Insurers blend telemedicine into primary care

With help from Arthur Allen (@arthurallen202) and Darius Tahir (@dariustahir)

PROGRAMMING NOTE: Morning eHealth will not be published on Monday, Oct. 14. We’ll be back on our normal schedule on Tuesday, Oct. 15.

Editor’s Note: This edition of Morning eHealth is published Mondays, Wednesdays and Fridays at 10 a.m. POLITICO Pro eHealth subscribers hold exclusive early access to the newsletter each morning at 6 a.m. Learn more about POLITICO Pro’s comprehensive policy intelligence coverage, policy tools and services at politicopro.com.

Quick Fix

Today is Stanford’s second annual EHR symposium. Next week, NIST and OCR convene a conference on HIPAA. Until then, here’s what we’re tracking.

— Insurers blend telemedicine into primary care: Plans are thinking of new ways that on-demand, 24-7 doctor apps can coordinate with patients’ network of local doctors.

— Former FDA head speaks on health data, privacy: Robert Califf, who will soon become Google’s head of medical strategy and policy, spoke at a conference in Washington this week.

— Results from new Apple Watch study: Researchers found that digital nudges prompt wearers to exercise more.

eHealth tweet thread of the day: Joseph Ross, @jsross119, “Our latest study just published @JAMANetworkOpen, led by @YaleMed student Vicky Bartlett! We determined the feasibility of using real-world data to replicate clinical trial evidence (1/5)

There is a meeting every other week in DC focused on [real world data for real world evidence] with many speculating that research using observational data will soon replace RCTs, providing the same strength of evidence at a tenth of the cost. This is unlikely. (2/5)

Only 15% of US-based clinical trials published in high-impact journals in 2017 could be feasibly replicated using administrative claims or EHR data, as many lacked replicable interventions, clinical indications, inclusion/exclusion criteria or primary endpoints. (3/5)

Instead, RWE is more likely to complement clinical trials, not obviate them. Will continue to be useful for larger safety evaluations, but less so to study new products, and perhaps not even new clinical indications. (4/5)

Relevant to yesterday’s @axios story by @caitlinnowens on what type of evidence is valuable for evaluating drugs? RCTs or observational data? Need both. (5/5) #vitals”

It’s FRIDAY at Morning eHealth. Got any dystopian health data privacy-themed longreads? Pass them along to your author at [email protected]. Tweet the team at @arthurallen202, @dariustahir, @ravindranize, @POLITICOPro and @Morning_eHealth.

Driving the Day

URGENT CARE IS LOW-HANGING FRUIT FOR TELEMEDICINE COMPANIES — Now that insurers widely offer on-demand virtual access to doctors across the country, telemedicine companies are thinking about the next frontier: integrating with patients’ local network of clinicians.

Skeptics have said these on-demand telemedicine sites, such as American Well, Teladoc and Doctor on Demand, generally rely on their own doctors who patients likely haven’t met. As we’ve reported, researchers have warned that these doctors’ potential lack of context and complete medical history puts patients at risk of overprescription of antibiotics and diagnostic errors.

...Coordinating with local providers, or at least ensuring that telemedicine companies can share data, could address those concerns. American Well, for instance, has been inviting insurers to add their own, in-network physicians to the site so patients can virtually consult with familiar doctors.

But local providers have only recently shown interest in being online, Danielle Russella, American Well’s general manager of payer solutions, told POLITICO. Plan customers have always had on-demand access to American Well’s network of doctors for urgent care but more are signing up to bring on their own network. They “frankly weren’t completely ready for that up until a couple years ago,” she said.

CALIFF’S PLEA FOR PATIENT DATA — Society needs to think about making sacrifices in patient privacy if it wants to reap the rewards of better health care treatment, the former FDA head told a group of impatient dataheads at an event on Thursday. Califf, the vice chancellor at Duke University Medical School, announced last month that he’s headed to Google.

“People have to understand that their diseases will be taken care of better if they collaborate and share their information,” he said during the conference sponsored by Datavant. “Sharing your data in a way that’s not consented has a real public benefit. We need to talk about this and find the sweet spot for the American public.”

Califf noted that social data from things like Google searches and credit card use predicts most peoples’ health outcomes better than their EHR data. Google rules prohibit outsiders from deploying that data in health care and “that’s a good thing, now, but if I’m a cardiologist advocating you to lay off red meat and credit card shows you at Burger King every day, I’m wasting my time without information that could be useful.” (See our eHealth tweet thread of the day.)

...Speaking of tweets, when Califf was FDA commissioner, the White House told him he couldn’t tweet, he said while ruing his successor Scott Gottlieb’s use of the medium. Califf saw that former CMS Administrator Andy Slavitt was tweeting and asked him about it. “They told me I couldn’t tweet. I just did it anyway,” Slavitt said, according to Califf.

A NUDGE CAN GO A LONG WAY, APPLE WATCH STUDY FINDS — Almost 600 steps, to be exact. A new study in The Lancet suggests that nudges from an Apple Watch — ranging from reminders not to stay sitting for an hour at a time to reminders to get 10,000 steps in — can get users to increase their physical activity.

The study, which signed up some 2783 subjects, tested four types of digital nudges and found that the tactics are effective: overall step count increased by 595 per day.

The results come with caveats: Interaction with the app decreased significantly during the study, and participants were substantially whiter and better-educated than the general population (though many declined to fill out personal information).

HHS’ LONG-AWAITED STARK AND ANTI-KICKBACK PROPOSALS ARE HERE — And they would allow health care systems to donate cybersecurity technology and services to providers without fear of violating anti-kickback laws, our Arthur Allen reports. The agency might also get rid of a requirement that all physicians pay a 15 percent share of any EHR technology provided to them.

...The proposals, published by CMS and HHS’ Office of Inspector General this week, are part of the Trump administration’s broader efforts to revamp restrictions on physician self-referrals known as the Stark Law and the anti-kickback statute, Arthur writes.

They were lauded by professional groups including the College of Healthcare Information Management Executives, the American Hospital Association and the American Medical Association. Notably disappointed, however, was the Medical Group Management Association.

“For those fortunate medical groups that can utilize the new value-based exceptions, this proposal is a step in the right direction,” said Anders Gilberg, the group’s senior vice president of government affairs. “For medical groups that have been waiting years for relief from the complexity of the Stark law, this isn’t it.”

DOJ SETTLES FALSE CLAIMS CASE — Speaking of kickbacks, a New Orleans-based laboratory and its executives will pay $42.6 million to settle allegations that they paid kickbacks in exchange for referrals for unnecessary pharmacogenetic testing billed to Medicare, Arthur reports.

UTC Laboratories, whose trade name is Renaissance RX, will pay $41.6 million in the False Claims Act case. Three principals — Patrick Ridgeway, Barry Griffith and Tarun Jolly — will pay the remaining $1 million. (Jolly is an anesthesiologist whose wife is former Louisiana Gov. Bobby Jindal’s cousin.)

Cybersecurity

NHS STILL DEALING WITH WANNACRY EFFECTS — Fallout from ransomware that affected hundreds of organizations and cost millions of pounds is still plaguing the U.K’s National Health Service, our POLITICO Europe colleague Helen Collis reports.

“Every single health care system is more at risk of any kind of cyber attack just because of the fact that we are dealing with more and more digitized systems,” said Saira Ghafur, lead author of a fresh report that detailed the attack’s cost.

The report shows that the attack cost NHS £5.9 million in terms of its impact on hospitals and specialists. The Department for Health and Social Care has pegged the total cost covering general practitioners, pharmacists, community care and IT repairs at £92 million.

“On the flip side, say cyber experts, the attack showed just how woefully unprepared the NHS was in fending off a sophisticated hack,” Helen writes. “That lesson has jolted the agency into spending hundreds of millions of pounds to beef up national and local IT security systems.”

What We're Reading

— In a Hastings Center report, Robert Truog urges clinicians to remember the importance of touch in medicine as AI looms larger in health care.

— In The Atlantic, Rachel Monroe examines the dark side of GoFundMe, which has hosted several fundraisers for medical treatment.

— Mark Zuckerberg complained about his philanthropy project’s AWS bill at a Chan Zuckerberg Initiative event this week, CNBC’s Chrissy Farr reports.

— The CONSORT-AI and SPIRIT-AI Steering Group advocate in Nature for reporting guidelines for clinical trials examining AI interventions.

— 23andMe has opened a pop-up store at a California mall ahead of the holiday season, Bloomberg’s Kristen V. Brown writes.