About Covid-19
Senate Seeks Covid Origins Information Declassification “The Senate voted unanimously Wednesday night to require Director of National Intelligence Avril Haines to declassify information on the origin of Covid-19.
The bill (S. 619), which was passed without objection or a roll-call vote, could put pressure on the Biden administration to voluntarily declassify.”
US public investment in development of mRNA covid-19 vaccines: retrospective cohort study "The US government invested at least $31.9bn to develop, produce, and purchase mRNA covid-19 vaccines, including sizeable investments in the three decades before the pandemic through March 2022.”
Read the article for the sources and timing of funds that account for the total.
Biden pushes for $1.6B funding for pandemic fraud measures “President Joe Biden’s administration is asking Congress to approve more than $1.6 billion to help clean up the mess of fraud against the massive government coronavirus pandemic relief programs.
In a strategy announced Thursday, the administration called for money and more time to prosecute cases, to put into place new ways to prevent identity theft and to help people whose identities were stolen.”
Pfizer and BioNTech Submit for U.S. Emergency Use Authorization of Omicron BA.4/BA.5-Adapted Bivalent COVID-19 Booster in Children Under 5 Years “The Omicron BA.4/BA.5-adapted bivalent vaccine is currently authorized as the third dose of the three-dose primary series for children in this age group. Authorization of a booster dose would give families the option to further protect their young children against more recently circulating Omicron sublineages.”
About health insurance/insurers
After People on Medicaid Die, Some States Aggressively Seek Repayment From Their Estates “Federal law requires all states to have ‘estate recovery programs,’ which seek reimbursements for spending under Medicaid… The recovery efforts collect more than $700 million a year, according to a 2021 report from the Medicaid and CHIP Payment and Access Commission, or MACPAC, an agency that advises Congress.
States have leeway to decide whom to bill and what type of assets to target. Some states collect very little. For example, Hawaii’s Medicaid estate recovery program collected just $31,000 in 2019, according to the federal report.
Iowa, whose population is about twice Hawaii’s, recovered more than $26 million that year, the report said.”
Healthcare billing fraud: 18 recent cases FYI. Notice how many cases involved Medicare/Medicaid.
Bright Health staring down bankruptcy, needs to raise $300M, execs say “Bright Health Group needs to raise about $300 million to avoid bankruptcy after it overdrafted its credit, executives told investors on Wednesday.
Chief Financial Officer Cathy Smith said that the company spent the $350 million available in its revolving credit facility, violating its liquidity covenant with its lenders as it is required to keep at least $200 million in that account. The company did secure a waiver and must address the shortfall by the end of April.”
BCBS Michigan posts $777M loss in 2022 “Blue Cross Blue Shield of Michigan reported a $777 million loss for 2022, driven in part by the ongoing cost of the COVID-19 pandemic and pricing pressures in Medicare Advantage.
In a March 1 news release, the company reported its total revenue was $32.8 billion in 2022, resulting in a net loss of 2.3 percent for the year.
Other factors contributing to the loss were declining investment portfolio values and costs related to the sale of Advantasure, the company's health services arm.”
Humana, Aledade ink 10-year value-based care partnership “Humana has inked a 10-year partnership with Aledade to provide value-based care services to its Medicare Advantage members.
The two companies have a long-term working relationship, and, by the end of 2022, more than 100,000 Humana members were Aledade patients, according to an announcement. Their partnership dates back to 2019 in several states, and, since then, the two have been able to reduce inpatient hospitalizations by 5% and readmissions by 12%.”
Texas' gold card prior authorization rule not worth its weight so far “Texas' physician gold-card rule took effect in October, but providers are not seeing the results they hoped for, the American Medical Association reported March 1.
Under the law, physicians who have a 90 percent prior authorization approval rate over a six-month period on certain services are exempt from prior authorization requirements for those services.
The implementation of the law by the Texas Department of Insurance has been problematic, according to the AMA. The Texas Medical Association has reported a lack of enforcement and liberties taken with the rulemaking that create barriers to qualify for the exemption.”
20 things to know about the fastest growing form of Medicare Advantage “Special needs plans, Medicare Advantage plans for individuals with chronic or disabling conditions, are growing faster than the general MA program.
[The article has]… 20 facts and figures to know about who SNPs serve, how they work and their rapid growth.”
About hospitals and healthcare systems
20 health systems reporting losses in 2022 FYI
Genesis Health System joins MercyOne “MercyOne is a member of Trinity Health, headquartered in Livonia, Michigan. Trinity Health is one of the largest not-for-profit health care systems in the country with 88 hospitals across 26 states. Trinity Health is not affiliated with any Iowa-based entities currently using the name ‘Trinity’ or ‘Trinity Health.’”
UnityPoint Health, Presbyterian Healthcare set sights on 40-plus hospital merger “Des Moines, Iowa-based UnityPoint Health and Albuquerque, New Mexico-based Presbyterian Healthcare Services have pulled back the curtain on plans to merge and form a system with more than 40 hospital facilities across four states.
The nonprofit systems announced Thursday that they have signed a letter of intent ‘to explore the formation of a new healthcare organization.’ The announcement didn’t include a timeline as each system works toward a definitive agreement and regulatory approvals.”
CEOs Are Losing Faith in Their Direct Reports “A new survey indicates that CEO confidence in their own executive-leadership teams has fallen from 74% in the first half of 2021 to about 66% in 2022. More bosses have expressed pessimism about the capabilities of their direct reports, their overall behavior, and their approach to tackling critical issues…
The pattern was consistent across multiple industries, including telecommunications (46%), technology (41%), manufacturing (43%), and health care (42%).”
Early NFP Hospital Medians Show Expected Deterioration; Will Worsen “Not-for-profit hospital operating margins were pressured following a difficult FY22, according to medians compiled by Fitch Ratings for hospitals with an earlier FYE 2022. Audited results show materially weaker profitability and liquidity relative to FY21 due to expense increases and investment market losses.
The decline in operating results are likely to be even more pronounced in our full-year medians later this year when we have financial reporting for all rated hospitals, given the fact that the results of hospitals with later FYEs bore the full brunt of intensifying financial pressures in 2022, including labor inflation and market volatility. Fitch does not expect a rapid financial recovery for most providers, although hospitals under operational pressure will begin to see breakeven results on at least a month-to-month basis at some point in 2023 with revenue growth and expense pressures easing. Nevertheless, margins are not expected to return to pre-pandemic levels for quite some time.”
About pharma
Drugs likely subject to Medicare negotiation, 2026-2028 “In 2026-2028, we estimate that Medicare will negotiate prices for 38 Medicare Part D drugs and 2 Part B drugs. Combined, the 40 products eligible for negotiation in 2026-2028 accounted for $67.4 billion in gross Medicare spending in 2020. Part D drugs eligible for negotiation in 2026-2028 include 7 inhalers, 8 antidiabetics, 5 kinase inhibitors, and 3 oral anticoagulants. In all but 5 cases, high-spend drugs ineligible for negotiation were disqualified because of generic or biosimilar competition.”
WE Brands in Motion Health Study: Corporate Reputation Is Leading Factor in Prescribing Decisions “WE Communications (WE) released its latest Brands in Motion global report, ‘Healthy Reputation: More Than Medicine.’ The data reveals that, outside a medication’s functional characteristics, healthcare professionals ranked corporate reputation as the foremost influencing factor when it comes to making prescribing decisions.”
ICER dials up recommended price range for Eisai's Leqembi—but still calls for sizable discount “Influential U.S. drug pricing research group the Institute for Clinical and Economic Review (ICER) has updated its assessment of Eisai’s new Alzheimer's disease drug Leqembi. In the wake of a rival drug's rejection, the agency supports a slightly higher price tag for the Eisai medicine than it had previously proposed.
Leqembi, also known as lecanemab, should cost between $8,900 to $21,500 per year to be considered cost effective, ICER said Wednesday.
The new recommended price means Eisai should take 19% to 66% off of Leqembi’s current list price of $26,500, ICER contends.”
Financial Impact of Metabolic Surgery on Prescription Diabetes Medications in Michigan “The mean decrease in diabetes prescription payments made by the insurance provider was $4133 per patient ($6736 for gastric bypass and $3409 for sleeve gastrectomy) in the 360 days postsurgery compared with the 360 days presurgery. Meanwhile, the price-standardized 30-day payment for surgery was $14 832. Given that 34% of all patients undergoing metabolic surgery in Michigan have diabetes and a total of 54 454 metabolic procedures were performed between 2015 and 2021, it is estimated that insurance providers in Michigan saved more than $76.5 million on diabetes medications in the 360 days following surgery.”
Walgreens cuts its stake in Option Care Health “Walgreens Boots Alliance is selling off a chunk of its stake in Option Care Health, an infusion services company that Walgreens first purchased more than 15 years ago.
The Deerfield-based pharmacy giant said it sold about 15.5 million Option Care shares for $30.75 per share. With the sale, Walgreens’ ownership stake in Bannockburn-based Option Care falls from 14% to 6%.
The funds will be used to pay down Walgreens’ debt, some of which was incurred during recent deals to invest or acquire health care delivery businesses.”
About the public’s health
Recommended Adult Immunization Schedule, United States, 2023 FYI
Colorectal cancer statistics, 2023 The most alarming finding was: “…the proportion of cases among those younger than 55 years increased from 11% in 1995 to 20% in 2019.”
More than half of the world will be overweight or obese by 2035 - report “More than half of the world's population will be overweight or obese by 2035 without significant action, according to a new report.
The World Obesity Federation's 2023 atlas predicts that 51% of the world, or more than 4 billion people, will be obese or overweight within the next 12 years.
Rates of obesity are rising particularly quickly among children and in lower income countries, the report found.”
Walgreens won’t sell abortion pills in 20 states after warning “Walgreens Boots Alliance Inc. will not sell abortion pills in 20 states after warnings by Republican attorneys general of legal action, a decision that limits the medication’s availability in many places where access to the procedure is already restricted.
The company won’t dispense mifepristone in those states, Fraser Engerman, a company spokesman, said in an emailed statement to Bloomberg News.”
About healthcare IT
FACT SHEET: Biden-Harris Administration Announces National Cybersecurity Strategy The document is more aspirational than operational.
Most Primary Care Telehealth Visits Unlikely to Need In-Person Follow-Up “Key Findings
—More than 60% of the time, primary care telehealth visits did not have an in-person follow-up visit in the same specialty within 90 days.
—Kids more frequently had an in-person office visit following a telehealth visit; however, more than half of the time (54%), kids did not have an in-person follow-up.
—55% of patients with Medicare or Medicaid insurance coverage did not have an in-person follow-up after a primary care telehealth visit.”
Best Buy's $400M remote patient monitoring company partners with Geisinger, Mount Sinai, NYU Langone Health “Best Buy has partnered with five of the 10 largest U.S. health systems on remote patient monitoring, according to a March 2 earnings call.
Its subsidiary, Current Health, now works with Danville, Pa.-based Geisinger, New York City-based Mount Sinai Health System and New York City-based NYU Langone Health…
The company's platform combines remote patient monitoring, telehealth, patient engagement and a full support model…,
Best Buy acquired Current Health for $400 million in 2021, part of its continued push into providing technology for remote patient monitoring.”
About healthcare personnel
Oak Street posts almost $510M loss as it continues clinic ramp-up Chicago-based Oak Street Health, which CVS Health is planning to acquire, reported a net loss of $509.7 million in 2022 as it continued to expand the number of centers it operates…
The 2022 loss compared with a net loss of $414.6 million in 2021. Revenues increased by 51 percent to total $2.16 billion.”
About health technology
Large language models generate functional protein sequences across diverse families “Deep-learning language models have shown promise in various biotechnological applications, including protein design and engineering. Here we describe ProGen, a language model that can generate protein sequences with a predictable function across large protein families, akin to generating grammatically and semantically correct natural language sentences on diverse topics. The model was trained on 280 million protein sequences from >19,000 families and is augmented with control tags specifying protein properties. ProGen can be further fine-tuned to curated sequences and tags to improve controllable generation performance of proteins from families with sufficient homologous samples.”