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January 26, 2024

2023 Bankruptcies Highest In Five Years As was reported earlier, another report also shows that bankruptcies were very high in the healthcare arena in 2023.  Hospitals, pharmaceutical and senior care companies were on the list. Additional articles here: https://www.modernhealthcare.com/finance/healthcare-bankruptcies-2023-gibbins-advisors and https://www.healthcaredive.com/news/healthcare-bankruptcies-spike-2023-gibbins-advisors/705738/ (Some articles may require a subscription.) #hospitals #healthcare #bankruptcies Link to Article Biden Administration Strikes Again On Mergers The Federal Trade Commission opposes another prominent merger – Novant Health’s purchase of two Community Health Systems hospitals. Additional article here: https://www.healthcaredive.com/news/federal-trade-commission-sues-block-novant-health-community-health-systems-hospital-acquisition/705648/ #mergers #acquisitions #ftc #antitrust Link to Article Drug Maker CEOs To Appear On Capitol Hill A day after some very bad press, Johnson & Johnson CEO Joaquin Duato, Merck CEO Robert Davis and Bristol Myers Squibb CEO Chris Boerner all said they would appear at  hearing on drug pricing.  Additional article here: https://www.statnews.com/2024/01/26/merck-johnson-johnson-ceos-drug-prices/ (Some articles may require a subscription.) #drugpricing #branddrugmakers Link to Article Medicaid Enrollment Losses Under Redeterminations

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January 25, 2024

Humana Reconfirms Bad News On Utilization In MA After an earlier filing, Humana reconfirmed bad news on the medical expense front. Because it is a predominant Medicare Advantage (MA) insurer, it has seen a major and unexpected rise in utilization, which impacted the company’s 2023 numbers and prospects for 2024 and beyond.  Broussard is one of the smartest healthcare leaders out there and he is someone I listen to closely. Given the medical expense rise, rate compression, and regulatory changes (such as the new prior authorization rule), Broussard said he expects similar pricing adjustments from other payers, as the spike in utilization along with ongoing regulatory changes will have major impacts in 2025 and potentially beyond. Broussard says this could very well be industrywide. Humana reduced benefits for 2024 and this could be a continued trend into the future. Humana plans on cutting about $700 million in administrative costs. It

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January 24, 2024

Record Enrollment In Exchanges Nationwide The Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services (HHS) announced something to celebrate.  Driven in part by Medicaid redetermination enrollment losses and enhanced premium subsidies, state and federal exchange enrollment reached a projected 21.3 million for 2024. An amazing achievement. Over 5 million new enrollees joined over 16 million existing members. Nearly 4.2 million people with incomes of less than 250% of the federal poverty level signed up for 2024 coverage.  They receive both premium subsidies and cost-sharing reductions. About 15% of those enrollment previously had Medicaid.  That translates to a little over 3 million – a small amount of those who lost Medicaid coverage. Over 16 million are in the federal Exchange and about 5 million in various state Exchanges. CMS press release here: https://www.cms.gov/newsroom/press-releases/historic-213-million-people-choose-aca-marketplace-coverage . CMS Snapshot here: https://www.cms.gov/newsroom/fact-sheets/marketplace-2024-open-enrollment-period-report-final-national-snapshot . HHS press release here: https://www.hhs.gov/about/news/2024/01/24/historic-21-million-people-choose-aca-marketplace-coverage.html Kaiser

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January 23, 2024

Rural Hospitals In Distress A good measure of the distress rural hospitals: most no longer deliver babies. Over half of the country’s rural hospitals aren’t offering labor and delivery services and more could end such services. Some would argue that the rural hospitals’ plight could be solved by more money for hospitals overall.  The truth is the abominable hospital price system we have in this country along with the gross inefficiency of most hospitals drains overall healthcare resources and means we do not have enough to respond to true crises, such as those in rural communities. #ruralhealthcare #hospitals Link to Article Good Summary Of New Interoperability Rule’s Impact On Health Plans Modern Healthcare has a good article summarizing the provisions and impacts of the new interoperability rule.  Among the mandates are a swifter turnaround time for medical service authorizations in 2026 and the new FHIR electronic prior authorization process in

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January 22, 2024

Elevance Health All In On AI Elevance Health CEO Gail Boudreaux gave a keynote speech that shows the second-largest insurer will be all in on AI. She wants her company to use the technology to make healthcare more proactive, predictive and personalized. She wants AI to help people navigate the system and simplify it. #elevancehealth #ai #digitalhealth Link to Article Physicians Want Rollback Of Medicare Cut As Well As New System Not only do physicians want both a rollback of their payment cut, but also a brand new way of paying them in the Medicare traditional system. They are not wrong.  Each of the payment formulas has always been controversial and has led to an inability to calculate payments and last-minute rescues by lawmakers. (Article may require a subscription.) #medicare #physicians #providers #payments Link to Article Canada Ramping Up To Stop U.S. Importation Despite visits by U.S. officials, Canada seems intent on

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