This is Jacob Emerson with the Becker's payer
issues podcast
here's your biweekly industry news briefing for December
9th
in an internal video message to employees on
December 6th UnitedHealth Group CEO Andrew Witty addressed
the fatal shooting of UnitedHealthcare
CEO Brian Thompson
along with the wave of public scrutiny and
online vitriol the event has unleashed.
To quote mister Witty, he said, I'm sure
everyone has been disturbed by the negative and
in many cases, vitriolic media and commentary that
has been produced over the last few days
particularly in the social media environment.
There were very few people in the history
of the US health care industry who had
a bigger positive effect on American health care
than Brian.
To continue quoting mister Witty, he said our
role is a critical role and we make
sure that care is safe, appropriate,
and is delivered when people need it. We
guard against the pressures that exist for unsafe
care or for unnecessary care to be delivered
in a way which makes the whole system
too complex and ultimately unsustainable.
Brian Thompson was fatally shot the morning of
December 4th in a brazen and targeted attack
according to the NYPD.
As of the morning of December 9th, the
police are still actively searching for the suspect.
A motive is currently unknown, but the words
deny, defend, and depose
were written on shell casings found at the
crime scene.
The killing of the CEO of the nation's
largest health insurer has sparked a firestorm of
online hostility toward the health insurance industry moradly.
Individuals took to social media to share their
experiences with delayed and denied care.
1 federal lawmaker described the situation as unjustified
but not surprising, while another said the anger
should be directed towards congress.
Mike Tuffin, the CEO of AHIP, wrote in
the December 5th on post on LinkedIn that
the association condemns any suggestion that threats against
our colleagues or anyone else in our country
are ever acceptable.
Insurers have quickly tightened security around their executives,
moving conferences to virtual formats and removing biographical
information online.
To quote mister Witty again, he said, I
encourage you to tune out the critical noise
that we're hearing right now. It does not
reflect reality. It is simply a sign of
an era in which we live. What we
must do is focus on what we know
to be true and what we know to
be true is that the health system needs
a company like UnitedHealth Group and it needs
people like Brian within it.
Well a health care entrepreneur
and former federal health official is reportedly guiding
a president-elect Donald Trump's new government efficiency panel.
Mister Trump announced the department of government efficiency
in November, tapping Elon Musk, owner of Tesla
and X, formerly known as Twitter, and Vivek
Ramaswamy,
founder of Royvin Sciences, to spearhead its creation.
Brad Smith, founder and CEO of the health
care investment firm Russell Street Ventures,
effectively has been leading the panel in recent
weeks, though his official role has not been
announced according to The New York Times.
Mister Smith was named director of the Center
For Medicare and Medicaid Innovation in 2020.
Prior to that, he served as COO of
Anthem's diversified business
group. During the pandemic, he also helped coordinate
project Airbridge and sat on the board for
operation Warp Speed during mister Trump's first term.
Mister Smith founded the in home palliative care
company,
Aspire Health. His latest venture CareBridge is slated
to be acquired by Elavance in a deal
reportedly worth $2,700,000,000
Well AHIP, the trade association representing health insurers
has laid off an unknown number of employees.
The organization's former director of communications and public
affairs posted on LinkedIn December 5th that he
had been part of quote a layoff.
The company or the organization
told Politico that AHIP is constantly assessing organizational
needs to ensure they are best positioned to
advance the interest of their member companies and
those that they serve.
Well, Anthem Blue Cross Blue Shield has walked
back a controversial policy, capping the amount of
time it would reimburse providers for anesthesia services.
In November, Anthem plans in Connecticut, New York,
and Missouri said they would implement
physician work time values set by CMS for
anesthesia reimbursement.
Anthem said it would not pay for anesthesia
services billed beyond the minutes recommended by CMS.
That policy was set to take effect in
February.
The American Society of Anesthesiologists
criticized that policy alleging the insurer would quote
arbitrarily
predetermined the time allowed for anesthesia care.
To continue quoting the association,
it's a cynical money grab by Anthem designed
to take advantage of the commitment anesthesiologists
make thousands of times each day to provide
their patients with expert, complete, and safe anesthesia
care. Anthem faced additional scrutiny when posts about
the policy went viral on Twitter on December
4th, prompting lawmakers
to weigh in. New York governor, Kathy Hochul,
called the policy outrageous.
On December 5th, she said Anthem agreed to
reverse the policy. To quote her, she said,
I shared my outrage. I had a plan
from Anthem to strip away coverage from New
Yorkers who had to go and under anesthesia
for surgery. We pushed Anthem to reverse course
and today they will be announcing a full
reversal
of this misguided policy.
A spokesperson for Anthem called the called the
coverage of the decision widespread information and
said that that's what led them to change
course. To quote Anthem, they said to be
clear, it never was and never will be
the policy of Anthem to not pay for
medically necessary anesthesia services.
The proposed update to the policy was only
designed to clarify the appropriateness of anesthesia consistent
with well established
clinical guidelines.
Anthem is owned by Elevance Health which operates
the Blue Cross Blue Shield affiliates in 14
states.
Well, AM Best has downgraded the outlook for
Blue Cross Blue Shield of Michigan from stable
to negative based on a sharp deterioration in
underwriting and operating income.
The credit rating agency specializing in insurance said
the decline in underwriting performance was driven by
higher utilization
across Blue Cross's business.
Pent up demand for surgeries after the pandemic
and high demand for GLP 1 drugs and
autoimmune therapies were the major causes of the
losses for Blue Cross. Medicare Advantage risk adjustment
changes and rising acuity in Medicaid also contributed.
Blue Cross reported a $3,200,000,000
increase in medical costs in 2023
compared to the year prior. The company has
made significant efforts to improve its performance, including
rightsizing its workforce.
The company laid off 64 employees in August
as part of that effort to reduce administrative
costs.
Blue Cross is also ending coverage for GLP
ones for weight loss in its largest commercial
plan at the beginning of 2025,
citing concerns about safety, effectiveness, and cost as
the reason for the decision.
Well, Humana's CFO, Susan Diamond, is stepping down
after 18 years with the insurer.
Celeste Millett, the CFO of Global Infrastructure Partners
and Investment Fund, will be Humana's next CFO.
Miss Millett will assume with the CFO role
in January.
Miss Diamond will remain with Humana through the
end of 2025
in an advisory role.
And Meridian Health Plan of Illinois, a subsidiary
of Centene, has terminated its Medicaid contract with
Northwestern Medicine in Chicago effective December 31st.
After that, patients with that health plan must
select a new plan during open enrollment to
continue receiving care at the 11 hospital system.
Tens of thousands of Medicaid patients will be
affected by that change.
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