Suicide rates have been rising in the U.S.; over 49,000 died of suicide in 2023, and this number could understate the problem, as some cases of suicide are likely mislabeled. Six in ten Americans report that they know someone who’s thought about, attempted, or died by suicide. Military veterans have a rate of suicide over 50% higher than non-veterans. Suicide rates for LGBTQ and Indigenous peoples are also higher than the general population.
The Veterans Administration did a study to see if using virtual mental healthcare was linked to suicide. Their population was over 16,000 recently discharged from active duty veterans with an average age of 33. They found each 1% increase in the use of virtual mental health visits was associated with a 2.5% decrease in the rate of suicide-related events. This study was published in JAMA Network Open.
The GLP-1 drug semaglutide (sold as Ozempic for diabetes and Wegovy for weight loss) has already been shown to have substantial health benefits, including decreased progression to renal failure, decreased major adverse cardiovascular event, improved mortality and decreased joint pain. A study presented at the recent Obesity Society conference showed that semaglutide was associated with a decrease in hospitalizations for all causes and specifically for cardiac disease, infections, surgical and medical procedures and respiratory disease. All these differences were statistically significant.
These results were from a randomized trial with 17,604 patients, which included those over 45 years old. This is relevant to employer-sponsored health plans because the average age of participants is under 62. The decrease in hospitalizations was significant (11% lower overall, 18% less in cardiac disease), and those on semaglutide had 19 fewer hospital days per 100 patient years on average. Such a decrease in hospitalization could help strengthen the case that semaglutide is cost-effective. However, like most medical interventions, it’s unlikely to be a cost saving, since saving 1.9 hospital days per person per year isn’t likely to fully offset the high cost of these medications.
This study has not yet been published in a peer-reviewed journal, but likely will be in the coming months.
I’m a primary care physician by training, and I love practicing primary care. Primary care physicians (PCPs) can help patients navigate our confusing healthcare system, keep up with preventive care and make difficult healthcare decisions that are consistent with their wishes and values. As a patient, especially as I get older, I value my visits with my primary care physician.
But I’m lucky. Many people can’t find a primary care physician. Wait times to get an appointment with a new pediatrician, general internal medicine doctor, or family physician are often over a month. Many primary care clinicians aren’t seeing new patients.
And things are getting worse. Physicians in training aren’t choosing to go into primary care; a record number of training positions in primary care fields went unfilled in this year’s residency match. The training process for new PCPs is long; residency is at least three years long, and most medical students have decided whether to pursue primary care by the middle of their third year of medical school.
There’s one bright spot. Nurse practitioners (NPs) and physician assistants or physician associates (PAs) represent most of the increase in primary care capacity over the last decade. But even NPs and PAs are increasingly considering joining specialty practices instead of going into primary care. While traditional NP programs required years of clinical practice, Bloomberg Businessweek reported that some graduates of newly accredited remote nurse practitioner training programs received little clinical training during their education, and some of these programs required no previous clinical experience.
A report in the Journal of General Internal Medicine used data from the Medical Expenditures Panel Survey and databases of physicians, NPs and PAs to estimate current primary care clinician counts, and project how many net new primary care clinicians are needed by 2040. They found that about 58,000 new primary care clinicians are needed to meet the population’s needs by 2040.
We’re unlikely to train this many new primary care physicians by 2040, so many of these services will need to be provided by non-physicians. Some hoped that new tuition-free medical schools could encourage more physicians to pursue primary care training, but preliminary data show that graduates of these programs go into primary care less often than graduates of programs that charge tuition. Another potential solution is foreign-trained doctors who could help meet this need. Some states have made it easier for foreign-trained doctors to practice.
High blood pressure is the second leading cause of premature cardiovascular disease (after cigarette smoking). The initial treatment for high blood pressure is diet and exercise, although many will continue to have high blood pressure despite limiting calories and salt and exercising regularly, and many would benefit from treatment with blood pressure medications. According to the National Committee on Quality Assurance, 45% of those on commercial preferred provider organizations with a diagnosis of hypertension had blood pressure of over 140/90 at their last office visit.
The most commonly used effective blood pressure medications are taken as pills once a day, have few side effects and are available generically. Many cost under $100 for a year of treatment. Many people with high blood pressure don’t even know they have hypertension, and many aren’t being treated adequately to reduce their risk of a premature heart attack or stroke. Hypertension is sometimes called the “silent killer” because it may show no symptoms.
Researchers reviewed data from the 2022 NHANES database (National Health and Nutrition Examination Study) to assess how likely people were to know of their hypertension, and what treatment, if any, they received. They found that about half (52%) of people with uncontrolled hypertension didn’t know they had high blood pressure. Less than one-third (32%) were both aware of their blood pressure and treated with medication.
Jeff is an internal medicine physician and has led WTW’s clinical response to COVID-19 and other health-related topics. He has served in leadership roles in provider organizations and a health plan and is an Assistant Professor at Harvard Chan School of Public Health.
Plan redesign outweighs cost-shifting to reduce the cost of care, WTW survey finds
