August 14, 2020

The Weekly Gist: The Touched-Up Unicorn Edition

by Chas Roades and Lisa Bielamowicz MD

We spend a lot of time on Zoom calls. Like, a lot. Enough that we’re starting to have coronavirus dreams about Alice from the Brady Bunch and Paul Lynde from Hollywood Squares. That’s why it didn’t surprise us to learn that there’s been a measurable spike in Zoom-related cosmetic surgeries, among people who are starting to notice just how haggard they look on-screen. We’re all movie stars now, and some people are starting to act like it. But before you sink your money into a designer nose or customized chin, don’t forget to play with Zoom’s wacky new filters, introduced in their most recent update. Surprise your coworkers—start your next call with bunny ears or a unicorn horn, or even a pirate hat and eyepatch! Now instead of just “touching up” your appearance—a tried and true Zoom trick—you can transform yourself completely, like a 2015 tween who just got Snapchat on their hand-me-down iPhone. Hours of fun!

(Is it the apocalypse yet?)


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

Prosecuting the case against the COVID response

This week, in her debut as running mate to presidential candidate Joe Biden, California Sen. Kamala Harris gave a preview of one of the Democratic ticket’s key arguments for the fall campaign, making a full-throated, prosecutorial case against the Trump administration’s handling of the coronavirus pandemic. “The virus has impacted almost every country,” Harris said, “but there’s a reason it has hit America worse than any other advanced nation. It’s because of Trump’s failure to take it seriously from the start.” After receiving a briefing from public health experts on Thursday, Biden and Harris argued for a more comprehensive, aggressive national strategy to battle the virus, including major federal investment in contact tracing, a national mask mandate, and guaranteed free access to a COVID vaccine when it becomes available. The remarks came as the US experienced the deadliest day of the summer so far, with nearly 1,500 COVID fatalities on Wednesday, and a seven-day rolling average of over 1,000 deaths per day for the last 17 days. Meanwhile, a new analysis by the New York Times, using data from the Centers for Disease Control and Prevention (CDC), indicated that the true US death toll from COVID may be as much as 35 percent higher than the reported total of 167K—a finding based on “excess deaths” above normal levels since March.

As President Trump continued to urge schools to reopen for in-person instruction nationwide, the White House released new guidance for ensuring students’ safe return to school. The guidance encouraged social distancing, frequent handwashing, better ventilation of school facilities, and the use of outdoor settings wherever possible. Despite the President’s claim last week that children are “virtually immune” from the virus, a new analysis from the American Academy of Pediatrics and the Children’s Hospital Association showed that 97,000 children tested positive for COVID in the last two weeks of July alone, a 40 percent increase in the total number of known cases over that period. About 340,000 children have tested positive so far, representing about 9 percent of all US cases. As schools face pressure to reopen, those numbers are likely to mount, and early-opening school districts in Georgia, Tennessee, Indiana, and Mississippi are already struggling to keep schools open amid rising cases. Federal assistance to help schools deal with what seems like inevitable rounds of positive cases and closures is not forthcoming, however: after failing to reach a deal on another round of COVID relief, lawmakers have left Washington until September. US coronavirus update: 5.2M cases; 167K deaths; 64.6M tests conducted.

Sentara, Cone Health announce merger to create $11.5B system

On Wednesday, Greensboro, NC-based Cone Health and Norfolk, VA-based Sentara Healthcare announced plans to merge. (Cone Health is a member of Gist Healthcare.) The combination will create a $11.5B, 17-hospital system with over 2,400 doctors and advanced practice providers. The combined organization will be led by Sentara CEO Howard Kern; Cone CEO Terry Akin will serve as President of the system’s Cone Health division. Both systems bring health plan assets and experience managing risk, with Cone operating a 15,000-member Medicare Advantage plan as well as a long-running, successful Medicare and commercial ACO. Sentara owns Optima Health and Virginia Premier Health Plan, which together manage nearly 900,000 lives. Speaking with Gist Healthcare Daily’s Alex Olgin this week, Akin noted that synergies between the plans could create new, more affordable insurance options: “It gives us the opportunity to combine the provision of healthcare with the payment for that healthcare. And we think that will allow us to maximize value to those we serve, to individuals, and to businesses and across our communities. We look forward to a way to offer yet another option to people who are looking at how to fund their healthcare through various insurance products.” The combination bears watching to see if two like-minded, integrated systems with complementary health plan and contracting assets will be able to deliver strategic value and lower-cost solutions.

A new pilot program for rural healthcare

The Center for Medicare & Medicaid Innovation (CMMI) announced a new, voluntary payment program for rural providers, aimed at addressing healthcare disparities by providing a way for rural communities to transform their delivery systems. The new Community Health Access and Rural Transformation (CHART) model will test whether upfront investment, capitated payments, and regulatory flexibilities can enable rural providers to improve care quality and access while reducing costs. The model will have two different options. In the first, the Community Transformation Track, CMMI will give 15 “lead organizations” in rural communities up to $5M in upfront funding, and a stable revenue stream through capitated payments. Examples of eligible lead organizations include, but are not limited to, state Medicaid agencies, local public health departments, independent practice associations, and academic medical centers. In the second option, the Accountable Care Organization (ACO) Transformation Track, CMMI will select 20 “rural-focused” ACOs to receive advanced payments as part of participation in the Medicare Shared Savings Program. CMMI’s focus on rural providers comes at a critical time in the COVID pandemic—nearly 20 percent of Americans live in rural communities, and they tend to be older, suffer disproportionally from chronic diseases, and have less access to healthcare. Because of financial difficulties, one in four rural hospitals is potentially at risk of closure, and these facilities have reportedly had a harder time accessing COVID relief. Addressing the needs of these struggling rural providers—so critical to their communities’ well-being—is welcome and long-overdue.


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

Home as the center of “care anywhere”

We’re increasingly convinced that virtual physician visits are just one part of a continuum of care that can be delivered in the convenience and safety of the patient’s home. Health systems that can deliver “care anywhere”—an integrated platform of virtual services consumers can access from home (or wherever they are) for both urgent needs and overall health management, coordinated with in-person resources—have an unprecedented opportunity to build loyalty at a time when consumers are seeking a trusted source of safe, available care solutions. The graphic below outlines the key components of a comprehensive home-based care model, which requires the integration of three main elements: a technology backbone, a supply chain to provide services like labs and diagnostics, and a tiered, flexible workforce. Of course, these infrastructure needs will increase with care acuity level, ranging from a simple virtual visit to home-delivered vaccination, all the way to hospital-level care at home. Delivering safe, accessible care within the home can be the foundation for an access platform that creates ongoing consumer loyalty—especially for systems who can build a financial model less dependent on payers’ long-term support for telemedicine reimbursement “parity”.


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

A not-so-VIP concierge medicine experience

Last week a family member asked me to help him sort out his medications. A few months ago, he’d been taking just two prescriptions, for mild hypertension and cholesterol. But early in the pandemic his blood pressure spiked, and he found himself with a large bag of pill bottles, unclear as to what he should be taking. Finding a half-dozen medications prescribed by two different doctors, including multiple bottles of the same medication at different doses, I wasn’t sure either. He said his primary care physician had “gone concierge” and become part of MDVIP, a nationwide concierge physician network. He’d paid the fee to join the new services, and was told to call whenever he had a question, so we decided to give that offer a try.

This was my first interaction with MDVIP, so we started with their patient help line (first listing on the Google search for his doctor’s name). After fifteen minutes of looking, the help line couldn’t even find our patient’s name in their records. We asked to be transferred to the doctor’s office, and were told a nurse would be in touch shortly. Four hours later, a practice nurse called, and we went through the medications one by one. Alarmingly, two medications prescribed by doctors in the practice weren’t even in their EMR, and the nurse said she’d check with the doctor and call back in a few minutes. Which turned out to be the next morning. We were then able to winnow down the prescriptions by half. My takeaway: the experience was what I’d consider “average” for the typical primary care practice—but fell far short of my expectations for a concierge relationship, especially one for which my family member was paying nearly $4,000 annually (for himself and his wife). It’s understandable that some doctors prefer a practice model that allows them to devote more time and service to a smaller patient panel. But if the patient experience is not measurably different, we should be honest that “going concierge” means patients paying a hefty fee primarily for the privilege of staying on the patient panel of their long-term provider.

A virtual listening tour of the board

Like many healthcare organizations, our members are spending a lot of time these days trying to figure out how COVID will impact future strategy. For some, the pandemic hit just as the “traditional” planning cycle was kicking into gear. In our work with one member, the transition of all work to Zoom is turning out to be fortuitous. It’s provided the opportunity to do one-on-one videoconference calls with every member of the board (and every member of the executive team), to get their confidential observations on how the system has performed through COVID, what strengths and vulnerabilities they see, and where they believe future opportunities lie. It’s a hefty round of interviews that would have been harder to pull off if we weren’t all grounded by travel restrictions and lockdowns, with the added benefit of having more personal interactions “face to face” by video chat. Not only are we getting a thorough picture of what’s going on with the system, but we’re able to build rapport and engagement with board members and executives in a way that will make the future work of strategic direction-setting much more powerful. We’ll be synthesizing our findings and reporting back to the system’s leaders, giving them a nuanced and honest assessment of how everyone is viewing the situation. Even if we weren’t supporting a formal planning process, we’d still recommend the virtual listening tour—especially in the wake of the COVID crisis. There’s a lot to be learned from taking the time to get a 360-degree view of where we stand now, in the midst of all of the uncertainty we face. As fatiguing as dozens of hours spent on Zoom calls can be, the process has been really rewarding and worthwhile.


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

On last Monday’s episode, New York Times economics reporter Jim Tankersley talked about his new book “The Riches of This Land”, and how minorities who have been disadvantaged by American economic policy are now harder-hit by the pandemic-induced recession. Tankersley told us he believes women and men of color are key to rebuilding the country’s middle class.

Coming up next Monday, we’ll hear from Travis Messina, CEO of hospital-at-home company Contessa. He compares the hospital-at-home model’s potential to that of early ambulatory surgery centers, which performed only a handful of procedures until Medicare expanded coverage and reimbursement. Make sure to tune in!

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

If nostalgia ends up being the secret drug that gets us through these dark months, then we’ll have documentary filmmaker Alison Ellwood to thank for being our rock and roll Dr. Fauci. Having already delivered a sumptuous, two-part film about the Laurel Canyon scene of the late 1960s and early 70s, released on Epix earlier this year, she’s out now with a stunning tribute to the greatest female rock band of all time, The Go Go’s. First shown at the 2020 Sundance festival, and now airing on Showtime, the film is a faithful and revealing look at the quintessential 80s punk-pop band, from their early days on the LA hardcore scene, to their meteoric rise to the top of the charts with one of the greatest debut albums of all time, Beauty and the Beat. More than just a hagiographic rockumentary, Ellwood’s retelling centers the feminist power of the band, the first chart-topping “girl group” to write all their own songs and play all their own instruments, amid a male-dominated industry that had no interest in lending a hand. We hear their full, unvarnished story, from all the key players: the “classic” lineup of Belinda Carlisle, Jane Wiedlin, Charlotte Caffey, Gina Schock, and Kathy Valentine, as well as members and friends cast aside during the band’s turbulent career. Despite drug problems, disputes over money, and personality conflicts among bandmates, The Go Go’s managed to deliver several iconic tracks that defined the 80s: “We Got the Beat”, “Our Lips are Sealed”, “Vacation”, “Head Over Heels”. Gratifyingly, with skeletons firmly back in the closet, the band is back together and out with a new track to accompany the film—“Club Zero”, a worthy addition to their catalogue. Tune in, embrace the nostalgia, and ask yourself: how are these kick-ass women not in the Rock and Roll Hall of Fame?


Stuff we read this week that made us think.

Sizing the pandemic’s toll on mental health

A Centers for Disease Control and Prevention (CDC) survey of over 5,400 adults completed in late June shows that mental health challenges have spiked during the COVID-19 crisis, with over 40 percent of respondents reporting that they currently suffer from a substance abuse or mental health condition. Rates of anxiety and depression were over three times higher than during the same period last year. Nearly 11 percent of those surveyed considered suicide in the past month; rates were higher among Blacks, Hispanics, essential workers and unpaid caregivers. Most alarmingly, the data show a mounting mental health crisis among young adults, with over 60 percent of adults aged 18 to 24 reporting depression or anxiety attributed to the pandemic, and a full quarter having considered suicide. Ongoing social isolation is creating unprecedented rates of mental illness—and will continue to grow as high rates of COVID infection persist and economic challenges worsen. While telehealth has created some additional capacity for behavioral health services, the country is dramatically short of the resources needed to manage a mental health crisis that will likely extend through the pandemic and for years beyond.

Beware the office toilet

Returning to the office after months of lockdown may bring an unexpected risk for workers. According to the New York Times, the CDC recently closed some of its Atlanta offices after finding that its water sources contained Legionella, the bacteria that causes Legionnaire’s disease. The bacteria can grow in stagnant water systems, including plumbing and air conditioning units. After a prolonged absence, inhaled vapors from flushing toilets, running taps or restarted air conditioners can carry Legionella into the lungs. While older individuals with lung conditions are most vulnerable, Legionnaire’s pneumonia carries a 10 percent fatality rate—leading the CDC to publish reopening guidelines for building operators that include flushing long-dormant systems with heated water and additional disinfectant in advance of reopening, and the suggestion that at-risk individuals should wear an N95 respirator or facepiece when aerosol generation is likely. (Unsurprisingly, the guidelines have been criticized as overly vague and lacking prescriptive advice.) As if we all didn’t have enough to worry about, don’t forget to bring a N95 mask for any bathroom breaks during your first day back at the office! (Or maybe just hold it.)

That’s it for another edition of the Weekly Gist. Thanks for joining us, and do share your comments and feedback—we love to hear from our readers! If you’ve got a moment, please forward this to a friend or colleague and encourage them to subscribe too, and to listen to our daily podcast. The more the merrier!

Most importantly, please 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