About Covid-19
White House COVID czar Ashish Jha stepping down “White House COVID-19 response coordinator Ashish Jha is stepping down from his position on June 15 to return to his previous role as dean of the Brown University School of Public Health…
Jha's role will be replaced by the newly created Office of Pandemic Preparedness and Response, which currently has no leader and no staff.”
Safety Monitoring of mRNA COVID-19 Vaccine Third Doses Among Children Aged 6 Months–5 Years — United States, June 17, 2022–May 7, 2023
“What is already known about this topic?
All children aged 6 months–5 years are recommended to receive ≥1 bivalent mRNA COVID-19 vaccine dose; approximately 550,000 children in these age groups have received a third monovalent or bivalent mRNA vaccine dose.
What is added by this report?
In v-safe, 38% of children had no reported reactions after a third dose; most reported reactions were mild and transient. Vaccination errors accounted for 78% of events reported to the Vaccine Adverse Event Reporting System.
What are the implications for public health practice?
Findings after receipt of a third mRNA vaccine dose among young children were similar to those described after receipt of 1 and 2 doses; no new safety concerns were identified.”
About health insurance/insurers
CMS announces new decade-long primary care payment experiment “How it works: The Centers for Medicare and Medicaid Services envisions running Making Care Primary between July 1, 2024, and December 31, 2034.
It's designed to draw providers with little or no experience in value-based care.
Participants will receive enhanced payment and tools from CMS to coordinate care with specialists and support care integration.
CMS will test the program in Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina and Washington. Provider applications open later this summer.”
Here are more details from CMS:
MCP’s three progressive tracks are designed to recognize participants’ varying experience in value-based care—from under-resourced participants to those with existing advanced primary care experience in alternative payment models. MCP aims to give these organizations flexibility, allowing them to choose their participation track and receive payments that reflect each participant’s experience towards accountable care. Again, MCP is a three-track model with one track reserved for organizations with no prior value-based care experience.
Track 1 –Building Infrastructure: Participants will begin to develop the foundation for implementing advanced primary care services such as risk-stratifying their population, reviewing data, building out workflows, identifying staff for chronic disease management, and conducting health-related social needs screening and referral. Payment for primary care will remain fee-for-service (FFS), while CMS provides additional financial support to help participants develop care transformation infrastructure and build advanced care delivery capabilities. Participants can begin earning financial rewards for improving patient health outcomes in this track.
Track 2 – Implementing Advanced Primary Care: As participants progress to Track 2, they will build upon the Track 1 requirements by partnering with social service providers and specialists, implementing care management services, and systematically screening for behavioral health conditions. Payment for primary care will shift to a 50/50 blend of prospective, population-based payments and FFS payments. CMS will continue to provide additional financial support at a lower level than Track 1, as participants continue to build advanced care delivery capabilities. Participants will be able to earn increased financial rewards for improving patient health outcomes.
Track 3 – Optimizing Care and Partnerships: In Track 3, participants will expand upon the requirements of Tracks 1 and 2 by using quality improvement frameworks to optimize and improve workflows, address silos to improve care integration, develop social services and specialty care partnerships, and deepen connections to community resources. Payment for primary care will shift to fully prospective, population-based payment while CMS will continue to provide additional financial support, at a lower level than Track 2, to sustain care delivery activities while participants have the opportunity to earn greater financial rewards for improving patient”
Comment: Look at the payment systems. It appears that Track 1 is fee-for-service (FFS) with incentives. The exact population-based payment mechanisms for Tracks 2 and 3 are unclear. Is it capitation or a different kind of FFS? Research has shown that if providers do not have downside risk, the desired behaviors are unlikely to occur. Further, if ACOs are any indication, providers are reluctant to assume risk, in this case, it might mean going into Step 3. Additionally, the country has a shortage of primary care physicians (PCPs), particularly if you remove hospitalists (many of whom are internists and pediatricians) from the equation. Finally, a 5 or 10% increase for primary care physicians does not put them anywhere near the ballpark of procedural or imaging practitioners, e.g., surgeons and radiologists, respectively. In other words, it will not provide enough of an incentive to recruit PCPs from medical school.
So…is this program “old wine in new bottles?” let’s wait to see how it plays out.
The Facts About Medicare Spending A must read from the KFF.
Supreme Court upholds right to sue public nursing homes The Supreme Court upheld an individual right to sue public nursing homes for violated rights protected under a federal law that sets standards for these institutions.
The court affirmed an appeals court ruling in a 7-2 decision that found a private individual can sue for rights protected by the Federal Nursing Home Reform Act through Section 1983 of the federal code, which allows someone to sue for their federal civil rights.”
About hospitals and healthcare systems
Top 100 critical access hospitals, state by state FYI.
About pharma
FDA panel unanimously endorses Leqembi for full approval “An FDA advisory panel has voted 6-0 in favour of recommending that Eisai and Biogen's Alzheimer's drug Leqembi be granted full approval. The drug secured accelerated approval back in January based on Phase II results indicating that it helped reduce amyloid plaques in the brain, with the committee meeting on Friday to discuss whether that should be converted to a traditional nod in light of the Phase III Clarity AD trial, which showed that it slowed cognitive decline in early Alzheimer's patients by 27% versus placebo.”
Comment: Now comes the real controversy—figuring out how to pay for it.
About the public’s health
F.D.A. Panel Recommends R.S.V. Shot to Protect Infants “A Food and Drug Administration advisory panel recommended approval of a monoclonal antibody shot aimed at preventing a potentially lethal pathogen, respiratory syncytial virus, or R.S.V., in infants and vulnerable toddlers…
The 21-member panel voted unanimously in favor of giving the treatment to infants born during or entering their first R.S.V. season. The advisers voted 19-2 for giving the shot to children up to 24 months of age who remain vulnerable to severe disease.”
The 2023 nonhormone therapy position statement of The North American Menopause Society “Evidence-based review of the literature resulted in several nonhormone options for the treatment of vasomotor symptoms. Recommended: Cognitive-behavioral therapy, clinical hypnosis, selective serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors, gabapentin, fezolinetant (Level I); oxybutynin (Levels I-II); weight loss, stellate ganglion block (Levels II-III). Not recommended: Paced respiration (Level I); supplements/herbal remedies (Levels I-II); cooling techniques, avoiding triggers, exercise, yoga, mindfulness-based intervention, relaxation, suvorexant, soy foods and soy extracts, soy metabolite equol, cannabinoids, acupuncture, calibration of neural oscillations (Level II); chiropractic interventions, clonidine; (Levels I-III); dietary modification and pregabalin (Level III).”
HHS Releases First-Ever STI Federal Implementation Plan Thursday, “the U.S. Department of Health and Human Services (HHS) released the STI Federal Implementation Plan to detail how various agencies and departments across the federal government are taking a comprehensive approach to making meaningful and substantive progress in improving public health…
The STI Federal Implementation Plan highlights more than 200 actions that federal stakeholders will take to achieve its five goals:
Goal 1: Prevent New STIs
Goal 2: Improve the Health of People by Reducing Adverse Outcomes of STIs
Goal 3: Accelerate Progress in STI Research, Technology, and Innovation
Goal 4: Reduce STI-Related Health Disparities and Health Inequities
Goal 5: Achieve Integrated, Coordinated Efforts That Address the STI Epidemic”
PEPFAR at 20—Looking Back and Looking Ahead “In his State of the Union Address on January 28, 2003, President Bush announced the creation of the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—with $15 billion provided over a 5-year plan to combat AIDS in the countries with the greatest disease burden…
By any global health metric, PEPFAR has surpassed every milestone imagined. More than 25 million lives have been saved, 5.5 million infants have been born HIV-free, and today more than 75% of the 38.4 million people living with HIV/AIDS globally are taking ART. Wide-scale treatment has also meant that annual transmission rates have dropped by 52% since 2010, largely attributable to durable viral suppression preventing onward transmission, demonstrating the impact of treatment as prevention.”
Read the article to understand where the program goes from here.