Partnerships Leading to a Healthier Tomorrow | Future of Health Summit 2024

Panelist Backgrounds and Roles

• Yele Aluko: Former cardiologist (22 years practice), currently Chief Medical Officer at Ernst & Young and Director of the EY Center for Health Equity.
• John Crowley: President and CEO of BIO (Biotechnology Innovation Organization); formerly CEO of Amicus Therapeutics (founded ~20 years ago to address Pompe disease after his children's diagnosis).
• Cody Kinsley: Secretary of Health and Human Services (HHS) for North Carolina; former CFO of the US Treasury under Presidents Obama and Trump.
• Megan Turrell: Runs Royalty Pharma (New York-based company founded ~28 years ago) and a biotech lending business started in 2009.

Financial and Operational Strategies

• North Carolina Medical Debt Relief: The state forgave $4 billion in medical debt for 2 million residents by leveraging state-directed payments within Medicaid.
  • All 99 acute care hospitals in the state opted into the program to receive funding and forgive debt.
  • The initiative also prospectively raised charity care floors and established presumptive eligibility for patients.
• Royalty Pharma Funding Model:
  • Invested approximately $25 billion in the life sciences ecosystem over the last decade.
  • Allocated roughly $10 billion to non-approved products, funding clinical trials via non-dilutive royalty agreements rather than equity or debt.
  • Currently exploring second and third-generation GLP-1 (weight loss/obesity) drugs, drawing parallels to the "anti-TNF" wave (Humira, Remicade) that generated significant returns.

Systemic Healthcare Challenges Identified

• Industry Dysfunction: The healthcare sector is described as overtly expensive with an estimated $500 million in annual waste from unnecessary procedures, avoidable admissions, and fraud.
• Fee-for-Service Barriers: The current reimbursement model incentivizes volume over value, making prevention an "afterthought" and failing to pay providers for preventing disease onset or recurrence.
• Access Disparities:
  • Complex utilization management by insurance companies disrupts the physician-patient bond.
  • Significant disparities exist in treatment access and health outcomes based on race and economic class, though numerically more Caucasians remain uninsured in absolute terms.
• Global Comparison: The US is the only top-14 OECD nation without universal health coverage, leading to poorer macroeconomic indices for health efficiency compared to Japan, Singapore, Korea, and Nordic countries.

North Carolina State Initiatives and Results

• Medicaid Expansion: Achieved through a bipartisan effort after a decade-long battle, enrolling 578,000 people in 11.5 months.
• Healthy Opportunities Pilots: Launched in 2022 to use Medicaid funds for social determinants of health (food, housing, transportation, safety).
  • Results from ~20,000 participants show 300,000 services provided.
  • Statistically significant reductions in emergency department visits and hospitalizations.
  • Generated net savings of $80–$85 per member per month despite program costs.
• GLP-1 Coverage: North Carolina Medicaid became one of the first in the US to cover weight-loss drugs to mitigate future long-term care costs.
  • State employees in the private plan were excluded due to separate policy decisions, despite Medicaid securing superior rebates.
• Food Security: The state is heavily investing in food access (e.g., "Healthy Opportunities"), noting that SNAP enrollment is significantly lower than potential need, requiring administrative simplification.
  • North Carolina's most expensive drug identified is Dupixent (anti-inflammatory for asthma/COPD/skin conditions), not the GLP-1 class.

Biotechnology Industry Priorities (BIO)

• Strategic Focus: Innovation and access are the top priorities, framed as matters of public health, economic security, and national security.
• Innovation Ecosystem:
  • ~70% of new medicines originate from small emerging biotech companies.
  • Calls for a "virtuous circle" involving patients, academia (NIH), and industry to accelerate development.
  • Proposes regulatory reforms including Bayesian statistics and adaptive study designs.
• Access Reforms: Advocates for a "21st-Century Access Act" to address economic barriers like co-pays and out-of-pocket costs, distinct from list price manipulation.
  • Seeks transparency to decarbonize the byzantine rebate system and remove perverse incentives for middlemen (PBM/wholesalers).
• Agricultural Biotechnology: Highlights biotech's role in food security, citing examples like anti-browning apples that reduce 40% of food waste.
• Genetic and Environmental Limits: Acknowledges that behavioral changes alone cannot solve outcomes for genetic disorders (e.g., Pompe disease) or high-risk biological factors (e.g., LDL cholesterol), necessitating medical intervention.

Forward-Looking Statements and Optimism

• Golden Age of Medicine: John Crowley expresses optimism that technology now exists to prevent, control, or cure diseases, provided regulatory and manufacturing bottlenecks are resolved.
• Prevention Shift: Yele Aluko advocates for political advocacy to address "political determinants of health" to force a cultural shift from reaction to prevention.
• Bipartisan Efficiency: Cody Kinsley argues that framing health reform as an efficiency and cost-saving measure is the only viable path for cross-party agreement.
• Data and Collaboration: Royalty Pharma is partnering with Mount Sinai's Institute of Health Equity Research to utilize data for addressing treatment disparities and improving access.

Specific Disclosures and Clarifications

• John Crowley confirmed the accuracy of the movie depiction of his life regarding Pompe disease, with the sole exaggeration being the actor's height (6'5" vs. actual).
• The discussion clarified that GLP-1 drugs are viewed as a necessary investment for Medicaid to prevent skyrocketing long-term care costs associated with obesity.
• North Carolina's administrative rules prevent automatic "reverse" enrollment (e.g., Medicaid to SNAP), highlighting the need for aligned rules across agencies.