The post-Covid era comes into focus

The ideas and innovators shaping health care

Jul 20, 2023 View in browser   By Ben Leonard, Carmen Paun, Erin Schumaker and Evan Peng FORWARD THINKING Northwell CEO Michael Dowling. | Peconic Bay Medical Center - Northwell Health via YouTube Northwell Health CEO Michael Dowling — the influential head of New York’s largest health care provider and private employer — wants a post-pandemic future more focused on the root causes of health problems. He spoke with POLITICO’s Kelly Hooper about how that means looking “upstream” at social determinants of health — lifestyle, behavior and ZIP code — and expanding the definitions of health to include issues like gun violence and food insecurity. Dowling also said providers will have to adapt to the transition from hospitals to outpatient care and the growth and regulation of artificial intelligence in health. This interview has been edited for length and clarity.  As we move into this post-Covid era, what are some of the biggest trends to watch in health care? Eighty percent of ill health is a result of lifestyle, behavior and your ZIP code. What you eat, whether you exercise or don’t, what you drink, what you smoke and where you live. We’re very actively involved in going what we call “upstream” so that you can actually intervene earlier so that you prevent the “downstream,” or at least curtail it to some extent, and this is why we’re very involved in issues like gun violence, food insecurity, education, diabetes screening. What about AI and its increasing role in health care? The big issue for me long term is what happens if the machines become smarter than the human brain? That, I think, is something that we have to be careful of. The use of technology to enhance our health care delivery has wonderful potential benefits, but I always caution that we have to be careful to make sure that we don't become so dependent upon very, very smart technology when we don't fully understand what it actually can do. What does integration of AI into health care look like, specifically for Northwell?   It has wonderful potential because it allows you to analyze data — unbelievable amounts of data, historic data, look for trends, analyze what the data tells you, and then be able to predict what you should or shouldn't be doing with a patient. It's the wave of the future. It cannot substitute, however, for the human interaction in health care. What’s your next frontier for expanding Northwell’s innovation in healthcare? I think outpatient care is going to dramatically expand. There’s a lot of stuff done even in the hospitals today that I think in five years’ time will be done on the outside. I have 900 locations. Imaging, cancer — we’re the largest cancer provider in New York; most of it is outpatient.   JOIN 7/27 FOR A TALK ON WOMEN LEADERS IN THE NEW WORKPLACE: In the wake of the pandemic, U.S. lawmakers saw a unique opportunity to address the current childcare system, which has become increasingly unaffordable for millions of Americans, but the initial proposals went nowhere. With the launch of the Congressional Bipartisan Affordable Childcare Caucus in May, there may be a path to make childcare more affordable. Join Women Rule on July 27 to dive into this timely topic and more with featured speakers Rep. Nancy Mace (R-S.C.), Rep. Ro Khanna (D-Calif.) and Reshma Saujani, Founder & CEO of Moms First and Founder of Girls Who Code. REGISTER HERE.     WELCOME TO FUTURE PULSE Ruby Beach, Wash. | Evan Peng This is where we explore the ideas and innovators shaping health care. For heart surgery patients, rehab really helps, according to a new study. University of Michigan researchers found that those who do cardiac rehabilitation, including exercise and healthy eating after surgery, have lower mortality rates. Share any thoughts, news, tips and feedback with Ben Leonard at bleonard@politico.com, Ruth Reader at rreader@politico.com, Carmen Paun at cpaun@politico.com or Erin Schumaker at eschumaker@politico.com. Send tips securely through SecureDrop, Signal, Telegram or WhatsApp. Today on our Pulse Check podcast, Erin talks with host Katherine Ellen Foley about her interview with former House Speaker Newt Gingrich, who was once one of the biggest champions of the National Institutes of Health but now backs funding cuts to the agency. Plus, how a budget cut would impact the NIH's work. Listen to today’s Pulse Check podcast PANDEMIC Covid sparked many clinical trials, but interest in studying the disease is ebbing. | Getty Images Clinical trials are shifting away from Covid-19 now that the threat posed by the disease has diminished, according to a new report from health research firm Phesi. In its sted, depression research is growing. In 2022, Covid was the second most-studied disease in trials, behind breast cancer, according to the report. During the first six months of 2023, it fell out of the top 5. Cancer and strokes remained at the top of the list, but depression rose to No. 4 in the first half of this year. Why so? Even before the pandemic, depression was on the rise. One in 20 U.S. adults have regular feelings of depression, according to the latest Centers for Disease Control and Prevention data, and 1 in 8 have regular feelings of anxiety. It’s “likely due to greater awareness, improved understanding of the underlying causes of the disease, and growing investment in new avenues such as psychedelics,” the report said.   JOIN 7/26 FOR A TALK ON THE NEW ENERGY ECONOMY: Join POLITICO's lively discussion, "Powering a Clean Energy Economy," on July 26 to explore the effectiveness of consumer-targeted policies to boost sustainability and create clean energy jobs. How are the Inflation Reduction Act's provisions faring? Which strategies truly sway consumer behavior? Hear from featured speaker, Rep. Debbie Dingell (D-Mich.), among other experts. Don't miss this insightful event — register today and be part of the conversation driving America's clean energy future! REGISTER NOW.     WASHINGTON WATCH Burgess got his way on the IMD exclusion. | Francis Chung/POLITICO | Francis Chung/E&E News Opioid addiction-fighting legislation moving through the House would remove a nearly 60-year-old rule that bars states from using Medicaid funds to pay for addiction treatment in large mental health institutions. States must now obtain a waiver from the Centers for Medicare and Medicaid Services to do that. Republicans pushed for the change and reluctant Democrats acceded when the Energy and Commerce Committee approved the bill on Wednesday in a unanimous vote. Why the controversy? The Institutions for Mental Disease, or IMD, exclusion limiting institutional treatment was part of the law that created Medicaid in 1965. It came at a time when the government was seeking to move mental health patients from institutional to community care, given advancements in psychiatric drugs and concern about how patients were treated in the large facilities. Congress also wanted to ensure the states picked up the bulk of the treatment costs. New Jersey’s Frank Pallone, the ranking Democrat on the committee, said earlier this year he was worried that ending the rule would create financial incentives to institutionalize people with substance use disorder instead of offering them treatment in their communities. But Republicans, backed by treatment advocates, prevailed. “It is no longer the 1960s and there is no longer the same stigma against the treatment of mental health,” said Rep. Michael Burgess (R-Texas). He called for bolstering the health care workforce and supporting providers “to ensure that mental health and substance use patients have access to personalized care, personalized medicine.”   Follow us on Twitter Ben Leonard @_BenLeonard_ Ruth Reader @RuthReader Carmen Paun @carmenpaun Erin Schumaker @erinlschumaker Evan Peng @thepngfile   Follow us

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