Health Equity & Access Weekly Roundup: November 2, 2024

Understanding the Financial Return to Investments in the Social Determinants of Health

Despite broad recognition of the important role social determinants of health (SDOH) play in health outcomes, substantial barriers remain, including the lack of clear evidence on such interventions' effectiveness and return on investment (ROI). Efforts by federal, state, and private sectors, like the Center for Medicare and Medicaid Innovation's Accountable Health Communities model, seek to bridge the gap between health care and social services. Yet, challenges persist in implementation and coordination with community-based organizations (CBOs). The authors outlined recommendations to enhance SDOH impact, such as increasing federal support, leveraging CBO expertise, expanding data-sharing, and fostering cross-sector partnerships, advocating for policy actions to promote sustainable SDOH funding.

Employers Shift to Equity-Focused Strategies as Health Costs Outpace Wages

The Pulse of the Purchaser 2024 survey published this week by National Alliance of Healthcare Purchaser Coalitions reveals that escalating health care costs are prompting employers to explore cost-management strategies that balance employee benefits with organizational sustainability. With 74% of employers concerned about the impact of rising health care costs on wages and benefits, many are considering shifts in cost sharing with employees and implementing targeted initiatives for high-cost claims, such as managed maternity benefits, early screening, and site-of-care redirection. Additionally, employers are prioritizing health equity, with 74% engaging in cross-departmental discussions on the topic and analyzing data to address disparities. The survey also highlights dissatisfaction with current pharmacy benefits manager practices, with over half of respondents considering a change to improve transparency and control.

Contributor: Vulnerable Seniors Are at Risk With Looming Medicare Advantage Cuts—Income-Based Programs Can Minimize the Damage

The 2024 Medicare Advantage (MA) open enrollment period reveals significant challenges for beneficiaries as regulatory changes and financial pressures force MA plans to cut benefits and raise costs. With an average of 43 MA options, many seniors face plan disruptions, with 1.38 million losing access to their current plan and 4.56 million automatically moving to new plans. Key changes include increased Part D deductibles, reduced supplemental benefits like Flex Card allowances and over-the-counter coverage, and increased premiums, leaving many beneficiaries—particularly low-income seniors—at risk of higher out-of-pocket expenses. Income-based programs such as Medicaid could help alleviate these costs, but up to half of eligible seniors remain unenrolled. As seniors navigate these changes, using resources like the Medicare Advantage Annual Enrollment period checklist and external advisors may help them better understand their options and secure necessary benefits amidst the shifting landscape.

New AI Tool Identifies Undiagnosed PNH in Health Records

A recent study investigated using a machine learning model to help identify undiagnosed cases of paroxysmal nocturnal hemoglobinuria (PNH), a rare blood disorder with high misdiagnosis rates due to its varied symptoms. The algorithm analyzed electronic health records data from the Optimum Patient Care Research Database, distinguishing PNH cases with significant specificity and accuracy by focusing on key clinical markers associated with PNH, such as aplastic anemia and hemolytic anemia. The initial Positive Predictive Value (PPV) was 60.4% (95% CI, 33% to 82%), indicating that over half of the flagged patients already had a PNH diagnosis in their records. However, when researchers adjusted for PNH’s rarity (3.81 cases per 100,000 individuals), the PPV decreased to 19.59% (95% CI, 7.63% to 41.81%), suggesting that approximately 1 in 5 flagged patients may need further investigation for PNH. The study’s findings underscore the potential of machine learning to improve early diagnosis of rare diseases, though additional testing on diverse datasets is required for clinical application.

Biosimilars Expand Access and Reduce Costs in Oncology, Immunology

New research presented at the Academy of Managed Care Pharmacy (AMCP) Nexus highlights the cost savings and access benefits of biosimilars in health care. With over 60 biosimilars approved in the US, these alternatives offer significant savings, especially in costly treatment areas like immunomodulation, oncology, and endocrinology. Studies showed biosimilars such as denosumab and adalimumab enable substantial budget-neutral savings, thereby expanding treatment access and promoting health equity. For example, a projected 70% adoption of biosimilar denosumab could save over $31 million in 5 years. Similarly, adalimumab biosimilars, with costs up to 80% lower than Humira (adalimumab), could extend access to treatments for chronic inflammatory conditions. This real-world evidence suggests biosimilars' growing role in reducing health care costs while broadening patient access to essential therapies.