IHA Daily Briefing: Nov. 28

Wednesday, November 27, 2019
CDC on Possible EVALI-Vitamin E Acetate Link
CMS Accepting Direct Contracting Model Applications
Working Families Spending More on Health Insurance
State’s Unemployment Rate Down in All 14 Metro Areas
Briefly Noted

CDC on Possible EVALI-Vitamin E Acetate Link
A new report issued Tuesday by the Centers for Disease Control and Prevention (CDC) provides more evidence that vitamin E acetate may play a key role in vaping-related illnesses. The report says that tetrahydrocannabinol (THC)-containing e-cigarette, or vaping, products also containing vitamin E acetate appear to be associated with e-cigarette, or vaping, product use-associated lung injury (EVALI).

According to the CDC, the chemical, used as an additive or thickener in some vaping products, was found in vaping products used by 11 of 12 patients with EVALI in Minnesota. In an earlier analysis, vitamin E acetate was found in every sample of lung fluid collected from 29 patients EVALI in 10 states, including Illinois.

The new report may also shed light on why vaping-related illnesses and deaths appear to have started this year even though vaping products have been around for several years. To explore whether vitamin E acetate is a recently added component in THC-containing products, the Minnesota Dept. of Health (MDH) tested ten products seized by law enforcement in 2018, before the EVALI outbreak, and 20 products seized in 2019, during the outbreak. Twenty-four products obtained from 11 EVALI patients from 2019 contained vitamin E acetate. Among the seized products tested by MDH, none seized in 2018 contained vitamin E acetate, although all tested THC-containing products seized in 2019 tested positive for vitamin E acetate.

The report’s authors say additional analyses are needed to establish whether a causal link exists between inhaled vitamin E acetate exposure and EVALI. They note that it is possible that more than one compound or ingredient could be a cause of lung injury, and evidence is not yet sufficient to rule out contribution of other toxicants.

CMS Accepting Direct Contracting Model Applications
The Centers for Medicare & Medicaid Services (CMS) this week announced that it is accepting applications from eligible entities – including hospitals that employ clinicians, critical access hospitals and rural health clinics – to participate in two voluntary, direct contracting payment models in calendar year 2020. The models will be tested over six years, with an optional initial Implementation Period, followed by five performance years.

CMS says it will test two voluntary risk-sharing options in direct contracting: (1) Professional, a lower-risk option (50% Shared Savings/Shared Losses (SS/SL)) and Primary Care Capitation (PCC) equal to 7% of the total cost of care benchmark for enhanced primary care services; and (2) Global, a full risk option (100% SS/SL) and either PCC or Total Care Capitation (TCC). According to CMS, direct contracting leverages lessons learned from other Medicare Accountable Care Organization (ACO) initiatives, such as the Medicare Shared Savings Program and the Next Generation ACO (NGACO) Model, as well as innovative approaches from Medicare Advantage (MA) and private sector risk-sharing arrangements.

CMS began accepting applications Nov. 25 and will continue to do so through Feb. 25. Prospective applicants who have not already submitted a non-binding letter of intent to apply must do so by Dec. 10.

Working Families Spending More on Health Insurance
A new Commonwealth Fund report finds that health insurance costs are taking a larger share of middle-class incomes as premium contributions and deductibles grow faster than wages.

Among the key national findings from the report:

  • Premium and deductible costs amounted to more than 11% of median income in 2018.
  • Workers' payments for health insurance grew faster than median income over the last decade. Between 2008 and 2018, employee premium contributions grew at an average annual rate of more than 4%, outpacing the growth in median household incomes, which dipped to a low of negative 1.5% during the recession from 2008 to 2010 and more recently, from 2016 to 2018, 3.4%.
  • Rising deductibles leave workers and families exposed to high out-of-pocket costs. In many states, workers are saddled with high deductibles relative to their income. This leaves many at risk of being “underinsured” and more likely to struggle paying medical bills and more likely to skip care because of costs.
  • Workers’ premium contributions consume nearly 7% of median income, up from 5% a decade ago.

The report also includes extensive state-by-state findings. In Illinois:

  • Average health insurance premium for a single person was $7,123 in 2018, an increase of 6.6% from 2016 to 2018.
  • Average premium for a family was $20,407 in 2018, an increase of 5% from 2016 to 2018.
  • Total employee contribution for premiums was 22% for a single person, 26% for families.
  • Average combined employee premium contribution and deductibles as a percentage of median household income is 10%.

For more information, see the Commonwealth Fund’s press release.

State’s Unemployment Rate Down in All 14 Metro Areas
Illinois’ unemployment rate decreased over-the-year in October in all of the state’s 14 metropolitan areas, according to preliminary data released by the U.S. Bureau of Labor Statistics and the Illinois Dept. of Employment Security. The not seasonally adjusted Illinois unemployment rate was 3.6% last month. Data also shows the number of nonfarm jobs increased in 11 Illinois metropolitan areas, decreased in two, and was unchanged in one.

“Communities in every corner of the state have experienced sustained job growth throughout this year. By passing the bipartisan Rebuild Illinois capital plan and legislation like the minimum wage increase, Governor Pritzker is ensuring the state's economy continues to thrive,” said Deputy Governor Dan Hynes.

The industry sectors recording job growth in the majority of metro areas included Transportation, Warehousing and Utilities (9 of 14), Education and Health Services (9 of 14), Government (9 of 14), and Leisure and Hospitality (8 of 14).

Briefly Noted
In recognition of World Aids Day on Dec. 1, the National Institutes of Health has issued a statement on its efforts to support President Trump and the U.S. Dept. of Health and Human Services’ plan, “Ending the HIV Epidemic: A Plan for America,” to reduce the incidence of HIV domestically by 75% in 5 years, and by 90% by 2030.