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
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#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
Medicare Part D will cover obesity drugs if they are approved for specific medical conditions. For example, Novo Nordisk’s Wegovy, just received approval from the Food and Drug Administration (FDA) to reduce risk of stroke or heart attack in people with cardiovascular disease and who are obese/overweight. The same rule will apply to Medicaid. The decision does not make these weight-loss drugs available more broadly.
Additional article on trials showing GLP-1s slowing kidney disease progress and cardiovascular events: https://www.managedhealthcareexecutive.com/view/ozempic-reduces-kidney-disease-progression-cardiovascular-events-by-24-
Additional articles:
https://www.fiercehealthcare.com/payers/wsj-cms-broadens-part-d-coverage-obesity-drugs and https://www.medpagetoday.com/publichealthpolicy/medicare/109305
#weightlossdrugs #medicare #medicaid
Change healthcare will face both class-action lawsuits from patients as well as lawsuits from providers impacted by the Change Healthcare cyberattack. Meanwhile, provider groups, including the American Hospital association, are arguing the government and UnitedHealth Group responses have been inadequate and are pressing lawmakers to intervene with the Department of Health and Human Services (HHS). The complaint is that advanced payments are simply not enough. Congress is also asking HHS if a bill needs to pass granting the agency flexibility in collecting advanced payments.
My blog tomorrow will be a comprehensive review of the Change cyberattack.
Additional articles: https://www.modernhealthcare.com/politics-policy/change-update-aha-financial-help-congress and https://insidehealthpolicy.com/daily-news/lawmakers-does-hhs-need-authority-allow-flexible-repayments-after-cyberattack
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#changehealthcare #cyberattacks
In an effort to further build out its Carelon service subsidiary, Elevance Health is buying Kroger Specialty Pharmacy. This will add to its growing PBM offerings.
Additional articles: https://www.fiercehealthcare.com/payers/elevance-health-acquire-kroger-specialty-pharmacy and https://www.modernhealthcare.com/finance/elevance-health-carelonrx-kroger-specialty-pharmacy
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#kroger #elevancehealth
Some services have been restored by Change Healthcare and more are readying. Change says that claim preparation software for providers will soon come back online. Electronic payments have come back online. United says it has made more than $2 billion in advanced payments from its program.
United as an insurer, Highmark, and the Blue Cross and Blue Shield Association have developed advanced payment programs for providers, but many other insurers are moving slowly on the idea. Other insurers are contracting with Change competitors to help providers file claims. They also are extending claim deadlines. Provider groups say aid is not enough. The Centers for Medicare and Medicaid Services is also asking states to submit state plan amendments so they can advance Medicaid payments.
Additional articles here: https://www.modernhealthcare.com/cybersecurity/change-update-unitedhealth-systems-progress and https://www.modernhealthcare.com/insurance/change-outage-prior-authorization-pay and https://www.modernhealthcare.com/government/change-update-cms-medicaid-reimbursements and https://www.healthcaredive.com/news/change-healthcare-cyberattack-medicaid-flexibilities-american-hospital-association-survey/710561/
(Some articles may require a subscription.)
#changehealthcare #cyberattacks
Good article from Fierce Healthcare and analysis from Kaiser Family Foundation on healthcare spending in Medicare households. Medicare households spend more on healthcare than other households. Health spending burden was twice as high.
Analysis by KFF: https://www.kff.org/medicare/issue-brief/medicare-households-spend-more-on-health-care-than-other-households/
#coverage #costs #medicare #medicareadvantage
While insurtechs overall have struggled, at least three – Alignment Healthcare, Devoted Health, and Clover Health – appear to be doing well. Clover Health had an adjusted EBITDA loss of $19.1 million in the fourth quarter and a full-year loss of $44.7 million last year. This is significantly better than in 2022. Its medical loss ratio (MLR) is projected to be just 81.2% for 2024. It expects adjusted EBITDA profit up to $20 million. Since it began, it, too, amassed a sizeable membership.
#clover #insurtechs
While insurtechs overall have struggled, at least three – Alignment Healthcare, Devoted Health, and Clover Health – appear to be doing well. Clover Health had an adjusted EBITDA loss of $19.1 million in the fourth quarter and a full-year loss of $44.7 million last year. This is significantly better than in 2022. Its medical loss ratio (MLR) is projected to be just 81.2% for 2024. It expects adjusted EBITDA profit up to $20 million. Since it began, it, too, amassed a sizeable membership.
#clover #insurtechs
At an unprecedented meeting, UnitedHealth Group CEO Andrew Witty heard from both Health and Human Services (HHS) Secretary Xavier Becerra and providers at a government sponsored meeting. The plea was for United to take responsibility for the Change Healthcare cyber attack and give additional financial support to providers.
In addition, HHS detailed more about what a $1.3 billion fund for cyber security would be used for. About 2,000 hospitals will receive incentive funds to adopt new cyber security practices. Another $153 million would go for various government initiatives.
Additional article: https://www.fiercehealthcare.com/providers/becerra-stakeholders-its-time-take-accountability-cybersecurity
#changehealthcare #unitedhealthcare #cyberattacks
