About health insurance/insurers
Social Determinants of Health [SDoH] and US Health Care Expenditures by Insurer “This cross-sectional study found individual-level SDOH to be significantly associated with US health care expenditures, potentially incentivizing health insurers to utilize SDOH in their decision-making practices to identify and control expenditures. Health insurers may use HRSN [health-related social needs]to identify beneficiaries at greater risk for high expenditures to target interventions by prioritizing SDOH domains found to be significant in our analysis. Addressing structural SDOH may require insurers to engage with multisectoral stakeholders with shared funding mechanisms and for public policymakers to adopt a health-in-all policies approach. While addressing HRSN may be more feasible in the short term, targeting structural SDOH through multisectoral partnerships may address the root cause to achieve a more equitable and sustainable health care system.”
Medicaid Enrollment & Spending Growth: FY 2024 & 2025 “Key survey findings include the following:
Following years of significant growth, Medicaid enrollment declined by -7.5% in FY 2024 and state Medicaid officials expect enrollment to continue to decline by -4.4% in FY 2025. These growth rates reflect the net Medicaid enrollment change from year to year including new enrollments, coverage losses due to unwinding, and some “churn” when those who lose coverage re-enroll within a short period of time. The unwinding of the continuous enrollment provision was the largest driver of enrollment declines. [Emphasis added]
Total Medicaid spending growth slowed to 5.5% in FY 2024 and is expected to slow further to 3.9% in FY 2025. While state Medicaid officials identified unwinding-related enrollment declines as the most significant factor driving changes in total Medicaid spending, they also noted a number of upward pressures on total spending. This included enrollment increases from eligibility changes such as 12-month continuous eligibility for children or overall state or Medicaid eligible population growth, the higher health care needs of enrollees that retained coverage during unwinding, and rate increases.
As anticipated, state Medicaid spending growth increased sharply in FY 2024 (19.2%) as the enhanced FMAP phased down and expired (after declining earlier in the pandemic despite high enrollment growth). State Medicaid spending growth is projected to slow to 7.0% in FY 2025, only slightly higher than total spending growth as the shifts caused by the enhanced FMAP expiration end.”
About pharma
Walmart plans to deliver prescriptions nationwide in as little as 30 minute “Walmart's new service includes new prescriptions and refills, which customers can receive along with groceries and other products, the Bentonville, Arkansas-based company announced on Tuesday. Prescriptions will be delivered in as little as 30 minutes and should be available for over 86% of American households, according to Walmart.”
In a related article: Walmart and Amazon threaten US drugstores in prescription delivery
About the public’s health
FDA approves 1st RSV vaccine for adults under 60 “The FDA approved Pfizer's Abrysvo, the first and only RSV vaccine for adults aged 18 to 59 who are at increased risk of severe respiratory illness caused by RSV.”
About healthcare IT
Transparency has led to uniformity in healthcare costs—but not necessarily lower prices: study “Price transparency regulations are leveling the cost landscape for consumers, but that doesn’t always lead to lower prices, according to a new report from Turquoise Health…
Since the regulations were established, and adjusting for inflation, the top 25% of prices fell by 6.3%. However, the bottom 25% of prices increased by 3.4%. Meanwhile, the middle 50% of prices decreased just 1.1%. Turquoise analyzed prices at 232 hospitals across the 10 largest U.S. metro areas to track changes across market segments, from December 2021 to June 2024.”
About healthcare personnel
Clinician Staffing and Quality of Care in US Health Centers “In this cross-sectional study of health centers, physician FTE ratio was associated with higher performance in cancer screening, infant vaccinations, and HIV testing; APRN FTE ratio was associated with higher performance in preventative health assessments; and PA FTE ratio was associated with higher performance in infant vaccination. These findings suggest that targeted staffing strategies may be associated with quality of care in certain domains and that tailored approaches to health center staffing based on community-specific needs are warranted.”