Health Care of the Future | Future of Health Summit 2024

Economic and Historical Impact of Medical Advances

• More than 50% of global economic growth over the last 200 years is attributed to advances in public health and medical research.
• Eliminating cancer as a cause of death in the U.S. was estimated in 1993 to be worth $50 trillion to the economy.
• Average human life expectancy increased by 11 years over four million years of evolution, but surged by over 40 years in the last 120 years.
• At the start of the 20th century, 20% of Americans (1 in 5) died before their fifth birthday, a rate drastically reduced by public health interventions.
• The 2021 "Innovations Shaping Healthcare" initiative led to the creation of the National Center for Advancing Translational Science (NCATS), with the federal government committing $5–6 billion within two months.

ARPA-H Strategy and "Sputnik" Moments

• ARPA-H targets "ARPA-hard problems": technically risky projects that the private sector cannot yet pursue due to high risk.
• The agency empowers program managers with a unique term limit structure where one year represents 3% of their tenure, enforcing a "one percent of time per two weeks" urgency.
• Unlike DARPA's single geopolitical trigger, ARPA-H identifies "personal Sputnik moments" for individual patients, such as rare diseases or neurodegenerative disorders.
• ARPA-H utilizes a "stacked deck" funding model where initial grants support multiple teams, accepting high attrition rates to ensure at least one viable solution reaches the market.
• The "Sprint for Women's Health" solicitation received 1,700 submissions from 34 countries; 42% of applicants were organizations with fewer than 10 employees.
• ARPA-H awarded $110 million across 23 projects via a streamlined process (3-page applications, 30-minute pitches) to bypass traditional grant writing barriers for startups.
• Winners of the Women's Health Sprint receive two-year "launch pads" including entrepreneur-in-residence mentors to assist with regulatory and commercialization strategies.

Legislative Priorities and "Cures 2.0"

• Rep. Diana DeGette (D) and Sen. Fred Upton (R) are collaborating on "Cures 2.1" to fund innovations through CMS and ensure accessible research for all Americans.
• A white paper outlining Cures 2.1 is scheduled for release before the end of the year.
• Key legislative focuses include addressing prescription drug affordability, maintaining telehealth access post-pandemic, and supporting biomedical research advances.
• Rep. Chris Carter (R) introduced the "Made in America Act" to incentivize the repatriation of pharmaceutical manufacturing and active ingredient production to the U.S.
• Carter argues that pharmaceutical independence is as critical as energy and food independence, citing hoarding of PPE by China in Fall 2019 as a warning sign.

Medicare Advantage (MA) and Payment Models

• Medicare Advantage enrollment recently surpassed 50% of seniors, driven by supplemental benefits (dental, vision, hearing) not covered by fee-for-service plans.
• A bipartisan consensus supporting MA has been undermined by a MedPAC report claiming MA costs 122% of fee-for-service rates after "normalizing" for patient health status.
• The Biden administration lowered MA reimbursement rates and adjusted risk adjustment formulas, reducing credits for sicker beneficiaries.
• A McKinsey analysis indicated that in 2023-2024, only five MA plans remained profitable, with most operating at zero margin or losses due to increased utilization and reduced rates.
• Financial distress in MA plans is causing providers to withdraw from value-based care models, pushing the system back toward fee-for-service reimbursement.

Operation Warp Speed and Supply Chain Innovations

• Operation Warp Speed utilized authorities from the 21st Century Cures Act to enable rapid vaccine development during the pandemic.
• The timeline from the first human case of SARS-CoV-2 to the first Moderna vaccine administration was reduced to nine weeks (63 days).
• ARPA-H and BARDA addressed "valley of death" market failures by de-risking development and using the government as a unique purchaser for countermeasures (e.g., botulinum antitoxin).
• BARDA investments allow for immediate manufacturing capacity before product approval, compressing timelines that previously required six months to a year of plant construction.

Future Challenges in Financing Curative Therapies

• Alex Azar highlighted a systemic mismatch where health insurance is designed for chronic management (e.g., Lipitor) rather than one-time curative therapies costing millions.
• A specific example cited involves a 19-year-old cured of sickle cell anemia for a high cost, which traditional insurance models may reject despite long-term savings.
• Panelists emphasize the need for new payment models that reward innovation without "killing the golden goose" while democratizing access to cures.
• There is a growing concern regarding vaccine resistance (e.g., in Colorado) which threatens to reverse decades of public health progress.
• The cost of genomic sequencing is dropping rapidly, with projections suggesting home sequencing could become available within five years.

Call to Action and Government Reform

• Rep. Carter urged business leaders and professionals to run for government to increase the diversity of experience in Congress, noting it is a "citizen legislature."
• The panel called for continued high-risk government investment, arguing that a failure rate above 50% is necessary for breakthrough innovation.
• Experts urged Congress to maintain funding for NIH and other research agencies to sustain the pace of discovery.
• Panelists stressed the need to maintain public trust in science and institutions to prevent regression in medical adoption and policy.