Review Of Healthcare Consolidation
Excellent Health Affairs Forefront Blog on the impacts of healthcare consolidation. A good read. As the authors note:
- Consolidation is a main driver of increased healthcare costs.
- Horizontal hospital consolidation increases hospital prices 20 to 40%.
- 90% of hospital markets are highly concentrated.
- Hospital acquisition of providers means 55% of all doctors are now employed by hospitals and health systems. This changes practice patterns to higher cost settings.
- Public equity continues to grow in healthcare.
The authors recommend a series of changes to strengthen oversight:
- Taking steps to make it easier to block anticompetitive mergers.
- Refining payments in traditional Medicare to dissuade overpayments related to acquisitions, including moving to site-neutral payments.
- Refining the minimum medical loss ratio (MLR) formula to ensure Medicare Advantage (MA) cannot shuttle monies to plan-owned physician entities to get around the MLR requirement.
- Instituting better transparency on acquisitions and consolidations.
(Article may require a subscription.)
#antitrust #manda #acquisitions #mergers #healthcare
https://www.healthaffairs.org/content/forefront/rise-health-care-consolidation-and-do
2025 Medicare Advantage Benefit Anxiety
Two articles that show the rising anxiety over potential reductions in Medicare Advantage (MA) as well as Part D. Health plans are emphasizing the need for education. Predictions are that consumers will attempt to emphasize consistency over new innovations in benefits. Plans will need to build closer relationships with providers as well as emphasize care and risk management.
Additional article: https://www.beckerspayer.com/payer/medicare-advantage-plans-contend-with-election-anxiety.html
#medicareadvantage #enrollment
https://www.beckerspayer.com/payer/the-great-disruption-coming-for-medicare-advantage.html
AMA Study Shows PBM Market Highly Concentrated
An American Medical Association (AMA) study says that the four largest pharmacy benefit managers (PBMs) control 70% of the national market related to commercial and Medicare Part D coverage. It also concludes that most regional PBM markets are highly concentrated. Both horizontal and vertical integration are issues. The Big 3 PBMs control about 60%.
The AMA believes the findings “warrant attention as Congress and the administration continue their work to protect patients and ensure prescription drugs remain affordable and accessible.” The AMA wants increased regulatory oversight.
#pbms #manda #drugpricing
https://www.fiercehealthcare.com/payers/ama-study-four-largest-pbms-control-70-market-nationally
Congress Headed For Another Stop Gap
With the start of FFY 2025 coming on October 1, Congress is headed for a continuing resolution. Other healthcare reform and policy changes are slated for any final funding bill or as separate measures in the Senate. Some Democrats want to force a vote on a permanent extension of the enhanced premium subsidies in the Exchanges. The House may attach a voting measure on any bill. This would cause huge issues for passage.
Additional articles: https://insidehealthpolicy.com/daily-news/cr-timing-upcoming-elections-leave-expiring-health-care-programs-limbo and https://insidehealthpolicy.com/inside-drug-pricing-daily-news/drug-price-reforms-still-table-passage-year-schumer-says
(Some articles may require a subscription.)
#crs #governmentshutdown #ffy2025budget #healthcare
GLP-1 Drug Facts
Becker’s culled together interesting facts about the state of GLP-1 coverage. Commercial coverage of GLP-1s is clearly the greatest, but coverage in other insurance is rising. Coverage is higher for those with disease states and overweight, but employer coverage is largely the only line covering the drugs for just weight loss.
#weightlossdrugs #glp1s #coverage
https://www.beckerspayer.com/payer/glp-1s-and-insurance-coverage-10-key-numbers.html
Mental Health Parity Finalized
The Biden administration has finally issued new requirements for health plans to strengthen mental health parity laws for about 175 million Americans. While existing laws exist on parity, the new regulations strengthen requirements for plans and employer groups, especially in the area of prior authorization. The health plan lobbies oppose the provision as too far-reaching and opening the potential for unneeded care.
Additional article: https://www.beckerspayer.com/policy-updates/white-house-expands-mental-health-parity-coverage.html
#mentalhealth #healthcare
Divergent Healthcare Views Of Candidates Explained
A very good article discussing the various healthcare views of Kamala Harris and Donald Trump. As noted, Trump says he has backed away from his firm proposal to repeal Obamacare. In general, though, Harris’ pro-coverage views are more in line with Americans’ views. As I have said, healthcare could play a role in swing states.
#healthcare #election2024
— Marc S. Ryan
