About health insurance/insurers
Healthcare billing fraud: 10 recent cases FYI. Notice the prevalence Medicare/Medicaid cases.
More than 1 million people are dropped from Medicaid as states start a post-pandemic purge of rolls An update on this process: “More than 1 million people have been dropped from Medicaid in the past couple months as some states moved swiftly to halt health care coverage following the end of the coronavirus pandemic.
Most got dropped for not filling out paperwork…
Already, about 1.5 million people have been removed from Medicaid in more than two dozen states that started the process in April or May, according to publicly available reports and data obtained by The Associated Press.”
Major payers' large size propels them to 'stable' outlook: Fitch “The sheer size of the country's largest health plans positions them well for a ‘stable’ business outlook, according to analysts at Fitch Ratings.
The report digs into the outlook for four companies: UnitedHealth, Cigna, Elevance Health and Humana. Each of these insurers benefits from strong market share across multiple metropolitan areas, the analysts said. And while none owns a majority of the market share in the U.S., their penetration in individual regions can be very high.
This gives them very strong positioning when they come to the negotiating table with providers, according to the report.”
About hospitals and healthcare systems
35 health systems ranked by revenue FYI. Note: These figures are more indicative of patient care activity, since many of these organizations have recently had negative “bottom lines.”
About pharma
‘It’s beyond unethical’: Opaque conflicts of interest permeate prescription drug benefits “Employers across the country — from big names like Boeing and UPS to local school systems — pay consulting firms to handle a straightforward task with their prescription drug coverage: Get the best deals possible, and make sure the industry’s middlemen, known as pharmacy benefit managers, aren’t ripping them off with unfair contracts.
But a largely hidden flow of money between major consulting conglomerates and PBMs compromises that relationship, a STAT investigation shows. Some consulting firms often are getting paid more — a lot more — by the PBMs and health insurance carriers that they are supposed to scrutinize than by companies they are supposed to be looking out for.
Consulting firms can collect at least $1 per prescription from the largest PBMs, according to more than a dozen independent drug benefits consultants and attorneys involved with employers’ PBM contracts. That can go as high as $5 per prescription in extreme cases, three of those people said.”
Walgreens, CVS issue new rules to stop denials, delays for lawful reproductive drugs “Walgreens and CVS are voluntarily implementing new procedures designed to improve timely access to medications that, while they can be used for abortion, have been prescribed for other purposes, according to a statement Friday from a federal agency.
Following confusion brought on by the overturning of Roe v. Wade, the U.S. Department of Health & Human Services Office for Civil Rights said it received complaints that pharmacies had delayed or denied filling prescriptions for lawful access to medications, such as methotrexate and misoprostol, and for accessing emergency contraceptives, the HHS OCR statement said…
The pharmacies' new procedures include use of special teams to provide internal guidance and respond to complaints, creating direct paths for customers to submit complaints, new training of reproductive health care and monitoring denials of medication related to reproductive health care, OCR's statement said.”
About the public’s health
Heavy drinkers really don’t ‘handle their liquor,’ study says “It’s a misnomer that heavy drinkers can ‘hold their liquor,’ a new study found.
Instead, people with alcohol use disorder — what used to be called alcoholism — were significantly impaired on cognitive and motor tests up to three hours after downing an alcoholic drink designed to mimic their typical habits.”
Depression and Suicide Risk ScreeningUpdated Evidence Report and Systematic Review for the US Preventive Services Task Force “Direct evidence indicated that screening programs improved depression outcomes. In addition, robust indirect evidence exists that screening tools feasible to administer in primary care settings have reasonable accuracy and that treatment is effective. The direct evidence is more equivocal than the indirect evidence, being based on a smaller number of studies and having fewer statistically significant findings. The presence of additional program components beyond screening in many of the depression screening studies made it difficult to isolate the specific effects of screening alone in these studies…
While there is likely an important role for health care settings, only 1 trial reporting direct evidence on suicide risk screening among primary care patients was found, and it was limited to patients who had screened positive for depression. The findings were inconclusive. This review was scoped to include evidence on screening in broad populations (not only those who screen positive for depression), but no such evidence was found. In addition, there was minimal evidence on the test performance of suicide risk screening instruments; no instrument was addressed in more than 1 study.”
Comment: Read the entire study. It reveals how much we do not know about our screening techniques and whether or not acting on them is effective.
And in a related article: Screening for Anxiety Disorders in AdultsUS Preventive Services Task Force Recommendation Statement “The USPSTF recommends screening for anxiety disorders in adults, including pregnant and postpartum persons. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for anxiety disorders in older adults. (I statement).”
About healthcare IT
Experiences with information blocking in the United States: a national survey of hospitals “Overall, 42% of hospitals reported observing some behavior they perceived to be information blocking. Thirty-six percent of responding hospitals perceived that healthcare providers either sometimes or often engaged in practices that may constitute information blocking, while 17% and 19% perceived that health IT developers (such as EHR developers) and State, regional and/or local health information exchanges did the same, respectively. Prevalence varied by health IT developer market share, hospital for-profit status, and health system market share.”
Note: Per the Cures Act, such blocking is illegal.
Racial and Ethnic Bias in Risk Prediction Models for Colorectal Cancer Recurrence When Race and Ethnicity Are Omitted as Predictors “In this prognostic study of the racial bias in a cancer recurrence risk algorithm, removing race and ethnicity as a predictor worsened algorithmic fairness [emphasis added] in multiple measures, which could lead to inappropriate care recommendations for patients who belong to minoritized racial and ethnic groups. Clinical algorithm development should include evaluation of fairness criteria to understand the potential consequences of removing race and ethnicity for health inequities.”
Comment: A great deal of attention has been focused on measures bias due to inclusion of racial differences. This article is important because it emphasizes the need to evaluate each measure before racial difference inclusions are assumed to be detrimental.
About healthcare finance
Medtech firm Surgalign files for Chapter 11 bankruptcy “Surgalign filed for the bankruptcy with estimated assets and liabilities in the range of $50 million to $100 million in the Bankruptcy Court for the Southern District of Texas.”
Eli Lilly boosts immunology business with $2.4 billion deal for Dice “Eli Lilly and Co. will buy Dice Therapeutics Inc for about $2.4 billion in cash, the company said on Tuesday, bolstering its immune disease-related portfolio with an experimental pill to treat psoriasis.
The company has been looking to bulk up its immunology pipeline, even as it bets on potential blockbuster obesity drug tirzepatide, also known as Mounjaro, to drive future growth.”