healthy muse healthcare news.
Georgia’s new Medicaid plan and the future of Medicaid?
Big state news this week: CMS approved Georgia’s reinsurance program waiver. That means starting in 2023, people in Georgia on ACA plans will have to purchase insurance directly through insurance websites or web brokers RATHER than through healthcare.gov.
- As another key component of the 1332 state innovation waiver, CMS would incentivize health insurers to participate in these exchanges by offering protection against catastrophically high claims.
Critics of the waiver argue that the shift from Healthcare.gov could confuse people, leading to lower coverage for 500,000 individuals on ACA plans.
Georgia has the highest uninsured rate in the country at 13.7%. Then there’s the whole question of whether the policy is legal under the ACA. Read the critics’ viewpoint here.
Proponents of the waiver think that the policy will lower health care costs in the state and provide more choice in plans for Georgians.
CMS thinks that premiums could drop 13% on average beginning in 2023. Further, ACA enrollment dropped 22% on average between 2016 and 2019. Read the CMS press release here.
- Bigger picture: What Georgia is doing could be the future of Medicaid under the Trump administration. Reinsurance programs, Medicaid work requirements, and more privatization. The news comes at the beginning of open enrollment period for Obamacare.
Coronavirus updates.
The latest numbers: 9.2 million cases, 230k deaths. 18 states set single-day case records over the past week. Certain cities (New York, Denver, El Paso) are tightening restrictions once again.
Vaccine updates: AstraZeneca and Pfizer’s vaccine candidates are beginning accelerated approval reviews in the UK. Moderna is on track to report initial results next month.
- Fauci now expects a vaccine to be ready for high-need groups by the end of December or early January. Meanwhile, the vaccine frontrunners are stressing that all vaccines will be ‘apolitical’ despite any rhetoric you might have heard.
Other ‘Rona Reads: Could a cough-hearing AI application detect Covid at an early stage? As cases rise, hospitals in hot spots will have to balance elective surgeries (more profitable) with Covid safety (less profitable).
Things to find hope in: This opinion piece argues that there have been structural, not cultural, flaws in Western governments’ approaches to the ‘Rona when compared to how well Asia is faring against the disease. Death rates have dropped for seriously ill Covid patients.
Quick Hits
Biz Hits
- Read more on the Sanford/Intermountain merger and one of the biggest reasons for the merger: their health insurance plans.
- Find out more about the Mayo Clinic and Google Health’s A.I. partnership to improve treatment planning for radiation therapy.
- Keep an eye on Honor – a home care tech platform that provides infrastructure and revenue cycle management for independent home care agencies. The firm just raised a smooth $140 million for expansion.
- As a part of another SPAC deal (as opposed to an IPO) SOC Telemed joined the public markets this week under the ticker $TLMD, valued initially at $720 million. The firm provides telemedicine and other tech services to hospitals in almost every state and is taking advantage of the boom in remote health care.
- Pfizer and Mylan received FTC approval this week for its previously announced generic drug combination.
Notables from Q3 Earnings szn:
- CHS: Community Health’s shares jumped 30% after reporting a profit (!!) and much better than expected financial results. Its CEO Wayne Smith will step down after a 23-year tenure.
- Teladoc: The telehealth firm had a busy third quarter. The Teladongo merger closed this week – a quick 3 short months from announcement to close. Most of the Livongo execs will depart from the combined firm. In fact, several of them are starting their own SPAC in order to bring “1,000 more Livongo’s” to health care.
- HCA: Is weathering the COVID storm despite declining admissions, surgeries, and ER visits. The hospital giant said that the months of September and October started to give a glimpse into what stability looks like in a post-COVID world. HCA returned $6 billion in provider relief funds it received as a part of the CARES act in a major power move.
- Other earnings: Encompass, UHS, Molina
Policy Hits
- Price Disclosure: CMS finalized its price transparency rule this week. Starting in 2022, insurers and group health plans will be required to disclose in-network, out of network, and net drug pricing rates between the plans and their providers. Additional requirements will phase in beyond 2022.
- Home health: CMS finalized its 1.9% basket home health price increase for 2021. More notable: the PDGM behavioral adjustment will stay despite fierce industry opposition.
- Skilled nursing: Administrators are working hard to implement finalized COVID guidelines for nursing homes, but the changes come with a high expense.
Other Hits
- Seriously? Three U.S. agencies are cautioning U.S. hospitals against potential widespread cyber attacks coming from Russia.
- Could Apple purchase Oura?
- 60 Minutes published an episode concerning CMS’ response at a specific nursing home in Kirkland, Washington this week, which elicited a preliminary response from CMS administrator Seema Verma, calling the episode ‘revisionist history.’ Yikes.
- The U.S. Preventive Services Task Force just lowered the recommended screening age for colorectal cancer to 45 (from 50)
Thought-Provoking Editorials
- The upside of cash-pay for providers. (Acute Condition)
Healthy Muse Top Picks
- Read this Bloomberg feature about Hims, questionable prescribing practices, and a larger look at the drug industry in America. (Bloomberg)
- Cool facts about Health Insurance Enrollment (Out-of-Pocket)
- Visual: Take a look at the major provisions included (and at stake) with the ACA.
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