About Covid-19
FDA Approves First Oral Antiviral for Treatment of COVID-19 in Adults Thursday, “the U.S. Food and Drug Administration approved the oral antiviral Paxlovid (nirmatrelvir tablets and ritonavir tablets, co-packaged for oral use) for the treatment of mild-to-moderate COVID-19 in adults who are at high risk for progression to severe COVID-19, including hospitalization or death. Paxlovid is the fourth drug—and first oral antiviral pill—approved by the FDA to treat COVID-19 in adults.
Paxlovid manufactured and packaged under the emergency use authorization (EUA) and distributed by the U.S. Department of Health and Human Services will continue to be available to ensure continued access for adults, as well as treatment of eligible children ages 12-18 who are not covered by today’s approval. Paxlovid is not approved or authorized for use as a pre-exposure or post-exposure prophylaxis for prevention of COVID-19.”
BioNTech is proceeding with COVID-shot in line with WHO guidance “Germany's BioNTech said it was on track to introduce a COVID-19 shot by the early fall in the northern hemisphere that is adapted to currently dominant virus variants in line with recommendations by the World Health Organization.”
Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection “Question What symptoms are differentially present in SARS-CoV-2–infected individuals 6 months or more after infection compared with uninfected individuals, and what symptom-based criteria can be used to identify postacute sequelae of SARS-CoV-2 infection (PASC) cases?…
Adjusted odds ratios were 1.5 or greater (infected vs uninfected participants) for 37 symptoms. Symptoms contributing to PASC score included postexertional malaise, fatigue, brain fog, dizziness, gastrointestinal symptoms, palpitations, changes in sexual desire or capacity, loss of or change in smell or taste, thirst, chronic cough, chest pain, and abnormal movements. Among 2231 participants first infected on or after December 1, 2021, and enrolled within 30 days of infection, 224 (10% [95% CI, 8.8%-11%]) were PASC positive at 6 months.”
Comment: Clearly, these non-specific symptoms do not constitute solid diagnostic criteria. As the authors point out: “iterative refinement that further incorporates other clinical features is needed to support actionable definitions of PASC.”
About health insurance/insurers
Average hospital payer mix in every state FYI. While you might guess Florida, Maryland has the highest Medicare mix (29.6 percent), closely followed by Delaware (29.5 percent).
Than Age 65: Expiration Of Temporary Policies Projected To Reshuffle Coverage, 2023–33 “The Congressional Budget Office estimates that in 2023, 248 million people in the US who are younger than age sixty-five have health insurance coverage (mostly through employment-based plans), and twenty-three million people, or 8.3 percent of that age group, are uninsured—with significant variations in coverage by income and, to a lesser extent, by race and ethnicity. The unprecedented low uninsurance rate is largely attributable to temporary policies that kept beneficiaries enrolled in Medicaid and enhanced the subsidies available through the health insurance Marketplaces during the COVID-19 pandemic. As the continuous eligibility provisions unwind in 2023 and 2024, an estimated 9.3 million people in that age group will transition to other forms of coverage, and 6.2 million will become uninsured. If the enhanced subsidies expire after 2025, 4.9 million fewer people are estimated to enroll in Marketplace coverage, instead enrolling in unsubsidized nongroup or employment-based coverage or becoming uninsured. By 2033 the uninsurance rate is projected to be 10.1 percent, which is still below the 2019 rate of about 12 percent.”
Home Health Value-Based Purchasing Model Lowered Medicare Spending “The Home Health Value-Based Purchasing (HHVBP) Model reduced Medicare spending by $1.38 billion and improved care quality during its first six years, according to a report from CMS.
The CMS Innovation Center implemented the original HHVBP Model in nine states from January 2016 to December 2021: Arizona, Florida, Iowa, Massachusetts, Maryland, Nebraska, North Carolina, Tennessee, and Washington.
The model aimed to improve the quality of home healthcare services for Medicare beneficiaries by providing financial incentives to home health agencies for quality improvements. Home health agencies received performance scores for individual measures of quality of care that were combined into a total performance score to determine their payment adjustment.”
Comparison of Out-of-Pocket Spending on Ultra-Expensive Drugs in Medicare Part D vs Commercial Insurance “Findings This cohort study including 37 324 Part D beneficiaries and 24 159 commercially insured individuals showed that Medicare Part D beneficiaries without low-income subsidies spent 2.5 times more out of pocket on ultra-expensive drugs and were subject to greater variation in this spending compared with commercially insured patients aged 45 to 64 years.
Meaning Recent legislation establishing a $2000 out-of-pocket cap in Part D has the potential to lower out-of-pocket costs for more than 125 000 Part D beneficiaries who use ultra-expensive drugs and are ineligible for low-income subsidies, thus ameliorating increases in out-of-pocket spending when transitioning from commercial insurance to Part D.”
CVS could lose up to $1B next year from MA star ratings drop “Dive Brief:
CVS expects its 2024 operating income to drop by $800 million to $1 billion next year due to lost bonus payments from lower plan star ratings in the Medicare Advantage program.
Just 21% of CVS’ MA members are currently in plans with a star rating of at least four, down from 87% at the end of 2021, the payer disclosed in a filing with the Securities and Exchange Commission on Thursday. Plans with a rating of four or above are eligible for bonus payments.
CVS’ score for its largest MA plan, Aetna National PPO, dropped from 4.5 to 3.5 stars. That was the main driver of the overall decrease in MA members in highly rated plans, CVS said. As a result, the plan — one of the largest in the U.S., with more than 1.9 million members — is no longer eligible for quality bonus payments in 2024.”
About hospitals and healthcare systems
Kaiser, Cleveland Clinic and more: 6 nonprofit systems back in the black “March was the first time in 15 months that revenue growth outpaced expense increases, according to a report from Syntellis. The median hospital year-to-date operating margin in March was 0.4 percent, up from -1.1 percent in February.”
About pharma
FDA pushes back Sarepta DMD gene therapy decision Sarepta Therapeutics announced that the FDA has delayed a decision on its gene therapy application for ambulant patients with Duchenne muscular dystrophy (DMD)…The agency had been expected to render a decision on SRP-9001 (delandistrogene moxeparvovec) by May 29, but that has now been pushed back to June 22 to allow ‘modest additional time’ to complete its review, including final label negotiations and post-marketing commitment discussions, the drugmaker said.
The deferral comes on the heels of an FDA advisory panel that narrowly backed an accelerated approval for the AAV vector-based gene therapy with a vote of 8 to 6 in favour.”
About the public’s health
Multivitamin supplementation improves memory in older adults: A randomized clinical trial “…we estimate that the effect of the multivitamin intervention improved memory performance above placebo by the equivalent of 3.1 years of age-related memory change.”
For your comparison, the authors used Centrum Silver vitamins.
The top 5 medical services Americans are skipping “Financial uncertainty and the high cost of medical expenses have caused many people to forgo medical treatment, a Federal Reserve report released in May found…
In 2022, 28 percent of adults went without some form of medical care because they could not afford it. The following were the top five medical services Americans did not undergo due to cost (Note: Survey participants could vote for more than one option):
1. Dental care: 21 percent
2. Physician or specialist visit: 16 percent
3. Prescription medication: 10 percent
3. Follow-up care: 10 percent
3. Mental healthcare: 10 percent”
About healthcare IT
Logging on for health: More older adults use patient portals, but access and attitudes vary widely “Overall, 78% of people aged 50 to 80 have used at least one patient portal, up from 51% in a poll taken five years ago, according to findings from the University of Michigan National Poll on Healthy Aging. Of those with portal access, 55% had used it in the past month, and 49% have accounts on more than one portal…
Older adults with annual household incomes below $60,000, and those who are Black or Hispanic, have lower rates of portal use, and were less likely to say they’re comfortable using a portal, than respondents who are higher-income or non-Hispanic white.
There were also differences among older adults who don’t use portals, or haven’t used one in three or more years. Those who say they’re in fair or poor health physically or mentally were much more likely to say they’re not confident about their ability to log in and navigate a portal than those with better physical or mental health.”
Diverse patients’ attitudes towards Artificial Intelligence (AI) in diagnosis “Our main outcome measure was selection of AI clinic or human physician specialist clinic (binary, “AI uptake”). We found that with weighting representative to the U.S. population, respondents were almost evenly split (52.9% chose human doctor and 47.1% chose AI clinic). In unweighted experimental contrasts of respondents who met pre-registered criteria for engagement, a PCP’s explanation that AI has proven superior accuracy increased uptake (OR = 1.48, CI 1.24–1.77, p < .001), as did a PCP’s nudge towards AI as the established choice (OR = 1.25, CI: 1.05–1.50, p = .013), as did reassurance that the AI clinic had trained counselors to listen to the patient’s unique perspectives (OR = 1.27, CI: 1.07–1.52, p = .008). Disease severity (leukemia versus sleep apnea) and other manipulations did not affect AI uptake significantly. Compared to White respondents, Black respondents selected AI less often (OR = .73, CI: .55-.96, p = .023) and Native Americans selected it more often (OR: 1.37, CI: 1.01–1.87, p = .041). Older respondents were less likely to choose AI (OR: .99, CI: .987-.999, p = .03), as were those who identified as politically conservative (OR: .65, CI: .52-.81, p < .001) or viewed religion as important (OR: .64, CI: .52-.77, p < .001). For each unit increase in education, the odds are 1.10 greater for selecting an AI provider (OR: 1.10, CI: 1.03–1.18, p = .004). While many patients appear resistant to the use of AI, accuracy information, nudges and a listening patient experience may help increase acceptance. To ensure that the benefits of AI are secured in clinical practice, future research on best methods of physician incorporation and patient decision making is required.”
Startup Florence acquires Zipnosis from Bright Health to build out telehealth services “On the heels of its official launch last month, health tech startup Florence picked up Zipnosis from Bright Health to expand its virtual care capabilities.
Bright Health, which is looking to shed business lines as it tries to stave off bankruptcy, bought the white-labeled virtual care solution just two years ago. Bright Health revealed March 1 that it had overdrawn its credit and would need to secure $300 million by the end of April to stay afloat.”
About healthcare personnel
Flash Report: Health System Workforce Market & Solutions A great quick look at the state if this issue. Among the findings: Health system labor expenses increased 20% in the twelve months prior to March 2023 compared to pre-pandemic levels, largely driven by growth of contract labor. Contract hours relative to paid hours were up 91% in March 2023 from March 2020.
Nursing shortages are at the forefront of workforce difficulties.The average professional tenure of nurses dropped from 3.6 years prior to the pandemic to just 2.8 years in 2023.”
A REUTERS SPECIAL REPORT How doctors buy their way out of trouble “Over the last decade alone, at least 540 doctors and healthcare practitioners collectively paid the government hundreds of millions of dollars to negotiate their way out of trouble via civil settlements, then continued to practice medicine without restrictions on their licenses despite allegations that included fraud and patient harm, a Reuters investigation found. That figure is the result of the first-ever comprehensive analysis of federal civil settlements and state disciplinary actions.”
About health technology
Medtronic acquires insulin patch pump maker EOFlow for $738M amid new MiniMed rollout “Medtronic is set to acquire EOFlow, the South Korea-based maker of an insulin patch pump. In its announcement of the deal Thursday, Medtronic suggested that integrating the tubeless device with its own continuous glucose monitors and meal-detection algorithm—both of which can also be used alongside the MiniMed pumps—could create a new closed-loop system for largely hands-off diabetes management.”
