Tag Archives: Personalized Medicine

“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.
Adslot’s refresh function: googletag.pubads().refresh([gptadslots[1]])

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.

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.

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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.”

Precision Wellness at Mt Sinai

My Sinai announcement

Mount Sinai to Establish Precision Wellness Center to Advance Personalized Healthcare

Mount Sinai Health System Launches Telehealth Initiatives

Joshua Harris, co-Founder of Apollo Global Management, and his wife, Marjorie has made a $5 million gift to the Icahn School of Medicine at Mount Sinai to establish the Harris Center for Precision Wellness. As part of the part of the Icahn Institute for Genomics and Multiscale Biology, the new center will leverage innovative approaches to health monitoring and wellness management by integrating emerging technologies in digital health, data science, and genomics to enable people’s health to be treated in precise, highly individualized ways.

A first-of-its-kind at a major U.S. academic medical institution, the precision wellness research programs will be closely tied to clinical initiatives across the Mount Sinai Health System. The Harris Center’s immediate efforts will focus on digital health, molecular profiling, and data science. The Center is evaluating the usability of wearable devices to see how effective they can measure activity, stress, sleep, cognitive functioning, mood, and environmental exposures and using sequencing technology to bring DNA, Microbiome, and immune system profiles into predictive models of wellness.

Additionally, the new Center will apply state-of-the-science analytics and machine learning to the wealth of individualized metrics to produce actionable, data-driven insights into key aspects of wellness, and to help lead the way to a nextgen healthcare that is scalable and far superior to anything now available.

Joel Dudley, PhD, a highly regarded genomics and bioinformatics expert at the Icahn Institute, and by Gregory Stock, PhD, an accomplished life-science entrepreneur and technology-innovation expert will serve as the Harris Center directors.

“We are deeply grateful to Mr. Harris for his generosity, vision, and passion,” said Dr. Dudley. “His gift will help realize the promise we see in new digital health technologies such as wearable sensors and mobile applications. By drawing upon the core competencies in genomics, multiscale biology, bioinformatics, data science, population health, and clinical trial design at the Icahn Institute, the Harris Center initiatives will further enhance Mount Sinai’s reputation as one of the world’s premier innovators in personalized healthcare. It is exciting to have an opportunity to integrate and apply these emerging technologies in a meaningful and scientific way in the pursuit of optimal wellness, vitality, and preventive care.”

ResearchKit from Apple

I wrote last fall about Apple’s new HealthKit platform. That update is below.

Now, Apple takes the next step – into Medical Research. Take a look:

Research Kit Update

======================= post from 201504: Apple, IBM, and J&J ====================

Post from April 2014 about Apple, IBM, and K&J

======================= post from 201411: Apple HealthKit ====================

Apple has done a great thing – rolled out a well-being platform called HealthKit that creates a dataset that finally allows consumers to bring everything together in one place.

Note 43 apps have announced integration plans, and thus the issue that is highly relevant is: who will help consumers make sense of all this?

Here is what they are saying to consumers:
Apple to Consumers

Here is how they are encouraging developers to build an interface:
Apple to Developers

The roll-out from Apple was rocky for sure, as documented by this Forbes Article: Forbes Article on Apple’s HealthKit

Here’s some commentary on the roll-out and integration so far:
Commentary on Apple’s Move to Introduce HealthKit

And here is running update of apps who have integrated so far:
Updates on Apps that have announced integration plans
(Note Nike is integrating, while Fitbit is (so far) holding out….and note that – as of 11/5/14 …. 43 apps have announced integration plans)

But at least Apple is working on something that really matters. Now the question is: how will people know how to use it? Interpret the results? Share with their doctor? Integrate with the Dr’s electronic medical records?

I know the answers will come, but we all need to get there sooner rather than later.

Apple Watch, IBM, and J&J

IBM Watson Health and Apple Watch and HealthKit update

There is a lot going on! Much of the news is rotating around Apple, IBM, and J&J. They all are getting into health – big-time. Remember that everything is connected.

Apple Watch is a decent place to start. Apple isn’t saying, but analysts are beginning to predict a successful launch for the Apple Watch – their new wearable. Pre-orders are predicted to have already passed 1 MM, and will soon pass 2 MM, which is more than all Android wearables sold in a year. They ship this month, so we will know soon.

Everything is connected. For example, IBM is connected to Apple. How? IBM announced that it is jumping big-time into the digital health game, with their new 2,000+ employee Watson Health Unit. They want to “share and analyze health data for greater insights into trends to improve individual and overall patient outcomes.” And guess what? They have a massive data cloud – called Watson Health. Linked to the Apple data cloud – called Apple HealthKit.

So here is the connection:

“IBM will apply Watson Health cloud services and analytics to Apple’s HealthKit and ResearchKit, two features announced with last month’s release of Apple Watch. HealthKit enables the collection of data from the Apple Watch, and ResearchKit enables Apple Watch wearers to take part in massive health data studies by sharing the baseline vital signs and activity data.”

So here is the plain english version of this: Apple Watch is just an appliance, like a phone or a Nike wearable. But the real value here is the data. And that data resides in Apple HealthKit.

HealthKit is their new data platform. Their watch is just one of many data links to their platform. It pulls data from, and adds data to, their new Health Platform, which they call HealthKit.

Everything is connected. J&J is in the game too – starting out with experiments in virtual coaching and diabetes management. Their “Patient Athlete” program will likely be the first of many. “We’re going to start this collaboration [with IBM’s Watson Health] with joint replacement surgery… joints, knees and hips.”

“ (IBM) Watson’s analytics and “cognitive” capability will enable the program to grow into a virtual patient coach, working with patient data to tailor a post-operative recovery coaching program.”

Everything is connected. Medtronics is in the game too – – working from data gathered from diabetes patients – like glucose monitors.

References:

http://www.computerworld.com/article/2909534/ibm-launches-watson-health-global-analytics-cloud.html

IBM announced a new business unit, Watson Health, that will offer cloud-based access to its Watson supercomputer for analyzing healthcare data.
The Watson Health Cloud will be an open source but secure platform on which care providers and researchers can share and analyze health data for greater insights into trends to improve individual and overall patient outcomes.

IBM, which made the announcement at the Healthcare Information Management Systems Society (HIMSS) conference in Chicago, also said it has acquired big data healthcare analytics providers Phytel and Explorys, whose software will be used in concert with Watson Health.
The Explorys platform enables healthcare systems to collect, link and combine data from hundreds of disparate sources across their enterprise and clinically integrated networks. This data will be derived from clinical, claims, billing, accounting, devices, community and patient information.
Phytel develops and sells cloud-based services that help healthcare providers coordinate care in order to meet new healthcare quality requirements and reimbursement models.
“Their data sets represent 90 million lives, primarily in this country,” said Mike Rhodin, senior vice president of IBM’s Watson Business Group.
Additionally, IBM announced three new partnerships with Apple, Johnson & Johnson, and Medtronic to optimize consumer and medical devices.

IBM will apply Watson Health cloud services and analytics to Apple’s HealthKit and ResearchKit, two features announced with last month’s release of Apple Watch. ResearchKit enables Apple Watch wearers to take part in massive health data studies by sharing the baseline vital signs and activity data.
Apple engineers have been working with dozens of research institutes, such as the Mayo Clinic, in developing apps that will help in research on Parkinson’s Disease, diabetes, cardiovascular problems, asthma and breast cancer.
IBM will provide a secure research capability on the Watson Health Cloud platform, de-identifying personal data to allow researchers to easily store, aggregate and model information collected from iOS users who opt-in to contribute personal data to medical research.
Johnson & Johnson will collaborate with IBM to create intelligent health coaching systems centered on preoperative and postoperative patient care, including joint replacement and spinal surgery.
“There’s so much we have to learn with this sea of data,” said Len Greer, president of Health and Wellness Solutions at Johnson & Johnson. “We’re going to start this collaboration [with IBM’s Watson Health] with joint replacement surgery… joints, knees and hips.”
Johnson & Johnson recently launched Patient Athlete, a pre and post operative video health coaching program, but Watson’s analytics and “cognitive” capability will enable the program to grow into a virtual patient coach, working with patient data to tailor a post-operative recovery coaching program.
Johnson & Johnson also plans to launch new health apps targeting chronic conditions, such as diabetes and obesity, which take up as much as 80% of $7 trillion global healthcare spending, according to Greer.
Medtronic will leverage the Watson Health Cloud insights platform to collaborate with IBM around delivery of new highly personalized care management services for people with diabetes. The system will receive and analyze patient information and data from various devices including insulin pumps and continuous glucose monitors, and use this information to provide dynamic, personalized diabetes management strategies to patients and their providers.
Rhoden said Watson Health will include the open source sharing of code, so that any company can become a partner and develop applications for the platform.
“They’ll be solutions we bring to market, solutions we work with others to bring to market, and startups can even take advantage of the analytics to build future solutions,” Rhoden said.

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http://wtop.com/tech/2015/04/apple-watch-pre-orders-already-outnumber-android-wears-annual-sales/

(NEW YORK) — Estimates are already hinting that Apple Watch pre-orders may have hit one million units this weekend, surpassing the number of Android Wear sold last year.
Apple Watch pre-orders began on Friday in select countries, but one estimate says already that 957,000 people in the U.S. alone ordered the device on the first day.
The company that produced that report, Slice Intelligence, referred to their panel of two million online shoppers and found that 9,080 people in that panel had pre-ordered the Apple Watch this past Friday. That already surpasses the more than 720,000 Android Wear devices that sold last year, according to another research firm Canalys, which released its report in February.
Gene Munster, Piper Jaffray & Co. senior research analyst, called Slice Intelligence’s estimate “optimistic,” but Apple Watch’s launch is still strong.
Munster estimates Apple will ship close to one million Apple Watches by April 24, around which time he estimates Apple will have about 50 percent of the wearables market.
“We’re a little bit more measured,” he said. “But no matter how you cut it, it’s a good launch.”
Jaimee Minney, vice president of marketing and public relations for Slice Intelligence, told ABC News she wasn’t surprised with the early pre-order estimates for the highly anticipated wrist device.
In other Slice Intelligence research, Apple users were “far underrepresented” in the smartwatch market, even though Apple customer demographics were very similar to those of the smartwatch market.
“Apple users were waiting for the Apple watch, so when we saw this huge surge in demand, we were not surprised at all,” she said.
Meanwhile, Apple has so far remained silent on how many pre-orders it received.
Tim Coulling, Canalys senior analyst, agreed that he wasn’t surprised if Apple Watch pre-orders have already surpassed Android Wear device sales. Most recent examples of Android Wear devices sell for around $199.99 and up and include the ASUS Zenwatch, Moto 360, Sony SmartWatch 3, as well as Samsung and LG devices.
“There’s a lot of anticipation around the product. It’s far more advanced in terms of functionality,” Coulling told ABC News. “Apple’s brand is a very fashionable brand so it’s likely that people will buy the product as a watch as well as a smartwatch.”
But, Coulling said, he doesn’t expect Apple Watch sales to reach the same levels of those of the iPhone and iPad.
“There isn’t really an overriding reason to buy a smartwatch right now at the moment,” he said. “An iPhone is an essential communication device, like a smartphone. A tablet or the iPad is a computing device. A lot of people don’t even wear watches because they have a smartphone all the time.”
Apple and Google did not immediately respond to requests for comment.

LABS revolution continues

Biggest of them all has now joined the revolution I posted about on 3/28/14 tagged LABS. The post was about the new service by a Stanford Grad (newly minted billionaire) who had gotten rid of vials in blood tasting and had drastically reduced the complexity and price of LAB results. Her company is called Theranos.

Take a look at this news from LabCorps.

Article on New LabCorps policy

The original post about Theranos is here:

Theranos 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.

HealthKit from Apple

Apple has done a great thing – rolled out a well-being platform called HealthKit that creates a dataset that finally allows consumers to bring everything together in one place.

Note 43 apps have announced integration plans, and thus the issue that is highly relevant is: who will help consumers make sense of all this?

Here is what they are saying to consumers:
Apple to Consumers

Here is how they are encouraging developers to build an interface:
Apple to Developers

The roll-out from Apple was rocky for sure, as documented by this Forbes Article: Forbes Article on Apple’s HealthKit

Here’s some commentary on the roll-out and integration so far:
Commentary on Apple’s Move to Introduce HealthKit

And here is running update of apps who have integrated so far:
Updates on Apps that have announced integration plans
(Note Nike is integrating, while Fitbit is (so far) holding out….and note that – as of 11/5/14 …. 43 apps have announced integration plans)

But at least Apple is working on something that really matters. Now the question is: how will people know how to use it? Interpret the results? Share with their doctor? Integrate with the Dr’s electronic medical records?

I know the answers will come, but we all need to get there sooner rather than later.

Digital Health Again

So everyone is talking about Dr. Eric Topol as he speaks about his new book and it’s implications. Very provocative.

My own take is – things take a LONG time to happen. Dr. Topol talks about 17 years and – sadly – I think he is right. However, the amount of real change that is available to early adopters right now is scary good. Look out 18 months and it is even better.

Digital Health

This “super-convergence” in medicine, triggered by cheap genetic sequencing and sensors, makes good sense, but the tiny implanted sensors that track things blood pressure, oxygen saturation, blood glucose, heart and respiratory rates – these are probably way out there.

Available now????
– an add-on to a smartphone which does eye refraction and then sends the prescription to get your glasses made, bypassing the optician.
– skin lesion scanned and get a message back quickly saying that there’s nothing to worry about, or not, which would have big implications for a dermatologist.