Lessons From Ebola: Boosting National Preparedness for Pandemics

NEW ORLEANS—At the first day of the International Disaster Conference and Expo (IDCE), one of the primary topics of areas of concern for attendees and speakers alike was the risk of pandemics and infectious diseases. In a plenary session titled “Contagious Epidemic Responses: Lessons Learned,” Dr. Clinton Lacy, director of the Institute for Emergency Preparedness and Homeland Security at Rutgers, focused on the recent and ongoing Ebola outbreak.

While only four people in the United States were diagnosed with Ebola, three of whom survived what was previously considered a death sentence, government and health officials cannot afford to ignore the crisis, Lacy warned.

“This outbreak is not just a cautionary tale, it is a warning,” Lacy said. “Ebola is our public health wakeup call.”

A slow start by the Centers for Disease Control, inadequate protective gear in healthcare facilities, and inadequate planning for screening quarantine and waste management were some of the key failings in national preparedness for Ebola. And all were clearly preventable. A significant amount has been done to improve preparedness, Lacy said, but there is still a significant amount yet to do as well.

Among the issues to be addressed, Lacy pointed to:

Lacy Pandemic Preparedness

Some of that improvement must come from the top. Funding has been cut for healthcare facilities nationwide, as has money for the Hospital Preparedness Program, operated by the CDC. Other solutions can be carried out at both a national level and among individual healthcare facilities, including:

Lacy Solutions

Ultimately, Lacy said, the concern is not about Ebola—it’s about the new and emerging diseases that could prove even more catastrophic. Dozens of diseases have been discovered emerging in nature, and we have no previous contact with them, meaning we have no immunity. Further, the risks of reemerging illnesses and synthetic bio threats that any graduate student or doctor of biology could make in a lab pose a significant danger that must be prepared for now.

“Public health infrastructure is like fire departments—you can’t just fund them when there are fires,” Lacy said.

Lloyd’s Underwrites Ebola Indemnity Coverage

A new class of insurance is now being offered to address the occupational hazards faced by healthcare workers and first responders who are in jeopardy of contracting blood-borne pathogens such as Ebola, HIV, Hepatitis B and Hepatitis C.

Underwritten by Lloyd’s of London and distributed by Specialty Insurance Advisors, Essential Professional Insurance Coverage (EPIC) is the first such indemnity coverage available to individuals, including administrators who check in patients, doctors and nurses treating patients and patrolmen and women responding to 911 calls. The coverage goes beyond workers compensation and disability insurance to protect these individuals, EPIC said.

According to the Occupational Safety and Hazards Association (OSHA), up to 800,000 needle sticks occur each year, of which 16,000 are likely to be contaminated with HIV. The risk of acquiring Hepatitis B or C from a needle stick is even higher than HIV.

EPIC President Richard Kosinski said in an online interview with Fox Business, “We provide the ability for a health care worker or law enforcement professional to buy very inexpensive coverage in the event they get infected with Ebola, HIV or Hepatitis B or C. For a nominal amount of $269 per year they can get $200,000 of coverage if the worst case happens and they get infected with Ebola or some other type of blood pathogen.”

While the coverage has been available for more than a year, primarily through unions, to large health care hospitals and other institutions, “We have just announced the ability for an individual to buy a policy,” Kosinski said. Centinela Hospital Medical Center in Inglewood, California was one of the first hospitals in the United States to offer EPIC to its healthcare workers, and the first to add Ebola infection coverage, according to EPIC.

The plan provides a safety net that can help defray some of the costs, Kosinski explained, adding that otherwise, “No one is going to pay the cost for the average health care worker to be flown by a private jet to a specific CDC facility to get Ebola care.”

How is it possible to write this coverage? “Because this is Lloyd’s of London, which has a 500 year history of writing specialty risks,” Kosinski said. “We understand the risk, how to price it correctly and how the claims will be paid out.”

CVS Announces Plan to Stop Selling Cigarettes

CVS to Stop Selling Cigarettes

On Feb. 5, CVS Caremark Chief Executive Larry Merlo said, “We’ve come to the decision that cigarettes have no place in an environment where healthcare is being delivered.” The company, he announced, will remove all cigarette and tobacco products from its 7,600 pharmacies nationwide by Oct. 1. The move is expensive, with up to $2 billion in projected lost sales. But CVS is betting on the long-run gains from doubling down on brand reputation and helping customers to live—and shop—far longer.

President Barack Obama personally took the time out to praise CVS, saying in a statement that the move will help wider efforts to “reduce tobacco-related deaths, cancer, and heart disease, as well as bring down healthcare costs.”

“CVS is now one of a small group of companies that have realized that their reputation is the most valuable asset they have and that building a stronger reputation by avoiding risks to that reputation can create a significant competitive advantage,” said Paul Argenti, professor of corporate communications at Dartmouth’s Tuck School of Business, in a column for the Harvard Business Review. “From the White House to the American Lung Association, CVS has received kudos for what seems to be a focus on shared value with society rather than the reckless pursuit of revenue at any cost.”

While CVS stock initially dropped the day of the announcement, shares have since risen 2.3%, success further bolstered when the country’s largest drugstore chain reported 2013 revenue of $126.8 billion—up 3% on healthy growth for drug plans and in-store pharmacies offset by weak growth in front-of-store sales.

“Its profit comes increasingly from health plans, which aren’t keen on carcinogens,” Jack Hough wrote in Barron’s. “Consider: CVS’ tobacco decision is expected to subtract six to nine cents from its yearly earnings per share. But a prescription deal with the Federal Employee Health Program, which expires at year’s end, is worth 16 cents to 21 cents a share, estimates investment bank Mizuho Securities. For CVS, a good chance at renewal just became better, and there’s plenty more business to be won.”

In Forbes’ CMO Shift blog, brand consultant Scott Davis wrote:

The $2 billion decision to boldly dump tobacco sends CVS’ boldest signal of commitment to the brand and to where it sees its future growth; it’s an unprecedented move and one that is wickedly smart. CVS is putting its money where its brand is, betting that this first mover advantage will pay off. I say “first mover” because no one truly owns health and wellness. Sixteen thousand health and wellness apps were downloaded last year. Over $1.4 billion was spent by people trying to learn more about the topic. The overall category is heading to $1 trillion in the next 3-5 years and the timing is right for someone to step in and lead the dialog and become the Amazon of health and wellness. Why not CVS?

Indeed, CVS has spent considerable time and money extending the legacy of pharmacists as community health experts by adding over 800 MinuteClinic walk-in facilities. In doing so, the company has become the largest U.S. pharmacy healthcare provider.

The chain’s competitors are also branching into anti-smoking efforts as they expand their role in the wellness market. Walgreens recently unveiled a partnership with GlaxoSmithKline Consumer Healthcare to launch a free, Internet-based smoking cessation program called Sponsorship to Quit.

Overall U.S. cigarette sales fell 31.3% from 2003 to 2013, according to Euromonitor International. Many health officials hope that the move will help continue to decrease the number of smokers and smoking-related deaths in the U.S. “I think CVS recognized that it was just paradoxical to be both a seller of deadly products and a healthcare provider,” U.S. Centers for Disease Control and Prevention Director Thomas Frieden told Reuters.

Working to build and maintain a strong reputation also boosts the bottom line. Studies from Argenti and a range of other researchers suggest that companies with a strong reputation enjoy price advantages, being able to negotiate lower prices with suppliers and higher charges to customers. They can also recruit better employees, have more stable revenues and, “when something bad happens, they are given the benefit of the doubt by their stakeholders.” Further, “highly reputed companies are more stable, which means they have higher market valuation and stock price over the long term and greater loyalty of their investors, which leads to less volatility,” according to Argenti.

Convenience stores account for 75% of cigarette sales nationwide, so the tobacco industry has yet to express concern about prospective losses from drugstore sales. But Dr. Richard Wender of the American Cancer Society said CVS’s move would have an effect. “Every time we make it more difficult to purchase a pack of cigarettes, someone quits,” he told Reuters. So far, CVS is betting on that for patients’ health, and its own.

The 10 Most and Least Expensive Health Insurance Markets in the U.S.

Health Insurance

Under Obamacare’s new insurance marketplaces, people in Minnesota, northwestern Pennsylvania, and Tucson, Ariz., are getting the best bargains for health care coverage. Premiums in these areas are half the price of policies in the most expensive regions, based on the lowest cost of a “silver” plan – the mid-range plan most consumers are choosing.

“The cheapest cost regions tend to have robust competition between hospitals and doctors, allowing insurers to wrangle lower rates,” according to a report from Kaiser Health News and NPR. “Many doctors work on salary in these regions rather than being paid by procedure, weakening the financial incentive to perform more procedures.”

The 10 regions with the lowest premiums are:

$154: Minneapolis-St. Paul – Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, Sherburne and Washington counties.

$164: Pittsburgh and Northwestern Pennsylvania – Allegheny, Armstrong, Beaver, Butler, Crawford, Erie, Fayette, Greene, Indiana, Lawrence, McKean, Mercer, Warren, Washington and Westmoreland counties.

$166: Middle Minnesota – Benton, Stearns and Wright counties.

$167: Tucson, Ariz. – Pima County.

$171: Northwestern Minnesota – Clearwater, Kittson, Mahnomen, Marshall, Norman, Pennington, Polk and Red Lake counties.

$173: Salt Lake City – Davis and Salt Lake counties.

$176: Hawaii

$180: Knoxville, Tenn. – Anderson, Blount, Campbell, Claiborne, Cocke, Grainger, Hamblen, Jefferson, Knox, Loudon, Monroe, Morgan, Roane, Scott, Sevier & Union.

$180: Western and North Central Minnesota – Aitkin, Becker, Beltrami, Big Stone, Cass, Chippewa, Clay, Crow Wing, Douglas, Grant, Hubbard, Isanti, Kanabec, Kandiyohi, Lac qui Parle, Lyon, McLeod, Meeker, Mille Lacs, Morrison, Otter Tail, Pine, Pope, Renville, Roseau, Sibley, Stevens, Swift, Todd, Traverse, Wadena Wilkin and Yellow Medicine counties. In Chisago County, the lowest premium is $162.

$181: Chattanooga, Tenn. – Bledsoe, Bradley, Franklin, Grundy, Hamilton, Marion, McMinn, Meigs, Polk, Rhea and Sequatchie counties.


The 10 most expensive regions are:

$483: Colorado Mountain Resort Region – Eagle, Garfield and Pitkin counties, home of Aspen and Vail ski resorts. Summit County premiums are $462.

$461: Southwest Georgia – Baker, Calhoun, Clay, Crisp, Dougherty, Lee, Mitchell, Randolph, Schley, Sumter, Terrell and Worth counties.

$456: Rural Nevada – Esmeralda, Eureka, Humboldt, Lander, Lincoln, Elko, Mineral, Pershing, White Pine and Churchill counties.

$445: Far western Wisconsin – Pierce, Polk and St. Croix counties, across the border from St. Paul, Minn.

$423: Southern Georgia – A swath of counties adjacent to the even more expensive region. Ben Hill, Berrien, Brooks, Clinch, Colquitt, Cook, Decatur, Early, Echols, Grady, Irwin, Lanier, Lowndes, Miller, Seminole, Thomas, Tift and Turner counties.

$405: Most of Wyoming – All counties except Natrona and Laramie.

$399: Southeast Mississippi – George, Harrison, Jackson & Stone counties. In Hancock County, the lowest price plan is $447.

$395: Vermont*

$383: Fairfield, Conn. – The southwestern-most county, which includes many affluent commuter towns for New York City.

$381: Alaska.

*Unlike other states, Vermont does not let insurers charge more to older people and less to younger ones. Its ranking therefore will differ depending on the ages of the consumers.