Legislation Forces Big Health Care Players to Sell Pharmacies
Background and Context
Members of Congress are pushing for legislation that could break up some of the nation's largest health care conglomerates. The federal legislation, introduced on Wednesday by a group of prominent Republican and Democratic lawmakers, prohibits companies owning drug middlemen or health insurers from also owning pharmacy businesses. This is the most aggressive legislative effort in recent years to target pharmacy benefit managers (P.B.M.s), which control a significant portion of prescriptions in the US. 1: The three largest P.B.M.s - CVS Health's Caremark, Cigna's Express Scripts, and UnitedHealth's Optum Rx - collectively hold 80 percent of prescriptions. This dominance has raised concerns about market manipulation and increased drug costs. The new legislation signals a renewed effort by lawmakers to address these issues. 2: While there has been a bipartisan push to rein in the largest P.B.M.s with legislation requiring more transparency and modest changes to pricing practices, those bills have stalled in Congress. The powerful health care lobbies have put up significant resistance, but the new legislation shows that lawmakers on both sides of the aisle are determined to take on the issue.Impact on UnitedHealth Group, CVS Health, and Cigna
1: Under the new legislation, UnitedHealth Group, CVS Health, and Cigna would be forced to sell their pharmacies within three years. This is a major blow to these companies, which have built significant pharmacy businesses over the years. It will require them to restructure their operations and potentially find new ways to generate revenue. 2: For UnitedHealth Group, which has Optum Rx as its pharmacy business, this could mean a significant change in its business model. The company will need to focus on its core health insurance business and find alternative ways to provide pharmacy services to its members. For CVS Health, which has Caremark, the sale of its pharmacy could have a major impact on its retail operations and its ability to provide one-stop health care services.Resistance and Future Outlook
1: It's not clear whether the legislation will gain traction. The powerful health care lobbies have shown that they are willing to fight to protect their interests. However, the fact that lawmakers on both sides of the aisle are supporting the legislation gives it some momentum. 2: If the legislation does pass, it will have a significant impact on the health care industry. It could lead to increased competition in the pharmacy market, which could ultimately benefit consumers by lowering drug costs. But it will also require these companies to adapt and find new ways to operate in a changing regulatory environment.Uniting AI for Faster Healthcare Insights
Expanding Combined AI Platforms
The acquisition aims to combine the strengths of both companies. Realyze Intelligence's platform utilizes AI to match patients to clinical trials, expediting research and reducing costs. It examines structured and unstructured data in EHRs to identify ideal patients, while its clinician-trained AI can assemble suitable cohorts in seconds. Carta Healthcare's platform, on the other hand, applies AI to structured and unstructured data to reduce the time and price for data abstraction. Together, they anticipate that their combined technologies' "powerful" automation will offer faster insights and significantly reduce labor demands for various healthcare programs.For example, in oncology, cardiovascular health, and other specialty areas, the combined platforms have the potential to expand the feasibility of trials and research while increasing data abstraction with expert clinician oversight. This is a major step forward in leveraging AI to improve healthcare outcomes.
CEO Perspectives on the Importance of Data
Brent Dover, CEO of Carta Healthcare, emphasizes the significance of data in healthcare. He believes that data is the single most important ingredient for improving care practices and patient outcomes. From clinical trials to clinical registries, clinicians face vast amounts of data filled with valuable information. Realyze Intelligence's ability to use clinician-trained AI and a human-in-the-loop approach aligns with Carta Healthcare's mission to maximize insights from clinical data.This shared vision is driving the collaboration and innovation between the two companies. By combining their expertise, they are poised to make a significant impact on the healthcare industry.
Addressing Challenges in Clinical Trials
Aaron Brauser, founder and CEO of Realyze Intelligence, highlights the challenges faced by health systems and pharmaceutical companies in identifying and enrolling patients for clinical trials. The process is costly, labor-intensive, and time-consuming. However, with high-quality, timely data from EHRs and other systems, Realyze Intelligence aims to revolutionize clinical trial matching and reuse the data to enhance research, optimize care pathways, and improve patient outcomes.For instance, by leveraging AI, they can quickly identify eligible patients and assemble suitable cohorts, saving valuable time and resources. This not only benefits the patients but also accelerates the progress of medical research.
Recent Developments and Funding
In 2023, Carta Healthcare closed a $25 million series B financing round, with additional investments from Memorial Hermann Health System and UnityPoint Health. This follows a $20 million Series B financing round in 2022, which included investors like Paramark Ventures, Frist Cressey Ventures, American College of Cardiology, Asset Management Ventures, CU Healthcare Innovation Fund, Mass General Brigham, Maverick Ventures Investment Fund, and Storm Ventures.In 2022, Carta Healthcare also became a certified software vendor for the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. This further showcases their commitment to advancing healthcare through technology.
Moreover, in April, researchers at Memorial Sloan Kettering Cancer Center applied machine learning and large language models to augment the manual curation of cancer data elements using the Realyze Intelligence platform. In February, Realyze Intelligence earned a position among the inaugural class of start-up companies selected for the CancerX Startup Accelerator, part of the Biden administration's Cancer Moonshot program.These recent achievements demonstrate the growing impact and potential of AI in healthcare and the importance of collaborations like the one between Carta Healthcare and Realyze Intelligence.
Why Claire Grisham's Joining is a Big Deal
Claire Grisham's arrival at Saint Francis Clinic Dexter brings a wealth of expertise and care. Her specialized skills in primary and urgent care will undoubtedly enhance the services offered at the clinic. With her board certification, patients can have confidence in the quality of care she provides. The fact that she graduated from a prestigious institution like Walden University further adds to her credibility.
Moreover, the location of the clinic at 1212 Saint Francis Drive in Dexter, MO makes it easily accessible for the local community. This ensures that residents can receive timely and quality medical attention without having to travel long distances.
Primary Care with Claire Grisham
Claire Grisham's focus on primary care is crucial for the overall health of patients. She takes the time to understand each patient's unique needs and provides comprehensive care. From routine check-ups to managing chronic conditions, she is dedicated to ensuring the well-being of her patients.
Her approach is patient-centered, making patients feel comfortable and at ease during their visits. She builds strong relationships with her patients, which helps in providing better care and improving health outcomes.
Urgent Care Services Offered
In addition to primary care, Claire Grisham also offers urgent care services. In case of sudden illnesses or injuries, patients can rely on her to provide prompt and effective treatment. Her expertise in this area ensures that patients receive the care they need quickly, minimizing the risk of complications.
The availability of urgent care services at Saint Francis Clinic Dexter gives patients peace of mind, knowing that they have a reliable source of medical help when needed the most.