The Rundown | Week of 9.17.2018

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DOJ OK’s $67 Billion Cigna-Express Scripts Deal

The Department of Justice (DOJ) announced on Monday, September 17, it will not challenge Cigna’s $67 billion acquisition of Express Scripts, a pharmacy benefit management (PBM) company. A key factor in the verdict was that Cigna is not a nationwide provider of PBM services, which are sold to employers and health insurance companies to provide access to pharmacy networks and other services. “Quality healthcare and competitive pricing for healthcare services [are] critical to U.S. consumers. After a thorough review … [the acquisition] is unlikely to result in harm to competition or consumers,” said Assistant Attorney General Makan Delrahim. The deal, which has already secured shareholders’ approval, is expected to close by the year’s end.
>>Read More: Cigna-Express Scripts merger cleared by DOJ

Apple’s EKG App Cleared by FDA

The Food and Drug Administration (FDA) approved Apple’s electrocardiography (EKG) app for over-the-counter use, though some restrictions apply. The app was deemed a Class II medical device, which poses a “moderate to high risk to the patient and/or user,” and is not recommended for users younger than 22 or anyone with known arrhythmias. The app aims to detect irregular heartbeats and atrial fibrillation and then notify the user of their condition so that they may seek medical attention. The FDA identified some risks, including “misinterpretation and/or over-reliance on device output” that could lead to “failure to seek treatment” or “discontinuing or modifying treatment,” a topic explored in our recent podcast, “The Murky Ethics of Wearable.” This approval paves the way for Apple’s other health initiatives, which include medication management, disease diagnosis, and personal health records to allow owners to store comprehensive medical data securely on their device.
>>Read More: New Apple Watch adds FDA-cleared ECG application

Study: PCP Shortage May Get Worse Before It Gets Better

America’s aging population is exponentially increasing the shortage of primary care providers (PCPs). The study from UnitedHealth Group indicates that elderly patients are both the highest consumers of primary care services and also the most likely to be a PCP of retirement age. Researchers found that 44 million Americans live in a county with a primary care shortage, which is defined as less than one PCP per 2,000 residents; even at that level, PCPs would need to allocate 17.4 hours each day to provide recommended care. This dearth is particularly acute in rural areas, where 38 percent of residents experience a shortage. In 2017, only one in six medical school graduates opted for a primary care residency. The shortage is projected to grow from 18,000 — the current level — to 49,000 in 2030. To combat the shortage, researchers proposed solutions such as enabling nurse practitioners and other advanced practice clinicians to work “at the top of their license” by amending scope of practice laws to allow them to work more independently.
>>Read More: Growing, aging population straining primary care, report shows

The Cost of Poor Health Literacy? $4.8 Billion

A recent report from Accenture indicated that more than half of American healthcare consumers are “illiterate” when it comes to healthcare. Researchers defined low healthcare literacy as an inability to “correctly identify terms related to health insurance coverage including premium, deductible, copayment, coinsurance, and out-of-pocket maximum” and other criteria such as failing to differentiate between out-of- and in-network doctors as well as not knowing how to obtain prior authorization. This unfamiliarity results in a greater reliance on administrative support, which then results in $4.8 billion in excess administrative fees. Twenty-six percent of consumers are both high-need and low-literacy, which results in increased costs to those patients. Researchers proposed a multi-pronged solution to lower costs for payers by simplifying processes and educating low-literacy consumers. Primary care providers can help as well by performing a health literacy audit and intervention.
>>Read More: Poor Healthcare Literacy Leads to $4.8B in Administrative Costs

Daily Aspirin Regimen Poses Potential Risks

Three recent research articles contradict — or at least complicate — the widely-held belief that a daily low-dose aspirin regimen is a crucial part of older adult’s health decisions. The New England Journal of Medicine recently illuminated the risks of this routine, which instead resulted in a “significantly higher risk of major hemorrhage” without any decrease in the risk of cardiovascular disease when compared with a placebo. The study gathered data from more than 19,000 patients and measured the rates of disability-free survival and found no conclusive difference. Since the risk of severe, even life-threatening, bleeding increases with aspirin intake, healthy older individuals with no previous heart problems are advised to abstain from a daily aspirin routine. Furthermore, rates of mortality among cancer patients were 19 percent higher in the group that followed an aspirin regimen than the control group.
>>Read More: Taking Daily Aspirin May Be Risky for Healthy Older Adults: Study

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