Happy Birthday!
Today is Professor Phillip Kotler’s 90th birthday.
Among his many accomplishments, he is the father of Social Marketing, which has been used to improve the health of countless people.
[For his latest writing on this subject, see: Strategic Marketing for Healthcare Organizations 2nd Edition (c)2021]
About Covid-19
Faster than a PCR test: dogs detect Covid in under a second: More on canine detection of Covid-19.
SARS-CoV-2 infection induces long-lived bone marrow plasma cells in humans: As we understand more about the natural history of Covid, this update on the longevity of immunity is important:
”Here we demonstrate that in patients who experienced mild infections (n=77), serum anti-SARS-CoV-2 spike (S) antibodies decline rapidly in the first 4 months after infection and then more gradually over the following 7 months, remaining detectable at least 11 months after infection. Anti-S antibody titers correlated with the frequency of S-specific BMPCs [long-lived bone marrow plasma cells] from bone marrow aspirates of 18 SARS-CoV-2 convalescent patients 7 to 8 months after infection.”
Moderna says its vaccine triggers immune response in teenagers, will seek FDA approval: “Biotechnology company Moderna announced Tuesday that its two-shot coronavirus vaccine produced the same immune response in teenagers as adults, and it plans to submit the data to U.S. regulators in early June.”
Push for vaccines reduced drug options for Covid patients: “While the Biden administration has committed to channeling billions of dollars into finding therapies, a key government agency that invests in drug development recently stopped reviewing requests for new treatments — in part because it doesn't have enough cash available, according to one senior health official…
The Health department’s agency to fund early countermeasures, the Biomedical Advanced Research and Development Authority, suspended calls for new therapies in May, partly because of tight budgets that one senior HHS official said could be refreshed with dollars from the American Rescue Plan, H.R. 1319 (117). And past trials yielded mixed results from a number of potential products. BARDA continues to fund nine ongoing projects, eight of which are aimed at more severe Covid cases. Only a single early project for potential antiviral formulas targets mild illness.”
In a related article: EU panel backs GSK, Vir's antibody sotrovimab for early COVID-19 treatment: “The European Medicines Agency (EMA) on Friday said its Committee for Medicinal Products for Human Use (CHMP) issued an opinion recommending GlaxoSmithKline and Vir Biotechnology's sotrovimab to treat COVID-19 in adults and adolescents aged 12 and older who do not require supplemental oxygen, but are still at risk of progressing to severe disease. The dual-action SARS-CoV-2 monoclonal antibody is also under review by the FDA to prevent at-risk patients with mild-to-moderate COVID-19 from getting worse.”
Pfizer study to investigate co-administration of COVID-19, pneumococcal vaccines: “The study's primary objective is the safety of both vaccines administered together, with follow-up six months after immunisation, while secondary goals include immune responses produced by each of the vaccines.”
COVID-19 Vaccine Breakthrough Infections Reported to CDC — United States, January 1–April 30, 2021: Published today from the CDC: “A total of 10,262 SARS-CoV-2 vaccine breakthrough infections had been reported from 46 U.S. states and territories as of April 30, 2021. Among these cases, 6,446 (63%) occurred in females, and the median patient age was 58 years (interquartile range = 40–74 years). Based on preliminary data, 2,725 (27%) vaccine breakthrough infections were asymptomatic, 995 (10%) patients were known to be hospitalized, and 160 (2%) patients died.”
Vaccine waitlist Dr. B collected data from millions. But how many did it help?: “Millions of users gave personal and health information to the US waitlist service.
Users say they were only offered appointments once eligibility was wide and appointments easy to come by.
The company refuses to say how many people it actually got vaccinated.”
About the public’s health
America’s Health Rankings® Annual Report: The 31st annual report on the status of our public health by the United Health Foundation in partnership with the American Public Health Association. In the report are:
”74 measures to track current and emerging health issues at the state and national level.
Five categories of health in a new model: social and economic factors, physical environment, clinical care, behaviors and health outcomes.
20 data sources”
It is an excellent source to track the progress (or decline) of public health and associated measures (like education and income).
A megastudy of text-based nudges encouraging patients to get vaccinated at an upcoming doctor’s appointment: “We present a large field experiment (N = 47,306) testing 19 nudges delivered to patients via text message and designed to boost adoption of the influenza vaccine. Our findings suggest that text messages sent prior to a primary care visit can boost vaccination rates by an average of 5%. Overall, interventions performed better when they were 1) framed as reminders to get flu shots that were already reserved for the patient and 2) congruent with the sort of communications patients expected to receive from their healthcare provider (i.e., not surprising, casual, or interactive). The best-performing intervention in our study reminded patients twice to get their flu shot at their upcoming doctor’s appointment and indicated it was reserved for them. This successful script could be used as a template for campaigns to encourage the adoption of life-saving vaccines, including against COVID-19.”
A perfect example of social marketing research.
STATEMENT of the American Medical Association to the U.S. House of Representatives Committee on Oversight and Reform Re: Birthing While Black: Examining America’s Black Maternal Health Crisis: This document is the AMA’s Congressional testimony about the high rate of maternal complications and death among Black women. Knowledge of this disparity is not news; but what is important are the recommendations the report contains to address this severe problem.
Effects of Diet and Sodium Reduction on Cardiac Injury, Strain, and Inflammation: The DASH-Sodium Trial: “Combining a DASH dietary pattern with sodium reduction can lower 2 distinct mechanisms of subclinical cardiac damage: injury and strain, whereas DASH alone reduced inflammation. (Dietary Patterns, Sodium Intake and Blood Pressure.”
In the Debate Over ‘SIDS Monitors,’ Evidence Is Thin All Around: “…short of stronger evidence — ideally from a carefully controlled clinical trial — some pediatric experts continue to raise pointed questions about what, exactly, modern monitoring companies are selling. Ruey-Kang Chang, a pediatric cardiologist at Harbor-UCLA hospital who has published research on SIDS, said it’s clear that there is no clinical trial data or scientific evidence that shows these monitors can save babies from SIDS. Instead, he said, ‘I think they prey on parents’ anxiety.’”
About health insurance
Meet new CMS Administrator Chiquita Brooks-LaSure: 4 things to know: “The Senate has confirmed Chiquita Brooks-LaSure as the next CMS administrator. She will lead the trillion-dollar agency within HHS that manages Medicare, Medicaid and health insurance marketplace programs.”
Private payers to dole out over $2B in ACA rebates this fall: “Private insurance companies are expected to provide $2.1 billion in rebates to 10.7 million policyholders, the second-highest amount issued under the Affordable Care Act…”
The amounts are due to low Medical Loss Ratios that plans experienced last year due to decreases in elective care. Expect a rebound over “normal” this year.
Marketplace Premiums and Participation 2021: “In 2021, the ACA Marketplaces entered their eighth year of operation and premiums have stabilized. The national average benchmark premium fell again in 2021, following decreases in both 2019 and 2020. This decline is remarkable because it contrasts with premium increases in the employer-sponsored insurance market over the same period. However, the nationwide average belies the variation in premiums both across and within states…
We found that the number of insurers was a strong predictor of lower premiums; markets with only one or two insurers had substantially higher premiums than markets with five or more insurers. On the other hand, the presence of a Medicaid insurer was associated with lower premiums. Similarly, regions in states that expanded Medicaid or established state-based Marketplaces had lower premiums than regions in states that had not enacted such policies.”
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Anthem Community Insurance Company, Inc. (Contract H3655) Submitted to CMS: “With respect to the seven high-risk groups covered by our audit, most of the selected diagnosis codes that Anthem submitted to CMS for use in CMS's risk adjustment program did not comply with Federal requirements. For 123 of the 203 enrollee-years, the diagnosis codes that Anthem submitted to CMS were not supported in the medical records and resulted in $354,016 of net overpayments for the 203 enrollee-years.
These errors occurred because the policies and procedures that Anthem had to detect and correct noncompliance with CMS's program requirements, as mandated by Federal regulations, were not always effective. On the basis of our sample results, we estimated that Anthem received at least $3.47 million of net overpayments for these high-risk diagnosis codes in 2015 and 2016.”
In a related article: Humana nets nearly $200M in overpayments, OIG audit finds: “Humana allegedly overcharged the federal government by nearly $200 million for submitting documentation that inaccurately showed some of its Medicare Advantage members were sicker than they actually were in 2015, according to an audit conducted by the HHS Office of Inspector General.
OIG is recommending Humana return $197.7 million and improve its policies to prevent such overpayments in the future.”
Time and Financial Costs for Physician Practices to Participate in the Medicare Merit-based Incentive Payment System: “In this qualitative study using interviews with leaders of 30 physician practices across the US, an average of $12 811 per physician was spent to participate in MIPS in 2019. Clinicians and administrators spent more than 200 hours per physician on MIPS-related activities.”
Lawmakers Propose Permanent Medicare Coverage Of Audio-Only Telehealth: “Medicare would permanently cover audio-only telehealth visits under a new bill introduced Monday by two members of Congress.
The bill, introduced by Rep. Jason Smith (R-Mo.) and Josh Gottheimer (D-N.J.), would also remove a requirement that patients receive telehealth services at a health facility for it to be covered by Medicare.”
CMS: Prior authorization slashed ambulance transportation by 70%: “Prior authorization dramatically lowered the use of regular, non-emergency ambulance transportation among Medicare beneficiaries without affecting quality or beneficiaries’ access to care, according to a government report on Monday.
Those are the results of a CMS Center for Medicare and Medicaid Innovation experiment to test whether requiring ambulance service providers to get pre-approval for such services would reduce their use among Medicare beneficiaries with End-stage Renal Disease or pressure ulcers.
Researchers found that prior authorization reduced unnecessary use and spending by more than 70%, lowering total Medicare spending by 2.4%. The findings suggest that expanding prior authorization for regular non-emergency ambulance transportation could save Medicare even more money without affect beneficiaries’ health.”
About healthcare IT
UPMC Health Plan rolls out virtual concierge for Amazon Alexa, Google Assistant devices: “The insurer, headquartered in Pittsburgh, launched a new virtual concierge feature that will assist commercial plan members with some of their most frequently asked questions related to their benefits and coverage and how to access care and services. Members can also use the service to find out more about health insurance basics and how to access services like telehealth.
UPMC Health Plan is owned by the University of Pittsburgh Medical Center (UPMC).”
Humans Top Digital Scribes For Better EHR Documentation: “Human scribes still trump digital scribes in EHR documentation, according to a study published in the Association for Computing Machinery Digital Library.
A digital scribe is not currently capable of widespread adoption because of a lack of accuracy, completeness, and medical synthesis, clinician respondents said.”
Microsoft’s cloud boss says the company doesn’t want to compete with doctors: “Thanks to its pending acquisition of Nuance Communications, Microsoft will soon have a suite of software tools that doctors use to automatically keep notes on meetings with patients. But Microsoft isn’t interested in automating everything doctors do, said Scott Guthrie, the software company’s executive vice president for cloud and artificial intelligence.
The pending acquisition, worth $19.7 billion including debt, is an unusual case of a major technology company drawing from its cash pile to gain relationships in an individual industry. Microsoft’s rivals in the growing cloud computing market have not gone so far. If the move proves successful, Microsoft could convert Nuance customers into big users of Microsoft’s Azure cloud and strengthen its position relative to the market leader, Amazon.”
ONC Defines EHR Certification For SDOH Data To Pursue Health Equity: “ONC announced its health IT demographic EHR certification requirements to standardize race and ethnicity data collection in the pursuit of health equity.
ONC outlined that the agency’s “demographics” certification criterion requires health IT to record race and ethnicity at the same level of detail as the CDC’s Race & Ethnicity code technology. This system encompasses over 900 concepts for race and ethnicity, giving patients precise options for self-identifying their demographic information.”
Hospitals and health systems
Hospitals faced slight patient volume declines in April compared to March: “Hospital patient volumes in April saw a major increase compared to the same month in 2020 but were below March 2021’s levels, a new report from Kaufman Hall found.
The report, released Monday (PDF), shows the volatility and uncertainty the hospital industry still faces as facilities recover from the pandemic.”
Fintech takes aim at a $400B healthcare puzzle: Patients contract with companies for interest-free payments of hospital bills over time. The companies make their money by paying hospitals a discounted on the patients’ charges. Think of this scheme as the mirror image of paying premiums in advance of the event for traditional insurance coverage.
About diagnostics
Memorial Sloan Kettering AI spinout, Quest Diagnostics partner to expedite cancer diagnoses: “Paige, New York City-based Memorial Sloan Kettering's artificial intelligence spinout, teamed up with Quest Diagnostics May 25 to improve and expedite diagnoses for cancer and other diseases that need pathologic assessment..
Initially, the collaboration will focus on solid tumor cancers, such as breast, prostate, lung and colorectal.”
About pharma
CVS Health Introduces Clinical Trial Services: CVS is entering the Clinical Research Organization business and aims to increase recruitment for drug trials by tapping into each of its local markets.
Implantable piezoelectric polymer improves controlled release of drugs: Repeated tests showed a similar amount of drug release per activation, confirming robust control of release rate: “A membrane made from threads of a polymer commonly used in vascular sutures can be loaded with therapeutic drugs and implanted in the body, where mechanical forces activate the polymer's electric potential and slowly release the drugs.
The novel system, developed by a group led by bioengineers at UC Riverside and published in ACS Applied Bio Materials, overcomes the biggest limitations of conventional drug administration and some controlled release methods, and could improve treatment of cancer and other chronic diseases.”