Monkeypox and employers (HBR article), influenza, full body scans and Hep C

August 19, 2022

In today’s note: employer considerations for the fall influenza season, full body screening MRIs, undertreatment of hepatitis C and a study showing no significant benefit from app-based remote hypertension monitoring at home.  

1.     Our article “What Employers Need to Know About Monkeypox” was published yesterday in Harvard Business Review (HBR) online.

Thanks to Patricia Toro, MD MPH Siupo Becker, MD and Meg Alexander, MPH for coauthoring! Feel free to share this article (HBR allows a few free downloads for nonsubscribers each month)

Our main points:

• The risk of transmission in most work settings is small.

• Employers should be prepared for exposures in the workplace and have a policy in place.

• State and local health departments will lead prevention and treatment efforts.

• Monkeypox can cause workforce disruption and employee income loss.

• Avoid stigmatizing people, and increase employee confidence through prompt, accurate and sensitive communication.

• Our knowledge of monkeypox will rapidly advance (so recommendations will change).

2.     This influenza season could be bad, and vaccines can help

The US has had relatively few cases of influenza over the last few years, likely due to a combination of decreased travel and in-person activities and increased mask use. Since immunity to influenza wanes rapidly and influenza strains differ from year to year, many experts fear that this year we could see a higher rate of influenza illness.  Mortality rates are increased in those who get influenza and COVID-19 simultaneously.

Influenza pandemics generally start in Asia in our summer, and travel east to North America by fall. This year influenza cases increased earlier than usual in Australia, which could portend increased risk in North America. In the Northern hemisphere, influenza cases tend to start in October and peak in late January/early February.  Influenza is a major cause of time away from work during most years.

Implications for employers:

-        Encouraging flu shots is more important than ever.  These vaccinations are covered by employer sponsored health insurance with no cost share at doctors’ offices and pharmacies.

-        Many employers are reestablishing their on-site flu shot clinics as more employees return to the workplace

-        Covering influenza vaccinations through both the pharmacy benefit manager and the health insurance carrier increases access and makes it more likely that employees will be vaccinated.

-        Check out the newly updated flu shot deck for more information about how to support your clients during this upcoming flu season.

3.     No proof of benefit for full body “preventive” MRI scans

My twitter feed has been littered with promoted tweets about full body MRI scans for early detection of cancer or other abnormalities. These scans can certainly occasionally find an undetected cancer, but they have an exceptionally high rate of false positives.  People can suffer real harm if they need an operation to address a finding that would have posed no danger to them. There is no study showing survival benefit, improved health or decreased cost in a population that receives full body MRI scanning. The cost of the MRI and follow up tests will increase total cost of care for a population, and this will not be offset by “future savings.”

Implications for employers:

-        Cover and promote evidence-based screening tests, like mammography, cervical cancer screening, and colonoscopy and other colorectal cancer screening tests.

-        Limit MRI coverage to diagnostic tests that are medically necessary. Don’t offer coverage for ‘screening’ whole body MRIs.

4.     Better quality masks associated with lower rates of COVID-19 infection

Researchers in Switzerland studied the rate of COVID-19 infections in health care workers exposed to patients with COVID-19 for a year from September of 2020.  All workers wore at least surgical masks, and about 22% always wore respirators (the European equivalent of N95 masks). Those who always wore the better quality well-fitted masks were about 40% less likely to get infected.

Implications for employers:

-        This adds to the evidence that high quality masks provide the best protection available against respiratory spread of COVID-19.

-        Although mask mandates outside of health care have dwindled, individuals can increase their protection against COVID-19 or other respiratory diseases, including influenza, by using N95 or KN95 masks.

-        Employers that provide masks to employees should consider furnishing KN95 or N95 masks rather than surgical masks.

5.     Undertreatment of Hepatitis C in private health insurance plans

Hepatitis C is a terrible disease. It causes liver failure and liver cancer. Fourteen thousand a year die of this disease in the US. Hepatitis C is the number one reason for liver transplants in the US, Europe and Japan. Hepatitis C is often associated with intravenous drug use, and many with hepatitis C are insured by Medicaid or incarcerated. Still, about 20% of those with positive tests were covered by private insurance.

Hepatitis C is also curable, with drugs that were very expensive when they were first introduced, but are now available as generics. Treatment per case is now often under $30,000, substantially less than the cost of treating advanced liver disease. But not enough people are treated! 

Researchers at the Centers for Disease Control and Prevention reviewed a large database that included almost 6500 people who had a positive Hepatitis C test with private insurance, and found that only 35% filled a prescription for antiviral drugs within a year of diagnosis.

Implications for employers:

-        The US Preventive Services Task Force recommends one-time screening of all adults ages 18 to 79 for Hepatitis C.  This should be covered without out-of-pocket cost.

-        Employers can ask their health plans what they are doing to be sure that providers are screening members and those who have positive hepatitis C tests get appropriate therapy

-        This would be an appropriate future standardized quality measure, which would attract additional provider attention.

6.     Smartphone app to guide blood pressure control didn’t lower blood pressure more than a device alone

Researchers randomized 2101 people with newly diagnosed poorly controlled hypertension to receive either a “smart” home blood pressure (BP) monitor with associated smartphone app, or a home BP monitor with no app. There were no other interventions for either group, and no BP readings were reported to treating physicians. The good news is that each group showed a decrease in systolic blood pressure of over 10 mm Hg. Slightly more of those with the app (32% vs. 29%) achieved the target of BP 140/<90.  Participants reported they were satisfied with either device.

Implications for employers:

-        Home blood pressure monitoring can help improve blood pressure control and allow patients to assess what raises or lowers their blood pressure outside of a physician’s office.

-        This is an evaluation of a single mobile app which is marketed by the manufacturer of the smartphone, not an evaluation of standalone programs currently marketed to employers

-        Employers should push digital vendors for high quality evaluation studies. These won’t always show positive results, but they will help employers purchase more valuable digital health services

7.Brief COVID-19 Update.

Formal reported US cases are down almost 20% from 2 weeks ago, though these represent only a small portion of total cases and hospitalizations and intensive care stays are down slightly. Laboratory test positivity rate remains high(16%), and 93% of counties have a high transmission rate. The Biden Administration is likely to extend the pandemic health emergency until January, 2023, which delays Medicaid disenrollment for as many as 14 million people.