About health insurance/insurers
Molina to acquire Bright Health's Medicare Advantage business in $600M deal “Molina Healthcare will purchase Bright Health Group's California Medicare Advantage business for $600 million, the two businesses said June 30.
The sale marks Bright Health's exit from the insurance business. The company, which has faced several financial challenges in the past year, ended all of its insurance offerings outside of California at the end of 2022.
Bright Health will use the proceeds from the sale to pay off its debts and pay liabilities remaining from its shuttered individual insurance business, the company said in a news release. The company breached its minimum liquidity requirements in the first quarter of 2023.”
About hospitals and healthcare systems
Monthly Healthcare Industry Financial Benchmarks May’s Hospital Financial Performance “The nation’s hospitals continued to stabilize in May as higher patient volumes contributed to increases in revenues and margins. Key trends for the month include:
Median hospital operating margins rose for the first time since breaking into the black in March after 15 straight months of negative operating margins
Outpatient revenues had sizable, double-digit increases, marking the biggest jump in the metric in more than a year as patients increasingly opt for outpatient services
Patient volumes continued to grow with increases in both inpatient and outpatient metrics, including higher surgery volumes
Total expenses remained on the rise while per-patient expenses decreased across most metrics, signaling that hospitals are better managing expenses relative to rising patient volumes”
About pharma
Gilead and Teva defeat antitrust lawsuit that claimed prices for HIV medicines were unfairly kept high “In a setback to AIDS activists, a federal court jury on Friday cleared Gilead Sciences and Teva Pharmaceuticals of allegations that the companies struck an illegal deal that inflated prices for HIV medicines.
A lawsuit filed four years ago accused Gilead of using a range of controversial business tactics that led the U.S. health care system to overspend for HIV medicines. These included so-called pay-to-delay settlements of patent litigation and moves that purportedly stalled development of safer versions of medicines that had years left of patent protection.”
U.S. will allow drugmakers to discuss Medicare drug price negotiations “The U.S. government on Friday revised its guidance for its Medicare drug price negotiation process, allowing drug companies to publicly discuss the talks, but did not make major changes likely to convince drugmakers to end their suits seeking to halt the program…
In September, the U.S. Centers for Medicare and Medicaid Services (CMS) will select 10 of the Medicare program's costliest prescription medicines and negotiate price cuts to go into effect for 2026.”
About healthcare IT
CMS slated to introduce nearly 400 new CPT codes in October “The Centers for Medicare and Medicaid Services is slated to roll out nearly 400 new current procedural terminology (CPT) codes this coming fall, according to a June 16 announcement.
The upcoming changes include a total of 395 new codes, 25 deletions and 13 revisions. Additionally, hundreds of changes have been made to the tabular instructions for the fiscal year 2024.
Here’s a quick rundown of some of the impending changes:
Of the 395 new codes, 123 pertain to the external causes of morbidity chapter of the ICD-10-CM manual, with many of those specific to documenting accidents and injuries.
Social determinants of health will be addressed with 30 new diagnosis codes that take factors influencing health status and patient contact with health services into consideration. The updates include new guidance instructing coders to report various risk factors of HIV, in addition to several changes related to patients’ upbringing (family support, death/disappearance of family, divorce/separation, etc.), history of stressful life events and military service backgrounds.
Several changes have been made related to osteoporosis with fractures, retinopathy and muscle entrapment in the eye and disease of the nervous system, including five new codes pertaining specifically to Parkinson’s disease.
New inclusion terms have been added to the segment on gender identity disorders.
Coding instructions for coagulation related to COVID-19 have been updated.
The 2024 ICD-10-CM codes will go into effect on October 1, 2023 and will be used for discharges and patient encounters occurring between that date and September 30, 2024.”
GAO Statement on Protest of Systems Plus, Inc., B-419956 et al. “On Thursday, June 29, 2023, the U.S. Government Accountability Office (GAO) sustained 98 protests filed by 64 offerors whose proposals were eliminated from the competition conducted by the Department of Health and Human Services (HHS), National Institutes of Health (NIH) … which was issued for the award of multiple indefinite-delivery, indefinite-quantity (IDIQ) governmentwide acquisition contracts for information technology services, known as Chief Information Officer-Solutions and Partners (CIO‑SP4).
The RFP sought proposals to provide information technology solutions and services in the areas of health, biomedical, scientific, administrative, operational, managerial, and information systems requirements. The solicitation advised that the agency will award approximately 305 to 510 IDIQ contracts across multiple socioeconomic groups. The solicitation provided for a 3‑phase evaluation, wherein a proposal must successfully pass each phase to be eligible for award. Each awarded contract will have a base period of performance of 5 years with one 5‑year option, and a maximum ordering value of $50 billion.
In the challenges filed at GAO, the protesters argued that the agency unreasonably failed to advance their proposals past phase 1 of the evaluation, thereby eliminating them from the competition.”
About healthcare personnel
Payers? Big Tech? Who acquired the most physicians in past 5 years, per AHA “As payers, retailers and Big Tech companies gobble up medical practices, private equity is the type of entity most likely to buy a physician office, the American Hospital Association found.
Here is who acquired the most physicians from 2019 to 2023, per the June 26 AHA analysis:
1. Private equity: 65 percent
2. Physician medical groups: 14 percent
3. Payers: 11 percent
4. Hospitals and health systems: 8 percent
5. Other: 4 percent
About health technology
First-gen mRNA flu vaccines 'will not win,' Sanofi execs admit as they retool strategy “First-generation mRNA vaccines for flu “will not win,” Sanofi executives have admitted as they set out plans to develop more advanced candidates they believe will overcome the technology’s existing shortfalls.
The biggest names in messenger RNA like Moderna, Pfizer and CureVac are all working on their own influenza candidates, but Sanofi used a vaccines investor event [Thursday] to spell out bluntly why those initial attempts to target the technology on flu just won’t work.”
Roche nabs FDA nod for another pair of CSF biomarker tests for Alzheimer's disease “For the second time in less than a year, the company has scored FDA clearance for a pair of assays that can be used together to help spot signs of Alzheimer’s disease.
The duo comprises the Elecsys Beta-Amyloid (1-42) CSF II, or Abeta42, and Elecsys Total-Tau CSF, or tTau, assays. The tests can run on any of Roche’s Cobas immunoassay analyzers, and both, as the names suggest, are cerebrospinal fluid assays. They analyze CSF samples to measure the concentration of beta-amyloid and tau proteins, respectively—two biomarkers linked to the development of Alzheimer’s.”
FDA Approves First Cellular Therapy to Treat Patients with Type 1 Diabetes “U.S. Food and Drug Administration approved Lantidra, the first allogeneic (donor) pancreatic islet cellular therapy made from deceased donor pancreatic cells for the treatment of type 1 diabetes. Lantidra is approved for the treatment of adults with type 1 diabetes who are unable to approach target glycated hemoglobin (average blood glucose levels) because of current repeated episodes of severe hypoglycemia (low blood sugar) despite intensive diabetes management and education.”