February 17, 2023

The Weekly Gist: The Strange Times in Chocolate-Land Edition

by Chas Roades and Lisa Bielamowicz MD

In case you’re thinking of giving up chocolate for Lent, you may want to accelerate those plans. Two alarming stories caught our eye this week. First, the federal government just fined giant candy maker Mars Wrigley $14,500 after two workers an M&M plant in Pennsylvania fell into a huge vat of chocolate, eventually having to be rescued through a hole cut into the side of the container. No word on whether one of the workers was named Augustus Gloop, nor whether the incident explains why M&Ms have been tasting so weird lately. Then, an Englishman named Joby Pool (now there’s a name torn straight from the pages of a Roald Dahl story) absconded with 200,000 Cadbury Creme Eggs from a factory in the West Mercia region of England. Fortunately, Pool was caught red-handed (or possibly goo-covered), and the eggs were “returned safely” to the plant for processing. We wouldn’t eat ‘em…and for us, those are a perennial springtime fave. Strange times in Chocolate-Land lately, munch with caution!


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

  1. Doximity unveils ChatGPT tool for physicians. Doximity, a digital collaboration and workflow platform for medical professionals, released a beta version of a ChatGPT-powered tool that offers to streamline time-consuming administrative tasks for providers, including prior authorization requests and insurer appeals. Developed by San Francisco-based OpenAI, ChatGPT is a versatile artificial intelligence (AI) large language model that launched in November 2022, immediately garnering attention for its ability to process complex commands and present relatively intelligent (though occasionally wildly incorrect) answers. Doximity’s beta site, DocsGPT.com, integrates ChatGPT into the company’s free fax service, which Doximity’s CEO sees as its most promising early use case, but other prompts on the site include post-procedure and treatment instructions.

The Gist: While there is justified skepticism around the sweeping premise that AI will revolutionize healthcare, this application of next-generation chatbots seems well-targeted to address a painful problem for doctors. Doximity has begun at a logical starting point, by enabling AI to manage repetitive tasks like faxes to insurers, while keeping the final stamp of approval in providers’ hands. This is essential because ChatGPT struggles with accuracy, which could be worrisome when it comes to patients. Rather than replacing providers, AI’s current potential in healthcare is to make basic tasks more efficient, freeing up providers’ time so they can focus on patient care.

  1. FDA advisers recommend selling Narcan over the counter (OTC). On Wednesday, a joint Food and Drug Administration (FDA) advisory panel unanimously recommended that the anti-opioid overdose drug Narcan (known generically as naloxone) be made available in nasal spray form without a prescription. It’s highly likely the FDA will grant OTC approval to Narcan next month, which could make it more widely available to the public as soon as this summer.

The Gist: Narcan has become one of the most essential tools to combat the unrelenting epidemic of opioid-related drug overdoses, which claimed a record 107K lives in 2021. Even though the medication can be prescribed to at-risk individuals and others who are in close contact with drug users, access thus far has been limited mostly to emergency responders and outreach workers. While the US has successfully reduced the availability of the prescription opioids that initially sparked the crisis, a majority of recent deaths are attributed to synthetic opioids like fentanyl. This much-needed policy change acknowledges that efforts to restrict drug supply have stalled, and shifts the focus to broadening access to effective harm-mitigation tools. As community leaders on the frontline of the opioid epidemic, hospitals and providers can play a valuable role in publicizing expanded Narcan availability.

  1. Biden administration announces three new drug pricing pilots. This week, the Biden administration released a roadmap for implementing three new drug pricing pilots through the Centers for Medicare and Medicaid Innovation (CMMI). These models seek to offer certain common generic drugs to Medicare beneficiaries for two dollars per month, test new ways for how Medicaid pays for expensive cell and gene therapies, and explore alternative reimbursement models for drugs that receive accelerated Food and Drug Administration approval.

The Gist: On the heels of last week’s State of the Union Address, the announcement of these pilots exemplifies the kind of health policy efforts we expect across the remainder of President Biden’s current term: smaller, incremental initiatives to curb healthcare costs at the margins. But given that all these initiatives have lengthy timelines, in part to allow for industry input, they will likely require the support of the next administration, Biden’s or otherwise, to reach full implementation.

Pluswhat we’ve been reading.

  1. An unprecedented mental health crisis for adolescent girls. Responding to the Centers for Disease Control and Prevention’s (CDC) latest Youth Risk Behavior Survey for 2011-2021, an article in The Atlantic attempts to make sense of the historic levels of anxiety and depression being reported by today’s teens, especially girls and those who identify as lesbian, gay, or bisexual (the survey does not track trans identity). The survey, which is the definitive measure of youth behavior and mental health in the country, found nearly 60 percent of teenage girls reported “persistent feelings of sadness or hopelessness”, and that the share contemplating suicide grew by 50 percent since 2011. The article explores several possible drivers, including a pandemic-induced effect that could subside, pervasive exposure to social media, the normalization of discussing mental distress, and the outcome of growing up with ongoing crises like school shootings and climate change. But none of the explanations fully accounts for the alarming crisis, nor do any of them present easily workable solutions.

The Gist: Echoing the drug overdose epidemic, the unfolding crisis in teen mental health is difficult for providers to address because many victims don’t access healthcare services until their conditions deteriorate to the point of requiring hospitalization, often from a suicide attempt or an overdose. And when teenagers in mental health crisis present to emergency departments, hospitals are often forced to board them for days, as the number of psychiatric treatment facilities for teens has dropped by 30 percent from 2012 to 2020. These data should be a call for providers to focus more upstream diagnosis and care, by partnering with children, families, schools, and other community organizations.


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

Consumers are skeptical of “hospitals”—just not their own

Health systems have recently been the subject of high-profile media accusations that they prioritize “profits over patients”, as an unflattering New York Times series has framed it. New consumer survey data from strategic healthcare communications consulting firm Jarrard Inc. shows that while consumers find some merit in these claims, they tend to see their local hospital in a better light. As shown in the graphic below, a majority of US adults believe that, on a national level, hospitals are more focused on making money than caring for patients, and that they don’t do enough to help low-income people access high quality care. Despite only one in five survey participants having seen news stories alleging hospitals fail to provide enough charity care in exchange for tax breaks, 65 percent of survey respondents find those allegations believable. But while the consumer perception of hospitals may be suffering nationally, the responses were quite different when consumers were asked about their preferred local hospital. More than half strongly agreed that their preferred local hospital is a good community partner—one that puts patient care ahead of making money. (Just as with Congress: people love to criticize the institution, while continuing to return their own representatives to Washington.) While the negative national attention can be disheartening, at the end of the day, to consumers, healthcare is local, and health systems must continue to build direct consumer relationships to strengthen patient loyalty.


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

Desire, I Want to Turn Into You, by Caroline Polachek—Stellar new art-pop album from the former founder of indie outfit Chairlift, who maintains she’s not “this generation’s Kate Bush”, but might be after all. This second LP positions Polachek as the standard bearer and living proof of pop’s highest possibilities. Look for it on “best of” lists at the end of 2023.


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

The shrinking book of “profitable” health system business 

This week, a health system CFO referenced the thoughts we shared last week about many hospitals rethinking physician employment models, and looking to pull back on employing more doctors, given current financial challenges. He said, “We’ve employed more and more doctors in the hope that we’re building a group that will allow us to pivot to total cost management. But we can’t get risk, so we’ve justified the ‘losses’ on physician practices by thinking we’re making it up with the downstream volume the medical group delivers. But the reality now is that we’re losing money on most of that downstream business. If we just keep adding doctors that refer us services that don’t make a margin, it’s not helping us.”

While his comment has myriad implications for the physician organization, it also highlights a broader challenge we’ve heard from many health system executives: a smaller and smaller portion of the business is responsible for the overall system margin. While the services that comprise the still-profitable book vary by organization (NICU, cardiac procedures, some cancer management, complex orthopedics, and neurosurgery are often noted), executives have been surprised how quickly some highly profitable service lines have shifted. One executive shared, “Orthopedics used to be our most profitable service line. But with rising labor costs and most of the commercial surgeries shifting outpatient, we’re losing money on at least half of it.” These conversations highlight the flaws in the current cross-subsidy based business model. Rising costs, new competitors, and a challenging contracting environment have accelerated the need to find new and sustainable models to deliver care, plan for growth and footprint—and find a way to get paid that aligns with that future vision.


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

Last Monday, JC spoke with Even Health co-founder and CEO David Black about his organization’s digital platform Cabana, which provides professionally-moderated, anonymous peer support groups for healthcare professionals.

Coming up this Monday, JC will talk to David Jarrard, Executive Chairman of strategic healthcare communications consulting firm Jarrard Inc., about the results of his company’s latest national consumer survey on the public perception of hospitals and healthcare in the United States.

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Here endeth the reading from today’s Weekly Gist. Thanks so much for joining us this week—hope you have fun plans for the long weekend ahead! If you get a moment, drop us a line and let us know what’s on your mind. We love hearing your comments and suggestions! And remember to pass this along to friends and colleagues, and encourage them to subscribe, and to listen to our daily podcast.

As ever, please let us know if 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