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Esko Bionics targets UK construction with exoskeleton
 Construction workers could soon have a taste of a superhero's strength, thanks to a robotic vest that is designed to prevent injuries on building sites.

The futuristic device is a miniature version of an exoskeleton, like the one worn by Iron Man in the Marvel comic's movie franchise.

The power suit will allow workers to spend long days lifting materials and holding tools at awkward angles without the associated physical stresses.

It could revolutionise the trade according to its creators and prevent ageing bricklayers and others from keeling over on the job.

A full body version could also become available for the full Tony Stark experience.

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Construction workers could soon have a taste of a superhero's strength, thanks to a robotic vest that is designed to prevent injuries on building sites. Built by Ekso, the power suit will be one of a number of new technologies being introduced next year (heavy tool support pictured)

BIONIC WORKERS Construction workers could soon have a taste of a superhero's strength, thanks to a robotic vest that is designed to prevent injuries on building sites. The futuristic device is a miniature version of an exoskeleton, like the one worn by Tony Stark in Marvel's Iron-Man franchise. The power suit will allow workers to spend long days lifting materials and holding tools at awkward angles without the associated physical stresses. Esko Bionics, based in Richmond, California, is bringing a number of innovative products to the UK to help to tackle a number of challenges faced by the country's construction industry. The Zero G will help builders using heavy power tools and the Ekso Vest will take the strain of holding heavy items and working for prolonged periods with hand held tools. And by the end of 2019, a full body version could be available to allow builders to carry heavy loads around a site without the need for specialist vehicles. Advertisement !- - ad: https://mads.dailymail.co.uk/v8/ru/sciencetech/none/article/other/mpu_factbox.html?id=mpu_factbox_1 - ->

Esko Bionics, based in Richmond, California, is bringing a number of products to the UK to help to tackle some of the challenges faced by the country's construction industry.

From March 2018, the Zero G will help builders using heavy power tools, weighing up to 35lbs (16kg), making them weightless through a gravity balancing arm.

The Ekso Vest is a smaller, personal, version of this technology, which will take the strain of holding heavy items and working for prolonged periods with hand held tools.

And by the end of 2019 a full body version, similar to the Iron Man suit, could be available to allow builders to carry heavy loads around a site without the need for specialist vehicles.

The Ekso Vest is expected to cost around $5,000 (£3,800) and the full suit around £10,000 (£7,700).

The vest elevates and supports a worker's arms to assist them with tasks ranging from chest height to overhead.

It weighs 9.5lbs (4.3kg) and can support loads of between five and 15lbs (2.2 to 6.8kg) per arm.

It has already been tested out on hundreds of building sites in the US, with positive results.

The company claims workplaces experience fewer on-site injuries while tasks are completed faster and with higher quality results.

Around 30 per cent of bricklayers in the UK are over-50 and 700,000 are expected to retire over the next decade, according to reports in The Times

There are also fears that the impact of Brexit is likely to mean workers from eastern-Europe, relied on by the industry, will return to their home countries.

All of this could mean a massive shortage of builders in the coming years.

The new bionic tools being introduced by Esko could allow people who were traditionally unable to enter the trade to sign up.

Speaking to The Times Tom Mastaler, the company's senior vice-president for business development, said: 'Exoskeletons will allow staff to work for longer and more safely and help to solve a demographic crisis in the construction industry.

The vest (left) weighs 9.5lbs (4.3kg) and can support loads of between five and 15lbs (2.2 to 6.8kg) per arm. By the end of 2019 a full body version, similar to the Iron Man suit (right), could be available

'They'll also change forever the kind of body types that can work in heavy-duty construction.

'In future women will be able to do the jobs that men now do because of the support that exoskeletons can provide their bodies to handle great weights.

'Future generations will also look forward to not suffering the kind of damaging body problems today's constructions workers face.'

Exoskeletons, taken from the Greek word meaning 'outer skeleton', are inspired by the hardened shells of the insect world and involve a frame of hydraulics.

Ekso has previously hit the headlines for their work with both military and medical exoskeletons. Their Hulc exoskeleton for the lower body (pictured) is powered by a lithium-ion battery that works to redistribute the weight across the hips and legs.

Full body bionic suits developed by the firm have also enabled people who have been paralysed in accidents to regain the use of their legs (pictured)

EXOSKELTONS Exoskeletons, taken from the Greek word meaning 'outer skeleton', are inspired by the hardened shells of the insect world and involve a frame of hydraulics. These magnify the leg and arm movements of the wearer, allowing them to take more effortless strides and carry greater weights. Military exoskeletons trialled as far back as the 1960s, such as General Electric's Hardiman, were able to increase the magnitude by a factor of 25. This made lifting 25lb (11kg) loads as easy for the wearer as lifting 1lb (0.5kg). These projects were ultimately unsuccessful but exoskeletons are increasingly becoming a reality in many walks of life. Advertisement !- - ad: https://mads.dailymail.co.uk/v8/ru/sciencetech/none/article/other/mpu_factbox.html?id=mpu_factbox_2 - ->

These magnify the leg and arm movements of the wearer, allowing them to take more effortless strides and carry greater weights.

Military exoskeletons trialled as far back as the 1960s, such as General Electric's Hardiman, were able to increase the magnitude by a factor of 25.

This made lifting 25lb (11kg) loads as easy for the wearer as lifting 1lb (0.5kg).

The also had force feedback, similar to an XBox or PlayStation controller, so the operator could get an idea of the resistance that he or she was experiencing.

These projects were ultimately unsuccessful as the early exoskeletons reacted unpredictably, and sometimes violently, to anything less than gentle movements.

But they are increasingly becoming a reality in many walks of life.

Ekso has previously hit the headlines for their work with both military and medical exoskeletons.

Their Hulc exoskeleton for the lower body, developed with Lockheed Martin, is powered by a lithium-ion battery that works to redistribute the weight across the hips and legs.

This allows its operator to comfortably carry 200lbs (91kg) with less effort.

Full body bionic suits developed by the firm have also enabled people who have been paralysed in accidents to regain the use of their legs.

Output: Esko Bionics is branching out into the UK with an array of exoskeleton products set to be available from March next year. Its Zero G balancing arm can help builders using heavy tools, and the Ekso Vest provides upper body strength and support to help carry and transport heavier items. A full body suit is also expected to be available at some stage, offering powerful support for workers, with reduced physical stress.


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UK Transport Secretary backs Crossrail 2
 T he £30 billion Crossrail 2 project took a major step forwards today as Chris Grayling confirmed that he supported the scheme.

The Transport Secretary said there was no doubt London needed new infrastructure in order to retain its status as the UK’s economic powerhouse.

His remarks will calm nerves among London politicians and businesses that the Government had gone cool on the capital’s flagship infrastructure project.

There had been fears the scheme could be derailed by competing pressures from the North after it was left out of the Tory manifesto and Queen’s Speech.

What is Crossrail 2?

Yet despite the Transport Secretary’s backing for the major north-south rail link there remain concerns about how it will be funded.

Mr Grayling said: "I am a supporter of Crossrail 2" / Getty Images

Mr Grayling said: “I am a supporter of Crossrail 2 but given its price tag we have to ensure that we get this right”.

He issued a joint statement with Mayor Sadiq Khan announcing plans to work together on a financial package ahead of this autumn’s Budget.

Transport for London was already expecting to pay for at least half of the cost of the project - but much of it in arrears, as with Crossrail 1.

However, the Department for Transport has now said it wants half of the construction costs paid for up-front.

Mr Grayling added: “The Mayor and I have agreed to work together on it over the coming months to develop plans that are as strong as possible, so that the public gets an affordable scheme that is fair to the UK taxpayer.”

This would be followed by a fresh public consultation on issues including the route.

Crossrail 2 is embroiled in a series of disputes over the location of stations, with major local opposition to proposed stops at Chelsea and Wimbledon.

Mr Khan added: “Crossrail 2 is essential for the future prosperity of London and the South East, so I’m pleased that the Transport Secretary and I have reached an agreement to take this vital project forward.

“We will continue to work together to ensure the project is value for money and provides the maximum benefits for jobs and growth in the region over coming decades.”

Crossrail 2 is seen as critical to London’s future rapid growth and will unlock an estimated 200,000 new homes and 200,000 jobs.

Business groups welcomed the announcement. David Leam, infrastructure director of London First, said: “With this joint statement, Crossrail 2 has moved forward - from whether we do it to how we do it.

“The Government’s funding ambition is a challenging one but London business will play its part in developing an affordable funding package, as we did with Crossrail 1.”

The announcement follows a meeting between the two politicians last week that was described as “constructive”, marking a thaw in relations after disagreements over the devolution of suburban rail.

Output: UK Transport Secretary Chris Grayling has thrown his weight behind the £30bn ($39bn) Crossrail 2 scheme, allaying fears among proponents of London's flagship infrastructure project after it was omitted from the Queen's Speech. In a joint statement with Mayor Sadiq Khan, Grayling said the two would work on a financial package ahead of this autumn’s Budget, after the Department for Transport said it requires half of the construction costs paid upfront. A fresh public consultation period will follow.


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Nick Dunning Associates acquires London agent Stirling Ackroyd
 In a statement this morning, Nick Dunning Associates says it will invest in the Stirling Ackroyd brand and branch network through a refurbishment and infrastructure upgrade programme.

Stirling Ackroyd was established 30 years ago and now has a network of offices in Bankside, Clerkenwell, Hackney, West End and Chatsworth Road, alongside the original Shoreditch branch.

It says it will also seek to treble the business in size in three years, through organic growth and acquisition.

This is the third acquisition for Nick Dunning Associates, following the purchase of Adams Property in June and Badger Holdings Group in January.

Nick Dunning, chief executive of Nick Dunning Associates says: "We are very excited about this acquisition and delighted to be able to make this announcement. Stirling Ackroyd is a well-known and successful agency in London with a committed and loyal team behind it. We hope to grow the business over the next few years and further increase its presence in the city fringes and beyond."

Nick Dunning Associates launched in late 2016. Working with a private equity investor, it says it intends to become "a new scale player" in the agency industry and in lettings in particular by purchasing around 20 letting focussed businesses every year for the next five years in a buy and build play.

The leadership team consists of chief executive Nick Dunning, sales director Graham Harrison, commercial director Matt Hewitt and chief financial officer Julian Irby, all of whom worked together at Countrywide in the past.

Output: Property leasing and management services firm Nick Dunning Associates has acquired London property agency Stirling Ackroyd, as part of its buy and build programme. Established 30 years ago, Stirling Ackroyd comprises six branches. As well as implementing a refurbishment and infrastructure upgrade scheme, Nick Dunning Associates said it plans to treble the size of the business over the next three years via acquisitions and organic growth.


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Redrow Redrow works with RSPB to improve biodiversity around Caddington Woods development
 Redrow is working with the RSPB to improve biodiversity in and around its Caddington Woods development.

The show home gardens are interlinked with lots of features designed to demonstrate how homeowners can encourage wildlife to thrive in their own gardens.

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The gardens also present lots of opportunities for children to learn about different species’ habitats as pupils from The Vale Academy in Dunstable discovered.

Head of school Kate Hooft said: “The children of Year 5 thoroughly enjoyed their visit to Caddington Woods, where they took part in a nature trail searching for creepy crawlies and learnt lots of fascinating facts about the development from the site manager.

Output: Redrow Homes has partnered with the Royal Society for the Protection of Birds to improve the understanding of biodiversity in and around the area of its Caddington Woods development. Inviting children from the Vale Academy in Dunstable, Redrow's show garden, including hedgehog highways and bug hotels, offered an ideal field trip for children.


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edX taps Examity for online learning procturing
 Online Testing

Examity to Provide Online Proctoring for Open edX Platform

This fall, courses delivered on the Open edX platform will be able to incorporate live, recorded or fully automated proctoring from online proctoring and identify verification company Examity. As the learning experience platform that powers Harvard- and MIT-founded MOOC provider edX, Open edX serves courses offered by thousands of partners on Open edX sites, reaching more than 12 million students worldwide, according to a news release.

Examity's online proctoring platform will be integrated into Open edX, giving the organization's partner institutions a suite of verification options suitable for various course types and student populations. "EdX has been a pioneer in increasing access to high-quality educational opportunities for learners worldwide through online learning," noted Michael London, founder and CEO of Examity, in a statement. "Our platform makes us uniquely suited to the multitude of platforms and modalities that Open edX schools require for not just reliable proctoring and ID verifications, but also insights and analytics to better understand and improve academic integrity in online assessments."

"We are excited to welcome Examity to the Open edX community," said Anant Agarwal, edX CEO and MIT professor, in a statement. "As the ecosystem of companies offering online learning continues to expand, the need for tools and technology to ensure academic integrity becomes even more important. It is energizing to see organizations like Examity lead the charge toward developing innovative tools that can tackle this challenge."

For more information, visit the Examity site.

Output: Open edX, the platform behind Harvard- and MIT-founded MOOC provider edX, has partnered with identify-verification company Examity to offer live, recorded or fully automated proctoring, beginning in the autumn, according to a company statement. Open edX will integrate Examity's online proctoring platform, offering users a suite of verification options according to course type and student requirement.


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Google Glass finds fresh uses in the healthcare industry
 Google Glass didn’t go over well in the consumer space.

But now it’s turned its eyes to the business market, looking to industries like manufacturing and healthcare for renewed success.

Last week, Google unveiled Glass Enterprise Edition, a new version of the technology catered to the workplace.

A recent blog post by the team at X (formerly known as Google X) detailed exactly what Google Glass is: “a very small, lightweight wearable computer with a transparent display that brings information into your line of sight.”

Glass Enterprise Edition amps up the wearable’s initial capabilities. It allows users to “[a]ccess training videos, images annotated with instructions, or quality assurance checklists that help [people] get the job done, safely, quickly and to a higher standard,” according to the Glass website.

Undeniably, that could have a positive impact on healthcare. And that’s why hospitals and health systems are catching on.

One such system is San Francisco, California-based Dignity Health. By utilizing Glass and a “remote scribe” application from Augmedix, providers can have more direct contact with their patients. They simply wear the device and instead of taking notes themselves, they can have confidence that all the record keeping is being done for them.

Dignity’s CMIO Davin Lundquist told X that Glass has significantly cut down on the amount of note taking providers have to do. In fact, the technology has reduced the amount of time clinicians spend on administrative work from 33 percent of their day to less than 10 percent.

Sutter Health in Sacramento, California, is also relying on Glass and Augmedix to enhance the lives of its providers. Albert Chan, a physician and chief of digital patient experience at Sutter, told X that with the technology, clinicians have seen a two-hour decrease in the daily amount of time they have to focus on patient record keeping.

In a recent blog post, Augmedix CEO and cofounder Ian Shakil said health systems such as Cincinnati, Ohio-based TriHealth; Englewood, Colorado-based Catholic Health Initiatives; Bangor-based Eastern Maine Medical Center and Wilmington, Delaware-based Christiana Care are making use of Glass Enterprise Edition and Augmedix as well.

Glass Enterprise Edition’s release comes after good news for Glass startup Augmedix. In April 2016, the San Francisco-based company closed a $17 million funding round. Investments came from Sutter Health, Dignity Health, CHI and TriHealth.

Photo: aislan13, Getty Images

Output: Google Glass may not have fared well among consumers, but it has found a role in the healthcare industry. Google said its workplace-targeted Glass Enterprise Edition helps people "to get a job done safely and quickly". San Francisco-based Dignity Health uses Glass in combination with a "remote-scribe" application from Augmedix. Instead of taking notes themselves, healthcare providers can wear Glass to keep records automatically and significantly reduce administration time. Glass said the technology can be used to "access training videos, images annotated with instructions or quality assurance checklists".


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IoT take-up will turn real estate brokers into tech strategists
 The commercial real estate (CRE) industry is on the verge of a major disruption: the Internet of Things (IoT). Technology is making its way into an industry that historically lacks the innovative spirit, and we’re beginning to see a drastic change in what it means to be a real estate broker. As client needs evolve, brokers must develop new skills to keep up with the changing technology landscape and remain competitive.

The Evolving Commercial Real Estate Landscape

Today, many offices and industrial properties throughout the U.S. are old and outdated. They are costing owners and tenants huge amounts of money and, in many cases, hindering business growth. These assets are dead and play no role in advancing the strategies your board and management team have set forth, thus hurting overall enterprise performance.

In this age of innovation, buildings should have the capacity to work in alignment with your business objectives, helping to achieve your goals and improve operational efficiency. What if the building you are sitting in right now had the ability to work with you and your employees to understand trends, optimize work environments and increase revenue?

The good news is that it can. Welcome to the 21st-century real estate deal.

The Internet of Things Brings Buildings to Life

Look closely at an older, historic building. Observe its structure, entrance doors, lobby, elevators, parking area and office space. Notice anything? Probably not, because that building is dead. It is just sitting there, doing nothing, providing no additional value to the occupants inside.

Imagine if that building were alive. What if the building could communicate with your business and help achieve your goals? The IoT is allowing organizations to bring both office and industrial buildings to life.

Buildings are generating data every second of every day, and it’s up to today’s real estate brokers to help their clients capture and understand that data. Whether it’s the HVAC system adjusting the temperature throughout the day, manufacturing equipment running and shutting off as needed, or a security system logging when an employee enters or leaves the premises, buildings can now provide value-added insights that can help management make more informed business decisions.

To make these smart decisions, your building must be a part of your corporate growth strategy. It can be a tool to accelerate growth and reduce operational expenditures. With this in mind, organizations need to be aware of the benefits of utilizing smart building technologies. In a warehouse, building automation can give organizations complete visibility into their supply chain, increase delivery accuracy, modernize storage strategies, drastically cut utility cost and increase customer satisfaction.

From an office perspective, smart building technology creates a more collaborative work space for employees, and increases productivity and performance. Imagine if you pulled into your assigned parking space and the building knew you were there. Your office computer and lights turn on, climate control is set to the way you like it, and your coffeemaker brews you a cup of coffee. These things are all possible with connected devices.

Revolutionizing Commercial Real Estate

Currently, the CRE industry is very transaction-focused. A broker represents a client, finds what he or she needs and collects a paycheck. But this era of transactional real estate will soon come to an end, and the IoT is a major reason why.

The IoT is forcing commercial real estate brokers to acquire a new, more sophisticated skill set rooted in technology, cybersecurity and innovation. Nowadays, clients require brokers to be more than just real estate experts — they must also be technology strategists that can help clients acquire buildings that support their corporate technology goals.

Companies can gain a noticeable competitive advantage by using a real estate broker who understands the market, and who can work with them to design a building automation strategy that supports business goals.

The Internet of Things Is Here

Disruption is coming to the commercial real estate industry. According to a white paper from IDC and SAP, 60 percent of global manufacturers will use data collected from IoT devices to optimize their processes this year. The report also predicted a 15 percent boost in delivery and supply chain productivity by 2018 thanks to the IoT. Another IDC report estimated that global IoT spending would reach $1.29 trillion by 2020, with an annual growth rate of 15.6 percent.

In other words, the IoT is here and changing the commercial real estate industry for the better. Clients want and need brokers who understand this change. Navigating the markets and negotiating deals is not nearly enough. To assist in the transformation of business processes at both the office and industrial level, clients need a true strategic partner and broker who brings a technological skill set to the table.

To put it simply, if you wish to remain competitive in the commercial real estate industry during the age of the IoT, you have only one option: Disrupt yourself before the competition does it for you.

Listen to the podcast: When We Don’t Know What We Don’t Know — Connected Cars, Smart Homes and IoT Security

Output: The take-up of the internet of things (IoT) will turn commercial real estate brokers into technology strategists. The IoT will be one of the main reasons behind the transformation of the transaction-based industry, as it forces brokers to acquire a new, more sophisticated skillset rooted in technology, cybersecurity and innovation. In addition to traditional real estate skills, brokers can help clients meet their corporate technology goals by assisting them in acquiring smart buildings.


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Coalition To Trump: Include HSA Policy In Final Drug Executive Order
 A broad coalition of health care stakeholders is urging the White House to include a provision that would expand the services that consumers can purchase with pre-tax health savings account dollars prior to hitting the deductible in the final version of an expected drug-pricing executive drug order. The provision, which was included in the draft order leaked last month , aims to help individuals with chronic conditions by letting people use the pre-deductible funds to pay for services, including medication,...

Output: A broad coalition of health care stakeholders is urging the White House to include a provision that would expand the services that consumers can purchase with pre-tax health savings account dollars prior to hitting the deductible in the final version of an expected drug-pricing executive drug order.


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Kaiser Foundation Health Plan, California come to agreement on mental health services
 Kaiser Permanente's health plan and California's Department of Managed Health Care have come to an agreement to settle years-long allegations that the plan fell short on access to mental health services.

The Kaiser Foundation Health Plan allegedly did not not provide enrollees with timely access to behavioral health treatment. This was in violation of California law that requires insurers to provide patients access to a medical appointment within 48 hours for an urgent problem, or within 10 business days for a non-urgent issue.

The Kaiser health plan was fined millions, and on July 12 and 18, it signed a stipulated settlement agreement with the state.

The agreement sets deadlines for benchmarks for a corrective action plan that if not reached, will result in Kaiser Foundation Health Plan being fined $75,000 to $100,000 for each violation.

Since the California's Department of Managed Health Care issued a final report on March 6, 2013, Kaiser has taken steps to beef up its behavioral health services.

[Also: CMS to address telehealth reimbursement in future behavioral health payment and delivery models]

Kaiser Foundation Health Plan has invested in hiring 850 additional behavioral health therapists statewide, about 188 behavioral health physicians and made contracts with additional external behavioral health provider groups to improve access, according to the agreement. It has made capital investments in additional buildings, medical offices, leased office space and remodeled space to accommodate the new hires and has implemented a mental health awareness campaign aimed at reducing the stigma and expanding the number of enrollees who seek mental health services.

The agreement was signed on July 12, signed by the Kaiser Foundation Health Plan and on July 18 by the Department of Managed Health Care.

In 2013, Kaiser agreed to pay a $4 million fine for several deficiencies in the plan's delivery of mental health services. In 2015, the state found that some Kaiser patients still had to wait weeks or even months to see a psychiatrist or a therapist.

[Also: After $4 million fine in 2013, Kaiser Permanente cited again for mental health access problems]

The Centers for Medicare and Medicaid Services Innovation Center is in the process of designing a payment model to reimburse Medicare and Medicaid providers for telehealth behavioral health services and to address issues such as treatment for opioid abuse, mental health and Alzheimer's disease.

Twitter: @SusanJMorse

Output: Kaiser Permanente's health plan and California's Department of Managed Health Care have come to an agreement to settle years-long allegations that the plan fell short on access to mental health services.


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Centralized patient-centered medical home may reduce burden on practices
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This article is more than 5 years old. Information may no longer be current.

Centralized patient-centered medical home may reduce burden on practices

Source/Disclosures Source: Fleming NS, et al. J Am Board Fam Med. 2017;doi:10.3122/jabfm.2017.04.170039. ADD TOPIC TO EMAIL ALERTS Receive an email when new articles are posted on . Please provide your email address to receive an email when new articles are posted on Subscribe ADDED TO EMAIL ALERTS You've successfully added to your alerts. You will receive an email when new content is published.

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Although centralized patient-centered medical homes reduce burden on practices, overall time and cost remain significant and should be weighed against the mixed evidence regarding their impact on quality and costs of care, according to research published in the Journal of the American Board of Family Medicine.

“Evidence regarding the impact of the [patient-centered medical home (PCMH)] model on quality of care, health resource utilization, and outcomes has been gradually accumulating. However, little information is available regarding the time, effort, and costs involved,” Neil S. Fleming, MD, Robbins Institute for Health Policy and Leadership, Baylor University, and colleagues wrote.

“Such information is critical to primary care providers engaged in decisions about whether (or when) to commit to PCMH transformation so that they can anticipate the demands and allocate resources accordingly in order to ensure minimal disruption of patient care and the practice's financial health,” they added.

Fleming and colleagues noted that many primary care physicians may need to reconsider the PCMH option when the Medicare Access and CHIP Reauthorization Act, or MACRA, of 2015 comes into effect this year, as PCMH recognition from a national third-party program is an avenue that guarantees physicians following the Merit-Based Incentive Payment System pathway full credit in the Clinical Improvement Activities portion of the Merit-Based Incentive Payment System score.

Researchers performed structured interviews with corporate leaders, office managers, physicians and practice administrators from a conventional sample of practices regarding time spent on PCMH transformation and National Committee for Quality Assurance application, and related purchases between October 2014 and October 2015. According to Fleming and colleagues, the time period was chosen to capture both initial PCMH transformation and renewal experiences.

Researchers then developed and sent a survey to 57 primary care practices across Texas that consisted of four blocks of questions. This allowed for the fact that some respondents were not involved in PCMH transformation and renewal experiences, recognition or recertification at all, whereas others participated in one or the other or both. Direct costs were estimated as time spent multiplied by average hourly wage for the relevant job category, plus observed expenditures.

Researchers estimated that corporate costs for HealthTexas — a fee-for-service ambulatory care provider network affiliated with a not-for-profit health care system in north and central Texas —for initial National Committee for Quality Assurance recognition (2010–2012) were $1,508,503. The estimated costs for renewal (2014–2016) were $346,617. The Care Coordination resource costs were an additional ongoing $390,790 per year. A theoretical five-physician HealthTexas practice spent an estimated 239.5 hours ($10,669) obtaining, and 110.5 hours ($4,957) renewing, recognition.

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“Because no previous studies have, to our knowledge, examined PCMH transformation and [National Committee for Quality Assurance] recognition in a large physician network providing central support for the process, comparison of our results with those in the literature is difficult,” Fleming and colleagues wrote.

The researchers added that future studies should address the extent to which practices were “transformed” through the PCMH recognition process, as well as whether attaining PCMH recognition is a truly a representation of the PCMH model being meaningfully implemented. – by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.

Output: Although centralized patient-centered medical homes reduce burden on practices, overall time and cost remain significant and should be weighed against the mixed evidence regarding their impact on quality and costs of care, according to research published in the Journal of the American Board of Family Medicine.


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CMS to address telehealth reimbursement in future behavioral health payment and delivery models
 Providers and insurers are paying more attention to behavioral health reimbursement, especially as the opioid crisis fills hospital beds and emergency rooms.

The Centers for Medicare and Medicaid Services Innovation Center is designing potential payment and service delivery models focused on behavioral health and the use of telehealth-enabled care.

The behavioral health models will focus on opioid abuse and other substance use disorders, serious mental illness, mental health disorders in the presence of co-occurring conditions, dementia and Alzheimer's disease.

An upcoming CMS Innovation Center Behavioral Health Payment and Care Delivery Innovation Summit will also address behavioral health workforce challenges, the integration of services and Medicaid and Medicare reimbursement for telehealth-enabled care.

The behavioral health summit will be held from 10 a.m. to 5 p.m., Friday, Sept. 8 to get feedback from professionals and members of the public in the design of a payment model and service delivery model. The summit will be held at the CMS Central Office in Baltimore, Maryland.

Participants will be invited to present recommendations for payment or care delivery and share experiences of delivering behavioral health services.

"The opinions and alternatives provided during this meeting will assist us as we explore the possibility of developing a model to address behavioral health payment and care delivery," CMMI said.

Twitter: @SusanJMorse

Output: Providers and insurers are paying more attention to behavioral health reimbursement, especially as the opioid crisis fills hospital beds and emergency rooms. The Centers for Medicare and Medicaid Services Innovation Center is designing potential payment and service delivery models focused on behavioral health and the use of telehealth-enabled care.


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Trump Plan Might Cut Expenses For Some Insured Patients With Chronic Needs
 Erin Corbelli takes three medications to treat high blood pressure, depression and an anxiety disorder. Her health plan covers her drugs and specialist visits, but Corbelli and her family must pay a $3,000 annual deductible before the plan starts picking up any of that tab.

Corbelli’s insurance is linked to a health savings account so that she and her husband can put aside money tax-free to help cover their family’s drug and medical expenses. But there’s a hitch: Plans like theirs can’t cover any care for chronic conditions until the deductible is satisfied.

Those out-of-pocket expenses could shrink under a Trump administration draft executive order that would change Internal Revenue Service rules about what care can be covered before the deductible is met in plans linked to health savings accounts, or HSAs.

“It would save us a lot of money,” said Corbelli, 41, who lives in Orlando with her husband and their two children, ages 3 and 5.

Insuring Your Health KHN contributing columnist Michelle Andrews writes the series Insuring Your Health, which explores health care coverage and costs. To contact Michelle with a question or comment, click here. This KHN story can be republished for free (details).

Health plans with deductibles of thousands of dollars have become increasingly commonplace. Plans often cover services like generic drugs or doctor visits before consumers have satisfied their deductibles, typically requiring a copayment or coinsurance rather than demanding that consumers pony up the entire amount.

But plans that link to health savings accounts have more restrictions than other high-deductible plans. In addition to minimum deductibles and maximum HSA contribution limits, the plans can’t pay for anything but preventive care before consumers meet a deductible. Under current IRS rules, such preventive care is limited to services such as cancer screenings and immunizations that prevent a disease or condition, called “primary prevention.” With HSA-eligible plans, medical services or medications that prevent an existing chronic condition from getting worse or prevent complications from occurring — called “secondary prevention” — can’t be covered before the deductible is paid.

The Trump administration’s draft executive order, which was first obtained last month by The New York Times and has yet to be issued, would allow such secondary preventive services to be covered.

Under the Affordable Care Act, most health plans, including HSA-eligible plans, are required to cover services recommended by the U.S. Preventive Services Task Force without charging consumers anything for them. That requirement is generally limited to primary prevention.

“We know health savings accounts are here to stay and we’d like to make them better,” said Dr. A. Mark Fendrick, an internist who is director of the University of Michigan’s Center for Value-Based Insurance Design and who has advocated for the change.

If people have diabetes, for example, they need regular eye and foot exams to prevent complications such as blindness and amputations down the road. But HSA plans can’t pay anything toward that care until people satisfy their deductible. “The executive order gives plans the flexibility to do that,” he said.

Similarly, it’s critical to remove obstacles to treatment for people like Corbelli with high blood pressure or heart disease, said Sue Nelson, vice president for federal advocacy at the American Heart Association.

“For people with cardiovascular disease, affordability is their No. 1 concern,” Nelson said.

The draft executive order is short on details, and administration officials would have to determine which new preventive services should be covered pre-deductible. Guidelines from medical specialty boards and quality metrics that many physicians are already being measured against could be used, said Roy Ramthun, president and founder of HSA Consulting Services who led the Treasury Department’s implementation of the HSA program in the early 2000s.

Use Our Content This KHN story can be republished for free ( details ).

Back then, they took a conservative approach. “We said we can be more flexible later, but we can’t put the genie back in the bottle,” said Ramthun, who supports expanding preventive services coverage.

Many more employers would offer HSA-eligible plans if the list of services that could be covered pre-deductible were expanded, said Tracy Watts, a senior partner at human resources consultant Mercer. Fifty-three percent of employers with 500 or more workers offer HSA-eligible plans, according to Mercer survey data. Three-quarters of employers put money into their employees’ HSA accounts, she said.

Erin Corbelli’s husband’s employer contributes up to $1,500 every year to their health savings account, which can help cover their pre-deductible costs.

Not everyone is so fortunate. “You’re kind of at the mercy of what your employer can offer and what your disposable income is,” she said.

Republicans have long advocated for the expanded use of health savings accounts as a tax-advantaged way for consumers to get more financial “skin in the game.”

Consumer advocates have been much less enthusiastic, noting that the accounts typically benefit higher-income consumers who have cash to spare.

Still, given the reality of the growing prevalence of high-deductible plans, with or without health savings accounts, it’s a sensible proposal, many say.

“This is not a silver bullet or a solution to the problems that high-deductible plans can pose,” said Lydia Mitts, associate director of affordability initiatives at Families USA, an advocacy group. “But this is a good step in thinking about how we offer access to treatment people need in a timely and affordable way.”

Please visit kffhealthnews.org/columnists to send comments or ideas for future topics for the Insuring Your Health column.

Output: Erin Corbelli takes three medications to treat high blood pressure, depression, and an anxiety disorder. Her health plan covers her drugs and specialist visits, but Corbelli and her family must pay a $3,000 annual deductible before the plan starts picking up any of that tab.


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Byrd Bath: Seven Provisions That Could Disappear From the Senate Health Bill
 We still don’t know what bill Republican senators will take up next week when they turn to health care. There are three versions of the legislation that could be considered, each with slightly different provisions.

But the bill that the senators vote on, if they vote at all, is likely to be different from any of those. That’s because the draft bills have not yet undergone scrubbing and analysis by the Senate’s parliamentarian, an expert who scrutinizes legislation to make sure it complies with the rules. The parliamentarian, Elizabeth MacDonough, a lawyer who has long worked for the Senate, has the power to strip out key parts of the bill if they don’t pass legal muster.

Congressional leadership is trying to pass its health care overhaul through a special budget process called reconciliation, and there are limitations on what provisions can be added to such a bill.

Experts from both parties make arguments before the parliamentarian, in a process somewhat like a Supreme Court oral argument. And, in the end, the parliamentarian will issue her rulings on which things stand and which must be removed from the bill.

Output: We still don’t know what bill Republican senators will take up next week when they turn to health care. There are three versions of the legislation that could be considered, each with slightly different provisions.


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Health Care Is Still in Danger
 At this point the more or less official G.O.P. line is that the budget office — whose director, by the way, was picked by the Republicans themselves — can’t be trusted. (This attack provoked an open letter of protest signed by every former C.B.O. director, Republicans and Democrats alike.) In particular, the claim is that its prediction of huge losses in coverage is outlandish, and that to the extent that fewer people would be covered, it would be due to their voluntary choices.

In reality, those C.B.O. predictions of coverage losses are totally reasonable, given the Senate bill’s drastic cuts to Medicaid — 26 percent by 2026, and even deeper in the next decade. You have to wonder how someone like Senator Shelley Moore Capito of West Virginia could even consider supporting this bill, when 34 percent of her nonelderly constituents are on Medicaid. The same goes for Jeff Flake of Arizona, where the corresponding number is 29 percent.

And on those claims that it’s O.K. if people drop coverage, because that would be their own choice: It’s crucial to realize that the Senate bill would degrade the quality of subsidized private insurance, leading to a huge rise in deductibles.

Current law provides enough in subsidies that an individual with an income of $26,500 can afford a plan covering 87 percent of medical expenses, which, the C.B.O. estimates, implies an $800 deductible. The Senate bill reduces that standard of coverage to 58 percent, which would raise the implied deductible to $13,000, making the insurance effectively useless. Would deciding not to buy that useless insurance really be a “choice”?

By the way, remember when Republicans like Paul Ryan used to denounce Obamacare because the insurance policies it offered had high deductibles? It’s hypocrisy all the way down.

Output: Will Senate Republicans try to destroy health care under cover of a constitutional crisis? That’s a serious question, based in part on what happened in the House earlier this year.


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Small Businesses Split Over Republican Health Plans
 “Being able to buy health insurance that didn’t completely break us financially was key to our ability to take the risk and become entrepreneurs,” Ms. McCarthy said.

Her opposition highlights a growing schism about the Affordable Care Act among small-business owners — a split exposed as Republicans have pursued reversing much of the law in recent months. The divide also points to an unexpected outgrowth of the Republican agenda in Washington: As lawmakers pushed their plans, public support for the Affordable Care Act grew from new corners.

With so many forces aligned in opposition to the Senate’s proposed changes, the views of small-business owners have not been a decisive factor. But the enthusiasm that a growing number are voicing for the health care law weakened the argument, often cited by Republicans, that small businesses had been harmed by it and need a rollback.

Business owners with a few dozen or more workers often resent the cost and regulatory burden of complying with the law’s mandates, and many have backed the Republican efforts. For those who employ only themselves, however, some of the features of the Affordable Care Act — like coverage for existing conditions and curbs on prices — opened up coverage unavailable to them before the law.

In addition, there is a vocal group of self-employed workers who are, like many people, paying higher premiums and deductibles because of the law. But some of them want lawmakers to adjust the law to address those higher costs, instead of repealing and replacing it entirely.

Output: Small-business owners have been some of the most vocal opponents of the Affordable Care Act. One trade group fought the overhaul all the way to the Supreme Court.


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Housing Policy Solutions to Support Aging with Options
 The number of adults age 65 and older in the United States is growing at a rapid pace. Today, many communities are not yet prepared to address their numerous needs. As the population increases, older adults and their families will need quality, affordable, and accessible housing, access to health care services at home and in the community, to live in neighborhoods near reliable transportation services and facilities like public buses and bike trails and find healthy food options as well as other important amenities.

These features make communities more livable for people of all ages, including keeping older adults engaged and active in community life. This publication outlines several challenges that hinder livability but also includes corresponding policies that communities can adopt to support a person’s choice to age in place.

Output: The number of adults age 65 and older in the United States is growing at a rapid pace. Today, many communities are not yet prepared to address their numerous needs.


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Improving Medicare With Expanded Telehealth Services
 By Anthea Daniels (July 21, 2017, 4:14 PM EDT) -- As the American Health Care Act, replaced by the Better Care Reconciliation Act, and the Affordable Care Act (commonly referred to as "Obamacare") and national health care continue to be debated in the United States Senate and around the country, one aspect of the end game is to provide health care services which are high-quality and at an affordable cost to all involved. Telehealth and wellness care continue to be one of the potential front-runners for achieving the so-called "Triple Aim." The Triple Aim addresses (1) improving the patient experience of care; (2) improving the health of populations; and (3) reducing the per capita cost of health care. To date, government reimbursement for telehealth services has lagged behind....

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Output: As the American Health Care Act, replaced by the Better Care Reconciliation Act, and the Affordable Care Act and national health care continue to be debated in the United States Senate and around the country, one aspect of the end game is to provide health care services which are high-quality and at an affordable cost to all involved. Telehealth and wellness care continue to be one of the potential front-runners for achieving the so-called "Triple Aim."


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Perceiving oneself as less physically active than peers is linked to a shorter lifespan
 Credit: George Hodan/public domain

Would you say that you are physically more active, less active, or about equally active as other people your age?

Your answer might be linked to your risk of premature death decades from now - no matter how physically active you actually are, according to research by Stanford scholars Octavia Zahrt and Alia Crum.

The research, appearing July 20 in Health Psychology, finds that people who think they are less active than others in a similar age bracket die younger than those who believe they are more active—even if their actual activity levels are similar.

"Our findings fall in line with a growing body of research suggesting that our mindsets—in this case, beliefs about how much exercise we are getting relative to others—can play a crucial role in our health," Crum said.

Powerful effects of perception

Crum, an assistant professor of psychology, and Zahrt, a doctoral candidate at the Graduate School of Business, analyzed surveys from more than 60,000 U.S. adults from three national data sets. The surveys documented participants' levels of physical activity, health and personal background, among other measures. In one of the samples, participants wore an accelerometer to measure their activity over a week.

Zahrt and Crum were interested in one question in particular: "Would you say that you are physically more active, less active, or about as active as other persons your age?"

The researchers then viewed death records from 2011, which was 21 years after the first survey was conducted. Controlling for physical activity and using statistical models that accounted for age, body mass index, chronic illnesses and other factors, they found that individuals who believed that they were less active than others were up to 71 percent more likely to die in the follow-up period than individuals who believed that they were more active than their peers.

Fit on the Farm?

Much of the study's inspiration derived from Zahrt's experience when she arrived at Stanford. Zahrt, a native of Germany who previously studied in France and England, had stayed in shape by biking to school and making occasional trips to the gym.

But at Stanford, Zahrt said it seemed that "everyone was incredibly active" and perhaps she wasn't exercising as much as she should.

"Suddenly, I felt like I had done something wrong all these years," Zahrt said. "I felt unhealthy and I was stressed about fitting more exercise into my busy schedule. I really had a negative mindset."

While taking a health psychology class taught by Crum, Zahrt learned more about the effects of mindsets on health outcomes. For example, Crum's prior research shows that the health benefits people get out of everyday activities depend in part on their mindsets—that is, whether or not they believe that they are getting good exercise. In her 2007 study, Crum made a group of hotel room attendants aware that the activity they got at work met recommended levels of physical activity. Through this shift in mindsets, the workers, many of whom had previously perceived themselves as inactive, experienced reductions in weight, body fat and blood pressure, among other positive outcomes. Zahrt wondered if many people, like her, had negative mindsets about their physical activity levels because of social comparison with more active peers, and if this might be harming their health. Her class paper on this topic sparked the collaboration leading to the published study.

How mindsets influence us

Zahrt and Crum offer possible explanations for mindsets and perceptions having such powerful effects on health. One is that perceptions can affect motivation, both positively and negatively. Those who are made aware of their healthy activity levels—like the hotel room attendants in Crum's 2007 study—can build on them and exercise more. Those who deem themselves unfit are more likely to remain inactive, fueling feelings of fear, stress or depression that negatively affect their health.

The researchers also cite the established influence of placebo effects, where patients who think they are getting a treatment experience physiological changes without receiving actual treatment. In the same way, people who believe they are getting good exercise may experience more physiological benefits from their exercise than those who believe they aren't getting enough exercise.

"Placebo effects are very robust in medicine. It is only logical to expect that they would play a role in shaping the benefits of behavioral health as well," Crum said.

The researchers emphasize that the study is correlational in nature and thus does not prove that perceptions of inactivity cause earlier death. However, other experimental research—such as Crum's 2007 study - does suggest a causal nature to the link between perceived amounts of exercise and health outcomes.

Taking mindsets seriously

"So much effort, notably in public health campaigns, is geared toward motivating people to change their behavior: eat healthier, exercise more and stress less," Crum said. "But an important variable is being left out of the equation: people's mindsets about those healthy behaviors."

In fact, a growing volume of research from Crum and other labs shows that perceptions and mindsets predict health and longevity, for example, in the domains of stress, diet and obesity.

That our mindsets could have such potent effects on our physiology may seem provocative and unlikely at first glance, but Crum reminds us that we shouldn't be surprised by these results considering the "everyday experiences where our beliefs or a simple thought have very palpable and physiological effects."

"In the case of stress, a thought about something going wrong can make us sweat or [become] shaky or increase our heart rate," Crum continued. "With sexual arousal, a simple thought or idea can have immediate physical effects. We experience these things regularly, and yet we're not cataloguing them as something that matters. For whatever reason—dualism or a prioritization of the material—we tend to ignore the fact that our thoughts, mindsets and expectations are shaping our everyday physiology."

How can people use this finding? Many Americans think that vigorous exercise in a gym is the only way to attain a proper activity level, according to Zahrt and Crum. But being mindful of and feeling good about activities you do every day - like taking the stairs, walking or biking to work, or cleaning the house—could be an easy first step for everyone to benefit their health.

"It's time that we start taking the role of mindsets in health more seriously," Crum said. "In the pursuit of health and longevity, it is important to adopt not only healthy behaviors, but also healthy thoughts."

Provided by Stanford University

Output: Would you say that you are physically more active, less active, or about equally active as other people your age? Your answer might be linked to your risk of premature death decades from now - no matter how physically active you actually are, according to research by Stanford scholars Octavia Zahrt and Alia Crum.


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Another Possible Indignity of Age: Arrest
 It was the sort of incident that happens at facilities that care for people with dementia.

At a residence for older adults in San Francisco last summer, Carol King momentarily left a common sitting area. When Ms. King returned, she found that another resident had taken her chair, a nurse who witnessed the episode later reported. She grabbed the usurper’s wrist.

Though staff members intervened promptly and nobody appeared injured, the other resident (who also had dementia) called 911 to say she had been attacked. Soon, Ms. King’s son, Geoffrey, was summoned and four police officers arrived.

Over objections from staff members and her son, the officers decided to place Ms. King on an involuntary psychiatric hold, which allows a 72-hour detention when an officer believes someone is unable to care for herself or poses a danger to herself or others.

As they searched and handcuffed Ms. King and placed her in a patrol car, “she started crying,” Mr. King recalled.

Output: It was the sort of incident that happens at facilities that care for people with dementia. At a residence for older adults in San Francisco last summer, Carol King momentarily left a common sitting area. When Ms. King returned, she found that another resident had taken her chair, a nurse who witnessed the episode later reported. She grabbed the usurper’s wrist.


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The Ethics of Adjusting Your Assets to Qualify for Medicaid
 At any given moment, there is a large group of citizens who want nothing more than to make absolutely certain that they are impoverished enough to qualify for Medicaid sooner rather than later. Someday, you might be one of them.

Welcome to the (perfectly legal) world of Medicaid planning, the plain-vanilla term for the mini-industry of lawyers and others who help people arrange their financial lives so they don’t spend every last dime on a nursing home. Once properly impoverished under the law, then Medicaid, which gets funding both from your state and the federal government, picks up the tab.

Whatever twists and turns the health insurance debates in Washington take, Medicaid will be at the center, and the program will probably affect you and your family more than you know. After all, if you run out of money in retirement, it is Medicaid that pays for most of your nursing home or home-based care.

The bill that contains the caps that Republican senators have proposed, which would remake Medicaid, seems for now to have a low chance of passing. But even if no bill survives, politicians on both sides of the aisle fear what demographics will do to the program’s costs. Most Americans haven’t saved enough to pay for decades of post-retirement living expenses and years of expensive end-of-life care, so it stands to reason that Medicaid will come under increasing strain.

Output: At any given moment, there is a large group of citizens who want nothing more than to make absolutely certain that they are impoverished enough to qualify for Medicaid sooner rather than later. Someday, you might be one of them.


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Three Things I Should Have Said About Retirement Planning
 All these factors make a huge difference, as I was always quick to point out.

By working five more years, a husband and wife who are both 55 today, earning a combined $120,000 a year with retirement savings of $75,000, would end up with 47 percent more a year to live on at age 70. That’s assuming they continue to save 10 percent of their income each year, and withdraw 4 percent of savings each year in retirement.

A huge part of that 47 percent increase comes from higher Social Security benefits. If our hypothetical couple apply for Social Security at age 65, they are in essence penalized for not waiting two years. They would each receive $3,348 less a year.

So, I wrote it was just a no-brainer to work until age 70, if you can.

While my math was right, what I now realize is just how hard it is to keep working as you age. My job doesn’t require much more than typing all day long, and I find myself getting fairly tired by day’s end. I can’t imagine I am going to have more energy a decade from now.

EXAMPLE TWO Implicit in all my retirement advice was the assumption that everything in life moves in a straight line. For example, once you begin saving, you keep saving. But as the father of four, I have come to realize life is not that orderly.

For instance, I used to believe that people edging closer to retirement usually had the ability to save more, since child-rearing expenses were no longer a factor. So, I blithely wrote, you could take all that money you had been putting toward college, for example, and invest it for retirement.

Well, our “baby” graduated five years ago, and now all that tuition money is going to … home repair. While the children were still in school, we put off every major expense we could in order to fund the very expensive colleges of their choice. In the process, our home went from shabby chic to simply shabby. A new roof, a paint job (inside and out), upgraded air-conditioning, a new driveway and the like will eventually take care of that. But all that is going to cost money that could have otherwise gone toward our retirement. I glossed over situations like this when I was writing my retirement books.

EXAMPLE THREE Remember all those things you want to do before you retire? Maybe go on a big trip or pay for a child’s wedding? In our case it was a big trip that involved a wedding.

Output: A friend of mine had been a pediatrician for a few years before he had his first child. “Now that you’re a father,” I asked, “has your advice to parents changed?” “No,” he said. “But I am more empathetic when I give it. I now realize things are not quite as easy as I made them sound.”


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Lose It to use DNA-based scheme for its dieting app
 Last year, calorie-tracking app Lose It launched a feature called Snap It, which promised to identify the foods you were eating just from a photo. By adding machine learning and computer vision to the mix, it turned the ordinary act of food logging into a high-tech affair. Now, the company is evolving its app with the introduction of more tech: personal genetics. Today, Lose It is introducing embodyDNA, a weight loss plan that's based on your actual, well, DNA.

To get started, you'll have to order a kit from embodyDNA.com for $189.99. Once you receive it, you provide a saliva sample through a swab and send it off to Helix, a personal genomics company that's in partnership with Lose It. After about six to eight weeks, Helix then delivers the results through the Lose It app to your account. If you're an existing Lose It user, the app looks at your food log history to identify patterns and then make recommendations based on the results of your DNA test.

The embodyDNA test essentially gives you a series of insights about your body when it comes to diet and fitness. It figures out what your metabolism is, what your fitness levels are, and if you have any sensitivities to certain foods like gluten or dairy. If you have a family history of diabetes, for example, you might find that you're particularly reactive to sugar. It also tells you if you're genetically predisposed to a high BMI, if you should do more or less exercise, and what kinds of exercise you should do. As the technology gets more advanced, it's able to tell you even more about your body and the weight loss strategy that is best for you.

Lose It's embodyDNA is not the first program that has sought to alter people's fitness strategies based on genetics. DNAFit, for example, offers tailored diet and exercise plans based on an examination of your DNA, including a meal planner and information on specific exercises you should do to suit your body type.

We've yet to give Lose It's version a go, but hope to do so in the near future. In the meantime, you can try it out for yourself by going to embodyDNA.com.

Output: Boston-based calorie-tracking app Lose It has launched embodyDNA, a kit which offers insights into a user's physical condition based on their DNA. Customers can purchase a $189.99 sample kit from the embodyDNA website, which is then analysed by personal genomics company Helix. The results, sent via the app, will reveal data including metabolism rates, a genetic disposition toward diabetes and indicate whether users are exercising too little or too much. As the technology becomes more developed, it will provide a tailored weight loss strategy rooted in the data.


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Change Healthcare joins Hashed Health to fuel blockchain adoption
 Change Healthcare, the company formed in March by combining McKesson Technology Solutions and Change Healthcare Holdings, has joined the Hashed Health consortium – which gather health IT companies to innovate use blockchain and distributed ledger technologies.

"With a network reaching nearly every payer and provider in the United States, Change Healthcare advances our efforts to create meaningful innovation," said John Bass, CEO of Hashed Health, in a statement. "By joining the Hashed Health consortium, Change Healthcare is demonstrating that it understands the potential of blockchain technologies to improve care delivery and now is the time to build the networks responsible for the realization of approaching solutions."

"Blockchain has potential to enable value-based care, and we’re committed to championing innovation that helps our customers and partners realize that potential,” said Aaron Symanski, chief technology officer at Change Healthcare. "We look forward to working with the Hashed Health members to evolve and establish blockchain as a safe, secure, and transparent way to foster financial interoperability in healthcare."

In May, Change Healthcare also announced its membership in the Linux Foundation's Hyperledger initiative – the first healthcare-specific organization to join that blockchain group at the premier level, joining Accenture, IBM and others. Symanski also joined Hyperledger's governing board.

Twitter: @MikeMiliardHITN

Email the writer: mike.miliard@himssmedia.com

Like Healthcare IT News on Facebook and LinkedIn

Output: Change Healthcare has joined the Hashed Health consortium to encourage the adoption of blockchain technology. By signing up to the consortium, Change Healthcare shows it understands the potential of distributed technology in improving care delivery, Hashed Health CEO John Bass said. The healthcare organisation is also a member of the Linux Foundation's Hyperledger initiative.


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Out-of-home advertising signs undergo digital transformation
 The outdoor ad industry has invested huge amounts in a digital transformation that has helped reignite excitement among marketers by making the format more creative, interactive and targeted.

An 8 Outdoor campaign for Land Rover at Heathrow Terminal 5

Print experienced a whopping 10% fall to £1.1bn in UK ad spend in 2016. Direct mail also struggled, with an even steeper 10.4% fall to £1.71bn. TV, meanwhile, saw flat 0.2% growth to £5.27bn, which is forecast to turn into a 0.5% decline by the end of 2017, according to the AA/Warc’s annual Expenditure Report. Compare this to the 13.4% rise in internet ad revenues (£10.3bn) and the 45.4% increase in mobile ad spend (£3.86bn) for 2016, and there’s clearly a stark difference.

However, it isn’t all doom and gloom for the so-called traditional advertising channels. Last year, out-of-home grew total ad revenues by 4.5% to £1.1bn. And although this is predicted to slow over the coming years (2017: 3.4%, 2018: 2.3%), outdoor is backed to remain in positive territory while other traditional channels are expected to fall into even deeper decline.

Once treated as an opportunity to put a giant Big Mac poster on a motorway, out-of-home is increasingly being used by marketers for interactive storytelling and hyper-targeting. According to Cadi Jones, commercial innovation director at Clear Channel, the whole industry has evolved.

“Out-of-home is no longer just static billboards by the side of the road – the business model of the whole industry has fundamentally changed,” she says.

“Over the last few years, out-of-home advertising has undergone an exciting transformation through huge investment in digital technology. Digital out-of-home now enables advertisers to be more creative than ever, as the screens can now deliver intelligent, real-time and contextually relevant content to consumers – all in a fraction of the time it once took. This has reignited excitement among brands.”

The impact of programmatic

The rise of programmatic is also helping out-of-home to become more targeted. Through its Digital Audio Exchange (DAX) platform, Global, owner of radio stations including Capital and Heart, recently worked with energy brand E.ON to set up geo-fencing around out-of-home sites.

The technology enabled E.ON to identify when someone walked into one of the geo-fenced zones so when they later listened to digital radio or streamed music via their mobile device they were served an E.ON audio ad that mirrored the outdoor poster they’d already seen.

Adding the digital audio element to the out-of-home campaign increased consideration for the brand by 26%, while people exposed to both the outdoor activity and audio ads were 31% more likely to recommend E.ON. These same people were also four times more likely to sign up for a smart meter – the main objective of the activity – when visiting the energy firm’s website compared to average site traffic.

Out-of-home and mobile video ads are converging; there’s barely any differences. David McEvoy, JCDecaux

In January, Clear Channel launched what it claimed was an “industry-first” programmatic offering for the out-of-home ad industry. And with 50% of all online spend now made via programmatic channels in the UK, Jones says it saw an opportunity to apply the same approach to outdoor.

Initially launched in Belgium before being rolled out to the UK in April, Clear Channel’s programmatic solution is already used by O2, Mercedes Benz and Deliveroo.

“Programmatic isn’t purely about the automation of our processes – it’s about connecting brands more effectively with their audiences by allowing them to deliver the right message to the right audience at the right time,” says Jones. He believes programmatic will be a “game changer” when it comes to ensuring out-of-home remains the jewel in the crown of traditional advertising channels.

“Ultimately, programmatic can revolutionise out-of-home – making it as flexible, measurable and creative as other media. It brings down buying barriers, making out-of-home even easier to buy. This will bring new spend to out-of-home from ‘digital’ budgets and programmatic buyers, helping to grow out-of-home’s share of the media spend,” she claims.

READ MORE: How to amplify programmatic’s new role in out-of-home advertising

Outdoor has also benefited from its similarities to mobile video ads, according to David McEvoy, director of marketing at JCDecaux. This is the reason, he says, the likes of Google and Facebook are now among the biggest spenders in out-of-home. “Their digital platforms are built on smart, short form, autoplay video ads where sound isn’t initiated and that’s exactly what digital out-of-home is now offering at large scale,” he explains.

“In the UK, digital out-of-home now makes up 40% of the market. That will tip over to 50% by the end of 2017. Therefore, out-of-home and mobile will continue to converge; there’s barely any differences and the Facebooks of this world are realising this.”

More sophisticated storytelling

O2’s Decoded campaign rewarded passersby who cracked its code

Two years ago, Women’s Aid debuted an interactive billboard in Canary Wharf, which featured the image of a bruised woman’s face with the tagline ‘Look at Me’.

It used facial recognition technology so that the more people viewed the image, the quicker the lady’s bruises would heal. The campaign promoted how domestic abuse can only be confronted if members of the public stop turning a blind-eye to its victims. The campaign, created by WCRS, is just one example of a deeper approach being used in out-of-home storytelling.

READ MORE: How OOH advertising is moving beyond awareness

O2, for example, drove awareness and sales of its exclusive for the One Plus 3 handset by having agency CCP create ‘Coded’ – a campaign that targeted tech fans in three different locations. The interactive campaign worked by displaying coded messages that contained geographical coordinates. If a tech enthusiast cracked the code and got to the particular site in time, they’d win the handset.

Ian Cafferky, director of brand and marcomms at O2, says the #Coded campaign drove a 130% increase in footfall at the three targeted sites.

He says: “At its simplest, out-of-home is a great driver of fame and awareness on a national scale. But recent developments in out-of-home technology have allowed us to serve hyper-local and hyper-relevant advertising messages to the regional or local audiences. It allowed us to combine high impact creative and customer engagement.”

Much like Global’s campaign with E-ON, Deliveroo has targeted radio ads based on the out-of-home ads customers have been exposed to. And Deliveroo’s marketing director Jamie Swango believes hyper-local targeting is giving out-of-home an edge over other traditional advertising channels.

She explains: “Out-of-home advertising allows us to combine mass advertising with a hyper-local approach. However, Digital and dynamic out-of-home has allowed us to feature multiple new occasions that are displayed to consumers based on day of week, time of day, and weather, allowing us to increase the relevance of the advert.

“This ultimately supports our goal of increasing consideration of Deliveroo for new occasions in the summer, such as delivery of sushi to the park for lunch or delivery of beer to your Saturday barbecue with friends.”

Competing against digital

Outdoor campaigns can also make a social impact. These Body Shop posters spread fresh air in areas high in pollution

Deliveroo’s Swango says outdoor ads also allows the brand to be “smarter” than digital and social channels. She adds: “Out-of-home allows us to communicate a message – broadly, publicly – that is difficult to do in digital marketing alone. Many out-of-home formats have longer dwell times than digital, allowing us to be a bit smarter and more interesting in the ad creative to engage customers.”

According to Tim Lumb, insight and effectiveness director at out-of-home body Outsmart, high-profile scandals at Google and Facebook have boosted the industry.

With dozens of brands yet to return to YouTube after an investigation by The Times showed brand advertising was appearing next to extremist content as well as concerns around the accuracy of Facebook’s audience metrics, he argues this backdrop is playing right into the hands of out-of-home.

“The issue around online stats and brand safety has eroded trust. Advertisers want a medium they can trust and they are returning to out-of-home as it’s resilient. It is proven to work and properly verified,” he claims.

This is a sentiment echoed by 8 Outdoor, an out-of-home provider that, despite only launching 21 months ago, reaches 16% of the population and is opening up to 10 out-of-home screens per month.

OOH is no longer just static billboards by the side of the road – the business model of the whole industry has fundamentally changed. Cadi Jones, Clear Channel

Its CEO Cennydd Roberts says the waters are less muddied for marketers when it comes to out-of-home. He explains: “All of the benefits of digital, such as immediacy, flexibility and bespoke tailored solutions, are coming to out-of-home and, at the same time, we do not face the same problems with contextual placement. Advertisers know exactly where their ads will appear because they can see the sites they are booking.”

Over the coming years, Outsmart’s Lumb concedes that out-of-home will experience a decline in ad spend due to concerns around Brexit. He also admits current concerns around advertising on Facebook and Google are only “momentary” and says advertisers will “inevitably” forgive the two.

READ MORE: UK advertisers split over ending YouTube boycott after brand safety scandal

He believes there’s also a lot for his industry to do in terms of communicating to marketers what the creative possibilities of out-of-home actually are. If it doesn’t, he says, there’s a risk many will still just see the channel as “nothing more than a poster”.

However, with the rise of programmatic changing the face of the out-of-home ad industry, Lumb is confident the momentum of recent years will continue. He concludes: “I used to hear out-of-home described as ‘tweets from giants’, but with programmatic out-of-home it will be more like TweetDeck. We’re on the up and you’d be silly to bet against the momentum we’re currently experiencing.”

Output: Unlike other traditional ad formats for which revenues have steadily declined, total UK ad revenues for out-of-home advertising channels grew by 4.5% to £1.1bn ($1.4bn) last year, according to AA/Warc's annual expenditure report. The digitisation of out-of-home advertising is enabling advertisers to serve real-time, contextually relevant content through billboards. Additionally, programmatic ad buying has enabled outdoor campaigns to become flexible, measurable and more compatible with wider multichannel campaigns.


Instruction: create a high quality summary of the given input

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Helix offers customers access to a lifetime of DNA analysis
 Which could actually have the opposite of Helix’s intended effect, he cautions. If people get back results that don’t wind up being that relevant or interesting, they could become disenchanted with the whole idea. Or users could over-engage with results that are intended only to educate and inform—not diagnose. As a physician, Topol worries that incidental findings from direct-to-consumer tests could trigger patients to ask for unnecessary tests from their doctors, increasing health care costs and straining resources. Researchers call this phenomenon “raiding the medical commons."

Helix tries to avoid these consequences by carefully evaluating the genetic interpretations and recommendations made by each product, based on the most up-to-date scientific literature. And product developers do their part by setting clear expectations up front. Take Sema4, a company spun out of New York’s Mount Sinai Health System by geneticist and big data evangelist Eric Schadt. It sells tests that tell expectant mothers if they carry a gene that might pass on an inherited disease to their children. Its flagship product uses DNA sequencing to screen for disease-causing mutations for 281 different genetic conditions, and is ordered only at the recommendation of your physician. But Monday, Sema4 announced a new, less expensive test on Helix’s marketplace that identifies genetic indications for only 67 diseases, which you can order yourself from the comfort of your home—with a small caveat. After you select the test, Sema4 requires that you submit some additional health information to a doctor online, who then reviews it before giving the final okay. That's a precaution the company takes to stay on the right side of current regulations.

Technically, the FDA has the authority to regulate genetic test kits, though the exact scope of the agency's jurisdiction is still a matter of legal dispute. As it stands now, the degree of FDA oversight of a test depends on its intended use and the risk posed by an inaccurate result. To date, the agency has mostly turned a blind eye to direct-to-consumer products (with the notable exception of 23andMe). So as long as companies don’t overpromise on the clinical validity of results, they can pretty much escape regulatory scrutiny.

Which is why Schadt says the product isn’t for people actively trying to get pregnant “We view it as an educational guide in the long term family planning journey, much further upstream than a clinical care scenario,” says Schadt. The idea is that if women see anything of concern show up in their simple screen, they’ll come back to Sema4 for the clinically comprehensive test when it comes to actually making a baby. But they shouldn’t use the product on the Helix marketplace to make any serious family planning decisions.

From a business perspective, the appeal of Helix’s platform is obvious. But owning DNA also presents some thorny ethical issues. Bioethicists have pointed out that when companies have a financial incentive to keep genetic data private, information that could otherwise be used for the common good stays behind closed doors. Helix’s parent company, Illumina, has a pretty good reason to keep those exomes for itself. In January, it spun out another company, called Grail, to leverage big DNA data to commercialize a technology called liquid cancer biopsy. It detects cancer in its very earliest stages by finding tiny amounts of tumor DNA in a drop of blood. A massive genetic database would give Grail a boost on validating that technology. While Helix wouldn’t comment on how the company plans to use its genetic information internally, it did say it doesn’t have any plans to share data with any third parties, to support external research efforts or otherwise.

These are the kinds of concerns Sema4’s Schadt had previously tried to confront, by opening up his company’s own genetic library to academic and nonprofit medical researchers for free. And while that vision is at odds with Helix’s own vice-grip policies, he still found something in the partnership that he couldn’t get on his own: volume. While Sema4 doesn’t receive any raw sequencing data from its Helix-based customers—just a report on the 67 diseases in the screen—it’s still worth it to get more long-term users. “It’s not perfect,” says Schadt, who spent many months working with Helix to come to a data-sharing agreement. “But it’s not bad either. I would love to have every single variant that Helix is generating, but this still gives us a far larger pool to go after to for studying diseases.”

Last year, Schadt published a paper in Nature Biotechnology describing something he calls the Resilience Project. The idea is to find people with mutations that should result in terrible disorders, but for some reason don’t. Something in their DNA protects them, and could offer clues to potential treatments. For that paper, Schadt analyzed the genomes of nearly 600,000 people—an incredibly time and cost-intensive project. He’s betting that Sema4, and Helix, can help speed up the treasure hunt. Some of the genes that harbor these disease-causing mutations are on the smaller Sema4 screening test, so Schadt is still hoping he can use that data to recruit individuals for further study. “Helix provides us this really broad net,” he says. “It’s a cool way to identify promising people.”

Other health researchers are also interested in that broad net. Though not on the list of marketplace products announced Monday, two big hospital networks with hundreds of thousands of patients—Geisinger Health and the Mayo Clinic—have plans to launch products there later this year. Being able to tie even limited genetic data with information from those patients’ electronic health records is the kind of thing that gets even skeptics like Topol excited. But even so, he thinks it will be at least five years before the science really catches up to the product platform’s promises. If Helix can ride the wave that long, you might actually be able to stake some everyday decisions on your DNA.

Output: Helix, a spin-off from San Diego-based genomics giant Illumina, has launched a platform offering access to 18 personalised genomics lifestyle products for customers who take a $80 DNA saliva test. The sample is sequenced and the client's genome is saved in the cloud, from which it is accessible via an API. While Helix said the platform will democratise the DNA market, critics have argued it offers little to people who are generally healthy.


Instruction: create a high quality summary of the given input

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US doctors use VR to prepare for conjoined twins surgery
 The conjoined newborn sisters in Minnesota were successfully separated using virtual reality. (File)

During an 18-year career in medicine, Daniel Saltzman -- the chief of pediatric surgery at University of Minnesota Masonic Children's Hospital -- has grown accustomed to looking at X-rays as if they were imperfect road maps of the human body.He compares this exercise to looking at a one-dimensional traffic map on your smartphone and thinking about that image in three-dimensional terms in your mind.Like any other road map, an X-ray image is an incomplete reduction of reality that can misrepresent challenges or include distortions, which explains why, even in 2017, high-stake surgeries can involve a shocking degree of guesswork and improvisation."That's why medicine is still an art as much as a science," Saltzman told The Washington Post.For decades, increasingly sophisticated imaging techniques have allowed doctors to peer into the human body before they cut it open, reducing uncertainty and helping them prepare for complicated procedures. Now, advances in virtual reality may flip that dynamic on its head, allowing doctors to confront the unknown before they evenenter the body.The latest evidence of this revolutionary shift in health care is the successful separation of two conjoined newborn sisters in Minnesota. Until their separation in May, Paisleigh and Paislyn Martinez were attached from their lower chest to their bellybuttons -- a condition known as thoraco-omphalopagus. Both babies survived the dangerous, nine-hour procedure, a development that Saltzman and other surgeons involved link directly to their use of virtual reality before surgery."It felt like I was working in the future," Saltzman said. "It was extraordinarily exhilarating."Conjoined twins are extremely rare, occurring as infrequently as one of 200,000 live births to up to one in a million births, depending on how the babies are attached, according to University of Minnesota doctors.Separating them is a risky procedure, though survival rates differ depending on how the siblings are connected and which organs they share, according to the University of Maryland Medical Center. The Medical Center notes that twins "joined at the sacrum at the base of the spine have a 68 percent chance of successful separation, whereas, in cases of twins with conjoined hearts at the ventricular (pumping chamber) level, there are no known survivors." In the latter case, the hearts are completely joined.Experts said they were unaware of any other example of virtual reality being used to prepare for the separation of twins partially conjoined at the heart. Virtual reality has been used to assist in the separation of twins conjoined at the head on three occasions, two of which were carried out by Housing and Urban Development Secretary Ben Carson, experts said.Anthony Azakie -- chief of pediatric cardiac surgery and co-director of the Heart Center at the University of Minnesota Masonic Children's Hospital -- called the university's procedure a "once-in-a-lifetime event."Using goggle-like virtual reality headsets a month before surgery, Saltzman, Azakie and their team were able to explore a 3-D model of the twins' hearts, virtually embedding themselves inside the walnut-sized organs as if the infant's anatomy had been blown up to the size of a living room."It's completely surreal and the resolution is unbelievable," Azakie said. "T he details are absolutely superb."The experience was not only riveting but revelatory, doctors said, so much so that the stunned surgeons decided to alter their entire operative strategy. Within minutes after strapping on the headsets, Saltzman and Azakie discovered something unexpected: new connective tissue -- a "bridge" -- linking the girls' intertwined hearts, one of which had become heavily reliant upon the other to filter impurities and remain beating because of a severe congenital heart defect.That defect meant that the lives of both babies were in jeopardy and doctors would have to conduct the surgery several months early, before the twins were as robust and healthy as doctors had hoped they'd be.Standing inside the 3-D rendering of the infants' hearts, the challenge before the physicians was daunting. They realized that improperly severing that connection could lead to the twins bleeding to death. Placing pressure on the hearts could cause blood loss or arrhythmia so severe that the organs could stop beating entirely. They needed to find a way to navigate around the connection that didn't damage each delicate organ.The team members interacted with the 3-D model using a "track system" that allowed them to turn their heads without distortion. Doctors said the ease of the virtual interaction helped the team arrive at a simple yet elegant solution, which they drew on a whiteboard moments later. The surgeons decided to flip the babies around on the operating table so that the procedure occurred from the opposite angle. In the end, doctors said, the straightforward solution to a complicated quandary may have saved the twins' lives."In our line of work -- especially in pediatric cardiac surgery -- it's important that one is able to think on their feet and plan for the unexpected," Azakie said. "The imaging helped us prepare by developing an approach in the event that we came across something we didn't expect."It was like the Oculus Rift of pediatric heart surgery."The planning effort to get to that point was methodical, with weekly meetings, endless tests and trialruns with a team of nearly 50 hospital staffers who practiced each stage of the surgery using baby dolls that had been sewn together.To create the virtual model of the infants' hearts, Saltzman and Azakie and other team members partnered with the University of Minnesota's Earl E. Bakken Medical Devices Center, where experts used software to turn MRI's and CT scans from both infants into a detailed virtual model. The university's Visible Heart Lab also created a 3-D printed model of the hearts using a printer purchased online for $300.Bethany Tourek, a PhD candidate in the University of Minnesota's department of mechanical engineering, said watching the medical team experience the virtual heart for the first time was a seminal moment."My favorite part was actually watching these four medical doctors standing inside this screen and being in complete silence at first," Tourek said. "You could just see them thinking and processing and taking it all in for the first time. It was a wonderful experience."Two months after their separation, the twins are still recovering, but doctors say that they'll lead healthy, independent lives, with a scar on their chests the only evidence that they were ever conjoined.Doctors said they expect the 3-D modeling and imaging used to see the twins' anatomy to appear in medical journals, setting a precedent for surgeries that ripples beyond procedures involving conjoined twins."Separating these infants was no small feat," he said. "The fact that we got to do it using virtual reality for direct patient care makes that feat truly incredible."

Output: Doctors have used virtual reality (VR) to save the lives of conjoined twin sisters in Minnesota. Daniel Saltzmann, head of paediatric surgery at the University of Minnesota Masonic Children's Hospital, and his team used VR during preparations for the separation of the girls in a nine-hour operation. Both babies, who were attached from their lower chest to their belly buttons, survived the procedure. Using VR headsets before the surgery, Saltzman and his team were able to explore a 3D model of the twins' hearts, virtually embedding themselves inside the walnut-sized organs as if the infants' anatomy had been blown up to room size.