Dom Smith/STAT

President Trump and congressional Republicans are eyeing sweeping Medicaid reforms that could encourage innovation and reduce its $545 billion annual cost. But how might those changes affect the program’s most vulnerable beneficiaries?

STAT’s Andrew Joseph traveled to Fenton, Mo., to report on the medical odyssey of Nathaniel Rankin, a four-year-old boy who is battling a range of physical and cognitive deficits. His case illustrates how Medicaid is more than a safety net for the poor. It is a lifeline for many hard-working Americans who can’t afford the costs of lifesaving care.

Read more.

Operating a hospital — from powering the ER to lighting up rooms — requires a massive amount of energy, often from fossil fuels. Some hospitals are trying to change their carbon footprint.

During a recent Climate & Health meeting, Health Care Without Harm’s Gary Cohen pointed to how Wisconsin-based Gundersen Health Care System built a wind farm to replace coal as its primary energy source. Kaiser Permanente has vowed by 2025 to cut its carbon footprint by getting food from sustainable sources and purchasing half its products and materials from suppliers committed to improving the environment.

One of Cohen’s favorite hospitals, Spaulding Rehabilitation in Boston, was “built with climate change in its DNA.” The LEED-certified hospital has a roof that is home to most of the hospital's electrical equipment. It can run if the grid goes down or if catastrophic flooding occurs due to rising sea levels. “It’s the future,” he says.

Samsung is investing in telemedicine via a partnership with American Well, a Boston-based company serving more than 200 health systems and health plan partners nationwide. The partnership follows Google, Apple, and other tech companies who seem to all be staking a claim in the future of digital health care.

In its joint statement yesterday, neither of the companies shared specifics except that American Well’s partners can offer their services to Samsung consumers. But as the use of telemedicine grows, the two companies have brought aboard key allies in Anthem, the Cleveland Clinic, and New York-Presbyterian that each want to see the companies develop new digital services for health providers and payers alike.

The Human Diagnosis Project, a global effort to provide online access to specialty medical care, was just named a semifinalist for a $100 million award from the MacArthur Foundation. The nonprofit’s medical director, Dr. Shantanu Nundy, spoke with On Call about how the project seeks to change medicine. This interview is lightly edited for clarity.

How would this online data tool improve access to care?
We know nationally that 40 percent of referrals to specialists can be served in primary care. We refer so many people to these limited specialists that it creates a bottleneck for people who really do need it. And that’s the crux of what we’re trying to address — delivering better information on who needs speciality care and who doesn’t.

Walk me through the mechanics. How would it work for doctors and patients during a visit?
If I saw a patient in the clinic and wasn’t sure what to do, I would take the basic information and put it in the Human Diagnosis system as structured data. Then, over the next day, our community of physicians around the world would see that case and basically provide help.

How is this different from other efforts to crowdsource solutions?
With each case, the system is learning and encoding all the insights. It will be able to talk to any other system, device, electronic medical record, etc. That’s what differentiates us from other crowdsourcing products, which can be great for individual patients but don’t solve the problem in a generalized way.

So what’s the next step?
The next phase is putting a whole clinic on the system. That’s going to be starting this summer with San Francisco General Hospital, which is great because it helps to fulfill our social mission now. Specialty medical care is part and parcel of basic health care, and it’s missing right now from the safety net. Regardless of the political winds, we need a permanent solution.

• Records show homeopathic remedies harmed hundreds of babies while the FDA spent years investigating (STAT)
• Why mental illness and heart disease are often found in the same patients (Washington Post)
• The GOP’s Obamacare replacement would help the wealthy buy insurance (Vox)
• Sequencing patients is becoming a normal part of care (Modern Healthcare)