About health insurance
Grandfathered Group Health Plans and Grandfathered Group Health Insurance Coverage: This proposed rule from the Departments of Labor, HHS and Treasury (IRS) will be issued for comment on Wednesday. If finalized, it would “amend current rules to provide greater flexibility for certain grandfathered health plans to make changes to certain types of cost-sharing requirements without causing a loss of grandfather status.” Recall that when the ACA was passed, certain group health plans were grandfathered so they could keep the terms of coverage. If anything subsequently changed, plans would lose that exemption. These changes would allow the plans to retain their grandfathered status.
MultiPlan and Churchill Capital Corp III Reach Agreement to Combine: “Churchill Capital Corp III, a public investment vehicle, and MultiPlan, Inc., a market-leading, technology-enabled provider of end-to-end healthcare cost management solutions, announced today that they have entered into a definitive agreement to merge. The combined company will operate as MultiPlan and will be listed on the NYSE. The transaction implies an initial enterprise value for MultiPlan of approximately $11 billion or approximately 12.9x estimated 2021 Adjusted EBITDA. The transaction will bring to MultiPlan up to $3.7 billion of new equity or equity linked capital to substantially reduce its debt and fund new value-added services.”
Oak Street Health files to go public: “Oak Street is a tech-enabled, value-based care primary care company that specifically targets Medicare-eligible patients, particularly those in underserved communities..”
Judge vacates CMS rule forcing ACA insurers to bill separately for abortions: “A federal judge in Maryland has vacated the Trump administration's 2019 rule that would require Affordable Care Act (ACA) marketplace insurers to bill separately for abortions.
Judge Catherine Blake for the District Court for the District of Maryland ruled Friday that the restrictions were "arbitrary and capricious" and violates the ACA. The case was brought by Planned Parenthood and the American Civil Liberties Union.”
State of Medicare Advantage: Report July 2020: An excellent review of the current state of the Medicare Advantage program looking at cost, quality and access issues. The reason these plans are important is because:
”In June 2020, there were 24.2 million Medicare Advantage beneficiaries, and over 68 million people eligible for Medicare. While the total number of enrolled beneficiaries in Medicare in 2020 has not been released, based on CMS’s projections Medicare Advantage penetration will reach 40% of overall enrollment in 2020…
In 2020, 99% of Medicare beneficiaries have access to at least one Medicare Advantage plan, with on average, 39 plan choices per county.”
About the public’s health
White House takes aim at Fauci as he disagrees with Trump on virus: A good summary of the rift. The part that caught my eye was:
“In an interview on NBC's ‘Meet the Press’ Sunday, Adm. Brett Giroir, a member of the White House coronavirus task force, said there is ‘open discourse’ within the team.
‘I respect Dr. Fauci a lot, but Dr. Fauci is not 100% right and he also doesn't necessarily -- and he admits that -- have the whole national interest in mind. He looks at it from a very narrow public health point of view,[emphasis added]’ Giroir said.”
In the end, what other view matters?
Long delays in getting test results hobble coronavirus response: “The long testing turnaround times are making it impossible for the United States to replicate the central strategy used by other countries to effectively contain the virus — test, trace and isolate. Like catching any killer, speed is of the essence when it comes to the coronavirus.” The article is a current update on the problem we have had from the beginning of the pandemic.
New U.S. dietary guideline recommendations take aim at sugar for children and adults: “The committee, a group of 20 doctors, registered dietitians and public health experts, recommends reducing added sugars to 6 percent of daily calories, from 10 percent….
And for the first time, the committee made recommendations for children up to 2 years old, suggesting a ban on sugar-sweetened beverages. The experts argued that calories from sugar-sweetened beverages may displace those from nutritious foods and increase the risk of the child becoming overweight.”
About hospitals and health systems
UHS settles false claims allegations for $122M:”As part of the settlement, announced July 10, UHS and UHS of Delaware Inc. agreed to pay $117 million to resolve allegations that the hospitals and facilities knowingly submitted false claims to government insurers, including Medicaid, Medicare and Tricare.
Prosecutors alleged that the company billed for inpatient behavioral health services that were not medically necessary or failed to provide adequate services for patients admitted to its facilities. The alleged billing scheme occurred between January 2006 and December 2018, prosecutors said.“
About pharma
Coronavirus (COVID-19) Update: FDA prepares for resumption of domestic inspections with new risk assessment system: From the FDA: “At this time, we are working toward the goal of restarting on-site inspections during the week of July 20. However, resuming prioritized domestic inspections will depend on the data about the virus’ trajectory in a given state and locality and the rules and guidelines that are put in place by state and local governments. In order to move to the next phase, we must see downward trends in new cases of COVID-19 and hospitalizations in a given area. Our ability to resume is also affected by other services that have been curtailed by the pandemic, such as public transportation. The availability of these services will be an important factor in how we determine resuming domestic inspections.”
About healthcare IT
Doximity Telehealth App Becomes One of the Most Used Telemedicine Tools in the U.S.:After you get through some self-promotion, there are a couple interesting findings of their research:
“Physician adoption by age: Physicians in their 40’s and 50’s are using telemedicine more often than younger colleagues in their 30’s.
Physician adoption by gender: A gender disparity was identified among physician users, showing female doctors adopting telemedicine at a much higher rate (25%) than their male colleagues.”
4 AI systems outperforming medical experts: Interesting summary of four AI technologies.