Highlighting Opportunities for Progress in a Changing Health Care Landscape

The COVID-19 pandemic has inarguably been a devastating ordeal both globally and in the United States—but some of the health care transformations that were forced by COVID-19 could continue to benefit patients and the health care system. This was a central theme of the first keynote presentation at the National Association of Managed Care Physicians (NAMCP) Spring Managed Care Forum 2023.

The presentation, delivered by Jacque Sokolov, MD, president and chairman at SSB Solutions, gave optimistic insight into the evolution and expansion of digital health and the way COVID-19 took the concept of a human mRNA vaccine and other immunologic therapies from fantasy to reality. Sokolov also discussed the state of the US health care economy and future directions in the wake of the worst of the pandemic.

To start, Sokolov gave context on the state of the health care market, with a key theme being tech company investments into health care.

“The major aggregators—the strategic aggregators—are doing their thing, even though the financial markets are shot,” he said. Despite a lack of IPOs going on, he added, “the bottom line is, the major financial piece of all this is literally being done by the strategic aggregators—and many of them are the large, non–health care players coming into health care.”

One example Sokolov noted is Amazon, which acquired One Medical, a membership-based, tech-integrated, consumer-focused primary care platform, for $3.9 billion in 2022. One Medical had acquired Iora Health in 2021 for $2.1 billion. The acquisition of One Medical by Amazon could allow for long-term integration plays, with Amazon’s massive footprint providing expansion opportunities for One Medical. Amazon Clinic, a virtual care service for nonurgent and chronic care needs, was launched in November 2022 and provides care plans, prescriptions through Amazon Pharmacy, and referrals, Sokolov noted.

Physician consolidation and the physician practice management industry is booming after, as Sokolov put it, “being dead in the water” at the end of the 1990s.

He brought up CVS, which acquired Oak Street Health for $10 million. “Walgreens owns 53% of this new physician company, $9 billion of it that came from Summit [Health]; Village MD is also part of it. But in aggregation, the entity that was created by pulling all these physician groups together is a $25 billion physician practice management company.” CVS is also investing in areas that optimize value-based care, Sokolov said.

Value-based care was a separate topic of discussion, with Sokolov noting that value-based care organizations are finally starting to scale and could potentially change the consumer experience going forward.

One key tenet of value-based care in terms of patient experience is keeping people out of the hospital. Considering the aim is to optimize patient care while reducing the cost of care, a reduction in costly hospitalizations is key to success on the financial front—and in theory, it means providers have been able to mitigate acute patient health incidents. The traditionally 2-dimensional clinically integrated network, he explained, has become more 3-dimensional, and digital platforms have been helpful in value-based care.

“Whether the sponsor is a physician group, whether it's a hospital, whether it’s a payer, or some combination of the above, the delivery system has increasingly moved outside the hospital, as we predicted it would. It just took a digital platform and a variety of incentives to make it work,” Sokolov said.

Physician consolidation under aggregators has only amplified the potential of value-based care, and more providers and payers are embracing the products and technology that may help foster positive results in value-based plans, he said. Payers are also getting to the point where they can return data to providers, which is crucial in value-based structures where cost and outcomes are both in focus.

Sokolov also spoke to ways that the COVID-19 pandemic opened doors in mRNA vaccination and therapies that were previously stuck shut. “This transformational mRNA and COVID-19 vaccine, and additional DNA products, are absolutely changing the way we look at things,” he said.

Although mRNA-based COVID vaccines have been available for animals, namely horses, for nearly 12 years now, the outlook was bleak when it came to funding the massive $20 billion endeavor it would take to create an mRNA vaccine that would be effective in humans.

“The entire scientific community said, as recently as 6 or 7 years ago, this was just not going to happen. This company bought all of its intellectual property back from anyone who had it because nobody thought it was worth anything,” Sokolov said.

The potential of mRNA is substantial, with an ongoing dog trial of a preventive mRNA cancer vaccine demonstrating promising results. So far in the Vaccination Against Canine Cancer Study, the dogs given an off-the-shelf vaccine to broadly prevent cancer have shown reduced cancer deaths, a lower incidence of late-stage tumors, and are living years longer than dogs given the placebo, Sokolov said. The findings are significant for the prospect of a human mRNA cancer vaccine, which Sokolov believes could happen in the foreseeable future.

He likened the current landscape of immunogenic therapies to that of biologics decades ago.

“Where we were with biologics 20 years ago, is where we are starting down the road with immunologics today,” Sokolov said. “And hopefully, we will make enough progress that these immunologics, in our time, will affect the way we treat cancer, coronary artery disease, multiple sclerosis, dementia—anything that has an immune signature can basically be treated with an immunologic of some type.”