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Intermountain, Stanford Children’s CEOs say hospitals need to get comfortable being a ‘frenemy’
Health systems have had to adjust to a lot of change in a short amount of time since the COVID-19 pandemic began.
Among the biggest changes they need to get comfortable with?
Collaborations with their rivals, said Intermountain President and CEO Marc Harrison, M.D., at Fortune’s Brainstorm Health virtual event Wednesday.
“I think that the opportunity is to get comfortable with the whole ‘frenemy’ relationship,” Harrison said. “Other industries recognize that an organization is both going to compete and collaborate with another organization, often simultaneously.”
Intermountain and the other system have co-branded drive-thru testing sites to eliminate redundancies, they share personal protective equipment numbers and they load level patients between systems. They have also “harmonized” clinical trials to ensure consistent criteria for all patients admitted to them, he said.
“I think that’s fantastic,” Harrison said, speaking during a virtual panel called Reinventing the Hospital. “We will compete in the future in certain areas but I’d love to continue to see this.”
The increasing level of collaborations amid the pandemic is also among the biggest changes Paul King, CEO of Stanford Children’s Health, has noticed since COVID-19 began its spread across the U.S.
“That is one of the silver linings of what we’ve seen with this crisis, particularly in the children’s hospital space. We’ve seen a level of collaboration, heretofore unseen, with the amount of sharing of best practices real-time,” King said. “The other outcome of this crisis is the idea of speed. We’ve been able to really stand up some capabilities that we would’ve said weren’t possible just 12 weeks ago. That level of collaboration is part of the genie we don’t want to go back in the bottle.”
Merkel says pandemic reveals limits of ‘fact-denying populism’
Merkel says pandemic reveals limits of ‘fact-denying populism’
German Chancellor Angela Merkel told European Union (EU) countries Wednesday that the coronavirus pandemic is showing the limits of “fact-denying populism” as she urged the bloc to reach an agreement on an economic recovery package.
Merkel said that the EU “must show that a return to nationalism means not more, but less control,” according to France 24.
Without naming any specific nations, Merkel said: “We are seeing at the moment that the pandemic can’t be fought with lies and disinformation, and neither can it be with hatred and agitation.”
“Fact-denying populism is being shown its limits,” she added. “In a democracy, facts and transparency are needed. That distinguishes Europe, and Germany will stand up for it during its presidency.”
The pandemic has killed more than 100,000 people in the 27 EU nations and sparked what is expected to be the largest recession the continent has experienced in decades.
On Tuesday the EU released a report predicting the bloc’s economy will contract more than initially expected due to coronavirus-related lockdowns.
Merkel on Wednesday joined EU Economy Commissioner Paolo Gentiloni in urging the commission to quickly reach an agreement on the 750 billion-euro stimulus package proposed earlier this year.
“The depth of the economic decline demands that we hurry,” Merkel told lawmakers, according to The Associated Press. “We must waste no time — only the weakest would suffer from that. I very much hope that we can reach an agreement this summer. That will require a lot of readiness to compromise from all sides — and from you too.”
Texas and Arizona ER doctors say they are losing hope as hospitals reach capacity
As concerns over the capacity of hospitals resurface amid surging Covid-19 cases, two emergency room doctors say they worry about where the pandemic could take them next.
Dr. Mina Tran, an emergency room doctor in Texas, said 70 to 80% of her patients have been admitted with upper respiratory or coronavirus complaints.
In Arizona, which saw its lowest-ever number of available ICU beds Tuesday, Dr. Murtaza Akhter told Lemon so many patients are coming in that he is already having to make tough decisions over resources.
“I’m trying not to be an alarmist. I’m an emergency physician — we’re prepped for this. Dr. Tran and I both trained very hard for this. But we can’t just build beds overnight. We can’t just hire staff overnight. And like I said, our numbers are only increasing,” he said. “It’s only going to get worse and that’s the scary part.”
With a rise in hospitalization rates across the US, doctors like Akhter are reporting waiting lists for ICU beds and having to decide who will be admitted for treatment and who will not.
Surges in hospitalization and infection rates have followed larger crowds gathering in newly reopened public spaces. Every state has started their plan to reopen, and 35 are currently seeing more new cases reported compared to last week.
Tran applauded Texas Gov. Greg Abbott closing down bars once again but said she does think the state was too quick to open back up.
While many states have paused or rolled back reopening in light of a resurgence of cases, Akhter said seeing individuals continue disregard safe practices as his emergency room treats coronavirus patients makes him feel like he is “losing hope.”
“I’m going through shifts making some very tough decisions and then I’m driving home and seeing people who are clearly not distancing, having their Fourth of July celebrations, being in big congregate settings, and it feels like what I’m doing is futile,” Akhter said. “I don’t know what more people need to hear.”
And California and Florida are feeling the strain as well.
In Florida, where cases have surged, ICUs at 56 hospitals have reached capacity. And California’s hospitalizations were at an all-time high on Tuesday with nearly 6,000 coronavirus patients.
Providence, Humana back ad campaign urging patients to stop ‘medical distancing’
Dive Brief:
- A coalition of providers, payers and other healthcare organizations on Tuesday launched an ad campaign to encourage patients not to put off important care during the COVID-19 pandemic.
- The announcement encourages people to continue social distancing but not “medical distancing” by putting off routine care or avoiding checking on concerning symptoms. That could be either through telemedicine or an in-person visit.
- The campaign will be on TV, in print and across social media. The 11 organizations behind it include Providence, Humana, Baylor Scott & White, LabCorp and Walgreens.
Dive Insight:
While some hospitals in hotspots in Texas, Florida, California and Arizona have had to once again put off non-emergency procedures, providers in other areas of the country are trying to ramp up regular patient volumes as the number of positive cases eases.
Surveys show, however, that people are wary of returning to the doctor’s office, either because they worry about exposure to the novel coronavirus or have lost coverage to help pay for care.
The new ad campaign seeks to ease these concerns. No dollar figure was attached to the plan, which advertising agency MullenLowe U.S. took on pro bono. It follows an ad the American Hospital Association launched in May to ensure the public facilities are still available for non-COVID-19 care.
Since the pandemic’s onset in the United States, health officials have been concerned about the short- and long-term consequences of routine and preventive care being delayed or put off entirely. Chronic diseases that are caught early can be managed more easily and less expensively.
Also, research shows even some crucial services aren’t being sought even for issues such as strokes and heart attacks. In April, emergency room visits nationwide dropped more than 40%, according to the Centers for Disease Control and Prevention.
Public health experts are also beginning to fear vaccinations may be avoided, which could cause trouble with the upcoming flu season.
For providers the reduction in patient volumes has meant a major revenue loss. Some patient volume has been recaptured, but that rolled back again in recent weeks with hospitals in large states like Texas and Florida again reaching capacity with a COVID-19 surge.
At the end of June, hospital traffic in Arizona, New York and Texas was down week over week, according to an analysis from Jefferies.
Primary care has particularly suffered. Visits to medical offices were down nearly 60% in March and April, meaning losses to those practices could top $15 billion this year, according to a recent Health Affairs study.
The ad campaign stresses that providers have guidelines in place to keep patients safe, such as isolation of those suspected of having COVID-19 and increased virtual options.
“While we understand the fears that many people have around contracting the virus, our country’s medical facilities have adopted CDC guidelines and best practices and even telemedicine options to make your visit as safe as possible to prevent the spread of the virus,” Humana CMO William Shrank said in a statement. “The intent of the campaign is to let people know that protecting yourself against getting this virus does not need to come at the expense of your overall health.”
Walgreens invests $1B in primary care clinics with VillageMD deal
Dive Brief:
- Walgreens on Wednesday announced plans to open up to 700 primary care clinics across the country over the next five years in partnership with medical services provider VillageMD, and “hundreds more” after that.
- As part of the agreement, Walgreens will invest $1 billion in equity and convertible debt in Chicago-based VillageMD over the next three years, including a $250 million equity investment Wednesday. VillageMD will use 80% of the funds to pay for opening the clinics, called Village Medical at Walgreens, and integrate digitally with Walgreens.
- Walgreens, which saw its stock rise slightly in early morning trading on the news, anticipates owning 30% of VillageMD once the investment is done. More details on the partnership will be released in the first quarter next year.
Dive Insight:
Retail clinics, which can generate additional script-writing and drive front-of-store sales for their owners, have seen renewed interest in recent years from giants like pharmacy rival CVS Health and retail behemoth Walmart. But Walgreens is the first national pharmacy chain to work toward building out a primary care infrastructure in stores across the U.S.
The move represents a massive investment in the healthcare delivery space for the Illinois-based company, which began trialing the full-service doctor’s offices in its stores late last year with five clinics in Houston, Texas. The pilot was successful, Walgreens said, driving high patient satisfaction scores.
Additionally, the integrated pharmacy model is correlated with increased medication adherence and better patient outcomes, according to internal VillageMD data — important factors in managing chronic conditions, which drive roughly 85% of all U.S. healthcare spend.
As such, Walgreens plans to open 500 to 700 stores over the next five years, staffed by more than 3,600 primary care physicians recruited by VillageMD, along with nurses, social workers and therapists working alongside Walgreens’ pharmacists in 30 U.S. markets.
The two companies are still finalizing what those initial markets are going to be, but the very first will be in Texas and Arizona, Walgreens’ Director of Pharmacy and Healthcare Services Communications Kelli Teno told Healthcare Dive. More than half of the clinics will be located in government-designated medically underserved areas such as Houston, which have a large share of low-income populations, migrant workers and Medicaid beneficiaries.
The stores will accept a broad array of insurance options, according to the release. Many plans VillageMD works with have a zero dollar to $10 co-pay for primary care services, Teno said.
The clinics use a sliding scale payment model for patients who don’t have insurance to try to make care more affordable for the broad range of primary care services provided, like preventative visits, acute infection or minor trauma care or chronic condition management.
Telehealth will be available around the clock for consumers via Walgreens’ healthcare marketplace app, called Find Care, or via VillageMD’s internal capabilities. VillageMD doctors can also provide at-home doctor visits for vulnerable populations, such as senior citizens or the immunocompromised.
Walgreens already has 14 in-store primary care clinics operated by different partners like Partners in Primary Care, Southwest Medical — part of Optum’s physician group — and VillageMD. Late last year, Walgreens announced it was closing 160 of its internally staffed walk-in clinics, though it still has more than 400 clinics nationwide, most staffed or run by local health systems or physician groups.
Its outsourcing model flies against CVS, which built out its health-focused store network, called HealthHUBs, through acquisitions and builds. HealthHUBs designate at least a fifth of floor space to health and wellness focused products. CVS plans to have a chain of 1,500 locations by the end of 2021 as part of its enterprise growth strategy, adding to its almost 10,000 retail locations and more than 1,100 walk-in medical clinics.
For its part, Walgreens’ clinics will be between 3,300 and 9,000 square feet and use existing space within Walgreens’ locations. To make room, clinic-linked stores will offer fewer unhealthy front-end products like snacks and sodas. Tobacco products will not be sold in the first 200 Village Medical at Walgreens locations.
“Many of the stores that we’re initially looking at to build these clinics naturally sell more pharmacy and health and wellness products,” Teno said. “It will really depend on the needs of that local community.”
VillageMD, through its subsidiary Village Medical, includes more than 2,800 doctors across nine markets. The seven-year-old company, which competes with other primary care management companies like UnitedHealth-owned Optum has raised $216 million in total funding across three rounds from investors like Oak HC/FT and Town Hall Ventures, a firm founded by Andy Slavitt, former CMS administrator under President Barack Obama.
IHME Model Projects 208,255 U.S. Deaths By November, But Estimate Falls Sharply If Mask Use Increases
TOPLINE
The University of Washington’s influential Covid-19 model, extended out to November 1 for the first time, estimates that 208,255 Americans will die from the virus by then, though, the death toll could be reduced by nearly 22% if mask use were to become widespread, researchers said.
KEY FACTS
The university’s Institute for Health Metrics and Evaluation (IHME) forecasts 162,808 deaths by November if at least 95% of people were to wear face coverings in public.
A Gallup poll released Monday found that 86% of adults wore masks in the past week.
Masks have become a political issue, with only 66% of Republicans reporting mask use in the poll, while President Trump continues to refuse to wear one in public and his campaign has declared them optional at recent public campaign events and rallies.
“Mask mandates delay the need for re-imposing closures of businesses and have huge economic benefits,” said IHME Director Dr. Christopher Murray.
The model anticipates a surge in deaths in September and October, with the IHME noting Tuesday that, “Current data show a strong statistical relationship between Covid-19 transmission and pneumonia seasonality, which is included as a covariate in the model.”
While many of the people infected during the current surge in cases worldwide have been on the younger side, and therefore at lower risk of death, the university warns its current projection could increase if the virus is spread to at-risk populations.
The U.S. is currently experiencing a surge in cases following the easing of social distancing policies, particularly in Southern and Western states, a situation that Dr. Anthony Fauci, the country’s top infectious disease official, characterized as “really not good” during an interview Monday.
CHIEF CRITIC
President Trump, who pushed back against Fauci’s comments on Tuesday. “Well, I think we are in a good place. I disagree with him,”Trump said, according to CNN. “Dr. Fauci said don’t wear masks and now he says wear them. And he said numerous things. Don’t close off China. Don’t ban China. I did it anyway. I didn’t listen to my experts and I banned China. We would have been in much worse shape.”
BIG NUMBER
57,718. That’s the new daily record for confirmed cases of Covid-19 in the U.S., reached on July 2, according to the CDC. The toll has been broken several times since June, the previous high coming in early April with 43,438. The U.S. leads the world in cases of the coronavirus with 2,981,602, as well as reported deaths with 131,248.
TANGENT
Both Fauci and Murry at the IHME agree that the U.S. is still deep into its first wave, as exemplified by Texas, which broke its records for cases, hospitalizations and deaths on Tuesday. Because of the situation, Houston Mayor Sylvester Turner urged Texas’ GOP on Monday to cancel its in-person convention set for next week.
Walmart confirms a new avatar — it’s also a health insurance agency
Walmart confirms a new avatar — it’s also a health insurance agency
Walmart quietly launched a new health insurance business. The company, called Walmart Insurance, was filed with the Arkansas Secretary of State last month.
Walmart is making clear what an executive declared in a virtual conference: that it is firmly in the healthcare business, not just in retail healthcare.
News emerged today that the company is planning to throw its weight around in another healthcare segment in need of an overhaul: insurance. A spokeswoman from the Bentonville, Arkansas retail behemoth confirmed that the company has created “Walmart Insurance Services LLC” to sell insurance policies. The business entity’s name was first filed with the Arkansas Secretary of State in late June.
“We currently offer access to insurance information in our Walmart Health locations, and we have a long-standing education program called Healthcare Begins Here to help people find the right insurance plan for them,” spokeswoman Marilee McInnis wrote in an email. “We’re expanding our current insurance services to now include the sale of insurance policies to our customers.”
A handful of job postings at a call center in the Dallas metro also match up with Walmart Insurance Services, as first pointed out by Talk Business & Politics. Walmart has listings for licensed insurance agents and Medicare sales supervisors.
“Yes, you read that right, Walmart now has an insurance agency,” the listings read.
It looks like the new subsidiary will be focused on selling Medicare Advantage plans, though the company was mum when asked for additional details. The spokeswoman’s statement about the “sale of insurance policies to our customers” also leaves open the possibility of Walmart expanding its services beyond senior shoppers in the future.
Medicare Advantage plans have been experiencing rapid growth in the past decade, with more than a third of all beneficiaries enrolled in a plan managed by a private insurer. That figure is expected to increase in the future.
Deeper into the pharmacy space
Separately, on Tuesday, Walmart announced that it had struck a partnership with PBM startup Capital Rx, which provides health plans real-time information on prescription drug prices.
Walmart has been a big player in the pharmacy space for several years, and the company appears to be deepening that through this partnership.
“‘Everyday low price’ has been a guiding principle at Walmart. We take pride in providing affordable prices to more than 160 million customers who shop Walmart each week,” Walmart Health and Wellness Vice President Luke Kleyn said in a news release. “Working with Capital Rx will allow us to do the same for prescription drugs,”
Capital Rx was founded just over two years ago by AJ Loiacono, a former insurance auditor, with the idea of providing drug prices as part of pharmacy benefit plans.
Loiacono started his career in the pharmaceutical manufacturing industry, where “everything that comes out of that plant has a price.”
When he moved over to the auditing and procurement side, working with payers and self-insured companies, he was shocked to find out that none of their contracts included drug prices. To solve this, the company uses Medicaid’s National Average Drug Acquisition Cost, rather than the average wholesale price, to calculate costs.
As a standalone company, Capital Rx was able to provide price information for retail drugs, but they weren’t able to do the same for mail and specialty drugs. The partnership with Walmart will “complete the model,” with Walmart providing mail and specialty drug fulfillment.
With the partnership, Capital Rx was able to quickly sign on some payers, though it hasn’t yet disclosed which ones.
“Walmart is a diversified company. We liked the fact that they were independent. They’re not part of a PBM or a health system today,” Loiacono said. “The other part of it is, they have scale.”
Loiacono also pointed to similar goals in price transparency — something Walmart emphasized when it shared the cash pay prices for its new health clinics.
“This is what we’re seeing a little bit more of as the future in the roadmap,” Loiacono said. “They’re making a serious investment in healthcare.”
HENRY KOTULA 