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Axios-Ipsos poll: Thanksgiving Roulette

Posted on by • Posted in Coronavirus, Coronavirus Delta Variant, Coronavirus Mutation, Happy Thanksgiving, Infection Control, Infection Control Plan, Infectious Virus, Pandemic, Public Health, Public Opinion, Public Perception, Public Safety, Sign of the Times, Unvaccinated, Vaccination, Vaccine, Vaccine Booster, Vaccine Efficacy, Vaccine Safety, Vaccine Supply • Leave a comment

https://www.axios.com/axios-ipsos-poll-thanksgiving-covid-7a043049-d25c-4d3a-9bab-2853973f67af.html

Axios-Ipsos poll: Americans are ready to play COVID roulette for Thanksgiving

Two-in-three Americans will celebrate this Thanksgiving with friends or family outside their immediate households, and about half of those say their gatherings could include unvaccinated people, according to the latest installment of the Axios/Ipsos Coronavirus Index.

Why it matters: Vaccinations and booster shots are giving more people confidence to resume traditions like sitting around a packed table with masks off. But many are doing so with heightened awareness of what they don’t know when it comes to their holiday companions.

  • This year, 31% see a large or moderate risk in seeing friends or family for Thanksgiving — way down from 64% a year ago.
  • People’s assessment of overall risk of returning to their normal pre-COVID lives is also down, with 44% seeing it as a large to moderate risk this year compared with 72% last year.
  • But when Americans are asked how concerned they still feel about the virus, the numbers haven’t diminished all that much: 69% compared with 85% a year ago.

What they’re saying: “We’re just in a holding pattern,” said Cliff Young, president of Ipsos U.S. Public Affairs.

  • “They’re going to Thanksgiving because they have to, they have to see their family and friends, it’s human nature,” Young said. “But Americans are still deploying mitigating strategies.”
  • Ipsos pollster and senior vice president Chris Jackson said the vaccines “have attenuated some of that risk. But there’s a larger sense of anxiety or concern that hasn’t been dealt with.”

By the numbers: 67% of U.S. adults surveyed said they’ll see friends or family outside their households. That’s 73% of Republicans, 70% of independents and 63% of Democrats.

  • 30% of them said the guests will include unvaccinated people, and another 17% said they don’t know whether other guests will be vaccinated or not.
  • 38% said they’ll be with people who don’t regularly wear masks outside the home, while another 21% said they didn’t know if their guests regularly wear masks.
  • 4% said they’ll be seeing people who’ve been exposed to COVID-19 in the last two weeks; another 28% aren’t sure if people at their gatherings have been exposed.

Between the lines: There’s a modest partisan gap around openness to returning to the communal Thanksgiving table — but a gulf around who you’re willing to sit with.

  • 41% of Republicans expect to spend the holiday with someone who’s unvaccinated, compared with 17% of Democrats.
  • When we asked unvaccinated respondents, 56% of those who will celebrate Thanksgiving with friends and family outside the home expect the guests to include other unvaccinated people.

The big picture: This week’s findings show overwhelming support (86%) for every vaccinated American who wants a booster being able to get one. But only about one in four respondents said they knew much about an anti-viral COVID-19 pill awaiting FDA approval.

  • 23% hadn’t heard about the pill at all, and half had heard of it but said they didn’t know much about it.
  • When the unvaccinated were asked whether they’d rather get a shot to prevent the virus, or wait to catch the virus and then take an approved pill to treat it, the pill drew a slight edge (17% versus 12%) and 15% had no preference, while a majority — 53% — said they’d prefer to take neither.
  • That suggests the pill won’t be a silver bullet — and offers more evidence that there is a segment of American society that doesn’t trust science or government to tell them what to do.

Booster strategy could backfire

Posted on by • Posted in Centers for Disease Control & Prevention (CDC), Coronavirus, Coronavirus Delta Variant, Coronavirus Mutation, Evidence Based Decision Making, Evidence-Based Care, Evidence-Based Policy, Food and Drug Administration (FDA), Health Policy, Infection Control, Infection Control Plan, Infectious Virus, Vaccination, Vaccine, Vaccine Booster, Vaccine Efficacy, Vaccine Safety, Vaccine Supply • Leave a comment

https://www.axios.com/covid-vaccine-boosters-thanksgiving-5851be4a-79a7-423a-93bb-390d1eb7d4d3.html

Federal officials waited months before making all American adults eligible for a COVID-19 booster shot — meaning millions of Americans may not have the strongest possible protection as they head into holiday travel.

Why it matters: Critics say the confusing process undermined what has now become a critical effort to stave off another wave of the pandemic.

  • Most vaccinated people, even without a booster, still have very strong protection against serious illness or death. But a third shot drastically increases people’s defenses against even mild infections, which could in turn help reduce the virus’ spread.
  • And some vulnerable vaccinated adults are at risk of serious breakthrough cases.

What they’re saying: “We have a consensus. Boosters are very important in maintaining people’s defenses against COVID. We need to get as many people vaccinated and boosted [as possible] as the winter sets in,” David Kessler, the chief science officer of Biden’s COVID response, said in an interview.

Context: Preliminary data released months ago suggested a significant decline in the vaccines’ effectiveness at preventing infection, although they held up well against severe disease.

  • Based on that data, the Biden administration had hoped to begin allowing booster shots in September for any American adult who was at least eight months removed from their second dose.
  • The CDC and the FDA opted instead to only authorize boosters for seniors, people with high-risk medical conditions and people at high risk of infection, before opening them last week to everyone at least six months out from their initial shots.

In the meantime, red and blue states alike decided to ignore the CDC and open up booster eligibility on their own, and breakthrough infections have become increasingly common.

  • Millions of people who weren’t technically eligible for boosters got them anyway, and a large portion of the most vulnerable patients still haven’t gotten one.
  • Where it stands: Only 41% of vaccinated Americans 65 and older have received a booster shot, as have 20% of all vaccinated adults, per the CDC.

“Some of us were there several months ago. Some wanted more data. In the end, there’s a convergence of opinions. It’s the way an open scientific public health process should work,” Kessler said.

Between the lines: The U.S. drug approval process — with its insistence on high-quality data and careful expert reviews — is the world’s gold standard precisely because it moves deliberately. Regulators have been trying this whole time to figure out how to adapt that system to a fast-moving pandemic.

Some federal officials, as well as many outside experts, said there wasn’t enough data to make a broad booster recommendation earlier this fall.

  • Early on, many public health experts also argued that it was unethical to give Americans a third shot while much of the rest of the world awaited their first shots.
  • Israel embraced boosters before the U.S. beginning over the summer, and its emerging data has been key to making the case that boosters are needed and can help bring surges under control. However, experts still don’t know how long the enhanced protection they give will last.

What they’re saying: “Some argued early on that the primary series was good enough and we should conserve doses for the world. What’s emerging is that all people in the world are going to need to be boosted,” a senior administration official said.

  • “Everyone has a different threshold for how much data they need in making a decision,” the official added. “What made this different is that there’s a pandemic underway, and many saw we were heading into a winter surge.”

CVS wants to employ doctors. Should health systems be worried?

Posted on by • Posted in Competition, Health Insurance Industry, Health System, Hospital, Hospital Industry, Market Consolidation, Market Power, Market Segmentation, Market Share, Market Trends, Market Uncertainty, Medicare Advantage, Physician, Physician Acquisition, Physician Alignment, Physician Employment, Physician Network, Physician Practice Management, Primary Care, Primary Care Delivery Model, Primary Care Loyalty, Primary Care Strategy, Strategy • Leave a comment

https://mailchi.mp/96b1755ea466/the-weekly-gist-november-19-2021?e=d1e747d2d8

HealthHUB | CVS Health

We recently caught up with a health system chief clinical officer, who brought up some recent news about CVS. “I was really disappointed to hear that they’re going to start employing doctors,” he shared, referring to the company’s announcement earlier this month that it would begin to hire physicians to staff primary care practices in some stores. He said that as his system considered partnerships with payers and retailers, CVS stood out as less threatening compared to UnitedHealth Group and Humana, who both directly employ thousands of doctors: “Since they didn’t employ doctors, we saw CVS HealthHUBs as complementary access points, rather than directly competing for our patients.” 

As CVS has integrated with Aetna, the company is aiming to expand its use of retail care sites to manage cost of care for beneficiaries. CEO Karen Lynch recently described plans to build a more expansive “super-clinic” platform targeted toward seniors, that will offer expanded diagnostics, chronic disease management, mental health and wellness, and a smaller retail footprint. The company hopes that these community-based care sites will boost Aetna’s Medicare Advantage (MA) enrollment, and it sees primary care physicians as central to that strategy.

It’s not surprising that CVS has decided to get into the physician business, as its primary retail pharmacy competitors have already moved in that direction. Last month, Walgreens announced a $5.2B investment to take a majority stake in VillageMD, with an eye to opening of 1,000 “Village Medical at Walgreens” primary care practices over the next five years. And while Walmart’s rollout of its Walmart Health clinics has been slower than initially announced, its expanded clinics, led by primary care doctors and featuring an expanded service profile including mental health, vision and dental care, have been well received by consumers. In many ways employing doctors makes more sense for CVS, given that the company has looked to expand into more complex care management, including home dialysis, drug infusion and post-operative care. And unlike Walmart or Walgreens, CVS already bears risk for nearly 3M Aetna MA members—and can immediately capture the cost savings from care management and directing patients to lower-cost servicesin its stores.

But does this latest move make CVS a greater competitive threat to health systems and physician groups? In the war for talent, yes. Retailer and insurer expansion into primary care will surely amp up competition for primary care physicians, as it already has for nurse practitioners. Having its own primary care doctors may make CVS more effective in managing care costs, but the company’s ultimate strategy remains unchanged: use its retail primary care sites to keep MA beneficiaries out of the hospital and other high-cost care settings.

Partnerships with CVS and other retailers and insurers present an opportunity for health systems to increase access points and expand their risk portfolios. But it’s likely that these types of partnerships are time-limited. In a consumer-driven healthcare market, answering the question of “Whose patient is it?” will be increasingly difficult, as both parties look to build long-term loyalty with consumers. 

Understanding the mechanics of the 340B drug pricing program

Posted on by • Posted in Center for Medicare and Medicaid Services (CMS), Dept of Health and Human Services (HHS), Health Policy, Medicare 340B Drug Discount Program, Supreme Court, Uncompensated Care • Leave a comment

https://mailchi.mp/96b1755ea466/the-weekly-gist-november-19-2021?e=d1e747d2d8

The 340B Drug Pricing Program, designed to increase access to specialty pharmaceuticals for low-income patients, is a perennial area of concern for health policy. The program has grown exponentially since its inception almost 30 years ago: 340B providers increased purchases of discounted drugs from $4B in 2009 to $38B in 2020, five times faster than the overall growth rate of US drug sales. Insurers and drug manufacturers are advocating for significant changes to the program, or even favor eliminating it entirely, claiming that 340B has grown beyond its original intent to help safety net facilities, and simply enriches providers without directly benefiting patients. Indeed, the profits from 340B have become essential for many hospitals’ sustainability; some systems tell us that 340B accounts for their entire margin.
 
In the graphic above, we outline the basics of revenue and product flow within this complex program. The 340B program is meant to allow hospitals that treat low-income, underserved patients to purchase drugs from manufacturers at a 25 to 50-plus percent discount, but still be reimbursed by payers at standard network rates. The discounts are intended to help hospitals overcome losses they incur in providing uncompensated care, but apply to drugs for all patients, regardless of income and insurance status. 340B providers often partner with independent pharmacies to dispense the drugs, and payers are billed the full list price for the medication. Thus, insured patients pay co-payments on the full price of drugs, leading to criticism that 340B savings are not passed on to patients. 340B providers share an estimated $40B in total annual profit with partner contract pharmacies.

The program has been targeted for overhaul by both the Trump and Biden administrations, and faces another threat later this month, when the US Supreme Court is set to hear a case between the hospital industry and the Department of Health and Human Services (HHS) to decide whether the Centers for Medicare & Medicaid Services (CMS) has the authority to enact payment cuts through rulemaking. 

If the court rules in favor of the agency, 340B providers could see significant cuts in payment rates. In our next edition, we’ll dive deeper into the potential impact of that ruling on the industry.