About health insurance/insurers
Clover Health execs say MCR improvements, cost reduction program put it on path toward profitability “Clover Health made significant strides in addressing its medical cost ratio (MCR), which executives said Tuesday sets the company up for its future profitability goals.
The Medicare Advantage insurtech reported an MCR of 86.6% in the first quarter of 2023, down from 96.4% in the prior-year quarter. Clover Health also slimmed its losses to $72.6 million in the first quarter, down from $75.5 million in the first quarter of 2022.
Revenues were down substantially, however. Clover brought in $527.8 million in revenue for the first quarter, compared to its $874.4 million haul in the first quarter of 2022. That said, premium revenue grew year over year, reaching $317.1 million.”
Troubled insurtech Bright Health focused on sale of California MA plans, execs say “Selling off the last of its insurance business is critical to staving off bankruptcy. The company secured an extension to its credit facility through June 30. According to a company spokesperson, ‘Bright must deliver an initial draft purchase agreement with respect to the proposed sale of the California Medicare Advantage business to one or more interested buyers no later than May 31, 2023.’
The company overdrew its credit facility and needs to raise about $300 million to avoid going under.”
Oscar Health to exit California's ACA exchange in 2024 “Oscar Health will pull out of California's individual market for the 2024 plan year, CEO Mark Bertolini told investors Tuesday…
Oscar Health posted a net loss of $39.7 million in the first quarter of 2023, slimming its losses considerably from $75.1 million in the prior-year quarter. Revenues in the quarter were $1.5 billion in the first quarter of 2023, up from $972.8 million in the first quarter of 2022.
The company reported about 1 million total members in its plans in both 2022 and 2023, although there were 56,000 fewer members this year than last. Membership in its individual and small group plans dropped from 1,032,768 in 2022 to 948,431 in 2023.”
About hospitals and healthcare systems
Market Analysis and Monthly Hospital & Physician KPIs MARCH 2023 DATA Lots of interesting stats in this report, but focus on these:
”Per-physician expenses continued to rise in the first quarter of 2023, as they have each quarter for more than two years. Total Direct Expense per Full-Time Equivalent (FTE) — including advanced practice providers — rose to $973,420 in Q1 2023, up 14.2% versus the same quarter of 2022…
Per-physician revenues increased in the first quarter, as they have each quarter for the past year. Median Net Revenue per Physician FTE reached $668,775 in Q1 2023, up 15.7% from Q1 2022 and up 6.8% from Q4 2022.”
How are hospitals profiting by employing physicians?
Group purchasing organization Premier exploring potential sale, other strategic alternatives “The board of healthcare group purchasing organization Premier Inc. announced Monday that it has retained financial and legal advisers to explore a potential sale or other strategic alternatives…
In quarterly earnings reported last week, the company reported nine-month net revenues had fallen roughly 8.8% from the previous year. Nine-month net income attributable to stockholders had also dropped from $236 million in fiscal 2022 to $154 million in fiscal 2023.”
CommonSpirit plans to have virtual nursing in every market by end of '23 “Chicago-based CommonSpirit Health intends to have virtual nursing in each of its markets by the end of 2023, with plans to have it across the entire system within five years.
The health system, which has more than 140 hospitals across 21 states, has started rolling out its proprietary virtual nursing technology with a recent launch at Saint Joseph Hospital in Lexington, Ky…
CommonSpirit has two types of virtual nurses: ones who work at a command center to help with admissions, discharges and transfers, and ones who are part of the care team, attending rounds with physicians and being available to patients at the push of the button. The system is debuting the initiative in its medical-surgical units.”
About pharma
3rd Circ. Says J&J Talc Unit's Ch. 11 Should Proceed The headline is the story.
DEA extends telemedicine option for prescribing controlled medications “The federal government will allow doctors to keep using telemedicine to prescribe certain medications for anxiety, pain and opioid addiction, extending for six months emergency flexibilities established during the coronavirus pandemic…
The ability to prescribe controlled medications remotely will run through Nov. 11, 2023. And that deadline will be longer still if doctors have already established a telemedicine relationship with patients. In that circumstance, physicians can keep prescribing the medications virtually through Nov. 11, 2024.”
Eli Lilly damages tripled to $184M in Medicaid rebate fraud case “When a federal jury last year ordered Eli Lilly to pay $61 million for skimping out on Medicaid rebates, the company vowed to fight the verdict. But instead of the result Lilly wanted, the award has been tripled to more than $183 million.
On Tuesday, Illinois federal judge Harry Leinenweber ruled that Eli Lilly owes triple damages from last year's award after whistleblower Ronald Streck convinced a jury that the company violated the False Claims Act and short-changed Medicaid on rebate payments.
Since the case falls under the False Claims Act, the award was eligible for ‘trebled’ damages, according to court filings.”
About the public’s health
FDA advisers endorse making birth control pill available over the counter “Advisers to the Food and Drug Administration on Wednesday unanimously endorsed making birth control pills available without a prescription, overriding concerns raised by the agency about whether the medication could be used in a safe and effective manner without physician oversight.
The FDA’s outside experts expressed confidence, in a 17-0 vote, that consumers could use an oral contraceptive called Opill correctly. They said the benefits of over-the-counter status, such as increased access to contraception, outweighed the risks, including a potential lack of adherence to daily pill-taking that could result in unintended pregnancies…
The FDA does not have to follow the guidance of its advisers, but a rejection of the OTC application — especially given the committee’s view — would be awkward for an administration that has repeatedly pledged to protect reproductive rights following the Supreme Court’s overturning of Roe v. Wade, which guaranteed the nationwide right to abortion.”
About health technology
Human ‘pangenome’ published, with goal of making genomics more useful for diverse populations Read the entire article- it is fascinating!
“An international team of scientists has assembled the first human ‘pangenome’ — an attempt to make a more representative reference genome, one that captures almost all the genetic variability residing in the DNA of humans around the globe.
The technological achievement, published Wednesday in Nature, is the result of years of work by more than 100 researchers behind The Human Pangenome Project, a $30 million effort launched in 2019 and funded by the U.S. National Human Genome Research Institute.”
About healthcare finance
Bicycle rides to 2nd $1.7B Big Pharma deal in 2 months, this time with Bayer “Bayer has taken its radiopharmaceutical pipeline up a gear, paying out $45 million upfront to Bicycle Therapeutics in a collaboration spanning multiple oncology targets.
Bicycle will use its phage platform to discover and develop so-called bicyclic peptides, which consist of 9 to 20 amino acids that can bind to specific targets. This morning’s release offers few clues to the number and exact application of the peptides to be covered by the deal beyond ‘several undisclosed oncology targets.’
The German Big Pharma will oversee and bankroll all development from preclinical work through potential commercialization. Including the upfront payment, Bayer’s total payout to Bicycle could top out at $1.7 billion once development and commercial milestone fees are taken into account.”
All the rumors are true: Syneos Health inks $7.1B acquisition with investment firm trio “All the rumors are true. After months of sale speculation, Syneos Health has officially been snapped up by three private investment firm affiliates for the eye-watering sum of $7.1 billion.
The North Carolina-based CRO has inked a deal to be acquired by Elliott Investment Management, Patient Square Capital and Veritas Capital for $43 per share in cash. The total transaction is valued at $7.1 billion, a figure that includes outstanding debt. The purchase price adds a 24% premium to Syneos’ closing stock price on Feb. 13—the last day of trading before media reports surfaced suggesting the CRO was searching for a buyer.”