Centene restructuring to cull 3K employees, 1.5K open jobs

 Centene Corporation is undergoing a broad organizational restructuring initiative in an effort to boost efficiency and scale, executives told investors Tuesday morning.

CEO Michael Neidorff said on Centene's earnings call that the effort will cull 3,000 employees from the company and eliminate 1,500 open jobs. The initiative is set to reduce Centene's workforce by roughly 6%, he said.

Nixing the open jobs was initially laid out as part of Centene's investor day in December, Neidorff said. In determining where to make changes, he said the company focused on "innovation, growth and agility" in its strategy.

"The reductions are primarily in areas where we have significant overlap from acquisitions and where we have opportunity to leverage our size and scale for increased efficiency remain focused on innovation, growth and agility," he said.

Neidorff also outlined several headwinds and tailwinds that the company is bracing for in the coming months. He said Centene expects to be buoyed by several policy changes undertaken due to COVID-19, such as the suspension of Medicaid redetermination and the new special enrollment period on the Affordable Care Act's exchanges that opens shortly.

However, he said that changes to the physician fee schedule and potential fluctuations in care utilization due to the pandemic are headwinds to watch.

"Taken together, we expect they will trend to the positive," Neidorff said.

Centene held on to its 2021 guidance, but Neidorff said that if the company feels it needs to make adjustments based on these potential impacts, it will do so on the first-quarter 2021 call.

Centene posted a $12 million profit loss in the fourth quarter of 2020.

In the same quarter a year earlier, the insurer brought in $209 million in profits, according to its earnings report released Tuesday morning. Despite the fourth-quarter loss, Centene's profits for full-year 2020 were up from the year before, with the company earning $1.8 billion, up 38% compared to $1.3 billion in 2019.

Centene brought in $28.2 billion in revenue for the quarter. The company beat Wall Street analysts' projections on profits but missed on revenue.

Centene's full-year revenue in 2020 was $111.1 billion, up 49% from $74.6 billion in 2019.

Centene joins its peers in experiencing weaker results in the fourth quarter as the financial impacts of the COVID-19 pandemic fully come to bear. Humana also posted a loss in the fourth quarter.

While it posted a fourth-quarter loss, Neidorff said in a statement that the insurer's overall performance in 2020 highlights the success of its growth strategy.

"Building on our leadership position in government-sponsored healthcare, we are focused on delivering the next phase of growth through product and geographic expansion, advancing our technology strategy and further integrating our diverse capabilities," Neidorff said. "Looking ahead, we have great confidence in our ability to pursue our growth strategy in 2021 and beyond."

By the end of the year, Centene reached 25.5 million members, up 67% from 2019, due in large part to its acquisition of rival WellCare closing in the beginning of 2020.

In 2021, the insurer expects earnings per share to be between $5 and $5.30 and revenues between $116.1 billion and $118.1 billion. 

https://www.fiercehealthcare.com/payer/centene-reports-12m-profit-loss-q4-2020

HDL Cholesterol Linked to Parkinson's

 Lower levels of high-density lipoprotein cholesterol (HDL-C) and greater HDL-C variability were linked to higher incidence of Parkinson's disease, a population-based longitudinal study in Korea showed.

Older adults with the lowest quartile of baseline HDL-C showed higher Parkinson's incidence over 5 years (adjusted HR 1.20, 95% CI 1.08-1.34) compared with those in the highest quartile group, according to Do-Hoon Kim, MD, PhD, of Korea University College of Medicine in Ansan, and co-authors.

Those with the highest levels of HDL-C variability also had greater likelihood of incident Parkinson's disease (adjusted HR 1.19, 95% CI, 1.06-1.33) than those with the least variability. People who had both risk factors -- lowest baseline HDL-C and highest variability -- had the highest risk of Parkinson's (adjusted HR 1.6, 95% CI 1.31-1.96), the researchers reported in Neurology.

Lipids may play a role in Parkinson's disease, but the connection between HDL-C and Parkinson's is unclear, Kim and colleagues noted. "Previous studies reported inconsistent results with positive or null associations. Only a few small studies have suggested an association between HDL-C and Parkinson's disease but did not exclude the possibility of reverse causality."

The study looked at 380,404 people ages 65 and older who had at least three health exams provided by the Korean National Health Insurance System from 2008 to 2013, following them until 2017. People with a history of Parkinson's disease were excluded. About 62% of participants were men.

The researchers assessed HDL-C variability using three indices including variability independent of the mean (VIM). Mean baseline HDL-C was 53.1 ± 13.0 mg/dL, and median HDL-C variability, measured with VIM, was 7.6. Mean ages ranged from 69.8 in the lowest HDL-C variability group to 70.5 in the highest.

People in the higher quartile of HDL-C variability were older, had lower income, were more likely to be current smokers, and had lower rates of alcohol consumption and regular exercise than other groups. They also had higher mean body mass index, waist circumference, and fasting plasma glucose levels; a higher prevalence rate of hypertension, diabetes mellitus, and chronic kidney disease; and were more likely to use lipid-lowering medications.

With median follow-up of 5.03 years, 2,733 people were newly diagnosed with Parkinson's disease. People with a baseline HDL-C under 40 mg/dL were more likely to develop Parkinson's than those with HDL-C of 60 mg/dL or more (HR 1.21, 95% CI 1.07-1.37).

The data confirm previous findings "and showed for the first time that an increased temporal variability of serum HDL was an independent predictor of Parkinson's disease development, after adjusting for relevant potential confounders," wrote Gian Pietro Sechi, MD, of the University of Sassari in Italy, and co-authors, in an accompanying editorial.

How variability in HDL-C may be linked to Parkinson's is unknown, but it may account for some discordant results observed in prior studies, the editorialists noted. Besides the anti-oxidative and anti-inflammatory properties of HDL-C, "a direct interaction between alpha-synuclein and cholesterol may be hypothesized, which may influence alpha-synuclein aggregation and accumulation," Sechi and co-authors said.

"Also, the possibility of a yet unidentified confounding factor linked to both HDL cholesterol levels and Parkinson's disease might also explain the proposed association found in this report, and deserves to be mentioned," the editorialists added.

They noted that the study did not find substantial differences in outcomes by sex, which may be due to a unique preponderance of Parkinson's in women in Asian populations, as well as lower mean HDL cholesterol levels in Korean women after age 70. The study also may have other unique limitations, including a possible association between HDL-C levels and genetic variants like mutations in the cholesterol ester transfer protein, which are frequent in Asian populations.

While patients with a prior diagnosis of Parkinson's disease 4 years before the study started were not included, reverse causality still is possible due to Parkinson's long prodromal phase, the editorialists pointed out: "The question may arise whether the altered HDL cholesterol profile is a mere epiphenomenon of Parkinson's disease, a disorder with evident features of systemic involvement."

Disclosures

The study was supported by Korea University Ansan Hospital and Korea Medical Institute.

The researchers had no disclosures.

The editorialists had no disclosures.

Primary Source

Neurology

Source Reference: Park J-H, et al "Association of High-density Lipoprotein Cholesterol Variability and the Risk of Developing Parkinson's Disease" Neurology 2021; DOI: 10.1212/WNL.0000000000011553.

Secondary Source

Neurology

Source Reference: Pes GM, et al "Cholesterol trafficking in the brain: Are we overlooking an important risk factor for Parkinson's disease?" Neurology 2021; DOI: 10.1212/WNL.0000000000011595.

https://www.medpagetoday.com/neurology/parkinsonsdisease/91084

Indian army drills dog squad to sniff out COVID-19

 The Indian army is training dogs to find COVID-19 in its ranks by sniffing human sweat and urine, a senior officer said on Tuesday.

Breeds such as cocker spaniels and labradors are being trained to detect the disease from the cells of infected people at a facility in New Delhi.

Several countries are considering using dogs to identify the coronavirus at airports and other public spaces. But the military deployment is the first time in India that dogs are being used to detect COVID-19, said Colonel Surender Saini, an army dog trainer.

“Based on the data from the samples which we have tested till now, we can infer the ability to detect the disease is more than 95% among sniffer dogs,” Saini told Reuters partner ANI.

At least eight dogs were being trained to be deployed to a transit camp in northern India, from where troops move to high security border areas. Dogs would allow quicker detection of the disease and reduce the need for tests in remote locations.

India has recorded the second-highest number of coronavirus cases in the world after the United States, but daily numbers have fallen since hitting a peak September last year.

https://www.reuters.com/article/us-health-coronavirus-india-dogs/indian-army-drills-dog-squad-to-sniff-out-covid-19-idUSKBN2A928G

J&J CEO: May need annual COVID-19 vaccine shots for next several years

 Johnson & Johnson Chief Executive Officer Alex Gorsky told CNBC on Tuesday that people may need to get vaccinated against COVID-19 annually over the next several years, like seasonal flu shots.

“Unfortunately, as (the virus) spreads it can also mutate,” he said in an interview.

“Every time it mutates, it’s almost like another click of the dial so to speak where we can see another variant, another mutation that can have an impact on its ability to fend off antibodies or to have a different kind of response not only to a therapeutic but also to a vaccine,” he added.

Last week, Johnson & Johnson said it asked U.S. health regulators to authorize its single-dose COVID-19 vaccine for emergency use, and added it will apply to European authorities in the coming weeks.

The drugmaker’s application to the U.S. Food and Drug Administration (FDA) followed its Jan. 29 report in which it said the vaccine had a 66% rate of preventing infections in its large global trial.

Gorsky told CNBC the company was “extremely confident” that it will meet its target to deliver 100 million doses of its coronavirus vaccine to the United States by the end of June.

J&J is continuing work on a two-dose coronavirus vaccine, Gorsky said. It expects two-shot vaccine data from clinical trials in the second half of the year, he added.

https://www.reuters.com/article/us-health-coronavirus-johnson-johnson-va/jj-ceo-says-people-may-need-annual-covid-19-vaccine-shots-for-next-several-years-cnbc-idUSKBN2A92U0

2 new variants of coronavirus found in England probed

 Two new COVID-19 variants, one of which has been classified as a “concern”, have been identified in England with some similarities to the South African and Brazilian variants, a government advisory scientific committee said on Tuesday.

One of the new variants, first identified in Bristol, has been designated a “Variant of Concern”, by the New and Emerging Respiratory Virus Threats Advisory Group.

The other, first identified in Liverpool, has been designated as a “Variant under Investigation” by the group.

The new variants have the E484K mutation, which occurs on the spike protein of the virus, which is the same change as has been seen in the South African and Brazilian variants that have caused international concern.

Public Health England has now identified 76 cases of the new variants, and is confident that vaccines will work against them.

https://www.reuters.com/article/us-health-coronavirus-britain-variants/two-new-variants-of-coronavirus-found-in-england-under-investigation-idUSKBN2A92K1

U.S. to start sending COVID-19 vaccines directly to community health centers

 The U.S. government will begin shipping COVID-19 vaccines directly to community health centers next week in an effort to speed vaccinations and ensure doses are reaching vulnerable people, U.S. health officials said on Tuesday.

The government will send doses to 250 centers nationwide selected based on their proximity to vulnerable groups, such as homeless people and those with limited proficiency in English, they said. Typically, vaccine doses would go to state governments for distribution to health centers.

Eventually the effort will expand to more than 1,300 community health centers.

The federal government will initially distribute 1 million vaccine doses to the health centers and increase from there, they added.

The program is part of a broader push by the Biden administration to increase access to COVID-19 shots with the goal of administering 100 million doses in Biden’s first 100 days in office. Biden has also made it a priority to ensure that vaccines are distributed equitably with respect to race, ethnicity and economic status.

The U.S. government is already ahead of pace to meet its goal of 100 million shots in 100 days, which only required it to modestly outpace the previous administration’s distribution levels. Biden said in January he may aim for 150 million shots in that time, but his press secretary later said 100 million was still the official target.

The White House this week began coordinating shipments of vaccines directly to 6,500 pharmacies with the goal of reaching about 40,000.

“We are providing tools to communities around the country to do this work and look forward to partnering with them to ensure equity,” said Marcella Nunez-Smith, chair of the Biden administration’s COVID-19 Health Equity Task Force, on a press call.

The United States has boosted vaccine distribution from 8.6 million doses to 11 million doses weekly since Biden came into office three weeks ago, said Jeff Zients, the White House’s COVID-19 response coordinator.

The White House has said it plans to continue boosting the number of doses it distributes and will use the federal government’s emergency powers under the Defense Production Act, to increase production of vaccines. Johnson & Johnson is expected to receive authorization for its experimental COVID vaccine as soon as this month which would further increase vaccine supplies.

https://www.reuters.com/article/us-healh-coronavirus-usa-vaccine/u-s-to-start-sending-covid-19-vaccines-directly-to-community-health-centers-idUSKBN2A92LC

J&J applies for COVID-19 vaccine emergency authorisation from South Africa

 South Africa's joint lead investigator for the Johnson & Johnson COVID-19 vaccine trial said on Tuesday that a government regulator was processing an application for the vaccine to be granted emergency use authorisation.

Addressing a webinar on vaccines, the official, Glenda Gray, said discussions were underway with regulatory authorities to roll out the single-dose vaccine to health workers, after the government on Sunday halted distribution of the AstraZeneca vaccine over efficacy concerns.

In December, the U.S. pharmaceutical company was the first to apply to the South African Health Products Regulatory Authority (SAHPRA) for registration of its vaccine.

South Africa had given fast-track approval to AstraZeneca's COVID-19 vaccine for emergency use last month and had said it was reviewing applications by Pfizer and Johnson & Johnson.

"J&J also submitted a rolling submission to SAHPRA to expedite the regulatory processes in South Africa, so this AD26 vaccine as we speak is being processed for emergency use," Gray said on Tuesday.

AD26 is the clinical name of the J&J vaccine.

She said there has been progress in discussions with regulatory authorities, enough to consider evaluating the vaccine in exposed health care workers, who are the first sector of the 60 million population earmarked for inoculations.

"So what we are discussing is whether, under regulatory authorisation, we can use this vaccine rapidly in health care workers in South Africa as a single shot," she said, adding that the vaccine is safe and has shown to work on the South African variant of the novel coronavirus.

South Africa has pivoted to the J&J vaccine after data showed AstraZeneca's shot offered minimal protection against mild-to-moderate illness from a dominant local virus variant.

With the most coronavirus infections in Africa and more than 46,000 deaths, South Africa had planned to start offering healthcare workers the AstraZeneca vaccine soon before it was put on hold.

Shabir Madhi, the principal investigator of South Africa leg of trials of the vaccine manufactured by AstraZeneca, said human trials for a second generation of vaccines to tackle new variants of the coronavirus are already underway.

He did not specify the company conducting these trials. The vaccines should be available by the third quarter, Madhi said.

https://www.marketscreener.com/quote/stock/ASTRAZENECA-PLC-4000930/news/J-J-applies-for-COVID-19-vaccine-emergency-authorisation-from-South-Africa-32399502/