Tom Knight, Healthcare Diversion
Above the Fold
We Need to Nationalize to Prevent Fraud
By MATTHEW HOLT
Two weeks ago I wrote an April Fool’s piece that claimed that Elon Musk and DOGE were going to nationalize American health care to save some money. That piece was half-joking but full-serious.
If you look at what Musk is complaining about there are two major areas of “waste, fraud and abuse” in government spending.
One is people directly employed by government agencies. Most of the people I’ve ever met in government work damn hard and for much less money than they’d get in the private sector. But you can of course find stories about useless government bureaucrats, who don’t do any work and pad their expense accounts. Those stories are probably about as true as Reagan’s pink Cadillac driving welfare queen in that there is some basis in reality for there being a tiny minority of bad actors, but the politics has far outrun the truth. (BTW that Welfare Queen article by Josh Levin in Slate is remarkable and very long!)
The other major area where Musk claims to be finding fraud is in work contracted out. There are of course lots of types of government work contracted out. If, like me, you’re old enough to remember the Iraq war, you probably are thinking of beltway bandits like Halliburton supplying any number of services to the military. (Remember when the Cheneys were baddies?). Another is the Blue Cross & Blue Shield plans who were the original contractors processing Medicare & Medicaid claims. Funnily enough they couldn’t actually deliver on that so in turn they outsourced it to Ross Perot at EDS and others like ACS, later Conduent. But there’s a ton more across every agency.
Musk & DOGE have been running around in the most ham-fisted way imaginable, axing both actual employees–including 20,000 of the 80,000 working at HHS– and allegedly slashing $150 billion in contracts. Of course on closer examination, many of the “contracts” were already over, or were made up. DOGE has been a pathetic piece of performance art that would be funny if it hadn’t ruined so many careers of people doing great work, or killed so many desperately poor children in poor countries.
The clever people at Brookings, (Elaine Kamarck and Paul Light) in a detailed piece on the topic, came up with an estimate of the ratio between direct employees and contractors.
Continue reading…“Health Care” vs. “Healthcare” Signals Change Greater Than Grammar
By MICHAEL MILLENSON
“The New Yorker House Style Joins The Internet Age” announced the magazine’s daily newsletter under the byline of Andrew Boynton, whose appropriately old-fashioned title was “Head of Copy.” Among the alterations Boynton acknowledged readers might feel “long overdue,” were “Internet” becoming “internet,” “Web site” consolidating to “website” and “cell phone” becoming “cellphone.” Other quirky spellings (teen-ager, per cent, etc.) were deliberately retained.
But what about “health care” vs. “healthcare”?
A New York Times interview described Boynton as “tight-lipped” about the style changes, which came as the publication celebrated its 100th anniversary year. When I nonetheless sought to discover whether a descriptor central to a massive chunk of the U.S. economy was more like a cellphone or a “teen-ager,” the magazine graciously responded.
“’Health care’ is our style,” a spokesperson wrote me in an email. “There has not been any discussion of diverging from this.”
Not even a discussion? This was shocking news! But as I dug deeper, it seemed to me that the choice of the one-word versus two-word term often sent an underlying signal about the evolution of not just language, but of health care as both a profession and an industry.
Debating Evolution
Back in 2012, after I dived into the “health care vs. healthcare” debate for The Health Care Blog, my friend and colleague, the determinedly data-driven David Muhlestein, PhD, JD, accused me of ignoring language evolution by insisting on the “two words” usage. He eventually presented me with Google searches showing that the ratio of uses of the one-word to the two-word term ineluctably indicated “health care” was going the way of “Web site.”
When I solicited a 2025 update, Muhlestein obliged with a Google trends graph tracing relative usage since 2004.
Apart from a brief time that “health care” was more prevalent as discussion of the Affordable Care Act dominated the news, the preference for “healthcare” has steadily strengthened. “As of now, people use the one-word version more than twice as often as two words,” Muhlestein wrote in an email.
He added, “You can’t predict how language will evolve, you just have to go with what it is, and for the U.S., healthcare is definitely going to one word.”
Perhaps. But even a cursory qualitative analysis suggests a more nuanced picture than volume alone provides. After poking into the preferences of publications, corporations, the U.S. government and others, I decided that a 2022 April Fool’s column in Health Affairs actually provided a rough guide to understanding many usage decisions.
Continue reading…Elevare Law launches!
There’s a new health innovation law firm in town! Rebecca Gwilt & Kaitlyn O’Connor have started Elevare Law to help health tech companies. We spent a little time talking about the new firm and who it’s going to work with, and a lot about the different legal and regulatory challenges facing digital health companies. Deep dives into the regs around RPM, RTM & more, and also a lot about what we might expect from the FDA and the rest of the chaos in the new Administration. Plus a little about how AI helps lawyers be more efficient and a lot about how AI may or may not be influenced by health care regulation (TL:DL, it’s going to be slow & state by state) –-Matthew Holt.
League Connect Digital Summit on May 7
I’m thrilled to be working with League and I’ll be MC-ing health care’s must-attend virtual CX event, League Connect Digital Summit on May 7.
An immersive day of inspiration, insights, and incredible speakers is headlined by Moneyball & Big Short Best-Selling Author, Michael Lewis and @HighmarkHealth CEO, @DavidHolmberg, as well as many more.
More than just theory, at the Summit you’ll get actionable strategies and everything you need to drive health care CX forward. – Matthew Holt
Register today to save your spot
I’m on the Baker Health Podcast
It was great fun to talk about the health care system with Dr Zeyad “Z” Baker on his podcast, so I thought I would share it here–Matthew Holt
Consensus is taking fax data, received by rural clinics, post acute, substance abuse clinics, home health et al, and helping them put it into their systems of records–which are in general not FHIR-enabled. They allow those facilities & services to receive referrals from acute care hospitals. By 2027 many of these standards are going to need to be FHIR enabled. Bevey Miner, EVP at Consensus, is a health care veteran who is working on both a policy and technology level to improve access to care, and thinks a lot about what unstructured data means in a world where we are trying to use data for AI and more. Super interesting chat about the murky backwaters of health care data and services. As Bevey says, “Not everyone is going to be Epic to Epic to Epic”–Matthew Holt.
Feeling the Pressure
By MIKE MAGEE
After Trump crashed the markets, citizens worldwide are “feeling the pressure.” But in the spirit of calming us down, let’s consider a story of human cooperation and success from our past.
It has been estimated that a medical student learns approximately 15,000 new words during the four years of training. One of those words is sphygmomanometer. the fancy term for a blood pressure monitor. The word is derived from the Greek σφυγμός sphygmos “pulse”, plus the scientific term manometer (from French manomètre).
While medical students are quick to memorize and learn to use the words and tools that are part of their trade, few fully appreciate the centuries-long efforts to advance incremental insights, discoveries, and engineering feats that go into these discoveries.
Most students are familiar with the name William Harvey. Without modern tools, he deduced from inference rather than direct observation that blood was pumped by a four chamber heart through a “double circulation system” directed first to the lungs and back via a “closed system” and then out again to the brain and bodily organs. In 1628, he published all of the above in an epic volume, De Motu Cordis.
Far fewer know much about Stephen Hales, who in 1733, at the age of 56, is credited with discovering the concept of “blood pressure.” A century later, the German physiologist, Johannes Müller, boldly proclaimed that Hales “discovery of the blood pressure was more important than the (Harvey) discovery of blood.”
Modern day cardiologists seem to agree.
Continue reading…The World’s Psychoactive Drug of Choice
By MIKE MAGEE
Question: What is the world’s most widely used psychoactive drug?
Answer: Caffeine
In the U.S., caffeine is consumed mainly in the form of coffee, tea, and cola. But coffee dominates. Worldwide, humans consume over 10 million tons of coffee beans a year. Roughly 16% (1.62 million tons) is devoured by Americans. The daily intake of caffeine varies depending on type of beverage and brand as the chart below indicates.
On average, each American consumes approximately 164 mg of caffeine each day. That’s roughly 1 small cup of Dunkin or (3.5) 12-ounce Diet Cokes (Trump consumes at least 12 cans of Diet Coke a day).
Across the globe, daily consumption of caffeine is close to universal. Eight in 10 humans consume a caffeinated beverage daily. That makes this chemical substance the “most commonly consumed psychoactive substance globally.” Its popularity is related to its ability to deliver three useful physiological enhancements – wakefulness, motor performance, and cognition.
Chemically, caffeine is a close cousin of adenosine which is present in brain neurons. Adenosine builds up in synaptic connections between brain neurons. When it binds to special receptors, it activates neurons that promote sleepfulness. Ingested caffeine is water and lipid soluble, and therefore is able to traverse the blood-brain barrier. Once inside, its chemical structure mimics that of adenosine, and it occupies adenosine receptors because it shares the same approximate shape and size. When these receptors are occupied by caffeine, adenosine molecules are unable to activate the receptors. The net effect is wakefulness.
Continue reading…Platform Shift: From EHRs to UDHPs (Unified Digital Health Platforms) – – Section 2
By VINCE KURAITIS, GIRISH MURALIDHARAN & JODY RANCK
This entry is Section 2 of part 3 of 3 in the series Platforming Healthcare — The Long View. This essay is the next in the series entitled “Platforming Healthcare — the Long View”. The series presents a 30-Year Framework for Platforming Healthcare. An updated v2.0 of a graphic depicting this 30-Year Framework is shown above.
Today’s post is section 2 and will continue to describe and discuss a potential successor to the EHR era — Unified Digital Health Platforms (UDHPs). Here’s an overview:
- Mayo Clinic Platform
- Business and Strategic Implications of UDHPs
- APPENDIX: Additional Readings on UDHPs
Mayo Clinic Platform: Healthcare platforms and AI
The Mayo Clinic Platform (MCP)was launched several years ago with the goal of building the future Mayo Clinic business model that could move beyond the bricks-and-mortar approach to traditional healthcare and open up new avenues for products and services. The adoption of a platform business model was considered essential to serving patients beyond the traditional Mayo Clinic geography as well as a way to incentivize innovation in AI and decentralized care in the home.
A large longitudinal database with both structured and unstructured data provides a foundation for the MCP, particularly in respect to catalyzing innovation in clinical applications of AI. The database called Mayo Clinic Platform Discover has over 7.3 million de-identified patient records that can be used for training AI models as well as in research and discovery for early-stage startups in particular who wish to join the MCP ecosystem. The dataset is referred to as “Data behind glass” for the privacy and security standards that are needed to create the bedrock for a collaborative ecosystem.
Source: Mayo Clinic Platform Playbook
MCP is a three-sided market that has solution developers, data providers, and clinicians composing the three sides. MCP acts as the orchestrator of the ecosystem and additional partners such as Mercy have joined as data contributors in the MCP component called Mayo Clinic Platform Connect. These are the primary components of the platform.
The Mayo Clinic Platform Playbook identifies six key success factors:
- A privacy-protecting, secure collaborative environment with de-identified data from global sources. Longitudinal databases of patient records are vital to clinical research and the development of new clinical decision-support tools, therapeutics, and digital health solutions. Privacy and security need to be maintained to protect the trust of Mayo Clinic’s patients.
- Breadth and depth of patient data must be sufficient to generate insights for both rare and common diseases.
- Seamless capabilities to both ingest diverse data sources (e.g. -omic (genome, metabolome, etc.), EHR, wearables, social determinants of health (SDoH)) and to deliver actionable insights at the point of care.
- Cutting-edge data science analytic tools, robust computing power, and uniform data standards.
- Strong governance to assume security, scientific validity, interoperability and validation of technologies fit for purpose.
- Pathways for commercialization of effective, validated solutions.
MCP vets startups and more mature technology vendors through a process that can begin with providing access to the longitudinal database for developing and training models (early-stage startups) to scaling solutions across MCP and affiliated hospitals with Mayo Clinic. The robust governance structure and integration with MCP makes scaling into other systems much more feasible.
AI governance is a core component of the MCP and why they were one of the original sponsors of the Coalition for Health AI (CHAI) to bring together leading industry players to create the standards for responsible AI across validation, explainability, and transparency. Ensuring that AI tools have been rigorously validated is necessary for clinician adoption of AI as well as maintaining the trust of patients. These standards act as a kind of “rules of the road” for technology solution providers on the MCP.
Continue reading…Musk Moves US to Socialized Medicine
By THCB STAFF
After a few weeks analyzing government spending and putting all of his calculations into Grok, the head of DOGE, Elon Musk, has made another decisive move in the attempt to save the government money. Speaking on the Joe Rogan show, Musk declared that his team had given Big Balls and Little Balls instructions to stop screwing around with the minor stuff like cutting off foreign aid saving the lives of children or getting all worked up about storing paper records in a mine, and to “go after the real money”. It turns out that means putting all US health care into a national health service and eliminating all private, non state-run health care.
He told Rogan, in between injections of what he claimed were vitamin supplements, that “the DOGE team realized that the British government spends about $7,500 per capita on health care, and the US government spends about $8,000”. After observers noticed a few puffs of smoke coming from Musk’s side of the room he went on to say, “that means our government can use the example of the Brits and cut spending by $500 a head and as an added bonus, private employers can stop wasting money on health care premiums”. When asked by Rogan if this new move was influenced by his desire to cut costs at his companies, Musk appeared to be unaware that he ran any companies.
Musk went on to say, “it’s incredible that we’ve been giving all these hospitals and health insurers government money and they’ve been sticking it in their hedge funds. Little Balls told me that he read a post from some blogger claiming that there’s over $500 billion sitting on the balance sheets of big hospitals and non-profit health plans. Now we have nationalized them all, that money can be put to better use.”
Rogan asked him how this would work and Musk said that all doctors, nurses and hospitals now worked for the Federal government and could just deliver care for free. “They’ll be paid British wages, and they’ll be happy–British people are still rich enough to be buying Teslas, no one else is! And if the line is too long, then people can fly to Scotland where they’ve got this socialized health care thing down pat. I understand President Trump has a special going at his hotel on that golf course, if you don’t mind looking at the windmills.”
When asked whether he supported Musk’s move, President Trump told the White House press corps that he wasn’t on the group call but that Don Jr had mentioned that Adderall was free in the UK, so it seemed like a good idea to both of them.
In unrelated news, Tesla also announced a stock buy-back in the amount of $500 billion.
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