Last Tuesday, the Center for Medicare and Medicaid Services (CMS) announced the first 10 medicines that will be subject to price negotiations with Medicare starting in 2026 per authorization in the Inflation Reduction Act (2022). It’s a big deal but far from a done deal.
Here are the 10:
- Eliquis, for preventing strokes and blood clots, from Bristol Myers Squibb and Pfizer
- Jardiance, for Type 2 diabetes and heart failure, from Boehringer Ingelheim and Eli Lilly
- Xarelto, for preventing strokes and blood clots, from Johnson & Johnson
- Januvia, for Type 2 diabetes, from Merck
- Farxiga, for chronic kidney disease, from AstraZeneca
- Entresto, for heart failure, from Novartis
- Enbrel, for arthritis and other autoimmune conditions, from Amgen
- Imbruvica, for blood cancers, from AbbVie and Johnson & Johnson
- Stelara, for Crohn’s disease, from Johnson & Johnson
- Fiasp and NovoLog insulin products, for diabetes, from Novo Nordisk
Notably, they include products from 10 of the biggest drug manufacturers that operate in the U.S. including 4 headquartered here (Johnson and Johnson, Merck, Lilly, Amgen) and the list covers a wide range of medical conditions that benefit from daily medications. But only one cancer medicine was included (Johnson & Johnson and AbbVie’s Imbruvica for lymphoma) leaving cancer drugs alongside therapeutics for weight loss, Crohn’s and others to prepare for listing in 2027 or later. And CMS included long-acting insulins in the inaugural list naming six products manufactured by the Danish pharmaceutical giant Novo Nordisk while leaving the competing products made by J&J and others off. So, there were surprises.
To date, 8 lawsuits have been filed against the U.S. Department of Health and Human Services by drug manufacturers and the likelihood litigation will end up in the Supreme Court is high. These cases are being brought because drug manufacturers believe government-imposed price controls are illegal. The arguments will be closely watched because they hit at a more fundamental question: what’s the role of the federal government in making healthcare in the U.S. more affordable to more people? Every major sector in healthcare– hospitals, health insurers, medical device manufacturers, physician organizations, information technology companies, consultancies, advisors et al may be impacted as the $4.6 trillion industry is scrutinized more closely . All depend on its regulatory complexity to keep prices high, outsiders out and growth predictable. The pharmaceutical industry just happens to be its most visible.
The Pharmaceutical Industry
The facts are these:
- 66% of American’s take one or more prescriptions: There were 4.73 billion prescriptions dispensed in the U.S. in 2022
- Americans spent $633.5 billion on their medicines in 2022 and will spend $605-$635 billion in 2025.
- This year (2023), the U.S. pharmaceutical market will account for 43.7% of the global pharmaceutical market and more than 70% of the industry’s profits.
- 41% of Americans say they have a fair amount or a great deal of trust in pharmaceutical companies to look out for their best interests and 83% favor allowing Medicare to negotiate pricing directly with drug manufacturers (the same as Veteran’s Health does).
- There were 1,106 COVID-19 vaccines and drugs in development as of March 18, 2023.
- The U.S. industry employs 811,000 directly and 3.2 million indirectly including the 325,000 pharmacists who earn an average of $129,000/year and 447,000 pharm techs who earn $38,000.
- And, in the U.S., drug companies spent $100 billion last year for R&D.
It’s a big, high-profile industry that claims 7 of the Top 10 highest paid CEOs in healthcare in its ranks, a persistent presence in social media and paid advertising for its brands and inexplicably strong influence in politics and physician treatment decisions. The industry is not well liked by consumers, regulators and trading partners but uses every legal lever including patents, couponing, PBM distortion, pay-to-delay tactics, biosimilar roadblocks et al to protect its shareholders’ interests. And it has been effective for its members and advisors.
My take:
It’s easy to pile-on to criticism of the industry’s opaque pricing, lack of operational transparency, inadequate capture of drug efficacy and effectiveness data and impotent punishment against its bad actors and their enablers. It’s clear U.S. pharma consumers fund the majority of the global industry’s profits while the rest of the world benefits. And it’s obvious U.S. consumers think it appropriate for the federal government to step in. The tricky part is not just government-imposed price controls for a handful of drugs; it’s how far the federal government should play in other sectors prone to neglect of affordability and equitable access.
There will be lessons learned as this Inflation Reduction Act program is enacted alongside others in the bill– insulin price caps at $35/month per covered prescription, access to adult vaccines without cost-sharing, a yearly cap ($2,000 in 2025) on out-of-pocket prescription drug costs in Medicare and expansion of the low-income subsidy program under Medicare Part D to 150% of the federal poverty level starting in 2024. And since implementation of these price caps isn’t until 2026, plenty of time for all parties to negotiate, spin and adapt.
But the bigger impact of this program will be in other sectors where pricing is opaque, the public’s suspicious and valid and reliable data is readily available to challenge widely-accepted but flawed assertions about quality, value, access and outcomes. It’s highly likely hospitals will be next.
Stay tuned.
Paul
P.S. The Senate returns from its August recess this week and the House returns next week as another debt ceiling default approaches October 1. The arraignments in the Georgia election probe will grab headlines Wednesday when all 19 are scheduled to be arraigned in Atlanta and post-Labor Day school and work routines commence in earnest this week. And thankfully, college football has returned though not without its own issues: how can the Big 10 be 18 teams or the ACC host 2 West Coast teams next year or how will play-by-play announcers keep track of transfer-portal plus NIL funding line-up changes de jour? Life’s complicated and increasingly stressful. That’s why institutional trust including faith in our health system is so important and why lack of attention to the erosion of its moral high ground is so disappointing. Even college football is impacted!
Sheryl Gay Stolberg, Rebecca Robbins “U.S. Announces First Drugs Picked for Medicare Price Negotiations”
Matthew Herper, Damian Garde “Winners and losers from Medicare’s list of drugs subject to price negotiation” StatNews August 29, 2023 https://www.statnews.com/2023/08/29/winners-and-losers-from-medicares-list-of-drugs-subject-to-price-negotiation
Beth Snyder Bulik “Medicare’s first drug negotiation list likely to fuel public pricing discussions for pharma marketers” EndPoints August 29, 2023 https://endpts.com/medicares-first-drug-negotiation-list-likely-to-fuel-public-pricing-discussions-for-pharma-marketers/
CEO compensation: Highest paid chief executive officers in the United States in 2022 CEO World May 6, 2023 https://ceoworld.biz/2023/05/06/ceo-compensation-highest-paid-chief-executive-officers-in-the-united-states-in-2022/
Quotable
Re: Medicare drug purchasing program: “The pharmaceutical industry has been up in arms over Medicare’s first list of 10 prescription drugs that will be subject to negotiations. But other major parts of the health care industry — hospitals, doctors, and other providers — have refrained from either lending support or criticizing the government’s process.
The quiet PR presence from groups that routinely attack pharmaceutical companies’ “egregious price hikes” underscores a reality that has existed for providers for decades: Medicare already sets their prices. And the world has not ended: Almost all hospitals, doctors, and nursing homes continue to take Medicare, and experts say those groups are not withering on the vine.
But providers are not quick to highlight that reality. Nearly all hospital and doctor lobbying groups have opposed universal price regulation, so supporting price caps for one part of the industry, like pharmaceuticals, would be a tacit endorsement of price caps everywhere.”
Bob Herman “As pharmaceutical companies bemoan Medicare’s drug negotiations, hospitals and doctors stay mum” Stat Today August 31, 2023 https://www.statnews.com/2023/08/31/pharma-medicare-drug-negotiation-hospitals-doctorshttps
Re: prescription drug prices: “The cost of prescription drugs in the U.S. consistently eclipses prices in other countries. They are a staggering average 156% higher…Consider these statistics:
- 66% of American adults rely on prescription medications.
- 40% of Americans say they struggle to pay for medications.
- Many Americans skip doses or cut pills in half to make their prescriptions last longer.
- 90% of Americans say their drug costs are higher or the same as the year before.
- The top five drug companies last year made more than $80 billion in profit.
There are downstream effects when a patient doesn’t take their medications. Diseases and disorders worsen, leading to more expensive conditions. That leads to higher spending a by patients, insurance companies, and taxpayers (because of Medicare and Medicaid).”
Adam Brown Drug Prices Are Too Damn High September 1, 2023 https://www.medpagetoday.com/opinion/prescriptionsforabrokensystem
Re: anger at the health system: “Accounting for 73% of all nonfatal workplace injuries and illnesses due to violence, healthcare experiences more non-fatal workplace violence than any other profession, surpassing even law enforcement…It begs the question: in the field of healing, why are people so angry?
For the same reasons we, in healthcare, are angry too: because the healthcare system failed us when we needed it the most.
Staffing shortages, drug shortages, prior authorization, extortionist middlemen, long wait times, high prices, rampant health disparities and inequities, feeling gouged and powerless when we are at our most vulnerable. We’re all angry about the same things: failures of a system we depended on…
We want healthcare to be about care again — not the $4.3 trillion business it has become.”
Amy Faith Ho “Violence in Healthcare: Why Are People So Angry?” MedPage September 3, 2023 https://www.medpagetoday.com/opinion/second-opinions
Re: US News Hospital rankings: “On August 1, buried amidst the news of unprecedented heat waves and political conflicts of the day, was the annual release of U.S. News & World Report‘s “Best Hospitals” rankings . But there was a huge difference this year from prior years: no hospital got first place.…They announced this change by saying, “Specifically, there will be no ordinal ranking for hospitals selected for this year’s Honor Roll when that list is ultimately published.” And there weren’t. Instead, there is an “honor roll” of 22 best hospitals, a number that in itself seems arbitrary, listed alphabetically. I am not going to republish the list. Because a group award is hardly worth repeating. Not all agree.
Many hospitals and academic medical centers continue to flout their U.S. News awards with full page ads in major newspapers or on social media. They claim they are “Among the Best in NYC” or “4 CT Hospitals Among Nation’s Best” or “3 Wisconsin Hospitals Ranked Among Nation’s Best: U.S. News Ranking.” Far too many hospital PR departments have gone into overdrive to brag about their local, regional, state, or national status…
We all care about the quality of care we are likely to receive from our hospitals, doctors, and nurses. But how much sense does it make to rely on a self-appointed, for-profit journalism company to tell us? Healthcare should demand the assessment of standardized evaluation by healthcare professionals.”
Art Caplan Ph.D. “It’s Time to Move on From the U.S. News Rankings” MedPage August 30, 2023 https://www.medpagetoday.com/opinion/second-opinions
Re: college football: “This week the 14 teams in the athletic conference that still calls itself the Big Ten will begin their 2023 seasons. As early as next fall, the Big Ten will consist of 18 (count ’em) teams, stretching from California and Oregon on the Pacific Coast to New Jersey and Maryland on the Atlantic. Much of this—all right, all of it—has to do with money and television rights…
If, since the days of Oosterbaan and Evashevski, America had expanded at the same rate the Big Ten has, the U.S. would have gone from 48 states to 86. The new, coast-to-coast, 18-team Big Ten may never again be purely Midwestern, but as a league from nowhere and everywhere it will without question turn out to be staggeringly lucrative. It might as well be a hedge fund.”
Related: “The Atlantic Coast Conference is adding teams on the West Coast: Stanford, Cal (Berkeley) and SMU will join for the 2024-25 school year.. According to the Knight Commission, conference payouts for the College Football Playoff are projected to reach $2 billion annually by 2027.”
Bob Greene “Inflation Devalues the Big Ten” Wall Street Journal August 29, 2023 https://www.wsj.com/articles/inflation-devalues-the-big-ten-college-football-sports-midwest-coaches-flyover-states-teams
ACC expands to the Pacific with Stanford, Cal and SMU Axios September 1, 2023 https://www.axios.com/2023/09/01/acc-stanford-cal-smu-college-sports
Re: employer role in systemic change: “Employers fund more than $1 trillion of the U.S. health care ecosystem, and nearly half of Americans receive health insurance through an employer. Despite the high per capita costs of employer-sponsored insurance, it is plagued by widespread quality variation. Employers have a timely opportunity to catalyze health care improvements, not just for their own members, but systemwide. New data assets are increasingly available to understand — in robust and clinically relevant ways — the quality of care that clinicians provide.”
Employer-sponsored insurance is the most common source of coverage for Americans, insuring approximately 180 million people and accounting for more than $1 trillion dollars in health care spending annually. The high costs paid by employers and employees alike are well documented: The average annual premium for family coverage in 2022 rose to $22,463, with the worker contributing $6,106 per year for that coverage. This represented an increase of 20% over the previous 5 years and 43% over the previous 10 years. What is less clear is the value that American employers and their employees and their families receive from the U.S. health care system. As purchasers that fund much of the health care ecosystem, employers have a meaningful opportunity to catalyze system change…
…Despite the high cost of employer-sponsored insurance, covered members continue to receive variable care that may fail to meet quality standards. By leveraging provider-level quality data in their operations and making these data accessible to their members, employers have a timely opportunity to take a leading role in creating a health system that consistently delivers high-quality care for employees and their families.”
Alley et al “The Role of Employers in Addressing Quality Variation in Employer-Sponsored Health Insurance” NEJM Catalyst, August 29, 2023 https://catalyst.nejm.org/doi/full/10.1056/CAT.22.0224 Note: JPMorgan Chase & Co is an investor in Embold Health, the primary data source used in this analysis.
Re: interoperability: “One necessary culture change: our medical system must make it the norm, the habit, to exchange health information for the good of the patient — not because some federal rule said so. Case in point, one of Dottie’s doctors refused to continue a medication, saying it is a habit-forming controlled substance. Right. Pretty sure the habit-forming opportunities are over for (101-year-old) Dottie. Let’s hope that all doctors can form the habit of exchanging health records so Americans can look forward to old age. “
Julie Barnes Julie, barnes@maverickhealthpolicy.com
Re: insurer-hospital disputes: “Last Monday, Bon Secours Mercy Health sued Anthem Blue Cross Blue Shield alleging that the insurer owes the health system nearly $100 million in unpaid, reduced and denied claims for patient care provided in Virginia. According to the lawsuit, Anthem owes Bon Secours Mercy more than $73 million in unpaid claims for care delivered at its 10 Virginia hospitals and affiliated facilities, as well as more than $20 million in incorrectly reduced or denied claims.
Health systems and insurers are increasingly taking their contract disputes public as they debate appropriate reimbursement rates and billing practices. So far this year, 49 provider-payer contracting disputes have become public, said Adam Broder, a managing director at FTI Consulting, which has been tracking the growing number of contract standoffs. Only 20 public contract disputes were recorded through Aug. 30 of last year…. Nineteen of the 49 contracting stalemates this year have led to out-of-network care, compared with nine from January through August 2022”
Alex Kacik Bon Secours Mercy suit alleges Anthem owes $93M in disputed claims Modern Healthcare August 28, 2023 www.modernhealthcare.com
Government Reports, Economic Indicators
The Bureau of Economic Analysis released its July Personal Income and Outlays Report (www.bea.gov):
- Personal income increased $45.0 billion (0.2% at a monthly rate)
- Disposable personal income (DPI), personal income less personal current taxes, increased $7.3 billion (less than 0.1%)
- Personal consumption expenditures (PCE) increased $144.6 billion (0.8%). Over the past three months, core PCE inflation has risen at a 2.9% annual rate, down from a 3.3% rate in the three months ended in June.
- The personal saving rate fell to 3.5% in July, down from 4.3% in June and 4.7% in May vs. 8.8% in 2019 (pre-pandemic).
CMS warns states re: Medicaid redeterminations: Last Wednesday, Medicaid issued letters to all 50 states they may be unnecessarily disenrolling children from Medicaid or the Children’s Health Insurance Program because they are reviewing families as a whole despite there being a higher threshold to remove children from the programs. States have disenrolled more than 5.5 million people since the pandemic freeze on Medicaid ended this spring: 74% were procedural removals i.e. removed because they did not complete the renewal process. (www.cms.gov)
CMS issues nursing home staffing rule (www.cms.gov): In an update to 1987 staffing directives, the proposed rule requires nursing homes to provide a minimum of three hours of nursing care per resident, per day, with at least 0.55 from registered nurses and at least 2.45 hours from nurse aides. The draft regulation would also mandate that a registered nurse be on duty at all times. CMS projects that full adherence to the rule would cost nursing homes $40.6 billion over 10 years. Per a June survey by the American Health Care Association, more than 70% of nursing homes are very or somewhat concerned that workforce challenges may force them to close. Note: this announcement comes on the heels of a CMS sponsored study conducted by Abt which did not specify a staffing level and industry pushback (American Health Care Association) who believe the proposed level will pose financial problems forcing many operators to close facilities due to workforce shortages.
Jordan Rau “CMS study hurts efforts to increase nursing home staffing: advocates” KFF Health News
Labor Department issues proposed rule for salaried worker overtime pay (www.: Restaurant managers, store supervisors and salaried workers make up to $55,000 would be eligible for time-and-a-half pay if they log more than 40 hours a week extending eligibility to 3.6 million more workers. The proposed rule would raise the annual salary threshold from the current $35,568 a year, set at the start of 2020. The rule will cost employers $1.2 billion to implement and boost wages by $1.2 billion. (www.dol.gov)
FTC clears Amgen-Horizon deal: Friday, the Federal Trade Commission (www.ftc.gov) said Friday it had agreed to end its legal challenge of drugmaker $27.8 billion deal averting a trial that was to have started this month. The pact also dismisses the antitrust claims of six states that joined the FTC in May seeking to block the deal over concerns that Amgen would illegally bundle its products with Horizon’s medicines for thyroid eye disease and gout. Amgen agreed in the proposed settlement to not bundle the Horizon treatments and swore off conditional rebates or other tactics that could entrench the monopoly position of Horizon’s products., which sells cancer, osteoporosis and other drugs, Horizon’s portfolio of rare-disease medicines.
Hospitals
Study: Availability of substance abuse services in hospitals: Researchers analyzed the associations of safety-net status and ownership with the availability of SUD services at acute care hospitals in the US. In 2022. Findings:
“In this cross-sectional study of SNHs and non-SNHs, SNHs had significantly lower odds of offering the full range of SUD services. These findings add to a growing body of research suggesting that SNHs may face additional barriers to offering SUD programs. Further research is needed to understand these barriers and to identify strategies that support the adoption of evidence-based SUD programs in SNH settings.”
Chang et al “Substance Use Disorder Program Availability in Safety-Net and Non–Safety-Net Hospitals in the US” JAMA Network Open August 28, 2023;6(8):e2331243. doi:10.1001/jamanetworkopen.2023.31243
Study: use of low value services: “Using national Medicare data for fee-for-service beneficiaries ages 65 and older and attributed to 595 US health systems, we describe where and from whom they received forty low-value services during 2017–18 and identify factors associated with out-of-system receipt.
- 43% of low-value services received by attributed beneficiaries originated from out-of-system clinicians: 38% from specialists, 4% from primary care physicians, and 1% from advanced practice clinicians.
- Recipients of low-value care were more likely to obtain that care out of system if age 75 or older (versus ages 65–74), male (versus female), non-Hispanic White (versus other races or ethnicities), rural dwelling (versus metropolitan dwelling), more medically complex, or experiencing lower continuity of care.
- Out-of-system service receipt was not associated with recipients’ health systems’ accountable care organization status. “
Ganguli et al “Who’s Accountable? Low-Value Care Received By Medicare Beneficiaries Outside Of Their Attributed Health Systems” August 2023 https://doi.org/10.1377/hlthaff.2022.01319
Kaufman Hall: Highlights of August Flash Report: Highlights: The median calendar year-to-date (CYTD) operating margin index for hospitals was 1.3% in July, down slightly from 1.4% in June. Adjusted discharges per calendar day decreased 7% from the previous month. Lower patient volume led to a decline in expenses, but not enough to offset revenue losses.
National Hospital Flash Report www.kaufmanhall.com
Retail Health
OTC opioid remedy: Tomorrow, the first over-the-counter naloxone, a drug used to reverse an opioid overdose, will be available in retail stores and online. Narcan, a nasal spray, will have a suggested retail price of $44.99 per carton of two doses and be available initially in stores and online.
Study: fish oil supplement use: A study of 2819 fish oil supplements found that nearly three-fourths made at least 1 health claim, often about their ability to promote cardiovascular health. But only a quarter of supplements with health claims used US Food and Drug Administration–approved language that captures the uncertainty and lack of scientific consensus surrounding the claims.
In addition, the researchers found substantial variation in the amount of omega-3 fatty acids, specifically eicosatetraenoic acid (EPA) and docosahexaenoic acid (DHA), contained in 255 different supplements from 16 leading brands, with less than 10% of supplements containing a combined daily dose of 2 g or more of EPA and DHA.
Note: 20% of older adults in the US report taking fish oil supplements.
Emily Harris “Most Fish Oil Supplements Make Unsupported Claims” JAMA August 30, 2023. doi:10.1001/jama.2023.16107
CVS: Last week, CVS Health® (NYSE: CVS) announced that it has launched Cordavis, a wholly owned subsidiary that will work directly with manufacturers to commercialize and/or co-produce biosimilar products for the U.S. pharmaceutical market. As its first product, Cordavis has contracted with Sandoz to commercialize and bring to market Hyrimoz® (adalimumab-adaz), a biosimilar for Humira®, in the first quarter of 2024 under a Cordavis private label. The list price of the Cordavis Hyrimoz® will be more than 80% lower than the current list price of Humira®.The biosimilars market in the U.S. is projected to grow from less than $10 billion in 2022 to more than $100 billion by 2029. CVS has told investors it is looking to trim up to $800 million from its cost structure after its acquisitions of Signify Health and Oak Street Health, amounting to nearly $19 billion. (www.cvshealth.com)
Walgreens Boots Alliance: Last Thursday, Walgreens Boots Alliance CEO Rosalind Brewer stepped down as CEO of the company and as a member of its board of directors in a “mutual agreement” with the company’s board. The company’s U.S. healthcare operations reported an adjusted operating loss of $172 million in its fiscal third quarter, ended May 31 and YTD in its healthcare operations to $483 million. Brewer was named CEO in March 2021and previously served as chief operating officer at Starbucks and president and CEO at Sam’s Club. (www.walgreensbootsalliance.com)
Prescription Drugs
Study: Formulary design and out of pocket expense: High-deductible health plans with health savings accounts (HDHP-HSAs) incentivize patients to use less health care, including necessary care. Preventive drug lists (PDLs) exempt high-value medications from the deductible, reducing out-of-pocket cost sharing; the associations of PDLs with health outcomes among patients with asthma is unknown. Researchers studied the associations of a PDL for asthma medications on utilization, adverse outcomes, and patient spending for HDHP-HSA enrollees with asthma.
“In this case-control study, reducing cost-sharing for asthma medications through a PDL was associated with increased adherence to controller medications, notably ICS-LABA medications used by patients with more severe asthma, but was not associated with improved clinical outcomes. These findings suggest that PDLs are a potential strategy to improve access and affordability of asthma care for patients in HDHP-HSAs.”
Sinalko et al Utilization and Spending With Preventive Drug Lists for Asthma Medications in High-Deductible Health Plans JAMA Network Open August 29, 2023;6(8):e2331259. doi:10.1001/jamanetworkopen.2023.31259
Health Insurers
Humana expands in-home senior services: Humana’s CenterWell Senior Primary Care announced it is offering in-home care to older adults through a new program called Primary Care Anywhere starting in the Georgia cities of Atlanta, Savannah and Columbus, as well as in New Orleans and Baton Rouge, Louisiana. Services offered will include routine medical exams, laboratory work and prescription management from doctors and nurses.
Diana Eastabrook “Humana’s CenterWell Primary Care joins move into the home” www.humana.com
Public Health
CDC: overdose deaths doubled recent years: Among more than 100,000 recent overdose deaths in the U.S., the percentage caused by pills disguised as legitimate pharmaceutical products increased from 2.0% in the third quarter of 2019 to 4.7% in the last quarter of 2021.
The proportion of those deaths involving illicitly manufactured fentanyl jumped to 93.0% from 72.2%, while illicit benzodiazepines also rose to 5.3% from 1.4%. Fake fentanyl was the sole drug involved in 41.4% of counterfeit pill-related deaths, compared with 19.5% of overdose deaths without evidence of counterfeit pill use.
Western states drove the increase in deaths with evidence of counterfeit pill use, with a rise from 4.7% to 14.7% across the study period, whereas percentages remained below 4% elsewhere.
CDC Morbidity and Mortality Weekly Report www.cdc.gov
Physicians
Study: steerage in vertically integrated systems: Researchers studied steerage from PCPs to specialists: ”In this case-control study involving 4,030,224 observations, PCP–health system vertical relationships were associated with increased total specialist visits and total spending per patient-year as well as specialist visits, emergency visits, and hospitalizations within the health system. There was no change in readmission rates or use of hospitals with low readmission rates. “Findings of this study suggest that the vertical relationships between PCPs and large health systems were associated with steering patients into health systems and increased spending on patient care.”
Sinaiko et al “Utilization, Steering, and Spending in Vertical Relationships Between Physicians and Health Systems”JAMA Health Forum September 1. 2023;4(9):e232875. doi:10.1001/jamahealthforum.2023.2875
Study: use of virtual care during pandemic: Researchers examined changes to in-person and virtual care during the pandemic for patients treated by primary care physicians (PCPs) in independent vs vertically integrated practices and examined subgroups of patients by chronic conditions.
“Overall, physicians in integrated practices experienced reductions in volume for patients with no chronic conditions relative to independent practices in the first post pandemic quarter (−18.75%) decreasing to −14.05% in the sixth post pandemic quarter. Patterns for other conditions were similar. In most cases, differences in volume became smaller with time. In contrast, physicians in integrated practices experienced increases in the proportion of telehealth visits for individuals with no chronic conditions vs independent practices in the first post pandemic quarter (7.59%) similar differences were found for all subgroups.”
Cuellar et al “Volume of Care for Primary Care Physicians in Integrated vs Independent Practices Through the COVID-19 Pandemic” JAMA Health Forum September 1, 2023;4(9):e232883. doi:10.1001/jamahealthforum.2023.2883
Governance
NACD: private company ESG board survey: Directors of private companies pay less attention to ESG issues than public company boards. Highlights:
- 30% of private company respondents indicate that ESG issues have actually increased in priority, compared to more than half (58%) of public company respondents.
- 28% of private company respondents indicate that their board has assessed human capital-specific experience and expertise to identify board gaps, compared to more than half (52%) of their public company peers.
- 21% considered problematic individuals to be among the most significant barriers to sustaining an effective board culture, compared to 30% of public company respondents. 27% percent of private companies highlighted the lack of diverse perspectives as a significant barrier to sustaining an effective board culture, compared to 18% of public companies.
2023 NACD Private Company Board Practices and Oversight Survey August 24, 2023 https://www.nacdonline.org/all-governance/governance-resources/governance-surveys/surveys-benchmarking/2023
