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CHS Sues MultiPlan Arguing Conspiracy With Health Plans To Fix Commercial Rates

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/

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#antitrust #healthplans #providers

https://www.modernhealthcare.com/legal/community-health-systems-chs-multiplan-lawsuit

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Possible Cyberattack At Ascension

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

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#cyberattacks

https://www.fiercehealthcare.com/providers/systems-clinical-operations-interrupted-ascension-amid-apparent-cybersecurity-event

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Telehealth and Hospital At Home Extensions Coming

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

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#pbms #hospitalathome #telehealth #medicare

https://www.fiercehealthcare.com/regulatory/house-ways-means-committee-reveals-two-year-telehealth-extension-legislation

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Medicare Part A Trust Fund Has A Bit More Life

The Medicare Part A Insurance Trust Fund will be solvent for longer than previously projected says the annual Medicare Trustees report. While there are “significant financing issues,” the program will be able to pay all scheduled benefits until 2036, five years longer than the last report. No one can take policy credit (even though the Biden administration will try to do so) for meaningfully adding years to Medicare’s life.  It is all related to technical issues and occurrences. The truth is no party has a coherent policy to stabilize Medicare or entitlements for that matter. Benefit cuts or tax increases will be big if nothing is done.

Additional articles: https://www.beckershospitalreview.com/finance/medicares-financial-picture-brightens-slightly.html and https://thehill.com/policy/healthcare/4647137-medicare-fund-economy-solvent-yellen/

#medicare #entitlements #healthcare

https://www.fiercehealthcare.com/payers/medicare-hospital-trust-fund-extended-five-years-2036

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Biden Administration Rule Makes DACA Dreamers Eligible For Exchanges

Under a new rule, the Centers for Medicare & Medicaid Services (CMS) will make the Deferred Action for Childhood Arrivals (DACA) or dreamers eligible for Exchange enrollment. There are hundreds of thousands of Dreamers and the administration estimates that 100,000 will enroll.

Additional articles: https://www.fiercehealthcare.com/regulatory/daca-recipients-eligible-obamacare-under-cms-rule and https://www.modernhealthcare.com/politics-policy/biden-obamacare-access-daca-affordable-care-act-hhs-xavier-becerra

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#exchanges #aca #obamacare

https://thehill.com/latino/4639985-biden-obamacare-dreamers-affordable-care-act-daca/

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Alignment Healthcare Reports Growth In Members But Continued Losses

Alignment Healthcare will report 165,000 increased enrollment at its Q1 2024 investor call, but a loss from operations of $41.1 million. This still means the insurtech likely is on its way to profitability.

#alignmenthealthcare #medicareadvantage

https://www.fiercehealthcare.com/payers/alignment-healthcare-raises-membership-guidance-posts-466-million-loss

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Stunning Admission By United HealthGroup CEO

It was the roasting that was expected, with both sides of the aisle attacking Andrew Witty when he appeared on Capitol Hill.  The United HealthGroup CEO made a stunning admission when he said that Change Healthcare had legacy architecture and technology based largely on internal data centers. It says it is rebuulding all of it on a cloud-based, modern infrastructure. This alone substantiates a lack of business continuity and disaster recovery readiness. In the last few days, United also admitted that simple multi-factor authentication was not in place and that is how the cyber criminals got into the Change platforms.

The testimony adds to my theory that when massive consolidation occurs, technology is not modernized and as I call it “spaghetti-ed together.”  The testimony will lead to additional scrutiny of United, a review of vertical integration and consolidation in healthcare, as well as more lawsuits and eventual fines for United.

See my blog and podcast on the Change debacle: https://www.healthcarelabyrinth.com/17-what-happened-when-change-healthcare-suffered-a-major-cyberattack-and-what-will-it-mean-to-the-broader-healthcare-system-moving-forward/ and https://www.healthcarelabyrinth.com/the-change-healthcare-cyberattack-what-it-is-and-its-implications/

Additional articles: https://www.fiercehealthcare.com/payers/too-big-fail-consolidation-concerns-loom-over-hearing-change-healthcare-cyberattack and https://www.modernhealthcare.com/politics-policy/unitedhealth-andrew-witty-change-healthcare-hearings and https://www.medpagetoday.com/washington-watch/washington-watch/109918 and https://www.beckershospitalreview.com/finance/a-crisis-of-your-creating-unitedhealth-ceo-grilled-by-congress-on-cyberattack.html

(Some articles may require a subscription.)

#changehealthcare #cyberattacks #unitedhealthcare

https://thehill.com/homenews/4635480-unitedhealth-ceo-heat-cyberattack-senate/

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A Peak At United HealthGroup CEO’s Planned Testimony

The United HealthGroup CEO plans on giving detailed testimony this week on Capitol Hill.  His testimony outlines how the cyberattackers got in, which may point to a security flaw in Change Healthcare’s system. United has funneled $6.5 billion to providers impacted so far.

Additional article here: https://www.modernhealthcare.com/politics-policy/unitedhealth-andrew-witty-congress-change-healthcare-outage

(Some articles may require a subscription.)

#changehealthcare #cyberattacks

https://www.fiercehealthcare.com/payers/unitedhealth-ceo-witty-set-go-congress-week-heres-look-his-testimony

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New Study Recommends Health-Related Tiering For Access To GLP-1s

A new study recommends a tiering of GLP-1 medication access based on health status. The problem is the price of the drugs are exorbitant compared with other developed countries. And wide access to the drugs is often only available in richer health plans. As such, the reasonable proposal is destined for the ash heap for now.

#weightlossdrugs #branddrugmakers #drugpricing

https://www.fiercehealthcare.com/regulatory/heres-what-fair-allocation-glp-1s-and-other-weight-loss-drugs-could-look

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FTC Approves Rule Extending Data Privacy To Digital Apps

On a 3-2 vote, the Federal Trade Commission (FTC) finalized a rule that extends the scope of its breach notification rule to include personal health information collected by health apps and other technology that are outside the Health Insurance Portability and Accountability Act.  It is a very controversial move and may be beyond the FTC’s authority.

Additional article: https://insidehealthpolicy.com/daily-news/ftc-issues-controversial-breach-notification-rule-despite-two-commissioners-dissent

#cybersecurity #breaches

https://www.fiercehealthcare.com/health-tech/ftc-finalizes-changes-data-privacy-rule-step-scrutiny-digital-health-apps

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