THIS WEEK IN HEALTHCARE
What happened in healthcare this week—and what we think about it.
- New COVID booster authorized, though federal financial support is running out. This week, the Food and Drug Administration approved tweaks to the COVID-19 vaccine booster doses from Pfizer and Moderna to better target the BA.5 omicron strain, currently the most prevalent in the US. Yesterday, outside advisors to the Centers for Disease Control and Prevention (CDC) recommended that these bivalent doses, which mix the original recipe with a BA.5-specific formulation, be administered to all individuals ages 12 and up, a recommendation CDC Director Rochelle Walensky quickly adopted. The federal government has already purchased 170M booster doses, but with additional COVID funding failing to pass Congress, consumers may soon be required to cover out-of-pocket costs for vaccinations.
The Gist: Given that fewer than half of the country’s fully vaccinated population has received even a first booster, the CDC will face an uphill battle in its efforts to encourage widespread uptake of a new booster. While we’re heartened by the mounting evidence that COVID case numbers have decoupled from severe illness and death rates, it’s worth asking what another fall or winter COVID wave would look like for US hospitals, given persistent staffing shortages. A successful rollout of a new booster could help prevent any worst-case scenarios, but the CDC’s vaccination rollout performance over the past few years doesn’t instill much confidence. Health systems may yet again be facing this threat on their own, without any government financial support this time.
- Amazon shutters Amazon Care. Amazon announced late last week that it will stop offering Amazon Care to employer clients at the end of this year. Initially developed as a virtual care option for Amazon employees in 2019, Amazon Care grew to include virtual care for other employers in all 50 states, and earlier this year, released expansion plans to establish in-person clinics in 20 cities. Amazon shared its decision to shut down Amazon Care one month after it announced plans to acquire primary care company One Medical. Amazon Care’s failure to establish itself in the employer health benefits market appears to have driven the closure decision, raising questions about whether One Medical will serve as a replacement business, or whether the e-commerce giant has other plans for the new acquisition.
The Gist: By giving up on its employer-oriented healthcare business after only a couple of years, Amazon has handed its critics another piece of evidence that “healthcare is hard”. Perhaps it will find better success with One Medical—which operates 182 medical offices in 25 markets and has many established contracts with major employers—than it did building its own offering. But so far neither Amazon nor One Medical has figured out how to make money in primary care delivery. Though Amazon has yet to prove its “business genius” translates to healthcare, it still has deep pockets, a willingness to experiment, and a unique understanding of American consumers that will keep healthcare insiders watching its every move. Enjoy the schadenfreude while it lasts.
- Surprise billing ban hampered by arbitration frustrations. Eight months after the No Surprises Act went into effect, the dispute resolution process it established to settle rate disagreements between providers and insurers has settled less than three percent of 46K cases submitted to the federal mediation portal, which was established in April. Insurers have blamed providers for overloading the system with frivolous claims, while providers have accused insurers of slow-walking the submission of necessary information. Both parties have challenged the eligibility of nearly half the cases in mediation, and a recently published, more provider-friendly final rule will likely cause further delays to the process.
The Gist: The No Surprises Act is another example of what happens when an ambitious health policy fix is negotiated down to a Band-Aid solution that does little to solve the underlying causes of the problem. Instead of setting prices or regulating physician networks, the law only added another layer of administrative bloat to the already convoluted healthcare billing system. While consumer advocates can celebrate that at least it’s serving to prevent surprise bills for many—one survey from earlier this year estimates that it will prevent 12M surprise bills this year—we are left holding out hope for true reform to come.
Plus—what we’ve been reading.
- Are Americans now sicker? A stagging number of Americans either postponed or avoided nonemergency healthcare across the past two and a half years, whether out of fear of COVID infection, financial concerns, or because of provider closures and scheduling backlogs. A recent Atlantic article explores the impact of this delayed care, which now threatens the health of many Americans and presents new challenges for the delivery system. While the anecdotal reports of returning patients presenting with more advanced illness are compelling, the article also cites recent research that 30-day mortality rates for non-COVID hospitalized patients rose during the pandemic and remain persistently elevated.
The Gist: Hospital leaders today point to higher inpatient acuity levels as not only a sign of delayed care, but also a prospect for higher volumes as patients resume pre-pandemic healthcare consumption patterns. However, this rise in acuity might also simply be the result of successful diversion of lower-acuity patients to non-hospital settings, leaving only the sickest to be admitted. Nonetheless, many Americans who delayed care are still grappling with an array of problems, especially chronic disease exacerbations, which will further impact their health for years to come. Health systems must continue targeted outreach to these patients, who are disproportionately Black, Hispanic, and lower income. As the article notes, “It’s still possible to prevent an acute public health crisis from seeding an ever bigger chronic one.”