Weight-Loss Apps Ride Wegovy Wave; Stillbirths Sidelined; Private Equity Erodes Care

Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.

Weight-Loss Apps Ride Wegovy Wave

A handful of online weight-loss startups are riding the wave of GLP-1 agonist hype, making promises like, “This is the last weight-loss program you’ll try.” But companies such as Found and Calibrate may be prescribing drugs without delivering the personalized intensive coaching they advertise — and access to the medications isn’t always guaranteed, according to Kaiser Health News (KHN).

That’s not stopping them from attracting more than $200 million in venture capital funding, and flooding Facebook and Instagram with 40,000 ads. The companies market themselves to wealthier white women, promising specialized coaching and nutrition advice. But patients complained to KHN and online that they got canned advice about behavioral care; that questions about medications or the app were slow to be answered; and that they had ups and downs with their coaches.

Despite the complaints, some experts say the companies will increase access to GLP-1-agonists, which have shown to be effective for weight loss in clinical trials (though the popular brand, Wegovy, is in short supply). They may also boost access to specialized weight-loss care, which is in high demand.

Yet that will come at a steep price: Calibrate costs $1,600 a year, with an additional $1,500 a month for drugs, although insurance can cover them in limited circumstances. Found costs $600 for 6 months, including generic drugs.

Stillbirths Preventable, but Still Overlooked

When Amanda Duffy raised concerns about her baby’s movement prior to her due date, healthcare professionals assured her everything would be okay. But just a day before her scheduled C-section, the baby was stillborn, with the umbilical cord wrapped around her neck twice.

Some 20,000 stillbirths happen in the U.S. each year — around 15 times the number of infants that die of Sudden Infant Death Syndrome — and about a quarter are deemed to be preventable. A ProPublica investigation found that the federal government has not prioritized policies and laws that could reduce stillbirths.

Parents are rarely taught about stillbirths, and how to look for signs that the baby is in danger, such as decreased movement. Placental exams and autopsies are underused because parents aren’t aware they should ask for them, according to the report.

“I’ve spoken to more women than I can count that said, ‘I raised the red flag, and I was sent home,’ … only to wake up the next day and their baby is not alive,” Haine Vijayvergiya, a maternal health advocate and mom, told ProPublica.

The CDC and NIH began two studies years ago that would have tracked and researched stillbirths, but both were halted. Resources have been channelled into preventing maternal mortality and reducing maternal racial inequities. But stillbirths, which are more common than maternal deaths, and at least twice as common in Black women than white women, have been given less attention.

Advocates have brought forward a number of measures for preventing stillbirths, including legislation in Iowa to create a stillbirth registry. Organizations such as PUSH for Empowered Pregnancy and Healthy Birth Day have done their own education campaigns, or pushed for national legislation that would allocate funding for research, data collection, and fetal autopsy training. But, according to ProPublica, little meaningful progress has been made.

Private Equity Eroding Care

Private equity’s rapid entry into healthcare has driven up healthcare costs and eroded quality, according to an investigation from Kaiser Health News (KHN).

In 2021, there were 1,400 acquisitions of healthcare companies by private equity firms, worth some $206 billion. Although leadership argues they can turn around failing practices and increase efficiency, the policies they implement amount to unnecessary or sub-standard care and maximum profits, according to KHN.

While private equity-operated practices still make up a small part of the national market, firm ownership dominates metropolitan areas across the country. For example, private equity controls almost three-quarters of the gastroenterology practices in Winston-Salem, North Carolina; Lancaster, Pennsylvania; Olympia-Tumwater, Washington; and others.

On average, the cost of a medical claim shot up by $71 after private equity takeovers in three specialties, KHN reported. One chain of pain clinics billed Medicare up to $1,100 for back braces and $1,800 for urine drug tests, both of which were often unnecessary.

Private equity ownership also has been linked to worse care and increased patient deaths in nursing homes. Yet firms may mandate that staff see more patients per day, fire employees, and hire less qualified staff.

KHN found that because more than 90% of private equity deals fall below a reporting threshold, they avoid regulatory oversight and aren’t subject to antitrust reviews. Since 2014, private-equity run companies have had to pay $500 million in lawsuits alleging they fraudulently billed Medicare and Medicaid, but in most cases have avoided liability.