The Kaiser Family Foundation reports that almost 18 million initially lost coverage during Medicaid redeterminations. Some regained eligibility later. Most lost coverage on procedural grounds. Enrollment has dropped by about 10M so far in Medicaid nationwide.
#medicaid #redetermintations
Walgreens says that its road to financial recovery will be long – not a 12-month plan. It is undertaking a strategic review of its business. It plans to cut $1 billion in expenses this year.
Additional article: https://www.modernhealthcare.com/providers/walgreens-tim-wentworth-villagemd-shields-health-ownership
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#walgreens
I am a big fan of Mark Cuban and what he and his Cost Plus Drugs are doing to reform the drug price system. So when he speaks, I listen. At a White House round table, Cuban proposed that federal programs cut off all ties to traditional pharmacy benefits managers (PBMs) and embrace full transparency. He has a direct-to-consumer firm and various transparent PBMs are all in on this idea.
The White House liked the transparency idea but knows it is easier said than done and there are many barriers to unravel what we have now. I note that the transparency model emerging right now works well for generic drugs, but it will be harder and take more time for brand drugs, especially until we get prices lower and solve for the shadowy rebate system.
But Cuban’s transparency and frankness is where the drug world needs to go. Cuban and advocates for reform also noted that at least some of the shortages we are seeing now are caused by the traditional opaque pricing and delivery channels. Cost Plus Drugs will begin manufacturing generics, targeting some with major supply issues. Hopefully Cuban’s radical approach gets people to think differently. PBMs need to reform. Brand drug makers have to embrace lower prices while safeguarding innovation. Direct-to-consumer models are the way to go.
Additional article: https://insidehealthpolicy.com/inside-drug-pricing-daily-news/biden-admin-urged-cut-ties-top-pbms-achieve-lower-drug-costs
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#drugpricing #cuban #costplusdrugs #pbms #healthcarereform
A bipartisan spending bill has been agreed to by key lawmakers and will need to be voted on in each House. The package basically cuts in half the Medicare doc fix cut of 3.4%, pushes back scheduled disproportionate share hospital (DSH) payment cuts, and increases annual funding for community health centers. Accountable Care Organizations’ (ACOs) bonus program was also protected. Absent from the bill are major healthcare reforms. Docs are not very happy with the partial fix and no total overhaul of their rates.
Additional articles here: https://www.fiercehealthcare.com/providers/congress-reaches-spending-deal-doc-pay-bump-delayed-dsh-cuts-and-more and https://insidehealthpolicy.com/health-insider/lame-duck-battle-looms-health-wins-skinny-bill-expiring-december and https://insidehealthpolicy.com/daily-news/skinny-health-package-scales-back-doc-fix-adds-chc-funding and https://www.medpagetoday.com/practicemanagement/reimbursement/109008 and https://thehill.com/policy/healthcare/4507164-government-funding-bills-leave-out-phamacy-benefit-manager-industry-changes-as-white-house-mulls-reforms/
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#governmentshutdown #healthcare
Good article in Modern Healthcare discussing the fact that, while there will be major bumps in the road, Medicare Advantage (MA) will remain viable and strong. A great quote from Paul Ginsburg, senior fellow at the University of Southern California Schaeffer Center for Health Policy and Economics. “We’re not talking about any risk to the financial integrity of these companies at all. The Medicare Advantage business is very viable long-term because they’re providing something that more and more Medicare beneficiaries are deciding they want,” Ginsburg said. “Will it be as great for the next few years as it has been? Probably not. It’ll still be very good, though.”
This echoes what I said in a January 29, 2024 blog ( https://www.healthcarelabyrinth.com/with-boom-over-will-medicare-advantage-collapse-or-adjust/ ) as well as a February 9 Podcast ( https://www.healthcarelabyrinth.com/9-is-medicare-advantage-exploding-after-its-boom-or-simply-adjusting/ ).
As I say, the real victims of terrible policies from the Centers for Medicare and Medicaid Services (CMS), such as the prior authorization rule, will be fixed income seniors who will lose a great deal of benefits. It is a shame.
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#medicareadvantage
The fallout continues over the cyber attack suffered by Change Healthcare. United Health Group confirmed the attack was a ransomware one and that the BlackCat cyber gang was behind it.
Additional article here:https://www.modernhealthcare.com/cybersecurity/change-healthcare-cyberattack-outage-blackcat-alphv-2024
As well, good overviews of cyber security and the overall event and impacts: https://www.modernhealthcare.com/cybersecurity/change-healthcare-outage-cyberattack-data-breaches-2024 and https://kffhealthnews.org/news/article/unitedhealth-change-healthcare-blackcat-hack-cybersecurity/
Meanwhile, a prominent provider group is calling on the federal government to help them regarding the current Change Healthcare cyber attack, but to also strengthen security overall: https://insidehealthpolicy.com/daily-news/mgma-hhs-help-industry-mitigate-massive-ransomware-attack
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#cyberattacks #changehealthcare
House Speaker Mike Johnson, R-LA, and Senate Majority Leader Chuck Shumer, D-NY, announced that a stop gap continuing resolution has been agreed to by leaders. This would extend keeping the government open for several weeks. It likely will include a partial Medicare doc fix and restoration of disproportionate hospital cuts. How the House Freedom caucus will vote is unknown.
Additional article here: https://insidehealthpolicy.com/daily-news/lawmakers-announce-partial-approps-deal-including-fda-new-cr
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#governmentshutdown #crs
With the ongoing cyberattack at Change Healthcare ongoing, The Wall Street Journal reports that the U.S. Department of Justice has an active antitrust investigation going on. It centers on certain relationships between the company’s UnitedHealthcare insurance unit and its Optum health services arm. Optum is the largest service organization associated with an insurer corporately. Optum’s tentacles are long and hit almost every area of healthcare. Health plans like Cigna and Elevance Health will be watching as they have dreams of having service units as big as Optum. These service units generate huge revenue and margins as the business is basically unregulated compared with an insurer (which is confined by the minimum medical loss ratio (MLR) requirements in most products)
Additional article here: https://www.reuters.com/business/healthcare-pharmaceuticals/us-launches-antitrust-investigation-into-unitedhealth-wsj-reports-2024-02-27/
#unitedhealthcare #antitrust #optum
While the hospital industry is recovering overall from the COVID slump, recovery is not universal in the hospital industry. And there are still some bad barometers of financial performance overall.
#hospitals
Change Healthcare announced a major cyber attack on its systems this week. The event shows how vulnerable major healthcare organizations can be. Change is owned by The United Health Group, granddaddy of insurance and owner of prominent service entity, Optum. Change rolls up to Optum.
The attack shows how far-reaching a successful penetration could be. Change is a vendor. It has various products and connects to health plans throughout the country. It also connects to providers and pharmacies throughout the country.
Change says the attacker was a nation-state associated cyber security threat actor. Little else is known about how far-reaching the attack was or the fallout yet.
Additional article here: https://www.modernhealthcare.com/cybersecurity/change-healthcare-outage-cyberattack-2024-update
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#cyberattacks #healthcare
