About Covid-19
Biden says ‘pandemic is over’ “President Biden declared the coronavirus pandemic ‘over,’ in apparently off-the-cuff remarks that reflect the growing sentiment that the threat of the virus has receded, even as hundreds of Americans continue to die of covid each day.
’We still have a problem with covid,’ Biden said on ‘60 Minutes,’ which aired Sunday night. ‘We’re still doing a lot of work on it … but the pandemic is over.’”
About health insurance/insurers
UnitedHealth Beats Class Suit Over Office Surgery Facility Fees “UnitedHealth Group. Inc. defeated a class action by more than 200 doctors who say they weren’t paid facility fees for office-based surgeries, when a New York federal judge ruled that the insurer used reasonable payment systems and followed ERISA plan terms.
“[Judge] Oetken’s ruling, issued after a five-day nonjury trial, also blessed UnitedHealth’s ‘C Flag process,’ which internally flags physician offices submitting claims for facility fees and sends these offices a letter inviting them to submit proof of facility licensure. This was a ‘reasonable way to ensure that benefits are administered consistent with plan terms,’ he said.”
Humana raises profit outlook as it looks to regain footing in Medicare Advantage market “Humana is bullish on future growth in Medicare Advantage (MA), its main line of business, in 2023 to bounce back from lackluster performance this year.
The insurer also raised its profit outlook for 2022, sending its shares up some 8% since the news Thursday.
The company projected it will grow its adjusted profits at a 14% annual rate over the next three years, executives told investors.”
Humana looks to buy clinics from PE partner for up to $550M “Humana expects to pay between $450 million and $550 million to acquire the first group of senior-focused primary care centers that it developed through a joint venture with Welsh, Carson, Anderson & Stowe, Chief Financial Officer Susan Diamond said Friday during the insurer’s investor day.
The agreement inked with Welsh Carson in 2020 included options for Humana to acquire the private equity firm’s interest in the joint venture in stages over the next five to 10 years. The venture was expected to open 67 clinics by early 2023. “We are planning for the full acquisition of centers built in partnership with Welsh Carson through our put and call options beginning in 2025,” Diamond said.
In mid-May, Humana and Welsh Carson announced a second joint venture that will spend up to $1.2 billion to open about 100 new value-based primary care clinics for Medicare patients between 2023 and 2025 under the CenterWell Senior Primary Care brand.”
Beneficiary Experience, Affordability, Utilization, and Quality in Medicare Advantage and Traditional Medicare: A Review of the Literature “We found few differences between Medicare Advantage and traditional Medicare that are supported by strong evidence or have been replicated across multiple studies. Both Medicare Advantage and traditional Medicare beneficiaries reported similar rates of satisfaction with their care and overall measures of care coordination. Medicare Advantage outperformed traditional Medicare on some measures, such as use of preventive services, having a usual source of care, and lower hospital readmission rates. However, traditional Medicare outperformed Medicare Advantage on other measures, such as receiving care in the highest-rated hospitals for cancer care or in the highest-quality skilled nursing facilities and home health agencies. Additionally, a somewhat smaller share of traditional Medicare beneficiaries than Medicare Advantage enrollees experienced a cost-related problem, mainly due to lower rates of cost-related problems among traditional Medicare beneficiaries with supplemental coverage. Several studies found lower use of post-acute care among Medicare Advantage enrollees but were inconclusive as to whether that was associated with better or worse outcomes. Findings related to the use of other health care services, including hospital care and prescription drugs, and condition-specific quality of care measures varied – likely due to differences in data and methodology across studies.”
Medicare is using one of its biggest hammers to try to fix the dialysis system: how providers are paid “The new End-Stage Renal Disease Treatment Choices (ETC) model is the largest such experiment in the history of American health care, signaling to some a more aggressive federal approach to improving dialysis. This program, unlike previous voluntary ones, mandates about 30% of dialysis providers in the country participate, and the other 70% are used as a control group…
The ETC model is a two-part incentive system on top of the existing payment system. The first incentives, which rolled out in 2021, were focused on increasing home dialysis use exclusively — centers got a boost in payments for home dialysis use relative to in-center dialysis. The second part of the incentive is payment increases or decreases depending on how dialysis facilities perform in home dialysis, waitlisting patients for organ transplant, and living donor kidney transplantation rates, relative to control facilities…
The ETC model is slated to run through the middle of 2026. After that, it’s up to Medicare to decide whether the program continues or not.”
UnitedHealth beats Justice Dept on $13 billion merger “UnitedHealth Group's $13 billion acquisition of Change Healthcare will proceed, after a federal judge on Monday denied the Justice Department's efforts to block the deal on antitrust grounds.”
About hospitals and healthcare systems
The Current State of Hospital Finances: Fall 2022 Update Highlights:
“Margins remain depressed relative to pre-pandemic levels. After a difficult first half of 2022, optimistic projections for the rest of the year indicate margins will be down 37% relative to pre-pandemic levels.
More than half of hospitals are projected to have negative margins through 2022. Projections for the remainder of the year demonstrate an increase in hospitals with negative margins relative to pre-pandemic levels, to 53%.
Expenses are significantly elevated from pre-pandemic levels. Expenses are projected to increase throughout the rest of 2022, leading to an increase of nearly $135 billion over 2021 levels. Labor expenses are projected to increase by $86 billion, while non-labor expenses are projected to increase by $49 billion.
Hospitals have faced a profound financial toll. Hospitals have incurred serious losses in 2022 relative to pre-pandemic levels and future federal support is uncertain.”
NCQA Unveils 2022 Health Plan Ratings FYI: “The 2022 Health Plan Ratings are based on data from calendar year 2021, when 203 million people were enrolled in health plans that reported Healthcare Effectiveness Data and Information Set (HEDIS®) results to NCQA. Plans are rated on a 0–5 stars scale. Six out of 1,048 health plans that earned a numerical rating achieved 5 stars—the highest possible rating.”
Social Risk Adjustment In The Hospital Readmissions Reduction Program: A Systematic Review And Implications For Policy “These findings support the use of social risk adjustment to improve provider payment equity and highlight opportunities to enhance social risk adjustment in value-based payment programs.”
About pharma
Curbing patent abuse: Tackling the root of the drug pricing crisis Highlights:
■ “On average, there are 74 granted patents on each of America’s ten top selling drugs, providing major drugmakers substantial advantage to keep generic and biosimilar competitors off the market.
■ Drugmakers filed more than 140 patent applications on average per drug; on average 66% of patent applications were filed after the FDA approved the drug to be on the market.
■ Nearly one-third of Revlimid’s cumulative sales in the U.S. have occurred after its primary patents expired, and over two-thirds of Humira’s U.S. sales have come after the expiration of its primary patents.
■ On average, four times as many patents are granted on the top ten drugs in the U.S. compared to Europe.
■ Lower-cost generic and biosimilar versions of three top selling drugs - Humira, Eliquis, and Enbrel - launched in Europe an average of 7.7 years earlier than their expected U.S. entry. During this time, without generic or biosimilar competition Americans will spend an estimated $167 Billion on branded versions of just these three drugs. To date, these drugs still do not have generic or biosimilar competition in the U.S.”
McKesson to acquire private pharmacy tech company “Pharmaceutical and medical supply company McKesson signed an agreement Sept. 19 to acquire Rx Savings Solutions, a tech insights business that aims to lower drug costs, for up to $875 million.”
About health technology
FDA slaps Class I tag on Baxter recall of Clearlink chemotherapy delivery sets “After uncovering a handful of patient safety and cybersecurity risks in many of its infusion pumps over the last year, Baxter has now begun a recall of yet another product that works alongside those pumps.
The medtech giant’s latest recall concerns some of its solution sets, also known as IV sets, which connect patients to their prescribed IV bags and bottles of medications. It’s specifically focused on the Clearlink Basic Solution Sets with Duovent, a drug that’s used to open the airways.
According to Baxter, which first issued the recall notice (PDF) in early August, the company has received an increased number of reports of leaks in the Clearlink IV sets. As of this week, the FDA has categorized the recall as Class I, indicating a high risk of patient injury or death.”
About healthcare finance
AmerisourceBergen (ABC) to Buy Germany's PharmaLex for $1.3B “AmerisourceBergen Corporation announced that it has signed a definitive agreement to acquire Germany-based PharmaLex Holding GmbH for €1.28 billion (approximately $1.3 billion) in cash.
PharmaLex is a leading provider of specialized services for the life sciences industry that is owned by funds advised by AUCTUS Capital Partners AG. The company consists of a global team of scientific, regulatory, and safety and compliance experts who provide strategic guidance and regulatory support to biopharma companies throughout a product’s lifecycle.”