Big business’ buyout

The ideas and innovators shaping health care

Oct 03, 2022 View in browser   By Ben Leonard, Ruth Reader and Carmen Paun Continued access to telehealth is crucial to new health care business models. | Antonio Perez/Chicago Tribune/Tribune News Service via Getty Images AROUND THE NATION Corporate titans want to take over health care. In the last year alone, Amazon, CVS and Best Buy have spent close to $13 billion on health care acquisitions to expand into telehealth, in-home care and remote patient monitoring, with Walmart also getting in on telehealth for an undisclosed price. Telehealth is key since it's less expensive than in-person visits. It can also be used to reach rural populations. "We are making a long-term strategic bet that more care will move to the home over the next 10 years," Chris McCann, who's running Best Buy's new Current Health arm, told Future Pulse. But it's not without risk — The Biden administration is giving the deals heightened antitrust scrutiny. And Congress hasn't yet decided what to do about pandemic-era rules that made it easier for Medicare beneficiaries and people on high-deductible insurance plans to use telehealth. The big firms are lobbying Congress to pass legislation extending the rules for Medicare, the country's largest health insurer, which serves older adults. "Medicare is a functional linchpin to this," said John Nosta, founder of the digital health think tank NostaLab. The Medicare rules, which allow patients to have virtual visits without first seeing their doctor in person, expire five months after the end of the Covid-19 public health emergency. The high-deductible rule, which allows the plans to offer beneficiaries telehealth access before they hit their deductibles, runs out at the end of 2022. Getting that rule extended is also important because it affects more than 30 million people. Where things stand: In July, the House passed a bill that would extend loosened Medicare telehealth rules through 2024, though the Senate hasn't taken it up. Telehealth advocates hope that Congress will include an extension in a year-end spending bill. Why it matters: An endorsement from Congress could have ripple effects through the private insurance market, lobbyists and experts say. "When Medicare makes a decision about telehealth, that really influences the entire market," said Neil Ravitz, who led a study on the economics of telehealth at Penn Medicine. Even if: Government could give the firms what they need, but the companies could still fail. Health care is difficult to break into — bids by Google, IBM and a previous one by Amazon have so far failed to gain a footing. Some telehealth startups are also struggling. The firms must differentiate themselves to make a splash, said Rachel Stauffer, a senior director of McDermott+Consulting who has lobbied for the Advanced Care at Home Coalition, a group made up largely of health systems, including the Mayo Clinic. "It's hard to disrupt health care," said Barak Richman, a law and business professor at Duke University and a telemedicine researcher. "It's hard to get individuals to seek health care in ways that they're unfamiliar with." WELCOME TO FUTURE PULSE This is where we explore the ideas and innovators shaping health care. Share news, tips and feedback with Ben at bleonard@politico.com, Ruth at rreader@politico.com or Carmen at cpaun@politico.com.  Send tips securely through SecureDrop, Signal, Telegram or WhatsApp Today in our Pulse Check podcast, Alice Miranda Ollstein and Krista Mahr on the war against superbugs in Congress. Plus, Ruth Reader on four consequential trends that will further affect health care. Listen to today's Pulse Check podcast. Listen to today's POLITICO Pulse Check! TECH MAZE Pulse oximeters sometimes fail to gauge the blood oxygen levels of people with dark skin. | Anupam Nath/AP Photo Medical devices that don't work as well for people of color as they do for white people have serious consequences when they fail, new research found. The problems in pulse oximeters suggest that the FDA will need to give tough scrutiny to the breakthrough devices many expect to revolutionize health care. The study looked at tens of thousands of patients whose blood oxygen levels were tested using pulse oximeters. The devices sometimes overestimated those levels in Black patients, making it less likely they'd be hospitalized or receive supplemental oxygen. The inaccuracy led to an average of a more than four-and-a-half-hour delay in supplying oxygen. As we've previously reported, the situation raises broader concerns about bias becoming embedded in technology as tech plays a more prominent role in health care and about regulators' ability to prevent it. Government's role: Current Food and Drug Administration guidance recommends device makers study their products on at least 10 people, with "at least 2 darkly pigmented subjects." The agency is holding an expert panel to discuss device accuracy in November. "The FDA really should immediately evaluate its policies around approving pulse oximeters for clinical use," said study author Stephanie Brown, clinical lead at Sutter Health's Institute for Advancing Health Equity. "Manufacturers of these devices … must go back to the drawing board." The scope of the problem: It goes beyond pulse oximeters. A recent study found that forehead thermometers were more likely to miss fevers in Black patients than in white patients. Experts fear that as medicine melds with artificial intelligence, algorithms could include biases and exacerbate disparities if the technology isn't vetted with care. FUTURE THREATS $48.9 million The cost to fight a virus with pandemic potential The European Union and the Coalition for Epidemic Preparedness Innovations, a coalition of private and public organizations, are spending nearly $50 million to fight one of nine diseases scientists believe could cause a pandemic. The effort to develop a vaccine for Rift Valley fever underscores the new urgency of preempting outbreaks following the Covid-19 pandemic. The threat: Rift Valley fever can cause anything from a mild flu-like illness to a deadly hemorrhagic fever, according to the World Health Organization. Spread by mosquitoes and flies, the virus first appeared in sheep in Kenya's Rift Valley in 1931. An 1977 outbreak in Egypt infected as many as 40,000 people and killed 600. Mauritania and Uganda reported about two dozen cases this summer. Most countries in Africa and some in the Arabian Peninsula are at risk, but scientists believe climate change that impacts where disease-carrying mosquitoes live could increase the severity and frequency of outbreaks. "With climate change, we have examples of other viruses, which now have expanded — again, mosquito-borne diseases — like dengue, for example, or chikungunya. You can see those mosquitoes now in the southern U.S. or in southern Europe," said Melanie Saville, executive director of vaccine research and development at the CEPI. Game plan: The nearly $50 million will go toward moving vaccine candidates to the first phase of human clinical trials and scaling up manufacturing to produce a vaccine stockpile, Saville said. This is the second round of funding for Rift Valley fever vaccines from the European Union and CEPI. The first one, in 2019, supported two vaccine candidates developed at Colorado State University and Wageningen University in the Netherlands. The latter is now in the first stage of human testing.   Follow us on Twitter Ben Leonard @_BenLeonard_ Ruth Reader @RuthReader Carmen Paun @carmenpaun   Follow us

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