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This Week in Managed Care: October 16, 2020


This week, the top managed care news included the first case of COVID-19 reinfection in the United States; a positive side to halting trials to evaluate vaccine safety; a rise in employer-sponsored health insurance premiums for 2020.

First case of COVID-19 reinfection detected in the US, why halting trials to evaluate vaccine safety is a good thing, and a survey finds a rise in employer-sponsored health insurance premiums for 2020.

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

First Case of COVID-19 Reinfection Detected in the US

This week, the United States had its first reported case of COVID-19 reinfection and the fifth case of reinfection worldwide.

Reported in The Lancet Infectious Diseases journal, the case study involved a 25-year-old man in Nevada who had no known immune disorders. After feeling mildly ill and testing positive in April for SARS-CoV-2, the virus that causes COVID-19, he tested negative on 2 subsequent occasions.

However, in June, he was hospitalized after experiencing severe COVID-19 symptoms, including fever, headache, and cough, with test results coming back as positive.

Dr Mark Pandori, lead author of the study, director of the Nevada State Public Health Laboratory, and associate professor of pathology at the School of Medicine at the University of Nevada in Reno, said in a statement that the case study suggests that people who have previously tested positive for COVID-19 should continue to take serious precautions, including practicing social distancing, wearing face masks, and handwashing.

“If we have truly reported a case of reinfection, initial exposure to SARS-CoV-2 might not result in a level of immunity that is 100% protective for all individuals. With respect to vaccination, this understanding is established, with influenza regularly showing the challenges of effective vaccine design,” the researchers wrote.

Besides the United States, Ecuador is the only other country to have a reinfection case that resulted in increased symptom severity for the patient. In Hong Kong, Belgium, and the Netherlands, the reinfected patients did not have more severe symptoms.

For more, visit ajmc.com.

How Halting Trials to Evaluate Vaccine Safety Is a Good Thing

In recent weeks, clinical trials by AstraZeneca and Johnson & Johnson examining their COVID-19 vaccine candidates, as well as a clinical trial by Eli Lilly on an antibody treatment for COVID-19, were halted over safety concerns.

Although the halted trials have garnered widespread media attention, Dr Maura Abbot, assistant professor of nursing at the Columbia University School of Nursing, explains in an interview with The American Journal of Managed Care® how, in general, halting trials to evaluate vaccine safety is actually a good thing.

“Anytime there’s an adverse event or potentially adverse event related to whatever is being trialed, if it’s serious enough, the vaccine or the medication trial is halted temporarily,” says Abbott. “In general, this is actually a good thing because it shows that we’re following the rules of safety. So, the fact that you can restart a trial and keep going generally leads you to believe that everything’s safe and okay.”

For the full interview, visit ajmc.com.

KFF Survey Finds Employer-Sponsored Health Insurance Premiums Rose 4% in 2020

Last week, the Kaiser Family Foundation, or KFF, released findings of its benchmark 2020 Employer Health Benefits Survey, which found that family premiums for employer-sponsored health insurance rose 4% over the past year, averaging $21,342.

Conducted from January to July of this year, the annual survey, whose findings were also published in the journal Health Affairs, polled 1765 nonfederal public and private firms on their employer-sponsored health coverage, including premiums, employee contributions, and cost-sharing provisions.

Although it does not capture the full scope of the impact of the COVID-19 pandemic on health care costs and coverage, the study results still exhibit the rising cost that employees are responsible for contributing. On average, the study found that workers are paying $5588 in out-of-pocket costs toward family coverage, with employers paying the remaining amount.

“Conducted partly before the pandemic, our survey shows the burden of health costs on workers remains high, though not getting dramatically worse,” said Drew Altman, president and chief executive officer of KFF, in a statement. “Things may look different moving forward as employers grapple with the economic and health upheaval sparked by the pandemic.”

With nearly 157 million Americans relying on employer-sponsored coverage, next year’s survey will provide the first full look at how the pandemic may have affected workers’ health benefits. Moreover, the upcoming election may have a significant influence on projections, particularly the fate of the Affordable Care Act, or ACA.

Although the Democratic party seeks to protect and build upon the ACA, the Trump administration’s pursuit of its repeal, without a concrete plan in place, could impact coverage of health care costs for employers and their respective workforce.

For more, visit ajmc.com.

Dialysis Is on the Ballot Again in California

Two years after California voters soundly defeated a measure that would have capped profits for dialysis centers, the people get to weigh in on a different proposal—one that would require a doctor to be on site whenever the clinic is open.

The measure, known as Proposition 23, would also require dialysis centers to report infection data to the state and not just the federal government. Supporters, including a service union, say it will lead to better care.

Opponents to the move, including the American Nurses Association and the California Medical Association, argue that adding costs in the 6 figures to each dialysis center may force many to close and send dialysis patients to the emergency department if they can’t get access to care.

Additionally, clinics would need permission to close or reduce hours of operation, and the measure would bar centers from refusing to treat patients based on “payment source.”

The ballot measure comes as the Trump administration pursues payment reforms that would make it easier for patients to have dialysis at home by creating financial incentives that promote home dialysis technology. CMS was heading in this direction already, but the COVID-19 pandemic made home dialysis a more urgent priority, as patients with renal failure are at much higher risk of death if they develop the disease.

For more, visit ajmc.com.

AJMC® to Cover AMCP Nexus, Kidney Week 2020, CHEST Annual Meeting 2020

Next week, The American Journal of Managed Care® will be covering 3 conferences, AMCP Nexus 2020, Kidney Week 2020, and the CHEST Annual Meeting 2020, all in a virtual format.

AJMC.com is providing full coverage of each virtual meeting, including late-breaking sessions, interviews with panelists, and developments in each care field.

For full conference coverage, visit ajmc.com/conference/amcp-nexus, ajmc.com/conference/asn, and ajmc.com/conference/chest.

Paper of the Week

And now, our paper of the week, which looks back at some of the most important papers over the past 25 years of The American Journal of Managed Care® and why they matter today.

In a week when the Senate Judiciary Committee discussed the future of the Affordable Care Act, this week’s paper from authors at Kaiser Permanente covers an early look at the effects of the ACA. The March 2017 study examined self-reported data from patients in Kaiser Permanente California and Kaiser Permanente Colorado who enrolled on the ACA exchanges for coverage that began on January 1, 2014.

The authors found increases of people who said they had a personal health care provider, along with large decreases who said they delayed care due to cost compared with the period prior to the ACA. There was also a large jump in people who received a flu shot in 2014 compared with 2013, and almost twice as many smokers reported receiving advice on how to quit using tobacco.

For the paper, visit ajmc.com.

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

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