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July 3, 2024

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CMS Published Recalculated 2024 Medicare Advantage Star Scores

The Centers for Medicare and Medicaid Services (CMS) made public its revised Star scores for 2024 for Medicare Advantage (MA) plans today. The agency will have to fund an additional $1.3 billion after being rebuked by two courts on how it ignored regulations when setting guardrails for 2024. Actuarial firm Milliman says seventy-six MA contracts from 44 insurers (with almost 3.5 million members) saw increased Star scores.

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#medicareadvantage #stars #cms

https://www.modernhealthcare.com/medicare/medicare-advantage-star-ratings-recalculation-scan-elevance

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July 2, 2024

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KFF Analysis Says MA Still Has Highest Margins

A Kaiser Family Foundation (KFF) analysis says that the highest gross margins were found in Medicare Advantage (MA) in 2023. At the end of 2023, gross margins per enrollee in MA were $1,982 on average compared to $1,048 in the individual market. Medicaid was the lowest at $753. Group plans fell in the middle at $910.

Despite some of the troubles health plan are having with MA right now, the data proves MA is still a good place to be, with high revenues per enrollee and the ability to reduce spending to generate good margins.

KFF Analysis: https://www.kff.org/medicare/issue-brief/health-insurer-financial-performance/

#medicareadvantage #healthplans

https://www.fiercehealthcare.com/payers/kff-insurance-market-had-highest-gross-margins-last-year

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July 1, 2024

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Healthcare World Panicking Over Chevron Deference Being Struck By Supreme Court

With the Supreme Court striking down the Chevron deference as the backbone of promulgating regulations, the healthcare world is officially in panic.  Most argue it will grind rule-making to a halt, create court backlogs and inconsistent rulings, and jeopardize health.  I touch upon many of these points in my Thursday blog.  I have mixed views on the ruling. I am not sure the world comes to an end as many think, but it will have vast implications.

#chevrondeference #cms #hhs #regulations #healthcare

https://kffhealthnews.org/news/article/supreme-court-chevron-deference-doctrine-health-care-policy-shockwaves/

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June 28, 2024

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Supreme Court Takes Out Chevron Deference

In an expected move, the Supreme Court ruled that the Chevron deference precedent is no more. It has pulled back on the precedent and has now thrown it out.  The precedent said that courts must give deference to regulatory agencies when they make reasonable interpretations of ambiguous laws. Proponents of deference said that it is a necessary power of regulatory agencies and that its elimination will now lead to a Wild West of court decisions in the future. Opponents argued that it created an administrative state that was far-reaching and one that went well beyond legislative intent. I will write a blog on the possible implications for healthcare.  The removal of the deference rule does not change the fact that the Centers for Medicare and Medicaid Services (CMS) has often just got its regulations wrong or ignored them entirely. But it does have vast implications for healthcare policy.

Additional Articles: https://www.modernhealthcare.com/government/supreme-court-chevron-ruling-federal-regulation and https://insidehealthpolicy.com/daily-news/cms-fda-face-weakened-authority-following-scotus-chevron-decision and https://insidehealthpolicy.com/inside-drug-pricing-daily-news/chevron-ruling-could-chill-fda-s-public-health-efforts-stem-ai-ldt and https://www.fiercehealthcare.com/regulatory/supreme-court-overrules-chevron-deference-dealing-blow-federal-healthcare-agencies and https://www.healthcaredive.com/news/scotus-overturns-chevron-doctrine-healthcare/720219/

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#chevron #cms #hhs #regulations

https://www.washingtonpost.com/politics/2024/06/28/supreme-court-chevron-federal-agency-authority

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June 27, 2024

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Walgreens’ Bleeding Continues

Walgreens’ stock fell 24% as the drugstore chain slashed its profit outlook. It will reduce the size of its pharmacy footprint and continue to evaluate and right size its investment in VillageMD, primary care clinics tied to retail settings.

Additional articles: https://www.healthcaredive.com/news/walgreens-to-reduce-villagemd-stake-close-stores/719984/ and https://www.modernhealthcare.com/providers/walgreens-villagemd-ownership-majority-stake and https://www.modernhealthcare.com/providers/walgreens-boots-alliance-shares-drop-store-closings-ceo-tim-wentworth

(Some articles may require a subscription.)

#walgreens #retailmeetshealthcare #primarycare

https://www.fiercehealthcare.com/providers/walgreens-slashes-profit-guidance-plans-close-more-pharmacy-stores-turnaround

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June 26, 2024

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Quarterly Drug Inflation Rebate Caps Save More Dollars For Medicare And Enrollees

The Centers for Medicare & Medicaid Services (CMS) announced 64 new drugs subject to quarterly caps because price increases exceeded allowable inflation. This will mean additional rebates and lower out-of-pocket costs for 750,000 enrollees. The provision was passed as part of Medicare drug price negotiations in the Inflation Reduction Act (IRA).

In addition, states increasingly are passing protections on drug manufacturers limiting 340b discounts to certain providers.  This came after the Supreme Court upheld such state laws. I do not agree generally with the ruling as it perpetuates an abuse of 340b’s intent.

Additional articles: https://thehill.com/policy/healthcare/4740963-biden-lower-prescription-drug-costs-medicare-inflation-reduction-act/ and https://www.modernhealthcare.com/supply-chain/340b-drug-program-discounts-arkansas-missouri-laws

Press Release Here: https://www.cms.gov/newsroom/press-releases/hhs-announces-cost-savings-64-prescription-drugs-thanks-medicare-rebate-program-established-biden

(Some articles may require a subscription.)

#drugpricing #ira #medicare #partd #pdp #medicareadvantage

https://www.fiercehealthcare.com/payers/hhs-lowers-64-prescription-drug-prices-under-medicare-rebate-program

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June 25, 2024

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Security Group Rates Healthcare Cyber Readiness

SecurityScorecard gave healthcare a “B+” in cybersecurity, but some healthcare organizations had low ratings despite the group concluding that ratings were “higher than expected.” I tend to think that ratings are a bit inflated, but nonetheless it is a good service for the nation.

#cyberattacks #healthcare

https://www.fiercehealthcare.com/health-tech/report-90-healthcare-orgs-get-b-cybersecurity-medical-devices-fall-below-mark

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June 24, 2024

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Supreme Court Declines To Hear BCBS Antitrust Case

The Supreme Court declined to hear a case challenging the anti-trust settlement between the federal government and BCBS plans nationwide.  While no wrongdoing was admitted, BCBS plans were accused of anti-competitive behavior in the employer market because it limited employers to contracting with BCBS entities in their headquarters’ area and required a threshold for Blues revenue.

The appeals court argued the settlement does not preclude future actions. The high court agreed. Several employers argued the settlement was not enough and that it did preclude certain actions over time. I will be writing about this soon. While the settlement was somewhat of a defeat for the Blues and its association, it actually tends to underscore the anti-competitive aspects of the broader healthcare market and protects the Blues.

Additional articles: https://www.modernhealthcare.com/legal/supreme-court-bcbs-settlement-home-depot and https://www.beckerspayer.com/payer/supreme-court-rejects-home-depots-challenge-to-2-7b-bcbs-settlement.html

(Some articles may require a subscription.)

#bcbsa #blues #healthcare #coverage #employercoverage

https://www.fiercehealthcare.com/payers/supreme-court-declines-hear-challenge-27b-bcbs-settlement

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June 21, 2024

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Mixed Bag Court Decision On Preventive Services Mandate

A Federal Appeals Court issued a mixed-bag ruling on whether free preventive services will continue in the Affordable Care Act (ACA).  It upheld a lower court ruling finding that the government could not compel a Christian-based business to cover certain services that violate its religious beliefs.  At the same time, it struck down the lower court’s bar on enforcement of preventive services nationwide and returned the future of the preventive services mandate back to a lower court.

Additional article: https://thehill.com/policy/healthcare/4733629-obamacare-preventive-care-mandate-to-stay-in-place-after-court-ruling/

#aca #obamacare #exchanges #healthcare #coverage #healthcarereform

https://www.fiercehealthcare.com/payers/mixed-bag-fifth-circuit-rules-aca-preventive-services-legal-case

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June 20, 2024

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Change Healthcare Begins Breach Notification Process

Change Healthcare began reaching out to clients who had data compromised in the ransomware attack and breach that brought much of the healthcare system to a standstill earlier this year.  Compromised data includes personal and health information. The breach hit a substantial portion of Americans.

An additional article points to the great vulnerability of hospitals to cyberattacks.

Additional articles: https://kffhealthnews.org/news/article/hospitals-cyberattacks-ascension-patient-care/ and https://www.modernhealthcare.com/cybersecurity/change-healthcare-data-breach-cyberattack-notification

(Some articles may require a subscription.)

#changehealthcare #cyberattacks

https://www.fiercehealthcare.com/payers/optums-change-healthcare-responding-cybersecurity-issue

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