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NEST Smart Home Update

I have been tracking Google’s NEST for awhile now. It’s the best example I know of a learning system for the home. The latest is …. it is still the best!

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CREDIT: http://thewirecutter.com/reviews/the-best-thermostat/

We spent more than a month trying five popular smart thermostats—testing the hardware, their accompanying mobile apps, and their integrations with various smart-home systems—and the third-generation Nest remains our pick. Five years after the Nest’s debut, a handful of bona fide competitors approach it in style and functionality, but the Nest Learning Thermostat remains the leader. It’s still the easiest, most intuitive thermostat we tested, offering the best combination of style and substance.

Last Updated: November 10, 2016
We’ve added our review of Ecobee’s new Ecobee3 Lite, and we’ve updated our thoughts on HomeKit integration following the launch of Apple’s Home app. We’ve also included details on Nest’s new Eco setting and color options, a brief look at the upcoming Lyric T5, and a clarification regarding the use of a C wire for the Emerson Sensi.

The Nest works well on its own or integrated with other smart-home products. Its software and apps are solid and elegant, too, and it does a really good job of keeping your home at a comfortable temperature with little to no input from you. Plus, if you want to change the temperature yourself, you can easily do so from your smartphone or computer, or with your voice via Google or an Amazon Echo. All of that means never having to get up from a cozy spot on the couch to mess with the thermostat. While the competition is catching up, none of the other devices we tested could match the Nest’s smarts. The expansion of the Works with Nest smart-home ecosystem and the introduction of Home/Away Assist have kept the Nest in the lead by fine-tuning those smart capabilities. The recent hardware update merely added a larger screen and a choice of clock interfaces, but the ongoing software improvements (which apply to all three generations of the product) have helped keep the Nest in its position as the frontrunner in this category without leaving its early adopters out in the cold.

Runner-up

Ecobee3
Not as sleek or intuitive as the Nest, but it supports Apple’s HomeKit and uses stand-alone remote sensors to register temperature in different parts of a house, making it an option for large homes with weak HVAC systems.
The Ecobee3’s support for remote sensors makes it appealing if your thermostat isn’t in the best part of your house to measure the temperature. If you have a large, multistory house with a single-zone HVAC system, you can have big temperature differences between rooms. With Ecobee3’s add-on sensors (you get one with the unit and can add up to 32 more), the thermostat uses the sensors’ occupancy detectors to match the target temperature in occupied rooms, rather than just wherever the thermostat is installed. However, it doesn’t have the level of intelligence of the Nest, or that model’s retro cool look (which even the Honeywell Lyric takes a good stab at). Its black, rounded-rectangle design and touchscreen interface have a more modern feel, it looks a bit like someone mounted a smartphone app on your wall.

Ecobee3 Lite
Ecobee’s new Lite model is a great budget option. It doesn’t have any occupancy sensors or remote temperature sensors, but it would work well for a smaller home invested in the Apple ecosystem.
For a cheaper smart thermostat with most of the important features of the more expensive models, we suggest the Ecobee3 Lite. This budget version of the Ecobee3 lacks the remote sensors and occupancy sensors of its predecessor but retains the programming and scheduling features, and like the main Ecobee3, it works with a variety of smart-home systems, including HomeKit, Alexa, SmartThings, Wink, and IFTTT. However, the lack of an occupancy sensor means you’ll have to manually revert it to its prescheduled state anytime you use Alexa, Siri, or any other integration to change its temperature.

real people should not fill this in and expect good things – do not remove this or risk form bot signups

Table of contents
Why a smart thermostat?
Smart-home integration
Who this is for
The C-wire conundrum
Multizone systems
How we picked and tested
Our pick
Who else likes our pick
Flaws but not deal breakers
Potential privacy issues
The next best thing (for larger homes)
Budget pick
The competition
What to look forward to
Wrapping it up

Why a smart thermostat?
A smart thermostat isn’t just convenient: Used wisely, it can save energy (and money), and it offers the potential for some cool integrations. If you upgrade to any smart thermostat after years with a basic one, the first and most life-changing difference will be the ability to control it remotely, from your phone, on your tablet, or with your voice. No more getting up in the middle of the night to turn up the AC. No dashing back into the house to lower the heat before you go on errands (or vacation). No coming home to a sweltering apartment—you just fire up the AC when you’re 10 minutes away, or even better, have your thermostat turn itself on in anticipation of your arrival.
Technically, thermostats have been “smart” since the first time a manufacturer realized that such devices could be more than a mercury thermometer and a metal dial. For years, the Home Depots of the world were full of plastic rectangles that owed a lot to the digital clock: They’d let you dial in ideal heating and cooling temperatures, and maybe even set different temperatures for certain times of the day and particular days of the week.
The thermostat landscape changed with the introduction of the Nest in 2011 by Nest Labs, a company led by Tony Fadell, generally credited to be one of the major forces behind Apple’s iPod. (Google acquired Nest Labs in 2014; Fadell has since moved on to an advisory position at Alphabet, Google’s parent company.) The original Nest was a stylish metal-and-glass Wi-Fi–enabled device, with a bright color screen and integrated smartphone apps—in other words, a device that combined style and functionality in a way never before seen in the category.
The Nest got a lot of publicity, especially when you consider that it’s a thermostat. Within a few months, Nest Labs was slapped with a patent suit by Honeywell, maker of numerous competing thermostats.
But once the Nest was out there, it was hard to deny that the thermostat world had needed a kick in the pants. And five years later, not only have the traditional plastic beige rectangles gained Wi-Fi features and smartphone apps, but other companies have also entered the high-feature, high-design thermostat market, including the upstart Ecobee and the old standards Honeywell, Emerson, and Carrier.
The fact is, a cheap plastic thermostat with basic time programming—the kind people have had for two decades—will do a pretty good job of keeping your house at the right temperature without wasting a lot of money, so long as you put in the effort to program it and remember to shut it off. But that’s the thing: Most people don’t.
These new thermostats are smart because they spend time doing the thinking that most people just don’t do.
“The majority of people who have a programmable thermostat don’t program it, or maybe they program it once and never update it when things change,” said Bronson Shavitz, a Chicago-area contractor who has installed and serviced hundreds of heating and cooling systems over the years.

Smart thermostats spend time doing the thinking that most people just don’t do, turning themselves off when nobody’s home, targeting temperatures only in occupied rooms, and learning your household schedule through observation. Plus, with their sleek chassis and integrated smartphone apps, these thermostats are fun to use.

Nest Labs claims that a learning thermostat (well, its learning thermostat) saves enough energy to pay for itself in as little as two years.
Since the introduction of the Nest, energy companies have begun offering rebates and incentives for their customers to switch to a smart thermostat, and some have even developed their own devices and apps and now offer them for free or at a greatly reduced price to encourage customers to switch. Clearly, these devices provide a larger benefit than simple convenience. Because they can do a better job of scheduling the heating and cooling of your house than you can, they save money and energy.

Smart-home integration
Among the useful features of smart thermostats is the ability to work as part of a larger smart-home system and to keep developing even after you’ve purchased one. For example, many of the thermostats we tested now integrate with the Amazon Echo, a Wi-Fi–connected speaker that can control many smart-home devices. You can speak commands to Alexa, Echo’s personal assistant, to adjust your climate control. This function came to the thermostats via a software update, so a smart thermostat purchased last year has the same functionality as one bought yesterday.
These over-the-air software updates, while sometimes known to cause issues, are a key feature of smart devices. Shelling out $250 for a thermostat that has the potential to become better as it sits on your wall helps cushion some of the sticker shock. The Nest earns particularly high marks in this area, because whether you bought one in 2011 or 2016, you get the same advanced learning algorithms and smart integrations.
Additionally, all of the thermostats we tested work with one or more smart-home hubs such as SmartThings and Wink, or within a Web-enabled ecosystem like Amazon’s Alexa or IFTTT (If This Then That). The Nest also has its own developer program, Works with Nest, which integrates the company’s thermostat and other products directly with a long and growing list of devices including smart lights, appliances, locks, cars, shades, and garage door openers. This means you can add your thermostat to different smart scenarios and have it react to other actions in your home: It could set itself to Away mode and lock your Kevo smart door lock when you leave your house, for instance, or it could turn up the heat when your Chamberlain MyQ garage door opener activates. These ecosystems are continually growing, meaning the interactions your thermostat is capable of are growing as well (sometimes with the purchase of additional hardware).
With the release of the Home app for HomeKit, Apple’s smart-home unification plans have taken a bigger step toward fruition. While the devices are still limited (a hardware update is required for compatibility), you can now create scenes (linking devices together) and control them from outside the home on an iPad; previously you had to use a third-generation Apple TV. This change increases the number of people who will see HomeKit as a viable smart-home option. Even without an iPad permanently residing in your home, you can still talk to and operate HomeKit products using Siri on your iPhone or iPad while you are at home. The system works in the same way Alexa does, and it’s actually a little more pleasant to use than shouting across the room.
The Ecobee3, Ecobee 3 Lite and Honeywell Lyric (released January 2016) are all HomeKit compatible, and can communicate with other HomeKit devices to create scenes such as “I’m Home,” to trigger your thermostat to set to your desired temp and your HomeKit-compatible lights to come on.
Google now offers its own voice-activated speaker similar to Amazon’s Echo, the Google Home. The Home, which integrates with Nest as well as IFTTT, SmartThings, and Philips Hue, allows you to control your Nest thermostat via voice.

Who this is for
Get a smart thermostat if you’re interested in saving more energy and exerting more control over your home environment. If you like the prospect of turning on your heater on your way home from work, or having your home’s temperature adjust intelligently, a smart thermostat will suit you. And, well, these devices just look cooler than those plastic rectangles of old.
Get a smart thermostat if you’re interested in saving more energy and exerting more control over your home environment.
If you already have a smart thermostat, such as a first- or second-generation Nest, you don’t need to upgrade. And if you have a big, complex home-automation system that includes a thermostat, you may prefer the interoperability of your current setup to the intelligence and elegance of a Nest or similar thermostat.
If you don’t care much about slick design and attractive user interfaces, you can find cheaper thermostats (available from companies such as Honeywell) that offer Wi-Fi connectivity and some degree of scheduling flexibility. The hardware is dull and interfaces pedestrian, but they’ll do the job and save you a few bucks.
The devices we looked at are designed to be attached to existing heating and cooling systems. Most manufacturers now offer Wi-Fi thermostats of their own, and while they’re generally not as stylish as the models we looked at, they have the advantage of being designed specifically for that manufacturer’s equipment. That offers some serious benefits, including access to special features and a deep understanding of how specific equipment behaves that a more general thermostat can’t have.

The C-wire conundrum
One major caveat with all smart thermostats is the need for a C wire, or “common wire,” which supplies AC power from your furnace to connected devices such as thermostats. Smart thermostats are essentially small computers that require power to operate—even more so if you want to keep their screens illuminated all the time. If your heating and cooling system is equipped with a C wire, you won’t have any concerns about power. The problem is, common wires are not very common in houses.
In the absence of a C wire, both the Nest and the Honeywell Lyric can charge themselves by stealing power from other wires, but that can cause serious side effects, according to contractor Bronson Shavitz. He told us that old-school furnaces are generally resilient enough to provide power for devices such as the Nest and the Lyric, but that the high-tech circuit boards on newer models can be more prone to failure when they’re under stress from the tricks the Nest and Lyric use to charge themselves without a common wire.
Installing a C wire requires hiring an electrician and will add about $150 to your costs. The Ecobee3 includes an entire wiring kit to add a C wire if you don’t have one (for the previous version of this guide, reviewer Jason Snell spent about two hours rewiring his heater to accommodate the wiring kit). The Emerson Sensi is the only thermostat we tested that claims not to need a C wire, but it too draws power from whichever system is not in currently in use (for example, the heating system if you’re using the AC). This means that if you have a heat- or air-only system, you will need a C wire.
Note: If the power handling is not correct, the damage to your system can be significant. The expense of replacing a furnace or AC board, plus the cost of professional installation, will probably outweigh the convenience or energy savings of a smart thermostat. Nest addresses the power requirements of its thermostat, including whether a common wire is necessary, in detail on its website, so if you’re unsure whether your system is suited for it, check out this page for C wire information, as well as this page for system compatibility questions and this page for solutions to wiring problems.

Multizone systems
If you have more than one zone in your HVAC system, you will need to purchase a separate smart thermostat for each zone. Currently, while all of the smart thermostats we tested are compatible with multizone systems, none can control more than one zone. Even though the Ecobee3 supports remote sensors, those feed only a single thermostat—so if you want more zones, you’ll still need separate thermostats, with their own sensors. However, the Ecobee3 is the only thermostat we tested that allows you to put more than one thermostat into a group so that you can program them to act identically, if you choose.

How we picked and tested

We put these five smart thermostats through their paces to bring you our top pick. Photo: Michael Hession
By eliminating proprietary and basic Wi-Fi–enabled thermostats, we ended up with six finalists: the third-generation Nest, Ecobee’s Ecobee3 and Ecobee3 Lite, Honeywell’s second-generation Lyric, Emerson’s Sensi Wi-Fi thermostat, and Carrier’s Cor. We installed each model ourselves and ran them for three to 10 days in routine operation. We did our testing in a 2,200-square-foot, two-story South Carolina home, running a two-zone HVAC system with an electric heat pump and forced air.
For each thermostat, our testing considered ease of installation and setup, ease of adjusting the temperature, processes for setting a schedule and using smartphone app features, multizone control capabilities, and smart-home interoperability.

Human connection lies at the heart of human well-being.

See NYT article below: if these facts are anywhere close to right, a community-based BeWell Center has an opportunity to do a whole lot of good by simply being an organizer of volunteer outreach. Low or no cost, big impact, great from a philanthropy POV. Meals on Wheels, elderly check-ins, classes, etc. “Research confirms our deepest intuition: Human connection lies at the heart of human well-being.”

“Social isolation is a growing epidemic — one that’s increasingly recognized as having dire physical, mental and emotional consequences. Since the 1980s, the percentage of American adults who say they’re lonely has doubled from 20 percent to 40 percent.

About one-third of Americans older than 65 now live alone, and half of those over 85 do. People in poorer health — especially those with mood disorders like anxiety and depression — are more likely to feel lonely. Those without a college education are the least likely to have someone they can talk to about important personal matters.
A wave of new research suggests social separation is bad for us. Individuals with less social connection have disrupted sleep patterns, altered immune systems, more inflammation and higher levels of stress hormones. One recent study found that isolation increases the risk of heart disease by 29 percent and stroke by 32 percent.
Another analysis that pooled data from 70 studies and 3.4 million people found that socially isolated individuals had a 30 percent higher risk of dying in the next seven years, and that this effect was largest in middle age.”

Research confirms our deepest intuition: Human connection lies at the heart of human well-being.

Iora Health – Update …$75 million Series D (moving toward 65+?)

Here is an update on Iora Health ….. the Cambridge, Mass innovator in Health Care supporting primary care services in 34 US locations. I first began tracking them when I was tracking Turntable in Ls Vegas, which is one of their sites.

Few points:

1. I see no big announcements about closings….interesting (there are rumors the Harken Health and Turntable will cease their partnership with Iora)
2. They just raised $75 million in a Series D financing ….. really interesting. The lead investor was the Singapore State fund Temasek … also interesting (big dogs). Apparently all existing investors stayed in the Series D – a good sign. Series C was $48 million, and the dollars before that (in A and B) were $13 million, I think. So that means that they have now raised $146 million…..that is a ton of money for a venture backed company! This tells me that they are telling investors what I believe to be true….that Year 1 hurts because the subscriber base in building but years 2 and onward can be profitable……but I have found no docs that say this.
3. They say they have 34 “primary care practices”…..looked at their backup for this. Here is what they (seem to) have:

18 sites are Medicare only Advantage Plans for 65+ only —— 16 sites partnering with Humana and 2 partnering with Tufts. So Humana is their big partner, but only to support their Medicare advantage plan for seniors.

1 corporate site for Hartford Health Care employees only

3 “fund” sites —— one for cooks and one for carpenters and one in Queens for “Grameen members”…..must be a credit union for each trade maybe?

6 sites with Harken/United Health ….. but very interesting that they are not listed on their official website…. they just take about 6 sites in ATL.

1 community site – Turntable in Las Vegas

2 pilot sites

31 sites total

4. My guess: the Series D raise of $75 million is going to be dedicated to Medicare Advantage plan expansion, through Humana, Tufts, and a few others. My hunch is that they do not see how to make the community model work…moreover, they see the ramp up as being needlessly painful. My hunch is that the Medicare Advantage model is profitable in Year 1, which investors would love! My hunch is that they have figured out to make these site smaller, more manageable, more care flow positive from the start, and that they are ultimately most profitable sites. Humana and other big dogs probably see them as a way to keep health care costs down……..while maintaining or improving senior outcomes. Anyone else have a guess or facts on this????

See my notes below:

===========NOTES on IORA Health ==========
October 16, 2016

US-based Iora Health has closed a $75-million Series D financing in a round led by Singapore state fund Temasek Holdings. Other investors who participated in the round include Iora Health’s existing institutional investors .406 Ventures, Flare Capital Partners, F-Prime Capital, GE Ventures, Khosla Ventures, Polaris Partners, and Rice Management Company. “We are honored to have Temasek join Iora on our journey to transform healthcare,” said Rushika Fernandopulle, MD, MPP, co-founder and CEO of Iora Health. “Temasek’s investment in Iora will accelerate our vision of fixing health care delivery which is one of the largest business and social problems, not just in the US, but globally.

Iora Health has built a different kind of health system that delivers high impact, relationship based care. With 34 primary care practices in 11 US markets, Iora serves diverse populations with an increasing focus on the most under-served and complex patients — including people aged 65 years and older on Medicare. Iora’s innovative model delivers an exceptional patient experience, with coordinated care that drives better clinical outcomes and significantly lower costs than the traditional healthcare system. Iora will use the new capital to drive further expansion and efficiencies in the model

Read more at: http://www.dealstreetasia.com/stories/55411-55411/

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Iora Health lands $28M from GE Ventures, Khosla Ventures and others
Jan 26, 2015, 9:58am EST Revised Date/Time Publish Updated Jan 26, 2015, 2:06pm EST
Iora Health, a Cambridge startup aiming to “reinvent primary care” with a novel model for payment and delivery of care, said Monday that it raised $28 million in Series C funding from new investors including Foundation Medical Partners, Rice Management Co., GE Ventures and Khosla Ventures.

Existing investors included Boston’s .406 Ventures, Fidelity Biosciences and Boston-based Polaris Partners. Iora Health will use the additional financing to fund rapid expansion to continue delivering transformative health care, according to the company. The company has raised $48.2 million in total and plans to double its current workforce of 140.
Iora Health has developed a different health care operating system that starts with primary care, driving patient experience, engagement and clinical outcomes, while reducing overall health care costs, according to the company.
“We’re humbled by the great interest in our Series C financing and we are honored to have such a great group of new investors join our current ones.,” said Rushika Fernandopulle, co-founder and CEO of Iora Health, in a statement. “In the last four years, Iora Health has grown from a start up with an idea of how to improve health care to serving and improving the lives of thousands of patients across the U.S. We are excited to grow with this round to continue to deliver on our mission to restore humanity to health care.”

Iora Health currently manages eleven primary care practices across the U.S. for distinct patient populations including employee groups, Medicare Advantage patients and union members and their families. Iora sponsors include the Culinary Health Fund, Dartmouth College, the Freelancers Union, Grameen PrimaCare, Humana, King Arthur Flour, Lahey Health, the New England Carpenters Benefits Fund and Turntable Health.
The company, founded in 2011, last raised a $13 million round of funding two years ago from existing investors including Zappos CEO Tony Hsieh.

================== IORA Practices from their website =====

Source: http://www.iorahealth.com/practices/list-of-offices/

SPONSOR: CULINARY HEALTH FUND (serves workers who participate)
Las Vegas, NV 89104
SPONSOR: DARTMOUTH COLLEGE (Dartmouth Health Connect is a primary care practice in Hanover)
Hanover, NH 03755

SPONSOR: GRAMEEN PRIMACARE (for Grameen Members)
Queens, NY 11372

SPONSOR: HARTFORD HEALTHCARE (employees and family members)
Hartford, CT 06106

SPONSOR: Harken Health and United Health Care
Metro Atlanta (6)

SPONSOR: NEW ENGLAND CARPENTERS BENEFITS FUNDS
Dorchester, MA 02125

SPONSOR: TUFTS HEALTH PLAN (for 65+ members of Preferred HMO plans)
2 LOCATIONS
Medford, MA 02155
Hyde Park, MA, 02136

SPONSOR: HUMANA (All seem to support only Humana Medicare Advantage Plan)
16 LOCATIONS

Aurora, CO 80012
Littleton CO 80123
Arvada, CO 80003
Glendale, CO 80246
Lakewood, CO 80214

Federal Way WA 98003
Shoreline, WA 98133
Seattle, WA 98144
Renton, WA 98057
Tucson, AZ 85712 (2)
Mesa AZ 85206 (2)
Glendale, AZ 85302
Phoenix, AZ 85032 (2)

SPONSOR: TURNTABLE HEALTH
Las Vegas, NV 89101

Pilot Program Renaissance Health
Arlington, MA

PIlot Program Intensive Outpatient Care
Program Partner: The Boeing Company

“Direct Primary Care”

Its pretty clear that a coalition of “direct primary care” providers is pushing Congress to recognize subscription services as a service reimbursable under Medicare.

I believe they are differentiating themselves from “concierge” care, for political reasons. The coalition says concierge care is $2000-$5000, instead of under $2000. One of the main advocates for direct primary care says that it does not seek third party reimbursement, while concierge services might.

“The Primary Care Enhancement Act of 2016” has been brought to the Ways and Means Committee, where is was referred in September, 2016 to the Health Sub-Committee.

Sponsor: Rep. Paulsen, Erik [R-MN-3] (Introduced 09/13/2016)
Committees: House – Ways and Means
Latest Action: 09/19/2016 Referred to the Subcommittee on Health. (All Actions)

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Direct primary care could get a big boost next year. Under the federal health care law, these practices will be able to operate in state-based health insurance exchanges. However, insurers on exchanges must offer a basic benefits package that includes hospital, drug and other coverage, so direct primary care practices will likely team up with other health plans.
If you’re considering a direct primary care practice, get a list of provided services and talk with a physician in the practice. Also, some practices that are similar to concierge care may accept insurance but charge a monthly fee for extra services. For options in your area, visit the Web site of the Direct Primary Care Coalition (www.dpcare.org).

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The Primary Care Enhancement Act of 2016  proposes to amend the tax code so consumers can use their health savings accounts (HSAs) to pay physicians in direct primary care (DPC), bypassing insurance. H.R. 6015 would also enable Medicare enrollees to pay for direct primary care using Medicare funds, rather than pay out of pocket.

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http://www.dpcare.org

Senators Bill Cassidy, MD (R-LA) and Maria Cantwell (D-WA) have introduced bipartisan legislation which clarifies that DPC is a medical service for the purposes of the tax code regarding Health Savings Accounts. The bill also creates a new payment pathway for DPC as an alternative payment model (APM) in Medicare. “Co-sponsors are important. They show Senate leaders that there is widespread support for the legislation,” said Sen. Cassidy when he addressed the DPCC Fly-in Sept. 24. We need your help today to ensure that S.1989 moves forward.  Please contact your Senators and urge them to co-sponsor the Primary Care Enhancement Act today.

On the Move in the States with DPC
16 States Move to Clear Regulatory Hurdles for DPC 
Legislation  defines DPC outside of Insurance.
 
As of June, 2016, 16 states have adopted Direct Primary Care legislation which defines DPC as a medical service outside the scope of state insurance regulation. 
 
The DPCC has developed model legislation to help guide legislators and their staffs on the best way to accomplish  this important reform. Click here to see the model bill.
States With DPC Laws:

• Washington – 48-150 RCW
• Utah – UT 31A-4-106.5
• Oregon – ORS 735.500
• West Virginia – WV-16-2J-1
• Arizona – AZ 20-123
• Louisiana – LA Act 867
• Michigan – PA-0522-14
• Mississippi – SB 2687
• Idaho – SB 1062
• Oklahoma – SB 560
• Missouri – HB 769
• Kansas – HB 2225
• Texas – HB 1945
• Nebraska – Leg. Bill 817
• Tennessee – SB 2443
• Wyoming – SF0049

Current as of June, 2016

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Direct Primary Care is an innovative alternative payment model in primary care model embraced by patients, physicians, employers, payers and policymakers across the United States.The defining element of DPC is an enduring and trusting relationship between a patient and his or her primary care provider. In DPC unwanted fee-for-service incentives are replaced with a simple flat monthly fee. This empowers the doctor-patient relationship and is the key to achieving superior health outcomes, lower costs and an enhanced patient experience.
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http://medicaleconomics.modernmedicine.com/medical-economics/news/bill-could-allow-health-saving-account-use-dpc

Direct primary care physicians charge patients a monthly fee for care and access to a package of services rather than by fee-for-service or insurance. The subscription model can grant patients increased access to doctors, discounted drugs and laboratory services. 
According to Meigs, the proposed law will allow people with high deductible plans to use their HSA to pay for primary care, given that people with high deductible insurance plans can use their insurance for catastrophic coverage and hospitalizations, and cost-effectively tap their HSAs for primary care.  

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Direct primary care and concierge medicine: They’re not the same

Direct primary care and concierge medicine: They’re not the same
SAMIR QAMAR, MD | PHYSICIAN | AUGUST 24, 2014
Samir Qamar
Direct primary care (DPC) and concierge medicine are rapidly growing models of primary care. Though the terms are used interchangeably, both are not the same. Such liberal use of terms, many times by even those within the industry, confuses those who are attempting to understand how these primary care models operate. As former concierge physician for the Pebble Beach Resorts, and subsequent founder of one of the nation’s largest direct primary care companies, I have attempted to differentiate the two based on extensive personal knowledge and experience.

First, concierge medicine. Born in the mid 1990s, this practice design was first created by wealthy individuals who were willing to “bypass” the woes of the current fee-for-service system by paying a subscription to access select primary care physicians. This access consists of same-day appointments, round-the-clock cell phone coverage, email and telemedicine service, and sometimes, as in my previous practice, house calls. Although some high-end practices charge as much as $30,000 a month, most charge an average monthly fee of $200.
In return, to allow such unrestricted access, physicians limit their patient panels to several hundred patients at most, a significant drop from the typical 2,500-plus panel size most doctors are used to. Many concierge doctors also bill insurance or Medicare for actual medical visits, as the monthly “access fee” is only for “non-covered” services. This results in two subscriptions paid by patients — the concierge medicine fee, and the insurance premium. Importantly, a few concierge practices do not bill insurance for medical visits, as the monthly fees cover both access and primary care visits.
Direct primary care started in the mid 2000s, and was created as an insurance-free model to serve a new patient population: the uninsured. In DPC, patients, and now their employers, are also charged a monthly fee, but the fee can be as low as $50 per month and there is typically no third-party payer involvement. Consumers pay physician entities directly (hence, direct primary care), and because the insurance “middle man” is removed from the equation, all the overhead associated with claims, coding, claim refiling, write-offs, billing staff, and claims-centric EMR systems disappears.

Patient panels can be as high as 1,500 patients per doctor, and there is typically no physician cell phone access or house call service. Similar to higher-priced concierge practices, DPC practices also allow for longer patient visits and telemedicine. The most important characteristic of DPC practices, however, is that insurance claims are not filed for medical visits.

Direct primary care’s definition, therefore, is any primary care practice model that is directly reimbursed by the consumer for both access and primary medical care, and which does not accept or bill third party payers.
Confusion arises from similarities that exist in both models, such as decreased patient panels, monthly subscriptions, and longer visits. There is added confusion when a DPC physician offers house calls or email access, typical of concierge practices. Confusion is maximized when a physician is by definition practicing direct primary care, yet calls the practice a “concierge practice.” Similarly, a concierge practice may decide to abstain from participating in third party payer systems, and thus would also be a DPC practice.
The distinction is important because direct primary care is explicitly mentioned in the Affordable Care Act, while concierge medicine is not. Several state laws have also recognized direct primary care as medical practice models, and non-insurance entities. In addition, the term “concierge medicine” causes visceral reactions in select social and medical circles, drawing criticism such as elitism and exacerbation of physician shortage.
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In summary, not all direct primary care practices are concierge practices, and not all concierge practices are direct primary care practices. The terms are not synonymous, and even the basic fundamentals of either model do not overlap. The key to differentiation is whether or not a third party payer is involved. If not, then the model is a direct pay, or direct primary care model, no matter what the fees.
Samir Qamar is CEO, MedLion and president, MedWand. He can be reached on Twitter @Samir_Qamar.

NantHealth NantWorks 2016 Update

Dr. Patrick Soon-Shiong, CEO of NantWorks, the holding company of NantHealth, announced today the IPO of NantHealth:
WSJ 5/24/2016 article on NantHealth
MedCity News Article
The IPO, if successful, will value the company at $2 billion.

So … a few items:

The IPO had been expected last year, but Soon-Shiong told MedCity News in January that he put off the move until NantHealth completed its acquisition of payer-provider communications platform NaviNet.

Here are seven interesting tidbits we found in NantHealth’s S-1 registration statement.

1. The Culver City, California-based company filed for an IPO worth as much as $92 million. That’s actually relative pocket change, given that Allscripts Healthcare Solutions invested $200 million in NantHealth last year, and that NantHealth has been valued at $2 billion. (However, the S-1 lists net tangible book value at $239.4 million as of Dec. 31, which means total tangible assets minus liabilities.)

2. The government of Kuwait owns at least 10 percent of NantHealth, via two holding companies. The Kuwait Investment Authority had put $250 million into NantHealth in 2014.

3. NantHealth has named its knowledge, provider and payer platform CLINICS, for Comprehensive Learning Integrated NantHealth Intelligent Clinical System.

“CLINICS is designed to address many of the key challenges healthcare constituents face by enabling them to acquire and store genomic and proteomic data, combine diagnostic inputs with phenotypic and cost data, analyze datasets, securely deliver that data to providers in a clinical setting to aid selection of the appropriate treatments, monitor patient biometric data and progression on a real-time basis, and demonstrate improved patient outcomes and costs.”

Latest on well-being convenience

I just had a great experience at a CVS Minute Clinic, which I documented here:

JCR Experience with CVS Minute Clinic

It’s been awhile since I revised this mega-trend, so here is an update.

So CVS has been busy. They changed their name to CVS Health, threw tobacco out of their store, and set out to create 900 “Minute Clinics”. These were intended to provide consumers with highly convenient access to nurse practitioners who were armed with the latest in diagnostic tools and online diagnostic protocols.

The latest? CVS now has 800 Minute Clinics in 28 states plus DC.

Walgreens now has 400 clinics. Their press recently has raised questions about whether they are rethinking their corporate strategy.
 
Seattle-based Arivale arrived on the scene in 2015, announcing their intention to revolutionize this space by brings LABS to the foreground, especially through genomics. What caught my eye then was the background of the CEO, Clayton Lewis, who was in genomics from the beginning with Genentech, and Lee Hood, who is a thought-leader in the area.
 
The latest? Well, the update on Arivale is this: they did indeed raise $40 million, and they now have a year’s experience with their “pioneers”. The pioneers are individuals who opted into this intensive longitudinal tracking. The pioneers were offered well-being coaches as well. There originally were 170 pioneers, and there now are over 1,000.

Learnings:

1. the Company says that well-being coaches are a winner. People like them and they say they really help keep them on track.  
2. They are finding that it is difficult (impossible) to keep people focused on long-term risks.
3. They are finding that “experiences” – avoiding bad experiences and promoting good “experiences” is proving useful as a way to motive the pioneers.
 
References:
I wrote about my own vision for this subject here, in 2014:

JCR 2014 Predictions
 

 I wrote about Walgreens here:
2011 post on Walmart with Updates

I Wrote about Arivale here:
2015 post on Arivale

….and here are the two co-founders, on stage in March, 2016:
Lee Hood and Clayton Lewis
 
… an astute 2016 synopsis of what Arivale has learned is here:
 
2016 synopsis of Arivale learnings
 
…and a March 2016 article provides an update, including the acquisition of the Institute for System Biology:
March 2016 Article on Arivale

A good summary on Walgreens and CVS overall is here:

Walgreens and CVS Summary

 

CVS Minute Clinic

I have written before about the trend toward convenience well-being centers (like convenience stores but for all things health and wellness-related). Every big box – most especially Walmart, CVS, and Walgreens – wants their store to be the convenience store for well-being. See all posts tagged BeWell or Well-Being.

There is a retail component – and CVS is an example of best practice. And there is a back-end component. Iona Heath and Arivale are examples there of best practice.

In any event….

Yesterday, with my daughter insisting I had pink eye, I decided to check out the CVS Minute Clinic in my neighborhood. I had a great experience.

There was the usual “set-up/registration” time. It was acceptable and on-line – at a kiosk outside the clinic rooms themselves. Took me about 10 minutes to tell them about me. At the end of registration, they asked online whether I wanted to be in line to see a clinician. I said yes.

There was no wait! Amazing. Not sure how this could be – but true.

The clinician was a “nurse practitioner”. That worried me until I watched her work with all her online and in-clinic diagnostic tools. She gave me a viral pink eye test – negative. So all that was left was the possibility of bacterial pink eye. For this possibility, I needed to take seven days of drops.

How to get the drops? She offered to provide a prescription at the store. I said “yes, please”, and she literally called the pharmacy next to her, and said ‘Josh, I need 7 days of drops in five minutes. Can you handle that. Josh said yes, and I was on my way – so simple!

So here is what I also loved. She took all vitals, she checked my ears and eyes with a laser light (or whatever it is called), she even checked my eyesight! But I am sure she would not have done all these things if I had said I was busy.

So what’s up with this trend? Here’s one mom’s take:

One Mom’s Take on CVC Minute Clinics

I left convinced that a good nurse practitioner could handle 95% of my medical needs – saving the tough stuff for my primary care physician.

References:

Here is my July 11, 2015 blog post about CVS Minute Clinics – printed here in its entirety:

This update about CVS is from today’s NYT:

Strategic Summary:

CVS is placing a very big bet, and my guess is it is right:

That the future consumer of health care in the US will:
– rarely have a primary care physician
– have “high deductible” insurance (so they will be very tough buyers)
– demand services closer to home (convenience is a premium)
– demand services with great frequency of visits (shorter waits, no hassle)
– value convenient treatment for routine illnesses, basic screenings and vaccinations.

So these consumers still need a “front end” to the health care system that allows them to get what they need, when they need it – when it is routine. They also want to crisis services, and other backend services – arranged when the need arises. They think CVS is the answer to those consumers. They want to be the one-stop shop for those consumers.

Their push to retail clinics can be seen in their 900 MinuteClinics and plan to have 1500 by 2017. A typical CVS clinic staffed by nurse practitioners sees 35 to 40 patients a day; those patients pay $79 to $99 for minor illnesses and injuries, and most insurance plans are accepted. Analysts estimate each clinic typically brings in $500,000 a year..

And … just a few months ago …they bought all of Target’s 1900 pharmacy locations. Assuming that some of these become clinics, there could there be even more retail clinics in the future.

So they want to be the one-stop-shop for a consumer’s health, with a front end that is both behind the counter (traditional pharmacy) and in-front-of-the-counter (the store with lotions and magazines and diagnostic equipment etc).

On the back end, they want to best prices for everything that is health-oriented. They also are partnering with Rush University in Chicago to make sure that more-critical needs are serviced properly.

Highlights:

– The Company started in 1963 as Consumer Value Stores (Lowell, Massachusetts)
– CVS under CEO Larry Merlo (who came to CVS when they acquired People’s Drug) has moved aggressively to rebrand the company as a health company. This move began in 2004, when they bought Eckerd Drug.
– They now have 7800 stores, and 900 “MinuteClinics” within their stores …. and plan to have 1500 soon.
– “Its MinuteClinics diagnose and treat patients, and its pharmacies dispense medicine to more than two million prescriptions a day. It negotiates the price of medicines and helps 65 million people navigate drug coverage under their insurance plans.”

Last year, the company changed its name from CVS Caremark to CVS Health.

Acquisitions history is:

2004: The shift toward health care started in 2004, when CVS acquired Eckerd Stores and Eckerd Health Services, giving CVS a foothold in administering drug benefits to employees of big corporations and government agencies.

2006: CVS acquired MinuteClinic, a pioneering in-store health clinic chain that was offering treatment for routine illnesses, basic screenings and vaccinations.

2007: $21 billion merger between CVS and Caremark, which gave birth to the country’s leading pharmacy benefits manager.

2012: CVS struck a deal with the medical products distributor Cardinal Health to form the country’s largest generic drug sourcing operation.

2012: $2.1 billion acquisition of Coram, a business that allows CVS to dispatch technicians to patients’ homes to administer pharmaceuticals through needles and catheters.

2015: In May, it paid $12.7 billion to acquire Omnicare, which distributes prescription drugs to nursing homes and assisted-living operations.

2015: In June, CVS announced it would buy Target’s pharmacy and clinic businesses for $1.9 billion and left open the possibility of pursuing further deals. Once the Target deal closes, CVS will operate about 9,600 retail stores, or about one out of seven retail pharmacies, according to Pembroke Consulting.

= = = = = = = = = =
Article begins here:

How CVS Quit Smoking and Grew Into a Health Care Giant

Michael Gaffney’s throat was scratchy for days, and lemon tea was not helping. So he dropped into a MinuteClinic above a CVS store in Midtown Manhattan on a lunch break. Within minutes, a nurse practitioner tested him for strep throat (negative), suggested lozenges and a regimen (ample fluids, no spicy food), collected a co-payment ($25 cash) and sent him on his way.

“That was quick,” said Mr. Gaffney, 26, an account executive for Indeed.com, who, like millions of Americans, does not have a primary care physician, even though he is covered by health insurance. He has been meaning to find a doctor since moving to New York last year, but his sore throat did not seem serious enough to warrant what was sure to be a time-consuming search and a long wait for an appointment.

The CVS MinuteClinic, on the other hand, was just blocks away from his office. “I waited longer for my bagel this morning,” he said.

With 7,800 retail stores and a presence in almost every state, CVS Health has enormous reach. And while shoppers might think of CVS as a place to pick up toothpaste, Band-Aids or lipstick, it is also the country’s biggest operator of health clinics, the largest dispenser of prescription drugs and the second-largest pharmacy benefits manager. With close to $140 billion in revenue last year — about 97 percent of that from prescription drugs or pharmacy services — CVS is arguably the country’s biggest health care company, bigger than the drug makers and wholesalers, and bigger than the insurers.

Even before the Affordable Care Act created millions of newly insured customers in the almost $3 trillion health care industry, CVS saw that there were more profits to be made handling prescription drugs than selling diapers. But while its transformation from drugstore to health care company began a decade ago, CVS has more recently taken on a new advocacy role, that of a public enemy of cigarettes.

Last year, CVS became the first major pharmacy chain to stop selling tobacco, a business that brought in $2 billion a year. And on Tuesday, CVS said that it would resign from the United States Chamber of Commerce after revelations that the chamber and its foreign affiliates were engaged in a global lobbying campaign against antismoking laws.

Its stand against smoking has allowed CVS to make alliances with health care providers and rebrand itself fully as a health care company. But with smoking rates on a steady decline, and cigarettes sales slumping, CVS also saw that future profits lie not with Big Tobacco but in health and wellness.

Taking the high road for health has its challenges. For one thing, it means new competitors in a rapidly changing industry. And, for a major retailer with tens of thousands of products on its shelves, it leads to an uncomfortable question: If we cannot sell cigarettes, what does that mean for potato chips?

Road to Growth

The Consumer Value Store started as a scrappy discount health and beauty outlet in Lowell, Mass., in 1963. Four years later, the small chain opened its first in-store pharmacies, and those became the core of the company — and its growth — for years. Larry Merlo, the chief executive, is a pharmacist by training and came into the company when it bought People’s Drug, a drugstore chain based in a suburb of Washington.

In a phone interview, Mr. Merlo spoke mostly in corporate platitudes, but when the conversation turned to the subject of pharmacists, he spoke passionately about pharmacists’ role in delivering health care.

“Hypertension, diabetes, osteoporosis,” he said. “It’s the same story — people don’t take their medication as prescribed.”

Pharmacists, who see patients more frequently than doctors do, can make sure patients stay on their drug regimens, he said, keeping them out of the hospital and saving the health care system billions of dollars down the road.

“I think back to my own personal experience,” he said. “Sometimes, it’s as simple as answering questions to get people to stay on their prescription therapies.”

Mr. Merlo said the company stood out in the breadth of products and services it offered: Its MinuteClinics diagnose and treat patients, and its pharmacies dispense medicine to more than two million prescriptions a day. It negotiates the price of medicines and helps 65 million people navigate drug coverage under their insurance plans.

The shift toward health care started in 2004, when CVS acquired Eckerd Stores and Eckerd Health Services, giving CVS a foothold in administering drug benefits to employees of big corporations and government agencies. Two years later, CVS acquired MinuteClinic, a pioneering in-store health clinic chain that was offering treatment for routine illnesses, basic screenings and vaccinations. CVS also expanded its very profitable specialty pharmacy business, which focuses on expensive drugs to treat complex or rare diseases like cancer or H.I.V.

Then in 2007 came the $21 billion merger between CVS and Caremark, which gave birth to the country’s leading pharmacy benefits manager. Three years ago, CVS struck a deal with the medical products distributor Cardinal Health to form the country’s largest generic drug sourcing operation. It followed up with a $2.1 billion acquisition of Coram, a business that allows CVS to dispatch technicians to patients’ homes to administer pharmaceuticals through needles and catheters.

The acquisitions keep coming. In May, it paid $12.7 billion to acquire Omnicare, which distributes prescription drugs to nursing homes and assisted-living operations. Just weeks later, CVS announced it would buy Target’s pharmacy and clinic businesses for $1.9 billion and left open the possibility of pursuing further deals. Once the Target deal closes, CVS will operate about 9,600 retail stores, or about one out of seven retail pharmacies, according to Pembroke Consulting. Last year, the company changed its name from CVS Caremark to CVS Health.

The growth of CVS comes at a time when the way Americans get access to and pay for health care is evolving quickly. Surveys show that many of the estimated 30 million people who gained insurance coverage last year under health care reform do not have a primary health care physician or do not use one. Many, too, opted for high-deductible health plans and are expected to become picky with the dollars they spend, and less tolerant of the opaque pricing that is still the industry’s norm. And consumers in general are starting to demand more convenient, on-demand access to health care, closer to home.

In that fast-changing world, CVS’s strategy is to be a one-stop shop for health care.

“Say you have diabetes, and you go into a pharmacy to get your insulin, how great is it if, in the same aisle, there’s a cookbook for people with diabetes?” said Ceci Connolly, managing director of PwC’s Health Research Institute. “And maybe there’s some foods that are already approved for you, and a place to check your feet, and a clinician to check your eyes,” she said.

“Consumers are saying: I want all of that at a place near my house that’s open on Saturdays, when it’s convenient for me. I want that place to post prices. It’s in CVS’s interest to pull in more and more pieces of that puzzle.”

A typical CVS clinic staffed by nurse practitioners sees 35 to 40 patients a day; those patients pay $79 to $99 for minor illnesses and injuries, and most insurance plans are accepted. Analysts estimate each clinic typically brings in $500,000 a year, representing just a fraction of CVS’s revenue. Still, the clinics are an important part of the company’s health care proposition.

Other retailers are also getting into the business. The number of retail clinic sites grew to 1,800 locations nationwide in 2014 from 200 in 2006, though they still represent just 2 percent of primary care encounters in the United States, according to a report published this year by Manatt Health, a health advisory practice, and the Robert Wood Johnson Foundation. But CVS is by far the leader. Walmart, which charges just $40 a visit, has fewer than 100 clinics, compared with the more than 900 in CVS’s portfolio. Walgreens, the second-largest, has half as many clinics as CVS. And CVS plans to add more, reaching 1,500 by 2017, the company has said.

Whether these clinics provide the best kind of care is a question sometimes raised by doctors in more traditional practices, like Robert Wergin, president of the American Academy of Family Physicians and a doctor in Milford, Neb.

“These retail clinics, they’re run by competent folks, and they probably have some role to play,” he said. “But you’re being seen at a clinic next to the frozen food section by a stranger. And if you go back for a follow-up, you’re going to get seen by someone else.”

For employers and insurers, however, the clinics offer a way to reduce costs for noncritical conditions. A study by researchers at the RAND Corporation estimated that more than a quarter of emergency room visits could be handled at retail clinics and urgent care centers, creating savings of $4.4 billion a year.

Reducing health care spending, however, may turn out to be complicated.

“You might imagine that they keep people out of E.R., so that’s one way you could save money,” said Martin Gaynor, professor of economics and public policy at Heinz College, Carnegie Mellon University. “On the other hand, just because they’re more convenient, people might go and obtain care in circumstances where they otherwise would not have sought care.”

CVS might have more sway reducing health care costs in its role as a middleman between drug companies and patients with drug benefits. The company is expected to start shifting the balance between end users on one hand, and drug manufacturers and wholesalers on the other.

CVS and other large dispensing pharmacies — Walgreens, Express Scripts, Rite Aid and Walmart — made up about 64 percent of prescription-dispensing revenue in the United States in 2014, according to Pembroke Consulting. That year, CVS was also the leading provider of specialty drugs in North America, with $20.5 billion in revenue, representing 26 percent of the total market.

“Scale is a big factor in pharmacy,” said Joseph Agnese, senior equity analyst at S&P Capital IQ. “There’s a lot of pricing pressure from drug manufacturers and one way for retailers can come back at them is to become larger, and become a more significant purchaser of drugs.”

Dr. Gaynor of Carnegie Mellon said, however, that cost reduction varied greatly by type of drug. “If there’s a drug that is very important for CVS to carry, and there are no alternatives, they aren’t going to have a lot of negotiating power,” Dr. Gaynor said. “But of course, the bigger CVS gets, the more they can move product, the more important it becomes.”

The company’s size also creates significant competition issues, says David A. Balto, an antitrust lawyer and former policy director at the Federal Trade Commission who often represents independent pharmacies. CVS’s ownership of Caremark could restrict consumers’ access to rival pharmacies, he said, and CVS’s acquisition of Omnicare, already a dominant player in long-term care, could reduce competition in that industry.

“There are tremendous concerns when you see someone becoming so terrifically large,” Mr. Balto said. “The acquisitions might conceivably be efficient, but whether those efficiencies are passed on to consumers really depends on the level of competition in the market.”

Quitting Cigarettes

Helena B. Foulkes, who leads CVS’s retail business, swept past the sales counter at a newly renovated CVS in downtown Manhattan. Where cigarette packs once lined up in neat rows, now there were nicotine gum and patches to help smokers quit. (There are no e-cigarettes either, much to the chagrin of that industry, which had hoped CVS would embrace its products as a lower-risk alternative.)

Ms. Foulkes, who lost her mother to lung disease, leads the retail business, which is starting to change to fit the company’s health care bent better.

The move to forgo $2 billion in annual tobacco sales has bolstered CVS’s health care bona fides. The White House lauded CVS’s move. “Thanks @CVS_Extra, now we can all breathe a little easier,” Michelle Obama wrote in a Twitter post. The praise seemed to give Mr. Merlo a jolt of confidence. At a TEDx talk this year in Winston-Salem, N.C., he declared: “CVS kicks butts across the U.S.”

“When we exited the tobacco category, it was the most important decision we’d made as a company,” Ms. Foulkes said. “That decision really became a symbol both internally and externally for the fact that we’re a health care company.”

It also made economic sense. Adult smoking rates have dropped to 18 percent in 2014, from 43 percent in 1965, according to the Centers for Disease Control, and experts predict that rate to dip below 10 percent in the next decade. Ditching cigarettes allows CVS to trade a small — less than 2 percent of revenue — and shrinking part of its business for an instant enhancement of its credentials in the faster-growing health and wellness space.

In October, CVS announced that its Caremark arm would require some of its customers to make higher co-payments for prescriptions filled at pharmacies that still sold tobacco products — in effect driving more traffic to the now tobacco-free CVS pharmacies. While that move encourages pharmacies to quit selling tobacco, it also raised the ire of an antitrust law research firm, which called the announcement “a smokescreen” that masks higher costs for those who fill prescriptions at competing pharmacies.

“CVS’s use of its market power to bludgeon consumers and rivals into ending tobacco sales is not a legitimate form of competition,” the American Antitrust Institute said in a statement. It has urged the Federal Trade Commission to investigate.

In general, CVS’s new anti-tobacco stance has helped it forge affiliations with regional hospitals. Before CVS went tobacco-free, negotiations with local health systems were awkward, Mr. Merlo said during a recent analyst conference call.

“That question would always come up — ‘You guys sell tobacco products, don’t you?’ — and that literally sucks all the energy out of the room,” Mr. Merlo said. But since the company stopped selling tobacco, he said, “We’ve been able to accelerate partnerships with leading health systems across the country.”

A new partnership with Rush University Medical Center in Chicago will involve patient referrals and shared electronic health records. Anthony Perry, vice president for ambulatory care and population health at Rush, said that traditional health care providers and companies like CVS could be natural allies.

“Take people with high blood pressure. That’s the type of thing you manage steadily over time, and you work on things like diet and exercise, and lifestyle changes, and if those things don’t work, you get into the world of medications,” he said. “What we asked was: If we’re going to do a series of visits with somebody, might they be able to do some of that closer to home?”

The flip side, he said, is that CVS can refer people with more serious ailments, but no primary care doctor, to Rush. “So CVS can now say: You need to see a primary care doctor, and we can connect you.”

The anti-tobacco stand has had other effects. Notably, the company has had to start thinking about other unhealthy items on its shelves. If it is a company that promotes health, can it also sell sugary sodas and candy bars?

The downtown Manhattan store where Ms. Foulkes walked the aisles is one of 500 locations that CVS is remodeling to emphasize healthy fare.

“I was in Long Island the day after the tobacco announcement, and I ran into a store manager who said: ‘I’m so proud of the company,’ ” she recalled. “But he also said, ‘I’m hearing customers now saying, why don’t you have healthier food?’ ”

“Customers quickly made the leap. They expected more from us,” she said.

Ms. Foulkes pointed to a prominent snack corner at the front of the store.

“What you’ll see in our stores are brands that convey healthy without being overly edgy. It’s Chobani yogurt, it’s Kind bars, it’s lots of proteins and nuts,” she said. “Health for the masses.”

At this point, there are no plans to stop selling high-fat or high-sugar snacks, still a big part of CVS stores’ sales. But they might be harder to spot.

When asked where the Oreos were, she smiled. “You’ll find them, but you’ll have to look for them.”

NantHealth Update

Allscripts invests $200M in Soon-Shiong’s NantHealth in software integration deal (updated)
By NEIL VERSEL
Post a comment / 61 Shares / Jun 30, 2015 at 1:33 PM
Patrick Soon-Shiong
Dr. Patrick Soon-Shiong
Electronic health records vendor Allscripts Healthcare Solutions has bought a 10 percent equity stake in NantHealth, the health IT arm of Dr. Patrick Soon-Shiong’s empire, for $200 million, while another Soon-Shiong company has bought $100 million worth of stock in Allscripts.

The deal, announced Tuesday, extends a partnership first disclosed in March, in which the two companies agreed to share technology in developing more personalized cancer treatments.

Chicago-based Allscripts paid cash for its 10 percent stake in NantHealth, the two companies said. Soon-Shiong bought into Allscripts via his personal investment vehicle, NantCapital, part of his burgeoning NantWorks conglomeration.

The Los Angeles Times reported that the cross-investment, which values Culver City, Calif.-based NantHealth at $2 billion, closer to a planned initial public offering later this year. “We feel we have one or two transactions to accomplish, then we will initiate the public offering that we anticipate will happen probably within this year,” Soon-Shiong reportedly told the Times.

NantHealth and Allscripts said that they would jointly integrate their software via application provider interfaces, including placing dashboards to NantHealth databases and analytics engines into Allscripts EHRs. For example, NantHealth will make its Eviti cancer-specific clinical decision support technology available through Allscripts front ends, NantHealth President Robert Watson said in an interview with MedCity News.

The two companies also plan on developing several specific pieces of technology: an ontology and industry standard for cross-clinical usage of a NantHealth-developed test known as GPS Cancer (GPS stands for genomic-proteomic sequencing); invitations for GPS Cancer sequencing delivered to specific patients through Allscripts’ FollowMyHealth portal; and a new product for accountable care organizations that promotes semantic interoperability.

“We believe that our GPS Cancer test should become a standard of care,” Watson said. It takes the kind of access to hospitals and cancer centers that Allscripts has to make it happen, Watson explained.

The test is more comprehensive than others on the market, Watson said, in that it takes into account the full genome and full exome, not just a small subset of pairs.

In a press release, Allscripts President and CEO Paul Black said:

“We’re taking an important step forward in our strategic partnership that fully aligns our resources and furthers Allscripts’ strategy to invest in new technologies that can revolutionize service to hospitals and physicians. Under the leadership of Dr. Soon-Shiong, NantHealth is pioneering extraordinarily innovative, personalized healthcare solutions that will empower more efficient and effective clinical decisions. We’re confident that our joint efforts will help Allscripts lead the way in our vision of delivering open, integrated and precision-based medical solutions to physicians and patients

============== Prior Blog Post =======

NantHealth Update
Remember Dr. Patrick Soon-Shiong and NantHealth?

He is the LA billionaire I met in 2013. I was saying “watch him make his next move” in 2013 when he came to Coke and showed a vision of how he wanted to revolutionize health care. I drove in a car with him to see if he could use some of his genomic knowledge to help my friend John Farrell live (it was too late but he really tried hard and I came to respect him as a physician and oncologist).

His vision them was for a revolution in health care based on breathtaking new genomic understandings, including how genes changed over time, combined with revolutionary new home appliances that would record cloud-based data relevant to your personal health, e.g. a scale that recorded weight and pill bottles that recorded compliance with medications.

In any event ….

Take a look at his investors – – – $320 million so far, from elite players:

I’m reminded of what Dr. Patrick Soon-Shiong is doing with NantHealth, which is a lot more opaque other than the approximate $320M of private equity money invested to date by Sovereign Wealth Fund, Kuwait Investment Authority, Verizon, Celgene, Blackberry, and Blackstone.