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COVID-19 Updates with Andy Slavitt

ByHLTH & Andy Slavitt|April 15, 2020

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.

HLTH Team: I read the Scott Gottleib and team piece that they put out about achieving containment and the various phases for easing social distancing. In your opinion, what does phase one/phase two/phase three look like and how do we get there?

Andy Slavitt: So, there's no question that the social distancing and the hashtag #stayhome is working. It’s probably not working quite as well as it works in other countries, but it’s probably harder in a liberal democracy, and it’s harder because we were a little bit less prepared. You know it's going to be this phase one social distancing that’s going to do a few things. It's going to spare our hospitals and our hospital workers from an overload. And it's also going to give our scientists time to develop therapies and better testing protocols and allow us to catch up with things.

I think what was smart about Scott's piece was that it focused on not the timeframe but what the conditions on the ground have to be like in order to move forward. And, you know, I think you focus on the rights and the things so it's a good road map, which is to say we need the ability to test and track and trace, and be able to contain the outbreaks.

We need to be in a position to protect the most vulnerable people who will want to avoid getting it and we're going to have to adjust some of our habits and some of our patterns. So I think it was a fairly decent road map back. And well, you know, we'll have to figure out how that can happen regionally and how we can ramp testing into a much more kind of scalable form before we can do that. So there's a lot of work to be done, I don't think we're quite ready at the end of April, but I think, you know, it would be great if we can get there by the beginning of June. 

HLTH Team: Do you think by June we’ll have the ability to rapid test?

Andy Slavitt: We've been working a lot on that. We're making about a million tests a week. We need to at least get to three and half a million a week. And, and even then I think that doesn't make it ubiquitous. I think we can probably get to a million and a half a week in the next few weeks, then I think we start to run into different further supply chain issues that are the ones we're still facing, but we can optimize. How well we solve that problem is going to depend on how fast we get there. But we're not going to do it everywhere because we'll do it in places where we have this reasonably well under control. I think we could conceivably have tests to do it and I also just don't think the public is going to be able to wait much longer than that, so we're going to sort of have to do the best we can. The Southeast hasn't even begun to see the worst of it yet, that's going to really start hitting the Southeast really hard much in the way that it’s hit the Northeast.

HLTH Team: Do you think that the New York metro area will, when all is said and done, still far surpass other metro areas with their numbers? Or do you think there are other metro areas who didn't react fast enough and will be worse off than New York?

Andy Slavitt: I mean, New York's been a costly six days. New York and California we're kind of roughly on the same track. Governor Newsom in California acted about six days earlier. And that has pointed the curb, and it's proved to be an enormous difference. There's something that says cities like New York, take a city like Hong Kong, can't contain this but, but obviously if you don’t in a city of this size, you end up with what you have. 

So I think from an absolute numbers standpoint I don't think anything will approach New York thankfully. But from a relative standpoint, I think we're going to see a lot of tragedy in New Orleans and we’re already starting to see it in the black community. We're going to see that, I think Texas and Florida are very concerning, Georgia is very concerning.

So, you know, relative to those population sizes, I think we're going to see some really bad events but hopefully, you know, their political leaders and their infrastructure learn some of the lessons that they didn't learn at the beginning.

HLTH Team: With most of our team living in New York City, we watch the Cuomo daily briefings, and it seems like there's a lot of regional plans happening, and maybe not one cohesive plan across the whole country. So, with that, where do you think that the federal government has taken the right steps, where do you think they have not taken the right steps, and do you think there's a chance for them to get on the right path from here?

Andy Slavitt: You know I think their biggest issue has been that they've just been late. So, you know, when you start late, you know we’ve all been late with things before. And you work the weekend, you can catch up, you can stay up late nights, you can catch up. But when you're late with something that's growing exponentially, that's just not possible. It's like swimming after a speedboat that’s 15 feet away from you and by the time you get 15 feet the speedboat is 100 feet away from you. You're just not able to catch it. So the consequence of being late has been that the rest of the world was buying up masks and testing materials before we were even in the game.

We were just, you know, caught completely unprepared. And there was a little bit of denialism that was going on. I think that's changed. I think the problem now is more organization than it is of anything else. You know, the states and the hospitals have to be the people on the ground executing. But the federal government can really help by the role it plays. It can set one for example, one standard national price for a ventilator, instead of having the Governor's bidding each other on ventilators. It can coordinate the movement of ventilators and staff and resources from one location, one hot spot to the next. It can coordinate the public health workforce by having public health workers moved from one place to the next. So I think there are good people inside the administration. It's almost like they’re playing hero, like “hey we just got 3000 ventilators to a hospital, aren’t we great?” Or to the city or whatever, as opposed to, and you know, that is great. I mean you have to do that at the beginning, but you have to also put that on a sustainable path and we have that skill inside the government, it's in military operations, it’s not in the places that we're using it. And FEMA is used to responding to regional disasters. And they're very good at it. There’s a lot they can do. Same with the army corps.

So we just need more organizational leadership that I think we would get if we put military ops in more of a leadership role, more of a structure. And then, I think you know the federal government needs to just be more transparent. Biding not selected facts, not hopeful facts, not a different set of facts every day, but the same consistent pieces of data, good or bad for the public is the kind of leadership that's required. I think Cuomo has done a nice job of that in his briefings. I think some of the other governors certainly have as well.

So, you know, I’m not trying to sound critical because it's a hard thing. It's a hard problem. But that's where I think we could really use more leadership at the federal level.

HLTH Team: With many health policies, specifically around telemedicine, being changed or just relaxed during this time, and proving to be pretty successful, do you think that these changes will remain for good or will they revert back to how they were before the crisis?

Andy Slavitt: Well, I think the bigger issue is, we may not have primary care doctors and specialists, after this disaster if we don't do something about it. We have to do a lot more to keep those practices in business. We’ve seen 40 to 50% declines in patient flow and revenue and these particularly small practices, they don’t keep a lot of cash on hand. And a lot of the money that's been put forward is being put forward for hospitals. So that's going to be a real issue. Telemedicine helps both them and it helps patients. I think, you know, the opposition to telemedicine before is still going to be there, which is that if you're in Pennsylvania, you're licensed in Pennsylvania. If a doctor in another state can practice in your state, through telemedicine, it takes business away. So, telemedicine I think has good potential to stay. But the real liberalization that allows a lot of telemedicine to occur, because it can cross state borders, you know, I think there's still going to be opposition to that. I’m not saying it’s right, I’m just saying it doesn’t automatically go away.

HLTH Team: How about the transparency that I think we've all wanted in healthcare for a long time that is actually happening now? At least in New York, they're sharing resources across public and private systems and have one central database that they're working off of now, do you think these changes will remain after the crisis?

Andy Slavitt: For data and analytics, I think so. I mean, If you look at what happened after 2004 with Vioxx, you know, they created a sentinel capability to look for signals around people who were having heart conditions and taking Vioxx. And then they left that system in place called the sentinel system so that you could look for drug safety issues by looking at whole sets of data in the population. I do think public health will help us think about why these things matter. Interoperability, it sort of mattered to a lot of people and in ways that are too abstract to explain oftentimes. People can say well I'm worried about privacy or it costs money to do this or I want to keep my data, this way or that way. When you have a real scare like this it's an opportunity for people to see why we can build assets that can really help us.

HLTH Team: I just read the playbook that United States of Care put out for a rapid COVID response at a city-level. Can you share a little information on that and what you guys are hoping for there?

Andy Slavitt: First we wrote something for Congress which was the five priorities that Congress needs to take care of. And we've had a number of opportunities to talk to Congress about that. Secondly, we have put together for states, and we'll continue to put together for states, a set of what are the best practices and kind of rapid response center and resource center as people are trying to set up and move to the next stage and next wave. So I think United States of Care has focused a lot on how to help those best practices spread, how to capture the things that are really helping and how to make that kind of thing work.

HLTH Team: Do you think there will be multiple waves of the virus? And if there are multiple waves, will the next one be worse, better, just about the same as this?

Andy Slavitt: There will be multiple waves. I did a call several nights with scientists and homeland security folks, and others just kind of talking about things and one person said that there can be as many as 40 or 50 different waves. Which is kind of crazy to think about but, you know, a lot of this just depends on the sort of sociological issues about like how much you can open up, when, and so forth. I think I'm worried, along with many others that, you know, we started to see some good numbers flattening the curve. There's a lot of political pressure to open up, we do it before we have the kind of testing in place we need and then we still see second outbreaks.

You still get Singapore in the last few days, we're talking now in April, 8 or ninth or whenever we're talking, in Singapore which has been very successful, is now just seeing a dramatic increase because they have started to open up again. So there's no silver bullet, right, there's no happy place where we can say oh let's just open up and everything's great again. It will be a tough process. And you know, we'll have to find a middle zone that's comfortable.

HLTH Team: How do you think that health industry professionals, startups, and entrepreneurs can help right now? How is this changing the startup landscape in health?

Andy Slavitt: Look, figuring out how to care for people who are most vulnerable to COVID-19 is going to be like an enormous challenge and therefore opportunity. Whether that's social services, medical care, text based services or obviously telemedicine. But finding ways to take in, you know, an isolated population, social work, mental health. So, I think that there's a whole litany of things that are going to become an even more important part of what get done every day.

Secondly, mental and behavioral health and addiction are going to be really important areas. I just read a paper that someone just sent me on what happens with sustained exposure to trauma. And it's pretty clear cut that this is going to feel a lot like PTSD for a lot of our healthcare workforce, and maybe a lot of others.

And the levels of anxiety and with, normally if you have a crisis or some kind of a healthcare crisis, or a financial crisis (we have both), you have your friends and your support structure to rely on. Here, you have those two things, and you can’t see the people who help you get through all these things, so it's a really difficult period of time to manage. It's not like anything we've had to manage before. 

So, you know, my view, just startups, has always been the same. If you're solving a big important problem, you’re probably headed in the right direction. If you're focusing on a problem that was important yesterday or seemed important yesterday, but it's not important now, you have to ask yourself if it still makes sense to focus on that problem. And to me it's not a matter of “just waiting it out” it's a matter of saying, is what I'm doing going to be as valuable and be valuable again in the future and you have to be very very honest with yourself. Entrepreneurs are good at being in love with their own products, services and with our investors I think that there's going to be a different set of IDs then yeah and then I think there's always people who are starting businesses to exploit the opportunities. Those can succeed for a time, but they tend not to be long lasting in my view. I'm sure people will find opportunities to exploit here, but I don't think those are going to be the kinds of things that will make good lasting businesses that people should invest in.

HLTH Team: That’s a good point on mental health. I saw Patrick Kennedy tweeted an article by Ben Miller earlier today calling mental health “the epidemic within the pandemic” which was well put. Anything else that you think our audience needs to know right now?

Andy Slavitt: I mean, you know, there's this interesting phenomenon in healthcare where health insurers are getting fat and health care providers are getting really low on cash, for good reason. There's a huge decrease in demand for services and you know a lot of places that have stopped with any elective procedures. So, I think health insurers should really take it to heart what their obligation is in a time like that. It's not just to reward shareholders because of this, it's actually I think to sustain the care provider community in a way that will keep care coming for the long term. So, I would like to see health insurers, for example, advancing payment care providers and saying here's what we paid you the last six months, we're going to pay you this for the next six months, to keep you in practice, and then we're going to, you know, over time we're going to, if you continue to deliver high quality results to patients we’ll make that right but we'll keep you going. I worry instead we'll see people exploiting the situation buying up practices shuttering. And I think that becomes a forever restructuring of our healthcare system in ways that I don't think we want. 

HLTH Team: That's a good point. Where do you think pharma plays a role in this. I know, obviously people are wondering if there is treatment that gets approved or vaccine, what will the price be on those? Will they make it affordable to all? Will they donate it, in some cases, do you think we'll run into a pricing issue?

Andy Slavitt: Someone's going to have to pay to have the vaccine made available to everybody or the vaccine doesn't do any good. There's probably some help from the federal government. You know, likewise with therapies, pharma successfully got rid of any language in the first bill that would have done anything to make sure the price was affordable of a vaccine or trial so I don't think people will necessarily change their stripes, but we value the work of the scientists inside the pharma companies a great deal. We want that. We want them inventing, we want them helping.

What we don't want is them taking drugs that have been on the market forever and look like other drugs and just inflating those prices unnecessarily. So, I don't think anybody shouldn't have a problem with rewarding the companies that create great therapies and good vaccines. But I think what we should be doing is saying all the people that take insulin every day or our blood pressure medication every day and make sure that those prices remain affordable to people, or we're going to lose a lot of people that we shouldn’t

About Andy Slavitt:

During his decades-long career as a private sector healthcare technology leader, including as group executive VP for Optum, Andy Slavitt drove some of the most significant and successful initiatives in healthcare, impacting millions of Americans as well as the shape of the healthcare system.  He was the former Acting Administrator of the Centers for Medicare and Medicaid Services under President Obama. Prior to that he was the Group Executive Vice President of Optum, and before that a healthcare tech founder and entrepreneur. He currently serves as Board Chair of United States of Care, a Senior Advisor to the Bipartisan Policy Center and is a columnist for USA Today and JAMA and is a frequent commentator on MSNBC, CNN, Fox and CNBC. He attended University of Pennsylvania and Harvard Business School.