May 20, 2024

Optum Announces Transparent-Like Pharmacy Model

Pressured by the rise of transparent pricing models, Optum Rx has announced its own approach to greater transparency. I would call it transparency-like. It is offering a single per member cost, encompassing retail, home delivery, specialty drug and rebate components.

#transparency #pbms #optumrx


Health Plan CEO Compensation

Fierce Healthcare assembles the top 5 in terms of health plan compensation in 2023.



Government To Fund $50 Million For Cybersecurity

The Department of Health and Human Services’ (HHS’) research funding agency will provide more than $50 million to developers who can build a scalable cybersecurity platform to protect hospitals for cyberattacks.

Additional articles: https://www.modernhealthcare.com/cybersecurity/hhs-arpa-h-hospital-cyberattacks-unitedhealth-change-healthcare-ascension and https://www.healthcaredive.com/news/healthcare-cybersecurity-arpa-h-upgrade-program/716609/ and https://www.healthcareitnews.com/news/hhs-offers-50m-help-providers-patch-ransomware-vulnerabilities

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#cyberattacks #healthcare


Senate Finance Joins HELP Committee In Wanting To Reform Medicare Doc Pay

The Senate Finance Committee joins the HELP Committee in wanting to fix the Medicare physician payment dilemma.

Additional articles: https://www.modernhealthcare.com/politics-policy/medicare-physician-pay-reform-proposals-senate-bill-cassidy-ron-wyden and https://insidehealthpolicy.com/daily-news/senate-finance-leaders-unveil-potential-medicare-physician-pay-reforms-telehealth

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#medicare #physicians #reimbursement


Steward Is Progressing In Sale Of Assets

Steward Health Care is seeing interest from potential buyers of its hospitals in multiple states.  It, too, is in advanced discussions with Optum on its provider group.

Additional article: https://www.modernhealthcare.com/legal/steward-health-care-bankruptcy-hospital-asset-sale-timeline

(Some articles may require a subscription.)

#healthcare #hospitals


Telehealth Extension Advances

The House Energy & Commerce health subcommittee advanced an extension for telehealth for two years.

(Article may require a subscription.)

#telehealth #healthcare


New Study Critical Of FTC Oversite Of Pharmaceutical Industry

A new study finds that the Federal Trade Commission (FTC) pursued very few challenges to mergers or enforcement actions of the pharmaceutical industry over the last two decades. From 2000 to 2022, the FTC initiated or completed just 85 actions in the pharmaceutical sector, including 62 challenges of mergers, 22 enforcement actions against allegedly unlawful business practices, and one rule related to pharmaceuticals.  It allowed 61 of 62 mergers, but some drug divestitures did occur in mergers. The study finds a poor track record overall. This finding comes as the Biden administration is ramping up scrutiny of consolidations in healthcare.

(Article may require a subscription.)

#ftc #healthcare #mergers #acquisitions #manda #antitrust


Becker’s Reviews Medicare Advantage Issues

Becker’s reviews Medicare Advantage (MA) in a slightly pro-provider way but it is not terrible.  It finds that providers are terminating MA plan contracts as well as setting up their own plans. It discusses the status of the new prior authorization rule. It notes MA plans have financial headwinds and will cut back benefits. It also raises issues with supplemental benefits, overpayments, and the future of fee-for-service (FFS).

#medicareadvantage #medicare #hospitals


— Marc S. Ryan

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