Strong testing and decreased COVID-19 cases are key to “Opening Up America Again” plan.

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Apr. 17, 2020


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So You’re Telling Me There’s a Chance: Opening Up America Again


Yesterday, President Donald Trump and his White House Coronavirus Task Force outlined a plan for governors to recover from the financial crumbling due to the coronavirus pandemic, referred to as “Opening Up America Again.” The plan involves a phased approach to restoring normal activity in areas with strong testing and a decrease in COVID-19 cases.

Areas with declining infections and strong testing would begin a 3-phased gradual reopening of businesses and schools, to ensure that infections do not accelerate. Each phase would last at least 14 days.

–    Phase 1. Recommends strict social distancing for all people in public. Gatherings larger than 10 people are to be avoided, and nonessential travel is discouraged.

–    Phase 2. Encourages people to maximize social distancing, where possible, and limits gatherings to no more than 50 people unless precautionary measures are taken. Travel could resume.

–    Phase 3. Envisions a return to normalcy for most Americans, with a focus on the identification and isolation of any new infections.

The plan also includes recommendations for businesses as they begin reopening, suggesting temperature-taking, rapid COVID-19 testing, and widespread increased disinfection efforts in workplaces.


Impact of COVID-19 Pandemic on Patient Access Programs


As the COVID-19 pandemic continues, what could this mean for patients and the assistance programs that ensure access to medications?

Xcenda examined the ripple effect an economic downturn could have on families, on their employment and insured status, and ultimately on patient support programs.

Download our newest issue brief, Impact of COVID-19 Pandemic on Patient Access Programs, to get insights and to better understand how manufacturers can project future patient needs.

Download now >

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Congress in Spring Recess


The House and Senate extended their spring recess until at least May 4.

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Our Favorite Nerds (Who Have Been There, Done That) Chime In:
Duke-Margolis National COVID-19 Surveillance System


Last week, the Duke-Margolis Center for Health Policy released a working paper detailing a potential national surveillance system for containing COVID-19. The authors of the working paper represent national leaders in public health and policy, health experts, and former top government healthcare officials—and include 2 former Food and Drug Administration (FDA) commissioners and physicians: Mark McClellan, MD, Director of the Duke-Margolis Center for Health Policy, and Scott Gottlieb, MD, a Resident Fellow with the American Enterprise Institute.

The intention of the response policies proposed in the working paper is “to inform and help guide policy makers addressing the evolving COVID-19 pandemic in the United States” and includes recommendations for the federal government as well as other vital stakeholders involved in the ongoing response efforts. The report suggests the most immediate priority against COVID-19 is to mitigate transmission of the virus though community-wide measures. It asserts a national surveillance system is crucial in planning for the future and enhancing our ability to contain spread and manage cases.

The 4 capabilities recommended in the paper are:

  • Test and Trace Infrastructure: Capacity for widespread diagnostic testing and data sharing to enable rapid case-based interventions
  • Syndromic Surveillance: Integration of test and trace into an enhanced national syndromic surveillance system
  • Serologic Testing: Capacity to conduct widespread serologic testing to identify reliable markers of immunity
  • Rapid Response: Capacity for isolation, contact tracing, and quarantine

The authors recommend this surveillance expansion effort be coordinated by the Centers for Disease Control and Prevention (CDC) in collaboration with state and local public health authorities. As the federal government issued guidelines on reopening the economy (see Featured Story) and states begin to ease stay-at-home orders, implementing strategies from top public health leaders to effectively test, track exposure, contain transmission, and treat patients will be critical in the ongoing effort against COVID-19.


Alternative Payment Models Require Payment. And in the COVID Era, That’s Unpredictable


The National Association of Accountable Care Organizations (NAACOS) recently released an open letter to the Centers for Medicare & Medicaid Services (CMS) voicing concerns regarding COVID-19’s impact on the Alternative Payment Model (APM) and the value movement in general. The key challenges facing participating practices include using appropriate metrics to assess practice performance and managing unanticipated financial burdens. Although COVID-19 presents unprecedented challenges to the value-based system, the association believes action by CMS could mitigate the financial impact to APM-participating practices.

In its open letter, NAACOS suggests corrective measures to ensure accurate performance evaluations:

  • Extension of APM application deadlines
  • Implementation of a gradual timeline for the Merit-based Incentive Payment System (MIPS) Value Pathways
  • Adjustment to performance benchmarking metrics, including exempting clinicians from performance and quality-related penalties in the 2020 performance year

In response to COVID-19, NAACOS states that, at a minimum, adjustment must be made to account for financial expenditures, performance scores, patient attribution, and risk adjustment. NAACOS further notes that certain quality scores, such as preventive services rendered, will be heavily impacted by COVID-19.

The association states that failure to implement appropriate policy updates now will impact ACO performance calculations in subsequent years. COVID-19 will impact the healthcare system, but NAACOS hopes the impact will be lessened with adaptable policy.

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COVID-19 Resources


Coronavirus Task Force Resources and Updates

Centers for Disease Control and Prevention (CDC) Information for Healthcare Professionals

Centers for Medicare & Medicaid Services (CMS) Current Emergencies (Coronavirus)

Food and Drug Administration (FDA) COVID-19 Information

Medicaid and Children’s Health Insurance Program (CHIP) Resources

American Medical Association (AMA) Physician’s Guide to COVID-19

National Foundation for Cancer Research (NFCR) Coronavirus Resource Center for Cancer Patients and Caregivers


COVID-19 Bulletin

  • CMS announced expanded coverage for essential diagnostic services amid the COVID-19 public health emergency.
  • CMS increased the Medicare payment for high-production coronavirus lab tests.
  • The National Institutes of Health (NIH) began a study to quantify undetected cases of coronavirus infection.
  • America’s Essential Hospitals, representing safety-net hospitals that primarily rely on Medicaid and disproportionate-share payments, sent a letter to congressional leaders requesting more funding, regulatory changes, and help for the 340B drug discount program.
  • Apple and Google are partnering on COVID-19 contact tracing technology.

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A Tale of 2 Frameworks: Impact of ICER and NICE Updates on Future HTAs and Market Access


The National Institute for Health and Care Excellence (NICE) and the Institute for Clinical and Economic Review (ICER) are recognized health technology assessment (HTA) bodies that independently conduct economic evaluations of healthcare interventions by comparing clinical efficacy and safety, estimating incremental cost-effectiveness of 1 or more interventions relative to a common comparator, and providing determinations regarding the value of a treatment in terms of the cost per quality-adjusted life-year (QALY) gained.

Methodologies utilized by NICE and ICER need to be regularly updated to stay relevant. What implications will these updates have on manufacturers looking to commercialize health technologies in these markets over the next several years, and what is the impact on evidence-generation requirements?

Xcenda value experts examine and compare the current and forthcoming method updates to help shed light on these questions.

If you need assistance with all things ICER or value-related, please contact Linnea Tennant.

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Home on the Grange: Xcenda Looks at Rural Health


Xcenda recently partnered with the National Grange to report on the great challenges for overworked rural physicians as they face limited resources and high patient-to-provider ratios. Even more recently, Xcenda’s rural health expert Daniel Fellenbaum contributed to the National Grange’s A Special Report on Healthcare in Rural America Before, During, and Post the COVID-19 Crisis. The paper also references Xcenda’s Air Medical Services Cost Study Report, reporting that three-quarters of air med flights originate from rural areas.


“The beds and workforce are not there to handle a pandemic. It’s almost like the hospital is there but it’s not conditioned to take care of these folks.”

Daniel Fellenbaum, Xcenda rural healthcare expert, A Special Report on Healthcare in Rural America Before, During, and Post the COVID-19 Crisis


Information Buffet (AKA, Other Stuff That Caught Our Attention)


We kept running into stories we wanted to bring to your attention, so here’s a quick (short) hit list of other news we thought you should know:

  • Merck announced the US launch of ONTRUZANT (trastuzumab-dttb), a biosimilar of HERCEPTIN (trastuzumab). ONTRUZANT is the fifth trastuzumab biosimilar now available and the 17th biosimilar on the market.

Determine Your Value Story With Greater Precision and Perspectives With Xcenda’s Value Identification Process 2.0


Gathering diverse perspectives to pinpoint and vet your product’s value messages is, well, invaluable. But assembling HEOR, brand, patient support, legal, and field personnel in 1 room for a workshop can be daunting, especially in this current safer-at-home or shelter-in-place environment.
With Xcenda’s Value Identification Process (VIP) 2.0, critical viewpoints of all your key stakeholders can now be captured through our interactive, real-time format that makes identifying and ranking your most salient go-to-market messages easier than ever before. Learn more >


“In advance of a pandemic, anything you say sounds alarmist. After a pandemic starts, everything you’ve done is inadequate.”

 – Former Secretary of Health and Human Services Michael Leavitt, commenting on his experience addressing the avian flu in 2005

Source: “Inside America’s 2-Decade Failure to Prepare for Coronavirus,” Politico Magazine, April 11


(Picture Dr. Evil saying it)

$1.8 Trillion


The Congressional Budget Office (CBO) and the staff of the Joint Committee on Taxation (JCT) estimated the budgetary effects of the Coronavirus Aid, Relief, and Economic Security Act (the CARES Act) (HR 748). On a preliminary basis, the CBO and JCT estimate that the act will increase federal deficits by about $1.8 trillion over the 2020–2030 period.

The estimate includes:

  • A $988 billion increase in mandatory outlays
  • A $446 billion decrease in revenues
  • A $326 billion increase in discretionary outlays, stemming from emergency supplemental appropriations

Although the act provides financial assistance totaling more than $2 trillion, the projected cost is less than that because some of that assistance is in the form of loan guarantees, which are not estimated to have a net effect on the budget.

Source: “H.R. 748, CARES Act, Public Law 116-136,” CBO, April 16


Count on Health Policy Weekly for an at-a-glance view of legislative and regulatory developments and news that impacts the healthcare industry.


Jennifer Snow
Vice President,
Reimbursement and
Policy Insights,

Scott Shields
Associate Director,
Health Policy



Doug Cook
President | Commercialization Services & Animal Health

Kristine Flemister, PharmD
President | Xcenda

Tommy Bramley, PhD, RPh
President | Lash Group

Stacie Heller
Vice President | Government Policy | AmerisourceBergen Corporation

Rita Norton
Senior Vice President | Government and Public Policy | AmerisourceBergen Corporation

Ana Stojanovska
Vice President | Commercial Consulting | Xcenda


Reeya Patel | Scott Shields | Ryan Sullivan


Laurie Kozbelt | Ellen Olson


Apr. 17, 2020


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