The digital health company Babylon recently completed a deal to acquire health kiosk manufacturer Higi Health, followed by an announcement this week that it is also buying episodic care management company DaytoDay Health. London-based Babylon, which went public last October, has moved quickly into the US market, acquiring two independent physician associations in California last year, and expanding its at-risk Medicaid contracts across five states.
The Gist: Babylon has long rejected being called a “virtual care” or “telehealth” company in favor of being called a “digital-first value-based care” company. It now claims to manage more than 350,000 lives worldwide, which are the driving force behind its strong financials.
We’d expect Babylon and other digital-first companies to seek out avenues to “own” attributable lives, as pure-play telemedicine services become increasingly commoditized.
This week the Biden Administration unveiled actions to make at-home COVID tests and N95 masks available, free of charge, to hundreds of millions of Americans. However, even as US COVID hospitalizations have now surpassed last winter’s previous peak, two newly-approved COVID antiviral drugs remain scarce. Just as fast as Omicron has surged across the country, it may be starting to recede, with cases beginning to drop in several states in the Northeast. Modelers now project the incredibly contagious variant will infect 40 percent of Americans and more than half the human race by the end of March.
The Gist:Absent another significant variant, experts are cautiously optimistic that enough of the US population will soon have either infection-acquired or vaccine-induced immunity that we may be nearing the end of the pandemic, and the beginning of “endemic COVID.”
The US must now shift from COVID “war footing” to learning how to live with the virus long term. That will mean tackling difficult and politically-charged decisions, such as what level of testing and masking are sustainable, and how many COVID deaths we are willing to tolerate.
Net prices of brand-name drugs have increased significantly over the last decade. But savings from generics have driven average prescription prices down in Medicare and Medicaid, Axios’ Caitlin Owens writes about a new analysis by the Congressional Budget Office.
Why it matters: The analysis reiterates that the generic market is largely working as it’s intended to.
By the numbers: The average net price of a prescription fell from $57 in 2009 to $50 in 2018 in Medicare Part D, and from $63 to $48 in Medicaid.
The drop is largely attributable to the growing use of generics, which jumped from 75% to 90% of all prescriptions nationally during that time frame. The average price for a generic prescription also fell in both programs.
But the average net brand-name prescription price more than doubled in Part D and increased by 50% in Medicaid, per the analysis. These increases were driven by higher launch prices for new drugs and price increases for drugs already on the market.
The second year of the pandemic did not dampen UnitedHealth Group’s finances, and the company actually surpassed its initial 2021 revenue and profit projections, Bob writes.
The big picture: UnitedHealth’s revenue has tripled from 2010 to 2021, and profit has almost quadrupled. The company continues to make more of its money from owning doctor groups and controlling pharmacy benefits instead of relying on health insurance.
Workers in New Jersey healthcare facilities and high-risk congregate settings like hospitals and nursing homes will be required to be up to date with their COVID-19 vaccinations, including a booster, Gov. Phil Murphy announced Jan. 19.
Mr. Murphy said there would no longer be an option to opt out of vaccination through testing, except for the purposes of providing an accommodation for people exempt from vaccination.
New Jersey healthcare facilities’ covered workers subject to the CMS vaccination mandate for healthcare settings were already required to ensure covered employees received at least one vaccine by Jan. 27 and completed their primary vaccine series by Feb. 28. Mr. Murphy said the state is now requiring proof that these workers are up to date with their vaccination by Feb. 28, which also includes any booster shots for which they are eligible. Noncompliant workers risk losing their jobs.
Workers at covered healthcare settings not subject to the CMS mandate and covered high-risk congregate settings like prisons and jails have until Feb. 16 to receive their first dose of the primary vaccine series and must submit proof that they are up to date with their vaccination by March 30. Mr. Murphy said workers who become newly eligible for a booster after the two deadlines must submit proof of their booster shot within three weeks of becoming eligible.
“With the highly transmissible omicron variant spreading across the country and New Jersey, it is essential that we do everything we can to protect our most vulnerable populations,” Mr. Murphy said in a news release. “With immunity waning approximately five months after a primary COVID-19 vaccination, receiving a booster dose is necessary to protect yourself and those around you. It is critically important that we slow the spread throughout our healthcare and congregate settings in order to protect our vulnerable populations and the staff that care for them.”
The rule in New Jersey, which was issued through an executive order, comes after New York and California also announced booster requirements for healthcare staff.
Omicron and staffing constraints pushed hospitals and health systems to once again suspend nonurgent, elective procedures — a move that hurts patients and their care teams.
Physicians told The Washington Post that notifying patients of their surgeries being postponed is one of the most difficult things they do during the pandemic, and the idea of prolonging patients’ suffering is anguishing. In interviews, a patient rated the pain he felt from a ruptured cervical disk — for which his surgery has been indefinitely postponed at Mercy Health-St. Rita’s Medical Center in Lima, Ohio — as a 12 out of 10.
In addition to extended pain, pushed back surgeries leave more time for disease advancement. Certain cancers can advance to later stages in four to eight weeks, for instance. Even procedures considered low acuity, such as joint replacements or bariatric cases, will have material implications from delays through reduced activity, mobility and quality of life for patients. Delays in surgery have also been shown to result in higher rates of surgical site infections.
“I’d say it’s a bona fide mess right now,” Kenneth Kaufman, chair and founding partner of Kaufman Hall, told The Washington Post. “We seem to be back to square one. Omicron has significantly compounded staffing shortages in a very profound way.”
Hospitals hit pause on surgeries over the last several weeks as growing COVID-19 inpatient volumes were compounded by omicron sidelining healthcare professionals infected with the virus. Vaccinated healthcare professionals experienced mild breakthrough cases that temporarily took them out of the workforce.
Cleveland Clinic has extended its postponement of elective surgeries four times over the past month as thousands of employees were sidelined from COVID-19 infection. Hospitals in New York, Chicago, St. Louis, Washington and Virginia are among those that have either moved back surgeries or complied with government officials’ requests to do so in January.
Healthcare professionals have taken issue with the industry term “elective,” which does not describe the acuity of the medical condition or necessity of the procedure. Rather, the use of “elective” distinguishes these surgeries that are scheduled in advance from emergency surgeries, such as trauma cases.
University of Utah Hospital in Salt Lake Citypostponed about 20 percent of its surgeries when at least 500 clinical and nonclinical employees were out sick or isolating from COVID-19 at the start of the month.
“Around Christmastime and the week after Christmas, we didn’t have to reschedule any operations for a period of three weeks, until January 1. Then the wheels came off,” Robert E. Glasgow, MD, interim chair of the hospital’s surgery department, told The Washington Post.
On Jan. 14, the physicians at the hospital learned they could accommodate six additional surgery cases Jan. 18, leaving them in a mad dash to identify priority patients and determine who could present for surgery with less than four days’ notice.
“How can we find six cases that are most in need and are most able to come?” said Dr. Glasgow said.
Beaufort (S.C.) Memorial Hospital has created a homebuyer assistance program to help staff purchase a home or refinance mortgages, with up to $10,000 in assistance.
To be eligible for the program, employees must be full time, have worked at the hospital for at least six months, attend a homebuyer education workshop and meet household income requirements, among other criteria, according to a Jan. 10 news release from the hospital.
Additionally, properties must be within a 15-mile radius of a designated Beaufort Memorial campus, be the buyer’s primary residence and have monthly mortgage payments of no more than 33 percent of monthly income.
Recipients can use the funds for down payments and closing costs, the release said.
The hospital is partnering with development financial institution CommunityWorks for the program.
“We know that homeownership provides stability, security and a means to building financial health and wealth for future generations,” Beaufort Memorial President and CEO Russell Baxley said. “We also recognize that a major obstacle can be coming up with the money needed for a down payment or closing costs. This assistance program will help our employees bridge that financial gap.”
The latest Omicron developments continue to be encouraging. New Covid-19 cases are plummeting in a growing list of places. The percentage of cases causing severe illness is much lower than it was with the Delta variant. And vaccines — particularly after a booster shot — remain extremely effective in preventing hospitalization and death.
I also think it’s time to begin considering what life after the Omicron wave might look like.
1. Plunging cases
Since early last week, new cases in Connecticut, Maryland, New Jersey and New York have fallen by more than 30 percent. They’re down by more than 10 percent in Colorado, Florida, Georgia, Massachusetts and Pennsylvania. In California, cases may have peaked.
“Let’s be clear on this — we are winning,” Mayor Eric Adams of New York said yesterday. Kathy Hochul, the governor of New York State, said during a budget speech, “We hope to close the books on this winter surge soon.”
If anything, the official Covid numbers probably understate the actual declines, because test results are often a few days behind reality.
The following data comes from Kinsa, a San Francisco company that tracks 2.5 million internet-connected thermometers across the country. It uses that data to estimate the percentage of Americans who have a fever every day. The declines over the past week have been sharp, which is a sign of Omicron’s retreat:
Many hospitals are still coping with a crushing number of patients, because Covid hospitalization trends often trail case trends by about a week. But even the hospital data shows glimmers of good news: The number of people hospitalized with Covid has begun declining over the past few days in places where Omicron arrived first:
The U.S. seems to be following a similar Omicron pattern as South Africa, Britain and several other countries: A rapid, enormous surge for about a month, followed by a rapid decline — first in cases, then hospitalizations and finally deaths.
Some of the clearest research on Covid’s risks comes from a team of British researchers led by Dr. Julia Hippisley-Cox of the University of Oxford. The team has created an online calculator that allows you to enter a person’s age, vaccination status, height and weight, as well as major Covid risk factors. (It’s based on an analysis of British patients, but its conclusions are relevant elsewhere.)
A typical 65-year-old American woman — to take one example — is five foot three inches tall and weighs 166 pounds. If she had been vaccinated and did not have a major Covid risk factor, like an organ transplant, her chance of dying after contracting Covid would be 1 in 872, according to the calculator. For a typical 65-year-old man, the risk would be 1 in 434.
Among 75-year-olds, the risk would be 1 in 264 for a typical woman and 1 in 133 for a typical man.
Those are meaningful risks. But they are not larger than many other risks older people face. In the 2019-20 flu season, about 1 out of every 138 Americans 65 and older who had flu symptoms died from them, according to the C.D.C.
And Omicron probably presents less risk than the British calculator suggests, because it uses data through the first half of 2021, when the dominant version of Covid was more severe than Omicron appears to be. One sign of Omicron’s relative mildness: Among vaccinated people in Utah (a state that publishes detailed data), the percentage of cases leading to hospitalization has been only about half as high in recent weeks as it was last summer.
For now, the available evidence suggests that Omicron is less threatening to a vaccinated person than a normal flu. Obviously, the Omicron wave has still been damaging, because the variant is so contagious that it has infected tens of millions of Americans in a matter of weeks. Small individual risks have added up to large societal damage.
3. Effective boosters
The final major piece of encouraging news involves booster shots: They are highly effective at preventing severe illness from Omicron. The protection is “remarkably high,” as Dr. Eric Topol of Scripps Research wrote.
Switzerland has begun reporting Covid deaths among three different groups of people: the unvaccinated; the vaccinated who have not received a booster shot; and the vaccinated who have been boosted (typically with a third shot). The first two shots still provide a lot of protection, but the booster makes a meaningful difference, as Edouard Mathieu and Max Roser of Our World in Data have noted:
The next stage
The Covid situation in the U.S. remains fairly grim, with overwhelmed hospitals and nearly 2,000 deaths a day. It’s likely to remain grim into early February. Caseloads are still high in many communities, and death trends typically lag case trends by three weeks.
But the full picture is less grim than the current moment.
Omicron appears to be in retreat, even if the official national data doesn’t yet reflect that reality. Omicron also appears to be mild in a vast majority of cases, especially for the vaccinated. This combination means that the U.S. may be only a few weeks away from the most encouraging Covid situation since early last summer, before the Delta variant emerged.
If that happens — and there is no guarantee it will, as Katherine Wu of The Atlantic explains — it will be time to ask how society can move back toward normalcy and reduce the harsh toll that pandemic isolation has inflicted, particularly on children and disproportionately on low-income children.
When should schools resume all activities? When should offices reopen? When should masks come off? When should asymptomatic people stop interrupting their lives because of a Covid exposure? Above all, when does Covid prevention do more harm — to physical and mental health — than good?
These are tricky questions, and they could often sound inappropriate during the Omicron surge. Now, though, the surge is receding.
HENRY KOTULA 