Midweek Update

David Ermer

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

Midweek Update

David Ermer–CDC, Congress, COVID-19, COVID-19 vaccine, Medicare, OPM, Rx coverage, Telehealth–

Tomorrow morning the House Oversight and Reform Committee will mark up its bipartisan Postal Reform Act (H.R. 3076) and the Postal Improvement Act (HR 3077). H.R. 3076 would eliminate the Postal Service’s unique obligation to pre-fund the cost of FEHB coverage for its annuitants. It also would create a subprogram with the FEHB for postal service employees and annuitants that would be fully integrated with Medicare Parts A (hospital), B (professional services) and D (prescription drugs) for annuitants over age 65.

Existing FEHB plans largely receive the financial benefit of Medicare Parts A and B integration, but OPM does not permit FEHB plans to offer Medicare Part D integration known as EGWPs. The FEHBlog expects H.R. 3076’s mandatory use of Part D EGWPs in the subprogram will unleash a gusher of new benefit savings for subprogram plans. Fingers crossed that successful adoption of Part D EGWPs in this subprogram leads OPM to allow carriers to add them in existing FEHB too. However, as currently drafted, the subprogram would launch on January 1, 2023, which is aggressive timing in the FEHBlog’s view.

Today according to the Wall Street Journal

The Centers for Disease Control and Prevention recommended that 12- to 15-year-olds receive the Covid-19 vaccine from Pfizer Inc. and BioNTech SE, expanding the nation’s vaccination campaign. 

The CDC took the step after its vaccination advisory panel voted to recommend the shot at a meeting Wednesday after reviewing clinical trial data and other relevant information. The vote by the Advisory Committee on Immunization Practices, or ACIP, was 14-0, with one voting member recusing. * * *

Covid-19 cases are rising in adolescents, and as older Americans have gotten vaccinated, adolescents make up an increasing proportion of the overall U.S. case count, Sara Oliver, a CDC medical officer, said. Adolescents accounted for 9% of reported cases in April, a larger proportion than cases involving people 65 years and older as more adults have been vaccinated, she said.

According to the CARES Act of 2020, health plans, including FEHB plans, must begin to cover the Pfizer vaccine without member cost sharing for this age group no later than fifteen days from today, May 27, 2021. According to the Journal, “Pfizer anticipates asking the FDA in September to authorize its vaccine’s use in children 2 to 11 years old should ongoing studies prove positive. The company said It plans to make a similar request for children 6 months to 2 years of age in the fourth quarter.”

In Biden Administration news, the American Hospital Association reports that

Health and Human Services Secretary Xavier Becerra today swore in Andrea Palm as deputy secretary. Confirmed by the Senate yesterday, Palm previously served as secretary-designee of Wisconsin’s Department of Health Services and in several leadership roles at HHS during the Obama-Biden administration.  
“My focus will be on improving the lives and livelihoods of the American people: tackling the COVID-19 pandemic, efficiently and equitably distributing vaccines, expanding access to affordable health care, addressing the epidemic of substance use disorders, and improving mental health care,” she said. 
Biden’s nominee to serve as Centers for Medicare and Medicaid Services administrator, Chiquita Brooks-LaSure, today moved one-step closer to confirmation with the Senate voting 51-48 to discharge the nomination. The Senate could hold a final vote on her confirmation next week.  

STAT News informs us

  • “Telehealth companies, flush with cash after the Covid-19 pandemic spiked both demand and investment, are now embarking on massive lobbying efforts to secure their interests on Capitol Hill. The goal is clear: Lawmakers are weighing whether to permanently loosen regulations that were temporarily eased during the pandemic. Among other changes, providers have been allowed to practice in states where they are not licensed, and Medicare has been permitted to pay providers the same for virtual visits as in-person ones. Lobbyists for the rapidly growing industry are determined to keep those changes intact.” Watch for this result the big infrastructure bill.
  • Amazon’s objectives for its nascent pharmacy business are straightforward: “better selection, better convenience, and better prices,” according to TJ Parker, the vice president of pharmacy at the company.“ It really is the Amazon playbook,” he said during a Wednesday panel at STAT’s Health Tech Summit. * * * “Customers really want more Amazon and less pharmacy and so our work from here is to make pharmacy truly as seamless to us as amazon.com [is] for other categories,” Parker said. Among Amazon’s latest offerings: a new price-comparison tool for medications, which launched Tuesday. Now, when someone searches for a prescription drug on Amazon, Amazon Pharmacy’s price for a drug is listed alongside the cost for Prime members at other pharmacies like CVS, Walgreens, Walmart, and Costco.” Watch out GoodRx.

On a related note, the Drug Channels blog assesses how Cigna’s growing pharmacy platform expands its channel power.

Last week, Cigna released its earnings for the first quarter of 2021. I was struck by how quickly Cigna’s Express Scripts PBM business has increased revenues and prescriptions from its retail pharmacy network. Our second chart below highlights this growth. The businesses in Cigna’s Evernorth segment—especially Express Scripts, Ascent Health Services, and InsideRx—are already providing rebate negotiation, network management, and/or a sourcing platform for Prime Therapeutics, Kroger, Humana, GoodRx, and Amazon.”

Tuesday’s Tidbits

David Ermer–Congress, Federal employment benefits, HIPAA Privacy and Security Rules, Mental health care, U.S. Healthcare–
Photo by Patrick Fore on Unsplash

The FEHBlog had been wondering what was going on with the Postal Reform bill that includes a new Postal Service Health Benefits Program. It turns out that the House Oversight and Reform Committee plans to mark up the latest draft of that bill on Thursday morning. The FEHBlog plans to tune in for this meeting.

In health equity developments —

  • The Wall Street Journal reports that “Ride-sharing companies Uber Technologies Inc. and Lyft Inc. will make all rides to and from vaccination sites free until July 4 under a new partnership with the White House. * * * While the companies were already providing free or discounted rides in some circumstances, the rides will now be free to anyone in the U.S. who is going to a vaccination site to get the shot, and Lyft and Uber will promote the rides to and from tens of thousands of vaccination sites through their apps. The feature will launch in the next two weeks and run until July 4.”
  • Health Leaders Media informs us about Horizon Blue Cross’s ongoing efforts to advance health equity in New Jersey in cooperation with healthcare and community organizations as well as solid data.
  • The American Medical Association released a “strategic plan to embed racial justice and advance health equity.” “With the input of many both inside and outside of AMA, this strategic plan serves as a three-year roadmap to plant the initial seeds for action and accountability to embed racial justice and advance health equity for years to come.”

In regulatory developments –

  • Professor Katie Keith in the Health Affairs blog provides background on yesterday HHS decision to “interpret Section 1557 and Title IX, which prohibit discrimination on the basis of sex, to include discrimination on the basis of sexual orientation and gender identity.”
  • Fierce Healthcare reports that “The Centers for Medicare & Medicaid Services has sent its first wave of warning letters out to hospitals breaking federal rules requiring them to disclose payer-negotiated prices, a spokesperson for the agency confirmed.”
  • Healthcare Dives discusses healthcare organization comments to HHS’s Office for Civil Rights on its proposed rule that would make generally helpful adjustments to the HIPAA Privacy Rule, in the FEHBlog’s opinion.

Miscellaneous tidbits —

  • Reg Jones discusses the Federal Employees Group Life Insurance Program in FedWeek.
  • The Society for Human Resources Management writes about “Supporting Mental Health in the Post-Pandemic Workplace.”
  • Health Payer Intelligence discusses Blue Cross of North Carolina’s successful effort to consolidate member experience data from across the company to boost member satisfaction.

Monday Roundup

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

Happy National Hospital Week.

Per a Food and Drug Administration press release,

Today, the U.S. Food and Drug Administration expanded the emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 Vaccine for the prevention of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to include adolescents 12 through 15 years of age. The FDA amended the EUA originally issued on Dec. 11, 2020 for administration in individuals 16 years of age and older.

The FDA has updated the Fact Sheets for Healthcare Providers Administering the Vaccine (Vaccination Providers) and for Recipients and Caregivers with information to reflect the use of the vaccine in the adolescent population, including the benefits and risks of the Pfizer-BioNTech COVID-19 Vaccine.

The CDC will take up the matter on Wednesday and assuming that CDC approval is given, then health plans will become obligated to cover the full cost of administering the vaccine to this new age group fifteen days later.

The Wall Street Journal adds FAQs:

Do we need to vaccinate children?

Yes, according to most infectious-disease experts. Children can and do get sick from Covid-19, though research shows they typically experience milder cases and are much less likely than adults and the elderly to be hospitalized or die from the virus. As of late March, more than 3.4 million children had been infected with Covid-19, according to the American Academy of Pediatrics, including nearly 14,000 hospitalizations and 279 deaths. The emergence of more-contagious variants, including the B.1.1.7 variant that was first identified in the U.K. and is now dominant in the U.S., appears to be sending younger patients to the hospital with a higher frequency, making vaccines in young adults and adolescents all the more urgent, some doctors and scientists say. In addition, scientists say children need to be vaccinated to achieve the communitywide, or herd, immunity that renders spread of the virus unlikely. “Vaccines give us the opportunity to really turn the tide on this pandemic, and children and teens really need to be a part of that strategy,” said Lisa Costello, a pediatrician and president of the West Virginia chapter of the American Academy of Pediatrics.

Monday continues to be a good day for COVID-19 vaccine news.

In other news —

  • Healthcare Dive reports that “Kaiser Permanente generated a profit of $2 billion in the first quarter of 2021, the integrated health system reported Friday, bouncing back from a staggering $1.1 billion loss in the first quarter of last year, largely tied to investment losses amid the stock market slide spurred by the COVID-19 pandemic.”
  • The Internal Revenue Service announced 2022 inflation adjustments for (a) minimum deductibles and maximum out of pocket cost sharing in high deductible health plans (“HDHP”) associated with health savings accounts {“HSA”) and (b) maximum health savings account contributions. The Journal of Accountancy explains

The annual limitation on deductions under Sec. 223(b)(2)(A) for an HSA with self-only coverage is $3,650, an increase of $50 over 2021; the corresponding amount for family coverage is $7,300, up $100 from 2021. Sec. 223(b)(3) allows an additional $1,000 annual contribution for individuals age 55 or older before the end of the tax year.

The high-deductible health plan (HDHP) that must accompany an HSA also has inflation adjustments, for its minimum plan deductible amount and its maximum annual out-of-pocket limitation. The deductible for 2022 must be at least $1,400 for self-only and $2,800 for family coverage, both the same as for 2021. The out-of-pocket maximums are $7,050 for self-only coverage and $14,100 for family coverage, increases of $50 and $100, respectively, from 2021.

  • The Department of Health and Human Services overruled the Trump Administration’s narrow interpretation of sex discrimination for purposes of the Affordable Care Act’s individual non-discrimination provision known as Section 1557. “Consistent with the Supreme Court’s decision in Bostock and Title IX, beginning today, [HHS’s Office for Civil Rights] will interpret and enforce Section 1557’s prohibition on discrimination on the basis of sex to include: (1) discrimination on the basis of sexual orientation; and (2) discrimination on the basis of gender identity. This interpretation will guide OCR in processing complaints and conducting investigations, but does not itself determine the outcome in any particular case or set of facts. In enforcing Section 1557, as stated above, OCR will comply with the Religious Freedom Restoration Act, 42 U.S.C. § 2000bb et seq., and all other legal requirements.
  • Federal News Network reports that “Few aspects of federal retirement seem to be trending down more than a year after the pandemic first hit the U.S. According to numbers released by the Office of Personnel Management, new claims, processed claims, processing times and the overall claims backlog were all higher in April 2021 than April 2020.” 
  • Fierce Healthcare informs us that “COVID-19 has only worsened social isolation, but [Blue Cross licensee] Anthem is addressing senior’s loneliness through a “wrap-around” program that encourages them to reach out. Through Member Connect, seniors are assigned a social care partner, who assists with connecting them to community services to address their social needs. They also have a phone pal, a volunteer Anthem associate who reaches out to them weekly. Many members (78%) said they either agreed or strongly agreed that participating in the program led to more meaningful connections with people. In addition, 66% said they are happy or very happy when taking into account all facets of their life in the past seven days.”

Weekend update

David Ermer–Congress, COVID-19, COVID-19 vaccine, U.S. Healthcare, Uncategorized–
Photo by Michele Orallo on Unsplash

Happy Mothers’ Day.

Congress will be engaged in Committee business and floor votes for the next two weeks. The Hill reports on what we can expect from Congress in the near term.

From the COVID-19 front, Bloomberg informs us that

The share of U.S. hospital beds occupied by Covid-19 patients fell to 5.37%, the lowest since Oct. 5, according to the U.S. Department of Health & Human Services. Michigan had the biggest percentage of beds occupied by Covid patients at 13.3% followed by Maryland at 10.8%, according to the latest HHS data, which reflect the situation on Thursday. Florida had 3,504 hospitalized Covid patients, the most of any state, followed by Texas with 3,080.

The U.S. added fewer than 35,000 cases on Saturday, sending the seven-day rolling average of new infections to the lowest since the end of September. While reporting often lags on weekends, the data collected by Johns Hopkins University and Bloomberg is the latest sign that the pandemic in America is easing.

Another 625 people nationwide died of Covid-19, bringing the toll to more than 581,000 since the outbreak began. Detroit and New York City had the most deaths per capita among major metro areas in the week through Wednesday, according to a Centers for Disease Control and Prevention report dated May 6.

According to the CDC’s website, nearly 7.5 million doses of COVID-19 vaccine were administered over the past three days. Approximately 43% of the U.S. population over age 18 and 71% of that population over age 65 is fully vaccinated against COVID-19. All of these facts are clearly related.

Govexec reports on the Postal Service’s first quarter 2021 financial results.

USPS lost just $82 million in the second quarter of fiscal 2021, a marked improvement over the same quarter the previous year. When excluding inflationary adjustments to the agency’s workers’ compensation liabilities that are outside of management’s control, however, the agency experienced $1.7 billion in losses from January through March compared to $1.9 billion in that period of fiscal 2020. 

Total revenue jumped 6% over the same period last year, led by a 34% spike in package business. The shift from regular mail—where plummeting volume persisted—to packages continued to add costs to the postal system, as packages entail additional personnel and transportation costs. * * *

The Postal Service’s costs jumped by 4% in the most recent quarter, which management attributed to package delivery and paid leave related to the pandemic. The agency’s total net loss of $82 million was down from $4.5 billion in the same period last year. 

Joe Corbett, the USPS chief financial officer, speculated the agency would break even by fiscal 2023 or fiscal 2024, provided DeJoy’s plan is implemented. USPS is relying in large part on Congress to pass reforms that would remove much of its liabilities for retiree health care costs from its balance sheets.  

Fredric Rolando, president of the National Association of Letters Carriers, said the postal revenue increases demonstrate those retiree health care reforms are the primary change needed.  The uptick in business drives home “how much the American people and their businesses rely on the essential work of the Postal Service,” Rolando said

If the the Postal Service’s healthcare reforms would save money and the Medicare Part D integration would create a gusher of savings, why not just apply those reforms across the entire FEHB which would avoid the additional administrative cost of creating a new Postal Service Health Benefits Program within the FEHB Program?

Cybersecurity Saturday

David Ermer–Cybersecurity–

Ransomware attacks remain in the headlines. Today Bloomberg reports

Colonial Pipeline is working to restore operations after a cyber-attack prompted the company to take its systems offline, threatening the supply of refined petroleum products to gas stations in major cities on the U.S. eastern seaboard.

The Washington Post reported that ransomware was used in the attack, citing two U.S. officials it didn’t identify. It wasn’t clear if the attack was carried out by foreign government hackers or a criminal group, the officials told the Post.

Cyberscoop reports on two major ransomware attacks on healthcare organizations — Scripps Health in San Diego and the Kansas based Midwest Transplant Network — which have occurred since the last Cybersecurity Saturday post. Bleeping Computer maintains a log of ransomware attack and issues here.

ZDNet calls attention to “paper by the Institute for Security and Technology’s (IST) Ransomware Task Force (RTF) – a coalition of cybersecurity companies, government agencies, law enforcement organisations, technology firms, academic institutions and others – has 48 recommendations to help curb the threat of ransomware and the risk it poses to businesses, and society as a whole, across the globe.”

The FBI offers password guidance in honor of World Password Day which was held last Thursday May 6.

“The following tips may help protect you and your information from a breach:

  • Make sure, at the very least, that your email, financial, and health accounts all have different unique passwords and/or passphrases.
  • Make sure your password is as long as the system will allow.
  • Set up multi-factor authentication for your accounts.
  • Don’t allow password ‘hints.’”

In closing here are a few cybersecurity tidbits —

  • Cyberscoop reports that “The Department of Homeland Security announced on Wednesday that it intends to hire 200 new cybersecurity professionals by July as the Biden administration aims to curb ransomware attacks affecting U.S. corporations, as well as foreign espionage operations.”
  • Fortune informs us that “Cloud rivals Microsoft, Google, and IBM have teamed up on a project to help companies better defend against hackers and other cybersecurity problems. The initiative, announced Thursday, involves tracking and recording attempts by hackers to infiltrate corporate systems. Because each cloud-computing vendor records security incidents differently, companies can have a hard time getting the full picture about the latest cybersecurity attacks, explained Daniel Conroy, chief technology officer for the digital unit of aerospace giant Raytheon, which is also part of the project.”
  • Cyberscoop provides the latest on fallout from the SolarWinds hack.

Friday Stats and More

David Ermer–CDC, COVID-19, COVID-19 vaccine, OPM, Patient safety, 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 18th week of this year (beginning April 2, 2020, and ending May 5, 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 5, 2021):

The Wall Street Journal observes and the charts evidence that

The U.S. may finally have turned a corner in the Covid-19 pandemic, according to epidemiologists and public-health officials.

Newly reported coronavirus cases have declined for three straight weeks, and the seven-day average of Covid-19 PCR tests that returned positive is hovering around 4%, one of its lowest points in the pandemic. Hospitalizations have been declining and reported deaths have fallen every week since late March.

The decrease in nearly every key metric comes as the U.S. meets a benchmark in its vaccination campaign. More than 40% of the adult population is now fully vaccinated, which many public-health experts say is an important thresholdwhere vaccinations gain the upper hand over the virus.

Here is a weekly COVID-19 vaccinations chart over the period December 17, 2020, through May 5, 2021, which also uses Thursday as the first day of the week:

The Centers for Disease Control observes

Following a rapid acceleration in vaccination rates, we are now seeing U.S. vaccination progress slow. This is not surprising considering the prior focus on vaccinating people at increased risk. Also, people eager to be immunized when they became eligible may have already secured their vaccine in line with increased supply. While more than 8 in 10 people 65 years and older have received at least one dose of vaccine, only around 1 in 3 people ages 18-29 have. All age groups currently eligible for the vaccine can benefit from the protection it provides themselves and others, especially as more states are easing prevention measures. 

Also from the COVID-19 vaccination front:

  • The Society for Human Resources Management provides helpful guidance to employers on how to help achieve herd immunity.
  • The CDC’s Advisory Committee on Immunization Practices will vote on Wednesday May 12 on whether to extend Pfizer’s emergency use application for its COVID-19 vaccine to children ages 12-15.
  • The Wall Street Journal reports that “AstraZeneca PLC could skip asking the Food and Drug Administration for emergency-use authorization for its Covid-19 vaccine, according to people familiar with the matter—and instead pursue the more time-intensive application for a full-fledged license to sell the shot.”
  • Law professor Richard Epstein weighs in on the hot topic of “Intellectual Property and the COVID-19 vaccines.”

From the healthcare business front

  • Healthcare Dive reports on Cigna’s 1st quarter 2021 results. The health insurer “beat Wall Street expectations in the quarter, and increased its forecast for the full year, signaling optimism for the remainder of 2021 despite the ongoing uncertainty.”
  • Fierce Healthcare reviews several health insurers’ first quarter 2021 results.

In other news —

  • The FEHBlog understands why according to Becker’s Payer Issues, 95% of insurers “are worried about meeting No Surprises Act requirements by [the January 1, 2022] deadline. Congress created an overcomplicated law. Hopefully the regulators can straighten it out in time.
  • The American Hospital Association questions the Lown Institute report on low value hospital care that the FEHBlog mentioned earlier this week.
  • Health Payer Intelligence brings us up to date on electronic attachments to HIPAA standard claims transactions, the one HIPAA requirement that HHS has not been able to tackle successfully.
  • Strangely, a British website helpfully summarizes the path of Kiran Ahuja to become OPM Director. “At her hearing, Ahuja said: “I believe people are, and should be, at the centre of all policy decisions, and… I would carry forward this guiding principle while working in service to the American public.” It remains to be seen whether the Senate, in a time of division, accepts that Ahuja can be the unifier the US public service needs.” My bet remains on confirmation.

Thursday Miscellany

David Ermer–COVID-19, COVID-19 vaccine, Telehealth, U.S. Healthcare, Uncategorized–
Photo by Juliane Liebermann on Unsplash

Today is the first day of National Nurse’s Week. The well-deserved celebration begins each year on May 6th and ends on May 12th, Florence Nightingale’s birthday. What a marvelous profession.

Meanwhile Healthcare Dive reports that

  • Last year marked a historic shift in the organization of medicine, with fewer than half of U.S. doctors working in a private practice, according to the latest American Medical Association Physician Practice Benchmark Survey. And among those private practices that continue to operate, many are trending toward a larger size.
  • According to the report, 50.2% of physicians were employees, up from 47.4% in 2018 and 41.8% in 2012. The proportion of doctors working in a private practice was 49.1% last year.
  • Hospitals are one of the largest employers of physicians, with the proportion increasing nearly 50% between 2012 and last year. And with the vast majority of doctors under the age of 40 now employees rather than employers, it suggests the trend will continue over the long term.

The Raleigh (NC) News-Observer reports that

CVS [Health] announced Wednesday it’s joining the list of pharmacies offering people the coronavirus vaccine without requiring an appointment, spokesperson Matt Blanchette told McClatchy News. Same-day scheduling as soon as one hour ahead of time is also available.  Walk-ins are available at 8,300 CVS locations across the country, Blanchette said. The company has more than 9,900 locations across 49 states, Washington, D.C., and Puerto Rico. 

The New York Times adds that “Chains like Walmart, Walgreens, Safeway and Stop & Shop have said that they are now offering vaccines to walk-in clients at some locations or in mobile clinics. Other pharmacies preceded the president’s announcement. Rite Aid said that it would accommodate walk-ins on a limited basis last week, for example.” Let’s go.

Forbes reports that Pfizer-Biontech and Moderna will apply for full FDA marketing approval of their respective COVID-19 vaccines later this month.

The FDA authorized the Moderna vaccine under an EUA on Dec. 18, after granting the same authorization to the Pfizer Covid-19 vaccine. The FDA can grant emergency use authorizations when a panel of experts determine the “known and potential benefits outweigh the known and potential risks,” and when the secretary of Health and Human Services determines a health crisis deems emergency use of unapproved products “appropriate.” Pfizer announced Monday it would file for full FDA approval, and it’s likely Johnson & Johnson, manufacturers of the only other Covid-19 vaccine authorized for emergency use in the U.S., will file for full FDA approval as well. Emergency use authorizations can be revoked when public health crises subside, and FDA approval would allow companies, like Moderna and Pfizer, to directly market their vaccines to consumers. 

FLASH: Politico reports that Pfizer/BioNTech applied for full FDA approval on Friday May 7.

Errata: The FEHBlog included in a post last month an erroneous report that Moderna had filed for FDA approval. He had understood that the application was overdue. Whoops.

Forbes further informs us

Moderna announced Wednesday its booster shot showed a positive immune response against the Covid-19 variants found in South Africa and Brazil. Moderna is testing booster shots in individuals who already received their two-dose Moderna vaccine regimen. [Moderna CEO Stephane] Bancel has said he expects booster shots will be necessary, and Pfizer CEO Albert Bourla said it’s “likely” vaccinated individuals will need a booster within a year of being fully vaccinated. 

From the healthcare business front —

  • According to the Wall Street Journal “Walmart Inc. said Thursday it purchased telehealth provider MeMD and plans to offer nationwide virtual healthcare services, another sign of the retail behemoth’s healthcare ambitions. The acquisition will allow Walmart to expand its Walmart Health service around the country, the company said. The retail giant didn’t disclose the financial details of the transaction.
  • The Journal further reports that ‘The MeMD deal opens another front in which Walmart and Amazon will compete, as Amazon recently announced plans to provide its telehealth service, Amazon Care, to its nearly 1 million U.S. employees by summer. Amazon Care, which now serves company workers in Washington state, will also be offered to other employers.” STAT News informs us that “Amazon Care signed its first enterprise customer this week, a significant milestone as the virtual-first health care platform looks to expand its footprint. The client, Precor, is a fitness business that was recently acquired by fitness technology company Peloton for $420 million in cash. Although small financially, the deal is a significant opener for Care.”
  • Healthcare Dive adds that “Nearly two out of three healthcare leaders say they’re currently prioritizing investment in telehealth as the pandemic continues, but that could change over the next few years, when investing in artificial intelligence shoots up the list of priorities, according to a new report from health tech giant Philips.”

Midweek Update

David Ermer–ACA, COVID-19, Mental health care, OPM, Telehealth–
Photo by Thought Catalog on Unsplash

OPM has released the 2020 highlights of its FEHB Plan Performance Assessment System. With this system, the 2020 plan scores which are based on 2019 data are used to determine the 2021 service charge for experience rated plans and the 2021 performance adjustment for community rated plans. 2020 was a tricky scoring year because the data was being gathered and analyzed just as the great hunkering down began in March 2020.

Reg Jones provide FEHB background for federal employees in Fedweek.

On the COVID-19 front, Bloomberg discusses the work of the federal government’s recently created COVID-19 Community Corps. The article discusses a Maine dairy farmer who set up a COVID-19 vaccination clinic for her employees and community members. “Organized in small teams that run the gamut from veterans and religious groups to progressive youth organizations and a Black LGBTQ group, the corps has been in the forefront of reaching the reluctant. The idea is that this wide demographic outreach will radiate, so that the friends and neighbors of the vaccinated follow suit.” Bravo.

WTOP, a local news radio station here in Washington DC reports that Pfizer “will seek [emergency] approval for use [of its COVID-19 vaccine] in children between 2 and 11 years old as early as September.

In other healthcare news

  • Mobihealth News reports that “On-demand behavioral health platform Ginger is now available as a health benefit for Cigna’s 14 million members, the companies announced [on April 28]. Members with Cigna’s employer-sponsored or individual and family insurance plans can now access Ginger’s behavioral health coaching, therapy and psychiatry services as an in-network benefit.” Smart move.
  • Healthcare Dive reports that “Telehealth utilization among the commercially insured fell 16% from January to February, the first month-to-month drop since September, according to a tracker from nonprofit Fair Health. The data suggests a potential slowdown in demand for virtual care services that spiked last year in the early months of COVID-19. Historically high levels of telehealth utilization spurred an unprecedented influx of cash into the digital health sector, but the sustainability of that boom depends in part on continued demand from consumers that could be waning as vaccinations increase and the pandemic wanes. Mental health conditions continued to top the list of diagnoses. However, COVID-19, which joined the top five diagnoses list in December, dropped from the list, likely reflecting the national decline in cases in February.”
  • Since Monday the FEHBlog has been looking at the Health Affairs blog to post here Katie Keith’s follow up post on the 457 page long second final ACA notice of benefit and payment parameters. It turns out that he had posted Prof. Keith’s follow up post on Monday and that the lead entry was made last Saturday May 1. Here are the links to Prof. Keith’s lead and follow up posts on that important ACA rule making. Considering it’s Cinqo de Maio, lo siento lectors.

The FEHBlog hasn’t mentioned the Econtalk podcast in a while but he does listen every week. This week the host Russ Roberts spoke with behavioral scientist Katy Milkman of the Wharton School at the University of Pennsylvania talks about her new book How to Change: The Science of Getting from Where You Are to Where You Want to Be.” Professor Milkman talks about soft commitment strategies [to achieve goals] and hard commitment strategies. An example of a soft commitment strategy involved a doctor posting a letter visible to patients committing to specific Choosing Wisely recommendations such as proper prescribing of antibiotics. As for hard commitments she notes this example, which was news to the FEHBlog, “websites like StikK and Beeminder that let you fine yourself if you’re not achieving your goals.” She also discusses the carrot strategy .”The carrot is, let’s actually figure out ways to make it more enjoyable in the moment, and that way your willpower won’t be needed to do the thing that’s good for you.” An example is binging junk TV while using the treadmill. Their discussion on self control is fascinating. Check it out.

Tuesday’s Tidbits

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

The Wall Street Journal reports

The Biden administration said it would begin reallocating some Covid-19 vaccine doses to states with higher demand for shots and direct pharmacies to offer walk-in vaccinations, as the president aims to get 70% of the adult population at least one dose by July 4.

President Biden said Tuesday he also wants 160 million U.S. adults to have the full course of the vaccine by that point, which he said would mean administering about 100 million shots over the next 60 days. The U.S. administered about 220 million shots in Mr. Biden’s first 100 days, but the pace of vaccinations has fallen in recent weeks, according to the Centers for Disease Control and Prevention. Roughly 56% of U.S. adults had received at least one dose as of Monday, according to the CDC.

Also from the COVID-19 front, the NIH Director Dr. Francis Collins offers a real world look at COVID-19 vaccines versus variants.

Healthcare Dive reports

  • CVS Health beat Wall Street expectations for earnings and revenue in the first quarter, reporting a topline of $69.1 billion, up 3.5% year over year due to growth across all major businesses.
  • The diversified healthcare behemoth brought in net income of $2.2 billion, compared to $2 billion at the same time last year in financial results released premarket Tuesday. 
  • Following the quarter, which saw a strong financial showing from all major U.S. payers, CVS raised its full-year earnings guidance, noting it expects normal utilization throughout 2021 and minimal effects from the COVID-19 pandemic. However, management did warn vaccine hesitancy could slightly hamper expected earnings growth.

In related CVS news —

  • NPR Shots informs us about how CVS Health is adding mental health therapists to its Minute Clinics and Health Hubs.
  • Drug Channels places CVS Specialty at the top of its list of top 15 specialty pharmacies.

In other healthcare business news

  • STAT News informs us that “Although the pharmaceutical industry argues that wholesale prices do not accurately reflect prescription drug costs, a new study finds that rising wholesale prices have, in fact, led to higher out-of-pocket expenses for roughly half of insured patients.” Shocking.
  • The Wall Street Journal reports that “Pfizer Inc. raised this year’s sales forecast for its Covid-19 vaccine to about $26 billion, a 73% increase that reflects the shot’s growing role in a long-term global vaccination campaign.” Thanks Pfizer.
  • Health Payer Intelligence reports

Gross margins and medical loss ratios from 2020 may confirm that payer profitability increased during the coronavirus pandemic, according to a brief from Kaiser Family Foundation.

The researchers leveraged data from the National Association of Insurance Commissioners (NAIC) to observe the pandemic’s effects on the profitability of four health insurance markets: Medicare Advantage, Medicaid managed care, the individual health insurance marketplace, and the fully-insured group health insurance marketplace.

“By the end of 2020, gross margins per member per month across these four markets remained relatively high and medical loss ratios were relatively low or flat compared to recent years,” the researchers discerned. “These findings suggest that many insurers remained profitable through 2020.”

Here are some additional healthcare tidbits —

  • The Lown Institute announced that “Every 80 seconds, a hospital in the U.S. delivers a low-value test or procedure to an older adult, putting hundreds of thousands at risk of harm, according to a new analysis from the Lown Institute, a health care think tank. The Institute today released a ranking of over 3,100 U.S. hospitals that examines success at avoiding the use of tests and procedures that offer little to no clinical benefit.”
  • The Congressional News Service released a helpful report titled “A Comparison of Tax-Advantaged Accounts for Health Care Expenses.”
  • The Department of Health and Human Services announced “the availability of nearly $1 billion to strengthen COVID-19 response efforts and increase vaccinations in rural communities. As part of the Biden Administration’s commitment to expanding access to vaccines and ensuring equity in the COVID-19 response, the Health Resources and Services Administration, a part of HHS, will increase the number of vaccines sent to rural communities, expand testing and other COVID-19 prevention services, and work to increase vaccine confidence by empowering trusted local voices with additional funding for outreach efforts in underserved communities.”

Last but not least here are some federal employment tidbits —

  • The Office of Personnel Management reminds us that “Each year Federal Executive Boards (FEBs) across the nation recognize federal employees who have made exceptional contributions in their community or the advancement of their agency’s mission. This year, OPM and the Partnership for Public Service are highlighting more than 300 awards winners from FY2020 and FY2021. To learn more about these recipients and their exemplary accomplishments, visit the FEB awards site.  “
  • Federal News Network reports that “Union leaders say staffing shortages are stretching their agencies thin.”
  • Govexec reports that “Some U.S. Postal Service employees will receive layoff notifications later this month, the mailing agency told workers in a memorandum this week. * * * USPS declined to specify how many positions would be eliminated, but said it aims to offer impacted workers opportunities for reassignment.”

Monday Roundup

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

The Office of Personnel Management reminds us that this is Public Service Recognition Week. “Celebrated annually during the first week of May since 1985, Public Service Recognition Week (PSRW) (external link) is time set aside to honor the men and women who serve our nation as federal, state, county and local government employees.”

From the COVID-19 front:

The Food and Drug Administration is preparing to authorize use of the Pfizer-BioNTech Covid-19 vaccine in adolescents 12 to 15 years old by early next week, according to federal officials familiar with the agency’s plans, opening up the nation’s vaccination campaign to millions more Americans.

The news is highly anticipated: Eager parents have been counting down the weeks since Pfizer announced results from its trial in adolescents, showing the vaccine is at least as effective in that age group as it is in adults. Vaccinating children is also key to raising the level of immunity in the population and bringing down the numbers of hospitalizations and deaths.

The authorization could come as early as late this week, according to the federal officials, who did not give their names because they weren’t authorized to speak publicly. If it is granted, the Centers for Disease Control and Prevention’s vaccine advisory panel will likely meet the following day to review the clinical trial data and make recommendations for the vaccine’s use in adolescents.

  •  The Wall Street Journal informs us

Everyone who was desperate for a vaccine has gotten a shot, said Alexandra Simon, the California director of vaccines for Curative, a Covid-19 testing and health-services company administering vaccines across the country. The company is now seeing people with access issues, including questions about insurance or identification, and fears about being unable to take care of children because of side effects. Many people, she said, simply can’t take time off. Others only want an appointment on Thursday or Friday, or prefer a site with the vaccine from Pfizer Inc. and BioNTech SE, said Curative’s chief information officer, Isaac Turner.

But the fact that supply now exceeds immediate demand means getting vaccinated is a much easier process. That message may be getting across because over 3.3 million doses of COVID-19 vaccine were administered Sunday per the CDC.

  • The Wall Street Journal also hopefully reports that “The next generation of Covid-19 vaccines in development could come as a pill or a nasal spray and be easier to store and transport than the current handful of shots that form the backbone of the world-wide vaccination effort.”

Good advice from the American Medical Association (“AMA”)

  • The AMA offers six lifestyle changes that can prevent heart disease.
  • The AMA also recommends eight keys to ending the drug overdose crisis.

In healthcare business news, the Wall Street Journal reports that

The Blue Cross Blue Shield Association said it dropped a rule that limited competition among its member insurers, moving to implement a key aspect of an antitrust settlement the companies reached last year with customers. * * *

Previously, the rule was that two-thirds of a Blue licensee’s national net revenue from health plans and related services must stem from Blue-branded business.

The Blue Cross Blue Shield Association includes 35 insurers, each of which typically hold exclusive rights to the Blue Cross and Blue Shield brands within a certain territory, a setup that would remain intact under the antitrust settlement.

However, lifting the revenue cap could allow the Blue insurers to compete more against one another by expanding their non-Blue businesses, experts said. Dropping the limit “certainly should increase competition,” said Tim Greaney, a professor at the University of California Hastings College of the Law, though he said it isn’t clear how quickly it would have an effect.

Following up on a couple of items from Friday’s post:

  • The FEHBlog mentioned that a company called ClosedLoop.ai had won a million dollar healthcare artificial intelligence prize from the federal government. The FEHBlog couldn’t figure out what the prize winning invention did. STAT News tells us that ClosedLoop.ai “bested 300 rivals with a system capable of forecasting adverse health events by crunching an array of data on patients.” Nifty.
  • The FEHBlog also pulled the key tidbit from the 457 page long HHS second notice of 2022 benefit and payment parameters. Katie Keith in the Health Affairs blog provides much more detail for all those interested.