December 15, 2023

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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BCBSLA Could Be Acquired by Elevance Health

At the same time, Elevance Health may acquire BCBSLA after pausing the process earlier this year. This is based on revised regulatory activity. Elevance Health is the largest for-profit owner of Blue Cross and Blue Shield plans, with 14 states nationwide. Additional article here: https://www.modernhealthcare.com/mergers-acquisitions/elevance-health-blue-cross-louisiana-merger-acquisition .

(Some articles may require a subscription.)

#elevancehealth #bcbsla #mergers #acquisitions

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Hospital-Based Colonoscopies Over 50% More Costly Than ASC-Based

A new study underscores the crying need for site-neutral payment policies across the healthcare system. A study finds over 50% higher facility fees for commercially insured colonoscopies performed in hospitals rather than ambulatory surgery centers (ASCs). Based on the available data, hospitals charged average facility fees of $1,530 for a colonoscopy, $1,760 for a colonoscopy plus a biopsy and $1,761 for a colonoscopy with the removal of polyps. At an ASC, the same three items were $989, $1,034 and $1,030 respectively.

The House passed a bill that would institute site-neutral payments in Medicare for Part B drugs and administration.


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Walgreens To Close More Primary Care Clinics

Walgreens is closing more primary care clinics after a big round announced in October. Part of this is tied to Walgreens’ financial issues. But some of it shows that retail primary care needs to be watched and rolled out carefully.

(Article may require a subscription.)

#walgreens #retailhealthcare #primarycare

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Sanders To Unveil Trump-Like Drug Pricing Bill

No, planets are not colliding and the world is not ending. Upset that the Inflation Reduction Act’s Medicare drug price negotiations do not go far enough in his view, Sen. Bernie Sanders says he will unveil a bill that would invoke international reference pricing for drugs. It appears he wants to cover all lines of business. Surprisingly, this is similar to a Medicare Part B drug rule the Trump administration finalized, with Trump saying he would do the same for Medicare Part D. The Biden administration withdrew the bill on entering office due to several procedural issues. At the time, Biden said he too supported the concept.

Sanders says the bill would reduce expensive weight-loss drugs by as much as 90 percent or more. The proposal would cap U.S. drug prices at those in other developed countries. The exact formula is not known.

The bill likely faces little chance in the GOP-controlled House. Unfortunate.

(Article may require a subscription.)

#drugpricing #sanders #trump #ira

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No Surprises Act Arbitration Portal Open Again For Batched Disputes

The federal independent dispute resolution portal created by the surprise billing law began accepting batched disputes on Dec. 15 after being shut down since August CMS has also granted parties additional time to initiate a new dispute or address existing cases. The arbitration process for the No Surprises Act (NSA) has faced huge caseloads, procedural issues, and court decision striking aspects. The NSA was poorly thought out, seeking to please both providers and plans by supposedly being neutral. It is slanted toward providers in my view and providers are seeking to gain even more leverage in the process. The law should have pegged out of network payments at average in-network rates.

(Article may require a subscription.)

#nosurprisesact #nsa #providers #healthplans

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Dying Broke Series From KFF and NYT Gets Huge Feedback

This article sums up reader feedback from the Kaiser Family Foundation/New York Times series “Dying Broke” on long-term care in America. The series was an eye-opener. People face financial ruin due to little access to cost-effective solutions. The labor force is stretched and limited. Long-term care insurance is in crisis. Some call for the federal government to create a comprehensive, national long-term care system, as some other countries have. 

In my book, The Healthcare Labyrinth (available via this site), I devote a full chapter to the fact that the nation needs an aging policy. I tell you what we should do.

#ltc #longtermcare

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Kansas Attempting To Expand Medicaid

Kansas Democratic Gov. Laura Kelly on Thursday offered a Medicaid expansion plan that would ask hospitals to provide funding and includes a work requirement to attract Republicans. Republicans are still cool and advocates are concerned. Kansas is one of ten states that have not expanded Medicaid under the Affordable Care Act (ACA).

#medicaid #aca #obamacare #workrequirements

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Biden and Obama Team Up Against Trump On The ACA

President Biden and former President Obama shot a video to support the Affordable Care Act (ACA). As I say, former President Trump gave Democrats momentum on an issue when he raised the prospect of repeal of Obamacare under a second term.

#aca #obamacare #exchanges #medicaid #trump #biden #obama

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Relooking At AI In Decision-Making

This is a thoughtful piece on how correct use of AI might work. It calls out both provider, payer and healthcare system concerns. As well, here is a Health and Human Services release on guiding principles for AI use, with links to a JAMA article on the subject: https://www.hhs.gov/about/news/2023/12/15/guiding-principles-help-healthcare-community-address-potential-bias-resulting-from-algorithms.html .

#ai #claimsdenials #priorauthorization

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Employers With Retiree Coverage Increasingly Turning To Medicare Advantage

Good Kaiser Family Foundation analysis of employers with retiree coverage and how they are turning to Medicare Advantage (MA) for coverage and savings. More than half of employers that offer retiree coverage tie to Medicare Advantage in some way. About two-thirds mandate enrollment in MA to obtain the wrap employer retiree coverage. These are called EGWP plans in MA.

#medicareadvantage #egwp #retireecoverage

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— Marc S. Ryan

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