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July 19, 2024

Widespread Healthcare IT Outages Due To Security Update Error A widespread global IT outage impacted hospitals and providers worldwide. Electronic health record software was affected in a big way. Procedures and services had to be cancelled. Some states’ 911 call centers were impacted as well. Financial institutions, airlines, and more were all impacted. The outage was the result of a faulty routine software security update by cybersecurity firm CrowdStrike meant for Microsoft computers and systems running Windows. A fix was deployed. Separately, an article discusses 911 outages generally in states as a result of a patchwork and antiquated system nationally. It is one example of our under-reimbursement in public health compared with other developed world nations. Additional articles: https://www.healthcareitnews.com/news/worldwide-it-disruption-disrupts-healthcare-delivery and https://www.modernhealthcare.com/cybersecruity/crowdstrike-outage-ehr-hospitals-epic-mychart and https://www.healthcaredive.com/news/crowdstrike-outage-hits-us-hospitals/721887/ and https://www.medpagetoday.com/special-reports/features/111179 and https://www.modernhealthcare.com/providers/911-outages-massachusetts-emergency-response-system-flaws-mass-general-brigham (Some articles may require a subscription.) #hospitals #providers #healthcare https://www.fiercehealthcare.com/health-tech/global-it-outage-takes-down-health-system-ehrs-forces-hospitals-cancel-non-emergency GoodRx And Drug Maker Team Up On Biosimilar For Humira GoodRx has teamed

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July 18, 2024

Sinister Optum Layoffs And Closures Continue UnitedHealth Group’s Optum services subsidiary continues its shedding of jobs. The layoffs have occurred quietly in many areas of the sprawling and amazingly profitable enterprise post the ChangeHealthcare pandemic. In conversations I have had with health plan executives, the layoffs seem to be impacting numerous areas, putting health plans and providers in tough situations. All systems and services are not up yet post the cyberattack and United seems to be abandoning without notice key health plan and provider functions without any reasonable notice or guidance to clients. This is meant to shed questionably profitable areas and assets in favor of the bottom line. The fact that United is leaving major pieces of the healthcare system at risk is a travesty and should be investigated by the executive and legislative branches. Perhaps the class-action suits against United need to be expanded to cover these unseemly practices

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Hillbilly Heart: Despite His Conservatism, Could GOP VP Nominee JD Vance Be A Healthcare Maverick?

The political world is abuzz about the naming of Ohio Senator JD Vance as former President Donald Trump’s vice presidential running mate. I will stay out of the broader political fray right now, but I thought it was worth writing about how GOP candidates increasingly do not always meet a strict GOP litmus test on every issue. This could be – I emphasize could – with Vance on healthcare. Vance came to fame with his bestselling book, Hillbilly Elegy: A Memoir of a Family and Culture in Crisis, which recounted the social and economic problems his family faced during his upbringing in Kentucky and later in Ohio. Vance recounts the plight of poor white working-class families in Appalachia, including family struggles with alcoholism and drug dependence, as well as the embedded love of culture and country. He tells of his rise from this meager existence in a one-parent household to

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July 17, 2024

Elevance Beats The Street For Q2 Elevance Health beat The Street on both profit and revenue in Q2 2024. The insurer posted $2.3 billion in profit and $43.9 billion in revenue. It signaled it is seeing 5% enrollment declines in Medicaid due to redetermination. That should end later this year. Utilization could increase due to increased acuity in Medicaid. Carelon, its service entity, increased its financial position dramatically. With its win in a lawsuit on Star ratings, Elevance expects 56% of its Medicare Advantage (MA) members to be in 4 Star or greater plans. A huge boost to its MA program. Additional articles: https://www.fiercehealthcare.com/payers/elevance-health-beats-street-q2-it-posts-23b-profit and https://www.healthcaredive.com/news/elevance-second-quarter-2024-medicaid-medicare-advantage/721551/ and https://www.beckerspayer.com/payer/medicaid-utilization-rising-elevance-health-warns.html and https://www.beckerspayer.com/payer/elevance-health-posts-2-3b-profit-in-q2.html (Some articles may require a subscription.) #elevancehealth #medicaid #medicareadvantage https://www.modernhealthcare.com/insurance/elevance-health-profits-medicaid-medical-costs Humana Invests In AI-Driven Medicare Advantage Plan Choice Firm Humana has acquired a minority stake in Healthpilot, which offers consumers artificial intelligence-driven guidance in selecting Medicare Advantage (MA)  plan options.

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July 16, 2024

Despite Conservatism, Vance Has Surprising Record On Healthcare J.D. Vance is seen as a rightist Republican. But Donald Trump may have chosen a bit of a maverick on healthcare for his VP partner. In the past, Vance has criticized the Obamacare repeal because it would have impacted lower income people. In addition, he has signaled support on drug price reform, which is similar to Trump’s position. While he previously endorsed Medicare cuts, he has backed away from this position and has indicated that more should be spent on healthcare. Additional article: https://insidehealthpolicy.com/daily-news/jd-vance-s-record-includes-drug-negotiation-support-mixed-record-medicare-abortion (Some articles may require a subscription.) #election2024 #trump #vance https://thehill.com/policy/healthcare/4775098-vance-healthcare-positions UnitedHealth Reports Q2 Earnings UnitedHealth Group reported that second-quarter net earnings declined 23% year-over-year to $4.2 billion. It reported revenue of $98.9 billion, a 6.5% increase from the prior year period. The medical loss ratio (MLR) was 85.1%, an increase from 83.2% a year ago. High Medicaid and Medicare

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Medicare Advantage Plans Need To Get Their Focus On Supplemental Benefits Quickly

Medicare Advantage (MA) critics like to shout about revenue overpayments and this is sure to generate headlines and ongoing controversy. But MA plans need to worry about yet another concern from the Centers for Medicare and Medicaid Services (CMS), investigatory agencies, and Capitol Hill. This surrounds supplemental benefits and whether enrollees are benefiting from the vast amount of dollars supposedly earmarked for their utilization each year. This is yet another complicated subject so let’s try to break this down a bit. Rate-setting quick primer As we have discussed on this website often, the rate-setting process in MA has helped MA plans grow considerably. Plans submit annual bids on how much it will cost to deliver traditional Medicare benefits. It then is paid out a portion of the difference between the county benchmark and the bid amount for traditional benefits. This is called the rate rebate. The amount given back to

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July 15, 2024

What Will Health Policy Look Like Under A Trump 47 Administration? As the Republican National Convention (RNC) begins this week, a Modern Healthcare article finds that the GOP platform is light on healthcare.  However, it points to Trump 45’s record, documents from the House Republican Study Committee, and the Heritage Foundation’s Project 2025 for possible insights into a Trump 47 healthcare agenda. Culling it all together, policy likely will be fundamentally different from the current administration.  Whether the Affordable Care Act (ACA) is repealed or not, coverage declines can be expected in the Exchanges and Medicaid.  Despite some reform proposals, Trump has distanced himself from radical changes in Medicare. It is unknown if Trump would pick up his previous stances on drug pricing, which are much closer to President Biden’s views. (Article may require a subscription.) #election2024 #healthcare #trump #biden https://www.modernhealthcare.com/politics-policy/donald-trump-republicans-2024-election-medicare-medicaid-aca-abortion-project-2025 Chevron Sunset Opens Up Many Litigation Fronts Interesting article

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Slower Growth From June to July In Medicare Advantage

As noted, I decided to continue my Medicare Advantage (MA) monthly enrollment blogs because of continuing strong month-over-month increases. Admittedly, the continuing growth is tied to remaining strong benefit packages for 2024 and appears to be isolated to a few big plans. Month-over-month growth appears to be slowing a bit, but we are so close to the Fall open enrollment season that I will keep doing these monthly snapshots for those who like to track the data. One new feature in the chart below: you may notice the percentage of MA enrollment against the total Medicare beneficiary population has changed slightly. That is because I stumbled upon a great Centers for Medicare and Medicaid Services (CMS) monthly Medicare enrollment site. It has both annual average enrollment as well as monthly enrollment. This goes all the way to the county level in each state. The site is here: https://data.cms.gov/summary-statistics-on-beneficiary-enrollment/medicare-and-medicaid-reports/medicare-monthly-enrollment . The good

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July 12, 2024

Price Transparency Hearing Shows More Needs To Be Done A Senate hearing on price transparency shows much more needs to be done on price transparency despite progress during the Trump and Biden years. #pricetransparency #healthcare #healthplans #hospitals https://www.fiercehealthcare.com/regulatory/it-isnt-normal-senators-condemn-insurers-hospitals-resistance-price-transparency FFS Medicare Physician Pay Cuts Proposed Despite More Money For ACOs The Centers for Medicare and Medicaid Services (CMS) is a bit schizophrenic on physician pay, proposing a base physician pay cut in Medicare but added incentives in the Accountable Care Organization (ACO) reform pilot.  There is little evidence thus far that ACOs are redefining cost and quality in the traditional Medicare program. (Article may require a subscription.) #acos #medicare #physicians https://www.modernhealthcare.com/policy/cms-aco-proposals-medicare-shared-savings-program-health-equity-value-based-care Republican Platform Light On Policy Details Former President Trump put his stamp on the Republican Party platform, but it looks light on details.  Trump has distanced himself, from the Heritage Foundations’ “Project 2025.” #election2024 #healthcare https://www.medpagetoday.com/washington-watch/electioncoverage/111080 HELP Committee Examines Medical

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July 11, 2024

Senate Passes Key Generic and Biosimilar Drug Competition Measure The Senate unanimously passed a bill that would bar so-called “patent thickets” and similar measures that brand drug makers use to stop the swift entry of generics and biosimilars. Drug makers would be barred from using multiple patents and lawsuits to stop generic and biosimilar approval. As well, the companies could not essentially “re-patent” drugs by making cosmetic changes. The Federal Trade Commission (FTC) would also have power to impose limits on patent litigation on biologics. (Article may require a subscription.) #drugpricing #branddrugmakers #biosimilars #generics https://insidehealthpolicy.com/inside-drug-pricing-daily-news/advocates-applaud-senate-passage-patent-thicket-reform-bill Could Smaller, Innovative PBMs Thrive At Expense of Big 3 Not too many years ago, the Big 3 pharmacy benefits managers (PBMs) dominated the business because their size and scope delivered the most cost-savings.  But the rise of transparency and headlines about how traditional PBMs could be abusing employers and insurers has smaller PBMs, including

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