Top health industry issues of 2020: Endnotes

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A looming tsunami of high prices

[i] PwC Health Research Institute, Beyond the Hype: Gene Therapies Require Advanced Capabilities to Succeed after Approval, October 2019, accessed October 13, 2019.

[ii] Ibid.

[iii] Adam Feuerstein, “Novartis’ Zolgensma Gene Therapy Study Halted by FDA on Animal Safety Concerns,” STAT, October 30, 2019, accessed November 11, 2019.

[iv] Massachusetts Institute of Technology New Drug Development Paradigms Initiative, “Projections from the Existing Pipeline of Cell and Gene Therapies: Launches and Patient Numbers,” research brief, October 29, 2018.

[v] Food and Drug Administration, “Statement from FDA Commissioner Scott Gottlieb, M.D. and Peter Marks, M.D., Ph.D., Director of the Center for Biologics Evaluation and Research on New Policies to Advance Development of Safe and Effective Cell and Gene Therapies,” January 15, 2019.

[vi] Shelby Livingston, “Cigna Aims to Expand Affordable Access to Gene Therapies,” Modern Healthcare, September 6, 2019, accessed October 13, 2019.

[vii] PwC Health Research Institute interview with Niall Brennan, president and executive director, Health Care Cost Institute, February 12, 2018.

[viii] Kaiser Family Foundation, “Benchmark Employer Survey Finds Average Family Premiums Now Top $20,000,” September 25, 2019, accessed Oct. 13, 2019.

[ix] PwC Health Research Institute, Medical Cost Trend: Behind the Numbers 2020, June 2019, accessed October 13, 2019.

[x] Chapin White and Christopher Whaley, Prices Paid to Hospitals by Private Health Plans Are High Relative to Medicare and Vary Widely, Rand Corp., 2019, accessed October 14, 2019.

[xi] Ibid.

[xii] Kevin Uhrmacher, Kevin Schaul, Paulina Firozi, and Jeff Stein, “Where 2020 Democrats Stand on Medicare-for-all,” Washington Post, September 20, 2019, accessed October 13, 2019.

[xiii] Alexander Gaffney, “House Drug Pricing Bill Calls for Mandatory Negotiation,” PwC Health Research Institute, September 20, 2019, accessed Oct. 13, 2019.

[xiv] Sarah Kliff, “I Read 1,182 Emergency Room Bills This Year. Here’s What I Learned,” Vox, December 18, 2018, accessed October 13, 2019.

[xv] Ben Comer, “Six Drug Pricing Models Have Emerged to Improve Product Access and Affordability,” PwC Health Research Institute, September 23, 2019, accessed October 13, 2019.

[xvi] Cigna Corp., “Cigna Health Services Business Pioneers an Innovative Solution to Affordably Bring Life-Changing Therapies to Patients,” news release, September 5, 2019, accessed October 13, 2019.

[xvii] United Healthcare, “Outpatient Surgical Procedures – Site of Service Utilization Review Guideline,” accessed October 17, 2019 ; Shelby Livingston, “UnitedHealthcare Outpatient Surgery Policy Threatens Hospital Revenue,” Modern Healthcare, October 17, 2019, accessed October 17, 2019.

[xviii] Motley Fool, “Unitedhealth Group Inc (UNH) Q3 2019 Earnings Call Transcript,” October 15, 2019, accessed October 17, 2019.

[xix] “Healthcare Built Around You,” Amazon.care, accessed October 14, 2019; Jay Greene, “In a First for Michigan, Henry Ford Health Signs Direct Contract with GM,” Crain’s Detroit Business, August 6, 2018, accessed October 14, 2019.

[xx] Cigna Corp., “Cigna Health Services Business Pioneers an Innovative Solution to Affordably Bring Life-Changing Therapies to Patients,” news release, September 5, 2019, accessed October 13, 2019.

[xxi] Ibid.

[xxii] Shelby Livingston, “Cigna Aims to Expand Affordable Access to Gene Therapies,” Modern Healthcare, September 6, 2019, accessed October 13, 2019.

[xxiii] Express Scripts Holding Co., “Express Scripts Closes Acquisition of eviCore; Companies Unite to Improve Healthcare for 100 Million Americans,” news release, December 15, 2017, accessed October 13, 2019.

[xxiv] Cigna Corp., “Cigna Health Services Business Pioneers an Innovative Solution to Affordably Bring Life-Changing Therapies to Patients,” news release, September 5, 2019, accessed October 13, 2019.

[xxv] CVS Health, “A New Path to Better Health,” news release, November 28, 2018, accessed October 13, 2019 ; Shelby Livingston, “Cigna Aims to Expand Affordable Access to Gene Therapies,” Modern Healthcare, September 6, 2019, accessed October 13, 2019.

[xxvi] Shelby Livingston, “Cigna Aims to Expand Affordable Access to Gene Therapies,” Modern Healthcare, September 6, 2019, accessed October 13, 2019.

[xxvii] PwC Health Research Institute interview with Patrick Fortune, vice president of market sectors, Partners HealthCare, 2019.

[xxviii] PwC Health Research Institute, Beyond the Hype: Gene Therapies Require Advanced Capabilities to Succeed after Approval, October 2019, accessed October 13, 2019.

[xxix] PwC Health Research Institute, Money Matters: Billing and Payment for a New Health Economy, May 2015.

[xxx] Ibid.

[xxxi] Thomas Goetz, chief of research, GoodRx, PwC 180 Health Forum, September 24, 2019.

[xxxii] PwC Health Research Institute, Top Health Industry Issues of 2019: The New Health Economy Comes of Age, December 2018.

[xxxiii] Walmart Inc., “In Dallas, Georgia, Walmart Unveils Enhanced Store Experience and First-Ever Walmart Health Center,” news release, September 13, 2019.

[xxxiv] “Walmart Rx Program Guide to Low-Cost Prescriptions,” effective November 28, 2018.

A looming tsunami of high prices

Regulation trumps policy

[i] PwC Health Research Institute interview with Brian Marcotte, president and CEO, National Business Group on Health, 2019.

[ii] Centers for Medicare and Medicaid Services, Historical National Health Expenditure Accounts, NHE Summary, accessed October 23, 2019.

[iii] Centers for Medicare and Medicaid Services, Historical National Health Expenditure Accounts, NHE Projections 2018–2027, accessed October 23, 2019.

[iv] Edward R. Berchick, Jessica C. Barnett, and Rachel D. Upton, Health Insurance Coverage in the United States: 2018, US Census Bureau, September 2019, accessed October 23, 2019.

[v] PwC Health Research Institute consumer survey, “In the 2020 presidential election, how likely are you to vote for a candidate based on their healthcare policies or ideas?,” September 2019.

[vi] Robert Pear, “Trump to Issue Rule That Weakens Affordable Care Act,” New York Times, June 18, 2018, accessed November 7, 2019.

[vii] Kaiser Family Foundation, “Bipartisan Majorities Support Trump Administration’s Push to Get Drug Prices in Advertisements, Even after Hearing Counter-Arguments,” November 28, 2018.

[viii] Alexander Gaffney, “House Drug Pricing Bill Calls for Mandatory Negotiation,” PwC Health Research Institute, September 20, 2019, accessed October 13, 2019.

[ix] Abby Goodnough and Margot Sanger-Katz, “Why Baby Elijah Lost Medicaid and a Million Fewer Children Have It,” New York Times, October 22, 2019, accessed October 22, 2019.

[x] Rajesh Kumar Singh, “On-off Trade Tariffs Wreak Havoc on U.S. Company Planning,” Reuters, August 23, 2019, accessed November 7, 2019.

[xi] Thomas Beaton, “Value-Based Care Key to Bipartisan Healthcare System Reform,” Health Payer Intelligence, March 01, 2018, accessed November 7, 2019.

[xii] “Geisinger at Home,” accessed November 7, 2019.

[xiii] Dr. Jaewon Ryu, president and CEO, Geisinger Health, Cleveland Clinic Medical Innovation Summit, October 21, 2019.

[xiv] Kathleen Sebelius, former HHS secretary, PwC 180 Health Forum, September 24, 2019.

[xv] PwC Health Research Institute, “CMS Expands Medicare Advantage Coverage for Social Determinants of Health,” January 25, 2019, accessed November 7, 2019.

[xvi] “Opportunity Zone Program Offers Investors, Healthcare Organizations and Commercial Businesses a Chance to Work on Social Determinants of Health,” June 2019, accessed November 7, 2019.

[xvii] PwC Health Research Institute, “Opportunity Zone Program Offers Social Determinants of Health Opportunities,” June 2019, accessed October 22, 2019.

[xviii] PwC Health Research Institute, The New Health Economy in the Age of Disruption: Novel Combinations Attempt to Remake the Health System, April 2018.

[xix] PwC Health Research Institute interview with Elizabeth Mitchell, president and CEO, Pacific Business Group on Health, 2019.

[xx] PwC Health Research Institute executive survey, “How concerned are you about a potential economic downturn or recession impacting your business in 2020? (All respondents),” September 2019.

Regulation trumps policy

Consumers inch closer to DIY healthcare

[i] The Office of the National Coordinator for Health Information Technology, “Hospitals’ Use of Electronic Health Records Data, 2015–2017,” ONC Data Brief No. 46, April 2019.

[ii] Ciitizen, “Consumer Health Tech Company Ciitizen™ Raises $17M in Series A Financing to Accelerate Data Platform Development and Commercialization,” news release, January 16, 2019.

[iii] “A More Personal Health App. For a More Informed You,” Apple Inc.

[iv] “Institutions That Support Health Records on iPhone and iPod Touch,” Apple Inc., October 23, 2019, accessed October 23, 2019.

[v] TrialSpark, “23andMe and TrialSpark Announce Joint Clinical Trial Offering and Request for Proposals,” news release, September 26, 2019.

[vi] 23andMe, “23andMe for Scientists: Accelerating Research. Making an Impact,”.

[vii] PwC Health Research Institute interview with Dr. Praveena Kandula, head of strategic operations and strategic partnerships, TrialSpark, 2019.

[viii] PwC, “Data Trust Pulse Survey,” February 2019.

[ix] “Mapping and Managing Cyber Risks from Third Parties and Beyond,” PwC.

[x] Geoffrey A. Fowler, “Help Desk: Can Your Medical Records Become Marketing? We Investigate a Reader’s Suspicious ‘Patient Portal,’” Washington Post, October 22, 2019.

[xi] Natasha Lomas, “Researchers Spotlight the Lie of ‘Anonymous’ Data,” TechCrunch, July 24, 2019.

[xii] Ellen Jorgensen, co-founder and chief science officer, Carverr, PwC 180 Health Forum, September 24, 2019.

[xiii] Gregory Barber, “AI Needs Your Data — and You Should Get Paid for It,” Wired, August 8, 2019, accessed October 23, 2019.

Consumers inch closer to DIY healthcare

US health organizations are seeking opportunities overseas and through innovation. Beware of the tax risks.

[i] PwC Health Research Institute analysis of the holdings and activities of the five largest US-based companies and organizations in each health sector by 2018 revenue, September 2019.

[ii] “Businesses,” UnitedHealth Group, accessed September 29, 2019.

[iii] PwC Health Research Institute analysis of the holdings and activities of the five largest US-based companies and organizations in each health sector by 2018 revenue, September 2019.

[iv] PwC, “Top Ten” Global Mobility Issues for Tax Directors to Think About, April 2018, accessed September 29, 2019.

[v] PwC, Cross-border Tax Talks, podcast, accessed September 29, 2019.

[vi] Organisation for Economic Co-operation and Development, Secretariat Proposal for a “Unified Approach” under Pillar One, October 9, 2019, accessed October 23, 2019.

[vii] PwC, “OECD Publishes Proposal to Rewrite International Profit Allocation Rules,” October 9, 2019, accessed October 23, 2019.

[viii] PwC, “OECD Secretariat Seeks Input on Global Minimum Tax Design,” November 8, 2019, accessed November 11, 2019.

[ix] Ibid.

[x] “Our History,” Centene Corp., accessed September 29, 2019.

[xi] Centene Corp., “Centene Corporation Announces Purchase of Stake in University Hospital of Torrejon In Madrid,” news release, December 28, 2018, accessed September 29, 2019.

[xii] Centene Corp., “Centene and Washington University Collaborate to Advance Personalized Medicine Research,” news release, April 8, 2019, accessed September 29, 2019.

[xiii] “Global Partnerships,” Providence Health and Services, accessed September 29, 2019 ; “History,” Providence Health and Services, accessed September 29, 2019.

[xiv] “Providence Ventures: Current Portfolio,” Providence Ventures ; “Providence Ventures: Investors in Health Innovation,” Providence Ventures, accessed September 29, 2019.

[xv] PwC Health Research Institute interview with Christopher Khoury, vice president of environmental intelligence and strategic analytics, American Medical Association, September 26, 2019.

[xvi] PwC, “Top Ten” Global Mobility Issues for Tax Directors to Think About, April 2018, accessed Sept. 29, 2019.

US health organizations are seeking opportunities overseas

A whole new you: Deals as makeovers

[i] PwC Health Research Institute executive survey, “In 2020, how likely is your company to acquire, partner or collaborate with a company from a different industry sector?,” September 2019.

[ii] Cleveland Clinic, “Plan for 2020 UK Launch Extends Cleveland Clinic’s Global Presence,” January 29, 2018.

[iii] Marc Probst, chief information officer, Intermountain Healthcare, Cleveland Clinic Summit, October 21, 2019.

[iv] Shelby Livingston, “Cigna and Express Scripts Close on $67 Billion Merger,” Modern Healthcare, December 20, 2018. ; Cigna Corp., “Cigna Health Services Business Pioneers an Innovative Solution to Affordably Bring Life-Changing Therapies to Patients,” news release, September 5, 2019, accessed October 13, 2019.

[v] Vertex Pharmaceuticals, “Vertex to Acquire Semma Therapeutics With a Goal of Developing Curative Cell-Based Treatments for Type 1 Diabetes,” news release, September 3, 2019.

[vi] Clover Health, “Clover Health Launches Clover Therapeutics, a New Research Subsidiary to Develop Treatment for Chronic Diseases,” news release, July 10, 2019.

[vii] Signify Health, “Signify Health Acquires TAVHealth to Address Social Determinants of Health,” news release, March 15, 2019.

[viii] Paladina Health, “Paladina Health Acquires Activate Healthcare to Amplify Impact of Primary Care Nationwide,” news release, January 16, 2019.

[ix] PwC Health Research Institute, Clinical Trials in the New Health Economy: Digital Tools and Data Driving Awareness, Engagement and Retention, April 2018.

[x] UnitedHealth Group, “Optum Completes Acquisition of DaVita Medical Group from DaVita,” news release, June 19, 2019.

[xi] CVSHealth, “CVS Health Completes Acquisition of Aetna, Marking the Start of Transforming the Consumer Health Experience,” news release, November 28, 2018.

[xii] Pfizer Inc., “Mylan and Upjohn, a Division of Pfizer, to Combine, Creating a New Champion for Global Health Uniquely Positioned to Fulfill the World’s Need for Medicine,” news release, July 29, 2019.

[xiii] Dr. Peter Diamandis, executive chairman, XPRIZE Foundation, PwC 180 Health Forum, September 24, 2019.

[xiv] Dr. King Li, dean, Carle Illinois College of Medicine, and chief academic officer, Carler Health System, PwC 180 Health Forum, September 24, 2019.

[xv] PwC Health Research Institute, Medical Cost Trend: Behind the Numbers 2019, June 2018.

[xvi] PwC Health Research Institute, Medical Cost Trend: Behind the Numbers 2020, June 2019.

[xvii] PwC Health Research Institute, Top Health Industry Issues of 2019, December 2018.

[xviii] The Carlyle Group, “The Carlyle Group Invests in One Medical, the Largest Independently Held, Technology-Enabled Primary Care Practice in the U.S.,” news release, August 22, 2018.

[xix] EQT AB, “EQT to Acquire Majority Interest in Aldevron — the Leading Global Supplier of Plasmid DNA Used in Cell and Gene Therapies,” news release, July 31, 2019.

[xx] PwC Health Research Institute interview with Les Funtleyder, healthcare portfolio manager, E Squared Capital, September 25, 2019.

A whole new you: Deals as makeovers

Equity and inclusion, not just diversity, as a business imperative

[i] Forbes, “The Best Employers for Diversity 2019,” January 15, 2019.

[ii] Laxmi S. Mehta et al., “Acute Myocardial Infarction in Women,” Circulation 133, no. 9 (March 1, 2016): 916–47, doi:10.1161/CIR.0000000000000351.

[iii] “Men and Mental Health,” National Institute of Mental Health, 2019.

[iv] Lisa C. Richardson et al., “Patterns and Trends in Age-Specific Black-White Differences in Breast Cancer Incidence and Mortality – United States 1999–2014,” Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report 65, no. 40 (October 14, 2016): 1093–98.

[v] Kelly M. Hoffman, Sophie Trawalter, Jordan R. Axt, and M. Norman Oliver, “Racial Bias in Pain Assessment and Treatment Recommendations, and False Beliefs about Biological Differences between Blacks and Whites,”PNAS 113 (16): 4296–4301 (April 19, 2016; first published April 4, 2016).

[vi] P. R. Lockhart, “What Serena Williams’s Scary Childbirth Story Says about Medical Treatment of Black Women,” Vox, January 11, 2018.

[vii] “Pregnancy Mortality Surveillance System,” U.S. Centers for Disease Control and Prevention.

[viii] “Physicians and Surgeons,” DataUSA.

Samantha Artiga, Kendal Orgera, and Anthony Damico, Changes in Health Coverage by Race and Ethnicity since Implementation of the ACA, 2013–2017 (KFF issue brief, February 13, 2019).

PwC Health Research Institute consumer survey, 2016.

PwC Health Research Institute, Provider Systems of the Future: What Happens When the Hospital Is No Longer the Center of the Health Universe?, October 2018.

PwC Health Research Institute consumer survey, Medical Cost Trend: Behind the Numbers 2019, June 2018.

PwC Health Research Institute consumer experience trade-off survey, 2017.

Kelly M. Hoffman, Sophie Trawalter, Jordan R. Axt, and M. Norman Oliver, “Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites,” Proceedings of the National Academy of Sciences of the United States of America 113, no. 16 (April 2016): 4296–4301, doi:10.1073/pnas.1516047113.

Laxmi S. Mehta et al., “Acute Myocardial Infarction in Women,” Circulation 133, no. 9 (March 1, 2016, originally published January 25, 2016): 916–47, doi:10.1161/CIR.0000000000000351.

PwC Health Research Institute clinician survey, 2018.

Victor Okunrintemi et al., “Gender Differences in Patient-Reported Outcomes among Adults with Atherosclerotic Cardiovascular Disease,” Journal of the American Heart Association 7, no. 24 (December 18, 2018), doi: 10.1161/JAHA.118.010498.

A. AlBadri et al.,Sex Differences in Coronary Heart Disease Risk Factors: Rename It Ischaemic Heart Disease!”, Heart 103, no. 20 (2017): 1567–8.

American Heart Association, “A Woman’s Heart Attack Causes, Symptoms May Differ from a Man’s,” news release, January 25, 2016, accessed August 1, 2019.

PwC Health Research Institute consumer survey, June 2019.

[ix] PwC, “Diversity & Inclusion Benchmarking Survey,” Healthcare Data Sheet, 2019.

[x] PwC, Diversity Is the Solution, Not a Problem to Solve, The Diversity Project, June 2018.

[xi] PwC Health Research Institute consumer survey, “Agreement with ‘The mix of people at my company is diverse enough to meet the cultural, ethnic and generational preferences of the patients/customers we serve’ in regards to diversity in your workplace,” September 2019.

[xii] PwC, “Saratoga Benchmarking”

[xiii] Oliver Wyman, Women in Healthcare Leadership 2019.

[xiv] “#18 Emma Walmsley,” Forbes.

[xv] PwC Health Research Institute executive survey, “Of the following, which will your organization prioritize for your workforce strategy in 2020?,” September 2019.

[xvi] Ibid.

[xvii] PwC, “Diversity & Inclusion Benchmarking Survey,” Healthcare Data Sheet, 2019.

[xviii] Shelby Livingston, “Fostering Diversity for the Next Generation of Healthcare Leaders,” Modern Healthcare, September 6, 2019, accessed October 13, 2019.

[xix] Roche, Annual Report 2018.

[xx] “BlueCross BlueShield of Illinois: Leadership,” BlueCross BlueShield of Illinois.

[xxi] PwC Health Research Institute interview with Dr. Derek Robinson, vice president and chief medical officer, Blue Cross and Blue Shield of Illinois, September 25, 2019.

[xxii] Dr. Tom Mihaljevic, “Breaking Bias: Diversity and Inclusion in Healthcare Cannot Be Left to Chance,” Modern Healthcare, May 18, 2019.

[xxiii] “Science 37 for Participants,” Science 37.

[xxiv] PwC Health Research Institute interview with Dr. Travis Singleton, executive vice president, Merritt Hawkins, September 18, 2019.

[xxv] PwC Health Research Institute interview with Dr. Sharonne Hayes, October 29, 2019.

[xxvi] “Implicit Bias Training: Are Medical Schools’ Admissions Committees Unconsciously Biased against Minorities?,” The Ohio State University College of Medicine.

[xxvii] PwC Health Research Institute interview with Dr. John Andrews, vice president of graduate medical education at the American Medical Association, and Dr. Kimberly Lomis, vice president of undergraduate medical education at the American Medical Association, September 25, 2019.

[xxviii] PwC Health Research Institute consumer survey, “When you are considering a new employer to work for, how important or unimportant is diversity in the workforce/leadership team in your decision?,” September 2019.

[xxix] PwC Health Research Institute interview with Dr. Travis Singleton, executive vice president, Merritt Hawkins, September 18, 2019.

Equity and inclusion, not just diversity, as a business imperative

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