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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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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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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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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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July 10, 2024

FTC To Sue Big Three PBMs The Wall Street Journal (WSJ) is reporting that the Federal Trade Commission (FTC) will sue the Big 3 pharmacy benefits managers (PBMs) – United’s Optum, Cigna’s Express Scripts, and CVS’ Caremark — over anti-competitive behavior.  The suits could center on the vertical integration with their sister health plans, which means the PBMs favor corporate-owned pharmacy assets at higher costs to the public. The suit may also challenge rebate deals with brand drug makers and concomitant formulary restrictions. The move likely means more pushes on Capitol Hill to reform PBMs. While some of this may be true, I continue to believe that brand drug makers are the biggest problem in terms of high drug prices. Additional article: https://www.fiercehealthcare.com/payers/wsj-ftc-sue-pbms-over-drug-pricing-tactics #pbms #drugpricing #ftc #antitrust https://www.healthcaredive.com/news/ftc-to-sue-pharmacy-benefit-managers-caremark-express-scripts-optumrx-wsj/72102 Brand New Interoperability Rule Published Even though major new interoperability requirements have yet to go into effect, the nation’s healthcare interoperability regulator,

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July 9, 2024

New FTC Investigation Report Targets PBMs In its initial report on an antitrust investigation into the role of pharmacy benefits managers (PBMs), the competitiveness watchdog Federal Trade Commission (FTC) says PBMs have vast power that disadvantages consumers and independent pharmacies. It reports the following: The major PBM lobbying group pushed back on the findings vigorously.  While PBMs need reform and more transparent approaches, I feel the FTC has put the entire onus for high prices and anti-competitive behavior on PBMs and not brand drug makers. The FTC has adopted the same whipping boy mentality as Congress. Additional articles: https://www.fiercehealthcare.com/payers/ftc-report-pbms-may-urgently-require-potential-regulation and https://www.modernhealthcare.com/politics-policy/pharmacy-benefit-managers-pbms-higher-prices-ftc-cvs-cigna-unitehealth and https://thehill.com/policy/healthcare/4762024-federal-trade-commission-report-pharmacy-middlemen-price-hikes/ (Some articles may require a subscription.) #pbms #drugpricing https://www.healthcaredive.com/news/ftc-pharmacy-benefit-manager-investigation-interim-report/720814 Physician Burnout Declining The portion of physicians who report at least one symptom of burnout has dropped below 50%, the first-time since the beginning of the COVID-19 pandemic. #covid #providers #physicians https://www.fiercehealthcare.com/providers/physician-burnout-drops-below-50-first-time-2020-ama-poll-finds Sackler Family May Be Sued By

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July 8, 2024

New Wall Street Journal Study To Generate Huge Capitol Hill Focus A Wall Street Journal (WSJ) analysis published today finds that Medicare Advantage (MA) plans filed numerous questionable diagnoses in the risk adjustment program to generate about $50 billion between 2018 and 2021. The WSJ found diagnoses for patients that did not have certain conditions or could not possibly have such conditions. It also found that many conditions were diagnosed at a much higher rate in MA than in the traditional fee-for-service (FFS) prorgam. This adds to numerous other private and public studies that will be fodder for reforms coming from Capitol Hill on MA overpayments. As many of you know, I am a defender of MA and feel that some accusations of overpayments are not accurate.  I do not doubt there are some inaccuracies in what the WSJ found as well.  At the same time, I have said there

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