Day Three Notes for the 40th Annual J.P. Morgan Healthcare Conference, 2022 | Sheppard Mullin Richter & Hampton LLP

Have you been working lately? Hopefully that day, the third day of the fortyy The annual JP Morgan Healthcare Conference was definitely a day to lift the heavy lifting. Got a challenge that seems overwhelming? A problem big enough to completely scare others? Do you eat triathlon for lunch? Well, you’ll like the third day comps. Let’s talk about solving America’s huge diabetes problem, providing better healthcare for Medicaid and eligible recipients, and helping people beat cancer. All of that, plus a thought exercise for COVID-19…

Diabetes fix: Virta Health

Diabetes is a large and growing problem in the United States. Approximately 34 million people (~10% of the US population) have diabetes today, at an economic cost of more than $400 billion according to Virta Health, a day 3 service provider. Nearly 88 million people have prediabetes — 1 in 3 Americans. What will this look like for health in America (and our health care expenditures) in another 10 years? Sami Enkinen, founder and CEO of Virta — the former world triathlon champion who developed type 2 prediabetes — shared the troubling news that current approaches to treating diabetes have not produced better outcomes for people, even with the massive medical spending in the United States on diabetes. . The Centers for Disease Control and Prevention reports on its website that the number of new diagnosed cases of type 2 diabetes has increased significantly among young adults in the United States and is higher among minorities. Many adults are not aware that they have prediabetes or prediabetes. Virta CEO Inkinen told his audience that our healthcare system gets it wrong. We should focus on reversing diabetes, not managing or caring for the disease.

It’s an interesting thesis – that feeding and patient interaction on a one-to-one basis can lead to reversal of diabetes or moderation of insulin need. What is the opposite of type 2 diabetes? After a year of treatment, not taking specific diabetes medication and not meeting criteria for type 2 diabetes or prediabetes. Virta shared her published research which showed that after one year of treatment, 60% of patients were able to reverse type 2 diabetes and 83% of patients either reduced or eliminated insulin use. To achieve these results, new patients have high involvement, typically with three times daily interaction in early treatment to help manage patient needs. Virta provides guidance, custom algorithms, tips, and analytics using a whole person health approach (if you don’t know what that is, read Day 2’s feedback post here). This can lead to significant cost savings for the healthcare system. Clients are large employers and health plans provide this service to employees and members. Interestingly, in 2021, Virta expanded its diabetes-only offering to also include diabetic and obese patients. This effectively means that the total addressable market for Verta now could be 50% of the US adult population. Its treatment approach, according to Inkinen’s CEO, could be applicable to, among other things, high blood pressure, cardiovascular disease risk factors, and inflammation.

So with diabetes drugs costing more than $60 billion annually, the question is why haven’t we, as a healthcare system, used an approach similar to Virta with nutrition, support, and other ways to reverse or control diabetes? The cost of this intervention is small compared to the cost of ongoing treatment and other negative effects of diabetes. It’s care versus treatment, and in this case, treatment may be worth the cost.

Making Medicaid Better and Reaching Doctors More: Cityblock Health and ZocDoc

Keeping on the topic of digital technology that enables patients and providers to continuously evolve value-based care, we saw two interesting presentations today. First, there was Cityblock Health which, like many other presenters, emphasized the thesis of multi-channel engagement with a digital platform as the key to connecting its providers with their patients. Cityblock is marked in many ways. Cityblock focuses solely on Medicaid and dual-qualified residents in underserved geographic areas. As we know, the managed Medicaid program and the dual qualifying market spend nearly $1 trillion. Did you know that on average one in two babies today is born on Medicaid?

Toyin Ajayi, CEO of Cityblock, suggested that underinvestment in primary care, behavioral health, and social care in Medicaid and dual eligible populations leads to (1) higher rates of inpatient spending when needs are not previously met and (2) higher total cost of care, Especially for individuals with complex needs. What was that old English saying – Idiot Pennywise? As Chiquita Brooks-LaSure, Director of CMS, said yesterday, this is the cost we are paying for not addressing inequities and health inequalities.

By increasing investment in the above uninvested areas, Cityblock aims to reduce hospital stays, and has achieved a 20% reduction in inpatient admissions in its early cohorts. With an average hospital stay cost around $10,000, Cityblock suggested canceling a single hospital stay could result in 230 primary care visits, 120 hours to a psychiatrist, two years of food stamps, or 600 Uber rides. Seems like a compelling value proposition to us!

By counting patients who are often low-income without access to healthcare provider options, Cityblock has committed to attracting its employees from the communities it serves by providing a range of primary care and behavioral and social services to its members with an emphasis on home health services. The goal emphasized by Cityblock is to orchestrate an otherwise fragmented care plan faced by many Cityblock members in an effort to address those underlying health issues that often result in Cityblock members switching to acute care settings for treatment – an outcome that dramatically increases the cost of treatment. Care. Using an easy-to-use mobile app (as most Cityblock patients have smartphones) as well as providers and care coordinators from within the community, Cityblock was able to build a dedicated, engaged team serving over 100,000 patients in five markets after just two years. Cityblock receives recurring risk returns of between $15-30,000 annually and cares for patients with complex needs, with 75% of whom have 3 or more chronic conditions, 26% with a behavioral health diagnosis and 58% with low social support.

So, let’s recap – healthier people, lower costs, more jobs in communities, check! Less stress on hospitals and state budgets, lower tax burden with lower healthcare costs, check! Everyone is using this form now? number? Well why not?

We also heard from ZocDoc who focused on creating the number one digital marketplace for doctors. Think of Airbnb as a model. If you want to see a doctor, you don’t need to call the doctor’s office, leave a message (because the staff is out for lunch), wait a few days for a response, and finally reach out to schedule and get an appointment two weeks from then (according to ZocDoc, average The national waiting time to see a doctor after making an appointment is 29 days). With ZocDoc, the user can log into the slick ZocDoc application, fill in some useful information (including insurance information to provide results within the network) and usually see a doctor of their choice within a day. The app takes care of scheduling and ZocDoc receives a fee from the doctor after the patient’s visit.

Not only does ZocDoc’s approach help patients communicate faster with the care they need, it also addresses a serious problem clinicians face. While we all think doctors should be at 100% utilization rates given how difficult it is to get an appointment, the actual numbers are over 72% once cancellations and rescheduling are taken into account. Doctors actually end up with perishable inventory (time in this case, which is really money) that they can’t sell because no one is able to track availability and match patients with open slots in real time. ZocDoc solves this problem by integrating with a physician table that allows physicians to quickly fill slots.

Cancer Test: Exact Sciences Corporation

Kevin Conroy, CEO of Exact Sciences Corporation, asked today why, if deaths from cardiovascular disease fell 68% from 1969 to 2013, deaths from cancer fell by less than half that, 31%, From 1991 to 2018. His answer: There have been more efforts to address early detection, prevention, and intervention for heart disease and high cholesterol than for cancer. Exact, maker of Cologuard’s noninvasive colon cancer test, believes early cancer detection is the holy grail (an inside joke to those who follow liquid biopsies companies) and should become a routine part of medical care. Conroy reported seeing 2021 growth of 30% annually for Exact.

Conroy brought tears to my eyes, and brought back the fact that colon cancer is the No. 2 cancer in the world, with 150,000 new cases and 53,000 deaths each year in America, by sharing that his brother died last year of colon cancer at this age. 60. His brother has not been screened for colon cancer. Colon cancer grows slowly, and often begins with precancerous polyps, making it a good target for effective screening. Exact also works on breast cancer treatment, comprehensive cancer screening test and other products, including treatment guides for certain types of cancer.

While there is a great battle now going on between different approaches to early detection of cancer – given methylation, DNA mutations and other new and innovative technologies – it is clear that a more focused effort in our healthcare system to support and expand early detection of cancer will save lives and money. . This will be a game changer in the future, but it should be sooner rather than later.

Some thoughts on COVID-19 and what we haven’t picked up (yet)

On a separate note, there was some interesting news out of Canada yesterday with Quebec choosing to impose monetary fines on unvaccinated adults. Quebec is not the first to impose such a punishment, as Austria and Greece have fined unvaccinated people. We broke our minds in this country about how to increase vaccination rates among our adult population (which is widely accepted as the only way to protect ourselves in the long-term from every evolving strain of COVID).

This approach may seem harsh to some but in Quebec it is estimated that 10% of unvaccinated adults account for about 50% of intensive care patients. Last year, Singapore also took action, deciding that unvaccinated COVID patients who end up in hospital should pay their own hospital bills rather than the government paying for their healthcare. Other countries are taking the opposite approach and paying people to get the vaccine.

The more you know…

What do you think the United States should do?

Fill in the white space

The phrase of the day was ‘white space’ – that empty area of ​​TAM (Total Addressable Market) that has yet to be occupied and that is just begging to be filled by someone’s ‘value proposition’. Fee-for-service Medicare is full of white space, value-based care is an evolving white space, vast parts of the country have white space to fill in value-based care / telehealth / chronic care management / gummy worms / person centered care / half person care / JPM Day 4! (look it was worth reading to the end)

See you tomorrow for the fourth day notes

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