June 10, 2024

Elevance Wins Star Lawsuit

A second lawsuit has been decided in favor of a Medicare Advantage (MA) plan and against the Centers for Medicare and Medicaid Services (CMS) on the calculation of Star scores. In this case, Elevance Health won its suit and a judge declared that Georgia contract scores must be revised. It will be increasingly difficult for CMS to ignore these rulings. I will write on this on LinkedIn tomorrow.

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#medicareadvantage #cms #stars #elevancehealth


White House Announces Cybersecurity Support For Hospitals

The White House announced that Microsoft and Google will provide free or discounted support to help hospitals strengthen their cybersecurity.

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#hospitals #cybersecurity


Supreme Court To Hear Hospital Funding Case

The Supreme Court said it will review a lower court decision that limits Medicare payments for hospitals under the federal disproportionate share hospital program. It is a rather technical, arcane case.

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#hospitals #medicare


Trump Attempts To Take Credit For Insulin Cost Reductions

In social media posts, former President Donald Trump attempted to take credit away from President Biden, arguing he is responsible for lower insulin prices.  While the Trump administration did approve pilots in Medicare Part D where insulin was reduced, there is no question that Biden championed the passage of the Inflation Reduction Act (which capped insulin at $35 per month in Medicare) and subjects insulin prices to negotiation. During his administration, pressure also led drug makers to reduce insulin costs in the commercial world. 

Additional article: https://thehill.com/homenews/campaign/4712736-clyburn-on-trump-attempt-to-take-credit-for-insulin-pricing-how-can-you-be-so-bold-with-your-lies/

#insulin #drugpricing #ira #trump #biden


New York Seeking To Import Drugs From Canada

The New York legislature is seeking to pass legislation that will import drugs from Canada.  This follows approval for Florida to do so, although that state legislation is very narrow initially. Canada is known to oppose such efforts due to potential impact on its supply.

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#drugimportation #drugpricing


FTC Wants Stay Of Judge’s Ruling Allowing Hospital Merger

The Federal Trade Commission (FTC) is seeking a stay of a judge’s order that allows Novant Health to acquire two North Carolina hospitals owned by Community Health Systems. I am skeptical of any hospital acquisition. But based on the judge’s reasoned approach, the FTC could face an uphill battle.

#manda #mergers #acquistions #ftc #hospitals


Two New York Insurers Want To Merge

Capital District Physicians Health Plan (CDPHP) and The Lifetime Healthcare Co.(owner of Excellus Blue Cross Blue Shield and Univera) want to affiliate.  Lifetime would become CDPHP’s parent.  The deal requires state and federal approval, but the two insurers have little overlap.

#manda #mergers #acquistions #ftc #healthplans


Medicare Alliance Analysis Shows MA Enrollees Save

The Better Medicare Alliance commissioned a study by ATI Advisory that shows Medicare Advantage (MA) beneficiaries spend an average of $2,541 less per year on out-of-pocket costs and premiums compared to those enrolled in traditional Medicare.  This is up from $2,400 last year. The analysis has additional findings on the benefits of MA from a cost standpoint.

Additional article: https://www.beckerspayer.com/payer/medicare-advantage-members-spend-over-2-500-less-than-traditional-medicare-enrollees-annually-study.html

#medicareadvantage #medicare #coverage


Researchers Propose Tweak on QALYs

Interesting Health Affairs Forefront blog that covers the ongoing controversy over the use of quality-adjusted life-years (QALYs) in healthcare decision-making. To address possible discrimination against the elderly, disabled, and ill, the researchers say a Generalized Risk-Adjusted Cost-Effeciveness (GRACE) model could be used.

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#qalys #healthcare


— Marc S. Ryan

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