February 12, 2024

Kaiser Turns Around Performance

Kaiser Permanente moved from a $1 billion loss in 2022 to about breakeven at least in terms of operating income in 2023.  Its income was $4.1 billion with investments.  It reached the $100 billion mark in both operating revenues and expenses.

#kaiserpermanente #managedcare

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Article Summing Up Congressional And Regulatory Issues On AI

A good article on all the activities surrounding the use of AI and possible regulations.  The article discusses potential Capitol Hill bills, recent rules and guidance from the Centers for Medicare and Medicaid Services (CMS) and lawsuits against insurers on AI issues.

#ai #claimsdenials #priorauthorization

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Humana Study Shows Discrimination In Healthcare

A new study sponsored by Humana focused on structural determinants of health rather than social determinants.  The study found that 88% of respondents reporting healthcare discrimination were black. While similar and related to social determinants, structural determinants focus on the economic and social experiences and policies that influence health.  Humana should be congratulated on the study and using it as a benchmark for improvement over time.

#sdohs #socialdeterminants #structuraldeterminants

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Hospitals Need To Do More To Avoid High-Cost Care

A good article on how hospitals need to adapt as Medicare populations grow.  The article has a great graphic on outyear coverage for Medicare, Medicaid and commercial.  Medicare growth outpaces all others significantly (7.8% annually from 2025 to 2031).  With that comes higher risk and costs for hospitals if they do not approach the population right. While the article shows how Tampa General has prepared, it says most hospitals are not ready. If not ready to avoid high-cost care, it says margins will erode. A number of reforms and mitigations are discussed.

(Article may require a subscription.)

#hospitals #medicare

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Private Equity Deals Dropped in 2023, But Still Third Highest Year

Pitchbook says private equity deals in healthcare dropped in 2023 but still were the third-highest on record by deal count. An estimated 788 deals closed in 2023. A decline was seen quarter over quarter.

Pitchbook says interest rate cuts could boost deal-making in 2024, but increased antitrust scrutiny and enforcement could hurt it.

#privateequityfirms #healthcare

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Another Article On State Prior Authorization Reforms

Kaiser Health News has an article on state initiatives in the area of prior authorization reform.  It discusses prior authorization reform and gold-card initiatives in a number of states.  This follows a Modern Healthcare article on Friday. In state legislation, gold-carding with regard to prior authorization is taken out of a plan’s hands and is dictated by statute (e.g., the provider must be relieved of all prior authorization if he or she reaches 90% approval rates in a prior period).


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Excellent Article On NHS In The United Kingdom

Margaret Murray and Nancy Wise have a great article in Managed Healthcare Executive on the U.K.’s single payer National Health Service.  They discuss that people always have affordable coverage, no churn, lower admin costs, and even some creative drug pricing deals.

Some of their findings are in my blog on the subject: https://www.healthcarelabyrinth.com/american-healthcare-is-a-huge-outlier-in-terms-of-costs-and-outcomes/ . As well here is a podcast I did: https://www.healthcarelabyrinth.com/2-2/ . Of course I also discuss a lot of this in my book, The Healthcare Labyrinth (available through this site).

As well, remember I am writing about my courageous daughter’s brain surgery. Part 1 is here: https://www.healthcarelabyrinth.com/part-1-my-courageous-daughter-is-having-brain-surgery/ . Since she lives in the U.K. as well as America, we will offer some comparisons between the two systems as well in future entries.

#coverage #healthcare #uk

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Health System Tracker Outlines Burden Of Medical Debt

The Peterson-Kaiser Family Foundation (KFF) Health System Tracker has put together a good overview of medical debt in America.  Among the findings include:

  • Worse health and disability contributes to medical debt
  • Blacks have greater medical debt
  • Those who are middle aged have greater medical debt
  • Low income and the uninsured have greater medical debt
  • Over 20 million have some medical debt

#medicaldebt #healthcare #coverage

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— Marc S. Ryan

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