December 12, 2023

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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At The Same Time, Overall Healthcare Costs Rising

Advisory firm WTW surveyed 266 insurers across 66 countries and found that 58% are bracing for “higher or significantly higher” healthcare cost increases in the three upcoming years. Global costs increased by 10.7% in 2023, up from a 7.4% increase in 2022. The average cost trend insurers expect is 9.9% next year.

#healthcare #healthinsurance

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Excellent Pro Publica Analysis of Waste and Abuse in Medicare

Latest estimates suggest that 25% of all costs in the healthcare system are fraud, waste, or abuse.  This Pro Publica study examines one procedure that shows clear evidence of waste and abuse.  Perhaps it could even be considered fraud.  The article mentions Marty Makary, a brilliant Johns Hopkins University professor who has written and studied over-practicing and other aberrations in the healthcare system. We need more studies like these and researchers like Makary to begin focusing a light on the abuse.  I find it ironic that the Centers for Medicare and Medicaid Services (CMS) is reining in prior authorization in Medicare Advantage (MA) when this kind of abuse is well-known in the healthcare system, specifically traditional Medicare.

#fwa #medicare #medicareadvantage

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House Passes Transparency Bill On Bipartisan Basis

The House passed a bill forcing greater transparency and reform at hospitals and for PBMs. Hospitals and plans are required to post files in machine readable formats. Hospital disproportionate share grants are postponed, while grants to community health centers increase. Site-neutral payments begin for Part B drugs and administration in Medicare. Restrictions on spread pricing on PBMs are also implemented. No word yet on whether the Senate will pass the bill.

Additional articles here: https://www.modernhealthcare.com/politics-policy/house-passes-bill-covering-pbms-dsh-cuts-site-neutral-payments and https://www.healthcaredive.com/news/house-passes-bill-pbms-price-transparency-site-neutral-payments-hospitals/702236/ and https://insidehealthpolicy.com/health-insider/house-passes-lower-costs-more-transparency-act-debate-support-act-reauthorization . The bill would also promote generic adoption and use: https://insidehealthpolicy.com/daily-news/transparency-bill-includes-measure-aimed-speeding-generics

(Some articles may require a subscription.)

#siteneutral #pbms #spreadpricing #pricetransparency #transparency

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Next Steps For Cigna

Good article on what Cigna may do now that the merger with Humana is off.  It could seek to divest Medicare Advantage (MA) or acquire smaller MA plans.  It could also focus efforts on building out its service division under Evernorth.

#cigna #medicareadvantage

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More On Medicaid Redeterminations

Health Affairs Forefront blog has a few good articles on Medicaid redeterminations.  One examines Arkansas efforts on redeterminations, which are now complete.  The second analyzes what has happened so far and recommends improvements with regard to Medicaid enrollment.  Some great excerpts from this second article:

“… It should no longer be acceptable to maintain policies and practices that make it so difficult for people to enroll and retain their coverage. It’s past time to improve eligibility systems and remove confusing, outdated, cumbersome practices that create unnecessary barriers for people to obtain coverage and that significantly increase workloads for states. And federal agencies and the public must hold states accountable for making these improvements.

At the most basic level, states across the country need to commit to delivering high-quality, modern, consumer-friendly customer service, and reject processes that are designed to put up unnecessary roadblocks….”

Second article here: https://www.healthaffairs.org/content/forefront/unwinding-should-call-action-fix-fragmented-system .

First article at link.

(Articles may require a subscription.)

#medicaid #redeterminations

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Significant Developments on Interoperability

Bold new step for interoperability as five qualified health information networks or QHINs completed their onboarding under the Trusted Exchange Framework and Common Agreement (TEFCA).  More developments on the FHIR and other fronts are expected in 2024.  Health and Human Services press release here: https://www.hhs.gov/about/news/2023/12/12/hhs-marks-major-milestone-nationwide-health-data-exchange.html .  Additional article here: https://www.healthaffairs.org/content/forefront/tefca-live-future-network-interoperability-here

(Some articles may require a subscription.)

#interoperability #tefca #fhir

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Biden Differentiating Himself On Drug Pricing

Interesting article on how President Biden is differentiating himself on drug pricing compared with former President Donald Trump.  The truth is Trump is not that far from Biden on drug pricing. He had very aggressive proposals on drug pricing as a Republican, but never quite delivered.  Biden won the Inflation Reduction Act, which included Medicare drug price negotiations. He is now proposing a “march-in” on drug patents if these drugs benefited from taxpayer-funded dollars and are excessively priced. This study from Kaiser Family Foundation discusses some important aspects of drug reform in the IRA and the fact that most Americans are simply not aware: https://www.kff.org/policy-watch/the-new-help-for-medicare-beneficiaries-with-high-drug-costs-that-few-seem-to-know-about/

#drugpricing #biden #trump

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Medicaid Home and Community Services Access

The Centers for Medicare and Medicaid Services (CMS) and Department of Health and Human Services (HHS) published press releases on tools available from earlier acts on fostering greater home and community-based services through Medicaid.  CMS release at link.  HHS release here: https://www.hhs.gov/about/news/2023/12/12/hhs-provides-critical-tools-to-help-improve-access-for-millions-who-receive-medicaid-home-and-community-based-services.html

#ltc #hcbs #longtermcare

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— Marc S. Ryan

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