1 00:00:00,080 --> 00:00:02,240 This is Jacob Emerson with the Becker's payer 2 00:00:02,240 --> 00:00:03,220 issues podcast 3 00:00:03,679 --> 00:00:06,879 here's your biweekly industry news briefing for December 4 00:00:06,879 --> 00:00:07,379 9th 5 00:00:08,000 --> 00:00:10,880 in an internal video message to employees on 6 00:00:10,880 --> 00:00:14,794 December 6th UnitedHealth Group CEO Andrew Witty addressed 7 00:00:14,794 --> 00:00:16,654 the fatal shooting of UnitedHealthcare 8 00:00:17,114 --> 00:00:18,335 CEO Brian Thompson 9 00:00:18,635 --> 00:00:21,195 along with the wave of public scrutiny and 10 00:00:21,195 --> 00:00:23,774 online vitriol the event has unleashed. 11 00:00:24,634 --> 00:00:26,554 To quote mister Witty, he said, I'm sure 12 00:00:26,554 --> 00:00:28,875 everyone has been disturbed by the negative and 13 00:00:28,875 --> 00:00:31,899 in many cases, vitriolic media and commentary that 14 00:00:31,899 --> 00:00:34,320 has been produced over the last few days 15 00:00:34,539 --> 00:00:36,880 particularly in the social media environment. 16 00:00:37,340 --> 00:00:39,100 There were very few people in the history 17 00:00:39,100 --> 00:00:40,780 of the US health care industry who had 18 00:00:40,780 --> 00:00:43,515 a bigger positive effect on American health care 19 00:00:43,515 --> 00:00:44,255 than Brian. 20 00:00:44,634 --> 00:00:46,634 To continue quoting mister Witty, he said our 21 00:00:46,634 --> 00:00:48,314 role is a critical role and we make 22 00:00:48,314 --> 00:00:50,094 sure that care is safe, appropriate, 23 00:00:50,634 --> 00:00:52,475 and is delivered when people need it. We 24 00:00:52,475 --> 00:00:54,715 guard against the pressures that exist for unsafe 25 00:00:54,715 --> 00:00:57,420 care or for unnecessary care to be delivered 26 00:00:57,420 --> 00:00:58,940 in a way which makes the whole system 27 00:00:58,940 --> 00:01:01,280 too complex and ultimately unsustainable. 28 00:01:02,219 --> 00:01:04,700 Brian Thompson was fatally shot the morning of 29 00:01:04,700 --> 00:01:07,819 December 4th in a brazen and targeted attack 30 00:01:07,819 --> 00:01:09,120 according to the NYPD. 31 00:01:09,775 --> 00:01:11,454 As of the morning of December 9th, the 32 00:01:11,454 --> 00:01:14,034 police are still actively searching for the suspect. 33 00:01:14,575 --> 00:01:16,814 A motive is currently unknown, but the words 34 00:01:16,814 --> 00:01:18,674 deny, defend, and depose 35 00:01:18,974 --> 00:01:21,215 were written on shell casings found at the 36 00:01:21,215 --> 00:01:21,954 crime scene. 37 00:01:22,734 --> 00:01:24,594 The killing of the CEO of the nation's 38 00:01:24,709 --> 00:01:27,189 largest health insurer has sparked a firestorm of 39 00:01:27,189 --> 00:01:30,409 online hostility toward the health insurance industry moradly. 40 00:01:31,030 --> 00:01:33,590 Individuals took to social media to share their 41 00:01:33,590 --> 00:01:36,329 experiences with delayed and denied care. 42 00:01:36,629 --> 00:01:39,849 1 federal lawmaker described the situation as unjustified 43 00:01:40,149 --> 00:01:43,015 but not surprising, while another said the anger 44 00:01:43,015 --> 00:01:44,715 should be directed towards congress. 45 00:01:45,334 --> 00:01:47,655 Mike Tuffin, the CEO of AHIP, wrote in 46 00:01:47,655 --> 00:01:49,974 the December 5th on post on LinkedIn that 47 00:01:49,974 --> 00:01:52,935 the association condemns any suggestion that threats against 48 00:01:52,935 --> 00:01:55,115 our colleagues or anyone else in our country 49 00:01:55,415 --> 00:01:56,479 are ever acceptable. 50 00:01:57,099 --> 00:02:00,319 Insurers have quickly tightened security around their executives, 51 00:02:00,540 --> 00:02:04,319 moving conferences to virtual formats and removing biographical 52 00:02:04,619 --> 00:02:05,759 information online. 53 00:02:06,140 --> 00:02:07,979 To quote mister Witty again, he said, I 54 00:02:07,979 --> 00:02:10,484 encourage you to tune out the critical noise 55 00:02:10,484 --> 00:02:12,644 that we're hearing right now. It does not 56 00:02:12,644 --> 00:02:14,965 reflect reality. It is simply a sign of 57 00:02:14,965 --> 00:02:16,884 an era in which we live. What we 58 00:02:16,884 --> 00:02:18,324 must do is focus on what we know 59 00:02:18,324 --> 00:02:19,764 to be true and what we know to 60 00:02:19,764 --> 00:02:21,204 be true is that the health system needs 61 00:02:21,204 --> 00:02:23,659 a company like UnitedHealth Group and it needs 62 00:02:23,659 --> 00:02:25,520 people like Brian within it. 63 00:02:28,620 --> 00:02:29,919 Well a health care entrepreneur 64 00:02:30,219 --> 00:02:33,180 and former federal health official is reportedly guiding 65 00:02:33,180 --> 00:02:36,240 a president-elect Donald Trump's new government efficiency panel. 66 00:02:36,534 --> 00:02:38,854 Mister Trump announced the department of government efficiency 67 00:02:38,854 --> 00:02:41,574 in November, tapping Elon Musk, owner of Tesla 68 00:02:41,574 --> 00:02:44,294 and X, formerly known as Twitter, and Vivek 69 00:02:44,294 --> 00:02:44,794 Ramaswamy, 70 00:02:45,094 --> 00:02:48,314 founder of Royvin Sciences, to spearhead its creation. 71 00:02:48,775 --> 00:02:50,615 Brad Smith, founder and CEO of the health 72 00:02:50,615 --> 00:02:52,709 care investment firm Russell Street Ventures, 73 00:02:53,009 --> 00:02:55,009 effectively has been leading the panel in recent 74 00:02:55,009 --> 00:02:57,169 weeks, though his official role has not been 75 00:02:57,169 --> 00:02:59,349 announced according to The New York Times. 76 00:02:59,969 --> 00:03:01,810 Mister Smith was named director of the Center 77 00:03:01,810 --> 00:03:04,310 For Medicare and Medicaid Innovation in 2020. 78 00:03:04,735 --> 00:03:06,735 Prior to that, he served as COO of 79 00:03:06,735 --> 00:03:08,435 Anthem's diversified business 80 00:03:08,974 --> 00:03:11,534 group. During the pandemic, he also helped coordinate 81 00:03:11,534 --> 00:03:13,455 project Airbridge and sat on the board for 82 00:03:13,455 --> 00:03:16,275 operation Warp Speed during mister Trump's first term. 83 00:03:16,669 --> 00:03:18,989 Mister Smith founded the in home palliative care 84 00:03:18,989 --> 00:03:19,489 company, 85 00:03:19,789 --> 00:03:22,750 Aspire Health. His latest venture CareBridge is slated 86 00:03:22,750 --> 00:03:24,750 to be acquired by Elavance in a deal 87 00:03:24,750 --> 00:03:26,129 reportedly worth $2,700,000,000 88 00:03:28,685 --> 00:03:31,485 Well AHIP, the trade association representing health insurers 89 00:03:31,485 --> 00:03:33,424 has laid off an unknown number of employees. 90 00:03:33,724 --> 00:03:36,444 The organization's former director of communications and public 91 00:03:36,444 --> 00:03:38,924 affairs posted on LinkedIn December 5th that he 92 00:03:38,924 --> 00:03:40,784 had been part of quote a layoff. 93 00:03:41,680 --> 00:03:43,539 The company or the organization 94 00:03:43,919 --> 00:03:46,900 told Politico that AHIP is constantly assessing organizational 95 00:03:47,039 --> 00:03:49,120 needs to ensure they are best positioned to 96 00:03:49,120 --> 00:03:51,280 advance the interest of their member companies and 97 00:03:51,280 --> 00:03:52,659 those that they serve. 98 00:03:53,935 --> 00:03:56,094 Well, Anthem Blue Cross Blue Shield has walked 99 00:03:56,094 --> 00:03:58,814 back a controversial policy, capping the amount of 100 00:03:58,814 --> 00:04:02,114 time it would reimburse providers for anesthesia services. 101 00:04:02,574 --> 00:04:05,775 In November, Anthem plans in Connecticut, New York, 102 00:04:05,775 --> 00:04:07,555 and Missouri said they would implement 103 00:04:07,909 --> 00:04:10,550 physician work time values set by CMS for 104 00:04:10,550 --> 00:04:11,689 anesthesia reimbursement. 105 00:04:12,229 --> 00:04:14,330 Anthem said it would not pay for anesthesia 106 00:04:14,389 --> 00:04:17,370 services billed beyond the minutes recommended by CMS. 107 00:04:17,829 --> 00:04:19,589 That policy was set to take effect in 108 00:04:19,589 --> 00:04:20,089 February. 109 00:04:20,564 --> 00:04:22,185 The American Society of Anesthesiologists 110 00:04:22,725 --> 00:04:25,285 criticized that policy alleging the insurer would quote 111 00:04:25,285 --> 00:04:25,785 arbitrarily 112 00:04:26,165 --> 00:04:29,064 predetermined the time allowed for anesthesia care. 113 00:04:29,685 --> 00:04:31,785 To continue quoting the association, 114 00:04:32,245 --> 00:04:34,449 it's a cynical money grab by Anthem designed 115 00:04:34,449 --> 00:04:36,470 to take advantage of the commitment anesthesiologists 116 00:04:36,930 --> 00:04:38,930 make thousands of times each day to provide 117 00:04:38,930 --> 00:04:42,069 their patients with expert, complete, and safe anesthesia 118 00:04:42,209 --> 00:04:45,169 care. Anthem faced additional scrutiny when posts about 119 00:04:45,169 --> 00:04:47,495 the policy went viral on Twitter on December 120 00:04:47,495 --> 00:04:49,194 4th, prompting lawmakers 121 00:04:49,495 --> 00:04:52,134 to weigh in. New York governor, Kathy Hochul, 122 00:04:52,134 --> 00:04:53,595 called the policy outrageous. 123 00:04:53,974 --> 00:04:56,214 On December 5th, she said Anthem agreed to 124 00:04:56,214 --> 00:04:58,375 reverse the policy. To quote her, she said, 125 00:04:58,375 --> 00:04:59,894 I shared my outrage. I had a plan 126 00:04:59,894 --> 00:05:01,814 from Anthem to strip away coverage from New 127 00:05:01,814 --> 00:05:04,269 Yorkers who had to go and under anesthesia 128 00:05:04,269 --> 00:05:06,670 for surgery. We pushed Anthem to reverse course 129 00:05:06,670 --> 00:05:08,589 and today they will be announcing a full 130 00:05:08,589 --> 00:05:09,089 reversal 131 00:05:09,389 --> 00:05:10,850 of this misguided policy. 132 00:05:11,310 --> 00:05:14,610 A spokesperson for Anthem called the called the 133 00:05:15,550 --> 00:05:18,944 coverage of the decision widespread information and 134 00:05:19,324 --> 00:05:21,404 said that that's what led them to change 135 00:05:21,404 --> 00:05:23,404 course. To quote Anthem, they said to be 136 00:05:23,404 --> 00:05:25,245 clear, it never was and never will be 137 00:05:25,245 --> 00:05:26,925 the policy of Anthem to not pay for 138 00:05:26,925 --> 00:05:28,944 medically necessary anesthesia services. 139 00:05:29,245 --> 00:05:31,404 The proposed update to the policy was only 140 00:05:31,404 --> 00:05:34,819 designed to clarify the appropriateness of anesthesia consistent 141 00:05:34,819 --> 00:05:35,800 with well established 142 00:05:36,259 --> 00:05:37,240 clinical guidelines. 143 00:05:37,939 --> 00:05:40,180 Anthem is owned by Elevance Health which operates 144 00:05:40,180 --> 00:05:42,580 the Blue Cross Blue Shield affiliates in 14 145 00:05:42,580 --> 00:05:43,080 states. 146 00:05:44,580 --> 00:05:46,675 Well, AM Best has downgraded the outlook for 147 00:05:46,675 --> 00:05:49,154 Blue Cross Blue Shield of Michigan from stable 148 00:05:49,154 --> 00:05:51,875 to negative based on a sharp deterioration in 149 00:05:51,875 --> 00:05:53,735 underwriting and operating income. 150 00:05:54,115 --> 00:05:56,914 The credit rating agency specializing in insurance said 151 00:05:56,914 --> 00:05:59,154 the decline in underwriting performance was driven by 152 00:05:59,154 --> 00:05:59,974 higher utilization 153 00:06:00,354 --> 00:06:01,949 across Blue Cross's business. 154 00:06:02,490 --> 00:06:04,810 Pent up demand for surgeries after the pandemic 155 00:06:04,810 --> 00:06:07,370 and high demand for GLP 1 drugs and 156 00:06:07,370 --> 00:06:09,930 autoimmune therapies were the major causes of the 157 00:06:09,930 --> 00:06:12,889 losses for Blue Cross. Medicare Advantage risk adjustment 158 00:06:12,889 --> 00:06:15,870 changes and rising acuity in Medicaid also contributed. 159 00:06:16,394 --> 00:06:17,694 Blue Cross reported a $3,200,000,000 160 00:06:18,475 --> 00:06:20,175 increase in medical costs in 2023 161 00:06:20,555 --> 00:06:22,795 compared to the year prior. The company has 162 00:06:22,795 --> 00:06:26,154 made significant efforts to improve its performance, including 163 00:06:26,154 --> 00:06:27,454 rightsizing its workforce. 164 00:06:27,754 --> 00:06:30,074 The company laid off 64 employees in August 165 00:06:30,074 --> 00:06:32,270 as part of that effort to reduce administrative 166 00:06:32,410 --> 00:06:32,910 costs. 167 00:06:33,370 --> 00:06:35,610 Blue Cross is also ending coverage for GLP 168 00:06:35,610 --> 00:06:37,610 ones for weight loss in its largest commercial 169 00:06:37,610 --> 00:06:39,310 plan at the beginning of 2025, 170 00:06:39,930 --> 00:06:43,050 citing concerns about safety, effectiveness, and cost as 171 00:06:43,050 --> 00:06:44,670 the reason for the decision. 172 00:06:46,464 --> 00:06:49,185 Well, Humana's CFO, Susan Diamond, is stepping down 173 00:06:49,185 --> 00:06:51,365 after 18 years with the insurer. 174 00:06:51,985 --> 00:06:55,664 Celeste Millett, the CFO of Global Infrastructure Partners 175 00:06:55,664 --> 00:06:58,485 and Investment Fund, will be Humana's next CFO. 176 00:06:58,704 --> 00:07:01,180 Miss Millett will assume with the CFO role 177 00:07:01,180 --> 00:07:01,919 in January. 178 00:07:02,220 --> 00:07:04,379 Miss Diamond will remain with Humana through the 179 00:07:04,379 --> 00:07:05,360 end of 2025 180 00:07:05,979 --> 00:07:07,439 in an advisory role. 181 00:07:08,139 --> 00:07:10,459 And Meridian Health Plan of Illinois, a subsidiary 182 00:07:10,459 --> 00:07:13,419 of Centene, has terminated its Medicaid contract with 183 00:07:13,419 --> 00:07:17,035 Northwestern Medicine in Chicago effective December 31st. 184 00:07:17,495 --> 00:07:19,495 After that, patients with that health plan must 185 00:07:19,495 --> 00:07:21,654 select a new plan during open enrollment to 186 00:07:21,654 --> 00:07:24,395 continue receiving care at the 11 hospital system. 187 00:07:24,694 --> 00:07:27,095 Tens of thousands of Medicaid patients will be 188 00:07:27,095 --> 00:07:28,555 affected by that change. 189 00:07:29,014 --> 00:07:30,350 If If you like the latest health insurance 190 00:07:30,350 --> 00:07:32,430 industry news delivered straight to your inbox every 191 00:07:32,430 --> 00:07:34,430 morning, subscribe to the Becker's Pay Your Issues 192 00:07:34,430 --> 00:07:36,770 e newsletter on our website at beckerspayor.com.