About health insurance/insurers
Fidelity® Releases 2023 Retiree Health Care Cost Estimate: For the First Time in Nearly a Decade, Retirees See Relief as Estimate Stays Flat Year-Over-Year “Fidelity Investments®… shared its 22nd annual Retiree Health Care Cost Estimate, revealing that a 65-year-old retiring this year can expect to spend an average of $157,500 in health care and medical expenses throughout retirement. Fidelity’s 2023 estimate remains the same as last year, due to expected limits to retiree out of pocket costs for prescription drugs starting in 2025. This is the first time in nearly a decade that the anticipated health care costs for retirees have stayed flat year-over-year.”
Fiscal Implications for Medicaid of Enhanced Federal Funding and Continuous Enrollment “For a three-year period, states provided continuous enrollment in Medicaid in exchange for an increase in the percentage of Medicaid spending that is paid for by the federal government (the Federal Medical Assistance Percentage or ‘FMAP’)…
Key findings include:
State spending dipped below pre-pandemic levels even as Medicaid enrollment increased by 23 million during the continuous enrollment period. With the substantial enrollment growth, total spending increased, including significant increases in federal Medicaid spending due to the enhanced FMAP.
We estimate states received over $117 billion from the increased FMAP during the continuous enrollment period, with enhanced federal funds comprising a larger share of total Medicaid spending in states that had not adopted Medicaid expansion through the Affordable Care Act (ACA).
Although the magnitude is uncertain, significant decreases in Medicaid enrollment are expected during the unwinding of the continuous enrollment provision, which will result in lower Medicaid spending. Even with lower enrollment, state spending will likely increase as the enhanced FMAP expires.
The phase down of the enhanced FMAP was designed to provide continued financial support to states during the unwinding process and to mitigate sharp increases in state Medicaid spending. How much state Medicaid spending increases as the enhanced FMAP phases down and is ultimately eliminated next year will depend on how many and how quickly people are disenrolled, how many new people come on to Medicaid, and how spending per person in the Medicaid program will change.”
June is the month each year when MedPAC and MACPAC make their annual recommendations to Congress.
While summarizing these extensive documents is not possible, here are a few of the major recommendations:
1. Align Medicare fee-for-service payment rates across all ambulatory settings, meaning eliminating the facility fee for hospital affiliated practices
2. Shifting telehealth payments back to the lower facility rate
3. Giving the Department of Health and Human Services greater authority to set price limits for Part B-covered drugs. Recall the lawsuits by pharma companies and PhRMA to block price regulation.
This article has a more extensive narrative.
Caveat:These Committees only advise Congress. Their recommendations are not binding. Whether or not they are adopted is highly dependent on the political process.
About hospitals and healthcare systems
'You're not God': Doctors and patient families say HCA hospitals push hospice care “…new criticisms are arising related to HCA’s palliative and end-of-life care for patients, according to some physicians and nurses who have worked in its facilities. They say HCA officials press staff to persuade families of ailing patients to initiate such care, as Salas says she experienced with her daughter. Although this can harm patients by withdrawing lifesaving treatments, the push can benefit HCA two ways, the doctors and nurses said, and an internal hospital document confirms. It reduces in-hospital mortality rates, a closely watched quality measure, and can free up a hospital bed more quickly for HCA, potentially generating more insurance reimbursements from a new patient.
This article is based on interviews with six nurses and 27 doctors who currently practice at 16 HCA hospitals in seven states or did so previously.”
Best Children's Hospitals Honor Roll FYI from US News.
Consolidation And Mergers Among Health Systems In 2021: New Data From The AHRQ Compendium
Some highlights:
1. “Larger percentages of providers were affiliated with vertically integrated health care systems in 2021 than in 2018, with three-quarters of hospitals and half of all physicians in one of the 635 identified systems…
2.Merger and acquisition activity that resulted in new systems in 2021 was entirely concentrated in the top and bottom thirds of the system size distribution.”
The entire article is worth reading.
About pharma
CENTER FOR DRUG EVALUATION AND RESEARCH [CDER] Fiscal Year 2022 Report on the State of Pharmaceutical Quality “Key Takeaways
CDER’s Product Catalog contains over 140,000 application and non- application products.
Nearly 90% of essential medicine, medical countermeasures and critical inputs (EM) [Essential Medicine] products have at least one domestic finished dosage form manufacturer; however, 52% of EM products are completely reliant on foreign sites for active pharmaceutical ingredient manufacturing. [Emphasis aded]
Field Alert Reports decreased by 15%, due in part to a decline in the use of injectable products related to COVID-19.”
About the public’s health
CDC advisory panel backs use of GSK and Pfizer RSV vaccines in adults 60 and older “An advisory committee to the Centers for Disease Control and Prevention on Wednesday recommended that adults ages 60 and above, after consulting their doctors, receive a single dose of RSV vaccines from Pfizer and GSK.
The panel said seniors should use “shared clinical decision-making,” which involves working with their healthcare provider to decide how much they will benefit from a shot.
Outgoing CDC director Rochelle Walensky will decide whether to finalize the recommendation.”
2023 Scorecard on State Health System Performance From The Commonwealth Fund: “Scorecard Highlights:
Massachusetts, Hawaii, and New Hampshire top the 2023 State Scorecardrankings for health system performance, based on 58 measures of health care access, quality, use of services, costs, health disparities, reproductive care and women’s health, and health outcomes. The lowest-performing states were Oklahoma, West Virginia, and Mississippi.
Deaths from COVID-19 — as well as premature, avoidable deaths from causes like drug overdoses, firearms, and certain treatable chronic conditions — rose dramatically during the first two years of the pandemic, lowering life expectancy across the United States.
There was wide state variation on the Scorecard’s new measures of health outcomes and access to care for women, mothers, and infants. Maternal mortality and deaths related to substance use rose quickly among women of reproductive age during the pandemic — a particular concern given new state policies limiting reproductive care access.
Temporary federal policies during the COVID-19 pandemic drove uninsured rates to record lows, with nearly all states realizing gains in health coverage. But some of those policies have ended, and high health costs still saddle millions of Americans with medical debt.
There are ways the nation could improve health outcomes and lessen variation from state to state. Federal and state governments could: close the coverage gaps that remain and enroll uninsured people who are eligible for subsidized coverage; improve the cost protections of insurance plans; and lower barriers to reproductive health, preventive health, and behavioral health care, particularly for the most vulnerable.”
A National Survey of OBGYNs’ Experiences After Dobbs This KFF survey has a number of categories of questions and is worth reading in its entirety. One highlight (or lowlight): “Most OBGYNs (68%) say the ruling has worsened their ability to manage pregnancy-related emergencies. Large shares also believe that the Dobbs decision has worsened pregnancy-related mortality (64%), racial and ethnic inequities in maternal health (70%) and the ability to attract new OBGYNs to the field (55%).”
BREAKING: 3M Strikes Deal Worth Up To $12.5B Over PFAS Contamination Claims “Attorneys representing public water systems on Thursday announced that 3M has agreed to pay up to $12.5 billion to end claims over contamination from so-called forever chemicals in firefighting foam, in what they say is the largest settlement over drinking water in U.S. history.”
About healthcare IT
Amazon launches $100M generative AI center, targeting healthcare “Amazon debuted a $100 million generative artificial intelligence center June 22 to help customers harness the new technology.
The AWS Generative AI Innovation Center will connect AI and machine learning experts with the company's cloud clients to build generative AI products and services.”