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March 6, 2024

Walgreens Will Have Long Road To Recovery Walgreens says that its road to financial recovery will be long – not a 12-month plan.  It is undertaking a strategic review of its business. It plans to cut $1 billion in expenses this year.  Additional article: https://www.modernhealthcare.com/providers/walgreens-tim-wentworth-villagemd-shields-health-ownership (Some articles may require a subscription.) #walgreens Link to Article Major Claims Reductions Reported In Light of Change Healthcare Cyber Attack While UnitedHealth Group remains mum, Humana and Elevance Health say they are seeing a 15% to 20% reduction in data from providers since the Change Healthcare cyber attack. The rate of reduction is now down to 10% as providers and plans adapt to the outage from Change. Plans are adopting a reserve strategy to ensure a set aside for such claims in the future. Change Healthcare/Optum will likely lose a great deal of business as providers and plans lose faith in Change and migrate to other

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March 5, 2024

Cuban Recommends Radical Change In Drug World To Reduce Costs I am a big fan of Mark Cuban and what he and his Cost Plus Drugs are doing to reform the drug price system.  So when he speaks, I listen.  At a White House round table, Cuban proposed that federal programs cut off all ties to traditional pharmacy benefits managers (PBMs) and embrace full transparency.  He has a direct-to-consumer firm and various transparent PBMs are all in on this idea.   The White House liked the transparency idea but knows it is easier said than done and there are many barriers to unravel what we have now. I note that the transparency model emerging right now works well for generic drugs, but it will be harder and take more time for brand drugs, especially until we get prices lower and solve for the shadowy rebate system. But Cuban’s transparency and

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March 4, 2024

FFY 2024 Spending Package Agreed To By Key Lawmakers A bipartisan spending bill has been agreed to by key lawmakers and will need to be voted on in each House.  The package basically cuts in half the Medicare doc fix cut of 3.4%, pushes back scheduled disproportionate share hospital (DSH) payment cuts, and increases annual funding for community health centers. Accountable Care Organizations’ (ACOs) bonus program was also protected. Absent from the bill are major healthcare reforms. Docs are not very happy with the partial fix and no total overhaul of their rates. Additional articles here: https://www.fiercehealthcare.com/providers/congress-reaches-spending-deal-doc-pay-bump-delayed-dsh-cuts-and-more and https://insidehealthpolicy.com/health-insider/lame-duck-battle-looms-health-wins-skinny-bill-expiring-december and https://insidehealthpolicy.com/daily-news/skinny-health-package-scales-back-doc-fix-adds-chc-funding and https://www.medpagetoday.com/practicemanagement/reimbursement/109008 and https://thehill.com/policy/healthcare/4507164-government-funding-bills-leave-out-phamacy-benefit-manager-industry-changes-as-white-house-mulls-reforms/ (Some articles may require a subscription.) #governmentshutdown #healthcare Link to Article All Drug Makers Submit Counter Offers In Medicare Drug Price Negotiations The White House announced that all ten companies involved in the initial Medicare drug price negotiations have sent in counter proposals to what

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Part 4: My Courageous Daughter Is Having Brain Surgery!

This is one of a number of blogs that will appear on my daughter. I call her Kitty. She is a wonderfully talented, bright, and empathetic individual in her late ‘20s. She and I agreed I would write this series to impart how important health coverage is. Not only is her decision to have surgery courageous, but so is her decision to share her journey through me. The principal reason to share the journey is because we both want to explain what many average Americans go through financially when they have major operations and do not have the best insurance or no insurance at all. My daughter is privileged to come from a well-off family and to have consistent and robust insurance. This will mean that she will pay a tiny amount for a surgery with a sticker price in the hundreds of thousands of dollars. But for uninsured and

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March 1, 2024

Medicare Advantage Will Remain Viable Over The Long Run Good article in Modern Healthcare discussing the fact that, while there will be major bumps in the road, Medicare Advantage (MA) will remain viable and strong.  A great quote from Paul Ginsburg, senior fellow at the University of Southern California Schaeffer Center for Health Policy and Economics. “We’re not talking about any risk to the financial integrity of these companies at all. The Medicare Advantage business is very viable long-term because they’re providing something that more and more Medicare beneficiaries are deciding they want,” Ginsburg said. “Will it be as great for the next few years as it has been? Probably not. It’ll still be very good, though.” This echoes what I said in a January 29, 2024 blog ( https://www.healthcarelabyrinth.com/with-boom-over-will-medicare-advantage-collapse-or-adjust/ ) as well as a February 9 Podcast ( https://www.healthcarelabyrinth.com/9-is-medicare-advantage-exploding-after-its-boom-or-simply-adjusting/ ). As I say, the real victims of terrible policies

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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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Medicare Advantage Enrollment Growth Continued From January To February

In my January 22, 2024 Healthcare Labyrinth Blog ( https://www.healthcarelabyrinth.com/great-news-for-insurers-and-medicare-beneficiaries-january-2023-to-january-2024-medicare-advantage-growth-rebounds/ ), I told you about the exciting news of Medicare Advantage’s (MA) continued strong growth (from January 2023 to January 2024) as well as a nice recovery from a bit of a sluggish increase from January 2022 to January 2023. As I always do, I publish short follow-up blogs in the first few months of each year given continuing growth outside of the main enrollment season of October 15 to December 7. The key takeaways from the January 22, 2024 blog were: So what happened with February enrollment? A change over the past few years now allows all members enrolled in an MA plan to change to a different MA plan or go back to traditional Medicare (and also get a standalone Part D plan) between January 1 and March 31 of each year. Previously, an MA member could only

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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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