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December 29, 2023

Devoted Health Has Successful Funding Raise Kudos to Devoted Health for its successful Series E funding raise. Devoted has been one of the few very successful insurtechs. It has excelled in the Medicare Advantage (MA) market as a startup. Run by career veterans with discipline, it is giving big plans a run for their money in some markets. Devoted’s record is very different to some of the other insurtechs, who cratered this year or are performing poorly. (Article may require a subscription.) #insurtechs #devotedhealth #medicareadvantage Link to Article Buchanan Right On Scoring Reform Rep. Vern Buchanan, R-FL and chair of the Ways and Means health subcommittee, wants a bipartisan group of lawmakers to work on legislation to revise the Congressional Budget Office’s (CBO) scoring techniques to include long-term savings from preventive healthcare. Others have backed changes too. Without getting into the technical details of CBOs methodology (I often see it

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December 28, 2023

Retailers Targeting Senior Populations In Primary Care Investments Good article showing why retailers are targeting seniors for their primary care initiatives. Retailers are interested in the potential financial arrangements (risk funds) that Medicare Advantage plans are focusing on. In addition, the seniors will tap other important features of their offerings, including pharmacies. (Article may require a subscription.) #retailhealthcare #medicareadvantage Link to Article Rural Hospitals Cite MA For Plight As Medicare Advantage (MA) grows, rural hospitals are saying that MA is responsible at least in part for their financial plight.  The argument is that even if MA plans pay traditional Medicare rates, they are getting so much less due to claim denials.  The net is not the same.  In addition, you have the wait time to get paid. This may be true in part, but I ask whether there is not waste and abuse in what the traditional system pays. Just

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The Healthcare Labyrinth 2023 Year-In-Review

As I have done for many years, I write a healthcare year-in-review blog to tell you about all the major health stories and trends of the last twelve months. It is meant to be a general assessment and you can check this website’s Newsfeeds and Blogs as well as my LinkedIn posts ( https://www.linkedin.com/in/marc-s-ryan-%F0%9F%87%BA%F0%9F%87%A6-1a99529/ ) for more information.  I break the stories and trends into categories to help your understanding. It is clear that 2023 was a busy year for healthcare, so this blog will be a long one! Here we go! Healthcare, Insurers, and Providers In General In general, 2023 was a continuing year of recovery from the COVID pandemic (2020 to 2022). Healthcare utilization was up again and costs/inflation are returning to normal. We shall see this continue into 2024. We saw moderate inflation in the healthcare sector in 2023 with similar projections for next year (5% to

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December 27, 2023

Healthcare Lawsuits To Watch in 2024 Good article on the healthcare lawsuits to watch in 2024, including many challenging the Inflation Reduction Act’s (IRA) Medicare drug price negotiations as well as preventive service mandates in the Affordable Care Act (ACA). #aca #ira #exchanges #obamacare #drugpricing Link to Article Lower Quality When Private Equity Firms Acquire Hospitals There is a lot of good data on hospital combinations leading to higher costs and no improvement in quality.  This study points to a rise in adverse events after a private equity takeover of a hospital.  This is despite the pool of lower risk patients in PE targeted hospitals. Additional article here: https://www.medpagetoday.com/publichealthpolicy/practicemanagement/108014 #mergers #acquisitions #hospitals Link to Article Insurtech Overview In 2023 Interesting review of insurtechs in 2023.  In general, insurtechs have been a huge disappointment for investors over the years and the companies have failed to make important gains in the market. 

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December 26, 2023

Predictions That Hospital M and A Will Pick Up in 2024 The article says that hospital mergers and acquisitions will pick up in 2024. A number of factors are cited, including financial pressures and outside forces. Deals were robust before the COVID pandemic and then collapsed.  They picked up in 2023 and will grow more in 2024. They won’t hit pre-pandemic levels though. New merger guidelines and the Biden administration’s anti-trust views could be a wild card and impact the ongoing recovery of M and A. (Article may require a subscription.) #hospitals #mergers #acquisitions Link to Article Threats From FTC Push Brand Drug Makers To Change Orange Book Entries The Federal Trade Commission’s (FTC) threats to come after brand drug makers who misrepresent patents in the Food and Drug Administration’s (FDA) Orange Book are leading several drug makers to change or pull patent entries.  It is good news as these

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The Insanity of Drug Pricing and Shortages: A Christmas Story

After what I went through, I asked Santa to bring me a rational drug pricing system for Christmas . But not even the great St. Nick can sort this mess out. Drug shortages or supply disruptions are in the news of late, with serious concerns over the availability of critical cancer and other life-saving drugs. While my drug supply story is not nearly as serious, I write about it today as I have been dealing with it over the Christmas holiday and it shows the pure insanity of our drug supply and pricing system in America. I am withholding the names of the pharmacies and the pharmacy benefits manager (PBM) as not doing so would be unfair to an individual drug chain or PBM. What we see here occurs across the drug supply chain. I am disclosing the drug manufacturers as this helps make clear the complexity of drug pricing.

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