help them participate fully in the activities they choose.&nbsp;
HLTH Team: Lastly, what do you feel have been the top 3 lessons learned so far in battling this pandemic?&nbsp;
David Van Sickle:&nbsp;A global community of scientists and doctors came together in a way I&rsquo;ve never seen before. With the help of technology, the community immediately began collaborating, learning and improving day after day. We quickly had diagnostic tests, candidate therapies, and potential vaccines under study. Thankfully, coronavirus has neither the speed nor the agility to keep up.
But the approach of the clinical and scientific community, which united to face the virus and share and apply emerging knowledge and practices, has not been adopted as consistently by governments. Instead we&rsquo;ve seen slow and variable responses, muddied by disbelief and denial, resulting in avoidable disasters. At the moment, we have learned enough from the global experience to assemble a national strategy and effective counter-measures. What we need now is coordinated leadership to pull this together and put it to work.

About David Van Sickle:
David Van Sickle is the co-founder and CEO of Propeller Health, a leading digital health company dedicated to the management of chronic respiratory disease. He founded Propeller Health in 2010 after observing how digital health tools could improve the experience of chronic disease and give patients and their providers new insights into their disease. David received his PhD in medical anthropology from the University of Arizona in 2004 and went on to complete his dissertation research on the rising prevalence of asthma and allergy in India, a topic he previously studied among Native Americans in Alaska, Arizona and New Mexico. From 2004 to 2006, he served as an Epidemic Intelligence Service officer at the Centers for Disease Control and Prevention in Atlanta, assigned to the Air Pollution and Respiratory Health Branch. During that time, he provided epidemiological support to the National Asthma Control Program and investigated the health effects of a variety of environmental exposures. Between 2006 and 2009, David was a Robert Wood Johnson Foundation Health and Society Scholar at the University of Wisconsin School of Medicine and Public Health. David specializes in asthma, chronic respiratory disease, medical device development, health data and disease surveillance.

COVID-19 Updates with David Van Sickle

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
Frank Rivera: Patient Advocate- Fight for those who can't fight for themselves! Frank Rivera founded Sarcoidosis of Long Island in 2012. In 2011 Frank was diagnosed with Sarcoidosis after being misdiagnosed with lung cancer for 7 years prior. Since opening Sarcoidosis of Long Island he has been a local, state and federal advocate for Sarcoidosis. Frank strives to raise awareness for Sarcoidosis nationally, but specifically in the government sector. He has represented the Rare and Sarcoidosis community as a speaker at two Congressional briefings for Sarcoidosis.
<a href="https://twitter.com/SarcofI" target="_blank" rel="follow noopener">https://twitter.com/SarcofI</a>
Kristal Kent: Kristal is a Patient Advocate for the Fibromyalgia, Veteran, Chronic Pain and Chronic Illnesses Communities. Utilizing social media, Kristal educates and provides support for her communities. Kristal serves on the Cleveland Clinic Patient Panel and a Board Of Trustee for the Fibromyalgia Care Society Of America.
The Fibromyalgia Pain Chronicles:&nbsp; <a href="https://www.facebook.com/FibroPainChronicles/" target="_blank" rel="follow noopener">https://www.facebook.com/FibrolPainChronicles/</a>
Candace Lerman: Candace Lerman, Esq., is an attorney, consultant, and author of the rare disease blog, RareCandace.com. She earned her Juris Doctorate with a concentration in Health Law at the Shepard Broad School of Law at Nova Southeastern University in Fort Lauderdale, Florida and a certificate in Healthcare Compliance from Seton Hall University School of Law. In addition, she holds a Bachelor&rsquo;s and Master&rsquo;s degree in International Affairs from Florida State University. A rare disease patient, Candace researched and repurposed a drug to put her blood disorder into remission twice! She works closely with members of Congress on federal healthcare policy, and can often be found on Capitol Hill meeting with staff on various topics involving health policy. Candace serves on the board of Our Odyssey, an organization dedicated to fostering support and community among young adults living with rare and chronic conditions.
<a href="https://twitter.com/RareCandace" target="_blank" rel="follow noopener">https://twitter.com/RareCandace</a>

COVID-19 Discussion with Patient Advocates

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
In recent days, COVID-19 has dramatically impacted the health of our communities and the conduct of our daily lives. We have experienced great disruption and witnessed suffering around the globe. The rapid spread of the coronavirus has made one thing abundantly clear: we are all in this together, connected by our shared humanity. COVID-19 presents a major opportunity for businesses to advance society and deepen a sense of trust with consumers. &nbsp;&nbsp;&nbsp;
Trust in the competency of business is higher than in other institutions, filling a void left by government partisanship.&nbsp; Economic growth that has long fueled trust in institutions now sows deep-seated concerns about income inequality and future uncertainty, according to the 2020 Edelman Trust Barometer, particularly among consumers and employees.
The survey states that trust is built on two factors: (1) competence &ndash; delivering on promises and (2) ethical behavior &ndash; doing the right thing and working to improve society.&nbsp; Last year, the Business Roundtable redefined the purpose of an American corporation &ldquo;to promote an economy that serves all Americans,&rdquo; moving away a focus on &ldquo;shareholder primacy&rdquo; to serving all stakeholders.&nbsp;
The survey also found three-quarters of the general population believe &ldquo;CEOs should take the lead on change instead of waiting for government to impose it.&rdquo; Ninety-two percent said, &ldquo;I expect my CEO to speak up on issues of the day.&rdquo; Trust has become local, and the survey finds that the most trusted institution for most people is their employer.
The message is clear: today people expect &ndash; and trust &ndash; business leaders to lead the country through difficult times and help address the issues that impact us all.&nbsp;
We&rsquo;ve seen business leaders taking head-on critical issues like diversity, LGBTQ, sustainability, data protection and gun control, among others, and earning the public&rsquo;s trust in the process.&nbsp;
The COVID-19 pandemic is no different.&nbsp;
During this challenging time, businesses were among the first to implement working from home policies to flatten the curve and keep employees safe while continuing to serve customers.&nbsp; Businesses pooled together charitable donations to accelerate COVID-19 recovery efforts in local communities. These initial actions are laudable, and yet there is more that we, as business and industry leaders, can do to demonstrate leadership and build trust in our communities.&nbsp; Consider the following:
Conduct a needs assessment with non-profit community partners and public health officials.
Partnerships between businesses, non-profit community organizations and governmental entities will be essential to our recovery, levering the unique skills and strengths of each entity.&nbsp; Contact the community partners and public health officials in your state to assess local needs and determine how you can best partner with organizations that are providing critical services to those impacted. Food insecurity and blood supply shortages have emerged as urgent and immediate community needs.&nbsp;&nbsp;
If you have a philanthropic arm, consider allowing grantees to repurpose existing investments to address local, immediate needs related to COVID-19 as well as general operations to ensure they can continue to serve. If additional needs are identified, make short-term donations.&nbsp;&nbsp;
Donate supplies and/or dollars.
Call your local hospital or clinic to ask about their policies regarding dropping off donated supplies, ask what they need and see what you can find in your office.&nbsp;
Think about the supplies that are at your once-busy office. Do you have unopened first aid kits or hand-sanitizer? Boxes of gloves or masks that were never used? Cans of Lysol that are now just sitting in a storage closet? Consider donating them to a local hospital or urgent care clinic. Doctors, nurses and other healthcare professionals need equipment and could use all the help, supplies and support they can get.&nbsp;
If your business has a philanthropy program or a foundation, now is the time to make a monetary donation to a pooled COVID-19 recovery fund or directly to organizations that are protecting the health of our communities. Homeless shelters may need money to buy food for their residents. Urgent care clinics could be running low on thermometers and the funds to buy more. Food banks may need support as they accommodate more people than ever before. Donating supplies or dollars can help make a significant difference in your community.&nbsp;
Continue to learn and practice agile planning.&nbsp;&nbsp;
Community impacts will continue long after the virus has peaked.&nbsp; Underserved populations in our communities are the first to be impacted and last to recover during challenging times.&nbsp; Set up learning mechanisms and listening channels to inform future strategic decision-making and actions that mitigate long-term health and socio-economic impacts of the immediate crisis.&nbsp;
Look for opportunities to collaborate for greater impact.
None of us can solve COVID-19 on our own, but together we can make a difference. Look for other businesses and funding partners, both regionally and nationally, to identify best practices and expand your impact. This will be key to addressing the needs of people and families impacted by this outbreak and allow you to adapt those best practices to address local needs and concerns.
Implement a donation match program for you and your employees.&nbsp;
Matching donation programs &ndash; by team, department, or organization-wide scale &ndash; allow for employees to contribute what they can, while doubling or tripling the impact of their donation depending on the match you&rsquo;re able to put in place. It helps employees feel connected to something larger than themselves.&nbsp; Donation match programs can also be made open to the public, if you wish to do so. Opening donation matches to the public can allow those who are financially able to make donations and unable to volunteer in other ways, make a difference in their community while practicing social distancing.&nbsp;
Encourage other opportunities to give back.&nbsp;
During this challenging time, people often wonder what more they can do. We have seen examples of people across the country reaching out to help their neighbors in need, expressing gratitude for healthcare heroes and taking action to recognize and support caregivers.&nbsp; It is incumbent on businesses to help their employees engage, recognizing that intentional activity can reduce anxiety and help employees feel a greater sense of connection and control. Provide employees with specific, non-financial opportunities to support and give back to their communities like volunteering for local food bank, delivering meals to seniors, donating blood, making face masks or just connecting with those being forced to self-isolate.&nbsp;&nbsp;
As business leaders, we must take every chance we get to support our employees, customers and the communities that support us each and every day. By coming together and supporting our communities through financial and supply donations, employee match programs and volunteerism, we can truly make a difference for people working on the front lines of this pandemic and lead the way to recovery and resilience for all.&nbsp;
How are you and your business planning to give back to your community?

How Businesses Can Collaborate to Support Their Communities and Build Trust During the COVID-19 Pandemic

<a href="https://youtu.be/FPBKf-cGPEI" rel="follow noopener" target="_blank">Click here to watch the video on YouTube</a>
In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
About Dr. Jay Bhatt:
Jay Bhatt, D.O., MPH, MPA is a physician executive, internist, geriatrician, public health innovator and widely quoted expert on the most pressing challenges and exciting opportunities in health care. These include cross-sector initiatives; the application of predictive analytics and informatics; using Medicare and Medicaid as opportunities to redesign the healthcare system; addressing the social determinants of health to lower costs, improve outcomes and eliminate inequities; technology innovation; and emergency preparedness. As a physician executive, Jay&rsquo;s innovative initiatives have helped hospitals deliver safer, smarter and better care; made physicians and nurses more skilled and responsive to patients; and helped government across sectors impact health outcomes and the health of communities. These accomplishments have been informed by his earliest positions practicing internal medicine and geriatrics in underserved communities at the Erie Family Health Center on Chicago&rsquo;s Northwest Side and as the managing deputy commissioner and chief innovation officer for the Chicago Department of Public Health. Though hard work and fresh ideas, he became a trusted community leader and eventually was able to bring the voice of those patients to the Illinois Health and Hospital Association (IHA) and American Hospital Association (AHA) as a senior executive. Jay earned a B.A. from the University of Chicago; a Doctor of Osteopathic Medicine (D.O.) from Philadelphia College of Osteopathic Medicine; a MPH in public health from the University of Illinois at Chicago; and a MPA in public administration from the Harvard Kennedy School of Government as a Zuckerman and Commonwealth Fund Minority Health Policy Fellow. Over the years, Jay has received many honors. He was an Aspen Health Innovator Fellow and a Presidential Leadership Scholar; was named to 40 Under 40 lists by Crain&rsquo;s Chicago Business, the National Minority Quality Forum, MedTech Boston and Becker&rsquo;s Healthcare, where he was a Rising Star; and received UIC School of Public Health&rsquo;s Distinguished Alumni Achievement Award, the National Medical Fellowships&rsquo; Champions of Health Award and the American College of Physicians&rsquo; (ACP) Walter J. McDonald Award for Early Career Physicians. He was also named a leader in the ACP&rsquo;s Resident/Fellow Membership and is part of the National Health Service Corp, a program aimed at reducing health workforce shortages in underserved areas.
Follow him on Twitter @bhangrajay, Instagram at drjaybhatt and <a href="https://www.linkedin.com/in/dr-jay-bhatt/" target="_blank" data-saferedirecturl="https://www.google.com/url?q=https://www.linkedin.com/in/dr-jay-bhatt/&amp;source=gmail&amp;ust=1587068901489000&amp;usg=AFQjCNHE2vmojFucaDLLWa4s4wzFw9pyXg" rel="noopener">LinkedIn</a>.

COVID-19 Updates with Dr. Jay Bhatt

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
About WEGO Health:
WEGO Health is a mission-driven company connecting healthcare with the experience, skills and insights of Patient Leaders.
We are the world&rsquo;s largest network of over 100k Patient Leaders, working across virtually all health conditions and topics. Our network collaborates with pharmaceutical and life sciences companies, agencies, consultancies, startups and all types of organizations across healthcare.
HLTH Team: How has the patient leader community responded to the COVID pandemic?
WEGO Team: Having been a part of this community for many years now, I really feel so inspired by the work that all of these patient leaders do. During this recent COVID-19 outbreak, the impact that they have been making has been amplified. It&rsquo;s not only within just their own conditions but to the larger population. Now people are really starting to notice what an important role these patient leaders play. Every day people are drawing on their experience. I really think that patient leaders are teaching the rest of the world empathy, connection, and support in this moment of crisis. For years, they have helped their own communities just survive the uncertainties of their own conditions. So navigating with symptoms, diagnosis, treatment options and negative situations and they have really mastered the art of validating others fears and concerns while proactively suggesting positive approaches that they can do to combat their anxieties and the conditions that they face. They are really now taking these lessons learned from their own communities and applying it to the situation at large. For example - it&rsquo;s not just within the breast cancer space, it&rsquo;s everybody now. They&rsquo;re promoting ways to deal with the negatives creatively and showing people they can still spark joy and do fun things that they used to.&nbsp;
One thing we&rsquo;ve been doing here at WEGO Health is we&rsquo;ve been hosting zoom roundtables with patient leaders. One of the HIV patient leaders <a href="https://app.wegohealth.com/JesusH">Jesus</a> said in one of the calls &ldquo;besides what I&rsquo;ve been advocating for already, it&rsquo;s really helping people realize there is hope and a light at the end of this tunnel.&rdquo; They&rsquo;re really stepping up helping not only their communities, but the greater good.
HLTH Team: That&rsquo;s wonderful! How do you think the role of the patient leader has changed in this time of crisis?
WEGO Team: Before now (and of course there are always outliers), a majority of people always stayed within their condition areas. But now, they really are stepping outside of that condition zone, if you will, and helping the broader people. They&rsquo;re recognized as health leaders, so people are coming to them for advice and resources that wouldn&rsquo;t normally come to them. I&rsquo;ve heard people say on any given day I have &ldquo;X&rdquo; amount of dm&rsquo;s on Facebook from the IBD community, but now I look and it&rsquo;s the IBD community and everybody else that follows me on Facebook and on my private Facebook. These individuals realize these patient leaders are really good at weeding out the fake news and they&rsquo;re really good at asking the right questions. One of the arthritis patients we work with, <a href="https://app.wegohealth.com/37500595">Maria</a>, on one of our zoom calls said she was saying how she had some of her friends, and they weren&rsquo;t necessary in the arthritis community, following her on twitter and they realized what an expert she&rsquo;s become. She said I realize I have become this safe voice within this conversation because I already know what I&rsquo;m talking about when it comes to medication and dealing with doctors and dealing with hospitals. So people are coming to me and asking me, &ldquo;hey can you decode what these CDC guidelines are&rdquo; or &ldquo;hey does this treatment really sound like it&rsquo;s going to be effective?&rdquo; They&rsquo;re drawing upon their experiences to help the broader population.&nbsp;
HLTH Team: How do you think that patient leaders are extending themselves to their communities to cope with this pandemic and remain informed? It would be great to hear specific examples of those who are going above and beyond.
WEGO Team: From what I&rsquo;ve been hearing, it&rsquo;s a balancing act of wanting to be there for others but then also realizing it&rsquo;s a tough time for them too and staying sane themselves. People are saying they&rsquo;re getting inundated with questions and are only answering questions at a certain point in the day otherwise they&rsquo;ll get so bogged down.&nbsp;
There are some patient leaders within our network that have banned together and started a hashtag campaign for the high-risk community around COVID-19 (<a href="https://www.wegohealth.com/2020/03/17/highriskcovid19/">#HighRiskCOVID19</a>). This started because at the beginning of all this, the everyday person was saying that you are only at high-risk for COVID if you have a chronic illness or you&rsquo;re part of the elderly population. This spread like wildfire throughout the patient leader community as people were offended saying &ldquo;hey, we&rsquo;re people too!&rdquo;. They really wanted to educate the general public and to make a point that they mattered too and that yes, they may be high-risk but you can&rsquo;t just negate this. There were then leaders across condition areas who stepped up to start this campaign. They&rsquo;re having anyone who has a chronic illness post a picture and share their story about how they&rsquo;re high-risk. They really wanted to educate the general public by saying &ldquo;just because you don&rsquo;t think you&rsquo;re high-risk, I look like I&rsquo;m seemingly healthy and fine but I&rsquo;m at high-risk. You going out and doing everything you&rsquo;d normally do is putting me in harm&rsquo;s way.&rdquo;
It&rsquo;s been great to see people sharing each other&rsquo;s resources. There have been individuals who have been doing yoga classes on social media or video conferencing as well as people doing meditations. People in cross condition areas are sharing that out to their own communities.&nbsp;
HLTH Team: You mentioned high-risk groups, help us define which particular patient groups you really do consider high risk and that you&rsquo;re particularly concerned about. What advice are you giving them as well?
WEGO Team: What I&rsquo;m seeing in our community is that the majority of the patient leaders that we work with have a chronic illness and if you have a chronic illness, they already take extra precautions even when it&rsquo;s just cold and flu season and making sure that they&rsquo;re staying healthy. I feel like all the patient leaders that we have in our network are just trying to say to their own communities; &ldquo;be cognizant of your own health issues, be practical, follow the CDC recommendations.&rdquo; If you can stay home, stay home. Above that, I really feel like, in all of the conversations I&rsquo;ve been having with patient leaders, they&rsquo;re not necessarily focusing just on high-risk, but they&rsquo;re focusing on educating the general public about how even if you aren't at &ldquo;high-risk&rdquo; for getting the virus, you still could be a carrier, you&rsquo;re still putting everyone else in danger of getting this virus. To be smart, to stay at home and to educate them on how it really is affecting everybody. Specifically to your question, how would I categorize high-risk, I would say anyone with a chronic condition.
HLTH Team: What has WEGO in particular been doing to engage with patient leaders?
WEGO Team: When I look at patient leaders, I really look at them as patients and leaders. They need support on the patient side, and they need support as leaders. So, at WEGO Health, we really try to step up all the time to support them as leaders, but now more than ever, they really do need the support from the other leaders. They&rsquo;re getting so inundated with messages from everybody now, so we brought back regular Twitter chats to bring the community together. We have been holding Zoom calls, so our leaders in our network can come and sign up to get on video Zoom calls and talk to other patient leaders. At first, we weren&rsquo;t sure if people just really wanted the interaction of being with each other, so the first week that we held them, some of the topics that we talked about were specific to COVID-19, then others we made more broad, more like patient leader support type topics. And every single time it always came back to COVID and it always came back to what&rsquo;s going on right now and how they can support each other and support the network. So, I really feel like bringing them together and being able to play off of each other is important at this moment. Someone in the breast cancer community can talk to someone in the fibromyalgia community and they can learn from each other. So, that&rsquo;s been really great to see.
And, on our <a href="https://app.wegohealth.com/">WEGO Health platform</a>, which houses different courses that patient leaders can take to increase their skills as a patient leader. We have discussion boards on there and we also host paid opportunities on there. What we&rsquo;ve now done is we&rsquo;ve spun up a COVID-19 channel that has specific resources to the patient leaders that either was created by leaders in the network or we&rsquo;ve created it. So there are some practical things they can share out to their communities. There are also fun things like, we had the community suggest different songs to put in a COVID-19 playlist - so we&rsquo;ve been trying to keep it lighthearted as well. And then, the last thing we&rsquo;ve been doing is, we have these WEGO Health Answer sites - they&rsquo;re basically questions and answer sites where regular patients ask a question and a patient leader answers them in video form. It&rsquo;s not live yet, but we are spinning up a COVID-19 specific one. There will be CDC recommendation info on there, but then also patient leaders speaking on behalf of their own communities.&nbsp;
HLTH Team: Anything in particular, you&rsquo;re doing to assist with mental health challenges that your patient groups might be facing right now?
WEGO Team: Right now, the zoom calls we&rsquo;re holding I would categorize under mental health. I feel like every time we get off it&rsquo;s almost like a therapy session. Other than that, we haven&rsquo;t been doing anything specific. I had mentioned before there are some patient leaders doing meditations and yoga classes - we&rsquo;ve been sharing that out with our network. We&rsquo;ve been trying to pull resources that our network has been creating and give it to them.
HLTH Team: Anything else you&rsquo;d want to share with our community?
WEGO Health: I love the fact that the everyday person is now realizing how important patient leaders are. Selfishly, I think it&rsquo;s great they can finally get the recognition they deserve! I hope that after all of this, it doesn&rsquo;t just go back to the way that it was, but they really start to lean on these patient leaders going forward for everything. These leaders are there, they&rsquo;re so knowledgeable and they won&rsquo;t be going away after all of this COVID19 craziness dies down.

COVID-19 Updates with WEGO Health: The Role of the Patient Leader Community

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
HLTH Team: How is Livongo using technology to address COVID for the hundreds of thousands of your members, specifically those living with chronic conditions?&nbsp;
Dr. Schneider: As you know, people living with chronic conditions, myself included, were no more likely to get COVID. We are, however, at higher risk from complications. So if you look at death rates, somewhere between 70 and 90 percent of people who die with COVID-19 infections have a chronic condition, depending who's reporting the statistics. So diabetes, hypertension are at the top of the list. So what [Livongo&rsquo;s] been able to do from the get-go is monitor where that vulnerable populations are to and provide care in their own settings. So we're not asking them to come into the healthcare ecosystem. We've just been able to [passively] collect data, provide advice, and nudges and continue monitoring them and connect to live coaches when needed or when necessary. In a setting of COVID-19, we've also launched fifteen unique modules within our behavioral health solution that are beneficial for people in this time of physical distancing, working from home, increased anxiety and stress. So we've added that and continued to deliver our existing services, which allow that vulnerable population to stay in their own house and receive wonderful care. In a way it&rsquo;s better than telehealth in terms of how we are collecting the data. We're not waiting for someone to call us. We're passively monitoring them and collecting their data streams.
Watch the Livongo Live @home, online event, co-presented by HLTH and Livongo for more information on Livongo&rsquo;s COVID-19 capabilities and advice from leading experts on staying healthy. Watch the recording <a href="https://www2.livongo.com/news/livongo-live-at-home-watch">here</a>.&nbsp;
HLTH Team: What makes the patients suffering from chronic conditions more at risk? Is it a particular characteristic of the virus itself and which chronic conditions are more vulnerable than others?&nbsp;
Dr. Schneider: Yeah, it's a great question. Nobody knows for sure, but if you look at mortality rates, respiratory illness, cardiovascular, diabetes, there's a CDC website that detects different mortality with each of those chronic conditions. These numbers are constantly changing, but a recent CDC report did show that 78% of people who were admitted to the intensive care unit due to COVID-19 had at least one pre-existing health condition. Now, again, in all types of mortality statistics, it is challenging to determine denominator because we're not testing the whole population, but across the board we are seeing the trend that people with chronic conditions are at higher risk of complications from COVID-19.
HLTH Team: Do you think that your organization is prepared for such a widespread health pandemic? Once you realized that things were going to get bad - what did you do to further prepare?
Dr. Schneider: These are unprecedented times for all of us. From our own employee workforce, we already have a third of our employees working from home - we call them Remotie Nation. So it was an easy transition in a cultural standpoint, to be able to transition the remainder of our employees into a work at home situation. And again, because our product is all about meeting people where they are in their time of need - collecting data, living their life on the go, there were no tweaks to the product&rsquo;s solution as it currently existed because it already addressed many of people&rsquo;s needs when staying healthy and at-home. I often say that the pandemic has accelerated the work that we've been doing and I think made the healthcare ecosystem recognize that remote monitoring and telehealth services are very valuable. Remote monitoring is not a new idea or new technology.&nbsp; Livongo entered the COVID crisis with over 800 clients and hundreds of thousands of members live on our platform. But [COVID-19] has accelerated the broader adoption and recognition of the value that we play today.
HLTH Team: For companies with remote monitoring and telehealth capabilities, what have been the biggest challenges so far with scaling up operations to meet the growing demands now?
Dr. Schneider: You know, I would say that from our vantage point, we don't have any issues scaling with our supply chain. And we've built our platform on a reinforcement learning platform which allows us to do most of our coaching digitally and deeply understand when members need our human coaching capabilities. And so we can offer that as a scalable solution. I do know that some solutions, such as some of the telehealth vendors have experienced increased wait times. So companies that are highly dependent on human volume or have had their supply chain broken have been hit harder. Those are areas that have some risk. Thankfully, Livongo is not in either of those camps.
HLTH Team: You mentioned your behavioral health solutions before, which are extremely important during these challenging times. What have you seen people utilizing the most for so far?&nbsp;
Dr. Schneider: We have seen a lot of stress and anxiety come through. We've launched our COVID-19 set of modules and now have made those free to all people nationwide through the end of June. And those include things like living with people in tight quarters, stress and anxiety, working from home. There's a number of those modules within that package. And so that package has seen an uptick in utilization. In addition, when our members with diabetes leverage our solution, they've always been able to address the feeling tag associated with their blood glucose. And we've seen an increasing number of those tags as being stress or with anxiety. And so there's a clear need, which is not surprising all. But I think we&rsquo;re feeling it to some degree greater, less in this ecosystem.
HLTH Team: If we focus on employers and health plans in particular, what do you think their biggest challenges have been so far in facing this pandemic?&nbsp;
Dr. Schneider: So many businesses have been interrupted. Right. Businesses that rely on daily purchasing, businesses that rely on travel, hotels, airlines. I'm sure you've read about the number of wage reductions and furloughs that are taking place across the ecosystem. There's other industries like healthcare providers, who are looking at protecting the population. You know, my heart goes out to so many of my colleagues and friends who are on the frontlines and really doing incredibly brave work in the pandemic. And so I think each industry or just each company has a different set of areas that are either decelerator or accelerators or different stressors across their employee population. But we hear continuously from all the employers, that they continue to remain focused on their most vulnerable populations, ensuring the safety of that population. And that's where I think we've been able to offer a service that keeps the vulnerable population and people outside the healthcare ecosystem and safely monitored and managed at home.
HLTH Team: Digital health has really stepped up during this time. Do you think that the way people view digital health will permanently change based on this pandemic?
Dr. Schneider: Yeah, I think digital health is a very, very broad umbrella term. Like I said earlier, remote monitoring and telehealth services that can be provided without the need for an inpatient visit, which is both good for the healthcare system and more enjoyable for the consumer. And while very important in the times of a pandemic like we are having now, I do think adoption will just be accelerated. It will be interesting to see which companies are able to scale to meet the demand.
HLTH Team: Once we're on the other side of this crisis, what will be the biggest lessons learned or biggest takeaways?&nbsp;
Dr. Schneider: As a mom homeschooling three children, I will say that it's amazing what somebody can get done in a short amount of time. My kids have all said to me that in the three weeks that they've learned more French, Spanish, math, geography, in the hours that I get them to work in the house than they do at school. So, there's a realization around the utility of time. Second is our ability to communicate and connect above and beyond in person. The healthcare ecosystem was already shifting and there is now an expedited adoption. Doctors are seeing their patients remotely. I have a friend who's an OBGYN and she knows that she can&rsquo;t do everything she needs, but she can do all the fetal monitoring work for the individual remotely. In many ways, that's a wonderful experience for the expecting mom as well as the healthcare ecosystem. So keeping people healthy where they want to be receiving that care I think is a really great thing. And I think we'll see more of that to come.
HLTH Team: Any other thoughts or advice that you'd want to share with our community?&nbsp;
Dr. Schneider: Yeah, the last thing I would say is that we are in unprecedented times. Things will forever look different. There will be many new opportunities that come out of this and many wonderful things that are unexpected. I am really honored and humbled by the work that so many people are doing on the front lines. And, you know, I think this is a time where kindness and grace really shows through in both our cultural items that I think will be prominent and more prominent as we come through this together.
About Dr. Schneider:
Dr. Jennifer Schneider is the President of Livongo. In this role, she is responsible for product, data science, engineering, marketing, and clinical operations. Dr. Schneider previously served as the company&rsquo;s Chief Medical Officer where she led the company&rsquo;s strategic clinical product vision, data science, clinical trials, and the organization&rsquo;s certified diabetes educators and coaches. She is the author of Decoding Health Signals: Silicon Valley&rsquo;s Consumer-First Approach to a New Era of Health, which offers a guide to the depth of the chronic conditions problem facing the industry today and explores how companies are using big data analytics and artificial intelligence to reinvent care delivery for people with chronic conditions.&nbsp;
Prior to Livongo, Dr. Schneider held several key leadership roles at Castlight Health, most recently as Chief Medical Officer. She also has held leadership roles in the provider setting as a health outcomes researcher and Chief Resident at Stanford University, and has practiced medicine as an attending physician at Stanford University, the VA Palo Alto Health Care System, and Kaiser Permanente. Dr. Schneider has an undergraduate degree from the College of the Holy Cross, a Doctor of Medicine degree from Johns Hopkins School of Medicine, and a Master of Science degree in Health Services Research from Stanford University. She completed her internal medicine residency at Stanford University Hospital.
Dr. Schneider is a frequent speaker about innovation in healthcare, where she shares her unique perspective as a practicing physician, health services researcher, senior executive and individual who has lived with Type 1 diabetes for more than 30 years. She has three children and is an avid runner and athlete, having completed her first IronMan in 2016.

COVID-19 Updates with Dr. Jennifer Schneider: Using Remote Monitoring to Care for People with Chronic Conditions

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
HLTH Team: How should women delivering in the upcoming weeks think about their birth plans? Should they make any changes?
Dr. Jane van Dis: There are a lot of changes and the important thing to know is that unfortunately, it does change week to week and even day to day. So having said that, I can say with pretty good accuracy that most hospitals are limiting visitors to one partner. From ObGyns I know, there are hospitals in which the timing of when the partner can come to Labor &amp; Delivery has changed as well, really just to limit the amount of potential exposure to the healthcare workforce and other moms and babies. We all know that two weekends ago in some New York City hospitals were banning birth partners, but then reversed that decision.&nbsp;&nbsp;
I think one really good and important moment out of this series of events is the acknowledgment that support during labor is essential for women and improves their outcomes. Having said that, there are of course times where you might want your partner and your doula as well. The way to bring your doula in the birth room may be through telemedicine or a Facetime platform. So encouraging women to know that as the policies change and as they prepare for giving birth that some of the ways that we reach out to each other virtually for support will be available via telemedicine. On <a href="https://www.mavenclinic.com" rel="follow">Maven</a>, we have doulas who can be with women during labor, we have certified nurse midwives, and other types of personnel that may be helpful. Encouraging women to prepare for labor and still have the support that they need is essential &ndash; even though some of that may be via telehealth.&nbsp;
HLTH Team: Those are great options! For women planning their delivery, how can they stay safe if the hospital is treating COVID patients as well?&nbsp;
Dr. Jane van Dis: It&rsquo;s funny, someone said to me the other day they were worried about the potential of contracting COVID while going to labor and delivery. What I will say is that infection control is something that hospitals and practitioners like myself practice everyday and have done so for years on end. We understand how to be safe and how to keep our patients safe. I would encourage women not to let fears about the hospital taking care of COVID patients affect their feelings about whether or not to give birth in a hospital solely based on infection fears. We at hospitals have taken a lot of care and thoughtfulness in terms of our policies and procedures. Infection control is a language that we&rsquo;ve always spoken. We will do everything in our power to keep patients safe. Having said that, as the conversation has evolved in the last days around masks, I think that pregnant women can expect that when they come to labor and delivery, regardless of if they have had any signs of symptoms of COVID, they will have a mask on. Their partner will also be expected to wear a mask at all times while in the hospital. This is for the safety of the patients, the newborns and the healthcare workforce. They shouldn&rsquo;t be afraid that everyone in the hospital is wearing masks, that&rsquo;s becoming standard in the last few days and weeks.&nbsp;
HLTH Team: How about women who are not expected to deliver in the near future - should they expect to postpone prenatal care or OB-GYN visits?
Dr. Jane van Dis: What we&rsquo;re seeing is a lot of consolidation of visits and moving some of the non-essential, in-person visits over to telehealth visits. I saw an algorithm recently from the University of Michigan Department of OB-GYN and then actually had narrowed the number of in-person visits to five. So what you&rsquo;re seeing is that we&rsquo;re looking at in-person visits being ones where key laboratory tests are necessary as well as key imaging studies and really being able to move some of those other visits over to telemedicine. Again, that is to keep the patient and the OB-GYN or midwife safe.
HLTH Team: Can you elaborate on other ways telehealth is aiding women&rsquo;s health during this crisis?
Dr. Jane van Dis: I can not speak highly enough or emphasize enough the importance of mental health care during this time. Even outside of COVID, pregnant women carry a lot of responsibility just being pregnant, knowing that they are bringing a new life into the world. That level of responsibility can feel crushing at times during this pandemic and this sense:&nbsp; How do you maintain control and how do you feel a sense of well-being when everything around is changing. Whether it&rsquo;s the nature of your prenatal care visits, or your employment and finances, or how many people you had planned on bringing to your delivery, all of that has changed, and know that there will be so moments of anxiety, sadness or grief around all those changes. In addition, I&rsquo;m sure that some of our pregnant moms across the country know someone who has been sick or maybe even passed away from COVID. There is going to be an enormous need to reach out and I want to encourage all pregnant moms to think about their mental health during this time.&nbsp;
At Maven, we have six different types of mental health practitioners and they are experienced in women&rsquo;s health and maternal mental health. Recognizing those feelings of anxiety and sadness can be overwhelming and reaching out can be an essential part of your healthcare during this pandemic.&nbsp;
HLTH Team: I imagine after as well because normally after a birth, your house is flooded with visitors and it may seem a little lonely now, so that seems like a great resource for women.&nbsp;
How about people planning to get pregnant within the next year? Should they postpone those plans or can they move forward as planned?
Dr. Jane van Dis: I think that&rsquo;s such a good question but it&rsquo;s a really challenging question in part because it&rsquo;s so personal &ndash; deciding when to become a parent. What I will say is that the risks due to COVID are small, the risks in the first trimester are around fever. As a women&rsquo;s healthcare provider it&rsquo;s really not my place to say whether someone should or should not become pregnant. I will say if you had a high risk pregnancy in the past, health care and prenatal care services are contracted at this time and that it might be better to wait for your own safety.&nbsp;
HLTH Team: That makes sense! Outside of pregnancy, what advice would you give women who are seeking care during this time? What would you consider an emergency?
Kate Ryder: All of our providers are not just for pregnancy so anyone can go on Maven and download our app and talk to an OB-GYN, pediatrician, nurse practitioner, and midwife for any number of issues. My 65 year old mother used Maven a few nights ago because she couldn&rsquo;t go in-person and get care so really our telemedicine network is accessible to anyone.&nbsp;
HLTH Team: And you&rsquo;d recommend doing that first before going to the ER or hospital?
Kate Ryder: Yes, given the guidance from the CDC and all medical bodies in the government, everyone should try to do telemedicine before ever walking into a clinical environment right now.&nbsp;
HLTH Team: A lot has been said about the impact of COVID on infants and small children. At first we thought they were immune and now we&rsquo;ve seen some cases where that wasn&rsquo;t the case, what generally are you finding in regards to how at risk infants and young children are to the virus?&nbsp;
Dr. Jane van Dis: This question has to be on the hearts and minds of many and yet the answer&rsquo;s really, scientifically, are not there. We are still trying to answer the question &ldquo;is it possible for the mother to pass COVID to the baby?&rdquo; and we just need more information there. When we&rsquo;re talking about pediatrics, for the most part, we&rsquo;re talking about data that we saw coming out of China which was, as others have probably read as well, really good in terms of how sparing the virus was for children. Having said that, we did see 10 month old and 6 month old deaths in the last week due to COVID. I think we just have to wait and get more data in order to be able to answer that question robustly or sufficiently. What we will say is that if you are sick and home with children, there are some precautions you can take to prevent giving the illness to children.&nbsp;
HLTH Team: In the event where you&rsquo;re a single parent, or maybe your partner is an essential worker, and you do come down with COVID, what tips would you give when you&rsquo;re still caring for your children and also recovering at the same time?
Dr. Jane van Dis: I am actually a single parent, so it is something that I have thought deeply about. I think that the types of tips that you can take are really just to mask yourself at home, if you are positive with COVID. Wash your hands probably more times a day than you ever imagined. We talk about what to do in the setting where a mom is COVID and she gives birth. How does she prevent transmission of COVID to the newborn? The advice there, coming from the CDC is just a lot of hand washing, wearing a mask, making sure not to cough or sneeze on the child. Washing dishes that you might potentially share. Something like that. So I think it just involves a lot of protection of the face and then massive amounts of handwashing.&nbsp;
HLTH Team: Have they found anything with breastfeeding, is that considered safe for COVID patients to continue?
Dr. Jane van Dis: Yes, so we have no indication that the virus passes through breast milk. So what I have also said to moms who may be COVID positive and are thinking about breastfeeding, is that breastfeeding is actually still the best food that a baby can have. If you want to take all the precautions possible as a new mother, you could potentially pump the breast milk and have someone else in the household feed the baby. Making sure to obviously wash the pump pieces very carefully and even wash the breast with a soft soapy cloth before placing the pump on the breast. But that would provide all the nutritional needs for the baby, keep your milk supply established while still creating some of that physical distance. And we're only talking usually around 14 days for the woman to recover, so I just want to make sure that women know that breast milk is still the best even in the setting of COVID. I worry too we have to think a little bit about the food insecurity that could happen with infant formula. It's possible that there could be limited or no infant formula available in your region or locale. Making sure you have good breast milk if you&rsquo;re able is going to be the healthiest thing for the baby and for the family. Recognizing, too, that some moms have medical complications or multiples (like me, I had twins) and will be unable to exclusively breastfeed.&nbsp; Knowing that some moms can't always exclusively breastfeed and they will absolutely need to be able to buy formula to feed their baby.&nbsp;
Team HLTH: That&rsquo;s important to know. Both of you are working mothers during this time, I know it's probably a lot juggling working and then full-time caregiving at the same time. So what advice would you give for parents out there doing the same?
Kate Ryder: Don&rsquo;t be hard on yourself right now. Lots of self-care because you as the mom need to be well to be able to take care of your family.&nbsp;
Dr. Jane van Dis: I have to give a shoutout. I have the best kids, my daughter is with me right now, and she is so amazingly self sufficient. I am so blessed because I work for Maven during the day and I work at the hospital on some nights and so I am pretty busy too. So thank goodness for good kids and TV.&nbsp;
Kate Ryder: Mine are three and two, so i think that the advice there also would be schedules. Try to get on a schedule, if your kids are young, as quickly as possible because that keeps their behavior in line.&nbsp;
Team HLTH: For kids that may start to ask some questions about what&rsquo;s going on right now, for example why can't we go outside and play as usual, see grandma, etc. What advice would you give to parents there?
Kate Ryder: I can speak from the perspective of my kids, my son kind of knows something is wrong, and so I think just always painting a picture of it's all going to be okay. It&rsquo;s so important for psychological safety for kids. Eventually we will be on the other side of this. I think the silver lining of this time, as maddening as particularly your kids can make you, is that families will be closer and at a time when a lot of dialogue in the world is about how apart everyone feels. Some of the stories I was reading out of Hong Kong and Wuhan after 6-7 week lockdowns, is yes there were times of sheer madness and anger and frustration, but there were also a lot of times of love and new habits. You will emerge closer as a family unit whatever your family unit is over the next however long we&rsquo;re here.
Dr. Jane van Dis: One thing that I did, I have asked my kids, if we can, we try to do this as a family, to have daily reflections. We sit in the living room each with our own notepad and write down what we&rsquo;re reflecting on that day in order to sort of coalesce some of our feelings.&nbsp;
Team HLTH: That&rsquo;s so nice, how old are your kids?
Dr. Jane van Dis: I have 12 year old twins.
Team HLTH: Any other advice that you would give to parents out there, on simply getting through this, whether they are working or potentially laid off from their job during this time?
Kate Ryder: Again, just being gentle with yourself and self care. This is not normal, this is abnormal. And to not think that this is the new normal. Just to remember that there is going to be a time where we're all beyond this. So just cutting yourself some breaks, and trying to see the silver linings.

About Dr. Jane van Dis:&nbsp;
Jane van Dis, MD is a board certified ObGyn and Medical Director at <a href="http://www.mavenclinic.com/">Maven</a> and has been practicing telemedicine in Women's Health since 2011.&nbsp; She also works as an OB Hospitalist in La Ca&ntilde;ada, California at Keck-USC Verdugo Hills Hospital, and is a founder of <a href="http://www.timesuphealthcare.org/">TIMES UP Healthcar</a>e and CEO of <a href="http://www.eqmedicine.com/">Equity Quotient</a>. She is a single mom to 12 year old twins.&nbsp;&nbsp;
About Kate Ryder:
Kate Ryder is the founder and CEO of <a href="https://www.mavenclinic.com" rel="follow">Maven</a>, the leading women&rsquo;s and family digital health company. Working with employers and health plans, Maven closes critical gaps in care with its fertility, pregnancy, and pediatric programs, which improve maternal outcomes, lower healthcare costs, and attract and retain more women in the workforce. During the COVID-19 pandemic, with the largest women&rsquo;s and family health telemedicine network in the country,&nbsp; Maven has been innovating around the clock to provide high-quality care to women and families in need of more access and support.&nbsp;
Kate founded Maven in 2014, reimagining healthcare for women and families from the ground up after seeing first hand how the lack of access to care impacted those starting a family and returning to work as new parents. Prior to founding Maven, Kate worked in venture capital and as a journalist, writing for the Economist from Southeast Asia, New York and London and for the New Yorker. Kate has been named to Crain&rsquo;s New York Business 40 under 40 and to Fast Company&rsquo;s &ldquo;Most Creative People.&rdquo; She lives in Brooklyn with her husband, son and daughter.

Women's Health During COVID-19 with Maven Clinic

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.

In the middle of the coronavirus pandemic, our response needs to be focused on reducing illness, providing care and saving lives. While we are doing what&rsquo;s needed to reduce the spread of coronavirus, especially staying home, let&rsquo;s not forget our vulnerable neighbors in our communities who also need access to information &amp; care. There are some people who are too often forgotten during national emergencies: those who are homeless, low-income families and immigrants.
As most of us are sheltering in place and staying at home to prevent the spread of coronavirus, those who are homeless do not have a home to retreat to. This leaves them more exposed and at higher risk to contract the virus. Additionally, they do not have the same access to soap, water, disinfectants, etc. for basic prevention. This is where local community partnerships are immensely helpful.
Partnering during public health emergencies is critically important and time sensitive. We all need to step up and offer assistance wherever we can. At Providence, we have taken the initiative to make donations to local food banks and shelters to ensure they receive the necessary supplies like soap and disinfectant. For now, while the coronavirus continues to spread, please consider donating supplies or funds to your local shelters, food banks and community organizations for the many people in need. Viruses don&rsquo;t discriminate. We can&rsquo;t hope to curtail the spread or reduce illness unless everyone in our communities has adequate information and the basic resources for prevention.
For immigrants, I fear the U.S.'s public charge rule could hamper efforts to raise awareness and control the spread of the disease. Any time there is a change in immigration policy, we see a decline in health care visits. Particularly in during a pandemic, if patients are not coming to us, that means we must go to them with proactive care. The last thing we need is for people to not renew their Medicaid, not come in and use their food assistance, or not seek our assistance for housing because they&rsquo;re concerned that public charge is just another effort to put them in the process of deportation.
They also may not be receiving the information necessary to keep themselves safe and minimize the spread of the virus. Those who may be fearful of facing consequences for seeking help from medical professionals or support from local officials may not be willing to come forward. One of the most important things we can do is provide immigrants with up-to-date information through a community-focused effort. Marginalized people aren't living in a box. They're part of our larger community. If we don&rsquo;t include everyone in prevention, we will not be effective protecting the public&rsquo;s health.
When it comes to serving these vulnerable populations, the key is to deliver care locally. Some communities have been sharing information and best practices already, which is great. The best way to do it is to ensure that whoever is at the top level of the healthcare organization, system, etc. is tied to the head of the community level members. Care and the screening cannot be managed from headquarters; they must be managed locally. It is imperative to coordinate and get local partners and community members the resources they need.&nbsp;
Corporate and system leaders must understand the work that&rsquo;s happening on the ground and the barriers frontline providers are working to overcome. At Providence, we have been communicating with the Catholic Health Association and the American Hospital Association to share best practices. We hope that this will help provide consistent messaging and a community-wide effort to mitigate the spread of the disease.
These times are unsettling for all of us, but we are in it together and together we will persevere. Keep yourself safe, help those you can, consider donating locally and thank your healthcare workers.

COVID-19 Perspectives with Dr. Rhonda Medows

On February 29, the Economist published an article succinctly titled &ldquo;<a href="https://www.economist.com/briefing/2020/02/29/covid-19-is-now-in-50-countries-and-things-will-get-worse">COVID-19 is now in 50 countries, and things will get worse.</a>&rdquo; They were very right. Exactly a month later, on March 29, the World Health Organization reported that <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019">203 countries, areas or territories</a> have been affected by the outbreak. Countries have been working furiously to &ldquo;flatten the curve&rdquo; &ndash; lower the reproductive rate of the virus -- to ease the burden on healthcare systems, buy time to find new treatments, and reduce the total number of infections throughout the course of the pandemic.&nbsp; With &ldquo;social distancing&rdquo; the key weapon in this fight, approximately <a href="https://www.sciencealert.com/one-third-of-the-world-s-population-are-now-restricted-in-where-they-can-go">2.6 billion people, or one-third of the world&rsquo;s population</a>, are now under complete or partial lockdown. Large gatherings, day-to-day activities and business as usual have halted.&nbsp;
While there is no escaping the disruption this crisis is causing, there is a lot that employers can do to support their employees and employees&rsquo; families that will have a meaningful impact. Our <a href="https://www.mercer.com/our-thinking/mercer-marsh-benefits-health-on-demand.html">Health on Demand</a> research found that employees typically have a good deal of trust in their employers, and the steps you take now to help maintain their well-being -- physical, emotional, financial, and social &ndash; will echo far in the future. Here are 10 ways employers can help empower their workers to push through the uncertainty and persevere:
<ul>
<li>Err on the side of over-communicating. Consistent communication can convey strong leadership, avoid confusion and reduce anxiety. A well-organized and supported COVID-19 communications team can take in the evolving information, distill the key implications, and distribute it effectively to the workforce.&nbsp; Remind employees and their managers of the support resources available through the company and in the public.&nbsp;</li>
</ul>
<ul>
<li>Provide testing &amp; coverage information. Employers who sponsor medical, life, disability, accident and special-risk insurance (such as business travel and expatriate coverage) should be familiar with the terms and conditions in their policies testing coverages, eligibility requirements and unique provisions for quarantine. Employers should also pay special attention to public health, law, and policy updates in their geography for further implications to testing and coverage information. Consistent messaging by managers about access to health benefits and leave is critical during a crisis.&nbsp;</li>
</ul>
<ul>
<li>Support mental health &amp; wellbeing. <a href="https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html">The COVID-19 pandemic is already resulting in increased stress, depression and anxiety</a>. Employers have a role in communicating information and providing mental health support for their employees. Educating managers, making services available for those affected, and communicating the availability of Employee Assistance Programs and other support services (e.g., tele-therapy) that are in place will help to mitigate the mental health impact of the pandemic.</li>
</ul>
<ul>
<li>Encourage telemedicine. If you are an employer that provides telehealth benefits, it is imperative to communicate to employees the support that is available to them and the services available. Unnecessary exposure to infection at hospitals and care centers can be avoided through virtual care. Telemedicine or other forms of virtual care are good options for many issues.&nbsp;</li>
</ul>
<ul>
<li>Assist with pharmacy changes. Employers should support early refills (including for behavioral health-related prescriptions) and home delivery through a local pharmacy in order to minimize trips by employees to the pharmacy. Many employer are considering or have implemented a one-time override to allow for 90-day supplies of specialty medications. Furthermore, some employers have also extended the duration of existing authorization approvals for items such as prior authorization, step programs and quantity limit overrides to limit administrative burden, while continuing to do so for newly initiated therapies.&nbsp;</li>
</ul>
<ul>
<li>Leverage reliable resources. In your communications, be sure to direct employees to reliable sources of information on COVID-19, such as the <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019">WHO</a>, <a href="https://www.cdc.gov/">Center for Disease Control (CDC)</a>, and their local public health entities. Reinforce to employees and their families that they should reference those and communications from you as their sources of truth as opposed to the 24/7 news cycle or social media.</li>
</ul>
<ul>
<li>Manage communications with local health systems &amp; public officials. A robust preparedness plan comprises governance structures, clear protocols and lines of communication. It also includes assessing supply chain viability and collaborating with public health entities. The National Association of County and City Health Officials (NACCHO) has put together a <a href="https://www.naccho.org/membership/lhd-directory">Directory of Local Health Departments</a> by state. Be sure to monitor local, state and national legislative updates to understand what else you can do to support your employees and society to flatten the curve.</li>
</ul>
<ul>
<li>Put policies &amp; processes in place. All employers should review their existing pandemic crisis management and response plans and establish new protocols for the current environment as needed. Employers should seek legal counsel and follow the direction of local public health department officials if there are concerns about known, suspected or high-risk cases. If an employee is found to have been exposed to COVID-19, there should be protocols for transport, communication and decontamination.&nbsp;&nbsp;</li>
</ul>
<ul>
<li>Comply with occupational health needs. To ensure employee safety, check to see if company policies are in alignment with the <a href="https://www.osha.gov/">Occupational Safety and Health Administration (OSHA)</a>, the <a href="https://www.cdc.gov/niosh/index.htm">National Institute for Occupational Safety and Health (NIOSH)</a>, and the Environmental Protection Agency (EPA). As businesses resume operations and individuals return to work during the COVID-19 recovery phase, all employers must manage fitness for work and other occupational health practices to keep the workforce safe</li>
<li>Think innovatively. Many organizations are innovating to support their workforce. We have seen employers adding hospitalization cash allowances, enhanced mental health benefits, special caregiving benefits, even allowances for creating a comfortable home-working space. Employers are also finding new ways to manage employees in the remote working culture, with innovative training and tools. Looking outside the box for solutions can help employees to thrive inside their homes.</li>
</ul>
While it is important to ensure that employees have access to continually updated information, it is just as important to show empathy to ensure your key messages get through. In addition, as your organization works through this stressful process, remember to take notes!&nbsp; Lessons learned will help pinpoint and address vulnerable areas in your business and human capital strategies in preparation for the next crisis.

Ten Ways for Employers to Assist Their Employees during the COVID-19 Outbreak

I cried at work yesterday.&nbsp; During a conference call.
We were discussing how ICU workers are updating their personal Advanced Directives after virtually tucking their&nbsp;children in at night.&nbsp; I had a few tears before I signed off and then sobbed as I envisioned their bravery. Then &ndash; like so many others who are several steps removed from the front line of health care &ndash; I got back to work attempting to find ways to support those who need it most.
I have held crying at work with disdain for as long as I can remember. How dare a professional (especially a woman) be so unprofessional?&nbsp; I built my career in venture capital much like my mother built her career in Silicon Valley in the 80s. We both draw a bright bold line between work activities and personal life.&nbsp; I take immense pride in her padded-shoulder-pantsuit-trajectory, rising in the ranks at tech companies throughout my childhood. Still vibrantly working, she continues to&nbsp;model for me how to unequivocally and fiercely love your work &ndash; and your kids.&nbsp; Always staying &ldquo;professional&rdquo; at work is one of the foundations of this. There&rsquo;s no crying. Even on a bad day. Especially in a crisis.
However, this unprecedented time where home, work, and emotions continuously collide has required me to re-assess this line and consider breaking old habits.&nbsp; Our humanity is on the line. And as I think about the colleagues and bosses I truly seek to emulate in their treatment of others (including my dear mom), I realize they were not only brilliant in conveying information and mentoring my career, but also in showing me and others&nbsp;that they truly cared. I watch Rob Coppedge daily lead a master class in how to lead with authenticity, I see Bryony Winn&rsquo;s heart on her sleeve as she balances a pandemic and motherhood, I marvel at Lisa Suennen&rsquo;s unshakable sass and honesty as she welcomes us into her life through her blogs, and I appreciate more every day Jodi Hubler&rsquo;s steadfast teaching that the blurring of these lines are worth it.&nbsp; And I realize it&rsquo;s not about the tears &ndash; it is about living fully and honestly through the other stuff going on in life too.
So, as these unusual weeks go on, I am instituting a new personal rule. I plan to ask everyone about how they are doing before I launch into pressing work issues. Is there anyone impacted in your life? How are you really holding up? Likewise, I let down my guard and the mask of a brave face more than I ever would have deemed &ldquo;professional&rdquo; before.&nbsp;
To be clear, there are pressing work issues.&nbsp; Those of us working on the financing side of the health care services world are spending long hours scenario planning, challenging unknown realities as the venture capital market begins to react to the crisis, and evaluating unproven pandemic-facing innovations (for instance, how to rapidly expand at-home clinical models, distribute self-service COVID-19 content, and share data rapidly but securely).&nbsp; We counsel CEOs, gather best practices, and learn to play offense and defense at the same time. For strategic investors, who provide additional long-range support to their fund sources, we share an added role of being an advisor and source of new perspectives and innovations from the broader market.&nbsp; We&rsquo;re not on the front line, but our portfolio companies are (or close to it). Our companies are finding ways to support providers and patients in ways they did not consider two months ago while also adapting to the professional and interpersonal challenges in this new reality.&nbsp; It is humbling to be working with so many digital health and health care services company trying to truly make an impact.
Learning to interact in a new way during one of the busiest times in my career is new ground for me.&nbsp; For all of us. We wouldn&rsquo;t be the forward-thinking and problem-solving humans we need to be if it was easy. But we can&rsquo;t waste this chance to show each other our competency &ndash; and our character &ndash;&nbsp;in equal measure.
So yes, I cried at work.&nbsp; And am better for it.

Crying at Work During COVID-19: A Novice’s Perspective

<a href="https://youtu.be/clE7BnPjZ28" target="_blank" rel="follow noopener">Click here to watch the video on YouTube</a>
In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
About ATA:
As the only organization completely focused on accelerating the adoption of telehealth, ATA is working to change the way the world thinks about healthcare.
We are committed to ensuring that everyone has access to safe, effective, and appropriate care when and where they need it, enabling the system to do more good for more people. We represent a broad and inclusive member network of technology solution providers and payers, as well as partner organizations and alliances. Together, we are working to advance industry adoption of telehealth and virtual care, promote responsible policy, advocate for government and market normalization, and provide education and resources to help integrate virtual care into emerging value-based delivery models.

COVID-19 Updates with the American Telemedicine Association

<a href="https://youtu.be/yAvRvNeGWPo" target="_blank" rel="follow noopener">Click here to watch the video on YouTube</a>
In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.
About William Winkenwerder, MD:
Dr. Bill Winkenwerder is Chairman of CitiusTech, a global health information technology services firm. He is Chairman and CEO of Winkenwerder Strategies LLC, a US-based healthcare advisory firm. As one of the most influential and recognized leaders in health care, with broad experience in medical care delivery, population health, healthcare finance, and health insurance, Dr. Winkenwerder is a respected expert on leading large scale organizational change and innovative health information technologies. Currently he works with global private equity firms, and in addition to CitiusTech, serves as director or advisor for healthcare firms &ndash; Net Health, Confluent Health, WPS Health Solutions, Elation Health and RxRevu.
Dr. Winkenwerder is a Fellow of the American College of Physicians, and a Board Certified Physician who has practiced primary care medicine at top medical institutions. He has been widely recognized for his outstanding contributions. Charitable work includes service with the Executive Advisory Board of the Leonard Davis Institute of Health Economics, the CEO Roundtable on Cancer, The Board of Trustees of Davidson College, and The Bob Woodruff Foundation.
Dr. Winkenwerder has been an advisor to US Presidents, Presidential Candidates, and many large corporations. He has been a contributor to various national news and media outlets. A graduate of Davidson College, and The University of North Carolina School of Medicine, Dr. Winkenwerder, a board certified physician, received his Masters in Business Administration from The Wharton School and completed a fellowship at The University of Pennsylvania.

COVID-19 Updates with Dr. William Winkenwerder

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.&nbsp;
About Dt. Tista Ghosh:
<a href="https://www.linkedin.com/in/tistaghosh" rel="follow">Dr. Tista Ghosh, MD, MPH</a>, is a medical director at Grand Rounds. She has specialized training in epidemiology and disease control and previously oversaw all outbreak response and preparedness activities for the state of Colorado. She has also consulted for the World Health Organization.
HLTH Team: What are your future projections on how COVID19 will continue to spread throughout the US?&nbsp;
Dr. Tista Ghosh: I think that will depend on where you live. Typically, a novel virus that nobody has any immunity to will tear through an area and cause a fast spike in illness, unless we truly practice social distancing. So for example, the Bay Area, which was a couple weeks ahead in implementing social distancing policy, may see lower numbers of cases than New York City, which also has a much more dense population. I predict we will see spikes in cases throughout the country over the next few weeks, but they will be worse in places where social distancing policies were delayed or not implemented. And as a result, I think healthcare resources will become overwhelmed in many parts of the country, and virtual care options will become increasingly important.
HLTH Team:&nbsp; What states and metro areas are of a particular concern for you?
Dr. Tista Ghosh: We&rsquo;re obviously seeing New York and New Jersey getting hit very hard with this virus. We&rsquo;re also seeing spikes in Louisiana and Michigan. I think a great indicator to keep an eye on is the <a href="https://gis.cdc.gov/grasp/fluview/fluportaldashboard.html">Outpatient Influenza-Like-Illness (ILI) </a>monitoring system that the CDC has in place across the country. What that tells you is how many people are seeking outpatient care for flu-like symptoms (which in this case could be COVID-related). As those numbers surge in a certain location, it&rsquo;s a pretty good indicator that we will start to see a surge in inpatient hospitalizations and deaths in those areas relatively soon. I also think those places that have been less stringent with their social distancing policies will be hardest hit. The <a href="https://www.kff.org/health-costs/issue-brief/state-data-and-policy-actions-to-address-coronavirus/">Kaiser Family Foundation</a> has a great resource summarizing policy actions taken in each state. In addition, I think parts of our country with the oldest populations may see the highest death rates.
HLTH Team: Looking at NY, why do you think the virus spread so rapidly here and what lessons can other states learn from what happened in NY?
Dr. Tista Ghosh: I think New York didn&rsquo;t implement strong social distancing policies early enough. It was days behind other major metropolitan areas like San Francisco. Given that and how densely packed the population is, it&rsquo;s not surprising to see such high numbers of cases and deaths. Other states can learn from this by acting quickly with regards to social distancing.
HLTH Team: When do you predict the shelter-in-place and other self-quarantine orders will begin to relax?
Dr. Tista Ghosh: I&rsquo;m assuming it will be location-dependent, and will depend on how ravaged the healthcare system is in each place. Shelter-in-place is hard on everyone, but the longer we can maintain it, the less likely we&rsquo;ll see a resurgence in cases.
HLTH Team: Many experts are saying that those who have had COVID19 and recovered are now immune, is this certain and what evidence is backing this up?
Dr. Tista Ghosh:&nbsp; We don&rsquo;t know yet if infection with the novel coronavirus results in long-lasting immunity. A recent study in rhesus monkeys did see some short-term immunity. However, other studies of common coronaviruses in humans have been shown to result in only partial, short-term immunity. Whether natural infection with this novel coronavirus will result in short-term or long-term immunity in humans is still not clear.
HLTH Team: Do you predict that the warmer weather will slow the spread and if so, will there be another wave come the Fall?
Dr. Tista Ghosh:&nbsp; We don&rsquo;t know yet. We&rsquo;ve seen that type of pattern with other viruses, but we are also seeing this virus in countries with warmer climates, like Costa Rica or Australia (where it is summer right now). That said, if we do see a decrease during warmer months, we may see another wave in the fall.
HLTH Team: Switching to the front lines of the crisis, where do you think we failed to support our healthcare workers and what can we do to better support them as the coronavirus continues to spread?
Dr. Tista Ghosh: We have really failed healthcare workers with regards to Personal Protective Equipment. We are asking them to put themselves at risk, without appropriate masks or other equipment. And as those healthcare workers get sick themselves, clinicians will become a limited resource as well. It&rsquo;s shocking to see this happening in America. We should have been ramping up production of masks and other medical equipment weeks ago. While I feel hopeful because many companies are voluntarily stepping up to&nbsp; producef masks and ventilators now, I still worry that this will be too late in some parts of the country.
HLTH Team: What can leaders across the health system, and perhaps executives outside of healthcare, do to contribute to the solution?
Dr. Tista Ghosh: I think access to virtual health services will be key in offloading the traditional, in-person healthcare setting. Health systems should consider expanding virtual methods to answer questions for the worried well or those with mild symptoms, and to serve people with chronic conditions like high blood pressure, asthma, or diabetes who may have difficulty getting their medications refilled or getting their regular checkups during this time.
If you are an employer in any industry, augmenting virtual health options could be the best thing to offer your employees. Consider making virtual guidance available through telephone support lines, clinician chat services, or other digital methods. In many cases, this will help offload the worried well from the overstretched healthcare system, and help those who are really ill get the healthcare they need.&nbsp;
For those employees who are having difficulty getting into their doctor for routine visits or regular medication refills, consider what telehealth options or mail-order/delivery pharmacy solutions you might offer. And think about tele-psych or virtual behavioral health support options that you might offer your employees through this intense and difficult period. Another way to support employees is by offering virtual town halls or webinars with experts in infectious disease or epidemiology to help address questions and quell panic.
HLTH Team: Keeping in mind that things will rapidly change over the next few months, what do you feel have been the three biggest lessons learned so far stemming from this pandemic?
Dr. Tista Ghosh:&nbsp;
<ol>
<li style="font-weight: 400;">More social distancing early on is incredibly important in lowering the impact of a novel virus.</li>
<li style="font-weight: 400;">We need to prepare better for the potential next wave of this virus, by increasing production of masks and ventilators in advance. We should not be caught flat-footed next time. And we need to better support our healthcare workers.</li>
<li style="font-weight: 400;">We, as a country, need to invest more time, effort and capacity-building in the telehealth space to better respond to emergencies.</li>
</ol>

COVID-19 Updates with Dr. Tista Ghosh

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.&nbsp;

HLTH Team: What are your short and long term projections on how COVID-19 will progress in the United States?
Dr. David Shulkin: That&rsquo;s a good question because we are really operating without complete data. The fact that we did not have testing available on a widespread scale and still are not seeing testing accessible to large numbers of patients who are exhibiting symptoms means that we don&rsquo;t have complete data about the level of community spread. It looks like in terms of the reporting that we are on track with what is more like the European experience, maybe specifically the Italian experience, where we are seeing the doubling of cases every three to four days and that would indicate that we are looking at a peak incidences in the United States in approximately 10-12 weeks and a number that looks like a total cases of about 250,000 and that would be assuming that our containment practice such as social distancing and hygiene and quarantining where necessary in geographic locations are effective. If there is not evidence of effective reduction in the incidence of new cases through our efforts in social isolation, we could see a far more aggressive epidemiologic curve than that. It is my feeling right now, with incomplete data, that we are probably looking much more at the scenario I described earlier.&nbsp;&nbsp;
HLTH Team: What do you feel is the biggest misconception out there right now concerning the virus, perhaps in the media?
Dr. David Shulkin: I think the media is doing a good job of trying to report on data that is credible and accurate. I think the internet and the rumor mill and social media in general too often is&nbsp; creating false information that is out there.&nbsp;
The number one misconception is that people that are asymptomatic are not likely to be spreading the virus or carrying the virus. Number two that young people are protected against the virus. I think we need to take a look at what is happening in Italy and France and see that that is no longer the case. I think even in the United States experience so far we are seeing people under the age of 60 with severe hospitalizations and very extreme demonstration of the impact of this disease. People on respirators, people requiring life support who are far younger than what people had previously thought.&nbsp;
HLTH Team: In your opinion, what have been the biggest missteps by the Federal Government in their response so far?&nbsp;
Dr. David Shulkin: To me I think that every day that there wasn&rsquo;t and continues not to be very aggressive preparedness and planning is a missed opportunity that will end up extending both the impact and the consequences of this virus. When there became evidence of a serious outbreak in China in mid-December there was a lot of time that was lost between then and when it started to be taken seriously as an emergency in the US. There was a misconception at the top of our government that this was something that could be stopped by stopping airline travel between countries. They felt that this was an international problem, not a US problem and that reflected a lack of understanding on how these pandemics occur and that infectious agents in these modern ages really have no boundaries. We could have jumped on this a lot earlier than we did. The fact that we were not prepared for diagnostic testing I think we will turn out to be the single biggest misstep. A country like South Korea that is far smaller in population than us has tested close to 300,000 people and we&rsquo;re probably closer to 30,000 tests having been done at this point really shows that other countries were really more prepared on the diagnostic front.&nbsp;
HLTH Team: Where do you feel the Federal Government has succeeded in handling this outbreak? What appropriate steps have been taken?
Dr. David Shulkin: While I think the federal government may have had a slow start, I do believe we are now dealing with this as a top priority. They are bringing in help from the private sector, coordinating with our local and state governments, they are moving aside regulations that have been barriers to getting people the type of treatment that they need, in particular with telehealth. Government is also looking into waving barriers to vaccine development and antiviral therapies. I believe that the government is now communicating in a credible fashion and doing many of the things that need to be done so I do give them credit for that. However, it just took longer for us than I would have liked to have gotten here.&nbsp;
HLTH Team: You mentioned telehealth and this plays into the next question - how can we close the gap in inequities to receiving care? Please touch on how we can provide assistance to people who are underinsured or who have no insurance, and assistance to people in more rural or remote areas with not as many hospitals or clinics around.&nbsp;
Dr. David Shulkin: Addressing inequities and disparities is essential. The recent bill that went through the house and senate and that the president signed does have an important component on that with making testing available without charge and I think that&rsquo;s a good first step but it&rsquo;s not at all clear how you would get the test without having to also get charged for a facility fee from a hospital, a physician fee, some of the ancillary testing that would go along with it such as chest x-rays, lab equipment, etc. so I do believe that financial access to care is still going to be a barrier for people seeking the right type of healthcare that&rsquo;s needed. The bill that passed was not nearly as comprehensive as I think it is needed to to eliminate those disparities.&nbsp;
The telehealth regulations that were waved will be helpful. The fact that providers are not able to wave medicare copays and cost shares is a very important step and I&rsquo;m glad to see that. We are also seeing some commercial payers waving all costs for telehealth. But, if you do not have insurance and you do not already have access, as 30 millions Americans do not, it is not clear how you would access telehealth at this point. And for many people who do have insurance, it&rsquo;s not clear to them how they would access telehealth. So while I think that while we&rsquo;re moving aggressively and doing the right things, again more time would have helped to prepare for this. It&rsquo;s pretty common sense that in an infectious pandemic, we do not want people rushing to doctors' offices and emergency rooms in hospitals, you want them to get testing where they can remain self-quarantined or isolated.&nbsp;
HLTH Team: And do you think this is resulting in people not getting tested or not taking the appropriate steps who are showing symptoms because they fear receiving a bill afterwards?&nbsp;
Dr. David Shulkin: I do not think that people that should be getting medical care are getting the type they need right now and this could be for a number of reasons.&nbsp;
I think first people are fearful about leaving their homes and going to a setting where they may get exposed to other people that have COVID-19.&nbsp;
Secondly, the cost aspect is considerable. People do not know what type of liabilities they may occur by going to seek medical help at a time where they have great uncertainties about their own personal economics. People having either been laid off or furloughed, or their businesses no longer viable during this crisis, I think everyone is very concerned about their own personal economics.&nbsp;
Third, people simply don&rsquo;t know where to go. A lot of people are now calling their doctors, and their doctors themselves have closed their offices. Hospitals are telling people not to come in unless they are very, very ill. I&rsquo;m certainly familiar with patients who have had high fevers and coughs who have gone to seek care and have been told that they are not sick enough to get a test and have been sent away without any real instructions other than if you get much sicker, then come back to us. So unfortunately, we&rsquo;re in the point where there are so many barriers to people seeking the right type of healthcare resources.&nbsp;
HLTH Team: So switching gears a little bit, bridging on your experience at the VA, what steps do you think we can take to better protect our elderly, more vulnerable populations?
Dr. David Shulkin: I believe that our elderly and medically vulnerable populations are certainly at the greatest risk and if you take a look at how many of our senior citizens are cared for, they are cared for in long-term care facilities, nursing homes and institutional settings. And those people tend to be extremely vulnerable to an infectious outbreak, because there is often more than one patient in a room.&nbsp; Staff go between patients often with hands on contact in many situations. So, ideally we'd like to find a way to begin to start social distancing many of our most vulnerable patients that is going to mean doing things that in the past we just never thought of. For example, taking advantage of empty hotel rooms. The President mentioned today that there was an offer to use empty cruise ships which each have individual rooms on those. And I think that we are going to need to begin to protect our senior citizens and those that are vulnerable in ways like that where we can help get them out of group settings and certainly out of shared rooms and provide the type of social distancing that may be necessary. Now that is logistically extremely complex, it is also very costly, and I certainly hope that this doesn&rsquo;t become necessary on a wide scale, but as we saw in washington state where there were many deaths in one senior citizen housing facility, they did obtain a local hotel to be able to get people out of that environment and so just like we are planning our hospitals for surge capacity, i believe all of these facilities need to be having plans to act upon and implement quickly should they be required to do so.
HLTH Team: And for seniors that are self-isolating at home, by themselves in some situations, how do you think the industry could address isolation, loneliness, maybe some mental health issues stemming from this crisis?
Dr. David Shulkin: I do believe that the long-term unintended consequences of social isolation and preventing people from doing their normal daily activities will ultimately end up having greater negative consequences than actually the virus itself. What we do know from past pandemics is that social isolation is associated with increased anxiety, depression, and in past pandemics we've seen up to 30% of those who have been isolated experiencing symptoms of post traumatic stress. And those tend to last for quite long periods of time. So whatever we can do to recognize that we&rsquo;re asking literally hundreds of millions of Americans to change what they've been doing, and restrict their activities, we should anticipate that without intensive social contact, and trying to retain as normal a life as possible, that we will see these consequences. So I think simple things like reaching out to people that you know that are isolated on the phone or on video. Encouraging social contact on the media and other technologies to keep people engaged. Getting out where you can safely exercise and to walk, being able to engage with tech communities where social distancing is safe. I think all these are things that are important and I also believe that innovation and invention is often done at times where it's needed the most. We're going to find new ways to connect with other people that frankly haven't been necessary in the past. Americans and people around the world are beginning to learn that their life is different and there will be ways of adapting to that new circumstance that I believe will be helpful to all of us.
HLTH Team: What do you think they could do to contribute to the solution?&nbsp;
Dr. David Shulkin: There are a couple of things that come to mind.&nbsp;
First is a general recognition that this type of infectious pandemic has no boundaries. So the artificial limits that we even posed upon ourselves in the healthcare segment. The differences between payers and providers, the separate systems that we have for physical health and mental health, the payment barriers that have been created, that create inequities in healthcare, the cultural differences have divided us, even the political difference that has divided us, the democrats and republicans. All of that now is really meaningless. We&rsquo;re all in this together. We need to break down those artificial barriers and begin thinking about ourselves as a connected ecosystem where we begin to reach out beyond our comfort zones and offer help. The pharmaceutical industry which traditionally has been somewhat separate from the provider side, they're going to need to be an integral part of these solutions. Our supply chain manufacturers , our PROVIDER organizations, and you're beginning to see these types of barriers break down not only in congress but also in the community where people are pulling together.&nbsp;
Secondly, I think its the job of a healthcare leader, no matter what segment of the industry you&rsquo;re in to prepare for the worst, hope for the best, but prepare for the worst. I think our healthcare leaders around the country that I am in touch with are doing amazing jobs with that. They are doing things they have never done before, they&rsquo;re clearing out their cafeterias, they're converting cafeterias to make room for additional bed capacity.They are changing their operating rooms into ICUs. they are identifying space outside in local businesses and potentially hotels if they need to be able to use them. They&rsquo;re cross training their staff. They're using equipment particularly those that protect their employees in ways that it wasn't necessarily intended, but they're required at this point because of the shortages that we&rsquo;re seeing. And they&rsquo;re challenging their own rigid rules to see where they can make greater flexibility so that staff and patients have quick access and the flexibility that will be required in the time that we may see just a massive on-slaught of resources required.&nbsp;
I think, finally, it&rsquo;s important as a leader to show moral leadership and being very visible during these times of crisis, reminding people why almost all of us chose to go into healthcare. The professionalism that I see day in and day out when I work with people in healthcare settings that they&rsquo;re there to help people, and they really are the heroes on the front line when they&rsquo;re showing up risking their own health and that of their family by being there to help others. I think that's incredible. So I think showing recognition, showing gratitude. Reminding people that they are working under very difficult circumstances. What we know from past pandemics, up to 35-50% of healthcare workers will not be able to work or do not show up for work because they themselves are sick, or they are caring for somebody at home, or they are too fearful to come in to expose themselves to that type of risk. So, for the 50% or 60% that do remain, they are going to be under incredible stress with not only less staff but greater demands on them. And they have to be supported, and you can support them in many ways, making sure that they don't have to worry about transportation, to and from home. Making sure that they have food available for them and their families, so they don't have to worry about being in lines at supermarkets. Making sure that they do have the right type of protective equipment so that they feel the most confident about their own safety. And Making sure that they are supported and thanked for what they&rsquo;re doing. Times of crisis are when leadership matters the most, so leaders can do things that frankly other people in the organization may think about, but they&rsquo;re not empowered to do. So this is really where we're gonna see the real outstanding leaders step up to this type of crisis and get us through this.

About David Shulkin:
The Honorable <a href="https://www.linkedin.com/in/davidshulkin/" rel="follow">Dr. David J. Shulkin</a> was the ninth Secretary of the US Department of Veterans Affairs. Nominated by President Trump to serve in his Cabinet, Secretary Shulkin was confirmed by the US Senate by a vote of 100-0. Secretary Shulkin previously served as Under Secretary for Health having been appointed by President Obama and confirmed unanimously by the US Senate. Prior to coming to VA, Secretary Shulkin was a widely respected healthcare executive having served as chief executive of leading hospitals and health systems including Beth Israel in New York City and Morristown Medical Center in Northern NJ. Secretary Shulkin has also held numerous physician leadership roles including the Chief Medical Officer of the University of Pennsylvania Health System, the Hospital of the University of Pennsylvania, Temple University Hospital, and the Medical College of Pennsylvania Hospital. Secretary Shulkin has held academic positions including the Chairman of Medicine and Vice Dean at Drexel University School of Medicine. As an entrepreneur, Secretary Shulkin founded and served as the Chairman and CEO of DoctorQuality one of the first consumer orientated sources of information for quality and safety in healthcare. Secretary Shulkin is the University of Pennsylvania Leonard Davis Institute Distinguished Health Policy Fellow. He is board-certified internist. He received his medical degree from the Medical College of Pennsylvania, his internship at Yale University School of Medicine, and a residency and Fellowship in General Medicine at the University of Pittsburgh Presbyterian Medical Center. He received advanced training in outcomes research and economics as a Robert Wood Johnson Foundation Clinical Scholar at the University of Pennsylvania.

COVID-19 Updates with Dr. David Shulkin

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.&nbsp;

About John Brownstein:
<a href="https://www.linkedin.com/in/john-brownstein-611b8658/" rel="follow">John Brownstein</a>, Ph.D is Professor of Biomedical Informatics at <a href="https://dbmi.hms.harvard.edu/people/john-samuel-brownstein" rel="follow">Harvard Medical School</a> and is the Chief Innovation Officer of <a href="https://www.childrenshospital.org/research/researchers/b/john-brownstein" rel="follow">Boston Children&rsquo;s Hospital.</a> He also directs the Computational Epidemiology Lab and the Innovation and Digital Health Accelerator both at Boston Children&rsquo;s. He was trained as an epidemiologist at Yale University. Overall, his work aims to have translation impact on the surveillance, control and prevention of disease. He has been at the forefront of the development and application of data mining and citizen science to public health. His efforts are in use by millions each year including the CDC, WHO, DHS, DOD, HHS, and EU, and has been recognized by the National Library of Congress and the Smithsonian.
HLTH Team: What are your short and long term projections for how COVID-19 will progress in the US? Let&rsquo;s focus on 1, 2 and 6 months out.
John Brownstein: It&rsquo;s challenging to know what this is going to look like over time. There are some credible models that are being developed by leading experts in the space. Of course, a big part of it relates to factors of how the response happens. So, how quickly a population responds early on before you even see cases; around social distancing, various closers, schools, mass gatherings. And then, how well testing is in place to identify cases and to track contacts and attempt to really isolate the infection, but also isolate people. The more that works, the more we have the concept of bending the curve like what we saw in South Korea where with massive amounts of interventions, social distancing, testing, tracking, contact tracing, they were able to deal with it incredibly well and reduce the load on the healthcare system. Obviously in other places like Italy which didn&rsquo;t inact some of these interventions early enough and had probably limited capacity on the healthcare side, have had a much tougher time.
HLTH Team: Within the Federal Government, on diagnostic testing in particular, what do you think the biggest missteps have been so far?
John Brownstein: It&rsquo;s really challenging because there was this view early on that the risk to the US was going to be low and misidentifying this as a Chinese virus. Experts have recognized that the features of this virus meant that you were going to see cases because if you have asymptomatic transmission people can infect other people without having symptoms which means it&rsquo;s very hard to contain at the source. The virus was on a path to a pandemic, we could see that very early on, and we were preparing a way that made sense with having adequate amount of testing and preparation. Even though experts have known about these kind of events for years and have tried to sound alarm bells - there&rsquo;s been a deep lack of funding and support in this space and a lack of preparation on the part of government. So unfortunately, we lost weeks and when you think that there&rsquo;s opportunity to try to mitigate the spread, the things that you try to do very early on are going to impact what&rsquo;s going to happen 2-3 weeks from now. Even the moves that we&rsquo;re making now, even though they seem extreme, are ones that are actually going to have real impact a few weeks down the line.
HLTH Team: Do you think that China gave us enough of a head start?
John Brownstein: We should have had more of a head start because of China. Our technology identified the first event, the cluster of cases, end of December, so we have been sounding alarm bells since early January about this, but we weren&rsquo;t really adequately doing anything over the first couple of months. We should have had more of a head start then we did, but of course, China did give a window into the valuable interventions, like very intense social distancing, quarantining, that ultimately means that right now we&rsquo;re not seeing new cases not reporting.
HLTH Team: Although testing is becoming a little more widespread now, it hasn&rsquo;t been up to this point. There&rsquo;s been a ton of articles out there about the inequities between the haves and the have nots with receiving tests, mostly celebrities and athletes. Do you think that gap is closing in who is able to receive a test?
John Brownstein: The celebrity efforts are definitely creating a normalization of some of these interventions - the importance of testing, the importance of social distancing, the importance of staying home so I&rsquo;ve seen a lot more positive than displays of disparities I would say because of course, a Tom Hanks recognition of infection is actually incredibly valuable to create awareness. So I see that as more and more sort of people in areas of influence. I just saw Will Smith give an incredible piece about the importance of social distancing so you know, I&rsquo;m seeing that valued more than anything. There&rsquo;s been a broad lack of availability, regardless of who you are. So I haven&rsquo;t seen that disparity as much.
HLTH Team: In your opinion, what steps have been successful so far at the state government level?
John Brownstein: I can only talk about my experience being in the city of Boston. I have to say I&rsquo;ve been incredibly impressed to see the use of a data-driven approach and models to make decisions on important things like school closures and various social distancing measures. It&rsquo;s been really all about understanding the current data but also models that make projections of what future cases look like in different scenarios. So as much as it&rsquo;s been a challenge, it&rsquo;s been a great moment for the value of modeling in data science as a contribution directly to policy decisions and I think there&rsquo;s been a recognition that we need to have a data driven approach to this - and I&rsquo;ve seen that at least locally.
HLTH Team: I think telemedicine is having its moment now, AI as well in some cases- do you think this crisis is going to change the role of digital health in the future?
John Brownstein: Yes, I think this has been an incredible pivotal moment in digital health. It&rsquo;s a bit frenetic in terms of how much is happening and people obviously want to be opportunistic and we have to be careful not overvaluing the value of tech in this moment. But at the same time, the massive adoption that I&rsquo;m seeing of chat bots, digital triage tools, telemedicine, remote patient monitoring. We all now recognize how valuable they are and so the fact that we&rsquo;ve been able to get that kind of traction is incredible, because it&rsquo;s all the things we recognize as important but we finally got to use case. And I actually believe that it&rsquo;s not a spike in change but we&rsquo;re at a new level of adoption that I don&rsquo;t think will go away. It&rsquo;s at least exciting for all the things we&rsquo;ve been trying to push at Boston Children&rsquo;s finally showing a huge amount of value.
HLTH Team: Being part of a health system, where do you think they&rsquo;ll see their biggest challenges in handling the outbreak? What are the biggest challenges that are happening now? Do you think we&rsquo;ll get a handle on the equipment shortages or will that just compound over time?
John Brownstein: I think it&rsquo;s going to be highly variable from location to location depending on how much level of preparation is happening. How much level of bending the curve is taking place - that&rsquo;s something we&rsquo;re spending a huge amount of time on, modeling healthcare utilization and making predictions of what might happen. So, right now we&rsquo;re trying to assess potential risk and so we&rsquo;re going day by day looking at the numbers and trying to evaluate where we are on this epidemic curve. Every health system across the country is doing some level of utilization modeling which on one hand is incredibly stressful and on the other hand, exciting to see these sorts of analytics directly being applied.
HLTH Team: What are your thoughts on when hospitals will get access to some of the experimental treatments that Trump spoke about?
John Brownstein: Vaccines are far off. It depends, but obviously we&rsquo;re talking about utilization of medications that already have safety profiles that pushes them a lot quicker into potential use. So we&rsquo;re talking months as opposed to years, because we already have safety profiles on things like chloroquine. I don&rsquo;t know how far off, but obviously clinical studies still need to be shown, so widespread prescription can happen.
HLTH Team: The HLTH community is mostly executives across the health ecosystem - what steps could they take to contribute to the solution? Let&rsquo;s focus on health tech startups.
John Brownstein: We&rsquo;ve seen a ton of health tech startups building technology to be, you know, it&rsquo;s a double edge sword because it can create confusion. But we&rsquo;ve seen so many companies developing specific products for covid and offering them for free which has been amazing to see and also what we&rsquo;re seeing is an incredible amount of sharing of data cross health systems among numerous different conversations across health systems where everybody&rsquo;s in real time sharing the value of startups with others which is creating rapid adoption of tech. The fact is, finally health systems are working at the speed that startups were always hoping for. On one hand, they&rsquo;re not in this big buying moment, but on the other hand they&rsquo;re ready for adoption. So, as long as startups are figuring out their business model, as long as they can get to adoption and worry about potential license fees after, it&rsquo;d be incredibly successful.
HLTH Team: Lastly, what resources out there now do you think are particularly helpful?
John Brownstein: We have our own resource at <a href="https://healthmap.org/covid-19/" rel="follow">healthmap.org/covid-19</a>, we&rsquo;re spending a huge amount of time trying to create a global database of cases which have been used by the government and by corporations to get situational awareness. Obviously, we&rsquo;re spending a lot of time and Hopkins has a great resource as well.

COVID-19 Updates with John Brownstein

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.&nbsp;
About Zachariah Reitano:
Zachariah Reitano is the CEO and cofounder of <a href="http://www.ro.co/">Ro</a>, a patient-driven healthcare company that powers three digital health clinics -- <a href="http://www.getroman.com/">Roman</a> (men&rsquo;s health), <a href="http://www.hellorory.com/">Rory</a> (women&rsquo;s health) and <a href="http://www.quitwithzero.com/">Zero </a>(addiction treatment) -- providing a personalized end-to-end telehealth experience from diagnosis to delivery.&nbsp;
HLTH Team: Ro recently launched a Coronavirus Telehealth Assessment. What is it?
Zachariah Reitano: Ro has created a <a href="http://covid.ro.co" rel="follow">free telehealth triage service</a> for people seeking guidance and information about the novel coronavirus (COVID-19).
If an individual thinks they may be experiencing signs or symptoms of the novel coronavirus, they can complete Ro&rsquo;s online assessment and, if appropriate, Ro will connect them with a provider who will follow up via secure messaging, phone or video consultation.
The service is currently available nationwide (and Washington D.C.).&nbsp;
HLTH Team: What are the benefits of a service like this?
Zachariah Reitano: The CDC and other public health agencies have strongly encouraged patients and providers to have remote consultations (phone, video, text) as an initial step. Telehealth services like Ro&rsquo;s have key public health benefits during a crisis:
<ul>
<li> Unburdening the system: Through telehealth consultations, Ro can keep low-risk patients from going to the hospital or doctor&rsquo;s office and free up appointments and hospital beds for people who need them most. Telehealth can mitigate the risk of health centers from getting overwhelmed with patients. Ro will help facilitate in-person care for higher risk patients.</li>
<li> Increasing safety: For low-risk patients, it might be more dangerous to spend time in a hospital or clinic than to self-quarantine at home.</li>
<li> Providing care quickly: People have easy, free access to a doctor and can avoid typically long wait times.</li>
<li> Tracking spread to help with containment: Ro is collecting valuable data about symptoms, geography, and travel history that can be shared with public health officials in an anonymized format.</li>
</ul>
HLTH Team: How does the service work?
Zachariah Reitano: Developed with guidance from infectious disease specialists, Ro&rsquo;s telehealth assessment collects health information from the patient (e.g., health history, symptoms, travel history, locale, proximity to confirmed cases). Based on that information and using the most up-to-date guidelines from the Centers for Disease Control (CDC), the World Health Organization (WHO), and state/local public health departments, we provide an initial risk assessment.
Those who are symptomatic or have other risk factors (e.g., travel history or proximity to confirmed cases, pre-existing/underlying conditions) will be connected to a U.S. licensed provider who will follow up via secure messaging, phone or video consultation
During the consultation, the provider will collect additional information about the patient&rsquo;s symptoms and concerns, recommend the proper course of action (which may include self-quarantine), and, if recommended, instruct them to follow up with a local provider for testing and diagnosis. For patients who are recommended to seek in-person care, we will provide them resources to find a local provider so they can get the help they need. Suspected cases of COVID-19 are also reported to applicable public health authorities, as required, to help inform local and national response efforts.
Individuals who are at low risk of having contracted COVID-19 will be guided to a number of resources at our <a href="https://www.getroman.com/health-guide/coronavirus/">Coronavirus Resource Hub</a> and will be encouraged to keep monitoring their symptoms. These resources are regularly updated and are based on the latest government guidelines and best practices. Our goal is that these resources will help the public understand this complex virus and help keep themselves, their families, and their communities safe.
Please note: Ro is not providing testing or diagnosing for COVID-19.&nbsp;
HLTH Team: How can executives out there contribute to the solution with Ro?
Zachariah Reitano: As soon as we launched, companies, health care institutions, government agencies, and individuals reached out to see how they could spread the word and help. Startups wanted to offer the telehealth assessment to their employees. Online education platforms were interested in offering it to their students at home. Marketplaces wanted to offer it to their freelancers, especially those who may not be insured.
While we&rsquo;re in uncharted territory and uncertain times, the optimist in me is grateful people have been willing to work together, day and night, to lend a hand in whatever way they could.
If any organization, institution, or agency would like their own branded free coronavirus telehealth assessment page and to help in whatever way they can, please fill out <a href="https://form.asana.com/?hash=9508c291b1cf1b3eb22fca93cee3f4973dc09595715406ebe2ac212aa0f0b417&amp;id=1166015922476861">this form</a> and we&rsquo;ll get back to you within 24 hours.
HLTH Team: Will Ro share any of its data with public health officials?
Zachariah Reitano: We have the ability to collect and provide relevant and anonymized data to public health officials. We would welcome their advice on the types of data that would aid their efforts. If you are part of an agency or healthcare institution that is responding to the COVID-19 outbreak and think Ro could be helpful in any way, please contact covid19-feedback@ro.co.
HLTH Team: Will telemedicine be more widely adopted in a post-Coronavirus world?
Zachariah Reitano: Today, providers like Ro are focused on the public health response to COVID-19. As reported in <a href="https://www.nejm.org/doi/full/10.1056/NEJMp2003539?query=TOC">NEJM </a>and widely covered since COVID-19 emerged, telehealth can help to slow the spread of COVID-19 and keep the &ldquo;worried well&rdquo; and those with mild COVID-19 symptoms from overwhelming the healthcare system, keeping high-risk patients and providers safe. Outside of COVID-19, individuals may still need to consult with a physician and, in some cases, receive care for other conditions and acute illnesses, like sinus infections and UTIs. Telemedicine can help to treat those individuals, while also keeping those patients out of the healthcare system in this time of overwhelming need.&nbsp;
Tomorrow and over the long-term, we believe that telehealth will not only be used in times of crisis, but more and more as a safe, high-quality, accessible and affordable healthcare option.

How Ro is Responding to COVID-19

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.&nbsp;
About Leana Wen:
Dr. Leana Wen is a physician &amp; public health professor at George Washington University. She has served as Commissioner of Health for Baltimore and President of Planned Parenthood. In 2019, she was one of TIME magazine&rsquo;s 100 Most Influential People.
<a href="https://www.linkedin.com/in/leanawen/">Leana Wen Linkedin</a>
HLTH Team: What is your general sentiment on the current state of the coronavirus in the US and globally? Dr. Leana Wen: This is a pandemic situation. Things are about to get much worse here in the U.S. Just two weeks ago, we only had 15 cases diagnosed. Now, we have over 1,000. Things in the U.S. will quickly escalate in the next week to several weeks and we have to all prepare and brace for a very challenging time ahead.&nbsp;
HLTH Team: What is the biggest misconception out there right now?
Dr. Leana Wen: The biggest misconception is that things are fine because many of us are not seeing the new coronavirus, COVID-19, in our communities. But this is the calm before the storm. This is what happened in China, in Italy, in South Korea, in other places where Covid-19 has spread like wildfire and that type of spread is going to happen in the U.S. The best thing that we can do now is to prevent this rapid escalation to avoid overwhelming our healthcare system. We can do that by taking matters into our own hands and each doing what each of us can right now. For example, stay home while we&rsquo;re sick, not going to work unless essential (doing telework when possible), and avoiding large gatherings. If we are employers ourselves or in-charges of planning events, this is a time to cancel all non-essential events or travel and implement social distancing now in our communities.&nbsp;
HLTH Team: As follow up to that, how can healthcare executives out there contribute to the solution?
Dr. Leana Wen: Healthcare executives are an essential part of the solution. In addition to what they could each do as individuals, as employers they can also raise their voices at this time to help others see why this type of rapid, joint response is so important.&nbsp;And practice social distancing themselves.
HLTH Team: If you are starting to show symptoms or come into contact with someone who is symptomatic, what steps should you be taking?&nbsp;
Dr. Leana Wen: This is a rapidly evolving situation. As of now, there are not enough testing kits to test everyone that wants to or even needs to be tested. This will hopefully change in the coming days to weeks, but that&rsquo;s the situation right now. If you are concerned about COVID-19, do not go to the ER, do not go to the hospital, do not go out and be around other people. Call your physician right now. You should work with your doctor to figure out your own risk factors, the availability of testing in your area to decide what you should do next. In areas where there is enough testing, your doctor will help, with the public health official in your area, to arrange for that testing. In areas where there is not that capability, you will likely be told to stay at home and recover there. In any case, do not go to the ER or hospital unless you would have gone otherwise&mdash;as in if you otherwise would have gone because you&rsquo;re very ill, you should obviously keep going to the ER. But do not go just because you&rsquo;re worried about COVID-19.
HLTH Team: What sources should people be turning to for the most up-to-date information?
Dr. Leana Wen: There is now a website -&nbsp;<a href="http://coronavirus.gov">coronavirus.gov</a>, the CDC website (<a href="http://www.cdc.gov">www.cdc.gov</a>) is also an excellent resource and you should also vigilantly and constantly check the updates for your local health department for updates because there will be specific advice for your locale.
HLTH Team: Lastly, what is the most important piece of information, so a fact or figure that people should be aware of and tracking?
Dr. Leana Wen: Actually, nothing. And here&rsquo;s the reason why - we should not just be reacting to what has happened. We should be anticipating what&rsquo;s ahead. Do not just look at the figures now, the figures right now are misleading. Just because there have been 1,000 diagnosed cases in the U.S. does not mean that that&rsquo;s where we are going. So don&rsquo;t look at where we are now, anticipate where we are going.&nbsp;

COVID-19 Updates with Dr. Leana Wen

Building the HLTH agenda is both a thrilling and extremely difficult undertaking. HLTH has tasked itself to become THE event for health innovation and it is not taken lightly. To accomplish this lofty goal, HLTH will feature the latest and greatest content on the most current topics impacting the industry. Our 2018 and 2019 iterations created excellent groundwork to build on as HLTH expands the scope of topics for 2020.&nbsp;
There are a couple of areas that I am particularly excited about diving into this year. To start, we saw the incredible reaction to many of the amazing partner presentations we had at HLTH 2019 from Crossover Health and Comcast to Microsoft with The Jackson Laboratory. We quickly realized that unique partnerships between unlikely players are where real innovation takes place. In 2020, we plan to feature an entire track on new and novel partnerships stemming from unexpected sources in a theme called &ldquo;Health Collabs&rdquo;.&nbsp;
HLTH takes attendees&rsquo; feedback on sessions seriously, and one standout session at HLTH 2019 was a primary care debate featuring Aledade, Iora Health and VillageMD. The session was 40 minutes long, but could have gone on for hours! Primary care innovation was clearly a pressing topic then and even more so moving into 2020. There has been so much movement in the space particularly in subscription-based clinics and fully digital PC options. HLTH 2020 will feature a track, &ldquo;Primary Care v.2020&rdquo; dedicated to the future of primary care including top organizations leading the change.&nbsp;
AI is in no way new to health or HLTH, but our approach this year will be. HLTH&rsquo;s &ldquo;AI&rsquo;s Reality Check&rdquo; track will purposely avoid broad panel discussions talking around the potential for AI in health. Instead, the track will feature presentations from leaders touting real data and evidence on where AI is making an incredible impact here and now.
Lastly, we are very interested in diving deep into the economics of health in 2020 and beyond in our &ldquo;Health-o-nomics&rdquo; track. In the wake of the coronavirus pandemic, several weaknesses in the health system have been put in the spotlight. The virus has forced us to face challenges head-on around vaccine &amp; medication shortages, price transparency &amp; surprise billing, access to care &amp; prevention tools, supply &amp; demand imbalance, and more. Our speakers will delve into the details and provide unique solutions to balance the scales of health and better prepare ourselves for the future.&nbsp;
Aside from the aforementioned new track themes, we are exploring a plethora of other key topics that we feel will continue to trend into 2021:
<ul>
<li style="font-weight: 400;">The sleep tech space has been of particular interest this year. The evidence connecting poor sleep patterns to greater health issues is overwhelming and the industry&rsquo;s response has been pretty spectacular.&nbsp;</li>
<li style="font-weight: 400;">The liquid biopsy market is moving quickly and we are watching closely. HLTH 2020 will showcase incredible companies making early intervention the new normal of care.&nbsp;</li>
<li style="font-weight: 400;">Human-centered design has been taken to the next level to impact the patient experience through physical spaces. We will feature novel hospital designs centered solely around the patient.</li>
<li style="font-weight: 400;">The 2020 Presidential Election&rsquo;s impact on healthcare will be weaved into various discussions throughout the HLTH agenda. HLTH is only a few weeks away from the election and our expert speakers will make sure attendees are prepared for whatever results occur.</li>
</ul>
I can go on forever about our agenda, it is a labor of love! There is so much happening in every corner of the industry and our goal is to showcase it all across our 100+ session agenda. We pride ourselves on not siloing the players within the health ecosystem to specific tracks, but want multiple perspectives involved in every conversation being had on stage. We encourage speakers to break out of their comfort zones and speak on topics that our attendees would not expect.&nbsp;&nbsp;
The goal is to evolve our agenda in response to new discoveries, pressing news, and attendee feedback. We want to move away from stale discussions and towards the uncomfortable conversations that are necessary to create positive change. Our HLTH team is confident that 2020 will be bigger and better than ever!&nbsp;
I look forward to meeting you in Vegas this October!&nbsp;

A Labor of Love

I am headed to the annual HLTH conference in Las Vegas at the end of October to shed light on the radical transformation AI is having in healthcare. Last year I spent significant time preparing for the inaugural event only to be put on maternity travel restrictions. Since it&rsquo;s clinically unpopular for a woman to travel at 35 weeks pregnant, I missed the event entirely. My, how my trips to Vegas have changed over the years&hellip;

&ldquo;How do you do it?&rdquo; they love to ask. &ldquo;Do what?&rdquo; I ask, wondering if they&rsquo;re referencing my career and work travel, parenting three young children, building a life in a city away from my hometown and family, or building a fast-growing company in a nascent space.
My answer is always the same: &ldquo;It takes a strong village and technology that allows me optionality to manage my schedule and activities on my own terms.&rdquo; We are no longer limited by traditional business hours, brick-and-mortar access, or even the constraints of unproductive commuter time. And so, I tap into my two default go-tos on a daily basis: the village of people I&rsquo;m closest with for moral support and the technology I use for operations.
In the realm of healthcare, this technology empowers me to do a 2 am video visit when my child spikes a fever, to use a mobile app to reschedule an appointment when a high-priority conference call comes up, and to search ER wait times on a Sunday morning when my oldest two children accidentally slam the toddler&rsquo;s finger in a door. I do all of this through self-service channels. I&rsquo;m thankful for the convenience, efficiency, and optionality this technology provides. Gone are the frustrations of spending too much time on hold on phone calls only to have them &ldquo;accidentally&rdquo; dropped or tell me it&rsquo;s after-hours.
To those still waiting to make bets on this technology and especially on its use for healthcare, let me be clear. I&rsquo;ve been using these technologies for four years and make many decisions on for my clan of 5 and also my out-of-town aging family members based not only on the information I access digitally, but also executing on many time-consuming tasks. For me, it&rsquo;s not &ldquo;if&rdquo; or even &ldquo;when&rdquo; anymore &mdash; It just &ldquo;is&rdquo;.
The promise of 24/7 self-service is not new. Today, web, mobile and search are well-seasoned: the iPhone is 12 years old, Google is a 21-year-old company, and even Facebook is older than most teenagers.
What is new then? Conversational technologies (voicebots and chatbots) and their speed of adoption, along with hyper-advances in NLP, machine learning and AI. The technology has arrived, and with it mass adoption, even among groups of people who haven&rsquo;t touched anything new since getting&nbsp; their first landline.
Voicebots and chatbots are ubiquitous: they can be delivered over a smartphone or smart speaker and also even a landline or analog phone. I can ask a voicebot to help me find a nearby urgent care and schedule an appointment while I&rsquo;m making dinner or holding a child. I can ask a chatbot what weight-based dose of ibuprofen I should give or to have my care team call me to see if that fever is something to worry about. I think back to my last hospital stay when I was waiting for the epidural to wear off after giving birth and how I couldn&rsquo;t reach the call button to order my first meal in 24 hours. Hands-free access brings empowerment and efficiency.
Conversational AI along with new connectivity and extensibility bring new capabilities previously out of reach. Notifications and reminders delivered via SMS text message, email, or smart speaker allow the initiation of conversational dialogues to happen without friction: there&rsquo;s no need to install or download anything. And, dialogues can meet you where you are in the channel you prefer &ndash; even toggling between a smart speaker and a chatbot to address privacy concerns.
Wow. This means that my nonagenarian grandparents can use it as easily as my millennial babysitters. Sign. Me. Up.
As I see rapid adoption of AI-powered conversational technologies: chatbots and voicebots alike, I am encouraged by the consumerization of our industry and the benefits we can derive from it. We&rsquo;ve learned enough by now that there is no magic pill when it comes to technology and healthcare. But there are quite a few technologies that feel pretty magic to me.

Technology as a Magic Pill

Sep 25, the Kaiser Family Foundation annual survey of Employers reported that the cost of Health Insurance has hit a high of over $20000 a year for a working American family. Average annual deductibles of $1655 annual are 2x that of a decade ago. And workers at lower wage employers are half as likely to have access to affordable coverage.

The Sep 12 Democratic Primary debates had Healthcare front and center with the left advocating for single Payor Medicare for All that costs $30 Trillion over a decade as the answer to affordability.
Separating the key facts from fiction seems in order. I wrote a blog post recently about &ldquo;What&rsquo;s Working; What Needs Fixing.&rdquo; As I prepare to moderate the very interesting panel &ldquo;What&rsquo;s at Stake?&rdquo; at HLTH October 28, it&rsquo;s worth taking a deeper look at US Healthcare spend and trend. Ultimately, addressing the healthcare cost conundrum is the basis of improving access and quality for working Americans.
The facts speak for themselves. We are making a great deal of progress through public private partnerships on moderating utilization of healthcare products and services. Middlemen are not the driver of the cost problem. Rather, the crux of the cost conundrum is two-fold. First unit price inflation, especially the burden borne by employer sponsored insurance. Second, re- directing the flow of subsidies within the ecosystem and plugging the hole to improve affordability for working Americans.
The Facts&nbsp;
The 85% of medical spend in that $3.8 T Healthcare economy has meaningfully moderated as utilization has subsided.&nbsp;
The US healthcare economy is now at $3.8T annual spend and ~18% of the GDP. And yes, healthcare spend per capita of over $10000 per year is higher than other OECD countries. What are the key cost drivers in the employer sponsored healthcare economy for working Americans?
The bulk of healthcare spend (80-85%) is deployed toward actual medical, pharmacy and behavioral costs for Americans. Per the latest Milliman Medical Index report in 2019, for working Americans, Hospital costs comprise close to ~50% of the total medical costs split.
between Inpatient costs at 19% and Outpatient costs at 29% of spend. Physician costs represent the other 30% and Pharmaceutical costs are 20% of the medical spend.
Per Milliman as well,&nbsp;Healthcare costs are increasing at a much slower pace, by historical standards.&nbsp;The cost of healthcare for a family of four with employer benefits has moderated from the low double digits in the early 2000s to very low single digits in 2018 and 2019. Back in the early 2000s, healthcare expenses were growing by 10% a year. Now, the growth rates are at record-low levels as costs grew 2.9%. Drug costs for a working American family in 2019 increased by only 2.1% in 2019, compared to solid double digits in the early 2000s.
Unit price inflation Is the leading driver of medical cost growth. Fixes can improve affordability for working Americans.&nbsp;
The leading driver of trend increases for 2019 continues to be unit price inflation for hospital services. Price Inflation Is 4x the growth in utilization for Hospitals which represent 50% of the overall spend. Even for Prescription drugs, unit price inflation is more than 50% greater than the growth in spend from the volume of drugs consumed by Americans, per the latest report from the Employer Benefits Consulting Firm Segal.
Transparency in Hospital pricing is key. In-network discounts, impactful policies such as Site Neutral payments as have been proposed by CMS and bipartisan solutions to address surprise medical billing must make it to the finish line, without invoking judicial loopholes. Drug pricing reform drafts from the House and the Senate Finance Committee need to move forward.
Flow of Subsidies can be re-directed or means tested Supplemental policies created to reduce the burden on working Americans&nbsp;
Employers subsidize healthcare for Government programs of Medicare and Medicaid. America more broadly subsidizes innovation in Biopharma therapies for the rest of the world. While this places a burden on working Americans, eliminating employer-sponsored insurance entirely for a $30 Trillion price tag is not the answer. Rather, targeted means tested Federally funded supplemental policies could be created to improve premium subsidies and plug the out- of-pocket cost burden for working Americans. Drug manufacturer rebates, and employer premium subsidies could be carefully allocated to keep the burden on working Americans, particularly in the lower wage brackets in mind.
Fiction&nbsp;
It is not the Middlemen.&nbsp;
In actuality, the profit pool for middlemen is a very small fraction of US healthcare costs. Post ObamaCare, 80-85% of the US Healthcare Dollar goes toward medical spend, which has capped profit margins for health plans. The total estimated profit pool for the health insurance and pharmacy benefits manager (PBM) industry combined is $50 B or just ~1.5% of the entire healthcare economy across all the segments they serve: Medicare Advantage, Employer- Sponsored Insurance, Managed Medicaid, TriCare and Individual/Exchanges.
The now largely vertically integrated health plan and PBM administrative cost base is deployed toward essential functions of claims payment and moderating consumption, while improving outcomes. These essential functions will need to be performed by the US Government, with an infrastructure that is not in place and could take decades if it can be rebuilt at all.
Americans in recent surveys have overwhelmingly said they want to keep their current health insurance, with half the country getting their coverage from their employers, so completely dismantling the employer benefits markets is not the answer.
Policy makers can work with the private sector to build on the successes to date&nbsp;
Pubic private partnerships are at the heart of American healthcare. Value based care is finally being embraced not just by private payors but also CMS and the Center for Medicare and Medicaid Innovation (CMMI). We are even seeing the beginnings of biopharma contracting focusing on clinical outcomes in partnership with health plans and employers.
The integration of medical, behavioral and pharmaceutical spend that looks holistically at drivers to lower total costs has been embraced by the private sector through vertical consolidation, and through strategic partnerships.
Technology is becoming an enabler. It is driving the integration of data across claims, and clinical data as well as through remote patient monitoring, Technology is enabling care for those who need it in the setting they need it most; in store, in retail friendly settings, at home, virtually and for remote rural Populations. The efforts by innovative players to reshape the antiquated technology backbone so claims adjudication and payment becomes more efficient is now on the horizon, reducing the administrative cost burden.
While campaign rhetoric is dominating the headlines, what Americans need are practical bipartisan solutions. Much remains to be done. United the public and private sector can make healthcare better for all Americans.

Why Public-Private Partnership Are the Path Forward for Healthcare Affordability

As I prepare for my talk on October 28th at HLTH 2019, I&rsquo;m reflecting on my work as a physician,&nbsp;<a href="http://www.endwellproject.org/">End Well</a>&nbsp;founder, and palliative care activist. As a clinician, I regularly meet people dealing with serious illness or nearing the end of their life. These moments bring an urgency and focus to getting to know a patient&rsquo;s goals and values in order to determine the right treatment and care. I am excited to have the opportunity to share how the lens of palliative care, combined with the latest innovations shaping our increasingly customizable world, might transform the entire healthcare experience.&nbsp;

The Broken System&nbsp;
As a hospital-based physician, I&rsquo;ve witnessed the terrible toll broken systems, miscommunication, and perverse incentives can have on patients and their families. Far too many people end up alone and in pain rather than surrounded by those they love. This is particularly true for those who are at the end of their lives. I have also seen that things can be markedly different when a palliative care team (usually comprised of a nurse, social worker, chaplain, and physician) is involved.
When I learned that the data shows the earlier the engagement with palliative care, the longer people tend to live with a better quality of life, I became obsessed with moving the dial on improving perceptions and access to this kind of care. Rather than defaulting to &ldquo;doing everything we can,&rdquo; no matter the negative impact on quality of life, palliative care helps people receive the care that&rsquo;s in line with their individual goals and values.
Rethinking the Status Quo
When we stop to ask the question, &ldquo;What matters most to you right now?&rdquo; the answers can be illuminating. This got me thinking, what if we radically transformed healthcare&nbsp; by shifting from a top-down approach to engaging patients and their families in a completely different way?
What if the entire healthcare system was geared toward asking patients one question: What are your goals and values of how you want to live your life? We could then tailor all care based on the answers to that question. To do this, we&rsquo;re going to have to stop asking &ldquo;What&rsquo;s the matter?&rdquo;&nbsp; and instead start asking &ldquo;What matters most?&rdquo; When we do this, the patient-provider relationship becomes truly collaborative. We strive to enhance the patient&rsquo;s ability to engage with their own care, and as providers, we actively engage with our patients over time. In other words, to start making this shift, we need to start talking more.
The Future of Care
Thinking about the future of healthcare through this lens requires those of us who are linear, data-driven, and analytical thinkers to step far out of our comfort zones. We must learn and become comfortable with soft skills like communication, empathy, compassion, and cultural awareness&mdash;skills that, for the most part, neither our training nor our current system enables or incentivizes.
I very much believe that the entire health care system can benefit enormously from engaging with patients in new ways across all aspects of treatment and care. What draws me to make this conclusion through the lens of end of life is that at those final moments, the stakes are so very high.
I look forward to seeing all of you at this year&rsquo;s HLTH and hearing how you think we can transform healthcare for good.

Let’s Start Asking “What Matters Most?” Instead of “What’s The Matter?”

As I prepare to moderate an erstwhile panel of policy experts that have crossed both the public and private sectors at HLTH: Create Health&rsquo;s Future Oct 27-30 in Las Vegas, I reflect on my dozen years as a Wall Street healthcare analyst. While the political rhetoric on Medicare for All continues leading up to the Primary, it is important to take stock of what&rsquo;s working before offering a prescription for the future.
What&rsquo;s Working
ObamaCare Has Made a Dent In the Uninsured
Half of America receives healthcare through Employer-sponsored insurance. A third of American Seniors receive healthcare through private Medicare Advantage. Over two thirds of Medicaid eligibles are managed privately. And the overwhelming majority of Americans, per recent surveys have said that they are more satisfied than not with their current healthcare. The passage of ObamaCare which by no means perfect offered access to nearly 20 MM new Americans through subsidized Exchanges and Medicaid expansion, while offering coverage for pre-existing conditions.
Medicare Advantage Is Saving Money for American Seniors
Medicare Advantage (MA) has been the most noteworthy success of the public-private partnerships now covering one in three American Seniors, from the one in six in 2006, and poised to grow to one in two within the next several years. 3x Seniors are opting into MA as compared to Government run Medicare at 90% satisfaction levels. It is highly under-appreciated that MA does not require a Supplemental policy, running at ~$2500 annual, while STAR quality bonuses are being ploughed back to subsidize dental, vision and fitness benefits, and more recently even subsidize food insecurity. MA now includes telehealth enabling Americans to age at home longer. Managed Medicaid Is Solving the State Fiscal Burden States are seeing an ever-growing Medicaid burden, and a future recession will only compound the budget constraints. States that cannot run budgets in deficit, are meeting fiscal obligations through privately managed Medicaid, with close to half the Medicaid spend managed privately and growing.
We Are Ushering An Era of Value Based Care
After decades of Fee for Service incentives for providers, we are finally ushering the era of value-based care, particularly in MA and Medicaid, sparking innovation for cost moderation and outcomes.
Technology Is Becoming an Enabler
The actionable use of cloud-based healthcare data across claims, and clinical with decision support tools is influencing treatment decisions real time at the point of care. The antiquated technology backbone in the country is being reshaped and digitally enabled virtual care models are enabling care at home, in store and for remote rural populations.
Mental Health is Finally on the Front Burner
The cost of treating a person with behavioral comorbidities can be as much as 4x that with a physical ailment alone, especially in Medicaid. The recent drop in US life expectancy from 78.9 years in 2014 to 76.6 years in 2017 has been driven by suicide and drug overdose. The private sector is bringing the focus back on mental health and the mind-body connection. Encouragingly the CDC projects deaths from drug overdose to decline for the first time since 1990, though public funding remains woefully thin.
What Needs Fixing
The US healthcare system is a patchwork of legacy solutions and decidedly complex. Pockets of American society lack access to affordable coverage. All the juice seems to have been extracted from the high deductible orange. More can be done to moderate healthcare inflation even as America ages, particular on the unit cost equation to bring it closer to GDP growth.
Cracks In ObamaCare Need Fixing
The Medicaid coverage gap of 5 MM Americans in States that have not expanded Medicaid, and expanded subsidies for the 4+ MM middle-class Americans to as much as ~400% of Federal Poverty Level (FPL) would offer a reprieve to those Americans still falling through the cracks.
Medicare Can Be Expanded To Under 65 Boomers
Medicare as an entitlement can be extended to those from 55-65 years of age. This age band has been faced with challenges during early retirement or sole proprietorships even as they develop high risk conditions. If they preferentially opt into MA, it would be another proof point of its value.
Out of Pocket Cost Burden for Working Americans Must Shrink
Surveys of working Americans points to this as a key pain point. Politicians need to overcome entrenched interests and take well-intentioned bills such as surprise medical billing to the finish line.&nbsp;
Access to Drug Therapies Needs Free Market And Policy Change&nbsp;
Policy changes encompass benefit design to cap out of pocket spend, while restricting the price inflation. Within the private sector, Health plans are re-directing a portion of Pharmaceutical Drug Manufacturer rebates to the highest utilizing workers and their families to subsidize their out of pocket cost burden at the pharmacy. Innovative benefit options for employers to offer affordable access to high priced gene therapies are being spawned and need to become the safety net for working Americans.&nbsp;
Health Plans Need to Regain Confidence of their Self-funded Employer Customers&nbsp;
Employer sponsored insurance (ESI) that funds half of Americans also subsidizes Government healthcare. That being said, the vocal dissatisfaction of large self-funded employers who continue to experience rising medical costs must be addressed, particularly as unit cost offset managed utilization.&nbsp;
The Democratic Primary: We Have Seen This Movie Before
Healthcare in America is messy but still is the seat of innovative change. No other country is funding innovation for new life saving therapies, or at the cusp of the intersection of technology and healthcare. Public and private funding from investors remains the backbone of this innovation. Over time, excess returns continue to get squeezed from pockets within the healthcare industry. Even with a Democratic super majority in 2009/10, there was no legislative support for a single Payor system. More recently, the drug manufacturer rebate rule was scrapped given the negative impact on Part D premium subsidies. As we head into the Democratic Primary on Sep 12, healthcare, will remain front and center. The playing field has been whittled down and most candidates are backing off single Payor. We need to fix what is, not isn&rsquo;t broken. And celebrate successes to date.

U.S. Healthcare: What’s Working; What Needs Fixing

This October, I&rsquo;ll be attending the HLTH conference in Las Vegas, and will be moderating a panel on artificial intelligence and medical imaging. HLTH is a premier meeting that brings together healthcare providers, investors, and innovators. The session topic got me thinking about the past, present, and future of radiology and radiologists, and what I call the 3 C&rsquo;s: Collegiality, Communication, and Commoditization.

Collegiality
My father&rsquo;s lengthy radiology career spanned more than 50 years, from 1959 to 2015. When he started, the field hadn&rsquo;t changed much from the discovery of the x-ray in 1895. Although the quality of the images had improved, those images were still produced on large sheets of film that captured radiation passing through a patient&rsquo;s body. With only one copy of each exam, other doctors often came to the Radiology Department to discuss challenging cases.
The period from the 1970&rsquo;s through the 1990&rsquo;s saw massive leaps in radiological innovation. Ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) were all introduced into clinical practice. Before these technologies became widespread, a patient experiencing belly pain or a severe headache might only receive a diagnosis after surgical intervention. The demand for imaging grew, and enhanced technology lead to subspecialization within the field of radiology. When I finished my training in the late 1990&rsquo;s, radiology professionals were more likely to be subspecialists&mdash;for example, neuroradiologists, breast imagers, orthopedic imagers, et cetera&mdash;than general radiologists.
Communication
In the late 1990&rsquo;s, things changed again. Leveraging advances from digital cameras developed for the general public, radiology transitioned from film exams to filmless files. Exams were interpreted on computer monitors; this technology is referred to as PACS (Picture Archiving and Communications System). Given that most medical imaging (ultrasound, CT, MRI) is computer-generated, this transition made sense; film was an unnecessary expense.
But change is hard. A colleague of mine gave a talk on PACS in the late 90&rsquo;s. Many radiologists in the audience were opposed to the new technology. For them, improved efficiency meant fewer jobs. Of course, cost savings from going filmless drove the rapid adoption of PACS anyway.
Despite early fears, radiologists prospered. The amount paid for interpreting each exam went down, but quality and efficiency went up&mdash;way up. With computers, cases were easily sent to and interpreted by the right subspecialist rather than a general radiologist. Case volume and complexity also increased. Today, a radiological practice without PACS would quickly go the way of the dodo.
Commoditization
Given quick access to limitless exam copies and technology that streamlined dialogue among healthcare providers, radiologists intended the C in PACS to represent Communication. However, for most radiologists, the C actually stands for&nbsp;Commoditization. With a patient&rsquo;s CT or MRI just a click away, doctors no longer need to visit the Radiology Department. It takes too long. Radiologists have become something of a faceless commodity. Although there are efforts to measure patient quality and value, the radiologist&rsquo;s speed&mdash;how many reports he or she can generate in an hour&mdash;has become the universal measure of a radiologist&rsquo;s worth.
This is now being done at scale. Over the course of my relatively short career (about 20 years), the practice of radiology has gone from local monopolies that cover a few zip codes to national private-equity-backed providers with over 1,000 doctors! Investment in technology and specialization certainly promises exam interpretations at a lower cost. However, these changes have disrupted the professional collegiality and cross-specialty dialogues of my father&rsquo;s generation, which often proved vital in determining the right treatment for some patients.&nbsp;<a href="https://www.radiologybusiness.com/topics/care-delivery/burnout-physicians-radiologists-new-york-city">Burnout</a>&nbsp;is also an issue: Evidence has shown that larger radiology groups have higher burnout compared to smaller practices.
Does Artifical Intelligence Signify &ldquo;Automaggedon&rdquo; for Radiologists?
A recent Forbes&nbsp;<a href="https://apple.news/AB49WHCafT9WACB6_sOSWZw">article</a>&nbsp;called AI &ldquo;automaggedon,&rdquo; or automation technology that would oust many hardworking individuals from their jobs. Like PACS before it, some radiologists view AI as an existential threat. Not today, not tomorrow, but AI will interpret exams more accurately and more quickly than radiologists will. AI does not get flustered by previous interpretation errors or concerns of medical liability. AI never gets tired or distracted. AI can correlate other clinical information. And at scale, AI is cheaper than radiologists.
Don&rsquo;t panic! AI may perform parts of a job, but is extremely unlikely to perform the whole job.
Although there is a lot of hype about AI interpreting images and negating the need for radiologists, I believe two other scenarios are far more likely to play out in the near term: Workflow automation and radiology report analysis.
First, workflow automation. Compared to the amount of time radiologists actually spend looking at and interpreting images, far more time is consumed with locating the old exam, dictating chart notes, communicating with other doctors, and following up on difficult cases. Recently I spoke to a radiologist in Chicago who had adopted a novel approach. He trained foreign medical school graduates to be radiology scribes and to do the prep work while he interpreted the actual cases. This allowed him to triple his productivity&mdash;and his income. Much of that prep work could easily be automated.
Second, although image quality today is light years away from where it started, clinical information from already-interpreted exams is being wasted. Today, radiology reports are used by clinicians to guide care, but there is no aggregated learning, and the findings of these reports are not tied back to the rest of the clinical chart in any meaningful way. Imaging reports need to actively support clinical notes, and vice versa.
Before AI could be used as the final interpreter or even as a supplemental everyday tool, it would have to overcome significant obstacles. Like airline pilots who continue to fly our planes despite autopilot, the public&rsquo;s perceived risk and federal guidelines will keep radiologists in the captain&rsquo;s seat for a long while. Furthermore, as investors continue to pour money into AI, seeking solutions to unique problems like brain volume for dementia or cancer detection, widespread adoption would demand AI integration into PACS. Years ago, 3D technology was introduced to imaging. I spent years never using 3D. Like most of my peers, I was too busy (or lazy?) to walk over to another computer down the hall.
Applying Lessons Learned from Radiology to Other Medical Specialties
Telemedicine has caught up with teleradiology. With advances in telemedicine, any doctor can care for any patient, anywhere. That means that competition is coming. Just like radiologists, local internists and specialists are at risk of becoming a commodity, exchangeable, replaceable. Although physical touch and the doctor&ndash;patient relationship still matter, people want 24/7 access and they&rsquo;re not willing to wait. I believe&mdash;I hope&mdash;that this technology will be used for the common good, and not just for cost savings. In other words, whether for radiology or for the rest of clinical medicine, the ultimate focus should be on two things: Automating menial tasks and managing huge amounts of data. This would allow doctors to go back to being doctors rather than high-priced data-entry clerks. That&rsquo;s what doctors want, and frankly, it&rsquo;s what patients deserve.
From film to filmless to information automation and interpretation, the future of radiology is not in doubt. But radiologists must adapt, or they run the risk of following film into the history books, being removed as an unnecessary expense in the supply chain. A radiologist stationed at his or her computer, churning out as many exams as possible, remaining detached from the patient and the patient&rsquo;s outcomes is not sustainable. Instead of viewing AI as a competitor, I see it as a tool, a collaborator of sorts, that will allow radiologists and clinicians to spend more caring for patients and less time managing data.