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Our Take: Experts, enterprises, and a billionaire work to move the country forward in the face of the pandemic

Apr 13, 2020
Health experts offer a strategy for containment
Former FDA commissioners Drs. Mark McClellan and Scott Gottlieb and other national health experts have recommended a strategy for a national COVID-19 surveillance system that could help contain the spread of the coronavirus when the current “intensive” social distancing and stay-at-home policies are relaxed.

In a working paper issued last Tuesday by the Duke-Margolis Center for Health Policy, the co-authors describe features of the surveillance system that could mitigate the current wave of COVID-19 cases and suppress future outbreaks.

The surveillance system incorporates four overarching components:
  • A test-and-trace infrastructure that would provide the capacity to conduct widespread rapid diagnostic testing and data sharing, to allow fast, case-based interventions
  • Surveillance based on syndromic indicators of spikes and falls in potential symptoms, along with “timely and transparent reporting of COVID-19 outbreaks and testing and response capacity at the local level”
  • Widespread serologic testing to measure community exposure and identify reliable markers of immunity
  • Rapid response mechanisms that would provide the capacity to isolate new cases and quickly trace, test, and quarantine contacts, as well as the capacity to treat new cases effectively
“Timely and efficient implementation of such a surveillance system will require ongoing coordination between health care providers and state and local public health authorities, with federal support coordinated through the Centers for Disease Control and Prevention to achieve effective implementation throughout the country as soon as possible, and certainly in time for the fall, when COVID-19 may become a seasonal threat,” the authors wrote.

A new portal promises to facilitate data sharing
Last Monday, HCA Healthcare and Google Cloud announced an open data platform, the National Response Portal, to promote data sharing about the pandemic and how it is spreading, so that hospitals, policymakers, and communities can better prepare for and respond to cases as they arise.

Hospital systems across the country can use the portal to share and display anonymous, aggregated metrics, such as the supply and utilization of ICU beds and ventilators, COVID-19 test results, and the number of healthy patients who’ve been discharged, the organizations said. The platform can also integrate public datasets, including local policies intended to deter spread of the coronavirus, and traffic or mobility patterns. That information can be used to determine the effect that public behavior and policies are having on the spread of the virus.

“While COVID-19 has driven us apart physically, we will respond to it by coming together digitally,” said Dr. Edmund Jackson, HCA Healthcare’s chief data officer, adding that “collaboration and coordination is more important than ever to help ensure the best possible response.”

The portal, built and operated by SADA, is expected to go live this week.

Bill Gates reaches into his deep pockets to speed a possible vaccine
Through the Bill and Melinda Gates Foundation, Bill Gates is spending billions to help fund factories for seven potential vaccines against the coronavirus — even though he acknowledged that only two vaccines, at most, would likely be deployed. Rather than waiting to see which vaccine works and then building the factory, Gates said during an appearance on The Daily Show with Trevor Noah that he hopes to save months by scaling up manufacturing capabilities during the testing phase.

Although the strategy will result in the loss of “a few billion dollars,” Gates said it would be worth it to save critical time in making a vaccine available and getting economies up and running again sooner.

“The ultimate solution, the only thing that really lets us go back completely to normal and feel good about sitting in a stadium with lots of other people, is to create a vaccine,” Gates said. “And not just take care of country, but take that vaccine out to the global population so that we have vast immunity and this thing, no matter what, isn’t going to spread in large numbers.”
What else you need to know
Several top insurers are taking steps to ease providers’ financial strain. UnitedHealth Group said it will offer nearly $2 billion in accelerated payments and other financial support, including up to $125 million in small business loans for clinical operators that partner with OptumHealth. Blue Shield of California said it is working with financial service partners to provide up to $200 million in direct support through financing guarantees, advance payments, and restructuring of contracts. The company will also accelerate the launch of a high-tech patient billing solution that allows providers to receive the patient’s part of a bill when a claim is adjudicated. Similarly, Humana announced that it is implementing simplified, expedited claim processing so that providers could receive reimbursement payments as quickly as possible. Centene said it has created a provider support program for its network providers to help them with grant writing and small business loan applications, so they can more easily access funding available through the CARES Act.

Novartis terminated the $1 billion agreement to sell its Sandoz US generic oral solids portfolio and dermatology business to Aurobindo Pharma USA after failing to receive approval from the Federal Trade Commission within the anticipated time frame. Novartis said the decision to end the agreement was mutual. Announced a year and a half ago, the deal would have created the second-largest generics company (by prescriptions) in the U.S.

Pharmacy benefit manager Prime Therapeutics launched the PreserveRx reinsurance program to make it easier for Blues plans and self-funded employers to handle the high cost of gene therapies. Program participants will pay a per-member per-month fee for coverage for the two currently approved gene therapies, Zolgensma and Luxturna, and have the option of coverage for three other gene therapies expected to gain FDA approval this year. Prime is offering PreserveRx in conjunction with BCS Insurance Company; both companies are owned by Blue Cross and Blue Shield plans.

Tenet Healthcare is withdrawing its first-quarter and full-year outlook for 2020, according to a press release, and will furlough about 500 full-time employees who are not involved in patient care. The steps are being taken in response to the “rapidly evolving environment and continued uncertainty,” the Dallas-based, for-profit hospital operator said. Tenet estimated that its hospitals, ambulatory surgery centers, and physician practices would be eligible to apply for approximately $1.5 billion of accelerated payments, and it expects to receive direct grant aid under the recently passed CARES Act, Fierce Healthcare reported.

Payments to Medicare Advantage and Part D plans will increase by 1.66% for the 2021 plan year, according to a CMS fact sheet released last week. The fact sheet states that the average change in revenue of 1.66% does not reflect an adjustment for underlying coding trend, and that CMS expects the underlying coding trend to increase risk scores by 3.56% on average for 2021. In calculating risk scores for payment, CMS will rely more on detailed encounter data than on members’ diagnoses. In addition, individuals with end-stage renal disease will be able to enroll in an MA plan even if they weren’t already in one when they received their diagnosis.

CMS will permit providers to practice across state lines and at the top of their license, Modern Healthcare reported Thursday. Designed to increase provider capacity during the pandemic, the move makes it possible for out-of-state physicians to treat patients at rural hospitals, using telehealth. It also gives nurse practitioners and occupational therapists broader capabilities.

The Department of Veterans Affairs is delaying its Cerner EHR implementation project yet again, multiple sources reported. VA Secretary Robert Wilkie said in a letter sent to Congress earlier this month that the pandemic “has shifted the [VA’s] overall priorities,” noting that the VA is still committed to modernizing its medical records system — which is more than 40 years old. Healthcare Dive reported that spending on the project has increased from $10 billion to about $16 billion, “with little concrete to show for it.”

Quorum Health filed for Chapter 11 bankruptcy last Tuesday. A spinoff of Community Health Systems, Brentwood, Tenn.-based Quorum operates 23 hospitals in 13 states. In a press statement, the for-profit company said its hospitals would be unaffected as it works to recapitalize and reduce its debt by approximately $500 million.

What we’re reading
COVID Calclus” is changing medicine. Medscape, 4.9.20 (registration required)
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