This Week in Managed Care: August 14, 2020

All-cause mortality disparities persist among Black and White men living in rural US, vaping a risk factor for COVID-19 in teens and young adults, and an inside look on how the pandemic presents an opportunity to promote value-based care delivery.

Welcome to This Week in Managed Care, I’m Matthew Gavidia.

All-Cause Mortality Disparities Persist Among Black, White Men Living in Rural US

From 1968 to 2016, differences among Black and White older adults’ mortality rates narrowed in urban areas throughout the United States. However, data from a cross-sectional study of more than 3000 counties published in JAMA Network Open show a considerable widening in the mortality rate among Black and White men living in rural counties.

Using mortality data from the CDC WONDER database, as well as county-level socioeconomic data from the Area Health Resources Files of the US Health Resources and Services Administration, investigators assessed sex-specific age-adjusted all-cause mortality rates of older Black and White adults living in rural and urban counties.

While decreased mortality rates were exhibited among both Black and White men and women in urban and rural-adjacent counties, the racial mortality gap increased among men living in rural counties after 1980.

Compared with White men, approximately 1200 more deaths per 100,000 Black men occurred in urban counties in 2004, and 1900 more deaths per 100,000 Black men occurred in rural-adjacent areas in 2007.

Additionally, after controlling for county-level socioeconomic characteristics, in the mid-2000s the racial gap remained highest and continued to increase in rural-nonadjacent counties.

“Notably, the current mortality rate of Black men living in rural areas is similar to that of White men living in urban and rural areas in the mid-1980s,” researchers conclude. “Controlling for income and unemployment rate, the current adjusted mortality rate of Black men in rural areas is higher than that of White men more than 2 decades ago.”

For more, visit ajmc.com.

Vaping a Risk Factor for COVID-19 in Teens, Young Adults

This week, a new study by researchers at the Stanford University School of Medicine found that e-cigarette use, vaping, and smoking traditional cigarettes by US teenagers and young adults are associated with a greater likelihood of contracting COVID-19.

The findings, which were based on an online national survey of 4351 adolescents and young adults aged 13 to 24, indicated that those who vaped were 5 to 7 times more likely to be infected than those who did not use e-cigarettes—while those who had smoked via either e-cigarettes or combustible cigarettes in the past 30-days were 4.7 times more likely to show COVID-19 symptoms.

Lost amid efforts to address the COVID-19 pandemic, the CDC and FDA were tracking lung injuries associated with vaping and e-cigarettes, which came to light last summer after teens and young adults started showing up in emergency departments across the country with a mysterious lung illness.

In an email to The American Journal of Managed Care^®, Dr Bonnie Halpern-Felsher, a professor of pediatrics and research director in the Division of Adolescent Medicine at Stanford University, said pulmonologists are still seeing cases of e-cigarette, or vaping, product use–associated lung injury.

The last regulatory action the FDA took on e-cigarettes came in January, but Halpern-Felsher said it does not go far enough. "The FDA should eliminate the sale and marketing of all e-cigs right now. There is too much concern over their health impact and on youth use to keep them on the market.”

For more, visit ajmc.com.

How Can the COVID-19 Pandemic Enhance Value-Based Health Care Delivery?

As the health care industry manages the new normal precipitated by the COVID-19 pandemic, a webinar this week, titled “Increasing Access to Necessary Care During the COVID-19 Pandemic & Beyond,” addressed how the pandemic has created a rare opportunity to enhance the efficiency of medical expenditures.

One of the speakers, Dr Mark Fendrick, co-editor-in-chief of The American Journal of Managed Care^® and director of the University of Michigan Center for Value-Based Insurance Design, or V-BID, expands on this opportunity in an interview with AJMC^®.

By hitting every pressure point of the health care delivery system, including access, safety, infrastructure, and affordability, Fendrick explains that the restructuring of these aspects and subsequent reallocation of health care dollars can allow for greater investment in value-based care.

For the full interview, visit ajmc.com.

FDA Clears clonoSEQ to Detect MRD in Chronic Lymphocytic Leukemia

This week, Adaptive Biotechnologies received its third approval from the FDA for the use of its next-generation sequencing assay to detect minimal residual disease, or MRD, in chronic lymphocytic leukemia, or CLL.

The assay, clonoSEQ, uses a proprietary immunosequencing platform to monitor for MRD, where a small number of cancer cells remain during and after treatment.

“We know that traditional CLL treatment response criteria are insufficient, so the ability to measure MRD with a test that is one hundred times more sensitive than standard flow cytometry may change our approach to treating CLL,” said Dr John Pagel, principal investigator and chief of Hematologic Malignancies at the Swedish Cancer Institute.

The approval follows a decision by CMS in January to pay for cloneSEQ testing for CLL, in addition to multiple myeloma and B-cell acute lymphoblastic leukemia. Nearly 80% of US patients with CLL are age 65 or older.

For more, visit ajmc.com.

Paper of the Week

And, now our paper of the week, which looks back at some of the most important papers over the past 25 years of The American Journal of Managed Care^® and why they matter today.

Recent attention to disparities in health care, including among patients with COVID-19, raises the question: does access to care always equal better outcomes?

A paper in the August 2012 issue from authors at Geisinger Health suggests that simply tracking health measures doesn’t bring better results. In the paper, “Racial Disparities in African Americans With Diabetes: Process and Outcome Mismatch,” the authors found that Black patients were far more likely than White patients to have diabetes data entered into a health registry over a 5-year period, but a smaller share of Black patients achieved glycemic control.

For the paper, visit ajmc.com.

For all of us at AJMC^®, I’m Matthew Gavidia. Thanks for joining us!