The Healthy Muse (hospitalogy)

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• This week in healthcare: Accolade joins the digital health conglomerates with its purchase of PlushCare, health funding hits an all-time high, what’s next for the Biden Admin in healthcare policy, M&A in Q1, and more.

Digital Health Convergence.

Anotha One: In the next major push to become a digital health player offering a conglomerate of services for employers, Accolade is purchasing PlushCare for $450 million and becomes the latest firm to offer telehealth for its platform. (Link)

• The larger trend: These new-age healthcare firms are starting to compete for employers by offering a suite of services – care navigation, telehealth, chronic care management, and more – especially as the push toward value based care materializes. Read the company’s blog post about the acquisition here. (Link)

In other notable digital health news…

• Health funding hit an all-time high of $31.6 billion in Q1. (Link)
• Oscar Health launched its health-tech platform to little fanfare. (Link)
• GoodRx purchased a healthcare and pharma-focused media firm for what appears to be marketing purposes. (Link)
• Essential service provider Agiliti is going public, aiming to raise a few hundred million dollars. (Link)

What’s next for Biden’s healthcare agenda.

After setting several coronavirus-related goals in the first few months in office, the Biden Administration is now pivoting to other hot-button healthcare issues spurred on by congressional Democrats. (Link)

Here are the major issues you’ll need to keep in mind during Biden’s term:

• Medicare to 60 and Medicare Expansion: As one of Biden’s original campaign issues, several Democratic senators are now asking Biden to expand Medicare. The thinking here is that individuals aged 60-64 (current Medicare eligibility age is 65) would be allowed to ‘buy-in’ to Medicare
  • Expansion: Not stopping there, the Biden Admin also wants to expand traditional Medicare benefits to include hearing, dental, and vision care, among other things. Currently, only Medicare Advantage plans provide these supplemental benefits. (Link)
• Drug Pricing: Biden wants to allow Medicare to negotiate lower prices with drug manufacturers.
• Surprise Billing: Although surprise billing was banned in 2020, the specifics of the bill are a bit fuzzy, which is the next fight the Biden Admin is facing in this arena. (Link)
• Medicaid Expansion: After expanding subsidies for the ACA in the latest stimulus bill, the Biden Admin turned its focus toward the 12 remaining holdout states which haven’t yet expanded Medicaid through the ACA. One of these states is Texas, where Biden recently rescinded Texas’ 1115 Medicaid waiver, essentially meaning that the Admin is trying to strong-arm Texas into expanding the social safety net healthcare service. (Link)
  • Medicaid managed care player Molina Healthcare seems to think Texas is trending in that direction – the insurer just purchased a large Medicaid plan in the state from Cigna. (Link)

Coronavirus updates.

Cases: Are once again dropping after a gradual increase over the past couple of weeks. The U.S. seven day average is 58k – down from last week’s report of 69k – as of this writing. (Link).

Vaccines: are trending at 2.74 million per day, down from last week’s 7-day average of 3.2 million. (Link). Fully vaccinated = 29% of Americans. At least one dose administered = 42% of Americans

• All adults are now eligible for the vaccine nationwide. (Link)
  • This news comes at a time when some states are scaling back vaccination operations as vaccine supply is expected to outstrip demand. Essentially, we’ve reached the point where the ‘hesitant’ third of Americans are the stragglers yet to be vaccinated. (Link)

The FDA paused J&J’s vaccine in order to analyze cases of an extremely rare blood clot side effect. Over the weekend, vaccinations were given the all clear.

• Still, the damage has already been done – 73% of unvaccinated Americans say they won’t get the J&J vaccine. (Link)

Quick Hits

Biz Hits

Q1 M&A: Here a few solid articles involving an overview of M&A in healthcare:

• This well-researched article provided a solid overview of current trends in M&A while also comparing these trends with transactions prior to Covid. The essay does a great job of breaking down the factors causing transactions into three broad categories. (Link)
• HIT Consultant broke down notable digital health SPACs, IPOs and other top-dollar transactions during the first quarter. (Link)

Air Ambulance: Major health system Intermountain purchased air ambulance firm Classic. (Link)

Q1 earnings: kicked off this week:

• United’s profit jumped 44% as the Optum machine continues to churn and Medicare Advantage plans soared. (Link)
• Anthem likewise reported major growth in its Medicaid plans segment. The payor interestingly shrugged off concerns of ‘pent-up’ demand utilization from Covid, dubious that any such wave existed at this point. (Link)
• HCA reported a strong quarter, noting a strong commercial payor mix, higher acuity patients in its hospitals, and a bounce back in surgical volumes in its ASCs. (Link)

Policy Hits

Imaging: Take a look at the expected reimbursement rate changes coming to diagnostic imaging and its effect on operators, including anticipated further consolidation in the segment stemming from reimbursement pressure. (Link)

Site Neutral: The AHA published an interesting argument revolving around site neutral payments, arguing that hospital departments deserved higher reimbursement because the patients HOPDs see tend to be higher acuity, impoverished, and with chronic conditions when compared to freestanding facilities. What do you think? (Link)

Fined: a federal audit found that Humana improperly overcharged Medicare by nearly $200 million for a Medicare Advantage plan in Florida. Chump change, right? Humana ‘sharply disputed’ the findings of the audit. (Link)

MLRs: The Kaiser Family Foundation dives into 2021 rebates for the abnormally low medical loss ratios in 2020, including how much payors are expected to pay back. (Link)

Other Hits

Costs and Utilization: The Health Cost Institute published an interesting summary of utilization trends and the impact of Covid on preventive care. (Link)

Pharmacy: Here’s an interesting dive into another frontdoor of healthcare – the pharmacy – and what the future of the pharmacy looks like. (Link)

Canceled: UVA Health canceled thousands of lawsuits over medical bills over the past couple of weeks after receiving major flak for the practice. (Link)

Drug Development: The average cost to bring a drug to market is $1 billion. (Link)

Malaria: In a world-first, a University of Oxford malaria vaccine became achieved a 75% efficacy goal. (Link)

Thought-Provoking Editorials

Get to the point: This was a thoughtful article from NPR on how physicians should be more upfront with their patients. (Link)

Wearables: A survey conducted recently cast some doubt on the current utility of wearables. I’m personally bullish on the segment but definitely think there’s room for improvement here. (Link)

Healthy Muse Top Picks

Digital Health: This is a fantastic overview of digital health from Triple Tree – trends to watch, major players to follow, and more. (Link)

Status Vax: This was a fascinating read about how Pfizer’s vaccine somehow became top tier from a social perspective – the Pfizer elites (full disclosure, I’m a Pfizer elite – sorry to all you JnJ peasants). (Link)

A New Era: Here’s a good well thought out essay from Joe Connolly about healthcare’s movement toward a virtual first ecosystem – how a host of anti-consumer factors are causing a paradigm shift in the industry. (Link)

All about the FDA: This write-up was a great dive into how the FDA works – the article starts from the ground up and left me with a solid understanding of how things get done at the agency. (Link)

Racism: There were a few thought-provoking articles involving racism in healthcare over the past couple of weeks. I’ve linked both of them below:

• The world’s leading medical journals don’t write about racism. That’s a problem. (Link)
• Race and Healthcare in America. (Link)

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