Health Plans Can Leverage Data, Care Coordination to Manage Long Covid

An estimated 16 million working-age U.S. residents are afflicted with “long COVID,” but the risk factors and mechanisms of the condition — let alone how to treat it — are poorly understood, which means caring for patients with the disease is a daunting challenge for health plans. According to one health insurance leader, identifying members struggling with long COVID and proactively coordinating their care are crucial to contain costs and help members manage the disease.

Long COVID is a loose term for a condition with a variety of symptoms that persist after acute COVID-19 infection has passed. According to the National Institutes of Health (NIH), clinicians refer to the term as Post-acute Sequelae of SARS-CoV-2 Infection (PASC). Typical symptoms include fatigue, post-exertional malaise, shortness of breath, coughing, chest pain, heart palpitations, gastrointestinal issues, and joint and muscle pain, according to the Centers for Disease Control and Prevention. Medical researchers have yet to arrive at a consensus on the risk factors behind long COVID and have yet to develop a standard of care. For the most part, practitioners are just trying to manage symptoms as they come.


COVID-19 Vaccine Commercialization Will Be Costly for U.S. Health System

COVID-19 vaccines could add billions of dollars to overall health care spending each year if the federal government’s purchasing program ends early next year, according to a Kaiser Family Foundation analysis. To date, the federal government has spent about $25 billion on purchasing Pfizer and Moderna COVID-19 vaccines combined, at a weighted average purchase price of $20.69 per dose.

Pfizer and Moderna both announced that the average commercial price per dose for their vaccines could be three to four times greater than the price paid by the government, between $82 and $130 per dose. If half of U.S. adults receive a booster shot at the expected commercial prices, it could cost between $3.7 billion and $14.8 billion to purchase enough doses for the group (129 million).


COVID Vaccine Prices Set to Rise After Commercialization — But Are They Fair?

COVID-19 vaccines are likely to cost payers billions on an annual basis, according to a new analysis based on publicly disclosed vaccine price projections by executives from Pfizer Inc. and Moderna Inc. Despite criticism from some progressive members of Congress, who say the vaccines will be priced too high, one vaccine expert tells AIS Health, a division of MMIT, that per-dose costs aren’t out of line with typical vaccine prices for adults.

The federal government initially bought COVID vaccines, using its purchasing power to accelerate research and development. COVID vaccines were developed in record time, and federal purchasing helped manufacturers hit remarkable earnings figures. However, despite requests from the Biden administration for more funds to purchase future COVID vaccines, Congress seems unlikely to pay for more. Federal vaccination funds and vaccine stockpiles are likely to run out sometime in 2023.


After COVID-19 Emergency Expires, Medicaid’s Loss Could Be Employer Plans’ Gain

If the COVID-19 public health emergency (PHE) expires in April 2023, about 18 million Medicaid enrollees could lose their coverage over the following 14 months, an Urban Institute analysis projected. Among them, about 9.5 million people could transition to employer-sponsored insurance, 3.2 million could move to Children’s Health Insurance Program (CHIP) coverage, and 3.8 million could become uninsured. If the PHE were extended for an additional quarter, the number of people losing coverage could rise to nearly 19 million. The PHE is set to last at least through January, as the Biden administration is concerned about the potential of a winter wave of COVID infections.


2022 Saw Some Pharma Challenges, but Industry Has Continued to Innovate With Novel New Agents

As the pharma industry dealt with the ongoing COVID-19 pandemic amid heightened economic pressures, it largely weathered the storm that was 2022. But with provisions of the Inflation Reduction Act (IRA) set to start rolling out next year, many questions remain that may impact pharma manufacturers. The industry, however, saw continued innovation in novel therapeutics, and in the second half of the year, the number of gene therapies on the U.S. market more than doubled with the approval of three new agents. And while the merger and acquisition (M&A) activity may have been a bit muted compared with past years, 2022 is closing out with the unveiling of the biggest biotech deal of the year: Amgen Inc.’s agreement to purchase Horizon Therapeutics plc for $27.8 billion. AIS Health, a division of MMIT, spoke to industry experts about other 2022 pharma trends.


Federal Watchdogs Raise Telehealth Fraud Concerns

The pandemic-induced telehealth revolution expanded access to an exciting new modality of care delivery, but a new report from federal watchdogs found that federal payers face new, telehealth-derived challenges in stopping waste, fraud and abuse. Those findings mean the commercial carriers that administer certain federally underwritten health insurance plans have a new auditing and accountability challenge as telehealth settles in as a permanent part of the care delivery landscape.

The report, prepared by six Offices of Inspectors General (OIGs) from HHS, the Dept. of Justice, Dept. of Defense, Dept. of Veterans Affairs (VA), Dept. of Labor and Office of Personnel Management (OPM), found that “while the expansion of telehealth has been essential to maintaining individuals’ access to care, there have been concerns about the potential for fraud, waste, and abuse associated with expanded telehealth services.”


New FDA Approvals: FDA Issues Emergency Use Authorization to Kineret

Nov. 9: The FDA issued an emergency use authorization to Amgen Inc.’s Kineret (anakinra) for the treatment of COVID-19 in hospitalized adults with pneumonia requiring supplemental oxygen (low- or high-flow oxygen) who are at risk of progressing to severe respiratory failure and likely to have an elevated plasma soluble urokinase plasminogen activator receptor (suPAR). The agency initially approved the interleukin-1 receptor antagonist (IL-1Ra) on Nov. 14, 2001. The recommended dosing for this latest use is 100 mg administered daily by subcutaneous injection for 10 days. lists the price of one 100 mg prefilled syringe as more than $1,265.


For Privately Insured, Half of COVID Hospitalizations Cost Over $25K

A COVID-19 hospitalization cost more than $40,000 on average for people with large-employer health coverage in 2020, according to the Peterson-Kaiser Family Foundation Health System Tracker. Half of those hospital admissions cost over $25,000, and a quarter cost almost $39,000. About 38% of COVID-related hospitalizations in 2020 included an intensive care unit stay, and the average cost of such admissions was $65,569 — more than double the average amount paid for COVID admissions without an ICU stay.


Horizon BCBS Launches NovaWell to ‘Reimagine’ Behavioral Health

A new behavioral health venture that sprung from an innovative Horizon Blue Cross Blue Shield of New Jersey initiative is focused on embedding its integrated approach within other health plans and provider groups. NovaWell, a Horizon affiliate that launched Nov. 14, is offering a suite of technology-forward solutions aimed at tackling the country’s ongoing mental health crisis. Jolted into the public consciousness by the COVID-19 pandemic, the crisis is characterized by rising rates of anxiety and depression amid a shortage of trained professionals.

Backed by more than five years of testing and program design aimed at addressing the behavioral health needs of Horizon’s members, the NovaWell suite brings an integrated care management approach supported by network-enhancing solutions to a wider audience. Two of the company’s four core offerings, a fully integrated clinical model called NovaClinical and a network solution known as NovaNetwork, are positioned to bolster health plans, Suzanne Kunis, president and CEO of NovaWell, tells AIS Health, a division of MMIT.


UnitedHealth Survey Finds Large Increase in Number of People Using Virtual Care

A recent survey from UnitedHealthcare found that 71% of respondents said they would likely use virtual care in the future, up from 53% in last year’s survey. Donna O’Shea, M.D., UnitedHealth’s chief medical officer of population health, tells AIS Health that the results indicate the use of virtual care is more than just a COVID-19-specific trend and is likely to become a permanent part of health care.

Still, that’s not to say that people prefer virtual care over visiting doctors in their offices. In fact, the 2022 UnitedHealthcare Consumer Sentiment Survey found that 60% of respondents preferred in-person appointments for non-emergency issues such as allergies, flu or rashes, while 26% preferred virtual appointments and 14% had no preference. The question assumed that the quality and costs of care were comparable between in-person and virtual settings.