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A Weekly Health Policy Round Up From Health Affairs            

**November 22, 2020**

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FAST TRACK AHEAD OF PRINT

This set of fast-track ahead-of-print journal articles kicks off with a
broad overview of the US Food and Drug Administration (FDA) approval
process

by Aaron Kesselheim and colleagues. The paper explores vaccine
development, approval, and regulation as well as trade-offs in balancing
safety, efficacy, and speed.

New research asks the question: How successful will newly emerging
vaccines be in stemming the pandemic?

Different combinations of vaccine characteristics, effectiveness, pace
of distribution, and "background epidemic severity" can affect
infection rates, hospitalizations, and mortality. While more effective
vaccines always lead to better outcomes, the story gets more complex
when you start to vary the parameters. David Paltiel and Jason Schwartz
from the Yale University School of Public Health and Amy Zheng and
Rochelle Walensky from Harvard Medical School walk us through the
variables.

Three analytic papers review key policy questions such as why we must
invest in vaccine delivery strategies; how public and private leaders
can ensure equitable access; and what to consider in pricing vaccines
and treatments.

* Delivery strategies
:
Rebecca Weintraub of Adriadne Labs and colleagues analyze why leaders
must invest in vaccine delivery strategies now. This paper offers
recommendations for policy makers and looks at past pandemics and
vaccine campaigns to offer lessons on successful vaccine delivery.

* Equity
:
Angela Shen of Children's Hospital of Philadelphia and colleagues
offer recommendations to public and private leaders to help ensure
equitable access to all who are recommended for vaccination, regardless
of ability to pay, where people live, or historic or systemic
limitations to health care.

* Pricing
:
In this broad look at pricing, authors Peter Neumann of Tufts University
Medical School and colleagues shed light on solutions to the "policy
puzzle" of balancing lower prices to ensure access to essential
medications, vaccines, and tests, while also ensuring adequate revenue
streams to provide manufacturers incentives to make the substantial,
risky investments needed to develop products in the first place.

In preparation for publishing these peer-reviewed papers today, Health
Affairs brought researchers, industry leaders, and advocates together at
an August 2020 symposium (available online) to discuss promoting vaccine
and treatment innovation and equity
.

Reporter Harris Meyer summarized the event in this month's EntryPoint
in Health Affairs, noting themes of collaboration and competition
.

Health Affairs is grateful to the theme advisers, Helen Saxenian and
Jason Schwartz, and to the following sponsors for their support of this
fast-track publication and the symposium: Anthem, Inc.; Amgen Inc.;
Avalere; Kaiser Permanente; Pharmaceutical Research and Manufacturers of
America (PhRMA); Gilead; McKesson; Quest Diagnostics; Dynavax; Alexion;
and Danaher.

THIS WEEK ON THE BLOG

COVID-19

COVID-19's Deadly Lesson: Time To Revamp Long-Term Care

By Deborah Gastfreund Schuss (11/17/20)

COVID-19 pulled back the curtain on long-standing cracks in the entire
long-term care system. Our approach to caring for the vulnerable among
us has failed, with nursing home residents disproportionately stricken.
It's time to abandon our deeply entrenched and outdated views of
long-term care in favor of a disruptive model that invests more heavily
in home and community services. Read More >>

GOVERNMENT PROGRAMS AND POLICIES

"Better Care Plan": A Public Option Choice

By George C. Halvorson, Stephen M. Shortell, Laurence Kotlikoff,
Elizabeth Mitchell, Richard M. Scheffler, John Toussaint, Peter A.
Wadsworth, and Gail R. Wilensky (11/16/20)

The public option plan outlined under the Biden-Harris health care
proposal offers an opportunity to advance the use of prepaid,
risk-adjusted, per-member-per-month budgets that will set the country on
a path to continuously improving care and sustaining universal coverage.

Read More >>

PUBLIC HEALTH

What History Can Tell Us About Who Will Lead HHS In A Biden
Administration

By Richard Sorian (11/19/20)

The person who answers this call to serve the new president, his
administration, and the American people would do best to study the work,
accomplishments, and criticisms of past HHS secretaries to help
determine the best way forward. Read More >>

DISPARITIES

Bridging The Black Mental Health Access Gap

By Victor Agbafe, Will Boles, and Rebekah E. Gee (11/20/20)

We must address mental health gaps with an antiracist mindset. Only then
can we begin to solve the mental health divide and take meaningful steps
to heal our nation's psyche.
Read More >>

FOLLOWING THE ACA

ACA Round-Up: Record-High Medical Loss Ratio Rebates, Pass-Through
Funding, Preventive Services

By Katie Keith (11/17/20)

Overall, insurers owe record-high medical loss ratio rebates of nearly
$2.46 billion to more than 11.2 million consumers. This represents an
average of $219 in rebates per person. Consistent with prior years, the
rebates are most significant in the individual market. Read More >>

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Honoring Tim Jost, The Affordable Care Act Advocate

By Mark Regan (11/20/20)

Tim knows insurance regulation, and Tim knows the Affordable Care Act
(ACA). That combination made it possible for him to lead the private
effort to support the government's position in the King v. Burwell
premium tax credits litigation. It has also made it possible for him to
support the recent private effort to defend the ACA in California v.
Texas. Read More >>

MEDICAID

Administration Effectively Rescinds "Families First" Medicaid
Continuous Enrollment Protection

By Sara Rosenbaum, Devon R. Minnick, Maria Velazquez, and Morgan Handley
(11/18/20)

To qualify for a bump in federal Medicaid funding during the COVID-19
pandemic, states must cover COVID-19 testing and treatment, and provide
continuous Medicaid enrollment throughout the pandemic. However, a new
rule issued by the Trump administration significantly weakens these two
protections while also imposing major new burdens on states. Read More
>>

IN THE JOURNAL

BEHAVIORAL HEALTH CARE

Variation In The Effectiveness Of Collaborative Care For Depression:
Does It Matter Where You Get Your Care?

By Jürgen Unützer, Andrew C. Carlo, Robert Arao, Melinda Vredevoogd,
John Fortney, Diane Powers, and Joan Russo

Randomized controlled trials have demonstrated that the collaborative
care model for depression in primary care is more effective than usual
care, but little is known about the effectiveness of this approach in
real-world settings. Jürgen Unützer and coauthors used
patient-reported outcome data from 11,303 patients receiving
collaborative care for depression in 135 primary care clinics to examine
variations in depression outcomes.
Read More >>

COVID-19

Racial/Ethnic Differences In COVID-19 Screening, Hospitalization, And
Mortality In Southeast Wisconsin

By Leonard E. Egede, Rebekah J. Walker, Emma Garacci, and John R.
Raymond

Leonard Egede and coauthors examine racial and ethnic disparities in
COVID-19 outcomes in Milwaukee, Wisconsin, a highly segregated
"minority-majority" city. Blacks and Hispanics are 3.7 times and 3.1
times, respectively, more likely to test positive for COVID-19 than
non-Hispanic Whites. Read More >>

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New podcast!

Podcast: What Milwaukee Tells Us About COVID-19 and its Impact on Race

Alan Weil

Listen to Health Affairs Editor-in-Chief Alan Weil interview Leonard
Egede from the Medical College of Wisconsin, lead author of today's
featured journal article.

Listen here.

GLOBAL HEALTH POLICY

The Macroeconomic Consequences Of Firearm-Related Fatalities In OECD
Countries, 2018-30: A Value-Of-Lost-Output Analysis

By Alexander W. Peters, Rachel R. Yorlets, Mark G. Shrime, and Blake C.
Alkire

Alexander Peters and coauthors estimate the macroeconomic consequences
of firearm-related fatalities in the thirty-six Organization for
Economic Cooperation and Development (OECD) countries. They estimate
cumulative losses of $239.0 billion in economic output from 2018 to
2030, with $152.5 billion attributable to the US alone, meaning that
losses in the US exceed the combined losses of all other OECD countries.
Read More >>

PHARMACEUTICALS & MEDICAL TECHNOLOGY

Net Spending On Retail Specialty Drugs Grew Rapidly, Especially For
Private Insurance And Medicare Part D

By Steven C. Hill, G. Edward Miller, and Yao Ding

A wide range of medications are classified as specialty drugs, including
most injectables, biologics, and other drugs requiring specialized
administration. According to one source, they accounted for
approximately half of total US spending on retail, mail-order, and
provider-administered drugs in 2018. Specialty drugs are expensive, but
spending can be difficult to measure because of large manufacturer
rebates. To get a clearer picture on net spending for retail specialty
drugs, Steven Hill and coauthors from the Agency for Healthcare Research
and Quality (AHRQ) looked at data from the Medical Expenditure Panel
Survey (MEPS) and SSR Health for the period 2010-17. Read More >>

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About Health Affairs

Health Affairs is the leading peer-reviewed journal
at the intersection of health,
health care, and policy. Published monthly by Project HOPE, the journal
is available in print and online. Late-breaking content is also found
through healthaffairs.org , Health Affairs Today
, and Health Affairs Sunday
Update .  

Project HOPE is a global health and
humanitarian relief organization that places power in the hands of local
health care workers to save lives across the globe. Project HOPE has
published Health Affairs since 1981.

Copyright © Project HOPE: The People-to-People Health Foundation, Inc.

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