About pharma
The top 15 pharma companies by 2018 revenue: For those of you into lists, here is one of the top 15 pharma companies by revenue.
NIH to undertake first in-human trial of universal influenza vaccine: The National Institute of Allergy and Infectious Diseases announced it is starting human trials of a universal flu vaccine. If successful, it would not need to change each year in anticipation of a prevalent strain. The question remains: who will manufacture, sell and profit from it?
About the public’s health
Chicago health tech incubator’s products reach 92 million patients: This article is an update on Matter, the Chicago health tech incubator. It has had great success identifying important healthcare problems and nurturing startup companies to solve them. [Disclosure: I have lectured there and advised several of the companies.]
National Hospital Ambulatory Medical Care Survey: 2016 Emergency Department Summary Tables: The CDC just released this study (even though it is for 2016). It has a wealth of data including who went to the ED (age, sex, race, geography), when they went (time of day and season), how they got there, how long they waited, what their diagnoses and acuity of illness were, whether they were admitted, and what their insurance was. Overall, the number of visits was significantly increased from the previous year; Medicaid was the most common insurance; blacks had by far the highest utilization; stomach pain was the most common diagnosis, and 70% of patients are seen in an hour or less. Lots to think about with respect to lowering these numbers.
About health insurance
The Implications of “Medicare for All” for US Hospitals: As previously reported, the definition of this proposal varies across its diverse proponents. Nevertheless, expanding Medicare will have serious repercussions on the entire healthcare system.
In order to make up for lower Medicare rates, hospitals rely on their ability to charge higher amounts to private payers (“cost shifting”). This article quantifies how much hospitals will lose if they cannot cost shift: “Given the relative proportion of patients with each type of insurance, the estimated net effect on hospitals would be a 15.9% decline in revenue, equal to a loss of $151 billion nationally incurred by 5262 US community hospitals.”
Medicare for All Might Require Student Debt Relief to Work: On the same theme as the above article, this one discusses the implication of Medicare for All on physician payments. Much of the article is about how payments are a lot higher in this country than in all others. It does not address the fact that physician behavior is behind overall higher costs- not just their incomes. Reducing charges alone will not solve our cost problems.
CMS Finalizes Expanded Medicare Advantage Telehealth Coverage: Currently, telemedicine services are an add-on option for Medicare Advantage plans. Starting next year, CMS will start paying for them as a core benefit. This action is significant and may give a real boost to this communication sector.
Centene and Washington University collaborate to advance personalized medicine research: In a continuing trend of public-private collaborations in population health, insurer Centene has agreed to fund up to $100 million over 10 years for research at Washington University. The studies will focus on personalized medicine approaches to Alzheimer's disease, breast cancer, diabetes and obesity.
Medicare Part D wasn’t built for costly specialty drugs. MedPAC wants to change that: Part D is the child of the Medicare Modernization Act of 2003. At that time, specialty pharmaceuticals were not as important to overall costs as they are today. In fact, they account for a large majority of the rising pharma costs. Policy makers thought this problem would be mitigated by the emergence of generic forms of these expensive drugs (so-called biosimilars). But their introduction has not lived up to expectations. MedPAC is therefore considering changing recommendations to update the structure of Part D to address these rapidly rising costs.
U.S. judge expecting CVS merger hearing for May: It’s not over until it’s over. Although the CVS-Aetna deal closed in November, Judge Richard Leon of the U.S. District Court for the District of Columbia has taken the unprecedented step of agreeing to hear arguments from those who still oppose the deal, including the American Medical Association. While the justice department cleared the purchase, the judge is unsure of its antitrust implications.
Medicaid expansion tied to fewer heart-related deaths, study finds: The title is self-explanatory but has implications if proposals to cut Medicaid go forward.
Concerns Regarding the Proposed Rule to Restrict Drug Manufacturer Rebates in Medicare Part D and Medicaid MCOs: This analysis by Matrix Global Advisors reviews the evidence on what would happen if Medicare Part D restricts (or eliminates) drug rebates. There is a nice illustration of the value/cost chain on page 2 and summaries by various authorities/agencies that speak against the proposal as cost increasing. From a patient perspective, the argument is that insurers count on the rebates to subsidize costs; if the rebates are decreased, premiums will go up. This paper is worth reading for the thought process it forces on the careful reader.
Plan to End Drug Rebates Adds Protections for Insurers: Continuing the above theme, the Trump administration is proposing to “offer a risk-sharing system” for insurers if Part D drug rebate losses would cause the companies to increase their premiums. So who pays the federal government to pay the insurance companies?
Medtronic, Blue Cross sign glucose monitor deal linked to patient outcomes: This deal is another example of value-based products. The agreement requires Medtronic to pay rebates to Blue Cross of Minnesota if members with diabetes who use Medtronic's Guardian Connect device fail to keep their blood sugar levels within a targeted range for a specific period of time. Patients who use the device and participate in the Medtronic user-engagement program called the Inner Circle can earn up to $300 a year to offset the cost of the monitor and sensors.
Walmart, Other Employers Get Choosier About Workers’ Doctors: Usually insurance companies are the ones imposing narrow provider networks. This interesting article explains how and why employers are now doing the same for their employees.
About healthcare IT
CTA Brings Together Tech Giants, Trade Associations to Improve Efficiencies in AI and Health Care: More than 30 organizations, including Google and IBM, have joined the Consumer Technology Association to “examine and advance the impact of AI in health care by providing standards and recommend best practices to enhance the application of the technology.”
Apple envisions devices that can 'smell' blood sugar, toxic gases: A quick read but fascinating. So much father along than “Star Trek” technology.
Telemedicine tied to more antibiotics for kids, study finds: There is something still to be said for having a primary care doctor. Bottom line: “Children received prescriptions for antibiotics more than half the time during telemedicine visits, compared with 42% at urgent care clinics and 31% at doctors’ offices.”