Rising Medical Costs Raise Flags and Drop Stocks for Health Plans

Patients who put off elective surgeries during Covid such as joint replacements are returning for care at a much higher rate than insurers had predicted. This jump has led to a jump in medical costs and a drop in stock prices for groups such as Humana and UnitedHealth, which saw their most significant loss since March 2020.

While this news caused drops in insurer stocks, stock prices for medical devices and hospitals rose. UnitedHealth said in addition to a rise in elective surgeries, behavioral health services were also happening at significantly higher levels.

Source: BenefitsPro.com

Uber Health Expands Services for Patients

In 2018 Uber created Uber Health, allowing healthcare workers to book rides for patients to and from their medical appointments. In March 2023, the company expanded services to include same-day prescription delivery. This past week Uber announced additional delivery services for patients including grocery delivery and delivery for over-the-counter items.

This expansion focuses on value-based care, which helps lower healthcare costs and improves patient outcomes. Uber Health’s focus on delivery services will help reduce the burden for patients. Assisting with transportation helps reduce no-shows at appointments and reliance on emergency services. Lack of transportation is cited as the reason for 3.6 million people each year who miss appointments. Most often these services are included in health plans and patients are not charged for Uber Health Services.

Source: Healthcare Dive

United Healthcare’s New Rules on Colonoscopy Authorizations

United Healthcare was set to announce a new policy for prior authorization for colonoscopies, however, the company instead announced a new alternative advanced notification process that requires physicians to provide more data before performing “non-screening and non-emergent” colonoscopies, capsule endoscopies, and esophagogastroduodenoscopies.

The American Gastroenterological Association (AGA), is concerned that this new process isn’t warranted as UHC doesn’t have any data showing that these procedures are overused. The AGA is also concerned that the paperwork requirements for this new process will be more of an administrative burden for providers. As of now, other health plans have not announced plans to emulate this UHC process.

Source: Fierce Healthcare

Trends in Artificial Intelligence and Healthcare

Artificial Intelligence (AI) is integrating into every industry, including healthcare. AI can be used to improve experiences for the provider and the patients and help address staffing shortages and burnout rates. Some ways AI is being used include research, charting, and analyzing electronic health records (EHRs).

Google Cloud is partnering with the Mayo Clinic to use generative AI to search across health databases and EHRs. Carbon Health is integrating AI-enabled notes into its EHRs. This should help generate a summary of patient history, diagnostic codes, and other notes. Charts can be completed in less than four minutes so providers can spend more time with patients and less time on paperwork. A large language model (LLM) of AI is analyzing EHRs to provide predictive data to providers. This model tool can estimate a hospitalized patient’s stay, and chance of readmission.

Source: Healthcare Brew

A Lawsuit and Interest on Unpaid Medical Debt

Patient Bethany Birch had emergency gallbladder surgery at Ballad Health in Tennessee in 2016. At the time, she was uninsured and didn't have a permanent address. When the hospital bills were mailed, they never made it to Birch who had moved since the surgery.

In addition, her phone number was pay-as-you-go, and the hospital wasn't able to reach her via phone either. In 2018 Birch received paperwork from the hospital informing her that they were suing her for the cost of the bill, plus interest. She was ordered to pay $11,590.10 plus over $2,700 in interest.

The ACA requires hospitals to follow certain procedures for collecting debt before they sue a patient. In this case, the hospital followed those protocols, however, Birch's life circumstances created gaps in the process. She likely would have qualified for free or reduced-cost care, however, those options were presented to her in the letters that the hospital sent that weren't reaching her.

In May 2023, Birch had already paid over $5,000 of her debt, however, the principal balance was still over $9,000 for her debt, barely a dent due to the accruing interest. A third-party patient advocate was able to help Birch negotiate a lower final payment and in 2023 the hospital settled, calling her $5.270.20 plus $500 a complete repayment. Since 2018 Ballad Health has updated its financial assistance program to better screen and help people such as Birch.

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