CVS, Walgreens Employees Strike, Patients Support Sharing Wearable Data with Docs

November 01, 2023 - Employees at Walgreens and CVS Health are going on strike to end harsh working conditions. Without a strong union presence, coordination has been difficult and the companies say previous strikes have not had a serious impact.

Meanwhile, the Biden administration is trying to fix a contentious part of the No Surprises Act related to surprise billing. As it stands, the Act’s independent dispute resolution process for settling payer-provider disagreements without impacting patients has been fraught with challenges.

Many healthcare consumers state they would make better choices for their health if providers integrated patients’ wearable data, according to a Software Advice survey. Slightly more than nine in ten respondents said they wanted to share their data with physicians.

The Biden administration has issued an executive order that addresses artificial intelligence, calling for AI standards that are “safe, secure, and trustworthy.” The order comes at a time when much of the healthcare world is excited about artificial intelligence tools but craves speedy regulation.

Kyle Murphy:

Hello and welcome to Healthcare Strategies | Headlines edition. Today, we have

• The pharmacists are walking out
• The White House addresses AI
• Feds try to fix surprise billing
• Most patients are pro-wearable

This is Kyle Murphy, vice president of editorial at Xtelligent Healthcare Media, a division of TechTarget, and I am joined, as always, by Kelsey Waddill...

Kelsey Waddill:

Hello.

Kyle Murphy:

... senior editor of all the things HealthPayerIntelligence and multimedia manager. So Kelsey, it is Halloween proper. I'm wearing my skull and bones. No one can see it, but it's here. It's existing.

Kelsey Waddill:

Can attest.

Kyle Murphy:

I also glow in the dark.

Kelsey Waddill:

Yeah, that was awesome.

Kyle Murphy:

This is my second, this is my second costume of the day. The first costume, I had a big mushroom hat on, where only a select people get to see that. What costume or costumes are you looking forward to seeing this evening?

Kelsey Waddill:

I'd be curious to see if someone does a Barbenheimer costume. That would be a blast.

Kyle Murphy:

I think the time calls for such things. Now that cinema has realized that to get people into the movie theater, you need to offer them an experience that they just can't replicate at home....

Kelsey Waddill:

Yeah.

Kyle Murphy:

And we come full circle, haven't we?

Kelsey Waddill:

We have.

Kyle Murphy:

All right, you ready to get into some headlines?

Kelsey Waddill:

Let's go.

Kyle Murphy:

All right.

Pharmacists threaten walkouts. So per CNN, this happened over the weekend, employees at Walgreens and CVS pharmacies across the US initiated a series of walkouts to protest poor working conditions that they claim compromise patient safety. Don't they all? Although most employees are not unionized, making large-scale walkouts challenging, actions have begun and are scheduled through November 1st, which would be the day this airs, tomorrow.

Previous walkouts led to minor disruptions, but momentum appears to be building. Workers concerned about retaliation are calling in sick, which is not counted as an official walkout by the companies. Clever. Got to read the fine print.

A planned demonstration outside Walgreens headquarters is set for Wednesday. Various unions and advocacy groups support the walkout and a GoFundMe page just raised over $60,000 for striking workers. The walkout coincides with increased demand for pharmacy services due to the cold and flu season. We all know that the pharmacy is no longer just the place where you get your prescriptions. Both Walgreens and CVS claim minimal disruption to operations so far. What else you supposed to say? "We've been crippled."

Kelsey Waddill:

Yeah.

Kyle Murphy:

Kelsey, have you noticed any changes around your local pharmacy?

Kelsey Waddill:

I haven't personally, but I also haven't been to the pharmacy a whole lot recently. I'm more-so worried about the people who are out in rural areas. And if people are striking in the rural areas, the folks who go an hour or half an hour even to get to their pharmacy and then show up and nobody's there, that's a little bit disheartening.

But even that being said, people deserve to work in safe environments, and if there's stuff going on that's not safe, then they should make a statement about it.

Kyle Murphy:

We talked about frontline workers during the pandemic, and pharmacists were one of those places that had to stay open and they were working all hours a day. Mail order stuff started just flowing out the door. So there was so much these people had to do. But there seems to have been no relaxation, no return to the mean, and that they've just been working these long hours. And now you've got to impose--they're finally getting real labor laws in pharmacies. It's just wild to me.

Kelsey Waddill:

Yeah, yeah. It's sad that they have to go through the pandemic and then still have to fight for that.

Kyle Murphy:

Healthcare is a wacky world, is it not? All right, what we got next?

Kelsey Waddill:

The Biden administration is posing some changes to the independent dispute resolution process that was implemented through the No Surprises Act. It's been a bit fraught, but per RevCycle intelligence, the Biden-Harris administration proposed a rule to refine the independent dispute resolution process, also known as IDR...

Kyle Murphy:

[in a pirate-like voice] IDR.

Kelsey Waddill:

... for surprise medical billing. The changes that they are suggesting aim to improve payer and provider communication during a 30-day open negotiation period, which will be initiated via a federal IDR portal. New content elements such as plan type and service location are going to be included in the negotiation notice. The rule proposes standardized batching provisions for handling multiple items or services in a single dispute, which aims to increase the efficiency of the process. Eligibility determinations will be streamlined to occur within five business days.

Five business days. I don't even get my packages in five business days a lot of the time, so I feel like...

Kyle Murphy:

Those are high hopes right there.

Kelsey Waddill:

... that's a tall order. But we'll see.

And administration fees will be collected directly by the departments from disputing parties. The changes aim to reduce administrative burden, protect patients from unfair billing practices.

Kyle, the IDR was highlighted as a solution to surprise billing and out-of-network spending. What gives with its rollout?

Kyle Murphy:

This is one of those instances--it kind of reminds me of healthcare.gov. It's a really great idea, but launching any type of federal portal or process takes way more troubleshooting and planning prior to it being opened up. As soon as this portal opened up originally for the disputes to begin, it just got flooded. And we should have anticipated that.

Kelsey Waddill:

Right.

Kyle Murphy:

The option is there to dispute these claims. Out-of- network claims are like the used cars of the healthcare world where the value is no one really knows what the value of it is.

Kelsey Waddill:

Right.

Kyle Murphy:

So there's a lot of negotiation that goes on. And let me tell you, payers are paying a lot of money on payment integrity to nip this in the bud. And providers, the smaller ones that are not affiliated with large health systems, do not have the legal resources and the technology resources to go to bat with these organizations. So it's a wild situation.

Now, any attempts to make this more efficient is great, but I feel like the idea was fully cooked, but the operation was half-baked. And that's where... So you can tell I have trick or treats on my brain right now, sweets and all those things. Nice.

Kelsey Waddill:

Lots of baking.

Kyle Murphy:

So it's just crazy that whereas the intention is good, the execution is poor. And it's going to take a lot more time for this to even out. But at the end of the day, it's necessary.

One could say that you could just eliminate all of this just by creating some kind of reimbursement system that was different than the ones we currently have. And the thing is, it's getting more and more expensive to get to subscribe to a plan that can give you everything you want. So going out-of-network, it's still very much a reality because navigating the healthcare system is an absolute nightmare.

Kelsey Waddill:

Yeah. Yep.

Kyle Murphy:

Too strong?

Kelsey Waddill:

No, it's Halloween. That's absolutely appropriate.

Kyle Murphy:

All right, let's get on to something a little bit more positive.

Kelsey Waddill:

Yeah.

Kyle Murphy:

Healthcare consumers and their wearables. Everyone under the sun these days, except for Kelsey, has either an Apple Watch, a Fitbit, some other variation, right? There are so many.

So a survey by Software Advice found that 59 percent of healthcare consumers [said they] would make healthier choices if physicians incorporated data from wearable devices into treatment plans. I can't imagine physicians really want more data, but hey, whatever, let's just get onto that. We'll hold on, we'll hold off that one for just a moment here.

Conducted in September 2023, or otherwise last month, the survey included 876 US respondents who own healthcare wearables. A significant 91 percent wish to share their wearables data with doctors primarily to take an active role in health management and improve health outcomes. Most prefer to review this data in person with physicians or include it on intake forms. While interest in prescribed activities in future wearable tech remains high, concerns remain around data privacy and accuracy. Their findings align with previous research indicating increased adoption and daily usage of wearable devices alongside ongoing concerns about data security.

Kelsey, what is your stance on wearables? Payers have been huge proponents of wearables, even giving them away as part of the health plans. So where do you stand on the whole wearable situation?

Kelsey Waddill:

Yeah, I don't own a wearable, but I am not against the idea of wearables. I just don't wear watches generally, and I don't need more things telling me how many messages I have because I already know that I have too many.

But as a healthcare device, I think that they have been really helpful in helping patients to take control of their own care and to actually be more aware of where their health is at on an hour-by- hour or even minute-by-minute basis. I think it is interesting what you said about maybe physicians don't want all of this new data. There's two sides to each coin in healthcare, and there is the side of the coin that says we're already struggling to process the data that we currently have. But I think there's also a side that says more data tends to be, once we've sifted through it, it tends to be more helpful than not.

Kyle Murphy:

Yeah.

Kelsey Waddill:

Maybe the physicians don't even need it. Maybe it's really just for patients.

Kyle Murphy:

Honestly, that's where I think a lot of it is. Because I think that from the people I know who use wearables, it's really about keeping them and holding themselves accountable, or with a group so there's a community experience to it. So I don't necessarily know that showing your doctor [your] activity in real numbers is any better than just being honest with your doctor and saying that you're getting physical activity. I feel like that stuff will be borne out in your lab work and things like that. There should be improvements in other areas.

And the other thing is, if that data, in many ways it's just continuous data, what does it tell the provider that the provider doesn't necessarily know? Unless you're having some kind of cardiac episode or unless you're talking about a continuous glucose monitor, which is something we actually talked about on the Healthcare Strategies podcast not too long ago, I don't see how this could lead to any type of intervention. If somebody's wearing a wearable and is not active, is the doctor going to say, "I looked at your data. You're not doing anything. Do things"?

But back to your point though, from a consumer standpoint, as somebody who owns a watch that's branded by a company named after a fruit, I would say that it does remind me of certain things, and it can be part of a mindfulness component, which we know is really vital for somebody kind of having power to make changes in their life and to get that support on a regular basis. So Kelsey, I know you hate wearables, but I just think that we need to...

Kelsey Waddill:

Strong stance. Strong stance.

Kyle Murphy:

Strong stance, anti-wearables. All right, what we got last, what we got last today?

Kelsey Waddill:

All right. The last thing we have here is another headline about what the feds are up to. President Joe Biden signed an executive order setting standards for artificial intelligence, and the goal was to ensure that it is "safe, secure, and trustworthy."

Kyle Murphy:

Strong quote right there. I'm glad we had that in quotation marks.

Kelsey Waddill:

Yeah, it's a very...

Kyle Murphy:

Powerful, moving statement.

Kelsey Waddill:

The order emphasizes safety, privacy, and civil rights, and it directs AI developers to share safety test results if their tools do pose a national security or public health risk. One would hope that that's...

Kyle Murphy:

Oh, so Skynet could come, everyone. I'm glad somebody in the White House did watch Terminator, and they know that we should be mindful.

Kelsey Waddill:

That's comforting. The Department of Health and Human Services is instructed... So this is the health part. There's the national security part, but then the health part is that the Department of Health and Human Services is instructed to monitor AI use in healthcare for any potential safety issues. The order also aims to stimulate AI research and is part of a broader strategy involving legislative and international efforts. It responds to growing concerns in the healthcare sector that have been voiced even on this podcast sometimes about the impact of AI tools on patient care and safety, that double-sided coin of the good that it can do and the danger that might be possible with it. Kyle...thoughts?

Kyle Murphy:

It's about time, right? This technology has been... Everyone's been talking about it. No matter where you go, any healthcare conference you go to right now, there is non-stop talk about some tool and it does this, does that. And these are the low-hanging fruit of AI. I would even... Calling it a chatbot, like generative AI, to me is a little ridiculous. It's just a scripted experience.

However, we do know that AI can do a lot of the computational work that we would like to do or like to see done more efficiently, thereby freeing up providers to actually do much more of the human intelligence component, which is translating that into some kind of care action. So that's what I want to see. I do not see, at least in the healthcare space, I would definitely shy away from this replacing any type of meaningful interaction between two humans.

Kelsey Waddill:

Yeah.

Kyle Murphy:

Healthcare is literally the laying on of hands and figuring things out. That type of vibe. Technology is not there. Technology needs to be in the background doing all these other things. So that exchange--the two people can be present, they can actually look at each other, and they can communicate in real time about real things and not worry so much about the complexity of healthcare and all the other things that go on behind the scenes.

Kelsey Waddill:

Yeah.

Kyle Murphy:

It's two weeks in a row where I've ended on the soapbox.

Kelsey Waddill:

That's totally fair.

Kyle Murphy:

That concludes today's episode of Healthcare Strategies | Headlines. Happy Halloween to all of our trick-or-treaters out there, and the rest of you. We'll catch you in November.

Kelsey Waddill:

Yeah.

Kyle Murphy:

Take care.

Kelsey Waddill:

See you.