Midweek Update

COVID-19

Midweek Update

David Ermer–COVID-19, NIH, OPM, Rx coverage, U.S. Healthcare–

From the Omicron and siblings front —

Health Day informs us

COVID-19 might be easing into a new status as a widely circulating and somewhat harsher version of the common cold, experts say — a virus that folks could contract repeatedly, even if they were recently infected.

“[SARS-CoV-2] is destined to join four of its family members and become an endemic coronavirus that will repeatedly infect individuals throughout their lifetimes,” said Dr. Amesh Adalja, of Johns Hopkins Center for Health Security, referring to the four circulating coronaviruses that cause the common cold.

“It will become one of several respiratory viruses that people contend with, and will become increasingly less disruptive and more manageable with medical countermeasures and the population’s risk acclimatization,” he added.

The FEHBlog recently has pointed out unusual disease cases involving childhood hepatitis , monkeypox, a flu spike, etc. STAT News seeks to put these unusual cases in perspective.

These viruses are not different than they were before, but we are. For one thing, because of Covid restrictions, we have far less recently acquired immunity; as a group, more of us are vulnerable right now. And that increase in susceptibility, experts suggest, means we may experience some … wonkiness as we work toward a new post-pandemic equilibrium with the bugs that infect us. * * *

Marion Koopmans, head of the department of viroscience at Erasmus Medical Center in Rotterdam, the Netherlands, said she believes we may be facing a period when it will difficult to know what to expect from the diseases that we thought we understood.

“I do think that’s possible,” Koopmans said.

This phenomenon, the disruption of normal patterns of infections, may be particularly pronounced for diseases where children play an important role in the dissemination of the bugs, she suggested.

Ruh roh.

From the Rx coverage front, Fierce Healthcare reports

Prime Therapeutics cut per member per month drug costs by 26% in one year through its MedDrive program, which leverages biosimilars to help drive down expenses.

The program uses advanced analytics to flag ways that health plans can cut down drug spend, with a particular focus on the potential of biosimilars. Pharmacy benefit managers are betting on biosimilar products to introduce new competition to popular branded products and drive down costs.

Prime, which serves 33 million members across 23 Blue Cross Blue Shield plans, first launched MedDrive in May 2021 and in its first year the program drove savings by focusing on just three biosimilar categories, the PBM said. Cancer drugs led the way for savings.

The International Foundation of Employee Benefits Plans adds

The U.S. Department of Health and Human Services (HHS) and the Food and Drug Administration (FDA) announced the availability of a final guidance for industry entitled “Importation of Prescription Drugs Final Rule Questions and Answers.” The guidance is intended to help small entities comply with the final rule entitled “Importation of Prescription Drugs.” The final rule was issued to implement a provision of the Federal Food, Drug, and Cosmetic Act (FD&C Act) to allow importation of certain prescription drugs from Canada.

In OPM news, OPM announced a group of new staff appointees at the agency today including a new General Counsel and a new Deputy General Counsel.

From the miscellany department —

  • Rebecca G. Baker, Ph.D., the director of the NIH HEAL Initiative, shares insights gained from the Third Annual HEAL Investigators Meeting. HEAL is an NIH branch that focus on creating solutions to the opioid epidemic.
  • EHR Intelligence discusses how a National Patient Identifier could boost population health. It is mystifying that Congress has not released funds for this important initiative.
  • The Medical Group Management Association identifies four ways medical groups can remove barriers to mammography compliance.
  • Health Payer Intelligence outlines 2022 actions today by the U.S. Preventive Services Task Force.

Despite rising availability in online transparency tools, consumers remain unsure about costs and avoid care as a result, a new survey has found.

The annual consumer sentiment survey was conducted in January 2022 by Healthsparq, a health tech company, and reached more than 1,000 insured Americans. Transparency tools were defined as those provided by payers such as in-network provider search, cost estimates and information on treatment. 

The majority (70%) of respondents knew that their health plan offered these, up from 49% last year, and most had used them in the past year. They also said this access helps them better understand their coverage and manage costs. Yet nearly half reported avoiding care due to unclear costs, up from a quarter last year. Care avoidance was even more pronounced among those under the age of 34, at 63%. 

Mark Menton, Healthsparq’s general manager, told Fierce Healthcare he suspects that is because the tools exist, but consumers do not know how to access the information.

“I think that’s a hurdle we as an industry need to overcome,” Menton said. “They don’t know where to find this information.” 

Tuesday’s Tidbits

David Ermer–CDC, Congress, COVID-19, COVID-19 vaccine, NIH, No Surprises Act, U.S. Healthcare–
Photo by Patrick Fore on Unsplash

From Capitol Hill, Fierce Healthcare reports

New bipartisan legislation introduced in the Senate aims to empower the Federal Trade Commission (FTC) to crack down on pharmacy benefit manager practices such as spread pricing.

The legislation, introduced Tuesday, comes as the PBM industry faces other areas of reform, including a proposed rule to get rid of clawback fees PBMs can charge pharmacies after the drug is dispensed.

Lawmakers said federal agencies need more power, though, to rein in PBM practices. 

From the No Surprises Act (“NSA”) front, AHIP and the Blue Cross Association inform us

A recent survey and analysis conducted by AHIP and the Blue Cross Blue Shield Association (BCBSA) found that in the first two months of 2022, the NSA prevented more than 2,000,000 potential surprise medical bills across all commercially insured patients. If only a fraction of these claims are ultimately disputed through IDR, it would still far exceed the government’s estimate. Should the trend hold, more than 12,000,000 surprise bills will be avoided in 2022 due to the NSA.

The law is working to protect millions of consumers from costly surprise bills and yet several hospital and provider organizations have filed lawsuits challenging the NSA regulations and legislation in order to increase their own profits at patients’ expense. Recent polling conducted by Morning Consult on behalf of the Coalition Against Surprise Medical Billing found that 8 in 10 voters, after learning about the NSA, are concerned that lawsuits from physician and hospital organizations could delay or overturn the patient protections in the Act.

The findings of the AHIP-BCBSA survey are important to demonstrate how many consumers have already benefitted from the NSA and to underscore the extent of total claims that could be impacted if the IDR process is not a predictable process with payment amounts that trend towards market rates.

That’s great news.

In public health news, the American Hospital Association tells us ‘

U.S. births rose 1% in 2021 to about 3.7 million, the first increase since 2014, according to preliminary data released today by the Centers for Disease Control and Prevention. Birth rates declined for women aged 15-24 and rose for women aged 25-49. The cesarean delivery rate rose 0.3 percentage point to 32.1%, while the preterm birth rate rose 4% to 10.48%, the highest rate since 2007, CDC said.

From the Omicron and siblings front

  • Reuters reports “The U.S. Food and Drug Administration set June 14-15 as the new meeting date to review Moderna Inc’s emergency authorization request for its COVID-19 vaccine for children aged 6 months to 5 years and Pfizer Inc’s vaccine for those aged 6 months through 4 years.”
  • Precision Vaccines tells us “The U.S. Centers for Disease Control and Prevention (CDC) issued today Health Alert Network Health Advisory CDCHAN-00467 to update healthcare providers, public health departments, and the public on the potential for recurrence of COVID-19 or “COVID-19 Rebound.”  COVID-19 Rebound cases have been reported to occur between two and 8 days after initial recovery. They are characterized by a recurrence of COVID-19 symptoms or a new positive viral test after testing negative.  A brief return of symptoms may be part of the natural history of SARS-CoV-2 (the beta coronavirus that causes COVID-19) infection in some persons, independent of treatment with Paxlovid and regardless of vaccination status.” STAT News offers a more detailed article on this topic for those interested.

In other virus news, the Hill informs us

Officials for the Centers for Disease Control and Prevention (CDC) on Monday said the agency is releasing doses of a smallpox vaccine in response to the few recent cases of monkeypox that have been detected in the U.S. Jennifer McQuiston, the deputy director for the CDC’s Division of High Consequence Pathogens and Pathology, said during a press briefing that more than a thousand doses of the Jynneos smallpox vaccine are currently available in the U.S., with more doses expected to become available as production ramps up. * * * The vaccines will be designated for people who are most likely to benefit from them, McQuiston said, including those who are known to have had close contact with monkeypox patients, health care workers and people who would be at high risk of developing a severe case of the disease.

From the healthcare business front, Beckers Hospital News identifies Walmart’s 18 Centers of Excellence in the U.S.

In National Institutes of Health news, NIH Reseach Matters discusses antioxidant effects on dementia risk and how the health benefits of dietary fibers depend on the fiber type, the amount, and the individual.”

Weekend Update / Monday Roundup

David Ermer–CDC, Congress, COVID-19, COVID-19 vaccine, Employee Wellness Programs, Mental health care, Telehealth, U.S. Healthcare–
Photo by Michele Orallo on Unsplash

The Senate will and the House of Representatives will be engaged only in Committee business this coming week.

From the Omnicron and siblings front —

  • Fortune reports “The U.S. is experiencing a sixth wave of COVID, with over 90,000 confirmed new cases a day and a 20% increase in hospitalizations over the past two weeks. The actual number of new cases per day likely sits at a half-million or more, “far greater than any of the U.S. prior waves, except Omicron,” writes Dr. Eric Topol, the executive vice president of Scripps Research and a professor of molecular medicine, in a recent blog post on the maps.” It’s hard to argue against this point.
  • Bloomberg Prognosis offers a useful Q&A on when you can back to life after a case of Omicron. Here is a link to the CDC’s guidelines on isolation and quarantine due to Omicron.
  • The FEHBlog noticed that 75% of the American population age 12 and older is fully vaccinated against Covid.
  • The American Medical Association discusses how Covid telemonitoring sets the model for other acute conditions.

From the Aduhelm front, the Wall Street Journal reports

The commercial failure of Biogen Inc.’s drug Aduhelm is putting new focus on the state of research into the causes of Alzheimer’s disease.

More than six million people in the U.S. are living with the progressive type of dementia, according to the Alzheimer’s Association, an advocacy group. 

Aduhelm was hailed as a potential blockbuster that targeted a root cause of the disease by clearing a sticky protein known as amyloid from the brain. Abnormal accumulations of amyloid called plaque and tangles of another protein known as tau are characteristic features of the brains of people with Alzheimer’s.

“If you cut the brain open and amyloid plaque is absent, Alzheimer’s was not the cause of disease,” said Jeffrey Cummings, director of the Chambers-Grundy Center for Transformative Neuroscience at the University of Nevada, Las Vegas.

But research into the benefits of targeting amyloid in Alzheimer’s patients has been mixed. There are more questions than answers about the role amyloid plays in the development of the disease, neurologists say. 

“Alzheimer’s is a complex disease. It’s unlikely that a single mechanism is contributing to it,” said Maria Carillo, the Alzheimer’s Association’s chief science officer. * * *

More than 140 drugs are in the pipeline as potential Alzheimer’s treatments, including drugs that target tau and microglia function, according to a survey of registered clinical trials in the U.S. Three other amyloid-targeting monoclonal antibodies, which are in the same class as Aduhelm, are in development. One, called lecanemab, was submitted this month by co-developers Biogen and Japan-based Eisai Co. to the Food and Drug Administration for potential approval.

Time will tell.

From the preventive care wellness front —

  • Medscape reports an “alarming increase in esophageal cancers in middle-aged adults. The study’s author,  Bashar Qumseya, MD, MPH, recommends that people with multiple risk factors for these cancers, i.e., obesity, diet, and gastroesophageal reflux disease, should undergo an endoscopy at the time of their first colonoscopy at age 45.
  • The American Medical Association identifies steps that patients can follow to reverse pre-diabetes.

The FEHBlog just discovered that the Weekend Update did not go out on Monday morning. So here are Monday’s items that normally would have been posted in the Monday Roundup —

More from the Omicron and siblings front —

BioPharma Dive reports

Three doses of Pfizer and BioNTech’s COVID-19 vaccine met the Food and Drug Administration’s bar for success in a trial studying the shot in children younger than 5 years old, the companies said Monday. The FDA has tentatively scheduled a meeting of outside advisers to review the data in three weeks.

The agency delayed review of the vaccine in the youngest children earlier this year after a December review of data indicated a two-shot series didn’t spur an immune response that was likely to protect against disease. When Pfizer and BioNTech disclosed that data, they announced plans to test immune response and efficacy after three shots.

The announcement comes days after U.S. officials warned of a new surge of COVID-19 cases as mask mandates have been lifted and while immunity from vaccination and previous infections wanes. The FDA has granted emergency use authorization for as many as four shots of Pfizer and BioNTech’s vaccine — an initial two-dose series followed by two periodic boosters — for adults at least 50 years old.

Reuters adds U.S. “Health officials are considering extending the eligibility for a second COVID-19 vaccine booster dose to people under 50 amid a steady rise in cases, with the United States seeing a threefold increase over the past month.”

Bloomberg Prognosis recommends carrying around a portable carbon dioxide monitor to help prevent Covid or at least remind you to mask up and / or move along:

Carbon-dioxide monitors can assess how Covid-risky a space is because they help tell you whether you’re breathing in clean air. They measure the concentration of carbon dioxide, which people exhale when they breathe, along with other things like, potentially, virus particles. The more well-ventilated a space, the lower the reading on my monitor’s screen — meaning not only less carbon dioxide but also less of the stuff like Covid that might make people sick. 

One place I didn’t expect this to be an issue was airplanes, because you hear so much about their top-of-the-line air quality systems. But in fact, some of the highest carbon dioxide readings on my travels were taken on flights, specifically during the boarding process.

It turns out that during boarding and deplaning, air systems aren’t typically running. Those periods are risky because people are mingling more than they do during a flight, says Joe Allen, an associate professor at the Harvard T.H. Chan School of Public Health who carries around his own CO2 monitor.

“We’ve been warning about this,” Allen says. 

Fresh air is important for our health in ways that go well beyond Covid, but it’s also largely invisible. Carbon-dioxide monitors can change that. 

What will they think of next?

The FEHBlog confesses that he took his eye off the flu virus this year. Beckers Hospital Review informs us “The CDC estimates there have been at least 6.7 million flu illnesses, 69,000 hospitalizations and 4,200 flu-related deaths so far this season.”

In other virus news, Reuters reports “Infection with adenovirus, a common childhood virus, is the leading hypothesis for recent cases of severe hepatitis of unknown origin in children that have led to at least six deaths, U.S. health officials said on Friday [May 20]. Furthermore,

The Centers for Disease Control and Prevention (CDC) said it is continuing to investigate whether 180 cases identified in 36 states and territories since last October represent an increase in the rate of pediatric hepatitis or whether an existing pattern has been revealed though improved detection.

From the mental healthcare front, Fierce Healthcare tells us

Mental health concerns are on the rise among teens, and the impact on parents and families is an unmet need employers could address, new data from Cigna’s Evernorth show.

The pandemic has significantly worsened mental health among teens and young adults, with 25% experiencing depressive symptoms and 20% experiencing anxiety symptoms, a JAMA study shows. About 80% of the 1,000 parents included in Cigna’s survey said their children are struggling with their mental health.

Nearly one-fifth (18%) of parents say their child’s needs are negatively impacting their job performance and productivity, according to the survey. In addition, 55% said they do not have enough support from their employer, and 1 in 7 said they were forced to leave or stay out of the workforce to manage their teenager’s needs.

“I think there’s going to be a long tail for these kids and also their family members,” Stuart Lustig, M.D., national medical executive for behavioral health at Evernorth, told Fierce Healthcare. “I think we’re in this for the long haul.”

Friday Stats and More

David Ermer–COVID-19, Federal employment benefits, OPM–

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 20th week of 2022:

The CDC’s weekly review of its COVID statistics notes

As of May 18, 2022, the current 7-day moving average of daily new cases (101,130) increased by 18.8% compared with the previous 7-day moving average (85,143). A total of 82,820,565 COVID-19 cases have been reported in the United States as of May 18, 2022.

Here is the CDC’s chart seven-day movings averages of new Covid hospital admissions:

The CDC’s weekly review notes “The current 7-day daily average [of new hospital admissions for Covid] for May 11–17, 2022, was 3,250. This is a 24.2% increase from the prior 7-day average (2,617) from May 4–10, 2022.

Here’s the FEHBlog’s weekly chart of new Covid deaths over the same period as the new weekly cases chart:

The CDC’s weekly review notes:

The current 7-day moving average of new deaths (280) has decreased 1.2% compared with the previous 7-day moving average (284). As of May 18, 2022, a total of 998,512 COVID-19 deaths have been reported in the United States.

Here’s the FEHBlog’s weekly chart of Covid vaccinations distributed and administered from the beginning of the Covid vaccination program in December 2020 through the 20th week of 2022.

The CDC’s weekly review notes “As of May 18, 2022, the 7-day average number of administered vaccine doses reported (by date of CDC report) to CDC per day was 388,308, a 0.5% decrease from the previous week.”

To sum it up, the CDC’s weekly review points out,

As of May 19, 2022, there are 301 (9.35%) counties, districts, or territories with a high COVID-19 Community Level, 477 (14.81%) counties with a medium Community Level, and 2,442 (75.84%) counties with a low Community Level. This represents a moderate (+5.10 percentage points) increase in the number of high-level counties, a slight (−0.74 percentage points) decrease in the number of medium-level counties, and a corresponding (−5.84 percentage points) decrease in the number of low-level counties. Five (9.62%) of 52 jurisdictions had no high- or medium-level counties this week.

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

Federal News Network suggests “Federal employees [and annuitants] can use these next few months between now and open season, which begins Nov. 14, to do something that most feds rarely do — research and planning [for Open Season]. The article suggests how to conduct this research, and the FEHBlog thinks that Federal News Network is on the right track.

Thursday Miscellany

David Ermer–CDC, CMS, Congress, COVID-19, Federal employment benefits, Medicare, Mental health care, OPM–

From Capitol Hill, The Hill informs us

Photo by Josh Mills on Unsplash

A growing number of Senate Democrats say they’re ready to take a tough vote on an amendment to keep the Title 42 health order in place at the U.S.-Mexico border if that’s what’s needed to move a stalled COVID-19 relief package. 

Senate Majority Leader Charles Schumer (D-N.Y.) has held the bill from the floor because Republicans are insisting on voting on a bipartisan amendment to overrule the Biden administration’s decision to lift Title 42, a pandemic order that has stopped thousands of immigrants from entering the country on asylum claims.   * * *

Without giving in to the Republicans’ demand for a vote on the hot-button issue of securing the border, COVID-19 relief could be stalled until after the November election.  

The amendment is expected to fail but it’s a tough vote for vulnerable Senate Democrats. 

More likely, in the FEHBlog’s view, the Majority Leader is waiting until the Title 42 health order is lifted later this month to see what happens.

From the Omicron and siblings front —

The Wall Street Journal informs us

The Centers for Disease Control and Prevention recommended that children ages 5 to 11 receive the newly authorized Covid-19 booster shot from Pfizer Inc. and BioNTech SE.

Following the recommendation Thursday, many of the nation’s doctors, pharmacies and other vaccination sites are expected to begin offering the extra doses to the 28 million U.S. children in the age group.

The shots are to be given five months after the second dose. The extra dose is one-third the amount that those 12 years old and above receive.

Also Thursday, the CDC said it was strengthening its recommendation that people 12 years and older who are immunocompromised, or who are 50 and older, should receive a second booster dose at least four months after their first.

This means that health plans must start covering the booster with no member cost-sharing pursuant to ACA FAQ 50.

The Journal adds

Moderna Inc.’s leader said it is possible the company would be able to start shipping its Covid-19 vaccine for use in young children as soon as early June, pending a decision by U.S. regulators.

“We are ready from a manufacturing standpoint,” Moderna Chief Executive Stéphane Bancel said during a virtual appearance Thursday at The Wall Street Journal’s Future of Everything Festival.

The FDA/CDC decision is expected next month.

In other virus news, STAT News interviewed a top CDC expert on monkeypox. From the FEHBlog’s standpoint, the key takeaway is that monkeypox is not Covid.

I think we can take away a lot from what we know about monkeypox in Congo Basin and in West Africa. Even if human-to-human transmission is documented, it is generally documented among very close contacts. So family members, people taking care of ill patients. Or health care providers.

In funding news, the Department of Health and Human Services announced today a $1.5 billion funding opportunity under the State Opioid Response

SOR grant program provides formula funding to states and territories for increasing access to FDA-approved medications for the treatment of Opioid Use Disorder (OUD), and for supporting prevention, harm reduction, treatment, and recovery support services for OUD and other concurrent substance use disorders (SUD). The SOR program also supports care for stimulant misuse and use disorders, including for cocaine and methamphetamine. The SOR program helps reduce overdose deaths and close the gap in treatment needs across America by giving states and territories flexibility in funding evidence-based practices and supports across different settings to meet local community needs.

From the miscellany department

  • Today “the U.S. Office of Personnel Management (OPM) released guidance regarding the implementation of EO 13932; Modernizing and Reforming the Assessment and Hiring of Federal Job Candidates.  OPM’s guidance represents a major step towards the federal government’s adoption of skills-based hiring practices and is an important innovation in federal hiring, which has historically relied on education and candidate self-assessments as a proxy for a candidate’s ability to perform in a job. This new approach helps hiring managers recognize and value skills regardless of where they were acquired, whether in a formal degree program, on the job, or on one’s own.”
  • Employee Benefit News identifies the ten most popular mental health and wellness apps.
  • Benefits consultant Tammy Flanagan discusses federal employee life insurance benefits in Govexec.
  • Health Payer Intelligence reports that CMS has updated the Medicare.gov website “to include new features such as highlighting pages that answer popular questions and spotlighting key steps that consumers should take related to Medicare coverage.”

Midweek Update

David Ermer–CDC, COVID-19, Employee Wellness Programs, Federal employment benefits, NCQA, OPM, SDOH, Telehealth, U.S. Healthcare–
Photo by Mel on Unsplash

From the Omicron and siblings front

The Wall Street Journal reports

The seven-day moving average of new Covid-19 cases recently topped 94,000 a day, Centers for Disease Control and Prevention data show, nearly four times lows reached in late March. The true number of new cases is likely significantly higher, epidemiologists say, because so many people are self-testing at home or not testing at all. 

The rise in cases hasn’t translated thus far into major surges in severe illness. The seven-day average of confirmed cases in hospitalized patients reached about 18,550 on Wednesday, up from lows near 10,000 in mid-April, but far below a record peak above 150,000 in January. The numbers include people who test positive on routine screening after getting hospitalized for other reasons. The daily average of reported deaths has slipped under 300 a day, the lowest point since last summer.

But * * * the more an outbreak spreads, the more likely it will reach the most vulnerable including elderly people and others with compromised immune systems, the experts say, and the more likely the virus will continue to mutate.

Bloomberg Prognosis adds

As Covid-19 again surges across the US, many people are going without time-sensitive therapeutics like Paxlovid because doctors worried about shortages are reluctant to prescribe the drugs. But the situation has changed and supplies are now abundant.

The Food and Drug Administration has issued emergency-use authorizations for the drug to treat mild to moderate Covid-19 in people who are at high risk. The Centers for Disease Control and Prevention defines those as individuals ages 50 years or older, unvaccinated, or with certain medical conditions like kidney, liver, lung and heart disease, diabetes, cancer and HIV. It also recommends the drug for people who are immunocompromised, pregnant, obese, cigarette smokers or suffering from mood disorders.

You can find the one stop test to treat locations “by using the Department of Health and Human Services’ Test to Treat Locator or by calling 1-800-232-0233.”

Kaiser Health News recommends “improving ventilation and filtration of the air. ‘Ventilation matters a lot,’ said Dr. Amy Barczak, an assistant professor of medicine at Harvard Medical School. ‘If you’re taking care of someone at home, it’s really important to maximize all the interventions that work.’”

Viral particles float through the air like invisible secondhand smoke, diffusing as they travel. Outside the home, viruses are quickly dispersed by the wind. Inside, germs can build up, like clouds of thick cigarette smoke, increasing the risk of inhaling the virus.

The best strategy for avoiding the virus is to make your indoor environment as much like the outdoors as possible.

In related viral news, Beckers Hospital Review tells us

More than 400 children worldwide have developed unusual cases of acute hepatitis, and researchers are still searching for the cause of the outbreak, the World Health Organization said May 17.  

As of May 15, the WHO reported 429 probable cases in 22 countries, up from 348 cases a week prior, according to Philippa Easterbrook, MD, a senior scientist in the global hepatitis program at the WHO. Another 40 cases are still under investigation, and 75 percent of all affected children are under age 5. 

Twelve countries are reporting more than five cases, double the amount from last week. Of these 12 countries, nine are in Europe. In total, six children have died in the outbreak and 26 have required liver transplants, according to Dr. Easterbrook. 

As of May 17, researchers were still investigating the cause of the hepatitis outbreak. The leading hypothesis is that an adenovirus and SARS-CoV-2, the virus that causes COVID-19, may be causing hepatitis in children. Scientists are exploring “how these two infections may be working together as co-factors either by enhancing susceptibility or creating an abnormal response,” Dr. Easterbrook said. 

From the healthcare policy front, AHIP today launched

Healthier People through Healthier Markets, a new policy roadmap and set of solutions to improve health care affordability and access for every American. The effort is focused on boosting competition in health care markets and reining in harmful practices that hurt American families. With the launch of this policy roadmap, AHIP sent letters to President Biden and the leadership of Congress that lay out a detailed set of legislative and regulatory enforcement actions to increase competition in health care, drive down costs, and improve health care access for patients.

The FEHBlog supports this approach.

From the mental healthcare front, Govexec reports

The Office of Personnel Management on Wednesday urged federal agencies to ensure their employees are aware and can access the mental health benefits provided to federal workers, in light of May being Mental Health Awareness Month.

In a memo to agency heads, OPM Director Kiran Ahuja noted that promoting the federal workforce’s wellbeing, including mental health, is a priority in President Biden’s management agenda.

“We want to make sure that all federal employees understand the supports available to them and underscore that there should be no shame or stigma for taking care of their mental health,” Ahuja wrote. “[As] a reminder, employee assistance programs and Federal Employees Health Benefits health plans offer mental health services to employees and their family members. We encourage agencies to proactively communicate to their workforces about their options and encourage employees to contact their agency benefits officers or EAP coordinator to learn more.”

The FEHBlog encourages OPM to better coordinate mental health care services among FEHB plans, EAPs and wellness programs.

From the telehealth front

  • mHealth Intelligence informs us “In the second half of 2020, only 14.1 percent of children used telehealth due to the pandemic, but use was higher among those with asthma, a developmental condition, or a disability, the Centers for Disease Control and Prevention (CDC) found.”

From the survey department, Beckers Payer Issues advises that “Castlight Health analyzed more than 160 million commercial medical claims nationwide to reveal insights about healthcare utilization patterns from 2018 to 2021.” Castlights report ranks the fifty States and DC based on average medical spending per member in 2021.  

From the miscellany department —

  • Beckers Payer Issues reports “Anthem shareholders voted at their annual meeting May 18 to change the company’s name to Elevance Health.”
  • Federal News Network discusses the Postmaster General’s plans to close and consolidate Postal facilities across the delivery network. “The network transformation initiative will impact nearly 500 network mail processing locations, 1,000 transfer hubs and 100,000 carrier routes. It will also impact 10,000 delivery units, which USPS defines as post offices, stations, branches or carrier annexes that handle mail delivery functions.”
  • FedSmith tells us “Starting May 26, 2022, federal retirees will notice a new process for signing into the OPM Retirement Services Online website. The login process will now be managed through the federal government’s Login.gov website and will require you to create a new username and password at login.gov if you do not currently have one.”

Tuesday’s Tidbits

David Ermer–CDC, COVID-19, Medicare, Mental health care, Rx coverage, SDOH, U.S. Healthcare–
Photo by Patrick Fore on Unsplash

From the Omicron and siblings front —

The Secretary of Health and Human Services has extended the Covid public health emergency for another 90 days. Bloomberg explains, “The declaration allows the US to grant emergency authorizations of drugs, vaccines and other medical countermeasures, as well as administer those products to millions of people at no out-of-pocket cost. It’s also enabled millions of Americans to get health coverage through Medicaid, among other benefits.” Bloomberg’s sources expect the declaration to be renewed again in July 2022.

The American Hospital Association informs us

The Food and Drug Administration today authorized a single Pfizer COVID-19 booster dose for children aged 5-11 who completed the Pfizer vaccine primary series at least five months before. FDA authorized the vaccine for this age group last October.

“The FDA has determined that the known and potential benefits of a single booster dose of the Pfizer-BioNTech COVID-19 Vaccine for children 5 through 11 years of age at least five months after completing a primary series outweigh its known and potential risks and that a booster dose can help provide continued protection against COVID-19 in this and older age groups,” said Peter Marks, M.D., director of FDA’s Center for Biologics Evaluation and Research.

In public health news —

  • The federal government’s Million Hearts campaign has launched a website discussing hypertensive disorders of pregnancy. The site explains “Hypertensive disorders of pregnancy are a leading cause of maternal mortality and can put both mother and baby at risk for problems during pregnancy.1 High blood pressure can also cause problems during and after delivery. Importantly, hypertensive disorders of pregnancy are often preventable and treatable.”
  • The Centers for Disease Control has updated its website discussing diabetes and heart disease. The FEHBlog knows from his PCP about the dangerous relationship between those two diseases.

In survey news —

  • Beckers Hospital Review relates that “The Lown Institute, a nonpartisan healthcare think tank, released its ranking May 17 of the best hospitals in the U.S. for avoiding overuse of low-value tests and procedures.”
  • Fierce Healthcare tells us, “Utah is the healthiest state for seniors this year, earning high marks for low prevalence of smoking and excessive drinking, according to a new report from the United Health Foundation. The philanthropic arm of UnitedHealth Group issued its annual America’s Health Rankings senior report Tuesday morning, which highlights state-specific performance across a slew of measures as well as progress, or lack thereof, on several key health issues facing seniors.”

From the healthcare business front

Fierce Healthcare reports

Private insurance plans paid hospitals on average 224% more compared with Medicare rates for both inpatient and outpatient services in 2020, a new study found. 

Researchers at RAND Corporation looked at data from 4,000 hospitals in 49 states from 2018 to 2020. While the 224% increase in rates is high, it is a slight reduction from the 247% reported in 2018 in the last study RAND performed. 

“This reduction is a result of a substantial increase in the volume of claims in the analysis from states with prices below the previous average price,” the study said. 

The report showed that plans in certain states wound up paying hospitals more than others. It found that Florida, West Virginia and South Carolina had prices that were at or even higher than 310% of Medicare. 

But other states like Hawaii, Arkansas and Washington paid less than 175% of Medicare rates. 

The American Hospital Association replies

The RAND Corporation’s latest hospital pricing report again “overreaches and jumps to unfounded conclusions based on incomplete data,” AHA President and CEO Rick Pollacksaid today. “The report looks at claims for just 2.2% of overall hospital spending, which, no matter how you slice it, represents a small share of what actually happens in hospitals and health systems in the real world. RAND also continues to ignore that hospitals are not all the same. Researchers should expect variation in the cost of delivering services across the wide range of U.S. hospitals — from rural critical access hospitals to large academic medical centers. Tellingly, when RAND added more claims as compared to previous versions of this report, the average price for hospital services declined. This suggests what we have long suspected: you simply cannot draw credible conclusions from such a limited and biased set of claims. 

“Further, the results highlight what even the Medicare Payment Advisory Commission (MedPAC) acknowledges: Medicare does not fully cover the cost of providing care to Medicare beneficiaries. Pinning commercial prices to inadequate Medicare rates would cause even more financial strain to hospitals already facing tremendous challenges as a result of the ongoing COVID-19 pandemic and rising inflation. The result could be reduced patient access to care.” 

I agree with the American Hospital Association that the problem is Medicare. Why Sen. Sanders continues to push Medicare for All is a mystery to the FEHBlog.

Also, Healthcare Dive informs us

Humana plans to open about 100 new value-based primary care clinics for Medicare patients between 2023 and 2025 through its second joint venture with private-equity firm Welsh, Carson, Anderson & Stowe, according to a Monday release from the payer.

The clinics will be managed and operated under Humana’s CenterWell Senior Primary Care brand, and WCAS will have majority ownership while Humana will have a minority stake.

The $1.2 billion expansion builds upon an existing venture with the same firm to open 67 clinics by early 2023.

From the Rx coverage front, Drug Channel reports on “The State of Specialty Pharmacy 2022: Reflections, Trends, and Photos from #Asembia22.”

I had the honor of presenting during the event’s general session: The Specialty Pharmacy Industry Update & Outlook. As in past years, I was joined by Doug Long from IQVIA. 

You can download our full slide deck here: https://drugch.nl/asembia22. 

From the mental healthcare front, Health Payer Intelligence discusses another angle considered in the UHG report on seniors mentioned above.

Over the last decade, seniors have experienced rising rates of mental healthcare needs, drug-related deaths, and early mortality, the UnitedHealth Foundation’s 2022 Senior Report shows.

“The 2022 Senior Report shows that the wellbeing of older adults was declining before the pandemic, which we know exacerbated many of these challenges,” Rhonda Randall, DO, executive vice president and chief medical officer of UnitedHealthcare Employer and Individual, said in the press release. 

“We urge people to help the seniors in your lives reconnect with the communities and activities they have enjoyed in the past but may not yet have returned to. We are focused on reducing disparities in the health care system for everyone, including older Americans.”

In webinar news — The Labor Department is holding a virtual event on May 25 concerning building mental health-friendly workplaces.

Monday Roundup

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

From the Omicron and siblings front —

  • Bloomberg observes “Covid hospitalitalization count makes vaccines seem less effective, Researchers say. The researchers point out that a patient who tests positive for Covid is a Covid hospitalization even if the patient is hospitalized for an unrelated reason.
  • In its recent review of Covid pills, the Institute for Clinical Review (ICER) gave a mildly favorable report on using an inexpensive anti-depressant fluvoxamine to treat Covid. This part of the ICER report was physician investigator-initiated. Those investigators sought FDA approval. Today, however, STAT News reports that “In an unusual two-page summary — the FDA does not generally disclose the reasoning behind rejections — regulators said that the doctors failed to provide adequate evidence of the effectiveness of the drug, called fluvoxamine.” The investigators indicated that more fluvoxamine trials are ongoing as well as trials of other repurposed drugs.
  • The National Institutes of Health announced today that a research team is successfully using deidentified electronic health record data to better identify characteristics of persons with long Covid. “One reason long COVID is difficult to identify is that many of its symptoms are similar to those of other diseases and conditions. A better characterization of long COVID could lead to improved diagnoses and new therapeutic approaches.”
  • Roll Call delves into the use of wastewater surveillance to track Covid trends. Urban areas are good — rural areas are not so good.
  • Medpage Today offers an epidemiologist’s perspective on the occasionally observed Omicron rebound from Paxlovid, the Pfizer Covid pill. Reuters adds, “Pfizer has said that from more than 300,000 patients it is monitoring who received the 5-day treatment, around 1-in-3,000 – about 0.03% – reported a relapse after taking the pills.”

In other FDA news, MarketWatch informs us

The Food and Drug Administration on Monday authorized a test developed by Laboratory Corporation of America Holdings LH, -0.92% that allows people in the U.S. to self-test for respiratory syncytial virus (RSV), a type of common cold, as well as the flu and COVID-19. The test does not require a prescription. People swab at home and send the test by mail to a Labcorp lab. Results are then made available in an online portal. Teens and children are also authorized to test with the support of adults. The test kit costs $169 and may be covered by insurance, according to a spokesperson. It is expected to be available within the next three weeks. 

That’s helpful.

From the SDOH front —

  • Health Day informs us that “a new study shows that telemedicine has closed the gap in access to primary care between Black and non-Black Americans.”
  • Beckers Payers Issues tells us “Despite little change before the pandemic, the number of adults with medical debt, issues paying medical bills and medical debt in collections have declined since the pandemic began. New policies will be needed to sustain the decrease, according to a May 11 report from the Urban Institute.” 

From the preventive care front, Healio reports

A decrease in cervical cancer rates in the United States, most notably among younger women, may be associated with HPV vaccination approval, according to a retrospective, cross-sectional study published in JAMA Network Open. 

Researchers added that an increase in oropharyngeal and anal/rectal cancers, particularly among men, highlights a need for vaccination uptake among both men and women.

From the interoperability front, the Sequoia Project “selected by the Office of the National Coordinator for Health IT (ONC) as the Recognized Coordinating Entity (RCE) to support the implementation of the Trusted Exchange Framework and Common Agreement (TEFCA), today released additional details regarding the process and requirements for becoming a Qualified Health Information Network (QHIN). The Sequoia Project is requesting feedback on these items before the final documents are released.” The Sequoia Project’s comment deadline is June 15, 2022, and “drafts are available on the RCE website.”

From the healthcare business front, Healthcare Dive reports

Hospitals’ labor costs rose by more than a third from pre-pandemic levels by March 2022, according to a report out Wednesday from Kaufman Hall.

Heightened temporary and traveling labor costs were a main contributor, with contract labor accounting for 11% of hospitals’ total labor expenses in 2022 compared to 2% in 2019, the report found.

Contract nurses’ median hourly wages rose 106% over the period, from $64 an hour to $132 an hour, while employed nurse wages increased 11%, from $35 an hour to $39 an hour, the report found.

In other government news —

  • The Department of Health and Human Service is marking the 10th anniversary of the National Plan to Address Alzheimer’s Disease. “HHS is commemorating the Anniversary through a series of publications and presentations highlighting the Department’s accomplishments in addressing Alzheimer’s disease and related dementias (ADRD), including those at the Centers for Disease Control and Prevention (CDC), Administration for Community Living (ACL), National Institutes of Health (NIH), Indian Health Service (IHS), and other HHS agencies. HHS will also sponsor a state policy roundtable to hear from state leaders about their work to address ADRD.  All events and materials will be shared on the 10th Anniversary HHS page.”
  • The Society for Human Resource Management relates that “An FAQ explains that the EEOC will permit employers to submit their EEO-1 Reports after the May 17 deadline, during what the agency is calling the “failure to file” phase. The EEOC stated, “All filers who have not submitted and certified their mandatory 2021 EEO-1 Component Report(s) by the Tuesday, May 17, 2022, published deadline will receive a notice of failure to file instructing them to submit and certify their data as soon as possible, and no later than Tuesday, June 21, 2022.”  All FEHB carriers must file this report.

Weekend update

David Ermer–ACA, Congress, COVID-19, Rx coverage, U.S. Healthcare–

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.

Friday Stats and More

David Ermer–CDC, COVID treatment, COVID-19, COVID-19 vaccine, Telehealth, U.S. Healthcare–

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.