FEHBlog

Weekend update

The House of Representatives and the Senate to continue to be engaged in Committee business and floor voting this coming week.

From the omicron and siblings front, Bloomberg Prognosis reports

People who are vaccinated and then get infected with omicron may be primed to overcome a broad range of coronavirus variants, early research suggests.  

A pair of studies showed that infection produced even better immune responses than a booster shot in vaccinated patients. Teams from Covid-19 vaccine maker BioNTech SE and the University of Washington posted the results on preprint server bioRxiv in recent weeks.

The researchers have found the silver lining in the Omicron cloud.

In other encouraging healthcare news, BioPharma Dive informs us

The Food and Drug Administration on Friday approved Eli Lilly’s diabetes drug Mounjaro, a first-of-its-kind treatment that can help control patients’ blood sugar and, potentially, help them lose weight as well.

Mounjaro, also known as tirzepatide, expands Lilly’s diabetes business, which includes insulins as well as other types of therapies. The company recorded $9 billion in diabetes drugs sales last year.

Mounjaro works by stimulating two hormones, called GLP-1 and GIP, that control insulin production. In clinical testing, the drug outperformed several other diabetes medicines, including one made by rival drugmaker Novo Nordisk that only acts on one hormone. Mounjaro was more effective in controlling blood sugar than two types of insulin as well. * * *

The drug’s approval will heighten competition between Lilly and Novo, which have battled for market share in the U.S. for years. Novo, for instance, has recently had success by launching a similar, once-weekly shot to Lilly’s top-selling drug Trulicity, as well as a daily pill that works the same way.

Novo is testing a dual-acting competitor to tirzepatide, but it’s only in Phase 2 testing, well behind Lilly’s drug. Both companies are also trying to develop a once-weekly insulin shot, with similar programs in Phase 3 development.

The next frontier for both companies is in obesity, where they are working to prove their drugs’ worth as weight loss treatments. Novo has already won approval for a drug called Wegovy, while Lilly reported promising data for Mounjaro last month.

The article adds that Lilly did not disclose pricing for its newly approved drug on Friday.

The FEHBlog also noticed that Katie Keith’s latest article on the Affordable Care Act delves into the recent guidance on posting three machine reading pricing files on health plan websites by July 1. The discussion may be found in the closing paragraphs of the article.

Cybersecurity Saturday

From our Nation’s Capital, Cybersecurity Dive reports

On the one-year anniversary of the Executive Order on Improving the Nation’s Cybersecurity, industry experts say the Biden administration has made significant inroads in raising software security standards, but additional work and financial support is necessary to achieve security end goals. 

The Office of Management and Budget’s (OMB) federal zero trust strategy enjoys almost unanimous support from federal cybersecurity decision makers, however two-thirds of federal cybersecurity decision makers said the three-year timeline was unrealistic, according to a study from MeriTalk, sponsored by AWS, CrowdStrike and Zscaler. Just 14% of those surveyed believe the program is properly funded.

Almost two-thirds of federal officials expect to achieve zero trust goals by the goal date of 2024, according to a separate study from General Dynamics Information Technology. However, many of those officials see significant challenges, including a lack of sufficient IT staff and the need to replace legacy infrastructure.

My, how time flies.

Cyberwire adds

A $63 million settlement has been reached in the class-action lawsuit filed over the 2015 data breach of the US Office of Personnel Management (OPM) that exposed the data of over 21 million current, former, and prospective federal employees and families members, the Epoch Times reports. The files were allegedly stolen by China-backed hackers, who exfiltrated highly sensitive information such as fingerprints and psychological and emotional health histories, and it is reported that the Chinese government has been using data from such breaches to build a database on American citizens for political and economic espionage. The agreement explains, “The settlement is the result of extensive negotiations and accounts for the unique aspects of this litigation, including the strict limitation on recovering from the Government and the causation problems that Defendants would have argued result from the hack’s attribution to a foreign state actor…That these data breaches were attributed to the Chinese government, apparently motivated by foreign policy considerations, would have compounded the risks associated with tracing plaintiffs’ harm to [OPM].” Under the settlement, which is still awaiting approval from a federal judge, OPM will pay $60 million and OPM contractor Peraton will pay $3 million into a fund for victims of the hack. 

The news strikes the FEHBlog as a good deal for the government.

From the ransomware front, Cyberscoop informs us

vosLocker, a prolific ransomware group that was the subject of a recent joint FBI and U.S. Treasury Department warning, claimed this week that it had hit a Dallas-based nonprofit Catholic health system with more than 600 facilities across four U.S. states, Mexico, Chile and Colombia.

The attack on CHRISTUS Health marks the second health care system AvosLocker targeted in the last two months. Michigan-based McKenzie Health System began notifying customers this week that patients’ personal data had been stolen from the company’s network in a “security incident” that “disrupted” some of its IT systems in March. The company did not identify the attacker, but AvosLocker posted purported McKenzie data to its dark web leak site April 6. * * *

Security Week adds

Over the past several months, Iran-linked cyberespionage group Charming Kitten has been engaging in financially-motivated activities, the Secureworks Counter Threat Unit (CTU) reports.

Also referred to as APT35, Magic Hound, NewsBeef, Newscaster, Phosphorus, and TA453, the advanced persistent threat (APT) actor is known for the targeting of activists, government organizations, journalists, and various other entities. * * *

The security researchers assess that, while the group has managed to compromise a large number of targets worldwide, “their ability to capitalize on that access for financial gain or intelligence collection appears limited.” However, the use of publicly available tools for ransomware operations shows that the group remains an ongoing threat, Secureworks concludes.

For more on Charming Kitten, check out this Cyberscoop article.

Here is a link to the Bleeping Computer’s Week in Ransomware column.

From the cyber vulnerabilities front, CISA added one new known vulnerability to its catalog.

From the cyber defenses front, here’s a link to a press release of note

The Cybersecurity and Infrastructure Security Agency (CISA), in partnership with the United Kingdom’s National Cyber Security Centre (NCSC-UK), Australian Cyber Security Centre (ACSC), Canadian Centre for Cyber Security (CCCS), New Zealand National Cyber Security Centre (NZ NCSC), National Security Agency (NSA), and Federal Bureau of Investigation (FBI) released an advisory today [May 11] with cybersecurity best practices for information and communications technology (ICT), focusing on enabling transparent discussions between managed service providers (MSPs) and their customers on securing sensitive data. CISA, NCSC-UK, ACSC, CCCS, NZ-NCSC, NSA, and FBI expect state-sponsored advanced persistent threat (APT) groups and other malicious cyber actors to increase their targeting of MSPs against both provider and customer networks. 

Security Week offers an expert view on seven steps to reduce risk to your critical infrastructure quickly.

Friday Stats and More

Based on the CDC’s Covid Data Tracker and using Thursday as the first day of the week, here is the FEHBlog’s weekly chart of new Covid cases from the 27th week of 2021 through the 19th week of 2022.

The CDC’s weekly review of its Covid statistics notes

As of May 11, 2022, the current 7-day moving average of daily new cases (84,778) increased 30.7% compared with the previous 7-day moving average (64,863). A total of 82,087,117 COVID-19 cases have been reported in the United States as of May 11, 2022.

Here’s the CDC’s weekly chart of new Covid hospitalizations

The CDC’s weekly review of Covid hospitalization notes, “The current 7-day daily average for May 4–10, 2022, was 2,629. This is a 17.5% increase from the prior 7-day average (2,238) from April 27–May 3, 2022.”

Here’s the FEHBlog’s weekly chart of new Covid deaths from the 27th week of 2021 through the 19th week of 2022:

The CDC’s weekly review notes “The current 7-day moving average of new deaths (273) has decreased 15.4% compared with the previous 7-day moving average (322). As of May 11, 2022, 996,376 COVID-19 deaths have been reported in the United States.”

Finally, here is the FEHBlog’s weekly chart of Covid vaccinations distributed and administered from the beginning of the Covid vaccination era through the 19th week of 2022.

Per the CDC’s weekly review, “As of May 11, 2022, the 7-day average number of administered vaccine doses reported (by date of CDC report) to CDC per day was 390,306, an 11.1% decrease from the previous week.”

76% of the U.S. population aged 18 and older are fully vaccinated against Covid, and 50% of that cadre has received the first booster. Likewise, 90% of the U.S. population aged 65 and older is fully vaccinated, and 70% of that cadre has received the first booster. There is work still to be done but the public health community and the U.S citizenry deserves credit for these accomplishments.

To wrap up this week’s Covid stats, let’s include the CDC’s latest Communities report:

As of May 12, 2022, there are 137 (4.25%) counties, districts, or territories with a high COVID-19 Community Level, 453 (14.07%) counties with a medium Community Level, and 2,630 (81.68%) counties with a low Community Level. This represents a small (+1.77 percentage points) increase in the number of high-level counties, a moderate (+4.10 percentage points) increase in the number of medium-level counties, and a corresponding (−5.87 percentage points) decrease in the number of low-level counties. Eight (15.38%) of 52 jurisdictions had no high- or medium-level counties this week.

To check your COVID-19 Community Level, visit COVID Data Tracker.

NPR Shots offers a valuable article describing three ways to get the Paxlovid pill if diagnosed with Covid. The key takeaway from the FEHBlog’s perspective is the need to have a primary care provider in your life.

For those with health insurance and access to their primary care providers or health care team, you can make an in-person or telehealth appointment to get tested (or share your positive test results), assessed for risks and medications and, if eligible, obtain a prescription for the pills. 

You’d then get the prescription filled at a nearby pharmacy

Having a provider that knows your medical history, as well as the details of your current situation, can be very helpful, says Dr. Ulrika Wigert, a family medicine physician at CentraCare in Sauk Center, Minnesota. “Did you test the first day [of symptoms]? Did you test the second day? How sick were you when you tested?” And, if you’re starting to feel better by the time you get the medication, do the benefits of taking the medication outweigh any risks? “Having a provider help navigate that on the individual patient basis” can help guide you through an appropriate course of care, she says. 

STAT News addresses three burning questions about the future of prescribing drugs using telehealth services (not for a PCP visit).

Research by Lori Uscher-Pines, a senior policy researcher at RAND, suggests that providers are starting to prescribe buprenorphine — a controlled substance used to treat opioid use disorder — without in-person visits. But they’re typically more comfortable continuing the prescriptions virtually for patients they’ve already met, compared to taking on new patients virtually.

Still, “very few studies of medication treatment for opioid use disorder via telehealth have shown safety or diversion concerns,” she said. And she noted that one recent study suggested that relaxed restrictions have improved treatment retention for opioid use disorder patients.

Telehealth prescription could help patients in regions with acute clinician shortages — especially of mental health providers — obtain critical medication.

“A key question going forward is how to strike a balance between increasing access to important medications on the one hand and limiting the potential for misuse on the other,” Uscher-Pines said.

In the past, federal and state regulations have required clinicians to frequently examine patients in-person to guard against misuse, addiction, or fraud. “But are there other ways to accomplish this, perhaps ways that actually leverage telehealth rather than restrict it?” she asked.

A better system might involve hybrid care: In-person exams for certain types of prescriptions blended with virtual follow-ups, for instance. But Schwamm cautioned against over-regulating telehealth prescriptions, given that clinical guidelines evolve faster than federal and state policies typically do.

“Whenever you put these kinds of restrictions in place, you are restricting access to care,” he said. “Do we need to require, and is it good medical practice, to require by regulation that the person come in-person? I would argue that we just don’t know.”

It’s complicated.

Thursday Miscellany

Photo by Josh Mills on Unsplash

The Hill reports

White House COVID-19 coordinator Dr. Ashish Jha issued a dire warning Thursday that the U.S. will be increasingly vulnerable to the coronavirus this fall and winter if Congress doesn’t swiftly approve new funding for more vaccines and treatments.

In an Associated Press interview, Jha said Americans’ immune protection from the virus is waning, the virus is adapting to be more contagious and booster doses for most people will be necessary — with the potential for enhanced protection from a new generation of shots.

STAT News offers this ray of sunshine

Epidemiologist David Dowdy of Johns Hopkins’ Bloomberg School of Public Health said that, despite the case increases, hospitalization and death rates overall remain relatively low compared with earlier periods in the pandemic — a reflection of how much immunity there is in the population.

“In some ways, this is encouraging, in that we’re starting to see a divergence between the number of cases and the number of hospitalizations and deaths,” Dowdy said. “But it’s also a little bit discouraging that we’ve been through all this and we’re still seeing a flat line and an uptick in the number of people getting admitted to the hospital and in people dying.”

In the FEHBlog’s view, the coordinator should stop fighting the Delta pandemic by focusing attention on better government distribution of Pfizer’s Paxlovid, which can cure the Omicron if taken timely. Kaiser Health News discusses this continuing and vexing distribution problem.

Unquestionably a need to focus attention on vaccinations and boosters remains essential. Govexec and Kaiser Health News ask why one-third of Americans over 65 have not received the first booster. Nearly all Americans over 65 are fully vaccinated. The article explains

People 65 and older account for about 75% of U.S. covid deaths. And some risk persists, even for seniors who have completed an initial two-dose series of the Moderna or Pfizer vaccine or gotten one dose of the Johnson & Johnson vaccine. Among older people who died of covid in January, 31% had completed a first vaccination round but had not been boosted, according to a KFF analysis of CDC data

FEHB plans are well-positioned to help with this effort, given their demographics.

In other virus news, the American Hospital Association tells us

The Centers for Disease Control and Prevention yesterday updated its testing guidance for clinicians treating children with hepatitis of unknown cause. The agency is investigating 109 potential hepatitis cases of unknown cause in U.S. children since last October, including five deaths. More than 90% of the patients were hospitalized, 14% received liver transplants and more than half had a confirmed adenovirus infection, but officials still don’t know the actual cause of their hepatitis and cautioned that it may take time to assess the evidence and learn more. Potential cases also have been reported in the United Kingdom and other countries. 

Following up on last night’s hospital system merger news, Healthcare Dive reports

The Advocate Aurora Health and Atrium Health merger is likely to get a close review from the Federal Trade Commission as the Biden administration has taken a tougher stance on healthcare consolidation, antitrust and legal experts say. * * *

“I don’t think anything of this size in a healthcare transaction today is going to get rubber stamped,” said Bill Horton, a partner at Jones Walker who focuses on healthcare transactions. * * *

“Historically, the FTC concern in hospital and healthcare institution mergers has been the geographic overlap,” Horton said.

Advocate Aurora and Atrium do not have any geographic market overlap. The systems span six separate states through the Midwest and South.

“It doesn’t raise the same red flags, but it doesn’t mean that it gets waved through,” said Leemore Dafny, a Harvard Business School professor and former deputy director of healthcare and antitrust at the FTC.

The FTC is likely to examine whether the two systems negotiate with the same insurers even if they’re in different geographic locations, Dafny said.

From the interoperability front, Health Data Management offers an interesting take on government efforts to meet lofty public health goals for Data Modernization Initiative.

From the mental health care front, and to end on a high note, Health Payer Intelligence informs us

Consumers reported having positive experiences with their employer-sponsored mental and behavioral healthcare coverage during the coronavirus pandemic, a survey conducted on behalf of AHIP discovered.

“Health insurance providers are working every day to support Americans by helping them find the mental health support and counseling they need at a price they can afford,” Matt Eyles, president and chief executive officer of AHIP, said in a press release.

Midweek update

Thanks to Alexandr Hovhannisyan for sharing their work on Unsplash.

From Capitol Hill, Roll Call reports

Third time’s a charm. Or so Democrats hope as they attempt to negotiate a third COVID-19 funding deal after their previous two bipartisan agreements — one for $15.6 billion in domestic and international aid, and a second for $10 billion in only domestic funds — stalled out. 

The House is taking the lead on the latest iteration. But it’s not yet clear whether they’ll hold out for a bipartisan, bicameral agreement or attempt to move a Democrat-led version that would provide more funding, closer to President Joe Biden’s original $22.5 billion request. 

“All the options are on the table,” House Majority Leader Steny H. Hoyer, D-Md., said Wednesday. “But it’s critical to get it done. And the fastest way to get it done is have an agreement on the four corners.” 

From the No Surprises Act front, the U.S. Court of Appeals for the Fifth Circuit has granted the federal government/appellant’s “unopposed motion to stay further proceedings in this court pending ongoing rulemaking proceedings involving provisions of the No Surprises Act, with a status report due every sixty (60) days.” It’s worth noting that the final independent dispute resolution rule has not yet appeared on the OMB’s Office of Regulatory Affairs reginfo.gov site.

From the Omicron and siblings front, Fierce Healthcare tells us

Reported cases of COVID-19 and hospitalizations for the disease are on the rise across most of the U.S., with the Centers for Disease Control and Prevention (CDC) recently shifting many counties in the Northeast to medium or high levels of community risk. * * *

COVID-19 hospitalizations—which have become the CDC and other public health experts’ preferred metric for decisionmaking—have similarly begun to tick upward over the past month.

After reaching a seven-day average low of 1,426 daily admissions in early April, national admissions have continually increased and exceeded the seven-day average of 2,400 daily hospitalizations late last week. These new admissions represented an 11% increase over the previous week’s seven-day average, according to the agency, but were still nearly 90% below the January peak of more than 21,500 average daily admissions.

From the opioid epidemic front, the Wall Street Journal reports

Drug-overdose deaths in 2021 topped 100,000 for the first time in a calendar year, federal data showed, a record high fueled by the spread of illicit forms of fentanyl throughout the country.

More than 107,000 people in the U.S. died from drug overdoses last year, preliminary Centers for Disease Control and Prevention data released Wednesday showed, roughly a 15% increase from 2020. The proliferation of the potent synthetic opioid fentanyl has been compounded by the destabilizing effects of the Covid-19 pandemic on users and people in recovery, according to health authorities and treatment providers. 

The U.S. has recorded more than one million overdose deaths since 2000, and more than half of those came in the past seven years. 

“We’ve never seen anything like this,” said Robert Anderson, chief of the mortality-statistics branch at the CDC’s National Center for Health Statistics, regarding fentanyl’s impact on the numbers.

From the telehealth front, Healthcare Dive informs us

Telehealth visits for COVID-19 diagnoses fell in February, mirroring the sharp decline in new cases of the virus reported to the Centers for Disease Control and Prevention after January’s omicron-driven peak, according to Fair Health’s monthly telehealth claims tracker.

Overall telehealth use also slowed, falling 9.3% in February across the country. Virtual visits were 4.9% of all medical claim lines, down from 5.4% in the prior month.

With declining COVID-19 cases generating fewer telehealth sessions, mental health conditions accounted for a greater share of all diagnoses conducted via virtual platforms, according to the Fair Health data released Monday. Mental health diagnoses rose to about 64% of telehealth claims, up from 60% in January.

The FEHBlog is happy that people are using telehealth for mental healthcare,e which strikes the FEHBlog as a good, productive fit.

From the healthcare business front, Healthcare Dive reports

Advocate Aurora Health and Atrium Health said Wednesday they plan to merge, creating one of the nation’s largest nonprofit health systems with $27 billion in combined revenues and 67 hospitals across six states.

Board members from both systems unanimously approved the agreement, which is subject to regulatory review. The combined entity will be led by both CEOs for the first 18 months, at which time Advocate’s CEO Jim Skogsbergh will retire, leaving Atrium’s CEO Eugene Woods as sole leader.

Advocate and Atrium will have an equal number of board seats. Atrium’s board chair Edward Brown will first serve as chair until the end of 2023, followed by a two-year term for Advocate’s chair Michele Richardson.

The health systems’ joint press release adds

The new organization will have a combined footprint across Illinois, Wisconsin, North Carolina, South Carolina, Georgia and Alabama. It will serve 5.5 million patients, operate more than 1,000 sites of care and 67 hospitals, employ more than 7,600 physicians and nearly 150,000 teammates, and have combined annual revenues of more than $27 billion.

That’s an interesting combination.

Health Payer Intelligence calls attention to

Six technology vendors [who] were highlighted for their abilities to address one of the six main points of friction between payers and providers that leading healthcare organizations strive to address, according to a KLAS report that is part of the KLAS Payer/Provider Initiative.

KLAS launched the Payer/Provider Initiative to identify points of friction between payers and providers and to highlight strong collaboration case studies.

The six payer-provider challenges that leading healthcare organizations tackled were prior authorization, value-based care, payer-provider interoperability, denials, credentialing, and patient billing.

From the OPM front, Federal News Network tells us

Agencies have to choose two out of four new focus areas to help improve their workforce over the next four years.

Deciding which options are most impactful gives agencies flexibility in how they approach new workforce objectives from the Office of Personnel Management.

Although OPM’s federal workforce priorities report, released on May 10, asks agencies to focus on only two of the four focus areas, implementing all four can help agencies resolve bigger workforce issues.

Among four primary priorities and four enabling priorities, OPM hopes agencies can implement proactive approaches to common issues, such as recruitment challenges.

From OPM’s federal workforce priorities report via Federal News Network

Tuesday’s Tidbits

Photo by Patrick Fore on Unsplash

From the Omicron and siblings front

  • The Wall Street Journal has updated its article on Covid boosters.
  • The Institute for Clinical and Economic Review (ICER) today released “a Final Evidence Report assessing the comparative clinical effectiveness and value of [specific] outpatient treatments for COVID-19 [, principally Pfizer’s pill Paxlovid and Merck’s pill molnupiravir ].

A majority (11-2) found current evidence is not adequate to demonstrate a net health benefit when molnupiravir is compared to symptomatic care alone.

All panelists (13-0) found that current evidence is adequate to demonstrate a net health benefit when Paxlovid is compared to symptomatic care alone.

Due to uncertainty in the net health benefit for molnupiravir, a majority of panelists voted that it represents “low-to-intermediate” long-term value for money.

A majority of panelists found that Paxlovid represents “high” long-term value for money.

  • ICER presented at the OPM/AHIP carrier conference last month. ICER “is an independent non-profit research institute that produces reports analyzing the evidence on the effectiveness and value of drugs and other medical services. ICER’s reports include evidence-based calculations of prices for new drugs that accurately reflect the degree of improvement expected in long-term patient outcomes, while also highlighting price levels that might contribute to unaffordable short-term cost growth for the overall health care system.”
  • Speaking of the Covid pills, STAT News discusses the use of telehealth services to prescribe them. The upshot, as the FEHBlog understands it, is while using telehealth for this purpose is convenient for patients, experts are unsure whether the telehealth service provides adequate follow-up care to the patient.

Also, from the Rx coverage front, the Food and Drug Administration issued a news roundup today.

From the healthcare business front, BioPharma Dive reports

Pfizer has agreed to acquire Biohaven Pharmaceuticals for $11.6 billion in a deal that turns an existing alliance on a fast-selling migraine drug into a big bet on its future growth.

Pfizer will pay $148.50 per share in cash for each Biohaven share it doesn’t already own, representing a roughly 79% premium to the company’s Monday closing price and a 33% premium to its average share price of $111.70 over the last three months. The deal, which is expected to close early next year, is by far the biggest biotech buyout of 2022, according to data compiled by Biopharma Dive.

Announced Tuesday, the acquisition hands Pfizer full rights to Nurtec ODT, a pill that’s approved in the U.S. and other countries for the treatment and prevention of migraines. Biohaven’s pipeline also includes an experimental nasal spray for migraines, zavepegant, that’s been submitted to U.S. regulators, as well as five additional, preclinical treatments that block the same protein target.

From the mental health parity front, the Labor Department’s Employee Benefits Security Administration announced that the agency will be holding a mental health parity compliance assistance webcast on May 24 from 2-3 pm ET. Here is a link to the announcement which explains how to register for the webcast.

From the patient safety front, the Leapfrog Group “released the spring 2022 Leapfrog Hospital Safety Grade, which assigns a letter grade to nearly 3,000 U.S. general hospitals based on over 30 measures of patient safety.”

At HospitalSafetyGrade.org, the public can find detailed information about a hospital’s performance on patient experience and other safety measures used to grade hospitals.

Across all states, highlights of findings from the spring 2022 Leapfrog Hospital Safety Grade include:

Thirty‐three percent of hospitals received an “A,” 24% received a “B,” 36% received a “C,” 7% received a “D,” and less than 1% received an “F.”

Five states with the highest percentages of “A” hospitals are North Carolina, Virginia, Utah, Colorado, and Michigan.

There were no “A” hospitals in Wyoming, West Virginia, the District of Columbia, or North Dakota.

From the medical research department, Medscape informs us

Eight modifiable risk factors were linked to more than one in three cases of Alzheimer’s disease and related dementia in the U.S., a cross-sectional analysis showed.

The eight risk factors — midlife obesity, midlife hypertension, physical inactivity, depression, smoking, low education, diabetes, and hearing loss — were associated with 36.9% (95% CI 36.5-37.3) of Alzheimer’s and dementia cases, reported Roch Nianogo, MD, PhD, of the University of California Los Angeles, and Deborah Barnes, PhD, MPH, of the University of California San Francisco, and co-authors.

The factors most prominently associated with Alzheimer’s and dementia were midlife obesity, at 17.7% (95% [Confidence Interval] CI 17.5-18.0); physical inactivity, at 11.8% (95% CI 11.7-11.9); and low educational attainment, at 11.7% (95% CI 11.5-12.0).

“We published a similar study a little more than 10 years ago, and the most important risk factors then were physical inactivity, depression, and smoking,” Barnes told MedPage Today.

“Today, the top three risk factors are midlife obesity, physical inactivity, and low education,” she observed. “This is important because it suggests that the growing number of people who are obese in the U.S. could have a major long-term impact on dementia rates.”

From the clarification front, the FEHBlog often reminds folks that federal employees who retired under the Civil Service Retirement System before 1984 are not eligible for free Medicare Part A. The FEHBlog dug into this issue today, and he discovered this 2013 Reg Jones Q&A on this topic that the Federal Times published.

Q. I retired in 2009 under CSRS. I am close to 65, and the answer to one of the questions asked states that people in CSRS are not eligible for Medicare because they didn’t pay into Social Security.

I was in CSRS before the change to FERS and stayed with CSRS. I had Medicare deductions taken from my pay from 1983-84 till I retired in 2009.

Do the Medicare funds I paid since 1983 make me eligible for Medicare or just part of it?

So which is right? I need to know so I can do what needs to be done — enroll or not. I’m currently insured under federal BCBS.

A. CSRS employees who retired before Dec. 31, 1983, aren’t eligible for Medicare Part A. Nor are CSRS employees who retired after that date but before having Medicare deductions taken from their pay for 10 years.

On the other hand, they are eligible to enroll in Medicare Part B, which is open to everyone 65 or older.

Consequently, the cadre of 65 and older federal annuitants without Medicare A is larger than the FEHBlog understood. This cadre is relevant to the Postal Reform Act because that law keeps Postal annuitants over aged 65 without Medicare Part in the legacy FEHBP.

Monday Roundup

Photo by Sven Read on Unsplash

From the Capitol Hill front, Roll Call reports

President Joe Biden and top Democrats have agreed to a GOP demand to disentangle a stalled COVID-19 response package from a separate supplemental request for military and humanitarian aid to Ukraine so the latter can move more quickly.  * * *

Senate Minority Leader Mitch McConnell didn’t reject the outlines of the Democrats’ offer in brief remarks Monday. “It may adjust some in the process, but we need to do it quickly,” McConnell told Punchbowl, while adding he was pleased that COVID-19 funds and an immigration-related dispute that tangled up the pandemic relief bill would be handled separately.

A separate, bipartisan $10 billion aid package for the ongoing pandemic response effort has been held up for a month due to a dispute over the so-called Title 42 program that allows migrants to be turned away at the border to prevent the spread of COVID-19. Biden has proposed to end the Trump-era program as of May 23, which Republicans and several Senate Democrats have said they oppose without alternatives in place to stem the expected surge of migrants.

From the Omicron and siblings front, the Centers for Disease Control has updated its long Covid website. The CDC explains

What You Need to Know

Post-COVID conditions can include a wide range of ongoing health problems; these conditions can last weeks, months, or years.

Post-COVID conditions are found more often in people who had severe COVID-19 illness, but anyone who has been infected with the virus that causes COVID-19 can experience post-COVID conditions, even people who had mild illness or no symptoms from COVID-19.

People who are not vaccinated against COVID-19 and become infected may also be at higher risk of developing post-COVID conditions compared to people who were vaccinated and had breakthrough infections.

There is no single test for post-COVID conditions. While most people with post-COVID conditions have evidence of infection or COVID-19 illness, in some cases, a person with post-COVID conditions may not have tested positive for the virus or known they were infected.

CDC and partners are working to understand more about who experiences post-COVID conditions and why, including whether groups disproportionately impacted by COVID-19 are at higher risk.

From the SDOH front, STAT News tells us

Widely used physician guidelines that ignore patients’ race and ethnicity could be doing more harm than good when it comes to catching diabetes in people of color. New research, published in the Annals of Internal Medicine on Monday, suggests that people from certain racial and ethnic groups should be screened for diabetes at lower body mass index than non-Hispanic white people — a recommendation that contradicts recent guidelines from the United States Preventive Services Task Force.

It’s an admittedly tricky proposition, to reaffirm the role of race and ethnicity at a time when medicine is trying to rid itself of race-based tools — such as an algorithm used to assess kidney function — that have contributed to the large health disparities in the United States. The paper’s authors recognized as much in interviews with STAT.

They argue, however, that using a one-size-fits-all approach to screening, when diabetes is two to four times more prevalent and more deadly in Black, Hispanic, and Asian Americans, is likely to result in underdiagnosis of the disease, and widen health gaps.

From the healthcare business front, Fierce Healthcare informs us

Telehealth giant Amwell saw telehealth visits grow to 1.8 million in the first quarter of 2022, up 16% compared to the tail end of 2021 and up about 11% from 1.6 million virtual care visits during the same time last year.

The total number of active providers using its virtual care platform grew to around 102,000 during the quarter, up 25% compared to 81,000 a year ago. * * *

Amwell has been making significant investments in its new virtual care platform, Converge. Announced in April, Converge makes all of Amwell’s products and programs, plus third-party applications, available in one place. * * *

The company is in the process of migrating its customers over to the new platform. About 10% of the company’s virtual visits occurred through Converge in the first quarter, up 40% compared to the fourth quarter, said Ido Schoenberg, chief executive officer. The first wave of upgrades will focus on hospital systems and then move to health plans, executives said. 

“The market increasingly appreciates that automation is a compelling new element of digital healthcare and they require a trusted partner to provide integrated automation into their care delivery workflows,” he told analysts during the company’s first-quarter earnings call Monday.

Healthcare Dive meanwhile looks back at large health insurers’ reports on first-quarter 2022 earnings.

FedWeek compares annuitant eligibility rules for FEHB vs. FEDVIP and concludes that FEDVIP has more flexible rules. Why not?, considering that FEHB provides a government contribution while FEDVIP is enrollee pay-all. It’s still worth knowing the differences.

Weekend update

Photo of Texas Bluebonnets by Ryan Riggins on Unsplash

From the Capitol Hill front, the House of Representatives and the Senate will be holding Committee business and floor voting this week.

From the Omicron and siblings front, the Wall Street Journal reports

New Omicron subvariants are proliferating even in the face of significant protection from vaccinations and prior infection, as policy makers consider measures including open-ended vaccination drives to keep the evolving virus at bay.

Much of the U.S. population already had some level of antibodies to the virus when Omicron hit late last year, the Centers for Disease Control and Prevention estimates. That likely shielded many from more-severe disease, but the variant still fueled a record case surge and the second-highest peak in Covid-19 deaths. Immune defenses bolstered by the massive wave appear to be muting the impact of the yet-more-infectious Omicron variants even as cases and hospitalizations increase once again. 

These recurring run-ins with a changing virus demonstrate the challenge of maintaining long-lasting defenses, even as Covid-19 vaccines and exposures build up protection against the virus’s worst outcomes. * * *

“To decrease the [variant] changes, it’s about decreasing the space the virus can actually play in and limiting that space to evolve,” said Ali Ellebedy, an immunologist at Washington University School of Medicine in St. Louis.

From the healthcare business front —

The Wall Street Journal informs us

Some hospitals grappling with rising nurse salaries are seeking to raise prices by up to 15%, touching off contract fights with health insurers and businesses and threatening higher premiums.

HCA Healthcare Inc. and Universal Health Services Inc. are among the hospitals asking health plans to pay them more for care to offset mounting nurse costs.

Neither of the chains would specify the price increases they are requesting, but people familiar with negotiations say some hospitals are asking to increase their prices by 7.5% to 15%.

The requests are more than the 4% to 6% price increases that hospitals typically seek, according to employers and insurers. The hospitals usually won an average 3% price increase in recent years, according to Altarum, a nonprofit that does healthcare research.

If hospitals win heftier price increases they are seeking this year, that would likely result in higher premiums for employers and workers.

But insurer and employer groups, which push for lower-cost contracts or negotiate them on behalf of coalitions of businesses, are rejecting the requests. The groups say the priciest hospitals can absorb higher labor costs without raising their rates.

“Most of the employers have been unable to increase the wages of their workers for years primarily because of the increasing cost of healthcare,” said Karen van Caulil, chief executive of employer coalition Florida Alliance for Healthcare Value.

STAT News offers its perspective on these developments here.

From the OPM call letter front, OPM has encouraged plans to offer discounted infertility treatment benefits. The FEHBlog discovered Progyny which offers fertility testing and a network of infertility specialists. Fierce Healthcare reports on Progny’s favorable first quarter 2022 financial results. The article adds

The first fertility benefits management company to ever go public, Progyny has grown its client base to more than 265 large self-insured employers, up from 179 clients a year ago. Those clients represent about 3.9 million covered lives.

The company brought on 85 new self-insured employers in the first quarter, representing 1.2 million covered lives, [CEO Pete] Anevski told Fierce Healthcare. * * *

The company says it offers a “purpose-built, data-driven and disruptive platform” that delivers “superior clinical outcomes in a cost-efficient manner.” Progyny’s benefits solution empowers patients with education and guidance from a dedicated Patient Care Advocate and provides access to a premier network of fertility specialists using the latest science and technologies.

Company executives tout Progyny’s industry-leading clinical outcomes, noting that for the sixth straight year, the company significantly outperformed as compared to the national averages for fertility outcomes released by the Centers for Disease Prevention and Control and Prevention. 

Progyny’s pregnancy rate improved to 17% better than the national average, while its live birth rate, which had been 25% better than the national average a year ago, is now 27% better, Anevski said.

“To give you a sense for just how impactful this is, our higher live birth rate means that Progyny clients need to fund on average significantly fewer rounds of treatment than they otherwise would, had they be using either a carrier program or one of the venture capital-backed startups,” he said. “This once again reveals that Progyny’s uniquely helping people to get pregnant faster, have healthier pregnancies and deliver healthy babies.”

Worth a look.

From the telehealth front, Fierce Healthcare informs us

Cerebral is among a handful of virtual care startups that prescribe controlled substances without patients seeing a doctor in-person. * * *

Last week, Insider reported that the Drug Enforcement Agency (DEA) is investigating the company. U.S. DEA agents interviewed former Cerebral employees about issues with clinician licensing and about allegations that some patients had set up multiple accounts to obtain more drugs, Insider reported, citing sources.

According to Insider’s most recent story, the grand jury subpoena demands documents such as Cerebral’s policies and procedures regarding controlled substances and documents related to Cerebral’s relationship with the online pharmacy Truepill.

Earlier this week, Truepill, which is reportedly Cerebral’s preferred pharmacy, said it was temporarily halting prescriptions for Adderall and other controlled substances used to treat attention-deficit/hyperactivity disorder (ADHD).

Out of an abundance of caution, Truepill is temporarily pausing all fulfillment of schedule 2 substances while we evaluate appropriate next steps,” the company said in a statement to Fierce Healthcare.

The Wall Street Journal was the first to disclose these shenanigans.

Cybersecurity Saturday

From the ransomware front

The HHS Cybersecurity Program released a PowerPoint presentation on ransomware trends in the first quarter of this year.

Here’s a link to Bleeping Computers’ The Week in Ransomware.

Ransomware operations continue to evolve, with new groups appearing and others quietly shutting down their operations or rebranding as new groups. * * * [For example,] the notorious REvil ransomware operation has returned amidst rising tensions between Russia and the USA, with new infrastructure and a modified encryptor allowing for more targeted attacks.

Bleeping Computer adds

The US Department of State is offering up to $15 million for information that helps identify and locate leadership and co-conspirators of the infamous Conti ransomware gang.

Up to $10 million of this reward are offered for info on Conti leaders’ identity and location, and an additional $5 million for leading to the arrest and/or convictions of individuals who conspired or attempted to participate in Conti ransomware attacks.

From the vulnerabilities front

  • The HHS Cybersecurity Program issued a bulletin on “April Vulnerabilities of Interest to the Health Sector”

The FBI has warned that business email compromise (BEC) fraud cost businesses around the world $43 billion in losses during the period between June 2016 and December 2021.  The FBI’s Internet Crime Center (IC3) logged a whopping 241,206 complaints in the four-and-a-half-year period, with losses totaling $43 billion, according to a new public service announcement

From the cyberdefenses front, CISA “is beginning a month-long mission to rock the message that multifactor authentication keeps you more secure! So, join us for MFA May!” Throughout the month of May:

Follow CISA on TwitterFacebookLinkedIn, and Instagram for rocking content all month on MFA.

Tell us on social media that your business or personal devices are now protected by MFA with the hashtag #EnableMFA!  We’ll do our best to Pour Some Sugar on your posts!

And since we all get by With A Little Help from Our Friends, challenge your friends, family, co-workers, and fellow rockers to #EnableMFA too.

For What it’s Worth, you can always learn more about multi-factor authentication at https://www.cisa.gov/mfa

Friday Stats and More

Based on the CDC’s Covid Data Tracker and using Thursday as the first day of the week, here’s the FEHBlog’s weekly chart of new Covid cases displayed from the 27th week of 2021 through the 18th week of 2022.

The CDC reports in its latest weekly review that “The current 7-day daily average of new Covid hospital admissions for April 27–May 3, 2022, was 2,219. This is a 16.6% increase from the prior 7-day average (1,903) from April 20–26, 2022.

Here’s the FEHBlog’s latest weekly chart of new Covid deaths display from the 27th week of 2021 through the 18th week of 2022.

The CDC’s weekly review sums it up as follows:

COVID-19 cases and hospitalizations are on the rise in the United States. Although deaths continue to decrease, the United States is expected to reach 1 million deaths soon. * * *

As of May 5, 2022, there are 78 (2.42%) counties, districts, or territories with a high COVID-19 Community Level, 316 (9.81%) counties with a medium Community Level, and 2,826 (87.76%) counties with a low Community Level. This represents a slight (0.75 percentage points) increase in the number of high-level counties, a small (+1.86 percentage points) increase in the number of medium-level counties, and a corresponding (−2.61 percentage points) decrease in the number of low-level counties. Sixteen (28.57%) of 56 jurisdictions had no high- or medium-level counties this week.

To check your COVID-19 community level, visit COVID Data Tracker.

Here’s the FEHBlog’s weekly chart of Covid vaccinations distributed and administered from the inception of the vaccination program until this 18th week of 2021.

Nearly 75% of the U.S. population aged 12 and older are fully vaccinated and nearly 50% of the U.S. population aged 18 and older have received a booster.

STAT News reports

The White House could run out of Covid-19 vaccines if it moves forward with plans to encourage all adults to get a second Covid-19 vaccine booster dose by roughly Sept. 1, according to a tranche of budget documents sent to Congress that have not previously been made public.

In other CDC news, the American Hospital Association informs us

The Centers for Disease Control and Prevention is investigating 109 potential hepatitis cases of unknown cause in U.S. children since last October, including five deaths. More than 90% of the patients were hospitalized, 14% received liver transplants and more than half had a confirmed adenovirus infection, but officials still don’t know the actual cause of their hepatitis and cautioned that it may take time to assess the evidence and learn more. CDC alerted clinicians to the first cases last month.

To date, 25 states and territories have reported potential cases: Alabama, Arizona, California, Colorado, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Louisiana, Michigan, Minnesota, Missouri, North Carolina, North Dakota, Nebraska, New York, Ohio, Pennsylvania, Puerto Rico, Tennessee, Texas, Washington and Wisconsin.

Potential cases also have been reported in the United Kingdom and other countries

From the Rx coverage front, Medscape tells us

The US Food and Drug Administration (FDA) has cleared the first in vitro diagnostic to aid in the early detection of Alzheimer’s disease (AD).

The Lumipulse G β-Amyloid Ratio 1-42/1-40 (Fujirebio Diagnostics) test detects amyloid plaques associated with AD in adults age 55 or older who are under investigation for AD and other causes of cognitive decline.

“The availability of an in vitro diagnostic test that can potentially eliminate the need for time-consuming and expensive [positron emission tomography (PET)] scans is great news for individuals and families concerned with the possibility of an Alzheimer’s disease diagnosis,” Jeff Shuren, MD, JD, director of the FDA’s Center for Devices and Radiological Health, said in a statement.

“With the Lumipulse test, there is a new option that can typically be completed the same day and can give doctors the same information regarding brain amyloid status, without the radiation risk, to help determine if a patient’s cognitive impairment is due to Alzheimer’s disease,” he added.

From the healthcare business front, Beckers Payer Issues informs us

Cigna reported over $44 billion in total revenues in the first quarter, with the strongest growth in the company’s Evernorth business. Projected revenues at year end stand at $177 billion, according to the company’s earnings report released May 6.

“We’ve had a strong start to the year as we advance our growth strategy and support the health and well-being of our clients and customers,” Chair and CEO David Cordani said. “We’re taking decisive steps forward with innovation, new partnerships and re-investing in our company so we can achieve greater impact for the customers and communities we’re privileged to serve.”

Also, Becker’s Hospital CFO Report tells us

Driven mainly by nonoperating losses, Oakland, Calif.-based Kaiser Permanente recorded a net loss of $961 million in the first quarter of 2022, down from a net income of $2 billion in the same quarter in 2021, according to financial data released May 6. 

For the quarter ending March 31, Kaiser reported total operating revenue of $24.2 billion, up from $23.2 billion the year prior. Tom Meier, corporate treasurer of Kaiser Permanente, said the revenue increase was attributed to several factors, including growth of its health plan. 

Kaiser also saw its expenses increase significantly in the first quarter of 2022 to $24.3 billion, up 9.5 percent from the same quarter last year. Mr. Meier said the health system incurred about $1.4 billion in costs from COVID-19, including $900 million for the cost of care, $550 million for testing and $50 million for vaccinations. 

In related news, Govexec reports

USPS saw a net loss of $639 million in the period between Jan. 1 and March 31, up from $82 million in the same period last year. The Postal Service Reform Act was not enshrined into law until after the second quarter of fiscal 2022, meaning the relief it will provide by eliminating the requirement that the Postal Service prefund health care costs for future retirees was not reflected in the financial results. USPS grew revenue in the quarter by about $900 million, a 5% increase from the same period in 2021. Volume grew by about 3%. 

Federal News Network adds

Postmaster General Louis DeJoy expects the Postal Service will need to keep raising prices on its monopoly mail products for the foreseeable future, as part of a 10-year reform plan to improve its long-term financial health.

DeJoy said Thursday said the mailing industry needs to be prepared for USPS to raise prices on its market-dominant products “at an uncomfortable rate,” until it reaches a point where the agency is on track to be self-sustaining in the long term.

As we approach Mothers’ Day this weekend, the American Hospital Association tells us

The Health Resources and Services Administration will launch May 8 a toll-free hotline for expecting and new mothers experiencing mental health challenges, where trained counselors will provide brief interventions and referrals to community-based and telehealth providers as needed. Callers also will receive evidence-based information and referrals to support groups and other community resources.

“Today, we are creating a safe space for expecting and new moms who are experiencing maternal depression, anxiety or other mental health concerns to have confidential conversations and get the support they need,” said HRSA Administrator Carole Johnson. “Moms can call or text 1-833-9-HELP4MOMS and connect with a counselor at no charge. We are going to continue to grow our investments in this resource, as we know it’s what women need.”

Nothing is too good for our Moms.