A Put up-Covid Well being Care World, Half 2


The 2020 HLTH VRTL convention targeted on how the COVID-19 disaster is accelerating traits which are reworking healthcare. On this article, I’ll describe the image painted by the audio system of what the soon-to-be post-COVID well being care world will appear like.

I seen the convention via my multifocal lens as a monetary analyst, advisor, and affected person and consistent with my mission at Your Autoimmunity Connection, I stored one query in thoughts:

How may these accelerating post-COVID traits assist sufferers with the subset of power inflammatory ailments with which the group is most involved: autoimmune and autoinflammatory problems?

Recap and hyperlink to Half 1

In Half 1, I described how COVID-19 has accelerated the usage of telemedicine and distant affected person monitoring. On the identical time, it has speeded the migration from FFS by displaying {that a} VBC reimbursement mannequin generally is a extra dependable income stream for practices in disruptive instances. These disruptor-driven traits have additionally spurred new main care supply fashions and client competitors for the digital entrance door as described under. Corporations highlighted in Half 1 have been Amwell, Oscar Well being, Massachusetts Common Physicians Group, and Aledade.

Rising traits in supply methods

Novel, experimental main care supply fashions are rising from inside and out of doors the present system. Not solely large gamers (payers, suppliers, apply methods, and modern employers), but in addition DTC on-line and walk-in acute care, “doc-in-a-box” on-line suppliers, drugstore, retail, and tech giants are all competing to be healthcare digital entrance doorways.

  • Modifying current built-in supply methods

Geisinger Well being System

Geisinger Well being System (GHS) is a regional well being care supplier to central, south-central and northeastern Pennsylvania and southern New Jersey. Headquartered in Danville, Pennsylvania, Geisinger serves over three million sufferers in 45 counties with 9 hospitals, a 550,000-member well being plan, two analysis facilities and the Geisinger Commonwealth Faculty of Medication. It has been widely known for delivering high-quality healthcare at low price via an built-in supply system mannequin.

 

Jaewon Ryu, President and CEO of Geisinger, mentioned, “Main Care is the entrance door and it’s how we drive affordability. We now have been on a journey over the past three years on which now we have been redesigning main care. We consider there is a chance to introduce totally different flavors for these with a number of power circumstances.”

What does this imply for autoimmune/autoinflammatory care?

As a big built-in supply system, Geisinger has already developed services and products that would doubtlessly assist autoimmune sufferers, akin to:

  1. The myGeisinger affected person portal: 24/7 appointments, message your care group and extra.
  2. Geisinger at-home program https://www.geisinger.org/athome. Though, discover their listing of power circumstances: Most cancers, dementia, coronary heart and kidney illness. These are apparent targets for geriatric populations, however what about different power circumstances that would profit from dwelling visits? That features extra extreme autoimmune and autoinflammatory circumstances, together with power fatigue and post-viral (led by post-COVID) syndromes.

New fashions of main care

One Medical is a membership-based and technology-powered main care platform providing seamless digital well being and alluring in-office care, handy to the place folks work, store, stay, and click on. Their imaginative and prescient is to please tens of millions of members with higher well being and higher care whereas decreasing prices. Their mission is to remodel well being look after all via our human-centered, technology-powered mannequin.

Their suite of providers goes past the normal main care to incorporate 24/7 digital care, identical or next-day appointments, on-site lab providers and longer appointments. These kinds of providers give sufferers extra handy entry.

Amir Dan Rubin, CEO of One Medical, defined, “We are attempting to remodel healthcare via our modernized main care strategy and concurrently handle the wants of key stakeholders.”

He continued, “We now have created a employees mannequin, HMO-like strategy hidden in concierge sheep’s clothes. We now have all salaried main care suppliers, now we have constructed our personal software program utilizing machine studying to route the messages to digital group members. As well as, we get reimbursed at an organizational stage via typical insurance coverage, however now we have constructed the underlying incentives to ship value-based, coordinated care.”

However will this enhance autoimmune care?

Enhancements in care collaboration and coordination, together with a extra preventive mindset beneath VBC, may gain advantage autoimmune sufferers, however care supply fashions should select to give attention to them. One Medical’s power illness listing, as standard, omits point out of autoimmune, autoinflammatory and immune-related power inflammatory circumstances. Till such circumstances are greater than an afterthought, these main care improvements are unlikely to enhance their care. Though improved autoimmune/autoinflammatory care may very well be a aggressive edge for brand new firms, in the event that they seize the chance.

 

Firefly Well being is a virtual-first, main care, behavioral well being, and system navigation service. Their care groups embody a well being information, a nurse practitioner, a behavioral well being specialist and a main care doctor. Their service choices embody same-day appointments, video visits, fast prescription refills and extra time with suppliers.

 

Fay Rotenberg, CEO of Firefly Well being: Main care as “bonding, steering and well being care fiduciary. Remodeling from a reactive, transactional, doctor-centered mannequin, in direction of a proactive, personalised, digitally-enabled strategy that helps wholesome behaviors to drive higher outcomes and decrease prices. Our mission is to supply half-priced healthcare that’s twice nearly as good clinically and emotionally.”

 

Firefly Well being was designed with the buyer in thoughts so it’s simple to make use of. First obtain the app, then join along with your care group who may help you in individual, just about and by way of chat. Their tech-enabled digital care platform, Lucian™, is constructed to trace customers’ care over time. For diagnostic testing, Firefly has an in depth, curated community of companions, a few of which supply in-home testing. As well as, their groups can handle power ailments akin to diabetes and hypertension. For extra severe circumstances, they accomplice with specialists.

How may Firefly Well being advance autoimmune care?

The Firefly Well being tech-enabled digital care platform and coordinated care groups provide parts that may very well be directed to assist autoimmune and different power immune dysfunction sufferers higher handle their day by day well being points.  I can think about how Firefly Well being’s proactive personalised app may develop its performance to assist autoimmune sufferers with proactive way of life modifications that would decrease stress ranges and scale back flares. However there’s no point out of power fatigue or autoimmune/inflammatory on their web site, simply the standard point out of tension, diabetes and hypertension as examples of power circumstances. They have already got behavioral well being specialists on care groups, and as we all know, psychological well being points, particularly nervousness, loom giant in autoimmune sufferers. Possibly psychological well being is the wedge to get Firefly Well being to give attention to immuno-inflammatory illness sufferers, too.  

Will group pharmacies turn out to be the subsequent neighborhood healthcare vacation spot, an more and more digital entrance door to extra than simply Rx and OTC merchandise?

 

 

Walgreens  – from pharmacy to retail clinics   

Walgreens is a part of the Retail Pharmacy USA Division of Walgreens Boots Alliance, Inc. (Nasdaq: WBA), a worldwide chief in retail and wholesale pharmacy. Working greater than 9,000 retail areas throughout America, Puerto Rico and the U.S. Virgin Islands, Walgreens is a neighborhood well being vacation spot serving roughly eight million prospects every day. Walgreens pharmacists present a variety of pharmacy and healthcare providers. To finest meet the wants of consumers and sufferers, Walgreens presents a real omnichannel expertise, with platforms bringing collectively bodily and digital, supported by the newest expertise to ship high-quality services and products in native communities nationwide.

 

Alex Gourlay, the Co-Chief Working Officer at Walgreens, thinks that, “Placing collectively the household physician and the native pharmacist with HIPAA-compliant well being data and offering actually native options for sufferers and prospects each bodily and digitally will open the entrance door of well being care.”

 

Sooner or later he sees that the native pharmacy will give attention to well being (prescriptions, counseling and polypharmacy administration) and effectively being (vaccines, blood stress and lipids monitoring) in addition to some acute diseases. He hopes that making the pharmacy an necessary a part of the digital entrance door will enhance preventive well being by making it extra out there at decrease prices, particularly to folks of decrease socioeconomic sources.

 

Will this be a brand new entrance door for power autoimmune sufferers?

Walgreen’s partnering with Village MD to open physician–led main care clinics explicitly mentions focusing on power illness sufferers, however we suspect that, as standard, they’ve diabesity, coronary heart, lung and kidney illness of their sights, not autoimmune/inflammatory. It’s fairly simple to see how this mannequin may very well be useful for autoimmune sufferers, e.g., early detection of rheumatoid arthritis and thyroid illness, however we might want to see if their plans even give attention to this inhabitants.

   

 

CVS/Aetna – from retail Rx to broader healthcare

CVS/Aetna connects customers with the well being sources of CVS Well being in communities throughout the nation and amongst Aetna’s community of suppliers to assist take away limitations to high-quality care and construct lasting relationships with customers, making it simpler for them to entry the data, sources and providers they should obtain their finest well being.

 

CVS Well being has 9,800 retail areas, roughly 1,100 walk-in medical clinics, a pharmacy advantages supervisor with roughly 93 million plan members, a devoted senior pharmacy care enterprise serving multiple million sufferers per 12 months, increasing specialty pharmacy providers, and a number one stand-alone Medicare Half D prescription drug plan. CVS Well being additionally serves an estimated 39 million folks via conventional, voluntary and consumer-directed medical insurance merchandise and associated providers, together with a quickly increasing Medicare Benefit providing.

 

Larry Merlo, President and CEO of CVS Well being, mirrored that, “As an organization, we’re 20 months into reworking the enterprise with CVS and Aetna coming collectively. The pandemic turned a possibility to reprioritize parts of the transformation journey to ship well being providers, create new options and make them accessible in nontraditional settings.”

 

He sees a future the place they will play a task in fostering dependable public well being data.  Given the quantity of dis- and misinformation round vaccines, the approaching large COVID vaccine rollouts are a possibility for CVS as a significant cold-chain distributor and vaccine dispenser to play a optimistic position.

 

Karen Lynch, EVP CVS Well being and President of  Aetna commented “We have been frequently innovating round new services and products whereas client habits was altering quickly because the virus was raging. Individuals need to entry healthcare digitally… Supply of well being care extra within the dwelling than earlier than means we’ll proceed to see transformational adjustments in healthcare post-pandemic.”

How may this assist autoimmune care?

For autoimmune and autoinflammatory sufferers, making the nook pharmacy extra accessible will solely be marginally useful for some routine care (e.g., vaccinations, common prescriptions). Nonetheless, dwelling supply of prescription and OTC merchandise generally is a life-saver for autoimmune sufferers in voluntary or involuntary isolation.  Nonetheless, if firms like Walgreens and CVS may determine a extra consumer-friendly strategy to distribute and administer infusion biologic medicine, that may very well be a recreation changer. Having access to biologics may very well be a part of placing clinics contained in the pharmacy that concentrate on the wants of autoimmune sufferers by streamlining a few of the extra routine and repetitive features of their care.

 

As I mirrored on pharmacies changing into the digital entrance door, I puzzled if dental places of work, which at the moment see many customers twice a 12 months for his or her common cleanings, may even attempt to develop their choices. Dental practices are already screening sufferers for oral most cancers, sleep apnea and periodontal illness (which might set off autoimmune illness and flares). Maybe they will develop this listing to supply thyroid screening, vitamin teaching, and different providers that relate to the mouth as a gateway to the remainder of the physique, together with to the immune system.

 

 

Along with the increasing position of the pharmacy in care supply, there are different new rivals. Some examples observe from girls’s, household and behavioral well being, on-line clinics which are experimenting with novel supply fashions, utilizing girls’s well being wants because the digital entrance door.

Maven – digital girls’s and household well being

Maven is the world’s largest digital clinic in girls’s and household well being. They provide on-demand entry to over 1,000 girls’s and household healthcare suppliers, in addition to devoted care coordinators who personally assist customers navigate their advantages.

 

 

In response to Katherine Ryder, the Founder and CEO of Maven,  “At Maven we owe higher care to the subsequent technology and this begins with a give attention to household well being.” She continued,

“one of many silver linings of COVID is that digital well being firms with new digital fashions to assist extra holistic and patient-centered care can have a extra pressing place in our system at present.”  As well as, “we’re integrating care for fogeys with care for teenagers to assist the well-being of your complete household.”

 

 

Implications for autoimmune care

Ladies of childbearing age are at increased danger of autoimmune, autoinflammatory and circumstances like power fatigue syndrome than some other demographic. With Maven’s give attention to household well being, they may simply provide screening for autoimmune problems, together with genomic testing (which they’re possible doing already for fertility and household planning functions) to establish those that are at increased danger. This may very well be built-in with their intergenerational strategy, trying to detect and even forestall power immuno-inflammatory circumstances of their sufferers’ youngsters. They might assist join autoimmune sufferers with specialists and even coach them in way of life modification approaches which will scale back their probabilities of growing illness, or a minimum of get them earlier prognosis and therapy.

  

Kindbody – fertility and reproductive well being

 

kindbody is increasing entry to fertility and reproductive well being with digital or in-clinic look after fertility, gynecology and wellness. With clear pricing, their web site consists of pricing data for providers akin to IVF, egg freezing, and embryo banking, in addition to vitamin counseling. Care groups can embody an ob-gyn, endocrinologist, doctor assistant and a wide range of counselors and coaches.

 

 

In response to Gina Bartasi, the Founder and CE of kindbody- “kindbody is on a mission to extend entry to fertility and family-building look after all. 50% of our company group identifies as non-caucasian, 45% of our sufferers are girls of colour and 15% are GBTQ+ so once we take into consideration creating change, we’re actually being aware of at present’s social inequity.”

Implications for autoimmune care

For autoimmune sufferers, a lot of whom are girls of colour with low incomes (a gaggle that faces slower prognosis and fewer aggressive care), a logical extension of kindbody’s present choices may embody autoimmune screening as a part of genetic testing used for household planning in addition to routine thyroid screening for autoimmune thyroiditis, the most typical autoimmune ailments amongst girls. Moreover, kindbody may assist join autoimmune sufferers with specialists and even coach them in way of life modification approaches which will scale back flares or their probabilities of growing illness, or a minimum of get them earlier prognosis and therapy.

Brightline – Behavioral well being for youngsters, teenagers and households

Brightline is reinventing behavioral well being care for youngsters, teenagers, and their households. Brightline delivers built-in care via modern expertise, digital behavioral well being providers, and a collaborative care group targeted on supporting youngsters throughout developmental phases and their households.

 

Given the continuing explosion of psychological and behavioral well being points amongst youngsters, teenagers and younger adults, particularly beneath the stress of COVID-19 lockdowns, the present setting is ripe for an answer like Brightline.

 

 

 

In response to Naomi Allen, CEO and Co-Founding father of brightline, we’re “offering unusual assist to the most typical household challenges in behavioral well being”

 

As proven under, Brightline presents the broadest multidisciplinary care groups of any of the businesses (not simply the feminine/household choices) profiled in these posts. This represents extra silo-busting coordination of specialists than any of the opposite platforms, one thing I need to see extra of as an advocate for autoimmune sufferers. So I’ve supplied screenshots to indicate this aggressive benefit.

 

Brightline consists of behavioral well being therapists, occupational therapists, speech therapists, coaches and others, with tailor-made content material, telehealth visits, therapy plan monitoring and digital workouts at dwelling. 

 

 

Notably noteworthy is their strategy to prevention, which features a yearly pediatric effectively go to as proven under.

 

 

May Brigthline work for autoimmune sufferers too?

Brightline is an instance of various multidisciplinary care groups being scaled via digital expertise to assist youngsters with all kinds of remedy applications. Higher care coordination and specialist collaboration is required by autoimmune sufferers, too. What’s extra, autoimmune sufferers, an growing variety of them youngsters, nearly at all times have comorbid psychological well being points, primarily melancholy and nervousness. It will be a logical extension of the Brightline strategy to achieve out to their temper dysfunction sufferers to see what number of of their households undergo from power ailments, particularly autoimmune, possibly even undiagnosed immuno-inflammatory problems.

 

Taking this even additional, a platform like this might work for power GI circumstances with immunological features such because the IBDs (inflammatory bowel ailments: Crohn’s and ulcerative colitis). Given what we now know concerning the gut-brain axis, GI ailments nearly at all times contain a giant psychological well being element. Particularly, Brightline may provide IBD sufferers entry to care groups that embody gastroenterologists in addition to dieticians, well being coaches and psychologists, which may assist them higher handle their day by day lives between common appointments. Such an strategy may assist IBD sufferers keep away from flares and issues requiring expensive hospitalizations or emergency visits. As well as, making use of Brightline’s prevention strategy to their inhabitants of households may enable earlier identification of IBD, particularly in youngsters, when early way of life modifications (food regimen triggers, meals sensitivities) may forestall illness altogether.

The HLTH VRTL convention was a wonderful alternative to seize a glimpse of a few of the adjustments led to by the COVID-19 pandemic. The sudden, pandemic-triggered enhance in use of telemedicine and distant monitoring (hyperlink to half 1), plus a shift in cost fashions to VBC (hyperlink to half 1) is accelerating competitors for the digital well being entrance door (hyperlink above) in addition to spurring new care supply fashions. (hyperlink above). Rising competitors for attracting sufferers via the digital entrance door additionally consists of an expanded position of pharmacies, in addition to new, digitally enabled, built-in approaches to girls’s and household well being.

 

All through HLTH VRTL there was nearly no point out of autoimmune or different power immuno-inflammatory ailments, making it tougher to see how these new gamers may assist. This omission is telling when it comes to the place healthcare managers are focusing their efforts. Whereas psychological well being is now receiving extra (well-deserved) consideration, autoimmune, autoinflammatory and circumstances like power fatigue and post-viral syndromes, simply as expensive and as large a explanation for human struggling as most cancers, are nonetheless invisible to most payers and plenty of suppliers. Possibly the emergence of post-COVID syndromes (aka lengthy covid) will lastly immediate payer and supplier curiosity in power immuno-inflammatory problems in the identical means the pandemic & lockdowns have speeded beforehand sluggish progress in telehealth and earn a living from home.

 

There isn’t a one-size-fits-all strategy for autoimmune sufferers and far experimentation is required, particularly since so little has been achieved outdoors a handful of small firms. Principally targeted on particular person autoimmune ailments. I hope subsequent 12 months’s HLTH convention will provide extra tangible examples of how giant and small healthcare firms are utilizing telemedicine, distant affected person monitoring, new supply care fashions, together with VBC reimbursement to raised serve the person day by day wants of power autoimmune sufferers. 

 

Elevating and enhancing the position of main care via digitally enabled platforms and salaried physicians in each established supply methods and new care fashions may additionally profit immuno-inflammatory illness sufferers. Nonetheless, this may solely occur if payers and suppliers give attention to this large unmet want/enterprise alternative. We nonetheless marvel the place immune illness specialists: dermatology, rheumatology, gastroenterology, immunology, endocrinology, match into these fashions. Are specialists going to turn out to be members of coordinated care groups? Or will they be satellite tv for pc practices coordinated via digital platforms that assist chronically in poor health sufferers get the total spectrum of care they want? How will these new fashions and digital platforms sort out the complexities of power autoimmune and autoinflammatory illness prognosis and therapy? Such questions can be good ones for HLTH and its contributors to give attention to for 2021.



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