Yesterday, the price of gas hit an all-time high of $5.01 per AAA—from $4.48 in Georgia to $6.43 in California. In the last 12 months, prices for fuel oil (+106.7%), gas (+48.7%), used cars and trucks (+16.1%), electricity (+12.0%), groceries (+11.9%), transportation (+7.9%), shelter (+5.5%) hit all-time highs per the BLS May Report. Inflation hit a 40-year high at 8.6%.
It’s the lead story in every news outlet, supplanting gun violence and the January 6 insurrection. As the Fed meets this Wednesday to consider a 50-75 basis point borrowing rate hike intended to slow inflation, its toll on the public’s psyche is a major concern:
· Per the Wall Street Journal-NORC Poll of 1071 adults May-May 17, 2022, 83% described the state of the economy as poor or not so good, 38% said their financial situation had gotten worse in the past few years and 35% said they aren’t satisfied at all with their financial situation– the highest level since NORC began asking the question every few years starting in 1972.
· Per the Federal Reserve’s latest survey of 12,000 adults,78% of Americans are confident in their personal financial well-being (up from 74% in 2017), but just 24% are confident in the U.S. financial well-being. (down from 41% in 2017 and 50% peak in 2021).
· Per the Economist and YouGov Poll, 55% believe the US is currently experiencing an economic recession (including 70% of Republicans and 55% of Independents) vs. 21% who don’t believe the country is in a downturn and 24% said they aren’t sure.
· Per the Pew Charitable Trust poll of 5,074 adults conducted April 25-May 1, 2022, only 20% say they trust the government in Washington to do the right thing “just about always or most of the time” and 60% say the government should play a do more in terrorism, immigration, the economy, access to health care and protecting the environment.
Comparatively, healthcare has seen relatively constrained price increases while the rest of the economy’s price hikes have soared: In the last 12 months, the energy index rose 34.6%–the largest 12-month increase 2005, the food index increased 10.1 %–the first increase of 10% or more since 1981 vs. 4.0% for medical care–notably the lowest 12 month increase of any category in the CPI. The details are even more insightful:
In the last 12 months, per the BLS, prices for prescription drugs increased 1.9%, over the counter and self-care remedies increased 3.2%, medical devices & equipment increased 4.7%, physician services increased 1.1%, dental services increased 2.7%%, eyeglasses & eye care increased 1.4%, services by other medical professionals increased 4.5%, inpatient hospital services increased 3.9%, outpatient services increased 3.5%, nursing home & adult day care services increased 3.4%, care for individuals in the home increased 2.4% and insurance premiums increased 13.8%.
The reality is that these price increases, no matter how small, are passed through to purchasers in wildly variable pricing schemes that bear scant correlation to actual costs. And the industry’s aversion to transparency and the enormity of its size (19% of GDP) means even modest price hikes impact utilization and heighten public criticism about access and affordability.
So, what’s all this mean for healthcare?
Price sensitivity among consumers will increase in every sector of the economy including healthcare until inflation is controlled. Price sensitivity is significant in a subset of value-conscious consumers. It impacts industries or sectors in which consumers have choices and see little utility-value between high price and low-price options. This concept is widely understood in the travel, retail, and hospitality industries among others, but not so much in healthcare. That’s changing. The growing accessibility of comparative performance data about drug efficacy, diagnostic accuracy, avoidable complications, physician competence, hospital administrative costs, user experiences, total costs of care et al are foundational to price sensitivity in healthcare. Individual accountability for decisions, aided by personal decision-support devices, is next, and they’re readily available now. Notable investments by venture capitalists in technology-enabled self-care is the bridge to consumer price sensitivity and price-driven healthcare.
The complicity of health insurers in healthcare price inflation will heighten tensions between providers and payers. The BLS CPI data unveil a startling reality: health insurers are able to define what’s covered, raise premiums, reduce reimbursement to providers and pass healthy premium increases through to groups and individuals. They own pharmacy benefits mangers who profit from drug price escalation in the supply chain and withhold discounts negotiated with drug makers from retail pharmacies. They have claims data, relationships with employers and significant sway over state insurance commission regulations.
While legitimately alerting their customers to the lack of price transparency, waste and inexplicable variability in the performance of providers, they enjoy tremendous clout. Like hospitals, they keep their secret sauce secret, but increasingly the spotlight has turned to their coverage and denial methods, risk-scoring and premium setting calculus, executive compensation, investment activities, member experiences and more. As provider organizations, particularly hospitals and medical groups, pursue risk sharing arrangements with insurers, tension will mount. Neither trusts the other, and there’s lots of money at stake.
The attractiveness of low-price goods and services in healthcare will increase significantly. While hospitals, physicians and traditional providers war with payers over negotiated rates of reimbursement, start-ups not tethered to traditional payment schemes will gain market share. Insurtechs, over-the-counter therapeutics, self-care technologies and price estimator apps will flourish, especially those with access to private equity capital and online operating platforms that equip consumers to compare prices and choose wisely.
Price-driven purchasing in healthcare is here: its focus is outpatient, physician services and high-cost acute hospital services and its detractors are incumbents for whom prices obscure their actual costs and results.
In every sector of the U.S. economy, price sensitivity is increasing. It’s driving purchasing decisions by individuals, households and employers. The U.S. healthcare system is not immune to these forces. In our industry, price opacity is SOP: it’s what makes us, like education, an industry able to pass thru cost increases routinely, price based on what the market can bear and build reputations impervious to consumer pressure for price controls.
Consumer healthcare price sensitivity has been latent in healthcare. It has not translated to consumer activism but it will. In some states, in some companies and in many households, healthcare prices are on the radar. Few in the industry are taking it seriously.
The key takeaway from the May BLS CPI report is this: healthcare prices in the last 12 months across the board have gone up and the biggest beneficiary are health insurers. Stay tuned.
PS: Two days after completing its $28.4 billion acquisition of Cerner, Oracle Board Chair and CTO Larry Ellison announced the firm’s expansion strategy in healthcare with 3 key elements: a national EHR database to enable interoperability, expanded capabilities for the Cerner Millennium platform including artificial intelligence tools and mobile remote patient-monitoring using its V-safe solution. Bold. Provocative. Timely, especially if the table is set with Epic and MediTech invited.
US Bureau of Labor Statistics Consumer Price Index May Report June 10, 2022 www.bls.gov
Distribution of Household Wealth in the U.S. since 1989 Federal Reserve www.federalreserve.gov
Wall Street Journal NORC
“Americans’ Views of Government: Decades of Distrust, Enduring Support for Its Role” Pew Research June 6, 2022www.pewresearch.org/politics/2022/06/06/americans-views-of-government-decades-of-distrust-enduring-support-for-its-role
Health Care Cost Institute www.healthcostinstitute.org
Understanding the Global Price-Sensitive Consumer Boston Consulting Group July 14, 2021 www.bcg.com
The Role of Prices in Excess US Health Spending Health Affairs June 9, 2022 www.healthaffairs.org/do/10.1377/hpb20220506.381195
Research points to high prices in the private sector as a critical driver of excess health spending and growth in the US. June 9, 2022 10.1377/hpb20220506.381195
Consumer Price Index Summary May 2022 BLS June 10, 2022 www.bls.gov
Study: branded drug prices escalate faster than overall health prices: Harvard Researchers evaluated recent trends in prices for newly marketed brand-name drugs (n=1230) from 2008 to 2021. Findings:
“From 2008 to 2021, launch prices for new drugs increased exponentially by 20% per year. In 2020-2021, 47% of new drugs were initially priced above $150 000 per year. Prices increased by 11% per year even after adjusting for estimated manufacturer discounts and changes in certain drug characteristics, such as more oncology and specialty drugs (e.g., injectables, biologics) introduced in recent years.
Rome et al Trends in Prescription Drug Launch Prices, 2008-2021 JAMA June 7, 2022;327(21):2145-2147. doi:10.1001/jama.2022.5542
Study: indirect billing by primary care practices significant, growing: Background: If NPs and PAs bill directly for a visit, Medicare and many private payers pay 85% of what is paid to a physician for the same service. Researchers analyzed indirectly billed visits by tracking prescriptions
Finding: “We estimated that the number of all NP or PA visits in fee-for-service Medicare data billed indirectly was 10.9 million in 2010 and 30.6 million in 2018. Indirect billing was more common in states with laws restricting NPs’ scope of practice. Eliminating indirect billing would have saved Medicare roughly $194 million in 2018, with the greatest decrease in revenue seen among smaller primary care practices, which are more likely to use this form of billing.”
Patel et al Frequency Of Indirect Billing To Medicare For Nurse Practitioner And Physician Assistant Office Visits Health Affairs June 2022 https://doi.org/10.1377/hlthaff.2021.01968
Study: physician face time disparity significant: From 1979 to 2018, annual outpatient physician face time per capita rose from 40.0 to 60.4 min, an increase driven by a rise in mean visit length and not in the number of visits. A racial/ ethnic gap in physician visit time present at the beginning of the study period widened over time: In 2014–2018, White individuals received 70.0 min of physician face time per year, vs. 52.4 among Black and 53.0 among Hispanic individuals.
J Gen Intern Med June 6, 2022 DOI: 10.1007/s11606-022-07688-x
Study: Hospital price transparency low: Background: The federal Hospital Price Transparency Final Rule requires hospitals to disclose 5 types of standard charges for all services in an accessible file and provide a consumer-friendly display for at least 300 shoppable services. Researchers collected data on hospital characteristics and adherence to the final rule between July 1 and September 30, 2021.Findings:
· Adherence: Across 5239 total hospitals, 729 (13.9%) had an adherent machine-readable file but no shoppable display, 1542 (29.4%) had an adherent shoppable display but no machine-readable file, and 300 (5.7%) had both. There were 2668 hospitals (50.9%) without an adherent machine-readable file or a shoppable display.
· Market concentration: Being in a moderately concentrated one and highly or very highly concentrated one was associated with worse adherence. Urban vs rural location was associated with higher adherence to the final rule.
· Hospital size, emergency service capabilities, and hospital ownership were not associated with adherence.
· Hospital Revenue: Total gross revenue had no significant association with final rule adherence. In contrast, being in the first quartile (lowest) of revenue per patient-day was associated with greater rates of adherence than was being in other quartiles.
Note: the penalty for non-compliance was $300/day during the study period (July and September 30, 2021); starting January 1, 2022, it increased for hospitals with more than 30 beds to $10 per bed per day up to a maximum of $5,500 per day up to a maximum total penalty of $2 million per hospital per year. To date, 352 warnings and 157 requests for corrective action plans. Last week, Northside Hospital was advised of its fine for failure by two hospitals within its system to comply with federal price transparency rules. Northside Hospital Atlanta, the health system’s flagship facility, was fined $883,180, according to CMS. Northside Hospital Cherokee in Canton, Ga., was fined $214,320. As of early June, CMS had issued 352 warning notices to hospitals and 157 requests for a corrective action plan to hospitals that received a warning and had not made any corrections. To date, 171 hospitals have had their cases closed after addressing issues.
Hague et al Adherence to a Federal Hospital Price Transparency Rule and Associated Financial and Marketplace Factors JAMA. 2022;327(21):2143-2145. doi:10.1001/jama.2022.5363
HCA sued for price gauging in Mission acquisition: The city of Brevard, North Carolina, sued HCA Healthcare for allegedly inflating healthcare costs after it acquired Mission Health.
Mission (HCA) controls more than an 85% of the acute care market in the Asheville, NC area and at least 70% of that market in the surrounding region, city officials claim in a complaint filed Friday in a North Carolina federal court. The city of Brevard seeks class certification for similarly situated health plans that paid for acute or outpatient services from HCA since June 3, 2018, and an injunction preventing future alleged conduct. The allegations are similar to ones posed in an August lawsuit filed in state court by North Carolina residents.
Kacik “HCA Healthcare hit with more price inflation allegations”
Study: paid sick leave associated with job satisfaction: Researchers analyzed data from a nationally representative sample of US workers responding to the Medical Expenditure Panel Survey–Household Component during 2017–19, combined with occupational data from the Occupational Information Network database. Results: “a one-unit increase in job flexibility was associated with a 2.15% increase in the likelihood of having an office-based health care visit in the past year and a 2.42% increase in the likelihood of having a usual source of care. Access to paid sick leave was associated with a 3.83% increase in the likelihood of having an office-based health care visit. Black and Hispanic workers, as well as workers with low-wage jobs, had less job flexibility and less access to paid sick leave.”
Hegland, Berdahl High Job Flexibility And Paid Sick Leave Increase Health Care Access And Use Among US Workers Health Affairs June 2022 https://doi.org/10.1377/hlthaff.2021.01876
McKinsey: workplace culture predicts employee burnout, turnover: Employees who report experiencing high levels of toxic behavior in the workplace are 8 times more likely than their peers to have symptoms of burnout, according to McKinsey Health Institute’s survey of nearly 15,000 employees and 1,000 HR leaders. Burnout is costly: respondents who have symptoms such as extreme tiredness are also 6 times more likely than others to say they intend to quit their jobs in the next 3-6 months.
“Battling Burnout” McKinsey www.mckinsey.com
Regulation (FTC, CMS, IRS)
FTC announces PBM probe: Last week, the Federal Trade Commission (FTC) announced it is initiating a probe of pharmacy benefit manager business practices. The probe, which the commission unanimously approved, will focus on how vertical integration in the PBM sector affects access and pricing in the prescription drug market, according to a news release.
The FTC has asked the six largest PBMs to provide information about their activities (CVS Health’s CVS Caremark, Cigna’s Express Scripts, UnitedHealth Group’s OptumRx, Humana, Blue Cross and Blue Shield-affiliated Prime Therapeutics, and MedImpact Healthcare Systems). CVS Caremark, Express Scripts and OptumRx collectively control about 80% of the PBM market. Of specific interest: clawbacks PBMs charge to unaffiliated pharmacies, efforts to direct patients toward PBM-owned pharmacies, prior authorization policies, and the effects of manufacturer rebates and fees on formulary design.
Related: Sens. Maria Cantwell (D-WA) and Chuck Grassley (R-IA) introduced a new bill to allow the FTC and state attorneys general to investigate PBM “spread pricing” in which they charge health plans and payers more for a prescription drug than what they reimburse to the pharmacy, and keep the difference. The bill would also prohibit PBMs from clawing back payments made to pharmacies, increasing fees or lowering reimbursements to offset reimbursement changes in federally-funded health plans.
FTC opens investigation into largest PBMs’ anticompetitive practices EndPoints June 7, 2022 https://endpts.com/ftc-opens-investigation-into-largest-pbms
HCA’s Deal to Buy Steward’s Utah Hospitals on Hold After Court Order: Last Monday, a Utah judge issued a temporary restraining order after the FTC Commission won court approval for a temporary restraining order forcing suspension of HCA Healthcare’s proposed acquisition of Steward Health Care System’s five hospitals in Utah. The injunction would allow the FTC time to consider the case (Federal Trade Commission v. HCA Healthcare et al, D. Utah, no. 2:22-cv-00375). in an administrative trial scheduled to begin on Dec. 13, according to an agency statement on June 2.
FTC Sues to Block Merger Between Utah Healthcare Rivals HCA Healthcare and Steward Health Care System Federal Trade Commission June 2, 2022 www.ftc.gov
Study: HSA tax break increasingly unjustified on basis of cost savings: Background: Two decades ago, Congress enabled Americans to open tax-favored health savings accounts (HSAs) in conjunction with qualifying high-deductible health plans (HDHPs). This HSA tax break is regressive: Higher-income Americans are more likely to have HSAs and fund them at higher levels. “Indeed, people who have HDHPs with HSAs are becoming less likely than others with private insurance to report financial barriers to care. In sum, promised gains in efficiency from HSAs have not borne out, so it is difficult to justify maintaining this regressive tax break.”
Glied et al Health Savings Accounts No Longer Promote Consumer Cost-ConsciousnessJune 2022No https://doi.org/10.1377/hlthaff.2021.01954
BLS Jobs Report: Per the Glide Labor Department jobs report released Friday, the economy added 390,000 jobs in May, and the unemployment rate held low and steady at 3.6%. Stats:
· Since March, the economy has added an average of 408,000 jobs per month vs.600,000 in previous 6 months. Between 2011 and 2019, job growth averaged a 194,000 between 2011 and 2019.
· Average hourly earnings rose by 5.2% in the past 12 months to May, slowing down from a previous rate of 5.5%. And, if you annualize the figures from just the past three months, hourly earnings rose at a rate of about 4.5%.
The New Jobs Report Is Encouraging on Jobs and Inflation New Yorker June 3, 2022 www.newyorker.com/news/our-columnists/the-new-jobs-report-is-encouraging-on-jobs-and-inflation
Pitchbook: 10% recession likelihood: “With inflation rising to a 40-year high, the market’s expectation of the federal funds rate at year-end has increased by 200 basis points to 2.8% over the past six months.
While a federal funds rate of around 3% may ease some demand-side inflationary pressures, continued supply chain issues and a tight labor market represent supply-side constraints that could help keep inflation elevated, and in turn, force the Fed to hike interest rates more than expected….Despite the challenging environment, our economic modeling indicates there is only a 19% chance of a recession occurring in the next 18 months based on data available at the end of May.
QUANTITATIVE PERSPECTIVES Q2 2022 US PE Enters a New Regime Pitchbook www.pitchbook.com
Press Ganey: Medicare Advantage plans could lose a star or more in 2023 ratings: 87% of Medicare Advantage plans are in danger of losing at least one star in one or more of their ratings for 2023 due to lower ratings from members and higher performance cut points per the Press Ganey analysis of 2022 member experience data for 446 MA plans. Findings:
· 48% of MA plans are at risk of losing a star on the measure of getting needed prescription drugs, while 44% are at risk of losing one due to customer service and for care coordination.
Note: MA enrollment represents 46% of all Medicare enrollment and is projected to be 53% in 2030 per the Medicare Trustees’ 2022 Report released last week. Several measures in 2022 will carry a higher weight in 2022: Customer service, Getting needed prescription drugs, rating of drug plan, care coordination, and healthcare quality rating. From 2015 through 2021, annual bonuses to MA plans based on star ratings increased from $3 billion to $11.6 billion.
Press Ganey June 6, 2022 www.pressganey.com
Medicare Advantage Debate: Prominent thought leaders are on opposite sides of a debate about prospects for Medicare Advantage: supporters George Halverson (former Kaiser CEO) and Don Crane (former CEO of America’s Physician Groups) vs. critics Don Berwick (former CMS Administrator) and Rick Gilfillan (former Trinity Health CEO and CMMI director). At issue: whether Medicare Advantage is the optimal platform for reining in health Medicare costs vs. the profiteering by health insurers and investors in current MA sponsorship.
“The Emperor Still Has No Clothes: A Response to Halvorson and Crane”, Health Affairs Forefront, June 6, 2022. DOI: 10.1377/forefront.20220602.413644
538 Analysis: only 10% of districts in Campaign 2022 competitive: since 2008, Republicans could have held onto the majority of seats in the House in 2012 while losing the popular vote by 4.3%. in fact, Republicans did win a hefty majority in 2012 while losing the popular vote by 1%.
· This November, Republicans could pull off the same feat while losing by as much as 2.5%. Any less, and Democrats are favored to hold their majority
· The number of truly competitive seats—defined as those where Democrats or Republicans have won by fewer than 5% relative to the national popular vote over the previous two election cycles—will fall from 46 to 40 out of a total of 435. (That is already down from 54 in 2010.) Put another way, less than 10% of seats will be competitive in November).
America’s congressional maps are a bit fairer than a decade ago Economist June 2, 2022www.economist.com/graphic-detail/2022/06/02/americas-congressional-maps-are-a-bit-fairer-than-a-decade-ago
Teladoc lawsuit: Last Monday, shareholder Jeremy Schneider sued Teladoc (TDOC) in a federal court in the Southern District of New York Monday, alleging he and others purchased company shares at “artificially inflated prices.” The share price has dropped drastically in recent months after “alleged corrective disclosures,” the lawsuit alleges. Purchase, New York-based Teladoc, which went public in 2015, has seen its share price drop from 293.66 in February 2021 to 31.74 Friday.
Teladoc hit with investor lawsuit after share price sinks Modern Healthcare June 6, 2022 www.modernhealthcare.com/legal/teladoc-hit-investor-lawsuit
Study: interstate televisits increased during pandemic: Background: During the COVID-19 pandemic, all fifty states and Washington, D.C., passed licensure waivers that allowed patients to participate in telehealth visits with out-of-state clinicians (interstate telehealth). Researchers analyzed trends in interstate telehealth use by Medicare beneficiaries during 2017–20. Findings: Although the volume of interstate telehealth use increased in 2020, out-of-state telehealth made up a small share of all outpatient visits (0.8%) and of all telehealth visits (5%) overall. For individual states, out-of-state telehealth made up between 0.2% and 9.3% of all outpatient visits.
Andino et al Interstate Telehealth Use By Medicare Beneficiaries Before And After COVID-19 Licensure Waivers, 2017–20 Health Affairs June 2022 https://doi.org/10.1377/hlthaff.2021.01825
CDC: BA.4, BA.5 Variants Rise among U.S. Covid-19 cases: In its report last week, the Centers for Disease Control and Prevention estimates the slightly more contagious BA.4 and BA.5 variants represented a combined 13% of U.S. Covid-19 cases for the week ended June 4.The CDC estimated BA.4 and BA.5 represent the highest percentage of cases in a region that includes Texas, New Mexico, Oklahoma, Arkansas and Louisiana and lowest in the Northeast. The dominant Omicron variant in the U.S. remains BA.2.12.1, which the CDC recently estimated at about 62% of cases following months of steady growth.
Study: Covid death rates higher in Republican counties: Researchers compared the number of COVID-19 deaths through October 31, 2021 among counties with differing levels of Republican vote share, using 2020 presidential election returns to characterize county political affiliation. Finding: “Majority Republican counties experienced 72.9 additional deaths per 100,000 people relative to majority Democratic counties during the study period, and COVID-19 vaccine uptake explains approximately 10% of the difference. “
Sehgal et al The Association Between COVID-19 Mortality And The County-Level Partisan Divide In The United States Health Affairs 2022 https://doi.org/10.1377/hlthaff.2022.00085
FDA Committee recommends 4th Covid vaccine: Last Tuesday, a federal advisory committee recommended that a fourth COVID-19 vaccine from Novavax be authorized for use in the USA.
The vaccine, which was supported by $1.8 billion in taxpayer funding, relies on a more traditional approach than the vaccines from Moderna and Pfizer-BioNTech, used by more than three-quarters of Americans. The third vaccine from Johnson & Johnson, has been used in more than 16 million people but 23% of the public remains unvaccinated and 73% favor more vaccine options.
US Food and Drug Administration June 7, 2022 www.fda.gov
Rock Health: 13 unicorn digital health ventures: Per Rock Health, healthcare venture funding is slowing down after two years of investment mania. Digital-health startups banked $6 billion in the first quarter of 2022, trailing the $7.3 billion the industry raised in the fourth quarter of 2021 but above pre-pandemic levels. 13 companies saw their valuations hit $1 billion mark or higher this year:
· NexHealth, San Francisco: Founded 2017, valuation $1 billion, total funding to date $176M, solution: patient scheduling platform for medical practices integrated with EHR
· Wheel, Austin TX: Founded 2018, valuation $1.02 billion, focus: virtual care platform
· Omada Health, San Francisco: Founded 2011, $1.03 billion valuation, solution: behavior modification for chronic care management
· IntelyCare, Quincy MA: Founded: 2014, $1.1 billion valuation, solution: nurse staffing logistics for post-acute care
· Viz.ai, San Francisco: Founded 2016, $1.2 billion valuation, solution: AI enabled patient diagnostics
· Biofourmis, Boston: Founded 2015, $1.3 billion valuation, solution: digital disease monitoring
· Clipboard Health, Walnut CA: Founded 2015, $1.3 billion valuation, solution: app for self-scheduling for nursing/mid-level openings
· Clarify Health, San Francisco: Founded 2015, $1.5 billion valuation, solution: value-based payment reimbursement
· Athelas, Mountain View CA: Founded 2016, $1.56 billion valuation, solution: smartphone self-monitoring devices l
· Transcarent, San Francisco: Founded 2020, $1.62 billion valuation, solution: employer cost reduction
· BostonGene, Waltham MA: Founded 2015, $2.15 billion valuation, solution: AI enabled cancer diagnostics
· Oura Health, Oulu, Finland: Founded 2013, $2.55 billion valuation, solution: smart ring device that monitors
· Somatus, McLean VA: Founded 2016, $2.56 billion valuation, solution: in-home kidney care coordination
Rock Health: 13 healthcare companies hit $1 billion valuations this year as the market stumbles Business Insider June 9, 2022 www.businessinsider.com/healthcare-startups-1-billion-valuation-unicorns-2022
Pitchbook: Public PE firms outperforming market: Publicly traded PE firms have continued to outperform the S&P 500. Buyout giants including Blackstone and Ares are paying out approximately 80%-plus of their distributable earnings as dividends and trading at a premium to firms that keep more on the balance sheet, such as KKR.
Analysis of Public US PE Firm Earnings: Q1 2022 Pitchbook June 8, 2022 www.pitchbook.com
Study: ESRD ACO model reduced hospitalization: The Comprehensive End-Stage Renal Disease (ESRD) Care (CEC) Model was the first Medicare specialty-oriented accountable care organization (ACO) model. Researchers examined whether it provided better results for beneficiaries with ESRD than primary care–based ACO models. Results: We found significant decreases in Medicare payments ($126 per beneficiary per month), hospitalizations (5%), and likelihood of readmissions (8%) among beneficiaries with ESRD during the first year of alignment with the CEC Model and no impacts on these measures among beneficiaries with ESRD who were aligned with primary care–based ACOs.
Ullman et al Medicare’s Specialty-Oriented Accountable Care Organization: First-Year Results For People With End-Stage Renal Disease Health Affairs :June 2022 https://doi.org/10.1377/hlthaff.2021.01856
CDC Opioid Guideline increased prescriber adherence: In 2016, the Centers for Disease Control and Prevention (CDC) released the evidence-based Guideline for Prescribing Opioids for Chronic Pain.
In this cohort study of the insurance claims data of more than 15 million patients from 2011 thru 2018, nonopioid pain medication prescribing rates were higher by 3.0% in post-guideline year 1, by 8.7% in post-guideline year 2, and by 9.7% in post-guideline year 3 than the pre-guideline pattern–based estimates. All patient subpopulations analyzed showed larger-than-expected prescribing rates, but the relative magnitude of the difference varied.
Goldstick et al Patterns in Nonopioid Pain Medication Prescribing After the Release of the 2016 Guideline for Prescribing Opioids for Chronic Pain JAMA Netw Open June 10, 2022;5(6):e2216475. doi:10.1001/jamanetworkopen.2022.16475
Study: black women under-represented in cancer studies: Results from the BECOME Research Project presented at the American Society of Clinical Oncology meeting last week:
· 71% of Black respondents said they trusted trials, compared to 91% of white respondents. Just 32% of Black respondents said they trusted that people of all races or ethnicities got fair treatment in clinical trials, compared to 56% of white respondents.
· 60% of Black respondents were never offered a clinical trial or had a discussion about one with their provider.
Many Black cancer patients say they aren’t offered the chance at clinical trials, survey finds StatNews June 6, 2022
Study: hospice benefits for dementia patients: Researchers analyzed National Health and Aging Trends Study and Medicare claims from the period 2011–17 to examine the impact of hospice enrollment on proxy perceptions of last-month-of-life care quality. Findings:
· Those with dementia enrolled in hospice compared with those not enrolled reported care to be excellent (predicted probability: 52% vs. 41%), more often reported having anxiety or sadness managed (67% vs. 46%), and less often reported changes in care settings in the last three days of life (10% vs. 25%).
· There were no differences in the impact of hospice on proxy ratings of care for people with and without dementia.
Harrison et al Hospice Improves Care Quality for Older Adults with Dementia in their Last Month of Life Health Affairs June 2022 https://doi.org/10.1377/hlthaff.2021.01985
KFF: women unaware of abortion pills: While abortion using the pill mifepristone accounts for more than half of all abortions in the U.S., just 27% of adults overall and 40% of women under 50 have heard of it. 92% of adults have heard of emergency contraceptive pills, but 73% incorrectly believe emergency contraceptive pills can end pregnancy in its early stages.
Americans’ Knowledge and Attitudes About Abortion Access and the Pending Supreme Court Ruling Kaiser Family Foundation June 9, 2022 www.kff.org