Jared Dashevsky, MD, MEng 💌
@jareddashevsky
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Physicians' go-to friend for staying ahead on digital health, policy & business | Writing 💌Healthcare Huddle newsletter
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AbbVie's Humira is the most financially successful drug of all time, with over $200B in revenue.
If it were its own company, Humira would be worth more than PayPal.
Introducing the biggest drug success story you've never heard of.
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I wrote in my 5th grade yearbook I wanted to be a doctor.
I embarked on a long and arduous journey to just get INTO medical school and then to get THROUGH medical school.
Now, I’m officially Jared Dashevsky, MD.
I’m so f*cking happy to be done with school (doesn’t mean I’ll
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Doctors' offices should be texting GenZ/Millenials to confirm appointments... no calling, please
It takes me 2 seconds to reply "YES" vs needing to listen to someone introduce themselves (automated or not) only to ask if I can confirm my appointment
Thoughts?
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Doctors are BANNED from owning hospitals.
We'd never ban NBA players from buying basketball teams.
Or lawyers from owning law firms.
But doctors can't own hospitals. Why?
The Affordable Care Act.
Here's how ACA banned physician-owned hospitals (POHs).
Part 1/2 ⬇️
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Startups selling whole-body imaging scans as a “cancer screening tool” are popping up
Whole-body scans for cancer detection in asymptomatic individuals are low-yield, leading to unnecessary physical, emotional, and financial harm...
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I can’t describe how badly I crave for some Epic-integrated AI model to summarize a patient’s entire chart for me and provide key details from recent admissions, office visits, labs, and imaging
Pre-charting time would be non existent!
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What's the easiest way to understand the U.S. healthcare system?
Follow the money.
Once you know where the money is flowing, you'll understand why things are the way that they are.
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Healthcare is evolving, and Direct Primary Care (DPC) is at the forefront of this transformation.
Imagine a world where primary care physicians say goodbye to insurance complexities.
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Digital health startups have raised millions, yet their solutions have seldom been clinically validated.
Rock Health evaluated the "clinical robustness" of digital health companies (sum of clinical trials+regulatory filings)
40% of companies studied scored 0.
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The next 10 yrs for 🧠mental health care will be akin to what the 🚗automobile industry saw in 100 yrs
What will mental health care look like in 10 years?
Here are my 3 predictions:
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Sure, these new GLP-1/GIP drugs are remarkable
But if insurers don’t add them to formularies and pts can’t afford them… how remarkable are they *really*?
I mean… we’re talking about novel meds that:
1. Decrease body weight
2. Reduce HA1c
3. Decrease fatty liver in NAFLD
4.
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Name a $300M company that offers little value
I'll start 👇
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📚5 must-read books to gain a basic understanding of U.S. healthcare
1. An American Sickness by
@RosenthalHealth
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I understand the largest health insurers are for-profit
but still, something doesn't sit well knowing their CEOs are making tens of millions of $ annually in addition to their cos making billions in profit
yet premiums are still absurdly unaffordable
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Who is building tech for physicians?
That is, who is building to make physicians’ day-to-day easier, allowing them to better care for themselves and patients?
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How can we unlock the power of AI in healthcare with ChatGPT?
Here are 9 revolutionary ways it could change the game... 🧵
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Wow, Blue Shield of California is DROPPING CVS Caremark as their PBM
Instead, Blue Shield will turn to low cost alternatives like Amazon Pharmacy and Cost Plus Drugs
Will we see more insurers follow? So long to the middleman?
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There must be a better way to streamline prerounding
I should be able to print my patient list which will show recent vitals, trending labs, most recent imaging done, and plan for the day
Or I should be able to see all this in an organized way on epic Haiku in SOAP format
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Quick update:
Officially tied the knot
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And if you haven’t been following my journey, subscribe to Healthcare Huddle:
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CVS, Walgreens, Amazon, and other retail giants are entering the $4.2 trillion healthcare industry, eyeing a share of the growing "value-based care" market.
Value-based care is projected to be worth over $1 trillion by 2027.
Guess what's a part of that?
Medicare Advantage.
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Happy 💌-day to my high school prom date
10 Valentine’s Days and 150+ healthcare huddle articles later…
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@StuartBlitz
Nice!
I broke down ChatGPTs healthcare use-cases in a recent article
Definitely a lot of barriers before widespread implementation!
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After my first 5 nights in the ED, I realized I truly didn’t understand the prevalence and impact of housing instability on health
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Amazon just launched RxPass to expand its pharmacy footprint.
Primer users can pay a $5/month OOP fee for unlimited access to their generic medications (as prescribed).
80 generic drugs for common conditions like hypertension, depression, and hair loss will be available.
...
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Amazon Web Services launched HealthScribe, an ambient clinical documentation service using generative AI.
It was only a matter of time before Amazon launched something like this.
HealthScribe will allow seamless voice-to-text transcribing that will generate encounter summaries
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You really don’t realize how f’ed the healthcare system is until you try coordinating care
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Is Uworld obsessed with Rhabdomyolysis or am I just on a weird question streak?
cc:
@joshmcgoo
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Me trying to figure out how this healthcare system works
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Clinical and nonclinical workflow startups will soon be the hottest investment opportunities for investors
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CVS Caremark is partnering with GoodRx to automatically apply drug discounts for folks with commercial insurance
GoodRx is already partnered with Express Scripts
The last one left to partner with is OptumRx.
GoodRx would then have partnered with the three PBMs who own 80% of
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Healthcare Huddle just crossed 20,000 subs!!!
Thankful for the Huddlers who've been sharing the newsletter and for the
@workweekinc
team supporting my content and growth over the past several months
Not part of the Huddle? Sign up below 👇
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If you're in medicine and you find yourself ignoring the ChatGPT4 news...
Please don't.
Yes, it's a bit scary; yes, it's advancing exponentially; yes, there are a lot of unknowns.
But you must embrace ChatGPT with curiosity.
It is the future stethoscope: a tool we'll have
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Epic and Microsoft are partnering to introduce GPT4 into Epic
But the tech won’t be there to aid in diagnosing—it’ll be there to improve workflow!
I truly believe GPT’s greatest potential is in streamlining the grossly inefficient clinical and non clinical workflows
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Hear me out...
Legislation that requires insurers to reimburse physicians for time spent dealing with prior authorization rejections
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Americans trying to find an in-network provider
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The business of healthcare is essential to understand if you’re a physician
But it’s seldom taught in medical school curricula
What are some innovative ways to teach the biz of healthcare to med students? Fun answers only.
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How can the gov't save $3.6B on generic drugs?
By partnering with
@mcuban
's
@costplusdrugs
Seriously. Check out the latest study👇
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Finished my last day of medical school today
When will it hit me?
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Even if physicians knew the bare basics about the biz of healthcare, it would be a game changer.
So, part of my mission is to inform MD/DOs on the biz of healthcare
And I have 18k folks who are joining me on that mission…
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You have one chance to *immediately* fix an aspect of U.S. healthcare
What do you choose to fix?
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I recapped the great work
@mcuban
and
@costplusdrugs
have achieved in just these past 6 months
The tenacity and focus of the company to provide extraordinarily cheap medications for Americans is truly remarkable.
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The weight management space is heating up!!
Weight Watchers will acquire Sequence, a chronic weight management telehealth startup
It was only a matter of time before Weight Watchers added GLP-1s to their clinical weight management pathways!
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Rising and young physicians are the most innovative breed of physicians healthcare has ever had
The next two decades of healthcare will be nothing short of exciting
Physician innovators with tangible patient care experience will rise and transform care delivery
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I wonder if other countries find it fascinating that the largest retailers in the U.S. are now delivering care.
-Amazon
-Walmart
-Walgreens
-CVS
-Dollar General
The corporatization of American healthcare is real.
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@EricTopol
we’ll inevitably end up in the UK’s position...
we seem to always be REACTIVE vs PROACTIVE, the former being waaaay too late
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If physicians aren't well taken care of, how can we expect patients to be well taken care of?
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Cigna will follow Cost Plus Drug's playbook, offering a cost-plus drug option
The trend: incumbent insurers and retailers are starting to launch new models to keep up with Cost Plus Drugs
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Digital health solutions skyrocketed during the pandemic.
Today, these companies claim improved outcomes and ROI without strong evidence.
Which leads me to ask, are digital health solutions ACTUALLY solutions?
There's some nuance to the answer, and an impending churn 🧵
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2,000 people opened and read this past Sunday's Healthcare Huddle newsletter, the most ever
to an outsider, this may not seem like a lot, but I count it as a major milestone in
@hchuddle
journey to building a healthcare media platform
celebrate the small wins 😊
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Apple is rumored to launch an AI-powered personal health coach next year.
The combination of this personal health coaching and their massive market share + vast user data... just wow.
This new service will further strengthen Apple's position in the digital health landscape.
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Who has the largest network of independent primary care?
@AledadeACO
-1,500 independent primary care practices and health centers (450 added in 2023)
-2 mil patients covered
-150+ VBC contracts across Medicare, MA, Medicaid, Medicaid, and commercial payers
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Startups offering weight loss solutions shouldn’t be conflated with startups offering obesity management solutions
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Friendly reminder:
Whole body imaging scans in *healthy* folks for “prevention” do more harm than good
No competent physician would ever prescribe WBI w/o clear indications (eg Li-Fraumeni syndrome)
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UnitedHealth Group made $8.1B in Q1 '23, nearly 20% more than Q1 '22...
FYI: UHG isn't making its lucrative profits from its commercial insurance lines
The money is coming from its PBM service (OptumRx) and tax-payer programs (Medicare, MA, Medicaid)
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What role does private equity play in healthcare?
PE is significantly transforming the healthcare landscape, bringing much-needed capital and innovation.
But there's a growing debate about their impact on the quality of patient care and ethical considerations.
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So EHRs transitioned from a billing/scheduling platform ➡️ clinical notetaking platform ➡️ essentially a social media feed where pts can now (or will be able to) see clinical notes as soon as they're signed
This includes radiology reports, biopsy reports, etc
I certainly see
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Why is the business of death so attractive? 👇
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Noom launches Noom Med and will start prescribing AOMs like Wegovy.
If you can't beat them, join them!
At this point, weight management cos need to (as medically indicated) offer GLP-1 agonists or they'll be left in the dust.
Those that excel, however, will be those offering
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Tomorrow two big things are happening:
1. I graduate from medical school
2. The public health emergency ends
One of the above will negatively impact the healthcare 😂😂😂
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Eli Lilly's weight loss drug tirzepatide will be the most successful drug to ever hit the market
Here's why 👇
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Doximity launched Doximity GPT
You hear that? Is that our admin time decreasing in the future?
Next step is integrating all of this into EHRs... but I just can't see it right now, especially for Epic which takes 15 seconds to process anything.
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Wearable technology will soon be as regularly used as putting on shoes before leaving the house.
While wearable tech has gained popularity over the decade (Fitbit, Apple Watch, Garmin), we're still in the "iPod mini" stage.
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Some BIG 💌 news.
I'm excited to share that after a mere year and a half,
@hchuddle
has been acquired by
@Workweekinc
.
Our goal? To make sure our healthcare community has a kick-ass work week. every. single. week.
Here are the deets 🧵👇
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Why do you think emergency departments are always so crowded?
I'll give you a little hint... it has nothing to do with the actual ED 👇
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79% lost Medicaid insurance because of procedural reasons
This is so utterly infuriating
CMS says that as of April 2023, 79% of people terminated from Medicaid coverage lost it for procedural reasons (i.e., paperwork problems, rather than being evaluated and determined ineligible)
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I lol'ed
@B_Madden4
Talking about Dollar General's business model:
"Sell sodas and cigs to your community of 500 people, then treat them for chronic conditions like high blood pressure and diabetes. Talk about a flywheel!"
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Dollar General enters the clinical retail space
The co is partnering with mobile health provider DocGo and piloting mobile clinics at 3 stores
The clinical retail space is heating up... some may say it's already boiling.
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nothing else matters except the people you love
this is what I wrote about in my weekly newsletter to the
@hchuddle
team 😊
the emotions as I proposed to my high school sweet heart👇
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Stubbing your toe is frustrating
but have you tried getting a patient’s records from another hospital that uses a different EHR?
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There’s no weight-management company that addresses the root-cause of obesity
That’s bc the root-cause is in the jurisdiction of public health (just like vaccine access, safe drinking water, seatbelts)
Idg why ppl discount startups offering GLP meds as obesity *therapy* by
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Patients should have easy access to communicate with physicians
But it shouldn't be free...
5 mins the physician spends to answer a patient's MyChart question is 5 mins they could've spent with another patient—physicians should be compensated appropriately...
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CVS will shut down its clinical trial business after a two-year run to focus on its "core business"
What are Walmart and Walgreens thinking, who both launched a clinical trials business last year?
Seeing CVS's clinical trials vertical go down after 2 years is quite ominous
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Here's what "modernizing healthcare" really means:
"catching healthcare up to what other industries have been doing for the past decades."
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Humana pulls out of commercial insurance to focus on Medicare Advantage
Who do they turn to for help?
@AledadeACO
@Humana
and Aledade just announced a 10-year partnership to provide value-based primary care for Humana's MA members.
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If you could change one small thing about US healthcare, what would it be?
For me, I'd want to make my care processes as streamlined as walking into an Apple store.
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By the end of the decade, 25% of acute-level care will be done in the patient's home
Thoughts?
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To solve the metabolic health crisis, start with addressing social factors. Easy access to:
-fresh foods
-education
-health and wellness programs
-PCPs.
Oh, and decrease the subscription price, given metabolic dysfunction disproportionately affects low-income
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my gf and I find ourselves in a dilemma
I got the Pfizer-BioNTech vaccine, she got the moderna vaccine 💉
should we still be friends or are we now rivals?
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AbbVie's Humira loses market exclusivity next week
A 20-year-long run of *ZERO* U.S. competition—the most successful drug ever
$200+ billion in revenue, consistently making up ~35% of AbbVie's revenue (if Humira were a solo company, its market cap would greater than PayPal's)
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Who am I missing from this?
Is anyone in the wrong place?
Any different categorization word other than "weight-loss"?
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Eli Lilly is now capping OOP insulin at $35/mo
CMS sets the standard, corporations follow
This is why sound health policy is critical to public health
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Friendly reminder that every system is perfectly designed to get the results it gets
Don't like the results?
Change the system.
But... the longer a system is in place, the harder it is to change.
Add trillions of dollars to the system, and it becomes seemingly impossible
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Looking to learn more about direct primary care
Who should I follow?
Which resources should I be reading?
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And it's a market that was exclusively cornered through AbbVie's patent tactics since 2003.
AbbVie’s patent fortress around Humira, extended their original expiration from 2016...to 2034.
This was key to their wild success. They filed +130 patents during the past 20 years.
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My last weekend before residency begins…
I woke up this morning to this text from my father-in-law (ICU doc):
“Enjoy this last weekend pre Residency. The value of weekends will never be the same.”
*gulp* 😟
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I only hope the pendulum will shift back to the independent physician
There’s nothing more fun than leveraging your creativity and knowledge to solve business and medical problems.
People forget that medicine used to be a calling for folks who were inherently entrepreneurial. There used to be much more of an opportunity to run a practice and be your own boss. Now it's all employees of a system.
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Quality of care should be prioritized over costs
The fixation on cutting costs allows care to appear "high value" when, in fact, the quality of care remains the same.
Thoughts?
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first person in NY is getting the coronavirus vaccine right now
I keep saying this, but science and medicine is f*cking COOL and EXCITING
(it’s also tough af, someone help me with EKGs)
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We need a program that automatically notifies outpatient providers when their patient is hospitalized
If the pt has an upcoming appointment w/in 1-2 weeks, then doc office should know their pt likely won’t show up
-Better coordination of care
-Decrease no shows
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Millions raised but no proof...
We *finally* have someone working to independently evaluate the cost and quality of digital health solutions:
The Peterson Center on Healthcare launched a new $50 million nonprofit initiative under the new Peterson Health Technology Institute.
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Continuous glucose monitors aren't solving—or preventing—the obesity epidemic
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