Preventive care’s decline in popularity

Oct 24, 2023

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By Ben Leonard and Chelsea Cirruzzo

Presented by

Driving The Day

A waiting room.

The number of patients seeking preventive care seems to be dwindling. | Getty Images

PRIMARY CARE DIP — Demand for health care is still “tepid” after the pandemic’s peak, and Americans still haven’t returned to getting preventive care at the levels they were pre-pandemic, according to a new analysis from data firm Trilliant Health.

Primary care visits fell more than 6 percent between 2021 and 2022, continuing a long-standing dip in primary care visits.

Urgent care visits rose nearly 14 percent between 2021 and 2022, Trilliant’s data found, while emergency department visits — which can be costly — rose more than 3 percent.

Trilliant’s chief research officer, Sanjula Jain, warned that the decline in demand could hurt stakeholders across the sector, especially providers and device manufacturers. The pandemic and the restrictions that came with it led many to fear that patients would skip getting care, and some data has suggested that such care might never be made up.

Questions still remain about whether this trend will continue, though.

“Just as we see back-to-office rates and travel statistics beginning to rebound, people may have gotten out of the habit of preventive care during the pandemic but will pick it back up over time. It feels like it’s too early to know for sure,” Dr. Bob Wachter, head of the department of medicine at the University of California, San Francisco, told Pulse.

Dr. Kevin Schulman, a professor of medicine at Stanford University who has focused on health care economics, told Pulse that while some preventive care is handled by pharmacies, it’s not necessarily comparable.

“This leads to fragmentation of care and will lead to access challenges,” Schulman said.

He argued that the primary care payment model doesn’t sufficiently reward high-quality primary care and health systems aren’t investing as much in primary care as in other lucrative services like cancer care.

“Since 52 percent of physicians now work for health care systems, this is a worrisome trend,” Schulman said.

Dr. Ateev Mehrotra, a health policy and medicine professor at Harvard, said it’s not clear yet that the decline in preventive care is a “bad trend,” arguing it could indicate a decline in unnecessary visits.

From the Hill: Sen. Bernie Sanders (I-Vt.), chair of the Health, Education, Labor and Pensions Committee, advanced primary care legislation aiming to strengthen the sector last month despite opposition from ranking member Bill Cassidy (R-La.).

WELCOME TO TUESDAY PULSE. New research suggests that ransomware attacks have cost the U.S. health care sector more than $77 billion in downtime since 2016. Reach us at bleonard@politico.com or ccirruzzo@politico.com. Follow along @_BenLeonard_ and @ChelseaCirruzzo.

TODAY ON OUR PULSE CHECK PODCAST, your host Ben talks with POLITICO health care reporter Robert King, who explains why some state insurance commissioners want Congress to restore their authority to regulate Medicare Advantage marketing.

Listen to today’s Pulse Check podcast

A message from PhRMA:

Middlemen game the system at your expense. Pharmacy benefit managers (PBMs) charge fees tied to the price of medicines, which experts warn can lead to higher costs for patients and the health care system. A new survey finds 72% of voters believe PBMs should receive a fixed fee for their services instead. See the data.

Public Health

The Sanofi logo.

A shortfall of Sanofi's RSV shot for infants has prompted the CDC to tell doctors to ration their supply. | Thibault Camus/AP

CDC TO DOCS: RATION RSV SHOT — Federal health officials told doctors Monday to ration doses of a newly approved immunization to protect babies against respiratory syncytial virus, Chelsea reports.

The CDC said the injection, called Beyfortus and recently approved for children up to 8 months old, should be prioritized for those at the highest risk of severe disease amid supply shortages. They include infants under 6 months and those with underlying conditions.

The health alert comes after Sanofi, which manufactures the therapy, confirmed that it underestimated demand and was no longer accepting orders for the 100 milligram dose, which is given to babies who weigh equal to or more than 11 pounds. Babies who weigh less than 11 pounds receive a 50 milligram dose.

The CDC warned against using two 50 milligram doses for one infant to preserve supplies of those shots.

Other rationing measures the agency recommended include giving children with certain underlying conditions a different prophylaxis, called palivizumab and marketed under the brand name Synagis, to prevent severe disease, and encouraging people who are pregnant to receive the maternal RSV vaccine.

The CDC said RSV transmission has increased to “seasonal epidemic levels” in the South and is expected to increase nationwide during the next two months.

GO INSIDE THE MILKEN INSTITUTE FUTURE OF HEALTH SUMMIT: POLITICO is proud to partner with the Milken Institute to feature a special edition of our Future Pulse newsletter at the 2023 Milken Institute Future of Health Summit from November 6-8. The newsletter takes readers inside one of the most influential gatherings of global health industry leaders and innovators solving the biggest public health issues to ensure a healthier, more resilient future for all. SUBSCRIBE TODAY TO RECEIVE EXCLUSIVE COVERAGE.

In Congress

BERNIE QUESTIONS NIH AHEAD OF VOTE — Sen. Bernie Sanders (I-Vt.) is pressing HHS’ Inspector General to investigate the NIH for proposing an exclusive patent license for a cervical cancer treatment that he says could be worth billions of dollars to an “obscure company” last month.

The comments — which come before Biden’s nominee to be NIH director, Dr. Monica Bertagnolli, is set to get a HELP Committee vote this week — don’t bode well for her nomination. Sanders had held up the National Cancer Institute director’s nomination for months, vowing to oppose the administration’s health nominees until it took more action to reduce drug costs.

POLITICO’s Erin Schumaker reports that Sanders said the treatment could be worth hundreds of millions, if not billions, of dollars in revenue for the person or company that gets the patent.

Sanders argued the NIH should instead offer nonexclusive licenses so more manufacturers can produce the therapy and drive down its cost. He suggested that “one of the leading NIH researchers of this cancer treatment appears to have a direct relationship with the company.”

“The NIH should be doing everything within its authority to lower the outrageously high price of prescription drugs,” Sanders wrote. “It should not be granting a monopoly on a promising taxpayer-funded therapy that could cost hundreds of thousands of dollars for cancer patients in a way that appears to exceed its statutory authority.”

An NIH spokesperson didn’t respond to a request for comment. A Sanders spokesperson didn’t respond to a request for comment on what the concerns could mean for Bertagnolli’s nomination.

A message from PhRMA:

IN THE STATES

NEW JERSEY: IT’S JUST DIFFERENT — New Jersey state Democrats, running in this November’s legislative elections, are telling voters that the deep blue state “is just one election away from losing abortion access."

Republicans, pointing to the Democratic governor, say that’s nonsense.

“It’s just a political issue to scare their own voters,” John DiMaio, the Republican minority leader in the state Assembly, told POLITICO’s Matt Friedman. “In reality, we have full-term abortion in New Jersey that was passed about two years ago. The governor signed it. And there’s no real push that we’re going to do anything about that.”

New Jersey Republicans’ approach bears little resemblance to national party talking points and largely contrasts with how their counterparts in other states have dealt with abortion since the fall of Roe. The issue is indisputably a winning one for Democrats in states where abortion rights are genuinely at risk, but New Jersey’s legislative elections — among the few key races this year — offer one of the last chances before 2024 for the GOP to prove it can mount a real defense in a state where those rights are firmly protected.

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WHAT WE'RE READING

The Daily Beast reports on Rep. David Schweikert’s (R-Ariz.) pitch to cut health care spending with drugs like Ozempic and Wegovy.

STAT reports on health tech investors becoming selective with their cash.

Healthcare Dive reports on a lawsuit against Express Scripts from independent pharmacies over alleged price fixing.

A message from PhRMA:

Middlemen can make you pay more. Newly released data show 74% of voters think health insurers and their PBMs should pass the rebates and discounts they receive to patients, so no patient pays more for their medicines than their insurer. Read the new poll.