A Suggestion

A Suggestion

While enjoying the Fourth of July weekend with perhaps a favorite beverage, listen to or read the transcript of the Econtalk podcast in which the host Russ Roberts interviews Vivian Lee, MD, about her book on healthcare reform called The Long Fix. Ms. Lee was CEO of the University of Utah health system and she currently is an executive with Alphabet’s Verily Life Sciences. Very informative. Happy Fourth of July to all.

Monday Roundup

Modern Healthcare reports tonight that

HHS spokesperson Michael Caputo on Monday tweeted that HHS intends to extend the COVID-19 public health emergency that is set to expire on July 25. The extension would prolong the emergency designation by 90 days. Several payment policies and regulatory adjustments are attached to the public health emergency, so the extension is welcome news for healthcare providers.

The Centers for Disease Control released updated guidance on the use of cloth face coverings during the COVID-19 emergency.

Cloth face coverings are recommended as a simple barrier to help prevent respiratory droplets from traveling into the air and onto other people when the person wearing the cloth face covering coughs, sneezes, talks, or raises their voice. This is called source control. This recommendation is based on what we know about the role respiratory droplets play in the spread of the virus that causes COVID-19, paired with emerging evidence from clinical and laboratory studies that shows cloth face coverings reduce the spray of droplets when worn over the nose and mouth. COVID-19 spreads mainly among people who are in close contact with one another (within about 6 feet), so the use of cloth face coverings is particularly important in settings where people are close to each other or where social distancing is difficult to maintain.

Healthcare Dive alerts us that

Gilead will charge between $2,340 and $3,120 for a typical course of treatment with its COVID-19 drug remdesivir, which has been shown to speed the recovery of patients hospitalized with the infectious disease.

The drug’s price will depend on whether patients are covered by government insurance or commercial health plans. Gilead will offer remdesivir to governments in developed countries at a price of $390 per vial. In the U.S., private insurers will pay $520 per vial. 

Most patients will be treated for five days, using six vials, Gilead said in announcing its much anticipated pricing decision Monday. If treatment stretches to 10 days — initially the standard treatment course — remdesivir’s cost would rise to $5,720 for patients who are commercially insured. 

The announced prices are in line with expert predictions.

MedCity News discusses Walmart’s new health clinics.

The company rolled out two Walmart Health clinics this month, in Loganville, Georgia and Springdale, Arkansas.

These aren’t your usual walk-in clinics that might serve as a quick place to get vaccinated or get a cold checked out. Rather, they’re more like a one-stop shop for healthcare, with primary care, urgent care, diagnostics, x-rays, behavioral health and dental care.

Walmart Health’s other big differentiator: A primary care appointment costs just $40. For children? $20.

Weekend Update

The House and Senate will be conducting legislative and committee business this week preceding the Fourth of July holiday. Of note, on Tuesday at 10 am the Senate Health Education Labor and Pensions Committee will hold a hearing on ways to return to work and school safely following the great hunkering down.

The Supreme Court has thirteen more opinions to release before its summer break. The Court is expected to release opinions on Monday, Tuesday, and Wednesday this week, all at 10 am.

On the COVID-19 front —

  • Fierce Healthcare discusses how the Walgreen’s Pharmacy chain has leveraged its partnership with Microsoft and other technology companies to better respond to the COVID-19 emergency.
  • A few weeks ago, the Journal podcast offered a fascinating show on the Hertz bankruptcy. It’s worth a 17 minute long listen. The story highlights how a strong balance sheet helps companies weather storms like the COVID-19 emergency. Becker’s Hospital Review identifies 14 well known health systems in this favorable situation, including Kaiser Permanente. It’s not an exclusive list.
  • Healthcare Dive reports on the significant adverse financial impact that the COVID-19 emergency has had on primary care practices in the U.S. Surprisingly that article does not note that these practices have been eligible for Payroll Protection loans and federal grants. The government deserves credit for trying to soften the blow to this critical sector of our health care system. Tuesday June 30 is the deadline for applying for a PPP loan.

On the human nature front, the Wall Street Journal reports that COVID-19 first responders have been relaxing by playing a boardgame called Pandemic.

Friday Stats and More

According to the CDC’s COVID-19 cases in the U.S. website, which the FEHBlog tracks, over the past seven weeks the numbers of new COVID-19 cases had taken a downward path for the first four weeks and then has turned up for the past three weeks. New deaths saw steady weekly reductions over the same time span until this week when there was a slight upturn. The COVID-19 hospitalization rates continue to trend down.

Week endingNew CasesNew Deaths
May 15297,5818,856
May 22159,4968,160
May 29142,2107,561
June 5142,2896,353
June 12153,3715,850
June 19161,2894,865
June 26199,2525,270

In other healthcare news —

  • Health Payer Intelligence reports that the CDC “estimates that 90 percent of national healthcare spending goes toward chronic disease management and mental healthcare, which means that strong mental health and chronic disease prevention strategies can help reduce payer spending. The CDC has named the eight most expensive chronic diseases in the US. The good news for payers is that most of these can be prevented to some degree. By being aware of preventive care strategies for these eight chronic conditions, payers can actively reduce their healthcare spending and support positive patient outcomes.”
  • The Commonwealth Fund and the Healthcare Transformation Task Force have created a Maternal Health Hub.

In federal agency news

  • Govexec.com informs us about the President’s executive order, issued today, requiring federal “agencies to increase the use of skill assessments and interviews with subject matter experts to determine an applicant’s qualifications, rather than simply looking at educational achievements. Degree requirements will not go away entirely, and certain positions—such as those in medical, legal and certain technical fields—will still require advanced degrees. The goal of the order, Trump administration officials said on Friday, is to create a broader pool of potential federal employees and a more equitable hiring process.”
  • Federal News Network reports that “The Postal Service expects to withstand the financial impact of the coronavirus impact better than it anticipated a few months ago, but warns that it could still run out of cash before the end of 2021 without long-term reform from Congress.”

Thursday Miscellany

Robert Redfield, MD, the Director of the Centers for Disease Control gave a press conference on the COVID-19 emergency today as discussed in this STAT News article.

“I’m asking people to recognize that we’re in a different situation today than we were in March, in April, where the virus was being disproportionately recognized in older individuals with significant comorbidities and was causing significant hospitalizations and deaths,” he said.

“Today we’re seeing more virus. It’s in younger individuals. Fewer of those individuals are requiring the hospitalizations and having a fatal outcome. But that is not to minimize it.”

But Redfield went on to note that descriptions of the state of the pandemic in the country can be misleading, with maps that show where transmission is high suggesting much of the nation is experiencing high levels of spread. In reality, he said, about 110 or 120 counties in the country currently have significant transmission. There are more than 3,100 counties in the United States.

The CDC also released updated guidance identifying categories of people who are most at risk for severe illness by contracting COVID-19.

The Washington Post reports that drug manufacturers are increasing production of the flu vaccine for the next flu season. “Getting a flu shot does not protect against the coronavirus, but disease experts said reducing episodes of flu could prove pivotal in freeing up space in hospitals and medical offices to deal with covid-19, the disease caused by the coronavirus.”

Healthcare Dive informs us that pediatric visits are lagging in the recent doctors office visit rebound following the great hunkering down. “[O]ver the past week, visits to some specialists have returned to normal, including dermatology and rheumatology. However, pediatric practices are among the hardest hit and have seen the greatest decline in visits when comparing specialties . . .”

Health Payer Intelligence discusses CVS Health’s new service called “Return Ready.” It’s “a COVID-19 testing strategy for employers whose workforces are returning to the workplace and academic populations returning to campus.” Timely. Here’s a link to current Equal Employment Opportunity Commission guidance on employer compliance with the Americans with Disabilities Act and the Rehabilitation Act in COVID-19 related matters. .

The Society for Human Resource Management provides observations about how the the Supreme Court’s recent ruling holding that Title VII’s sex discrimination protections extend to sexual orientation and gender identity situations affects employer sponsored health coverage.

Midweek update

Fierce Healthcare reports on PriceWaterhouseCooper’s three tier approach to estimating 2021 health care costs. Of course, the variable is impact of the COVID-19 emergency. The Goldilocks increase is estimated at 6%.

Fierce Pharma informs us that Gilead’s as yet unpriced remdesivir treatment for severe COVID-19 has gained stiff competition for a “low-cost [drug called] dexamethasone.”

According to results just published on preprint site medRxiv, dexamethasone treatment led to a 35% reduction in death rate among patients on invasive mechanical ventilation and 20% for those receiving oxygen without invasive ventilation.

Because of that showing, clinical experts told ICER that dexamethasone could soon become the new standard of care throughout the U.S., “and that the relative benefits of remdesivir will now be judged to be most pertinent as an adjunct to dexamethasone treatment,” the organization noted in its new analysis. In the ACTT-1 trial, the death rate for remdesivir among severe patients were reduced to 7.7% from 13% for placebo, a difference that was not statistically significant.

Both drugs remain under study.

Smartbrief offers four innovative approaches for payers in the post hunkering down world. The FEHBlog’s favorites approach is as follows:

Humana Vice President Caraline Coats defined whole person care through the lens her company’s Bold Goal initiative uses: Primary care, social determinants of health, pharmacy, home health and behavioral health. Their work strives to help members in targeted communities enjoy more Healthy Days per month – when they feel physically and mentally well. A lot of their progress comes down to taking the time to ask members the right questions, and then having the ability to act on what is learned.

In an industry built around episodic care, “whole-person care is really different,” Coats said, and it is still being defined. So, her team’s work looks a lot like vetting of clinical interventions: rigorous testing, followed by publication of results so others may learn, too. Among their recent promising experiments is a partnership with Mom’s Meals to meet the needs of certain members with diabetes and a program with Papa (which provides companionship and help with everyday tasks) that measurably brought down loneliness scores among participants.

Meanwhile Blue Cross and Blue Shield of North Carolina is offering monetary support to primary care practices in that State. That’s quite a helping hand. Bravo.

On the technology front —

  • Anthem, the large Blue Cross licensee, is now an Alexa skill. Currently

Using the Anthem Skill, you can:

Order your digital member ID card.
Access your health savings account (HSA) or health reimbursement account (HRA) balance.
Check your progress toward meeting your medical plan’s deductible and out-of-pocket maximum.
Schedule a call with someone from our Member Services team.
Refill, renew and check the order status of any home delivery prescription medicines.
Find out how close you are to reaching your dental plan’s deductible and annual maximum.
Use the glossary to learn what a health care term means.

  • STAT News has an interesting article about about how North Dakota is testing a contacts app with COVID-19 patients. The app was developed by a Microsoft engineer for use with North Dakota football games. Unfortunately, however, according to the article:

While apps can’t replace health care workers, they may be used to bolster their efforts — so long as enough people use them. So far, though, that hasn’t gone as planned: Early excitement over cutting-edge technology has given way to a largely lackluster role for contact tracing apps. Many states have opted against adopting the tools as part of their arsenal. And the handful of states that are launching such apps — including North Dakota — haven’t seen them gain much traction.

Midweek update

On the COVID front —

  • Forbes reports on a new Centers for Disease Control analysis confirming that the disease has hit racial minority and ethnic groups, the elderly, and people with multiple chronic conditions harder than others. Also “Incidence was highest among people 80 and older (902 cases per 100,000), while it was lowest among children 9 and younger (51), but surprisingly people between the ages of 40 to 59 saw higher incidence (between 541 and 550) than people between 60 and 79 (478 and 464).”
  • The Department of Health and Human Services has posted a fact sheet on its Operation Warp Speed which “aims to deliver 300 million doses of a safe, effective vaccine for COVID-19 by January 2021, as part of a broader strategy to accelerate the development, manufacturing, and distribution of COVID-19 vaccines, therapeutics, and diagnostics (collectively known as countermeasures).”
  • The FEHBlog also ran across the Food and Drug Administration’s COVID-19 resources website. Check it out.

The Senate Health Education Labor and Pensions Committee held a telehealth hearing today. Healthcare IT news reports on the hearing. “HELP Committee Chairman Sen. Lamar Alexander, R-Tenn., advocated for two particular policy changes to be made permanent: the originating site rule, allowing physicians to be reimbursed for telehealth appointments wherever a patient is located, including a patient’s home, and the expansion of Medicare- and Medicaid-reimbursable telehealth services.” Also Health Payer Intelligence identifies three telehealth challenges for payers one of which is on Sen. Alexander’s short list: “Discerning how to provide coverage for many different sites of care and for various types of telehealth technologies as well as complying with state and federal regulatory barriers can put a damper on the telehealth boom.”

Fierce Healthcare reports that two Northeastern Blue Cross licenses Highmark and HealthNow have announced a merger. “[upper New York State’s]”HealthNow will bring nearly 1 million additional members into the [central Pennsylvania based] Highmark fold and boasted $2.8 billion in revenue for 2019. It will join the fourth largest Blues organization in the country, building on Highmark’s 5.6 million members and $18 billion in operating revenue for 2019.” The affiliation agreement is subject to regulatory approval.

Weekend Update

Happy Flag Day.

Both Houses of Congress will be conducting committee and floor business this week. The House had added floor voting days for Thursday and Friday next week as well as all of the following week (except for next Friday which is the work holiday associated with the Fourth of July.)

The Senate Health Eduction Labor and Pensions Committee is holding a committee hearing of relevance to the FEHBP — Telehealth: Lessons from the COVID-19 Pandemic — on June 17 at 10 am.

The Supreme Court has nineteen more opinions to release before its summer break. This week the Court is releasing opinions tomorrow and Thursday, both days at 10 am ET.

Here are a couple of non-COVID-19 research items that caught the FEHBlog’s attention over the weekend:

  • Precision Vaccinations reports that “With a surprisingly simple approach in which cancer cells are first grown, ruptured and converted into nanoparticles, and then used as a vaccine, Vanderbilt University researchers say they have developed what appears to be a promising treatment for breast cancer metastasis. Metastasis is the last stage of cancer, responsible for about 90 percent of cancer-related deaths.
  • The Wall Street Journal reports that

Scientists may be just a few years away from delivering new treatments for age-related macular degeneration (AMD), the leading cause of irreversible vision loss in people more than 50 years old.

Over the past 15 years there has been only one class of successful AMD drugs, known as anti-VEGF agents, and they have worked for a minority of AMD sufferers. Now researchers are having success fighting AMD from new directions. They include an immune-system inhibitor and stem-cell therapy, which show promise for treating the dry form of AMD in its advanced stage, for which there is currently no treatment approved by the U.S. Food and Drug Administration.

“I’m cautiously optimistic that we will have markedly improved treatments for both wet and dry AMD within two to three years,” says Joshua Dunaief, professor of ophthalmology at the Scheie Eye Institute at the University of Pennsylvania.

Midweek Update

This morning the Senate Homeland Security and Governmental Affairs Committee favorably reported the nomination of Craig E. Leen to be Inspector General, Office of Personnel Management “en bloc by voice vote.” The Committee also favorably reported the nomination of Russel Vought to be Director, Office of Management and Budget by a 7-4 roll call vote. Next step for these nominations — the Senate floor for confirmation votes presumably later this month.

Stat News reported on another COVID-19 treatment candidate. A Boston MA company Constant Therapeutics currently manufactures an enzyme therapy that may help COVID-19 patients. The article concludes

Constant’s task ahead is the blocking and tackling of running a clinical trial, something he believes the company is well-prepared for. “I’d love to say that a year from now there’s no need for this drug because we’re all immune, but that’s not going to happen,” [Constant’s CEO] said. “I think we can provide an enormous benefit to people and to the health care system if this drug works. And my gut says that it’s going to.”

These ongoing efforts to give doctors treatments for COVID-19 is our best bet along with public health efforts to bridge the gap to an effective vaccine, in the FEHBlog’s view.

The Wall Street Journal informs us that

In the Covid-19 pandemic, people with obesity are at higher risk for severe illness and death—adding new urgency to efforts to rethink the way doctors treat what has long been a public-health problem.

Instead of focusing only on diet and exercise, medical experts say, health-care providers need to shift to a multipronged strategy that includes new prescription weight-loss medications, behavioral therapy and possibly surgery. And to ensure the best results, they argue, this new approach should be overseen by clinicians specially trained in treating obesity. * * * The fast-emerging specialty of obesity medicine aims to close the education gap.

This is encouraging news. The Journal also reports about a study authored by

Lindsey Woodworth, an assistant professor in economics at the University of South Carolina. [Her study] first showed that when a new emergency room opens, crowding at nearby facilities instantly falls an average of 10%.

She then compared mortality rates at the older emergency departments before and after the change. She found that a 10% drop in patient volume leads to a 24% reduction in mortality rates in the first 30 days and a 17% reduction over six months.

Why can’t lower cost urgent care centers have the same effect?

Tuesday Tidbits

Healthcare spending tidbits:

  • Fierce Healthcare reports on an AHIP sponsored study estimating COVID-19 spending by health plans through next year. The projected range is dramatic which illustrates that while we may be seeing the light at the end of the tunnel, we are still in the tunnel.
  • Beckers Hospital Review informs us “Emergency department volume fell 49 percent between January and April, with facilities in urban areas seeing the largest drop, according to an analysis from the Emergency Department Benchmarking Alliance.” Let’s hope that patient habits of addressing urgent care changed too.
  • Of the three spending tidbits the FEHBlog’s favorite is this Health Payer Intelligence article an about out of network spending study. “While overall out-of-network or potential surprise billing is slightly declining, out-of-network healthcare spending is on the rise for laboratory tests and hospitalists—particularly in pathology, a recent Health Affairs study found.” The article reminded me that before the great hunkering down Congress was expected to address surprise billing by the end of May. It’s now early June. Whoops.

In other tidbits —

  • Fierce Healthcare reports on a change of leadership at the American Medical Association. “Susan Bailey, M.D., the new president of the American Medical Association (AMA), called for physicians to advocate at the highest levels of government and insurance companies for support needed ‘to sustain private practice during a pandemic that threatens its very survival.'” Good luck Dr. Bailey.
  • Govexec.com discusses the pace of federal government office reopenings. The FEHBlog was more taken with this Wall Street Journal article on how larger employers are applying technology to reopen their offices safely.
Our firm is closely monitoring the impacts of COVID-19. Effective 6/08/20, Ermer & Suter has reopened its physical offices for business, however for the continued safety of our staff, in-office capacity will not exceed 40%. We remain fully operational and are readily available from both our office and telework locations.