Updates from your ACE team
We made it. It's officially fall!

We’ve seen a lot about the pandemic and the Centers for Disease Control and Prevention’s (CDC) numbers that were taken out of context and turned into fake news. The CDC’s website featured two different graphs that were both related to COVID-19 deaths. One chart featured deaths by COVID-19 and underlying health conditions while the other chart only featured the deaths by COVID-19. Amateur medical experts shared the chart that only featured COVID-19 deaths and claimed the CDC’s COVID-19 numbers were wrong. We (those working in the medical field) know and understand what happened and what the CDC was trying to showcase and why those numbers are much lower; most Americans have chronic illnesses or underlying health conditions. Those with chronic illnesses are at higher risk for COVID-19 and those cases are more severe because COVID-19 triggers underlying health conditions to react as it attacks the lungs.

Last month, we talked about expanding practices through dental specialties and introduced some very newsworthy pharmacy topics, which included joining the 340B Program on a weekly basis through the pandemic and manufacturers current challenge on 340B contract pharmacies. We have a few updates for you this month:
  • How offering dental services helps patients manage their chronic illnesses
  • Progress on the current challenge manufacturers’ have brought to covered entities and Health Resources and Services Administration (HRSA) 2010 guidance that allows covered entities to utilize the 340B Program through contract pharmacies
  • COVID-19's impact on specialty pharmacies and patient communication
  • The president’s executive order that is intended to target Federally Qualified Health Centers (FQHC)
  • The Department of Health and Human Services (HHS), through HRSA, released $25 million in grants to fight the opioid crisis.

Here's your friendly reminder to get and encourage your patient base to get their flu vaccine this flu season. Centers of Medicare and Medicaid Services (CMS) has campaign materials for your utilization.
Dental health: the perceived most important
Last month we discussed how adding a dental provider and dental specialties can help you increase your financial independence in addition to better serving your patient base. The National Association of Community Health Centers’ (NACHC) latest white paper, Oral Health Value-Based Care: The Federally Qualified Health Center (FQHC) Story, comes from a partnership with DentaQuest and was released earlier this month. The paper discusses how Americans perceive dental services and how they can support and improve a patient’s chronic disease management. Since the pandemic, FQHCs have leveraged telehealth to reach and provide services to their patients. NACHC believes that through FQHC's utilization of telehealth and once the permanent changes for telehealth are made, dental services for patients will only improve. During the pandemic, “teledentistry models can help dental clinicians identify urgent cases and provide [preventative] care, [reducing] the burden of non-essential visits while preserving needed personal protective equipment (PPE).”

Some interesting stats from the white paper:
  • Approximately half of patients rank oral health as their top concern - over heart, eye, skin, digestive and mental health.
  • 3 in 4 Americans have experienced barriers to accessing dental care. Patients most commonly cite the high costs of dental care and a lack of dental insurance coverage as barriers to accessing dental care.
  • For Americans in poverty, receiving dental care is more challenging – 93 percent of individuals living in poverty have unmet dental needs. When they can access dental care, low-income Americans spend 10 times more as a proportion of their annual family income on dental services.
  • Nationally, 23 percent of FQHC patients are medically uninsured. It is likely that the uninsured rate for patients seeking dental services at FQHCs is even higher given the limited dental coverage for adults through Medicaid.

As models and payers continue to move toward value-based care, “FQHCs and their dental programs could benefit from intentional efforts to integrate value-based care as they restore oral health services following the pandemic.” This may also encourage other FQHCs that do not currently provide dental services to offer them because dental services can help prevent obesity and manage chronic diseases. “Despite having a patient population with higher disease burdens and a lower ability to pay for care, FQHCs perform better on ambulatory care quality measures compared to physicians in private practice and are narrowing health disparities. Dental services help FQHCs reduce the burden of chronic diseases.”

The key findings from the paper are:
  • 13 percent of Medicaid dental visits to FQHCs were acute or emergency in nature
  • FQHCs are conducting caries risk assessments during Medicaid encounters more regularly than non-FQHC dental programs
  • 12 percent of FQHC dental patients have a chronic condition
  • For every 1 percent increase in patients receiving dental services, the proportion of diabetes patients with uncontrolled diabetes declined by 0.2 percent.
  • FQHCs generally have a higher degree of interoperability, which supports the ability to collect both outcomes and payment information crucial to a value-based model, but inconsistent metrics still present a challenge.

Manufacturers continue to challenge HRSA's 2010 340B contract pharmacy guidance
Last newsletter discussed 340B HRSA audits and that manufacturers are challenging HRSA's 2010 guidance on 340B prescriptions being filled through contract pharmacies and what that could mean for covered entities, such as FQHCs.

Since that newsletter, new developments have surfaced. Hospitals are now urging HHS to step in on the 340B fight with drug manufacturers. HRSA is "considering whether manufacturer policies violate the 340B statue and whether sanctions such as civil monetary policies may apply." Since the increase use of contracted pharmacies dispensing 340B drugs on behalf of covered entities, manufacturers are concerned that their drugs are being discounted twice. In a recent letter from the American Hospital Association (AHA), the AHA outlined that this stance may limit drugs dispensed to vulnerable patients in rural and underserved areas. HRSA is encouraging manufacturers to continue to work with contract pharmacies to ensure patients in underserved and rural areas can continue to receive their medications.

"On July 24, 2020, President Trump issued four Executive Orders intended to address drug pricing. One of [the orders] would require FQHCs, [the only covered entity the Order applies to], to pass the 340B discounts they receive on insulin and injectable epinephrine to their low-income patients. [The order relies on] HRSA’s grant-making authority under Section 330 of the federal Public Health Service Act.” 

There are several letters circulating Congress that concern this issue. NACHC encourages covered entities and others to connect with their Federal Affairs team at or your Primary Care Association (PCA).

We will keep you updated as this issue continues to unfold.
COVID-19's impact on specialty pharmacy and the 340B Program
In a recent video from Drug Channels Institute’s, The State of Specialty Pharmacy 2020: Market Data and Trends, CEO Adam Fein reviews the role of specialty drugs in the pharmacy industry, Drug Channels Institute’s largest data on specialty pharmacy accreditation and commentary on PBM’s role in the specialty industry.

Specialty drugs are the fastest growing in the pharmaceutical market. Specialty pharmacy drugs have grown from 29 percent in 2015 to 36 percent of the market in 2019. The number of healthcare provider specialty pharmacies has and continues to grow. Of all the different types of specialty pharmacies (independent, healthcare provider, retail/LTC chain, PBM/health plan and wholesaler); 45 percent are independently owned, and 32 percent are through healthcare providers, which includes hospital systems, health care systems, private practices, etc. The number of specialty pharmacies owned through retail/LTC chains is 11 percent, PBM/health plans is 11 percent and wholesalers is at 1 percent. Though the retail/LTC chains, PBM/health plans and wholesalers are at a lower percentage, they have the most control because they can choose which pharmacies they dispense to and why.

Covered entities, such as hospitals and FQHCs, may partner with specialty pharmacies to dispense 340B drugs to their patients. Fein estimates that 15 to 20 percent of specialty medications are 340B drugs and are run through specialty pharmacies today. He believes that COVID-19’s impact on specialty pharmacies will:
  • Enhance the overall position of specialty pharmacy
  • Payer mix shift away from employer-sponsored insurance
  • Create business and profit risks for PBM-owned pharmacies.
  • Generate new opportunities for smaller pharmacies and industry de-consolidation

As unemployment increases, because Americans lost their jobs and therefore insurance, the participation in Medicaid has and may continue to increase. While 340B specialty pharmacies and covered entities must determine which of the three (contracted specialty pharmacy, covered entity or state) is going to carve the Medicaid discount in or out, the influx of Medicaid participation may affect the 340B drug pricing. This is because some states decide if the Medicaid discount is carved in or out from the covered entities operating within its state lines and governance.
COVID-19's impact on patient communication
COVID-19 has changed the healthcare landscape. Telehealth, for example, has made several advances to benefit the patient and healthcare employees, comply with stay at home government orders and reduce the risk of healthcare professionals and patients in healthcare settings passing and contracting COVID-19. Since the pandemic started and normal has changed, “SR Health by Solutionreach commissioned a two-part patient research study to better understand if COVID-19 impacted patients’ healthcare communication preferences. [The survey reviewed] the patient journey [from] scheduling, patient care, financial [to] patient outreach and where opportunities for automation may exist within [their] preferences [within these pieces of patient care]. Only the second survey, conducted during the COVID-19 pandemic, collected data regarding patient preferences and satisfaction with telehealth. [According to the survey], COVID-19 [hasn’t] significantly [changed] the perceived desirability of automation in patient communication. The pandemic [has changed] how patients prefer to communicate. It appears that [patients are] moving away from live telephone calls and toward more convenient, digital communication,” such as text messaging. Text messaging allows patients to get their questions answered quickly without being seen. This allows providers to see the patients that need to be seen.

  • The level of patient satisfaction with healthcare communication during COVID-19 decreased by 7 percent
  • During COVID-19, the desirability of live phone calls dropped 14 percent

Click the link for the survey results to see where you can implement the changes that patients are recommending and would prefer. 
From the Hill and other useful info
The president signed an executive order on August 3, 2020 that addresses rural healthcare. The order requests HHS to produce a report on on existing and upcoming efforts to improve rural healthcare. HHS released the Rural Action Plan on September 3, 2020. The action plan provides a roadmap for HHS to strengthen departmental coordination to better serve the millions of Americans who live in rural communities.


HHS and HRSA are working together to fight the opioid crisis. On September 14, 2020, “HHS, through HRSA, awarded approximately $25 million through the Rural Communities Opioid Response Program (RCORP). RCORP is [a] HRSA initiative [that works] to reduce the morbidity and mortality of substance use disorder (SUD) and opioid use disorder (OUD) in high-risk rural communities. [This effort is building on] HRSA’s RCORP awards made [in] August [2020]. [The goal of this] funding, [totaling about $115 million in 2020 alone, is to assist] rural communities address barriers to care and [the] additional strains that COVID-19 has placed on both rural individuals with SUD and on rural organizations [that are] providing prevention, treatment, and recovery services.”


CMS has been working around the clock to ensure its beneficiaries get the flu vaccine. The overall goal of the campaign is to keep hospital beds open for those that contract COVID-19 and need one. CMS urges institutions to utilize their campaign materials.

The flu vaccine does not prevent its recipients from getting COVID-19, but will reduce their chances of getting the flu.