Today's News and Commentary

About the public’s health

First death reported from vaping-related lung illness, officials say: The previously reported respiratory illness associated with vaping has claimed its first life.

Human Papillomavirus–Attributable Cancers — United States, 2012–2016: This report from the CDC was published today. Despite the data’s age it has some good news: 92% of HPV-related cancers were attributable to the types targeted by the 9-valent HPV vaccine. With more widespread use, the incidence of these cancers should be dramatically reduced over time.

Effectiveness of polypill for primary and secondary prevention of cardiovascular diseases (PolyIran): a pragmatic, cluster-randomised trial: This Iranian study published in the Lancet appeared in many media outlets today. It showed effectiveness of a 4 drug “poly pill” (aspirin, atorvastatin, hydrochlorothiazide, and either enalapril or valsartan) used for primary and secondary prevention of cardiovascular disease. Since all those components are available in cheap generic versions, the authors recommend such pill be should be considered in low or middle income countries.

More than Twice as Many Employers than 10 Years Ago are Planning to Increase Investments in Employee Health and Wellness, Optum Study Shows: The headline speaks for itself. With a tight labor market, this strategy makes sense, provided the right programs are implemented correctly. Such data-driven programs should be a good business opportunity.

Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2019–20 Influenza Season: Today the CDC released its 2019-2020 recommendations for flu vaccines. Recommendations for who should receive the vaccine are basically the same: “ Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. Recommendations regarding timing of vaccination, considerations for specific populations, the use of specific vaccines, and contraindications and precautions are summarized” in the article.

Fitbit to Work With Singapore to Promote Public Health: Singapore is a very health-conscious country. Also, its people heavily rely on government-sponsored social welfare programs. Could a joint venture like this one work in this country?

Feds to revamp confidentiality rules for addiction treatment: Despite usual confidentiality rules mandated by HIPAA (see Chapter 9 of the text), behavioral health records are held to a higher standard. While securing very sensitive information, this protection has hampered information sharing among professionals and institutions who treat those affected by the opioid crisis. “Federal health officials proposed Thursday to revamp stringent patient confidentiality regulations from the 1970s to encourage coordination among medical professionals treating people caught in the nation’s opioid epidemic.

Health and Human Services Secretary Alex Azar said the goal is to make it easier to share a patient’s drug treatment history with doctors treating that person for other problems. That can stave off serious — even fatal — errors, like unwittingly prescribing opioid painkillers to a surgical patient with a history of dependence. A patient’s consent would still be required.”

About pharma

China vows to maintain stable drug prices: Which one of these measures (if any) could we implement in this country to stabilize or lower drug prices?

EMA/FDA analysis shows high degree of alignment in marketing application decisions between EU and US: Since the FDA does not have the resources to police drug approvals and manufacturing worldwide, it has made agreements with other entities to act on its behalf. This study looked at the “alignment in marketing application decisions between” the FDA and the EMA (the counterpart for the EU). The two agencies agreed on more than 90% of marketing authorization decisions for new medicines. ”The most common reason for diverging decisions at the two agencies were differences in conclusions about efficacy. Differences in clinical data submitted in support of an application were the second most common root of divergent FDA and EMA decisions.”

Has the FDA been approving some drugs without proper evidence?: This article is a nicely balanced presentation of the FDA’s conflicting missions of quick drug approvals to aid the health of the population versus its responsibility to make sure those products are safe and effective.

About health insurance

Did the Affordable Care Act Reduce Racial and Ethnic Disparities in Health Insurance Coverage?: This just-released research from the Commonwealth Fund found that: “All racial and ethnic groups saw gains in health coverage between 2013 and 2016, but these gains were especially pronounced for minority groups and individuals with incomes below 139 percent of the federal poverty level. In 2017, gains for minority groups generally flattened. The ACA’s disparity-reducing effects have been strongest in states participating in the Medicaid expansion.”

Hospital revisits within 30 days after discharge for medical conditions targeted by the Hospital Readmissions Reduction Program in the United States: national retrospective analysis: “In the United States, total hospital revisits within 30 days of discharge for conditions targeted by the HRRP [Hospital Readmissions Reduction Program] increased across the study period. This increase was due to a rise in post-discharge emergency department visits and observation stays, which exceeded the decline in readmissions.{Emphasis added] Although reductions in readmissions have been attributed to improvements in discharge planning and care transitions, our findings suggest that these declines could instead be because hospitals and clinicians have intensified efforts to treat patients who return to a hospital within 30 days of discharge in emergency departments and as observation stays.” This research shows the importance of measuring total episodes of care, not just their components.

Calif. surprise medical bill law boosts number of in-network docs: The results of a study on California health plans (excluding Kaiser and plans with fewer than 10,000 members) showed that after California passed its 2016 law limiting surprise medical bills, the number of in-network specialty doctors either remained flat, or increased by as much as 26 percent (depending on specialty). Overall there was a 16% increase in in-network participation.

Health Insurers Set to Expand Offerings Under the ACA:[Wall Street Journal- subscription may be required]: While the article starts with the good news that Oscar, Cigna and Centene plan ACA expansions, at the end it mentions that “UnitedHealth Group Inc. said it expects to be in the same three ACA markets next year as this year. CVS Health Corp. ’s Aetna and Humana Inc. both said they have no plans to offer ACA products in 2020.”

Some major exchange insurers post lower star ratings (Modern Healthcare- may require subscription): Speaking of expanding plans…About 64% of 195 ACA plans received an overall quality rating of four or five stars, and across all plans, the average rating was 3.8 stars. Kaiser scored 4.8 stars while Centene, Corp., which has the highest enrollment at 1.9 million received 3.3 stars. Cigna rated 3.3 stars and Molina Healthcare received 2.7 stars.

About healthcare IT

Telehealth is here to stay, so why won’t employees sign up?: While almost 75% of major employers offered some type of telehealth benefit in 2018, “the average employee sign-up rate for large employers who offered telehealth services either through their health plan or a specialty vendor was only 8% in 2017…[and] only 9.6% of Americans have used telehealth services of all types, including those provided by employers.” Three reasons for these low enrollments and usage, according to Stephany Verstraete, chief marketing officer at Teladoc Health, are:
“First, many times employees don’t know they have the benefit. Second, employees don’t remember they have the benefit at the moment they need it. Third is the notion of behavior change. Employees are hesitant at first, asking themselves is this quality care?”
The implication is that educational programs addressing these barriers should increase usage.

Beyond Compliance: Cyber Threats and Healthcare: This short monograph is a really good overview of cyberthreats with many specific examples.