STATE BOARD GIVES ADVOCATE AURORA MERGER GREEN LIGHT: The Illinois Health Facilities & Services Review Board Monday approved Advocate Aurora Health’s change of ownership exemptions by a vote of 6-0.
The vote came at a special meeting of the review board, which in September initially voted down Advocate Aurora Health’s regulatory request, needed for its planned joint operating agreement with Charlotte, N.C.-based Atrium Health to form the fifth-largest hospital chain by revenue.
On Sept. 13, the board delayed a vote on a change of ownership exemptions needed for the deal, with board members looking for more details.
Although Advocate Aurora provided additional details about why the JOA was necessary, and more information about how the new Advocate Health, Inc. would be structured, some board members expressed concern that they still do not have enough clarity on where decisions about Illinois hospitals will be made: here, North Carolina or somewhere else.
Board member Antoinette Hardy-Waller said her biggest concern is “who has control over establishing, constructing and eliminating much, much needed services.” She said she was still hasn’t gotten answers to all those questions. READ MORE.
LEAPFROG’S LIST OF SAFEST HOSPITALS IN ILLINOIS: Only a quarter of Illinois hospitals received top marks in the latest Leapfrog Hospital Safety Grade report, published today, making Illinois No. 28 in the nation among states with the safest hospitals.
The Leapfrog Group, a Washington, D.C.-based watchdog organization, publishes its bi-annual list of hospital safety grades each spring and fall for nearly 3,000 general hospitals. They are measured on criteria including the rates of preventable medical errors, accidents, injuries, and infections.
Thirty Illinois hospitals received A grades this fall. Notably, Elmhurst Memorial Hospital in Elmhurst, Northwestern Medicine Central DuPage Hospital in Winfield and the University of Chicago Medical Center have received 22 straight “As” for every list published over the last 10 years since Leapfrog began publishing the report. READ MORE.
AMA TACKLES GUN VIOLENCE, MENTAL HEALTH/SUBSTANCE USE DISORDER PARITY AND MORE: The American Medical Association at its interim meeting of its house of delegates this week adopted a policy that would establish a task force focused on firearm violence prevention, including firearm-involved suicide.
The policy also points to more lawsuits against gun manufacturers. It calls on the AMA to increase litigation related to firearm safety by collaborating with state and specialty medical societies.
“Six years ago, just before the AMA Annual Meeting, a shooting at the Pulse Nightclub in Orlando prompted physician and medical student delegates to declare firearm violence a public health crisis in the United States,” AMA President Dr. Jack Resneck said in a statement. “Today we gather in the wake of another tragic shooting, this one on the campus of the University of Virginia, that left young people dead and a campus on lockdown. We cannot continue to live this way.”
The house of delegates is also calling for better mental health and substance abuse coverage parity in Medicare.
Medicare is not subject to laws mandating parity in coverage for mental health and substance-use disorder, yet nearly 2 million Medicare beneficiaries report having a substance-use disorder and only 11% got any SUD treatment last year, the AMA said in a statement.
Therefore, delegates voted to support federal actions that would require Medicare to follow the federal law that requires health insurance coverage for mental health and addiction, the Paul Wellstone and Peter Domenici Mental Health Parity and Addiction Equity Act of 2008.
The policy would also support requiring all health insurance plans to implement a compliance program to demonstrate compliance with state and federal mental health parity laws.
AMA delegates also want to include third-party administrator TPAs in the rules and regulations that apply to pharmacy benefit managers (PBMs). The AMA said in a statement that TPAs are similar to pharmacy benefit managers that manage formularies, negotiate rebates, process claims and pay pharmacies for prescriptions. However, “TPAs are relatively new to the health care landscape,” so they can avoid PBM-related regulations and laws.
“With little transparency and opaque practices, third-party benefit administrators managing specialty pharmacy benefits use heavy-handed tactics with patients and physicians to force them to use preferred prescriptions and generally use proprietary algorithms to guide decision-making,” the resolution said.
“The AMA will remind state and federal regulators not to ignore TPAs in their oversight of drug middlemen,” AMA trustee Dr. Marilyn Heine, said in the statement. “Specialty drugs are often a critical part of a patient’s care for cancer, certain forms of arthritis and other medical conditions. As such, the AMA believes TPAs should be subject to the same licensing, registration and transparency-reporting requirements that regulators mandate for PBMs.”
The AMA also took aim at Medicare Advantage plans, which they want to be easier for patients to use.
Medicare Advantage must provide enrollees with additional benefits beyond those Medicare covers. The AMA policy seeks to promote uniformity and enforcement of Medicare Advantage plans and regulation by supporting better enforcement of Medicare Advantage regulations, requiring Medicare Advantage plans to post all components of Medicare covered and not covered in all plans across the U.S. and for a federal, publicly available database of physicians in network under Medicare Advantage and the status of each of these physicians in regard to accepting new patients in a manner least burdensome to physicians.
ILLINOIS TO SHARE IN $3.1B OPIOID SETTLEMENT WITH WALMART: If approved in court, Illinois will share Walmart’s $3.1 billion settlement with 43 other states and numerous local governments to fight opioid abuse.
The settlement resolves allegations that Walmart contributed to the opioid addiction crisis by failing to appropriately oversee the dispensing of opioids at its stores. It also requires significant improvements to how Walmart’s pharmacies handle opioids, according to a statement by Illinois Attorney General Kwame Raoul.
Raoul said the settlement includes broad, court-ordered requirements, such as robust oversight to prevent fraudulent prescriptions and to flag suspicious prescriptions.
Should the settlement become effective, funds will be allocated in Illinois according to the Illinois Opioid Allocation agreement that Raoul’s office reached with other states’ attorney general offices in December 2021. Raoul’s office did not have an estimate of what Illinois’ share would be.
For its part, Walmart says it still disputes the allegations.
“Walmart believes the settlement framework is in the best interest of all parties and will provide significant aid to communities across the country in the fight against the opioid crisis, with aid reaching state and local governments faster than any other nationwide opioid settlement to date, subject to satisfying all settlement requirements,” Walmart said in a statement posted on its website.
“Walmart is proud of our pharmacists and our efforts to help fight the opioid crisis. Walmart strongly disputes the allegations in these matters, and this settlement framework does not include any admission of liability.” READ MORE.
PEDIATRIC GROUPS CALL FOR NATIONAL RSV, FLU EMERGENCY: The American Academy of Pediatrics & Children’s Hospital Association have asked President Joe Biden and Health & Human Services Secretary Xavier Becerra to declare an emergency because of “the alarming surge of pediatric respiratory illnesses, including respiratory syncytial virus (RSV) and influenza, along with the continuing children’s mental health emergency.”
Capacity problems at pediatric hospitals crowded with children with respiratory illnesses requires the flexibility that a formal federal emergency declaration would provide, the groups said in a letter to Biden and Becerra.
The flexibilities that have been provided during the COVID-19 pandemic are now needed for children’s health care providers, the letter said. Emergency declarations would allow waiver of certain Medicare, Medicaid or Children’s Health Insurance Program requirements so that hospitals, physicians and other health care providers may share resources in a coordinated effort, the letter said.
“We are making this urgent request now because the crisis unfolding across the country warrants immediate, comprehensive action from the federal government. We must address longstanding underinvestment in Medicaid and increase payment rates to at least what Medicare and private insurance pay for the same services. Pediatricians are rising to this challenge once again, but we need federal action to allow the flexibilities and resources to support this care. And we need to remain focused on how this emergency is disproportionately impacting historically under-resourced communities,” Mark Del Monte, CEO of the Itasca-based pediatrics academy said.
VILLAGEMD EXPANDS INTO LAS VEGAS WALGREENS STORES: Walgreens Boots Alliance and VillageMD are opening the first Village Medical at Walgreens primary care practice in Las Vegas and said in a joint statement that more Village clinics will open by the end of the year.
Village Medical at Walgreens are primary care practices located alongside a Walgreens pharmacy location in which physicians and pharmacy team members can coordinate care for chronic conditions, as well as everyday illnesses and injuries, the statement said.
With the Las Vegas opening, VillageMD and Walgreens now have more than 150 Village Medical at Walgreens locations in markets across the country—including in Arizona, Florida, Texas, Kentucky, Indiana, Massachusetts, New Hampshire, Georgia and Rhode Island, in addition to Nevada—and are on track toward 200 practices by the end of this year, the statement said.
SUMMIT HEALTH CEO DISCUSSES BEING BOUGHT BY WALGREENS/VILLAGEMD: Walgreens’ VillageMD unit last week announced a $8.9 billion deal to acquire Summit Health-CityMD, which operates hundreds of primary, urgent and specialty care practices across the tri-state area, Pennsylvania and Oregon.
Summit Health was formed by the 2019 merger between CityMD and New Jersey-based Summit Medical Group. Global private-equity firm Warburg Pincus held a majority interest in the company, which has brought in about $2.9 billion in revenue this calendar year, according to a U.S. Securities & Exchange Commission filing.
Jeff Alter, chief executive of Summit Health, said the two companies’ relationship dates back to 2020, when VillageMD acquired Summit Medical Group of Arizona. VillageMD operates more than 250 primary care locations in 22 markets across the country, including standalone practices and full-size locations alongside Walgreens pharmacies.
Alter said the acquisition will enable Summit Health to accelerate its transition to value-based care arrangements centered on primary care while continuing to expand its number of locations. READ MORE.
BLUES PLANS AGREEING TO PAY FOR PRESCRIPTION DIGITAL THERAPIES: A growing number of Blue Cross Blue Shield insurers, including Blue Cross & Blue Shield of Illinois, have agreed to pay for patients to use prescription digital therapeutics, paving the way for broader coverage among carriers and kick-starting an emerging sector.
At least 17 Blues plans now offer at least one prescription digital therapeutic as a standard pharmacy or medical benefit for some members, according to an analysis provided to Modern Healthcare by PalmHealthco, a firm that helps digital therapeutics companies commercialize their offerings.
Prescription digital therapeutics are software applications that must be prescribed by clinicians. Unlike for nonprescription digital health services, health insurance companies have been slow to cover these tools due to concerns over liability, a lack of clinical evidence and slow Food and Drug Administration approvals.
Blue Cross & Blue Shield plans may have been faster to adopt these tools because they share coverage decisions, said Dr. Matt Fickie, senior medical director at Pittsburgh-based Highmark Health. READ MORE.
AMAZON LAUNCHES VIRTUAL CLINIC: As it waits for federal approval of its $3.9 billion One Medical acquisition, Amazon is furthering its investment in health care with the launch of Amazon Clinic, which will operate as a “virtual health storefront” offering users access to third-party telehealth providers, Crain’s sister publication Modern Healthcare reports.
Nathan Ray, a partner in consultancy West Monroe’s health care and life sciences practice, said Amazon’s big plans for health care are still unclear.
“It’s yet to be seen,” he said. “Are they just dabbling or is all of this is going to be connected into something larger?”
Ray said large tech players that rely on cloud data for profit will each attempt to fold health care services into businesses differently.
Amazon has been persistent in its health care push even after the company’s joint health care-specific venture with JPMorgan Chase and Berkshire Hathaway disbanded last year.
The results have been mixed. One month after the July acquisition of One Medical, Amazon announced it was shutting down its Amazon Care service at the end of the year. Amazon Health Services also comprises Amazon’s diagnostics business and pharmacy service, which includes an online pharmacy it launched in 2020 that grew out of the company’s acquisition of PillPack.
PUBLIC HEALTH DEPARTMENTS LOSING ACCESS TO CDC EXPERTS: As COVID-19 raged, roughly 4,000 highly skilled epidemiologists, communication specialists and public health nurses were hired by a nonprofit tied to the Centers for Disease Control & Prevention to plug the holes at battered public health departments on the front lines.
But over the past few months, the majority of the CDC Foundation’s contracts for those public health workers at local and state departments have ended as the group has spent nearly all of its almost $289 million in COVID relief funding. The CDC Foundation, an independent nonprofit that supports the CDC’s work, anticipates that no more than about 800 of its 4,000 hires will ultimately staff those jurisdictions, spokesperson Pierce Nelson said.
That has left many local and state health departments facing staffing shortages as the nation eyes a possible winter uptick in COVID cases and grapples with the ongoing threat of monkeypox, exploding caseloads of sexually transmitted infections and other public health issues.
In Chicago, CDC Foundation employees made up about as much as a tenth of the city’s public health workforce, said Dr. Allison Arwady, commissioner of the city’s public health department. Although she got 26 of those 66 employees extended into December, she said it’ll hurt to lose the rest. They’ve contributed to everything from public health nursing to communicating the latest guidance about the pandemic to Chicagoans. READ MORE.
PEOPLE ON THE MOVE
• Denis Moore has been named senior vice president of finance at Chicago-based marketing communications agency HDMZ.
HDMZ serves life science, biotech and health care companies.
Prior to HDMZ, Denis was the chief financial officer at Butler, Shine, Stern & Partners. Prior to that, he was CFO of Wieden + Kennedy.
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November 17, 2022 at 07:11AM