Health at a Glance 2023 OECD INDICATORS This biennial report has a wealth of information about international healthcare systems and is the standard, reliable source for these data.
US Senate confirms Monica Bertagnolli as NIH director “The U.S. Senate on Tuesday voted to confirm President Joe Biden's pick to run the National Institutes of Health (NIH), Dr. Monica Bertagnolli, filling the director spot at the country's top medical research agency after a vacancy of almost two years.
Bertagnolli, a cancer surgeon, was approved by a bipartisan 62 to 26 vote. The NIH had been without a director since December 2021, when former director Francis Collins retired, ending a 12-year reign.”
About Covid-19
Trends in United States COVID-19 Hospitalizations, Deaths, Emergency Department (ED) Visits, and Test Positivity by Geographic Area From the CDC. You can look up data from your location.
About health insurance/insurers
Payers ranked by total enrollment in Q3 FYI
Payers ranked by medical loss ratios in Q3 FYI
14 insurers exiting Medicare Advantage in 2024 FYI
Biden administration seeks to crack down on private Medicare health plans “Under a draft rule issued Monday by the federal Centers for Medicare and Medicaid Services, Medicare Advantage plans would be required to work harder to encourage customers to make use of extra benefits available to them, rather than the companies merely invoking them as a selling point.
The proposal also would help Americans with Medicare drug benefits gain access to biosimilars, less expensive versions of biologic drugs made from living cells or other organisms.”
In a related article: What Non-Medical Supplemental Benefits Will MA Plans Offer in 2024? “Food and produce services are the most common non-medical supplemental benefit in Medicare Advantage for 2024, offered by 1,475 plans, a report from ATI Advisory found.”
ACA RISK ADJUSTMENT — A SUCCESS STORY WITH ROOM TO IMPROVE “Oliver Wyman Actuarial recently authored a report for the Blue Cross Blue Shield Association, a federation of 35 separate US health insurance organizations and companies, providing health insurance to more than 106 million Americans. The report analyzed publicly available data to determine whether the risk adjustment system of the Affordable Care Act (ACA) is functioning as intended…
In this report we use publicly available data to show the following:
The current risk adjustment system does move funds from issuers with low-cost claimants to issuers with high-cost claimants, as intended
The risk adjustment system does not appear to disadvantage small issuers or issuers that are new to the market
The current risk adjustment system does not disadvantage issuers that are new to a state
The risk adjustment system underpays for high-cost claimants
It is likely that some issuers’ financial difficulties were the result of underpricing, and not risk adjustment
Making changes to the risk adjustment system to favor new or small issuers would be unworkable and would cause existing issuers to reconsider their participation in the market”
Allstate looking to sell health benefits division “Allstate is looking to sell its health benefits division in 2024, CEO Tom Wilson told investors on a Nov. 2 quarterly earnings call.
The health benefits division is composed of group, individual and voluntary benefits offerings. It generated $2.3 billion in revenue and $240 million in adjusted net income over the last 12 months. The division has about 48,000 customers ranging from Fortune 50 companies to small businesses.”
Amazon launches One Medical for Prime “Amazon Prime members can now get healthcare for an extra $9 a month.
The tech giant launched One Medical for Prime on Nov. 8, hoping to capitalize on its nearly $4 billion acquisition of the membership-based primary care company earlier this year.
The new service offers One Medical subscriptions to Prime members at a discounted rate, giving them unlimited 24/7 virtual visits and online scheduling for same- or next-day appointments at One Medical's more than 200 brick-and-mortar clinics.”
Health Benefits In 2023: Premiums Increase With Inflation And Employer Coverage In The Wake Of Dobbs “In 2023 the average annual premium for employer-sponsored family health insurance coverage was $23,968—an increase of $1,505 (7 percent) from 2022. Both single and family premiums increased faster in 2023 than in 2022, in a period of generally high inflation throughout the US economy. On average, covered workers contributed 17 percent ($1,401) of the cost of single coverage and 29 percent ($6,575) of the cost of family coverage. When compared to employers’ perceptions of the number of primary care providers in their networks, a smaller share of employers believed that their provider networks had a sufficient number of mental health and substance abuse providers to provide timely access to services. One-quarter of employers indicated that their employees had a “high” level of concern with the level of cost sharing required by their plans. When asked about abortion coverage in the wake of the Supreme Court Dobbs decision, almost a third of large employers reported that their largest plan covered abortion in most or all circumstances.”
Cigna explores selling Medicare Advantage business: report “Discussions to sell the business are preliminary, and Cigna could decide to hold onto its MA plans, sources told Reuters. Cigna expects changes to the reimbursement model and star rating system could impact its MA performance next year.”
About hospitals and healthcare systems
New Fall 2023 Hospital Safety Grades from The Leapfrog Group Find Improved Infection Rates Following Major Spike During COVID-19 Pandemic “The latest grades show hospitals reducing health care-acquired infections (HAIs) post-pandemic, after significant increases in infection rates during the COVID-19 pandemic. This cycle, nearly 30% of hospitals earned an ‘A,’ 24% earned a ‘B,’ 39% earned a ‘C,’ 7% earned a ‘D,’ and less than 1% earned an ‘F.’”
You can check individual hospitals on the site.
Hospital cash flow, margins to surge in 2024: Moody's “Operating cash flow hit nearly -40% last year, but is projected to have double-digit growth this year. The operating cash flow growth will mean hospitals can invest in facilities and programs for the future.”
Average hospital payer mix in every state FYI
Initial Findings From an Acute Hospital Care at Home [AHCAH] Waiver Initiative “Patients who received care under AHCAH had a low mortality rate consistent with the hospital-at-home literature and minimal complications related to escalations back to the brick-and-mortar hospital.”
'Stunning' court ruling broadens hospitals' 340B use, calls HRSA's enforcement authority into question “A recent federal district court ruling against the office overseeing the 340B Drug Pricing Program has opened the doors for hospitals to more broadly claim discounts, healthcare legal experts say.
The decision in Genesis Healthcare, Inc. v. Becerra, handed down Friday by the U.S. District Court of South Carolina, establishes that ‘at least some of [the] interpretative policies surrounding the 340B definition of patient are inconsistent with the 340B statute,’ Anil Shankar, a partner at Foley & Lardner, told Fierce Healthcare.”
CMS bumps up pay increase to 3.1% in final FY24 OPPS rule “The Centers for Medicare & Medicaid Services (CMS) initially proposed a 2.8% payment increase for 2024 as part of its annual Outpatient Prospective Payment System rule, which providers slammed as subpar. In the final rule, the increase is instead set at 3.1%.
The agency said the rate is based on a projected market basket percentage increase of 3.3%, according to a fact sheet…”
2023 State of the Healthcare Consumer Report From Kaufman Hall:
“KEY FINDING #1
Among hospital system leaders, use of consumer-focused measurement is limited, and organizations over-rely on traditional transaction-focused metrics.
KEY FINDING #2
Leading healthcare systems— and more frequently companies outside of healthcare—are using consumer-focused measurement to understand key business drivers and measure ROI on consumer-focused investments.
KEY FINDING #3
There are barriers to health systems adopting consumer- focused measurement, but
the path forward is clear if organizations are committed to becoming consumer centric.”
About pharma
FDA approves new obesity drug from Eli Lilly named Zepbound If you can access this Washington Post article, it has a great review of the current weight loss drugs- including how they work.
"I've never seen anything like this": High demand fuels drug shortages Good, short article about drug shortages.
FTC Challenges More Than 100 Patents as Improperly Listed in the FDA’s Orange Book Tuesday, “the Federal Trade Commission (FTC) challenged more than 100 patents held by manufacturers of brand-name asthma inhalers, epinephrine autoinjectors, and other drug products as improperly or inaccurately listed in the Food and Drug Administration’s (FDA) publication of “Approved Drug Products with Therapeutic Equivalence Evaluations,” commonly known as the ‘Orange Book.’
The Commission has also notified FDA that it disputes the accuracy or relevance of the listed information for these patents, which may require that the manufacturers remove the listing or certify under penalty of perjury that the listings comply with applicable statutory and regulatory requirements.
The FTC sent notice letters to 10 companies, which include: AbbVie, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Impax Laboratories, Kaleo, Mylan Specialty, and subsidiaries of Glaxo-Smith Kline and Teva.”
About the public’s health
Marijuana use increases risk of heart attacks, new studies suggest “Two new studies suggest that regular use of marijuana could be linked to a higher risk of heart failure or heart attack, especially among older people.
The preliminary findings of the studies, which have yet to be published, will be presented next week at the American Heart Association’s (AHA) Scientific Sessions 2023 in Philadelphia.”
Syphilis cases in US newborns skyrocketed in 2022. Health officials suggest more testing “More than 3,700 babies were born with congenital syphilis in 2022 — 10 times more than a decade ago and a 32% increase from 2021, the Centers for Disease Control and Prevention said Tuesday. Syphilis caused 282 stillbirth and infant deaths, nearly 16 times more than the 2012 deaths.
The 2022 count was the most in more than 30 years, CDC officials said, and in more than half of the congenital syphilis cases, the mothers tested positive during pregnancy but did not get properly treated.”
Reduction of Financial Health Incentives and Changes in Physical Activity “Findings In this case-control study using a large natural experiment design with 584 760 participants, financial health incentive withdrawal after more than a year of incentive intervention led to statistically significant, but modest and not clinically meaningful, physical activity declines.
Meaning These results suggest that physical activity, once established, may be maintained with less frequent and less costly financial health incentive reinforcement.”
The Global Wellness Economy Reaches a Record $5.6 Trillion—And It’s Forecast to Hit $8.5 Trillion by 2027 “If the market was worth a record $4.9 trillion in 2019, and then shrank 11% to $4.4 trillion in the pandemic year of 2020, the research indicates that the wellness economy has seen recent, economy-defying momentum. It grew 27% since 2020 to reach $5.6 trillion, with 7 of the 11 wellness sectors now surpassing their 2019, pre-pandemic values. With consumers, the medical world, and governments now placing a much bigger value on prevention and wellness, the GWI forecasts that the wellness economy will grow at an impressive 8.6% annual pace through 2027, when the market will reach $8.5 trillion—nearly double its 2020 size.”
The article also breaks down data by sector.
Coverage with Selected Vaccines and Exemption from School Vaccine Requirements Among Children in Kindergarten — United States, 2022–23 School Year “During the 2022–23 school year, coverage remained near 93% for all reported vaccines, ranging from 92.7% for DTaP to 93.1% for measles, mumps, and rubella and polio. The exemption rate increased 0.4 percentage points to 3.0%. Exemptions increased in 41 states, exceeding 5% in 10 states.
What are the implications for public health practice?
Exemptions >5% limit the level of achievable vaccination coverage, which increases the risk for outbreaks of vaccine-preventable diseases. Vaccination before school entry or during provisional enrollment periods could reduce exemptions resulting from barriers to vaccination during the COVID-19 pandemic.”
About healthcare IT
CMS EXTENDS MEDICARE TELEHEALTH REIMBURSEMENT WAIVER THROUGH 2024. “The Centers for Medicare & Medicaid Services has included in its final CY 2024 Medicare Physician Fee Schedule (PFS) Medicare reimbursement for providers who use virtual care at home to treat patients. In addition, the provision states that providers will not be required to list their home address as a practice location.”
Studies Of Prescription Digital Therapeutics Often Lack Rigor And Inclusivity “We conducted the first retrospective cross-sectional analysis of clinical studies of twenty prescription digital therapeutics authorized by the FDA and available on the market as of November 2022. Our analysis found that just two prescription digital therapeutics had been evaluated in at least one study that was randomized and blinded and that used other rigorous standards of evidence. Two-thirds of clinical studies of prescription digital therapeutics were conducted on a postmarket basis, with less rigorous standards of evidence than the standards used in premarket studies. More than half of studies did not report data on participants’ race, and more than 80 percent did not report their ethnicity. More than one-third required English proficiency, and nearly half of nonpediatric studies had an upper age limit. These results suggest the need for a more rigorous and inclusive approach to clinical research supporting FDA-authorized prescription digital therapeutics.”
About healthcare personnel
After 50 Years, Health Professional Shortage Areas Had No Significant Impact On Mortality Or Physician Density “Since 1965, the US federal government has incentivized physicians to practice in high-need areas of the country through the designation of Health Professional Shortage Areas (HPSAs). Despite its being in place for more than half a century and directing more than a billion dollars annually, there is limited evidence of the HPSA program’s effectiveness at reducing geographic disparities in access to care and health outcomes. Using a generalized difference-in-differences design with matching, we found no statistically significant changes in mortality or physician density from 1970 to 2018 after a county-level HPSA designation. As a result, we found that 73 percent of counties designated as HPSAs remained physician shortage areas for at least ten years after their inclusion in the program. Fundamental improvements to the program’s design and incentive structure may be necessary for it to achieve its intended results.”
Nineteen Surgical Organizations Strongly Oppose CMS’ Plan to Implement the G2211 Code From The American College of Surgeons:
“The American College of Surgeons (ACS), with 18 other surgical organizations, has expressed strong opposition to the implementation of Centers for Medicare & Medicaid Services (CMS) code G2211, which would harm surgeons and, in turn, surgical patients.
In a letter today to CMS, the 19 groups expressed continued opposition to the code, which was first introduced in 2020 but has been delayed for three years. During this time, nothing has been done to fix flaws in the G2211 code or the larger problems with the Medicare physician payment system.
The G2211 add-on code is an effort by CMS to pay more for certain office visits. These additional payments would predominately help primary care physicians despite the fact that the majority of the office visit codes for this type of care were increased in 2021.”
About health technology
Surgeons in New York announce world's first eye transplant “Surgeons in New York have performed the first-ever whole-eye transplant in a human, they announced on Thursday, an accomplishment being hailed as a breakthrough even though the patient has not regained sight in the eye.
In the six months since the surgery, performed during a partial face transplant, the grafted eye has shown important signs of health, including well-functioning blood vessels and a promising-looking retina, according to the surgical team at NYU Langone Health.”
About healthcare finance
BMS snags another ADC with modest $100M Orum deal “Another day, another antibody-drug conjugate deal. This time it’s Bristol Myers Squibb snapping up Orum Therapeutics’ phase 1 blood cancer med for $100 million upfront.
Orum will also be eligible for milestone payments of $80 million if the ORM-6151 program is successful, according to a Monday press release. Further financial details of the acquisition were not disclosed.”