Blog - Page 13 of 20 - The Healthcare Labyrinth

A Trump Second Term Would Be A Schizophrenic Experience On Healthcare

January 18, 2024 No Comments

Kaiser Health News recently did a piece on what a second Donald Trump term would mean for healthcare. It was a good piece and there is a link at the bottom of this story. That prompted me to do my own evaluation of the prospects of what might happen in Trump 2. After all, lawsuits and indictments do not appear to be impacting the president’s standing in the GOP primary polls, but we will see what New Hampshire brings with candidate Nikki Haley closing in on Trump. In the general election polls, Trump and President Biden are neck and neck. To be fair to the former president, his tenure on healthcare was a mixed bag. As a bit of an atypical Republican, he ventured into areas not usually seen. Here are some major areas I would call out as the good and then the bad and ugly. The Good Price

January 17, 2024

January 17, 2024 No Comments

CMS Finalizes Interoperability And Prior Authorization Rule The Centers for Medicare and Medicaid Services (CMS) finalized a sweeping interoperability rule today that also sets much stricter timelines for medical service prior authorizations. The rule was published some time ago and garnered a great deal of comments. The rule takes effect in January 2026 and requires 7 day standard and 72 hour expedited prior authorization turnaround times (federal Exchange plans excepted). Plans now have until 2027 to have APIs to allow providers to submit authorizations electronically. A national format exists for retail prescription drugs, but not a consistent one for medical service requests yet. The final specifications for medical services will tie to the Davinci Project, which will use the new FHIR standard. But plans will be able to use X12 formats as well. The rule applies to Medicare Advantage (MA), Medicaid, children’s coverage, and the federal Exchanges. The finalization of

January 16, 2024

January 16, 2024 No Comments

Congressional Leaders Agree on Extension of Funding The four congressional leaders announced a deal to extend government funding to March 8 to avoid a government shutdown. This is a concession by House Speaker Mike Johnson, R-LA, who originally said he would not extend government by a short-term continuing resolution (CR). A number of items are left out of the funding package. Conservatives in the House GOP caucus are not happy with Speaker Johnson’s (one of their own) endorsement of the extension. Additional articles here: https://insidehealthpolicy.com/daily-news/short-term-cr-carries-extenders-through-march-8 and https://thehill.com/homenews/house/4410728-congress-shutdown-conservative-anger/ Additional article on status of healthcare bills, including hospitals’ opposition to site-neutral payments that is in a passed bill that would forestall disproportionate share hospital(DSH) funding cuts: https://www.modernhealthcare.com/politics-policy/congress-spending-deal-hospitals-dsh-medicare-site-neutral (Some articles may require a subscription.) #governmentshutdown #crs Link to Article More Fallout From MedPAC Report On Medicare Advantage The fallout from the MedPAC meeting continues. A leading member has argued that the analysis by

January 15, 2024

January 15, 2024 No Comments

Good Articles On Takeaways From JPM Healthcare Conference Two good articles summarizing some major trends and topics at the JPM healthcare conference. Highlights include: Additional article here: https://www.modernhealthcare.com/finance/jpm-2024-takeaways-commonspirit-mayo-clinic-centene-cvs-cigna-teladoc (Some articles may require a subscription.) #healthplans #providers #hospitals #stars #pbms Link to Article AI Can Help Drive Social Determinant Information And Extraction Stories on the ability for generative AI to identify social determinants of health (SDOH) data in notes is a key development. The study indicates that extraction from clinical notes in tuned models show success in insights into housing, employment status, etc. Language models were able to identify about 94% of cases where SDOH barriers existed compared with 2% using diagnostic codes. We know that social determinants may be a greater predictor of health outcomes than underlying disease status. This will be key to driving outcomes in the future. Additional article here: https://www.modernhealthcare.com/digital-health/generative-ai-social-determinants-of-health-mass-general-brigham (Some articles may require a subscription.) #sdoh

The GOP Primary: My Dilemma From A Healthcare Perspective And Other Policy Issues

January 15, 2024 No Comments

Update: Posted early on January 1/15/2024 — Martin Luther King Day. The Iowa Republican Caucuses were on 1/15. After the Iowa Caucus results, Vivek Ramaswamy dropped out of the presidential race and endorsed Donald Trump. In Iowa, Trump won at least 20 delegates, at least DeSantis 8, Haley at least 7, and Ramaswamy at least 3. While you have learned I definitely have opinions, I try to keep politics per se out of my blogs. You do know, though, I am a Republican. As we approach the primary season, I have to try to pick a candidate. My decision will be a mix of healthcare and non-healthcare issues. So here is how I view it. As a Florida resident, I have until March 19 to make my decision on whom I want to win the GOP nomination. Forgive my delving into non-healthcare issues, but I believe the nation is on

January 12, 2024

January 12, 2024 No Comments

What Would A Nikki Haley Healthcare Agenda Look Like? The Republican debates continue with Donald Trump bowing out and Ron DeSantis and Nikki Haley taking center stage. A recent CNN debate saw the two sparring, sometimes on healthcare issues. Both Haley and DeSantis declared that they would like to replace the Affordable Care Act (ACA) with a block grant. It is a horrible idea. With Chris Christie’s departure from the race and Haley rising in the polls, Kaiser Health News (KHN) did a feature on what a Haley administration’s healthcare agenda may look like. Additional article on Haley’s views on entitlement reform here: https://www.cnn.com/2023/12/05/politics/nikki-haley-social-security-medicare-reform/index.html #gopprimary #haley #desantis #trump #healthcare #aca #obamacare Link to Article Fight (Verbal Anyway) Breaks Out at MedPAC Meeting A verbal clash broke out at a MedPAC meeting, with one member reasonably arguing that MedPAC is not truly as non-partisan as it says it is. I generally

5. Modeled In Part On Processes In Other Developed Countries, The Medicare Drug Price Negotiations Should Save Money, Promote Better Outcomes, And Have Little Impact On Innovation

January 12, 2024 No Comments

Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through the Healthcare Labyrinth website. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. On this episode of the Healthcare

January 11, 2024

January 11, 2024 No Comments

Dysfunction Junction Update: Will Government Shutdown? Faced with an upheaval by the rightists (his very own!) in the House GOP caucus and upended procedural votes, Speaker Mike Johnson, R-LA, met with the Freedom Caucus members to discuss a possible alternative spending bill. This came as a surprise to other leaders. But Johnson could face the same purge that former Speaker McCarthy saw when he tried to do the right thing and comprise to keep government operating. While no one has explicitly said they would call a vote to vacate the speakership, the idea has again been put out there by prominent members of the right-wing fire-setting brigade. Meanwhile, Senate Majority Leader Chuck Schumer, D-NY, has begun drafting a continuing resolution (CR) that extends government while the agreed-upon deal is worked on. Senate Minority Leader Mitch McConnel, R-KY, has said this is needed. Johnson may be softening, but previously ruled out

Major Health Insurers Can Have Differing Profiles and Priorities

January 11, 2024 No Comments

With so much going on in the health insurance world, I thought it would be interesting to profile some of the largest insurers and discuss some of their priorities/activities. I picked the seven largest insurers owned by for-profit publicly traded companies. Collectively, they cover about 200 million people, or 60% of the U.S. population. Collectively, their revenues are over $1.25 trillion annually. While this is not meant to be an exhaustive review of financial information or advice on stock purchases, I combed investor relations filings and sites as well as the internet for this information. As you will see, some are focused a bit on diversification from insurance alone and strengthening services units. Others continue to be more pure-play insurers. A few points: Here goes: United Health Group 2022 Revenue: $324 billion Q3 2023 Membership: Commercial – 27.3 million Medicaid managed care – 8.0 million Medicare Advantage – 7.6 million

January 10, 2024

January 10, 2024 No Comments

Oscar Says It Can Be Profitable in 2024 And May Expand To Other Products Insurtech Oscar says its enrollment will hit 1.3 million members in the Exchanges once open enrollment concludes, a 31% increase year-over-year. It also could see positive margins in 2024, as much as 5%. It could expand into individual coverage health reimbursement arrangements (ICHRA) and Medicare Advantage (MA) in the future. Both Oscar CEO Mark Bertolini (former Aetna CEO) and Centene CEO Sarah London are right that the Affordable Care Act (ACA) is here to stay with over 20 million enrollees. ICHRA is a good Trump-era rule that allows employers to make tax-free contributions toward employees’ individual coverage. Oscar would be well-placed to offer a total ICHRA administrative solution coupled with enrollment in individual Exchange enrollment. Bertolini is a genius on this issue. In other news, Alignment Healthcare touted its Star scores. Additional articles: https://www.fiercehealthcare.com/payers/jpm24-oscar-health-eyes-2024-profitability-and-ichra https://www.fiercehealthcare.com/finance/jpm24-day-3-goodrx-expects-least-749m-revenue-2023