optum

CVS Executive Pushes Back On Cuban And PBM Transparency Narrative CVS Caremark President David Joyner wrote and op-ed for Fortune to explain the innovation and transparency his pharmacy benefits manager (PBM) is engaged in.  It seeks to counter some of the press Mark Cuban is getting.  I will note that leadership at CVS Health overall is on a path of reform and innovation. #cvshealth #pbms #transparency Link to Article Good Wall Street Journal Article On Why We Need Site-Neutral Payments This Wall Street Journal article tells how hospitals and health systems are buying up physician practices.  In so doing, they are changing practice patterns and forcing their now doctor-employees to practice at hospital-owned settings.  This increases costs for sometimes low professional fees into gigantic bills because facility fees are added on.  The hospital lobby was successful stopping the start of site-neutral payments in Medicare, but I doubt they can hold

Private Equity’s Role In Healthcare Takes Center Stage At Hearing Democrat members of the Senate HELP Committee staged a hearing on the role of corporate greed in healthcare.  Of particular concern was the role of private equity firm monies and whether dollars are diverted out from healthcare to corporate margins.  PE firms have big investments in both hospitals and provider groups. Additional article: https://www.fiercehealthcare.com/regulatory/steward-healthcares-struggles-full-display-clinicians-policy-researchers-tell-senators #privateequityfirms #healthcare Link to Article Clover Health CEO Defends CMS MA Payments for 2025 In a strong but divergent move from other MA plans, Clover Health CEO Andrew Toy defended the Center for Medicare and Medicaid Services’ final rate for 2025.  Depending on whether you count risk score trends increases, the rate would produce either a 3.7% increase or negative 0.16 decrease.  Plans do not believe the risk score trends should be counted. Clover may not be seeing the major increases that other plans are. Other

Scrutiny Of Private Equity Healthcare Investments Expand Private equity investments are already being broadly looked at by Congress and regulators.  Now, the Senate Homeland Security and Governmental Affairs Committee is seeking information on private equity’s role in emergency physician staffing firms that are leaving hospital emergency departments unprepared. Letters were sent to Apollo Global Management, the Blackstone Group and KKR — three of the nation’s largest private-equity firms — and four emergency medicine staffing companies owned by the firms.  It is estimated at least 40% of hospital emergency departments are overseen by staffing companies that are owned by private-equity firms. Additional article: https://www.fiercehealthcare.com/providers/senator-probes-private-equity-physician-staffing-firms-emergency-care-cost-cutting #privateequityfirms #healthcare Link to Article MA Plans Say Rate Hike For 2025 Will Have Dire Consequences Health plans are pummeling the Centers for Medicare and Medicaid (CMS) for finalizing what they see as an inadequate 2025 rate hike.  Plans say this will force them to reduce key

New GLP-1 Survey Says Growth Is Explosive A new survey from Virta Health backs up the bleak cost picture. It says that 43% of health plan leaders are predicting 100% or more growth in GLP-1s for weight loss and obesity in 2024. More than half say GLP-1s will be a top 3 drug in 2024 in terms of spending. One fifth say they will be their most expensive drug class this year. Executives believe the media is misrepresenting GLP-1s and that lifestyle programs should be tried first. At the same time, a Vitra Health-linked study comes to a different conclusion on what occurs after stopping GLP-1s.  It says those who stop taking GLP-1s can avoid negative effects on glycemia and body weight if they are properly engaged in their healthcare, including proper nutrition. See my blog today on the subject: https://www.healthcarelabyrinth.com/whats-all-the-clamor-over-glp-1s-for-weight-loss/ #weightlossdrugs #drugpricing Link to Article CMS Maintains Insufficient Rate