Lawsuit alleges bulk claims denials by Cigna, the race is on for new Alzheimer's diagnostics, & how IQVIA has built a health data empire

A new lawsuit accuses Cigna of using an algorithm to automatically deny claims in bulk instead of individually reviewing each case.

July 25, 2023 Check out STAT+

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By Elizabeth Cooney Reporter, Morning Rounds Writer

Good morning. We have a lot going on in health tech today, from diagnostics being developed for Alzheimer's to IQVIA's data juggernaut drawing FTC disapproval. And then there's a Q&A with AMA's new leader, who happens to be an anesthesiologist and an informaticist. Read on.

health tech The advent of new Alzheimer's drugs has accelerated the race for new diagnostics New Alzheimer's drugs — Eisai/Biogen's approved Leqembi and Lilly's donanemab likely headed that way — are heating up demand for diagnostics to reveal who might do well on them, balancing modest benefits in slowing cognitive decline with serious side effects including brain bleeds. Now the standard confirmatory test looks for amyloid clumps on a PET scan, but if they're visible, the disease has already progressed. Blood tests hold more appeal, particularly ones that aim for diagnosis before symptoms appear. Some tests used in clinical trials for Leqembi and donanemab have won FDA breakthrough device designation, though none is authorized yet. There's still disagreement in the field about what to look for: amyloid? Tau? Phosphorylated tau? And where: cerebrospinal fluid? Blood? "Whereas in the CSF, it's a nice clean fluid that you can measure, in the blood it's a bit of a minestrone soup," Mark Stearman of Roche said. STAT's Brittany Trang breaks it down. insurance Cigna uses an algorithm to deny claims in bulk, lawsuit alleges  We've been telling you about a new wrinkle in insurance claim denials:  A recent STAT investigation found that artificial intelligence is driving denials to new heights in Medicare Advantage. And in March, ProPublica reported that over two months in 2022, Cigna doctors denied more than 300,000 requests for payment using a system called PXDX to identify discrepancies between diagnoses and what it covers. On average, that's at a clip of 1.2 seconds to  "review" each request. A new lawsuit filed in California yesterday accuses Cigna of using an algorithm to automatically deny claims in bulk instead of individually reviewing each case, as state law requires. Claims denials can boost insurers' bottom lines because most people simply pay up. In a statement, Cigna said PXDX is "a simple tool to accelerate physician payments that has been grossly mischaracterized in the press."  STAT's Tara Bannow has more. mental health White House promotes 'true parity' in mental health coverage, including addiction If the Biden administration gets its way, health insurers would be compelled to cover mental health conditions, including addiction, as much as they do physical health conditions. The notion, long known and advocated for as parity, forms the basis for a plan announced today that would eliminate the bureaucratic hoops patients have had to jump through since the 1990s, when  insurers were first legally required to cover mental health and addiction treatment.  The new rule would force insurers to evaluate their own networks to measure not just whether they're offering adequate mental health and addiction coverage, but also whether patients are truly accessing it. "This rule will ensure that we have true parity," said Neera Tanden, President Biden's domestic policy adviser. STAT's Lev Facher has more.

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Closer Look IQVIA's data health empire is drawing fire from FTC Adobe We may not know much about IQVIA, but it knows a lot about us. The health data behemoth has gobbled up so many other companies for their datasets or novel technologies that it's drawing scrutiny from government regulators. The FTC is suing to block its latest acquisition (of the digital advertising firm DeepIntent) because IQVIA's data vault has become so large and revealing that it forms the substrate of an entire industry focused on showering doctors and patients with marketing messages. How much is too much? IQVIA holds 1.2 billion non-identified patient records — enough to crash a supercomputer in seconds — as well as the email addresses of 95% of the nation's health care professionals. That makes it a repository whose penetrating view into Americans' lives commands consistent business from the world's largest drug companies and device makers — and existential dread from industry watchdogs, STAT's Casey Ross tells us. Read more. Health tech The AMA's new president brings chops in informatics Jesse Ehrenfeld owns some career firsts. The first openly gay president of AMA, the anesthesiologist is also the first board-certified clinical informaticist in the top role. So STAT's Katie Palmer asked him about health tech. Gender and sexual minorities have historically been invisible in clinical data. Any change? There's still a lot of progress to be made in making sure that the data we collect is actually brought to life and that we're actually using these data to inform clinical care, inform clinical decision support, and help patients stay healthy. What forms and applications of AI do you think will change the practice of medicine the most? I don't believe that it's too far off when every radiology film, MRI, CT scan is primarily read by a machine first and then overread by a human. But even the most advanced algorithms and AI enabled tools still can't diagnose and treat diseases.  Read the full interview. climate Heat and pollutants may double heart attack risk The Greek island of Rhodes is on fire, the latest scene of what seem like unending fires around the world. A new study in Circulation documents one health impact from extreme heat and fine particulate pollution we're seeing more often now, concluding that the combination may double the risk of heart attack deaths. The researchers studied just over 200,000 fatal heart attacks from 2015 to 2020 in Jiangsu province in China during days of both extreme heat and cold as well as high pollution. All three conditions raised heart attack risk, but heat plus pollution was the most deadly, especially for women and people over 80. Overall, up to 2.8% of heart attack deaths could be attributed to the combination of extreme temperatures and high levels of fine particulate pollution, the researchers estimate. One way heat and pollution might do their synergistic damage is when sweating elevates skin blood flow and accelerates the uptake of pollutants.

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What we're reading Gene therapy eyedrops restored a boy's sight. Similar treatments could help millions, Associated Press A new morning-after pill to stop STDs could also make the problem worse, Washington Post Roche's $3 billion Alnylam deal shows drug firms are interested in long-acting heart drugs, STAT Rise in cancer among younger people worries and puzzles doctors, Boston Globe A new study finds a strong link between depression and dementia, CNN Opinion: Enough with the health care policy patchwork. It's time for universal insurance, STAT

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Thanks for reading! More tomorrow,

elizabeth.cooney@statnews.com

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