About health insurance
Association of Participation in the Oncology Care Model [OCM] With Medicare Payments, Utilization, Care Delivery, and Quality Outcomes: “In its first 3 years, the OCM was significantly associated with modestly lower Medicare episode payments that did not offset model payments to participating practices, and there were no significant differences in most utilization, quality, or patient experience outcomes.”
See, also, the accompanying editorial: Medicare Spending, Utilization, and Quality in the Oncology Care Model, which raises some good policy questions.
Whistleblower alleges Aetna used dead, out-of-state physicians to bolster network: “A recently unsealed whistleblower lawsuit out of Philadelphia accuses Aetna of assigning children under Medicaid to providers who were dead, out of state or did not specialize in pediatrics.”
Georgia ASCs, anesthesia providers to pay $28M to resolve kickback allegations: “Three anesthesia providers and several Georgia ASCs, along with their physician-owners and an administrator, agreed to pay more than $28 million to resolve allegations that they entered kickback agreements…
The suit alleges that Ambulatory Anesthesia of Atlanta and Northside Anesthesiology Consultants, both in Atlanta, paid a number of ASCs for medications, supplies, equipment and labor in exchange for patient referrals between 2005 and 2015.”
Clover Health Reports Third Quarter 2021 Financial Results: The company provides an interesting case study. The Medical Loss Ratio is still high as the company has rapidly expanded. It blames Covid-19 rebound of deferred care for the increase costs, but other companies are not reporting such numbers.
About Covid-19
U.S. government to buy $1 billion more worth of Merck's COVID-19 pill: “The U.S. government will buy another $1 billion worth of the COVID-19 pill made by Merck & Co Inc and partner Ridgeback Biotherapeutics, the companies said on Tuesday.
The government in June agreed to buy 1.7 million courses of molnupiravir for $1.2 billion and is now exercising options to buy 1.4 million more.”
WHO warns of shortage of 1 to 2 billion COVID-19 vaccine syringes: “There could be a shortage of one to two billion syringes needed to administer COVID-19 vaccinations in 2022 which could also impact routine immunisations and undermine needle safety, the World Health Organization warned on Tuesday…”
Moderna took NIH money and help for its covid vaccine. Now it wants to leave government scientists off a lucrative patent.: “Moderna is disputing some claims by the National Institutes of Health that it was behind the invention of the company’s mRNA coronavirus vaccine, raising the stakes in the debate over the government’s ability to exert influence over the availability and price of the vaccine in the future.
At the core of the dispute is the contribution of NIH-funded scientists who worked closely with Moderna at the dawn of the pandemic to develop the groundbreaking vaccine.
The dispute was revealed in patent applications filed by Moderna that were reviewed by researchers for the consumer advocacy group Public Citizen.
Some of Moderna’s applications excluded government-funded scientists.”
Surgeon general releases guide to combating COVID-19 vaccine misinformation: See the article for the illustrated “toolkit” to be used to combat misinformation.
Association of Self-reported COVID-19 Infection and SARS-CoV-2 Serology Test Results With Persistent Physical Symptoms Among French Adults During the COVID-19 Pandemic: “In this cross-sectional analysis of 26 823 adults from the population-based French CONSTANCES cohort during the COVID-19 pandemic, self-reported COVID-19 infection was associated with most persistent physical symptoms, whereas laboratory-confirmed COVID-19 infection was associated only with anosmia. Those associations were independent from self-rated health or depressive symptoms.
Findings suggest that persistent physical symptoms after COVID-19 infection should not be automatically ascribed to SARS-CoV-2; a complete medical evaluation may be needed to prevent erroneously attributing symptoms to the virus.”
Express Scripts Creates Industry-First Solution to Provide Coverage for At-Home COVID-19 Test Kits : “Beginning January 1, 2022, members of plans who enroll in this Express Scripts solution can visit a participating in-network pharmacy, choose an applicable COVID-19 OTC test kit, and show their Express Scripts member ID card at checkout to process the kit through their pharmacy benefit. Plans have the flexibility to set the member copay for the tests, either at a discounted rate or $0 copay.”
About the public’s health
Accelerometer-derived sleep onset timing and cardiovascular disease incidence: a UK Biobank cohort study : ”Growing evidence suggests that poor sleep health is associated with cardiovascular risk. However, research in this area often relies upon recollection dependent questionnaires or diaries. Accelerometers provide an alternative tool for measuring sleep parameters objectively…
An age- and sex-controlled base analysis found that sleep onset time of 10:00 p.m.–10:59 p.m. was associated with the lowest CVD incidence…
Importantly, sensitivity analyses revealed this association with increased CVD risk was stronger in females…”
Type of fat, not how much, linked to stroke risk, study finds: “The study found that eating more animal fat was linked to a higher risk of stroke, while getting more fat from vegetable sources was linked to a lower risk…
The results come from 27 years of data from more than 117,000 health care professionals. The data were pulled from two of the largest and longest-running nutritional studies in the U.S. — the Nurses’ Health Study and the Health Professionals Follow-Up Study.”
Adults Who Report Fair or Poor Health Status by Race/Ethnicity: The report is based on 2020 data and should be cautiously interpreted; self-reported data does not often correlate well with objective data. The poorest health reported is Puerto Rico, followed by West Virginia. The best reported health is in D.C., followed by Massachusetts.
About healthcare devices
FDA clears AFib notification on Apple Watch: “If the irregular rhythm consistent with AFib is identified and confirmed, IRNF 2.0 Watch app will notify the user and transfer the AFib notification to the iPhone Health App through Apple’s HealthKit sync. It will encourage the user to seek medical care. The app will display a history of all prior AFib notifications and allow the user to view a list of times for the irregular rhythms contributing to the notification.”
FDA Designates ReWalk’s ReBoot Soft Exo-Suit a Breakthrough Device: “ReBoot is a lightweight, battery-powered orthotic exo-suit intended to assist ambulatory functions in people with reduced ankle function related to neurological injuries, such as stroke. It works in conjunction with the muscles of the affected leg to assist with maintaining safe foot positioning and with pushing off the ground, which means it may improve users’ gait.”
GE Plans to Form Three Public Companies Focused on Growth Sectors of Aviation, Healthcare, and Energy: “GE Aviation, GE Healthcare, and the combined GE Renewable Energy, GE Power, and GE Digital businesses [are] to become three industry-leading, global, investment-grade public companies…”
GE Healthcare will be a tax-free spinoff, “creating a pure-play company at the center of precision health in early 2023, in which GE expects to retain a stake of 19.9 percent…”
About pharma
Sun Pharma Agrees to $85 Million in Settlements Over Price-Fixing Allegations: “Two U.S. subsidiaries of Indian generics company Sun Pharmaceutical Industries have reached settlements totaling $85 million with plaintiffs in the companies’ drug-pricing antitrust litigation, said Sun in a statement…
From 2013 to 2015, according to the U.S. Department of Justice, Taro Pharmaceuticals USA, Sandoz and Apotex are alleged to have conspired to set prices on a number of popular unnamed generic drugs. The companies are alleged to have paid each other — and other unnamed companies — to manipulate price, supply and customer allocations between 2013 and 2015.”
AstraZeneca to set up division for vaccines and antibody therapies: The headline is the story.
About hospitals and health systems
Record Number of Hospitals Receive an ‘A,’ ‘B,’ ‘C,’ ‘D,’ or ‘F’ on the Leapfrog Hospital Safety Grade: Published today on the Leapfrog website. Highlights:
“Thirty-two percent of hospitals received an "A," 26% received a "B," 35% received a "C," 7% received a "D," and less than 1% received an "F.”
The five states with the highest percentages of "A" hospitals are Virginia, North Carolina, Idaho, Massachusetts, and Colorado.
There were no "A" hospitals in Delaware, Washington, DC, and North Dakota.”
About medical groups
Justice Department probing Oak Street Health for potential false claims violations: “The Justice Department is investigating Oak Street Health, a Chicago-based network of primary care centers for Medicare beneficiaries, over potential False Claims Act violations, according to a filing the company submitted to the Securities and Exchange Commission.
The Justice Department requested a civil investigative demand from the company on Nov. 1. It is requesting documents and information related to Oak Street Health's relationships with third-party marketing agents and its service offering free rides to Medicare beneficiaries.”
Offering “free” services to Medicare recipients can lead to charges of illegal inducements. Medicare Advantage companies have received federal permission to offer many non-traditional services; however, Oak Street is a provider and may not fall under those permissions.