Hospital Consolidation Has Meant Little Competition In Many Markets
A great Kaiser Family Foundation (KFF) analysis shows the impact of massive hospital consolidation over the past many years. Nearly half (47%) of metropolitan areas had only one or two hospitals or health systems providing inpatient hospital care in 2022. About one in five (19%) metropolitan areas have only one hospital or health system providing hospital care. More than a quarter (27%) are controlled by two hospitals or systems.
Digging deeper, in 82% of metro areas, one or two hospitals or health systems were responsible for at least three quarters of all inpatient hospital discharges. This signifies these markets are highly concentrated under federal antitrust guidelines.
We know that hospital consolidation has led to major price increases. As well, hospitals and healthcare systems have acquired physician practices, raising prices for physician care by changing practice patterns to more expensive hospital locations.
Congress needs to intervene to stop further consolidation and pass site-neutral policies.
#hospitals #antitrust #manda #mergers #acquisitions
BSC Goes Direct To Acquire Humira Biosimilar
Blue Shield California (BSC) will offer a biosimilar version of Humira for free to show the medicine can reach Americans affordably. BSC is going directly to the manufacturer to purchase the drugs to cut out various middlemen, including pharmacy benefits managers (PBMs). The move adds to a previous major announcement of a novel approach to rein in costs and bring transparency to drug purchasing.
BSC will pay $525 per 30-day supply. This is well below the price of Humira but also what PBMs charge for their very own biosimilars, which is $1,000 to $1,300 for the big three PBMs. BSC will save even if it offers the drug free – some $20 million over three years. Amazing.
BSC’s approach is like Mark Cuban’s Cost Plus Drug and GoodRx initiatives that sell for roughly the same price as BSC’s cost. Of course, PBMs have all sorts of excuses about why you cannot compare their prices to these prices. It of course is all obfuscation.
Congrats to BSC for reforming the system, calling out the dysfunction, and supporting transparency. The move is certain to lead to more reform.
(Article may require a subscription.)
#biosimilars #generics #branddrugmakers #healthplans #bsc
Plans Open Medicare Enrollment Season Plugging Their Wares; But There Are Major Cutbacks
Today was the day to put the best spin as possible on Medicare Advantage (MA) offerings for 2025. And the big plans did so, largely ignoring the major reductions as the Centers for Medicare and Medicaid Services (CMS) did a few days ago.
The big plans touted nationwide coverage, low or no premium options, growing special needs plans (SNPs) investments, growth in certain supplemental benefits, and some growth of plans and products in areas of the country.
But it is important to note the cutbacks due to headwinds in the MA program. Based on announcements from Humana, Cigna, Aetna, Centene, BCBS Kansas City, Premera, and others, we know there will be plan exits from service areas, network changes, and significant changes to benefits in some areas. At least 27 health systems have terminated MA plan contracts over disputes on rates, prior authorization, and claims denials. A brand new analysis suggests that there will be fewer Medicare Advantage plans available in 2025 than in 2024 in 22 states and Washington, D.C. This is the October Surprise I have been talking about – about half the nation with cutbacks.
On the Part D PDP side, while the CMS premium stabilization program certainly helped (it will cost $5 to $10 billion over 3 years), we will also see formulary changes and higher cost-sharing. In addition, plan choice in the PDP world will continue to contract.
Additional article: https://www.beckerspayer.com/payer/aetna-launches-2025-medicare-plans-7-notes-2.html and https://www.managedhealthcareexecutive.com/view/aetna-updates-ma-and-drug-programs-for-medicare-in-2025 and https://www.beckerspayer.com/payer/premera-blue-cross-exits-medicare-advantage.html and https://www.beckerspayer.com/payer/22-states-where-medicare-advantage-offerings-are-shrinking.html
#medicareadvantage #healthplans
Hospital At Home Has Mixed Record
A Centers for Medicare and Medicaid Services (CMS) assessment of the hospital-at-home waiver program finds patients and clinicians widely appreciate it, but there is no clear value from a quality and cost front yet documented vs. brick-and-mortal inpatient stays. There is some evidence quality is better but it is not material right now. About 332 hospitals across 38 states are participating in the waiver.
The waiver is authorized through 2024. Some are suggesting Congress will extend it for another two years later this year. While the record is mixed, given the advent of technology and the ability to perform more and more care in the community, the waiver should be extended. A case can also be made that this represents hospital reform.
#hospitals #hospitalathome #medicare
New Analysis Shows Health Outcomes On Decline
A new analysis points to troubling trends in the U.S. healthcare market as costs continue to rise but health outcomes are declining. Trilliant Health’s “2024 Trends Shaping the Health Economy” finds that U.S. national health expenditures increased from $2.8 trillion in 2012 to $4.5 trillion in 2022, with relatively little change in demand or utilization. Spending is expected to grow to $7.7 trillion by 2032.
More people are insured due to the passage of the Affordable Care Act (ACA). At the same time, data show that the ongoing investments in more money for healthcare has not meant rising health outcomes. Life expectancy is barely higher and is well below other developed nations. Chronic disease in America is high comparatively.
In addition, investments in value-based care to improve quality has not resulted in savings or improvements.
Report here: https://www.trillianthealth.com/market-research/reports/2024-health-economy-trends
#healthcare #healthcarereform
Industry Reeling From CVS Troubles
The health plan industry is reeling from the recent troubles of CVS Health, including major financial problems, the announcement of major layoffs, the potential for an activist investor to force changes, and the potential breakup of the company. Modern Healthcare has published a timeline of major CVS Health events since July 2006.
(Article may require a subscription.)
#cvshealth #aetna #healthcare
https://www.modernhealthcare.com/insurance/cvs-health-aetna-breakup-caremark-karen-lynch
— Marc S. Ryan
