About health insurance/insurers
Payers ranked by Medicaid membership | Q2 2023 FYI
Spending on Medicare Advantage Quality Bonus Payments Will Reach at Least $12.8 Billion in 2023 “Key takeaways:
Federal spending on Medicare Advantage bonus payments has increased every year since 2015 and will reach at least $12.8 billion in 2023, an increase of nearly 30% ($2.8 billion) since 2022.
Most Medicare Advantage enrollees (85%) are in plans that are receiving bonus payments in 2023.
The average bonus payment per enrollee is highest for employer- or union-sponsored Medicare Advantage plans ($460) and lowest for special needs plans ($374).
Bonus payments vary substantially across firms, with UnitedHealthcare receiving the largest total payments ($3.9 billion) and Kaiser Permanente receiving the highest payment per enrollee ($523).”
Medicare Advantage Satisfaction Index “Key Takeaways
71% of beneficiaries are satisfied with their Medicare Advantage plan.
Affordable costs and out-of-pocket expenses are the top reasons people enroll in Medicare Advantage.
Over the past year, 1 in 10 beneficiaries believes they were overbilled for their Medicare Advantage plan.
Almost 20% of Medicare Advantage beneficiaries had challenges receiving care due to delays caused by the prior authorization process.”
Report: Black, Latino, Asian Americans Are More Likely To Choose MA Plans Over Traditional “Black, Latino and Asian Medicare beneficiaries are more likely to select Medicare Advantage plans over traditional Medicare plans than White beneficiaries, a new report found.
About 69% of Latino Medicare beneficiaries select Medicare Advantage, as do 65% of Black Medicare beneficiaries and 60% of Asian Medicare beneficiaries. About 48% of White Medicare beneficiaries choose Medicare Advantage.”
Georgia is now the only state with work requirements in Medicaid “Georgia is now the only state in the US to implement work requirements in its Medicaid program – a feat many Republican lawmakers nationwide will be closely monitoring.
But unlike GOP-led states’ prior attempts to impose work mandates in Medicaid, Georgia’s effort is expected to increase the number of people with health insurance, rather than strip coverage away from an untold number of low-income residents. That allowed it to pass muster in court, though critics still deride the program as complicated, ineffective and expensive.
Pathways to Coverage, which began July 1, comes as House Republicans in Congress are pushing to expand work requirements in the nation’s safety net programs, particularly Medicaid and food stamps.”
About hospitals and healthcare systems
Hospital cash flow to take years to recover, Moody's says “Healthcare operating cash flows may be gradually improving but will take years to recover and may never reach pre-pandemic margins, Moody's warned in an Aug. 9 report.
Before COVID-19, such margins were at a median of about 8.4 percent. Now, the target for hospitals and systems is to reach about 7 percent by the middle of 2024.
The current operating cash flow margin, up to March 31, was 5.4 percent, an increase from 4.9 percent in 2022.”
Hospital sues data analytics company MultiPlan in US court antitrust case “Nonprofit hospital system AdventHealth has sued data analytics company MultiPlan in U.S. court, accusing it of leading a price-fixing conspiracy that underpaid healthcare providers billions of dollars for out-of-network reimbursements from major insurers.
Florida-based AdventHealth, which operates 50 hospitals across the U.S. and says it is the country's largest Protestant hospital system, filed its antitrust lawsuit in Manhattan federal court on Wednesday against MultiPlan, the lone defendant.”
About pharma
Novo Nordisk lifts full-year guidance as Wegovy sales soar The headline is the story.
Novo Nordisk bets $1.1B on Canadian biotech buyout, adding an old approach to obesity pipeline “The biotech, Inversago Pharma, is focused on drugs that block the cannabinoid CB1 receptor. Sanofi won approval for a CB1 receptor blocker weight loss drug, rimonabant, in Europe in 2006. However, European authorities withdrew the approval in 2009 after studies linked the drug, sold as Acomplia, to a doubling of the risk of psychiatric disorders. The product never won approval in the U.S.”
BREAKING: Justices Halt Purdue Ch. 11 Plan Over Sackler Releases “The U.S. Supreme Court on Thursday granted the U.S. trustee's office request to pause Purdue Pharma LP's Chapter 11 plan, directing parties in the case to brief whether a court must expressly approve a plan that would release third-party claims against the Sackler family ‘without the claimants' consent.’”
About the public’s health
Deaths, disabilities from heart problems related to air pollution are on the rise, study finds “The number of people killed or disabled by certain heart problems caused by exposure to air pollution has risen significantly since 1990: 31% worldwide, according to a study published Wednesday in the Journal of the American Heart Association.
Particle pollution is specifically to blame, the researchers say. Also called PM2.5 or particulate matter pollution, it’s the mix of solid and liquid droplets floating in the air, according to the US Environmental Protection Agency. It can come in the form of dirt, dust, soot or smoke. Particulate pollution comes from coal- and natural gas-fired plants. Cars, agriculture, unpaved roads, construction sites and wildfires can also create it.”
About healthcare IT
Amazon partners with Maven Clinic to offer reproductive care to employees in 50 countries “Maven Clinic and Amazon are joining forces to offer fertility and family-building support to Amazon employees in 50 countries outside the U.S. and Canada.
The program will be available to full-time, part-time and hourly Amazon workers, reportedly reaching more than 1 million eligible employees. They and their partners will have free access to board-certified reproductive endocrinologists, obstetricians, gynecologists, nutritionists, mental health providers, adoption coaches and other care providers through Maven.”