April 11, 2023
12:12 pm
For the Healthcare Leadership Council (HLC), an alliance of leading companies and organizations from every health sector, one of the most important priorities on which all of our members are unified is the need to advance equity within our healthcare system and to eliminate health disparities. It’s not enough to say that we have the greatest healthcare system in the world. We need to ensure that every American has access to care of the highest quality.
Last September, HLC, in coordination with the management consulting and technology firm ZS, published a comprehensive report on existing variations in care quality within the healthcare system and how each health sector, and the government, can play a role in addressing them.
What we’re seeing from our member companies in all sectors is that the commitment to equity is not just rhetorical. There are tangible actions taking place throughout the healthcare industry to create healthier futures for the population as a whole. We are going to use this space to examine many of the initiatives taking place, beginning with a sampling from the biopharmaceutical sector.
Amgen is partnering with multiple organizations to improve care delivery for cancer patients as well as those with cardiovascular and respiratory diseases. The company is working to incorporate the patient perspective across the drug development process to aid in its efforts to achieve representation of patients in clinical trials and throughout the process all the way to commercialization. As part of improving the clinical trial process, Amgen is partnering with community hospitals and health systems in an effort to execute clinical trials as close as possible to where patients live and work. The company is also investing in the training and development of healthcare providers from historically underrepresented populations to increase the number of investigators and clinical trial staff who look like the patients intended to benefit from the medicines Amgen develops.
Bristol Myers Squibb, as part of the company’s global Diversity and Inclusion and Health Equity Commitments, has committed $150 million over five years to address health disparities, increase clinical trial diversity, expand supplier diversity, increase workforce representation, and enhance employee giving in support of social justice organizations. Separately, the Bristol Myers Squibb Foundation has also committed $150 million to address health disparities, increase clinical trial diversity and enhance employee giving. The funds are provided as grants to non-profit organizations intended to bolster community outreach and engagement, increase care coordination services, and ensure an ethnically diverse, culturally competent community health worker and patient navigator workforce. BMS also worked with HLC in spotlighting the work of the Center for Information and Study on Clinical Research Participation, which is working to bring greater diversity to clinical trials.
Genentech, as well, is committed to the concept that clinical research should reflect real-world populations. It is incorporating enhanced population, science-driven strategies and inclusive clinical research action plans across its research and development programs. The company partnered with several clinical research centers in launching the Advancing Inclusive Research Site Alliance. This coalition of clinical research sites works with Genentech to advance the representation of diverse populations in oncology clinical trials, test new recruitment and retention approaches, and establish best practices that can be leveraged across the industry to achieve health equity for all patients. Genentech is also sponsoring health equity regional symposia to identify health equity issues that matter most to the community and is investing in partnerships that provide healthcare and education in communities while contributing to positive change in our society.
Merck is continuing to partner with community-based organizations, clinical trial investigators and others to advance clinical trial diversity initiatives and ensure that the company’s clinical trials are diverse and inclusive. The company is also focusing on equity in care delivery, collaborating with organizations to develop innovative initiatives to improve access to prevention, diagnosis, and treatment across the patient journey. Merck has made clear that it will continue to partner with community-based organizations to build trust in the community and better address the needs of underserved patients by meeting them where they are.
Pfizer is continuing to lead on health equity as a connector through its Multicultural Health Equity Collective, which is addressing health disparities among the most vulnerable and historically underserved populations. The company is continuing to pursue policies that promote data collection, interoperability and outcome measures that advance health equity, supporting efforts by stakeholders to develop standards informed by clinical development, post-marketing and education. It is prioritizing efforts to eliminate barriers, increase access, and raise awareness of the clinical trial process among diverse populations. And because Pfizer products span diseases for which underserved populations experience increase morbidity, it is ensuring that its patient assistance programs reach populations most in need while continuing to focus, as well, on social determinants of health.
Our next post on this topic will take a look at the health equity initiatives of some leading hospitals and health systems.
April 04, 2023
7:44 pm
The Report of the Secretary’s Task Force on Black and Minority Health was released in 1985, serving as a catalyst for the U.S. Department of Health and Human Services (HHS) to begin addressing health disparities, and Congress to form the Office of Minority Health within HHS the following year. Today, much of the progress in this arena is taking place in the private sector. The healthcare industry is taking steps to achieve health equity with considerable vigor and with some lessons learned under its belt. The Healthcare Leadership Council (HLC), representing all health industry sectors, released a report in January 2023 with ZS, entitled, “Addressing Health Equity: Practical Solutions to Address Variations in Care,” identifying multiple structural barriers in both the private and public sectors that contribute to existing health disparities. The report was followed by a release stating HLC members’ commitment to shared principles aimed at eliminating health disparities. HLC also recently hosted a webinar, “Breaking Down Barriers to Achieve the Highest Level of Health,” in which representatives from its member companies discussed current strategies and overarching philosophies. The panel was made up of three participants:
- Joneigh Khaldun, MD, Chief Health Equity Officer, CVS Health
- Josette Gbemudu, Executive Director, Health Equity and Social Determinants of Health, Merck
- Keith Dawson, Principal Science Leader, Global Health Equity and Population Science, Genentech
Dr. Khaldun opened by describing CVS’s enterprise-wide health equity strategy, highlighting the need to empower all employees by educating them about systemic inequities and providing tailored training for cultural competency. Dr. Khaldun also talked about measuring what matters to uncover inequities and utilizing these insights to design programs and policies to address them effectively. Examples of specific programs included CVS’s Community Equity Alliance, which aligns academic, community and healthcare partners to expand and integrate community health workers into care teams, and its workforce innovation training centers, which support job training needs across the country. Dr. Khaldun noted that disparities took centuries to develop, and that health equity is a journey that will not be achieved by one initiative in a short period of time.
Josette Gbemudu echoed Dr. Khaldun in that there must be internal integration of health equity across an entire business and not just through one initiative. She pointed to Merck’s $650 million commitment to improving maternal health globally and how it is using the learnings to embed health equity into its core business functions. Citing numerous statistics to show the broad range of disparities, Josette shared that Merck is not just focused on addressing social determinants of health barriers such as food insecurity, health literacy and health access, but it is dedicated to strengthening the entire health ecosystem. Merck Foundation launched a $20 million initiative to advance equity in U.S. cancer care. Josette emphasized that many communities have historically been unable to access screenings, which leads to later diagnoses and poorer outcomes. The alliance is utilizing a collaborative approach to build community partnerships in order to address barriers to care.
Keith Dawson discussed Genentech’s efforts to develop solutions that will broaden inclusion of historically underrepresented groups in clinical research so that all patients can realize the full benefits of personalized healthcare. He stressed that clinical research is not benefiting all groups equally, that genomic data is not diverse enough and that Blacks and Hispanics are not informed about clinical trial opportunities. The diversity of patients enrolled in clinical studies is highly correlated with site personnel diversity, he pointed out. Keith stated that Genentech prioritizes fostering belonging and cultivating an environment where all are included. The Advancing Inclusive Research Site Alliance Partnership was created to develop an ecosystem based on trust and meeting patients where they are. This alliance uses an external council of advisors and patient and provider partnerships to provide educational tools to improve awareness of clinical trials. It also distributes grants to external organizations striving to address inclusive research, equity in care and workforce diversity.
March 09, 2023
3:41 pm
It’s no wonder why Medicare Advantage (MA) is so popular among America’s seniors, with a greater share of the Medicare population choosing MA plans as its coverage of choice each year. MA has consistently outperformed conventional fee-for-service Medicare in reducing avoidable hospitalizations, lowering hospital readmissions, and encouraging utilization of preventive services. Patients have benefited from supplemental benefits such as vision and dental care as well as programs to affect the social determinants of health, addressing food insecurity, social isolation and transportation needs, to name a few examples.
This progress should be encouraged. So, needless to say, we were concerned at the proposed changes from the Centers for Medicare and Medicaid Services (CMS) for the 2024 plan year. Three changes – revisions in the MA risk model resulting in a 3.12 percent reduction, reduced quality bonus payments under the Medicare Star Ratings program of 1.24 percent, and a 2.09 percent benchmark, which is less than half of the five percent projected per-enrollee growth in Medicare costs – would result in an average 2.27 percent reduction in MA payment rates in 2024. While not all plans would be affected equally, many enrollees could see higher premiums or a loss of programs and benefits that have a direct impact on health outcomes.
As well, there are concerns about proposed changes to health data, specifically the precision that enables providers to identify a patient’s condition and administer effective treatment. The CMS regulatory proposal would remove nearly 2,300 ICD-10 diagnosis codes. Restricting the ability to recognize asymptomatic diseases would result in an unwanted increase in avoidable emergency room visits and hospital admissions. We could see physician revenue cuts and the closure of clinics in underserved urban and rural areas.
The solutions here are evident. The proposed MA payment growth rate for 2024 should be adjusted to reflect document increases, including inflation, in Medicare costs. Other proposed changes should be delayed in order to gather stakeholder input and fully understand the potential impact on health providers and patients. We have an opportunity to continue the momentum that MA plans have successfully generated, enabling the 65-and-older population to live healthier lives and better manage the chronic illnesses that become more prevalent as we age. CMS should make the adjustments to ensure that we don’t take an unnecessary step backward.
February 27, 2023
6:33 pm
The Healthcare Leadership Council hosted a webinar entitled, “Cybersecurity Playbook for Healthcare,” in conjunction with the Confidentiality Coalition. The discussion brought clarity to the current federal infrastructure around cybersecurity, existing tensions around breach notifications in the healthcare industry, and recommendations to improve cybersecurity practices within and beyond healthcare. Four speakers joined the panel:
- Marilyn Zigmund Luke, Vice President, AHIP
- Alicia Bowers, Senior Vice President and Enterprise Chief Privacy and Compliance Officer, Atrium Health (now part of Advocate Health)
- Todd Greene, Vice President & Enterprise Chief Information Security Officer, Atrium Health
- Allison Miller, Global Chief Information Security Officer and Senior Vice President for Optum, a division of UnitedHealth Group
Infrastructure
The healthcare system is one of 17 national critical infrastructures. As cybersecurity stretches across federal agencies, money is allocated to various agencies to maintain cybersecurity capabilities. Within the U.S. Department of Homeland Security, the Cybersecurity and Infrastructure Security Agency (CISA), was established to receive reports from critical infrastructure sectors. The public is awaiting future regulations from CISA of how to proceed with that reporting process. The Healthcare and Public Health Sector Coordinating Council Cybersecurity Working Group identifies and mitigates systemic risks that affect patient safety, security, privacy, and national confidence in the health system.
The Problem with Breach Notifications
As healthcare is a highly regulated industry, organizations who comply with one law run the risk of violating another law because the federal agencies and states have not adequately communicated with each other regarding the larger operational impact of what they are trying to accomplish. There are unintended consequences to conflicting laws, and the burden of reporting a breach is significant. The panel noted the juxtaposition of portability and security of data, as tension arises between becoming increasingly transparent and connected while protecting patient privacy and securing data.
Breach notification requires contacting both patients and the media. Patients who receive these notifications are either confused or desensitized by the mass mailings, and are generally not concerned unless their social security number was compromised. Media outlets generally go for the more sensational headline and stories are frequently reported inaccurately. Often, the primary organization is named in the breach even though the actual breach involved a business associate or vendor. It has become clear that the majority of patients take no action after a notification, and media coverage actually helps cyber criminals and plaintiff attorneys target an organization that has just been victimized. Healthcare entities are spending more resources on class action defense rather than proactive measures due to the punitive ramifications of how breach notifications are designed.
Recommendations
The majority of breaches are not due to negligence, and the compromised entities are victims of a crime. The “Wall of Shame”, posted by the U.S. Department of Health & Services Office for Civil Rights, should come down. There is stigma associated with this and the primary organization is listed even if a vendor was breached. Healthcare is a complex industry, and multiple vendors are required to fulfill all the responsibilities that come with delivering care. Vendors should be held directly responsible, and other sectors should have the same reporting standards as healthcare.
Reduce the administrative burden and use an exclusive reporting route instead of involving multiple agencies. Avoiding creating duplicative processes and tearing down commodity channels would allow sectors to effectively communicate valuable information about cyber threats and defend against them collaboratively in a timely fashion. An additional approach to reducing the burden of unnecessary notifications is to redefine what is considered protected health information, as routinely disclosed data is easily found online outside of healthcare.
January 24, 2023
2:01 pm
Cancer is one of the leading causes of death across the globe and affects the lives of millions every year in the United States. As advances have been made in screening, diagnosing and therapeutics, providers have been able to utilize new technologies and precision medicine to achieve improved outcomes. The Healthcare Leadership Council hosted a webinar to highlight the commitment to medical research and discovery and the most recent accomplishments of some of its member companies. The webinar, “What’s New in Cancer Innovation?”, included three panelists:
- Dr. Qasim Ahmad, Head of US Oncology Medical Affairs, Novartis
- Dr. Harlan Levine, President, Health Innovation and Policy, City of Hope
- Victoria Raymond, Senior Director of Medical Affairs, Guardant Health
Ms. Raymond described Guardant’s focus on blood-based diagnostics as a less invasive way to screen for specific cancers. This method of screening can assist in early detection as well as ensuring appropriate therapy selection. Dr. Ahmad concurred that there has been a shift from making the patient fit the treatment, to making the treatment fit the patient. He presented Novartis’s strategy to harness the power of targeted therapy, immunotherapy, cell and gene therapy, and radioligand therapy to attack cancer using multiple approaches and provide the best outcomes for patients at every stage of the disease.
Dr. Levine noted that the rate of change in oncology exceeds the ability for most oncologists to keep up with the advances in each subtype of cancer or surgical technique. He stated that while with precision medicine and genomics we are able to identify tumor types and DNA signals, we still address value-based oncology with tools that were developed decades ago as though cancer is a single specialty with only a handful of chemotherapy agents. Reliance on these generic tools will limit the benefit of emerging technology and propagate disparities.
The discussion underscored the lack of diversity across clinical trial sites, doctors, study investigators and trial participants. A map was provided as a visual to portray how one’s survival is directly impacted by one’s zip code. The need to innovate the system so that it is accessible and equitable is vital to improving cancer care. The panelists acknowledged efforts to increase diversity in clinical trials and addressing barriers that hinder trial participation and access to treatment. Educating the public on opportunities is just one piece of the puzzle. Finding easier ways for people to follow through with what they know they need to do is the next challenge.
Finally, the Inflation Reduction Act (IRA) was raised as a hindrance to cancer research, which require long-term commitments and significant investments. There is a need for broader understanding of the investment required to subsidize clinical trials for cell-based therapies and the potential impact of the IRA in discouraging that investment. Policy measures that result in reduced research and fewer trials, ultimately limiting access to new therapies, is harmful to patients and society as a whole.
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