Morgan Stanley hires 1st chief med officer to combat rising healthcare costs

• Morgan Stanley is the latest big employer to take a more active role in tackling rising healthcare costs, hiring its first chief medical officer and head of human resources data and analytics earlier this week. The new hire is David Stark, assistant professor and medical director from the Icahn School of Medicine at Mount Sinai, a spokesperson confirmed to Healthcare Dive.
• Stark is a doctor who has worked at New York-based Icahn as an assistant professor of health system design and global health and served as medical director of the Institute for Next Generation Healthcare since July 2016. Business Insider first reported the new role.
• Stark will seek ways to stem the tide of healthcare costs while boosting wellness for the 57,000 employees at the bank. Stark created Lab100 earlier this year, a clinic and research lab at Mount Sinai that leverages data and analytics to help patients try to improve their own health and behavior.

Morgan Stanley married HR data and analytics with the role of CMO, Jeff Brodsky, chief human resources officer at Morgan Stanley, said in an emailed statement to Healthcare Dive. “Harnessing our HR data, we can achieve better wellness for our employees and address rising healthcare costs.”

This goal is shared by the triumvirate of J.P. Morgan, Amazon and Berkshire-Hathaway, except inside the company as opposed to creating an entirely new healthcare venture.

Though more and more heavy hitters are trying, cutting costs is a tall order.

Employers expect the price tag of providing healthcare for their employees will rise another 6% for the sixth consecutive year to almost $15,000 per employee, according to a National Business Group on Health survey earlier this year.

Companies themselves will cover roughly 70% of that figure. Many employers are pushing more of that burden on their workers in the forms of high-deductible plans that increase out-of-pocket expenses.

One way businesses are trying to cut employee healthcare costs is direct contracting with providers. More are taking this route — the same NBGH study found some 11% of companies plan to contract directly with providers in 2019, up from just 3% this year.

Walmart has a Center of Excellence network that contracts with 12 centers around the U.S. to reduce unnecessary spinal surgeries in its employees. It incentivizes specialists to provide the right treatment through bundled payments, allowing the biggest private U.S. employer to influence costs.

Employer-specific plans are another route. Walmart has a partnership with Ochsner Health Network announced earlier this week and General Motors partners with the Henry Ford Health System.

To helm their venture, Amazon-BH-JPM snatched up Atul Gawande, New Yorker staff writer and Harvard surgery professor, and Jack Stoddard, former general manager for digital health at Comcast, to be CEO and COO, respectively.

Though much younger, Stark has an impressive resume. He was a medical and bioengineering research fellow at Stanford University School of Medicine and received his undergraduate degree from Yale, his medical degree from Harvard and has a Master of Science in biomedical informatics from Stanford.

“In this role, I’ll have a unique opportunity to leverage data and technology to unlock value-based care for our employees while also generating data-driven insights to better support our workforce,” Stark told Healthcare Divein a statement. “I look forward to working with the talented team at Morgan Stanley to innovate new solutions and find synergies between employee health and work.”

https://www.healthcaredive.com/news/morgan-stanley-hires-first-cmo-to-combat-rising-healthcare-costs/541093/

Cigna revenue boosted by commercial growth, now eyes Medicare Advantage

• Cigna announced Thursday its revenue increased by 9% to $11.5 billion in the third quarter and credited growth in its global healthcare and supplemental benefits segments.
• The Bloomfield, Connecticut-based payer’s adjusted income from operations increased to $945 million from $716 million a year ago.
• The payer finished the quarter with nearly 16.3 million medical customers, mostly commercial members. Unlike other payers that have focused more on government health plans, Cigna has only 485,000 members in government plans but is looking at Medicare Advantage as a future growth opportunity.

Cigna continues to grow organically in commercial plans, differing from other payers that are expanding government plans like as Medicare Advantage and Medicaid in the quarter. One reason for Cigna’s focus on commercial plans is that CMS barred the payer from the MA market for more than a year. Cigna returned to the the market last year, but missed out on some of the growth other payers have enjoyed in MA.

Despite Cigna being behind other payers in MA, the company’s CEO David Cordani said the payer still views the plans as an “attractive growth opportunity.” Cordani added that Cigna is adding a new market in MA next year and expects a larger expansion in the area in 2020.

Cigna said its third quarter revenue increase came from commercial customer growth, expanded specialty relationships and premium increases. Premiums increased from $8.1 million in Q3 2017 to almost $9 million in Q3 2018. For the year, Cigna has picked up about $3 million more in premium revenue compared to 2017. The payer finished the quarter with $27 million in premium revenue for 2018.

Cigna has seen membership growth over the past year in commercial plans. Overall, medical health plans increased from 15.8 million a year ago to almost 16.3 million in Q3 2018. Nearly all of that increase came from commercial plans. Cigna said it’s seen continued organic growth in the select, middle market and individual segments.

Cigna’s medical care ratio, also called medical loss ratio, was 76.3% for its commercial plans in Q3. The company said the positive number is connected to its employer business, individual market and the return of the health insurance tax. Cigna’s MCR for government plans was 80.7%.

Cigna’s purchase of Express Scripts is the latest vertical integration move involving a payer. Cigna/Express Scripts and CVS Health/Aetna are both going through the regulatory process now.

The Express Scripts deal cleared an important hurdle in September when the Department of Justice said it wouldn’t challenge the $67 billion transaction. DOJ said the acquisition “is unlikely to result in harm to competition or consumers.” So far, 23 states have approved the Cigna/Express Scripts deal and six states remain. It is expected to close at the end of the year.

Payers have been buying pharmacy benefit managers as they look to rein in spending on specialty drugs. Cordani said Thursday that bringing Express Scripts on board will improve affordability, expand the company’s distribution reach and provide more predictability for clients and customers. He added that with Express Scripts, Cigna is confident to get the medical cost trend in line with the consumer price index by 2021.

Still, Cordani pointed to potential headwinds for 2019, including individual market revenues not as strong as this year. Cigna expects a mid-single-digit growth in that market. “Margins above that are not sustainable,” Cordani said of the individual market.

Cigna will grow to seven states in the individual market in 2019 by adding Arizona, but the company is “projecting a little compression in the number of lives we’re serving in ’19,” Cordani added.

However, Cigna is looking to offset headwinds by growing its customer base, including in MA, improved global disability and life business and higher earnings from Express Scripts, he said.

https://www.healthcaredive.com/news/cigna-revenue-boosted-by-commercial-growth-now-eyes-medicare-advantage/541156/

LabCorp rolls out Apple Health integration for lab test results

• LabCorp, one of the largest commercial clinical diagnostic laboratory companies in the country, announced this week its patients now can sign up to integrate lab test results into Apple’s health app.
• Alongside its partnership with Walgreens to expand its retail presence to more than 600 locations, the move to share testing results is the latest by LabCorp to boost its relationship with its patients. Company executives argue that more in-depth and robust engagement is critical to differentiate itself from competitors and stoke growth.
• To use the new iPhone feature, patients who have a LabCorp Patient account will have to enable integration with the Health Records app. The clinical lab giant said that the partnership with Apple will make it easier for patients to see their lab data alongside other medical information paired with the app such as allergies, immunizations and medications.

LabCorp CEO David King foreshadowed the Apple partnership during last week’s Q3 earnings call by stating the company sees an increasing adoption of mobile health technologies and touted its efforts to improve patient tools such as enhanced mobile applications.

“Our multifaceted consumer engagement strategy is advancing at a rapid pace, further differentiating our offering from competitors and creating new opportunities for long-term profitable growth,” King said.

According to Apple’s website, more than 115 institutions and companies support health records on the iPhone health app. LabCorp rival Quest Diagnostics is not listed.

King argues the move to enable patients to view their testing results alongside other health data in Apple Health comes at a time when individuals are increasingly interested in gaining a “more holistic view of their health.”

“Laboratory test results are central to medical decision making, and broadening access to this information will help patients take charge of their health and wellness, and lead to more informed dialogues between patients and their healthcare providers,” King said in a statement.

The announcement comes shortly after LabCorp reported a substandard Q3 coming off of a ransomware attack and the aftermath of Hurricane Florence. The company reported $2.83 billion in revenue, but lowered its full year guidance for 2018.

https://www.healthcaredive.com/news/labcorp-rolls-out-apple-health-integration-for-lab-test-results/541152/

Teladoc cuts loss to $23M in Q3, sees boost in international revenue

• Teladoc Health reported a loss of $23.3 million in the third quarter of 2018, compared with $31.3 million loss in the same period last year. Per share loss amounted to 34 cents, according to consolidated financial information released Thursday.
• Revenue for the Purchase, New York-based company totaled $111 million, up 62% from $69 million in the third quarter of 2017. Organic revenue, excluding Advance Medical, which Teladoc acquired in May, grew 29% year over year to $88.3 million.
• The telehealth vendor expects fourth quarter revenue to total between $119 million and $121 million, and full-year revenue to be in the $414 million to $416 million range.

The results were buoyed by strong enrollment. Total paid membership reached 22.6 million in the third quarter, an 18% increase from the prior year. Teladoc attributed the growth to new subscribers to its behavioral health services.

Total visits shot up 110% to 641,000 in Q3. For the first nine months of 2018, the company tallied nearly 1.8 million telehealth visits.

Teladoc’s purchase of global telemedicine provider Advance Medical during the second quarter provided a big boost to international revenue, which grew 187% to $24 million in third quarter. Headquartered in Barcelona, Spain, Advance Medical reported revenue of about $63 million and adjusted EBITDA of $2 million in 2017.

Offsetting revenues were operating expenditures and costs associated with growing the telehealth business. Advertising and marketing expenses totaled $22 million, sales expenses were $16.3 million and outlays for technology and development were about $13.6 million.

Teladoc ended the quarter with adjusted EBITDA of $6.3 million for the quarter, versus a loss of $0.6 million in Q3 2017.

During the quarter, CVS Health launched MinuteClinic Video Visits using Teladoc’s technology platform. The program, currently available in nine states and the District of Columbia, offers 24/7 virtual visits for minor ailments and wellness needs.

https://www.healthcaredive.com/news/teladoc-cuts-loss-to-23m-in-q3-sees-boost-in-international-revenue/541233/

Medicare Advantage audits could save $4.5 billion over a decade: CMS

• CMS said its proposed rule for Risk Adjustment Data Validation (RADV) audits could save $4.5 billion in recouped savings over a decade.
• The proposed rule, which was part of the telehealth proposal last month, calls for audits to confirm that Medicare Advantage (MA) payers are providing supported medical record documentation for what they’re owed.
• CMS found that more than 8% of MA payments were incorrect in fiscal year 2017. That’s more than $14 billion in improper payments, including 35% that were underpayments.

Federal policymakers, regulators and investigators have bought up the issue of overpayments in the past. The Department of Justice has been involved in multiple cases involving MA payments.

CMS’ proposal calls for digging into data for a sampling of members to explore any possible improper payments or overpayments. CMS said the change involves improving “program integrity,” as well as recovering improper payments.

Responding to the audit proposal, Matt Eyles, president and CEO of America’s Health Insurance Plans (AHIP), said in a statement that health insurers are committed to providing “clarity and certainty” for the MA program but question the proposal.

“AHIP supports program oversight to protect taxpayers and beneficiaries – but audits must be conducted in ways that are methodologically and actuarially sound, and are legally appropriate, to avoid highly inaccurate findings that could undermine the ability of MA plans to deliver for the 20 million Americans they serve,” Eyles said.

Eyles said AHIP is concerned that CMS’ proposal reverses a position that “the adjuster is legally and actuarially required.” AHIP is also worried about methodological issues brought to light in a recent study by the Wakely Consulting Group, which could cause highly random and arbitrary results. Retroactively applying the proposed rule would “exacerbate these problems,” AHIP said.

Payers have increasingly turned to MA as a growth area. From the largest MA payers like UnitedHealthcare and Humana to more modest MA populations like Cigna, they all view the marketplace as a place for expansion. MA has grown in premiums from $69.9 billion in 2007 to $202.7 billion in 2017. It represented one-quarter of overall industry premiums in 2017.

One reason is the continuous stream of healthy seniors who become eligible for Medicare daily. Another key is the advantageous payment model that includes risk-adjusted payments. While payers view the payment model positively, investigators and regulators see a program fraught with possible overpayments.

CMS is attempting to capture some of those improper payments through the proposed rule. The proposal likely won’t affect the MA market’s momentum but may cause the payers to lose some of the money they’ve come to expect from the program.

https://www.healthcaredive.com/news/medicare-advantage-audits-could-save-45-billion-over-a-decade-cms-says/541188/

Stryker to host analyst meeting with a conference call hookup

Stryker to host analyst meeting with a conference call hookup  Analyst meeting to be held in, NJ on November 8 at 2:30 pm.  Webcast: https://edge.media-server.com/m6/p/7nemgedg
https://thefly.com/landingPageNews.php?id=2817003

Adverse Effects of Proton Pump Inhibitors: Fact or Fake News?

Abstract and Introduction

Abstract

Purpose of review: The present review summarizes the past year’s literature, both clinical and basic science, regarding potential adverse effects of proton pump inhibitors.

Recent findings: Proton pump inhibitors are amongst the most widely prescribed and overprescribed medications worldwide. Although generally considered well tolerated, epidemiologic studies mining large databases have reported a panoply of purported serious adverse effects associated with proton pump inhibitors, including chronic kidney disease, cognitive decline, myocardial infarction, stroke, bone fracture and even death. It should be noted that the quality of the evidence underlying these associations is very low and these studies, by design, cannot ascribe cause and effect. Nonetheless, these associations have been sensationalized in the media and misinterpreted by patients and providers. Unintended consequences of the fake news are that patients are not being prescribed and/or taking clinical guideline-recommended proton pump inhibitors to prevent and treat complications from gastroesophageal reflux disease and upper gastrointestinal bleeding precipitated by NSAIDs and dual antiplatelet therapies. In addition, physicians, who already have limited time to interact with their patients, are spending an inordinate amount of additional time placing these findings into proper perspective and reassuring their patients when initiating treatment as well as on every follow-up visit.

Summary: Most of the recent highly publicized serious adverse effects ascribed to proton pump inhibitors are not based on demonstrable evidence. Nevertheless, when proton pump inhibitors are prescribed long-term, they should be used at the lowest effective dose and the need for their use periodically reassessed.

Introduction

Gastric acid secretion is precisely regulated to maximize benefits and minimize harms. Acid kills ingested microorganisms, renders the stomach and small intestine relatively sterile, modulates the gut microbiome, assists in protein digestion and facilitates the absorption of nonheme iron, calcium and vitamin B₁₂, and enhances the bioavailability of certain medications (e.g. ketoconazole, itraconazole, thyroid hormone and atazanavir). However, when levels of acid (and pepsin) overwhelm mucosal defense mechanisms, gastroesophageal reflux disease (GERD) and peptic ulcer disease (PUD) may occur.

The development of proton pump inhibitors (PPIs; omeprazole, lansoprazole, pantoprazole, rabeprazole, esomeprazole and dexlansoprazole), medications that block the parietal cell acid pump, has revolutionized the management of GERD and PUD. These potent antisecretory medications have reduced complications and hospitalizations as well as improved the quality of life for patients suffering from acid-peptic disorders. PPIs have also become the gold standard in the prevention of NSAID-induced gastroduodenal ulcer, prevention of NSAID-induced upper gastrointestinal (UGI) bleeding and Helicobacter pylori eradication regimens. Consequently, PPIs are one of the most commonly prescribed (and overprescribed) medications. In the United States, nearly 15% of adults have used a PPI within the last year, with even greater use in the elderly.^[1,2] The use and overuse of PPIs is a world-wide phenomenon, with similar results reported in a drug-utilization study conducted in Iceland.^[3] Over a 13-year period, the overall outpatient prescription for PPIs doubled and patients were increasingly treated with higher doses for longer durations than recommended by clinical guidelines.

Although PPIs have long been considered well tolerated medications, there have been numerous recent publications purporting potential harms. These reports, published in the medical literature and sensationalized in the media, have caused alarm and angst amongst patients and providers. An unintended consequence of the adverse publicity is that PPIs are now often underprescribed for conditions necessitating their use such as erosive esophagitis and prevention of NSAID-induced UGI bleeding, particularly in patients taking dual antiplatelet therapies.

There is now a long list of dozens of potential serious adverse effects associated with PPI therapy, including alterations in gut microbiome, enteric infection, micronutrient deficiencies, fundic gland polyps, gastrointestinal malignancy, chronic kidney disease (CKD), cognitive dysfunction, myocardial infarction (MI), bacterial overgrowth, bacterial peritonitis, pneumonia, bone fracture, drug interactions and death. There is relatively strong evidence, including biologic plausibility, linking PPIs with alterations in gut microbiome, micronutrient deficiencies (e.g. magnesium, vitamin B₁₂, iron and calcium), fundic gland polyps and enteric infection. Increasing basic science data suggest a possible association with carcinogenesis that is mediated by PPI-induced hypergastrinaemia.^[4–7] The quality of the evidence, however, underlying the other associations is very low and often inconsistent.^[8,9] The aim of this chapter is to critically review the recent literature, published within the past year, regarding potential adverse effects of PPIs and place the findings in proper perspective. [MORE]

https://www.medscape.com/viewarticle/903378