About health insurance/insurers
18 payers to join CMS value-based Medicare Advantage model for 2023 “CMS' Value-Based Insurance Design program for Medicare Advantage plans is growing for 2023, expanding to 52 participating organizations, the agency said Sept. 29.
CMS estimates the number of enrollees covered by the program will increase by 24 percent this year with the new participating organizations, according to a news release.
The model, started in 2017, is designed to test improvements in care quality for Medicare Advantage plan enrollees, including people with low income and those dually eligible for Medicare and Medicaid.
Medicare Advantage plans participating in the test can offer supplemental benefits like nutrition and transportation assistance, reduced cost sharing, or other incentives designed to promote healthy behavior and health equity.”
Optum, Change Healthcare complete $7.8B merger “Optum has completed its $7.8 billion merger with Change Healthcare.
Optum's parent company, UnitedHealth Group, completed the acquisition Oct. 3, which merges Optum with healthcare data and analytics giant Change Healthcare, according to an Oct. 3 press release. The acquisition allows Optum to gain access to data from millions of healthcare transactions covering a broad swath of the U.S. population.”
Health care costs in retirement: They could exceed $300K for women, $264K for men “A healthy 65-year-old man can expect to incur up to $264,000 in health care expenses during retirement, while a woman retiring at age 65 may spend up to $300,000, according to a projection by consulting and actuarial firm Milliman Inc.
The 2022 Retiree Health Cost Index projects total premiums and out-of-pocket expenses for medical and prescription drug costs in retirement and looks at cost variations across sex, geography and the two most common coverage options for Medicare-eligible retirees.
According to Milliman, a healthy 65-year-old man with a Medicare Advantage plus Part D (MAPD) plan will spend $137,000 in health care expenses, while the same retiree with Original Medicare with Medigap (Plan G) and Part D is projected to spend $264,000. A corresponding woman on MAPD will spend $158,000 and on Original Medicare will spend $300,000. That equates to savings needed of between $92,000 and $177,000 for a man and $103,000 and $194,000 for a woman. Higher health care costs for women are largely the result of longer life expectancy when compared to men.”
About hospitals and healthcare systems
September 2022 National Hospital Flash Report Highlights:
1. “Volumes were higher in August than in July, boosting revenue. However, costs still climbed slightly month-over-month as hospitals and health systems continue to shoulder heightened expense loads.
2. Expenses rose, but not as much as revenue. Supplies and expensive drugs contributed to this uptick more than labor costs, which remain elevated.
3. Outpatient revenue slightly drove up margin. This metric is substantially higher than it was in August of 2021. It demonstrated the most growth month-over-month as patients scheduled more elective procedures.
4. Hospitals are still facing extreme difficulty. Nine months into a challenging year, margins have fluctuated wildly. Although most metrics improved from July to August, organizations are still operating with negative margins and well below pre-pandemic levels.
5. New market entrants present strategic challenges. As disruptors chip away at outpatient volume, hospitals should reimagine how to deliver care in non- hospital settings as part of their long-term planning.”
About pharma
Amylyx's ALS drug will cost $158K for annual supply “A recently approved amyotrophic lateral sclerosis treatment will be $158,000 for a year's supply, the product's manufacturer said in a Sept. 30 investor conference call, according to The New York Times.”
Rite Aid lost $331M in Q2 “Rite Aid reported a loss of nearly $331.3 million in its second fiscal quarter, which is three times more than its loss in its 2021's second quarter…
the Philadelphia-based retail pharmacy chain attributed the most recent financial results to inflationary pressures.”
HHS: Price of more than 1,200 drugs outpaced inflation “Between July 2021 and July 2022, the prices for 1,216 drugs rose more than the 8.6 percent rate of inflation, with these products having an average price increase of 31.6 percent. The price increases observed in 2022 were affected by the high rate of general inflation this year. The HHS report noted that most drug price increases occur in either January or July.
The prices for some drugs rose by more than 500 percent in 2022. The antifungal fluconazole, a common medicine, saw increases of 1101 percent, with the price of one 150 mg tablet rising from $2 to $28.
Some of the drugs that saw the highest dollar amount increases in 2022 include lymphoma medications like Tecartus, Yescarta and Zevalin as well as diabetes medications like Korylm, though the overall percentage increases were small due to the already enormous cost of these drugs.”
About healthcare IT
Prevalence and Sources of Duplicate Information in the Electronic Medical Record “In this cross-sectional analysis of 104 456 653 routinely generated clinical notes, 16 523 851 210 words (50.1% of the total count of 32 991 489 889 words) were duplicated from prior documentation. Duplicate content was prevalent in notes written by physicians at all levels of training, nurses, and therapists and was evenly divided between intra-author and inter-author duplication.”