News : Innovation — but at what price?

Friday, April 26, 2024

Innovation — but at what price?

Apr 26, 2024

View in browser

By Chelsea Cirruzzo and Ben Leonard

Driving The Day

Jodey Arrington walking in a hallway in the U.S. Capitol.

Rep. Jodey Arrington wants an investigation into why CMMI overspent by $1.3 billion. | Francis Chung/POLITICO

FIRST IN PULSE: CMMI UNDER THE MICROSCOPE — Leading House GOP lawmakers are pushing for an investigation into the agency created to test ways to finance health care costs after it increased spending by more than $1 billion, Ben reports.

Budget Committee Chair Jodey Arrington (R-Texas) and Rep. Michael Burgess (R-Texas), who chairs the panel’s health care task force, called on the Government Accountability Office today to scrutinize the Center for Medicare and Medicaid Innovation.

“CMMI has failed to deliver on its mandate,” Arrington and Burgess said in a statement, first reported by POLITICO.

They asked GAO to assess the agency’s funding and performance and identify which of the payment models tested by the agency had saved money or increased spending.

The bigger picture: The move comes as lawmakers look to rein in health care spending and could shed more light on CMMI’s practices. The U.S. spends significantly more on health care than other wealthy nations but still has worse health outcomes than other countries.

The Congressional Budget Office found last year that the agency, created to test strategies for financing health care costs, is set to increase federal spending by $1.3 billion between 2021 and 2030, POLITICO has reported. It added to spending by $5.4 billion in the previous decade, CBO found.

Republicans on the House Ways and Means Health Subcommittee have pushed for more guardrails for CMMI and introduced legislation late last year on the issue aiming to limit model scope in early testing phases.

CMMI’s history: The center was created under the Affordable Care Act to facilitate alternative payment models to address increasing concerns about health care costs and quality. So far, most experiments haven’t panned out, and CMMI has acknowledged shortcomings.

The agency has said that just 6 in 50-plus models it tried over a decade had resulted in statistically significant savings. Only four of those met the criteria for wider use.

In announcing a “strategic refresh” in 2021, CMMI said complex policies and overlap in models can create “conflicting or opposition incentives” for providers, so it aimed to cut the number of models it uses to reduce overlap.

The agency also said that some benchmarks and methodologies allowed for “potential gaming and upcoding among participants,” minimizing savings. It said it would test methodologies that incentivize “appropriate coding” and improve testing before launching models.

WELCOME TO FRIDAY PULSE. Your cleaning sprees may have an impact on your brain cells. Send your tips, scoops and feedback to ccirruzzo@politico.com and bleonard@politico.com and follow along @ChelseaCirruzzo and @_BenLeonard_.

THE GOLD STANDARD OF HEALTHCARE POLICY REPORTING & INTELLIGENCE: POLITICO has more than 500 journalists delivering unrivaled reporting and illuminating the policy and regulatory landscape for those who need to know what’s next. Throughout the election and the legislative and regulatory pushes that will follow, POLITICO Pro is indispensable to those who need to make informed decisions fast. The Pro platform dives deeper into critical and quickly evolving sectors and industries, like healthcare, equipping policymakers and those who shape legislation and regulation with essential news and intelligence from the world’s best politics and policy journalists.

Our newsroom is deeper, more experienced and better sourced than any other. Our healthcare reporting team—including Alice Miranda Ollstein, Megan Messerly and Robert King—is embedded with the market-moving legislative committees and agencies in Washington and across states, delivering unparalleled coverage of health policy and the healthcare industry. We bring subscribers inside the conversations that determine policy outcomes and the future of industries, providing insight that cannot be found anywhere else. Get the premier news and policy intelligence service, SUBSCRIBE TO POLITICO PRO TODAY.

In Congress

Phillip Swagel, Director of the Congressional Budget Office, testifies during a House Committee hearing.

According to CBO Director Phill Swagel, weight-loss drug prices would have to drop considerably to avoid an increase in the national debt. | Mariam Zuhaib/AP

A WEIGHTY DRUG COST — The net cost of weight-loss drugs would have to drop by 90 percent to “get in the ballpark” of not increasing the national deficit, the head of the Congressional Budget Office said Thursday.

Speaking at an event in Washington on how health care costs contribute to the federal debt, hosted by Paragon Health Institute and the Economic Policy Innovation Center, CBO Director Phill Swagel gave insight into his office’s look at how much anti-obesity drugs could cost the federal government if they’re covered under Medicare.

In 2003, Congress prohibited Medicare from covering obesity drugs, and some lawmakers hope to change that. Earlier this year, CBO told Congress it was evaluating how the drugs if covered under Medicare could change baseline projections for health program costs.

The growth in Medicare spending is projected to account for more than two-thirds of the increase in spending in major health care programs over the next 30 years.

Swagel said policymakers could explore reducing the drugs’ cost to lower Medicare costs in the long run, but the price drop would be steep. On the other hand, he said, more people using the drugs could mean savings for other programs, such as disability services.

Swagel also said the CBO is analyzing how the cost of hepatitis C treatment could impact long-term health care spending. Hepatitis C rates have grown in recent years.

“If we can spend money up front, improve people's health … In principle, we could lower spending on health care,” Swagel said.

Public Health

GOT (RAW) MILK? DON’T — A fifth of the U.S. milk supply contains fragments of avian flu — which suggests the virus might have spread beyond symptomatic dairy herds, POLITICO’s Emily Cadei, David Lim and Marcia Brown report.

The news from the FDA on Thursday night comes as the Biden administration and the dairy industry race to convince the public not to worry.

Public health experts say the government should be more transparent about its efforts to expand testing and research into bird flu amid an outbreak in cows across multiple states.

The pathogen has been found in at least 33 dairy herds across eight states since first being detected among Texas cattle in late March, and virologists say it could be much more widespread than the data suggests.

Federal officials and industry executives maintain the discovery of inactive fragments of the virus strain, known as H5N1, in milk sold to consumers is not worrisome in itself — instead, it’s evidence that the pasteurization process is working to neutralize the virus. Raw milk, however, should be avoided.

Other safety caveats: The Biden administration has been careful to say that pasteurization is “likely” to inactivate the avian flu virus in milk but acknowledges the detection of the virus in dairy cows “is a novel and evolving situation” and “no studies on the effects of pasteurization on HPAI viruses (such as H5N1) in bovine milk have previously been completed.”

Jennifer Nuzzo, director of the Pandemic Center at the Brown University School of Public Health, questioned why the FDA did not immediately say it would test milk products and expeditiously culture any potential virus fragments found.

“Just from a government credibility standpoint, being transparent about what you're doing, it's important,” Nuzzo said.

LONG COVID DATA RELEASED — The NIH released data from more than 14,000 adults involved in federal long Covid research Thursday, making it available to researchers.

The NIH, which has been researching long Covid through its RECOVER initiative since 2021, said it had uploaded deidentified data to a cloud-based database to “help investigators identify and explore long COVID connections that may benefit from or inform future studies.”

Long Covid is a set of symptoms — ranging from annoying to debilitating — experienced after a Covid infection. Advocates for treatment have criticized federal officials for moving too slowly in researching the condition, with few treatment options over three years into the RECOVER Initiative. Federal officials have defended their pace as necessary.

“Sometimes research takes as long as it takes to have results,” Admiral Rachel Levine, HHS’ assistant secretary for health, told Pulse earlier this year. “It takes longer than people want, but we want to make sure that we have robust results that will actually help patients.”

Researchers can request data from studies conducted between Oct. 29, 2021, and Sept. 15, 2023. The NIH will add new research regularly.

TRANQ USE TIED TO INFECTIONS — A rise in bloodstream infections among people who inject drugs observed at a medical center in Vermont coincided with the rise of the illicit use of xylazine, a horse tranquilizer.

A CDC study released Thursday found that, during 2022-2023, the University of Vermont Medical Center saw a substantial rise in people with community-acquired group A streptococcal bloodstream infections, mostly among people who inject drugs.

This increase came as xylazine became more prominent in the illicit drug supply, with dealers adding it to synthetic fentanyl. Last April, the White House called the deadly tranquilizer, which can cause a user’s flesh to rot, an “emerging threat.” The president signed a bill at the end of last year to coordinate research into the drug at the NIH.

According to the study, 64 cases of bloodstream infections were reported at the Vermont Medical Center during 2022-2023, with 45 cases in the first 10 months of 2023. Seventy percent were among patients known to self-inject drugs. Nearly all those patients who self-injected drugs had wounds consistent with xylazine use — which researchers say could contribute to the entry of bacteria causing bloodstream infections.

What’s next? Researchers said the study suggests that introducing wound care services as part of substance-use harm reduction can prevent infections.

POLITICO IS BACK AT THE 2024 MILKEN GLOBAL CONFERENCE: POLITICO will again be your eyes and ears at the 27th Annual Milken Institute Global Conference in Los Angeles from May 5-8 with exclusive, daily, reporting in our Global Playbook newsletter. Suzanne Lynch will be on the ground covering the biggest moments, behind-the-scenes buzz and on-stage insights from global leaders in health, finance, tech, philanthropy and beyond. Get a front-row seat to where the most interesting minds and top global leaders confront the world’s most pressing and complex challenges — subscribe today.

WHAT WE'RE READING

POLITICO’s Paul Demko reports on Democrats pushing the DOJ to loosen weed restrictions.

The Washington Post reports on people who acquired HIV during treatments at unlicensed med spas.

Reuters reports on a suit by GSK against Pfizer and BioNTech, alleging the latter companies infringed on patents related to mRNA in their Covid vaccines.

Follow us on Twitter