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KFF Finds Spending Higher When MA Enrollees Return To Traditional Medicare A new analysis from Kaiser Family Foundation (KFF) finds higher Medicare spending among those who switch from Medicare Advantage (MA) to traditional Medicare as compared with similar beneficiaries who were in traditional Medicare all along. KFF says Medicare spent an average of 27% more on those switching in, after adjusting for differences in health status and other characteristics. This amounts to a difference of $2,585 in Medicare spending per person, on average, between the two groups in 2022. The difference in spending among people with certain health conditions varied from 15% for those with pneumonia to 34% for people with diabetes. The causes for the higher spending are as follows: skilled nursing facility spending (34%), outpatient hospital spending (23%), and inpatient hospital spending (20%). Differences in spending were greater for people of color and dual eligibles and increased with age.

Primary Care Market To Shift by 2023 A Bain & Company study on primary care suggests non-traditional providers, including retailers, payers, and advanced primary care providers, are expected to capture 30% of the U.S. primary care market by 2030. Bain says payers will continue to invest in primary care and population-focused models and will capture 20% of the market. How retailers will fare is more of a question. Bain also says providers will pivot to and grow their value-based care focus. #primarycare #healthplans #insurers #providers https://www.fiercehealthcare.com/providers/primary-care-market-will-see-major-shifts-2030-payers-nontraditional-providers-gain CMS Says Exchanges To Hit Record Numbers Again, But That May Be In Doubt The Biden administration says nearly 1 million new customers have enrolled in coverage through the Affordable Care Act’s (ACA’s) Exchanges during open enrollment so far and that 4.4 million people have returned to a marketplace plan for 2025. The Centers for Medicare and Medicaid Services (CMS) says 2025 could set yet

Tragedy In New York A tragedy in New York today as UnitedHealthcare CEO Brian Thompson, the leader of UnitedHealth Group’s insurance subsidiary, was shot and killed just before an investor meeting in Manhattan. All indications point to the fact that the shooting was premediated and targeted and not a random act. Our thoughts and prayers are with Thompson’s family and the UnitedHealth community. Additional articles: https://www.modernhealthcare.com/people/unitedhealthcare-ceo-brian-thompson-shot-new-york-city and https://www.healthcaredive.com/news/unitedhealthcare-ceo-brian-thompson-fatally-shot-nyc/734557/ (Some articles may require a subscription.) #unitedhealthcare https://www.fiercehealthcare.com/payers/reports-unitedhealthcare-ceo-brian-thompson-fatally-shot-manhattan Progress On Stop Gap Measure To Fund Government Republican lawmakers have proposed a lame-duck healthcare deal to Democrats that includes extending key Medicare telehealth measures and the Acute Hospital Care at Home program for three years as well as a one-year Medicare physician pay patch. This would be paid for with a full repeal of the Biden administration’s nursing home staffing rule and pharmacy benefit manager reforms. (Article may require a subscription.) #crs #governmentshutdown

Government Spending Bill Needed In Next Two Weeks With the government running out of money as of December 20, Congress is back for a lame-duck session and needs to pass a permanent funding bill or stop-gap continuing resolution (CR) soon. The latest guess is that the parties will come together in each chamber to pass a stop-gap CR and boot major funding and policy decisions until the next Congress. But that certainly puts Democrats at a disadvantage as they become the minority in both chambers. But the sheer work to get a permanent bill passed is likely just too much right now for anyone. There is wide speculation on what will happen with various healthcare policy proposals. Many hope for a great deal of healthcare bills to be rolled up into an end-of-year act. But that hope is dying given all that needs to be done. More likely are some

United And Centene Get Star Hikes For 2025 After a federal court ordered the Centers for Medicare and Medicaid Services (CMS) to revise United Healthcare’s 2025 Star ratings, the agency issued new Star ratings for both United and Centene today. The agency increased the quality ratings for 12 UnitedHealthcare contracts and 7 Centene contracts. Centene now has a sole 4-Star contract under the agency changes. Two United contracts were upgraded to 5 Stars and three contracts to 4 stars. United now will have 37 contracts rated at least 4 stars. The United and Centene cases surrounded how CMS handled the two call center ratings. Centene sued like United and the Centene case is still pending. It likely will be withdrawn. Humana and Elevance Health also sued and both suits are still pending. No changes to Star ratings have yet been made for Humana and Elevance Health.  One reason could be

Paragon Says DOGE Could Save $2.1 Trillion In Healthcare Donald Trump has created the informal Department of Government Efficiency (DOGE) to reduce the size of government. He is also looking for budget cuts to help pay for extension of his 2017 tax cuts. As such, healthcare spending cuts are anticipated. Trump is chummy with certain conservative healthcare policy groups, including the Paragon Health Institute. Paragon has put together some possible healthcare cuts amounting to $2.1 trillion in savings over a decade. The possible reductions include the following. While Trump has said he will preserve Medicare, some Medicare cuts are below. The proposals are not a radical reform of current healthcare programs, but would remove a great deal of funding, shift costs to states and citizens, and mean reduced coverage overall. Some proposals, such as site neutral payments and certain Medicaid and Medicare abusive hospital funding practices, are tremendous ideas. As