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December 19, 2023

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New Antitrust Merger Guidelines

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

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December 18, 2023

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More “Retail Meets Healthcare” Investments

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

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December 15, 2023

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Elevance Health and HCSC Looking At Cigna Medicare

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

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December 14, 2023

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Medicare Drug Reform Law Working

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

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December 13, 2023

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CMS Actuary Releases 2022 Healthcare Statistics

The CMS Actuary has released its analysis of 2022 national healthcare expenditures. I will write a blog on this in the next week. At the link is the website where the data is uploaded. Centers for Medicare and Medicaid release here: https://www.cms.gov/newsroom/fact-sheets/national-health-expenditures-2022-highlights .

In addition, four other articles on the new data: https://www.fiercehealthcare.com/payers/back-normal-health-care-spending-growth-rates-down-pandemic-era-times and https://www.healthaffairs.org/content/forefront/ahead-print-national-health-spending-2022 and https://www.modernhealthcare.com/policy/us-health-care-spending-rose-over-4-trillion-2022 and https://insidehealthpolicy.com/daily-news/cms-2022-health-spending-report-finds-medicaid-drove-federal-spending .

Healthcare spending increased 4.1% in 2022 to $4.5 trillion. In 2022, the share of the economy devoted to healthcare spending as a percentage of gross domestic product (GDP) was 17.3 percent. Healthcare’s share of GDP as well as the percentage cost increase both went down in part due to lower government spending on the pandemic from prior years. In addition, Medicaid spending due to enrollment growth was very high.

(Some articles may require a subscription.)

#healthcare #costs

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December 12, 2023

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A Rare Occurrence For Healthcare Costs

In a rare occurrence, medical service costs at hospitals increased 2% in the first three quarters of 2023. This is about the 1.9% that the economy grew. Generally, hospital costs tend to far exceed economic growth and inflation. The report is from Turquoise, a new price transparency startup.  The findings also show that costs can vary across regions/markets as well as within markets.

#pricetransparency #healthcare

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December 11, 2023

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Cigna-Humana Merger Off — For Now

The Cigna-Humana merger is reportedly off as the entities could not arrive at financial terms. This leaves Cigna with two big decisions: (1) What smaller deals will they enter into? and (2) Will they sell their Medicare Advantage (MA) business? While MA is a smaller portfolio than many big plans have, if it can improve its Star scores and make additional investments, it could still be lucrative for Cigna. On the other hand, Cigna may be investing most of its efforts in its non-margin-limiting Evernorth services subsidiary. Additional articles: https://www.modernhealthcare.com/mergers-acquisitions/cigna-humana-merger-deal-scrapped-stock-buyback and https://www.healthcaredive.com/news/cigna-humana-deal-falls-through-wall-street-journal/702091/ and https://thehill.com/policy/healthcare/4353008-cigna-ends-plans-to-merge-with-humana-report/

(Some articles may require a subscription.)

#healthplans #mergers #acquisitions #cigna #humana

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December 8, 2023

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New Poll On Affordable Care Act And Healthcare Issues

A new poll shows that the American public favors maintaining the Affordable Care Act and reforming the current healthcare system. My blog Monday will build on my December 7 blog and go deep into this poll.

#healthcare #healthcarereform #affordableuniversalaccess #universalaccess

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December 7, 2023

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United Health Foundation Says Chronic Conditions Rising

The United Health Foundation released a study that concludes chronic conditions are rising in the U.S. It also released its annual “America’s Health Rankings” report, which tracks health across the country based on 87 measures and 28 data sources.

United finds that persons with multiple chronic conditions has reached their highest levels since they were first tracked. Mental health and diabetes have risen.  It also found health condition disparities exist for asthma, COPD, and diabetes. United also found that more people have multiple co-morbidities.

United calls for investments in care management as well as health equity.

As I note in my book, The Healthcare Labyrinth (available on this website), one of America’s key problems is a lack of investment in health, wellness, and care management.  Other developed nations concentrate resources here and have much better outcomes, fewer people with disease states and conditions, and have better maintenance of conditions. 

There is no question plans need better data and analytics in order to intervene not only at the member level, but also at the group level to tackle social determinant barriers and health equity. This is a good place for plans to focus as the prior authorization area becomes much more constrained via regulation.

#healthcare #chronicconditions #disparities #healthequity

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December 6, 2023

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Affordable Care Act 2025 Rule And Ongoing Press On Trump Repeal Remarks

While we have already covered the proposed 2025 Exchange rule, this article from Kaiser Health News discusses the rule as well as some of the history of the Affordable Care Act under Trump and later Biden.

#aca #obamacare #exchanges #medicaid

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