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April 26, 2024

FTC Approves Rule Extending Data Privacy To Digital Apps On a 3-2 vote, the Federal Trade Commission (FTC) finalized a rule that extends the scope of its breach notification rule to include personal health information collected by health apps and other technology that are outside the Health Insurance Portability and Accountability Act.  It is a very controversial move and may be beyond the FTC’s authority. Additional article: https://insidehealthpolicy.com/daily-news/ftc-issues-controversial-breach-notification-rule-despite-two-commissioners-dissent #cybersecurity #breaches https://www.fiercehealthcare.com/health-tech/ftc-finalizes-changes-data-privacy-rule-step-scrutiny-digital-health-apps Study Shows Hospital Mergers Raise Price, Little Government Scrutiny Two academic studies say hospital mergers and acquisitions raise price and receive little scrutiny from regulators. That could change with the Biden administration’s new focus. #manda #mergers #acquisitions #hospitals https://www.fiercehealthcare.com/finance/hospital-ma-studies-highlight-higher-prices-tepid-antitrust-intervention Centene Reports Positive Financial News Centene reported reasonably good financial news, beating expectations.  It says its Medicaid dominant business is doing well against forecasts for redetermination enrollment losses and is about 90% through the process. Q1 medical costs were up. 

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April 25, 2024

Cigna Arm To Offer Humira Biosimilar At $0 Cost-Share Finally, we are making some advances on biosimilar adoption.  For awhile, pharmacy benefits managers (PBMs) were teaming up with brand drug makers to stop the uptake of biosimilars through rebate arrangements.  That still happens, but PBMs are seeing the light. Evernorth’s Accredo Specialty Pharmacy will make a Humira biosimilar available to patients with no cost-share. Evernorth is partnering to produce the biosimilar. The biosimilar price is about 85% lower than that of the brand. #biosimilars #drugpricing #brandrugmakers #cigna #evernorth https://www.fiercehealthcare.com/payers/evernorths-accredo-offer-humira-biosimilar-0-out-pocket Kaiser Permanente Reports Major Breach A data breach at Kaiser Foundation Health Plan affected more than 13 million individuals.  It is not a hack or ransomware attack.  It appears the plan’s technology may have inadvertently transmitted personal information to Google, Microsoft Bing and X. (Article may require a subscription.) #cyberattacks #kaiserpermanente #breaches https://www.modernhealthcare.com/cybersecurity/kaiser-permanente-data-breach Mixed News For Molina Healthcare The Molina stock went

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April 24, 2024

Humana Bounced Back But Has Challenges Humana’s Q1 2024 investor call was better than its Q4 one.  It reported better results, including a slightly improved medical loss ratio for its large Medicare Advantage (MA) business. Costs seem to be coming down but the delay in claims due to the cyberattack could cause a re-evaluation. Humana projects flat margins in 2024 and long-term margins to decline to a floor of 3%, which is noticeably down. It will cut $700 million in response in 2024. It pulled its 2025 projections for now. It continued to note that the 2025 rate hike will mean reductions in benefits and retreating in some geographies.  Additional article: https://www.modernhealthcare.com/finance/humana-medicare-advantage-profit-2024 and https://www.healthcaredive.com/news/humana-withdraws-2025-earnings-outlook-q1-2024/714105/ and https://www.beckerspayer.com/payer/humana-reported-741-million-in-net-income-in-the-first-quarter-of-2024.html and https://www.beckerspayer.com/payer/humana-plans-to-leave-some-medicare-advantage-markets-in-2025.html (Some articles may require a subscription.) #humana #medicareadvantage https://www.fiercehealthcare.com/payers/humana-confirms-2024-guidance-even-it-beats-street-q1 Notable Layoffs Hitting Healthcare These are not the first announced layoffs due to tightening times, but more announcements have come.  Optum has laid

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April 23, 2024

FTC Votes To Ban Most Non-Competes The Federal Trade Commission (FTC) bans most non-competes.  The final rule would ban such agreements for anyone that is not both a senior executive (in a “policy-making position”) and earning more than $151,164 annually.  These positions represent less than 0.75% of the workforce. The FTC does not have cognizance over non-profits.  The rule is expected to be challenged in court, but seems to be a reasonable proposal.  Non-competes are used extensively in healthcare, even for doctors who do not meet the policy-making provision. This impacts up to 40% of doctors. A non-compete would remain for senior positions, which does not seem unreasonable. Surprisingly, provider lobbies are against a ban, largely because they are now influenced by private equity owners, who seek to freeze out doctors from taking other jobs. Many entities promise to sue. Additional articles: https://www.fiercehealthcare.com/regulatory/ftc-votes-3-2-issue-final-rule-banning-noncompetes and https://www.modernhealthcare.com/providers/ftc-noncompete-ban-agreement-lina-khan and https://www.healthcaredive.com/news/ftc-noncompete-ban-healthcare-doctor-effects/713846/ (Some articles may

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April 22, 2024

United Did Pay Ransom In Cyberattack United HealthGroup confirmed that personal health information (PHI) and personally identifiable information (PII) was exposed in the attack and “could cover a substantial proportion of people in America.” It also confirmed a ransom was paid. It will take awhile to get to what was exposed and who was impacted. Experts have data which points to the payment of a $22 million ransom by United.  United confirms that while some systems are functioning near normal, others are not yet up and will be restored over time. In additional news, the United CEO will appear before a House subcommittee on May 1: https://www.reuters.com/business/healthcare-pharmaceuticals/unitedhealth-ceo-testify-before-us-house-panel-cyberattack-tech-unit-2024-04-19/ . Additional article: https://www.modernhealthcare.com/cybersecurity/change-healthcare-update-unitedhealth-ransom (Some articles may require a subscription.) #united #changehealthcare #cyberattacks https://www.fiercehealthcare.com/payers/unitedhealth-offers-update-cyberattack-data-analysis-systems-restoration Sweeping Medicaid Manage Care Rule Finalized The Centers for Medicare and Medicaid Services (CMS) finalized Medicaid managed care rules today that cover a number of critical areas, including requiring

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April 19, 2024

Optum Appears To Be Laying Off Employees Over Cyberattack Given the fallout from the Change Healthcare cyberattack, Optum appears to be laying off hundreds if not thousands of employees.  United HealthGroup has not commented on the matter at this point. I have heard that some of the laid off employees are even within the Change Healthcare unit, which could be impacting the return to normal business operations for some plans and providers. If this is true, that is outrageous. #changehealthcare #optum #cyberattacks https://www.fiercehealthcare.com/payers/optum-undergoes-mass-layoffs-scale-unclear Continued Fallout Over Change Healthcare Cyberattack Good Kaiser Health News article on the continued fallout over the Change Healthcare cyberattack.  United tries to put the best face on the issue, saying that in many cases it is seeing normal operations.  But this article shows that many healthcare entities continue to see huge impacts on cash flow and their ability to bill.  I have personally been in contact

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April 18, 2024

Elevance Health Reports Positive Q1 News Elevance Health reported overall good numbers for Q1 2024.  While membership has dropped in Medicare Advantage (MA) and Medicaid, margins were up and it reported little fallout on the Medicare medical expense or Change cyberattack front. Due to the MA rate cut, Elevance will balance business expansion with margin. On the call, the CEO also discussed the need to excel at Star measurement in MA.  It also continues to build its Carelon services unit. Additional articles: https://www.fiercehealthcare.com/payers/elevance-health-sees-double-digit-profit-growth-q1-posting-22b-earnings and https://www.modernhealthcare.com/insurance/elevance-health-medicaid-medicare-advantage-earnings (Some articles may require a subscription.) #elevancehealth #medicareadvantage https://www.healthcaredive.com/news/elevance-health-earnings-q1-change-cyberattack-medicaid-medicare-advantage/713521 Lawmaker-Physician Burgess Calls For Site-Neutral Policies Retiring Rep. Michael Burgess, a physician, is calling on the Biden administration to implement site-neutral payments for hospitals, arguing it could be a way to free up dollars to overhaul the physician payment formula in Medicare and lower overall costs.  He is right! I am not always sympathetic to physicians,

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April 17, 2024

Many Healthcare Bankruptcies Linked To PE Firms I often talk about the pernicious impact that private equity firms have on healthcare.  Where the firms are successful, they tend to drive up costs in the system by buying provider groups, including owning emergency room providers, and pushing for huge payouts in No Surprises Act (NSA) arbitrations.  They also own hospitals where they cut costs due to high debt. Quality of course suffers and patient care takes a back seat. Such firms also force providers to practice at high-cost hospital places of service (the same is true for hospitals who are independent but are buying up doc groups). But the other pernicious impact is on shoddy investments and the churn and fallout that occurs.  PE firms tend to saddle the entities they buy with debt.  What’s more, some of the investments are questionable and speculative.  A new report says that more than

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April 16, 2024

Affiliate Of BlackCat Reportedly Published PHI From Change Cyberattack While the main operator of BlackCat ransomware appears to have kept a rumored $22 million ransom paid by United HealthGroup, an affiliate published data from the Change Healthcare cyberattack after United did not pay an additional ransom.  The affiliate controlled the captured PHI and data. #changehealthcare #cyberattacks https://www.fiercehealthcare.com/payers/optums-change-healthcare-responding-cybersecurity-issue United Reports Stabilization of MA And Costs Of Cyberattack United HealthGroup reported two critical factors on Tuesday.  First, Medicare Advantage (MA) costs have stabilized in Q1 2024.  Second, the Change Healthcare cyberattack will cost up to $1.6 billion.  The costs will likely far exceed this estimate. Additional articles: https://www.modernhealthcare.com/insurance/change-healthcare-update-cyberattack-cost-unitedhealth and https://www.healthcaredive.com/news/change-cyberattack-unitedhealth-cost-q1-earnings/713288/ and https://www.beckerspayer.com/payer/medicare-advantage-costs-begin-to-stabilize-unitedhealth-says.html (Some articles may require a subscription.) #unitedhealthcare #changehealthcare #cyberattacks #medicareadvantage https://www.fiercehealthcare.com/payers/unitedhealth-says-seasonal-pressures-ma-utilization-eased-q1 Lawmakers Receptive To Provider Recommendations On Cyber Security With United HealthGroup declining an invitation to attend a congressional hearing, lawmakers largely were empathetic to providers’ views on the cyber

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April 15, 2024

Some Big Insurers May Lose Medicaid Contracts In Florida Humana, Centene, and Elevance Health were the three big plans to win Florida Medicaid awards moving forward along with a number of local plans. But UnitedHealthcare, Aetna, Molina Healthcare, and AmeriHealth Caritas Florida were not given awards. Many states are seeking to cultivate local plans. Appeals will likely follow from the three big plans not selected. Additional article here: https://www.fiercehealthcare.com/payers/unitedhealth-cvs-molina-big-losers-florida-medicaid-contract-awards #medicaid #fl #managedcare #healthplans https://www.healthcaredive.com/news/florida-medicaid-awards-centene-elevance-humana-unitedhealth-cvs-molina/713154 Carelon And Private Equity Firm Partner On Primary Care Elevance Health announced that its service unit Carelon will partner with private equity firm Clayton, Dubilier & Rice and its assets, Apree Health and Millennium Physician Group on advancing primary care.  About 1 million will be covered. The move seeks to drive a close relationship between primary care and Elevance as an insurer.  The move is a bit of a surprise given the extreme focus on private equity’s

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