|THIS WEEK IN HEALTHCARE
What happened in healthcare this week—and what we think about it.
As cases and deaths rise, Americans ponder a return to school
The US spent another week headed in the wrong direction, with daily new COVID-19 cases reaching nearly 60,000 on Thursday, the sixth record-setting total in the past ten days. The spike continued to be most pronounced in states that reopened early, with Texas, South Carolina, Arizona, and Florida hit particularly hard. More worryingly, several states saw daily deaths from COVID rise, with Alabama, Florida, Mississippi, South Dakota and Tennessee hitting one-day death records. Like the light from some malign star, death numbers are a lagging indicator—a reflection of new case totals from weeks earlier—leading health experts to warn of dark days ahead for the rest of the summer. In his customary understated manner, top White House health advisor Dr. Anthony Fauci said this week, “I don’t think you could say we’re doing great. I mean, we’re just not.” Responding to concerns about the availability of hospital capacity, Texas Gov. Greg Abbott expanded a ban on elective surgeries to more than 100 counties across the state, and HCA Healthcare delayed inpatient surgeries at more than a dozen of its hospitals in Florida, as did other health systems there.
School reopening emerged as a political flashpoint this week, with President Trump hosting a summit meeting on “Safely Reopening America’s Schools” on Tuesday at the White House. The President criticized reopening guidelines from the Centers for Disease Control (CDC) as being “very tough & expensive”, but on Thursday CDC director Dr. Robert Redfield told CNN that the guidelines, first published in May, would not be revised. With schools and colleges set to restart in many places next month, the influential American Academy of Pediatrics modified its earlier support for reopening schools, pushing back on the administration’s threatened funding cuts for school districts that do not reopen on time, with in-person classes. The debate over how to handle school reopening underscores how much time was lost between March and May, when a national reopening plan should have been developed. As the virus surges, with students and teachers set to return in just a few short weeks, and further economic recovery hinging on parents’ ability to send their kids safely to school, the window is rapidly closing on our ability to navigate this critical transition. US coronavirus update: 3.2M cases; 135K deaths; 38.0M tests conducted.
Democrats align around a health policy platform
Promising that “we are going to at last build the health care system the American people have always deserved”, a joint task force of health policy advisors from the Biden and Sanders campaigns this week released a unified set of proposals that will serve as part of the former Vice President’s campaign platform for the November election. While the document does not include Sanders’ signature “Medicare for All” proposal, it does support a government-run public insurance option that would be available to all Americans, at income-adjusted, subsidized rates—including free coverage for those with low incomes. It also promises to expand Medicare benefits to include dental, vision, and hearing coverage, and to extend Medicare eligibility to those age 60 and above. For those who lose their health coverage due to the COVID pandemic, the unity document endorses having the government pick up the tab for COBRA benefits and shifting enrollees into premium-free coverage on the Obamacare exchanges when their COBRA eligibility expires. It also promises greater investment in public health resources, including increased funding for the CDC, and funding to recruit 100,000 contact tracers nationwide. Other key components of the proposal include eliminating “surprise billing”, reducing drug costs, addressing racial and gender-based health inequities, and bolstering investment in scientific research.
This week’s document represents an important step in unifying the progressive and moderate wings of the Democratic party around key health policy principles. Should Biden win in November, and if Democrats gain control of the Senate, we’d expect quick action on many of these proposals. Clearly the most difficult would be the public option and Medicare expansion, which would require lengthy negotiation with various industry groups to garner sufficient political support. Similar to the 2009 process that led to the Affordable Care Act, we would likely see a year’s worth of political horse-trading, leading to passage of some compromise legislation before the midterm elections in 2022. All of that in the midst of an ongoing pandemic and likely prolonged economic downturn—both of which will probably allow for the passage of more far-reaching legislation than might otherwise be possible.
Walgreens to open primary care practices in hundreds of stores
Walgreens Boots Alliance announced Wednesday that it plans to launch physician-led clinics in 500 to 700 stores in 30 markets nationwide, in a major expansion of its partnership with VillageMD, a Chicago-based primary care startup. The companies previously partnered on a pilot of in-store clinics in five Houston-area Walgreens stores. Walgreens will acquire a 30 percent stake in VillageMD through an investment of $1B, 80 percent of which will be used to fund the launch and operations of the clinics, including the hiring of 3,600 primary care physicians. The “Village Medicine at Walgreens” clinics will also be integrated with Walgreens’ larger digital health offerings into a care management-focused model designed for Medicare beneficiaries, which could also be marketed to employers.
Other retailers, most notably CVS and Walmart, have continued to expand their care delivery offerings amid the pandemic. Walgreens’ physician-centric model is in contrast to its competitors, which more heavily rely on nurses and advanced practice providers. We visited one of Walgreens’ pilot sites on a trip to Houston last December. This VillageMD clinic was part of a larger Walgreens store renovation, but had a separate entrance, and felt distinctly less integrated with the retail store and pharmacy than CVS’ HealthHUB clinics. It will be worth watching to see if this launch, with its significantly more expensive labor model, is able to generate better outcomes and gain traction with consumers—and whether Walgreens will seek an insurer partner to create a risk model that allows the company to profit from the delivery of lower-cost care.