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Blood and Silicon Episode 15: This Could've Been an Email
[Summary: Blake and Leo head to Harrison to bargain for the Salubri Yen's safety, but first they have to get rid of a body. Meanwhile, Harrison welcomes a newly-awakened Kindred to San Jose...] @kentuckycaverats @zwoelffarben
It's a silent 1am drive to one of San Jose's national parks. Blake has the radio on at a low volume, to fill the silence more than anything as the scenery changes from cities, to suburbs, til finally they can't see lights from the houses anymore.
Blake tells Leo he can stay in the car, and gets out to grab Kyra's body, among other things. He gets a distance away from the car, and begins to gather materials to prepare for a fire. Leo decides he's had enough of people telling him what to do for tonight, and gets out of the car to follow him.
Blake takes out a buck knife from inside his coat and begins to slice off parts of Kyra's clothing to expose the skin and have her burn quicker. He covers her body in a white sheet, covering it with gas and leaving a trail of it so he can safely light it from a distance.
As Leo watches Blake gather material/ prepare to dispose the body, there's a small spark of recognition in the back of his mind; this is somehow familiar. Blake gives Leo a warning before lighting the fire; still it scares him, and her body ignites. Fire seems different now, more like a monster, so Leo takes a step back as Final Death overtakes her. Blake is unphased; he's lit a cigarette.
[It's silent for a moment; anger builds up Leo's chest. Finally he turns to Blake, if only to not look at the fire. "What the fuck was that back there?"]
Blake is taken aback by this sudden question, and admits he doesn't quite know what happened, insinuiating it was Yen's fault. His tone is almost a bit too casual as he looks back at the fire, saying he's never frenzied at another vampire before; the blood normally doesn't make them do that. Leo continues- the point of the mission was to capture Yen, not kill her, and Blake could've fucked it up entirely. Leo keeps going, taking all his frustrations about Blake and from the past week out on him, and finally reveals he's been having headaches. After his outburst, there's silence. Finally, Blake breaks it.
["...I'm sorry, Leo."]
Blake agrees, saying he hadn't been very helpful. He says there's a lot of things that won't be nice to them, and someone you trust shouldn't make you feel like that. He apologizes again, saying he's not very good at talking about this sort of thing, but he hears Leo; he's right. Leo is taken aback by Blake's apology; Part of him had been expecting more of an argument, a byproduct of having been with Jeremiah.
Blake asks if Leo even wants him to come with to Harrison. ["I get the sense you're tired of being told what to do-" and Leo laughs, bitter- "So why don't you tell me what to do?" Leo pauses at this choice. "...I'd like you to come with," he says. "The past two times I've met with Harrison haven't gone well."]
Leo fidgets with his hands, tapping his fingers as he realizes they don't have a plan; Blake advises him that dealing with Kindred business comes with practice, and that he himself also didn't come into this unlife prepared. Some have to learn quick, and it's almost like he's saying that from experience. Blake says what he's doing works well for him, but Leo can find a better route for himself.
["Hopefully you'll have a long time to figure that out," Blake says. He seems to be somewhere else. Leo's hold on his own hands tightens. "...I already have a route I don't want to go down." "That's good," Blake responds. "You have a choice. A lot of us don't get anything when we wake up besides the fact we wake up."]
He tells Leo he's in a special position; a lot of people will try to make him what they need him to be, and people are constantly being used- and it's not great, especially when you're on the other side. Leo nods in understanding.
The body is embers now; Blake extinguishes his cigarette, putting Kyra's remains that didn't burn back into the duffel bag. He tells Leo that killing her was the best option; she would've come back later. For a moment he considers putting a hand on the Malkavian's shoulder, but settles for a nod; in this moment he suddenly seems much older.
The two of them walk back to the car.
---
[Blake: Finished with the first half. On our way to downtown now. Pauline: Understood. Be safe. He has an appointment as of the moment, but he can make your meeting work. As far as I'm being told in this game of telephone.]
---
Meanwhile, in Harrison's office: A man has just walked into in the room. Harrison sits at his desk, an old computer to the side, with his pressed grey suit the same color as his eyes. He smiles.
["Sir Percival, yes? Please, sit down."]
They shake hands, and the man Leo had tried to distract earlier sits down across from Harrison. He thanks Harrison for having this meeting with him, and Harrison asks if there's any ulterior motives. Yes, actually- Percy wants to know more about the movements of the Sword of Caine in the past. Harrison comments he'll ask how Percy knows about that later, but confirms he learned about them as they were threatening San Jose some years ago (Percy taps his foot at the word "threaten," not seeming to like that word being used here)- he mainly learned about their battle tactics; Percy says he's more interested in their scholars, and Harrison rises an eyebrow before saying that scholars, battle tactics and history are all entwined, and as far as he knows the Black Hand doesn't have an active presence in the city. Percy says he's been getting responses like that from other Cainites he's asked these questions to. Harrison isn't opposed to looking into it, wondering if Percy is suspicious of their activities- Percy only says he's following breadcrumbs, as he recently came out of torpor. Harrison says there was recent activity- the Sabbat's attempt to fully pierce the city, somewhere around... 2005? 2008? He suggests to talk to those who were around back then, and says he's not opposed to helping Percy, but what business does he have here besides following breadcrumbs of a failing sect?
Percy taps his foot again, jaw clenching.
He assumes this assistance won't be free, and grabs a notepad to write down any names Harrison can give him. Harrison notes Percy seems agitated, and the man responds that answers like this can be disheartening when looking for something more concrete. Harrison says they should talk more, as he thinks Percy has as interesting perspective of the Sabbat- But a pressing matter came up, and the individuals should be arriving soon; but he doesn't expect it to take long.
There's a knock on the office door- Cynthia, one of Harrison's ghouls, enters with Blake and Leo (his headache spikes as he enters the office). He and Blake had vaguely overhead the last few sentences of the conversation through the door- and he and Percy recognize each other. Harrison introduces them, saying Leo is his adopted childe, before asking if they know each other? Blake's over here confused, since he wasn't aware the two had met (he was busy tearing out Kyra's throat); Anyway, Percy and Leo shake hands (Percy notices the Malkavian doesn't make any eye contact), and the Venture says they met briefly about 2 hours ago.
[Blake leans in to whisper to Leo. "You know this guy?"]
Leo is asked to recount how they met; it was a chance meeting, they didn't realize the other was a Kindred. Percy confirms this. Harrison changes the subject to Yen, and upon being asked he says he only wishes to talk to her- and Blake says he understands Harrison was in the middle of a meeting, but maybe this could be just between us three? And Percy should leave? The man offers to come back later, and as he exits Harrison says he can help himself to the bar; they can finish their meeting later.
Once out in the hallway, Percy gives a polite smile to Cynthia, though his eyes are a bit cold when regarding her. He activates Heightened Senses, and listens in to the conversation.
---
Seeing as the two vampires before him won't sit down, Harrison stands to match their vibe. Leo expresses his concern for Yen after his conversation with her, and Harrison reassures it's fine- What, did they think he'd kill her or something? (They kinda did, in fact) Blake says they couldn't be too sure with a Tremere hunting her, questioning why she was hunting down such a rare vampire anyway- he doesn't trust her. Harrison states Asha isn't that kind of Tremere; won't hurt Yen if she knows what's good for her. Leo explains his concern is because he had spoken to her and she had seemed afraid, and he wanted to make hear from Harrison that she would be safe, so that he could relay that and reassure her- and as he says that, he realizes it isn't a lie, he really did want to confirm Harrison had good intentions. Blake adds that it's hard to get her to come with peacefully when she's only ever been hunted- and Harrison's like yeah man that's the fucking problem, no shit it's been hard to get a meeting with her. Leo wants to know what the meeting would be about; it would satisfy his curiosity.
Harrison knew Yen's sire, and figures she'd like to talk to him once she learns that- and no danger towards Yen would come from him. Blake seems relieved she'll be safe but still doesn't trust Harrison, and apologizes for interrupting his meeting; they thought it would be best to talk in person.
Harrison confirms if he should expect Yen tonight, hopefully around 3, and Blake says "if she wants to"- Harrison tells him that while Yen doesn't seem to want to talk, he's done nothing to her, and after the meeting with her she can do as she wants.
Blake wants to know what would happen if we don't bring her to him- Leo shoots his coterie member a look (what are you doing we don't want to get in serious trouble-). Blake continues questioning if she'll be safe.
["...Will there be a problem, Blake?" The man shakes his head. "Nope. Just curious." "Curiosity... Is the fledgeling rubbing off on you?" "Nope."]
Harrison vaguely answers that there'd be trouble if they did that, and opens one of his desk drawers to pull out an old phone. He calls Asha to bring Yen, and the meeting concludes.
---
Leo finds Percy in the VIP area of the bar (it's reserved specifically for Kindred), and he apologizes for being annoying when they first met. Percy says it's fine, and really that was all Leo came over here to do so he leaves. Percy bids him farewell, wishing their paths to cross in better circumstances.
---
Leo has gone outside. He's told himself he's just lighting a cigarette, he's trying to convince himself that's the only thing he wants to do out here, but in the back of his mind he knows that's a lie. He's out here to find victims. He's not really present, lost in thought with a mix of that internal dialogue and headaches, when Blake suddenly appears with a tap to his shoulder- Leo jumps.
Blake apologizes, asking if Leo's okay, and he says he's fine as he can be currently. Blake wants to know when Leo met Percy, and the Malkavian says it was at the alleyway- he's annoyed, not from Blake asking, but from his headache. Blake apologizes for not realizing Leo had distracted someone, saying he was caught up in the moment (referring to tearing out Kyra's throat). Leo turns away from him, gaze darkening. He's quiet. Blake tells Leo he did a good job distracting Percy, making a lighthearted comment about how they should send Leo out to do that more often. Leo pauses, saying that after Yen arrives he needs to go... do something- he won't say feed. Blake understands, and asks if Leo wants him to go with, but the fledgeling wants to prove himself. Blake gives a thumbs up at his refusal.
Leo gets a text: [Pauline: Can you confirm the meeting with Harrison truly went well? Leo: Yeah, it went good. We got confirmation that Harrison isn't going to hurt her. He just wants to talk. Pauline: Understood. We will be there soon.]
Eventually a car pulls up, and the girls get out- Asha is holding Yen's arm. The Salubri looks scared, but is reassured to see Leo there. Pauline splits off from those two as they enter building, and heads toward Blake and Leo.
As Leo turns the corner to try and find someone to feed from, Blake can't help but wonder if the Malkavian's headaches are tied to his hunger.
---
Percy enter Harrison's office; Harrison apologizes for the interruption, and continues where they left off, saying he can introduce Percy to people to ask about the Sabbat, but he'd like to know more about Percy beforehand.
Percy says it depends on what he finds out, but he's not planning on staying long, and currently doesn't have a place to stay- Harrison offers him exactly that in exchange for information, because surely during his search for breadcrumbs, he's learned some things about the Sabbat? And Harrison had taken an interest in them during his own research. Percy says the Sabbat seems to show up, wreck havoc, and be defeated in terms of politics- he's more interested in their dogma. Percy pauses, before adding the Sabbat tries to sever the ties that be; rarely do the Sabbat go out of their way to kill fledgelings. They target elders at the top of the Anarch and Camarilla movements because those Kindred have gathered power and are stepping on those below them; they're targeted to try and take down the system. Cut off the head of the snake for something else to flourish. Harrison says that's true, but unfortunately his understanding runs no deeper than his; he wishes to know more about Percival before introducing him to others.
He answers that he falls closer to being a Neonate, and that he's a Ventrue- but there's a bit of distaste there. ["Ventrue have very little presence in this city," Harrison says. "Any interest in seeing your fellow clanmates?" "No," the other man declines, a bit of a smile on his face. "They won't take kindly to me."]
He explains he's a farmboy, not really from the common origins of a typical Ventrue. Harrison, in exchange for this information, says he knows of a kindred named Van who was around during the Sabbat Incursion- her knowledge of the city layouts were very useful, and while he'd need to explain himself, the Nosferatu of San Jose are always open for a deal. Percival says he's fine with explaining himself, as he has very little to hide.
Harrison asks why Percy is so interested in the Sabbat, anyway- Percy says he was close to the chaos from the Week of Nightmares during July 1999, when the Ravnos Antediluvian awoke. He wants to learn more about the Antediluvians, and figured the Sabbat's Noddist scholars would have more information.
["Noddist scholars?" Harrison grins, almost jovial. "Well, why didn't you say so!"]
Harrison says their interests are well aligned, and hopes Percy sticks around. He can point Percy towards a particular Noddist Scholar- his own grandchilder, in fact! He tells the Ventrue the scholar is called Jeremiah. And the problem is that he seem to have gone missing.
["He may very well be dead. I'm not certain that's true, but even so; I need his notes back."]
Harrison also adds if he is dead, he would like to know what killed him- his strongest lead on Jeremiah's disappearance would be the man's childe; which is Leo, one of the men Percy had just met. Harrison continues to say that he believes in the power of bloodlines and wants to work with Leo, but the fledgling doesn't seem to want to talk to him. Maybe he'd talk to Percy about what's going on, but only if he's unaware the Ventrue is reporting back to Harrison.
Percy is uneasy about lying, but reckons if it's to get Harrison's grandchilde back, the good outweighs the bad. Harrison states he also doesn't like lying, but that being direct wasn't getting him anywhere- he refuses to believe that Leo knows nothing about Jeremiah's whereabouts. He explains he had put Leo into the care of some older kindred to try and ease him into his new existence, and its given him mixed results. Harrison will tell Leo they worked out a deal where Percy will be given a place to stay on their Territory, and he informs Percy to build a relationship with Leo to gain his trust; If questioned on why he wants to know about Jeremiah, just say you want to seek info about Noddism. Percy agrees to this plan.
---
Leos phone rings.
[“Hello?” “Leo!" Harrison's voice. "Long time no talk!”]
Harrison asks Leo is they'd have room on their territory for one more resident- Probably.
["What are your thoughts on Percival?" "Uh- neutral, so far." The two had just met, after all. "How'd you like to improve it?" Leo pauses. "..Are you implying he's going to be the new resident?"]
Harrison tells Leo that Percy is good at protection, adding that that's not to say Blake isn't, but it's good to have more hands. Leo agrees to let Percy stay because what else can he do, say no? Harrison says he'll be in touch later to send Leo Percy's contact info.
---
Harrison confirms Percy will find his own place for the day, and asks for any contact info he can relay back to Leo.
[Percy hands Harrison a note. "Here's my phone number," he says, "But if Shreknet works for you as well-" "Oh. Yes." Harrison makes a face. "About that..." "Did something happen?" "..You could say that."]
Harrison informs Percy of the Second Inquisition, warning him to be careful what he says over the phone. They shake hands again as Percival gets up to leave, and Harrison makes a note that he never did get Leo's last name.
The two Kindred bid each other good evening, and Percy goes to find a motel for the morning.
---
[New Text:] [Cynthia: Leo, Harrison wishes to know who "Michael" is.]
Notes/Commentary:
Leo's gained a point in Streetwise! ☆ (im normal about it)
Love how Leo wouldn't normally have revealed the headache thing but it just kinda slipped out! And now Blake knows!! oughuh vampires normally dont get headaches!!!! love it here
Something about how Leo was expecting Blake to argue back due to how he was with an Extremely Defensive person for three years...
BLAKE FINALLY USING LEOS NAME?? aaaa
All of us losing it over hints of blake lore <3 (blore, if you will)
Leo saying he already has a route he doesn't wanna go down (being like Jeremiah). Hey buddy that's kinda funny bc you're not doing a good job at that /lh
Something about Blake warning that people will try to use him,,, and how Pauline is right there,,,,
Leo being protective over Yen not only cause she lowkey reminds him of himself but also.. he has a younger sister. projection moment fr
It was suggested later that what if Blake is a bit protective over Yen bc he's lowkey blood bound to her after trying to kill her, aaAAAA-
Percy saying he's not planning on staying long as if he's not a main character now /lh
Cue the spiderman pointing meme with Leo and Percy /j
Harrison continues to be funny, sorry. Just standing with us to match the vibe and having? a dial phone in his desk? amazing
Blake wondering about Leo's headaches being connected to his Hunger,,, OGUHHGH.
,,Is Harrison a noddist?
NODDIST JEREMIAH NODDIST JEREMIAH–
I got so incredibly excited over that bit of Jeremiah lore that I had to bite my arm im so fucking normal (i'm ok)
"[Jeremiah] very well might be dead." Hey. Hey Harrison. Hello??
Howdy yall, have we considered that Jeremiah just doesn't want to fuck with Harrison anymore? That he threw his phone away into the Navy Pier? /hj
Oh or what if he's just gone Sabbat? One of the players is still hung up on the "pawns of the Antediluvians" line from ep2 👀
"Leo! Long time no talk!" HARRISON THATS THE FUNNIEST THING YOUVE EVER SAID. You just spoke to him 5 minutes ago /lh
LEO. LEO YOU DIDNT CHECK IN WITH THE OTHER COTERIE MEMBERS IF THEYD BE FINE WITH PERCY STAYING WITH THEM. LEO-
head in hands. i am a fool i should've mentioned he used a fake name oh my god
#hello new tagged friend! welcome to my Recap posts- well rlly these arent recaps theyre more novelizations ig#there's so much dialogue here bc i liked a lot of what was said#eric finally speaks#leo west#blood and silicon#blood and silicon recap#vtm ocs
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back at it again at krispy kreme
so to start off, this request is very wild and specific and out of nowhere and will most likely be the only of its kind. I would suggest watching season 1 and 2 recap videos of Girl From Nowhere. NOW TO THE REQUEST
with a yandere reader (who is basically like nanno from the show i mentioned earlier) who stalks character of your choice 24/7, constantly tormenting them and their friends (who keep killing reader but reader just keeps coming back) until the character is worn down to where they are stockholm syndromed by reader, and reader finally claims what is his ♡
~🕷
Okay y'all, this is actually 🕸️ annon, bro wrote 🕷️ on accident again.
Also, bruv, this bomb ASS request has been sitting in my inbox for a while, and I must say, I'm sorry I didn't do it sooner. I was kind of running away from it without realising I was.
Q: Why were you running away?
A: Because I didn't wanna ruin it in a hurry 😭 I wanted to do it justice. Now, I will! (Hopefully)
Contents: Chuuya x Yandere!Stalker!Reader
Warnings: No smut, but has mentions of masturbation, stalking, obsessive tendencies, mentions of murder, blood, and more, Stockholm Syndrome.
You had been watching him for the longest time.
Chuuya Nakahara.
He was so fucking beautiful, you never wanted to take your eyes off of him. So you followed him around, setting your lackeys everywhere around him to report to you with even the minutest details of his days.
You followed him around yourself, too. Only you were allowed to watch from his bathroom ventilator as he showered or changed. Only you were permitted to peek through that one window in his bedroom and watch as he pushed a lucky dildo deeper and deeper into his ass, cock throbbing and twitching with want. Oh, the things you'd do to be that bit of silicon that slid in and out of his asshole as he trembled on the bed, huffing and panting.
Fuck, you were obsessed with him.
And you knew full well.
You were starting to get desperate, too. Just sneaking into his house when he wasn't there to wrap his boxers around your cock and jerk off wasn't enough anymore. So after hiding in the dark for a while, you decided to leave behinds hints.
The first one ever was the splatter of cum you'd left on his bed sheets. It had been a mistake, but even as you raised a hand to pull the sheets off the bed and hide the evidence, you couldn't help but pause.
Chuuya should know how much you loved him. He should know who owned him.
Thus, you left the stains right as they were.
That night, Chuuya returned from a hefty mission, tired and ready to collapse into bed. The sight of the half-dried cum stopped him.
"What the fuck?!"
You, watching from behind the bushes next to his bedroom window, smirked. Fuck yes.
Later, you became more and more bold. You starting leaving behind more proof of your presence, leaving behind sappy messages on his walls with spray paint, dropping photos of him that you'd taken in secret. You watched him break down from his window.
You chased him into a corner, forcing him to ask Mori for help. Even the Port Mafia had nothing on you, though. You continued leaving behind dirty underwear, condoms filled with your cum and stuff like that around his house.
Chuuya changed places, and you followed. He couldn't get rid of you no matter how much he tried, only running pathetically around with you right at his heels.
It was fun, but only for a few months.
At one point, only watching him from a distance had been enough for you. Now, you wanted him to see you, know you, fear you, want you. You were growing more and more greedy, you knew. And yet you couldn't stop yourself.
So one day, you showed Chuuya your face. You left behind a video clip for him, a video of you jerking off to his photos. Chuuya decided, enough is enough.
He decided to put his pride down and asked for Dazai to help. The latter might be a big piece of shit and a pain in the ass, but he was smart when it came to stuff like this. And so Dazai was involved.
You knew it, and Dazai knew that you knew you knew. It was a fun game of pretending to hide while both of you knew of each other's presence.
It wasn't long before Dazai caught you, though. You were pleasantly surprised by his wit. You two fought, and Dazai managed to kill you. As he turned around, thinking about teasing Chuuya about owing him for the rest of his life, he saw you standing beside him instead. His eyed widened, and he stepped back slightly.
"...How?" Was the only thing Dazai, the smartest man in the Port Mafia, could say.
You chuckled. "Pity you won't be able to find out."
And before he'd known it, he was on the ground, knocked out. You couldn't help but tread on his hands as you passed him a little. He got to be around Chuuya everyday, and here you were, working so hard every time you so much as wanted to see his face. Wasn't it unfair?
Either way, after that day, the Port Mafia increased security around Chuuya. If it had been anyone else, Mori would've just kicked them out, but this was Chuuya, one half of Twin Dark.
From then on, you had to be slightly more careful. But you couldn't control your greed either. You couldn't stop wanting him to see you in person, not just in the photos and videos that you left behind.
And so, one evening Chuuya came back home to find all the guards dead on his porch steps. His eyes widened, and he took a small step back.
The front door was open.
He wanted to run away, wanted to go back to the Port Mafia headquarters and report to Mori, but he thought he saw a shadow flash past the door in the house. He hesitated.
Was it rational for him to not run away? No. It was perhaps the craziest decision he'd ever made in his entire life. But he couldn't help but think internally, Fuck it, if he wanted to harm me, I wouldn't have been alive all this while.
And so Chuuya stepped over the corpses that decorated his front door, pushed open the door more, and stepped in.
You were sitting right there, on his couch, wiping your bloody hands with a handkerchief. You looked up when he entered.
And gods, he was even more gorgeous up close like this. You were used to watching him from afar, or through the cameras that you'd placed in his house, but never face-to-face. Fuck, you almost pounced on him right then.
As for Chuuya, he didn't know what to do. His heart was pounding so fast against his ribcage he was scared it'd stop for good. His palms were sweaty even as he fisted his hands, and his breathing was slightly laboured.
You stood up from the couch, walking closer to him. Somehow, he did not back away.
"Chuuya,"
The way you said his name, gods, what were you? Some sort of a siren? But sirens were supposed to sing, not stand in his house covered in blood and smile at him like he was the most precious thing in the world.
"You're home." You raised a hand, caressing his cheek, leaving a smearing some of the blood on your hand against his pale skin. "Did you have dinner?"
"W-why are you doing this?" Chuuya managed to choke out, fuelled by his last dreg of rationality.
His eyes were red.
"Doing what, baby?" You cooed, smiling. "Chasing you? Because I love you, that's why."
Chuuya felt the back of his throat burning, and tried to fight back the tears that were already gathering in his eyes. "Why? Why, like this... Wha-"
He couldn't form coherent sentences, and stopped trying with a sniffle, tears starting to dribble down his face.
He looked pretty when crying, too.
You cupped his face with both your hands, tilting it upwards to make him look at you. "Because I can't help but want you so much, Chuuya. So much, that I'd have obliterated the Port Mafia if it hadn't been for the fact that you like those people."
Chuuya felt so tired, so exhausted. For almost half a year now he'd been running from you, running and running and running. He'd changed houses, gotten protection from the Mafia, even asked Dazai, for Christ's sake. And yet somehow you'd always gotten through it. He didn't want to run anymore. He wanted to sleep.
He wanted to rest.
He wanted to curl up and close his eyes and not have to worry about anything, not even the nightmares that had started because of you. He wanted to be carefree, the way he had been when he was a kid, poor but honest in the ugliest parts of Yokohama.
Chuuya didn't want to run anymore.
And so he collapsed, his knees buckling as more tears slid down his skin, onto his shirt. You caught him before he could hit the floor, and pulled him into an embrace. He was sobbing, his shoulders shaking and hands trembling.
"C'mere," You pushed his face into the crook of your neck.
Slowly, his hands rose, and for a moment you thought he would try to push you off. You braced for impact, preparing to restrain his hands if you had to. But then, all of a sudden, he wrapped his arms around your neck.
You froze for a moment, and then, a small smile climbed up your face. Chuuya was sobbing into your shoulder, clinging on to you as if for dear life. His fingers fisted in the material of your shirt as he muffled his whimpers against your skin.
He wouldn't run anymore.
That night, standing in the middle of Chuuya's eighth house that year, finally, you got what you wanted.
#dom male reader#top male reader#bungou stray dogs#dom reader#sub bsd#sub bsd x you#bsd x you#sub bungou stray dog x you#sub bungou stray dogs#sub character#sub character x you#sub chuuya x you#sub chuuya
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Welcome, Kindred & Kine, to a land of Blood and Silicon...
Our Beloved ST:
@blood-bound
Character Directory:
Leo West, Malkavian. (Played by @eric-the-bmo!)
His Tag
Blake "Robinson" Moore, Gangrel. (Played by @vtmgremlin)
His Tag!
Sir Percival, Ventrue [Antitribu] (Played by me.) His Tag.
Pauline Palmer, Malkavian. (Abandoned by me.) Storyteller Character.
Her Tag!
Tag Directory:
Canon
Non-Canon
Q&A
Art Tag
Meme Tag
Music Tag
Metal Pipe Tag
Session Recaps:
Session 1: ... (Canon Date: Monday, December 6th. 2021.)
Session 2: The Movement Waits For No One (Canon Date: Monday, December 6th. 2021.)
Session 3 [Lost]: I Miss Coffee More Than I Miss the Sun (Canon Date: Tuesday, December 7th. 2021.)
Session 4: Cinnamon Apples [+ Files] (Canon Date: Tuesday, December 7th. 2021.)
Session 5: The Dice Hate Us (Canon Date: Tuesday, December 7th. 2021 -> Wednesday, December 8th. 2021.)
Session 6: New Territory [Part 1] (Canon Date: Wednesday, December 8th. 2021)
Session 7: New Territory [Part 2]. Your Cross to Bear (Canon Date: Wednesday, December 8th. 2021 -> Thursday, December 9th. 2021.)
Session 8: Lingering Evermore (Canon Date: Thursday, December 9th. 2021.)
Session 9: The Box (Canon Date: Saturday, December 11th. 2021.)
Session 10: Night At The Museum (Canon Date: Saturday, December 11th. 2021.)
Session 11: Museum Escape (Canon Date: Monday, December 13th. 2021)
Session 12: [BMO] Can't Think Of A Clever Fox Pun For This Title (Canon Date: Monday, December 13th. 2021.)
Session 13: Alleycat Brawl (Canon Date: Monday, December 13th. 2021.)
Session 14: Yen/Conversations (Canon Date: Monday, December 13th. 2021.)
Session 15: This Could Have Been An Email (Canon Date: Monday, December 13th, 2021.)
Session 16: Past Sins (Canon Date: December 14th, 2021.)
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ALL ABOUT THAT ASS
Let's talk about anal! Specifically pegging because well when doing anal it's me having a dude bent over and him taking my strap on up the ass. So in today's post we're going to cover a few different points related to pegging and if you'd like for me to go in depth regarding something covered just ask!
First and foremost pegging doesn't make you gay! Yes, a dildo is a replica of a dick but it's not a flesh and blood dick and if you don't find men attractive, or sexy, or fuckable you aren't gay. You just enjoy getting your back door banged down. It makes sense considering how a guy's pleasure button is shoved up there. So don't feel any shame in enjoying being pegged or wanting to be. Pegging isn't gay. If you wanna try anal with a man that might not be gay either, bisexuality and bi curious are also sexual identities that are valid and acceptable. The world isn't gay or straight, so take time figuring out yourself before exploring pegging.
Enemas! Before we plunder the booty let's clean it out. Butt stuff can be dirty, shit happens. I personally prefer a bottom use a enema before we go at it however that's optional. So be prepared for farts maybe some shit on the dildo, the bed spread, each other. It happens.
The dildo! Your eyes are always bigger than your hole! Why starting smaller works better. Don't buy a elephant when you can only fit a shrimp dick. I always say start with a dildo about the same size of your dick before working up to the larger sizes! Eventually it'll fit only takes time and practice and practice is fun!
Lube! You never wanna go spelunking dry. Dry pegging hurts and can fuck you up not in a fun way. Tearing is always a risk to your health so let's be mindful of the lube we use and how much we use. There are different kinds of lube and let's make sure we're using lube and not some random slick/liquidy shit we find lying around. No lotion, shampoo, jelly, Vaseline, cooking oils of any kind. Let's be mindful about what we're putting inside of our bodies boys and girls. Also let's not use warming lubes on the first go. You wanna get a feeling for your body's normal before adding in extra sensations. Also avoid the numbing lubes for the same reason. Let's also be mindful that oil based lubes can break down condoms and aren't the nicest for sex toys either. That leaves us silicone based lube and water based lube. Both work fine for this compared to what we just covered. I prefer water based because I just hate how silicone based lubes feel. AND FOR THE LOVE OF GOD PRECUM/CUM IS NOT NEARLY ENOUGH LUBE FOR NOTHING SO DO NOT DO THIS. It might have looked good in porn but porn is fake, it's basically sexy wrestling.
If there is anything I missed you'd like covered don't hesitate to reach out! This is just a quick recap of the things I think are important when you consider exploring ass play, specifically pegging and this can even apply to regular old anal in most cases as well!
Remember we aim to advocate for and promote happy and healthy fetish based relationships. We also want to act in a safe, sane, and consensual manner when engaging in kink. As always the inbox is open for questions, comments, and conversation. Don't hesitate to reach out.
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2022 Re-read Saturday Recap
2022 Re-read Saturday Recap
Over the years we have explored a wide range of books on Saturdays. Sometimes our re-reads reflect the real world outside software development. For example, in 2018 we re-read Bad Blood, Secrets and Lies in a Silicon Valley Startup by John Carreyrou, the story of Theranos and Elizabeth Anne Holmes. This year Ms. Holmes went to prison. While I don’t expect prison sentences for the subjects in…
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9 Healthcare Companies Who Changed the 2010s
By ANDY MYCHKOVSKY
In order to celebrate the next decade (although the internet is confused whether its actually the end of the decade…), we’re taking a step back and listing our picks for the 9 most influential healthcare companies of the 2010s. If your company is left off, there’s always next decade… But honestly, we tried our best to compile a unique listing that spanned the gamut of redefining healthcare for a variety of good and bad reasons. Bon appétit!
1. Epic Systems Corporation
The center of the U.S. electronic medical record (EMR) universe resides in Verona, Wisconsin. Population of 13,166. The privately held company created by Judith “Judy” Faulkner in 1979 holds 28% of the 5,447 total hospital market in America. Drill down into hospitals with over 500-beds and Epic reigns supreme with 58% share. Thanks to the Office of the National Coordinator for Health Information Technology (ONC) and movement away from paper records (Meaningful Use), Epic has amassed annualized revenue of $2.7 billion. That was enough to hire the architects of Disneyland to design their Google-like Midwestern campus. The other amazing fact is that Epic has grown an average of 14% per year, despite never raising venture capital or using M&A to acquire smaller companies.
Over the years, Epic has been criticized for being expensive, non-interoperable with other EMR vendors, and the partial cause for physician burnout. Expensive is probably an understatement. For example, Partners HealthCare (to be renamed Mass General Brigham) alone spent $1.2 billion to install Epic, which included hiring 600 employees and consultants just to build and implement the system and onboard staff. With many across healthcare calling for medical record portability that actually works (unlike health information exchanges), you best believe America’s 3rd richest woman will have ideas how the country moves forward with digital medical records.
My very first interview out of undergrad was for a position at Epic. I chose a different path, but have always respected and followed the growth of the company over the past decade. In a world where medical data seems like tomorrow’s oil, a number of articles have speculated whether Apple or Alphabet would ever acquire Epic? I don’t buy it. I’m thinking it’s much more likely that 2020 is the first year they acquire a company. How you doing Athenahealth?
2. Theranos
No one can argue Theranos didn’t change the game in healthcare forever… for the worse. I do my best to give all healthcare founders the benefit of a doubt, but Elizabeth Holmes and Ramesh Balwani make that nearly impossible. Turns out that an all-star cast of geopolitical juggernauts on your Board of Directors and the black turtleneck of Steve Jobs is not the recipe for success. Founded by 19-year Elizabeth Holmes, Theranos raised over $700 million at a peak valuation of $9 billion. In retrospect, they have become the poster-child for Silicon Valley’s over-promise and under-deliver mantra. The only problem is that instead of food delivery, their failures resulted in invalid blood testing that could’ve really hurt people.
Despite this failure, the mission and purpose would’ve been tremendously impressive. Cheaper blood tests that require only 1/100 to 1/1,000 the amount of blood that LabCorp or Quest Diagnostics needed. I think the craziest part of the whole saga was that seemingly sophisticated healthcare leaders thirsted for the new technology to beat competitors and improve patient convenience. Before the technology was proved defunct, Theranos convinced Safeway to invest $350 million to retrofit 800 locations with clinics that would offer in-store blood tests. Theranos convinced Walgreens to invest $140 million to develop a partnership that would help beat CVS. Theranos partnered with Cleveland Clinic to test its technology and was working with AmeriHealth Caritas and Capital BlueCross to become their preferred lab provider.
To be clear, they weren’t the first, and won’t be the last healthcare company to fail. I only hope that this extremely well documented (thanks Hollywood) experience has re-focused founders and investors towards building sustainable growth companies that actually help patients live higher quality lives, not just make people money as quickly as possible.
3. One Medical
Thanks to Tom Lee and the One Medical crew, primary care is now investable. Whether you’re talking about private equity or venture capitalists, many have dived head first into the space in search of value-based care treasure. One Medical is the most well-known tech-enabled primary care practice, with 72 clinic locations across seven states, and new locations opening in Portland, Orange County, and Atlanta. The Carlyle Group liked the company so much that it invested $350 million in August 2018, at a reported $1.5 billion valuation. This has led to a number of primary care focused companies (ChenMed, Iora Health, Forward) to amass significant valuations that historically would’ve seemed optimistic. However, the elevation of the primary care provider from the “punter” to the “quarterback” of a patient’s medical journey has lifted all boats.
Interestingly, One Medical has unique differentiators over the traditional primary care competitors. For example, One Medical limits doctors to seeing 16 patients a day, versus the average physician seeing 20-30 patients a day. One Medical also built its own medical records in hopes of a more user friendly experience, instead of outsourcing to practice-based EMRs. One Medical charges $199 annually to each patient to help make up for lower volume, and in return provides same-day appointments, onsite lab draws, and a slick app that allows online appointment scheduling and telehealth consults with providers 24/7. They are also adding capabilities and services to cover mental health and pediatric services to increase revenue.
This change is remarkable. Historically, primary care has been a low-margin business with high administrative and staffing costs, along with physician burnout and regulatory burden. One Medical pioneered the concept of a more modern primary care experience, and I am looking forward to their initial public offering (IPO) targeted for early 2020 and whatever Tom Lee is cooking up at Galileo.
4. Centene
Centene is my favorite health plan to study over the past decade. You would never know that the second largest publicly-traded company headquartered in Missouri was originally started by Elizabeth “Betty” Brinn in Milwaukee, Wisconsin. Under-hyped, which is rare in healthcare nowadays, Centene has quietly grown to become the largest player in both the Medicaid managed care and Affordable Care Act (ACA) exchanges. Under Michael Neidorff’s leadership, Centene now serves 32 states with over 15 million lives and 53,600 employees. They were most recently ranked #51 on the Fortune 500 list. In addition, they are about to grow with the $17.3 billion acquisition of WellCare. Here’s a brief rundown of some major events that demonstrate why I’m so bullish on Centene dominating another decade:
April 2018: WellCare and Centene awarded Medicaid managed care contracts in Florida.
July 2018: Centene acquires Fidelis Care and their 1.6 million New Yorkers for $3.75 billion. This single-handedly gives Centene the leading Medicaid share in the state.
September 2018: WellCare acquires Meridian Health Plan and their 1.1 million lives in Michigan, Illinois, Indiana, and Ohio, for $2.5 billion.
February 2019: Centene and WellCare awarded Medicaid managed care contracts in North Carolina.
December 2019: WellCare awarded Medicaid managed care contract in WellCare (re-procurement underway)
In addition, Texas Medicaid is set to award their STAR contracts for 3.4 million lives between Medicaid and CHIP, of which Centene already won a contract to serve the STAR+PLUS (aged, blind, and disabled population). Seems like a pretty solid guess that Centene will fair pretty well in the STAR RFP rankings. Next decade, I look for Centene to significantly increase their efforts to recruit Medicare Advantage (MA) lives, and I wouldn’t bet against them.
5. Mylan
One word. EpiPen. Mylan, the $10 billion market cap pharmaceutical manufacturer and producer of the epinephrine auto-injector product, EpiPen, became the lightning rod in a consumer and political drug pricing debate in 2016. For those who were living under a rock, here’s the quick recap. Epinephrine auto-injectors are used to treat anaphylaxis (severe allergic reaction). Prior to 2016, Mylan held absolute dominant share of the auto-injector market, hovering around 90% for the first half of the 2010s. The only real competitor was Adrenaclick, produced by Lineage Therapeutics, but they were barely considered a competitor despite having cheaper prices. In 2016, news outlets caught wind of Mylan’s 500% list price increase over a decade ($100 to $600) and a nationwide discussion about drug prices began.
If you asked the Mylan CEO, Heather Bresch, she would tell you that the reason brand EpiPen’s list price increased 500 percent over 7 years is because they invested billions of dollars to significantly increase access in schools and employers across America. These efforts increased the number of EpiPen prescriptions in the U.S. from 2.5 million to more than 3.5 million between 2011 and 2015. She would also tell you that there is a big difference between wholesale acquisition cost price (list price) and net price. This part is often misunderstood by media. The net price takes into account discounts, prescription savings cards, and rebates that Mylan provides to purchasers (PBMs, Employers, Plans). The exact negotiated rebate or discount is different by line of business and organization. However, safe to say that Mylan made a good amount of profit with increasing volume.
At the end of the day, Mylan settled with the U.S. Justice Department for $465 million over claims it overcharged the government. Mylan kept their $600 list price brand EpiPen product with rebates, and added a generic version of EpiPen for $300 list price without rebates and requiring commercial insurance. According to a GoodRx analysis in 2018, the epinephrine auto-injector market now looks much different, with 60% of the market moving to the generic version of EpiPen, 10% of the market remaining with brand EpiPen, and 30% of the market switching to the generic version of Adrenaclick. However, whether generic or brand EpiPen, Mylan makes strong profits and American will continue to discuss the best strategy forward to control drug spend.
6. Evolent Health
First let me caveat. I’ve worked for Evolent Health for the past 5 years and seen it grow from a Series B startup to a publicly-traded company (NSYE: EVH). However, the reason they’re on this list is because Evolent Health has forever changed the game for future value-based care startups. When Frank Williams, Seth Blackley, and Tom Peterson founded the company in 2011 with the help of UPMC Health Plan and The Advisory Board Company, concepts like the Medicare Shared Savings Program (MSSP) did not even exist. Fast forward a decade later, and Evolent Health now serves approximately 3.7 million lives across 35 different U.S. healthcare markets. The mission of Evolent Health is to, “Change the health of a nation, by changing the way healthcare is delivered.” To do this, you need both the technology, clinical, financial, and operational capacity to empower providers to confidently move away from fee-for-service towards fee-for-value.
With the implementation of MACRA and the continued perseverance of CMS under this new administration, value-based care is still full steam ahead (good luck incoming CMMI Director, Brad Smith). Despite the naysayers of value-based care, find me a better way to control medical inflation that is accepted by nearly all healthcare institutions and doesn’t negatively impact patient outcomes, and we can talk. I will mention the importance of “significant” downside risk to actually change provider culture, strategy, and operations. I don’t want the primary purpose of setting up a clinically integrated network (CIN) to be negotiating higher fee-for-service commercial rates for independent physicians aligned to tertiatiary academic medical centers.
I wholeheartedly believe that providers will continue to seek partner options (not vendors with high fees independent of performance) who are not wholly-owned by the large for-profit health plans (Optum…). Of all the available options, Evolent Health is the market leader across a variety of areas. In 2020, I look forward to watching how the 3,000+ Evolenteers push the boundaries of downside risk value-based care with both payers and providers.
7. Livongo
To me, Livongo represents Daenerys Targaryen in Game of Thrones. Not the blood-thirsty character towards the end, but the only person to bring back dragons to the world of Westeros. Except in this example, the dragon is a successful digital health IPO. This was a big deal. Going public rewarded early investors who believed in the nascent digital health and chronic condition space. It allowed public investors an opportunity to peak under the hood of the financials and get comfortable with future economics of the industry. And it provided a legitimacy and a peer valuation to other leading digital health companies like Omada Health. All-in-all, 207,000 members use Livongo for Diabetes management solutions, including a connected glucose monitor, unlimited test strips, and personalized health coaching. This number is expected to grow significantly, with the announcement of a new, two-year diabetes contract with the BlueCross BlueShield Federal Employee Program (FEP). They anticipate the partnership will add an additional $50-60 million in revenue across 2020 and 2021
Livongo has done a brilliant job marketing itself as building a full-stop solution for the 147 million Americans with a chronic condition. According to their estimates, their immediately addressable markets for managing diabetes and hypertension represents a $46.7 billion opportunity. Digging into the unit economics, Livongo estimates that diabetes is worth $900 per patient per year and $468 per patient per year. Since they’re focused on chronic conditions, the business model is subscription-based. In the Q3 quarterly report, Livongo provided full year guidance of $168.5 million on the low end and $169 million on the high end. In either scenario, FY2019 Adjusted EBITDA is projected to lose around $26 million for the year.
Livongo has smartly started with addressing diabetes, given the downstream health impacts of mismanagement of blood sugar and the ability to impact spend with regular insulin, diet, and exercise. They also are very smart to efficiently sell into self-funded large employers using existing channel partners like Express Scripts, CVS, Health Care Services Corporation (HCSC), Anthem, and Highmark BCBS. I know that the stock is down 35% since IPO, but I fundamentally believe chronic conditions are not going away and over time, Livongo will add supplementary clinical programs to expand revenue growth.
8. Optum
UnitedHealth Group is the single largest healthcare company in the world with a $280 billion market cap. It owns UnitedHealthcare, the country’s largest private insurer serving Medicare Advantage, managed Medicaid, employer-sponsored insurance, and ACA exchanges. And yet in 2020, more than 50% of the company’s earning and $112 billion in revenue will come from the lesser known side of the business, Optum. It is difficult to describe Optum because they do so much, but they technically split their business into three units: OptumHealth, OptumInsight and Optum Rx. OptumHealth provides care delivery (primary, specialty, urgent care) and care management to address chronic, complex, and behavioral health needs. OptumInsight utilizes data, analytics, and clinical information to support software, consulting, and managed services programs. OptumRx is a pharmacy benefit management (PBM) to create a more streamlined pharmacy system. In total Optum estimates the U.S. addressable market for its services to exceed $850 billion. If that wasn’t enough, here’s some fun facts why they made the list:
Works with 9 out of 10 U.S. hospitals, more than 67,000 pharmacies, and more than 100,000 physicians, practices, and other providers.
Added 10,000 physicians in the past year, growing its network to 46,000 physicians.
Includes 180,000 team members and serves 120 million customers.
Serves 80% of health plans to reduce total cost of care.
Works with 9 out of 10 Fortune 100 companies.
Pretty remarkable for a business unit that was only technically created in 2011, by merging existing pharmacy and care deliver services into one brand. As chronic disease increases and value-based care is here to stay, Optum is focused on comprehensively treating patients and coordinating their care to improve quality and lower costs. With UnitedHealthcare under the corporate umbrella, Optum has the adequate scale to test any new clinical initiatives before rolling out to other health plans.
9. Purdue Pharma
Purdue Pharma is a privately owned drug company owned by the Sackler Family and most well known for creating OxyContin in 1996. OxyContin represents 90% of Purdue Pharma’s revenue and was aggressively marketed to doctors for use in patients with chronic pain. According to court records, Purdue Pharma has grossed an estimated $35 billion. This is the same prescription painkiller that many experts say fueled the U.S. opioid crisis that has resulted in more than 130 deaths each day after overdosing on opioids. To be clear, the deaths are caused by prescription pain relievers, heroin, and synthetic opioids (fentanyl), however, the initial addiction to opioids is often caused by OxyContin and other prescription drugs. All but two U.S. states and 2,000 local governments have taken legal action against Purdue, other drug makers and distributors.
The Sackler family is the 19th richest family and is well known for supporting the fine arts, including the Sackler Wing at the Metropolitan Museum of Art in New York City where the Ancient Egyptian Temple of Dendur sits. I’ve seen a number of articles persecuting the entire Sackler family, but I want to be a little more nuanced. In 1952, three Sackler brothers (Arthur, Raymond, and Mortimer) bought a drug company called Purdue Frederick. Arthur’s branch of the family got out of the company after his death in 1987. The Raymond and Mortimer branches of Sacklers, who own it, founded affiliate Purdue Pharma in the early 1990s. According to a 2017 article from The New Yorker, there are 15 Sackler children in the generation following the founders of Purdue. Some family members have served on the Board of Directors, while others (most notably descendants from Arthur Sackler who died before OxyContin was invented), have distanced themselves from the company and condemned the OxyContin-based wealth.
Purdue Pharma filed for bankruptcy in September 2019 as part of a tentative settlement related to misleading marketing of the controversial painkiller. The settlement requires the owners of Purdue Pharma and the Sackler family to pay out $3 billion of their own fortune in cash over the next seven years. The only problem is that some family members have reportedly moved $10.7 billion from Purdue Pharma to trusts and holding companies across the world between 2008 and 2017. And all we’re left with is a complicated web of holding companies and offshore bank accounts, ravaged communities, and the leading cause of injury-related death in the U.S.
Andy Mychkovsky is a Director at Evolent Health and the Founder of a healthcare startup and innovation blog, Healthcare Pizza. This post originally appeared on Healthcare Pizza here.
The post 9 Healthcare Companies Who Changed the 2010s appeared first on The Health Care Blog.
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9 Healthcare Companies Who Changed the 2010s
By ANDY MYCHKOVSKY
In order to celebrate the next decade (although the internet is confused whether its actually the end of the decade…), we’re taking a step back and listing our picks for the 9 most influential healthcare companies of the 2010s. If your company is left off, there’s always next decade… But honestly, we tried our best to compile a unique listing that spanned the gamut of redefining healthcare for a variety of good and bad reasons. Bon appétit!
1. Epic Systems Corporation
The center of the U.S. electronic medical record (EMR) universe resides in Verona, Wisconsin. Population of 13,166. The privately held company created by Judith “Judy” Faulkner in 1979 holds 28% of the 5,447 total hospital market in America. Drill down into hospitals with over 500-beds and Epic reigns supreme with 58% share. Thanks to the Office of the National Coordinator for Health Information Technology (ONC) and movement away from paper records (Meaningful Use), Epic has amassed annualized revenue of $2.7 billion. That was enough to hire the architects of Disneyland to design their Google-like Midwestern campus. The other amazing fact is that Epic has grown an average of 14% per year, despite never raising venture capital or using M&A to acquire smaller companies.
Over the years, Epic has been criticized for being expensive, non-interoperable with other EMR vendors, and the partial cause for physician burnout. Expensive is probably an understatement. For example, Partners HealthCare (to be renamed Mass General Brigham) alone spent $1.2 billion to install Epic, which included hiring 600 employees and consultants just to build and implement the system and onboard staff. With many across healthcare calling for medical record portability that actually works (unlike health information exchanges), you best believe America’s 3rd richest woman will have ideas how the country moves forward with digital medical records.
My very first interview out of undergrad was for a position at Epic. I chose a different path, but have always respected and followed the growth of the company over the past decade. In a world where medical data seems like tomorrow’s oil, a number of articles have speculated whether Apple or Alphabet would ever acquire Epic? I don’t buy it. I’m thinking it’s much more likely that 2020 is the first year they acquire a company. How you doing Athenahealth?
2. Theranos
No one can argue Theranos didn’t change the game in healthcare forever… for the worse. I do my best to give all healthcare founders the benefit of a doubt, but Elizabeth Holmes and Ramesh Balwani make that nearly impossible. Turns out that an all-star cast of geopolitical juggernauts on your Board of Directors and the black turtleneck of Steve Jobs is not the recipe for success. Founded by 19-year Elizabeth Holmes, Theranos raised over $700 million at a peak valuation of $9 billion. In retrospect, they have become the poster-child for Silicon Valley’s over-promise and under-deliver mantra. The only problem is that instead of food delivery, their failures resulted in invalid blood testing that could’ve really hurt people.
Despite this failure, the mission and purpose would’ve been tremendously impressive. Cheaper blood tests that require only 1/100 to 1/1,000 the amount of blood that LabCorp or Quest Diagnostics needed. I think the craziest part of the whole saga was that seemingly sophisticated healthcare leaders thirsted for the new technology to beat competitors and improve patient convenience. Before the technology was proved defunct, Theranos convinced Safeway to invest $350 million to retrofit 800 locations with clinics that would offer in-store blood tests. Theranos convinced Walgreens to invest $140 million to develop a partnership that would help beat CVS. Theranos partnered with Cleveland Clinic to test its technology and was working with AmeriHealth Caritas and Capital BlueCross to become their preferred lab provider.
To be clear, they weren’t the first, and won’t be the last healthcare company to fail. I only hope that this extremely well documented (thanks Hollywood) experience has re-focused founders and investors towards building sustainable growth companies that actually help patients live higher quality lives, not just make people money as quickly as possible.
3. One Medical
Thanks to Tom Lee and the One Medical crew, primary care is now investable. Whether you’re talking about private equity or venture capitalists, many have dived head first into the space in search of value-based care treasure. One Medical is the most well-known tech-enabled primary care practice, with 72 clinic locations across seven states, and new locations opening in Portland, Orange County, and Atlanta. The Carlyle Group liked the company so much that it invested $350 million in August 2018, at a reported $1.5 billion valuation. This has led to a number of primary care focused companies (ChenMed, Iora Health, Forward) to amass significant valuations that historically would’ve seemed optimistic. However, the elevation of the primary care provider from the “punter” to the “quarterback” of a patient’s medical journey has lifted all boats.
Interestingly, One Medical has unique differentiators over the traditional primary care competitors. For example, One Medical limits doctors to seeing 16 patients a day, versus the average physician seeing 20-30 patients a day. One Medical also built its own medical records in hopes of a more user friendly experience, instead of outsourcing to practice-based EMRs. One Medical charges $199 annually to each patient to help make up for lower volume, and in return provides same-day appointments, onsite lab draws, and a slick app that allows online appointment scheduling and telehealth consults with providers 24/7. They are also adding capabilities and services to cover mental health and pediatric services to increase revenue.
This change is remarkable. Historically, primary care has been a low-margin business with high administrative and staffing costs, along with physician burnout and regulatory burden. One Medical pioneered the concept of a more modern primary care experience, and I am looking forward to their initial public offering (IPO) targeted for early 2020 and whatever Tom Lee is cooking up at Galileo.
4. Centene
Centene is my favorite health plan to study over the past decade. You would never know that the second largest publicly-traded company headquartered in Missouri was originally started by Elizabeth “Betty” Brinn in Milwaukee, Wisconsin. Under-hyped, which is rare in healthcare nowadays, Centene has quietly grown to become the largest player in both the Medicaid managed care and Affordable Care Act (ACA) exchanges. Under Michael Neidorff’s leadership, Centene now serves 32 states with over 15 million lives and 53,600 employees. They were most recently ranked #51 on the Fortune 500 list. In addition, they are about to grow with the $17.3 billion acquisition of WellCare. Here’s a brief rundown of some major events that demonstrate why I’m so bullish on Centene dominating another decade:
April 2018: WellCare and Centene awarded Medicaid managed care contracts in Florida.
July 2018: Centene acquires Fidelis Care and their 1.6 million New Yorkers for $3.75 billion. This single-handedly gives Centene the leading Medicaid share in the state.
September 2018: WellCare acquires Meridian Health Plan and their 1.1 million lives in Michigan, Illinois, Indiana, and Ohio, for $2.5 billion.
February 2019: Centene and WellCare awarded Medicaid managed care contracts in North Carolina.
December 2019: WellCare awarded Medicaid managed care contract in WellCare (re-procurement underway)
In addition, Texas Medicaid is set to award their STAR contracts for 3.4 million lives between Medicaid and CHIP, of which Centene already won a contract to serve the STAR+PLUS (aged, blind, and disabled population). Seems like a pretty solid guess that Centene will fair pretty well in the STAR RFP rankings. Next decade, I look for Centene to significantly increase their efforts to recruit Medicare Advantage (MA) lives, and I wouldn’t bet against them.
5. Mylan
One word. EpiPen. Mylan, the $10 billion market cap pharmaceutical manufacturer and producer of the epinephrine auto-injector product, EpiPen, became the lightning rod in a consumer and political drug pricing debate in 2016. For those who were living under a rock, here’s the quick recap. Epinephrine auto-injectors are used to treat anaphylaxis (severe allergic reaction). Prior to 2016, Mylan held absolute dominant share of the auto-injector market, hovering around 90% for the first half of the 2010s. The only real competitor was Adrenaclick, produced by Lineage Therapeutics, but they were barely considered a competitor despite having cheaper prices. In 2016, news outlets caught wind of Mylan’s 500% list price increase over a decade ($100 to $600) and a nationwide discussion about drug prices began.
If you asked the Mylan CEO, Heather Bresch, she would tell you that the reason brand EpiPen’s list price increased 500 percent over 7 years is because they invested billions of dollars to significantly increase access in schools and employers across America. These efforts increased the number of EpiPen prescriptions in the U.S. from 2.5 million to more than 3.5 million between 2011 and 2015. She would also tell you that there is a big difference between wholesale acquisition cost price (list price) and net price. This part is often misunderstood by media. The net price takes into account discounts, prescription savings cards, and rebates that Mylan provides to purchasers (PBMs, Employers, Plans). The exact negotiated rebate or discount is different by line of business and organization. However, safe to say that Mylan made a good amount of profit with increasing volume.
At the end of the day, Mylan settled with the U.S. Justice Department for $465 million over claims it overcharged the government. Mylan kept their $600 list price brand EpiPen product with rebates, and added a generic version of EpiPen for $300 list price without rebates and requiring commercial insurance. According to a GoodRx analysis in 2018, the epinephrine auto-injector market now looks much different, with 60% of the market moving to the generic version of EpiPen, 10% of the market remaining with brand EpiPen, and 30% of the market switching to the generic version of Adrenaclick. However, whether generic or brand EpiPen, Mylan makes strong profits and American will continue to discuss the best strategy forward to control drug spend.
6. Evolent Health
First let me caveat. I’ve worked for Evolent Health for the past 5 years and seen it grow from a Series B startup to a publicly-traded company (NSYE: EVH). However, the reason they’re on this list is because Evolent Health has forever changed the game for future value-based care startups. When Frank Williams, Seth Blackley, and Tom Peterson founded the company in 2011 with the help of UPMC Health Plan and The Advisory Board Company, concepts like the Medicare Shared Savings Program (MSSP) did not even exist. Fast forward a decade later, and Evolent Health now serves approximately 3.7 million lives across 35 different U.S. healthcare markets. The mission of Evolent Health is to, “Change the health of a nation, by changing the way healthcare is delivered.” To do this, you need both the technology, clinical, financial, and operational capacity to empower providers to confidently move away from fee-for-service towards fee-for-value.
With the implementation of MACRA and the continued perseverance of CMS under this new administration, value-based care is still full steam ahead (good luck incoming CMMI Director, Brad Smith). Despite the naysayers of value-based care, find me a better way to control medical inflation that is accepted by nearly all healthcare institutions and doesn’t negatively impact patient outcomes, and we can talk. I will mention the importance of “significant” downside risk to actually change provider culture, strategy, and operations. I don’t want the primary purpose of setting up a clinically integrated network (CIN) to be negotiating higher fee-for-service commercial rates for independent physicians aligned to tertiatiary academic medical centers.
I wholeheartedly believe that providers will continue to seek partner options (not vendors with high fees independent of performance) who are not wholly-owned by the large for-profit health plans (Optum…). Of all the available options, Evolent Health is the market leader across a variety of areas. In 2020, I look forward to watching how the 3,000+ Evolenteers push the boundaries of downside risk value-based care with both payers and providers.
7. Livongo
To me, Livongo represents Daenerys Targaryen in Game of Thrones. Not the blood-thirsty character towards the end, but the only person to bring back dragons to the world of Westeros. Except in this example, the dragon is a successful digital health IPO. This was a big deal. Going public rewarded early investors who believed in the nascent digital health and chronic condition space. It allowed public investors an opportunity to peak under the hood of the financials and get comfortable with future economics of the industry. And it provided a legitimacy and a peer valuation to other leading digital health companies like Omada Health. All-in-all, 207,000 members use Livongo for Diabetes management solutions, including a connected glucose monitor, unlimited test strips, and personalized health coaching. This number is expected to grow significantly, with the announcement of a new, two-year diabetes contract with the BlueCross BlueShield Federal Employee Program (FEP). They anticipate the partnership will add an additional $50-60 million in revenue across 2020 and 2021
Livongo has done a brilliant job marketing itself as building a full-stop solution for the 147 million Americans with a chronic condition. According to their estimates, their immediately addressable markets for managing diabetes and hypertension represents a $46.7 billion opportunity. Digging into the unit economics, Livongo estimates that diabetes is worth $900 per patient per year and $468 per patient per year. Since they’re focused on chronic conditions, the business model is subscription-based. In the Q3 quarterly report, Livongo provided full year guidance of $168.5 million on the low end and $169 million on the high end. In either scenario, FY2019 Adjusted EBITDA is projected to lose around $26 million for the year.
Livongo has smartly started with addressing diabetes, given the downstream health impacts of mismanagement of blood sugar and the ability to impact spend with regular insulin, diet, and exercise. They also are very smart to efficiently sell into self-funded large employers using existing channel partners like Express Scripts, CVS, Health Care Services Corporation (HCSC), Anthem, and Highmark BCBS. I know that the stock is down 35% since IPO, but I fundamentally believe chronic conditions are not going away and over time, Livongo will add supplementary clinical programs to expand revenue growth.
8. Optum
UnitedHealth Group is the single largest healthcare company in the world with a $280 billion market cap. It owns UnitedHealthcare, the country’s largest private insurer serving Medicare Advantage, managed Medicaid, employer-sponsored insurance, and ACA exchanges. And yet in 2020, more than 50% of the company’s earning and $112 billion in revenue will come from the lesser known side of the business, Optum. It is difficult to describe Optum because they do so much, but they technically split their business into three units: OptumHealth, OptumInsight and Optum Rx. OptumHealth provides care delivery (primary, specialty, urgent care) and care management to address chronic, complex, and behavioral health needs. OptumInsight utilizes data, analytics, and clinical information to support software, consulting, and managed services programs. OptumRx is a pharmacy benefit management (PBM) to create a more streamlined pharmacy system. In total Optum estimates the U.S. addressable market for its services to exceed $850 billion. If that wasn’t enough, here’s some fun facts why they made the list:
Works with 9 out of 10 U.S. hospitals, more than 67,000 pharmacies, and more than 100,000 physicians, practices, and other providers.
Added 10,000 physicians in the past year, growing its network to 46,000 physicians.
Includes 180,000 team members and serves 120 million customers.
Serves 80% of health plans to reduce total cost of care.
Works with 9 out of 10 Fortune 100 companies.
Pretty remarkable for a business unit that was only technically created in 2011, by merging existing pharmacy and care deliver services into one brand. As chronic disease increases and value-based care is here to stay, Optum is focused on comprehensively treating patients and coordinating their care to improve quality and lower costs. With UnitedHealthcare under the corporate umbrella, Optum has the adequate scale to test any new clinical initiatives before rolling out to other health plans.
9. Purdue Pharma
Purdue Pharma is a privately owned drug company owned by the Sackler Family and most well known for creating OxyContin in 1996. OxyContin represents 90% of Purdue Pharma’s revenue and was aggressively marketed to doctors for use in patients with chronic pain. According to court records, Purdue Pharma has grossed an estimated $35 billion. This is the same prescription painkiller that many experts say fueled the U.S. opioid crisis that has resulted in more than 130 deaths each day after overdosing on opioids. To be clear, the deaths are caused by prescription pain relievers, heroin, and synthetic opioids (fentanyl), however, the initial addiction to opioids is often caused by OxyContin and other prescription drugs. All but two U.S. states and 2,000 local governments have taken legal action against Purdue, other drug makers and distributors.
The Sackler family is the 19th richest family and is well known for supporting the fine arts, including the Sackler Wing at the Metropolitan Museum of Art in New York City where the Ancient Egyptian Temple of Dendur sits. I’ve seen a number of articles persecuting the entire Sackler family, but I want to be a little more nuanced. In 1952, three Sackler brothers (Arthur, Raymond, and Mortimer) bought a drug company called Purdue Frederick. Arthur’s branch of the family got out of the company after his death in 1987. The Raymond and Mortimer branches of Sacklers, who own it, founded affiliate Purdue Pharma in the early 1990s. According to a 2017 article from The New Yorker, there are 15 Sackler children in the generation following the founders of Purdue. Some family members have served on the Board of Directors, while others (most notably descendants from Arthur Sackler who died before OxyContin was invented), have distanced themselves from the company and condemned the OxyContin-based wealth.
Purdue Pharma filed for bankruptcy in September 2019 as part of a tentative settlement related to misleading marketing of the controversial painkiller. The settlement requires the owners of Purdue Pharma and the Sackler family to pay out $3 billion of their own fortune in cash over the next seven years. The only problem is that some family members have reportedly moved $10.7 billion from Purdue Pharma to trusts and holding companies across the world between 2008 and 2017. And all we’re left with is a complicated web of holding companies and offshore bank accounts, ravaged communities, and the leading cause of injury-related death in the U.S.
Andy Mychkovsky is a Director at Evolent Health and the Founder of a healthcare startup and innovation blog, Healthcare Pizza. This post originally appeared on Healthcare Pizza here.
The post 9 Healthcare Companies Who Changed the 2010s appeared first on The Health Care Blog.
9 Healthcare Companies Who Changed the 2010s published first on https://wittooth.tumblr.com/
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Blood and Silicon Ep6: New Territory Part 1
[Summary: The coterie meets up with Harrison and receives their reward. Something's up with Leo.]
The coterie finally gets to Harrison's bar, known as the Haberdash. There's two lines leading into the speakeasy bar- one for humans, and another for VIPs. They head inside, and there's music playing over the speakers, like a chill kinda vibe. The bouncer is a ghoul; he lets the trio inside.
Leo starts to get a headache.
Inside the Haberdash, there's two sides [for VIPs and humans] connected by a hall with by a hall with curtains. We see some characters, but Blake wants to get this over with, and is looking for the ghoul we were instructed to find. He goes to the bartender and asks for her; the bartender asks if we were expected, he can see if shes available, and asks for a name.
Blake says they're probably expecting Leo; the barman walks around to a sideroom, goes in, and comes back out after few seconds with a ghoul- Leo recognizes her from his session 0.5. The ghoul, Cynthia, asks if the job went well. Pauline responds that its been according to plan, and we have the information Harrison requested. Cynthia leads us to the back of the bar where we enter the hallway, with one door at the end, and she follows behind. She gives a sharp knock, and opens the door- It leads to an office.
There's a generic painting on the wall, some files on the desk, a computer that's just for show, and- to quote the DM- "Who the fuck is sitting behind the desk besides Harrison himself?" Pauline greets him and hands him the folder, and we all sit down. Cynthia leaves, closing the door behind her, and with that it blocks out the music from the bar; the place is now eerily quiet.
Harrison asks how Leo's been (Leo says he's learned a lot), and Harrison says the two of them might have a chat later. Our boss opens the folder, looks through it, and asks for a summary. We inform him of the gang activity, what they're comprised of, and then he asks our opinions on the gang; Pauline is surprised. She says the Diablo's Descendants are classic Anarchs, no specific doctrine-and they're pretty confused on what they believe in, adds Blake. They don't seem to fully have any connections to a larger movement- there's a split in the group. Harrison asks how the coterie got this info, and we say we spoke to them- we're very persuasive, says Pauline. We don't mention Victor.
We do, however, mention the other gang [the Ashen Roses], doesn't like us that much; when asked, Pauline admits she made one bark like a dog. Blake adds it was all going fine until Leo messed it up, earning a look from the fledgeling. Harrison asks Leo if this will be a problem; he says he'll try not to let it happen again.
Harrison continues his questions, and wants to know if the coterie mentioned him to the gang? Blake says yes, they didn't seem to like him, but also didn't seem to care. Harrison wants to know if he needs someone to take care of the gangs; Pauline says the gang is beneath him, and Leo informs him of the items in the garage, placing a bag of stolen drugs on the desk. Upon Harrison asking us if we think the gang is competent, Blake says they need to be more put together, given how we were able to steal their drugs from right underneath them. The coterie tells him about the fridge theory, and how the gang probably doesn't know the coterie saw the inside of the garage; However they might be moving locations soon, so the address is given to Harrison in case he wants to check out the fridge- which is probably involved in the process of making the weed/its strange side effects. A warlock can look over the weed to figure out whats up with it, which might uncover what's going on with fridge and lead to further investigation.
Harrison continues the discussion, bringing up territory terms as well as contracts/tributes:
Keep it clean
No Hunters or unknown Kindred
Harrison stays informed of what's happening/ is alerted of anything weird
Kay, his ghoul, needs unlimited access and protection
Harrison will help protect the grounds.
We all agree.
Harrison pulls out a file and gives us information about the territory; it's near his own place, just downtown with decent foot traffic. There's a museum, some bars, and a cathedral- only one member is truly a man of faith, but it's overall a good place.
Blake asks about the man of faith and gets an answer- the guy is human, and while he hasn't done anything problematic yet, Harrison says, Father William needs to be watched out for.
Harrison wants to know if we have any more questions. Pauline asks why he's willing to gives us this territory after only one mission; Harrison replies that he would rather have the territory be owned by people who have ties to him but not many ties to others. We're all new to the area in different ways- we need reliability, and we don't have much to lose. Blake wants to know how he found Leo; Harrison makes Leo answer it instead ["He found me in an alleyway."]. Leo decides he'll ask his questions during their one-on-one chat, and mentions he's acclimating to his unlife.
Harrison suddenly goes "Leo- you know your sire, yes?" to which Leo confirms this. Harrison extends his apologies to Pauline, as she didn't know her sire, and says he spoke to the Voerman sisters; he states they're an interesting bunch. He offer Pauline assistance with possibly helping find her sire, and she says she'll consider it- she doesn't mean it, though.
Harrison gives us the keys to the buildings, and asks if he should get Kay to give us a tour or if we want to explore on our own. Pauline says she was thinking of checking out the church, and Leo agrees, saying he wants to explore on his own. Cynthia escorts us out.
We begin to drive over to our new territory; Blake is enjoying his music, and Pauline sends a text to Jeannette Voerman, her adoptive sire, asking if she mentioned Pauline's "blood donor" to any "local politicians" lately. Leo still has a headache, somehow...
Notes and Thoughts:
Part of my game notes just has a bit that says [Blake fucking dies /j] and i genuinely don't remember why that's there
I decided to verbatim look up "do vampires get headaches," and the first result is someone asking if they're becoming a vampire because they have a headache.
I don't think vampires can get those in VtM, so I have my theories for why Leo's got one, of course, but I'm keeping those to myself.
The fact Harrison has a computer just for show is a little bit funny
With Harrison asking Leo to have a private conversation with him later, I'm once again reminded (and possibly even more convinced) of my theory that our boss knows what happened with Leo before he was sent to San Jose.
Keeping Victor a secret is very smart bc listen!! He can get us info on so much stuff!! He's a surprise tool that an help us later
Why did Harrison redirect the question of how he found Leo over to Leo himself? Did Harrison encounter Leo before and the guy just doesn't remember it? I'm reading too much into it.
HARRISON. SIR. god ok- wanting us to have ties to him, saying how we don't have many ties to others and then giving us that territory, like dude holy fuck he's gonna manipulate us [and tbh i only picked up on this as I was typing the recap]. something something, isolation and gratitude and all that. Sir I so don't fucking trust you.
Harrison, my man, what are you planning. I'm clinging to my conspiracy board rn.
HOORAY VOERMAN MENTION! Pauline called her Aunt Jenny, which was very cute in my opinion.
#i wonder if the other players read these?#anyway i need to stop writing my notes in-session but then how else will i remember everything?? /lh#blood and silicon#blood and silicon recap#vtm#eric finally speaks#vampire the masquerade#vtm oc#session recap#how do i tell the st its okay if he doesnt get the voermans perfect and that i dont know them very well anyway like bestie its ok
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It might sound like science fiction, or a recent episode of "Silicon Valley," but a start-up called Ambrosia is charging $8,000 for blood transfusions from young people.
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2018-04-02 21 ANDROID now
ANDROID
Android Advices
AT&T starts Rolling Oreo update to its Samsung Galaxy S8 Active
ZTE Tempo Go is the first Android Go Smartphone to be available in the US
Sony Xperia XZ1 Compact Smartphone is now available for a cutdown price of $380
Moto G6 Smartphone gets certified with 5.7” Display & Dual rear cameras
Honor View 10 Smartphone now available for $499 in the US
Android Authority
Android 8.1 Oreo landing on Indian Nokia 6 and Nokia 5 handsets
IPVanish – A Top Tier VPN for $3.33/month
Huawei is now the Apple of Android
AI on the Honor V10 is a game-changer
Razer Phone gets Android 8.1 Oreo preview build
Android Central
It's official: Google Home and Google Home Mini are coming soon to India
Samsung Galaxy S9 vs. Google Pixel 2: Which should you buy?
Google reportedly working on a mid-range Pixel aimed at emerging markets
Moto Z3 Play CAD renders reveal side-mounted fingerprint sensor, no 3.5mm jack
Despite recent setbacks, Huawei isn't exiting the U.S. market
Android Developers
Android Developer Story: AppOn build games for the next billion
What’s new in Android Studio 3.1
Introduction to Wear OS Complication Data Provider Development
Introduction to Wear OS Watch Face Development
Introduction to Wear OS Application Development
Android Guys
T-Mobile now offers a Galaxy S9 BOGO deal (for a limited time)
QardioArm wireless blood pressure cuff – utilitarian and effective
Here are the five best Samsung Galaxy S9 and Galaxy S9 Plus cases you can buy right now (Vol. 3)
Tip: How to speed up your Samsung Galaxy S6
Xiaomi Mi Mix 2 review: Still worth it in 2018?
Android Headlines
LG G7 Android Flagship To Have Bixby-Like AI Button: Report
Xiaomi Mi Band 3’s Setup Tutorial Leaks Via Screenshots
OnePlus 6 Name Seemingly Confirmed By WFA Certificate
Nubia Z18 Mini Will Launch On April 11, Company Confirms
OnePlus 6’s Pricing Leaks Along With Red Silicone Case
Android Police
WhatsApp's 'change number' feature now includes an option to automatically notify your contacts [APK Download]
[Continuously Updated] 2018 April Fools' Roundup: All the jokes from around the web
Weekend poll: What operating system does your phone use?
LG G7 CAD renders leak, revealing display notch and headphone jack
AT&T Galaxy S8 Active now receiving Android 8.0 Oreo update
Droid Life
Weekly Recap: Easter Bunny x S9 Reviews
Always On Display for Galaxy S8, Note 8 Updated to Support GIFs
You can Download and Use the Pixel 3’s Double Bubble Launcher Right Now
Podcast: Galaxy S9 Reviews are In!
MyFitnessPal Informs Users of Data Breach, Usernames and Passwords Compromised
Reddit Android
OnePlus 6 goes through WiFi certification running Android 8.1
Oreo update starts rolling out to T-Mobile's Galaxy Note 8
Google reportedly working on a mid-range Pixel aimed at emerging markets
Google Home to launch in India on April 10
Google plans a big consumer play in India
TechCrunch Android
Google Play audiobooks get Smart Resume, bookmarks and Assistant routines support
Review: 2018 Lincoln Navigator
Hide 3D paintings anywhere with AR app Artopia
It was not consent, it was concealment
The NEEO universal remote is a modern Logitech Harmony alternative
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How Much Water to Drink a Day + My Top 10 Hydration Tips
Hiya Gorgeous!
I hope you’ve been enjoying my 5 pillars of wellness blog series as much as I have! If that doesn’t sound familiar to you, here’s a quick recap: My pillars of wellness are about optimizing what you’re eating, drinking and thinking, and how you’re resting and renewing.
Why those pillars? Over my years of personal experience and research, learning from doctors and dietitians, and working with folks like you, I’ve found these self-care practices to have the biggest impact on overall well-being.
And because the pillars of wellness are fundamental not only to your health, but also to everything we talk about here on KrisCarr.com, I’ve been exploring each one on a deeper level. And today we’re diving into one of the most essential, yet often overlooked and underestimated pillars: What you’re drinking.
When it comes to the pillars of wellness, that pretty much boils down to one thing (something that actually DOES boil)… water!
I’m passionate about hydration… but you probably already knew that if you’ve followed me for a while because I talk about it a lot! So you can imagine my surprise when I realized that this would be my first blog post 100 percent dedicated to it. That just goes to show how much of an unsung hero H2O truly is. So let’s give it the attention it deserves, shall we?
Why is proper hydration important?
Water is considered an essential nutrient for a reason. It makes up 60 percent of our bodies and is crucial for so many internal systems. Water aids in your body’s digestion and detoxification processes, keeps your skin healthy, helps maintain energy and boosts physical performance. It protects your joints, tissues and spinal cord by lubricating and cushioning them. Without enough water our cells actually shrink… and I can’t blame them!
Bottom line: Getting enough water is a matter of survival. How many of your daily “essentials” can you say that about?
How much water to drink a day
Ok, so we can all agree that getting enough water is super important. But what does enough really mean? Here’s a simple formula to help you figure out how much water to drink a day:
Your weight in pounds: ______ divided by 2 = ______ oz of water per day
Or, if you use the metric system:
Your weight in kilograms: ______ divided by 30 = ______ liters of water per day
So for example, a person who weighs 150 lb should consume about 75 oz of water per day (150 divided by 2 = 75). A 77-kg person should consume just over 2 ½ liters of water per day (77 divided by 30 = ~2.5).
Got it, tootsie? Write down the formula and your personal daily amount if it’ll help you remember. I know it might sound like a lot if you’re not a big water drinker, but don’t worry because I’ve got some easy tips for staying hydrated coming up in just a bit. Once you feel the many benefits of bathing your cells in plenty of H2O, I have a feeling you’ll never look back!
Special hydration considerations
Keep in mind that certain folks may have increased hydration needs. For example, if you do vigorous exercise, spend a lot of time in the sun or sweat a lot, make sure to keep extra close tabs on your H2O intake. Cancer patients, especially those in treatment, may need extra water to prevent dehydration from cancer therapy side effects like diarrhea and vomiting.
It’s also possible for people with certain health conditions (such as thyroid disease or kidney, liver or heart problems) and those taking certain medications to get too much water. Please work with your healthcare practitioner if you have any health challenges or are uncertain about your specific hydration needs.
How to tell if you’re dehydrated
Now that you know how much water to drink a day, let’s talk about how to tell if you’re not getting enough. Dehydration is serious business. Even a low-level H2O deficiency can affect how you feel. Here are some tell-tale signs of dehydration:
Digestive troubles such as constipation
Lack of energy
Peeing less frequently or decreased urine output when you go
Deep yellow or amber-colored urine (check out this handy guide to urine colors!)
Headaches
Low blood pressure
Dizziness
Dry skin and/or eyes
Mental fog, anxiety and other mood changes (source)
Dehydration can be mistaken for hunger—if you feel hungry soon after a meal or when you’ve had enough to eat, try drinking some water
And surprise… thirst!
If you have any signs of dehydration, especially the more serious symptoms, please consult with your doctor! I’m just here to empower you with info—this post is not a replacement for working with a knowledgeable healthcare practitioner. These symptoms could be indicative of other health issues, so they need to be evaluated within the context of your holistic well-being and background.
The skin elasticity test
I shared this in my Wellness Wednesday episode on hydration because it’s one of my favorite tricks! A simple way to measure your hydration level is by testing your skin elasticity. Lightly pinch the skin on your arm for a few seconds and then let it go. If your skin forms a tent and doesn’t return to normal immediately, it could be a sign of dehydration. Just keep in mind that skin loses elasticity as we age, so if you’re over 65, this test may be less accurate.
How to stay hydrated
Wondering how you’ll possibly meet your daily hydration needs? I have no doubt you’re up to the task, but here are some tips and tricks to help you get there:
Get a pitcher big enough to hold your entire recommended daily intake. Fill it up at the beginning of the day and pour a fresh glass whenever you find yourself on empty. You’re done when you hit the bottom of the pitcher! Pro tip: I keep my pitcher at my desk so I don’t forget.
Set hydration reminders. Use calendar notifications, an app (like WaterMinder) or old school sticky notes. Whatever works for you!
Track your progress. Stay motivated by gamifying your hydration. Make note of how many ounces or liters you drink throughout the day so you can pace yourself. My free Wellness Tracker is perfect for this!
Enjoy green drinks. Your daily ounces or liters don’t have to be 100 percent plain water. Fruits and veggies are made of water just like we are, so blend or juice ‘em up into a tasty, hydrating treat. I named my Hello Hydration juice after two of its ultra-hydrating ingredients: watermelon (about 92 percent water) and cucumber (about 96 percent water).
Bring water with you wherever you go. On walks and car rides, to work and the movies… wherever you are, your water should be, too! Avoid those disposable plastic bottles—they’re bad for the environment. Get yourself a reusable stainless steel, glass or silicone water bottle instead.
Add some flavor! Who ever said water had to be boring? If you have trouble getting excited about water, infuse it with fruits, veggies and herbs. Experiment with different flavor combos and don’t forget to enjoy how pretty it looks! Here’s a delightfully quenching recipe for Orange, Grapefruit, Rosemary Infused Water.
Filter your water to make sure it’s free of icky pollutants. Check out this article to learn more about the importance of water filtration and the best types of filters.
Mix things up with seltzer or sparkling water. Isn’t everything more fun with bubbles? You may have heard rumors that carbonation robs calcium from bones, erodes tooth enamel and irritates the stomach. But some of the research that prompted these concerns involved carbonated colas rather than plain carbonated water. Just steer clear of store-bought varieties with added sugar, artificial sugars and other additives. And if you want to reduce waste, try making your own sparkling water with a machine like this one from Kitchenaid or this one from SodaStream.
Don’t just pound water all day. Guzzling too much in a short time frame could make you feel sick, which could demotivate you from your long-term hydration goals. And while overhydration is rare, it could dilute your body’s healthy sodium and electrolyte levels (source). Check in with your doc if your pee is totally clear—it may be a sign that you’re drinking too much water.
Sip on green or herbal tea, nut milks and fluids from soups and broths. Water is everywhere, so get creative to meet your daily needs!
Next stop: hydration station!
I hope the info and tips in this article help you stay happily hydrated. Paying attention to what you’re drinking is just one piece of the wellness puzzle—but just like your favorite jigsaw, the picture isn’t complete without it. Think of every sip as a thank you to your amazing bod for all the walking, loving, playing, running, thinking, sitting, standing, stretching, laughing, etc. it allows you to do. Cheers!
One more thing before you go… As you may already know, billions of people all over the world do not have access to clean, safe drinking water. I believe that hydration is a human right—no one should have to worry about getting poisoned by their water or not being able to find enough. If you’re interested in learning more about this global crisis and/or getting involved, I encourage you to check out charity: water, the Bill & Melinda Gates Foundation or another organization that aligns with your values.
Your turn: What’s your biggest challenge when it comes to getting enough water everyday? Or, if you’re an H2O pro, what’s your secret to hydration success?
Peace & heavenly H2O,
The post How Much Water to Drink a Day + My Top 10 Hydration Tips appeared first on KrisCarr.com.
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Urbana, day 3
Currently writing this at a boba shop and I’m feeling relatively more tired & slower than usual so this might be noticeably less descriptive in comparison to previous posts, but I’ll try. Rather than breaking down the day into parts, I’ll instead highlight a few main takeaways from the larger, holistic day.
Day 3, as far as I can recall, wasn’t a day that incredibly transformed the way I viewed the world in any such manner. But there were definitely still moments in which God moved and revealed gaps between my life and my faith. Recalling from morning bible study, we studied through Revelation 5:1-14, in which we recapped Jesus’ approaching the throne to open the un-openable scroll. A couple thoughts arose in this session, one of which was a recollection of a responsive song we’ve been singing for worship at Highrock, in which we praise “Is He Worthy?” by Andrew Peterson. I felt overcome in a sudden moment of shock as I began to understand the significance of the song, illustrating a moment when all the earth & heaven above were crippled as the realization that this rare, heavenly scroll is beyond the reach of all things. However, Jesus, in the form of the Lamb with seven horns and seven eyes symbolic of His completeness, redeems our ineptitudes by approaching He who sat at the throne, broke the seals, and opened the scroll. This realization solidified Jesus’ authority and our need for dependence on Him, for me. The four living creatures, the twenty-four elders, and “angels numbering thousands upon thousands, and ten thousand times ten thousand” in heaven, along with “every creature in heaven and on earth and under the earth and on the sea” responded, for the rest of the passage, in absolute worship, praising Jesus for being the only one worthy of opening the scroll, by his blood that he shed. Bringing the relevance back to our daily lives, the beginning of the passage starts with a mighty angel proclaiming and asking if anyone is worthy enough to open the scroll. When no response was raised, John began weeping as it felt as though all hope was lost. In that place of lost hope, Jesus arrives in a hero-like fashion to redeem we who are unworthy. This is a recurring theme in my own life -- feeling as though I’m in a life-stage where it’s hard to pick my head up and look forward towards what’s to come. In that place though, I should be able to recognize that Jesus is there, and Jesus is able.
The morning session was good! I don’t think that I resonated *as* much with the speaker -- partially because of sheer exhaustion, but there were for sure highlights to step away with. Beth Paz came to speak, and she drew a beautiful and vivid image of John’s situation during the time at which God had given him these multitudes of visions. Stepping into his shoes, we begin to understand a fraction of the sheer awe and wonder John must’ve been overwhelmed with. A couple quotes that I loved & jotted down were: “The story of suffering has an end. Jesus has spoken, “it is finished”” and “Revelations is the preview of this new story”.
Seminar time was again really good! I went to a talk titled, “Is Google the New God? Rethinking Community in a Digital Age”. James Kelly, an entrepreneur, pastor, and storyteller from Canada who has dipped his feet into the world of the Silicon Valley, spoke about the life-impacting effects that technology has on our modern-day society -- both the goods and the bads. He started his talk by posing a scenario followed by a question: “Imagine you walked into a Starbucks and saw 30 or so people there, all looking fairly sad. At that moment, you somehow found out that they were all experiencing suicidal thoughts and considered killing themselves. What would you do?” There really isn’t a clear answer for this, but regardless, the idea and *hopefully* standard reaction would be that you would have to do SOMETHING. With that, he transitioned into an anecdote of his time at a hackathon, when he realized that in Canada, he had found out that on average 30,000 people google, “how to kill myself”, every month. That realization stirred a movement lead by him and a team of volunteers at the hackathon, resulting in the purchase of “howtokillyourself.org”. This movement had apparently later resulted in lives being saved as they were told that this wasn’t the solution and that there was a hope outside of this option. It had me thinking and realizing that we live in a world where, especially in the Christian context, technology is strictly seen as an idol and therefore a negative aspect of living. However, there are so many great ways to utilize the recent advancement of technology to further God’s kingdom. We should not live in a state where we neglect the change, but instead, see God’s kingdom possibilities in those changes. Key takeaways here were: “FaithTech”, the speaker’s tech startup dedicated to evangelizing via technology, and Hebrews 12:1-3 to address how we should approach using our time -- to view it not as sin or not sin, but as, “does it bring us towards God or not?”.
I don’t remember this fully either, but I wanted to write this down for posterity somewhere. In our debrief session with Phil, Annika, and Tim, Phil mentioned something he took away from his session on worry. The first was an activity in which you would model Habakkuk 3:17-19, in which you’d start a short poem by saying “Even though...”, continue it with the *worst* things that could possibly happen to you, then finish the poem with a praise to God, remembering that through ALL things, God is still present and there for us. In addition, Phil brought back a quote, “Now rest easy and go to sleep, for God is awake”.
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9 Healthcare Companies Who Changed the 2010s
By ANDY MYCHKOVSKY
In order to celebrate the next decade (although the internet is confused whether its actually the end of the decade…), we’re taking a step back and listing our picks for the 9 most influential healthcare companies of the 2010s. If your company is left off, there’s always next decade… But honestly, we tried our best to compile a unique listing that spanned the gamut of redefining healthcare for a variety of good and bad reasons. Bon appétit!
1. Epic Systems Corporation
The center of the U.S. electronic medical record (EMR) universe resides in Verona, Wisconsin. Population of 13,166. The privately held company created by Judith “Judy” Faulkner in 1979 holds 28% of the 5,447 total hospital market in America. Drill down into hospitals with over 500-beds and Epic reigns supreme with 58% share. Thanks to the Office of the National Coordinator for Health Information Technology (ONC) and movement away from paper records (Meaningful Use), Epic has amassed annualized revenue of $2.7 billion. That was enough to hire the architects of Disneyland to design their Google-like Midwestern campus. The other amazing fact is that Epic has grown an average of 14% per year, despite never raising venture capital or using M&A to acquire smaller companies.
Over the years, Epic has been criticized for being expensive, non-interoperable with other EMR vendors, and the partial cause for physician burnout. Expensive is probably an understatement. For example, Partners HealthCare (to be renamed Mass General Brigham) alone spent $1.2 billion to install Epic, which included hiring 600 employees and consultants just to build and implement the system and onboard staff. With many across healthcare calling for medical record portability that actually works (unlike health information exchanges), you best believe America’s 3rd richest woman will have ideas how the country moves forward with digital medical records.
My very first interview out of undergrad was for a position at Epic. I chose a different path, but have always respected and followed the growth of the company over the past decade. In a world where medical data seems like tomorrow’s oil, a number of articles have speculated whether Apple or Alphabet would ever acquire Epic? I don’t buy it. I’m thinking it’s much more likely that 2020 is the first year they acquire a company. How you doing Athenahealth?
2. Theranos
No one can argue Theranos didn’t change the game in healthcare forever… for the worse. I do my best to give all healthcare founders the benefit of a doubt, but Elizabeth Holmes and Ramesh Balwani make that nearly impossible. Turns out that an all-star cast of geopolitical juggernauts on your Board of Directors and the black turtleneck of Steve Jobs is not the recipe for success. Founded by 19-year Elizabeth Holmes, Theranos raised over $700 million at a peak valuation of $9 billion. In retrospect, they have become the poster-child for Silicon Valley’s over-promise and under-deliver mantra. The only problem is that instead of food delivery, their failures resulted in invalid blood testing that could’ve really hurt people.
Despite this failure, the mission and purpose would’ve been tremendously impressive. Cheaper blood tests that require only 1/100 to 1/1,000 the amount of blood that LabCorp or Quest Diagnostics needed. I think the craziest part of the whole saga was that seemingly sophisticated healthcare leaders thirsted for the new technology to beat competitors and improve patient convenience. Before the technology was proved defunct, Theranos convinced Safeway to invest $350 million to retrofit 800 locations with clinics that would offer in-store blood tests. Theranos convinced Walgreens to invest $140 million to develop a partnership that would help beat CVS. Theranos partnered with Cleveland Clinic to test its technology and was working with AmeriHealth Caritas and Capital BlueCross to become their preferred lab provider.
To be clear, they weren’t the first, and won’t be the last healthcare company to fail. I only hope that this extremely well documented (thanks Hollywood) experience has re-focused founders and investors towards building sustainable growth companies that actually help patients live higher quality lives, not just make people money as quickly as possible.
3. One Medical
Thanks to Tom Lee and the One Medical crew, primary care is now investable. Whether you’re talking about private equity or venture capitalists, many have dived head first into the space in search of value-based care treasure. One Medical is the most well-known tech-enabled primary care practice, with 72 clinic locations across seven states, and new locations opening in Portland, Orange County, and Atlanta. The Carlyle Group liked the company so much that it invested $350 million in August 2018, at a reported $1.5 billion valuation. This has led to a number of primary care focused companies (ChenMed, Iora Health, Forward) to amass significant valuations that historically would’ve seemed optimistic. However, the elevation of the primary care provider from the “punter” to the “quarterback” of a patient’s medical journey has lifted all boats.
Interestingly, One Medical has unique differentiators over the traditional primary care competitors. For example, One Medical limits doctors to seeing 16 patients a day, versus the average physician seeing 20-30 patients a day. One Medical also built its own medical records in hopes of a more user friendly experience, instead of outsourcing to practice-based EMRs. One Medical charges $199 annually to each patient to help make up for lower volume, and in return provides same-day appointments, onsite lab draws, and a slick app that allows online appointment scheduling and telehealth consults with providers 24/7. They are also adding capabilities and services to cover mental health and pediatric services to increase revenue.
This change is remarkable. Historically, primary care has been a low-margin business with high administrative and staffing costs, along with physician burnout and regulatory burden. One Medical pioneered the concept of a more modern primary care experience, and I am looking forward to their initial public offering (IPO) targeted for early 2020 and whatever Tom Lee is cooking up at Galileo.
4. Centene
Centene is my favorite health plan to study over the past decade. You would never know that the second largest publicly-traded company headquartered in Missouri was originally started by Elizabeth “Betty” Brinn in Milwaukee, Wisconsin. Under-hyped, which is rare in healthcare nowadays, Centene has quietly grown to become the largest player in both the Medicaid managed care and Affordable Care Act (ACA) exchanges. Under Michael Neidorff’s leadership, Centene now serves 32 states with over 15 million lives and 53,600 employees. They were most recently ranked #51 on the Fortune 500 list. In addition, they are about to grow with the $17.3 billion acquisition of WellCare. Here’s a brief rundown of some major events that demonstrate why I’m so bullish on Centene dominating another decade:
April 2018: WellCare and Centene awarded Medicaid managed care contracts in Florida.
July 2018: Centene acquires Fidelis Care and their 1.6 million New Yorkers for $3.75 billion. This single-handedly gives Centene the leading Medicaid share in the state.
September 2018: WellCare acquires Meridian Health Plan and their 1.1 million lives in Michigan, Illinois, Indiana, and Ohio, for $2.5 billion.
February 2019: Centene and WellCare awarded Medicaid managed care contracts in North Carolina.
December 2019: WellCare awarded Medicaid managed care contract in WellCare (re-procurement underway)
In addition, Texas Medicaid is set to award their STAR contracts for 3.4 million lives between Medicaid and CHIP, of which Centene already won a contract to serve the STAR+PLUS (aged, blind, and disabled population). Seems like a pretty solid guess that Centene will fair pretty well in the STAR RFP rankings. Next decade, I look for Centene to significantly increase their efforts to recruit Medicare Advantage (MA) lives, and I wouldn’t bet against them.
5. Mylan
One word. EpiPen. Mylan, the $10 billion market cap pharmaceutical manufacturer and producer of the epinephrine auto-injector product, EpiPen, became the lightning rod in a consumer and political drug pricing debate in 2016. For those who were living under a rock, here’s the quick recap. Epinephrine auto-injectors are used to treat anaphylaxis (severe allergic reaction). Prior to 2016, Mylan held absolute dominant share of the auto-injector market, hovering around 90% for the first half of the 2010s. The only real competitor was Adrenaclick, produced by Lineage Therapeutics, but they were barely considered a competitor despite having cheaper prices. In 2016, news outlets caught wind of Mylan’s 500% list price increase over a decade ($100 to $600) and a nationwide discussion about drug prices began.
If you asked the Mylan CEO, Heather Bresch, she would tell you that the reason brand EpiPen’s list price increased 500 percent over 7 years is because they invested billions of dollars to significantly increase access in schools and employers across America. These efforts increased the number of EpiPen prescriptions in the U.S. from 2.5 million to more than 3.5 million between 2011 and 2015. She would also tell you that there is a big difference between wholesale acquisition cost price (list price) and net price. This part is often misunderstood by media. The net price takes into account discounts, prescription savings cards, and rebates that Mylan provides to purchasers (PBMs, Employers, Plans). The exact negotiated rebate or discount is different by line of business and organization. However, safe to say that Mylan made a good amount of profit with increasing volume.
At the end of the day, Mylan settled with the U.S. Justice Department for $465 million over claims it overcharged the government. Mylan kept their $600 list price brand EpiPen product with rebates, and added a generic version of EpiPen for $300 list price without rebates and requiring commercial insurance. According to a GoodRx analysis in 2018, the epinephrine auto-injector market now looks much different, with 60% of the market moving to the generic version of EpiPen, 10% of the market remaining with brand EpiPen, and 30% of the market switching to the generic version of Adrenaclick. However, whether generic or brand EpiPen, Mylan makes strong profits and American will continue to discuss the best strategy forward to control drug spend.
6. Evolent Health
First let me caveat. I’ve worked for Evolent Health for the past 5 years and seen it grow from a Series B startup to a publicly-traded company (NSYE: EVH). However, the reason they’re on this list is because Evolent Health has forever changed the game for future value-based care startups. When Frank Williams, Seth Blackley, and Tom Peterson founded the company in 2011 with the help of UPMC Health Plan and The Advisory Board Company, concepts like the Medicare Shared Savings Program (MSSP) did not even exist. Fast forward a decade later, and Evolent Health now serves approximately 3.7 million lives across 35 different U.S. healthcare markets. The mission of Evolent Health is to, “Change the health of a nation, by changing the way healthcare is delivered.” To do this, you need both the technology, clinical, financial, and operational capacity to empower providers to confidently move away from fee-for-service towards fee-for-value.
With the implementation of MACRA and the continued perseverance of CMS under this new administration, value-based care is still full steam ahead (good luck incoming CMMI Director, Brad Smith). Despite the naysayers of value-based care, find me a better way to control medical inflation that is accepted by nearly all healthcare institutions and doesn’t negatively impact patient outcomes, and we can talk. I will mention the importance of “significant” downside risk to actually change provider culture, strategy, and operations. I don’t want the primary purpose of setting up a clinically integrated network (CIN) to be negotiating higher fee-for-service commercial rates for independent physicians aligned to tertiatiary academic medical centers.
I wholeheartedly believe that providers will continue to seek partner options (not vendors with high fees independent of performance) who are not wholly-owned by the large for-profit health plans (Optum…). Of all the available options, Evolent Health is the market leader across a variety of areas. In 2020, I look forward to watching how the 3,000+ Evolenteers push the boundaries of downside risk value-based care with both payers and providers.
7. Livongo
To me, Livongo represents Daenerys Targaryen in Game of Thrones. Not the blood-thirsty character towards the end, but the only person to bring back dragons to the world of Westeros. Except in this example, the dragon is a successful digital health IPO. This was a big deal. Going public rewarded early investors who believed in the nascent digital health and chronic condition space. It allowed public investors an opportunity to peak under the hood of the financials and get comfortable with future economics of the industry. And it provided a legitimacy and a peer valuation to other leading digital health companies like Omada Health. All-in-all, 207,000 members use Livongo for Diabetes management solutions, including a connected glucose monitor, unlimited test strips, and personalized health coaching. This number is expected to grow significantly, with the announcement of a new, two-year diabetes contract with the BlueCross BlueShield Federal Employee Program (FEP). They anticipate the partnership will add an additional $50-60 million in revenue across 2020 and 2021
Livongo has done a brilliant job marketing itself as building a full-stop solution for the 147 million Americans with a chronic condition. According to their estimates, their immediately addressable markets for managing diabetes and hypertension represents a $46.7 billion opportunity. Digging into the unit economics, Livongo estimates that diabetes is worth $900 per patient per year and $468 per patient per year. Since they’re focused on chronic conditions, the business model is subscription-based. In the Q3 quarterly report, Livongo provided full year guidance of $168.5 million on the low end and $169 million on the high end. In either scenario, FY2019 Adjusted EBITDA is projected to lose around $26 million for the year.
Livongo has smartly started with addressing diabetes, given the downstream health impacts of mismanagement of blood sugar and the ability to impact spend with regular insulin, diet, and exercise. They also are very smart to efficiently sell into self-funded large employers using existing channel partners like Express Scripts, CVS, Health Care Services Corporation (HCSC), Anthem, and Highmark BCBS. I know that the stock is down 35% since IPO, but I fundamentally believe chronic conditions are not going away and over time, Livongo will add supplementary clinical programs to expand revenue growth.
8. Optum
UnitedHealth Group is the single largest healthcare company in the world with a $280 billion market cap. It owns UnitedHealthcare, the country’s largest private insurer serving Medicare Advantage, managed Medicaid, employer-sponsored insurance, and ACA exchanges. And yet in 2020, more than 50% of the company’s earning and $112 billion in revenue will come from the lesser known side of the business, Optum. It is difficult to describe Optum because they do so much, but they technically split their business into three units: OptumHealth, OptumInsight and Optum Rx. OptumHealth provides care delivery (primary, specialty, urgent care) and care management to address chronic, complex, and behavioral health needs. OptumInsight utilizes data, analytics, and clinical information to support software, consulting, and managed services programs. OptumRx is a pharmacy benefit management (PBM) to create a more streamlined pharmacy system. In total Optum estimates the U.S. addressable market for its services to exceed $850 billion. If that wasn’t enough, here’s some fun facts why they made the list:
Works with 9 out of 10 U.S. hospitals, more than 67,000 pharmacies, and more than 100,000 physicians, practices, and other providers.
Added 10,000 physicians in the past year, growing its network to 46,000 physicians.
Includes 180,000 team members and serves 120 million customers.
Serves 80% of health plans to reduce total cost of care.
Works with 9 out of 10 Fortune 100 companies.
Pretty remarkable for a business unit that was only technically created in 2011, by merging existing pharmacy and care deliver services into one brand. As chronic disease increases and value-based care is here to stay, Optum is focused on comprehensively treating patients and coordinating their care to improve quality and lower costs. With UnitedHealthcare under the corporate umbrella, Optum has the adequate scale to test any new clinical initiatives before rolling out to other health plans.
9. Purdue Pharma
Purdue Pharma is a privately owned drug company owned by the Sackler Family and most well known for creating OxyContin in 1996. OxyContin represents 90% of Purdue Pharma’s revenue and was aggressively marketed to doctors for use in patients with chronic pain. According to court records, Purdue Pharma has grossed an estimated $35 billion. This is the same prescription painkiller that many experts say fueled the U.S. opioid crisis that has resulted in more than 130 deaths each day after overdosing on opioids. To be clear, the deaths are caused by prescription pain relievers, heroin, and synthetic opioids (fentanyl), however, the initial addiction to opioids is often caused by OxyContin and other prescription drugs. All but two U.S. states and 2,000 local governments have taken legal action against Purdue, other drug makers and distributors.
The Sackler family is the 19th richest family and is well known for supporting the fine arts, including the Sackler Wing at the Metropolitan Museum of Art in New York City where the Ancient Egyptian Temple of Dendur sits. I’ve seen a number of articles persecuting the entire Sackler family, but I want to be a little more nuanced. In 1952, three Sackler brothers (Arthur, Raymond, and Mortimer) bought a drug company called Purdue Frederick. Arthur’s branch of the family got out of the company after his death in 1987. The Raymond and Mortimer branches of Sacklers, who own it, founded affiliate Purdue Pharma in the early 1990s. According to a 2017 article from The New Yorker, there are 15 Sackler children in the generation following the founders of Purdue. Some family members have served on the Board of Directors, while others (most notably descendants from Arthur Sackler who died before OxyContin was invented), have distanced themselves from the company and condemned the OxyContin-based wealth.
Purdue Pharma filed for bankruptcy in September 2019 as part of a tentative settlement related to misleading marketing of the controversial painkiller. The settlement requires the owners of Purdue Pharma and the Sackler family to pay out $3 billion of their own fortune in cash over the next seven years. The only problem is that some family members have reportedly moved $10.7 billion from Purdue Pharma to trusts and holding companies across the world between 2008 and 2017. And all we’re left with is a complicated web of holding companies and offshore bank accounts, ravaged communities, and the leading cause of injury-related death in the U.S.
Andy Mychkovsky is a Director at Evolent Health and the Founder of a healthcare startup and innovation blog, Healthcare Pizza. This post originally appeared on Healthcare Pizza here.
The post 9 Healthcare Companies Who Changed the 2010s appeared first on The Health Care Blog.
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New Post has been published on jaccblog
New Post has been published on https://jaccblog.com/in-depth-news-recap-of-health-2-0s-fall-conference/
In-Depth: News recap of Health 2.0's Fall Conference
This week in Santa Clara marked the tenth anniversary for Health 2.zero, a Fitness tech conference held each year in Silicon Valley to explore the progress being made in the digital Fitness area and the demanding situations that remain. MobiHealthNews became onsite all 4 days of the convention and under we’ve rounded up our insurance of the event, plus quite some displays and bits of information that didn’t make the publication in advance this week.
Snake oil revisited
Even though the buzz has finally started to fade from the news cycle, Fitness 2.zero cofounder Matthew Holt couldn’t face up to bringing American Medical Affiliation CEO James Madara on degree to take him to challenge for his now well-known “snake oil” comments from the Spring.
“Ultimate yr, you sat right here in this chair and you had been excellent great to us,” Holt joked. “Then, I’m on my vacation in Vietnam and my Twitter feed begins blowing up with this snake oil stuff. Do you love us or do you hate us?”
Madara spoke back that “there is love and there’s hate”, mentioning the AMA’s work with Omada Health as an instance of a virtual Health intervention he cherished and the troublingly misguided blood stress app Immediate Blood pressure as one he hated.
“Why boost a siren now with this deliberately used time period ‘snake oil’? The reason now is I assume we’re in a duration of criticality for [digital health]. The criticality is that there’s no regulatory framework. I suppose virtual Fitness is going to be part of the transformation of healthcare. However, if that is so crucial for healthcare, does all and sundry think that it’s going to stay unregulated?”
Madara thinks the industry wishes self-regulation of apps and connected devices that’s strong enough that HHS will furnish legitimacy to the ones efforts. He thinks relying too closely at the FDA may want to bring about rules which are “heavy-handed, they overreach, and that they’re one-length-fits-all”.
But also … snake bites?
One of the most exciting shows at the pre-conference pharma roundtable changed into from Deloitte, which contracted with pharma business enterprise BTG to create Snakebite 911, an app to assist users keep away from snake bites and reply efficiently in the event of a snake chunk. BTG makes Crofab, an antivenom for North American pit viper bites.
Matthew Visitor, head of virtual method consulting at Deloitte, pointed out how the use of a lean startup technique helped BTG increase the app on a faster product cycle than the organisation became used to, and how an awesome knowledge of the consumer’s needs and behaviors knowledgeable the development.
“This one’s all approximately know-how your customers as human beings,” he stated. “The snake tracker became very arguable, due to the fact we didn’t want humans going to find snakes. That could probable have caused excellent use of the drug, But it’s not definitely the final results we were seeking out.”
Fitness 2.0 move over, Health 3.0 is here
Some days before the convention, healthcare investor Dave Chase and athenahealth CEO Jonathan Bush teamed up to pen an article arguing that Fitness 1.0 — healthcare before computers became inefficient, But healthcare nowadays (Health 2.0) has misplaced the human contact and made medical doctors spend too much time in provider of EMRs and documentations. The next generation in healthcare, they argue, will integrate the fine aspects of the two, and make technology serve affected person care, as opposed to the alternative manner round.
Bush took the stage on Wednesday and expounded on some more of the specifics of that idea, pronouncing that it would take big EHR providers committing to a real connectivity to allow the real feel of digital Fitness technology to scale.
“You’ve been given a lot of these ideas, you do the demos, they make sense,” he stated. “But they don’t explode, they don’t raise off. I suppose humans gets out of company software program or the corporation software program agencies will remake themselves. You’re already seeing the Mad Hatter talking approximately pulling the various times of Epic collectively, making it more of a network. As that happens, that idea of a web makes the capacity to genuinely blow out, to make cash fast a possibility in healthcare.”
Karen DeSalvo on the virtual Fitness revolution
The shift of presidency, the personal region and clients of coming collectively to address the biggest troubles in healthcare is beginning to expose, and the excellent indication is the innovation in virtual Health. However, if you want to do greater, all parties should continue working collectively and supplying possibilities inside the shape of policies, partnerships and data. That was the takeaway from a speech by way of Karen DeSalvo, HHS’s Acting Assistant Secretary for Fitness, at Fitness 2.0. “We’ve visible some historical adjustments within the Ultimate eight years,” stated DeSalvo. “And that I sometimes think we begin to take them for granted, However it’s been a first rate possibility to definitely placed people first and understand that they’re at the center of all of this.
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Blood and Silicon ep22: Baptism
[Summary: Leo drowns.] @sanguineasylum @kentuckycaverats @zwoelffarben
The coterie makes arrangements; Blake, due to the contact he received from Sticky, acquires the body of a man with some of Leo's features at a pickup-spot, and gives him the Malk's tattoo. We pay off a morgue to identify the eventually-found corpse as Leo.
Dec 28, 2021.
The next night Leo takes a long drive with his rented car to the drowning spot with the radio down low; the corpse is in the trunk. He's not wearing his trenchcoat, and it's a bit odd to not have it on. He parks the car at the planned location and starts to get things set up.
["God, did you ever have to do something like this? Fuck-!" He mutters to himself, readjusting his grip on the corpse as he drags it to the driver's seat.]
He eventually gets the body into the car, and pauses before giving it his cross necklace. He sends the car into the lake, and watches until the water is still. Leo is silent and gives a solemn bow. ["And so ends, once again," He says, "The life of Leo West."]
He steps into the water and begins to go to the meetup spot the coterie agreed upon. Besides Leo accidentally heading the wrong direction for a bit, the rest of the escapade went well- he emerges from the correct spot. ["Hey Kid," Blake offers him a hand on the shore. "How're you doing?" Leo takes it. Water pours out of his mouth.] Blake helps him up, the coterie gives him a fresh set of clothes (including the trenchcoat), the Gangrel offers him a cigarette, and on the way back the two older vampires keep an eye out for Lupines as they walk back to the car to start their drive back to San Jose.
As they drive, Leo gets a text from his sister- it's a selfie of Amy at a bar smiling with a girl he's never seen before ("Look who I got a date with!!! <3"). And, of course, he can't respond now.
Notes:
This was a short session bc I was headed for surgery early the next morning! We spent Way too long discussing how to go about the specifics of faking this death lol
I've been wanting for Leo to do a Dramatic Bow to his death for a long time so it was nice I was able to do that
something something i can have him be a bit of a morbid theatre kid if i want. something something slowly losing his sense of self, idk
Something about being attached enough to the coat to not want it to get it wet
The way the ST and the coterie described what if feels like to be full of water as a corpse was So uncomfortable, ty. Leo's having a bad time.
Waugh i imagine there was such an Odd disconnect while Leo was faking his death i am having a Time
Leo's new shirt is specifically this one btw
Amyyyyyy :-( girl im so sorry you found a nice person to possibly date and u have no idea ur brother just faked his death and can never speak to u again or even ask about ur new date aaaaaugh //falls
Anyway yayy!! Chicago is over (goodbye!), and so it's back to San Jose! ⭐
#Jeremiah didn't show up here which has caused one of the players to wonder if he'll show up in San Jose. Terrifying! Thank you!#eric finally speaks#blood and silicon#session recap
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Blood and Silicon ep21: What's Blue and Sticky? (I didn't want to name the episode this)
[Summary: The boys finally find a way to fake Leo's death, and Blake collects things. Leo spends time with his sister as Blake and Percy visit a contact.] @zwoelffarben @kentuckycaverats @sanguineasylum
On the way back to the hotel the coterie agrees to ask Harrison what his "last resort" contact is for them, since they've been unable to figure out how to realistically fake Leo's death.
Leo calls Harrison, reassures him that nothing's gone wrong, and asks him for more info on the contact he had given the coterie- how would we know when to call the contact if we don't know what they can do?? Harrison says the contact is an old friend, but he'd rather the coterie not contact them unless they mess up horribly and it's absolutely necessary- surely it's not too difficult to not mess up. Leo reminds the Baron that police are able to figure out a lot of things now, like how to identify a corpse from its teeth. Harrison says to just Dominate the police, or make the death unquestionable; maybe a family member could see it. He'd rather it be imperfect than have the coterie call his mysterious contact.
["Leo, you can do this without help. Surely."] Leo shrinks back from the condescending remark and says he'll figure it out, and ends the call.
He fills the coterie in about the contact, and they reason the contact owes one to Harrison; maybe he wants to save it for something else. The coterie gets back to brainstorming Leo's fake death, and eventually they settle on a plan: Leo will drive a ways out from Chicago towards the Great Lake and leave a note behind (he's driving there himself just in case cameras spot him). He'll make it look as if he drowned, and the other two will pick him up at a separate spot. Leo mentions the police would expect a body to wash up at some point, but agrees to the plan regardless.
The coterie agrees to puil it off two nights later on the 27th, since Leo is spending time with his sister the next night (there's some emotion on Blake's face there, just for a moment). Blake says he's going to get the coterie one more night in Chicago, and that he'll be right back.
He gets some coffee grounds from the hotel lobby and puts them in a baggy, and then also takes the coffee maker; He returns to the room and Leo and Percy watch as he gets some bugs and mold from underneath the floorboards. Leo follows Blake into the bathroom and asks him what the hell he's doing as the Gangrel is gathering rust from the showerhead.
["Making sure you and me got something to eat later." "I- I don't see how this wouid help. "If you've been around as long as I have you pick up a few things along the way"]
Blake puts the materials into a cup of coffee grounds, mixes it with some of his own blood, and put this into the filters of the coffee maker. He starts to brew it, and hey. It smells super bad. Once it's done Blake pours it all into a flask he's got. Percy goes to find a Febreeze.
[Blake raises an eyebrow. "So you spend most of your time running around with blood-crazed lunatics but that sets you off unease?" "Forgive my Ventrue sensibilities."]
dark room, cluttered. grey blue skin, huge black eyes and nails. shocked to see Blake. how ya been, the lasombra have embedded themselves. jackie is mentioned.
blake asks for other favor, provide body to fake death? yeah S knows people. gives number.
Back in car, Percy learns the Lasombra are part of Camarilla
"absolute freedom requires absolute resposibility"
____
The next night, Leo grabs a rental car. He spends the rest of the night with his sister- she tries to ask him about the breakup, and they play Mario Kart at one point- and he succeeds his composure roll in trying not to cry. At one point they take a selfie and Leo specifically makes sure she takes it with her phone. Eventually, Amy gets tired, so he hugs her goodbye and says he loves her. Outside and away from anyone's sight, he breaks down sobbing.
Eventually, he steels himself and starts the walk back to the hotel. ["You've come this far. It's all for him. It's all for him- You can't go back."]
______
After Leo left the hotel to meet with Amy, Blake offered Percy to feed from him since the guy's looking hungry. Percy accepted the offer (he adds to his list of things he owes Blake for), and then was asked if he wanted to tag along with Blake; he has a contact to meet up with. Blake drives with Percy to an adult store in a seedy part of Chicago. Entering, Blake asks the store clerk if he can talk to his boss. ["Tell him his old friend Blake is here."] As Blake waits for the clerk to return from the back room he browses the 1988 playboy magazines. Percy is confused by one of the products on a shelf, and Blake jokingly asks if he's interested in buying it.
[Percy, deadpan: "...Seriously?"]
The store clerk returns and tries to ask Percy a few questions, like if he's interested in buying, if he needs help finding anything- Percy gives him some cash like "take this and stop asking me questions." The clerk accepts and leads Blake to the back office and down into a dark and cluttered basement and then leaves. A Nosferatu with blue-grey skin and large black eyes is shocked to see Blake in Chicago- he's called Sticky, which is probably the worst name ever considering this is under a sex toy shop. They exchange a few words– Stick informs Blake the Lasombra have "embedded themselves" in the city, but it's nothing they can't handle, and someone named Jackie is mentioned– and Blake says he's back in Chicago for business.
He asks for some bulletproof vests and gun silencers. Sticky gets those for him; one of the vests is pink ["Sorry. I got it though! You can just spray paint it."]. Blake bargains the price down to 3,000, saying Stick owes him one, and the Nos relents. Blake also asks if Sticky knows anyone who fake a death/make a fake body. Sticky says of course he does, but hesitates to give Blake a number to call until Blake says it would "make them even." Sticky says to not let the contact know it was him that gave Blake the number. He gives Blake a box to put his newly-acquired things in, and they say their goodbyes.
Blakes leaves the basement and tbh Percy was listening in the whole time with Heightened Senses. They start to leave, the clerk sees the box he's got and thinks he's stealing, but Blake attempts to convince him he paid for it already.
Back in the car, Percy asks about the Lasombra comment and unfortunately learns that clan has defected from the Sabbat and joined the Camarilla. Percy's visibly pissed about this, and Blake comments that's why he doesn't quite want to stick around for too long; There's no telling who's watching in the shadows. Percy goes from fidgeting with his ring to his gun- he reassures Blake he's not going to do anything, as he gave his word to not cause any problems, and Blake implies he's not too sure.
Percy informs Blake of the "absolute freedom requires absolute responsibility" belief that he has, and how not all of the Sabbat agreed with him on it- point is, he keeps his word.
______
Leo arrives back at the hotel room to see Blake and Percy with the vests, but he's like "I'm too distraught to ask about that rn," and goes to wipe the remaining blood off his face. Blake wants Leo to go feeding with him, and grabs that weird concoction he had made earlier. They drive out to some sort of road/field, where Blake takes the mixture and paints symbols into the ground, muttering something. Leo's confused as hell but Blake tells him that now they'll be able to feed from the animals here safely, since this isnt anyone's territory- it's a Weird Road. Leo's still confused tbh, but the two of them hunt and feed anyway.
Notes:
Hi we were overthinking the death/body thing Way too much lmao
The ST said he wouldn't tell us what the contact is after this bc it has "too many spoilers regarding Harrison's lore" 👀
Special shoutout to Percy suggesting Leo mail his suicide note. Bro who does that- /lh
Yayyy we finally have a way to kill Leo!! 🎉
istg i thought Blake was doing thinblood alchemy or something. Dude what the fuck are you doing
Percy in the adult store was hilarious. Love it when this man is in Situations
Blake how do you know this guy. Why does he owe you something. What's up
Sticky did have a fun voice though ⭐
WEIRD ROAAAAADDDDD!!!! :-D
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