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March 18, 2024

Progress And Support During Change Healthcare Cyber Attack Some services have been restored by Change Healthcare and more are readying.  Change says that claim preparation software for providers will soon come back online. Electronic payments have come back online. United says it has made more than $2 billion in advanced payments from its program. United as an insurer, Highmark, and the Blue Cross and Blue Shield Association have developed advanced payment programs for providers, but many other insurers are moving slowly on the idea. Other insurers are contracting with Change competitors to help providers file claims. They also are extending claim deadlines. Provider groups say aid is not enough. The Centers for Medicare and Medicaid Services is also asking states to submit state plan amendments so they can advance Medicaid payments. Additional articles here: https://www.modernhealthcare.com/cybersecurity/change-update-unitedhealth-systems-progress and https://www.modernhealthcare.com/insurance/change-outage-prior-authorization-pay and https://www.modernhealthcare.com/government/change-update-cms-medicaid-reimbursements and https://www.healthcaredive.com/news/change-healthcare-cyberattack-medicaid-flexibilities-american-hospital-association-survey/710561/ (Some articles may require a subscription.) #changehealthcare #cyberattacks Link

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March 15, 2024

Medicare Households Spend The Most On Healthcare Costs Good article from Fierce Healthcare and analysis from Kaiser Family Foundation on healthcare spending in Medicare households. Medicare households spend more on healthcare than other households. Health spending burden was twice as high. Analysis by KFF: https://www.kff.org/medicare/issue-brief/medicare-households-spend-more-on-health-care-than-other-households/ #coverage #costs #medicare #medicareadvantage Link to Article AHA Survey Says 94% Of Hospitals Impacted By Change Cyber Attack While for-profit hospitals are going out of their way to send a message of stability after the Change Healthcare cyber attack, an American Hospital Association (AHA) says 94% of hospitals were impacted. Mounting evidence from providers (impacted by up to $1 billion a day in revenue) and health plans (claims dried up!) that this will have big and lingering impacts. While some systems are back online, the sheer magnitude of the missed throughput of transactions is amazing and will take time to work through the backlog and

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March 14, 2024

Change Pharmacy Network Back On While insurtechs overall have struggled, at least three – Alignment Healthcare, Devoted Health, and Clover Health – appear to be doing well.  Clover Health had an adjusted EBITDA loss of $19.1 million in the fourth quarter and a full-year loss of $44.7 million last year.  This is significantly better than in 2022. Its medical loss ratio (MLR) is projected to be just 81.2% for 2024. It expects adjusted EBITDA profit up to $20 million. Since it began, it, too, amassed a sizeable membership. #clover #insurtechs Link to Article Federal Appeals Court Deals Drug Makers A Blow On 340B A federal appellate court said that a state law could be reconciled with the federal 340B drug discount program. Drug makers are fighting to rein in the discounts they give to various pharmacies and hospitals.  While I find Big Pharma’s constant lawsuits defending their unreasonable pricing system

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March 13, 2024

Clover Health Readying For Positive Margin While insurtechs overall have struggled, at least three – Alignment Healthcare, Devoted Health, and Clover Health – appear to be doing well.  Clover Health had an adjusted EBITDA loss of $19.1 million in the fourth quarter and a full-year loss of $44.7 million last year.  This is significantly better than in 2022. Its medical loss ratio (MLR) is projected to be just 81.2% for 2024. It expects adjusted EBITDA profit up to $20 million. Since it began, it, too, amassed a sizeable membership. #clover #insurtechs Link to Article Feds Investigating Change Healthcare The federal government has launched an investigation into UnitedHealth Group and its Change Healthcare subsidiary after a major cyber attack.  While I am always weary of government investigations based on headlines, in this far-reaching incident it is important to understand what happened and whether there was negligence.  In related news, major for-profit

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March 12, 2024

UnitedHealth Group CEO Hears From Becerra And Providers At an unprecedented meeting, UnitedHealth Group CEO Andrew Witty heard from both Health and Human Services (HHS) Secretary Xavier Becerra and providers at a government sponsored meeting. The plea was for United to take responsibility for the Change Healthcare cyber attack and give        additional financial support to providers. In addition, HHS detailed more about what a $1.3 billion fund for cyber security would be used for.  About 2,000 hospitals will receive incentive funds to adopt new cyber security practices. Another $153 million would go for various government initiatives. Additional article: https://www.fiercehealthcare.com/providers/becerra-stakeholders-its-time-take-accountability-cybersecurity #changehealthcare #unitedhealthcare #cyberattacks Link to Article New Study Says Provider Email Claims Largely Require No Patient Cost-Sharing A new study says that less than 20% require a patient to pay out-of-pocket for so-called “email messaging” claims. Those that did paid a median of $25 per claim. Good summary of the

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March 11, 2024

Biden Releases His FFY 2025 Budget The President announced his FFY 2025 budget even as all bills for the current FFY 2024 year have not been approved (including Health and Human Services spending).  Biden did sign into law the bill that funds some agencies for the current fiscal year, including a partial retreat on a major Medicare doc cut. Because of the split in Congress, most of his proposals are dead on arrival but serve as campaign differentiators against his GOP opponent, former President Donald Trump. In the FFY 2025 budget, Biden funds the commitments he made at the State of the Union and more: Additional articles: https://www.modernhealthcare.com/politics-policy/biden-budget-cybersecurity-insurance-subsidies and https://insidehealthpolicy.com/health-insider/admin-releases-budget-addresses-fallout-over-change-healthcare-attack and https://www.fiercehealthcare.com/providers/congress-reaches-spending-deal-doc-pay-bump-delayed-dsh-cuts-and-more (Some articles require a subscription.) #budget2025 #healthcare #healthcarereform Link to Article Change Healthcare Cyber-Attack Update The Department of Health and Human Services (HHS) urged UnitedHealth Group and other payers to provide financial assistance to providers impacted by the

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March 8, 2024

Biden SOTU Address Fiery And With Major Expansion Requests President Joe Biden gave a fiery campaign speech at the State of the Union Thursday.  He touched on policy changes he wants to see across government and society.  In the healthcare world, he asked for significant additions to what he thinks is his successful record: Additional articles: https://www.fiercehealthcare.com/payers/biden-call-drug-negotiation-expansions-stronger-reproductive-care-access-sotu and https://insidehealthpolicy.com/daily-news/biden-advocates-expansion-drug-price-controls-aca-state-union and https://www.modernhealthcare.com/politics-policy/joe-biden-state-union-sotu-2024 (Some articles may require a subscription.) #biden #sotu #healthcare #healthcarereform #aca #obamacare #exchanges #drugpricing #ira #coveragegap #insulin Link to Article Change Healthcare May Need Until Mid-March To Fully Restore All Services While some services have been restored, Change Healthcare says all services may not be restored until mid-March.  Meanwhile, class-action lawsuits are beginning to be contemplated.  Major parts of health plan and provider services have been impacted. Additional articles: https://www.fiercehealthcare.com/payers/optums-change-healthcare-responding-cybersecurity-issue and https://www.modernhealthcare.com/cybersecurity/change-healthcare-update-systems-online-march15 (Some articles may need a subscription.) #changehealthcare #cybertattacks Link to Article Sanders Asks Other Drug Makers To

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March 7, 2024

Almost 18 Million Initially Lost Medicaid Coverage During Redeterminations The Kaiser Family Foundation reports that almost 18 million initially lost coverage during Medicaid redeterminations.  Some regained eligibility later.  Most lost coverage on procedural grounds.  Enrollment has dropped by about 10M so far in Medicaid nationwide. #medicaid #redetermintations Link to Article Evernorth Continues Growth Cigna’s Evernorth service subsidiary continues its growth. It announced an expansion to its GLP-1 management solution as well as the launch of a new behavioral-health-focused medical group. #cigna #evernorth Link to Article Biden To Propose Major Expansion Of Healthcare Initiatives President Biden will propose major healthcare expansions in his State of the Union Address tonight.  Among other things, a Fact Sheet says he will propose an expansion of Medicare drug price negotiation (500 drugs negotiated over the next 10 years), permanent expansion of enhanced premium subsidies in the Exchanges, a special program for those in the coverage

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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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