Friday Stats and More

Friday Stats and More

Based on the Centers for Disease Control’s COVID-19 Data Tracker website, here is the FEHBlog’s chart of new weekly COVID-19 cases and deaths over the 14th week of 2020 through 18th week of this year (beginning April 2, 2020, and ending May 5, 2021; using Thursday as the first day of the week in order to facilitate this weekly update):

and here is the CDC’s latest overall weekly hospitalization rate chart for COVID-19:

The FEHBlog has noticed that the new cases and deaths chart shows a flat line for new weekly deaths  because new cases greatly exceed new deaths. Accordingly here is a chart of new COVID-19 deaths over the period (April 2, 2020, through May 5, 2021):

The Wall Street Journal observes and the charts evidence that

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

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

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

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

The Centers for Disease Control observes

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

Also from the COVID-19 vaccination front:

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

From the healthcare business front

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

In other news —

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

Midweek Update

Photo by Thought Catalog on Unsplash

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

Reg Jones provide FEHB background for federal employees in Fedweek.

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

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

In other healthcare news

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

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

Tuesday’s Tidbits

Photo by Patrick Fore on Unsplash

The Wall Street Journal reports

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

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

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

Healthcare Dive reports

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

In related CVS news —

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

In other healthcare business news

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

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

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

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

Here are some additional healthcare tidbits —

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

Last but not least here are some federal employment tidbits —

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

Monday Roundup

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

From the COVID-19 front:

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

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

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

  •  The Wall Street Journal informs us

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

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

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

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

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

In healthcare business news, the Wall Street Journal reports that

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

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

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

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

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

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

Thursday Miscellany

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Today the U.S. Office of Personnel Management released guidance to federal agencies on American Rescue Plan Act “provisions authorizing emergency paid leave (EPL) for covered Federal employees in specified qualifying circumstances through special funds.” The Federal News Network offers information on how federal employees can apply for EPL.

From the COVID-19 front, the Wall Street Journal reports that Astra-Zeneca now expects to file an emergency use application for its COVID-19 vaccine with the Food and Drug Administration in the middle of next month.

“One especially time-consuming task has been compiling British data from almost four months of vaccinations in the U.K., including efficacy, virus-transmission and safety statistics, people close to the process say. That has added to the complexity of AstraZeneca’s submission and is expected to lengthen any FDA review. Other shots that the FDA has authorized had large-scale human trial data but little or none from real-world rollouts outside of controlled studies.”

No good deed, etc.

From the patients safety front, the Leapfrog Group released its Spring 2021 hospital safety grades yesterday. The two hospitals closest in proximity to the FEHBlog’s residence are graded A and B. Beckers Hospital Review helpfully points out the 27 hospitals with straight A scores and F scores. Meanwhile, Healthcare Finance reports that

The Centers for Medicare and Medicaid Services on Wednesday released the overall hospital quality star ratings that now include new methodology in five measure groups.

CMS rated over 4,500 hospitals from one to five stars, with five representing the highest quality rating.

Of 4,586 hospitals, 13.5%, or 455 hospitals, received five stars; 988 received four stars; 1,018 received three stars; 690 received two stars; and 204 received one star.

For more than a quarter of hospitals, 1,181, no information was available.

This compares to January 2020 data, when of the 5,340 hospitals listed, 396 received five stars; 1,132 received four stars; 1,108 got three stars; 710 received two stars; and 226 got one star. Another 1,761 had no rating information available.

Furthermore, the Centers for Disease Control released a new study setting a “Baseline to Measure Quality of Antibiotic Prescribing in U.S. Hospitals.”

Since 2015, when the prescribing data were collected, CDC has been working diligently with partners like the American Hospital Association and others to implement stewardship efforts and programs in acute care.

CDC will continue building on this progress and important work in the coming years as a part of the newly released Combating Antibiotic-Resistant Bacteria National Action Plan. Good luck with that effort.

In healthcare business news:

  • Healthcare Dive informs us that ” Virtual care powerhouse Teladoc reported a wider-than-expected net loss in the first quarter, but beat Wall Street estimates on revenue with a topline of $454 million, up 151% year over year, driven by growth in specialty offerings and multi-product contracts. * * * CEO Jason Gorevic contended he is unworried about mounting competition in the lucrative telehealth space, banking the company’s heft and variety of clinical services will fend off entrenched rivals and new entrants like Amazon.”
  • Fierce Healthcare advises “Do not expect the Biden administration to pull away from price transparency even though the administration wants to pull a requirement for hospitals to post Medicare Advantage rates, experts say. The proposal included in a hospital inpatient payment rule released late Tuesday is more aimed at easing administrative burdens for hospitals still struggling due to the pandemic, several experts said. “The repeal of this requirement more falls into the bucket of easing hospitals’ burden as opposed to the agency’s stance on hospital price transparency,” said Caitlin Sheetz, head of analytics and a director for the consulting firm ADVI, in an interview with Fierce Healthcare.
  • Fierce Healthcare also reports that “Anthem has completed its acquisition of home health benefits manager MyNEXUS, the insurer announced Thursday morning. MyNEXUS offers comprehensive home-based nursing management to health insurers, providing integrated clinical services to some 1.7 million Medicare Advantage beneficiaries in 20 states. The company’s platforms largely automate the visit and authorization, which allows members to access care more quickly, according to the announcement. MyNEXUS will be folded into Anthem’s Diversified business group.”

In benefit design news, Health Payer Intelligence offers a thoughtful article describing key considerations for implementing diabetes management programs.

Monday Roundup

Photo by Sven Read on Unsplash

In a move hinted at in yesterday’s Weekend Update, the Office of Personnel Management today released government wide results from the 2020 Federal Employee Viewpoint Survey.

As shown in the 2020 OPM FEVS results, the federal workforce adapted quickly to the challenges presented by the pandemic. Together with their managers and policy makers, employees found creative solutions and leveraged workplace flexibilities – including the widespread adoption of telework — to continue to support their agency’s mission while balancing personal responsibilities. Results demonstrate that federal workers derive great satisfaction and meaning from successfully doing their jobs through even the most disruptive of circumstances.

Medscape reports on a recent Health Affairs reports on last year’s dip in healthcare services stemming from the great hunkering down.

Since last spring, utilization of healthcare services has largely rebounded, and [study coauthor Kevin] Callison [, PhD, assistant professor in the Department of Health Policy and Management at the Tulane School of Public Health and Tropical Medicine] speculated that involuntary delays in care have diminished greatly. He attributed that partly to improved treatment of COVID-19, the restored capacity of many healthcare facilities, and the expiration of orders to delay or cancel elective procedures. Also, he noted, people have become more comfortable with seeing physicians in person, which has partly explained the increase in ambulatory visits. Nevertheless, he added, “we’re not seeing a rebound above pre-pandemic levels to make up for that lost care.”

Healthcare Dive informs us that primary care “practices are financially stabilizing more than a year after the pandemic began. However, primary care practices are facing enormous challenges in the near term, including pent-up demand for medical and mental health services and a growing feeling of exhaustion among physicians.” Also those practice now are playing a much larger role in COVID-19 vaccination administration.

The Primary Care Collaborative surveyed more than 650 primary care physicians, nurse practitioners and pharmacists in 48 states, the District of Columbia and Guam. Altogether, nearly four out of 10 practices are administering the COVID-19 vaccines, “a marked increase” compared to just a few weeks prior, while 47% are partnering with local vaccination administration sites. “Primary care is now beginning to be leveraged to target the vaccine to hard-to-reach populations,” the survey’s authors concluded.

The International Foundation of Employee Benefits Plan discusses its “a webcast on legal considerations for employers regarding employee vaccinations.” Check it out.

Last week the FEHBlog called attention to National Prescription Drug Take Back Day, which was held on April 24. The Drug Enforcement Administration points out today that there are many convenient drug disposal sites open year round in our country.

OPM Director Hearing / End of the Carrier Conference / Thursday Miscellany

The virtual OPM AHIP FEHB Carrier Conference ended today. For a good chunk of the conference, Kiran Ahuja, the President’s nominee for OPM Director contemporaneously had her confirmation hearing before the Senate Homeland and Government Security Committee. Here are the Federal Times, Govexec , and Federal News Network articles on that hearing which reportedly went smoothly for the nominee.

At the carrier conference today, the FEHBlog learned about the many things including the following:

  • The Blue Cross Blue Shield Association has released a strategy to help bring about healthcare equity. “The strategy is centered around improving racial health disparities in maternal health, behavioral health, diabetes, and cardiovascular conditions [by] “measuring racial health disparities, forming community and clinical partnerships, scaling effective programs, and influencing local and federal policy decisions.”
  • The American Pharmacists Association has produced a report on promising practices for pharmacist engagement in tobacco cessation interventions. 
  • OPM now has a list of documentation that enrollees must furnish to the employing office or the FEHB carrier to verify family member eligibility in FEHB.

Thanks OPM and AHIP for a great conference.

In Thursday Miscellany —

  • As promised here is a link to the Internal Revenue Service guidance making “tax credits [available to certain employers] for providing paid leave to employees who take time off related to COVID-19 vaccinations.
  • The AP reports on encouraging “new data reassuring for COVID-19 vaccination in pregnancy.”
  • The Secretary of Health and Human Services has extended the COVID-19 public health emergency for another 90 days from yesterday.
  • The American Hospital Association is touting Hospital-at-Home Innovation During COVID-19 and Beyond. “What was once a small but mighty contingent of health care systems providing “hospital-at-home” care before the pandemic has grown into a larger movement. With this model, hospitals across the country are “admitting” patients to their own homes for acute care with excellent results. As highlighted in AHA’s recent issue brief on hospital-at-home, patients receiving this care have a 20% reduction in mortality, were three times less likely to be admitted to an emergency department than usual care patients and have higher satisfaction with their care. And these results are achieved at a 25% lower cost of care.”
  • Fierce Healthcare reports that [Blue Cross licensee] Highmark Health and ChristianaCare are launching a new joint venture that aims to harness data to accelerate value-based, equitable care. The joint company, which has yet to be named, will take advantage of the strengths of both companies to drive toward more accessible and affordable care. Karen Hanlon, chief operating officer at Highmark Health, said on a call with reporters Wednesday that the venture aims to disrupt the traditional dynamic between payers and providers for greater collaboration.” Here’s hoping.
  • AHIMA reports that the ICD-10 coding authorities are considering releasing new codes for October 1, 2021 (as usual) and April 1, 2022 (special supplement.)

Midweek update

Today was the second day of the OPM AHIP FEHB Carrier Conference. One of the sessions concerned COVID-19 vaccination outreach to socially disadvantaged communities. The FEHBlog learned that Kaiser Permanente, which is the third largest FEHB plan carrier, has released a COVID-19 vaccination equity tookit and that Geisinger, a Pennsylanvia based FEHB plan carrier, has produced a Neighborly website chock full of community resources. A speaker referenced this New York Times article on the following topic: “Half of American adults have received at least one shot of the coronavirus vaccine. Now comes the hard part: persuading the other half to get it.”

In COVID-19 vaccine news from outside the carrier conference

  • The Society for Human Resource Management reports that “To encourage more widespread vaccinations, President Joe Biden has announced a paid leave tax credit to employers that provide full pay for any employee who takes time off to get a COVID-19 vaccination. The tax credit is available to organizations with fewer than 500 employees, and it also provides full pay for employees who take time to recover from the vaccination. The credit covers up to $511 per day for each vaccinated employee, and is funded by the American Rescue Plan.” The FEHBlog will post the implementing IRS notice tomorrow.
  • Fierce Pharma reports that “AstraZeneca is still planning to apply for emergency use authorization of its shot in the U.S., a company spokesman confirmed. * * * If going down that road yields an endorsement from the U.S., it could help boost the damaged reputation of the shot. Much of the world, especially poorer nations, are in dire need of vaccines and global demand is expected to extend into the next few years at least. In addition, the shot has a key advantage over its mRNA rivals––its lower price, which makes it particularly attractive to developing nations.”
  • Govexec reports that “State Department Spokesperson Ned Price said on Tuesday that the department had delivered vaccines to all of its posts abroad, as of Sunday.“ and “The Defense Department said on Tuesday it expects to start receiving 390,000 vaccine doses weekly, which is up from an average of 155,500 per week. “[Eighty-three] percent of vaccines received by the Defense Department have been administered, exceeding the U.S. average of 78%, and more than 28% of our total force is now vaccinated,” Pentagon Press Secretary John Kirby said during a briefing on Monday. 

There was a lot of carrier conference discussion about expensive yet curative cell and gene therapies. The FEHBlog ran across this recent MIT report on that topic.

Also the FEHBlog was overjoyed to hear from an OPM speaker that with any luck laterthis decade OPM will begin providing carriers with HIPAA 820 standard transactions that will allow them to reconcile premiums to headcount. The FEHBlog has been advocating this logical step for quite a while.

In other healthcare news —

  • Healthcare Dive informs us about Elizabeth Fowler’s first public address since taking the reins of the CMS Center for Medicare and Medicaid Innovation earlier this year. “‘In my view, we’re at a really critical juncture in the path to value-based care,’ Fowler said at the National Association of Accountable Care Organizations’ spring conference on Tuesday, asking stakeholders for patience as CMMI reviews paused models and outlines a path forward.”
  • Saturday is the Drug Enforcement Administration’s spring edition of National Prescription Drug Take Back Day. “National Prescription Drug Take Back Day is a safe, convenient, and responsible way to dispose of unused or expired prescription drugs at locations in communities throughout the country. The October 2020 Take Back Day brought in 985,392 pounds (492.7 tons) of medication. This is the largest amount ever collected in the program’s ten years!” You can find your nearest collection site here.

Tuesday Tidbits

Photo by Patrick Fore on Unsplash

Fedweek reports that

A Senate [Homeland Security and Governmental Affairs] Committee hearing is set for Thursday April 22 [at 10:15 am] on Kiran Ahuja’s nomination to become OPM director, potentially setting the stage for her confirmation in the near future.

No opposition has emerged to Ahuja, who was OPM’s chief of staff for part of the Obama administration and who most recently led the Biden transition team for the agency. She also has experience as a Justice Department attorney and with the White House Initiative on Asian Americans and Pacific Islanders under Obama, among other roles.

The FEHB Carrier Conference’s keynote speaker today was Dr. Garth Graham who spoke on social determinants of health issues. Dr. Graham who is Director and Global Head of Healthcare and Public Health at Google/YouTube published a 2018 study finding that

In this cohort study of 6402 patients from 2 acute myocardial infarction registries, self-identified black patients and white patients differed in several clinical and socioeconomic characteristics. The higher the prevalence of characteristics associated with being a black patient, the higher the 5-year mortality rate, but no differences were observed between black patients and white patients with similar characteristics.

These findings illustrate social determinants of health concerns in a nutshell. MedCity News discusses how healthcare providers and payers are addressing these concerns.

Another speaker Dr. Mark Fendrick from the University of Michigan discussed value based insurance design which focuses on paying more for high value care by identifying and excluding low value care.

The alignment of clinically nuanced, provider- facing and consumer engagement initiatives is a necessary and critical step to improve quality of care, enhance patient experience, and contain cost growth.

That’s easier said than done, but you have to start somewhere as OPM points out in its 2022 call letter.

In COVID-19 tidbits

  • ABC News reports that as of yesterday, “All adults in the United States are eligible for COVID-19 vaccines starting Monday, with all 50 states and Washington, D.C., meeting the April 19 deadline President Joe Biden had set for opening eligibility.” The minimum age for the Pfizer vaccine is 16 years old. The minimum age for the Moderna and currently paused Johnson and Johnson vaccine is 18 years old.
  • STAT News informs us about the “many key questions about SARS-2 and the disease it causes, Covid-19, [that] continue to bedevil scientists.” “There was surprising diversity in the questions, though many cluster around certain themes, such as the nature of immunity or the impact of viral variants. Knowing what scientists still want to learn shows us how far we’ve come — and how far we have left to go to solve the mysteries of SARS-2 and Covid-19.”

In telehealth tidbits:

  • More news comes out of last week’s United Healthcare first quarter 2021 earnings report. Becker’s Hospital News reports that “UnitedHealth Group subsidiary Optum has deployed a new telehealth product across all 50 states, company leaders said April 15. The new virtual care product, dubbed Optum Virtual Care, is now live in all 50 states, said OptumHealth CEO Wyatt Decker during UnitedHealth Group’s Q1 2021 earnings call transcript, which was transcribed by the Motley Fool. With the new offering, Optum aims to integrate physical care, virtual care, home care and behavioral care. Optum Virtual Care offers virtual health services but also, if necessary, can connect patients to a bricks-and-mortar facility for more complex care or identifying and triaging both physical and behavioral healthcare needs, Mr. Decker said.
  • Fierce Healthcare reports that “Cigna’s Evernorth has completed its acquisition of virtual care provider MDLive. Cigna first announced the deal in late February, with the expectation it would close in the second quarter. The deal, the insurer said, will enhance the Evernorth subsidiary’s efforts to lower healthcare costs.
  • The upshot of the FEHB Carrier Conference’s discussion of telehealth today was that health plan payments for virtual care should reflect the quality and efficacy of care relative to in-person care. For example, the Insurance Journal reports that

Published in the April issue of Health Affairs, the [University of Michigan] study finds that patients who had an on-demand virtual care visit for an upper respiratory infection in the three years before the pandemic began were slightly more likely to receive additional follow-up care than similar patients who had their first visit in person.

The study compared data from more than 28,700 virtual visits with data from more than 57,400 in-person visits for acute respiratory infections in 2016 through 2019. Those visits, and any follow-up care, were all covered by a large insurer. All the virtual visits were done through a direct-to-consumer telehealth company with which the insurer had partnered.

The authors say it’s important to note that the vast majority of the patients did not require any further care for their infections, which included ear infections, bronchitis, laryngitis, sore throat and pneumonia.

But 10.3% of the patients first seen through a direct-to-consumer telehealth visit ended up having an in-person visit in the next week, compared with 5.9% of those who had their first visit in person. This includes second telemedicine visits or visits to clinics, urgent care centers and emergency rooms.

In other tidbits, Healthcare Dive discusses what to watch as public traded providers and payers report their first quarter 2021 results and CVS Health announced a new joint CVS Health / Aetna benefit design.

Monday Roundup

Photo by Sven Read on Unsplash

Mondays have tended to be good news days for COVID-19 vaccines. As of today, over 50% of Americans over age 18 have received at least one dose of a COVID-19 vaccine.

Fierce Healthcare reports that

“CVS Pharmacy has begun stocking its virtual and in-store shelves nationwide with rapid tests for COVID-19—which can be purchased without a prescription and used by anyone regardless of whether or not they are showing symptoms—including three FDA-authorized diagnostics and sample collection kits produced by LabCorp, Ellume and Abbott.”

“Even as vaccines become more widely available, COVID-19 testing remains a critical tool to keep our communities safe,” Walgreens President John Standley said in a statement. Walgreens currently offers on-site testing at more than 5,500 of its pharmacies and plans to expand to 6,000 drive-thru sites by May, using Abbott’s ID NOW portable testing machines.

In addition, earlier this month CVS began offering COVID-19 antibody testing for $38 at 1,100 in-house clinics, using fingerstick blood samples to determine previous infections.

The U.S. Office of Personnel Management announced today that the agency

will allow [FSAFEDS] flexibilities permitted under the Consolidated Appropriations Act 2021 and the American Rescue Plan Act including allowing full carryover for a health care flexible spending account (HCFSA) and Limited Expense FSA (LEX FSA); extending the grace period for a dependent care flexible spending account (DCFSA); and permitting care for dependents through age 14 for 2020 and 2021 under a DCFSA. In addition, OPM is working with our FSAFEDS contractor, Health Equity, to offer a Special Enrollment/Election Period (SEP) in the near future.  This SEP will allow participants to increase or decrease their current elections for their DCFSA and/or their HCFSA.  In addition, the SEP will allow those who did not re-enroll for 2021 during Open Season in the Fall, the opportunity to enroll in a DCFSA and/or HCFSA for 2021.  Finally, OPM will allow DCFSA participants to increase their election during the Special Election Period to the new IRS maximum of $10,500 for 2021. 

All good news.

What’s more, the Wall Street Journal reported in its Saturday essay about the U.S. airline safety revolution.

Over the past 12 years, U.S. airlines have accomplished an astonishing feat: carrying more than eight billion passengers without a fatal crash.

Such numbers were once unimaginable, even among the most optimistic safety experts. But now, pilots for domestic carriers can expect to go through an entire career without experiencing a single engine malfunction or failure. Official statistics show that in recent years, the riskiest part of any airline trip in the U.S. is when aircraft wheels are on the ground, on runways or taxiways.

The achievements stem from a sweeping safety reassessment—a virtual revolution in thinking—sparked by a small band of senior federal regulators, top industry executives and pilots-union leaders after a series of high-profile fatal crashes in the mid-1990s. To combat common industry hazards, they teamed up to launch voluntary incident reporting programs with carriers sharing data and no punishment for airlines or aviators when mistakes were uncovered.

One wonders whether this successful strategy may be transferable to other pressing safety issues, such as patient safety. In this regard, a friend of the FEHBlog suggested check this Washington Post opinion piece written by a group of psychologists titled “We instinctively add on new features and fixes. Why don’t we subtract instead?
‘Less is more’ is a hard insight to act on, it turns out.” How true.

In other healthcare news —

  • The Kaiser Family Foundation informs us that

a relatively small number and share of drugs accounted for a disproportionate share of Medicare Part B and Part D prescription drug spending in 2019 (Figure 1).

— The 250 top-selling drugs in Medicare Part D with one manufacturer and no generic or biosimilar competition (7% of all Part D covered drugs) accounted for 60% of net total Part D spending.

— The top 50 drugs covered under Medicare Part B (8.5% of all Part B covered drugs) accounted for 80% of total Part B drug spending.

Some recent proposals to lower prescription drug prices have limited the number of drugs subject to price negotiation and international reference pricing. This analysis shows that Medicare Part D and Part B spending is highly concentrated among a relatively small share of covered drugs, mainly those without generic or biosimilar competitors. Focusing drug price negotiation or reference pricing on a subset of drugs that account for a disproportionate share of spending would be an efficient use of administrative resources . . . .

  • Employee Benefits News tells us

New research from Voya shows employees have a bias against HDHPs and the reason for that is as simple as marketing.

“One of the really interesting findings that we saw from the research about why there is that bias comes down to branding, pure and simple,” says Nate Black, vice president of consumer driven health for Voya Financial. “When we replaced the high deductible health plan name and called it something more generic, the share of people choosing high deductible health plans doubled. So just the name itself can have a really significant impact on how people think about what plan they should choose.”

Sixty-three percent of the people surveyed by Voya said they would choose the plan with the lowest deductible. As part of the study Voya designed an experiment asking participants to choose between a PPO and an HDHP. The experiment was set up in a way that the HDHP was always the optimal financial choice, despite this, 65% of those surveyed still chose the PPO plan.

Communicating the long term value of plans connected with health savings accounts is quite important.

  • Here’s a link to the CDC’s website on the Johnson & Johnson vaccine pause which explains

If you received the vaccine more than three weeks ago, the risk of developing a blood clot is likely very low at this time.

If you received the vaccine within the last three weeks, your risk of developing a blood clot is also very low and that risk will decrease over time.

Contact your healthcare provider and seek medical treatment urgently if you develop any of the following symptoms: severe headache, backache, new neurologic symptoms, severe abdominal pain, shortness of breath, leg swelling, tiny red spots on the skin (petechiae), or new or easy bruising.

If you experience any adverse events after vaccination, report them to v-safe and the Vaccine Adverse Event Reporting System

The FEHBlog enrolled in v-safe after his first Pfizer vaccination and the CDC has continued to inobtrusively check in weekly. The FEHBlog is happy to help out.