Apps and web portals are streamlining vaccine rollout, but the digital strategies could leave vulnerable populations behind, experts warn

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Summary List Placement

Older Americans, who have died from COVID-19 more than any other population, are finally getting broad access to vaccines in the US. 

Some health systems are starting to release plans on how they will get older populations vaccinated. Michigan-based Beaumont Health, for instance, said the only way people 65-years-old or older can make vaccine appointments will be through the hospital’s online portal, via email. The Cleveland Clinic in Florida has encouraged seniors to sign up for appointments online due to “extremely high volume of calls.” Tennessee’s Department of Health will soon require residents to make appointments online to streamline distribution.

CVS Health, which will assist the US in providing 20 to 25 million shots per month to the public, requires scheduling a vaccine appointment online or via the app.

Using technology could be an efficient way for health systems to keep track of appointments, but might limit access among older Americans. 

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Fewer than half of seniors aged 80 or older report using the internet and only 28% have broadband service, according to Pew Research Center. Just 46% of older adults living in households earning less than $30,000 a year use the internet.

AARP, the nation’s leading interest group for those 50-years-old and older, has found though older Americans are increasingly more tech-savvy, there’s a “large discrepancy” between low-income seniors compared to the general population in terms of owning technology.

The Sarasota Herald-Tribune has already reported older people without smartphones or computers had difficulty making appointments online in Florida.

“There continues to be a digital divide in the senior population as there is for the general population,” said Tricia Neuman, senior vice president at the Kaiser Family Foundation. “People in communities of color, lower income people, and much older people are less comfortable or have less access with technology and wi-fi than others.”

How to ensure older Americans get equitable access to the COVID-19 vaccines

The Food and Drug Administration is now encouraging states to begin inoculating elderly Americans to speed up the distribution process after the slower-than-expected vaccine rollout: 2.8 million Americans received vaccines in 2020, far short of President Donald Trump’s goal of 20 million

“There is no reason that states need to complete, say vaccinating all health-care providers, before opening vaccinations to older Americans or other especially vulnerable populations,” Health and Human Services Secretary Alex Azar told reporters on Wednesday

People 75 and older are 8 times more likely to be hospitalized with COVID-19 and 220 times more likely to die than 18-28 year olds, according to the Centers for Disease Control and Prevention. The disease has also spread particularly fast among Black Americans and lower-income workers.

Adam Gaffney, a critical care physician and an instructor at Harvard Medical School, argued in USA Today the US should have begun vaccinating the oldest Americans before slowly widening the scope to younger people to decrease deaths and hospitalizations. 

Even as the disease hurts America’s most vulnerable at higher rates, vaccine distribution seems to be favoring privileged groups. Insider’s Shirley Livingston recently reported white people are getting more vaccines than Black people and other groups, according to state data. Wealthy donors and hospital administration staff getting have reportedly gotten vaccines before frontline workers in some cases. Celebrity plastic surgeons have gotten vaccinated as contract nursing home staff still waits in line.

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Angela K. Shen, visiting research scientist at the Children’s Hospital of Philadelphia who formerly worked at the US Department of Health and Human Services, co-authored a recommendation on how the US should equitably distribute vaccines. In the report, Shen said ensure older adults should get first access to the vaccine without needing to pay.

Shen said relying on online appointments to get vaccines not only disadvantages some older Americans, but also rural communities that lack fast internet access. But Shen said healthcare systems should focus on getting large swaths of the population access to vaccines, which might require using apps and technology. 

“If you can kind of like capture like a large swath of the population, then you can change and have more precise strategies or tweak strategies that weren’t working before to kind of get at those people that you may have missed,” Shen said. 

Shen and Neuman both said the key to getting equal access to older Americans is to use a variety of methods to reach different groups. In Colorado, for instance, drive-through vaccination clinics were able to inoculate seniors from small and disadvantaged areas first, The Colorado Sun reported. The US gave health systems paper cards with reminders on when to get a second dose. 

Systems will also need to work with in-home providers to access the 2 million people over 65 that are permanently homebound, according to STAT News.

If access to vaccines remains unequal among older populations, Shen said high-risk communities should continue to engage in social distancing and mask wearing.

“Just because you’re older and you don’t use a cell phone doesn’t mean that you’re higher risk; it depends on what actions you yourself are doing,” Shen said. “There’s plenty of older adults who use technology, but then there’s plenty of who don’t.”

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A startup that's taking on Big Pharma just raised $500 million

Summary List PlacementHello, 
Today in healthcare news: EQRx has raised another $500 million, at least 50% of COVID-19 cases spread from people without symptoms, and some evidence that Pfizer’s vaccine works against virus mutations. 

EQRx, a startup that’s taking on Big Pharma by making drugs cheaper, just raised $500 million

EQRx, a company developing new drugs that’ll compete with some of the highest-priced drugs on the market at a lower price, is moving faster than it expected.
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The CEO of major health insurer Humana laid out why he's betting big on primary care

Summary List PlacementLong before Humana became the dominant health insurer it is today, its business revolved around operating hospitals.
Now, decades later, Humana is getting back to its roots of providing medical care.
This time, the company is hyper-focused on transforming primary care for older people.
The national health insurer is investing heavily in building clinics in underserved areas across the country. It’s also partnering with primary-care startups like Oak Street Health, ChenMed, and Iora Health to reach more seniors. And last year, Humana pumped $100 million into telehealth startup Heal to bring primary care into patient’s homes.
Humana’s quest, CEO Bruce Broussard told Insider, is to weave together health insurance with the delivery of healthcare. Integrating the two could lead to lower costs and better health outcomes, he said.
The insurer is focusing on primary care because that’s one type of clinical care that has shown to reduce costs in the long run. Various studies have demonstrated that investing more money into primary care is associated with fewer costly hospitalizations and emergency department visits.
“We’re big believers in primary care,” Broussard told Insider in an interview on Friday. “We see great results, high satisfaction scores, high quality scores, and in addition, from a cost point of view, some really great outcomes there.”
Over the next decade, as Humana continues to invest in primary-care clinics, along with home-based and virtual care, the company may start to look different, Broussard said. Soon, it could employ as many clinicians as it does other types of employees, he said.
“Over the longer run, a decade, you’ll see a very substantial healthcare service business within Humana,” Broussard said. “I think you’ll see considerably larger platform and a changing organization.
Humana got serious about primary care after its Aetna break-up
Humana began buying primary-care clinics about a decade ago, but it became “intentional” about its clinic strategy when it called off its planned merger with rival insurer Aetna in 2017 after a federal judge blocked the deal, Broussard said.
After the break-up, Humana did some soul-searching. It looked to big, integrated health systems like Kaiser Permanente in California and University of Pittsburgh Medical Center and Geisinger in Pennsylvania and concluded that delivering healthcare is most successful when integrated with insurance under one organization.
Primary care was one clinical area Humana decided to focus on. In 2018, Humana moved the various primary-care groups it had acquired under one brand called Conviva. Those clinics were largely concentrated in South Florida.
For a time, Broussard said Humana doubted that a clinic strategy would work outside of Florida, where the strategy had proven successful because people from Cuba and other Hispanic backgrounds who have a large presence in Florida were already used to getting care in clinics, he said.
Humana wanted to see where else a primary-care clinic strategy would work, but there weren’t a lot of senior-focused clinics out there. So it began investing in other primary-care startups like Oak Street, ChenMed and Iora. According to Oak Street’s latest earnings report, Humana comprised nearly half of the startup’s revenue for the first nine months of 2020.
“We wanted to fund a number of different companies, both to see who was going to be successful or not and also to get capacity in the marketplace,” Broussard said.
Humana then started building its own clinics under the brand Partners in Primary Care “both for defensive and offensive reasons,” Broussard said. It struck a deal last year with private equity company Welsh Carson to build out 50 more clinics over three years.

Read more: Humana just made $643 million on its bet on a new way to pay for doctor’s visits — and the CEO signaled that this is just the start
Humana owns 150 primary-care clinics and partners with about 100 more
Humana’s primary-care clinics cater to seniors enrolled in Medicare Advantage, which is a private alternative to the traditional government-run Medicare program that provides health coverage to older people. Humana serves about 4.7 million people in Medicare Advantage plans.
The clinics are paid in a nontraditional way. Insurers give them set monthly fees to care for each patient, so the clinics make money by keeping patients healthy and out of the expensive hospital or emergency room. Doctors see fewer patients than normal so they can give each patient more attention.
Broussard said the company would continue to open clinics in areas that are starved for primary care, both by building its own centers and partnering with startups.
Humana owns about 150 clinics that serve seniors enrolled in multiple health plans and boasts partnerships with 108 additional clinics operated by other companies. It aims to open about 50 to 60 more clinics with partners in 2021, a Humana spokeswoman confirmed.
About 8%, or 300,000, of Humana’s Advantage members, get care in owned and partnership clinics, and company executives have expressed plans to grow that figure.
Beyond primary care, Humana is also pushing deeper into delivering care in patients’ homes.
It bought a 40% stake in Kindred Healthcare’s home health business in 2018 for about $800 million, with a right to buy the whole business after a few years. In addition to its investment in Heal, Humana last year put money into DispatchHealth, which provides urgent medical care in the home.
Broussard said the insurer is testing a model in Atlanta that integrates the services of Kindred, DispatchHealth and Heal so that seniors can see a nurse or doctor, or even “visit” the emergency room, all without leaving the couch.
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Humana’s transformation is emblematic of an industry-wide shift toward integrated healthcare companies
Humana’s focus on delivering healthcare is part of a broader movement among health insurers to become more that just intermediaries who pay medical bills.
This industry-wide shift has been happening for some time, but it seems to be speeding up as insurers look for ways to control runaway healthcare costs.
The poster child for this trend is UnitedHealth Group, the healthcare behemoth that houses insurance company UnitedHealthcare and Optum, a company that manages pharmacy benefits and provides care, under one roof. Optum generates about 45% of UnitedHealth’s total earnings from operations.
Optum includes 1,400 medical clinics and employs or partners with 50,000 doctors. It aims to add at least another 10,000 doctors to its roster in the next year, UnitedHealth CEO David Wichmann said in January.
Broussard told Insider that Optum is a more diverse business than Humana’s healthcare services division aims to be. Humana is focusing more narrowly on integrating clinical services to deliver holistic care to seniors.
Still, Broussard wants to grow the care-delivery side of Humana over the next decade. The insurer’s healthcare services segment collected $25.8 billion in revenue and $789 million in earnings in 2019, driven in large part by its pharmacy benefit management business. Humana’s total revenue that year was $64.9 billion and its net income was $2.7 billion.
He noted that when Humana acquires the rest of Kindred Healthcare’s home health business, Humana will employ as many clinicians as it does other workers. Kindred’s home health operation employs 50,000 clinicians.
The COVID-19 pandemic is accelerating the changes underway at Humana
Broussard said the coronavirus crisis has bolstered the case for offering care through multiple channels, whether in person in a patient’s home or virtually.
“There are many things that are done in the hospital that can be done in someone’s home,” he said. “I think the ability to serve the population in a broader way I think it was coming, but it just wasn’t coming fast enough, and the pandemic pushed that.”
The pandemic also highlighted the benefits of moving away from the traditional way of paying for care based on the volume of services provided, toward a model that pays doctors set amounts to keep patients healthy.
Doctors in such value-based arrangements continued to receive payments when patients stopped coming to the clinic for fear of contracting the coronavirus. Other healthcare providers saw their revenues plummet. Value-based clinics were also able to pivot quicker to telehealth and were more proactive about reaching out to patients, Broussard said.
As a result, Humana is pushing faster and faster into providing care in different settings. It’s also investing heavily in its technology, and launched a new internal Medicare company called Author, which will provide digitally-enabled health plans for seniors.
“I just feel that we’re at this cusp here,” Broussard said. “We still have a lot of development and organic build to do, but the energy level and the effort and the focus and the prioritization is much different.”

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A healthcare startup serving LGBTQIA+ patients just raised $25 million, and its growth reveals a key area of opportunity for other primary care startups

Summary List PlacementPrimary care, and healthcare more broadly, is largely one-size-fits-all in the US. 
A growing group of entrepreneurs and investors are trying to dismantle it and rebuild a more equitable healthcare system in its wake.
One such startup is Folx, a consumer healthcare startup for LGBTQIA+ patients, although there are tens more startups hoping to build trust among other long-neglected and underserved communities of patients. 
On Tuesday, Folx announced it raised $25 million in Series A funding from Bessemer Venture Partners, Polaris Partners, Define Ventures, and Red Antler. 
Although Folx is launching with direct-mail hormone replacement therapy treatments for transgender patients, founder and CEO A.G. Breitenstein told Business Insider of her long-term goals to unseat traditional care avenues for the LGBTQIA+ community, which is often discriminated against in traditional primary care settings. In the coming years, Breitenstein sees Folx drastically expanding the conditions it is able to treat through telemedicine in addition to expanding into owned-and-operated in-person clinics across the country.
“Discrimination is newly legal,” Breitenstein said of the Trump administration’s retraction of protections for transgender patients. “It allowed providers to discriminate against our community. Care has always been unstable for them, but we can be there for them and that’s what we’re here for.” 
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Startups like Folx want to reimagine the US healthcare system based on overcoming patients’ negative experiences, and that means building new models that don’t rely on the current network of doctors and clinics. 
“Our big takeaway is that other groups have underestimated the immense market size for advances in healthcare for distinct populations,” Bessemer Ventures Partners investor Morgan Cheatham told Business Insider. “We’re more bullish than ever that these niches aren’t so niche.”
That could contribute to a boon of highly specialized care startups, Cheatham said, in addition to those like his latest investment, Folx, that are already seeing growth among target populations. In fact, he said niche care could become the default for all primary care in the United States after the massive inequities were unearthed during the coronavirus pandemic.
Underserved patients need new healthcare solutions
Since 2014, highly targeted healthcare companies like Folx have collectively raised more than $1 billion, according to Pitchbook data.
The future of primary care could look like Cityblock Health, a $1 billion startup serving primarily low-income communities by addressing external factors like access to reliable transportation and clean drinking water as part of its holistic healthcare model. Its goal is to offset medical costs by addressing those factors, leading to better long-term health in the community. 
Until recently, investors didn’t consider these external factors, now commonly referred to as the “social determinants of health,” as a key area of cost reduction and innovation, one investor told Business Insider. It took a pandemic, and the cracks in the system it illuminated, to prove the environmental aspects of many Americans’ health. Now, it is an area of top investment for VCs going into 2021.
The future could also look like Oak Street Health, a more traditional primary care clinic model for elderly patients on Medicare, or ChenMed, for seniors with complex chronic conditions that need to be actively monitored by doctors. Oak Street went public in August, giving an air of legitimacy to the growing eldercare space.
Startups like One Medical have a broad-strokes approach to primary care but tend to focus primarily on city-dwelling young professionals with a subscription-based payment model and perks like cucumber water in waiting rooms. Village MD is another primary care startup with a broad appeal that works with physicians to provide care and has in-person clinics in select Walgreens locations. Those companies’ successes, however, have helped paved the way for tech-enabled challengers to grow while serving other groups that aren’t able to afford or access care through their networks.
Read more: Meet the 8 primary-care companies building a new future for medicine during the pandemic
Of more interest to Cheatham and other VCs are the communities that don’t yet have tailormade healthcare solutions. He pointed to communities like recent immigrants, undocumented individuals, low-income communities, and even racial or ethnic-specific groups as developments he is hoping for in primary care. 
“The One Medicals of the world focus on the upper end of that income spectrum, but there’s a lot of work to do on the other end,” Cheatham said, referring to the membership-based primary care model primarily targeted at healthy, working-age upper-middle-class patients.
Healthcare equity will have to come from outside
Getting patients to trust upstarts, a monumental task in healthcare broadly, still remains a challenge for the community-based care companies. Winning them over requires an entirely new perspective on medical care and clinic experience, Breitenstein said, even if that perspective comes from someone largely outside the existing system.
That approach involves lots of educational materials, Breitenstein said, so that patients know of and are able to adjust to complications from medications and make informed decisions about their own courses of treatment. 
That “informed consent” model differs from traditional symptom-based care in that it is more proactive and takes more stock of a patient’s lifestyle and goals, Breitenstein said, all in an effort to win patients’ trust.
“The paradigm shift around informed consent model of care, where you come to us and tell us what your goals are so we can help educate and guide you through the healthcare system, it’s informative and empowering,” Cheatham said, adding that he sees the model moving into other aspects of healthcare in the future.
Breitenstein has big ambitions for Folx and believes the market opportunity is large enough to support its growth. Beyond adding new capabilities like STI testing and mental health visits, she sees Folx expanding into in-person clinics across the country that could eventually include surgery centers for gender confirmation surgeries. She also has an eye on family planning and fertility, an already booming market with several startups serving heterosexual couples.SEE ALSO: SIGN UP HERE: Hear from healthcare’s biggest VCs on the future of digital health, biotech, and startups
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