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December 18, 2023

More “Retail Meets Healthcare” Investments Kroger is piloting value-based primary care clinics like many other retailers. The grocery chain will team up with Better Health Group, a provider network, to build out primary care centers.  Kroger in-store clinics will be replaced. There is a senior focus. Walgreens is pulling back on its clinic investments.  So, retail healthcare is not without its risks but will continue to grow. #retailhealthcare #kroger Link to Article Molina Reduces Bright Payment for Medicare Advantage Business After diligence, Molina Healthcare will cut how much it will pay for Bright Health Group’s California Medicare Advantage plans to $425 million, from $600 million. Molina did not specify in a news release Monday why it reduced the agreed-upon purchase price by 16.7% from $600 million gross/$510 million net.  This is more bad news for the insurtech world, which has seen stunning reversals.  (Article may require a subscription.) #brighthealth #molina

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December 15, 2023

Elevance Health and HCSC Looking At Cigna Medicare Reports suggest Elevance Health and Health Care Service Corporation (HCSC) are looking at acquiring Cigna’s Medicare Advantage (MA) lives. Cigna has just over 600,000 Medicare Advantage lives, but has had lower Star ratings than desired. HCSC has just 180,000 MA lives and would love to acquire a bigger footprint. Elevance Health has just over 2 million lives and is trying to grow Medicare as well. In 2021, Elevance acquired MMM’s almost 300,000 lives in Puerto Rico to help with organic growth. #elevancehealth #hcsc #cigna #medicareadvantage #mergers #acquisitions Link to Article BCBSLA Could Be Acquired by Elevance Health At the same time, Elevance Health may acquire BCBSLA after pausing the process earlier this year. This is based on revised regulatory activity. Elevance Health is the largest for-profit owner of Blue Cross and Blue Shield plans, with 14 states nationwide. Additional article here: https://www.modernhealthcare.com/mergers-acquisitions/elevance-health-blue-cross-louisiana-merger-acquisition

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December 14, 2023

Medicare Drug Reform Law Working The Centers for Medicare & Medicaid Services (CMS) says 48 prescription drugs will have lower Part B beneficiary coinsurances in the first quarter of 2024 due to price hikes by drug makers that exceeded allowable increases, with out-of-pocket costs decreasing by $1 to as much as $2,786 per average dose. Over the last four quarters, 64 drugs in total had prices that increased faster than inflation and may be subject to inflation rebates because of the Inflation Reduction Act (IRA). It is hard to argue that the Medicare drug reforms are not working in this case.  At the same time, CMS issued a letter to plans and PBMS urging fair reimbursement to pharmacies and urging preparation for 2024 changes under Part D. CMS letter here: https://www.cms.gov/newsroom/fact-sheets/cms-letter-plans-and-pharmacy-benefit-managers . Additional article here: https://www.medpagetoday.com/publichealthpolicy/healthpolicy/107878 . The CMS announcement and backup material here: https://www.cms.gov/newsroom/press-releases/cms-releases-revised-guidance-medicare-prescription-drug-inflation-rebate-program . Similar Health and Human Services release and info here: https://www.hhs.gov/about/news/2023/12/14/new-hhs-actions-and-research-highlight-how-president-bidens-administration-lowering-prescription-drug-costs.html . #drugpricing #ira

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December 13, 2023

CMS Actuary Releases 2022 Healthcare Statistics The CMS Actuary has released its analysis of 2022 national healthcare expenditures. I will write a blog on this in the next week. At the link is the website where the data is uploaded. Centers for Medicare and Medicaid release here: https://www.cms.gov/newsroom/fact-sheets/national-health-expenditures-2022-highlights . In addition, four other articles on the new data: https://www.fiercehealthcare.com/payers/back-normal-health-care-spending-growth-rates-down-pandemic-era-times and https://www.healthaffairs.org/content/forefront/ahead-print-national-health-spending-2022 and https://www.modernhealthcare.com/policy/us-health-care-spending-rose-over-4-trillion-2022 and https://insidehealthpolicy.com/daily-news/cms-2022-health-spending-report-finds-medicaid-drove-federal-spending . Healthcare spending increased 4.1% in 2022 to $4.5 trillion. In 2022, the share of the economy devoted to healthcare spending as a percentage of gross domestic product (GDP) was 17.3 percent. Healthcare’s share of GDP as well as the percentage cost increase both went down in part due to lower government spending on the pandemic from prior years. In addition, Medicaid spending due to enrollment growth was very high. (Some articles may require a subscription.) #healthcare #costs Link to Article ONC Finalizes AI And

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