care.ai,
an artificial intelligence company based in Florida, has partnered with Googlevto create an autonomous patient monitoring system. By combining multiple sensors in a patient’s room and neural network data analysis, the system can identify and predict accidents and clinical events, in some cases warning healthcare staff before an incident happens.
Preventable accidents and medical issues in healthcare facilities result in thousands of patient deaths and significant patient suffering every year. These include falls, infections, and pressure ulcers. While such issues are theoretically avoidable, in many cases it is difficult or impossible for healthcare staff to identify and anticipate every such instance, and in many cases, they can only hope to react to such circumstances once they arise.
To address this, the patient monitoring system developed by care.ai allows patient rooms to be “self aware,” whereby patients are automatically monitored 24 hours a day through advanced sensors, and AI identifies and anticipates mishaps and issues, providing healthcare staff with advanced warning.
The company claims that the system allows healthcare staff to have more time to focus on their patients’ specific needs, rather than constantly keeping an eye on them or reacting to unforeseen events. Moreover, it should also allow healthcare staff to be much more proactive, and lead to lower overall levels of avoidable mishaps in healthcare facilities.
Medgadget had the opportunity to talk to Chakri Toleti, Founder and CEO of care.ai, about the company’s technology.
Conn Hastings, Medgadget: What inspired you to develop a patient monitoring system?
Chakri Toleti, care.ai: In early 2018, I received
a call that my mother in India had fallen and remained on the bathroom floor
for half an hour before her caregiver found her. Even the best medical
professionals simply can’t be everywhere at once, so they are often delayed in
responding to patient issues. This was the catalyst for care.ai, fueled by the
idea that patients should be able to maintain independence and privacy while
still being kept safe.
Other industries, like transportation and aviation,
have really transformed because of AI. Healthcare, however, has been slower to
adopt it. I considered the autonomous
driving – how self-driving technology constantly scans and monitors its
environments, responding to pedestrians, roadblocks, debris, etc. I thought,
“what if we could bring the autonomous monitoring of a self-driving car to a hospital?”
I created care.ai to turn every room into a Self Aware RoomTM.
Medgadget: Please give us some background on the types of incident the system is designed to anticipate.
Chakri Toleti: These
are the few use cases that we have deployed: staff efficacy, fall prevention, pressure
ulcer prevention, and hand sanitization monitoring.
In phase 2 we will be
deploying other use cases such as patient elopement prevention (wandering
patients), security violations and visitor management.
Medgadget: What type of sensors are included?
Chakri Toleti: care.ai’s sensors use the
most advanced technology of any solution in a healthcare setting. We use a wide
range of propriety sensors within our patented hardware and software framework.
We are leveraging NVIDIA’s Jetson platform as a core compute engine and further
accelerating the inferencing of the sensor data using Coral’s Edge TPU.
Medgadget: Please give us a basic overview of how the AI system learns to anticipate incidents in a patient’s room.
Chakri Toleti: care.ai’s purposefully architected deep neural networks are trained on our propriety library of behavioral data – in fact, it’s the world’s largest library of human behavior data in a healthcare setting. Using edge-computing framework, care.ai’s deep neural networks deliver predictive results within nanoseconds. Using this proprietary library, the sensors identify recognized behaviors and immediately send relevant alerts to the appropriate care team members. The alerts are sent through a mobile app, SMS, desktop app, or integrated into existing HIS solutions using our SDK/APIs.
Medgadget: How has the collaboration with Google helped the system?
Chakri Toleti: We chose to work with Google because their software and hardware frameworks for AI – and now their capability to bring it to the edge – meet care.ai’s needs for the scale, accuracy and performance necessary to build an enterprise-class platform. Coral’s edge TPU has been instrumental for us to scale, allowing us to preserve patients’ privacy while still conducting constant monitoring and processing.
Medgadget: Is the system in use at present? How do you deal with patient confidentiality and data security?
Chakri Toleti: Consulate Health Care, a leading provider of long-term healthcare services, is currently piloting care.ai. care.ai’s platform is the most scalable and secure AI solution in Healthcare, we process all of our data on the edge on a highly secure and custom-built operating system and publish the deidentified inferenced data in a secure and HIPAA complaint framework back to the server.
New research shows how some types of proteins stabilize damaged DNA and thereby preserve DNA function and integrity.
Two proteins called 53BP1 and RIF1 engage to build a three-dimensional “scaffold” around the broken DNA strands. This scaffold then locally concentrates special repair proteins, which are in short supply, and that are critically needed to repair DNA without mistakes.
“This could be compared to putting a plaster cast on a broken leg.”
The finding also explains why people with congenital or acquired defects in certain proteins cannot keep their DNA stable and develop diseases such as cancer.
Every day, the body’s cells divide millions of times, and the maintenance of their identity requires that a mother cell passes complete genetic information to daughter cells without mistakes.
This is not a small task because our DNA is constantly under attack, not only from the environment but also from the cell’s own metabolic activities. As a result, DNA strands can break at least once during each cell division cycle and this frequency can be increased by certain lifestyles, such as smoking, or in individuals who are born with defects in DNA repair.
In turn, this can lead to irreversible genetic damage and ultimately cause diseases such as cancer, immune deficiency, dementia, or developmental defects.
“Understanding the body’s natural defense mechanisms enables us to better understand how certain proteins communicate and network to repair damaged DNA,” says professor Jiri Lukas, director of the Novo Nordisk Foundation Center for Protein Research.
“This could be compared to putting a plaster cast on a broken leg; it stabilizes the fracture and prevents the damage from getting worse and reaching a point where it can no longer heal,” says first author Fena Ochs, a postdoctoral researcher at the Novo Nordisk Foundation Center for Protein Research.
The previous assumption was that proteins such as 53BP1 and RIF1 act only in the closest neighborhood of the DNA fracture. However, with the help of super-resolution microscopes, scientists were able to see that error-free repair of broken DNA requires a much larger construction.
“Roughly speaking, the difference between the proportions of the protein-scaffolding and the DNA fracture corresponds to a basketball and a pin head,” says Ochs.
According to the researchers, the fact that the supporting protein scaffold is so much bigger than the fracture underlines how important it is for the cell to not only stabilize the DNA wound, but also the surrounding environment.
This allows it to preserve the integrity of the damaged site and its neighborhood and increases the likelihood of attracting the highly specialized “workers” in the cell to perform the actual repair.
One of the most notable benefits of basic research such as the new study is that it provides scientists with molecular tools to simulate, and thus better understand, conditions that happen during development of a real disease.
When the scientists prevented cells to build the protein scaffold around fractured DNA, they observed that large parts of the neighboring chromosome rapidly fell apart.
This caused DNA-damaged cells to start alternative attempts to repair themselves, but this strategy was often futile and exacerbated the destruction of the genetic material.
According to the researchers, this can explain why people who lack the scaffold proteins are prone to diseases caused by unstable DNA.
Erika Cheung and Tyler Shultz were the whistleblowers who helped to expose corruption at Theranos. They spoke at the Manova Summit in Minneapolis this week.
“There were words we couldn’t say at Theranos, like ‘biology,’ ‘pipette,’ ‘research,’” Shultz recalled. “And we weren’t supposed to talk to other people at Theranos about what you were doing.”
Still, the two didn’t have any other career experience, so it took a while for the red flags to add up, Cheung said.
Now, with the former leadership of Theranos waiting for a 2020 trial, Cheung and Shultz have established an organization they call Ethics in Entrepreneurship, hoping to prevent other tech and health startups and employees from going through what they did.
“We’re all here because we want to make an impact and we want to do good and we have good intentions, but making sure you have that strong vision and figuring out how to maintain that” is challenging, Cheung said. “You have to figure out how to stick to those morals and standards and values despite the chaos.”
Though they’re far from having all the answers at this point, they pointed to some basics that can be applied to almost any company:
Discretion from investors: “If the average age of the board is 80, maybe insist on a board seat,” Shultz said. “Or insist on younger blood.”
So-called vanity boards are popular in Silicon Valley, Cheung agreed, but especially in a highly regulated space like health care, “you need the right people asking the right questions.”
Be proactive: Think about the impacts a startup will have on customers, investors, employees and society. It’s better to think about these ethical issues early on in the process, Cheung said, rather than reactively.
Consider realigning incentives: Shultz and Cheung agree that there should be a way within the investment landscape to prevent an unethical situation from going too far. For example, if someone was personally profiteering or committing egregious actions, there could be a system in place for investors to pull back money. “There need to be ways to keep people accountable, to nudge them to good behavior,” Cheung said.
Think before investing: When people were investing in Theranos, Cheung pointed out, it was during a time when investors were scared of losing the next opportunity to buy into an Amazon. “There was not a lot of deep thinking about how to invest in tech companies,” she said. Theranos should serve as a warning to potential investors that they need to ask the questions before signing the check.
Create a culture of healthy disagreement: Shultz has started a new company, and while it only has three employees so far, one of his primary missions is to establish a culture in which people are allowed to disagree — even with the boss. “My lab bench scientist and I get into some arguments that are pretty intense, but I tell him it’s really healthy — and we can move on,” he says. How do you scale that for a bigger company? “That’s the hard question,” Cheung said. “But the biggest one is, do you have a way for employees to report problems? Are the right mechanisms in place to compile evidence, and is there investigation and followup?” An ethics hotline, she said, is one way to do that.
Despite spending most of his 20s wrapped up in the Theranos scandal, Shultz maintains a sense of optimism.
“So many things had to go wrong [in the Theranos case] that I think it’s unlikely something like this would happen again,” he said. “Though maybe I’m naive.”
Moderator Rebecca Jarvis of ABC asked the pair whether they thought former Theranos CEO Elizabeth Holmes should go to jail.
“There has to be some justice,” Cheung said, to great applause from the audience. “There has to.”TrendMD v2.4.3
Group Health Cooperative in Seattle, one of the nation’s oldest and most respected nonprofit health insurance plans, is accused of bilking Medicare out of millions of dollars in a federal whistleblower case.
Teresa Ross, a former medical billing manager at the insurer, alleges that it sought to reverse financial losses in 2010 by claiming some patients were sicker than they were, or by billing for medical conditions that patients didn’t actually have. As a result, the insurer retroactively collected an estimated $8 million from Medicare for 2010 services, according to the suit.
Ross filed suit in federal court in Buffalo, N.Y., in 2012, but it remained under a court seal until July and is in the initial stages. The suit also names as defendants two medical coding consultants, consulting firm DxID of East Rochester, N.Y., and Independent Health Association, an affiliated health plan in Buffalo, N.Y. All denied wrongdoing in separate court motions filed late Wednesday to dismiss the suit.
The Justice Department has thus far declined to take over the case, but said in a June 21 court filing that “an active investigation is ongoing.”
The whistleblower suit is one of at least 18 such cases documented by KHN that accuse Medicare Advantage managed-care plans of ripping off the government by exaggerating how sick its patients were. The whistleblower cases have emerged as a primary tool for clawing back overpayments. While many of the cases are pending in courts, five have recovered a total of nearly $360 million.
“The fraudulent practices described in this complaint are a product of the belief, common among MA organizations, that the law can be violated without meaningful consequence,” Ross alleges.
Medicare Advantage plans are a privately run alternative to traditional Medicare that often offer extra benefits such as dental and vision coverage, but limit choice of medical providers. They have exploded in popularity in recent years, enrolling more than 22 million people, just over 1 in 3 of those eligible for Medicare.
Word of another whistleblower alleging Medicare Advantage billing fraud comes as the White House is pushing to expand enrollment in the plans. On Oct. 3, President Donald Trump issued an executive order that permits the plans to offer a range of new benefits to attract patients. One, for instance, is partly covering the cost of Apple Watches as an inducement.
Group Health opened for business more than seven decades ago and was among the first managed-care plans to contract with Medicare. Formed by a coalition of unions, farmers and local activists, the HMO grew from just a few hundred families to more than 600,000 patients before its members agreed to join California-based Kaiser Permanente. That happened in early 2017, and the plan is now called Kaiser Foundation Health Plan of Washington. (Kaiser Health News is not affiliated with Kaiser Permanente.)
In an emailed statement, a Kaiser Permanente spokesperson said: “We believe that Group Health complied with the law by submitting its data in good faith, relying on the recommendations of the vendor as well as communications with the federal government, which has not intervened in the case at this time.”
Ross nods to the plan’s history, saying it has “traditionally catered to the public interest, often highlighting its efforts to support low-income patients and provide affordable, quality care.”
The insurer’s Medicare Advantage plans “have also traditionally been well regarded, receiving accolades from industry groups and Medicare itself,” according to the suit.
But Ross, who worked at Group Health for more than 14 years in jobs involving billing and coding, said that from 2008 through 2010 GHC “went from an operating income of almost $57 million to an operating loss of $60 million. Ross said the losses were “due largely to poor business decisions by company management.”
The lawsuit alleges that the insurer manipulated a Medicare billing formula known as a risk score. The formula is supposed to pay health plans higher rates for sicker patients, but Medicare estimates that overpayments triggered by inflated risk scores have cost taxpayers $30 billion over the past three years alone.
According to Ross, a GHC executive attended a meeting of the Alliance of Community Health Plans in 2011 where he heard from a colleague at Independent Health about an “exciting opportunity” to increase risk scores and revenue. The colleague said Independent Health “had made a lot of money” using its consulting company, which specializes in combing patient charts to find overlooked diseases that health plans can bill for retroactively.
In November 2011, Group Health hired the East Rochester firm DxID to review medical charts for 2010. The review resulted in $12 million in new claims, according to the suit. Under the deal, DxID took a percentage of the claims revenue it generated, which came to about $1.5 million that year, the suit says.
Ross said she and a doctor who later reviewed the charts found “systematic” problems with the firm’s coding practices. In one case, the plan billed for “major depression” in a patient described by his doctor as having an “amazingly sunny disposition.” Overall, about three-quarters of its claims for higher charges in 2010 were not justified, according to the suit. Ross estimated that the consultants submitted some $35 million in new claims to Medicare on behalf of GHC for 2010 and 2011.
In its motion to dismiss Ross’ case, GHC called the matter a “difference of opinion between her allegedly ‘conservative’ method for evaluating the underlying documentation for certain medical conditions and her perception of an ‘aggressive’ approach taken by Defendants.”
Independent Health and the DxID consultants took a similar position in their court motion, arguing that Ross “seeks to manufacture a fraud case out of an honest disagreement about the meaning and applicability of unclear, complex, and often conflicting industry-wide coding criteria.”
In a statement, Independent Health spokesman Frank Sava added: “We believe the coding policies being challenged here were lawful and proper and all parties were paid appropriately.
Whistleblowers sue on behalf of the federal government and can share in any money recovered. Typically, the cases remain under a court seal for years while the Justice Department investigates.
Accelmed, a group of funds that invests in health tech companies, announced Monday that it is launching a new, nearly $100 million fund to invest in early-stage, pre-revenue medical devices and digital health startups in Israel and around the world.
This is the fourth fund launched by Accelmed, which currently manages more than $300 million. The new fund will be led by Dr. Irit Yaniv and Amir Blatt, both partners at Accelmed. Dr. Yaniv said that the fund will help to alleviate the problem that device entrepreneurs face in raising capital for their novel devices, in a news release. Blatt said that the fund will invest in device companies “in advanced clinical trials, nearing FDA approval, and after first-in-human trials” whereas in digital health, the fund will invest in “companies in initial commercialization stages in the US, be it with hospitals or insurers.”
The fund expects to make an average investment of $8 million to $10 million per startup, including follow-on investments.
Accelmed comprises of two entities:
Accelmed Partners – a U.S. -based private equity fund focused on health tech that does buyout and growth investments in commercial-stage companies.
Accelmed Ventures – an Israel based venture fund that invests in pre-commercialization health tech companies.
Since Aceelmed’s founding in 2009 by Dr. Uri Geiger, founder and managing partner and Mori Arkin, it has funded about 20 healthtech companies, of which several have been acquired.
These include Edge Medical Devices that was sold in 2011 to Claymount, which was then acquired by Varian Medical Systems; NLT Spine was sold to Seaspine Holdings in 2016; and MCS (Medical Compression Systems) was sold to Zimmer Biomet in 2017.
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Arizona Medicaid Director Jami Snyder heard many complaints about enrollees missing medical appointments because the transportation provided by the state didn’t show or came too late.
So this summer she hatched a solution familiar to millions of Americans looking for an efficient ride: She turned to Uber and Lyft.
Arizona became the first state to revamp its Medicaid regulations to make it easier for ride-sharing companies to participate in its nonemergency transportation benefit. Under the changes, Arizona eliminated several safety rules, such as requiring all drivers to undergo drug testing and first aid training.
The strategy has added thousands of vehicles to the fleet serving Arizonans on Medicaid, nearly 24% of the state’s 7 million residents.
“It seemed like an obvious solution,” Snyder said. “So far, our anecdotal reports have been very positive.”
As they seek to lower costs and improve care, Medicaid and other insurers have begun to examine the transportation needs of patients — along with other so-called social determinants of health such as adequate food and housing. Whether states save money remains to be seen.
In 2017, more than 2 million Medicaid enrollees under age 65 ― about 4% of the program’s members — delayed care because they lacked transportation, according to a federal survey.
Lyft is working with about 35 state Medicaid programs or Medicaid managed care organizations, according to LogistiCare, one of the nation’s largest Medicaid transportation brokers. Uber works with Medicaid only in Arizona.
Lawmakers in Florida and Texas this year also relaxed state regulations to make it easier for Uber and Lyft to provide services for appropriate Medicaid patients. That service is expected to begin early next year.
Uber and Lyft can’t handle all Medicaid transportation demands because they generally don’t have enough drivers with cars fit to ferry people with serious disabilities, such as those who use a wheelchair. But Arizona’s Snyder said many Medicaid enrollees are healthy enough to use a typical ride-sharing service.
Van Means, executive director of a company that Arizona pays to arrange transportation for Medicaid enrollees, said the expanded options help even some patients who can’t use them.
“It gives us way more supply, it’s faster and frees up space [in specialized transportation] for people who need more substantial help such as those in wheelchairs,” he said.
In most traditional Medicaid transportation programs, patients need to reserve rides days ahead and then often must share a van. In contrast, the ride-sharing companies need little advance notice and can easily take solo passengers.
To ease the use of Uber and Lyft, states generally waive safety requirements that are standard for more traditional transportation. Those include mandates that drivers undergo drug testing and learn first aid and CPR. State officials said such mandates are not necessary since Uber and Lyft serve ambulatory enrollees who likely are in better health than those needing specialized transportation.
The ride-sharing companies already work with hospitals and health systems across the country, but participating in Medicaid could bring them millions of more riders.
Unlike typical Uber or Lyft riders, Medicaid enrollees don’t order rides on their smartphones. Instead, these patients will continue to request transportation services by phone or computer through their health plan or a Medicaid transportation broker.
The Medical Transportation Brokerage of Arizona said about 15% of rides taken by Medicaid recipients this summer relied on Uber and Lyft.
So far, though, Means said the brokerage hasn’t found the service substantially cheaper in most areas of the state.
Arizona officials did not have an estimate of cost savings.
Officials at Atlanta-based LogistiCare said working with Lyft in dozens of cities has added vehicles and helped speed service.
“The ride-sharing companies are cost-effective and for curb-to-curb, urban or suburban short-distance trips,” said Effie Carlson, a LogistiCare executive vice president.
But she cautioned that the companies are not the ideal option for enrollees who need extra time getting in and out of their house because drivers typically leave within five minutes of arriving.
Uber and Lyft are often cheaper than using taxis or other private transportation companies, but not always. She noted that when companies raise prices during peak-traffic hours, alternatives may be less expensive.
Carlson said her company decides whether ride-sharing services or more traditional transportation is most appropriate based on the health information provided about each Medicaid enrollee.
The Medicaid transportation benefit varies by state but typically includes rides by taxi services, wheelchair vans, private vehicles, and public transportation. Enrollees are eligible for the services if they do not have another means of transport.
Despite states’ growing interest in expanding transportation options, a University of Pennsylvania study, published last year in JAMA Internal Medicine, found providing ride-sharing services did not improve the no-show rate for primary care appointments among Medicaid patients in West Philadelphia. The no-show rate among patients offered free rides was 36.5%, compared with 36.7% for those who weren’t offered free rides.
Krisda Chaiyachati, co-author of the study and a University of Pennsylvania associate professor of medicine, said reliability of transportation is not the only factor determining whether Medicaid enrollees show for medical appointments. “People on Medicaid tend to live more chaotic lives, so they may be more OK with missing primary care appointments,” he said, referring to how low-income people often fear missing work, or have difficulties arranging childcare and other necessities.
Still, Chaiyachati envisions Uber and Lyft playing larger roles for Medicaid.
“Their cars can be everywhere, and having a dispatcher draw upon that network is a no-brainer,” he said. “It may not solve the transportation needs for everybody, but it’s certainly an answer for many.”
Megan Callahan, vice president of health care at Lyft, said she expects more states to adopt ride-sharing.
“I think what we are seeing is the beginning of a domino effect,” she said. “Our overall driver availability and speed are the big advantages that will have an impact on Medicaid members’ satisfaction.”
Uber officials said in about dozen cities they are developing a fleet of drivers trained to work with patients who must travel with fold-up wheelchairs, walkers and scooters.
“From a cost standpoint, we can save states significant dollars,” said Dan Trigub, head of Uber Health.
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