| | | | |  | | By Chelsea Cirruzzo and Ben Leonard | Presented by Humana | With Gregory Svirnovskiy and Carmen Paun Programming note: We’ll be off this Monday for Presidents Day but will be back in your inboxes on Tuesday.
| | |  Health insurers want Biden administration officials and congressional offices to pressure CMS to make changes to its proposed cut to Medicare Advantage payments. | Pablo Martinez Monsivais/AP | INSURERS’ STRATEGY TO STOP MA CUTS — Health insurers are pushing back on the Biden administration’s proposed 0.16 cut to Medicare Advantage payments next year, POLITICO’s Robert King and Megan R. Wilson report. Plans are waging a campaign against the cut by running digital ads and organizing meetings on Capitol Hill with older Americans who like the benefits the privately run plans offer. While insurers say the proposed rule released on Jan. 31 would cut payments by 0.16 percent in 2025, CMS said it would amount to a 3.7 percent bump after adjusting payments to account for the insured population’s health. However, groups such as the Better Medicare Alliance, AHIP and Blue Cross Blue Shield Association argue that CMS didn’t fully factor in predictions of higher Medicare spending in the future. “There has been a notable increase in seniors using health care services from their doctors and providers, which makes sense given an increasingly aging population and the pent-up demand after the Covid-19 pandemic,” said Mary Beth Donahue, president of the Better Medicare Alliance, in a statement. More than 30 million Americans, representing over half of all eligible Medicare beneficiaries, are in a Medicare Advantage plan. Critics have said that while the plans are popular, they’re paid too much and deny care too frequently. “It is ridiculous that insurers are pushing back, but this is insurance companies’ attempt to privatize Medicare,” said Rep. Pramila Jayapal (D-Wash.). “We need to make sure that these rates are set in a way that we can stop insurance companies from profiteering from Medicare.” Insurers have coaxed policy wins from regulators before. The proposed rate notice for 2024 included a potential 3 percent cut to payments and a change to its risk model to improve the accuracy of payments. After the plans conducted a massive lobbying campaign, CMS decided to phase in the risk model changes over three years. The agency is expected to finalize the payment rule by April 1. CMS said it looks at multiple factors when it comes to the calculation of the payment rate. "All factors are vital when analyzing the full picture of how the government’s payment to MA insurance plans is expected to change year over year," the agency said in a statement. "Omitting factors would be cherry picking numbers and underestimating what the government is expected to pay in 2025." WELCOME TO FRIDAY PULSE. The virologist who discovered Epstein-Barr virus passed away earlier this month at the age of 102. The work of Dr. Anthony Epstein opened the door to research into viral links to certain cancers, lupus and even long Covid. Send your tips, scoops and feedback to ccirruzzo@politico.com and bleonard@politico.com and follow along @ChelseaCirruzzo and @_BenLeonard_.
| | | | A message from Humana: Humana takes a holistic approach to clinical care, as is outlined in our tenth annual value-based care report. Value-based payment models—which prioritize quality of care—lower costs and provide better outcomes for patients and physicians. Patients spend on average more time with their primary care physicians, helping providers better understand and treat their needs. Learn more in Humana's 2023 VBC report. | | | | | | | 
A large proportion of health companies have conformed with a federal rule to employ API software to share electronic health records. | M. Scott Mahaskey/POLITICO | M. Scott Mahaskey/POLITICO | MOST HEALTH COMPANIES USE APIs — A large proportion of digital health companies follow standards established under a 2020 rule to share electronic health records, the HHS Office of the National Coordinator for Health IT said Thursday in a blog post. A national survey published by researchers in the Journal of the American Medical Informatics Association of companies showed that 73 percent use standards-based application programming interfaces, called APIs, when integrating electronic health records. APIs allow data to be shared safely on third-party applications like smartphone apps. The survey was conducted in 2022, before the deadline to comply with the rule. Researchers also found digital health companies that integrate their apps with multiple EHRs are more likely to use the standards. Why it matters: According to federal officials, the survey shows high adoption of the standards — but also highlights issues with implementation. Background: The rule, which finalized the CURES Act, required developers of certified APIs to adopt certain standards by the end of 2022. The survey was conducted in 2022, before the deadline. Many companies surveyed also said they used other types of APIs, at times due to challenges with implementing standards-based APIs and limited support for certain use cases. Among those barriers, companies reported high fees, a lack of realistic clinical testing data and data elements that weren’t of value. “The results validate other concerns raised by health IT community members, especially app developers and other digital health companies, about the limited scope of the current certified APIs and barriers to entry like fees, data access, and developer support, that affect realization of APIs ‘without special effort’ as called for in the 21st Century Cures Act,” ONC officials wrote.
| | | | CONGRESS OVERDRIVE: Since day one, POLITICO has been laser-focused on Capitol Hill, serving up the juiciest Congress coverage. Now, we’re upping our game to ensure you’re up to speed and in the know on every tasty morsel and newsy nugget from inside the Capitol Dome, around the clock. Wake up, read Playbook AM, get up to speed at midday with our Playbook PM halftime report, and fuel your nightly conversations with Inside Congress in the evening. Plus, never miss a beat with buzzy, real-time updates throughout the day via our Inside Congress Live feature. Learn more and subscribe here. | | | | | | | | | 
| THE STATES OF LONG COVID — More than 8 percent of adults in seven states report having experienced long Covid, according to preliminary research out Thursday by the CDC. What the survey found: Researchers analyzed data from the Behavioral Risk Factor Surveillance System conducted in 2022, finding that, nationally, 6.4 percent of adults reported ever having experienced long Covid. It also found wide variation across states — from 1.9 percent of adults in the U.S. Virgin Islands to 10.6 percent of adults in West Virginia reporting an experience with long Covid. The states with the highest rates of reported long Covid were mainly in the South and Midwest. Why it matters: Much is still unknown about long Covid, which is a range of symptoms — from mild to debilitating — that some people experience after a Covid infection. Some long Covid treatment advocates and providers have criticized the NIH’s study of long Covid for focusing too much on observational research instead of treatment. Adm. Rachel Levine, HHS assistant secretary for health, told Pulse earlier this month that HHS is working with the National Academies of Sciences, Engineering and Medicine on a definition for long Covid. The study’s limitations: The survey data didn’t capture treatment during an acute Covid infection, the time since the illness, its duration or symptom severity. It also didn’t take into account vaccination data for all states.
| | | | A message from Humana:   | | | | | VA EHR SYSTEM CRITICIZED — Just weeks before the Department of Veterans Affairs prepares to expand a new electronic health records system to a Chicago hospital, Congress isn’t convinced the system is ready. At a House Veterans’ Affairs Committee hearing Thursday, members criticized the VA and its vendor, Oracle Health, for a botched rollout of the new system and expressed concern about bringing it to another facility, Gregory reports. VA Deputy Inspector General David Case told the committee that 250,000 veterans’ medication records at the five medical centers using the new software contained errors that could result in unintentional drug interactions and allergic reactions. Subcommittee Chair Matt Rosendale (R-Mont.) pressed three VA officials — Dr. Neil Evans, acting executive director of the VA’s EHR modernization office; Thomas Emmendorfer, executive director of pharmacy benefits management services; and Robert Silverman, chair of the VA’s EHRM Pharmacy Council — on why the agency hadn’t notified veterans that their records were at risk. Evans said the agency could commit to looping patients in, but informing health care providers had to come first when the VA learned about the error. Background: The EHR rollout was paused last April, felled by cost overruns, technical issues and safety concerns tied to at least four veterans’ deaths. The agency and Oracle have spent the better part of the last year focusing on issuing fixes for the five medical centers and 22 clinics using the software.
| | | | DON’T MISS POLITICO’S GOVERNORS SUMMIT: Join POLITICO on Feb. 22 to dive into how Governors are wielding immense power. While Washington remains gridlocked, governors are at the center of landmark decisions in AI and tech, economic development, infrastructure, housing, reproductive health and energy. How are they setting the stage for the future of American politics, policies and priorities? How are they confronting major challenges? Explore these questions and more at the 2024 Governors Summit. REGISTER HERE. | | | | | | | | | Amanda Perl has joined the American Society of Human Genetics as its chief executive officer. She previously was executive director of the American Thyroid Association.
| | The New York Times reports on a lawsuit that alleges a medical supplies company’s product destroyed embryos created via in vitro fertilization. POLITICO’s Rachel Bluth reports on the ACLU’s opposition to the California governor’s sweeping mental health reform proposal. STAT reports that a hospital group claims that some drugmakers vastly overcharged them and the federal government through the 340B safety-net program.
| | | | A message from Humana: Coordinating primary care and value-based care solutions can lead to better health outcomes.
Patients at CenterWell, a Humana Inc. company, experience improved health outcomes, including 31% fewer avoidable hospital admissions and 22% fewer emergency department visits.1
By connecting people with individualized and holistic care options, Humana helps increase patient satisfaction and health.2
1) Humana and CenterWell data. For details, see here.
2) Humana, "Value Based Care Report 2023," November 2023.
Learn more about the benefits of primary care. | | | | | | | Follow us on Twitter | | | | Follow us | | | | |
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