1/ Some more peeks at age-specific COVID symptom trends from FB/CMU surveys at state level.
Here's Massachusetts and Maine
The rates are VERY LOW- the Northeast is the only oasis of green in the country on COVIDExitStrategy.org
but is there a worrisome trend developing?
2/ Look at the y axis for these states- GA/SC/TN/KY
Unlike MA/ME, they are persistently over 0.8% CLI rate , and heading thew wrong direction, including among the older age group.
Rising deaths will follow.
3/ The y axis jumps again-
MS and LA are very high, especially in youngest age group, but also 55+
They are also among the highest in test positivity.
We need to quench the outbreak in these states. If governments won't, then schools, businesses, families have to act
4/ I'm also worried about Florida
Like Texas, trends came down from the July peak. But unlike Texas, there was a second August wave among the young, and now an increase among the older population
1/ When Walmart enters any business you can expect that they will leverage their massive scale to get better economics, create value for customers- and drive out local mom and pop competitors
Thats what many assumed would happen w primary care clinics
but it didn't
why not?
2/ The first thing I have to acknowledge is to rule out "execution"
They aren't perfect (their Athena and Epic EMR travails show that) but Walmart knows how to execute, and they won't scale something until they've figured out how to make it profitable.
They couldn't
3/ To their credit, they tried a lot of permutations over the past 10 years, and strictly as an operator, you have to give them respect that they could be a force
- Third party vendor
- Walmart Health clinics
-Oak St Health
- Own clinics + telehealth
You've read the headlines ("Medicare pay cuts partially averted") but to understand what led us here--and what's to come-- we need to go deeper
Also, some cool tangents on effective/ineffective financial incentives
2/ let's walk through the weeds of
"a temporary patch on an expiring pandemic patch for the unintended consequences of a good-will effort to fix pay imbalance between primary care & specialists, made worse by a failure to predict future inflation, w a sop to value-based pay"
3/ The "failure to predict medical inflation"
remember the annual "doc fix" scramble? it was because the "sustainable growth rate" was indexed to inflation, which was near zero for years. So Congress had to constantly step in to reverse its own past efforts to control costs. 😧
1/ Let's flip through the Physician Fee Schedule Final Rule just out, w shared savings focus
Here's a little trick to get past all the pesky comments (that people spent 1000's of hours developing and submitting), and right to the meat of the matter:
CTRL-F "we are finalizing"
2/ First up: we want to increase participation!
strong evidence for providing upfront capital, especially to rural, underserved, low income ACOs (see AIM)
Good idea to expand it 👍
Lots of comments about eligibility criteria, repayment, etc etc.
"finalized as proposed"
3/ We want to increase participation!
Let's allow folks to stay in one sided risk for longer, especially lower income (no hospital) ACOs