September 12, 2022: Dr Colin Banas, Chief Medical Officer for DrFirst joins Bill for the news today. CVS Health is acquiring Signify Health, a home health company, for $8 billion beating out bids from Amazon and others. Researchers at Northwestern University and John Hopkins University plan to study if an Apple Watch app can help prevent strokes. Why are Cyber Attackers targeting smaller hospitals? Can AI help deliver greater success at birth? Has Walmart’s brick and mortar kind approach revolutionized rural healthcare? Evernorth, the health services arm of Cigna and Varian are partnering to improve data standardization and interoperability in oncology with a HL7 CodeX pilot.
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It's frustrating when you as a patient, can't get something that your doctor is prescribed for you or thinks that you need. And there's also this inherent lag that's built into the therapy in something like cancer treatment, radiation treatment time is of the essence. So. Anything we can do to reduce the friction, remove that lag and still get appropriate therapies to our patients. I'm all for it.
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All right. It's Newsday. And today we're joined by Colin Banis, the chief medical officer for Dr.First. And we've got a lot of news to talk about. Good morning, Colin. Welcome to the show and good morning, bill. Good to see you again. Yeah I'm looking forward to this. You did get a chance to go to UGM. I'm curious. What was your takeaways from UGM?
U GM's always fun. Madison is a, is a great city. And it's a nice place to get a lot of connections with colleagues and partners of ours at Dr. First. So we had a number of events right off campus, couple of dinners, and it was good energy.
it's a great event. I have not made it up there. The last couple of last couple of years. I don't know, maybe sometime in the future we will do that. We've got a lot of news today.
Let's see, we got the signify health CVS thing. We could talk about that. We've got some things on apple watch, some NIH funded studies. We've got some prior authorization information, our work that's going on I wanna talk to you about specifically and then always, there's always something to talk about in cybersecurity. Isn't there, it feels that way. Yes, there is. Let's start with the signify health. CVS acquisition so this is a proposed acquisition. CVS has stated as their strategy. They are looking to focus on three pillars, primary care, home health, and managed service organizations.
So they're looking to grow quickly in those three areas. This actually does check two of those boxes. It's an 8 billion acquisi. And there was a couple of players in the running for this. It wasn't just CVS, you had Amazon going for it and you also had United healthcare. it's not like deep pockets weren't going after this.
CVS won this bid 8 billion is a pretty sizable bet. they believe strongly that the way healthcare gets acquired is going to change. In fact, let me just give you a couple of excerpts here, so, and I'm just gonna pull out the, the, I think the key pieces here, cuz we, we do a half hour new show.
We'll just get right. So this from the press release, this acquisition will enhance our connection to consumers in the home and enable providers to better address patient needs as we work to redefine the healthcare experience. So that's what they're after to re redefine the healthcare experience, signify health for their part.
As this on their website our reach into the home community and cross sites of care enables holistic support of individuals. And I think this is a key phrase, lessening dependence on facility centric care and preventing adverse events. And finally I pull this from a fierce healthcare article, which is that we're looking at signify as planning to be in two and a half million homes this year and joining up with CVS enables them to accelerate that push, I guess my as I'm reading this, my question to you is as you hear this strategy home based care, primary care. And MSO is this just more of the same? A lot of healthcare providers will hear this and go, yeah, yeah.
We heard this. Amazon's coming in. United's coming in. Walmart's coming. We've heard this. CVS is now coming. I mean, we've heard this before and nothing really changes. I mean, United is. A significant healthcare provider at this point, this moves CVS in that direction as well. Does this change things or is this just more of the, of the same.
I would challenge that assumption by existing providers that nothing really changes. I think it's changing all around us actually, and it's sort of like testing the trying to penetrate the barrier and eventually you're gonna break through and you're gonna flip the. paradigm So I actually do think this is a big deal. The CVS is building a, sort of a nice, a very nice little vertical here.
And they're taken away some of the more profitable services from traditional brick and mortar. So If you look at the the younger generation right now, they are already accessing these types of services, whether it's minute clinic, whether it's telehealth niche kind of services that you can get on your app.
And these are of course, the future consumers of tomorrow for. healthcare This is just to me, this is a big deal because CVS is doubling down on meeting the patient where they want to be met rather than traditional brick and mortar. And I've heard you say this on your show before how is CVS gonna win in some of these markets?
Well, your, your first joke was always parking which which is dead on but now it's, Hey, I don't even have to look for parking cuz you're coming to my house and what's gonna happen. And it's, I think it's inevitable and maybe not necessarily a bad thing, but it's gonna be a financial hit to health systems is they're gonna be left with a really high dollar care, the sickest of the sick, whereas the other the stuff that we could call the cream, if you will. Is gonna get scooped up by these nontraditional players, the Amazons Uniteds, and now the CVSs. I think it's a big deal.
Yeah. It's interesting. I think the mistake that gets made is people look at it and say, Hey, they're not coming after our existing business. And they're maybe not coming after your existing business. How things change. And we have the Kodak example and we have the Netflix example and those kinds of things, but even Netflix it's kind of funny. So Netflix. Blockbuster misses the move and Netflix pops in, and now you're seeing Netflix struggle because the game, what happens is it's not about where the game is now.
It's about where is the game gonna be in three years or five years? And Netflix was right. It was streaming. And and they got there first and whatnot. Now you have these big players coming in and saying, Hey, we could do streaming. Not only that we're gonna do streaming and we're gonna do bundling cuz we have all these other assets and now Netflix is sitting there going, oh my gosh, we don't own the content.
We can't really do this bundling thing and they're struggling to exist. in the new, space, I think healthcare is the same way. They really do 8 billion significant bet. And you're seeing United healthcare make these same kind of bets. They're looking at it going, alright, how is healthcare going to be delivered in three to five years?
Are we going to have an onslaught of sensors and passive sensors at that? And they're gonna. Scattered throughout the home. And instead of having these services be delivered in person, a lot of 'em are gonna be delivered remotely via telehealth. And we are gonna have to have capabilities of going into the home and delivering care into the home.
And I think they see very clearly actually these players, Amazon United and and definitely CVS. Walmart has a little D. View of things. I think still, I think there's still, Walmart has sort of a brick and mortar kind of approach, but again, their brick and mortar approach is I think, in a revolutionized rural healthcare. And so each player has this view of what healthcare is going to be. I wonder if traditional brick and mortar healthcare providers have a vision of what healthcare is going to be, or if they're just playing defense.
Yeah, it feels like they're just playing defense except for maybe some of the larger health systems that tend to be a little bit more innovative or have a little bit more leeway to experiment with some of these things. But I know where I live. I still live in central Virginia. I haven't seen massive innovation or changes in the, the care paradigm for any of the brick and mortar that you know, that I frequent or that I still interact with. So I, I think that, I think the comment of playing defenses spot on.
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Well, let's take a look. NIH funded study to test. If apple watch can prevent strokes, limit blood thinner. So this is, this is interesting. I like to pull the medical stories and you recommended some of these stories as well for our conversation. Researchers at Northwestern university in John Hopkins university. Plan to study. If an apple watch app can help prevent strokes the national heart lung and blood Institute, a national Institute of health division awarded a 37 million grant for researchers to test whether apple watches can be used as part of the strategy to cut down on the use of blood thinners, prevent strokes from AFib.
American heart association, John Hoskins, Stanford and university of California. San Francisco are also partners on the study. AFib is the most common heart rhythm disorder in adults affecting two and a half to 5 million Americans. The number is estimated to grow to 12.1 million by 2030 worldwide. The estimated number of individuals with AFib in 2010 was 33.5 million.
This is an example of those monitors. My mother went into the doctor and they caught AFib and whatnot. And then my sister just went out and bought her an apple watch. Like we're, we're going, this is going to be how we're going to track this. the apple watch is in, it's an expensive device.
It's not a cheap device, but we're seeing more and more applications of how they're going to participate in healthcare. What are your thoughts on this study?
Yeah, this is a perfect segue from what we were just talking about in terms of sensors, as you mentioned, but the real importance of this study is. forever and ever including my training. When we get someone with AFib, we put them on blood thinners and it's sort of indefinite. And of course that's not without risk itself. And as blood thinner as pharmaceuticals have gotten better, some of those blood thinners while safer are also very, very expensive.
And what this study is seeking to do is to. say Your risk of stroke is really increased after an episode of AFib or after a prolonged episode of AFib. But a lot of times that that rhythm corrects itself or, or medications help get you back into the normal rhythm and you stay there. And so could we limit our blood thinner usage to just these high risk times?
And then once the, once the watch detects that you're sort of back to normal and enough time has passed, we'll take you back off the blood thinners. And so you're really reducing your risk of Adverse bleeding things like that from being on excessive blood thinners. So I actually think this has the potential to be a game changer in terms of the way that we treat AFib, which is as you rattled off is extremely common.
So I really, really enjoyed this study and I have an apple watch. I've listened to your comments on apple and what they're actually doing around the apple watch. And I think it's spot on it's. I'm not sure that they really want to revolutionize healthcare as much as they want to get you to buy more iOS devices. But be that as a may, I do think this is the potential to be a game changer for a very common and lethal condition.
Yeah. And people are gonna say, why aren't you commenting on the apple event, cuz there's an apple event today at I dunno if it's 10 o'clock Eastern or whatever.
And so we're recording on Wednesday, 10:00 AM. Pacific time today there's an apple event and typically you'll have Tim cook come out and say how committed to healthcare they are. And actually they, they released like an 80 page document on their healthcare strategy. Not too long ago.
It was right before I went on vacation. I should go back and do a series on it cuz it's kind of kind of a fascinating document. So we'll see. so. If people are wondering, Hey, why didn't you comment on the apple event? Because we haven't seen it yet. So we will, as soon as we see it, we will comment on it.
Let's see. What's the next story. Next story. HHL seven. Codex pilot to test prior authorizations in oncology. This is always interesting. So this becomes an interoperability story. The collaboration will use fire accelerator codex to enable automation between payers and providers with the goal of improving access to radiation treatment for cancer patients.
This is a story that you pulled out. And prior authorizations is sort of the holy grail of interoperability, because it's such a from an experience standpoint, I could speak to it pretty strongly. It's such a dissatisfier, not probably not only for patients, but also for providers, isn't it?
Yeah. It's friction for everybody involved. It's frustrating when you as a patient, can't get something that your doctor is prescribed for you or thinks that you need. And there's also this inherent lag that's built into the therapy in something with like cancer treatment, radiation treatment time is of the essence. So. Anything we can do to reduce the friction, remove that lag and still get appropriate therapies to our patients. I'm all for it. And I think the term holy grail of interoperability is spot on,
is it the movement of data that slows this down? Or is it the bureaucracy in the policies that slows this.
Say it's 80% bureaucracy, 20% data. But you know, a lot of this stuff is still occurring on printed paper and faxes and telephone calls and phone trees and things like that. Maybe I'll maybe I'll adjust my answer to 50 50. And I think there are ways it's 20, 22. There are ways to deliver this data, this information securely and appropriately so that we can get through these barriers of prior auth.
And so maybe if we took down 50% of the barrier and we're still left with 50, that's still pretty massive progress in something, is this important?
interesting I was talking to a doctor and this was a special case, but he walked me through this process of going through the prior authorization and he, he said finally he was on the phone for an hour. He finally got a doctor on the other end of the line and said, look, Here's what's happening. Here's why the normal protocol doesn't work and here's what I'm going to do. And the doctor said, oh yeah, that makes perfect sense. That's exactly what we should do now, if that was the first conversation, it would've been a, I don't know, would've been a five minute conversation and would've been done instead.
He was on the phone for an hour, trying to work his way to get somebody on the phone who could understand his clinical diagnosis and treatment.
Yeah, that. So that's the bureaucracy, right? That's the phone tree, the paper faxes, the et cetera. I, I think we're so good at logistics for other things in the way that we consume there's gotta be a better mouse trap when it comes to prior authorization.
So yeah, this one was I've sat in on some of the codex Webinars and group calls they're seeking to do this, not only for oncology and radiation treatment, but also for traditional prior auth around medication and specialty pharmacy. So fingers crossed for success in this realm, cuz I think it'll be a game changer for providers and patients alike.
Yeah. So let me just give a couple XRP and then we'll move on to the next story. So. Payer prior authorization process often rely on manual inspections with no automation or standard health system interface. So we're gonna have, if we're moving discrete data, we're gonna be able to apply some some technology to it.
But no single organization can solve the endemic challenges of information sharing that requires. Extracting complex data from one system and inserting it into another system that uses a different database schema and different user interfaces in order to get accurate and fast results. So if people are wondering what we're talking about with this interoperability, that's essentially what we're talking about laying the ground because it's, it's not just getting the data out.
Because getting the data out has become a lot easier, but now you're transferring it across and you've gotta put it in to the right, to the right places in the right format. So that's no small task laying the groundwork for how interoperability is expected to look recent mandates. The 20, 20, 20 interoperability and patient access funnel rule, and the 21st century cures act Hasting the speed of delivery via secure API, that converts data into digestible information. And so essentially what we're looking at is a set of standards for how information is stored, how it's extracted and how it's shared across the healthcare ecosystem.
So that's, that is exciting. Work, love what they're doing. Love what 21st century cures really has, Started in our.
Yeah. Well what you're talking about is semantic interoperability, right? We've gotten decent at moving data from a to B maybe it's blob texts, maybe it's it's not immediately interpretable by the receiving system. And that's why this story was so relevant, to what we do at Dr. First is because we have a role in semantic interoperability related to medication data. Making sure that it lands in the right way in the right format, et cetera. We have some technology around that space. And then also in our role as e-prescribing, we have a big role in prior auth and we're constantly looking to improve the prior auth experience.
So that's why I'm very interested in what codex is doing. And, I'm grateful that they're pushing into other prior auth friction points like radiation and other therapies.
Fantastic. I love the fact that doctors at Dr. First are working on this problem because it's it's great. There's a lot of benefits on the other side of this. Gosh, security. I, I feel like every week I talk about security, this one I think is interesting. It's. Attackers targeting smaller healthcare organizations. It used to be, we thought, well, our health system is so small. It was security by obscurity.
It's like, we're so small. No one really notices us . But at the end of the day, what's happening is that they're saying, Hey. The bad actors are targeting smaller health systems for the very reasons that we think less security, less staff, less budget. And some of the findings from the report include this.
The total number of breaches has steadily declined. That's good. That's good news from the peak of 3, 393 to 360 7 in the first half of 20 21, 344 in the second half of 2021 and 324 in the first half of 2022, approximately 20 million individuals were affected by, by a data breach in the first half of 2022, a 10% drop compared to the previous six months and a 28% drop from the first F of 2021.
Healthcare providers represent 73% of total breaches business associate represents 15%. Health plans represent 12. Hacks associated with network servers declined from a peak of 67% in the first half of 2021 to 57% in the first half of 2022 EHR related breaches increased from 0% in the first half of 2020 to almost eight in 2022.
And that's that's the crown jewels. So that should be very productive. That 0% should be the, should be the number when it gets to 8%. That means they're getting to. The system of record. That's a little, little scary. There's a bunch of bunch of stuff. You're not a cybersecurity professional per se, but what are your thoughts on this?
Well, it, it was exactly what you just did right there. I was reading the article and I said, oh, it they're actually going down. Like, Hey, maybe we're getting better at this. And maybe. Maybe we've really improved our cybersecurity posture as an industry. And then I got to that EHR zero to 8% and I said, oh and I think that was, I think that was a very large breach mentioned earlier in the article that was millions and millions of patient records.
That is probably responsible for that big jump there. But as I was reading and I was wondering what your take would be. Is it a part of, Hey, the big guys have gotten better at this and hardened their posture and the bad guys are giving up on those bigger targets and going to the smaller ones because we've gotten better or is it just is it like a swarm of locust moving through the ether and they're gonna get everything eventually
I went fly fishing last week. fly. Fishing's a lot like cybersecurity in that the guide is telling me, I'm like, where should I fish? He goes, he said, fish are lazy. They're gonna go to where the food is plentiful. And it's easy. It's easy until by the way, until the food is not plentiful, in which case they will work to go where they need to get to.
And at this point in the bad actor situation they're just lazy fished. I mean, they don't have to do much. They didn't have to do much for the last three to five years. Blast, a health system with a bunch of emails, set up a fake site where people would essentially give you their credentials.
And once they gave you their credentials, you could get in and establish your foothold and then start working horizontally across the across the network. That was, that was pretty easy. That's been about five years. What's happened though is most major health systems. This is a board level conversation.
They freed up money. I most CISOs that I talked to from the large health systems, the large IDNs and the academic medical centers, they all got more money. For cybersecurity specifically and which means more accountability. It's like, Hey, I don't want to end, I don't end up in this journal. I don't wanna end up on our newspaper.
So here's some more money. What else do you need? Let's make sure that we are, we are protected now. This is a constant cat and mouse game, so the bad actors will get smarter. They will start. Look for different ways to get in. But at the end of the day, the thing that concerns me the most, you see the EHR breaches.
You mentioned it. I read it off here. We are in the process of trying to aggregate information in healthcare and we really have to be careful when we're aggregating information, cuz it becomes the store, right? The. Fort Knox of our health system. And so we have these large aggregation platforms bringing all this data together and I'm concerned that, Hey, you don't have to breach 20 health systems. You can just breach one place and get all the information you're looking for. And maybe that's what's happening. Maybe they're, they're planning their big heist of like oceans 11 they're planning to hit the Bellagio of healthcare data. I don't know.
Yeah. The other thing I don't, I don't think we spend enough time talking about is the business continuity plans for when these things eventually happen how are you gonna continue to document, how are you gonna continue to prescribe?
How are you gonna continue to do med re cuz paper's not gonna cut it anymore? So are there. Are there platforms out there, are there solution vendors that we need to be including in our cybersecurity type bundle or posture? If you will, just food for thought.
Yeah. Well, business con I'm glad you brought up business continuity. I was talking to somebody this week and we were talking about business continuity and they were saying, yeah, well we just fall back on paper. I'm like, how do you do imaging on paper? Like, how do you do your MRI on paper? And they just said, well they go into sort of a standalone mode and I'm like, okay, well at, at some point, if they can compromise those systems and take those systems down now, you're not able to do imaging.
That's a scary position to be in. Yeah. Alright. Last story thing I love about working with you. Colin is you're a professional and we get through a lot of stories. AI could help deliver greater success at birth. Once validated machine learning based labor risk scores could be used.
In clinical practice to monitor labor in real time and improve maternal care, new Mayo clinic research shows. So you're the doctor. You recommended this story. I love, I it's interesting to me because people are always asking me. It's like, yeah, AI is hype. I don't see where it's gonna be used in healthcare.
We keep seeing these stories seep up. It's one at a time right now, but I think at some point the floodgates are gonna open and we're gonna see a lot of AI stories, improving care. So what's what's the takeaway from this story? Yeah.
I often comment that there's the AI hype of AI is gonna cure cancer Watson style or. AI is gonna cure sepsis. And you've seen how, how difficult that has proven to be over the past decade with lots of fits and starts. And then there's, there's AI that rather than trying to hit a home run, can we hit a single, can we automate some things? Can we take some things off of the cognitive load of providers? Using AI in a safe way. And that's a lot of what Dr. First seeks to do in the medication space. I viewed this one as an in between I said here's a great example of a certain population that we now have a lot of data points around And a lot of money at risk too, with high risk maternity.
And can we start to use smaller algorithms to figure out what is the best way to deliver this baby? The safest way the is a routine delivery gonna cut it or do we need to do a cesarean, things like that. And so I said, you know what, this is that in between step of the single and the home run and the folks that are pulling this off, have the juice to do it.
So I like this story because I think as you mentioned, you see these more and more often, and some of them are really outrageous claims, like I said before of, of curing cancer. But it's the it's these that we're building on that are eventually going to insert themselves in traditional workflows and actually benefit the providers and the patients alike by giving them the data and the recommendations they need at the point of care.
Yeah, this, this is worth looking at there's a, this healthcare it news story. Let me just read a little bit here. Use of the models could result in more individualized clinical decisions using the baseline characteristics of each patient. They could also be, this could also be a tool to help remote physicians and midwives transfer rural or remote patients to the appropriate level of care. And then I love this next phrase. This is the first step in using algorithms in providing powerful guidance to physicians and midwives as they make critical decisions during the labor process. And I think that's what you're talking about. It's not AI is gonna solve these things. It's, it's providing insights. It's providing guidance. That clinicians and midwives can act upon.
Yeah, AI's not replacing the clinician it's augmenting it's an extra set of insight during, during care. And so that was the, that was the big thing early on was, oh AI can read our x-ray or a, a pathology slide just as good as a human and not so much, but it can certainly. help the work queue or help float more relevant things to the top to get those things looked at more acutely. So I've stopped saying artificial intelligence has started saying augmented or advanced intelligence, because I think that's a little less intimidating to the, to the human factor of healthcare. And it's a little bit more on the nose in terms of what we're really trying to accomplish with AI.
Cool. All right. So. That's enough. I mean we're at 30 minutes. That's about our thing. Is that a Virginia football behind you?
It is. I am a UVA grad class of 98.
So is UVA gonna be good in football this year?
It's hard to say brand new coach. They did win their first game against Richmond. real test is coming up this week with Illinois. So we'll see.
Yep. Yeah, no, it's it's it is football season. It's a lot of fun. My daughter graduated from Baylor and I'm so glad she did because the other college teams I've rooted for were not that good. So rooting for Baylor has been fun. Hey Colin, thank you again for your time. Really appreciate it.
Oh, anytime love to 📍 do it.
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