January 3, 2024

Aggressive Agenda for Healthcare on Capitol Hill

Good article on all the healthcare priorities for 2024.  This tracks very closely to my predictions for 2024 blog ( https://www.healthcarelabyrinth.com/channeling-nostradamus-the-healthcare-labyrinths-2024-predictions/ ).

As I noted, a continuing resolution (CR) or other funding bill must pass soon to keep healthcare agencies open. As well, the article says that price transparency reporting, PBM reforms, and site-neutral payments are on the agenda. Note the reference to the long shot possibility of Medicare Advantage (MA) payment reductions. Troubled by prior authorization and overpayment headlines, Congress could take a bite out of rates for MA plans. This was also a possibility I raised in my predictions. There is also the issue of physician fee cuts in Medicare.

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#transparency #pricetransparency #governmentshutdown # crs #siteneutral #pbms #medicareadvantage #medicare #overpayments #providers #rates

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FDA Approvals Up

FDA approvals of new novel drugs are up.  Among the biggest drugs approved include a new Alzheimer’s drug and an obesity drug. At the same time, biotech investments are down.

#branddrugmakers #drugpricing #biotech

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Limiting Your Drug Costs As The New Year Opens

The Wall Street Journal gives tips for controlling your drug spending as your deductible rolls around again in some plans.

(Article may require a subscription.)


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Blockbuster Drugs May Be Used For Other Disease States In The Future

Brand drug makers are engaging in research to see where certain blockbuster drugs may be useful for other disease states. They then would seek approval for additional use.  This part of brand drug makers’ playbook. Related article here: https://www.reuters.com/business/healthcare-pharmaceuticals/weight-loss-drugs-who-what-are-they-good-2024-01-02/

#drugpricing #branddrugmakers

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NY Wants To Curb Surprise Billing Lawsuits

New York Gov. Kathy Hochul wants to curb hospitals’ ability to sue patients and expand financial assistance programs as part of her 2024 State of the State address. She wants to limit lawsuits for those earning less than 400% of the federal poverty level ($120,000 for a family of four). 

#ny #surprisebilling

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Cigna In Exclusive Talks With HCSC on MA Business

It appears that Cigna could sell its Medicare Advantage (MA) business.  One article says HCSC is in an exclusive agreement to negotiate a purchase right now.  Others report that Elevance Health is competing as well for the business.

While MA is one of the most profitable sectors, Cigna has struggled to ensure good performance with MA and also has suffered low Star scores overall.  In addition, CEO David Cordani believes in investing more in commercial lines as well as his services business, Evernorth.  Evernorth is what I view as a more unregulated area of healthcare and Cigna has done a good job of building this operation — second only to United’s Optum.

HCSC is trying to grow its MA line, but today has just 181K as of December enrollment.  It could grow organically in 2024 due to a major expansion.  But buying Cigna’s roughly 600K members ($7.9 billion in revenue) would make HCHS a major player in MA.  The deal could go for between $3B and $4B. It likely would pass regulatory muster. Elevance Health has over 2M in MA members. Additional article here: https://www.modernhealthcare.com/mergers-acquisitions/cigna-hcsc-medicare-advantage-deal-david-cordani

(Some articles may require a subscription.)

#cigna #elevancehealth #hcsc #medicareadvantage

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Cano Health Accelerating Turnaround Plan

Evidence that primary care is not always a solid investment.  We see major retailers and health plans picking up primary care doctors.  Walgreen’s over expanded and is cutting back.  Here Cano, which was put on notice for delisting on the NYSE, is bleeding and is now undergoing a turnaround plan to survive.

#retailhealthcare #primarycare #providers #canohealth

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Debate On Value Of Private Equity In Healthcare

Nice article in the Health Affairs Forefront blog that discusses private equity’s argument that it provides value, efficiency and better outcomes in healthcare. The blog politely counters the arguments. For me it goes a bit too far at points.  But, despite my support for private investment in healthcare, we do need to look at some balance given some obvious PE issues that are well documented – impacts to quality at hospitals, PE firms’ role in increasing price, etc.

(Article may require a subscription.)

#privatequityfirms #providers #hospitals

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— Marc S. Ryan

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