The Health Care Blog – Page 153 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Crossover Health: The Amazon Deal, Primary Care & The Rise of the ‘Health Activist’ Employer

Aug 18, 2020

By JESSICA DaMASSA, WTF HEALTH

“Next-gen” healthcare might just be getting its start in primary care. So says Crossover Health’s CEO, Scott Shreeve, who laughingly channels Justin Timberlake and says he’s “bringing sexy back” to it too. With Walmart launching its own Healthcare Super Centers, Walgreens partnering with VillageMD in a $1-billion-dollar three-year deal, and some soaring post-IPO stock prices for OneMedical and Oak Street Health — it appears he’s onto something. And, hopefully, it’s something big that’s borne from Crossover’s recent partnership deal with Amazon. Will this be the tech giant’s next foray into healthcare? We’ve got the analysis on Amazon, Scott’s insider insights on what’s next for the primary care market, AND some phenomenal perspective on the “rise of the ‘Health Activist Employer’” as healthcare’s “most innovative payer.”

Health Insurers Ride High for Now, But Watch What’s Coming Next

Aug 18, 2020• 1

By KEN TERRY

In the strangest healthcare business story of 2020, the major health insurance companies are thriving despite—or because of—the pandemic. As the second quarter reports of United, Anthem, Cigna and other insurers reveal, their COVID-19-related costs were outweighed by the sharp drop in claims for other healthcare services.

As a result, the second quarter operating gain for Anthem, one of the largest national carriers, jumped 65% from the prior-year period, while the portion of its premiums spent on member benefits dropped to 78%. The earnings of UnitedHealth, similarly, vaulted 98% as the percentage of its premiums spent on health care fell to 70.3%. Such a low “medical loss ratio” has probably not been seen since the 1990s.

At the same time, the big insurers’ membership has been rising, but not among workers covered by employer-sponsored plans. Commercial insurance members served by United, for example, fell by 270,000 to 26.8 million, following a drop of 720,000 in Q1. In contrast, the number of people in United’s Medicaid managed care plans rose by 330,000.

These trends track with the short-time fallout of the pandemic. Families USA reported that 5.4 million workers who lost their jobs from February to May also lost their health insurance. Another study predicted that by the end of 2020, 10.1 million people will lose employer-based insurance tied to someone in their household.

Healthcare Sings The Non-Profit Blues

Aug 17, 2020• 1

By MICHAEL TURPIN

Powers once assumed are never relinquished, just as bureaucracies, once created, never die.
Charley Reese

As we ponder the 100 day count down to the Presidential Elections, the rhetoric and ranting swirling around the best solution for our nation’s healthcare crisis, is hitting decibel levels not heard since the passage of the Affordable Care Act. As with any major entitlement legislation, there are commendable elements, inefficiencies, and a host of unintended consequences. The current administration’s obsession with repeal while the ranks of uninsured people grow, begs the question, “what is the blue-print for expanding coverage and reducing waste, fraud and abuse while increasing transparency, quality and overall public health. Answer: There is no plan and if there was, it would fall well short of achieving many of these objectives given the deeply entrenched stakeholder who actually do not benefit if the cost of healthcare declines. It a classic NIMBY response: “I’m all for reform as long as I maintain my role and revenue in whatever solution is proposed.”.

The Affordable Care Act is a solid foundation to build a 2.0 version of a solution to solve for the uninsured and to act as a catalyst for market reforms that will either reshape the misaligned incentives and embedded inequities in our current system or it will lead to voters demanding the expansion the role of Medicare and Medicaid. 70M adults and children are covered under Medicaid – including those who benefited by the passage of the ACA. Approximately 55M are covered under Medicare resulting in 125M covered under some form of state or federal aid. 155M receive coverage through employers.

Its estimated by the Economic Policy Institute that 29.8M individuals who received coverage as a result of ACA expansion would lose coverage if no legislation replaced it. Add in the severe economic dislocation arising from Covid-19 that could result in an additional 14M unemployed and you could see a worst case of uninsured swell from a current 27M to as high as 70M according to Policy Advice, a non-profit industry watch dog.

So how can you change the current market to drive reforms without a legislated intervention? It starts by enforcing laws already in place and challenging regulators to do their jobs – ensuring that we minimize waste, fraud and abuse. As of 2020, the average annual cost of family health coverage has eclipsed the cost of a mid-sized economy car. We must tackle the affordability problem by reducing the number of intermediaries who extract profits from the delivery system but do not play properly in the sand box of regulation that is often poorly monitored. We must demand transparency and deconstruct expensive bureaucracies only inflate the cost of care without improving it. It’s impossible to moderate the cost of healthcare without reducing the size of the pie and those feeding on it.

I Cured My Patient, But What Was His Diagnosis?

Aug 14, 2020• 1

By HANS DUVEFELT

He cancelled his followup appointment because he was feeling fine. He didn’t see the point in wasting a Saturday to come to my clinic when he had lawns to mow and chores to do.

Less than two weeks before that he was sitting on the exam table in my office, again and again nodding off, waking up surprised every time his wife prodded him. The stack of printouts from the emergency room illustrated all the normal testing they had done.

He had experienced a brief episode of numbness in the left side of his face and felt tired with just a slight headache. When I saw him the headache was a bit more severe in the back of his head and down the right side of his neck. But his neck wasn’t stiff.

His blood sugar was 87, normal for most people, but this man had a history of diabetes although his blood sugars had steadily improved over the past year. I told him to stop all his diabetic medications although I don’t think he took notice. His wife said she would make sure he stopped them.

Teladoc & Livongo — The Health Techerati Weigh-In

Aug 14, 2020• 1

Six competitor CEOs and one ex-CMO discuss the biggest-ever digital health merger

By JESS DAMASSA & MATTHEW HOLT

It was the news that stunned the world of health tech. And us! So we had seven of Teladoc and Livongo’s biggest competitors weigh-in on what the merger means for telehealth, digital health, the future of health care delivery–and their businesses! You’ll hear from the CEOs of Omada, Ginger, One Drop, Vida, Lark & Cloudbreak, with some spicy commentary from Lyle Berkowitz who was, until recently, CMO at MD Live. From reaction to the merger to speculation about how this will impact the future of digital health funding, fasten your seat belts for some impactful and fun infotainment about all the implications of the deal.

THCB Gang Episode 21

Aug 13, 2020

Episode 21 of “The THCB Gang” was live-streamed on Thursday, August 13th! Watch it below.

Joining Matthew Holt (@boltyboy) today are some of our regulars: policy & tech expert Vince Kuraitis (@VinceKuraitis), MD turned leadership coach Maggi Cary (@MargaretCaryMD), patient advocate Grace Cordovano (@GraceCordovano), and Consumer advocate & CTO of Carium Health Lygeia Ricciardi (@Lygeia). It was a great conversation surrounding the patients’ role in all the technology being deployed, how providers can work to close the gap in care, and whose duty is it really to ensure a person is “healthy”. Give it a listen below if you missed the live show

If you’d rather listen to the episode, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels — Zoya Khan

The Story of an American Mask Distributor

Aug 13, 2020• 2

By SAURABH JHA

Seven weeks before President Trump declared COVID-19 a federal emergency heralding the economic lockdown, Jesse’s customers began cutting their orders. Jesse sells garments and cotton, imported predominantly from India, to wholesalers and retailers, big and small, in malls across the North East corridor. His business had a good January. December was like any December. But February was different. His customers, reassuring him that it wasn’t personal, were predicting a falling demand for their products because of COVID-19. They may be over reacting, but better shortage than glut, they felt.

Jesse, who has no medical background, had heard of a virus which quarantined cruise ships, but nothing seemed foreboding back in February. He had tuned out the President, who was being his usual clownish self. It was business as usual in Manhattan, where he lives. He received reassuring messages from public health figures about the novel coronavirus. New York City’s mayor was particularly upbeat, urging New Yorkers to mingle with even more vigor.

Jesse didn’t know how to reassure his customers. A week later, more customers cancelled their orders. By middle of February, the orders halved. Being a businessman, not philosopher, it mattered not to him why his customers had seemingly overestimated COVID-19’s threat. What mattered is that they had. Since his business operated on small margins, the reverberations could be substantial. The first order of the day was reducing the output of his factory in India which was running on all cylinders.

The second order of the day was survival. If his customers’ fears came true, his business would be destroyed. Jesse had no qualms accepting government bailout. But this was long before the federal government announced relief for businesses. The virus had yet to strike Italy. COVID-19, like Chengiz Khan, seemed to prefer the eastern perimeters of the Silk Road.

In his culture, Jesse Singh is an American Sikh hailing from the Punjab – there’s a simple rule. When customers don’t want a certain product, find something else to sell. His family motto is that you should love the act of selling, not the product being sold (the motto sounds better when said by a Punjabi in Punjabi).

Another Punjabi rule, technically not a rule but part of their cultural RNA, is that Punjabis don’t sit idle. During the partition of the subcontinent, thousands of Sikhs arrived at Delhi train station hungry, battered, penniless, and homeless, after losing their homes and families to the mobs. After feeling sorry for themselves for a couple of days, they started selling tea and biscuits on the railway platforms.

If the panic from coronavirus could shut old businesses it surely could open new ones, Jesse thought. A soaring demand for personal protective equipment (PPE) seemed obvious. Since N-95 supply was regulated, he threw his weight behind surgical masks, believing that they’d be demanded by healthcare workers and eventually the general public. He decided to import a small batch on a trial basis.

Don’t Underestimate Doctor On Demand – CEO Hill Ferguson on the Era of ‘Tele-Everything’ Healthcare

Aug 12, 2020

By JESSICA DaMASSA, WTF HEALTH

JUST before the Teladoc-Livongo merger was announced, I had a chance to catch up with Doctor on Demand’s CEO, Hill Ferguson. The future for telehealth, he said, is “bright green” — and I’m pretty sure it’s looking even greener now! Doctor On Demand has stood out among telehealth companies for being particularly early on virtual primary care and it sounds like they’re going to continue developing that line of business — in which they have key partnerships with Humana and Walmart — with the $75M series D funding they just received.

Add to that a brand-new, first-of-its-kind telehealth program for the Medicare Part B population, and crazy consumer-focused type UX features like same-day scheduling for behavioral mental health care (yes, that’s right, dynamic scheduling for healthcare is here, folks!) and you can start to see how DOD is strategizing to pull away from the pack.

With the competitive landscape shifting, especially after Teladoc-Livongo, how does Hill view the onslaught of new entrants like digital health companies who added telehealth in reaction to the COVID-19 pandemic, or potential unicorns like Ro or HIMS, who are focused on tying the prescription drug business into virtual care delivery? It’s the insider insight you’ve been waiting for in this era of ‘tele-everything’ healthcare.

Take Your Mom to Work

Aug 12, 2020• 1

By KIM BELLARD

If you are a working mom, or married to one, or simply know one, you know that it is tough to balance a job and raising a child even under ideal circumstances. Even if she has a supportive spouse, chances are that it is the mom who ends up providing the most child care, and whose career it impacts the most.

But, of course, these are not ideal circumstances. Prior to the pandemic, women had made great strides in the workforce; more women had payroll jobs than men, for example (although they continued to be paid less for them). Those gains quickly came crashing down once the pandemic hit. It is believed to be the first time that job and incomes losses have hit women harder than men. Some are calling our pandemic-driven economic downturn a “shecession” as a result.

That’s bad enough, but the even bigger danger is that the pandemic could set back women’s careers for a generation.

A recent study by Collins, et. alia confirmed what most might have guessed: in the wake of the pandemic, women are more likely than men to have reduced their work hours to take on additional child care responsibilities due to school/daycare closing — four or five times as much.

The study found that:

Scaling back work is part of a downward spiral that often leads to labor force exits—especially in cases where employers are inflexible with schedules or penalize employees unable to meet work expectations in the face of growing care demands.

We are also concerned that many employers will be looking for ways to save money and it may be at the expense of mothers who have already weakened their labor market attachment.

Even more worrying, lead author Caitlyn Collins, a professor at Washington University, says: “Our findings indicate mothers are bearing the brunt of the pandemic and may face long-term employment penalties as a consequence.”

The Need for Measuring Clinician-Patient Cost-of-Care Conversations

Aug 11, 2020• 1

By MORENIKE AYOVAUGHAN, NELLY GANESAN, EMMY GANOS, and JOSH SEIDMAN

It is no surprise that beyond COVID-19 health risks, the pandemic has also caused significant disruption to the lives of everyone in America. It has caused exacerbating financial pressures and ongoing job losses. An estimated 42 million people have lost their job since March 2020, which has increased the number of uninsured. The loss of coverage has the potential to yield catastrophic healthcare costs for those seeking care during the period.

While the pandemic has exacerbated coverage challenges, it also highlights gaps that existed long before the outbreak. Prior to COVID-19, average out-of-pocket costs were on the rise with an estimated 24% of Americans spending over $1,000 per year on direct medical care and surprise medical billing. The pandemic-induced economic disruption reinforces the need for physicians and patients to embrace conversations regarding cost in the clinical setting; avoiding such discussion may result in patients foregoing care and not realizing their options.

Patients should be able to rely on their clinicians to help them understand the costs of their care, including losses associated with the time away from work and transportation expenses for visits. Our past research, and the research of others, has demonstrated that these conversations are valued and can be impactful in helping patients understand their options to address concerns upfront. And yet, the concept of having a Cost-of-Care (CoC) conversation is merely optional. These conversations are not typically supported with access to price information, nor are they consistently viewed as a routine part of practice. Cost conversations are not consistently documented, lack standardization, and structure. Furthermore, physicians have not adequately been trained to address CoC conversations with their patients.