About healthcare quality
Aligning Quality Measures across CMS — The Universal Foundation Statement from CMS: “CMS operates more than 20 quality programs focused on individual clinicians, certain health care settings such as hospitals or skilled nursing facilities, health insurers, and value-based entities such as accountable care organizations. Each of these programs has its own set of quality measures; entities report on and are held accountable for their performance on various measures. Although some of these measures are consistent across our programs, many are not…
The Universal Foundation is part of CMS’s efforts to implement the vision outlined in our National Quality Strategy and is fundamental to achieving several of the agency’s quality and value-based care goals. It is intended to focus providers’ attention on measures that are meaningful for the health of broad segments of the population; reduce provider burden by streamlining and aligning measures; advance equity with the use of measures that will help CMS recognize and track disparities in care among and within populations; aid the transition from manual reporting of quality measures to seamless, automatic digital reporting; and permit comparisons among various quality and value-based care programs, to help the agency better understand what drives quality improvement and what does not…
Our intention is that the Universal Foundation will eventually include selected measures for assessing quality along a person’s care journey — from infancy to adulthood — and for important care events, such as pregnancy and end-of-life care.”
See that chart in the article for measures across this “journey.”
About health insurance/insurers
Cigna reports $1.2B in profit, $45.8B in revenue on Q4 beat “Cigna beat the Street on both earnings and revenue, reporting $1.2 billion in profit for the fourth quarter.
The company also brought in $45.8 billion in revenue for the fourth quarter. Analysts polled by Zacks Investment Research expected $45.5 billion. Those figures are both up slightly from the prior-year quarter, when Cigna posted $1.1 billion in profit and $45.7 billion in revenue.”
Plans Generally Offered Some Supplemental Benefits, but CMS Has Limited Data on Utilization “MA plans are required to submit detailed, service-level utilization data to the Centers for Medicare & Medicaid Services (CMS), the agency that oversees MA. These data—known as encounter data—must include supplemental benefits to the extent required by CMS. However, GAO found that information submitted by plans on enrollees’ use of supplemental benefits is limited…”
Over 35 Million Prior Authorization Requests Were Submitted to Medicare Advantage Plans in 2021
"We find that, in 2021:
More than 35 million prior authorization requests were submitted to Medicare Advantage insurers on behalf of Medicare Advantage enrollees.
The volume of prior authorization determinations varied across Medicare Advantage insurers, ranging from 0.3 requests per Kaiser Permanente enrollee to 2.9 requests per Anthem enrollee.
Over 2 million prior authorization requests were fully or partially denied by Medicare Advantage insurers.
Just 11 percent of prior authorization denials were appealed.
The vast majority (82%) of appeals resulted in fully or partially overturning the initial prior authorization denial.”
About hospitals and healthcare systems
Assessment of Patient Retention of Inpatient Care Information Post-Hospitalization “Fifty-three patients participated. The vast majority (> 90%) were confident in their knowledge of their diagnoses and treatment, yet independent review revealed only 58.5%, 64.2%, 50.9%, and 43.4% of patients correctly recalled each respective key domain. Whiteboards were the most frequently used facilitator (96.2%), yet their content was rated least helpful for retaining care information. Patients suggested several areas for improvement, including prioritizing bedside pen and paper along with updating whiteboards with diagnostic and therapeutic information.”
Busy January kicks off 2023 M&A activity: 13 transactions to note FYI
About pharma
Bayer, EMD Serono announce 340B restrictions in wake of pharma's courtroom win “Two more drugmakers have announced they will be restricting some sales of 340B-discounted products to contract pharmacies just two days after the pharma industry was handed a win on the contentious issue by a federal appeals court.
Bayer and EMD Serono, a subsidiary of Merck KGaA, informed customers in letters that they will only be shipping discounted drugs to locations registered as 340B-covered entities or eligible child site locations.”
About the public’s health
Health Care — White House offers new cancer investments “The White House on Thursday marked one year since President Biden relaunched the Cancer Moonshot initiative, announcing a series of new efforts to reduce cancer deaths and provide support to those getting treatment.
The National Cancer Institute will launch a new public-private partnership to assist families with children diagnosed with cancer, the White House said. The Childhood Cancer – Data Integration for Research, Education, Care, and Clinical Trials, or CC-DIRECT, will provide support to families to help them find ideal care for their child and participate in research initiatives like clinical trials and share data on optimal treatments…
The White House also announced that the Health Resources and Services Administration is awarding $10 million to improve access to cancer screenings to improve early detection. The funds will go to 22 National Cancer Institute-designated cancer centers, which will conduct patient outreach in their communities to promote early detection.”
Comment: Not everyone has easy access to such centers. Is this method the best one for accomplishing the outreach goal?
About healthcare IT
2022 CAQH INDEX “By tracking automation along the healthcare administrative workflow and identifying opportunities for improvement, report findings have enabled health plans, providers, government, and vendor organizations to benchmark progress and set a course for greater efficiency and cost savings.”
Really worth a look. Among the findings:
Medical spending increased 47% to $55B, while cost savings from automated processes was $22.3B.
About healthcare personnel
Healthcare adds 58K jobs in January Among the data is the fact that: “Within healthcare, ambulatory healthcare services gained the most jobs in January (29,900).”