Weekend update

Telehealth

Weekend update

David Ermer–ACA, Congress, COVID-19, Telehealth–

In view of the impending national election on Tuesday, Congress is out of session for the next two weeks except for one Committee hearing on November 10.

On the COVID-19 front –

  • The Wall Street Journal reports about research and medical efforts to address the health problems of so-called COVID-19 long haulers.

Nearly a year into the global coronavirus pandemic, scientists, doctors and patients are beginning to unlock a puzzling phenomenon: For many patients, including young ones who never required hospitalization, Covid-19 has a devastating second act.

Many are dealing with symptoms weeks or months after they were expected to recover, often with puzzling new complications that can affect the entire body—severe fatigue, cognitive issues and memory lapses, digestive problems, erratic heart rates, headaches, dizziness, fluctuating blood pressure, even hair loss.

What is surprising to doctors is that many such cases involve people whose original cases weren’t the most serious, undermining the assumption that patients with mild Covid-19 recover within two weeks. Doctors call the condition “post-acute Covid” or “chronic Covid,” and sufferers often refer to themselves as “long haulers” or “long-Covid” patients.

According to the article, the estimated numbers of long haulers varies “widely.” Nevertheless, [w]ith more than 46 million cases world-wide, even the lower estimates would translate into millions living with long-term, sometimes disabling conditions, increasing the urgency to study this patient population, researchers said. What they find could have implications for how clinicians define recovery and what therapies they prescribe, doctors said.” What’s more, “[o]ther viral outbreaks, including the original SARS, MERS, Ebola, H1N1 and the Spanish flu, have been associated with long-term symptoms.”

  • Last Friday, ” the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Defense (DOD) jointly announced a $12.7 million contract with InBios International Inc., of Seattle, to expand domestic production capacity for two rapid point-of-care tests for SARS-CoV-2, the virus that causes COVID-19. The first, called the SCoV-2 Ag Detect Kit, detects current infections by identifying antigens – genetic material – of the virus in a nose swab sample. The second test, called the SCoV-2 Detect IgM/IgG Kit, detects antibodies for the virus in a finger prick of blood, indicating whether the person had a previous COVID-19 infection. The contract enables InBios to ramp up production of either or both tests to 400,000 units per week – 20 times the facility’s current output – by May 2021, significantly expanding the nation’s testing capacity.

Fierce Healthcare informs us

According to UnitedHealth Group’s fifth annual UnitedHealthcare Consumer Sentiment Survey, which examines Americans’ opinions about multiple areas of healthcare, a survey-record 56% said it is likely they would use virtual care for medical services.  More than a quarter of respondents (26%) said they would prefer a virtual relationship with a primary care physician, the survey found. And when comparison shopping for care, 55% of respondents said they had used the internet or mobile apps to comparison shop for healthcare during the past year, with 1 in 4 patients saying that online or mobile resources were their first option for evaluating health issues.

Follow up on a couple of stories that the FEHBlog has been following:

  • Health Payer Intelligence discusses various angles on the payer transparency rule that the ACA regulators issued last week. That rule is applicable to the FEHBP.
  • A friend of the FEHBlog related that the federal government has noticed an appeal to the D.C. Circuit of District Judge James Boasberg’s September 2, 2020, decision preliminarily enjoining certain provisions of the Trump Administration’s revised ACA Section 1557 rule that adversely affected transgendered people. The government’s 60 day period to notice such an interlocutory appeal would have expired tomorrow.

Friday Stats and More

David Ermer–COVID-19, OPM, Telehealth–

Based on the CDC’s Cases in the U.S. website, here is the FEHBlog’s chart of new weekly COVID-19 cases and deaths over the 20th through 43rd weeks of this year (beginning May 14 and ending October 28; using Thursday as the first day of the week in order to facilitate this weekly update):

By golly that’s a wavelike graph of new cases but bear in mind that new weekly cases have been over 200,000 since late June.

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

Although hot spots for hospitalizations continue to occur around the country, the overall hospitalization rate is trending down even while new cases jump.

The FEHBlog has noted that the new cases and deaths chart shows a flat line for new weekly deaths because new cases greatly exceed new deaths. Accordingly here is a chart of new COVID-19 deaths over the same period (May 14 through October 28).

In this regard, Medscape reports that

A new study conducted by researchers at Imperial College London found the COVID-19 infection fatality ratio is about 1.15% of infected people in high-income nations [e.g. the U.S.] and 0.23% in low-income nations.

The infection fatality ratio (IFR) represents the proportion of deaths among all infected individuals. It is “a key statistic for estimating the burden of COVID-19 and has been continuously debated throughout the current pandemic,” the Imperial College London said in a news release.

For context here are stats that the FEHBlog captured for the 2019-2020 flu season in the U.S.

CDC Fluview 28-Mar
Flu Deaths24000
Flu Cases39,000,000
Deaths over total cases0.06%

The CDC’s latest Fluview surveillance report indicates that seasonal flu activity in the United States remains low.

In other telehealth news, Healthcare Dive reports

  • “Teladoc has completed its $18.5 billion acquisition of Livongo following overwhelming shareholder approval, the virtual care giant announced Friday. Under the terms of the merger, Livongo shareholders will receive 0.5920 times shares of Teladoc, plus cash of $11.33 for each Livongo share. Teladoc shareholders will own about 58% of the combined company, and Livongo shareholders about 42%.” The merged company will continue to use the Teladoc name and its Purchase NY headquarters. Now that the merger has closed, “several of Livongo’s top executives, including CEO Zane Burke and President Jennifer Schneider, will depart the company, along with Livongo’s CFO and SVP of Business Development. The combined company’s board will consist of eight directors from Teladoc, including CEO Jason Gorevic, and five from Livongo, including founder Glen Tullman.”
  • More generally, “telehealth claim lines increased 3,552% in August this year compared to last, according to new data from Fair Health’s monthly tracker. Virtual care volume was relatively flat compared to July, following two months of declines, hinting at the staying power of telehealth even as COVID-19 cases fluctuate nationwide. Telehealth rose from just 0.17% of all medical claim lines in August last year to 6.07% this year. That’s compared to 6% in July this year.”

Federal News Network informs us that

The Office of Personnel Management has told its workforce it’s no longer actively pursuing the administration’s proposed merger with the General Services Administration.

In an email to staff, which covered everything from flu shots for employees to the status of reopening agency facilities, acting OPM Director Michael Rigas said Thursday he wanted to provide an update about the administration’s proposed GSA merger.

“As Congress has not acted on the administration’s legislative proposal, we are no longer devoting time and energy to the merger and are focused on ensuring OPM can function as a standalone personnel agency for the federal government,” Rigas said in the email, which Federal News Network obtained. “We are also conducting an independent analysis of the agency to help inform how OPM can best carry out its mission and meet the needs of the American people.”

A senior OPM official told Federal News Network the agency was looking at other options, especially now that the governmentwide security clearance business had moved to the Defense Department.

Midweek Update

David Ermer–ACA, COVID-19, Telehealth, U.S. Healthcare–
Photo by Manasvita S on Unsplash

The Affordable Care Act regulators (the Departments of Health and Human Services, Labor and Treasury) issued an interim final rule with an opportunity to comment (“IFC”) on coverage of COVID-19 preventive services. This rule focuses on coverage of COVID-19 vaccinations. The fact sheet explains with respect to private plans, including FEHB plans, that

the Departments [have] amend[ed] existing regulations to implement the unique requirements related to rapid coverage of qualifying coronavirus preventive services. This coverage is required to be provided within 15 business days after the date on which the United States Preventive Services Task Force or the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) makes an applicable recommendation relating to a qualifying coronavirus preventive service.

Specifically, plans and issuers must cover COVID-19 immunizations that have in effect a recommendation of ACIP with respect to the individual involved, even if not listed for routine use on the Immunization Schedules of the CDC. This IFC also provides that during the public health emergency for COVID-19, plans and issuers must cover without cost sharing qualifying coronavirus preventive services, regardless of whether an in-network or out-of-network provider delivers such services. The IFC also affirms that plans and issuers subject to section 2713 of the Public Health Service Act must cover without cost sharing items and services that are integral to the furnishing of recommended preventive services, including the administration of COVID-19 immunizations.

In related news, Route Fifty reports that

When the coronavirus vaccine arrives on the market, demand will far exceed supply. During those first few months, state and county public health officials will face tough questions about who should be first in line to get one of the limited vaccine doses. The Vaccine Allocation Planner for Covid-19, a new tool released Wednesday, aims to help make those decisions with data.

Jointly developed by Ariadne Labs, a project run out of Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health, and the Surgo Foundation, a nonprofit at the intersection of behavioral and data science, the tool allows policymakers to look at region-specific data. They can estimate the size of high-risk populations, consider factors like particular community’s vulnerabilities, and run scenarios based on an estimated number of vaccine doses available.

The New York Times maintains a COVID-19 vaccine tracker here

In other healthcare news —

Anthem beat Wall Street’s third-quarter expectations on earnings and reported revenue of $31.2 billion, up 16.8% from the year prior, in results released Wednesday morning. Expenses, however, were up more than 22% year over year, leaving profit to plummet roughly 80%.
Total medical membership jumped 4%, attributed to increases in Medicare and Medicaid rolls. Anthem CEO Gail Boudreaux said on the earnings call the overall membership trends are outpacing internal expectations.
The payer also reported a $594 million payment in Q3 toward a federal antitrust settlement reached with Blue Cross Blue Shield plans that is still awaiting approval by a judge. Other terms include nixing the “best efforts” rule that required member plans to generate at least two-thirds of their annual revenue from Blues brands and allowing employers to request a second bid from a non-local Blues plan, Boudreaux said, adding “we don’t see this changing our strategy.”

There is a clear overlap between specialties that are using telemedicine the most, and those specialties that manage chronic illnesses, such as endocrinology and rheumatology. Treating long-term chronic conditions like diabetes and arthritis require frequent patient visits, but they don’t always need to be in-person. For patients that require long-term care, telemedicine tools can reduce taxing trips to hospitals or clinics.

Doximity is a professional network for physicians.

  • Medpage Today lets us know that

Screening for colorectal cancer (CRC) should begin at age 45 for all average-risk adults in the United States, the U.S. Preventive Services Task Force (USPSTF) recommends in a guideline draft. Screening should continue at recommended intervals until age 75, the draft states. For patients ages 76 to 85, the decision to continue screening should be based on an individualized assessment of the benefits and harms associated with screening.

Currently FEHB plans are required to cover CRC screening with no member cost sharing for members beginning at age 50. If this guideline is finalized in 2020, the no cost sharing coverage requirement would drop to age 45 on January 1, 2022 pursuant to the Affordable Care Act’s requirements.

Here is a list of all of the USPSTF Grade A and B preventive service for adults recommendations which are eligible for cost free coverage starting in the plan year that begins on or after exactly one year from the issue date. FEHB plan years follow the calendar year, but not all health plans do.

Weekend update

David Ermer–AHRQ, Congress, COVID-19, Mental health care, Telehealth, U.S. Healthcare–
Lincoln Memorial in the Fall

The House of Representatives is on the campaign trail. The Senate will join them tomorrow after a confirmation vote on Judge Amy Coney Barrett’s nomination to the Supreme Court. Her nomination narrowly cleared a cloture vote at the Senate today. If you want to understand why the Supreme Court will not strike down the Affordable Care Act this term even with Judge Barrett on its illustrious bench, click here.

There is only one Congressional hearing this week — a Senate Commerce Committee hearing on Wednesday morning, October 28, about the federal internet liability shield. The witnesses will be the CEOs from Twitter, Alphabet/Google, and Facebook, large companies that currently benefit from this shield. Congress returns to its legislative business on November 16 following the Presidential and Congressional election on November 3.

Today, the Department of Health and Human Services shared news on how States and the District of Columbia will use the rapid COVID-19 BinaxNOW tests that the federal government purchased on their behalves. “HHS also provided all CLIA-certified nursing homes over 11 million rapid, point-of-care tests. The tests include the following FDA-authorized antigen diagnostic tests: Abbott BinaxNOW and either a Quidel Sofia 2 or Becton, Dickinson and Company (BD) Veritor™ Plus System instrument(s).”

The Washington Post’s Lily website offers an interview with a 14 year young lady, Anika Chebrolu, who was awarded a $25,000 prize “for her discovery: a compound that can bind to the coronavirus [COVID-19-, inhibiting its ability to infect people. She beat out nine other finalists — whose own projects ranged from a robotic glove to a device that detects invisible particles in water — to be named America’s top young scientist.” Ms. Chebrolu modestly explains that “my effort to find a spike protein binder isn’t unique in its methodology, and it may appear to be a drop in the ocean, but it adds to all these efforts and therefore is quite substantial.” Congratulations.

It’s also worth pointing out this Healthcare Dive article informing us that

Medical device funding hit a new high in the third quarter, growing 63% year on year to top $5 billion for the first time in CB Insights’ dataset. Investments in robotic surgery startups was a major driver of the increase. The analysts listed the progress of neuromodulation devices and Medtronic’s deals in diabetes and neurosurgery as other medical device highlights of the quarter.

The Mayo Clinic explains that “Robotic surgery, or robot-assisted surgery, allows doctors to perform many types of complex procedures with more precision, flexibility and control than is possible with conventional techniques. Robotic surgery is usually associated with minimally invasive surgery — procedures performed through tiny incisions.”

The International Modulation Society further explains that

Neuromodulation is technology that acts directly upon nerves. It is the alteration—or modulation—of nerve activity by delivering electrical or pharmaceutical agents directly to a target area.

Neuromodulation devices and treatments are life changing. They affect every area of the body and treat nearly every disease or symptom from headaches to tremors to spinal cord damage to urinary incontinence. With such a broad therapeutic scope, and significant ongoing improvements in biotechnology, it is not surprising that neuromodulation is poised as a major growth industry for the next decade.

Most frequently, people think of neuromodulation in the context of chronic pain relief, the most common indication. However, there are a plethora of neuromodulation applications, such as deep brain stimulation (DBS) treatment for Parkinson’s disease, sacral nerve stimulation for pelvic disorders and incontinence, and spinal cord stimulation for ischemic disorders (angina, peripheral vascular disease).

Cochlear implants to treat deafness, for example, are intermodulation devices.

The FEHBlog noticed on Twitter today that the HHS Agency for Healthcare Quality and Research has made available in the Apple Store and Google Play an app to help patients to develop questions for the doctor visits.

On the healthcare survey and report front

The top 12 reasons for using telehealth, according to the 2020 survey, are listed below, with the 2019 ranking and percentages in parentheses:

  1. Convenience, 51 percent (1, 64 percent)
  2. Safety, 46 percent (12, 13 percent)
  3. Speed – ability to receive care quickly, 44 percent (2, 53 percent)
  4. Quality care, 30 percent (6, 25 percent)
  5. Condition covered by telehealth visit, 28 percent (7, 22 percent)
  6. Ease of access to health information, 27 percent (3, 34 percent)
  7. Convenient communication channels, 26 percent (4, 33 percent)
  8. Lower overall cost, 23 percent (5, 30 percent)
  9. Difficult to travel to medical office, 21 percent (7, 20 percent)
  10. Recommendation, 19 percent (7, 20 percent)
  11. Reputation, 19 percent (11, 14 percent)
  12. Past experience, 17 percent (9, 19 percent).
  • Health Payer Intelligence reports that

Around a third of Millennials [ages 24 – 39] have a behavioral health condition, emphasizing a greater need for behavioral healthcare options and coverage as well as a new approach to millennial member engagement, the latest Blue Cross Blue Shield Association (BCBSA) report revealed. * * * Not only do Millennials have a high percentage of behavioral health conditions but their rate of developing a behaioral health condition is rising by double digits. Over five years from 2014 through 2018, the prevalence of major depression rose by 43 percent, ADHD rose by 39 percentage percent, and psychotic disorders rose by 26 percent among Millennials.”

Midweek update

David Ermer–Congress, COVID-19 vaccine, Telehealth–
Photo by Manasvita S on Unsplash

The Hill brings us up to date on the status of bipartisan negotiations over a COVID-19 relief bill. At least the negotiated bill may be teed up for the lame duck session of Congress next month.

On Monday, Healthcare Dive reported the CVS Health is hiring 10,000 pharmacy technicians to administer vaccinations and today, and today

the U.S. Department of Health and Human Services (HHS), through the Assistant Secretary for Health (ASH), issued guidance under the Public Readiness and Emergency Preparedness Act (PREP Act) authorizing qualified pharmacy technicians and State-authorized pharmacy interns to administer childhood vaccines, COVID-19 vaccines when made available, and COVID-19 tests, all subject to several requirements. This guidance clarifies that the pharmacy intern must be authorized by the State or board of pharmacy in the State in which the practical pharmacy internship occurs, but this authorization need not take the form of a license from, or registration with, the State board of pharmacy.

Smart move, CVS.

On Monday, NCQA released the results of its Spring 2020 telehealth questionnaire. Check it out.

On the opioid front, the Wall Street Journal reports today that

Purdue Pharma LP agreed to plead guilty to three felonies related to its marketing and distribution of powerful painkiller OxyContin, as part of an $8.34 billion settlement that caps yearslong federal investigations into tactics the government said helped fuel the opioid crisis.

The Justice Department unveiled the settlement Wednesday, alongside a deal with Purdue’s owners, members of the Sackler family. The price tag for Purdue, however, is largely symbolic: The bankrupt company’s assets fall well short of $8 billion. It will pay the federal government $225 million, and much of the rest of the fines will be waived to allow more money to flow to states, counties and tribes that accuse Purdue of sparking widespread opioid addiction and deaths.

The Sacklers, meanwhile, resolved civil charges for a separate $225 million, but prosecutors made clear criminal investigations into the family continue.

Thursday Miscellany

David Ermer–COVID-19, OPM, Telehealth, U.S. Healthcare–
Photo by Juliane Liebermann on Unsplash

Well, this year’s FEHBP / FEDVIP Open Season announcement will be the latest in recorded history as the FEHBlog found on opm.gov that the past champion turtle was the Open Season announcement issued on October 7. OPM did send out its second Benefit Administration Letter on the Open Season today but that’s not the same thing as announcing 2021 premium changes. What’s particularly odd is that OPM usually settles all of the FEHBP premium negotiations by mid-August. What possibly could be the reason for this hold up? The FEHBlog hopes that this is not the new normal as the ongoing delay impairs FEHBP competition.

In an example of good corporate citizenship, Forbes reports today that

The large hospital operator HCA Healthcare Thursday said it will “return, or repay early” about $6 billion in federal stimulus money from the Coronavirus Aid, Relief, and Economic Security Act, known as CARES. HCA, one of the nation’s biggest hospital operators, has been performing well financially and earlier this year reported a profit of more than $800 million in its second quarter thanks to CARES Act funds.

In other business news, Fierce Healthcare reports that

[Telehealth vendor] Amwell’s stock climbed 38% Wednesday just three weeks after raising an outsized initial public offering of $742 million. Investor interest in Amwell was fueled by speculation that insurer UnitedHealth may buy the telehealth giant, according to healthcare analysts, Business Insider reporter Blake Dodge reported.

The article adds that “UnitedHealth Group also is reportedly in talks to buy online pharmacy DivvyDose that would put the insurer in direct competition with Amazon’s PillPack.” Interesting moves.

On the COVID-19 front today, the Wall Street Journal confirmed by its investigational reporting, at least to the FEHBlog’s satisfaction, that the COVID-19 virus was spreading across our country months before the mid-March commencement of the great hunkering down. “While the country was still looking outward [in January and February 2020, researchers now believe the earliest infections in many states came mostly from travel within the U.S.” This reminds me of the course of the Great Influenza in 1918 according to J.M. Barry’s Great Influenza book. Again, the difference between then and now is 100 years of medical advances. The FEHBlog continues to have faith in the U.S. healthcare system as well as the common sense of the American people.

Midweek Update

David Ermer–CDC, COVID-19, HIPAA Privacy and Security Rules, Telehealth, U.S. Healthcare–
Photo by Maria Teneva on Unsplash

The Blue Cross Blue Shield Association has a new president and CEO effective January 4, 2021 — Kim A. Keck. Ms. Keck, who will be the first woman to hold this position, is currently president and CEO of Blue Cross of Rhode Island. She worked for Aetna for 28 years. Of course, she succeeds Scott Serota. Congratulations, Ms. Keck.

Congratulations as well to the 2020 winners of the Nobel Prize in Chemistry, Emmanuelle Charpentier of the Max Planck Institute in Berlin and Jennifer Doudna of the University of California, Berkley, for their work in developing “genetic scissors” known as CRISPR-Cas9 “that can cut DNA at a precise location, allowing scientists to make specific changes to specific genes.” NPR explains that

“Once in a long time, an advance comes along that utterly transforms an entire field and does so very rapidly,” says Francis Collins, director of the National Institutes of Health, which has long supported Doudna’s research. “You cannot walk into a molecular biology laboratory today, working on virtually any organism, where CRISPR-Cas9 is not playing a role in the ability to understand how life works and how disease happens. It’s just that powerful.”

In other good news Precision Vaccinations reports that

The CDC researchers noted in the Morbidity and Mortality Weekly Report published on October 2, 2020, that during the 2019-20 flu season, 61.2 percent of surveyed pregnant women received the flu vaccine, which was 7.5 percentage points higher than the previous flu season. In addition, 56.6 percent of the women received the Tdap vaccine during pregnancy, and 40.3 percent received both vaccines. The percentage of women receiving both vaccines significantly increased from 35 percent just one year ago.

These increases were driven by increased vaccination coverage among Black and Hispanic women and those of other races reported the CDC. The CDC authors stated: “Racial disparities in vaccination coverage could decrease further with consistent provider offers or referrals for vaccination, in combination with culturally competent conversations with patients.” Specifically, this data found approximately 20 percent of pregnant women reported not receiving a provider recommendation for these vaccinations.

On the COVID-19 front, STAT News informs us that Eli Lilly reports good results with its synthetic antibody treatments for COVID-19. Lilly is seek emergency authorization use approval from the Food and Drug Administration as it continues to clinical trials on the treatments.

In other news —

The Department of Health and Human Services (“HHS”) announced today that

Surgeon General VADM Jerome M. Adams, M.D., M.P.H., issued a Call to Action urging Americans to recognize and address hypertension control as a national, public health priority. The Surgeon General’s Call to Action to Control Hypertension provides strategies for those on the frontlines of health care and public health to address this costly, dangerous and far too common chronic health condition.

According to Fierce Healthcare, Express Scripts has added new tools to its digital formulary that address “women’s health needs, tobacco cessation, muscle and joint pain, caregiver care and COVID-19 workplace support. The formulary’s goal is to assist employers and other plan sponsors in finding the digital health solutions that best fit their worker’s needs, and which have been vetted by experts at Express Scripts for key concerns like effectiveness, value, user experience and security.”

Healthcare Dive lets us know that

Doctors and consumers expect to use virtual care more often after COVID-19 than they did before, according to a new survey from telehealth vendor Amwell, hinting at the long-term potential of the virtual care model in healthcare. Prior to the pandemic, the majority of virtual visits were for on-demand urgent care. But this year, the volume of virtual specialty and scheduled visits outpaced urgent care, suggesting telehealth is becoming normalized across more fields and use cases. Only about 21% of consumers had a virtual visit for on-demand urgent care visit this year. By comparison, 54% had a scheduled visits with their primary care physician.

HHS’s Office for Civil Rights announced another HIPAA scalping of a healthcare provider that failed to provide individual access to their medical record, a top OCR priority at this time. “Dignity Health, doing business as St. Joseph’s Hospital and Medical Center (“SJHMC”), has agreed to take corrective actions and pay $160,000 to settle a potential violation of the HIPAA Privacy Rule’s right of access provision. SJHMC, based in Phoenix, Arizona, is a large, acute care hospital with several hospital-based clinics that provide a wide range of health, social, and support services.”

Weekend Update

David Ermer–ACA, Congress, COVID-19, Telehealth–

The House of Representatives is now on a district work period / the campaign trail until after election day. According to the Hill, the Senate which had planned to hold votes this week will be switching to pro-forma session for the next two week as three Republican Senators unfortunately have been diagnosed with COVID-19. The Senate Majority Leader expects to resume holding votes during the week of October 19.

Over the summer, the House leadership changed its rules to permit remote House floor voting during the COVID-19 public health emergency. That action permits the House leadership to rapidly schedule a House vote in October if necessary. The FEHBlog wonders whether the Senate leadership will take the same action this month.

The House and Senate will be holding a handful of Committee meetings this week.

The FEHBlog is confident that this will be the week that OPM publicizes 2021 premiums for FEHBP and FEDVIP carriers.

Tomorrow, being the first Monday in October, the U.S. Supreme Court will begin its October 2020 Term with virtual oral arguments. The Court will virtually hear argument in a blockbuster ERISA state law preemption case on Tuesday October 6. Courts tend to read certain aspects of the ERISA and FEHBA state law preemption provisions similarly.

Last Friday, the Internal Revenue Service announced delays and flexibilities in 2020 ACA Form 1095-B and 1095-C reporting similar to those that were in effect for 2019, the first reporting year in which the individual mandate penalty was zeroed out. These reports are now ordinarily used for the six jurisdictions that have reinstated the individual mandate penalty for their respective residents.

Health Payer Intelligence offers a helpful overview of three categories of telehealth that payers cover – synchronous communication between members and providers of care by telephone, tablet, or PC; asynchrouous secure direct messaging between members and providers, and remote monitoring of member health.

For example, UnitedHealth Group designed its new diabetes program, Level2, around a remote patient monitoring device. The company transformed the continuous glucose monitor—which is usually used for patients with type 1 diabetes—into a tool for those with type 2 diabetes.

The monitor delivered hundreds of readings per day. These readings go into the member’s individual health record. By looking at the readings over time, the payer can assess potential trends.

However, the remote patient monitoring device provides instantaneous information, meaning that the payer can also address health concerns the moment they occur even though the member is not in a provider’s office.

If a member had a sugar spike, the payer’s platform would let the member know certain steps he could take to control his sugar levels, through exercise or food consumption, for example.

Friday Stats and More

David Ermer–COVID-19, Telehealth–

Based on the CDC’s Cases in the U.S. website, here is the FEHBlog’s chart of new weekly COVID-19 cases and deaths over the 20th through 39th weeks of this year (beginning May 14 and ending September 30; 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 September 30):

The trends generally are down but the number of cases and deaths is still high as illustrated by the President’s condition. Of course, the FEHBlog hopes for a speedy recovery for all afflicted by COVID-19.

In COVID-19 miscellany:

  • “The National Academies of Sciences, Engineering, and Medicine today released the final report of a consensus study recommending a four-phased equitable allocation framework that the U.S. Department of Health and Human Services (HHS) and state, tribal, local, and territorial (STLT) authorities should adopt in the development of national and local guidelines for COVID-19 vaccine allocation.”
  • The Wall Street Journal reports that the Speaker of the House and the Treasury Secretary are continuing their discussions about a compromise fourth COVID-19 relief bill.
  • The Society for Human Resources Management has collected answers to the most common questions raised by employers in the COVID-19 era.
  • The Department of Health and Human Services announced yesterday “$20 billion in new funding for providers on the frontlines of the coronavirus pandemic. Under this Phase 3 General Distribution allocation, providers that have already received Provider Relief Fund payments will be invited to apply for additional funding that considers financial losses and changes in operating expenses caused by the coronavirus. Previously ineligible providers, such as those who began practicing in 2020 will also be invited to apply, and an expanded group of behavioral health providers confronting the emergence of increased mental health and substance use issues exacerbated by the pandemic will also be eligible for relief payments.” Providers can begin applying for these funds on Monday October 5.

In other news, Healthcare Dive reports

Consumers are overwhelmingly satisfied with telehealth, but barriers to virtual care access remain, according to a new survey by J.D. Power of more than 4,300 people between June and July who had a telehealth visit within the past year. The overall consumer satisfaction score for telehealth was 860 out of 1,000 — among the best J.D. Power has ever recorded in its surveys of the healthcare, finance and insurance sectors, the data analytics firm said. However, many consumers said they still experienced barriers in obtaining such a visit, and those who considered themselves to be in poorer health were far less satisfied with the experience than those who considered themselves healthy.

Here’s the study finding the caught the FEHBlog’s eye — “Among patients who used a telehealth offering this year, 46% say their top reason for choosing telehealth was safety. That compares with just 13% in 2019.”

Tuesday Tidbits

David Ermer–Congress, COVID-19, COVID-19 vaccine, Telehealth, U.S. Healthcare–
Photo by Patrick Fore on Unsplash

Today the Senate invoked cloture on the compromise FY 2021 continuing resolution (HR 8337) by an 82 to 6 vote. The Senate now is in a position to pass the legislation and send it to the President for signature before the end of this federal government fiscal year, tomorrow September 30.

The Wall Street Journal reports that House Speaker Nancy Pelosi and Treasury Secretary Stephen Mnuchin have resumed discussing a compromise COVID-19 relief bill. Their discussions will continue tomorrow.

Healthcare consulting company WillisTowersWatson released a new white paper about the impact of the COVID-19 public health emergency on healthcare spending in the U.S.

Health care plan sponsors may see an unprecedented decrease in year-over-year medical costs in 2020, as system capacity shifts and fear of contracting COVID-19 in medical settings drives a significant volume of foregone and deferred care. Significant uncertainties remain however, including the course of the pandemic, the availability of effective vaccines and treatments, and changes in the health care delivery system that could impact future health care costs.

Willis Towers Watson has evaluated a set of potential future care utilization scenarios contemplating a variety of patterns of infection and care return. Across our scenarios, 2021 costs to employer plans are expected to be slightly higher (0.5% to 5.0%) than the non-pandemic baseline projection. Nevertheless, when 2020 and 2021 are combined, all scenarios show cost reductions (–2.8% to –3.8%) relative to the non-pandemic baseline. The baseline comparison from which these estimates were developed reflects projected costs for 2020 and 2021 assuming the pandemic never occurred. Employers should consider these scenarios as they budget for and measure the performance of their health care plans in the upcoming year.

Speaking of COVID-19 vaccines, the National Institutes of Health today announced that based on a separate Phase I study, the COVID-19 vaccine being jointly developed by Moderna and NIH had a positive impact on 40 older adult volunteers. This vaccine currently is in the Phase III study with a younger cohort. The separate Phase I study found that “Overall, the researchers found that “the investigational vaccine was well-tolerated in this older age group. Importantly, the immune response to the vaccine seen in older volunteers was comparable to that seen in younger age groups.” NIH is proposing that the Phase III study be expanded to include a senior cohort.

In other tidbits

  • Beckers Hospital Review reports on “13 things to know about Aetna, Anthem, Cigna, Humana and UnitedHealthcare’s virtual care strategies.” The article reminds the FEHBlog that the current end date for the federal government’s COVID-19 public health emergency technically is October 23. In all likelihood HHS will extend the deadline for another ninety days to Inauguration Day.
  • Healthcare Dive reports that “HHS has sent the Office of Management and Budget an interim final rule, called Information Blocking and the ONC Health IT Certification Program: Extension of Compliance Dates and Timeframes in Response to the COVID-19 Public Health Emergency, received on Sept. 17. ONC declined to comment on the rule. But the title implies it will extend dates identified in the sweeping information blocking provisions — notably, the looming November compliance deadline for providers — and dates for the Conditions and Maintenance of Certification provisions requiring EHR platforms to be interoperable.”