Top Reads Overview

In an age of unprecedented change, staying current has never been more important. Our team at Chartis is curating news most relevant to the healthcare industry and tracking the topics that are trending on seven key issues: high reliability care, digital and advanced technology, financial sustainability, health disparities, the health ecosystem of the future, partnerships, and the provider enterprise. Each week, we break down what’s happening and why it matters.

The Buzz This Week

When President-elect Biden takes office next week, his party will narrowly control the U.S. Senate and House of Representatives after last week’s Georgia Senate runoffs saw the final two seats go to the Democrats. A bipartisan majority also voted to certify Biden’s win, following the attack on the Capitol on January 6. The incoming president will need to secure much more of that bipartisan support if he hopes to get key healthcare priorities through Congress. The 50 Democratic votes in the Senate are 10 short of what would be needed to end a filibuster. The Biden-Harris administration has stated some of their key healthcare priorities will be:

• Cabinet selection of healthcare leaders: While Biden may prefer to have Cabinet selections easily approved, he only needs a simple majority for confirmation, which he will likely get even without any GOP support. Republican Senators have noted that they feel Xavier Becerra is unqualified to lead the Department of Health and Human Services because of his lack of healthcare background, but that is unlikely to have an impact on confirmation.
  
• Additional COVID relief bill: Biden has stated the relief bill passed in December was a “down payment” for a larger bill to support the American people and healthcare system. Specifically, Democrats want to see a higher stimulus payment to individuals. Approval of additional relief will almost certainly require some bipartisan support.
  
• Health equity: The Biden Administration has noted that racial disparities in outcome and access, as highlighted by the disproportionate impact of COVID, will be a top priority. Biden has created a new administration role, health equity adviser, and named Dr. Marcella Nunez-Smith to be the first to serve. She notes her role will include health equity related to the vaccine rollout, as well as ongoing PPE distribution and testing. While the initial focus is COVID, new priorities for health equity will be identified post-pandemic.
  
• Drug pricing: While there is bipartisan support for action on drug pricing, the GOP is unlikely to approve authorization for the federal government to negotiate Medicare drug prices, an option the Democrats have proposed.

An area that now seems to have gained agreement from both the GOP and Democrats is speeding up the distribution of the COVID vaccine to states. The new guidance released by the Trump Administration says that states should expand the eligible population to those over 65 and those with underlying health conditions. States will also be receiving vaccination allocation based on how quickly they are distributing the vaccines in an effort to incentivize states to vaccinate more quickly. This is in line with what the Biden Administration has planned.

Why It Matters

President-elect Biden will need to address more pressing healthcare needs than any president in recent history, with the pandemic and health equity being top priorities. He also faces competing issues for focus — a struggling economy from the pandemic, racial justice concerns, climate change, and a second impeachment for President Trump — that may not be voted on in the Senate until after Inauguration Day. With multiple demands on attention, it remains to be seen how much of the Biden-Harris healthcare agenda can be accomplished and on which key healthcare issues Biden may be able to garner support from across the aisle.

The Buzz This Week

The pandemic put incredible strain on the healthcare system in 2020 and is likely to have lasting impacts on the way care is delivered in the future, often because COVID-19 necessitated the change. In digital health and telehealth, many of the trends seen in 2020 are likely to continue. Telehealth is likely to mature and expand, though traditional EHRs may not be the best platform to host telehealth services. Digital health adoption, including telehealth, will accelerate, especially as consumers have gained comfort with its use. Consumers’ ongoing desire for low-contact care will mean an increase in remote monitoring, self-monitoring, and at-home testing. As consumers play a bigger role in their care, and as interoperability compliance goes into effect, they will have access to more data, both their own and what is available online. We will need innovative ways to manage data and reduce medical misinformation.

Why It Matters

Much of the digital transformation we are seeing now was already underway, but COVID accelerated its need (i.e., telehealth, low-contact care and monitoring, and consumer-focused technology). As the pandemic moves into Year Two, there will likely be a growing number of companies to address these digital health needs in an already crowded space. While it’s vital these technologies solve for healthcare needs, that alone will not be enough. Consumer experience and ease of integration into current platforms and workflows will also be paramount to determine which of these start-ups succeed.

The Buzz This Week

Primary care is the foundation of our healthcare system, serving as a first touchpoint for a patient, a gatekeeping mechanism to assess a patient and refer them to specialists and other services if necessary. When the system works well, primary care can support care coordination, foster continuity of care, help patients stay healthy, and serve as a lower-cost option for less-acute healthcare needs. It can also be a fulfilling career. However, the system breaks down when primary care supply cannot meet demand, when lack of health insurance creates a barrier to access, and when primary care health professionals find themselves overworked — particularly with administrative tasks. In this scenario, people seek primary care in the costly emergency room setting because they are guaranteed access; some people forego care, and a health problem worsens; and primary care providers frequently experience stress, fatigue, and burnout.

We have been in this unfortunate scenario in many parts of our country for years, and the impact of COVID-19 — financially decimating some practices — has only made the situation worse. The Primary Care Collaborative (PCC) found in a survey conducted in December 2020 that more than 90 percent of primary care practices have some shortage of personnel, more than 60 percent have “severe/near severe practice stress,” and more than 40 percent have staff positions they can cannot fill. PCC went as far to say that primary care in the U.S. is on the brink of collapse.

Amidst this dire situation, some see an opportunity. Big tech companies as well as smaller start-ups and non-traditional players are increasingly entering the primary care space. Circumventing the traditional primary care model, they are consumer-oriented, offering convenience (online scheduling, extended hours, virtual care) and often a straightforward payment model (pay per visit or a subscription model) that is affordable for many. Some start-ups, described in a recent report from CB Insights, are limiting their focus to only a piece of primary care — offering lifestyle or wellness services, triage or symptom checking tools, remote monitoring, and medication management. These companies see an opportunity to disrupt primary care (or portions of it) by providing a similar or improved service more efficiently and at a lower cost. Given the explosion of virtual care adoption during COVID, some may also see the potential in a scalable business that doesn’t require bricks and mortar, allows health professionals to maintain flexible hours in a setting of their choice, and attracts patients willing and able to pay. A recent JAMA study found that the largest proportion of individuals who had telemedicine visits during the first few months of COVID had attractive characteristics from a business standpoint — more than half had a median household income of $50,000 to $100,000 and/or were commercially insured, more than 40 percent were below age 55, and three-quarters had a Charlson Comorbidity Index of less than 3.

Why It Matters

While these new entrants and potential disruptors may “threaten” traditional primary care, chipping away at primary care practices’ businesses, they may also help fill a growing gap in supply and introduce new and valuable services to a specialty that has been struggling for years. New entrants are developing some tools that don’t have to directly compete with primary care practitioners but can enhance the care they provide or make it more efficient, potentially increasing patient capacity, reducing administrative tasks, and lowering burnout rates.

However, by dividing up the components of primary care and enabling patients to seek the different pieces from a variety of sources (e.g., annual visit, medication monitoring, virtual visit for urgent triage), there is potential to lose continuity of care — a key ingredient in successful population health management and value-based care models. Our healthcare system will need to find a way to incorporate these new providers and services in a productive way.

Payor-providers are well-positioned to incorporate new models of primary care into a population health management, value-based care model. CVS Health/Aetna, which recently hired its first Chief Customer Officer, has built consumer-friendly low-acuity healthcare services in its retail stores, via drive-throughs, and through virtual care. The objective is to attract consumers — ideally many who have health insurance through Aetna — and keep them healthy (and their healthcare costs low) while also selling them services (and drugstore products). The result, if successful, will be a win-win for CVS Health/Aetna and consumers, though it will compete with traditional primary care providers and potentially reduce the need for higher-acuity services offered by traditional health systems.