Kaiser Permanente's CEO sent a member email this morning which suggests that - even w/ ample supply - KP will not be able to vaccinate all of its adult members until the Spring or Summer of 2022.

At this point, relying on big health systems looks like the definition of insanity. Image
To clarify, KP says it has 9.3M members in California, of whom 75-80% are prob over 16, given CA's population structure.

Administering ~200K doses/week means 70 - 75 weeks to fully vaccinate 7 - 7.5M patients. Not even close to fast enough, even if they hit that pace on Monday.
Another way to look at this:

KP has ~12.4M members nationwide, or ~3.8% of the U.S. population, and they are *planning* to administer ~200K doses per week.

Extrapolate, and KP is apparently shooting for roughly half of the daily goal @JoeBiden has established for the country.
FWIW, a @kpthrive spokesman separately told @CalMatters yesterday that they have the capacity to administer "up to 250,000 [doses] per week."

Still probably less than half the necessary pace.

calmatters.org/health/coronav…

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More from @dp_oneill

1 Feb
Whatever the other merits of this proposal, funneling another ~$30B to hospitals is the antithesis of "targeted relief."

A dozen hospital chains just presented at #JPM21, two weeks ago.

General theme: Financially speaking, hospitals are doing quite well. 1/n
We have, for example, Community Health Systems, which operates 89 hospitals in 16 states, many of them in smaller towns / metro areas.

Through the pandemic, CHS's EBITDA margin never even fell into single digits, and profitability actually *increased* in 2020. ImageImage
Meanwhile, Lifepoint Health (84 hospitals, 30 states) also saw profits increase in 2020, while its cash-to-debt ratio fell. Pretty solid year. Image
Read 13 tweets
7 Oct 20
I've been mulling @Clover_Health's (superficial) investor deck. While I see huge potential in MA & other value-oriented models, my TL;DR take is:

1- Nothing here clearly establishes Clover as a differentiated MA plan

2- The Direct Contracting pivot is *very* interesting 1/n
Caveat to all this is the startling lack of meat in the investor presentation. It is >100 pages, but most look something like this 👇, and cite only "internal company analysis."
We can start by unpacking that growth. As @chamath notes, Clover had 41K MA members at the end of 2019, and the investor deck projects 57K by end-2020. So, adding a net 16,000 MA members over the course of the year.

By contrast, @Humana added ~480,000 in the year to June 2020.
Read 16 tweets
15 Jul 20
I'm late to this, but the @OakStreetHealth S-1 is well worth a tour.

Lots of fascinating detail on the economics of capitated primary care, building a business that straddles fee-for-service & value-based care, and even some tidbits on #COVID19's (mild) financial impact. 1/n
Big picture:

- 85K patients as of March 2020, of which about two thirds are capitated and at-risk

- $556M in 2019 revenue

- Very rapid growth - revenue up 75% YoY in FY 2019 and 72% in the first quarter of 2020

- Lost ~$100M last year
Hard to avoid a comparison to @onemedical, which reports 5x the # of patients, but half the revenue, primarily because Oak's at-risk/HMO model runs most medical spend for 55K patients through its own P&L.

ONEM's patient growth is also much slower, up ~22% in 2019 vs. 75% for Oak
Read 17 tweets
2 Mar 20
The @Accolade S-1 made for an interesting weekend read.

Not just as #coronavirus distraction, but for the window into a health tech solution that *could* be more aligned with the fundamental cost problem for employers and patients with private coverage (ahem...prices).

1/n
Prior digital health IPOs have seen firms pitching employers on savings through lower utilization, either via chronic disease mgmt (@Livongo) or convenient services that might reduce ER visits (@Teladoc, perhaps @OneMedical).

But for employers, price is the problem, not volume.
Accolade, in short, is a fairly high-touch service (tech + lots of call center staff) to help employees navigate the M.C. Escher painting that is American health care (find an affordable etc).

That service could potentially save $$ by nudging employees toward lower-cost options.
Read 19 tweets
11 Feb 20
I've shared concerns about @onemedical and their commercial strategy before; new data illustrates the issue.

TL;DR:
- In SF, some ONEM visit prices run 350 - 400% of Medicare
- Employers should be cautious. Proactive primary care can cut costs, but this is not the way.

1/n
Two points for context:

1) Evidence suggests that high-performing PCPs can save $$, even in the commercial population.

E.g. @Mass_HPC, finds risk-adjusted cost deltas up to $1,500 PMPY across medical groups, via referral patterns (i.e. secondary care prices) and low-value care
2) As noted elsewhere, One Medical's strategy seems to rely heavily on price arbitrage - i.e. billing under the umbrella of a higher-priced health system - which would be to the clear detriment of employers who pay these claims.

More on that here:

Read 14 tweets
28 Jan 20
I'm inclined to share a few thoughts on this (rather nauseating) news, having worked at Practice Fusion for a couple of yrs, though not when this episode occurred.

As @chrissyfarr notes, PF has become a bit of a cautionary tale. Perhaps there are useful lessons in that tale. 1/n
As full disclosure, this is partly speculative. I was at the company in the 2013 - 2015 time frame, and did not work on the pharma/life sciences business at any point.

From what I can glean via purely public info, the opioid episode seems to have happened in late 2016 and 2017.
At the outset, PF's basic thesis was arguably similar to @flatironhealth or perhaps AmeriSource's IntrinsiQ.

I.e. that cloud-based EHRs could help transform a fragmented care delivery landscape into a connected clinical community, while generating useful data for research/RWE.
Read 18 tweets

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