The health system is low hanging fruit for federal spending hawks and government reformers. It’s increasingly evident the Trump administration’s well aware.
The reasons are obvious:
- Size: Healthcare represents 32% of total federal spending and is projected to increase at least 5% per year through 2032. Its workforce—18 million—is the largest and fastest growing of any sector in the economy—above rates of population growth
- Satisfaction: Trust, confidence and satisfaction with the health system is at a historic low among consumers and non-healthcare employers. Affordability, accessibility, and transparency are widespread complaints and, among consumers, a significant majority across all demographic and partisan groups want fundamental change.
In Campaign 2024, Trump voters expressed more concern about inflation, the economy and national debt. Protecting the health system was less important, though its costs and affordability were issues. So, it’s understandable the administration would pay special attention.
Today marks the 70th day of President Trump’s second term. To date, the administration’s attention to healthcare has been significant based on key actions:
- Executive Orders: Of 93 Executive Order issued to date including 9 last week, 12 are specific to healthcare i.e. healthcare price transparency, drug pricing, and changes to the Affordable Care Act (ACA).
- Key appointments: Successful confirmations of new leadership in HHS (Kennedy), CMS (Oz), FDA (Makary), CDC (Monarez), NIH (Bhattacharya) and others along with appointments of Trump-friendly followers to key agencies (DOJ, FTC, FCC) where healthcare business practices (consolidation, tax exemptions, competition, fraud et al) are settled.
- Spending cuts: DOGE has announced a 20% targeted reduction in the federal workforce. In healthcare is seeking a cut from 82,000 to 62,000 across every major program and department. In tandem, the GOP-led Congress is incorporating policy changes in its budget reconciliation plan to reduce spending in core elements of the system’s operation i.e. Medicare Advantage plan risk adjustment, Medicaid spending reductions and FMAP formula reductions, implementation of site neutral payments and limits on not-for-profit hospital tax exemptions, drug prices and patent protections, vaccine development and accessibility, elimination of Affordable Care Act insurance subsidies and many others.
This week, Congress returns to DC to continue its budget reconciliation deliberations against a backdrop of growing anxiety about an economic downturn and potential recession. The stock market is down 10% from its February 19 high and consumer sentiment about the economy hit a 12-year low last week. Notably, households of low and middle-income means are experiencing record levels of debt and unpaid bills: these include 4 million in lower-paying healthcare jobs and 3 million unpaid family caregivers who can’t afford to pay for outside care. And physicians, now 3 months into their fifth-year without a Medicare reimbursement increase, are simply mad and burnt-out.
Today, every healthcare organization (public/private) is operating in limbo: leaders are worried, lenders are more cautious, researchers and public health agencies are paralyzed, state and local health officials are preparing for the worst and hospitals, medical practices, ancillary and long-term care providers face an insecure, disgruntled workforce.
The playbook for everyone in U.S. healthcare—payers, providers, suppliers and advisors—is being re-written. All are concentrating on 2 imperatives:
1- Understanding the underlying beliefs held by the Healthcare 2.0 team is the basis for organizational planning. Trump Healthcare 2.0 believes the U.S. health system is wasteful, self-protective and in need of fundamental change. It considers substantial reforms to lower its costs and improve its performance a mandate from voters and Wall Street. Incrementalism is a non-starter. To that end, it operates around these 5 presumptions:
- Significant cost-cutting is urgently needed. The Department of Government Efficiency (DOGE) can lead the process working outside the traditional norms of policy making.
- Capital to fund the system has been misspent and needs re-focus. Private solutions are better than government programs: entrepreneurship and private investment are essential.
- States over central government: Major decisions about health, education et al should be made in states via voter-approved referenda and legislation. States are closer to citizens than the federal government, so the federal government should play a secondary role limited to certain programs (Medicare, Medicaid and a few others). Federalism and state’s rights should be the guiding principle.
- Consumer choice: Consumers should be equipped to make choices based on their values without unnecessary legal constraint. Transparency is the key to informed decision-making in healthcare: no sector should be protected from mandates and policy changes that maximize public awareness about how the system operates—its winners and losers.
- Courts (federal and state) exist to arbitrate disputes. They interpret law within the context of the U.S. constitution; legal precedent is a secondary consideration. These presumptions run afoul of tradition in the industry: the Trump Healthcare 2.0 team welcomes challenges to its actions and policies. Being sued is not a deterrent: it’s an expected consequence of fundamental change.
2-Contingency planning. Everything is on the table: capital investments, pricing, product differentiation, procurement, staffing, compliance and risk management, leadership performance and compensation and others need refreshing to adapt. And growth strategies must include consolidation and partnership arrangements once considered in violation of laws and legal precedent. Boards of Directors must be actively engaged alongside senior management.
I am in DC this week in meetings to better understand Trump Healthcare changes ahead and how key trade groups are modifying their counsel to members. Disruption is an over-used word in healthcare and with good reason: the status quo has not faced it in the modern era. Based on actions and statements from Trump Healthcare 2.0 leaders to date, disruption is precisely their intended result. And lest it be missed, consumers and employers welcome it.
Paul
P.S. I am a college sports junkie: March Madness is a feast for species like me. But in recent years, I find myself perplexed by the impact of “Name, Image and Likeness” monies on rosters and the compensation packages paid coaches who succeed in the new NIL world order of college sports. For sure, college sports have been disrupted: the concept of “student athlete” seems an artifact of a by-gone era replaced by “pay to play” deals struck by agents with school collectives. Makes me think of other industries disrupted by money and the desire to win. Do folks outside healthcare think the same of us? Most in our ranks believe our mission supersedes all else, but some are attracted first and foremost by its profitability.
Perhaps as Trump Healthcare 2.0 disruption is digested, some will reflect on our industry’s shared purpose to improve the health needs of the population and our long tradition of servant leadership.
Resources
Stocks Fall as Inflation Anxiety Dampens Mood on Wall Street NYTimes March 28, 2025 www.nytimes.com
Inflation may create quandary for Fed as Trump pushes rate cuts
HHS announces sweeping reorganization, including cuts of 10K workers
Sections and References for today’s report
- Quotables
- Corporate News
- Economy
- Hospitals
- Insurers
- Physicians
- Polling
- Population Health
Quotables
HHS on its Restructuring March 27, 2025: “Today, the U.S. Department of Health and Human Services (HHS) announced a dramatic restructuring in accordance with President Trump’s Executive Order, “Implementing the President’s ‘Department of Government Efficiency’ Workforce Optimization Initiative.”
The restructuring will address this and serve multiple goals without impacting critical services. First, it will save taxpayers $1.8 billion per year through a reduction in workforce of about 10,000 full-time employees who are part of this most recent transformation. When combined with HHS’ other efforts, including early retirement and Fork in the Road, the restructuring results in a total downsizing from 82,000 to 62,000 full-time employees.
Secondly, it will streamline the functions of the Department. Currently, the 28 divisions of the HHS contain many redundant units. The restructuring plan will consolidate them into 15 new divisions, including a new Administration for a Healthy America, or AHA, and will centralize core functions such as Human Resources, Information Technology, Procurement, External Affairs, and Policy. Regional offices will be reduced from 10 to 5.
Third, the overhaul will implement the new HHS priority of ending America’s epidemic of chronic illness by focusing on safe, wholesome food, clean water, and the elimination of environmental toxins. These priorities will be reflected in the reorganization of HHS.
Finally, the restructuring will improve Americans’ experience with HHS by making the agency more responsive and efficient, while ensuring that Medicare, Medicaid, and other essential health services remain intact.
HHS Announces Transformation to Make America Healthy Again HHS March 27, 2025 https://www.hhs.gov/about/news/hhs-restructuring-doge.html https://www.hhs.gov/about/news/hhs-restructuring-doge.html
Gist Weekly on HHS’ reorganization March 28, 2025: “The reorganization, which has been rumored for weeks but the details of which had been a closely guarded secret, reduces HHS to a size not seen since 2002. The biggest cuts target the Food and Drug Administration (FDA); 3,500 employees at FDA, which HHS Secretary Robert F. Kennedy Jr. has long criticized, will lose their jobs. Those 3,500 employees comprise about 19% of FDA’s workforce, although HHS said the reduction will not affect drug, medical device or food reviewers. The new Administration for a Healthy America will combine several existing agencies, including the Health Resources and Services Administration (which administers the Federally Qualified Health Center program) and the Substance Abuse and Mental Health Services Administration. Public health advocates criticized the cuts as a “brain drain,” while activists who support President Trump’s agenda called the reorganization a long overdue reform. Kennedy acknowledged that cuts would plunge HHS into a “painful period.”
Peter Marks former head of FDA’s Center for Biologics Evaluation and Research resignation letter March 28, 2025: “I was willing to work to address the Secretary’s concerns regarding vaccine safety and transparency, However, it has become clear that truth and transparency are not desired by the Secretary, but rather he wishes subservient confirmation of his misinformation and lies. …undermining confidence in well-established vaccines that have met the high standards for quality, safety, and effectiveness that have been in place for decades at FDA is irresponsible, detrimental to public health, and a clear danger to our nation’s health, safety and security.”
My hope is that during the coming years, the unprecedented assault on scientific truth that has adversely impacted public health in our nation comes to an end so that the citizens of our country can fully benefit from the breadth of advances in medical science.”.”
FDA’s Peter Marks resigns, in disagreement with Kennedy
Sen. Baldwin on NIH cuts March 28, 2025: “This administration is seeking to dismantle the NIH and destroy the hopes of millions of Americans who are counting on life-saving treatments and cures, The NIH is the global leader in biomedical research. NIH-funded research contributed to 354 out of the 356 drugs approved by the [FDA] between 2010 and 2019. Simply put, without the NIH, there would be no cancer immunotherapy, no anti-overdose medications, and no cutting-edge treatments.
… for 10 days in February, no grants were awarded…which is unheard of for the agency that typically awards 60,000 grants per year. The administration has canceled more than 300 NIH grants so far, with the promise of terminating more each week: that’s 300 opportunities for cutting-edge research and life-saving cures stopped short.”
Sen. Tammy Baldwin (D-Wisc.) NIH Cuts Will Devastate Disease Research, Say Senators and Scientists | MedPage Today
Matthews on consulting effectiveness: “For too long, advisory work has been propped up by glossy decks, vague roadmaps, and “strategic alignment” workshops. But in major projects and government-funded programmes, the pressure to deliver real outcomes has never been higher.
The clients are changing. They’re data-literate, AI-curious, and tired of paying premium rates for advice they could get from a well-trained dashboard.
The big firms—McKinsey, PwC, EY, Accenture—aren’t collapsing, but they’re being directly challenged. Not because they’re necessarily bad at what they do, but because what clients want is changing and evolving rapidly. They want solutions, not templates. Boutique firms who can co-create, not just commentate. Delivery that’s measured in actions and outcomes, not outputs.
This isn’t the end of consulting. It’s the end of a certain kind of consulting. The kind that thrives in complexity but struggles in clarity. The firms that adapt—by embedding AI, delivering pragmatic and effective transformation and with practical, real-world capability —will thrive. The decline of traditional consulting isn’t a crisis, it’s a correction.”
Val Matthews, Project Advisory Group www.projectadvisorygroup.com/au
Zandi on recession possibility March 27, 2025: “Back on recession watch, Leading Indicator #2 – the FHA mortgage delinquency rate. This isn’t typically in lists of leading economic indicators, but it may be a proverbial canary in the coal mine in the current context. FHA borrowers have low to moderate incomes, with a median income of about $75,000 a year, and most are first-time homebuyers. Judging from the recent increase in the delinquency rate on FHA loans, these households are under mounting financial stress. This is despite the exceptionally low 4% unemployment rate and goes in part to the credit characteristics of the borrowers, including lower credit scores and downpayments. Even more important may be their high debt-to-income ratios…. Indeed, high and middle-income mortgage borrowers are having no trouble making their payments at this time – the gap between the FHA delinquency rate and those on Fannie and Freddie loans has never been as large. But if the economy is headed for trouble, it is FHA borrowers who will signal it first. And they are.”
Pollack on hospital advocacy agenda March 28, 2025: “Congress is back in Washington, D.C., for a critical three-week stretch in which House and Senate Republicans are seeking to strike a compromise on a common budget resolution that would allow them to start the budget reconciliation process to push through priorities on taxes, border security, energy and deficit reduction…as part of these efforts Congress is considering proposals that would reduce funding for hospital care — including potentially devastating cuts to the Medicaid program — that would jeopardize access to the 24/7 care and services that hospitals provide.
In addition to rejecting cuts to Medicaid, we’ll be discussing, among other priorities, extending the enhanced premium tax credits that expire at the end of this year so millions of low- and middle-income individuals can purchase affordable private insurance on the health care exchanges; protecting the 340B Drug Pricing Program that requires drug companies to provide certain hospitals with discounted prices when buying outpatient medicines; and preventing so-called Medicare site-neutral payment policies, which if implemented would reduce access to critical health care services, especially in rural and other underserved communities.
With so much at stake in the coming weeks and months, speaking out often and with a unified message is critical. Let’s make sure our lawmakers hear from all of us about the indispensable role hospitals play in their communities and why we must protect access to 24/7 care for patients across America.”
Corporate News
23andMe filed for bankruptcy March 22, 2025. The company, once valued at $6 billion, claimed about $277.4 million in total assets and $214.7 million in debts at the end of 2024. The company reported $191.8 million in revenue last year, a 28% decline year over year, as public demand for DNA testing has subsided.
Camino: Daniel Lubetzky, founder of Kind, and Camino Partners President Elle Lanning plans to invest $350 million over the next five years in consumer-health and longevity companies having sold his company to Mars in 2020. Camino is investing in companies seeking that help people eat better, exercise better and take other measures to improve their health.
Two of a Kind: Founder of Snack Company Seeks to Back Next Big Consumer-Health Startup WSJ Brian Gormley March 25, 2025 https://www.wsj.com/articles/two-of-a-kind-founder-of-snack-company-seeks-to-back-next-big-consumer-health-startup–
Economy
Conference Board: Consumer confidence at 12-year low: The Conference Board’s March survey found expectations fell to an index level of 65.2, below the threshold of 80 that often signals a recession. The survey’s broader headline index fell to 92.9, down 7.2 points from a month earlier, marking the fourth straight month of declines. Economists polled by The Wall Street Journal had expected the index to land at 93.5 in March.
Sentiment among businesses and households alike has darkened in recent months, with many respondents across recent surveys citing concerns that the Trump administration’s fast-changings tariff plans could disrupt the economy….
Another closely watched consumer survey, run by the University of Michigan, has fallen precipitously, declining by 27% over the year through mid-March. The latest figures from the Michigan survey are due on Friday.
Newsweek: Recession Indicators:
Consumer Confidence: Key indicators:
- Conference Board’s Consumer Confidence Index, arguably the most commonly consulted measure, saw a 7.2-point drop between February and March–the fourth consecutive month of declines and brought the index to its lowest level since January 2021.
- The Expectations Index, which weighs consumers’ forecasts for economic conditions in the short-term, tumbled to 65.2, the lowest reading in 12 years and below the 80-point threshold that the Conference Board said “usually signals a recession ahead.”
- University of Michigan’s widely watched Consumer Sentiment Index also revealed a drastic decline in Americans’ economic optimism in March… dropping over 15 percent from February.
Credit Card Late Payments and Default Rates:
- S. credit-card debt reached a record $1.2 trillion in the 4Q 2024, now comprising about 6% of America’s total $18 trillion of debt serious delinquency—defined as late payments of more than 90 days—edged up in the quarter, and are now over double the levels in early 2022.
- According to Fitch Ratings, private credit default rates rose to 5.7 percent for the 12 months period ending in February, compared to 5.0 percent in January.
- The rise of buy-now-pay-later services such as Klarna, dubbed “the new credit card—without the plastic” by personal finance expert George Kamel, has also been pointed to as a sign of America’s growing debt struggles.
Business Uncertainty:
- The National Federation of Independent Business’ (NFIB) Uncertainty Index climbed 4 points to 104 in February, its second-highest reading since the index began in 1973.
- The percentage of respondents who believed it was a good time to expand their business experienced its steepest monthly drop since April 2020. Meanwhile, the net percentage of owners expecting economic improvement declined by 10 points from January to 37%. Labor costs, identified as the most pressing issue for business owners, increased by 3 points to 12%, just 1 point shy of the survey’s record high of 13% set in December 2021.
Trade Policy Uncertainty Index:
According to the St. Louis Federal Reserve, economic policy uncertainty and uncertainty around trade policy specifically have risen in recent months to levels not seen since 2019, when the U.S. trade war with China was in full swing.
“Two 10 percent tariff hikes on China add to the 10.8% already in place, then add another 25 percent for their Venezuelan oil at 25%that raises the tariff to 55.8 percent,” she explained. “Then there are specific sector tariffs such as steel, which are an additional 25 percent on that. The range and scope of tariffs easily gets us to levels not seen prior to the 1930s, it could be as high as 1906.”
Inflation Expectations:
According to the University of Michigan, year-ahead inflation expectations rose from 4.3%in February to 4.9% in March. This marks the highest reading since November 2022 and the third consecutive month of “unusually large increases” of 0.5 percentage points or more.
The Conference Board’s most recent report also found that average 12-month inflation expectations had risen from 5.8%to 6.2% between February and March, which senior economist Stephanie Guichard said reflected consumers’ persistent concerns “about high prices for key household staples like eggs and the impact of tariffs.”
According to a recent 1,000-person survey by life insurance and asset management firm Allianz Life, 71 % of Americans believe inflation will worsen over the next 12 months, an increase from 60% in the fourth quarter of 2024.
Five Recession Indicators Now Raising Alarm in the US – Newsweek
BPC on economic uncertainty: “Absent congressional action, BPC projects that the X Date—the date when the federal government will be unable to pay all its bills in full and on time—is most likely to occur between mid-July and early October.”
Elements of uncertainty this year include:
- Strength of tax collections (for example, albeit not very likely, falling far short of expectations could inject heightened X Date risk in early June ahead of quarterly receipts on June 15)
- Tax filing extensions in the calendar year for several states due to natural disasters that will shift tax revenue to later
- The potentially elevated pace of disaster recovery spending and the June start of hurricane season • New revenue from tariffs
- Changes in and the timing of planned spending or adjustments by Congress and the Department of Government Efficiency
- The strength of the economy and economic outlook
March 2025 Debt Limit Analysis | Bipartisan Policy Center
CBO on national debt: “The Congressional Budget Office estimates that if the debt limit remains unchanged, the government’s ability to borrow using extraordinary measures will probably be exhausted in August or September 2025. The projected exhaustion date is uncertain because the timing and amount of revenue collections and outlays over the intervening months could differ from CBO’s projections. If the government’s borrowing needs are significantly greater than CBO projects, the Treasury’s resources could be exhausted in late May or sometime in June, before tax payments due in mid-June are received or before additional extraordinary measures become available on June 30. Conversely, if borrowing needs fall short of the amounts in CBO’s projections, the extraordinary measures will permit the Treasury to continue financing government activities longer than expected.”
Federal Debt and the Statutory Limit, March 2025 | Congressional Budget Office
Arnold Ventures’ Plan government spending over 10 years: “This report presents 20 priority reforms — 10 spending cuts and 10 tax loophole closers — that would generate up to $4 trillion in savings to help advance the permanent extension of the TCJA without adding to the deficit”. Healthcare highlight:
Of 10 spending cut recommendation totaling $1.9 trillion, the 5-health system specific cuts total up to $1.4 trillion (74%) of total:
- Repeal limitation on recapture of ACA exchange subsidy overpayment
Savings: $47 – 96 billion - Advance comprehensive site-neutral payment reforms
Savings: Up to $157 billion - Reduce the payment benchmark for Medicaid state-directed payments
Savings: Up to $120 billion - Extend drug price inflation penalties to commercial plans
Savings: $40 billion - Modify risk adjustment payments to Medicare Advantage insurers
Savings: Up to $1 trillion
Achieving Fiscally Responsible Tax Reform | Arnold Ventures
Hospitals
Fitch: Nonprofit hospitals’ 2024 financial performance: Highlights:
- Median operating margin among hospitals with early fiscal year ends (often June 30) was 1.2%, a flip from the prior year’s -0.5%.
- “Persistent” labor pressures continue to push base salary and wage expenses upward by a median 6.9% among the rated hospitals These helped nonprofit hospitals with early fiscal year endings reduce personnel costs as a percent of their total operating revenues down from 2023’s 55.4% to 54.5% in 2024, which Fitch also attributed to less reliance on contract labor.
- Nonprofit hospitals also saw a median rise in revenues of 9.1%, fueled by higher patient volumes, better revenue cycle management and greater success in payer contract negotiations.
nonprofit hospitals Fitch Ratings Finance
Litigation risk: “Health systems could spend less money and time fighting fraud allegations if their legal challenges to federal oversight are successful. Supreme Court cases, including Loper Bright Enterprises v. Raimondo and Securities and Exchange Commission v. Jarkesy, along with a federal lawsuit questioning the constitutionality of whistleblower cases are poised to revamp healthcare fraud enforcement. Decisions in these cases, combined with the Trump administration’s renewed emphasis on deregulation, could narrow the scope of healthcare fraud investigations and ease federal oversight, healthcare lawyers said.”
Why hospitals could see lower fraud litigation costs Modern Healthcare March 28, 2025https://www.modernhealthcare.com/providers/chevron-ruling-hospital-fraud
AHA on provider taxes: “Medicaid is not a money laundering scheme. Medicaid is a complex program that takes into account state and federal priorities to provide coverage for children, older adults, people with disabilities, and low-income adults. Let’s be clear: Any suggestion that provider taxes are anything but longstanding, legally vetted, state and federally approved tax arrangements, is dishonest and a distraction from what these proposals truly are — a way to cut the Medicaid program.”
AHA on Paragon Health Institute report, “Addressing Medicaid Money Laundering: The Lack of Integrity with Medicaid Financing and the Need for Reform”
Insurers
Chartis: Medicare Advantage results for 2024: “The Medicare Advantage market is undergoing a period of correction after rapid growth in the early part of the decade. Last year showed the first signs of a tempering of this growth, and the cooldown continued into this year.” Highlights:
- Enrollment trends: With more than half of Medicare-eligible individuals in Medicare Advantage plans, the market grew by 1.3 million (+3.9%). This slow-down from the previous year’s growth of 2.2 million (+7.0%) continues the trend of tempered growth compared to the first few years of the decade.
- Special Needs Plan (SNP) growth: SNP enrollment continued its rapid growth, adding 665,000 (+10.1%) members. However, growth cooled relative to prior years. More than 50% of new Medicare Advantage enrollees opted for SNPs.
- Plan options and preferences: The number of plan options decreased slightly from the previous year, with the average senior having access to 5,581 plans.
- Reaction to recent market disruption: In response to challenging market conditions and financial pressure, several plans exited the MA market (e.g., Premera, Blue Cross Blue Shield Kansas City, Care N’ Care), others reduced their service area or terminated plans (e.g., Aetna, Humana), and 60% of plans weakened benefit offerings…. When for-profits like Aetna and Humana reduced their service area or terminated plans, growth tended to accrue to Blues and nonprofits. On average, plans that dampened benefit offerings still grew—but substantially less so than plans that enriched their benefit offering.
- Market dynamics and quality: Only 64% of membership is attributed to plans with four or more stars, down from nearly 80% the year prior.
- Market outlook and executive sentiment: However, 59% of plan executives surveyed said their outlook on growth is positive or extremely positive, compared to just 47% last year. 91% expect the same or better performance in 2026 (compared to just 74% the year prior), indicating confidence in the stability and growth potential of the market.
Medicare Advantage market growth slows amid intensified headwinds
Health Care Service Corp: “The member-owned insurer’s $3.3 billion acquisition of Cigna’s Medicare Advantage, Part D and Medigap assets this month transformed Health Care Service Corp. into a national carrier. The company is bullish on Medicare Advantage, despite persistent headwinds. But the deal also reflects the continuing aftershocks of the Blue Cross Blue Shield Association’s historic settlements in a pair of antitrust lawsuits…
Health Care Service Corp. has 26.5 million members and is the largest nonprofit and the largest member-owned health insurance company. But a greatly expanded Medicare presence elevates its standing. Health Care Service Corp. was limited to selling Blue Cross and Blue Shield policies, including Medicare Advantage plans, in Illinois, Montana, New Mexico, Oklahoma and Texas before the deal. After the Cigna acquisition, Health Care Service Corp… can offer Medicare Advantage in 25 more states and the District of Columbia, Part D nationally, and Medigap in 48 states and the District of Columbia. The insurer now counts 830,000 Medicare Advantage members, about four times as many as prior to the Cigna purchase.
Moving up a weight class means facing dominant for-profit Medicare Advantage carriers such as UnitedHealth Group subsidiary UnitedHealthcare, Humana and CVS Health subsidiary Aetna head on. Those three insurers collectively cover 57% of Medicare Advantage enrollees, according to an analysis of Centers for Medicare and Medicaid Services data the investment bank Stephens published in February…
Health Care Service Corp. levels up Modern Healthcare March 28, 2025 https://www.modernhealthcare.com/insurance/hcsc-medicare-advantage-strategy-cigna
Improper payments by year:
| Program | 2020 | 2021 | 2022 | 2023 | 2024 |
| Medicaid | $12,669.1 3.1% |
$98,724.9 21.7% |
$80,573.00 15.6% |
$50,332.10 8.6% |
$31,099.10 5.1% |
| Medicare advantage | $15,919.8 6.6% |
$23,188.1 10.3% |
$13,940.80 5.4% |
$16,550.80 6.0% |
$19,066.90 5.6% |
| Medicare fee-for-service | $10,026.2 2.4% |
$25,034.2 6.3% |
$31,456.70 7.5% |
$31,228.80 7.4% |
$31,702.60 7.7% |
| Medicare prescription drug benefit | $248.0 0.3% |
$1,369.2 1.6% |
$1,361.10 1.5% |
$3,354.80 3.7% |
$3,575.10 3.7% |
| Total Health and Human Services improper payments | $40,314.2 3.5% |
$153,869.6 12.8% |
$132,415.80 9% |
$104,232.70 7% |
$88,549.70 5.6% |
Source:: paymentaccuracy.gov
Physicians
Physician sentiment: Per the fourth annual Physician Sentiment Survey (PSS) conducted online within the United States by the Harris Poll on behalf of athenahealth from January 2 – 15, 2025:
“Though physicians remain concerned about the state of U.S. healthcare, their day-to-day sentiment is on the rise compared to last year, with fewer physicians reporting that they are considering leaving the profession. And while obstacles remain to improve the physician experience, survey results indicate growing physician optimism that technology can address key pain points.” Highlights:
- Two-thirds of respondents indicated they look forward to coming to work each day. And notably, the number of physicians who are considering leaving the medical profession on a weekly basis has declined 22% since last year’s respondents indicated they look forward to coming to work each day.
- The survey explored physicians’ views around practice challenges, as well as the role of AI and technology as a means of addressing administrative burdens. This year’s results reveal a notable shift, with fewer physicians believing AI is overhyped or unable to meet expectations (27% this year, down from 40% a year ago). Only three in ten (31%) of physicians expressed concern that AI is one more thing that would complicate healthcare, a decrease from 42% last year.
Annual athenahealth Physician Survey Finds Improved Day-to-Day Experience and Attitudes around AI Mixed with Pessimism around the Future of U.S. Healthcare System
Wollensky on needed medical school application process improvement: The American Medical College Application Service (AMCAS), managed by the Association of American Medical Colleges (AAMC), is the primary application platform for U.S. medical schools.1 AMCAS assembles demographic information, grades, Medical College Admission Test (MCAT) scores, inventories of extracurricular activities, personal statements, and letters of recommendation for distribution to each applicant’s list of chosen medical schools. These lists are ever-growing.
The cost is approximately $150 per school for application fees, plus $345 for taking the MCAT and having the score distributed through AMCAS. These fees are waived for qualifying low-income applicants (as primarily defined by household income below 400% of the national poverty level) who apply to the AAMC Fee Assistance Program and provide the required financial documentation. After submitting the primary application, applicants face a flood of secondary applications, some requiring up to eight additional essays. Even when the essay prompts are similar to those from other schools, the instructions often specify different lengths. One premedical student posted on social media the findings of his review of 54 medical schools’ secondary applications: he identified 222 different prompts, which he provided to help applicants get a jumpstart on their frenzied essay writing…
Between 2013 and 2023, the number of medical school applicants increased by 10% (from 48,014 to 52,577) and the number of matriculants increased by 15% (from 20,055 to 22,981). Over the same period, however, the total number of applications and the average number of applications per student increased dramatically — by 40% (from 690,281 to 966,947) and 28% (from 14.4 to 18.4), respectively. Despite the disproportionate escalation in applications submitted, the success rate (matriculants divided by applicants) remained flat (range, 36 to 44%). The surge in applications per student was even more striking for M.D.–Ph.D. program applications.
In 2019, a total of 23% of applicants reported submitting 25 or more secondary applications, a proportion that had increased to 34% by 2023 (up by 49%). Median spending on secondary applications alone also grew, from $1,200 in 2019 to $1,500 in 2023 (an increase of 25%), with the subset of students who spent $3,000 or more increasing by 43%. Yet the median number of interviews was unchanged, at three per applicant per year
Population Health
Study: Mortality by race: Researchers analyzed differences in Results:
“The gaps in absolute life expectancy and age-standardized mortality between Black and White Americans decreased over the 70-year period beginning in 1950, but relative mortality in infants and children increased during this same period. The mortality rates in the 1950s for White and Black infants were 2703 and 5181 deaths per 100 000 persons, respectively, for an excess mortality ratio of 1.92 (95% CI, 1.91 to 1.93). In the 2010s, the mortality rates were 499 deaths per 100 000 persons in White infants and 1073 deaths per 100 000 persons in Black infants, for an excess mortality ratio of 2.15 (CI, 2.13 to 2.17). A total of 5.0 million excess deaths of Black Americans (including 522 617 infants) could have been avoided during these 7 decades if their mortality rates were equal to those of White Americans.
Black infants, children, and adults have experienced persistent excess mortality in the United States since the 1950s relative to the White population.
