Thursday Miscellany

Telehealth

Thursday Miscellany

David Ermer–CDC, Congress, COVID-19, Federal employment benefits, Mental health care, OPM, Telehealth, U.S. Healthcare–
Photo by Josh Mills on Unsplash

From Capitol Hill, Roll Call reports

Lawmakers are facing increased pressure to pass a comprehensive mental health and substance use package but are unlikely to make an initial goal of advancing legislation before the implementation of a three-digit suicide hotline in July.

At least four congressional committees have committed to advancing a swath of bipartisan mental health bills under their jurisdiction, but lawmakers have not yet unlocked the puzzle of how to incorporate a growing laundry list of programs to authorize and establish existing and new programs dedicated to treatment, prevention, education, crisis care, drug interdiction and the workforce.

One of those four committees is the Senate Finance Committee which announced today

Senate Finance Committee Chair Ron Wyden (D-Ore.), Ranking Member Mike Crapo (R-Idaho), Senator Ben Cardin (D-Md.) and Senator John Thune (R-S.D.) today released a discussion draft for telehealth policies as a part of the committee’s ongoing work to improve mental health care across the nation, which has included a public call for comments and three hearings to help develop these initiatives. * * *

The discussion draft includes policies that would:

* Remove Medicare’s in-person visit requirement for tele-mental health services.

* Establish benefit transparency for mental health care services delivered via telehealth to inform Americans with Medicare how and when they can access telehealth.

* Preserve access to audio-only mental health coverage in Medicare when necessary and appropriate.

* Direct Medicare and Medicaid to promote and support provider use of telehealth.

* Incentivize states to use their CHIP programs to establish local solutions to serve behavioral health needs in schools, including through telehealth.

From the Omicron and siblings front

Beckers Hospital Review informs us

A highly contagious sublineage of the BA.2 omicron subvariant is now the nation’s dominant strain, according to the CDC’s latest variant proportion estimates. 

The sublineage, BA.2.12.1, accounted for 57.9 percent of all U.S. COVID-19 cases in the week ending May 21, CDC data shows. BA.2, which became the nation’s dominant strain in mid-March, now accounts for an estimated 39.1 percent of all cases.

BA.2.12.1 is estimated to have a 25 percent growth advantage over BA.2, which is already more transmissible than the original omicron strain. The newer omicron sublineage has been gaining traction in the U.S. over the last month. In the week ending April 23, BA.2.12.1 accounted for just 24.1 percent of U.S. COVID-19 cases. 

Health officials are also monitoring another omicron subvariant — BA.1.1.529 — which currently accounts for an estimated 2.8 percent of cases.  

“Epidemiologically, it doesn’t appear as if we’re seeing more severe disease in places that are having more cases,” CDC Director Rochelle Walensky said of the sublineages during an April 26 news conference. “So we are not anticipating more severe disease from some of these subvariants, but we are actively studying it.”

CBS News reports

As many as one in four seniors and one in five adults under 65 experienced “long COVID” or “post-COVID” symptoms after surviving a coronavirus infection, a new study from the Centers for Disease Control and Prevention reported Tuesday. 

The study — published in the CDC’s Morbidity and Mortality Weekly Report — is the latest to try and quantify how many of the millions of Americans who have now tested positive for the virus are facing long-term issues caused by their infection. 

By comparing electronic health records in a large national database of patients, the study’s authors found 38.2% of COVID-19 survivors “experienced at least one incident condition” — a list that includes heart, lung, kidney and gastrointestinal problems, pain, fatigue, loss of smell or taste, mental health issues, and more —  in the months after their infection. By contrast, just 16% of other people were diagnosed with such conditions.

The Wall Street Journal adds

Vaccination reduces your risk of developing long Covid, but not by much on average, new research suggests. 

A Veterans Affairs study out Wednesday found that vaccinated people with breakthrough Covid-19 infections had a 15% reduction in experiencing persistent or new symptoms and health conditions up to six months after infection compared with those who were unvaccinated and got Covid. 

Most of the vaccinated people had received two doses of the Pfizer or Moderna vaccine, while 8% received one dose of the Johnson & Johnson vaccine. The study didn’t look at people who had received boosters.

Bloomberg discusses the risks of contracting Covid while pregnant.

Canada’s first dual specialist in infectious diseases and obstetrics/gynecology, Deborah Money, MD comments “For the most part, women in communities even with Covid circulating do well,” she says. “The majority of babies are fine.”

But that’s just part of the story. Their analysis of data from 6,012 people in six Canadian provinces who tested positive for the virus during their pregnancy found a substantial increase in hospitalizations and ICU admissions compared with reproductive-age, non-pregnant females infected with the coronavirus. Their study in the May 2 issue of the JAMA medical journal also found that 11.1% of Covid–affected pregnancies resulted in preterm birth, compared with 6.8% among all unaffected Canadian pregnancies. * * *

Money says it underscores the need for obstetricians to carefully monitor their pregnant patients who become infected with SARS-CoV-2, and for expecting moms to get vaccinated and boosted.

“That’s the biggest thing they can do,” she says. “It really does look like vaccine is preventative for the serious outcomes.” 

From the studies front —

  • The Medical Group Management Association informs us “Despite multiple waves of disruption in 2021, medical practices navigated through the “new normal” of COVID-19 to restore a sense of normalcy in productivity and compensation last year.”
  • Milliman released its 2022 Medical Index (MMI). “In 2022, the cost of healthcare for a hypothetical American family of four covered by an average employer sponsored PPO plan is $30,260,” 4.6% above 2021.
  • HR Dive tells us “[a] 2019 IRS notice expanded the list of medications and health services Health Savings Account-eligible health plans may cover prior to meeting a patient’s deductible. Employers that take advantage of the expansion could cover these treatments with little to no increases in patient premiums, according to an Employee Benefits Research Institute report published May 19.”

Commercial insurance members’ satisfaction with their plans stayed flat between 2021 and 2022, according to a new survey from J.D. Power.

Satisfaction was on a steady climb over the past five years, the survey found, but plateaued in the past year amid declines in how well members’ expectations for customer service were met and dissatisfaction with their plan designs and network providers.

Health plans that were perceived by members as responsive enjoyed higher scores than those that were not, J.D. Power found. The Kaiser Foundation Health Plan and regional Blues insurers were consistently ranked as the highest scoring in the study’s 22 geographic regions.

From the mental healthcare front, the International Foundation of Employee Benefit Plans notes

The U.S. Department of Labor (DOL) published new guidance on obtaining job protected leave under the Family and Medical Leave Act (FMLA) for workers seeking mental health support. The guidance clarifies that eligible employees are able to take FMLA leave for their own serious health condition or to care for a spouse, child or parent because of their serious health condition, and that a serious health condition can include a mental health condition.

The guidance includes:

* Fact Sheet #28O: Mental Health Conditions and the FMLA, and

* Frequently Asked Questions on the FMLA’s mental health provision

From the federal employee benefits front, benefits consultant Tammy Flanagan writes in Govexec about Federal Employee Group Life Insurance Program options for federal and postal annuitants. What’s more, Fedweek explains how FEHBP fills Medicare coverage gaps for those fine folks.

Weekend Update / Monday Roundup

David Ermer–CDC, Congress, COVID-19, COVID-19 vaccine, Employee Wellness Programs, Mental health care, Telehealth, U.S. Healthcare–
Photo by Michele Orallo on Unsplash

The Senate will and the House of Representatives will be engaged only in Committee business this coming week.

From the Omnicron and siblings front —

  • Fortune reports “The U.S. is experiencing a sixth wave of COVID, with over 90,000 confirmed new cases a day and a 20% increase in hospitalizations over the past two weeks. The actual number of new cases per day likely sits at a half-million or more, “far greater than any of the U.S. prior waves, except Omicron,” writes Dr. Eric Topol, the executive vice president of Scripps Research and a professor of molecular medicine, in a recent blog post on the maps.” It’s hard to argue against this point.
  • Bloomberg Prognosis offers a useful Q&A on when you can back to life after a case of Omicron. Here is a link to the CDC’s guidelines on isolation and quarantine due to Omicron.
  • The FEHBlog noticed that 75% of the American population age 12 and older is fully vaccinated against Covid.
  • The American Medical Association discusses how Covid telemonitoring sets the model for other acute conditions.

From the Aduhelm front, the Wall Street Journal reports

The commercial failure of Biogen Inc.’s drug Aduhelm is putting new focus on the state of research into the causes of Alzheimer’s disease.

More than six million people in the U.S. are living with the progressive type of dementia, according to the Alzheimer’s Association, an advocacy group. 

Aduhelm was hailed as a potential blockbuster that targeted a root cause of the disease by clearing a sticky protein known as amyloid from the brain. Abnormal accumulations of amyloid called plaque and tangles of another protein known as tau are characteristic features of the brains of people with Alzheimer’s.

“If you cut the brain open and amyloid plaque is absent, Alzheimer’s was not the cause of disease,” said Jeffrey Cummings, director of the Chambers-Grundy Center for Transformative Neuroscience at the University of Nevada, Las Vegas.

But research into the benefits of targeting amyloid in Alzheimer’s patients has been mixed. There are more questions than answers about the role amyloid plays in the development of the disease, neurologists say. 

“Alzheimer’s is a complex disease. It’s unlikely that a single mechanism is contributing to it,” said Maria Carillo, the Alzheimer’s Association’s chief science officer. * * *

More than 140 drugs are in the pipeline as potential Alzheimer’s treatments, including drugs that target tau and microglia function, according to a survey of registered clinical trials in the U.S. Three other amyloid-targeting monoclonal antibodies, which are in the same class as Aduhelm, are in development. One, called lecanemab, was submitted this month by co-developers Biogen and Japan-based Eisai Co. to the Food and Drug Administration for potential approval.

Time will tell.

From the preventive care wellness front —

  • Medscape reports an “alarming increase in esophageal cancers in middle-aged adults. The study’s author,  Bashar Qumseya, MD, MPH, recommends that people with multiple risk factors for these cancers, i.e., obesity, diet, and gastroesophageal reflux disease, should undergo an endoscopy at the time of their first colonoscopy at age 45.
  • The American Medical Association identifies steps that patients can follow to reverse pre-diabetes.

The FEHBlog just discovered that the Weekend Update did not go out on Monday morning. So here are Monday’s items that normally would have been posted in the Monday Roundup —

More from the Omicron and siblings front —

BioPharma Dive reports

Three doses of Pfizer and BioNTech’s COVID-19 vaccine met the Food and Drug Administration’s bar for success in a trial studying the shot in children younger than 5 years old, the companies said Monday. The FDA has tentatively scheduled a meeting of outside advisers to review the data in three weeks.

The agency delayed review of the vaccine in the youngest children earlier this year after a December review of data indicated a two-shot series didn’t spur an immune response that was likely to protect against disease. When Pfizer and BioNTech disclosed that data, they announced plans to test immune response and efficacy after three shots.

The announcement comes days after U.S. officials warned of a new surge of COVID-19 cases as mask mandates have been lifted and while immunity from vaccination and previous infections wanes. The FDA has granted emergency use authorization for as many as four shots of Pfizer and BioNTech’s vaccine — an initial two-dose series followed by two periodic boosters — for adults at least 50 years old.

Reuters adds U.S. “Health officials are considering extending the eligibility for a second COVID-19 vaccine booster dose to people under 50 amid a steady rise in cases, with the United States seeing a threefold increase over the past month.”

Bloomberg Prognosis recommends carrying around a portable carbon dioxide monitor to help prevent Covid or at least remind you to mask up and / or move along:

Carbon-dioxide monitors can assess how Covid-risky a space is because they help tell you whether you’re breathing in clean air. They measure the concentration of carbon dioxide, which people exhale when they breathe, along with other things like, potentially, virus particles. The more well-ventilated a space, the lower the reading on my monitor’s screen — meaning not only less carbon dioxide but also less of the stuff like Covid that might make people sick. 

One place I didn’t expect this to be an issue was airplanes, because you hear so much about their top-of-the-line air quality systems. But in fact, some of the highest carbon dioxide readings on my travels were taken on flights, specifically during the boarding process.

It turns out that during boarding and deplaning, air systems aren’t typically running. Those periods are risky because people are mingling more than they do during a flight, says Joe Allen, an associate professor at the Harvard T.H. Chan School of Public Health who carries around his own CO2 monitor.

“We’ve been warning about this,” Allen says. 

Fresh air is important for our health in ways that go well beyond Covid, but it’s also largely invisible. Carbon-dioxide monitors can change that. 

What will they think of next?

The FEHBlog confesses that he took his eye off the flu virus this year. Beckers Hospital Review informs us “The CDC estimates there have been at least 6.7 million flu illnesses, 69,000 hospitalizations and 4,200 flu-related deaths so far this season.”

In other virus news, Reuters reports “Infection with adenovirus, a common childhood virus, is the leading hypothesis for recent cases of severe hepatitis of unknown origin in children that have led to at least six deaths, U.S. health officials said on Friday [May 20]. Furthermore,

The Centers for Disease Control and Prevention (CDC) said it is continuing to investigate whether 180 cases identified in 36 states and territories since last October represent an increase in the rate of pediatric hepatitis or whether an existing pattern has been revealed though improved detection.

From the mental healthcare front, Fierce Healthcare tells us

Mental health concerns are on the rise among teens, and the impact on parents and families is an unmet need employers could address, new data from Cigna’s Evernorth show.

The pandemic has significantly worsened mental health among teens and young adults, with 25% experiencing depressive symptoms and 20% experiencing anxiety symptoms, a JAMA study shows. About 80% of the 1,000 parents included in Cigna’s survey said their children are struggling with their mental health.

Nearly one-fifth (18%) of parents say their child’s needs are negatively impacting their job performance and productivity, according to the survey. In addition, 55% said they do not have enough support from their employer, and 1 in 7 said they were forced to leave or stay out of the workforce to manage their teenager’s needs.

“I think there’s going to be a long tail for these kids and also their family members,” Stuart Lustig, M.D., national medical executive for behavioral health at Evernorth, told Fierce Healthcare. “I think we’re in this for the long haul.”

Midweek Update

David Ermer–CDC, COVID-19, Employee Wellness Programs, Federal employment benefits, NCQA, OPM, SDOH, Telehealth, U.S. Healthcare–
Photo by Mel on Unsplash

From the Omicron and siblings front

The Wall Street Journal reports

The seven-day moving average of new Covid-19 cases recently topped 94,000 a day, Centers for Disease Control and Prevention data show, nearly four times lows reached in late March. The true number of new cases is likely significantly higher, epidemiologists say, because so many people are self-testing at home or not testing at all. 

The rise in cases hasn’t translated thus far into major surges in severe illness. The seven-day average of confirmed cases in hospitalized patients reached about 18,550 on Wednesday, up from lows near 10,000 in mid-April, but far below a record peak above 150,000 in January. The numbers include people who test positive on routine screening after getting hospitalized for other reasons. The daily average of reported deaths has slipped under 300 a day, the lowest point since last summer.

But * * * the more an outbreak spreads, the more likely it will reach the most vulnerable including elderly people and others with compromised immune systems, the experts say, and the more likely the virus will continue to mutate.

Bloomberg Prognosis adds

As Covid-19 again surges across the US, many people are going without time-sensitive therapeutics like Paxlovid because doctors worried about shortages are reluctant to prescribe the drugs. But the situation has changed and supplies are now abundant.

The Food and Drug Administration has issued emergency-use authorizations for the drug to treat mild to moderate Covid-19 in people who are at high risk. The Centers for Disease Control and Prevention defines those as individuals ages 50 years or older, unvaccinated, or with certain medical conditions like kidney, liver, lung and heart disease, diabetes, cancer and HIV. It also recommends the drug for people who are immunocompromised, pregnant, obese, cigarette smokers or suffering from mood disorders.

You can find the one stop test to treat locations “by using the Department of Health and Human Services’ Test to Treat Locator or by calling 1-800-232-0233.”

Kaiser Health News recommends “improving ventilation and filtration of the air. ‘Ventilation matters a lot,’ said Dr. Amy Barczak, an assistant professor of medicine at Harvard Medical School. ‘If you’re taking care of someone at home, it’s really important to maximize all the interventions that work.’”

Viral particles float through the air like invisible secondhand smoke, diffusing as they travel. Outside the home, viruses are quickly dispersed by the wind. Inside, germs can build up, like clouds of thick cigarette smoke, increasing the risk of inhaling the virus.

The best strategy for avoiding the virus is to make your indoor environment as much like the outdoors as possible.

In related viral news, Beckers Hospital Review tells us

More than 400 children worldwide have developed unusual cases of acute hepatitis, and researchers are still searching for the cause of the outbreak, the World Health Organization said May 17.  

As of May 15, the WHO reported 429 probable cases in 22 countries, up from 348 cases a week prior, according to Philippa Easterbrook, MD, a senior scientist in the global hepatitis program at the WHO. Another 40 cases are still under investigation, and 75 percent of all affected children are under age 5. 

Twelve countries are reporting more than five cases, double the amount from last week. Of these 12 countries, nine are in Europe. In total, six children have died in the outbreak and 26 have required liver transplants, according to Dr. Easterbrook. 

As of May 17, researchers were still investigating the cause of the hepatitis outbreak. The leading hypothesis is that an adenovirus and SARS-CoV-2, the virus that causes COVID-19, may be causing hepatitis in children. Scientists are exploring “how these two infections may be working together as co-factors either by enhancing susceptibility or creating an abnormal response,” Dr. Easterbrook said. 

From the healthcare policy front, AHIP today launched

Healthier People through Healthier Markets, a new policy roadmap and set of solutions to improve health care affordability and access for every American. The effort is focused on boosting competition in health care markets and reining in harmful practices that hurt American families. With the launch of this policy roadmap, AHIP sent letters to President Biden and the leadership of Congress that lay out a detailed set of legislative and regulatory enforcement actions to increase competition in health care, drive down costs, and improve health care access for patients.

The FEHBlog supports this approach.

From the mental healthcare front, Govexec reports

The Office of Personnel Management on Wednesday urged federal agencies to ensure their employees are aware and can access the mental health benefits provided to federal workers, in light of May being Mental Health Awareness Month.

In a memo to agency heads, OPM Director Kiran Ahuja noted that promoting the federal workforce’s wellbeing, including mental health, is a priority in President Biden’s management agenda.

“We want to make sure that all federal employees understand the supports available to them and underscore that there should be no shame or stigma for taking care of their mental health,” Ahuja wrote. “[As] a reminder, employee assistance programs and Federal Employees Health Benefits health plans offer mental health services to employees and their family members. We encourage agencies to proactively communicate to their workforces about their options and encourage employees to contact their agency benefits officers or EAP coordinator to learn more.”

The FEHBlog encourages OPM to better coordinate mental health care services among FEHB plans, EAPs and wellness programs.

From the telehealth front

  • mHealth Intelligence informs us “In the second half of 2020, only 14.1 percent of children used telehealth due to the pandemic, but use was higher among those with asthma, a developmental condition, or a disability, the Centers for Disease Control and Prevention (CDC) found.”

From the survey department, Beckers Payer Issues advises that “Castlight Health analyzed more than 160 million commercial medical claims nationwide to reveal insights about healthcare utilization patterns from 2018 to 2021.” Castlights report ranks the fifty States and DC based on average medical spending per member in 2021.  

From the miscellany department —

  • Beckers Payer Issues reports “Anthem shareholders voted at their annual meeting May 18 to change the company’s name to Elevance Health.”
  • Federal News Network discusses the Postmaster General’s plans to close and consolidate Postal facilities across the delivery network. “The network transformation initiative will impact nearly 500 network mail processing locations, 1,000 transfer hubs and 100,000 carrier routes. It will also impact 10,000 delivery units, which USPS defines as post offices, stations, branches or carrier annexes that handle mail delivery functions.”
  • FedSmith tells us “Starting May 26, 2022, federal retirees will notice a new process for signing into the OPM Retirement Services Online website. The login process will now be managed through the federal government’s Login.gov website and will require you to create a new username and password at login.gov if you do not currently have one.”

Monday Roundup

David Ermer–COVID-19, Rx coverage, SDOH, Telehealth, U.S. Healthcare, Uncategorized–

From the Omicron and siblings front —

  • Bloomberg observes “Covid hospitalitalization count makes vaccines seem less effective, Researchers say. The researchers point out that a patient who tests positive for Covid is a Covid hospitalization even if the patient is hospitalized for an unrelated reason.
  • In its recent review of Covid pills, the Institute for Clinical Review (ICER) gave a mildly favorable report on using an inexpensive anti-depressant fluvoxamine to treat Covid. This part of the ICER report was physician investigator-initiated. Those investigators sought FDA approval. Today, however, STAT News reports that “In an unusual two-page summary — the FDA does not generally disclose the reasoning behind rejections — regulators said that the doctors failed to provide adequate evidence of the effectiveness of the drug, called fluvoxamine.” The investigators indicated that more fluvoxamine trials are ongoing as well as trials of other repurposed drugs.
  • The National Institutes of Health announced today that a research team is successfully using deidentified electronic health record data to better identify characteristics of persons with long Covid. “One reason long COVID is difficult to identify is that many of its symptoms are similar to those of other diseases and conditions. A better characterization of long COVID could lead to improved diagnoses and new therapeutic approaches.”
  • Roll Call delves into the use of wastewater surveillance to track Covid trends. Urban areas are good — rural areas are not so good.
  • Medpage Today offers an epidemiologist’s perspective on the occasionally observed Omicron rebound from Paxlovid, the Pfizer Covid pill. Reuters adds, “Pfizer has said that from more than 300,000 patients it is monitoring who received the 5-day treatment, around 1-in-3,000 – about 0.03% – reported a relapse after taking the pills.”

In other FDA news, MarketWatch informs us

The Food and Drug Administration on Monday authorized a test developed by Laboratory Corporation of America Holdings LH, -0.92% that allows people in the U.S. to self-test for respiratory syncytial virus (RSV), a type of common cold, as well as the flu and COVID-19. The test does not require a prescription. People swab at home and send the test by mail to a Labcorp lab. Results are then made available in an online portal. Teens and children are also authorized to test with the support of adults. The test kit costs $169 and may be covered by insurance, according to a spokesperson. It is expected to be available within the next three weeks. 

That’s helpful.

From the SDOH front —

  • Health Day informs us that “a new study shows that telemedicine has closed the gap in access to primary care between Black and non-Black Americans.”
  • Beckers Payers Issues tells us “Despite little change before the pandemic, the number of adults with medical debt, issues paying medical bills and medical debt in collections have declined since the pandemic began. New policies will be needed to sustain the decrease, according to a May 11 report from the Urban Institute.” 

From the preventive care front, Healio reports

A decrease in cervical cancer rates in the United States, most notably among younger women, may be associated with HPV vaccination approval, according to a retrospective, cross-sectional study published in JAMA Network Open. 

Researchers added that an increase in oropharyngeal and anal/rectal cancers, particularly among men, highlights a need for vaccination uptake among both men and women.

From the interoperability front, the Sequoia Project “selected by the Office of the National Coordinator for Health IT (ONC) as the Recognized Coordinating Entity (RCE) to support the implementation of the Trusted Exchange Framework and Common Agreement (TEFCA), today released additional details regarding the process and requirements for becoming a Qualified Health Information Network (QHIN). The Sequoia Project is requesting feedback on these items before the final documents are released.” The Sequoia Project’s comment deadline is June 15, 2022, and “drafts are available on the RCE website.”

From the healthcare business front, Healthcare Dive reports

Hospitals’ labor costs rose by more than a third from pre-pandemic levels by March 2022, according to a report out Wednesday from Kaufman Hall.

Heightened temporary and traveling labor costs were a main contributor, with contract labor accounting for 11% of hospitals’ total labor expenses in 2022 compared to 2% in 2019, the report found.

Contract nurses’ median hourly wages rose 106% over the period, from $64 an hour to $132 an hour, while employed nurse wages increased 11%, from $35 an hour to $39 an hour, the report found.

In other government news —

  • The Department of Health and Human Service is marking the 10th anniversary of the National Plan to Address Alzheimer’s Disease. “HHS is commemorating the Anniversary through a series of publications and presentations highlighting the Department’s accomplishments in addressing Alzheimer’s disease and related dementias (ADRD), including those at the Centers for Disease Control and Prevention (CDC), Administration for Community Living (ACL), National Institutes of Health (NIH), Indian Health Service (IHS), and other HHS agencies. HHS will also sponsor a state policy roundtable to hear from state leaders about their work to address ADRD.  All events and materials will be shared on the 10th Anniversary HHS page.”
  • The Society for Human Resource Management relates that “An FAQ explains that the EEOC will permit employers to submit their EEO-1 Reports after the May 17 deadline, during what the agency is calling the “failure to file” phase. The EEOC stated, “All filers who have not submitted and certified their mandatory 2021 EEO-1 Component Report(s) by the Tuesday, May 17, 2022, published deadline will receive a notice of failure to file instructing them to submit and certify their data as soon as possible, and no later than Tuesday, June 21, 2022.”  All FEHB carriers must file this report.

Friday Stats and More

David Ermer–CDC, COVID treatment, COVID-19, COVID-19 vaccine, Telehealth, U.S. Healthcare–

Based on the CDC’s Covid Data Tracker and using Thursday as the first day of the week, here is the FEHBlog’s weekly chart of new Covid cases from the 27th week of 2021 through the 19th week of 2022.

The CDC’s weekly review of its Covid statistics notes

As of May 11, 2022, the current 7-day moving average of daily new cases (84,778) increased 30.7% compared with the previous 7-day moving average (64,863). A total of 82,087,117 COVID-19 cases have been reported in the United States as of May 11, 2022.

Here’s the CDC’s weekly chart of new Covid hospitalizations

The CDC’s weekly review of Covid hospitalization notes, “The current 7-day daily average for May 4–10, 2022, was 2,629. This is a 17.5% increase from the prior 7-day average (2,238) from April 27–May 3, 2022.”

Here’s the FEHBlog’s weekly chart of new Covid deaths from the 27th week of 2021 through the 19th week of 2022:

The CDC’s weekly review notes “The current 7-day moving average of new deaths (273) has decreased 15.4% compared with the previous 7-day moving average (322). As of May 11, 2022, 996,376 COVID-19 deaths have been reported in the United States.”

Finally, here is the FEHBlog’s weekly chart of Covid vaccinations distributed and administered from the beginning of the Covid vaccination era through the 19th week of 2022.

Per the CDC’s weekly review, “As of May 11, 2022, the 7-day average number of administered vaccine doses reported (by date of CDC report) to CDC per day was 390,306, an 11.1% decrease from the previous week.”

76% of the U.S. population aged 18 and older are fully vaccinated against Covid, and 50% of that cadre has received the first booster. Likewise, 90% of the U.S. population aged 65 and older is fully vaccinated, and 70% of that cadre has received the first booster. There is work still to be done but the public health community and the U.S citizenry deserves credit for these accomplishments.

To wrap up this week’s Covid stats, let’s include the CDC’s latest Communities report:

As of May 12, 2022, there are 137 (4.25%) counties, districts, or territories with a high COVID-19 Community Level, 453 (14.07%) counties with a medium Community Level, and 2,630 (81.68%) counties with a low Community Level. This represents a small (+1.77 percentage points) increase in the number of high-level counties, a moderate (+4.10 percentage points) increase in the number of medium-level counties, and a corresponding (−5.87 percentage points) decrease in the number of low-level counties. Eight (15.38%) of 52 jurisdictions had no high- or medium-level counties this week.

To check your COVID-19 Community Level, visit COVID Data Tracker.

NPR Shots offers a valuable article describing three ways to get the Paxlovid pill if diagnosed with Covid. The key takeaway from the FEHBlog’s perspective is the need to have a primary care provider in your life.

For those with health insurance and access to their primary care providers or health care team, you can make an in-person or telehealth appointment to get tested (or share your positive test results), assessed for risks and medications and, if eligible, obtain a prescription for the pills. 

You’d then get the prescription filled at a nearby pharmacy. 

Having a provider that knows your medical history, as well as the details of your current situation, can be very helpful, says Dr. Ulrika Wigert, a family medicine physician at CentraCare in Sauk Center, Minnesota. “Did you test the first day [of symptoms]? Did you test the second day? How sick were you when you tested?” And, if you’re starting to feel better by the time you get the medication, do the benefits of taking the medication outweigh any risks? “Having a provider help navigate that on the individual patient basis” can help guide you through an appropriate course of care, she says. 

STAT News addresses three burning questions about the future of prescribing drugs using telehealth services (not for a PCP visit).

Research by Lori Uscher-Pines, a senior policy researcher at RAND, suggests that providers are starting to prescribe buprenorphine — a controlled substance used to treat opioid use disorder — without in-person visits. But they’re typically more comfortable continuing the prescriptions virtually for patients they’ve already met, compared to taking on new patients virtually.

Still, “very few studies of medication treatment for opioid use disorder via telehealth have shown safety or diversion concerns,” she said. And she noted that one recent study suggested that relaxed restrictions have improved treatment retention for opioid use disorder patients.

Telehealth prescription could help patients in regions with acute clinician shortages — especially of mental health providers — obtain critical medication.

“A key question going forward is how to strike a balance between increasing access to important medications on the one hand and limiting the potential for misuse on the other,” Uscher-Pines said.

In the past, federal and state regulations have required clinicians to frequently examine patients in-person to guard against misuse, addiction, or fraud. “But are there other ways to accomplish this, perhaps ways that actually leverage telehealth rather than restrict it?” she asked.

A better system might involve hybrid care: In-person exams for certain types of prescriptions blended with virtual follow-ups, for instance. But Schwamm cautioned against over-regulating telehealth prescriptions, given that clinical guidelines evolve faster than federal and state policies typically do.

“Whenever you put these kinds of restrictions in place, you are restricting access to care,” he said. “Do we need to require, and is it good medical practice, to require by regulation that the person come in-person? I would argue that we just don’t know.”

It’s complicated.

Midweek update

David Ermer–CDC, Congress, COVID-19, No Surprises Act, OPM, Telehealth, U.S. Healthcare, Uncategorized–
Thanks to Alexandr Hovhannisyan for sharing their work on Unsplash.

From Capitol Hill, Roll Call reports

Third time’s a charm. Or so Democrats hope as they attempt to negotiate a third COVID-19 funding deal after their previous two bipartisan agreements — one for $15.6 billion in domestic and international aid, and a second for $10 billion in only domestic funds — stalled out. 

The House is taking the lead on the latest iteration. But it’s not yet clear whether they’ll hold out for a bipartisan, bicameral agreement or attempt to move a Democrat-led version that would provide more funding, closer to President Joe Biden’s original $22.5 billion request. 

“All the options are on the table,” House Majority Leader Steny H. Hoyer, D-Md., said Wednesday. “But it’s critical to get it done. And the fastest way to get it done is have an agreement on the four corners.” 

From the No Surprises Act front, the U.S. Court of Appeals for the Fifth Circuit has granted the federal government/appellant’s “unopposed motion to stay further proceedings in this court pending ongoing rulemaking proceedings involving provisions of the No Surprises Act, with a status report due every sixty (60) days.” It’s worth noting that the final independent dispute resolution rule has not yet appeared on the OMB’s Office of Regulatory Affairs reginfo.gov site.

From the Omicron and siblings front, Fierce Healthcare tells us

Reported cases of COVID-19 and hospitalizations for the disease are on the rise across most of the U.S., with the Centers for Disease Control and Prevention (CDC) recently shifting many counties in the Northeast to medium or high levels of community risk. * * *

COVID-19 hospitalizations—which have become the CDC and other public health experts’ preferred metric for decisionmaking—have similarly begun to tick upward over the past month.

After reaching a seven-day average low of 1,426 daily admissions in early April, national admissions have continually increased and exceeded the seven-day average of 2,400 daily hospitalizations late last week. These new admissions represented an 11% increase over the previous week’s seven-day average, according to the agency, but were still nearly 90% below the January peak of more than 21,500 average daily admissions.

From the opioid epidemic front, the Wall Street Journal reports

Drug-overdose deaths in 2021 topped 100,000 for the first time in a calendar year, federal data showed, a record high fueled by the spread of illicit forms of fentanyl throughout the country.

More than 107,000 people in the U.S. died from drug overdoses last year, preliminary Centers for Disease Control and Prevention data released Wednesday showed, roughly a 15% increase from 2020. The proliferation of the potent synthetic opioid fentanyl has been compounded by the destabilizing effects of the Covid-19 pandemic on users and people in recovery, according to health authorities and treatment providers. 

The U.S. has recorded more than one million overdose deaths since 2000, and more than half of those came in the past seven years. 

“We’ve never seen anything like this,” said Robert Anderson, chief of the mortality-statistics branch at the CDC’s National Center for Health Statistics, regarding fentanyl’s impact on the numbers.

From the telehealth front, Healthcare Dive informs us

Telehealth visits for COVID-19 diagnoses fell in February, mirroring the sharp decline in new cases of the virus reported to the Centers for Disease Control and Prevention after January’s omicron-driven peak, according to Fair Health’s monthly telehealth claims tracker.

Overall telehealth use also slowed, falling 9.3% in February across the country. Virtual visits were 4.9% of all medical claim lines, down from 5.4% in the prior month.

With declining COVID-19 cases generating fewer telehealth sessions, mental health conditions accounted for a greater share of all diagnoses conducted via virtual platforms, according to the Fair Health data released Monday. Mental health diagnoses rose to about 64% of telehealth claims, up from 60% in January.

The FEHBlog is happy that people are using telehealth for mental healthcare,e which strikes the FEHBlog as a good, productive fit.

From the healthcare business front, Healthcare Dive reports

Advocate Aurora Health and Atrium Health said Wednesday they plan to merge, creating one of the nation’s largest nonprofit health systems with $27 billion in combined revenues and 67 hospitals across six states.

Board members from both systems unanimously approved the agreement, which is subject to regulatory review. The combined entity will be led by both CEOs for the first 18 months, at which time Advocate’s CEO Jim Skogsbergh will retire, leaving Atrium’s CEO Eugene Woods as sole leader.

Advocate and Atrium will have an equal number of board seats. Atrium’s board chair Edward Brown will first serve as chair until the end of 2023, followed by a two-year term for Advocate’s chair Michele Richardson.

The health systems’ joint press release adds

The new organization will have a combined footprint across Illinois, Wisconsin, North Carolina, South Carolina, Georgia and Alabama. It will serve 5.5 million patients, operate more than 1,000 sites of care and 67 hospitals, employ more than 7,600 physicians and nearly 150,000 teammates, and have combined annual revenues of more than $27 billion.

That’s an interesting combination.

Health Payer Intelligence calls attention to

Six technology vendors [who] were highlighted for their abilities to address one of the six main points of friction between payers and providers that leading healthcare organizations strive to address, according to a KLAS report that is part of the KLAS Payer/Provider Initiative.

KLAS launched the Payer/Provider Initiative to identify points of friction between payers and providers and to highlight strong collaboration case studies.

The six payer-provider challenges that leading healthcare organizations tackled were prior authorization, value-based care, payer-provider interoperability, denials, credentialing, and patient billing.

From the OPM front, Federal News Network tells us

Agencies have to choose two out of four new focus areas to help improve their workforce over the next four years.

Deciding which options are most impactful gives agencies flexibility in how they approach new workforce objectives from the Office of Personnel Management.

Although OPM’s federal workforce priorities report, released on May 10, asks agencies to focus on only two of the four focus areas, implementing all four can help agencies resolve bigger workforce issues.

Among four primary priorities and four enabling priorities, OPM hopes agencies can implement proactive approaches to common issues, such as recruitment challenges.

From OPM’s federal workforce priorities report via Federal News Network

Tuesday’s Tidbits

David Ermer–COVID treatment, COVID-19, Federal employment benefits, Patient safety, Rx coverage, Telehealth, U.S. Healthcare–
Photo by Patrick Fore on Unsplash

From the Omicron and siblings front

  • The Wall Street Journal has updated its article on Covid boosters.
  • The Institute for Clinical and Economic Review (ICER) today released “a Final Evidence Report assessing the comparative clinical effectiveness and value of [specific] outpatient treatments for COVID-19 [, principally Pfizer’s pill Paxlovid and Merck’s pill molnupiravir ].

A majority (11-2) found current evidence is not adequate to demonstrate a net health benefit when molnupiravir is compared to symptomatic care alone.

All panelists (13-0) found that current evidence is adequate to demonstrate a net health benefit when Paxlovid is compared to symptomatic care alone.

Due to uncertainty in the net health benefit for molnupiravir, a majority of panelists voted that it represents “low-to-intermediate” long-term value for money.

A majority of panelists found that Paxlovid represents “high” long-term value for money.

  • ICER presented at the OPM/AHIP carrier conference last month. ICER “is an independent non-profit research institute that produces reports analyzing the evidence on the effectiveness and value of drugs and other medical services. ICER’s reports include evidence-based calculations of prices for new drugs that accurately reflect the degree of improvement expected in long-term patient outcomes, while also highlighting price levels that might contribute to unaffordable short-term cost growth for the overall health care system.”
  • Speaking of the Covid pills, STAT News discusses the use of telehealth services to prescribe them. The upshot, as the FEHBlog understands it, is while using telehealth for this purpose is convenient for patients, experts are unsure whether the telehealth service provides adequate follow-up care to the patient.

Also, from the Rx coverage front, the Food and Drug Administration issued a news roundup today.

From the healthcare business front, BioPharma Dive reports

Pfizer has agreed to acquire Biohaven Pharmaceuticals for $11.6 billion in a deal that turns an existing alliance on a fast-selling migraine drug into a big bet on its future growth.

Pfizer will pay $148.50 per share in cash for each Biohaven share it doesn’t already own, representing a roughly 79% premium to the company’s Monday closing price and a 33% premium to its average share price of $111.70 over the last three months. The deal, which is expected to close early next year, is by far the biggest biotech buyout of 2022, according to data compiled by Biopharma Dive.

Announced Tuesday, the acquisition hands Pfizer full rights to Nurtec ODT, a pill that’s approved in the U.S. and other countries for the treatment and prevention of migraines. Biohaven’s pipeline also includes an experimental nasal spray for migraines, zavepegant, that’s been submitted to U.S. regulators, as well as five additional, preclinical treatments that block the same protein target.

From the mental health parity front, the Labor Department’s Employee Benefits Security Administration announced that the agency will be holding a mental health parity compliance assistance webcast on May 24 from 2-3 pm ET. Here is a link to the announcement which explains how to register for the webcast.

From the patient safety front, the Leapfrog Group “released the spring 2022 Leapfrog Hospital Safety Grade, which assigns a letter grade to nearly 3,000 U.S. general hospitals based on over 30 measures of patient safety.”

At HospitalSafetyGrade.org, the public can find detailed information about a hospital’s performance on patient experience and other safety measures used to grade hospitals.

Across all states, highlights of findings from the spring 2022 Leapfrog Hospital Safety Grade include:

Thirty‐three percent of hospitals received an “A,” 24% received a “B,” 36% received a “C,” 7% received a “D,” and less than 1% received an “F.”

Five states with the highest percentages of “A” hospitals are North Carolina, Virginia, Utah, Colorado, and Michigan.

There were no “A” hospitals in Wyoming, West Virginia, the District of Columbia, or North Dakota.

From the medical research department, Medscape informs us

Eight modifiable risk factors were linked to more than one in three cases of Alzheimer’s disease and related dementia in the U.S., a cross-sectional analysis showed.

The eight risk factors — midlife obesity, midlife hypertension, physical inactivity, depression, smoking, low education, diabetes, and hearing loss — were associated with 36.9% (95% CI 36.5-37.3) of Alzheimer’s and dementia cases, reported Roch Nianogo, MD, PhD, of the University of California Los Angeles, and Deborah Barnes, PhD, MPH, of the University of California San Francisco, and co-authors.

The factors most prominently associated with Alzheimer’s and dementia were midlife obesity, at 17.7% (95% [Confidence Interval] CI 17.5-18.0); physical inactivity, at 11.8% (95% CI 11.7-11.9); and low educational attainment, at 11.7% (95% CI 11.5-12.0).

“We published a similar study a little more than 10 years ago, and the most important risk factors then were physical inactivity, depression, and smoking,” Barnes told MedPage Today.

“Today, the top three risk factors are midlife obesity, physical inactivity, and low education,” she observed. “This is important because it suggests that the growing number of people who are obese in the U.S. could have a major long-term impact on dementia rates.”

From the clarification front, the FEHBlog often reminds folks that federal employees who retired under the Civil Service Retirement System before 1984 are not eligible for free Medicare Part A. The FEHBlog dug into this issue today, and he discovered this 2013 Reg Jones Q&A on this topic that the Federal Times published.

Q. I retired in 2009 under CSRS. I am close to 65, and the answer to one of the questions asked states that people in CSRS are not eligible for Medicare because they didn’t pay into Social Security.

I was in CSRS before the change to FERS and stayed with CSRS. I had Medicare deductions taken from my pay from 1983-84 till I retired in 2009.

Do the Medicare funds I paid since 1983 make me eligible for Medicare or just part of it?

So which is right? I need to know so I can do what needs to be done — enroll or not. I’m currently insured under federal BCBS.

A. CSRS employees who retired before Dec. 31, 1983, aren’t eligible for Medicare Part A. Nor are CSRS employees who retired after that date but before having Medicare deductions taken from their pay for 10 years.

On the other hand, they are eligible to enroll in Medicare Part B, which is open to everyone 65 or older.

Consequently, the cadre of 65 and older federal annuitants without Medicare A is larger than the FEHBlog understood. This cadre is relevant to the Postal Reform Act because that law keeps Postal annuitants over aged 65 without Medicare Part in the legacy FEHBP.

Monday Roundup

David Ermer–CDC, Congress, COVID-19, Federal employment benefits, OPM, SDOH, Telehealth, U.S. Healthcare–
Photo by Sven Read on Unsplash

From the Capitol Hill front, Roll Call reports

President Joe Biden and top Democrats have agreed to a GOP demand to disentangle a stalled COVID-19 response package from a separate supplemental request for military and humanitarian aid to Ukraine so the latter can move more quickly.  * * *

Senate Minority Leader Mitch McConnell didn’t reject the outlines of the Democrats’ offer in brief remarks Monday. “It may adjust some in the process, but we need to do it quickly,” McConnell told Punchbowl, while adding he was pleased that COVID-19 funds and an immigration-related dispute that tangled up the pandemic relief bill would be handled separately.

A separate, bipartisan $10 billion aid package for the ongoing pandemic response effort has been held up for a month due to a dispute over the so-called Title 42 program that allows migrants to be turned away at the border to prevent the spread of COVID-19. Biden has proposed to end the Trump-era program as of May 23, which Republicans and several Senate Democrats have said they oppose without alternatives in place to stem the expected surge of migrants.

From the Omicron and siblings front, the Centers for Disease Control has updated its long Covid website. The CDC explains

What You Need to Know

Post-COVID conditions can include a wide range of ongoing health problems; these conditions can last weeks, months, or years.

Post-COVID conditions are found more often in people who had severe COVID-19 illness, but anyone who has been infected with the virus that causes COVID-19 can experience post-COVID conditions, even people who had mild illness or no symptoms from COVID-19.

People who are not vaccinated against COVID-19 and become infected may also be at higher risk of developing post-COVID conditions compared to people who were vaccinated and had breakthrough infections.

There is no single test for post-COVID conditions. While most people with post-COVID conditions have evidence of infection or COVID-19 illness, in some cases, a person with post-COVID conditions may not have tested positive for the virus or known they were infected.

CDC and partners are working to understand more about who experiences post-COVID conditions and why, including whether groups disproportionately impacted by COVID-19 are at higher risk.

From the SDOH front, STAT News tells us

Widely used physician guidelines that ignore patients’ race and ethnicity could be doing more harm than good when it comes to catching diabetes in people of color. New research, published in the Annals of Internal Medicine on Monday, suggests that people from certain racial and ethnic groups should be screened for diabetes at lower body mass index than non-Hispanic white people — a recommendation that contradicts recent guidelines from the United States Preventive Services Task Force.

It’s an admittedly tricky proposition, to reaffirm the role of race and ethnicity at a time when medicine is trying to rid itself of race-based tools — such as an algorithm used to assess kidney function — that have contributed to the large health disparities in the United States. The paper’s authors recognized as much in interviews with STAT.

They argue, however, that using a one-size-fits-all approach to screening, when diabetes is two to four times more prevalent and more deadly in Black, Hispanic, and Asian Americans, is likely to result in underdiagnosis of the disease, and widen health gaps.

From the healthcare business front, Fierce Healthcare informs us

Telehealth giant Amwell saw telehealth visits grow to 1.8 million in the first quarter of 2022, up 16% compared to the tail end of 2021 and up about 11% from 1.6 million virtual care visits during the same time last year.

The total number of active providers using its virtual care platform grew to around 102,000 during the quarter, up 25% compared to 81,000 a year ago. * * *

Amwell has been making significant investments in its new virtual care platform, Converge. Announced in April, Converge makes all of Amwell’s products and programs, plus third-party applications, available in one place. * * *

The company is in the process of migrating its customers over to the new platform. About 10% of the company’s virtual visits occurred through Converge in the first quarter, up 40% compared to the fourth quarter, said Ido Schoenberg, chief executive officer. The first wave of upgrades will focus on hospital systems and then move to health plans, executives said. 

“The market increasingly appreciates that automation is a compelling new element of digital healthcare and they require a trusted partner to provide integrated automation into their care delivery workflows,” he told analysts during the company’s first-quarter earnings call Monday.

Healthcare Dive meanwhile looks back at large health insurers’ reports on first-quarter 2022 earnings.

FedWeek compares annuitant eligibility rules for FEHB vs. FEDVIP and concludes that FEDVIP has more flexible rules. Why not?, considering that FEHB provides a government contribution while FEDVIP is enrollee pay-all. It’s still worth knowing the differences.

Weekend update

David Ermer–Congress, COVID-19, OPM, Telehealth, U.S. Healthcare–
Photo of Texas Bluebonnets by Ryan Riggins on Unsplash

From the Capitol Hill front, the House of Representatives and the Senate will be holding Committee business and floor voting this week.

From the Omicron and siblings front, the Wall Street Journal reports

New Omicron subvariants are proliferating even in the face of significant protection from vaccinations and prior infection, as policy makers consider measures including open-ended vaccination drives to keep the evolving virus at bay.

Much of the U.S. population already had some level of antibodies to the virus when Omicron hit late last year, the Centers for Disease Control and Prevention estimates. That likely shielded many from more-severe disease, but the variant still fueled a record case surge and the second-highest peak in Covid-19 deaths. Immune defenses bolstered by the massive wave appear to be muting the impact of the yet-more-infectious Omicron variants even as cases and hospitalizations increase once again. 

These recurring run-ins with a changing virus demonstrate the challenge of maintaining long-lasting defenses, even as Covid-19 vaccines and exposures build up protection against the virus’s worst outcomes. * * *

“To decrease the [variant] changes, it’s about decreasing the space the virus can actually play in and limiting that space to evolve,” said Ali Ellebedy, an immunologist at Washington University School of Medicine in St. Louis.

From the healthcare business front —

The Wall Street Journal informs us

Some hospitals grappling with rising nurse salaries are seeking to raise prices by up to 15%, touching off contract fights with health insurers and businesses and threatening higher premiums.

HCA Healthcare Inc. and Universal Health Services Inc. are among the hospitals asking health plans to pay them more for care to offset mounting nurse costs.

Neither of the chains would specify the price increases they are requesting, but people familiar with negotiations say some hospitals are asking to increase their prices by 7.5% to 15%.

The requests are more than the 4% to 6% price increases that hospitals typically seek, according to employers and insurers. The hospitals usually won an average 3% price increase in recent years, according to Altarum, a nonprofit that does healthcare research.

If hospitals win heftier price increases they are seeking this year, that would likely result in higher premiums for employers and workers.

But insurer and employer groups, which push for lower-cost contracts or negotiate them on behalf of coalitions of businesses, are rejecting the requests. The groups say the priciest hospitals can absorb higher labor costs without raising their rates.

“Most of the employers have been unable to increase the wages of their workers for years primarily because of the increasing cost of healthcare,” said Karen van Caulil, chief executive of employer coalition Florida Alliance for Healthcare Value.

STAT News offers its perspective on these developments here.

From the OPM call letter front, OPM has encouraged plans to offer discounted infertility treatment benefits. The FEHBlog discovered Progyny which offers fertility testing and a network of infertility specialists. Fierce Healthcare reports on Progny’s favorable first quarter 2022 financial results. The article adds

The first fertility benefits management company to ever go public, Progyny has grown its client base to more than 265 large self-insured employers, up from 179 clients a year ago. Those clients represent about 3.9 million covered lives.

The company brought on 85 new self-insured employers in the first quarter, representing 1.2 million covered lives, [CEO Pete] Anevski told Fierce Healthcare. * * *

The company says it offers a “purpose-built, data-driven and disruptive platform” that delivers “superior clinical outcomes in a cost-efficient manner.” Progyny’s benefits solution empowers patients with education and guidance from a dedicated Patient Care Advocate and provides access to a premier network of fertility specialists using the latest science and technologies.

Company executives tout Progyny’s industry-leading clinical outcomes, noting that for the sixth straight year, the company significantly outperformed as compared to the national averages for fertility outcomes released by the Centers for Disease Prevention and Control and Prevention. 

Progyny’s pregnancy rate improved to 17% better than the national average, while its live birth rate, which had been 25% better than the national average a year ago, is now 27% better, Anevski said.

“To give you a sense for just how impactful this is, our higher live birth rate means that Progyny clients need to fund on average significantly fewer rounds of treatment than they otherwise would, had they be using either a carrier program or one of the venture capital-backed startups,” he said. “This once again reveals that Progyny’s uniquely helping people to get pregnant faster, have healthier pregnancies and deliver healthy babies.”

Worth a look.

From the telehealth front, Fierce Healthcare informs us

Cerebral is among a handful of virtual care startups that prescribe controlled substances without patients seeing a doctor in-person. * * *

Last week, Insider reported that the Drug Enforcement Agency (DEA) is investigating the company. U.S. DEA agents interviewed former Cerebral employees about issues with clinician licensing and about allegations that some patients had set up multiple accounts to obtain more drugs, Insider reported, citing sources.

According to Insider’s most recent story, the grand jury subpoena demands documents such as Cerebral’s policies and procedures regarding controlled substances and documents related to Cerebral’s relationship with the online pharmacy Truepill.

Earlier this week, Truepill, which is reportedly Cerebral’s preferred pharmacy, said it was temporarily halting prescriptions for Adderall and other controlled substances used to treat attention-deficit/hyperactivity disorder (ADHD).

Out of an abundance of caution, Truepill is temporarily pausing all fulfillment of schedule 2 substances while we evaluate appropriate next steps,” the company said in a statement to Fierce Healthcare.

The Wall Street Journal was the first to disclose these shenanigans.

Weekend update

David Ermer–ACA, Congress, COVID-19, Rx coverage, Telehealth–

Happy Law Day 2022!

The House of Representatives and the Senate will be engaged in Committee business and floor voting this week.

From the Omicron and siblings front

The Wall Street Journal informs us

As new Omicron variants further infiltrate the U.S., a jumble of signals suggest the latest increase in Covid-19 infections hasn’t sparked a commensurate surge in severe illness even as risks remain.

Covid-19 virus levels detected in wastewater in the Northeast, the first region to see significant concentrations of the easily transmitted Omicron BA.2 variant, appear to have flattened out in the past two weeks. Covid-19 hospital admissions have risen in the region, but they remain far below levels during earlier surges that indicated widespread severe illness and taxed healthcare facilities. 

“This wave of Covid in the United States, in the places where it is, is not dangerous in a way that prior waves of Covid were,” said Megan Ranney, an emergency physician and academic dean at Brown University’s School of Public Health.

The fast-mutating virus still poses risks, she said. 

The new Fortune Well website offers timely guidance on the symptomatic differences between Covid and allergies.

Bloomberg Prognosis posted its late April Word Covid resilience rankings. Norway rides atop the rankings for the second month in a row The U.S. dropped six rankings to 30th. The article notes that the U.S. and the U.K are “weighed down by ongoing fatalities—their Covid Mortality Rate scores are among the worst of developed economies.

From the Affordable Care Act front, Health Affairs Forefront posted the ever-reliable Katie Keith’s first of three articles on the final 2023 ACA notice of benefit and payment parameters that was issued last week. This article’s section on Essential Health Benefits is relevant to FEHB carriers as each of them must select an EHB benchmark in order to apply the ACA’s restriction on annual dollar limits. The article’s section on Medical Loss Ratio is relevant to community-rated FEHB plans who generally use that benchmark to determine the reasonableness of their prices.

From the Rx coverage front, Medcity News reports “Bristol Myers Squibb drug Camzyos has received FDA approval for treating obstructive hypertrophic cardiomyopathy, a rare and potentially fatal heart disorder. The drug is projected to become a blockbuster seller, and its approval marks a payoff for BMS’s 2020 acquisition of the medicine’s developer, MyoKardia.”

From the telehealth front, mHealth Intelligence informs us

A majority of clinics (79 percent) used telemedicine to provide contraceptive services during the COVID-19 pandemic, according to a recent study published in the journal Reproductive Health.

For the study, researchers surveyed 907 US providers and clinic staff between April 10, 2020, and Jan. 29, 2021. They collected data on contraceptive service delivery challenges and strategies, including telehealth. The sample of respondents included physicians (17 percent), advanced practice clinicians (41 percent), registered nurses (16 percent), and health educators and social workers (11 percent).

The respondents practiced in a wide array of care settings, including youth clinics/school-based health centers or college health centers (36 percent), primary care clinics or health departments (29 percent), family planning clinics (22 percent), and independent abortion care clinics (4 percent). They saw, on average, 3,184 contraceptive patients annually.

Though only 11 percent of the clinics offered telemedicine for contraceptive services before the pandemic, this figure shot up to 79 percent after March 2020.