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Federal judge stymies Trump Administration’s association health plan expansion efforts

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In yet another legal blow to the Trump Administration’s healthcare policy priorities, a federal judge in Washington, D.C. struck down efforts to expand access to association health plans.

U.S. District Judge John Bates invalidated a rule by the U.S. Department of Labor which allowed individuals or businesses to band together and buy healthcare coverage through so-called association health plans (AHP), calling the policy an “end-run” around the patient protections and regulations established with the passage of the Affordable Care Act.

The decision comes the same week that another Washington, D.C. federal judge struck down Medicaid work requirements in Kentucky and Arkansas, which were a part of an effort to rein in spending after Obamacare’s Medicaid expansion provisions.

In the wake of the legislative failure to repeal the ACA, the Trump Administration has taken executive action to undermine Obamacare by expanding the entities who could join association health plans.

A U.S. Department of Labor rule made it so that associations could be formed for the sole purpose of creating health plans and opened up the ability of self-employed individuals to join associations by considering them both employers and employees.

The idea behind association health plans was to create cheaper coverage options for small businesses that could increase access to healthcare services by allowing them to skirt certain Obamacare requirements.

While association health plans pre-date the ACA, they were previously limited to groups with close economic and representational ties. Associations are allowed to base premiums on factors such as gender, age and industry which are largely prohibited in ACA-regulated marketplaces.

Critics of the plans say they have the potential to take healthier, younger members from ACA-regulated marketplaces, leaving health plans with older and sicker members and higher premiums. An analysis from healthcare consulting firm Avalere estimated that 3.2 million people would shift from ACA individual and small group markets into AHPs by 2022

Conflict over the association health plan expansion led to a suit brought by a coalition of attorneys general who challenged the policy on the grounds that it violated the ACA and the Employee Retirement Income Security Act (ERISA).

“The Final Rule is clearly an end-run around the ACA,” Judge Bates wrote in his decision. “Indeed, as the President directed, and the Secretary of Labor confirmed, the final rule was designed to expand access to AHPs in order to avoid the most stringent requirements of the ACA.”

He went on to write that the rule “does violence to ERISA” by deconstructing the law’s focus on employee benefit plans arising from actual employment relationships.

The Trump Administration is expected to appeal the ruling and many proponents of AHPs say they will continue to move forward with efforts to launch their plans, which are set to start in 2020.

“Thousands of employees and family members within the small business community have already enrolled in association health plans – which help lower health care costs – since they first became available last fall. They have provided a means by which broad benefits may be accessed at more economical prices,” AssociationHealthPlans.com President Kevin Coleman said in a statement.

“While I do not believe today’s ruling will survive appeal, I believe Judge Bates’ decision is an unnecessary detour on small businesses’ path toward more affordable health coverage.”

Picture: Chip Somodevilla, Getty Images

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This digital therapeutics company helps patients with neurologic injuries and diseases improve walking

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Brian Harris is a board-certified music therapist. His work took him to Spaulding Rehabilitation Hospital in Boston, where he started the organization’s first Neurologic Music Therapy program. Harris was utilizing music to help patients improve their ability to walk, and it was working.

Doctors were interested and so were patients, who wanted to get that type of care outside the hospital. Eventually, the demands outgrew Harris’ ability to supply assistance.

Out of that, MedRhythms was born. Harris co-founded the Portland, Maine-based company with Owen McCarthy, whose background is in engineering and entrepreneurship.

The startup began as a therapy services organization and was aiding individuals at Spaulding and doing in-home care. But then Harris realized something: “This was a much bigger need than just Spaulding or Boston or New England,” he said in a phone interview.

Today, MedRhythms is using sensors, software and music to build evidence-based neurologic interventions to measure and improve walking. The digital therapeutics company, which raised an oversubscribed Series A financing round last summer, aims to improve the lives of individuals with neurologic injuries and diseases.

The startup’s approach is based on clinical research indicating music improves outcomes in neurologic rehabilitation by globally engaging the brain.

MedRhythms’ platform involves a web application, mobile application and sensors, which can connect to a patient’s shoes and collect clinical-grade data about the cadence of their walking.

After collecting a user’s baseline data, MedRhythms adds music to the equation. In an effort to improve their gait, the patient listens to music through headphones while walking. The company’s algorithm can also make changes to the music and tempo so the patient can improve their speed.

“The goal of this is that it can be used in the home without the need of a clinician there,” Harris said.

Currently, MedRhythms is working to secure FDA approval for its product for stroke patients. Other than its FDA work and bringing its post-stroke tool to market, the startup’s future goals involve looking at other disease states such as multiple sclerosis and Parkinson’s.

Photo: ArisSu, Getty Images

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NEWS

In last Senate testimony, FDA’s Gottlieb highlights agency’s opioid epidemic efforts

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FDA

Outgoing Food and Drug Administration Commissioner Scott Gottlieb used his testimony before lawmakers on the FDA’s budget to highlight the agency’s efforts to combat the opioid crisis.

In his testimony, before the Senate Subcommittee on Appropriations, Gottlieb said that the $55 million he is requesting for the FDA to support its work on the crisis, which he said would remain the agency’s highest priority for “many years to come.” The total amount allocated for the FDA in the Trump Administration’s fiscal year 2020 budget is $6.1 billion.

“Today, I want to focus on one of my highest priorities since taking my role two years ago – the FDA’s work to combat the opioid crisis,” Gottlieb said in his remarks. “This is the biggest public health crisis facing the agency and remains one of the biggest crises facing our nation.”

The epidemic has become the subject of numerous lawsuits against companies that aggressively marketed opioid painkillers, often to patients for whom they were not appropriate. In January, a criminal trial against former executives of Insys Therapeutics began. The executives, including founder John Kapoor, were charged with conspiracy to commit racketeering, wire fraud and mail fraud, based on allegations that they used bribery and fraud to persuade doctors to prescribe the drug Subsys – a sublingual spray used to treat breakthrough cancer pain – mostly off-label, for patients who did not have cancers.

More recently, this week OxyContin (oxycodone) manufacturer Purdue Pharma and its founders, the Sackler family, reached a $270 million settlement with the state of Oklahoma that will allow them to avoid a courtroom trial, based on allegations that Purdue drugs contributed to the deaths of thousands of people. Purdue is perhaps the most infamous of opioid manufacturers and is also the subject of numerous other cases filed by federal, state and local governments. It was reported earlier this month that the company was exploring a Chapter 11 bankruptcy filing.

“We’re focused on decreasing exposure and preventing new addiction, supporting the treatment of those with opioid use disorder, promoting development of novel pain treatment therapies and increasing enforcement and carefully assessing benefit-risk of opioids,” Gottlieb said in his remarks.

Gottlieb, who was appointed FDA commissioner in May 2017, announced his resignation on March 5. Norman Sharpless, director of the National Cancer Institute, was named acting commissioner, though others have been suggested to be Gottlieb’s ultimate successor as well.

Photo: Zach Gibson, Getty Images

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WEIGHT LOSS

Farmers Market Diet: Lose Weight With Our Fresh Recipes

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Farmers Market Diet: Lose Weight With Our Fresh Recipes – Health

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WEIGHT LOSS

10 Diet Tricks That Work

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“Your specific [weight loss] program may differ from someone else’s based on climate, geography, heredity, the quality of the food you’re buying, the volume in which you’re eating that food, and so much more. A lot people take advice that doesn’t honor themselves. What works for me is not going to work for you. It’s just not. So really, it’s [about] having an honest look at who you are, what your tendencies and triggers are, and how you can build a program that revolves around that.”

—Jennifer Widerstrom, The Biggest Loser Trainer

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A look at the health tech transformation behind the $2.5 billion invested in the Midwest in 2018

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Last year the first software product utilizing machine learning to screen for diabetic retinopathy received marketing approval from the FDA. The company behind that device, IDx, isn’t in California or Massachusetts: it’s in Iowa. It was founded by an ophthalmologist and a professor of ophthalmology at the University of Iowa Hospitals and Clinics. It’s a reflection of the growth of health tech and medtech sectors in the Midwest in recent years.

In 2018, investment in Midwest companies added up to $2.5 billion, according to a new report from BioEnterprise. Health IT and health IT service companies received the most investor dollars with $968.3 million, a 39 percent share of total capital. Biotech and pharma companies raised $780.4 million, a 31 percent share, while investment in medical device companies reached $750.3 million, a 30 percent share.

Aram Nerpouni, president and CEO of BioEnterprise, noted that investment in Midwest healthcare companies has soared 40 percent over the past five years. He will offer a deeper dive of the findings from the report at the MedCity INVEST conference in Chicago April 23-24.

“It’s evidence that investors are finding the Midwest an ideal location for startups to grow and thrive.”  

Minnesota companies attracted the most investment in 2018 at $698.8 million across 108 deals led by health insurance startup Bright Health’s $200 million Series C round. Ohio dominated other Midwestern states by deal volume with 121 deals.

Other supersized deals last year included Chicago’s medical marijuana business Cresco Labs’s $100 million fundraise. Bind in Minneapolis raised $70 million for its on-demand support services for health insurance aimed at self-insured employers. Sollis Therapeutics in Columbus, Ohio raised $50 million to support its drug-device combination as an alternative to prescribing opioids for pain. Its regional backers include Ohio State University and Ohio Third Frontier. Indiana-based Outpost Medicine, which is developing treatments for overactive bladder and fecal incontinence and is led by former Eli Lilly executive Scott Byrd, raised $41 million last year. While the majority of funding trended towards later-stage companies, seed-stage companies accounted for more than half of the deals.

The Midwest has benefited from a couple of trends happening in healthcare. The need for data to deliver more meaningful insights for clinicians to improve outcomes for different patient populations coupled with the growth of machine learning applications has led to the greater use of software across the medical device and biopharma sectors. One example is the $225 million acquisition of Propeller Health, a ‘digital therapeutics’ company connecting inhalers via software to track medication usage and monitor symptoms, by ResMed, a medical device company in the respiratory market.

“Last year’s smaller, early stage investments in machine learning tools, whether used for the analysis of MR by Surgical Information Sciences in Minneapolis or pathology images by Spintellx in Pittsburgh, will lead to exits via larger imaging companies down the road,” noted Nerpouni.

Also, the rise and growing maturity of regional healthcare startup ecosystems involving universities, payers and providers, shared workspaces, incubators and increasingly diverse investment vehicles are also playing a part in developing a pipeline of healthcare startups that can obtain local early stage funding and have a pathway to validating their technology with healthcare organizations. That’s happened in cities such as Cleveland, Minneapolis, and Chicago, but also on a smaller scale in other regions as well.

“The shifts that are happening today are playing very much to the Midwest’s favor,” Nerpouni observed. They are evening up the playing field.”

There has also been a rise of corporate venture investors in healthcare. Although a Rock Health report on 2018 investment trends noted that technology venture capital accounted for the most deals, provider venture arms as well as payers came in second for funding the most deals.

Although the investment arm of the Ascension health system, Ascension Ventures, has been around since 2001, there are newer hospitals with venture arms coming onto the scene. This year, OSF Ventures, the corporate investment arm of Peoria, Illinois-based OSF HealthCare, became a limited partner in LRVHealth in Boston.  

7wire Ventures in Chicago, led by Livongo executives Glen Tullman and Lee Shapiro, has eight healthcare organizations as investors in its $100 million fund including Allina Health in Minneapolis, Arkansas BlueCross BlueShield, Bon Secours Health System Inc., Cigna, Horizon Blue Cross Blue Shield of New Jersey, Memorial Hermann Health System, Rush University Medical Center in Chicago, and Spectrum Health.

Nerpouni observed that many of the new corporate venture groups from healthcare organizations are still exploring how to put internal capital to work. Strategic investments to access new technologies or working through beta site opportunities for young companies are ways for health systems to be more active players in creating their own value.

“They are acting as true investors. They are not just investing in internal technologies but also outside technologies that will generate financial and strategic returns on investment,” Nerpouni said.

Picture: claudenakagawa, Getty Images

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FOOD

Martyn’s birthday | BBC Good Food

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Skills & know how

As well as helping you decide what to cook we can also help you to cook it. From tips on cookery techniques to facts and information about health and nutrition, we’ve a wealth of foodie know how for you to explore.

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WEIGHT LOSS

Lose Weight Without Dieting – Health

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Lose Weight Without Dieting – Health

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How The Iowa Clinic implemented a virtual scribe solution to ease physician documentation burden

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The Iowa Clinic, which is based in West Des Moines, implemented its EHR system about 13 years ago. A lot of physicians at the clinic have done well with utilizing the EMR. But at the same time, “you put the physician in the place of being a court reporter instead of just going in and being the physician,” Dr. Christina Taylor, an internist and the chief quality officer and director of the population health, quality analytics and care management team at The Iowa Clinic, said in a phone interview.

The physicians still have a mountain of documentation work to handle. Some were taking work home and charting from 8:00 to 11:00 p.m., while others were staying late or coming in on the weekends.

“We had a number of people who were at a breaking point,” Taylor added.

So the West Des Moines organization began looking at solutions. It tried out a model where nurses could handle some of the documentation. It also turned to ScribeAmerica, a company offering medical scribes to hospitals. While The Iowa Clinic liked ScribeAmerica’s service, it found that the scribes were often young people who only worked with the company for a short period of time. There weren’t enough scribes to fill the clinic’s needs.

Eventually, the organization came across IKS Health and its Scribble tool, which is an asynchronous virtual scribe service. The first five or six providers started using the tool in the fall of 2017, and the next five or six doctors came on in January 2018. The number of providers using Scribble is now in the low- to mid-20s — or about 10 percent of the clinic, Taylor said. They’re in various departments, including internal medicine, family medicine, ENT and podiatry. Today, The Iowa Clinic continues to bring on additional providers to use Scribble.

Once implemented, here’s how Scribble works: The IKS team starts by reading each provider’s previous patient notes to learn about their specific documentation style. Essentially, this is IKS doing its background homework on the doctor.

Next, each provider’s exam room is equipped with a microphone and the Scribble application is installed on their desktop computer. When a patient enters the room, the doctor obtains their verbal consent for the visit to be recorded. The visit then proceeds as normal. Taylor noted that if a patient wants to speak about something without the recording device on, the doctor can easily pause it or turn it off. After the patient leaves, the physician can end the recording and can type any additional information into the HIPAA-compliant application.

The recording is immediately encrypted and sent to the IKS clinical team in India. There is not any personal health information connected to the recording, and the IKS team doesn’t see or know who the patient is. They play the audio and create the note per the doctor’s preferred documentation style. It is then sent back to the clinic as a note that is fully integrated into The Iowa Clinic’s EMR system.

The next day, it’s ready for the provider at The Iowa Clinic to review. If everything is to the doctor’s liking, he or she can sign it. If not, the physician can make changes before OK’ing the note.

Thus far, The Iowa Clinic is reaping multiple benefits from using Scribble. Physicians are happy with it, Taylor said. She noted that “the biggest ROI is time.” When surveyed, the clinic’s doctors said they’re saving anywhere from less than 30 minutes per day to five hours per day.

Others said they’ve been able to see more patients. Taylor herself said that until she started using Scribble, she generally wasn’t able to see new patients.

Photo: sturti, Getty Images

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WEIGHT LOSS

15 Weight Loss Success Stories With Before and After Photos

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43, 5’4″, Marietta, Penn.

BEFORE: 209 lb., size 20

AFTER: 133 lb., size 2-4

TOTAL LOST: 76 lb., 9 dress sizes

Casie’s weight loss tips:

Bag it up: I portion out all my snacks, like almonds or sliced apples, ahead of time in ziplock bags. This lets me take my healthy eats anywhere while keeping my serving sizes in check.

Crush a quickie workout: On extra-busy days, I do a Tabata sequence—in just 20 minutes, I can get a full-body workout. It really revs up my heart rate.

Write it out: When I’m dreading the gym, I grab a pen and paper and map out my workout; having a game plan prevents me from wasting time or slacking off during my session.

Find sweet swaps: I love peanut butter. To avoid some of the fat that comes with it, I mix the powdered kind, PB2, into Greek yogurt. It gives me that nutty, creamy taste without the guilt.

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