Blacks, Hispanics lost nearly twice as many quality adjusted life years as Whites.
The COVID-19 pandemic that has claimed more than 660,000 lives in the U.S. has also cut aggregate life expectancy here by more than 9 million years, according to a study published Monday in Annals of Internal Medicine.
The study authors said their findings suggest that the mortality burden of COVID-19 is more substantial than previously thought.
"Beyond excess deaths alone, the COVID-19 pandemic imposed a greater life expectancy burden on persons aged 25 to 64 years, including those with average or above-average life expectancies, and a disproportionate burden on Black and Hispanic communities," study lead author Julian Reif, PhD, and colleagues concluded.
With data from the Health and Retirement Study, Panel Study of Income Dynamics, and CDC and CMS data, University of Illinois and University of Southern California researchers used their Future Adult Model and Future Elderly Model to create a microsimulation that measured years of life lost (YLLs) and quality adjusted life years (QALYs) lost from the COVID-19 pandemic, by age, sex, race/ethnicity, and comorbidity.
The researchers measured YLLs and QALYs lost per 10,000 persons and included demographic information, along with obesity, smoking behavior, and other risk factors. They found that the COVID-19 pandemic resulted in 9.08 million years of excess lost life through March 2021, with 4.67 million years lost by those aged 25 to 64 years.
The greatest toll was on Blacks and Hispanics, who lost more than twice as many QALYs per capita as Whites. The toll was especially high among Black and Hispanic men age 65 or older. The researchers estimate that 38% of excess deaths in the first year of the pandemic would have otherwise had average or above-average life expectancies for their subgroup.
"Measuring the mortality burden of the COVID-19 pandemic is about more than excess deaths," the researchers said. "Focusing solely on excess deaths from the COVID-19 pandemic can underestimate its effect on young and middle-aged adults who have a longer life expectancy than older, sicker adults."
"Understanding disproportionate mortality rates by race/ethnicity is also important. Calculating years of life lost (YLLs) and QALY by demographics and risk factors may provide greater perspective into the true mortality burden of the pandemic," the researchers said.
Writing a corresponding editorial, Ashish K. Jha, MD, MPH, dean of the Brown University School of Public Health -- who was not involved in the research -- said the study may be lowballing the grim numbers because it analyzes deaths only through the middle of March 2021.
"In the months since, more than 120 000 Americans have died of COVID-19, and it is likely that the burden of disease has shifted to a younger population as older Americans have generally embraced vaccination," Jha wrote. "Furthermore, measuring mortality yields an incomplete picture of the pandemic's effect. Those who survive COVID-19 often face a long road to recovery and may endure chronic symptoms and disability."
When a Medicare Advantage plan fails for three straight years to meet the 85% threshold, CMS must suspend them from accepting new enrollees for the next contract year.
Four Medicare Advantage plans affiliated with UnitedHealthcare and Anthem, Inc. have been barred from enrolling new members until 2023 after failing to meet the 85% medical loss ratio threshold for paying benefits, the Centers for Medicare & Medicaid Services says.
The medical loss ratio, mandated by the Social Security Act, is applicable to all Medicare Advantage plans. When an MA plan fails for three straight years to meet that 85% threshold, CMS must suspend them from accepting new enrollees for the next contract year.
The UHC plans affected by the suspensions are: UHC of the Midwest (MLR in 2020 of 84.5%), with a footprint in Missouri, Kansas, Nebraska, Iowa; UHC of New Mexico (MLR 84.9%); and UHC of Arkansas (MLR 79.8%). The enrollment suspensions affected about 80,000 of UHC's 7.5 million Medicare Advantage enrollees, the Minnetonka, Minnesota-based payer confirmed.
In a statement to the media, UHC said it "spends at least 85% of the premiums we take in on care for the people we serve."
"In a few markets, we were not able to do that because so many of our members deferred going to get care due to COVID-19. As a result, we can’t enroll any new members in a few local plans until 2023 when we expect care patterns to be at more normal levels," the payer said.
Existing members will not be affected by the suspension, UHC said, adding that it would "continue to offer alternative plan options for people who want to choose a new UnitedHealthcare plan in these select markets."
Also suspended was Indianapolis-based Anthem, Inc.'s MMM Healthcare, purchased as part of MMM Holdings LLC, in June from InovaCare. MMM Healthcare is Puerto Rico's largest MA plan, with more than 260,000 enrollees. CMS said the plan had a MLR of 77% in 2020.
In a statement to the media, Anthem stressed that the suspension "does not impact any of MMM Healthcare's other Medicare Advantage plans nor any other Anthem-affiliated health plan."
"Anthem will continue to invest in our health plans to ensure our members have access to high-quality healthcare services. We will also work with MMM Healthcare and CMS to address the agency’s concerns," Anthem said.
If the plans can document that they have achieved a medical loss ratio of at least 85% in 2021, they will be allowed to resume enrollments effective January 1, 2023.
Both payers may appeal the suspensions, but neither indicated that it would.
The two health systems say they hope to have a definitive agreement finalized by year's end, and to close the deal in early 2022, pending regulatory approval.
Nonprofits Intermountain Healthcare and SCL Health announced Thursday that they have signed a letter of intent to merge and create a 33-hospital health system serving six states.
Under the deal, the consolidated health system will keep the Intermountain Healthcare brand. SCL Health's seven Catholic hospitals and one secular hospital will keep their names and continue to operate under existing religious guidelines.
Salt Lake City-based Intermountain operates 25 secular hospitals, 225 clinics, employs 42,000 people, and includes a medical group, SelectHealth insurance company, and other services in Utah, Idaho, and Nevada.
The consolidated health system would employ more than 58,000 people, with 386 clinics in Utah, Idaho, Nevada, Colorado, Montana, and Kansas, and would provide health insurance to about 1 million people.
Intermountain and SCL Health say they now provide services in adjacent regions with no geographic overlap.
"American healthcare needs to accelerate the evolution toward population health and value, and this merger will swiftly advance that cause across a broader geography," said Marc Harrison, MD, president and CEO of Intermountain. "We'll bring together the best practices of both organizations to do even more to enhance clinical excellence, transform the patient experience, and support healthy lives."
Lydia Jumonville, president and CEO of SCL Health, said the two health systems are negotiating the merger "from positions of strength."
"We are two individually strong health systems that are seeking to increase care quality, accessibility, and affordability. We will advance our missions and better serve the entire region together," she said.
The consolidated system will be headquartered in Salt Lake City, with a regional office in Broomfield. Harrison will be president and CEO of the merged organization. Jumonville will keep her job during a two-year transition and become a member of a new combined board.
"The ability to access care virtually has gained momentum and become a valued option for employees," says Mercer.
One-fifth of 14,000 employees from 13 nations surveyed in a poll conducted by Mercer consultants used telehealth for the first time during the COVID-19 pandemic and 72% of them say they intend to keep using it.
The 2021 Mercer Health on Demand survey, released this week, also detected a big bump in employee interest in other digital health options, including apps to find providers and virtual reality tools for self-care.
Compared to the 2019 Health on Demand survey, a greater percentage of employees in the 2021 survey found digital solutions to be highly or extremely valuable," Mercer wrote. "The ability to access care virtually has gained momentum and become a valued option for employees. Survey results reinforce that employers need to plan for a future in which most healthcare journeys include virtual visits and digital healthcare supports."
The survey also found that:
The pandemic has had a material impact on the mental, financial, and physical health of employees, with more than half of U.S. employees feeling some level of stress in the last year. Nearly one-fourth say they experienced mental health issues such as depression or anxiety, a fifth are financially worse off, and nearly a fifth feel less physically healthy or fit.
However, 53% of employees feel their employer has provided good support during the pandemic – and, compared to those who have received little support, they are less likely to have experienced the pandemic’s impact as mostly or entirely negative.
45% of employees who feel they have received good support from their employers during the pandemic say they are less likely to leave their company as a result.
"There is nothing more important to the health of a business than the health of its people and the communities in which that business operates," Mercer CEO and President Martine Ferland said.
"COVID-19 challenged our global healthcare system, but the ability of employers to have a positive impact on employee health and resiliency is one of the most important findings from our 2021 Health on Demand survey," he said.
"The research is clear – employers that place health and humanity at the center of business transformation will build a more energized and adaptable workforce that is better able to persevere through periods of crisis."
The study sought to determine whether an integrated or referral approach was more effective when providing clinic-to-clinic mental health care in a primary care setting.
Telepsychiatry delivered from rural, federally qualified health centers provides highly effective treatment for patients struggling with care access for complex mental health disorders.
However, integrated telepsychiatry allows for more efficient use of precious and sparse mental health resources than do traditional referrals, according to a study published in JAMA Psychiatry.
The five-year trial -- Study to Promote Innovation in Rural Integrated Telepsychiatry (SPIRIT) -- examined the efficacy of remote mental healthcare access for 1,004 patients who had been screened for post-traumatic stress disorder and/or bipolar disorder and who were receiving telepsychiatry from one of 24 federally qualified health centers in Washington, Arkansas, and Michigan.
The study, conducted by researchers from the University of Michigan Medicine School and the University of Washington School of Medicine, sought to determine whether the integrated or referral approach was more effective when providing clinic-to-clinic mental health care in a primary care setting via interactive video.
Tele-referrals require one-on-one visits with a psychiatrist or psychologist. Tele-collaboratives use a telepsychiatrist and care manager to support a primary care provider, which allows a psychiatrist to manage more patients than the referral model.
"Both approaches significantly and substantially improved clinical outcomes. The referral approach used substantially more mental health specialist time than the integrated approach," the researchers wrote.
"Based on findings from this trial, from a healthcare system perspective, clinical leadership should implement whichever approach is most sustainable; from a societal perspective, policy makers should incentivize the integrated approach because it required less scarce mental health specialist time."
The patients in the study were divided to receive either tele-referral care or tele-collaborative care, and the clinics partnered with the state medical schools to provide the care.
Patients in both groups reported improvements in access to care and quality of life and decreases in their mental health symptoms and medication side effects, with no differences between the groups, and no differences based on age, sex, race, or ethnicity.
"The results of our trial showed that if you give access to high-quality care for patients who are underserved, they improve their quality of life," said lead researcher John Fortney, Ph.D., a professor of psychiatry and behavioral sciences at the University of Washington School of Medicine.
The collaborators say they'll provide personalized in-store access for consumers to improve health outcomes and access, and lower costs.
Blue Shield of California and Walgreens are collaborating to offer lower-cost healthcare in retail and virtual settings with a focus on wellness and disease management for communities across the state.
"We are thrilled to announce this collaboration with Walgreens because of our shared goal to reimagine healthcare," said Peter Long, executive vice president of Strategy and Health Solutions at Blue Shield of California.
"Together, we are transforming healthcare by launching innovative, high-touch, personalized, and holistic solutions for members and Californians with the ultimate goal of providing enhanced access to care that is worthy of our family and friends and sustainably affordable."
The collaboration will open at Walgreens Health Corner services for Blue Shield commercial members to improve health outcomes. The Health Corner locations will include health advisors – pharmacists, dieticians, or nurses – to help with health, nutrition, fitness, and disease management care coordination for either real-time or future care, the two businesses said in a joint media release.
Blue Shield members in eligible plans will have access to blood pressure screenings, administration of A1C blood tests, and mammography care coordination. They can also pick up take-home health screening tests with in-person assistance from health advisors, who will also help members set up digital health apps on their mobile devices.
The collaboration will begin later this year with the goal to expand Blue Shield services offerings in Walgreens stores, virtually, and at home, in early 2022. Walgreens has 586 stores in California.
"Blue Shield has a long-standing history of transforming healthcare for their members and beyond," said Vish Sankaran, Walgreens Boots Alliance chief innovation officer.
"By leveraging our trusted retail pharmacy locations, deep healthcare experience, and community relationships, together we are uniquely positioned to bridge gaps in care for many Californians to create a more seamless and convenient consumer experience," Sankaran said.
After a spike in telehealth during the public health emergency, a study suggests that virtual care appears to be leveling off.
Telehealth visits are leveling off for health systems in the year since most providers lifted COVID-19 restrictions on non-emergency care, a new survey shows.
More than 80% of the 96 healthcare executives responding to the Center for Connected Medicine survey this spring said telehealth represents about 20% of their non-emergency visits.
A smaller number of hospital executives said telehealth represents about 30% or more of their patient volumes, but they expect those percentages to decline in the coming months as the COVID-19 pandemic ebbs.
Even though telehealth volumes are expected to decline in the coming months, the survey found that many health systems are planning to expand their telehealth services to monitor and manage patient populations, lower readmissions, and reduce costs.
Chronic care management, behavioral health and urgent care were the top three service lines cited by survey respondents for future expansion of telehealth.
"Telemedicine is an important technology for advancing care and improving value at health systems," said Rob Bart, MD, CMIO at UPMC and a founding partner at CCM.
"While utilization has declined compared with pandemic highs of 2020, we continue to invest in our telehealth capabilities because it is the right thing to do for our communities," he said.
The survey also found that 92% of respondents were measuring telehealth use by patients to better understand the technology's value, up from the 77% of respondents to the same question in a survey taken in 2020.
In addition, about 25% of respondents reported measuring health outcomes for patients using telehealth in the latest survey, up from 12% who said they were doing so in the 2020 report.
Even with temporarily loosened regulations and higher reimbursement for telehealth services during the PHE, health systems identified ongoing obstacles for telehealth, including patients' inability to access the technology and broadband and provider uncertainty around reimbursements.
Hospitals gained 3,200 jobs in August, a significant slowdown from the 18,000 new jobs created in July.
The healthcare sector shed 4,900 jobs in August, with slight gains by hospitals more than offset by job losses in ambulatory care and nursing homes, preliminary federal data released Friday show.
While the 3,200 jobs created by hospitals in August marks the second straight month of job growth, the pace of growth is a fraction of the 18,000 hospital payroll additions in July. And those slight gains were negated 1,200 job losses in ambulatory care – normally the job-producing engine of the healthcare sector -- and 6,900 job losses in residential care and nursing homes, the Bureau of Labor Statistics reports.
The BLS report accounts for employment in mid-August and can be subject to considerable revision.
The healthcare sector has shed 513,400 jobs since the start of the pandemic in February 2020, with hospitals accounting for 84,800 job losses, and nursing homes accounting for 383,200 job losses. Ambulatory services sector lost 45,300 jobs in that span.
There were 15.9 million people attached to the healthcare sector workforce in August, BLS said.
The larger economy created 235,000 new jobs in August, down from the 943,000 new jobs created in July, the unemployment rate ticked down to 5.2% from 5.4% in July, and the number of unemployed people fell to 8.4 million, BLS reported.
Nonfarm payroll employment is up by 17 million since April 2020 but down by 5.3 million, or 3.5%, from its pre-pandemic level in February 2020.
Stakeholders are urged to take proactive steps to protect patient data, provide perinatal staff with anti-implicit bias training.
California Attorney General Rob Bonta is reminding healthcare providers of their obligations to protect patient data and to provide anti-implicit bias training for perinatal care staff.
In a bulletin sent to the California Hospital Association, the California Medical Association, and the California Dental Association, Bonta said state law requires stakeholders to notify the California Department of Justice when the health data of more than 500 Californians has been breached.
"Entities entrusted with private and deeply personal data, like hospitals and other healthcare providers, must secure information against evolving threats," Bonta said, pointing to the recent and worrisome spate of ransomware attacks on hospitals.
Bonta urged stakeholders to take proactive steps to protect patient data, including:
Keeping operating systems and software housing health data updated with the latest security patches;
Installing and maintaining virus protection software;
Providing data security training for staff that includes education on avoiding suspicious web links and phishing;
Restricting users from downloading, installing, and running unapproved software;
Maintaining a data backup and recovery plan for all critical information. .
"I implore all entities that house confidential health-related information to be vigilant and take steps now to protect patient data, before a potential cyberattack," Bonta said.
"Implicit bias is present in all aspects of life, but when it comes to healthcare, it can be the difference between life and death," Bonta said. “In California, Black women account for 21% of total pregnancy-related deaths, but only 5% of all pregnancies. The number of deaths is even more concerning when we account for the fact that the majority are preventable."
"Implicit bias is unconscious, but training has been shown to help providers become aware of their biases and work to intentionally minimize their effects when working with patients," Bonta said.
The AG has asked perinatal care providers to submit by mid-September data that includes:
Dates of any implicit bias trainings providers have completed;
Dates of implicit bias trainings planned for the future;
Lists of attendees at each training;
Copies of all written training materials used;
A list of the perinatal healthcare workers at the facility who have yet to participate in any training; and
A description of efforts to reduce implicit bias among the facility’s perinatal healthcare providers.
Consumers in counties under a state of emergency have 60 days from the date the emergency was declared to sign up for coverage.
Covered California has opened a special-enrollment period for people in 11 counties ravaged by historic wildfires.
"The wildfires have disrupted the lives of thousands of people across the state, and we want to make sure those affected know they can get financial help to have quality healthcare coverage," said Peter V. Lee, executive director of Covered California. "Providing this path to coverage will ensure that those who have been affected by the fires have an opportunity to get quality coverage through Covered California or Medi-Cal."
The affected counties are: Alpine, Butte, El Dorado, Lassen, Nevada, Placer, Plumas, Shasta, Siskiyou, Tehama, and Trinity.
Consumers in counties under a state of emergency have 60 days from the date the emergency was declared to sign up for coverage.
The new enrollees can take advantage of subsidies provided under the federal American Rescue Plan for health insurance offered by Covered California. The new law ensures that eligible enrollees will pay no more than 8.5% of their household income on their health insurance premiums. Lee said recent data shows that nearly 700,000 enrollees now have quality coverage through brand-name health plans for $1 per month.
