Kudos for Kaiser Health News’ articles and focus on fraudulent switching in the Exchanges by untrustworthy agents. The trend has caused a lot of misery for enrollees. One problem was the access by agents and brokers to full social security numbers (SSNs). As of today, that has been cut off by the Centers for Medicare and Medicaid Services (CMS) in the federal Marketplace. Henry Kaiser is smiling from heaven.
#kff #khn #fwa #exchanges #aca
A Harvard and Inovalon study finds that enrollees in Medicare Advantage (MA) with zero-dollar premiums are three times more likely to be minorities than white. They also are more likely to be urban. Researchers note that MA is not monolithic and that different benefit offerings appeals to enrollees. The same researchers have found that MA enrollees have fewer hospitalizations, yet more social determinant barriers. More are in Health Maintenance Organization (HMO) products which has lower costs.
I would note that MedPAC and other critical organizations simply spend too little time on these types of stats. I would also say that these kind of advantages for low and fixed income seniors will be ruined by poor rate hikes and terrible prior authorization rules that have just been finalized. It is a real shame.
#medicareadvantage
Medicare Part D plans can now immediately substitute all FDA-approved biosimilars even if they are not deemed interchangeable by the drug approval agency, under the 2025 Medicare Advantage (MA) and Part D rule finalized by the Centers for Medicare and Medicaid Servies (CMS). Interchangeability is an extra step that drug makers take to substitute for brand biologics. The new rule will allow Part D plans to treat formulary substitutions of any biosimilars as maintenance changes as was allowed earlier just for interchangeables.
The Biden administration has pushed for biosimilar adoption in many ways and this is yet another. This should begin to mean lower biologic costs for Medicare members.
(Article may require a subscription.)
#biosimilars #drugpricing #medicareadvantage #partd #medicare
CVS Caremark President David Joyner wrote and op-ed for Fortune to explain the innovation and transparency his pharmacy benefits manager (PBM) is engaged in. It seeks to counter some of the press Mark Cuban is getting. I will note that leadership at CVS Health overall is on a path of reform and innovation.
#cvshealth #pbms #transparency
Democrat members of the Senate HELP Committee staged a hearing on the role of corporate greed in healthcare. Of particular concern was the role of private equity firm monies and whether dollars are diverted out from healthcare to corporate margins. PE firms have big investments in both hospitals and provider groups.
Additional article: https://www.fiercehealthcare.com/regulatory/steward-healthcares-struggles-full-display-clinicians-policy-researchers-tell-senators
#privateequityfirms #healthcare
Private equity investments are already being broadly looked at by Congress and regulators. Now, the Senate Homeland Security and Governmental Affairs Committee is seeking information on private equity’s role in emergency physician staffing firms that are leaving hospital emergency departments unprepared.
Letters were sent to Apollo Global Management, the Blackstone Group and KKR — three of the nation’s largest private-equity firms — and four emergency medicine staffing companies owned by the firms. It is estimated at least 40% of hospital emergency departments are overseen by staffing companies that are owned by private-equity firms.
Additional article: https://www.fiercehealthcare.com/providers/senator-probes-private-equity-physician-staffing-firms-emergency-care-cost-cutting
#privateequityfirms #healthcare
A new survey from Virta Health backs up the bleak cost picture. It says that 43% of health plan leaders are predicting 100% or more growth in GLP-1s for weight loss and obesity in 2024. More than half say GLP-1s will be a top 3 drug in 2024 in terms of spending. One fifth say they will be their most expensive drug class this year. Executives believe the media is misrepresenting GLP-1s and that lifestyle programs should be tried first. At the same time, a Vitra Health-linked study comes to a different conclusion on what occurs after stopping GLP-1s. It says those who stop taking GLP-1s can avoid negative effects on glycemia and body weight if they are properly engaged in their healthcare, including proper nutrition.
See my blog today on the subject: https://www.healthcarelabyrinth.com/whats-all-the-clamor-over-glp-1s-for-weight-loss/
#weightlossdrugs #drugpricing
Touching story on NBA great Robert Horry’s healthcare adventures with his daughter, who lived with a genetic disorder and died in her 18th year. It is a testament to why we need affordable universal access to healthcare. Horry is now with a company promoting Individual Coverage Health Reimbursement Arrangements (ICHRA), which allows businesses to cover portions of healthcare premiums and allows employees to privately procure insurance (usually on the Exchange). To me, it is one of the few positive healthcare developments from the Trump administration.
#ichra #obamacare #aca #exchanges
We don’t know yet if Change’s breach will be a record. But based on the 6 terabyte report of compromise as well as the breadth of the Change system, it very well could be. United is reporting that it may be hard to tell who was impacted by the breach. Further, because of Change’s tentacles in the market with providers and payers, it could be that people are notified multiple times from different providers and a payer that their data was impacted. There could be hundreds of millions (even billions) of notifications. This will cause mass confusion.
In other events, United seems to be complaining that some insurers and providers are slow to reconnect to Change systems, which is needed to get the flow of information and claims. Some complain that they do not know yet if Change is secure. They are testing and obtaining independent verification. Also, some argue that reconnecting is difficult as certain systems are still down. Article here: https://www.modernhealthcare.com/cybersecurity/change-healthcare-update-unitedhealth-reconnect
This other article speaks to the continuing fallout and issues with systems, even those that have been restored. Things are not business as usual: https://www.modernhealthcare.com/providers/change-healthcare-update-networks-issues
(Some articles may require a subscription.)
#changehealthcare #cyberattacks
A new Government Accountability Office analysis finds that the federal government made nearly $236 billion in improper payments in 2023. The payments were largely in Medicare, Medicaid, Pandemic Unemployment Assistance, the Earned Income Tax Credit and Paycheck Protection Program loan forgiveness.
Medicare had the largest improper payments at $51.1 billion. Medicaid had $50.3 billion.
GAO Report here: https://www.gao.gov/products/gao-24-106927
#fwa #medicare #medicaid
