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This Week in Managed Care: March 12, 2021


This week, the top news in managed care included CDC guidance on safe activities for fully vaccinated individuals; American Rescue Plan signed into law; new lung cancer screening criteria expand eligibility.

CDC provides first guidance on safe activities for fully vaccinated individuals; President Biden signs American Rescue Plan into law; and new USPSTF lung cancer screening criteria nearly doubles the number of people eligible for screening.

Welcome to This Week in Managed Care, I’m Matthew Gavidia.

CDC Provides First Guidance on Safe Activities for Fully Vaccinated Individuals

This week, the CDC released long-awaited guidelines announcing that people who are fully vaccinated against COVID-19 will be able to meet in small, private gatherings with other vaccinated individuals or low-risk individuals who are unvaccinated without masking or social distancing.

Noting that the guidance is not final and subject to updates based on the level of community spread and the proportion of the population that is fully vaccinated, the CDC is also recommending that fully vaccinated individuals continue to wear masks in public, maintain distance, and follow other public health measures.

“We’ve been through a lot this past year, and with more and more people getting vaccinated each day, we are starting to turn a corner,” said CDC Director Rochelle Walensky, MD, MPH, during a briefing by the White House COVID-19 team. “And as more Americans are vaccinated, a growing body of evidence now tells us that there are some activities that fully vaccinated people can resume at low risk to themselves.”

Although most of the country remains unvaccinated,some states are lifting mask mandates and ending capacity limits on restaurants and large gatherings, such as Texas, Mississippi, South Carolina, Connecticut, Massaschusetts, and Maryland, according to CNBC.

Clinical trial data has shown that COVID-19 vaccines are highly effective at protecting vaccinated individuals against severe illness, hospitalization, and death, but there remains a small risk that they can become infected with a mild disease or be asymptomatic and potentially transmit the disease to unvaccinated individuals, Walensky said. As the science of COVID-19 evolves, the recommendations will be updated.

“Importantly, our guidance must balance the risk to people who have been fully vaccinated, the risk to those who have not yet received a vaccine, and the impact on the larger community transmission of COVID-19,” said Walensky.

For more, visit AJMC.com.

In American Rescue Plan, ACA Exchanges Start Clock for New Enrollees

This week, President Joe Biden signed the $1.9 trillion COVID-19 relief package, called the American Rescue Plan, into law after it won final approval by Congress on Wednesday.

In addition to the $1400 in direct payments provided to 85% of American households, the bill represents the biggest investment in the the exchange marketplaces created by the Affordable Care Act, or ACA, since the landmark law was passed 11 years ago. The bill makes federal premium subsidies, or tax credits, for ACA plans more generous and eliminates the maximum income cap for 2 years and limits the amount paid to 8.5% of income.

The package also contains incentives for states that have not yet expanded Medicaid to do so, and subsidizes COBRA premiums until September 2021 for recently laid-off workers who want to remain on their employer’s health plan.

The bill also includes:

  • $14 billion for researching, developing, distributing, administering, and strengthening confidence in vaccines
  • $47.8 billion toward testing, contact tracing and mitigation, including investing in laboratory capacity, community-based testing sites and mobile testing units, particularly in medically underserved areas
  • $880 million for the Special Supplemental Nutrition Program for Women, Infants, and Children, known as WIC, to help increase participation and temporarily improve benefits

For more, visit AJMC.com.

New USPSTF Lung Cancer Screening Criteria Cover More High-Risk Patients

In updated recommendations on lung cancer screening issued this week by the US Preventive Services Task Force, or USPSTF, 2 notable changes will nearly double the number of people eligible for screening.

The new recommendations include yearly low-dose computed tomography, or CT, scans for people aged 50 to 80 years old, rather than starting at 55, and will also reduce the pack-years of smoking history that make a person eligible, dropping the baseline from 30 to 20.

“The Task Force reviewed new evidence that shows screening can help many more people who are at high risk for lung cancer,” says USPSTF member Michael Barry, MD. “By screening people who are younger and who have smoked fewer cigarettes, we can save more lives and help people remain healthy longer.”

The eligibility expansion in the new recommendations will be particularly helpful for earlier detection of lung cancer in Black patients and women. Both groups have been shown to smoke fewer cigarettes than white men, but data also show that Black people face a higher risk of lung cancer than white people. Many more patients in both groups will be eligible for screening under the new guidelines.

In 2020, an estimated 228,820 people in the United States were diagnosed with lung cancer. It is the leading cause of cancer death in the US population, with an estimated 135,720 people in the United States dying from lung cancer in 2020.

For more, visit AJMC.com.

Addressing Health Care Access Gaps With Digital Solutions

Bringing disparities in health care to the forefront of national conversation, the COVID-19 pandemic has simultaneously jump-started widespread use of telehealth and digital solutions to address newly formed health care access gaps.

But even before the pandemic began, the Center for Care Transformation at AVIA was helping members move from reactive, episodic, and uncoordinated care to proactive, longitudinal, and efficient care.

AVIA, a network of 50 leading health systems brought together in a collaborative membership model, offers a range of digital solutions to drive clinical, operational, and financial results.

In this week’s episode of Managed Care Cast, we speak with Sarah Carroll, MPH, director of the Center for Care Transformation at AVIA, about the challenges of implementing digital health in underserved populations and the potential of these solutions to better address health disparities in the United States.

For the podcast, visit AJMC.com.

Study Illustrates Kidney Impact After COVID-19 Resolves

More than a year into the COVID-19 pandemic, a new study published in JAMA Network Open suggests that individuals recovering from acute kidney injury, or AKI, stemming from COVID-19 will require kidney monitoring after they leave the hospital.

Prevalent in up to 57% of hospitalizations and 78% of intensive care unit admissions in patients with COVID-19, AKI has been found to be more severe when linked with the virus, with more than a third of survivors not yet recovering baseline kidney function at a median of 21 days after leaving the hospital.

Researchers from Yale University sought to further examine the association, deriving data of adults admitted and discharged at 5 hospitals within the Yale New Haven Health System network between March 10, 2020, and August 31, 2020.

In their findings, kidney function declined faster in patients with COVID-19–linked AKI after discharge compared with patients who did not have AKI linked to infection.

For those who survived past discharge, patients with AKI stemming from COVID-19 who had not recovered from AKI by the time they left the hospital were associated with decreased kidney recovery later compared with those negative for the virus.

Notably, patients with COVID-19–associated AKI were more likely to be Black or Hispanic and had fewer comorbidities than patients with AKI not related to COVID-19.

For more, visit AJMC.com.

COVID-19 Vaccine Developments Timeline

March 11 represents the one-year anniversary since the World Health Organization declared COVID-19 a global pandemic.

If 2020 was dominated by the news of how COVID-19 spread across the globe, putting normal life on hold for most people and overwhelming health care providers, then 2021 has so far been focused on ending the pandemic through vaccine distribution.

With research conducted into hundreds of vaccine candidates, there are now 3 vaccines approved by the FDA, and as of March 10, the CDC reports that more than 93.6 million vaccine doses have been administered.

Eager to learn more on how vaccine development, approval, and rollout has progressed so far this year?

Read our timeline published this week of COVID-19 vaccine developments in 2021!

For more, visit AJMC.com.

For all of us at AJMC®, I’m Matthew Gavidia. Thanks for joining us!

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