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February 20, 2024

Analysts Say Digital Health Facing Funding Challenges After record years of funding, digital health ventures are facing lean times to stay solvent. (Article may require a subscription.) #digitalhealth #healthcare Link to Article 2024 Financial Woes For Medicare Advantage Plans Excellent Healthcare Dive article on the potential financial woes for Medicare Advantage (MA) plans resulting from rising medical expense and insufficient rates.  I covered some of this in my blog here: https://www.healthcarelabyrinth.com/with-boom-over-will-medicare-advantage-collapse-or-adjust/ #medicareadvantage #rates Link to Article New Challenges For Providers On Medicare Drug Price Negotiations Interesting article on the impediments to provider entities suing on their fallout from the Medicare drug price negotiations. A judge found they have a lack of standing right now to sue. (Article may require a subscription.) #ira #drugpricing Link to Article AI Task Force In The House Similar to Senate interest, the House Speaker has formed a bipartisan task force on regulating AI in healthcare.

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February 19, 2024

A Look At Growing Provider-Payer Disputes In California A good article from Kaiser Health News (KHN) that looks at growing contract disputes between providers and payers.  This one was in CA, but this is occurring nationwide.  KHN mentions higher costs coming from provider consolidation as well as increasing leverage when payers merge. The Biden administration is on to something with its anti-trust initiative. #providers #healthplans #coverage #payments Link to Article Wakely’s Assessment Of The 2025 Medicare Advantage Advance Notice As it does each year, Wakely has issued its annual assessment of the advanced notice for Medicare Advantage (MA).  My analysis is here: https://www.healthcarelabyrinth.com/2025-rates-for-medicare-advantage-plans-look-tight/ . #2025 #rates #medicareadvantage Link to Article Dual Eligible Special Needs Plan Analysis By Kaiser Family Foundation The Kaiser Family Foundation (KFF) published a look at Dual Eligible Special Needs Plans (D-SNPs).  Among the findings: My own research shows that SNPs in general, most of it dual

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February 16, 2024

No Surprises Act Dispute Process Favors Providers The No Surprises Act (NDA) remains  a huge mess with volume 13 times higher than forecast for 2023.  What’s more, providers won 77% of arbitration cases and health insurers won in 23% of cases. The winning offers were above the qualifying payment amount, which is the median in-network rate. The good news is that 10 million surprise bills were avoided with the law in the first nine months of 2023.  The bad news is that providers are winning huge in the baseball-style arbitration as they do in other states that have it.  Studies show that rates and premiums rose in those states under the provider-friendly process.  Researchers say that will happen nationwide now.  Yet, providers continue to sue to get things even more slanted toward them.  Congress has to even the playing field.  But they won’t as lawmakers from both sides of the

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February 15, 2024

Cigna To Start Stock Buyback Cigna said it would repurchase $3.2 billion in stock as part of a repurchase of $5 billion of common stock over the first half of 2024. This will help enhance its stock price.  Cigna will get $3.7 billion for its Medicare Advantage sale to Health Care Service Corporation (HCSC) when it closes. #cigna #hcsc Link to Article New Bill To Establish “Essential Hospital” Designation Lawmakers are sponsoring a bill that would designate about 1,000 hospitals as “essential health systems” under federal statute.  This would provide a vehicle to shelter these hospitals from negative programmatic decision (similar to critical access hospitals and sole community hospitals) as well as target new dollars for health equity and related initiatives. Hospitals would need to meet certain Medicare or Medicaid thresholds. #hospitals #medicare #medicaid Link to Article Capitol Hill Interest In AI Legislation But Little Progress A good article on the interest

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February 14, 2024

Elevance Health Takeover Of BCBSLA On Hold Again Facing pushback from Louisiana regulators, the governor and some lawmakers, BCBSLA has again withdrawn its application for sales to Elevance Health. BCBSLA sought permission to transition to a for-profit entity. Additional article: https://www.modernhealthcare.com/mergers-acquisitions/elevance-health-blue-cross-louisiana-merger-called-off (Some articles may require a subscription.) #bcbsla #elevancehealth Link to Article Biden Administration To Scrutinize Middlemen In Drug Shortage Controversy The Biden administration has issued a Request for Information (RFI) about the role of drug channel middlemen in creating drug shortages. The middlemen include group purchasing organizations (GPOs) and drug wholesalers. About six entities dominate. The Federal Trade Commission (FTC) and the Department of Health and Human Services (HHS) are leading the effort. The agencies will look at market concentration, contracting practices, and regulatory exemptions. In addition, GPOs’ sole-source agreements that prevent hospitals and other providers from acquiring drugs elsewhere will be examined. HHS Press Release here: https://www.hhs.gov/about/news/2024/02/14/ftc-hhs-seek-public-comment-generic-drug-shortages-competition-amongst-powerful-middlemen.html Additional

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