Today's News and Commentary

About Covid-19

 As commercial COVID pivot looms, Moderna logs $2.8B in demand-related expenses “For all of 2022, the mRNA specialist logged a $1.3 billion charge for inventory write-downs, plus $725 million for contract cancelations. Moderna paid another $776 million for unused manufacturing capacity and CDMO charges, representing total expenses tied to slouching demand of around $2.8 billion.
All told, Moderna reported total 2022 sales costs of $5.4 billion, representing 29% of the company’s $18.4 billion that its roster of COVID shots and boosters brought home for the year. Aside from third-party royalty costs of $1.1 billion—plus other expenses related to activities like actually producing the shot—Moderna credited the charges to ‘overall lower demand’ for its vaccines ‘in particular from low-income countries.’ Moderna also cited a shift in demand to the company’s Omicron-busting bivalent boosters, alongside costs ‘associated with surplus production capacity.’”

About health insurance/insurers

Humana to Exit Employer Group Commercial Medical Products Business “Humana Inc. today announced that it will be exiting the Employer Group Commercial Medical Products business, which includes all fully insured, self-funded and Federal Employee Health Benefit medical plans, as well as associated wellness and rewards programs. No other Humana health plan offerings are materially affected. The company remains committed to the long-term growth of its core Insurance lines of business, including Medicare Advantage, Group Medicare, Medicare Supplement, Medicare Prescription Drug Plans, Medicaid, Military and Specialty (Dental, Vision, Life, etc.), as well as its CenterWell healthcare services business.
Following a strategic review, the company determined that the Employer Group Commercial Medical Products business was no longer positioned to sustainably meet the needs of commercial members over the long term or support the company’s long-term strategic plans. The exit from this line of business will be phased over the next 18 to 24 months. The company is committed to ensuring a smooth transition of services for members and commercial customers.”

 U.S. Medicare says no change to Alzheimer's drug restrictions “The U.S. government health plan for people over the age of 65 on Wednesday said it would not reconsider strict coverage limits put in place last year for new Alzheimer’s treatments, rejecting a request from the Alzheimer’s Association.
The Centers for Medicare and Medicaid Services (CMS) reaffirmed its policy allowing coverage for drugs designed to clear amyloid plaques from the brains of Alzheimer’s patients only if a medication is approved under the Food and Drug Administration’s standard review process, not under its accelerated review program.
The agency said it would also continue to require a registry to collect evidence of patient outcomes to reflect ‘real-world’ care.”

About hospitals and healthcare systems

Costly discharge delays highlight need for more downstream care options, New York group's analysis shows  “Rampant discharge delays last spring cost New York hospitals an average of $168,000 per inpatient case and $18,000 per day in the emergency department, much of which was not reimbursed by payers, according to hospital data from the Healthcare Association of New York State (HANYS).
The data collection pilot, published Tuesday, pulled information from 52 New York hospitals from April 1 to June 30, 2022.
Among these, HANYS found 1,115 patients who “for circumstances largely outside hospitals’ control” couldn’t be discharged from the ED for at least four days or from an inpatient unit for 14 days. These patients collectively represented about 60,000 days of ‘avoidable’ delays, according to the pilot.”
This problem has national scope.

About pharma

 Exposure to US Cancer Drugs With Lack of Confirmed Benefit After US Food and Drug Administration Accelerated Approval[AA] “Among 5 oncology indications, 26.1% of eligible treatment initiations involved an AA indication subsequently withdrawn due to lack of benefit. An expected trade-off exists between expediting access to promising cancer drugs and withdrawal of some indications. Given the growth of withdrawals due to negative confirmatory trials and emerging evidence on the high spending associated with AA drugs, it is critical to balance early access against population-level exposure to cancer therapies with no benefit over standard of care.” 

Moderna teams up with ElevateBio in mRNA gene editing pact “Moderna and ElevateBio's Life Edit Therapeutics on Wednesday announced a partnership to co-develop in vivo mRNA gene editing therapies using the latter's "large and diverse" library of base editors and RNA-guided nucleases (RGNs). Financial specifics about the multi-target collaboration were not disclosed, but the companies said the focus will be on creating potentially curative therapies for the ‘most challenging’ rare genetic and other diseases.”

HHS prioritizing FDA labeling, DTC advertising, and compounded drug rules “The US Department of Health and Human Services (HHS) on Tuesday published a list of regulations its agencies will prioritize over the coming year. It includes several rules that the Food and Drug Administration (FDA) will work on to address issues such as patient labeling, conduct of clinical trials and drug compounding.
 On 22 February, HHS published its semiannual regulatory agenda, which included a number of rules either under development or set to be finalized by FDA, as well as a timetable for expected completion. Notably, several of the rules, including a rule on medication guides, have been listed in the regulatory agenda for multiple years.”
 
About the public’s health

Flu vaccine was 68% effective at preventing hospitalization in children but less protective for seniors this season “The flu vaccine has been 68% effective at preventing hospitalizations in children and 35% effective at preventing hospitalization in seniors this season, according to preliminary CDC data.
Dr. Jose Romero, head of the National Center for Immunization and Respiratory Disease, said flu cases and hospitalizations are declining but that the U.S. could see a second wave later this year.”
For the full CDC report, click here.

Associations of timing of physical activity with all-cause and cause-specific mortality in a prospective cohort study “Moderate-to-vigorous intensity physical activity (MVPA) at any time of day is associated with lower risks for all-cause, cardiovascular disease, and cancer mortality. In addition, compared with morning group (>50% of daily MVPA during 05:00-11:00), midday-afternoon (11:00-17:00) and mixed MVPA timing groups, but not evening group (17:00-24:00), have lower risks of all-cause and cardiovascular disease mortality. These protective associations are more pronounced among the elderly, males, less physically active participants, or those with preexisting cardiovascular diseases. Here, we show that MVPA timing may have the potential to improve public health.”

CDC panel recommends Bavarian Nordic's mpox vaccine for all adults at risk “Advisers to the U.S. Centers for Disease Control and Prevention (CDC) on Wednesday voted in favor of use of Bavarian Nordic's Jynneos vaccine for all adults at risk of mpox during an outbreak.
The panel of outside experts voted unanimously in favor of use of two doses of the vaccine, and finalizing the interim guidelines provided by CDC during the mpox outbreak in the United States.
The recommendation of the committee is based on studies that showed vaccine effectiveness of 66%-83% for patients with full vaccination and 36%-86% for partial vaccination with no severe adverse affect.”

FDA Files Civil Money Penalty Complaints Against Four E-Cigarette Product Manufacturers The FDA “oday, the U.S. Food and Drug Administration announced it has filed civil money penalty (CMP) complaints against four tobacco product manufacturers for manufacturing and selling e-liquids without marketing authorization. This is the first time the FDA has filed CMP complaints against tobacco product manufacturers to enforce the Federal Food, Drug, and Cosmetic (FD&C) Act’s premarket review requirements for new tobacco products.
It is illegal to manufacture, sell, or distribute e-liquids that the FDA has not authorized. The FDA previously warned each of the companies that, by making and selling their e-liquids without marketing authorization from the FDA, they were in violation of the FDA’s premarket requirements for tobacco products and that failure to correct these violations could lead to an enforcement action, such as a CMP. Despite the agency’s warning, these companies continue to make and sell their unauthorized e-liquids to consumers.”

Most parts of world saw maternal mortality rates spike in 2020 “Maternal mortality rates climbed or stagnated in nearly all regions across the world in 2020, according to a report released by U.N. agencies on Wednesday, marking a major setback in global efforts to combat complications during childbirth or pregnancy.
The report, which tracks maternal mortality nationally, regionally and globally from 2000 to 2020, showed there were an estimated 287,000 maternal deaths worldwide in 2020, and it marks only a slight decrease from 309,000 in 2016.
That translates to a woman dying every two minutes during childbirth or pregnancy, the report estimated.”

About healthcare IT

 FDA Sees Spike in Drug Applications That Involve AI Tools “The number of drug applications that the FDA has received involving artificial intelligence (AI) and machine learning (ML) tools jumped from just a handful before the COVID-19 pandemic to more than 120 in 2021 and topped 150 in 2022.”

Teladoc Health Reports Fourth Quarter and Full Year 2022 Results Among the statistics: “Net loss totaled $3,810.1 million, or ($23.49) per share, for the fourth quarter of 2022, compared to $11.0 million, or ($0.07) per share, for the fourth quarter of 2021. Results for the fourth quarter of 2022 primarily included non-cash goodwill impairment charges of $3,772.8 million, or ($23.26) per share, stock-based compensation expense of $50.8 million, or ($0.31) per share, and amortization of acquired intangibles of $49.0 million, or ($0.30) per share.”

Does deidentification of data from wearable devices give us a false sense of security? A systematic review The quick answer is “No.”
“Correct identification rates were typically 86–100%, indicating a high risk of reidentification. Additionally, as little as 1–300 s of recording were required to enable reidentification from sensors that are generally not thought to generate identifiable information, such as electrocardiograms. These findings call for concerted efforts to rethink methods for data sharing to promote advances in research innovation while preventing the loss of individual privacy.”

About healthcare personnel

 What’s your specialty? New data show the choices of America’s doctors by gender, race, and age Interesting breakdown and worth a read. The statistic on which the media is focusing is the 5.7% “Black or African American” category, which is significantly underrepresented given population proportion percentages (12%). 

Today's News and Commentary

About Covid-19

 WHO says independent panel of experts is evaluating evidence on new COVID variants to determine whether vaccines need to be updated  “Members of the agency’s Technical Advisory Group on COVID-19 Vaccine Composition, an independent group of experts, outlined the process in a commentary in Nature Medicine journal, in which they agreed the vaccines are still offering a high level of protection against severe disease caused by all of the variants, including omicron, which is dominant globally.” 

Veklury (Remdesivir) Reduced Risk of Mortality in Hospitalized COVID-19 Patients Across all Variant Time Periods in a Real World Study of More than 500,000 Hospitalized Patients “Two studies analyzed clinical practice information from the U.S. Premier Healthcare databases of more than 500,000 adult patients hospitalized with COVID-19. The overall analysis examined all-cause inpatient mortality rates at 14- and 28- days and demonstrated that initiation of Veklury within the first two days of hospital admission was associated with a statistically significant lower risk for mortality in all oxygen levels compared to matched controls that did not receive Veklury during their hospitalization for COVID-19. For patients with no documented use of supplemental oxygen at baseline, treatment with Veklury was associated with a 19% (p<0.001) lower risk of mortality at Day 28. Patients on low-flow or high-flow oxygen also had a 21% (p<0.001) and 12% (p<0.001) lower risk of mortality at Day 28, respectively. Patients on invasive mechanical ventilation/ECMO at baseline had a 26% (p<0.001) reduced risk for mortality at Day 28. These findings were observed throughout all variant time periods, including Omicron, in patients who did not require supplemental oxygen and across all levels of supplemental oxygen use, including those on invasive mechanical ventilation (IMV)/ECMO.”

About health insurance/insurers

 CMS data: Medicare Advantage enrollment now more than 31M “The Centers for Medicare & Medicaid Services (CMS) released its latest look at enrollment in the MA program, which showed that nearly 30.9 million people had enrolled in MA plans, with most choosing plans that have prescription drug coverage. In addition, 308,881 people are enrolled in commercial Medicare-Medicaid plans, according to the data.
By comparison, about 29.1 million people had such coverage in February 2022, for a year-over-year increase of 7.1%. The 2023 data represent 776 MA contracts, up from 740 a year ago.
Enrollment in standalone prescription drug plans was 22.5 million, bringing total enrollment in private Medicare coverage to 54 million.”
See, also, this Chartis report: In a Shifting Market, Medicare Advantage Shows Continued—but Decelerating—Growth

CMS now accepting applications for extended bundled payment program “CMS began accepting applications Feb. 21 for its Bundled Payments for Care Improvement Advanced model. 
Through May 31, acute care hospitals, physician groups and Medicare ACOs can apply to participate in the value-based program for two years beginning in January.”

About the public’s health

 Pfizer RSV vaccine that protects infants could receive FDA approval this summer “KEY POINTS

  • The FDA is reviewing Pfizer’s RSV vaccine on an expedited basis and will make a decision on whether to clear the shot by August.

  • The single-dose vaccine is administered to expectant mothers in the late second to third trimester of their pregnancy.

  • The antibodies triggered by the shot are passed to the fetus, and they protect the infant from RSV after birth.” 

About healthcare IT

 Hospital Price Transparency: Progress And Commitment To Achieving Its Potential A great review of the topic by authors from CMS. One highlight to show the current program status: “As of January 2023, CMS had issued nearly 500 warning notices and over 230 requests for corrective action plans since the initial implementing regulation went into effect in 2021. Nearly 300 hospitals have addressed problems and have become compliant with the regulations, leading to closure of their cases. While it was necessary to issue penalties to two hospitals in 2022 for noncompliance (posted on the CMS website), every other hospital that was reviewed has corrected its deficiencies.”

A multi-site randomized trial of a clinical decision support intervention to improve problem list completeness “The CDS [clinical decision support] was highly effective at improving problem list completeness. However, the improvement in problem list utilization was not associated with improvement in the quality measures. The lack of effect on quality measures suggests that problem list documentation is not directly associated with improvements in quality measured by National Committee for Quality Assurance Healthcare Effectiveness Data and Information Set (NCQA HEDIS) quality measures. However, improved problem list accuracy has other benefits, including clinical care, patient comprehension of health conditions, accurate CDS and population health, and for research.”

About healthcare personnel

Board Rules that Employers May Not Offer Severance Agreements Requiring Employees to Broadly Waive Labor Law Rights  The NLRB “issued a decision in McLaren Macomb, returning to longstanding precedent holding that employers may not offer employees severance agreements that require employees to broadly waive their rights under the National Labor Relations Act. The decision involved severance agreements offered to furloughed employees that prohibited them from making statements that could disparage the employer and from disclosing the terms of the agreement itself.”

About health technology

White House opts not to veto ITC ruling in favor of AliveCor in ECG patent battle with Apple “A potential import ban on the Apple Watch is still on the table as an International Trade Commission (ITC) ruling against the technology cleared presidential review this month.
Rulings such as the late December one between Apple and AliveCor—which determined the built-in ECG technology within some Apple Watches infringes on AliveCor’s own patented portable ECG devices—can be vetoed by the White House within 60 days. In this case, the Biden administration has allowed the ruling to stand, AliveCor announced this week.”

Philips Sees Another Ventilator Recall Deemed Class I “The FDA has identified a recall for certain reworked Philips Trilogy and Garbin ventilators as Class I, the most serious type of recall, as use of these devices can cause serious injuries or death…
This recall is for two potential issues. The adhesive used to attach the silicone sound abatement foam installed to replace PE-PUR foam may fail and potentially block the airpath. Philips also found some residual PE-PUR sound abatement foam in some reworked ventilators, which poses potential health risks.”

About healthcare finance

 Amazon says it has completed $3.49 billion deal for One Medical “ Amazon.com Inc. says it has completed its purchase of One Medical parent 1Life Healthcare Inc., sealing the $3.49 billion acquisition after the US Federal Trade Commission declined to challenge it.
The deal gives the e-commerce giant a network of primary-care doctors, Amazon’s biggest move to date into the health care industry. One Medical operates more than 200 medical offices in 26 markets in the US. Customers pay a subscription fee for access to its physicians and digital health services.” 

Today's News and Commentary

About Covid-19

 Past SARS-CoV-2 infection protection against re-infection: a systematic review and meta-analysis “Protection from past infection against re-infection from pre-omicron variants was very high and remained high even after 40 weeks. Protection was substantially lower for the omicron BA.1 variant and declined more rapidly over time than protection against previous variants. Protection from severe disease was high for all variants.” 

About health insurance/insurers

 Best Health Insurance Companies of 2023 FYI from “insure.com” Kaiser comes out first with United a close second.

About pharma

2022's 10 top clinical trial flops FYI

 Novartis loses $940M arbitration case against Mitsubishi Chemical over Gilenya royalties “Novartis has made more than $30 billion from sales of its multiple sclerosis therapy Gilenya. But lately the drug’s decline has brought headaches for the Swiss pharma giant.
A series of patent defeats has led Novartis to a last ditch appeal with the U.S. Supreme Court. Now, the company has been told to fork over $940 million in royalties to Mitsubishi Chemical Group.”

About healthcare IT

 59.7M patient records were breached in 2022 “In 2022, the number of patient records breached increased by 18 percent compared to 2021 to 59.7 million, according to a new report from healthcare analytics company Protenus Breach Barometer.”
And in a related article:  
Reported HIPAA complaints and breaches shot up from 2017 to 2021: HHS “According to the report, the number of large HIPAA breaches rose by 58 percent between 2017 and 2021, and the number of complaints rose by 39 percent. The agency defines large breaches as ones that affect at least 500 individuals.”

Survey Finds 57% of U.S. Physicians Have Changed Their Perception of a Medication as a Result of Info on Social Media “A new joint survey from Sermo and LiveWorld found that 57% of U.S.-based physicians frequently or occasionally change their perception of a medication or treatment based on content they’ve seen on social media. Only 16% of surveyed physicians reported that their perceptions have never been influenced by social media.”

Today's News and Commentary

About Covid-19

 White House mulls post-Covid emergency backstop for uninsured “The Biden administration is zeroing in on a plan to keep Covid vaccines, treatments and tests free for the uninsured into 2024, even as it plots a quicker wind-down of its broader pandemic response, four people with knowledge of the matter told POLITICO.”

About health insurance/insurers

The Joint Commission and Manchester Specialty Programs collaborate to provide insurance pricing benefits to eligible nursing homes and assisted living facilities JC accredited facilities can get premium discounts on insurance from this company. Like good drivers getting an insurance discount.

About hospitals and healthcare systems

 Unfortunate trend continues (following 3 articles):
Alabama Hospital Association: Over a dozen rural hospitals at immediate risk of closing 

Financial and Operational Impacts on Tennessee Hospitals Since the Onset of the Pandemic “The vast majority of hospitals at risk of closure in Tennessee are rural hospitals, though urban hospitals have also been stressed and are at a higher risk than pre-pandemic levels.”

 Duke University Health reports $70M operating loss, overall profit “Overall income for the period totaled $28.8 million, boosted by positive returns on investment income.”
And when the market declines again…?

About pharma

Years after the first US biosim launches, doctors still have their concerns: survey “In the U.S., when a biosimilar is shown through a switching study to have comparable efficacy and safety to a reference product, it is classified as “interchangeable.” As such, it can be swapped out by a pharmacist for the original medicine.
But while the interchangeable designation is valuable, many manufacturers of biosimilars are not willing to undergo the time consuming and expensive studies that are required to gain the status…
When asked in the Sermo study whether regulatory agencies should do away with switching studies and deem all U.S. biosimilars interchangeable, 48% of doctors said they were unsure.  
Similarly, when asked about the key factor in prescribing a biosimilar, 48% of doctors cited comparable efficacy data—as proven through a switching study. Meanwhile, only 19% of those surveyed said financial savings to the patient was an important factor.”

High drug prices are not justified by industry’s spending on research and development “Key messages:

  • From 1999 to 2018, the world’s 15 largest biopharmaceutical companies spent more on selling, general, and administrative activities than on research and development

  • Most of these companies also spent more on share buybacks and paying out dividends than on research and development

  • Most new medicines developed during this period offered little or no clinical benefit over existing treatments

  • Industry could generate more medically valuable and affordable innovation with existing resources

  • Government action is needed to encourage research and development focused on public health priorities”

About the public’s health

Vaping Dose, Device Type, and E-Liquid Flavor are Determinants of DNA Damage in Electronic Cigarette Users  “We demonstrate a dose-dependent formation of DNA damage in oral cells from vapers who had never smoked tobacco cigarettes as well as exclusive cigarette smokers. Device type and e-liquid flavor determine the extent of DNA damage detected in vapers. Users of pod devices followed by mod users, and those who use sweet-, mint or menthol-, and fruit-flavored e-liquids, respectively, show the highest levels of DNA damage when compared to nonusers. Given the popularity of pod and mod devices and the preferability of these same flavors of e-liquid by both adult- and youth vapers, our findings can have significant implications for public health and tobacco products regulation.” 

Investigation spotlights rise of for-profit ethics boards in research “Federal regulations require that certain research on human subjects — including those testing the safety of new drugs — first get approval from a registered institutional research board. These boards, which are made up of at least five members and can include researchers and academics, are designed to make sure that a study poses as little risk as possible and that participants have enough information to give consent.
While the majority of these boards are affiliated with universities, a small number have no affiliation with institutions conducting research. But according to a new report from the U.S. Government Accountability Office, these independent boards now account for the largest share of reviews of studies involving new drugs and biologics. Independent boards conducted 48 percent of such research regulated by the Food and Drug Administration in 2021, up from 25 percent a decade earlier, despite making up just 2 percent of all U.S. review boards.”

About health technology

Labcorp plots 2023 revenue growth despite a possible 90% drop in COVID test revenues “In a full-year earnings report published Thursday, Labcorp reported a 7.7% year-over-year drop in revenues in 2022, thanks almost entirely to a COVID diagnostics haul that weighed in at less than half the size of the previous year’s.
For all of 2022, Labcorp raked in $1.1 billion in revenues from sales of its PCR and antibody tests for the coronavirus—just over a 60% drop from 2021’s tally, which added up to $2.8 billion. Though an undeniably huge decrease, that was actually the best-case scenario for Labcorp, which predicted at the start of 2022 that COVID-related revenues for the year would fall at a rate between 60% and 75%.”

Today's News and Commentary

About Covid-19

 Moderna promises $0 cost for its COVID-19 vaccine post PHE “As the federal public health emergency for COVID-19 is set to end May 11, Moderna whistled a new tune Feb. 15, saying both insured and uninsured Americans will not pay a price for its vaccine.” 

About health insurance/insurers

Understanding the Role of Medicaid Managed Care Plans in Unwinding Pandemic-Era Continuous Enrollment: Perspectives from Safety-Net Plans “Only about one-third of responding plans reported having verified/current contact information for between 76% to 100% of their Medicaid members. Most responding plans reported they are taking action to reach out to members directly to assist with updating contact information and many are working with third parties (e.g., providers, community-based organizations (CBOs), subcontractors/vendors etc.). Nearly all responding plans said that reaching Medicaid beneficiaries is a challenge. Plans also described challenges involved with transferring updated contact information data to the state.”

 Medicare Advantage plans deny the most inpatient level-of-care claims: report “Initial clinical denial rates rose in 2022 with the highest denial rates coming from Medicare Advantage plans, according to a Feb. 15 report from Crowe Revenue Cycle Analytics…
Four things to know: 
1. Through November 2022, the dollar value of initial clinical denials by payers represented 3.2 percent of billed inpatient dollars. That is 18.5 percent higher than in 2021. 
2. Providers wrote off 3.6 percent of their inpatient revenue as uncollectible in 2021. That number increased to 5.9 percent in 2022, through November.  
3. The initial inpatient level-of-care claim denial rate for Medicare Advantage plans was 5.8 percent in 2022, through November. That is compared to 3.7 percent for all other payer categories. 
4. Clients in Crowe's benchmarking data wrote off $535.4 million on account of Medicare Advantage plan denials based on lack of medical necessity.”

Elevance Health completes BioPlus buy “Elevance Health has closed its acquisition of BioPlus, a specialty pharmacy company, the insurer announced Wednesday.
BioPlus was a subsidiary of CarepathRx, part of Nautic Partners' portfolio. BioPlus will join the insurer's Carelon arm, which is a major focus of growth within Elevance, formerly Anthem…
BioPlus will now operate as part of CarelonRx, the company's pharmacy benefit management arm.”

Evaluation of Prices for Surgical Procedures Within and Outside Hospital Networks in the US “A total of 3195 hospitals reported prices and were included in this analysis. For 15 of the 16 procedures, the median negotiated price was significantly higher at facilities within networks compared with independent hospitals... Median price for shoulder arthroscopy was 1.68 times higher at facilities within networks compared with independent hospitals ($4432 [IQR, $1611-$10 593] vs $2643 [IQR, $519-$8286]; P < .001). For each procedure, there was significant variation in negotiated prices... The median price for prostatectomy at facilities in hospital networks and independent facilities was $9567 (IQR, $3657-$18 944) and $8601 (IQR, $4038-$17 575), respectively.”

The Budget and Economic Outlook: 2023 to 2033 Annual report from the CBO. Search for Medicare mentions. For example:
”…outlays for many programs are projected to increase in 2023. The largest increases are for the following programs:

  • Medicare. Outlays for Medicare (net of offsetting receipts) rise by $110 billion (or 16 percent) in 2023, to $820 billion, in CBO’s projections. That increase results from a decrease in offsetting receipts and an increase in outlays. Medicare offsetting receipts are projected to decrease in 2023 because recoupments from the COVID-19 Accelerated and Advance Payment Program are expected to be lower than they were last year. Beginning in April 2020, the government provided about $100 billion in assistance to Medicare providers under that program. That sum was to be recouped later through reductions in claim payments. Because most of the outstanding amounts were recouped in 2021 and 2022, CBO expects such receipts to fall from $62 billion in 2022 to $3 billion in 2023. Additionally, Medicare outlays are projected to rise in 2023 because of increases in enrollment (which is projected to rise by 2 percent), payment rates, and spending related to beneficiaries’ use of care…”
    See also: Analysis of CBO's February 2023 Budget and Economic Outlook

About hospitals and healthcare systems

 CommonSpirit records $451M operating loss in 2nd half of 2022 “Chicago-based CommonSpirit Health, one of the largest healthcare systems in the country operating 138 hospitals in 21 states, has reported $451 million in operating losses for the six-month period ending Dec. 31.
Those figures compared with operating losses of $47 million for the same period in the prior year.”

Steward to sell 5 hospitals to CommonSpirit “CommonSpirit Health will acquire Steward Health Care's sites of care in Utah, which will then be managed by Centura Health, the systems announced Feb. 15. 
The three health systems signed an asset purchase agreement, under which Chicago-based CommonSpirit will acquire five hospitals, more than 35 medical group clinics and a clinically integrated network of providers from Dallas-based Steward. The assets will be wholly owned by CommonSpirit but managed by Centennial, Colo.-based Centura.”

CHS' net income drops 51% in 2022 “Franklin, Tenn.-based Community Health Systems, one of the largest for-profit health systems in the country, reported $179 million net income in 2022, a 51.4 percent drop from the $368 million net income reported the prior year. 
The drop was driven by a decline in net operating revenues, fewer inpatient admissions and what CHS termed ‘unfavorable changes’ in payer mix.”

About pharma

 Labeling Changes for Aduhelm Detail Risks of ARIA Brain Bleeds “The FDA has updated the labeling for Biogen’s Alzheimer’s drug Aduhelm (aducanumab-avwa) to include a warning of potential amyloid-related imaging abnormalities (ARIA), which can lead to brain bleeding and swelling, and in some cases, intracerebral hemorrhage greater than one centimeter.” 

About the public’s health

FDA advisers recommend approval of Narcan for over-the-counter use “The anti-opioid overdose drug Narcan should be made available for over-the-counter use, advisers to the Food and Drug Administration said Wednesday.
A joint FDA advisory panel unanimously voted 19-0 to recommend the agency approve the drug, which is currently only available by prescription. FDA approval would allow more people to acquire the treatment more easily in more places.”

Wolters Kluwer survey reveals two-thirds of patients still have questions after healthcare visits “The survey found that two-thirds (66%) of patients have questions after a provider encounter and one in five patients (19%) has new questions following the appointment. The research found that patients are eager to receive educational materials from their providers, but when left without those resources, patients turn to unvetted sources of information including website articles, peer recommendations, and social media.”

 About healthcare personnel

 Factors Associated With Primary Care Physician Decision-making When Making Medication Recommendations vs Surgical Referrals “Question  How do the factors associated with primary care physician decision-making differ for medication recommendations compared with surgical referrals?
Findings  This qualitative study found that primary care physicians use evidence-based decision support tools to make medication recommendations and used professional experiences, subjective information on quality, and convenience when making surgical referrals.
Meaning  This study suggests that there is an opportunity to reduce variability and improve surgical outcomes by supporting primary care referral decision-making with valid and reliable data on surgeon and hospital quality.”

About health technology

 GE HealthCare lands Class I recall for 1,200-pound scanners at risk of falling onto patients “GE HealthCare has begun a recall of several models of its nuclear medicine imaging systems that were found to be at risk of collapsing while in use, potentially crushing or trapping a patient underneath.”

Today's News and Commentary

About health insurance/insurers

 18% drop since 2020 in people with reported medical debt “The number of people with medical debt on their credit reports fell by 8.2 million — or 17.9% — between 2020 and 2022, according to a report Tuesday from the U.S. Consumer Financial Protection Bureau.
White House officials said in a separate draft report that the two-year drop likely stems from their policies. Among the programs they say contributed to less debt was an expansion of the Obama-era healthcare law that added 4.2 million people with some form of health insurance. Also, local governments are leveraging $16 million in coronavirus relief funds to wipe out $1.5 billion worth of medical debt.
There has also been a persistent effort by the CFPB to reduce medical debt. The major credit rating agencies said last year that they will no longer include in their reports medical debts under $500 or debts that were already repaid.”

About hospitals and healthcare systems

 Most board members at the nation's top hospitals have no healthcare background Highlights:
—”Among the 529 board members, 44 percent had a background in finance. Among them, more than 80 percent led private equity funds, wealth management firms, or multinational banks. The remainder were in real estate (14.7 percent) or insurance (5.2 percent).
—The second and third most common sectors were health services (16.4 percent) and professional and business services (12.6 percent).
—Across the 15 hospitals, 14.6 percent of board members were healthcare professionals — primarily physicians (13.3 percent) and followed by nurses (0.9 percent).”
Comment: This distribution provides insight into what hospitals want their boards to do. The results indicate help with financial management or fund raising.

About pharma

 After J&J's Texas two-step stumble, another talc plaintiff heads to trial: report “Following a hold on nearly 40,000 lawsuits alleging J&J’s talc products cause cancer, U.S. bankruptcy judge Michael Kaplan on Tuesday agreed to let plaintiff Anthony Hernandez Valadez proceed with his case against the drug behemoth in California…”

Competition And Vulnerabilities In The Global Supply Chain For US Generic Active Pharmaceutical Ingredients “The US supply of generic drugs is heavily dependent on the global supply chain for sources of generic active pharmaceutical ingredients (APIs) for the US pharmaceutical market….We identified a total of 565 facilities producing 1,379 unique generic APIs across forty-two countries. India, China, and Italy were the top producers; 14 percent of APIs were manufactured in the US. About a third of APIs were manufactured by a single facility, and another third were manufactured by two or three facilities. More than one in every five APIs reflected markets in which current Food and Drug Administration standards would have failed to detect low competition because there were three or fewer API manufacturers despite there being four or more manufacturers of finished generic drugs.”

CMMI releases three new models aimed at lower generic, novel drug costs “The three models initially chosen will test:

  • Creating new payment methods for drugs put on the market via accelerated approval, a pathway that lets the Food and Drug Administration (FDA) clear drugs which address unmet medical needs. The agency would create new methods that would encourage drugmakers to complete confirmatory trials as well as boost ‘access to post-market safety and efficacy data. This would reduce Medicare spending on drugs that have no confirmed clinical benefit,’ according to a release. CMS decided to narrowly cover a new class of Alzheimer’s disease drugs for Medicare beneficiaries in a confirmatory clinical trial.

  • A list of generic drugs for which the out-of-pocket Part D costs will be capped at $2 a month per drug. The goal of the model is to encourage Part D plans to lower cost-sharing on ‘relatively inexpensive generic medications that have significant clinical benefits, but cost-sharing can vary widely across insurance plans based on the specific formulation a doctor prescribes,’ a release said.

  • A model to address the skyward cost of gene and cell therapies for diseases like sickle cell and cancer that can come with a price tag of up to $1 million. The goal is for state Medicaid agencies to assign CMS to ‘coordinate and administer multi-state, outcomes-based agreements with manufacturers for certain cell and gene therapies,’ CMS said.”

 

Today's News and Commentary

About Covid-19

U.S. government to buy 1.5 mln more Novavax COVID vaccine doses “The U.S. government has agreed to buy 1.5 million more doses of Novavax Inc COVID-19 vaccine, the company said on Monday, adding that the modified agreement includes funds for development of an updated vaccine by fall this year.
Sales of the company's vaccine have been hurt by a global supply glut and waning demand, with Novavax cutting its full-year revenue forecast for the shots twice last year.”

About health insurance/insurers

Projected Savings Medicare Beneficiaries Need for Health Expenses Remained High in 2022 “To have a 90 percent chance of meeting their health care spending needs in retirement, a man will need to have saved $166,000, and a woman will need to have saved $197,000. Couples enrolled in a Medigap plan with average premiums, meanwhile, will need to have saved $212,000 to have a 50 percent chance of covering their medical expenditures in retirement and $318,000 to have a 90 percent chance.” 

Biden Administration Allowing State Medicaid Funds to Cover Groceries, Nutritional Care “The Biden administration has started allowing state Medicaid funds to be used to pay for groceries and dietary advice in an effort to promote better overall health and wellness among the population and to decrease the need for expensive medical interventions.”

AFFORDABILITY SOLUTIONS FOR THE HEALTH OF AMERICA From the BCBSA.
”We recommend policymakers take action in three areas to address the root causes of rising costs:
1. Improve competition among health care providers
2. Enhance consumer access to lower-cost prescription drugs
3. Ensure patients receive high-quality care delivered at the right place and the right time
The solutions outlined here by the Blue Cross Blue Shield Association (BCBSA) will reduce health care costs for consumers, patients, and taxpayers by approximately $767 billion over 10 years.” [Emphasis in original]
Read the short paper for more details in each category.

About pharma

 FDA Accepts Sandoz BLA for Biosimilar Referencing Amgen’s Prolia and Xgeva “The FDA has accepted Sandoz’s Biologics License Application (BLA) for its biosimilar candidate denosumab to treat osteoporosis in postmenopausal women and in men at increased risk of fractures, treatment-induced bone loss, giant cell tumor of the bone, hypercalcemia of malignancy refractory to bisphosphonate therapy and to prevent skeletal related complications in cancer that has spread to the bone.” 

Assessment of FDA-Approved Drugs Not Recommended for Use or Reimbursement in Other Countries, 2017-2020 “In this cross-sectional study of all 206 new US drug approvals in 2017 through 2020, 47 drugs were refused marketing authorization or not recommended for reimbursement in other countries due to unfavorable benefit-to-risk profiles, uncertain clinical benefit, or unacceptably high price. The median US cost for these drugs was $115 281 per patient per year.”

US Food and Drug Administration Approval of Drugs Not Meeting Pivotal Trial Primary End Points, 2018-2021 “Between 2018 and 2021, the FDA approved 210 new drugs, 21 (10.0%) based on pivotal studies with null findings for 1 or more primary efficacy end points... These 21 drugs were approved for 21 unique clinical indications. Of these drugs, 11 (52.4%) were first in class, 10 (47.6%) received orphan designation, and 13 (61.9%) received an expedited review designation. Before approval, an advisory committee was convened for 3 (14.3%) of the drugs.”

About the public’s health

 The Use of Opioids in the Management of Chronic Pain: Synopsis of the 2022 Updated U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline Focus on the information in the Table.

 9 in 10 employers plan to change health and wellbeing vendors in next two years, WTW survey finds “…the survey of 232 U.S. employers found nearly nine in 10 respondents (88%) are planning to make changes to their vendor partnerships either this year or next. Such changes include adding, enhancing or ending various solutions and services, or working with a different vendor in the foreseeable future.”

Millennials with chronic health conditions have higher utilization rates than older generations: UnitedHealthcare report “Individuals aged 27 to 42 in 2023 with chronic health issues are using healthcare services at a significantly higher rate than older generations, according to a new white paper from UnitedHealthcare and the nonprofit Health Action Council…”
Among the findings:
—”Compared to Generation X (born 1965–1980), millennials (1981–1996) are 106 percent more likely to go to the hospital for diabetes-related issues, 55 percent more likely to visit the emergency room or urgent care for hypertension, and are 31 percent more likely to visit the ED/UC and 29 percent more likely to visit the hospital for obesity-related issues.
—Utilization rates for emergency, urgent and virtual care per 1,000 individuals:
Generation Alpha: 564.8
Generation Z: 709.1
Millennial: 761.2
Generation X: 664.2
Baby boomer: 514.7”
• Generation Alpha (born since 2013)
• Generation Z (born 1997–2012)
• Millennials (born 1981–1996)
• Generation X (born 1965–1980)
• Baby Boomers (born 1946–1964)

About healthcare IT

 ONC debuts first cohort of qualified networks in TEFCA, including Epic, eHealth Exchange “On Monday, the HHS unveiled the first six networks that have been approved to be onboarded as qualified health information networks, or QHINs, under TEFCA, the government’s framework for a nationwide health information exchange.
It’s been about a year since the Office of the National Coordinator for Health IT released TEFCA, or the Trusted Exchange Framework and Common Agreement. Now, Epic, CommonWell Health Alliance, eHealth Exchange, Health Gorilla, Kno2 and Konza — organizations that collectively cover a significant swath of American health records — have committed to become eligible and go live within TEFCA in 12 months.”

About health technology

 FDA Clears bioMérieux’s 15-Disease Point of Care Respiratory Test “The FDA has granted 510(k) clearance and a Clinical Laboratory Improvement Amendments (CLIA) waiver for bioMérieux’s point-of-care Biofire Spotfire system and accompanying R Panel which detects 15 common bacteria, viruses and viral subtypes, including COVID-19.
The system, which delivers results in about 15 minutes during a patient visit, is designed to be used by non-laboratory personnel and can be expanded to include up to four testing modules.”

About healthcare finance

 CVS Health to offer bonds to finance purchase of Signify Health “CVS Health has issued a prospectus for senior notes that will be used for general corporate purposes, as well as help fund its ~$8B acquisition of Signify Health.”

Today's News and Commentary

About health insurance/insurers

CMS puts No Surprises Act payment determinations on hold after court loss CMS is instructing certified independent dispute resolution entities to hold all payment determinations under the No Surprises Act until HHS and the Treasury Department issue further guidance. 
The request comes after a federal judge in Texas ruled Feb. 6 that the No Surprises Act's revised arbitration process ‘continues to place a thumb on the scale"‘in favor of insurers and ‘that the challenged portions of the final rule are unlawful and must be set aside.’”

Pharmacist Convicted for $1M Prescription Drug Fraud “…Ronald A. Beasley II, 33, of Portsmouth, was the pharmacist in charge at NH Pharma, a pharmacy located in Lake Mary, Florida. Through NH Pharma, Beasley and his co-conspirators billed Medicare for expensive compound drug creams that they never actually purchased or dispensed, and instead provided Medicare patients an inexpensive compound drug cream not covered by Medicare. Inventory records showed that NH Pharma did not buy enough of the expensive prescription drugs to fill all the prescriptions NH Pharma billed to Medicare. In total, Beasley and his co-conspirators received more than $1 million in fraudulent proceeds from Medicare.”

 Cigna rebrands to the Cigna Group “Cigna is rebranding to The Cigna Group and launching two brands under the new corporate umbrella.
The company said Feb. 13 that the new health benefits segment is called Cigna Healthcare and will serve its commercial, government and international members.
Evernorth Health Services will house the company's pharmacy, care delivery and benefits solutions. Express Scripts, Express Scripts Pharmacy, Accredo, eviCore, MDLIVE and myMatrixx will exist under the Evernorth name.”
Compare to United HealthCare and Optum.

Kaiser posts $4.5B net loss in 2022 amid staff shortages, economic headwinds “Oakland, Calif.-based Kaiser Permanente reported a net loss of $4.5 billion in 2022, down from a net income of $8.1 billion in 2021, according to its financial results released Feb. 10. Its operating margin dipped from 0.7 percent in 2021 to -1.3 percent in 2022. 
The swing from net income in 2021 to net loss in 2022 reflects an increase in healthcare costs driven by inflation, high COVID-19 costs, ongoing labor shortages and a rise in care volume, according to Kaiser, an integrated healthcare provider with 39 hospitals.”

CMS physician pay down 22% from 2001-2022; providers urge Congress to fix 'broken' system “Adjusted for inflation in practice costs, Medicare physician payment declined 22 percent from 2001 to 2022, according to the American Medical Association. In addition, as commercial payers typically base their reimbursement rates on Medicare rates, their physician payments have also declined over this period, though it is unclear by how much since that information is not publicly available and varies from insurer to insurer.”

About hospitals and healthcare systems

 The No. 1 problem keeping hospital CEOs up at night FYI (top 5):
”1. Workforce challenges (includes personnel shortages and staff burnout, among other issues) — 1.8 
2. Financial challenges — 2.8
3. Behavioral health and addiction issues — 5.2 
4. Patient safety and quality — 5.9
5. Governmental mandates — 5.9”

Henry Ford, MSU, Pistons dunk $2.5B into expanded health facilities in the Motor City “Henry Ford Health, Michigan State University and Detroit Pistons owner Tom Gores announced a plan to pump $2.5 billion into a new joint medical research center, hospital expansions, housing developments and public spaces. The community development project aims to turn the city's New Center neighborhood into a ‘vibrant, walkable community with state-of-the-art residential, commercial, retail, recreational and health care components,’ officials said in a press release.”

About healthcare IT

Doximity rolls out beta version of ChatGPT tool for docs aiming to streamline administrative paperwork “The open beta site, called DocsGPT.com, is an integration with ChatGPT that works with Doximity’s free fax service, said Jeffrey Tangney, Doximity co-founder and CEO, during the company's fiscal 2023 third-quarter earnings call Thursday.”

Today's News and Commentary

About Covid-19

CDC adds Covid-19 vaccinations to immunization schedules for children, adults “The CDC’s vaccination schedule, released Thursday, does not mandate vaccines. States and localities determine which vaccines schools require for students, and all 50 states have medical exemptions for vaccines. Some states also have nonmedical vaccination exemptions for religious or philosophical reasons.”

As the pandemic ebbs, an influential COVID tracker shuts down “The Johns Hopkins Coronavirus Resource Center plans to cease operations March 10, officials told NPR.”

 HHS secretary sends letter to state governors on what’s to come when Covid-19 public health emergency ends A good summary from CNN.
See, also: Fact Sheet: COVID-19 Public Health Emergency Transition Roadmap

About health insurance/insurers

Oscar posts $226M loss in Q4 “Oscar Health reported major gains in total membership but posted a net loss of $606 million in 2022, according to the company's fourth quarter earnings published Feb. 9.”

Twenty-Three Individuals Charged in $61.5 Million Medicare Fraud Schemes “According to court documents, Walid Jamil, 62, and Jalal Jamil, 69, both of Oakland County, owned and operated several home health agencies in the Detroit metropolitan area. They allegedly concealed their ownership interest in these agencies using straw owners – including family members and other associates – and submitted approximately $50 million in fraudulent home health care claims to Medicare. Specifically, Walid and Jalal Jamil allegedly paid bribes to other co-conspirators to recruit patients in violation of the Federal Anti-Kickback Statute. These patients did not need home health care, did not qualify for home health care under Medicare rules, and in many instances were not actually provided the care for which Medicare was billed. Walid and Jalal Jamil allegedly entered into quid pro quo relationships with physician clinics to receive the necessary information to fraudulently bill Medicare. Based on their fraudulent claims, Walid and Jalal Jamil received more than $43 million from Medicare, which they misappropriated for their personal benefit.”

Big payers ranked by 2022 profit Yesterday, the payers were ranked by revenue. United tops both lists.

About hospitals and healthcare systems

 Rural Health Safety Net Under Renewed Pressure as Pandemic Fades “Over the course of the last 13 years, 143 rural hospitals closed, and research conducted by Chartis indicates that another 453 are vulnerable to closure…”
Among the study’s findings: “Overall, 43% of America’s rural hospitals have a negative operating margin, while 51% of facilities located in states that have resisted or not yet implemented Medicaid expansion are in the red. Our analysis of rural hospital financial performance excludes the influence of measures and relief programs designed to ease the financial burden of the pandemic.” 

About pharma

 Vertex teases launch plans for first CRISPR gene editing therapy ahead of FDA decision “s Vertex Therapeutics nears completion of a historic FDA submission, the rare disease specialist has depicted a rosy launch picture for what could become the first CRISPR-based gene editing therapy.
Vertex believes a network of about 50 authorized treatments centers in the U.S., and 25 in Europe, should suffice for its sickle cell disease and beta thalassemia gene therapy candidate exagamglogene autotemcel, or exa-cel…”

U.S. government to start imposing inflation penalties on drugmakers in 2025 “Companies that raise prices higher than the inflation rate will be required to pay Medicare the difference in the form of a rebate. Those that fail to pay the rebate will face a penalty equaling 125% of the rebate amount.”

About the public’s health

SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent healthcare-associated infections through hand hygiene: 2022 Update Key on Table 1.

 Recent Changes in Suicide Rates, by Race and Ethnicity and Age Group — United States, 2021 Latest subject report from the CDC: “After 2 consecutive years of declines in suicide (47,511 in 2019 and 45,979 in 2020), 2021 data indicate an increase in suicide to 48,183, nearly returning to the 2018 peak (48,344) with an age-adjusted rate of 14.1 suicides per 100,000 population (versus 14.2 in 2018).”
Read the rest of the report for more granular data.

The Public Health Fixes That Missed the Omnibus “At the national level, the $1.7 trillion omnibus bill that Congress passed in December 2022 reflects some of what the nation has learned from the pandemic. The legislation responds to several urgent needs, yet only narrowly addresses some of the critical determinants of pandemic preparedness.”
A good summary of what’s in the bill and its potential shortcomings.

About healthcare IT

 Congress Told HHS to Set Up a Health Data Network in 2006. The Agency Still Hasn’t. “Public health officials, data specialists, and government auditors said the problems caused by these communications failures could have been minimized had federal health officials followed the order.
They said there are many reasons the system was never created: the complexity of the task and inadequate funding; a federal-first approach to health that deprives state and local agencies of resources; unclear ownership of the project within HHS; insufficient enforcement mechanisms to hold federal officials accountable; and little agreement on what data is even needed in an emergency.
And today, even after the lessons of the pandemic, experts worry that the ideal remains a pipe dream given the number of stakeholders, a lack of federal leadership, and a divided Congress.”

About healthcare finance

NuVasive, Globus Medical ink $3.1B orthopedic device merger, sending investors scrambling “Two long-standing makers of implants and surgical tools for orthopedic procedures are set to combine into a single musculoskeletal device powerhouse.
NuVasive and Globus Medical announced their plans to merge in a joint press release Thursday.”

Abbott to acquire Cardiovascular Systems for $837.6 mln “The deal will help Abbott gain access to CSI’s minimally invasive device to treat blocked arteries.”

Today's News and Commentary

About Covid-19

 Federal official warns $191 billion in covid unemployment aid may have been misspent “The U.S. government may have misspent roughly $191 billion in pandemic unemployment benefits, a top federal watchdog told Congress on Wednesday, as Washington continues to uncover the vast and still-growing extent of the waste, fraud and abuse targeting coronavirus aid.
The new estimate — computed by Larry D. Turner, the inspector general of the Labor Department — galvanized House Republicans as they intensified their scrutiny of the roughly $5 trillion in emergency funds approved since the start of the crisis.” 

Characterisation of SARS-CoV-2 variants in Beijing during 2022: an epidemiological and phylogenetic analysis “All of these genomes belong to the existing 123 Pango lineages, showing there are no persistently dominant variants or novel lineages.”[Emphasis added]

Early Treatment with Pegylated Interferon Lambda for Covid-19 “Among predominantly vaccinated outpatients with Covid-19, the incidence of hospitalization or an emergency department visit (observation for >6 hours) was significantly lower among those who received a single dose of pegylated interferon lambda than among those who received placebo.”

About health insurance/insurers

Big payers ranked by 2022 revenue FYI

UnitedHealthcare Introduces New Rewards Program With a Modern Approach to Well-Being “UnitedHealthcare Rewards is a new approach to wellness, offering members easy ways to earn up to $1,000 per year through integration with wearable devices and one-time reward activities…
Once enrolled, UnitedHealthcare Rewards members can earn incentives totaling up to $1,000 per year for completing the following ongoing and one-time activities:

  • Achieve 5,000 steps or more each day.

  • Complete 15 minutes or more of activity per day.

  • Track sleep for 14 nights.

  • Get a biometric screening.

  • Complete a health survey. 

  • Select paperless billing.

  • Additional qualifying activities will be added throughout the year.”


About hospitals and healthcare systems

Hospital Rankings Shift Emphasis to Objective Data Away from Expert Opinion “The 2023-2024 Best Hospitals and Best Children’s Hospitals rankings slated to be published this summer will assign more weight to clinical outcomes and other objective measures of quality and less weight to U.S. News & World Report’s opinion survey of physicians. This shift reflects our ongoing effort to use more objective data in our hospital ranking methodologies.”

 Tenet generates $102M in profits for Q4, releases 2023 financial outlook “Major for-profit hospital chain Tenet Healthcare generated $102 million in net income for the fourth quarter of 2022 and released its outlook for 2023. 
The hospital chain announced in its earnings release Thursday that it generated $4.9 billion in net operating revenues. However, the net income of $102 million was down compared to the $250 million it generated in the same quarter in 2021.”

About pharma

 Zantac Plaintiffs Must File Separate Complaints, Judge Says “A Florida federal judge ruled Tuesday that tens of thousands of consumers claiming they developed cancer after taking the heartburn medication Zantac could not be combined in multi-plaintiff personal injury cases in the wake of the court's decision that there was insufficient evidence the drug's active ingredient caused cancer. . . .”

About the public’s health

 Recommended Adult Immunization Schedule, United States, 2023 FYI

Physical interventions to interrupt or reduce the spread of respiratory viruses From the Cochrane Library: “Key messages
We are uncertain whether wearing masks or N95/P2 respirators helps to slow the spread of respiratory viruses based on the studies we assessed.
Hand hygiene programmes may help to slow the spread of respiratory viruses…
The observed lack of effect of mask wearing in interrupting the spread of influenza‐like illness (ILI) or influenza/COVID‐19 in our review has many potential reasons, including: poor study design; insufficiently powered studies arising from low viral circulation in some studies; lower adherence with mask wearing, especially amongst children; quality of the masks used; self‐contamination of the mask by hands; lack of protection from eye exposure from respiratory droplets (allowing a route of entry of respiratory viruses into the nose via the lacrimal duct); saturation of masks with saliva from extended use (promoting virus survival in proteinaceous material); and possible risk compensation behaviour leading to an exaggerated sense of security...”
Comment: The takeaways (for me) are: continue to wear masks and wash your hands.

About healthcare IT

 Epic to connect hospitals with outside labs, diagnostic firms through EHR “EHR vendor Epic is expanding its lab capabilities to allow hospitals to more easily communicate with outside labs and diagnostic companies…
The change would affect Epic's Orders and Results Anywhere tool…”

Today's News and Commentary

Biden's State of the Union: 10 healthcare takeaways A good summary of the healthcare points in last night’s speech. See, also: Full Transcript of Biden’s State of the Union Address

About Covid-19

 Should you report the results of an at-home COVID test? “When you take an at-home coronavirus (COVID-19) test, you’re supposed to report your results to federal and local governments.
That’s right. The National Institutes of Health (NIH) has a website dedicated to collecting at-home COVID-19 test results data, both positive and negative, but medical experts fear it is being grossly underused…
Simply visit MakeMyTestCount.org. The site doesn’t ask for personal information, only your ZIP code and age.
The results, positive or negative, are then submitted to the same public health systems that currently receive COVID-19 results from tests done in laboratories and doctors’ offices.”

About health insurance/insurers

 The Pill Club Reaches $18.3 Million Medicaid Fraud Settlement With California “The Pill Club, an online women’s pharmacy, has reached an $18.3 million settlement with California authorities over claims it defrauded the state’s Medicaid program by prescribing birth control pills without adequate consultation and shipping tens of thousands of female condoms to customers who didn’t want them.”

Analysis of Recent National Trends in Medicaid and CHIP Enrollment “This data note looks at national and state-by-state Medicaid and CHIP enrollment data through October 2022. After declines in enrollment from 2017 through 2019, preliminary data for October 2022 show that total Medicaid/CHIP enrollment grew to 91.3 million, an increase of 20.2 million from enrollment in February 2020 (28.5%), right before the pandemic and when enrollment began to steadily increase…”
A great summary from the KFF.

Centene bracing for 2.2 million member loss in Medicaid redeterminations “Centene expects to lose millions of members in the redeterminations process and is focused on shifting members no longer eligible for Medicaid coverage to its marketplace offerings, executives said on a Feb. 7 investor call transcribed by Motley Fool. 
The company expects to lose 2.2 million members over the next year and a half through the redeterminations process, CFO Drew Asher told investors.”

False Claims Act Settlements and Judgments Exceed $2 Billion in Fiscal Year 2022 “Settlements and judgments under the False Claims Act exceeded $2.2 billion in the fiscal year ending Sept. 30, 2022, Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division, announced today. The government and whistleblowers were party to 351 settlements and judgments, the second-highest number of settlements and judgments in a single year. Recoveries since 1986, when Congress substantially strengthened the civil False Claims Act, now total more than $72 billion.”

About hospitals and healthcare systems

Lifepoint scoops up 18 behavioral hospitals “Lifepoint Health acquired a majority ownership interest in behavioral health network Springstone, closing a deal that adds 18 hospitals and 35 outpatient locations to the Lifepoint network. 
Louisville, Ky.-based Springstone was founded in 2010 and includes sites of care in nine states: Arizona, Colorado, Indiana, Kansas, North Carolina, Ohio, Oklahoma, Texas and Washington.”

About pharma

 CVS reports $2.3B Q4 profit, will buy Oak Street Health “CVS Health has reported $4.2 billion in 2022 profit and said it will acquire primary care company Oak Street Health in an all-cash deal worth $10.6 billion.
Chicago-based Oak Street manages a value-based primary care network with more than 160 clinics in 21 states that primarily focus on Medicare beneficiaries — ​​by 2026, the company expects to have more than 300 locations, according to a Feb. 8 news release from CVS.”

About the public’s health

 Less sugar, less salt: USDA proposes nutrition changes to school meals “The Agriculture Department on Friday proposed new nutrition standards for school meals that would impose the first limit on added sugar in lunches and breakfasts served by school cafeterias.
The proposal also seeks to lower sodium levels and puts more of an emphasis on whole-grain products in school meals. It aims to improve the health of millions of students at a time when childhood obesity has risen dramatically, with the Centers for Disease Control and Prevention estimating that nearly 20% of children and adolescents have obesity.
The suggested nutrition changes, which would be implemented gradually over years, are part of a national strategy on hunger, nutrition and health announced by the Biden administration in September.”

About health technology

3M rolls out skin-sticking adhesive allowing wearable monitors to last up to 4 weeks “The newest addition to the company’s line of adhesives is designed to stay in place for up to 28 days, 3M announced this week, doubling the two-week wear time that has long been the standard for stick-on medical devices…
According to its maker, the four-week adhesive, sold as 3M Medical Tape 4578, is pressure sensitive and designed to maintain its stickiness for up to one year in storage, even without a protective liner.”

Today's News and Commentary

Justice Department Withdraws Outdated Enforcement Policy Statements The FTC is in the process implementing major changes in antitrust enforcement, especially in healthcare. Withdrawal of the three listed documents will have immense implications for the field. For example, the ANTITRUST ENFORCEMENT POLICY STATEMENTS ISSUED FOR HEALTH CARE INDUSTRY contains “policy statements [that] provide antitrust safety zones which describe circumstances under which the Department of Justice and the Federal Trade Commission will not challenge: 
—Hospital mergers; 
—Hospital joint ventures involving high-technology or other expensive medical equipment; 
—Physicians' provision of information to purchasers of health care services; 
—Hospital participation in exchanges of price and cost information; 
—Joint purchasing arrangements among health care providers; 
—Physician network joint ventures.”
Replacement language has yet to be drafted but will obviously be less forgiving.
Also unclear is how these changes will affect extant relationships. 

About health insurance/insurers

 Judge hands providers another win by striking down surprise billing arbitration process “A federal judge struck down key parts of a regulation outlining a ban on surprise medical bills, siding with doctors that the rule tilts too favorably to insurers. 
The ruling delivered late Monday in the U.S. District Court for the Eastern District of Texas centers on an arbitration process for settling disputes over out-of-network charges.”

Cigna focused on partnerships—not M&A—in care delivery strategy, CEO says “Cigna CEO David Cordani told investors Friday that the company isn't planning to begin snapping up large swaths of doctors as it continues to chart a growth strategy for its Evernorth subsidiary.
Instead, the insurer is focused on finding the right partners to continue building out its service offerings, such as its recent investment in VillageMD, Cordani said. There are segments, though, where Cigna is looking to buy, he added, namely home health, virtual care and behavioral health.”

CVS Nearing $10.5 Billion Deal for Primary-Care Provider Oak Street Health “CVS Health Corp. is close to an agreement to acquire Oak Street Health Inc. for about $10.5 billion including debt, a deal that would rapidly expand the big healthcare company’s footprint of primary-care doctors with a large network of senior-focused clinics, according to people with knowledge of the matter.”
Comment: Recall that Oak Street has never achieved profitability.

CENTENE CORPORATION REPORTS 2022 RESULTS Summary:

  • “2022 Full Year Diluted EPS of $2.07; Adjusted Diluted EPS of $5.78 --

  • 2022 adjusted diluted EPS growth of 12%.

  • 2022 total revenues of $144.5 billion, up 15%.

  • 2022 health benefits ratio of 87.7%.

  • Continued progress on portfolio review, completing five divestitures in the past three months: Magellan Rx, Magellan Specialty Health, Ribera Salud, Centurion, and HealthSmart.

  • Executed on capital deployment with $1.4 billion of share repurchases in the fourth quarter, bringing full year repurchases to $3.0 billion, largely funded through divestiture proceeds.

  • Increased 2023 premium and service revenues guidance by $2.0 billion.”

Google’s fastest-growing business is insuring companies against their workers’ health Verily “more than doubled its revenue to become the biggest Alphabet subsidiary after Google proper… — its health insurance business, Granular, is the biggest contributor to that growth…
Granular doesn’t sell health insurance to employees. It sells ‘stop-loss’ insurance to employers who are worried that their own workers’ medical claims might hurt them.”

About hospitals and healthcare systems

Fourth Semi-Annual Hospital Price Transparency Report “Our latest review of hospital compliance, completed just over two years after the Hospital Price Transparency Rule’s implementation, analyzed the websites of 2,000 U.S. hospitals focusing on the nations’ largest health systems, and found only 24.5% of them (489) to be compliant with all the requirements of the rule. Though the majority of hospitals have posted files, the widescale noncompliance of 75.5% of hospitals is due to most hospitals’ files being incomplete, illegible, or not having prices clearly associated with both payer and plan.”

 City of Hope to Rebrand Cancer Treatment Centers of America Locations to Reflect Transition to National System “City of Hope, one of the largest cancer research and treatment organizations in the United States, today announced that its subsidiary, Cancer Treatment Centers of America® (CTCA), will fully transition its clinical locations to City of Hope's brand. CTCA locations in different cities will now be called City of Hope Atlanta, City of Hope Chicago and City of Hope Phoenix. In addition to the replacement of CTCA branding at clinical facilities, all marketing, advertising, communications and  activities supporting these locations will reflect City of Hope's name. A new advertising campaign will launch on Feb. 6 to communicate the name change in existing CTCA markets.”
The transition was completed today.

About pharma

Pharma loses a court battle in its bid to block states from importing drugs from Canada “In a setback to the pharmaceutical industry, a federal judge has tossed a lawsuit that sought to prevent state governments from importing medicines from Canada. The decision is likely to embolden more states to now consider the approach as they look to lower the cost of prescription drugs
In a 26-page opinion, U.S. District Court Judge Timothy Kelly ruled that drug companies failed to prove they would face a ‘concrete risk of harm’ from a federal rule that would allow states to import medicines. In his view, any harm is only speculative, because there is no guarantee the federal government will approve any state proposal. As a result, the industry did not have standing to file suit.”

Association Between Drug Characteristics and Manufacturer Spending on Direct-to-Consumer Advertising “In this exploratory cross-sectional study of 150 prescription drugs with the highest US sales in 2020, a higher proportion of promotional spending allocated to direct-to-consumer advertising was associated with drugs rated as having lower added clinical benefit than for those having higher added clinical benefit (absolute 14.3% increase in proportion) and with total drug sales (absolute 1.5% increase in proportion for every 10% increase in sales).”


 Eisai’s New Alzheimer’s Drug Leqembi Hits the U.S. Market “Eisai did not divulge numbers on how many prescriptions were filled or how the patients paid. The drug costs $26,500 annually and doesn’t yet have insurance coverage through commercial payers. The company awaits a decision on whether Medicare will cover it.
Leqembi, an anti-amyloid antibody, got accelerated approval from the FDA as a treatment for Alzheimer’s on Jan. 6. The company must conduct a confirmatory study to gain a full approval.”

Top 10 most anticipated drug launches of 2023 FYI

Aledade, Mark Cuban's drug company and a handful of others are public benefit corporations. Could it be the Rx to improve healthcare? “PBCs are a type of for-profit corporate entity that has also adopted a public benefit purpose and is currently authorized by 35 states and the District of Columbia. A PBC must consider the nonfinancial interests of its shareholders and other stakeholders when making decisions. As a public benefit corporation, companies have to weigh their social/environmental objectives alongside maximizing value for shareholders…
PBCs also are required to provide a report to shareholders every two years that detail how well the company is achieving its overall public benefit objectives. In some states, the report must be assessed against a third-party standard and be made publicly available. Delaware PBCs are not required to report publicly or against a third-party standard.”

About healthcare IT

Beyond high hopes: A scoping review of the 2019–2021 scientific discourse on machine learning in medical imaging A really good summary of potential (and actual) benefits and problems with machine learning in medical imaging. You can key on the Figures for the takeaways.

About healthcare personnel

The 10 Largest Medical Groups in the US The list is FYI, but the takeaway is: “Three out of four physicians are now employed by a hospital, health system or corporate entity…
Among employed physicians, 52% are employed by hospitals or health systems, with another 22% employed by other corporate entities, including health insurers and private equity firms. Over the three year period studied, an additional 108,700 physicians became employees, which represents a 19% increase in employed doctors.”

About health technology

Chinese DNA giant’s U.S. affiliate looks to rival Illumina, touting $100 genome and high-power sequencers “Complete Genomics, a U.S. firm affiliated with Chinese sequencing giant BGI, on Tuesday announced plans to launch a new line of sequencers it says can decode DNA in larger amounts — and at lower costs — than any instrument on the market.
The company claims the sequencer, dubbed DNBSEQ-T20, can read up to 50,000 human genomes a year, 2.5 times the max output of a line of new high-end sequencers that Illumina, the market leader, recently launched. And the cost of reading each genome will be as low as $100, which the company’s executives boast would be the lowest-ever price point since the figure includes the cost of the materials and chemicals used in sequencing as well as amortization of the machine.”

 Labcorp to pay $19 Million to settle allegations under the False Claims Act “Laboratory Corporation of America Holdings (Labcorp), one of the largest providers for clinical laboratory services, has agreed to pay $19 million to resolve allegations that it violated the False Claims Act by its submission of false claims to Medicare.
The settlement resolves allegations that Labcorp caused the submission of false claims to Medicare as a result of Labcorp’s provision of phlebotomy services for patients whose health care providers were ordering laboratory testing from Labcorp, Health Diagnostic Laboratory, Inc. (HDL), and/or Singulex, Inc. (Singulex) at a time when relators allege Labcorp knew HDL and/or Singulex were paying health care providers process and handling fees as an inducement to refer patients to their laboratories. HDL and Singulex previously settled their civil liability with the government for a combined $48.5 million.”

About healthcare finance

 Healthcare Services Report PE [Private Equity] trends and investment strategies  [Information is in the pdf. that can be accessed for free from this page.]
"The healthcare services PE landscape closed out 2022 with a declining, but still healthy, level of deal activity. Firms announced or closed an estimated 863 deals in the year, making 2022 easily the second-best year for PE healthcare services dealmaking, after 2021. However, quarterly trends show a steady decline throughout the year, especially in Q4, for which we estimate 158 deals, 26.4% off Q3’s figure…
The end-of-year decline in deal activity can be attributed principally to two factors. First, the pace of PE dealmaking has slowed due to macroeconomic uncertainty and rising capital costs…
Second, staffing cost inflation continues to plague healthcare services businesses. The lowest-skilled roles are most affected due to workers’ ability to maintain similar pay levels while transitioning into other industries.”

Today's News and Commentary

 About healthcare quality

Aligning Quality Measures across CMS — The Universal Foundation Statement from CMS: “CMS operates more than 20 quality programs focused on individual clinicians, certain health care settings such as hospitals or skilled nursing facilities, health insurers, and value-based entities such as accountable care organizations. Each of these programs has its own set of quality measures; entities report on and are held accountable for their performance on various measures. Although some of these measures are consistent across our programs, many are not…
The Universal Foundation is part of CMS’s efforts to implement the vision outlined in our National Quality Strategy and is fundamental to achieving several of the agency’s quality and value-based care goals. It is intended to focus providers’ attention on measures that are meaningful for the health of broad segments of the population; reduce provider burden by streamlining and aligning measures; advance equity with the use of measures that will help CMS recognize and track disparities in care among and within populations; aid the transition from manual reporting of quality measures to seamless, automatic digital reporting; and permit comparisons among various quality and value-based care programs, to help the agency better understand what drives quality improvement and what does not…
Our intention is that the Universal Foundation will eventually include selected measures for assessing quality along a person’s care journey — from infancy to adulthood — and for important care events, such as pregnancy and end-of-life care.”
See that chart in the article for measures across this “journey.”

About health insurance/insurers

 Cigna reports $1.2B in profit, $45.8B in revenue on Q4 beat “Cigna beat the Street on both earnings and revenue, reporting $1.2 billion in profit for the fourth quarter.
The company also brought in $45.8 billion in revenue for the fourth quarter. Analysts polled by Zacks Investment Research expected $45.5 billion. Those figures are both up slightly from the prior-year quarter, when Cigna posted $1.1 billion in profit and $45.7 billion in revenue.”

Plans Generally Offered Some Supplemental Benefits, but CMS Has Limited Data on Utilization “MA plans are required to submit detailed, service-level utilization data to the Centers for Medicare & Medicaid Services (CMS), the agency that oversees MA. These data—known as encounter data—must include supplemental benefits to the extent required by CMS. However, GAO found that information submitted by plans on enrollees’ use of supplemental benefits is limited…”

Over 35 Million Prior Authorization Requests Were Submitted to Medicare Advantage Plans in 2021
"We find that, in 2021:

  • More than 35 million prior authorization requests were submitted to Medicare Advantage insurers on behalf of Medicare Advantage enrollees.

  • The volume of prior authorization determinations varied across Medicare Advantage insurers, ranging from 0.3 requests per Kaiser Permanente enrollee to 2.9 requests per Anthem enrollee.

  • Over 2 million prior authorization requests were fully or partially denied by Medicare Advantage insurers.

  • Just 11 percent of prior authorization denials were appealed.

  • The vast majority (82%) of appeals resulted in fully or partially overturning the initial prior authorization denial.”

About hospitals and healthcare systems

 Assessment of Patient Retention of Inpatient Care Information Post-Hospitalization “Fifty-three patients participated. The vast majority (> 90%) were confident in their knowledge of their diagnoses and treatment, yet independent review revealed only 58.5%, 64.2%, 50.9%, and 43.4% of patients correctly recalled each respective key domain. Whiteboards were the most frequently used facilitator (96.2%), yet their content was rated least helpful for retaining care information. Patients suggested several areas for improvement, including prioritizing bedside pen and paper along with updating whiteboards with diagnostic and therapeutic information.” 

Busy January kicks off 2023 M&A activity: 13 transactions to note FYI

About pharma

 Bayer, EMD Serono announce 340B restrictions in wake of pharma's courtroom win “Two more drugmakers have announced they will be restricting some sales of 340B-discounted products to contract pharmacies just two days after the pharma industry was handed a win on the contentious issue by a federal appeals court.
Bayer and EMD Serono, a subsidiary of Merck KGaA, informed customers in letters that they will only be shipping discounted drugs to locations registered as 340B-covered entities or eligible child site locations.”

About the public’s health

 Health Care — White House offers new cancer investments  “The White House on Thursday marked one year since President Biden relaunched the Cancer Moonshot initiative, announcing a series of new efforts to reduce cancer deaths and provide support to those getting treatment. 
The National Cancer Institute will launch a new public-private partnership to assist families with children diagnosed with cancer, the White House said. The Childhood Cancer – Data Integration for Research, Education, Care, and Clinical Trials, or CC-DIRECT, will provide support to families to help them find ideal care for their child and participate in research initiatives like clinical trials and share data on optimal treatments…
The White House also announced that the Health Resources and Services Administration is awarding $10 million to improve access to cancer screenings to improve early detection. The funds will go to 22 National Cancer Institute-designated cancer centers, which will conduct patient outreach in their communities to promote early detection.”
Comment: Not everyone has easy access to such centers. Is this method the best one for accomplishing the outreach goal?

About healthcare IT

 2022 CAQH INDEX “By tracking automation along the healthcare administrative workflow and identifying opportunities for improvement, report findings have enabled health plans, providers, government, and vendor organizations to benchmark progress and set a course for greater efficiency and cost savings.”
Really worth a look. Among the findings:
Medical spending increased 47% to $55B, while cost savings from automated processes was $22.3B.

About healthcare personnel

 Healthcare adds 58K jobs in January Among the data is the fact that: “Within healthcare, ambulatory healthcare services gained the most jobs in January (29,900).”

Today's News and Commentary

About Covid-19

How will life change once the COVID-19 emergency ends? A good summary of what’s in store after the May 11 deadline. For example: “Insurers will no longer be required to cover the cost of free at-home COVID-19 tests.
Free vaccines, however, won’t come to an end with the public health emergency.”

Protective effectiveness of previous SARS-CoV-2 infection and hybrid immunity against the omicron variant and severe disease… “Individuals with hybrid immunity [previous infection and immunization]had the highest magnitude and durability of protection, and as a result might be able to extend the period before booster vaccinations are needed compared to individuals who have never been infected.”

 U.S. FDA removes COVID test requirements for Pfizer, Merck pills “The U.S. Food and Drug Administration (FDA) on Wednesday removed the need for a positive test for COVID-19 treatments from Pfizer Inc and Merck & Co Inc.
Pfizer's Paxlovid and Merck's Lagevrio pills were given emergency use authorizations in Dec. 2021 for patients with mild-to-moderate COVID who tested positive for the virus, and who were at risk of progressing to severe COVID.
Still, the FDA said the patients should have a current diagnosis of mild-to-moderate COVID infection.”

Vaccine Makers Kept $1.4 Billion in Prepayments for Canceled Covid Shots for the World’s Poor “As global demand for Covid-19 vaccines dries up, the program responsible for vaccinating the world’s poor has been urgently negotiating to try to get out of its deals with pharmaceutical companies for shots it no longer needs.
Drug companies have so far declined to refund $1.4 billion in advance payments for now-canceled doses, according to confidential documents obtained by The New York Times.”

About health insurance/insurers

Medicare Advantage plans get a proposed 1.03% payment increase in 2024 “Medicare Advantage plans are expected to receive a 1.03% increase in revenue under the 2024 Advance Notice for the Medicare Advantage and Part D Prescription Drug Programs released by the Centers for Medicare and Medicaid Services on Wednesday. 
CMS is proposing technical updates to the MA risk adjustment model by fully transitioning to the Internal Classification of Diseases from ICD-9 to ICD-10. The latter has been in use since 2015. It also updates underlying fee-for-service data years from 2014 diagnoses and 2015 expenditures to 2018 diagnoses and 2019 expenditures.
Under the Advance Notice, the Risk Model Revision and Normalization is -3.12%.”

States ranked by 2023 ACA enrollment FYI, but interesting that the top two states are “Red.”

About hospitals and healthcare systems

 Majority of Rural Providers are in Good Financial Health and Confident about their Futures, according to New Wipfli report “Wipfli LLP (Wipfli), a top 20 accounting and advisory firm, today published a new report based on a survey of 110 rural healthcare organizations across 25 states to learn how they're coping with economic and regulatory challenges. Despite a record number of rural hospitals closing during the past two years and several other rural hospitals at risk of closure, the State of Rural Healthcare report reveals that organizations surveyed are cautiously optimistic for the future.
Nearly all of the organizations surveyed received Provider Relief Funds during the pandemic, and two-thirds of respondents indicated that their financial situation has either stayed the same or improved from five years prior. Encouragingly, 65 percent of institutions surveyed are confident that they won't merge with another organization in the next five years, rather anticipating growth instead of consolidation. In fact, 75 percent anticipate revenue to either grow or remain flat over the next three years.”

About the public’s health

Support for Policies to Prohibit the Sale of Menthol Cigarettes and All Tobacco Products Among Adults, 2021 “Data came from SpringStyles 2021, a web panel survey of adults in the US aged 18 years or older (N = 6,455). Overall, 62.3% of adults supported a policy prohibiting the sale of menthol cigarettes, and 57.3% supported a policy prohibiting the sale of all tobacco products. A majority of adults supported tobacco retail policies aimed at preventing initiation, promoting quitting, and reducing tobacco-related disparities. These findings can help inform federal, state, and local efforts to prohibit the sale of tobacco products, including menthol cigarettes.”

New Ipsos Survey Reveals Nearly Half of American Women Forgo Preventive Care Services “A new Ipsos poll commissioned by the Alliance for Women's Health and Prevention (AWHP) reveals that nearly half of American women (45%) are forgoing preventive care services like check-ups, screenings, and vaccines, and the inability to afford out-of-pocket costs is the most common reason women cite for skipping this critical care. The survey of 3,204 women looked at women's experiences with preventive healthcare, the challenges they face accessing it and the disparities that exist.” 

Today's News and Commentary

About Covid-19

 Long COVID: What Do the Latest Data Show? “The percentage of people who have had COVID and currently report long COVID symptoms declined from 19% in June 2022 to 11% in January 2023.”
Read the KFF report for more information. 

About health insurance/insurers

 FTC unlikely to challenge UnitedHealth-LHC Group deal: report “The Federal Trade Commission is not expected to challenge UnitedHealth Group's acquisition of home health firm LHC Group, Seeking Alpha reported Jan. 31, citing a CTFN report. 
The news comes after Capitol Forum reported Jan. 26 that the FTC was reviewing the planned acquisition under a ‘potential vertical harm theory.’ CTFN said in its report that legal arguments about vertical theories of harm are unlikely to effectively halt the deal. 

Humana Reports Fourth Quarter 2022 Financial Results; Provides Full Year 2023 Financial Guidance“Reports 4Q22 loss per share of $0.12 on a GAAP basis, Adjusted EPS of $1.62; reports full year (FY) 2022 EPS of $22.08 on a GAAP basis, $25.24 on an Adjusted basis
—Announces FY 2023 EPS guidance of at least $27.57 on a GAAP basis; at least $28.00 on an Adjusted basis
—Affirms strong 2023 individual Medicare Advantage membership growth of at least 625,000, or 13.7 percent growth over FY 2022 ending membership; anticipates growth to be meaningfully higher than the industry growth…”

CVS Health goes live with virtual care service with a focus on primary care, mental health “As part of its new virtual primary care service, CVS Health is expanding telehealth-based mental health care to include appointments with licensed therapists and psychiatrists. 
The retail drugstore giant announced its virtual care offering last May to give consumers access to primary care, on-demand care, chronic condition management and mental health services.”

Two large cases of health fraud prosecuted by the DOJ (both involve DME):
Three Men Indicted in San Antonio on Charges Related to $14.5 Million Healthcare Fraud Scheme “According to court documents, Kuba Zarobkiewicz, 35, of San Antonio, and Anthony Fermin, 32, of Boca Raton, Florida, own various medical equipment companies and pharmacies involved in a scheme to defraud Medicare by paying kickbacks to telemarketing firms owned and operated by Farrukh Mirza, 39, of Richmond, Texas, in exchange for signed doctor’s orders issued for unnecessary hip, knee and back braces.”

Two Florida Doctors Convicted in $31 Million Medicare Fraud Scheme "According to court documents and evidence presented at trial, Dean Zusmer, 54, of Miami, was a chiropractor who conspired with others to steal millions of dollars from Medicare. Zusmer owned one of four DME companies that collectively billed Medicare over $31 million for medically unnecessary DME, of which over $15 million was paid. Zusmer and his co-conspirators, including Jeremy Waxman, acquired patient referrals and signed doctors’ orders by paying kickbacks to marketers who used overseas call centers to solicit patients and telemedicine companies to procure prescriptions for unnecessary braces for these patients.”

About hospitals and healthcare systems

Association of Hospital Quality and Neighborhood Deprivation With Mortality After Inpatient Surgery Among Medicare Beneficiaries Findings  In this cross-sectional review of 1 898 829 Medicare beneficiaries undergoing 1 of 5 common surgical procedures, patients from the least deprived neighborhoods going to high-quality hospitals had a 3.9% probability of postoperative mortality compared with 8.1% among patients from the most deprived neighborhoods going to low-quality hospitals, a significant difference.
Meaning  These findings suggest that the scope of hospital-driven efforts and investments to minimize disparities in postoperative mortality should include attention to factors associated with socioeconomic deprivation in the communities where patients live.”

About pharma

 Moderna's RSV Vaccine Snags FDA Breakthrough Therapy Nod “The FDA granted Moderna's RSV vaccine candidate Breakthrough Therapy Designation … based on the pivotal Phase III ConquerRSV trial, in which the mRNA-based vaccine, mRNA-1345, demonstrated 83.7% efficacy against RSV lower respiratory tract disease in older adults.”

GoodRx pays $1.5 million to settle health privacy allegations “U.S. healthcare firm GoodRx Holdings has agreed to pay $1.5 million to settle allegations that it failed to notify customers that it shared personal health information with Alphabet's Google, Meta's Facebook and others, the Federal Trade Commission said on Wednesday.
Under the terms of the settlement, GoodRx will be barred from sharing user health data with other companies to use for advertising.”

Nearly 1K drug prices rose in January “So far in 2023, pharmaceutical companies have raised prices on 988 brand-name drugs for an average 5 percent wholesale acquisition cost increase, according to 46brooklyn Research, a nonprofit that tracks drug pricing data. 
This is the highest number of January drug price increases since 2011, its dashboard shows. More than 600 of them don't have generic alternatives.”

3 companies report 4thQ sales and projections:
Amgen's Q4 profit slides, as sales tick above estimate
Novartis posts drop in Q4 sales, profit ahead of Sandoz spin-off
Shrinking demand for COVID products expected to cut Pfizer sales by 30% this year

About the public’s health

 FDA creates food safety, nutrition program in wake of baby formula crisis “The Food and Drug Administration will create a senior position to oversee food safety and nutrition after recent foodborne-illness crises, including a baby formula shortage, exposed major flaws in the agency’s structure and culture.” 

About healthcare finance

KKR veteran sets records with $3.9 billion health care fund “The former head of health care investing at private equity giant KKR has set records with the first fundraising for his new firm.
The firm, Patient Square Capital, closed on $3.9 billion for its fund Wednesday. That makes it the largest inaugural fund for a new U.S.-based private equity firm. The previous record was set by Centerbridge Partners’ $3.2 billion fundraising in 2006, according to data from PitchBook."

Today's News and Commentary

U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes
Latest international comparisons from The Commonwealth Fund. The headline sums it up.
“Highlights
—Health care spending, both per person and as a share of GDP, continues to be far higher in the United States than in other high-income countries. Yet the U.S. is the only country that doesn’t have universal health coverage.
—The U.S. has the lowest life expectancy at birth, the highest death rates for avoidable or treatable conditions, the highest maternal and infant mortality, and among the highest suicide rates.
—The U.S. has the highest rate of people with multiple chronic conditions and an obesity rate nearly twice the OECD average.
—Americans see physicians less often than people in most other countries and have among the lowest rate of practicing physicians and hospital beds per 1,000 population.
—Screening rates for breast and colorectal cancer and vaccination for flu in the U.S. are among the highest, but COVID-19 vaccination trails many nations.”

About Covid-19

 $5.4 billion in covid aid may have gone to firms using suspect Social Security numbers “The U.S. government may have awarded roughly $5.4 billion in coronavirus aid to small businesses with potentially ineligible Social Security numbers, offering the latest indication that Washington’s haste earlier in the pandemic opened the door for widespread waste, fraud and abuse.
The top watchdog overseeing stimulus spending — called the Pandemic Response Accountability Committee, or PRAC — offered the estimate in an alert issued Monday and shared early with The Washington Post. It came as House Republicans prepared to hold their first hearing this week to study the roughly $5 trillion in federal stimulus aid approved since spring 2020.”

5 impacts of ending COVID emergency “1) Reduced Medicaid & CHIP health coverage 2) Telehealth more difficult 3) Reduced access to free tests & treatments 4) Hobbles CDC surveillance 5) Public messaging undermined”

About health insurance/insurers

Feds expect to collect $4.7B in insurance fraud penalties More on yesterday’s CMS audit announcements regarding Medicare Advantage plans.
"The Biden administration estimated Monday that it could collect as much as $4.7 billion from insurance companies with newer and tougher penalties for submitting improper charges on the taxpayers’ tab for Medicare Advantage care.
Federal watchdogs have been sounding the alarm for years about questionable charges on the government’s private version of the Medicare program, with investigators raising the possibility that insurance companies may be bilking taxpayers of billions of dollars every year by claiming members are sicker than they really are to receive inflated payments.
The Department of Health and Human Services said it will begin collecting payments from insurers when an audit turns up that they charged for diagnoses that are not reflected in the patient’s medical records. The government has not sought refunds for those payments in over a decade, the agency said.”

 CVS Health launches initiative with Meharry Medical College, Sinai Chicago aiming to reduce disparities in marginalized communities “CVS Health has created the Community Equity Alliance, an initiative aimed at addressing barriers to care in underserved communities.
The initiative, launching this month, was established to help make healthcare more accessible and to decrease health disparities. The first institutions to join the initiative are Meharry Medical College, Sinai Chicago and Wayne State University, which will, among other efforts, gather and share data with CVS Health on local community needs.”

CMS Announces ACA Special Enrollment Period during PHE Unwinding “CMS announced that there will be a special enrollment period on the Affordable Care Act marketplace for individuals who lose their Medicaid coverage due to the public health emergency unwinding.”

About pharma

 Amgen's Humira biosimilar Amjevita hits the market with two different list prices “California-based Amgen is offering the first U.S. Humira biosimilar at two different price points—one 55% below Humira's list price and the other at a 5% discount. Humira's U.S. list price is $6,922 per month, Reuters reports.
While the 55% discount looks good on paper, the more expensive product might end up being more popular with payers because of rebate dynamics.”

About healthcare IT

CMS IMPROVES MEDICAID REIMBURSEMENT FOR DIGITAL HEALTH CONSULTS KEY TAKEAWAYS
The Centers for Medicare & Medicaid Services has issued new guidance on Medicaid and CHIP coverage for eConsults, or interprofessional consultations between a primary care provider and a specialist on treatment for a specific patient.
Under the new guidance, specialists are able to bill Medicaid for eConsults rather than primary care providers, who would often have to bill higher rates so that they could reimburse specialists for their services.
The platform is popular with primary care providers who want to keep more of their patients and specialists who want to expand their reach, while it improves access to care for underserved populations who can't afford or won;t travel to see a specialist.”

 Russian hackers disrupt health system websites across US “Russian hacking group Killnet claimed responsibility for a cyberattack that disrupted hospital and health system websites across the U.S., according to BetterCyber, a technology company.”
The article has a list of affected hospitals.

About healthcare personnel

 11 medical schools boycott US News rankings: Who, why and what's next The list is slowly growing. Still not at an inflection point.

Today's News and Commentary

About Covid-19

Biden to end covid health emergencies on May 11 “President Biden informed Congress on Monday that he will end the national emergencies to combat the covid outbreak on May 11, a move that will restructure the federal government’s response to the pandemic nearly three years after the virus first arrived in the United States.”

COVID DATA TRACKER WEEKLY REVIEW “As of January 25, 2023, the current 7-day average of weekly new cases (42,163) decreased 11.3% compared with the previous 7-day average (47,515). A total of 102,171,644 COVID-19 cases have been reported in the United States as of January 25, 2023.” 

[WHO] Statement on the fourteenth meeting of the International Health Regulations (2005) Emergency Committee regarding the coronavirus disease (COVID-19) pandemic “The WHO Director-General concurs with the advice offered by the Committee regarding the ongoing COVID-19 pandemic and determines that the event continues to constitute a public health emergency of international concern (PHEIC). The Director-General acknowledges the Committee’s views that the COVID-19 pandemic is probably at a transition point and appreciates the advice of the Committee to navigate this transition carefully and mitigate the potential negative consequences.”

About health insurance/insurers

CMS issues final rule on Medicare Advantage risk adjustment The Centers for Medicare and Medicaid Services has finalized risk adjustment policies in a final rule to prevent overpayments to Medicare Advantage Organizations.
Rather than applying extrapolation beginning for payment year 2011 audits as CMS initially proposed, the agency has finalized a policy not to extrapolate RADV [Risk Adjustment Data Validation] audit findings for payment years 2011-2017 and begin extrapolation with the 2018 RADV audit. 
As a result, CMS will only collect the non-extrapolated overpayments identified in the CMS RADV audits and OIG audits between payment years 2011 and 2017.
The rule finalizes a proposed policy that CMS will not apply an adjustment factor, known as an Fee-for-Service Adjuster, in RADV audits.”


 What Happens After People Lose Medicaid Coverage? “Key findings include:

  • In the year following a disenrollment from Medicaid/CHIP, roughly two-thirds (65%) of people had a period of uninsurance.

  • Roughly four in ten (41%) people who disenrolled from Medicaid/CHIP eventually re-enrolled in Medicaid/CHIP within a year …”

About hospitals and healthcare systems

National Hospital Flash Report “Key Takeaways

  1. Hospital margins end year in difficult shape.

    Despite modest margin improvements in November and December, suggesting a positive trendline heading into the new year, 2022 was the worst financial year since the start of the pandemic. Approximately half of U.S. hospitals finished the year with a negative margin as growth in expenses outpaced revenue increases.

  2. Financial pressures driven by labor expenses.

    Hospitals faced prolonged increases in labor expenses last year. The increases were driven in part by a competitive labor market, as well as hospitals needing to rely on more expensive contract labor to meet staffing demands. Increased lengths of stay due to a decline in discharges also negatively affected hospital margins.

  3. Outpatient settings see increased volume.

    The front door of the hospital continues to shift away from the emergency department. Hospitals experienced increased outpatient volumes, including in surgical settings.

  4. Success in 2023 tied to learning lessons of '22.

    Expense pressures are unlikely to recede in 2023. Hospitals that embrace better workforce management strategies, secure more stable supply lines, and more effectively negotiate with payers are likely to have better financial years in 2023. Hospitals should also leverage their outpatient footprint and improve relationships with post-acute settings to maximize current patient volume trends.”

 Why urgent care centers are popping up everywhere A good review if the status these facilities. One disturbing statistic: “One urgent care industry magazine says, in 2009, 70% of its providers were physicians, but that the percentage had fallen to 16% by last year.”

About pharma

J&J Can’t Use Bankruptcy to End Cancer Suits Over Baby Powder, Court Says “Johnson & Johnson can’t use bankruptcy to resolve more than 40,000 cancer lawsuits over its baby powder, a federal appeals court ruled. 
The three-judge panel in Philadelphia sided with cancer victims, who argued that J&J wrongly put its specially created unit, LTL Management, under court protection to block juries around the country from hearing the lawsuits.”

Pharma wins a key round in a court battle with hospitals over a drug discount program “In a victory for the pharmaceutical industry, a federal appeals court ruled drug companies have the right to limit discounts to hospitals that rely on numerous contract pharmacies as they participate in a U.S. government drug discount program.
The decision was made in response to lawsuits that were originally filed by three large drugmakers — Sanofi, Novo Nordisk, and AstraZeneca — that the federal government was unlawfully interpreting key provisions in the controversial 340B drug discount program. The matter is actually not resolved, though, because the same dispute is still being considered in two other appeals courts.”

 Simulated Medicare Drug Price Negotiation Under the Inflation Reduction Act of 2022 “In this cross-sectional study using a policy simulation analysis, 40 top-selling drugs that would have been selected for negotiation from 2018 to 2020 were identified; although individual Medicare Part D plans already received substantial discounts for many of these drugs, the statutory ceiling prices for negotiation would have reduced spending by $26.5 billion on these drugs, or 5% of estimated net Medicare drug spending, from 2018 to 2020.”

10 top M&A targets in biotech for 2023 FYI

The top 10 biopharma M&A deals of 2022 FYI

Pharma reputation scores drop to pre-COVID levels as Haleon tops most respected, but it's a huge fall from grace for Pfizer and Moderna “Although trust in pharma spiked during the pandemic, it seems companies' reputations are back to pre-COVID-19 levels—and there’s bad news for the biggest COVID vaccine makers.
That’s according to a new report out by Caliber, which found that in 2022 only four out of 10 people were likely to say something positive about a pharma company…
Before the COVID-19 pandemic, about 32% of the U.S. public had a positive opinion of the pharmaceutical industry, Rob Jekielek, managing director of Harris Poll, said in an interview with Fierce Pharma in late 2021.
That number jumped to 59% of patients rating pharma’s reputation as “excellent” or “good” in the same year. In 2023, it seems the industry is coming down from its peak, and consumers are looking for new ways to affirm their trust.”

CVS, Walmart to Cut Pharmacy Hours as Staffing Squeeze Continues “CVS Health Corp. and Walmart Inc. are cutting pharmacy hours in the midst of a pharmacist shortage that has plagued the nation’s biggest drugstore chains throughout the Covid-19 pandemic.
CVS, the largest U.S. drugstore chain by revenue, plans in March to cut or shift hours at about two-thirds of its roughly 9,000 U.S. locations. Walmart plans to reduce pharmacy hours by closing at 7 p.m. instead of 9 p.m. at most of its roughly 4,600 stores by March.
Walgreens Boots Alliance Inc. previously said it was operating thousands of stores on reduced hours because of staffing shortages. Combined, the three chains operate some 24,000 retail pharmacies across the U.S.”

About healthcare IT

The Potential Impact of Artificial Intelligence on Healthcare Spending “In this paper, we estimate that wider adoption of AI could lead to savings of 5 to 10 percent in US healthcare spending—roughly $200 billion to $360 billion annually in 2019 dollars. These estimates are based on specific AI-enabled use cases that employ today’s technologies, are attainable within the next five years, and would not sacrifice quality or access. These opportunities could also lead to non-financial benefits such as improved healthcare quality, increased access, better patient experience, and greater clinician satisfaction. We further present case studies and discuss how to overcome the challenges to AI deployments. We conclude with a review of recent market trends that may shift the AI adoption trajectory toward a more rapid pace.” 

Today's News and Commentary

About Covid-19

 FDA advisers favor retiring original covid shot and using newer version “Advisers to the Food and Drug Administration on Thursday unanimously endorsed retiring the original coronavirus shot in favor of one that targets both the original strain of the coronavirus and the omicron variant.” 

California law aiming to curb COVID misinformation blocked by judge “A U.S. judge has blocked a California law that sought to penalize doctors who spread ‘misinformation or disinformation’ about COVID-19 while he considers a pair lawsuits challenging it on free speech grounds.
Senior U.S. District Judge William Shubb in Sacramento ruled on Wednesday that Assembly Bill 2098, which was signed last October by California Governor Gavin Newsom, a Democrat, was too vague for doctors to know what kind of statements might put them at risk of being penalized.’COVID-19 is a quickly evolving area of science that in many aspects eludes consensus,’ he wrote.”

About health insurance/insurers

 States jump into fight over prior authorization requirements “Efforts to overhaul the prior authorization process are hitting a crescendo in state legislatures, with at least 40 states expected to consider measures that would streamline the way doctors must obtain health plan sign-offs before they can order procedures, tests or treatments.”

CMS OKs California Medicaid experiment for inmates “The Centers for Medicare & Medicaid Services (CMS) is approving California’s…request to amend the section 1115(a) demonstration titled, ‘California Advancing and Innovating Medi-Cal (CalAIM)’… to provide limited coverage for certain services furnished to certain incarcerated individuals for up to 90 days immediately prior to the beneficiary’s expected date of release… CMS is also approving federal matching funds for Designated State Health Programs (DSHP) that California will use, going forward, to partially support the Providing Access and Transforming Health (PATH) program that was approved as part of CalAIM on December 29, 2021.”

About hospitals and healthcare systems

 Minnesota attorney general asks Sanford Health, Fairview Health Services to delay 58-hospital merger “The Minnesota attorney general’s office has formally asked Sanford Health and Fairview Health Services to postpone the March 31 closing date of their proposed merger as it seeks more information on the repercussions of the deal, Chief Deputy Attorney General John Keller said during a public meeting held Wednesday evening.
The Midwest nonprofit health systems had announced their 58-hospital merger plans in November, saying at the time that joining together would expand care quality and access across their rural and urban markets. The resulting organization would employ nearly 80,000 people.”

HCA posts $5.6B profit for 2022 “Nashville, Tenn.-based HCA Healthcare saw revenue of $15.5 billion in the fourth quarter of 2022, up from $15.1 billion over the same period in 2021, according to its financial report released Jan. 27. 
The 182-hospital, for-profit system had a net income of $2.08 billion in the quarter ended Dec. 31, 2022, up from $1.81 billion over the same period last year.”

About the public’s health

 FDA eases blood donation ban on gay and bisexual men after years of protest “Gay and bisexual men in monogamous relationships will no longer be forced to abstain from sex to donate blood under federal guidelines announced Friday, ending a vestige of the earliest days of the AIDS crisis.
The proposed relaxation of restrictions by the Food and Drug Administration follows years of pressure by blood banks, the American Medical Association and LGBT rights organizations to abandon rules some experts say are outdated, homophobic and ineffective at keeping the nation’s blood supply safe.”

Gesundheit! Allergies Affect More Than One in Four "The rate of 27.2% among children 17 years and under represented an increase from previous decades, reported Benjamin Zablotsky, PhD, of the NCHS in Hyattsville, Maryland, and coauthors in NCHS Data Brief.
Among adults, 31.8% reported experiencing at least one allergic condition in 2021, Amanda E. Ng, MPH, and Peter Boersma, MPH, of the NCHS, reported in the same publication.
Seasonal and food allergies were more prevalent in adults than children in the U.S.”
[Note: This article from MEDPAGE TODAY is much more readable than the original. More data are in this article.]

It’s easy to buy flavored vapes in California, even in cities with longtime bans “California cities are supposed to be cracking down on sales of flavored vapes, which are now illegal across the state. But even cities that have banned such vapes for years are unwilling — or unable — to police the sellers.
STAT visited 24 vape shops earlier this month in Oxnard, Ventura, Pasadena, El Monte, Carson and West Hollywood — all of which have had bans on flavored vapes on the books for at least a year; most for two or more years. Seventeen of the shops, or 70%, were selling the products anyway. One city is doing much better than the others: In Oxnard, where we hit five shops, none of the stores sold flavored vapes.
Many of the sellers of these products appeared to be openly flouting the law with impunity.”

About healthcare IT

Interoperability and Methods of Exchange among Hospitals in 2021 Study from healthIT.gov:
"HIGHLIGHTS
In 2021, more than 6 in 10 hospitals engaged in key aspects of electronically sharing health information (send, receive, query) and integrating of summary of care records into EHRs, a 51 percent increase since 2017.
—Availability and usage of electronic health information received from outside sources at the point of care significantly increased over the last four years, reaching 62 and 71 percent, respectively, in 2021.
—Health Information Service Providers (HISPs) and HIEs were the most common methods used for electronic exchange among hospitals.
—About three-quarters of hospitals participate in health information exchange organizations (HIEs) and about 35 percent participate in both HIEs and national networks.
—In 2021, 39 percent of hospitals reported participating in more than one of four measured national networks.
—Nearly 90 percent of hospitals upgraded their EHRs to 2015 Edition through 2021 and 74 percent of hospitals adopted bulk data export technology.”

Attorney General Merrick B. Garland Delivers Remarks on the Disruption of Hive Ransomware Variant “We are here to announce that last night, the Justice Department dismantled an international ransomware network responsible for extorting and attempting to extort hundreds of millions of dollars from victims in the United States and around the world.
Known as the ‘Hive’ ransomware group, this network targeted more than 1,500 victims around the world since June of 2021…
In one instance in August 2021, Hive affiliates deployed ransomware on computers owned by a Midwest hospital. At a time when COVID-19 was surging in communities around the world, the Hive ransomware attack prevented this hospital from accepting any new patients. The hospital was also forced to rely on paper copies of patient information. It was only able to recover its data after it paid a ransom…”

Today's News and Commentary

About Covid-19

Early Estimates of Bivalent mRNA Booster Dose Vaccine Effectiveness in Preventing Symptomatic SARS-CoV-2 Infection Attributable to Omicron BA.5– and XBB/XBB.1.5… “Using spike (S)-gene target presence as a proxy for BA.2 sublineages, including XBB and XBB.1.5, during December 2022–January 2023, the results showed that a bivalent mRNA booster dose provided additional protection against symptomatic XBB/XBB.1.5 infection for at least the first 3 months after vaccination in persons who had previously received 2–4 monovalent vaccine doses.”

About health insurance/insurers

Biden-Harris Administration Announces Record-Breaking 16.3 Million People Signed Up for Health Care Coverage in ACA Marketplaces During 2022-2023 Open Enrollment Season “…the Biden-Harris Administration announced that a record-breaking more than 16.3 million people have selected an Affordable Care Act (ACA) Marketplace health plan nationwide during the 2023 Marketplace Open Enrollment Period (OEP) that ran from November 1, 2022-January 15, 2023 for most Marketplaces.”

About pharma

Meet the 3 PBMs partnered with Mark Cuban's pharmacy “After Mark Cuban Cost Plus Drug Co. rerouted plans and partnered with a pharmacy benefit manager in September, the 1-year-old online pharmacy has grabbed two similar deals. 
The company chose Rightway, EmsanaRx and RxPreferred Benefits because ‘they pass through our pricing as is,’ Mr. Cuban told Becker's. On the company's site, Cost Plus calls itself ‘unPBM’ because there are ‘no rebates or off-shore entities to be found here.’”

Walgreens Weighs $2 Billion Sale of Pharmacy Automation Unit iA “Walgreens Boots Alliance Inc. is weighing a sale of its pharmacy automation business, which could fetch up to $2 billion, according to people familiar with the matter. 
The company, which is working with an adviser, is preparing to start a sales process in the next month or so for iA, said the people, who asked to not be identified because the matter is private. The unit is expected to draw interest from rival health-care companies and private equity firms, the people said. No final decision has been made and Walgreens could opt to keep the business, they added.”

 After nearly 4 years of deliberation, FDA punts on how to regulate CBD “The FDA is giving up on trying to figure out a way to regulate CBD on its own. The agency announced Thursday that it is formally calling on Congress for help — and, according to one official, looking for guidance on other hemp products like Delta 8 THC, too.”

Orphan Drug Exclusivity Regulations Will Remain As Is, Says FDA “The FDA said it will keep in place its regulations on orphan drug exclusivity rather than altering them in response to a pivotal U.S. appeals court ruling.
The agency said it plans to continue to tie orphan drug exclusivity to the uses or indications for which the orphan drug was approved rather than considering allowing for more expansive marketing rights.”

About the public’s health

 Predictive Accuracy of Stroke Risk Prediction Models Across Black and White Race, Sex, and Age Groups Findings  In this retrospective study of predictive accuracy that included 62 482 participants, existing stroke-specific risk prediction models and novel machine learning techniques did not significantly improve discriminative accuracy for new-onset stroke compared with the pooled cohort equations. All algorithms exhibited worse discrimination in Black individuals than in White individuals. Calibration was most accurate using the Reasons for Geographical and Racial Differences in Stroke (REGARDS) model based on self-reported risk factors.
Meaning  Results indicate the need to expand the pool of risk factors and improve modeling techniques to address observed racial disparities and improve model performance for predicting new-onset stroke.”

Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association Summaries of all chapters at the beginning of the paper are a helpful guide to this extensive report.

About healthcare personnel

 'Operation Nightingale': Feds charge 25 in sweeping nurse diploma scheme “Twenty-five people have been charged for their alleged participation in a coordinated scheme to sell aspiring nurses thousands of fake nursing degree documents, the Justice Department said Jan. 25.
The scheme involved selling more than 7,600 fraudulent diplomas and transcripts from three now shuttered nursing schools in Florida to aspiring nurses who had not actually completed the necessary coursework to graduate or sit for the National Council Licensure Examination. Aspiring nurses would allegedly pay $10,000 or more for the fake diplomas, which fast-tracked the process for them to take the NCLEX test and gain licensure. Once licensed, applicants allegedly used the fake documents to secure employment ‘with unwitting healthcare providers throughout the country,’ officials said.”

Institutional Variability in Representation of Women and Racial and Ethnic Minority Groups Among Medical School FacultyFindings  In this cross-sectional study of faculty from 144 US medical schools from 1990 to 2019, the median representation quotient for women increased from 0.42 to 0.80. The median representation quotient for URM increased from 0.16 to 0.24, but the trend was not significant, and variability across institutions was high.
Meaning  These findings suggest that representation of women in academic medicine increased over time, whereas URM experienced only modest increases in representeation with wide variability across institutions.”

About health technology

 The Power 500 Healthcare Technology Companies of 2023 FYI (Categories include IT)

Today's News and Commentary

About health insurance/insurers

AFFORDABILITY SOLUTIONS FOR THE HEALTH OF AMERICA A statement and recommendation from the BCBS Association. It claims their recommendations will save $767B over ten years. One recommendation is to enact single site payments.

Elevance Health posts $949M profit in fourth quarter “Elevance Health reported double-digit revenue growth and beat investor expectations in 2022, but posted a slight dip in profits year-over-year, according to the company's fourth quarter earnings report published Jan. 25.”

Health Insurers Face $3 Billion Medicare Clawback Threat A really good summary of the impact of upcoming Medicare audits to assess overpayments due to excessive severity of illness extra payments.

6.8 million expected to lose Medicaid when paperwork hurdles return “The federal Department of Health and Human Services expects 6.8 million people to lose their coverage even though they are still eligible, based on historical trends looking at paperwork and other administrative hurdles. Pre-pandemic, some states made signing up for and re-enrolling in Medicaid very difficult to keep people off the rolls.
In the three pandemic years, the number of Americans on Medicaid and CHIP – the Children's Health Insurance Program – swelled to 90.9 million, an increase of almost 20 million.”

About pharma

 CVS Health debuts new virtual primary care “CVS Health launched new virtual care offerings Jan. 23 focused on primary care and mental health services.
CVS Health Virtual Primary Care includes pre-scheduled primary care and mental health visits as well as on-demand services. All Aetna commercial members in fully-insured and self-insured health plans can use the virtual care platform.”

Kroger to launch its 1st personalized medicine trial “Kroger Health, the national grocery chain's healthcare division, will set up clinical trial sites for research on colorectal cancer gut and immune health with the aim of developing personalized medicines. 
It will be the company's first clinical trial…”
Healthcare gets stranger and stranger…

Pharma's 15 biggest lobbyists FYI

J&J Gets Ready to Break Up With Tylenol “Johnson & Johnson confirmed during an earnings call on Tuesday that its consumer health business is on track to become independent this year. Earlier this month, J&J filed for an initial public offering of the unit as a separate company called Kenvue.
The idea of the separation is that, by spinning out its slower-growing consumer unit, J&J will be able to focus on its higher growth divisions: med-tech and pharma. 
But in the most recent quarter, it was the consumer unit that delivered growth, while pharma and med-tech were laggards. The main reason for that was the heightened demand for over-the-counter products like Tylenol and Motrin.”
See, also: J&J's profit forecast tops estimates, with key drugs, new launches to drive growth

About the public’s health

 USPSTF Declines to Recommend Lipid Tests for All Kids “Citing a lack of available data, the US Preventive Services Task Force (USPSTF) announced Tuesday that it is unable to make a recommendation on whether clinicians should screen children and adolescents for lipid disorders.” 

With the X-Waiver repealed, officials urge providers to begin prescribing buprenorphine for opioid addiction “The White House, federal agencies and lawmakers today marked the elimination of the DATA-Waiver Program, better known as the X-Waiver requirement, with calls for providers to begin incorporating opioid use disorder treatment buprenorphine in everyday patient care.
The X-Waiver requirement only permitted doctors who had received specialized training and federal permissions to prescribe the opioid partial agonist, which is a controlled substance.”

How Gen Z sees healthcare: 10 stats FYI

Medical Costs of Substance Use Disorders in the US Employer-Sponsored Insurance Population Findings  In this economic evaluation of 162 million non–Medicare eligible enrollees with employer-sponsored health insurance in 2018, 2.3 million had an SUD diagnosis. The annual attributable medical expenditure was $15 640 per affected enrollee and $35.3 billion in the population; alcohol-related disorders ($10.2 billion) and opioid-related disorders ($7.3 billion) were the most costly.”

About healthcare IT

 Payers spent about the same for telehealth or in-person visits in 2020 “Prices were broadly similar for in-person and virtual services. The average cost for established patient evaluations was $33 dollars for in-person care and $34 dollars for telehealth.” 

FCC Allows Use of Automated Calls, Texts for Coverage, Enrollment Info “The Federal Communications Commission (FCC) has issued guidance allowing federal and state governmental agencies to send automated calls and text messages providing individuals with information about retaining their enrollment in government healthcare programs.
The declaratory ruling responds to a letter from US Department of Health and Human Services (HHS) Secretary Xavier Becerra, in which the department asked for clarification about which types of calls and text messages were permissible under the Telephone Consumer Protection Act (TCPA).”

About healthcare personnel

 Major medical schools join widening revolt against U.S. News rankings “Criticism of ranking system grows as schools based at Stanford, Columbia, U-Penn and Mount Sinai pull out.”