Category: Cost

Why are telehealth companies treating healthcare like the gig economy?

Posted on by MedicareMall

Why are telehealth companies treating healthcare like the gig economy?

Telehealth has taken off.

Spurred by the pandemic, many doctors in the U.S. now offer online appointments, and many patients are familiar with getting live medical advice over the internet. Given the obvious benefits, many experts have concluded that telehealth is here to stay. “It’s taken this crisis to push us to a new frontier,” said Seema Verma, administrator of the Center for Medicare and Medicaid Services. “But there’s absolutely no going back.”

Now the question is, where are we going? Telehealth has played an essential role during the pandemic, and it could do even more good in the years to come. But we are still in the very early days of its development. And if we are to realize telehealth’s full potential, then we must first reckon with the fact that there are serious flaws in the predominant way it is delivered today– flaws that endanger patients themselves.

Legacy telehealth services like Teladoc and others were built for a time when telehealth was a fringe phenomenon, mostly used to support acute needs like a bad cold or a troubling rash. They largely offer, in effect, randomized triage care. Patients go online, wait in a queue and see the first doctor who happens to be available. These companies market this as a virtual house call, but for patients, the experience may feel more like being stuck on a conveyer belt. Too often, they get funneled through they system with little to no choice along the way.

Insurance companies love this model because it is cheap to operate. But patients bear the cost. Doctors, in this arrangement, get paid to work the assembly line. Every minute they spend listening to patients– learning about their lives, building a personal relationship– is a minute they’re not moving them down the line, seeing the next patient and earning their next fee. The system doesn’t reward doctors for providing care; it rewards them for churning through patients.

As we build telehealth’s future, doubling down on this model would be a worrisome mistake since it is antithetical to how our healthcare system should operate. Healthcare has long been premised on the idea that you should have an ongoing relationship with your local care provider– someone with a holistic, longitudinal view of your health, who you trust to help navigate difficult or sensitive medical issues.

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The randomized triage model breaks this bond and replaces it with a series of impersonal interactions that feel more like the ones you have with an Uber driver– polite but transactional, brief and ephemeral. Healthcare, however, should not be treated in the same way as the gig economy.

As a physician, I am troubled by the prospect of what happens when you scale this model up. Every time a patient gets passed from one doctor to the next, there is a chance that critical information is lost. They won’t understand your baseline mood, your family context or living situation– all critical “intangibles” for informed treatment. That lack of longitudinal data leads to worse outcomes. This is why the healthcare system has long been designed to minimize patient handoffs– and why it would be a mistake for us to choose a telehealth infrastructure that increases them.

What, then, does a better approach look like?

We are at the very dawn of telehealth’s integration into our country’s healthcare system, and I won’t claim to know the full answer. But I do know that patients are far better stewards of their own health than a random doctor generator. A more effective approach to telehealth puts the power in the patients’ hands. Because when we give them choices and then listen to them, patients tell us what they prefer.

Data gathered by my company makes it clear that by a substantial margin, people want to make this decision themselves: 9 out of 10 telehealth patients prefer to schedule an appointment with a provider of their choosing rather than seeing a randomly assigned doctor after waiting in a digital queue.

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Not only that: when given this choice, most patients– about 7 out of 10– make an appointment with a nearby doctor when booking a virtual visit. Patients instinctively know that at some point, they’ll want or need to physically be in the same room with their doctor. And they know that choosing a local provider makes it possible to pick up the conversation in-person right where they left it off online. They don’t want to be forced to choose between telehealth and an ongoing relationship with a trusted provider. And they’re right– they shouldn’t have to.

None of the legacy telehealth companies focus on this imperative. Instead, while the pandemic rages on, they are rushing to scale while their randomized triage model is still viable. And the markets may reward them in the near term for being in the right place at the right time. But long-term value will be derived from listening to, responding to and iterating on what patients want.

Experience suggests patients will reward whoever can give them the most control over their healthcare. That’s where I’m placing my bet, too.

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The world’s now scrambling for dry ice. It’s just one headache in getting coronavirus vaccines where they need to go

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Vaccines like to be kept cool, none more so than the Pfizer candidate for Covid-19, which has to be deep-frozen. And that’s going to be an issue for developing countries — and for rural areas in the developed world.

The “cold rain” is just one of the challenges in distributing vaccines worldwide.

There are plenty of others: decisions about priority populations and databases to keep track of who’s received what vaccine, where and when. Additionally, different vaccines may have more or less efficacy with different population groups; and governments will need PR campaigns to persuade people that vaccines are safe.

But the logistics of transporting and storing vaccines– getting them from the factory gate to the patient’s arm– are critical. And as most vaccines are likely to require two doses, the whole chain needs must be repeated within weeks. 

Unique challenges 

The Pfizer-BioNTech vaccine needs to be kept at around -70 degrees Celsius (-94 degrees Fahrenheit) while it’s transported. That’s 50 degrees Celsius colder than any other vaccine currently used.

Moderna says its vaccine can be kept in freezers typically available in pharmacies, and in a refrigerator for up to 30 days. But there are likely to be fewer doses of the Moderna vaccine than of the Pfizer’s available over the next year.

Phase 3 trials have shown both vaccines to be around 95% effective but the results haven’t yet been reviewed by regulators.

On Wednesday, the CEO of BioNTech, the German biotech company partnering with Pfizer, acknowledged the issue of temperature control.

The world's now scrambling for dry ice. It's just one headache in getting coronavirus vaccines where they need to go

Employees fill a clinical and pharmaceutical product shipping box with dry ice at the Va-Q-Tec AG factory in Wurzburg, Germany, on Wednesday, Nov. 18, 2020. 

“We are working on formulation which could allow us to ship the vaccine even maybe at room temperature,” Ugur Sahin told CNN. “We believe that in the second half of 2021 we will have come up with a formulation which is comparable to any other type of vaccine.”

But in the meantime US Health and Human Services Secretary Alex Azar believes the Moderna candidate is “more flexible” for settings like a local pharmacist. Pfiszer’s, he said Monday, would be better suited to “big institutional vaccination, say a while hospital setting, several nursing homes at once.”

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Pfizer plans to ship up to 1.3 billion doses next year, requiring a lot of dry ice (carbon dioxide in solic form at around -78 degrees Celsius), and a lot of isothermic boxes. The boxes will hold up to 95 vials (4,875 doses) and be refilled with dry ice for up to 15 days of storage.

Pfizer is testing the supply chain in four US states. Its CEO, Albert Bourla, said Wednesday he has “zero concerns” about the cold chain requirements.

But shipping such a vaccine can pose big challenges. Dr. Jarbas Barbosa, assistant director of the Pan American Health Organization, told CNN that “the rural and the urban areas in any country in the world are not ready to manage this vaccine today.”

“So, who is prepared in the world? No one.”

One issuee is the availability of dry ice.

The Compressed Gas Association says carbon dioxide production capacity in the US and Canada is about 30,000 tons a day and is confident its members can meet demand for dry ice. It says that vaccine supply-chain officials believe less than 5% of dry ice production will be needed to support ultra-cold storage of Covid-19 vaccines in the United States and Canada.

Others in the industry expect bottlenecks. Several dry ice producers in the US told CNN they’ve already had offers for their entire output. Buddy Collen at Reliant and Pacific Dry Ice told online publication GasWorld: “We are in scramble mode trying to manipulate our production plants.”

Sam Rushing, president of Florida-based Advanced Cryogenics, told CNN there are already regional shortages in the US.

The main problem, Rushing says, is fewer vehicles on the road during the pandemic, meaning lower production of ethanol, from which carbon dioxide is a byproduct. European ethanol production has also fallen sharply this year.

US officials are confident enough dry ice will be available. Paul Ostrowski, director of supply, production, and distribution of Operation Warp Speed, told CNN last week that courier UPS had pledged to “provide dry ice replenishments throughout all of America upon demand.”

But Rushing cautions that dry ice is not very user-friendly and can be hazardous if stored improperly, especially in a confined space. The Federal Aviation Administration classifies it as hazardous cargo.

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Peter Gerber, CEO of Lufthansa Cargo, told CNN that the need for dry ice “clearly reduces also the transport capacity because if you have to load more ice you can’t load so much vaccine. And of course the procedures have to be very special in order to ensure that it always has this degree of coldness.”

US courier DHL is adapting distribution plans according to each vaccine’s specifications. David Goldberg, CEO of Global Forwarding US for the company, says “there is a restriction on the amount of dry ice used on an aircraft– typically 500-1,000 kilos depending on a number of factors.”

Once they arrive, Pfizer vials can be stored at between 2 and 8 degrees Celsius for up to five days before deteriorating. Pfizer says it has developed a “just-in-time system which will ship the frozen vials direct to the point of vaccination.” It will also monitor the temperature of every box being shipped.

Julie Swann, an expert in supply chains at North Carolina State University, says that large hospital systems, which often have ultra-cool freezers, may have a role as distribution hubs. But not all US states have them; Hawaii said last week none of its hospitals has such freezers.

Breaking down shipments of a frozen vaccine for rural areas or small groups of essential workers– without compromising their temperature– will be another headache, Swann said.

When a vaccine needs to be used with a few days, providers will need to ensure they are ready. “You can’t just wait to see who shows up,” Swann told CNN. “And we don’t really have good data yet defining where and who the priority populations are.”

The more links in the supply chain, the more risk that the vaccine’s temperature will be compromised. Last month the US Centers for Disease Control and Prevention advised states they should “limit transport of frozen of ultra-cold vaccine products.”

Prashant Yadav, a supply chain expert and senior fellow at the Center for Global Development said: “It’s a question of how soon can we start thinking about multiple packaging formats.”

Beyond the US

If getting a frozen vaccine to tens of millions of people is a challenge in the US, it’s a far greater problem for poorer countries.

Transport links are slower and medical facilities less equipped in the developing world. CO2 production is scarce, and the cost and hazards of shipping huge amounts of dry ice are also a hurdle, Yadav says.

David Gitlin, the CEO of refrigeration specialists Carrier, told CNN last week: “When you look at places like Africa and India, they just don’t have the cold chain infrastructure. The Untied State spends 300 times more per capita on cold chain than India.”

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Peru is one of many countries that have order the Pfizer vaccine. In the capital, Lime, where large volumes can be administered quickly, it should be effective, says Dr. German Malaga, one of a team working on Peru’s vaccine options. But while there are probably 30 ultra-cold freezers in Lima “for the other 20 million Peruvians including in the Andes and the rainforest there are none.”

“For the rest of the country we could use vaccines like the Chinese one that requires from 2 to 8 degrees is more manageable,” Malaga said.

“It’s about cost-effectiveness, which is not just about the vaccine but the whole process of vaccinating,” said Yadav. But if Pfizer’s candidates proves to be the most effective, demand for ultra-cold freezers would be overwhelming. 

Barbosa says the Pan American Health Organization is urging member states not to spend huge sums on preparing for one vaccine but join a multilateral facility called COVAX– essentially a clearing house for buying vaccines run by the World Health Organization.

Beyond the cold chain, there are other logistical hurdles. 

A massive airlift will be required to get vaccines where they need to go. Pfizer, which has production lines in Europe and the US, says it expects an average of 20 daily cargo flights worldwide.

DHL expects that 15 million cooling boxes will need to be delivered on 15,000 flights over the next two years. David Goldberg told CNN the company has established a high quality cold-chain network and is adding flights between China, Europe and the US.

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Many countries can call on existing programs as models. Peru’s national vaccination program reaches about 75% of its population, Malaga said.

India’s polo vaccination program is ubiquitous– covering more than 90% of children by this year, according to Gagandeep Kang of the Wellcome Trust Research Laboratory at the Christian Medical College in Vellore.

“For polio programs, we have used boats and mules and enterprising health staff,” said Kang. But such programs are designed for less than a tenth of the population, and Covid-19 vaccines will need to focus on different groups, she said.

India will need “a series of waves each addressing a different group as vaccines become available,” she told CNN.

“We will need to see performance characteristics of other vaccines, and their delivery requirements before making a call on what to go with,” said Kang, who is also a member of the World Health Organization’s Global Advisory Committee on Vaccine Safety.

In such a dynamic situation, record-keeping becomes critical. Dr. Anna Blakney, who is working on a vaccine being developed by Imperial College London, said there is no centralized infrastructure in the US for monitoring who is getting what and when, which she describes as a “really critical issue.”

Yadav says that even when the vaccine reaches its destination there will need to be some flexibility to allow people to get their second dose in a different location if desired. And that demands reliable databases.

Barbosa said that beyond the supply chain, governments “must have a good communications strategy to overcome public skepticism and conspiracy theories about vaccines.”

Blakney agrees. “The process [of vaccine development] has been so fast that it’s not surprising people are skeptical as they read about safety and possible side-effects,” she said. Blakney is part of an international effort launched by research scientists to reassure people via social media about the safety and efficacy of Covid-19 vaccines.

Finding enough dry ice is just one in a sequence of challenges to get the world vaccinated against Covid-19.

 

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Missourians faced a health care gap, so they took matters into their own hands

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Missourians faced a health care gap, so they took matters into their own hands

Missourians faced a health care gap, so they took matters into their own hands

Organizing for Medicaid expansion

Missourians mobilized by the thousands to get Medicaid expansion on the ballot this year, a move that will impact 230,000 low-income residents in the “coverage gap.”

For almost a decade, advocates in Missouri have been lobbying their legislators to expand Medicaid coverage in the red state. 

Since the Supreme Court ruled in 2012 that the Medicaid expansion under the Affordable Care Act was optional, 36 states plus Washington, D.C., have adopted and implemented the expansion. In those states where coverage has not been expanded, the decision has come at a devastating cost to Americans who fall into the “coverage gap,” advocates said.

“When the Affordable Care Act was originally passed, folks who were making up to 138% of the federal poverty level were supposed to be on Medicaid. And folks making more than 138% of the federal poverty level would be given subsidies to buy coverage through the exchange or healthcare.gov,” Kelly Hall, director of health policy for the Fairness Project, told ABC News.

“Because some states haven’t expanded their Medicaid program, they are creating a problem for people who don’t make enough money to get the subsidies on the exchange, but they make too much money to be on their state’s Medicaid program.”

In the states that chose not to expand Medicaid coverage, the maximum income for Medicaid eligibility varies. In Missouri– which for now has one of the lowest Medicaid income eligibility limits in the U.S.– this meant that a family of three had to earn at most 21% of the federal poverty level, or $4,479 in 2019, annually to be eligible for Medicaid. Subsidies for the Affordable Care Act marketplace aren’t accessible until earning 100% to 400% of the federal poverty level.

After their conservative state legislature did not address the issue for years, Missourians mobilized by the thousands to get Medicaid expansion on the ballot. This year, Missouri became one of two states–along with Oklahoma– that voted to implement that expansion next year.

ABC News is examining the coverage gap and expansion of Medicaid as part of its “My America” video series, which highlights issues that are key to the electorate in the run-up to the 2020 election and spoke to voters and experts about the issue. 

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The personal cost

Fair Grove, Missouri resident Amber Ledbetter, a single mother of two, is one of thousands of Americans without healthcare because their income falls into the “coverage gap.”

“It’s stressful, especially with the kids,” Ledbetter told ABC News. “I don’t want to end up in a position where I’m having to bankrupt my family just to get the health care that I need immediately.”

Ledbetter has Crohn’s disease, a chronic illness that causes her fatigue and pain and impacts her ability to work as a house cleaner. Last year, she was so sick she had to go to the emergency department. 

“I kept putting it off and putting it off and was working through the pain and probably causing myself more harm,” she said. “I was more concerned about what the bill would be than the treatment I was going to get.”

Ledbetter said she makes too much money to qualify for Medicaid in Missouri, but not enough to qualify for Affordable Care Act subsidies. 

“I was just caught in this gap that I didn’t know existed,” said Ledbetter, who has to take into consideration what she could get covered through charity when she discusses treatment options with her gastroenterologist. 

Single mom Victoria Altic fell into the coverage gap last year. The Missouri resident racked up thousands of dollars in medical debt, she told ABC News, after several episodes of seizures a couple of years ago. She delayed seeking medical care for an ear infection, and the resulting visits caused her to go further into debt, she said. 

“One of the worst parts about all of that, besides the actual health effects of not having health insurance, is the financial aspect, where you’re falling into debt,” said Altic, who was laid off from her restaurant job at the start of the coronavirus pandemic.

Erich Arvidson’s parents were in the coverage gap– both retired but not yet eligible for Medicare– when his father fell ill last year, he told ABC News.

“My sister and I were forced to make decisions for him based on what he could afford and not necessarily what was the best course of action for him,” the Boonville, Missouri resident said.

His father died last February. Then, a few months later, his mother fell ill. “We had to make those same decisions just right away,” Arvidson said.

On the ballot

In Missouri, citizens can petition to put constitutional amendments on the ballot. Arvidson was one of thousands of volunteers who worked to get the Medicaid expansion on the ballot as on amendment in August.

“Ballot measures are a team sport,” said Hall, of the Fairness Project, which focuses on ballot initiative efforts to promote economic and social justice. “It takes a lot of different folks putting money into the effort, putting sweat equity in the effort, standing on street corners with clipboards and talking to their neighbors.”

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In Missouri, volunteers collected over 350,000 signatures from all over the state to get Medicaid expansion on the ballot, Hall said.

“We went everywhere,” Arvidson said. “We went to county fairs. We went to cotton carnivals and apple festivals and stood on town squares and just talked to people about it and gathered the signatures that we needed.”

On August 4, Missourians voted 53% to 47% to pass the amendment to expand Medicaid coverage. The move came two months after Oklahoma also passed its expansion through a ballot measure.

That signaled to Hall and other experts that Medicaid expansion is “not a partisan issue anymore.”

“The same voters in Missouri and Oklahoma who are going to the polls to vote for President [Donald] Trump are also saying we want Medicaid expansion,” she said.

“Nobody really asked, well, is this a Democratic thing or is this a Republican thing?” Richard Von Glahn, policy director of the coalition Missouri Jobs with Justice, told ABC News. “Voters don’t actually think that way. They think, well, what is this actually going to mean for the state?”

Beyond Oklahoma and Missouri, other states, including Idaho, Maine, Nebraska and Utah, have voted to expand Medicaid through a ballot measure, as opposed to a bill.

“What we learned is that if we’re going to be successful in moving and shifting power in a state like Missouri, which is so adverse to providing equity for the poor and people of color, what we must do if organize and mobilize,” Dr. Rev. Vernon Howard, president of the Southern Christian Leadership Conference of Greater Kansas City and a community organizer for Missouri’s Medicaid expansion, told ABC News. 

Step in the right direction

Medicaid expansion coverage is set to begin in Missouri on July 1, 2021. The constitutional amendment, protected from changes by the state legislature, will impact about 230,000 low-income Missourians, according to Von Glahn– Missourians like Ledbetter and Altic.

“I know it’s still gonna take some time before I can take advantage of those health care options for Medicaid,” Ledbetter said. “But it’s a step in the right direction.”

The move will make a “huge difference” for Altic.

“I wouldn’t have to worry about whether I can go to the doctor if I have a small earache and wonder if it’s going to become something way worse,” she said.

For Howard, the passage was a sign of “hope to bring equal access to voting to the ballot.”

“There is hope to bring living wages for the working poor,” he said. “There is hope to bring healthcare as a right and not a privilege. And when we mobilize and organize together around these issues, we can see good things happen.”

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Medicare finalizing coverage policy for coronavirus vaccine

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Medicare finalizing coverage policy for coronavirus vaccine

Medicare finalizing coverage policy for coronavirus vaccine

A senior Trump administration official says Medicare will cover the yet-to-be approved coronavirus vaccine free for older people under a policy change expected to be announced soon

Medicare will cover the yet-to-be approved coronavirus vaccine free for older people under a policy change expected to be announced shortly, a senior Trump administration official said Tuesday.

The coming announcement from the Centers for Medicare and Medicaid Services aims to align the time-consuming process for securing Medicare coverage of a new vaccine, drug or treatment with the rapid campaign to have a coronavirus vaccine ready for initial distribution once it is ready, possibly as early as the end of the year.

It’s questionable under normal circumstances if Medicare can pay for a drug that receives emergency use authorization from the Food and Drug Administration, as expected for the eventual coronavirus vaccine. Emergency use designation is a step short of full approval.

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The administration official said Medicare’s announcement will try to resolve several legal technicalities that could conceivably get in the way of delivering free vaccines to millions of seniors, a high-risk group for COVID-19, the disease caused by the coronavirus. The officials spoke to The Associated Press on the condition of anonymity to discuss a pending regulation.

President Donald Trump and lawmakers of both parties in Congress have spelled out their intention that all Americans will be able to get the vaccine for free. But the official said a series of potential legal obstacles that could get in the way of Medicare payment never got unscrambled. 

Earlier this month, Medicare administrator Seema Verma said her agency was close to resolving the issue.

“I think we’ve figured out a path forward,” Verma said at the HLTH conference, a forum for innovators. “It was very clear that Congress wants to make sure that Medicare beneficiaries have this vaccine and that there isn’t any cost-sharing.”

“Stay tuned,” she added.

The $1.8 trillion CARES Act passed by Congress in March called for free vaccination for all Americans, from seniors covered by Medicare to families with employer-sponsored health insurance.

A White House-backed initiative called “Operation Warp Speed” is pushing to have a vaccine ready for distribution in the coming months. The government is spending billions of dollars to manufacture vaccines even before they receive FDA approval, thereby cutting the timeline for delivery. Officials at the FDA have committed that the program will not interfere with their own science-based decisions. Vaccines that don’t meet the test for approval would be discarded.

States have already begun submitting their plans for vaccine distribution to the federal government. 

Initially, it’s expected vaccines will go to people in high-risk groups such as medical personnel, frontline workers and nursing home residents and staff. Older people are also high on the priority list because their risks of serious illness and death from the coronavirus– which has killed more than 225,000 people in the United States– are much higher. It could be well into next year before a vaccine is widely available.

Medicare’s impending announcement was first reported by Politico.

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Trump administration set to announce Medicare and Medicaid will cover Covid vaccine

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Trump administration set to announce Medicare and Medicaid will cover Covid vaccine

Trump administration set to announce Medicare and Medicaid will cover Covid vaccine

The Trump administration is set to announce as early as this week that Medicare and Medicaid will cover out-of-pocket costs for a potential coronavirus vaccine that is granted emergency use authorization, according to a person familiar with the matter.

Coming days before the election, the move could help President Donald Trump among seniors and lower-income Americans even though top medical experts don’t expect a vaccine to be approved until well after Election Day. In the run-up to the election, Trump had applied intense pressure on agencies to deliver policy wins that might help his reelection, aides said.

Officials have been working for several weeks on changing regulations to allow for Medicare and Medicaid recipients to receive free vaccines.

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It’s not clear whether Trump himself will make the announcement of the rule change, though he is working to appeal seniors during stops in Florida later this week.

Politico first reported the coming changes.

There are currently four US Phase 3 trials of coronavirus vaccines as part of the federal government’s Covid-19 vaccine program, Operation Warp Speed.

Dr. Anthony Fauci, the nation’s top infectious disease expert, said Sunday that experts will know by early December whether a potential coronavirus vaccine is safe and effective, but widespread availability will likely not occur until several months into 2021.

Operation Warp Speed aims to have Covid-19 vaccines moved to administration sites within 24 hours of emergency use authorization or Food and Drug Administration license– with the goal of providing the vaccine free of charge.

“In terms of a principle and an aspiration, it’ll be that no American has to pay for a single dime out of pocket to get a vaccine,” Paul Mango, deputy chief of staff for policy at the US Department of Health Human Services, said back in September.

The federal government already struck a deal earlier this month with retail pharmacies CVS and Walgreens to help distribute the coronavirus vaccine– once one or more gets authorized– to long-term care facilities like nursing homes, with no out-of-pocket costs.

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Inaccurate Census count could affect $1.5 trillion in federal funding

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Inaccurate Census count could affect $1.5 trillion in federal funding

A census taker knocks on the door of a residence in August in Winter Park, Fla. Census workers visited households that hadn’t yet responded to the 2020 census.

The consequences of an inaccurate census

Highway construction. Food stamps. Rural education. Medicare.

The federal government relies on data derived from the decennial census to distribute roughly $1.5 trillion in funds for these programs, along with more than 300 others. The money goes to state and local governments, non-profits, businesses and households across the nation.

That’s why experts are so concerned that the US Census Bureau could end its 2020 count early, which they say will increase the chances of missing many Americans, particularly immigrants, people of color, low-income folks and rural residents. And that, in turn, could reduce federal funding for programs that support them and entire communities.

“The Census data are used to determine who gets what slice of each pie,” said Andrew Reamer, a research professor at George Washington University who specializes in Census-guided federal spending. “If you miss 10,000 people, they are gone for the decade.”

The Supreme Court on Tuesday granted a request for from the Trump administration to halt the process while an appeal plays out. A lower court order would have required the count to continue until October 31, but the administration argues that the shortened deadline is needed to give the agency time to deliver the results to the President by December 31, as required by law.

The decennial census serves as the foundation for three other sets of data the Census Bureau creates that are used in apportioning federal funding. An accurate population count is key and any undercount can translate into significant losses.

For instance, had Texas’ population been undercounted by 1% in 2010, the state would have lost nearly $292 million in federal reimbursements for Medicaid and the Children’s Health Insurance Program in fiscal 2015, Reamer’s research found. Pennsylvania would have received about $222 million less, while Florida would have been sent nearly $178 million less.

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Medicare uses geographic data based on the Census to determine how many pharmacies must be in Part D enrollees’ networks and how much to reimburse physicians.

And states utilize Census-based population data to allocate federal highway funding, while federal agencies determine support of disadvantaged youth employment efforts and nutrition programs for women, infants and children based on the share of kids in poverty in a specific area.

Some states and local communities incorporated the importance of the Census count into their outreach, reminding their residents that federal funding for their roads, schools and other programs depends on their filling out the survey.

“It’s a very critical piece of policy and planning and funding,” said Mallory Bateman, state data center coordinator at the University of Utah. “This is our way to show who lives in the state… and get them the funding that they need.”

The census has never been perfect. It typically overcounts White Americans and misses people of color and those living in rural areas, among others. But this year, the problem could be even more extensive, largely because of the shorter deadlines for following up with those who don’t respond and for processing the results, said John Thompson, a former Census Bureau director under the Obama administration.

Also, immigrants– both legal and undocumented– may be less likely to fill out the survey because of increased fears that the data will be used against the, after President Donald Trump issued a memorandum to exclude undocumented immigrants from the counts used to apportion the House of Representatives, Thompson said. The Supreme Court will hear a case this term seeking to block Trump’s move.

“Many communities will certainly receive less than their fair share of federal funds,” said Alex Tausanovitch, director, campaign finance and electoral reform at the left-leaning Center for American Progress.

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What you need to know about at-home Covid-19 tests

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Is Covid testing on your shopping list?

Costco, a popular wholesale store with locations across the US, has announced that it will sell a direct-to-consumer diagnostic test for Covid-19, joining a growing list of retailers providing diagnostic tests.What you need to know about at-home Covid-19 tests

Kent Sepkowitz writes that even though at-home Covid-19 tests will now be available at a number of retailers, it does not necessarily mean testing will get faster or more accessible.

But there are problems with the program, starting with the cost. The test is not cheap, especially for those looking to test themselves and family more than once. At Costco, the kit costs $129 for the most basic version and $139 for the fancy version that includes video instructions. Federal law mandates that private insurers, Medicare, and Medicaid cover Covid-19 tests without any cost to the patient. Whether they will pay fully for a more bells and whistles program such as that provided by Costco likely will vary plan to plan.

That price is actually cheaper than buying the at-home kit directly from AZOVA, the company that administers the program, which charges at least $20 more. AZOVA is also encouraging pharmacies to offer the kits. In a blog entry titled, “Four ways to generate revenue when you offer Covid-19 testing in your pharmacy and on your website,” lists some tips on how pharmacies can maximize profits, including receiving a $22 to $29 administration fee for in-pharmacy tests and $5 for each test ordered online and conducted at home, noting that “you don’t need to do anything but add a link to your website” to get the five bucks a pop.

As for the speed of the results– sorry, you’ll have to wait at least a couple days. The term “home test” evokes the home pregnancy test approach where the wait for the big reveal is measured in minutes. However, for the Covid-19 test, the “home” refers only to where you collect the specimen, not where you run the test. This is performed by a lab reached by (hopefully) overnight mail.

AZOVA promises a result by email one to three days after receipt of the kit in an approved lab. But there is an additional lag in the time of one to three days for the kit to be delivered to you at home if you order it online. In other words, order on Monday and get your test result at the earliest on Wednesday but as late as the weekend. (Costco advertises a slightly quicker turnaround between ordering the kit and receiving it at your home.) So those who would want to use the test for assurance prior to seeing the family or returning to the office need to plan many days in advance.

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Which Brings us to accuracy. The involved companies claim the test is excellent, with the website advertising 98% sensitivity and 99% specificity, meaning almost every case is detected by the test with very few false positives. But we don’t know how accurate a test really is until people have used it in real life conditions, rather than under perfected lab conditions. OraSure experienced this difference when its home test for HIV, once approved, showed a higher false positive rate than clinical trials had shown.

And that was the good old days, before the Trump administration weakened the process for how lab tests can gain emergency use authorization (EUA) through the FDA. In the name of swiftness, the FDA decided to allow qualified labs themselves to determine whether their test worked. No longer is the company’s data subjected to FDA scrutiny prior to issuing EUA. It is possible therefore that some tests that would not have received FDA emergency authorization six months ago are now receiving a greenlight.

Plus, there is the simple fact that a test is performed today may accurately show no infection, but by the time the result is available– days later– the same person may have become infected. The immediacy of the test result, therefore, is crucial for both personal and public health decisions.

So here we are, eight months into the pandemic and still waiting for an accurate, fast, cheap, readily available test– the game-changer first promised in April. The at-home version in its current form may be helpful for worried families but will not be a game-changer from a public health perspective.

But having several companies trying to solve a problem the Trump administration should have resolved long ago, similar to governments in South Korea, China, Germany and other countries, is a faintly hopeful sign.

The collaborating companies seem to understand that basic principle for controlling the Covid-19 pandemic is the same as for every infectious disease: it is necessary to have a rapid and reliable test to identify who is potentially infectious. Otherwise we are simply trying to swat flies in a pitch-dark room, hitting and missing, missing and hitting, with no hope of knowing anything at all about the effectiveness of our efforts. This single profound limitation more than anything else has led us into America’s historic public health catastrophe.

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Uber Launches Medicine Delivery Service in South Africa

Posted on by MedicareMall

Uber launches medicines delivery service in South Africa

Uber launches medicines delivery service in South Africa

Uber Eats’ South African unit on Thursday expanded delivery offerings, launching an app-based over-the-counter medicines service as it seeks to claw market share in the fast-growing online shopping sector in Africa’s most industrialized economy.

Uber Eats, a unit of U.S. ride-hailing service Uber Technologies already has a lion’s share of South Africa’s $600 million food dispatching market.

The equally lucrative medicines delivery market is controlled by pharmacy chains Clicks and Dis-Chem, which offered delivery services long before Covid-19 spurred a shift to online shopping.

Analysts say such “first movers” including Naspers-owned Takealot, have a natural advantage over newcomers, especially with users increasingly seeking to use fewer smartphone applications to do more things.

But Uber Eats is banking on a “marketplace” strategy–combining ride-hailing and grocery deliveries and other services on a single mobile phone app that already has over 2 million users in the country, it said in a statement.

Its latest foray in the delivery sector is in partnership with local health group Medicare, which operates more than 50 clinics and pharmacies around the country, and will allow its app users to purchase over-the-counter medication.

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“The nationwide lockdown and restriction in movement created an immediate need to accelerate our business in increasing the accessibility to daily essentials,” general manager of the Uber Eats South Africa Shane Austin told Reuters.

“Which is part of the reason our focus has been towards on-boarding various other merchants onto the app, aside from just restaurants.”

In its latest Digital Market Outlook, information portal Statista predicted South Africa’s e-commerce market would see annual compound growth of 11% up to 2024, with the number of online shoppers growing to nearly 37 million from around 25 million currently.

What are your thoughts on having your medications delivered? Would you make the switch if this service is offered in your area? Leave your comments below!

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Medicare Website Can Help In Choosing A Nursing Home

Posted on by Chris Kennedy

When you hear about Medicare, you probably think of the federal program that helps pay for older adults’ health care. What you may not realize is that another of Medicare’s major responsibilities is to inspect health care facilities to make sure that patients receive safe and high-quality care. Among those facilities are the nation’s more than 15,000 nursing homes.

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CMS Projects Health Costs To Rise Over Next Decade

Posted on by Chris Kennedy

National health expenditure growth is expected to average 5.5 percent annually from 2018-2027, reaching nearly $6.0 trillion by 2027, according to a report published today by the independent Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS).

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