Welcome to The Donut Hole’s weekly summary. The news doesn’t stop. Lucky for you, we are here to help you take in the week that was in the business of healthcare.
AHA moves to shift cost blame to health plans in letter to antitrust regulators
In the long running blame game between payors and health systems, the AHA is the latest to throw a punch. The influential hospital lobby is ramping up its defense of hospital mergers and casting blame on payors as the Biden administration aims to crack down on provider consolidation. In its letter to the White House and several agencies, the group said that payors “have skirted much of the antitrust enforcement and regulatory attention provided by this assemblage of federal agencies," and in fact are responsible for consumers not seeing any savings from hospital consolidation. The letter included an attachment that expands on several anticompetitive / anti-consumer practices, including:
Bait and switch coverage policies (mid-year changes to prescription drug formularies and in-network care sites)
Specialty pharmacy restrictions
Payor acquisitions of physician practices
It’s worth noting that the AHA’s data in support of hospital consolidation has been previously criticized by outside experts for cherry-picked data and other methodological weaknesses.
Commentary: It’s fair to say that there is plenty of fault to go around when it comes to America’s high healthcare costs. The AHA raises some appropriate criticisms of anti-consumer payor practices, but hospitals are far from an innocent bystander. Moreover most data has shown that hospital consolidation tends to increase prices as the surviving health systems are larger and in better positions to negotiate higher rates. Suffice to say, any policies or federal actions designed to lower costs and protect healthcare consumers must consider both payor and provider abuses. Addressing one but not the other is likely to undermine the ultimate impact of any new policy.
Many insurers are no longer waiving cost sharing for COVID-19 treatment
Health plans are starting to change their tune on patient cost exposure for COVID-19 treatment. Last year, during the height of the pandemic, many insurers voluntarily waived patient cost sharing for COVID-19 treatment (cost sharing is what a patient owes out of their own pocket, either through a deductible, copay or coinsurance). However, payors have largely done away with those waivers and more are expected to disappear by the end of October. With the Delta-driven rise in hospitalizations, many expect to see patients across the country once again face large bills for inpatient care.
Commentary: This policy change is not unexpected, particularly as office visits and procedures rebound (i.e. driving a recovery in payor MLR). That said, it’s a good reminder that those recovering from inpatient stays for COVID will face a second challenge of expensive bills. This economic impact of treatment is likely to be particularly acute in areas of the country with higher unemployment.
Google shuts down unified health division as chief leaves company
Big news from Google, which had been working on some interesting healthcare products (such as the clinician-facing solution that would better organize EMR and other health data). Google is reportedly dismantling its health technology initiative and splitting its projects across other teams, according to Business Insider. Additionally, Dr. David Feinberg, the chief of the division, is leaving Google to join EMR company Cerner as its CEO and president.
Interestingly, the news of Google's health reorganization comes about a day after a report indicated that Apple is scaling back a specific health team that was focused on an internal health app.
Commentary: Google’s and even Apple’s announcements have attracted a lot of comments across the industry, most of them pessimistic on the role for big tech in healthcare. But we don’t think that’s the best response here. Rather, these announcements reflect that fact that large, global companies are complicated and it’s difficult to create new divisions out of thin air. Also, it’s not like these companies are exiting the healthcare scene. Google Cloud will continue to penetrate the healthcare market along with Amazon’s AWS and Microsoft’s Azure cloud offerings. Google Search will continue to flag COVID misinformation. Google’s recent acquisition, Fitbit, will expand deeper into healthcare use cases along with Apple Watch and the Health app. In addition, Amazon is firmly in the pharmacy space and Microsoft is moving into the clinician workflow with its Nuance acquisition. It’s just that big tech’s impact on healthcare may be more subtle than major announcements from a newly formed business unit.
Other news you may like:
Study: Private consultancies can influence hospital participation in CMS bundled payments model
Burnout, delta variant boost demand for traveling nurses again
Biden administration invests $19M to bolster rural telehealth
Number of uninsured adults steady despite impact from COVID-19 pandemic: analysis
Funding for Health Care Providers During the Pandemic: An Update
5 Charts About Public Opinion on the Affordable Care Act and the Supreme Court
Have a great week!
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