Rising Health Care Costs, Surging Prescription Drug Pricing, Acute Focus on Chronic Conditions Among 9 Trends to Watch in 2024, Says Business Group on Health FYI, Well worth reading this short piece.
About Covid-19
New COVID-19 Hospitalizations Increase “New coronavirus hospital admissions topped 18,100 the week ending in Nov. 18 – a nearly 10% increase over the week prior.”
About health insurance/insurers
Cigna, Humana in Talks for Blockbuster Merger “Cigna, which had revenue of about $181 billion last year, would be able to marry its huge pharmacy-benefit unit, which manages drug plans, and its strength in commercial insurance with Humana’s big position in the fast-growing Medicare segment, something Cigna has long sought.”
Comment: Let’s see what the DOJ has to say.
A Look at Navigating the Health Care System: Medicaid Consumer Perspectives “Key take-aways include the following:
Medicaid enrollees report worse health status compared to those with other coverage, which could lead to greater need for health care and more opportunities to encounter problems with the system. Still, the large majority (83%) of Medicaid enrollees rate the overall performance of Medicaid positively. However, over half of Medicaid enrollees report having experienced a problem in the past year, and relative to Medicare and employer-sponsored insurance (ESI), Medicaid enrollees are more likely to report certain negative outcomes from insurance problems.
Medicaid enrollees report fewer cost-related problems relative to those with Marketplace coverage and ESI; however, Medicaid enrollees report more problems with prior authorization and provider availability compared to people with other insurance types.
Across racial and ethnic groups, most enrollees rate their Medicaid coverage positively, with White Medicaid enrollees the most likely to describe their insurance as ‘excellent.’ Similar shares of enrollees among all racial and ethnic groups report experiencing problems with their coverage. Similar to the experiences of people with other coverage, Medicaid enrollees who utilize more health care services experience more problems with their insurance.”
Optum faces antitrust lawsuit from California health system “According to court documents, several physicians employed at an Optum-owned clinic in Covina left to join Emanate Health in and after December. Optum then transferred patients to other Optum-affiliated physicians without informing them of their physicians' departure, Emanate Health alleged in its complaint.
The health system alleged Optum instructed its employees not to inform patients their physicians had moved practices, telling patients their physicians had retired or were on vacation…
Emanate Health also alleged that Optum pressured the system to stay out of the primary care business. Optum did not renew its hospital service agreement contracts with Emanate's three hospitals for its commercial and Medicare Advantage HMO members after the system did not agree to limit its primary care business, the system said in court documents.”
Cost of Exempting Sole Orphan Drugs From Medicare Negotiation “Findings This cross-sectional study identified 25 “sole orphan” drugs qualifying for exemption from Medicare price negotiation. Medicare spending on these drugs increased from $3.4 billion in 2012 to $10.0 billion in 2021; the sole orphan exemption would have prevented Medicare from negotiating prices on drugs with $1.1 to $3.0 billion in Medicare spending in each year.
Meaning The results of this study suggest that exempting sole orphan drugs from Medicare price negotiation will cost taxpayers billions of dollars per year; such savings could be used to control Medicare premium increases or provide other benefits for patients.”
Consistency and Adequacy of Public and Commercial Health Insurance for US Children, 2016 to 2021 “This cross-sectional study of 203 691 children found that publicly insured children experienced higher rates of inconsistent coverage, whereas commercially insured children faced higher rates of inadequate coverage. Public insurance consistency and commercial insurance adequacy improved substantially during the COVID-19 public health emergency.”
CMS cut Medicaid improper payments in 2023 “CMS reported …The improper payment rate in the program was 8.58%, or $50.3 billion, in fiscal year 2023, down from 15.62% in 2022, according to a fact sheet from the agency.”
No Improvement In Mental Health Treatment Or Patient-Reported Outcomes At Medicare ACOs For Depression And Anxiety Disorders “Among patients not enrolled in ACOs at baseline, those who newly enrolled in ACOs in the following year were 24 percent less likely to have their depression or anxiety treated during the year than patients who remained unenrolled in ACOs, and they saw no relative improvements at twelve months in their depression and anxiety symptoms. Better-designed incentives are needed to motivate Medicare ACOs to improve mental health treatment.”
About hospitals and healthcare systems
BJC, Saint Luke's move forward with 28-hospital merger St. Louis-based BJC Healthcare and Kansas City, Mo.-based Saint Luke's Health System — which signed a letter of intent to combine in May — have satisfied all regulatory reviews and reached a definitive agreement to merge.
The transaction is expected to close Jan. 1, 2024, according to a Nov. 29 news release shared with Becker's. An integrated academic health system will be formed, though the systems will maintain their distinct brands and operate from dual headquarters: BJC in St. Louis, and Saint Luke's in Kansas City.
Together, the two entities will pool $10 billion in revenue, 28 hospitals and hundreds of clinics and service centers, reaching more than 6 million patients across Missouri, Illinois and Kansas. Richard Liekweg, the CEO of BJC, will helm the new system, while Melinda Estes, MD, the CEO of Saint Luke's, will retire.”
Health system antitrust cases pick up steam FYI
NOVEMBER 2023 National Hospital Flash Report “Key Takeaways
1. Hospital performance in October reflects continued stabilization. Operating margins are elevated over pandemic levels and revenue continue to show improvement compared to the previous month.
2. Emergency department visits declined compared to the previous month. This likely reflects the shift in patient behavior to outpatient care. Organizations need to continue to build strong
provider and outpatient networks.
3. This month there was a decrease in observation patient days. This could be attributed to patient type but also likely reflects increased vigilance of these patients, including the deployment of case managers and use of observation units.”
Lawmakers seek to ban fees that cost hospitals millions “A bipartisan group of U.S. representatives introduced a bill Nov. 28 that would ban fees on electronic healthcare payments that cost hospitals millions of dollars.
The No Fees for EFTs Act would outlaw payers from tacking on fees for providers to be reimbursed electronically. The ACA required payers to offer electronic payments to providers, but payers and middlemen charge as much as 5% for the transactions, a practice exposed in August by ProPublica.”
About pharma
Mounjaro is more effective than Ozempic for weight loss in overweight and obese adults, real-world study says “The blockbuster diabetes drug Mounjaro is more effective for weight loss than another highly popular diabetes treatment, Ozempic, in overweight or obese adults, according to a large analysis of real-world data published Monday.
Patients taking Eli Lilly’s Mounjaro were significantly more likely to lose 5%, 10% and 15% of their body weight overall and saw larger reductions in body weight after three months, six months and a year compared with those on Novo Nordisk’s Ozempic in the study by Truveta Research. The firm compiles and analyzes patient data from a collective of health-care systems.”
The Impact of Biosimilar Use on Total Cost of Care [TCOC] and Provider Financial Performance in the Medicare Oncology Care Model: A Population-Based Simulation Study “Among the total of 8281 6-month oncology care episodes identified in the study period (initiating January 2020 to July 2020) in Medicare claims, 1586 (19.2%) episodes met OCM [Medicare’s Oncology Care Model] and study criteria and were included. Applying the simulation methods to these observed episodes, biosimilar substitution reduced mean TCOC per episode by $1193 (95% CI $583–1840). The cost reduction from biosimilars represented 2.4% of the average TCOC benchmark and led to a 15% reduction in the risk of providers needing to pay recoupments to Medicare for exceeding TCOC benchmarks.”
Pharma's Q3 growth rankings: GLP-1 drugs from Eli Lilly, Novo Nordisk were once again the big story FYI
FDA publishes Real-Time Oncology Review (RTOR) Guidance for Industry “To be considered for RTOR, submissions should demonstrate the following:
—Clinical evidence from adequate and well-controlled investigation(s) indicates that the drug may demonstrate substantial improvement on a clinically relevant endpoint(s) over available therapies.
—Easily interpreted clinical trial endpoints (e.g., overall survival, response rates), as determined by the review division and OCE [Oncology Center of Excellence].
—No aspect of the submission is likely to require a longer review time (e.g., requirement for new REMS [Risk Evaluation and Mitigation Strategy] advisory committee, etc.).”
Insulin users beware: your Medicare drug plan may drop your insulin. What it means for you In an informal survey of 22 Medicare plans, 10 plans are dropping at least one insulin from their formulary, according to Diane Omdahl, founder of 65 Inc., which provides Medicare enrollment guidance through fee-for-service, one-on-one consultations. Four plans are dropping four or more different insulins, she said.
If you’re banking on the $35 out-of-pocket insulin cap to continue saving money next year, you must check your plan to see if your insulin is still covered. Only if your drug plan covers your insulin will you receive the $35 cap, according to the Centers for Medicare & Medicaid Services.”
About the public’s health
U.S. life expectancy rose in 2022, but not enough to erase the pandemic's toll “Life expectancy in the U.S. ticked upward in 2022, following two years of significant declines driven primarily by the Covid pandemic, according to a Centers for Disease Control and Prevention report published Wednesday.
The CDC data showed that life expectancy at birth — how long a baby born in a particular year is expected to live — was 77.5 years in 2022, a 1.1-year increase from 2021.
The number, however, still lags behind what U.S. life expectancy was in 2019: 78.8 years.”
Flu hospitalizations climb for 3rd week in a row “For the third straight week, flu hospitalizations have climbed in the U.S., according to new CDC data.
For the week ending Nov. 18, 3,296 patients with laboratory-confirmed flu cases were admitted to a hospital — up from 2,721 the week prior. Influenza A continues to be the dominant strain, still making up 79.4% of cases. Influenza B currently accounts for 20.6% of cases.”
Ultra-processed foods, adiposity and risk of head and neck cancer and oesophageal adenocarcinoma in the European Prospective Investigation into Cancer and Nutrition study: a mediation analysis “Purpose: To investigate the role of adiposity in the associations between ultra-processed food (UPF) consumption and head and neck cancer (HNC) and oesophageal adenocarcinoma (OAC) in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort…
Conclusions: We reaffirmed that higher UPF consumption is associated with greater risk of HNC and OAC in EPIC. The proportion mediated via adiposity was small. Further research is required to investigate other mechanisms that may be at play (if there is indeed any causal effect of UPF consumption on these cancers).”
Mortality risk from United States coal electricity generation “Exposure to coal PM2.5 was associated with 2.1 times greater mortality risk than exposure to PM2.5 from all sources. A total of 460,000 deaths were attributable to coal PM2.5, representing 25% of all PM2.5-related Medicare deaths before 2009 and 7% after 2012.”
Health experts decry New Zealand's scrapping of world-first tobacco ban “Health and tobacco campaigners said on Monday that New Zealand's plan to repeal laws that would ban tobacco sales for future generations threatened lives and put international efforts to curb smoking at risk.
The country's new centre-right coalition will scrap the laws introduced by the previous Labour-led government, according to coalition agreements published on Friday.
The package of measures would have seen bans on selling tobacco to anyone born after Jan. 1, 2009, reduced the amount of nicotine allowed in smoked tobacco products and cut the number of retailers able to sell tobacco by over 90%.”
Comment: The law was the first of its kind in the world and real progress for public health. The “problem” for countries passing tobacco bans is loss of tax revenue.
Minister for Health announces Ireland is on target to eliminate cervical cancer by 2040 “Goal will be achieved by:
—Increasing HPV vaccination rates for girls by age 15 from 80% to WHO target of 90% by 2030
—Continuing to exceed WHO targets by maintaining cervical screening coverage at or above 73%
—Continuing to exceed WHO targets by maintaining the number of women receiving treatment within the first year of diagnosis at or above 97%”
Long-Term Aspirin Use and Cancer Risk: a 20-Year Cohort Study “Among 1,909,531 individuals, 422,778 were diagnosed with cancer during mean follow-up of 18.2 years. Low-dose aspirin use did not reduce the HR [Hazard Ratio] for cancer overall irrespective of continuity and duration of use (continuous use: 1.04, 95% CI, 1.03-1.06). However, long-term (≥5 or ≥ 10 years) use was associated with ≥10% reductions in HRs for several cancer sites: colon, rectum, esophagus, stomach, liver, pancreas, small intestine, head and neck, brain tumors, meningioma, melanoma, thyroid, non-Hodgkin lymphoma, and leukemia. Substantially elevated HRs were found for lung and bladder cancer. In secondary analyses, consistent high-dose aspirin use was associated with reduced HRs for cancer overall (0.89, CI, 0.85-0.93) and for several cancer sites.”
Sports despite masks: no negative effects of FFP2 face masks on cardiopulmonary exercise capacity in children “In this study, no significant differences in the cardiorespiratory function at peak exercise could be discerned when wearing an FFP2/N95 face mask.”
About healthcare personnel
Optum now has 90,000 physicians “Optum added nearly 20,000 physicians in 2023, Optum Health CEO Amar Desai, MD, said.
During a presentation at UnitedHealth Group's 2023 investor conference on Nov. 29, Dr. Desai said Optum has nearly 90,000 employed or affiliated physicians and another 40,000 advanced practice clinicians serving tens of millions of people.”
About health technology
Avoid syringes made in China, FDA says “As the FDA investigates reports of China-made syringes breaking and leaking, the agency is recommending healthcare workers prioritize syringes manufactured in other countries.
Glass syringes, pre-filled syringes, and syringes used for oral or topical purposes are not part of the quality control concern, the FDA said Nov. 30. Incident reports have included several syringe manufacturers based in China, so the agency is analyzing the issue that might be attributed to changes in the products' dimension.”
Britain’s genetic databank to unveil largest-ever sequencing release “The pioneering UK Biobank is to publish the largest-ever release of genetic sequencing data to boost the research and development of drugs to treat diseases ranging from heart conditions to cancers. The latest £200mn project was a collaboration funded by the government, Wellcome Trust, Britain’s biggest biomedical charity, and four pharmaceutical companies. Biobank’s store of data from some 500,000 individuals collected over more than 15 years makes it a world-leading resource to study the impact on health of genetics, lifestyle and ageing.”
Biden Administration Announces Actions to Strengthen the Drug Supply Chain “‘I'm proud to announce that I'll be invoking what's known as the Defense Production Act to boost production of essential medicines in America by American workers,’ Biden said. ‘You notice that people have to get certain kinds of shots overseas’ because they're not available in the U.S. ‘Well, that supply chain is going to start here in America.’
President Biden also will issue a Presidential Determination giving HHS the authority to invest in domestic manufacturing of essential medicines and medical countermeasures. ‘HHS has identified $35 million for investments in domestic production of key starting materials for sterile injectable medicines,’ according to a White House fact sheet.”
About healthcare finance
AbbVie pays $10B to acquire ImmunoGen, doubling down on red-hot ADC cancer field “…AbbVie is shelling out $10.1 billion in cash to acquire ImmunoGen, maker of the ovarian cancer treatment Elahere, which won accelerated approval from the FDA about a year ago.
The acquisition accelerates AbbVie’s entry into the solid tumor space and strengthens the company’s oncology pipeline…”