Read today’s Kaiser Health News
In other news:
Nobel Prize in medicine goes to trio of scientists for discovering how the immune system is kept in check: The 2025 Nobel Prize in physiology or medicine has been awarded to a trio of scientists – two of them American and one Japanese – for unraveling how the immune system protects us from thousands of different microbes trying to invade our bodies.
Mary E. Brunkow, Fred Ramsdell and Shimon Sakaguchi will share the prize “for their fundamental discoveries relating to peripheral immune tolerance,” the Nobel Committee announced Monday at a ceremony in Stockholm, Sweden.
The laureates identified “regulatory T cells,” which function like the immune system’s security guards and prevent immune cells from attacking our own body, a cause of autoimmune diseases.
About health insurance/insurers
Major health insurers scaling back Medicare Advantage offerings in 2026 FYI
Commercial Insurers Paid More For Procedures At Hospital Outpatient Departments Than At Ambulatory Surgical Centers: Overall, in 2024, commercial prices were $1,489 (78 percent) higher in HOPDs than in ASCs, whereas Medicare prices were $633 (97 percent) higher. However, site payment differentials varied substantially across payers: Cigna had the lowest differentials between HOPDs and ASCs ($327), whereas United had the highest ($1,673). Cigna achieved this through provider selection, contracting with only 14 percent of HOPDs in applicable markets compared with an average of 76 percent for United and BlueCross BlueShield. If United and BlueCross BlueShield paid Cigna’s average HOPD rates for these procedures, together they would save approximately $1.4 billion a year.
About the public’s health
CDC Immunization Schedule Adopts Individual-Based Decision-Making for COVID-19 and Standalone Vaccination for Chickenpox in Toddlers: The Centers for Disease Control and Prevention (CDC) today updated its adult and child immunization schedules to apply individual-based decision-making to COVID-19 vaccination and recommend that toddlers receive protection from varicella (chickenpox) as a standalone immunization rather than in combination with measles, mumps, and rubella vaccination.
Comparing COVID-19 Acute And Postacute Medical Spending By Vaccination Status For Child And Adult Medicaid Enrollees: We examined expenditures during acute (within thirty days after diagnosis) and postacute (at least thirty days after diagnosis) periods from April 2021 through July 2022. Among children, average acute medical expenditures were $194 less for vaccinated than unvaccinated cases and among adults, $1,743 less for vaccinated than unvaccinated cases. Medical expenditures in the postacute period were not statistically different by vaccination status. The findings suggest that COVID-19 vaccination is associated with lower medical expenditures in the acute period. Vaccination continues to be important for reducing the economic impact of COVID-19.
Another reason to give children the Covid-19 vaccine:
Long COVID associated with SARS-CoV-2 reinfection among children and adolescents in the omicron era (RECOVER-EHR): a retrospective cohort study: Children and adolescents face a significantly higher risk of various PASC outcomes after reinfection with SARS-CoV-2. These findings add to previous evidence linking paediatric long COVID to multisystem effects and highlight the need to promote vaccination in younger populations and support ongoing research to better understand PASC, identify high-risk subgroups, and improve prevention and care strategies.
About healthcare IT
Claims Denial Navigator Tool Microsoft now has an AI app that helps hospitals overcome insurance company coding-based denials:
Claims Denial Navigator is an AI-powered tool that helps recover lost revenue and streamline the process of researching and resolving denied Medicare, Medicaid, and Commercial Insurance claims. Claims Denial Navigator is available for free on Github.com.