The future of alternate payment models, importance of health equity and biggest question marks hanging over the fast-changing telehealth industry were among topics headlining the virtual HLTH conference last week.
Along with a flurry digital health funding expansions and new product lines, retail pharmacy giants Walgreens and Rite Aid outlined plans to change the job of the pharmacist, and Trump administration officials teased reimbursement details for an eventual COVID-19 vaccine.
Here are six big takeaways from the massive health conference's third year as the industry faces unprecedented disruption from COVID-19.
Retail pharmacy players double down
Major retail pharmacy companies are re-evaluating the role of the pharmacist and attempting to introduce new technologies and workflows to allow the pharmacist to practice at the top of their license, executives said at HLTH.
Along with a brand facelift, the 2,400-store pharmacy chain Rite Aid plans to overhaul its stores to put a much stronger focus on the pharmacist, COO Jim Peters said in a Wednesday keynote.
"Pharmacists are the most under-utilized providers and can be the missing link in that last mile of healthcare," Peters said.
Along with connecting its pharmacists with other providers and health plans via virtual care, Rite Aid got its some-6,300 pharmacists certified as integrative pharmacy specialists to educate consumers about potential alternate, nontraditional remedies for their medical problems.
Peters also made it clear that Rite Aid is not interested in offering primary care, putting it in direct opposition to rivals CVS Health, Walgreens and Walmart, which have doubled down on healthcare delivery in recent years.
"We're pharmacists at our core. We embrace that role," Peters said. "We want to act as a connector, not a competitor to nurses and doctors."
CVS Health plans to run a network of 1,500 HealthHUBs, stores allocating a fifth of floor space to health and wellness products and services, by the end of next year.
And in July, drugstore operator Walgreens announced it was partnering with Chicago-based medical network VillageMD, representing a $1 billion investment in its primary care services.
In a keynote, Alex Gourlay, co-chief operating officer at Walgreens, said the company has already opened five in-store clinics staffed by VillageMD physicians in the Houston area, plans to have 40 operational by the end of the 2020 fiscal year and more than 500 up and running within the next five years.
Gourlay also said pharmacists should play a bigger part in services like vaccinations, testing and treatment as part of a holistic care team instead of being stuck behind the counter, divvying out medicines. Walgreens is investing in technologies to free up its some 27,000 pharmacists, Gourlay said.
Rite Aid also wants to become the dominant mid-market pharmacy benefit manager, Peters said, in a bid to differentiate its Elixir business from other payer-owned PBMs like CVS Caremark, Cigna's Express Scripts and UnitedHealth Group's OptumRx.
Drugstore operators are also trying to find digital pathways to the consumer amid the pandemic. Walgreens' healthcare navigation platform, Find Care, added telehealth features in April and now has about 8.5 million customers using the platform, Gourlay said.
Value-based efforts helped with quality, not cost
The pandemic has highlighted myriad problems within the healthcare industry, including fee-for-service payment. Providers in alternative payment arrangements were better situated to ride COVID-19 headwinds like the sharp drop in in-person visits beginning in March and April.
Brad Smith, who took over the reins of the Center for Medicare and Medicaid Innovation in January, said Wednesday he's been busy reviewing the 54 payment models the innovation agency has trialed over its 10-year tenure. Only about five had actually saved the system money, while a number broke even, and a handful of outliers — usually the bigger models, Smith admitted — had actually cost more than they saved.
However, quite a few significantly improved care outcomes, and none caused quality to worsen, according to Smith, who noted there was a lag time of a few years to understand model outcomes and that he hopes more payers will participate in the models when ROI is proven.
"My hope is that we'll be able to drive more savings, continue to improve quality, " Smith said.
In a Tuesday interview, CMS Administrator Seema Verma also said the agency is looking at ways to incent providers to take on more risk in its value-based models, taking inspiration from COVID-19 relief waivers. Some of those flexibilities granted earlier in the pandemic could retain high levels of provider participation while nudging them toward risk, the agency head suggested.
"Going forward, I think we can look at the types of waivers we provided [during the pandemic], and maybe use that as an incentive for some of our value-based models," Verma said. "Because I think the way they were set up before was just to encourage participation, that didn't necessarily lead to lower costs."
Targeting underserved populations
Several major health systems announced big moves in the social determinants of health and integrated care space at HLTH.
New Jersey-based academic medical system RWJBarnabas Health launched a SDOH program in partnership with digital referral platform NowPow and patient engagement platform ConsejoSano.
The program, currently being piloted, screens all patients for factors like housing access, food security and transportation issues then refers them to community services, RWJBH Senior Vice President DeAnna Minus-Vincent said.
And nonprofit giant CommonSpirit plans to start offering behavioral health in the primary care setting through a partnership with virtual care provider Concert Health, CEO Lloyd Dean announced Wednesday. CommonSpirit is also expanding its partnership with Docent Health, a care navigator, with the goal of expanding health access, especially in underserved communities.
Greg Adams, CEO of integrated health system Kaiser, said on Monday the nonprofit is trying to figure out how to include ethnicity and race factors into how it evaluates quality and care. Kaiser's board is still figuring out what that means in practice, but the goal is to eventually "own healthcare disparities for all care that we provide," Adams said.
As part of the strategic pivot, Kaiser is expanding its Thrive Local social health network launched last year to reduce homelessness, food insecurity and other community needs and publishing a COVID-19 Social Health Playbook.
It's good that entrenched players are moving to address health inequities, but companies need to take care when applying data on race or ethnicity to their interventions to avoid inadvertently targeting the wrong patient or worsening disparities, Ian Tong, CMO of telehealth vendor Doctor on Demand, said Monday.
"I would ask those developers, those coders, to think of those technologies as a loaded gun … or like a medication," Tong said. "Too much or irresponsible use of that therapy can cause harm."
Back-to-work products pick up steam
Smaller startups, along with big names like CVS and UnitedHealth Group, have released products focused on reopening workplaces and other public spaces safely in the past few months. That momentum carried on in HLTH.
IBM launched an app for companies to check people's health status before they enter a public space like airplanes, workplaces or sports stadiums. The health status is based on verified data sources, like the results of a COVID-19 test, and organizations can choose what requirements are needed for entry, IBM Watson Health's General Manager Paul Roma said Monday.
Mayo Clinic released an app to reduce the cost of COVID-19 testing and treatment, along with other conditions, in partnership with Los Angeles-based Safe Health Group. The app will enable on-demand testing, collate COVID-19 test results and contact tracing efforts and proof of vaccine administration in a bid to verify users' health statuses, Mayo Clinic Platform President John Halamka said on Monday.
Earlier this month, a digital health pass meant for international travelers, called CommonPass, began testing internationally. The technology, launched by the Commons Project Foundation and the World Economic Forum, allows travelers to document their COVID-19 status electronically and present it when boarding an airplane or crossing a border, Commons Project CMO Brad Perkins said Wednesday at HLTH.
In the next few weeks, the project will launch trials on several intercontinental air routes with major carriers in partnership with governments, airports and accredited labs, Perkins said.
And Vivian Lee, president of health platforms at Alphabet's life sciences business Verily, stressed the importance of regular testing of asymptomatic people on Wednesday. Verily, which has been testing its employees weekly, also sells a COVID-19 screening and testing program to employers and universities, launched in June.
Telehealth on fire, but needs to prove ROI
Many consumers, spurred by COVID-19, have sampled virtual care for the first time and found they like the convenience, while payers see it as an opportunity for efficiency by bringing services to people in the home, Cigna CEO David Cordani said Wednesday.
Additionally, health systems, facing flatlining admissions earlier this year, quickly moved to implement virtual care infrastructures to retain a hold on patient volumes and will likely continue offering telehealth to patients, and using it to link in remote specialists, in the coming years.
"I like to think we're in the midst of the fourth industrial revolution," Albert Chan, chief of digital patient experience at California-based nonprofit Sutter Health, said.
Tools to glean insights from longitudinal patient data, such as remote patient monitoring devices, are especially integral to this shift, attendees said. Sensors and embeddables are becoming increasingly popular as a way to get doctors access to biometric information in the home, allowing physicians to practice at the top of their licenses.
And video and audio analytics can even go a step beyond, perceiving things not clearly notable by the provider, Steve Allen, director of the clinical systems segment at Intel, said. "I think we’re beginning to see some green shoots already emerge," like natural language processing to capture visit notes and write prescriptions, or uber-sensitive hyperspectral cameras, Allen said.
And enabling telemedicine platforms with artificial intelligence and machine learning on the doctors' end may help with productivity and reducing burnout.
"We have to enable some level of cognitive automation for them so they can make decisions on actionable insights, not just data," Neil Gomes, SVP of digital and human experiences at nonprofit giant CommonSpirit Health, said at a Thursday panel.
However, the industry is still trying to figure out the balance between physical and virtual care, even as telehealth vendors foray more into areas like primary care, behavioral health and chronic condition management. Rising investments in digital health have oiled such expansions, sparking massive exits and deals in the space.
Teladoc and Livongo announced their first commercial cross-selling agreement at HLTH on Monday, to GuideWell, the parent company of Florida Blue, a previous Teladoc customer. The virtual care giant said in August it planned to acquire Livongo in a deal valued at $18.5 billion — the largest U.S. digital health deal ever.
And Aashima Gupta, global director of healthcare strategy and solutions at Google Cloud, said her company invested $100 million in Teladoc competitor Amwell due to the potential to couple Google technologies, like AI, with virtual care to support clinician productivity and co-develop other capabilities.
However, despite the potential at the intersection between technology and healthcare, industry needs to do more to target underserved populations like rural patients, experts said. Proponents of telehealth tout virtual care's ability to connect patients in remote areas to high-quality providers, but those areas usually lack the internet connection required for a high-quality video visit, despite rising acknowledgment of the issue from both the public and private sectors.
"I think we as a country have to figure out what do we do for telehealth for an indigent population who don't have the access to it," Epic CEO Judy Faulkner said Monday.
Vaccine looms, distribution plans ramp up
As the pandemic puts health disparities in sharp relief, the Food and Drug Administration is telling pharmaceutical companies developing COVID-19 vaccines that their clinical trials need to include a diverse and inclusive patient population, Commissioner Stephen Hahn said in a Monday keynote.
The agency wants to see at least 50% effectiveness from a vaccine across patients of different races, ethnicities, age and comorbidities, Hahn said. But FDA could eventually approve a vaccine for the general population or a more targeted vaccine for a specific population.
"I can't prejudge that, because I don't know the data," Hahn said.
A slew of government agencies, including the Centers for Disease Control and Prevention, HHS and Operation Warp Speed, are working together to generate a vaccine distribution plan in tandem with private sector partners.
Plans for distribution are ongoing but shift as the frontrunners in the vaccine race do, experts say. Different vaccines require different processes. For example, there may be additional costs to store a coronavirus vaccine at cold temperatures, or because some of the candidates require two doses.
"All those things we're working through to try and understand," Alan Lotvin, president of CVS' pharmacy benefit management arm Caremark, said Monday. "It's going to be different for every vaccine."
Walgreens, for example, is in regular conversations with five manufacturers in the last stages of clinical tests, the federal government and other retail partners to coordinate a distribution strategy, Gourlay said.
And CMS plans to release a rule before the end of the month for how Medicare will cover an eventual COVID-19 vaccine without cost-sharing, Verma said.
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