Oct 28, 2019

Axios Vitals

By Caitlin Owens
Caitlin Owens

Good morning. My condolences to all of the real Nats fans out there. But hey, this isn't over yet!

Today's word count is 912 words, or ~3 minutes.

1 big thing: Providers, employers link up on suicide prevention

Illustration: Aïda Amer/Axios

Hospital-based programs are working with employers and community organizations to tackle gun violence and suicide, Axios' Marisa Fernandez reports.

What's happening: Companies have pleaded with Congress to pass stronger gun control laws to help stop workplace shootings and suicides. But as bills from the House stall in the Senate, employers are turning to health care providers for help.

By the numbers: The suicide rate among adults ages 16 to 64 rose 34% from 2000 to 2016, according to the Centers for Disease Control and Prevention.

Where it stands: Businesses don't want to get into partisan conversations about gun violence. Instead, they're working with clinicians on access to treatment, warning signs and safety measures for employees, per the Harvard Business Review.

  • In Utah, Intermountain Healthcare partners with human-resources departments and local religious leaders on an outreach program designed to reduce the state's high suicide rate.
  • In New York City, the New York Police Department is partnering with a privately run hospital for free counseling and prescriptions. At least 10 officers have died by suicide this year.

Yes, but: Many employees still struggle to get their mental health treatment covered, NPR reports.

  • Out-of-pocket spending on inpatient mental health care between 2012 and 2017 grew nearly 13 times faster than all inpatient care.

The bottom line: The American Psychological Association found the percentage of people dealing with suicidal thoughts increased by 47% from 2008 to 2017.

  • 60% of all gun deaths in 2017 were from suicide, the Pew Research Center notes.
  • There is great public support among gun owners and non-gun owners for health care providers to talk about gun safety, an October study published in Health Affairs says.

If you have any thoughts of self-harm or suicide, please pick up the phone right now and call the National Suicide Prevention Hotline at 1-800-273-8255.

2. Private equity's other stake in surprise bills

Private equity firms don't just own physician firms and air ambulances that would be most affected by eradicating surprise bills. They also hold stakes in the companies that help health insurers determine what they should pay for out-of-network care, Axios' Bob Herman reports.

Why it matters: Private equity has its footprint all throughout health care, but these financial firms especially have a lot on the line in Congress.

By the numbers: Seven major companies — CareCentrix, MedRisk, MultiPlan, naviHealth, One Call, Paradigm and Zelis — are hired by insurers to handle "health care cost containment," which includes things like bill editing and renegotiating out-of-network claims, according to Moody's Investors Service. 

  • Private equity owns a slice of each, and Moody's anticipates the aggregate annual revenue of these companies will reach $8 billion by 2020.
  • Two of those companies, MultiPlan and Zelis, are most directly involved with out-of-network claims and have the most to lose from any changes.

The big picture: Everything hinges on Congress' leading solution, which would use a benchmark rate to pay out-of-network providers.

  • "Should the new legislation set benchmark pricing, repricing claims would become de facto irrelevant, making part of these companies' business models obsolete," Moody's analysts wrote.

Yes, but: Because some of these companies already handle medical bill negotiating between providers and insurers, they "could play an active role in setting benchmark pricing for the industry and could even monetize their expertise," Moody's wrote.

  • "This would lessen the adverse impact of new legislation."
3. Harris explains her health care evolution

Sen. Kamala Harris. Photo: Win McNamee/Getty Images

Sen. Kamala Harris said in an interview with "Axios on HBO" that she changed her approach to Medicare for All after understanding how many Americans feel strongly about keeping their private health insurance.

At first, she embraced Sen. Bernie Sanders' Medicare for All plan that would end private insurance, but then rolled out an alternative in July that would preserve a role for private insurance to compete inside a government-run system.

  • "I have publicly and will always applaud Bernie for what he did to bring this conversation to the place that it now exists," she said.
  • But "I heard from people, 'Kamala, don't take away my choice if I want a private plan. Please don't take away my choice.' And I said, you know what? That is fair."
  • "I said to my team, I know we're going to take a political hit for it ... I knew I'd be called a flip flopper for that."
  • "But here's the thing. I plan to govern" and "just because it might get you political points, that's not what people want. They want a leader who actually sees them as responsive to their needs and is honest and willing to have the courage to maybe take a political hit."
  • "I'm never gonna apologize for listening to people and then deciding, hey, they've got a point. This can be better."

My thought bubble: Harris' swift evolution says volumes about the Democratic party's uneasiness with Medicare for All.

4. The West has a meth problem

Methamphetamine led to more drug overdose deaths in 19 western states in 2017 than fentanyl, according to a new report from the Centers for Disease Control and Prevention.

Between the lines: This was the first time that the CDC has broken down regional differences in overdose deaths by drug, the Wall Street Journal writes.

  • Nationally, meth was the 4th-most common cause of overdose deaths. Fentanyl was most common.

What they're saying: "It has important implications around what we do for prevention and where resources need to go," Holly Hedegaard, an author of the CDC report, told the WSJ. "Clearly, not all drug problems are the same."

What we're watching: The meth overdose rate has risen from 0.6 fatalities per 100,000 people in 2011 to 2.9 in 2017 — a growth trajectory similar to what researchers saw with heroin and fentanyl.

5. While you were weekending...
  • The Trump campaign is warning the president that the administration's ban on flavored e-cigarettes could backfire next year in the election, WashPost reports.
  • New York's insurance regulator is investigating a UnitedHealth Group algorithm that, according to a study, prioritizes healthy white patients over sicker black patients, per WSJ.
  • The federal government is shutting down a research program that attempts to identify animal viruses that may infect humans — a move that has global health experts worried, NYT reports.
Caitlin Owens