David Johnson: Consumerism introduces itself to U.S. healthcare
Unlike other consumer people-oriented businesses, healthcare essentially operates independently of its end-users (also called patients, consumers and/or customers). Individuals engage providers to diagnose and treat their ailments, while third parties largely pay for any services rendered. This convoluted relationship among providers, patients and payers creates two fundamental anomalies within healthcare business models that distort the…
The pace of hospital rating downgrades slowed in 2024: Five key takeaways
When combining the rating actions of the three rating agencies (Fitch Ratings, Moody’s Ratings and S&P Global Ratings), the number of downgrades (95) declined in 2024 while the number of upgrades (37) increased, compared with 116 and 33, respectively, in 2023. Rating agency downgrades versus upgrades, 2024 Many of the downgrades reflected ongoing expense pressure…
Medicare Part D drug price negotiations are set to include GLP-1s, but questions abound
GLP-1 medications made the second round of drugs that are subject to price negotiations under the Inflation Reduction Act (IRA), according to a CMS announcement during the final days of the Biden administration. However, the future of Medicare’s price negotiation authority is uncertain following the transition of power in Washington, D.C. Congressional Republicans have criticized…
Real-world solutions in primary care
Zeev Neuwirth, MD discusses the challenges in primary care and potential strategies to address them.
How gun violence affects the mental, behavioral and physical health of communities
Dr. Daniel Semenza of the New Jersey Gun Violence Research Center discusses the ripple effects of gun violence. HFMA's Nick Hut and Shawn Stack talk about the appointments of Robert F. Kennedy, Jr. and Mehmet Oz.
Susan Dentzer: It is time to move past denying the perfect storm facing U.S. healthcare
The healthcare sector is facing a perfect storm of aging patients, rising costs, aging providers, and a shortage of primary care physicians, creating a need to a shift toward preventive care, increased use of technology, more virtual and home care and sustainable care teams.
FTC takes legal action against pharmacy benefit managers, citing a distorted drug-pricing structure
A growing dispute between pharmacy benefit managers (PBMs) and government regulators intensified Sept. 20 when the Federal Trade Commission (FTC) filed suit against the three leading PBMs and their affiliated group purchasing organizations (GPOs). The complaint against CVS Caremark, Express Scripts, Inc. (ESI, owned by Cigna) and OptumRx (UnitedHealth Group) seeks to address a system…
David Johnson: 10 forces are combining to disrupt healthcare’s status quo
The U.S. healthcare system operates in much the same way it has for the past 100 years: always hospital-centric, physician-centric, disease-centric, treatment-centric and transaction-centric. Providers receive payment for the specific treatments they deliver. There is limited care coordination, little emphasis on prevention, inadequate provision of mental health services and woeful chronic disease management. The result…
Improving diversity in clinical drug trials
Erika is joined by Quintin Maidment, a vice president at CTRx Pathways, to discuss why diversity is critical in clinical drug trials and what barriers stand in the way.
ONC issues proposed technical standards to improve health information sharing
Proposed regulations bring healthcare providers and patients a step closer to gaining access to key health information stored in payer databases. Provisions in a proposed rule published Aug. 5 by the Office of the National Coordinator for Health Information Technology (ONC) support a CMS final rule released in 2020 and another issued early this year,…