The headlines above the previous several months have been about a scary pathogen, considerations about vaccine availability, and what policymakers are doing to prepare ought to this turn into a common pandemic. No, these are not revisiting the news three a long time back. Fairly, the modern headlines about H5N1 Avian influenza circulating in mammal populations are much more reminders that novel pathogens, pandemics and biothreats are here to continue to be.
The new Congress has an prospect to reinvest in the nation’s health and fitness infrastructure and greater place the country for the subsequent pandemic. This signifies, first, putting politics aside and, next, on the lookout to fortify pandemic preparedness. Whilst the former might be difficult, looking to advance the latter may well offer a auto to accomplishing better preparedness outcomes for our nationwide safety, economic prosperity and the region as a complete.
According to the International Monetary Fund, the COVID-19 pandemic could cost the international economic system upwards of $12.5 trillion dollars by means of 2030 — a simply staggering amount of money of funds. With the globe heading to additional “zero sum” results as The Economist indicates, obtaining intelligent techniques of investing at home and making certain economic resilience will lead to not just far better development, but stronger development.
It is fitting that policymakers converse of prescribed drugs and biotech now in the identical breath as semiconductors and other large-tech provide chains. They too are essential motorists of economic power, though also vital to our nationwide stability. For pandemic preparedness, this signifies hunting at crucial investments not as sunk prices, but as an coverage coverage that will, inevitably, be drawn on in the long run, no matter if artifical or pure in origin.
Too frequently Congress has seen pandemic preparedness as a luxury at best or basically a sunk expense at worst — a little something that can be eradicated when the risk or menace is lowered or gone. This has found our country lurch from disaster to crisis, accelerating investing in the experience of an emergent condition only to cut down the costs or even zero out paying once the menace has passed. This inconsistent funding is mirrored in our reaction to novel conditions — small is carried out at 1st and then every thing is done all at at the time. This is a high-priced and dangerous technique to disorder administration. Even even worse, if we start off to see pandemic preparedness and response as a result of a political lens, we become divided on an situation related to the fundamental wellness of our country — and our skill to protect ourselves.
As a starting issue, bad coverage provokes scattered responses and — irrespective of important attempts to the contrary — uncoordinated responses. We have the classes learned, irrespective of whether from SARS, Ebola, Swine Flu, H5N1, and now COVID-19 — the problem is not a scarcity of clever concepts, it is a scarcity of political will and a necessary framework. We have to have to look at pandemic ailment not as a collection of isolated incidents or mishaps but as a very long-phrase management problem that does, from time to time, need an elevated response.
The begin-quit, all-in or all-out pandemic preparedness method sends the wrong alerts to the private sector which, though not wholly reliant on the federal government, does glance to the federal government for course and regular investment for stockpiling and producing. We are not suggesting that the government subsidize industrial growth, but that commitments are produced to preparedness all over which the private sector can prepare, compete and innovate. Here, all can understand classes from the Trump administration’s Procedure Warp Speed to the Biden administration’s subsequent vaccine and booster rollouts.
In the long run although sources can come from Washington, we have to remember that care will be offered by state and area authorities and medical doctors, nurses, and EMTs on the pandemic entrance line. The federal federal government with its scale and resourcing is the metaphorical 800-pound gorilla in the room — it can do matters providers and even state and nearby governments can not.
Nonetheless, it lacks the agility, adaptability and neighborhood/issue make any difference knowledge that the non-public sector, states and localities have. By investing in pandemic preparedness at this amount we can cut down the stress on the federal governing administration, and empower these at the issue of treatment. This usually means encouraging stockpiling at a area degree and augmenting local health care methods and networks. Below the federal authorities can use its dimensions and scale to get improved charges from private sector corporations, give direction for state and neighborhood communities and present a coordinating functionality in the occasion of a crisis.
When we might experience extensive removed from COVID-19 the virus, its effects and its legacies are incredibly substantially with us. Placing the acrimonious politics to the aspect, we are even now registering bacterial infections, albeit at considerably-lowered rates and with much a lot less virulence and lethality.
Now is not the time to come to be idle or complacent basically mainly because the immediacy of the danger has ebbed. Instead, it is the time to mirror on what worked and what didn’t, to double down on required reforms and prepare for the next sickness.
Glenn Nye is the president and CEO of the Middle for the Examine of the Presidency & Congress (CSPC). Dan Mahaffee is the senior vice president & director of Plan at the Centre for the Examine of the Presidency & Congress, exactly where he sales opportunities its Geotech Program.
The New South Wales (NSW) state election next month is being held amid an unprecedented crisis of the public healthcare and education systems, in the state and across the country. Decades of funding cuts, and now the consequences of bipartisan “let it rip” COVID policies, have brought the public schools and hospitals to a breaking point.
Striking NSW teachers at Sydney rally in May, 2022. [Photo: WSWS]
Public school classrooms and entire schools are chronically overcrowded, while overworked teachers are leaving the profession in droves. The situation in health is deteriorating by every metric, with ambulance and emergency wait times at record levels, and nurses forced to work gruelling shifts while being denied decent pay amid a cost-of-living crisis.
In this election, Labor and the Liberal-National Coalition are making various phoney funding promises. But even if met, they will not resolve what is increasingly an existential crisis for these key social services. Moreover, after the election, the agenda of whichever parties form government will be to slash spending further, in line with a growing budget deficit that already sits at over $200 billion.
While there is supposedly no money to meet the most fundamental needs of the population, spending on the military and war has reached record proportions. While that is primarily at the federal level, it impacts developments in all the states.
The federal Labor and Coalition governments, while allocating vast sums to the war machine, have been reducing or keeping stagnant their funding contributions to education, health and other areas of social spending. The drive to slash spending at the state level, moreover, contributes to the process whereby an ever-greater proportion of total government funds are allocated to the military.
In the NSW election, and more broadly, the Socialist Equality Party (SEP) is alone in raising the call, billions for education and health, not for war!
The SEP’s election campaign is fighting to help develop an international anti-war movement of the working class against the US-led conflict with Russia in Ukraine and preparations for a catastrophic war against China, both of which are supported by Australian governments. The fight against war must be connected to the struggle for the social rights of the working class, including high-quality, free public healthcare and education for all, and decent jobs and wages for all staff in both sectors.
Both Labor and the Coalition are committed to military spending of at least $575 billion this decade, a figure they are already on track to meet. But with plans for the acquisition of nuclear-powered submarines, hypersonic missiles and other advanced weapons systems, that figure is only an initial downpayment.
The sharp contrast between the vast sums handed to the military and the pitiful spending on essential social services was summed up in the federal Labor government’s October budget.
A Ukrainian soldier fires an NLAW anti-tank weapon during an exercise in the Joint Forces Operation, in the Donetsk region, eastern Ukraine, Tuesday, February 15, 2022. [AP Photo/Vadim Ghirda]
It boosted defence spending by 8 percent on the previous financial year, to $52.2 billion. But amid an ongoing global pandemic and health crisis, the budget revealed that federal funding for public hospitals would decrease by $755 million this financial year and $2.4 billion over four years. The budget lowered the federal share of healthcare funding from 50 to 45 percent and reinstated a 6.5 percent annual cap on federal hospital funding, under conditions where official inflation was already above that level, there is an ageing population and increased demands on the hospital system due to the impact of the COVID pandemic and Long COVID.
The extent of the crisis, that this funding reduction will exacerbate, was demonstrated by a recent Australian Medical Association (AMA) report, which found that only three of the country’s 201 public hospitals were providing most care within a recommended timeframe.
Before the pandemic began, Australia’s hospital system had an average of 3.9 beds per 1,000 people, compared with the OECD average of 4.7. Despite various pledges during the COVID crisis, virtually nothing was done to increase staffed hospital beds.
Thus, in October 2021, a Medical Journal of Australia report found that the number of staffed intensive care beds had actually declined during the pandemic by 200, or 8 percent, since March 2020. The reduction in NSW equated to 45 beds lost.
In what it describes as a first step in reversing chronic underfunding, the AMA has called for the federal government to resume its 50 percent funding of health, up from 45 percent. This, of course, would do little to resolve the healthcare crisis. But Labor has rejected even that appeal.
As the AMA noted, the 5 percentage point increase would represent an investment of “$12.7 billion over four years.” That is, it would represent, over four years, some 24 percent of what Labor has allocated to military spending this year alone.
In the first three weeks of the year, moreover, federal Labor earmarked over $4 billion for new military acquisitions, including HIMARS, naval strike missiles and sea mines, all aimed at war with China. That spend alone is more than the yearly sum that would be required to increase federal health funding from 45 to 50 percent.
The healthcare crisis extends beyond the hospitals. General practitioners are also at a breaking point. After years of an effective funding freeze, many are ending bulk-billing, whereby consultations are fully subsidised through the government Medicare program. Amid this situation, federal Labor has developed a Strengthening Medicare Fund of just $750 million. That is less than 2 percent annual military spending.
For their part, Labor and the Coalition at the NSW state level have made various pledges to increase the number of hospital beds and staff. But they have rejected the fundamental structural improvements that would be required to facilitate an expansion of the health system. Both reject nurse-to-patient ratios, meaning staff will continue to be forced to care for a dangerous and unviable number of patients at a time. And they reject any pay rises in line with, let alone above inflation, which will drive more nurses out of the profession.
The same is the case in education. As the SEP recently explained, amid chronic overcrowding and an inadequate number of schools, the $575 billion in military spending this decade would “would be enough to build nearly 20,000 new secondary schools, or twice as many primary schools.”
Instead, funding cuts are on the order of the day. Funding is based upon the Schooling Resource Standard (SRS), a regressive program which ties monies allocated to schools to testing performances. Its own benchmarks are woefully inadequate, but even they are not being met.
In December, the federal Labor government and all the state education ministers agreed to roll over current funding arrangements until 2024, meaning an effective funding freeze. That means public schools will only be funded at 87 percent the level recommended by the SRS for the coming years. In NSW that equates to a funding shortfall of approximately $1.95 billion.
NSW Labor leader Chris Minns recently pledged to establish a $400 million fund to supposedly address the underfunding. Virtually no details were provided, but the figure alone is woefully inadequate, potentially equating to some $40 million a year. The Coalition immediately hit back by noting that reaching 95 percent of the state funding for the SRS would cost $750 million a year, something that neither party would commit to.
The chasm between the funding for the war machine and social need extends to virtually every area. Amid the worst housing and cost-of-living crisis in living memory, the federal Labor government has pledged $10 billion to construct 30,000 “affordable” and social housing dwellings over the next five years. Experts estimate that there are as many as 437,000 households in immediate need of access to social housing.
The $10 billion is scarcely 20 percent of annual defence funding, but spread over five years. It is less than half the estimated cost of each of the nuclear-powered submarines that the government is planning to acquire. With the above figures, each dwelling is calculated to cost $333,333 to build. A HIMAR missile alone, not including the rocket launcher, is estimated to cost approximately $150,000 ($US100,000). Two missiles therefore could build a house.
As is always the case, it is the working class that is made to pay for war, both in terms of the fighting itself, and in bearing the burden of the immense expenses involved. The defence outlays thus far involved are only a fraction of what will eventually be allocated. In a speech this week, Albanese proclaimed that “national security demands a whole-of-nation effort.” That is, every aspect of society is to be subordinated to the war drive.
That demonstrates the urgency of workers linking their growing struggles against the onslaught on wages, jobs and conditions, to the fight against war. In this fight, the watchwords must be: “Lives before profits! Billions for health and education, not the military.”
The spending underscores the need for workers to take up a new political perspective aimed at reorganising society. The military-intelligence apparatus must be dismantled, and the banks and corporations placed under public ownership and democratic workers’ control. That is the only means of ensuring decent health and education and ending war. It is an international fight, requiring the unity of the international in a common revolutionary struggle for the socialist reorganisation of the world.
The burden of neurological disorders is growing in the US and abroad, with neurological conditions representing the most frequent cause of disability worldwide1. The resulting consequences are considerable individual suffering and substantial societal healthcare costs2,3. R&D investments are needed to identify new therapies, but clinical research faces challenges including high costs, administrative hurdles, and challenging patient recruitment4,5,6. Furthermore, clinical trials and their associated follow-up visits burden patients and their relatives7, especially for those with highly disabling neurological diseases.
Against this backdrop, the use of digital tools, such as connected sensors, promises to make research more patient-centered and move clinical trials beyond single “snapshots” of disease status toward more continuous measurement of chronic disorders8. Connected digital products9 or Digital Health Technologies (DHTs)10,11 are software-containing, patient-focused, portable, and connected sensors of health-related measurements, which describe different products, including many wearables. DHT examples from current FDA guidance include spirometers with smart connectivity, consumer activity trackers, and mobile applications for patients to report outcomes11. Such connected sensors may improve both the quantity and quality of data collection during clinical trials and enable patient recruitment in a less burdensome and more patient-empowering remote setting9.
In neurological diseases such as Parkinson’s disease (PD), use of validated, reliable, and sensitive tools has already been shown to provide better data on the “real-life distribution of disease severity, as it fluctuates longitudinally” in early-stage patients12,13. DHTs can therefore facilitate new study designs12, improve the efficiency of clinical trials14,15,16, and contribute to tackling many of the challenges neurological research faces. As more researchers adopt such technologies, understanding the use and development of DHTs in neurological clinical trials will be valuable for investigators, practicing clinicians, and those designing patient care pathways. As such, this study documents trends in the use of DHTs in neurology research and highlights opportunities for both R&D activities and care delivery going forward.
We assessed studies registered on ClinicalTrials.gov for four exemplary chronic neurological disorders. Building on methods from Marra et al. (2020)9, we identified trial-indication pairs for clinical studies in epilepsy, the neuroinflammatory disease multiple sclerosis (MS), and the two neurodegenerative diseases, PD and Alzheimer’s disease (AD). We present quantitative and qualitative (categorical) analyses of the trials that used connected sensors to describe technology adoption in neurology research and outline underlying trends over the years 2010-2021, inclusive.
Of the 6763 trial-indication pairs for epilepsy, MS, AD, and PD considered, 503 trial-indication pairs were identified as using DHTs by our search algorithm. After manual verification, 441 trial-indication pairs, associated with 430 unique clinical trials, were determined to be relevant and included in the analysis sample (Supplementary Fig. 1). Analysis sample trial counts varied significantly across indications: most frequent were studies in PD (198, 44.9{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}), followed by MS (119, 27.0{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}), AD (87, 19.7{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}), and epilepsy (37, 8.4{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}).
We document growth in the use of DHTs in neurological clinical trials, with a compound annual growth rate of ~39{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} from 2010 – 2020, consistent with trends in DHT growth that have been documented in registered clinical studies more broadly9. Most analyzed trials were interventional, with DHT trials based on registries having started only in recent years and typically incorporating some kind of digital activity or speech tracking (Fig. 1).
Fig. 1: Development of clinical trials for chronic neurological diseases by year of initiation, trial type and indication.
a Number of analyzed studies using Digital Health Technologies (DHTs) per year, stratified by the type of the respective trial. Line depicts the percentage of DHT trials out of all trials for the analyzed indications starting in the respective year. b Number of analyzed studies using DHTs per year, stratified by the indications epilepsy (Epi.), Alzheimer’s disease (AD), multiple sclerosis (MS), and Parkinson’s disease (PD). * Data for the year 2021 may be incomplete due to late registrations on ClinicalTrials.gov.
The relative frequency of DHT use in trials for the focal conditions increased from 0.7{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of trials in 2010 to 11.4{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} in 2020. PD trials showed early uptake of DHTs and the highest use rate over the full period of the study (8.3{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} on average). AD, MS, and epilepsy trials showed a delayed upward trend, with respective use rates of 7.3{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}, 5.8{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}, and 3.3{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} overall (Supplementary Table 1).
Among all DHT trials, 16.6{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} included an industry sponsor or collaborator – slightly less frequently than the 19{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} previously documented across all medical disciplines9 – with industry partnerships more commonly observed in trials for epilepsy (37.8{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}) and AD (23.0{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}) (see Supplementary Fig. 2).
With respect to studies’ categorical (qualitative) features, most trials tracked patient symptoms (91.4{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}), with exceptions focusing on vital signs of caregivers or other disease-related outcomes such as medication adherence. The majority of trials measured motor functions (68.9{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}), with many including exercise elements (34.7{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}), sometimes through the use of gaming consoles (7.9{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}). Sleep (15.4{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}), cognition (10.4{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}), and speech (4.3{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}) tracking were less common as were gamification (19.3{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}), caregiver support (6.6{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}), and medication adherence (4.3{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}) elements (Table 1). A large share of studies used some form of mobile application (35.1{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}) and the most commonly referenced DHTs were wearables (129, 29.3{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}), smartphones (76, 17.2{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}), actigraphs (48, 10.9{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}) and mobile applications (42, 9.5{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}) (see Supplementary Table 2).
Table 1 Qualitative (categorical) features of trials by indication.
PD and MS trials often focused on motor symptoms and physical exercise, with a high share of gamification elements in MS trials. Other observed characteristics included numerous caregiver support and speech recognition tools in AD trials, frequent sleep tracking in AD and epilepsy trials, cognition tracking in AD and MS trials, and a recurrent tracking of medication adherence in epilepsy trials (Table 1).
Generally, a trend toward more complex and more extensive studies was observed, as represented by a gradual change in categorical trial features over time (Fig. 2). Whereas the use of motor function and exercise tracking were already observed in 2010, speech and cognition tracking were not observed until the mid-2010s (Fig. 2). Speech and cognition tracking both grew over time and were present in 8.1{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} and 14.0{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of analyzed DHTs using trials in 2021, respectively (Supplementary Table 1). Conversely, the relative use of gamification elements decreased slightly in more recent years (Supplementary Table 1).
Fig. 2: Use of selected Digital Health Technology tracking modalities in trials registered on ClinicalTrials.gov for chronic neurological diseases by year of trial initiation.
Number of ClinicalTrials.gov registered trials of four different neurological indications using DHTs for different tracking modalities by trial initiation year (green bar plots). Additionally, rate of these studies compared to all trials for the same indications registered on ClinicalTrials.gov for the respective year is shown (orange line). Trials for the indications epilepsy, Alzheimer’s disease, multiple sclerosis, and Parkinson’s disease were included. a Absolute number and share of all trials for motor function tracking. b Absolute number and share of all trials for sleep tracking. c Absolute number and share of all trials for cognition tracking. d Absolute number and share of all trials for speech tracking. * Data for the year 2021 may be incomplete due to late registrations on clinicaltrials.gov.
Most registered trial-indication pairs were identified in North America or Europe, with a large share of trials having principal investigators in the US (209, 47.4{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}), followed by Italy and France (both 28 or 6.3{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} each), the UK (19, 4.3{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}), Belgium (17, 3.9{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}), Switzerland (16, 3.6{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}), Israel (14, 3.2{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}), Canada, Turkey, and Germany (all 13 or 2.9{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} each). In total, trials from 33 countries and all inhabited continents were included in the analysis sample. Some regions showed a local/regional concentration of DHT studies, often related to a specific indication. An interactive map displaying the locations of sample trials are publicly accessible at https://www.reine-nervensache.de/eigene-forschungsergebnisse/digital-health-technologies-in-neurology-trials.
Qualitatively, included studies displayed heterogeneity in their aims. Whereas some clinical trials aimed to validate products or novel biomarkers, others already applied them as endpoints in studies of other interventions.
While some have highlighted insufficient prospective clinical research applying DHTs and mobile health17, the use of DHTs in neurology trials has not previously been characterized in detail. We analyzed disease-specific DHT adoption in trials registered on ClinicalTrials.gov to provide insights specific to four chronic neurologic diseases.
The analysis confirmed a clear trend in DHT adoption, with some disease-specific heterogeneity. The earlier application of such tools in disorders with primarily motoric symptoms, such as PD or MS, is likely due to the early availability of wearable sensors to track motor functions and might contribute to the higher number of trials observed for these two indications. However, as novel sensors and sophisticated technical setups became available in more recent years, multimodal clinical trials tackling diverse research questions with DHTs began to emerge. This development is evident in the subset of AD trials, where recent growth in the share of trials using DHTs is consistent with increasing readiness of novel digital measures that integrate speech and cognition tracking18,19. In parallel, the repertoire of DHTs used in early-adopting subfields has also expanded, for example through potential PD monitoring technologies that now include passive tremor monitoring via wearables12,13, smartphone-based motor and vocal symptom assessments20,21, gait analysis via smart insoles22, and sensors for swallowing23.
Interestingly, pharmaceutical companies tested self-developed DHTs in some trials24,25,26, indicating a possibility for broader prospective adoption by other stakeholders. Differences in the share of industry-sponsored trials across neurologic diseases could indicate differences in experience with digital measures across indications or difference in research funding for different diseases (either within firms themselves and/or from investments by research foundations or public funders). Any of these factors could shape biopharmaceutical and medical device firms’ investments in their use in clinical trials. Regions with a higher density of clinical trials using DHTs differ in their indication-specificity, suggesting different backgrounds and foci of research teams: high-density areas with multiple indications were more frequent in the US and could indicate technology-driven research, whereas regional clusters focusing on research in a single indication appeared more common in other countries.
Some digital measures assessed in the analysis sample integrate information previously unavailable to clinicians and researchers, such as details of smartphone usage27 or characteristics of patient-caregiver-interactions28,29, in one case deploying real-time monitoring of mood and stress via a smart-home approach29. Monitoring cognitive and motor skills with ‘byproduct data’ such as metadata on smartphone keystroke dynamics, for example, in epilepsy27 or MS30, could allow remote monitoring to be passively and therefore more seamlessly integrated into patients’ daily lives and eventually, into clinical routines. Further examples of the use of previously inaccessible data for novel phenotyping include approaches such as longitudinal repetitive cognitive testing18,31, speech characterization32, or swallowing monitoring23. Especially in more complex recent studies, digital biomarkers or measures were observed in conjunction with biological and radiological biomarkers22,33, promising a more detailed overview of patients’ health status than ever before. Furthermore, the small but growing trend of monitoring and supporting caregivers or relatives via DHTs28,29 could preview new forms of promising assistance for these essential but often neglected alleviators of the burdens of chronic diseases. A personalized prevention of secondary burn-out or depression among caregivers could be supported by DHTs that objectively track interactions with patients and monitor caregivers’ vital signs and stress28,29.
The observed heterogenous use pattern of DHTs in the analysis sample highlights different use cases for validating DHTs, gathering data with DHTs, or using DHTs as interventions; understanding this heterogeneity should be a focus of future research. Examples of trials categorized by the use cases according to Marra et al.9 can be found in Supplementary Table 3. Generally, there appears to be a large variety of new therapeutic and monitoring solutions under study, although solutions often remain fragmented, stand-alone approaches, making it difficult to bring user-friendly, holistic approaches into practice at scale.
The growing share of disease-specific trials applying DHTs show that neurological research is already adapting and increasingly integrating remote digital measurements into its research agenda. In addition to growing adoption of established digital measures, such as motor function, novel approaches, such as speech and cognition tracking are being deployed more often.
Recent regulatory trends further support this development, as seen in the first qualification of a digital endpoint by the EMA in Duchenne muscular dystrophy34, a neuromuscular disorder, and published guidance for applying DHTs by the FDA11. Nevertheless, there remains ample opportunity to extend the use of DHTs in clinical trials and support their transition into routine clinical care. Different technologies promise improved patient healthcare access and new setups for decentralized clinical trials, thereby enabling previously unimaginable measures for gathering real-world evidence. Further research is needed to clarify what is required for broader adoption in practice, thus enabling the translation of verified, analytically validated, and clinically validated tools35 into improved patient care.
Methods
We identified DHTs in trials registered on ClinicalTrials.gov following Marra et al. (2020)9 and using an updated and curated version of the searched product list (see Supplementary Note 1 and GitHub repository in the Data Availability Statement). Additionally, trials were filtered for the conditions epilepsy, MS, AD, or PD, resulting in a dataset built around unique trial-indication pairs (only 10 trials had multiple indications). The analysis sample was restricted to trials launched from 2010–2021 (inclusive) that had at least begun recruitment. Data were retrieved on February 28th, 2022. The resulting set of records was analyzed for the use of DHTs and trials that referenced such products were included in the analysis and mapped to a list of relevant categories defined for this purpose. This list included non-mutually-exclusive features such as different tracking characteristics as listed in Table 1 and Supplementary Table 1 (mapping was carried out by L.M. and P.G.). For comparison, other contemporaneous trials for the same indications were pulled from ClinicalTrials.gov. All analyses were run using Python 3.8 (Python Software Foundation, Delaware, USA). An interactive map of the principal trial locations was generated using plotly version 5.4.036 after geocoding addresses with geopy version 2.2.037. The co-author team included a patient with one of the focal disorders.
Reporting summary
Further information on research design is available in the Nature Research Reporting Summary linked to this article.
The Psychological Well being Project is a Seattle Instances initiative targeted on covering psychological and behavioral health and fitness issues. It is funded by Ballmer Team, a countrywide business centered on financial mobility for young children and people. The Seattle Times maintains editorial command above perform produced by this staff.
Thirty-odd many years in the past, Time magazine hailed a new psychological health and fitness facility in downtown Seattle as a position of hope.
El Rey, with its ethereal interior style and individualized solution to mental wellbeing treatment, experienced opened a couple of a long time prior. In contrast to the aged institutional product, it experienced a fashionable, humane attractiveness. All those who could are living with relative independence did so. People who desired round-the-clock treatment gained that variety of consideration. “Unless a consumer is unmanageable, he will hardly ever be thrown again onto the road,” the short article reads. Explained a facility supervisor quoted in the posting: “El Rey is a location the place some persons can live indefinitely if they pick out to.”
There were being several new or restored psychological health homes in Seattle back again then.
Now, practically all of them are absent.
On a chilly early morning in early February, a Downtown Ambassador swept litter from padlocked doorways of the now-closed El Rey making on Next Avenue. “No Trespassing,” a signal on the doorway warned. About a mile absent, Capitol Hill’s Summit Inn psychological wellness dwelling has been changed by fashionable studio flats. A facility torn down around Fuel Is effective Park is now the site of high-priced city houses.
As King County’s populace swelled by virtually 50{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} given that El Rey very first opened, the number of beds wherever folks with mental diseases can are living or get well has halved. There’s no definitive resource that tracks psychological wellbeing beds below. But estimates compiled by The Seattle Situations counsel beds were being out there for about 548 folks countywide in the 1990s. About 261 exist today.
The decline in beds has come to be an urgent focal point for nearby plan leaders. The range of individuals in psychological overall health crisis is too much to handle jails and emergency departments, and in April, a ballot measure to develop mental wellness crisis facilities will go to voters.
But these who’ve invested decades seeing the psychological health disaster unfold say the arc of decline is most effective comprehended if you zoom out. Search, they say, at how persons with psychological ailment have extended been dealt with by culture.
“Unfortunately, behavioral wellness has never been a priority,” at the very least from a funding perspective, reported Kelli Nomura, previous director of King County’s behavioral wellbeing division, and the new CEO of Intercontinental Group Wellness Products and services.
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When Northern State Hospital shut in the mid-1970s, and the state’s other psychiatric hospitals began emptying wards in the a long time that followed, community companies and county federal government attempted to fill the gaps.
Agencies repurposed outdated structures — El Rey was a former resort — or produced new types. Instead of shuttling individuals absent to massive psychiatric hospitals, services that housed anywhere from 16 to 64 individuals sprung up in neighborhoods and company districts. Some areas have been intended to provide men and women for months or many years. Other folks offered a much more non permanent spot to stabilize, or transition from intense care to impartial living.
But when the condition shifted accountability for household psychological health treatment from big institutions to communities, dollars of assistance didn’t adhere to, coverage professionals and psychological health agency leaders agree. Many years of paltry reimbursement charges from the condition — and small to nonexistent money for cash maintenance or improvements — eventually manufactured community mental health facilities a shedding proposition for the nonprofit businesses seeking to run them.
Initial arrived price-savings steps, which includes mergers. Then arrived closures.
Seem Overall health, for occasion, employed to function El Rey, and until eventually not too long ago operated quite a few of the county’s residential mental wellness facilities Seem, which is the most significant company of Medicaid-funded behavioral overall health companies in King County, declined quite a few requests for interviews. Around the earlier few years, it has divested from all but two of its long-time period mental health and fitness amenities, according to King County officials. Sound Health’s revenue dropped from $99.5 million to $79.4 million from 2019 to 2020, the nonprofit’s most recently readily available tax paperwork exhibit. In the meantime, compensation for its government management jumped from $1.4 million to $2.4 million around the exact same period of time.
In 2014, when Tim Sipes began performing as a situation manager at El Rey, indicators of drop had already begun. The constructing by itself was in dire have to have of maintenance. Sipes was not paid a lot — $22 or $23 an hour — but he was drawn to operating with individuals with mental illnesses mainly because it was rewarding in other approaches. “It’s not like I could transform every thing,” he stated. “But if they found any person who was compassionate and keen to hear and figure out them as a human staying, that type of made a change. … While in the bigger outside the house earth, they ended up typically dismissed.”
As the yrs went on, nevertheless, companies started to falter. Personnel schedules grew to become eaten by administrative and safety responsibilities rather of therapeutic functions.
Morale tanked.
And pressures to streamline treatment received to him.
That optimism — that hope — from El Rey’s early days, experienced light. And in 2019, Sipes still left.
The next 12 months, El Rey was shuttered for very good.
Rearview mirror
At the lunch hour on a latest Thursday, tiny teams of grown ups ate pizza, paged by way of newspapers and chatted quietly in a popular space at Neighborhood Home Mental Wellbeing Company. A whiteboard advertised karaoke and a newsletter club. Volunteers wiped down tables and identified as out, “Last simply call for seconds and just take homes!”
“We’re what there utilized to be a large amount of in this town,” reported Chris Szala, who has been government director of the nonprofit considering the fact that 1991. “That’s disappeared.”
On the initially ground of Community House’s headquarters on Jackson Avenue, people and guests can wash laundry, get a shower, inventory up on foodstuff or check out with a psychiatric nurse practitioner who prescribes medication. Upstairs, persons with persistent psychological illness live in 54 single-occupancy units. Most come to Neighborhood Residence by referral from a healthcare facility or a jail.
Community Home is King County’s major certified, 24-hour service provider of household psychological well being beds. It operates a number of 24-hour assisted residing amenities, transitional properties and supportive housing models. Still, many of its facilities have closed.
In a 2-inch-thick black binder, Szala retains previous leases from psychological health and fitness boarding properties Local community Residence applied to run. The aged Tudor property on 17th Avenue on Capitol Hill, when named The Inn. A massive assets near the aged Glo’s diner.These amenities shut in 2008, alongside with two some others that yr. By Szala’s estimates, that to start with wave of closures resulted in a whole of 175 mental health beds missing.
Old newspaper stories provide a slew of causes. To commence: Leases were up at quite a few of the agency’s facilities. But the state’s Division of Social and Wellness Services experienced also leveled really serious sanctions in opposition to at the very least six of Local community House’s homes. Inspectors observed weak disorders, like filthy carpets and furniture, and folks residing in a basement bedroom with a dirt and worm-infested flooring. At a single Group House-operated home, a resident died by suicide.
“I have no doubt that the state had every appropriate to sanction points at instances,” Szala said. “There just wasn’t the dollars to consider care of it.”
Everybody interviewed for this story recurring Szala’s issue. Most psychological health services were being compensated a day-to-day fee to care for residents. But they had few selections to shell out for repairs.
When Szala took more than at Group Property much more than 30 yrs ago, land was comparatively inexpensive, and developing or leasing big houses for mental health and fitness care was possible. By the late 1990s, although, quite a few psychological well being facilities had been quickly place below the same umbrella as assisted living amenities, a designation that came with considerably stricter rules and teaching necessities. These more regulatory burdens did not arrive with further reimbursement, Szala said. And by the time the condition sanctions came down, Seattle was an amazingly pricey town to do organization in.
The county was eventually confronted with subsidizing properties in have to have of maintenance — or letting them close.
“The boat was missed” to get and make lasting the form of household psychological health and fitness amenities that are now sorely needed, Szala said.
Psychological wellbeing assets from The Seattle Instances
At the time, however, closing congregate care, or boarding houses, match with a change absent from the old, paternalistic mentality that people suffering from mental disease just can’t get far better, reported Amnon Shoenfeld, who was director of King County’s behavioral health and fitness division all through the 2008 closures.
“It led to us on the lookout at people amenities and declaring, ‘We definitely require to get persons to shift into the local community,’ ” he reported.
The county’s prepare was to transfer people today from congregate care into a distinctive design and style of housing: everlasting supportive housing, the place they could dwell independently, with accessibility to psychological health and compound use assist as they required it. While boarding properties had been often established up more like dorms, with roommates, delivered meals and communal loos and kitchens, lasting supportive housing provides extra privateness and a extra normal apartmentlike room, and doesn’t involve spherical-the-clock care. It is also not solely for people today with a psychological well being diagnosis, and is geared towards low-money people who indicator leases.
But looking in the rearview mirror 15 many years on, Shoenfeld reported, the county did not account for skyrocketing housing expenses, or how many persons would want guidance. “We don’t have sufficient everlasting supportive housing,” he mentioned.
Was it the right decision? To enable so lots of mental wellbeing beds vanish?
“That’s a hard a person,” he claimed. “In hindsight, we likely must have performed much more to increase the alarm about the deficiency of economical housing.”
“Then what?“
The county is now experimenting with the reverse strategy, having on possession of these facilities: When a 60-plus mattress facility termed Cascade Hall near Northgate was at possibility of closing past year, King County and point out officers pooled $10 million to help save it.
Audio Well being had acquired the facility, which provides equally mental wellness and material use companies, when in 2019 it merged with one more longstanding behavioral health and fitness agency, Community Psychiatric Clinic, exactly where Nomura labored for 26 years.
Sound has not responded to repeated requests for details about why it moved to market Cascade Corridor, however government officers have cited staffing shortages as one purpose for the sale. Nomura, who even now worked at King County at the time, said her office encouraged providers to work with the county to dilemma-fix when they have been experiencing closure — but that companies finally get to make their possess small business choices.
“I experienced conversations with Seem. And I comprehended some of where they were coming from,” she said. But about the time of the sale, 70 individuals were on Cascade Hall’s waitlist. Nomura mentioned she had lingering queries about men and women who were presently living there. “For me it was: ‘Then what? What are we likely to do? In which are they heading to go?’ ”
She and her colleagues floated the notion that the county could purchase the area Neighborhood Property is now contracted to deliver expert services there. But she’s make any difference-of-reality about the expense of these sorts of deals. “The county can not do that for just about every facility that is setting up to near,” she stated. “It cannot.”
Legislative agendas published by King County suggest county officials have lobbied point out lawmakers — with different stages of results — for capital investments and policy changes considering that at least 2018. In 2021, for instance, the county requested lawmakers to protect against the closure of any supplemental Western Condition Healthcare facility wards till much more community psychological wellness beds have been created. In 2022, the point out allotted $16 million to the county for psychological overall health capital improvements.
It’s nonetheless not more than enough, county officers say.
But when the county acknowledges a need for a lot more extended-expression beds, huge policymaking initiatives are mainly concentrating on a distinct type of behavioral well being treatment: serving to folks for shorter periods though they are in the midst of disaster.
In late January, the Metropolitan King County Council unanimously signed off on a behavioral wellness proposal that would elevate an approximated $1.25 billion in taxes around 9 yrs. An early estimate from the county suggests about 12{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of the proposed funding — $146 million — would be utilized to assist present lengthier-phrase household amenities or support establish new types.
“Hopefully, this 9-calendar year levy can give a steady stream of profits and revenue for these buildings and for the workforce,” claimed King County Councilmember Girmay Zahilay. “Right now, they just do not have that.”
But a wide bulk of the bucks are pinned to crisis care. An estimated $886 million would help build 5 disaster treatment centers that involve behavioral health and fitness urgent treatment, brief-term observation models and 14-working day stabilization beds — but no lengthy-expression residential treatment akin to the services that have closed in excess of the yrs. The proposal heads to voters in April.
For now, it is increasing awkward issues for individuals who’ve aided run the psychological well being system for years, which include these who function disaster services.
“I have this conversation with colleagues considerably consistently where we fret, wring our fingers, lament that there is a danger listed here,” reported Daniel Malone, government director of the nonprofit Downtown Unexpected emergency Company Center, who states he supports the levy. His get worried: “We’re heading to divert or build up way too substantially emphasis on disaster reaction, and we aren’t likely to acquire treatment of the relaxation of the needs that, if finished nicely and sufficiently, will stop disaster in the first position.”
Oakland, CA – The Public Wellness Institute’s president and chief government officer, Mary A. Pittman, DrPH, has been recognized by Contemporary Healthcare as one of the top 2023 Women Leaders in healthcare. Females executives from distinctive sectors of health care were acknowledged for their contributions to treatment supply enhancement, overall health equity, policy and gender fairness in healthcare leadership.
“I’m deeply honored to receive this award which extends beyond me in its recognition to the unbelievable team, partners, funders, and other stakeholders who are all supporting to build healthier, equitable communities all-around the world,” explained Dr. Pittman, president and main government officer of the Public Well being Institute. “It’s been an absolute joy and passion to guide PHI and to get the job done with so quite a few devoted and proficient folks who are all aiding to create more healthy, equitable communities all around the globe,” she extra.
Dr. Pittman has helmed the General public Wellness Institute (PHI) for 15 several years, and all through her tenure, her concentration has been to create PHI’s reputation for unbiased, collaborative and details-centered investigate and interventions that integrate the electricity and contributions of community experience and management. She designed a flexible, responsive, immediate-funding model that makes it possible for PHI to scale and improve packages, and to speedily and successfully answer to rising issues. In December 2023, Pittman ideas to retire from PHI but not from her determination to improving upon health for all.
Under Pittman’s leadership, PHI’s plans ended up ready to pivot to deal with the continuing opioid crisis. PHI’s CA Bridge provides its gold-standard Medication Assisted Therapy product to just about every medical center in the condition of California, and PHI’s FACES for the Foreseeable future trains substantial faculty youth as ambassadors in their schools and communities by mastering how to safely administer Narcan, an efficient and safe and sound drug that can reverse an overdose and preserve life.
“The ladies named to our 2023 course of the Top Women Leaders in Health care are serving to guideline their organizations and improve the communities they phone household,” stated Mary Ellen Podmolik, editor-in-main of Modern day Healthcare. “Internally, they are innovators and crew-builders advancing their companies. They are mentoring co-employees when inspiring some others to pursue careers in the business. And externally, they are forging coalitions to strengthen access to treatment for all sufferers. The women of all ages we’ve picked this calendar year, from hundreds of nominations, are leading essential enhancements in the nation’s health care method.” Dr. Pittman was selected as 1 of the Major 25 Women in Healthcare in 2021 and 2022.
For the duration of COVID, Pittman was instrumental in guiding and supporting PHI function that lowered the transmission of COVID in communities, greater entry to vaccination, and saved life. PHI has ongoing to lover and assistance statewide and national fairness-primarily based, group-centered COVID-19 restoration initiatives.
Dr. Pittman’s tactic facilities range and fairness as basic factors of greater results and more healthy, much better communities. PHI systems like Communities Increase Together work on the floor with communities of coloration, migrant and small-earnings communities, across the country applying a reliable leadership design to join individuals to vaccines and well-currently being resources for an equitable restoration. In California, PHI’s Collectively Toward Wellbeing method is top outreach for COVID-19 tests and vaccine shipping and delivery, doing the job with much more than 539 community-centered companies in communities of coloration throughout the point out.
PHI’s Acquiring Resilient Communities, Roots of Improve and Tracking California programs are operating with partners and farmworker-led advisory teams to handle the wellness inequities and impacts of wildfires and warmth on group users. On a worldwide scale, PHI’s Increase Up initiative is powering girl and women leaders who progress gender fairness and gender justice in their communities all over the globe.
Modern Health care will honor its 2023 Leading Ladies Leaders throughout an yearly awards gala in Chicago on August 10. The program acknowledges leaders from all sectors of the field, spotlighting their specialist achievements and contributions to their companies. The profiles of all the honorees are showcased in the February 20 situation of MH journal and at ModernHealthcare.com/topwomenexecs.
Amazon has not been shy about its intentions to disrupt healthcare.
The tech giant’s $3.9 billion acquisition of primary care company One Medical, which closed Wednesday, is the latest in a series of moves from a company determined to stake its claim in healthcare.
Here’s a look at Amazon’s recent history in healthcare dating back to 2018 including discontinued projects, current offerings and what could potentially be next.
Haven was an employer-led coalition focused on lowering costs by using the three companies’ collective bargaining power to negotiate prices with providers. But Haven disbanded in January 2021, six months after CEO Dr. Atul Gawande stepped down from the company. The companies didn’t possess the economies of scale to tip the balance when it comes to healthcare, experts said at the time.
Another employer-focused flop was Amazon Care. The service was announced in 2019 as a virtual health clinic for employers enrolled in Amazon health insurance plans. The service became available to all customers in 2021 and added a behavioral health component in August 2022. But a few weeks later, the company shuttered the service after Amazon’s healthcare chief Neil Lindsaysaid the offering was not complete enough for large enterprise customers.
“We’ve determined that Amazon Care isn’t the right long-term solution for our enterprise customers,” Lindsay wrote in an email to employees.
Pharmacy
In June 2018, Amazon acquired online pharmacy PillPack for $753 million. Initially, Amazon offered drug discounts to its Prime members but PillPack would eventually serve as the foundation for its Amazon Pharmacy service.
Amazon Pharmacy launched in November 2020 and allowed Prime members across 45 states to have access to unlimited, free two-day deliveries of prescription medications and drug pricing transparency tools. The pharmacy service has since expanded to customers in all 50 states with or without a Prime membership but still limits discounts to members.
Last month, the company announced RxPass, a generic drug subscription service aimed at consumers with common conditions like high blood pressure, acid reflux or anxiety. The medication delivery service costs $5 per month for Prime members.
Christina Farr, an investor at San Francisco-based venture capital firm OMERS Venture, said launching RxPass was unsurprising given the company’s vast logistics networks and PillPack acquisition.
Amazon Clinic
In November 2022, Amazon launched virtual health offering Amazon Clinic in 32 states, allowing users to access third-party telehealth providers for non-urgent health conditions ranging from sinusitis to urinary tract infections. Patients can send prescriptions to any pharmacy including Amazon’s in-house pharmacy service.
The service operates as a “virtual health storefront” offering users access to third-party telehealth providers. HealthTap, a virtual primary care provider, and SteadyMD, a telehealth provider operating in all 50 states, have listed services in several states and conditions.
The service does not accept insurance for visits but users can choose to use health savings accounts for payment. Amazon said costs of appointments will be shared with members beforehand.
One Medical
Amazon’s $3.9 billion acquisition of One Medical is the company’s latest and potentially most significant move.
Amazon announced its intent to acquire the primary care provider in July. The deal drew interest from federal regulators and took seven months to close. With the deal finalized, Amazon inherits One Medical’s 836,000 members and 221 medical offices across 27 markets, according to regulatory filings by One Medical’s parent company 1Life Healthcare.
By acquiring One Medical’s in-person clinics, Amazon dramatically increases the services it’s able to offer patients, said Jacob Effron, principal at venture capital firm Redpoint Ventures. Effron said the tech giant is trying to build an end-to-end patient experience in a way that can scale quickly.
It could also lead to an extension of brick-and-mortar storefronts, experts say.
“Following the leads of other retail, I imagine we’ll see some collaboration of this [One Medical] storefront with other storefronts they own [such as Whole Foods],” said Nathan Ray, a partner in consultancy West Monroe’s healthcare and life sciences practice.
Competition is expected to heat up as more big retailers look to expand in healthcare services through primary care offerings. Earlier this month, CVS Health announced it will acquire primary care provider Oak Street Health in a $10.6 billion deal. And Walgreens subsidiary VillageMD agreed in November to buy Summit Health-CityMD for $8.9 billion.
AWS endeavors
Amazon’s healthcare reach is also evident in its efforts to bring hospital data to the cloud, an area experts say will continue to grow as on-site data center environments become increasingly antiquated. Amazon Web Services holds 24.3{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of the global healthcare cloud market, according to market research firm Insider Intelligence.
The cloud computing division of Amazon introduced Amazon Omics in December, described as a “purpose-built managed service” intended to help bioinformaticians and biomedical researchers store, query, and analyze genomic, transcriptomic, proteomic and other data to advance scientific discovery and develop new diagnostics and therapeutics.
Amazon said the goal of the service is to “enable large-scale analysis and collaborative research for organizations to analyze omics data with purpose-built data stores, scalable workflows, and multimodal analytics.” Amazon Omics stores data—and thus bills customers—according to the number of gigabases the platform ingests. This offers “price predictability” regardless of whether the sequences are from short-read or long-read instruments, according to AWS.
What’s next?
Amazon has not commented specifically on what could come after One Medical but experts have their opinions. Ray said forming relationships with payers is likely to be important as the company becomes more deeply intertwined in healthcare.
“The idea here is not to break what you just bought,” Ray said. “They’re going to [need] some expanded relationship with how [their suite] works with payers.”
Other experts said the company could begin to address price transparency.
“The question of how much does it cost has still not been solved. Nobody even knows,” Farr said. “I think that’s where they’re moving. A lot of the moves they’ve made already get them some of the data to start putting that together.”
Farr highlighted the strong relationships One Medical has with health systems as a way to see the true costs of primary care referrals. Amazon could pair that data with data it has from prescriptions and expenditures to develop a fuller picture of patient care costs.
Ray said there could be a simpler reason for the company’s healthcare strategy.
“[Connecting] strategically the things they’re doing in healthcare is maybe the wrong way of thinking about it. Just think about each of these [initiatives] as maximizing [profit] until they have to connect.”
This story first appeared in Digital Health Business & Technology.
