Today's News and Commentary

House passes slimmed-down spending bill to keep government open “PBM reform, doctor pay boost, and pediatric cancer measures were cut.”

About health insurance/insurers

Federal ACA marketplace enrollment lagging “New and returning sign-ups through healthcare.gov — the federal marketplace that serves 31 states — are well below last year’s rate. New enrollments were just over 730,000 in early December, compared with 1.5 million at the same time last year.”

New York health insurer, executive agree to up to $100 million settlement over Medicare fraud tied to improper diagnoses “A New York health insurer and one of its former executives have agreed to pay the Justice Department up to $100 million to resolve claims that they made their Medicare members appear sicker than they really were to get more money from the government. 
The government’s lawsuit, filed in 2021, accused Independent Health, its now defunct subsidiary DxID, and DxID’s former CEO, Betsy Gaffney, of systematically scouring Medicare Advantage patients’ medical records for money-making diagnoses and pressuring doctors to sign off on them, resulting in Independent Health getting millions more from the government than it otherwise would have.”

About hospitals and healthcare systems

Financial Performance Gaps Between Critical Access Hospitals and Other Acute Care Hospitals “CAHs have unique financial pressures, particularly in the years following the COVID-19 pandemic. In this cross-sectional study, CAHs had lower overall operating margins but higher Medicare operating margins than other acute care hospitals. Operating margins for system-affiliated CAHs were 63% higher than for independent CAHs (4.4–percentage point absolute difference). Relative to independent hospitals, system-affiliated hospitals had higher commercial prices. Limitations of this study include use of financial metrics derived from CMS cost report data, rather than audited financial statements, and the lack of national hospital price data.” 

About pharma

Judge blocks West Virginia's 340B contract pharmacy law “U.S. drugmakers have won a court order blocking a West Virginia law that would require them to offer discounts on drugs dispensed by third-party pharmacies that contract with hospitals and clinics serving low-income populations.”

FDA says Eli Lilly’s weight loss drug Zepbound is no longer in shortage KEY POINTS

  • The Food and Drug Administration said the active ingredient in Eli Lilly’s weight loss drug Zepbound is no longer in shortage, a decision that will eventually bar compounding pharmacies from making unbranded versions of the injection.

  • But the FDA said it will provide a 60 to 90-day transition period where it will not take action against pharmacies for making compounded tirzepatide, which will give patients time to switch to the branded version.

  • It’s the latest in a high-stakes dispute between compounding pharmacies and the FDA over a shortage of tirzepatide, the active ingredient in Eli Lilly’s widely prescribed weight loss drug Zepbound and diabetes treatment Mounjaro.” 

About the public’s health

Long COVID affects 8.4% of U.S. adults, with income and geography shaping impact “The study found that 8.4% of U.S. adults reported experiencing PCC, while 3.6% were currently experiencing symptoms characteristic of PCC. Among these individuals, 2.3% reported symptoms severe enough to limit daily activities. Women, bisexual individuals, and adults aged 35 to 64 had the highest reported rates of PCC and activity-limiting PCC.
Economic status was also observed to influence prevalence, with higher rates of PCC observed among individuals with lower family incomes. Rural residents also reported higher rates of both PCC and activity-limiting PCC compared to urban residents.
Additionally, the findings revealed significant racial and ethnic disparities, with Hispanic adults and non-Hispanic American Indian and Alaska Native adults experiencing higher rates than other groups. Conversely, non-Hispanic Asian adults reported the lowest prevalence.
Nearly 65% of those with current PCC indicated that their symptoms limited their daily activities, with “a little” or ‘a lot’ of interference in their ability to function. The prevalence of PCC and activity limitations showed clear trends based on urbanization, with rural populations consistently more affected.”

Review of US vaccine injury reimbursement program shows less than 3% of claims eligible for compensation “A report yesterday from the US Government Accountability Office (GAO) on federal response to medical countermeasure injury compensation claims—primarily about COVID and flu vaccines—reveals that, during the first few years of the COVID-19 pandemic, claims spiked to 27 times the typical number received, and less than 3% of the claims were eligible for compensation.
About half of the claims were related to COVID vaccination. The vast majority of money paid for claims, however—more than $6 million—was for harms tied to the H1N1 flu vaccine.” 

About healthcare technology

Top health tech companies by VC funding: A look at 2024 and the past decade “According to Silicon Valley Bank, investment so far this year is hovering between $4 billion and $4.5 billion per quarter. Funding in the first eight months of 2024 has already exceeded investment totals from full-year 2019, SVB reported.
And it's perhaps no surprise that healthcare AI startups are driving the momentum this year. It was reported in October that generative AI startup Abridge is raising $250 million in new funding with a pre-money valuation of an eye-popping $2.5 billion.”
See the charts in the article.

Medline sets stage for blockbuster US IPO with confidential filing “Medline has confidentially filed for an initial public offering in the United States, paving the way for one of the major stock market flotations in 2025 that could value the medical supplies provider as high as $50 billion.
The company has not determined the size of the offering, it said on Thursday, but Reuters reported last month the stock sale could fetch $5 billion.”

Today's News and Commentary

About health insurance/insurers

12 key insurance industry lawsuits in 2024 FYI 

About hospitals and healthcare systems

From -10.2% to 21.3%: 41 health systems ranked by operating margins FYI 

About pharma

Incidence of side effects associated with acetaminophen in people aged 65 years or more: a prospective cohort study using data from the Clinical Practice Research Datalink Results: In total, 180,483 acetaminophen-users and 402,478 non-users were included in this study. Acetaminophen use was associated with an increased risk of peptic ulcer bleeding (aHR 1.24; 95% CI 1.16, 1.34), uncomplicated peptic-ulcers (aHR 1.20; 95% CI 1.10, 1.31), lower gastrointestinal-bleeding (aHR 1.36; 95% CI 1.29, 1.46), heart-failure (aHR 1.09; 95% CI 1.06, 1.13), hypertension (aHR 1.07; 95% CI 1.04, 1.11), and chronic kidney disease (aHR 1.19; 95% CI 1.13, 1.24). [Emphases added]
Conclusion: Despite its perceived safety, acetaminophen is associated with several serious complications. Given its minimal analgesic effectiveness, the use of acetaminophen as the first-line oral analgesic for long-term conditions in older people requires careful reconsideration.”

US accuses CVS of filling, billing government for illegal opioid prescriptions “The US Department of Justice announced a lawsuit on Wednesday accusing pharmacy chain CVS of filling illegal opioid prescriptions and billing federal health insurance programs, contributing to a nationwide epidemic of opioid addiction and overdose.
The newly unsealed complaint in Providence, Rhode Island, federal court alleges that, from October 2013 to the present, CVS violated the federal Controlled Substances Act by filling prescriptions for dangerous quantities of opioids and dangerous combinations of drugs.”
 
About the public’s health

FDA Finalizes Updated “Healthy” Nutrient Content Claim “The U.S. Food and Drug Administration today issued a final rule to update the “healthy” nutrient content claim to help consumers identify foods that are particularly useful as the foundation of a diet that is consistent with dietary recommendations. Manufacturers can voluntarily use the claim on a food package if the product meets the updated criteria.”

Transgender Minors Unable to Stop Lawmakers' UNC Records Request “Transgender minors, their parents, and a doctor challenging North Carolina’s gender-affirming care ban for youths can’t block lawmakers’ request for mental-health records of nonparty adolescents treated by the plaintiff doctor, a federal court said.
The minors and parents lacked standing to request an order preventing the University of North Carolina Health System’s release of the documents, and the doctor didn’t show that the records were protected from discovery, the US District Court for the Middle District of North Carolina said. UNC wasn’t a party to the action, nor were the patients whose records were sought.”

Mortality in the United States, 2023 Data from the National Vital Statistics System

  • Life expectancy for the U.S. population in 2023 was 78.4 years, an increase of 0.9 year from 2022.

  • The age-adjusted death rate decreased by 6.0% from 798.8 deaths per 100,000 standard population in 2022 to 750.5 in 2023.

  • Age-specific death rates decreased from 2022 to 2023 for all age groups 5 years and older.

  • The 10 leading causes of death in 2023 remained the same as in 2022, although some causes changed ranks; heart disease, cancer, and unintentional injuries remained the top 3 leading causes in 2023.

  • The infant mortality rate of 560.2 infant deaths per 100,000 live births in 2023 did not change significantly from the rate in 2022 (560.4).”  

Today's News and Commentary

National Health Expenditures In 2023: Faster Growth As Insurance Coverage And Utilization Increased A must- read from Health Affairs: “Health care spending in the US reached $4.9 trillion and increased 7.5 percent in 2023, growing from a rate of 4.6 percent in 2022. In 2023, the insured share of the population reached 92.5 percent, as enrollment in private health insurance increased at a strong rate for the second year in a row, and both private health insurance and Medicare spending grew faster than in 2022. For Medicaid, spending and enrollment growth slowed as the COVID-19 public health emergency ended. The health sector’s share of the economy in 2023 was 17.6 percent, which was similar to its share of 17.4 percent in 2022 but lower than in 2020 and 2021, during the height of the COVID-19 pandemic. State and local governments accounted for a higher share of spending in 2023 than in 2022, while the federal government share was lower as COVID-19-related funding declined and federal Medicaid spending growth slowed.”

Congress' end-of-year health deal may be falling apart “The bill text for the deal to extend expiring healthcare programs like Medicare telehealth flexibilities was finally finished Wednesday evening. By Thursday morning, there was blowback from Elon Musk, an incoming watchdog on federal spending, about the cost of the bill and the rush to pass it in the days before the government runs out of funding.
Elon Musk, who president-elect Donald Trump wants to advise the White House on federal spending through the Department of Government Efficiency, opposed the bill on his social media platform X on Thursday morning. He wrote that any lawmaker that votes to pass the C.R. ‘should not be reelected in 2 years.’”

About health insurance/insurers

CMS sunsets Medicare Advantage value-based model, citing billions in costs “The Centers for Medicare & Medicaid Services (CMS) is discontinuing the Medicare Advantage (MA) Value-Based Insurance Design model at the end of 2025.
The CMS said the model was too costly because of ‘increased risk score growth and Part D expenditures’ among participating plans.
In calendar years 2021 and 2022, the model cost the Medicare Trust Fund a combined $4.5 billion. That level of costs was ‘unprecedented,”’ and there were no ‘viable policy modifications’ to make the model more sustainable.”

Mandatory Medicare Bundled Payment and the Future of Hospital Reimbursement A great review of this program, which starts next month. A report from the Institute for Accountable Care highlights that hospitals participating in the Transforming Episode Accountability Model (TEAM) could face an average financial loss of $500 per episode of care.

About hospitals and healthcare systems

Hospitals tried to cut labor expenses this year. Did it work? “Four things to know:
1. Labor expenses are still above pre-pandemic levels, signaling a new normal. But hourly earnings growth has slowed to below 4% monthly from January through October of this year. It's unfeasible to reduce staff because patient volumes are growing, even in areas where the population is stagnant, according to the report.
2. Hospital employee average hourly earnings growth dropped 3.2% in 2024, compared to 4.2% the year prior. However, hospital payrolls have increased every month for the past 35 months, while health system payrolls have risen consistently for the past 46 months.
3. Over the last 12 months, the average hospital job additions hit 17,780, up from 15,800 over the previous year. Health systems added an average of 29,630 jobs per month in the last 12 months, compared with 28,760 the year prior.
4. Quit rates for the healthcare and social assistance sector hit 2.3% in October, compared to 2.9% in May 2023, according to the report. While quit rates have decreased, they are still above the 1.6% average in the 10 years before the pandemic.”
 

About pharma

Giant Companies Took Secret Payments to Allow Free Flow of Opioids Excellent investigative journalism shows how PBMs encouraged and profited from expanded opioid use. For example: “Even as the epidemic worsened, the P.B.M.s collected ever-growing sums. The largest of the middlemen bought competitors and used their increasing leverage not to insist on safeguards but to extract more rebates and fees. From 2003 to 2012, for example, the amount Purdue was paying P.B.M.s in rebates roughly doubled to about $400 million a year, almost all of it for OxyContin.”

About the public’s health

CDC confirms first known severe case of H5N1 bird flu in the U.S. “The United States has confirmed its first known severe human infection of H5N1 bird flu, in a person in Louisiana believed to have contracted the virus through contact with sick or dead birds in a backyard flock.”

REVIEW OF EVIDENCE ON ALCOHOL AND HEALTH [Click on Download Free PDF]
Much controversy has arisen in recent years about beneficial and deleterious effects of alcohol. This excellent review provides some answers. For example, “For those who do consume alcohol, the DGA [Dietary Guidelines for Americans] recommend drinking in moderation by limiting intake to two drinks or fewer in a day for men and one drink or fewer in a day for women on days alcohol is consumed…
On the basis of a meta-analysis of eight eligible studies, there was a 16 percent lower risk of all-cause mortality among those who consumed moderate levels of alcohol compared with those who never consumed alcohol (RR 0.84, 95% CI 0.81–0.87).”
 
Subset recommendations warrant caution, for example, the association of higher incidence of breast cancer with alcohol consumption.

Vitamin D, Calcium, or Combined Supplementation for the Primary Prevention of Falls and Fractures in Community-Dwelling Adults: Preventive Medication “The USPSTF recommends against supplementation with vitamin D with or without calcium for the primary prevention of fractures in community-dwelling postmenopausal women and men age 60 years or older.” [Grade D recommendation]

Effects of Microplastic Exposure on Human Digestive, Reproductive, and Respiratory Health: A Rapid Systematic Review “We concluded that microplastics are “suspected” to harm human reproductive, digestive, and respiratory health, with a suggested link to colon and lung cancer.”

Today's News and Commentary

Potential Health Policy Administrative Actions in the Second Trump Administration A great review from the KFF.

About health insurance/insurers

Insurer stock prices fall after Trump pledges to 'knock out middlemen' The reference is to PBMs. “Following his comments, shares of CVS Health fell by more than 4% Monday afternoon, UnitedHealth Group shares slipped more than 3.5% and Cigna declined by 2.6%. The companies operate the nation's three largest PBMs — CVS Caremark, Optum RX and Express Scripts — which collectively control around 80% of all U.S. prescription claims.”

About hospitals and healthcare systems

The Leapfrog Group Announces 2024 Top Hospitals and Top ASCs Notable absenses are Cleveland Clinic, Mayo Clinic and Johns Hopkins (in the teacxhing hospital category). Does this rating have face validity?

Ascension, Prime hospital deal gets green light from state “Illinois state health officials approved Prime Healthcare’s deal to buy 11 hospitals and care sites from Catholic health system Ascension Illinois, marking one of the largest local hospital deals of the year.
The $375 million deal, first announced in July, got the unanimous approval of the Illinois Health Facilities & Services Review Board at a meeting in Bolingbrook today. Board members probed about Prime’s relationship with its nurses, its decision to retain the facilities’ Catholic values, investment initiatives and litigation scandals, but ultimately signed off on the transaction.” 

About the public’s health

Chronic Pain and High-impact Chronic Pain in U.S. Adults, 2023 Data from the National Health Interview Survey

  • In 2023, 24.3% of adults had chronic pain, and 8.5% of adults had chronic pain that frequently limited life or work activities (referred to as high-impact chronic pain) in the past 3 months.

  • Chronic pain and high-impact chronic pain both increased with age.

  • American Indian and Alaska Native non-Hispanic adults were significantly more likely to have chronic pain (30.7%) compared with Asian non-Hispanic (11.8%) and Hispanic (17.1%) adults.

  • The percentage of adults with chronic pain and high-impact chronic pain increased with decreasing urbanization level.”  

Today's News and Commentary

About health insurance/insurers

2024-An Evaluation of Primary Care in Medicare Accountable Care Organizations “The report examines a subset of MSSP ACOs that are primary care centric, as defined by two measures:
—50 percent or more primary care physicians as a percentage of all physicians contracted by the ACO
—Top quintiles of ACOs with respect to primary care evaluation and management (E&M) visits as a percentage of all physician E&M visits, per 100 beneficiaries…
Key findings for the years from 2017 to 2022 include:
—MSSP ACOs in the highest quintiles of primary care centricity were consistently more likely to generate savings and generate savings above the median rate, as compared to ACOs with a lower measure of primary care centricity.
—Primary care centric ACOs outperformed most other ACOs. Concurrently, the median level of shared savings of all MSSP ACOs increased modestly, from 1.1 percent to 3.4 percent.
—High primary care centric ACOs generated 2.4 times the savings as low primary care centric ACOs between 2017–2022.
—By two different measures examined, MSSP ACOs did not appear to achieve these savings by targeting beneficiaries that have fewer social and economic vulnerabilities, although more research is needed at a smaller geographic level to confirm this encouraging finding.”

About pharma

Fierce Biotech's Rotten Tomatoes of 2024  A good summary of this year’s biotech gaffs.

SCOTUS declines to take up PhRMA's challenge of Arkansas 340B drug pricing law “The U.S. Supreme Court refused to hear an appeal by a pharmaceutical industry group challenging Arkansas' 340B drug pricing law.
The decision last Monday affirms a lower court's ruling in March that upheld an Arkansas law prohibiting drugmakers from restricting 340B drug discounts for providers using contract pharmacies.”

Goldman Sachs’ investment arm agrees €2bn deal for drugmaker Synthon “Synthon specialises in developing and manufacturing generic versions of complex drugs. Its portfolio includes treatments for cancer, cardiovascular conditions and multiple sclerosis.”

About the public’s health

How Are States Spending Opioid Settlement Cash? We Built a Database of Answers FYI
And in a related article: Consulting firm McKinsey to pay $650 million to end opioid criminal probe “Business consulting giant McKinsey & Company will pay $650 million to end a criminal probe by the Justice Department into the company’s role in bolstering sales of addictive pain pills, prosecutors announced Friday.”

Texas AG sues out-of-state doctor over mail-order abortion pills “Texas Attorney General Ken Paxton (R) sued a New York doctor this week for allegedly prescribing abortion pills to a suburban Dallaswoman in violation of Texas law — setting up the first major legal challenge to “shield laws” enacted by some Democratic-led states to protect doctors providing abortion access after Roe v. Wade was overturned in 2022.”
Comment: This one is going to The Supreme Court.

About healthcare IT

HHS releases slimmed-down HTI-2 interoperability rule, with more regulations on the horizon “The draft HTI-2 rule, developed by the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC), clocked in at 1,067 pages and built on the agency's HTI-1 final rule published in January. It would have established, for the first time, a path for certification for payers. Further, it would have established voluntary certification for health IT software used by public health organizations and health plans.
However, the rule finalized last week, called Health Data, Technology, and Interoperability: Trusted Exchange Framework and Common Agreement, left out many of those broader provisions and mainly focused on advancing TEFCA-related proposals from the draft rule. The pared-down version was only 156 pages, as compared to the hefty draft rule.”

Today's News and Commentary

About health insurance/insurers

Centene expects to earn at least $166.5B in revenue for 2025 “The health insurer expects to bring in between $166.5 billion and $169.5 billion in revenue for the year, including between $154 billion and $156 billion in premium and service revenue, according to the announcement. It also estimates earnings per share of at least $7.25 in 2025.
The company is bracing for elevated utilization trends to continue as well, according to the announcement. It projects a medical loss ratio of between 88.4% and 89%. 

About hospitals and healthcare systems

8 changes coming to HCAHPS in 2025 Numerous HCAHPS changes are set to take effect Jan. 1, aiming to modernize the survey and increase patient response rates. 
The survey's main mode of administration — paper — and its question sets have remained largely unchanged since CMS launched HCAHPS in 2008, according to Rick Evans, senior vice president of patient services and chief experience officer of NewYork-Presbyterian Hospital in New York City. 
CMS outlined key changes to the survey process in its inpatient prospective payment system final rule released Aug. 1. HCAHPS scores collected under the modernized process will be reflected in hospitals' payment determinations for fiscal 2027.

Eight survey changes that will take effect in 2025
1. CMS will allow patients to fill out the HCAHPS survey online, as opposed to only over the phone or by mail. In a 2021 pilot run, CMS found adding an option for electronic administration increased survey response rates. The three new web-first survey offering will include:

  • Email survey, followed by mail survey to non-respondents

  • Email survey, followed by phone survey to non-respondents 

  • Email survey, followed by mail survey then phone survey to non-respondents   

2. CMS will sunset two current survey administration options — the aActive interactive voice response and the hospitals administering HCAHPS for multiple sites survey modes — which have not been used by any hospitals since 2016 and 2019, respectively. Mail-only, phone-only and mail-phone survey options will remain available.

3. The current HCAHPS survey includes 29 questions organized into 10 submeasures. The updated version will add three new submeasures for care coordination, restfulness of hospital environment and information about symptoms, bringing the total number of questions to 32

4. Four questions, including those about call-button use and care transitions, will be eliminated as they either reflect outdated hospital processes or prove redundant with other survey questions. 

5. The data-collection period for the survey will extend from 42 days to 49. 

6. CMS will end a regulation that prohibits patients' loved ones from filling out the survey on their behalf, though patients will still be encouraged to fill out the survey themselves. 

7. CMS will limit the number of supplemental items to 12 to align with its other patient experience surveys. 

8. Hospitals will be required to collect information about what language a patient speaks. Spanish-speaking patients must be presented with the official CMS Spanish translation of the survey.”  

About pharma

Pharma Has Kept M&A Spending Small This Year, With Just One Deal Topping $5B “By far, the largest acquisition of 2024 was Novo Holdings’ yet-to-be-closed buyout of manufacturer Catalent at $16.5 billion. Outside of that, the leading pharmaceutical companies kept to less than $5 billion per deal.” 

Using the Inflation Reduction Act to Rein in Patenting & Evergreening Abuses “Four of the 10 drugs subject to negotiation would likely have faced competition before negotiated prices go into effect were it not for evergreening tactics and patent abuses. As a result, Medicare will lose between $4.9 and $5.4 billion in savings that should have accrued from access to competing, lower-cost treatments. These lost savings are nearly as much as what Medicare is expected to save if negotiated prices go into effect on all of the selected drugs in the first year of the program ($6 billion).” [Emphasis in the original]
Comment: The IRA mandated that Medicare negotiate prices for some high cost drugs. This research reveals that the reason many of the prices were so high to start, was that the companies were granted monopolies through the legal creation of “patent thickets.”

If private equity buys Walgreens, these assets could face the chopping block Excellent summary of the likely consequences if Sycamore Partners buys Walgreens.
In a related article: Why private-equity health care investments are poised to rise in 2025

About the public’s health

Flu vaccines drop among kids despite record deaths last year: CDC “Fewer children in the U.S. have gotten a flu vaccine in 2024 compared to last year, according to new data from the Centers for Disease Control and Prevention (CDC).  
As of Nov. 30, about 36 percent of the nation’s children aged six months to 17 years received a flu vaccination, a drop from last year’s 43 percent.”

Changes in Adult Obesity Trends in the US “These findings suggest that BMI and obesity prevalence in the US decreased in 2023 for the first time in more than a decade. The most notable decrease was in the South, which had the highest observed per capita GLP-1RA dispensing rate. However, dispensing does not necessarily mean uptake, and the South also experienced disproportionately high COVID-19 mortality among individuals with obesity”
 

About healthcare IT

Major health systems including Mayo Clinic, UPMC join with ATA to launch digital tech alliance “The American Telemedicine Association (ATA) is collaborating with health systems to push forward the integration of digital technologies into care delivery.
The new alliance, called the ATA Center of Digital Excellence (CODE), convenes a group of leading health systems to work together on best practices that "prioritize patient-centered care, equitable access and improved clinical and operational outcomes," the ATA said in a press release.”

Hackers threaten to leak data of 17M California patients “A ransomware group sent faxes to Whittier, Calif.-based PIH Health outlining the data it had stolen, which spanned patients' personal information to photos and test results, Whittier Informed reported. The three-hospital system took its IT networks offline and switched to paper records following the Dec. 1 cyberattack. The hackers did not specify their demands in the letter.”

Today's news and Commentary

About health insurance/insurers

FTC urges 21 healthcare marketers to review protocols to avoid misleading claims “The Federal Trade Commission (FTC) has sent warning letters to 21 companies that conduct marketing outreach or generate sales leads for health plans amid a busy window for open enrollment.
The letters do not accuse the recipients of any wrongdoing but warn against practices that could get them into trouble. For example, they cannot misrepresent the benefits included in a plan or misrepresent the costs associated with a certain plan.”

Warren, Hawley introduce bill requiring insurers to offload PBM businesses “Democratic and Republican lawmakers are calling on insurers to divest their pharmacy benefit manager (PBM) businesses in bills introduced to Congress Dec. 11.
While PBM reform has been a widely supported but largely fruitless endeavor so far, mandating insurers sell their PBM businesses is the most sweeping change suggested to date.
The mirrored bills were introduced by Senators Elizabeth Warren, D-Massachusetts, and Josh Hawley, R-Missouri and House representatives Jake Auchincloss, D-Massachusetts, and Diana Harshbarger, R-Tennessee.”

Paying More for Primary Care—A New Approach by Medicare “CMS recently announced a new prospective payment model through the agency’s Innovation Center that supports primary care for ACOs in the MSSP. The ACO Primary Care (ACO PC) Flex model aims to strengthen primary care with one of Medicare’s most substantial increases in payments for primary care services to date. Although a stated goal of ACO PC Flex remains to achieve savings for Medicare, the new model will also direct millions of additional dollars to participating primary care organizations. The model will serve as a time-limited test running from January 2025 through December 2029 and include up to 130 MSSP ACO participants…
ACO PC Flex is open only to ‘low-revenue’ ACOs, or those with patients who generate a small portion of revenue for the ACO compared with their overall costs to Medicare. Low-revenue ACOs, which include less than a third of existing ACOs and involve smaller groups of independent physicians rather than hospitals, are often less resourced. They serve more rural and diverse populations and have demonstrated greater savings for Medicare relative to their high-revenue counterparts.”
Comment: These “less resourced” groups may not only have lack of needed infrastructure, but, more importantly, they will probably not have the expertise to manage this model. Further, if they do not have significant numbers of enrollees in the program, they will not be able to achieve the program’s goals (or if they do, it will be by chance). It would have been better if the plan was rolled out to the larger, more experienced, ACOs.

About hospitals and healthcare systems

Divided court tosses rule boosting rural hospitals’ Medicare payments “The U.S. Department of Health and Human Services overstepped its authority when it boosted Medicare reimbursements to hospitals in low-wage areas to help them recruit and retain staff, a divided federal appeals court ruled on Wednesday.
A 2-1 panel of the San Francisco-based 9th U.S. Circuit Court of Appeals found that HHS's 2020 policy shift ran afoul of the law governing Medicare, the federal health insurance program for seniors and some people with disabilities.”

Hospitals' 'credit split' to widen in 2025: Fitch “Elevated inflation, Medicaid expansion, the reinstatement of Medicare sequestration and significant waves of M&A all have intensified a long-term trend of credit divergence, splitting hospitals into stronger and weaker segments, Fitch Ratings said in a Dec. 9 report.”


About pharma

Unsupported Price Increases Occurring in 2023 From ICER: “We continue to see list price increases that are far above the rate of inflation for many of the costliest drugs. These price hikes resulted in over $800 million in excess costs to the US health care system in just one year alone. This impacts everyone in the country, especially patients and their families… Since launching this report in 2019, we have noticed a decrease in the number of drugs that have significant price hikes without any new clinical evidence. In this report, half of the drugs we assessed had price increases in the setting of new evidence of additional benefits or reduced harm, while the other half lacked such evidence to support their higher price tag.”
 

About the public’s health

Overdose deaths in the U.S. fell 17% in 1-year period, CDC says “Drug overdose deaths in the United States fell 17% between July 2023 and July 2024, the Centers for Disease Control and Prevention said in a new report released Wednesday. 
Since 2021, over 100,000 people have died of overdoses each year in the United States. A record number of overdose deaths — over 108,000 — were recorded in 2022. The numbers dipped in 2023 and have continued to drop monthly throughout 2024.”

Montana Supreme Court upholds lower court ruling that allows gender-affirming care for minors “A Montana law banning gender-affirming medical care for transgender minors will remain temporarily blocked, the state Supreme Court ruled Wednesday, after justices unanimously agreed with a lower court judge who found the law likely violates the state's constitutional right to privacy.
The case against the Montana law now goes to trial before District Court Judge Jason Marks in Missoula.”

Infant RSV vaccine trials on hold: FDA “The FDA has placed a hold on all clinical studies of vaccines for respiratory syncytial virus in infants due to safety concerns following a trial involving two mRNA-based vaccine candidates from Moderna. 
A briefing document released by the FDA ahead of the Vaccine and Related Biological Products Advisory Committee revealed that a phase 1 trial evaluating two RSV vaccines in infants aged 5 to 8 months was paused in July after five severe cases of RSV-related illness were reported among infants receiving the vaccine candidates.”

Today's News and Commentary

About health insurance/insurers

Medicare Advantage: National Carriers Expand Market Share While Regional Carriers Without Affiliation Decline, 2012–23 “National carriers expanded their national market share significantly from 2012 to 2023, whereas the collective market share of regional carriers without affiliation to Blue Cross and Blue Shield organizations declined because of acquisitions. For example, the combined national market share of national carriers increased from 46 percent in 2012 to 66 percent in 2023, while the combined national market share of non-Blue regional carriers decreased from 25 percent to 6 percent. Conversely, concentration in local markets has declined but remains highly concentrated, and evidence suggests that further declines may be unlikely. Specifically, declines in local market concentration have been limited to markets with low MA penetration. Once MA penetration exceeds 20 percent, further MA growth is not associated with further drops in concentration, on average.”

Optum backs out of proposed 'dummy code' settlement  “Optum has backed out of a proposed settlement between Aetna and class members in a lawsuit that accused the companies of improperly charging administrative fees as medical expenses. 
In a Dec. 6 court filing, Optum said it disagreed with the settlement's terms and is prepared to proceed to a bench trial. The company also plans to argue that the plaintiffs lack evidence to support their original claims.
The lawsuit, initially filed in 2015, claimed that Aetna and Optum used misleading billing practices — specifically, employing "dummy codes" to disguise administrative fees for chiropractic services as medical charges — thereby causing plan participants and their employers to pay the fees unknowingly.” 

About pharma

Walgreens Is in Talks to Sell Itself to Private-Equity Firm Sycamore Partners “Walgreens Boots Alliance and Sycamore Partners have been discussing a deal that could be completed early next year, assuming talks don’t fall apart, according to people familiar with the matter.
Walgreens’s market value reached a peak of over $100 billion in 2015 but had since shrunk to around $7.5 billion as of Monday. Mounting pressures on both its pharmacy and retail businesses had helped send its shares down nearly 70% so far this year before The Wall Street Journal reported on the deal talks Tuesday.”

Pharmacies prevail in appeal of $650-million opioid award in Ohio “Ohio's top court ruled on Tuesday that pharmacy chain operators CVS , Walmart and Walgreens could not be held liable for fueling an opioid epidemic in two Ohio counties that won a $650.9-million judgment against them.
The Ohio Supreme Court held on a 5-2 vote, opens new tab that a state law barred Lake and Trumbull counties' claims that pharmacy chains' dispensing of addictive pain medications created a public nuisance that the companies should be forced to remediate.”

About the public’s health

US health panel adds self-testing option for cervical cancer screening “Women should have the option of taking their own test samples for cervical cancer screening, an influential health panel said Tuesday.
Draft recommendations from the U.S. Preventive Services Task Force are aimed at getting more people screened and spreading the word that women can take their own vaginal samples to check for cancer-causing HPV.
Women in their 20s should still get a Pap test every three years. But after that — from age 30 to 65 — women can get an HPV test every five years, the panel said.”

Biden HHS Extends Covid Vaccine Liability Shield Through 2029 “The US Department of Health and Human Services is extending through 2029 liability protections for those producing and administering Covid-19 vaccines, in a move to guard against future potential health emergencies.”

Dietary guidelines may promote plants but punt on ultra-processed foods “Americans should eat more plant and low-fat dairy foods while limiting their intake of red and processed meats, sugary beverages and foods high in sodium and saturated fat, an advisory committee of health and nutrition experts that helps shape the federal government’s Dietary Guidelines for Americans said in a report Tuesday
The report, however, drew fierce criticism from some nutrition experts because it did not take a hard stance against ultra-processed foods, which many studies and some lawmakers have blamed for the nation’s rising rates of obesity and chronic disease.”

Bird flu in California child related to virus in dairy cows, CDC says “Federal disease trackers reported Tuesday that the first child diagnosed with bird flu in an ongoing U.S. outbreak was infected with a virus strain closely related to one moving rapidly through dairy cattle, even though there is no evidence the youngster was exposed to livestock or any infected animals.”

Today's News and Commentary

Nobel Laureates Urge Senate to Turn Down Kennedy’s NominationAbout health insurance/insurers “More than 75 Nobel Prize winners have signed a letter urging senators not to confirm Robert F. Kennedy Jr., President-elect Donald J. Trump’s pick to lead the Department of Health and Human Services.
The letter, obtained by The New York Times, marks the first time in recent memory that Nobel laureates have banded together against a Cabinet choice, according to Richard Roberts, winner of the 1993 Nobel in Physiology or Medicine, who helped draft the letter. The group tries to stay out of politics whenever possible, he said.”
On the other hand: The pharma industry isn’t lobbying against RFK Jr.’s nomination for a top health role

About health insurance

US Judge Blocks Biden Healthcare Rule for DACA Immigrants in Some States “A [Republican, Trump-appointed] U.S. judge in North Dakota has blocked the Biden administration from requiring 19 Republican-led states to provide health insurance coverage to immigrants brought to the U.S. illegally as children.”

More in U.S. See Health Coverage as Government Responsibility “Sixty-two percent of U.S. adults, the highest percentage in more than a decade, say it is the federal government’s responsibility to ensure all Americans have healthcare coverage. The figure had slipped to as low as 42% in 2013 during the troubled rollout of the Affordable Care Act’s (ACA's) healthcare exchanges. It has been as high as 69% in 2006.”

Trends in Employer Health Insurance Costs, 2014–2023: Coverage Is More Expensive for Workers in Small Businesses “Highlights

  • Total premiums (combined employer costs and employee contributions) were generally lower for small firms than large firms in 2023.

  • Despite lower total premiums, workers at small businesses faced higher costs on average for their share of premiums. Small-firm employees in most states contributed a larger share of the premium for family coverage than large-firm employees did.

  • The average annual family premium contribution for workers nationally in 2023 was $7,529 at small firms and $6,796 at large firms.

  • In nearly all states, small-firm employees have larger deductibles than large-firm employees. The average annual family deductible nationally in 2023 was $5,074 at small companies and $3,547 at large ones.

  • Within the same state, workers often pay considerably more in premium contributions depending on the size of their employer. For example, in Massachusetts, those at small firms spent an average of $12,604 annually on premiums for family plans in 2023, compared to $6,933 for workers at large firms.”  

 

View of U.S. Healthcare Quality Declines to 24-Year Low “Americans' positive rating of the quality of healthcare in the U.S. is now at its lowest point in Gallup’s trend dating back to 2001.
The current 44% of U.S. adults who say the quality of healthcare is excellent (11%) or good (33%) is down by a total of 10 percentage points since 2020 after steadily eroding each year. Between 2001 and 2020, majorities ranging from 52% to 62% rated U.S. healthcare quality positively; now, 54% say it is only fair (38%) or poor (16%).
As has been the case throughout the 24-year trend, Americans rate healthcare coverage in the U.S. even more negatively than they rate quality. Just 28% say coverage is excellent or good, four points lower than the average since 2001 and well below the 41% high point in 2012.”

How Trump could roll back Biden-era healthcare regulations “One avenue for quick recissions of federal rules is through the Congressional Review Act (CRA). The lesser-known federal law enacted during President Bill Clinton’s term allows Congress a short window to overturn final rules with the support of the president.”
The article is a great review of how this Act would work after Trump takes office.

Trends to Watch in 2025 [From The Business Group on Health The following trends represent areas of focus for employers and other industry stakeholders throughout 2025:


About health insurance/insurers

The Effects of Not Extending the Expanded Premium Tax Credits for the Number of Uninsured People and the Growth in Premiums From the CBO: “CBO estimates that, relative to extending the tax credits, not extending them—either for a year or permanently—will increase the number of people without health insurance. The agency expects some people will exit the marketplaces and become uninsured because of higher out-of-pocket costs for health insurance premiums.
Without an extension through 2026, CBO estimates, the number of people without insurance will rise by 2.2 million in that year. Without a permanent extension, CBO estimates, the number of uninsured people will rise by 2.2 million in 2026, by 3.7 million in 2027, and by 3.8 million, on average, in each year over the 2026-2034 period.

Anthem Blue Cross Blue Shield reverses plan to limit anesthesia coverage “One of the country’s largest health insurers is facing backlash from doctors and government officials over its decision to no longer pay for anesthesia care if a surgery or procedure goes beyond a time limit.
Anthem Blue Cross Blue Shield insurance announced in early November that it planned to change how it evaluates billed time on professional claims for anesthesia services next year and deny any claims for anesthesia services that exceed that time limit.
The change was set to apply to members in Connecticut, New York and Missouri. A spokesperson for the company said in a statement that Anthem had decided not to proceed with the change following what the company claimed was ‘widespread misinformation.’”

Older Adults in U.S. Struggle with Health Care Costs More Than Those in Other Nations “Among the key findings:

•Out-of-pocket costs are high. Nearly one in four older adults in the U.S. spent at least USD 2,000 out of pocket on health care last year. In contrast, less than 5 percent of older adults in France and the Netherlands spent that much. Switzerland was the only survey country where older adults reported spending more.

•Older adults are delaying care because of costs. Delaying medical treatment can worsen health conditions. Although less than 10 percent of older adults across countries reported skipping needed care or forgoing medical treatment because of costs, older Americans did so at the highest rate. One-third of older U.S. adults facing cost-related barriers reported being in fair or poor health.

•People are skipping dental care. One in five older adults in the U.S., Australia, and Canada skipped needed dental care because of costs. By comparison, 5 percent or fewer of older adults in the Netherlands and Germany went without dental care.

Spending was 27% More for People who Disenrolled from Medicare Advantage than for Similar People in Traditional Medicare Key Takeaways

  • Medicare spent 27% more, on average, for people who were covered by traditional Medicare after disenrolling from Medicare Advantage than for people who were continuously covered by traditional Medicare, after adjusting for differences in health status and other characteristics. This is a difference of $2,585 in Medicare spending per person, on average, between the two groups in 2022.

  • Differences in Medicare spending between people who disenrolled from Medicare Advantage and beneficiaries continuously in traditional Medicare varied by health condition, ranging from 15% for people with pneumonia to 34% for people with diabetes. For example, among people with certain cancers, Medicare spending was 28% ($4,907) higher, on average, among those who disenrolled from Medicare Advantage than among people continuously covered by traditional Medicare.

  • Differences in Medicare spending between people who disenrolled from Medicare Advantage and those continuously in traditional Medicare increased with age for Medicare beneficiaries ages 65 and over. For example, among people ages 85 and over the difference was 46% ($7,113) compared to 25% among people ages 65 to 69 ($1,843).

  • Differences in Medicare spending between people who disenrolled from Medicare Advantage and beneficiaries continuously in traditional Medicare were larger among Black (55%, $5,203) and Hispanic (54%, $4,434) beneficiaries than White beneficiaries (25%, $2,464).

  • People dually-eligible for Medicare and full Medicaid benefits who disenrolled from Medicare Advantage had spending that was 61% ($9,435) higher than their counterparts who were continuously in traditional Medicare, while the difference in spending for Medicare beneficiaries who do not receive Medicaid was 20% ($1,684).

  • Skilled nursing facility spending accounted for the largest share of the difference in average Medicare spending per person between people who disenrolled from Medicare Advantage and those continuously in traditional Medicare (34%), followed by outpatient hospital spending (23%), and inpatient hospital spending (20%), with some variation by chronic conditions and other beneficiary characteristics.” 

About hospitals and healthcare systems

Buying across borders: 5 systems acquiring hospitals in a new state FYI

National Hospital Flash Report “Key Takeaways

1. Overall, October data show continued stability. Revenue, average length of stay, and other indicators show stable performance.

2. Outpatient revenue continues to grow. Revenue growth has been steady over the past few years, indicating a shift in how patients seek care.

3. Discharges per calendar day increased compared to the previous month. This has led to a decrease in overall expenses on a volume adjusted basis, though supplies and drug expenses continue to grow. 

About pharma

Novo Holdings wins EU blessing for Catalent buy “Novo Nordisk's controlling shareholder, Novo Holdings, has secured European Commission approval for its $16.5-billion acquisition of Catalent, a move that some say could dramatically reshape the CDMO landscape—and potentially limit manufacturing options for competing pharmaceutical companies.”

The deal involves Novo Holdings acquiring Catalent and subsequently selling three manufacturing sites to Novo Nordisk for $11 billion, positioning the Danish drugmaker to expand production of its popular obesity and diabetes treatments 

About the public’s health

Increases in U.S. life expectancy forecasted to stall by 2050, poorer health expected to cause nation’s global ranking to drop “Key takeaways:

  • The U.S. is forecasted to fall in its global rankings below nearly all high-income and some middle-income countries.

  • Drug use disorders, high body mass index, high blood sugar, and high blood pressure are driving mortality and disability higher across the U.S.

  • Future scenarios for health outcomes identify the states that are forecasted to gain ground, face stagnation, or grow worse.

  • Scientific evidence underscores the urgent need to prioritize public health to prevent the economic consequences of sickness, disabilities, and premature mortality in the U.S.” 

About healthcare IT

David O. Sacks, future White House AI Czar, likely to favor startups and 'thoughtful' regulation “Sacks is reportedly a close confidant of Elon Musk, who will also hold a special advisory role to the White House on cutting government spending.
Sacks founded a venture capital firm in 2017 called Craft Ventures. He was also a pivotal player at PayPal in the early 2000s. Sacks is a lawyer by training and hosts the weekly podcast ‘All In’ about the technology industry.”

About healthcare technology From ECRI: “Top 10 Health Technology Hazards for 2025 The List for 2025

1. Risks with AI-Enabled Health Technologies
2. Unmet Technology Support Needs for Home Care Patients
3. Vulnerable Technology Vendors and Cybersecurity Threats
4. Substandard or Fraudulent Medical Devices and Supplies
5. Fire Risk in Areas Where Supplemental Oxygen Is in Use
6. Dangerously Low Default Alarm Limits on Anesthesia Units
7. Mishandled Temporary Holds on Medication Orders
8. Infection Risks and Tripping Hazards from Poorly Managed Infusion Lines
9. Skin Injuries from Medical Adhesive Products
10. Incomplete Investigations of Infusion System Incidents”

About healthcare personnel

Clinician Turnover 2024 “KLAS Arch Collaborative is—for the first time—asking clinicians who report plans to leave their organization where they intend to go. This report examines the cost of clinician turnover, how burnout and the EHR experience affect staff retention, and best practices from organizations who have improved their clinicians’ satisfaction and reversed turnover trends…
[For example]: Since 2019, the risk of clinician turnover has steadily increased. In 2024, nearly half of nurses and physicians are classified as at risk. Of these at-risk clinicians, 21% of nurses and 13% of physicians actually leave…
This turnover results in steep costs for organizations—the average cost of turnover for a nurse and physician respectively is $56,300 and $500,000–$1,000,000.”

The Future of Primary Care: Traditional and Nontraditional Models Continue to Evolve A great overview from Bain. For example: “By 2030, 30% of primary care could be delivered by nontraditional providers, with strong growth from payer-owned providers and enabled primary care providers.”

Aya Healthcare to Acquire Cross Country Healthcare for Approximately $615 Million in Cash “ya Healthcare and Cross Country Healthcare today announced that they have entered into a definitive agreement whereby Aya will acquire Cross Country for $18.61 per share in cash in a transaction valued at approximately $615 million. The all-cash transaction represents a premium of 67 percent to Cross Country’s closing price on December 3, 2024, and a premium of 68 percent to the volume-weighted average trading price for the 30-day trading period ended December 3, 2024.
Aya and Cross Country offer complementary, tech-enabled workforce solutions across the continuum of care.”

Today's News and Commentary

HealthcareInsights.MD will resume on Monday, December 9.

About health insurance/insurers

CMS says ACA open enrollment is on track to set another record for sign-ups “The sign-up period officially kicked off Nov. 1. The Centers for Medicare & Medicaid Services (CMS) said that close to 988,000 people who did not previously have coverage in a marketplace plan have secured it over the past month.
The CMS also said 4.4 million people have returned to a marketplace plan for 2025, putting the exchanges on pace to set another record in enrollment. For the 2024 plan year, the CMS tallied a record 21.4 million sign-ups on HealthCare.gov.”

Enrollment in High-deductible Health Plans Among People Younger Than Age 65 With Private Health Insurance: United States, 2019–2023 “In 2023, among privately insured people younger than age 65, 41.7% were enrolled in an HDHP. Enrollment increased from 40.3% in 2019 to 43.3% in 2021, followed by a decrease to 41.7% in 2023. Among people with employment-based coverage, enrollment in an HDHP increased from 40.2% in 2019 to 43.4% in 2021, followed by a decrease to 41.9% in 2023. For people with directly purchased coverage, enrollment in an HDHP increased from 44.3% in 2019 to 47.0% in 2020, followed by a decrease to 43.1% in 2023.”

Blue Cross Blue Shield will begin limiting anesthesia coverage in some states “Anthem Blue Cross Blue Shield will soon change the way it covers anesthesia for procedures in certain states…
Under the new policy, the Chicago-based company said it would determine a specific amount of time it would cover anesthesia costs for, depending on a procedure.
‘Claims submitted with reported time above the established number of minutes will be denied,’ the company said in its announcement.
Exceptions would be made for anyone under the age of 22 and for maternity-related care.
The policy is slated to begin on Feb. 1, 2025.”
Comment: Sounds like global anesthesia rates by procedure.

About hospitals and healthcare systems

Kaiser's Risant Health to become $35B system in 5 years: 14 things to know FYI 

About pharma

U.S. Patent Office pulls controversial rule to curb pharma patent abuse In an unexpected move, the U.S. Patent & Trademark Office has withdrawn a controversial proposal that was designed to prevent pharmaceutical companies from abusing the patent system.
Specifically, the proposed rule was crafted to stem the use of so-called patent thickets, which are wielded by drug companies to delay the arrival of lower-cost generic medicines in the marketplace. Essentially, thickets are collections of numerous patents that critics contend add only incremental changes to a drug and, therefore, produce little to no additional benefit to patients.”

About the public’s health

Chocolate intake and risk of type 2 diabetes: prospective cohort studies “Increased consumption of dark, but not milk, chocolate was associated with lower risk of T2D. Increased consumption of milk, but not dark, chocolate was associated with long term weight gain. Further randomized controlled trials are needed to replicate these findings and further explore the mechanisms.” 

About healthcare IT

Change Healthcare cyberattack drives 2024 into another record year for health data breaches “As many as 172 million individuals — more than half the population of the United States — may have been impacted by large health data breaches reported to the Department of Health and Human Services in 2024, according to a STAT analysis of records from HHS’ Office for Civil Rights. It’s a new record for the scale of large health care breaches, breaking one set just last year
The vast majority of those health data breaches — 532 of the 656 reported as of December 4 — have resulted from hacks and ransomware attacks, continuing a years-long trend. Since 2018, HHS has reported, it has seen a 264% increase in large ransomware breaches, and seven health systems have been fined up to $950,000 for failing to protect patients’ protected health information from ransomware attacks.”

About healthcare personnel

Highest-paid specialties for nurse practitioners, physician assistants FYI

Today's News and Commentary

Trump’s pick to head DEA withdraws after GOP criticism of his covid policies “Chronister, a career law enforcement officer who has spent little time on the national stage, announced his withdrawal from consideration on social media early Tuesday evening, just three days after Trump’s selection. Chronister said he planned to continue serving as the sheriff in Hillsborough County.”

About health insurance/insurers

Police Hunt for Gunman After UnitedHealthcare C.E.O. Is Killed in Midtown Manhattan “he executive, Brian Thompson, was shot in what the police described as a ‘brazen targeted attack’ outside a hotel where the company was holding an investor meeting. The assailant was last spotted in Central Park, investigators said at a news conference.”

 9 States Poised To End Coverage for Millions if Trump Cuts Medicaid Funding “More than 3 million adults in nine states would be at immediate risk of losing their health coverage should the GOP reduce the extra federal Medicaid funding that’s enabled states to widen eligibility, according to KFF, a health information nonprofit that includes KFF Health News, and the Georgetown University Center for Children and Families. That’s because the states have trigger laws that would swiftly end their Medicaid expansions if federal funding falls.
The states are Arizona, Arkansas, Illinois, Indiana, Montana, New Hampshire, North Carolina, Utah, and Virginia.”

The largest commercial insurer in every state | 2024 FYI

Small employers are fleeing from fully insured market, analyst tells regulators “Roughly 40% of employers with three to 99 employees are escaping from the fully insured small-group health insurance market by using level-funded plans, an analyst told state insurance regulators earlier this month in Denver.
In 2018, fewer than 10% of small firms had level-funded health plans, according to Kelly Edmiston, policy research manager at the National Association of Insurance Commissioners' Center for Insurance Policy and Research.”

Insurers Collected Billions From Medicare for Veterans Who Cost Them Almost Nothing “A Wall Street Journal analysis of Medicare and VA data found that Medicare Advantage insurers collected billions of dollars a year in premiums to provide medical coverage for about one million veterans like Kitt, even though they go to the VA for some or all of their healthcare needs.
The analysis found the insurers paid far fewer medical bills for those veterans than for typical members. About one in five members of Medicare Advantage plans that enroll lots of veterans didn’t use a single Medicare service in 2021, the Journal found. That compares with 3.4% of members of other Medicare Advantage plans.
The federal government paid insurers an estimated $44 billion from 2018 through 2021 to cover Medicare Advantage-plan members who were also users of VA services, based on average payments for all members of those plans. The VA spent $46 billion on the same group’s medical care, according to VA data reviewed by the Journal. The figures exclude pharmacy costs, which many Medicare Advantage plans focused on veterans don’t cover.”

About hospitals and healthcare systems

Kaiser's Risant Health acquires 2nd health system “Risant Health, a nonprofit formed by Oakland, Calif.-based Kaiser Permanente, acquired Greensboro, N.C.-based Cone Health, a five-hospital system, effective Dec. 1. 
The transaction cements Risant as the sole corporate member of Cone Health. There was no purchase price or exchange of cash.”

About pharma

Lilly lands first blow against Novo in head-to-head study of weight loss drugs “op-line results from the Phase IIIb SURMOUNT-5 trial showed that on average, Zepbound led to weight loss of 20.2% compared to 13.7% with Wegovy after 72 weeks. Participants on Zepbound lost 50.3 lbs (22.8 kg), while those given Wegovy lost 33.1 lbs (15.0 kg)” 

Nearly 30% of US drugstores closed in one decade, study shows “Nearly three out of 10 U.S. drugstores that were open during the previous decade had closed by 2021, new research shows.
Black and Latino neighborhoods were most vulnerable to the retail pharmacy closures, which can chip away at already-limited care options in those communities, researchers said in a study published Tuesday in Health Affairs.
The trend has potentially gained momentum since the study’s timeframe, because many drugstores are still struggling. In the last three years, the major chains Walgreensand CVS have closed hundreds of additional stores, and Rite Aid shrank as it went through a bankruptcy reorganization.”

About the public’s health

UK junk food ad ban includes porridge and pitta bread snacks “Unhealthy versions of breakfast cereals including muesli, porridge oats and granola will be included in a UK junk food advertising ban from next year. Pitta bread snacks, rice cakes, tea and coffee with added sugar also fall within the regulations that prevent unhealthy food being advertised online or before 9pm on TV. The UK government wants to reduce children’s exposure to foods high in fat, sugar or salt to tackle obesity-related diseases such as diabetes.”
Comment: A laudatory move, but the many special interests in this country would make this move very difficult here.

Acceptability of Guidelines to Stop Colon Cancer Screening by Estimated Life Expectancy “While many older adults found guidelines limiting colon cancer screening after 75 years of age to be somewhat or very acceptable, a sizable minority did not, and this finding is consistent across respondents with different life expectancies.” 

About healthcare IT

Use of Artificial Intelligence in Peer Review Among Top 100 Medical Journals “Overall, 78 medical journals (78%) provided guidance on use of AI in peer review. Of these provided guidance, 46 journals (59%) explicitly prohibit using AI, while 32 allow its use if confidentiality is maintained and authorship rights were respected. Internationally based medical journals are more likely to permit limited use than journals’ editorial located in the US or Europe, and mixed publishers had the highest proportion of prohibition on AI use.

Secure Messaging Use and Wrong-Patient Ordering Errors Among Inpatient Clinicians “In this cohort study of inpatient clinicians, higher daily secure messaging was associated with increased odds of wrong-patient ordering errors. Although messaging may increase cognitive load and risk for wrong-patient ordering errors, these results do not provide conclusive evidence regarding the direct impact of secure messaging on errors, as increased messaging may also reflect greater care coordination, increased patient complexity, or communication of the presence of a wrong-patient ordering error.”

About healthcare technology

Top health tech hazards of 2025 “The biggest safety concern in health technology for 2025 is artificial intelligence, a new report from nonprofit patient safety organization ECRI found.”
See the ECRI monograph or this article for the list. 

Today's News and Commentary

About health insurance/insurers

UnitedHealth, Centene get Medicare Advantage Star Rating upgrades “UnitedHealthcare and Centene have received higher Medicare Advantage star ratings for the 2025 plan year after the Centers for Medicare and Medicaid Services revised their scores.
On Monday, CMS published updated Medicare Advantage Star Ratings program data that reveal the agency increased the quality ratings for 12 UnitedHealthcare contracts and seven Centene contracts, each of which comprise multiple Medicare Advantage plans…
Centene gained its sole four-star contract under the recalculations CMS disclosed Monday. Two UnitedHealthcare contracts were upgraded to five stars and three to four stars, giving the UnitedHealth Group subsidiary 37 contracts rated at least four stars.
The U.S. District Court for the Eastern District of Texas ordered CMS to redo UnitedHealthcare’s scores last month in a case involving how the agency evaluated the company’s call center services. Centene initiated a similar lawsuit in October, which is still on the docket, as is a complaint from Humana. Elevance Health and Blue Cross and Blue Shield of Louisiana sued over their scores on different grounds.” 

About hospitals and healthcare systems

Inova first to earn Joint Commission's health data certification “Falls Church, Va.-based Inova has become the first health system in the U.S. to achieve The Joint Commission's Responsible Use of Health Data certification. 
Launched Jan. 1, the voluntary certification program recognizes hospitals and health systems for ethical practices in using data beyond clinical care, such as for safety and quality work or operational improvements. The certification provides a framework for healthcare organizations to safely use and transfer patient data, ensuring transparency and responsible use.”
And in a related article:Biggest hospital cyberattacks of '24 

About the public’s health

House COVID-19 panel releases final report: 3 key takeaways From the Republican controlled House: The report starts with the finding that the SARS-CoV-2 virus ‘likely emerged because of a laboratory or research related accident…’  
The report is critical of many of the mitigation measures that were employed early on in the pandemic. 
It found masks and mask mandates were ‘ineffective at controlling the spread of COVID-19.’ Several studies, including one published this August, have found masking in public has an effect on lowering respiratory viral transmission, though this should not be the sole measure used to mitigate spread.
Further, the report concluded lockdowns caused ‘more harm than good’ to the economy, overall health of Americans and development of children…
The subcommittee’s report paid particular attention to the actions of EcoHealth Alliance, the nongovernmental organization that subawarded NIH grants to global labs including the Wuhan Institute of Virology. 
Echoing criticism from members of the subcommittee, the report found EcoHealth failed to carry out proper oversight of the experiments it provided funding for, facilitated gain-of-function research and misled the NIH on the details of its research projects. 
The NIH in turn was found to have failed in its oversight of EcoHealth.”

Treatment patterns in patients with newly diagnosed COPD in the USA “Overall, during the 4-year follow-up period, 32.9% of the patients had at least one moderate or severe exacerbation, and 25.8% and 13.8% experienced moderate and severe exacerbations, respectively. At diagnosis, 86.2% of the patients were untreated and most remained untreated by the end of the follow-up (63.8%).”


About healthcare IT

The invisible wasteland of health care data According to a 2019 report from the World Economic Forum, the average hospital produces approximately 50 petabytes of data per year, with 97% of the data going unused. To put that enormous number in perspective, this is the equivalent of streaming a two-hour movie about 25 million times annually. Multiply that number by the over 6,000 hospitals in the United States, and the amount of data becomes incomprehensibly large. And that report was from five years ago — the numbers are likely even higher now!
Based on carbon dioxide production per unit of electricity estimates from the Environmental Protection Agency, some experts have stated that storing 100 gigabytes of data — about the size of many modern hard drives — in the cloud over a year would produce 0.2 tons of carbon dioxide. By this logic, a typical hospital in the United States employing a similar storage strategy would have a carbon footprint of 100,000 tons from its digital data storage alone. Furthermore, this would mean that digital waste would be responsible for 97,000 tons of the carbon dioxide produced. The U.S. health care sector is responsible for over 8% of the country’s carbon emissions annually, yet many estimates don’t factor the toll of digital waste into the carbon footprint.”

Today's News and Commentary

About health insurance/insurers

HIV prevention pills should be free, but insurers are still charging “Nearly a third of a national sample of 325 health coverage plans on government insurance marketplaces did not include PrEP on their lists of covered preventive services, according to the AIDS Institute, a New York-based nonprofit.|
Between 20 and 30 percent of PrEP users with commercial insurance still had to pay for it despite the coverage mandate, with an average cost of $227 for 2022, according to the Centers for Disease Control and Prevention.”

About hospitals and healthcare systems

25 largest health systems by hospital beds FYI

Update from StatNews:

Ascension: The Catholic system, still reeling from a massive cyberattack earlier this year, has been busy offloading hospitals in Alabama and Michigan. Its operating margin stood at -3% in the most recent quarter.

Bon Secours Mercy Health: BSMH narrowed its operating losses in the latest quarter as demand for care grows. Bon Secours Mercy also received $331 million in July from its investment in the revenue cycle company Ensemble Health Partners.

Cleveland Clinic: The 21-hospital academic health system posted a 1.1% operating margin in the quarter on almost $4 billion of revenue, and big investment gains pushed Cleveland Clinic’s total margin above 9%. Higher drug costs continued to gnaw at its expenses.

Northwell Health: Northwell, which operates 21 hospitals throughout New York, remained in the black with a 1.7% operating margin in the quarter. The system noted higher demand for medical care and pharmacy services.

Providence: The 51-hospital system that’s mostly in the Pacific Northwest has been losing money from patient operations for years, the latest quarter being no exception. But Providence narrowed its operating losses in the most recent quarter thanks to seeing more patients, negotiating higher prices from commercial insurers, and reducing contract labor costs by 39%. Providence registered a 1.3% net margin in the first nine months of this year after factoring in investment profits.

UPMC: UPMC registered a -0.7% operating loss in the last three months, but not because of its hospital and physician businesses, which were booming. It was due to higher costs in its insurance business. Pennsylvania is one of 13 states where Medicaid programs and their insurers cover the pricey GLP-1 drugs for obesity.”

8 health systems ditching their health plans FYI

Novartis pays PTC $1B upfront for midphase Huntington's program, reestablishing itself in R&D race “Novartis is paying $1 billion upfront for global rights to PTC Therapeutics’ midphase Huntington's disease program, helping the biotech bounce quickly back from disappointing data on another program.
PTC went into the Thanksgiving break reeling from the failure of an amyotrophic lateral sclerosis trial and its subsequent decision to stop further development of the candidate. Monday, PTC revealed a deal with Novartis for its Huntington's drug candidate PTC518, sending its share price up 17% to above $51 in premarket trading.”

About pharma

Trump taps Florida sheriff as DEA administrator “President-elect Donald Trump on Saturday tapped Hillsborough County Sheriff Chad Chronister to lead the Drug Enforcement Administration, replacing Anne Milgram.
In picking the Florida sheriff to lead the DEA, Trump has selected a law enforcement professional with three decades of experience working for the Hillsborough County Sheriff’s Office but seemingly little time in the national spotlight.”

A twice-yearly shot could help end AIDS. But will it get to everyone who needs it? “The twice-yearly shot was 100% effective in preventing HIV infections in a study of women, and results published Wednesday show it worked nearly as well in men.
Drugmaker Gilead said it will allow cheap, generic versions to be sold in 120 poor countries with high HIV rates — mostly in Africa, Southeast Asia and the Caribbean. But it has excluded nearly all of Latin America, where rates are far lower but increasing, sparking concern the world is missing a critical opportunity to stop the disease.”

Drug Prices Negotiated by Medicare vs US Net Prices and Prices in Other Countries “Apart from insulin, which had a voluntary price reduction in 2024, all products remained more expensive in the US than in other countries (Table). For example, the price negotiated by Medicare for ustekinumab ($4695.00 per 30-day supply) was higher than prices in other countries, which ranged from $1219.92 in France to $2503.99 in Germany. However, the gap between US and non-US prices narrowed for all drugs.”

About the public’s health

Reusing plastic water bottles, to-go containers? Scientists say that’s a bad idea. “That means a single-use plastic water bottle sheds micro- and nanoplastics into your water when you refill it, and a takeout container or frozen meal tray sheds these particles into your food.”

Characteristics of Older Adults Who Met Federal Physical Activity Guidelines for Americans: United States, 2022 From the CDC: “Overall, 13.9% (age adjusted) of adults age 65 and older met federal physical activity guidelines for both aerobic and muscle-strengthening activities in 2022. Differences were seen by several sociodemographic characteristics. Men (16.9%), White non-Hispanic adults (15.2%), and those living in metropolitan areas (14.7%) were more likely to meet the guidelines. The percentage meeting the federal physical activity guidelines increased with increasing education level and family income and decreased with number of chronic conditions.”

How Much Water Should We Drink in a Day? The “8 glasses a day” you may be used to hearing does not tell the whole story. This article provides a really good, evidenced-based reply to the title’s question.

About healthcare technology

Baxter moves closer to 100% allocation levels for IV products “Baxter… outlined plans to gradually increase allocations over the next several weeks, with the goal of reaching 100% allocation for several IV product codes by the end of 2024. The company has also said it will provide updates on its allocation plans in mid-December and again at year's end.” 

About healthcare personnel

The Past, Present, and Future of Restrictive Covenants in Medicine in the United States: A Narrative Review An excellent review of the topic from The Annals of Internal Medicine. If you are interested in this topic, it is well-worth seeking out this article, which is from a subscriber-only publication.

Today's News and Commentary

HealthcareInsights will resume Monday, December 2.
Happy Thanksgiving!

About health insurance/insurers

CMS pitches major Medicare Advantage changes: 10 notes A great summery of recent activity

Highmark posts $22.1B in revenue through first 3 quarters of 2024 “Pittsburgh-based health insurer and provider Highmark Health has brought in $529 million in net income through the first three quarters of the year, according to its latest financial details released Tuesday.
That's on $22.1 billion in revenue through the first nine months of 2024 along with $273 million in operating gain.
Highmark said its financial performance is driven by its health plans along with increased volumes at its Allegheny Health Network (AHN). As of Sept. 30, the AHN saw a 3% increase in inpatient discharges and observations as well as 7% more outpatient registrations compared to the same time last year.”

About hospitals and healthcare systems

40 largest health systems in the US | 2024 FYI

Seventh Semi-Annual Hospital Price Transparency Report November 2024 “Our latest review, conducted nearly four years after the rule took effect, analyzed the websites of 2,000 U.S. hospitals and found only 21.1% of them (421) to be fully compliant with all requirements of the rule, a significant decrease from our last report’s compliance finding of 34.5% and from the highest observed rate in July 2023 of 36.0%. The widespread noncompliance of 78.9% of hospitals is due to files not having prices clearly associated with payer and plan names and not following required formats. All of the hospitals reviewed for this report posted a machine-readable file, though 532 hospitals’ files failed the Centers for Medicare & Medicaid Services (CMS) Validator Tool.”

About pharma

Same Drug, 2,200 Different Prices “The reason for the huge price differences: America’s complicated drug-reimbursement system, which uses middlemen to negotiate prices. 
To control drug spending, these firms have created a pricing patchwork, negotiating different prices for different plans.”
The interstate and intrastate differences are astounding. 

About the public’s health

HHS invests $44M in medical supply chain “The Administration for Strategic Preparedness and Response, an HHS agency, is providing $44 million to bolster the U.S. public health supply chain. 
Under the Defence Product Act, the agency greenlit $32.4 million for Manus Bio, a biomanufacturing company in Waltham, Mass., and up to $12 million for Antheia, an active pharmaceutical ingredient manufacturer in Menlo Park, Calif. 
With these funds, Manus and Antheia will focus on expanding capabilities to produce key starting materials and APIs for essential medicines

Pertussis Surveillance and Trends “In 2024, reported cases of pertussis increased across the United States, indicating a return to more typical trends. Preliminary data show that nearly six times as many cases have been reported as of week 46 reported on November 16, 2024, compared to the same time in 2023.”

I Ran Operation Warp Speed. I’m Concerned About Bird Flu A thoughtful and compelling article by former FDA Commissioner and public health expert Dr. David Kessler.

Americans are not getting seasonal vaccines ahead of the holidays As of this month, about 37 percent of adults 18 and older had received a seasonal flu shot, while 19 percent had received updated coronavirus vaccines and 40 percent of adults 75 and older — the group at greatest risk — got an RSV vaccine.
The vaccination rates are similar to last year’s figures, and the numbers reflect a persistent public health challenge achieving broader vaccine uptake for these illnesses.”

Trump picks Jay Bhattacharya to lead NIH, overseeing scientific research “President-elect Donald Trump selected Jay Bhattacharya, a Stanford-trained physician and economist, on Tuesday to lead the National Institutes of Health, the nearly $50 billion agency that oversees the nation’s biomedical research…
Trump also announced Jim O’Neill, a Silicon Valley investor and former federal health official, as his selection to be HHS deputy secretary. That role would position O’Neill to help run day-to-day operations and shape policy at the nearly $2 trillion agency.”

Cervical Cancer Mortality Among US Women Younger Than 25 Years, 1992-2021 “This study found a steep decline in cervical cancer mortality among US women younger than 25 years between 2016 and 2021. This cohort of women is the first to be widely protected against cervical cancer by HPV vaccines. The findings from this study in the context of other published research suggest that HPV vaccination affected the sequential decline in HPV infection prevalence, cervical cancer incidence, and cervical cancer mortality. Since its introduction, HPV vaccination coverage (≥1 doses) has increased steadily, reaching 78.5% in 2021. The gradual decline in mortality observed from 1992 to 2015 was likely due to improved screening coverage and approaches.”

Today's News and Commentary

About Health Policy

Impact of Trump tariffs on US medical device market “President Trump’s plan to impose tariffs on imported goods will affect the prices of the approximately 75% of available US-marketed medical devices that are manufactured out of the country, and more specifically the 69% of available US-marketed devices that are manufactured solely outside of the US, according to GlobalData’s Medsource Database, which collates data on the medical device supply chain…
As a result of these policy changes, companies will be forced to increase prices to make up for losses incurred by the proposed tariffs. Additionally, this may cause supply chain disruptions, reducing accessibility to medical devices and inflating the cost of these products due to the higher demand in comparison to the supply.”

Trump's tariffs could raise the cost of generic drugs in the U.S. “Dr. Aaron Kesselheim, a professor of medicine at Harvard Medical School, said that about half of all generic drugs are manufactured overseas and that about 80% of all active pharmaceutical ingredients, or APIs, are produced abroad, in China, India and other places.
Generic drugs are the backbone of medicines prescribed in the U.S.: They account for about 90% of all prescriptions filled…”
Comment: Not only will prices go up, but the tariff will disrupt the supply chain and exacerbate shortages.

About health insurance/insurers/costs

Double-digit medical cost increases expected globally in 2025 “Insurers expect global medical costs to increase by 10.4% in 2025, which mirrors this year’s rate. The projected growth in medical costs varies by region:

  • In North America, costs are projected to rise from 8.1% in 2024 to 8.7% in 2025.

  • In the United States, insurers project a 10.2% increase in 2025, up from 9.3% this year.

  • Costs also are projected to accelerate in Asia Pacific, the Middle East and Africa, while Europe and Latin America will see slower increases”

About pharma

Thousands turn to Wegovy copies each month as FDA considers shortage status “Summary:
—More than 200,000 prescriptions for Wegovy alternatives are filled in the U.S. each month
—FDA is weighing whether to remove Wegovy from its shortage list
—Pharmacy compounding group has asked FDA to consider its data when making a decision”

Obesity Drugs Would Be Covered by Medicare and Medicaid Under Biden Proposal “The Biden administration, in one of its last major policy directives, proposed on Tuesday that Medicare and Medicaid cover obesity medications, a costly and probably popular move that the Trump administration would need to endorse to become official.
The proposal would extend access of the drugs to millions of Americans who aren’t covered now.
C.M.S. estimates that around 3.4 million more patients in Medicare would become eligible for obesity drugs, and around four million patients in Medicaid would gain coverage…
C.M.S. estimates that coverage will cost the federal government about $25 billion for Medicare and $11 billion for Medicaid over a decade; states would pay around $4 billion for their share of the Medicaid bill…”

Roche inks $1.5B Poseida buyout, betting off-the-shelf CAR-Ts will democratize access to cell therapies “Roche has struck a $1.5 billion deal to buy Poseida Therapeutics. The takeover will establish off-the-shelf cell therapies, which Roche has said can democratize CAR-Ts, as a new core capability at the drugmaker.”

About the public’s health

Ten Americas: a systematic analysis of life expectancy disparities in the USA “Our analysis confirms the continued existence of different Americas within the USA. One's life expectancy varies dramatically depending on where one lives, the economic conditions in that location, and one's racial and ethnic identity. This gulf was large at the beginning of the century, only grew larger over the first two decades, and was dramatically exacerbated by the COVID-19 pandemic. These results underscore the vital need to reduce the massive inequity in longevity in the USA, as well as the benefits of detailed analyses of the interacting drivers of health disparities to fully understand the nature of the problem. Such analyses make targeted action possible—local planning and national prioritisation and resource allocation—to address the root causes of poor health for those most disadvantaged so that all Americans can live long, healthy lives, regardless of where they live and their race, ethnicity, or income.”
Look at Table 1 for an explanation of the “10 different Americas.”

Global rates of HIV infections and deaths fall sharply “Global rates of HIV infections and deaths related to the virus have dropped sharply but must fall faster to meet a UN target to end Aids as a public health threat by 2030, research has found. New HIV infection rates in sub-Saharan African countries have plunged more than half since their 1995 peak, but risen steeply in central Europe, eastern Europe and central Asia, the international survey said.

Supreme Court rejects tobacco industry challenge to graphic anti-smoking images on cigarette packs “The Supreme Court declined Monday to hear a challenge from major tobacco companies to the Food and Drug Administration’s requirement that they place graphic health warnings on cigarette packages and in advertisements.
The FDA issued a rule in 2020 that requires health warnings on cigarette packages and in advertisements, occupying the top 50% of the area on the front and back panels of packages and at least 20% of the area at the top of cigarette ads, according to the FDA.”

About healthcare IT

Yale study shows how AI bias worsens healthcare disparities “A new research report from Yale School of Medicine offers an up-close look at how biased artificial intelligence can affect clinical outcomes. The study focuses specifically on the different stages of AI model development, and shows how data integrity issues can impact health equity and care quality.” 

Artificial Intelligence and Machine Learning (AI/ML)-Enabled Medical Devices “The FDA is providing this list of AI/ML-enabled medical devices marketed in the United States as a resource to the public about these devices and the FDA’s work in this area. The devices in this list have met the FDA’s applicable premarket requirements, including a focused review of the devices’ overall safety and effectiveness, which includes an evaluation of appropriate study diversity based on the device’s intended use and technological characteristics.”

Teladoc Health launches AI motion detection solution to improve patient safety in hospital beds “Teladoc Health launched an artificial-intelligence-enabled technology that allows hospital staff to virtually detect when a patient is at risk of falling from a hospital bed. The solution, unveiled Monday and called Virtual Sitter, is now commercially available.”

The Office for Civil Rights Should Enhance Its HIPAA Audit Program to Enforce HIPAA Requirements and Improve the Protection of Electronic Protected Health Information From the OIG: “OCR fulfilled its requirement under the HITECH Act to perform periodic HIPAA audits. However:

  • OCR’s HIPAA audit implementation was too narrowly scoped to effectively assess ePHI protections and demonstrate a reduction of risks within the health care sector. Specifically:

    • OCR’s audits consisted of assessing only 8 of 180 HIPAA Rules requirements; and

    • only 2 of those 8 requirements were related to Security Rule administrative safeguards and none were related to physical and technical security safeguards.

  • OCR oversight of its HIPAA audit program was not effective at improving cybersecurity protections at covered entities and business associates.

We made a series of recommendations to OCR to enhance its HIPAA audit program, including that it expand the scope of its HIPAA audits to assess compliance with physical and technical safeguards from the HIPAA Security Rule, document and implement standards and guidance for ensuring that deficiencies identified during the HIPAA audits are corrected in a timely manner, and define metrics for monitoring the effectiveness of OCR’s HIPAA audits at improving audited covered entities and business associates’ protections over ePHI and periodically review whether these metrics should be refined.”
Comment: According to StatNews analysis: “OCR has not conducted any HIPAA audits since 2017, leaving the nation’s health care organizations to either police themselves or wait until a cyberattack exposes their systems’ inadequacy.”

Today's News and Commentary

President-elect Trump's picks for CDC, FDA, surgeon general: 31 notes FYI- a really good summary.

About health insurance/insurers  

Most American workers satisfied with employer-provided health coverage “A new nationwide poll finds that a strong majority of Americans receiving health care coverage through work — about 180 million people — are satisfied with their current employer-provided plans (75%) and prefer to get their coverage through an employer rather than through the federal or state government (74%).”

UnitedHealthcare beats CMS in Medicare Advantage star ratings lawsuit “UnitedHealthcare has prevailed in its lawsuit against CMS regarding the methodology used to calculate its 2025 Medicare Advantage star ratings. 
The lawsuit, filed Sept. 30 in the U.S. District Court for the Eastern District of Texas, revolved around the inclusion of a single disputed customer service phone call in the agency's calculations.
Judge Jeremy Kernodle ruled that CMS must "recalculate Plaintiffs' 2025 star ratings without consideration of the disputed call and shall immediately publish the recalculated star ratings." The court found that CMS had acted "contrary to its own guidelines" when evaluating the phone call, which was marked as "unsuccessful" despite evidence showing it lasted over eight minutes and connected to a call center representative.”

12 payers recently fined by states FYI

How much each state has spent to expand Medicaid “States spend nearly $40 billion annually on expanded Medicaid coverage under the ACA, according to KFF.
Medicaid is financed by the federal government and the states based on per capita income. The federal funding share varies from 50% to 74%, depending on the state. The ACA expanded Medicaid eligibility in 2014, and the federal government has paid for 90% of expansion costs since 2020.”
Expansion costs range from $3.23B (California) to $960K (Sound Dakota).

Attributing Racial Differences in Care to Health Plan Performance or Selection “In this cross-sectional study, we found substantial variation across MMC [Medicaid managed care] plans in racial differences in health care that was largely an artifact of selection bias. These findings highlight the difficulty of measuring a plan’s impact on health equity while underscoring that health care disparities remain large in Medicaid. Although these findings suggest that initiatives to adjust payments to MMC plans based on health equity measures may have unintended consequences, they also demonstrate a pressing need for well-designed policies to measure and address inequities in Medicaid.”

About hospitals and healthcare systems

Geisinger performs 1st shoulder surgery with 'lifetime guarantee' “Wilkes-Barre, Pa.-based Geisinger performed the first reverse shoulder replacement surgery in the world with a guarantee for the full cost of care throughout the patient's lifetime.
The surgery and lifetime guarantee are in partnership with Medacta Group SA, a Swiss company specializing in innovative and sustainable solutions for joint replacement, sports medicine and spine surgeries…”

About the public’s health

Study provides more positive data for Paxlovid use in high-risk patients with COVID-19 “Overall, the analysis showed that Paxlovid “significantly reduced” times to sustained alleviation (13 vs. 15 days; HR = 1.27; P < 0.0001) and resolution through day 28 (16 vs. 19 days; HR = 1.2; P = 0.0022). Treatment with Paxlovid also reduced the number of COVID-19related medical visits by 64.3% and reduced the number of patients needing these visits (2.3% vs. 8.4%).”

New Clinical and Public Health Challenges: Increasing Trends in United States Alcohol Related Mortality “During the last 20 years there have significant increases of about 2-fold in US alcohol-related mortality. Clinical challenges are increased by interrelationships of risk factors, especially overweight and obesity and diabetes.” 

State Reported Efforts to Address Health Disparities: A 50 State Review “This analysis focuses on current state efforts, many of which were implemented during or after 2020, to address health disparities and advance health equity based on a review of publicly available materials from all 50 states and DC. In addition, case study interviews were conducted with 14 stakeholders in three states (California, North Dakota, and Michigan) to increase understanding of the factors contributing to success of these state initiatives, lessons learned, and potential implications for other states.” 

About healthcare personnel

MD-Granting Medical Schools in the US, 2023-2024 FYI. Annual report from the AMA

Today's News and Commentary

About healthcare policy

Sweeping nonprofit House bill passes, healthcare groups turn attention to Senate “Legislation that gives a president wide-reaching power to financially harm any nonprofit an administration deems as terrorist supporting passed out of the House of Representatives Nov. 21.
By a vote of 219 to 184, 15 Democrats joined with an overwhelming majority of Republicans allowing a president to abolish the tax-exempt status of nonprofits. Just one Republican voted against H.R. 9495, and 30 representatives did not vote…
’To those who say this bill only applies to groups who are supporting terrorism, consider how expansive that term can be,’Rep. Lloyd Doggett, D-Texas, said on the House floor Tuesday.”

About health insurance/insurers

RFK Jr. weighs major changes to how Medicare pays physicians The proposals (still preliminary) are to take the relative rate payment determinations away from the AMA.

Medicare’s New Pathway for Transitional Coverage for Emerging Technologies A good review of this topic.

Mercer: As costs rise, employers are pursuing benefit enhancements. Here's how “Earlier this fall, Mercer released the first look at initial results from its annual survey of employer-sponsored health plans. That showed employers are bracing for medical costs to rise by more than 5% in 2025 for the third straight year…
To address affordability more broadly, employers are taking steps to offer more plan options for workers with the goal of accommodating a broader range of financial and health needs. Mercer found that 65% of large employers provided at least three plan options to employees…
Employers are also focusing on benefits in key areas. For example, the study found that 47% of large employers cover in vitro fertilization, growing from 45% in 2023.”

About the public’s health

Influenza, COVID-19, and Respiratory Syncytial Virus Vaccination Coverage Among Adults — United States, Fall 2024 “By November 9, 2024, an estimated 34.7% and 17.9% of adults aged ≥18 years had received influenza and COVID-19 vaccines, respectively, for the 2024–25 season; 39.7% of adults aged ≥75 years and 31.6% of adults aged 60–74 years at increased risk for severe RSV disease had ever received RSV vaccine. Many unvaccinated adults reported intent to get vaccinated.” 

Chloronitramide anion is a decomposition product of inorganic chloramines “Municipal drinking water in the US is often treated with chloramines to prevent the growth of harmful microorganisms, but these molecules can also react with organic and inorganic dissolved compounds to form disinfection by-products that are potentially toxic. Fairey et al. studied a previously known but uncharacterized product of mono- and dichloramine decomposition and identified it as the chloronitroamide anion... This anion was detected in 40 drinking water samples from 10 US drinking water systems using chloramines, but not from ultrapure water or drinking water treated without chlorine-based disinfectants. Although toxicity is not currently known, the prevalence of this by-product and its similarity to other toxic molecules is concerning.”

About healthcare technology

Baxter International releases first IV solutions manufactured at hurricane-hit NC facility “Baxter International this week released the first product – 1-liter IV solutions – manufactured post-hurricane at its North Cove, North Carolina facility. 
The product release is ahead of the company's original expectations and made possible by the dedication and resilience of the North Cove and broader Baxter teams, working in coordination with FDA, the company said in an update posted to its website.

Today's News and Commentary

About health insurance/insurers

Four Million People Will Lose Health Insurance If Premium Tax Credit [PTC] Enhancements Expire in 2025 From The Urban Institute: “By our analysis, if PTC enhancements expire after 2025, subsidized Marketplace enrollment would decline by 7.2 million people, and 4.0 million people would become uninsured. However, these effects aren’t felt equally across states or by race, income, and age, which means some communities may experience greater coverage losses, making health care unaffordable and inaccessible. To explore these effects by state, we produced an interactive tool displaying effects on health insurance coverage in each state by age, income, race, and ethnicity.” 

The State of Health Insurance Coverage in the U.S.: Findings from the Commonwealth Fund 2024 Biennial Health Insurance Survey “Survey Highlights

  • More than half (56%) of U.S. working-age adults were insured all year with coverage adequate to ensure affordable access to care. But there are soft spots requiring policy attention: 9 percent of adults were uninsured, 12 percent had a gap in coverage over the past year, and 23 percent were underinsured, meaning they had coverage for a full year that didn’t provide them with affordable access to heath care.

  • Among adults who were insured all year but underinsured, 66 percent had coverage through an employer, 16 percent were enrolled in Medicaid or Medicare, and 14 percent had a plan purchased in the marketplaces or the individual market.

  • Nearly three of five (57%) underinsured adults said they avoided getting needed health care because of its cost; 44 percent said they had medical or dental debt they were paying off over time.

  • Delaying care has health consequences: two of five (41%) working-age adults who reported a cost-related delay in their care said a health problem had worsened because of it.

  • Nearly half of adults (48%) with medical debt are paying off $2,000 or more; half of those with debt said it stemmed from a hospital stay.”

About pharma

CVS Health 1st to earn new health equity accreditation “CVS Health has become the first organization to receive the Health Equity Accreditation from URAC, an independent accrediting body, for its efforts to address health disparities, according to a Nov. 19 news release from the company.” 

Trump leans toward selecting surgeon and COVID mandate critic Martin Makary for top FDA job: reports “England-born Makary, current chief of Inlet Transplant Surgery at Johns Hopkins, has received worldwide recognition for his achievements in novel surgeries and widely-used research, including a World Health Organization-sponsored checklist on surgical safety.
On the drug policy front, Makary has previously raised concerns about pharmaceutical companies “gaming the system” of the Orphan Drug Act, a pathway used to usher in treatments for rare diseases.
More recently, Makary has been an outspoken critic of vaccine mandates during the pandemic, which ‘ignored natural immunity, he argued in 2023 remarks to the Senate’s COVID subcommittee. During the pandemic, natural immunity and herd immunity were topics often addressed by Makary, who expected the concepts to help COVID be ‘mostly gone’ by April 2021.
The possible FDA commissioner pick has also argued against the use of masks for children to reduce the spread of COVID and has been accused of using misleading claims to make criticisms of the U.S. government.”

About the public’s health

A quarter of Americans suffer from chronic pain “Researchers asked more than 87,000 people how often they experienced pain in the last three months and found 24.3% reported "most days" or "every day."

  • To get at how many people were experiencing what they called "high-impact chronic pain" the researchers asked how often people experienced pain that limited their life or work activities. A total of 8.5% said most or all days.

  • The risk for chronic pain rose as people aged and was highest in rural areas.

  • American Indian and Alaska Native adults were more likely to have chronic pain in the past three months (30.7%) compared with white (28%), Black (21.7%), Hispanic (17.1%) and Asian (11.8%) adults.”


Total and High-density Lipoprotein Cholesterol in Adults: United States, August 2021–August 2023 From the CDC: “Key findings

  • During August 2021–August 2023, the prevalence of high total cholesterol was 11.3% in adults, with no significant difference between men (10.6%) and women (11.9%).

  • The prevalence of low high-density lipoprotein cholesterol (HDL-C) for adults was 13.8%, was higher in men (21.5%) than women (6.6%), and declined with increasing age.

  • High total cholesterol prevalence declined from 1999–2000 to 2013–2014 and then did not change significantly. Low HDL-C prevalence declined from 2007–2008 to August 2021–August 2023.” 

About healthcare technology

Scientists map out the human body one cell at a time 
“Researchers have created an early map of some of the human body’s estimated 37.2 trillion cells…
Scientists focused on certain organs — plotting the jobs of cells in the mouth, stomach and intestines, as well as cells that guide how bones and joints develop. They also explored which cells group into tissues, where they’re located in the body and how they change over time.
They hope the high-resolution, open-access atlas — considered a first draft — will help researchers fight diseases that damage or corrupt human cells.”
See: Human Cell Atlas 

Today's News and Commentary

About healthcare quality

The Joint Commission and the National Association for Healthcare Quality Form Strategic Alliance to Advance Global Patient Safety and Healthcare Quality “The Joint Commission and the National Association for Healthcare Quality (NAHQ) announce a strategic alliance to advance global healthcare Quality and safety for all…
With the alliance, The Joint Commission and NAHQ will transform healthcare by:

  • Uniting to a universal set of Quality competencies: The Joint Commission endorses and encourages healthcare organizations to adopt NAHQ’s Healthcare Quality Competency Framework™, which defines the full spectrum of work required for a high-functioning Quality program. This framework will not be a requirement for Joint Commission accreditation or certification. It will not be scored or determinative of survey or review outcome.

  • Skilling healthcare professionals: NAHQ offers the only accredited certification in healthcare Quality through its Certified Professional in Healthcare Quality (CPHQ)® To support the importance of competency development, Joint Commission and Joint Commission International (JCI) surveyors and reviewers will obtain and maintain this certification. Furthermore, The Joint Commission and NAHQ will jointly offer 25 annual scholarships to fund CPHQ attainment in underfunded organizations.

  • Co-developing best-in-class training and education: The alliance will create training and education on the most critical topics in healthcare, along with other global products and services. NAHQ will develop a series of micro-credentials aligned with each of the eight domains of its Healthcare Quality Competency Framework, including a micro-credential in Regulatory & Accreditation in collaboration with The Joint Commission.

  • Aligning critical missions and approaches: NAHQ recognizes and endorses Joint Commission and JCI accreditation and certification approaches and products as best practices for assessing Quality and safety within healthcare organizations around the world.”

About health insurance/insurers

IRS loosens rules on health plan coverage for preventive care “The IRS has expanded its list of preventive care benefits for high-deductible health plans. Services that must be covered at no cost to policyholders now include condoms and breast cancer screenings other than mammograms, among other items.”

COMPETITION in HEALTH INSURANCE From an annual AMA report: “A comprehensive study of U.S. markets“We find that the vast majority of U.S. health insurance markets are highly concentrated. In fact, health insurance markets have remained stubbornly highly concentrated over time, with the vast majority of them being so in the last 10 years. The share of commercial markets that are highly concentrated was 95% in both 2014 and 2023 and hovered between 95% and 96% over that 10-year period.” 

About pharma

CVS, UnitedHealth, Cigna sue to block FTC case over insulin prices “KEY POINTS

  • CVS Health, UnitedHealth Group and Cigna sued the Federal Trade Commission, claiming the agency’s case against drug middlemen over high insulin prices in the U.S. is unconstitutional. 

  • The complaint is the latest move in a bitter legal fight between the three largest pharmacy benefit managers, or PBMs, in the U.S. and the FTC.

  • The FTC in September sued CVS’s Caremark, Cigna’s Express Scripts and UnitedHealth’s Optum Rx in the agency’s administrative court.”

About the public’s health

What to know about microplastics, phthalates, BPA and PFAS An excellent review of this topic.