December 8, 2023

New Poll On Affordable Care Act And Healthcare Issues

A new poll shows that the American public favors maintaining the Affordable Care Act and reforming the current healthcare system. My blog Monday will build on my December 7 blog and go deep into this poll.

#healthcare #healthcarereform #affordableuniversalaccess #universalaccess

Link to Article

House May Cancel Physician Medicare Rate Cut

A bipartisan group of representatives has introduced a bill in the House that would cancel the 2024 Medicare physician pay cut finalized last month by the Biden administration. Physicians are always on a roller coaster when it comes to rates in Medicare. I think the formula has to be revisited broadly. The House committee bill would only restore 2.5% of the 3.4% cut: https://insidehealthpolicy.com/daily-news/house-ec-bill-would-erase-only-25-physician-fee-cuts-matching-senate

(Some articles may require a subscription.)

#providers #physicians #rates

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Bipartisan Effort Looking At Healthcare Entity Ownership And Anti-Competitive Behavior

Must-read article about efforts by the Biden administration and lawmakers (on a bipartisan basis) to tackle the trend of private equity firms taking over provider entities and the impacts on the healthcare system.  This issue has many tentacles but it appears to be very bipartisan.  The Biden administration is pursuing scrutiny of mergers and acquisitions and the takeover of drug patents in some extreme cases.  The administration and Senate are shining a light on private equity and other firms that acquire provider entities. When you see the words “profits over patient care and safety” used on a bipartisan basis, you know the movement is real. The article does a great job of putting all the issues in context. The administration fact sheet is here: https://www.whitehouse.gov/briefing-room/statements-releases/2023/12/07/fact-sheet-biden-harris-administration-announces-new-actions-to-lower-health-care-and-prescription-drug-costs-by-promoting-competition/ Additional articles here: https://www.healthcaredive.com/news/senators-probe-private-equity-hospital-operations/702016/ and https://insidehealthpolicy.com/daily-news/whitehouse-grassley-launch-hospital-private-equity-inquiry

(Some articles may require subscription.)

#mergers #acqusitions #privateequityfirms

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What the Cigna/Humana Merger Would Look Like

This article does a nice job of showing what a combined Cigna-Humana would look like and what likely will be offloaded to pass regulatory muster.

(Article may require subscription.)

#cigna #humana #mergers #acquisitions

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Reaction To Biden Administration’s Drug Patent “March-In” Framework

Rather long and technical article on reactions to the Biden Administration’s proposal to “march-in” on drug patents if drug research was funded by taxpayer dollars and the drugs are excessively priced. See my newsfeed entry yesterday on the proposal.  Suffice it to say that drug makers and business groups are apoplectic and promise a challenge. They argue it is yet another way that innovation will be crippled. They see it as a takings issue. On the other hand, advocates are arguing that the framework does not go far enough as it concentrates on the highest cost drugs. I have expressed my discomfort with seizing patents but have argued that a reformed drug pricing system should take into account taxpayer support for drug development. As well, it is hard to feel sorry for the drug makers.

(Article may require a subscription.)


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Almost 12 Million Cut From Medicaid Rolls With Redeterminations

According to the Kaiser Family Foundation, at least 11,967,000 Medicaid enrollees have been disenrolled as of December 7, 2023, based on the most current data from all 50 states and the District of Columbia.

#medicaid #redeterminations

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Drug Makers Want To Be In Obesity Drug Game

With the first GLP-1 drug approved by the Food and Drug Administration for weight loss, brand drug makers are clamoring to get in on developing and marketing these high-cost drugs.  There is no question there is an epidemic of obesity in America, but reading this article seems to indicate that drug makers’ interest is more about profits than healthcare.

#drugpricing #weightlossdrugs

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Remote Monitoring Expected To Increase In 2024

A survey of healthcare executives by Sage Growth Partners says most plan to maintain or increase their spending on remote patient monitoring in 2024.


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Warren And Other Senators Want More Medicare Advantage Data

Sen Elizabeth Warren, D-MA, and other senators want the Centers for Medicare and Medicaid Services (CMS) to increase the amount of data collected and reported from Medicare Advantage (MA) plans, especially when it comes to prior authorizations, claim denials, and coverage of supplemental benefits.

(Article may require a subscription.)

#medicareadvantage #priorauthorizations #claimsdenials #supplementalbenefits

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Review of Risk Adjustment Post Pandemic

Interesting interview on how risk adjustment has changed post pandemic.  Trends as well as tech and data tools for both prospective and retrospective programs discussed.

#riskadjustment #radv

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— Marc S. Ryan

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