Midweek update

U.S. Healthcare

Midweek update

David Ermer–CDC, COVID-19, SCOTUS, U.S. Healthcare–

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.

Tuesday Tidbits

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

Happy 100th anniversary of American women’s suffrage to all. It seems to the FEHBlog that the British women’s suffrage movement overshadows the American women’s suffrage movement in history. (Perhaps the FEHBlog watch too much English television). The FEHBlog was favorably struck by the fact that American women got the same right to vote as men about ten years before British women did.

The FEHBlog discovered today that the OPM Inspector General has posted his semi-annual report to Congress for the period ended March 31, 2020, and OPM has posted its management response thereto. The first page of the Inspector General’s report following the cover is particularly flashy.

The Department of Health and Human Services released today its Health People 2030 report which “features 355 core – or measurable – objectives with 10-year targets, new objectives related to opioid use disorder and youth e-cigarette use, and resources for adapting Healthy People 2030 to emerging public health threats like COVID-19. For the first time, Healthy People 2030 also sets 10-year targets for objectives related to social determinants of health.” Check it out.

In a related action, the Wall Street Journal reports that the federal government is in the midst of crafting its five year plan for American diets. The alcohol committee is proposing that men meet the same daily consumption standard set for women — one alcoholic beverage per individual. This reminds the FEHBlog of another action that happened a century ago but only lasted a thirteen years — prohibition. The Department of Agriculture will finalize the five year diet plan later this year.

On the prescription drug front —

  • Medscape offers a description of the 35 prescription drugs that the Food and Drug Administration has approved so far in 2020.
  • Drug Channels to the FEHBlog’s surprise informs us that “nine out of ten large hospitals now operate a specialty pharmacy. Hospitals and other healthcare providers account for one-third of all U.S. accredited specialty pharmacies. Clinical and general financial motivations are driving hospitals’ DIY specialty pharmacy growth. The enormous profit opportunities from the 340B Drug Pricing Program offer further encouragement for hospitals. In-house specialty pharmacies are also a valuable hedge against the potential loss of contract pharmacies.”

Speaking of hospitals, Beckers Hospital Review reports that the Centers for Medicare and Medicaid Services announced yesterday that “Hospitals will get a [20%] payment boost on Sept. 1 for caring for Medicare beneficiaries diagnosed with COVID-19. A positive COVID-19 laboratory test must be documented in the patient’s medical record for the hospital to receive the higher payment.”

Finally, on the Postal Service front, the Federal News Network reports that “Postmaster General Louis DeJoy says the Postal Service will hold off on ‘longstanding operational initiatives’ to reduce costs until after this November’s election.” The Wall Street Journal adds that

The House plans to vote Saturday on a bill that would give $25 billion in additional funding to the agency, which is what the Postal Service requested to meet budget shortfalls and costs related to the coronavirus pandemic. The bill would also prohibit the agency from implementing any changes to operations or service levels it had in place on Jan.1 until the end of the Covid-19 emergency or Jan. 1, 2021, whichever comes later.

Senate Republicans are preparing a pared-down coronavirus aid package that would include $10 billion for the Postal Service as well as money for the unemployed and for testing and combating the coronavirus.

The Postmaster General will appear before the Senate Homeland Security and Governmental Affairs Committee on Friday August 21 at 9 am and the House Oversight and Reform Committee on Monday August 24 at 10 am.

Monday Roundup

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

The Wall Street Journal reports that House of Representatives Speaker Nancy Pelosi (D CA) has decided to bring the House back for a vote later this week on a bill to protect the Postal Service. Of course because the House has approved remote voting during the continuing COVID-19 emergency members will not be required to return to DC.

It appears to the FEHBlog that the legislative vehicle for this action will be HR 8015 which House Oversight and Government Reform Committee Chair Carolyn Maloney introduced last Tuesday. The bill’s title / purpose reads “To maintain prompt and reliable postal services during the COVID-19 health emergency, and for other purposes.” It has 37 co-sponsors. The Congressional Research Service summary and the text of the bill are not yet available but the FEHBlog has signed up for alerts on congress.gov.

This afternoon, a federal district court judge from Brooklyn, NY, issued a decision enjoining the recently revised ACA Section 1557’s rule’s “repeal” of the sex discrimination definition found in the Obama Administration’s Section 1557 rule. That definition offered express protection to transgendered people. The federal district court in Washington, DC, which is considering a challenge to the legality of the entire rule, hasn’t issued a ruling today. The rule’s effective date is tomorrow. Perhaps the Brooklyn district court’s action will cause HHS to re-evaluate the rule. In the FEHBlog’s view that would be the most sensible course of action in the wake of the Supreme Court’s Bostock County decision.m

On the COVID-19 front —

  • STAT News recounts what we know and don’t know about the COVID-19 virus from its standpoint. The article is worth a skim.
  • The Centers for Disease Control has released updated guidance on the duration of isolation and precautions for people who have been infected with COVID-19.
  • Managed Healthcare Executive reports that “The report on Deloitte’s biennial Center for Health Solutions Survey of U.S Consumers shows a significant increase in virtual care visits versus pre-pandemic trends, and a reversal in consumers’ willingness to share health data following the COVID-19 pandemic.” Silver lining?
  • Fierce Healthcare discusses “the unexpected ways [Artificial Intelligence] AI is impacting the delivery of care, including for COVID-19.” For example,

[A team lead by] Paul Friedman, M.D., the chairman of the cardiovascular department at Mayo Clinic * * * has trained an AI-algorithm embedded into standard electrocardiogram tests to detect which patients have weak heart pump, Friedman said speaking during a recent Fierce AI Week event. Five years later, the team discovered that the algorithm had made accurate predictions. “The physiological signals are affecting the electrocardiogram in subtle ways,” Friedman said. * * * So it looks like it’s looking into the future.”

Groovy.

Weekend update

David Ermer–Congress, COVID-19, COVID-19 testing, U.S. Healthcare, Uncategorized–

Because Congress is out of town until after Labor Day. let’s lead with the story that caused the FEHBlog to levitate out of his easy chair yesterday. The Yale News headline says it all — “Quick and affordable saliva-based COVID-19 test developed by Yale scientists receives FDA Emergency Use Authorization.”

A couple weeks ago the FEHBlog mentioned a USA Today story about an Xprize competition to find a quick and inexpensive COVID-19 test that would facilitate going back to work, school, etc. The Xprize competition’s first round closes next week and we already have one winner.

Check this out:

Wide-spread testing is critical for our control efforts. We simplified the test so that it only costs a couple of dollars for reagents, and we expect that labs will only charge about $10 per sample. If cheap alternatives like SalivaDirect can be implemented across the country, we may finally get a handle on this pandemic, even before a vaccine,” said [Yale Assistant Professor of Public Health Nathan] Grubaugh.

One of the team’s goals was to eliminate the expensive saliva collection tubes that other companies use to preserve the virus for detection. In a separate study led by Wyllie and the team at the Yale School of Public Health, and recently published on medRxiv, they found that SARS-CoV-2 is stable in saliva for prolonged periods at warm temperatures, and that preservatives or specialized tubes are not necessary for collection of saliva.

The Yale researchers validated their test with the cooperation of the National Basketball Association. It was interesting to watch this season’s opening Hard Knocks show on HBO which showed how NFL teams similarly are focused both on the team’s schedule and COVID-19.

In litigation news —

  • Last Friday, as Healthcare Dive reports, the U.S. Court of Appeals for the Federal Circuit handed health insurers participating in the ACA’s marketplace another win against the federal government. This time the unpaid amounts involve reimbursable cost sharing reductions for low income marketplace participants.
  • On Tuesday, August 18, the Health and Human Services Department’s revised rule on the ACA’s individual non-discrimination provision, Section 1557, takes effect. The federal government, as requested by the Court, filed a sur-reply on the standing issue last Monday, and one of the plaintiff’s advised the Court on Wednesday that the U.S. Court of Appeals for the Fifth Circuit has revived the dormant Franciscan Alliance case which is the granddaddy of challenges to the 1557 rule (although it was filed in an effort to challenge the Obama Administration’s versions of the rule.)

In other news, Health Payer Intelligence reports that

Payers can play a significant role in decreasing the expense and complexity of serious illness care for patients through whole person care and palliative care, a study from America’s Health Insurance Plans (AHIP) found.

“Recognizing the difficulties of serious illness, health insurance providers have set out to help, support, and ease the journey for patients, caregivers and loved ones,” the AHIP study stated.

“Ensuring access to tools, education, and services for patients and their loved ones during a difficult time can provide the opportunity to plan, allow patients to maintain their dignity and choice, and support loved ones to know their role and how best they can help.”

Check it out.

Finally, the Federal News Network informs us that the General Services Administration made no changes to the current standard per diem rates for hotels, meals, and incidental expenses of federal employee business travel within the contiguous United States effective for the next federal fiscal year beginning October 1, 2020. What’s more,

There are, however 319 non-standard areas (NSAs), which have higher per diem rates than the standard CONUS allowance. GSA added one area, Albuquerque, New Mexico, as a new NSA location this year. Four locations came off the NSA list from 2020 and will now receive the standard per diem rate: Gainesville, FL; Atlantic City, NJ; College Station, NJ, and Abingdon, VA.

These rates also apply to government contracts such as experience rated FEHB carriers that are subject to the Federal Acquisition Regulation’s Cost Principle. The GSA assumes, of course, that business travel will resume next year, and in view of the low cost saliva test, it just might.

Friday Stats and More

David Ermer–CDC, COVID-19, HSA, U.S. Healthcare, Uncategorized–

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 32nd weeks of this year (beginning May 14 and ending August 12; 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:

Beckers Hospital Review reports that

The U.S. government is working with commercial health insurers to make future COVID-19 vaccines free of charge with no copay, an HHS official told The Wall Street Journal.

Paul Mango, deputy chief of staff for policy at HHS, said government health insurance programs such as Medicare and Medicaid will cover the cost of administering COVID-19 vaccines, and a federal fund created by the CARES Act will provide the shots free for uninsured people.

A collaboration between the federal government and the healthcare industry will handle the distribution of the vaccines, and the government will announce distributor contracts soon, Mr. Mango told the Journal.

Indeed, the Wall Street Journal reports this afternoon that

McKesson Corp., MCK 4.26% one of the world’s largest drug wholesalers and the biggest vaccine middleman in the U.S., will be a main distributor of Covid-19 vaccines nationwide should the shots prove to work safely, federal health officials said. The U.S. Centers for Disease Control and Prevention is exercising an option in an existing 2016 contract with McKesson for the distribution of a vaccine in the event of a pandemic, the U.S. Health and Human Services Department said Friday.

A friend of the FEHBlog shared this link to an interesting Harvard Business Review article from July 24 discussing the following three scenarios in which the COVID-19 emergency may play out.

1.A dream case in which everything goes as well as could reasonably be expected.
2.A catastrophic case in which everything goes badly.
3.A middle case in which some things go well, but others don’t.

It strikes that FEHBlog that we have been in the midst of scenario three since March. The FEHBlog does not think it can get worse, while he thinks that it may get better.

The FEHBlog was pleased to run across these DOL Office of Federal Contractor Compliance Program’s FAQs on its recent final rule exempting TRICARE but not FEHBP providers from its affirmative action rules.

If my company participates in the Federal Employees Health Benefits Program (FEHBP), are we covered under the amended regulations?

OFCCP did not adopt any regulatory changes related to FEHBP providers. OFCCP plans to issue sub-regulatory guidance to address concerns regarding FEHBP providers.

That’s a clearer update than what the FEHBlog noticed in the preamble to the final rule. The TRICARE exemption likely will not be useful to providers unless the FEHBP also is exempted, in the FEHBlog’s opinion.

The Congressional Research Service has updated its helpful report on Health Savings Accounts (HSAs). CRS reports that for tax year 2017 the IRS processed 11 million tax returns showing employer or employee contributions to HSAs.

Monday Roundup

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

The Washington Examiner reports that the House Majority Leader announced today that the House, which currently is in recess, will be in session for three weeks beginning September 14 (unless required to address COVID emergency relief legislation). Beginning no later than October 2, the House will recess for the November 3 election. The House will commence a lame duck session on November 13. A short term continuing resolution to fund the federal government past September 30 is looking like a sure thing.

Healthcare Dive informs us that the large for profit hospital chains, like the large health insurers, are reporting profitable second quarter results.

“[Federal relief funding for healthcare providers in] The CARES Act was instrumental ensuring we did not have a financial crisis while we were fighting the pandemic crisis,” Tenet CEO Ron Rittenmeyer said during last week’s earnings call with investors. A similar story emerged among Tenet’s competitors — volume plunged but profits did not.

Today, the Department of Health and Human Services made public all of the State COVID-19 testing plans through the end of 2020, which have received HHS oversight.

A multidisciplinary team of experts from HHS has completed a technical review for each jurisdictions’ plan to ensure that it is sufficient to mitigate the spread of the virus, protect vulnerable groups, and account for adequate testing supplies and reagents to reach jurisdiction testing goals. The review panel, chaired by the HHS Assistant Secretary for Health, includes subject matter experts from the Laboratory and Diagnostics Task Force within the Office of Assistant Secretary for Health, the National Institutes of Health (NIH), CDC, and other agencies. The panel also reviews state testing progress, needs assessment, and plans on a monthly basis to determine if modifications are required or additional assistance is needed. Modifications may be necessary if patterns of virus transmission change or are projected to change, case rates increase or additional types of testing and inventory of tests and reagents become available through the Rapid Acceleration of Diagnostics (RADx) program at NIH or other sources.

In healthcare award news —

  • Fierce Health announced its choices of most influential minority healthcare executives. The award winner from the health insurance sector is AHIP’s Chief Operation Officer John Matthewson.
  • A friend of the FEHBlog pointed out that “The American Hospital Association (AHA) [on July 27, 2020] announced that it will honor five programs with the AHA Dick Davidson NOVA Award for their hospital-led collaborative efforts that improve community health. The winning programs are Eagle Valley Behavioral Health, Vail Health, Vail, Colo.; Hackensack Meridian School of Medicine at Seton Hall University, Edison, N.J.; Supportive Housing for the Homeless, Baltimore City Hospitals, Baltimore; Healthy Roanoke Valley, Carilion Clinic, Roanoke, Va.; and Mothers in Recovery, Memorial Healthcare System, Hollywood, Fla.

Congratulations to all of the award winners.

The FEHBlog recently noted that the federal government had awarded a large business loan to Kodak to uses its chemical expertise on drug manufacturing. Today the FEHBlog read in Fierce Pharma that the loan has been put on hold due to Congressional and SEC investigations.

Friday Stats and More

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

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 31st weeks of this year (beginning May 14 and ending August 5; using Thursday as the first day of the week in order to facilitate this weekly update):

and here is the CDC’s latest chart of weekly rates per 100,000 of COVID-19 hospitalizations without regard to age:

The CDC’s weekly surveillance summary states that

Nationally, levels of influenza-like illness (ILI) are below baseline but higher than typically seen at this time of year. Indicators that track ILI and COVID-19-like illness (CLI) showed decreases nationally from week 30 to week 31, with decreasing or stable (change of ≤ 0.1%) levels in all regions of the country. Nationally, the percentage of laboratory tests positive for SARS-CoV-2 decreased from week 30 to week 31 and decreased in nine of ten HHS regions.

As of today’s CDC report the nation has experienced nearly 4.9 million cases of COVID-19 and 158,887 COVID-19 related deaths this year.

Kaiser Health News reports that two COVID-19 vaccine developers are having no problem recruiting 60,000 Americans to test their still experimental vaccines. One of the vaccines in the third and final phase of trials is made by Pfizer and BioNTech, a German company, and the other by biotech startup Moderna with support from NIH.

The Wall Street Journal reports tonight that the latest round of COVID-19 relief bill negotiations today was unsuccessful.

It wasn’t known whether negotiations could later resume, potentially among a different constellation of leaders. Both Mr. McConnell and Mr. Trump haven’t been in the room for the past two weeks of talks. Mrs. Pelosi said Democrats weren’t interested in peeling off a short-term extension of just the federal unemployment insurance, as Republicans had proposed in the closed-doors negotiations. One possibility is that the debate over coronavirus aid gets merged with discussions expected in September about keeping the government running when its current funding expires on Oct. 1.

In the meantime, we may see executive orders from the White House.

The Federal Times reports on the U.S. Postal Service’s second quarter financial results. “Though revenue for the first three quarters of 2020 is $553 million greater than for the same period in 2019, due in part to a strong increase in package volume, the agency continues to report significant losses of $2.2 billion in the third quarter of this year compared to a net loss of $2.3 billion for the same quarter last year.”

In healthcare news –

  • HHS’s Agency for Healthcare Research and Quality has issued a timely Brief on Telediagnosis for Acute Care: Implications for the Quality and Safety of Diagnosis. The Director of AHRQ’s Center for Quality Improvement and Patient Safety observed that “The use of telemedicine is growing at the same time it is evolving rapidly. These changes will make the healthcare ecosystem increasingly reliant on telemedicine for several aspects of care, including diagnosis. Now is the time for the research community to come together and help ensure telemedicine is as safe and effective as possible.”
  • MedCity News reports that an eight year old primary care company, Oak Street Health, has successfully issued public shares of stock in its business. “Oak Street [which is based in Chicago] currently operates in nine states, striking value-based care agreements to care for Medicare and Medicare Advantage patients. That model has helped Oak Street where many primary care clinics have struggled as in-person visits have dropped during the Covid-19 pandemic. More than 97% of its revenue is tied to value-based contracts, according to its prospectus.” Good luck.

Thursday Miscellany

David Ermer–Congress, COVID-19, COVID-19 vaccine, Federal employment benefits, U.S. Healthcare–

The Wall Street Journal reports that

White House chief of staff Mark Meadows and Treasury Secretary Steven Mnuchin said Wednesday that if they don’t reach a deal by Friday with Mrs. Pelosi and Senate Minority Leader Chuck Schumer (D., N.Y.), they saw little point in continuing the daily negotiating sessions they have been conducting for nearly two weeks.

The quartet was expected to meet again early Thursday evening.

Democrats said Thursday that the slow pace of progress in the talks stems from a central clash over how much assistance the federal government should provide.

The President has stated that he plans to issue executive orders providing COVID-19 emergency relief if a compromise is reached.

Today the President signed an executive order directing administrative action to “reduce our dependence on foreign manufacturers for Essential Medicines, Medical Countermeasures, and Critical Inputs to ensure sufficient and reliable long-term domestic production of these products, to minimize potential shortages, and to mobilize our Nation’s Public Health Industrial Base to respond to these threats.” That seems sensible. Here’s a link to a Wall Street Journal article on the executive order. The Journal explains that “The order seeks to reverse the practice in recent decades of moving drug manufacturing outside of the U.S. That shift is partly because of more favorable tax rates, cheaper labor and friendlier environmental regulations, industry officials say.”

On the miscellany front —

  • The Federal Times reports that the U.S. Office of Personnel Management is poised to publish an interim final rule implementing the new paid parental leave program for federal employees. The program takes effect on October 1, 2020, and the interim final rule will be published in the Federal Register on August 10, 2020.

The act enables federal employees to substitute 12 weeks of paid leave for the same amount of time of unpaid leave authorized under the Family and Medical Leave Act of 1993.

But not all of the circumstances covered by unpaid leave apply to the new paid leave provisions.

Federal employees covered by the act may only take paid parental leave after the birth or placement of a child and may only do so within a 12-month window of that birth or placement.

  • Health Payer Intelligence reports on a Blue Cross study discussing payer strategies to improve sagging colorectal cancer screening rates in our country. OPM scores FEHB plans on the NCQA’s HEDIS measure for this preventive care measure. The article explains

“A major barrier to preventative screening is attitudinal – stemming from misperceptions surrounding discomfort, lack of risk awareness, and general fear of negative results,” [BCBSA Vice President Reed] Melton said. “Payers can start by working to change those perceptions and provide accurate, accessible resources to better inform the public.”

Payers can act on the information that this report unveiled by making colorectal cancer information—including screening information and other data—available to members online. This is a strategy that many Blue Cross and Blue Shield companies are already implementing.

  • Last week the FEHBlog called attention to successful COVID-19 vaccine tests performed on monkeys. One group of monkeys was given the experimental vaccine and the other group wasn’t. However, both groups were exposed to COVID-19 which increases the reliability of the testing. A friend of the FEHBlog shared a link to the 1 Day Sooner site. 1 Day Sooner proposes that human volunteers engage in the same type of testing which are known as challenge trials. ” Human challenge trials deliberately expose participants to infection, in order to study diseases and test vaccines or treatments. They have been used for influenza, malaria, typhoid, dengue fever, and cholera. Researchers are exploring whether human challenge trials could speed up the development of a vaccine for COVID-19, saving thousands or even millions of lives.” Who knew? Certainly gutsy. In any event, the FEHBlog shares a monkey’s picture today in gratitude to their efforts to protect fellow primates.

Midweek Update

David Ermer–ACA, Congress, COVID-19, COVID-19 vaccine, Telehealth, U.S. Healthcare–

The Wall Street Journal reports this evening that “White House and Democratic negotiators emerged frustrated from their [latest COVID-19 relief bill} meeting Wednesday. White House officials said Democrats were dragging their feet on talks, and Democrats countered that Republicans were thinking too small.” “Absent an agreement [by this Friday, [Treasury Secretary Steven] Mnuchin said, “We’ll have to look at the president taking actions under his executive authority.”

On the vaccine front —

  • Kaiser Health News reports that obese people are less responsive to vaccines than other folks. ” Dr. Timothy Garvey, an endocrinologist and director of diabetes research at the University of Alabama, was among those who stressed that, despite the lingering questions, it’s still safer for obese people to get vaccinated than not. “The influenza vaccine still works in patients with obesity, but just not as well,” Garvey said. “We still want them to get vaccinated.” FEHBP plans typically offer effective coaching problems to help plan members with weight reduction.
  • On the brighter side, the Wall Street Journal reports that “Researchers and companies developing Covid-19 vaccines are taking new steps to tackle a longtime challenge: Those who need the vaccines most urgently, including Black and Latino people, are least likely to participate in clinical trials to determine whether they work safely.” Health plans may be able to offer support here to researchers.

Publicly traded healthcare companies have been report second quarter results recently. Healthcare Dive reports that “All of the nation’s largest insurers, Anthem, Centene, Cigna, Molina, UnitedHealth Group (which operates UnitedHealthcare) and CVS (which owns Aetna), all reported a surge in second quarter profits due to lower medical usage among members.” To the extent that these profits stem from health insurance premiums, the ACA’s requirement that health insurers rebate premium income when they fall below the minimum medical loss ratio threshold (80% for individual coverage and 85% for group coverage) is designed to prevent excess profits.

  • For more details on second quarter results CVS Health and Humana reported today. Becker’s Hospital Review inform us about other major insurer results here.

Forbes advises us that according to a recent study, deferral of care during the great hunkering down in March and April caused a concerning drop in new cancer diagnoses. “This report demonstrates that our initial response to the pandemic of limiting so-called elective screening and diagnostic tests has consequences,” said Craig Bunnell, MD, Dana-Farber Cancer Institute Chief Medical Officer. “The true incidence of these cancers did not drop. The decline clearly represents a delay in making the diagnoses, and delays matter with cancer,” Bunnell added. But physicians are keen to stress that for symptoms that cannot wait such as anything which might indicate cancer, people must not hesitate to seek medical care, despite the pandemic. “We need to safely perform these diagnostic tests and the public needs to not think of them as optional. Their lives could depend on them,” said Bunnell.

How true. Becker’s Hospital Review provides additional perspective on this issue by publishing a Census Bureau ranking of the states by the estimated percentage of deferred care due to the COVID-19 emergency.

Nationwide, 40 percent of Americans are still delaying care, according to a survey from the U.S. Census Bureau. The agency launched its Household Pulse Survey April 23, polling roughly 1 million Americans weekly on how the pandemic is affecting their household. Over the past 12 weeks, the percentage of U.S. adults delaying care has hovered around 40 percent with little fluctuation.

Finally, there was a big healthcare industry transaction announced today. STAT reports that “telemedicine provider Teladoc Health has reached an agreement to buy the diabetes coaching company Livongo in an $18.5 billion deal.” Both companies are publicly traded. The Wall Street Journal explains that

Under the deal, each share of Livongo will be exchanged for 0.5920 shares of Teladoc, plus cash consideration of $11.33 for each Livongo share. Upon completion of the merger, existing Teladoc shareholders will own 58% of the combined company, and existing Livongo shareholders will own 42%. The transaction is expected to close by the end of this year.

Tuesday Tidbits

David Ermer–Congress, COVID-19, Telehealth, U.S. Healthcare–

The Wall Street Journal reports tonight that “White House negotiators said they aim to reach a deal with Democrats on a new coronavirus-relief package by the end of the week, with both sides saying they made progress in talks to bridge differences in unemployment payments and other aid proposals.” It’s hard to believe that a new law will not come out of these talks next week as it is a Presidential and Congressional election year.

The Journal also informs us that

The National Institutes of Health on Tuesday said it is launching wide-ranging studies of potential Covid-19 drugs known as monoclonal antibodies, the synthetic targeted versions of proteins produced by recovered Covid-19 patients.

The potential drugs that emerge from the research could be among the foremost medical treatments to prevent or treat infections with the new coronavirus while the U.S. and world await possible vaccines. Anthony S. Fauci, who heads the NIH institute overseeing the work, said monoclonal antibodies have great potential because they are specifically designed to block the virus from infecting a human cell.

Also on the COVID-19 front, the FEHBlog today ran across this handy CDC site full of varying U.S. map perspectives on the COVID-19 emergency. Check it out.

Promptly following up on the President’s executive order issued yesterday concerning rural healthcare access and telehealth, the Centers for Medicare and Medicaid Services has issued proposed rules that would implement significant aspects of the order. As part of this proposed rules package, CMS issued its proposed 2021 calendar year update to the Medicare Part B physician fee schedule. Here are Fierce Healthcare and Healthcare Dive articles on these actions.

Health Affairs alerts us that “Provider consolidation into vertically integrated health systems increased from 2016 to 2018. More than half of US physicians and 72 percent of hospitals were affiliated with one of 637 health systems in 2018. For-profit and church-operated systems had the largest increases in system size, driven in part by a large number of system mergers and acquisitions.” Check out this statistic — “the share of primary care physicians affiliated with vertically integrated health systems increased from 38 percent to 49 percent, or 11 percentage points, from 2016 to 2018.” This statistic is bound to keep growing as Baby Boomer physicians retire.

Since the NCQA Digital Quality Summit last month, the FEHBlog floated the idea of adding racial, ethnic, and gender identification to the ICD-10 as a way to help identify and address healthcare disparities. He notes that those codes could be added to the Z section of the ICD-10. It’s worth adding that SDOH considerations (which are not the same as racial disparity considerations) are already found in the Z section, e.g. , Z56 , Z59, and Z62 .