Blog - Page 17 of 20 - The Healthcare Labyrinth

PBM Transparency And Reform Is A Big Trend In The American Healthcare System

December 14, 2023 No Comments

The push for lower drug prices in general and reform of America’s Pharmacy Benefit Management (PBM) industry specifically are major focuses of Capitol Hill and state and federal regulators. With these trends taking center stage, I thought it would be interesting to lay out where the impetus for reform is coming from and what the future likely holds. I don’t pretend this is an exhaustive piece, but it is meant to set the table for future discussions and blogs. It is clear to me that the push for reform substantially is coming from outside the industry, but there are clear trends even within the drug and PBM industry toward change. What is the current status? It is critical to recognize that PBMs alone do not set prices in American healthcare. We have a tremendously opaque drug supply channel that begins with drug makers. The below walk-through is simplified and does

December 13, 2023

December 14, 2023 No Comments

CMS Actuary Releases 2022 Healthcare Statistics The CMS Actuary has released its analysis of 2022 national healthcare expenditures. I will write a blog on this in the next week. At the link is the website where the data is uploaded. Centers for Medicare and Medicaid release here: https://www.cms.gov/newsroom/fact-sheets/national-health-expenditures-2022-highlights . In addition, four other articles on the new data: https://www.fiercehealthcare.com/payers/back-normal-health-care-spending-growth-rates-down-pandemic-era-times and https://www.healthaffairs.org/content/forefront/ahead-print-national-health-spending-2022 and https://www.modernhealthcare.com/policy/us-health-care-spending-rose-over-4-trillion-2022 and https://insidehealthpolicy.com/daily-news/cms-2022-health-spending-report-finds-medicaid-drove-federal-spending . Healthcare spending increased 4.1% in 2022 to $4.5 trillion. In 2022, the share of the economy devoted to healthcare spending as a percentage of gross domestic product (GDP) was 17.3 percent. Healthcare’s share of GDP as well as the percentage cost increase both went down in part due to lower government spending on the pandemic from prior years. In addition, Medicaid spending due to enrollment growth was very high. (Some articles may require a subscription.) #healthcare #costs Link to Article ONC Finalizes AI And

December 12, 2023

December 12, 2023 No Comments

A Rare Occurrence For Healthcare Costs In a rare occurrence, medical service costs at hospitals increased 2% in the first three quarters of 2023. This is about the 1.9% that the economy grew. Generally, hospital costs tend to far exceed economic growth and inflation. The report is from Turquoise, a new price transparency startup. The findings also show that costs can vary across regions/markets as well as within markets. #pricetransparency #healthcare Link to Article At The Same Time, Overall Healthcare Costs Rising Advisory firm WTW surveyed 266 insurers across 66 countries and found that 58% are bracing for “higher or significantly higher” healthcare cost increases in the three upcoming years. Global costs increased by 10.7% in 2023, up from a 7.4% increase in 2022. The average cost trend insurers expect is 9.9% next year. #healthcare #healthinsurance Link to Article Excellent Pro Publica Analysis of Waste and Abuse in Medicare Latest estimates

December 11, 2023

December 11, 2023 No Comments

Cigna-Humana Merger Off — For Now The Cigna-Humana merger is reportedly off as the entities could not arrive at financial terms. This leaves Cigna with two big decisions: (1) What smaller deals will they enter into? and (2) Will they sell their Medicare Advantage (MA) business? While MA is a smaller portfolio than many big plans have, if it can improve its Star scores and make additional investments, it could still be lucrative for Cigna. On the other hand, Cigna may be investing most of its efforts in its non-margin-limiting Evernorth services subsidiary. Additional articles: https://www.modernhealthcare.com/mergers-acquisitions/cigna-humana-merger-deal-scrapped-stock-buyback and https://www.healthcaredive.com/news/cigna-humana-deal-falls-through-wall-street-journal/702091/ and https://thehill.com/policy/healthcare/4353008-cigna-ends-plans-to-merge-with-humana-report/ (Some articles may require a subscription.) #healthplans #mergers #acquisitions #cigna #humana Link to Article Bill Would Reform PBMs And Introduce Site-Neutral Payments in Medicare I reported on this last week, but another good article describing a large House bill that would bring some transparency to PBMs and start site-neutral policies

New Poll Shows Americans Want To Work To Improve The Current Healthcare System Not Replace It

December 11, 2023 No Comments

In my last blog on December 7, I argued that former President Donald Trump gave Democrats an issue to run on in 2024 when he stated on two occasions that he wanted to repeal the Affordable Care Act (ACA). I argued that the Republican party has a “compassion gap” and Trump signaling he would repeal the ACA widens that gap and gives a leg up to the Democrats. A recent Kaiser Family Foundation (KFF) poll showed that the ACA was a very important issue for about half of those surveyed and that about a third of Republican voters felt that way. In general, on healthcare issues, the poll underscored that voters may trust the Democrats more. As I noted, my blog was published on December 7 and later that day a new poll was published that underscores my views. The poll had 2,000 respondents and was conducted by the Partnership

December 8, 2023

December 8, 2023 No Comments

New Poll On Affordable Care Act And Healthcare Issues A new poll shows that the American public favors maintaining the Affordable Care Act and reforming the current healthcare system. My blog Monday will build on my December 7 blog and go deep into this poll. #healthcare #healthcarereform #affordableuniversalaccess #universalaccess Link to Article House May Cancel Physician Medicare Rate Cut A bipartisan group of representatives has introduced a bill in the House that would cancel the 2024 Medicare physician pay cut finalized last month by the Biden administration. Physicians are always on a roller coaster when it comes to rates in Medicare. I think the formula has to be revisited broadly. The House committee bill would only restore 2.5% of the 3.4% cut: https://insidehealthpolicy.com/daily-news/house-ec-bill-would-erase-only-25-physician-fee-cuts-matching-senate (Some articles may require a subscription.) #providers #physicians #rates Link to Article Bipartisan Effort Looking At Healthcare Entity Ownership And Anti-Competitive Behavior Must-read article about efforts by the

December 7, 2023

December 7, 2023 No Comments

United Health Foundation Says Chronic Conditions Rising The United Health Foundation released a study that concludes chronic conditions are rising in the U.S. It also released its annual “America’s Health Rankings” report, which tracks health across the country based on 87 measures and 28 data sources. United finds that persons with multiple chronic conditions has reached their highest levels since they were first tracked. Mental health and diabetes have risen. It also found health condition disparities exist for asthma, COPD, and diabetes. United also found that more people have multiple co-morbidities. United calls for investments in care management as well as health equity. As I note in my book, The Healthcare Labyrinth (available on this website), one of America’s key problems is a lack of investment in health, wellness, and care management. Other developed nations concentrate resources here and have much better outcomes, fewer people with disease states and conditions,

Republicans Have a Compassion Gap But Trump Gives Democrats Momentum on Healthcare Anyway

December 7, 2023 No Comments

Former President Donald Trump recently brought up the possible repeal of the Affordable Care Act (ACA) and has put his (and my) party in a bind. Republicans suffered at the polls on the very issue Trump has resurrected. Why is he raising the status of the landmark act again? In a post on Truth Social on November 25, Trump declared: “The cost of Obamacare is out of control, plus, it’s not good Healthcare. I’m seriously looking at alternatives.” He clearly caught his party by surprise. You could hear the collective signs and groans coming from Capitol Hill Republicans who survived the issue in the past. After some criticism, Trump sought to clarify his remarks but actually reiterated his stand. On November 29 on Truth Social, Trump stated: “I don’t want to terminate Obamacare, I want to REPLACE IT with MUCH BETTER HEALTHCARE. Obamacare Sucks!!!” Fellow candidate and FL Gov. Ron

December 6, 2023

December 6, 2023 No Comments

Affordable Care Act 2025 Rule And Ongoing Press On Trump Repeal Remarks While we have already covered the proposed 2025 Exchange rule, this article from Kaiser Health News discusses the rule as well as some of the history of the Affordable Care Act under Trump and later Biden. #aca #obamacare #exchanges #medicaid Link to Article Drug Donations Help The Uninsured and Low Income Great Kaiser Health News article on drug donation programs in states. Helping to save lives and reduce healthcare costs. #drugpricing Link to Article Exchange Enrollment Doing Very Well But Not Picking Up Many Losing Medicaid Coverage Nearly 7.3 million people have selected an Affordable Care Act (ACA) Health Insurance Marketplace plan since the 2024 Marketplace Open Enrollment Period (OEP) opened on November 1. It runs through January 15, 2024. The numbers from the Centers for Medicare and Medicaid Services (CMS) represents activity through December 2 (Week 5)

December 5, 2023

December 5, 2023 No Comments

Is Interest In ACA Truly Fading? The Kaiser Family Foundation (KFF) poll says that the ACA and generally healthcare are fading as issues in the 2024 campaign. The poll was done before Donald Trump’s remarks on the Affordable Care Act (ACA). But let me take a slightly contrarian view here. As the poll notes, about half of the 1,401 people surveyed said the future of the ACA is a key topic. About 70% of Democrats thought so and 32% of Republicans thought so. To me, in a close election, 32% of Republicans thinking the ACA is significant is, well, significant. In a close election, how do you win if one-third of Republicans and a greater percentage of independents care about an issue? KFF poll here: https://www.kff.org/health-reform/press-release/poll-by-a-wide-margin-democratic-voters-now-care-more-about-the-affordable-care-act-than-republican-voters-do-and-voters-trust-democrats-more-than-republicans-to-handle-its-future/ #aca #obamacare #exchanges #medicaid #healthcare #healthinsurance #healthcarereform Link to Article CVS Follows Other Large PBMs in Reforming Reimbursement CVS unveiled Tuesday that it will