Cybersecurity Saturday

David Ermer

I am an attorney who practices law in Washington DC. My practice has involved the Federal Employees Health Benefits Program since 1983.

Cybersecurity Saturday

David Ermer–Cybersecurity–

It has been another crazy ransomware week as reflected in Bleeping Computer’s weekly update headlined “Healthcare Under Attack.”

The Wall Street Journal in an article about why the Colonial Pipeline paid ransom quotes “Ciaran Martin, the former head of the National Cyber Security Center, the British government’s cybersecurity agency.”

“There are three problems contributing to the ransomware crisis,” Mr. Martin said. “One is Russia sheltering organized crime. A second is weak cybersecurity in too many places. But the third, and most corrosive, problem is that the business model works spectacularly for the criminals.”

In that regard, Cyberscoop and the American Hospital Association report on the Conti ransomware gang which last week struck Ireland’s health system. Here is a link to the FBI’s May 20 alert on the Conti gang.

STAT and Becker’s Health IT brings us up to date on the May 1 ransomware attack on Scripps Healthcare in San Diego which was eclipsed publicly by the ransomware attack against Colonial Pipeline. The articles illustrate how these attacks have a lot of ramifications that can’t be cleaned up overnight.

ISACA and Security Boulevard provide insights into securing protected health information and other types of confidential data.

And let’s not lose sight of the SolarWinds cyberattack. SecurityWeek reports that

The hackers who carried out the massive SolarWinds intrusion were in the software company’s system as early as January 2019, months earlier than previously known, the company’s top official said Wednesday [May 20]. SolarWinds had previously traced the origins of the hack to the fall of 2019 but now believes that hackers were doing “very early recon activities” as far back as the prior January, according to Sudhakar Ramakrishna, the company’s president and CEO.

Also Wednesday, Ramakrishna apologized for the way the company blamed an intern earlier this year during congressional testimony for poor password security protocols. That public statement, he said, was “not appropriate.” “I have long held a belief system and an attitude that you never flog failure. You want your employees, including interns, to make mistakes and learn from those mistakes and together we become better,” he added. “Obviously you don’t want to make the same mistake over and over again. You want to improve.”

Friday Stats and More

David Ermer–COVID-19, COVID-19 vaccine, Rx coverage, Telehealth, U.S. Healthcare–

Based on the Centers for Disease Control’s COVID-19 Data Tracker website, here is the FEHBlog’s chart of new weekly COVID-19 cases and deaths over the 14th week of 2020 through 20th week of this year (beginning April 2, 2020, and ending May 19, 2021; using Thursday as the first day of the week in order to facilitate this weekly update):

and here is the CDC’s latest overall weekly hospitalization rate chart for COVID-19:

The FEHBlog has noticed that the new cases and deaths chart shows a flat line for new weekly deaths  because new cases greatly exceed new deaths. Accordingly here is a chart of new weekly COVID-19 deaths over the period April 2, 2020, through May 19, 2021:

Finally here is a COVID-19 vaccinations chart over the period December 17, 2020, through May 19, 2021, which also uses Thursday as the first day of the week:

With respect to COVID-19 vaccinations, Medscape reports that

The COVID-19 vaccines authorized for use in the United States and Europe offer protection against the four main coronavirus variants known to exist, a World Health Organization official says. “All COVID-19 virus variants that have emerged so far do respond to the available approved vaccines,” WHO European Regional Director Hans Kluge said Thursday at a news conference.

In sum, from the COVID-19 stats front, the Centers for Disease Control states

COVID-19 cases, hospitalizations, and deaths are going down, and the number of people vaccinated continues to go up, providing a sense of optimism as summer approaches. As of May 20, 48.4% of the U.S. population ages 18 years and older is fully vaccinated, and 60.5% have received at least one dose of a COVID-19 vaccine. Additionally, as of last week, millions more are now eligible to receive a COVID-19 vaccine. These trends and new CDC evidence-based guidance on masking provide encouragement that we are making progress toward returning to a sense of normalcy.

As you look ahead to summer, consider how COVID-19 is spreading in your community when choosing activities. Outdoor activities and visits are safer than those indoors, but fully vaccinated people can participate in most indoor activities without much risk. If you are not yet vaccinated, you should continue to practice prevention strategies such as wearing a well-fitted mask, practicing physical distancing, avoiding crowds, and washing your hands. 

In the “and more” category

Health Affairs discusses five keys to realizing health equity in U.S. health plans. To wit

“The five major priorities (and the achievements that will result from these priorities) for health equity leadership in health plans are:

  • Prioritizing Prevention and Wellness: Benefits and care delivery redesign
  • Prioritizing Communities: Engagement and investments
  • Prioritizing Innovation: Population and digital health
  • Prioritizing Education, Research, and Workforce Development: Academic-community collaborations
  • Prioritizing Action and Accountability: Data-driven improvement.”

mHealth Intelligence reports that “GAO tells Congress to wait on expanding telehealth coverage past the pandemic.
A new report and testimony from the Government Accountability Office says the full effect of CMS waivers on telehealth coverage during the pandemic isn’t yet known, and more study is needed. That conclusion won’t make the American Medical Association happy.

Reuters informs us that “CVS Health Corp., best known for its national chain of drugstores, said on Thursday it had started offering clinical trial services to support drug developers with tasks like patient enrollment. CVS said it had already collaborated with drug developers to help facilitate clinical trials for investigational COVID-19 vaccines and treatments, which the new business will now expand.”

Speaking of clinical investigations, Medscape reports that

The novel Galleri blood test (GRAIL, Inc.), which claims to detect up to 50 different cancers from single blood draw, is about to make its clinical debut in the United States. However, an expert cautions that this test should be considered as being under clinical investigation. Providence Health System, based in Renton, Washington, will be the first health system in the US to offer access to the Galleri test, where it will be available as a complement to recommended single-cancer screening tests.

On its website, GRAIL notes that the Galleri blood test is recommended for use in adults with an elevated risk for cancer, such as those aged 50 or older. It is intended to detect cancer signals and to predict where in the body the cancer signal is located. However, it does not detect all cancers and should be used in addition to routine cancer screening tests recommended by a healthcare provider. It is “intended to be used in addition to, and not replace, other cancer screening tests,” [GRAIL’s Leslie] Strope emphasized.

The FEHBlog strongly recommends this week’s episode of the Econtalk podcast (three strong weekly episodes in a row) in which

Podcaster and author Julia Galef talks about her book The Scout Mindset with EconTalk host Russ Roberts. Galef urges us to be more rational–to be open-minded about what we might discover about the world–rather than simply defend what we already believe, which she calls the soldier mindset. The conversation is a wide-ranging discussion of our biases and the challenges of viewing the world objectively.

Thursday Miscellany

David Ermer–Congress, COVID-19, Federal employment benefits, OPM, U.S. Healthcare–

Following up on yesterday’s post about the proposed Postal Service Health Benefits Program that Congress is considering, here is a link to the Senate Homeland Security and Governmental Affairs Committee’s press release on its companion bill to the House measure (HR 3706). The press release provides a link to the Senate bill for those interested.

The Office of Personnel Management issued a benefit administration letter to federal agencies “which provides guidance on the OPM implementation of FSAFEDS Program flexibilities offered under the Consolidated Appropriations Act 2021 and accompanying law and guidance.”

From the COVID-19 front, the American Hospital Association reports

FDA authorizes storing thawed Pfizer COVID-19 vaccine in refrigerator for up to 30 days before diluting. The Food and Drug Administration yesterday authorized storing thawed, undiluted vials of the Pfizer COVID-19 vaccine at refrigerator temperatures (35°F to 46°F) for up to 30 days after the company submitted data showing the vials can remain stable that long, up from the previously authorized five days. For details, see the updated fact sheet for health care providers administering the vaccine.
Peter Marks, M.D., director of FDA’s Center for Biologics Evaluation and Research, said the change should make it easier for vaccine providers such as doctors’ offices to administer the vaccine.
Once the thawed vials are diluted, providers must use them within six hours, a potential challenge for clinicians who lack sufficient demand for the vaccine during regular office visits.

That’s quite a conundrum. On the brighter side, Politico informs us

Emergent BioSolutions could resume manufacturing Johnson & Johnson’s Covid-19 vaccine within days, CEO Robert Kramer told a House [of Representatives] panel Wednesday. Restarting Emergent’s production of the J&J shot would revitalize efforts to get the single-dose vaccine to many Americans. The United States is currently relying entirely on vaccines from Pfizer and Moderna for its vaccination efforts; for the second straight week, the White House on Tuesday told state officials that the J&J vaccine was not available to order.

The American Medical Association adds that “The biggest impediment to getting more people fully vaccinated for COVID-19 is access, not vaccine hesitancy, according to Thomas R. Frieden, MD, MPH, former director of the Centers for Disease Control and Prevention during the Obama administration.” “We can make a lot of progress by making vaccination more convenient,” said Dr. Frieden, CEO of Resolve to Save Lives, an initiative to prevent epidemics and cardiovascular disease. “That’s really important. That means walk-in hours. That means easy locations, easy hours, supporting transportation and setting up pop-up sites outside of everywhere, from ballgames to bars to bowling alleys to shopping centers. We need to make it the default choice, basically, to get a vaccine.”

In healthcare business news,

  • Healthcare Dive lets us know that “Anthem and Epic on Wednesday announced a collaboration expanding bidirectional data exchange, in a bid to streamline administrative process like prior authorizations, a frequently cited pain point for providers, and give providers more real-time data on patient behaviors like medication adherence. The partnership will integrate Epic’s payer platform into Anthem’s operating system. The Indianapolis-based payer will also combine Epic’s information with other sources such as claims logs, health information exchanges and lab companies. Providers will also be notified of significant health events, such as when a patient is discharged, in an effort to improve follow-up care.” Awesome!
  • Fierce Healthcare reports that “While its joint venture with Amazon and Berkshire Hathaway, Haven, is no more, JPMorgan Chase is launching a new effort to address the cost and efficiency of employer-sponsored healthcare. Morgan Health will serve as a new business arm within the company that’s focused on these issues, the financial giant announced Thursday. Dan Mendelson will serve as CEO of Morgan Helth and report to Peter Scher, vice president of JPMorgan Chase. Mendelson is the founder and former CEO of Avalere Health.”

In healthcare news

  • The Associated Press informs us that “Screening and the HPV vaccine have led to drops in cervical cancers over the last two decades in the U.S., a new study finds, but the gains are offset by a rise in other tumors caused by the [HPV] virus. In the U.S., the HPV vaccine has been recommended since 2006 for girls at age 11 or 12, and since 2011 for boys the same age, and catch-up shots are recommended for anyone through age 26 who hasn’t been vaccinated. Experts agree it will take years to see the true impact because it can take decades for a chronic HPV infection to turn into cancer. What’s driving the HPV cancer trends is the youthful sexual behavior of baby boomers before the vaccine was out. The vaccine works best when given at younger ages before people are exposed to HPV through sexual activity, so it arrived too late for the boomers.
  • The Blue Cross Blue Shield Association reports that “Black women under the age of 24 are more likely to experience severe childbirth complications than white women over the age of 35 – an age group usually considered high risk, according to new data from the Blue Cross Blue Shield Association (BCBSA). Data shows the rates of childbirth complications have been increasing for women of color. In the last two years, the rate of Hispanic women with severe childbirth complications increased 19%. “There is an urgent maternal health crisis in our country,” said Kim Keck, president and CEO of BCBSA. “It is unconscionable that women of color face a greater risk of childbirth complications compared to white women. We must confront health disparities across the board to change the trajectory.” Amen to that.

Postal Reform Update and More

David Ermer–Congress, Federal employment benefits, U.S. Healthcare–

The Washington Post reports today that

A bipartisan group of senators [led by the Chair and Ranking Member of the Senate Homeland Security and Governmental Affairs Committee] introduced legislation Wednesday to lift significant financial burdens off the ailing U.S. Postal Service while tightening accountability requirements for mail delivery, a major stride for an agency that has tussled with its balance sheet and reputation for the better part of a year. The bill, identical to a version that has advanced in the House [H.R. 3706], would repeal $5 billion a year in mandatory retiree health-care expenses and require future postal retirees to enroll in Medicare[ via a Postal Service Health Benefits Program (“PSHBP’) within the FEHB Program]. Advocates say the measures would save the agency $30 billion over the next decade.

FedSmith recapitulates the key aspects of the PSHBP provisions in the House bill for us. FedSmith also helpfully shares NARFE’s comments on the House bill. However, FedSmith concludes that “What is not mentioned in the [House] bill, but a possibility that could impact the rest of the federal workforce is the possibility that this “reform” package could become just the first step in removing federal retirees from the FEHB.”

With all due respect to FedSmith, OPM, and presumably Congress, knows full well that removing retirees from the FEHB would discourage federal employees from opting for long term employment with the government. Currently, if a federal employee has at least five years of FEHB coverage preceding their civil service retirement, they carry FEHB coverage into retirement with the full government contribution.

FEHB coverage tops any Medicare supplement plan out there by a long shot. What’s more the dirty little secret of Medicare is that federal law does not prohibit Medicare supplement plans to impose pre-existing condition limitations on prospective members except when an individual becomes first eligible for Medicare. (Only four northeast states prohibit that practice.) For example, the FEHBlog lives in Maryland which allows Medicare supplement plans to impose pre-existing condition limitations. If the FEHBlog had picked a Medicare Advantage plan initially and later wanted to switch to traditional Medicare, his selection of Medicare supplement plans would be limited particularly he had encountered health problems.

In any event, annuitants with primary Medicare coverage are good FEHB risks who help control premiums for everyone. For those reasons, the FEHBlog does not foresee annuitants being removed from the FEHB. He would like to see OPM permit FEHB carriers to offer Medicare Part D prescription drug plan integration in their “traditional” plans because that Part D integration and not the Part A and B integration will generate the greatest savings for the PSHBP carriers. Congress already opened the door the FEHB integration with Medicare Part D In the Medicare Modernization Act of 2003 which created Part D.

Here are some other nuggets of interest:

  • Reg Jones continues his series on federal employee benefits in FedWeek. This week’s article concerns opportunities to enroll in or change coverage in federal employee benefit programs upon marriage.
  • The National Committee for Quality Assurance takes us on a trip along the road to health equity.
  • Healthcare Dive reports that “CommonSpirit Health and Essentia Health have called off a deal for Essentia to acquire 14 CommonSpirit facilities in North Dakota and Minnesota, the two Catholic systems announced Tuesday.”

Tuesday’s Tidbits

David Ermer–Congress, COVID-19, COVID-19 vaccine, Mental health care, Telehealth, U.S. Healthcare–
Photo by Patrick Fore on Unsplash

Over 275 million doses of the COVID-19 vaccines have been administered in the United States and 47.5% of the U.S population has received at least one dose of COVID-19 vaccine ,and 37.5% of the total U.S. population has been fully vaccinated. The Wall Street Journal reports today that

Covid-19 vaccines are showing up in unlikely places—on public transportation, at churches and in factories. Shots are also being offered in restaurants, casinos and ballparks. These pop-up locations represent a bid by health advocates and community leaders to reach a group of unvaccinated individuals less likely to make headlines: the ambivalent.

From the American Medical Association front

  • The AMA continues to rail against health insurer requests for prior authorizations.
  • In contrast the AMA is now a fan of telehealth as long as health insurers pay adequately for it.

“Here are the top five services physicians surveyed say they want to offer after the COVID-19 pandemic has ended, along with the percentage who said they wanted to continue each service:

  • Chronic disease management—73%.
  • Medical management—64%.
  • Care coordination—60%.
  • Preventative care—53%.
  • Hospital or emergency department follow-up—48%.

“Physicians also identified what they anticipate to be the barriers to maintaining telehealth after the public health emergency. No. 1 on that list? About 73% of physicians worry there will be low—or no—payment.”

STAT News reports that the House Oversight and Reform Committee bludgeoned prescription drug manufacturer Abbvie’s CEO over its pricing practices particularly for its blockbuster drug Humira during a hearing held today.

Three powerful Democrats wrote to the Federal Trade Commission Tuesday urging them to investigate whether drug maker AbbVie violated the law in trying to keep cheaper versions of its blockbuster drug Humira off the market.

The surprise announcement came in the first minutes of a Tuesday hearing held by the House Oversight Committee investigating the company’s pricing practices. AbbVie’s CEO Richard Gonzalez is testifying.

“I sent a letter to the FTC today … asking for a formal inquiry into whether AbbVie’s anticompetitive practices violated the law,” said the committee’s chair, Rep. Carolyn Maloney (D-N.Y.). The letter was also signed by the chair of the House Judiciary Committee, Rep. Jerrold Nadler (D-N.Y), and the chair of that committee’s antitrust subcommittee, Rep. David Cicilline (D-R.I.).

From the tidbit front

  • The Internal Revenue Service released guidance for employers on the American Rescue Plan’s subsidization of COBRA continuation coverage for employees who lose their health coverage due to an involuntary termination or reduction in hours.
  • The Department of Health and Human Services announced that its “Substance Abuse and Mental Health Services Administration (SAMHSA) is distributing $3 billion in American Rescue Plan funding — the largest aggregate amount of funding to date for its mental health and substance use block grant programs. The Community Mental Health Services Block Grant (MHBG) Program and Substance Abuse Prevention and Treatment Block Grant Program (SABG) will disperse $1.5 billion each to states and territories (with the latter also awarding money to a tribe). This follows the March announcement of supplemental funding of nearly $2.5 billion for these programs.”
  • The U.S. Preventive Services Task Force released a new final recommendation that persons aged 45 through 49 should receive screening for colorectal cancer. This supplements USPSTF’s current recommendation that persons aged 50 to 75 received this testing. The new recommendation will become a mandate on FEHB carriers and other group health plans to provide in-network coverage with no member cost sharing for this service for the lower aged cadre beginning January 1, 2023.
  • In 2019 the FEHBlog heard a hospital system executive vociferously object to Medicare’s new site neutrality policy under which Medicare pays the same rate whether the service is rendered inpatient or outpatient. It occurred to the FEHBlog that this site neutrality rule may lower healthcare costs. Needless to say, a trade association lawsuit challenged the rule, and the government won before the U.S. Court of Appeals for the D.C. Circuit. Healthcare Dive reports that Justice Department is opposing the American Hospital Association’s petition for U.S. Supreme Court review of the D.C. Circuit ruling.

Monday Roundup

David Ermer–COVID-19, COVID-19 vaccine, OPM, U.S. Healthcare–
Photo by Sven Read on Unsplash

A bevy of encouraging articles from the COVID-19 vaccination front today.

The Wall Street Journal reports that the “Covid-19 Vaccine works, even if side effects differ for all, doctors say.
Age and other factors may play a role, but scientists say the shots provide immunity, including in the absence of fatigue, chills or other symptoms.” Of note,

Age appears to be a factor in determining who experiences side effects. People over age 65 are less likely than younger people to experience side effects. Older adults tend to have less robust immune responses to vaccines.

Vanderbilt’s Dr. Edwards said women appear to be more likely than men to experience the side effects, which may be related to hormonal or weight differences.

The Food and Drug Administration says age, sex and general health likely influence the occurrence and severity of common side effects in the first couple of days after vaccination. Side effects don’t correlate with the effectiveness of a vaccine in an individual, an FDA spokeswoman said. 

Some doctors say heredity may also play a role. “I am sure that our genes at some level determine differences in these responses,” Paul Offit, director of the vaccine education center at Children’s Hospital of Philadelphia, said of varying levels of symptoms following vaccination.

David Leonhardt helpfully provides in the New York Times an updated COVID-19 guide for four different types of families.

CNN informs us that “A new Axios/Ipsos poll finds that 67% of American adults have either gotten a Covid-19 vaccine or will get it as soon as possible. The same poll shows on a separate question that 75% of respondents said they either had gotten the vaccine or were likely to get it. Both of these were all-time highs in Ipsos polling.”

To sum up, the Wall Street Journal points out

“There’s no question that the average age of hospitalization has gone way down,” said Joan Boomsma, chief medical officer for MaineHealth, the largest healthcare provider in Maine. Dr. Boomsma said that in January, the average age of those hospitalized was around 65. That figure fell to 58 in March, and again to 50 in April.

“It’s not that we never saw younger people—in fact we saw roughly the same, or comparable numbers of them when they’re in their 40s and even 30s,” she said. “What does seem to be different now is that those who are being hospitalized, are really very ill,” Dr. Boomsma said, adding that it’s unclear why.

“I think the real story here is that vaccines work,” she said. “We’re seeing fewer hospitalizations in the older age groups, and the only patients we’re seeing in the ICU now are those who are not vaccinated.”

In other COVID-19 news, Federal News Network reports that

Agencies are lifting mask requirements for fully-vaccinated federal employees, contractors and visitors after the Centers for Disease Control and Prevention announced changes to its national mask guidance last week.

Masks are no longer required for fully vaccinated federal employees, on-site contractors and visitors inside federal buildings, the Office of Management and Budget told agencies in an email last week.

Employees who are at least two weeks past their second COVID-19 vaccine dose no longer need to wear masks inside federal buildings. Those who are not fully vaccinated should continue to wear their masks, OMB said.

“For now, this change related to masking is the only change to federal workplace COVID-19 safety guidance — maximum telework and workplace occupancy limits remain in place — but we will continue to update based on public health guidance,” the OMB email reads.

In other healthcare new, MedCity News informs us about how providers, payers and startups are all looking for key pieces to solve the maternal care puzzle in our country.

Startups are focused on reducing care gaps through expanding access to prenatal services and connecting them to women of color, so they have a community to support them through their pregnancy. Digital health startups for women are gaining steam, receiving $388 million in funding in 2018. Within this landscape, fertility and pregnancy/motherhood represent two key segments. 

Mainstream providers, on the other hand, are employing clinical tools to predict potential delivery complications and partnering with community-based organizations to provide wraparound care. 

But it’s going to take more than just innovative care strategies to truly make a difference. Policymakers must also get involved and implement regulations that can have a huge impact, like extending Medicaid coverage from 60 days to one year post-partum and setting up a data collection mechanism to gather race-related information on maternal outcomes.

Weekend update

David Ermer–Congress, COVID-19, COVID-19 vaccine, Mental health care, OPM, Rx coverage, Telehealth, U.S. Healthcare, Uncategorized–

FEHBlog opening note — The FEHBlog goofed by posting this May 7 COVID-19 charts in the May 14 Friday Stats and More post. The FEHBlog corrected his error on Saturday after the Friday post email went out. You can check out the website if you want to see the May 14 charts which are encouraging. In contrast, check out the Wall Street Journal’s charts on the COVID-19 situation in India which is still struggling with virus. Whereas 37% of the U.S. population is fully vaccinated, less than 5% of the much larger and younger Indian population has reached that status. In this regard, the Rome (N.Y.) Sentinel offers an Excellus Blue Cross consulting pharmacist’s valuable guidance on why people in the age 18 to 34 bracket should received the COVID vaccination.

Q: Katie [Abbott, Pharm.D.], you are in that age group. Why did you choose to get vaccinated? 

I trust the science behind the vaccines and believe they will help bring us back to how life was before the pandemic.

Q: Some, or most cases of COVID-19 in younger people are not severe. Why would a younger person get vaccinated if younger people aren’t really dying from COVID-19?

The younger population may not be seeing as many severe cases or deaths, but they are still at high risk of long COVID. Long COVID is when those who have recovered from COVID-19 experience lasting effects, including a range of symptoms such as fatigue, brain fog, chest pain, shortness of breath, cough, joint or muscle pain, depression, anxiety, and so much more. Long COVID can develop weeks or months after infection. It can happen to anyone who has had COVID, even if they had mild or no symptoms. Getting the vaccine remains a safe way to protect yourself, along with your community, family members, and those who cannot be vaccinated.

Returning to the regular weekend update, both Congress will be in session this week for Committee work and House and Senate floor votes. The House Oversight and Reform Committee will hold its third recent hearing on prescription drug costs on Tuesday morning. It’s worth noting that although the House Oversight and Reform Committee approved the Postal Reform bill (HR 3076) last week, the House Energy and Commerce and Ways and Means Committees also have jurisdiction over the bill. So we don’t know right now, when the bill may reach the House floor.

In OPM news, the Federal Times reports that

In anticipation of more employees returning to the office and in the spirit of May’s Mental Health Awareness Month, the Office of Personnel Management issued a tip sheet for agency human resource staff to better support employees at a vulnerable time. * * * In addition to communicating with employees about the usual resources available to them – such as the Employee Assistance Program and mental health treatments offered through Federal Employee Health Benefit plans – OPM encouraged agency work-life coordinators and HR professionals to be as communicative as possible about office safety procedures and available work schedule adjustments to ease any potential employee anxiety.

In other healthcare news,

  • mHealth Intelligence discusses the work of University of West Virginia researchers who are seeking to determine the best mix of in-person and virtual care. “With telehealth use skyrocketing over the past year and a half due to the coronavirus pandemic, some have wondered if there’s a limit to its effectiveness. Is there a certain number of virtual visits that a patient – especially one with a chronic condition – should get, after which the technology outlasts its value? The answer, according the researchers at the University of West Virginia, is … uncertain.” While that outcome is surprising to the FEHBlog, the researchers have gone back to the drawing board.
  • Fierce Healthcare reports that “GoodRx, a telehealth and drug-pricing comparison software company, acquired competitor RxSaver for $50 million in cash. The company closed the deal in late April, GoodRx reported during its first-quarter 2021 earnings call Thursday. RxSaver, which was owned by Vericast Corp., the payment and marketing company controlled by billionaire Ronald Perelman, operates a price comparison platform to provide discount offerings through partnerships with pharmacy benefit managers (PBMs). The acquisition will expand GoodRx’s business capabilities and consumer reach, particularly with respect to its prescription offering, the company said in its first-quarter 2021 earnings report.”
  • Health Payer Intelligence informs us that ” To help combat racial care disparities in communities of color, Blue Shield of California (Blue Shield) provided $300,000 to 12 different nonprofit organizations in California that promote the mental health and well-being of youths in their communities.   This act supports the health equity strategy of Blue Cross Blue Shield Association (BCBSA), Blue Shield’s parent company, as it seeks to improve racial care disparities by collaborating with local community leaders. By contributing $25,000 to each organization, Blue Shield is providing opportunities for youths of color that can improve their mental health.”
  •  Healthcare Dive reports that “Piedmont Healthcare signed a non-binding letter of intent to acquire Augusta, Georgia-based University Health Care System, which operates three hospitals as well as skilled nursing facilities and urgent care clinics along Georgia’s eastern border with South Carolina. * * * Just last week, the 11-hospital system announced plans to buy four additional hospitals from HCA Healthcare for $950 million. The sale is expected to close in the third quarter of this year. The hospitals in the HCA deal circle the outskirts of the Atlanta region. * * * Altogether, the two most recent deals would give Piedmont a total of 18 hospitals in Georgia, in addition to more ancillary services.” Healthcare Dive adds that the two deals are likely to face regulatory scrutiny.

Cybersecurity Saturday

David Ermer–Cybersecurity–

Particularly if you live on the East Coast, the Colonial Pipeline ransomware incident has given you practical familiarity with ransomware. Bleeping Computer provides the latest details on the denouement of the incident.

On Wednesday, President Biden issued an executive order on cybersecurity. Here’s link to the accompanying fact sheet and Nextgov and Cyberscoop also report on the EO. The EO focuses attention on the federal government and its information technology and operations technology contractors. The FEHBlog expects that the EO will kick loose a couple of Federal Acquisition Regulation cases a couple of related FAR cases (2017-013 and 2017-016) that have been under development for going on four years.

Health IT Security reports on “recent federal threat alerts detail ongoing Russian-backed and Avaddon ransomware campaigns targeting global entities, including healthcare and COVID-19 vaccine developers.”

ZDNet informs us that

Web applications represented 39% of all data breaches in the last year with phishing attacks jumping 11% and ransomware up 6% from a year ago, according to the Verizon Business Data Breach Investigations Report. 

The report, based on 5,358 breaches from 83 contributors around the world, highlights how the COVID-19 pandemic move to the cloud and remote work opened up a few avenues for cybercrime.

Here are some more figures to ponder in the Verizon Business DBIR [which alway worth a gander]:

  • 85% of breaches involved a human element.
  • 61% of breaches involved credentials.
  • Ransomware appeared in 10% of breaches, double the previous year.
  • Compromised external cloud assets were more common than on-premises assets in incidents and breaches.

Friday Stats and More

David Ermer–COVID-19–

Based on the Centers for Disease Control’s COVID-19 Data Tracker website, here is the FEHBlog’s chart of new weekly COVID-19 cases and deaths over the 14th week of 2020 through 19th week of this year (beginning April 2, 2020, and ending May 12, 2021; using Thursday as the first day of the week in order to facilitate this weekly update):

and here is the CDC’s latest overall weekly hospitalization rate chart for COVID-19:

The FEHBlog has noticed that the new cases and deaths chart shows a flat line for new weekly deaths  because new cases greatly exceed new deaths. Accordingly here is a chart of new COVID-19 deaths over the period April 2, 2020, through May 12, 2021:

Finally here is a COVID-19 vaccinations chart over the period December 17, 2020, through May 12, 2021, which also uses Thursday as the first day of the week:

As of today, 43% of the U.S. population over age 12, 46% of the U.S. population over age 18, and 72% of the U.S. population over age 65 have been fully vaccinated against COVID-19 as reflected in the dropping case, hospitalization and death counts. It’s encouraging.

The FEHBlog heard today about the New York Yankees eight “breakthrough” COVID-19 infections. All of the infected team members had received the Johnson and Johnson vaccine and one previously had the disease. Only one of the infected team members was symptomatic; the other infections were identified through regular testing. STAT News explains

Eight breakthrough infections seem like a lot, and something odd could be at play here. But it’s notable that only Nevin had some symptoms. It’s possible that at least some, if not all, of the other seven other infections would have been missed if they didn’t occur on a team that’s undergoing regular testing.

Overall, the Centers for Disease Control and Prevention has received reports of 9,245 breakthrough cases, a tiny fraction of which resulted in hospitalization or death. More than 118 million people in the United States have been fully vaccinated. The low number of breakthrough infections has been touted as a testament to the power of vaccines, which are providing both protection for individuals and helping drive down transmission.

But experts also point out two caveats with the number of breakthrough infections. For one, some large number of the people who’ve been fully vaccinated haven’t since been exposed to the coronavirus, so it’s not known how many infections there would have been without that vaccine coverage. The tally of breakthroughs is also certainly an undercount because many asymptomatic cases go undetected — unless, of course, they occur in a setting with widespread and frequent testing, like on a professional sports team.

Two extra points: Starting Friday, the CDC will only report breakthrough infections that lead to hospitalization or death because those have the “greatest clinical and public health importance.” The Yankees cases, of course, didn’t rise to that level.

And Torres, the shortstop, had Covid-19 last year, indicating that his case is both a breakthrough infection and a reinfection. Scientists think reinfections remain rare, though given that second infections are generally thought to be mild or asymptomatic (akin to breakthrough infections), experts similarly don’t have great estimates for how often they occur. But considering Torres was asymptomatic, his case fit with what experts expect from most reinfections.

Thursday Miscellany

David Ermer–CDC, Congress, COVID-19 vaccine, Telehealth, U.S. Healthcare–
Thanks to Aaron Burden for sharing their work on Unsplash.

The FEHBlog enjoyed watching a love-fest of a Congressional business meeting this morning when the House Oversight and Reform Committee approved the Postal Reform Act, HR 3076, by a voice vote. Govexec reports on the proceedings and adds that the Senate has confirmed two Postal Service Board of Governors nominees. OPM Director nominee Kiran Ahuja had her confirmation hearing on the same day as these new Postal Governors. Her nomination should be considered on the Senate floor soon.

From the COVID-19 front

  • Bloomberg reports that ““Anyone who is fully vaccinated can participate in indoor or outdoor activities, large or small, without wearing a mask or physical distancing,” said CDC Director Rochelle Walensky. “If you are fully vaccinated [two weeks after two doses], you can start doing the things that you had stopped doing because of the pandemic. We have all longed for this moment when we can get back to some sense of normalcy.” Of course, “the CDC guidance spelled out ample exceptions, however, that signal the era of masks isn’t over yet. The agency still recommends fully vaccinated people wear masks on “all planes, buses, trains and other forms of public transportation,” as well as in health care settings, correctional facilities, homeless shelters, and where required by state and local governments, or businesses.”
  • Fierce Healthcare informs us that large pharmacy chains such as CVS Health, Rite Aide and Walgreen’s, are scheduling Pfizer vaccine appointments for young adolescents ages 12-15 following issuance of FDA and CDC approval over the last week.
  • Kaiser Health News reports that “Hispanics who have yet to receive a covid shot are about twice as likely as non-Hispanic whites or Blacks to say they’d like to get vaccinated as soon as possible, according to a survey released Thursday. The findings hint at fixable, though difficult, vaccine access problems for the population. One-third of unvaccinated Hispanics say they want the shots, compared with 17% of Blacks and 16% of whites, according to the survey released Thursday by KFF.” As of today, 59% of Americans over age 18 have received at least one dose of a COVID vaccine.
  • The Wall Street Journal reports that “Prominent scientists are calling for a deeper investigation into the origin of Covid-19, including the possibility that a laboratory accident released the new coronavirus that caused the pandemic. In a letter published Thursday in the journal Science, an international group of 18 biologists, immunologists and other scientists criticized the findings of a report released in March by a World Health Organization-led team into the pandemic’s origin and called for a more extensive evaluation of the two leading hypotheses: that the pandemic virus entered the human population and began spreading after escaping from a lab or after jumping to humans from infected animals.”
  • Govexec tells us that “The OPM Office of the Inspector General published a report analyzing the agency’s response to the coronavirus pandemic, finding officials fell short in a number of areas. In addition to failing to adequately inform employees of COVID-19 “incidents,” the agency failed to adequately document post-incident workplace cleaning or cleaning of “high contact” areas of its Washington, D.C., headquarters. The inspector general also said the agency needed more signage regarding social distancing and other ways to mitigate spread of the disease.” Who hasn’t fallen short at some point during these extraordinary circumstances? (Fortune Magazine suggests that New Zealand Prime Minister Jacinda Adern may be the exception that proves the rule.)

In other public health news,

  • The Centers for Disease Control offers the public a pre-diabetes risk test.
  • Health Payer Intelligence reports that “In response to the coronavirus pandemic’s influence on moms’ and caregivers’ stress levels, CVS Health and Aetna are taking steps to prioritize the mental well-being of individuals in these groups.” Bravo.

In healthcare business news, Healthcare Dive informs us that

  • Telehealth giant Amwell saw a rise in revenue and visits in the first quarter, but its growth is decelerating from 2020, bolstering market fears about the sustainability of the virtual care boom.
  • In quarterly results released aftermarket Wednesday, the Boston-based telehealth vendor beat Wall Street expectations on earnings but missed on revenue. Its topline was $57.6 million, up 7% year over year, spurred by subscription and digital revenue growth. In comparison, Amwell notched 34% year-over-year growth in the fourth quarter.
  • Similarly, Amwell’s total visits of 1.6 million were up 121% year over year, paling in comparison to the 351% growth seen in the fourth quarter.

Also from Healthcare Dive

  • Kaiser Permanente and Mayo Clinic are investing $100 million in a hospital-at-home company as the COVID-19 pandemic accelerates the push toward care settings outside a hospital’s four walls.
  • The investment is in Boston-based Medically Home, which has a virtual and physical delivery model allowing providers to shift acute care typically administered in a hospital to a patient’s home. Its software platform, called Cesia Continuum, integrates communications and monitoring for care teams.
  • The partnership will allow patients to be treated at home for infusions and conditions like cancer, infections and COVID-19, according to the companies’ announcement Thursday.