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February 29, 2024

Change Healthcare Cyber Attack Fallout Continues The fallout continues over the cyber attack suffered by Change Healthcare.  United Health Group confirmed the attack was a ransomware one and that the BlackCat cyber gang was behind it. Additional article here:https://www.modernhealthcare.com/cybersecurity/change-healthcare-cyberattack-outage-blackcat-alphv-2024 As well, good overviews of cyber security and the overall event and impacts: https://www.modernhealthcare.com/cybersecurity/change-healthcare-outage-cyberattack-data-breaches-2024 and https://kffhealthnews.org/news/article/unitedhealth-change-healthcare-blackcat-hack-cybersecurity/ Meanwhile, a prominent provider group is calling on the federal government to help them regarding the current Change Healthcare cyber attack, but to also strengthen security overall: https://insidehealthpolicy.com/daily-news/mgma-hhs-help-industry-mitigate-massive-ransomware-attack (Some articles may require a subscription.) #cyberattacks #changehealthcare Link to Article Congress Passes Short-Term Funding Bill The House passed a short-term funding bill by a vote of 320-99 vote and the Senate turned around passing it with a 77-13 vote.  It pushes a government shutdown out to March 8 and March 22. Work continues on appropriation bills.  House Speaker Mike Johnson, R-LA, is under attack by his

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February 28, 2024

Stop-Gap Resolution To Keep Government Open Agreed To By Leaders House Speaker Mike Johnson, R-LA, and Senate Majority Leader Chuck Shumer, D-NY, announced that a stop gap continuing resolution has been agreed to by leaders.  This would extend keeping the government open for several weeks. It likely will include a partial Medicare doc fix and restoration of disproportionate hospital cuts.  How the House Freedom caucus will vote is unknown. Additional article here: https://insidehealthpolicy.com/daily-news/lawmakers-announce-partial-approps-deal-including-fda-new-cr (Articles may require a subscription.) #governmentshutdown #crs Link to Article Mississippi Could Expand Medicaid There is some movement in certain deep South states to expand Medicaid under the Affordable Care Act (ACA).  Mississippi could be the first. The House Medicaid Committee on Tuesday advanced the bill and include the highest ACA level.  The measure could extend benefits to about 250,000 people. However, the bill would require at least 20 hours of work with some exceptions. What would

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February 27, 2024

Justice Department Launches Antitrust Investigation Of UnitedHealth Group With the ongoing cyberattack at Change Healthcare ongoing, The Wall Street Journal reports that the U.S. Department of Justice has an active antitrust investigation going on. It centers on certain relationships between the company’s UnitedHealthcare insurance unit and its Optum health services arm.  Optum is the largest service organization associated with an insurer corporately.  Optum’s tentacles are long and hit almost every area of healthcare. Health plans like Cigna and Elevance Health will be watching as they have dreams of having service units as big as Optum.  These service units generate huge revenue and margins as the business is basically unregulated compared with an insurer (which is confined by the minimum medical loss ratio (MLR) requirements in most products) Additional article here: https://www.reuters.com/business/healthcare-pharmaceuticals/us-launches-antitrust-investigation-into-unitedhealth-wsj-reports-2024-02-27/ #unitedhealthcare #antitrust #optum Link to Article Change Healthcare Cyber Attack Fallout Continues The Change Healthcare cyber attack continues to have

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February 26, 2024

Not All Is Rosy In Hospital Finance While the hospital industry is recovering overall from the COVID slump, recovery is not universal in the hospital industry. And there are still some bad barometers of financial performance overall. #hospitals Link to Article PBM Reform and Site-Neutral Policy May Not Be Included In Health Bill Due to the major threat of a government shutdown and no consensus yet on the issue, time is running out on passing substantive policy reforms.  Congress is looking at a very skinny health bill and that could mean the death of PBM reform and site-neutral policies this year. A partial or full prospective Medicare doc payment fix will likely still be included. I don’t like the tone and tenor of the PBM reform measures, but would like the site neutral reforms to begin. At the same time, Sen. Chuck Grassley wants a PBM reform vote given the

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February 23, 2024

Major Cyber Attack On United’s Change Healthcare Change Healthcare announced a major cyber attack on its systems this week.  The event shows how vulnerable major healthcare organizations can be.  Change is owned by The United Health Group, granddaddy of insurance and owner of prominent service entity, Optum.  Change rolls up to Optum.  The attack shows how far-reaching a successful penetration could be. Change is a vendor. It has various products and connects to health plans throughout the country.  It also connects to providers and pharmacies throughout the country. Change says the attacker was a nation-state associated cyber security threat actor.  Little else is known about how far-reaching the attack was or the fallout yet. Additional article here: https://www.modernhealthcare.com/cybersecurity/change-healthcare-outage-cyberattack-2024-update (Some articles may require a subscription.) #cyberattacks #healthcare Link to Article Surge In Weight-Loss Drug Costs Troubles States Interesting assessment of the surge in costs for weight-loss drugs in state employee health plans

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February 22, 2024

New Poll Suggests MA Enrollees Have Issues With Prior Authorization, But Some Use Added Benefits A new poll says Medicare Advantage (MA) enrollees are more likely than those in traditional Medicare fee-for-service (FFS) to experience care delays due to prior authorization, but they do receive supplemental benefits not in the traditional program. While the rates of such use can always be better, a 70% member-use rate is encouraging.  Still, it is indeed time for MA plans to show their value by encouraging the use of all of the added benefits at reasonable rates. Proposed supplemental benefits reporting rules will encourage this trend. Overall, MA plans need to educate members thoroughly on all benefits, lest critics and researchers build a case that there is no added value. The critics continue to argue massive overpayments, which I do not agree with. One point just does not resonate with me. About 12% of

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February 21, 2024

New CMS DSH Rule Will Reduce Medicaid Hospital Payments Medicaid disproportionate share hospital (DSH) payments are being cut by $8 billion annually for the nest five fiscal years based on a new rule finalized by the Centers for Medicare and Medicaid Services (CMS).  The rule is purported to rein in overpayments. A recent study suggested that a liberal formula calculation meant a third of all qualifying hospitals should not have received payments.  CMS has been pushing to reduce such payments in favor of broad coverage. Additional articles: https://www.fiercehealthcare.com/providers/many-disproportionate-share-hospitals-face-lower-medicaid-payments-under-new-final-rule and https://www.modernhealthcare.com/policy/medicaid-dsh-cuts-safety-net-hospitals-cms-final-rule (Some articles may require a subscription.) #medicaid Link to Article HCSC Believes In Medicare Advantage As Cigna decided its investment in Medicare Advantage (MA) was too much on the health plan side, Health Care Service Corporation (HCSC) agreed with most large insurers that MA investments made sense.  It paid $3.3 billion for about 600,000 Cigna MA lives, bringing its total

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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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