The Oprah Effect: The Shifting Conversation around Obesity and GLP-1s

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I hope you and your family are having a great holiday season. Onto this week’s news!

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The Oprah Effect: The Shifting Conversation around Obesity and GLP-1s

I didn’t ever think I’d link out to a People Magazine article, but here we are. A fascinating story unfolded this week as Oprah disclosed she’d started taking GLP-1s as part of a holistic weight management program.

The story perfectly personifies the broader conversation playing out with weight loss medication and the exorbitant demand coming online for obesity treatment.

For better or worse, the public knows way too much about Oprah’s weight struggles over the years. But that dynamic creates the perfect backdrop for Oprah to become a huge spokesperson and proponent of GLP-1 usage.

In fact, Oprah might be the single biggest, most qualified celebrity to discuss weight loss dynamics.

Oprah has used WeightWatchers for years, but even more recently Oprah has opened up about holistic weight management and taking weight loss medication as a part of that program. The shift in attitude toward GLP-1 medication resulted in a significant change that women across the U.S. have now seen:

Please note that this is not ANY sort of commentary on how Oprah looks – she is objectively beautiful – I simply want to present this as part of the argument toward why there is insane, nutso demand for GLP-1 medication

There’s a lot to unpack in this article, and Oprah does a good job of navigating the complexity of obesity, including her lifelong battle against weight and associated shame.

In mainstream media and among medical professionals over the past couple of years, obesity has experienced a marked shift: from an issue of lifestyle and willpower into a full-fledged medical disease.

The downstream results of that shift will continue to play out for years. And businesses (apart from the drugmakers, of course) are scrambling to capitalize on the massive market.

Don’t forget – Oprah owns a significant stake in WeightWatchers (WW, whatever). In March, WW acquired Sequence, a telehealth platform designed for clinical weight management. At the time of acquisition, Sequence had 24,000 members, and WW has around 3.5M users.

While Oprah obviously cares about her personal health, this People story is part of a broader marketing blitz to grab attention, get people on-platform (ESPECIALLY with the new year almost here, new weight loss goals you guys!!), and destigmatize the shame around the obesity conversation. On the same day the People story dropped, WeightWatchers launched its GLP-1 program.

And it worked. At least, in general. According to Axios, “after the Oprah People story revealed she’s taking an anti-obesity medication, online appointment booking company Zocdoc saw a 30% spike in bookings among patients seeking semaglutide.”

Of course, all of this doesn’t address the number one barrier to access here, and that’s cost – upwards of $1000 PMPM. Nor does it worry about long-term implications of taking GLP-1s, or what happens when patients stop taking the drug, or – are there any issues with overdoses?

As for the advertisement at the bottom of that People story?

Kroger Enters Senior Primary Care Space with Better Health Group

Kroger is boosting its healthcare presence by jumping onto the senior primary care clinic train. The grocery chain full of seniors is partnering with Better Health Group and their MSO offering to transform Kroger’s existing Little Clinic footprint into value-based primary care for Medicare & MA enrollees.

According to Fierce, there are 225 Little Clinic locations and Better Health Group operates 162 of its own but we all know that this sort of play is a keeping up with the Joneses maneuver to drive downstream grocery and pharmacy sales.

Still, more access is better than less, and if Kroger succeeds in offering longitudinal primary care services, especially in underserved areas, it’s not a problem for me. Call me dubious, but I it’ll be interesting to see how Kroger plans to transform a more “Minute Clinic” urgent care-like offering into advanced comprehensive primary care services. Kroger is also likely looking to jump into the ‘Food as Medicine’ movement as those programs emerge.

Bigger picture: Kroger joins the likes of a horde of retail players entering the primary care space. This year alone, we’ve seen Walmart Health announce serious expansion plans, Humana triple down on CenterWell de-novo’s, Best Buy in at-home care programs, HEB (shout out Texas), Dollar General piloting mobile urgent cares, Amazon buying One Medical, and finally, CVS’ marquee acquisition of Oak Street Health. 2023 really was the year of retail health evolution, but that’s a teaser for my 2023 Year in Review coming in January.

Strategy Updates:

Anything affecting decision making in healthcare – notable moves and strategies to keep on your radar.

VillageMD’s Scaleback: After a long period of clinic expansion including an $8.9B purchase of Summit Health, VillageMD is exiting certain markets including Indiana as part of its announced cost cutting plan from October. I touched on this before, but Walgreens was also downgraded to junk status by Moody’s amid a push for its new healthcare transformation. Walgreens has a lot to answer for in 2024 but has the assets to make it happen. (Link)

Lawsuits for Humana, HCA: Humana is facing a lawsuit alleging the use of an algorithm to deny care to Medicare Advantage patients – and don’t forget UnitedHealth’s fiasco along similar lines with naviHealth. Very problematic development. (Link)

• Another problematic development on the PROVIDER side – North Carolina’s Attorney General sued HCA Healthcare for breaching the Mission Health purchase agreement. The lawsuit involves HCA shutting down service lines they said they wouldn’t, etc. From what I understand, HCA saw an exodus of clinical talent post-acquisition. I wonder if they regret the transaction or if the hospital operator will have to make major concessions in the NC market. (Link)

HCSC and Elevance Eye Cigna’s MA Business: On the back of the failed Cigna-Humana attempted merger, HCSC and Elevance Health are reportedly in the running for the purchase of Cigna’s Medicare Advantage business. (Link)

Molina Healthcare’s Bright HealthCare Deal: Molina Healthcare revised terms for acquiring Bright HealthCare’s Medicare business in California: (Link)

• The purchase price for the transaction, net of certain tax benefits, is reduced from the previously announced $510 million to approximately $425 million, and now represents 23% of expected 2023 premium revenue of $1.8 billion. As previously stated by Molina, the acquisition adds $1.00 per share to new store embedded earnings

ACA Exchange Hits 19M: A KFF poll reveals that Democratic voters are now more concerned about the Affordable Care Act than Republican voters as the program is expected to grow to more than 19 million enrollees in 2024. Right now I’m doing some research on an exploratory piece around ACA exchange growth and economic effects of that growth in 2024, and this trend is pretty notable:

• “Compared to the same time in 2022, 33 percent more people have enrolled in marketplace plans in states that use HealthCare.gov.” – as folks get bumped off Medicaid redeterminations they’re finding themselves eligible for exchange plans based on the expanded subsidies in place through 2025 (Link)

Florida’s Live Healthy state proposals held some interesting healthcare provisions:

Along with the above, Beckers pointed out a few other high level provisions that the state is targeting in the package:

• Alleviating the healthcare workforce problem
• Making it easier for providers to practice in critical need areas
• Addressing ER and acute care admissions & boosting funding for programs to divert these volumes (e.g., the above hospital at home initiative to get Florida Medicaid funding for the program)
• Money for hospitals for labor & delivery programs and GME programs for highly specialized tertiary care
• Creation of an innovation council to learn of new solutions for labor and care delivery innovation

Autism and IDD Care Growth: Demand for autism and intellectual and developmental disabilities (IDD) care is at an all-time high, according to a CentralReach report. My wife is a speech therapist, so we have lots of interesting conversations around ABA and how things are evolving in the space, especially from a therapy standpoint. (Link)

Walmart’s New Health Executives: Walmart has hired two executives from health systems to bolster its healthcare initiatives. (Link)

Top Hospital-at-Home Programs: An inside look at the top 8 hospital-at-home programs. Side note that many of these systems have more propensity for innovation in general (Link):

1. Atrium
2. MGB
3. Mayo Clinic
4. Kaiser
5. Mount Sinai
6. UMass Memorial
7. ChristianaCare
8. Saint Luke’s

Management Competence in Healthcare: Kaufman Hall discusses the importance of executive intelligence in relation to management competence. (Link)

Medicare Advantage and Retiree Benefits: Medicare Advantage gains popularity among employers offering retiree health benefits. (Link)

Providence Physicians Unionize: More physicians at Providence have voted to form a union. A small, but growing number of MDs. (Link)

Hospital Rankings Redefined: A look at how hospital rankings have evolved and been redefined over the year. (Link)

Nurses Top Healthcare Ratings: A Gallup poll shows nurses earning the highest grades for care, far above other healthcare workers. (Link)

Supreme Court and Abortion Pill Access: The Supreme Court is set to decide on access to the abortion pill, mifepristone. (Link)

Google Cloud’s MedLM: Google Cloud introduces MedLM, a new offering for the healthcare industry. (Link)

Partnership, Products, and Pilot Announcements:

• Aledade and Anthem announce a new Medicaid partnership to bring value-based care to more Virginians. (Link)
• Augmedix partners with Google Cloud to bring medically-tuned AI technology to ambient documentation. (Link)
• Karoo Health publishes a report validating its cardiac value-based care model with high patient conversion and engagement. (Link)
• Medcase adopts Awell’s CareOps Platform for faster care flow design. (Link)
• Phelps Health collaborates with KeyCare to offer 24×7 virtual care via an Epic-based platform. (Link)
• Blue Shield of California offers virtual access to Ornish Lifestyle Medicine’s cardiac rehab program. (Link)
• Nemours plans to launch a pediatric hospital-at-home program in the coming year. (Link)
• Nascentia Health selects Biofourmis’ tech-enabled care solution to enhance aging in place programs. (Link)
• Arcadia partners with WellSpan Health to support their healthcare journey. (Link)
• Atropos Health and Seqster team up to reduce disparities in clinical trials. (Link)
• Mark Cuban Cost Plus Drugs forms a partnership with a fourth PBM company PCA Rx. (Link)
• Cerebral Way – yes, THAT Cerebral – introduces a new solution for personalized mental wellness. (Link)
• Komodo Health launches a new enterprise strategy & transformation team for clients. (Link)

Finance and M&A Updates:

Anything related to the financial side of healthcare and M&A.

KKR is reportedly close to finalizing a deal for Cotiviti, valuing the firm at $11 billion. (Link)

An interesting update on national health expenditures from CMS – healthcare costs as a % of GDP hit 0.2% below that of 2019 levels. Health Affairs has a good breakdown of the activity. Much of this dynamic has to do with a drop in utilization over these years but also…the unfortunate result of high-cost individuals passing away? (Link)

Orlando Health improved its operating performance by $734 million in the fiscal year 2023. (Link)

Mass General Brigham released its financial results for the fiscal year 2023. (Link)

• Total revenue = $18.8B (12% increase). Patient care revenue grew to $12.8 billion, an increase of $901 million (8%). The system also generated $1.5 billion in premium revenue (63% increase, reflecting the addition of approximately 160,000 MassHealth members under a new Accountable Care Organization), $2.7 billion in research and academic revenue (8% increase) and $1.7 billion in other revenue (20% increase, driven by outpatient pharmacy).
• Operating expenses totaled $18.7 billion, an increase of $1.6 billion (9%) over 2022, reflecting increases in medical claims ($364 million or 51%, related to the increase in Health Plan membership), wages ($543 million or 8%, including market adjustments for certain employees and ongoing use of temporary staffing), costs and use of clinical ($127 million or 14%) and pharmaceutical ($320 million or 26%) supplies, and depreciation and interest ($9 million, 1%).
• The system reported an overall gain of $1.2 billion in 2023, including a nonoperating gain of $1.1 billion. In 2022, the system reported an overall loss of $2.3 billion, including a nonoperating loss of $1.8 billion.

Westchester Medical Center faces a $120 million jury verdict for missing signs of a stroke on a CT scan. Pretty insane case. (Link)

ConcertAI announced plans to acquire CancerLinQ, aiming to create the premier healthcare learning and research network in oncology. (Link)

The current market conditions are described as ‘grim’ for high-value mergers and acquisitions. (Link)

Advanced Diagnostics Healthcare System completed the acquisition of TREND Healthcare. (Link)

Digital Health and Innovation Updates:

Notable fundraising announcements, health tech product launches, breakthrough innovation, and reasons for optimism.

Some interesting intel on AI scribes from a survey of 200 PCPs: Of those [200 primary care physicians] surveyed, 33% reported they are already trialing AI scribe technologies. This group of early adopters reports being relatively dissatisfied with current solutions, expressing the need for more advanced features that better support template personalization, patient education materials, and automation of repetitive processes like lab, imaging, and referral orders. For those who have tried AI scribing and have decided not to purchase yet, they are also looking to EHR vendors to provide a solution. (Link)

TEFCA launched a significant nationwide health data sharing initiative. (Link)

The U.S. Department of Health and Human Services (HHS) implemented new rules to enhance AI transparency and interoperability in healthcare. (Link)

AI Adoption in Healthcare: Healthcare executives are increasingly planning to implement generative AI in the coming year. (Link)

The FDA approved the first gene therapies for treating patients with sickle cell disease. (Link)

Researchers have identified a potential cause for extreme morning sickness, as reported by Nature. (Link)

The Commonwealth Fund discussed the importance of consistent measurement in understanding health drivers. (Link)

Martin Shkreli filed an appeal against his lifetime ban from the pharmaceutical industry. (Link)

Fundraising Announcements:

Note that these roundups are AI-generated for the newsletter.

Medefy Health raised $10M in a Series A round to help employees navigate complex health benefits. (Link)

Maia Oncology picked up $4.25M to build out a virtual primary care clinic for cancer patients. (Link)

Doctor Anywhere secured $41M to expand its offerings and enter the generative AI (genAI) space. (Link)

Ludi, Inc. received a growth investment from Great Point Partners, though the exact amount isn’t specified. They aim to expand their healthcare-focused administrative and financial solutions. (Link)

Twin Health secured $50M to enhance its digital twin technology platform, which aims to revolutionize personalized health management. (Link)

Certainly Health raised $2.3M in funding to enable consumers to book any doctor with upfront pricing, making healthcare more accessible and transparent. (Link)

Season Health snagged $7M for its food-as-medicine platform, intending to integrate nutritional solutions into healthcare. (Link)

KAID Health announced new financing (amount undisclosed) to fuel the market expansion of its Whole Chart Analysis™ Platform, aiming to improve healthcare outcomes through advanced analytics. (Link)

PursueCare raised $20M and acquired Pear Therapeutics’ technology, focusing on expanding its addiction treatment and recovery solutions. (Link)

Digital Health Strategies closed a Series A funding round (amount undisclosed) to expand its Share of Health™ Patient Loyalty Platform, enhancing patient engagement and loyalty in healthcare. (Link)

Ketryx, provider of the first and only connected application lifecycle management software for the life sciences industry, raised $14 Million in Series A funding (Link)

Canopy emerged from stealth to sell a Life Alert style panic button for healthcare workers amid growing workplace violence. Unfortunately, a needed device at this point given the increase in hospital violence. (Link)

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Hospitalogy Top Reads

My favorite healthcare essays from the week

MedCity News highlighted the challenges women’s health entrepreneurs face, including biases from male venture capitalists. (Link)

Chrissy Farr wrote up an in-depth analysis on the collapse of a once-prominent digital health startup Call9. (Link)

SmithRx critiques the flaws in Cigna’s new Cost Plus Model and I’m sure the arguments are similar for CVS’ recent announcement. More of this from health tech founders please! (Link)

Jan-Felix is back from his writing hiatus with a great article discussing why more capitalism could be beneficial for healthcare. (Link)

An Op-Ed from Kat McDavitt and Lisa Bari – We need a Chief Patient Officer in the US Department of Health and Human Services

The Forgotten Man of mRNA Research by the Wall Street Journal’s (paywall) Gregory Zuckerman

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