Will Vertical Integration Be A Focus?
An interesting Becker’s Payer article indicating vertical integration will become a strong focus. Recently, late-night TV host John Oliver tore into the inner workings of huge vertically integrated company UnitedHealth Group. The article notes that UnitedHealth is now the fourth-largest company in the world by revenue, taking in $447 billion last year, up 11.8% year over year. It reported ten significant subsidiaries down from a reported 2,700 a short time ago. Vertical integration is not unique to United.
While health plan execs have defended vertical integration it is increasingly being looked at by Congress and federal agencies. Sens. Elizabeth Warren, D-Mass., and Josh Hawley, R-Mo., introduced the Break Up Big Medicine Act, which would prevent companies from simultaneously owning a health insurer or pharmacy benefit manager and a provider or management services organization.
#verticalintegration #healthplans #unitedhealthcare
Oz Says AI Will Cost More In Short Run
Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Mehmet told an audience of healthcare experts that AI will cost more than it saves in the short term. A good example Oz raises is the impact of AI on medical billing. It does reduce time and effort but coding intensity could be increasing. Providers argue it has boosted accuracy, while health plans see it as abusive. A Blue Cross Blue Shield Association study found that the increase of billing has added about $1 billion in costs between 2023 and 2025. Oz argues AI will save costs and lives over time.
#ai #healthcare #coding #costs
TrumpRx Price Assessment
Healthcare policy group has assessed TrumpRx prices for brand-name drugs against other wealthy countries. It finds they are as likely to be higher as lower compared to those countries. It looked at 32 brand drugs and tracked the TrumpRx price against those in Australia, Austria, Belgium, Canada, France, Germany, Japan, the Netherlands, Sweden, Switzerland, and the United Kingdom.
For 17 of the 32 drugs, the TrumpRx price is lower. Eight drugs have a price that is $100 less than the average in other countries. For the other 15 drugs, the TrumpRx price is higher than the average price in comparable countries. This includes 13 drugs for which the TrumpRx price is higher than prices available in any of the other countries.
The findings are not shocking. Trump did not promise TrumpRx would be lower than other nations, just that there were significant concessions. I believe Trump has made huge progress on drug pricing when you look at all his initiatives.
#drugpricing #trump #trumprx #irp #mfn
https://www.kff.org/health-costs/how-trumprx-brand-name-drug-prices-compare-to-other-countries/
— Marc S. Ryan
