JPMorgan wants to bring back 60-minute doctor’s appointments

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https://www.beckershospitalreview.com/disruptors/jpmorgan-wants-to-bring-back-60-minute-doctors-appointments.html?utm_medium=email&utm_content=newsletter

The demise of Haven — a coalition of three big employers aiming to lower the cost of healthcare for their workers — was met with a surprising reaction from Jamie Dimon, CEO of JPMorgan Chase: “We want to do this again.” 

A Dec. 6 report from Bloomberg details some of the aftermath of Haven’s end and also the origins of Morgan Health, the bank’s second go at lowering healthcare costs that was rolled out in spring 2021. While still in its early stages, one tenet of its strategy is a return to basics, including appointments between clinicians and patients that take at least 30 minutes if not an hour.  

Haven was the healthcare partnership formed in 2018 by Amazon, JPMorgan Chase and Berkshire Hathaway with an aim to lower healthcare costs for their 1.2 million workers. It disbanded in 2021. As its end neared, Mr. Dimon set out to learn what had gone wrong. 

When he asked the question of Bill Wulf, MD, CEO of Central Ohio Primary Care, the internist told the businessman the initiative had moved too slowly. A virtual care program drew in only 150 people in Ohio, for example, before it was scrapped. 

Shortly after the debrief with Dr. Wulf, Mr. Dimon assigned a lieutenant to restart the work on lowering employer healthcare costs, this time focusing on JPMorgan Chase alone. That leader was Peter Scher, vice chairman with the bank, who had his doubts at first. “There are a lot of things we could be spending our time on,” he told Bloomberg. “I was perfectly prepared to go back to Jamie and the operating committee and say, ‘Listen, it was a good try.'” 

Mr. Scher stuck with it and brought on Dan Mendelson, founder and former CEO of healthcare advisory group Avalere Health, to lay the groundwork for JPMorgan’s second healthcare attempt. Mr. Mendelson, who had been a skeptic of Haven, spent three months crafting a strategy and playbook that recognized where Haven had fallen short and avoided repeated mistakes. He signed on to lead the group, dubbed Morgan Health. 

The group has made more headlines since its launch than its predecessor Haven, which premiered with much bravado but went nearly a year without releasing any news except for its name and a new website. In fall 2022, Morgan Health opened three advanced primary care centers in Ohio for a total of five and formed a healthcare venture capital team targeting early- to later-stage healthcare companies with innovations in areas like genetic medicine, autoimmune diseases, cardiometabolic diseases and rare disorders. It also hired Cheryl Pegus, MD, Walmart’s executive vice president of health and wellness, as a managing director.

Morgan Health’s strategy is marked by what appears to be common sense and a return to basics, including the placement of clinics in office building atriums — “a full-service practice where employees can develop long-term relationships with primary-care providers, wellness coaches, mental health providers and care coordinators.” 

All appointments are booked for at least 30 minutes with many going an hour, according to Bloomberg. Patients generally see the same practitioner for each visit to build long-term relationships. Clinicians’ payments are tied to goals like avoiding emergency room visits, providing cancer screenings and keeping high blood pressure in check. If it plays out as designed, JPMorgan says the investment in prevention and primary care will curb high-cost services and hospital stays, ultimately leading to meaningful savings.

The goal is to “​​identify high-risk patients and then bubble-wrap them,” Dr. Wulf told Ohio business leaders in an October meeting, Bloomberg reports. “How do we keep you out of the hospital?”

JPMorgan has opened five clinics in the area of Columbus, Ohio, which will also be open to other employers who want to sign on. The clinics and primary care centers are managed and staffed by Vera Whole Health and Central Ohio Primary Care. JPMorgan is seeking “like-minded” medical groups in markets like New York, Chicago and Dallas where it has hubs of workers, Bloomberg reports. 

Walgreens’ VillageMD inks $9B deal to buy Summit Health, marking largest physician deal of the year

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https://www.fiercehealthcare.com/providers/walgreens-villagemd-inks-9b-deal-buy-summit-health-expand-healthcare-footprint

VillageMD, which is majority owned by Walgreens Boots Alliance, plans to shell out nearly $9 billion to pick up medical practice Summit Health, the parent company of urgent care clinic chain CityMD.

The deal, announced Monday morning, is valued at $8.9 billion and includes investments from Walgreens Boots Alliance and Cigna Corp’s healthcare unit Evernorth, which will also become a minority owner in VillageMD. Bloomberg first reported on a potential deal back in late October.

The deal will expand Walgreen’s reach into primary, specialty and urgent care. The transaction creates one of the largest independent provider groups in the U.S., the organizations said. Combined, VillageMD and Summit Health will operate more than 680 provider locations in 26 markets. The two companies will have 20,000 employees.

Walgreens said Monday it will invest $3.5 billion through an even mix of debt and equity to support the acquisition, which is expected to close in the first quarter of 2023. The company will remain the largest and consolidating shareholder of VillageMD with about 53% stake.

Walgreens also raised its fiscal year 2025 sales goal for its U.S. healthcare business to between $14.5 billion and $16 billion from $11 billion to $12 billion previously. That business segment is now expected to achieve positive adjusted EBITDA by the end of fiscal year 2023. 

Last year, Walgreens invested $5.2 billion in VillageMD and said it planned to open at least 600 Village Medical at Walgreens primary-care practices across the country by 2025 and 1,000 by 2027.

The deal comes amid a frenzy of M&A activity in the past two years. Major retailers like CVS, Walgreens and Amazon are ramping up their focus on providing medical services to gain bigger footholds in the healthcare market.

Drugstore rival CVS Health won the bidding war for home health and technology services company Signify Health and plans to shell out $8 billion to acquire the company. Amazon also plans to buy primary care provider One Medical for $3.9 billion.

The M&A move signals that Walgreens wants to become a “dominant entity in the overall healthcare services ecosystem,” according to David Larsen, healthcare IT and digital health analyst at financial services firm BTIG.

“Walgreens Boots Alliance is graduating up from being a drug retail store to owning the life-cycle of members’ health,” he wrote in an analyst’s note. “We view this transaction as being a statement by the market that primary care continues to be one of the key drivers of healthcare long-term.”

The deal also will put additional pressure on CVS Health to break into the primary care business “sooner rather than later,” Larsen wrote. 

“I think at the most strategic level, I think there continues to be recognition that an integrated, coordinated, connected model of care is one that will ultimately deliver the best results. You see this through Optum’s acquisition of Kelsey-Seybold Clinic and VillageMD’s acquisition of Summit Health,” Tim Barry, CEO and chair of VillageMD, said in an interview with Fierce Healthcare.

“If we’re going to ultimately stem the rising tide of this fee-for-service healthcare system, we need a better solution, and that solution needs to have doctors working with other doctors in a coordinated way and trying to solve the unique problems that these patients have and making sure that the right doctors are accessing the patient at the right time, and doing it all underneath the umbrella of a risk-based contract,” Barry said.

He added, “We think that this is going to continue to be where healthcare goes. And, we have to do it in a way that is integrated and value-oriented. Any organization focused on doing that, and doing that at size and scale, is going to continue, I think, to be the successful winners of our healthcare system.”

In 2019, Summit Medical Group, a physician-owned and governed multispecialty group, merged with CityMD, a leading urgent care company in New York City. The combined organization, Summit Health, has more than 370 locations in New Jersey, New York, Connecticut, Pennsylvania and Oregon.

VillageMD provides value-based primary care for patients at traditional free-standing practices, Village Medical at Walgreens practices, at home and via virtual visits. VillageMD and Village Medical have grown to 22 markets and are responsible for more than 1.6 million patients, according to the company.

Barry said the combination of VillageMD and Summit Health-CityMD will enable the organizations to scale up value-based care and build out integrated primary and specialty care services.

“If you look at the long history of Summit Health, it’s an organization that has done some very innovative things. The way that they deliver multispecialty care, it is truly integrated, it’s truly connected and they are known as the preeminent brand in their marketplace. They also have CityMD, which is one of the more unique and differentiated urgent care models out there in the market. They really are a best-of-breed organization,” he said.

“When I look at what we’ve been able to do at VillageMD, we built this incredible model of value-based primary care delivery. The idea of bringing these two organizations together to bring those best-of-breed capabilities under one umbrella was just so compelling. We will soon be able to offer a more comprehensive, integrated and connected model by also offering other specialty services to our patients, but all still done through a value or risk-based reimbursement structure.”

Barry is bullish on the combined capabilities of the two companies in the primary and specialty care markets. 

“We’ll be delivering a consistent value-based model of integrated, multispecialty care in a way that delivers the best clinical results on the planet,” he said.

Jeff Alter, CEO of Summit Health-CityMD, said in a statement that the deal adds Summit Health’s expertise and geographic coverage to VillageMD’s proven value-based primary care approach.

The acquisition also expands Walgreens’ reach into providing medical care directly to patients. “This transaction accelerates growth opportunities through a strong market footprint and wide network of providers and patients across primary, specialty and urgent care,” Roz Brewer, CEO of Walgreens Boots Alliance, said in a statement.

With Cigna’s investment, the combined company will be able to tap into Evernorth’s health services capabilities to potentially lower healthcare costs, Barry said. Evernorth encompasses Cigna’s health services businesses including pharmacy benefit manager Express Scripts  

“In order to be a risk-based provider or a value-based provider, you have to have contracts with a payer that allows you to work in this value or risk-based construct. We learned over the years that Cigna has been a really good partner to us on that journey,” Barry said. 

“There are companies that [Cigna] has purchased over the years that have different specializations and capabilities that we believe ultimately will allow us to deliver better care to our patients,” he noted. “Evernorth has some capabilities tied to behavioral health, and they have some capabilities tied to the management of specialty pharmaceutical spend, which everyone knows those costs continue to be soaring. We both liked the idea of supporting an organization like ours that’s going to continue to grow and continues to be focused on risk and value.”

With the investment in VillageMD and Summit Health, Cigna gets a leg up in the primary care space as it looks to build out its Evernorth division.

“Our collaboration with VillageMD accelerates our efforts to improve the way care is accessed and delivered,” said Eric Palmer, CEO of Evernorth, in a statement. “Harnessing the breadth of Evernorth’s health services capabilities and connecting them with physicians who provide care in a value-based model like VillageMD, helps more people to get the right care at the right time—driving better health and value.” 

More large employers and unions turn to Medicare Advantage to offer retiree health benefits

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https://www.fiercehealthcare.com/payers/kff-more-large-employers-and-unions-turn-medicare-advantage-offer-retiree-health-benefits

More and more employer and union-sponsored retiree health plans are offering Medicare-eligible coverage through Medicare Advantage (MA), a new analysis finds. 

The analysis from the Kaiser Family Foundation, released Thursday, comes as MA is expected to surpass traditional Medicare in total enrollment for 2023 and more insurers enter the lucrative market. Employers and unions are turning to MA in a bid to control retiree healthcare costs. 

“For some large employers, the shift to Medicare Advantage appears to be a strategy to maintain benefits for their retirees, without terminating coverage or adopting other changes that more directly shift costs onto retirees,” the analysis said. “However, the shift to Medicare Advantage has implications for retirees that extend beyond supplemental benefits.”

Kaiser relied on data from its 2022 employer health benefits survey of large private and nonfederal public employers. It showed that half of the large employers with 200 or more workers are offering health benefits to retirees through an MA contract, nearly double the 26% doing the same in 2017. Another 44% that offer MA coverage to retirees don’t give them another choice in coverage. 

Among the companies with 2,000 or more employers, 60% offered benefits through an MA plan. The top reason such companies turn to MA is to combat higher costs, with 42% citing it as a reason compared with 14% for flexibility for enrollees. 

Unlike traditional Medicare, MA relies on provider networks and cost management tools to cut down on costs. Kaiser warned that this shift toward MA has some unintended consequences for retirees. 

“This approach has potential to restrict retirees’ access to doctors and hospitals, depending on the plan’s provider network, and subject retirees to cost management tools, such as prior authorization, that may limit access to Medicare-covered services,” the analysis said. 

Kaiser cited a recent move by New York City to move its city worker retirees to an MA plan, a decision that is on hold after the insurers Elevance Health and Empire Blue Cross Blue Shield dropped out, according to a published report on The City news site. 

The MA market has grown in popularity among seniors in recent years. The program has also received heightened scrutiny surrounding overpayments to plans based on inaccurate risk scores and aggressive marketing tactics by agents and brokers.

Will health systems see the usual end-of-year spike in elective care? 

Posted on by • Posted in Elective Care, Elective Care Demand, Elective Health Conditions, Elective Procedures, Elective Surgery, Health Insurance Coverage Adequacy, High Deductible Health Plans, Labor Shortages, Labor Spend Management, Operating Expenses, Operating Income, Operating Margin, Operating Metrics, Operating Performance, Operating Revenue, Operating Room, Out of Pocket Expenses, Underinsured • Leave a comment

https://mailchi.mp/0622acf09daa/the-weekly-gist-december-2-2022?e=d1e747d2d8

2022 has disproven the old trope that “healthcare is recession-proof”. With the average family deductible nearing $4,000, a significant portion of healthcare services are exposed to consumer concerns about affordability. Reflecting the impact of the recession, health systems nationwide have reported sluggish volumes, particularly for elective cases, in the second half of the year.

One COO recently shared, “We’re 15 percent off where we expected to be on elective cases…We didn’t see the usual pick-up in early fall, after summer vacation. I’m not sure if it’s related to the economy, or whether demand changed during COVID, but this decline has eroded any possibility of a positive margin for the quarter.” The recession hit just as providers mostly finished working through the backlog of cases delayed by COVID in 2020 and 2021. 

To determine whether demand declines are related to the current economic environment, or signal real shifts in care patterns, health systems are looking closely to see if the usual end-of-year swell of demand for elective care materializes, as patients max out their deductibles. But even if the demand is there, some systems are worried about being able to accommodate it: “We’ve been so short-staffed for nurses and surgical techs, we’ve had to intermittently take some ORs and units offline…If we get a big December spike in elective care, I’m not sure we’ll have the staff to accommodate it.” Facing the triple threat of sky-high costs, sluggish demand, and a worsening payer environment, the ability to accommodate this demand will be critical to securing margins as providers move into 2023. 

Many insured Americans still struggle to afford care 

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https://mailchi.mp/0622acf09daa/the-weekly-gist-december-2-2022?e=d1e747d2d8

Driven by the steady progress of Medicaid expansion and pandemic-era policies to ensure access to health insurance coverage, the US uninsured rate hit an all-time low of 8 percent in early 2022. Since the Affordable Care Act passed in 2010, the US uninsured rate has been cut in half, with the largest gains coming from Medicaid expansion. 

However, using data from Commonwealth Fund, the graphic below illustrates how this noteworthy achievement is undermined by widespread underinsurance, defined as coverage that fails to protect enrollees from significant healthcare cost burdens. A recent survey of working-age adults found that eleven percent of Americans experienced a coverage gap during the year, and nearly a quarter had continuous insurance, but with inadequate coverage. 

High deductibles are a key driver of underinsurance, with average deductibles for employer-sponsored plans around $2,000 for individuals and $4,000 for families. 

Roughly half of Americans are unable to afford a $1,000 unexpected medical bill. Americans’ healthcare affordability challenges will surely worsen once the federal COVID public health emergency ends, because between 5M and 14M Medicaid recipients could lose coverage once the federal government ends the program that has guaranteed continuous Medicaid eligibility. 

The process of eligibility redeterminations is sure to be messy—while some Medicaid recipients will be able to turn to other coverage options, the ranks of uninsured and underinsured are likely to swell.

More health systems are charging patients to message their physicians

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https://mailchi.mp/0622acf09daa/the-weekly-gist-december-2-2022?e=d1e747d2d8

 A growing number of health systems have begun to bill for certain electronic communications with patients via portals like MyChart. The systems instituting these practices, including Cleveland Clinic and Chicago-based Northwestern Medicine, have justified the billing based on the time demands placed on their providers to answer messages involving additional efforts, including extensive patient chart review. Northwestern shared that fewer than one percent of MyChart messages incurred fees, which are typically covered by insurance, and require patient consent before billing. 

The Gist: In a time of significant margin pressure, we understand the instinct to seek additional revenue by collecting whatever reimbursement is available. However, in the ongoing transition to technology-enabled hybrid care, this practice has the potential to confuse, or even drive away, patients, who finally began to embrace virtual provider communication during the pandemic. 

Viewing portal messaging as a “digital front door” for patients, rather than a revenue-generating service in and of itself, may prove more fruitful in the long run.

Hospice Industry Awash with For-Profit Bad Actors

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https://mailchi.mp/0622acf09daa/the-weekly-gist-december-2-2022?e=d1e747d2d8

An unsparing piece published this week in the New Yorker examines the unscrupulous and exploitative practices of AseraCare and several other for-profit hospice providers, who have gone from controlling 30 percent of the hospice market to more than 70 percent across the last decade. The article outlines the companies’ playbook of delivering the least amount of care to the greatest number of patients, many of whom are not actually in need of hospice services at all.

In order to game Medicare’s policy to extract repayments from hospice providers whose average patient stay exceeds six months, many of these companies have employed strategies ranging from recruiting “last breath” patients from oncologists to lower their average length of stay, to “graduating” an absurd 70 percent of enrolled patients once they reach their six-month limit. 

The Gist: While it only takes a few bad apples spoil the bunch, the US hospice industry appears to be in a thoroughly rotten state. Caring for the elderly and dying is already a difficult (and expensive) proposition, and the questionable practices detailed in this piece further undermine the good work being done by those providers committed to helping patients and their families during extraordinarily difficult times. 

Currently subject to only minimal federal oversight, the hospice industry is in dire need of stronger regulation, which might take its cue from California, which recently issued a licensing moratorium for hospice providers while redesigning its auditing process.

Twitter no longer policing COVID misinformation

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https://mailchi.mp/0622acf09daa/the-weekly-gist-december-2-2022?e=d1e747d2d8

Amid a flurry of policy changes initiated by Elon Musk since his takeover of the social media company last month, Twitter has ceased its formal efforts to combat COVID misinformation. To date, Twitter had removed over 100K posts for violating its COVID policy. The company will now rely on its users to combat disinformation through its “Birdwatch” program, which lets users rate the accuracy of tweets and submit corrections. Many of the 11K accounts suspended for spreading COVID misinformation, including those of politicians like Rep. Marjorie Taylor Greene (R-GA), have also been reinstated. 

The Gist: We’ve seen the damage caused by inaccurate or deliberately misleading COVID information, which has likely played a role in the US’s lower vaccination rates compared to other high-income countries. Around one in five Americans use Twitter, far fewer than Facebook or YouTube, but the platform is seen as highly influential, both for the reach of its content and also its moderation decisions. 

This policy change is worrisome, not only because COVID is still taking the lives of hundreds of Americans daily, but also because COVID misinformation catalyzes broader healthcare misinformation, including antivax sentiments and an overall mistrust of medical experts.

U.S. economy adds 263,000 jobs in November

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https://www.axios.com/2022/12/02/jobs-report-november?stream=top&utm_source=alert&utm_medium=email&utm_campaign=alerts_all

The jobs market stayed strong last month: Employers added 263,000 jobs, while the unemployment rate held at 3.7%, near the lowest level in a half-century, the Labor Department said on Friday.

Why it matters: The figures are the latest signal of a roaring labor market that continues to defy fears of a recession.

  • November’s payroll gains are above the addition of 200,000 jobs that economists had expected.

By the numbers: Job growth last month was slightly slower than the 284,000, added in October, which was revised up by 23,000. In September, the economy added 269,000 jobs, 46,000 fewer than initially estimated.

  • Average hourly earnings, a measure of wage growth, rose by 0.6% in November — faster than the prior month, when earnings rose by 0.5%. Over the past year ending in November, average hourly earnings increased by 5.1%.
  • The share of people working or looking for work, known as the labor force participation rate, ticked down to 62.1%, compared to 62.2% in October.

The backdrop: Economists have been bracing for cracks in the labor market that have yet to appear.

  • It has been an ugly stretch for layoffs in a handful of sectors like technology, with large-scale job cuts announced at Meta, Amazon and Twitter.

But overall, the booming job market has continued for workers, even in the face of ultra-aggressive efforts by the Federal Reserve to try to cool demand for labor to help put a lid on inflation.

  • Last month, Fed chair Jerome Powell said that employers bidding up wages to attract workers is not “the principal story of why prices are going up.”
  • Still, the labor market may point to clues about how inflation will evolve in certain categories, including industries within the services sector where wages make up the biggest costs for businesses, Powell said on Wednesday.

Virus roundup: There are new dominant Covid-19 strains in the US

Posted on by • Posted in Coronavirus, Coronavirus Mutation, Coronavirus Omicron Subvariant BQ.1, Coronavirus Omicron Subvariant BQ.1.1, Infectious Virus, Monkeypox, Personal Protective Equipment (PPE), Public Health • Leave a comment
https://www.advisory.com/daily-briefing/2022/11/28/virus-roundup?utm_source=member_db&utm_medium=email&utm_campaign=2022Nov28&utm_content=member_headline_final_x_x_x_x&elq_cid=4838956&

Monkeypox cases in women and non-binary people may be getting misdiagnosed as sexually transmitted infections (STIs), daily Covid-19 hospital admissions are expected to increase for the first time since July, and more in this week’s roundup of monkeypox and Covid-19 news.

Monkeypox:

  • Monkeypox may be getting misdiagnosed as STIs in women and non-binary people, according to a new study published in The Lancet. For the study, researchers gathered data from 69 cisgender women, 62 transgender women, and five nonbinary people assigned female at birth with confirmed monkeypox cases between May 11 and Oct. 4 across 15 countries. The study found that 73% of monkeypox infections among this group were likely acquired from sexual contact. While nearly all monkeypox infections among trans women were likely acquired through sexual contact, roughly 24% of cis women and nonbinary people were believed to have acquired an infection outside of sexual contact, such as household or occupational exposure, according to the researchers. In addition, the researchers found that around 33% of cisgender women were misdiagnosed before being diagnosed with monkeypox—and almost half received a delayed diagnosis. “It’s very likely that infections have been missed and not picked up at all,” said Chloe Orkin, a physician and researcher at Queen Mary University of London. “The lesson here is that everybody needs to know about this,” Orkin noted. While public health messages have been primarily directed toward men who have sex with men, “it’s important to recognize this is not the only group,” she added. (Mandavilli, New York Times, 11/21; Hart, Forbes, 11/17)

Covid-19:

  • CDC is forecasting an uptick in Covid-19 hospitalizations for the first time since July, according to national disease modeling. In the coming weeks, CDC’s ensemble forecast from 15 modeling groups is projecting a nationwide increase in daily Covid-19 hospital admissions, with a forecasted 2,000 to 9,000 new daily admissions on Dec. 9. As of Nov. 11, the seven-day average of new hospital admissions for Covid-19 was 3,330—a slight decrease from 3,374 the previous week. In addition, modeling from Mayo Clinic is projecting a 51.5% increase in daily Covid-19 cases over next two weeks, with average daily cases projected to increase from 37,912.7 cases on Nov. 18 to 57,441 on Dec. 2. However, CDC’s ensemble forecast from 13 modeling groups projects that Covid-19 deaths will remain stable or follow an uncertain pattern over the next month. (Bean, Becker’s Hospital Review, 11/21)
  • Earlier this month, omicron subvariants BQ.1 and BQ.1.1 surpassed BA.5 as the dominant strains of the coronavirus in the United States. Currently, BA.5 accounts for roughly 25% of new Covid-19 cases, and BQ.1 and BQ.1.1 account for an equal proportion of around 48% of cases. As BQ.1 and BQ.1.1 become more dominant, many experts are voicing concern over low vaccine uptake and evidence that suggests the dominant strains are not as susceptible to current treatments. For instance, FDA earlier this month updated its guidance for two monoclonal antibody treatments—bebtelovimab and Evusheld—warning that BQ.1 and BQ.1.1 showed significant declines in susceptibility to the treatments. (Choi, The Hill, 11/18)
  • A new study published in JAMA Network Open found that almost 15% of 62,525 hospitalized Covid-19 patients had a medical contradindication after taking Paxlovid’s antiviral combination of nirmatrelvir and ritonavir. To evaluate Paxlovid eligibility among hospitalized Covid-19 patients, researchers used a list of individual contraindications created by FDA. The patients were hospitalized in Paris University hospitals between Jan. 24, 2020, and Nov. 30, 2021. In total, over 9,100 patients—or 14.6%—experienced a medical contraindication to Paxlovid, making the treatment inadvisable. Notably, contraindication rates were higher among men (18%) than in women (11.3%). Among older patients, contradiction rates were 26.9%. “The most prevalent contraindications were severe kidney impairment and use of medications dependent on CYP3A for clearance,” researchers said.