Zeke Emanuel has an Rx for pharmacies

By Ben Leonard

Presented by Nomi Health

Bioethicist and venture capitalist Ezekiel “Zeke” Emanuel spoke with Future Pulse about the future of pharmacies and much more.

Ezekiel “Zeke” Emanuel is a bioethicist at the University of Pennsylvania and served on the Covid-19 group that advised President Joe Biden’s transition. Emanuel helped develop the Affordable Care Act and is now a health care venture partner with Oak HC/FT. 

Emanuel spoke with Future Pulse about automation, what makes digital health companies successful, what pharmacies will look like in the future and more. The interview is edited for length and clarity.

What do you think makes digital health companies poised for success? 

Health care has been dragged into the electronic age kicking and screaming, not voluntarily. The digital space is going to grow. It's also going to have to be refined multiple times if we learn about problems with it and how to have the right interface for digital with in person.

For example, I have a rash, I want to get an answer, that can be done digitally pretty easily. On the other hand, if you know you've got multiple chronic conditions, that's probably not something that's going to be best handled digitally.

Virtual mental health company Cerebral has come under fire for allegedly overprescribing ADHD meds. Does it reflect a broader digital health reality?

We should put Cerebral in context. It's not like in-person doctors seeing hyperactive patients had been models of ideal prescribing. It’s a fraught area in general, and putting it in digital just highlights that. This is common for lots of different new technologies — figuring out what they do well and mitigating problems that they create.

You’re invested in VillageMD, which brings primary care to Walgreens stores. How do Walgreens and other large retail pharmacies look in the future?

The divide between the various parts of health care that we have maintained got instituted for a good reason. In the end of the 19th century, doctors were largely viewed as snake oil salesmen. That separated out to what we'll call ethical pharmaceutical companies, and doctors got out of the business of actually dispensing medications.

Some of those separations may not be in this era all that useful. We need to bring all the health care services together and make it more one-stop shop. It also has the advantage that Walgreens is in thousands and thousands of communities, including a lot of underserved communities that are lacking physicians and health facilities.

Do you see the traditional retail footprint shrinking as health care delivery becomes bigger at pharmacies like Walgreens? 

They’re a for-profit company. What they sell is dependent upon how many dollars they can return per square foot. That’s pretty clear. Given all the home delivery of stuff, the notion that some of that square footage is better used by in-person interaction in the health care space makes a lot of sense.

You’ve touted automation in health care and said it’s often seen as a dirty word. Do you think job cuts are inevitable from it?

We’re going to have some job reallocation. People are going to be reallocated to other activities rather than focus on the repetitive tasks. There are a lot of places where you can see automation would make life easier and reduce mind-numbing activities that are frustrating and contribute to burnout. I was just reading a report where just physicians logging onto electronic health records systems takes 20 to 30 minutes a day. That’s an easy thing to get rid of.

In terms of future pandemic preparedness, how do you see the CDC’s new disease forecasting center?

I love the CDC forecasting center. I love the people on it, but the forecasting center is only as good as the data, and we don't have good data. We don’t have real-time data. You can have geniuses looking at crummy data; you’re not going to get reliable predictions and forecasting that we need. We’re going to again be reliant on the data coming from other countries, which just has been totally frustrating.

Welcome back to Future Pulse, where we explore the convergence of health care and technology. Share your news and feedback at bleonard@politico.com or @_BenLeonard_ . 

We’re excited to announce that we have a new team member covering health tech, Ruth Reader! She spent the previous six years at Fast Company covering tech and has been covering health tech since 2019. Welcome her and send tips to rreader@politico.com and follow her on Twitter @RuthReader.

A message from Nomi Health:

If not us, who? We’re looking to Congress to help organizations like Nomi Health bring care – like free COVID-19 testing – to the un- and under-insured. Learn more.

Michael Albert @MichaelAlbertMD: “I’m going to be honest, digital health companies publish a lot of fluff and praise each other for publications, despite the results being trivial and the quality of the data low. Digital health needs to recruit actual research scientists to improve the quality of research done.”

PHE LIKELY EXTENDED — The federal Covid-19 public health emergency will presumably be extended through October after the Department of Health and Human Services didn’t announce an expiration date Monday.

HHS Secretary Xavier Becerra pledged to give 60 days’ warning before the emergency expires, a mark that came and went Monday sans announcement. The likely extension would keep broadened telehealth access in place for three additional months, including for Medicare beneficiaries and prescribing of controlled substances online. It would also preserve expanded Medicaid coverage.

It also gives officials, the industry and advocates more time to brace for the end of the emergency, which has transformed the way care is delivered in the U.S. While Becerra has extended the public health emergency every 90 days since taking his post, this was the time a renewal was the least expected.

The American Medical Association and American Hospital Association had called on Becerra to keep the emergency intact to avert future Covid surges.

TELEHEALTH OPTIMISM — CDC Director Rochelle Walensky and other officials are bullish on telehealth’s future.

But they were largely quiet at HRSA’s National Telehealth Conference on significant policy questions facing virtual care.

At the confab on Monday, Walensky said the CDC is pinpointing areas where more data is needed to make telehealth policy decisions, as well as increasing access and bolstering equity.

“[We have to] ensure that telehealth is a service that provides equitable access and does not create additional disparities or widen the technology gap,” Walensky said.

The agency is also working on researching confidentiality and technical issues with virtually prescribing contraceptives and treating sexually transmitted infections, as well as antibiotic stewardship via telehealth versus in-person.

View from Congress: Senate HELP Chair Patty Murray (D-Wash.) called telehealth an “essential option” Monday, pledging to push for more virtual care access.

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HEALTH TECH DIVIDE — People in urban and suburban areas are much more likely than people in rural areas to use digital tech like live video telehealth and wearables, according to Rock Health’s 2021 digital health consumer survey.

“We’re excited by the care delivery approaches we’re seeing from today’s rural-focused digital health startups and expect to see more innovation here,” Rock Health researchers wrote. “But individual companies’ initiatives must be paired with continued federal and state investment in digital infrastructure and affordability measures.”

Patients on commercial insurance plans are most likely to use health tech, including health tracking at 67 percent, followed by Medicaid (52 percent), Medicare (45 percent) and people without insurance (35 percent).

Transgender people are overwhelmingly more likely to use health tech than cisgender people — 89 percent of transgender people report owning wearables versus 41 percent of cisgender people.

“Given the risk transgender individuals face in receiving healthcare in-person, this may encourage them to use (and ultimately prefer) digital-first pathways,” the report said.

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LACK OF TRIAL DIVERSITY — A lack of diversity in clinical trials costs the U.S. billions of dollars in lost life expectancy and labor force years and might be stifling innovation, a report from the National Academies of Sciences, Engineering, and Medicine found.

The report called for increased investment in technology to make it easier for underrepresented groups to participate in trials. More flexible recruitment techniques, including collecting data online and making phone calls, can help boost diversity, the authors wrote.

Clinical trials have long been hindered by inefficiency and a lack of diversity. The push to modernize clinical trials received billions in venture funding in 2021, gaining steam amid the pandemic.

SPANISH LANGUAGE MISINFO — Twenty-three Democratic members of Congress, including Sens. Ben Ray Luján of New Mexico and Bob Menendez of New Jersey, pressed the leaders of messaging apps Signal, WhatsApp and Telegram in letters Tuesday to address Spanish language mis- and disinformation on their platforms.

“Unless they address this problem, dangerous lies and conspiracies will continue to go unchecked — fueling distrust in safe, effective COVID-19 vaccines and undermining our elections,” Luján said in a statement.

Lawmakers in the Congressional Hispanic Caucus have been frustrated with social media platforms for not handing over more data on Spanish language misinformation. They’ve pushed to meet with the CEOs of TikTok, Meta’s Facebook and Twitter and met with the CEO of YouTube.

STEP INSIDE THE WEST WING: What's really happening in West Wing offices? Find out who's up, who's down, and who really has the president’s ear in our West Wing Playbook newsletter, the insider's guide to the Biden White House and Cabinet. For buzzy nuggets and details that you won't find anywhere else, subscribe today.

Billions of dollars are flowing into the mental health sector, The Wall Street Journal's Khadeeja Safdar and Gregory Zuckerman report.

Researchers were able to accurately flag patients possibly having long Covid, lead author Emily Pfaff and others wrote in The Lancet Digital Health.

Cerebral will no longer prescribe most controlled substances, Business Insider’s Shelby Livingston and Blake Dodge report.

A message from Nomi Health:

During the pandemic, Nomi Health partnered with federal, state, and local governments to perform free COVID tests for millions of uninsured Americans. Now, we’re asking Congress to pass a supplemental bill to fund HRSA programs that help our nation’s most at-risk populations get the care they need. Learn more about how you can help.

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