About health insurance/insurers
Centene expects to earn at least $166.5B in revenue for 2025 “The health insurer expects to bring in between $166.5 billion and $169.5 billion in revenue for the year, including between $154 billion and $156 billion in premium and service revenue, according to the announcement. It also estimates earnings per share of at least $7.25 in 2025.
The company is bracing for elevated utilization trends to continue as well, according to the announcement. It projects a medical loss ratio of between 88.4% and 89%.
About hospitals and healthcare systems
8 changes coming to HCAHPS in 2025 Numerous HCAHPS changes are set to take effect Jan. 1, aiming to modernize the survey and increase patient response rates.
The survey's main mode of administration — paper — and its question sets have remained largely unchanged since CMS launched HCAHPS in 2008, according to Rick Evans, senior vice president of patient services and chief experience officer of NewYork-Presbyterian Hospital in New York City.
CMS outlined key changes to the survey process in its inpatient prospective payment system final rule released Aug. 1. HCAHPS scores collected under the modernized process will be reflected in hospitals' payment determinations for fiscal 2027.
Eight survey changes that will take effect in 2025
1. CMS will allow patients to fill out the HCAHPS survey online, as opposed to only over the phone or by mail. In a 2021 pilot run, CMS found adding an option for electronic administration increased survey response rates. The three new web-first survey offering will include:
Email survey, followed by mail survey to non-respondents
Email survey, followed by phone survey to non-respondents
Email survey, followed by mail survey then phone survey to non-respondents
2. CMS will sunset two current survey administration options — the aActive interactive voice response and the hospitals administering HCAHPS for multiple sites survey modes — which have not been used by any hospitals since 2016 and 2019, respectively. Mail-only, phone-only and mail-phone survey options will remain available.
3. The current HCAHPS survey includes 29 questions organized into 10 submeasures. The updated version will add three new submeasures for care coordination, restfulness of hospital environment and information about symptoms, bringing the total number of questions to 32.
4. Four questions, including those about call-button use and care transitions, will be eliminated as they either reflect outdated hospital processes or prove redundant with other survey questions.
5. The data-collection period for the survey will extend from 42 days to 49.
6. CMS will end a regulation that prohibits patients' loved ones from filling out the survey on their behalf, though patients will still be encouraged to fill out the survey themselves.
7. CMS will limit the number of supplemental items to 12 to align with its other patient experience surveys.
8. Hospitals will be required to collect information about what language a patient speaks. Spanish-speaking patients must be presented with the official CMS Spanish translation of the survey.”
About pharma
Pharma Has Kept M&A Spending Small This Year, With Just One Deal Topping $5B “By far, the largest acquisition of 2024 was Novo Holdings’ yet-to-be-closed buyout of manufacturer Catalent at $16.5 billion. Outside of that, the leading pharmaceutical companies kept to less than $5 billion per deal.”
Using the Inflation Reduction Act to Rein in Patenting & Evergreening Abuses “Four of the 10 drugs subject to negotiation would likely have faced competition before negotiated prices go into effect were it not for evergreening tactics and patent abuses. As a result, Medicare will lose between $4.9 and $5.4 billion in savings that should have accrued from access to competing, lower-cost treatments. These lost savings are nearly as much as what Medicare is expected to save if negotiated prices go into effect on all of the selected drugs in the first year of the program ($6 billion).” [Emphasis in the original]
Comment: The IRA mandated that Medicare negotiate prices for some high cost drugs. This research reveals that the reason many of the prices were so high to start, was that the companies were granted monopolies through the legal creation of “patent thickets.”
If private equity buys Walgreens, these assets could face the chopping block Excellent summary of the likely consequences if Sycamore Partners buys Walgreens.
In a related article: Why private-equity health care investments are poised to rise in 2025
About the public’s health
Flu vaccines drop among kids despite record deaths last year: CDC “Fewer children in the U.S. have gotten a flu vaccine in 2024 compared to last year, according to new data from the Centers for Disease Control and Prevention (CDC).
As of Nov. 30, about 36 percent of the nation’s children aged six months to 17 years received a flu vaccination, a drop from last year’s 43 percent.”
Changes in Adult Obesity Trends in the US “These findings suggest that BMI and obesity prevalence in the US decreased in 2023 for the first time in more than a decade. The most notable decrease was in the South, which had the highest observed per capita GLP-1RA dispensing rate. However, dispensing does not necessarily mean uptake, and the South also experienced disproportionately high COVID-19 mortality among individuals with obesity”
About healthcare IT
Major health systems including Mayo Clinic, UPMC join with ATA to launch digital tech alliance “The American Telemedicine Association (ATA) is collaborating with health systems to push forward the integration of digital technologies into care delivery.
The new alliance, called the ATA Center of Digital Excellence (CODE), convenes a group of leading health systems to work together on best practices that "prioritize patient-centered care, equitable access and improved clinical and operational outcomes," the ATA said in a press release.”
Hackers threaten to leak data of 17M California patients “A ransomware group sent faxes to Whittier, Calif.-based PIH Health outlining the data it had stolen, which spanned patients' personal information to photos and test results, Whittier Informed reported. The three-hospital system took its IT networks offline and switched to paper records following the Dec. 1 cyberattack. The hackers did not specify their demands in the letter.”