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Channeling Nostradamus: The Healthcare Labyrinth’s 2025 Predictions

Even a master seer would have problems predicting what will occur in healthcare in 2025 In my last blog, I gave you my healthcare year-in-review for 2024. After that, as I always do each year, I play Nostradamus to prognosticate about what will happen in the next twelve months in the world of healthcare. Despite my Irish last name, I do have French blood (well, 50% French Canadien, so I count it). But I don’t claim to be an oracle or seer like our 16th century physician, apothecary, and astrologer friend. I do take a page from Nostradamus, though, in that my healthcare predictions for 2025 (not really prophecies) will be sometimes deliberately vague (they include a lot of mays, coulds, shoulds, perhaps, likelys and possibles) so as to amass a reasonable record for those tracking and putting together my forecasting report card for the history books. It also tends to make my

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January 1, 2025

Hospitals In Better Financial Shape Going Into 2025 Hospitals and health systems are on better financial footing than a year ago. Operating margins, cash flows, outpatient revenue, average inpatient length of stay, and outpatient revenue improved from 2023. For many providers (in particular health systems), volumes have rebounded to above pre-pandemic levels. In October 2024, the mean operating margin for hospitals was 4.4%, up from 2.5% in November 2023 and 2.7% in December 2023, says consulting firm Kaufman Hall. Labor expenses have dropped and inflationary pressures have subsided. But there has been continued growth in supplies, drug expenses, and purchased service expenses. On the policy front, hospital groups are worried about budget cuts under the incoming Trump administration that could lead to the expiration of Exchange enhanced subsidies, rate cuts in Medicare and Medicaid, and a pullback on coverage overall. As well, smaller entities could struggle on the cybersecurity preparedness

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December 31, 2024

Kennedy And Oz At Odds On GLP-1s Department of Health and Human Services (HHS) Secretary-nominee Robert F. Kennedy Jr. and Centers for Medicare and Medicaid Services (CMS) Administrator-nominee Dr. Mehmet Oz are at odds over support for GLP-1 weight-loss drugs. Oz has opined that the drugs could have a positive effect on weight loss and reducing disease prevalence. Kennedy sees them as a scam and insists that the American public simply needs to eat better. The Biden administration has proposed in a draft rule to provide Medicare Part D coverage for obesity alone. Trump will need to finalize the rule or remove the provision. This will be the first test of who will win the GLP-1 coverage war. The drugs are expensive at $1,000 or greater per month at list price. #glp1s #weightlossdrugs #drugpricing #branddrugmakers https://thehill.com/policy/healthcare/5055607-rfk-jr-vs-oz-sets-up-clash-on-weight-loss-drug-coverage Employers And PBMs Under Attack A good article on the rise of lawsuits against

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December 30, 2024

Some Hope For Medicaid Hikes Medicaid managed care plans have argued that risk in the program has gone up with the Medicaid unwinding (redeterminations) and rates have become inadequate to serve remaining enrollees. A number of state Medicaid directors are now saying mid-year rate hikes could address the financial woes of plans. The Alliance of Community Health Plans is urging the current administration to urge states to re-evaluate current rates. Notwithstanding the positive signs, states will have a hard time affording major hikes given the drying up of extraordinary federal revenue given to states during the COVID pandemic. (Article may require a subscription.) #medicaid #redeterminations #rates #healthplans #managedcare https://insidehealthpolicy.com/daily-news/states-promote-mid-year-rate-adjustments-mcos-struggling-post-covid Article Recaps Tough Year for UnitedHealth Group Becker’s recounts the very tough year seen by UnitedHealth Group, including the Change Healthcare cyberattack, government investigations, and the tragic killing of executive Brian Thompson. #unitedhealthcare #tragedy #changehealthcare #cyberattacks https://www.beckerspayer.com/payer/an-unimaginable-year-for-unitedhealth.html MA Does Not Offer

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The Healthcare Labyrinth 2024 Year In Review Blog

A busy year in healthcare with insurer woes and a presidential election that brought changing political winds As is my tradition at year’s end, I reflect back on all that occurred in healthcare in the year. It was a big year in healthcare and the election portends another massive one next year. I will have my 2025 predictions blog on Thursday. So, here are the major healthcare happenings from 2024. You can go to various blogs at the blog tab to learn more. In a few instances, I call out good blogs to go back to as well. NHED shows robust healthcare growth National healthcare expenditure data (NHED) was published for 2023. Costs rose 7.6% from 2022 to 2023 and reached almost $4.9 trillion. This made spending on healthcare expeditures hit 17.6% of the gross domestic product (GDP). Healthcare expenditure will consume almost one-fifth of the economy by 2032. Insurer

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December 27, 2024

HHS Issues Cybersecurity Rule The U.S. Department of Health and Human Services (HHS), through its Office for Civil Rights (OCR), issued a proposed rule to improve cybersecurity and better protect the healthcare system from cyberattacks. The proposed rule modifies the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Security Rule. It requires health plans, healthcare clearinghouses, most healthcare providers, and most business associates, to strengthen cybersecurity protections against external and internal threats. It requires updates to existing cybersecurity safeguards, using modern best practices, to reflect advances in technology and cybersecurity. It provides greater detail on what covered entities and business associates need to do to protect the security of electronic protected health information (PHI). Policies and procedures would have to be in writing, reviewed, tested, and updated on a regular basis. Specifically, HHS says the rule reacts to: The rule is in response to growing cybersecurity incidents, including the

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December 26, 2024

Wakely Finds VBID Sunset Could Impact Medication Adherence Rates Many Medicare Advantage (MA) proponents have said that the sunset of the Value Based Insurance Design (VBID) in Medicare Advantage (MA) as of 2026 could have impact on outcomes and complicate affordability of healthcare for beneficiaries. Wakely Consulting, an actuarial and consulting firm, has found that this could be true in the area of medication adherence. Plans have used the VBID program to target waiver of pharmacy cost-sharing for low-income (LI) beneficiaries. These are the same targeted individuals in the new Health Equity Index (HEI) rolling out in Star Year 2027. Wakely found that medication adherence for diabetes, hypertension, and hyperlipidemia could be impacted if the cost-sharing waivers disappear. The analysis found that removing copays on maintenance medications improved beneficiary adherence, which is tied to improved quality of care and health outcomes. These are three key star measures in the Part

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December 24, 2024

What More Could The CMS Actuary Do For Its Annual Healthcare Spending Report? Interesting Health Affairs Forefront Blog on what more the Centers for Medicare and Medicaid Services (CMS) Actuary could do in terms of analysis of National Healthcare Expenditures Data (NHED) each year. As the author notes, there are some crucial missing pieces that could aid analysis and reform. (Article may require a subscription.) #nhed #cms #healthcare #spending https://www.healthaffairs.org/content/forefront/beyond-national-health-expenditure-data-three-things-wish-were-better-measured Fierce Healthcare’s Top 10 Payer Stories of 2024 Fierce Healthcare has issued its article on the top ten payer stories of 2024. The events include the Change Healthcare breach, numerous financial woes and cutbacks at major plans, the UnitedHealthcare CEO shooting, and Cigna selling its Medicare Advantage (MA) line. I will have my normal year-end wrap up and predictions soon at the blog tab. #healthcare #2024 #healthplans https://www.fiercehealthcare.com/payers/editors-corner-fierce-health-payers-top-10-stories-2024 Multiplan Reaches Debt Refinancing Deal Healthcare analytics company Multiplan reached an agreement

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December 23, 2024

CMS Pushing Streamlining Of Quality Measurement Interesting article on the Centers for Medicare and Medicaid Services’ (CMS) push to streamline quality metrics across programs. Its approach, called the Universal Foundation, is meant to ease complexity, burden, and the administrative costs on providers and health plans by establishing standardized metrics and financial incentives. Right now, CMS has about 20 measure sets that encompass hundreds of discrete measures. I certainly endorse standardization and streamlining, but migrating to the Universal Foundation will take years. Further, given differences in demographics, we will always have some unique measures in each program. But standardizing Accountable Care Organization (ACO) and Medicare Advantage (MA) measures would be a great place to start. (Article may require a subscription.) #quality #stars #acos #medicareadvantage #cms  https://www.modernhealthcare.com/policy/cms-universal-foundation-quality-data-reporting-measurement What Might HHS Look Like Under RFK Jr. An interesting article on what might occur under the Trump administration as Robert F. Kennedy Jr. pursues

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December 20, 2024

House Passes Stop Gap; On To Senate To Avoid Shutdown The House passed a continuing resolution (CR) to fund the government late Friday. This should avert a midnight shutdown. The CR funded government through March 14, 2025. Far-reaching healthcare provisions once going to pass as part of a free-standing bill or within the CR became a closely tailored list of must-haves for healthcare. The funding bill extends Medicare telehealth flexibilities and CMS’ acute hospital at home program for 90 days, through March 31, 2025. The CR postpones scheduled cuts to Medicaid disproportionate share payments for safety-net hospitals and extends special Medicare reimbursements for low-volume hospitals and Medicare-dependent hospitals until April 1. It sustains funding for community health centers and pandemic preparedness programs until March 31. No relief for Medicare physicians, who now will see a 2.8% rate reduction as of January 1. ACOs did not see an extension of critical

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