A group of employers wanted to learn more about the cost of healthcare and compare it to other states. What they found was that the data wasn’t accessible to them. The group then combined their claims data and sent it to an outside think tank, Rand Corp. which then compared the employers’ data to Medicare rates. The results angered the employers as they realized they were paying the highest prices among the states in the study and more than three times Medicare rates.
A bipartisan effort began in the state legislature to reform the cost of healthcare in the state. One of the main concerns was that high healthcare costs hurt Indiana’s ability to attract new businesses to the state. The legislation also effectively blocked facility fees from hospitals and requires hospitals to submit detailed pricing data to the state.
Source: Wall Street Journal (note: a subscription is required to read the full article)
In the biggest jump in cost since 2011, the average employer-sponsored health insurance premium for families rose 7% in 2023. This increase places a burden on both employers and employees who now spend nearly $24,000 in healthcare costs per family. Employees on average are paying $6,575 for their share of the premium.
The rise in costs is likely related to pandemic issues including higher costs for healthcare worker salaries. Industry watchers are monitoring prescription drug coverage, the labor market, and price increases across healthcare. Both employers and employees have seen a rise of 20% over the past five years for insurance coverage.
Pharmacy benefit managers or PBMs have been under fire recently for the rising costs of prescription drugs. Adding to the PBMs' woes, independent, community pharmacies are fighting back against direct and indirect remuneration (DIR) fees. A pharmacy trade group called the National Community Pharmacists Association (NCPA) has formed a new entity called Trust LLC to investigate the PBM business model.
Trust LLC will back pharmacies with arbitration and litigation services if needed. Members of the NCPA argue that the DIR fees violate anti-trust laws and strip pharmacies of large sums of money. These fees contribute to failing pharmacies that can’t compete with large PBMs that stack the deck against independent pharmacies. An Iowa pharmacy recently filed a lawsuit against CVS Health, Caremark and Aetna for exorbitant DIR fees. Representatives from the NCPA say that DIR fees have increased more than 107,400% in recent years which is unsustainable.
A new artificial intelligence (AI) medical scribe product is hitting the market, starting with doctors in the Permanente Medical Group (TPMG) which is the largest physician-led medical group in the United States. The maker of the AI scribe is Nabla who touts the quality-of-life benefit for providers more than cost savings. Nabla determined in their pilot program that the AI scribe tool saved providers an average of 1.5 hours per day on paperwork. The tool works by recording and transcribing doctor and patient encounters, virtual or in person.
Transcription happens when the provider either activates the AI tool for a virtual or in-person visit and the tool captures the conversation. Then, the AI generates a clinical note that can be integrated into any EHR system in less than 20 seconds and with 95% accuracy.
The AI tool was developed in Europe and complies with European Union privacy laws against storing user data. To accomplish this, the company created its own large language models. Overall Nabla hopes that the AI tool will help doctors be able to listen more intently during visits with patients.
Source: Fierce Healthcare
Elevance Health posted a $1.3 billion profit in the third quarter of this year which is down almost 20% compared to the same time frame last year. The company said the net charge for Q3 was $697 million, which included write-offs for some IT technology assets and contract exits.
Additionally, they have strategically reviewed costs and implemented some saving measures including reductions in staff, office and data center closures, and partial closures. Revenues in Q3 were $42.5 billion (up 7.2% from 2022), while expenses were at $41.2 billion (an 8.9% increase from last year). Net income was $1.3 billion, which is down 19.6% from 2022.
Source: Becker’s Payer
The pandemic changed many aspects of our society, and now, another wave of change is happening in healthcare. “Medtail” is when a former retail space is converted into a healthcare space. As many businesses failed due to the pandemic or became remote, a plethora of spaces became available. Renovating a space is often much more cost-effective than new construction, so healthcare providers and systems are seizing the opportunity to expand services.
Retailers and healthcare providers consider the same types of features when determining where to locate. Visibility, accessibility, and transportation access are all important factors when moving to a new location, or creating and new space for both retailers and providers.
Spaces with high ceilings are perfect for surgical or imaging because they can accommodate large machinery. Spaces with lower ceilings are good for primary or specialty care. Additionally, these “medtail” spaces in cities often allow healthcare providers to practice in areas that didn’t have access to healthcare before. The “medtail” surge has benefits for both healthcare providers and in turn, patients in the community.
Source: Healthcare Brew