About health insurance/insurers
Millions of Uninsured People Can Get Free ACA Plans From KFF research: “…updating the analysis with 2023 ACA premiums and subsidy amounts, we now find that about 5 million uninsured people are eligible for an ACA Marketplace plan that is essentially free. (This does not include uninsured people who previously fell in the family glitch and who may now be eligible for free plans, so the number of people eligible for a free plan may be slightly higher, though most people in the family glitch were already insured).”
Now the task is identifying those people/families and getting them on the insurance rolls.
HCSC Community Support Strategy Increases Focus on Social Barriers to Health “Health Care Service Corporation (HCSC) is realigning its community investments in 2023 into five newly redesigned strategic pillars to better support its umbrella mission of expanding access to care….
The new pillars are:
Economic Opportunity and Stability: Addressing issues such as poverty, removing barriers to employment, providing good jobs and upskilling.
Nutrition: Supporting efforts to decrease hunger and increase access to nutritious food.
Neighborhood and Built Environment: Focusing on affordable healthy housing, access to transportation and access to physical activity.
Locally Defined Health Solutions: Addressing hyperlocal health and human service needs.
Optimal Health Outcomes: Helping close gaps in care, specifically around six priority areas: immunizations, diabetes care, cardiovascular care, behavioral health, early detection cancer screening and maternal and infant health.”
Comparing Detection, Treatment, Outcomes, and Spending for Patients with Type 2 Diabetes Between Medicare Advantage and Fee-For-Service Medicare “Avalere created cohorts for each disease phase, comprised of matched comparison groups of MA and FFS patients.
Findings
• Among patients with prediabetes who developed type 2 diabetes:
o MA patients received a type 2 diabetes diagnosis earlier (relative to the date of the prediabetes diagnosis) than FFS patients, and
o MA patients had a lower diabetes severity score at diagnosis than FFS patients.
• Among patients with incident diabetes, MA patients were more likely than FFS patients to fill prescriptions for medications to treat diabetes and related conditions within the first year of diagnosis.
o Similarly high shares of MA and FFS patients filled prescriptions for blood pressure and cholesterol medications.
• Among patients with chronic diabetes:
o Similarly high shares of MA and FFS patients visited primary care providers,
o MA patients were more likely than FFS patients to receive preventive care, including diabetes- related office visits and testing for kidney disease, and
o MA patients were less likely than FFS patients to require dialysis.
• Among patients with prediabetes and diabetes:
o MA patients had fewer emergency department visits and hospital admissions than FFS patients,
o Both MA and FFS patients rarely had avoidable hospital admissions, and
o Total medical spending was lower for MA patients than FFS patients. However, among patients with diabetes, MA patients had higher diabetes-related spending than FFS patients.
• Among dual eligible patients with diabetes (i.e., patients who are enrolled in both Medicare and Medicaid), MA patients were more likely than FFS patients to visit a primary care provider and fill prescriptions for diabetes medications. Total medical spending was lower for these MA patients than these FFS patients.”
Comment: The reasons these studies are done is to make sure that, compared to Medicare FFS, the MA economic model is not compromising patient care; as this study shows, the results are frequently the opposite.
About pharma
BioNTech buys UK AI start-up InstaDeep in £562mn deal “BioNTech has agreed to buy UK artificial intelligence start-up InstaDeep for up to £562mn in its biggest-ever deal, as the German company expands beyond the Covid-19 vaccine that transformed its fortunes.”
District court remands 340B underpayment remedy to HHS despite hospitals' push for immediate relief “The Department of Health and Human Services (HHS) will have the final say in how to best compensate 340B hospitals for years of underpayments, disappointing industry groups that had hoped the courts would order a swift resolution.
For months, the courts have been unraveling a June Supreme Court decision declaring a nearly 30% payment rate cut first introduced in 2018 to be unlawful. The top court unanimously rejected HHS’ argument that it did not need to survey hospitals’ acquisition costs before introducing the adjustment but returned the case to lower courts to address potential remedies.”
The Big Three PBMs’ 2023 Formulary Exclusions: Observations on Insulin, Humira, and Biosimilars “For 2023, the three largest pharmacy benefit managers (PBMs)—Caremark (CVS Health), Express Scripts (Cigna), and OptumRx (United Health Group)—have again increased the number of drugs they exclude from their standard formularies.
Each exclusion list now contains about 600 products. Growth in the number of excluded drugs slowed for the second year, due partly to the fact that so many drugs have already been dropped from PBMs’ formularies.”
Read the entire article, it is an excellent current summary and has links to the formulary changes for those “big 3” PBMs.
Airsupra (PT027) approved in the US for asthma “First and only rescue medication approved in the US for as-needed use to reduce risk of asthma exacerbations…
Airsupra is a first-in-class, pressurised metered-dose inhaler (pMDI), fixed-dose combination rescue medication containing albuterol, a short-acting beta2-agonist (SABA), and budesonide, an anti-inflammatory inhaled corticosteroid (ICS) in the US. It is being developed by AstraZeneca and Avillion.”
About healthcare personnel
CMS Awards 200 New Medicare-funded Residency Slots to Hospitals Serving Underserved Communities “Medicare & Medicaid Services (CMS) took a critical step to advance health equity and access to care, awarding the first 200 of 1,000 Medicare-funded physician residency slots to enhance the health care workforce and fund additional positions in hospitals serving underserved communities. Approximately three-quarters of the new positions will be for primary care and mental health specialties.”
About healthcare finance
GE HealthCare makes first acquisition as independent company “Chicago-based GE HealthCare, which spun off from General Electric on Jan. 4, has agreed to purchase Imactis, a maker of advanced radiology equipment.
GE HealthCare did not disclose financial terms of the deal but said in a statement that it intends to fund the transaction with cash on hand. The deal is subject to regulatory approval. GE HealthCare, which makes medical imaging machines, diagnostic tools and digital products used by hospitals, did not immediately respond to a request for comment.
mactis' primary product, CT-Navigation, is an ergonomic device and software duo that uses minimally invasive techniques to perform diagnostic and therapeutic medical procedures like ablations, aspiration, biopsies and body cavity drainage.”