Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:


Health Insurer Centene Is Sued Over Lack of Medical Coverage

People who bought policies from Centene, a large for-profit health insurance company, filed a federal lawsuit on Thursday claiming the company does not provide adequate access to doctors in 15 states.

The New York Times

Thursday, January 11, 2018

Legislators say they are close to CHIP deal

Republicans and Democrats in Congress have said they are close to approving a long-term funding deal for the Children's Health Insurance Program, which could come as soon as next week, according to The Hill. CHIP provides insurance for nearly 9 million low-income children across the nation.

Becker's Hospital Review

Thursday, January 11, 2018

Trump administration to let states adopt Medicaid work requirements

The Trump administration told U.S. states on Thursday they can for the first time move toward imposing work or job training requirements on people as a condition for obtaining health insurance under the Medicaid government program for the poor.


Thursday, January 11, 2018

The impact of Medicaid expansion on hospital closures

Medicaid expansion significantly decreased the number of people without insurance, and in turn may have prevented some cash-strapped hospitals from closing, according to a new study.

Fierce Healthcare

Tuesday, January 9, 2018

Drug Overdose Deaths Soar Nationally But Plateau In Some Western States

The opioid crisis on the East Coast and in the Midwest has fueled a national surge in drug deaths, even as fatal overdoses have decreased or remained stable in parts of the West, new federal data show.

Kaiser Health News

Monday, January 8, 2018

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members. 


Ten Large Objects on the Highway to Healthcare in 2018

By Clive Riddle, January 5, 2018

We find ourselves suddenly situated in 2018. How did that happen? Where did 2017 go, and for that matter, 2016 and its younger siblings? A Meat Loaf ballad once lyricized how Objects in the Rear View Mirror Appear Closer Than They Are. With apologies to AC/DC - on the highway to healthcare, here are ten large objects that demand our attention to stay focused on the road ahead and not in that fabled rear view mirror:

Merger Mania

In 2015 three health plan mega mergers were hatched, but only the Centene-HealthNet one made it out of the nest, and no other mega deals immediately followed suit. Will the late 2017 CVS-Aetna and hospital mergers such as CHI-Dignity signal more major activity in 2018, such as the rumored St. Joseph-Ascension merger? The answer should be a big yes for hospitals and other providers. In the health plan arena, look for additional players to pursue out of the box approaches such as CVS-Aetna (see below.)

CVS/Aetna and Multi-Level Integration

CVS will become a distribution center for applicable Aetna products. Aetna will become a distribution system for CVS products. CVS will further build upon its base retail clinics to become a direct care delivery system for Aetna. It’s a different kind of integrated delivery system than traditional hospital-medical group-health plan integrated systems, but integration it is, all the same, at multiple levels.

Amazon and the Decline of Retail Pharmacies

Especially coming off the holiday season, we read reports on the continuing rise of online shopping and decline of brick and mortar retail. Mail order pharmacy has been around for decades but has been focused on maintenance meds. Now that Amazon has mastered rapid on-demand delivery and has filed for pharmacy licenses in various states, and can deliver the other non-prescription products typically purchased at retail pharmacies – the rush is on. Major retail pharmacies will try mightily to enhance their own online offerings or partnerships.

Consumer Embrace of Technology

Private practice physicians aren’t so wild about the demands of EHR, and are skeptical at times about all things new bright and shiny, but numerous surveys indicate consumers are enthusiastic about the range of advances in healthcare technology that touch them. Consumers have plenty to be grumpy about in healthcare – but their embrace of technology will continue to drive demand for telehealth, e-visits, apps, portals, wearables, and new treatment options.

Searching For Value in Value Based Care

In the business of healthcare, we love to give birth to innovative approaches in healthcare delivery and payment arrangements, and after a honeymoon period, we tend to eat our own. Studies are published that indicate the new approach doesn’t deliver on results. A chorus of naysayers rises. And then we rightly or wrongly move on to something else. Health Affairs recently published a study concluding that Medicare ACO program savings were more the result of patient selection than care efficiencies. Other studies have begun to question various value based care arrangements. Given the growing popularity of value based care, and the intrinsic notion that the proposition makes sense, there is much at stake for value based stakeholders to continue to demonstrate the true value in their arrangements.

All Things Healthcare CyberSecurity

Hackers are as plentiful and resilient as crabgrass. Healthcare provides fertile hacking ground. The challenges in cybersecurity will grow larger, not smaller in 2018. More data breaches, and ransomware and other intrusions will occur and disrupt. A greater portion of healthcare resources will have to be deployed from every budget.

Deploying Social Determinants of Health

SDOH has been around for some time, but in 2018 it will be put into practice for population health initiatives by healthcare organizations and health plans on a significantly wider scale, driven by analytics and innovative new approaches.

Ho-Hum Impact of Trump Health Insurance Reforms

Moving insurance plans offerings across state lines and promoting association health plans won’t make much of a dent in the individual health insurance market in 2018. Don’t count on these initiatives to drive much business.

The Certainty of Uncertainty

Uncertainly was the word of the year in 2017 as the ACA teetered on a year-long tightrope. The tax reform individual mandate axe further muddies the water, as well as threatened Medicaid funding and more in 2018, but then there are the November 2018 elections, and who knows what that will bring.

Fulfilling the Promise of Analytics

SDOH is just one of a spectrum of initiatives that analytics is driving that wouldn’t have been feasible in their current form earlier this decade. Analytics is helping to shape solutions for the Opioid crisis, healthcare identify management, and interventions throughout population health, readmissions management, complex case management, to name a few. Serious analytics requires no small sum of resources and scale, but the returns are mounting and will bear even more fruit in 2018.


Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

By Claire Thayer, January 5, 2017

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

Trump poised to take action on Medicaid work requirements

The Trump administration is preparing to release guidelines soon for requiring Medicaid recipients to work, according to sources familiar with the plans, a major shift in the 50-year-old program.
The Hill
Friday, January 5, 2018

Trump Administration Rule Paves Way For Association Health Plans

The Department of Labor on Thursday released proposed new rules that proponents say will make it easier for businesses to band together in “associations” to buy health insurance.
Kaiser Health News
Thursday, January 4, 2018

White House greenlights CMS' crackdown on Medicare Advantage plans

The White House has signed off on the CMS' proposal to ensure Medicare Advantage plans have adequate provider networks. Starting next year, the CMS will start reviewing Medicare Advantage networks on three-year cycles rather than only when a company applies to be or renews their status in the program.
Modern Healthcare
Wednesday, January 3, 2018

HHS updates rule on sharing patient substance use history

HHS issued a final rule Wednesday to ease the exchange of information on patients' substance use history between providers, insurers and third parties involved in the payment or delivery of care. The update to HHS' Substance Abuse and Mental Health Services Administration's regulatory rules aims to eliminate red tape that can slow the reimbursement process and impede timely access to care.
Becker's Hospital Review
Wednesday, January 3, 2018

Hospital groups dig in after cuts to discount drug program

Hospital groups are vowing to push forward with a fight against the Trump administration over changes to a federal drug discount program following a setback last week.
The Hill
Tuesday, January 2, 2018

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.


Looking A Little Deeper into CMS National Health Expenditure Report

Looking A Little Deeper into CMS National Health Expenditure Report

By Clive Riddle, December 20, 2017



The CMS Office of the Actuary recently released their annual National Health Expenditure Data, current and historical through 2016. We thought we’d take a slightly deeper look at data released to expand upon the publicized highlights.


CMS found that ”in 2016, overall national health spending increased 4.3 percent following 5.8 percent growth in 2015.” For comparison PwC in their annual Behind The Numbers medical cost trend report pegged the number at 6.8% in 2015; 6.2% in 2016; 6.0% in 2017 and project 6.5% for 2018. Of course overall national health expenditures measured by CMS are not an identical universe to how PwC measures medical cost trend.


The portion of national GDP that healthcare consumes has been one of the most used comparative measures of healthcare to the overall economy. CMS found that “During 2014 and 2015, the health spending share of the economy increased 0.5 percentage point from 17.2 percent in 2013 to 17.7 percent in 2015. Health care spending grew 1.5 percentage points faster than the overall economy in 2016, resulting in a 0.2 percentage-point increase in the health spending share of the economy – from 17.7 percent in 2015 to 17.9 percent in 2016.” Looking back into CMS historical files, in 1966 healthcare consumed 5.7% of the national GDP. In 1976 it was 8.1%. In 1986: 10.3; 1996: 13.3%; 2006: 15.5%; and last year to 17.9%.


CMS reports that “private health insurance spending increased 5.1 percent to $1.1 trillion in 2016, which was slower than the 6.9 percent growth in 2015.” Private insurance comprised 22% of national health expenditures in 1966, 25% in 1976, 29% in 1986, 32% in 1996, and 34% in 2006 as well as 2016.  


Regarding Medicare, CMS states “spending grew 3.6 percent to $672.1 billion in 2016, which was slower growth than the previous two years when spending grew 4.8 percent in 2015 and 4.9 percent in 2014.  Medicare comprised 4% of national health expenditures in 1966, 13% in 1976, 16% in 1986, 18% in 1996, 19% in 2006 and 20% in 2016


For Medicaid, CMS says “expenditures grew 3.2 percent in 2016, while federal Medicaid expenditures increased 4.4 percent in 2016. The slower overall growth in Medicaid spending was much lower than in the previous two years, when Medicaid spending grew 11.5 percent in 2014 and 9.5 percent in 2015.” Medicaid comprised 3% of national health expenditures in 1966, 10% in 1976, 9% in 1986, 14% in 1996 and 2006, and 17% in 2016.


CMS tells us that overall “out-of-pocket spending grew 3.9 percent to $352.5 billion in 2016, faster than the 2.8 percent growth in 2015.  Additionally, 2016 was the fastest rate of growth since 2007 and was higher than the average annual growth of 2.0 percent during 2008-15.”Examining out of pocket expenses as a percent of overall health expenditures, we found the percentage has decreased from to 48% in 1960; 33% in 1970; 22% in 1985; 15% in 2000 and 11% in 2016.


CMS reported that “retail prescription drug spending slowed in 2016, increasing 1.3 percent to $328.6 billion. The slower growth in 2016 follows two years of significant growth in 2014 and 2015, 12.4 percent and 8.9 percent, respectively” Looking back at historical files for Rx total spending, percentage of overall healthcare spending and the percentage paid out of pocket for the past six decades, we found:

1966: Total $4.0 Billion | 8.6% of Total Health Expenditures | 90.2% paid out of pocket

1976: Total $8.7 Billion | 5.7% of Total Health Expenditures | 74.7% paid out of pocket

1986: Total $24.3 Billion | 5.1% of Total Health Expenditures | 64.8% paid out of pocket

1996: Total $68.1 Billion | 6.3% of Total Health Expenditures | 35.6% paid out of pocket

2006: Total $224.1 Billion | 10.4% of Total Health Expenditures | 22.9% paid out of pocket

2016: Total $328.6 Billion | 9.8% of Total Health Expenditures | 13.7% paid out of pocket.



Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:


Good Deals for Some, Sticker Shock for Others As ACA Enrollment Winds Down

In most states, Friday night is the last chance to sign up for Affordable Care Act health insurance for 2018. The enrollment period is half as long as last year’s, and it got just a fraction of the marketing budget to tell consumers that.

Kaiser Health News

Friday, December 15, 2017

HHS greenlights secret pilot for Medicare Advantage to get real-time access to patient discharge records

The Department of Health and Human Services' Office of the Inspector General has given permission for a drug company to start a pilot program that will allow a private Medicare Advantage plan real-time access to a hospital's electronic patient discharge records, according to an HHS letter posted December 11.

Healthcare Finance

Wednesday, December 13, 2017

Hospitals Are Merging to Face Off With Insurers

A spate of hospital deals stands to further remake the U.S. health-care landscape, pushing up prices for consumers and insurers and changing how individuals get care. Just this month, health systems with at least 166 hospitals and $39 billion in combined annual revenue have announced merger plans.



Physicians argue Anthem's ER policy violates federal law

Physicians are concerned about a new policy Anthem is rolling out in Indiana in January, according to WBOI. Under the new policy, which is already effective in three other states, Anthem will review diagnoses after members' emergency room visits. If the condition is determined to be nonemergent, Anthem may not cover the ER visit.

Becker's Hospital Review

Monday, December 11, 2017

8.8 million Americans face big tax hike if Republicans scrap the medical deduction

Anne Hammer is one of millions of elderly Americans who could face a substantial tax hike in 2018 depending on the final negotiations over the Republican tax bill. In her retirement community in Chestertown, Md., it’s the big topic of conversation.

The Washington Post

Sunday, December 10, 2017

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

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