Elizabeth Holmes Halloween costumes caused a black turtleneck shortage. I love it.
Home Health Operators Skyrocket
After CMS finalized its 2020 payment policy, home health operators soared into the green. Amedisys, Encompass Health, and LHC Group stocks all rose double digits on the news.
Reform inbound.
Remember that the 2020 final ruling involves huge payment reform for the home health industry. They’re switching to the Patient-Driven Groupings Model (aka, PDGM), which will switch Medicare over to a 30-day unit of payment (called an ‘episode’).
One key point from the policy included allowing therapy assistants to perform ‘maintenance therapy’ (which will most likely help out margins).
Read the entire final ruling here.
What’s new with the Amazon-Berkshire-JP Morgan venture, Haven?
Piloting new healthcare programs.
After laying low for a while, Haven has taken the scene once again. This time around, the Amazon/Berkshire/JP Morgan venture is piloting a variety of health plans for certain employees among the three companies. The plans involve heavy access to primary care and looks like a host of other generous healthcare features in the plans.
Read more about the pilot program here.
The Healthcare Payments Trend.
Another day, another healthcare entrant.
This week, Mastercard launched a suite of services aimed at healthcare specifically.
Mastercard Healthcare Solutions will target typical wasteful areas of healthcare, like fraud, revenue cycle management, IT security, and general waste.
I’m most interested in the revenue cycle management component embedded in Mastercard’s statement. The firm will use ‘predictive analytics’ to make billing easier both for patients, providers, and payors.
But they’re not the only players entering the billing space.
JP Morgan also pushed into healthcare payments by buying InstaMed. Back in May, the banking giant purchased InstaMed for $500 million – its largest acquisition since the financial crisis.
Then, of course, there’s UnitedHealthcare. They bought healthcare payment firm Equian for $3.2 billion in June in more of a strategic alignment (meaning they’ll be able to integrate the service with Optum).
What’s the bigger picture here?
Providers, Patients, and employers all want to get rid of administrative burden in healthcare, and a huge part of that is billing – what patients owe, how much a procedure will cost, how to receive payment – you get the picture.
As the push for price transparency in healthcare continues, providers’ revenue cycle management and billing capabilities will only become MORE important. Which is why, I think, these payments firms are getting snatched up.
Healthcare Policy Corner, week of Nov 4 – Democratic candidate plans challenged, price transparency delayed, site-neutral payments march forward
Medicare For All plans from Warren, Sanders get challenged
Although Elizabeth Warren and Bernie Sanders both really want Medicare for All to be a thing, they’re getting attacked from all angles (even SNL). Their fellow candidates (AKA Biden, Buttigieg, others) are seizing the moment and challenging certain aspects of the individual plans, especially Warren’s. Read what Biden’s camp had to say about her health plan:
“Her plan would create a new tax on employers of almost $9 trillion that would come out of workers’ pockets, a new financial transaction tax that would impact investments held by middle class Americans, and a new capital gains tax that would affect far more people than she stated tonight,” Biden said in a statement on Saturday.
Meanwhile, Bernie, while less in the spotlight currently is mumbling in the corner about not having to explain how he’s planning to pay for the estimated $30 trillion policy proposal.
Trump Administration gets cold feet on price transparency rule.
In a big win for providers, the Trump Administration delayed its hospital price transparency proposal, which would have forced hospitals to disclose negotiated rates with insurers to the public.
CMS says screw federal judges, we’re doing site neutral payments. AND we’re cutting 340b payments.
In other CMS news, the agency is planning to move forward with site-neutral payment policy despite losing a court case on the matter earlier this year.
In a double whammy to hospitals, they’re also slashing 340b payments, which is a program designed to reimburse hospitals for drugs used on poor and underserved populations.
Read the ModernHealthcare article covering both policies here.
Federal judge blocks immigration rule that would have required immigrants to show they have or can afford health insurance
Finally, remember that healthcare rule that would have required new immigrants to prove that they had healthcare before being approved? A federal judge blocked that bad boy this week.
Quick Hits
Biz Hits
- Stryker’s big purchase: Stryker is purchasing Wright Medical for $4 billion, with a total enterprise value of $5.4 billion.
- AI Deals continue: Read about an interesting AI deal between UT Health, Virtusa, Cardinal Health, and Amazon Web Services.
- UTHealth, Virtusa, Cardinal Health, and AWS Use AI and Machine Learning to Advance Medical Research
- UHS ambulatory expansion: UHS is looking to expand its ambulatory network and just inked a deal to build out nationwide network of ASCs by partnering with Regent Surgical Health
- Community Health’s 3rd Quarter Falls Short: Despite reporting strong same-store growth, hospital operator Community Health fell short of expectations in its Q3 earnings report. Its stock sold off 17% as a result. They’re also continuing their hospital fire sale by selling 3 more hospitals to Bon Secours Mercy Health. With the transaction, CHS will exit the Virginia market.
- Teladoc’s Q3 Surge: Teladoc showed off some major growth in Q3, increasing its paid membership by 55%
- Another digital health acquisition for United: UnitedHealth’s Optum just bought patient monitoring startup Vivify Health
State Hits
- California Wild Fire majorly affecting hospitals: One California hospital had to choose between saving its vaccines, or losing its electronic health records.
- Drug Price Fixing Win for Illinois: Illinois to Get $248 Million From Drugmakers in Case-Closing Deal
- Medicaid Block Grants Update: Tennessee’s Medicaid block grant push is getting some major pushBACK. Second that for Indiana, too.
- $10 billion Medicaid contract shake-up in Texas: This week, the Texas Medicaid program chose Aetna, Centene, and UnitedHealthcare to cover various regional Medicaid contracts. The big losers? Molina (these guys lost the most here), Anthem, and Cigna. It’s a potential flip of $10 billion in premium revenues.
- Louisiana’s toxic waste problem
- Arisa health forms in Arkansas: Four big Arkansas behavioral health providers planned a merger this week to become Arisa Health.
Other Hits
- A rough flu season is predicted — but it’s an opportunity for some
- Opinion Piece from the WSJ: The biotech cures keep coming, if politicians don’t get in the way.
My favorite reads this week
- They notified the wrong family.
- Microsoft and its Autism Hiring Program
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