Two views on Covid emergencies, ruling on Medicare Advantage audits, & where health-tech Xooglers might end up

The federal government will audit Medicare Advantage insurers aggressively under a rule finalized yesterday, but there's a catch.

January 31, 2023 Check out STAT+

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By Elizabeth Cooney Reporter, Morning Rounds Writer

Good morning. That was fast: Bob Herman and Tara Bannow bring us a ruling on the billion-dollar Medicare Advantage audits we told you about yesterday.

coronavirus Biden will end Covid emergencies, but WHO's not ready — yet President Biden told Congress yesterday that he will end the two national emergencies governing Covid-19 on May 11. His decision — to halt the national emergency and public health emergency declarations in force since March 13, 2020 — would change the government's response to one that treats the virus as an endemic threat to public health, managed through agencies' normal authorities. Read more from the Associated Press, and get up to speed on the huge headaches ahead for the health system that STAT's Rachel Cohrs predicted here. Earlier yesterday, the WHO said the Covid-19 pandemic is still a public health emergency — for now. In its announcement, the global agency followed the advice of a committee of outside experts who met Friday on extending the public health emergency of international concern, or PHEIC. But the committee and WHO also signaled the pandemic may be at an inflection point. STAT's Helen Branswell has more on WHO's position.   insurance Medicare Advantage insurers would repay billions under final federal audit rule Adobe The federal government will audit Medicare Advantage insurers aggressively under a rule finalized yesterday, a decision likely to direct billions of dollars in overpayments back to Medicare and patients over the next decade. But there's a catch: Federal officials are giving insurers seven years of immunity from having the samples of their diagnosis coding errors extrapolated to their broader membership. Still, the rule, which was first floated in 2018, and figures in a decade-long feud between the insurers and regulators, will apply to all Medicare Advantage plans. And it's expected to spark lawsuits. The audits will compare patient diagnoses that Medicare Advantage insurers submit to the government to patient diagnoses in their medical records. The idea is to root out cases where insurance companies have inflated the number of health conditions their members have, making them appear sicker than they are. STAT's Bob Herman and Tara Bannow have more. business Andy Slavitt has ideas on how to invest in Medicaid and health tech Here's a novel idea: Health tech companies can make a viable business out of reaching low-income people who also face social challenges, like a lack of housing or nutritious food options. Andy Slavitt, who was an acting CMS administrator in the Obama administration, is making that part of his mission at Town Hall Ventures, just as the millions who signed up for Medicaid coverage during the public health emergency risk losing it as temporary expansions end. "Not every problem in health care will be solved with innovation," he said. "But some can, and the ones that can are the ones where you've got a clinical, social, behavioral model that addresses the need of a specific population where there's also some payment model that allows you to meet those needs." Read more of Slavitt's conversation with STAT's Mohana Ravindranath, including his thoughts on portfolio company and Alphabet spinout Cityblock Health.

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Closer Look Big tech's layoffs could be health care's gain, former employees say Sean Gallup/Getty Images One after another, tech behemoths have been announcing layoffs in recent months, adding up to 51,000 people since November. You may not think of Meta, Amazon, Alphabet, and Microsoft as health companies, but their ranks include employees with health-care expertise applicable elsewhere. Think about data services, where health care organizations are looking to expand their technical capabilities.  "You have to save the data and you have to understand it and you have to understand how it was collected and all of the kind of metadata associated with it," said Michelle Holko, a genetics researcher who became a strategic business executive at Google before being laid off in January. She named projects like DeepMind's AlphaFold as one of the "demonstrations of the art of the possible." Read what other former Google employees told STAT's Brittany Trang about the possibilities they see as "Xooglers." pandemic Children lost a third of year's learning to Covid School-age children around the world have seen their education fractured by almost three years of pandemic disruptions. A new report in Nature Human Behaviour estimates these children lost about 35% of an academic year's learning and still haven't made up for that loss, even after lockdowns and hybrid instruction ended. Fears that learning deficits would continue to mount haven't been realized, but the authors note the pandemic has widened already large educational gaps between children from different socio-economic strata. To reach their conclusion, the researchers analyzed 42 studies in 15 high- and middle-income countries, finding that delays in making progress in their learning as well as losing ground they'd previously gained were worse for children with disadvantaged backgrounds. Skills in math suffered more than in reading, possibly because to learn math children need more formal instruction, rather than reading at home on their own. The authors urge more research in low-income countries. health Smoking rates during pregnancy tumble At a time when it may seem rare to see anyone smoking, a new report says the small proportion of people who smoke during pregnancy has shrunk by 36%. A risk factor for poor pregnancy outcomes and health problems for newborns later in life, smoking at any time while pregnant was first tracked by the CDC researchers in 2016, citing notations on birth certificates. The 2016 rate was 7.2%, which dropped to 4.6% in 2021, with the largest annual decline coming  from 2020 to 2021. Smoking fell among all ages, racial and ethnic groups, and throughout the U.S., but there were some differences. These people had the highest prevalence in 2016 and 2021: Mothers under age 30. American Indian or Alaska Native mothers and white mothers. Mothers in these 10 states: Arkansas, Kentucky, Maine, Missouri, Montana, Ohio, South Dakota, Vermont, West Virginia, and Wyoming. by the numbers

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Thanks for reading! More tomorrow,

@cooney_liz

elizabeth.cooney@statnews.com

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