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INSTITUTE OF MEDICINE OF CHICAGO

  • 16 Jan 2024 1:31 PM | Deborah Hodges (Administrator)

    Parents often bask in the glow of their children’s accomplishments, so if SARS-CoV-2 variants were like people, BA.2.86 would be busting its buttons right about now. [JAMA]

    BA.2.86’s spawn, JN.1, has become the dominant SARS-CoV-2 variant in the US, status its parent variant never achieved. Fortunately, although COVID-19 cases have surged, hospitalizations and deaths from the disease are still considerably lower than they were the same time a year earlier.

    When BA.2.86 joined the SARS-CoV-2 Omicron family last summer, it grabbed pandemic trackers’ attention because it was so different from its progenitor, BA.2. Compared with BA.2, BA.2.86’s spike protein carries more than 30 mutations, suggesting that it might spread more easily than its predecessors.

    But even armed with those new mutations, BA.2.86 failed to dominate the other subvariants. Through early January of this year, BA.2.86 never exceeded much more than a 3% share of circulating SARS-CoV-2 subvariants in the US, according to Nowcast estimates from the US Centers for Disease Control and Prevention (CDC).

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  • 15 Jan 2024 12:13 PM | Deborah Hodges (Administrator)

    Honoring Dr. Martin Luther King, Jr. - his dream, his life and his accomplishments. 

    Ten books to understand Dr. M.L. King Jr's. legacy today, visit this page. . 

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  • 12 Jan 2024 1:10 PM | Deborah Hodges (Administrator)

    The Food and Drug Administration's green light for the state of Florida to begin importing prescription drugs from Canada surfaced as a talking point for state governor and presidential hopeful Ron DeSantis in Wednesday night's two-person GOP debate ahead of the Iowa caucuses. [US News - Healthy Communities]

    European countries dominate this list of nations seen by survey respondents as having well-developed public health systems.

    The long-awaited federal approval followed a lawsuit to speed up the process and already had been touted by DeSantis as a triumph over “the federal bureaucracy of 2 presidential administrations,” though both President Joe Biden and former President Donald Trump had hands in creating the pathway that led to it. Regardless, it's a sentiment that fits nicely with the governor's depiction of Florida as “a refuge for freedom” and the "envy of the nation."

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  • 11 Jan 2024 2:42 PM | Deborah Hodges (Administrator)

    A nation’s public health infrastructure serves as a pillar for the welfare and security of its population. From responding to infectious diseases and monitoring environmental health threats to addressing chronic illness and promoting general wellness, the public health system can be an important indicator of the well-being and quality of life within a nation. [US News] 

    Having a well-developed public health system is one of nine attributes used to develop a quality of life subranking that factors into the 2023 Best Countries rankings from U.S. News. The overall Best Countries analysis is based on a survey of more than 17,000 global citizens, and assessed perceptions of 87 countries using 73 different attributes. Survey respondents answered whether they associated various countries with the phrase "well-developed public health system,” and such perceptions also helped develop rankings of the best countries for a comfortable retirement and the best countries for raising kids.

    Countries perceived by respondents as having comprehensive public health systems tend to have attributes in common such as universal health care, longer life expectancy and substantial social spending.

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  • 10 Jan 2024 5:15 PM | Deborah Hodges (Administrator)

    Last fall, children in China were coming down with respiratory illnesses earlier and in greater numbers than usual. [JAMA]

    Ditto for respiratory syncytial virus (RSV) infections in the US and elsewhere in 2021 and 2022. And the current winter season doesn’t appear to be much different as far as higher-than-usual case numbers, according to CDC surveillance data.

    The surging case numbers and their out-of-whack timing have fueled an ongoing debate about how the COVID-19 pandemic contributed to rates of other infectious diseases. No one yet knows for sure.

    “Right now, this is phenomenology,” Wolfgang Leitner, PhD, chief of the Innate Immunity Section at the National Institute of Allergy and Infectious Diseases, told JAMA in an interview. “People are assuming a lot about the mechanism.”

    Much of the discussion has centered around immunity debt and immunity theft, terms born of the pandemic and not found in textbooks.

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  • 9 Jan 2024 5:29 PM | Deborah Hodges (Administrator)

    Do lockdowns work? Are masks effective? Did schools make the right decisions? {MedPage]

    During the COVID-19 crisis, these questions were urgent and pervasive. Yet, clear answers were often elusive, hindered by data gaps and inefficient information exchange. 

    Do lockdowns work? Are masks effective? Did schools make the right decisions?

    During the COVID-19 crisis, these questions were urgent and pervasive. Yet, clear answers were often elusive, hindered by data gaps and inefficient information exchange. As we move toward a post-COVID future, we must ask ourselves: Is our healthcare data infrastructure prepared for the next health crisis? Our researchopens in a new tab or window indicates that it is alarmingly unprepared.

    Two major issues became apparent early in the pandemic. First, the lack of data interoperability and effective analysis impeded the delivery of real-time insights to those making critical decisions. Second, the slow exchange of patient data severely limited treatment efforts. In a situation where a rapid response was essential, accessing comprehensive electronic records from different providers was crucial.

    This significant data gap was recognized at the highest levels of government. In 2021, President Biden prioritizedopens in a new tab or window enhanced public health reporting and data sharing. The National Academy of Medicine also highlighted this issueopens in a new tab or window, calling attention to the healthcare sector's disjointed data management. These statements underscored the urgent need for a more streamlined and efficient approach to healthcare data. 

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  • 8 Jan 2024 2:40 PM | Deborah Hodges (Administrator)

    Vaccination is one of the most highly effective public health interventions, responsible for saving millions of lives each year. In the US, authorized or approved preventive vaccines must be manufactured with high quality, and the effectiveness and favorable safety profile of vaccines must be demonstrated. Their safety over time is also closely and continuously monitored through multiple overlapping passive and active safety surveillance systems, including the Vaccine Adverse Event Reporting System, the Vaccine Safety Datalink, and the BEST Sentinel Initiative.1    [JAMA]

    Despite the care taken in the development and deployment of vaccines and their clear and compelling benefit of saving individual lives and improving population health outcomes, an increasing number of people in the US are now declining vaccination for a variety of reasons, ranging from safety concerns to religious beliefs. Setting aside for now the controversial issue of vaccine mandates at the federal, state, or local level in the US, which are not within the purview of the Food and Drug Administration (FDA), the situation has now deteriorated to the point that population immunity against some vaccine-preventable infectious diseases is at risk, and thousands of excess deaths are likely to occur this season due to illnesses amenable to prevention or reduction in severity of illness with vaccines.

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  • 5 Jan 2024 3:42 PM | Deborah Hodges (Administrator)

    The year begins with a number of challenges that have only intensified for U.S. healthcare providers.  

    Below are a dozen trends and issues that commanded our attention throughout 2023 and hold our curiosity in the year ahead. These patterns and shifts directly or indirectly influence how healthcare providers fare in 2024, and ultimately affect how Americans access, afford and receive care. [Becker's Hospital Review]

    1. Healthcare has a worsening numbers problem. The estimated 30,000 physicians who join the U.S. workforce will not be enough to meet the growing demand for care and number of doctors retiring, reducing clinical hours, or planning to exit the field each year. Keep in mind that an estimated 71,309 physicians left the workforce from 2021 through 2022 alone. These supply disruptions unfold as the nation as a whole continues to grow and age, intensifying demand for physicians even amid a growing pipeline of advanced practice providers. It's a fairly finite pool of doctors, APPs, nurses and all types therapists and techs to take care of a larger and older population. All in all, the U.S. faces an estimated shortage of between 37,800 and 124,000 primary care and specialist physicians by 2034.

    2. The payers have become massive. The largest payers are 10x the size of the largest health systems. The negotiating imbalance continues to grow in favor of the payers. One 2023 analysis found the market-leading insurer in the least competitive insurance markets pays 15 percent less to hospitals than the market-leading insurer in the most competitive markets, for example. Negotiated rates are just one part of the problem hospitals face amid growing payer power, along with denials and reimbursement policies that make a growing portion of payment slow, costly and inconsistent. At the same time, payers are finding the world more difficult in terms of profitability than they were. The most advantageous payers are a mix of payers and providers.

    3. The largest employer of physicians is one of the world's largest insurers. UnitedHealthCare with Optum has become the largest employer of doctors in the country. Optum added nearly 20,000 physicians in 2023, meaning it now has nearly 90,000 employed or affiliated physicians and another 40,000 advanced practice clinicians. Everyone else in the disruptor space is playing catch up and facing the same supply problems as legacy providers. There are not enough doctors and providers for each of the disruptors to be successful in providing and staffing clinics on a national level.

    4. Governmental healthcare payers, between Medicare and Medicaid, are now combined to be larger than commercial payer sources. This reliance on government-funded programs presents immediate business concerns for hospitals and health systems given that Medicaid fee-for-service payments for physician services are nearly 30% below Medicare payments, which are well below commercial rates. In the year of a presidential election, Medicare has long been seen as the third rail of politics due to the voting power of those 65 and up. Medicaid can now fall in that same category, given that it has even more enrollees than Medicare. 

    5. Technology is part of a solution, but not the entire solution. Artificial intelligence, automation, EHR optimization, virtual care programs and remote patient monitoring are increasingly important in helping to close some of the care gaps in our country and in making administrative efforts and clinician efforts a little less burdensome. But technology solutions without more doctor and provider solutions will not solve the problem of supply and demand.

    6. The movement to value-based care is still very much a work in process. In the fee-for-service reimbursement model, you see some challenges of overuse. Many value-based care models bring in the opposite: increased use of pre-authorization and efforts to avoid providing care. The right solution, as in most cases, is somewhere in between.

    7. Medicare Advantage now covers more than half of the Medicare population. Until recently, this has been a huge boon for payers and largely a debacle for providers. Medicare Advantage is one example of the power of political lobbying. Big payers have a lot of influence here, even as CMS overpaid Medicare Advantage organizations an estimated $16.6 billion in fiscal year 2023. 

    8. Mental and behavioral health in the U.S. has reached a critical stage with a worsening imbalance of needs and demands versus supply. It is estimated that 1 in 5 Americans already lived with a mental illness before the COVID-19 pandemic, which only exacerbated demand for this type of healthcare. Rates of depression among adults hit a high in 2023, suicides hit an all-time high in 2022, and emergency department visits for children's mental health conditions have surged over the past several years. At the same time, nearly half of the U.S. population resides in a mental health workforce shortage area. As it stands, the U.S. faces a shortage of 14,280 to 31,109 psychiatrists, and psychologists and social workers by 2050.

    9. Washington, D.C., tends to make noise about the impact of private equity in healthcare. Lawmakers are currently pursuing scrutiny of private equity's involvement in healthcare, but the issue risks serving as a political red herring for an unproductive Congress. Nine percent of private hospitals and 30% of proprietary for-profit hospitals (which make up 36% of all U.S. hospitals) are private equity-owned hospitals. Pricing, competition and quality of care linked to private equity-backed organizations warrant scrutiny, but lawmakers' attention is also needed toward many additional pressing healthcare issues affecting larger pieces of the industry's pie. 

    10. Aging well/preventive health is seeing a growth in interest. Both aging well and preventive health are difficult to institutionalize but are super important and generally underutilized. In 2020, it was estimated that only 8% of Americans undergo routine preventive screenings. Missed prevention opportunities go toward an estimated  30 cents on every healthcare dollar. 

    11. The diabetes/obesity drugs can have a large positive long term impact on healthcare. The year begins with steady interest on the long-term effects of GLP-1 agonist drugs, for which demand is high — 9 million prescriptions issued the final months of 2022 alone — and poised to increase. This raises questions for insurers, employers and the government related to spending and questions for healthcare providers' services and surgeries if weight is lost at scale.

    12. Hospital margins largely improved in 2023, but hospitals face huge long-term financial challenges. The median hospital operating margin rose to 2% in November, with margins varying among institutions and markets. Greater labor and supply expenses and patient acuity will continue to challenge hospitals in the year ahead, and certain types of hospitals face outsized risks. Hundreds of rural hospitals, for one, are at immediate risk of closure because of the severity of their financial problems.

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  • 4 Jan 2024 2:27 PM | Deborah Hodges (Administrator)

    Gov. J.B. Pritzker on Wednesday named Heidi Mueller — a child welfare and juvenile justice expert — as head of the state’s embattled Department of Children and Family Services. [Chicago Sun-Times]

    Mueller, who has served as director of the Illinois Department of Juvenile Justice since 2016, was selected after a national search. She will take the reins of the scandal-plagued agency beginning February 1, according to the governor’s office.

    Mueller will become the agency’s 13th director, either acting or interim, in 14 years. Since 1964, DCFS has had 29 directors.

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  • 3 Jan 2024 2:53 PM | Deborah Hodges (Administrator)

    The demand for mental health has increased significantly in the 2020s.

    Mental healthcare utilization grew 38.8 percent between 2019 and 2022 and spending on mental health jumped 53.7 percent in the same timeframe. The coronavirus pandemic was a key driver of these trends. It was disruptive and destructive to well-being, but it also opened many Americans’ eyes to their desperate need for mental health support. [Healthcare Executive Intelligence]

    As a result, in 2022 telemental health utilization had stabilized at around 1,068 percent of what it was pre-pandemic.

    In today’s episode of Industry Perspectives, Georgia Gaveras, DO, co-founder and chief medical officer at Talkiatry, discusses these trends and the state of telemental healthcare.

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