JustCare

Tag: Data

  • Coronavirus: What to think about Omicron

    Coronavirus: What to think about Omicron

    Most of us are a bit at a loss as to what to think about Omicron, let alone how to pronounce it. FWIW, I like to say Oh-my-cron! It’s yet another curve ball in the battle to conquer the novel coronavirus and liberate the world from this ghastly pandemic. StatNews has a lot to say about it.

    First, to date, there are still very few documented cases of Omicron, although it has been detected in 19 states. We do not yet have lab results that reveal whether vaccinated individuals are well protected against Omicron. But, researchers are now investigating how well the antibodies of vaccinated people fare against Omicron.

    The good news: Many experts believe that vaccinated individuals are protected from any serious illness and death, even if they might get sick from the virus.

    And, Helen Branswell reports for StatNews that the latest data from South Africa, based on 42 cases, suggests that Omicron does not appear to lead to as severe symptoms as other versions of the virus. For example, most people with the virus did not need extra oxygen or substantial care and very few needed intensive hospital care. Few developed Covid pneumonia; of those, only one had been vaccinated.

    While it is still early days and scientists and public health experts must draw conclusions based only on anecdotal evidence, it appears that vaccinated people need not worry about severe symptoms if they do contract Omicron. In the words of Anthony Fauci, “There’s every reason to believe, as we talk about boosters, when you get a level high enough, that you are going to get at least some degree of cross-protection, particularly against severe disease,”

    Here’s more from Just Care:

  • Insurers use prior authorization to keep people from getting care

    Insurers use prior authorization to keep people from getting care

    Private insurers are increasingly using prior authorization as a tool to keep people from getting needed care. Allison Bell reports for Think Advisor on what physicians are saying about the hoops they must jump through to ensure their patients’ care is covered. If you are enrolled in traditional Medicare, you do not have to worry about prior authorization rules; you and your physicians do not have to seek approval for care in advance of treatment. If you are enrolled in a Medicare Advantage plan, you might find that prior authorization rules make it harder for you to get needed care.

    In a survey for the American Medical Association, one in three physicians do not believe that there is clinical validity to insurers’ prior authorization programs. The rules are virtually never or never based on medical society guidelines. One in 11 physicians say that these programs hurt patients. Nearly one in four physicians say patients often do not comply with medical guidance because of prior authorization rules.

    Prior authorization rules are burdensome and time-consuming for physicians. They say that they typically have 40 procedures for which they need to secure prior authorization each week.

    One big issue is that the insurers do not disclose the terms of their prior authorization programs. Because they are not open to public scrutiny, they can impose them without having to justify them. Moreover, they can impose them with little worry of a big expose on their lack of validity.

    For sure, prior authorization requirements lower health care spending; they keep people from getting care. But, there is no comprehensive reliable evidence insurers can point to that shows that these requirements improve quality. Indeed, if you believe the physicians, they lower quality, delay care and force physicians to spend more time on paperwork that they could be spending with their patients.

    Recently, CMS removed barriers to prior authorization in most federal programs, but not Medicare Advantage. It’s time to go the next step. Congress should either prohibit their use or require full disclosure and justification for each rule insurers use.

    Here’s more from Just Care:

  • Expanding Medicare Advantage is a bad idea

    Expanding Medicare Advantage is a bad idea

    In an op-ed for Health Affairs, Ken Terry and David Muehlestein explain why expanding the Medicare private insurance option to everyone or “Medicare Advantage for All” is a bad idea.  Among other things, we can’t distinguish among Medicare Advantage plans or prevent plans from jeopardizing the health and well-being of their members through narrow networks with poor quality providers, cumbersome administrative hurdles, inappropriate delays and denials of care and high out-of-pocket costs. According to one recent NBER paper by Jason Abaluck at Yale et al., picking the wrong Medicare Advantage plan could kill you.

    Here’s what we know:

    • Medicare Advantage per member costs are higher than per member costs in traditional Medicare and have been since Medicare Advantage’s inception.
    • More than one in three people in Medicare Advantage plans are in plans with narrow provider networks.
    • In Alaska and Wyoming, fewer than five percent of people with Medicare are in MA plans. No MA plans are available in Alaska, and Wyoming has only one plan.
    • Medicare Advantage plans are not as good at reining in per-member costs as traditional Medicare. In 2019, MA costs increased 6.3 percent while traditional Medicare costs increased 2.4 percent. On average, per member payments to Medicare Advantage are 2 percent higher than traditional Medicare.
    • Medicare Advantage plans profit handsomely from Medicare, with annual gross margins of $1,608 per member between 2016 and 2018. They are driving up Medicare Part B premiums and draining the Medicare Trust Fund.

    Here’s what we don’t know:

    • Why does Medicare Advantage have faster cost growth per member than traditional Medicare?
    • Which, if any, Medicare Advantage plans offer better quality care than traditional Medicare? The data is not available. Studies that report overall data on Medicare Advantage plans are misleading at best. What’s important to know is individual plan performance. Reports of average performance are analogous to saying that houses in a community are better than average. The question is which ones specifically.
    • Data show that people with high costs tend to leave Medicare Advantage at high rates.
    • Health insurers say they spend 20 to 40 percent less on care than traditional Medicare. We know that they are paying providers about the same rate as traditional Medicare. Which Medicare Advantage plans are withholding needed care and which are preventing costly overtreatment? How much money is going to profits and would that money be better spent on additional benefits?

    Here’s more from Just Care:

  • Coronavirus: Senator Casey proposes legislation to protect nursing home residents and workers

    Coronavirus: Senator Casey proposes legislation to protect nursing home residents and workers

    As of now, more than 170,000 older Americans living in long-term care facilities and their caregivers have died from COVID-19. That works out to more than one in three people in the US who have died from COVID-19. Senators Casey, Whitehouse, Warnock, Booker and Blumenthal have introduced legislation to bring down the number of nursing home deaths. 

    Large numbers of nursing homes and other long-term care facilities were unprepared for the novel coronavirus. They did not have the personal protective equipment and other resources they needed to ensure the safety of their staff and residents.

    If passed, the COVID-19 Nursing Home Protection Act would provide additional money to states to ensure that residents and workers had necessary resources for their safety. Money would be available for infection control help and for organizing local workers to assist with both patient care and managing COVID-19 outbreaks. Money could also go towards ensuring everyone in these facilities got vaccinated.

    Significantly, the COVID-19 Nursing Home Protection Act would also mandate that the Department of Health and Human Services collect and publicly report demographic data regarding the number of cases of the virus and virus deaths in nursing homes. Among other things, information on age, race and ethnicity would be required.

    The pandemic’s toll has been greatest on older people of color. Nursing homes with high proportions of Black and hispanic patients had disproportionately high case and death rates. Three times more people of color died from COVID-19 in these facilities than in facilities that had mainly white patients.

    Nursing home residents are among the most vulnerable Americans. The COVID-19 Nursing Home Protection Act is designed to protect them. The Democrats have majorities in the House and the Senate. The question is will some of the more moderate members of this Democratic Congress support this legislation or will they put the kibosh on it?

    Here’s more from Just Care:

  • We pay a lot more than we realize for prescription drugs

    We pay a lot more than we realize for prescription drugs

    One thing the overwhelming majority of Americans agree on is that drug prices are too high and that the government should rein them in. Incredibly, we pay a lot more than we even realize for prescription drugs. In a new article for Health Affairs, Don Light and Jonathan Darrow explain the many additional ways we pay for drugs.

    You might have heard that Americans pay twice for prescription drugs. On top of a drug’s retail price, federal and state governments contribute billions of taxpayer dollars each year to pharmaceutical companies. Those dollars fund drug research.

    Light and Darrow explain that we pay a third way for drugs. The government gives pharmaceutical companies special tax benefits. They get tax credits and they can deduct the total cost of their research in year one rather than having to amortize those costs over several years.

    In addition, pharmaceutical companies get government payments for their drugs, at pretty much whatever price they set, through Medicare and other government insurance programs. Fifty years ago, most people did not have prescription drug coverage; insurance only paid for 12 percent of retail drug costs. In 2017, insurance paid for 86 percent of these costs. Insurance coverage drives up demand for drugs and rewards pharmaceutical companies.

    Of note, insurance has not helped with people’s out-of-pocket drug costs. They have remained about the same over the last 50 years, between $43 and $64 billion in total. But, drug insurance has also driven up medical costs, often requiring people to visit the doctor multiple times for prescriptions. And, it sometimes requires people to engage in step therapy, which can be cumbersome and of no value for people who need to go up further steps for drugs to meet their needs. People pay these costs directly in additional copays and indirectly in time and higher insurance premiums.

    And, what do we get for all that we pay? In many cases, very little. Of the 48 new drugs approved in 2019, 28 were not better than drugs already available. Of the remaining 20, patient benefit is not clear. Based on reviews, as few as two percent offer meaningful benefit.

    More than three in four dollars of pharmaceutical company spending goes to these new and not necessarily beneficial drugs. Consequently, billions in public money goes toward the development of many drugs that are unhelpful. We lack the data to know exactly how much drug companies receive from the public in total for the drugs they develop. We also don’t have a good handle on how efficacious many of these drugs really are.

    We do know that all of the 210 new drugs developed between 2010 and 2016 had government funding. The government contributed $100 billion for foundational research. Still, drug prices have increased dramatically. New cancer treatments, for example, now cost $10,000, up from $2,000 25 years ago.

    Darrow and Light argue that we need a full accounting of the direct and indirect ways pharmaceutical companies generate wealth. Transparency is needed. It would allow for a more thoughtful process for determining whether pharmaceutical company financial incentives are appropriate in relation to the benefits of the drugs they support.

    Here’s more from Just Care:

  • Health care: Where’s the data?

    Health care: Where’s the data?

    If we’ve learned anything during this novel coronavirus pandemic, it’s that the data matters. We need data to know what’s working and not working in our health care system, and how to fix problems. Not making data a priority is tantamount to ignoring issues of equity and access to care. And, yet, a national electronic health care data system does not yet seem to be either a Congressional or Biden administration priority.

    Rachana Pradhan and Fred Schulte report for Kaiser Health News that the government is not even collecting important data about the people receiving COVID vaccinations. As a result, we don’t know who has received and who is receiving the vaccine. We don’t know whether people less in need are getting the vaccine ahead of health care workers or the extent to which minority populations are being discriminated against.

    President Biden recognizes that data matters. Yet, the federal government is literally spending trillions of dollars on health care, including on the vaccine, and it has little data to show for it, except in traditional Medicare. If the goal is to promote racial and social equity, to address issues of discrimination in health care, to ensure that critical treatments are available throughout the country, where they are needed, data must be a top priority.

    Right now, the available data reveal that Black Americans are not getting vaccinated at the same rate as whites. But, the data is limited. And, it’s hard to know where vaccinations are needed to reach herd immunity.

    Each state has a vaccine registry, but the sophistication of the registry varies by state. It’s inexcusable that vaccination data collection is not standardized and, in this technological era, states are not collecting and reporting to HHS all the needed data. It’s beyond inexcusable that registries do not even exist for drugs or medical equipment; when equipment is defective or drugs are causing harmful side effects, the data is generally not available.

    Real-time data does not exist for health care services, including vaccinations. There is no national public health system in charge of data. Moreover, each of the 64  immunization registries that collects vaccination data is siloed, unable to connect with one another.

    The CDC wants the name, address, sex, birthday, race, ethnicity and vaccine site for every person vaccinated. It does not ask for occupation, so few states collect that information. And race and ethnicity information is often missing. In many states, half the time, race and ethnicity information is not collected.

    Electronic health records companies that provide software to hospitals and other facilities said they are scrambling to modify software to accommodate data reporting requirements that vary by state.

    There are plans in place to invest in better data collection at the national level, when it comes to vaccines. But, really, data collection only for vaccines? For our individual and collective health, we need a single national system collecting real-time time that flows directly to the appropriate federal government agency.

    We can learn a lot about strengths and deficiencies in our health care system through a national electronic database. We could develop plans to address deficiencies. You have to wonder why Congress and the Biden administration are not making it data collection and reporting a priority.

    Here’s more from Just Care:

  • Debt among older Americans increasing in good part because of health care costs

    Debt among older Americans increasing in good part because of health care costs

    More older Americans are facing debt now than 20 years ago, reports the Employee Benefits Research Institute (EBRI). And the size of their debt is twice what it has been. One principal reason: Health care costs.

    Medicare only covers about half of a typical person’s health care costs, in large part because it does not pay for long-term supports and services. Expanding and improving Medicare for everyone in the US would help reduce debt significantly for older adults. Not only would it cover health care costs in full, without copays and deductibles, it would cover long-term care. Expanded Social Security benefits would also help tremendously.

    The government and businesses once helped to support older people in retirement to a far greater extent than they do today. Medicare covered a larger proportion of people’s health care costs and people did not have to rely as heavily on their Social Security benefits for basic needs as they currently do.

    According to EBRI, “American families with heads just reaching retirement or those newly retired are more likely to have debt — and higher levels of debt — than past generations.” The EBRI data show that 68.4 percent of older adults 55 and older faced debt in 2019, up from 53.8 percent in 1992. Fifty-seven percent of older adult heads of household between 65 and 74 carried debt in 2016. In 1998, 47 percent of them carried debt.

    The proportion of older adults 75 and older with debt is higher than it has been since 1992. In 2019, 51.4 percent of heads of household who were 75 and older carried debt. In 2007, 31.2 percent of them carried debt.

    Total debt for 50 to 64 year olds increased by 50 percent between 1992 and 2016, from $80,000 to $120,000. But, for all people 55 and older, average debt decreased a bit from $88,245 in 2010 to $82,481 in 2019.

    Older adults represent about 12 percent of people filing for bankruptcy. That’s five times the percentage of older adults who filed for bankruptcy 25 years ago.

    As wealthy people age, their debt tends to fall. As people with less wealth age, their debt tends to grow. And mortgage and credit card debt are most prevalent among people 70 and older.

    Blacks and Hispanics and people with low incomes are at severe risk of economic insecurity as they get older. They are more likely than white Americans to spend 40 percent of their income paying off their debt. They are most likely to have credit card debt and loan debt to pay for basic needs.

    Older adults also often have student loan debt to pay off. It can be their student loans or their kids’ loans.

    Here’s more from Just Care:

  • Who’s protecting older adults from financial exploitation

    Who’s protecting older adults from financial exploitation

    Every state has an agency that provides protective services to adults. These adult protective services agencies collect and report data on abuses, including financial exploitation. But, the GAO reports that the data collection and reporting is not what it needs to be to understand the scope of the problem nationally and help older adults, their families and society at large.

    As you might imagine, older adults can be easy targets for financial exploitation by family, friends and unknown predators. There are so many types of scams. And, older adults might lose the mental acuity needed to manage their money without being scammed. Their judgment might be impaired because of dementia. But, with a good understanding of the biggest issues, interventions can be developed to help them.

    Right now, state reporting of data to the US Department of Health and Human Services (HHS) is voluntary. According to the GAO, 11 states and territories out of 56 do not report any financial exploitation data at all. Fewer than half of all states, 24, provide HHS with detailed financial exploitation case data. And, only 27 provide detailed HHS with case data on the the type of perpetrator.

    Without this data, the federal government does not have the needed information to devise strategies to minimize financial exploitation and develop interventions to improve the lives of abused and neglected older adults.

    To be sure, states cannot collect complete information on financial exploitation of older adults. Many instances are not reported. Often older adult victims do not want to implicate family members. But, to the extent states have this data it is generally not easily shareable with the federal government and it should be.

    Because complete and accurate national financial exploitation data is not available, we do not know the extent to which property and funds of older adults are illegally or wrongfully used. According to the Consumer Financial Protection Bureau, banks reported actual losses and attempts at elder financial exploitation totaling $1.7 billion in 2017. As high as that might seem, it appears it could be closer to $50 billion if complete data were collected everywhere in the country.

    Recent studies in New York, Pennsylvania, and Virginia, however, suggest the cost is likely to be more than $1 billion in each state. The GAO recommends that HHS do more to ensure states report the information they collet. States tend not to submit data on the cost of financial exploitation of older adults to HHS because they do not feel the need to do so.

    Here’s more from Just Care:

  • Google buys Fitbit, allegedly for its devices, not its data

    Google buys Fitbit, allegedly for its devices, not its data

    In our bigger is better corporate culture, it’s appropriate that Google, primarily known for its ability to search the web for data, would buy Fitbit, primarily known for its ability to search our bodies for data. The explicit benefit for Google is a powerful edge in the marketplace of clinical trials, health plans and employer benefits, according to Mario Aguilar and Erin Brodwin of StatNews. Google claims it is buying Fitbit for its devices, not its data, though the data could be a goldmine.

    Google clearly sees its acquisition as valuable, paying $2.1 billion for Fitbit. In the employee benefit space, there’s revenue from employers who are looking to offer new benefits, like Fitbits, to their workers. In the clinical trial space, there’s also large revenue opportunities. Fitbits can offer help with heart, sleep and respiratory research.

    Google already has a health studies app. It lets people with Android cellphones participate in medical research.

    Fitbit has large tentacles in the employer and health insurance markets. Businesses offer workers its fitness trackers. Workers also use its health coaching programs and its Covid-19 symptom tracking platform. Several dozen Medicare Advantage plans offer Fitbits to their members.

    Of course, if Google were to use data from Fitbits, it would give it a greater competitive edge with others in the space. Google is claiming that it is not interested in the data, likely because acquiring this new data source is a concern for regulators. There are antitrust issues. Still, it appears that Google is free to use the Fitbit data, so it’s fair to assume it will.

    Here’s more from Just Care:

  • Why doesn’t HHS penalize pharmaceutical companies for disregarding rules requiring drug discounts at hospitals?

    Why doesn’t HHS penalize pharmaceutical companies for disregarding rules requiring drug discounts at hospitals?

    It’s not surprising that pharmaceutical companies are disregarding the rules for discounting drug prices at hospitals serving low-income populations. What is concerning is that HHS has done nothing to penalize them about this violation. Now, Ed Silverman, STAT, reports that at least 25 state attorneys general are suing HHS to penalize the drug companies.

    The discounts the pharmaceutical companies are supposed to offer are part of a federal program–340B–to ensure that hospital patients with low incomes can afford their outpatient drugs. About 12,700 hospitals participate in the program.

    But, pharmaceutical companies do not like it when hospitals do not dispense these drugs themselves. Many hospitals send the drugs to retail pharmacies for pickup or delivery. As a result, drug companies do not see patient claims data.

    Many advocates argue that the drug companies are violating federal law. At the same time, the pharmaceutical companies are making it harder for low-income populations to get needed drugs, in the middle of a pandemic, no less.

    The attorneys general say that the drug companies have no authority to make these data demands.  HHS should not allow them to flout the law. Pharmaceutical companies that are denying hospitals 340B discounts include Novartis, Eli Lilly, AstraZeneca, Novo Nordisk, Sanofi and United Therapeutics.

    Republicans and Democrats support the 340B drug discount program. But, the agency at HHS in charge of overseeing the 340B program, said it did not have the authority to enforce the discounts. Since then, hospitals and hospital pharmacists have sued HHS for not acting.

    PhRMA, the trade group that represents the pharmaceutical companies, argues that the 340B program does not have the force of law.

    Here’s more from Just Care: