News: Axios Vitals: Walmart's research play

Tuesday, October 11, 2022

Axios Vitals: Walmart's research play

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Axios Vitals

By Tina Reed · Oct 11, 2022

Happy Tuesday, Vitals readers! Today's newsletter is 1,131 words or a 4½-minute read.

🍺 On tap this week: Walgreens and UnitedHealth Group kick off the fall health care earnings season on Thursday and Friday, respectively.

1 big thing: Employers expand reproductive health benefits amid tight labor market

Illustration: Sarah Grillo/Axios

A growing number of employers are expanding health coverage to in-vitro fertilization, surrogacy and other sometimes pricey fertility services in order to compete in the tight labor market amid heightened awareness of women's health, Axios' Oriana Gonzalez writes.

Why it matters: An estimated 1.1 million women left the workforce during the pandemic, accounting for more than 63% of jobs lost, per Harvard Business Review.

And the overturning of Roe v. Wade has scrambled the calculus for job-based reproductive health coverage.

Driving the news: Walmart, the largest private employer in the U.S., recently announced that it is adding family-planning benefits — coverage for IVF, surrogacy and adoption — for its workers.

"This is a catalyst for the democratization of care," said Annbeth Eschbach, CEO of Kindbody, the family-building benefits company that Walmart partnered with. "Fertility benefits have joined medical, dental, vision, as a standard."

Zoom out: Amazon, the second largest employer in the country, has been offering fertility benefits to all U.S. non-seasonal part-time and full-time employees through a partnership with Progyny, a fertility benefits provider, since 2019, according to a company spokesperson.

What they're saying: The moves suggest that "family-building benefits or reproductive health benefits are not restricted to just white-collar companies," said Jean Abraham, a health economist at the University of Minnesota.

The big picture: After the Supreme Court overturned Roe v. Wade, Walmart, Disney, Meta and a number of other big employers said that they would help employees living in states with abortion restrictions access reproductive health options, including paying for travel expenses.

The heightened focus on reproductive health is motivating employers to also consider also providing fertility and family-planning benefits, some of which were once deemed too costly, said Julie Campbell, a principal consultant in Mercer's total health management practice.
Coverage options are also expanding to pre-conception counseling, egg-freezing, menopause and postpartum care.

Go deeper.

2. Walmart launches research arm

Photo: Artur Widak/NurPhoto via Getty Images

Walmart today will announce it's getting into the business of clinical trials with the launch of its Walmart Healthcare Research Institute.

Driving the news: The venture — an outgrowth of Walmart Health & Wellness, which spans its pharmacy, vision centers and Walmart Health division — is aimed at improving clinical trial diversity by leveraging the retailer's massive footprint, Walmart's chief medical officer John Wigneswaran told Axios.

They aim to expand access to older adults, rural residents, women and minority populations by serving as a connector between drug researchers and potential trial participants, he said.
They plan to start with trials of drugs that most impact underrepresented communities, such as treatments for diabetes, cardiovascular disease, COVID-19 and asthma, but are also considering areas of research like HIV and dementia, he said.

What they're saying: "We're filling an important need because we have 150 million people coming through the stores, we have a very deep relationship with these customers and we also know their clinical histories so we're able to find the appropriate patients for those studies," Wigneswaran said.

The big picture: Getting a diverse pool of participants in clinical trials has proved an incredibly difficult problem in drug development. The FDA has called improving diversity in trials a priority.

The move comes just a few months after Walgreens announced a similar move to address trial diversity.

Between the lines: While this will be a profitable business, it has been set up to require oversight from an independent review board and a clinical advisory board to ensure the most beneficial trials are selected and appropriate messaging is sent to patients, Wigneswaran said.

Eventually, Walmart pharmacies could serve as access points for patients to get trial drugs, he said.

3. Medicare Advantage gets exploited by insurers

Insurers have been employing lucrative strategies to milk more money from the federal Medicare Advantage program than they may legally be due, according to a New York Times review of federal fraud lawsuits and watchdog investigations.

Why it matters: The Medicare Advantage program was created to allow private health insurers to bring innovation into Medicare. It's on track to potentially become the dominant form of Medicare coverage seniors select next year, over traditional Medicare.

But the NYT review shows the program is being exploited, with eight of the 10 largest MA insurers accused of submitting inflated bills while four of the five largest MA insurers have faced federal lawsuits for overbilling, the Times writes.

What they're saying: "Even when they're playing the game legally, we are lining the pockets of very wealthy corporations that are not improving patient care," Don Berwick, a former Centers for Medicare and Medicaid Services administrator, told the Times. "When you skate to the edge of the ice, sometimes you're going to fall in."

The other side: Most of the insurers contacted by the Times disputed the allegations and called the federal audits flawed.

The bottom line: Medicare's open enrollment period for 2023 starts later this week and we'll most likely see more seniors pick some of those MA plans. But while the program's problems have caught the attention of Congress, don't expect any fixes anytime soon.

A message from PhRMA

Americans want policy reforms that improve their insurance

Did you know 39% of insured Americans say they don't understand what's covered by their insurance? Health insurance coverage should be predictable and transparent, and insured Americans agree.

Learn more from PhRMA's latest Patient Experience Survey report.

4. Home health patients, advocates sue Becerra

Illustration: Brendan Lynch/Axios

Three disabled Medicare beneficiaries and two organizations are suing Health and Human Services Secretary Xavier Becerra, alleging he restricted the availability of home health services for individuals who need aides for short periods of time, Axios' Arielle Dreher writes.

Why it matters: The lawsuit in U.S. District Court for the District of Columbia comes as home health agencies face looming Medicare payment cuts that the providers say will reduce the number of visits for some patients, or result in the loss of care entirely.

Driving the news: The lawsuit alleges that the CMS payment model changes have impeded services for people in need of "part-time or intermittent" services usually totaling 28 or fewer hours a week.

The plaintiffs detail difficulty finding consistent and enough home health aides between hospital stays or when needed, and some had to use their own finances to cover necessary care.
The National Multiple Sclerosis Society and Team Gleason, a Louisiana charity for ALS patients, are among the plaintiffs seeking an injunction to ensure that those who qualify "have reasonable access to the home health aide services."

What we're watching: Home health agencies might get a reprieve from the worst of the payment cuts, but the lawsuit alleges a broader access issue that is made more difficult with staffing shortages following the pandemic.

5. While you were weekending

Illustration of a desk on a beach under a palm tree.

Illustration: Aïda Amer/Axios

👀 The benefit of colonoscopies may have been overstated, according to a study published over the weekend which found it reduced cancer incidence — but not death — from colon cancer. (STAT)

🏥 The spread of Catholic hospitals limits reproductive care access, including treatment options for miscarriages and ectopic pregnancies, across the U.S. (Washington Post)

👉 Hospitals have specialists ready to offer consult for concerns from cancer to childbirth, but they've often been slow to bring on addiction experts — a major gap amid a national drug crisis. (KHN)

A message from PhRMA

How insured Americans navigate unclear insurance coverage

According to new findings, insured Americans favor policy solutions that improve their ability to navigate and access their care while lowering their out-of-pocket costs.

An example: Tackling the barriers introduced by insurers and middlemen like pharmacy benefit managers.