After a summer hiatus, I am back to providing periodic, significant news stories.
you will need to check stories, since I will no longer send daily notices.
National Health Expenditure Projections, 2023–32: Payer Trends Diverge As Pandemic-Related Policies Fade Annual report in Health Affairs is always worth reading. “Health care spending growth is expected to outpace that of the gross domestic product (GDP) during the coming decade, resulting in a health share of GDP that reaches 19.7 percent by 2032 (up from 17.3 percent in 2022). National health expenditures are projected to have grown 7.5 percent in 2023, when the COVID-19 public health emergency ended. This reflects broad increases in the use of health care, which is associated with an estimated 93.1 percent of the population being insured that year. In 2024, Medicaid enrollment is projected to decline significantly as states continue their eligibility redeterminations. Simultaneously, private health insurance enrollment is projected to increase because of the extension of enhanced subsidies for direct-purchase health insurance under the Inflation Reduction Act (IRA) of 2022, as well as a temporary special enrollment period for qualified people losing Medicaid coverage (after eligibility redeterminations).”
About health insurance/insurers
Expanding Medicare Coverage Of Anti-Obesity Medicines Could Increase Annual Spending By $3.1 Billion To $6.1 Billion “Assuming that anti-obesity drugs were covered in 2025 and that 5 percent or 10 percent of newly eligible patients were prescribed one, annual Part D costs were estimated to increase by $3.1 billion or $6.1 billion, respectively. The marginal costs of this policy could fall by as much as 62.5 percent from baseline estimates if products were approved for additional indications in coming years because these additional conditions are common among people with obesity. This would increase Medicare spending but would occur regardless of a policy change.”
Use Of High- And Low-Value Health Care Among US Adults, By Income, 2010–19 “Among nonelderly adults, significant differences between those with high and low incomes were found for five of nine low-value services, and among elderly adults, significant differences by income level were found for three of twelve low-value services.”
Potential US Health Care Savings Based on Clinician Views of Feasible Site-of-Care Shifts “In this survey study of 1069 clinicians surveyed in 2021 and historical claims data from 2019, 10.3 percentage points of commercial and 10.9 percentage points of Medicare volume could be shifted from the hospital to alternative sites using today’s technology without compromising clinical outcomes. Based on observed reimbursement rates, this would be associated with savings of $113.8 billion (3.2%) to $147.7 billion (4.1%) in 2019 dollars annually for the overall US health care system.”
See, also:Site-of-Care Shifts and Payments—A Viable Strategy to Control Health Care Costs?
Medicare Physician Fee Schedule Reform An excellent review of the background, current status and proposals for reform for physician payment schemes.
About hospitals and healthcare systems
Financial and Clinical Characteristics of Hospitals Targeted by Private Equity [PE] Firms “PE hospitals were, on average, not worse off financially or clinically than comparable non-PE hospitals before acquisition. On the contrary, PE hospitals carried less debt and owned more of their inherent value before acquisition, likely representing more financial stability. Financially healthier hospitals may be better able to absorb new debt and cost-cutting such as reductions in staffing. Earnings, operating margin, hospital-acquired adverse events, and in-hospital mortality were all similar before acquisition relative to controls. Changes in financial or clinical performance after acquisition may thus reflect management—of debt, personnel, and capital—more so than differences in these preacquisition characteristics… These findings do not support the notion that PE investments generally target struggling hospitals and instead support broader evidence that PE firms target successful entities for acquisition.”
About pharma
Pfizer finalizes DTC virtual health platform for streamlined access to vaccines, tests and treatments This strategy is a major departure for a pharma company and could have a major disruptive influence on such channel participants as PBMs. “Just a few months after confirming that it was in the process of developing an online service to cut out middlemen and work directly with patients to help them access vaccines, diagnostic tests and medications, Pfizer has made good on its word.
The newly launched PfizerForAll platform is designed to connect patients in the U.S. with a range of healthcare services, serving as a one-stop shop where they can make doctor’s appointments, find vaccines and order tests and treatments.
To start, according to Pfizer’s launch announcement…, the platform’s services will focus on providing access to treatments for common conditions like migraine, COVID-19 and the flu as well as vaccines for COVID, flu, respiratory syncytial virus and pneumococcal pneumonia. Those services are powered by partnerships with other direct-to-consumer providers in healthcare and beyond…”
Time From Approval to Reimbursement of New Drugs: A Comparative Analysis Between the United States, England, Germany, France, and Switzerland (2011–2022) “Findings: A total of 290 drugs approved by all regulatory bodies (FDA, EMA, MHRA, and Swissmedic) were included in the analysis.
Median time from approval until reimbursement was fastest in Switzerland at 5.8 months (95% CI, 4.5 to 7.0), followed by Germany (7.4 months [CI, 7.2 to 7.6]), the United States (9.2 months [CI, 8.3 to 10.1]), France (12.9 months [CI, 10.6 to 15.4]), and England (17.7 months [CI, 13.8 to 24.9]).
One month after approval, France had the highest reimbursement rate at 25.9% (CI, 20.6% to 30.7%), followed by Switzerland (9.7% [CI, 6.2% to 13.0%]) and England (0.7% [CI, 0% to 1.6%]). The United States and Germany had 0 drugs reimbursed at 1 month.
One year after approval, Germany, the United States, and Switzerland had the highest reimbursement rates at 74.3% (CI, 68.7% to 78.9%), 70.7% (CI, 65.0% to 75.5%), and 62.8% (CI, 56.8% to 67.9%) of drugs, respectively. Reimbursement rates in England and France were 37.1% (CI, 31.3% to 42.5%) and 49.0% (CI, 42.9% to 54.4%), respectively.
All countries were faster in reimbursing cancer drugs versus noncancer drugs, with the exception of Switzerland with a median time of 7.1 months (CI, 0.9 to 12.8) for cancer drugs versus 4.5 months (CI, 3.1 to 6.3) for noncancer drugs.
At the end of the follow-up period (31 December 2023), 276 drugs were reimbursed in Germany, 266 in the United States, 242 in Switzerland, 231 in England, and 230 in France.”
About healthcare IT
Talkdesk survey reveals the right prescription of artificial intelligence and human support is vital to superior patient experience “Half of all United States patients surveyed are optimistic that artificial intelligence (AI) will improve their overall experience with medical providers and the healthcare system in the next year and anticipate seeing more administrative efficiencies.
4 in 5 individuals want medical advice from a human healthcare representative. Still, half of Americans like that AI chatbots don’t judge, while approximately one-third appreciate that chatbots don’t rush them or make them feel stupid.
Two-thirds of patients with sensitive health issues would be more comfortable making appointments with an online chatbot than with human staff.”