April 20, 2021
AHIP Solutions SmartBrief
Top Stories
AHIP says a CMS rule requiring Medicare coverage of breakthrough medical devices does not sufficiently address patient safety concerns and could lead to fraud, waste and abuse. The Medicare Coverage of Innovative Technology rule, which has been delayed for CMS review, also poses operational challenges, and projections underestimate the number of devices that will qualify, AHIP says.
Full Story: Health Payer Intelligence (4/19) 
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A Kaiser Family Foundation analysis found the top 50 drugs paid for by Medicare Part B made up 80% of total Part B drug spending, and the 250 top-selling Medicare Part D drugs that had one manufacturer and no generic or biosimilar accounted for 60% of net Part D spending. "This analysis shows that Medicare Part D and Part B spending is highly concentrated among a relatively small share of covered drugs, mainly those without generic or biosimilar competitors," the report said.
Full Story: Kaiser Family Foundation (4/19) 
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WEBINAR | Populations at Risk
Learn how to identify your members' chronic health care needs, the impacts of social determinants of health, and how clinical evidence can help optimize outcomes in our May 20 webinar. Register here.
Providers & Suppliers
Health care professionals and organizations are working to understand and address racism in health care and health equity, and experts say it requires systemic change as well as creating community partnerships. "We need to acknowledge, openly, loudly, that there were flaws in the way we treated minority communities which have led to the underlying health care disparities that we see today," New Orleans East Hospital CEO Dr. Takeisha Davis said.
Full Story: MedCity News (4/19) 
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Learn the secret to MAO enrollment success
Competition, compliance and cost pressures drive the need for Medicare Advantage plans to adopt a transparent and scalable member enrollment system. Learn how Edifecs has uncovered the secret to MA enrollment success. Download the datasheet.
Medical Update
CDC: Americans 16 and up can now get COVID-19 vaccine
(Joe Raedle/Getty Images)
All US individuals ages 16 and older can now receive a COVID-19 vaccine, according to the CDC, which said those with underlying medical conditions that raise the risk for serious complications should be given priority. Nearly 211.6 million COVID-19 vaccine doses had been administered in the US as of Monday, with more than 85.3 million people now fully vaccinated.
Full Story: Reuters (4/19),  Reuters (4/20) 
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The number of new COVID-19 cases in the US fell by 0.4% for the week ending April 18, following four consecutive weeks of increase, but the country still logged almost 70,000 new cases per day last week as variants continue to spread. The average number of patients hospitalized with COVID-19 climbed by 5% to over 41,000, marking the third straight weeks of increase, while related fatalities dropped 2.8%.
Full Story: Reuters (4/19) 
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Higher consumption of red and processed meat was linked to poorer cardiac function, adverse ventricular remodeling and higher arterial stiffness, while higher consumption of oily fish was linked to greater arterial compliance and better ventricular function, according to a study presented at the virtual ESC Preventive Cardiology 2021. The findings were based on data from 19,408 individuals with cardiovascular magnetic resonance imaging data.
Full Story: Physician's Briefing/HealthDay News (4/19) 
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Free Annual Notice of Change Comparison Report
Are you dreading the review and comparison of the updated CMS model documents? Let Toppan Merrill do the review for you. We'll provide you with a report showing each change, the exact location and its degree of impact. Reserve a FREE copy of the Annual Notice of Change (ANOC) Comparison Report today!
Emerging Trends: Social Determinants of Health
HealthPartners and Allina Health are partnering on a five-year value-based contract to prevent hospital admissions and readmissions by boosting routine and preventive care, sharing electronic health information, and screening for social determinants of health. HealthPartners members who get care at Allina Health hospitals or clinics will be automatically enrolled in the new arrangement, and Allina Health will be eligible for financial incentives from HealthPartners.
Full Story: Star Tribune (Minneapolis-St. Paul, Minn.) (tiered subscription model) (4/13) 
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Fifteen percent of Americans said their financial situation has become worse than it was before the start of the COVID-19 pandemic, while 55% said their circumstances are largely unchanged and 30% said they are better off than they were previously, a survey by Impact Genome and The Associated Press-NORC Center for Public Affairs Research found. Among people who reported living below the poverty line, 29% said their personal finances worsened and only 16% reported being able to save money in the past three months, and the survey of more than 2,300 adults also found racial disparities, as 39% of Black Americans reported saving money recently compared with 57% of white Americans and 47% of Hispanics.
Full Story: The Associated Press (4/13) 
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Combining genomic data with health outcomes data in EHRs can provide deeper insight into population health disparities than simple race and ethnicity data, and may improve health equity and outcomes, according to a study published in Cell. Embedding genomic data and using it to infer genetic ancestry "will allow the development of evidence-based means to utilize race and ethnicity, genetic ancestry, and the socioeconomic determinants of health for both rare and common diseases," researchers wrote.
Full Story: Health IT Analytics (4/16) 
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Webinar: Cleansing Provider Directories.
Supplying accurate provider directories is an expectation members have of their health plan; however, there are unspoken reasons why they remain in flux. We've uncovered a few, and have suggestions on how to tackle the challenges. Join our industry expert as he discuss real-world concerns, and what organizations can do to improve the data quality. Watch now.
Health Insurance Provider Company News
Genetic Counseling: Best Practice Standard of Care
The application of complex genetics often requires specialized knowledge and training. A pre-test genetic counseling requirement empowers members to make informed medical decisions while reducing inappropriate medical spend. Learn more in this original research.
Solutions Provider News
Pharma News
The FDA has asked Emergent BioSolutions to stop manufacturing a new drug substance for Johnson & Johnson's COVID-19 vaccine at its Baltimore plant while the agency investigates a contamination issue that resulted in the destruction of millions of doses last month. J&J said it will work with the agency and Emergent to address any issues uncovered in the investigation.
Full Story: Reuters (4/19) 
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Policy Watch
The CDC could decide by Friday if restrictions will be added to the Johnson & Johnson vaccine after six women reported blood clotting issues after receiving the shot, according to National Institute of Allergy and Infectious Diseases Director Anthony Fauci. The US paused use of J&J's vaccines last week.
Full Story: KOMO-TV/KOMO-AM (Seattle) (4/19) 
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Join us on Wednesday, April 28 from 1 to 2 p.m. ET for "The Role of Integrated Mental Health in Chronic Condition Care" as Vida Health's panel of clinical leaders shares unique insights into digital solutions that provide integrated polychronic care and are changing how health insurance providers engage with members. Examine existing programs to assess opportunities for improvement.
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Agents and brokers: Discover how an AHIP Individual Membership can grow your business. Gain access to the latest industry news and timely information that helps you better serve your clients. Benefits include discounts on dozens of AHIP online courses, including Health Insurance 101, Long-Term Care Professional (LTCP)--Combined Course, courses on health care management, and much more. Learn more and join today.
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As partnerships continue to be even more critical in our post-pandemic health care system, make sure you're part of Institute & Expo Online, June 22 through 24. Share your solutions and build your brand with thousands of health care professionals. Sponsorship packages can be customized for your goals and budget. Let's talk today. Contact BusinessDevelopment@ahip.org for details.
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April prepares her green traffic light and the world thinks Go.
Christopher Morley,
writer, editor, journalist
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