Read today’s Kaiser Health News
In other news:
About health insurance/insurers
Clinical Quality Performance of Value-Based and Fee-for-Service Models for Medicare Advantage: VBP outperformed FFS for all 15 clinical quality outcomes. Across the risk-sharing continuum, clinical quality performance consistently improved as financial arrangements moved toward 2-sided risk. Incremental clinical quality improvements were observed with increased risk-sharing for 6 measures related to hypertension, diabetes, and cancer—prevalent and costly conditions.
Comment: This study was not ranomized but showed an association, Also it comes from CVS.
However, the findings are consistent with much older data indicating that provider financial risk increases value-based performance.
ACA tax credit sunset could cost healthcare $32B: Analysis: Hospitals, physicians and other healthcare providers could lose more than $32.1 billion in revenue in 2026 should Congress allow ACA tax credits to expire at the end of 2025, according to a new Urban Institute analysis published by the Robert Wood Johnson Foundation.
The analysis found that 7.3 million people could lose subsidized ACA coverage and 4.8 million could become uninsured, pushing a $7.7 billion spike in uncompensated care in 2026. The increase could hit all provider types, including $2.2 billion for hospitals, $1 billion for physician offices, $1.5 billion for prescription drugs and $3.1 billion for other services.
Most regional payers are operating at a loss: Regional, nonprofit health plans are falling behind large national insurers, with 71% recording an operating loss in 2024 and more than half having two years or less before regulatory intervention is triggered, according to a Sept. 24 report from HealthScape Advisors.
Judge sides with Humana, tosses Medicare Advantage audit rule: A federal judge has vacated a CMS rule that would have allowed the agency to claw back billions of dollars in alleged Medicare Advantage overpayments, siding with Humana in a closely watched legal battle.
On Sept. 25, the U.S. District Court for the Northern District of Texas concluded that CMS’ 2023 final rule eliminating the “fee-for-service adjuster” in MA audits violated procedural requirements under the Administrative Procedure Act.
About pharma
Direct-to-patient programs are in the works at 94% of pharmas, set to become 'standard practice': The vast majority of drugmakers are either considering or have already established direct-to-patient (DTP) programs, cutting out middlemen to offer services like virtual care consultations, payment support, at-home diagnostics and digital pharmacies.
That’s according to a new report from ixlayer, based on a recent survey of about three dozen respondents from pharmas of all sizes.
Who Will Pay for Prescription Drugs in 2033 Really good review. At minimum, look at the charts.
About the public’s health
The global, regional, and national burden of cancer, 1990–2023, with forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2023: Risk-attributable cancer deaths increased by 72·3% (57·1 to 86·8) from 1990 to 2023, whereas overall global cancer deaths increased by 74·3% (62·2 to 86·2) over the same period. The reference forecasts (the most likely future) estimate that in 2050 there will be 30·5 million (22·9 to 38·9) cases and 18·6 million (15·6 to 21·5) deaths from cancer globally, 60·7% (41·9 to 80·6) and 74·5% (50·1 to 104·2) increases from 2024, respectively. These forecasted increases in deaths are greater in low-income and middle-income countries (90·6% [61·0 to 127·0]) compared with high-income countries (42·8% [28·3 to 58·6]). Most of these increases are likely due to demographic changes, as age-standardised death rates are forecast to change by –5·6% (–12·8 to 4·6) between 2024 and 2050 globally. Between 2015 and 2030, the probability of dying due to cancer between the ages of 30 years and 70 years was forecasted to have a relative decrease of 6·5% (3·2 to 10·3).