Dr. Paul M. Ellwood Jr., Architect of the H.M.O., Is Dead at 95 “Pioneer” is an oft overused term; but it certainly fit Dr. Ellwood.
About Covid-19
Ventilation is crucial, but until recently it took a backseat to other covid measures A great review of this subject.
About health insurance
UnitedHealth unit to pick up UK health tech company EMIS for $1.5B “EMIS provides healthcare software, information technology and other services in the U.K., with a focus on primary care and pharmacy systems.
Optum's U.K. business has worked in the country for 20 years supporting the state-run National Health Service (NHS), according to an announcement.”
Texas Supreme Court denies $3M premium tax refund to BCBS “The Texas Supreme Court ruled 5-4 on June 17 that Blue Cross Blue Shield of Texas cannot receive a $3 million tax refund from its stop-loss policies that reimburse self-insured employers because they are a form of health insurance, according to Law360.
In previous court rulings in favor of BCBS, the payer had argued that its stop-loss policies only covered employers and not individuals or groups, so therefore, the premiums were not taxable.
Texas' highest court, however, ruled that because the policies do cover more than individual and aggregate claims, the reimbursements are linked to care claims.”
3 in 10 U.S. workers struggling financially, WTW survey finds “Three in 10 U.S. workers (30%) are struggling financially, and more than two in five workers (43%) are having difficulty meeting basic needs, according to research from the 2022 Global Benefits Attitudes Survey by WTW…
Employee financial wellbeing has been deteriorating since the start of the pandemic. According to the survey, more employees are living paycheck to paycheck — 41% this year versus 38% in 2019. Among workers earning $100,000 or more, the number of employees living paycheck to paycheck doubled from 18% in 2019 to 36% this year. Over half of workers earning less than $50,000 (52%), single parents (53%), and those in poor or fair health (57%) are also living paycheck to paycheck. Additionally, employees living paycheck to paycheck are almost twice as likely to leave their employer for a 5% raise (48%) compared with those not living paycheck to paycheck (29%). The survey of more than 9,600 U.S. workers was conducted during December 2021 and January 2022.”
Justices validate denial of insurance coverage for outpatient dialysis “The case involved a coordination-of-benefits statute, which allocates the costs of medical care between private health plans and Medicare. In this particular case, the statute obligates private insurers to cover the costs of dialysis for the first 30 months after a patient is diagnosed with end-stage renal disease. Recognizing that insurers might try to force those (expensive) customers off their private plan and into the publicly funded Medicare system, Congress prohibited insurers from discriminating against patients with end-stage renal disease. Specifically, the statute provides that a plan ‘may not differentiate in the benefits it provides between individuals having end stage renal disease and other individuals covered by such plan.’
Marietta had the bright idea that it could solve this problem by providing unusually low reimbursement rates for outpatient dialysis. This is an effective way to lower the costs of customers with end-stage renal disease because about 99.5% of the patients that receive outpatient dialysis have end-stage renal disease. DaVita (one of the two largest dialysis providers in the United States) objected, arguing that discriminating against patients who receive outpatient dialysis is the same thing as discriminating against patients with end-stage renal disease. The lower courts agreed, but the Supreme Court rejected that argument by a 7-2 vote.”
Potential Medicare Part D Savings on Generic Drugs From the Mark Cuban Cost Plus Drug Company “In January 2022, the Mark Cuban Cost Plus Drug Company (MCCPDC) launched an online pharmacy selling more than 100 generic prescription drugs at the cost of ingredients and manufacturing plus 15% margin, $3 pharmacy dispensing fee, and $5 shipping fee. In some cases, these prices are lower than those paid by insurers, including Medicare…
In this cross-sectional study, Medicare could have conservatively saved up to $3.6 billion in 2020 by purchasing 77 generic drugs at MCCPDC prices… Our study was limited to the generic drugs sold by MCCPDC, which represent 25% of the approximately $38 billion in Medicare Part D generic drug spending in 2020.”
About hospitals and healthcare systems
Outstanding Patient Experience Award Just-released data by state from Healthgrades.
About the public’s health
Biden administration is expected to move to cut nicotine in cigarettes “The Biden administration is expected as soon as Tuesday to announce it intends to issue a rule requiring tobacco companies to reduce nicotine levels in cigarettes sold in the United States to minimally or nonaddictive levels, according to an individual familiar with the situation…
The decision to pursue a policy to lower nicotine levels marks the first step in a lengthy process, and success is not assured. It could take at least a year for the Food and Drug Administration, which regulates cigarettes, to issue a proposed rule, experts say. After that, the FDA would have to sift through comments from the public before issuing a final rule.”
Vitamin, Mineral, and Multivitamin Supplementation to Prevent Cardiovascular Disease and CancerUS Preventive Services Task Force Recommendation Statement “Recommendation The USPSTF recommends against the use of beta carotene or vitamin E supplements for the prevention of cardiovascular disease or cancer. (D recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the use of multivitamin supplements for the prevention of cardiovascular disease or cancer. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the use of single- or paired-nutrient supplements (other than beta carotene and vitamin E) for the prevention of cardiovascular disease or cancer. (I statement)”
Also of interest is an accompanying editorial: Multivitamins and Supplements—Benign Prevention or Potentially Harmful Distraction? One conclusion: “For multivitamins, proving the absence of a benefit is challenging and an I statement (ie, “insufficient” evidence) is not a recommendation for or against use. However, at best, current evidence suggests that any potential benefits of a multivitamin on reducing mortality are likely to be small. For example, for a healthy 65-year-old woman, who has a 9-year estimated mortality risk of about 8.0%, taking a multivitamin for 5 to 10 years might reduce estimated mortality risk to 7.5% (based on an odds ratio of 0.94).”
About healthcare IT
Mayo Clinic, K Health team up to use AI for personalized hypertension treatment “…K Health developed a personalized hypertension treatment algorithm that uses de-identified data from the Mayo Clinic to help reduce the time between diagnosis and treatment. The data points include demographics, medical history, lab results, medications prescribed and outcomes.
The company worked with the Mayo Clinic’s digital healthcare initiative, Mayo Clinic Platform. The two organizations began working on the project in November 2020.”
A reimbursement framework for artificial intelligence in healthcare A really good review of the issues that determine payment for AI services.
Texas Tech Health Science Center's vendor breach affects 1.2 million patients “In December 2021, Eye Care Leaders learned that an unauthorized user had access to its myCare Integrity system, which contained patient files.
On April 22, Eye Care Leaders informed Texas Tech University Health Science Center that some of the information obtained from their breach contained their patients' protected health information such as names, addresses, phone numbers, driver's license numbers, email, dates of birth, medical record numbers, health insurance information, Social Security numbers.”
Wearable Medical Device Market to Hit USD 132.5 billion by 2031| AI and 5G to Bolster Growth Potentials, Growth Plus Reports “Based on device type, the wearable medical device market has been segmented into: Monitoring & Diagnostic Devices and Therapeutic Devices…
Some of the prominent players operating in the global wearable medical device market includes:-
Koninklijke Philips N.V
Apple Inc
Fitbit, Inc
Omron Healthcare, Inc
Medtronic
Garmin Ltd
GE Healthcare
Sotera Wireless, Inc
BioTelemetry, Inc
Dexcom, Inc.”
About health technology
FDA Designates Anumana’s Pulmonary Hypertension Software a Breakthrough Device “The Pulmonary Hypertension (PH) Early Detection Algorithm is a screening tool that offers early diagnosis of patients with pulmonary hypertension, which can often go unnoticed until the disease has advanced. The company developed the algorithm in collaboration with Johnson & Johnson subsidiary Janssen and the Mayo Clinic.
The software analyses data from 12-lead ECGs in primary care, urgent care and emergency room settings. It uses an AI software platform developed by Anumana’s parent company, nference, which contains more than 6 million de-identified patient records.”