Thursday Miscellany

Thursday Miscellany

Photo by Juliane Liebermann on Unsplash

OPM has posted an announcement about the beginning of the Federal Benefits Open Season which kicked off last Monday and the NIH Director Dr. Francis Collins offers guidance on how to celebrate the upcoming holidays with exposing yourself to COVID-19.

To illustrate that the Pfizer COVID-19 game in town vaccine is not the only game, Fierce Healthcare offers articles on two candidate which offer greater pre-administration stability, one by CureVac and the other by Johnson & Johnson.

Leaning on its years of experience, the drugmaker is well on its way to producing 1 billion doses of its COVID-19 vaccine in 2021 and is looking ahead to 2022, said Paul Lefebvre, VP of strategic initiatives and COVID-19 vaccine supply chain at J&J’s Janssen unit, in an interview. 

J&J’s shot could have a storage and distribution edge over the likes of those from Pfizer and BioNTech, Lefebvre thinks. 

“In our plans, we will bring our product at -20° C into the J&J warehouses around the world,” he said.

J&J’s shot is expected to remain stable for up to two years at that temperature, about -4° Fahrenheit. Once it goes out to distributors and customers, it can be kept stable at 2 to 8° Celcius (a range of about 35.6° to 46.4° Fahrenheit) for up to three months, not much colder than your average refrigerator, Lefebvre said. 

As previously noted, the COVID vaccine manufacturers will seek emergency use authorization (“EUA”) from the Food and Drug Administration follow the completion of the phase III trial. Phrma, the drug manufacturer trade association, provides readers with an understanding of FDA EUA.

The FDA may issue an EUA, when, among other things, the agency determines that based on all of the available scientific evidence, the known and potential benefits of the vaccine outweigh the known and potential risks. To underscore this, FDA Commissioner Stephen Hahn has said repeatedly in recent weeks and months that the agency would only consider an EUA if it felt the risks associated with the vaccine were “much lower than the risks of not having a vaccine and the potential benefit of having a vaccine.”

The agency has further taken steps to ensure the robust vaccine candidate review process by engaging the Vaccines & Related Biological Products Advisory Committee (VRBPAC) to discuss the development and potential authorization of vaccines to prevent COVID-19 after issuing guidance on FDA’s recommendations for an EUA submission for a COVID-19 vaccine.­

The Department of Health and Human Services announced today its partnerships with chain and independent pharmacies to administer the COVID vaccines as the vaccines received EUA and are made available to the public under the government allocation plan, which kicks off with first responders.

In prescription drug benefit news,

  • Drug Channels is offering its “annual deep dive into employer-sponsored coverage for prescription drugs,” and
  • Good Rx unveils the 2021 changes in popular CVS Health and Express Script formularies.

Finally, the FEHBlog wants to call attention to Katie Keith’s excellent analysis of last Tuesday’s Supreme Court argument in the California v. Texas case. Although Ms. Keith does not project an outcome, the FEHBlog is comfortable stating that the Supreme Court will preserve the Affordable Care Act for the third time, except perhaps for the zeroed out individual shared responsibility provision, which already is a dead letter.

Monday Roundup

Photo by Sven Read on Unsplash

Perhaps at last we are beginning to see the light at the end of the COVID-19 tunnel. Pfizer announced positive initial results from the phase three trial of its two dose COVID-19 vaccine.

“Today is a great day for science and humanity. The first set of results from our Phase 3 COVID-19 vaccine trial provides the initial evidence of our vaccine’s ability to prevent COVID-19,” said Dr. Albert Bourla, Pfizer Chairman and CEO. “We are reaching this critical milestone in our vaccine development program at a time when the world needs it most with infection rates setting new records, hospitals nearing over-capacity and economies struggling to reopen. With today’s news, we are a significant step closer to providing people around the world with a much-needed breakthrough to help bring an end to this global health crisis. We look forward to sharing additional efficacy and safety data generated from thousands of participants in the coming weeks.”

The Wall Street Journal explains (in part) that ‘

“When will the Pfizer vaccine be ready for [emergency use] authorization?

“It will be several more weeks at the earliest, because researchers and regulators still need to make sure the shot is safe. The U.S. Food and Drug Administration has said it wants to see two months’ worth of safety outcomes after vaccination for at least half of the people participating in any large, final-stage clinical trial before it considers authorizing a Covid-19 vaccine. The FDA says this will allow identification of any side effects, such as neurological or heart conditions, that weren’t apparent immediately after vaccination. So far, no serious safety issues have been found, Pfizer says. It expects the two months of safety data later this month, and can ask the FDA to authorize the vaccine soon thereafter. It isn’t yet clear how long the FDA will take to make a decision.

“When will people start getting vaccinated?

“Shots from Pfizer and BioNTech could start becoming available before the end of the year, as production has already begun, but initial supplies will be limited. Pfizer says it expects to produce up to 50 million doses globally in 2020—enough for 25 million people because the vaccine is given in two doses—and up to 1.3 billion doses in 2021. This means only the highest risk groups, such as front-line health care workers, could be inoculated this year. Many more doses would be needed to cover the U.S. and global population. Other Covid-19 vaccines in development will likely be needed for everyone to get vaccinated. Their makers have projected they could produce billions of doses next year if their vaccines are successful in clinical testing.”

The Centers for Disease Control released a study of hospital readmissions of COVID-19 patients from March through July 2021.

Among 126,137 unique patients with an index COVID-19 admission during March–July 2020, 15% died during the index hospitalization. Among the 106,543 (85%) surviving patients, 9% (9,504) were readmitted to the same hospital within 2 months of discharge through August 2020. More than a single readmission occurred among 1.6% of patients discharged after the index hospitalization.

The CDC also offered us guidance on avoiding COVID-19 during the Thanksgiving holidays.

The Centers for Medicare and Medicaid Services (“CMS”) released Affordable Care Act medical loss ratio rebate data from the latest health insurer reports for the three year period ending in 2019. The medical loss ratio data is broken out into three cohorts — individual insurance (minimum MLR 80%), small group insurance (minimum MLR 80%), and large group insurance (minimum MLR 85%). Each cohort then is further broken down state by state which no doubt increase the rebates. FEHB plan insurer rebates sensibly are paid to the the carrier’s contingency reserve, which is FEHB lingo for a premium stabilization fund.

Katie Keith in the Health Affairs blog offers her insights into tomorrow’s California v. Texas oral argument before the U.S. Supreme Court. C-SPAN will play the audio live on radio and the internet.

“The main issues to listen for are:

  • “Do the challengers—a coalition of states led by Texas and two individuals—have standing to challenge the ACA?
  • “Is the individual mandate, with a $0 penalty, unconstitutional?
  • “If the mandate is unconstitutional, is it severable from the rest of the ACA? If not, which other ACA provisions should be struck down alongside the mandate?”

Weekend Update

The House and the Senate are resuming some Committee work this coming week. The Senate may be conducting floor votes but the House will not resume floor voting until next week. Wednesday November 11 is a federal holiday for Veterans’ Day.

Tuesday morning will feature the oral argument in the latest Affordable Care Act constitutionality case, California v. Texas (No. 19-840). The argument will proceed as follows beginning at 10 am:

  • 30 minutes for California, et al.,
  • 10 minutes for the U.S. House of Representatives,
  • 20 minutes for the Solicitor General, and
  • 20 minutes for Texas, et al. 

Of course, the FEHBlog will be listening to the oral argument and he will report his observations on Tuesday. The FEHBlog enjoys the live audio version of the Supreme Court’s oral arguments because the Justices ask questions in order of seniority following the Chief Justice. If you want to listen in too, here’s a link to C-SPAN website which will send you a reminder if you share your email address.

The Centers for Medicare and Medicaid Services did fix their broken link to the 2021 Medicare premium and cost-sharing changes fact sheet over the weekend. Here’s an active link for your information.

Of course, the Federal Benefits Open Season begins tomorrow and runs through December 14. Good luck to all.

Kaiser Permanente released its third quarter 2020 financial results last Friday.

“Although the pandemic continues to have an impact on Kaiser Permanente, during the third quarter we safely resumed in-person preventive and elective care, started to address the backlog of deferred procedures that were put on hold due to COVID-19, and continued to leverage and grow virtual care for members’ safety and convenience,” said executive vice president and chief financial officer Kathy Lancaster.

NPR Shots offers a useful overview of COVID-19 cases and deaths similar to the CDC and it offers a preview of the Biden Administration’s approach to the pandemic.

On Monday, I will name a group of leading scientists and experts as transition advisers to help take the Biden-Harris COVID plan and convert it into an action blueprint that starts on Jan. 20, 2021,” Mr Biden said last night in a public address.

A Biden spokesperson told NBC’s Meet The Press Sunday that the coronavirus task force will be led by former Surgeon General Dr. Vivek Murthy and Dr. David Kessler, who led the Food and Drug Administration during the 1990s.

“We have to function as one nation. That means having a national plan,” Dr. Murthy, a key adviser to the Biden campaign, told NPR recently.

Thursday Miscellany

Photo by Juliane Liebermann on Unsplash

The Senate Judiciary Committee sent Judge Amy Coney Barrett’s Supreme Court nomination to the Senate floor today. The Senate will confirm the nomination on Monday and Judge Barrett will be sworn in soon thereafter. Consequently, Judge Barrett will be sitting on Supreme Court bench when the Court hears the Affordable Care Act constitutionality case on November 10. The FEHBlog predicts a 9-0 decision in favor of the law’s constitutionality with the exception of the zeroed out individual mandate.

On the COVID-19 front, Medscape reports as follows:

  • The Food and Drug Administration gave marketing approval to Gilead Science’s “remdesivir (Veklury) today as a treatment for hospitalized COVID-19 patients age 12 and up, making it the first and only approved treatment for the disease.”
  • The Centers for Disease Control updated its COVID-19 social distancing guidance: “Previously, the CDC cautioned against spending 15 minutes or longer in close proximity to an infected person, particularly in enclosed indoor spaces. In a new report published online October 21 in Morbidity and Mortality Weekly Report, however, investigators ‘determined that an individual who had a series of shorter contacts that over time added up to more than 15 minutes became infected.'”
  • Dr. Anthony Fauci predicts that “People will likely need to wear masks and follow social distancing guidelines through the end of 2021 and into 2022.”

Healthcare Dive informs us about four healthcare story lines that COVID-19 has overshadowed this year — — 1. Price transparency going strong; 2. Companies rush to go public; 3. Surprise billing efforts slow to a crawl, and 4. preference for healthcare at home. The FEHBlog is pleased to reflect that he has been discussing these matters and COVID-19 this year.

Govexec reports on the eight most important birthdays for federal employees from a federal employee retirement standpoint — the birthdays range from ages 50 to 72

The Society for Human Management provides a comprehensive update on employer and health plan sponsored wellness programs which is worth a gander.

Beckers Hospital Review alerts us that “Healthgrades named the recipients of its 2021 Specialty Excellence Awards Oct. 20, which include the top hospitals for critical care.” The article lists the 214 award winners by state.

Saturday October 24 is National Prescription Drug Take Back Day. “Check DEA’s official Take Back Day website for more information and to find year-round collection sites near you.”

Finally in a man bites dog story, the Wall Street Journal headlines tonight on its website that “Walmart sued the federal government in an attempt to strike a pre-emptive blow against what it said is an impending opioid-related civil lawsuit from the Justice Department.” Best defense, etc. The article notes that “Quicken Loans Inc. tried a similar tactic against the federal government in 2015 to avoid being pegged with mortgage fraud, but the Justice Department sued weeks later in a case Quicken settled last year.” The FEHBlog expects the same outcome with this lawsuit.

Weekend update

Note: The third time is charm. The correct version of OPM’s 2021 Non-Postal Nationwide / FFS Plan Premium chart is now linked to Friday’s note. Thanks readers.

To compensate for this inconvenience, the FEHBlog has attached his treasured actual maximum FEHB government contribution chart 2016-2021. If a plan’s premium is below the maximum government contribution, prescribed by 5 USC Sec. 8906, then plan annual premium increase is covered by the government contribution increase. If, however, the plan’s premium is above the maximum government contribution, the “shield” typically vanishes. As a result, the “above the max” plan’s annual premium changes are quite visible to the member. The maximum government contribution helps tamp down premium increases in this competitive program. The purpose of the chart is to illustrate the fact that the CPI-U is a useful proxy for maximum government contribution changes.

Onto the Weekend Update

The Senate is open for voting and committee work this week. On Thursday morning, the Senate Judiciary Committee will vote on Judge Amy Coney Barrett’s Supreme Court nomination. The House remains on the campaign trail although, according to the Hill, the Speaker has warned the Administration that she will stop negotiating a pre-election COVID-19 relief bill unless a compromise is reached early this week. Turnabout is fair play.

On the COVID-19 vaccine front —

Alex Gorsky, chief executive of Johnson & Johnson, remains upbeat about the possibility of a COVID-19 vaccine arriving as early as this year, despite the health care giant suspending a late-stage clinical trial for one of its own candidates after a patient fell ill this week. “If you just look at the sheer number of compounds that are in development right now, there is a very good probability that late this year or early next year, we will have options for vaccines.”

  • The Department of Health and Human Services announced on Friday that “agreements with CVS and Walgreens to provide and administer COVID-19 vaccines to residents of long-term care facilities (LTCF) nationwide with no out-of-pocket costs.” “The pandemic has inflicted a devastating toll on America’s nursing home residents,” said Centers for Medicare and Medicaid Services Administrator Seema Verma. “That’s why the Trump Administration has taken unprecedented action to protect them in every possible way. This effort will ensure they are at the front of the line for the COVID vaccine and will bring their grueling trial to a close as swiftly as possible.”

On Saturday, according to CNN, the President signed into law a Congressionally approved bill that converts the national suicide hotlines ten digit number 1-800-273-8255 (TALK) to a three digit number 988. The Federal Communications Commission has ordered voice service providers to make the new three digit number available to subscribers by July 16, 2022.

The Centers for Medicare and Medicaid Services released the result of a Medicare beneficiary survey on the impact of COVID-19. It’s a survey of interest to FEHB plans because there is a large cadre of Medicare prime annuitants enrolled in their plans.

21% of Medicare beneficiaries report forgoing non-coronavirus disease 2019 (COVID-19) care due to the pandemic, and nearly all – 98% – of beneficiaries have taken preventative measures to keep themselves safe from the virus.

According to the survey, the most common type of forgone care because of the pandemic was dental care (43%), followed by regular check-up (36%), treatment for ongoing condition (36%), and diagnostic or medical screening test (32%). The most common reason cited for forgoing care was not wanting to risk being at a medical facility (45%).

“An infographic with a snapshot of the survey results is here.  A link to the public use file detailing the survey results is here.”

On the other side of the aging spectrum the Wall Street Journal reports on millennials agreeing to marry in part so that one partner can access the other partner’s employer sponsored health insurance. This has been happening for a long time. What’s interesting to the FEHBlog is that employer sponsored plans, not ACA marketplace plans , are viewed as the life raft.

Friday Stats and More

Based on the Centers for Disease Control (CDC) Cases in the U.S. website, here is the FEHBlog’s chart of new weekly COVID-19 cases and deaths over the 20th through 40th weeks of this year (beginning May 14 and ending October 7; 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:

Because the FEHBlog does look at his charts which are intended to show trends, he realized that new deaths chart is flat because new cases greatly exceed new deaths. Accordingly here is a chart of new COVID-19 deaths over the same period (May 14 through October 7 (nearly five months).

Chris Conover recently wrote about your risk of dying from COVID-19 in the Forbes Apothecary. Three takeaways from the article:

  • Covid-19 has increased the risk of death for the average American by about 10 percent, but this increase in risk is much higher for seniors than children.
  • For seniors age 70 and older, getting Covid-19 is riskier than climbing Mt. Everest; in contrast, for those under age 20, the infection fatality risk is equivalent to driving a car for 7,500 miles.
  • Those under age 50 who get infected with the coronavirus lose less than one day of discounted quality-adjusted life expectancy; seniors age 70 or older lose nearly 90 days.

Today the CDC released the first weekly influenza update for this flu season in our country. The key update is brief: “Seasonal influenza activity in the United States remains low.” In contrast, the key update from this week’s COVID-19 update from the CDC is more nuanced:

Nationally, indicators that track COVID-19 activity continued to decline or remain stable (change of ≤0.1%). However, one region reported a slight increase in the percentage of specimens testing positive for SARS-CoV-2 and four regions reported slight increases in the percentage of visits for influenza-like illness (ILI). Mortality attributed to COVID-19 declined but remains above the epidemic threshold.

Today, the CDC also issued its National Action Plan for Combating Antibiotic Resistance 2020-2025, a worthy goal. “The U.S. Government will report annually on progress toward the objectives set in the Plan.”

In his Libertarian podcast this week, law professor Richard Epstein discussed why the Supreme Court will uphold the constitutionality of the Affordable Care Act in the California v. Texas case, which will be argued on November 10. The FEHBlog is buying what the good professor is selling. The discussion is in the first 10 minutes of the podcast which is less than 30 minutes overall.

The HHS Office for Civil Rights took its second scalp this week from a healthcare provider that allegedly failed to give patients HIPAA required access to their medical records, a big OCR priority. “NY Spine Medicine (NY Spine) has agreed to take corrective actions and pay $100,000 to settle a potential violation of the HIPAA Privacy Rule’s right of access provision. NY Spine is a private medical practice specializing in neurology and pain management with offices in New York, NY, and Miami Beach, FL.”

Have a good weekend.

Tuesday Tidbits

The Wall Street Journal reported this afternoon that the President has “endorsed the U.S. Food and Drug Administration’s [“FDA”] plans for assessing whether a Covid-19 vaccine should be given to the public, making it likely that a shot won’t be cleared until after the election, people familiar with the matter said.” Here is a link to that FDA guidance which was issued today. The FEHBlog also has confidence in the FDA.

The Journal also reports that the President has called off further COVID-19 relief bill negotiations between the Speaker of the House and the Treasury Secretary until after the November 3 election which is four weeks away.

Mr. Trump said he had instructed Senate Majority Leader Mitch McConnell (R., Ky.) to focus his efforts on confirming his Supreme Court nominee Amy Coney Barrett, whose Judiciary committee hearings start Monday, rather than the stimulus effort.

Mr. McConnell said that he agreed with Mr. Trump’s decision.

“I think his view was that they were not going to produce a result and that we needed to concentrate on what’s achievable,” he told reporters.

In other inside the Beltway news, the FEHBlog this morning listened to the oral argument before the U.S. Supreme Court in the ERISA preemption case involving an Arkansas law governing prescription benefit manager pricing practices. Rutledge v. PCMA (No. 18-540) — the recording of the argument is available here.

At issue is a U.S. Court of Appeals decision holding that ERISA preempted this Arkansas law. The counsel for the State of Arkansas, supported by the U.S. Solicitor General, argued that ERISA does not preempt a state law that regulates health care pricing. However, the counsel for PCMA countered, successfully in the FEHBlog’s view that the Arkansas law was not merely a pricing requirement. Rather it was loaded with administrative requirements. If the Supreme Court were to reverse the Eight Circuit, then there are forty states at last count that would be able to impose their pricing and procedural requirement on employer-sponsored health plans, which outcome likely would wind up encompassing the FEHBP.

PCMA’s counsel described that outcome as an administrative nightmare for ERISA plans. He directed the Court’s attention to the amicus brief filed by a nationwide employer based in Arkansas, J.B. Hunt.

For example, if an over-the-road truck driver for J.B. Hunt maintains two separate residences in Arkansas and California, which state PBM law applies? Many Arkansas communities straddle border states (e.g., West Memphis, Texarkana, Ft. Smith, Rogers). What if a J.B. Hunt employee resides in a border state but fills prescriptions across the border in Arkansas— or vice-versa? What if a Minnesota-based over-the- road truck driver needs to fill a prescription while passing through Arkansas, and now the Plan has to process and pay the claim under two different sets of laws?

ERISA and FEHBA state law preemption are in place to permit uniform nationwide administration of these employer sponsored plans. The Supreme Court will issue a decision before the end of June 2021.

Monday Roundup

Photo by Sven Read on Unsplash

In COVID-19 vaccine news —

  • The American Hospital Association has a COVID-19 vaccine resources and information website.
  • PharmaManufacturing is reporting that ” Pfizer’s CEO recently stated that the company could be ready to submit data from a late-stage trial of its coronavirus vaccine by the end of October — but experts are urging the company to slow its roll. According to Bloomberg Law, more than 60 bioethicists and researchers have penned a letter asking Pfizer to delay data reporting until November.” Why not let the Food and Drug Administration do its job?

In COVID-19 rapid testing news, HHS announced today a detailed “national distribution plan for the Abbott BinaxNOW Ag Card rapid test to assist Governors’ efforts to continue to safely reopen their states. BinaxNOW is a unique testing option to provide support to K-12 teachers and students, higher education, critical infrastructure, first responders, and other priorities as governors deem fit. The BinaxNOW rapid test – the only U.S. Food and Drug Administration-authorized antigen rapid point-of-care test that does not require an instrument – is easy to use, will produce COVID-19 test results in 15 minutes, and costs $5. * * * The Federal government purchased these Abbott BinaxNOW diagnostic tests on August 27, 2020, to ensure equitable distribution of the first 150 million units – one day after an Emergency Use Authorization (EUA) was issued by the FDA to ensure they would be expeditiously distributed to vulnerable populations as quickly as possible.

In other news —

  • The Centers for Disease Control reported today about COVID-19 trends among school age children in our country. “Since March, 277,285 COVID-19 cases in children have been reported [out of seven million in total]. COVID-19 incidence among adolescents aged 12–17 years was approximately twice that in children aged 5–11 years.”
  • Healio reports on the multiple uses of telehealth beyond acute primary care. “[T]elehealth has been routinely incorporated in specialties such as psychiatry and asthma/allergy care, even prior to the COVID-19 era [‘PC”]. * * * Further, telemedicine allows for triage of patients with COVID-19 symptoms without requiring face-to-face visits to help direct next steps for testing and treatment. Telehealth can be effectively incorporated into oncology care — provided thoughtful and appropriate measures are taken.”
  • There has been a lot of press about the nomination of Judge Amy Coney Barrett to the Supreme Court following the sad occasion of Justice Ruth Bader Ginsburg’s death. It is quite likely that Judge Barrett will be sitting on the Supreme Court when the California v. Texas case is argued on November 10. Speculation is rife about this development and it is truly unfortunate that the Trump Administration is now siding with the States opposing the law’s constitutionality in the California v. Texas case. In the FEHBlog’s opinion, the position against the law’s constitutionality is a weak cup of tea. The FEHBlog is confident that the Supreme Court opted to hear the case to end this litigation in favor of the ACA’s general constitutionality. Congress obviously did not intend to render the ACA unconstitutional by zeroing out the individual mandate. The American Prospect observes

The whole legal argument [against the ACA’s constitutionality] depends on the fact that Republicans used reconciliation to pass the 2017 tax bill through the Senate with a simple majority. Due to the restrictions around reconciliation, Republicans couldn’t technically repeal the mandate in total, instead just lowering the penalty to nothing. The case effectively goes away if Congress either adds back in a penalty (even of just one cent), or just officially repeals the mandate, thereby severing it from the whole health care law.

Trying to bring back a penalty is a terrible option. The mandate is deeply unpopular, and it would be easy for Senate Republicans to oppose that move. What’s more, in the months since the mandate penalty went away, we’ve learned that it wasn’t as necessary to making the Obamacare system work as Democrats insisted in 2009 and 2010. Fully repealing the individual mandate, on the other hand, is an easy fight to win, as well as good policy. It is generally bad to have unenforced laws on the books.

Congress should take this action now by enacting an individual mandate repeal just as it repealed other ACA taxes in 2019. This is not to suggest that Congressional action is the only step that could save the law. But it would short circuit this craziness.

Tuesday Tidbits

The FEHBlog noted in the latest Weekend Update that the President had allowed pharmaceutical manufacturers until August 24 to present alternative to the President’s plan to tie American drug pricing to foreign benchmarks via executive order. As of August 22, the President was waiting for such a proposal. and according to STAT News today

The pharmaceutical industry is weighing two drug pricing policies that it could offer as a trade to President Trump, in exchange for his dropping a different proposal that drug makers detest, according to three drug industry lobbyists and a summary of the potential changes obtained by STAT.

In the meantime, the White House has not taken any action to implement this executive order.

On the COVID-19 front —

  • The Boston Globe reports that “An international meeting of Biogen leaders at a Boston hotel in February led to roughly 20,000 cases of COVID-19 in four Massachusetts counties by early May, far more than the 99 previously identified, according to three scientists involved in a new study.” Wow. That was a super spreader event for sure.
  • STAT News discusses “four scenarios on how we might develop immunity to Covid-19.” Interesting read.

Also other news from New England, Healthcare Dive informs us that

Google is investing $100 million in “Amwell, one of the biggest telehealth companies in the country, in a concurrent private placement with Amwell’s initial public offering, the two companies announced Monday. As part of the multiyear partnership, Amwell will become Google Cloud’s preferred telehealth platform and Amwell will migrate its video capabilities over to Google Cloud.”

Amwell is headquartered in Boston, Massachusetts.

Via AHRQ.gov, the FEHBlog ran across this recent study of “National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2017.” Here are the highlights:

In 2017, aggregate hospital costs for 35.8 million hospital stays totaled $434.2 billion.

The five most expensive inpatient conditions were septicemia, osteoarthritis, liveborn (newborn) infants, acute myocardial infarction, and heart failure. The 20 most expensive conditions accounted for slightly less than half of aggregate hospital costs.

The share of aggregate inpatient hospital costs by primary expected payer was 66 percent for Medicare and Medicaid combined, 27 percent for private insurance, and 3 percent for self-pay/no charge stays.

Septicemia ranked among the three most costly conditions in the hospital for all four expected payer groups

Conditions related to pregnancy and childbirth accounted for 4 of the top 20 most expensive conditions expected to be paid by Medicaid.

Medicaid was the only expected payer for which 3 of the top 20 most expensive conditions were related to mental and substance use disorders.

Finally, yesterday, the U.S. Supreme Court allocated oral argument time in Texas v. California case (No. 19-840) which raises the constitutionality of the Affordable Care Act for the third time before the Court.

The motions of the Solicitor General for divided argument and of the U.S. House of Representatives for enlargement of time for oral argument and for divided argument are granted, and the time is allotted as follows: 30 minutes for California, et al., 10 minutes for the U.S. House of Representatives, 20 minutes for the Solicitor General, and 20 minutes for Texas, et al. The motion of Ohio and Montana for leave to participate in oral argument as amici curiae, for enlargement of time for oral argument, and for divided argument is denied.

Midweek update

Healthcare Dive reports on the National Business Group on Health’s (“NBGH”) 2021 Large Employer Health Care Strategy and Plan Design Survey. This squib caught the FEHBlog’s eye:

Beyond expanding online mental health resources, respondents also mentioned interest in virtual care for musculoskeletal management conditions. Musculoskeletal conditions were most frequently cited by employers as contributing to rising health care costs, and 29% of those surveyed said they will offer musculoskeletal management virtually next year.

[NBGH President Ellen] Kelsay said virtual treatments for common joint conditions can help stave off unnecessary surgical interventions, and “now that we have a workforce that for many months has been working at home and probably not in the most ideal of ergonomic situations, we expect to see musculoskeletal conditions continue to worsen.”

If the FEHBlog were an employer in northeastern Ohio, he would jump at the new accountable care organization (“ACO”) that Aetna and the Cleveland Clinic have announced today. Here’s Beckers Payer Issues report on the arrangement. The FEHBlog loves the ACO concept.

The FEHBlog also has been intrigued by the research effort to develop convalescent plasma therapy for COVID-19. The AP reports today that the FDA is not ready to give emergency use authorization to this treatment because reliable evidence of efficacy has not emerged from currently reported studies. The FEHBlog was encouraged to find that yesterday “the National Institutes of Health awarded Albert Einstein College of Medicine and Montefiore a $4.3 million grant to support a randomized, double-blind, placebo-controlled phase 2 clinical trial that launched in April to evaluate the efficacy of convalescent plasma to treat COVID-19.” The public will be better served by waiting for the results of this study.

The FEHBlog ran across this CDC site on COVID-19 contact tracing, a topic that has been in the news lately. It may be helpful for health plans to share this information with their members.

Finally, the U.S. Supreme Court calendared the Texas v. California case for oral argument on November 10, 2020. This is the third case to present the issue of the Affordable Care Act’s constitutionality. In the FEHBlog’s legal opinion, the Supreme Court unanimously will support the ACA’s constitutionality in this case. The Supreme Court took this case to stop the Fifth Circuit court of appeals from slicing up the law based on a flawed severability analysis, not to strike the law down. The proof is in the pudding — the ACA marketplace did not fall apart without the individual mandate.