About Covid-19
CDC: New COVID-19 Hospitalizations Increase “Over 16,200 new COVID-19 hospital admissions were reported last week – an increase of more than 8% over the week prior. Experts will surely be monitoring the jump as it could potentially signal the start of a widely expected fall and winter coronavirus wave.”
Moderna loses a COVID vaccine patent in Europe amid heated clash with BioNTech, Pfizer “Pfizer’s Comirnaty partner BioNTech chalked up a win as the European Patent Office (EPO) snatched back one of Moderna’s patents, ruling it invalid.
The patent in question protects “respiratory virus vaccines,” according to its listing in the European Patent Register. Opposers to the patent include BioNTech and Pfizer, as well as Sanofi, the listing notes.”
About health insurance/insurers
CMS releases standards and payment parameters for plans on the ACA marketplace A really good summary of these standards and parameters for the next year.
Medicare Snapshot: AEP Costs & Trends “Highlights:
• Zero-premium Medicare Advantage plans remain popular, but demand has hit a plateau: 66% of all Medicare Advantage plans come with no monthly premium*, but they’re popular with enrollees. eHealth found that 83% of beneficiaries choosing Medicare Advantage plans selected zero- premium plans. Nevertheless, demand for zero-premium plans is lower than in prior years: 84% of beneficiaries chose zero-premium plans for the 2023 coverage year; for 2022, that figure was 88%.
• The average premium for Medicare Advantage plans is higher for the second year in a row: $9 is the average monthly premium among Medicare Advantage plans selected by beneficiaries shopping for 2024 coverage at eHealth, compared to $7 in the same period last AEP and $4 the year before.
• Average premiums for Medicare Part D prescription drug plans remains historically high: $29 is the average monthly premium for Part D plans selected by Medicare beneficiaries at eHealth, down slightly from $31 in the same period last AEP, but still significantly higher than eHealth tracked for the 2019 through 2022 coverage years.”
HHS' call to action for payers on health equity “CMS issued its first-ever playbook to address social determinants of health…
Here are HHS' calls for payers:
Medicare Advantage plans can partner with community organizations to address unmet health-related social needs for chronically ill beneficiaries.
States can contract with Medicaid managed care plans to address social needs, such as providing healthy meals to those living in food deserts, and design ways to address social determinants of health through the program using federal waivers.
Payers can work in partnership with community organizations to provide navigation and care pathways for members.
Payers can consider reimbursing the community-based workforce for helping patients with navigation, access and improving the cultural competency of services delivered to members.”
Fiscal Year 2023 Improper Payments Fact Sheet This CMS document covers federally sponsored programs. For example, “The Medicare Fee-for-Service (FFS) estimated improper payment rate was 7.38%, or $31.2 billion, marking the seventh consecutive year this figure has been below the 10%
threshold for compliance established by improper payment statutory requirements.”
Comment: When proponents of “Medicare for all” cite lower administrative costs vis-a-vis private payers, they did not take into account this higher rate of improper payments.
Medicare HI Trust Fund Solvency Assuming MA Utilization “Findings
MA vs. FFS Utilization Differences: For all Part A services analyzed, MA utilization, as measured by patient days, was lower than FFS. Between 2018 and 2019, the differences between MA and the alternative, utilization-based scenario were 36% for inpatient, 14% for SNF, and 28% for HH.
HI Trust Fund Solvency Projection: The HI Trust Fund would remain solvent for an additional 17 years—until 2048—if FFS utilization levels were similar to MA utilization levels.”
Quality Outcomes Are Better When Medicaid MCOs Administer Pharmacy Benefits “Pharmacy-related quality outcomes were better in states where Medicaid managed care organizations administered health plans’ pharmacy benefits, according to a report from Elevance Health…
Carve-in managed care organizations had more favorable HEDIS scores in 65 percent of the quality performance comparisons made between managed care organizations operating in pharmacy carve-in and carve-out states. Similarly, after excluding age-related measures, HEDIS scores were better in the carve-in setting for 65 percent of comparisons.”
About hospitals and healthcare systems
Hospital Vitals: Financial and Operational Trends, Q1-Q2 2023 Among the findings: “The median health system1 saw cash reserves — measured as days cash on hand — drop 28% from 173 in January 2022 to 124 in June 2023. Rapidly rising expenses across the board exacerbated the declines in cash reserves…
A recent American Hospital Association (AHA) member survey found that 50% of hospitals and health systems reported having more than $100 million in unpaid claims that were more than six months old.”
A related problem is the rising rate of insurer payment denials.
NCQA Picks 18 Organizations to Pilot Virtual Care Accreditation “The National Committee for Quality Assurance (NCQA) has launched a Virtual Care Accreditation Pilot program, which it says is a key step in NCQA’s development of a quality improvement framework for organizations that provide care via telehealth or other digital platforms.
The nonprofit NCQA selected as pilot organizations a set of 18 organized and engaged entities from the more than 100 that applied. Based in 12 states and Puerto Rico, pilot organizations include health plans, health systems, Federally Qualified Health Centers, patient-centered medical homes and virtual first/virtual only organizations.”
About pharma
FDA finalizes DTC ad rule 13 years after posting proposal, creating new standards for TV and radio “The FDA is finally finalizing its rule on the need for direct-to-consumer ads to present side effects and contraindications ‘in a clear, conspicuous and neutral manner’ more than 10 years after closing the third and final comment period…
The final rule, which is set to take effect May 20, establishes a set of standards for determining if an ad complies with the need to be clear, conspicuous and neutral.”
The article explains the background for this much-needed rule.
See, also: Drug ads must be more upfront about side effects, FDA says
Outcomes of the 340B Drug Pricing Program “In this scoping review of the 340B program, we found that the 340B program was associated with financial benefits for hospitals, clinics, and pharmacies; improved access to health care services for patients; and substantial costs to manufacturers. Increased transparency regarding the use of 340B program revenue and strengthened rulemaking and enforcement authority for the Health Resources and Services Administration would support compliance and help ensure the 340B program achieves its intended purposes.”
25% of current drug shortages are more than 5 years old “In early 2023, the number of drug shortages hit a 10-year high. A fourth of these shortages are more than five years old, and 58% are older than two years, according to a new report…
Shortages are more common in the cheapest drugs.”
Boom in weight-loss drugs to drive up US employers' medical costs in 2024 - Mercer “GLP-1 medications approved by the U.S. Food and Drug Administration could contribute between 50 and 100 basis points to the trend, Mercer's Chief Health Actuary, Sunit Patel, told Reuters in an interview.”
Therapeutic Benefit From New Drugs From Pharmaceutical Companies The article concludes that more beneficial drugs come from public sector research than private industry. “Over a quarter of new drugs originate in the public sector, and those drugs have more therapeutic value than the ones coming from industry. However, since industry is still ultimately responsible for up to 75% of new drugs, the question is how to structure public policy to better align pharmaceutical companies research and development activities with public health needs.”
About the public’s health
WHO asks China for data on ‘undiagnosed pneumonia’ cases “The World Health Organization has asked China for information on a rise in respiratory illness among children, in a sign of the heightened vigilance over outbreaks of infectious disease since the Covid-19 pandemic. The global health body made the request after reports of ‘undiagnosed pneumonia’ in northern China from ProMed, the outbreak surveillance network that first alerted the world to Covid.”
In 2 related articles:
China says no unusual pathogens found after WHO queries respiratory outbreaks and
Pandemic-related immunity gap in kids explains surge of respiratory infections in children in China, says WHO
Economic Evaluation of Blood Pressure Monitoring Techniques in Patients With Hypertension “Findings In this systematic literature review of 16 studies, at-home self-monitoring was the most cost-effective strategy long-term compared with traditional blood pressure monitoring in clinics, with 24-hour ambulatory blood pressure monitoring and at-home blood pressure monitoring combined with additional support or team-based care being more cost-effective compared with at-home blood pressure monitoring alone.
Meaning These findings suggest that clinicians, hospitals, health care systems, third-party payers, and other stakeholders should prioritize at-home self-monitoring of blood pressure as the main strategy for blood pressure measurement among patients with hypertension.”
About health technology
Masimo W1 watch gets FDA clearance for OTC, prescription use “The FDA has cleared Masimo’s W1 medical watch for both prescription and over-the-counter use.
The watch provides continuous real-time oxygen saturation and pulse rate monitoring and is approved for use by adults in hospitals, clinics, long-term care facilities and at home.”