What a Cigna-Humana merger would mean, HCA cost-cutting, & how big a risk is CAR-T?

Critics say ACA hospitals in Appalachia are short-staffed, which means that critically ill patients may not get checked on enough.

November 30, 2023 Check out STAT+

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By Elizabeth Cooney Reporter, Morning Rounds Writer

Good morning. Don't miss Tara Bannow's special report on how critics say HCA's cost-cutting is endangering Appalachian patients — a warning for the whole U.S. health care system.

special report 'It's not as safe as it was': Critics say HCA's cost-cutting is endangering Appalachian patients Mike Belem for STAT It's a damning list of what's different now that the country's biggest hospital chain, HCA Healthcare, owns mid-size Mission Hospital in Asheville and five other rural hospitals in Western North Carolina. The loss of nurses and support staff means critically ill patients may not get checked on enough. "It's not as safe as it was," said oncologist Mike Messino, whose namesake Messino Cancer Centers staffs the hospital.  He's heard horror stories about care in the hospital since 2019, when HCA came in. A young person with asthma going into respiratory failure in the waiting room. Ambulances lined up for hours before they can drop people off. Cancer patients missing life-saving chemotherapy doses. According to 10 doctors who either work or used to work at Mission and a current Mission nurse, this is all happening because many of their colleagues have quit, driven away by punishing working conditions, unsafe environments, and low pay. HCA disputed that the Mission facilities are short staffed. Read more from STAT's Tara Bannow. insurance Report: Cigna and Humana headed toward a merger Now this could be big. Two health insurance titans are talking about a merger, a deal that would create a behemoth in both health insurance and prescription drug benefits, worth about $300 billion in annual revenue. The Wall Street Journal first reported the talks between Cigna and Humana yesterday. Such a move would no doubt attract scrutiny from antitrust enforcers at the DOJ and FTC. A merged Cigna-Humana would further consolidate the market for pharmacy benefit managers, the controversial middlemen of drug pricing negotiations. Of the four largest PBMs, two are owned by Cigna and Humana. Wendell Potter, a health insurance whistleblower who used to work at Cigna, also wrote about merger discussions on his blog Tuesday. Humana had no comment on the deal rumors, spokesperson Mark Taylor said. Cigna did not immediately respond to questions. STAT's Bob Herman, Tara Bannow, and Brittany Trang explore what may lie ahead.   politics Menthol ban opponents gain White House access Have you been following the controversy over menthol cigarettes? STAT's Nicholas Florko has, and he shares news of an unusual meeting on the topic. A little-known group of Black law enforcement officers is getting significant access to the White House to talk about the FDA's proposal to ban menthol cigarettes — and it's bringing the tobacco industry along. Two dozen Biden officials, including FDA Commissioner Robert Califf and HHS Secretary Xavier Becerra, joined a call earlier this month with the National Organization of Black Law Enforcement Executives to discuss the ban. It's not uncommon for the White House to meet with opponents to a proposed policy, but the Nov. 20 meeting is notable for its participants. "How [were] Altria, [Philip Morris International], and their funded partners able to secure this kind of audience when the Lung Association, the American Cancer Society Cancer Action Network, and others still have not?" Erika Sward of the American Lung Association asked. Read more.

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closer look CAR-T's surprising link to causing cancer took 10 years to surface. Experts call the risk minuscule Adobe Tuesday's news that the FDA is investigating whether CAR-T immunotherapy had caused blood cancers was surprising for two reasons. First, a decade after its invention, the treatment has become a bright spot in cancer care. That's where the other surprise comes in: That it's taken 10 years for a theoretical risk to rise to what may (or may not) be a real one. From its earliest days, the genetic modifications that equip CAR-T to fight cancer have been considered capable of causing a second, new cancer in patients. That's a risk chemotherapy and radiation carry, too. The FDA is zeroing in on CAR-T because some of the 19 reports of T cell malignancy it's examining did have CAR positive cancer cells. So in at least some cases, cancer cells were carrying the synthetic receptor that CAR-T cells use to recognize and kill cancer, suggesting the cancer may have developed from a CAR-T cell. But experts told STAT's Angus Chen the risk is likely minuscule. Read more. genetics U.K. Biobank reaches whole-genome milestone One of the world's richest resources for health data has gotten more comprehensive. Data from half a million people's whole genome sequences are now available to researchers worldwide through the U.K. Biobank. Its collection has been growing for 20 years, based on 500,000 volunteers' answers to surveys about their health plus medical records, tests of molecular markers, and imaging scans. Some participants' whole genomes were already available, but this week's new release includes genomes of the full cohort. "The scientists are looking at this like Google Maps," said Rory Collins, Biobank's principal investigator. "When they want to know, what are the pathways from lifestyle, environment, genetics to disease, they don't go to Google, they go to U.K. Biobank." A caveat: Like the populations of England and Scotland, more than 80% of participants are white. Much genomic data has been derived from Northern Europeans. STAT's Andrew Joseph has more. climate  How to cut the environmental costs of health products Mosquito nets, rapid tests, pills, and injectable medicines save millions of lives, right? Yes, but they also contribute nearly 3.5 megatons of greenhouse gasses per year — more than the Swiss city of Geneva. A new Unitaid report says certain strategies could lead to a 70% reduction in health products' emissions by 2030. For pills, there are greener ways to manufacture them. For malaria nets and PCR tests, they could be made with less plastic.  Some of these changes could be costly and most would require some upfront investment, whether to increase the use of renewable energy in production, make supply-chain processes more effective, or use new materials. "I think [policymakers] have to think hard about how current policies need to be changed such that there are stronger market signals for producers to make these changes," said Cheryl Damberg of RAND, who was not involved in the report. STAT's Annalisa Merelli has more.

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Thanks for reading! More tomorrow,

elizabeth.cooney@statnews.com

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