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Change Cyberattack Could Open Americans Up To Multiple Notifications Of Breach

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

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#changehealthcare #cyberattacks

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Improper Payments Huge In Federal Programs

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

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The Looming Election Year Debate Over The Affordable Care Act

This article captures the big divide between advocates and detractors of the Affordable Care Act (ACA). Good links to various studies.

Proponents say that over 21 million are enrolled in the Exchanges and a total of about 45 million gained coverage including Medicaid expansion.  Opponents argue costs have been huge — 36,798 per additional private insurance enrollee and 20,739 per additional non-group enrollee.  This is well above original estimates. Further, critics say insurers have benefited disproportionately.

Here is my Republican defense of the ACA – as strange as that sounds.

  • Yes we could look at reining in the rich benefit, but upfront coverage even at these costs will ultimately save dollars.
  • At least some of the costs have been caused by poor policy actions that have driven costs under the Obama and Trump administrations.
  • With 45M gaining coverage and tens of millions helped by pre-existing condition rules and the ability to stay on parents’ coverage until age 26, this law is going nowhere.  Reform it – do not repeal it. Opponents have failed to recommend anything that promotes quality coverage.

I also am dubious of the study that says 3 in 4 (73%) U.S. adults “report that in one way or another the healthcare system is failing to meeting their needs.”  Other surveys would suggest general contentment with their coverage and insurer.

#healthcare #healthcarereform #aca #obamacare #exchanges #medicaid 

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Biden Signs Funding Bill

President Joe Biden signed a $1.2 trillion spending package on Saturday, avoiding a government shutdown. The package includes funding for the Department of Health and Human Services (HHS). The Senate passed the measure 74-24, technically after the deadline.

Additional article: https://www.modernhealthcare.com/politics-policy/spending-bill-passes-hhs-funding

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#governmentshutdown #spending #healthcare

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Senate Has Funding Bill After House Passage

The Senate will need to pass a huge funding bill before midnight Friday to avert a government shutdown.  The House passed the bill, which includes healthcare funding, on a vote of  286-to-134 (112 Republicans and 22 Democrats voted against the bill). One conservative House member has called for the ouster of House Speaker Mike Johnson, R-LA, who hails from the Freedom Caucus.  She says she has support from folks, but the caucus and some Democrats do not want to see more chaos. The GOP hold on the House will be razor-thin with two early retirements.

#governmentshutdown

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Medicare To Cover GLP-1s For Specific Conditions

Medicare Part D will cover obesity drugs if they are approved for specific medical conditions. For example, Novo Nordisk’s Wegovy, just received approval from the Food and Drug Administration (FDA) to reduce risk of stroke or heart attack in people with cardiovascular disease and who are obese/overweight. The same rule will apply to Medicaid. The decision does not make these weight-loss drugs available more broadly.

Additional article on trials showing GLP-1s slowing kidney disease progress and cardiovascular events: https://www.managedhealthcareexecutive.com/view/ozempic-reduces-kidney-disease-progression-cardiovascular-events-by-24-

Additional articles:

https://www.fiercehealthcare.com/payers/wsj-cms-broadens-part-d-coverage-obesity-drugs and https://www.medpagetoday.com/publichealthpolicy/medicare/109305

#weightlossdrugs #medicare #medicaid

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Both Class-Action And Provider Lawsuits Filed Against Change

Change healthcare will face both class-action lawsuits from patients as well as lawsuits from providers impacted by the Change Healthcare cyberattack. Meanwhile, provider groups, including the American Hospital association, are arguing the government and UnitedHealth Group responses have been inadequate and are pressing lawmakers to intervene with the Department of Health and Human Services (HHS).  The complaint is that advanced payments are simply not enough. Congress is also asking HHS if a bill needs to pass granting the agency flexibility in collecting advanced payments.

My blog tomorrow will be a comprehensive review of the Change cyberattack.

Additional articles: https://www.modernhealthcare.com/politics-policy/change-update-aha-financial-help-congress and https://insidehealthpolicy.com/daily-news/lawmakers-does-hhs-need-authority-allow-flexible-repayments-after-cyberattack

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#changehealthcare #cyberattacks

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Elevance Health To Buy Kroger Specialty Pharmacy

In an effort to further build out its Carelon service subsidiary, Elevance Health is buying Kroger Specialty Pharmacy.  This will add to its growing PBM offerings.

Additional articles: https://www.fiercehealthcare.com/payers/elevance-health-acquire-kroger-specialty-pharmacy and https://www.modernhealthcare.com/finance/elevance-health-carelonrx-kroger-specialty-pharmacy

(Some articles may require a subscription.)

#kroger #elevancehealth

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Progress And Support During Change Healthcare Cyber Attack

Some services have been restored by Change Healthcare and more are readying.  Change says that claim preparation software for providers will soon come back online. Electronic payments have come back online. United says it has made more than $2 billion in advanced payments from its program.

United as an insurer, Highmark, and the Blue Cross and Blue Shield Association have developed advanced payment programs for providers, but many other insurers are moving slowly on the idea. Other insurers are contracting with Change competitors to help providers file claims. They also are extending claim deadlines. Provider groups say aid is not enough. The Centers for Medicare and Medicaid Services is also asking states to submit state plan amendments so they can advance Medicaid payments.

Additional articles here: https://www.modernhealthcare.com/cybersecurity/change-update-unitedhealth-systems-progress and https://www.modernhealthcare.com/insurance/change-outage-prior-authorization-pay and https://www.modernhealthcare.com/government/change-update-cms-medicaid-reimbursements and https://www.healthcaredive.com/news/change-healthcare-cyberattack-medicaid-flexibilities-american-hospital-association-survey/710561/

(Some articles may require a subscription.)

#changehealthcare #cyberattacks

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Medicare Households Spend The Most On Healthcare Costs

Good article from Fierce Healthcare and analysis from Kaiser Family Foundation on healthcare spending in Medicare households. Medicare households spend more on healthcare than other households. Health spending burden was twice as high.

Analysis by KFF: https://www.kff.org/medicare/issue-brief/medicare-households-spend-more-on-health-care-than-other-households/

#coverage #costs #medicare #medicareadvantage

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