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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, and have better maintenance of conditions. 

There is no question plans need better data and analytics in order to intervene not only at the member level, but also at the group level to tackle social determinant barriers and health equity. This is a good place for plans to focus as the prior authorization area becomes much more constrained via regulation.

#healthcare #chronicconditions #disparities #healthequity

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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

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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

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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:

  • The U.K. has among the lowest drug prices in the world because of its buying power.  Imagine the buying power of America?
  • The U.K. looks at the cost-effectiveness of new medicines to set prices.
  • It also has inflationary caps of 2% per year, which will increase to 4% in the new deal. Anything over this is returned in a rebate. Some drugs are exempt to encourage innovation.

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

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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

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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

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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.  Cigna would have to sell its MA line in some states, but otherwise this merger is much cleaner than the earlier ones. The feds may still attempt to stop it given the political climate on Capitol Hill.

One story at the Article link and two more here. (Some may require a subscription.):

https://www.fiercehealthcare.com/payers/wsj-cigna-humana-exploring-insurance-mega-merger

https://www.modernhealthcare.com/insurance/cigna-medicare-advantage-sale-humana

#medicare advantage #commercial #medicaid #managedcare #mergers #healthplans

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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

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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

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The Healthcare Labyrinth Newsfeed will be off on November 23 and 24 for the Thanksgiving holiday. We will be back on November 27. Happy Thanksgiving to all! Stay safe!

— Marc S. Ryan

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