August 4, 2023

The Weekly Gist: The Bearing Human Resemblance Edition

by Chas Roades and Lisa Bielamowicz MD

Avid Weekly Gist readers will know that we have a particular affinity for stories involving bears, and we’ve opened many an edition with lighthearted stories about our ursine friends. We would, however, not advise pretending to be a bear as a way to get mentioned here. It’s unclear whether that motive was at play last month at the Hangzhou Zoo in China, where visitors filmed a Malayan sun bear named Angela, standing on her hind legs and seeming to wave at the crowd. Angela, if that is her real name, looked suspiciously like a person wearing a bear costume, so much so that zoo officials were forced to issue an official statement denying a widespread social media theory to that effect. Part of the zoo’s defense: no human could survive in a bear costume in the high temperatures of the region, which often hover around the triple digits. To which we say: ever been to a Baylor football game? Anyway, you can judge for yourself. Congrats “Angela”—you made the Weekly Gist.


What happened in healthcare this week—and what we think about it.

1. Amazon Clinic expands nationwide. Amazon announced that it has expanded its direct-to-consumer virtual care platform to all 50 states and the District of Columbia. Amazon Clinic, which the e-commerce giant launched in 32 states last November, connects consumers to third-party clinicians via Amazon’s website or mobile app. Through video call or message-based visits (the latter of which are only available in some states), it offers diagnosis and treatment for a range of low-acuity, common health conditions like pink eye and sinus infections. The clinic features flat, upfront cash pricing, and doesn’t currently accept insurance. On the provider side, Amazon is partnering with telehealth companies Wheel, SteadyMD, Curai Health, and Hello Alpha.

The Gist: This is the kind of venture at which Amazon excels: creating a marketplace convenient for buyers and sellers (patients and telemedicine providers, respectively), pricing it competitively to pursue scale over margins, and upselling customers by pairing care with Amazon’s other products or services (like Amazon Pharmacy). We’ll be watching for how Amazon builds on this service, and whether it connects Amazon Clinic to its Prime membership and One Medical assets. In the meantime, in addition to its consumer-focused offerings, Amazon is also simultaneously expanding its enterprise workflow offerings through its AWS for Health division, recently launching HealthScribe and HealthImaging.

2. Signs of a summer COVID bump could signal a tougher fall. After experiencing steadily declining numbers across 2023, the country is currently seeing an uptick in COVID-19 hospitalizations, which increased 12 percent week-over-week, to approximately 8,000 in the week ending July 22. This rise, the largest since December, follows an increase in national wastewater levels of COVID across the past month, particularly in the Northeast and South. Given that most health agencies are no longer tracking COVID case levels, and many Americans are no longer getting tested or testing themselves, actual case counts are unclear.

The Gist: Though COVID hospitalizations are up, weekly totals are still among the lowest the nation has seen since the pandemic began. And while COVID deaths are a lagging indicator, the most recent Centers for Disease Control and Prevention (CDC) data charts them at their lowest level since the start of the pandemic.  Nonetheless, if this COVID uptick continues into fall, we could once again be facing a “tripledemic” of COVID, flu, and respiratory syncytial virus (RSV) circulating at high levels all at once, straining hospital resources. Fortunately, an updated COVID vaccine is coming this fall. Urging Americans, particularly older and vulnerable patients, to get vaccinated for all three viruses will be critical—although convincing individuals to get three separate shots will increase the challenge.

3. Family of Henrietta Lacks settles over use of cells that have fueled modern medical innovations. Descendants of Henrietta Lacks, a Black woman once treated for cervical cancer at Johns Hopkins Hospital, whose cells have been used for scientific research over more than a half century, announced this week that they reached a settlement with Thermo Fisher Scientific over its use of cells that were obtained without Lacks’ consent in 1951. These cells were the first to reproduce in a laboratory, and have fueled myriad discoveries and advancements in medicine, including the development of the polio vaccine, treatments for Parkinson’s, and sequencing the human genome. The family’s lawsuit accused the biotech company of selling the cells and profiting from products the cells have helped develop without seeking either Lacks’ or her family’s permission or approval. The terms of the settlement are confidential.

The Gist: Anyone who has gone through medical training knows the importance of “HeLa” cells in fueling decades of medical innovation. This settlement brings light to the fact that for decades, tissue from patients, particularly those in the charity care system, has been used without patient consent, with no sharing in the profits from advances that would not have been possible without their contribution. Although most patients who undergo procedures at academic centers today sign away their rights to removed tissue, and this settlement doesn’t create legal precedent for other suits, we hope it renews debate about whether patients should have a stake in the profits directly derived from their contributions.

Plus—what we’ve been reading.


4. Price transparency has employers asking why insurance companies aren’t getting them a better deal. A recent Bloomberg article details how several large companies have recently sued the health insurers administering their benefit plans, accusing them of wasting money by overpaying insurance claims in excess of what was billed, often to the tune of millions of dollars in excess costs. They allege that some third-party administrators (TPAs) have refused requests to audit their payments, claiming that they can’t share this information with their employer clients, despite recent regulations that look to ban “gag clauses” in insurer contracts with providers. UnitedHealthcare, Aetna, Elevance, and other large insurers have all been targeted with legal action for overpaying providers and failing to provide sufficient transparency into their contracts.

The Gist: We’ve long thought that employers have the best platform to challenge insurance companies on whether they are truly delivering the highest-value product to their customers. A key issue here is whether or not courts view TPAs as fiduciaries, legally responsible for acting in their clients’ best interests. Court rulings on this issue to date have named employers themselves as the fiduciaries of their self-funded health plans, requiring them to make sure insurance money is doled out responsibly. But in a Catch-22, employers are not able to do that if their TPAs refuse to share claims payment data. And it is the insurers who negotiate contracts with providers, which govern reimbursement levels and payment terms. Breaking open payer-provider contracts with new transparency requirements has given employers a new window into how their healthcare benefit dollars are spent—and they seem unimpressed by what they’re seeing.


A key insight or teaching point from our work with clients, illustrated in infographic form.

The changing face of the nursing workforce

Last week we discussed how hospitals are still struggling to retain talent. This week’s graphic offers one explanation for this trend: a significant share of older nurses, who continued to work during the height of the pandemic, have now exited the workforce, and health systems are even more reliant on younger nurses. Between 2020 and 2022, the number of nurses ages 65 and older decreased by 200K, resulting in a reduction of that age cohort from 19 percent to 13 percent of the total nursing workforce. While the total number of nurses in the workforce still increased, the younger nurses filling these roles are both earlier in their nursing careers (thus less experienced), and more likely to change jobs. Case in point: from 2019 to 2023, the average tenure of a hospital nurse dropped by 22 percent. The wave of Baby Boomer nurse retirements has also resulted in a 33 percent decrease from 2020 to 2022 in the number of registered nurses who have been licensed for over 40 years. Given these shifts, hospitals must adjust their current recruitment, retention, training, and mentorship initiatives to match the needs of younger, early-career nurses.


A recommendation from our weekly diet of music, movies, TV, and other good stuff.

Heartstopper (Netflix)—Season 2 of this incredibly wholesome teen romance series launched this week, a welcome antidote to the anti-LGBTQ+ rhetoric that’s been on the rise lately. Based on Alice Osman’s bestselling graphic novel, the show hits all the right notes, providing a generous helping of positivity and affirmation as it follows the blossoming romance of two British teenagers. It’s so joyful you’ll be shedding happy tears—we certainly did!


What we learned this week from our work in the real world.

Searching for new hope in primary care

A physician who has led the primary care enterprise for a large health system for over twenty years told us he’s never seen physician morale as low as it is now: “Burnout is bad across the board for all specialties, but I’m having a really hard time finding the bright spots for primary care”. We recalled a recent survey of primary care physicians that confirmed his observations, with 61 percent of doctors stating that primary care is “crumbling”. But it struck us that we’ve been seeing these kinds of dire surveys about the state of primary care for the entire quarter-century we’ve been doing this work. What’s different now?

He posited one critical change. Ten years ago, during the heyday of accountable care, primary care was central to health system strategy. Systems were devoting resources to converting practices to patient-centered medical homes. “We felt like primary care was at the heart of transforming health systems, and that we were finally getting resources to help patients,” he shared. “Now it feels like the health system has moved away from ‘value’, the focus is all on specialists and growing procedure volume again, and we’re being treated as a cost center and told to cut staff and up our referral targets.” We agree. Although large independent primary care groups continue to command record valuations, overall, the transition to value has slowed, and work burden has increased given staffing shortages. Where could optimism come from now? We both agreed that workflow innovations to ease documentation burden and help the transition to virtual care appear closer to reality than ever before. And the increased focus on “consumerism” has many systems recognizing that primary care is the first—and principal—touchpoint for most patients and will be key to winning consumer loyalty.


All the headlines in healthcare policy, business, and more, in ten minutes or less every weekday morning.

Last Monday, JC spoke with Toni Ardabell, Chief of Clinical Enterprise Operations for Inova Health System in Falls Church, VA, about how the system is reducing the rate and severity of workplace violence incidents.

This Monday, JC will talk with attorney Stuart Vogelsmeier, EVP and Chair of the Healthcare and Business practices at St. Louis-based law firm Lashly & Baer. They’ll discuss the recent series of proposed antitrust changes issued by the Federal Trade Commission and Department of Justice that, if finalized, could change the landscape of healthcare M&A activity.

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That’s all for this week—another hot one! Hope you’re staying cool, well-hydrated, and up to speed on the latest happenings in healthcare. Make sure your friends and colleagues are too: let them know about the Weekly Gist, and encourage them to subscribe. And tell them about our podcast!

As always, please let us know how we can be of assistance in your work. You’re making healthcare better—we want to help!

Best regards,

Chas Roades
Co-President and Managing Director

Lisa Bielamowicz, MD
Co-President and Managing Director