valuebasedcare Archives - Page 14 of 16 - The Healthcare Labyrinth

December 11, 2023

December 11, 2023 No Comments

Cigna-Humana Merger Off — For Now The Cigna-Humana merger is reportedly off as the entities could not arrive at financial terms. This leaves Cigna with two big decisions: (1) What smaller deals will they enter into? and (2) Will they sell their Medicare Advantage (MA) business? While MA is a smaller portfolio than many big plans have, if it can improve its Star scores and make additional investments, it could still be lucrative for Cigna. On the other hand, Cigna may be investing most of its efforts in its non-margin-limiting Evernorth services subsidiary. Additional articles: https://www.modernhealthcare.com/mergers-acquisitions/cigna-humana-merger-deal-scrapped-stock-buyback and https://www.healthcaredive.com/news/cigna-humana-deal-falls-through-wall-street-journal/702091/ and https://thehill.com/policy/healthcare/4353008-cigna-ends-plans-to-merge-with-humana-report/ (Some articles may require a subscription.) #healthplans #mergers #acquisitions #cigna #humana Link to Article Bill Would Reform PBMs And Introduce Site-Neutral Payments in Medicare I reported on this last week, but another good article describing a large House bill that would bring some transparency to PBMs and start site-neutral policies

December 8, 2023

December 8, 2023 No Comments

New Poll On Affordable Care Act And Healthcare Issues A new poll shows that the American public favors maintaining the Affordable Care Act and reforming the current healthcare system. My blog Monday will build on my December 7 blog and go deep into this poll. #healthcare #healthcarereform #affordableuniversalaccess #universalaccess Link to Article House May Cancel Physician Medicare Rate Cut A bipartisan group of representatives has introduced a bill in the House that would cancel the 2024 Medicare physician pay cut finalized last month by the Biden administration. Physicians are always on a roller coaster when it comes to rates in Medicare. I think the formula has to be revisited broadly. The House committee bill would only restore 2.5% of the 3.4% cut: https://insidehealthpolicy.com/daily-news/house-ec-bill-would-erase-only-25-physician-fee-cuts-matching-senate (Some articles may require a subscription.) #providers #physicians #rates Link to Article Bipartisan Effort Looking At Healthcare Entity Ownership And Anti-Competitive Behavior Must-read article about efforts by the

December 7, 2023

December 7, 2023 No Comments

United Health Foundation Says Chronic Conditions Rising The United Health Foundation released a study that concludes chronic conditions are rising in the U.S. It also released its annual “America’s Health Rankings” report, which tracks health across the country based on 87 measures and 28 data sources. United finds that persons with multiple chronic conditions has reached their highest levels since they were first tracked. Mental health and diabetes have risen. It also found health condition disparities exist for asthma, COPD, and diabetes. United also found that more people have multiple co-morbidities. United calls for investments in care management as well as health equity. As I note in my book, The Healthcare Labyrinth (available on this website), one of America’s key problems is a lack of investment in health, wellness, and care management. Other developed nations concentrate resources here and have much better outcomes, fewer people with disease states and conditions,

December 6, 2023

December 6, 2023 No Comments

Affordable Care Act 2025 Rule And Ongoing Press On Trump Repeal Remarks While we have already covered the proposed 2025 Exchange rule, this article from Kaiser Health News discusses the rule as well as some of the history of the Affordable Care Act under Trump and later Biden. #aca #obamacare #exchanges #medicaid Link to Article Drug Donations Help The Uninsured and Low Income Great Kaiser Health News article on drug donation programs in states. Helping to save lives and reduce healthcare costs. #drugpricing Link to Article Exchange Enrollment Doing Very Well But Not Picking Up Many Losing Medicaid Coverage Nearly 7.3 million people have selected an Affordable Care Act (ACA) Health Insurance Marketplace plan since the 2024 Marketplace Open Enrollment Period (OEP) opened on November 1. It runs through January 15, 2024. The numbers from the Centers for Medicare and Medicaid Services (CMS) represents activity through December 2 (Week 5)

December 5, 2023

December 5, 2023 No Comments

Is Interest In ACA Truly Fading? The Kaiser Family Foundation (KFF) poll says that the ACA and generally healthcare are fading as issues in the 2024 campaign. The poll was done before Donald Trump’s remarks on the Affordable Care Act (ACA). But let me take a slightly contrarian view here. As the poll notes, about half of the 1,401 people surveyed said the future of the ACA is a key topic. About 70% of Democrats thought so and 32% of Republicans thought so. To me, in a close election, 32% of Republicans thinking the ACA is significant is, well, significant. In a close election, how do you win if one-third of Republicans and a greater percentage of independents care about an issue? KFF poll here: https://www.kff.org/health-reform/press-release/poll-by-a-wide-margin-democratic-voters-now-care-more-about-the-affordable-care-act-than-republican-voters-do-and-voters-trust-democrats-more-than-republicans-to-handle-its-future/ #aca #obamacare #exchanges #medicaid #healthcare #healthinsurance #healthcarereform Link to Article CVS Follows Other Large PBMs in Reforming Reimbursement CVS unveiled Tuesday that it will

December 4, 2023

December 4, 2023 No Comments

U.K. National Health Service Has New Drug Pricing Deal An article in The Economist discusses the United Kingdom’s new drug pricing deal. As we know, all other developed nations negotiate and set prices globally, as Great Britain does. The Inflation Reduction Act’s Medicare drug price negotiation will slowly bring some of what other developed nations have. In fact, we have some in force now. Key points from the article: Still, the U.K. says it is getting hurt by high-cost cancer and other drugs. The U.K. and other systems work and should be fully in place in America. (Article may require a subscription.) #drugpricing #medicare #partd #uk #nhs Link to Article Good Argument For Debt and Entitlement Commission The Heritage Foundation, a conservative think tank, has a great analysis of why a debt and entitlement commission is a good idea. It is very factual. A few points: #medicare #medicareadvantage #debt #deficit

December 1, 2023

December 1, 2023 No Comments

Cigna-Humana Deal Could Pass Muster While federal and state regulators will look closely and potentially oppose a combination, experts seem to think that the Cigna-Humana merger could eventually go through. As I have indicated as well, the company profiles are quite different than earlier deals that fell through. #cigna #humana #mergers #acquisitions Link to Article Our Primary Care Problem The article makes a couple key points. It notes the vast difference between primary care and specialist compensation. We are clearly over-specialized in the United States. It also discusses an important bill sponsored by Sen. Bernie Sanders, I-VT, and Sen. Roger Marshall, R-KS, that would invest $26 billion to bolster primary care, increase training opportunities for doctors and nurses, and expand access to community health centers. We do need to invest in so many ways in primary care so we can pivot healthcare from utilization management to care management. #utilizationmanagement #caremanagement #healthplans

November 30, 2023

November 30, 2023 No Comments

Walgreen’s Launches Drug Tool Similar to others, Walgreen’s has launched a drug price transparency and saver tool for its customers. No monthly fee applies. #drugpricing #walgreens Link to Article Investors Look To Medicaid Managed Care Interesting article on investors now looking to Medicaid managed care as the Medicare Advantage market cools and is dominated by big players. While Medicaid margins are skinnier, Medicaid has been growing and states have been pushing more and more lives into managed care. Rolls will drop with redeterminations coming out of COVID, but aging and long-term care remains a big opportunity for plans and investors. (Article may require subscription.) #medicaid #managedcare Link to Article United Details 2024 Outlook Healthcare behemoth United Healthcare detailed its outlook for 2024. Trends it sees will likely match the industry. United sees slower growth in Medicare Advantage, continued efforts to employ physicians, and increased investments in technology. Additional article here:

November 29, 2023

November 29, 2023 No Comments

Cigna and Humana Exploring A Merger Stunning news on the health plan front with speculation that Cigna and Humana are entertaining a merger. This explains reports not too long ago that Cigna was thinking about giving up its Medicare Advantage (MA) line of business. The merger seems like a match made in heaven. Cigna is a commercial powerhouse, but its MA line is much smaller than Humana’s. Its MA line is struggling from a Star perspective. It sold its only Medicaid assets a few years ago. Humana is second only to United in MA and has a growing Medicaid line. Both plans have some provider assets as well. And Express Scripts, Cigna’s PBM and one of the nation’s big three, would be a huge asset for Humana. Humana has a subscale PBM asset. Earlier mega mergers (Aetna-Humana and Cigna-Anthem) fell apart due to federal and state pushback and footprint overlaps.

November 28, 2023

November 28, 2023 No Comments

Innovation In State And Federal ACA Exchange Programs Interesting article on policy brief from the Commonwealth Fund on various innovations occurring in the state-based and federal Exchange programs. As of 2023, 20 states operate a state-based marketplace and 30 rely on Healthcare.gov for sign-ups. Some state-based exchanges use the federal website for enrollment. States are experimenting with enrollment campaigns, simplified enrollment, auto-enrollment programs, health-equity requirements, and more. Article at link. The actual study is here: https://www.commonwealthfund.org/publications/issue-briefs/2023/nov/policy-innovations-affordable-care-act-marketplaces #aca #obamacare #exchanges #commonwealthfund Link to Article Mark Cuban’s Firm Partners With Expion Mark Cuban’s Cost Plus Drugs (CPD) is partnering with Expion to tackle the high costs of specialty drugs. A press release says CPD will integrate into Expion’s dynamic pricing technology. It says “consumers can be confident they are getting a fair price and the convenience of medication mailed directly to their homes.” #cuban #costplusdrugs #drugpricing #expion Link to Article Healthcare Bankruptcies

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