September 11, 2020

The Weekly Gist: The Christmas in Manila Edition

by Chas Roades and Lisa Bielamowicz MD

As we leave summer behind and head into what promise to be difficult months ahead, we’d like to suggest borrowing a tradition from the Philippines—let’s start playing Christmas music now. We first learned of this phenomenon from Spotify, or more precisely from a cool little algorithmically-driven analytics site called Every Noise at Once, which slices and dices data from the music streaming service to serve up all sorts of fascinating insights. It turns out every year, reliably on September 1st, listeners in the Philippines start cueing up holiday tunes. That’s when the country starts celebrating the “Ber Months”—September, October, November, December—by getting a jump on the festive season. What a great idea, especially as a way to battle the pandemic blues. Go pick your favorites from playlists around the world, and start celebrating now!


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

Marking a somber milestone amid a mounting catastrophe

As the nation marks the solemn 19th anniversary of the attacks of 9/11, it does so at the end of the 23rd consecutive week in which more Americans lost their lives to COVID-19 than died in those tragic events. While 7-day rolling averages of daily new case counts and deaths have subsided from their peaks in July and August, the return of millions of children and young adults to school and college has already resulted in tens of thousands of new cases, and led to the deaths of several schoolteachers. The University of Washington’s Institute for Health Metrics and Evaluation (IHME) has now updated its prediction for the toll COVID will take on the country; their model projects more than 410,000 Americans will have been killed by the virus by the end of this year. With the country seeing pandemic-era record travel numbers over the Labor Day weekend, and seasonal influenza looming, the unofficial start of fall may also be the beginning of a new and dangerous phase of the coronavirus pandemic.

In addition to social distancing, universal masking, and widespread testing, our best hope lies in the early discovery of safe and effective vaccines from among the dozens now being developed. On that score, and in the face of growing concerns about the politicization of the Food and Drug Administration (FDA), it was reassuring this week that nine leading pharmaceutical and biotechnology companies involved in vaccine development jointly issued a pledge to put safety and efficacy before politics and profit. Paradoxically, it was even more reassuring that AstraZeneca, a drug maker in the late stages of testing a vaccine it developed alongside scientists at Oxford University, temporarily halted its trial this week after one study participant suffered serious complications. The company will now investigate the adverse event (in which a vaccine recipient developed inflammation of the spinal cord, which can be triggered by infection), and determine whether the study can go forward or must be abandoned. There are eight other vaccine candidates in Phase III trials, at least 39 in clinical trials, and 93 others under active investigation. The AstraZeneca situation is a useful reminder that developing a safe and effective vaccine will happen on a scientific timeline, not according to the political calendar. Faced with the prospect of losing 75 times as many people to COVID-19 between now and the end of the year as we did during the 9/11 terrorist attacks, we must continue to trust in the work of scientists and researchers, who will be the ultimate heroes of our pandemic era.

Spending millions on the Seema Verma Experience

This week Politico broke the news of a scathing Congressional investigation into the lavish spending of Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma, centered around boosting her own “brand image” and position among inside-the-beltway Washington power brokers. According to the report, Verma sidestepped the use of CMS’ internal public relations team, and instead engaged a handpicked group of consultants, who charged the government over $6M in less than two years for their work in polishing her public profile and personal brand, arranging meetings with media, and traveling with her to events around the country. The spending line items included tens of thousands of dollars focused on “getting Seema on lists”, including Politico’s “50 Most Powerful People in DC” and Washingtonian’s “Most Powerful Women in Washington”. Consultants were paid to arrange op-eds and interviews for Ms. Verma, with outlets such as AARP, Christian Broadcasting Network, and Fox News, and $450 was spent on a makeup artist to ensure Ms. Verma was perfectly camera-ready for a two-minute video shoot. The outside advisers even charged nearly $3,000 to arrange a private “Girls’ Night” event held last November at the home of a USA Today bureau chief, to network Verma with other DC insiders.

This isn’t the first time that Verma’s spending has come under scrutiny. In July the Office of the Inspector General found that Verma’s publicity spending violated federal contracting rules, and she was widely criticized for filing a $47,000 expense request for personal items stolen on an official trip, including a $325 jar of moisturizer and a $5,900 Ivanka Trump-brand necklace. Public relations expenses to educate the public and promote official initiatives are standard fare, but Verma’s lavish spending, often focused on boosting her personal image, shows a stunning lack of judgement, if not an overt misuse of taxpayer dollars. We’d rather see those dollars put to more worthwhile uses, like educating people on how to best shop for insurance, or how to access testing and other needed care services during the largest healthcare crisis of our lifetimes.

Mednax sells off its radiology division

National physician staffing firm Mednax announced the sale of its radiology practice—which includes teleradiology company Virtual Radiologic, known as vRad—to venture-backed Radiology Partners for $885M. Publicly-traded Mednax has been hit hard by both contracting disputes with UnitedHealthcare, as well as pandemic-related volume declines. Both its anesthesiology and radiology businesses suffered big losses with the halt of elective procedures in the spring, and saw volumes decline between 50-70 percent compared to the prior year. The company began divesting in May with the sale of its anesthesiology division to investor-backed North American Partners in Anesthesia. Mednax leaders say these decisions to sell were made independent of the pandemic, and that they have been planning to return to the company’s roots of focusing exclusively on obstetrics and pediatric subspecialty care, including changing its name back to Pediatrix. Acquiring firm Radiology Partners is the largest radiology practice in the country, working with 1,300 hospitals and healthcare facilities. With this acquisition, it will have 2,400 radiologists practicing in all 50 states and the District of Columbia. Hospital-based physician staffing firms have been especially hard hit by COVID-induced volume declines. This has created a softening in valuations and opened the door for investment firms to accelerate practice purchases. We expect the pace of deals to quicken as independent practices experience continued financial strain—with large national groups leading the way, taking advantage of lower practice prices to build large-scale specialty enterprises.


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

Nearly half of Americans hesitant to get a COVID vaccine

The race for a COVID-19 vaccine is well underway, with dozens of vaccine candidates being tested worldwide. Because vaccines typically take a decade to get to market, the pace of Operation Warp Speed—which aims to deliver a COVID vaccine by January 2021—has raised concerns that the government will sacrifice vaccine safety and efficacy for speed. Shown in the graphic below, a survey conducted by Jarrard Phillips Cate & Hancock and Public Opinion Strategies found nearly half of American adults are on the fence about getting a COVID-19 vaccine, with over 20 percent saying they are unlikely to get one at all. This hesitancy is greater among both female and Black respondents—with the latter doubly concerning given that Blacks have been disproportionately impacted by the disease. The top reasons given for skepticism include concerns about side effects (47 percent) and the risk of becoming infected by the vaccine (22 percent). A related survey from STAT and the Harris Poll found that 78 percent of Americans worry the vaccination approval process is being driven more by politics than science. Whom do consumers trust for information? Their doctors. Physicians must be prepared to answer questions about how they have evaluated a vaccine, why they believe it to be safe and effective, and whether they have chosen to take it themselves. As providers prepare to deliver millions of vaccine doses once one is approved and available, leveraging the trust inherent in physician-patient relationships will be essential, especially among vaccine-hesitant populations.


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

Losing the edge on telemedicine?

At the beginning of the pandemic, physicians and health systems implemented telemedicine solutions with unprecedented speed. In doing so, they went from mostly lagging behind payers and disruptors in digital medicine, to becoming the anchors who kept patients and doctors connected during the greatest health crisis in a century. But over the past few weeks, we’ve detected a marked shift in the tone and focus of conversations around telemedicine with doctors and executives. Universally, systems have seen a drop in virtual visits as in-person care has returned—and most agree that today’s levels of telemedicine visits are lower than ideal. “We peaked at 45 percent of outpatient visits delivered virtually in early May. Now telemedicine accounts for just five percent,” one physician leader told us. “I don’t know what ‘percent virtual’ is ideal, but I’m pretty sure it’s more than five percent.” Another leader described a shift from “rally to reality”.

At the height of the crisis, the entire system was singularly focused on keeping patients connected to care, bolstered by a loosening of regulatory and payment restrictions. As systems now plan for a long-term virtual care strategy, we’re sensing a shift in focus to pre-COVID challengesoperations (centralization is needed to create a sustainable model, but each doctor wants to do virtual visits his own way), payment (should we really invest before we’re sure health plans will continue to pay at parity?), and turf battles (reemerging political discussions of who “owns” virtual care strategy). Health plans, retailers and disruptors recognize the power of virtual care to build relationships and loyalty with consumers—and will invest heavily behind it. Providers have the advantage today. But to keep it, they’ll have to get out of their own way and continue to build, scale and refine their virtual care platforms.

Reflections on six months of virtual member service

We found ourselves back on the road this week, participating in a member board meeting that was being held in person for the first time since the start of the pandemic. Coincidentally, it was six months to the day since we had to shut down our schedule of member travel and convert to a largely virtual service model. While it was great to be back in person with the group—there’s really no substitute for the face-to-face interaction and hallway conversations that come with actually being there—it also provided a chance to reflect on how the pandemic has changed the way we work with our members, often for the better. Unconstrained by the limitations of flight schedules, we’ve been able to spend much more time working intensively with each of the systems we serve, often talking to executives in several states across the course of a typical day. We’ve discovered the power of virtual member convening, bringing teams from across the country together to share ideas and solutions with each other in real time. And we’ve developed a new expertise in facilitating group discussions and brainstorming sessions using virtual collaboration tools. Our own team has adapted as well—where once we had to schedule all-hands “in days” months in advance, now we get together for a huddle every morning, with team members from coast to coast. In short, despite spending the majority of our time in our own homes, we’ve rarely felt as connected to each other and the leaders we serve. Don’t get us wrong: we still cherish every minute we get to spend onsite with health system teams. But there’s no question the pandemic has added a whole new dimension to our work, and we can’t imagine going back to the old world.


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

On last Tuesday’s episode, we spoke with David Jarrard, CEO of strategic communications firm Jarrard Phillips Cate & Hancock, about consumer views on trust, safety and a potential COVID vaccine. He recommended that health systems plan for how to message and roll out a COVID-19 vaccine, so they’ll be ready when one is approved.

Coming up on Monday’s episode, we’ll hear from Dr. Daniel Stein, CEO of Embold Health, a healthcare analytics company that builds physician networks based on quality metrics. He discusses why, despite living in such a data-rich environment, there still aren’t objective ways for healthcare purchasers to evaluate which doctors provide the most appropriate and cost-effective care. Don’t forget to tune in!

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We would’ve worked harder, but we watched this instead.

With his landmark 2017 directorial debut Get Out, Jordan Peele breathed new life into the horror genre, rescuing it from numbing, low-budget scream-fests and bringing it back to its roots in service of social commentary. Three years later, amid the most significant racial reckoning our nation has seen in a half-century, Peele returns to the small screen, collaborating with television writer Misha Green to bring us Lovecraft Country, a new HBO prestige series based on the story collection of the same name. Just as last year’s superhero show Watchmen repurposed its comic book source material to explore the legacy of racial violence in Tulsa, Lovecraft Country inverts the “Cthulhu Mythos” of the early 20th century pulp-horror writer H.P. Lovecraft, a white supremacist whose Gothic monsters expressed his own racial fears. The new show centers on a band of Black sci-fi fans in the Jim Crow 1950s, who must literally battle Lovecraftian monsters as they explore their families’ complicated history. Here, the monsters (made terrifyingly real by stunning CGI work) represent not “the other”, but racism itself, deployed by white society to maintain the old social order. In addition to numerous visual and plotline references to the struggles of segregation, each episode is an homage to classics of the horror genre—Peele and Green bring a deep admiration and mastery of weird fiction to the storytelling. The cast is strong too, with stellar performances from Jurnee Smollett (Underground), Jonathan Majors (Da 5 Bloods), veteran character actor Michael K. Williams (The Wire), and of course, those monsters. How cool is the monster action? Suffice to say just one minute into the first episode, we find the many-tentacled Cthulhu locked in battle with a bat-swinging Jackie Robinson. That cool. The show airs Sundays on HBO, and there are still six episodes left—get watching!


Stuff we read this week that made us think.

Shortage of COVID testing for young children

As young children return to in-person school or daycare across the country, many parents are struggling to find a nearby COVID testing site for their kids, especially for babies or toddlers. The New York Times reports a gaping hole in the country’s COVID testing infrastructure: many testing locations refuse to test young kids, leaving some parents scrambling. Among drugstores, Walgreens does not serve children at its drive-through testing sites, and CVS only serves kids 12 and older. Many publicly funded testing sites either serve only adults, or set age minimums that exclude young children. Florida now prioritizes pediatric testing as children are returning to in-person school, but still only a quarter of state-funded testing sites serve kids of all ages. Age restrictions at testing sites are put in place due to a range of considerations, including different test administration procedures and clinician discomfort with treating younger kids. According to parents interviewed by the Times, even pediatricians’ offices may have limited testing availability. The testing situation is especially concerning as more than 630,000 children in the US have tested positive for COVID since the pandemic began, and cases in children are on the rise, increasing 90 percent between July and August. While COVID is typically mild in children, infected children can put others in the community at risk. Without widespread access to testing for young children, schools and daycares will have trouble identifying cases to prevent outbreaks and closures, and government officials will lack the data needed to monitor the ongoing impact of school reopenings.

Did the Sturgis rally really seed a quarter-million COVID cases?

The annual Sturgis Motorcycle Rally drew 460,000 enthusiasts from around the country to a small town in rural South Dakota in early August. With little attention to masking or social distancing among participants, public health experts warned the rally could trigger a super-sized superspreader event. A discussion paper grabbed attention this week, claiming that over 260,000 COVID cases, accounting for $12.2B of healthcare expenses, were traceable to the event. While the big numbers made headlines, epidemiologists and public health experts quickly criticized the analysis behind the findings. The study’s researchers used cell phone data to track attendees to their home locations, and attributed all before-and-after differences in case numbers to the rally. While the rally was surely the source of a large increase in COVID-19 spread (particularly in the Dakotas, whose per-capita case rates shot up in the weeks after the rally), researchers doubt this large number of cases (which would account for 20 percent of all new cases in the US) can be directly attributed to the event, and point out numerous possible flaws in the analysis. The Sturgis rally provided the perfect recipe for a superspreader event, and reports of the first deaths of patients who contracted COVID-19 at the event are beginning to emerge. But the rush to publish—and publicize—these dramatic numbers based on questionable analysis provides fodder for those who look to challenge and undermine public health guidance.

That’s it for this week! Thanks so much for taking time to read the Weekly Gist, and for sharing your thoughts and suggestions with us. We love hearing from you! And we’re so grateful when you share our work with friends and colleagues, and encourage them to subscribe as well, and to listen to our daily podcast. It’s a true privilege.

Most of all, we hope you’ll let us know if there’s anything we can do to be of assistance in your work. You’re making healthcare better—we want to help!

Best regards,

Chas Roades
Co-Founder and CEO

Lisa Bielamowicz, MD
Co-Founder and President