This is probably the strangest Labor Day in decades, perhaps ever. Tens of millions of workers remain unemployed due to the COVID-19 pandemic. Many of those who are still working are adapting to working from home. Those who are back at their workplace, or never left, are coping with an array of new safety protocols.
Those who work in the right industries – like the NBA – may get tested regularly but most workers have to figure out for themselves when to quarantine and when to get tested. For many workers, such as health care workers, people of color, and workers with underlying health issues, going to work is literally a life-or-death calculation.
No wonder that experts, like Dr. David B. Agus, are calling for companies to have Chief Health Officers.
Labor Day was originally intended to celebrate the labor movement, but these days labor unions don’t have much to celebrate. Only around 10% of U.S. workers belong to a labor union; both the number and the percent of unionized workers has been in steady decline over the past few decades.
Now Labor Day is mainly an extra day off for most, the unofficial end to summer, and, this year, possibly the springboard to a new surge in COVID-19 cases, due to holiday celebrations. Dr. Anthony Fauci warned:
(This is the fourth in a series of excerpts from Terry’s new book, Physician-Led Healthcare Reform: a New Approach to Medicare for All, published by the American Association for Physician Leadership.)
Many other countries’ healthcare systems outperform ours for one simple reason: They place a much greater emphasis on primary care, which occupies the central place in their systems. “The evidence is that where you have more primary care physicians, where you coordinate care, and where you pay to keep people healthy, you get better outcomes at lower cost,” says David Nash, MD, founding dean of the College of Population Health, part of Thomas Jefferson University in Philadelphia.
The evidence that Nash mentions includes studies by Barbara Starfield and her colleagues at Johns Hopkins University. In a 2005 Health Affairs paper, they showed that a higher ratio of primary care physicians to the population is associated with a lower mortality rate from all causes and from heart disease and cancer; in contrast, having more specialists in a particular area does not decrease the overall mortality rate or deaths from cancer and heart disease.
Another study of Medicare data found that states where a higher percentage of physicians were PCPs had higher quality care and lower cost per beneficiary. This factor alone accounted for nearly half of the variation in Medicare spending from one state to another. A separate study found that in the areas of the country that had the most primary care providers, the average Medicare cost per beneficiary was a third lower than in areas with the least PCPs.
One reason for this is that primary care doctors provide comprehensive, continuous care, including preventive and routine chronic care. Chronic illnesses drive 90% of health costs, and some studies show that intensive primary care can reduce ER visits and hospital admissions and improve the health of chronically ill people.
As we witnessed in last week’s Republication convention, when in doubt, go with the golden oldies. Australian songwriter Peter Allen said as much in the fourth stanza of his classic song, “Everything Old Is New Again”, which reads:
“Don’t throw the past away
You might need it some rainy day
Dreams can come true again
When everything old is new again”
In fact, there’s nothing original in Trump’s playbook, and that includes his postal service gambit. Manipulating and militarizing the US Postal Service dates back to 1873 in the form of one Anthony Comstock, a zealot who was fond of describing himself as a “weeder in God’s garden.”
A savvy New York City insider, he created the New York Society for the Suppression of Vice declaring himself committed to stamping out smut. But to accomplish this task, he needed a hammer. He turned to political allies in the United States Postal Service who provided him with police powers and the right to carry a weapon.
Still, the weapon was of little use without a law to enforce. So he turned to his friends in industry who reached out to Congress. “An Act for the Suppression of Trade in, and Circulation of, Obscene Literature and Articles of Immoral Use” was passed on March 3, 1873, ch. 258, § 2, 17 Stat. 599. Forever after known as the Comstock Law, the statute’s lofty intent was “to prevent the mails from being used to corrupt the public morals.”
In Partnership with the Duke-Margolis Center for Health Policy, Resolve to Save Lives, Carnegie Mellon University, and University of Maryland, Catalyst @ Health 2.0 is excited to announce the launch of The COVID-19 Symptom Data Challenge. The COVID-19 Symptom Data Challenge is looking for novel analytic approaches that use COVID-19 Symptom Survey data to enable earlier detection and improved situational awareness of the outbreak by public health and the public.
How the Challenge Works:
In Phase I, innovators submit a white paper (“digital poster”) summarizing the approach, methods, analysis, findings, relevant figures and graphs of their analytic approach using Symptom Survey public data (see challenge submission criteria for more). Judges will evaluate the entries based on Validity, Scientific Rigor, Impact, and User Experience and award five semi-finalists $5,000 each. Semi-finalists will present their analytic approaches to a judging panel and three semi-finalists will be selected to advance to Phase II. The semi-finalists will develop a prototype (simulation or visualization) using their analytic approach and present their prototype at a virtual unveiling event. Judges will select a grand prize winner and the runner up (2nd place). The grand prize winner will be awarded $50,000 and the runner up will be awarded $25,000.The winning analytic design will be featured on the Facebook Data For Good website and the winning team will have the opportunity to participate in a discussion forum with representatives from public health agencies.
Phase I applications for the challenge are due Tuesday, September 29th, 2020 11:59:59 PM ET.
Learn more about the COVID-19 Symptom Data Challenge HERE.
Challenge participants will leverage aggregated data from the COVID-19 symptom surveys conducted by Carnegie Mellon University and the University of Maryland, in partnership with Facebook Data for Good. Approaches can integrate publicly available anonymized datasets to validate and extend predictive utility of symptom data and should assess the impact of the integration of symptom data on identifying inflection points in state, local, or regional COVID outbreaks as well guiding individual and policy decision-making.
These are the largest and most detailed surveys ever conducted during a public health emergency, with over 25M responses recorded to date, across 200+ countries and territories and 55+ languages. Challenge partners look forward to seeing participant’s proposed approaches leveraging this data, as well as welcome feedback on the data’s usefulness in modeling efforts.
Indu Subaiya, co-founder of Catalyst @ Health 2.0 (“Catalyst”) met with Farzad Mostashari, Challenge Chair, to discuss the launch of the COVID-19 Symptom Data Challenge. Indu and Farzad walked through the movement around open data as it relates to the COVID-19 pandemic, as well as the challenge goals, partners, evaluation criteria, and prizes.
(This is the third in a series of excerpts from Terry’s new book, Physician-Led Healthcare Reform: a New Approach to Medicare for All, published by the American Association for Physician Leadership.)
The American Medical Association (AMA) last year announced that, for the first time, more physicians were employed than were independent. While many of these doctors were employed by private practices, the AMA said, about 35% of them worked directly for a hospital or for a hospital-owned practice.25
This estimate was lower than that of other surveys. According to research conducted by the Physicians Advocacy Institute (PAI) and Avalere Health, a consulting firm, 44% of physicians were employed by hospitals in January 2018, compared to 25% in July 2012. More than half of U.S. physicians now work for or contract with fewer than 700 healthcare systems across the country, according to a new study in Health Affairs.
Many of the physicians employed by hospitals and health systems formerly were in private practice. They sold their practices to hospitals because of increasing overhead, dwindling reimbursement, and the rising administrative burdens of ownership, according to Jackson Healthcare, a physician recruiting firm.
The many negative factors affecting primary care also have impelled a growing number of primary care physicians to seek employment in recent years. In 2018, 47% of general internists, 57% of family physicians and 56% of pediatricians were employed. There is evidence that this trend may be exacerbating the primary care shortage because employed doctors see fewer patients per day, on average, than do those in private practice.
(This is the second in a series of excerpts from Terry’s new book, Physician-Led Healthcare Reform: a New Approach to Medicare for All, published by the American Association for Physician Leadership.)
In January 2015, then Health and Human Services Secretary Sylvia Burwell announced lofty goals for the government’s value-based payment program. By the end of 2016, she said, 85% of all payments in the traditional Medicare program would be tied to quality or value, and 90% would be value-based by the end of 2018.
The government planned to tie 30% of Medicare payments to alternative payment models by 2017, according to Burwell, and hoped to reach the 50% mark by 2018. In March 2016, HHS said it had reached the 30% goal a year ahead of schedule, mainly because of the Medicare Shared Savings Program (MSSP).
More recent data on the value-based-care movement comes from the Health Care Payment & Learning Action Network (LAN), a public-private partnership launched in 2015 by the Department of Health and Human Services. The LAN reported in October 2018 that public and private payers covering 226 million lives, or 77% of insured Americans, had tied 34% of their payments to value-based care. According to the organization, only 23% of total payments had been value-based in 2016.A deeper analysis of the LAN data, however, shows that the vast majority of value-based payments—both in Medicare and in the larger healthcare system—were still limited to pay for performance, upside-only shared savings, and care management fees paid to patient-centered medical homes.
These are, no question, hard times, due to the COVID-19 pandemic. In the U.S., we’re closing in on 180,000 deaths in the U.S. Some 40 million workers lost their jobs, and over 30 million are still receiving unemployment benefits. Hundreds of thousands, if not millions, of small businesses are believed to have closed, and many big companies are declaring bankruptcy. Malls, retailers, and restaurants have been among the hardest hit.
Yes, these are hard times. But not for everyone.
Last week Target announced what CNBC called a “monster quarter.” Sales for online and stores open at least a year jumped 24% for the quarter ending August 1 – peak COVID-19 days – and profits were up an astonishing 80%. Its CEO specifically referenced the pandemic, as shoppers sought safe and convenient shopping options.
It is not just Target doing well. No one should be surprised that Amazon is doing well, as more turn to online shopping and Amazon’s quick delivery, but The Wall Street Journalreports that Bog Box stores generally are doing well, including not just Target but also Walmart, Home Depot, Lowe’s, Costco, and Best Buy. The efforts they were taking to compete with Amazon, such as increased online sales and curbside pickup, served to help them survive the pandemic’s effects.
Similarly, if you’re a streaming service like Netflix or Disney+, the pandemic has been great for business. Video conferencing services like Zoom are booming. Car dealers are struggling, but not online car sales.
And, of course, if you’re a cloud computing service supporting all these shifts to online, the world has become even more dependent on you. “Many customers are scaling beyond their wildest projections,” Carrie Thorp of Google Cloud told WSJ.
(This is the first in a series of excerpts from Terry’s new book, Physician-Led Healthcare Reform: a New Approach to Medicare for All, published by the American Association for Physician Leadership.)
Even before COVID-19, healthcare reform seemed to be stuck between a rock and a hard place, but there is a rational way forward. This approach, which I call “physician-led healthcare reform,” would engage doctors in building a healthcare system that was safe, effective, patient-centered, timely, efficient, and equitable, to use the Institute of Medicine’s set of foundational goals in its landmark book, Crossing the Quality Chasm: a New Health System for the 21st Century.Primary care physicians, rather than hospitals, would be in charge of the system, and they’d work closely with specialists and other healthcare professionals to produce the best patient outcomes at the lowest cost.
It would take a decade or more to restructure the healthcare system so that this goal could be achieved. Similarly, the transition to a single-payer insurance system needs to be accomplished gradually—although the pandemic might accelerate that timetable. Most people are not yet ready to abandon employer-sponsored insurance, and there’s still a lot of distrust of the government. Providers are more likely to accept changes in how they’re paid over time than all of a sudden. Additional benefits can also be brought online slowly. Ideally, we could transform healthcare financing over a 10-year period while rebuilding the care delivery system at the same time.
That is why implementing Medicare for America—a reform plan devised by the Center for American Progress and embodied in a current House bill–makes more sense than going directly to Medicare for All: it changes the system incrementally while achieving universal coverage fairly quickly. Medicare for America would do this by enrolling the uninsured, people who purchase individual insurance, and those now in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). People would also be enrolled automatically at birth. Companies could enroll their employees in Medicare for America, and employees could opt out of employer-sponsored plans and enroll in the public plan.
The THCB Book Club is a discussion with leading health care authors, which will be released on the third Wednesday of every month. And this is the first one!
We kicked off with the new book from Hemant Teneja (VC at General Catalyst who has been writing many big checks lately) and Stephen Klasko (CEO at Jefferson Health System and one of the most unusual hospital system bosses in America). Their book is called UnHealthcare: A Manifesto for Health Assurance which is a how-to for creating a platform for a revolutionary future for health care. You can go buy the book here (eVersion only $6!) It’s an easy read (about 130 pages on your iPad “Books” app).
UnHealthcare is about a new concept called Health assurance– which Tenaja says is “an emerging category of consumer-centric, data-driven healthcare services that are designed to bend the cost curve of care and help us stay well.”
Sitting in on the interview because we can’t get rid of him was Glen Tullman from Livongo (Just kidding, Glen!). He weighed in on how this connects with his new idea of Consumer Directed Virtual Care and the Teladoc-Livongo merger.
This was a great discussion. We had them explain the concept, and pushed them pretty hard on how realistic it was! And you can see it in the video below (and the podcast version will be in our iTunes & Spotify channels very soon)
In September the THCB BookClub will feature Jane Metcalfe with her 2020 book NEO.LIFE
Op-eds. Crossposts. Columns. Great ideas for improving the health care system. Pitches for healthcare-focused startups and business.Write-ups of original research. Reviews of new health care products and startups. Data driven analysis of health care trends. Policy proposals. E-mail us a copy of your piece in the body of your email or as a Google Doc.