About health insurance/insurers/costs
Healthy Marketplace Index Using nearly 4.3 billion commercial claims from 2017 to 2021, HCCI [Health Care Cost Institute]tracks drivers of health care spending across 183 U.S. cities through the Healthy Marketplace Index (HMI) project.” You can enter your location on this interactive site. It is set to Chicago as default.
Employers are increasingly suing their health plan for claims data “Lawsuits from large companies and employers are increasingly being filed against third-party health plan administrators in an effort to access complete employee medical claims data.
Through lawsuits recently filed against Aetna, Elevance Health and BCBS Massachusetts, employers claim payers have breached their fiduciary duties by not allowing complete access to claims data and how claims are processed.
In a June 30 complaint, Kraft Heinz alleged Aetna has used its role as its TPA "to enrich itself to Kraft Heinz's detriment" through undisclosed fees and processing medical and dental claims without human review.”
Medicaid work requirements resurface, threatening health A really good review of the topic.
Who Enrolls in Medicare Advantage vs. Medicare Fee-for-Service Excerpts:
—Demographically, MA enrollees differ meaningfully from FFS enrollees (Table 1). MA has a slightly higher proportion of males. Compared to FFS, those in MA are also twice as likely to be non-white, and much more likely to be Black, Hispanic, or Asian…
—Perhaps the starkest difference between the two groups is in the types of commercial plans in which they were enrolled, pre-65: MA enrollees are over 50% more likely than those in FFS to have been enrolled in an HMO plan (recall that 100% of both groups were in commercial coverage, pre-65). Given that MA plans tend to have relatively more restrictive care management policies, it makes sense that individuals who have previous exposure to care management would be more comfortable with that type of coverage under MA…
—The average income of an FFS enrollee (based on their corresponding ZIP9) is $85,085, compared to $76,720 for an MA enrollee. This gap arises from the relative lack of MA enrollees in the most affluent segments: while 35.5% of FFS enrollees live in a ZIP9 with incomes above $100,000, this is true for only 23.8% of MA enrollees. The average MA enrollee has a net worth that is only 74.2% of that of the average FFS enrollee…
—MA enrollees are more likely to face many other socioeconomic disadvantages relative to their FFS enrollee counterparts. Those in their near neighborhood are more likely to have only a high school education or less and slightly more likely to live in a high unemployment area, though the latter comparison is not statistically significant. They are less likely to own their home, to be married, and to own a vehicle, and more likely to have difficulty speaking English. Additionally, based on two aggregate measures of social risk, the Area Deprivation Index and the Socioeconomic Status (SES) index, MA enrollees are more socioeconomically disadvantaged than those in FFS.
—We find that, immediately prior to enrollment, those going into MA are modestly less sick than their FFS enrollee counterparts, having about 10% lower Hierarchical condition category (HCC) risk scores (0.566 vs 0.517) and Charlson Comorbidity Index (CCI) scores (0.853 vs. 0.751).
—MA and FFS enrollees have similar prevalence of the top chronic conditions among Medicare beneficiaries including hypertension and hyperlipidemia. FFS enrollees are more likely to have certain conditions, including cancer, joint issues (rheumatoid arthritis, osteoarthritis, and osteoporosis), and heart issues (ischemic heart disease and prior experience with heart failure). On the other hand, MA enrollees are more likely to have diabetes.”
About hospitals and healthcare systems
CMS to return $9B to 340B hospitals under new plan “The CMS’ long-awaited fix to repay hospitals for what the Supreme Court last year determined to be years of underpayments in the 340B drug discount program is garnering a mixed reaction from hospital groups.
The remedy proposed by regulators Friday would have Medicare send $9 billion in lump-sum payments to more than 1,600 hospitals that participate in 340B. To pay for the proposal, which needs to be budget-neutral, the CMS would cut payments to all hospitals for non-drug items and services by 0.5% over the next 16 years.”
About the public’s health
What is the cost-effectiveness of menu calorie labelling on reducing obesity-associated cancer burdens? An economic evaluation of a federal policy intervention among 235 million adults in the USA “Considering consumer behaviour alone, this policy was associated with 28 000 (95% UI 16 300 to 39 100) new cancer cases and 16 700 (9610 to 23 600) cancer deaths averted, 111 000 (64 800 to 158 000) QALYs gained, and US$1480 (884 to 2080) million saved in cancer-related medical costs among US adults. The policy was associated with net cost savings of US$1460 (864 to 2060) million and US$1350 (486 to 2260) million from healthcare and societal perspectives, respectively. Additional industry reformulation would substantially increase policy impact. Greater health gains and cost savings were predicted among young adults, Hispanic and non-Hispanic Black individuals.”
Half of US adults skip common health screenings, including tests for certain diseases, survey finds “Americans are likely to skip important health screenings, and women have a less positive outlook than men regarding their current and future health prospects, according to a survey released by Aflac.
The survey, based on about 2,000 employed adults, examined attitudes, habits and opinions about health and preventive care and found that half of adults have avoided at least one common health screening. These screenings include tests for certain diseases.
But for the 51% of respondents who said they have had cancer, that diagnosis came following a routine checkup or screening. For Hispanic survey respondents, 72% of individuals said a diagnosis was discovered at a routine checkup.”
About healthcare IT
Two Years After Coding Changes Sought to Decrease Documentation, Notes Remain ‘Bloated’ “We evaluated 1.7 billion clinical notes written by 166,318 outpatient providers in the U.S. from May 2020 to April 2023 to determine the average length in characters for each note. We found that the average note length across all clinical notes has increased 8.1%, from 4,628 characters in May 2020 to 5,002 characters in April 2023…
However, despite these increases in note length, the average time spent writing notes decreased 11.1% over this same period, from an average of 5.4 minutes per note to 4.8 minutes per note. Additionally, providers are spending less time in clinical review activities in the EHR…
These findings align with previous research that found increased use of SmartTools and copy/paste functions were correlated with longer notes.”
HCA Healthcare Reports Data Security Incident “HCA Healthcare, Inc..recently discovered that a list of certain information with respect to some of its patients was made available by an unknown and unauthorized party on an online forum. [It is estimated that about 11 million people are affected.] The list includes:
Patient name, city, state, and zip code;
Patient email, telephone number, date of birth, gender; and
Patient service date, location and next appointment date.”
About healthcare personnel
THE EMPLOYMENT SITUATION — JUNE 2023 From the Bureau of Labor statistics. “Health care added 41,000 jobs in June. Job growth occurred in hospitals (+15,000), nursing and residential care facilities (+12,000), and home health care services (+9,000). Offices of dentists lost 7,000 jobs. Health care has added an average of 42,000 jobs per month thus far this year, similar to the average gain of 46,000 per month in 2022.”