Midweek update

Midweek update

Photo by Josh Mills on Unsplash

From the Omicron front, Live Science informs us about the so-called stealth Omicron variant.

A stealthy version of the omicron variant has been detected in the U.S., but so far, it makes up a very low proportion of the overall cases in the country.

This version of the variant, called BA.2, bears some genetic mutations not seen in the original omicron lineage, and some of these mutations lie in the spike protein, according to the World Health Organization (WHO). Some preliminary data hint that BA.2 may be slightly more transmissible, but not more severe, than the original omicron, but it’s too early to interpret that data with any confidence.

In December, scientists reported that the original version of omicron had split into multiple sublineages, one of these being BA.2, Live Science previously reported. BA.2 bears a genetic quirk that makes it harder to track using PCR tests, so it’s been nicknamed “stealth omicron.” 

The New York Times tells us about a new study identifying four factors that may lead to “Long Covid“.

The researchers said they had found that there was an association between these factors and long Covid (which goes by the medical name post-acute sequelae of Covid-19, or PASC) whether the initial infection was serious or mild. They said that the findings might suggest ways to prevent or treat some cases of long Covid, including the possibility of giving people antiviral medications soon after an infection has been diagnosed. * * *

One of the four factors researchers identified is the level of coronavirus RNA in the blood early in the infection, an indicator of viral load. Another is the presence of certain autoantibodies — antibodies that mistakenly attack tissues in the body as they do in conditions like lupus and rheumatoid arthritis. A third factor is the reactivation of Epstein-Barr virus, a virus that infects most people, often when they are young, and then usually becomes dormant.

The final factor is having Type 2 diabetes, although the researchers and other experts said that in studies involving larger numbers of patients, it might turn out that diabetes is only one of several medical conditions that increase the risk of long Covid.

From the Covid booster front

The COVID-19 booster drive in the U.S. is losing steam, worrying health experts who have pleaded with Americans to get an extra shot to shore up their protection against the highly contagious omicron variant.

Just 40% of fully vaccinated Americans have received a booster dose, according to the Centers for Disease Control and Prevention. And the average number of booster shots dispensed per day in the U.S. has plummeted from a peak of 1 million in early December to about 490,000 as of last week.

Also, a new poll from The Associated Press-NORC Center for Public Affairs Research found that Americans are more likely to see the initial vaccinations — rather than a booster — as essential.

“It’s clear that the booster effort is falling short,” said Jason Schwartz, a vaccine policy expert at Yale University. * * *

As for why an estimated 86 million Americans who have been fully vaccinated and are eligible for a booster have not yet gotten one, Schwartz said public confusion is one important reason.

“I think the evidence is now overwhelming that the booster is not simply an optional supplement, but it is a foundational part of protection,” he said. “But clearly that message has been lost.”

The need for all Americans to get boosters initially was debated by scientists, and at first the government recommended only that certain groups of people, such as senior citizens, get additional doses. The arrival of omicron, and additional evidence about falling immunity, showed more clearly a widespread need for boosters.

But the message “has been lost in the sea of changing recommendations and guidance,” Schwartz said.

  • Speaking of confusion over boosters, Kaiser Health News reports that

The Centers for Disease Control and Prevention reached out to pharmacists Wednesday to reinforce the message that people with moderate to severe immune suppression are eligible for fourth covid shots.

The conference call came a day after KHN reported that immunocompromised people were being turned away by pharmacy employees unfamiliar with the latest CDC guidelines.

  • If you thought that the idea of mixing and matching Covid boosters was confusing, the National Institutes of Health reassureed us that

In adults who had previously received a full regimen of any of three COVID-19 vaccines granted Emergency Use Authorization (EUA) or approved by the U.S. Food and Drug Administration, an additional booster dose of any of these vaccines was safe and prompted an immune response, according to preliminary clinical trial results reported in The New England Journal of Medicine. The findings served as the basis for recommendations by the FDA and the Centers for Disease Control and Prevention in late fall 2021 to permit mix-and-match COVID-19 booster vaccinations in the United States. Additional data from the ongoing Phase 1/2 trial, sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, are expected in the coming months.

From the Postal Service front, Govexec reports that

USPS, like the rest of the nation, has experienced a surge in COVID-19 cases from the omicron variant and thousands of workers are sick or quarantining each day. Still, the agency oversaw a largely successful holiday period and continues to ramp up its delivery of COVID-19 rapid tests on behalf of the administration. The Health and Human Services Department is reimbursing USPS for its costs, but the Postal Service has declined to disclose the terms of that arrangement. The mailing agency has kept on thousands of temporary staff to support the effort and is using its own facilities to stage the shipments. Tens of millions of tests have already gone out, White House Coronavirus Response Coordinator Jeff Zients said on Wednesday. 

Zients added the administration opted against using USPS to distribute 400 million N95 masks from the National Stockpile because its alternative approach—sending them to pharmacies and other locations to give to customers for free—is quicker. The masks have already reached many facilities and Americans are picking them up. 

From the hearing aid front, Roll Call reports on the state of the Food and Drug Administration’s efforts to craft a rule allowing hearing aids to be sold over the counter, a Biden Administration initiative. Suffice it to say that nothing is simple.

From the healthcare business front, Healthcare Dive tells us that

The fourth quarter results for Indianapolis-based Anthem were mixed, analysts said. The financial results released premarket Wednesday beat Wall Street expectations on earnings, but missed on operating revenue.

Higher-than-expected coronavirus-related costs driven by the omicron variant — most notably in December — were “more than offset” by lower utilization of non-COVID-19 care, CFO John Gallina told investors on a Wednesday morning call.

Anthem’s commercial business had the highest costs relative to baseline, driven by factors like children becoming eligible for COVID-19 vaccines and the omicron surge. Medicare was next in line, followed by Medicaid, which actually ended the quarter slightly below baseline, Gallina said. The CFO noted he expects that theme to continue in 2022.

The payer’s medical loss ratio, the percentage of premiums invested back into patient care, was 89.5% in the quarter, in line with analyst forecasts and up sequentially from the third quarter’s 87.7%, which was much lower than analysts had expected. The fourth quarter of the year typically has a higher MLR, even notwithstanding pandemic pressures.

What’s more Fierce Healthcare informs us that

The number of accountable care organizations participating in the Medicare Shared Savings Program (MSSP) modestly increased to 483 this year compared with 477 for 2021, sparking new worries from advocates over the future of the program.

The Centers for Medicare & Medicaid Services released new figures Wednesday that show the patient population being served by ACOs has slightly grown. The new data come as the Biden administration released a strategic refresh last year for its payment models with the intent of getting every Medicare beneficiary in an accountable care relationship by 2030. * * *

ACO advocates have been concerned about a decline in overall participation that has been occurring in the MSSP in recent years. There were 517 ACOs participating in 2020, which was up from the 519 that operated in 2019. However, that’s down significantly from the 561 that participated in 2018.

The National Association of ACOs (NAACOS) has previously called for CMS to make it easier for organizations to take on financial risk. The group criticized a Trump-era program called “Pathways to Success” that requires ACOs to take on financial risk much earlier in the process.

NAACOS has also called for greater predictability in ACO benchmarks that set the spending and quality targets ACOs must meet to qualify for shared savings as well as increases in such shared savings rates.

From the mental health parity front, Health Payer Intelligence digs into yesterday’s government report on health plan compliance with the federal mental health parity law.

EBSA conducted a review from April 16, 2021 to October 31, 2021 that assessed 156 payers on their non-quantitative treatment limitations, a parity compliance measure that often poses challenges to payers. * * *

Out of all of the comparative analyses that EBSA received, not a single payer provided all of the information that the review requested in the initial submission.

As a result, the administration sent out 80 letters to payers requesting more information. Twelve of the letters went to payers that had already received a letter from EBSA notifying them that they had submitted insufficient information and seeking the requested details.

EBSA still has not announced any final determinations. However, after this back and forth with payers, EBSA accrued enough information to find 30 health plans in non-compliance on a total of 46 NQTLs.

Three major issues stood out to EBSA as the administration assessed NQTL compliance.

First, the administration found that many health plans and issuers were not prepared for compliance. * * *

Second, the initial comparative analyses perpetuated a historic trend of providing insufficient data due to five types of errors. * * * [For example] payers did not perform a comparative analysis before designing their NQTLs, so the NQTLs were unlikely to meet EBSA’s standards.  * * *

Finally, despite lack of preparation and a range of errors that led to a fragmentary picture of the NQTLs and their applications, EBSA found that some plans could receive an initial determination even for an incomplete analysis. Hence, 30 plans have already received initial determinations of non-compliance.

As EBSA continues the determinations, the administration recommended changes to Congress that would enhance enforcement of the mental health parity compliance law, promote access to coverage, and standardize compliance regulations.

The FEHBlog recommends reading the entire article. As the FEHBlog mentioned yesterday, the mental health parity law could be made simpler and more effective but that outcome is just not in the cards at least currently.

Tuesday’s Tidbits

Photo by Patrick Fore on Unsplash

From the Omicron front, the Wall Street Journal reports that

Covid-19 deaths in the U.S. have reached the highest level since early last year, eclipsing daily averages from the recent Delta-fueled surge, after the newer Omicron variant spread wildly through the country and caused record-shattering case counts.

The seven-day average for newly reported Covid-19 deaths reached 2,191 a day by Monday, up about 1,000 from daily death counts two months ago, before Omicron was first detected, data from Johns Hopkins University show. While emerging evidence shows Omicron is less likely to kill the people it infects, because the variant spreads with unmatched speed the avalanche of cases can overwhelm any mitigating factors, epidemiologists say.

“You can have a disease that is for any particular person less deadly than another, like Omicron, but if it is more infectious and reaches more people, then you’re more likely to have a lot of deaths,” said Robert Anderson, chief of the mortality-statistics branch at the National Center for Health Statistics, which is part of the Centers for Disease Control and Prevention.

Bloomberg adds that

Covid-19’s deadly effects manifest long after some patients leave the hospital, according to a new study that points to the pandemic’s grave aftermath. 

Hospitalized patients who survived at least a week after being discharged were more than twice as likely to die or be admitted again within months, scientists from the London School of Hygiene and Tropical Medicine and the University of Oxford found. The Covid survivors also had an almost five times greater risk of dying in the following 10 months than a sample taken from the general population.

The findings, published Tuesday in the journal PLOS Medicine, add to evidence that the pandemic’s effects on health and wellbeing extend well beyond an initial infection. A Dutch study on Monday showed that three-quarters of Covid patients treated in intensive care were still suffering fatigue, impaired fitness and other physical symptoms a year later, and one in four reported anxiety and other mental symptoms.

“Covid-19 isn’t just an acute respiratory viral illness — like a cold or some other inconsequential infection — that goes away in a few days or a few weeks,” said Ziyad Al-Aly, director of the clinical epidemiology center at the Veterans Affairs St. Louis Health Care System in Missouri, who has led similar studies in the U.S. “It carries serious long-term consequences, including higher risk of death.” * * *

Needless to stay these articles illustrate the importance of being vaccinated with a booster against Covid.

From the free COVID tests front, MedCity News reports that

In the days since the Biden Administration announced on January 15 that insurers would be required to cover eight over-the-counter Covid-19 tests per month for members, digital health company Truepill has been busy developing a platform to help health plans meet that mandate.

In May, the San Mateo, California-based startup, which provides pharmacy fulfillment and telehealth services for brands like Hims, Nurx and Lemonaid, added home testing. Co-founder and President Sid Viswanathan said in an earlier interview that the company had planned to also offer diagnostics from the beginning.

The Covid-19 test coverage platform will give clients a behind-the-scenes partner who can assist with everything from checking member eligibility for coverage of tests to delivering those tests to their homes and providing shipping updates en route.

“We found a lot of plans are having to react to this on very short timelines, and so we’re building out a white-labeled, e-commerce experience that a plan can utilize,” said Varun Boriah, senior vice president of diagnostics at Truepill, in a phone interview. “We can put any plan’s logo on that asset and manage their patient experience for them.”

Cool.

From the OSHA vaccinate or test mandate front, the Society for Human Resource Management informs us

The Occupational Safety and Health Administration (OSHA) is withdrawing its emergency temporary standard (ETS) that would have required by Feb. 9 that large businesses ensure employees are vaccinated against the coronavirus or undergo weekly COVID-19 testing. Nonetheless, the agency is moving forward with its proposal to make the temporary directive a permanent standard. 

On Jan. 13, the U.S. Supreme Court halted the ETS while the 6th U.S. Circuit Court of Appeals considered the merits of the challenge against the vaccination-or-testing directive. OSHA announced on Jan. 25 that it will no longer seek to enforce the ETS, which will end the lawsuit, but the temporary directive served a dual purpose. The ETS also acts as a proposal for a permanent standard, which is separate from the litigation. “OSHA is not withdrawing the ETS to the extent that it serves as a proposed rule,” according to the agency.  * * *

OSHA said in a statement that it is prioritizing a proposal for a permanent COVID-19 safety standard for health care workers. 

“Notwithstanding the withdrawal of the [ETS], OSHA continues to strongly encourage the vaccination of workers against the continuing dangers posed by COVID-19 in the workplace,” the agency said.

The FEHBlog noticed that the Justice Department has asked the U.S. Court of Appeals for the Sixth Circuit to dismiss the consolidated challenge to the OSHA ETS as moot citing this OSHA action.

From the mental health parity front, the Department of Health and Human Services announced the release of the government’s

2022 Report to Congress on the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 – PDF. The report includes information that suggests health plans and health insurance issuers are failing to deliver parity for mental health and substance-use disorder benefits to those they cover. The report also highlights the departments’ recent emphasis on greater MHPAEA enforcement in addition to guidance to correct those failures, and makes recommendations to strengthen MHPAEA’s consumer protections and enhance the departments’ enforcement abilities.

The FEHBlog is not surprised at allegations on non-compliance because this is a very complicated. The law requires carriers to build walls between physical and mental health benefits and then ensure parity in quantitative and nonquantitative treatment limits. Why not break down the wall and define general coverage rules to embrace mental and substance use disorder care? Simply put, establish one set of rules for both types of care.

From the healthcare business front, Bloomberg reports that

Change Healthcare Inc. is considering selling some assets to clear the way for its $8 billion acquisition by UnitedHealth Group Inc., according to people with knowledge of the matter. 

The company is working with advisers on a possible divestiture of its payment integrity business, ClaimsXten, said the people, who asked not to be identified because the information is private. ClaimsXten could fetch a value of more than $1 billion, the people said. The business generates $130 million to $150 million in annual earnings before interest, taxes, depreciation and amortization, they said.

There’s no certainty a deal for ClaimsXten will be reached or that it will be enough to satisfy regulators, the people said.

A representative for Change Healthcare didn’t immediately respond to requests for comment. A spokesperson for UnitedHealth declined to comment.

UnitedHealth and Change Healthcare have been caught in a regulatory limbo over their proposed merger since the U.S. Justice Department opened an investigation into the deal in March, two months after it was announced.

Can’t blame Change for trying.

From the benefit design front, Govexec offers a helpful article about the advantage of enrolling in a high deductible plan which permits funding a health savings account. Contributions to an HSA are tax deductible when contributed; grow tax free, and tax exempt when withdrawn for healthcare purposes. You can’t beat that.

Drug Channels offers a January news roundup featuring an Insulin G2N Update; OptumRx “Data,” HDHPs, 340B Projections, and Fun with the CDC. What’s not to like?

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 third week of 2022:

My word, could that be a cresting of the Omicron surge as discussed in this week’s posts?

The FEHBlog’s weekly chart of new Covid deaths has bounced up and down after climbing to just over 10,000 weekly deaths during the Delta surge. .

Last but not least here is the FEHBlog’s weekly chart of new Covid vaccinations distributed and administered from the 51st week of 2020 through the third week of 2022.

Here are links to the CDC’s Covid data tracker weekly review and its weekly Fluview.

In other COVID vaccination news —

  • The Wall Street Journal reports that

Vaccines and booster shots offer superior protection from the Delta and Omicron variants, according to three new studies released by the Centers for Disease Control and Prevention.

The data back up earlier findings supporting booster shots and offer the first comprehensive insight into how vaccines fare against the Omicron variant. In one of the studies published Friday, a CDC analysis found that a third dose of either the vaccine from Pfizer Inc.and BioNTech SE or Moderna Inc. was at least 90% effective against preventing hospitalization from Covid-19 during both the Delta and Omicron periods.

The American Hospital Association adds

According to data from 25 state and local health departments, adults who were unvaccinated against COVID-19 as the omicron variant emerged in December had nearly three times higher risk of infection than adults fully vaccinated against COVID-19 and five times higher risk than adults who had received a booster, the Centers for Disease Control and Prevention reported today. The highest impact of COVID-19 booster doses compared with full vaccination was recorded among persons aged 50 and older. Because of reporting lags, the influence of the omicron variant on COVID-19-associated deaths could not be evaluated by vaccination status in December, the authors note.

The FDA could authorize Pfizer’s COVID-19 vaccine for children under age 5 in the next month, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, said Wednesday.

“My hope is that it’s going to be within the next month or so and not much later than that, but I can’t guarantee that because I can’t out-guess the FDA,” he said during an interview with Blue Star Families, a nonprofit group that supports military families.

The younger age group will likely need three vaccine doses, he said, since two shots didn’t provide enough of an immune response during Pfizer’s clinical trials for kids ages 2-4.

In Covid vaccine mandate news, Govexec tells us

A federal court in Texas has issued an injunction against President Biden’s COVID-19 vaccine mandate for the federal workforce, pausing implementation of a requirement for more than 2 million civilian servants. 

The Biden administration has already had sweeping success with the mandate, as most agencies have seen virtually their entire workforces come into compliance. Still, federal offices across the country were just beginning to move forward with suspensions—which could eventually result in firings—for those who did not meet the requirements. Biden issued the mandate by executive order in September.    

Judge Jeffrey Brown, appointed by President Trump to the U.S. Court for the Southern District of Texas, said the case was not about whether individuals should be vaccinated or even about federal power generally. 

“It is instead about whether the president can, with the stroke of a pen and without the input of Congress, require millions of federal employees to undergo a medical procedure as a condition of their employment,” Brown wrote. “That, under the current state of the law as just recently expressed by the Supreme Court, is a bridge too far.” 

The Justice Department has appealed the decision to the U.S. Court of Appeals for the Fifth Circuit. The FEHBlog expects that the Fifth Circuit will lift the stay as soon as this weekend. The Society for Human Resource Management offers a helpful article for employers trying to keep track of the vaccine mandate decisions from the courts.

In other COVID vaccine mandate news, the Labor Department’s Wage and Hour Division announced today that

Employees [who are not exempt from the Fair Labor Standards Act] must be paid for time spent going to, waiting for, and receiving medical attention required by the employer or on the employer’s premises during normal working hours. Therefore, if an employer requires an employee to obtain a COVID-19 vaccine dose, undergo a COVID-19 test, or engage in a COVID-19 related health screening or temperature check during the employee’s normal working hours, the time that the employee spends engaged in the activity is compensable. Employees must be paid for such time during normal working hours, regardless of where the activity occurs. This is true regardless of whether the employer is subject to the OSHA Vaccination and Testing ETS.

In Covid treatment news, the Food and Drug Administration announced today that the agency “took two actions to expand the use of the antiviral drug Veklury (remdesivir) to certain non-hospitalized adults and pediatric patients for the treatment of mild-to-moderate COVID-19 disease. This provides another treatment option to reduce the risk of hospitalization in high-risk patients. Previously, the use of Veklury was limited to patients requiring hospitalization.”

From the Covid OTC testing coverage mandate department, the Kaiser Family Foundation has surveyed the coverage approaches of 13 large health insurers. Don’t blame the insurers on this one because health insurers don’t typically cover OTC products and the government only allow four days to implement the mandate.

From the and more department

  • In telehealth news, mHealth Intelligence tells us that

Telehealth utilization peaked in the first half of 2020 and decreased as the year came to a close, with providers predicting that virtual care use would continue to decline in upcoming years, according to the 2021 Medical Group Telehealth Survey.

AMGA Consulting conducted the survey and gathered responses from 56 medical groups representing more than 38,000 healthcare providers.

The majority of the participants (86 percent) were part of multispecialty groups with primary care, while the remaining were either multispecialty without primary care, primary care, or single-specialty groups. * * *

The survey results suggest that although telehealth use skyrocketed during the COVID-19 pandemic, virtual care may see the most success with patients who prefer the modality over in-person care or whose health concerns can be easily addressed virtually.

The FEHBlog remains a strong proponent of hub and spoke telehealth for mental health care because every televisit is in network.

  • The American Hospital Association informs us that “The Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology seeks comments through March 25 to inform potential future rulemaking on how the ONC Health IT Certification Program could incorporate standards, implementation specifications and certification criteria to reduce the burden of prior authorization.”
  • The Congressional Budget Office released a report titled “The Prices That Commercial Health Insurers and Medicare Pay for Hospitals’ and Physicians’ Services.”

CBO examined potential explanations for why the prices paid by commercial insurers are higher and more variable than those paid by Medicare FFS. CBO’s analysis and literature review suggest the following conclusions:

— Greater market power among providers consistently leads to prices for commercial insurers that are higher than Medicare FFS’s prices and that vary more widely, both among and within areas. Hospitals and physicians’ groups may have market power because they have a dominant share of the market in an area or because an insurer sees them as essential to its network of providers.

— Some of the variation in the prices that commercial insurers pay for hospitals’ and physicians’ services is explained by differences in the prices of inputs needed to deliver those services.

— Higher hospital quality is associated with higher prices paid by commercial insurers, although whether there is a causal link between quality and prices, and the direction of any such link, is not clear.

— The share of providers’ patients who are covered by Medicare and Medicaid is not related to higher prices paid by commercial insurers. That finding suggests that providers do not raise the prices they negotiate with commercial insurers to offset lower prices paid by government programs (a concept known as cost-shifting).

IBM is selling the data and analytics assets of its Watson Health business to a private equity firm as it looks to refocus on its core cloud business.

The sale, which is expected to close in the second quarter this year has been anticipated for quite some time, and comes following the limited success of Watson Health, despite a spate of high-profile acquisitions of health information companies to bolster the enterprise.

Financial terms of the deal were not disclosed.

[F]ederal civilian employees in the U.S. will now be paid at least $15 per hour.

OPM issued a memorandum for heads of Executive departments and agencies that provides implementing guidance for how agencies should adjust pay rates for General Schedule (GS) and Federal Wage System (FWS) employees stationed in the U.S., and how to use administrative authority for other pay systems to lift the pay of federal employees who currently make less than $15 per hour. In total, these changes will impact 67,000 out of 2.2 million federal employees. The largest share of these workers, over 56,000 of them, currently work at the Department of Defense. OPM’s guidance directs agencies to implement these changes by January 30, 2022

  • To tide you over the weekend, here is a link to Healthcare Dive’s Deep Dive on four 2022 key trends for providers and payers.

Midweek update

Photo by JOSHUA COLEMAN on Unsplash

In this morning’s New York Times, columnist David Leonhardt writes

Omicron appears to be in retreat, even if the official national data doesn’t yet reflect that reality. Omicron also appears to be mild in a vast majority of cases, especially for the vaccinated. This combination means that the U.S. may be only a few weeks away from the most encouraging Covid situation since early last summer, before the Delta variant emerged.

If that happens — and there is no guarantee it will, as Katherine Wu of The Atlantic explains — it will be time to ask how society can move back toward normalcy and reduce the harsh toll that pandemic isolation has inflicted, particularly on children and disproportionately on low-income children.

When should schools resume all activities? When should offices reopen? When should masks come off? When should asymptomatic people stop interrupting their lives because of a Covid exposure? Above all, when does Covid prevention do more harm — to physical and mental health — than good?

These are tricky questions, and they could often sound inappropriate during the Omicron surge. Now, though, the surge is receding.

Yes, indeed. Helen Branswell, writing in STAT News, offers an array of expert opinions on what could be next on the COVID front.

John Moore, a virologist at Weill Cornell Medical College, said a post-Omicron decrease in transmission “is certainly a plausible scenario,” suggesting it might take until late February or early March for most of the country to get there. But equally possible, he suggested, is that another variant will emerge, with the transmissibility of Omicron but without its reticence to replicate in the deep lungs [like Alpha and Delta did].

“This is where it’s all so freaking difficult. There are scenarios. You don’t know what the future’s going to hold. All these people who say ‘This is what’s going to happen.’ Well, this is what they think might happen, if they’re being honest,” he said.

While the situation remains unsettling, the FEHBlog thinks that Mr. Leonhardt’s thinking is on the right track.

From the masking front, the Wall Street Journal reports that

The Biden administration on Wednesday announced plans to make 400 million N95 masks available for free at pharmacies and community health centers across the country.

The move comes as President Biden has stepped up the federal government’s response to a nationwide surge in Covid-19 cases triggered by the highly transmissible Omicron variant. Some scientists and doctors have said popular single-layer cloth masks may not be sufficient to protect against Omicron and called on the administration to expand access to high-filtration masks such as N95s.

The nonsurgical N95 masks will start to be available at pharmacies and community health centers late next week and the program will be fully up and running by early February, the White House official said. The masks will be sourced from the Strategic National Stockpile, the nation’s safety net of medical-equipment supplies. * * *

Three masks will be available per person, the official said, to ensure broad access. Most of the pharmacies that are part of the federal pharmacy vaccine program will distribute the masks, the official said.

Following up on yesterday’s post on distribution of the Pfizer and Merck Covid pills, the New York Times offers a reporter’s saga of tracking down the Pfizer treatment for her ailing mother.

The fact that the process was so hard for a journalist whose job it is to understand how Paxlovid gets delivered is not encouraging. I worry that many patients or their family would give up when told “no” as many times as I was.

I was also reminded that even a “free” treatment can come with significant costs.

The federal government has bought enough Paxlovid for 20 million Americans, at a cost of about $530 per person, to be distributed free of charge. But I spent $256.54 getting the pills for my mother. I paid $39 for the telemedicine visit with the provider who told my mother that she would need to visit in person. The rest was the Uber fare and tip. Many patients and their families can’t afford that.

President Biden recently called the Pfizer pills a “game changer.” My experience suggests it won’t be quite so simple.

FEHB and other health plans hopefully are looking into helping their members navigate this complicate process.

From the COVID vaccine mandate front, Fierce Healthcare reports

All 50 states are now subject to the Centers for Medicare & Medicaid Services’ (CMS’) healthcare workforce mandate after a federal court tossed Texas’ lawsuit and preliminary injunction contesting the requirement.

Today’s dismissal comes less than a week after the Supreme Court removed a stay of the federal government’s industry-wide vaccine requirement in 24 states that opposed the policy. The Biden administration filed an appeal of Texas’ injunction the following day.

Although CMS’ requirement may now be enforced across the country, the agency has set varying compliance deadlines reflecting whether its initial interim final rule was enjoined in a particular state.

Healthcare Dive adds

Healthcare workers in the 24 states that legally challenged the requirement will now be on a different vaccine deadline than the rest of the nation. For these states, healthcare workers must be fully inoculated by March 15, CMS confirmed with Healthcare Dive.        

But for the healthcare workers in the other 25 states and D.C., which were not a part of the litigation, workers will need to be fully vaccinated by Feb. 28, per CMS.         

From the healthcare business front —

Healthcare Dive tells us that

UnitedHealth reiterated its 2022 enrollment targets for Medicare Advantage on Wednesday, easing recent concerns that rising competition could hamstring future growth in the fruitful market.

The forecast was released along with its fourth-quarter and full-year 2021 results. The Minnetonka, Minnesota-based healthcare behemoth also reported no serious change in utilization trends despite skyrocketing COVID-19 case counts due to the highly infectious omicron variant.

UnitedHealth beat Wall Street expectations on both earnings and revenue in the fourth quarter, with revenue of $73.7 billion, up 13% year over year, thanks in part to the outsized growth of its health services business Optum. Net earnings of $4.2 billion were almost double the $2.4 billion in profit brought in at the same time last year.

Healthcare Dive adds that

Antitrust regulators said Tuesday they are looking to modernize merger guidelines in an effort to crack down on tie-ups amid a flood of merger filings that has more than doubled in the past year.

Leaders of the Federal Trade Commission and Department of Justice are launching a review of the current guidelines that are used to detect and analyze potentially unlawful mergers. Those policing guidelines have not been updated in 12 years, potentially excluding realities of a modern economy, leaders said.

To bring the guidelines up to date, the FTC and DOJ are calling on the public to submit information and new evidence, about the potential effects of mergers so the agencies can ultimately beef up tools to block anticompetitive deals.

From the Rx coverage front —

  • Drug Channels offers five takeaways from the Big Three PBM’s exclusion lists.
  • The Congressional Budget Office released a report titled “Prescription Drugs: Spending, Use, and Prices.”

In general healthcare news —

  • The American Medical Association discusses what drives Black maternal health inquities in the U.S.

Researchers at the University of Wisconsin-Madison have spent years making sure that their meditation app, called the Healthy Minds Program, passes clinical muster and delivers positive outcomes. Designing studies to test the app’s efficacy led Simon Goldberg, an assistant professor at UW, to confront the mountain of thousands of studies of different mobile mental health tools, including apps, text-message based support, and other interventions.

Researchers had taken the time to synthesize some of the studies, but it was hard, even for someone steeped in the science like Goldberg, to draw definitive conclusions about what works and what doesn’t. So Goldberg teamed up with a few other researchers and took a step back to see if they could put order to the work collected in these meta-analyses — a kind of deep meditation on the existing research inspired by UW’s meditation app.

The meta-review, published on Tuesday in PLOS Digital Health, examined 14 meta-analyses that focused specifically on randomized control trials for mental health interventions, including treatments for depression, anxiety, and smoking cessation. In total, the review included 145 trials that enrolled nearly 50,000 patients. The review found universal shortcomings in study design, leading the researchers to write that they “failed to find convincing evidence in support of any mobile phone-based intervention on any outcome.”

Ruh roh.

Holiday weekend update

Happy King Day! Here is a link to the NPR website that includes a video and a transcript of his “I Have a Dream” speech given August 28, 1963. Dr. King proves that you don’t have to be President to lead the country. He accomplished so much in his tragically shortened life for which we all should be grateful.

From the Congress front, the House of Representatives remains in session this week for Committee business and floor voting while the Senate is on State work period. Govexec lets us know that last Thursday

Lawmakers sounded a rare note of optimism about reaching a spending agreement for the remainder of fiscal 2022 as they look to avoid yet another stopgap measure.  Leaders in both parties called a bicameral, bipartisan meeting “constructive,” saying they shared the goal of setting full-year appropriations by their Feb. 18 deadline. 

From the Omicron front, STAT News informs us that

As the coronavirus continues to wreak havoc, an expert panel at the World Economic Forum delivered a mix of good news and bad news on Monday: More variants will emerge, but vaccine production is accelerating and research is progressing toward a combined shot that may be able to attack these different variants.

On one hand, the world needs to prepare for newer strains that could be more vexing, or the “worst case scenario,” said Annelies Wilder-Smith, a professor of emerging infectious diseases at the London School of Hygiene and Tropical Medicine. “Omicron will not be the last variant. There’s a high probability we will have another variant coming up. The question is when and will it be less dangerous?”

Wall Street Journal columnist Alyssia Finley offers a column on the benefits of natural immunity created by Omicron breakthrough infections.

study last month by the Oregon Health and Science University found that vaccinated people who experienced breakthrough infections produced higher levels of antibodies that were up to 1,000% more effective than those generated two weeks after a second dose of the Pfizer vaccine. The researchers described this as superimmunity. 

“I think this speaks to an eventual end game,” said co-author Marcel Curlin. “It doesn’t mean we’re at the end of the pandemic, but it points to where we’re likely to land: Once you’re vaccinated and then exposed to the virus, you’re probably going to be reasonably well-protected from future variants.” Dr. Curlin added: “Our study implies that the long-term outcome is going to be a tapering off of the severity of the worldwide epidemic.” * * *

All of this suggests that infection with Omicron is likely to stimulate potent and durable protection against Covid-19—and potentially other coronaviruses—even if it mutates to become more virulent. As Omicron rapidly spreads, people who have been vaccinated or previously infected will develop superimmunity. Covid-19 will become a virus that causes cold- and sometimes flulike symptoms—annoying but rarely deadly or disruptive.

One caveat is that older people generate weaker T-cell responses and memories to infections and vaccines. They’re likely to need annual booster shots. Omicron will end the pandemic by making Covid-19 endemic.

The Journal also offers masking advice which help the FEHBlog finally understand the difference between N-95 and KN-95 masks. “If you can’t get an N95 [which is certified in the US], doctors suggest KN95, KF94 and FFP2 masks, which are certified in China, South Korea and Europe, respectively.”

The Journal also reports that

One year into her tenure as director of the Centers for Disease Control and Prevention, Rochelle Walensky acknowledges that she should have communicated certain things better to the American public.

She says the pandemic threw curveballs that she should have anticipated. She thinks she should have made it clearer to the public that new rules and guidelines were subject to change if the nature of the fight against Covid-19 shifted again.

“I think what I have not conveyed is the uncertainty in a lot of these situations,” Dr. Walensky said in an interview with The Wall Street Journal.

Dr. Walensky deserves credit for making these remarks.

From the FEHB and TRICARE fronts, benefits consultant Tammy Flanagan discusses the merits of enrolling in Medicare Part B when you retire from federal employment at or over age 65.

From the healthcare business front, Revcycle Intelligence calls to our attention the fact that “2021 did not set any records for the number of hospital mergers and acquisitions, but data shows a shift to larger deals between well-established organizations”

The report identified eight “mega-mergers” in which the seller or smaller partner by revenue had over $1 billion in annual revenue. Out of all the announced transactions, that is the largest percentage of announced mega-mergers in the last six years at 16.3 percent. It was also nearly double the percentage of mega-mergers announced in 2020.

The average size of the smaller party in hospital merger and acquisition deals was also up significantly compared to previous years, according to the report. The average size by annual receive increased to $619 million from $388 million in 2020.

The data may point to a new trend in healthcare consolidation.

From the benefit design front, Health Payer Intelligence reports that

Although acupuncture utilization has grown in recent years, only half of acupuncture visits had any form of coverage in 2019, according to a research letter published in JAMA Network Open.

The researchers analyzed acupuncturist visits in Medical Expenditure Panel Survey (MEPS) data from 2010 to 2019. Their aim was to uncover the total cost of the visit, the annual out-of-pocket healthcare spending for these visits, the portion of these visits that were covered under the patients’ insurance plans, and the percent of out-of-pocket costs.

The majority of the participants were female and nearly six in ten were White individuals.

Finally MedPage Today gives us a community-oriented story written by “a physician [Avik Chatterjee, MD, MPH] in a shelter-based clinic in Boston, near the intersection of Massachusetts Avenue and Melnea Cass Boulevard, where a large encampment of people experiencing homelessness has emerged. Injection drug use in this area has picked up recently, and overdoses are not uncommon. When people need help, outreach workers and shelter staff run in and call for us.” And clinic doctors and nurses respond to the calls.” His story concludes as follows:

The skills, knowledge, and compassion necessary to address the overdose crisis exist in the community of people who use drugs. Historically, this group of people has been particularly marginalized by healthcare institutions. But people who use drugs are finally starting to demand a seat at the table where decisions are made around research and treatment of substance use disorders. Researchers, clinicians, and policymakers need to come up with creative ways to partner with this community to meaningfully incorporate lived and living experience in designing research and clinical programs.

In the face of one of the biggest health crises of our generation, it’s time to realize that “we’re all family here.”

And the post comes full circle.

Midweek update

From the Omicron front, Roll Call reports that

The White House COVID-19 Response Team stopped short of announcing major changes to anticipated guidance surrounding masks and instead focused on changes to testing strategy on Wednesday.

Experts have been calling for the Centers for Disease Control and Prevention to update its mask guidance to recommend high-filtration masks such as N95s and KN95s in light of the surge of the omicron variant. * * *

CDC Director Rochelle Walensky also echoed that an update to the CDC’s mask guidance was coming to “best reflect the options that are available to people, as you note, and the different levels of protection different masks provide.”

But she also doubled down on refusing to endorse a certain type of mask, instead repeating that the “best” masks are those that individuals will wear continuously in indoor settings.

“We are updating information on our mask website to provide information to the public,” she said. “We will provide information on improved filtration that occurs with other masks, such as N95s, and information that the public needs about how to make a choice of which mask is the right one for them. But most importantly, we want to highlight the best mask for you is the one that you can wear comfortably.”

For context, Bloomberg tells us that

The omicron variant represents about 98% of cases, Centers for Disease Control and Prevention Director Rochelle Walensky said Tuesday. That number is based on data for the week ending Jan. 8 and is a significant increase from just two weeks prior, when omicron accounted for 71.3% of cases. 

Omicron’s heightened transmissibility coupled with the immunity some have built to combat the delta through vaccination and exposure, have made conditions favor the “more mild” variant, said David Wohl, a professor at the Institute of Global Health and Infectious Diseases at the University of North Carolina-Chapel Hill. But experts warn that for those who remain unvaccinated or who suffer from other health concerns, infection from any Covid-19 variant is a major concern. 

For even additional context, Bloomberg informs us that

Switzerland joined Spain and the U.K. in suggesting that the coronavirus pandemic may be shifting to an endemic phase. 

From the COVID vaccine front, Bloomberg reports that

Almost all teenagers who needed intensive care for Covid-19 were unvaccinated, according to a study published by the New England Journal of Medicine, bolstering the case for using the Pfizer-BioNTech shot in youths.

The vaccine prevented 98% of ICU visits and 94% of Covid-related hospitalizations in the real-world study of more than 1,000 adolescents ages 12 to 18 in 23 states. The research from the Centers for Disease Control and Prevention and a network of 31 hospitals is one is one of the most detailed yet showing that vaccines can prevent severe Covid complications in teenagers.

Following up on yesterday’s proposed national Medicare coverage determination on Aduhelm, Healthcare Finance News provides stakeholder perspectives on that decision. STAT News points out that because the CMS decision, if finalized would apply to all drugs under development to treat Alzheimers Disease that fall into the same drug class as Aduhelm — monoclonal antibody, the proposed decision is bad news for several of Biogen’s competitors too.

Both Eli Lilly and Roche have such treatments in the works, and Biogen has still two more, developed in partnership with Eisai, as well. All of those drug makers now have a big incentive to pressure Medicare to loosen the restrictions in the final version of its policy, which is due out this April.

“While so much of the focus has been on what this means for [the Biogen drug], this recommendation impacts an entire class of drug and is likely to result in a more aligned effort by stakeholders as they try to influence the final version,” said a consultant for different drug makers, including Biogen.

“All of the other companies have to start over,” said George Vradenburg, the founder of the advocacy group UsAgainstAlzheimer’s. “This now applies to three drugs that, in fact, might be better.”

In other healthcare news —

  • Fierce Healthcare reports on the third day of the JPMorgan Healthcare Conference.
  • Health Affairs discusses how to create a stronger Medicare.
  • The director of NIH’s Heal Inititiative which focuses on substance use disorders / overdose deaths offers her ideas on the new year.
  • Forbes reports that “Walgreens Boots Alliance will have more than 160 of its doctor-staffed Village Medical clinics open next to drugstores by the end of this year.”

In Postal Service news, Govexec reports that

The U.S. Postal Service on Wednesday elected a new Republican chairman of its governing board, elevating one of President Trump’s appointees over President Biden’s picks.  

Roman Martinez, who joined the USPS board of governors in 2019, will serve as the panel’s 25th chairman. Anton Hajjar, a former American Postal Workers Union official nominated to his post by Biden, will serve as vice chairman. The board members voted unanimously for the leadership positions at a meeting on Wednesday. * * *

The new chairman has been an ally of Postmaster General Louis DeJoy, defending his controversial decisions, endorsing his 10-year plan to improve postal finances through, among other things, service cuts and price hikes, and calling him the right leader for the Postal Service. Hajjar, meanwhile, has voiced a lukewarm response to DeJoy’s tenure. The new vice chairman has said, however, that there was “a lot to like” in DeJoy’s plan, despite having reservations over some provisions.  * * *

DeJoy said on Wednesday he has “benefited from Martinez’s broad experience and wise counsel throughout my tenure as postmaster general and especially during the development of the Delivering for America plan.”

Keeping DeJoy in charge and one of his allies in charge of the board raises the prospect for sweeping postal reform legislation to make its way through Congress, with a House bill so far earning only tepid Republican support. 

It’s worth noting too that at 10 am ET tomorrow the U.S. Supreme Court will release decisions in pending cases which could include a stay of the OSHA ETS as OSHA began the enforcement clock on that measure last Monday.

Midweek Update

From the Capitol Hill front, Roll Call reports that

The Senate easily passed the annual defense policy bill on Wednesday, authorizing $768 billion in defense spending for fiscal 2022.

The final tally for the fiscal 2022 National Defense Authorization Act was 88-11. * * *

The legislation marks the 61st straight year that Congress has passed the NDAA. President Joe Biden is expected to sign it into law shortly.

The Federal Times discusses the federal employment aspects of the new law.

The Wall Street Journal adds that “Democrats braced for weeks of delay and uncertainty on their roughly $2 trillion education, healthcare and climate package they had hoped to finish by year end, as efforts faltered to secure the pivotal support of Sen. Joe Manchin (D., W.Va.) for the bill.”

From the Omicron front Bloomberg informs us that

The results from initial studies of the omicron variant of the coronavirus are starting to roll in almost daily, and early suspicions are gaining more support. The mutation is much better at infecting—70 times faster than delta and the original strain. But the severity of illness is likely to be much lower, according to a study from the University of Hong Kong, echoing earlier observations from doctors in South Africa where the variant was first observed. The supercharged speed of omicron’s spread in the human bronchus was found 24 hours following infection, according to the university. However, the study found it replicated in lung tissue much less efficiently than earlier mutations, which may signal “lower severity of disease.”

The FEHBlog ran across not one but two articles prognosticating about the extension of no cost sharing coverage of at home rapid antigen COVID tests scheduled for next month:

  • The Society for Human Resource Management points out a Mercer consulting report on the coverage issue.

HR consultancy Mercer explained: “Under existing guidance (see FAQ Part 43, Q/A-4), at-home COVID tests must be covered without participant cost-sharing, but only when ordered by an attending health care provider who has determined the test is medically appropriate based on current accepted standards of medical practice.”

Mercer noted that “group health plans and insurers currently may (but are not required to) provide coverage of at-home tests without participant cost-sharing even absent a health care provider’s determination of medical necessity. While we await important details, it seems quite possible that forthcoming guidance will significantly expand the scope of required coverage of at-home COVID testing without participant cost-sharing, in short, by eliminating the need to involve a health care provider.”

  • Health Payer Intelligence notes that “In a letter to CMS, the Alliance of Community Health Plans (ACHP) has requested that the federal government establish certain requirements for at-home COVID-19 testing coverage.” ACHP letter builds on Mercer’s concerns.

From the substance use disorder front —

Overdose deaths involving the synthetic opioid, illicitly-manufactured fentanyl (IMF), skyrocketed across the country from 2019 to 2020, researchers found.

Between July 2019 and December 2020, IMF-involved overdose deaths nearly doubled in the West (93.9%), increased 65% in the South and 33% in the Midwest, reported Julie O’Donnell, PhD, of the CDC’s National Center for Injury Prevention and Control in New Orleans, and colleagues.

Moreover these deaths were quick, as 56% of people who died from an IMF-involved overdose did not have a pulse when first responders arrived on the scene, and approximately 40% of IMF-involved deaths also involved a stimulant, O’Donnell’s group wrote in the Morbidity and Mortality Weekly Report.

  • The NIH HEAL Initiative reported that texting and related apps can be used to lengthen use of drugs taken to treat opioid use disorder. Here’s the background:

Medications such as methadone, buprenorphine, and naltrexone are highly effective for treating opioid use disorder. Yet only a fraction of people who could benefit actually receive these medications. Worse, about half of those who start taking them discontinue use within the first 6 months of treatment. Research has shown that the longer people continue treatment, the better their outcome is and the lower their risk of overdose.

  • On the bright side, NIH also reports that

The percentage of adolescents reporting substance use decreased significantly in 2021, according to the latest results from the Monitoring the Future survey of substance use behaviors and related attitudes among eighth, 10th, and 12th graders in the United States. In line with continued long-term declines in the use of many illicit substances among adolescents previously reported by the Monitoring the Future survey, these findings represent the largest one-year decrease in overall illicit drug use reported since the survey began in 1975. The Monitoring the Future survey is conducted by researchers at the University of Michigan, Ann Arbor, and funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health.

From the this and that department —

  • Health Affairs unveiled the National Health Care Spending Report for 2020:

US health care spending increased 9.7 percent to reach $4.1 trillion in 2020, a much faster rate than the 4.3 percent increase seen in 2019. The acceleration in 2020 was due to a 36.0 percent increase in federal expenditures for health care that occurred largely in response to the COVID-19 pandemic. At the same time, gross domestic product declined 2.2 percent, and the share of the economy devoted to health care spending spiked, reaching 19.7 percent. In 2020 the number of uninsured people fell, while at the same time there were significant shifts in types of coverage.

  • The Wall Street Journal graphically points out that emergency room charges can vary significantly for common emergencies in downtown Boston.
  • Fierce Healthcare tells us that

UnitedHealth Group has pushed back the deadline for its nearly $8 billion acquisition of Change Healthcare, according to a new filing with the Securities and Exchange Commission.

Change said in the filing that UnitedHealth informed the company that it was pushing back the deal’s outside date to April 2022. Previous filings suggested that the acquisition could close as early as late February.

Within the merger agreement, both companies have the right to push back the outside date.

UnitedHealth and Change are awaiting the completion of an investigation into the merger by the Department of Justice, which has been probing the deal on antitrust grounds.

Midweek Update

From the Omicron front, and as a public service, the FEHBlog notes this Wall Street Journal A-hed article from yesterday explaining the proper pronunciation of Omicron:

“There isn’t one way of saying Omicron,” said Armand D’Angour, professor of classical languages and literature at the University of Oxford. “First of all, you know, we’re not there, we haven’t recorded it.”

Egbert Bakker, professor of ancient Greek at Yale University, says the letter is pronounced “AWE-mee-kron” in both modern and ancient Greek. But he is open to other forms: “Some people would say ‘oh-MIKE-ron,’ that is the Americanized way. I wouldn’t do it but I don’t think it’s completely unacceptable.”

Isn’t Egbert a perfect name for an Ivy League professor of foreign languages?

Also, the Wall Street Journal reports that

Pfizer Inc. and BioNTech SE  said that a third dose of their Covid-19 vaccine neutralized the Omicron variant in lab tests but that the two-dose regimen was significantly less effective at blocking the virus.

A third dose increased antibodies 25-fold compared with two doses against the Omicron variant, the companies said. Still, two doses may prove effective in preventing severe illness from Covid-19, they said, because immune cells are able to recognize 80% of parts of the spike protein that the vaccine targets.

The results were issued in a press release by the companies, and weren’t peer reviewed and published in a scientific journal.

As of today, just over 200 million Americans are fully vaccinated against COVID according the CDC. Next Tuesday December 14 will mark the first anniversary of COVID vaccinations outside of trials in the U.S.

From the Federal Benefits Open Season front, FedWeek reminds us that

December 13 is the last day of the current open season for electing or changing coverage in FEHB and FEDVIP for the 2022 plan (calendar) year of each program.

If current enrollees make no changes, they will retain the same coverage next year, subject to new premium rates and coverage terms. In practice, only single-digit percentages change plans, levels of coverage within plans that have more than one, or type of enrollment (between family coverage and self plus one, for example).

In contrast to the FEHB and FEDVIP programs, a new enrollment is required each year for those who want a health care flexible spending account, a dependent care account, or both in the following year. The dependent care maximum remains $5,000 while the health care maximum is rising $2,850.

OPM encourages FEHB plan enrollees to use its online FEHB and FEDVIP Plan comparison tools.

From the telehealth front —

Healthcare Dive reports that

— COVID-19 was no longer among the top five telehealth diagnoses nationwide in September, though use of virtual care rose overall, according to new data from nonprofit Fair Health.

— In August, COVID-19 was among the top five diagnoses nationally and in every U.S. census region except the Northeast. In September, the only region where the it ranked in the top five was the Midwest.

— However, national telehealth use (measured as a percentage of all medical claim lines) rose more than 2% in September for the second straight month as the delta variant gained a foothold in the U.S. following a sustained period of decline early this year.

Kaiser Health News discusses the provider push for expanded coverage of audio-telehealth services.

From the benefit design front, Health Payer Intelligence tells us that

UnitedHealthcare has launched a new employer-sponsored health plan for Arizona residents that seeks to prioritize customer support experiences and lower member premiums.

The Doctors Plan of Arizona is the result of a partnership between the payer and the accountable care organization (ACO) Banner Health Network. The plan will serve Maricopa and Pinal County residents who receive employer-sponsored health coverage.

Banner Health Network frequently partners with health plans and providers to increase access to affordable care, the press release noted. The ACO’s network includes primary and specialty care physicians.

Through the Doctors Plan of Arizona, members will gain access to Banner Health’s network of more than 5,000 physicians and 15 medical centers.

Additionally, the plan will offer members a chance to potentially save up to 15 percent on premiums compared to other traditional health plans. The plan will also offer zero-dollar copays for primary care and urgent care visits, around-the-clock access to telehealth visits, and care coordination from the member’s primary care provider.

UnitedHealthcare will work to improve the customer experience with a personalized concierge approach. The payer’s Doctors Plan of Arizona will include a customer service team that has access to patient data from the provider and the health plan, allowing for more streamlined coordination, the press release stated.

The FEHBlog’s love affair with the ACO concept has not abated.

Health Payer Intelligence also discusses nutritional benefits.

Payers face a variety of challenges in expanding nutritional benefits, particularly due to the lack of ability to measure outcomes, but there are ways to navigate this uncertainty, according to a report from McKinsey & Company (McKinsey).

Among American adults who have at least one chronic condition, 60 percent also have poor nutrition, the report noted. This social determinant of health tends to occur hand-in-hand with some of the most expensive conditions in the US such as hypertension, obesity, and diabetes.

Check out the McKinsey report and the article for nutritional benefit tips.

Finally the Internal Revenue Service today released its draft Fringe Benefits Tax Guide for 2022 which may come in handy for 2022 budgeting purposes.

Tuesday’s Tidbits

Photo by Patrick Fore on Unsplash

From Capitol Hill, Roll Call reports that

The House and Senate are moving swiftly toward passing legislation introduced Tuesday that would limit Senate debate on debt limit legislation to 10 hours, creating a loophole in that chamber’s 60-vote legislative filibuster rules.in his Morning’s column in the New York Times andor a vote Tuesday night, Speaker Nancy Pelosi wrote in a letter to lawmakers, along with a revised fiscal 2022 defense policy bill that would be sent to the Senate separately.

The two legislative vehicles are unrelated bills that previously passed both chambers with amendments; using them to carry the budget and defense measures allows Senate leaders to avoid a time-consuming motion to proceed in that chamber. Instead, only one cloture vote per bill would be needed. 

Senate Minority Leader Mitch McConnell, who briefed his caucus at lunch on Tuesday, blessed the arrangement in comments to reporters. He said the new debt limit measure could pass as early as Thursday, after the Senate clears the bill to create an expedited process.

“I’m confident that this particular procedure coupled with the avoidance of Medicare cuts will achieve enough Republican support to clear the 60 vote threshold,” McConnell said.

If Congress accomplishes all of these actions, it may just call it quits at the end of this week which was the original schedule. A delay in Medicare cuts is extremely important to the medical facility and provider professional associations.

On the COVID vaccine mandate front, a federal district judge in Georgia today ordered a nationwide preliminary injunction against enforcement of the federal government contractor mandate per Govexec which adds

The Biden administration’s vaccine rule for private businesses and vaccine mandate for Medicare- and Medicaid-certified providers and suppliers are also temporarily blocked by courts. So far, the vaccine mandate for federal employees has not been stopped.

This PI applies to all FEHB plan contractors and subcontractors.

From the Delta variant front, David Leonhardt who is the FEHBlog’s go-to COVID columnists recommends in his Morning column in the New York Times today

For now, vaccinated people can reasonably continue to behave as they were — but many should feel urgency about getting booster shots. Older people and others who are vulnerable, like people receiving cancer treatment, should continue to be careful and ask people around them to test frequently.

Unvaccinated people remain at substantial risk of serious illness. About 1,000 Americans have been dying each day of Covid in recent weeks, the vast majority of them unvaccinated.

Look up case and deaths counts for your county here.

From the Rx coverage front, Drug Channels released its

annual deep dive into employer-sponsored coverage for prescription drugs. 

For 2021, employers backed away slightly from high-deductible health plans. However, their pharmacy benefit designs increased the use of coinsurance for specialty and fourth-tier drugs. These designs have significantly raised patients’ out-of-pocket obligations and are likely to have reduced adherence. 

Manufacturers’ patient support funds help offset patients’ higher expenses. But employer plans are rapidly adopting copay accumulators, which allow payers and PBMs to absorb these funds. 

From the health benefits trends front, the Society for Human Resource Management informs us that

Three-quarters of health insurers say that managing a health plan’s network of care providers is critical to controlling rising medical costs.

The finding is from consultancy Willis Towers Watson’s 2022 Global Medical Trends Survey, conducted from July through September 2021 among 209 leading insurers globally.

The plan features mostly likely to keep costs under control, insuers said, were:

— Contracting with high-quality, cost-competitive doctors and hospitals for in-network coverage (cited by 75 percent of respondents).

— Requiring preapproval for scheduled inpatient services (67 percent).

— Offering telehealth services (63 percent).

Telehealth or virtual care rose to the third spot from the fifth position last year, “a sign that more insurers see potential savings from remote options for diagnosing and treating patients,” according to the report.

Yesterday was the deadline for submitting public comments on the the second No Surprises Act interim final rule, which concerns the independent dispute resolution process. For a ying and yang take on the comments, here are links to American Hospital Association’s comments and to AHIP’s comments.

Let’s wrap it up with a bunch of HHS tidbits

  • HHS today announced its plan to “propose a national “Birthing-Friendly” hospital designation on the Hospital Compare section of the CMS Care Compare website, and also encourages states to provide 12 months postpartum coverage to people with Medicaid and CHIP.”
  • The National Institutes of Health reported that “Researchers identified brain cells that help suppress hunger and regulate food intake” and that “The findings may help lead to better treatments for excessive eating and obesity.”
  • NIH also announced “The winners of the National Institutes of Health’s Decoding Maternal Morbidity Data Challenge were announced today in conjunction with the White House “day of action” on maternal health. Twelve prizes were awarded to seven winners who proposed innovative solutions to identify risk factors in first-time pregnancies. Without a prior pregnancy for comparison, it is difficult to identify risks for adverse pregnancy outcomes. Early detection of these risks can help reduce pregnancy complications and prevent maternal deaths.”
  • The Agency for Healthcare Quality and Researched released

A final report on strategies to improve patient safety and reduce medical errors has been delivered to Congress by the U.S. Department of Health and Human Services in consultation with AHRQ. Required by the Patient Safety Act of 2005, the report was made available for public review and comment and review by the National Academy of Medicine. It outlined several strategies to accelerate progress in improving patient safety, including using analytic approaches in patient safety research, measurement, and practice improvement to monitor risk; implementing evidence-based practices into real-world settings through clinically useful tools and infrastructure; encouraging the development of learning health systems that integrate continuous learning and improvement in day-to-day operations; and encouraging the use of patient safety strategies outlined in the National Action Plan by the National Steering Committee for Patient Safety

Access the final report, “Strategies to Improve Patient Safety: Final Report to Congress Required by the Patient Safety and Quality Improvement Act of 2005” (PDF, 1.16 MB).

  • The Centers for Disease Control “announced today that it has awarded $22 million to nearly 30 organizations around the world to combat antimicrobial resistance (AR) and other healthcare threats through the establishment of two new networks—the Global Action in Healthcare Network (GAIHN) and the Global AR Laboratory and Response Network (Global AR Lab & Response Network).”

Citing mounting evidence of ongoing harm, U.S. Surgeon General Vivek H. Murthy on Tuesday issued a public health advisory on the mental health challenges confronting youth, a rare warning and call to action to address what he called an emerging crisis exacerbated by pandemic hardships.

Symptoms of depression and anxiety have doubled during the pandemic, with 25% of youth experiencing depressive symptoms and 20% experiencing anxiety symptoms, according to Murthy’s 53-page advisory. There also appear to be increases in negative emotions or behaviors such as impulsivity and irritability — associated with conditions such as attention deficit hyperactivity disorder or ADHD.

And, in early 2021, emergency department visits in the United States for suspected suicide attempts were 51% higher for adolescent girls and 4% higher for adolescent boys compared to the same time period in early 2019, according to research cited in the advisory.

Midweek Update

From Capitol Hill, The Wall Street Journal reports that

Lawmakers worked Wednesday to reach an agreement on a short-term spending patch to avoid a potential partial government shutdown this weekend, with Democrats and Republicans still haggling over the details of the funding extension.

Party leaders had initially hoped to release an agreement earlier this week. Democrats have eyed a spending patch that would last until mid-or-late-January, while Republicans have pushed for a longer extension.

With just days until the government runs out of current funding at 12:01 a.m. on Saturday, Dec. 4, lawmakers will need to act quickly to pass the eventual agreement through the House and Senate. Meeting that tight timeline would require unanimous consent in the Senate to waive some of the chamber’s procedural hurdles, and any individual senator can slow down the process.

The article points out that Congressional leadership from both parties expects a continuing resolution to pass without a government shutdown. Of course we know from past experience that because the funding runs out on a Saturday, Congress has some additional time to complete work on the continuing resolution over the weekend if necessary.

From the Delta variant front the Centers for Disease Control announced today that

The California and San Francisco Departments of Public Health have confirmed that a recent case of COVID-19 among an individual in California was caused by the Omicron variant (B.1.1.529). The individual was a traveler who returned from South Africa on November 22, 2021. The individual had mild symptoms that are improving, is self-quarantining and has been since testing positive. All close contacts have been contacted and have tested negative.

The FEHBlog senses that Delta variant is becoming jealous over the attention that the Omicron varian is receiving.

From the Delta variant vaccine mandate front, the Society for Human Resource Management tells us that

Consultancy Willis Towers Watson conducted a survey of large U.S. companies from Nov. 12-18 and asked if they currently require employees to be vaccinated against COVID-19 or plan to do so; 543 companies responded to the survey. Respondents indicated that they: 

Currently require vaccinations (18 percent).

Will require vaccinations only if OSHA’s ETS takes effect (32 percent).

Plan to mandate vaccinations regardless of the ETS status (7 percent). 

Few employers (3 percent) with vaccination mandates have reported a spike in resignations, although nearly 1 in 3 (31 percent) of those planning mandates were very concerned that this could contribute to employees leaving their organizations. On the other hand, nearly half of employers (48 percent) believe vaccine mandates could help recruit and retain employees.

In addition to vaccine mandates, many large employers have taken or plan to take the following actions to protect employees who are returning to the workplace, saying that they will:

Offer COVID-19 testing (84 percent), most on a weekly basis (80 percent).

Require unvaccinated employees to pay for testing unless prohibited by state law (25 percent).

Require or plan to require masks to be worn indoors (90 percent).

In hospital news, Healthcare Dive reports that

Hospitals saw operating margins continue to erode in October, declining 12% from September under the weight of rising labor costs, according to a national median of more than 900 health systems calculated by Kaufman Hall. It was the second consecutive monthly drop and comes as facilities are preparing for the fast-spreading omicron variant of the coronavirus.

Although expenses remained highly elevated, patient days and average length of stay fell for the first time in months in October, likely reflecting lower hospitalization rates as the pressure of treating large numbers of COVID cases began to ease, Kaufman Hall said in its latest report.

At the same time, operating room minutes rose 6.8% from September, pointing to renewed patient interest in elective procedures.

Fierce Healthcare adds that

Despite the threat of daily fines, hospitals have so far been slow to publish their prices online in accordance with a new federal regulation.

Radiology services look to be no exception, with new study data now suggesting roughly two-thirds of U.S. hospitals have not published commercial negotiated prices for at least one of the 13 radiology services designated as a common shoppable service by the Centers for Medicare & Medicaid Services (CMS). Hospitals are required to publish these prices in compliance with CMS’ Hospital Price Transparency final rule.

Further, the hospitals that did share their radiology service commercial negotiated prices appear to be all over the map, often setting price tags that varied by hundreds or thousands of dollars for certain imaging services.

The analysis—published in Radiology by Michigan State University and Johns Hopkins researchers—found than a mean 2,053 out of 5,700 hospitals (36%) had reported a price for one of these services as of Sept. 6.

From the telehealth front, Healthcare Dive informs us that

When U.S. patients envision their future medical care, the majority see telehealth playing a role. But when presented with the choice between an in-person or video visit for nonemergent care, most prefer a traditional in-office visit, according to new research analyzing consumer telehealth preferences.

The survey conducted by the nonprofit Rand Corporation published in JAMA on Wednesday found those who leaned toward in-person care were more willing to pay for their preferred visit modality, while those who preferred video visits were more sensitive to out-of-pocket costs.

Of the respondents who had used telehealth at least once since last March, only 2.3% said they were unwilling to use telehealth in the future, suggesting the method’s continued importance in hybrid models of care even after the pandemic — though it’s unlikely to be most patients’ first choice, researchers said.

In other news —

  • Drug Channels offers its take on CVS Health’s recent announcement to right size its number of retail pharmacies (a roughly 10% reduction) and add even more healthcare focus to the remaining locations.
  • Today “the Centers for Medicare & Medicaid Services (CMS) issued a Request for Information (RFI) to solicit stakeholder and public feedback that will be used to inform potential changes and future rulemaking to improve the organ transplantation system and seek to enhance the quality of life of those living with organ failure.”
  • Becker’s Hospital Review discusses and provides interesting executive interview on how healthcare providers and health plans are seeking to improve and expand mental healthcare.
  • This week’s Econtalk episode on our sense of hearing is outstanding. Check it out.