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About health insurance/insurers

Humana posts $693M loss in Q4 “Humana lost $693 million in the fourth quarter of 2024, according to the company's year-end earnings report published Feb. 11.
The results reflect increased benefits expenses, particularly in Medicare Advantage and state-based contracts. Despite the challenges, the company projected earnings per share of $15.88 for 2025, with an adjusted EPS of approximately $16.25.”

UnitedHealth to pay $20M to settle emergency claims lawsuit from Labor Department “UnitedHealth Group reached a $20.25 million settlement with the U.S. Department of Labor on Feb. 7, resolving allegations that its subsidiary, UMR, improperly denied claims for emergency room visits and urinary drug screenings for thousands of patients. 
The Labor Department originally filed its lawsuit against UnitedHealth subsidiary UMR in July 2023 in a Wisconsin federal court. UMR is UnitedHealthcare's third-party administrator that provides health benefits services to more than 2,100 self-funded employer plans, according to the complaint.”  

Kaiser Permanente clears $115B revenue in 2024 thanks to Risant Health additions “Kaiser Permanente pushed its annual operating revenues to new heights last year thanks to the addition of its value-based care subsidiary Risant Health.
The integrated nonprofit health system shared Friday that it brought in $115.8 billion in operating revenues across 2024, up 14.9% from the prior year. Operating expenses also leapt 14.6% to $115.2 billion.
Taken together, Kaiser and new Risant acquisitions Geisinger Health and Cone Health posted an operating income of $569 million (0.3% operating margin) for the year.”

About hospitals and healthcare systems

20 large health systems growing bigger FYI

About pharma

How Medicare Says It Arrives At ‘Fair’ Prescription Drug Prices A great review of this process.

Novartis inks $925M Anthos takeover to buy back phase 3 clot-busting candidate “Novartis has brought abelacimab back into the fold. Six years after spinning the asset out to form Anthos Therapeutics, Novartis has struck a deal to buy Anthos for $925 million upfront to add the clot-busting prospect to its late-phase pipeline.
Abelacimab, an anti-factor XI/XIa antibody, is designed to stop blood clot formation without raising the risk of bleeding and bruising.”

About the public’s health

COVID vaccination saved more than 5,000 US lives in 7 months in 2023-24, CDC estimates “COVID-19 vaccination averted more than 5,000 US in-hospital deaths, 13,000 intensive care unit (ICU) admissions, and 68,000 hospitalizations in 7 months in 2023-2024, researchers from the US Centers for Disease Control and Prevention (CDC) estimatedlate last week in Vaccine, although with considerable uncertainty.”  

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About pharma

The US relies on China for key medicines. They won’t be spared from tariffs “President Trump’s tariffs in China are in place and hitting all products imported from the country — including a number of pharmaceutical drugs that Americans rely upon.
Chinese imports account for a significant proportion of U.S. prescriptions and over the counter drugs. Many of the Chinese-produced drugs are generics, which account for 91 percent of prescriptions dispensed in the U.S.” 

Hims & Hers faces scrutiny from senators on Super Bowl ad that ‘risks misleading’ patients “Sens. Dick Durbin, D-Ill., and Roger Marshall, R-Kan., wrote a letter to the U.S. Food and Drug Administration on Friday expressing concerns over an ‘upcoming advertisement’ that ‘risks misleading patients by omitting any safety or side effect information when promoting a specific type of weight loss medication.’”
Also, their drug is compounded, which avoids direct FDA scrutiny.

About the public’s health

Flu season in the US is the most intense it’s been in at least 15 years “One indicator of flu activity is the percentage of doctor’s office visits driven by flu-like symptoms. Last week, that number was clearly higher than the peak of any winter flu season since 2009-2010, when a swine flu pandemic hit the nation, according to data posted Friday morning by the Centers for Disease Control and Prevention.

Measles outbreak expands in West Texas around county with low vaccination rate A measles outbreak is growing in a rural area of West Texas where vaccination rates are well below the recommended level.
In late January, two children in Gaines County were hospitalized for measles. On Wednesday, the state health department shared in a health alert that the number of confirmed cases had grown to six. As of Friday afternoon, the outbreak has jumped to 14 confirmed cases and six probable cases among people who are symptomatic and had close contact with infected individuals, Zach Holbrooks, executive director of the South Plains Public Health District, told CNN.”

About healthcare technology

BD bids farewell to its diagnostic, bioscience divisions with company split “After parting ways with its diabetes franchise nearly three years ago, BD is slimming down even further with a plan to divest its diagnostic and biosciences businesses as the company nears the finish line in its five-year ‘BD 2025’ strategy.
The ‘New BD,’ as the company describes it, will continue on as a pure-play medtech company with its enterprises in medical essentials—such as its ubiquitous hardware for collecting blood samples and delivering IV medications, which number in the tens of billions of units per year—as well as its interventional devices and connected care programs, with the latter including the recent acquisitions from Edwards Lifesciences.” 

About healthcare personnel

Physicians working more but generating less revenue Physician productivity and pay increased during the fourth quarter of 2024, but reimbursement for hospitals remained low, according to Kaufman Hall's Physician Flash Report.
The report, issued Feb. 4, includes data from 200,000 providers showing the investment or subsidy per physician was up 5% to $306,792 and work relative value units increased 8% to 6,313 year over year for the quarter.

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Gallup, Rollins Survey Reveals Americans’ Public Health Priorities, Trust “Health care access and affordability was ranked by Americans as the highest public health priority for government leaders to address. One in four selected this issue as their highest priority, and more than half (52%) rated it in their top three priorities. However, the percentage varies across subgroups.
Republicans and Republican-leaning independents ranked ‘ensuring safe water and food’ (24%) as their highest priority, followed by reducing chronic disease (16%) and health care access and affordability (19%). Democrats and Democratic-leaning independents ranked health care access and affordability (32%) as the highest priority, followed by food and water safety (13%) and strengthening safety net programs (12%).”

About health insurance/insurers

Independence Blue Cross excludes accelerated approval drugs from coverage for 18 months “Philadelphia-based Independence Blue Cross has set a benefit exclusion for products that receive accelerated approval from the FDA in most plans.

The health insurer said in a notice that drugs, biologics or gene therapies that earn an accelerated approval "are considered a benefit contract exclusion for most plans" and as such are not eligible for reimbursement for 18 months after the approval is made.
Independence said in the notice that these therapies will be covered after the 18-month mark based on certain criteria, including that they do not have a traditional FDA approval in place and that the accelerated approval was based on a surrogate endpoint.”
Comment: This move is a major change from insurance policy and may not be allowed in other states or with federal programs.

About pharma

After $2.2B Zantac settlement, GSK now faces investor lawsuit over the heartburn medication “In October, when GSK agreed to a $2.2 billion settlement to resolve approximately 80,000 lawsuits brought by users of Zantac, it appeared that the drugmaker’s legal issues with the heartburn treatment were largely in its rearview mirror.
But four months later, the company is embroiled in more Zantac litigation—this time with investorOn Tuesday in federal court in Pennsylvania, a group of shareholders filed a proposed class-action complaint, accusing GSK of hiding an internal report which suggested that Zantac might contain a cancer-causing compound.”

Federal appeals court axes $650M opioid judgment against CVS, Walmart and Walgreens “A federal appeals court axed a $650 million judgment and corresponding injunction against CVS Pharmacy, Walgreens Boots Alliance and Walmart stemming from a lawsuit filed by two Ohio counties in 2018.
A federal jury in Cleveland concluded in November 2021 that an oversupply of addictive pain pills and the diversion of those opioids to the black market created a public nuisance in the counties and that the pharmacies helped cause it, as Reuters reported.
In 2022, a Cleveland federal judge ordered CVS, Walmart and Walgreens to pay a combined $650.9 million to help the two counties address, or abate, the harms caused by the epidemic.”

About healthcare personnel

Trump Administration Live Updates: Judge Temporarily Halts Federal Worker Resignation Program “A federal judge in Massachusetts has stopped, at least temporarily, the Trump administration’s effort to get federal employees to leave their jobs by accepting delayed resignation offers. The judge said the government could not move forward with the program — which gave workers until 11:59 p.m. to accept offers to stop working and collect pay until September — pending a hearing Monday afternoon on a legal challenge. The administration said Thursday that more than 40,000 workers had already accepted.”
However: Trump Administration Live Updates: Nearly All Jobs Are Said to Be Cut at Aid Agency “The Trump administration plans to retain only about 290 of the more than 10,000 employees worldwide at the U.S. Agency for International Development, according to three people with knowledge of the planned cuts to the work force. The cuts were communicated to agency leaders in a call on Thursday. Most of the employees expected to stay on are those who specialize in health and humanitarian assistance. About 800 grants and contracts awarded through U.S.A.I.D. were also starting to be canceled on Thursday, the people said.

Today's News and Commentary

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Elevance Health, Centene donated to Trump inaugural fund, key lawmakers “Companies spanning many industries donated to Trump’s fund, hoping to soften or improve relationships and advance organizational priorities in the new administration.
In healthcare, the Pharmaceutical Research and Manufacturers of America, Johnson & Johnson and Bayer all donated $1 million. Abbott Laboratories donated $500,000. The National Association of Manufacturers, which also represents pharmaceutical interests, donated $1 million. So did Amazon, with its executive chairman and founder Jeff Bezos attending the indoor inauguration in person.
Others in healthcare donated to the fund, albeit to a lesser degree. HCA Healthcare, the country's largest for-profit hospital chain, gifted $250,000 to the cause. Insurers Elevance Health and Centene donated $150,000 and $50,000, respectively. Elevance and Centene did not respond to a request for comment.”

About hospitals and healthcare systems

National Hospital Flash Report: December 2024 Data (Published 2/4/2025)
“Key Takeaways − 2024 Year in Review
1. Hospital performance improved compared to 2023. Outpatient revenue increased and over the year, there was a decrease in patient observation days.
2. Expenses rose in 2024 but did not outpace inflation on a volume-adjusted basis. The workforce continues to be competitive.
3. Bad debt and charity care rose in 2024. This trend may reflect the continued Medicaid redetermination process and increase in the rate of payer denials.” 

About the public’s health

Dietary Sodium- and Potassium-Enriched Salt Substitutes—The Tipping Point? Regulatory agencies including the US Food and Drug Administration should work in collaboration with consumers, scientists, and the food industry to reexamine the level of existing evidence to consider implementation of mandatory sodium limits in processed foods. If the conclusion of those discussions is that more evidence is necessary before taking steps toward mandatory limits, strong consideration should be given to examining existing observational evidence using evolving contemporary rigorous statistical approaches to offer the necessary confidence for decisions. Delaying the crucial step of limiting dietary sodium in the American diet is predicted to cost hundreds of thousands of quality-adjusted life-years.”

10 Things to Know About U.S. Funding for Global Health A great review of the topic. Not the least revelation is that: “U.S. global health funding totals approximately $12 billion but only represents less than 0.1% of the federal budget.”

About healthcare IT

Press Ganey partners with Microsoft in generative AI expansion “Press Ganey inked a strategic partnership with Microsoft to leverage the tech giant's artificial intelligence and cloud computing capabilities.
The patient experience monitoring company plans to bring new generative AI tools to market, including ambient listening for patient satisfaction, the company said.”

Teladoc to buy home testing company Catapult for $65 million “Teladoc Health will buy at-home testing company Catapult Health for $65 million in cash as it aims to grow its business around care for chronic diseases, the company announced Wednesday.”

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The Senate HELP subcommitte Approved RFK Jr.’s advancement to the full Senate for approval. The key vote was from Republican Senator Bill Cassidy (a physician) after receiving several assurances from Kennedy and the Trump administration. These assurances include:
1. Commitments on Vaccine Policy: Kennedy pledged to maintain existing vaccine approval and safety frameworks, keep the CDC’s Advisory Committee on Immunization Practices intact, and ensure no removal of CDC statements affirming that vaccines do not cause autism.
2. Collaborative Oversight: Cassidy was promised an “unprecedentedly close collaborative working relationship,” with Kennedy agreeing to meet or speak with him multiple times a month, provide input on HHS hiring decisions, and give 30 days’ notice before altering vaccine safety monitoring programs.
3. Senate Health Committee Role: Kennedy agreed to allow the Senate HELP Committee, chaired by Cassidy, to appoint representatives to any new vaccine safety boards and to appear before the committee quarterly if requested.
Cassidy emphasized his belief in vaccine safety, despite Kennedy’s controversial anti-vaccine stance, and cited these commitments as critical to his decision. Political pressures, including lobbying by Vice President JD Vance and grassroots supporters of Kennedy’s “Make America Healthy Again” agenda, also influenced Cassidy’s vote.
The question remains whether those assurances are genuine.

N.Y. Moves to Shield Doctors Who Send Abortion Pills to States With Bans “The newly signed law comes days after a New York doctor was indicted in Louisiana for prescribing and sending abortion pills to someone in the state. The charges represented an escalation in the fractious battle between mostly Republican-led states that ban abortion and Democratic-led states seeking to protect or expand abortion access.
The law, which takes effect immediately, will allow health-care practitioners to avoid putting their names on prescriptions for medications used in abortions, and instead use the names of their medical practices.”

C.D.C. Site Restores Some Purged Files After ‘Gender Ideology’ Ban Outcry Read the full article to understand what was restored and what is still missing.

Key Findings From New Polling on Public Opinion on Vaccines Read this short report. Americans are still overwhelmingly pro-vaccines and think the U.S. should maintain its leadership role in their development.

Loretta Ford, ‘Mother’ of the Nurse Practitioner Field, Dies at 104 “Loretta Ford, who co-founded the first academic program for nurse practitioners in 1965, then spent decades transforming the field of nursing into an area of serious clinical practice, education and research, died on Jan. 22 at her home in Wildwood, Fla. She was 104.”

FDA approves pig organ transplant trials for patients with kidney failure “The Food and Drug Administration has given two biotechnology companies approval for clinical trials that will transplant organs from genetically modified pigs into patients with kidney failure, an experimental but potentially groundbreaking innovation for thousands of Americans on the waiting list for organ transplants.”

Today's News and Commentary

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In other news:
Pro-RFK Jr. letter to the Senate includes names of doctors whose licenses were revoked or suspended “The AP found that in addition to the physicians who had faced disciplinary action, many of the nearly 800 signers are not doctors. The letter with the names of those who signed was provided to the AP by Sen. Ron Johnson’s office after he entered it into the Congressional Record on Wednesday during the first of Kennedy’s two confirmation hearings…
Over 20 were chiropractors, representing an industry that has funded Kennedy’s work. An AP investigation found that donations from a chiropractic group represented one-sixth of the revenues collected by Kennedy’s anti-vaccine nonprofit in 2019.”

Trump administration indefinitely suspends meetings of HHS' health IT advisory committee “The Trump administration indefinitely canceled meetings of the Health Information Technology Advisory Committee (HITAC), an advisory panel that helps the federal government establish rules and standards for the use of healthcare data and technologies.
The HITAC was established by the 21st Century Cures Act, was enacted in 2016 and began having its first public meetings in 2018.”

Trump tariffs threaten US drug supplies and risk higher prices, trade groups warn Comment: As of this writing, the Mexican and Canadian tarrifs have been suspended for a month pending further talks.

Bipartisan lawmakers introduce bill boosting physician pay by 6.6% from April through DecemberThe proposed adjustment would take effect April 1 and run through the rest of 2025, thereby leaving the year’s 2.83% Medicare pay cut in place for services furnished from January to March. Services furnished after the cutoff, however, would see a 6.62% increase—offsetting the pay cut, adjusting for inflation and prorating the first three months of pay cuts.”

In a first, scientists find microplastics are building up deep in our brains “A paper published Monday in Nature Medicine found that the tiny fragments of plastic are passing the blood-brain barrier and into human brains, and the amount of microplastics in the brain appears to be increasing over time. There were 50 percent more fragments in brains analyzed in 2024 than in 2016.
The scientists also examined the brains of 12 deceased patients diagnosed with dementia, and found that they had three to five times more microplastics than normal brains.”

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About health policy/law

Setting Public Health Priorities in the United States A thoughtful framework for setting these priorities.

States secure sweeping temporary restraining order against Trump's federal assistance 'pause' “A second federal judge has put the Trump administration's "temporary pause" and review of federal financial assistance on ice, and this time the temporary restraining order is indefinite and much more sweeping. 
The order, handed down Friday afternoon by Judge John J. McConnell, Jr., of the U.S. District Court for the District of Rhode Island, comes after the Office of Management and Budget (OMB) rescinded a memo outlining a funding freeze that threw much of the country's federal funding recipients into a panic.”
In a related story: National Science Foundation suspends salary payments, leaving researchers unable to pay their bills “Though a judge blocked that suspension on Tuesday before it could take effect, and the administration rescinded the memo that ordered it on Wednesday, on Thursday the NSF’s online payment system was still down, throwing lives into uncertainty. An NSF email seen by STAT suggested salaries had been suspended to ‘ensure only eligible activities’ are funded.”

CDC removal of databases on sexual orientation, gender identity sparks alarm “Data from an expansive federal survey on youth behavioral habits, including their sexual orientation and gender identity, have been removed from the website of the Centers for Disease Control and Prevention, which maintains the data.
The CDC and other federal agencies appeared to be racing to meet a Friday afternoon deadline to remove “gender ideology” from their websites, in accordance with a memo from the Office of Personnel Management. NBC News reported that all the CDC’s HIV pages were removed, but the main page appeared to have been restored later.”

N.Y. doctor charged with prescribing abortion pills to Louisiana girl “A New York doctor was criminally indicted Friday for allegedly prescribing abortion pills to a girl in Louisiana, setting up one of the first major legal challenges to ‘shield laws’ enacted by some Democratic-led states to protect doctors providing abortion access since Roe v. Wade was overturned in 2022.
Louisiana prosecutors accuse Margaret Carpenter, 55, of affecting a criminal abortion by means of abortion-inducing drugs. They also indicted her company, Nightingale Medical. Carpenter faces one to five years in prison and a $5,000 to $50,000 fine if convicted of violating a 2022 Louisiana law that bans abortion.”

KFF Tracking Poll on Health Information and Trust: January 2025 Too much information to summarize but look at the Figures. The level of mistrust and misunderstanding is very worrisome.

About pharma

Walgreens suspends quarterly dividend, stock plunges “Walgreens Boots Alliance is suspending its quarterly stock dividend to shareholders for the first time in 92 years, the latest sign that the Deerfield-based pharmacy chain is struggling to cut costs, improve margins and find stability.
The company said the dividend suspension is part of management’s plan to evaluate and refine its capital allocation policy amid a broader long-term turnaround plan. Doing so is aimed at strengthening Walgreens' balance sheet and allows it to focus on reducing debt and improving free cash flow.”

About health insurance

Allstate sells group health business to Nationwide in $1.25 billion cash deal “Insurance giant Allstate is selling its group health business to rival Nationwide for $1.25 billion in cash as part of its plan to focus on its core products such as property and casualty insurance.
Allstate is expected to post a financial book gain of $450 million from the sale of the business, which it acquired in 2021 as part of its purchase of National General, company Chief Financial Officer Jess Merten said in a statement.
The group health business, which provides insurance protecting small businesses from unexpected large medical claims, had revenue of $608 million and adjusted net income of $69 million for the first nine months of 2024, Allstate said.”

Cigna set to close $3.7B MA sale to HCSC in Q1 “age business in the first quarter of 2025, in line with its expectations.
The insurer announced plans to sell off its MA plans to Health Care Service Corporation in January 2024 in a deal valued at $3.7 billion. Chief Financial Officer Brian Evanko said that all federal antitrust approvals have been received, as have all but one state approval.”

Medicare Advantage Insurers Made Nearly 50 Million Prior Authorization Determinations in 2023
—"In 2023, there were nearly 2 prior authorization determinations on average per Medicare Advantage enrollee, similar to the amount in 2019
.
In 2023, insurers fully or partially denied 3.2 million prior authorization requests, which is a somewhat smaller share (6.4%) of all requests than in 2022 (7.4%).
—A small share of denied prior authorization requests was appealed in Medicare Advantage (11.7% in 2023)
.
Though a small share of prior authorization denials were appealed to Medicare Advantage insurers, most appeals (81.7%) were partially or fully overturned in 2023. That compares to less than one-third (29%) of appeals overturned in traditional Medicare in 2022.”

Aetna, Centene, Blue Shield launch 'single payment' primary care model in California “Instead of each health plan using its own payment system, the three insurers use a single, shared system that rewards physicians for providing high-quality care, especially among underserved populations. The CQC will help practices implement the new system, improve care coordination, and integrate mental and physical health services. A platform called Cozeva will provide data to help physicians track their performance and close care gaps.
Participating providers are here. A full model guide is available here.

Today's News and Commentary

See: https://kffhealthnews.org

Other news:

Freeze on Federal Funds Rescinded, and Trump Signs Law Easing Deportation for Migrants “The White House on Wednesday rescinded a directive that froze trillions of dollars in federal grants and loans after the order led to mass confusion and legal challenges that accused the Trump administration of violating the law.
The order, issued Monday night, was an attempt to purge the government of what President Trump has called a ‘woke’ ideology. A federal judge in the District of Columbia temporarily blocked it Tuesday afternoon, but the lack of clarity sent schools, hospitals, nonprofits and other organizations scrambling to understand if they had lost their financial support from the government.
On Wednesday, Matthew J. Vaeth, the acting director for the Office of Management and Budget, told federal agencies that the memo freezing aid had been ‘rescinded.’”

RFK Jr. grilled about his views on vaccines and abortion at first confirmation hearing

Three key takeaways from Robert F. Kennedy Jr.’s Senate confirmation hearing

About health insurance

Plans on Healthcare.gov denied 20% of claims in 2023 “Plans available through Healthcare.gov denied an average of 20% of claims in 2023, according to a new analysis from KFF.
Researchers found that exchange plans denied 19% of in-network claims and 37% of out-of-network claims, averaging out to 20%. There was notable variation between payers and states, according to the study, with denial rates ranging from 1% to 54%.
Insurers cited multiple reasons for denials, including 18% that were denied for administrative reasons, 16% for excluded services and 9% for lack of prior authorization or referral. Just 6% of denied claims cited a lack of medical necessity, according to the report.”

About pharma

GLP1Ra-based therapies and DXA-acquired musculoskeletal health outcomes: a focused meta-analysis of placebo-controlled trials “Approximately 30% of body weight lost with GLP1Ra-based therapy is LM [lean body mass].”

Independent pharmacies weigh stocking drugs under Medicare price negotiationThe National Community Pharmacists Association (NPCA) is warning the feds that independent pharmacists are likely to face significant financial hardship due to Medicare drug price negotiations.
In comments submitted on the latest Medicare advance notice, the organization says it conducted a survey of 8,000 pharmacy owners and managers about the drug price negotiation program and found that 93.2% have either decided not to stock drugs under negotiation or are considering not stocking these products.
The survey found that 32.8% of independent pharmacists have already made the decision to not stock one or more of the 10 drugs in the first round of negotiations. In addition, 60.4% of those surveyed said they are considering similar steps.
The NCPA said this is because they're concerned about ‘financial losses’ through the program.”

About the public’s health

Dangerous Virus’: Bird Flu Enters a New Phase “A human pandemic is not inevitable, even now, more than a dozen experts said in interviews. But a series of developments over the past few weeks indicates that the possibility is no longer remote.
Toothless guidelines, inadequate testing and long delays in releasing data — echoes of the missteps during the Covid-19 pandemic — have squandered opportunities for containing the outbreak, the experts said.”

Overview of President Trump’s Executive Actions on Global Health FYI

Today's News and Commentary

See toady’s KFF News

Today’s big healthcare story is the governmental freeze on Medicaid funds. The disbursement site ceased working this morning. White House spokesperson said the website problem is being fixed. But other parts of the government say that funds are being withheld to make sure they are not provided for inappropriate services.
A DC District Court passed the freeze until Feb. 3.
This story is still evolving. See the following articles for some background:
Payment System That Provides Medicaid Funding to States Stops Working, Officials Say 
Trump federal assistance 'pause': Court orders delay, states confirm Medicaid portal disruptions 
White House pauses all federal grants, sparking confusion
BREAKING: Judge Temporarily Halts Trump's Funding Freeze

Today's News and Commentary

While away, I was evaluating other news sites and found the best single one to be from The Kaiser Family Foundation.
Sign up for their daily newsletter
here.

In the future I will cover special articles not in that newsletter or highlight special topics.

About health policy

CDC staff ordered to cut off communication with WHO “Staff across the Centers for Disease Control and Prevention were ordered Monday to cut off all communications with the World Health Organization, multiple federal health officials confirmed to CBS News, to comply with President Trump's executive order last week. 
Beyond calling for the U.S. to begin the yearlong process to formally withdraw from funding the U.N. health agency, Mr. Trump's executive order had also instructed federal agencies to "recall and reassign" any U.S. government personnel from working with the WHO.”

Trump administration’s abrupt cancellation of scientific meetings prompts confusion, concern “A flurry of scientific gatherings and panels across federal science agencies were canceled on Wednesday, at a time of heightened sensitivity about how the Trump administration will shift the agencies’ policies and day-to-day affairs. 
Several meetings of National Institutes of Health study sections, which review applications for fellowships and grants, were canceled without being rescheduled, according to agency notices reviewed by STAT. A Feb. 20-21 meeting of the National Vaccine Advisory Committee, a panel that advises the leadership of the Department of Health and Human Services on vaccine policy, was also canceled. So was a meeting of the Presidential Advisory Council for Combating Antibiotic-Resistant Bacteria that was scheduled for Jan. 28 and 29.”

MedPage Today: Trump's Gag Order Halts CDC PublicationFor the first time in its more than 60-year history, the CDC's Morbidity and Mortality Weekly Report (MMWR) did not go out as scheduled because of a communications pause at federal health agencies issued by the Trump administration. Past editors of MMWR and prior leaders of CDC lamented the lack of publication, and its potential impact on the distribution of vital public health information.”
And in a related article: ‘This is censorship’: Trump freeze on communications forces medical journal to pull HHS authors’ article “An article that was written by U.S. Department of Health and Human Services employees and slated for publication in a medical journal this spring was placed on hold last week, apparently as a result of the Trump administration freeze on communications from government agencies.
The article reviewed the responsibilities of institutions that receive federal funding for research and was to have appeared in the Journal of Law, Medicine & Ethics.”

Trump ousts at least 15 independent inspectors general in late-night purgeThe White House removed the independent inspectors general of nearly every Cabinet-level agency in an unprecedented purge that could clear the way for President Donald Trump to install loyalists in the crucial role of identifying fraud, waste and abuse in the government…
The dismissals appeared to violate federal law, which requires Congress to receive 30 days’ notice of any intent to fire a Senate-confirmed inspector general. The legal uncertainty could create awkward encounters on Monday, when several watchdogs who were told they were fired planned to show up in their offices to work anyway.”
Comment: I have been following the HHS IG reports for years (and reporting on many in these postings). I have never found any hint of partisan politics in any report. They are geared to operational issues and not policy and clearly state why the report was prepared, what the findings were, and what were the recommendations.

Trump FDA officially withdraws long-delayed menthol cigarette ban “The Food and Drug Administration (FDA) has withdrawn a rule that would have banned menthol cigarettes and flavored cigars, putting a formal end to a policy that had been indefinitely delayed under the Biden administration. 
A regulatory filing showed the rule had been “withdrawn” on Jan. 21, President Trump’s second day in office. The move is a significant blow to public health groups who said banning menthol had the potential to save hundreds of thousands of lives, particularly among Black smokers.”

After disruption due to Trump administration communication pause, NIH told it can continue some purchasing for research “After purchasing for research at the National Institutes of Health was put on hold last week, employees have now been told they can continue working with some current vendors, according to a memo obtained by CNN.”

About health insurance/insurers

Flaws in the Medicare Advantage Star Ratings A good review of this issue.

About pharma

Top 10 most anticipated drug launches of 2025 FYI

Walgreens stock tumbles on report that private equity deal is unlikely ‘Shares of Walgreens Boots Alliance tumbled today following a CNBC report that the Deerfield-based pharmacy chain was unlikely to sell itself to a private-equity firm.”

China investigates generic drugs over safety concerns “Chinese regulators are investigating the quality of domestic generic drugs after a rare public backlash against a cost-cutting campaign that prioritised their use in the national healthcare system but has led to doctors complaining about their effectiveness. The probe comes amid increasing concerns among foreign pharmaceutical companies that China’s drug procurement system, in which producers bid for bulk tenders to supply public hospitals, in effect discriminates against international competition.”

About healthcare personnel

Growth of Private Equity and Hospital Consolidation in Primary Care and Price Implications “In this cross-sectional study including 198 097 primary care physicians, in 2022, nearly half of all primary care physicians (PCPs) were hospital-affiliated, while PE-affiliated PCPs were concentrated in certain regional markets. Relative to independent PCPs, negotiated prices for office visits were 11% higher for hospital-affiliated and 8% higher for PE-affiliated PCPs.” 

Today's News and Commentary

HealthcareInsights.MD will be on vacation and return Monday, January 27, 2025.

More than 15,000 doctors urge Senate to reject RFK Jr. as Health secretary “More than 15,000 doctors across the country signed an open letter urging senators to vote against President-elect Trump’s nominee for secretary of the Department of Health and Human Services (HHS): Robert F. Kennedy Jr.  
In the letter, physicians say they are ‘appalled’ by Trump’s ‘reckless’ appointment of Kennedy, arguing he would be ‘dangerous’ if confirmed to the top public health post.” 

About health insurance/insurers 

Health plan member experience in 2024 Key member experience insights for 2024

  • Patient experience and health plan quality ratings are closely linked. Patients who rate safety and privacy poorly in post-care PCP surveys typically award health plans 1 star for ‘rating of health care quality’ and ‘getting needed care’ in Medicare CAHPS surveys.

  • Primary care engagement is essential, but specialist engagement is the differentiator. High-performing plans (4+ stars) engage a larger proportion of members with specialists. 

  • Access to care remains a challenge. Patients who have positive experiences with scheduling and contacting their provider tend to give higher ratings to health plans. 

  • Tailored strategies are key to improvement. Medicare plans significantly outperform commercial plans in NPS, with a 47-point difference.

  • Prescription drug coverage is vital to member experience and quality of care, but it's not the only factor. Simplifying processes like prior authorizations and mail-order can significantly improve member satisfaction.

  • Addressing inequities in care is essential. Nearly 5% of Medicare members report experiencing insensitive or unfair treatment from healthcare providers—a figure that doubles for historically disadvantaged populations.”

About pharma

Walgreens stock jumps 27% after earnings surpass estimates. Analysts see early signs of recovery “Walgreens shares jumped Friday, despite a $265 million loss in the latest quarter, as the drugstore chain also posted better sales and adjusted profits than analysts expected.
The company is executing a turnaround plan to improve its financial performance that includes closing 1,200 stores, controlling operating costs and addressing reimbursement models.”

About the public’s health

Cardiorespiratory fitness [CRF], body mass index and mortality: a systematic review and meta-analysis “CRF is a strong predictor of CVD and all-­ cause mortality and attenuates risks associated with overweight and obesity.”  

Snack quality and snack timing are associated with cardiometabolic blood markers: the ZOE PREDICT study “Contrary to public perception, we find that the act of snacking, in terms of both frequency and quantity of energy from snacks, was not associated with unfavourable cardiometabolic blood or anthropometric markers. Instead, we observed that snack quality matters and is associated with favourable lipemic and insulinemic responses, as well as decreased hunger. Frequent high-quality snack intake was also associated with favourable weight and BMI compared to non-snackers and frequent low-quality snackers.”

COVID-19 Vaccine Hesitancy Among Black Women in the US “In this qualitative study of 54 Black women, 3 main themes emerged as being associated with vaccine hesitancy: mistrust in health care and government, concerns over vaccine safety and long-term effects, and ineffective and coercive vaccine communication and promotion. Participants expressed deep-rooted skepticism stemming from past medical exploitation, fears about rapid vaccine development, and frustration with inadequate and coercive vaccine messaging.”

About healthcare IT

Health Care AI, Intended To Save Money, Turns Out To Require a Lot of Expensive Humans The gist of this interesting article is: “Artificial intelligence systems require consistent monitoring and staffing to put in place and to keep them working well.
In essence: You need people, and more machines, to make sure the new tools don’t mess up.”

Health system ransomware attacks surge in '24 “Health system ransomware attacks nearly doubled in 2024, affecting more than 1,000 U.S. hospitals, cybersecurity firm Emsisoft reported.”

About healthcare personnel

Medical schools see record-high enrollment as applications fall: 10 takeaways “While the total number of applications declined in the 2024-to-2025 academic year, enrollment in U.S. medical schools reached a new high, according to data released Jan. 9 by the Association of American Medical Colleges.” 

Today's News and Commentary

About health insurance/insurers

Investors call on UnitedHealth to disclose human and economic costs of policies that limit care “Seven UnitedHealth Group shareholders are calling on the health care conglomerate to produce a report on how often its policies lead to denied or delayed care, and the effects on patients and the economy. 
The proposal, which could go up for a vote by UnitedHealth’s investors at the company’s annual meeting later this year, comes as the company is under tremendous public scrutiny for tactics such as prior authorization and care denials.”

About hospitals and healthcare systems

Changes in Patient Care Experience After Private Equity Acquisition of US Hospitals “ In this difference-in-differences analysis of 73 private equity–acquired hospitals and 293 matched control hospitals, global measures of patient care experience worsened after private equity acquisition of hospitals, as did patient-reported staff responsiveness. The difference in these measures of patient care experience at private equity–acquired hospitals compared with matched control hospitals increased with each subsequent year after acquisition.”

Joint Commission revamps survey process: 5 things to know “The Joint Commission has enhanced its survey process for 2025, after calls from member organizations to alleviate administrative burden with more modernized and improved tools.
The enhancements include redesigned survey reports, an updated process for uploading documents and a new peer benchmarking tool, according to a Jan. 8 news release from the organization.”

About pharma

US ‘notorious markets’ report warns of risks from online pharmacies “Nearly all of the world’s 35,000 online pharmacies are being run illegally and consumers who use them risk getting ineffective or dangerous drugs, according to the U.S. Trade Representative’s annual report on “ notorious markets.” The report also singled out 19 countries over concerns about counterfeit or pirated products.
The report also named about three dozen online retailers, many of them in China or elsewhere in Asia that it said are allegedly engaged in selling counterfeit products or other illegal activities.
The report says 96% of online pharmacies were found to be violating the law, many operating without a license and selling medicines without prescriptions and safety warnings.”

About the public’s health

Want to start a fight among virus experts? Ask about HIV’s new name “Many new names sounded as if they'd been cooked up by a medieval monk. HIV-1 would henceforth be known as Lentivirus humimdef1. SARs-CoV-2, the virus that causes Covid, would be known as Betacoronavirus pandemicum.”
Trips off the tip of the tongue?  

About healthcare personnel

Medical schools report steep drop in enrollment of Black and Hispanic students after Supreme Court ruling “Enrollment of Black and Hispanic students in medical schools dropped precipitously last year after the Supreme Court banned the consideration of race in admissions, according to data released Thursday by the Association of American Medical Colleges. 
The number of Black enrollees fell by 11.6% compared to last year, while the number of Hispanic enrollees decreased 10.8%. The numbers were even starker for Indigenous students; the number of American Indian or Alaska Natives dropped by 22.1%, while students who were Native Hawaiian or Pacific Islanders dropped by 4.3%.”

Today's News and Commentary

About health insurance/insurers

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

Biden administration achieves fourth record-breaking ACA enrollment ahead of exit “The Biden administration has achieved a fourth consecutive record year in HealthCare.gov Marketplace enrollment, one week before the final sign-up deadline and its imminent exit from office.
Nearly 24 million people signed up for Affordable Care Act Marketplace plans for 2025, according to White House domestic policy adviser Neera Tanden, exceeding the 21.3 million people who signed up last year.”

Assessing the Effect of the Medicare Part D Redesign “…of most concern for policymakers, the Part D redesign puts upward pressure on Part D premiums. This upward pressure stems primarily from the combination of increasing plans’ financial responsibility and insulating beneficiaries from the highest out-of-pocket costs. Because the redesign limits plans’ ability to pass along their increased costs to beneficiaries who use high-cost drugs, plans may seek instead to pass those costs along to beneficiaries in the form of increased premiums. Congress foresaw this possibility, and the IRA limits the annual increase in the Part D base beneficiary premium. Because this provision applies specifically to the base beneficiary premium, however, many plan premiums have increased by more than the targeted amount. A Part D premium stabilization demonstration program may have moderated these effects for 2025.” 

Healthcare consumers trust insurer AI tools, want more support: survey “Two-thirds of insured Americans say they would trust a health insurer’s artificial intelligence copilot to accurately inform them about a health plan’s benefits, a survey conducted by virtual care navigation platform Pager Health and market research firm The Harris Poll reveals.
Of the respondents, 66% believe AI can correctly personalize digital healthcare with the goals and needs of the member. Even more respondents think AI can find doctors accepting new members and schedule appointments.”

About hospitals and healthcare systems

Bipartisan Senate report slams private equity's "detrimental effects" on hospitals “Two private equity firms' efforts to wring profits out of hospitals in underserved communities put patients in danger, according to a new report released Tuesday by a powerful Senate committee…
And its findings add to a chorus of lawmakers trying to address the detrimental impact of private equity ownership on critical U.S. hospitals — a subject that has been the focus of a two-year CBS News investigation.”
 
About pharma

Drugs and dollars: Medication pricing in the US “A recent National Institute for Health Care Management Foundation webinar examined the future of prescription drug costs and access issues faced by Americans, and how obstacles may be removed so people can get the medicines they need.
Here are some key takeaways…
—the percentage of prescription drug costs as a share of overall insurance premiums is rising – it currently stands at 24%, compared with 22% about two years ago…
-…instead of collaborating with large firms to help them bring new medications to the market, smaller emerging firms are increasingly doing all of the heavy lifting themselves, from originating a product to gaining approval for it, then marketing it and reaping the revenue it generates.-In 2022, the breakdown of companies developing new drugs was 54% emerging firms, 13% small to medium firms and 32% large firms. That’s compared with 50%, 15% and 35%, respectively, in 2013.”

Wegovy and Zepbound tipped to fuel $20B boom in heart failure market “GlobalData has named heart failure as the next disease to feel the sales-boosting power of GLP-1 drugs. The analysts expect launches of medicines including Eli Lilly’s Zepbound and Novo Nordisk’s Wegovy to help add $20 billion to the value of the market in a decade.”

About the public’s health

Trends in Screening for Social Risk in US Physician Practices “This cross-sectional study found that in 2022, 27% of physician practices reported systematically screening patients for 5 common social risks, a significant increase from 15% in 2017.

Diet-wide analyses for risk of colorectal cancer: prospective study of 12,251 incident cases among 542,778 women in the UK “We showed a positive association [of colorectal cancer] with red and processed meat intake and weaker inverse associations with breakfast cereal, fruit, wholegrains, carbohydrates, fibre, total sugars, folate, and vitamin C. Genetically predicted milk consumption was inversely associated with risk of colorectal, colon, and rectal cancers. We conclude that dairy products help protect against colorectal cancer, and that this is driven largely or wholly by calcium.”

Coffee drinking timing and mortality in US adults “After adjustment for caffeinated and decaffeinated coffee intake amounts, sleep hours, and other confounders, the morning-type pattern, rather than the all-day-type pattern, was significantly associated with lower risks of all-cause (hazard ratio: .84; 95% confidential interval: .74–.95) and cardiovascular disease-specific (hazard ratio: .69; 95% confidential interval: .55–.87) mortality as compared with non-coffee drinking. Coffee drinking timing significantly modified the association between coffee intake amounts and all-cause mortality (P-interaction = .031); higher coffee intake amounts were significantly associated with a lower risk of all-cause mortality in participants with morning-type pattern but not in those with all-day-type pattern.”

About healthcare IT

HHS proposes new cybersecurity requirements as first major HIPAA update in 10 years “The Department of Health and Human Services (HHS) proposed a rule days before the new year began that would hold healthcare organizations to a higher standard for protecting sensitive healthcare information from security threats like cyberattacks. 
The proposal would require that entities covered by the Health Information Portability and Accountability Act (HIPAA) achieve specific technical standards like encryption and multifactor authentication. The rule also holds business associates to higher security standards and emphasizes that group health plans have a responsibility to protect electronic health information”

FDA issues first guidance on AI in medicine development “The draft guidance – which is open for comment until 7th April – proposes a risk-based assessment framework that drug developers can use to establish the credibility of an AI model for its intended use. Examples of uses could include predicting patient outcomes, improving understanding of predictors of disease progression, and analysing large datasets from sources like real-world studies or digital health technologies.”

Today's News and Commentary

10 healthcare names get Shkreli Awards for bad behavior If you are concerned about what (and who) is wrong in healthcare, read this article.

About health insurance/insurers

Massachusetts court orders UnitedHealth-owned insurers to pay $165M in penalties “A Massachusetts court has ordered three UnitedHealth-owned insurers to pay over $165 million for engaging in widespread deceptive practices that misled thousands of consumers into purchasing supplemental health insurance they didn't need.” 

About pharma

CVS officially rolls out CostVantage model for commercial prescriptions “All of the commercial prescriptions dispensed at CVS pharmacies will be processed through its CostVantage reimbursement model beginning this year, the healthcare giant announced Monday.
Under the model, prescriptions are priced based on the underlying cost with a delineated markup and dispensing fee to cover the services provided by CVS in the transaction. The company says this model makes it less necessary to raise the cost for certain prescriptions to cover losses on other drugs.
The model also seeks to increase transparency for insurers and pharmacy benefit managers, making it potentially easier for PBMs to establish their own more transparent programs for plans and clients.

About the public’s health

Louisiana health officials report first fatal case of H5N1 bird flu in the US. Here's the latest update “A Louisiana patient who had been hospitalized with the first human case of highly pathogenic avian influenza, or H5N1, in Louisiana and the U.S. has died, the state's health department reported Monday.
This marks the first human death related to bird flu in the U.S.
According to the Louisiana Department of Health (LDH), the patient was over the age of 65 and had underlying medical conditions. The patient contracted H5N1 after exposure to a combination of a noncommercial backyard flock and wild birds, health officials said.”

FDA disappoints child advocates with its new limit on lead in baby food “For the first time in history, the US Food and Drug Administration has established guidance for levels of lead in processed baby foods that are sold on supermarket shelves and online. The agency’s action, announced Monday, only provides guidance to industry and is not enforceable.” 

These common medications could be releasing ‘forever chemicals’ into the environment “The widespread use of pharmaceuticals in America is introducing even more toxic “forever chemicals” into the environment through wastewater, according to a study released Monday, and large municipal wastewater treatment plants are not capable of fully filtering them out…
The researchers found up to three-quarters of the extractable compounds were from 12 commonly prescribed fluorinated medicines, including antidepressants, statins and medications used to treat Type 2 diabetes and HIV. The facilities removed less than 25 percent of the compounds during treatment, the researchers found.”

Burdens of type 2 diabetes and cardiovascular disease attributable to sugar-sweetened beverages in 184 countries The headline says it all (or most of it). Read the abstract to find out which regions are most affected.

Today's News and Commentary

Healthcare Stocks Are Down and Out. Opportunities Abound. A really good WSJ analysis. The link is a gift link for those of you who do not subscribe.

Predatory Journals: What Can We Do to Protect Their Prey? “The number of predatory journals is difficult to accurately determine but was estimated at more than 15 000 in 2021…
The practices that these entities employ include aggressive solicitation of manuscript submissions; the promise of extremely rapid turnaround times; and a lack of transparency about article submission, processing, and even withdrawal charges. Predatory journals may claim that they follow legitimate editorial and publishing practices but do not actually conduct peer review or such functions as archiving journal content, managing potential conflicts of interest, enabling corrections, and responding to author queries in a timely manner. In egregious cases, the ‘published’ articles never appear despite authors having paid the requested fees.”

About health insurance/insurers

NeueHealth to go private in $1.3B acquisition by New Enterprise Associates “NeueHealth, the care management company formerly known as Bright Health, is set to be acquired by venture capital partner New Enterprise Associates later this month.
NEA will purchase the company for $1.3 billion. NeueHealth shareholders will receive $7.33 per share in cash. NEA and 12 NeueHealth investors will exchange their stock for equity.”

Aetna sues drugmakers for widespread price-fixing and collusion “Aetna is taking legal action against Pfizer, Novartis, Teva Pharmaceuticals and others, saying the list of drugmakers conspired to overcharge the insurer, consumers and the federal government for generic drugs.”

10 largest Medicaid managed care plans FYI

About hospitals and healthcare systems

100 of the largest US hospitals and health systems | 2024 FYI

About the public’s health

Caution Needed in Interpreting the Evidence Base on Fluoride and IQ An excellent critique of the article in the same issue of JAMA evaluating levels of fluoride and potential harmful effects.

About healthcare IT

Top EHRs for 40 medical specialties FYI

About healthcare technology

FDA issues draft guidance on ensuring pulse oximeter accuracy across skin tones “To address those concerns, the FDA’s guidance instructs manufacturers on how to improve clinical trial designs and validation efforts for pulse oximeters designed for hospitals and doctors' offices—namely by increasing the number of representative participants in studies—as well as using both subjective and objective measures of skin tones in lab experiments and real-world data.”

Today's News and Commentary

HealthcareInsights.MD will be on vacation for the holidays
and will resume January 6, 2025.
I wish you health and happiness in the coming year.

About health insurance/insurers

BCBS antitrust settlement provider website goes live “The website was launched after the Blue Cross Blue Shield Association, along with the 33 independent BCBS companies, agreed to pay $2.8 billion to settle antitrust claims from healthcare providers, marking the largest settlement of its kind in the healthcare industry. The settlement was reached in October. An Alabama court granted the agreement preliminary approval on Dec. 4.” 

Medical and Surgical Episodes Among Hospital Participants in the Bundled Payments for Care Improvement–Advanced Program Findings  In this cohort study that included 2 895 878 episodes, BPCI-A participation was associated with a decrease in Medicare payments of $882 per episode for medical episodes and $587 per episode for surgical or procedural episodes, a difference of $295 per episode that did not reach statistical significance when compared in absolute terms….
Conclusions and Relevance  In this cohort study analyzing the outcomes of the BPCI-A program for medical and surgical episodes, BPCI-A participation was associated with modestly decreased payments for both medical and surgical episodes compared with nonparticipants. Improvements in clinical outcomes associated with BPCI-A participation were also modest for both types of episodes; this study does not support a hypothesis that either medical or surgical episodes are better-suited for episode-based payments….
[However:] Our study has limitations. The planned duration of the BPCI-A program was 8 years, and we only analyzed the first 12 months. Previous studies have shown that several years of participation may be required before changes in payments and improvements in quality attain statistical significance. We only evaluated the hospital program, and not the PGP [Physician Group Practice] component; we can draw no conclusions about the efficacy of the PGP experience under bundling.”

About hospitals and healthcare systems

10 headwinds for health systems in 2025 A really good summary.

About pharma

PhRMA dues fell almost $100 million as major drugmakers exited “Three large pharmaceutical companies left the brand-drug lobby PhRMA after the passage of Democrats’ drug pricing law in 2022. Following the exits, the organization collected $100 million less in annual membership dues, new tax filings show.”

HHS releases latest round of prescriptions in Medicare rebate program including cancer drugs “The 64 drugs with reduced co-insurance costs for Medicare patients include Kepivance, which treats mouth sores caused by chemotherapy, Talvey, used to treat patients with multiple myeloma, and Yescarta for recurrent or treatment-resistant blood cancer.”

About the public’s health

US flu season is underway, as cases surge in some areas and vaccinations lag “The Centers for Disease Control and Prevention noted sharp increases in several measures, including lab tests and emergency room visits.”

Trump’s Return May Worsen Financial Woes for Global Health Institutions “Currently, the United States provides about half of all aid for global health, exceeding that of all other donor countries combined. In 2020, Mr. Trump began the process of pulling the United States out of the World Health Organization and sought to slash American donations to the Global Fund to Fight AIDS, Tuberculosis and Malaria and to PEPFAR, a program that supplies much of the H.I.V. treatment to Africa.
A really good article that summarizes the sources of financial aid to developing countries.

About healthcare IT

About healthcare quality

Variation in Emergency Department Physician Admitting Practices and Subsequent Mortality “In this cross-sectional study using electronic health record data from more than 2 million ED visits treated by 2098 physicians across 105 EDs, being treated by a physician with an admission propensity at the 90th percentile relative to a physician at the 10th percentile nearly doubled a patient’s probability of being admitted to the hospital but did not reduce their subsequent mortality rate.”  

Aligning Quality Measures Across CMS - the Universal Foundation “To further the goals of the CMS National Quality Strategy, CMS leaders from across the Agency have come together to streamline quality measures across CMS quality programs for the adult and pediatric populations. This “Universal Foundation” of quality measures will focus provider attention, reduce burden, identify disparities in care, prioritize development of interoperable, digital quality measures, allow for cross- comparisons across programs, and help identify measurement gaps.”

About healthcare technology

FDA designates Neuralink brain implant, infectious disease tests as ‘breakthroughs’ “A brain implant to restore vision loss made by Elon Musk’s Neuralink and several tests to detect infectious diseases are among the latest medical devices to receive “breakthrough” status from the Food and Drug Administration.” 

Today's News and Commentary

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

About health insurance/insurers

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

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

About hospitals and healthcare systems

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

About pharma

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

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

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

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

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

About the public’s health

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

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

About healthcare technology

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

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

Today's News and Commentary

About health insurance/insurers

12 key insurance industry lawsuits in 2024 FYI 

About hospitals and healthcare systems

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

About pharma

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

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

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

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

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

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

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

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

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

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

Today's News and Commentary

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

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

About health insurance/insurers

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

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

About hospitals and healthcare systems

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

About pharma

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

About the public’s health

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

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

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

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