FDA Approves Biogen’s Alzheimer’s Drug; UHC to Not Pay for Unnecessary ED Visits
After much back-and-forth, FDA clears Biogen's Alzheimer's drug Adulhem. UnitedHealthcare notifies members of a change to emergency department coverage. And a new study raises questions about the effect of Medicare ACOs on pricing.
Source: Getty Images
By - A heatwave has many across the country seeking shelter for a different reason. Stay cool out there!
FDA APPROVES BIOGEN’S ALZHEIMER’S DRUG AFTER DEBATE
The FDA has officially approved aducanumab, Biogen’s drug for Alzheimer’s Disease, the agency has announced. This marks the first Alzheimer’s drug in nearly 20 years and the first one to address cognitive decline in those with the illness.
FDA approved the drug, which is being marketed as Aduhelm, under the agency’s Accelerated Approval pathway.
This comes after long speculation about the drug’s efficacy. Biogen pulled the drug in 2019 after some trials showed it may not have much of an effect, but ultimately reversed course and announced it would submit Aduhelm for approval after all.
Outside experts have also called some of the trial data from Aduhelm “unconvincing.” But the FDA and other stakeholders have also faced immense pressure from patients and patient advocates to approve the drug. READ MORE
HIGHER PRICES FOR MEDICARE ACCOUNTABLE CARE ORGANIZATIONS
Some independent primary care practices joining health system-led Medicare ACOs raised their prices after what researchers called “soft consolidation,” according to a new Harvard study.
Under soft consolidation, practices are never formally acquired by a health system. Rather, the practices jointly negotiate prices with payers in conjunction with the health system. These softer consolidation strategies are permissible under federal antitrust laws.
On average, a national commercial insurer paid 4 percent more for office visits when provided by independent practices in health system-led ACOs in the Medicare Shared Savings Program (MSSP) compared to independent practices not part of an ACO. The price increases were driven by just 7.4 percent of the ACO-affiliated practices studied, which received a 49.3 percent average price increase after joining the system-led Medicare ACO.
Overall, the limited size and scope of the price increases among practices in system-led Medicare ACOs implied a small impact on market practices. READ MORE
UNITEDHEALTHCARE TO NOT COVER UNNECESSARY EMERGENCY ROOM USE
UnitedHealthcare announced in a network bulletin that it will be changing some of its methods around evaluating whether an emergency department visit meets the standards for coverage.
Starting July 1, 2021, UHC will evaluate emergency department facility commercial claims using its Optum Emergency Department Claim Analyzer to determine if the visit was emergent or non-emergent, a separate fact sheet explained. Claims that are considered non-emergent will receive limited or no coverage from UHC.
According to the bulletin, ED visits will be assessed based on factors such as the patient’s presenting problem, the intensity of diagnostic services performed, other patient complicating factors and external causes, and more.
The policy will apply to commercial, fully-insured ED facility claims in many states, and UHC plans to expand it to more states in the future. READ MORE
SOCIAL DETERMINANTS OF HEALTH IMPACTING PATIENT PORTAL USE
The latest data shows that patient portal offerings are near universal, according to the Office of the National Coordinator for Health IT showed that 99 percent of large hospitals and 97 percent of all hospitals in aggregate offer patient portal access to patients. That is the most recent year for which ONC has data.
But that patient portal access and use isn’t seen uniformly across patient populations. Like other aspects of medicine, patient portal use sees health disparities, and that’s largely because of inequities in access. In other words, not every patient has the same opportunity to make the most out of patient portal access. Race, income, geographic location or broadband access, and age can all influence patient portal use rates.
Sara Heath explores some of the most common social determinants of health affecting patient portal use and adoption. READ MORE
UPMC LAUNCHES AI COMPANY FOR CHRONIC DISEASE
Realyze Intelligence, a company launched recently by The University of Pittsburgh Schools of the Health Sciences (UPMC), will use natural language processing and artificial intelligence to pinpoint optimal treatments for chronic disease and cancer patients.
The company’s platform will read EHR data to pick out cohorts of patients with precise conditions who may be at a higher risk for negative health outcomes. The platform’s analysis will allow physicians to prioritize individuals who need the most urgent medical attention. Realyze Intelligence was founded in partnership with UPMC Enterprises, the solutions branch of UPMC.
In looking through detailed notes and data, the platform can get a holistic view of the entire patient and their history, not just the chronic condition they are being treated for at the moment. READ MORE
EFFECTIVENESS OF ASYNCHRONOUS TELEHEALTH FOR MENTAL HEALTH
A University of California Davis study indicates patients using either asynchronous or synchronous telemedicine technology to meet with psychiatrists saw no significant difference in improvements – though both “had statistically and clinically significant improvements” in treatment outcomes over the five-year study.
The UC Davis study compared the so-called “gold standard” to telehealth — a platform that includes audio and video capabilities – with a platform that allows a patient to answer questions online and submit them to a care provider, who reviews the answers and sends a diagnosis and treatment plan back within a certain amount of time.
The research is important at a time when the healthcare industry is striving to address barriers to access, including social determinants of health. READ MORE
