|THIS WEEK IN HEALTHCARE
What happened in healthcare this week—and what we think about it.
- Public health expert Dr. Ashish Jha to replace Jeff Zients as COVID czar. Next month Jha, an internist and dean of the Brown University School of Public Health, will take over as White House COVID coordinator, as the administration seeks to shift its COVID focus to managing an endemic virus. President Biden’s decision to replace Zients, instead of eliminating the position and shifting accountability back to the Department of Health and Human Services, signals that the administration intends to keep pandemic management centered in the White House.
The Gist: Zients, who demonstrated his operational leadership skills in spearheading the rework of the Obamacare insurance exchange, played a vital role in managing the immense logistical challenge of getting millions of vaccines, tests, and masks to Americans. But during his tenure, the administration’s coronavirus response team has struggled with issuing clear and consistent public guidance. This is where Jha, a familiar expert voice during the pandemic, shines. His calm, incisive communication skills, combined with his medical background and public health experience, make Jha a solid choice to lead the country through the next phase of the pandemic—provided the Biden administration is able to secure the funding needed to maintain the federal response effort as early signs indicate the US could be heading into another surge in cases.
- Pfizer and Moderna ask regulators to authorize a fourth COVID vaccine dose. While a fourth shot is already recommended for immunocompromised Americans, Pfizer is now asking the Food and Drug Administration (FDA) to expand that recommendation to include all adults over 65, and Moderna is asking for a broader expansion for all adults. The drugmakers are relying on data from Israel, which has administered fourth doses to healthcare workers and seniors. The FDA hasn’t signaled whether it will approve Pfizer’s request, but the agency’s top vaccine regulator recently said that, barring a surprise variant, they are planning for an additional COVID booster and seasonal flu shots to be combined.
The Gist: The “fourth shot” messaging already seems muddled. Pfizer CEO Albert Bourla has said in recent interviews that a third shot is “good enough” against hospitalizations and death, but a fourth shot could help decrease infections. After a months-long, halting, third-dose rollout across the summer and fall, it would be wise for the administration to ensure a well-planed rollout and education campaign is ready to go in advance of any FDA decision. Paging Dr. Jha?
- Millions risk losing Medicaid coverage. With the impending end of the public health emergency, states are preparing to resume eligibility checks for the more than 84M Americans enrolled in Medicaid or the Children’s Health Insurance Program (CHIP). In exchange for extra federal funding, states paused disenrolling beneficiaries because of changes in income, address, health status and other circumstances during the pandemic. The Centers for Medicare and Medicaid Services (CMS) has recommended states take at least a year to notify beneficiaries and complete coverage redeterminations, in order to avoid errors and allow time for those who might be disenrolled to seek other sources of insurance.
The Gist: The impact of these coverage redeterminations will vary by state. An estimated 8 percent of West Virginians on Medicaid could lose coverage, whereas a third of Medicaid beneficiaries in Hawaii could fall off the rolls. 40 percent of Utah children with CHIP lost coverage when the state restarted eligibility determinations last year. The redetermination process will be painful for many Americans, and will increase the nation’s uninsured rate at a time when many people are just now seeking care for conditions that went untreated during the worst of the pandemic—with more COVID surges possibly in the offing.
Plus—what we’ve been reading.
- Making the case for continued collaboration among hospitals. A recent article in Harvard Business Review demonstrates how multi-system quality collaborations in Michigan have improved outcomes and lowered costs, benefiting patients statewide. The authors draw on Steven Covey’s framework of “scarcity vs. abundance” thinking, using hospital collaboration on quality improvement projects as an example of the potential for “win-win” collaboration among players that might otherwise be in direct competition.
The Gist: Increased collaboration between hospitals has been a silver lining of the COVID crisis—and one that we hope stays. Systems have been banding together to harness their competitive advantages in order to solve shared problems, such as ensuring a steady supply of low-cost, commonly-used medications (Civica), aggregating and utilizing patient data (Truveta), and most recently, addressing workforce challenges (Evolve Health Alliance). These partnerships allow systems to deliver some of the benefits of greater scale without pursuing costly, and possibly anti-competitive, mergers.