2020 has been an interesting year for healthcare, to say the least. From virtual healthcare to COVID-19, we rank and reflect on the top ten healthcare stories of 2020.
David Williams (00:00):
Hey, John. Christmas 2020. This means I’m sure Santa is packing you up a nice bag of COVID-19 John.
John Driscoll (00:05):
Oh. Way to spread the holiday cheer.
David Williams (00:09):
Welcome to CARETALK, your holiday home for incisive debate about healthcare business and policy. I’m David Williams, President of Health Business Group.
John Driscoll (00:26):
And I’m John Driscoll, the CEO of CareCentrix.
David Williams (00:29):
Well John, it’s the end of the year and it’s time for our top 10 healthcare stories of the year. Now we know number one is COVID-19, so we’ll just get that one out of the way. But let’s talk about the others. Here’s my proposal, number 10, John. Number 10, the election. Remember at the start of the year we were talking about Medicare for all? It was actually pre-pandemic and the Democratic voters were deciding which candidate, looked like Bernie was going to run away with it. And we ended up with COVID being the number one topic of the election. The election’s almost over as we speak here. May not be over this year though.
John Driscoll (00:59):
Well, I think, isn’t your guy still contesting it? We have a clear winner. But I think you’re right. The election was really interesting. It’s sorted out American’s opinions, but healthcare was one of the most important issues. And yet, interestingly, although the party might’ve looked left, the party and the country chose the middle with Joe Biden. And I think that’s really instructive for how we’re going to be able to progress healthcare legislation going forward. Obviously, the election’s a big story, but the relevance for healthcare is, I think the moderates, one. Or at least the country wants to follow more of a middle path, rather than either no ACA or Medicare for All.
David Williams (01:51):
All right, so what’s number nine, John?
John Driscoll (01:53):
Well, I think that, as healthcare wonks, you got to be impressed with what’s going on with Medicare Advantage, don’t you think?
David Williams (02:03):
John, I love MA. You know why? Because to me it’s Massachusetts, my home sweet home. But I think it really is something. Medicare Advantage has really picked up, in fact, doubled the number of people in it over the past decade. And it covers things that traditional Medicare doesn’t. And it’s a good way if there’s going to be Medicare for All, Medicare Advantage for All might be a nice version of it.
John Driscoll (02:23):
Well, I think that the other thing that’s hard to fathom is, you’ve got 10,000 people a day turning 65. You’ve got an entire generation, the boomers, that are going to dominate the healthcare costs. And what’s interesting is, these sixties kids who demanded choice are choosing increasingly Medicare Advantage. Managed care, turns out to be the popular boomer option. And I think that’s because the Medicare Advantage plans, that’s the private side of the Medicare program, really have delivered. They’re delivered in terms of lower costs and better outcomes. But they’re also adding more and more benefits. It’s a fascinating move, that managed care may win the day in the over-65 crowd.
David Williams (03:13):
Amen, brother. Number eight, interoperability rules. John, we’re going from wonky to wonkier.
John Driscoll (03:19):
What is interoperability? Just explain the word.
David Williams (03:21):
It means the ability of two systems to be able to speak with one another. So everyone’s going digital and has electronic health records, but they don’t speak to each other. So you still have hundreds of millions of investments in an epic system or a Cerner system by one hospital in another, and they have to fax records back and forth. That’s unlike with an ATM. Imagine if you went to your ATM to withdraw money, and the banks were faxing your account information back and forth. So interoperability rules have come out from the health and human services, and we’re going to see interoperability really happening in 2021.
John Driscoll (03:55):
I think it’s really important, David, but I think what’s hard for people outside of healthcare to understand in a digital-first world, healthcare is still a fax first, and sometimes a phone call and paper world. And this interoperability is really laying down the digital highway for healthcare, and it potentially could really have an impact on transparency and cost. I think it’s really exciting, but it’s been a long battle coming, but it’s again interesting bi-partisan support. The smartest folks on both sides of the aisle really support interoperability. It’s the incumbents who run these slow, disconnected systems that are fighting it. If we get there, it really could potentially take a lot of costs out and potentially share outcomes. I think it, not to be ironic, it’s epic.
David Williams (04:47):
John, I think bi-partisan is the word of the year for 2020. Just that, I think refers to the two-person party that we’re having from New Year’s Eve due to COVID. So, what’s lucky seven John? Lucky seven?
John Driscoll (04:58):
Lucky seven, well, you insisted on putting this, but I’m not [crosstalk 00:05:02].
David Williams (05:02):
I was sucking up to you, John.
John Driscoll (05:03):
Come on, drug pricing? How can that be a top 10 issue in a year when we made no progress, David?
David Williams (05:11):
Oh, there’s some progress, John. There was a lot of hot air coming out of Washington about this. Trump decided that he’s going to outsource price setting to Australia, New Zealand and Lichtenstein.
John Driscoll (05:20):
Well, he outsourced a lot of thinking this year. But, how does that affect the average patient or the average plan? I don’t think it’s going to affect that it all. It’s going to be tied up in legislation. It doesn’t have a lot of authority. And it didn’t get much legislative support.
David Williams (05:36):
John, I think you’re right. I put it there because it’s lucky, and I know you’d like to have a lucky number. And it’s your favorite topic. I think it was number seven because you talked about it so much. Otherwise, it wouldn’t have hit it. John, I’m going to give number six. Number six. Let’s see if you like this one better. Home care. Okay? There’s actually-
John Driscoll (05:52):
Hey. Love it.
David Williams (05:54):
… Yeah. Yeah. There’s actually a lot of activity that came out of HHS and CMS this year, including expanding what could be done with telehealth. Relaxing some HIPAA requirements related to that. And more flexibility for hospitals to be able to treat patients in their homes in light of the surge of COVID. And hopefully, this is something that’s going to become more permanent in 2021. You had done actually some surveying on this, John.
John Driscoll (06:21):
Yeah. No. Clearly, in a time of COVID, no one wants to go to a hot box of infection, like a hospital or a nursing home. Nearly half of the people who died of COVID being nursing homes. So people want to clearly avoid that. But what’s remarkable, is I think the consumer choice aspect of this, once you create the opportunity to get more care to them, we did a care at home survey and nearly 75% of consumers love their doc, but they would prefer to access care at home, instead of going back to a medical facility after a major medical event. And nearly 100% of all health plan executives agreed that care at home is better for the plan and for the members, but they’re not quite sure how they’re going to get it done. So obviously that’s a tailwind for CareCentrix. But it’s honestly a tailwind and a support for the digital-first alternatives at home. The nurse coaching and advocates. The-
David Williams (07:22):
Digital-first, John. That’s like America First? Can I say “America digital-first?” Does that work?
John Driscoll (07:27):
… Number five is?
David Williams (07:29):
Number five is rural hospital closures. The hospitals are shutting down. Used to be, people would say like the steel mill shut down or something shut down in a town and it was dead. Now, a hospital shuts down, and that’s it.
John Driscoll (07:41):
The people locked into the major metro areas that do the navel-gazing that you guys do up in Boston, don’t realize it. But just in the first three months of 2020, 18 rural hospitals closed. Sorry, I guess it’s last year and the first two months of ’20. 18 hospitals, that’s a lot of hospitals. More than 170 have closed since 2005. David, that’s going to create … we talk about food deserts, but healthcare deserts are even more dangerous. And I think that COVID is the catalyst right now, but I don’t think we’ve got a good model for rural healthcare, otherwise, we wouldn’t have 170 hospitals closing nationwide since ’05. And those are hospitals that are often the only source of healthcare for the communities they served. And so, I think that rural care is a crisis and it’s under-recognized. And I think that to put it as number five, I think is critical, because we need to raise people’s attention.
David Williams (08:57):
Well, John you’re right. And hopefully what’s being done with home care is actually going to help to make up for the fact that some of these rural hospitals aren’t available. I don’t think the increase of home care is actually causing a problem for the hospitals, that’s not what’s leading to their crisis. Those people shouldn’t be in the hospital anyway. But it’s a real issue.
Now, John, number four, the pandemic has been driving everybody crazy, quite literally. Mental health is a big problem now.
John Driscoll (09:21):
Well, first of all, I think mental health has always been under-diagnosed and under-covered, and probably not gotten the support it needs. As you know, we’ve tried very hard at CareCentrixto highlight that it’s an integral part of how people should be thinking about whole-person care. We had an epidemic growing of loneliness before the lockdowns of COVID-19. According to CDC in June, 40% of all American adults feel like they’ve experienced a mental health or substance abuse issue. And gosh, just over 10%, 11%, have considered suicide. Those are terrifying statistics going into a cold winter. Not just from a temperature perspective, from a connection perspective. I think we’ve got to come to grips with the fact that, one, that mental health is an issue that isn’t just a clinical one, but it’s a social one, and we need to deal with it.
In addition to the mental health statistics, we’re also seeing a troubling rise in deaths of despair. Opioid abuse. Alcohol. And I think that all are part of it. And I hope that the COVID moment will allow us to focus on it and stay focused on it, to come up with solutions that are healthcare and not healthcare. Don’t you think, David, this is a bigger challenge than just getting care to the right people?
David Williams (10:58):
Oh, this is a huge challenge, John. I absolutely agree with you. And the statistics are just startling when you hear about 40% of people having a mental health or a substance abuse issue.
Now number three, John, I’m scratching my head a little bit about. Someone, I think, slipped this one in as a joke. Put in the name of one of my great aunts or something like that. mRNA, what the heck is she doing in here?
John Driscoll (11:18):
It’s the mRNA technology that is on the inside of the Moderna and the Pfizer vaccines. This is a technology, an approach to biotech drugs that injects almost the equivalent of a little bit of a decision machine for your virus system. It teaches your virus [inaudible 00:11:41], just very crudely, how to react to certain pathogens or disruptions. And it has been explored for many years unsuccessfully in the cancer drug world. And it actually had gone out of favor. But Moderna and Pfizer, and actually it’s about two-thirds of all of the vaccines that are being considered in the U.S., are using this new biologic technique. And it’s showing great success. Over 90% success. And what’s exciting about that is that A, it’s rapidly going to be scaled and leveraged to vaccinate the country. But I think underneath that is a validation of new technology that could be used across a number of other therapies, particularly cancer.
Moderna had, I think, 10 or 11 other use cases outside of COVID, and they quickly pivoted to COVID. But this is super-exciting. And I think we are at the cusp of a biotech moment. We beat up the drug companies on drug pricing on a pretty regular basis, that’s largely about the unnecessary increases in costs for simple chemical compounds whose patents have come and gone many, many years ago. But this new round of biotech drugs and biotech companies, I think we’re in the cusp of really turning diseases that were quite deadly, and curing them. And this is the mRNA technology is one of a number of them. The [CARTs 00:13:20] would be another one where we could be at the beginning of a major biotech moment that could transform healthcare and disease.
David Williams (13:28):
John, names are tough. And it took me a while to realize that Moderna actually has mRNA within the name, sort of like Modern RNA. Or, Mode RNA, is kind of cool. And there’s their ticker symbol is MRNA. So it all comes together and I’m looking forward to it. It should be a real shot in the arm for next year.
Now, we already told people about number one, COVID-19. So this is like when they have the people come up to the podium and number two is announced, and then people know who’s number one. But we didn’t announce number two, John. This is big. It’s big, but it’s not real. It’s virtual care.
John Driscoll (14:03):
David, what do you think? Why should we care about virtual care?
David Williams (14:08):
Exactly. It’s like caring about nothing. The reason to care, John, is that people like you and I have been at this for 20+ years, looking at things that were called, web visits and e-health and m-health, and all this sort of stuff. And you saw in one week in March, 10 years of progress in the use of telehealth. Because all of a sudden, you didn’t have all the excuses of why it might not work. But actually said, “Hey, we can’t actually see people in person. What are we going to do?” And boom, the technology is actually ready. Turns out patients like it. The physicians like it pretty much as well. And you saw some big deal-making this year, John, including an $18.5 billion mergers between Teledoc and Livongo, which are two leaders in this field, you know something big is happening.
Certainly the story of 2020, I don’t know for sure if it will be the story of 2021, or if people just float back to the status quo.
John Driscoll (15:05):
Well, I think your favorite political theorist, Lennon, once said that “There are decades when nothing happens and there are weeks when decades happen.” And I think that the weeks rolling into the early stage of the lockdown, where the federal government dropped many of their restrictions in the states on virtual care, we really showed that whether the utilization of the epic TeleHealth, that’s the big hospital computer system that has a telehealth capability, that hospitals went from 3 or 4% utilization to 80% utilization. That tele-visits went through the roof across pretty much every category of medicine. And what I think consumers found is that they were really happy with that access and convenience, and doctors got more comfortable with it. And I think it’s the first step towards people getting comfortable with innovations in virtual care.
I still think we have a very sticky system and I think most of the hospitals and doctors and that medical-industrial complex is going to fight it. But I think that the digital-first and digital integrated solutions, we’ve shown that we can, as a country, pivot and make it work. And I hope it’s an innovation that’ll stick. One of the things that I think will help that is the kind of market power of the Teledocs and the Livongos and the Amwells and the MDLIVEs, all of which are big corporations that are getting a lot of money to support the integration, exploration and scaling of their virtual care platforms. Because virtual care is really convenient care for patients. And I think that healthcare’s missed convenience. So I really do think virtual care is a big story and it will have the market power to support it.
Now, David, drum roll, please. What can you say new about COVID-19?
David Williams (17:09):
Well, I’m going to say, John, that COVID-19 is not only the biggest healthcare story of the year, but it’s also the biggest story of the year. And not just here but globally. So it’s really a huge thing. If you compare it with what we were talking about as top stories last year, vaping, which was a big deal. But really, think about COVID-19 versus vaping. It’s just that public health has become the story of the year. And I think that you’re going to see, it’s probably going to be the biggest story next year. And you’re going to see other kinds of global things that really affect people, like climate change, become the big stories. And so that’s my new thing to say about COVID-19 to contextualize it.
John Driscoll (17:45):
Well, I think for me, the most important long-term effect of COVID-19 is to look at the stark inequality of outcomes. That nearly half of the people who’ve died are people of color, know that people of color are nowhere near half the population. That they’re in healthcare deserts. Even in inner-city areas where people don’t have access to care, we’ve redefined the meaning of essential workers. The things that I think are going to be sustained from this COVID-19, well A, obviously, we’ve got a great investment in public health. But I think it should remind us of the dangers of the inequalities of access and care that are in the system. And I think we got to fix that, David. And that to me is, if we had more of those solutions in place, frankly, many fewer people would have died.
David Williams (18:38):
Well, John, that’s it for our 2020 CARETALK year in review. Thankfully, we are going to have a chance to look ahead to what I hope will be a brighter future. And next week, we’re going to do our 2021 look ahead. So meanwhile, I’m David Williams, President of Health Business Group.
John Driscoll (18:54):
And I’m John Driscoll, the CEO of CareCentrix. Thanks for listening.