About health insurance/insurers
Traditional Medicare or Medicare Advantage: How Older Americans Choose and Why Good summary from the Commonwealth Fund. No surprises, however: those who choose traditional Medicare value freedom to choose providers; Medicare Advantage enrollees value the extra benefits and “out of pocket cost limits.”
Elevance Health beats the Street with $1.6B in profit for Q3 “The company released its quarterly earnings report Wednesday morning. Profits were up 7.2% from the prior-year quarter, where Elevance Health posted $1.5 billion. The insurer, formerly Anthem, also surpassed Wall Street's expectations on revenue, according to Zacks Investment Research, with $39.9 billion.
Revenues were up 11.5% from the third quarter of 2021, when the company reported $35.8 billion in revenue.”
As ACA Marketplace Enrollment Reaches Record High, Fewer Are Buying Individual Market Coverage Elsewhere “Now, with enhanced subsidies in place, the vast majority of people buying coverage on the individual market are subsidized. The recently passed Inflation Reduction Act continues the ARPA subsidies without interruption for another three years through 2025. That means premiums are capped for people with incomes over 400% of the poverty level ($111,000 for a family of 4) who were ineligible for subsidies previously, and those who were already eligible for subsidies are paying even less than they were before. Overall, about three in four individual market enrollees are now subsidized – by far the highest share since the ACA was implemented – and some of those who aren’t receiving a subsidy might find they are eligible if they moved onto the Marketplace.”
About hospitals and healthcare systems
2022 State of Healthcare Performance Improvement: Mounting Pressures Pose New Challenges Select “Survey Highlights
100% of respondents have adopted some type of recruitment and retention strategy 98% have raised starting salaries or minimum wage
69% reported an increase in inpatient length of stay over the past year
67% have seen wage increases of more than 10% for clinical staff
67% reported an increased rate of claim denials
66% have run their facilities at less than full capacity because of staffing shortages
63% have pursued at least one outsourcing solution; the most common areas were revenue cycle, environmental services, and IT
56% have at least a 1-to-1 ratio of advanced practice providers to physicians in their physician enterprise; 40% have a ratio of 2-to-1 or higher”
Request a view: Having window in hospital room increases odds of survival after surgery “Researchers from the University of Michigan report that certain hospital room qualities — such as having a window view, staying in a single room, or closer proximity to a nursing station — may influence outcomes following high-risk operations.”
About pharma
Mark Cuban's online pharmacy, Vivio partner on specialty drugs for health plans, employers “Mark Cuban's online pharmacy, Cost Plus Drug Co., has picked up another partner to help it enter the specialty drug market.
Cost Plus said Oct. 18 it's now collaborating with Vivio, a San Leandro, Calif.-based specialty drug management platform that markets itself as a PBM alternative.
Vivio's clinicians and researchers match evidence from drug trials with individual patient data to improve outcomes and lower costs for their customers, which include health plans and self-insured employers.”
'Stickier than most have assumed': Abbott upends COVID forecasts yet again with $1.7B in test sales “After kicking off 2022 with its highest COVID test sales haul for a single quarter since the start of the pandemic—helped along by a new $1 billion contract with the U.S. government—Abbott predicted that marked the last hurrah for COVID-related sales. Though it roped in more than $3.3 billion in test sales during that three-month period alone, it forecasted full-year sales of just $4.5 billion, spreading out one last billion-dollar haul across the entire remaining nine months of the year.
One quarter later, Abbott had already far surpassed those expectations, reeling in another $2.3 billion in COVID test sales. Even so, it took a conservative view toward the end of the year, penciling in only another $500 million in test sales for the entire second half.
Fortunately for Abbott, once again, those predictions haven’t panned out. In its third-quarter earnings report, released Wednesday, the medtech giant tallied another $1.7 billion in the category, bringing its year-to-date total to more than $7 billion.”
Lilly to Acquire Akouos to Discover and Develop Treatments for Hearing Loss “Lilly will commence a tender offer to acquire all outstanding shares of Akouos for a purchase price of $12.50 per share in cash (an aggregate of approximately $487 million) payable at closing plus one non-tradeable contingent value right per share ("CVR") that entitles the holder to receive up to an additional $3.00 in cash, for a total consideration of up to $15.50 per share in cash without interest (an aggregate of up to approximately $610 million).”
”Akouos has integrated expertise across otology, inner ear drug delivery, and gene therapy with the goal of addressing the needs of people living with disabling hearing loss worldwide. Akouos's lead product candidate, AK-OTOF, is a gene therapy for the treatment of hearing loss due to mutations in the otoferlin gene (OTOF). Additional pipeline programs span across multiple inner ear conditions, and include AK-CLRN1 for Usher Type 3A, an autosomal recessive disorder characterized by progressive loss of both hearing and vision; GJB2 (which encodes connexin 26) for a common form of monogenic deafness and hearing loss; and AK-antiVEGF for the treatment of vestibular schwannoma.”
About the public’s health
FDA, DOJ Seek Permanent Injunctions Against Six E-cigarette Manufacturers “U.S. Department of Justice (DOJ), on behalf of the U.S. Food and Drug Administration, filed complaints for permanent injunctions in federal district courts against six e-cigarette manufacturers. These cases represent the first time the FDA has initiated injunction proceedings to enforce the Federal Food, Drug, and Cosmetic (FD&C) Act’s premarket review requirements for new tobacco products.
Each of these defendants failed to submit premarket applications for their e-cigarettes and have continued to illegally manufacture, sell, and distribute their products, despite previous warning from the FDA that they were in violation of the law. The injunctions would require the companies and named individuals to stop manufacturing, selling, and distributing their e-cigarettes. The injunctions would also require the defendants to obtain marketing authorization from the FDA before marketing such products, as required by law.”
NATIONAL BIODEFENSE STRATEGY AND IMPLEMENTATION PLAN From the White House:
”The Strategy has five goals with associated objectives for strengthening the biodefense enterprise, establishing a layered risk management approach to countering biological threats and incidents.”
'Medically tailored' meals can avert hospital stays, save billions, study says “Question What potential changes in health care utilization and expenditures would be associated with national implementation of medically tailored meal (MTM) access for patients with diet-related diseases and limited instrumental activities of daily living who have Medicaid, Medicare, or private insurance?
Findings This economic evaluation among 6 309 998 eligible US adults found that national implementation of MTMs for patients with diet-sensitive conditions and activity limitations could potentially be associated with 1.6 million averted hospitalizations and net cost savings of $13.6 billion annually from an insurer perspective.”
About healthcare IT
Hospital Capabilities to Enable Patient Electronic Access to Health Information, 2021 Just-published monograph from the ONC.
”HIGHLIGHTS
Seven in ten hospitals enabled patients to access their health information using mobile or other software applications in 2021.
Over half of hospitals enabled patient access through FHIR-based APIs in 2021.
Over four in five hospitals enabled their patients to view their clinical notes in their patient
portal in 2021.
Small, Critical Access, rural, and independent hospitals enabled patient access to health information at lower rates compared to their counterparts.
Nearly three quarters of hospitals using 2015 Edition Certified Health IT reported they provide patients access through apps using APIs.”
Fueling the AI transformation: Four key actions powering widespread value from AI, right now. From Deloitte. Below is a summary of the action recommendations, but the entire report is worth a look.
”Invest in culture and leadership:
Leaders should embark on reinventing work to capitalize on the growing optimism and opportunity that their human workforce sees in AI. People are still at the core of a business’ success, and AI can help unleash the power of a combined human and machine workforce.
Transform operations:
To ensure ethical and quality application of AI,
the entire operating model may need to change
to accommodate the unique capabilities of intelligent machines. Workflows and roles should be reevaluated to manage risk and achieve new value.
Orchestrate tech and talent:
On the flip side of the culture and leadership coin, companies must develop their AI strategies in a tight talent market, with growing off-the-shelf platforms, tools and accelerators that can jump-start a company’s transformation.
Select high-value use cases:
AI is fueling transformations across all industries, and many leaders have begun to unlock which use cases are driving the most value within their given context. The important takeaway is to orchestrate a strategy of both near- and long-term differentiating applications of AI.”