First Complete Sequence of a Human Genome
National Institutes of Health
The Human Genome Project, completed in 2003, covered about 92% of the total human genome sequence. The technologies to decipher the gaps that remained didn’t exist at the time. But scientists knew that the last 8% likely contained information important for fundamental biological processes.
Since then, researchers have developed better laboratory tools, computational methods, and strategic approaches. The final, complete human genome sequence was described in a set of six papers in the April 1, 2022, issue of Science. Companion papers were also published in several other journals.
The work was done by the Telomere to Telomere (T2T) consortium. T2T is led by researchers at NIH’s National Human Genome Research Institute (NHGRI), the University of California, Santa Cruz, and the University of Washington, Seattle. NHGRI was the primary funder.
“Short-read” technologies were originally used to sequence the human genome. These provide several hundred bases of DNA sequence at a time, which are then stitched together by computers. Such methods still leave some gaps in genome sequences.
Over the past decade, two new DNA sequencing technologies emerged that can read longer sequences without compromising accuracy. The PacBio HiFi DNA sequencing method can read about 20,000 letters with nearly perfect accuracy. The Oxford Nanopore DNA sequencing method can read even more—up to 1 million DNA letters at a time—with modest accuracy. Both were used to generate the complete human genome sequence.
In total, the new project added nearly 200 million letters of the genetic code. This last 8% of the genome includes numerous genes as well as repetitive DNA sequences, which may influence how cells function. Most of the newly added sequences were in the centromeres, the dense middle sections of chromosomes, and near the repetitive ends of each chromosome.
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A Staffing Crisis is Causing a Months Long Wait for Medicaid, and it Could Get Worse
Korra Elliott has tried to avoid seeing a doctor while waiting to get on Medicaid. She worries she can't afford more bills without any insurance coverage. But in early March — five months, she said, after applying and with still no decision about her application — a suspected case of the flu sent her blood pressure soaring and landed her in the emergency room.
The 28-year-old mother of four from Salem, Mo., is among the tens of thousands of uninsured Missourians stuck waiting as the state slogs through a flood of applications for the state-federal health insurance program. Missouri expanded the program last year after a lengthy legal and political battle, and it now covers adults who earn up to 138% of the federal poverty level — about $18,800 annually for an individual
Missouri had nearly 72,000 pending Medicaid applications at the end of February and was averaging 119 days to process one, more than twice the maximum turnaround time of 45 days allowed by federal rules. Adding people to Medicaid is labor intensive, and the jobs require training and expertise. The program covers many populations — children, people with disabilities, seniors, adults who are pregnant or have children, and some without children. Different rules dictate who qualifies.
Missouri simply doesn't have the workers to keep up. Last fiscal year, 20% of its employees who handled Medicaid applications left their jobs, said Heather Dolce, a spokesperson for the Missouri Department of Social Services. And the average number of job applications received for each opening in the department's Family Support Division — which oversees enrollment — dropped from 47 in March of 2021 to 10 in February of 2022.
Just about every industry is struggling to find workers now, but staffing shortages in state Medicaid agencies around the country come at a challenging time. States will soon need to review the eligibility of tens of millions of people enrolled in the program nationwide — a Herculean effort that will kick off once President Joe Biden's administration lets the covid-19 public health emergency declaration expire. If Missouri's lengthy application backlogs are any indication, the nation is on course for a mass-scale disruption in people's benefits — even for those who still qualify for the insurance.
"If you don't have people actually processing the cases and answering the phone, it doesn't matter what policies you have in place," said Jennifer Wagner, director of Medicaid eligibility and enrollment for the Center on Budget and Policy Priorities, a left-leaning think tank in Washington, D.C.
Federal officials have said they will give states 60 days notice before ending the public health emergency, so it's unlikely to expire before summer. Once it does, enrollees won't be kicked off immediately: States can take up to 14 months to complete renewals, although budget pressures may push many to move faster. A bump in federal Medicaid funds to states, provided by Congress through covid relief legislation in 2020, will end shortly after the emergency's expiration.
Ultimately, workers are needed to answer questions, process information confirming that someone's Medicaid enrollment should be renewed, or see whether the person qualifies for a different health coverage program — all before the benefits lapse and they become uninsured.
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Home Health Value Based Purchasing Updates
The CMS HHVBP TA Team hosted a live learning event: HHVBP Model Expansion 101 in February, which presented information such as participation criteria, cohort assignment, quality measures, payment adjustment methodology, and performance feedback reports. The webinar concluded with a live Q&A session.
A recording, slide deck, and transcript of the event are now available. To access other expanded HHVBP Model information and resources, please visit the Expanded HHVBP Model webpage
In addition to the recording and materials for the HHVBP Model Expansion 101 event, the following resources are now available on the Expanded HHVBP Model webpage:
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In Post-Acute Care, Many Prefer to Go Home
Managed Healthcare Executive | By Ron Southwick
More patients are opting for home health services over skilled nursing facilities, and a new analysis expects that trend to continue.
In an analysis of post-acute care trends, Trella Health noted an uptick in home health instructions between 2020 and 2021, while skilled nursing instructions dipped over the same time frame. In fact, the skilled nursing industry’s struggles look to continue for the foreseeable future with no end in sight, the report states.
In its 2021 Post-Acute Trend Industry Report, Trella Health also pointed to the growth of Medicare Advantage enrollment, opportunities for telehealth and projections for expansion of the hospice industry. Trella Health, based in Atlanta, Ga., provides data analytics for post-acute care providers, including home health agencies, skilled nursing facilities and hospice providers.
After a dip due to the emergence of COVID-19, post-acute care instructions rebounded to pre-pandemic levels. Between the fourth quarter of 2020 and the third quarter of 2021, post-acute care instructions rose to 52.2%, up from 51.1% during the previous four quarters.
Here is a rundown of some key findings in the Trella Health report…
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