CVS Caremark President David Joyner wrote and op-ed for Fortune to explain the innovation and transparency his pharmacy benefits manager (PBM) is engaged in. It seeks to counter some of the press Mark Cuban is getting. I will note that leadership at CVS Health overall is on a path of reform and innovation.
#cvshealth #pbms #transparency
Democrat members of the Senate HELP Committee staged a hearing on the role of corporate greed in healthcare. Of particular concern was the role of private equity firm monies and whether dollars are diverted out from healthcare to corporate margins. PE firms have big investments in both hospitals and provider groups.
Additional article: https://www.fiercehealthcare.com/regulatory/steward-healthcares-struggles-full-display-clinicians-policy-researchers-tell-senators
#privateequityfirms #healthcare
Private equity investments are already being broadly looked at by Congress and regulators. Now, the Senate Homeland Security and Governmental Affairs Committee is seeking information on private equity’s role in emergency physician staffing firms that are leaving hospital emergency departments unprepared.
Letters were sent to Apollo Global Management, the Blackstone Group and KKR — three of the nation’s largest private-equity firms — and four emergency medicine staffing companies owned by the firms. It is estimated at least 40% of hospital emergency departments are overseen by staffing companies that are owned by private-equity firms.
Additional article: https://www.fiercehealthcare.com/providers/senator-probes-private-equity-physician-staffing-firms-emergency-care-cost-cutting
#privateequityfirms #healthcare
A new survey from Virta Health backs up the bleak cost picture. It says that 43% of health plan leaders are predicting 100% or more growth in GLP-1s for weight loss and obesity in 2024. More than half say GLP-1s will be a top 3 drug in 2024 in terms of spending. One fifth say they will be their most expensive drug class this year. Executives believe the media is misrepresenting GLP-1s and that lifestyle programs should be tried first. At the same time, a Vitra Health-linked study comes to a different conclusion on what occurs after stopping GLP-1s. It says those who stop taking GLP-1s can avoid negative effects on glycemia and body weight if they are properly engaged in their healthcare, including proper nutrition.
See my blog today on the subject: https://www.healthcarelabyrinth.com/whats-all-the-clamor-over-glp-1s-for-weight-loss/
#weightlossdrugs #drugpricing
Touching story on NBA great Robert Horry’s healthcare adventures with his daughter, who lived with a genetic disorder and died in her 18th year. It is a testament to why we need affordable universal access to healthcare. Horry is now with a company promoting Individual Coverage Health Reimbursement Arrangements (ICHRA), which allows businesses to cover portions of healthcare premiums and allows employees to privately procure insurance (usually on the Exchange). To me, it is one of the few positive healthcare developments from the Trump administration.
#ichra #obamacare #aca #exchanges
We don’t know yet if Change’s breach will be a record. But based on the 6 terabyte report of compromise as well as the breadth of the Change system, it very well could be. United is reporting that it may be hard to tell who was impacted by the breach. Further, because of Change’s tentacles in the market with providers and payers, it could be that people are notified multiple times from different providers and a payer that their data was impacted. There could be hundreds of millions (even billions) of notifications. This will cause mass confusion.
In other events, United seems to be complaining that some insurers and providers are slow to reconnect to Change systems, which is needed to get the flow of information and claims. Some complain that they do not know yet if Change is secure. They are testing and obtaining independent verification. Also, some argue that reconnecting is difficult as certain systems are still down. Article here: https://www.modernhealthcare.com/cybersecurity/change-healthcare-update-unitedhealth-reconnect
This other article speaks to the continuing fallout and issues with systems, even those that have been restored. Things are not business as usual: https://www.modernhealthcare.com/providers/change-healthcare-update-networks-issues
(Some articles may require a subscription.)
#changehealthcare #cyberattacks
A new Government Accountability Office analysis finds that the federal government made nearly $236 billion in improper payments in 2023. The payments were largely in Medicare, Medicaid, Pandemic Unemployment Assistance, the Earned Income Tax Credit and Paycheck Protection Program loan forgiveness.
Medicare had the largest improper payments at $51.1 billion. Medicaid had $50.3 billion.
GAO Report here: https://www.gao.gov/products/gao-24-106927
#fwa #medicare #medicaid
This article captures the big divide between advocates and detractors of the Affordable Care Act (ACA). Good links to various studies.
Proponents say that over 21 million are enrolled in the Exchanges and a total of about 45 million gained coverage including Medicaid expansion. Opponents argue costs have been huge — 36,798 per additional private insurance enrollee and 20,739 per additional non-group enrollee. This is well above original estimates. Further, critics say insurers have benefited disproportionately.
Here is my Republican defense of the ACA – as strange as that sounds.
I also am dubious of the study that says 3 in 4 (73%) U.S. adults “report that in one way or another the healthcare system is failing to meeting their needs.” Other surveys would suggest general contentment with their coverage and insurer.
#healthcare #healthcarereform #aca #obamacare #exchanges #medicaid
President Joe Biden signed a $1.2 trillion spending package on Saturday, avoiding a government shutdown. The package includes funding for the Department of Health and Human Services (HHS). The Senate passed the measure 74-24, technically after the deadline.
Additional article: https://www.modernhealthcare.com/politics-policy/spending-bill-passes-hhs-funding
(Some articles may require a subscription.)
#governmentshutdown #spending #healthcare
The Senate will need to pass a huge funding bill before midnight Friday to avert a government shutdown. The House passed the bill, which includes healthcare funding, on a vote of 286-to-134 (112 Republicans and 22 Democrats voted against the bill). One conservative House member has called for the ouster of House Speaker Mike Johnson, R-LA, who hails from the Freedom Caucus. She says she has support from folks, but the caucus and some Democrats do not want to see more chaos. The GOP hold on the House will be razor-thin with two early retirements.
#governmentshutdown
