Tuesday Tidbits

OPM

Tuesday Tidbits

David Ermer–AHRQ, Medical / Rx research, OPM, Rx coverage, U.S. Healthcare–
Photo by Patrick Fore on Unsplash

From Washington, DC

  • The Medicare open enrollment period ends on Thursday, December 7. The Federal Benefits Open Season ends next Monday, December 11. While the Affordable Care Act open enrollment period continues into next month, December 15 is the last day to enroll if you want your coverage to begin on January 1, 2024.
  • FEHB open season changes take effect on January 1, 2024, for annuitants and on January 14, 2024, for federal employees. January 14 is the beginning of the first pay period in 2024.
  • Govexec tells us,
    • “In a memo to agency heads on Friday, OPM Associate Director for Workforce Policy and Innovation Veronica Hinton announced that the government’s HR agency had added shared certification functionality to the agency-facing portion of USAJOBS through a tool called Talent Pools.
    • “The Office of Personnel Management is proud to announce a new USAJOBS feature, Talent Pools, to ‘advertise’ available shared certificates of candidates across government,” Hinton wrote. “These certificates, issued under delegated examining procedures through the Competitive Service Act or an OPM-run cross government hiring action, contain candidates who have applied to an open announcement, have been assessed and are available for agencies’ consideration.”
    • “Hinton argued that the new feature should be a boon to agency hiring managers and job applicants alike by removing unnecessary and often duplicative red tape.”
  • Federal News Network informs us,
    • “Federal employees working in cyber now have a way to develop skills, while also seeing what it’s like to work at another agency.
    • “In the hopes of boosting retention of cyber employees, the Office of Personnel Management launched a new platform Monday for agencies to advertise openings in the cyber workforce rotation program.
    • “The rotation program lets agencies offer temporary assignments to federal employees who are currently working in IT, cyber or cyber-related positions in government. Eligible employees can apply for and work at a different agency for between six months and one year before returning to their home agency.
    • “The cyber rotations will advance career opportunities and support employee engagement, satisfaction and retention,” OPM said.”
  • The U.S. Preventive Services Task Force released two draft recommendation statements for public comment.
    • “Grade B — The USPSTF recommends exercise interventions to prevent falls in community-dwelling adults age 65 years or older who are at increased risk for falls.
    • Grade C — The USPSTF recommends that clinicians individualize the decision to offer multifactorial interventions to prevent falls to community-dwelling adults age 65 years or older who are at increased risk for falls. Existing evidence indicates that the overall net benefit of routinely offering multifactorial interventions to prevent falls is small. When determining whether this service is appropriate for an individual, patients and clinicians should consider the balance of benefits and harms based on the circumstances of prior falls, presence of comorbid medical conditions, and the patient’s values and preferences.”
    • The public comment period on the draft recommendation statements and the related draft evidence reviews ends on January 8, 2024. These recommendations would continue the current grades for these recommendations, last issued in 2018.

From the public health and medical research front,

  • Per Beckers Hospital Review,
    • “Leapfrog is winding down 2023 by recognizing 132 hospitals with its Top Hospital Award, a distinction for hospitals that demonstrate the highest performance in the U.S. on quality and patient safety. 
    • “Awarded hospitals are divided into four groups: general hospitals (34), children’s hospitals (8), rural hospitals (15) and teaching hospitals (75). Methodologies for the awards in each category can be found here. Seventeen more hospitals were awarded this year compared to last.”
    • The article lists all 132 recognized hospitals by state.
  • and
    • United Health Foundation released its 2023 America’s Health Rankings Dec. 5, which analyzes the overall health of the 50 states and this year identifies a record-high and rising prevalence of chronic conditions. 
    • For the 2023 rankings, UHF analyzed 87 measures across five categories of health: social and economic factors, physical environment, behaviors, clinical care and health outcomes. This year, eight chronic conditions — arthritis, depression, diabetes, asthma, cancer, cardiovascular diseases, chronic obstructive pulmonary disease and chronic kidney disease — reached their highest levels since America’s Health Rankings began tracking these measures in 1990. 
  • STAT News reports,
    • “Given the widespread acceptance that the current flu vaccines could use improvement, are mRNA shots the answer? As the scientific world waits for published data on which to formulate conclusions, STAT spoke to influenza and vaccine experts who see some significant benefits of applying mRNA technology to the production of flu vaccine — but also some serious challenges mRNA manufacturers will face breaking into this already crowded market.” 
    • In short, it’s messy.

From the U.S. healthcare business front,

  • The Wall Street Journal reports,
    • “CVS Health, the nation’s largest drugstore chain, will move away from the complex formulas used to set the prices of the prescription drugs it sells, shifting to a simpler model that could upend how American pharmacies are paid. 
    • “Under the plan, CVS’s roughly 9,500 retail pharmacies will get reimbursed by pharmacy-benefit managers and other payers based on the amount that CVS paid for the drugs, in addition to a limited markup and a flat fee to cover the services involved in handling and dispensing the prescriptions. Today, pharmacies are generally paid using complex measures that aren’t directly based on what they spent to purchase specific drugs.
    • “A similar payment model, sometimes known as “cost plus,” has been promoted by entrepreneur Mark Cuban’s eponymous pharmacy company, among others, which have said it brings greater clarity and accountability to drug pricing.  * * *
    • “The company will call the payment model CostVantage. When it starts rolling out next year, the new prices will first become available to consumers paying cash for their prescriptions using an array of drug discount cards. 
    • “In 2025, the setup will be incorporated into CVS pharmacies’ contracts with pharmacy-benefit managers covering drugs paid for under employer plans.
    • “CVS will also introduce a new option for clients of its PBM, CVS Caremark, that will work in tandem with the new retail pharmacy-payment scheme. The new PBM product, called TrueCost, will be based on the net cost of drugs with defined fee structures, the company said. Employers and other clients will have the choice to use it or not.”
  • Fierce Healthcare adds,
    • “After spending nearly $20 billion to pick up Signify Health and Oak Street Health this year, CVS rebranded its health services business to “CVS Healthspire” as it plots its long-term growth strategy.
    • “During the Forbes Healthcare Summit in New York City on Monday, CVS chief executive officer Karen Lynch said Healthspire will encompass CVS’ pharmacy services business, its care delivery assets, including home health company Signify Health and Medicare-focused primary care player Oak Street Health, as well as its new Cordavis operation. Cordavis is a new segment CVS launched in August that aims to work with drugmakers to bring additional biosimilars to market.”
  • BioPharma Dive points out,
    • “Johnson & Johnson expects its pharmaceuticals division will bring to market 20 new therapies for cancer, immune and neurological diseases by 2030, an outlook that underpins the industry giant’s forecast for sales growth of between 5% and 7% through the end of the decade.
    • “Seven of those anticipated drugs have the potential to earn more than $5 billion each in peak annual sales, J&J said Tuesday as part of a business review held three months after the company split off its consumer division. The separation left J&J slimmer, but focused on its higher-margin pharmaceuticals and medical device businesses.
  • Per Healthcare Dive,
    • “Next year is set to be another “make or break” year for nonprofit hospitals as they continue to weather staffing shortages and heightened inflation, according to a report from credit ratings agency Fitch Ratings released on Tuesday.
    • “The outlook for the sector is still “deteriorating” — a rating that’s been in place since August 2022. Fitch does not forecast credit downgrades en masse in the coming year. However, downgrades and negative outlooks will likely continue to outpace upgrades and positive outlooks.
    • “The single largest differentiator in performance will be hospitals’ ability to attract and retain staff in a hypercompetitive landscape, said Kevin Holloran, Fitch senior director and sector head, in a statement.” 

Monday Roundup

David Ermer–CDC, Congress, COVID-19, Electronic health records, Employee Wellness Programs, Federal employment benefits, Medical / Rx research, Mental health care, OPM, U.S. Healthcare–
Photo by Sven Read on Unsplash

From Washington, DC,

  • STAT News informs us,
    • “The Senate health care committee will consider a sweeping bill next week meant to combat the opioid epidemic, according to four lobbyists and a congressional aide familiar with the legislation. 
    • “The proposal would reauthorize a number of programs first created by the SUPPORT Act, an addiction-focused bill that Congress first passed in 2018. Many of those programs’ authorizations expired earlier this year, however, leading addiction treatment advocates to fret that lawmakers — and specifically the committee’s chairman, Sen. Bernie Sanders (I-Vt.) — no longer view the issue as a priority.    
    • “If passed, the legislation would mark Capitol Hill’s first major action this year on the addiction crisis. Current data shows that roughly 110,000 Americans are dying of drug overdoses each year. Roughly 85,000 of those overdoses involve opioids.” 
  • The Department of Health and Human Services announced,
    • “Today, United States Surgeon General Dr. Vivek Murthy is launching the 5-for-5 Connection Challenge, calling on Americans to take five actions over five days to build more connection in their lives. Dr. Murthy recently issued this challenge to students across the country on his “We Are Made to Connect” College Tour, which concluded just last week. Now, as we enter the holiday season, the 5-for-5 Connection Challenge aims to inspire people of all ages to build, strengthen, and prioritize their relationships.
    • “For the next two weeks, from December 4th – December 15th, the Surgeon General will encourage people to take five actions over five days that express gratitude, offer support to, or ask for help from people in their lives. These types of actions are outlined in the Surgeon General’s Advisory on Our Epidemic of Loneliness – PDF as some of the ways that people can catalyze social connection. As outlined in the Advisory, social connection can advance physical, mental, and cognitive health, and it is even associated with a decreased risk of mortality.”
  • MedTech Dive tells us,
    • “The Food and Drug Administration is evaluating the potential for plastic syringes made in China to suffer problems such as leaks and breakages.
    • “Officials began the investigation after receiving information about quality issues associated with “several Chinese manufacturers of syringes” that made them concerned that some devices “may not provide consistent and adequate quality or performance.”
    • “The FDA is advising consumers and healthcare providers to check where syringes are made and “consider using syringes not manufactured in China, if possible.” The advice applies to plastic syringes used for injecting fluids into, or withdrawing fluids from, the body.”

In FEHB Open Season news, Govexec offers helpful, last-minute advice from Kevin Moss.

From the public health and medicare research front,

  • U.S. News and World Report points out,
    • “After a period of limited change, COVID-19 activity is increasing again especially in the Midwest and Mid-Atlantic regions,” the CDC said in a report published Friday.
    • “Federal health officials are likely watching the increase given that they expect a “moderate” winter wave of coronavirus and this could be the start of it. Holiday gatherings and travel are also typically followed by an increase in coronavirus cases and hospitalizations.
    • “COVID-19 vaccination rates, meanwhile, have been disappointing for many.
    • “CDC Director Mandy Cohen told Congress this week that about 16% of Americans have gotten the updated COVID-19 vaccine.
    • “That’s not enough,” Cohen said.”
  • Beckers Hospital Review notes,
    • “So far this year, the CDC estimates there have been at least 1.8 million illnesses, 17,000 hospitalizations, and 1,100 deaths from flu in the U.S. 
    • “Influenza A continues to be the dominant strain in circulation, making up around 82% of cases, while influenza B is only accounting for around 18%. 
    • “Louisiana and South Carolina are still reporting the highest levels of flu activity in the country. 
    • “Nine states are experiencing high activity levels, but less than the two states above, including: California, New Mexico, Texas, Mississippi, Alabama, Georgia, Colorado, Florida and Tennessee. 
    • “Cases are also high in New York City and Puerto Rico.”
  • The Journal of the American Medical Association presented the following study results:
    • “Question  Is smoking still decreasing among US adults and do the trends vary by age, income, and race and ethnicity?
    • “Findings  In this cross-sectional study of 353 555 adults responding to the 2011 to 2022 National Health Interview Surveys, adults younger than 40 years had dramatic declines in smoking prevalence during the last decade, especially among those with higher incomes. In contrast, relatively slow declines were observed among adults aged 40 to 64 years, with no decrease in smoking among those 65 years or older.
    • “Meaning  These findings suggest that the precipitous decline in smoking among younger adults should be maintained, but that additional efforts are required to further reduce smoking in older adults.”
  • The American Medical Association explains “What doctors wish patients knew to improve their mental health.”
  • Per Endocrinology Advisor, “Decreased mortality risk is associated with concomitant reductions in glycated hemoglobin (HbA1c) and body weight among patients with type 2 diabetes, according to study results published in Diabetes Obesity and Metabolism.”

From the U.S. healthcare business front,

  • Fierce Healthcare profiles ten women of influence in U.S. healthcare. Check it out.
  • BioPharma Dive reports
    • “Roche on Monday agreed to acquire biotechnology company Carmot Therapeutics in a deal that bulks up the Swiss pharmaceutical giant’s pipeline with a group of weight loss drugs in early clinical testing.
    • “Roche will pay $2.7 billion upfront for the Berkeley, California-based Carmot. Roche could owe as much as $400 million more in future payments to Carmot shareholders, among them The Column Group and RA Capital, if certain milestones are met. The companies expect the acquisition to close next year.
    • “The deal hands Roche a trio of drugs in human testing for obesity, an area of pharmaceutical research that has been catalyzed by the success of weight loss medicines like Wegovy and Zepbound. Their progress has fueled a gold rush among large drugmakers, a number of which are either advancing in-house medicines or inking deals to acquire new prospects.”
  • and
    • “The Food and Drug Administration granted conditional approval to Eli Lilly’s oral cancer drug Jaypirca in two types of blood cancer, expanding its use from a rare type of lymphoma to people with leukemia and lymphoma patients who have previously received two other treatments, the company said Friday.
    • “Jaypirca is the fourth of a group of drugs called BTK inhibitors, a class that includes AbbVie and Johnson & Johnson’s Imbruvica and AstraZeneca’s Calquence. It gained approval earlier this year and posted $42 million in sales through Sept. 30.
    • “With this approval, Jaypirca can now be used in chronic lymphocytic leukemia or small lymphocytic lymphoma after patients have been treated with AbbVie and Roche’s Venclexta and another BTK inhibitor. Lilly said a Phase 3 trial meant to confirm Jaypirca’s accelerated approval has already met its primary goal.”
  • HR Dive discusses “Why EAPs go unused despite growing mental health awareness; Many factors contribute to the historic underutilization of employee assistance programs, despite their value as an access point to quality care.”
  • Medscape offers an infographic on how doctors grade their EHR systems while MedCity News explains how improved coding quality by healthcare providers can prevent denials and improve cash flow.
  • Health Payer Intelligence adds,
    • “Payers are investing in healthcare IT resources to support cost optimization and improve member experience, according to a study from EY-Parthenon and KLAS Research.
    • “As payers face operational and financial pressures, they are turning to healthcare IT solutions for help. Researchers sought to understand what strategies payers prioritize, how much they spend on healthcare IT resources, and what future investments look like.
    • “The study findings reflect responses from over 100 executives across payer entities serving commercial, Medicare, and Medicaid populations. Around 70 percent of respondents were traditional payers; the remaining were provider-sponsored, third-party administrators, and management services organizations.”
  • According to Healthcare Dive,
    • “A merger between major health insurers Cigna and Humana would go through the wringer of an intense antitrust review, but could come out finalized, experts say.
    • “Though, to receive the regulatory green light, a combined company would probably have to emerge looking different from the Cigna and Humana of today. * * *
    • “Gaining regulatory approval — especially if a challenge further ties up the process in the courts — could set a deal’s finalization back by a year or more. But, due to a lack of direct competition between the two, Cigna and Humana could be allowed to combine, creating a healthcare powerhouse with roughly $300 billion in annual revenue.”
  • and
    • “For-profit hospital chain HCA Healthcare’s Houston affiliate announced last week it completed its acquisition of 11 free-standing emergency departments from SignatureCare Emergency Centers. 
    • “HCA Houston Healthcare, which operates a network of 13 hospitals and nine outpatient surgery centers, now has 26 free-standing emergency departments in the area in addition to hospital-based emergency rooms, according to a Friday press release.
    • “The SignatureCare centers will be re-branded to HCA Houston ER 24/7. Financial terms of the deal were not disclosed.
  • and
    • “Rural hospital chain Lifepoint Health and Ascension Saint Thomas announced a joint venture last week to co-own Highpoint Health, a four-hospital system in Tennessee currently operated by Brentwood, Tennessee-based Lifepoint.
    • “The hospitals and care sites will be co-branded with Ascension Saint Thomas, but will be majority-owned and operated by Lifepoint, according to the release. The companies declined to comment on the cost of the buy-in.
    • “The health systems have partnered before. Ascension Saint Thomas partnered with Kindred Rehabilitation Services, a Lifepoint business unit, in 2022 to jointly own Ascension Saint Thomas Rehabilitation Hospital in Nashville.” 

Friday Factoids

David Ermer–AHRQ, CDC, COVID-19, Medical / Rx research, OPM, Telehealth, U.S. Healthcare–
Photo by Sincerely Media on Unsplash

From Washington, DC,

  • Yesterday, OPM’s Office of Inspector General posted its Semi-annual Report to Congress for September 30, 2023. OPM has not yet posted its Management Response thereto.
  • The HHS Office of Inspector General also issued its latest Semi-annual Report to Congress.
  • Federal News Network reports that federal employees in Japan continue to experience healthcare access problems.
  • The Director of HHS’s Agency for Healthcare Research and Quality explains how the Biden Administration is tackling financial strains on healthcare consumers.

From the public health and medical research front,

  • Beckers Clinical Leadership tells us,
    • “CDC Director Mandy Cohen, MD, said the season of respiratory syncytial virus is in “full swing” as flu slowly begins and COVID-19 leads the most hospitalizations and deaths, CNN reported Nov. 30. 
    • “What to know about COVID-19, RSV and flu:
      • “COVID-19: Dr. Cohen said while COVID-19 is “relatively low,” it remains the primary reason for new respiratory admissions and deaths. In November, each week saw between 14,000 and 18,000 hospitalizations and about 1,000 deaths. 
        • “The CDC revealed a new wastewater data tracking dashboard to track local and national trends per variant, and the dashboard also tracks mpox viruses. 
        • “Between Nov. 1 and Nov. 20, the most recent CDC information available, the proportion of wastewater sites reporting high increases of SARS-CoV-2 samples grew from 22% to 32%. During the same time, the proportion of wastewater sites finding decreasing samples slimmed from 60% to 49%. 
      • RSV: “Hospitalizations for RSV have been slightly rising, with RSV accounting for 0.5% of all hospitalizations in late October and 0.8% as of Nov. 18, according to the CDC. Ten states and New York City are reporting high levels of respiratory virus activity. Louisiana and South Carolina reported “very high” respiratory virus activity levels and Alabama, California, Colorado, Florida, Georgia, Mississippi, New Mexico and Texas are seeing “high” levels.
      • Flu: “The flu season is beginning as national estimates reveal 3.9% of healthcare visits were for flu for the week ending Nov. 25, a 0.2 percentage point increase from the prior week.  Most of the U.S. is reporting an increase in flu, with hot spots appearing in the South Central, Southeast, Mountain and West Coast regions. Twenty-five states and territories are reporting minimal flu activity.
        • “Hospitalizations for flu have grown for the third consecutive week.” 
  • The Wall Street Journal reports,
    • “The Centers for Disease Control and Prevention is urging people to avoid eating certain cantaloupe products amid a salmonella outbreak that has resulted in at least two deaths in the U.S.
    • “At least 117 people across 34 states have become sick after eating contaminated cantaloupe since mid-October, according to the CDC. At least 61 people have been hospitalized and two have died in Minnesota. The federal agency said the number of people sickened by the outbreak is likely much higher.
    • “The agency said it’s particularly concerned about the outbreak because the illnesses have been severe and some have occurred in long-term-care facilities and child-care centers. Fourteen people in long-term-care facilities and seven children who attended child-care facilities have been sickened, the CDC said.”
  • STAT News informs us,
    • “Advances in treatments for congenital heart abnormalities mean more patients are living into adulthood, with over 2 million adults estimated to have the condition in the U.S. But that means more are also developing heart failure as they grow older — and many aren’t receiving proper care.
    • “A new study published this week in the Journal of the American Heart Association found that while hospitalizations of adults with congenital heart disease stayed stable from 2010 to 2020, the proportion of admissions for those who have heart failure more than doubled from 6.6% to 14%.
    • “These patients with heart failure also had worse outcomes after hospitalization, with an 86% higher risk of death, a 73% higher risk of major heart and brain complications, and a 26% higher risk of hospital readmission.
    • “The findings suggest that adults with congenital heart disease who also have heart failure are an especially high-risk population, and they may need closer monitoring and unique treatment regimens.”
  • Health Day offers these key takeaways from recent study results:
    • “Sticking to your scheduled mammograms can significantly reduce your risk of death from breast cancer
    • “Women who got all their scheduled mammograms had a 66% to 72% reduced risk of breast cancer death
    • “Regular mammograms make it more likely that breast cancers can be caught early, when they are more treatable.”
  • Mercer Consulting discusses why an end to HIV in our country is in sight and shares five ways to address HIV in the workplace.
  • The American Hospital Association News adds
    • “Nine out of 10 people receiving medical care for HIV through the Ryan White HIV/AIDS Program in 2022 were virally suppressed, meaning they cannot sexually transmit the virus if they take their HIV medication as prescribed, according to the latest annual data from the Health Resources and Services Administration program.”

From the U.S. healthcare business front,

  • EBRI posted Fast Facts about the changing nature of primary care in our country.
    • “Among users of primary care, 95–97 percent utilized it in an office setting prior to 2020, but only 86 percent did so from 2020–2021 as employees began using telemedicine (7–8 percent) and urgent care clinics (3–4 percent) with greater frequency due to the COVID-19 pandemic.
    • “There has been a consistent downward trend in the share of employees whose primary care office visits are at a general/family practice, falling from 42 percent in 2013 to 37 percent in 2021. In addition, primary care office visits at internal medicine providers have fallen from 21 percent in 2013 to 17 percent in 2021.
    • “Finally, the provision of primary care by a medical doctor has fallen from 9 percent in 2013 to 4 percent in 2021. In contrast, primary are provision by nurse practitioners and physician assistants has risen over time. The share of employees whose primary care office visits have been with a physician assistant rose from 2 percent in 2013 to 6 percent in 2021.
    • “The corresponding change for nurse practitioners has been from 4 percent in 2013 to 16 percent in 2021.”
  • BioPharma Dive lets us know,
    • “Pfizer will not advance a twice-daily dose of an experimental obesity drug into further testing after results from a mid-stage study showed high rates of gastrointestinal side effects and participant dropout. 
    • “Treatment did lead to significant weight loss compared to placebo over the course of the Phase 2b study. Placebo-adjusted reductions in body weight ranged from 8% to 13% at 32 weeks, Pfizer said in a statement Friday. Discontinuation rates were more than 50% on some drug doses, however.
    • “Moving forward, Pfizer will turn its focus to a once-daily version that’s currently being tested in a study meant to determine how the drug’s processed by the body. Data are expected in the first half of next year.”
  • Healthcare Dive reports,
    • “Community Health Systems announced on Friday it has completed the sale of three Florida hospitals to Tampa General Hospital for about $294 million in cash.
    • “The deal includes 120-bed Bravera Health Brooksville, 124-bed Bravera Health Spring Hill and 128-bed Bravera Health Seven Rivers, as well as their associated assets, physician clinic operations and outpatient services, according to a press release.
    • “The sale allows the for-profit hospital operator to “deliberately focus our resources in markets that we deem as most investable and that can produce greater growth and returns over the long term,” CHS CEO Tim Hingtgen said during a call with investors shortly after the divestiture was announced this summer.” 
  • MedCity News explains how payers can break down barriers that prevent access to value-based virtual care.
  • Per Fierce Healthcare,
    • Daniel Jones, who pens the investment newsletter Crude Value Insights, wrote in an analysis that because Cigna and Humana have fairly different focuses despite both being large health plans, there is potential that the merger could be viewed as more of a vertical deal than a horizontal one, which is less likely to stymie competition.
    • Cigna is a far smaller player in the Medicare Advantage space while Humana’s insurance business is overwhelmingly centered in MA. Humana, meanwhile, has limited reach in the commercial market, where Cigna has a far greater footprint.
  • Beckers Payer Issues adds,
    • “The sale of Cigna’s Medicare Advantage business would remove one hurdle in the company’s reported goal to merge with Humana, and Health Care Service Corp. might be part of that equation, Bloomberg reported Nov. 29.”

Thanksgiving Weekend Update

David Ermer–CDC, Congress, COVID-19, Medicare, OPM, U.S. Healthcare–

We are halfway through the Federal Employee Benefits Open Season, which will end on December 11.

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

Axios brings us a dental coverage update for Affordable Care Act plans and Medicare. Of note, Axios tells us that “earlier this month, the Biden administration expanded all Medicare beneficiaries’ access to dental services when they’re necessary for other medical care, like cancer treatment.”

From the public health front,

  • Axios reports
    • “The big picture: In the two years since Omicron emerged, it has continued to rank as the predominant strain in the U.S., and its subvariants are now driving most of the country’s coronavirus infections.
    • “State of play: COVID-19 is circulating in every country and remains a threat, Maria Van Kerkhove, the WHO’s technical lead on COVID-19, said in an update Tuesday.
      • “Infection from the variants now in circulation can cause anything from asymptomatic infection to severe disease, pneumonia and death, she explained.”Infection from the variants now in circulation can cause anything from asymptomatic infection to severe disease, pneumonia and death, she explained.
      • “Luckily, she added, most people are experiencing less severe symptoms because they have population-level immunity from vaccination, prior infection, or both.
    • “Zoom in: Case rates are not as high as this summer, but experts expect they may rise during the winter as they have the past three years, given colder weather that drives people indoors and holiday gatherings.”
  • The Wall Street Journal adds,
    • “Flu and RSV killed thousands of people on their own during typical winters before the pandemic. Covid isn’t killing people as it once did, but it remains the deadliest of the three—in part because it is more active year-round. 
    • “The Centers for Disease Control and Prevention predicts hospitalizations this year will be about the same as last year: well above pre-pandemic levels. Even a milder season with the three viruses circulating together would likely mean more hospitalizations than a severe season of just flu and RSV, said Jason Asher, who directs a CDC forecasting department.
    • “More illness means more disruptions to life and work. The flu alone is responsible for billions of dollars in medical and economic costs and millions of lost workdays. Covid has added to worker absences in recent winters.  * * *
    • “There’s one more virus out there for you to get,” said Justin Lessler, an infectious disease epidemiologist at the University of North Carolina. “Your risk of getting sick has probably gone up.”

From the U.S. healthcare business front,

  • The Washington Post reports,
    • “About half of all people are in hospice at the end of their lives, but more than 25 percent of hospice patients enroll in the final week, according to 2021 data from the Medicare Payment Advisory Commission, which advises Congress on Medicare issues.
    • “Others among the 1.7 million Medicare patients who used hospice that year availed themselves of its services for much longer. That is reflected in data that reveal the dual nature of hospice: The median stay is only 17 days, meaning half of patients were in hospice less than 17 days and half longer than that. But the average is 92 days, which shows that some patients were in hospice for many months.”
  • The Wall Street Journal points out,
    • A healthcare hiring boom is helping offset weaker job growth in other areas of the softening U.S. economy, boosting its chances of skirting a recession.
    • The industry could serve as a strong job generator for years to come as an aging population and Covid-19 fuel widespread worker shortages and greater needs for healthcare services. 
    • Healthcare providers—including hospitals, clinics, pharmacies and doctors’ offices—accounted for 30% of U.S. job gains in the six months through October, though less than 11% of the country’s total employment, Labor Department figures show. 
    • “As behavior returns to normal—as kids go back to germ-factory indoor play spaces and daycare centers, and as people schedule elective procedures and catch up on routine scans delayed during the height of the pandemic—providers are having to staff up to keep up with demand,” said Julia Pollak, chief economist at Ziprecruiter.”

Happy Thanksgiving!

David Ermer–Congress, COVID-19 testing, Federal employment benefits, Generative AI, Medical / Rx research, OPM, U.S. Healthcare–
Photo by Priscilla Du Preez 🇨🇦 on Unsplash

Following this post, The FEHBlog will reappear on Saturday for Cybersecurity Saturday. The FEHBlog wishes his readers a Happy Thanksgiving.

From Washington DC

  • Thanks to Bloomberg, the FEHBlog learned about this Congressional Research Service report on FY 2024 USPS Appropriations. To wit,
    • “On September 30, 2023, Congress passed the Continuing Appropriations Act, 2024 and Other Extensions Act (H.R. 5860; P.L. 118-15), which provides continuing FY2024 appropriations to federal agencies through November 17,
    • “Section 126 of the act increases the rate of funding for the Office of Personnel Management (OPM) to approximately $219.1 million, which is about $28.3 million above its FY2023 funding.
    • “The additional OPM funding is provided for the implementation of the Postal Service Health Benefits Program (PSHBP), a new health benefit program for eligible postal employees and retirees. Under the PSRA, OPM is required to establish and administer the PSHBP.”
  • FEHBlog note — The Postal Service also is on the financial hook for funding implementation of the PSHBP.
  • STAT News reports,
    • “Senate Democrats, led by Sen. Bernie Sanders (I-Vt.), on Tuesday mounted a public pressure campaign to get the executives of Merck, Johnson & Johnson, and Bristol Myers Squibb to testify in a January hearing on why the United States pays more for prescription drugs than other countries.
    • “All three companies have sued the Biden administration over the new Medicare drug price negotiation that congressional Democrats passed last year. Bristol Myers Squibb’s blood thinner Eliquis; Johnson & Johnson’s blood thinner Xarelto, anti-inflammatory medicine Stelara, and blood cancer treatment Imbruvica; and Merck’s diabetes drug Januvia were selected as part of the first 10 drugs to go through the negotiation process.
    • “It’s unclear whether the executives will agree to testify at the hearing, which is titled “Why “Does the United States Pay, By Far, The Highest Prices In The World For Prescription Drugs?” Sanders also put out a fundraising email just before the letter was announced, with the subject line: “The greed of the pharmaceutical industry is out of control.” It featured an op-ed he wrote for the Guardian Monday.”

In FEHB Open Season and federal retirement news,

  • Fedweek provides Reg Jones’ observations on FEHBP and Medicare Parts A and B. The Federal Times offers articles titled “A Procrastinator’s Checklist for Choosing Open Season Benefits” and “What’s driving rate hikes for federal employee health premiums?”
  • The second Federal Times article is a topic that the FEHBlog follows throughout the year. In that regard, Mercer Consulting released the following survey findings last week:
    • “Mercer, a business of Marsh McLennan (NYSE: MMC), released the findings of its 2023 National Survey of Employer-Sponsored Health Plans, which found the average per-employee cost of employer-sponsored health insurance rose by 5.2% in 2023 to reach $15,797. * * *
    • “In 2022, cost rose by 3.2%, well below general inflation, which averaged 8% that year. Because healthcare providers typically have multi-year contracts with health plans, employers did not feel the full brunt of inflation last year. “Rather, inflation-driven cost increases are phasing in as contracts are renewed,” says Sunit Patel, Chief Health Actuary, Mercer. The survey shows employers project another sharp increase of 5.2% for 2024.
    • “It may take another couple of years for price increases stemming from higher healthcare sector wages and medical supply costs to be felt across all health plans,” Mr. Patel says.
    • “At the same time, inflation is only one factor behind this year’s higher cost increases. In 2023, spending on prescription drugs rose sharply. “While the effects of inflation may be relatively short-lived, new and ongoing developments in the pharmaceutical market seem likely to have a longer-term impact on health benefit cost.”
  • The Federal Times adds,
    • “Federal employees’ retirement applications take almost twice as long to process when they contain errors, leading to further delays in processing and dispensing annuities, according to a watchdog report published Monday.
    • “The Office of Personnel Management’s inspector general found that “healthy” application packages took on average 53 days to process, and “unhealthy” ones containing errors took more than 108 days, according to a random sample of applications the inspector general studied.
    • “That discrepancy needs be reflected in the data OPM reports monthly to accurately monitor whether retirement processing is improving, the IG report said.
    • “The lack of transparency for healthy versus unhealthy ‘incomplete’ application packages limits the quality of information being provided to external parties as the main cause for why Retirement Services has not met its goal for processing retirement application packages within 60 days,” according to the report.”

From the public health and medical research front,

  • Beckers Clinical Leadership tells us,
    • “Hospital and public health officials are urging people to take precautions and be mindful of where they seek care to limit capacity strain on emergency departments as respiratory virus activity heats up heading into the holiday season. 
    • “Since early September, COVID-19 metrics had mostly been trending downward or remained flat. Now they are on the rise again, though they remain far below levels seen in previous surges. There were 16,239 new admissions for the week ending Nov. 11, up 8.6% from the previous week. 
    • “Meanwhile, most of the country is seeing an uptick of flu and respiratory syncytial virus cases. Hospitalizations associated with the two infections are also ticking up, particularly among children and older adults. 
    • “The more concerning thing is the severity of some of the illness,” Hany Atallah, MD, chief medical officer Jackson Memorial Hospital in Miami, told ABC affiliate WPLG. “And we are also seeing some patients come in with more than one viral infection, so they may have RSV and flu, for example. We’re constantly trying to follow the science and encourage people to get vaccines.” 
  • The Wall Street Journal points out,
    • “Ozempic, Wegovy and their counterparts have exploded in popularity over the past year, earning billions for the drugs’ makers, transforming the American approach to weight-loss, and sparking widespread cultural discussion in a country that is already obsessed with weight. 
    • “That conversation lands on Thanksgiving tables this week, where some people say the drugs have boosted their confidence around food, and others say they are worried about facing questions about what they’re eating, what they’re not eating, and changes in their appearance.
    • “It’s a hot topic, and people have a lot of judgments,” says Dr. Gauri Khurana, a psychiatrist in private practice in New York City and a clinical instructor at Yale University who has prescribed the medications and helped patients manage them. * * *
    • “Doctors advise people to listen to their bodies—not their family members—when it comes to serving sizes. A balanced plate that gives priority to protein and high-fiber foods over carbohydrates and fatty foods, which tend to sit in the stomach and exacerbate the medication’s effects of delayed gastric emptying, can help patients avoid filling up too quickly or feeling nauseous.”
  • The New York Times reports,
    • “Just in time for the holiday season, the Biden administration is offering Americans a fresh round of free at-home coronavirus tests through the Postal Service.
    • “The administration revived the dormant program in September, announcing then that households could order four free tests through a federal website, covidtests.gov.
    • “Beginning Monday, households may order an additional four tests. Households that have not placed an order since the program resumed can submit two orders, for eight tests in total.”
  • The University of Minnesota informs us,
    • “A new survey of 158 hospital executives, conducted by the Sepsis Alliance, found that 90% see antimicrobial resistance (AMR) as a threat, and 88% think the problem is getting worse. The survey, conducted by Sage Growth Partners on behalf of the Sepsis Alliance, also dug into executives’ views on other related AMR issues. An 11-page report on the findings was published on the Sepsis Alliance websiteon November 17.
    • “Another top concern is the public’s lack of knowledge about AMR, with 59% of executives saying that public education of clinicians as well as patients is the largest barrier to antibiotic stewardship. Respondents recommend public service announcements covering the need for early treatment, the importance of completing treatment, and storing the drugs properly.”

From the U.S. healthcare business front,

  • Healthcare Dive asks “Where are all the nurses? Hospitals, advocates disagree on crisis; Hospitals and nursing unions disagree about what’s driving sluggish application rates for open registered nurse positions — a lack of qualified candidates or a lack of interest.”
  • BioPharma Dive notes,
    • “Roche’s Genentech unit is partnering with computing giant Nvidia in a multiyear deal that highlights the pharmaceutical industry’s growing hopes of using artificial intelligence to speed up the process of designing and developing new drugs. 
    • “By collaborating with Nvidia, Genentech expects to “significantly enhance” its existing AI research and potentially improve on the chip designer’s own software, such as its “BioNemo” platform for drug discovery. 
    • “Our teams will be continuously exchanging expertise on the advancement of science and the state-of-the-art methods emerging in accelerated computing, AI and simulation across this entire drug discovery process,” said Kimberly Powell, vice president of healthcare at Nvidia, in a briefing with reporters.” 

Weekend update

David Ermer–Congress, Medical / Rx research, OPM–
Thanks to ACK15 for sharing their work on Unsplash.

From Washington, DC,

  • Congress is back home this week to celebrate Thanksgiving. Roll Call has made available a tentative 2024 Congressional calendar.
  • FedSmith reports that the U.S. Office of Personnel Management issued a final 2024 calendar year locality pay rule last week.
    • “For 2024, four new locality pay areas have been established by the final regulations. These are:
      • “Fresno-Madera-Hanford, CA; 
      • “Reno-Fernley, NV; 
      • “Rochester-Batavia-Seneca Falls, NY; and 
      • “Spokane-Spokane Valley-Coeur d’Alene, WA-ID. 
    • “The President will set locality pay rates for these four areas. This usually occurs in late December.”
  • MedPage Today suggests that Medicare coverage of GLP-1 anti-obesity drugs is the key to lower prices. Medicare coverage would benefit FEHB plans with Medicare Part D EGWPs. While Medicare would pay lower prices for these drugs, the FEHBlog doubts that Medicare coverage will help payers without Medicare Part D EGWPs.

From the public health and medical research front,

  • The New York Times states,
    • “Shortly after a baby is born, doctors clamp the umbilical cord linking the infant to the placenta, which is still inside the mother’s uterus, and then cut it. New research shows that if doctors wait at least two minutes after the birth to clamp the cord, they significantly improve in-hospital survival rates for premature infants.
    • “Delayed cord clamping — an intervention that can be introduced at relatively little cost — is believed to help because it allows umbilical cord blood, which is rich in iron, stem cells and antibodies, to flow back to the baby. Some experts say that it’s not entirely clear why the strategy seems to help, but that the data is convincing.”
  • Fortune Well tells us what super-agers can teach us about living longer.
    • “One hundred year-old Maureen Paldo still lives in the same Chicago home that she and her husband purchased when they married after World War II. Paldo, who’s been widowed for about 30 years, says she still manages the stairs, takes walks as often as possible, and loves to have people come to visit. * * *
    • “Paldo is participating in a a large, genetic study of elders, called the SuperAgers Study, to help researchers answer some key questions about life span and health span. It may even lead to a longevity pill that could help more of us live healthier, longer lives.
    • “We still don’t really know why some people live well into their ninth or tenth decades of life with few physical or cognitive problems, while others show decline much sooner. While genetics plays a role, we are still learning about all of protective inherited and natural factors, according to Dr. Sofiya Milman, the study’s chief investigator and Director of Human Longevity Studies at the Institute for Aging Research at Albert Einstein College of Medicine in New York. SuperAgers all seem to have the APoE2 gene variant in common, which protects against Alzheimer’s or dementia, but that’s only a partial explanation.
    • “In one analysis, Milman’s team compared the lifestyle of centenarians to the lifestyle of a general population group from the same birth years. Those in the general population group didn’t live as long, despite similar rates of tobacco and alcohol use, diet, and exercise.
    • “What is it that makes the difference?” she asks. “We know enough to know that this is a very valuable group to study because looking at smaller groups of superagers and centenarians have indicated that there’s definitely heritability for healthy aging and healthy longevity.”

Friday Factoids

David Ermer–CDC, COVID-19, COVID-19 vaccine, FDA, Federal employment benefits, OPM, SDOH, U.S. Healthcare–

From Washington, DC,

  • The Washington Post reports,
    • President Biden on Friday named W. Kimryn Rathmell to be the next director of the National Cancer Institute, where the prominent researcher will help oversee several White House-backed initiatives intended to reduce cancer deaths and accelerate clinical breakthroughs.
    • Rathmell, an expert in kidney cancer, is the chair of medicine at Vanderbilt University Medical Center in Nashville. The Stanford University-trained physician and scientist has been a member of the National Cancer Institute’s board of scientific advisers since 2018, providing guidance to the institute’s leaders on its scientific research and operations. Rathmell’s new role as head of the cancer institute, which the White House said would begin in December, does not require Senate confirmation.
  • Federal News Network tells us,
    • “The Office of Personnel Management faces a tight deadline to set up a new health insurance marketplace for Postal Service employees and retirees to enroll in new plans, starting next year.
    • “Now OPM is addressing watchdog concerns about whether the IT infrastructure supporting this new USPS marketplace is following federal cybersecurity requirements.
    • “OPM’s Office of Inspector General, in a flash audit released Friday, raised concerns about the cybersecurity steps OPM took before launching the IT systems that will run the Postal Service Health Benefits (PSHB) Program.”
  • Govexec tells us,
    • The Office of Personnel Management this week proposed new regulations delegating its authority to waive the caps on recruitment and relocation incentive payments to federal employees and job candidates to the agencies themselves, a move the federal government’s HR agency says will ease administrative burdens and accelerate the hiring process. * * *
    • “Under the new process, each agency would be required to designate an official who would be tasked with reviewing and adjudicating waiver requests. Additionally, the new regulations would eliminate the minimum service period required to receive an incentive payment. Currently set at six months, OPM argued that removal of the minimum time period would allow short-term, yet still difficult to fill positions such as paid internships to become eligible for recruitment and relocation incentives.
    • “Retention incentive payments would not change under the regulatory proposal, as OPM reported that such changes would require the passage of legislation by Congress.”
  • The Government Accountability Office issued a report on the composition of the federal workforce.
    • “The federal government aims to hire and promote a workforce that reflects the diversity of the U.S. population.
    • “We looked at a decade of federal employment trends. For example, from 2011-2021 there were minor changes in the representation of historically disadvantaged racial groups—like Black or African American and Asians—in the federal workforce. But several of these groups made gains in senior executive service positions.
    • “The percentage of Hispanic federal workers also increased. But in FY 2021, Hispanic individuals made up 10% of the federal workforce, even though they represented 18% of the civilian labor force.”
  • Reuters reports,
    • “The U.S. Centers for Disease Control and Prevention said on Thursday it has expedited the release of more than 77,000 additional doses of Sanofi (SASY.PA) and AstraZeneca’s (AZN.L) respiratory syncytial virus (RSV) drug Beyfortus.
    • “The additional doses, which the CDC said will be distributed immediately to physicians and hospitals, will help improve the availability of the drug at a time when a surge in cases of the disease is outpacing supply.
    • “Beyfortus was approved earlier this year to prevent the disease in infants and toddlers.
    • “CDC said the agency, along with the U.S. Food and Drug Administration, will continue to be in close contact with the manufacturers to ensure availability of additional doses through the end of this year and early 2024 to meet the demand.”

In FEHB News, Federal News Network offers a lengthy and informative exchange with Kevin Moss from Consumer Checkbook.

From the public health and medical research front,

  • STAT News points out,
    • “Flu activity in many parts of the United States is starting to rise more rapidly, signaling that flu season is on the horizon, the Centers for Disease Control and Prevention reported Friday.
    • “With Americans set to travel for Thanksgiving gatherings next week, people who’ve been waiting to get a flu shot should think about acting now, Alicia Budd, the CDC’s team lead for domestic flu surveillance, told STAT.
    • “Really what we’re seeing is a more sharp increase in activity, week over week, and we know from experience when that happens often times we are entering into that period of even more increased activity,” Budd said. “It’s a great time for people to get vaccinated, if they’ve been holding off.”
  • ABC News states,
    • An estimated 36 million adults in the United States have received the updated COVID-19 vaccine as of Monday according to new data from the federal government.  Additionally, about 3.5 million children have also gotten the updated shot, according to the survey, which is a sample size of the U.S. population, from the Centers for Disease Control and Prevention. This is roughly equal to the number of Americans who had received the bivalent booster — which was targeted against different COVID variants — by this time last year.
  • The Wall Street Journal reports,
    • “The Food and Drug Administration said it is screening cinnamon shipments from several countries as part of its investigation of illnesses potentially linked to pouches of cinnamon-flavored applesauce.
    • “The federal agency said this week it believes the cinnamon used in these products could be the source of lead contamination. There have been 34 reports of lead-related illnesses potentially tied to the recalled products. 
    • “The FDA, which has been investigating the lead illnesses since October, said they are potentially linked to contaminated children’s fruit puree and applesauce pouches. WanaBana,  Weis Markets and Schnucks brands have recalled cinnamon-flavored fruit puree and applesauce pouches.”
  • CNN reports,
    • “The rate of premature birth in the United States remains high, especially in the southern region of the country, according to the infant and maternal health nonprofit March of Dimes.
    • “The group’s annual “report card” on US maternal and infant health, released Thursday, says that the nation’s preterm birth rate – the rate of babies born before 37 weeks gestation – was 10.4% in 2022, down only 1% from 2021’s rate, which was the highest in more than a decade.
    • “We went from 10.5% to 10.4%. It’s flat,” said Dr. Elizabeth Cherot, president and chief executive officer of March of Dimes. “A slight change is just not big enough in that direction.”
  • Per NBC News,
    • The rate of child and teen cancer deaths in the U.S. fell 24% from 2001 to 2021, according to a CDC report released Thursday. The report looked at death rates, for Black, Hispanic and non-Hispanic whit youths up to 19 years old. These groups comprised 92% of all youth cancer deaths in 2021, the report noted.
  • Per STAT News, while Wegovy and Zepbound ride high, interest in weight loss drugs that preserve muscle is surging.
    • [B]iotech startups are hoping to use those [earlier Johns Hopkins] findings to create what they believe will be better weight loss medications. In the last several months, multiple companies have disclosed they are testing drugs that preserve or grow muscle while reducing fat, as shown in the updated STAT Obesity Drug Tracker. They hope that their drugs, possibly when used in conjunction with existing obesity treatments, will result in healthier weight loss.

From the U.S. healthcare business front,

  • Healthcare Dive reports,
    • Rochester, Minnesota-based Mayo Clinic reported increased year-over-year operating revenue and income in its third-quarter earnings, on higher outpatient visits and surgical cases.
    • The nonprofit posted $4.5 billion in operating revenue, up 8.2% year over year, and $302 million in operating income. Operating expenses rose 4.8% year over year, totaling nearly $4.2 billion.
    • The earnings mark the third quarter Mayo has posted net income after the operator struggled last year. The health system reported profits last year that were half its 2021 returns, after contract labor expenses increased 37% year over year. 
  • and
    • For-profit operator Tenet Healthcare has agreed to sell three of its hospitals in South Carolina for about $2.4 billion in cash to Winston-Salem, North Carolina-based Novant Health. 
    • Proceeds from the deal, which is expected to close in the first quarter in 2024, will primarily go toward paying debt, Tenet said in a news release. 
    • Under the agreement, Dallas-based Tenet’s financial services subsidiary Conifer Health Solutions will also provide revenue cycle management for the hospitals and their related operations under an expanded 15-year contract. 
  • and
    • CommonSpirit Health reported a $441 million operating loss in the first quarter of the 2024 fiscal year on increased expenses.
    • The system expects a California assistance fund — due to be approved later this fall — to offset its operational losses slightly. However, CommonSpirit’s net loss ballooned to $738 million in the quarter as investments faltered, compared to a $413 million loss same time last year, according to its earnings report filed Wednesday
    • In the report, CommonSpirit also outlined plans to expand its ambulatory care footprint next year after a string of recent outpatient acquisitions in multiple states, despite liquidity concerns.

Monday Roundup

David Ermer–Congress, Federal employment benefits, OPM, Rx coverage, U.S. Healthcare–
Photo by Sven Read on Unsplash

From Washington, DC

  • The Hill reports,
    • “Senate Majority Leader Chuck Schumer (D-N.Y.) on Monday said he is “pleased” with Speaker Mike Johnson’s (R-La.) plan to avoid a government shutdown.
    • “Schumer noted that Johnson’s “laddered” stopgap spending bill — which funds four bills through Jan. 19 and the remaining eight through Feb. 2 — is “far from perfect,” but indicated the “clean” measure provides a path to funding the government for the next two months.”
  • The Department of Health and Human Services tells us,
    • “Today, amid new data released on substance use across the nation, the Biden-Harris Administration reiterated President Biden’s clear and urgent call for Congress to provide critical additional resources to strengthen addiction treatment and crack down on drug trafficking.
    • “Today’s new data from the 2022 National Survey on Drug Use and Health (NSDUH) show there were more than 48 million Americans who experienced a substance use disorder in 2022. Of the 48 million Americans struggling with substance use disorder, three out of every four did not get treatment. While the Biden-Harris Administration has made historic progress in expanding access to life-saving public health services and stopping the flow of illicit drugs like fentanyl into American communities, the nation is facing an unprecedented epidemic that requires the full support and funding of Congress.”
  • Govexec informs us,
    • “The Office of Personnel Management on Thursday released new guidance spelling out ways that federal agencies can implement a recent executive order aimed at making it easier for military spouses to have a career in public service. * * *
    • “In a memo to agency heads, OPM Director Kiran Ahuja said the government’s forthcoming strategic plan for hiring and retaining military spouses will be released later this year. But in the meantime, she offered a few avenues where agencies can take action now to improve their performance on the issue.”

In FEHB news, The Federal Times, Govexec, Federal News Network, and FedSmith offer advice to participants in the Federal Benefits Open Season.

From the public health and medical research front,

  • The New York Times reports,
    • “The gap in life expectancy between men and women in the United States grew to its widest in nearly 30 years, driven mainly by more men dying of Covid and drug overdoses, according to a new study in The Journal of the American Medical Association.
    • “In 2021, women had a life expectancy of 79.3 years, compared with 73.5 years for men, the study found.
    • “It was unsettling to see,” said Dr. Brandon Yan, a resident physician at the University of California, San Francisco, and lead author of the study, which analyzed death data from the Centers for Disease Control and Prevention.
    • “We need to understand which groups are particularly losing out on years of life expectancy so interventions can be at least partially focused on these groups,” Dr. Yan said.”
  • STAT News adds,
    • “The decline in life expectancy in the U.S. suggests that advancements in medical treatment are no longer sufficient to counter ongoing public health crises, Yan said. “We have a health care system that is very advanced in treating illnesses and advanced disease. But for the most part … it is not very good when it comes to preventative care.”
  • FEHBlog note — The English were tracking life expectancy in the late 1600s.
  • Last week, the Times of London reported,
    • “Thousands of women will avoid suffering breast cancer after a pill that costs 4p a day was approved as a preventive treatment for the disease.
    • “Almost 300,000 women at higher risk will be eligible for anastrozole, which studies have shown can nearly halve the chances of developing breast cancer if taken daily for five years.
    • “Campaigners hailed the approval as a “major step forward” in efforts to tackle the disease, which is Britain’s most common cancer, with 47,000 new diagnoses each year. Until yesterday, anastrozole had been licensed for use in Britain only as a treatment, rather than a preventive measure.
    • “NHS England said 289,000 women in their 50s and 60s at moderate or high risk of breast cancer would now be eligible for the drug. They will include women with a family history of the disease, or who have faulty genes such as BRCA1, the so-called Jolie gene, that put them at greater risk.”
  • STAT News adds today,
    • “Like the better-known tamoxifen, anastrozole was first used to treat breast cancer. Then, because risk doesn’t end with treatment, the hormone-blocking drug was also prescribed to prevent cancer’s return. Ten years ago, after a clinical trial showed convincingly that the drug could prevent breast cancer, U.S. oncologists began prescribing it off-label. In the U.K., anastrozole got the nod for this use last week from the country’s Medicines and Healthcare products Regulatory Agency. * * *
    • “The two drugs approved by the U.S. Food and Drug Administration for prevention, tamoxifen and raloxifene, reduce estrogen in different ways but offer the same kind of protection. Brewster said they are used more often in the U.S. than anastrozole, possibly because of milder side effects. * * *
    • “These prevention drugs themselves are not without risk. As [Dr. Abenaa] Brewster [a professor of clinical cancer prevention at MD Anderson Cancer Center] puts it, there’s no such thing as free lunch, and when patients are healthy, their tolerance for side effects is understandably lower than when they are in treatment for active disease. Most women tolerate tamoxifen well, but there are rare side effects of uterine cancer or blood clots. Some patients taking anastrozole and raloxifene experience joint stiffness, vaginal dryness, hot flashes, or bone thinning.”
  • The New York Times Morning column observes,
    • “The changing nature of the drug crisis was predictable, because drug use is historically faddish. In the 1970s, America struggled with heroin. In the ’80s, it was cocaine. In the ’90s and early 2000s, meth. Since then, opioids have taken off.
    • “One explanation for this is what’s known as generational forgetting: Young people tend to avoid the drug that is currently causing a crisis. But because they don’t have personal experiences with the drugs that caused harm before their time, they are more willing to use those substances.
    • “Different drugs can also complement each other, and so their popularity can rise simultaneously. Opioids, for example, often cause users to doze off, which can leave those who live on the streets vulnerable to theft or rape. So opioid users sometimes use stimulants, like meth and cocaine, to stay awake. And if they receive treatment for opioid addiction, they may continue using stimulants.
    • “All of this leads to a revolving door for different kinds of drug crises. It has happened before, and it is happening again.
    • “Read Jan’s full story, which includes details about the rise of a kind of meth so pure that some are calling it “super meth.”
  • Mercer Consulting offers a Q&A about weight loss medications with their pharmacy team.
    • Do these medications have an ROI? When might plan sponsors expect to see benefits from treating obesity as a chronic disease?
    • Jon Lewis, Mercer Rx Financial Leader:  These medications represent a big investment. While everyone talks about the high list prices, it is worth noting something fairly unique here. We do have manufacturer competition which means rebates are playing a role and should be monitored.  
    • In general though, we are looking at somewhere between three to five years before you start to realize any savings. Those who are at higher risk – for example, people with a higher BMI – are likely to produce more savings. With that said, changing eligibility to a narrower BMI does have a rebate impact and should be incorporated into any weight loss strategy. 
    • But these drugs are costly. You would have to have someone who is on the drug long enough to achieve the weight loss, still be employed, and still be maintaining that weight loss over the course of three to five years to see an ROI or some form of savings. 
  • Beckers Hospital Review discusses rural hospitals’ maternity care crisis.
  • Per MedPage Today,
    • “Peanut-allergic toddlers who stayed on an investigational, epicutaneous immunotherapy skin patch reached higher levels of peanut tolerance during the second year, according to the open-label extension of the EPITOPE trial.”Peanut-allergic toddlers who stayed on an investigational, epicutaneous immunotherapy skin patch reached higher levels of peanut tolerance during the second year, according to the open-label extension of the EPITOPE trial.”

From the U.S. healthcare business front,

  • MedTech Dive points out,
    • “More complete data from a clinical trial of Novo Nordisk’s Wegovy weight loss drug have rekindled the debate over how the treatment will affect patient demand for medical devices and procedures.
    • “The findings from the SELECT study, presented at a major heart meetingover the weekend, showed a 20% reduction in risk on a composite goal of heart attack, stroke or cardiovascular death, compared to a placebo, in overweight and obese patients with heart disease. But the data were inconclusive on a narrower measure of cardiovascular death alone.
    • “The data overall confirm a cardiovascular benefit for patients, but mixed results on secondary endpoints do not alter the outlook for heart device makers such as Boston Scientific, Medtronic and Edwards Lifesciences, Mizuho analyst Anthony Petrone said Monday in a report to clients.”
    • “At first blush, we see the final SELECT data as neutral for cardiovascular names,” he wrote.
  • BioPharma Dive informs us,
    • “Novartis is deepening its investment in cancer cell therapy, licensing an experimental project developed by Legend Biotech that is in early-stage trials for two types of lung cancer, the smaller company said Monday.
    • “Novartis will pay Legend $100 million upfront to secure rights to the cell therapy, called LB2102, and could send Legend up to $1 billion more if clinical, regulatory and commercial milestones are met. Legend will complete Phase 1 testing, after which Novartis will assume development responsibilities.
    • “Legend said Novartis may use in its development plan its new T-Charge manufacturing platform, which aims to reduce the time it takes to make cancer-fighting cells outside the body as well as improve their durability. Cell therapies like Novartis’ Kymriah can induce long-lasting responses in patients, but they require a weeks long manufacturing process that carries the risk of failure or patient progression.”

Thursday Miscellany

David Ermer–ACA, Congress, COVID-19, FDA, Federal employment benefits, Medical / Rx research, No Surprises Act, OPM, Rx coverage, U.S. Healthcare–
Photo by Josh Mills on Unsplash

From Washington, DC,

  • Roll Call reports,
    • “Republicans yanked another fiscal 2024 spending bill before a final vote scheduled for Thursday morning, leaving them empty-handed for the week and stuck at seven out of 12 annual appropriations bills passed.
    • “The $25 billion Financial Services bill [which funds OPM and the FEHBP] ran into trouble with GOP moderates over language that would block the District of Columbia from implementing its 2014 law preventing employment discrimination based on reproductive health decisions, including taking birth control or having an abortion.
    • “The simple analogy is they didn’t have the votes. Shocking,” said Rep. Ryan Zinke, R-Mont., who backs the bill. “Monday, we’ll see if we can have a consensus over the weekend for those people that have a problem with what I think is a very straightforward bill.”
    • “Another issue which contributed to the measure’s demise Thursday, according to a source familiar with the decision, was conservative opposition to allowing the General Services Administration to implement its plan to build a new FBI headquarters in Greenbelt, Md.”
  • As Rosanna Rosannadana would say, “If it’s not one thing, it’s another.”
  • The Society for Human Resource Management informs us,
    • “Employees can funnel an extra $150 into their health flexible spending accounts (FSAs) next year, the IRS announced Nov. 9.
    • “The annual contribution limit is rising to $3,200 in 2024, up from $3,050 in 2023. The hike is still significant, although it’s a smaller boost than the $200 hike seen this year.
    • “If the employer’s plan permits the carryover of unused health FSA amounts, employees can carry over up to $640 in 2024. That’s up $30 over the 2023 carryover amount, which is $610.”
  • Here’s a link to the IRS’s complete list of 2024 inflation adjustments to tax items.
  • STAT News tells us that the Ground Ambulance Committee created by the No Surprises Act wants to cap the cost-sharing for people who use ground ambulances at $100 per trip. The catch is that they have difficulty deciding how much health plans should pay for ground ambulance services.
    • “Some experts say a Medicare benchmark is the simplest administrative solution. Medicare’s payment system for ambulances is outdated, but it’s based on some measure of costs. But that shift would result in a lot of upheaval, especially for ambulance providers that currently are able to bill and collect large sums of money from the biggest insurance companies. * * *
    • “Early next year, the federal ambulance committee will deliver its recommendations to Congress. Key lawmakers have not shown a lot of interest in taking up surprise billing again because it requires a lot of political capital to confront the ambulance and insurance industries.”

In FEHBP news,

  • FedSmith offers its strategy for approaching the FEHB open season which begins next Monday.
  • FedWeek discusses coordinating benefits between FEHB plans and Medicare. The best resource is OPM’s chart found in Section 9 of every FEHB plan’s brochure.

From the public health and research front,

  • The Wall Street Journal reports,
    • “A team of New York surgeons has performed the world’s first whole-eye transplant on a human, a breakthrough that could change vision treatments even though the patient hasn’t regained sight in the grafted eye. 
    • “In the six months since the eye surgery was performed, in conjunction with a partial face transplant, the 46-year-old patient has shown promising signs of health in the eye, the surgical team at NYU Langone Health said Thursday. 
    • “The grafted eye is maintaining normal ocular pressure and has direct blood flow to the retina, the area at the back of the eye that receives light and sends images to the brain. It isn’t known if the patient will regain his sight, but the transplant is still a significant accomplishment, according to Dr. Eduardo D. Rodriguez, director of the Face Transplant Program at NYU Langone.  
    • “We’ve made one major step forward and have paved the way for the next chapter to restore vision,” Rodriguez said. Rodriguez led the May surgery, which lasted 21 hours and included more than 140 surgeons, nurses and other healthcare professionals.” 
  • The Food and Drug Administration announced,
    • “approving Adzynma, the first recombinant (genetically engineered) protein product indicated for prophylactic (preventive) or on demand enzyme replacement therapy (ERT) in adult and pediatric patients with congenital thrombotic thrombocytopenic purpura (cTTP), a rare and life-threatening blood clotting disorder.”
  • and
    • “approving Ixchiq, the first chikungunya vaccine. Ixchiq is approved for individuals 18 years of age and older who are at increased risk of exposure to chikungunya virus.
    • “The chikungunya virus is primarily transmitted to people through the bite of an infected mosquito. Chikungunya is an emerging global health threat with at least 5 million cases of chikungunya virus infection reported during the past 15 years. The highest risk of infection is in tropical and subtropical regions of Africa, Southeast Asia, and parts of the Americas where chikungunya virus-carrying mosquitos are endemic. However, chikungunya virus has spread to new geographical areas causing a rise in global prevalence of the disease.” 
  • and
    • clearing for marketing the first over-the-counter (OTC) antigen test for COVID-19. ACON Laboratories’ Flowflex COVID-19 Antigen Home Test, originally authorized for emergency use in 2021, is now the second home COVID-19 test to successfully complete a traditional FDA premarket review pathway, and the first indicated for use in children under 18. Today’s announcement follows clearance of a molecular home test earlier this year.
  • Per Beckers Hospital Review,
    • “Pneumonia patients who took an antibiotic that’s typically reserved as an alternative were less likely to develop Clostridioides difficile infections compared to those taking the recommended drug, according to a study from Veterans Affairs Hospitals. 
    • “The retrospective study analyzed 156,107 patients treated for pneumonia at a VA hospital between 2009 and 2022. Overall, less than 1% of pneumonia patients were diagnosed with a C. diff infection, but among those who had C. diff in the year before contracting pneumonia, 12% developed a new C. diff infection associated with their antibiotic treatment. 
    • “Clinical guidelines recommend azithromycin, and nearly 9 in 10 of the patient cohort received the drug. Of the 13% who received doxycycline, the alternative antibiotic, the drug was associated with reducing C. diff infections by 45%. 
    • “The researchers concluded that, if Legionella pneumonia can be ruled out, clinicians might consider doxycycline as a first-line treatment over azithromycin.”
  • The Wall Street Journal notes,
    • “There is hope for those of us who live (and sleep) in the real world: Getting less than 8 hours of shut-eye a night doesn’t mean you’re doomed to an early grave.
    • “A recent study looking at sleep and longevity found that sleep “regularity”—going to bed and waking up at consistent times with few mid-slumber interruptions—matters more than how long you sleep. Sleeping six hours every night on a consistent schedule was associated with a lower risk of early death than sleeping eight hours with very irregular habits.
    • “The study adds to a growing understanding of the links between sleep and longevity. Research in recent years has shown not only how important sleep is for health and lifespan, but also that the duration of sleep isn’t the only thing that matters.”

From the U.S. healthcare business front,

  • Healthcare Dive points out,
    • “For-profit hospital operators strained by physician fees, payer relations in the third quarter of 2023. Except for HCA, the biggest U.S. health systems all reported lower year-over-year profits in the third quarter.”
  • and
    • “More than 85,000 Kaiser Permanente healthcare workers have a new four-year contract with the nonprofit system after union members overwhelmingly voted to ratify a compromise reached in October following months of labor negotiations and a high-profile strike.”
  • and
    • “Virgin Pulse announced on Thursday it closed its merger with third-party health plan administrator HealthComp. Private equity firms New Mountain Capital and Marlin Equity Partners are new majority and minority owners of the company, respectively, according to a release.”
  • Per Fierce Healthcare,
    • “Optum Rx is shifting eight different insulin products to its preferred formulary in a bid to address affordability, the company said Thursday.
    • “The product selection includes all rapid-acting and short-acting insulin products and some long-acting insulins, according to the announcement. It includes insulins manufactured by Sanofi, Novo Nordisk and Eli Lilly.
    • “Optum’s Tier 1 includes the lowest cash prices that its members will pay, the company said.”
  • and
    • A BCBSA study concludes that the Affordable Care Act’s risk adjustment system works, notwithstanding noteworthy failures.
  • The Wall Street Journal reports,
    • “AstraZeneca raised its full-year guidance for core earnings per share and total revenue excluding Covid-19 medicines despite a lower third-quarter profit that missed forecasts after booking a tax charge compared with a credit for the comparable period.
    • “The Anglo-Swedish pharmaceutical giant said Thursday that it expects core earnings per share to increase by a low double-digit percentage compared with previous guidance of a high single-digit to low double-digit percentage increase.
    • “Total revenue excluding COVID-19 medicines is now expected to increase by a low-teens percentage at constant-exchange rates compared with previous expectations of low double-digit percentage growth.
    • “Total revenue is expected to increase by a mid-single-digit percentage compared with previous guidance of low-to-mid single-digit, it said.”

Tuesday Tidbits

David Ermer–CDC, Congress, FDA, Federal employment benefits, Generative AI, Medical / Rx research, NIH, OPM, Rx coverage, U.S. Healthcare–
Photo by Patrick Fore on Unsplash

From Washington, DC,

  • Roll Call informs us,
    • “House Republicans are aiming to reach a consensus this week on a stopgap funding measure that would get a vote next week before the current continuing resolution runs out on Nov. 17.
    • “During a Monday night leadership meeting, Speaker Mike Johnson, R-La., floated a “laddered CR” that would extend funding for four bills through Dec. 7 and the rest through Jan. 19. Johnson said Tuesday after meeting with the GOP conference that a stopgap bill running into January “with certain stipulations” is also on the table.
    • “The new speaker said he would be revealing his spending plan “in short order” but did not share any details Tuesday morning after House Republicans met to discuss the options. However, Senate Democrats are pushing for a stopgap measure into early December, with Dec. 8 as the preferred end date, according to sources familiar with the consideration.”
  • The Washington Post reports,
    • “The Senate on Tuesday voted 62 to 36 to confirm cancer surgeon Monica M. Bertagnolli as the director of the National Institutes of Health, ensuring that America’s flagship biomedical agency will have a permanent leader following a months-long dispute involving a key senator that threatened to derail her nomination.
    • “Bertagnolli will be the second woman ever to lead the nearly $48 billion agency, which plays a central role in the U.S. scientific agenda by funding grants to hundreds of thousands of researchers, overseeing clinical trials on its Maryland campus and supporting other endeavors to develop drugs and therapeutics.”
  • The U.S. Preventive Services Task Force gave brand new “inconclusive” recommendations to the following services:
    • The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of routine screening performed by primary care clinicians for oral health conditions, including dental caries or periodontal-related disease, in adults.
    • The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of routine screening performed by primary care clinicians for oral health conditions, including dental caries, in children and adolescents aged 5 to 17 years.
  • Federal News Network points out,
    • “In October, 6,924 new [federal and postal retirement] claims were filed, an increase of 156 more than September. OPM also processed fewer retirement claims last month. The agency said it processed 6,098 claims, a  2,781 drop from the previous month.
    • “Initial retirement cases in October completed in less than 60 days on average took 42 days to process, up 2 days from the previous month, while initial cases that were processed in more than 60 days on average took 113 days.  That’s a 9 day improvement from September.
    • “Along with the increase of the claims backlog, the monthly average processing time in days grew from 70 to 73. But there is some good news: The fiscal year-to-date average processing time in days decreased from 77 to 73 days in October.”

In FEHBP news,

  • Per the Federal Times,
    • “Millions of federal employees and their family members will be able to shop for health benefits beginning Monday. 
    • “Open enrollment, spanning for four weeks, could overlap with a government shutdown if Congress fails to extend the current continuing resolution or pass a spending package by next Friday. More than a month into fiscal 2024, the government is still operating on last year’s funding levels after Congress passed a last-minute stopgap bill on Sept. 30.
    • “As the name implies, a shutdown means that many agency offices close and employees whose work is outside of national security, health and “life or death” services are sent home without pay. However, the office that oversees the Federal Employee Health Benefits program and open season is funded by a trust that does not rely on annual appropriations.
    • “There are sufficient amounts in these trust funds to operate them throughout the duration of any lapse in appropriations,” according to the White House’s Office of Personnel Management.
    • “Thus, employees will be able to participate in open season in the event of a shutdown. And coverage will not lapse during this time either, either for medical or dental and vision.”
  • Federal News Network considers, in consultation with Kevin Moss from Consumers’ Checkbook, “six reasons feds why should take a look [at available FEHB plans] during Open Season this year.”

From the public health and research front,

  • The American Hospital Association News tells us,
    • “Over 3,700 babies were born with syphilis in 2022, 32% more than in 2021 and 10 times more than in 2012, the Centers for Disease Control and Prevention reported Nov. 7. Almost 9 in 10 cases last year could have been prevented with timely testing and adequate treatment, the agency said, and urged emergency departments, syringe service programs, prisons/jails and maternal and child health programs to use rapid syphilis testing and treatment during pregnancy and other settings to consider immediate treatment if a patient tests positive and faces obstacles to ongoing care.
    • “The congenital syphilis crisis in the United States has skyrocketed at a heartbreaking rate,” said CDC Chief Medical Officer Debra Houry, M.D. “New actions are needed to prevent more family tragedies. We’re calling on healthcare providers, public health systems, and communities to take additional steps to connect mothers and babies with the care they need.” 
  • The National Institutes of Health announced,
    • “In a small study, researchers at the National Institutes of Health have found that positron emission tomography (PET) scans of the heart may identify people who will go on to develop Parkinson’s disease or Lewy body dementia among those at-risk for these diseases. The findings, published in the Journal of Clinical Investigation and led by scientists at the National Institute of Neurological Disorders and Stroke (NINDS), part of NIH, may advance efforts to detect the earliest changes that years later lead to Parkinson’s disease and Lewy body dementia.
    • “In 34 people with Parkinson’s disease risk factors, researchers conducted PET scans of the heart to gain insight into levels of the neurotransmitter norepinephrine. They found that the scans could distinguish individuals who would later be diagnosed with Parkinson’s or Lewy body dementia—both are brain diseases caused by abnormal deposits of the protein alpha-synuclein that form clumps known as Lewy bodies. The research was conducted at the NIH Clinical Center, currently the only location for F-dopamine PET scanning.”
  • The Wall Street Journal reports on ways to control sugar consumption
    • People assume they can build up the willpower to completely avoid sweets or restrict them to tiny amounts, but cutting them out increases the chances of overeating later, says Dr. Judson Brewer, a neuroscientist and psychiatrist at Brown University and author of a forthcoming book about eating habits. 
    • “Willpower is more myth than muscle,” says Brewer.
    • “Unsurprisingly, a fully permissive approach to sugar won’t work for kids, says Crystal Karges, a San Diego-based dietitian who works with families. Still, she doesn’t encourage restriction. One strategy she suggests is to offer sweets alongside regular meals in order to normalize the treats. 
    • “Brewer, the neuroscientist, suggests another alternative to restricting yourself: Find your “pleasure plateau.” Rather than cutting out treats entirely, train yourself to pay close attention to how a treat is tasting as you eat it and note when you stop enjoying the taste of it. 
    • “Practicing attentive eating or mindfulness over time can help your body feel the rewards of limiting sugar consumption, which can be anything from having more energy to fewer cravings to weight loss, Brewer says. 
    • “Keeping your home well-stocked with healthy snacks, alongside indulgent treats, is helpful. In her own home, [University of Minnesota professor Dianne] Neumark-Sztainer says roughly 70% of the food options are nutritious and lack added sugar, including whole grains, fruits and vegetables. 
    • “She doesn’t recommend most people count the amount of sugar they eat each day, which can increase anxiety. “Try to look at the whole picture and not to make a big deal about it,” she says.”

From the U.S. healthcare business front,

  • Per STAT News,
    • “Sage Therapeutics set the price of Zurzuvae, its recently approved treatment for postpartum depression, at $15,900 for a 14-day course of therapy. The once-daily pill will be launched in December, co-marketed with Biogen. 
    • “Eisai reported sales of 300 million yen ($2 million) for Leqembi, its treatment for Alzheimer’s disease, in the company’s fiscal second quarter. Approximately 800 people were receiving treatment with Leqembi as of Oct. 27, the company said.” 
  • Beckers Payer Issues ranks the major health insurers by third-quarter medical loss ratios.
  • Per Healthcare Dive,
    • “E-prescribing giant Surescripts has acquired ActiveRADAR, a company that aims to find cheaper medication alternatives.
    • “ActiveRADAR, formerly known as RxTE Health, evaluates drugs in 165 therapeutic categories to identify clinical equivalents, then uses health plan-specific data to determine alternative medications that could reduce costs for employers and patients, according to the company.
    • “The deal, announced on Monday, makes ActiveRADAR a wholly owned subsidiary of Surescripts, according to a company spokesperson. Terms of the deal weren’t disclosed.”
  • Forbes offers “Five considerations for health plan leaders using AI-enabled prior authorization and utilization management.”