Insurers Making It Tough For Sanders And Warren To End Private Medicare

As health insurance companies expand into new regions offering privatized Medicare Advantage coverage and enroll more seniors, it could make the case for single payer more difficult for Democrats on the 2020 Presidential campaign trail.

Health insurance companies continue to announce record growth in their Medicare Advantage businesses with UnitedHealth Group, the nation’s largest health insurer, announcing last week that its Medicare Advantage enrollment jumped by 400,000 seniors to eclipse 5 million. Meanwhile, other health insurance companies are announcing plans to expand into new states and counties to sell Medicare Advantage coverage to seniors for 2020 and beyond.

This enrollment growth and geographic expansions come while U.S. Sens. Bernie Sanders of Vermont, Elizabeth Warren of Massachusetts and some other Democrats running for the presidency in 2020 are advocating a single payer version of Medicare for All that would replace the private insurance system. Sanders and others argue the single payer version of Medicare for All would eliminate co-payments, deductibles and allow Americans to pick the doctors they want free of insurance company restrictions and provider network rules.

But health insurers and analysts who follow the industry say the increasing enrollment and expansions mean it will be less likely for Congress and a future White House to replace Medicare Advantage given seniors continue to sign up for such coverage in record numbers.

“There is zero chance the Bernie/Warren plan gets enacted. Zero,” says John Gorman, a healthcare consultant who worked in the Clinton administration as Assistant Director, Office of Managed Care at HCFA, now known as the Centers for Medicare & Medicaid Services.

“Never in the history of this nation have we annihilated a $3 trillion industry and we’re not about to start with insurers,” Gorman added. “If there’s going to be ‘Medicare for All’ it will be Medicare Advantage for all.”

UnitedHealth ended the second quarter with 5.19 million Medicare Advantage enrollees compared to 4.79 million in the year-ago period, the insurer said last week in announcing the company’s second-quarter earnings.

UnitedHealth’s Medicare Advantage enrollment is the latest positive growth sign for such plans, which contract with the federal government to provide extra benefits and services to seniors, such as disease management and nurse help hotlines with some also offering vision, dental care and wellness programs. And now insurers are rolling out more supplemental benefits in their Medicare Advantage plans following rule changes implemented.

Several big Medicare Advantage players, including executives from UnitedHealth, CVS Health and its Aetna health insurance unit, Humana and top officials from the Trump administration are speaking this week at the Better Medicare Alliance’s Medicare Advantage Summit in Washington on the benefits, strategies and challenges ahead for the program.

Gorman projects the Medicare Advantage program will “represent over half of all” Medicare beneficiaries by 2025. “The infrastructure is built for it to handle many, many more, if United’s enrollment numbers are any indication,” Gorman said.

A recent study by L.E.K. Consulting projects enrollment of seniors in Medicare Advantage could reach 70% of those between 2030 and 2040. Insurers could be ahead of those projections.

UnitedHealth is the first major insurer to report quarterly earnings and related growth in the second quarter. Other insurers, including Humana, Anthem and CVS Health’s Aetna health insurance unit are expected to report their results and Medicare Advantage growth over the next month.

Health insurers are also beginning to announce where, exactly, they plan to grow and attempt to attract new Medicare Advantage customers.

Take Oscar Health, a relatively young health insurance company perhaps best known for sales of individual coverage under the Affordable Care Act, has been planning for more than a year enter the Medicare Advantage business. Last week, Oscar executives said they plan to roll out their first Medicare Advantage plans in Houston and New York for 2020, pending regulatory approval.

“We already know that Oscar’s tools are accessible to people of all ages and are capable of making the health care experience easier for everyone: 76% of our members who are 63-years-old and over already have digital accounts with us, and 83% of them have reached out to their concierge teams,” Oscar chief executive and co-founder Mario Schlosser said in announcing the expansion into Medicare Advantage. “We know these tools will be useful for our new Medicare Advantage members as well, whether they’re searching for a doctor on our mobile app, contacting their personalized Concierge team for guidance, or consulting a doctor via telemedicine.”

https://www.forbes.com/sites/brucejapsen/2019/07/21/insurers-making-it-tough-for-sanders-and-warren-to-uproot-private-medicare/#63d4046634d0

Coronary Artery Calcium Test Predicts Disease, Mortality in Patients Under 50

For adults in their 30s and 40s with risk factors for cardiovascular disease (CVD), high coronary artery calcium (CAC) scores were associated with increased risk for actual CVD and mortality, researchers found.

Data on 22,346 individuals with a mean age of 43.5 (SD 4.5; range 30-49) in the CAC Consortium registry — set up to capture data on patients undergoing CAC testing because of increased CVD risk — indicated that about one-third showed some degree of CAC and 7.2% had scores exceeding 100, reported Michael Miedema, MD, MPH, of the Minneapolis Heart Institute Foundation, and colleagues in JAMA Network Open.

The CHD death rate was 0.69 per 1,000 person-years among those with a CAC score over 100 (95% CI 0.41-1.16) — 10 times higher than those with a CAC score of 0 (0.07 per 1,000 person-years, 95% CI 0.04-0.12).

Previously, clinicians did not consider coronary artery calcium testing in younger individuals to be worth it because they often thought they were unlikely to find anything, would expose patients to radiation, and had concerns regarding cost, Miedema told MedPage Today.

“This paper gives credence to the idea that in certain individuals this might be something you want to think about. The radiation dose is pretty similar to a mammogram, so it’s a pretty low dose, and the cost now is around a $100, so it’s not a super expensive test, and it can provide some meaningful information clinically,” Miedema said.

Among younger populations, the utility of CAC testing is somewhat less clear, Miedema and colleagues noted in their paper. Prior research on younger adults have been limited by short follow-up periods, lack of cause-specific death, and small sample sizes, they said.

“Coronary artery calcium may potentially be used as a tool to aid decision-making among select young adults at elevated lifetime risk for cardiovascular disease; the relatively high prevalence of CAC in younger adults with cardiovascular risk factors reinforces the need for the adoption of healthy lifestyle behaviors early in life,” the researchers wrote.

But one prominent cardiovascular researcher cautioned that the study didn’t fully make the case for routine use of CAC testing in younger adults.

Although it could be useful in making decisions, the degree to which CAC scores add to traditional risk factors in gauging risk remains unclear, said JoAnn Manson, MD, DrPH, of Brigham and Women’s Hospital in Boston, who was not involved in the study. She told MedPage Today that the number of events was too small to completely resolve this uncertainty.

“Moreover, healthy lifestyle behaviors should be emphasized for the entire population, including young adults and even children. Most other treatments would depend on the assessment of actionable CVD risk factors, such as hypertension, dyslipidemia, or smoking,” Manson said.

Three-quarters of the CAC Consortium participants included in the study were men. Participants were free of clinical CVD at baseline.

Participants underwent CAC testing for indications such as hyperlipidemia or family history at baseline and were evaluated for cause-specific death at follow-up. The CAC Consortium includes patients at four medical centers in Ohio, California, and Minnesota.

There were 298 total deaths in the sample, 40 CHD-related deaths, and 84 CVD-related deaths over a mean follow-up of 12.7 years, the investigators found. Other data indicated that among patients with CAC at baseline, 27 CHD-related deaths occurred.

Limitations of the study included lack of vital status ascertainment in the U.S., self-reporting of risk factors, that generalizability must involve consideration of context, and potential referral bias.

The study was supported by the National Institutes of Health.

Miedema reported no disclosures.

Manson reported no disclosures.

• Primary Source

  JAMA Network Open

  Source Reference: Miedema MD, et al “Association of coronary artery calcium with long-term, cause-specific mortality among young adults” JAMA Netw Open 2019; DOI: 10.1001/jamanetworkopen.2019.7440.

https://www.medpagetoday.com/cardiology/prevention/81125

Consumer Giants Turn From Diapers and Detergent to Eye Rollers and Jelly Masks

Facing stagnant sales of household mainstays from diapers to detergent, the world’s biggest consumer-products companies are trying to crack the lucrative market for influencer-pitched, millennial-approved skin-care products.

Long the domain of beauty companies, household-goods makers such as Procter & Gamble Co., Colgate-Palmolive Co. and Unilever PLC have begun snapping up skin-care startups selling pricey creams, serums and lotions while relying on Instagram and Sephora, a U.S. beauty chain, to drive sales instead of drugstores and shopping malls.

Colgate said on July 11 it would pay $1.7 billion for Filorga, a luxury French skin-care line. Last year, P&G bought two high-end skin-care companies, First Aid Beauty and Snowberry, for several hundred million dollars.

In the past two years, consumer-products companies acquired nearly a dozen skin-care brands, far more activity than in previous years, according to Dealogic.

Drunk Elephant LLC, a popular skin-care startup that touts limited ingredients, is considering a sale and has drawn interest mostly from consumer-products companies, said people familiar with the matter.

Makers of household goods are striking such deals partly because they are being squeezed by both demographic and competitive pressures. Americans are having fewer babies and households are shrinking, denting demand for staples. Consumer-products companies haven’t returned to prerecession sales growth, and analysts don’t expect sales gains to accelerate in the near term.

Consumers, meanwhile, are increasingly gravitating to smaller, niche and online-only brands that are stealing share from big names like Gillette razors and Colgate toothpaste.

In contrast, skin-care products represent a lucrative and fast-growing global market, attractive to more millennials and men while still holding appeal for aging baby boomers. Sales are growing in overseas markets as well, particularly in Asia, where the expanding middle classes are willing to spend big on better skin.

Mainstream offerings have grown well beyond basic cleansers, night creams and face masks, to include a range of serums and products from facial oils to charcoal acne treatments. P&G’s First Aid Beauty’s products include a $26 detox eye roller and a $32 jelly mask. Colgate’s Physician Care Alliance Skin charges $100 for a 1-ounce tube of “antioxidant corrective.”

Skin care is a $135 billion global industry, more than cosmetics and fragrances combined, according to Euromonitor. Sales of skin-care products have grown more than 30% since 2013.

All that adds up to bidding wars for trendy names, bankers and consultants say, with deep-pocketed consumer companies driving up valuations.

“We see a race right now for these brands,” said Gary Stibel, chief executive of New England Consulting Group. “Our clients are looking to acquire and they are prepared to pay more than we think they should pay for beauty startups.”

Skin-care product makers tend to be a better fit for big consumer companies than makeup or fragrance brands, Mr. Stibel said, because they are more reliant on efficacy and less style-driven. While the brands strategically make sense, companies are overpaying in a rush to drive sales growth, he said.

P&G’s recent activity comes a few years after the company sold most of its beauty business to Coty Inc. in a $12 billion deal. The unloaded brands — mass-market names such as Cover Girl and Clairol — have proven costly for Coty, which has struggled since the acquisition.

One of the beauty brands P&G kept, SK-II, a high-end Japanese skin-care line popular in Asia, has been growing sales. Another, drugstore perennial Olay, has received a makeover as P&G works to restore the brand to growth.

P&G historically has focused on skin-care products with broad appeal, such as Olay, a mainstay of drugstores, grocery stores and big-box retailers. The company sees rising demand among younger women who, in addition to investing in skin-care as early as their 20s, are building regimens involving an array of products. A woman in her 20s or 30s who buys skin-care products on average uses six products daily and spends about $260 a year, a company spokeswoman said.

Whereas brands and dermatologists once had to convince people to consider skin-care regimens, “now women are more educated about skin-care and are proactive about investing in their skin at a younger age,” the spokeswoman said.

Brands in demand play to niche markets, from products with all-natural ingredients to lines with a medical pedigree. They are mostly companies founded in the past decade or so, often by entrepreneurs who found their audience on social media, and existed only online before moving into retailers.

Unilever has been a prolific buyer of beauty brands over the years, having purchased names such as Hourglass, Kate Somerville and Dermalogica. In June, the company agreed to pay about $500 million for Japanese beauty-inspired skin-care company Tatcha, people familiar with the matter said. The price tag equates to a multiple of nearly five times its projected revenue for 2019, the people said.

Unilever, which looked at Tatcha during its previous capital-raise process in 2017, approached the business earlier this year and pre-empted a broader auction, the people said. Bidders in sunscreen brand Sun Bum’s auction, too, were mostly other companies, including consumer conglomerates, the people said. S.C. Johnson & Son Inc. struck a deal in June to buy the brand.

“These businesses are trying to sustain their growth profile,” said Rich Gersten, a partner at private-equity firm Tengram Capital Partners who specializes in backing beauty brands. “And one of the main ways to do that is through M&A.”

https://www.marketscreener.com/PROCTER-GAMBLE-COMPANY-4838/news/Consumer-Giants-Turn-From-Diapers-and-Detergent-to-Eye-Rollers-and-Jelly-Masks-28937097/

New technology can improve sound quality for hearing implant users

New technology can improve sound quality for hearing implant users by a life-changing amount.

• Current technology sounds metallic – music sounds like “a crash”
• Audio quality of new system is 90-100% of original signal – ie almost perfect hearing
• Multiple stored versions mean high accuracy even if part of system drops

Dr Wim Melis from the University of Greenwich is working on deconstructing and reconstructing audio signals with extremely high accuracy.

Audio is captured and, from there, converted into a spiking signal – the type the brain uses. This is then fed into the brain and reconstructed as a 90-100% replica of the original sound.

Current technologies, known as cochlear implants, only achieve a fraction of this. They do the work of damaged parts of the inner ear (cochlea) to provide sound signals to the brain, whereas hearing aids make sounds louder.

Dr Wim Melis, University of Greenwich:

The signals created by current hearing implants sound very metallic to the user because they only a provide part of the full audio wave to the brain. This prevents a full reconstruction of the original signal.

We developed a method that breaks down the input signal in its analog components, while introducing multiple versions in storage. This means we can reconstruct the signal with very high accuracy, even if part of the system drops out.”

Wim continues, “To put it simply, imagine a line of buckets, which you walk along pouring water into. The water would go into the one underneath where you are pouring. If that bucket is broken then the water would be lost. The current hearing implant technology operates on this basis. It looks at the amount of water being poured at a point of time, not its other parameters, such as volume, phase and frequency.

“Our system is more advanced. Using the same analogy, you would have a row of buckets with partly-perforated funnels above them. This means that, while water goes through to the bucket underneath, some goes into the adjacent buckets.”

“What we’re working on will be very low power, making it ideal for bio-medical use. While the current technology could be improved to provide better outputs, they would be more difficult to make, as well as being bigger and using more power.

“We envisage our system, which could be available commercially within about six years, to be the same size as current hearing implants, or possibly even smaller.”

Current hearing implant users experience a metallic sound which means there needs to be a significant period of training for the brain to be able to interpret these signals appropriately.

Wim adds: “The training is necessary for the brain to learn to extract useful information from the noisy signal being received. Once the brain is trained, it receives a clearer signal. But it will still be rather metallic, as there is limited information about the audio signal being fed into the brain.

“So, while people will can have a conversation, they struggle to filter background noise in a busy environment, such as a crowd, heavy traffic or parties. Live music sounds horrible, like a crash.”

This study is forming the basis of work where Dr Melis’ aims to develop mimicking true human intelligence in hardware using analog computing.

His team are also exploring the possibility of using this method to compress audio with very high fidelity. This could be a replacement for the current compression and audio storage formats, used by streaming services and audio storage on phones, for example.

Source:

University of Greenwich

https://www.news-medical.net/news/20190719/New-technology-can-improve-sound-quality-for-hearing-implant-users.aspx

IPO marathon continues in a 7-deal week featuring health-tech

Health-tech is hot, and two more fast-growing but unprofitable IPOs are on deck for the week ahead. They’re joined by one of the the world’s largest hosts of marathons and triathlons (including the Ironman brand), along with a solar installation company, a specialty insurer, and a cancer diagnostics seller.

Backed by General Catalyst, diabetes management platform Livongo Health (LVGO) is the deal to watch, expected to raise $230 million at a market cap of $2.4 billion. That’s a large market cap for a company with only $88 million in sales, though it targets a massive market, and revenue spiked 157% in the 1Q19 to $32 million. Sequoia-backed healthcare analytics company Health Catalyst (HCAT) expects to raise $129 million at a market cap of $826 million. It grew sales at a 71% clip in the 1Q19, with a 51% gross margin.

Those two could see interest based on the performance of technology IPOs this year, along with the more than 35% gain from this past week’s health-tech provider Phreesia (PHR).

U.S. IPO CALENDAR
ISSUER BUSINESS	DEAL SIZE MARKET CAP	PRICE RANGE SHARES FILED	TOP BOOKRUNNERS
Castle Biosciences (CSTL) Friendswood, TX	$50M $259M	$14 – $16 3,333,334	Leerink Baird
Sells genetic tests used to diagnose skin cancers.
Health Catalyst (HCAT) Salt Lake City, UT	$129M $826M	$20 – $23 6,000,000	Goldman JP Morgan
Provides a data analytics platform and services to healthcare organizations.
Livongo Health (LVGO) Mountain View, CA	$230M $2,366M	$20 – $23 10,700,000	Morgan Stanley Goldman
Provides a unified healthcare platform for chronic illness management.

The following IPOs are expected to price this week:

Castle Biosciences (CSTL), which sells genetic tests used to diagnose skin cancers, plans to raise $50 million by offering 3.3 million shares at a price range of $14.00 to $16.00. At the midpoint of the proposed range, Castle Biosciences would command a market value of $259 million. Castle Biosciences, which was founded in 2007, booked $28 million in sales over the last 12 months. The Friendswood, TX-based company plans to list on the Nasdaq under the symbol CSTL. SVB Leerink and Baird are the joint bookrunners on the deal. Insiders intend to purchase up to $15 million of the IPO (30% of the deal).

Health Catalyst (HCAT), which provides a data analytics platform and services to healthcare organizations, plans to raise $129 million by offering 6.0 million shares at a price range of $20.00 to $23.00. At the midpoint of the proposed range, Health Catalyst would command a market value of $826 million. Health Catalyst, which was founded in 2008, booked $127 million in sales over the last 12 months. The Salt Lake City, UT-based company plans to list on the Nasdaq under the symbol HCAT. Goldman Sachs, J.P. Morgan, William Blair and Piper Jaffray are the joint bookrunners on the deal.

Livongo Health (LVGO), which provides a unified healthcare platform for chronic illness management, plans to raise $230 million by offering 10.7 million shares at a price range of $20.00 to $23.00. At the midpoint of the proposed range, Livongo Health would command a market value of $2.4 billion. Livongo Health, which was founded in 2008, booked $88 million in sales over the last 12 months. The Mountain View, CA-based company plans to list on the Nasdaq under the symbol LVGO. Morgan Stanley, Goldman Sachs and J.P. Morgan are the joint bookrunners on the deal. Insider Kinnevik AB intends to purchase up to $20 million of the IPO (9% of the deal).

https://www.renaissancecapital.com/IPO-Center/News/64298/US-IPO-Week-Ahead-The-IPO-marathon-continues-in-a-7-deal-week-featuring-hea

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Staying Safe As Heat Bakes the Nation

 The heat is on.

Across two-thirds of the United States, over 115 million Americans live where some level of heat alert is already in effect, and 290 million will see temperatures soar past 90 degrees at some point in the next week, USA Today reported Wednesday.

As a dome of high pressure settles over much of the eastern and mid-Atlantic states, the heat indexes (the real-feel temperatures) in many places will top 100 and approach 110 degrees or higher, according to the U.S. National Weather Service.

What to do when the temperatures soar so high that heat-related illnesses start to take their toll? One expert offers some sage advice.

“Weekend athletes exercising in the heat need to remember to keep ahead of their fluids. It’s vital to stay ahead of your thirst during these heat extremes, not just to drink when you are thirsty,” said Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City.

“Taking breaks is essential when intensely exercising in the heat for more than one hour. This includes rest, finding shade from the sun, and drinking water mixed with sugar and electrolytes. Salty pretzels, fruit and nuts are always a good option if you don’t have access to a drink with sugar and electrolytes,” Glatter noted.

If you exercise in the heat, try to do so early in the morning when humidity and heat from direct sunlight is low.

During heat waves, seniors are at greatly increased risk for heat stroke due to their reduced ability to sweat and therefore cool their bodies. They also may be taking medications to treat blood pressure, which can reduce their ability to sweat, Glatter said.

Heat stroke is a medical emergency that requires immediate treatment. Call 911 in such cases.

Medications such as acetaminophen (Tylenol) and ibuprofen (Motrin) do not reduce high core body temperatures, and could even be harmful. Patients need rapid cooling to reduce high core temperatures.

Along with blood pressure medications, antihistamines and medications to treat anxiety and depression may also increase the risk for heat stroke by reducing a person’s ability to sweat, Glatter noted.

“Hypertension, coronary artery disease and kidney disease — common in the senior population — all elevate the risk for developing heat stroke, due to reduced cardiac reserve and plasticity of blood vessels. These are major risk factors for heat stroke,” he explained.

During heat waves, check on seniors to see how they’re feeling. Make sure they have access to air conditioning, plenty of cool fluids, and create a heat response plan to help reduce the risk of heat stroke, Glatter advised.

Children are also at increased risk for heat stroke because they can’t regulate their body temperature as well as adults, and they may not drink enough in hot weather.

Everyone should drink plenty of cool fluids in the heat. Water is the best choice, but low-sugar sports drinks are recommended if you’re working in the heat or exercising for more than one hour. Don’t drink alcohol or sugary drinks, such as soda, in the heat because they can cause dehydration due to excessive water loss, Glatter said.

“Never leave a child or a senior in a parked car in the hot sun. In temperatures as low as 70 degrees Fahrenheit outside, the interior of the car can reach 90 to 100 degrees in as little as 20 to 30 minutes. When it’s 90 degrees outside, the interior can heat up to 110 to 120 degrees in 30 minutes and be lethal in that short time frame,” Glatter said.

More information

The U.S. Centers for Disease Control and Prevention has more on extreme heat.

https://consumer.healthday.com/diseases-and-conditions-information-37/heat-and-sunstroke-health-news-370/as-heat-bakes-the-nation-expert-offers-tips-to-stay-safe-748449.html

FBI Approves Next-Gen DNA Systems for National Databases

The FBI issued its latest operational procedures manual for the National DNA Index System, NDIS, recently.

One key milestone in the updated version is the approval of the first next-generation sequencing, or NGS, systems for use with the standard DNA databases.

Newly added is the Verogen ForenSeq DNA Signature Prep Kit for STR and Y-STR analysis.

Promega’s PowerSeq CRM Nested System is listed for use in analyzing mitochondrial DNA.

The approvals follow last week’s publication of two NGS DNA interpretation guidelines by the Scientific Working Group on DNA Analysis Methods (SWGDAM).

Verogen said in a statement their MiSeq FGx Forensic Genomics System is the first NGS system approved for genomic DNA analysis, which would “dramatically increase profiling efficiency and data recovery from biological evidence.”

“This is an important advancement,” said Jenifer Smith, director of Washington D.C.’s Department of Forensic Sciences, where some of the internal validation results that went into the Verogen NDIS approval were performed. (Also involved were the Armed Forces DNA Identification Laboratory, and the University of North Texas Human Identification Center).

NGS means more comprehensive and useful data – and better forensic evidence, added Smith.

“This means we will be able to aid more investigations and close more cases,” she said.

Promega showed some of its PowerSeq results for autosomal and Y-STR analysis, in addition to mitochondrial data, in a 2016 publication.

Verogen, an independent start-up founded 18 months ago by a partnership between Illumina and a San Francisco venture capital group, touts its MiSeq FGx Forensic Genomics System, which was recently featured in a Forensic Magazine webinar.

NGIS has now gone from a “visionary method” to a fully-validated forensic science tool, said Brett Williams, the Verogen CEO.

“Obtaining NDIS approval is an enormous step forward for the forensic genomics community, and for mainstream adoption of this technology,” said Williams.

Another NGS tool is Thermo Fisher’s Ion Torrent system. The tool was originally profiled by Forensic Magazine in 2016, and some of the Thermo Fisher NGS applications were demonstrated recently in the analysis of microbial communities on contraband artworks.

NGS has been tested for its upsides and limitations for years, including a massive series of trials conducted by Battelle and its scientists.

“With the (NGS) sequencing, you’re able to detect additional alleles that you couldn’t see through conventional typing,” said Richard Guerrieri, a research leader of applied genomics at Battelle, who presented the work at the International Symposium for Human Identification in September 2017.

https://www.forensicmag.com/news/2019/05/fbi-approves-next-gen-dna-systems-national-databases