#CareTalk Podcast – March 2019: Gottlieb’s Out. What’s Next For FDA?

#CareTalk Podcast – March 2019: Gottlieb’s Out. What’s Next For FDA?


– John, I’ve been eating Special K all day and I’m still depressed. – Ketamine, not Special K . (upbeat jazzy music) – Welcome to #CareTalk, your monthly home for incisive debate about
healthcare business and policy. I’m David Williams, president
of Health Business Group. – And I’m John Driscoll,
the CEO of CareCentrix. – John, a sad thing happened, Dr. Scott Gottlieb is out at FDA. Are you sad to see him go? – Anyone who cares about
public health in America has gotta be sad to see Scott go. He picked the right priorities,
and he was effective at driving them through the bureaucracy. He shows the effectiveness and importance of great appointees. The thing I’m most worried about is the lack or loss of momentum around vaping and controlling cigarettes. I mean, Cigarette smoking is
still the greatest opportunity to prevent premature death in America, yet half a million people die every year. And this is something
that had been going down until the vaping industry showed up and, you know, 48% year-over-year increase in vaping among middle schoolers. A four-X increase of vaping
in high school students. This is something that Scott Gottlieb identified, led, took on, and restricting nicotine and cigarettes incredibly important and could save tens of millions of lives. I just really hope that
momentum keeps going and we actually get the
sensible regulation there. What’s your perspective on it? – I mean, I second what
you say about the vaping. Major crisis, FDA got right on top of it. It’s also worth noting that he’s pushed through a lot of
generic drug approvals even though maybe you thought as a big pharma person he
wouldn’t have done that. – Super effective there. – He’s also been effective at looking at the opioid crisis and
trying to do something there, focusing on drug pricing. So yeah he’s definitely
going to be missed, John. – So, Dave, just switching
topics for a moment, what is all this complaining about home healthcare costs going up? I actually think an investment in home healthcare makes sense. – John, I think you would
say that given your role, but let’s face it-
– Oh come on. – Home health expenditures
are expected to grow faster than any other category
of health expenditures from 2019 to 2020, 17, including
faster than drug increases. That’s why people are up in arms. Up in arms! – Calm yourself down. We use home healthcare to humanize care and create more care to the home. If it’s a replacement
for staff and hospital it’s gonna be both popular and necessary. My biggest concern is that
we aren’t spending enough in home healthcare, and yeah, I’m advocating something I believe in, but it’s also something
we know something about. We know that care to the home works. A recent study that matched
more hospital at home against actual admissions
showed lower costs, better outcomes, fewer
labs tests, fewer consults, and much happier patients
who got healthier faster. I think you’re gonna see a revolution. That cost item is an investment. Not all investments in
healthcare are bad, David. – John, here’s the problem–
– Calm down – I’m calm. I’m calm, but I’m not calm, okay? So what happens with home healthcare, is supposed to be great. It sounds like, wouldn’t
it be cheaper and better to be at home for a day.
– Yes. – Rather than in a hospital for a day? – Yes.
– So they say, “great, so we’ll have that as a benefit,” but then people are in the
hospital and in the home. I think you’re right,
you want to have home substitute for a hospital. Too often it’s just unmanaged
and people are just out there, taking advantage, gaming the
system, spending my tax dollar. – I think that there is a role
for entities like ourselves, and others, managed care companies, really well-run home healthcare agencies, to show the value because not every visit is a great visit, but,
as a practical matter, with the aging of America and the need to move
people out of institutions, we are gonna be investing
more in home healthcare. Deal with it. – So John, here’s a crazy
thing, insulin, okay? Pretty necessary for a Type one Diabetic. The prices are just spiking, even though there’s all this
attention about drug pricing. I mean, hasn’t insulin been around for like 100 years, or more? What the heck is happening? – I mean, it is the best
example of big pharma gaming the system, rigging it, really. Mean, just in May, President Trump came out and asked for drug
prices to be stopped or reduced. In July, Novo Nordisk increased
its price on insulin by 5%. This is a drug that was invented in Canada and given for $3, effectively for free. – Eh, Canadian?
– To the world, the early 20th century, and insulin prices just… Humalog, Lilly’s lead product has gone up from like $27 to $275 for exactly the same drug. There’s a lot of noise
around drug pricing. The reason drug prices go
up for standard compounds that have been around for 100 years is because big pharma can drive them up, and it’s just a crime. There was one Yale study recently that one out of every four
diabetics rations their insulin, which means they’re going off of insulin. For a complex diabetic to go off insulin only costs the rest of us a lot more money and it’s devastating for that
insulin-dependent diabetic. This has gotta stop. I mean, if you saw, in Mexico
they actually identified the fact that all of the
insulin manufacturers in Mexico were actually
raising prices in lock-step. This is effectively a cartel. – I was gonna say, El Chapo may have been in the wrong business, John. (laughs) – Well, this is– – Maybe they’ll rehab
him and bring him out. He can straighten, he can
bang some heads together – No, the Mexican justice
system is ahead of ours on this one, David.
– Okay. – So David, what are you hearing about all these ride-sharing, Uber and Lyft? Lyft’s actually talking about
healthcare in their IPO docs. What do you think about that? – So John, the thing that’s
crazy is that, you know, they’re talking about social
determinants of health, which is something I
thought only you talk about, and Lyft is talking about it, and somebody mentioned
that to me, and I’m like– – And more people should be talking about it.
– “I think you’re kidding. “You’re joking, why are
they talking about it?” The fact is, a lot of people
miss their medical appointments because of lack of transportation. – Millions.
– What they have out there besides ambulances, which people know, there’s this whole category called Non-Emergency Medical Transportation, pronounced NEMT, and
they’re not very good, and there’s a lot corruption,
and it’s really expensive. So you have the advantage of Lyft, and they actually have an
agreement with Allscripts to be able to order the HR. – We don’t need all of the details– – Fine!
– I was just asking– – Oh, you were just asking.
– How you feel about it. I feel fine about it. How do you feel about it? – No, I think what’s
exciting is new technology is starting to creep in to our kind of old sector of healthcare, and that’s gotta be a good thing because, you know, over
three million adults last year missed their
medical appointments because of transportations Transportation’s actually a big challenge. You’re right, there is a– – I heard it.
– A broad, you know, infrastructure to provide
for those services, but what’s interesting is that healthcare, managed care, doctors, and hospitals, are starting to actually
pay transportation providers to make sure those visits happen, because if those visits don’t happen often people who need to
get help don’t get it. I think it’s exciting,
but the bigger theme that’s intriguing is not
all the detailed stuff you’re talking about,
but that new technology is starting to emerge to rationalize and improve access to
critical care in our industry. I think it’s exciting. – Well John, I hesitate
to spell out any details, sometimes known as a fact,
but one of the things that’s nice about the Medicare Advantage– – You could try
– Okay. The supplemental benefits, one of them is actually covering this
kind of transportation. I think that’s a very good use– – What is supplemental benefits? Because I think helping people understand that might be helpful. – Well, Medicare now allows, under the Medicare
Advantage Managed Care plan, the ability to cover services that weren’t strictly medical in nature but that are supportive,
such as transportation. So it fits into that framework
on the reimbursement side as well as the technology side. – But aren’t you excited about these new technology companies?
– I’m excited, John. I am so excited.
– You were excited about the wrong thing earlier. – I know.
– I don’t know. – I may have misplaced excitement. – But the supplemental benefit is actually really interesting because what it allows
folks in Medicare Advantage and the privately managed
Medicare plans to do is to invest in all the non-clinical, removing all the non-clinical
barriers to care. Whether it’s food, or
transportation, or housing, it’s a super-exciting area,
and the more we can bring great technology an innovation
to that sector, the better. – Speaking of excitement, John, I peeked ahead at some of the
lightning round questions. I’m excited about that, you? – I am as well. (electronic signals whirring) So David, the FDA approved a new drug for depression, ketamine. – John, that’s a party
drug, you know, Special K . I think soon they’re gonna approve sniffing glue and smoking … Oh they approved that already.
– Stop. – I think it’s, whatever, it’s nuts. – Six and a half million
people suffer from depression. First new depression drug
approved in 30 years. It’s a good idea. (descending spacey synthesizer) – What did we learn from
Michael Cohen’s testimony, regarding healthcare?
(laughs) Well, we knew what we already knew, which is it does, often, pay to play in healthcare, at least for big pharma. A million dollars for
four or five conversations to understand the enigma of Trump? I think you would’ve done it for less. – Maybe, John. I think that Michael Cohen
is hoping that the Special K is available in the prison commissary. (descending spacey synthesizer) – David, Medicare has a new app. What’s the point? – I don’t know, because
I looked at it, John, and just said I wasn’t covered, and I thought you might ask me about that, so I’m glad I’m not covered. – I think it’s really good that Medicare’s finally bringing apps and making some element
of benefit determination and information accessible
at a finger-stroke. It’s a good idea. (descending spacey synthesizer) – Meow! Did you hear about the
$50,000 cat bite, John? – It was $48,000–
– Excuse me. – For an outpatient procedure
to get a rabies shot. Absurd.
(laughs) – It just shows the craziness of healthcare, hospital pricing. It says something that after the news of the $44,000 drug cost for a injection of anti-rabies vaccine that the price suddenly dropped
the next month to $9,000. – Yeah, but they didn’t
give her insurance company the money back on the previous one, and they said, “No, it wasn’t a mistake. “Thanks for checking with me.” I’m glad that she didn’t need a dose of insulin while she was there. – Oh gosh. (descending spacey synthesizer) – Well, that’s it for
this edition of #CareTalk. I’m David Williams, President
of Health Business Group. – And I’m John Dirscoll,
the CEO of CareCentrix. Thanks for joining us. (jazzy lounge music) Hey there, listeners, want more #CareTalk? There’s more to be had
in out other episodes, so be sure to look for those and subscribe to #CareTalk
on your favorite service. (jazzy lounge music)

4 thoughts on “#CareTalk Podcast – March 2019: Gottlieb’s Out. What’s Next For FDA?

Leave a Reply

Your email address will not be published. Required fields are marked *