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Air, Air, Everywhere, and Not a Breath Safe to Take

BY KIM BELLARD

If you live, as I do, anywhere in the Eastern half of the country, for the past week you’ve probably been thinking about something you’re not used to: wildfires.  Sure, we’ve all been aware of how wildfires routinely plague the West Coast, particularly Oregon and Washington, but it’s novel for the East. So when the smoke from Canadian wildfires deluged cities through the East and Midwest, it came as kind of a shock.

For a day last week, New York City supposedly had the worst air quality in the world.  The next day Philadelphia had that dubious distinction.  The air quality index in those cities, and many others, got into the “Maroon” level, which means it was hazardous for everyone.  Not just for the elderly and other “sensitive” groups, and not just some risk for some people, but hazardous for everyone.   

If you didn’t know about AirNow.gov before, you should now.

New Yorkers are used to smog and air quality that is less than idyllic, but smoke from wildfires, containing fine particulates that easily get into the lungs, weren’t something anyone was prepared for.  “Wildfires were not really a scenario, in all honesty, that I recall us specifically contemplating,” Daniel Kass, New York City’s deputy commissioner for environmental health from 2009 to 2016, admitted to NBC News.   

“People on the East Coast aren’t used to seeing these types of situations. There was a much slower response,” Peter DeCarlo, an associate professor of environmental health and engineering at Johns Hopkins University, also told NBC News. “We can probably learn a thing or two from our West Coast friends.”

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Trump Earns a Failing Grade in Civics (K-12) in North Carolina.

BY Mike Magee MD

Events over the past year clearly have confirmed that we are a “work in progress” even as we stubbornly affirm our good intentions to create a society committed to “life, liberty, and the pursuit of happiness.”

With the Dobbs’ decision, our Supreme Court has unleashed long-abandoned regressive state laws designed to reinforce selective patriarchy and undermine the stability and confidence of America’s women and families. As a result, our nation’s health professionals, and the patients they care for, potentially find themselves “on the wrong side of the law.”

It calls to mind the well-worn phrase of mothers everywhere to their bossy children, “Who died and left you boss?”

Since our former President, on the eve of his latest indictment, decided to deliver a message to North Carolina Republican supporters this past weekend, claiming that he was engaged in the “final battle” with “corrupt” forces, most especially the “Deep State” that was “out to get him,” I decided to fact check his claims with the kids of North Carolina.

North Carolina’s K-12 lesson plan, titled “The Rule of Law,” begins with the Teddy Roosevelt quote, “No man is above the law, and no man is below it” from his 1903 State of the Union address.

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MA for Tomorrow: Moving Beyond the Status Quo to Advance Concrete Policy Changes for the Future of Medicare Advantage

BY CECI CONNOLLY AND MICHAEL BAGEL

Medicare Advantage (MA) has passed the tipping point, delivering coverage and care to more than half of the senior population in the US. The Congressional Budget Office projects more than 60 percent of people 65 years and older will be in the program by 2030. As enrollment soars and interest in value-based health care grows, it is imperative policymakers modernize the program that is expected to cost $7.5 trillion over the next decade.

Rather than taking the standard Washington posture of declaring victory or defending the status quo, our provider-aligned, nonprofit member plans spent nearly two years developing a detailed vision for MA for Tomorrow. The policy proposals being released at a Capitol Hill briefing on June 12 are concrete reforms from executives with decades of experience and a track record of achieving the highest quality ratings in the program.

MA for Tomorrow is built on five pillars: (1) Raising the Bar on Quality; (2) Improving Consumer Navigation; (3) Achieving Risk Adjustment for Care, not Codes; (4) Modernizing Network Composition; and (5) Transforming Benchmarks. Taken together, the policies foster greater competition, reduce provider burden, push quality standards higher, enhance the shopping experience and curb improper payments.

With consistently high-quality ratings, expanded benefits and a proven ability to reach minority populations, the MA public-private partnership is an undeniable success. More than 31 million seniors are enrolled in MA, a growth of over 107 percent since 2014. In the past five years, as seniors voted with their feet, MA grew by 9.1 million enrollees while fee-for-service Medicare shrunk by 5.1 million. 

But even the most successful programs must evolve. To serve current and future retirees, MA must keep pace with medical and technological advances; it must improve the shopping experience to match other retail sectors; it must address loopholes and bad behaviors that dampen competition and choice. While fundamentals of the program remain strong, change is necessary to ensure the MA program of the future is equitable, affordable and focused on health outcomes.

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Vaccine myocarditis update from Korea

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BY ANISH KOKA

A national study from Korea published in the European Heart Journal sheds important new light on complications related to COVID vaccine related myocarditis. While US public health authorities have been convinced from the very beginning about how safe and effective the new vaccines are, researchers in other countries with far smaller budgets have been testing that theory.

It was Israeli researchers that first highlighted the novel mRNA vaccines as potentially causing myocarditis in the Spring of 2021, but it has proven difficult to quantify the risk of severe complications beyond scattered case reports of severe morbidity and mortality. In part, US researchers are hampered by vaccine reporting systems in the US that are passive surveillance systems relying on voluntary reporting of vaccine adverse events. This has the potential of under-reporting adverse events, which was exactly the conclusion of an earlier JAMA analysis on US VAERS vaccine myocarditis cases.

Diving deep into the methods and results of the study

The South Korean approach was to organize a national reporting system under the auspices of the Korean Disease Control and Prevention Agency (KDCA). The KDCA also established a reporting system with a legal obligation for special adverse events including myocarditis and pericarditis after COVID-19 vaccination. To evaluate all reported cases of suspected myocarditis or pericarditis after COVID-19 vaccination, the KDCA organized an “Expert Adjudication Committee on COVID-19 Vaccination Pericarditis/Myocarditis”. The committee comprised 7 experts in cardiology, 1 in infectious disease, 2 in epidemiology, epidemiologic investigators in 16 regional centers, and officials from the KDCA.

Among 44,276,704 subjects vaccinated from 26 February to 31 December 2021, 1533 cases of suspected myocarditis were reported to the KDCA. The committee adopted the myocarditis case definition and classification of the Brighton Collaboration (BC) (see figure below) for the diagnosis and degree of certainty of a Vaccine Related Myocarditis (VRM) diagnosis.

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THCB Gang Episode 125, Thursday June 8

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday June 8 at 1PM PT 4PM ET are privacy expert Deven McGraw (@healthprivacy); Queen of employer benefits Jennifer Benz (@Jenbenz); THCB regular writer and ponder of odd juxtapositions Kim Bellard (@kimbbellard); and policy expert consultant/author Rosemarie Day (@Rosemarie_Day1);

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

Interview with Dr Pamela Tenaerts, Medable

Pam Tenaerts is the Chief Scientific Officer of Medable, which went from being a small company creating software helping clinical researchers to design their own experiments to being the big dog in remote clinical trials during the pandemic. Medable has raised over $500m in the past 3 years. Pam has a stellar research background and this interview covers the gamut about how clinical trials work, which companies are involved, how remote (or hybrid) trials actually work, and what the likely outcome for clinical research will be. If you have any interest in understanding the state of play in pharma R&D, this is compulsory viewing–Matthew Holt

Landed Gentry and Health

BY MIKE MAGEE

“The title of our lands is free, clear, and absolute, and every proprietor of the land is a princess his own domains, and lord paramount of the fee.” 

Jesse Root, 1798, Chief Justice of the Connecticut Supreme Court

When it came to social hierarchy and family position, land was the ultimate measure of success and influence in Great Britain. But by the time of the American Revolution, our Founders were already fast at work dismantling Primogeniture (“the right of succession belonging to the firstborn child, especially the feudal rule by which the whole real estate of an intestate passed to the eldest son.”) It had already largely disappeared in New England, and was gone in the southern colonies by 1800.

In its place, the colonists envisioned a “free and mobile market,” where land could be traded like money and other goods. To do so, the original land grants and “feudal tenures” were obliterated, and their legal documents swept clean by the new law of the land. The decisions on ownership were made locally, empirically and by “common wish” of those in power.

Property was meant to be traded, fast and furious, but most of all put to “productive use” in a young nation obsessed with rapid growth. As legal historian, Lawrence Friedman, suggested, “In land lay the hope of national wealth; for countless families, it was their chance to make some money. The land, once it was cleared of the native peoples (by hook or by crook), and properly surveyed, was traded with speed and fury. Speculation in raw lands was almost a kind of national lottery.”

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A Hand Up, Not a Hand-Out

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BY KIM BELLARD

As many of you did, I followed the recent debt ceiling saga closely, and am relieved that we now have a compromise, of sorts.  The House Republicans demanded a lot of things, most of which they did not get, but one area where they did prevail was in toughening work requirements for food (SNAP) and income (TANF).  They somehow believe that there are uncounted numbers of “able-bodied” people sitting around on their couches collecting government benefits, a myth that goes back to Ronald Reagan’s welfare queen stereotype, and have long advocated work requirements as the remedy. 

Ironically, according to the CBO, the work requirements passed may actually increase federal spending by as much as $2b, and increase the number of monthly recipients by as many as 80,000 people, but who’s counting?  

All this seems timely because of some new studies that illustrate – once again — that, yes, poverty is bad for people’s health, and helping them get even a little bit more out of poverty improves their health.  

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Matthew’s health care tidbits: Hedge Funds that Do Health Care on the Side

Each time I send out the THCB Reader, our newsletter that summarizes the best of THCB (Sign up here!) I include a brief tidbits section. Then I had the brainwave to add them to the blog. They’re short and usually not too sweet! –Matthew Holt

Lots of news about bad behavior in health care this week, with real shots about patient & staff safety at home care company Papa, and Grail misinforming 400 people that they had cancer. But the prize for tone deafness this week comes from another very well funded health care provider system being heartless to its poorest patients. 

This week it’s Allina, a Minnesota “nice” system which actually amended its Epic system so that clinicians could literally not book appointments or provide care to patients who owed Allina money. Clinicians on the sharp end of this were so appalled that they went on the record about their own employer to NY Times’ reporter Sarah Kliff. The most egregious example was a doctor unable to write a prescription for a kid that had scabies–an infectious parasitic disease–who was sharing one bed with two other kids!

Of course Allina also is on the low end of charity care provision (below 1% of revenues). In contrast ten employees make more than $1m a year and another 10 make more than $500,000. 

We all know about egregious private equity funds investing in payday loans and other scummy outfits that prey on the poor. Turns out that if you let a non-profit hospital become beholden to its financial, rather than moral, north star, it starts to behave in a similar manner. Allina, of course, had a smidge under $4bn in its “investment reserve” at the end of 2021. It’s by no means special. UPMC has over $7bn in its reserves (unclear if this includes the investments it has made in startups), while Ascension has a formal private equity fund that controversially paid its former CEOs over $10m as part of its $18bn reserves.

Somehow having hedge funds that provide a little health care service on the side doesn’t leave the best taste in the mouth for how we should be organizing this health care system.

THCB Gang Episode 124, Thursday June 1

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday June 1 at 1PM PT 4PM ET were double trouble futurists Jeff Goldsmith and Ian Morrison (@seccurve), and delivery & platform expert Vince Kuraitis (@VinceKuraitis). Lots of discussion about Kaiser and Geisinger and what this means about the model for the future of care delivery. Do incentives or professionalism matter more?

The video is below. If you’d rather listen to the episode, the audio is preserved from Friday as a weekly podcast available on our iTunes & Spotify channels