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
A new poll says Medicare Advantage (MA) enrollees are more likely than those in traditional Medicare fee-for-service (FFS) to experience care delays due to prior authorization, but they do receive supplemental benefits not in the traditional program. While the rates of such use can always be better, a 70% member-use rate is encouraging. Still, it is indeed time for MA plans to show their value by encouraging the use of all of the added benefits at reasonable rates. Proposed supplemental benefits reporting rules will encourage this trend. Overall, MA plans need to educate members thoroughly on all benefits, lest critics and researchers build a case that there is no added value. The critics continue to argue massive overpayments, which I do not agree with.
One point just does not resonate with me. About 12% of MA members said they had affordability issues while about 7% of traditional Medicare enrollees said so. With all that MA does to reduce gaps in traditional benefits, it makes little sense to me.
Additional article: https://www.medpagetoday.com/special-reports/features/108846
#medicare #medicareadvantage
Medicaid disproportionate share hospital (DSH) payments are being cut by $8 billion annually for the nest five fiscal years based on a new rule finalized by the Centers for Medicare and Medicaid Services (CMS). The rule is purported to rein in overpayments. A recent study suggested that a liberal formula calculation meant a third of all qualifying hospitals should not have received payments. CMS has been pushing to reduce such payments in favor of broad coverage.
Additional articles: https://www.fiercehealthcare.com/providers/many-disproportionate-share-hospitals-face-lower-medicaid-payments-under-new-final-rule and https://www.modernhealthcare.com/policy/medicaid-dsh-cuts-safety-net-hospitals-cms-final-rule
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#medicaid
After record years of funding, digital health ventures are facing lean times to stay solvent.
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#digitalhealth #healthcare
A good article from Kaiser Health News (KHN) that looks at growing contract disputes between providers and payers. This one was in CA, but this is occurring nationwide. KHN mentions higher costs coming from provider consolidation as well as increasing leverage when payers merge. The Biden administration is on to something with its anti-trust initiative.
#providers #healthplans #coverage #payments
The No Surprises Act (NDA) remains a huge mess with volume 13 times higher than forecast for 2023. What’s more, providers won 77% of arbitration cases and health insurers won in 23% of cases. The winning offers were above the qualifying payment amount, which is the median in-network rate.
The good news is that 10 million surprise bills were avoided with the law in the first nine months of 2023. The bad news is that providers are winning huge in the baseball-style arbitration as they do in other states that have it. Studies show that rates and premiums rose in those states under the provider-friendly process. Researchers say that will happen nationwide now. Yet, providers continue to sue to get things even more slanted toward them. Congress has to even the playing field. But they won’t as lawmakers from both sides of the aisle are provider-friendly due to campaign contributions and hospital board seats.
Evidence too that a small number of firms are driving cases. And the three largest are all private equity or venture backed.
Additional article here: https://www.fiercehealthcare.com/regulatory/surprise-billing-disputes-continue-far-outpace-federal-estimates-cms
#privetequityfirms #providers #nsa #nosurprisesact #surprisebilling
Cigna said it would repurchase $3.2 billion in stock as part of a repurchase of $5 billion of common stock over the first half of 2024. This will help enhance its stock price. Cigna will get $3.7 billion for its Medicare Advantage sale to Health Care Service Corporation (HCSC) when it closes.
#cigna #hcsc
Facing pushback from Louisiana regulators, the governor and some lawmakers, BCBSLA has again withdrawn its application for sales to Elevance Health. BCBSLA sought permission to transition to a for-profit entity.
Additional article: https://www.modernhealthcare.com/mergers-acquisitions/elevance-health-blue-cross-louisiana-merger-called-off
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#bcbsla #elevancehealth
Private equity firms’ investment in the Medicare Advantage (MA) space are way down from a peak in 2021. This is a sign that rising medical expense and regulation is impacting the industry. Just 4 deals occurred in 2023, down from 19 in 2021.
Additional article here: https://www.modernhealthcare.com/finance/private-equity-medicare-advantage-pesp-report
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#medicareadvantage #privatequityfirms
