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.

 

Today's News and Commentary

About healthcare quality

Safety of inpatient care in surgical settings: cohort study “Adverse events were identified in more than one third of patients admitted to hospital for surgery, with nearly half of the events classified as major and most potentially preventable. These findings emphasize the critical need for ongoing improvement in patient safety, involving all health professionals, throughout perioperative care.”
At least 1 in 5 of these complications is the result of medical errors.

About health insurance/insurers

TV personality and surgeon Dr. Oz nominated to run Medicare, Medicaid Another payback: “In 2022, he ran for the Senate in Pennsylvania as a [Trump-endorsed] Republican against then-Lieutenant Governor John Fetterman. Though he beat now-Senator-elect Dave McCormick in the primary, he lost to Fetterman in the general election.” 

Change Healthcare restores claims clearinghouse: 5 things to know A good update.

States rush Medicaid requests before Trump return “States are racing to have their Medicaid requests approved before the Trump administration takes power.
The new administration is expected to have a very different view of Medicaid than the Biden administration, and GOP lawmakers in Congress are eyeing major changes. Some states want waivers that will impact their states’ budgets, but others seek to allow Medicaid to pay for social services, a Biden administration innovation that links health to social well-being…”

Medicare Improperly Paid Acute-Care Hospitals an Estimated $190 Million Over 5 Years for Outpatient Services Provided to Hospice Enrollees From HHS OIG: “For 30 of 100 sample items, payments to acute-care hospitals for outpatient services provided to hospice enrollees complied with Medicare requirements. For the remaining 70 sample items, however, payments did not comply with the requirements. Specifically, our medical reviewer found that Medicare paid acute-care hospitals for outpatient services that palliated or managed hospice enrollees’ terminal illnesses and related conditions. These services were already covered as part of the hospices’ per diem payments and should have been provided directly by the hospices or under arrangements between the hospices and acute-care hospitals.”

About pharma

Antidiabetic Medication and Asthma Attacks “In this self-controlled case series and population-based cohort study of 12 702 patients with asthma, metformin was associated with a lowered risk of asthma attacks by approximately 30%, and adding glucagon-like peptide-1 receptor agonists were associated with an additional lowered risk of approximately 40%. Associations were found regardless of glycemic control, weight, or asthma phenotype.”

Semaglutide Eligibility Across All Current Indications for US Adults “A total of nearly 137 million adults, representing more than half of all US adults, are eligible for semaglutide therapy. This exceeds the number of adults eligible for statins (approximately 82 million), currently the most prescribed pharmaceuticals among US adults.6 Although most of these individuals are eligible for semaglutide based on the weight-management indication that is not universally covered by payers, we estimate that more than 39 million adults qualify for indications other than weight management alone, a substantial increase over the estimated 15 million currently taking a glucagon-like peptide-1 (GLP-1) receptor agonist.”

About the public’s health

The many legal fronts of RFK Jr.’s fight against vaccines “Robert F. Kennedy Jr. took leave as chairman of Children’s Health Defense, a nonprofit known for spreading doubt about vaccines, to run for president last year. But he is still fighting in court alongside the group, putting him in an unusual position for someone nominated as Secretary of Health and Human Services.  
If confirmed by the Senate, Kennedy will have power to guide the agencies he oversees toward his priorities. The legal fights he and his group pursue offer a glimpse of his policy interests and the tools he’s used to further them — as well as the scrutiny they could face in court.”

The US Preventive Services Task Force in Legal Jeopardy An excellent summary of recent court decisions on the legal ability of the USPTF to set policies (especially preventive care coverage for the ACA).

Childhood Vaccination Rates Continue to Decline as Trump Heads for a Second Term For example: “The share of kindergarten children up to date on their vaccinations continues to decline.
Over three-quarters (39) of states had MMR vaccination rates below the “target” rate of 95% for the 2023-2024 school year, an increase from 28 states during the 2019-2020 (pre-pandemic) school year.”

About healthcare IT  

A strategy for cost-effective large language model use at health system-scale “Large language models (LLMs) can optimize clinical workflows; however, the economic and computational challenges of their utilization at the health system scale are underexplored. We evaluated how concatenating queries with multiple clinical notes and tasks simultaneously affects model performance under increasing computational loads…Performance deteriorated as the number of questions and notes increased. High-capacity models, like Llama-3–70b, had low failure rates and high accuracies. GPT-4-turbo-128k was similarly resilient across task burdens, but performance deteriorated after 50 tasks at large prompt sizes. [Emphasis aded]After addressing mitigable failures, these two models can concatenate up to 50 simultaneous tasks effectively, with validation on a public medical question-answering dataset. An economic analysis demonstrated up to a 17-fold cost reduction at 50 tasks using concatenation. [Emphasis added] These results identify the limits of LLMs for effective utilization and highlight avenues for cost-efficiency at the enterprise scale.”

Consolidation Looms in Ambient Voice A good graphic summary of the consolidation in the voice transcription space.

Today's News and Commentary

“…it is however a bad day for science when truth is dominated by passions and expediency."
 Sir William John Ritchie Simpson [1855-1931]
Public Health Expert and contributing founder of the London School of Tropical Medicine and Hygiene

About healthcare policy

Jay Bhattacharya, an NIH critic, emerges as a top candidate to lead the agency “When three academics in October 2020 insisted it was time to roll back coronavirus lockdowns — writing an open letter known as the Great Barrington Declaration that attracted hundreds of thousands of signatures — public health leaders rebuked their proposal as premature. Francis S. Collins, then director of the National Institutes of Health, privately dismissed the authors as “fringe” experts and called for a “take down” of their suggestions to reopen schools and businesses, according to emails subsequently released under the Freedom of Information Act.
Now, one of the authors of that declaration Jay Bhattacharya, a Stanford University physician and economist — appears poised for a top government health role, perhaps as head of NIH itself…
The rise of Bhattacharya — from being scorned by the nation’s NIH director to possibly occupying his office four years later — reflects how the backlash to coronavirus policies has helped reshape conservative politics and elevate new voices. While Collins and other public health experts maintain that the Great Barrington Declaration’s ideas were rash and would have put vulnerable people at risk, many Americans have come to believe that school shutdowns and other pandemic-related policies lasted too long.”

Planned Parenthood, nonprofits condemn executive power granted in looming House bill “National healthcare groups have signed on in opposition to a House bill that would soon grant President Donald Trump the ability to undermine nonprofits and remove their tax-exempt status, civil liberty organizations claim.
These groups, led by the American Civil Liberties Union (ACLU), say the Stop Terror-Financing and Tax Penalties on American Hostages Act introduces “broad and easily abused new powers for the executive branch” in a letter sent to congressional leaders in September.”

Assistant Attorney General Jonathan Kanter Delivers Remarks on the Platformization of Health care A good summary about why the government has pressed antitrust actions in healthcare, The discussion may be moot as the Trump administration will probably cut back on antitrust actions.
See, also: A conversation with Assistant Attorney General Jonathan Kanter on U.S. HealthCare

About health insurance/insurers

5 big changes to Medicare 2025 plans you should know during open enrollment Good review of the 2025 changes.

Survey Shows Health Plans Are Expanding Value-Based Arrangements to Deliver Higher-Quality, More Affordable Health Care  [An AHIP survey] “Key findings from the survey include:

  • Continued growth in the adoption of VBC arrangements and shared risk arrangements. Across all lines of business, value-based arrangements grew by nearly 4 percentage points from 41.3% in 2022 to 45.2% in 2023. Shared risk arrangements also saw an increase, growing by 4 percentage points, from 24.5% in 2022 to 28.5% in 2023.

  • Medicare Advantage continues to lead the way. Medicare Advantage (MA) continues to lead innovation in this space with 64.3% of payments in 2023 flowing through value-based arrangements, compared to 42% for fee-for-service (FFS) Medicare. This is a 7.1 percentage point year-over-year increase for MA plans from 57.2% in 2022, compared with a 0.6 percentage point increase for FFS over 2022.

  • Commercial health plans continue making progress toward value-based adoption.Participation in commercial VBC arrangements grew from 34.6% in 2022 to 39.2% in 2023, a 5.1 percentage point increase. Adoption of downside risk arrangements in the commercial market also saw an increase of 5.1%.”

About hospitals and healthcare systems

Hospital financial stability in 2025: 8 predictions Good summary from Moody's Investor Services.

Caregiver-Reported Quality in Hospices Owned by Private Equity Firms and Publicly Traded Companies “Hospices owned by PEFs or PTCs performed significantly worse across CAHPS measures relative to not-for-profit and non-PEF/PTC for-profit agencies. Although prior research has highlighted poorer user experiences in for-profit vs not-for-profit hospices,1 this study found that PEF/PTC ownership was an especially problematic category of for-profit hospice.”

About the public’s health

Is it the flu or is it COVID? One at-home test can tell you “For the first time, new home tests — available at pharmacies without a prescription — can test for both the flu and COVID simultaneously.” 

About healthcare IT

DEA extends telehealth prescribing flexibilities “The Drug Enforcement Administration extended the flexibilities enacted during the COVID-19 pandemic that allows healthcare providers to prescribe specific controlled substances via telehealth.”

Today's News and Commentary

RFK Jr. conspiracy theories and false claims, in his own words
[Edited and quoted from the original, but read the entire article]
1.Kennedy has falsely linked vaccines to autism
“I do believe that autism does come from vaccines,” he said last summer in an interview with Fox News host Jesse Watters.
2.Kennedy falsely called the coronavirus vaccine the ‘deadliest vaccine ever made’
3.Kennedy promotes raw milk, stem cells and other controversial or debunked medical treatments
4.Kennedy argues government employees have an interest in ‘mass poisoning’ the American public
“The agency, the USDA, the FDA have been captured by the industries they’re supposed to regulate, and they all have an interest in subsidies and mass poisoning the American public,” Kennedy told Fox News in August.
5.Kennedy has suggested mass shootings committed by young people are spurred by antidepressants and video games.
6.Kennedy incorrectly suggests AIDS may not be caused by HIV
“They were doing phony, crooked studies to develop a cure that killed people without really being able to understand what HIV was, and pumping up fear about it constantly, not really understanding whether it was causing AIDS,” Kennedy said in an interview last summer with New York Magazine.
7.Kennedy falsely argues children’s gender identity can be impacted by water
8.Kennedy has falsely touted ivermectin and hydroxychloroquine as effective covid treatments
9. Kennedy argued that covid-19 was ‘ethnically targeted’ to spare Ashkenazi Jews and Chinese people
Kennedy said in a video recorded by the New York Post last July: “Covid-19 is targeted to attack Caucasians and Black people. The people who are most immune are Ashkenazi Jews and Chinese.”
10.Kennedy claims 5G high-speed wireless network is used to ‘control our behavior’
Kennedy has claimed that 5G high-speed wireless network service is being used to “harvest our data and control our behavior.”

Public Trust in Scientists and Views on Their Role in Policymaking Key findings
-
76% of Americans express a great deal or fair amount of confidence in scientists to act in the public’s best interests.
-Majorities view research scientists as intelligent (89%) and focused on solving real-world problems (65%).
-Communication is seen as an area of relative weakness for scientists.
-Americans are split over scientists’ role in policymaking.
-Democrats continue to express more confidence than Republicans in scientists, but ratings within the GOP have edged higher in the last year.
Read the entire article. Many difference exist among population subgroups.

About health insurance/insurers

CMS to lower importance of ‘call center’ metric in Medicare Advantage star ratings “UnitedHealthcare, Centene and Humana have all sued the government this fall for downgrading their quality scores based on assessments of their customer support centers. Payers argued the measure had an outsized impact on final star ratings, and it seems that regulators agree.
’We have already put in place that [the call center metric] is going to have a smaller weighting on star ratings moving forward,’ CMS Medicare Director Meena Seshamani said Wednesday at the Milken Institute’s Future of Health Summit in Washington, D.C.”

About hospitals and healthcare systems

A couple performance reports:
Advocate Health posts $885M operating gain through Q3 
Henry Ford Health's operating income up $242M through Q3 

About pharma

Vaccine maker stocks fall as Trump chooses RFK Jr. to lead HHS “The stocks fell in the final hour of trading as reports emerged about Trump’s expected pick. Moderna’s stock closed more than 5% lower on Thursday, shares of Novavax fell more than 7% and Pfizer’s stock ended more than 2% lower.
Shares of BioNTech, the German drugmaker that helped develop a Covid vaccine with Pfizer, closed more than 6% lower. British drugmaker GSK, which makes flu shots and several other vaccines, closed roughly 2% lower.”

New FDA rules for TV drug ads: Simpler language and no distractions “The new rules, which cover both TV and radio, instruct drugmakers to use simple, consumer-friendly language when describing their drugs, without medical jargon, distracting visuals or audio effects. A 2007 law directed the FDA to ensure that drug risk information appears ‘in a clear, conspicuous and neutral manner.’” 
Read the whole article for explanations about what why the FDA is taking these steps.

About the public’s health

A Big Climate Goal Is Getting Farther Out of Reach “The report by the Climate Action Tracker, a research group, estimates that the climate and energy policies currently pursued by governments around the world would cause global temperatures to rise roughly 2.7 degrees Celsius, or 4.9 degrees Fahrenheit, above preindustrial levels by 2100.
That estimate of future warming has barely budged for three years now, the group said.”

Recent Decade Saw Drop in Marijuana Use in U.S. Adolescents “The researchers found that the percentage of adolescents who reported current marijuana use dropped significantly from 23.1 percent in 2011 to 15.8 percent in 2021. There were also significant decreases in self-reports of trying marijuana for the first time before age 13 years (8.1 percent in 2011 to 4.9 percent in 2021). Similar significant decreases were seen for current use by race/ethnicity, with Asian, Hispanic, and White adolescents experiencing the steepest declines. The percentage of Black adolescents self-reporting marijuana use was significantly higher (20.5 percent) in 2021 compared with White (14.8 percent), Hispanic (16.7 percent), and Asian (5.1 percent) adolescents. While there were significant declines in current marijuana use for both girls and boys over time, in 2021, girls were more likely (17.8 percent) to currently use marijuana than boys (13.6 percent), but the opposite was true in 2011 (25.9 percent for boys versus 20.1 percent for girls).”


National-level and state-level prevalence of overweight and obesity among children, adolescents, and adults in the USA, 1990–2021, and forecasts up to 2050 “In 2050, in most states, a projected one in three adolescents (aged 15–24 years) and two in three adults (≥25 years) will have obesity.”

 March of Dimes Report Card “In 2023, over 370,000 babies were born preterm—10.4% of all births—earning our nation a D+ for the third year in a row. In addition to the preterm birth rate, the report also includes indicators to better reflect the state of maternal and infant health in the US.”
You can also see stat-by-state comparisons. The only “A’ grade is Vermont.

About healthcare IT

Amazon One Medical rolls out telehealth treatment services in competition with Ro, Hims & Hers “Amazon One Medical is rolling out a new service to provide Prime members access to clinical treatments for common health and lifestyle conditions like men's hair loss and anti-aging skin care.
The new service builds on Amazon One Medical's existing Pay-per-visit telehealth service that offers healthcare for more than 30 common conditions.
The new service offers a subscription plan with low, upfront monthly pricing for a clinical visit, treatment plan, and free medication delivery. The service initially focuses on five conditions: anti-aging skin care treatment, men’s hair loss, erectile dysfunction, eyelash growth, and motion sickness.

About healthcare quality

Fall 2024 Leapfrog Hospital Safety Grade Shows Significant Progress in Patient Safety Nationwide Go to this link for national figures for specific practices. Go here to find the ratings of hospitals near you.

Unnecessary Back Surgery From the Lown Institute:
KEY TAKEAWAYS

  • Over three years, U.S. hospitals performed more than 200,000 unnecessary back surgeries on Medicare beneficiaries. That’s one low-value back procedure every eight minutes.

  • These low-value back procedures cost Medicare about $2 billion in total over three years.

  • On average, 14% of spinal fusions/laminectomies met criteria for overuse, with individual hospital overuse rates ranging from less than 1% to more than 50%.

  • On average, 11% of patient visits for osteoporotic fracture resulted in an unnecessary vertebroplasty, with individual hospital rates of overuse ranging from zero to 50%.

  • New Hampshire, Iowa, Massachusetts, and Pennsylvania had the highest overuse rates of spinal fusion/laminectomy with rates over 18%. Arkansas, Kansas, Oklahoma, and Nevada had the highest overuse rates of vertebroplasty, with rates over 16%.

  • U.S. News Honor Roll hospitals had varied performance. At Cleveland Clinic fewer than 1% of patient visits with osteoporotic fracture resulted in an unnecessary vertebroplasty, compared to nearly 20% at Mayo Clinic Phoenix.

  • A total of 3,454 physicians performed a measurable number of low-value back surgeries. Over three years, these physicians received a total of $64 million from device and drug companies for consulting, speaking fees, meals, and travel, according to Open Payments data analyzed by Conflixis.

Today's News and Commentary

Trump taps Robert F. Kennedy Jr., vaccine skeptic, to lead health department “Kennedy, founder of one of the country’s most prominent anti-vaccine groups, has long criticized the Centers for Disease Control and Prevention’s recommended list of childhood immunizations, promoting debunked claims about vaccines’ link to autism. He has argued that federal agencies have not done enough research on the shots that hundreds of millions of Americans have received to protect them from measles, flu and other infectious diseases. His claims are rejected by health officials who say that vaccines have been thoroughly studied and are responsible for ending threats such as polio in the United States”
In a related story:RFK Jr.’s anti-vaccine group lost $3 million last year “After years of financial growth, Children’s Health Defense, the anti-vaccine nonprofit group founded by Robert F. Kennedy Jr., recorded a more than 30% drop in revenue last year, to $16 million, according to recent tax filings.”

About health insurance/insurers

Medicare Part D in 2025: Preferred Pharmacy Networks Fade in a Collapsing PDP Market “For 2025, DCI’s exclusive analysis of Center for Medicare & Medicaid Services’ (CMS) data reveals that the number of PDPs will drop to a historic low. What’s more, the share of plans with a preferred cost sharing pharmacy network will fall to its lowest rate in more than 10 years…
The destruction of the Part D market marks yet another unintended consequence of the Inflation Reduction Act of 2022 (IRA). The IRA makes PDPs less economically viable and will drive even more seniors into Medicare Advantage Prescription Drug (MA-PD) plans—despite the challenges facing those plans. The 2025 decline will occur even after CMS gifted $7 billion to PDPs to prevent a complete collapse of the 2025 market.”

Healthcare billing fraud: 10 recent cases FYI

How Lincare Became a Multibillion-Dollar Medicare Scofflaw A great investigative piece from ProPublica.

About hospitals and healthcare systems

Medicare Faces Barrage of Hospital Pay Cases After Chevron's End A thoughtful analysis of the impact of this Supreme Court decision vis-a-vis hospitals.

About pharma

Drug Safety:FDA Should Implement Strategies to Retain Its Inspection Workforce From the GAO: “The Food and Drug Administration paused many drug manufacturer inspections during the COVID-19 pandemic. Inspections help ensure that the drugs Americans rely on are safe.
Since resuming inspections, FDA has struggled to retain staff. From Nov. 2021 to June 2024, the vacancy rate among investigators who inspect foreign and domestic manufacturers jumped from 9% to 16%—leading to fewer inspections.
FDA said concerns with travel, pay, training, workload, and work-life balance contribute to turnover. For example, investigators can travel up to 75% of the time.
We recommended developing a plan that balances inspection needs with addressing turnover.”

About the public’s health

US overdose deaths are down, giving experts hope for an enduring decline “The decline in U.S. drug overdose deaths appears to have continued this year, giving experts hope the nation is seeing sustained improvement in the persistent epidemic.
There were about 97,000 overdose deaths in the 12-month period that ended June 30, according to provisional Centers for Disease Control and Prevention data released Wednesday. That’s down 14% from the estimated 113,000 for the previous 12-month period.

Tide is turning’: STI epidemic shows signs of slowing, CDC saysKey takeaways:
More than 2.4 million STIs were reported in the U.S. in 2023 — a 1.8% decrease from 2022.
Data showed rates of gonorrhea and chlamydia decreased, whereas overall syphilis rates increased by 1%.”

Measles cases rose 20% worldwide in 2023, per new report “Measles vaccination coverage globally has still not recovered to pre-Covid levels, a fact that contributed to a 20% increase in measles cases in 2023 over the previous year, according to a new report from the World Health Organization and the Centers for Disease Control and Prevention that was released Thursday.
The pandemic backsliding is hindering efforts to eliminate measles globally, and subjecting children — generally children under the age of 5 — to a health threat that can be fatal in some cases or trigger lifelong consequences such as deafness in others.”

About healthcare IT

Healthcare Cybersecurity: HHS Continues to Have Challenges From the GAO: “HHS has several initiatives intended to mitigate ransomware risks for healthcare and public health. Nevertheless, our prior work has found that the department had not adequately monitored the sector’s implementation of ransomware mitigation practices.”
This statement outlines a set of recommendations to address this problem.

About healthcare technology

PTC wins FDA approval for first brain-delivered gene therapy Kebilidi “The FDA issued its first stamp of approval for a cell or gene therapy back in 2017 to Novartis' Kymriah. Now, seven years and many approvals later, innovation in the space has hit new heights with PTC Therapeutics’ Kebilidi, the first U.S. gene therapy that’s administered directly in the brain.
The one-time therapy picked up an FDA nod to treat the ultra-rare disease aromatic L-amino acid decarboxylase (AADC) deficiency, a fatal genetic disorder that manifests in severe disability from the first months of life across the physical, mental and behavioral spectrums, according to PTC.

Gene screening can cut early disease deaths by 25%, study shows “The scientists used Genomics’ analytical tool, known as a polygenic risk score (PRS), to identify those at high risk from birth of nine diseases. The conditions, which all have existing screening programmes globally, are breast cancer, prostate cancer, colorectal cancer, abdominal aortic aneurysm, melanoma, type 2 diabetes, hypertension, cardiovascular disease and atrial fibrillation. The researchers found very high risk individuals reached the average risk levels on which screening programmes are based 12.4 years early. In other words, if a screening programme were devised on the basis of the average risk facing a 50-year-old, this high-risk group would face the same predicted risk at age 37.6. By contrast, a group of reduced genetic risk individuals did not reach normal initial screening-age risk levels until about 17.7 years later — or 67.7 years old in the example given. Overall, the use of the genetic prediction tools and consequent early medical intervention could prevent 24.5 per cent of premature, preventable deaths that occur before screening programmes start, the researchers said.”

Today's News and Commentary

About hospitals and healthcare systems

National Hospital Flash Report “Key Takeaways

1. September data show relative stability. Though most indicators are down this month, performance remained relatively stable overall.
2. Inpatient revenue and average length of stay increased. This indicates that hospitals are treating more high-acuity patients, which results in a decline in volume and an increase in expenses.
3. Expenses, with the exception of labor, are still high compared to 2021-2023. Contract labor rates and utilization have decreased, but the overall labor market is still tight. 

About pharma

Cardinal Health inks two deals worth $3.9B to expand diabetes, gastroenterology businessesThe pharmaceuticals and specialty products distributor announced Tuesday it entered into definitive agreements to acquire a majority stake in GI Alliance (GIA), a gastroenterology management services organization from a combination of GIA physician owners and funds managed by affiliates of Apollo. Cardinal Health said it will purchase its majority stake for approximately $2.8 billion in cash, which will represent 71% ownership. 
Also on Tuesday, the company, which also offers data analytics services, said it plans to buy the Advanced Diabetes Supply Group (ADSG), a leading diabetic medical supplies provider, for approximately $1.1 billion in cash. “

BioNTech pays $800M to take control of potential Keytruda killer “BioNTech is upping its bet on a PD-L1xVEGF-A bispecific, paying $800 million upfront to buy its Chinese partner Biotheus and secure full rights to a leading prospect in the white-hot immuno-oncology space.
Germany-based BioNTech got into the space before the gold rush that was unleashed in September by the news that Akeso and Summit Therapeutics’ PD-1xVEGF-A prospect ivonescimab had beaten Merck & Co.’s Keytruda.”

Many Americans Unable to Afford Medications, Navitus Survey Finds “In the survey, 48% reported that the price of medication had affected their ability to get a medicine they needed at least once, and few understand the role of pharmacy benefit managers…
The survey, which was conducted online via Pollfish on Oct. 2, 2024 of those aged 18 and older, also found that 75% of respondents don’t know what a PBM is, and 84% couldn’t name one.
Other key findings include:

  • 89% of Americans think healthcare consumers in the United States pay more than other countries.

  • 45% haven’t filled a prescription due to cost.

  • 43% have had to change medications because it wasn’t covered by insurance

  • 50% have used a cost savings options such as discount cards”

     

About the public’s health

CDC estimates a national diabetes prevalence of nearly 16% “A data brief from the CDC focused on the national diabetes prevalence across the U.S. estimates that 16% of adults in the U.S. have diabetes, with approximately 4.5% being undiagnosed.” 

About healthcare personnel

Physician employment models 'are not sustainable' as labor expenses rise “Medical groups are also experiencing high labor costs, with 84% of the group's total expenses attributed to labor, according to Kaufman Hall's Physician Flash Report based on data from more than 200,000 providers. The average subsidy per employed physician was $304,312. This is the first time it's exceeded $300,000. ‘Investment/subsidy per physician rose above $300,000 for the first time — a sign that current models of physician employment are not sustainable,’ said Matthew Bates, managing director and Physician Enterprise service line leader with Kaufman Hall. ‘Revenue is increasing but physicians and providers are working more while generating less revenue. Health systems need to rethink operations to align the costs of provider employment with the current healthcare environment.’”

Healthcare's most dangerous workplaces”In 2023, private industry employers reported 2.6 million nonfatal workplace injuries and illnesses, down 8.4% from 2022, the U.S. Bureau of Labor Statistics reported
Nov. 8…
ome of the healthcare subsectors with the highest rates of nonfatal injury or illness per 100 full-time workers are: 
Ambulance services — 7.4
Nursing care facilities (skilled nursing facilities) — 6.9
Continuing care retirement communities and assisted living facilities for the elderly — 6.5 
Psychiatric and substance abuse hospitals — 6.3
General medical and surgical hospitals — 5.1”

Primary care player Forward shutters after raising $400M, rolling out CarePods Primary care player Forward is abruptly shutting down its operations, closing its locations and canceling scheduled visits, the company publicly announced Wednesday.
The company also is shutting down its mobile application effectively immediately, the company said in a post on its website. There was no other information available on the website.”
Comment: It is worthwhile reading the whole article to get an understanding of what Forward did and speculate why it didn’t work.

Medical Board Discipline of Physicians for Spreading Medical Misinformation “Extremely low rates of disciplinary activity for misinformation conduct were observed in this study despite increased salience and medical board warnings since the start of the COVID-19 pandemic about the dangers of physicians spreading falsehoods; these findings suggest a serious disconnect between regulatory guidance and enforcement and call into question the suitability of licensure regulation for combatting physician-spread misinformation.”
See also: State Medical Board Sanctions for Misinformation Should Be Rare

Today's News and Commentary

About health insurance/insurers

Where does each health care dollar go? “Total hospital costs account for 40.7 cents of each dollar, according to AHIP.”
Read the rest of the article for the breakdown of payments.

Justice Department sues UnitedHealth over Amedisys deal The U.S. Justice Department has sued UnitedHealth Group over its planned purchase of home health company Amedisys for $3.3 billion, Bloomberg reported Nov. 12.
According to the report, the lawsuit was filed in a Maryland federal court Nov. 12 and comes over concerns of lessened competition in the home health market. UnitedHealth representatives have met with DOJ officials in recent weeks to make the case for the acquisition.
The lawsuit claims the purchase could increase home healthcare prices across 23 states and in Washington, DC. Maryland, Illinois, New Jersey, and New York attorney generals have also joined the complaint.”

31 health systems dropping Medicare Advantage plans | 2024 FYI

Major payers saw mixed results in Q3. Here's a look at how each fared “Profits in the third quarter shrunk year over year for all but two of the payers included in Fierce Healthcare's review of quarterly earnings reports. Industry juggernaut UnitedHealth Group came out on top yet again with nearly $6.1 billion in profit, up from $5.8 billion.” 

About hospitals and healthcare systemsCHS' $1B divestiture plan  Franklin, Tenn.-based Community Health Systems has completed or lined up multiple hospital sales this year as part of its divestiture plan, which aims to take in about $1 billion this year after offloading hospitals across various markets. 
CHS has sold 29 hospitals since 2020, but its long-term debt still stands at about $11.5 billion, with its debt exposure driving its M&A strategy. Despite recent reductions, CHS still has one of the highest debts among health systems, and remains focused on deleveraging its balance sheet.”

CDC Data: Uninsured Rate In US Steadies At 7.6% “The latest numbers collected from April to June show that about 25.3 million Americans don't have health insurance — numbers consistent with the 2023 all-time low uninsured rate. Nearly 40% of people are insured under public programs like Medicare, Medicaid, CHIP, or military plans.”

About the public’s health

Online Retailer Nonadherence to Age Verification, Shipping, and Flavor Restrictions on E-Cigarettes These results demonstrated pervasive nonadherence to age verification, shipping, and flavored tobacco restrictions among online tobacco retailers.” 

Obesity-Linked Heart Deaths Nearly Tripled in U.S. Over Past Two Decades Key Takeaways

  • Obesity-related heart disease deaths have nearly tripled over the past two decades

  • These deaths increased 2.8-fold between 1999 and 2020

  • Middle-aged men, Black adults, Midwesterners and rural residents are most at risk

About healthcare technology

23andMe shutters cancer drug research programs, lays off 40% of staff “23andMe is shutting down its therapeutics development division and plans to seek out buyers to find a new home for its in-house pipeline of DNA-informed immuno-oncology antibody drugs.
The consumer genetics company said it would lay off more than 200 employees, or about 40% of its workforce, to instead focus on the personalized DNA and ancestry tests that first made it famous as well as its telehealth platforms and the research services it provides for other drugmakers.

Today's News and Commentary

About health insurance/insurers

Cigna not pursuing Humana merger “Cigna directly confirmed that it is not pursuing a merger with Humana.”

About hospitals and healthcare systems

Half of US hospitals have enough IV fluids for 2 weeks “Three-fourths of respondents said Baxter is their facility's main supplier of large-volume fluids. The most common mitigation strategies included converting infused medications to injection or intramuscular administration (71% of respondents), rationing fluids for specific clinical indications (60%) and implementing oral hydration protocols (58%).”

Kaiser Permanente posts $608M operating loss in Q3 “The system said that it continues to experience ‘increased medical expenses due to higher-than-expected utilization of services, patient acuity and pharmacy costs.’ Kaiser also said that its third-quarter performance also included the ‘impact of Medicaid and other true-ups of annual contracts that normally occur earlier in the year.’”

About pharma

Drug at centre of AbbVie's $8.7B deal for Cerevel fails in key schizophrenia studies “The crown jewel in AbbVie's $8.7-billion acquisition of Cerevel Therapeutics failed to live up to expectations in a pair of Phase II studies for schizophrenia, putting the future of the selective M4 muscarinic modulator, dubbed emraclidine, in doubt.”

About the public’s health

RFK Jr. wants to change vaccine practices. Trump may empower him to do it. A good review of the issues.

About healthcare finance 

Astrana Health to acquire part of Prospect Health for $745M “Astrana will acquire Prospect Health Plan, Prospect Medical Groups, Prospect Medical Systems, RightRx and Tustin, Calif.-based Foothill Regional Medical Center under the agreement, according to a Nov. 8 news release.”

Cencora to buy Retina Consultants of America in $4.6B deal to expand specialty services “Drug distributor Cencora plans to buy Retina Consultants of America from Webster Equity Partners in a $4.6 billion deal. 
RCA is a management services organization that operates a network of retina specialists, and the deal will bolster Cencora's specialty drug business.”

Today's News and Commentary

About health insurance/insurers

Health Insurance Coverage: Early Release of Quarterly Estimates From the National Health Interview Survey, 2023–June 2024 FYI

Optum, Aetna agree to settle 'dummy code' lawsuit “Aetna and Optum have agreed to settle a class-action lawsuit that accused the companies of improperly charging administrative fees as medical expenses. 
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.”

Oscar Health’s Obamacare Business Continues To Grow As Trump’s Return Looms “Oscar Health Thursday reported a $54 million third quarter loss despite continued growth, heading into what could be an uncertain political period under Donald Trump and Republicans in Congress.
But those running the provider of individual coverage under the Affordable Care Act say they believe such health insurance, also known as Obamacare, is ‘positioned for long-term growth — appealing to GOP desires for consumer choice and a free market approach,’ Oscar said in a statement accompanying its third quarter earnings report.”

Millions at risk of losing health insurance after Trump's victory “Millions of Americans risk losing subsidies next year that help them pay for health insurance following President-elect Donald Trump’s election win and Republicans’ victory in the Senate.
The subsidies — which expire at the end of 2025 — came out of the 2021 American Rescue Plan, and increased the amount of assistance available to people who want to buy health insurance through the Affordable Care Act. The American Rescue Plan also broadened the number of people eligible for subsidies, extending them to many in the middle class.  
The looming expiration date means that the incoming Congress and next president will need to decide whether to extend them — something Trump and Republicans have already signaled they don’t support, said Chris Meekins, a health policy research analyst at the investment firm Raymond James.”

Payers ranked by Q3 MLRs FYI

About hospitals and healthcare systems

Characteristics of Health Systems Operating Medicare Advantage Plans “Nearly 1 in 7 MA beneficiaries are enrolled in system-operated MA plans, which remain a consistent source of Medicare enrollment. The findings of this study suggest that larger and church-affiliated health systems are associated with a higher likelihood of operating an MA plan. System-operated MA plans were associated with higher quality ratings and patient satisfaction than unaffiliated MA plans. This aligns with prior research suggesting system-operated plans may be more cost-effective, efficient, and of higher quality.” 

About pharma

Pharma giant GSK is quitting BIO in latest setback for the lobbying group GSK is the latest pharmaceutical company to quit this trade organization.

About healthcare IT

Primary Care Practice Telehealth Use and Low-Value Care Services “In this cohort study of Medicare fee-for-service beneficiaries who received care from primary care practices in Michigan, some low-value care services (ie, cervical cancer screening among women older than 65 years and low-value thyroid testing) were lower among practices with high telehealth use, and there was no association between practice-level telehealth use in rates of most other low-value care services not delivered in the office. As telehealth continues to be an important part of care delivery, evaluating how it may encourage or discourage low-value care services is critical to understanding its impact on quality of care.” 

Today's News and Commentary

About health insurance/insurers

Payers ranked by Q3 profits The nation's largest payers have filed their third-quarter earnings reports, revealing which recorded the largest profits.
Payers ranked by Q3 profits:
UnitedHealth Group: $6.1 billion, up 3.7%
Elevance Health: $1 billion, down 21%
Cigna Group: $739 million, down 47.5%
Centene: $713 million, up 52%
Humana: $480 million, down 42%
CVS Health: $87 million, down 96%”

About hospitals and healthcare systems

General Catalyst to acquire Summa Health for $485M “Summa Health comprises multiple hospitals, community medical centers, a health plan, an accountable care organization, a multi-specialty physician organization, research and the Summa Health Foundation.”
 Akron, Ohio-based Summa Health has reached a $485 million definitive agreement to join Health Assurance Transformation Corp.[HATCo], according to a Nov. 7 news release. ..
The parties shared plans for HATCo to purchase Summa Health in January, with plans to close the deal by the end of 2024. 
Under the agreement, the $485 million purchase amount will help Summa Health, which will transition into a for-profit structure, pay off $850 million in debt. Summa Health's remaining cash will fund a new, separately governed community foundation to support community investment in the Akron area.”

About pharma

GoodRx, PBMs accused of suppressing reimbursements “GoodRx and pharmacy benefit managers CVS Caremark, Express Scripts, MedImpact and Navitus Health Solutions are facing class-action lawsuits accusing them of colluding to suppress reimbursements to independent pharmacies for generic drug prescriptions. 
Three lawsuits were filed last week, with the first filed by Minnesota-based Keaveny Drug in federal court in California on Oct. 30. A second class-action lawsuit was filed Nov. 1 by Michigan's Community Care Pharmacy in the same court, and the third lawsuit was filed the same day by Pennsylvania's Old Baltimore Pike Apothecary and Smith's Pharmacy in federal court in Rhode Island. 
The lawsuits claim that starting in 2023, GoodRx partnered with PBMs to reroute patient prescriptions to whichever PBM offered the lowest price for generics, bypassing the patient's designated PBM. Pharmacies are charged a fee for these transactions, which is split among PBMs, but receive no reimbursements from dispensing the drugs, which result in financial losses for independent pharmacies…”

Acadia pockets $100M from paediatric voucher sale After scoring the first FDA approval for a Rett syndrome treatment last year, Acadia Pharmaceuticals has now sold the rare paediatric disease priority review voucher it gained along with the greenlight. Acadia said the voucher sold for $150 million, but did not disclose the buyer.  The drug developer will only profit $100 million off the sale, however, as Neuren Pharmaceuticals — from whom Acadia gained North American rights for Daybue — is entitled to one-third, or $50 million, of the proceeds.”

FDA Updates GLP-1 Label With Pulmonary Aspiration Warning “On November 5, the US Food and Drug Administration (FDA) updated the labels for all glucagon-like peptide 1 receptor agonists (GLP-1 RA) with a warning about pulmonary aspiration during general anesthesia or deep sedation. The affected drugs are semaglutide (Ozempic, Rybelsus, Wegovy); liraglutide (Saxenda, Victoza); and the dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 tirzepatide (Mounjaro, Zepbound).”

About healthcare IT

CMS finalizes telehealth pay changes: 5 notes FYI 

About healthcare technology

VHA2024 STATE OF INNOVATION REPORT FYI- Annual update on innovation in the Veteran’s Health Administration. 

About healthcare personnel

Patient Travel Patterns and Concordance With Geographic Market Boundaries  Among physician visits, the median travel time was 12.7 minutes (IQR, 7.0 to 22.3 minutes) for primary care and 17.1 minutes (IQR, 9.5 to 30.8 minutes) for specialty care. Median travel time was longer for patients living outside metropolitan statistical areas (MSAs), especially for specialty care (15.9 minutes inside vs. 41.8 minutes outside MSAs). For ED visits, the median travel time was 13.6 minutes (IQR, 7.5 to 24.2 minutes).”

Today's News and Commentary

THE ELECTION

Unlike immigration and economic issues (like tariffs and taxes), healthcare per se is not at the top of Trump’s to-do list; whom he appoints is more likely to influence policy. That said, below are a few thoughts about likely changes in the next few years.
1.        Antitrust.
Efforts at controlling mergers and acquisitions will be minimized. We are more likely in the next 4 years to see more combinations of insurance companies and provider organizations.
2.        Medicare.
While Trump denies connections with Project 2025, I believe he will adopt its suggestion to expand private Medicare options, like Advantage Plans. Today, shares of companies in that space have already soared.
3.        Medicaid.
As with his last term, consideration again will be given to other payment forms, such as block grants or capitation. More likely will be a federal enactment of a work requirement as a condition to receive benefits.
4.        Pharma
While Trump has vowed to repeal the IRA, he will continue to address drug prices. Previously, he said he wanted to implement a “most favored nations” program for pricing. Other possibilities include market basket calculations or even methods the Biden administration is currently using.
5.        ACA
This issue is the biggest wildcard.  During his debate with Harris, he says he is working on a plan. In his last term, tried to repeal it.
However, since his last term, the provision of health insurance through the ACA has become more popular; 62% of the population have a favorable opinion. It is therefore difficult to imagine a major change that would upset the electorate. The next national election is in 2 years and healthcare could be a major issue if the ACA is repealed or changed in a significant way.
6.        Public health
As I mentioned in my Blog on Monday, the public health changes could be disastrous. Trump said he would let RFK, Jr “go wild.”
Deleterious changes could range from removal of fluoride in the water to weakening of vaccine policies.
7.        Abortion
Trump promised there would not be a national abortion policy; rather, he said decisions should be left to the states. Republicans believed that many states would choose very strict rules or outright prohibition. However, most states, even conservative ones, have chosen more liberal legalization provisions. These actions might cause Trump to change his mind- especially with a Republican-controlled Congress.
8.        The Supreme Court
While not strictly a healthcare topic, its decisions have significantly affected healthcare laws (even beyond Roe v. Wade). For example, yesterday the Court heard arguments concerning Disproportionate Share Hospital payments. In the next four years, it is unlikely any of the justices will retire. However, if there are health issues, a Republican Senate would approve a conservative justice to replace a more liberal one or a much younger conservative to replace Justices such as Thomas or Alito.

Here are a few ballot item updates: Which healthcare ballot measures passed?  

About hospitals and healthcare systems

Intensity of the IV Fluid Shortage at US Hospitals Remains Very High “Baxter is posting regular updates on its website as North Cove recovers gradually. The latest update, dated Oct. 31, says a key production line has restarted and that the earliest shipments from the facility will happen in late November — ahead of original estimates.”

Today's News and Commentary

About pharma

Survey: 50% of Active Drug Shortages in the United States Persist for 2 or More Years “Although the number of active shortages decreased to 277 in the second quarter of 2024 from an all-time high of 323 in the second quarter of 2023, 50% of the active shortages in the United States persisted for 2 or more years, as reported by the American Society of Health-System Pharmacists. Furthermore, the report shows that 95 new drug shortages, 48% of which are injectables, were identified in 2024.” 

Kroger Finalizes $1.37 Billion Opioid Crisis Settlement “Kroger finalized a $1.37 billion settlement in connection with the grocery chain’s role in the U.S. opioid crisis…
Kroger also agreed to injunctive relief that requires its pharmacies to monitor, report and share data about suspicious activity related to opioid prescriptions, according to the settlement.”

Walgreens to pay $100M to resolve lawsuit over generic drug pricing “Walgreens has agreed to pay $100 million to settle a proposed class action lawsuit accusing it of fraudulently overcharging customers for a decade when they bought generic drugs through private insurance, Medicare or Medicaid.
Walgreens was accused of wrongly requiring insured customers to pay more than members of its Prescription Savings Club, who for a low annual fee could buy more than 500 widely prescribed generic drugs for $5, $10 and $15 for 30-day prescriptions, and $10, $20 and $30 for 90-day prescriptions without using insurance.”

America’s Most Popular Drugs by Dollars Spent See the chart- Ozembic/WeGovy [semiglutide versions] are at the top.

Transparency Shocker: Biosimilars Are Getting Cheaper—But Hospitals and Insurers Can Make Them Expensive “We focused our analysis on Avastin (bevacizumab) and its two largest biosimilar competitors.” See the chart.

About the public’s health

Trump might target fluoride in tap water. Here’s what the science says. See yesterday’s Blog. This potential action is another assault on evidence-based public health practice.  

About healthcare IT

Majority of cyberattacks are through third-party vendors “ The vast majority of cybersecurity risks and breaches are from third-party vendors and other organizations, said experts John Riggi and Richard Staynings during the closing keynote of the HIMSS Healthcare Cybersecurity Forum on Friday.
The numbers have grown from 27 million people affected in 2020 to the 150 million affected by the Change Healthcare ransomware attack in February, according to Riggi, former FBI special agent and national advisor for Cybersecurity and Risk, American Hospital Association.” 

Today's News and Commentary

About health insurance/insurers

CMS finalizes 2.9% pay increase for outpatient facilities, ASCs, with new maternal health mandates “Under a final rule issued by the Centers for Medicare and Medicaid Services, hospital outpatient facilities and ambulatory surgical centers will get a 2.9% Medicare pay increase next year, up from the 2.6% boost in reimbursement that was floated in the draft rule.
 Here is access to the full “unpublished document (scheduled for release 11/29/24)
Here is the CMS Fact Sheet.

Doctors, facing another pay cut in 2025, call for permanent Medicare payment reform “The Centers for Medicare and Medicaid Services (CMS) is moving forward with a 2.9% cut to physician payments in 2025 despite protest from major industry groups.
CMS announced Friday it finalized the calendar year 2025 Medicare Physician Fee Schedule rule that sets payment rates for next year and also outlines new policies focused on primary care, preserved telehealth flexibilities and a strengthened Medicare Shared Savings Program (MSSP). A CMS fact sheet on the rule outlines the key provisions.”

As ACA sign ups start, more Americans have health insurance than ever. Will it last? “More than 21 million Americans buy their health insurance through the Affordable Care Act, and open enrollment for next year’s Obamacare plans started Friday, Nov. 1…
This year, premiums are still very affordable — for many people, premiums are $10 or less per month — and there are more plan options than ever…
One group that’s newly eligible for these subsidized marketplace plans is Deferred Action for Childhood Arrivals recipients, also known as Dreamers. Secretary Becerra says that an estimated 100,000 DACA recipients are expected to enroll…
Also new in 2025 is a rule that allows low income people to enroll in a marketplace health plan at any time of the year, not just during fall’s open enrollment period. That mirrors how enrollment works for Medicaid, the public health insurance program for people with low incomes.
Insurance companies will also have to follow new limits on how long patients should have to wait to get a doctor’s appointment.”

Maryland is the first state to sign into new federal health care program “Maryland became the first state on Friday to join a federal program designed to improve health care quality and equity while lowering costs for all health care payers, including Medicare, Medicaid and private insurers.
It builds on Maryland’s Total Cost of Care Model, which sets a per capita limit on Medicare’s total cost of care in Maryland and encompasses the state’s unique all-payer hospital payment system, which reduces per capita hospital expenditures and supports improved health outcomes, as encouraged by the Affordable Care Act.
This new federal framework, known as the AHEAD model, has been designed to deliver high-quality health care through greater coordination, with a focus on health equity and social needs to support underserved patients.”

Medicare Advantage Plans With High Numbers Of Veterans: Enrollment, Utilization, And Potential Wasteful Spending “Medicare Advantage (MA) plans are increasingly enrolling veterans. Because MA plans receive full capitated payments regardless of whether or not veterans use Medicare services, the federal government can incur substantial duplicative, wasteful spending if veterans in MA plans predominantly seek care through the Veterans Health Administration (VHA) system. The recent growth of MA plans that disproportionately enroll veterans could further exacerbate such wasteful spending. Using national data, we found that veterans increasingly enrolled in MA between 2016 and 2022, including in a growing number of MA plans in which 20 percent or more of the enrollees were veterans. Notably, about one in five VHA enrollees in these high-veteran MA plans did not incur any Medicare services paid by MA within a given year—a rate 2.5 times that of VHA enrollees in other MA plans and 5.7 times that of the general MA population. Meanwhile, VHA enrollees in high-veteran MA plans were significantly more likely to receive VHA-funded care. In 2020, the Centers for Medicare and Medicaid Services paid more than $1.32 billion to MA plans for VHA enrollees who did not use any Medicare services, with 19.1 percent going to high-veteran MA plans.[Emphasis added]

Expected Out-Of-Pocket Costs: Comparing Medicare Advantage With Fee-For-Service Medicare “We compared the generosity of Medicare plans in terms of out-of-pocket costs attributable to cost sharing and premiums, including both basic and supplemental services. From 2014 through 2019, projected out-of-pocket costs for a typical enrollee were 18–24 percent lower in Medicare Advantage than traditional fee-for-service Medicare.”

Health Benefits In 2024: Higher Premiums Persist, Employer Strategies For GLP-1 Coverage And Family-Building Benefits “In 2024, the average annual premium for employer-sponsored family health coverage was $25,572, an increase of $1,604 (7 percent) from 2023. Over the course of the past five years, the average family premium has increased 24 percent, which is similar to growth seen in inflation (23 percent) and wages (28 percent). On average, covered workers contributed 16 percent ($1,368) of the cost of single coverage and 25 percent ($6,296) of the cost of family coverage. The average general annual deductible for single coverage for workers with a deductible was $1,787, similar to that in recent years but 47 percent higher than a decade ago. In 2024, 18 percent of large firms offering health benefits, including 28 percent of those with 5,000 or more employees, covered GLP-1 antagonists for weight loss. Large employers were more likely to perceive their overall provider networks as broader than their networks for mental health and substance use conditions.”

About hospitals and healthcare systems

US Nonprofit Hospitals Have Widely Varying Criteria To Decide Who Qualifies For Free And Discounted Charity Care Among hospitals that offered free care, income limits ranged from 41 percent to 600 percent of the federal poverty guideline. Many hospitals considered assets when determining eligibility for charity care, and a significant minority also had residency requirements and restrictions for insured patients. Hospitals generally allowed charity care in cases of hardship, with a median cutoff of a given hospital bill being 20 percent of the patient’s income. Hospitals in counties with lower levels of poverty and uninsurance had more generous eligibility policies. The wide variation in requirements for hospital financial assistance poses barriers to equitable access to care.”

Days of cash on hand at 35 health systems “Median days cash on hand dipped to a 10-year low for U.S. hospitals and health systems, according to an Aug. 7 S&P Global Ratings' report.
For the first time in the last decade, average days cash on hand dropped below 200 to 196.8, according to the report. The upper half of U.S.-based nonprofit acute healthcare providers reported an average of 292 days while the lower half reported 128 days on average.”

About pharma

What really happens to drug prices when patents expire  A great video explaining why prices do not come down when patents are expected to expire.

About the public’s health

COVID vaccine removed from Idaho district county health clinics: 5 things to know “The Southwest District Health Board voted 4-3 to remove COVID-19 vaccines from its facilities after receiving around 300 public comments urging the removal. The decision was followed by anti-vaccine presentations from multiple doctors widely accused of spreading misinformation, the outlet reported….
The removal marks the first instance in the U.S. where a health department is restricted from offering the COVID-19 vaccine.”
Comment: BELIEVE POLITICAL CANDIDATES WHEN THEY SAY THEY WILL REMOVE VACCINATIONS!

In a related article: Florida surgeon general who warned against vaccines may lead HHS under Trump “Florida’s top health official, whose tenure has been marked by his warnings against vaccines, threats to TV stations for running abortion ads and frequent clashes with public health experts, has emerged as a candidate to run the Department of Health and Human Services in a potential Trump administration, according to two people familiar with the process.”

Today's News and Commentary

About health insurance/insurers

Evaluation of Low-Value Services [LVS] Across Major Medicare Advantage Insurers and Traditional Medicare “In this cross-sectional study of nearly 6 million Medicare beneficiaries, utilization of LVS was on average lower among MA beneficiaries compared with TM beneficiaries, possibly owing to stronger financial incentives in MA to reduce LVS; however, meaningful differences existed across some of the largest MA insurers, suggesting that MA insurers may have variable ability to influence LVS reduction.” 
In a related article:
Higher MA enrollment linked to lower Medicare spending: report
“Medicare Advantage’s popularity is associated with lower total Medicare spending, a new report from Elevance Health finds.
Medicare spending was $431 billion less from 2010 to 2020 than the Congressional Budget Office predicted, and the overestimations were due to spending per enrollee. More than 32 million people, or 54% of the eligible Medicare population, are enrolled in an MA plan.
This trend is most noticeable geographically in midwestern and southern counties, researchers explained, but a weaker association is evident in northwest and western counties.
A 10% percent higher MA penetration in a county points to a 1.9% decrease in Medicare spending, correlating to a $204 decrease in per person spending. This resulted in up to $144 billion cumulative savings from 2012 to 2021.”

The Curious Persistence of Site-Dependent Payments Worth reading the entire article. “Despite the overwhelming bipartisan vote in the House (the bill passed with 320 votes to 71) and the US Congressional Budget Office’s estimate that site-neutral drug payments would save more than $3.7 billion over 10 years, the bill’s enactment by the US Senate remains uncertain because of aggressive lobbying from hospital interests…
Recent evidence, in fact, illustrates that the nation’s largest purchasers of health care—employers that purchase health insurance on behalf of employees (collectively, 178 million people or 54% of the US population and >80% of the privately insured)—are not exercising their preferences, intelligence, and purchasing power as much as rational models would estimate.”

About hospitals and healthcare systems

CMS' hospital capacity reporting rule takes effect “Beginning Nov. 1, CMS will require hospitals to report admission information related to respiratory illnesses, including capacity, to the CDC. The new rule reinstates some pandemic-era requirements that have been voluntary since May 1.” 

About pharma

Using Bayh-Dole Act March-In Rights to Lower US Drug Prices “In this cross-sectional study of drugs approved by the Food and Drug Administration (FDA) with patents listed in the FDA’s Orange Book from 1985 to 2023, the share of drugs where all patents were subject to march-in was 2% for new molecular entities approved between 1985 and 2022, 1% for all new drug applications (NDAs) ever listing a patent in the Orange Book, and 1% for all NDAs on patents in 2023.
Meaning  The findings suggest that few drugs have solely march-in–eligible patents, so the overall effect of march-in on removing patent barriers to competition would be limited.”

About the public’s health

Exposure to sugar rationing in the first 1000 days of life protected against chronic disease “We examined the impact of sugar exposure within 1000 days since conception on diabetes and hypertension, leveraging quasi-experimental variation from the end of the United Kingdom’s sugar rationing in September 1953. Rationing restricted sugar intake to levels within current dietary guidelines, yet consumption nearly doubled immediately post-rationing. Using an event study design with UK Biobank data comparing adults conceived just before or after rationing ended, we found that early-life rationing reduced diabetes and hypertension risk by about 35% and 20%, respectively, and delayed disease onset by 4 and 2 years. Protection was evident with in-utero exposure and increased with postnatal sugar restriction, especially after six months when solid foods likely began. In-utero sugar rationing alone accounted for about one third of the risk reduction.”

Extreme heat set records for health perils in 2023  “Heat-related deaths last year in people over age 65 increased by 167% globally above levels seen in the 1990s — nearly three times more than what would have been expected if temperatures had not changed.

  • People were also exposed to an average of 1,512 hours of high temperatures that posed at least a moderate risk of heat stress when doing light exercise such as walking or cycling — a 27.7% increase on the 1990-1999 yearly average.

  • Conditions were ripe for the spread of more deadly mosquito-borne infectious diseases, with dengue cases reaching an all-time high of over 5 million infections reported in more than 80 countries and territories in 2023.

  • On a more positive note, the report found deaths from fossil fuel-derived air pollution fell almost 7% from 2016 to 2021, with most of this decline due to efforts to reduce pollution from coal burning.

About healthcare technology

Baxter restarts IV solutions manufacturing line at hurricane-hit facility “Medical device maker Baxter International said on Thursday it has restarted the highest-throughput intravenous solutions manufacturing line at its North Carolina facility, which was impacted by hurricane-related flooding.
The North Cove facility was temporarily closed last month due to flooding caused by Hurricane Helene. The plant makes 60% of the United States' supply of IV fluids and peritoneal dialysis (PD) solutions, according to the American Hospital Association.

AI Colonoscopies: More Benign Lesion Removals, Potentially Higher Costs “Use of artificial intelligence (AI)-assisted colonoscopy led to a greater removal rate of exclusively benign lesions compared with colonoscopies that did not use AI, according to data analyzed from a previous single-center prospective study.
About a third more polypectomies were performed only for benign lesions in the AI-assisted colonoscopy group than in an unassisted historical cohort (12.4% vs 8.4%, P=0.04), reported Tessa Herman, MD, of the University of Minnesota and Minneapolis VA Health Care System, at the annual meeting of the American College of Gastroenterology in Philadelphia.”

About healthcare finance

Francisco Partners plans to buy medical software company AdvancedMD for $1.1B “Private equity firm Francisco Partners plans to buy medical software company AdvancedMD from Global Payments for $1.125 billion dollars, the companies announced Wednesday.
Global Payments, which sells payment technology and software solutions, bought the health tech company from investment firm Marlin Equity Partners in 2018 in a transaction valued at $700 million.
The company reported in a filing with the U.S. Securities and Exchange Commission that the transaction is valued at $1.125 billion and is expected to close this quarter.”

Today's News and Commentary

About health insurance/insurers

States ranked by average ACA benchmark premium FYI.
Comment: In addition to differing out-of-pocket exmpnses, yhese figures help explain the different opinions about the affordability of ACA plans.

About pharma

CVS is expanding its MinuteClinics into primary care. Here's why “In a bid to ease access challenges, CVS Health will offer in-network primary care to Aetna members in certain markets through its MinuteClinics.
The services are available to certain individual plan and commercial members in Houston, San Antonio and greater Atlanta, with an eye on future expansion. There are about 1,100 MinuteClinics across the country, with the walk-in retail health clinics located at CVS pharmacies.”
Comment: How is this program different from the failing VillageMD and OakStreet ventures?
In a related article: Cigna posts $739M in Q3 profit despite taking a $1B hit from VillageMD investment

Teva fined $503 million for disparaging a rival and using patents to thwart competition “Teva Pharmaceutical, the world’s largest generic drugmaker, was fined $503 million by European antitrust regulators for delaying competition to a blockbuster multiple sclerosis medicine.
The European Commission found the company had artificially extended the patent protection of Copaxone and systematically spread misleading information about a rival product. The decision follows an investigation opened three years ago, which marked the first time the EC probed potential antitrust abuses stemming from patent procedures as well as disparaging competing products.”

About the public’s health

N95 Filtering Facepiece Respirator Reuse, Extended Use, and Filtration Efficiency “We found the number of shifts of reuse and respirator model were associated with reduced FE. While associated with minimal reduction in FE after 1 shift, after 3 shifts almost one-third of respirators did not filter 95% of particles. This reduction in FE differed by filtering facepiece respirator model.”

You may not need to throw out those ‘expired’ Covid-19 home tests “t may be tempting to throw away those tests or other Covid-19 home test kits that are labeled near their expiration dates, but the US Food and Drug Administration is encouraging people to check its website for extensions before possibly throwing away perfectly good tests.”

About healthcare IT

Teladoc CEO emphasizes course corrections as Q3 revenue, earnings beat the Street “In the Q3 earnings call, Teladoc executives stressed the stability of the U.S. virtual care segment, which has gained millions of users since last year. It called BetterHelp a "company in transition," as the company pivots hard to offset the cost of a $790 million impairment charge in the second quarter.
BetterHelp, Teladoc's virtual mental health solution, continue to drag down its performance as the segment's revenue fell 10% year-over-year, coming in at $256.8 million in Q3.”

Large Language Model Influence on Diagnostic Reasoning “In a randomized clinical trial including 50 physicians, the use of an LLM did not significantly enhance diagnostic reasoning performance compared with the availability of only conventional resources.”

Today's News and Commentary

About health insurance/insurers

MSSP ACOs save Medicare $2.1B in 2023, the largest savings in program history “Accountable care organizations saved Medicare $2.1 billion, the largest yearly savings in program history, in 2023, the Centers for Medicare & Medicaid Services (CMS) revealed Tuesday.
The results come from the Medicare Shared Savings Program (MSSP), which saved a net $1.8 billion in 2022, at the time the second-highest annual savings.”

What 10 Medicare Advantage insurers earn from health risk assessments FYI

.Humana updates guidance as it beats on revenue, profit in Q3 “The company said in the second quarter that it anticipated full-year earnings per share of ‘approximately $16’ but now expects ‘at least $16,’ a slight bump amid a year of significant challenges in the Medicare Advantage space. Humana also reaffirmed that it expects a full-year medical loss ratio of about 90%, according to its earnings report released Wednesday.”

Mike Johnson vows major changes to Affordable Care Act if Trump wins election ““No Obamacare?” an attendee asked the speaker, invoking the term popularized by Republicans to describe the health law.
’No Obamacare,’ Johnson responded. ‘The ACA is so deeply ingrained, we need massive reform to make this work, and we got a lot of ideas on how to do that.’”

About hospitals and healthcare systems

Hospital service prices have surged at twice the rate of inflation since 2000 “Hospital service prices increased by more than 220% between 2000 and 2022, which was more than twice the rate of inflation and that of other medical services. “

About the public’s health

Extreme heat set records for health perils in 2023Heat-related deaths last year in people over age 65 increased by 167% globally above levels seen in the 1990s — nearly three times more than what would have been expected if temperatures had not changed.
People were also exposed to an average of 1,512 hours of high temperatures that posed at least a moderate risk of heat stress when doing light exercise such as walking or cycling — a 27.7% increase on the 1990-1999 yearly average.
Conditions were ripe for the spread of more deadly mosquito-borne infectious diseases, with dengue cases reaching an all-time high of over 5 million infections reported in more than 80 countries and territories in 2023.
On a more positive note, the report found deaths from fossil fuel-derived air pollution fell almost 7% from 2016 to 2021, with most of this decline due to efforts to reduce pollution from coal burning.”

Discrimination may cause gut inflammation, digestive woes, study says “Discrimination -- prejudiced actions toward people based on their identity -- may cause stress that impairs gut health and lead to the growth of unhealthy bacteria that promote inflammation, a new study has found.
The study was published… in Frontiers in Microbiology.”

WHO report shows global tuberculosis cases are rising “Tuberculosis (TB) is on the rise and has once again overtaken COVID-19 as the world's leading infectious disease killer, according to the latest report from the World Health Organization (WHO).
The Global Tuberculosis Report 2024, released today, shows 8.2 million people were newly diagnosed with TB in 2023, a figure that represents the highest number of TB cases recorded by the WHO since it began global TB monitoring in 1995. It also marks a significant increase from the 7.5 million new TB cases reported in 2022.”

Comparing Deaths from Gun Violence in the U.S. with Other Countries 
“Highlights

  • Globally, the U.S. ranks at the 93rd percentile for overall firearm mortality, 92nd percentile for children and teens, and 96th percentile for women.

  • The U.S. has among the highest overall firearm mortality rates, as well as among the highest firearm mortality rates for children, adolescents, and women, both globally and among high-income countries.

  • Nearly all U.S. states have a higher firearm mortality rate than most other countries. Death rates due to physical violence by firearm in U.S. states are closer to rates seen in countries experiencing active conflict.

  • Black and American Indian and Alaska Native (AIAN) people have the highest firearm mortality rates of any racial or ethnic group. “

 About healthcare IT

Large Language Model Influence on Diagnostic Reasoning “In a randomized clinical trial including 50 physicians, the use of an LLM did not significantly enhance diagnostic reasoning performance compared with the availability of only conventional resources.”

About healthcare personnel

A quiet driver of the nurse shortage, explained “In a nutshell, the average age of nursing faculty is between 48.6 and 62.5 years old, and one-third of nursing faculty who teach are expected to retire by 2025. Add in the stress of COVID-19 and the lack of clinical opportunities during that time, and a crisis is intensifying. 
In surveys conducted by nurse organizations, nurse faculty cite these three things as reasons not to teach:

  1. Salary gap. Educators in the field are required to have advanced degrees yet typically take pay cuts of as much as $40,000 when leaving clinical practice to teach full-time.

  2. Burnout left over from the pandemic. One academic study showed the highest contributing factor to burnout for nurse educators is high workload levels and lack of work-life balance. 

  3. Requirement for doctoral degrees. Experienced nurses may be reluctant to invest additional years and resources into advanced education while simultaneously accepting lower compensation.

Compounding the problem is it is proving difficult to find new faculty to replace the large number of Baby Boomers retiring.”  

About health technology  

37 best healthcare inventions of '24, per Time FYI. This article is a curated healthcare list from all categories in a Time report of best inventions of 2024.

National Academies calls to change how biomedical research uses race and ethnicity “Race and ethnicity are applied in inappropriate and even harmful ways in biomedical research, the National Academies of Science, Engineering, and Medicine said in a report issued Wednesday, calling on scientists, research funders, and publishers to transform the way they use — and don’t use — the categories in research.”

Today's News and Commentary

6 races to watch that could shape health care policy FYI

About health insurance/insurers

Healthcare billing fraud: 10 recent cases Note the preponderance of federal programs being defrauded.

About hospitals and healthcare systems

23 systems delaying surgeries amid the IV shortage FYI 

About pharma

Walgreens expands virtual healthcare services to 30 states, adds lab test orders and virtual STD treatments “Walgreens Virtual Healthcare is available in 30 states, up from its initial launch in nine states. This expansion aims to increase access to fast, reliable and affordable healthcare from the comfort of home by allowing patients to connect with doctors and nurse practitioners via virtual consultations, either through chat or video.”
Comment: This expansion is despite retrenchment of its VillageMD business. 

Wegovy users drop $80,000 on plastic surgery to shed extra skin “Patients taking Wegovy, Zepbound and other new weight-loss drugs are finding that after losing 50 pounds, their skin sags over their stomachs, arms and buttocks. In the face and chest, the loss of elasticity can make someone look much older than they actually are or give a hollowed-out appearance that’s been dubbed “Ozempic face.”
This has turned into a gold mine for plastic surgeons.”

About the public’s health

Digital Hypertension Management Solutions “The solutions reviewed in this report were grouped on the basis of their approach to guiding clinician and patient actions:
1 Blood Pressure Monitoring solutions extend existing hypertension care beyond the clinical office by supporting patients’ home monitoring and delivering data back to the healthcare provider. Companies with solutions in this approach include AMC Health, Health Recovery Solutions (HRS), and VitalSight (Omron Healthcare).
2Medication Management solutions employ dedicated, virtual care teams to coordinate patients’ medication adjustments as a supplement to the patient’s main primary care team. Companies with solutions in this approach include Cadence, Ochsner Digital Medicine, and Story Health.
3 Behavior Change solutions deliver educational content, alerts, reminders, and virtual interactions with coaches (digital or human) or care teams to improvepatient’s self-management of their hypertension. Companies with solutions in this approach include DarioHealth, Hello Heart, Lark, Omada Health, and Teladoc Health (Livongo)…
Medication Management: Creating dedicated care teams to help adjust prescribing, the Medication Management approach has the highest quality evidence showing clinically meaningful improvements in SBP that are achieved more rapidly than with usual care. The review concluded that these solutions increase net health spending in the initial three-year budget window, but — because hypertension risks accrue over the long term — they have the potential to offset costs over a decade because of savings from avoided cardiovascular events…
Behavior Change approach provides limited incremental benefit in SBP compared with usual care.”

Mortality Rates From Early-Onset CRC Have Risen Considerably Over Last Two Decades “The mortality rate of early-onset colorectal cancer (EO-CRC) has increased considerably across the United States over the past two decades, with the effects most pronounced in those aged 20-44 years, according to a new analysis of the two largest US mortality databases…
Furthermore, the researchers reported that increased mortality occurred across all patients included in the study (aged 20-54) regardless of tumor stage at diagnosis.”

Health Literacy: How Well Can Older Adults Find, Understand, and Use Health Information?Key Findings
20% of older adults are not confident they can identify health / medical misinformation.
—74% of adults age 50 and over would have very little or no trust in health information generated by artificial intelligence (AI)”

Today's News and Commentary

 About pharma

Greater Access to New Weight Loss Meds Could Save More Than 40,000 Lives Per Year “Making the drugs available to all obese people and overweight type 2 diabetics could save more than 42,000 American lives annually.”
About 45% of the U.S. adult population is eligible to take the weight-loss drugs by those standards.”

Why Does an $84,000 Drug in the U.S. Cost Less Than $1,000 in India An excellent article in Forbes reviews the relevant issues.

About healthcare IT

100M people impacted by massive Change Healthcare cyberattack: OCR “UnitedHealth Group has officially disclosed that 100 million people were affected by the massive cyberattack on Change Healthcare earlier this year.” 

About healthcare finance

AbbVie inks $1.4B Aliada buyout, landing ex-J&J Alzheimer's drug to leap the blood-brain barrier “AbbVie has agreed to pay $1.4 billion to buy Aliada Therapeutics. The acquisition will give AbbVie control of an Alzheimer’s disease drug candidate Aliada in-licensed from Johnson & Johnson to try to improve on the first generation of anti-amyloid-beta antibodies.
Aliada is developing an antibody that binds to pyroglutamate amyloid beta, a form of the peptide found in the brains of people with Alzheimer’s.”

Today's News and Commentary

About health insurance/insurers

1 million+ patients lose coverage as insurers, hospitals drop Medicare Advantage “…this year, as Medicare’s open enrollment season kicks off, more than 1 million patients will have to shop for new health insurance. Facing financial and federal regulatory pressures, many insurers are pulling their Medicare Advantage plans from counties and states they’ve deemed unprofitable. Meanwhile, large health systems in states including Alabama, Minnesota and Vermont have cut ties with some Medicare Advantage plans.”

Doc groups target alleged center of insurers' price-fixing 'cartel' in lawsuit “The American Medical Association and the Illinois State Medical Society say MultiPlan, a data analytics agency for health plans, is at the center of a price-fixing "cartel" with commercial health insurers.
In a lawsuit filed yesterday in U.S. District Court for the Northern District of Illinois, the Chicago-based associations say New York-based MultiPlan has undercut fair payment for out-of-network health care services and eliminated market competition.”

About hospitals and healthcare systems

The only 17 hospitals to earn Magnet's top honor FYI

  About health technology

Baxter International to restart highest-throughput IV solutions manufacturing line next week “Initial batches will be manufactured concurrently with ongoing quality activities and would only be released in accordance with applicable regulatory requirements to ensure the quality and safety of the products, the company said on its hurricane update page Thursday.” 

Today's News and Commentary

About health insurance/insurers

Medicare Advantage: Questionable Use of Health Risk Assessments [HRA] Continues To Drive Up Payments to Plans by Billions What OIG Found
Diagnoses reported only on enrollees’ HRAs and HRA-linked chart reviews, and not on any other 2022 service records, resulted in an estimated $7.5 billion in MA risk-adjusted payments for 2023.
The lack of any other followup visits, procedures, tests, or supplies for these diagnoses in the MA encounter data for 1.7 million MA enrollees raises concerns that either: (1) the diagnoses are inaccurate and thus the payments are improper or (2) enrollees did not receive needed care for serious conditions reported only on HRAs or HRA-linked chart reviews.
In-home HRAs and HRA-linked chart reviews generated almost two-thirds of the estimated $7.5 billion in risk-adjusted payments. In-home HRAs and HRA-linked chart reviews may be more vulnerable to misuse because these tools are often administered by MA companies or their third-party vendors and not enrollees’ own providers. Diagnoses reported only on these types of records heighten concerns about the validity of the diagnoses or the coordination of care for MA enrollees.
Just 20 MA companies drove 80 percent of the estimated $7.5 billion in payments. Also, these MA companies generated a substantially greater share of payments resulting from HRAs or HRA-linked chart reviews for certain health conditions, including serious and chronic illnesses, such as diabetes and congestive heart failure.”
UnitedHealth Group accounted for $3.7 billion of the questionable payments. See the full report as well.

CMS lifts enrollment suspension on UnitedHealthcare Medicare Advantage plan “CMS has lifted an enrollment suspension on a UnitedHealthcare subsidiary's Medicare Advantage plan following three years of not meeting the required 85% medical loss ratio.”

Results from an Annual Medicaid Budget Survey for State Fiscal Years 2024 and 2025 Exerpted highlights from this KFF report:
”PROVIDER RATES AND MANAGED CARE
--States had implemented (in FY 2024) and were planning (in FY 2025) a wide range of fee-for-service (FFS) rate increases across provider types and very few states were implementing rate restrictions. More than half of states (26 states) reported increasing both inpatient and outpatient hospital FFS base rates in FY 2024, and many states reported increases in both hospital FFS base rates and total non-DSH supplemental payments.
--About two-thirds of responding MCO states (25 of 41) reported seeking CMS approval for a capitation rate amendment to address shifts in the average risk profile (or “acuity”) of MCO members in FY 2024 and/or FY 2025.
BENEFITS AND PRESCRIPTION DRUGS
--Most states continue to implement benefit enhancements, particularly for mental health and/or substance use disorder (SUD) services.  and mortality and addressing racial/ethnic health disparities.
--Twelve state Medicaid programs reported covering GLP-1s (glucagon-like peptide-1s) when prescribed for the treatment of obesity, under FFS as of July 1, 2024.
SOCIAL DETERMINANTS OF HEALTH AND REDUCING HEALTH DISPARITIES
--A number of states are expanding or enhancing Medicaid coverage to help address enrollee social determinants of health (SDOH) or associated health-related social needs (HRSN). 
--States are implementing strategies to reduce racial and ethnic health disparities, including through changes in managed care contracts. 
--States may also tie MCO financial quality incentives to reducing health disparities. About one-third of states reported at least one MCO financial incentive tied to reducing racial/ethnic disparities in place in FY 2024, most commonly linking capitation withholds or pay for performance incentives to improving health disparities.”

About hospitals and healthcare systems

Celebrating Excellence: Healthgrades Names Leading Hospitals for Specialty Care in 2025  FYI.

Sanford, Marshfield Clinic to create 56-hospital system “The integration is expected to close by the end of 2024, with the parties remaining separate, independent organizations ahead of closing.” 

About pharma

Thousands of bottles of popular antidepressant recalled “Thousands of bottles of a popular antidepressant medication are being recalled due to the presence of what the National Library of Medicine describes as a toxic chemical, according to a notice from the U.S. Food and Drug Administration.
The recall involves the medication duloxetine, which is sold under the brand name Cymbalta, according to the FDA's notice of the voluntary recall, which began Oct. 10.”

About the public’s health

In boon for Pfizer and Merck, CDC panel backs expanded use of pneumococcal vaccines “In a 14-1 vote, the panel moved to expand its usage recommendation for both Pfizer’s Prevnar 20 and Merck’s Capvaxive to include all adults aged 50 and older as well as adults between 19 and 49 years of age with certain risk factors. Previously, the broad recommendation for PCV shots was for those older than 65.” 

About healthcare finance

General Catalyst:Announcing Fund XII “Today, we are announcing that we have raised approximately $8B of new capital, including around $4.5B for our core VC funds focused on seed and growth equity (across our Ignition, Endurance, and Health Assurance strategies), $1.5B for our Creation strategy, and $2B of separately managed accounts. As a global investment company that seeks to partner with the world’s most ambitious entrepreneurs to drive transformation, resilience, and applied AI, we believe this capital will turbocharge our investment theses across AI, Defense & Intelligence, Climate & Energy, Industrials, Healthcare and Fintech.”