May 8, 2024

Possible Cyberattack At Ascension

Catholic hospital system Ascension may have been a victim of a major cyberattack.  It runs 139 hospitals and 40 senior living facilities across the country.

Additional article: https://www.modernhealthcare.com/cybersecurity/ascension-possible-data-breach-cyberattack

(Some articles may require a subscription.)



House Ways And Means Passes Telehealth Extension

The House Ways and Means Committee passed a two-year extension of telehealth and a five-year addition to the hospital at home waiver. Some pharmacy benefits manager reforms were used as pay-fors.

Additional article: https://www.modernhealthcare.com/politics-policy/telehealth-rules-waiver-extension-congress

(Some articles may require a subscription.)

#telehealth #pbms #hospitalathome


Clover Health Improves Financial Results

Clover Health improved its financial performance with a $23 million loss. It also authorized a buyback program.  Clover is one of a few insurtechs doing well, including Alignment, Devoted, and Oscar.

#cloverhealth #medicareadvantage


Private Equity Healthcare Activity Slowing

A new study says private equity investments in healthcare is slowing due to the increased scrutiny from the federal government. Another report will be great fodder on Capitol Hill. It recounts how a private equity firm did well with its investment ($800 million gain) in now bankrupt Steward Health Care, so much so that an executive was able to use cash gained on a $40 million yacht.

In Health Affairs Forefront, authors recount the negative impact of private equity on healthcare from a stability, financial, and quality standpoint. They say the solution is to force re-structure of tax incentives to ensure investment in value-based arrangements.  As well, the use of real estate trusts should be examined. Other recommendations they discuss are escrow accounts and requirements to be obligated to debt, and holding timeframes, among others.

Additional articles: https://www.medpagetoday.com/special-reports/features/110025 and https://www.healthaffairs.org/content/forefront/tame-private-equity-beast-shifting-its-focus-value-based-care and https://www.fiercehealthcare.com/providers/steward-health-care-tells-bankruptcy-court-it-plans-sell-all-31-hospitals-summer-deadline

(Some articles require a subscription.)

#privateequityfirms #healthcare


Call For Reining In MA Risk Adjustment Assessments

A prominent study in Health Affairs indicates that the presence of health risk assessments for a Medicare Advantage (MA) member tends to increase risk adjustment scores. The study found risk scores increase by about 12.8 percent on average. Restricting their use could save up to $12.3 billion.

Additional articles: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2023.00787 and https://www.beckerspayer.com/payer/limiting-medicare-advantage-patient-surveys-could-save-billions-study.html

(Some articles may require a subscription.)

#medicareadvantage #riskadjustment


Cancer Drug Article Underscores What We All Hate About Brand Drug Makers

Excellent article by Kaiser Health News.  The article points to how brand drug makers put profits over real science and complex patients’ comfort. To me, it shows reform is needed in drug pricing and research.  Despite supposed reforms by the Food and Drug Administration (FDA), it, too, points to the FDA’s crumbling regulatory oversight. A must read.

#cancerdrugs #branddrugmakers #drugpricing


Brand Drug Makers Spend More On Marketing And Shareholder Payments Than On R & D

A new analysis finds that most brand drug makers spent more on marketing and shareholder dividends/payments than on research and development (R & D). Eight brand drug makers were examined.  They manufacture the ten drugs in the first year of Medicare drug negotiations. Four companies spent more on shareholder payments than on R & D.  Five spent more on administrative and marketing costs than on R & D.

#branddrugmakers #drugpricing #ira


Two Percent Of All Scripts Come Through Illegal Pharmacies

A new study shows that 2% of all prescriptions are filled through illegal pharmacies.  While some prescriptions run through these illegal shops are for highly regulated drugs like opioids, at least some of the volume is due to high prices elsewhere. There is a huge rise in GLP-1s through these means as well as a troubling rise in poisoning reports due to potential fraudulent drugs.



Becker’s Recounts Payer Layoffs

Becker’s has assembled a list of payer layoffs.  Plans are battling low rate hikes in Medicare Advantage as well as rising utilization across lines of business.



Prominent Democrat Says MA Plans Should Get Their PAs Approved by CMS

Senate Budget Committee Chairman Sheldon Whitehouse, D-R.I. says Medicare Advantage (MA) plans should have their prior authorization requirements approved by the Centers for Medicare and Medicaid Services (CMS) if doctors are also in accountable care organizations (ACOs). A positively terrible idea and further erosion of managed care.

#medicareadvantage #priorauthorization


— Marc S. Ryan

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