Good article on the healthcare lawsuits to watch in 2024, including many challenging the Inflation Reduction Act’s (IRA) Medicare drug price negotiations as well as preventive service mandates in the Affordable Care Act (ACA).
#aca #ira #exchanges #obamacare #drugpricing
The article says that hospital mergers and acquisitions will pick up in 2024. A number of factors are cited, including financial pressures and outside forces. Deals were robust before the COVID pandemic and then collapsed. They picked up in 2023 and will grow more in 2024. They won’t hit pre-pandemic levels though. New merger guidelines and the Biden administration’s anti-trust views could be a wild card and impact the ongoing recovery of M and A.
(Article may require a subscription.)
#hospitals #mergers #acquisitions
Merry Christmas and Happy Holidays to all!
— Marc S. Ryan and The Healthcare Labyrinth website.
A good article on what to expect in M and A. Discusses consolidation and technology as well as has suggestions for healthcare leaders.
#manda #acquisitons #mergers #healthplans #hospitals #providers #2024
A good article on what is in store for payers and providers in 2024. Included is retail healthcare, health plan investments, hospital struggles, and M and A prospects.
#manda #retailhealthcare #healthplans #hospitals #providers #2024
Based on current enrollments on the Exchanges, the feds say enrollment will break a record with 19 million in 2024. Up from 16.4 million in 2023. This is driven by the extension of the enhanced premium subsidies and other investments in outreach and marketing. Additional articles here: https://insidehealthpolicy.com/daily-news/admin-least-19m-enrolled-aca-plans-nationwide-nov-1 and https://thehill.com/policy/healthcare/4369743-white-house-touts-record-breaking-obamacare-enrollment/ CMS release here: https://www.cms.gov/newsroom/press-releases/healthcaregov-enrollment-exceeds-15-million-surpassing-previous-years-milestones
(Some articles may require a subscription.)
#aca #obamacare #exchanges #coverage
The Federal Trade Commission (FTC) and the Department of Justice (DOJ) finalized new guidelines for mergers and acquisitions. They are not legally binding. Each deal would receive an assessment based on the uniqueness of the parties and merger. The guidelines give health plans, hospitals, and others in healthcare a look into the decision-making process to determine consistency with antitrust rules. The guidelines and greater scrutiny fulfill a Biden administration pledge and come from an executive order.
FTC release here: https://www.ftc.gov/news-events/news/press-releases/2023/12/federal-trade-commission-justice-department-release-2023-merger-guidelines . Additional article here: https://www.healthcaredive.com/news/ftc-doj-final-merger-guidelines-healthcare/702897/
At the same time, two hospital entities called off their merger after challenges from the FTC and state of California regulators: https://www.fiercehealthcare.com/providers/john-muir-health-tenet-healthcare-nix-143m-hospital-deal-after-regulatory-pushback
Overall, the scrutiny is good, especially on provider proposals, as most mergers lead to higher costs.
#ftc #doj #mergers #acquisitions #antitrust #hospitals #healthplans
Kroger is piloting value-based primary care clinics like many other retailers. The grocery chain will team up with Better Health Group, a provider network, to build out primary care centers. Kroger in-store clinics will be replaced. There is a senior focus.
Walgreens is pulling back on its clinic investments. So, retail healthcare is not without its risks but will continue to grow.
#retailhealthcare #kroger
Reports suggest Elevance Health and Health Care Service Corporation (HCSC) are looking at acquiring Cigna’s Medicare Advantage (MA) lives. Cigna has just over 600,000 Medicare Advantage lives, but has had lower Star ratings than desired. HCSC has just 180,000 MA lives and would love to acquire a bigger footprint. Elevance Health has just over 2 million lives and is trying to grow Medicare as well. In 2021, Elevance acquired MMM’s almost 300,000 lives in Puerto Rico to help with organic growth.
#elevancehealth #hcsc #cigna #medicareadvantage #mergers #acquisitions
The Centers for Medicare & Medicaid Services (CMS) says 48 prescription drugs will have lower Part B beneficiary coinsurances in the first quarter of 2024 due to price hikes by drug makers that exceeded allowable increases, with out-of-pocket costs decreasing by $1 to as much as $2,786 per average dose. Over the last four quarters, 64 drugs in total had prices that increased faster than inflation and may be subject to inflation rebates because of the Inflation Reduction Act (IRA). It is hard to argue that the Medicare drug reforms are not working in this case. At the same time, CMS issued a letter to plans and PBMS urging fair reimbursement to pharmacies and urging preparation for 2024 changes under Part D. CMS letter here: https://www.cms.gov/newsroom/fact-sheets/cms-letter-plans-and-pharmacy-benefit-managers . Additional article here: https://www.medpagetoday.com/publichealthpolicy/healthpolicy/107878 . The CMS announcement and backup material here: https://www.cms.gov/newsroom/press-releases/cms-releases-revised-guidance-medicare-prescription-drug-inflation-rebate-program . Similar Health and Human Services release and info here: https://www.hhs.gov/about/news/2023/12/14/new-hhs-actions-and-research-highlight-how-president-bidens-administration-lowering-prescription-drug-costs.html .
#drugpricing #ira
