How 16 insurance policies stack up for substance use disorder benefits

Unfortunately, a chasm has separated primary care and behavioral health for many years in the U.S. This division is being repaired as the healthcare field recognizes the importance of behavioral health.

Dr. Itai Danovitch, chairman and associate professor of Cedars-Sinai Medical Center’s department of psychiatry and behavioral neurosciences, agrees.

“It’s now broadly recognized that in order for people to have good health outcomes, it’s not sufficient to pay attention to medical health,” he told MedCity in a phone interview. “You have to also address their mental health, which includes substance abuse.”

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Indeed, substance abuse is a crucial part of healthcare coverage today. But depending on your health insurer’s offerings, your benefits may strongly differ.

A recently published study by Dr. Danovitch and Dr. David Kan, assistant clinical professor at the University of California at San Francisco’s department of psychiatry, analyzes these differences. Titled The Addiction Benefits Scorecard: A Framework to Promote Health Insurer Accountability and Support Consumer Engagement, the study was published in the Journal of Psychoactive Drugs.

The study is based on a previous project headed up by Dr. Danovitch and Dr. Kan: the Consumer Guide and Scorecard. In 2014, the California Society of Addiction Medicine created an assessment framework (based on criteria from the American Society of Addiction Medicine) for rating the quality of substance use disorder treatment benefits offered by 10 insurers on California’s marketplace, Covered California. A panel of physicians then rated the 16 bronze-level plans across seven total categories, such as pharmacy benefits and outpatient benefits.

The result is the Consumer Scorecard, which clearly shows how the policies stacked up overall and in each category.

“The plans themselves had a fair amount of heterogeneity,” Dr. Danovitch said. A few specific plans tended to perform well across all seven categories, while another set of plans tended to perform poorly across all the categories, he noted.

However, Dr. Danovitch also pointed out a few caveats. “One is that the question of what’s in insurance plans is a moving target because it changes every year,” he said. “It’s certainly changed by now.”

Another is evaluating the difference between “what insurers said they offered and what they actually offered,” Dr. Danovitch said. “We did contact insurers to help sort out areas where there was a lack of clarity, but we didn’t get much of a response.”

In 2015, 20.8 million Americans met the criteria for a substance use disorder. But less than 11 percent of them receive treatment, according to the Substance Abuse and Mental Health Services Administration. “[Substance use disorders] are treatable, yet most people don’t get treatment or don’t get treatment that’s adequate,” Dr. Danovitch said.

Substance use disorders are clearly a problem. But then why don’t insurers cover everything they should? Dr. Danovitch says it’s because the population isn’t speaking up about it. “Insurers need to cover this, but they won’t until everybody expects it,” he said. “The population has to develop expectations about what their entitlements are in order to hold insurers accountable.”

Photo: ANDRZEJ WOJCICKI, Getty Images

With $25M fundraise, Amino launches price transparency services for employers, providers

About 16 months ago, Amino became the first for-profit company to gain access to the Centers for Medicare and Medicaid Services‘ vast database of Medicare claims. Now it’s not only expanding its price transparency services to self-insured employers and healthcare providers but also giving these groups access to this data.

The company raised a $25 million Series C round to support the launch of Amino Plus for EmployersAmino for Providers, and make its data platform available, according to a blog post about the fundraise. The physician search and appointment booking service allows consumers to search for physicians and gain information on prices based on individual conditions, service needs, health insurance coverage and personal preferences. One goal is to help hospitals improve their consumer/patient experience, particularly to find physicians in their network and make more informed decisions about their care. Another is to help self-insured employers reduce their healthcare costs.

Highland Capital Management led the round. Other investors that took included Accel, Aspect Ventures, Charles River Ventures, Northwestern Mutual Future Ventures, and Pilot Wall Group, among others.

“This phase of financing is about building the full ecosystem around Amino,” said David Vivero, Amino CEO, in a phone interview. “Through these services. we can make sure users get access to realtime deductibles, view their plan designs and [contact details].”

Vivero and his team have taken a number of steps to try to set Amino’s approach apart from other companies. Aside from the Medicare database access, it doesn’t allow physicians to pay for exclusion. Users can see whether a doctor’s rate for a given procedure is higher than, lower than, or similar to other doctors nearby. The search engine uses statistical adjustments to account for differences in the types of people doctors treat, so a doctor with healthy patients isn’t unfairly compared to a doctor who treats sicker patients. Last year, it became a Medicare consensus-based entity, a status that means Amino gets support from CMS to create healthcare quality measures that become available to other groups with the same status.

“This is a very big next step for us,” Vivero said. “In the history of American healthcare, everyone has had their own facts and that’s left consumers with conflicting data.”

Photo: Hong Li, Getty Images

How two California startups are preparing pharma companies for blockchain

Blockchain is coming to healthcare and medical fields, and being readied for the potential ways in which an innovative technology might turn the old ways of doing business on its head. Entrepreneurs and researchers have already begun considering different use cases. Blockchain for electronic medical records. Blockchain for Medicaid applicants. Blockchain for payments.

But perhaps the best suited medical application for blockchain, the underlying technology of Bitcoin and other crypto-currencies, is also the one being upended by federal legislation passed in 2013: tracking and tracing the movement of prescription drugs from manufacturer to the pharmacy to prevent counterfeit or dangerous drugs from entering the supply line.

To meet the challenge, two California-based companies have recently joined forces to build an electronic, interoperable pilot system to track the movement of prescription drugs throughout the U.S.

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The Link Lab and Chronicled, a blockchain startup that recently raised $6.25 million, are currently partnering to develop such a system based on blockchain, a networking system known for its security. In the blockchain, records of transactions are linked, meaning it’s easy to detect tampering, if any, by a bad actor. Come this fall, at least one global pharmaceutical company — which the two companies declined to name — will be plugged into this pilot application that’s currently under construction, and using it to verify prescription drugs.

“Our vision is a system where everyone would register a serial number, and you could develop technology so that every time a drug changes hands, the technology automatically verifies the authenticity of the drug,” said Susanne Somerville, co-founder of the Link Lab, a life sciences consulting firm.

But the bigger idea is that all of the players in the prescription drug supply chain — not only pharmaceutical companies, but also drug wholesalers, drug distributors, hospitals, and pharmacies — would be able to use blockchain for drug tracking and tracing.

“Everyone says it’s a no-brainer,” Somerville said in a call with MedCity News. “There’s a law that requires the serialization of any drug product, and then the ability to verify drugs as they move on to dispensing.”

What Somerville refers to is the Drug Supply Chain Security Act (DSCSA). Passed into law in 2013, the act says that by 2023 pharma companies should be able to track the production of drugs from raw materials all the way to dispensing to ensure safety and legitimacy, and that they should be able to do so in an interoperable, electronic way. The law is being slowly phased in, which gives startups like Chronicled the chance to experiment with what the best way will be for tracking drugs using serial numbers.

Blockchain technology, according to Chronicled CEO Ryan Orr, allows for the posting of such serial number data unidirectionally, creating an unbroken chain where the many players of the drug supply line can verify the drugs they are receiving are arriving from the correct source.

“The regulation requires the logging of serial numbers,” Orr said in a phone call. “We’re logging and tracking serial numbers through movement in the supply chain. Blockchain can log it automatically.”

What’s more, blockchain technology provides for an easy framework to create an electronic, interoperable mechanism — another requirement of the DSCSA — by which players in the prescription drug supply chain can track those serial numbers.

Where potential hangups exist in applying blockchain tech for this area of the healthcare industry is in widespread adoption.

“The pharmaceutical industry is super conservative. How do you explain the improved inherent security of a blockchain solution to somebody who doesn’t understand it?” Somerville said.

Jim Lebret, an assistant professor of medicine and clinical innovation at the NYU School of Medicine and a digital health consultant, said that infrastructure is the biggest challenge when it comes to bringing the prescription drug industry over to blockchain.

“I don’t have a lot of hope for a sudden, mass, industry-wide adoption of blockchain, unless there was some payment restructuring that required it,” he said. “It’s a culture-change question. It’s also a compliance question.”

Now until the end of 2017, Chronicled and the Link Lab will test its pilot system with a number of players on that drug supply chain. Their goal isn’t to build an enterprise-level blockchain for the medical industry, but rather explore two things: How to incorporate blockchain technology into the world of drug-tracking, and then the potential organizational structure for a public, prescription drug blockchain that, presumably, every player in the worldwide pharmaceutical industry would plug into. It’s a tall order for an industry that’s expected to be larger than $1.12 billion by 2022.

“We’ve spent the most time thinking about the model of organization to incorporate this technology as a back-end in an industry as large and as substantial as the pharmaceutical industry,” said Orr.

Chronicled and the Link Lab have already signed up one large pharmaceutical company to participate. At the time of their pilot project announcement this month, the plan was to sign up several other participants — drug wholesalers and distributors — to begin sussing out what the protocol and structure should be for posting drug records with blockchain.

Orr hopes to enlist one player at each stage of the supply chain, then build out the technology needed to have them use blockchain for logging serial numbers in a way that ensures they meet compliance with their specific regulations. If their pilot project proves successful, then a small startup will have blazed a trail for larger enterprise companies to follow in creating a large-scale blockchain for the pharmaceutical industry.

“Technologically, the problem we’re trying to solve is not a complex one. It’s more about aligning expectations around the configuration of this approach,” said Orr. “But we’re very hopeful and excited about where this can go.”

Photo: Pixtum, Getty Images

Carbon Health launches virtual clinic to create network of independent physician practices (updated)

Virtual visit interaction via Carbon Health app

This post has been updated with comments from Carbon Health CEO Eren Bali  

The technology entrepreneur who founded Udemy, a marketplace for online courses, is looking to make a big splash in the world of healthcare with the launch of Carbon Health. The San Francisco-based healthcare startup led by Eren Bali raised $6.5 million in its first institutional round led by early stage investor Builders VC, according to a company press release.

Other investors that took part in Carbon Health’s inaugural round included Javelin Venture Partners, Two Sigma Ventures, and Bullpen Capital which invests in companies at the post-seed funding stage. Angel investors in the business include Elad Gil — the cofounder of Color Genomics, and Russ Fradin, the CEO and cofounder of Dynamic Signal who served the board of Udemy for four years. Another is Aaron Patzer, who founded Mint.com, invested in HealthTap, and has a care coordination startup of his own in New Zeland.

Carbon Health gives patients virtual access to their providers and allows them to schedule appointments, make payments, fill prescriptions, and access medical through the app, according to the release. Although the approach seems pretty similar to HealthTap, TreatMD, Zipnosis, GrandRounds and other telehealth providers, many of which are also working to integrate labs,  insurance companies, pharmacies, and medical imaging centers, Bali claimed in a phone interview that Carbon Health’s approach differs in critical ways.

He said Carbon offers a more comprehensive service than rivals. He also predicted that most patients who would opt to use its app would have a primary care physician that’s part of Carbon’s network. Although individuals can use the service to ask questions about insurance and medications, they would only be charged if they had a virtual visit with a doctor or were recommended to come in for an appointment.

Bali founded Carbon Health with cofounders Tom Berry and Dr. Greg Burrell.

The investment will enable Carbon Health to advance its business beyond the pilot stage and expand its platform to independent healthcare practices across the country. Bali added that the company plans to expand from Northern to Southern California by the end of the year with independent practices that cover a total of 100,000 patients.

It’s an open question how much money these services actually save. Although one study seemed to indicate telehealth did little to reduce healthcare costs, another focusing on diabetes retinopathy showed how this technology can make a big difference.

Photos: Carbon Health

5 startups from the SXSW Accelerator that you should meet

Sound Scouts, an Australian-based business that developed a DIY hearing test app that parents can download and run for their children, emerged as the winner of the SXSW Accelerator pitch competition in the digital health and wearables track, according to an emailed announcement from the organizers. The test is cleverly disguised as a game designed to create a more interactive experience for kids but alert parents to any hearing problems that warrant attention from healthcare professionals.

It wasn’t immediately clear what Sound Scouts’ plans for the U.S. market are, but Founder Carolyn Mee said during her initial presentation that she wants to make the product available to adults and children around the world.

Although there was only one dedicated health track, the technology behind a few of the other startup winners have direct or indirect applications for healthcare as well.

Enterprise and Smart Data

Deep 6 AI developed technology to make it easier to match patients with appropriate clinical trials through natural language processing and artificial intelligence. The clinical trial recruitment process is one of the most time consuming and costly aspects of drug development and Deep 6 AI is one of several companies to take up the gauntlet of creating a more streamlined process. Wout Brusselaers is the founder and CEO.

Security and Privacy

UnifyID uses data collected by sensors from an individual’s mobile devices such as GPS, accelerometer, gyroscope, magnetometer, barometer, ambient light, and WiFi and Bluetooth signal telemetries to figure out what makes the owner unique, according to the San Francisco company’s website. The data is kept on the local device, is encrypted and anonymized. UnifyID’s approach can also be applied to desktop and laptop computers. Given the cybersecurity concerns in healthcare over the theft of personal health data it seems like UnifyID’s approach could have useful applications in this sector.

Innovative World

Thimble.io in Buffalo, New York wants customers to discover their inner engineer, their inner maker. A monthly subscription gives users an electronics kit each month that teaches them how to code, hack and construct electronic devices. By playing the long game, stimulating young and older minds to use these kits as stepping stones towards realizing their creative interests, they could help create a new generation of software developers and biomedical engineers wherever they might be.

Augmented and Virtual Reality

Lampix shuns the goggles and other head gear that tends to be associated with augmented and virtual reality. Instead, it takes a more subtle approach. The company’s product lets users adopt flat surfaces like a table to project a computer screen and interact with the screen projection as if it’s a touchscreen. As for healthcare applications, Lampix’s platform could be used as another approach to gaming technology for cognitive assessment to expanding health literacy delivery tools.