March 10, 2023

The Weekly Gist: The Double Down Edition

by Chas Roades and Lisa Bielamowicz MD

Karl Marx famously said that history repeats itself, first as tragedy, then as farce. But the Colonel has other ideas. As of this week, the finger-lickin’ chicken folks at KFC are bringing back the infamous Double Down sandwich, for a limited, four-week engagement. What, you may ask, is the Double Down? Why, it’s two deep-fried chicken filets with bacon, cheese, and mayo in the middle…and no bun. That’s right, the chicken is the bread. First introduced in 2010 as an April Fools’ joke (the farce), this obscenity was reprised in 2014 (the tragedy), and now seems to be taking its inevitable place as a standard repertory piece, a la the McRib at McDonalds. In the pre-launch hype, KFC announced that it was “embracing the chaos” by bringing back the Double Down, which is just what 2023 needs—more chaos. If the idea of holding two sizzling, greasy chicken patties in your hands as you bite into 950 calories of dripping cholesterol, then hurry on down to KFC—you’ve only got three weeks left! Go ahead, those cath labs aren’t going to fill themselves.
THIS WEEK IN HEALTHCARE

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

  1. Best Buy partners with Atrium Health on hospital-at-home. On Tuesday, electronics retailer Best Buy announced a three-year deal with Charlotte, NC-based Atrium Health, now part of the larger Advocate Health, to set up the technological components required for hospital-level care in patients’ homes, and to provide remote monitoring. Atrium will purchase the remote monitoring devices from Best Buy and commission its Geek Squad teams to handle installation and retrieval, while the data will be transmitted through Best Buy subsidiary Current Health’s virtual and home-based care hub. (Best Buy acquired Current Health in 2021.) Atrium reports it has cared for over 6,300 patients in its hospital-at-home program since enrolling in the Medicare waiver program in December 2020, and hopes to provide the service to around 100 patients per day under this new arrangement.

The Gist: Following its Current Health acquisition, Best Buy has been establishing partnerships with health systems around remote monitoring. Leveraging its consumer-friendly Geek Squad workforce as a trusted, capable “last mile” solution to bring health technology into patients’ homes, it believes working with health systems on hospital-at-home is a logical next step. If partnerships like this prove successful, Best Buy could funnel more business into its Current Health arm, while diversifying its overall revenue stream from big-box electronics retailer to enabler of home healthcare solutions.

  1. WW buys telehealth company Sequence to enter prescription weight-loss market. The company formerly known as Weight Watchers announced on Monday that it will purchase Sequence, a subscription-based telehealth platform company. It’s a bid to enter the growing market for prescription obesity and diabetes drugs like Ozempic and Wegovy, which target GLP-1 receptors to suppress appetite. The $106M acquisition will allow WW to promote Sequence’s telehealth services to its 3.5M subscribers and incorporate the prescriptions into its broader nutrition- and exercise-based wellness programs.

The Gist: We’re in the early days of a Wild West-style gold rush for this new generation of weight-loss drugs, driven by the prevalence of the conditions they treat, their need to be taken in perpetuity, and the current price tag they fetch (around $1,000 per-patient, per-month). With mounting evidence that lifestyle and dietary modifications may be ineffective in treating most patients with obesity, WW’s legacy model faces an existential threat, as more patients gravitate to these new medication-based treatments. A host of companies is looking to provide access to these drugs via telemedicine, but questions remain about both short-term and long-term side effects, which may be more difficult to track in absence of an ongoing patient relationship. Moreover, the national cost implications of widely available and affordable GLP-1 agonists are staggering, as over 40 percent of Americans are obese. But if these drugs do provide a long-term solution, they could ultimately prove cost-effective if they reduce the cost burden of obesity.

  1. Transcarent to acquire provider business from 98point6. On Monday, Palo Alto, CA-based startup Transcarent, which provides concierge, virtual-first health benefit services to employers, shared that it will purchase the clinician arm of Seattle, WA-based startup 98point6, which is re-focusing its business on software services sold to third-party providers. In a deal worth up to $100M, Transcarent—founded by Livongo founder Glen Tullman—will acquire 98point6’s network of almost 100 clinicians, its self-insured employer business, and access to its proprietary, AI-powered software that interfaces with patients to improve physician productivity.

The Gist: Amid a recently bleak investment landscape for digital health, these two buzzy startups are responding by making strategic bets in opposite directions to stay ahead of the curve. Transcarent is taking on provider assets to offer a more comprehensive benefits package to employers, while 98point6 is going “asset-light” to focus on a high-margin, software-specific platform play. Given the drop in value of many pandemic-era digital start-ups, these moves to hone value propositions seem like smart bets.

Plus—what we’ve been reading.

  1. We’ve become even less prepared for the next pandemic. Published this week in the Washington Post, this sobering article surveys the dismantling of our nation’s patchwork public health infrastructure, driven by a backlash to COVID pandemic restrictions. Positioning themselves as defenders of freedom, a coalition of conservative and libertarian activists, legislators, and judges have neutered many of the nation’s public health authorities. State health officials and governors in over half the country are now unable to issue mask mandates or order school closures without the permission of their state legislatures. While the implications for a hypothetical “next COVID” are dire, we’re already seeing the consequences today: officials in Columbus, OH can no longer, for example, quarantine a child with measles, or shut down a restaurant experiencing a hepatitis A outbreak.

The Gist: The anti-public health backlash in the wake of COVID has now been codified, with far reaching consequences for future disease outbreaks. COVID protections for hospital-based healthcare providers are winding down, even in states like California which quickly embraced masking. But now in over half the country, many reasonable responses to unknown future health threats won’t even be on the table, or will involve debate and legislative action, wasting precious response time.

GRAPHIC OF THE WEEK

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

Non-hospital physician employment rose sharply during pandemic  

While hospitals, payers, and private equity firms have long been competing to acquire independent physician groups, the COVID pandemic spurred a marked acceleration of the physician employment trend, with non-hospital corporate entities leading the charge. The graphic below uses data released by consulting firm Avalere Health and the nonprofit Physicians Advocacy Institute to show that nearly three quarters of American physicians were employed by a larger entity as of January 2022, up from 62 percent just three years prior. While hospitals employ a majority of those physicians, corporate entities (a group that includes payers, private equity groups, and non-provider umbrella organizations) have been increasing their physician rolls at a much faster rate. Corporate entities employed over 40 percent more physicians in 2022 than in 2019, and in the southern part of the country—a hotspot for growth of Medicare Advantage—corporate physician employment grew by over 50 percent. We expect the move away from private practice, accelerated by the pandemic, will only continue as physicians seek financial returns, secure a path to retirement, and look to access capital for necessary investments to help grow and manage the increasing complexities of running a practice.
INTERMISSION

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

Manzanita by Shana Cleveland—Third solo album from the frontwoman of the surf-rock band La Luz, which keeps the West Coast vibe but trades Dick Dale-inspired electric guitar for shimmery, acoustic psych-folk. There’s more than a hint of Laurel Canyon amid these brooding, baroque ballads, which ruminate on ecological collapse and personal loss. Play it on repeat.
THIS WEEK AT GIST—ON THE ROAD

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

So. Many. Portals.

Thanks to a combination of minor physical ailments and routine, middle-age upkeep, the past several weeks have brought a series of interactions with healthcare providers. An annual physical, rounds of labs, an x-ray, an ultrasound, and a long-overdue colonoscopy thrown into the bargain. I’m happy to report that for the most part, the scheduling and experiential components of these half-dozen visits have been more consumer-friendly than anticipated. I’ve seen little direct evidence of staffing shortage or provider burnout, though I’m sure it’s lurking behind the curtain. And the quality of care has been excellent: guideline-compliant, effective, and safe. (And I’m fine, thanks for asking.)

I have only one real complaint: PORTALS. There have been so many different online “front doors” to sign up for, in order to schedule, get records, get lab results, get imaging files, that I feel like I’m in a hall of mirrors. I’m a One Medical member, so that’s one. Then Labcorp has its own portal. As does Walgreens. And the hospital-affiliated radiology practice, which uses both MyChart and their own portal. The GI practice has one too, where I had to go for the all-important colonoscopy prep instructions. Eventually, I’ll need to access my insurance portal to see how it all gets paid for. Naturally, each of these online sites has its own separate login, and none of them talks to one another. Information from one provider to the other still happens the old-fashioned way—via email, phone call, and (in one instance) fax. I’m not sure how this portal-proliferation problem could be solved—there’s a definite coordination issue at work here (whose patient am I?)—but it strikes me that if I were a tech company looking to fix this issue, I’d start at the consumer end, not the provider end. Why can’t I have a digital avatar, a proxy persona, to run through all these portals on my behalf, which would have all my relevant information, collect results, and report them back to me. It’s 2023, but all of these portals are making me nostalgic for 1995, with that chipper AOL voice telling me, “You’ve got lab results!”
THIS WEEK AT GIST—ON THE PODCAST

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

Last Monday, JC spoke with Alec Tyson, Associate Director of Research at the Pew Research Center, about Pew’s recent survey, which found a majority of Americans are uncomfortable with healthcare providers that rely on artificial intelligence to make diagnoses or recommend potential treatments.

This coming Monday, JC will speak with Veronica Johnson, MD, Assistant Professor of Medicine at Northwestern University and an obesity and diabetes specialist, about the increasing popularity of GLP-1 drugs like Ozempic and Wegovy. In the first part of their conversation airing next week, they take a deep dive into the medications themselves, and discuss how they are being incorporated into patient care. The second part of their conversation, which will air the following week, delves into the current shortages of these drugs and factors physicians should consider when looking to use them for their patients.

[Subscribe on Apple, Spotify, Google, or wherever fine podcasts are available.]
That’s all for this week—thanks for joining us for another edition of the Weekly Gist! Friendly reminder: don’t forget to set your clocks forward on Saturday night…it’s time to spring forward. Why not use your extra hour of daylight to reach out with your feedback and suggestions? We’d love to hear from you. And please share this with a friend or colleague, and encourage them to subscribe, and to listen to our daily podcast.

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
chas@gisthealthcare.com

Lisa Bielamowicz, MD
Co-President and Managing Director
lisa@gisthealthcare.com