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Commonwealth Fund “Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System” Shows How Much Of A Healthcare Outlier America Really Is

Every three years, The Commonwealth Fund does a great public service by publishing its “Mirror Mirror” analysis of developed world healthcare systems. This is the eighth report, which relies on surveys as well as national and international healthcare data. The 2024 analysis accounts for the COVID pandemic impacts and results are consistent with previous years.  In effect, the Commonwealth Fund ranks healthcare systems’ performance based on leading access, efficiency, quality, and value metrics. It looks at 70 health system performance measures in five areas: access to care, care process, administrative efficiency, equity, and health outcomes. This year it compared statistics in ten countries instead of 11: Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, the United Kingdom, and the United States. Norway dropped off the analysis list because in 2022 the country exited the International Health Policy Survey. Norway was ranked number 1 in the 2021 analysis. The

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Driven By Drugs, Employer Coverage Headed For Huge Increases

One of the most important surveys performed to understand the year-to-year status as well as long-term trends in employer coverage is the Business Group on Health’s annual healthcare strategy survey. The 2025 survey was fielded between June 3 and July 12, 2024. The survey was completed by 125 employers, which cover more than 17.1 million lives in the United States. U.S. and multinational companies completed the survey and range from under 10,000 employees to 100,000 employees and over. About 73% of respondents had more than 10,000 employees. They represent a broad range of industries. Remember that close to a majority of Americans are covered by employer-furnished insurance, usually self-insured ERISA coverage. What does the survey tell us overall? Looking at projected annual increases before plan design changes, the projected trend rose from 6% in 2022 to almost 8% for 2025. Even after design changes, actual healthcare costs continued to grow

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Growth From August To September In Medicare Advantage

I decided to continue my Medicare Advantage (MA) monthly enrollment blogs because of continuing month-over-month increases. The growth is tied to remaining strong benefit packages for 2024.   Many plans will rein in benefits and geographies for contract year 2025 due to significantly deteriorating bottom lines. This is being caused by the return of robust utilization, inflation picking up in the healthcare sector (especially at hospitals), poor Star scores, negative rate increases for 2024 and 2025, new regulatory burdens (such as the new prior authorization restrictions), and the greater costs MA plans will bear due to the Inflation Reduction Act’s (IRA) Part D changes. See my earlier blogs on this Part D topic here: https://www.healthcarelabyrinth.com/will-democrats-be-victim-of-an-october-surprise-of-their-own-making/ and https://www.healthcarelabyrinth.com/part-d-premium-woes-due-to-the-inflation-reduction-act/ . While we are outside of the two regular annual enrollment windows, increases in MA enrollment still occur given the aging of America and the ability of some populations, such as dual eligibles, to continue to make changes

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Two Key CMS Announcements MA Plans Must Follow

Medicare Advantage (MA) plans are going to want to take note of two recent HPMS memos from the Centers for Medicare and Medicaid Services (CMS). Each touches on major areas of controversy for the program. Supplemental Benefits User Group CMS will host a user group to provide an overview of supplemental benefits data submission for encounter data records on September 26, 2024, 2:00 p.m. – 3:00 p.m. ET. You need to register in advance. See the flyer distributed with the September 10 HPMS memo on the topic. The issue of supplemental benefits is an explosive one right now. Opponents of MA say that MA plans are submitting bids that misrepresent supplemental benefit utilization and thereby inflating their margins. CMS has little to go by because encounter data for supplemental benefits is rarely submitted. CMS did two things to attack the controversial issue. First, it issued a memo requiring plans to submit

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Oliver Wyman Has Lessons For Today’s Medicare Advantage Plans

As management advisory firm Oliver Wyman noted in its recent study on Medicare Advantage’s (MA) woes, “history has a way of repeating itself.” And so it is with MA’s plight today. Oliver Wyman says MA plans can learn a great deal from what plans went through during the Medicare+Choice days almost thirty years ago. Oliver Wyman admonishes plans to avoid the Medicare+Choice mistakes lest MA plans suffer the same fate of many Medicare+Choice plans back then. What is Medicare+Choice and what happened? Medicare+Choice is the same program we have today but under its earlier name. While there was managed care in Medicare for a few decades, Medicare+Choice was formally established as Part C of the program via the Balanced Budget Act of 1997 (BBA). Plans were rolled out effective January 1, 1999. Medicare+Choice was renamed Medicare Advantage as part of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) in

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My Exhaustive Hunt For My GLP-1!

Your intrepid blogger is on a GLP-1. It was with great reluctance that I went on one. I have been a diabetic for about 17 years now. I tell everyone it runs in the family, which is indeed truthful. But I admit privately (and I guess publicly as of now) that a lot of my diabetes is tied to my poor eating habits and lack of exercise. I have tried a great deal over the years to keep my HbA1C below 7.0. It worked for a while with generic meds and then with one brand drug. But as I close in on my sixties, I began inching up and went above 7.0. I am a new drug skeptic. I don’t believe the Food and Drug Administration (FDA) or brand drug makers have the best interests of Americans at heart – the FDA because it is inept, the drug makers because

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Part D Restructuring in Inflation Reduction Act Could have Huge Implications On Standalone Part D Program

Many of you asked me to expound a little more on the recent controversy over the Centers for Medicare and Medicaid Services’ (CMS) establishment of a special off-budget premium stabilization program for standalone Part D plans and why it was needed. Your questions were as follows: In my various blogs, podcasts, and newsfeed commentary on the subject, I alluded to potential huge ramifications for the program (the previous entries are listed at the end of this blog). Let me dive a little deeper here and tell you why I am so worried. It continues to be a lesson in the unintended consequences of lawmakers – especially in campaign mode – making major changes to government programs. What happened in the Inflation Reduction Act (IRA) The IRA was passed on August 16, 2022 and included two major healthcare reforms – the enactment of Medicare drug price negotiations and major changes to

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Is America Getting The Value It Deserves From Part D?

A LinkedIn post from Healthcare and Drug Guru Bryce Platt ( https://www.linkedin.com/in/bryce-platt/ ) put me on to an April 18, 2023 JAMA Forum article on whether the U.S. is getting its bang for the buck with Medicare Part D.  And the results to me were very shocking. We take for granted that when a doctor prescribes a drug, it is the right move. But America has so much drug marketing by Big Pharma that doctors’ and our decision-making may be skewed. At least that is what a JAMA Network article points to. The JAMA Network assessment asked the question: “What was the added therapeutic benefit of the 50 top-selling drugs in Medicare in 2020, as assessed by key non-U.S. health technology assessment (HTA) organizations?” What is an HTA anyway and how are drugs evaluated? An HTA is undertaken by public and private entities around the world to assess the clinical

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The Truth About Hospital Costs And Payments

“We strongly discourage anyone from taking seriously the Arnold Ventures misinformation campaign and the flawed conclusions in (the Third Way report.)” With that, the American Hospital Association (AHA) seeks to dismiss a very credible analysis on the truth about hospital costs and finances. Hospital lobby playbook If you follow the AHA’s and other hospital lobbies’ script, it goes a little like this: But in came center-left think tank Third Way’s report, which fundamentally challenges these assumptions and consequently triggered the AHA’s visceral response above. Apparently, anyone questioning the hospitals’ playbook does not deserve a thoughtful response. There are a number of previous analyses that show that truly efficient hospitals can earn margin in government programs. Because commercial rates are higher, it stands to reason that the entire enterprise can be healthy. I read about the hospital inefficiency phenomenon in Marty Makary’s books – Uncontrollable and The Price We Pay. As

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Growth From July To August In Medicare Advantage

As noted last month, I decided to continue my Medicare Advantage (MA) monthly enrollment blogs because of continuing month-over-month increases. The growth is tied to remaining strong benefit packages for 2024 and largely ties to a few big plans. Many plans will rein in benefits and geographies for contract year 2025 due to significantly deteriorating bottom lines. This is being caused by the return of robust utilization, inflation picking up in the healthcare sector (especially at hospitals), poor Star scores, negative rate increases for 2024 and 2025, new regulatory burdens (such as the new prior authorization restrictions), and the greater costs MA plans will bear due to the Inflation Reduction Act’s (IRA) Part D changes. See my earlier blogs on this Part D topic here: https://www.healthcarelabyrinth.com/will-democrats-be-victim-of-an-october-surprise-of-their-own-making/ and https://www.healthcarelabyrinth.com/part-d-premium-woes-due-to-the-inflation-reduction-act/ . While we are outside of the two regular annual enrollment windows, increases in MA enrollment still occur given the aging of America

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