May 1, 2024

Stunning Admission By United HealthGroup CEO

It was the roasting that was expected, with both sides of the aisle attacking Andrew Witty when he appeared on Capitol Hill.  The United HealthGroup CEO made a stunning admission when he said that Change Healthcare had legacy architecture and technology based largely on internal data centers. It says it is rebuulding all of it on a cloud-based, modern infrastructure. This alone substantiates a lack of business continuity and disaster recovery readiness. In the last few days, United also admitted that simple multi-factor authentication was not in place and that is how the cyber criminals got into the Change platforms.

The testimony adds to my theory that when massive consolidation occurs, technology is not modernized and as I call it “spaghetti-ed together.”  The testimony will lead to additional scrutiny of United, a review of vertical integration and consolidation in healthcare, as well as more lawsuits and eventual fines for United.

See my blog and podcast on the Change debacle: https://www.healthcarelabyrinth.com/17-what-happened-when-change-healthcare-suffered-a-major-cyberattack-and-what-will-it-mean-to-the-broader-healthcare-system-moving-forward/ and https://www.healthcarelabyrinth.com/the-change-healthcare-cyberattack-what-it-is-and-its-implications/

Additional articles: https://www.fiercehealthcare.com/payers/too-big-fail-consolidation-concerns-loom-over-hearing-change-healthcare-cyberattack and https://www.modernhealthcare.com/politics-policy/unitedhealth-andrew-witty-change-healthcare-hearings and https://www.medpagetoday.com/washington-watch/washington-watch/109918 and https://www.beckershospitalreview.com/finance/a-crisis-of-your-creating-unitedhealth-ceo-grilled-by-congress-on-cyberattack.html

(Some articles may require a subscription.)

#changehealthcare #cyberattacks #unitedhealthcare


Two Parties Agree On Price Transparency

Both the Biden administration and former Trump administration agree that price transparency is here to stay and the policy likely will not change with the 2024 election.

#pricetransparency #healthcare


CVS Health Reports Huge Surge In MA Costs

While CVS’ Aetna subsidiary did remarkably well during the open enrollment season for Medicare Advantage (MA), like United and Humana it is reporting a huge surge in utilization and medical costs, with a medical loss ratio over 90%. CVS says part of the costs are seasonal (perhaps due to the huge surge in enrollment), but it also promises like the other plans to rein in benefits to get back to target profitability.  I contend the trend will continue with higher utilization and a bad prior authorization rule placed on the plans. Indeed, CVS mentioned the impact of the rule, which requires plans to follow the unfettered fee-for-service (FFS) guidelines. CVS slashed earnings for 2024.

Additional articles: https://www.fiercehealthcare.com/payers/cvs-lowers-2024-guidance-it-misses-profit-revenue-q1 and https://www.modernhealthcare.com/finance/cvs-health-aetna-medicare-advantage and https://www.healthcaredive.com/news/cvs-2024-forecast-cut-medicare-inpatient-q1/714807/

(Some articles may require a subscription.)

#cvshealth #aetna #medicareadvantage #healthplans


Modern Healthcare Reports On Health Plan CEO Pay

Modern Healthcare culled together executive compensation for publicly traded health plan CEOs.  The numbers are big and could attract attention on Capitol Hill. Provider lobbies are sure to use the info.

(Article may require a subscription.)

#healthplans #managedcare


Mark Cuban To Continue Tackling Drug Shortages

Mark Cuban and his Cost Plus Drugs say they have other deals being cultivated to produce pediatric cancer and other drugs in shortages. Cuban just struck a deal with Community Health Systems (CHS) to supply drugs.

Additional article: https://www.beckershospitalreview.com/pharmacy/another-system-partners-with-cost-plus-drugs.html

(Some articles may require a subscription.)

#drugshortages #drugpricing


Court Says Class Action On Redeterminations Can Proceed

A federal court in Florida says a class-action lawsuit against Florida can proceed involving how the Medicaid agency approached the return of Medicaid redeterminations. The suit says Florida did not properly inform people before dropping them from the Medicaid rolls.

#medicaid #redeterminations #fl


FTC Challenges GLP-1 Patent Claims

The Federal Trade Commission (FTC) continues to fight invalid patent claims in the Food and Drug Administration’s (FDA) Orange Book. The claims mean fewer organizations will introduce generics for high-costs drugs.  FTC now is saying invalid claims exist for some GLP-1 drugs for weight loss.

#weightlossdrugs #drugpricing #ftc #fda #brandrugmakers


Why Walmart Health Failed

Interesting article on why Walmart Health failed. A provider-side view.

#walmart #primarycare #retailmeetshealthcare


— Marc S. Ryan

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