January 25, 2024

Humana Reconfirms Bad News On Utilization In MA

After an earlier filing, Humana reconfirmed bad news on the medical expense front. Because it is a predominant Medicare Advantage (MA) insurer, it has seen a major and unexpected rise in utilization, which impacted the company’s 2023 numbers and prospects for 2024 and beyond.  Broussard is one of the smartest healthcare leaders out there and he is someone I listen to closely. Given the medical expense rise, rate compression, and regulatory changes (such as the new prior authorization rule), Broussard said he expects similar pricing adjustments from other payers, as the spike in utilization along with ongoing regulatory changes will have major impacts in 2025 and potentially beyond. Broussard says this could very well be industrywide. Humana reduced benefits for 2024 and this could be a continued trend into the future. Humana plans on cutting about $700 million in administrative costs.

It doesn’t mean MA is not a good place to be, but it does show the shortsightedness of the Centers for Medicare and Medicaid Services (CMS) and Capitol Hill as they seek to bind the hands of MA plans too much.

Additional articles: https://www.modernhealthcare.com/finance/humana-cuts-medicare-advantage-changes-earnings and https://www.healthcaredive.com/news/humana-dour-2024-profit-forecast/705537/

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#medicareadvantage #humana #medicalexpense

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Record Healthcare Breaches In 2023

Analysis of reported data breaches to the federal government shows 2023 had the highest number of breaches yet.  In 2023, almost 133 million individuals were affected by healthcare data breaches in which their information was stolen or otherwise exposed. The article cautions that AI could play a negative role in healthcare.  It can be used to promote breaches.

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#ai #breaches

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Epic Pushing Into Other Areas Of Healthcare

Interesting article on Epic’s push into other areas of healthcare, from hospitals to providers more broadly as well as the payer world.  With the rise of interoperability, what Epic is doing makes a great deal of sense.  But from what I know of Epic, it has a whole bunch to learn about payer operations, compliance, and more.

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#epic #interoperability #healthplans

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Senators Want Action On PBMs From FTC

Senators are asking why the Federal Trade Commission (FTC) hasn’t issued findings on PBM practices and how they impact drug costs 18 months after it launched an investigation. Senate Commerce Committee Chair Maria Cantwell (D-WA) and Sen. Chuck Grassley (R-ID), were joined by 12 other lawmakers, asking the FTC where their report is. The senators are also wanting to move key reform bills in the Senate soon.

(Article may require a subsection.)

#pbms #drugpricing

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Democrats Want Vehicle To Pass Permanent Subsidy Enhancements

After the record enrollment in the Exchanges, Democrats are looking for a vehicle to make the enhanced premium subsidies permanent.  The reality is that the bill stands no chance with a GOP House.

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#exchanges #aca #obamacare #coverage

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Bill Of The Month From Kaiser Shows Loophole

Good article from Kaiser Health News exposing a loophole in preventive services and how they can cost enrollees money.  The provision does not preclude other charges agreed to between insurers and providers, which can lead to surprise bills.

#surprisebilling #aca #nsa

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The Irony Of It All: Axios Calls Out The Benefit of Obamacare In Red States As Trump Calls For Repeal

I liked this article from Axios, which calls out the huge Exchange enrollment gains in red or reddish states. The fact is that Trump voters seemingly are benefiting from the program, even as the candidate himself is calling for repeal.

Additional articles here: https://www.texastribune.org/2024/01/24/texas-aca-health-insurance-enrollment/ and https://thehill.com/homenews/campaign/4427728-pelosi-sounds-warning-trump-attacks-obamacare/

#aca #obamacare #exchanges #trump

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Controversy on Issuing Subpoenas To Drug Maker CEOs

Democrats on the Senate HELP Committee, including Chairman Bernie Sanders, I-VT, want to subpoena two drug maker CEOs from Merck and Johnson & Johnson, to appear before the committee because they refused to voluntarily appear. Republican Ranking Member Bill Cassidy, R-LA, claims the Democrats are not interested in real investigation but simply targeting the company leaders.  I am of two minds here.  The two companies did offer other executives to appear.  But, I find it amazing that the CEOs would not appear and defend their practices.  One even claimed he wasn’t an expert on drug pricing.  Maybe he should be?

Additional article here: https://www.statnews.com/2024/01/25/merck-ceo-wont-testify-no-expertise-drug-prices/

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CMS Announces RFI On MA Transparency

In it latest foray against Medicare Advantage (MA), the Centers for Medicare and Medicaid Services (CMS) is asking the public for input on ways MA can be made more transparent. The request will lead to a cavalcade of provider and advocate entities attacking MA, managed care, and health plans. Health and Human Services Xavier Becerra stated in a press release that, “The lack of transparency in Medicare Advantage managed care plans deprives patients of important information that helps them make informed decisions.”  The truth is MA is one of the most accountable programs out there from mandatory disclosures to enrollees to a rigorous program audit regime to regulatory reporting.

I have been one of the biggest supporters of CMS over the years and defended their accountability and quality reforms. Over the years, it has assembled a talented and committed group of policy makers.  But as with the recent prior authorization rule, CMS has become overly political and has sided with providers and advocates, who want to rip down MA in favor of a costly and unaccountable traditional fee-for-service (FFS) alternative. This is not really about transparency. The agency should rethink its posture here.

#medicareadvantage #healthplans #managedcare #providers

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— Marc S. Ryan

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