Pressured by the rise of transparent pricing models, Optum Rx has announced its own approach to greater transparency. I would call it transparency-like. It is offering a single per member cost, encompassing retail, home delivery, specialty drug and rebate components.
#transparency #pbms #optumrx
https://www.fiercehealthcare.com/payers/optum-rx-puts-emphasis-predictability-new-pricing-model
Inequities in mental health will cost $332 billion on premature death and $116 billion in productivity loss in 2024. These combined numbers could grow to $1.3 trillion by 2040.
The inequities also mean greater healthcare spending. $5.3 billion in 2024 excess costs are tied to overutilization and excessive reliance on the emergency room for acute mental health incidents. That number could rise to $17.5 billion in 2040.
#mentalhealth #behavioralhealth #healthcare
https://www.fiercehealthcare.com/payers/mental-health-inequities-cost-478b-unnecessary-expenses-2024
California has fashioned an ambitious healthcare and social service experiment known as CalAIM, but some aspects on the community health and services front are struggling. Many states have mimicked California by requesting similar but less ambitious initiatives through Medicaid. With the majority of health outcomes tied to social factors and not underlying clinical conditions, it is a worthy pursuit overall. My fear is that California may be trying too much too quickly.
(Article may require a subscription.)
#ca #calaim #healthcare #sdohs #socialdeterminants #medicaid #managedcare
A bipartisan bill would tell the Centers for Medicare and Medicaid Services (CMS) to establish hybrid payments to reward primary care providers in the Medicare fee-for-service (FFS) program who provide the best care to their patients, including reducing patients’ emergency visits, hospitalizations, excess specialist services, and other big cost drivers.
Additional article: https://insidehealthpolicy.com/daily-news/whitehouse-cassidy-unveil-primary-care-payment-reform-related-rfi
(Some articles may require a subscription.)
#primarycare #medicare
Bruce Broussard will step down as CEO of Humana on July 1 and be succeeded by Jim Rechtin, who came in as President and COO. Despite some challenges right now financially, he deserves tremendous credit for building a stellar MA business over a decade plus at the helm. He tripled enrollment. Broussard will serve as a strategic advisor through 2026.
Additional articles: https://www.fiercehealthcare.com/payers/jim-rechtin-step-humana-ceo-role-july-1 and https://www.modernhealthcare.com/insurance/humana-jim-rechtin-bruce-broussard-ceo
(Some articles may require a subscription.)
#medicareadvantage #humana #broussard
https://www.healthcaredive.com/news/humana-ceo-transition-timeline-broussard-rechtin/716014
Kaiser Permanente reported $935 million of operating income (3.4% operating margin) and more than $2.7 billion of net income. This beats Q1 2023 dramatically. Kaiser is also looking to sell off up to $3.5 billion of its investment stakes.
Additional articles: https://www.modernhealthcare.com/finance/kaiser-permanente-investments-wsj and https://www.beckershospitalreview.com/finance/kaiser-posts-935m-operating-profit-in-q1.html
(Some articles may require a subscription.)
#kaiserpermanente #healthplans #hospitals
The U.S. Department of Justice (DOJ) has set up a multi-disciplinary task force to examine healthcare monopolies and collusion. It will facilitate policy advocacy, investigations, and civil and criminal enforcement.
#antitrust #mergers #acquisitions #manda
Hospital giant Community Health Systems has filed a lawsuit arguing the data analytics firm MultiPlan has conspired with health plans to fix commercial rates in violation of antitrust rules. Visit my blog on the controversy: https://www.healthcarelabyrinth.com/out-of-network-provider-billing-is-yet-another-provider-attack-issue-against-plans/
(Article may require a subscription.)
#antitrust #healthplans #providers
https://www.modernhealthcare.com/legal/community-health-systems-chs-multiplan-lawsuit
Catholic hospital system Ascension may have been a victim of a major cyberattack. It runs 139 hospitals and 40 senior living facilities across the country.
Additional article: https://www.modernhealthcare.com/cybersecurity/ascension-possible-data-breach-cyberattack
(Some articles may require a subscription.)
#cyberattacks
The House Ways and Means Committee may pass a 2-year extension of telehealth as well as a 5-year extension of hospital at home. It would be paid for by some more moderate pharmacy benefits manager (PBM) reforms, including PBM transparency reporting and income based on service fees only.
Additional article: https://insidehealthpolicy.com/inside-drug-pricing-daily-news/wm-uses-patchwork-pbm-reforms-pay-telehealth-extenders-bill
(Some articles may require a subscription.)
#pbms #hospitalathome #telehealth #medicare
