About Covid-19
Omicron sub-variant BA.2 makes up 72% of COVID variants in U.S. - CDC “The U.S. national public health agency said on Monday the BA.2 sub-variant of Omicron was estimated to account for nearly three of every four coronavirus variants in the country.
Overall COVID-19 cases in the United States have dropped sharply after hitting record levels in January, but a resurgence in cases in parts of Asia and Europe has raised concerns that another wave could follow in the United States. The country's health experts, however, believe it is unlikely.”
CMS rolls out free at-home COVID-19 tests for Part B, Medicare Advantage beneficiaries ”The Centers for Medicare and Medicaid Services announced Monday that beneficiaries can get up to eight at-home tests at participating pharmacy chains such as CVS, Rite Aid, Costco and Walmart and other providers, a few months after the Biden administration required private insurers to reimburse customers for tests.”
On the other hand: HRSA COVID-19 Uninsured Program Claims Submission Deadline FAQs “Any testing and treatment claims submitted in the Portal after March 22, 2022, will not be adjudicated for payment.
Any vaccine administration claims submitted in the Portal after April 5, 2022 [Midnight today], will not be adjudicated for payment.”
Obesity Prevalence Among U.S. Adults During the COVID-19 Pandemic “Relative to the 2019 to prepandemic 2020 period, significantly higher average BMI (+0.6%, p<0.05, N=3,555,865) and obesity prevalence rates (+3%, p<0.05, N=3,555,865) were observed among U.S. adults during the COVID-19 pandemic. Significantly higher rates of any exercise participation (+4.4%, p<0.01, N=3,607,272), average sleep hours in a 24-hour period (+1.5%, p<0.01, N=1,907,798), average alcoholic drink days in the past month (+2.7%, p<0.05, N=3,577,090), and lower rates of smoking at least some days (−4%, p<0.01, N=3,625,180) were also observed.
Conclusions: During the COVID-19 pandemic, U.S. adult obesity rates were higher and worsened the pre-existing epidemic of adult obesity in the U.S. Higher rates of alcohol consumption and lower smoking rates may have contributed to the higher rates of adult obesity in the U.S during the COVID-19 pandemic.”
Comment: While specific to Covid-19, these results may predict behaviors during future pandemics. Anticipation of these issues may help mitigate their effects.
Senators announce $10 billion COVID-19 deal, leave out global aid “Senators announced on Monday they had reached a deal to provide $10 billion for the fight against COVID-19, but the agreement leaves out funding for the global virus response….
he deal will be paid for by repurposing previous coronavirus funding, a red line garnering at least 10 GOP votes for the bill. Those funds include redirecting money from a shuttered venues fund, transportation aviation money, a higher education emergency relief fund and a small business administration loans program.
However, the $10 billion deal is less than half of the $22.5 billion the White House initially requested.”
Projecting COVID-19 Mortality as States Relax Nonpharmacologic Interventions “Question What is the expected trend in COVID-19 mortality if US states were to lift nonpharmacologic interventions (NPIs) at different times over the remainder of 2022?
Findings In this simulation modeling study, lifting NPIs was likely to result in rebounding epidemics regardless of the delay in lifting. The degree of population-level immunity was associated with the size of the rebounding peak in incident deaths.
Meaning This simulation study found no path to the end of the COVID-19 pandemic that avoided difficult trade-offs between prolonged NPIs and increased COVID-19 mortality following their removal.”
WHO Recommends Johnson & Johnson COVID-19 Booster Shot “The World Health Organization (WHO) has updated its Emergency Use Listing (EUL), which now includes a recommendation for the Johnson & Johnson COVID-19 vaccine booster in adults 18 years and older.”
About health insurance
With Obama looking on, White House to open ACA plans to more families “The tweak involves what is known in health-policy circles as the ACA’s “family glitch.” It involves who is eligible to buy health plans with federal subsidies through HealthCare.gov, the federal ACA insurance marketplace that opened in 2014, or similar marketplaces in states that operate their own…
The wrinkle has been that, in calculating how big a bite an employers’ health plan would take out of a worker’s income, the amount has taken into account only the premiums for an individual insurance policy — not a policy that covers a workers’ spouse or children, too….
During a briefing for reporters Monday evening to preview Biden’s announcement, senior administration officials said the Treasury Department, which handles ACA subsidies because they are in the form of a tax credit, is proposing a rewrite of the ACA’s rules so that the cost of job-based coverage for an entire family is taken into account.
Assuming the proposed tweak completes the federal regulatory process, the change would begin Jan. 1 next year…”
CMS finalizes 8.5% rate hike for Medicare Advantage, Part D plans in 2023 “The Biden administration finalized an 8.5% increase in rates to Medicare Part D and Medicare Advantage plans, slightly above the 7.98% proposed earlier this year.
The Centers for Medicare & Medicaid Services (CMS) released the final 2023 MA and Part D rate announcement on Monday and with it a 4.88% effective growth rate, slightly above the 4.75% rate released in the advance notice.”
Read the rest of the article for important background information.
UnitedHealth working to avoid class-action lawsuit from 1K independent pharmacies “UnitedHealth Group is working to avoid a major class-action lawsuit from around 1,000 independent pharmacies nationwide for alleged under-reimbursements totaling more than $100 million…
Last week, Optum Rx, UnitedHealth's pharmacy benefits manager, filed over 200 cases in California federal court to force individual arbitration instead of a joint lawsuit.
About 500 of the small pharmacies are involved in the current dispute, while the rest have filed cases in other courts.
The pharmacies claim Optum Rx under-reimbursed them and reversed payments. They also say Optum Rx occasionally considered prescriptions as brand-name when working with payers but considered the same medications as low-cost generics when reimbursing pharmacies. The disputed payments total in excess of $100 million for nearly a decade, though no pharmacy has filed any litigation yet.”
About hospitals and healthcare systems
Advocate Aurora acquires remote monitoring company “Advocate Aurora Health acquired MobileHelp, a company specializing in remote patient monitoring and personal emergency response systems…
MobileHelp's emergency response systems, which are used by more than 300,000 households, track users' locations so assistance can reach them quicker. In the future, Advocate Aurora Enterprises said it may bundle the technology with Senior Helpers, an in-home personal care services company it acquired in 2021, as doing so ‘could offer an even higher level of support to those aging independently.’”
Intermountain, SCL Health form 33-hospital system “Salt Lake City-based Intermountain Healthcare and Broomfield, Colo.-based SCL Health have completed their merger after the Colorado attorney general's office signed off on the deal March 31.
The combined system, named Intermountain Healthcare, has more than 58,000 employees and operates 33 hospitals and 385 clinics across six states. The nonprofit system also provides health insurance to about 1 million people.”
Financial Impacts And Operational Implications Of Private Equity Acquisition Of US Hospitals “We compared changes in the financial performance of 176 hospitals acquired during 2005–14 versus changes in matched control hospitals. Acquisition was associated with a $432 decrease in cost per adjusted discharge and a 1.78-percentage-point increase in operating margin. The majority of acquisitions—134 members of the Hospital Corporation of America, acquired in 2006—were associated with a $559 decrease in cost per adjusted discharge but no change in operating margin. Conversely, non-HCA hospitals exhibited a 3.27-percentage-point increase in operating margin without a concomitant change in cost per adjusted discharge. When we examined markers of hospital capacity, operational efficiency, and costs, we found that private equity acquisition was associated with decreases in total beds, ratio of outpatient to inpatient charges, and staffing (total personnel and nursing full-time equivalents and total full-time equivalents per occupied bed). Therefore, financial performance improved after acquisition, whereas patient throughput and inpatient utilization increased and staffing metrics decreased. Future research is needed to identify any unintended trade-offs with safety and quality.”
About pharma
CRISPR patent dispute not over yet as Emmanuelle Charpentier, universities appeal “Nobel Prize winner Emmanuelle Charpentier, Ph.D., and two universities have officially appealed in a dispute over certain patents for CRISPR gene editing, a long-running challenge that could have wide implications for companies working on therapeutics based on the technology.
Charpentier, the University of California, Berkeley and the University of Vienna have asked the U.S. Court of Appeals for the Federal Circuit to review a decision from the U.S. Patent and Trademark Office, which ruled in favor of the Broad Institute of MIT and Harvard.”
The Top Pharmacy Benefit Managers of 2021: The Big Get Even Bigger “We estimate that for 2021, 80% of all equivalent prescription claims were processed by three companies: CVS Health (including Caremark and Aetna), the Express Scripts business of Cigna, and the OptumRx business of UnitedHealth Group.”
Walgreens CEO: We’re Opening A New VillageMD Clinic ‘Every Three Days’ “The latest update from Walgreens CEO Roz Brewer on the company’s $6 billion investment into VillageMD revealed the opening of doctor-staffed clinics attached to drugstores is moving swiftly and ahead of Wall Street’s expectations.
Since Brewer became chief executive officer of Walgreens Boots Alliance a year ago, the iconic drugstore chain invested another $5.2 billion in VillageMD to escalate the expansion of doctor-staffed clinics across the U.S. under a new ‘Walgreens Health’ business.
The larger investment Walgreens made last year was designed to accelerate the opening of at least 600 Village Medical at Walgreens primary care practices in more than 30 U.S. markets by 2025 and 1,000 by 2027, with more than half of those practices in medically underserved communities, the company has said.
‘VillageMD has now opened 102 co-located clinics, and the rollout has accelerated to an average pace of one opening every three days for calendar year 2022,’ Brewer told analysts Thursday on the company’s fiscal second quarter earnings call.”
About the public’s health
Billions of people still breathe unhealthy air: new WHO data “Almost the entire global population (99%) breathes air that exceeds WHO air quality limits, and threatens their health. A record number of over 6000 cities in 117 countries are now monitoring air quality, but the people living in them are still breathing unhealthy levels of fine particulate matter and nitrogen dioxide, with people in low and middle-income countries suffering the highest exposures.”
Association Between Residential Proximity to Hydraulic Fracturing Sites and Adverse Birth Outcomes From the University of Calgary (Alberta has large reserves of shale oil): ” In this population-based cohort study including all reproductive-aged individuals who had a pregnancy in rural Alberta, Canada, from 2013 to 2018, those individuals living within 10 km of 100 or more hydraulically fractured wells during 1 year preconception or pregnancy had a significantly increased risk of spontaneous preterm birth and small for gestational age birth.”
CDC, under fire for covid response, announces plans to revamp agency “Centers for Disease Control and Prevention Director Rochelle Walensky announced plans Monday to revamp the agency that has come under blistering criticism for its performance leading the U.S. response to the coronavirus pandemic, saying, ‘it is time to step back and strategically position CDC to support the future of public health…’
After briefing the agency’s leadership team, Walensky sent staff the email, saying the one-month effort, set to begin April 11, would be led by Jim Macrae, associate administrator for primary health care at the Health Resources and Services Administration, or HRSA. HRSA and CDC are part of the Department of Health and Human Services.”
About healthcare IT
The harm of heart algorithms [From STAT health tech newsletter 4/5/22] “Algorithms used to estimate risk of heart problems are becoming increasingly common in cardiovascular care. But a new study of more than 100 of these tools published in Circulation found that they often performed poorly when applied to new populations…
The study is notable for two reasons. First, it is a rare attempt to calculate net benefit versus harm for algorithmic tools, and lays out a framework for applying that assessment to other products. And second, its finding that harm is likely to result from these tools runs counter to the prevailing assumption that, even if imperfect, using such algorithms to inform risk is better than nothing. The big takeaway? If these algorithms are ever to really help patients, better evaluation before deployment and monitoring afterward are both imperative.”
Medicaid:CMS Should Assess Effect of Increased Telehealth Use on Beneficiaries' Quality of Care From the GAO: “CMS does not collect, assess, or report information about any effect delivering services via telehealth has on the quality of care Medicaid beneficiaries receive and has no plans to do so. Doing so is important, given concerns GAO has raised about the quality of care provided via telehealth. It would also be consistent with how CMS has encouraged states to use data on quality of care to identify disparities in health care and target opportunities for improvement to advance health equity. These efforts could begin with data for quality measures CMS already collects or through other means.
CMS neither agreed nor disagreed with GAO's recommendations. GAO maintains it is crucial for CMS to collect and analyze information to assess telehealth's effect on the quality of care Medicaid beneficiaries receive.”
Q1 2022 digital health funding: Staying the course in choppy waters “Q1 2022 U.S. digital health funding closed with $6.0B across 183 deals, with an average deal size of $32.8M. This quarter fell significantly behind Q4 2021’s $7.3B and the trailing twelve month quarterly average of $7.1B. It’s worth noting that Q1 isn’t usually a blockbuster period for funding: at $6.7B, Q1 2021 was the smallest quarter last year for digital health dollars, and three of the past five years (2017-2021) had Q1 as their lowest funding quarter, possibly signaling a seasonality to funding dips. However, in three of the five past years, Q1’s funding beat its preceding quarter (Q4 of the prior year)—which isn’t the case this quarter.”
About health technology
Landmark study reveals 42 new genes associated with increased risk of Alzheimer’s disease “A major new international study involving UK DRI researchers has identified 75 genes associated with an increased risk of developing Alzheimer’s disease, including 42 new genes which had not previously been implicated in the condition. The study is published in the journal Nature Genetics…”
Comment: This new finding highlights the complexity of understanding the genetic basis of diseases and, hence, addressing gene-based treatments.”