About the public’s health
48 ORGANIZATIONS CALL FOR PHASING OUT SALES OF COMBUSTIBLE TOBACCO PRODUCTS: From the Action on Smoking and Health (ASH): “The vision to end the combustible tobacco epidemic is not new. Several countries have set themselves on a path to end smoking within a generation. Bhutan banned tobacco sales years ago, and two cities in California have already passed ordinances to end tobacco sales from 1 January 2021. Dutch lawmakers have passed laws aimed towards phasing out cigarette sales.”
The statement includes the list of organizations supporting the phase out.
Smoking kills more people annually than Covid-19. That fact should provide evidence for how deep political influence goes to keep tobacco products on the market.
Long-term Intake of Gluten and Cognitive Function Among US Women: There are many myths about the benefits of gluten-free diets in those without celiac disease. This research debunks one of them: “In this study, long-term gluten intake was not associated with cognitive scores in middle-aged women without celiac disease. Our results do not support recommendations to restrict dietary gluten to maintain cognitive function in the absence of celiac disease or established gluten sensitivity.”
About health insurance
White House budget plan set to leave out some health care proposals from campaign: “The White House jettisoned months of planning from agency staff as their initial plan could fuel criticisms that the administration is pushing new spending programs too aggressively. The budget will not include President Biden’s campaign pledge to enact a public option to create a government-run health insurance program, or his pledge to cut prescription drug costs, the people said. The people spoke on the condition of anonymity to describe internal administration deliberations.”
In cases like this one I always wonder what Lyndon Johnson would have done.
OptumRx analysts see more pharmacy fraud activity amid COVID-19: “The pharmacy benefit manager giant recovered $300 million in fraud, waste and abuse spend in 2020 and documented the largest ever increase in fraudulent claims, which were up 300% compared to 2019.
In addition, Optum's investigative audits led to an increase of 135% in fraud recoveries last year from 2019. The average audit recovery per case was also 70% higher in 2020 than in 2019, Optum found…
Optum found the fraudulent behavior concentrated among independent pharmacies and rarely found similar activity among retail chains…Due to the findings, the PBM axed 112 pharmacies from its network.”
State of Medicare Advantage [MA] REPORT MAY 2021: When comparing traditional Medicare with MA plans, the following findings should be kept in mind:
• “Enrollment in Medicare Advantage is growing year over year with over 26 million people, or 42 percent of all Medicare beneficiaries currently enrolled in Medicare Advantage.
• Medicare Advantage beneficiaries report a 98 percent satisfaction rate with their coverage.
•The Medicare Advantage population is increasingly diverse. 33.7 percent of Medicare Advantage beneficiaries identify as a racial or ethnic minority, compared to 16 percent in Traditional FFS Medicare.
• Medicare Advantage beneficiaries report lower average annual individual spending compared to Traditional FFS Medicare, with consumer cost savings of $1,640. This savings is a 40 percent lower rate of cost burden for Medicare Advantage beneficiaries.
• Medicare Advantage has a 43 percent lower rate of avoidable hospitalizations for any reason, as compared to Traditional FFS Medicare, and higher rates of screening for conditions such as cancer and depression.
• 99 percent of all Medicare beneficiaries have access to at least one Medicare Advantage plan and 96 percent of Medicare Advantage beneficiaries have access to at least one zero-dollar premium plan.
• About 90 percent of Medicare Advantage plans offer wellness, dental, vision, or hearing coverage, which are not available in Traditional FFS Medicare, and approximately 68 percent offer all four benefits. More plans also offer supplemental benefits for chronically ill beneficiaries that address social determinants of health.
• 52.7 percent of all Medicare Advantage beneficiaries live below 200 percent of the Federal Poverty Level, compared to 39.1 percent of beneficiaries in Traditional FFS Medicare.”
Laws to Curb Surprise Medical Bills Might Be Inflating Health Care Costs: “The concerns stem from guidelines states have established to help impartial arbitrators resolve disputes between providers and insurance carriers over how much should be paid for surprise, out-of-network bills.”
The problem is that these arbitrations rely on prevalent fees. Providers will anticipate these events and raise their prices to compensate.
The article has a helpful graph of which states have passed surprise billing legislation and an explanation of the arbitration process..
Federal court says HHS must recalculate years of Medicare payments to teaching hospitals: I previously reported this story, but now the financial impact of this decision is a bit clearer: “…plaintiff teaching hospitals said they were under reimbursed by millions of dollars for fiscal years dating as far back as 2005. One plaintiff, Milton S. Hershey Medical Center, said that its reimbursements were collectively reduced by more than $12.8 million due to the regulation.”
Commercial Savings Generated by Medicare Negotiation Under H.R. 3: “Title I and Title II of H.R. 3 address drug prices in two separate approaches. Title I, the ‘Lowering Prices Through Fair Drug Price Negotiation’ provision, would empower the Secretary of Health and Human Services (HHS) to negotiate prices directly with drug manufacturers for up to 250 of the costliest single-source brand drugs on the market. Negotiations would begin in 2023 and then each year thereafter HHS would establish a list of eligible drugs for which manufacturers would be required to negotiate prices. Title II, the ‘Medicare Parts B and D Prescription Drug Inflation Rebates’ provision, would require manufacturers to limit price increases to the rate of inflation by paying any greater price increase back as a rebate….
Under H.R. 3, West Health estimates that employers could see a $195 billion reduction in health care spending, while employees could see $61 billion in lower costs ($53 billion in lower premiums and $8 billion in lower out-of-pocket costs). Total costs for the ACA market could fall by $58 billion, including $34 billion in lower beneficiary premiums, $2 billion in lower cost-sharing, and $21 billion in federal savings through reduced Advance-Premium Tax Credits. Even though this scenario presumes that manufacturers will increase drug prices at a faster rate than current trends to make up for lower prices on negotiated drugs, the lower prices achieved under Title I of H.R. 3 outweigh these price increases.”
Biden admin to end Next Gen ACO model after this year: “The Biden administration has decided to not extend the Next Generation Accountable Care Organization Model, which is expected to end at the end of 2021.
The decision, announced late Friday, ends a program that called for ACOs to take on more financial risk than the Medicare Shared Savings Program (MSSP). The model was originally expected to end at the start of 2021 but was extended by the Trump administration due to the pandemic.”
About Covid-19
G-20 Health Accord Shows Split On Waiving COVID IP: “Leaders from the world's largest economies, including Vice President Kamala Harris, reached an agreement on Friday to support voluntary licensing of intellectual property covering COVID-19 vaccines, in a move that shows many countries are still reluctant to support a U.S.-backed World Trade Organization proposal to waive IP rights.
A declaration issued in Rome at the end of an international health summit failed to mention the proposal to waive aspects of the WTO's Council for Trade-Related Aspects of Intellectual Property Rights, or TRIPS, agreement, and instead focused on ways that G-20 members could work ‘consistently within’ the treaty's framework.”
The article is a good, current explanation of where the US currently stands on this issue vis-a-vis other countries.
Scientists zero in on long-sought marker of COVID-vaccine efficacy: “Triccas and his colleagues examined neutralizing-antibody data from trials of seven widely used vaccines. The team found a strong link between participants’ antibody levels recorded in early-stage trials and vaccine-efficacy results from late-stage trials. The researchers estimate that a vaccine has an efficacy of 50% even if it induces antibody levels 80% lower than those found, on average, in a person who has recovered from COVID-19.
Vaccines that generated the strongest neutralizing-antibody responses, such as the mRNA-based vaccines made by Moderna and Pfizer–BioNTech, were the most protective. Vaccines that induced a weaker response, which included the Oxford–AstraZeneca jab, provided lower levels of protection.
The researchers predict that because antibody levels wane over time, booster shots might be needed in about a year, but protection against severe disease could last many years even without them.”
Study finds Pfizer, AstraZeneca's COVID-19 vaccines "highly effective" against Indian variant: “An analysis by Public Health England (PHE) suggests that two doses of COVID-19 vaccines from Pfizer/BioNTech and AstraZeneca are "highly effective" against the B.1.617.2 coronavirus variant first identified in India, the UK government announced on Saturday.”
Pfizer, BioNTech to Distribute 2 Billion Doses to Lower-Income Countries: “The shipments to low- and middle-income nations would occur over the next 18 months, said Pfizer CEO Albert Bourla, adding that low-income countries would receive doses for free while middle-income countries would pay approximately half of what richer nations pay — an estimated $10 rather than $20 per dose.”
Americans favor vaccine mandates over vaccine passports, study shows: “Sixty-two percent of American adults said they support federal, state and local governments requiring citizens to get vaccinated against COVID-19, while just 27.5 percent said they supported businesses' use of vaccine passports, according to survey results released May 20 by the COVID States Project.”
Moderna taps Samsung for fill-finish duties on 'hundreds of millions' of COVID-19 vaccine doses: “Moderna has tapped Samsung Biologics for large-scale, commercial fill-finish duties on its mRNA-based vaccine, the companies said Saturday. Once the deal closes, tech transfer will kick off ‘immediately’ at Samsung's facilities in Incheon, South Korea, where the CDMO plans to leverage a finishing, labeling and packaging line to crank out ‘hundreds of millions’ of vaccine doses for countries other than the United States.”
About hospitals and healthcare systems
Mayo Clinic sees net income rebound to $782M in Q1: “Rochester, Minn.-based Mayo Clinic recorded a net income of $782 million in the first quarter of 2021, or a margin of 21.1 percent, according to recently released financial documents. In the same quarter one year prior, Mayo Clinic recorded a net loss of $623 million.” A good exercise is to review these statements and see what changed.
Advocate Aurora to make remote work permanent for 12,000 employees: “Under the new work model, dubbed WorkForward, the 12,000 non-clinical employees who have been working remotely throughout the COVID-19 pandemic will continue to do so permanently; these employees will 'no longer have dedicated workspaces’ like cubicles or offices at the health system's Milwaukee and Downers Grove, Ill.-based offices, the publication reports.
Affected departments include finance and accounting, consumer experience and public affairs, strategy and business development, government relations and administration. Employees will be able to choose to work from home, at a coffee shop or other locations…”
Another example of how COVId-19 has accelerated business trends. While productivity changes with remote work have yet to be adequately studied, many businesses find that they are saving large amounts due to reduced rent/building ownership as well as on-site support services (cleaning, food service, etc.).
About healthcare IT
FBI warns Conti ransomware hit Ireland system, targeted 16 U.S. medical, emergency networks: “The same hackers that hit the Irish health system a week ago also targeted at least 16 U.S. medical and first responder networks in the past year, according to a federal law enforcement alert.
The Cyber Division of the Federal Bureau of Investigation (FBI) said cybercriminals using the malicious software dubbed 'Conti' have targeted law enforcement, emergency medical services, dispatch centers, and municipalities.
The alert didn't name specific victim organizations or offer details about the nature or severity of the breaches…”
21 telehealth platforms ranked by KLAS: “Swymed, Doximity and Caregility topped the list of telehealth companies ranked highest for provider satisfaction, according to a recent KLAS Research report.
For its ‘Telehealth Ecosystem 2021’ report, KLAS Research analyzed customer-reported information on several telehealth platforms to generate overall performance scores for each platform.”
Hims & Hers Q1 revenue jumps 74% as company looks to expand virtual behavioral health services: “Hims & Hers, a consumer telehealth and wellness brand, saw its first-quarter 2021 revenue grow 74% to $52 million, beating both the company's expectations and Wall Street estimates…
The digital health company reported a net loss of $51 million for the first quarter of 2021 compared to a loss of $6 million for the first quarter of 2020. The year-over-year increase in net loss was primarily driven by one-time stock-based compensation and transaction bonus expenses related to the merger with Oaktree Acquisition Corp.”
Industry Voices—Digital twins of humans are closer than you think: Fascinating explanation of creating virtual human twins (digitally) so that treatments can be tried on the copy first.
Centering Equity In The Design And Use Of Health Information Systems: Partnering With Communities On Race, Ethnicity, And Language Data: A thoughtful discussion of the headline’s topic.