December 13, 2023

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

Link to Article

ONC Finalizes AI And Interoperability Rule

The Office of the National Coordinator for Health IT, the federal government’s interoperability and technology chief, finalized a rule that will govern AI transparency and further interoperability. The article has great links to fact sheets, etc. on the rule. New requirements include a certification program for electronic health record (EHR) software as well as moving to the United States Core Data for Interoperability (USCDI) Version 3 (v3) as the new baseline standard as of January 1, 2026. 

With regard to AI, new transparency and risk management expectations are laid out for artificial intelligence and machine learning technology that aid decision-making in healthcare, effective at the end of 2024. Those seeking certification of their AI-enabled health IT products through ONC (which likely will become requirements by plans and other organizations along the way), must show how their algorithm was designed, developed and trained. Also, they must disclose whether patient demographic, social determinants of health or other equity-related data were used in training the AI model. 

Second article here: https://www.modernhealthcare.com/digital-health/hhs-ai-predictive-algorithm-transpareny-requirements . Health and Human Services release here: https://www.hhs.gov/about/news/2023/12/13/hhs-finalizes-rule-to-advance-health-it-interoperability-and-algorithm-transparency.html .

(Some articles may require a subscription.)

#ai #interoperability

Link to Article

Lobbying Expenditures Show Activity in Healthcare World

Interesting article on the lobbying dollars spent by various healthcare groups on Capitol Hill. PBMs spent a great deal seeking to influence legislation that reforms pricing in the industry. But everyone got into the act, including hospitals opposed to site-neutral payments.

(Article may require a subscription.)

#lobbying #hospitals #pbms #healthplans

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AMA Releases Health Plan Market Concentration Report

The American Medical Association annually releases a market concentration report related to health plan coverage throughout the United States. It is interesting and lays out what we know is true — control of many markets by a handful of insurers in the commercial and Medicare Advantage (MA) worlds. But, MA concentration has gone down since 2017. The AMA wants regulators to closely scrutinize mergers and acquisitions of health plans. The same can be said, though, of hospitals and providers. Hospitals now own most physicians and that impacts price too. Additional article here: https://www.managedhealthcareexecutive.com/view/health-insurer-market-concentration-high-in-most-local-markets .

(Some articles may require a subscription.)

#ama #healthplans #commercial #medicareadvantage

Link to Article

AI Lawsuits Continue

Humana is now among the health plans (along with Cigna and United) being sued over its use of AI to deny care. Other article here: https://www.healthcaredive.com/news/humana-lawsuit-algorithm-medicare-advantage-deny-claims/702403/ .

(Some articles may require a subscription.)

#humana #ai #priorauthorization #claimsdenials

Link to Article

Fallout From ACA Repeal Comments Among Investors/Plans

Interesting article on health plans and investors worried about political statements on repeal of the Affordable Care Act (ACA) and what it could mean to certain health plans. I feel for plans such as Centene and Cigna who have been mainstays in the business despite some very challenging times. They stuck it out. They deserve to be congratulated. With Exchange stability, they should begin to see rewards. Centene’s view is the right one. I think raising repeal is a politically dumb thing to do and the likelihood of repeal is very low. Centene is right — how do you take away coverage for millions. The GOP has never come up with a credible alternative.

The comments on the growth of the Individual Coverage Health Reimbursement Arrangements (ICHRAs) is significant. A good move under Trump, as of 2020, businesses can reimburse employees for premiums and cost-sharing under ICHRA. This could lead more people to go to the Exchanges as this vehicle grows. While any business can take advantage, many small employers do not provide coverage and likely would not have major uptake setting up a small business plan on the Exchange. This provides a reasonable solution to help people afford coverage in the Exchanges.

#exchanges #obamacare #aca #ichra

Link to Article

FTC Stops Deal That Would Hurt Generic Uptake

Good for the Federal Trade Commission. Its threatened suit against Sanofi has stopped the drug maker from acquiring an exclusive license to Maze Therapeutics’ phase 2 developmental drug for Pompe disease. Drug makers engage in underhanded tactics like this to stop the penetration of alternative drugs and to maintain a monopoly and high costs. This would have been one of them. These types of arrangements should be stopped. Other article here: https://www.axios.com/2023/12/12/sanofi-scraps-750-million-drug-deal-after-ftc-sues-on-antitrust-grounds . Additional article here on advocates pressuring Senate Majority Leader to move on streamlining generic drug approvals and reforming patent policies used by brand drug makers to avoid generic competition: https://insidehealthpolicy.com/inside-drug-pricing-daily-news/patients-press-schumer-advance-patent-reform-generic-drug-bills . This is what really needs to be done as well.

(Some articles may require a subscription.)


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Opioid Settlement Monies Untouched

Concerns that opioid settlement funds untouched or slow to be spent by states.


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Review of Merger Guidelines

A good summary and review of draft merger guidelines from the Biden administration seeking to stop anti-competitive activities in healthcare. Biden has delivered on this promise. Strong oversight by government should occur on both the health plan and provider front.

(Article may require a subscription.)

#mergers #acquisitions #ftc

Link to Article

FTC To Scrutinize Patent Notifications in Orange Book

Very technical blog in Health affairs Forefront on the Federal Trade Commission’s (FTC) announcement that it will closely scrutinize patent disclosures in the Food and Drug Administration’s Orange Book. Generic drug makers use the patent disclosures to determine if they will engage in creating a generic drug as exclusivity of a brand drug comes close to lapsing. If brand drug makers over declare patents held, it could stop generics from coming to market in the future. Another subtle way of promoting generics.

(Article may require a subscription.)

#drugpricing #ftc

Link to Article

Medicare Advantage Has Better Outcomes Than Traditional Program

More evidence in this summary of an AHIP study showing much better outcomes for Medicare Advantage (MA) members than those in traditional Medicare fee-for-service (FFS). If you look at the study itself, the differences look small, but they are statistically significant, pointing to the potential for huge cost-savings over time because of the better management in MA vs. FFS. More evidence of the great value of MA that Capitol Hill and the Centers for Medicare and Medicaid Services (CMS) appear to be hurting with terrible regulations and bills, such as limits on prior authorization. AHIP study here: https://www.ahip.org/documents/202312-AHIP_HEDISMeasures-12.5.23.pdf .

In addition, a new Better Medicare Alliance study shows how the MA primary care model and focus means MA enrollees have higher engagement with primary care and better patient experiences than in FFS. Release and analysis here: https://bettermedicarealliance.org/news/new-study-medicare-advantage-beneficiaries-have-greater-access-to-and-better-experiences-with-primary-care-compared-to-ffs-medicare/ .

#medicare #medicareadvantage #quality

Link to Article

Possible Path On Obesity Drug Coverage

Obesity creates huge costs in our healthcare system. While weight-loss drugs are expensive, there is growing need to explore how these drugs could be responsibly covered as an investment for the long term. This article (admittedly by a drug maker executive) gives some insight to how other developed nations do it.

(This STAT article appears subscription free.)

#weightlossdrugs #obesity

Link to Article

— Marc S. Ryan

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