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With the next round of COVID-19 funding stalled in Congress, Americans face a future where vaccines and tests will no longer be free for everyone. Andy speaks with CVS Health’s Executive Vice President Tom Moriarty, who says cutting off funding for basic preventative measures along with new advances like a nasal vaccine is a bad decision both for public health and national security. Tom gives us an update on who’s getting the updated booster, along with the flu shot, and predicts how much sickness we’ll see this winter.

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Transcript

SPEAKERS

Andy Slavitt, Tom Moriarty

Andy Slavitt  00:18

This is IN THE BUBBLE with Andy Slavitt. And the first thing I want to tell you is I’m back. Thank you all my guest hosts for doing a wonderful job covering IN THE BUBBLE while I was away. And thank you everybody for being understanding enough to give me a break. I don’t mind telling you that it was really useful. I just got to spend some time with our boys in Chicago. That was refreshing. I hope that all of you are making it through the year. And also getting to spend time with family had a good Thanksgiving. I know it was a week ago now. And we’re getting ready for what’s coming up on the holidays. You know, last year at this time, it was Thanksgiving, when Omicron showed up. It was just about one year ago. And that sort of changed the entire picture. To me if you can recall, everybody was hoping to see their family but getting sick and not being able to find tests. And we weren’t producing enough tests, and people were getting very frustrated. And it was dawning on us that this COVID-19 virus had a life of its own and was going to be ever changing constantly. And here we are today a year later. And we are in a situation where all the things that have been going on to fight effective battle, building vaccines, funding vaccines, distributing vaccines are kind of coming to an end, because at least at this point, Congress has stopped funding, what got us out of the gate fast and got these vaccines and the vaccines that we need next, which I’ve written about and talked about nasal vaccines, universal vaccines, we are not funding. And we may even make them here the US and send them overseas. So the attitude, particularly of the new Republican led house, towards any kind of investment in future vaccine platforms that we need is almost nonexistent. It’s very, very resistant. And I’m going to talk about a bunch of this with my guest today. Tom already from CVS Health has been on the show a number of times. You know, right when we were beginning to see the first indication, we might have vaccines, I had pulled Tom on the show along with the scientist named David Agus. And we talked about how we’re gonna get vaccines into people’s arms and various challenges a twist in the road, I think Tom did a good job for us commenting on how the healthcare system, not just pharmacies, but healthcare systems as a whole was reacting and responding, because they were an active participant. And yet, a whole bunch of other things happened that I want to talk with Tom about as well. So I am going to talk to him about what happens when we can no longer get the vaccines we need and what needs to happen there. But also about some of the other stuff that he observed during COVID, virtual visits, seeing a doctor, not in person, but through your video screen went up by like 900% people were stuck at home. And I think that caused a lot of people I know in the health care system to start doing things differently, start providing care differently, start thinking in a bit of a different way. And maybe even us as individuals started thinking a bit differently. So between that and COVID, and then what’s going on with the flu. I got plenty to talk to Tom about today. I think you’ll enjoy it. Tom is good straight shooter, and gives me a good person to bounce things off of. Well, let’s go. Let’s bring him on. Great to be back with Tom Moriarty.

Andy Slavitt  04:12

It’s so good to have you back. Let me start out by a little bit about what are you what are you guys seeing? What are you seeing in terms of people with COVID? What you’re seeing in terms of people getting booster shots, not getting the booster shots? What can you tell us?

Tom Moriarty  04:25

Yeah, I think you know, Andy, a lot of folks, including us have been worried that this coming season might be a bad season because of the confluence of COVID with flu. And I think that’s what we’re starting to see. There’s been a pretty early uptake, pretty high uptake of flu so far this year, and all the data that came from Australia and South America indicated that we probably would have close to a normal or even higher than normal flu season. And keep in mind we haven’t had a normal flu season in what about two years now? I think 19 was the last time we really had a normal flu season. So we’re seeing that, we’re seeing roughly about 50% of folks who are getting their flu shots, or at the same time getting a COVID bivaillant shot so that that’s very good to see. But clearly, the rates of administration of the vaccines have slowed on COVID. And we’re doing an awful lot to try to re-energize that and keep folks educated, that it’s really, really important to get the buy valium because they are extremely effective. And we’re going into what will be a long winter if folks are not fully immunized for flu and for COVID.

Andy Slavitt  05:35

You mentioned fluid COVID. But then there’s also RSV.

Tom Moriarty  05:38

That’s right, seeing a huge uptick in that, particularly in in young children. But also, as you know it, it impacts younger kids, as well as older Americans and those with weakened immune systems. So making sure that you’re fully protected across the board is going to be really, really important heading into the winter.

Andy Slavitt  05:56

So some of the stuff written about the by Vaillant has suggested, well, the benefits are very clear if your older, sicker, are at risk. But there seems to be the implication that they’re more marginal for people who are younger, or who don’t feel at risk. You know, others have said, look, the risks involved in vaccination are so low and the benefits are real, that it doesn’t make a whole lot of sense for anybody not to get boosted. Where do you guys stand?

Tom Moriarty  06:26

Yeah, I mean, I’m definitely and we are definitely more on the line of it doesn’t make sense not to get vaccinated. And I’ll tell you why. The data clearly shows that even if you’re younger and healthy, if you do get COVID, and you’ve been vaccinated, your experience, the symptoms you have will be much, much less because of that vaccination. And I can tell you from my own personal experience, I had COVID for the first time just a few months ago, and it was right before I got the bivaillant. And I was really sick. And I consider myself to be pretty healthy and in shape and had to go on the antiviral. But even after that, I got my bivaillant last week, because I didn’t have a full cycle of the COVID experience and therefore really important to get that vaccination before heading into winter.

Andy Slavitt  07:14

Yeah, so it sounds like the message is, if you haven’t gotten your booster, get it and it sounds like you can get it the same time you get the flute your flu vaccine. You know, the first time you and I kind of started talking on this show is right, you’ll kind of as warp speed was kind of coming to Hill, you know, we hadn’t yet seen the data on the Pfizer product or any of the other vaccines. But we were hopeful because we had spent a whole lot of energy, time, and effort to try to consolidate kind of the vaccine development process into year playing back a little bit of that history. Maybe spend a second on the role you guys played at the outset, both with nursing homes, and kind of the handoff that that you guys had to take on in order to start to get people vaccinated once we had a vaccine for real.

Tom Moriarty  08:10

Yeah, no, it was a huge effort across the board. And probably the one of the best examples of public private partnership really delivering for the country. But the role we played obviously, we were very intimately involved in the rollout once the vaccines became available, but even before that, in setting up a nationwide COVID testing system, to allow folks to test very quickly and get the results. The rollout of the vaccines I think went very, very well. We had some issues in long term care. And that was a lot of scheduling. And folks, long term care, a lot of people think long term care are folks who are there, you know, for a long period of time. It’s amazing the number of people who actually go in and out of these long term care facilities because they’re there for rehabilitation or other things. So keeping track of new population and making sure they were vaccinated as they moved and moved out. That was a real learning lesson, I think across the government in that area. But once the vaccines became more fully available, pharmacy really stepped up. And I do give credit to the administration for recognizing the role that pharmacy could play. And in fact, we did play. We became the largest vaccinator within pharmacy and probably in the country overall. And probably most importantly, we were able to reach into areas that have not have access to care and really drive vaccination rates that had not been seen before. And that’s, again, a testament to the work we did with the administration, but then also the reach we have in communities across this country.

Andy Slavitt  09:41

Yeah, one of the first occasions and I’ve been in healthcare a long time where I actually saw a set a goal of improving health equity. Because we started out at home we started out with vaccination rates for White people like 10 points higher than people of color. And, you know, collectively public private partnership, as you say, we set a goal to close that gap. And indeed, that gap closed and a lot of people deserve a lot of credit for it. We’re at an interesting point in the vaccine cycle where vaccines are, as you said, Tom, they’re preventing people from more severe disease or preventing people from more severe illness. They’re not preventing people from getting COVID in the first place. And there are a couple of breakthroughs I’ve written about them, you know, you and I’ve talked about them in the past, that I ever considered to be the next step. One is a nasal vaccine, you know, can we spray something in our nostrils? That would prevent us from getting COVID in the first place. Wouldn’t that be nice. And second, is a universal vaccine. And I think when people talk about a universal vaccine, what they’re really talking about is one that the next variant can’t evade just by changing its shape, you’re gonna can’t shape shift around, but don’t. So those are the next sort of two big areas. And, you know, there’s been some recent press about how the funding for the US to develop those two things just hasn’t been there. What are you thinking about as you guys think about the next generation?

Tom Moriarty  11:15

Yeah, no, I think it’s a great point. And, Deanna, it is, to me, it’s an issue, not just a public health, but it’s an issue of national security. You saw what, what it did to the country during the pandemic, and our ability to respond as quickly as it did really accelerate our ability to come out. Not funding in these areas, not funding new advances, or even access to new technologies, I think is going to be a very bad decision, both from public health and national security. And it’s caught up, as you know, in congressional funding and a debate over congressional funding. And we’re the first dollars in COVID spent fully and accurately. And that’s sort of diligence that folks want to do before they’ll agree to funding more. I think we need to find a balance and a political compromise here to make sure we don’t fall behind as a country across the world, because we’re not done with this variant. And this pandemic, and folks cannot get complacent, I think is probably the strongest message we can deliver here.

Andy Slavitt  12:19

That’s right. There’s a current budget request sitting in front of the lame duck Congress. And your right, just to put any amount Republicans say they don’t want to fund it, because they want it accounted for how the funding before it was spent. I think the administration’s point is, look, we’re running through a pandemic, and it’s exactly the point you’re making, we’ve got to stay ahead of this thing. We’ve got to get to the next generation. And the point of fact, you know, there are other countries around the world that have nasal vaccines, and that are ahead of us. And the really interesting thing time is we could end up making those things here in the US, shipping them abroad and US not getting access to them.

Tom Moriarty  12:58

Exactly. Now, that’s and again, if you think about this in the broader geopolitical landscape of you know, what happened to trade and other things, as we locked down, other countries locked down, I hope we find a way through it and find the funding to do this.

Andy Slavitt  13:13

Let’s take a quick break, I want to turn to some topics, outside of the pandemic, maybe in the lessons learned category for the pandemic. CVS is biggest healthcare company; I think and the country’s I want to see how you think the world’s changing. Let me switch gears on you a little bit Tom, and talk about how healthcare has changed over the course of what we learned in the pandemic, or maybe should change. You know, at the outset, when folks were told, hey, don’t leave your house, particularly don’t go to the hospital or the doctor’s office, you know, where you can get COVID. There are a lot of doctors sitting around, going, how am I gonna make a living? How am I going to treat my patients. And one of the things that happened was something that’s happened in the rest of our lives, which is people said, hey, maybe we can connect, not in person all the time, but maybe virtually, maybe through the computer, maybe through text messaging apps, maybe through a video visit. And you know, we went from like, zero to hero in terms of our ability to have virtual care right away led to describe what you guys saw at that point in time and who what makes you think that carries?

Tom Moriarty  14:51

I think Andy, if you know, take a step back. I think one of the single biggest impacts in health care from the pandemic is the acceleration in movement away from institutionalized brick and mortar, to a more distributed community based and virtual care and access settings, and we had a front row seat to that, during the pandemic, pharmacy were really probably one of the only care settings that remained open during the pandemic. And if we really became in pharmacy became very much a center of how people were accessing care, accessing information about care, we saw a 900% increase in the huge use of virtual health care during the pandemic.

Andy Slavitt  15:34

What types of services did you see this work most successfully?

Tom Moriarty  15:39

Really, across the board, you know, primary care, access, a huge spike in mental health visits, not surprisingly, given everything folks were going through as a result of the pandemic. And so the next phase of this is now fully linking virtual care with distributed primary care and community based primary care, that’s where the next movements are going to be.

Andy Slavitt  16:05

So, I want to repeat something you said, you said, we saw a beginning of a movement away from you call that institutional base care. And I just put a fine point on it for folks, many of us are used to a model of going to the maybe the emergency room, or some other hospital setting when we’re sick. And that is just quite frankly, it’s the most expensive were placed to take care of somebody, you got a lot of costs, you got a lot of fixed costs, you got a lot of burden in that system. And a lot that can happen. And of course, you wait a long time. So this whole idea you’re talking about have I just call it more convenient, more close to home or close to work, ways to access care. And it doesn’t even matter whether it’s virtual or in person, or maybe one visit in person, the next visits virtual, I mean, are we going to see a world like that am I going to be able to just do like I do with the other parts of my life, or just pick up my phone and access the things I need? Sometimes the person sometimes via the phone?

Tom Moriarty  17:10

Yeah. And that’s what we’re building. And let me just, let me give you some stats here to show you why I really do think this, it’s going to move even more quickly than you and I may think today. So this is some survey data, almost 60% of consumers saying having access to virtual care is an important component of their care plan. 40% of consumers had some form of virtual visit in the last year, cost remains the top issue for 91% of people in virtual clearly Lower, lower those costs. And then most importantly, the providers like you indicated 93% of providers believe that virtual visits made patients more likely to make appointments, and more importantly, keep appointments. And so those are some really important statistics and facts that drive how you should be thinking about this going forward. And we’re going to build a virtual kind of continuum that goes from physical community based care all the way to virtual, and you can access it 24/7 depending on what your preference is. That’s kind of where we’re going.

Andy Slavitt  18:19

Yeah, I mean, look, you and I are sitting here and look like very comfortable places able to reach each other pretty easily. I guess one of the questions I have time is going back to the topic you raised earlier around health equity. Sometimes technology acts as a bridge to close gaps. And sometimes technology widens the gaps. Because it gives the halves even more access. It reduces it. For those who don’t have, what do you predict? Or even do you see happening in healthcare with access to care that is more flexible, more virtual more, you know, doesn’t require, of course people to get a transportation, take the bus pay for parking, etc. On the one hand, on the other hand, does require some amount of technology?

Tom Moriarty  19:11

Yeah, no, I think technology actually is going to open access not necessarily foreclose. And, you know, this statistic I use often when talking about this is if you drive I 10, through Atlanta, interstate 10 through Atlanta, one side versus the other. On one side, the life expectancy is eight years higher than the other side. And what is that all about? It’s about access to care, access to primary care. And that doesn’t mean you have to have a physical setting for a doctor to go in and you to see the doctor, you can do it virtually. And what we’re seeing because of how ubiquitous cell phones are, that device is playing having a huge impact on how people are accessing care. And we saw that in the pandemic, the virtual visits if you did it by zip code and income code. It was fairly distributed across all. So I do think technology is actually going to be a bridge builder to allow better access across the board.

Andy Slavitt  20:09

Well, that would be great. I mean, that’s the kind of disruption that we need. I think the question that it raises for me is like, we have some really pernicious gaps in our country. So there’s kids, for example, with asthma, who can’t see allergists, you know, if they’re if they’re on Medicaid if they live in low income communities. And so I on the one hand, I see some of those gaps being filled. But it what it requires is, it really is going to rely on providers to be able to get paid to see people virtually. And I wonder if you could talk a little bit about the status of that. And kind of where all that stands right now, as we come out of the public health emergency, presumably in the next month or two.

Tom Moriarty  21:01

I think one of the single one of the larger issues that we need to address from a policy and regulatory perspective is we have an antiquated rule set of laws and regulations around health care and access to care. And we have not kept pace with technological innovations, and advancing reimbursement models to meet where the technology is taking us. And what you highlighted at the beginning in terms of just general access, when you look at some of these key conditions like asthma, cardiovascular etc, if you build a model that has a care team that has a physician, a nurse practitioner, a pharmacist, and even a nutritionist, and then you leverage both the in person as well as virtual, you can double, sometimes even triple the patient cohort number that that practice group can address. And it’s that type of innovation that we need to start funding and advancing not just through, you know, CMS and through the Medicare and Medicaid programs, but also through the private payers and commercial. And I do think the movement of value based care and focusing on value based care is going to help drive that. But we also have to make payment models easier to allow for that technology to be reimbursed for the value it’s bringing.

Andy Slavitt  22:15

So, you know, it sounds like it makes sense to ask your employer, and to check to see if your employer offers and pays for virtual care. I know there are some insurance companies, you guys have one called […] which has very specific virtual models, either virtual first or virtual as a part of what’s being reimbursed, but you may work for an employer that doesn’t reimburse for virtual care. And put you’re telling me is true that doctors like it, patients like it, doctors believe patients actually follow up on their care more, and that it closes health equity gaps, then, you know, we’ve got to update our policies, right.

Tom Moriarty  22:59

Yeah. It’s one of the benefits of the integration that we put together by having CVS pharmacy, with Aetna, the insurance company and with Caremark the pharmacy benefit management. So what we’re developing, and what we will develop is going to be available not just to folks at Aetna, but we can make it available across multi payer spectrum. So what we develop, we will sell to other health plans through our Caremark and CVS Pharmacy. So our ability to accelerate access to these programs, and to the technology that we’re building, and that integrated model, it’s going to go more broadly than just that. And I think that’s the real value of having what we put together deliver for healthcare.

Andy Slavitt  23:40

Okay, let’s take one more break. And I want to come back and talk about some of the things we learned about cultural connections that have to take place between doctors and patients. So give us a quick minute, we’ll come right back and we’ll finish up with Tom. You noticed we finished up time, I’m wondering, as we step back, what are the other lessons learned, you know, certainly, this whole movement to see more things in the community, more convenient access to care, getting all of us to focus on the prevention side of life, whether it’s vaccines, or other things. Those all feel like advances that are both going to improve access to care, but also reduce costs. They may put pressure on hospitals, but you know, hospitals really should be for some very serious things, not for the sort of daily basic needs. Are there other lessons that you guys, as you know, major, major healthcare players who are big participants in all this? Have seen that ways you’re changing, the way you operate, or how you’re thinking about the way, you know, healthcare itself should be operating?

Tom Moriarty  25:08

Yeah, absolutely. And I think the there are two or three things I’ll highlight along that. One is, each of us, we’re individuals, we have preferences that maybe different from other people, etc. And how we access healthcare is not going to be uniform across the population. So the different ways that we structure the ability to access care is going to be really important, folks liked for better or worse, they want to be seen by folks who are like them. And so as we move into diverse communities and into other areas of the country, we’ve done this with pharmacy, mapping the workforce to that population is going to be really important. And we’ve seen, access and utilization go up when we do things like that. And I think, you know, we’ve talked as well about the care models, and the funding that needs to happen. But those are probably two of the biggest things that I would point out in terms of that diversity of the workforce, and mapping your workforce that communities you’re serving, and then driving, giving the choice and the convenience, on how you access care whether it’s physical, virtual, or even over the phone.

Andy Slavitt  26:17

I love this whole idea of a more culturally connected patient to physician workforce, because, look, those of us who have a great relationship with someone in the healthcare system are very fortunate. But oftentimes, there’s not a lot of, there’s not always not a lot of trust, you go to speak to someone who doesn’t have experience, it’s like yours may not look like you may not have a lot of time for you may ask suspicious of you when you come in for your visit. And, you know, you may not be telling them the truth about how you’re feeling. And I think this whole idea of getting an activating a workforce that comes from the communities of the people they treat, I know that I’ve been to near medical schools recently, that are really putting a big focus on that on trying to hire and train people who really want to go back into the communities where they grew up.

Tom Moriarty  27:11

Yeah, yeah. You know, another key thing wasn’t necessarily learning coming out of the pandemic, but I think it was really highlighted during the pandemic is you, we need to minimize the number of steps involved in folks access and care. And what I mean by that is, the studies show that if you go into your physician’s office, and she orders labs for you, and then you have to go to a specialist over here, and there’s two or three things you have to do, the fall off rate, and sticking to that care is dramatic. And so leveraging digital tools, and creating virtual homes for people where they can access their information directly through a digital application, and then connect and care virtually as well as physically, I think that’s going to be game changing in terms of driving higher adherence rates to what the physician has planned out for you for your care program.

Andy Slavitt  28:05

Well, if at the end of the day, we all want to stay healthy, we want to keep our family healthy. And you know, God forbid, when something happens, and it happens to all of us and all of our families, we want to be able to find a place we can trust, we want to find a place where we can, that’s convenient, where we can get care, and where people can get better. And where we can afford, as you said, you know, 91% of people view cost as an issue where we can afford to provide our loved ones, the care that they need, I think there’s a lot of promise, it sounds like coming out of the pandemic, it just in terms of if we really do apply the lessons learned if we do make care, more convenient to access, if we do make care closer to where people are, whether it’s as close as their phone, as close as their home, is closest, something local in the community, where they don’t have to wait a long time and pay a lot of money. So we should keep having these dialogues. Because there’s no way we’re going to make a better healthcare system. Unless we honestly unless people like you guys do the work unless policymakers, you know, push the envelope. And unless people out there listening really speak up and say what they want, whether it’s virtual care, more convenient care, lower cost care. And so this is going to be a recurring topic on our show, for sure.

Tom Moriarty  29:25

Absolutely. And just on the policy side, Andy, just quickly, it’s not a majority, but there’s a growing sort of distrust of integration. And I think integration is going to be one of the most important things.

Andy Slavitt  29:42

When you when you say integration, what do you mean?

Tom Moriarty  29:43

I mean, it’s integrating cross the lines of where you’re going to access care. And there’s a school of thought out there that that integration is not good and should not let it to happen. And it’s ignoring not just the efficiencies, but also the ability to provide that convenience for consumers, that leads to the higher adherence to the care plan that we were just talking about. And so it’s a message we press all the time, but I think your listeners should stay tuned to that trend as well.

Andy Slavitt  30:11

Yeah, look, I mean, the topic of integration. You know, people who live out here in California, where I love, some of them are Kaiser members. Kaiser’s doesn’t advertise itself as everything, but what they do advertise is if you walk in the door, and you’ll be able to go all the places you need to go. And I think constructing that and an even more virtual level, to say, I can pick up my phone, and I can go anywhere I need to go is a really interesting promise. And you know, if that is our future, it’s a better one. All right. Well, thank you, Tom, as always look forward to having you back for more chats.

Tom Moriarty  30:52

Great, great to be with you. Thanks, Andy. Appreciate it.

Andy Slavitt  31:09

Let me tell you about our next two upcoming shows. Friday, we’re going to be talking about the sudden protests in China, over the COVID-19 restrictions and some of the really surprising consequences that we’re seeing in that country. And then Monday, a show that I am very excited about. Nicholas Kristof. The New York Times columnist, just returned from nine days in Ukraine on the ground, and he’s going to talk to us about what’s really happening with the people in Ukraine. And it’s a pretty astounding conversation and I’m excited to bring it to you. So, enjoy the next couple days. Tune in on Friday.

CREDITS  31:55

Thanks for listening to IN THE BUBBLE. We’re a production of Lemonada Media. Kathryn Barnes, Jackie Harris and Kyle Shiely produced our show, and they’re great. Our mix is by Noah Smith and James Barber, and they’re great, too. Steve Nelson is the vice president of the weekly content, and he’s okay, too. And of course, the ultimate bosses, Jessica Cordova Kramer and Stephanie Wittels Wachs, they executive produced the show, we love them dearly. Our theme was composed by Dan Molad and Oliver Hill, with additional music by Ivan Kuraev. You can find out more about our show on social media at @LemonadaMedia where you’ll also get the transcript of the show. And you can find me at @ASlavitt on Twitter. If you like what you heard today, why don’t you tell your friends to listen as well, and get them to write a review. Thanks so much, talk to you next time.