Last week was the fifth of the Trump administration: it was significant for healthcare:
- The House of Representatives Republicans passed their “one big, beautiful budget bill” that aims to reduce federal spending with sharp cuts in major health programs like Medicaid (proposed $880 billion/10-year Medicaid reduction–an 11% cut).
- The Trump administration issued its “Radical Transparency” Executive Order requiring hospitals to disclose the actual prices of items and services, not estimates, to be implemented within 90 days.
- Grassley, Rep. Ryan called for Congressional investigations into UnitedHealth Group business practices in Medicare Advantage and their handling of employed medical groups.
- And the Department of Government Efficiency under Elon Musk announced second round federal workforce cuts ahead of the President’s address to a Joint Session of Congress tomorrow night.
In Nashville, news items like these get special attention for 2 reasons: healthcare is big business in Nashville and many of its leaders are playing active roles in Trump healthcare initiatives.
I have lived in Nashville since undergraduate school except for graduate school in seventies and my stint in DC from 2006-2015. I have watched it evolve from Music City, USA to arguably U.S. healthcare’s most influential hub.
This year, the Nashville Heath Care Council is celebrating its 30th anniversary. Its 900 members employ 333,000 and contribute $68 billion to the local economy. It hosts global conferences (VIVE, Sessions) among its 80+ events annually and promotes Nashville as the healthcare innovation hub of the planet. It is dominated by publicly traded health services companies and the armies of advisors, lawyers, accountants and analysts they employ.
Not surprisingly, entrepreneurs come to Nashville to find capital or sell their companies. Some relocate their companies to Nashville believing their fortunes better served in its university-rich, tax-friendly, healthcare dominated business climate. Here’s what most learn quickly:
- Nashville is a southern “town” in a red state. Nashville is conservative. Nashvillians go to church/synagogue, high school football games and Predators and Titans games. The business establishment favors low taxes, less regulation, lower government spending and private solutions over government programs. That’s why voters have rejected Medicaid expansion (1 of 10) and a state income tax (1 of 8).
- Nashville is a big city facing big city challenges. While experiencing dramatic population growth and national recognition, its public health, public transportation, public education and infrastructure investments have fallen behind. The healthiness of the Nashville population is embarrassing despite Herculean efforts led by former Senate Majority Leader Bill Frist’ Nashville Health initiative. obesity and mental health are tsunami’s impacting every facet of life in Music City.
Doing business in the Nashville health industry requires understanding unwritten rules about how its leaders think and operate:
- Perspective: The U.S. health industry is massive, expensive, wasteful and prone to self-protection. To improve its effectiveness, privately-financed innovations are necessary. The industry needs disruption, especially sectors that enjoy unwarranted protections/advantages (i.e. tax exemptions for large, not-for-profit hospital systems that are profitable and diversified, patent protections in certain drug classifications, insurer market concentration et al).
- Focus: Healthcare essentially revolves around the work of doctors with patients. Technologies, facilities, therapeutic innovations and data are means to the end of enhancing the effectiveness and efficiency of caregiving. Healthcare is not a B2C (Business to Consumer) industry: though consumer opinions and actions matter, the industry’s business is premised on business-to-business transactions (B2B), optimized by technologies that enable better, faster or cheaper.
- Business Acumen: The health system’s future is dependent on private solutions. Long-term, public funding through government programs (i.e. Medicare, Medicaid, VA, HIS et al) is inadequate to address changes in demand. While respectful of legacy professional associations, trade groups, academics and industry thought leaders. Nashville looks outside DC for its leaders, and rewards operators who execute well and shun self-promotion.
- Self-awareness: Nashville healthcare business leaders shun media attention. Local news outlets (Tennessean, Banner, Channels 2,4, 5 and 17) pay scant attention to the business of the health industry per se. Local business media (Nashville Business Journal, et al) compete with national health industry media for stories that usually involve acquisitions, profitability, leadership changes and increasingly conflicts. Nashville’s health industry leaders prefer respect from their peers and confidence of their investors over celebrity.
That’s how the Nashville health industry is wired today. It’s the background from which many of its leaders have now assumed major roles as part of the Trump healthcare team (i.e. Gleason, Boehler, Smith et al).
The Nashville healthcare community will not attempt to transform the industry: that’s for others. It will engage on industry challenges that require technology-enabled solutions, private capital and experienced operators. It is not paralyzed by regulation, industry norms, trade association affiliations or tradition. It is prone to think of healthcare as a opportunistic market, celebrate its profitability and leave systemic issues for others to fix.
The Nashville healthcare community is a fast follower: the bleeding edge is for others. But in following fast, it has emerged as a key influencer in Trump healthcare policies and their execution.
Paul
Fact File: Nashville Metropolitan Nashville
- Census: 2,104,235 (35th largest metro in US)
- Age: Median age 37 years; 63% aged 18 to 64.
- Race: 69% White, 13% Black, 3% Asian, 10% as Hispanic/Latino.
- Income: Median HH income $84,685, which is slightly higher than the national average.
- Education: Around 46.9% of residents aged 25 and older hold a bachelor’s degree or higher.
- Housing: The median value of owner-occupied housing units is $383,100
Fact File: The Nashville Healthcare Industry (circa the Nashville Health Care Council founded in 1995)
- 900 Healthcare Companies in Nashville
- 17 Publicly Traded Healthcare Headquarters in Nashville
- 333,000 Local Jobs in Healthcare
- $68 Billion Economic Impact to Middle Tennessee
- $97 Billion and 500,000 Jobs global
Fact file: Health Status (circa Nashville Health):
- Insurance Coverage: 90.1% have health insurance
- Primary care access: 67.5% have a personal physician; 64.7% visited a physician for a check-up in the last year
- Poor Mental Health Days/Month: 5.3 vs. 3.8 U.S. average (6.2 women, 4.3 men; 3.4 Grad/Professional vs. 10+ no HS diploma)
- Smoking: 13.2% are smokers; 13.7% of 18–29-year-olds vape
- Hypertension: 30.5% (17.7% college educated; 39.6% no HS diploma)
- Non-prescribed use of pain killers/tranquilizers: 4.4% employed vs. 8.2% unemployed;
- Obesity and Overweight: 6% of adults (78% African American, 73% Hispanic/Latino 55% White)
- Depression: 22.1% of adults diagnosed with a depressive disorder; 15.5% take medicine/ receive treatment for a mental health/ emotional problem.
Resources
Nashville Community Health and Wellbeing Survey https://www.nashvillehealth.org/survey/data/
Speaker Mike Johnson Is Living in a D.C. House That Is the Center of a Pastor’s Secretive Influence Campaign ProPublica February 28, 2025 https://www.propublica.org/article/mike-johnson-evangelical-pastor-steve-berger-roommates
Quotables
StatNews on UnitedHealth Group: “The heightened security in the wake of Brian Thompson’s killing is the most conspicuous sign of a company under siege. But UnitedHealth isn’t just contending with security jitters and one-off threats. It has been thrust into the center of surging public anger over care denials, unexpected bills, and unending hassles — and is now widely seen as the poster child of a dysfunctional health care system.
Beyond public relations concerns, the company is facing potential shareholder lawsuits and multiple government investigations, including a Department of Justice antitrust probe focused on how it uses its physician workforce to benefit its insurance business.”
Part 7 in StatNews Series Health Colossus series “Under siege after a tragedy, UnitedHealth grapples with fresh security threats and a customer backlash” Tara Bannow, Bob Herman, Casey Ross, and Lizzy Lawrence StatNews Feb. 25, 2025 https://www.statnews.com
NYT on Medicaid: “…The budget passed on Tuesday night by House Republicans directs Energy and Commerce, the committee that oversees Medicaid, to cut spending by $880 billion over the next decade, which would amount to an 11% reduction in the program’s planned spending.
In its 60 years, Medicaid has swelled from a small program that provided medical care to poor Americans receiving cash assistance to the largest source of public insurance. It covers 72 million Americans, about one-fifth of the population. It pays for about half of all nursing care in the United States, and 40% of all births.
The program has grown especially quickly over the last 15 years, as millions joined through the expansion of the Affordable Care Act to cover healthy adults who earn less than 138% of the federal poverty line, about $21,597 for an individual and $36,777 for a family of three. The rolls swelled again during the coronavirus pandemic, when Medicaid extended emergency coverage to millions.”
More Than 70 Million Americans Are on Medicaid. This Is Where They Live NY Times February 27, 2025 www. https://www.nytimes.com/interactive/2025/02/27/us/politics/medicaid-enrollment.
Johnson on consumerism in healthcare: “Platforming and consumerism are coming to healthcare…. This is not a radical vision. Rather it embodies a very American “the customer is always right” approach to business development and execution. For system executives clinging to volume driven business practices, it’s time to open your eyes and embrace the coming wave in healthcare consumerism. Change is hard. Not changing, however, will be catastrophic. There is salvation in value. “
David Johnson HFM March 2025 “Consumerism introduces itself to U.S. Healthcare”
Goldsmith on evidence-based policy: “I strongly believe in evidence-based health policy. But the quality of that evidence is critical to making the right choices, and who sponsors research is material to its quality and value…. The real world of healthcare markets is more complicated than a spindly web of artfully constructed regression equations would suggest.”
Jeff Goldsmith “Hospital Mergers Kil: A Case Study in Reality Distortion” HFM March 2025
On cancellation of March 13 meeting of the FDA’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) that selects strains to include in fall influenza vaccines: “I have no idea. Is it part of RFK Jr.’s cleansing project of removing anyone whom he presumes to have a conflict of interest related to vaccines? I don’t know. But I feel like the world is upside down. We aren’t doing the things we need to do to protect ourselves.”
Paul Offit, MD, a VRBPAC member since 2017 and vaccine expert at Children’s Hospital of Philadelphia “FDA Abruptly Cancels Critical Flu Shot Meeting” February 27, 2025 https://www.medpagetoday.com/special-reports
OPM Memo to Federal Employees: “The federal government is costly, inefficient, and deeply in debt. At the same time, it is not producing results for the American public. Instead, tax dollars are being siphoned off to fund unproductive and unnecessary programs that benefit radical interest groups while hurting hardworking American citizens. The American people registered their verdict on the bloated, corrupt federal bureaucracy on November 5, 2024 by voting for President Trump and his promises to sweepingly reform the federal government.
On February 11, 2025, President Trump’s Executive Order Implementing the President’s “Department of Government Efficiency” Workforce Optimization Initiative (Workforce Optimization) “commence[d] a critical transformation of the Federal bureaucracy.” It directed agencies to “eliminate[e] waste, bloat, and insularity” in order to “empower American families, workers, taxpayers, and our system of Government itself.”
Feb. 26 memo from the U.S. Office of Personnel Management and U.S. Office of Management and Budget to Federal Agency heads: Guidance on Agency RIF and Reorganization Plans Requested by Implementing The President’s “Department of Government Efficiency” Workforce Optimization Initiative February 26, 2025 https://chcoc.gov/content/guidance-agency-rif-and-reorganization-plans-requested-implementing-president
Russ Reynolds on Leadership: “Our H2 2024 Leadership Confidence Index has found that leaders’ confidence in their executive team continues to decline, and is at its lowest point since we began tracking the data in 2021.
A consistent decline is evident across all three constructs (capabilities, behavior and issue management), which speaks to the increasingly challenging business environment which leadership teams have found themselves operating under. External disruptors have consistently increased the complexity that leaders face daily, including uncertainty around economics and geopolitics, the availability of key talent, and tech change…. Strong alignment, trust, and quality discourse within leadership teams are essential for continued organizational resilience in the global market. Our research found that less than half of C-level leaders are confident that their ELT effectively works as a team and role models the right culture and behaviors…”
Keckley Note: of the 7 industry groups compared by RR, the Index for Consumer Goods (58.5) and Healthcare (59.0) were lowest.”
Leadership Confidence Index | Russell Reynolds Associates
Tuffin on public backlash against health insurers: “The U.S. spends more on healthcare than any other country in the world, and many experts agree that up to 25% of care is wasteful at best and harmful at worst. Health-insurance plans follow evidence-based clinical standards and approve the vast majority of claims, particularly coverage requests before patients receive treatment, while working to reduce the incidence of low-value, unnecessary and unsafe care. Health-insurance plans also routinely receive large numbers of duplicate, inaccurate or incomplete claims, which may be initially denied but are ultimately resolved.
None of this is comforting to any individual or family who has endured a traumatic experience navigating the costly, complicated and fragmented healthcare system. Health insurers embrace the responsibility to do better and to work with providers in continually improving the system for the patients we serve. In particular, we support abolishing error-prone manual processes and decisively moving away from fee-for-service to care models that are outcomes-based and patient-centric.”
Mike Tuffin, President and CEO, AHIP American Health Insurance Needs a Check Up “The law needs to catch up and close the loopholes that insurers use to escape paying valid medical claims” WSJ Opinion February 25, 2025 https://www.wsj.com/opinion/american-health-insurance-needs-a-check-up-medicare-
Employers
Study: Disengagement and burnout among employees in 2024: Researchers applied a computational model representing different engagement/burnout states they could be in and different stressors within and outside the workplace. Findings:
“Employee disengagement, overextension, ineffectiveness, and burnout over the course of 1 year costs an employer an average of $3,999 (95% range=$3,958-$4,299) for an average U.S. nonmanagerial hourly employee; an average of $4,257 (95% range=$4,215-$4,299) for an average nonmanagerial salaried employee; $10,824 (95% range=$10,700-$10,948) for an average manager; and $20,683 (95% range=$20,451-$20,915) for an average executive. At an average U.S. 1,000-person company (assuming average wages by employee type and an employee distribution of 59.7% nonmanagerial hourly, 28.6% nonmanagerial salaried, 10% managers, and 1.7% executives), employee disengagement/burnout resulted in $5.04 million (95% range=$5.03-$5.05 million) in costs and 801.7 (95% range=801.5-801.9) quality-adjusted life years lost annually.
Employee disengagement/burnout can cost employers 0.2-2.9 times the average cost of health insurance and 3.3-17.1 times the cost of training per employee.”
The Health and Economic Burden of Employee Burnout to U.S. Employers Am J Prev Med 2025 Jan 31, 2025 https://pubmed.ncbi.nlm.nih.gov/40019422/
Hospitals
Price transparency executive order: “Pursuant to Executive Order 13877 of June 24, 2019 (Improving Price and Quality Transparency in American Healthcare to Put Patients First), my Administration issued paradigm-shifting regulations to put patients first by requiring hospitals and health plans to deliver meaningful price information to the American people. These regulations require hospitals to maintain a consumer-friendly display of pricing information for up to 300 shoppable services and a machine-readable file with negotiated rates for every single service the hospital provides; health plans to post their negotiated rates with providers as well as their out-of-network payments to providers and the actual prices they or their pharmacy benefit manager pay for prescription drugs; and health plans to maintain a consumer-facing internet tool through which individuals can access price information…
Unfortunately, progress on price transparency at the Federal level has stalled since the end of my first term. Hospitals and health plans were not adequately held to account when their price transparency data was incomplete or not even posted at all…
The American people deserve better…The Secretary of the Treasury, the Secretary of Labor, and the Secretary of Health and Human Services shall take all necessary and appropriate action to rapidly implement and enforce the healthcare price transparency regulations issued pursuant to Executive Order 13877, including, within 90 days of the date of this order, action to:
(a) require the disclosure of the actual prices of items and services, not estimates;
(b) issue updated guidance or proposed regulatory action ensuring pricing information is standardized and easily comparable across hospitals and health plans; and
(c) issue guidance or proposed regulatory action updating enforcement policies designed to ensure compliance with the transparent reporting of complete, accurate, and meaningful data.
Making America Healthy Again by Empowering Patients with Clear, Accurate, and Actionable Healthcare Pricing Information The White House February 25, 2025 https://www.whitehouse.gov/presidential-actions/2025/02/making-america-healthy-again-by-empowering-patients-with-clear-accurate-and-actionable-healthcare-pricing-information/
Note: The American Hospital Association and other hospital trade groups unsuccessfully fought release of the 2019 Final Rule which was implemented in January 2021. The AHA maintained the complexity and additional costs for capturing the price data was burdensome to hospitals and consumers preferred estimates of their out-of-pocket obligations instead.
In its Feb. 26 reaction to the EO, AHA issued a two-sentence statement noting the executive order. “America’s hospitals and health systems — physicians, nurses and other caregivers — understand and share concerns regarding the high cost of health care and are working hard to make care more affordable by transforming the way health care is delivered in our communities. Real change will require an effort by everyone involved, including providers, the government, employers and individuals, device makers, drug manufacturers, insurers and other stakeholders.”
In July 2024, AHA issued a lengthier statement that noted 93.4% of hospitals met the requirement to post a machine-readable file, citing data from Turquoise Health. In contrast, the 2022 Foundation for Government Accountability (FGA) analysis estimated up to 75% of hospitals were non-compliance.
Keckley note: Consumers want both prices and their estimated out of pocket obligation. Most employers, consumers and elected officials think hospital pushback is premised on competitive protection above other considerations.
Trump orders ‘radical transparency’ for health care pricing Richard Payerchin February 27, 2025 https://www.medicaleconomics.com/view/trump-orders-radical-transparency-for-health-care-pricing?utm_source=www.medicaleconomics.com&utm_medium=relatedContent
Study: Analysis of nonprofit hospital community benefit spending (CBS): Researchers examined nonprofit hospital Internal Revenue Service tax filings from 2465 US hospitals between 2018 and 2023. Findings:
“A total of 2465 nonprofit hospitals across 3140 US counties were included. Allocation of CBS varied significantly across communities, with the counties in the highest quintile receiving a mean (SD) of $540 ($250) per capita compared with counties in the lowest quintile with $22 ($16) per capita. Communities in the highest quintile of CBS had a higher proportion of White residents, while communities in the lowest quintile had a higher proportion of residents who were non-Hispanic Black or Hispanic, had lower educational attainment, and were living with incomes below 138% of the FPL. For every 1% proportional increase in non-Hispanic Black or Hispanic residents in a community, there was 1.61% and 0.88% less CBS per capita, respectively. In addition, there was less allocation of CBS per capita among counties with a greater proportion of people with low educational attainment, greater levels of poverty, or higher SVI scores. These results were consistent before and during the COVID-19 pandemic.
This cross-sectional study found that nonprofit hospitals’ CBS was regressively allocated across US communities, with more socially vulnerable or racially and ethnically minoritized communities receiving less benefit than more affluent, non-Hispanic White communities, suggesting that the nonprofit tax system may be structurally discriminatory and contributing to health disparities.”
Kaufman Hall Hospital Flash Report: “In 2024 it was reasonably obvious that there was a widening divide between the highest performing hospitals and the lowest performers. While a significant cadre of hospitals and health systems have recovered to pre-Covid financial success, 37% of American hospitals continue to lose money….
Operating hospitals in 2025 is flat-out hard and likely to get harder over the year. Hospital executives right now should use every managerial advantage available.”
Implications of the National Hospital Flash Report for Hospital Operations February 26, 2025
Premier study: Insurer denial costs: Per Premier’s analysis of data from 516 hospitals based on their 2022 claims denial experiences:
- Nearly 15% of all claims submitted to private payers for reimbursement are initially denied, including many that were pre-approved to move forward through the prior authorization process.
- Denied claims tended to be more prevalent for higher-cost treatments, with the average denial pegged to charges of $14,000 and up.
- Over half (54.3%) of denials by private payers were ultimately overturned and the claims paid, but only after multiple, costly rounds of provider appeals.
- The average cost incurred by providers fighting denials is $43.84 per claim – meaning that providers spend $19.7 billion a year just to adjudicate with payers
Premier Inc https://premierinc.com/newsroom/policy/premier-survey-on-payment-denials-and-delays-by-health-plans
Insurance
2024 financial results: “Operating income fell for all but two insurance divisions operated by major payers in the fourth quarter. Major publicly traded insurers’ medical loss ratios, key metrics of spending on patient care, rose an average of 2.8 percentage points from the fourth quarter of 2023 to the fourth quarter of 2024.
In the fourth quarter, all major payers but Centene and Molina reported lower income from their insurance plans compared to the prior year (despite each company reporting year-over-year increases to their revenue).
Insurers closed out 2024 on shaky footing Feb. 25, 2025 https://www.healthcaredive.com/news/health-insurer-medical-costs-climbing-ma-medicaid/740611/
Grassley demands UHG data: Last week, Sen. Chuck Grassley (R-Iowa), Chair of the Senate Judiciary Committee wrote UnitedHealth Group demanding the company’s records on member diagnosis protocols by March 10.
Grassley called for information, including audits and internally documented overpayments, on how UnitedHealth Group reviews diagnoses from health risk assessments and chart reviews. Medicare Advantage insurers are required to conduct health risk assessments — an analysis of members’ health status, health risks, and daily activities — within 90 days of their enrollment, and annually from that point onward.
He also demanded training manuals, guidance documents and software programs used for risk assessments, documentation of the internal procedures staff follow to acquire medical records from enrollees’ primary care providers and a record of its performance under a compliance program that ran from 2019 through 2024.
Sen. Grassley presses UnitedHealth Group on billing practices February 27, 2025 https://www.hmenews.com/article/sen-grassley-presses-unitedhealth-group-on-billing-practices?form=MG0AV3&form=MG0AV3
Related: Lawsuit targets UHG medical group: “Following complaints from constituents, a New York congressman is launching an examination of UnitedHealth Group’s management of large physician groups in the state’s Hudson Valley region.
The inquiry by Congressman Patrick Ryan (D-N.Y.) seeks to gather information from community members about the quality and accessibility of health care services since UnitedHealth Group’s Optum subsidiary purchased CareMount Medical and Crystal Run Healthcare in 2022 and 2023…
UnitedHealth purchased CareMount Medical, with more than 2,100 providers and 1.6 million patients, in 2022 and increased its footprint in 2023 by acquiring Crystal Run Healthcare, which includes about 400 providers, Ryan said. The acquisitions were part of a string of deals that dramatically increased the number of physicians under UnitedHealth’s corporate umbrella to about 90,000 — almost 1 in 10 U.S. doctors…
Ryan, who has called for a possible break up of UnitedHealth, is not the only member of Congress pushing for urgent action to address the company’s market power. Senator Charles Grassley (R-Iowa) has also launched an inquiry into the company’s Medicare billing practices. And Congressman Greg Murphy (R-N.C.), recently said the company has abused its size and reach in health care markets. “
New York congressman launches examination of UnitedHealth clinics in Hudson Valley Care has deteriorated since UnitedHealth acquired medical groups, lawmaker says February 26, 2025 https://www.statnews.com/2025/02/26/congressman-ryan-unitedhealth-optum-caremount-crystal-run-clinic-examination
EBRI Study: Findings from the 2024 Consumer Engagement in Health Care Survey (CEHCS) of 2,011 individuals conducted online between Oct. 24 and Nov. 25, 2024:
- Health Plan Knowledge is Often Lacking
- Satisfaction with Various Aspects of Health Care Is High, Out-of-Pocket Costs Drives Satisfaction Down
- Smart Health Tech is Popular, but Enrollees Want Data Sharing with Health Providers
Health Savings Accounts Used in a Variety of Ways - Open Enrollment – Most enrollees spent less than two hours deciding on their health plan during open enrollment
- Sources of Health Coverage – Most people with private health insurance reported getting their coverage through their own job (61%) or through a spouse’s job (20%).
EBRI/Greenwald Research Consumer Engagement in Health Care Survey https://www.ebri.org/health/ebri-greenwald-consumer-engagement-health-care-survey.
Insurer Transparency in coverage: “This brief examines some of the issues and challenges researchers and other data users may encounter when using the price data reported pursuant to the Transparency in Coverage, or TiC regulation, promulgated by the Departments of Health and Human Services, Labor and Treasury (“Agencies”) during the first Trump administration. The regulation requires group health plans and health insurance issuers (“payers”) to make available, among other things, a machine-readable file with all of their in-network provider rates for covered items and services.”
Key findings include: TiC is not useful because current data is distorted/suboptimal:
- Unlikely rates reported for providers that do not provide the service
- Multiple rates reported for the same service
- Repetitive rates for multiple services
- Challenges identifying rates for hospitals
- Different, valid approaches to summarizing rates can meaningfully affect results
- Rate structures differ across payers
- Reporting structures can change materially over short periods of time
Challenges with effective price transparency analyses Peterson KFF Health System Tracker February 25, 2025 https://www.healthsystemtracker.org/brief/challenges-with-effective-price-transparency-analyses/
MA Enrollment concentration: “…Yet despite the upheaval, the program’s three largest insurers – UnitedHealthcare, Humana and Aetna – maintained their grip on the market although their combined share of policyholders slipped, to 58%, from 59%…The UnitedHealth Group subsidiary was the big winner, gaining almost 400,000 policyholders, while Humana lost the most policyholders, about 413,000.
Blue Cross Blue Shield licensees Elevance Health, Blue Cross Blue Shield of Michigan and Excellus BlueCross BlueShield also had big gains…
Cigna, which is about to exit the Medicare Advantage marketplace, posted gains as well. The company plans to close the $3.3 billion sale of its Medicare Advantage plan to Health Care Service Corp. before March 31.HCSC manages Blue Cross plans in five states — Illinois, Montana, New Mexico, Oklahoma and Texas.
Annual enrollment grew 4% to 34.4 million policyholders. That represents the slowest year-over-year growth rate since at least 2007.
Other companies showing enrollment declines included Centene and Florida Blue. Unlike Centene, Florida Blue and Humana, Aetna did not sue CMS to boost their Medicare Advantage Star Ratings for 2025. Insurers with high ratings receive big bonuses.
Insurtech Devoted Health also posted a large drop in enrollees, losing nearly 15% of its 243,000 members. In August, the privately held company was valued at more than $13 billion after raising another $112 million. The company in previous years was one of the fastest-growing Medicare Advantage insurers
Kaiser Family Foundation www.kff.org
Physicians
Hospital-based vs. independent primary care:
- About 77% of physicians have moved away from independent settings, opting for employment by hospitals or health systems.
- Florida and Texas had the highest proportion of PCPs affiliated with private equity-acquired practices, while North Dakota and Wisconsin led in hospital-affiliated PCPs.
- Office visit prices negotiated by hospital-affiliated PCPs were 10.7% higher ($14.91 more) than those at independent practices, while private equity-affiliated PCPs charged 8% more ($9.56 higher).
- Nearly 25% of physicians in health system-led organizations are considering changing employers, compared to 14% in physician-led practices, consulting firm Bain & Co. recently released its “Frontline of Health Survey” in an October blog post.
- Burnout rates were also higher among employed physicians (62%) compared to their independent counterparts (53%).
Changing Medicare Payment to Strengthen Primary Care | New England Journal of Medicine
Geriatric residency matching: New data from the National Resident Matching Program shows there were 204 applicants to geriatric medicine fellowships and 382 positions offered in residency programs for the 2025 match year. In the end, more than 100 openings went unfilled.
- U.S. medical school graduates are instead choosing higher-paying specialties, including cardiovascular disease, pulmonary disease and critical care medicine, and gastroenterology.
- There were more than 1,900 applicants for the cardiovascular disease residency, 1,131 for pulmonary medicine and critical care, and 1,121 for gastroenterology.
The American Geriatrics Society estimates there will be more than 71 million Americans age 65 and older by 2030 and that the medical system will have to train roughly 1,600 geriatricians per year to meet the projected demand.
Geriatric medicine among least popular options for new docs Axios February 18, 2025 https://www.axios.com/2025/02/18/geriatric-medicine-among-least-popular-options-for-new-docs
Kaufman Hall: 4Q2024 Physician Flash Report: Kaufman Hall’s “Physician Flash Report.”
- Subsidy per physician was up 5% to $306,792, and work relative value units increased 8% to 6,313 year over year for the quarter.
- Overall, for medical care providers, the median net patient revenue per provider FTE increased 9.7% year over year to $399,980. The breakdown by specialty for the fourth quarter of 2024 was: Primary care: ($498,000), Medical specialty: ($394,000), Surgical specialty: ($405,000) and Hospital-based specialty: ($255,000)
- Physician compensation increased. The median physician paid compensation per full-time physician was $371,589 in Q4, up 8% year over year. The breakdown by specialty was: Primary care: ($305,000), Medical specialty: ($420,000), Surgical specialty: ($491,000), Hospital-based specialty: ($368,000)
- Total expenses per full-time provider hit $645,530 in the fourth quarter and the median labor as a percent of total expense hit 83.9%, up from 83.6% the previous year. Despite increased productivity, physicians had less support. The median full-time support staff per 10,000 wRVUs dropped from 3.28 in the fourth quarter of 2023 to 3.01 in the Q4.
Kaufman Hall Physician Flash Report
Polling
Edelman: ‘Crisis of grievance puts pressure on trust’: The 25th anniversary edition of the Edelman Trust Barometer has revealed a profound shift to acceptance of aggressive action, with political polarization and deepening fears giving rise to a widespread sense of grievance.
- Majority hold grievances against government, business, and the rich: 61% globally have a moderate or high sense of grievance, which is defined by a belief that government and business make their lives harder and serve narrow interests, and wealthy people benefit unfairly from the system.
- Hostile activism is seen as a legitimate tool to drive change: To bring about change, 4 in 10 would approve of one or more of the following forms of hostile activism: attacking people online, intentionally spreading disinformation, threatening or committing violence, damaging public or private property. This sentiment is most prevalent among respondents ages 18-34 (53 percent approve of at least one).
2025 Edelman Trust Barometer “https://www.edelman.com/trust/2025/trust-barometer
Study: Public perception of primary care spending: Researchers surveyed 1,135 U.S. adults: “Researchers found that, on average, people believe 51.8% of U.S. health care dollars go toward primary care, when the figure is actually just 4.7%.”
The General Public Vastly Overestimates Primary Care Spending in the United States The Annals of Family Medicine February 2025, 240413; DOI: https://doi.org/10.1370/afm.240413
Press Ganey survey on patient experiences: “Drawing upon 6.5M patient encounters and a nationwide consumer survey, we’ve analyzed key touchpoints to learn how people find and engage with healthcare providers.” Results:
- “Over one third of consumers already use AI tools for healthcare-related purposes. These include researching conditions and treatments, finding providers, scheduling appointments, and understanding medical results.
- Nine out of 10 consumers say accurate listings information is key to establishing trust and credibility. Nearly half will walk away if the information in online listings is incorrect—or they can’t find what they’re looking for.
- 59% use online search to find a new primary care provider. This makes online search nearly tied with reliance on referrals (60%).
- Half (49%) of healthcare consumers will wait an average of one to three weeks for primary care—and up to three months for a specialist appointment. Even though they’re more patient than other industries, organizations that can see patients sooner are better able to build trust.
- 80% of consumers say online scheduling influences their choice of provider. And 24% will look for other options if booking an appointment isn’t as easy as making a dinner reservation. While many organizations have already embraced digital scheduling, there’s still room for improvement: Only a quarter of consumers call the experience “excellent.”
Consumer experience in healthcare Press Ganey February 18, 2025 https://www.pressganey.com/news/patients-as-consumers-new-era-of-expectations-in-healthcare/
On consumer confidence: “Consumer confidence plummeted in February as more Americans grapple with concern that President Donald Trump’s policies could slow growth and cause prices to rise…The Conference Board’s widely cited consumer confidence index notched its sharpest monthly decline since August 2021, when the country was experiencing a resurgence of Covid-19 variants. The index now stands at 72.3, well below the threshold that normally signals an imminent recession, as respondents reported increasing pessimism over income, business and labor market conditions. Average 12-month inflation expectations also spiked as Americans face higher prices on eggs and other household staples,…”
Consumer confidence buckles as Trump’s policies revive inflation concerns Politico February 25, 2025 https://www.politico.com/news/2025/02/25/consumer-confidence-buckles-as-trumps-policies-revive-inflation-concerns
Public Agenda survey: Privately insured views about prices: Survey of 2,049 people covered by health insurance (ESI) provided by their own or a family member’s current or former employer or union conducted March 22, 2024 to April 9, 2024 by NORC at the University of Chicago. Findings:
- Most people with ESI are veryconcerned about prices that providers charge for health care services. A plurality attribute rising prices to more expensive medication and supplies, more administrative costs, and hospitals making larger profits.
- A plurality of people think that higher provider prices explain rising employee premiums. A majority are not aware employers pay the larger share of premiums and a majority believe ESI is in need of improvement.
- To address increasing health care provider prices, over three quarters of people with ESI support requiring price transparency and limits on health care providers’ prices. Slightly fewer support government regulation of prices in general.
- Most people with ESI are concerned that providers would find ways to avoid government price regulation. Slightly fewer are concerned that regulation would negatively affect patients or health care providers. Their concerns influence their support for government regulation.
- A plurality of people with ESI believe that the government should be primarily responsible for addressing providers’ prices. Most want employers to advocate for price regulation, especially those who think that hospital prices contribute to rising premiums.
Regulating Health Care Providers’ Prices: Insights from People with Employer-Sponsored Insurance https://publicagenda.org/resource/esi-2024/
Population Health
Study: Nutrition security: Researchers combined self-assessed food security and diet quality indicators from the National Health and Nutrition Examination Survey (NHANES) to construct a measure of nutrition security. Findings:
Of 28,898 in the sample population, 20.2% were categorized as being nutrition insecure due to FSLD, 8.4% due to FIHD, and 7.0% due to FILD. The remaining 64.4% were classified as FSHD (i.e., nutrition secure).
