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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

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December 4, 2023

December 4, 2023 No Comments

U.K. National Health Service Has New Drug Pricing Deal An article in The Economist discusses the United Kingdom’s new drug pricing deal.  As we know, all other developed nations negotiate and set prices globally, as Great Britain does. The Inflation Reduction Act’s Medicare drug price negotiation will slowly bring some of what other developed nations have. In fact, we have some in force now. Key points from the article: Still, the U.K. says it is getting hurt by high-cost cancer and other drugs. The U.K. and other systems work and should be fully in place in America. (Article may require a subscription.) #drugpricing #medicare #partd #uk #nhs Link to Article Good Argument For Debt and Entitlement Commission The Heritage Foundation, a conservative think tank, has a great analysis of why a debt and entitlement commission is a good idea.  It is very factual.  A few points: #medicare #medicareadvantage #debt #deficit

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Medicare Advantage Insurers Focusing On Special Needs Plans And Growth Shows It

December 4, 2023 No Comments

While Medicare Advantage (MA) has seen huge increases in enrollment since the beginning of the decade, forecasts suggest that enrollment growth will be reduced moving forward.  Many things factor into the slowdown, including a new rate environment, poor Star performance, and reaching saturation in certain areas of the country.  Nonetheless, MA continues to be a strong program and the most-lucrative place to be if you are an insurer. One segment of the MA program, Special Needs Plans (SNPs), however, are destined to continue to grow significantly moving forward.  This is driven in part by policies from the Centers for Medicare and Medicaid Services (CMS) and the significant financial opportunity plans see. As of November 2023, SNP and related program enrollment stood at over 6.6 million.  That is a 15% growth since January 2023. There are three types of SNPs: (1) Institutional SNPs or I-SNPs (the individual is a resident of

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December 1, 2023

December 1, 2023 No Comments

Cigna-Humana Deal Could Pass Muster While federal and state regulators will look closely and potentially oppose a combination, experts seem to think that the Cigna-Humana merger could eventually go through.  As I have indicated as well, the company profiles are quite different than earlier deals that fell through. #cigna #humana #mergers #acquisitions Link to Article Our Primary Care Problem The article makes a couple key points.  It notes the vast difference between primary care and specialist compensation.  We are clearly over-specialized in the United States.  It also discusses an important bill sponsored by Sen. Bernie Sanders, I-VT, and Sen. Roger Marshall, R-KS, that would invest $26 billion to bolster primary care, increase training opportunities for doctors and nurses, and expand access to community health centers. We do need to invest in so many ways in primary care so we can pivot healthcare from utilization management to care management. #utilizationmanagement #caremanagement #healthplans

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November 30, 2023

November 30, 2023 No Comments

Walgreen’s Launches Drug Tool Similar to others, Walgreen’s has launched a drug price transparency and saver tool for its customers. No monthly fee applies. #drugpricing #walgreens Link to Article Investors Look To Medicaid Managed Care Interesting article on investors now looking to Medicaid managed care as the Medicare Advantage market cools and is dominated by big players. While Medicaid margins are skinnier, Medicaid has been growing and states have been pushing more and more lives into managed care. Rolls will drop with redeterminations coming out of COVID, but aging and long-term care remains a big opportunity for plans and investors. (Article may require subscription.) #medicaid #managedcare Link to Article United Details 2024 Outlook Healthcare behemoth United Healthcare detailed its outlook for 2024. Trends it sees will likely match the industry. United sees slower growth in Medicare Advantage, continued efforts to employ physicians, and increased investments in technology. Additional article here:

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American Healthcare Is A Huge Outlier In Terms Of Costs and Outcomes

November 30, 2023 No Comments

I am writing this blog from the United Kingdom on the occasion of the 75th anniversary of the National Health Service (NHS). The British newspapers this year, as they were five years ago for the 70th Anniversary, were filled with a curious mix of messages about the NHS. On the one hand, Britons defend the NHS and take pride in the system that has been built over the last 75 years.  The NHS is always at or near the top of the most important issues at election time. At the same time, Britons are frustrated with many elements of the system, including long wait times and the hoops that must be jumped through for certain services as well as notable staff shortages and other deficiencies.  Some blame privatization over the past few decades as well as the miserly increases given to the NHS during the conservative government’s tenure over the

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November 29, 2023

November 29, 2023 No Comments

Cigna and Humana Exploring A Merger Stunning news on the health plan front with speculation that Cigna and Humana are entertaining a merger.  This explains reports not too long ago that Cigna was thinking about giving up its Medicare Advantage (MA) line of business.  The merger seems like a match made in heaven.  Cigna is a commercial powerhouse, but its MA line is much smaller than Humana’s. Its MA line is struggling from a Star perspective. It sold its only Medicaid assets a few years ago. Humana is second only to United in MA and has a growing Medicaid line. Both plans have some provider assets as well. And Express Scripts, Cigna’s PBM and one of the nation’s big three, would be a huge asset for Humana. Humana has a subscale PBM asset. Earlier mega mergers (Aetna-Humana and Cigna-Anthem) fell apart due to federal and state pushback and footprint overlaps. 

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November 28, 2023

November 28, 2023 No Comments

Innovation In State And Federal ACA Exchange Programs Interesting article on policy brief from the Commonwealth Fund on various innovations occurring in the state-based and federal Exchange programs.  As of 2023, 20 states operate a state-based marketplace and 30 rely on Healthcare.gov for sign-ups. Some state-based exchanges use the federal website for enrollment. States are experimenting with enrollment campaigns, simplified enrollment, auto-enrollment programs, health-equity requirements, and more.  Article at link.  The actual study is here: https://www.commonwealthfund.org/publications/issue-briefs/2023/nov/policy-innovations-affordable-care-act-marketplaces #aca #obamacare #exchanges #commonwealthfund Link to Article Mark Cuban’s Firm Partners With Expion Mark Cuban’s Cost Plus Drugs (CPD) is partnering with Expion to tackle the high costs of specialty drugs.  A press release says CPD will integrate into Expion’s dynamic pricing technology. It says “consumers can be confident they are getting a fair price and the convenience of medication mailed directly to their homes.”  #cuban #costplusdrugs #drugpricing #expion Link to Article Healthcare Bankruptcies

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November 27, 2023

November 27, 2023 No Comments

Pro Publica Article on Health Plans Not Covering Mandated Services Pro Publica article recounts where health plans have not covered mandated services in state laws.  It is easy to sensationalize mistakes, but health plans every day are approving treatments timely. (May require subscription.) #plandenials #healthplans Link to Article Will New Marketing Rules Hurt Big Plan Performance? Interesting article that says the new Medicare Advantage (MA) marketing rules could mean smaller plans now have a fighting chance against bigger ones, which seemed to enter into the variable and extraordinary compensation with agents and other entities to attract members.  A new marketing clampdown in the 2025 rule would stop most of this. Note, too, a plan official saying that there may be loopholes in the new proposed rule. (May require subscription.) #marketing #medicareadvantage Link to Article Per Worker Healthcare Costs Increased 5.2% in 2023 More evidence that inflation is increasing for employer-provided

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The Importance of Price Transparency In Healthcare Reform

November 27, 2023 No Comments

While website postings of hospital and health plan negotiated prices may not seem of particular importance, the nation’s modest move toward price transparency should bear fruit over time. It is one of the more important initiatives we have seen in healthcare reform as of late. With interoperability of data, price transparency will finally give us some useful information on the inner workings (even machinations) of negotiations between health plans and providers. What are the price transparency requirements? Both health plans (effective July 1, 2022) and hospitals (effective January 1, 2021) have been required to post various pricing information on their websites. Hospitals must report all their gross and net charges in a machine-readable format as well as at least 300 shoppable services (cash and payer prices) in a consumer-friendly format. Health plans must report allowed amounts and contracted rates for hospitals and other provider services for all in-network covered services

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