About health insurance/insurers
Moody's: Why Medicare Advantage's profitability may be on the decline “The analysis found that margins declined from 4.9% in 2019 to 3.4% in 2022. Margins also fell in the commercial risk-based sector, but by a smaller amount, and they grew in Medicaid during that window, according to the report.
These data are based on reports from 10 payers rated by Moody's, which encompass two-thirds of all MA enrollees.”
Participation Continues to Grow in CMS’ Accountable Care Organization Initiatives in 2024 “Overall, in 2024 there are about 13.7 million people with Traditional Medicare aligned to an ACO. ACOs are now serving nearly half of the people with Traditional Medicare, a 3% increase since 2023. This growth in ACOs is important since ACOs have been shown to have superior quality performance compared to similar physician groups not participating in an ACO, and ACOs have generated year-over-year savings for the Medicare Trust Fund.”
No Surprises Act prevents 10M surprise bills, insurance groups say “The federal No Surprises Act is estimated to have prevented more than 10 million surprise medical bills during the first nine months of 2023, according to a Jan. 26 report from AHIP and the Blue Cross Blue Shield Association.
The findings come from a November survey of 21 health insurance providers representing 65% of the total commercial market, according to the report.”
DOJ, HHS press state Medicaid admins to cover Hepatitis C meds “In a joint letter by the Department of Justice and the Department of Health and Human Services, the agencies reminded states of their obligation, referring to an old settlement agreement between the DOJ and Alabama's Medicaid agency, or Alabama Medicaid.
Under the Americans with Disabilities Act, state Medicaid programs are not allowed to reject health services, such as administering HCV drugs to individuals with substance use disorder, if an individual is eligible.”
Comment: As the costs for very expensive medications grows, dyads are finning it difficult to balance the needs of the many with the needs of the few. See yesterday’s post about North Carolina removing weight loss drugs like Wegovy from coverage.
About hospitals and healthcare systems
Will there be new baselines for nonprofit hospitals' financial metrics? Fitch weighs in “Several nonprofit hospitals have found their operations and balance sheets settling into new ranges following a tough couple years, though that doesn’t necessarily mean that credit ratings will dive-bomb and investors should run for the hills, Fitch Ratings analysts said Monday.
The more substantial shift for the nonprofit hospital sector—and “The biggest question long term for rating agencies” like Fitch—is whether the nonprofit hospital sector sees operating margins “reset” from the ideal of 3% or higher to a range of 1% to 2%, analysts wrote in a new report.”
HCA posts $5.2B profit in 2023 “Nashville, Tenn.-based HCA Healthcare saw revenues of $17.3 billion in the fourth quarter of 2023, up from $15.5 billion over the same period in 2022, according to its financial report released Jan. 30.”
About healthcare IT
Specialty-Driven Platforms Outperform Broad-Spectrum EHRs in Top 2024 Physician Satisfaction Ratings, 14th Annual Black Book Ambulatory Practice Surveys “Physician practices reaffirm their confidence in specialty-distinctive electronic health record systems according to 32,854 medical and surgical practitioners surveyed by Black Book™ and the continued trend in physician technology replacements to specialty-driven EHRs with integrated RCM, interoperability, and analytics.”
Read the announcement for the specialty-specific preferred EMRs.
2024 State Policy Agenda for Telehealth Innovation A great source for understanding all the state-specific telehealth laws.
About health technology
Musk’s Neuralink implants brain chip in its first human subject “Brain chip start-up Neuralink implanted a device in its first live human subject Sunday, Elon Musk, the company’s founder, said on social media. The patient “is recovering well,” Musk wrote Monday, adding that initial data from the device was promising.
Placed in the part of the brain that plans movements, the device is designed to interpret a person’s neural activity, so they can control external devices such as a smartphone or computer with their thoughts, Neuralink’s website says. The device is currently in clinical trials, which are open to some individuals who have quadriplegia due to amyotrophic lateral sclerosis (ALS) or a spinal cord injury, according to a recruitment pamphlet.”