September's 41,000 new healthcare jobs were 22% below the average 53,000 jobs the sector created over the past 12 months.
Healthcare added 41,000 jobs in September and represented more than 12% of the 336,000 jobs created in the overall economy for the month, according to the Bureau of Labor Statistics.
While the healthcare sector continues to be a powerhouse job creator, September's 41,000 new healthcare jobs were 22% below the average 53,000 jobs the sector created over the past 12 months, BLS says.
More than half (24,000) of the new jobs were created in ambulatory services, while hospitals and the residential and nursing care sector each accounted for 8,000 new jobs, BLS says.
September's 336,000 new jobs are 25% higher than the average monthly gain of 267,000 jobs over the past 12 months.
Despite the robust job growth in the overall economy, the unemployment rate remains unchanged at 3.8%, with 6.4 million people reporting as unemployed, unchanged from August. Big job gains were seen in leisure and hospitality (96,000), government (73,000), social assistance (25,000) and professional and technical services (29,000).
In September, average hourly earnings for all employees on private nonfarm payrolls rose by 7 cents, or 0.2%, to $33.88. Over the past 12 months, average hourly earnings have increased by 4.2%. The average hourly earnings of private-sector production and nonsupervisory employees rose by 6 cents, or 0.2%, to $29.06.
The September statistics published by BLS are preliminary and subject to revision. Revised July and August employment numbers recorded 119,000 new jobs.
Nationally, telehealth diagnoses continued to be led by mental health conditions, which held at nearly 69% of telehealth claims.
Telehealth use slipped 5.6% across the nation in July, falling from to 5.1% of all private insurance and Medicare Advantage claims, down from 5.4% of those claims in June, according to nonprofit FAIR Health’s monthly tracker.
The South saw the nation’s biggest decline in telehealth use, falling by 9.3% from June to July, according to the tracker, which does not include Medicaid and fee-for-service Medicare.
In July, FAIR tracked the cost of CPT®3 99443 (telephone medical discussion with physician, 21-30 minutes.) and found that the median charge nationally for a telehealth visit was $211.49, and the median allowed amount was $97.93.
Nationally, telehealth diagnoses continued to be led by mental health conditions, which flickered around 69% of telehealth claims. That trend was similar in every region of the country, although the Northeast saw a more pronounced drop from 76.6% of telehealth claims in June to 75.9% in July, while the South and West recorded slight increases.
Other top telehealth claims were filed for developmental disorders, joint/soft tissue diseases, and endocrine and metabolic disorders.
Other highlights:
In the Midwest in July, sleep disorders climbed from fifth to third place in the rankings of telehealth diagnoses (from 1.2% of claim lines in June to 1.3% in July).
Nationally, the percentage of asynchronous telehealth claim for hypertension increased from 13.2% in June to 14% in July. The percentage of claim lines in all areas for the number one asynchronous diagnosis—mental health conditions—remained relatively stable in July.
Increases in asynchronous telehealth claim lines for hypertension occurred in every region except the Northeast, where they decreased from 23.3% in June to 22.6% in July.
Hypertension ranked number one for asynchronous telehealth claims the Midwest, climbing from the number two ranking in June (18.7% of claim lines), to number one in July (26.5%).
Hypertension displaced mental health conditions in the Midwest, which dropped from first place with 36% of claim lines in June to second place with 20.6% in July.
Audio-only telehealth held steady nationally in urban areas (4.8%) and increased slightly in rural areas 4.6% in July.
Nationally and in the South, urban areas showed higher telehealth use than rural areas, while in the Midwest, West and Northeast, use was higher in rural areas than urban areas.
The collaboration could expand to 'the entire drug discovery continuum', the two companies say.
Novo Nordisk and Boston-based Valo Health, Inc. this week announced the launch of a collaboration that taps Valo's artificial intelligence-powered platform to develop new drugs treating cardiometabolic diseases.
Using a $60 million upfront and near-term milestone payment, the collaborative could generate as much as $2.7 billion for Valo across 11 programs, along with R&D funding, and potential royalty payments.
Novo Nordisk already licenses three preclinical drug discovery programs in cardiovascular diseases discovered and developed by Valo using its AI-powered Opal Computational Platform. The platform provides access to real-world patient data, AI-enabled small molecule discovery, and a human tissue modelling platform that accelerates development.
"Artificial Intelligence and machine learning hold the promise to positively impact drug discovery and development, in particular enabling our vision of leveraging human datasets early in the process, which should lead to a better understanding of target biology," says Marcus Schindler, chief scientific officer of Novo Nordisk.
"Valo brings a differentiated and powerful approach to using these technologies on real-world human data to generate new insights and translate them into potential therapeutics for the benefit of patients suffering from cardiometabolic conditions," he says.
The collaboration could expand to "the entire drug discovery continuum", the two companies say, with Novo Nordisk and Valo partnering to tap human genetic and longitudinal patient data in cardiovascular disease.
"Partnering with Novo Nordisk… creates a unique opportunity to continue to deploy our Opal Computational Platform at scale in the discovery and development of novel cardiometabolic therapeutics," says Valo CEO / Founder David Berry.
"We are excited to implement the full spectrum of our platform spanning from disease characterization through clinical development as we aim to deliver new therapeutics to benefit patients living with some of the most prevalent chronic diseases of our time."
The wholesale club's discount offering is designed for uninsured members and those with high-deductible plans.
Wholesaler Costco is partnering with primary care telehealth "superstore" Sesame to offer $29 virtual visits for uninsured club members and those with high-deductible plans, the two companies announced Monday.
The discounted virtual care provided by Sesame's primary care physicians and nurse practitioners will be available to Costco members across 50 states. The partnership will also offer in-person health check-ups with standard lab panels and virtual follow-up consultations for $72, and virtual mental health sessions for $79, and a 10% discount for in-person visits.
Sesame does not accept health insurance.
Describing itself as "America's only superstore for great doctors and specialists," New York City-based Sesame says it has created "a unique healthcare marketplace, connecting thousands of outpatient healthcare providers covering all 50 United States with American consumers seeking high quality, convenient medical care at half the price of what is typical."
"By bringing marketplace dynamics to consumer healthcare for the first time, Sesame has created an environment where providers actually compete to serve patients, regardless of the patient's insurance status," Sesame says. "The resulting competition lowers the price of care, drives complete price transparency, provides ready access to health providers, mostly within two hours."
The Sesame partnership is the latest foray into healthcare by Issaquah, WA-based Costco. In 2011, Costco partnered with Aetna to create a health insurance plan for its members. That partnership transition in 2022 to Custom Benefit Consultants and expanded to provide members and member businesses with a health insurance marketplace, often with discounted prices.
In 2021, Walmart, Inc. entered the telehealth space with the acquisition of MeMed, allowing the retail giant to offer tele-behavioral and primary care across the nation. Amazon also stepped up its telehealth game in February with its $3.9 billion acquisition of San Francisco-based One Medical. The deal gives Amazon access to One Medical's virtual care platform, and more than 200 brick-and-mortar care venues, which operate in about 26 markets, and includes over 800,000 members.
However, Costco and Sesame claim their partnership is unique because it "provides its members access to Sesame's marketplace of low-price healthcare services, virtually or in-person with a provider, all at an exclusive discount."
"With the option to bring healthcare into their home, Costco members will have access to care in a setting that's right for them and have the option to develop long-term doctor-patient relationships with a Sesame provider."
Physicians will review every response before they're sent to patients to ensure the 'human touch.'
Ochsner Health this month is launching a pilot program that uses artificial intelligence to send "simple messages" to patients through its MyOchsner app portal.
Under the program the AI drafts responses to routine patient queries, which will be reviewed and edited by physicians before they're forwarded to patients. The hope is that the AI will accelerate physician responses to patient queries while also reducing the time that physicians are spending each day in front of a screen responding to reams of email messages from patients, and allowing them more face time with patients.
The first phase of the pilot will include about 100 Ochsner clinicians across the sprawling health system's 46 hospitals and hundreds of care venues that will use Microsoft's Azure OpenAI Service linked with Epic's electronic health record software, testing simple messages unrelated to diagnoses or clinical judgments.
"Ochsner has long been a leader in using digital tools to improve the patient experience," Ochsner CMIO Louis Jeansonne, MD says. "Now we are looking at how technology can simplify workflows for our clinical staff, which should significantly reduce the hours they are spending away from patients."
In a media release describing the pilot, Ochsner clinicians stressed that no AI generated responses would be sent to patients without being reviewed by their providers to ensure
a "human touch." The tech is incorporated into clinical workflows with HIPAA-compliant encryption for privacy.
"The AI will generate a draft for the clinician to review and send. It's meant to help clinicians respond more quickly to patient messages, so patients can get answers to their questions sooner," Ochsner Chief Application Officer Amy Trainor says. "And it will reduce time our clinicians are spending on computers so that they can spend more time doing what they do best—direct patient care."
Once seen as a niche or novel component of care delivery, EHR messaging expanded rapidly during the coronavirus pandemic and it has grown to become a virtually ubiquitous tool for most providers. However, a growing number of physicians have complained that they're overwhelmed by email responses, often spending several hours each day to complete them.
A study in the Annals of Family Medicine found that primary care physicians were spending more than half of their workday, nearly 6 out of 12 hours, addressing EHR messages. More than four million medical advice requests were sent to physicians via the MyOchsner app in 2022.
Some health systems are confronting the growing use of electronic messaging by charging patients a small copay. Cleveland Clinic, for example, charges three billing rates for virtual queries based on the amount of time a physician needs to complete the task.
To facilitate the process, the Centers for Medicare & Medicaid Services in 2020 created three billing codes for e-visits.
Maryland-based Mindoula has a footprint in 23 states and the District of Columbia.
Community Health Systems, Inc. says it will partner with population health specialist Mindoula to integrate virtual mental health services at CHS's more than 700 primary care venues across 15 states.
Franklin, TN-based CHS says it will use Mindoula's Collaborative Care program to offer patients behavioral health assessments, map out care regimens, and schedule follow-up and additional virtual or in-person care, as needed.
"By integrating behavioral care with primary care, we can help our providers address the whole health of their patients," says CHS CMO Lynn Simon, MD. "Our partnership with Mindoula will help ensure mental health care is readily available for our patients. It will also help address the behavioral health provider shortage by enhancing virtual access to these critical services."
The Mindoula Messenger app provides HIPAA-compliant "clinically-validated patient assessments" and provides patients with messaging for medication reminders and other treatments, secure two-way video, phone and encrypted email. Those assessments provide "actionable intelligence" for primary care physicians monitoring their patients, Mindoula says.
The dearth of mental health clinicians across the United States has been well-documented, even as the need for mental healthcare access increases.
The U.S. Census Bureau said that about 30% of the U.S. population self-reported some level of depression or anxiety in 2021, at the height of the COVID-19 pandemic. The bureau estimated that 122 million Americans -- 37% of the population -- lived in 5,833 "mental health professional shortage areas", with a projected additional 6,398 mental health providers needed to fill the gaps.
According to the Centers for Disease Control & Prevention, more than 48,000 Americans committed suicide in 2021, making it the 11th leading cause of death in the nation, while 1.7 million Americans attempted suicide. In addition, the National Institutes of Health estimates that 3 million Americans are addicted to opioids or in recovery.
As states – and especially rural areas -- deal with this dearth of mental healthcare providers, CHS CEO Tim Hingtgen says virtual access behavioral health specialists is becoming more critical.
"A sustainable future for our healthcare systems relies on our ability to deploy innovative solutions that leverage both technology and human interactions to help patients access the clinical resources they need and that also support our clinicians in their practice of medicine," Hingtgen says.
Mindoula, based in Silver Spring, MD, has a footprint in 23 states and the District of Columbia.
The announcement comes just one week Walgreens CEO Rosalind Brewer's sudden departure.
Executives at Walgreens and clinical technology provider Pearl Health say the partnership they announced Tuesday will accelerate the drug retailer's expansion into value-based care.
John Driscoll, president, U.S. Healthcare, of parent Walgreens Boots Alliance says the partnership demonstrates that "Walgreens is committed to being the partner of choice for providers and health systems looking to transition quickly and effectively to value-based care."
"Our partnership with Pearl Health allows us to reach more communities faster and enable comprehensive, affordable care that improves long-term health outcomes and fosters healthier communities," Driscoll says.
New York City-based Pearl Health, launched in 2020, specializes in value-based care and compensation software and tech platforms for independent primary care physician groups. The partnership with Walgreens will leverage that expertise with the retailer's complementary services that include prescription drugs, medication adherence, immunizations, care gap closure, diagnostics, and patient discharge transitions.
"Our technology-powered value-based care model aligns seamlessly with the healthcare services Walgreens offers, particularly in the most vulnerable communities," Pearl Health CEO Michael Kopko says. "With a focus on proactive, coordinated care, we'll collaborate to deliver a better solution to providers and ultimately deliver high-quality services to patients, while managing their care efficiently. We're very excited about the implications of this partnership for patients in Medicare and beyond."
The partnership is the latest in a concerted push by Walgreens to expand its footprint in value-based care. The Deerfield, IL-based company in 2020 bought a minority stake in VillageMD, the primary care provider, and in 2021 paid $5.2 billion for a 63% majority stake in the primary care provider, which operates more than 680 locations across the U.S., including 200 next to the Walgreens drugstores.
In January, VillageMD finalized its $8.9 billion acquisition of primary and multi-specialist care provider Summit Health-CityMD that was backed by a $3.5 billion stake from Walgreens, and includes a minority stake with Evernorth, a Cigna Corp. subsidiary.
Walgreens has also bolstered its home-based care resources with investments in CareCentrix and specialty pharmacy company Shields Health Solutions.
The Pearl partnership announcement comes just one week Walgreens CEO Rosalind Brewer's sudden departure.
The key to getting doctors on board is to present them with the evidence, and then put it to a vote.
One of the biggest hurdles in supply chain is gaining physician support for clinical product procurement.
In this interview, Dan Hurry, president of Advantus Health Partners, the Cincinnati based supply chain mangement and group purchasing organization, says the key to getting doctors on board is to present them with the evidence, and then put it to a vote. Hurry spells out the process that he recommends in this, the first of a two-part interview with HealthLeaders. This transcript has been edited for clarity and brevity.
HL: How big of a factor is physician preference in supply chain?
Dan Hurry: From aqualityofcare, fromaneconomic, andfromanefficiencystandpoint,it'sprobably60%ofwhatyoushouldbetalkingaboutandworkingonatanygiventime. Theactivityisrevolvingaround the ORs, the cathlabs,becausethat’s the implantspace,whetherit'scardiac, whether orthopedic, thosearethepredominantspaceswheretheengagementbetweenaphysician and a manufacturingrep andyouroperationalleadersinterconnect.
Would hospitals always belookingforthelowestcost? No.They’re lookingfor what’s thebestoutcomeforthepatientathand. Nowwiththat,it'salwaysdebatableabout whatisthebetterproduct. So, weleanintoclinicalevidenceinallthosescenarios. Thecostofgoods, howmuchwe'rebuyingitforisonlyonepartoftheequation.
HL: Where is the potential for conflict?
DH: In manycases it may berelationshipsthatamanufacturer'srephaswithaphysician. WhatistheirroleintheOR or the cathlab, andhowdoesthatimpactchoice?That spaceisalwaysunderscrutiny with the potential for conflict, butthere'susually asuperficialpointthat'sbroughtforward, so weleanintomostoftheevidenceand thatallcomesfromthephysicians’ sideofthehouse.
We collectandorganizedataonthefront end, andwe puttogether a “factpack.” Using cardiacrhythmdevicesasanexample, we ask what thepatient looks like, howthephysiciansusethe devices, wheredotheyusethesedevices, whatdoesthatlooklikefromeitheraregionaloranationalmarketshareutilizationperspective, whatdo theoutcomeslooklike with anyparticulardevices, etc.
Thefactpack yields datathat allows somecomparablesbetweendifferentscenarios,differentcompanies,differentproducts,whateverthatlookslike.Onceyougetthathomeworkdone,it'stimetoengagethephysicians andseewhat thestate of the unionlookslike.
Typically, there will beaverybriefengagementwith the physicians onthefrontend,beforegatheringthedata,telling them we'regoing to reviewthis.Whenwe'vegotbigger,betteranddeeper data,we'llengageyou onadeeperlevel.
Thenwhenweengagethemonallthefacts,they'rescientists, theywanttoseethedatatheywanttoseewhatthislookslike,andwehavesomedialoguefromthere.Ultimately, we ask wheredowewanttogowiththeproductbasedonitsleadwiththatclinicalevidence?Thenwe'llask howdowenegotiatefor thebestqualityproducts.
HL: How important is volume in price negotiations?
DH: We’ll use the Costcomodelasanexample.Theyusuallydon'tputsub-qualityproductsontheirshelves.Theynegotiateforthebestqualitywithinacategoryorproductmixandmatchwhatdeservesshelfspace.Wedothatat thefrontend.Whataretheproductsthatdeservesomeshelfspace,where weagreethat thisisaqualityproductmadebyaqualitycompany with outstanding outcomes?Howdowenegotiate to comeupwiththeeconomicpackagetosupportcontinuoususe?
Oncethat's done, there is a perpetual review, withcontinuousimprovementexercisesconstantlyengagedwithcategorymanagementteams of cross-functionalplayers in quality,clinical, economicandoperations.
HL: To whatdegreeiscostpartoftheequation?
DH: Wedonotchaselow-costgoods.Wechasethebestqualitygoodsandthendrivethebesteconomicoutcomeforthosequalitygoods. Cost is always a factor, but it is a tertiary concern, behind outcomes and quality.
We contract with afewoutsidecompaniesthatarerunbyphysicianswho doindependentassessmentsofoutcomes, quality,theattributesassociatedwithanygivenproduct. We’ll ask if theseassessmentsalignwithourphysicians’ experience. Theymayormaynotagreewithan analysis andthat'swherewewanttogaintheir input.
HL: Who has the ultimate say in what product is purchased?
DH: We have a cross-function of folks, physicians, C-suiteexecutives, quality,economics, finance.Supplychainis runbyacertaingroupoffolks that gothroughthisprocess. There’s a vote andaproxyandwhat welandonandwhat'sapproved.It'snoindependentgroup inandofitself.
Once we'velandedon therightproduct or productmix,like anyotherconsumer,wenegotiatebasedonattributes,ourcommitmenttotheproducts, theoptimallogisticssolution,whatdo ourpaymenttermslooklike, everythingthatkindofsupportstheeconomicequationfortheproductsthatwe'veselected. There’s no rocketscienceout there.
The FDA is providing a one-year soft launch for the Drug Supply Chain Security Act mandates, effective November 27.
Pharmaceuticals suppliers, manufacturers and other stakeholders are being urged to use the looming "stabilization period" for the Drug Supply Chain Security Act (DSCSA) to reach compliance with federal interoperability regulations, and "not take your foot off the gas."
The Food and Drug Administration on August 30 said it would exercise enforcement discretion during the one-year period, effective Nov. 27, 2023, "to accommodate additional time that trading partners in the pharmaceutical supply chain may need" to validate DSCSA mandates.
At a Healthcare Distribution Alliance seminar in late August, stakeholders were cautioned that the stabilization period is not an opportunity to slack off on compliance.
"The point of the stabilization period isn't to take your foot off the gas," Gregg Gorniak, vice president of the Manufacturer Operations and Data Services and Secure Supply Chain Lead, Cencora, told attendees at the seminar, while urging them to prioritize meeting the interoperability requirements laid down in DCSCA.
"This whole thing is around the safety of the patient," Gorniak says. "We need to make sure we get it right."
That advice was seconded by FDA officials who attended the seminar.
"This [stabilization period] should not be viewed as justification to stop implementation," Leigh Verbois, FDA director of Drug Security, Integrity and Response, told the gathering. "We want this implementation to be done by 2024."
Connie T. Jung, FDA senior advisor for policy, told the gathering that the agency's actions is "only intending for the stabilization period to apply to [FDA's final guidance for Enhanced Drug Distribution Security Requirements Under Section] 582(g)(1)," and emphasized."
"This does not mean to stop anything," she says.
Stakeholder Concerns
The HDA and other drug supply chain stakeholders have raised concerns with the FDA about DSCSA's requirements and the "uneven state of industry readiness for November 2023, underscoring that the progress of implementation and the law's single compliance date for all trading partners could lead to supply chain disruptions and interruptions to patient care."
HDA CEO / President Chip Davis praised the FDA's decision to ease into the mandate, saying "the agency heard the concerns of distributors, manufacturers and pharmacists and provided guidance that will ultimately minimize the potential for disruptions in the short term."
The FDA says it will use the stabilization period to fine-tune DSCSA guidance, with a focus on wholesaler/3PL provider licensing. Additionally, the agency is planning to survey small dispensary readiness and hold additional public hearings.
Help for Independent Pharmacists
In particluar, independent pharmacies have raised concerns about the special compliance challenges facing smaller dispensaries.
"If you look at most of the larger chains, they're ready, or they [would have been ready] to flip this on in November, but not necessarily be getting data because their trading partners may not be ready to send data," Ilisa Bernstein, chief lobbyist for the American Pharmacists Association, told seminar attendees.
"But for the small dispensers, the independent pharmacies ... they were just not ready."
However, the ATA urges tighter privacy provisions for physicians.
TheAmerican Telemedicine Association and affiliate ATA Action are voicing support for the Centers for Medicare & Medicaid Services' proposed rule for the 2024 Physician Fee Schedule, which the advocates note extends into the new year the telehealth flexibilities put forward during the COVID-19 public health emergency.
"The proposed rule is, overall, positive for the telehealth community and patients, and looks beyond the now-expired COVID-19 public health emergency to continue the expansion of telehealth services, providing much needed clarity for physicians and other stakeholders across the country," Kyle Zebley, ATA senior vice president, public policy, and executive director, ATA Action says in an 11-page letter sent this week to CMS Administrator Chiquita Brooks-LaSure.
However, Zebley says the proposed rule raises privacy concerns for physicians.
"During the PHE, CMS did not require providers to list their home address when most care was provided virtually," he says. "We urge CMS to permanently allow providers to bill their practice address in order to maintain the confidentiality and security of the provider’s home address, especially for those providing mental health services. It is imperative that this flexibility not be allowed to expire at the end of 2023."
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