What More Could The CMS Actuary Do For Its Annual Healthcare Spending Report?
Interesting Health Affairs Forefront Blog on what more the Centers for Medicare and Medicaid Services (CMS) Actuary could do in terms of analysis of National Healthcare Expenditures Data (NHED) each year. As the author notes, there are some crucial missing pieces that could aid analysis and reform.
- The NHED do not report prices by payer sector. We know that the commercial world is saddled with huge prices compared with the government sector. Interestingly, the author does note that healthcare inflation declined in a real sense. As I noted in a reent blog, the surge in overall spending was tied to utilization. That blog is here: https://www.healthcarelabyrinth.com/national-healthcare-expenditure-data-issued-for-2023-what-does-it-all-mean/ .
- The NHED do include estimates of the change in volume and intensity — overall and by provider sector. The author opines that: “What matters is the specifics of which prices could be reduced with little decline in access or quality and which care is not improving health. … Identifying opportunities for more efficient care delivery, and payment systems/delivery models that encourage those efficiencies to be realized, is crucial.”
- The NHED do not capture costs that are not funneled through providers or insurers. The commercial sector has vast costs in this area. Also, many activities directed toward studying and managing the complexity of the healthcare system are not counted.
(Article may require a subscription.)
#nhed #cms #healthcare #spending
Fierce Healthcare’s Top 10 Payer Stories of 2024
Fierce Healthcare has issued its article on the top ten payer stories of 2024. The events include the Change Healthcare breach, numerous financial woes and cutbacks at major plans, the UnitedHealthcare CEO shooting, and Cigna selling its Medicare Advantage (MA) line.
I will have my normal year-end wrap up and predictions soon at the blog tab.
#healthcare #2024 #healthplans
https://www.fiercehealthcare.com/payers/editors-corner-fierce-health-payers-top-10-stories-2024
Multiplan Reaches Debt Refinancing Deal
Healthcare analytics company Multiplan reached an agreement with a majority of its creditors to extend the maturities of its existing debt. About 78% of holders of various bonds and term loans have agreed to the deal. The company had $4.5 billion of long-term debt as of Sept. 30.
Multiplan has been harshly criticized along with health plans for its operation practices related to lowering out-of-network costs and payments for insurers, passing on huge fees to employer groups, and saddling consumers with big debts.
(Article may require a subscription.)
#multiplan #healthplans
https://www.modernhealthcare.com/finance/multiplan-deal-debt-creditors-refinance
Compounders Criticize Diabetes Group For Safety Advisory On GLP-1s
Compounders are criticizing the American Diabetes Association (ADA) for its advisory that consumers should avoid using compounded GLP-1 drugs. The ADA says there are heightened risk of adverse events and that such compounds are not chemically equivalent to branded products. The Food and Drug Administration (FDA) has levied similar concerns.
Compounding organizations argue the ADA is motivated by its vast financial support from various brand drug makers.
I guess my question is what is one to do when the branded drugs cost as much as $1,000 a month or more and health plans often do not cover them. In general, I would also note that the compound industry is reasonably regulated despite the ADA’s concerns.
(Article may require a subscription.)
#fda #weightlossdrugs #glp1s #drugpricing
— Marc S. Ryan
