Hospitals are dropping Medicare Advantage left and right

Posted on by • Posted in Accounts Receivable (AR), Administrative Burden, Cash-Flow Improvements, Health Insurance Industry, Health System, Hospital, Hospital Industry, Medicare Advantage, Medicare Advantage Contract Terms, Medicare Denials, Rev Cycle Management, Revenue Cycle • Leave a comment

https://www.beckershospitalreview.com/finance/hospitals-are-dropping-medicare-advantage-left-and-right.html

Medicare Advantage provides health coverage to more than half of the nation’s seniors, but a growing number of hospitals and health systems nationwide are pushing back and dropping the private plans altogether.

Among the most commonly cited reasons are excessive prior authorization denial rates and slow payments from insurers. Some systems have noted that most MA carriers have faced allegations of billing fraud from the federal government and are being probed by lawmakers over their high denial rates.

“It’s become a game of delay, deny and not pay,” Chris Van Gorder, president and CEO of San Diego-based Scripps Health, told Becker’s.

“Providers are going to have to get out of full-risk capitation because it just doesn’t work — we’re the bottom of the food chain, and the food chain is not being fed.” 

In late September, Scripps began notifying patients that it is terminating Medicare Advantage contracts for its integrated medical groups, a move that will affect more than 30,000 seniors in the region. The medical groups, Scripps Clinic and Scripps Coastal, employ more than 1,000 physicians, including advanced practitioners. 

Mr. Van Gorder said the health system is facing a loss of $75 million this year on the MA contracts, which will end Dec. 31 for patients covered by UnitedHealthcare, Anthem Blue Cross, Blue Shield of California, Centene’s Health Net and a few more smaller carriers. The system will remain in network for about 13,000 MA enrollees who receive care through Scripps’ individual physician associations.

“If other organizations are experiencing what we are, it’s going to be a short period of time before they start floundering or they get out of Medicare Advantage,” he said. “I think we will see this trend continue and accelerate unless something changes.”

Bend, Ore.-based St. Charles Health System has taken it a step further and is not only considering dropping all Medicare Advantage plans, but is also encouraging its older patients not to enroll in the private Medicare plans during the upcoming enrollment period in October.

The health system’s president and CEO, CFO and chief clinical officer cited high rates of denials, longer hospital stays and overall administrative burden for clinicians.

“We recognize changing insurance options may create a temporary burden for Central Oregonians who are currently on a Medicare Advantage plan, but we ultimately believe it is the right move for patients and for our health system to be sustainable into the future to encourage patients to move away from Medicare Advantage plans as they currently exist,” St. Charles Health CFO Matt Swafford said.

“I feel terrible for the patients in this situation; it’s the last thing we wanted to do, but it’s just not sustainable with these kinds of losses,” Mr. Van Gorder added. “Patients need to be aware of how this system works. Traditional Medicare is not an issue. With these other models, seniors need to be wary and savvy buyers.”

Here are six more recent examples of hospitals dropping Medicare Advantage contracts:

1. Adena Regional Medical Center is terminating its contract with Anthem BCBS’ Medicare Advantage and managed Medicaid plans in Ohio, effective Nov. 2. The flagship facility of Chillicothe, Ohio-based Adena Health System said rate negotiations between the organizations “have not been productive,” leading it to terminate its agreement with Anthem, whose parent company is Elevance Health.

2. Corvallis, Ore.-based Samaritan Health Services ended its commercial and Medicare Advantage contracts with UnitedHealthcare. The five-hospital, nonprofit health system cited slow “processing of requests and claims” that have made it difficult to provide appropriate care to UnitedHealth’s members, which will be out of network with Samaritan’s hospitals on Jan. 9. Samaritan’s physicians and provider services will be out of network on Nov. 1, 2024. 

3. Cameron (Mo.) Regional Medical Center stopped accepting Cigna’s MA plans in 2023 and plans to drop Aetna and Humana in 2024. It plans to continue Medicare Advantage contracts with UnitedHealthcare and BCBS, the St. Joseph News-Press reported in May. Cameron Regional CEO Joe Abrutz previously told the newspaper the decision stemmed from delayed reimbursements.

4. Stillwater (Okla.) Medical Center ended all in-network contracts with Medicare Advantage plans amid financial challenges at the 117-bed hospital. Humana and BCBS of Oklahoma were notified that their MA members would no longer receive in-network coverage after Jan. 1, 2023. The hospital said it made the decision after facing rising operating costs and a 22 percent prior authorization denial rate for Medicare Advantage plans, compared to a 1 percent denial rate for traditional Medicare.

5. Brookings (S.D.) Health System will no longer be in network with any Medicare Advantage plans in 2024, the Brookings Register reported. The 49-bed, municipally owned hospital said the decision was made to protect the financial sustainability of the organization. 

6. Louisville, Ky.-based Baptist Health Medical Group went out of network with Humana’s Medicare Advantage and commercial plans on Sept. 22, Fox affiliate WDRB reported.

Listening and Learning

Posted on by • Posted in Blood Test, Board, Imperative, Leadership, Leadership Culture, Leadership Learning, Leadership Listens, Leadership Vision, Learning, Learning Critical, Learning Systems, Strategy, Strategy and Transformation, Thought Platform • Leave a comment
https://www.kaufmanhall.com/insights/thoughts-ken-kaufman/healthcare-organizational-thought-platform?utm_source=mkto&utm_campaign=ken-weekly-blog&utm_medium=em&utm_term=231004&mkt_tok=NjU0LUNOWS0yMjQAAAGOmfYfjNcEKZN4LsbxaaDgp9L2ca6QT7CPo1ssHqCrrqIJwKqdH4wwHgcV9CIebWu6slcj9TbqCi64weMHKALrkZt0OKNiUvl4rBMjSxL9B10V

Something I have been writing about and speaking about recently is how difficult it is to operate a hospital in post-Covid America.

The line-up of management and governing obstacles includes both old and new healthcare issues:

  • Financial instability
  • Ongoing labor disruption
  • Remnants of significant healthcare inflation
  • Payer chaos
  • A continuing pivot from inpatient to outpatient services
  • The endless introduction of alternative care options (CVS, Walgreens, Walmart, Amazon, and now Costco)

It takes considerable hard thinking within executive suites to figure out the best way forward; to find the best roadmap through—at a minimum—the six obstacles outlined above. And as I have noted in my recent speaking engagements, a solution to one of these obstacles might actually make others of these obstacles more difficult to solve.

I have in recent weeks been looking for a “thought platform” that can assist hospital C-suite executives in resetting managerial expectations and operational initiatives—expectations and initiatives that can more effectively cope with the current and distressingly difficult environment.

Moving the hospital organizational thought platform from its 2019 managerial themes to a more relevant platform that better suits the challenges of 2023 is a managerial problem all of its own. Simply telling a large and very complex healthcare organization to stop thinking in pre-Covid terms is not likely to accomplish much. Before you can establish the organizational thought platform that best guides your hospital forward, you will need a leadership team that is committed to creating a “listening and learning” healthcare company.

A good tool for making your way to a listening and learning organization and eventually to a new and more relevant thought platform is the book The First 90 Days: Proven Strategies for Getting Up to Speed Faster and Smarter, by Michael D. Watkins.

Mr. Watkins is a co-founder of Genesis Advisers and a professor at the IMD Business School in Lausanne, Switzerland. The First 90 Days was originally published in 2003 as a guide to business executives moving into new senior positions of major responsibility. But the book also contains general management advice which is relevant not only to new jobs, but also to executives struggling with fast-changing and especially difficult market conditions.

One of the most compelling chapters in The First 90 Days is a chapter that focuses on the absolute importance of executive learning and the need to accelerate that learning.

While Professor Watkins was making a general business point, I would suggest that the need to accelerate executive learning and listening was never more important than in the “right now” post-Covid healthcare environment. Professor Watkins posed a series of critical leadership learning questions that I have modified to reflect the complex operating conditions of the 2023 hospital.

From that perspective, here are six critical learning questions for the hospital leadership team:

  1. How effective are you as a hospital leader at learning about your current job and how that current job is changing?
  2. What is your learning agenda for your current assignment? Have your day-to-day responsibilities changed so dramatically that you no longer know what you need to know?
  3. Given questions one and two, how should you go about gaining better insight?
  4. What is the best structure for being a top-flight learner within your organization? Note that this is a question that has both individual and organizational implications.
  5. What support is there within your organization for ongoing day-to-day learning? Note this should not be viewed as “training.” This is how executives “learn” through constant interaction with their changing jobs and changing market conditions. We are headed here not toward “skillsets” but toward “learned strategies and insights.” The difference is material.
  6. Professor Watkins suggests creating a learning agenda that relates directly to an ongoing learning plan. What don’t you know right now and how are you going to learn what you don’t know? And, importantly, how has the healthcare macroeconomy made your job more difficult and why?

One of my last blogs focused on the importance of vision and strategy in the post-Covid hospital recovery process; the importance of reinventing the hospital of the future that best fits into a rapidly changing marketplace. This marketplace requires entirely new skillsets and functions on top of changing shared experiences and perceived social values. Finding the right going-forward strategy and vision is the first imperative.

But without executive learning and listening that leads directly to organizational-wide learning and listening, the chances of finding your way to that highest and best and most effective vision and strategy will be greatly diminished.

Do insurers have a disincentive to help with transitions of care? 

Posted on by • Posted in Average Length of Stay (ALOS), Care Transition, Case Rates, Denial, Denial Rates, Health Insurance Industry, Health System, Hospital, Hospital Industry, Medicare Advantage, Medicare Denials, Post Acute Care, Post Acute Networks • Leave a comment

https://mailchi.mp/b7baaa789e52/the-weekly-gist-september-29-2023?e=d1e747d2d8

A number of health systems have recently noted increasing financial challenges for Medicare Advantage (MA) patient admissions. 

One CFO shared, “our rates from MA plans are roughly on par with fee-for-service Medicare. Denials have always been a problem, making our [revenue] capture about 90 percent. But this year it’s dropped to 80 percent…it’s a crisis for us, given fast how MA volumes are growing.”

His team investigated the change and found the cause: mean length of stay for MA patients has jumped sharply. The rise was almost entirely due to difficulties in discharging patients to rehab and skilled nursing facilities. 

Key insurers have narrowed their postacute networks, resulting in patients spending days waiting for a bed. “The payers told us they had focused the network on ‘high-performing’ providers. Our data and doctors’ experiences say otherwise. They chose a handful of facilities that are cheap, with questionable quality,” their CMO reported. Attempts to engage payers to solve the problem have gone nowhere:

“They have a disincentive to work with us on this. With case rates, they are saving money if patients are languishing in an expensive hospital bed rather than going to rehab.”

This system is exploring expedited placement and expanding their portfolio of home-based care and postacute offerings, while even considering guaranteeing payment themselves. If you’re having similar challenges or have found solutions to help with transitions of care, we’d love to hear from you and learn more. 

Epic expanding its lead on EHR competitors

Posted on by • Posted in Artificial Intelligence, Artificial Intelligence Generative, Cerner, Electronic Health Record (EHR), Epic • Leave a comment

https://mailchi.mp/b7baaa789e52/the-weekly-gist-september-29-2023?e=d1e747d2d8

Two large nonprofit health systems made headlines earlier this month announcing that they plan to transition, enterprise-wide, from Oracle Cerner to Epic for their electronic health record (EHR) system.

Using data from KLAS Research, the graphic below shows how Epic has emerged in recent years as the leader in the hospital EHR market. From 2016 to 2022, Epic increased its acute care hospital market share from 26 percent to 36 percent, while its main rival, Oracle Cerner, held flat at 25 percent.

Moreover, Epic is gaining popularity among larger health systems, while Oracle Cerner lost almost 5K beds in 2022, despite gaining 22 hospitals, as it trades large systems for smaller hospitals. 

Epic’s ability to consolidate multiple archives into a single, more functional platform has made it popular with physicians, whose feedback was cited by Intermountain as a key reason behind the system’s decision to switch. 

With three quarters of Americans having an Epic record, the company is leveraging its pole position in aggregating healthcare data as healthcare approaches the cusp of a generative AI boom, recently announcing an expanded partnership with Microsoft focused on integrating AI tools into its EHR system. 

National Hospital Flash Report: September 2023

Posted on by • Posted in Health System, Hospital, Hospital Industry, Operating Expense Reduction, Operating Expenses, Operating Income, Operating Margin, Operating Metrics, Operating Performance, Operating Revenue • Leave a comment
https://www.kaufmanhall.com/insights/research-report/national-hospital-flash-report-september-2023?utm_source=mkto&utm_campaign=nhfr-report&utm_medium=em&utm_term=september-nhfr-nonsub-231002&mkt_tok=NjU0LUNOWS0yMjQAAAGOkDKy0Li4XKA6Pi3INpSg2IqKztXEWrgPPstuEjEXtx1BYM4bxUp8CV4c7SRSyX0mZpwjEKp50R85MNHygk17ax4yOHplyUGgONIoTFFCsY7R

While hospital operating margins remain below historical levels, overall conditions have stabilized in 2023. The median Kaufman Hall Calendar Year-To-Date Operating Margin Index reflecting actual margins was 1.1% in August.

The September issue of the National Hospital Flash Report covers these and other key performance metrics.

DOWNLOAD REPORT

Click to access KH-NHFR_2023-09.pdf

A health system’s guide to reducing bureaucratic clinician busywork

Posted on by • Posted in Administrative Burden, Artificial Intelligence, Artificial Intelligence Generative, Bureaucratic Burden, Electronic Health Record (EHR), Work Flow, Work Flow Optimization • Leave a comment

https://mailchi.mp/b7baaa789e52/the-weekly-gist-september-29-2023?e=d1e747d2d8

Published this week in the Harvard Business Review, this intriguing case study tells the story of how Hawaii Pacific Health, a four-hospital system based in Honolulu, worked with its providers to reduce the deluge of needless or low-value administrative tasks required each day by the system’s electronic health record (EHR) platform.

The system’s “Get Rid of Stupid Stuff” (GROSS) initiative created a simple, accessible submission form that allowed providers to flag EHR prompts and workflows ranging from inefficient (printing and scanning discharge papers patients had already signed electronically) to nonsensical (affirming adolescent patients had received proper care for their non-existent umbilical cords). Around 10 percent of suggestions submitted were for prompts that could be immediately eliminated, 15 percent caught gaps in communication and workflow, and the remaining 75 percent identified more complex opportunities for redesign. The GROSS initiative not only freed thousands of labor hours, but also boosted morale by engaging clinicians in the system’s efforts to improve operations. 

The Gist: While Hawaii Pacific Health is far from the only system to have successfully engaged its providers in the mission of reducing administrative busywork, this case study provides an example of how sometimes the simplest approaches can be the most effective. 

As systems now look to generative AI as the next frontier of bureaucratic efficiency, they will need to optimize workflow processes before automating them in order to avoid ingraining today’s inefficiencies.

Transcarent unveils new national health system network

Posted on by • Posted in Direct Contracting, Health System, National Health System, Network Design, Transcarent • Leave a comment

https://mailchi.mp/b7baaa789e52/the-weekly-gist-september-29-2023?e=d1e747d2d8

On Tuesday, San Francisco, CA-based healthcare navigation company Transcarent announced ten health systems that will form the initial network for its new direct contracting offering for self-insured employers. The participating health systems include prominent systems like Advocate Health, Intermountain Healthcare, Baylor Scott & White Health, and Mass General Brigham, among others.

Transcarent plans to supplement these care delivery networks with virtual care offerings and digital wraparound services, supported by its recent acquisition of virtual care provider 98point6’s physician portfolio. Transcarent CEO Glen Tullman, who launched the company after selling Livongo to Teladoc in 2020, says the new network’s direct contracting package will guarantee same-day payments to providers and also include value-based incentives. 

The Gist: Transcarent was founded with the stated goal of lowering healthcare costs for employers, so it’s notable that the company is launching this direct contracting network with a group of big-name systems that aren’t all known for being value-oriented or low-cost. 

But these highly sought-after systems may end up forming an appealing “string of pearls” that attracts large employers and consumers to the product. More employers may be enticed to take a look at Transcarent’s direct contracting model, given employer healthcare costs are projected to rise another 7 percent in 2024, after a similar hike in 2023, and competition for talent has begun to soften

—but the ability of the product to deliver value will depend on the incentives and structure of the offering, about which public details are scarce.

For Healthcare, the Debt Limit and Possible Shutdown Further a Shift away from its Status Quo

Posted on by • Posted in Affordability, Health Policy, Healthcare Reform, State of the Union • Leave a comment
https://paulkeckley.com/the-keckley-report/2023/10/2/for-healthcare-the-debt-limit-and-possible-shutdown-further-a-shift-away-from-its-status-quo/

This week, all eyes will be on the U.S. Congress as the clock ticks toward a potential government shutdown. Whether lawmakers reach agreement on a continuing resolution to extend funding for30 to 60 days or the government shuts down at midnight this Saturday, it will have direct negative impact on consumer activities and spending in healthcare.

Background:

A shutdown alone is not apocalyptic for consumers: they’ve weathered 20 shutdowns averaging 8 days each since 1976 and recovered productivity shortfalls within 3-6 months. What’s complicating and most problematic for healthcare is its concurrence with equally threatening events and trends inside and outside healthcare:

  • The resumption of Student Loan debt payments starting in October 1 impacting 900,000 Americans– 90% say they can’t!
  • The probability the Federal Reserve will increase its federal borrowing rate by 25 basis points to 5.50 thus increasing interest costs and consumer prices.
  • The slowdown in GDP growth and increase in fuel costs projected by economists and regulators.
  • Increased workforce-management tension resulting in strikes, walkouts and slowdowns in labor-intense settings like auto manufacturing, nursing homes and hospitals.
  • Medical inflation: technological advancements, increased demand, rising drug prices, expensive medical equipment, and increased administrative costs are contributors. According to the U.S. Bureau of Labor Statistics, prices for medical care are 5,274.47% higher in 2023 vs. 1935 (a $52,744.67 difference in value). Between 1935 and 2023, medical care experienced an average inflation rate of 4.63% per year, but in that period, working-age consumers who are privately insured paid a disproportionate and growing share projected to exceed 10% in 2023.

The health system’s economics are partially protected from shutdowns since funding for the Medicare and Medicaid is somewhat protected. That’s the status quo.

But the confluence of growing bipartisan Congressional antipathy toward the industry vis a vis regulatory reforms (i.e. price transparency, site neutral payments, DOJ-FTC consolidation constraints et al), high profile congressional investigations (i.e. PBMs and drug prices, role of private equity ownership), administrative orders from the White House and Governors (i.e.medical debt, value initiatives, organ procurement et al) and negative publicity challenging community benefits, CEO compensation and fraudulent activities erode the industry’s good will and expose it to unprecedented consumer risks.

Evidence in support of this assessment is substantial as illustrated in the sections that follow. There are no easy solutions. The U.S. health industry status quo is a B2B2P2C (business to business to physician to consumer) industry in which most decisions impacting what consumers ultimately spend for healthcare products and services are made for them, not by them. The direct costs associated with supply chain, technologies, facilities and R&D are closely guarded secrets. Indirect costs, administrative overhead, off balance sheet activities, partnerships and alliances even more.

What’s clear is that every sector in healthcare will be subject to scrutiny through an uncomfortable lens—the consumer. Prices matter. Service matters. Integrity matters. Transparency matters. Ownership matters. Purpose matters. And whether accurate or not, fair or not, comfortable or not, information accessible to consumers is readily accessible.

The shutdown over the debt limit might happen or be diverted. What will not be diverted is growing discontent with the medical system that the majority of consumers believe wasteful, expensive and self-serving.  How the status quo is impacted is anyone’s guess, but it’s a good bet its future is not a cut-and-paste version of its past.

Ryder Cup Lessons for Team USA Healthcare

Posted on by • Posted in Affordability, Health Insurance Coverage Adequacy, Health Policy, Healthcare Reform, Lobbyist, Medical Debt, Mortality, Out of Pocket Expenses, Outcomes, Profit Motive, Public Health, Public Health Strategy, Quality of Care, Quality of Life, Underinsured, Uninsured, Universal Coverage, Universal Healthcare System • Leave a comment
Ryder Cup Lessons for Team USA Healthcare

Saturday, Congress voted overwhelming (House 335-91, Senate 88-9) to keep the government funded until Nov. 17 at 2023 levels. No surprise.  Congress is supposed to pass all 12 appropriations bills before the start of each fiscal year but has done that 4 times since 1970—the last in 1997. So, while this chess game plays out, the health system will soldier on against growing recognition it needs fixing.

In Wednesday night’s debate, GOP Presidential aspirant Nicki Haley was asked what she would do to address the spike in personal bankruptcies due to medical debt. Her reply:

“We will break all of it [down], from the insurance company, to the hospitals, to the doctors’ offices, to the PBMs [pharmacy benefit managers], to the pharmaceutical companies. We will make it all transparent because when you do that, you will realize that’s what the problem is…we need to bring competition back into the healthcare space by eliminating certificate of need systems… Once we give the patient the ability to decide their healthcare, deciding which plan they want, that is when we will see magic happen, but we’re going to have to make every part of the industry open up and show us where their warts are because they all have them”

It’s a sentiment widely held across partisan aisles and in varied degrees among taxpayers, employers and beyond. It’s a system flaw and each sector is complicit.

What seems improbable is a solution that rises above the politics of healthcare where who wins and loses is more important than the solutions themselves.

Perhaps as improbable as the European team’s dominating performance in the 44th Ryder Cup Championship played in Rome last week especially given pre-tournament hype about the US team.

While in Rome last week, I queried hotel employees, restaurant and coffee shop owners, taxi drivers and locals at the tournament about the Italian health system. I saw no outdoor signage for hospitals and clinics nor TV ads for prescriptions and OTC remedies. Its pharmacies, clinics and hospitals are non-descript, modest and understated. Yet groups like the World Health Organization (WHO) and the Organization for Economic Cooperation Development (OECD) rank Servizio Sanitario Nazionale (SSN), the national system authorized in December 1978, in the top 10 in the world (The WHO ranks it second overall behind France).

“It covers all Italian citizens and legal foreign residents providing a full range of healthcare services with a free choice of providers. The service is free of charge at the point of service and is guided by the principles of universal coverage, solidarity, human dignity, and health. In principle, it serves as Italy’s public healthcare system.” Like U.S. ratings for hospitals, rankings for the Italian system vary but consistently place it in the top 15 based on methodologies comparing access, quality, and affordability.

The U.S., by contrast, ranks only first in certain high-end specialties and last among developed systems in access and affordability.

Like many systems of the world, SSN is governed by a national authority that sets operating principles and objectives administered thru 19 regions and two provinces that deliver health services under an appointed general manager. Each has significant independence and the flexibility to determine its own priorities and goals, and each is capitated based on a federal formula reflecting the unique needs and expected costs for that population’s health. 

It is funded through national and regional taxes, supplemented by private expenditure and insurance plans and regions are allowed to generate their own additional revenue to meet their needs. 74% of funding is public; 26% is private composed primarily of consumer out-of-pocket costs. By contrast, the U.S. system’s funding is 49% public (Medicare, Medicaid et al), 24% private (employer-based, misc.) and 27% OOP by consumers.

Italians enjoy the 6th highest life expectancy in the world, as well as very low levels of infant mortality. It’s not a perfect system: 10% of the population choose private insurance coverage to get access to care quicker along with dental care and other benefits. Its facilities are older, pharmacies small with limited hours and hospitals non-descript.

But Italians seem satisfied with their system reasoning it a right, not a privilege, and its absence from daily news critiques a non-concern.

Issues confronting its system—like caring for its elderly population in tandem with declining population growth, modernizing its emergency services and improving its preventive health programs are understood but not debilitating in a country one-fifth the size of the U.S. population.

My take:

Italy spends 9% of its overall GDP on its health system; the $4.6 trillion U.S spends 18% in its GDP on healthcare, and outcomes are comparable.  Our’s is better known but their’s appears functional and in many ways better.

Should the U.S.copy and paste the Italian system as its own? No. Our societies, social determinants and expectations vary widely. Might the U.S. health system learn from countries like Italy? Yes.

Questions like these merit consideration:

Might the U.S. system perform better if states had more authority and accountability for Medicare, CMS, Veterans’ health et al?

Might global budgets for states be an answer?

Might more spending on public health and social services be the answer to reduced costs and demand?

Might strict primary care gatekeeping be an answer to specialty and hospital care?

Might private insurance be unnecessary to a majority satisfied with a public system?

Might prices for prescription drugs, hospital services and insurance premiums be regulated or advertising limited?

Might employers play an expanded role in the system’s accountability?

Can we afford the system long-term, given other social needs in a changing global market?

Comparisons are constructive for insights to be learned. It’s true in healthcare and professional golf. The European team was better prepared for the Ryder Cup competition. From changes to the format of the matches, to pin placements and second shot distances requiring precision from 180-200 yards out on approach shots: advantage Europe. Still, it was execution as a team that made the difference in its dominating 16 1/2- 11 1/2 win —not the celebrity of any member.

The time to ask and answer tough questions about the sustainability of the U.S. system and chart a path forward. A prepared, selfless effort by a cross-sector Team Healthcare USA is our system’s most urgent need. No single sector has all the answers, and all are at risk of losing.

Team USA lost the Ryder Cup because it was out-performed by Team Europe: its data, preparation and teamwork made the difference.

Today, there is no Team Healthcare USA: each sector has its stars but winning the competition for the health and wellbeing of the U.S. populations requires more.

2023 Nobel Prize in Medicine: Karikó, Weissman awarded prize for mRNA research

Posted on by • Posted in Clinical Research, Clinical Research Funding, Coronavirus, mRNA-based Vaccines, Nobel Prize, Pandemic, Public Health, Public Health Emergency (PHE), Public Health Strategy, Vaccine, Vaccine Development, Vaccine History, Vaccine RNA • Leave a comment
2023 Nobel Prize in Medicine: Karikó, Weissman awarded prize for mRNA research

Two pioneers of mRNA research — the technology that helped the world tame the virus behind the Covid-19 pandemic — won the 2023 Nobel Prize in medicine or physiology on Monday.

Overcoming a lack of broader interest in their work and scientific challenges, Katalin Karikó and Drew Weissman made key discoveries about messenger RNA that enabled scientific teams to start developing the tool into therapies, immunizations, and — as the pandemic spread in 2020 — vaccines targeting the SARS-CoV-2 coronavirus. Moderna and the Pfizer-BioNTech partnership unveiled their mRNA-based Covid-19 shots in record time thanks to the foundational work of Karikó and Weissman, helping save millions of lives.

Karikó, a biochemist, and Weissman, an immunologist, performed their world-changing research on the interaction between mRNA and the immune system at the University of Pennsylvania, where Weissman, 64, remains a professor in vaccine research. Karikó, 68, who later went to work at BioNTech, is now a professor at Szeged University in her native Hungary, and is an adjunct professor at Penn’s Perelman School of Medicine. 

The duo will receive 11 million Swedish kronor, or just over $1 million. Their names are added to a list of medicine or physiology Nobel winners that prior to this year included 213 men and 12 women.

The award was announced by Thomas Perlmann, secretary general of Nobel Assembly, in Stockholm. Perlmann said he had spoken to both laureates, describing them as grateful and surprised even though the pair has won numerous awards seen as precursors and had been tipped as likely Nobel recipients at some point.  

Every year, the committee considers hundreds of nominations from former Nobel laureates, medical school deans, and prominent scientists from fields including microbiology, immunology, and oncology. Members try to identify a discovery that has altered scientists’ understanding of a subject. And according to the criteria laid out in Alfred Nobel’s will, that paradigm-shifting discovery also has to have benefited humankind.

The Nobel committee framed Karikó and Weissman’s work as a prime example of complementary expertise, with Karikó focused on RNA-based therapies and Weissman bringing a deep knowledge about immune responses to vaccines.

But it was not an easy road for the scientists. Karikó encountered rejection after rejection in the 1990s while applying for grants. She was even demoted while working at Penn, as she toiled away on the lower rungs of academia.

But the scientists persisted, and made a monumental discovery published in 2005 based on simply swapping out some of the components of mRNA.

With instructions from DNA, our cells make strands of mRNA that are then “read” to make proteins. The idea underlying an mRNA vaccine then is to take a piece of mRNA from a pathogen and slip it into our bodies. The mRNA will lead to the production of a protein from the virus, which our bodies learn to recognize and fight should we encounter it again in the form of the actual virus.

It’s an idea that goes back to the 1980s, as scientific advances allowed researchers to make mRNA easily in their labs. But there was a problem: The synthetic mRNA not only produced smaller amounts of protein than the natural version in our cells, it also elicited a potentially dangerous inflammatory immune response, and was often destroyed before it could reach target cells.

Karikó and Weissman’s breakthrough focused on how to overcome that problem. mRNA is made up of four nucleosides, or “letters”: A, U, G, and C. But the version our bodies make includes some nucleosides that are chemically modified — something the synthetic version didn’t, at least until Karikó and Weissman came along. They showed that subbing out some of the building blocks for modified versions allowed their strands of mRNA to sneak past the body’s immune defenses.

While the research did not gain wide attention at the time, it did catch the attention of scientists who would go on to found Moderna and BioNTech. And now, nearly 20 years later, billions of doses of mRNA vaccines have been administered.

For now, the only authorized mRNA products are the Covid-19 shots. But academic researchers and companies are exploring the technology as a potential therapeutic platform for an array of diseases and are using it to develop cancer vaccines as well as immunizations against other infectious diseases, from flu to mpox to HIV. An mRNA vaccine is highly adaptable compared to earlier methods, which makes it easier to alter the underlying recipe of the shot to keep up with viral evolution.

As she gained global fame, Karikó has been open about the barriers she encountered in her scientific career, which raised broader issues about the challenges women and immigrants can face in academia. But she’s said she always believed in the potential of her RNA research.

“I thought of going somewhere else, or doing something else,” Karikó told STAT in 2020, recalling the moment she was demoted. “I also thought maybe I’m not good enough, not smart enough. I tried to imagine: Everything is here, and I just have to do better experiments.”