Healthcare Huddle Summer Recap - Healthcare Industry Reacts to Affirmative Action Ruling

Ben H.

Hatched by Ben H.

Apr 15, 2024

5 min read

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Healthcare Huddle Summer Recap - Healthcare Industry Reacts to Affirmative Action Ruling

Introduction:

The healthcare industry has been abuzz with various developments and controversies in the summer of 2023. From UnitedHealthcare's prior authorization rule reversal to Mark Cuban's Cost Plus Drug company's revolutionary approach, there is much to discuss. Additionally, the landscape of digital health funding, the competition faced by AbbVie's Humira, and the innovative ventures of Neko Health and Amazon Web Services have caught the industry's attention. Furthermore, Blue Shield of California's bold move and CMS's negotiations for Medicare Part D medications are reshaping the healthcare landscape. In the midst of all this, the Supreme Court ruling on affirmative action in higher education institutions has raised concerns about its impact on the healthcare industry's diversity efforts.

UnitedHealthcare's Prior Authorization Rule Reversal:

UnitedHealthcare's decision to reverse its new prior authorization rule for non-screening endoscopies has sparked controversy. While initially supported by evidence of procedure overutilization, gastroenterologists expressed concerns about potential patient harm and increased stress for physicians. This reversal highlights the importance of considering the input and concerns of healthcare professionals when implementing new policies.

Mark Cuban's Cost Plus Drug Company:

Mark Cuban's Cost Plus Drug company is making waves in the pharmaceutical world with its rapid expansion and partnerships with independent pharmacies. By delivering brand-name and biosimilar drugs at significantly reduced prices, Cost Plus Drugs has the potential to save billions for Medicare Part D beneficiaries. This innovative approach challenges the traditional pricing model and opens up possibilities for partnerships with government entities like CMS or the VA.

Digital Health Funding and Booming Sectors:

The digital health funding landscape for 2023 is witnessing a shift, with 12 mega deals accounting for 40% of total funding in the first half of the year. This reduced deal volume is accompanied by a focus on three booming sectors: non-clinical workflow, at-home care solutions, and value-based care enablement. These trends reflect the industry's increasing emphasis on improving efficiency, accessibility, and patient outcomes through technology.

Competition for AbbVie's Humira:

After dominating the market for two decades, AbbVie's Humira is now facing competition from biosimilars. However, the challenge lies not only in drug entry but also in navigating the complex web of pharmacy benefit managers (PBMs) and rebate systems. Companies like Cost Plus Drugs are finding ways to sidestep traditional hurdles and bring massive discounts to the biosimilar market. This competition could result in more affordable options for patients and potentially reshape the pharmaceutical landscape.

Neko Health's Preventive Healthcare Approach:

Neko Health, co-founded by Spotify's Daniel Ek, is generating excitement with its unique approach to preventive healthcare through non-invasive whole-body scans. While the broader market of whole-body imaging raises concerns about false positives and limited evidence, Neko differentiates itself by focusing on primary care-like screenings at potentially more affordable rates. This approach has the potential to revolutionize preventive care, particularly in light of soaring out-of-pocket healthcare costs.

Amazon Web Services and HealthScribe:

Amazon Web Services has introduced HealthScribe, an AI tool designed to transcribe and summarize patient-doctor dialogues for easy electronic health record (EHR) integration. While this service positions itself as a valuable addition to larger healthcare platforms, it enters a competitive market dominated by specialized health tech firms. The success of Amazon's venture will depend on its ability to overcome the challenges typically faced by big tech companies in the healthcare industry.

Blue Shield of California's Bold Move:

Blue Shield of California's decision to sever its ties with CVS Health's Caremark is shaking up the drug prescription world and sparking discussions about the future of pharmacy benefit managers (PBMs). This initiative aims to improve transparency and reduce costs by splitting the roles traditionally held by Caremark among five distinct entities. The implications of this move could reshape the drug supply chain and potentially mark the beginning of the end for dominant PBMs.

CMS's Price Negotiations for Medicare Part D Medications:

CMS is gearing up to negotiate prices for 10 key Medicare Part D medications following new permissions from the 2022 Inflation Reduction Act. This move has the potential to reshape the prescription landscape and offer significant government savings. However, it has also sparked legal challenges and concerns about potential impacts on drug innovation. The outcome of these negotiations will have ripple effects across the healthcare system and on patients' wallets.

The Impact of the Affirmative Action Ruling:

The recent Supreme Court ruling that prohibits higher education institutions from considering race in admissions decisions could have far-reaching consequences for the healthcare industry. Affirmative action has been crucial in diversifying medical school student bodies and addressing disparities in the healthcare system. Healthcare organizations have expressed concerns that eliminating affirmative action could impede diversity efforts and further exacerbate health inequities faced by Black and Hispanic populations.

Conclusion:

In a summer filled with groundbreaking developments and controversies, the healthcare industry is witnessing significant shifts and challenges. From the innovative approaches of companies like Cost Plus Drugs, Neko Health, and Amazon Web Services to the bold moves by UnitedHealthcare, Blue Shield of California, and CMS, the industry is constantly evolving. As the industry navigates these changes, it is essential to prioritize patient care, accessibility, and affordability. Three actionable advice for healthcare stakeholders would be: 1) Listen to the concerns and insights of healthcare professionals when implementing new policies, 2) Embrace technology and digital health solutions to improve efficiency and patient outcomes, and 3) Prioritize diversity and equity in healthcare to address disparities and provide quality care for all individuals. By staying informed and proactive, the healthcare industry can adapt to the evolving landscape and make meaningful advancements in patient care.

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