JPM20: Headlines from healthcare's biggest conference

SAN FRANCISCO—It's the last day of the conference, and as things wind down, there's plenty of exhaustion to go around from running to back-to-back meetings.

Here's a look at some of the news from the conference from our FierceHealthcare team:

It's digital health. But is it really digital health?

CMS Administrator Seema Verma wasn't exactly going out on a limb when she told the J.P. Morgan Conference on Wednesday about the importance of digital health. 

"It’s very important that we start looking at technology and innovation as a way to solve some of the healthcare problems we have," she said.

The thing is, in what's already a very crowded space, several companies at the conference told me it's important to make the distinction of what's truly a valuable innovation.

Kuldeep Singh Rajput, the CEO and founder of Boston-based digital health company Biofourmis, said there is still too much noise in the space when it comes to differentiating legitimate digital health products. The company has created a software-based therapeutics platform to intervene and optimize therapy for patients. Its lead product, BiovitalsHF, is FDA approved as a 12-week program that is prescribed to the patient and includes a clinical-grade wearable biosensor from Biovotion, a company Biofourmis recently acquired.

"One of the cultures at Biofourmis since day one has been legitimacy in data and validation," he said.  "You see 30,000 apps in the market today and not even 1% of them have FDA clearance, not even 1% of them have shown randomized controlled trials and proven efficacy and safety. And investors initially just by the buzzword of digital health started investing."

Meanwhile, Pear Therapeutics — which has offices in both Boston and San Francisco — is specializing in prescription digital therapeutics. Corey McCann, president and CEO of Pear, was careful to point out the difference in what his company is doing compared to the many companies that offer "wellness" products.

"The very simple definition is that these are pieces of software that are for use via a physician's prescription to directly treat disease. They’re not just for health and wellness outcomes, but they directly treat severe medical conditions," McCann said. "This is space is really a hybrid of tech and biotech. Everything that we do is almost with traditional biotech style rigor."

That means they develop products under Good Manufacturing Practices (GMP) the way drug manufacturers would, they run products through phase one, two and three clinical trials to demonstrate both safety and efficacy and takes that data to regulators.

It's rigor like that which investors recently told Rajput they are requiring from companies they back.

"They were essentially saying ‘We don’t even take the first meeting until we see on that the company has run a randomized controlled trial.' Because now investors are realizing that — taking an example of Livongo, which is public now — even though they’ve shown fantastic results, the business model is still building up. Investors are still understanding this space and how it will all pan out."   — Tina Reed

Community Health System revises guidance for 2020

Community Health Systems nearly halved itself in terms of the overall number of hospitals it owns in the last couple of years. The health system reported it now has 99 hospitals in 17 states after selling 90 hospitals over the last two and a half years. 

"We’re down in terms of our number of hospitals but the hospitals we do have are in great markets," CEO Wayne Smith said during the conference on Wednesday. “We’ve clearly improved our portfolio."

Among the shifts, he said, the company has pushed away from rural markets to more urban markets with 80% of its hospitals in communities with more than 50,000 residents.  "Our metrics are good and strong," Smith said. 

CHS revised its guidance for 2020 up based on its strengthening portfolio.

Smith said the company expects operating revenues to be $12.4 billion to $12.8 billion in 2020 with same-store adjusted admissions growth expected to hit 1.5% to 2.5%. He said the company's non-GAAP EBITDA for 2019 should be near the midpoint of its previously announced guidance of $1.6 billion to $1.65 billion.  — Tina Reed

Women at JPM talk about 'culture shock'

Our colleague at FierceBiotech Amirah Al Idrus caught up with four female executives at JPM this week to talk about their transitions to the top ranks of biotechs and large pharmaceutical companies. 

The consensus? If there was a culture shock, it was their job to transform the culture. 

For instance, Pearl Huang, Ph.D., who said she had a smooth transition to CEO of Cygnal Therapeutics last year, said getting the gig offered an "irresistible" opportunity. 

“A CEO is there to create culture. It was irresistible to get to create a culture that not only you will thrive in, but also the people you attract," she said.  “If you’ve seen a situation where you might have done something differently as a leader, this is your opportunity to do it right—so go do it,” she said. Check out the story here— Tina Reed

Cigna, Centene dismiss discussion over 'Medicare for All' 

Private insurers aren't likely to like the idea of a public option. But when asked this week about many of the Democratic presidential candidates' support for 'Medicare for All,' CEO's of insurers said they aren't worried. 

Centene CEO Michael Neidorff told FierceHealthcare the idea is just unrealistic and "divisive." 

"I call it a political sound bite," he said. "There's no way this country or any country right now could afford the switch they are talking about making. The estimates from the government are $25 [trillion] to $38 trillion over ten years on a budget that's estimated to be $56 trillion. You think about adding that to the budget. It's too high and needs to be controlled in itself."

Further, Neidorff said, the only way to contain costs within a single-payer system would be to withhold service. "And in this country, the last thing we need now is two-tiered service: public and whoever is still maintaining private coverage. We're divided enough as a country. Let's find ways to put it together versus creating more social and economic divides." 

Likewise, Cigna CEO David Cordani said he isn’t concerned about any impact “Medicare for All” could have on his company’s stock price because of how the company is positioned.

Cordani said at the annual J.P. Morgan Healthcare Conference on Tuesday that Cigna deliberately configured its portfolio to convert a significant amount of earnings into operating cash flow. He told CNBC in a separate interview Tuesday that the ability to generate cash flow has helped assuage investors skittish about the prospect of “Medicare for All,” which is being touted by progressive presidential candidate Sen. Bernie Sanders, I-Vt.

“A lot of our capital is not encumbered in a hardened way,” Cordani told CNBC. “It is fluid and dynamic. We will produce in excess of $8.5 billion in operating cash flow in 2021.” — Tina Reed and Robert King

Tenet continues buckling down on efficiencies

When Ron Rittenmyer, CEO of publicly-traded health system giant Tenet Healthcare, gave his update at the conference on Tuesday, he took several minutes to describe a new data "dashboard" introduced in the health system in late 2019.

The system features a number of realtime data points such as daily volume metrics, payer mix, expense management, quality and safety and more, he said. The big idea, he said: "Reducing decision to action" time.

With it, Tenet is enabling "more solid, data-informed decision making" within its facilities, he said. "This reframes the culture to a performance-driven organization at all levels," he said. The health system will continue to refine the dashboard into 2020, he said. 

It's just one example of the efficiencies that Tenet has been focusing on of late.

He reported the company's cost savings program was on track with $300 million of a $450 million goal realized by end of 2019 via centralization, overhead reductions, off-shoring and external spend management.

In November, the company announced it officially opened our global business center in Manila in mid-August and had personnel in place there.  At the time they said it was part of a shift in becoming more of a global operation equipped and staffed 24 hours a day.

On Tuesday, he said the GBC was building upon integrated corporate functions to further streamline processes and improve services. The selection for outsourcing versus the GBC was based on balancing strategy with capability, cost, risk, and timing. It's not simply moving the work, he said. "It's about smarter decisions with how we do our work," Rittenmyer said. — Tina Reed 

CVS Health CEO Merlo calls Omnicare performance 'disappointing'

While CVS Health CEO Larry Merlo was optimistic about the healthcare giant's overall business performance in a panel Tuesday, he did note that one acquisition — Omnicare, which provides pharmacy services to long-term care facilities — has underperformed.

CVS acquired Omnicare in 2015. Merlo said that the skilled nursing space "continues to be a challenge" as there is a greater focus on convalescence in the home instead of in a nursing home or other facility. 

He said, however, that despite the "disappointing" performance to date, CVS sees opportunity in Omnicare's growth and is looking to embrace the pivot to home care.

"We have seen some incremental lift, but our belief is we could still do better," Merlo said.

Omnicare came under fire from the Department of Justice in December for alleged fraudulent billing of federal health programs, and it's not the first time that such charges have emerged, DOJ said. CVS said it will "vigorously" defend the company in court. — Paige Minemyer

Mayo Clinic Platform launches its first venture

Mayo Clinic Platform — a coordinated portfolio Mayo Clinic launched last year to create new platform ventures and leverage emerging technologies, such as artificial intelligence, connected health care devices and natural language processing — has its first big venture.

Announced in conjunction with the J.P. Morgan Healthcare Conference on Tuesday, Mayo Clinic is launching what's called the Clinical Data Analytics Platform. The platform will apply advanced data analytics on de-identified data from Mayo Clinic and other organizations, as well as scientific literature, officials said in the statement.

It is based on a federated architecture, which enables multiple participants to build a common, robust artificial intelligence and machine learning model without sharing datasets in order to address issues such as privacy and security. 

They will partner with nference, a Cambridge-based augmented intelligence company. They will focus on identifying targets and biomarkers for new drugs, optimal matching of patients with a therapeutic regimen, and real-world data and evidence applications, such as label expansion, postmarketing surveillance and drug purposing. (The nference company recently announced the completion of a $60 million Series B round to advance its Augmented Intelligence platform. New investors included Mayo Clinic.) 

“Platform business models have been a force of disruption in many sectors, and the rapid digitalization of health care is affording us an unprecedented opportunity to solve complex medical problems and improve lives of people on a global scale,” said John Halamka, M.D., Mayo Clinic Platform president in a statement. — Tina Reed

Side note: Heather Landi just wrote a fascinating Executive Spotlight with John Halamka. Check it out here

Humana's Broussard says surprise billing must be addressed

In a Q&A session Monday, Humana chief Bruce Broussard said it's critical to find a way to address surprise billing.

headshot of Bruce Broussard
Bruce Broussard

"It's just improper. It's not the right thing to do," Broussard said. "I do believe that is something that needs to be taken on."

Broussard acknowledged that efforts to address surprise medical bills in Congress have largely stalled for now, but said he doesn't expect that to hold long term. Lawmakers have faced a number of recent distractions in their path to tackling surprise medical bills and other health priorities, including the ongoing impeachment inquiry and recent hostilities between the U.S. government and Iran.

He said that the 2020 election cycle is also likely to stymie discussion, but once the contest is over, Congress could get back to business on surprise billing.

"I do believe it isn't going away," he said.

Broussard didn't weigh-in on specific steps he'd like to see taken to address surprise medical bills, which has been a point of contention between payers and providers. Payers favor a rate-setting approach, while providers instead back using baseball-style arbitration to settle disputes.

There has been signficant lobbying from both sides on the issue. — Paige Minemyer

The 'reluctant' brain disease advocate

Susan Schneider (left)
(Tina Reed)

Susan Schneider — who is Robin Williams' widow — never bargained on becoming steeped in brain disease advocacy.

But that was what happened following the devastating loss of her husband to suicide and the subsequent news that that comedian had been suffering severe effects of Lewy Body Dementia.

Speaking at the Startup Health Festival in San Francisco, Schneider said Williams had been seeking medical help over frightening neurological symptoms. A documentary about that struggle is being released in May.

"Robin and I were trying desperately to get to an answer. He's been in medical testing for a solid year," Schneider said. "It was a team but they weren't acting like a team ... our story was very much what you don't want to have happen." 

She went on to say her story isn't about failures in healthcare delivery, but the complexity of the field of dementia. Schneider, whose father is a pathologist, said she needed to get answers from medical professionals about what happened to Williams. 

"Reluctantly, I was in a position where I had to do something because I felt like I had to do something with this information," she said. She partnered with the American Brain Foundation to support research into the interconnectedness of diseases such as Lewy Body Dementia, Parkinson's Disease and the spectrum of diseases in between.

She's partnered to raise money in 2020 for the Lewy Body Dementia fund to support finding a biomarker to help diagnose the disease. So far they've raised about $3 million toward a $5.5 million research grant award and is pushing to raise the next $2.5 million this year. "I want to see this done because I know the researchers are dying to go after this," she said. — Tina Reed

Using the immune system to detect disease

Among the many pharma and biotech companies in San Francisco this week is the Seattle-based Adaptive Biotechnologies Corp. 

Chad Robins

I caught up with CEO and co-founder Chad Robins as he jumped between meetings to chat about the company's technology and ambitions, which are pretty fascinating. In 2018, the company announced a partnership with Microsoft to take on the massive big data problem of mapping the immune system.

The goal: Use a blood test to look for signals from the immune system to help eventually create earlier disease detection of everything from Lyme disease to pancreatic cancer. This goal is still years off, Robins cautions. "That's a massive undertaking that is just in the nascent stages of what it could be," he said. "We could pour a ton of capital into that. It's one of the largest diagnostic opportunities in history, if we get it right."

What would he want the healthcare industry to know about their work? This has the potential to diagnose disease early and lead to better patient outcomes, he said. "We're learning how to read and translate this inherent biology of the immune system to be able to diagnose disease." Their first diagnostic test of that kind is expected to make it to the market at the end of 2021.

The company announced this week a deal with Genentech and its drug called venetoclax, which is being developed for the treatment of newly diagnosed people with chronic lymphocytic leukemia (CLL). They're using Adaptive's blood test that detects minimal residual disease (MRD), or the small number of cancer cells that can remain in the body during and after treatment as a primary endpoint to earn Food and Drug Administration approval for the drug. The company also recently announced Medicare would cover the test, and the two milestones are among the latest Robins will be presenting on Tuesday— Tina Reed

A peek behind the curtain at Mass General Brigham's 2020 priorities

As one of a slew of health system presenters this week, Mass General Brigham, formerly known as Partners HealthCare System, offered a look at its performance in 2019 and its strategic priorities for the coming year.

The rebranding process, which the system kickstarted in late November alongside of its five-year strategic plan, is a central focus in 2020, alongside creating new centers of excellence, eyeing potential new businesses both domestically and abroad and growing its reach in the commercial insurance market, the system said in its presentation Monday.

The system manages about 650,000 lives in value-based contracts, or about 12% of its patient population. Between 2020 and 2024, the health system has capacity for $6.8 billion in capital spending, and that capacity exceeds current spending commitments by $675 million, leaving additional room for growth.

Growing competition in the region is going to be a significant factor in the coming years, Mass General Brigham executives said. They noted the finalized merger that formed Beth Israel Lahey Health and merger plans between Harvard Pilgrim Health Care and Tufts Health Plan as key examples. — Paige Minemyer

Centene's Neidorff: "Reach for the stars ..."

Star ratings, that is...

Michael Neirdoff

On this sunny and 50-degree day in California, Centene CEO Michael Neidorff was among the first to present on Monday. He offered his latest update on Centene's plans to acquire WellCare—but also mentioned several times his dissatisfaction with and ambitions for the company's Medicare business.

"With Medicare, we're going to return to the four stars in 2020 and we're working to see what we can do to make sure that in 2021—we could fall back because of the way they do things but we have a whole team working—to make sure we not only get four stars but start to focus on four and a half," Neidorff said. "Because if you reach for the stars, you'll never come up with a handful of mud." 

Neidorff also offered reiterated his bullishness that the company's planned WellCare acquisition would be complete in early 2020 after winning approval from all 27 states it needed an OK from.

"It's moving along very well," he said. "We're now working through the final steps with the Department of Justice, and I may sound a little bit different than others but we've found them to be very constructive and very willing to listen and work with us in a very effective basis. While we have said it will be the first half of the year, we are cautiously optimistic—and I want to be very careful not to change expectations too much—but not surprise you if it happens much sooner." 

He said the company was in a position to begin integration by January 1 and that it will be a smooth integration.

"We're now in a position to say year one will be no less than breakeven" instead of what was originally projected to be small single-digit losses, he said. "By the middle of the second year, upper single digits is still very achievable." — Tina Reed

Plenty of announcements coming this week, including big M&A by Teledoc

There's no time like the JP Morgan Healthcare Conference to announce some big news, and you should expect plenty of it this week. One of the big announcements that dropped in advance of the conference over the weekend?  Telemedicine company Teladoc Health plans to acquire InTouch Health in a $600 million deal, the companies announced Jan. 12.

Santa Barbara, California-based InTouch Health is a leading provider of enterprise telehealth solutions for hospitals and health systems.

The acquisition positions Teladoc as the partner of choice for health systems seeking a single solution for their entire virtual care strategy, Teladoc executives said in a press release. Read more about it here.