7 healthcare trends we're watching now A thoughtful summary. Highly recommended.
About Covid-19
Interim Effectiveness of Updated 2023–2024 (Monovalent XBB.1.5) COVID-19 Vaccines Against COVID-19–Associated Emergency Department and Urgent Care Encounters and Hospitalization Among Immunocompetent Adults Aged ≥18 Years — VISION and IVY Networks, September 2023–January 2024 The vaccine lowers urgent care visits and hospitalizations by about 50% compared to no vaccination.
About health insurance/insurers
ObamaCare faces key hearing after Texas ruling “A federal appeals court is set to hear arguments Monday on the Biden administration’s appeal of a case that threatens the Affordable Care Act’s (ACA) promise of free preventive care to more than 150 million people.
A federal judge in Texas last year ruled that the law’s mandate requiring employers and insurers to cover a host of preventive services, like certain cancer screenings and HIV prevention, was unconstitutional.”
Why Medicare is adding prior authorization requirements as others cut back “Medicare is taking the rare step of adding pre-treatment approval requirements before patients can get care at certain outpatient surgical facilities that have seen a sharp uptick in billings…
The new requirements apply to 40 services related to five procedures,including rhinoplasty, eyelid lifts and varicose vein treatments.”
Primary Care Physicians In Medicare Advantage Were Less Costly, Provided Similar Quality Versus Regional Average “Assessing primary care physician costliness based on the gap between observed and predicted costs for their traditional Medicare patients, we found that the average primary care physician in MA networks was $433 less costly per patient (2.9 percent of baseline) compared with the regional mean, with less costly primary care physicians included in more networks than more costly ones. Favorable selection of patients by MA primary care physicians contributed partially to this result. The quality measures of MA primary care physicians were similar to the regional mean. In contrast, primary care physicians excluded from all MA networks were $1,617 (13.8 percent) costlier than the regional mean, with lower quality. Primary care physicians in narrow networks were $212 (1.4 percent) less costly than those in wide networks, but their quality was slightly lower. These findings highlight the potential role of selective contracting in reducing costs in the MA program.”
About hospitals and healthcare systems
Hospital Facility Prices Declined As A Result Of Oregon’s Hospital Payment Cap “In October 2019, the Oregon state employee health insurance plan instituted a cap on hospital payments…
The cap was associated with a significant reduction in outpatient facility prices over the course of the first twenty-seven months of the policy (−$130.50 per procedure). We estimated $107.5 million (or 4 percent of total plan spending) in savings to the state employee plan during the first two years. The hospital payment cap successfully reduced hospital prices for enrollees in that plan.”
About pharma
1 in 3 independent pharmacies to close this year: Survey “Thirty-two percent of independent pharmacy owners plan to shutter their businesses by the end of 2024, according to a February survey.
Local pharmacies are facing a plethora of headwinds, including dwindling reimbursements and struggles with pharmacy benefit managers, the National Community Pharmacists Association said Feb. 27.”
AstraZeneca's challenge to IRA price negotiations is rejected “Less than three weeks after a Texas judge tossed a lawsuit by industry lobbying group PhRMA that challenged the constitutionality of the Inflation Reduction Act (IRA), a federal court in Delaware has done the same with a similar action brought by AstraZeneca.
The company brought the suit in August of last year after its diabetes, kidney and heart drug Farxiga was named one of 10 products that will face Medicare price negotiations in 2026. Several other companies with drugs on the list have also filed lawsuits.”
Retail pharmacies to begin selling OTC birth control within weeks “Almost eight months after the FDA approved Opill, the first over-the-counter birth control pill, it will soon be available for purchase without a prescription at pharmacies like CVS and Walgreens in weeks…”
Drugs like Ozempic and Wegovy could boost the US economy by a trillion dollars in a few years, Goldman Sachs predicts “The US economy is set to reap considerable benefits from Americans taking popular medications used for weight loss, including Ozempic and Wegovy, Goldman Sachs analysts wrote in a recent research report…
The Wall Street bank estimates that GLP-1s could add 0.4% to America’s gross domestic product, a broad measure of all the goods and services produced in the economy, ‘in a baseline scenario where 30 million users take the drugs and 70% experience benefits,’ and as much as 1% if 60 million Americans take those drugs regularly.
The US economy overall was about $28 trillion in the fourth quarter, so if Goldman’s bullish case bears out, that means GLP-1 drugs alone could boost output by a trillion dollars over the next four years, more or less.”
Comment: On the other hand, consider how much the drugs could add to health care costs.
About healthcare personnel
Private Equity–Acquired Physician Practices And Market Penetration Increased Substantially, 2012–21 “PE-acquired physician practice sites increased from 816 across 119 MSAs in 2012 to 5,779 across 307 MSAs in 2021. Single PE firms had significant market share, exceeding 30 percent in 108 MSA specialty markets and exceeding 50 percent in 50 of those markets. The findings raise concerns about competition and call for closer scrutiny by the Federal Trade Commission, state regulators, and policy makers.”
About health technology
Health tech Q4 earnings recap FYI
In a first, fetal cell organoids generated from amniotic fluid, new study reports “…researchers working in the U.K. have discovered that some [amniotic fluid] cells are still alive, and they can be grown up into three-dimensional organoids — mini lung, kidney, and small intestines — providing a possible new tool to study and even diagnose congenital fetal diseases.”