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HEALTHCARE & GOVERNMENT
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Medicare Advantage Plans To See 2025 Base Pay Fall |
The Administration on Monday followed through on its proposal to cut next year's base payments to Medicare Advantage plans an average of 0.16%, despite pressure from insurers and their allies in Congress. Why it matters: While the plans will wind up seeing a net increase once payments are risk-adjusted to account for the health of their customers, the news sent shares of UnitedHealth, CVS Health, Humana and Centene falling amid predictions of continued financial pressure. (Goldman, 4/2) This news contradicts an earlier announcement from CMS re Payment Updates for 2025 Medicare Advantage and Medicare Part D Programs: Under the CY 2025 Rate Announcement, payments from the government to MA plans are expected to increase on average by 3.70 percent, or over $16 billion, from 2024 to 2025. The federal government is projected to pay between $500 and $600 billion in MA payments to private health plans in 2025. CMS is also finalizing improvements to the structure of the Medicare Part D drug benefit for CY 2025 that will result in lower drug costs for millions of people with Medicare through the concurrent release of the Final CY 2025 Part D Redesign Program Instructions. Due to the Inflation Reduction Act, annual out-of-pocket costs will be capped at $2,000 for people with Medicare Part D in 2025.. (https://www.hhs.gov/about/news/2024/04/01/cms-finalizes-payment-updates-2025-medicare-advantage-medicare-part-d-programs.html)
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Medicare Will Cover Wegovy to Reduce Heart Disease Risk |
Medicare will provide coverage for Wegovy for patients with an increased risk of heart attack, stroke or other serious cardiovascular problems, an agency spokesperson said. The decision, experts say, could grant millions of patients access to the popular yet expensive weight loss medication. Medicare, which currently provides health insurance to more than 65 million people in the U.S., has long been barred from paying for weight loss drugs. Earlier in March, however, the FDA expanded the approval for Wegovy, saying that it can be prescribed to people who are overweight or have obesity to reduce their risk of heart disease. The change prompted CMS to consider coverage because reducing heart disease risk is a medically accepted use under federal law, a spokesperson said. Medicare will still not cover Wegovy if it is only being used for weight management, the spokesperson said. Medicaid, the federal health insurance program for people with low incomes, will also be required to cover Wegovy to reduce heart disease risk. (https://www.nbcnews.com/health/health-news/medicare-will-cover-wegovy-reduce-heart-disease-risk-rcna143479)
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HHS Artificial Intelligence Task Force Takes Shape |
Details are emerging on a new HHS task force faced with a monumental task: creating a regulatory structure to oversee utilization of artificial intelligence in healthcare. An executive order signed by President Biden in October directed the HHS to create a comprehensive plan for assessing AI before it goes to market, and monitoring performance and quality once the technology is actually in use. The executive order gave the task force 12 months to deliver after it starts work. The HHS' task force is composed of senior members of the administration - mostly the heads of the agencies making up HHS: CMS, FDA, Office of the National Coordinator, NIH, and the CDC, according to sources. Beneath those leaders, the task force has specific working groups around core issues in AI: drugs and devices, research and discovery, critical infrastructure, biosecurity, public health, healthcare and human services, internal operations, and ethics and responsibility. The task force also plans to engage with the private sector to get their perspective on where it should focus. (https://www.healthcaredive.com/news/hhs-artificial-intelligence-task-force-details/710250/)
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Administration Streamlines ACA Enrollment and Renewals in Medicaid & CHIP Coverage |
The Administration has unveiled a final rule that will protect and improve how millions of eligible people apply for, renew, and maintain health care coverage through Medicaid, the Children's Health Insurance Program (CHIP), and the Basic Health Program (BHP). Also, HHS, through the CMS, announced additional actions it is taking to help people maintain coverage as states continue Medicaid and CHIP eligibility renewals, which restarted across the country last spring following a pause during the COVID-19 pandemic. The actions will continue and extend a previously announced flexibility to make it easier for people to transition to Health Insurance Marketplace coverage through 2024, help more people with Medicaid and CHIP navigate renewals, and reinforce important federal requirements that are crucial for protecting coverage in states during and beyond "Medicaid unwinding." CMS is extending a temporary special enrollment period (SEP) to help people who are no longer eligible for Medicaid or CHIP transition to Marketplace coverage in states using HealthCare.gov. The end date of this "Unwinding SEP" will be extended from July 31, 2024, to November 30, 2024, which will help more people leaving Medicaid or CHIP secure affordable, comprehensive coverage through the start of the next open enrollment period. (https://www.cms.gov/newsroom/press-releases/hhs-takes-additional-actions-help-people-stay-covered-during-medicaid-and-chip-renewals)
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Update On the Medicare Value-Based Care Strategy: Alignment, Growth, Equity |
A recent CMS blog, titled Update on the Medicare Value-Based Care Strategy: Alignment, Growth, Equity, provides a progress report on accomplishments and a look toward the future for CMS' Value-Based Care Strategy. It also covers CMS' strategy to move toward value-based payment, a focus on alignment across payers, growth in accountable care, and promoting equity. Among other topics, CMS aims to scale model learnings, support primary care providers in value-based care, improve quality measurement, and improve the flexibility of practitioners to work with community-based organizations to address social needs, while also emphasizing the importance of value-based data transparency and fostering competition within Medicare Advantage. (https://www.healthaffairs.org/content/forefront/update-medicare-value-based-care-strategy-alignment-growth-equity)
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PROVIDER NEWS & TRENDS
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UnitedHealth Offers Over $3.3B in Loans to Providers Impacted by Attack on Change Healthcare; ITM, State Dept Offers $10M Bounty for Info on Blackcat Hackers |
UnitedHealth Group said recently it has advanced more than $3.3 billion in loans to care providers impacted by a cyberattack on the healthcare conglomerate' tech unit. Earlier in March, UnitedHealth launched a temporary funding program for providers after a ransomware attack on Feb. 21 on Change Healthcare delayed their insurance claims processing, causing a severe cash crunch. The nation's largest health insurer said the providers will get 45 business days to pay back the loan. UnitedHealth has already given more than 40% of the $3.3 billion to safety net hospitals and FQHCs serving high-risk patients and communities. It will take United months to fully recover from the disruptions at Change, which was attacked by the hacking group "ALPHV" - also known as "BlackCat". The State Department has offered up to $10 million for information on the sophisticated group, which also recently took down Caesars Entertainment and MGM Resorts. (https://www.reuters.com/business/healthcare-pharmaceuticals/unitedhealth-group-has-paid-over-33-bln-care-providers-hit-by-cyberattacks-2024-03-28/)
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More Doctors are Charging Fees to Respond to Patient Messages |
More healthcare groups are charging fees to answer patients' electronic messages. Doctors say it's only fair if they're spending time on the messages and note that an email discussion can often save you the time of having to come in. The typical cost of an email message claim was $39 in 2021, including both the portion paid by insurance and by the patient, according to a Peterson-KFF Health System Tracker analysis. Some patients have been surprised at the notifications on portals about the change, and irritated at the idea of a new fee.
Doctors and private insurers typically follow federal guidelines which state that patients can only be charged if a response requires at least five minutes of a doctor's time over the course of seven days, and the response involves some sort of medical decision-making - rather than dealing with an administrative matter, like scheduling an appointment. Also emails that stem from a follow-up to a visit, such as explaining lab results, aren't typically billed. Health plans covered the full cost of about 82% of claims, according to the Peterson-KFF analysis, and when patients shared the cost, they paid only $25 on average. (https://www.wsj.com/health/wellness/doctor-medical-bills-email-37005e32)
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Meanwhile, Hospitals Are Adding Billions in 'Facility' Fees for Routine Care |
According to The Wall Street Journal, hospitals added $6 billion in "facility fees" to medical bills for routine care in outpatient centers they own in 2021. The fees are spreading as hospitals press on with acquisitions, snapping up medical groups and tacking on the additional charges. The fees raise prices by hundreds of dollars for widely used and standard medical care, including colonoscopies, mammograms and heart screening. While physicians and economists agree the added cost isn't justified, hospitals say facility fees help them offset the extra costs that they incur to meet federal regulations. Once purchased, hospitals can designate the newly acquired clinics as an extension of their operations, forcing patients to pay the fees to cover costs for the entire hospital. (https://www.wsj.com/health/healthcare/hidden-hospital-fees-cost-patients-hundreds-of-dollars-0024cd95?mod=hp_lead_pos7)
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PHARMACEUTICAL NEWS & TRENDS
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Merck's $11.5 Billion Bet on Its Next Big Drug Approved, but Will It Fill Keytruda's Hole? |
Merck is betting that its new drug, recently approved in the U.S. for a potentially fatal lung disease, will take the company a long way toward heading off a massive revenue decline later this decade. The drug, which will sell under the name Winrevair, treats a condition called pulmonary arterial hypertension that affects nearly 40,000 Americans annually. In 2021, Merck paid $11.5 billion for the company developing the medicine, which some analysts estimate will enjoy sales as high as $7.5 billion a year. Merck is counting on it, as more than 40% of the drug company's revenue, some $25 billion last year, came from cancer treatment Keytruda. Currently, the immunotherapy is the world's top-selling drug, but Merck's main U.S. patent for it expires in 2028, opening the door for lower-cost competition. Winrevair will list for a price of $14,000 a vial, which for about two-thirds of patients will be the amount given every three weeks. That translates into about $242,000 for a full year, though Merck said the cost would vary by patient because dosage is weight-based. (https://www.wsj.com/health/pharma/merck-new-drug-winrevair-pulmonary-hypertension-db2c19a3?mod=hp_lead_pos6)
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Drug Overdoses Reach Another Record with Almost 108,000 Americans in 2022, CDC Says |
Nearly 108,000 Americans died of drug overdoses in 2022, according to recently released final figures. Over the last two decades, the number of U.S. overdose deaths has risen almost every year and continues to break annual records - making it the worst overdose epidemic in American history. The official number for 2022 was 107,941, the CDC said, which is about 1% higher than the nearly 107,000 who died in 2021. (https://abcnews.go.com/Health/wireStory/drug-overdoses-reach-record-108000-americans-2022-cdc-108365805)
MEANWHILE, U.K. cracks down on synthetic opioid 10 times stronger than fentanyl causing overdoses in Europe: As authorities clamp down on fentanyl distribution, and the amount of heroin produced in Afghanistan decreases under the Taliban, criminal enterprises have turned to a deadly alternative: 2-Benzyl Benzimidazole opioids, commonly known as nitazines. Some health agencies in Europe are reporting a rise in deaths and overdoses from this synthetic opioid that can reportedly be hundreds of times stronger than heroin and up to 40 times stronger than fentanyl. Nitazines are a class of synthetic compound developed in the 1950s as painkillers, but were never approved for use as medicines. Their rising use has also been noted in the U.S., where they've been dubbed "Frankenstein opioids," and labelled a public health concern by the DEA. (https://www.cbsnews.com/news/nitazine-uk-synthetic-opioids-significantly-more-toxic-than-fentanyl-heroin/)
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PROMISING HEALTHCARE ADVANCES
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Doctors Can Now Edit the Genes Inside Your Body |
Regulators last year approved the world's first medicine using Crispr, the Nobel Prize-winning tool for modifying genes. For example, the medicine for sickle-cell disease (a group of inherited blood disorders), involves extracting cells, editing them in a lab and putting them back in the patient's body. By contrast, Crispr enables "in vivo" gene editing, as this experimental therapy is called. The editing of cells inside the patient's body could transform medicine, since in vivo editing could be less expensive and reach more people than editing cells outside the body (which requires the laboratories and expertise needed to extract and edit cells), plus editing inside the body might also be easier on patients. They don't have to undergo chemotherapy, for example, which is necessary for sickle-cell patients before receiving their cells that have been edited outside the body. (https://www.wsj.com/health/pharma/doctors-can-now-edit-the-genes-inside-your-body-4c8e1aea?mod=hp_listc_pos2)
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Nvidia & Hippocratic AI Want to Deploy AI Nursebots to Handle Your Care |
Medical startup Hippocratic AI and Nvidia have announced plans to deploy voice-based "AI healthcare agents." In demonstration videos, at-home patients converse with animated human avatar chatbots on tablet and smartphone screens. Examples include a post-op appendectomy screening, as well as a chatbot instructing someone on how to inject penicillin. Hippocratic's web page suggests providers could soon simply purchase its nursebots for less than $9/hour to handle such tasks, instead of paying an actual registered nurse $90/hour, Hippocratic claims. (The average pay for a registered nurse in the US is $38.74/hour, according to a 2022 U.S. Bureau of Labor Statistics' survey.) Based on Hippocratic's internal research, people's ability to "emotionally connect" with an AI healthcare agent reportedly increases "by 5-10% or more" for every half-second of conversational speed improvement, dubbed Hippocratic's "empathy inference" engine. But quickly simulating all that worthwhile humanity requires a lot of computing power - hence Hippocratic's investment in countless Nvidia H100 Tensor Core GPUs. (https://www.popsci.com/technology/ai-nurse-chatbots-nvidia/)
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