About pharma
Walgreens to Scale Back In-Store Clinics (Wall Street Journal- subscription may be required): Normally stories about pharmacies deal with medications or retail products. Lately, stores have been getting into the” healthcare business,” continuing to expand walk-in clinics and offering wellness services. For the first time, we are seeing some retrenchment. Walgreens announced that “it will close the roughly 160 in-store health clinics the company runs itself in the U.S., while keeping 220 clinics that are run by local health systems. It didn’t provide an estimate for the financial impact.” The article further notes: CVS and Walgreens “are taking different approaches. Walgreens has increasingly sought partnerships with other companies and health systems, while CVS is executing its plan through acquisitions or by building its own new business.
Walgreens’s roughly 400 walk-in clinics and CVS’s 1,000 Minute Clinic locations have at best barely broken even for the companies. The goal now for both is to shift away from treating minor or acute issues and focus instead on people with chronic conditions such as diabetes, heart disease and hypertension.”
Is it really a good idea to go to a walking clinic at a pharmacy and give it responsibility for chronic care?
An inside look at Walmart's new health clinic: This article provides an update on what Walmart is doing with its clinics.
Revenues and Profits From Medicare Patients in Hospitals Participating in the 340B Drug Discount Program, 2013-2016: This article is a useful read for policy makers as well as those in pharma. As the government contemplates reducing this program, it is important to understand the impact it has on hospitals serving this select population. “Estimated profits that hospitals derived from administering 340B-discounted drugs to Medicare patients are small compared with operating budgets yet substantial compared with uncompensated care costs for many hospitals. Revenue and profit estimates from 340B-discounted drugs represent a lower bound because data on revenue from the sale of outpatient retail dispensed drugs by hospital contract pharmacies and commercial insurer claims are not available.” For details about the 340B program see Chapter 6 (Payers) in the text.
Merck siphons off Gardasil CDC supplies again as global sales surge: “Merck & Co. won’t be able to fully meet global demand for HPV vaccine Gardasil until after 2023 when it completes production of a couple of manufacturing plants. So for now, the drugmaker is again turning to the CDC to borrow doses..to help cover vaccinations in the U.S., which will allow Merck to produce more for other parts of the world where demand is outrunning supply. The move will cost Merck about $120 million in Q4 sales, it said.” This article highlights how much pharma is an interdependent, global business.
Drug Shortages: Root Causes and Potential Solutions: This FDA report” identifies three root causes for drug shortages:
Lack of incentives for manufacturers to produce less profitable drugs;
The market does not recognize and reward manufacturers for ‘mature quality systems’ that focus on continuous improvement and early detection of supply chain issues; and
Logistical and regulatory challenges make it difficult for the market to recover from a disruption.
The report also recommends enduring solutions to address drug shortages. These solutions include:
Creating a shared understanding of the impact of drug shortages on patients and the contracting practices that may contribute to shortages;
Developing a rating system to incentivize drug manufacturers to invest in quality management maturity for their facilities; and
Promoting sustainable private sector contracts (e.g., with payers, purchasers, and group purchasing organizations) to make sure there is a reliable supply of medically important drugs.”
About health insurance
New federal rules to allow employers to '401(k)-ize' health benefits: “A change to the Internal Revenue Service code, set to take effect Jan. 1, allows employers to stop providing insurance for employees -- and instead pay workers pretax funds [through health reimbursement arrangements, or HRAs] to buy coverage themselves.” This change in the tax code is extremely important and could change the way many employers fund health insurance. It could be the first step to defined contribution plans, which employers talked about for years but never implemented. However, this method would not help employees working for large corporations , who get the benefit of their employer’s negotiating power.
Verily, John Hancock collaborating on life insurance solution that offers virtual diabetes management: This article is actually about a life insurance company. “John Hancock is teaming up with Verily Life Sciences to offer a life insurance solution and digital wellness program to help people with diabetes manage and improve their condition.
The new product, John Hancock Aspire, is a unique collaboration between the Boston-based life insurer and Verily, the healthcare division of Google parent company Alphabet, and will leverage the capabilities of Onduo, a virtual diabetes clinic….Plan members have the potential to save up to 25% on their premiums, according to the company.”
Like other such efforts, will results be coordinated with a primary care physician?
CMS wants prior authorization for non-emergency ambulances nationwide: “The CMS wants to expand prior authorization for non-emergency ambulance transportation nationwide and on Friday requested ambulance services for information that could help achieve that goal…The agency would freeze payments for review and approval if the ambulance supplier doesn't submit a prior authorization request after four round trips during a 30-day period.” Ambulance services have been a particular source of fraud and abuse for Medicare. I remember speaking at a CMS conference on fraud and abuse and hearing a panelist comment about a company that billed 1 million miles for a particular vehicle. The announcement is groundbreaking for CMS because the program is a volume-driven utilization process that the agency generally does not have.
With health care costs projected to rise another 5% in 2020, employers look to new strategies to control costs: This press release from Willis Towers Watson summarizes approaches employers are taking to reduce their healthcare costs. “Curbing the cost of health care and increasing its affordability remain the top priorities for almost all employers over the next three years (93%), according to the 24th annual Best Practices in Health Care Employer Survey… Yet nearly two in three (63%) employers see health care affordability as the most difficult challenge to tackle over that same period.” The entire report does not seem to be out yet, but this annual piece is always worth reading.
Premiums and Employee Contributions to Employer-Sponsored Health Insurance by Workforce Gender and Firm Size, Private Industry, 2018: This report from AHRQ shows how firms with a high percentage (>75%) of women have higher premiums than those companies with a low percentages (<25%) of women. The ACA was supposed to erase gender differences.
The Number of Uninsured Children is on the Rise: The key findings from this Georgetown study are:
The number of uninsured children in the United States increased by more than 400,000 between 2016 and 2018 bringing the total to over 4 million uninsured children in the nation.[The most since the ACA became law]
These coverage losses are widespread with 15 states showing statistically significant increases in the number and/or rate of uninsured children
Loss of coverage is most pronounced for white children and Latino children (some of which may fall into both categories), young children under age 6, and children in low- and moderate- income families who earn between 138 percent and 250 percent of poverty.
States that have not expanded Medicaid to parents and other adults under the Affordable Care Act have seen increases in their rate of uninsured children three times as large as states that have.
Several of the reasons cited include: confusion about Republican attempt to repel the ACA; elimination of the individual mandate penalty; delay in funding the Children’s Health Insurance Program (CHIP); cuts in outreach and enrollment funding; and shortening of the open enrollment period.
Medical billing is a nightmare, but start-up Ooda is working to make it way easier, and some insurers are optimistic: This program is the first innovation in insurance in decades. “Here’s how it works: Once a patient gets seen by a health provider, the claim gets submitted to the insurance company, which adjudicates it and issues a payment to the hospital or clinic for the insurance portion of the bill. From there, Ooda quickly pays the provider [such as doctors and hospitals] for the patient’s portion of the bill, and Ooda and the insurer jointly manage what the patient owes…
So why would insurers take on the liability when it wasn’t previously their problem? Blue Shield of Arizona’s CEO Pam Kehaly says this was a “worry item” for her. But she’s willing to test it because the financial exposure for her plan is offset by the improvement in experience for members. And it will potentially mean fewer member grievances, and therefore lower costs to staff call centers.”
The business model for Ooda’s carrying the risk of non payment is not clear.
Health Care Service Corporation Aims to Decrease Number of Uninsured Americans Through Be Covered Campaign: “Health Care Service Corporation (HCSC) announced today a multi-state education and outreach campaign aimed at decreasing the number of uninsured and underinsured Americans. Be Covered is a community-based education effort to help people understand the benefits of insurance, identify their options and empower them to make informed, sound health care decisions for themselves and their families.
The campaign focuses on Illinois, Montana, New Mexico, Oklahoma, and Texas, [states where HCSC operates] where nearly 7 million people are uninsured, yet more than 60% qualify for Medicaid or are eligible for a federal insurance subsidy .”
About the public’s health
Johnson & Johnson shares rise after it says no signs of asbestos found in baby powder after testing: After pulling 33,000 bottles of baby powder earlier this month because of FDA findings of asbestos contamination, J&J contracted with two independent labs which found the powder to be free of the contaminant. Undoubtedly, the previously reported lawsuits will continue.
Federal judge temporarily blocks Alabama's near-total abortion ban: The headline speaks for itself. Judge Thompson wrote that “the Alabama law ‘contravenes clear Supreme Court precedent’ and ‘defies the United States Constitution…It violates the right of an individual to privacy, to make 'choices central to personal dignity and autonomy.' " Despite unanimous federal court decisions against stricter abortion laws, these cases are undoubtedly headed to the Supreme Court.
About healthcare IT
Google parent company Alphabet eyeing acquisition of Fitbit, according to media reports: The headline explains a Google strategy to gather health data and tie in customers.
Facebook takes a first step into personal digital health with checkup reminder and screening tool: The reminders are not linked to medical records but are recommendations from major medical/healthcare organizations, such as the American Cancer Society, the American College of Cardiology, the American Heart Association and the Centers for Disease Control and Prevention (CDC).
Uber app to integrate directly into Cerner’s EHR so providers can schedule transportation for patients: The headline speaks for itself. Wonder how Lyft is reacting?
About healthcare quality and safety
Geographical Variation in Outcomes of Primary Hip and Knee Replacement: Volume-quality relationships are well known. Not so well investigated is whether the volume is associated with the doctor, facility (hospital) or both for a given treatment. In this English study, for these procedures it seems to be the experience of both that matters. Also private hospitals in that country had higher quality.
CMS: More hospitals will get value-based purchasing program payment bonuses in FY2020: "The value-based purchasing program adjusts Medicare payments to participating hospitals based on a series of healthcare outcomes that include cost efficiency, patient safety, mortality data and healthcare-associated infections.” According to CMS, “ 55%—more than 1,500 hospitals out of approximately 2,700 facilities participating in the program—got a slightly higher Medicare payment under the program. Overall there will be $1.9 billion in incentive payments for hospitals in federal fiscal year 2020, which runs from Oct. 1 until Sept. 30, the same amount as fiscal 2019.”
Minority heart failure patients may get less access to specialized ICUs: Inequalities persist in cardiac care: ”researchers found that compared to white patients, similarly-sick black patients were 9% less likely to be admitted to cardiac care units and Latinx patients were 17% less likely… women were 9% less likely than men and patients over age 75 were 15% less likely than younger patients to be admitted to cardiac units.” These difference result in poorer outcomes. For example, after “accounting for factors such as age, gender, heart failure features and chronic illnesses, the researchers found that black patients who were admitted to the general medicine service had a higher rate of death within 30 days than those who were admitted to the cardiology unit (3% versus less than 1%).”
About healthcare technology
Cleveland Clinic picks top 10 medical innovations for 2020: Each year Cleveland Clinic picks 10 top medical innovations for the following year. Can you come up with your list?