Welcome to Thursday's Health 202, where today this previous health providers reporter is turning back to her old beat.
For weeks now, the payment experiment — which loops private insurers and investor-backed companies into the traditional Medicare program — has faced backlash from influential progressives and single-payer advocates. They view this as a gateway to privatizing Medicare, and they're kicking up a fuss as the Biden administration considers whether to continue, modify or kill the model.
There are op-eds from progressive leaders. A sign on letter from Physicians for a National Health Program, which advocates for single-payer, calls for the program’s end. And there's been a flurry of conversations over the past few weeks with both critics and champions of the program pleading their case.
- “I just don’t think that involving private companies in a very extremely efficient and popular Medicare program is the way to increase coordination of health care,” Rep. Pramila Jayapal (D-Wash.) — the chair of the Congressional Progressive Caucus who led a letter to top Biden health officials calling for the program’s termination — said in an interview earlier this month.
But major provider groups have rushed to the program's defense, arguing it’s not the end of traditional Medicare and that the pilot could help improve care and lower costs.
- In a letter Monday, over 220 trade groups and other providers called many of the complaints lodged against the program “misleading and flat out false.” They urged CMMI to “fix, don’t end” a model they say has helped better coordinate care amid the pandemic.
- “This is indeed the grand irony of our times,” Don Crane, president and CEO of America’s Physician Groups, said in a recent interview, “because we have a program that is manifestly better for beneficiaries…. higher quality, better outcomes.”
There were initial indications that the Biden administration's decision could come Thursday — as Politico first reported — setting off another round of furious lobbying. However, an announcement isn’t happening today, according to a person familiar with the matter.
The backstory
Over a decade ago, Obamacare created the CMS Innovation Center and charged it with testing ways of paying for and delivering care. It’s part of a broader effort to shift the health system away from paying for the sheer number of services a patient gets, but rather the quality of the care they receive.
That’s where the direct contracting model comes in. The Trump administration first announced the time-limited payment experiment in 2019, as it looked to rev up the Medicare innovation lab.
Last year, CMS chose 53 health-care entities to participate in the program, where they’ll get paid a fee for managing the care of people in the traditional Medicare program. Program participants are generally rewarded for keeping patients healthy and lowering costs.
Next steps
Biden’s CMS has been determining what to do with two of the program’s options. (It put a broader third effort to test managing care by geographic region on hold nearly a year ago.)
Tweaking the model: Provider groups have suggested guardrails the program could set up to address concerns. And even some who are critical of the program don’t believe it needs to be killed entirely.
- “It would be disruptive to simply stop it cold,” said Don Berwick, a former Obama-era CMS administrator.
- Guidelines for the program could include: a very small size, exclude insurers and venture capital to the extent it can be, and ban the unlimited expansion of the model until it’s been seriously tested, he said.
The view from CMS: The agency is “actively listening to the comments being made” about the program — feedback which is “invaluable as we consider the future of the model,” according to a spokesperson. The agency will provide more information “soon,” but didn’t lay out a timeline.
Coronavirus
White House official hints U.S. is nearing a new phase of the pandemic
As new cases continue to steadily decline across the United States, White House coronavirus response coordinator Jeff Zients said the country is approaching a time when “covid isn’t a crisis.” Plans are underway for the next phase of the pandemic with the administration looking to increase vaccine uptake, tests and treatments, he said.
Let’s look at the numbers:
- The White House has fulfilled about 85 percent of initial orders for Biden’s initiative to deliver at-home coronavirus testing kits to Americans directly — that’s about 200 million tests.
- Nearly 65 percent of the country’s population is fully vaccinated, and roughly 43 percent of those fully vaccinated have received a booster shot, according to The Post’s vaccine tracker.
- Yet, vaccination efforts have lagged behind for children 5 to 11, with only 25 percent of the age group having received both doses of the vaccine.
Meanwhile, the Food and Drug Administration pumped the brakes last week on issuing emergency use authorization for the Pfizer-BioNTech vaccine for children under 5 years old while the agency waits for data on the effectiveness of a third shot.
CDC is drafting new covid-19 guidelines, says U.S. is ‘moving in the right direction’
The Centers for Disease Control and Prevention is currently updating its covid-19 guidelines so that their recommendations are more “relevant” for life with the virus today, Director Rochelle Walensky said during a briefing Wednesday.
Key takeaways:
- The agency will base their recommendations for relaxing pandemic restrictions, like loosening indoor masking guidelines, based on metrics like hospital capacity in local communities rather than transmission rates alone.
- Masks continue to be important in certain scenarios, such as when a person is ill or has been diagnosed or exposed to covid-19, she said.
- Walensky didn’t provide a timeline for the updates but said new guidance would be issued “soon.”
During a separate news briefing, press secretary Jen Psaki said the White House would wait and follow the agency’s lead before adjusting its own covid-19 policies on campus, despite Mayor Muriel E. Bowser moving to lift Washington, D.C.’s mask mandate.
Agency alert
Biden announces temporary replacements for former science adviser
On the move: President Biden named two people Wednesday to temporarily replace his former top science adviser Eric Lander, who resigned last week after Politico reported on a White House investigation that found the one-time Cabinet member bullied members of his staff, our colleague Tyler Pager reports.
Francis Collins, former director of the National Institutes of Health, will serve as the president’s science adviser in the interim. Alondra Nelson, who is currently a deputy director in the Office of Science and Technology Policy, will lead the office until Biden taps a permanent leader. (The director of the office requires Senate confirmation.)
On the Hill
Behind the latest bid for cutting drug costs
Progressive and grassroots groups are urging the Biden administration to use its executive authority to lower drug costs and inject more competition into the marketplace.
The latest push comes from a new campaign launched yesterday, called “Make Meds Affordable.” The effort comes as Democrats’ drug pricing ambitions — tucked into Biden’s Build Back Better Act — have been stalled on Capitol Hill for months.
- Organizations involved include Action Center on Race and the Economy, Center for Popular Democracy Action, Indivisible, People’s Action, PrEP4All, Public Citizen and Social Security Works.
- Sarah Lovenheim, chief HHS spokesperson, said the department has “made strong progress” in increasing transparency and competition in the system and will work to remove barriers to affordable care.
On tap today: Sen. Raphael Warnock (D-Ga.) will introduce a bill capping out-of-pocket insulin costs.
The legislation mirrors provisions included in Biden’s House-approved Build Back Better Act, which is currently stalled in the Senate. It would limit patient costs for insulin at $35 per month for those on Medicare and with private insurance. The stand-alone measure comes as Warnock enters a turbulent reelection bid.
In other health news
- Texas Attorney General Ken Paxton (R), Rep. Beth Van Duyne (R) and other conservatives filed a lawsuit against the Biden administration over mask mandates for trains and airports, The Post’s Lateshia Beachum reports.
- Coronavirus vaccine maker BioNTech announced plans to supply African countries with modular vaccine plants fashioned from shipping containers in an effort to boost access to vaccinations, our colleague Brittany Shammas reports.
- Public schools in Virginia can no longer require students to wear masks indoors under a new law signed by Gov. Glenn Youngkin (R) on Wednesday, Gregory S. Schneider, Laura Vozzella and Hannah Natanson report. Schools in the state have until March 1 to comply.
Sugar rush
Today’s fourth @washingtonpost TikTok features long covid https://t.co/IKtLS76CPo pic.twitter.com/4AsDX1wtT1
— Washington Post TikTok Guy 🤹🏼♂️ (@davejorgenson) February 16, 2022
Thanks for reading! See y'all tomorrow.