Once again, the threat of a government shutdown looms at the end of the fiscal year, which arrives on September 30. Lawmakers have two weeks to provide funding to keep large swaths of the federal government open and functioning, and the most likely result at this point is a short-term bill called a continuing resolution that funds the government for about 10 weeks, or until mid-December. Lawmakers would then look to pass an omnibus spending package to cover the rest of the 2023 fiscal year.
From the Omicron and siblings front, the Wall Street Journal offers an engaging interview with Moderna’s CEO Stéphane Bancel who “discusses the company’s latest Covid shot and research on using mRNA in seasonal flu vaccines and personalized treatments for cancer.”
From the social determinants of health front, Health Affairs discusses best practices to improve the collection and distribution of race, ethnicity, and language data for use by health care providers and payers. Healthcare payers, in particular, cannot address SDOH issues strategically without having REL data. The FEHBlog’s idea, which he has floated unsuccessfully to date, is to add REL codes to the AMA’s CPT 4 code system, thereby allowing the ready distribution of that data via reliable coders.
Speaking of the distribution of healthcare data, EHR Intelligence reports that “Large Health IT Networks Unveil Plans to Become Qualified Health Information Network (“QHIN”) Under TEFCA.” TEFCA will act as the Electronic Health Records “backbone” to vastly improve health record interoperability, which has long been a national EHR goal.
From the mental healthcare front, last Friday, “the U.S. Department of Health and Human Services (HHS) released the HHS Roadmap for Behavioral Health Integration (Roadmap), which details policy solutions that would help to better integrate mental health and substance use care into the larger health care system and other systems. The Roadmap is based on feedback Secretary Becerra received from patients and providers during more than two dozen stops on his National Tour to Strengthen Mental Health.”
Finally, a government contract expert discusses in Federal News Network why the 1994 federal acquisition reform law (actually the related 1994 and 1996 laws) aiming to simplify the federal procurement process needs a reboot. The FEHBlog heartily agrees.
Bloomberg Prognosis offers an interesting observation from Katrine Wallace, an epidemiologist at the University of Illinois at Chicago,
“For some viruses, where there is better mucosal immunity in the nose (via past infection or vaccines), people can fight off pathogens and develop an immune response without ever feeling ‘sick.’” In other words, for certain infections, your immune system might get revved up by recognizing a virus, and then swiftly fight it off.
“However, Covid-19 is not a virus that we have developed lasting mucosal immunity for, either through vaccines or via previous infections,” says Wallace.
This is the whole rationale for the development of the new Covid shots that are inhaled instead of injected, she says. The nose and mouth are where Covid first enters the body, so the vaccine antibodies elicited by those types of vaccines give people a more immediate line of defense.
The Wall Street Journal provides details on nagging Covid death levels:
Roughly 85% of people who died from Covid-19 through mid-August this summer were 65 or older, a Wall Street Journal analysis of death-certificate data show. The rate is similar to 2020 peaks, before vaccines were available. Deaths trended younger for much of last year.
Covid-19 is on pace to be the third-leading cause of death for the third straight year, said Dr. Robert Anderson, chief of the mortality statistics branch at the CDC’s National Center for Health Statistics. Since 2020, it has trailed only heart disease and cancer, significantly reducing life expectancy. * * *
The health system AdventHealth counted 24 deaths related to Covid-19 at its Orlando, Fla.-area hospitals in August. Age was the biggest factor, although younger patients with compromised immune systems were also at risk, doctors with the health system said. All but one Covid-19 patient who died had serious health problems such as diabetes, chronic obstructive pulmonary disease, heart failure and obesity.
Unfortunately, the Journal’s article discusses vaccination status but does not factor in the Paxlovid pill or other available treatments, which should be a game changer for older folks with Covid.
From the mental healthcare front — ‘
Yesterday, September 10, was World Suicide Awareness Day. McKinsey and Company reported,
The suicide rate in the United States has risen over the past 20 years to become the second-leading cause of death for people between the ages of ten and 34, write partner Erica Hutchins Coe, senior partner Martin Dewhurst, senior partner Tom Latkovic, and co-authors in a recent report from the McKinsey Health Institute (MHI). And by winter of 2021, the weekly rate of ER visits by adolescents who attempted suicide was 39 percent higher than pre-pandemic levels. By taking action to address this urgent public health issue, organizations, educators, healthcare professionals, governments, and society at large could help millions in crisis. This #WorldSuicidePreventionDay, learn about ongoing efforts by MHI and its collaborators to improve crisis care in the United States * * * .
The article provides links to relevant McKinsey publications on this important topic.
The American Medical Association’s “What Doctors Wish Their Patients Knew” column delves into loneliness and health.
From the social determinants of health front, Fierce Healthcare looks into CVS’s Healths efforts to improve health equity.
When the CVS Caremark team geared up to take on health disparities, it quickly realized that any initiative would require a significant basis in data to succeed.
That entailed both gathering more data and building the tools necessary to track and analyze them. For example, Joel Helle, vice president of physician services at CVS Specialty, told Fierce Healthcare that Caremark has not historically gathered race and ethnicity data, but now asks payers and plans sponsors for that information to more accurately target where disparities are occurring.
“It’s real race and ethnicity data, and we know who those patients are,” he said. “That’s the future, in my mind, of what everybody needs to do.”
In addition, the company built a proprietary tool that combs data from 17 different indexes to identify where disparities exist, he said. That tool, he said, puts “red dots” on the map to highlight risks, and the Caremark team can then use its internal data to further drill down to challenges in specific communities.
Based on the Centers for Disease Control’s Covid Data Tracker and using Thursday as the first week, here is the FEHBlog’s updated weekly chart of new Covid cases for 2022:
The enormous surge on the right is the original Omicron strain. Its sibling variants follow. The CDC’s weekly review of its Covid stats is back this week:
As of September 7, 2022, the current 7-day moving average of daily new cases (70,488) decreased 18.8% compared with the previous 7-day moving average (86,853).
CDC Nowcast projections* for the week ending September 10, 2022, estimate that the combined national proportion of lineages designated as Omicron will continue to be 100% with the predominant Omicron lineage being BA.5, projected at 87.5% (95% PI 86.2-88.7%).
Here is the CDC’s current chart of daily trends of new Covid hospitalizations:
The CDC’s weekly review adds “The current 7-day daily average for August 31–September 6, 2022, was 4,620. This is a 10.5% decrease from the prior 7-day average (5,163) from August 24–30, 2022.”
Here’s the FEHBlog’s weekly chart of new Covid deaths for 2022 which also is trending down.
The CDC’s weekly review adds “The current 7-day moving average of new deaths (314) has decreased 28.1% compared with the previous 7-day moving average (437).”
Here’s the FEHBlog’s chart of Covid vaccinations distributed and administered from the beginning of the Covid vaccination era (51st week of 2020) through the 36th week of 2022.
As of September 7, 2022, 610.7 million vaccine doses have been administered in the United States. Overall, about 263.1 million people, or 79.2% of the total U.S. population, have received at least one dose of vaccine. About 224.4 million people, or 67.6% of the total U.S. population, have been fully vaccinated.*
Of those fully vaccinated, about 109.0 million people have received a booster dose,* but 50.0% of the total booster-eligible population has not yet received a booster dose. Booster dose eligibility varies by age and health condition. Learn more about who is eligible.
Last week, according to the CDC’s stat review, the CDC’s Covid community level evaluations saw an 8.6% decrease in high-level communities and a 10.2% increase in low-level communities.
In other Covid news, Benefits Pro discusses a Brookings Institution report on long Covid’s impact of the U.S. workforce, and the Society for Human Resource Management offers an article confirming the FEHBlog’s take on the recent federal appellate court decision concerning the federal government’s stayed vaccine mandate on federal government contractors.
A federal judge grilled the Justice Department on Thursday over its antitrust claims that UnitedHealth Group Inc.’s $13 billion acquisition of health-technology firm Change Healthcare Inc. would suppress competition and limit innovation in health insurance markets.
During closing arguments, U.S. District Judge Carl J. Nichols questioned the department’s arguments that he should block the deal because it would limit competition for technology used in claims processing and would give UnitedHealth access to sensitive industry data that it could use to harm competitors. * * *
Judge Nichols is expected to issue his ruling in the coming weeks.
Home improvement retailer Home Depot and two other, smaller employers are appealing a recent $2.67 billion settlement that covers allegedly anticompetitive behavior from Blue Cross Blue Shield insurers.
The appeals could potentially delay the release of the funds and the broader terms of the settlement, which U.S. District Judge R. David Proctor finalized in August.
Negotiations are intensifying over massive, multibillion-dollar legislation to fund the Food and Drug Administration, with just weeks left before the current agreement expires, four sources following the talks said. * * *
Talks are still fluid, and there is no final agreement yet. Lawmakers are aiming to finalize a package by early next week.
The FDA agreement could ride along with a government funding package before the end of September, when government funding runs out. There’s a chance the user fee legislation could pass on its own, however, if there is a bipartisan deal. The Democrats’ user fee offer was a full five-year agreement, not a shorter-term deal.
From the fraud, waste, and abuse front, Beckers Hospital Review informs us
A small number of primary care providers have been responsible for most of the recent growth in remote patient monitoring, though it’s not known how much their patients needed that type of potentially expensive care, a new Health Affairsstudy found.
Remote patient monitoring grew fourfold during the pandemic’s first year, according to the analysis of OptumLabs Data Warehouse data from January 1, 2019, to March 31, 2021. The database includes Medicare Advantage claims that total about 20 million people annually.
Out of a group of 342 high-volume providers, 0.1 percent accounted for 69 percent of all general remote patient monitoring claims, the Sept. 6 study found.
But the Harvard University researchers said they didn’t observe that the high-volume providers targeted patients with more severe or uncontrolled disease. They said growth rates “indicate that total spending on remote patient monitoring could quickly escalate” and potentially burden CMS and other payers financially.
“More research is needed to identify which patients and use cases benefit most from remote patient monitoring,” the study’s authors wrote. “In the meantime, payers and policymakers should closely monitor its use and be prepared to establish appropriate controls as informed by new evidence.”
From the mental healthcare front, the American Hospital Association relates
The Department of Health and Human Services today reported a 45% increase in call volume and improved answer rates and wait times for the 988 Suicide and Crisis Lifeline this August compared to a year ago. The 10-digit National Suicide Prevention Lifeline in July transitioned to the 988 Suicide and Crisis Lifeline, meaning individuals experiencing a suicide, mental health or substance use crisis can simply call, chat or text 988 to connect with a trained crisis counselor.
The Substance Abuse and Mental Health Services Administration also announced a $35 million grant opportunity to better support 988 Lifeline services in tribal communities, which face unique challenges to accessing technology and crisis services.
OPM announced today that the next Federal Benefits Open Season will be held from November 14 through December 12, 2022. The announcement tells us that OPM expects to post 2023 FEHB and FEDVIP premiums on its website in “late September.”
From the Omicron and siblings front, the Wall Street Journal offers a helpful set of FAQs on the new bivalent mRNA boosters that are currently rolling out for administration.
From the monkeypox front, the Food and Drug Administration announced action to expand testing for the disease.
From the public health front, McKinsey and Company released its
United States of Health Dashboard. [McKinsey describes the tool as] an easy-to-use data visualization tool that enables users to explore the impact of disease and ill health within individual states, the dashboard is informed by key metrics encompassing maternal and neonatal health, behavioral health, communicable disease, chronic disease, and environmental health. It measures the total loss of healthy years of life, assuming full health (also known as “the burden of disease”), that affect a state’s population over the course of one year.
The dashboard is designed to help current and newly tapped state leaders, public-health agencies, and other stakeholders identify the highest-priority areas for investment by offering insights into key questions such as: How do behavioral health challenges affect a state’s population? How well is chronic disease managed and infectious disease controlled? How do mothers and their newborn infants fare? How well are health risks in the environment managed? And which populations are most significantly impacted by these metrics?
For example, here is a link to the Texas dashboard.
In other public health news, the American Hospital Association informs us
September is Suicide Prevention Awareness Month, with National Suicide Prevention Week running Sept. 4-10. In recognition of the effort to reduce the occurrence of suicide and destigmatize the conversation around it, AHA is proud to highlight resources available to our members and the public at large.
HR Director offers an interesting article about how HR professionals can approach this issue.
In the roughly dozen years since [he dealth with an employee suicide], [Matthew] Burr has advised every one of his clients (which include schools, financial firms and manufacturers, among other companies) to establish an EAP. Aside from a couple smaller companies, which have anywhere from five to 10 employees, every client has taken his advice. They were truly grateful to have done so ahead of the COVID-19 pandemic, so their employees had support systems already in place during the unprecedented time.
From the U.S. healthcare business front
Healthcare Dive reports that Walmart and UnitedHealthcare have teamed up to offer a Medicare Advantage plan under a ten-year-long contract. “Ultimately, the goal is to serve hundreds of thousands of seniors and Medicare beneficiaries in value-based arrangements through multiple Medicare Advantage plans.
Beckers Hospital Review tells us “Cost Plus Drug Co. founder Mark Cuban expects his online pharmacy to soon grow past 1 million customers, the billionaire of Shark Tank fame said Sept. 6 during Vox‘s Code Conference. ‘By the time I get back, we should, hopefully, be past a million patients in seven months,’ Mr. Cuban told Vox‘s Recode, referring to the late-January launch of Cost Plus Drug Co., according to CNET.”
Reuters reports, not surprisingly, that “CVS Health Corp’s (CVS.N) plan to buy healthcare services company Signify Health for about $8 billion will face a tough U.S. antitrust review even though the two companies do not compete directly in any markets, three experts said Tuesday.”
From the Rx coverage, BioPharma Dive discusses the near term future of biosimilar drugs.
From the health savings account front, Voya Financial discusses “five HSA funding strategies companies [or FEHB plans’ can employ to help boost employee saving.”
From the omicron and siblings front, AHIP informs us
Today the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) voted to recommend the use of the bivalent mRNA COVID-19 vaccines as a single-dose booster for all individuals ages 12 and older (Pfizer-BioNTech) and 18 and older (Moderna), at least two months following primary series or previous booster dose. The ACIP recommendation for the bivalent boosters was approved by a vote of 13-1.
The Committee reviewed modeling data showing the vaccine has the potential to reduce hospitalizations and deaths, especially among high-risk groups. The bivalent boosters are recommended for all those over age 12 who have completed a primary series, at least 2 months after the most recent dose. The modeling data indicates that the vaccine is safe and effective, and that booster strategies will be executed in an equitable manner. Models also indicate that waiting until more trial data is available (in two to three months) could lead to preventable hospitalizations and deaths.
ACIP members expressed concern that many assumptions had been made with the modeling, and that the vaccine being recommended – which includes protections specific to the BA.4/BA.5 variants – has not been tested in humans. Mouse models were used for data on this vaccine, in addition to extrapolations from human trials using the BA.1-specific vaccine. CDC pointed out that annual influenza vaccines are modified based on projected variants without direct clinical evidence. ACIP members also expressed concerns that the bivalent booster makes assumptions about future variants, which this booster may not protect against.
Earlier this week, the Food and Drug Administration (FDA) amended the Emergency Use Authorizations (EUAs) for both the Moderna COVID-19 vaccine and the Pfizer-BioNTech COVID-19 vaccine to authorize bivalent formulations of the vaccines for use as a single booster dose at least two months following primary or booster vaccination. The bivalent Moderna vaccine is authorized for use as a single booster dose in individuals 18 years of age and older and the Pfizer bivalent vaccine is authorized for use as a single booster dose in individuals 12 years of age and older. FDA also released fact sheets on both the Pfizer-BioNTech vaccine and the Moderna vaccine.
With the authorization, FDA has revised the EUAs to remove the use of the monovalent versions of the vaccines for booster administration for the age groups now covered by the bivalent booster products. ACIP also rescinded its recommendations for the monovalent booster vaccines.
Bivalent boosters may be available as early as next week.
The FEHBlog finds it noteworthy that the new bivalent booster replaces the monovalent booster.
STAT News also discusses the Omicron outlook for this autumn.
In a way, some physicians have said, Covid is becoming more like the other respiratory pathogens that most of us shake off but that can occasionally cause severe illness and death among the oldest adults or people who are already sick. So many more people are dying from Covid than from those other viruses, however, because of the massive number of cases that are still occurring overall.
Another trend that has continued into 2022 has been the racial and ethnic disparities associated with Covid. The gaps between different demographic groups’ death rates have shrunk over time, but at the peak of this summer’s wave, for example, death rates by age group among Hispanic adults were notably higher than those among white adults, federal data indicate.
One of the silver linings of the pandemic is that, unlike with some viruses, SARS-2 did not pose a particularly serious threat to children. That’s not to minimize the hospitalizations and deaths — as well as incidents of long Covid and MIS-C — that the virus did cause in pediatric populations. But overall, kids have faced much lower risks of severe outcomes from Covid than adults.
Still, something worrisome occurred this summer with kids and Covid, as hospitalizations reached their second highest peak of the entire pandemic, surpassing last summer’s Delta wave and only trailing the initial Omicron spike early this year.
The article’s experts encourage vaccinating children to stem this tide.
From the FEHB front, Govexec provides a handy just before and just after federal retirement checklist, and Fedweek helpfully delves into “What Counts and What Doesn’t for Keeping FEHB Coverage in Retirement,” which should be a key consideration for career feds.
From the public health front, the CDC reminds us September is Sepsis Awareness Month
Anyone can get an infection, and almost any infection, including COVID-19, can lead to sepsis. Sepsis is the body’s extreme response to an infection and is a life-threatening medical emergency.
September is Sepsis Awareness Month and CDC encourages patients and healthcare professionals to share Get Ahead of Sepsis resources, below, to learn how to protect themselves, their loved ones, and their patients from sepsis:
Patients and families: * New this year is an updated patient and family brochure. * Download and share any of CDC’s FREE patient education materials with your friends and loved ones to learn how to prevent infections, be alert to the signs and symptoms of sepsis, and act fast if sepsis is suspected. * Share updated sepsis graphics on social media to educate friends and loved ones about sepsis. * Are your children back to school? Talk to your child’s healthcare professional and school nurse about steps you can take to prevent infections that can lead to sepsis. Some steps include taking good care of chronic conditions and getting recommended vaccines. Healthcare professionals: New this year are two fact sheets for long-term care nurses and certified nurse assistants. Download and share CDC’s FREE healthcare professional education materials with your colleagues to educate them about how to recognize signs and symptoms of worsening infection and sepsis, how to get ahead of sepsis, and what to do if they suspect sepsis. Educate your patients and their families about: o Preventing infections o Keeping cuts clean and covered until healed o Managing chronic conditions o Recognizing early signs and symptoms of worsening infection and sepsis o Seeking immediate care if signs and symptoms are present
This Sepsis Awareness Month, spread the word about sepsis—you can help save lives.
To learn more about sepsis and how to prevent infections, visit www.cdc.gov/sepsis or call 1-800-CDC-INFO.
From the miscellany department —
Medpage Today offers a special report about a ” New Behavioral Health Database Reveals Gaps in Care — Researchers behind it hope to provide the data needed to remedy the problem.”
STAT News reports “Drug treatment of veterans with opioid use disorder increased during the first year of the pandemic, according to a new study, suggesting that the rapid shift from in-person to telehealth visits at VA medical centers enabled patients to get access to care despite Covid-related disruptions.”
Fierce Healthcare tells us “Cigna’s Evernorth subsidiary is expanding its diabetes care value program to combine traditional pharmaceutical interventions with devices, tools and resources to help patients better understand and manage their diabetes.”
Healthcare Dive informs us that “To staunch the losses of rural hospital closures that endanger access to care for millions, federal regulators are hoping some facilities opt in to a new payment model, but providers say they want more flexibilities and clarity before making the pivot. * * * The new rule ‘maybe gets halfway there,’ Jennifer Findley, vice president of education and special projects at the Kansas Hospital Association, told Healthcare Dive. ‘It’s not as much as we were hoping for but it does give some more flexibility than what you have today.’”
Health Payer Intelligence reports “Chronic diseases are common among emergency department patients, particularly among seniors and those ages 45 to 64, according to a National Health Statistics Report. ‘Monitoring ED visits made by adults at highest risk of severe COVID-19-related illness is important for understanding the health burden of COVID-19 and for planning prevention strategies,’ the researchers explained. ‘Ongoing monitoring of the presence of these underlying chronic conditions at ED visits will continue to inform COVID-19 response efforts.’”
Also Health Payer Intelligence notes that “Three major social determinants of health factors are particularly predominant barriers to care for America’s seniors: economic instability, loneliness, and food insecurity, according to a study sponsored by Alignment Healthcare. Researchers from Toluna conducted an online survey from July 24 to August 13, 2022, which reached 2,600 seniors ages 65 and older. Most respondents identified as white. Half were in Medicare Advantage and this population was divided primarily between preferred provider organizations and health maintenance organizations.”
Yesterday, the FEHBlog discussed a U.S. Court of Appeals for the 11th Circuit opinion issued last Friday narrowing the scope of a nationwide injunction that a federal district court had imposed on the Biden Administration’s federal government contractor mandate.
The executive order is still enjoined in Alabama, Alaska, Arizona, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, South Carolina, South Dakota, Tennessee, Utah, West Virginia and Wyoming as a result of the Friday opinion and the injunctions in the other cases, members of the law firm McGuireWoods noted in a post.
A spokesperson for the Office of Management and Budget told Government Executive on Monday morning the Justice Department is currently reviewing the decision. “At this time, the nationwide injunction remains in effect, and thus agencies should continue not to take any steps to enforce Executive Order 14042.”
The nationwide injunction remains in effect at least until the appellate court issues its mandate to the lower court which typically happens in two weeks.
Also from the Omicron and siblings front, the Wall Street Journal discusses best practices for Covid testing while NPR tells us
The federal government is putting a pause on sending free COVID-19 testing kits to Americans starting in September, due to a lack of funding.
“Ordering through this program will be suspended on Friday, September 2 because Congress hasn’t provided additional funding to replenish the nation’s stockpile of tests,” the ordering website says.
However, the program is still accepting orders before [next Saturday] Sep. 2.
From the No Surprises Act front, Mercer Consulting announced
A new prescription drug reporting mandate, adopted as part of the 2021 Consolidated Appropriations Act (CAA) (Pub. L. No. 116-260), requires group health plans and health insurers to report detailed data about prescription drug pricing (including rebates) and healthcare spending. The first reports are due by Dec. 27, 2022, and annually thereafter. The departments of Labor, Treasury, and Health and Human Services will use the information to prepare a biannual, publicly available report. The departments have issued interim final rules (IFR) detailing the data to report and recently updated submission instructions describing the mechanics of the reporting process. The updated instructions provide important information about reporting wellness services, prescription drug expenses that are covered by the pharmacy benefit manager and more.
Download the 21-page print-friendly article for details on the prescription drug reporting rules and the compliance challenges facing group health plans. This GRIST has been updated to reflect the updated submission instructions.
OPM added FEHB plans to the list of reporting plans and insurers. The initial report on the 2020 plan year is due no later than December 27, 2022.
From the FEHB plan design front, Federal News Network reports
Democratic lawmakers are urging the Office of Personnel Management to follow through on its plans to expand federal employees’ medical coverage to cover infertility diagnoses and treatments.
Sen. Tammy Duckworth (D-Ill.) and Government Operations Subcommittee Chairman Gerry Connolly (D-Va.) urged OPM on Monday to ensure all Federal Employee Health Benefits (FEHB) program carriers provide coverage for assistive reproductive technology (ART), which includes in vitro fertilization (IVF), starting in 2023.
The legislators’ demand strikes the FEHBlog as a day late and a dollar short because FEHB carriers and OPM closed their benefit and rate negotiations earlier this month. OPM did ask carriers in the agency’s 2023 call letter to plan on expanding ART coverage or offering a discounted ART network, among other options.
From the maternal health front, the Department of Health and Human Services announced “investments of over $20 million to improve maternal and infant health and implement the White House Blueprint for Addressing the Maternal Health Crisis – PDF. Funding aims to help reduce disparities in maternal and birth outcomes, expand and diversify the workforce caring for pregnant and postpartum individuals, increase access to obstetrics care in rural communities, and support states in tackling inequities in maternal and infant health.”
From the mental healthcare front, Health Payer Intelligence delves into the resources that AHIP has made available.
Seven strategic themes emerged from the list of ways that payers have helped members manage their mental health needs:
* Helping members find the right providers
* Creating opportunities for care through telehealth, online platforms
* Designing new payment models
* Expanding and educating the mental healthcare workforce
* Offering population-based services
* Supporting caregivers
* Expanding research and awareness
The article expounds on each of these themes.
From the U.S. healthcare business front, Fierce Healthcare reports
Months of inching performance gains were upended in July as the nation’s hospitals logged “some of the worst margins since the beginning of the COVID-19 pandemic,” Kaufman Hall wrote in its latest industry report. * * *
What’s more, seven straight months of negative margins “reversed any gains hospitals saw this year” and has the advisory group forecasting a brutal year for the industry.
“July was a disappointing month for hospitals and put 2022 on pace to be the worst financial year hospitals have experienced in a long time,” Erik Swanson, senior vice president of data and analytics with Kaufman Hall, said in a statement. “Over the past few years, hospitals and health systems have been able to offset some financial hardship with federal support, but those funding sources have dried up, and hospitals’ bottom lines remain in the red.” * * *
The silver lining in Kaufman Hall’s report were total expenses that, although up 7.6% from July 2021, saw a modest 0.4% decline since June. Those savings came squarely among supply and drug expenses as total labor costs and labor expense per adjusted discharge still grew 0.8% and 3.5%, respectively, since June. Increases in full-time employees per adjusted occupied bed “possibly” suggest increased hiring, the group wrote in the report.
From the electronic health record interoperability front, Becker’s Health IT informs us
Judy Faulkner, CEO of Epic, discussed the company’s vision to build a nationwide health IT infrastructure last week at the annual Users Group Meeting while dressed as Amelia Earhart, according to The Cap Times.
Ms. Faulkner has a history of dressing as characters and historical figures for her highly anticipated keynote address at the meeting every year, and this year she chose Ms. Earhart, the iconic female pilot, as a nod to the meeting’s theme: A Night at the Museum. She talked about new technologies and expectations for Epic and its data platform, Cosmos. * * *
“We are building a nationwide health IT infrastructure to connect the different parts of healthcare,” Ms. Faulkner told the crowd.
Epic’s largest competitor in the hospital market, Oracle Cerner, is also on a mission to digitally connect the U.S. healthcare system. Larry Ellison, chair, co-founder and chief technology officer of Oracle, revealed in June the company’s plans to build a unified national healthcare database after acquiring Cerner earlier this year for $28.4 billion. His vision of a national healthcare database includes anonymized data from hospitals, clinics and providers to give real-time information about patients’ health as well as public health statistics.
Congress’s State / District work break ends next Monday Labor Day.
From the Omicron and siblings front, Federal News Network tells us that last Friday the U.S. Court of Appeals for the Eleventh Circuit, which is based in Atlanta, issued a ruling on the federal government’s appeal of a district court preliminary injunction of the Biden Administration’s Covid vaccination mandate on federal government contractors.
The three-judge panel’s majority found that a narrower injunction to block the mandate would have been warranted, and that once the case is fully litigated, the plaintiffs are at least “reasonably” likely to win their claim that the president can’t use his authority under procurement law to mandate vaccines for contractors.
But the court found Georgia District Court Judge Stan Baker went too far by applying the injunction nationwide during the case’s earliest stages last December. Instead, the court ruled, the injunction can only apply to the handful of parties who actually sued. * * *
In this case, that means the government is barred from enforcing the mandate against members of the Associated Builders and Contractors (ABC), and state agencies from seven states that were part of the same suit: Georgia, Alabama, Idaho, Kansas, South Carolina, Utah and West Virginia. * * *
The administration completely suspended enforcement of the contractor mandate right after Judge Baker’s decision last December, and hasn’t yet said how it will respond to the new ruling partially lifting his injunction. A spokesman for the Office of Management and Budget did not immediately respond to an inquiry Friday evening.
From the healthcare cost front, Fierce Healthcare informs us
Healthcare price increases during the past year pale in comparison to those seen across the rest of the economy, suggesting that the healthcare sector has so far been spared from the full impact of 2022’s rapid inflation.
Healthcare’s upward price movement has so far been led by hospitals and nursing homes as opposed to other medical care spend, per an analysis of Bureau of Labor Statistics data released Wednesday.
Policy analysts affiliated with the Kaiser Family Foundation and the Peterson Center on Healthcare wrote that those quicker increases are likely a reflection of staff shortages and rising average wages and are likely to continue “unless hospitals can find ways to operate with fewer staff.”
With health prices often set in advance by the Centers for Medicare & Medicaid Services or private insurance contracting, however, the analysts wrote that “the relatively high rate of inflation seen in the rest of the economy may eventually translate to higher prices for medical care. This may lead to steeper premium increases in the coming years.”
In post-Dobb’s news, the Department of Health and Human Services brings us up to date on the steps that the Biden Administration has taken to protect access to abortion services. Most recently,
Secretary Xavier Becerra and Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure issued a letter to U.S. governors inviting them to work with CMS and apply for Medicaid 1115 waivers to provide increased access to care for women from states where reproductive rights are under attack and women may be denied medical care. The letter also underscored that current or proposed abortion restriction laws do not negate providers’ responsibilities to comply with federal laws protecting access to emergency health care. Also today, HHS issued a report and plan of action in response to the Dobbs v. Jackson Women’s Health Organization Supreme Court decision.
From the mental healthcare front, NPR brings us inside the operations of 988 call centers in Pennsylvania.
The 2020 law enacting the 988 number also allows states to pass legislation to add a small fee to cell phone bills as a permanent source of funds for 988 and associated mental health services. So far, only four states have done so, and only two more have proposed legislation.
Pennsylvania is not one of those states, and doesn’t have any other funding plan implemented. That worries Kevin Boozel, who heads the County Commissioners Association of Pennsylvania.
“This is life or death,” Boozel says. “And you can’t halfway do it.”
He pointed out that Pennsylvania has decided to hold back on publicizing the new 988 number until next year. The fear is that too many calls could flood the system, and counties need more time to set up funding, hire workers and build capacity for things like those mobile crisis teams.
Challenges aside, In Centre County, Herr McCann emphasizes that calling the hotline works. In most cases, just talking with someone is enough to defuse a crisis.
“When they have someone who is empathetic and who listens, that connection helps them,” she said. That lets people know that “it isn’t hopeless. There is hope out there. There is help out there.”
From the health benefit plan design front, Fierce Healthcare reports
Bicycle Health, a virtual provider for opioid use disorder treatment, has announced it is now part of Cigna Evernorth’s behavioral health network.
The startup’s services will now be available to all Evernorth and Cigna health plan customers in the 24 states where Bicycle Health operates. The potential reach is millions of patients, the company told Fierce Healthcare without disclosing additional details.
More than 200 post offices and other U.S. Postal Service facilities are set to shed some of their operations as soon as this year as the mailing agency seeks to consolidate those functions at larger buildings, according to documents shared by management.
The changes will mean letter carriers no longer go to their local facility to pick up mail for their route, instead traveling farther distances after starting at a consolidated location. The impacted post offices will still conduct their retail operations, but many of the back-end functions will be stripped away and relocated. They are connected to an initial 10 buildings that USPS previously announced it was standing up in previously closed facilities, as well as an additional 11 centers.
Most post offices around the country operate as delivery units, meaning mail carriers go to them to pick up mail and packages for their routes before bringing them to homes and businesses. Postmaster General Louis DeJoy has repeatedly decried this model, saying it is inefficient and can lead to as many as dozens of such units in one metropolitan area. Instead, he is looking to open “sorting and delivery centers” around the country, as well as larger mega-centers, that can take on more work in less space. Letter carriers will have to travel farther to take mail to its final destination, but DeJoy said it will save costs on the contracted trucks that USPS hires to bring mail between various facilities.
The impactedsites are located in Georgia, New York, Texas, Florida, Michigan, Pennsylvania, Ohio, Kansas, Maryland, Massachusetts, West Virginia, Kentucky, Washington, North Carolina, Indiana and Arkansas. The initial consolidations are expected to begin as soon as next month.
Based on the Centers for Disease Control’s Covid Data Tracker and using Thursday as the first day of the week, here is the FEHBlog’s latest weekly chart of new Covid cases for this year.
On the left side of the chart are the peak and downslope of the original Omincron strain, and what a peak it was. On the right side of the chart is the Omicron sibling’s plateau.
The CDC’s weekly review of its Covid statistics adds
As of August 24, 2022, the current 7-day moving average of daily new cases (90,676) decreased 6.7% compared with the previous 7-day moving average (97,184). * * *
CDC Nowcast projections* for the week ending August 27, 2022, estimate that the combined national proportion of lineages designated as Omicron will continue to be 100% with the predominant Omicron lineage being BA.5, projected at 88.7% (95% PI 87.3-89.8%).
Here’s the CDC’s latest chart of daily trends in new Covid hospitalizations:
The CDC’s weekly review adds “The current 7-day daily average for August 17–23, 2022, was 5,314. This is a 6.6% decrease from the prior 7-day average (5,687) from August 10–16, 2022.” That converts to a very low percentage of new Covid cases.
Here is the FEHBlog latest weekly chart of new Covid deaths for 2022:
Omicron is on the left, and Omicron’s siblings are on the right. The CDC’s weekly review adds “The current 7-day moving average of new deaths (390) has decreased 11.6% compared with the previous 7-day moving average (441).”
Contributing to the current low Covid death rate are the Covid vaccines, and here is the FEHBlog’s weekly chart of Covid vaccinations distributed and administered from the beginning of the Covid vaccination era in the 51st week of 2020 through the 34th week of 2022:
As of August 24, 2022, 608.9 million vaccine doses have been administered in the United States. Overall, about 262.6 million people, or 79.1% of the total U.S. population, have received at least one dose of vaccine. About 223.9 million people, or 67.4% of the total U.S. population, have been fully vaccinated.
In other Covid news
Medscape reports “Long COVID Mimics Other Post-Viral Conditions.” That’s reassuring.
Medscape also tells us that a major weak spot on the Omicron variants which could lead to effective treatments.
It’s the stuff that headline writers’ dreams are made of: Moderna is suing Pfizer and BioNTech over their Covid vaccines.
As someone who has written dozens of catchy headlines about patent suits and read hundreds more, let me offer a bit of advice: Take several deep breaths. Most likely, this is less dramatic than it seems.
The reality of patent litigation in the pharmaceutical industry is that it proceeds at a glacial pace. And it rarely results in products being pulled from the market (Moderna isn’t even asking for that!) or for payments or royalties so significant that they dramatically change the profitability of a product. These lawsuits, though, can involve sums large enough that they make a financial difference to investors.
Time will tell.
From the monkeypox front, the New York Times reports
Monkeypox cases are declining in New York City and globally as more people get vaccinated and as they change their sexual behavior in response to the outbreak, health officials said this week.
New York City on Thursday reported that 2,885 monkeypox cases had been identified in the city since the first case in the city was identified in May. In mid-August, about 50 new monkeypox cases were being detected each day, a drop from the 70 or so new daily cases emerging in late July and early August, according to city data. * * *
Monkeypox infections are also declining in parts of California and in Europe, which at one point had 90 percent of the world’s cases. The World Health Organization on Thursday reported that monkeypox cases globally dropped 21 percent last week. But the overall trend masked rising cases in other parts of the world, including Latin America and Africa.
In New York, Dr. Vasan attributed the decline to the city’s efforts to get tens of thousands of people vaccinated; the city has administered 69,311 doses of the vaccine, according to city data.
More than 28 million people are in a Medicare Advantage (MA) plan in 2022, with the program accounting for nearly half of all Medicare beneficiaries, a new analysis finds.
The analysis, released Thursday by the Kaiser Family Foundation, also showed how spending on MA, especially on quality bonuses, has surged to take up more than half of all federal Medicare spending. The findings underscore the widespread interest in the insurance industry on the MA marketplace, which has grown more lucrative in recent years.
Kaiser found that the share of eligible Medicare beneficiaries who chose an MA plan has more than doubled since 2007, growing from 19% that year to 48% in 2022. An earlier projection from the Congressional Budget Office projected that the percentage of Medicare beneficiaries in MA will swell to 61% by 2032.
From the substance use disorder front, Health IT Analytics reports
A new study by Epic Research and the University of Maryland’s Center for Substance Abuse Research (CESAR) shows that only 5 percent of drug overdose patients admitted to the emergency department are tested for fentanyl and synthetic opioids, despite these drugs being the leading cause of death for Americans 18 to 45 years.
The Centers for Disease Control and Prevention (CDC) report that synthetic opioids are currently the main driver of drug overdose deaths, which increased by 31 percent from 2019 to 2020. Opioids were involved in 75 percent of all drug overdose deaths in 2020, and 82.3 percent of all opioid overdose deaths involved synthetic opioids.
That is confounding.
From the coding front, Becker’s Hospital CFO Review points out the top 10 states with the highest coding rates for social determinants of health diagnoses. The FEHBlog suspects that these states have the most reliable coders.
From the omicron and siblings front, MedPage Today provides us with good news.
Older patients treated with nirmatrelvir boosted by ritonavir (Paxlovid) for COVID-19 had lower rates of hospitalization and death compared with those not treated with the antiviral during the Omicron wave, according to an observational retrospective cohort study from Israel.
Among patients ages 65 and older, the rate of hospitalization due to COVID was 14.7 cases per 100,000 person-days for the 2,484 patients who received nirmatrelvir compared with 58.9 cases per 100,000 person-days for the 40,337 untreated patients (adjusted HR 0.27, 95% CI 0.15-0.49), reported Ronen Arbel, PhD, of Clalit Health Services in Tel Aviv, and colleagues.
Death occurred in two nirmatrelvir-treated patients and in 158 untreated patients (aHR 0.21, 95% CI 0.05-0.82), they said in the New England Journal of Medicine.
Herd safety, indeed.
From the Rx research and development front, NBC News reports
Two doses of psilocybin pills, along with psychotherapy, helped people with alcohol use disorder reduce drinking for at least eight months after their first treatments, results from the largest clinical trial of its kind show.
During the eight-month trial, 93 men and women ages 25 to 65 were chosen to receive either two psilocybin doses or antihistamine pills, which the researchers used as a placebo. They all also participated in 12 psychotherapy sessions.
All of the volunteers were averaging seven alcoholic drinks at a time before the trial.
More than 80% of those who were given the psychedelic treatment had drastically reduced their drinking eight months after the study started, compared to just over 50% in the antihistamine control group, according to results published Wednesday in JAMA Psychiatry. At the end of the trial, half of those who received psilocybin had quit drinking altogether, compared to about one-quarter of those who were given the antihistamine.
A vaccine Pfizer is developing protected older adults against the respiratory syncytial virus, or RSV, which is a common cause of hospitalization and death in the U.S., the company said Thursday.
The experimental vaccine, known as RSVpreF, is considered a key product in Pfizer’s pipeline of experimental drugs. Right now drug companies are close to launching several different products against RSV, focused on protecting both older adults and infants.
BioMarin, a California-based biotechnology company, said Wednesday that its gene therapy for hemophilia has been cleared for market by European regulators, marking a first-of-its-kind approval.
The therapy, known as Roctavian, was given conditional marketing authorization as a treatment for certain patients with hemophilia A, the more common version of the rare bleeding disorder. Specifically, Roctavian is to be used in adults with “severe” disease — hallmarked by exceedingly low levels of a blood-clotting protein called Factor VIII — who don’t have a history of developing antibodies that attack this protein.
With approval in hand, BioMarin is now working to secure reimbursement across the European Commission’s various member states. Jeff Ajer, the company’s chief commercial officer, said on a conference call Thursday that the plan is to immediately launch Roctavian in Germany, followed by France. The company expects Roctavian’s list price in Europe to be “around” 1.5 million euros, or roughly $1.5 million, net of all discounts, he said.
Ajer added that BioMarin expects to disclose the specific European list price in October, a number that will be in-line but lower than the comparable net price in the U.S.
Employers view long-term mental health as the key healthcare issue coming out of COVID-19, according to a new survey.
Nearly half (44%) of employers surveyed by the Business Group on Health said they have seen this trend in their workforces, and another 44% expect to see worsening mental health in the future. Most (85%) said they anticipate enhanced mental health benefits launched under the pandemic to continue.
Mental health conditions also ranked sixth on the survey’s list of conditions driving healthcare costs, with 17% of those surveyed saying it was a major driver. This is a marked increase from 9% in 2020 and 14% in 2021.
Brenna Shebel, vice president of the Business Group on Health, said during a briefing with reports Tuesday that many employers are tackling mental health challenges “at all different angles.”
AHIP, which stands for America’s Health Insurance Plans, issued a statement and “advocacy vision” at a time its member health plans are looking beyond paying and coordinating just medical care but also integrating behavioral health care into benefit plans for their government, commercial and employer clients. * * * Further details of the policy proposals and commitments can be found here.
From the U.S. healthcare business front, we learn about financial results for two health systems involved with the FEHB Program.
Becker’s Hospital Review reports that ” Intermountain Healthcare [based in Utah and serves surrounding states] saw its revenues increase in the first half of this year, and its merger with SCL Health fueled a significant increase in net income, according to recently released financial documents. The financial documents are the first Intermountain has filed since completing a merger with Broomfield, Colo.-based SCL Health in April.
Beckers Hospital CFO Report tells us, “UPMC reported higher revenue in the first half of this year than in the same period of 2021, but the Pittsburgh-based health system’s operating income declined year over year, according to financial documents released Aug. 23. * * * “Throughout 2022, the continued effect of COVID-19, along with conditions in the labor and supply markets have resulted in cost growth in employment, staffing and other operating expenses in excess of revenue growth,” UPMC management wrote in the financial filing.”
Finally STAT News delves into why so many large healthcare companies are interested in Signify Health. Quite simply,
The bidding war over Signify Health — a health technology business that could fetch multibillion-dollar offers from Amazon, CVS, and UnitedHealth Group — is not about its dazzling software or a blockbuster AI algorithm.
The crush of corporate interest, experts said, stems from something much bigger: the opportunity to move medical services back into the home. In-home care is quickly becoming the biggest battlefield in America’s biggest business, with a huge array of companies seeking to move health care outside the institutional walls that have confined it for much of the last century.
Signify Health is among those at the forefront of the quest. The Texas-based company, founded in 2017 as the result of a merger, has built its business around delivering highly detailed assessments of patients by visiting with them in their bedrooms and living rooms, creating better visibility — and clearer data — about their lives and health status.
Pfizer and BioNTech said Monday that they have asked the Food and Drug Administration to authorize a new booster shot targeted at the Omicron BA.4/BA.5 strain of the coronavirus that causes Covid-19, the first step in a process that could lead to more effective booster shots.
Notably, in the same press release, the companies said that a clinical study investigating the safety, tolerability, and immunogenicity of the vaccine, which also includes the original Covid strain, is expected to start this month, meaning data would not be available for the FDA to consider.
The application to authorize the vaccine without new clinical trial data is part of a bold and potentially controversial gambit by the U.S. and its advisers to try and get ahead of the fast-mutating coronavirus, SARS-CoV-2. But it’s one that could also have a big payoff.
Officials with the FDA have granted an expanded Emergency Use Authorization (EUA) to Novavax for its COVID-19 vaccine, adjuvanted for adolescents 12 through 17 years of age, according to a press release. The announcement marks the first protein-based COVID-19 vaccine authorized in the United States for this patient population.
The expanded EUA allows for a 2-dose primary series for active immunization to prevent COVID-19 caused by SARS-CoV-2 in adolescents. Doses are now available and primary series immunizations for adolescents can begin once the CDC releases a policy recommendation.
Will the next Novovax approval from the FDA be for a booster?
Medpage Today points to a study suggesting a connection between myocarditis in children and long Covid.
Officials in New York are urging pediatricians and parents to bring patients up to date on polio shots, as evidence suggests the infectious and potentially debilitating poliovirus was present in the state as early as April.
Health officials said they have sent alerts to healthcare providers, hung fliers in houses of worship, grocery stores and summer camps, and talked with community leaders to boost polio vaccination rates in the greater New York City area. Some places including Rockland and Orange counties have polio vaccination rates around 60% among eligible children, compared with a national rate of around 93%, according to federal data.
Polio is particularly insidious, health officials and other public-health experts said, because the majority of cases occur in people who never develop symptoms but can still spread the virus. That silent spread can cause meningitis or paralysis in someone unvaccinated against the disease.
Anthony Fauci, the top U.S. infectious diseases official for decades and a leading researcher on crises from HIV to Covid-19, announced Monday that he would be stepping down from his positions in December.
Fauci, 81, has led the National Institute of Allergy and Infectious Diseases for 38 years, serving a line of presidents from both parties since the Reagan administration. He has also served as President Biden’s chief medical adviser since Biden took office. While Fauci has telegraphed that he was planning on leaving those roles in a matter of months, Monday’s announcement makes it official.
But Fauci, known as a tireless workhorse, said he would not be retiring. “After more than 50 years of government service, I plan to pursue the next phase of my career while I still have so much energy and passion for my field,” he said. “I want to use what I have learned as NIAID Director to continue to advance science and public health and to inspire and mentor the next generation of scientific leaders as they help prepare the world to face future infectious disease threats.”
From the U.S. healthcare business front, Bloomberg reports
UnitedHealth has submitted the highest bid in excess of $30 a share, while Amazon’s offer is close behind, the people said, asking not to be identified as the discussions are private. Signify is holding a board meeting Monday to discuss the bids, the people said. * * *
Final bids are expected Sept. 6, but a deal could come earlier if any of the parties preempt the sales process, the people said. * * *
Through its software and services, Signify aims to help clients — payers like health plans, government programs and employers — shift to value-based payment plans. It’s backed by private equity firm New Mountain Capital, which formed the company in 2017, according to the firm’s website.
That is quite a big business rumble.
From the No Surprises Act front, Prof. Katie Keith and her colleagues wrote two articles on last Friday’s “final, final” independent dispute resolution rule — one concerns its impact on IDR arbitrations and the other on miscellaneous topics.
From the mental healthcare front, Health Payer Intelligence lets us know that “Payers are working toward achieving broader access to mental healthcare and behavioral healthcare services by reimbursing at higher rates and supporting primary care” according to a recent AHIP survey.
Nearly eight in ten health plans had boosted behavioral healthcare workers’ reimbursement rates (78 percent). Additionally, 83 percent of payers had attracted and retained a diverse population of behavioral healthcare providers.
Substance abuse care is becoming more accessible, the survey found. Specifically, more providers have become eligible to offer medication-assisted therapy (MAT). This population has expended 114 percent over the course of three years.
Nearly three-quarters of health plans (72 percent) support behavioral healthcare training for primary care providers. The same share supported primary care providers by helping them find behavioral healthcare specialist referral partners.
Payers have also offered primary care providers the opportunity to call behavioral healthcare specialists via telehealth or telephone in order to consult them on a patient’s condition. More than half of the health plans (56 percent) provide this option. This method has been used in pediatric psychiatry to solve members’ challenges in connecting with specialists.
Health plans reported a couple of main ways that they try to connect members with mental healthcare services. Many plans do this by supporting patient navigation (83 percent). For example, health plans might connect members with community-based organizations that can address their social determinants of health needs.
Additionally, more than eight in ten health plans said they help members secure behavioral healthcare visits. Follow-up on inpatient care and emergency room visits is often part of health plans’ efforts to connect members with mental health services as well. Seventy-eight percent of the plans leveraged specialized case managers to perform this function.
Gilead’s long-acting HIV shot Sunlenca is now cleared for sale in Europe, marking the first marketing authorization for a treatment the California biotechnology company hopes can be used broadly as a standard therapy and preventive regimen.
The decision by the European Commission, announced Monday, authorizes Sunlenca for patients whose current treatment regimen can no longer keep their infection at bay. Sunlenca, previously called lenacapavir, will be added to other antiviral drugs to boost patients’ immune response and reduce levels of virus in the body.
Gilead is still waiting on a regulatory decision in the U.S., where it has been delayed by manufacturing issues. An approval by the Food and Drug Administration’s December deadline could put the drug on track to reach sales that RBC Capital Markets analysts estimate will climb as high as $4 billion a year.
Zapping the brain with weak electrical currents that mimic normal neural activity can boost memory in healthy older adults, at least over the short term, researchers said in a study published Monday in the journal Nature Neuroscience.
Electrical stimulation of the brain as a potential tool for enhancing memory is a growing field of research, with experiments showing that the ability to recall memories depends upon synchronized activity between different brain regions.
The new research, conducted on people over age 65, “adds to the growing evidence that noninvasive stimulation mimicking the rhythmic brain activity that supports cognition can improve memory” in this population, said Joel Voss, a University of Chicago professor of neurology who wasn’t involved in the research.
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