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Monday, February 3, 2020

Haven has been quiet for the past 2 years — what does that mean for healthcare?

On Jan. 30, 2018, three dynamic companies partnered with the goal of revolutionizing healthcare delivery and lowering costs. Since then, we haven’t heard much from them about the venture.
Amazon, Berkshire Hathaway and JPMorgan Chase & Co., set out to improve employee satisfaction while decreasing the cost of care through a new venture, dubbed Haven. The three partners aimed to bring scale and expertise to their new venture, with a focus on technology solutions that would provide transparent healthcare at a “reasonable cost.”
“The ballooning costs of healthcare act as a hungry tapeworm on the American economy,” Berkshire Hathaway Chairman and CEO Warren Buffett said when the venture was launched. “Our group does not come to this problem with answers. But we also do not accept it as inevitable. Rather, we share the believe that putting our collective resources behind the country’s best talent can, in time, check the rise in health costs while currently enhancing patient satisfaction and outcomes.”
The announcement was made with much bravado but few details, which ignited speculation about how the three would work together. The emphasis on technology and transparency is intriguing, and given the 1.2 million lives covered by the companies, some speculated they would negotiate directly with healthcare providers to lower costs. Others wondered whether they would test new distribution models for prescription drugs through Amazon.
Amazon acquired PillPack shortly after the announcement, and last year also launched a telehealth service for employees. The company also continues to support data storage efforts through Amazon Web Services for hospitals and health systems, but during their most recent earnings call addressing revenue growth in 2019, CEO Jeff Bezos was silent about the company’s involvement in Haven.
In June 2018, Atul Gawande, MD, became the CEO of Haven and its headquarters officially followed Dr. Gawande to Boston. The partners also announced then that Haven would operate independently from the others as an entity “free from profit-making incentives and constraints.”
The last time Haven publicly issued a statement was last March, when its name was revealed, and website launched. At the time, the company said Dr. Gawande was meeting with employees across all three founding organizations to understand their healthcare experiences, and he was hiring experts from a variety of backgrounds. Since then, the company has seemed dormant to the public eye. What does that mean?
“Even such incredible minds and visionaries have been surprised at the true complexity and difficulties in bringing about change in healthcare,” said Randy Davis, CIO of CGH Medical Center in Sterling, Ill. “It’s 3-dimensional chess, and surprise, surprise, those in healthcare like it that way. They’ll nibble at their easy wins, but it won’t amount to huge dollars. CVS/Aetna is better positioned to really run at it than these folks. They have location going for them. The Panama Canal wasn’t a canal project; it was a railroad project to move dirt. When these ‘players’ figure out what the real project is, look out. I expect a major reference lab to be on their purchase list in the near future.”
It also takes time to really get a new venture off the ground, and mindfully execute change. Their silence could be a good sign, said Lee David Milligan, MD, senior vice president and CMIO of Asante Health System, based in Medford, Ore.
“In this case, their silence has earned my respect because it demonstrates that they are willing to accomplish the necessary due diligence before framing up their plan and executing. If they focus on their own employees and families, leverage technology only where it makes sense, eliminate the mind-boggling bureaucracy for patients and providers, and emphasize clinically proven health maintenance programs, they have a real shot at creating something special and sustainable.”
Theresa Hush, CEO of Roji Health Intelligence, isn’t surprised by the slow start either. However, she is intrigued by the venture’s focus on first dollar coverage and primary care access with an incentive for wellness and health maintenance.
“That is the opposite direction that market coverage and employers have been going,” she said. “It would not surprise me for Haven to begin partnerships with providers, or even to create its own health system as a logical next step. What that approach so far says is that they believe that healthcare has to go back to the basics before sophisticated disruptive tools to control costs and reform healthcare can be considered, and targeting their own large employee population creates the perfect experimentation platform for the venture.”
Haven’s 2018 debut also sparked a flurry of partnerships, acquisitions and acceleration of non-traditional entrants into the healthcare market. CIO of Memorial Healthcare System Jeffery Sturman expects more new entrants in the future, including retail companies, as healthcare remains ripe for disruption.
“Although Haven may be quiet for now, I wouldn’t underestimate the capabilities they and others can impart upon our healthcare industry,” he said. “I think this can create opportunities for us as we look to new forms of partnership and delivering care in different and more productive ways.”
https://www.beckershospitalreview.com/healthcare-information-technology/haven-has-been-quiet-for-the-past-2-years-what-does-that-mean-for-healthcare.html

New lobby to represent Fortune 500 firms paying prescription drug bills

Tired of being “the sucker at the table,” a group representing Fortune 500 companies has formed a lobby to push congressional drug-pricing policies that focus beyond Medicare, STAT reported.
EmployersRx is a joint project of the National Alliance of Healthcare Purchaser Coalitions, the Pacific Business Group on Health, the ERISA Industry Committee, and the Silicon Valley Employers Forum.
The group has described its goal as “to mobilize large employers to drive down prescription drug costs by advocating for public policies based on increased competition, transparency and value,” STAT said.
Roughly 61 percent of workers are covered by plans under which the employer pays for each employee’s healthcare. However, most of the policy ideas to lower drug costs have focused on changes to Medicare.
Michael Thompson, president of the National Alliance, told STAT that employers have “had enough of being the sucker at the table.”
“Someone needs to represent the sector that is actually paying most of the bill,” Bill Kramer, the executive director for national health policy at the Pacific Business Group on Health told STAT.
EmployersRx is hoping that its economic power of the business community can swing political dynamics in Washington, largely dominated by pharmaceutical industry players, such as the Pharmaceutical Research and Manufacturers of America.
https://www.beckershospitalreview.com/pharmacy/no-more-sucker-at-the-table-new-lobby-to-represent-fortune-500-firms-paying-prescription-drug-bills.html

Pandemic fears force Chinese biotech to postpone Hong Kong IPO meetings

At the same time the coronavirus outbreak originating from Wuhan is boosting shares prices of a raft of (mostly overseas) drugmakers, it appears to have also forced at least one domestic biotech to slow down its IPO plans in Hong Kong.
InnoCare Pharma — a Beijing-based company focused on cancer and autoimmune diseases with a lead drug now lined up at China’s regulator — has decided to postpone investor meetings intended to gauge demand for the HKEX listing, Bloomberg reported. According to anonymous insiders, InnoCare had planned to raise about $200 million.
Depending on whether and how quickly a pandemic ensues, this could mark the first of many IPO disruptions.
While the major ports between mainland China and Hong Kong remain open for the time being (a controversial arrangement in the supposedly semi-autonomous city), many of the institutional investors backing public debuts and the bookrunners they hire are in crisis mode.
Banks have started to ask employees coming back from mainland China to work from home for two weeks — roughly the incubation period for the 2019-nCoV — potentially making meetings with company execs difficult. Furthermore, travel restrictions have put face-to-face discussions on hold, with one European banker telling Bloomberg that he’s going to stay overseas for longer.
But a couple of pharma companies already listed, whether in Hong Kong or mainland China, offered some rare bright spots amid a catastrophic rout for China’s stock market once it reopened following the 10-day Lunar New Year holiday.
Ascletis, the first pre-revenue biotech to join the HKEX, enjoyed a 19% surge to HK$4.95 after it notified investors that it’s coordinating with medical institutions to launch clinical trials of its experimental combo of ASC09 and ritonavir. It continues an upward trend that began days ago when the biotech said it’s submitted an emergency use application to the National Medical Products Administration to use the therapy, originally designed for HIV, as a treatment for the 2019-nCoV infection.
Well-known players such as Shanghai Pharma, Harbin Pharmaceutical Group and Hansoh also scored single-digit gains, despite not ostensibly doing anything to combat the coronavirus.
It didn’t float all boats, though. Despite announcing that it’s set up a dedicated team to enable development of neutralizing antibodies to the virus, WuXi Biologics shares stayed somewhat flat at HKD$99.65.
In its filings from October InnoCare indicated that it would allocate much of the IPO proceeds to its lead drug, orelabrutinib, a BTK inhibitor that’s been accepted by the NMPA for review in relapsed or refractory chronic lymphoblastic leukemia and small lymphoblastic lymphoma. Two other clinical-stage assets target pan-FGFR and FGFR4, respectively, followed by six drug candidates execs want to bring into Phase I.
Pandemic fears force Chinese biotech to postpone Hong Kong IPO meetings — Bloomberg

Former Aetna CEO Mark Bertolini Says He Is Being Pushed Off CVS Board

Former Aetna Inc. Chief Executive Mark Bertolini said he is being pushed off the board of CVS Health Corp.
Mr. Bertolini, who joined the CVS board after the November 2018 closing of CVS’s nearly $70 billion deal to buy Aetna, told The Wall Street Journal he was willing to stay on the board, and he said the integration between the two companies isn’t complete.
CVS said Monday that Mr. Bertolini and two other directors won’t stand for reelection to the board. The company said Mr. Bertolini would depart “following the successful integration of the Aetna business.”
The company said it was reducing the number of board members following corporate governance best practices.
CVS Chairman David Dorman said in a statement announcing the changes that the board wished to thank Mr. Bertolini “for his contribution to the successful integration of Aetna.” He said the remaining board members had strong confidence in CVS’s leadership and direction.
Mr. Bertolini said, “I was willing to continue to serve on the board of directors in support of the most transformative effort in health care for our nation. However, the board thought otherwise.” He said the “integration is far from over.”
Asked about his relationship with current CVS Chief Executive Officer Larry Merlo, he said, “There’s always going to be a natural tension between the current CEO and the former CEO in any discussions regarding how you move the strategy forward. He’s the guy in the seat, I’m not.”
A spokesman for CVS said, “As Dave Dorman said, the integration has been a success and the board has the utmost confidence in the current management team and the progress the combined company has shown to date. We will of course have more to share on that front when we report earnings next week.”
After the departures, CVS said its board membership will shrink to 13 from 16. In addition to Mr. Bertolini, the company said that Richard Swift and Richard Bracken won’t stand for reelection to the board and will leave after the company’s annual meeting. The date of this year’s annual meeting hasn’t yet been announced, but the meeting was in May last year.
The company’s 2018 merger created an industry giant that brings together retail pharmacy, a pharmacy-benefit manager and the Aetna insurance business. CVS has said it expects the combination to improve health care and bring down costs
CVS shares fell sharply last year after a downbeat earnings projection in February. Investors pressed for more detail about the company’s growth plans, and CVS promised that it would return to profit growth this year. Shares rose as the company delivered stronger-than-expected results in subsequent quarters.
Matthew Borsch, an analyst with BMO Capital Markets, said investors’ mood around CVS is brighter.
Yet, he said, Mr. Bertolini’s unusual public statement, combined with the recent departure of the company’s president of pharmacy, might “raise questions about whether everything is going as well as management insists.”
CVS is in the process of opening around 1,500 health hub stores, which are designed to offer a broader range of services than its traditional drugstores, many aimed at people with chronic illnesses such as diabetes.
Yet CVS, like competitor Walgreens Boots Alliance Inc., faces pressure on margins in its retail pharmacy business. Also, investors have pushed down shares of insurers over political concerns, as Democratic presidential candidates advocate for a major revamp of the U.S. health-care system.
https://www.marketscreener.com/CVS-HEALTH-CORPORATION-12230/news/Former-Aetna-CEO-Mark-Bertolini-Says-He-Is-Being-Pushed-Off-CVS-Board-Update-29934116/

Quick retraction of a faulty coronavirus paper was a good moment for science

As fears of the novel coronavirus 2019-nCoV continued to spread last Friday, an inflammatory new paper appeared on bioRxiv, a preprint server, where scientists post work that hasn’t been vetted.
Titled “Uncanny similarity of unique inserts in the 2019-nCoV spike protein to HIV-1 gp120 and Gag,” the paper claimed to find similarities between the new coronavirus and HIV, the virus that causes AIDS. The use of the word “uncanny” in the title, together with “unlikely to be fortuitous” in the abstract, led some to think that the authors were suggesting the virus had somehow been engineered by humans.
The paper, from academic institutions in New Delhi, India, was critical and alarming, if true. Except that it wasn’t.
The paper was almost immediately withdrawn, but not before plenty of handwringing from researchers who complained that the appearance of such shoddy work on a preprint server without vetting by peer reviewers is precisely why the hoary old model of science publishing is better at keeping junk science out of the literature.
Except that’s not true, either. The old model has its advantages, to be sure, but it, too, is prone to the menace of pseudoscience, bad data, and other flaws — despite traditional academic journals’ army of peer reviewers. And when these publications publish bad or erroneous research, it can take months or years for the papers to be corrected or retracted — if they ever are.
In contrast, the reaction from the scientific community to the bioRxiv paper was swift. In a nutshell, commenters on bioRxiv and Twitter said, the author’s methods seemed rushed, and the findings were at most a coincidence. By Saturday morning, bioRxiv had placed a special warning on all papers about coronavirus. Later Saturday, the authors commented on their paper, saying they were withdrawing it. And on Sunday, a more formal retraction appeared: “This paper has been withdrawn by its authors. They intend to revise it in response to comments received from the research community on their technical approach and their interpretation of the results.”
All of that happened before a single news outlet with any reach covered the paper, as best we can tell. But none of it was quite fast enough for some critics. “This is why preprints can be bad,” said one scientist on Twitter. That scientist, Michael Shiloh, said he had even used bioRxiv to post preprints. “What bugs me about this preprint is that had this manuscript undergone legitimate peer review, these flaws would have led to a swift rejection and it wouldn’t be contributing to the conspiracy theories and fear surrounding this outbreak,” Shiloh continued.
History suggests that Shiloh’s confidence in peer review’s ability to suss out pseudoscience may be a bit misplaced. The fraudulent 1998 paper that set off the vaccine-autism scare was published in The Lancet, one of the world’s leading peer-reviewed medical journals. Other examples — including a paper by an intelligent design advocate questioning the validity of the second law of thermodynamics as it pertained to evolution — abound. Papers claiming a link between autism and vaccines pop up nearly every year.
And even when peer-reviewed journals do realize they’ve been had, retractions can take months or years. The Lancet took 12 years. Another journal took five years to retract a paper claiming that HIV did not cause AIDS. We could go on, and the list includes papers that have never even been corrected.
Those who claim preprint servers are dangerous because they lack peer review — bioRxiv has a perfunctory screening process — sometimes acknowledge that journals have had to speed up their game to meet the pressures of an outbreak like coronavirus, or SARS in the early part of this century. Angela Cochran, president of the Society for Scholarly Publishing, a trade group for publishers, said on Twitter: “Earlier this week, folks celebrated that coronavirus papers were popping up in preprint servers. Now there is a reminder not to use them to guide clinical practice because they haven’t been reviewed. Journals ARE reviewing coronavirus papers and getting [them] pub’d quickly.”
Kent Anderson, another publishing industry veteran, put it more bluntly: “Journals Win The Coronavirus Race.”
Publishers have been looking for ways to score points against — and shut down — preprints for at least half a century. Journals have speedily published a number of important papers on the new coronavirus already, no doubt. Publishing industry champions are often quick to say that speedy peer review does not mean sloppy peer review — even in cases that require massive corrections.
But those same champions are often unwilling — with some notable and welcome exceptions — to acknowledge how slow and ineffective correction in science can be. Doing so might, after all, make some people question the expensive subscription deals universities agree to with publishers, as well as the article processing charges that can run into the thousands of dollars for open access publications.
Peer review can add a valuable filter. But those who work in publishing seem to be so wedded to the existing process that they can’t admit its flaws — or that it might be a good idea to also embrace preprint servers that could upend their business models. Just like in politics, maybe it’s time to agree that the publishing process is a messy one, and stop using single episodes, free of context, to score points against one’s rivals.
Quick retraction of a faulty coronavirus paper was a good moment for science

One Medical parent 1Life Healthcare’s stock soars in early trades

Shares of 1Life Healthcare Inc. ONEM, +6.57% soared 38% in their trading debut Friday, after the company, which operates under the name One Medical, priced its initial public offering at the low end of its range. The primary-care provider sold 17.5 million shares priced at $14 to raise $245 million. Shares are trading on the Nasdaq under the ticker symbol “ONEM.” JP Morgan and Morgan Stanley were lead bookrunning managers.
https://www.marketwatch.com/story/one-medical-parent-1life-healthcares-stock-soars-38-in-early-trade-2020-01-31

Stifel Starts AdaptHealth (AHCO) at Buy

Stifel analyst Mathew Blackman initiates coverage on AdaptHealth (NASDAQ: AHCO) with a Buy rating and a price target of $17.00.
https://www.streetinsider.com/Analyst+Comments/Stifel+Starts+AdaptHealth+%28AHCO%29+at+Buy/16395014.html