Homegrown malaria, more to come

With Katherine Ellen Foley, Robert King, Ben Leonard and Megan Messerly

Driving the day

RISING THREAT — Covid-19 may not dominate the headlines like it once did, but infectious disease news isn’t going anywhere.

The CDC is warning doctors to be on guard for malaria after at least five locally acquired cases, in Florida and Texas, were identified for the first time in decades.

Last week, European health officials announced a sizable increase in the number of locally acquired cases of dengue in the past year.

And those announcements may be just the beginning.

Climate change and increasing connections worldwide are likely the main drivers of rising disease threats across the board, Syra Madad, an epidemiologist and biosecurity expert, told Pulse.

Some have theorized that malaria and dengue — both spread through mosquitoes — being contracted in new places is connected with the changing climate, too.

Shifting temperatures and rain patterns mean mosquitoes stay in some places weeks longer than they did decades ago, leading to stronger breeding seasons.

“For those of us that are in this field,” Madad said of the increasing threats, “this is something that is bound to happen.”

The U.S. eliminated malaria in the late 1940s, but the mosquito that can transmit it remained, said Patrick Kachur, a professor at Columbia University Medical Center, who worked on malaria and global health at the CDC for most of his career.

The threat to individuals from the new malaria reports is relatively low, Madad said. But that doesn’t discount its significance at a population level.

“It doesn’t take a lot for something low risk to go to something that is high risk,” she said.

Policymakers feel the pressure. From Covid to mpox, malaria to dengue, headlines about new infectious disease risks remind lawmakers and administration officials that the need for health security plans will go beyond the pandemic.

Dyann F. Wirth, an infectious disease professor at the Harvard T.H. Chan School of Public Health, said the U.S. needs to ensure that its surveillance systems pick up people who have malaria, which people are typically not tested for unless they say they have traveled abroad.

“It’s important to remember that untreated malaria can be fatal very rapidly: The parasite replicates very rapidly in the human host,” she said. “So, it’s important also that the diagnostic capabilities in American hospitals and clinical practice remain well tuned, because if you miss a malaria case, it could have a serious consequence for the patient, not to mention for transmission,” she added.

WELCOME TO THURSDAY PULSE, where we were surprised to find Barbie dolls implicated in Covid funding scams. Pictures of doll faces and other figurines were paired with fake identities used to apply for cash from the government.

What other Covid cash corruption do you know about? Let me know — and be sure to share other health news — at [email protected].

TODAY ON OUR PULSE CHECK PODCAST, host Kelly Hooper talks with Katherine Ellen Foley, who gives an overview of the shifting Alzheimer’s drug landscape as drugmakers focus on developing the next class of treatments.

At the Agencies

GAO DINGS CMS — Medicaid managed care plans run by private insurers could face new scrutiny on overpayments by the federal government if the Government Accountability Office has its way, Robert reports.

The federal watchdog wants CMS to examine whether it’s cost-effective to include managed care plans in the Medicaid Recovery Audit Contractor program, which mandates states to hire outside contractors to find overpayments in Medicaid. Currently, managed care plans aren’t a part of the program, which isn’t in place for 35 states, according to a GAO report released Wednesday.

“Since 2011, CMS has not determined whether the inclusion of managed care payments in the Medicaid RAC program would be cost effective,” the report said. “However, states that have elected to use recovery audit contractors to review managed care have reported collecting overpayments, including one selected state that reported collecting more than $177 million in overpayments in one year.”

More than half of Medicaid spending is on managed care plans, where states give insurers a fixed amount and they’re then responsible for paying providers, GAO wrote.

CMS disagreed, however, with the recommendation. The agency told GAO that states can tailor their auditor programs to their specific needs. It noted that conducting a study on the cost-effectiveness of requiring all states to include managed care “may not be the most efficient use of time and resources,” GAO’s report said.

FIRST IN PULSE: HHS’ SMOKING-CESSATION DRAFT — The Department of Health and Human Services is expected to issue today the first fact sheet on the goals of its forthcoming interagency smoking-cessation program, Katherine reports.

The Biden administration first announced the initiative — part of the cancer moonshot — earlier this month and said it aims to harmonize efforts from agencies, including the CDC, the FDA and the Department of Veterans Affairs.

The Office of the Assistant Secretary for Health seeks information on how to carry out six specific goals, including eliminating tobacco-related health disparities, improving tools to quit smoking and promoting new research on ways to improve smoking cessation.

OASH is taking comments through July 30.

HEALTH TECH

DOJ FRAUD BUST — The Justice Department has charged 78 people with more than $2.5 billion in alleged health care fraud, Ben reports.

Eleven of the defendants were charged in alleged “telemedicine” schemes in which organizers used telemarketing to reach people who are elderly and disabled and upsell unneeded drugs and medical equipment.

“The software platform that the defendants allegedly operated was actually a conduit for these telemarketers to coordinate the payment of illegal kickbacks and bribes to telemedicine companies to obtain doctors’ orders for Medicare beneficiaries,” the DOJ said in a release.

Also, the DOJ charged 10 defendants tied to $370 million in allegedly fraudulent claims related to prescriptions and defendants tied to $150 million in other allegedly false billing, including for prescribing unneeded opioids.

IN THE STATES

STRUGGLE FOR STATE EMPLOYEE HEALTH PLANS — State employee health plans are often the largest commercial purchasers of health care in their states, Megan reports.

While that gives SEHPs significant negotiating power, they’re still struggling to contain health care cost growth amid resistance from both providers and people enrolled in the plans, according to a new report from Georgetown University’s Center on Health Insurance Reforms.

Researchers received survey responses from the District of Columbia and every state except New Jersey and found that only 15 SEHPs could show a return on investment from their cost-containment strategies. Others planned to abandon their mitigation measures because they hadn’t produced the desired results.

The report noted that most of the plans’ cost-containment strategies have centered around reducing prescription drug costs, with only one of the top five strategies focusing on hospital prices. It also found that, while state employee health plans have seen improved access to claims and price data, they still have struggled to use that data to contain costs.

Names in the News

Sarah Emond, most recently executive vice president and COO of the Institute for Clinical and Economic Review, has been named its president-elect.

Eric Triana, a former DEA diversion control leader, has been named chief compliance officer of Talkiatry, a psychiatric care provider.

Laura O’Donnell, previously senior vice president, chief compliance officer at McKesson, was named general counsel at Verily.

Hayley Alexander is now associate director of government affairs at pharmaceutical company Lundbeck. She most recently was senior manager for government affairs and public policy at BeiGene and is a Senate Approps alum.

What We're Reading

KFF Health News reports on the changing reality of primary care and its implications for the future.

STAT explores the efforts underway to eliminate bias in clinical algorithms.

The Wall Street Journal reports on the MDMA therapy developer looking for a cash infusion.