April 3, 2024

Private Equity’s Role In Healthcare Takes Center Stage At Hearing

Democrat members of the Senate HELP Committee staged a hearing on the role of corporate greed in healthcare.  Of particular concern was the role of private equity firm monies and whether dollars are diverted out from healthcare to corporate margins.  PE firms have big investments in both hospitals and provider groups.

Additional article: https://www.fiercehealthcare.com/regulatory/steward-healthcares-struggles-full-display-clinicians-policy-researchers-tell-senators

#privateequityfirms #healthcare

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Clover Health CEO Defends CMS MA Payments for 2025

In a strong but divergent move from other MA plans, Clover Health CEO Andrew Toy defended the Center for Medicare and Medicaid Services’ final rate for 2025.  Depending on whether you count risk score trends increases, the rate would produce either a 3.7% increase or negative 0.16 decrease.  Plans do not believe the risk score trends should be counted.

Clover may not be seeing the major increases that other plans are. Other plans predict major cuts to benefits in 2025 due to the rate announcement.

#medicareadvantage #cms #rates #clover

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Commonwealth Fund Finds U.S. Healthcare Lags Other Nations In Primary Care Investment

As I say in my book, The Healthcare Labyrinth (available at this site), America needs to make investments in primary care, wellness, and prevention. This is one of three pillars I see in healthcare reform, along with affordable universal access and price changes. A Commonwealth Fund study confirms the massive under-investment America has in primary care, including allocation of dollars to primary care, people who have relationships with primary care providers, after-hours care, home visits, and coordinating with specialists.

Just 43% of U.S. adults have a regular doctor or place of care. The U.S. spent just 4.7% of its healthcare budget on primary care compared to 14% in other developed countries on average.

All systems are struggling, though, due to physician burnout and current and looming shortages.

#primarycare #healthcare #healthcarereform

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Walmart Investing In Primary Care, But At Slower Pace

Walmart Health is investing in primary care clinics but is pulling back a bit. It said it  would add more than 30 health centers across four states in 2024, but has reduced the number to 22 in two states.

(Article may require a subscription.)

#walmart #primarycare #retailmeetshealthcare

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CMS Shoots Down Brand Drug Makers’ Medicare Price Offers; Negotiations To Commence

The Centers for Medicare and Medicaid Services (CMS) told ten brand drug makers Tuesday it was not accepting their counter-offers for Medicare drug price negotiations.  This was expected and kicks off a series of negotiations through August before CMS sets a price in September. The final prices will go into effect in 2026. Little has been revealed about CMS’ initial proposed price and the counter-offers for the ten drugs. 

Additional article: https://www.reuters.com/business/healthcare-pharmaceuticals/us-takes-next-step-medicare-drug-price-negotiations-with-pharma-companies-2024-04-02/

(Some articles may require a subscription.)

#ira #drugpricing #medicare #branddrugmakers

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Mounjaro In Short Supply

Certain dosages of GLP-1 Mounjaro are in short supply from drug maker Eli Lilly due to major demand for diabetes treatment.

#weightlossdrugs #drugpricing #drugshortages

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Biden And Sanders Claim Victory On Reducing Certain Drug Prices

President Biden and Sen. Bernie Sanders gathered in the White House to highlight the lowering of certain drug prices due to initiatives. Federal laws and rules advocated by the Biden administration have led to lowering of certain prices, including insulin. But I give Sanders the most credit here. He has been a bulldog on pressuring Big Pharma companies to lower prices, especially on asthma inhalers.  His pressure has very much made the difference.

#drugpricing #brandrugmakers #ira

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Kaiser Family Foundation Analysis On Unwinding And Impact On Five Big Medicaid Managed Care Insurers

Nice study by the Kaiser Family Foundation (KFF) on drop in Medicaid enrollment due to the return of redeterminations and the impact on enrollment as a whole and on the big five national Medicaid insurers. The big five account for about half of all Medicaid managed care enrollment. Enrollment losses in the big five was about 9.8%, while all Medicaid enrollment dropped over 9%.

#medicaid #redeterminations #coverage

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— Marc S. Ryan

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