Just off the historic U.S. Route 66 in eastern New Mexico, a 10-bed hospital has for decades provided emergency care for a steady flow of people injured in car crashes and ranching accidents.

It also has served as a close-to-home option for the occasional overnight patient, usually older residents with pneumonia or heart trouble. It’s the only hospital for the more than 4,500 people living on a swath of 3,000 square miles of high plains and lakes east of Albuquerque.

“We want to be the facility that saves lives,” said Christina Campos, administrator of Guadalupe County Hospital in Santa Rosa. Its leaders have no desire to grow or be a big, profitable business, she said.

But even with a tax levy to help support the medical outpost, the facility lost more than $1 million in the past six months, Campos said: “For years, we’ve been anticipating kind of our own demise, praying that a program would come along and make us sustainable.”

Guadalupe is one of the nation’s first to start the process of converting into a Rural Emergency Hospital. The designation was created as part of the first new federal payment program launched by the Centers for Medicare & Medicaid Services for rural providers in 25 years. And though it is not expected to be a permanent solution to pressures facing rural America, policymakers and hospital operators alike hope it will slow the financial hemorrhage that continues to shutter those communities’ hospitals.

More than 140 rural hospitals have closed nationwide since 2010, and health policy watchers aren’t sure how many of the more than 1,700 rural facilities eligible for the new designation will apply. CMS officials said late last month that seven have already filed applications. Dr. Lee Fleisher, director of the Center for Clinical Standards and Quality at CMS, said how long it will take to review the applications will vary. The agency declined to provide the names or locations of hospitals seeking the designation.

Facilities that convert will get a 5% increase in Medicare payments as well as an average annual facility fee payment of about $3.2 million in exchange for giving up their expensive inpatient beds and focusing solely on emergency and outpatient care. Rural hospitals with no more than 50 beds that closed after the law passed on Dec. 27, 2020, are eligible to apply for the new payment model if they reopen.

The new program “strikes me as the first time we are saying, you know, maybe we can just take the beds away,” said Dr. Paula Chatterjee, an assistant professor at the University of Pennsylvania’s Perelman School of Medicine. Outpatient and emergency visits already make up about 66% of Medicare payments for rural hospitals that are eligible to convert, according to Chatterjee’s recent research.

Still, she found that many would likely need to scale up some outpatient services, such as telehealth and substance use care. Even then the payment model might not be able to shift the “foundational pressures” of declining, aging, and sicker populations that are making it hard to deliver care in rural America, she said.

“This feels like rearranging deck chairs on the Titanic,” Chatterjee said.

More than 50 hospitals and other organizations have expressed interest in the rural emergency designation, said Janice Walters, chief operating officer of programs for the Rural Health Redesign Center, which has a federal grant to provide technical assistance to facilities interested in converting.

Most hospitals “are still trying to figure out, ‘Is the math going to work?’” Walters said.

Those showing immediate interest are very small, with three or fewer patients staying overnight any given day, and, generally, they long ago gave up maternity care to save on expenses. The federal law will need to be amended to help larger rural hospitals with more overnight stays, said Brock Slabach, chief operations officer for the National Rural Health Association.

“It’s enough for now,” Slabach said. “But is it going to be enough for the long term? I don’t think so.” Top priorities for the group include adding the ability for hospitals to participate in a federal drug discount program and allowing for longer patient stays.

At Stillwater Medical in Oklahoma, Chief Administrative Officer Steven Taylor said the switch already makes sense for two of the system’s smaller hospitals that “have struggled financially.” The small regional health system’s outpost in Perry, which rarely has more than two inpatients a day, has already filed an application, and its facility in Blackwell will likely do so soon, he said.

Keeping emergency services “is the most important thing” for the small communities, he said. The new model requires a 24-hour emergency department and a clinician on call. It also caps the average length of patient stays at 24 hours — which Taylor said is not a problem. One patient may need to be watched for 12 hours for chest pain while another, with pneumonia, may need to stay for 36 hours, but that will average out to less than 24 hours for the year, he said.

Plus, he said, anybody who needs more intense care can be transferred to their regional hospital in Stillwater. Oklahoma, like other states, is working to update state laws for licensing or regulations to ensure hospitals can be credentialed with the rural emergency designation quickly.

John Henderson, president and chief executive of the Texas Organization of Rural & Community Hospitals, agreed with other speakers at the National Rural Health Association’s February policy conference in Washington, D.C. The new rule “could be a relief valve” for very small rural hospitals, he said. A two-bed facility in Crosbyton confirmed for Henderson earlier that day that it was the first in Texas to be approved for the new payment mechanism.

Henderson said he knew of several more of the state’s 158 rural hospitals that are applying or have already applied, and others are considering it: “These are the folks that are just hanging on.”

Dr. Denise Brown, CEO of virtual care provider Fident, spoke up from the front row during Henderson’s presentation. Her company uses telehealth so doctors and other clinicians can work virtually with multiple hospitals in different states. Brown said she was concerned that hospitals that convert won’t have enough ambulances available to transport or a place to send sicker patients, especially if they aren’t part of a larger health system.

Heads began to nod throughout the crowded room. Many rural hospitals needed every bed they had during the worst of the covid-19 pandemic, and to give up those beds now seems counterintuitive.

Those same rural hospitals often find that larger facilities refuse to take their patients who need specialized care, Brown said.

“How do I know that I can guarantee somebody a bed?” Brown said, adding that she prefers rural hospitals keep patients longer. How would she explain to concerned family members that their loved one was “two or three hours from home”?

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Social Security adjudicators working on applications for benefits have licensed professionals to evaluate the case and rate them regarding the person’s ability to perform any work. Physicians and licensed psychologists never see the applicants, only the information in the file.

Applicants that can’t lift at least 5 lbs. for a specific length of time may still be seen as able to do sedentary work, and here’s where the cards are stacked against them.

The Dictionary of Occupational titles, last updated in 1977, lists over 12,700 jobs many available for unskilled, sedentary workers at that time. Among the jobs are shoe sole gluer, fish scaler, nut sorter, dowel inspector, and egg processor. Where in the US do we have people gluing soles on shoes or sorting nuts?

A pinball machine repairer is still available, but how would a person with sedentary issues be able to do that? The jobs are still listed as existing here, and adjudicators see that as a valid reason to deny benefits to a disabled person. Shouldn’t the listings be updated? Who’s responsible for that?

Some people receive benefits who can do other than sedentary work and be employed in a variety of jobs. I recall a man that field workers found lying under his truck doing repairs on it. Another man was engaged in a home repair business, a third was pulling a boat trailer, and the list continues.

How do I know about this? I worked as a medical consultant for Disability for over a decade, and I attended meetings where they pointed out recent fraud. Adjudicators told me about the old job listings they were using to deny benefits, and as long as they were in that book, they were used.

Those who knew they didn’t deserve benefits know one thing that protects their fraudulent claims; many states may have only two field inspectors to check up on questionable claims.

How does Disability know about these claimants? It’s simple; someone reported them to Social Security. As far as I know (from my years working there), there are no regular visits to check up on those receiving benefits. A paper trail tracks some on a one, three, or never basis according to their assigned disability rating. The last are those seen as rated with no medical improvement expected, such as terminal cancer or, perhaps, another terminal illness that will result in death within one year.

Reports may prompt the inspectors to make a trip out into the field. Nosey or unhappy neighbors and vigilant citizens keen to report fraud are the banes of those who are inappropriately collecting benefits. No reports might mean a cursory trip occasionally to check up on someone. Otherwise, various forensic methods will be used to catch the fraudsters.

Think how many people have been denied because they couldn’t find a fish scaling job. Also, think about the stress, the endless hours of trying to contact someone to help, or the process of giving up in depression. Isn’t it enough that they want to work and can’t? How demeaning is that?

Don’t we determine our self-worth by how we contribute to society or our families? Being pushed aside like this is saying the disabled are worthless, and that’s not as bad as it gets. Some may commit suicide. I don’t have data on that, but it’s not a bad guess on my part.

If you or someone you know has been denied Social Security Disability benefits, you have a right to ask for a reconsideration and a review after that by a judge. Should you not be satisfied with the outcome, contact the local office of your state’s Federal Senator and ask for a “sensitive inquiry” on their part.

You can also contact an attorney who specializes in these cases. Their fee is set by law and determined by how much money (often back benefits) is realized.

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What patients know about saving money and improving care could provide your hospital with the answers it needs in relation to cost-cutting, improving operational efficiencies, and enhancing patient care. Accessing that information is achieved through the application of ethnography.

Ethnography is an innovative practice that studies the culture and habits of people in specific situations. In healthcare, it can be used to improve patient and family satisfaction and care coordination within a bundled payment model by gaining frontline insights from patients and their families.

Hospitals deliver enormous value to their communities with initiatives to promote health and well-being, prevent disease, and strengthen community partnerships. Building on these relationships with ethnographic techniques enhances that trust.

Your hospital will need a unique patient map and proven strategies to deliver robust and data-rich insights by:

• Targeting the true needs of your patients and their families.
• Revealing the frustrations for patients and families in their experience with your hospital.

These insights inform the implementation of an actionable roadmap with innovative ideas for improvement.

As CMS now reimburses hospitals based on the quality of their patient care, which incorporates the patient experience, I encourage all healthcare providers to carry out this process.

Here are three areas where patient insights can help to deliver cost-saving initiatives. These can be frequently overlooked in the pressured environment in which hospital leaders often find themselves.

The impact of silos in your hospital

The patient journey through your hospital is complex, often involving multiple departments. When teams work in silos, or communication breaks down, the patient experience suffers. Patients also express concern over this process.

The breaking down of silos improves patient flow through your hospital, especially in critical areas, such as the ER. This is a concern for physicians as well as patients, according to the American College of Emergency Physicians:[1]

• 60% said overcrowding forces the diversion of patients with urgent needs elsewhere.
• 28% stated this occurs more than 20 times every year.

Hospital-wide resources management can save your hospital money and improve care. Our comprehensive Patient Journey Mapping™ survey can help to reveal the vulnerable points in your hospital which are increasing costs and impacting patient care.

The patient discharge process

Clear communication at the time of patient discharge means that patients are less likely to be readmitted to your hospital. The average readmission cost per diagnosis back in 2016 was $14,400. Furthermore, it is estimated that one in six patients are now readmitted to the hospital within 30 days of discharge.

Patients want to know what to expect when leaving the hospital after treatment or surgery. Research shows that when patients clearly understand guidance around their medications and care when arriving home, readmissions fall. Frontline insights from your patients will reinforce the need for hospital staff to ensure they fully comprehend all instructions and guidance relating to their discharge.

It should also be noted that we strongly recommend confirming the patient’s social circumstances prior to the time of discharge. Social determinants of health can often cause patients to return to the ER with the same symptoms that resulted in their initial admission.

The overlooked patient billing experience

As I highlighted above, CMS reimbursement is becoming increasingly dependent on patient satisfaction and that satisfaction includes the billing process.

Their experience with billing is often both the initial and final interaction your patients have with your organization. If they believe they are overcharged or their expectations are not met, patient satisfaction suffers.
The extent of the impact on your operating margins is revealed in a study published in October 2019 which found that US healthcare consumers will change their providers over a poor digital experience — which includes online bill payment and e-mailed billing processes[2].

• 41% of consumers would choose another healthcare provider over a poor digital experience.
• Furthermore, 60% of consumers find healthcare bills confusing, which often results in delayed payment and less money to invest in your hospital.
• In addition, that poor experience can lead to lower patient satisfaction scores and lower reimbursements.

Gaining invaluable patient insights into this often overlooked area can help to transform your overall patient experience and save your hospital money, particularly in administrative costs involved in billing.

[1]http://www.ihi.org/resources/Pages/ImprovementStories/BetterPatientFlowMeansBreakingDowntheSilos.aspx
[2] https://www.prnewswire.com/news-releases/study-finds-us-healthcare-consumers-will-switch-providers-over-poor-digital-experiences-300934851.html

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The Biden administration and state officials are bracing for a great unwinding: millions of people losing their Medicaid benefits when the pandemic health emergency ends. Some might sign up for different insurance. Many others are bound to get lost in the transition.

State Medicaid agencies for months have been preparing for the end of a federal mandate that anyone enrolled in Medicaid cannot lose coverage during the pandemic.

Before the public health crisis, states regularly reviewed whether people still qualified for the safety-net program, based on their income or perhaps their age or disability status. While those routines have been suspended for the past two years, enrollment climbed to record highs. As of July, 76.7 million people, or nearly 1 in 4 Americans, were enrolled, according to the Centers for Medicare & Medicaid Services.

When the public health emergency ends, state Medicaid officials face a huge job of reevaluating each person’s eligibility and connecting with people whose jobs, income, and housing might have been upended in the pandemic. People could lose their coverage if they earn too much or don’t provide the information their state needs to verify their income or residency.

Medicaid provides coverage to a vast population, including seniors, the disabled, pregnant women, children, and adults who are not disabled. However, income limits vary by state and eligibility group. For example, in 2021 a single adult without children in Virginia, a state that expanded Medicaid under the Affordable Care Act, had to earn less than $1,482 a month to qualify. In Texas, which has not expanded its program, adults without children don’t qualify for Medicaid.

State Medicaid agencies often send renewal documents by mail, and in the best of times letters go unreturned or end up at the wrong address. As this tsunami of work approaches, many state and local offices are short-staffed.

The Biden administration is giving states a year to go through the process, but officials say financial pressures will push them to go faster. Congress gave states billions of dollars to support the coverage requirement. But the money will dry up soon after the end of the public emergency — and much faster than officials can review the eligibility of millions of people, state Medicaid officials say.

In Colorado, officials expect they’ll need to review the eligibility of more than 500,000 people, with 30% of them at risk of losing benefits because they haven’t responded to requests for information and 40% not qualifying based on income.

In Medicaid, “typically, there’s always been some amount of folks who lose coverage for administrative reasons for some period of time,” said Daniel Tsai, director of the CMS Center for Medicaid and CHIP Services. “We want to do everything possible to minimize that.”

In January the eligibility of roughly 120,000 people in Utah, including 60,000 children, was in question, according to Jeff Nelson, who oversees eligibility at the Utah Department of Health. He said that 80% to 90% of those people were at risk because of incomplete renewals. “More often than not, it’s those that just simply have not returned information to us,” he said. “Whether they didn’t receive a renewal or they’ve moved, we don’t know what those reasons are.”

Arizona Medicaid director Jami Snyder said 500,000 people are at risk of losing Medicaid for the same reasons. She said that processing all the eligibility redeterminations takes at least nine months and that the end of the federal funding bump will add pressure to move faster. However, she said, “we’re not going to compromise people’s access to care for that reason.”

Still, officials and groups who work with people living in poverty worry that many low-income adults and children — typically at higher risk for health problems — will fall through the cracks and become uninsured.

Most might qualify for insurance through government programs, the ACA insurance marketplaces, or their employers — but the transition into other coverage isn’t automatic.

“Even short-term disruptions can really upend a family,” said Jessie Mandle, deputy director of Voices for Utah Children, an advocacy group.

‘More Marginalized People’

Low-income people could still be in crisis when the public health emergency ends, said Stephanie Burdick, a Medicaid enrollee in Utah who advocates on behalf of patients with traumatic brain injuries.

In general, being uninsured can limit access to medical care. Covid vaccination rates among Medicaid enrollees are lower than those of the general population in multiple states. That puts them at higher risk for severe disease if they get infected and for exorbitant medical bills if they lose their insurance.

“They’re more marginalized people,” Burdick said. She said she worries “that they’re going to fall off and that they’re going to be more excluded from the health care system in general and just be less likely to get care.”

Burdick knows this firsthand as someone who experienced traumatic brain injury. Before covid-19, she would periodically lose her Medicaid benefits because of byzantine rules requiring her to requalify every month. The gaps in coverage kept her from seeing certain specialists and obtaining necessary medicines. “I really do remember being at the pharmacy not being able to afford my medication and just sobbing because I didn’t know what to do about it,” she said. “It was horrible.”

The covid Medicaid continuous coverage requirement was enacted under the Families First Coronavirus Response Act, which gave states an increase of 6.2 percentage points in federal funds if they agreed to maintain eligibility levels in place at the time.

The boost meant tens of billions of additional dollars would flow to states, estimates from KFF show. The U.S. Department of Health and Human Services can extend the public health emergency in 90-day increments; it is currently set to end April 16.

Groups that advocate for the needs of low-income Americans say the renewal tidal wave will require outreach rivaling that of almost a decade ago, when the ACA expanded Medicaid and created new private insurance options for millions of people.

Independent research published in September by the Urban Institute, a left-leaning think tank based in Washington, D.C., estimated that 15 million people younger than 65 could lose their Medicaid benefits once the public health emergency ends. Nearly all of them would be eligible for other insurance options, including heavily subsidized plans on the ACA marketplaces.

Tsai said the 15 million estimate provides a “helpful grounding point to motivate everybody” but declined to say whether the Biden administration has its own estimates of how many people could lose benefits. “I don’t think anyone knows exactly what will happen,” he said.

Tsai and state officials said they have worked hand in hand for months to prevent unnecessary coverage loss. They’ve tried to ensure enrollees’ contact information is up to date, monitored rates of unreturned mail, worked with insurers covering Medicaid enrollees, and conducted “shadow checks” to get a sense of who doesn’t qualify, even if they can’t disenroll people.

Some enrollees could be renewed automatically if states verify they qualify by using data from other sources, such as the Internal Revenue Service and the Supplemental Nutrition Assistance Program.

For others, though, the first step entails finding those at risk of losing their coverage so they can enroll in other health benefits.

“It’s a big question mark how many of those would actually be enrolled,” said Matthew Buettgens, a senior fellow in Urban’s Health Policy Center and author of the September report. One factor is cost; ACA or job-based insurance could bring higher out-of-pocket expenses for the former Medicaid enrollees.

“I am particularly worried about non-English speakers,” said Sara Cariano, a policy specialist with the Virginia Poverty Law Center. “Those vulnerable populations I think are at even higher risk of falling out improperly.” The law center is planning enrollment events once the unwinding begins, said Deepak Madala, its director of the Center for Healthy Communities and Enroll Virginia.

Missouri, already sluggish in enrolling eligible people into the state’s newly expanded Medicaid program, had 72,697 pending Medicaid applications as of Jan. 28. Enrollment groups worry the state won’t be able to efficiently handle renewals for nearly all its enrollees when the time comes.

By December, the Medicaid rolls in the state had swelled to almost 1.2 million people, the highest level since at least 2004. The state — one of several with histories of removing from the program people who were still eligible — did not say how many people could lose their benefits.

“I want to make sure that everybody that is entitled to and is eligible for MO HealthNet is getting the coverage that they need — all the way from babies to older individuals to individuals on disability,” said Iva Eggert-Shepherd of the Missouri Primary Care Association, which represents community health centers.

‘No End in Sight’

Some people argue the current protections have been in place long enough.

“There’s no end in sight. For two years, it’s still a quote-unquote ‘emergency,’” said Stewart Whitson, a senior fellow with the Foundation for Government Accountability. The conservative think tank has argued that states can legally begin trimming people from Medicaid rolls without jeopardizing their funding.

“This is the kind of problem that just grows worse every day,” he said of not removing ineligible people. “At the beginning of the pandemic, people were in a different position than they are now. And so responsible legislators and government officials in each state have to look at the facts as they are now.”

Tsai said “it’s quite clear to us” that for states to be eligible for the covid relief bill’s enhanced Medicaid funding, they must keep people enrolled through the emergency. “Those two things are interlinked,” he said.

Meanwhile, states still have no idea when the renewal process will begin. HHS has said that it would give states 60 days’ notice before ending the emergency period. The additional Medicaid funds would last until the end of the quarter when the emergency expires — if it ended in April, for example, the money would last until June 30.

“It’s hard to do a communication plan when you say, ‘You’ve got 60 days, here you go,’” Nelson of Utah’s Department of Health said.

Colorado officials had debated sending letters to enrollees when the public health emergency was nearing its scheduled end on Jan. 16 but held off, expecting that it would be extended. HHS announced a 90-day extension only two days before it was set to expire.

“Those kinds of things are really confusing to members,” Medicaid Director Tracy Johnson said. “OK, your coverage is going to end. Oh, just kidding. No, it’s not.”

KHN senior Colorado correspondent Markian Hawryluk and Midwest correspondent Bram Sable-Smith contributed to this report.

[Correction: This article was updated at 11:15 a.m. ET on Feb. 14, 2022, to clarify the federal funding increase that states received under the Families First Coronavirus Response Act.]

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“…the breakthroughs behind the vaccines unfolded over decades, little by little, as scientists across the world pursued research in disparate areas, never imagining their work would one day come together to tame the pandemic of the century.”

Scientific discovery doesn’t happen in an instant. It almost always results from bringing together knowledge accumulated over time. Coronavirus vaccines were actually the result of some two decades of research, 20 years of blood, sweat, tears and disappointment. That process, with its frustrations and eventual triumphs, is seen in the development of therapeutics for countless other diseases, Alzheimer’s among them.

We Stand to Lose Public Health Impact

Despite the nature of the drug development process, we’re now seeing naysayers gloat over deceleration of Biogen’s Alzheimer’s therapy, Aduhelm. There’s no lack of trade media obituaries and Monday-morning quarterbacks casting blame generously. It’s hard to understand their glee, since all of us — scientists, regulators, patients, caregivers, physicians, media and yes, even private and public payers who foot the health bills of people with dementia — stand to lose dearly if we don’t fully explore the drug’s potential impacts.

Adulhelm isn’t an isolated example. Remember Merck’s Mevacor? The first cholesterol-reducing statin to reach the market and precursor of more effective blockbusters, Mevacor finally passed regulatory muster after much FDA Advisory Committee hand wringing. The drug was marginally effective compared to later statin entries. Today, science has generated data from more than 20 statin trials with some 135,000 patients showing how statins compare to placebo or no medication. The results show an impressive 23 percent reduction in heart attacks — a truly meaningful result. Mevacor, substandard to follow-on statins, was the door-opener that saves millions of lives globally. Then the health system embraced its possibility.

Amyloid Plaque the Holy Grail for Alzheimer’s Drug Targets

Is there be a similar path forward for Alzheimer’s? The FDA concluded there could be, when in April 2021, they approved Adulhelm, the first drug cleared for Alzheimer’s use since 2003. But regulatory approval of the medicine meant more than hope for patients and their caregivers, and more than market success. Adulhelm offers the potential to finally, definitively identify the clinical catalyst for Alzheimer’s, and the opportunity to data from real-world use that could pave the way for other therapies.

We can’t afford not to solve the Alzheimer’s puzzle and to study this medication in a real-world setting. We are facing a veritable tsunami onslaught of Alzheimer’s cases as the vast generation of baby boomers ages, and this epidemic of dementia could bankrupt us. In the absence of effective medicines, the estimated cost of Alzheimer disease management in 2020 alone was $305 billion, expected to increase to more than $1 trillion in the next generation. That astronomical figure accounts for skilled nursing care, home healthcare and hospice care, among other expenses.

For close to 25 years, the theory that amyloid plaque is the primary cause of Alzheimer’s disease has dominated clinical research and drug development. For that quarter-century, scientists have neither been able to confirm or disprove that theory. We are at an inflection point where we must either confirm amyloid plaque as the cause of Alzheimer’s, or move on.

Approval of Aduhelm set the stage to do that, at last. When FDA decided to accelerate approval for Aduhelm, the first drug to reduce amyloid plaque, perhaps they did so in large part to stimulate the generation of sufficient data to inform our path forward on addressing dementia-related illnesses. In this way, Aduhelm may be more important to the future of Alzheimer’s drug development and public health than its very vocal critics realize.

Despite the critical role Aduhelm is poised to play in the future of Alzheimer’s research, the media has gleefully focused on making it a “poster drug.” When the Centers for Medicare and Medicaid Services (CMS) issued draft National Coverage Determination (NCD) for Aduhelm use and reimbursement for patients in randomized controlled trials it opened the door for the cascade of players around the table to think differently. While the CMS pathway for use creates a significant stumbling block to access for the Medicare patient population, it is also a call to organize around making clinical research economically possible. Balance for patient access must be struck.

Neurology’s Who Moved My Cheese Moment

There should be no celebration that CMS has narrowly defined how Alzheimer’s patients can gain access to Aduhelm. We should be disappointed. And yet, CMS’s action could actually be a catalyst for decision-makers in drug development companies, government agencies, academia, medicine and payers to work together. It is a collective opportunity to unite in a massive public health research project to determine if amyloid plaque is or is not a worthwhile surrogate target. This may be a “Who Moved My Cheese” moment.

In fighting COVID-19, a combination of competitive spirit and collaborative mindset made breakthrough treatments possible. The world community — fractured on many other things –recognized a common threat and mobilized. Here, the Federal government rallied to support drug developers through public funds, flexible regulatory decisions to speed access to experimental treatments and fostering collaboration to accelerate therapies for the virus. Just as we are succeeding in protecting lives from the virus, we can collaborate to overcome Alzheimer’s.

Have We Chased a Surrogate Target Clue for Naught?

For decades, we have studied Alzheimer’s disease and chased our tails. We have spent billions on research, yet our progress in this category is still defined by what doesn’t work. We mustn’t let this opportunity pass us by; too much is at stake. If Aduhelm is struggling to gain traction with private and public payers, we must work together to find a path to getting it to the patients who need it for their benefit and for the generation that follows. This could become a massive public health real-world evidence effort and in doing so provide answers to questions we have pondered for decades. We must harness data, talent and resources, working across political and geographic boundaries to better serve the people we seek to help.

Appearances can deceive. Just as the COVID-19 mRNA discoveries are not the result of the past two years but are the outcome of two decades of arduous trial and error in research, Alzheimer’s research is on a long path, that will also have setbacks and successes. The proven collaborative approach to addressing COVID-19 provides a lesson we must now apply to Alzheimer’s if we’re to meet the coming wave of cases that, if unchecked, will undoubtedly cripple us.

[My thanks to colleague John Bianchi for his review of this article.]

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