Senators Send Letter Calling for Payer Investigation

• On November 22, Senators Elizabeth Warren (D-MA) and Mike Braun (R- IN) sent a letter to the U.S. Health and Human Services’ Office of Inspector General calling for an investigation into payers role in drug pricing. The letter included a recent Wall Street Journal report that cited some payers that are paying much more for drugs when cheaper generic versions are available. Along with looking into this, the Senators are asking the federal government to investigate if payers can circumvent federal laws requiring setting medical loss ratios (Inside Health Policy, November 22).

Federal Studies and Reports

• According to a Modern Healthcare analysis of data from 255 health systems, as nonprofit hospitals’ expenses rose during the COVID-19 pandemic, the hospitals provided proportionally less charity care. Nonprofit hospitals’ median operating costs rose approximately 20% from 2020 to 2022 while health systems’ median charity care as a percentage of operating expenses decreased from 1.21% to 0.99% during that time. Expanded Medicaid coverage during this period and the correlating lack of need for discounted or free care may have contributed to declining charity care spending overall (Modern Healthcare, November 27).

Waivers

• Section 1115
  • Tennessee
    • On November 13, 2023, Tennessee submitted a request to amend its 1115 demonstration, TennCare III. The proposed amendment would expand coverage of parents and caretaker relatives of dependent children, cover a supply of diapers for infants and young children enrolled in TennCare, and enhance HCBS available to individuals with disabilities. The comment period is open from November 24, 2023, through December 23, 2023.

SPAs

• In October, the Florida Department of Health (FDOH) settled a COVID-19 data-related lawsuit by releasing more detailed information spanning back three years on the state’s FLHealthCHARTS.gov website. Simultaneously, the state stopped providing its biweekly COVID reports. The data in the CHARTS site shows data for cases, surveilled COVID-related deaths, and general vaccination status by year, month, or week. The CHARTS also allows researchers to see how many people died of COVID-related conditions by county. While there is more data available, some users believe that information previously provided with the biweekly COVID reports is now either missing (positive COVID cases) or not specifically totaled (cumulative totals) (Florida Today, November 27).
• District Judge James T. Russell of Nevada has rejected a 2024 proposed ballot initiative that looked to preserve reproductive rights, including abortion, in the Neveda State Constitution. District Judge Russell has aligned with the Coalition for Parents and Children PAC, which filed a lawsuit last month to block the proposed ballot initiative, by deeming it as too broad and in violation of the single subject rule. Advocates for reproductive rights have vowed to appeal the decision. Should the Nevada Supreme Court reverse the decision, advocates will need to gather more than 100,000 signatures by July 8 for the proposed ballot initiative to be on the 2024 ballot. Currently, Nevada allows abortion up to 24 weeks following a 1990 referendum vote (The Hill, November 23).
• Blue Cross Blue Shield of Arizona (BCBS of Arizona) plans to open five additional clinics in Arizona under its subsidiary Prosano Health Solutions. Additionally, BCBS of Arizona was awarded a contract to provide services to thousands of employees at Taiwan Semiconductor Manufacturing Company (TSMC). TSMC is in the process of building computer chip production facilities in Phoenix. The payer is replicating Kaiser Permanente’s model for an integrated payer-provider organization, and is using One Medical’s approach to care, offering same day appointments, no copays, and longer visits. BCBS of Arizona will also open a primary care center serving employees of TSMC in July 2024 (Health Payer Specialist, November 22).
• On December 1, eligible individuals throughout North Carolina will be able to get health coverage through Medicaid, with half of those eligible being automatically enrolled. The state’s Medicaid website includes helpful tools and the state’s Medicaid agency continues to work with non-profit and other community-based organizations to contact people across the state to provide information about eligibility and enrollment processes. The expansion will offer full health insurance benefits to those who qualify and are between the ages of 19 and 64. The expansion also includes preventative care and prescription drug coverage (Yahoo, November 24).

News

• For decades, health systems and academic medical centers have formed and maintained complex partnerships. Despite benefits on both sides, integrating high-cost research and education into a health systems’ daily operations remains challenging. Contracting between the two systems can also be challenging and result in contracts that are imbalanced and financially strained. However, affiliations between the two institutions are expected to continue. As the scope and size of health systems have increased, academic medical center partnerships have increased as well due to the value of referral networks. Affiliations between health systems and universities can improve population health, recruitment and retention of employees, and improve the relationship between employers as evidenced by the success of the Houston-based Memorial Hermann Health System and University of Texas and University of Houston partnerships (Modern Healthcare, November 28).

• Since 2020, Sellers Dorsey has been collaborating with Pyx Health to address the epidemic of loneliness and social isolation across the country and create a healthier, happier population. Working together, Pyx Health has made significant strides including improving loneliness and depression for more than 60% of it’s Medicaid and Medicare members. Click here to read the full case study!