The who’s who of funders: 3 key relationships to watch

Posted on by • Posted in Decision Making Authority, Funding, Funding Partner, Health Insurance Industry, Health System, Hospital, Hospital Industry, Physician, Physician Aggregator, Physician Alignment, Physician Independence, Private Equity, Value Proposition • Leave a comment

https://www.advisory.com/blog/2021/09/physician-group-funders

We recently shared an updated perspective on the independent physician landscape. Notably absent from this map, but an important player in this space, are entities, like health plans, private equity, and health systems, who partially or wholly fund some independent physician groups.

We intentionally left these funders off the map because they don’t work in a uniform way with all physician groups. The reality is that funders have their handprints all over this map—and just knowing what type of funder you’re working with doesn’t necessarily tell you how they work with physician groups.

Funders work across the physician landscape because they recognize two things:

  • First, in order to play in today’s physician market, funders need to be flexible in how they work with physicians in order to appeal to the wide variety of groups and build a bigger market presence.
  • Second, building or buying these physician group archetypes outright is not the only way to work with them. Many funders instead opt to invest in them—either through dollars or resources.

Key funders to watch

There are three key funders we track the closest: private equity, health plans, and health systems. Below are brief overviews of how they commonly work with independent groups and our predictions for where you might see them go next.

Private equity (PE): Consistent approach with still to be proven outcomes

The goal of PE firms is to make money on their investments. To do this, these firms buy shares of practices in order to have partial ownership. In return, physician groups get the capital they need to make investments—investments that in theory drive profits for both the physician shareholders and the PE investors. Unlike other funders, PE is rarely associated with full acquisition.

Two of the places we’ve seen the most private equity investment are in consolidation of specialty practices (usually at the national level) or value-based care investments in primary care practices (across all archetypes).

Private equity is gaining traction as a physician group partner because they often try to preserve some degree of physician autonomy and they’ve learned to nuance their investments and pitches based on the group they’re seeking to work with.

We predict: PE will continue to back the full range of archetypes on this map—investing in both independent groups directly and the national archetypes.

What we’ll be watching:

  • What will happen to the handful of major PE investments in the independent physician group space that will be reaching their 5-7 year mark
  • What level of physician autonomy will PE firms continue to preserve as PE gains stronger footholds in the physician landscape

Health plans: The most eager to transform (incrementally)

Health plans are often predominantly associated with a single physician archetype for a given plan. For example, when you think about UnitedHealthcare, you might think of their sister company, OptumCare, and an aggregation strategy. Or, you might think of Blues plans most commonly as service partners.

However, when you dig deeper, the story is much more nuanced. Plans and their parent companies like UnitedHealth Group do often aggregate practices, but they also sell and integrate services via service partner models. And several Blues plans are now building practices from the ground up. To top it off, some plans are even adopting an investment strategy like Anthem with Privia.

Perhaps more than any other funder, health plans often adopt a range of strategies to develop their physician strategy and maintain their existing networks. And even cases where plans aren’t funding entities themselves, they’re thinking of new ways to work with the growing range of physician groups.

We predict: Health plans will move away from a uniform approach to physician practice partnership and towards more multifaceted approaches to appeal to a wide range of providers.

What we’ll be watching:

  • Will health plans diversify their suite of approaches based on the groups they’re pursuing
  • Will health plans tailor their value proposition for each partnership approach

Health systems: Playing catch up to evolve

We often tend to think about health systems as aggregators—they buy independent physician groups and add them to their employed medical groups. But we’re seeing two physician market shifts that are causing health systems to move away from a one-size-fits-all approach.

One, the remaining independent groups are growing in size and, two, they are less willing to be acquired. On top of that, as private equity firms and payers continue to diversify their strategies, health systems must adapt to keep pace—or risk being seen as the least attractive partner.

As a result, more health systems are telling us about their new approaches to physician partnerships, like starting an MSO to act as a service partner or convening coalitions between themselves and independent groups.

We predict: Health systems will face increasing pressure to diversify how they are operating with physician groups. Similar to health plans, we expect to see a pivot away from an aggregation-only approach. To learn more, read our take on how health systems and independent groups should think about partnership.

What we’ll be watching:

  • How quickly will health systems stand up additional partnership approaches
  • Will health systems in markets where they’re the dominant partner proactively adjust their partnership approach versus wait for the market to shift first

Your checklist to work successfully with today’s physician groups

As you evaluate your partnership strategy, here’s our starter list of questions to ask yourself:

  1. Clarify your partnership goals:
    • What are my organization’s goals for physician partnership broadly?
    • What are the archetypes I currently fund or partner with?
    • Do these archetypes serve my organization’s stated goals? 
  2. Identify the right partnership approaches for your organization
    • What new archetypes should I build or work with to advance my organization’s goals and target new physician groups?
    • Do I need to build this archetype myself or is it better to fund one that exists?
    • If funding, should I wholly own or invest in the archetype? 
  3. Define your value proposition to physicians
    • Have I adjusted my value proposition for each of the archetypes I fund or partner with?
    • Am I clearly articulating my value proposition in a way that speaks to physicians’ needs and wants?
    • Does my value proposition align with what I’m actually delivering? For example, if I say I’m preserving autonomy, how am I doing that?
    • How does my value proposition compare and compete with others in the market? 
  4. Map out the power dynamics of the archetypes you want to work with
    • Who has the ultimate decision-making power in the organization? (Hint: Decision-making power gets more diffuse as you move from right to left, national chain to service partner.)
    • Who are the key stakeholders who influence decision-making?

We’ve been defining the independent physician landscape wrong—here’s a new approach

Posted on by • Posted in Health System, Hospital, Hospital Industry, Medical Group, Physician, Physician Aggregator, Physician Coalition, Physician Independence, Physician National Chain Model, Physician Practice Management, Physician Service Partner, Strategic Alignment, Strategy • Leave a comment
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Physician groups and their funders—you've been thinking about their relationship wrong

We’ve historically divided the physician landscape in two parts: hospital-employed or independent. But over time, the “independent” segment has become more complex and inclusive of more types of groups who don’t fit the traditional definition of shareholder-owned and shareholder-governed. Even true independent groups don’t look like they once did, adapting in ways like receiving funding from a range of investors or adding more employed physicians.

So our standard way of thinking—hospital-employed or independent—has become obsolete. It’s time for a more nuanced approach to a diversified market.

When the pace of investment and aggregation in the independent space picked up, we conceptualized the changes primarily in terms of funder: private equity, a health plan, a health system, or another independent group.

That made sense at the time because each type of funder was using similar methods to partner with groups—health systems acquired, private equity invested directly in the independent group, and so forth.

But the market has shifted such that remaining independent groups are both stronger and more committed to independence. So organizations who want to partner with these groups have had to refine and diversify their value propositions—and often times are doing so without all-out acquisition. For more information on themes within these funder organizations, see our companion blog.

We set out to make sense of an ever-changing independent physician landscape in a way that would make it easier to understand for both independent groups and for those who work with them. Instead of dividing the landscape by funder, we assessed organizations based on their level of autonomy vs. integration, their growth model, and their geographic reach.

The map above has five physician practice archetypes and is oriented around two axes: local to national and autonomy to integration. The four archetypes on the top are larger in scale than a traditional independent medical group, often moving regionally and then nationally.

The archetypes are also ordered based on the degree of physician and practice autonomy, with organizations on the right using more of an integrated and standardized model for care delivery and sharing a brand identity.

So far, we’ve tracked two types of trends within this landscape. First, independent groups partner with national archetypes in one of two ways. Either the groups continue to exist as both independent groups and as part of the corporate identity OR they get integrated into the corporate entity. The exception is that we have not seen national chains integrate existing medical groups—though they may in the future.

The other trend we have seen is the evolution of some of these archetypes. We currently see service partners in the market shift to look more like coalitions. We assume we may see coalitions that start to look more like aggregators, and we know many aggregators have ambitions to function more like national chains. 

Below you will find a brief description of each archetype as well as a more robust table of key characteristics.

Definitions of physician archetypes

Independent medical group

Independent medical groups are traditional shareholder-owned, shareholder-governed practices. They are governed by a board of physician shareholders, and shareholders derive direct profits from the group.

Service partner

A service partner is an organization whose primary ambition is to make profits through providing a service, such as technology, data, or billing infrastructure, to physician groups. This type of partner may create some sort of alignment between practices since it sells to like-minded practices (e.g., those deep in value-based care, within the same specialty), but that alignment is more of a byproduct than the primary goal.

Coalition

Coalitions are formed from physician practices who want to get benefits of scale without giving up any individual autonomy. They join a national organization to share resources, data, and/or knowledge, but each practice also retains its individual local identity and branding. Common coalition models include IPAs, ACOs, and membership models.

Aggregator

Aggregators are the most traditional approach to getting scale from independent medical groups. They acquire practices and usually employ their physicians. The range of aggregators is very diverse. It includes health plans, health systems, private equity investors, and independent medical groups who have shifted to become aggregators themselves.

National chain

We have historically referred to national chains as disruptors, but that name is inclusive of many organizations who are not physician practices and what qualifies as “disruptive” is ever-changing—so we needed a new name that better suited these groups. National chains are corporate organizations who develop a model (e.g., consumerism, value-based care, virtual health) and bring that model to scale, usually by building new practices or hiring new providers. These are highly integrated organizations, with each new location using the same care delivery model and infrastructure.

As the independent physician landscape evolves, it has implications not only for independent groups but for those who work with them. We hope that a shared terminology helps bridge some of the gaps in understanding this complex landscape.

For those who partner with independent groups, we’d suggest reading our companion blog for our take on the three biggest funders and questions to ask yourself to work successful with today’s physician groups.

A $200 surcharge for unvaccinated spouses? It’s coming to one Louisiana health system.

Posted on by • Posted in Employee Insurance Surcharge, Employees Unvaccinated, Health System, Hospital, Hospital Industry, Self Insured Employers, Unvaccinated, Vaccination, Vaccine, Vaccine Efficacy, Vaccine Fee Covid, Vaccine Fee Covid Spousal, Vaccine Hesitancy Rate, Vaccine Safety, Vaccine Skepticism, Vaccine Supply • Leave a comment
https://www.advisory.com/daily-briefing/2021/10/05/louisiana-surcharge?utm_source=public_db&utm_medium=email&utm_campaign=2021oct05&utm_content=public_headline_public_x_x_x_x&elq_cid=4778863&x_id=
Louisiana Health System to Charge Fee to Employees with Unvaccinated Spouses - The New York Times

As more companies consider implementing insurance surcharges for their unvaccinated employees, Ochsner Health plans to add a $200 monthly surcharge for employees with unvaccinated spouses and domestic partners covered by the organization’s health plan.

Unvaccinated employees face potential insurance surcharges

While many companies have relied on incentives to encourage employee Covid-19 vaccination, some have recently opted to implement penalties, such as premium surcharges, for those who remain unvaccinated instead.

Recent polling suggests that these surcharges could spur a significant portion of unvaccinated employees to get the Covid-19 vaccine. According to an Affordable Health Insurance poll of 1,000  unvaccinated individuals with employer-based health plans, nearly 75% said a health insurance surcharge could motivate them to get vaccinated, with 43% saying a surcharge would definitely motivate them to get vaccinated.

“As they say, the vaccine is not mandatory, but if people have extra charges with their insurance due to not being vaccinated, people will surely push themselves to be vaccinated,” Nick Schrader, insurance agent at Texas General Insurance, said.

So far, Delta Airlines is the largest employer to implement an insurance surcharge for unvaccinated employees, and it has already seen significant increases in employee vaccination.

In August, Delta announced unvaccinated employees would have to pay a $200 monthly health insurance surcharge to remain on the company’s health insurance plan beginning Nov. 1.

According to Delta, the surcharge will protect the company from lost revenue due to unvaccinated employees being hospitalized with Covid-19—which costs the company an average of $50,000 for each case.

Henry Ting, Delta’s chief health officer, said almost 20% of the company’s unvaccinated employees received the Covid-19 vaccine in the two weeks after the surcharge was announced. In addition, the company did not see any employee turnover or resignation due to the announcement, Ting said.

Ochsner Health’s ‘spousal Covid vaccine fee’

Ochsner Health, Louisiana’s largest health system with nearly 32,000 employees and more than 4,500 physicians, plans to implement a $200 monthly surcharge for employees with unvaccinated domestic partners and spouses on the organization’s health insurance plan, the Associated Press reports.

Ochsner is the first health system to apply insurance surcharges to unvaccinated family members, not just employees. Other Louisiana health care organizations, such as Our Lady of the Lake Regional Medical Center and LCMC Health, said they would ask families of employees to be vaccinated, but did not plan on implementing a surcharge for unvaccinated spouses or partners, the Times-Picayune/New Orleans Advocate reports.

According to a letter sent from Ochsner leaders to employees, the surcharge, called the “spousal Covid vaccine fee,” will begin in 2022 and could deduct up to $2,400 a year from an employee’s paycheck. The surcharge will only apply to domestic partners or spouses, not other dependents covered by an employee’s health plan like children.

Warner Thomas, Ochsner’s president and CEO, said the surcharge for unvaccinated spouses and partners is similar to a surcharge for tobacco users and will be used to help keep health premiums low for employees. As a self-insured organization, Ochsner is responsible for the cost of Covid-19 treatment for patients on its health insurance plan, the Associated Press reports.

“The reality is the cost of treating Covid-19, particularly for patients requiring intensive inpatient care, is expensive, and we spent more than $9 million on Covid care for those who are covered on our health plans over the last year,” Thomas said.

“We know that Covid-19 vaccination dramatically reduces transmission, severity of symptoms, hospitalizations, and death. Approximately 90% of those hospitalized with Covid in our facilities have been unvaccinated since vaccines were approved in December 2020,” he added. “Widespread vaccination is critical to stopping the spread of Covid-19, and we hope this change will encourage even more community members to get vaccinated.”

Thomas also clarified that unvaccinated spouses and partners are not required to be vaccinated because of the surcharge. “This is not a mandate as non-employed spouses and domestic partners can choose to select a health plan outside of Ochsner Health offerings,” he said.

Unvaccinated spouses and partners can also apply for medical or religious exemptions for the Covid-19 vaccine, Thomas said. Currently, around 300 Ochsner employees have applied for medical or religious exemptions, the Times-Picayune/New Orleans Advocate reports.

Map: See the 2,500 hospitals that face readmission penalties this year

Posted on by • Posted in American Hospital Association (AHA), Center for Medicare and Medicaid Services (CMS), Health Policy, Health System, Hospital, Hospital Industry, Medicare, Medicare Hospital Readmissions Reduction Program (HRRP), Penalty • Leave a comment
https://www.advisory.com/daily-briefing/2021/10/05/hrrp-readmissions-map?utm_source=public_db&utm_medium=email&utm_campaign=2021oct05&utm_content=public_headline_public_x_infogram_x_x&elq_cid=4778863&x_id=
Which States Had the Most Hospitals Penalized for Readmissions 2020

A recent CMS analysis of its Hospital Readmissions Reduction Program (HRRP) found that 2,500 hospitals will face HRRP penalty reductions and around 18% of hospitals will face penalties of at least 1% of their Medicare reimbursements for fiscal year (FY) 2022, Modern Healthcare reports.

Cheat sheet: Hospital readmissions reduction program

How HRRP works

Under the HRRP, CMS withholds up to 3% of regular reimbursements for hospitals if they have a higher-than-expected number of 30-day readmissions for any of six conditions:
Toolkit: CV medical readmissions reduction

  • Chronic lung disease
  • Coronary artery bypass graft surgery
  • Heart attacks
  • Heart failure
  • Hip and knee replacements
  • Pneumonia

Historically, hospitals received a penalty if their observed readmissions for any one of these conditions exceeded a national standard. However, in response to criticism, CMS in 2019 scrapped the national standard comparison standard. It now compares hospitals’ performance with that of other hospitals serving a similar population of low-income patients.

Under the current methodology, CMS has categorized all participating hospitals into quintiles according to the proportion of dual-eligible patients (patients eligible for Medicare and Medicaid) each hospital serves. Now, each hospital is compared with the median readmissions performance of its cohort, and hospitals with higher-than-cohort-median performance are penalized.

The program does not apply to veterans hospitals, children’s hospitals, psychiatric hospitals, or hospitals in Maryland, which has a federal waiver for how it distributes Medicare funding. In addition, hospitals are not evaluated under the program if they do not treat enough cases of the conditions evaluated.

Fewer hospitals are facing high HRRP penalties

In a recent analysis, CMS looked at HRRP data from July 2017 to December 2019. It found that 2,500 hospitals will face HRRP penalty reductions for FY 2022, and around 18% of hospitals will be penalized more than 1% of their reimbursements, down from 20% from July 2016 through June 2019.
The financial value of readmissions reduction

The analysis also found that 80% of hospitals with the highest proportion of Medicare-Medicaid dual-eligible patients will pay penalties, while nearly 72% of hospitals with the lowest proportion of dual-eligible patients will receive penalties.

This likely will be the last set of readmissions data unaffected by the Covid-19 pandemic. Under ordinary circumstances, CMS reviews three years of data in calculating HRRP penalties, so the agency ordinarily would have considered data from July 2017 to June 2020 in calculating the fiscal year 2022 penalties. However, CMS elected to stop its analysis in December 2019 to exclude data gathered during the Covid-19 pandemic.

CMS has not yet said how it will handle readmissions data from the pandemic, Modern Healthcare reports.

Reaction

Akin Demehin, director of policy for the American Hospital Association (AHA), said the drop in hospitals paying high HRRP penalties is a success.

“America’s hospitals and health systems have made substantial progress in reducing unnecessary readmissions, which has improved quality and enhanced care coordination,” Demehin said.

Demehin also praised CMS for excluding data from the Covid-19 pandemic from its analysis.

“We are pleased that CMS heard our concerns and excluded data from the first six months of 2020 to account for the pandemic when calculating performance,” he said. “We will continue to ask CMS to use its discretion to exclude pandemic-affected data in calculating performance in its hospital quality and value programs going forward.”

Demehin also added that CMS should expand its peer-grouping of hospitals by incorporating other social risk factors beyond a hospital’s control.

“Peer grouping provides relief to many hospitals serving the poorest and most vulnerable communities,” he said. “Congress gave CMS the ability to refine its social risk factor adjustment approach over time, and because the research and science on this issue continues to evolve, the AHA has encouraged CMS to consider ongoing refinements.” (Gillespie, Modern Healthcare, 10/1)

Democrats’ moral Medicaid dilemma

Posted on by • Posted in ACA, Access, Access & Quality of Healthcare, Dilemma, Health Equity, Health Inequity, Health Insurance Coverage Adequacy, Health Policy, Medicaid, Medicaid Expansion, Medicare, Medicare Expansion • Leave a comment
https://www.axios.com/democrats-medicaid-medicare-dilemma-68bfff7e-48f9-41ff-8664-a923d7f5280b.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

Democrats’ push to extend health coverage to millions of very low-income people in red states has a lot working against it: It’s expensive, it’s complicated, it may invite legal challenges, and few national Democrats stand to gain politically from it.

Yes, but: The policy is being framed as a test not only of Democrats’ commitment to universal health coverage, but also their commitment to racial equity.

The big picture: Democrats are still figuring out how much money they have to spend in their massive social policy legislation, but there’s already intense competition among policies — including between health care measures.

  • Progressives are adamant about expanding Medicare to cover dental, vision and hearing benefits. But a handful of prominent Democrats are making the case that closing the Medicaid coverage gap is equally, if not more, important.
  • The gap exists in 12 Republican-controlled states that have refused to accept the Affordable Care Act’s Medicaid expansion, the majority of which are in the South.

What they’re saying: Closing the coverage gap is “very, very important to people of color. The majority of Black people in this country still live in the South,” said Rep. Jim Clyburn, one of the leading proponents of the measure.

  • More than 2 million adults are in the coverage gap, and 60% of them are people of color, according to the Center on Budget and Policy Priorities.
  • “What is the life expectancy of Black people compared to white people? I could make the argument all day that expanding Medicare at the expense of Medicaid is a racial issue, because Black people do not live as long as white people,” Clyburn added. “If we took care of Medicaid, maybe Black people would live longer.”

Between the lines: In terms of raw politics, it’s pretty easy to see why many Democrats would prioritize Medicare expansion over closing the Medicaid gap: Seniors live in every district and state in the U.S.

  • Only three Democratic senators represent non-expansion states, and in 2020, only ine of the 41 battleground House seats identified by Ballotpedia were in non-expansion states.

Yes, but: Sens. Jon Ossoff and Raphael Warnock, both from Georgia, are the reason that Democrats are able to consider their social policy legislation at all. Warnock is up for re-election next year.

  • “This is about people in this country, and I wish we’d stop this red state and blue state stuff,” Clyburn said. “Warnock and Ossoff won a runoff that nobody gave them a chance to win by promising they would close this gap.”

The catch: States that have already expanded Medicaid are covering a small portion of those costs themselves, and may question the fairness full federal funding for the holdout states.

  • That could create an incentive for existing expansion states to drop the ACA’s Medicaid expansion and pick up the new program instead. And any effort Congress makes to stop them could invite legal challenges.
  • “The case law in this domain is a bit of a moving target, and as we’ve seen over the past decade, there’s an awful lot of litigation over things pertaining to health reform,” said Nick Bagley, a professor at the University of Michigan Law School.

The bottom line: Like Democrats’ other proposed health policies, filling the coverage gap could cost hundreds of billions of dollars.

  • But “if your goals are relieving health care cost burdens or expanding access to care, then it’s hard to do better on a dollar-for-dollar basis than buying coverage for uninsured people below the poverty line,” said Brookings’ Matt Fiedler.

What we’re watching: “I don’t see Medicaid as being on the radar of some of my friends in the caucus who seem to feel it’s more important to do Medicare,” Clyburn said. “I’m trying to get Medicaid on their agenda.”

  • “I’m tired of my party perpetuating … inequity,” he added. “Treating people according to their needs is what breaks the cycle.”

Jefferson Health, Einstein Healthcare finalize merger, create 18-hospital system

Posted on by • Posted in Federal Trade Commission (FTC), Health System, Hospital, Hospital Industry, Market Consolidation, Market Power, Market Share, Mergers & Acquisitions • Leave a comment
https://www.beckershospitalreview.com/hospital-transactions-and-valuation/jefferson-health-einstein-healthcare-finalize-merger-create-18-hospital-system.html?origin=BHRE&utm_source=BHRE&utm_medium=email&utm_content=newsletter&oly_enc_id=2893H2397267F7G
Jefferson Health New Jersey |

More than three years after signing a letter of intent to merge, Jefferson Health and Einstein Healthcare Network have finalized the deal. 

The combination of the Philadelphia-based organizations brings together two academic medical centers and creates an integrated 18-hospital system with more than 50 outpatient and urgent care locations.

“The culmination of the multiyear process of bringing two great organizations with more than 300 combined years of service, clinical excellence and academic expertise is not just a merger,” said Stephen Klasko, MD, president of Thomas Jefferson University and CEO of Jefferson Health. “Einstein and the new Jefferson together represent an opportunity for the Philadelphia region to creatively construct a reimagining of healthcare, education, discovery, equity and innovation that will have national and international reverberations.”

The merger had previously faced antitrust scrutiny and delays from legal challenges. In particular, both the Federal Trade Commission and Pennsylvania’s attorney general sued the health systems in attempts to block the deal.

The FTC sued in February 2020, arguing that the combination of the two systems would reduce competition in both Philadelphia and Montgomery counties “to the detriment of patients.” An appellate court denied the FTC’s attempt to block the merger in December 2020, and the FTC officially dropped its challenge to the transaction in February 2021. 

The Pennsylvania attorney general also dropped his opposition to the merger in January 2021 after the FTC lost its case. 

Ken Levitan will continue serving as president and CEO of Einstein and add the role of executive vice president at Jefferson Health. In his new role, he will help guide the integration efforts. 

Read more here.

14 health systems with strong finances

Posted on by • Posted in Balance Sheet, Credit Quality, Credit Ratings, Financial Stewardship, Financial Strength, Financial Viability, Health System, Hospital, Hospital Industry, Net Income, Non-Profit Healthcare Industry, Nonoperating Income, Operating Expenses, Operating Income, Operating Margin, Operating Metrics, Operating Performance, Operating Revenue • Leave a comment
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What next for the US dollar? - TalkingPoint - Schroders

Here are 14 health systems with strong operational metrics and solid financial positions, according to reports from Fitch Ratings, Moody’s Investors Service and S&P Global Ratings.

1. Advocate Aurora Health has an “Aa3” rating and positive outlook with Moody’s. The health system, which has dual headquarters in Milwaukee and Downers Grove, Ill., has a leading market share in two regions and strong financial discipline, Moody’s said. The credit rating agency said it expects Advocate Aurora Health’s operating cash flow margins to return to pre-pandemic levels. 

2. Pinehurst, N.C.-based FirstHealth of the Carolinas has an “AA” rating and stable outlook with Fitch. The health system has a strong financial profile and stable operating performance, despite disruption from the COVID-19 pandemic, Fitch said. The health system’s revenue in the first quarter of fiscal 2021 rebounded to levels close to historical trends, according to the credit rating agency. 

3. Indianapolis-based Indiana University Health has an “Aa2” rating and stable outlook with Moody’s and an “AA” rating and positive outlook with Fitch. Cost controls and patient volume will help the system sustain strong margins and liquidity, Moody’s said. 

4. Rapid City, S.D.-based Monument Health has an “AA-” rating and stable outlook with Fitch. The health system has solid operating margins that Fitch expects to remain stable over the near term. Monument Health’s operating margins will continue to support liquidity growth and capital spending levels, the credit rating agency said. 

5. Chicago-based Northwestern Medicine has an “Aa2” rating and stable outlook with Moody’s, and an “AA+” rating and stable outlook with S&P. The system’s consolidated operating model will allow it to maintain a strong financial position while effectively executing strategies, Moody’s said. The credit rating agency expects Northwestern Medicine to expand its prominent market position in the broader Chicago region because of its strong brand and affiliation with Northwestern University’s Feinberg School of Medicine. 

6. Renton, Wash.-based Providence has an “AA-” rating and stable outlook with Fitch and an “Aa3” rating and stable outlook with Moody’s. Fitch said Providence has a long-term strategic advantage over most of its peers because it has invested heavily in developing technology in recent years, and the system’s plan to transform healthcare delivery through the use of data and technology has been undeterred through the COVID-19 pandemic. Fitch said it expects Providence’s cash flow margins to be close to 7 percent in the coming years. 

7. Livingston, N.J.-based RWJBarnabas Health has an “Aa3” rating and stable outlook with Moody’s. Moody’s said it expects RWJBarnabas, the largest integrated academic health system in New Jersey, to see near-term revenue growth and to execute on several strategic fronts while achieving targeted financial performance.  

8. Broomfield, Colo.-based SCL Health has an “AA-” rating and stable outlook with Fitch and an “Aa3” rating and stable outlook with Moody’s. The health system has consistently improved its liquidity levels and has a long track record of exceptional operations, Fitch said. SCL Health is well positioned for change in the healthcare sector because it has built up cash reserves over time, according to the credit rating agency. 

9. San Diego-based Scripps Health has an “Aa3” rating and stable outlook with Moody’s. The health system has ample liquidity coverage, an extensive footprint and strong brand and market share within San Diego County, Moody’s said. The credit rating agency said it expects Scripps to weather current operating challenges and to grow operating cash flow over the long term. 

10. Norfolk, Va.-based Sentara Healthcare has an “Aa2” rating and stable outlook with Moody’s. The health system has strong margins, and Moody’s said it expects the system to maintain a strong financial position and balance sheet. 

11. Arlington-based Texas Health Resources has an “Aa2” rating and stable outlook with Moody’s. The health system has a strong cash position, which will be boosted by favorable investment gains and bond proceeds, Moody’s said. Based on performance in the second quarter of this year, Moody’s expects Texas Health Resources’ patient volume and operating cash flow margins to recover to pre-COVID-19 levels. 

12. Iowa City-based University of Iowa Hospitals & Clinics has an “Aa2” rating and stable outlook with Moody’s. The credit rating agency said it expects the system to maintain strong operating performance and cash flow. The system benefits as the only academic medical center in Iowa, according to Moody’s. 

13. Des Moines, Iowa-based UnityPoint Health has an “AA-” rating and stable outlook with Fitch. The system has strong leverage metrics, and it benefited from strong market returns during the pandemic. The system’s days with cash on-hand increased to 285 days at the end of 2020, up from 231 days at the end of 2019, according to the credit rating agency. 

14. Kansas City-based University of Kansas Health System has an “AA-” rating and stable outlook with Fitch. The health system has solid operating results and has sustained significant revenue growth, Fitch said. The system’s profitability dipped in fiscal year 2020 because of the COVID-19 pandemic, but its profitability rebounded in fiscal year 2021, according to the credit rating agency. 

How Merck’s antiviral pill could change the game for COVID-19

Posted on by • Posted in Antiviral Pill, Clinical Research, Clinical Testing, Coronavirus, Coronavirus Delta Variant, Coronavirus Mutation, Coronavirus Treatment, Molnupiravir, Side Effects • Leave a comment

https://www.nationalgeographic.com/science/article/how-mercks-antiviral-pill-could-change-the-game-for-covid-19?cmpid=org=ngp::mc=crm-email::src=ngp::cmp=editorial::add=SpecialEdition_20211001::rid=C1D3D2601560EDF454552B245D039020

Coronavirus: 'Game-changing' oral pill molnupiravir reduces COVID-19 hospitalisations by half in trial | Newshub

A new drug by Merck significantly reduces the risk of hospitalization and death in people who take it early in the course of their COVID-19 illness, according to the interim results of a major study released today. It is the first oral antiviral found to be effective against this coronavirus.

People who took this drug, called molnupiravir—four pills twice a day for five days—within five days of showing symptoms were about half as likely to be hospitalized as those taking the placebo. They were also less likely to die, with eight deaths in the placebo group reported within a month of treatment and none in those who received the medicine.

“Having a pill that would be easy for people to take at home would be terrific. If this was available through a drug store, more people could get it,” says Albert Shaw, an infectious diseases specialist at Yale Medicine in New Haven, Connecticut, who was not involved with the research. All of the antiviral medicines available today, including remdesivir and the monoclonal antibodies, must be administered through an IV in a medical setting. Monoclonal antibodies are much more effective against COVID-19 and cut the risk of hospitalization and death by up to 85 percent, but this treatment costs almost three times as much as molnupiravir.

How the antiviral works

Antiviral drugs are used against many viruses, including for herpes and the flu. These drugs take advantage of the fact that viruses need to replicate inside a person’s cells in order to sicken them. Antivirals stop the replication process so the illness doesn’t progress.

The Merck drug works by introducing RNA-like building blocks into the virus’s genome as it multiplies, which creates numerous mutations, disrupts replication, and kills the virus.

Keeping the virus from multiplying is important because the more it replicates, destroying cell after cell, the sicker a person usually becomes, says Waleed Javaid, an epidemiologist and director of infection prevention and control at Mount Sinai Downtown in New York, who was not involved in the study. Additionally, when enough virus is inside the body the immune system may go into overdrive. “At a certain point the body detects a virus it has never seen and will throw everything against it, like a tank coming at a small target.” he says. This helps the body eliminate the virus but can cause sometimes deadly collateral damage throughout the body in its wake.

The research, which was conducted in numerous sites around the world, was stopped early because the results were so promising, Merck says. The drug was even effective against variants like Delta and Mu. Based on this interim analysis in 775 people, the company plans to submit an application for Emergency Use Authorization (EUA) to the U.S. Food and Drug Administration as well as regulatory bodies in other countries in hopes the drug can be made available. When that will happen is not clear, but the U.S. government has already agreed to purchase 1.7 million courses of treatment at $700 each, Merck notes.

Who can get the drug?

It’s also not known who would ultimately be authorized to take the medicine. The study included only people who were sick and unvaccinated and had at least one risk factor for developing a severe case of COVID-19, says Aaron Weinberg, national director of clinical research at Carbon Health, a for-profit provider of primary and urgent care, and a principal investigator of the study. This includes people who are older than 60, obese, immunocompromised from another condition, or have underlying heart or pulmonary disease, among others.

If the FDA does authorize the drug, it could limit who gets it to people like those in the research, Javaid says.

Although this drug looks promising, it’s a treatment but not a prophylactic like the vaccine. The medicine does not negate the need for unvaccinated people to get their shot, Shaw says. Some people taking the pills still got sick enough to be hospitalized. And while side effects in this study were mild—generally gastrointestinal issues, Weinberg says, and at comparable rates in the treatment and placebo groups—safety issues might emerge when the drug is given more broadly, Shaw says. Meanwhile, hundreds of millions of people have already gotten the vaccines with no major consequences.

Still, the results of this study should be celebrated, Javaid says. “Saving eight lives is huge, as is halving hospitalization,” he says. Perhaps another drug being studied will later prove to be more effective, reducing hospitalization by 80 or even 100 percent, he says. “But this is better than any oral antivirals we have right now, which is none,” he says.

Air Ambulance Costs Are Soaring

Posted on by • Posted in Air Ambulance, Airline Deregulation Act of 1978, Health Insurance Coverage Adequacy, Health Policy, Helicopter Transport, Medicare, No Surprises Act, Out of Network, Out of Pocket Expenses, Surprise Bills • Leave a comment
https://www.medpagetoday.com/special-reports/exclusives/94818?xid=nl_mpt_DHE_2021-10-05&eun=g885344d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%20Top%20Cat%20HeC%20%202021-10-05&utm_term=NL_Daily_DHE_dual-gmail-definition

Air ambulance transport costs have skyrocketed in recent years, according to a new report from FAIR Health.

Notably, the average estimated in-network allowed amount for air ambulance transport increased 76.4%, from $8,855 in 2017 to $15,624 in 2020.

The jump was part of a general rise in costs for both airplane and helicopter air ambulance transport during this time period, FAIR Health said, which included increases in charge amounts (the amount charged to a patient who is uninsured or obtaining an out-of-network service), estimated in-network allowed amounts for privately insured patients (the total fee negotiated between an insurance plan and a provider for an in-network service), and Medicare reimbursement amounts.

The average charges associated with a fixed-wing air ambulance rose 27.6%, from $19,210 in 2017 to $24,507 in 2020, according to the report, and the average Medicare reimbursement amount increased by 4.7%, from $3,071 to $3,216.

For helicopter transport, the average charges associated with a rotary-wing air ambulance rose 22.2%, from $24,924 in 2017 to $30,446 in 2020. The average estimated in-network allowed amount increased 60.8%, from $11,608 to $18,668, and the average Medicare reimbursement amount again rose 4.7%, from $3,570 to $3,739.

“Air ambulance services have been the subject of substantial policy focus,” said Robin Gelburd, president of FAIR Health, in a statement. “We hope that this study of air ambulance transport proves productive to policy makers, researchers, payors, providers, and consumers seeking to better understand this corner of the healthcare system.”

FAIR Health’s report also found that air ambulance claims increased 30% from 2016 to 2020 (0.7% to 0.9%) as a percentage of all ambulance (ground and air) claims.

In 2020, the most common diagnoses associated with fixed-wing air ambulance transport were chronic respiratory diseases, including chronic obstructive pulmonary disease and chronic respiratory failure, and the second most common was COVID-19, which accounted for 7% of fixed-wing air ambulance claims.

Because air ambulance transport is often used for patients in life-threatening situations, they generally have no control over type of transport or provider used, FAIR Health said. As a result, surprise bills occur frequently.

A number of states have made efforts to regulate air ambulance charges, but these attempts have been overturned by court rulings that state that such efforts are preempted by the Airline Deregulation Act of 1978, the report noted.

However, the federal No Surprises Act, signed into law in December 2020, contained provisions to protect consumers from surprise bills, including those from out-of-network air ambulance service providers.

On September 30, HHS held a press call on one of its surprise billing rules, which would require companies to give patients “good faith estimates” of charges upfront and to submit a dispute resolution for out-of-network surprise bills.

Asked by MedPage Today whether air ambulances would be included, a senior administration official responded, “Yes, air ambulances are covered by this rule. They will go through a very, very similar independent dispute resolution process [as other providers]. I think the only thing different about the air ambulance process is the list of allowable information that the parties can bring to be considered in addition to the qualifying amount.”