Happy Constitution Day!

From Washington, D.C.,

• The American Hospital Association News reports,
  • “A Capitol Hill briefing Sept. 17 in Washington, D.C., hosted by 11 national healthcare organizations, including the AHA, highlighted the growing epidemic of workplace violence and its effects on staff well-being and patient safety. At the briefing, titled Protecting Those Who Care: Addressing Violence Against Healthcare Workers, Hill staff heard panelists’ personal experiences with physical and verbal attacks on the job and how hospitals are working to reduce the incidence of violence. The panelists were: Elizabeth Wells, M.D., executive vice president, chief clinical officer, and physician-in-chief, Children’s National Hospital; Jonathan Ripp, M.D., chief wellness officer and dean for well-being, Icahn School of Medicine at Mount Sinai; Tiffany Covarrubias-Lyttle, RN, associate professor of nursing, University of Lynchburg; and, Sheila Roth, Ph.D., professor emeritus, Carlow University. Reps. John Joyce, R-Pa., and Joe Courtney, D-Conn., also made brief remarks during the event.
  • “In a joint statement, the AHA and other participating organizations said, “Workplace violence, including physical assaults, threats, intimidation, and harassment, erodes the safety and dignity of healthcare workers, directly contributes to staff burnout and turnover, and staffing shortages, and compromises the quality of care and patient safety. This violence undermines providers’ ability to ensure safe, healing environments for all.”
  • “The AHA’s Hospitals Against Violence initiative includes resources and best practices for hospitals to use and share to address workplace and community violence.” 

• Beckers Clinical Leadership relates,
  • “HHS Secretary Robert F. Kennedy Jr. appointed eight new members to the U.S. Preventive Services Task Force, bringing the influential preventive care panel to 16 members.
  • “Mr. Kennedy made the appointments Sept. 17 through the Agency for Healthcare Research and Quality. The eight join eight members currently serving on the volunteer panel of prevention and evidence-based medicine experts.
  • “The task force carries outsized weight for health system and payer leaders: preventive services that the panel grades “A” or “B” must be covered by most private insurers without cost-sharing under the ACA. Its composition effectively shapes which screenings and preventive services patients can get at no cost.” * * *
  • “Seth Corey, MD, a pediatric hematologist-oncologist at Cleveland Clinic, will chair the task force. The other seven appointees are:
    • “Patrick Hunter, MD, a pediatrician at Pensacola (Fla.) Pediatrics and member of the Florida State Board of Medicine
    • “Ronald Karlsberg, MD, a clinical professor of medicine at Los Angeles-based Cedars-Sinai Medical Center’s Smidt Heart Institute
    • “Venkatesh Murthy, MD, PhD, professor of preventive cardiology at the University of Michigan in Ann Arbor
    • “Stephen Parente, PhD, a health finance professor at the University of Minnesota’s Carlson School of Management in Minneapolis
    • “Goldie Stands-Over-Bull, MD, lead family medicine physician at Texas Native Health in Dallas
    • “Louis Wilson, MD, a gastroenterologist and managing partner at Wichita Falls (Texas) Gastroenterology Associates
    • “Dennis Wulfeck, MD, a diagnostic radiologist and president of the practice board at Radiology Partners’ MBB Radiology in Jacksonville, Fla.” 

• U.S. News and World Report tells us,
  • “The U.S. Senate ⁠health ⁠committee will hold a confirmation ⁠hearing next week for Dr. Heidi Overton, President Donald Trump’s pick to ​lead the embattled Food and Drug Administration, the panel said on Thursday.
  • “The hearing will take place ‌on September 24, the Senate Health, ‌Education, Labor, and Pensions Committee said in a statement. Trump nominated Overton, a White ⁠House policy aide, ⁠in August, turning to an “America First” ally to steady an agency ​shaken by staff losses, low morale and fights over vaccines, the abortion pill and drug approvals.
    
• Per Department of Health and Human Services news releases,
  • “The Advanced Research Projects Agency for Health (ARPA-H), an agency within the U.S. Department of Health and Human Services (HHS), today launched the new Systems for Phenotypic Evaluation, Clinical Trajectories, Response, and Agency (SPECTRA) program, a major research effort to transform how autism is understood, diagnosed, and supported across the lifespan. SPECTRA will bring together biological, clinical, behavioral, and real-world data with advanced computational tools to enable earlier and more accurate diagnosis, identify factors that shape individual health and developmental trajectories, and develop more precise approaches to care tailored to each person’s needs.
  • “Autism is not one-size-fits-all, and our science and care cannot be either,” said HHS Secretary Robert F. Kennedy, Jr. “Millions of American families are impacted by autism, and they need better answers about why it presents so differently from one person to another and which approaches can best meet each person’s needs. SPECTRA will harness the best of American science and innovation to deliver those answers — and turn them into better outcomes for people with autism and their families.” * * *
  • “Learn more about SPECTRA on its program page, including information about the solicitation.”
• and
  • “The U.S. Department of Health and Human Services (HHS) today issued a Request for Information (RFI) calling on Americans, scientists, physicians, industry, and public health experts to submit evidence and information on the potential health effects of electromagnetic fields (EMFs), radiofrequency (RF) radiation, and wireless radiation exposure.
  • “The RFI will help HHS evaluate the state of the science, compare U.S. and international safety standards and regulatory approaches, identify critical research gaps, and develop practical, evidence-based recommendations for policymakers, families, schools, communities, and public health professionals.
  • “Wireless technologies are part of daily life, and our science must keep pace,” said HHS Secretary Robert F. Kennedy, Jr. “The MAHA Strategy directed HHS to examine electromagnetic radiation and health research, and we are acting on that directive. I encourage scientists, physicians, industry, public health experts, workers, parents, and citizens to bring us the best available evidence so we can identify the gaps and focus federal research where it is needed most.” * * *
  • “More information about the RFI can be found at the Federal Register [PDF].”

• The International Foundation of Employee Benefit Plans helpfully shares information about “Red Flags for Mental Health Parity Compliance Problems.”

From the U.S. Office of Personnel Management front,

• FedSmith reports,
  • “Federal retirees and Social Security recipients are only one inflation report away from knowing their 2027 cost-of-living adjustment (COLA). The Bureau of Labor Statistics (BLS) will release the September inflation report on October 14. That report will provide all three CPI-W figures needed to calculate the 2027 COLA.”
  • “The latest estimate from The Senior Citizens League (TSCL) puts the 2027 Social Security COLA at 3.5%. The organization lowered its estimate from 3.6% after the latest inflation report.
  • “Because Social Security and Civil Service Retirement System (CSRS) benefits use the same underlying inflation measure, that estimate also indicates the COLA CSRS retirees may receive. For most Federal Employees Retirement System (FERS) retirees eligible for a COLA, however, a 3.5% increase in the CPI-W would result in a 2.5% FERS COLA because FERS uses a different formula.”
    
• Serving those We Serve tells us what federal and Postal employees should know about the redesigned Social Security Statement.

• Tammy Flanagan, writing in Govexec, lets us know how to navigate the Pay.gov maxe for federal retirement deposits.
  • “Don’t let missing service credits or opaque OPM billing notices shrink your monthly annuity. Here is what you need to know before clicking submit.”

• MeritTalk informs us,
  • “The Office of Personnel Management (OPM) used governmentwide OneGov deals to give every employee access to six artificial intelligence (AI) platforms, and more than 70% of its workforce actively uses at least one, according to OPM CIO Adam Starr.
  • “Speaking Tuesday at the GovExec Government & AI Summit in Washington, D.C., Starr said OPM has leaned heavily on the General Services Administration’s (GSA) OneGov agreements to rapidly expand employee access to AI.
  • “The OneGov deals were key to our ability to innovate at OPM with AI,” Starr said. “We basically bought all of the AI offerings at $1, and so we gave every employee six AI tools, and we encourage them to use it.”
  • “Those tools include Google’s Gemini, Microsoft Copilot, xAI’s Grok, OpenAI’s ChatGPT, Anthropic’s Claude, and Perplexity AI, Starr said.
  • “The strategy is intentionally multi-model. Starr said he wants employees to have access to several platforms because AI models are evolving quickly and vendors are regularly “leapfrogging each other.”

From the Food and Drug Administration front,

• Per an FDA news release,
  • “The U.S. Food and Drug Administration today approved Fayuvi (rebisufligene etisparvovec-hopf), the first treatment for pediatric patients with mucopolysaccharidosis type IIIA (MPS IIIA), also known as Sanfilippo syndrome type A., MPS IIIA is a rare inherited disease that progressively damages the brain and nervous system, causing children to lose cognitive, language and other developmental abilities over time. Until today, treatment was limited to managing symptoms; there was no FDA-approved therapy designed to change the underlying course of the disease.
  • “The Trump Administration is committed to bringing safe and effective treatments to patients with the most urgent and unmet needs. The approval of Fayuvi marks a historic moment for children and families living with MPS IIIA, which is a disease that has, until now, offered no approved treatment to alter its devastating course,” said Acting FDA Commissioner Kyle Diamantas, J.D. “Gene therapy holds tremendous promise for rare diseases like Sanfilippo syndrome type A, and this milestone reflects the FDA’s commitment to action.”  
  • “Fayuvi is a one-time, intravenous (given directly into a vein) gene therapy that uses a modified, non-infectious virus called an adeno-associated virus serotype 9 (AAV9) to deliver a working copy of the SGSH gene into the patient’s cells. This enables the body’s cells to produce sulfamidase — the enzyme that is missing or deficient in MPS IIIA — allowing heparan sulfate to be properly broken down in lysosomes and reducing its harmful buildup throughout the body and brain.”

• Targeted Oncology reports,
  • “FDA 510(k) clearance covers robotic colonoscopy for screening, surveillance, diagnostic evaluation, and advanced therapy including EMR and ESD across the full colon. 
  • “Triton 1 targets limitations of manual scope manipulation by adding robotic control intended to enhance stability, maneuverability, and procedural efficiency during flexible endoscopy. 
  • “CARE I (NCT06935734) reported 100% cecal intubation and no adverse events, meeting primary safety/efficacy end points in a first-in-human cohort. 
  • “Detection performance in CARE I included ADR 54.2% and polyp detection rate 67.5%, exceeding a cited 35% ADR industry threshold. 
  • “Endoscopist ergonomics improved, with a 67% lower perceived procedural workload versus manual colonoscopy on NASA-TLX, suggesting reduced physical and cognitive operator burden.”

• MedTech Dive adds,
  • “Medtronic has received Food and Drug Administration clearance for a vessel-sealing technology used with its Hugo soft tissue robotic surgery system.
  • “The clearance, which Medtronic disclosed Wednesday, brings LigaSure technology, used in more than 45 million procedures worldwide, to the company’s robotic-assisted surgery platform.
  • “Targeting markets dominated by Intuitive, Medtronic has identified an opportunity to win share by pairing its platform with energy instruments that physicians use in non-robotic surgeries.”

• MedPage Today informs us,
  • “Unapproved use of deoxycholic acid injection (Kybella) outside of the submental fat region may carry a risk of neuromuscular and other potentially serious adverse events, according to an FDA labeling update.
  • “A review of the FDA Adverse Event Reporting System (FAERS) revealed 129 cases of adverse events associated with use of deoxycholic acid in unapproved areas since the product was approved in 2015, the agency stated in a safety communication. The reports included some serious adverse events, such as blurred or reduced vision with periorbital use of deoxycholic acid injection and muscle or nerve injury, including facial paresis and paresthesia.
  • In announcing deoxycholic acid injection’s approval, the FDA emphasized, “It is important to remember that Kybella is only approved for the treatment of fat occurring below the chin, and it is not known if Kybella is safe or effective for treatment outside of this area.”

From the judicial front,

• Bloomberg Law reports,
  • “An out-of-network healthcare provider can’t sue Cigna Health and Life Insurance Co. to recover more than $3 million it won against the plan through the No Surprises Act’s independent dispute resolution process, a federal appeals court said Thursday.
  • “The text and structure of the federal law, which created a process for resolving disputes between health plans and out-of-network providers, make clear that it doesn’t provide a private right of action to enforce arbitration awards obtained through that process, Judge Michael H. Park said. The US Court of Appeals for the Second Circuit thus affirmed the dismissal of East Coast Advanced Plastic Surgery LLC’s suit against Cigna.
  • “Although the NSA gives providers a right to payment from health plans for certain services, it delegates enforcement authority to multiple federal agencies and to states,” Park said for the unanimous panel. “This statutory scheme reflects Congress’s intent that the NSA, including payment of IDR awards, be enforced through administrative action rather than private litigation.”

• Beckers ASC Review relates,
  • “San Tan Valley, Ariz.-based Rita Ntusa Anagho has been sentenced to 14 years in federal prison for orchestrating a $69 million Medicaid fraud scheme through her addiction treatment clinic, according to a Sept. 17 news release from the Department of Justice.
  • “Ms. Anagho, 54, a licensed nurse practitioner, owned and operated Tusa Integrated Clinic, which fraudulently billed Arizona’s Medicaid agency more than $69 million between about May 2022 and March 2023; the agency paid roughly $54.9 million on the false claims, according to court documents. 
  • “Ms. Anagho and her co-conspirators allegedly targeted patients covered under Arizona Medicaid’s American Indian Health Care Program, which reimburses at higher rates than other Medicaid plans, paid illegal kickbacks to sober home owners for patient referrals, and falsified treatment records to conceal the scheme.”

From the public health and medical / Rx research front,

• Beckers Clinical Leadership reports,
  • “The U.S. cancer death rate declined 35% between 2015 and 2024, averting more than 4.8 million deaths, according to the American Association for Cancer Research’s 16th annual Cancer Progress Report, published Sept. 16.
  • Here are [three] things [the article has eight] healthcare leaders need to know from the report:
  • Death rates fell an average of 4.2% per year for lung cancer, 1.3% for colorectal cancer and 1.2% for female breast cancer between 2015 and 2024.
  • An estimated 2.1 million new cancer cases will be diagnosed in 2026.
  • By 2050, the number of annual cancer diagnoses is projected to rise to 2.5 million.
  • More than 18.6 million people with a history of cancer were living in the U.S. as of Jan. 1, 2025.
  • AACR researchers expect 22 million people to be living with cancer or a history of cancer by 2035.
  • “Read the full report here.”

• Healio points out,
  • “Around 2.71 billion people worldwide were exposed to secondhand smoke in 2023.
  • “An expert encouraged clinicians to screen women, children and patients with cardiac issues for exposure.” * * *
  • “Despite the findings, Flor and colleagues highlighted progress from tobacco-reducing policies in the Americas, as “of the 79 countries attaining the highest level of achievement in smoke-free protections globally, 24 are in the Americas, approximately 70% of the countries in that region.”
    
• STAT News adds,
  • “For years, researchers have known that, among people diagnosed with lung cancer, the prevalence of nonsmokers has been increasing. But they have been trying to determine what factors — whether genetic, environmental, or something else — might put these “never-smokers” at heightened risk. 
  • “Now, researchers have identified a very rare genetic variant that is associated with 25-fold higher odds of lung cancer, they reported in the journal Science on Thursday. In the U.S., the variant is far more common among people in Southern Appalachia than in other regions. 
  • Experts said that the variant likely only plays a role in a small portion of never-smoker lung cancer cases. But the research provides further evidence that these types of tumors can be tied to distinct risk factors, which may in turn require thinking differently about screening programs and treatment strategies. More broadly, the new study highlights the types of narrow but crucial discoveries that can be made by turning to large datasets replete with health information from millions of people. In this case, the investigators relied on genetic data from 23andMe.” * * *
  • “The variant in question — known as T790M — is a version of a gene called EGFR, which typically helps regulate how cells grow and divide. Select EGFR mutations can crop up over a person’s life and are among the most important drivers of lung cancer, and in turn are targeted by some cancer drugs.”

• The Washington Post calls attention to “5 movements physical therapists say every adult over 50 should do daily.”
  • These simple moves can help you maintain mobility and independence as you age.”

• Beckers Behavioral Health informs us,
  • “A 13-item Mental Wellness Tool detected common or severe mental disorders, substance use disorders and suicide risk among patients receiving psychiatric emergency department care at a New York City hospital, according to a Sept. 17 Medscape report.
  • “Existing mental health screening tools typically assess for one disorder, and screening for a range of psychiatric conditions can take well over 45 minutes and require several assessment tools. The mwTool-13 is designed to screen for multiple conditions in a single assessment.
  • “The mwTool-13 can be administered in 2 to 10 minutes, according to a Sept. 3 study published in Psychiatric Services.”

• The Wall Street Journal shares readers views on patient portals.

• Health Day tells us,
  • “Nearly two-thirds of suspected poisonings in young children probably do not need the emergency department and can be handled by a call to the local poison control center, according to a study published in the August issue of Clinical Toxicology.
  • “Liam P. McLoughlin, M.D., from Rutgers New Jersey Medical School in Newark, and colleagues investigated the medical necessity of pediatric emergency department presentations for poison cases where a poison control center was not contacted prior to presenting at the emergency department. The analysis included toxicologist reviews of summaries from 348 poison control center cases, originating from a health care facility, involving patients aged younger than 6 years.” * * *
  • “A big takeaway from the paper is that more needs to be done to make sure parents, schools, and communities know the poison center is a resource they can turn to when a poisoning is suspected,” McLoughlin said in a statement. “The poison center is available 24/7, 365, and is staffed by amazing people who can provide life-saving information by phone at no cost.”
• and
  • “Exercise is already recommended to help people with cancer manage fatigue and improve quality of life. Now, there is evidence the benefits may go further.
  • “A new study finds structured exercise may help people with cancer live longer and have more time free of disease.
  • “Chih-Chen Tzang of the National Taiwan University and colleagues analyzed 21 clinical trials involving more than 8,400 cancer patients.
  • “Some followed supervised exercise programs that included aerobic exercise, strength training or both. Others did not.
  • “Over an average follow-up of about five years, those who exercised were 23% less likely to die and 17% less likely to have their cancer return before death.
  • “The benefits were strongest among people with early-stage cancer, those who did aerobic exercise — alone or with strength training — and those who completed at least 70% of their exercise program.”

• Per Genetic Engineering and Biotechnology News,
  • “The genome editing toolbox provides unprecedented opportunities to engineer the human genome. However, genome editing for therapeutic benefit continues to have its limitations. Most current methods rely on untargeted gene delivery or short DNA edits that need to be individualized to each patient.
  • “Now, a new paper describes a novel genome engineering method, prime assembly, that allows long DNA fragments to be integrated into precise and programmable target positions within living cells. This approach, which leverages CRISPR-targeted dual flap synthesis, may allow for the development of universal gene therapies.
  • “This work is published in Nature in the paper, “Targeted genomic integration and rearrangement using prime assembly.”
    
• Per Fierce Pharma,
  • “Roche’s T-cell engager portfolio has notched another milestone, as a phase 3 trial of the company’s Lunsumio met its primary endpoint in earlier-line follicular lymphoma.
  • “Without sharing any specific data, Roche and its subsidiary Genentech said Lunsumio’s combination with lenalidomide (Revlimid) demonstrated a statistically and clinically meaningful improvement in progression-free survival against rituximab (Rituxan) plus lenalidomide, known as R2, in the phase 3 Celestimo study. 
  • “The trial enrolled follicular lymphoma (FL) patients who have received at least one prior line of treatment, and it serves as the confirmatory study required to convert Lunsumio’s existing accelerated approval as a monotherapy in third-line FL into a full approval, while also potentially moving the drug earlier into the second-line setting.”

From the U.S. healthcare business and artificial intelligence front,

• Beckers Payer Issues reports,
  • “The National Committee for Quality Assurance has named the highest quality and most effective health plans of 2026 based on clinical quality, patient experience and health plan accreditation status.
  • “The ratings were released Sept. 16 and are based on 2025 data from commercial, Medicare, Medicaid and ACA plans that reported HEDIS and CAHPS results to the NCQA, which cover approximately 236 million people. Some MA plan data is from 2024 because of reporting schedules, and NCQA Accreditation status was also factored in. Plans were rated on a zero- to five-star scale, with five being the highest rating. In total, 956 plans received a rating.
  • “Commercial plans that received a five-star rating:
    • BCBS Massachusetts
    • Capital District Physicians’ Health Plan (New York)
    • Capital District Physicians’ Healthcare Network (New York)
    • Harvard Pilgrim Health Care (Massachusetts, Maine)
    • Independent Health (New York)
    • Kaiser Mid-Atlantic (Washington, D.C.; Maryland; Virginia)
    • Kaiser Northern California
    • UPMC Benefit Management Services
    • UPMC Health Plan
• and
  • “When Providence announced it was shutting down its health plan earlier this year after a $102 million loss in 2025, it joined a growing list of health systems stepping back from the insurance business. Carle Health’s Health Alliance, Michigan Medicine’s U-M Health Plan and others have wound down or are exiting, citing volatility in Medicare Advantage and government payer markets that have made provider-sponsored plans increasingly difficult to sustain.
  • “Terry Gilliland, MD, president and CEO of Danville, Pa.-based Geisinger, is watching the same environment unfold and coming to the opposite conclusion.
  • “Rather than say, this is hard and dump the plan, we’ve made the necessary changes including leadership top to bottom to grow profitably,” Dr. Gilliland said.”
• and
  • “CVS Health’s Aetna is expanding prior authorization bundles for cancer, available to some Medicaid members as of Sept. 1.
  • “The update impacts Medicaid members with providers in Oklahoma, Illinois, Maryland, New Jersey, Virginia, Florida, Kentucky and West Virginia who use the Eviti portal for prior authorizations. Aetna anticipates broadening eligibility to Medicare and commercial members in the first half of 2027.
  • “According to a Sept. 17 news release, Aetna observed providers submitting four different prior authorizations, on average, for its members needing cancer treatments. These bundles allow a single prior authorization request that could encapsulate medical oncology and radiation oncology services with high-tech imaging needs. The expansion builds upon an early rollout of the bundles. 
  • “By approving a broader set of treatments and related services upfront, we’re removing barriers that can delay care,” Aetna COO and Medicaid President Katerina Guerraz said.”

• Beckers Hospital Review relates,
  • “St. Louis-based Ascension has reached an agreement to transfer full ownership of its co-owned Arizona managed care health plan, Mercy Care, to CVS Health subsidiary Aetna, a spokesperson for Ascension confirmed with Becker’s. 
  • “Ascension co-owns the plan with San Francisco-based CommonSpirit’s Dignity Health, the spokesperson confirmed. The agreement is subject to regulatory reviews and approvals.
  • “Mercy Care has long served vulnerable populations, families and individuals across Arizona through Arizona Health Care Cost Containment System Medicaid programs and Medicare Duals Special Needs Plans,” the spokesperson said. “Aetna has successfully managed Mercy Care’s day-to-day operations and administrative services for over 20 years.”
• and
  • “HCA Healthcare CFO Mike Marks said payers have outpaced hospitals on AI-driven claims processing, adding another layer to the friction hospitals face on denials, underpayments and prior authorization.
  • “I know there’s a lot of talk about AI in the hospital revenue cycle, we’re behind the payers, in my view,” Mr. Marks said Sept. 15 at the Jefferies Healthcare Services and Technology Conference in Nashville, Tenn., where the 190-hospital system is also headquartered.
  • “Payers, he said, have real incentives driving their AI investments, including medical loss ratios and patient populations to manage.
  • “They’ve been working really hard on their version of AI in their claims shop,” he said.”
• and
  • “Nashville, Tenn.-based HCA Healthcare is seeing softer elective surgery volumes as patients lose coverage through the health insurance exchanges, with broader affordability pressures potentially contributing to the slowdown, CFO Mike Marks said Sept. 15 at the Jefferies Healthcare Services and Technology Conference.
  • “The 189-hospital, for-profit system continues to see strong overall demand for healthcare services, but the movement of patients from exchange coverage to uninsured status is weighing on elective procedures.
  • “On the inpatient side of elective, and frankly, on the outpatient surgery side as well, the biggest issue is HICS,” Mr. Marks said, referring to health insurance exchange coverage. “This movement out of HICS to uninsured — as people in our communities have lost coverage on the exchange [and] become uninsured — they generally lose access to elective care. That is the primary driver of the slowdown in our elective surgery volumes is exchanges.”

• Beckers ASC Review tells us,
  • “Brentwood, Tenn.-based Surgery Partners has completed the sale of its ownership interests in its Idaho Falls, Idaho, facilities to Intermountain Health for $797 million in gross proceeds, according to a Sept. 17 news release.
  • “The deal includes Mountain View Hospital and Idaho Falls Community Hospital, values the combined facilities at about $1.15 billion, and delivered Surgery Partners $587 million in net cash proceeds at closing, subject to customary post-closing adjustments. Physician ownership of Mountain View Hospital will remain unchanged under Intermountain’s leadership, and the proceeds will primarily go toward paying down debt, which is expected to improve the company’s balance sheet leverage by about 30 basis points from 4.4x at the end of the second quarter.
  • “Excluding the Idaho Falls facilities, Surgery Partners expects a 50% reduction in its Medicaid payor mix, to under 2% of revenue, along with the elimination of its neonatology, obstetrics, inpatient pediatrics and retail and compounding pharmacy service lines.”

• Fierce Healthcare informs us,
  • “Big box retailer Walmart is launching a six-month pilot program that places pharmacists in a new “Health Ambassador” role at five rural stores to help customers navigate health and wellness resources.
  • “Walmart’s Health Ambassador Associate will be able to aid patients in understanding their health goals and help connect them to relevant services and resources.
  • “The Health Ambassador role will be piloted at locations serving rural and underserved communities across the U.S., including in Lexington, Tenn.; Caro, Mich.; Franklin, Va.; Fort Scott, Kan.; and Searcy, Ark.
  • “The pilot will initially focus on three healthcare areas: diabetes, weight management and maternal health. Health Ambassadors can also aid customers in nutrition, movement, sleep and stress management through the program’s in-person conversations and tailored coaching.”
• and
  • “Humana researchers found that cancer patients who received specialty pharmacy care coordination services had fewer hospitalizations and emergency department visits, along with lower medical costs.
  • “The study, conducted by Humana Pharmacy Analytics and Consulting, analyzed health outcomes for people with cancer who are Humana Medicare Advantage members with Part D prescription plan coverage and who received medication adherence care coordination guidance, as compared to those who opted out of coordination. 
  • “Humana’s CenterWell Specialty Pharmacy Oncology Center of Excellence (COE) provided the care coordination services over the course of one year. That COE program provides specialized, personalized clinical care and mail-order delivery for patients managing complex cancer diagnoses and therapies. Within CenterWell, Humana’s health care services organization, CenterWell Pharmacy serves many Humana members as a mail-order pharmacy and also serves patients who are not enrolled in a Humana plan.”
• and
  • “Blue Shield of California announced Thursday that it plans to expand its Virtual Blue program, doubling program enrollment for members.
  • “Beginning in January 2027, the benefit will be included in fully insured preferred provider organization (PPO) plans for employers with 101 to 3,000 employees, as well as for certain individual and family plans, the insurer said.
  • “The expansion will allow an additional 200,000 mid-size employer PPO members and 60,000 individual and family plan members to utilize the program, increasing its total enrollment to more than 410,000 participants, executives say.
  • The virtual-first program, first launched in 2023 in collaboration with Accolade and TeleMed2U, has more than 150,000 members as of April. The program gives members access to a range of virtual health services at no additional cost, along with care from providers in Blue Shield’s PPO network.

• Per BioPharma Dive,
  • “Novo is investing in oral biologics, signing a deal with fellow Danish company Orbis Medicines to discover multiple “macrocycles” that have the “potential to replace injectable medicines,” Orbis said Thursday.
  • “Orbis could receive as much as $1.4 billion in up front and downstream payouts, as well as sales royalties, in the deal. The companies didn’t specify the number of drugs on which they would collaborate, nor specific diseases, only mentioning that they’ll pursue unnamed cardiometabolic targets.
  • “The use of macrocycles is one way Novo could overcome some of the limitations of standard oral peptide medicines, such as poor digestive absorption. The highest dose of Novo’s Wegovy pill contains 20 times the highest injectable dose because most of the drug’s active ingredient is chewed up before reaching the bloodstream.”
• and
  • “North Immunology, in the early stages of developing a potential competitor for the widely popular inflammatory disease drug Dupixent, plans to go public next year via a reverse merger with Aethlon Medical.
  • “After the merger, the companies expect North Immunology investors to own 95.25% of the new entity, with the rest going to Aethlon shareholders. Those who own Aethlon stock immediately prior to the merger will also get a contingent value right entitling them to potential proceeds from Aethlon’s legacy Hemopurifier business. 
  • “The new company will operate as North Immunology and trade on the Nasdaq under the ticker symbol “NRTX,” Aethlon said Thursday. North Immunology’s executives will lead the combined entity, and its directors will populate the board, along with some new independent directors. The companies expect the transaction to close in the first quarter of 2027.”

• Healthcare Dive points out,
  • “Healthcare organizations are rapidly adopting agentic artificial intelligence, but governance frameworks for managing the technology are not evolving at the same pace, according to a new survey from digital identity security firm Imprivata.
  • “More than 85% of leaders responsible for AI strategy at healthcare organizations say they’re confident they have visibility into AI agent activity and are able to fully control and govern an autonomous agent’s actions.
  • “However, 72% of respondents admit AI tools are deployed without IT approval at least occasionally within their organizations, highlighting a disconnect between confidence and reality.”