Read today’s Kaiser Health News
In other news:
About health insurance/insurers
Medicare Advantage struggles cited in 2024 $5.7B underwriting loss: Report: Higher utilization contributed to Medicare Advantage’s $5.7 billion underwriting loss in 2024, a marked reversal from serving as a source of earnings in the last five years, said an AM Best news release covering a Sept. 23 report.
“Changes to the risk-adjustment payment model by CMS, as well as lower star ratings across the industry, also have contributed to recent underwriting losses,” Industry Research and Analytics Associate Director Jason Hopper said.
UnitedHealthcare to pay $359M in ACA rebates: UnitedHealthcare is set to pay $359 million in ACA rebates for 2024, sending checks that are slated to arrive by Sept. 30, according to a news release from the insurer.
Last year, commercial payers were estimated to have spent $1.1 billion on rebates, according to KFF. These rebates are products of the medical loss ratio provision of the ACA, which restricts how much premium income can be used for profits and administrative and marketing expenses.
Centene to pay $87.5M in ACA rebates to Missouri policyholders: The rebates stem from failing to meet medical loss ratio requirements under the ACA, which outlines how much payers can retain for administrative or marketing costs and profits. For context, payers were expected to issue $1.1 billion in medical loss ratio rebates across all commercial markets in 2024, per KFF.
About hospitals and healthcare systems
What’s driving urban hospital closures? 6 GAO findings: Urban hospitals have faced mounting pressures in recent years, with closures outpacing new openings from 2019 to 2023, according to a recent report from the Government Accountability Office. The GAO reviewed five urban hospitals that closed in 2022 and 2023 to better understand the financial and operational challenges leading to their shutdowns and how those closures reshaped community access to care.
Hospital Price Markup and Outcomes of Major Elective Operations: Findings In this national cross-sectional study of 1960 hospitals across the US, approximately 10% marked up the true cost of care by a median of 8.5-fold. Surgical care at such high-markup centers was associated with significantly greater adjusted risk of morbidity and readmissions.
Meaning High-markup hospitals are associated with significantly inferior quality and value of care and represent an important initial target for national policy aimed at promoting transparency and regulating hospital pricing.
About the public’s health
4 vaccines linked to a lower risk of dementia, according to science Influenza, Shingles, RSV and Tdap vaccines are discussed.
Simple screening questionnaires better for identifying social needs compared to advanced machine learning, study determines: Simple patient screening questionnaires addressing five different health-related social needs (HRSNs) such as food insecurity, housing instability, financial strain, transportation barriers and legal issues performed better than advanced machine learning methods at tracking HRSNs. This is according to a new study led by researchers at the Fairbanks School and Regenstrief Institute. However, authors emphasized that there was no perfect method; each one had gaps.
Comment: Sometimes simpler is better.
Global, Regional, and National Burden of Cardiovascular Diseases and Risk Factors in 204 Countries and Territories, 1990-2023: CVDs were the leading cause of disability-adjusted life years (DALYs) and deaths estimated in the GBD [global burden of disease]. As of 2023, there were 437 million (95% UI: 401 to 465 million) CVD DALYs globally, a 1.4-fold increase from the number in 1990 of 320 million (292 to 344 million). Ischemic heart disease, intracerebral hemorrhage, ischemic stroke, and hypertensive heart disease were the leading cardiovascular causes of DALYs in 2023 globally…CVD DALY rates were highest in low and low-middle Socio-demographic Index (SDI) settings and lowest in high SDI settings.
About healthcare personnel
2 annual AMA reports FYI: