In The News

Health Prices Rising Much Faster in the Private Sector than Medicare

Axios | By Caitlin Owens

Health care prices overall may be lagging inflation, but there's a widening divergence between what's being paid in Medicare and the private sector, according to a new Altarum analysis.

Why it matters: Privately-insured Americans are about to pay more for their health care, if they aren't already.

The big picture: Economy-wide inflation has outpaced health care inflation over the last year — an anomaly, since medical prices typically rise faster.

  • Last month, overall prices were 8.5% higher than in July 2021, but prices for medical care were only 4.8% higher, per KFF.
  • Medical prices have risen by 110.3% since 2000, whereas economy-wide prices have risen by 71%.

Yes, but: July also saw a substantial divergence in what Medicare and the private sector pay for goods and services, which essentially cancelled each other out in the aggregate, according to the Altarum analysis.

  • Medicare prices fell by almost an entire percentage point last month, which dropped them below where they were in January 2021.
  • The drop was due to low or no increases in the reimbursement rates for hospitals and physician services, which are decided by the federal government, and mandatory cuts for Medicare provider payments kicking in this year.

In the private sector, the opposite happened: prices rose last month and reached 5.4% above what they were in January 2021.

  • "We believe many of these increases are occurring as new contracts or updated rates are slowly taking effect, and further expect there may be a noticeable discrete jump in private prices beginning in 2023," the authors write.
  • Hospital rates have risen the most and are 7.2% higher than January 2021. They've risen by nearly a full percentage point in each of the past three months alone.
  • Faster increases within the hospital sector may be a result of greater negotiating power with insurers amid ongoing consolidation, the authors note.

The bottom line: There's already a huge difference between what Medicare and private insurers pay for health services, and that disparity is on track to only grow.


COVID-19 PHE Expected to Extend to End of 2022

Partnership for Medicaid Home-Based Care

The COVID-19 public health emergency (PHE) is expected to be renewed for another 90 days beyond October 13 as the Biden administration did not issue a 60-day notice that it will terminate the PHE in August. However, we speculate that absent a COVID-19 surge this fall or winter that the PHE will likely end in January [2023].


CMS: ACOs Saved Medicare $1.6B Overall in 2021 as Big Changes on the Horizon

Fierce Healthcare | By Robert King
Accountable care organizations saved Medicare $1.66 billion last year as value-based care providers brace for potential major changes to the program like new health equity measures.
The Centers for Medicare & Medicaid Services (CMS) announced [last] Tuesday that 2021 was the fifth year in a row that ACOs generated overall savings for Medicare and met quality targets. The announcement comes roughly a month after the agency proposed several changes to entice smaller ACOs to enter the program and prevent an erosion of participation. 
“Accountable Care Organizations are a true Affordable Care Act (ACA) success story, and it is inspiring to see the results year after year,” said CMS Administrator Chiquita Brooks-LaSure in a statement.
CMS reported that 99% of all ACOs in the Medicare Shared Savings Program (MSSP) met quality standards, and approximately 58% earned shared savings for abiding by spending targets. An ACO agrees to take on a certain degree of financial risk and to meet spending and quality benchmarks.
The ACO gets a share of any savings if Medicare spending is below the benchmark and must repay the federal government if it spends too much. 
“The type of ACOs that saw more net savings tended to be low-revenue, meaning they were mainly made up of physicians, included a small hospital, or served rural areas,” according to a CMS release on the findings. 
A low-revenue ACO generated $237 in savings per capita while higher-revenue programs got $124 in net savings per capita. 
CMS also found that physician-led ACOs generated particularly high savings. ACOs that are comprised of 75% primary care physicians or more saw $281 in net savings compared with $149 in net savings for ACOs that had fewer physicians.
“These results underscore how important primary care is to the success of the Shared Savings Program and demonstrate how the program supports primary care providers,” CMS said.
CMS told Fierce Healthcare that ACOs overall generated $3.6 billion in gross savings for Medicare when not accounting for shared savings payments.
In 2020, ACOs generated $4.5 billion in gross savings for Medicare and nearly $2 billion after factoring in the shared savings payments. 
The additional savings were notable since ACOs were still facing the financial impact of the COVID-19 pandemic, advocates say. 

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Free COVID-19 Home Tests for Blind and Low-Vision Users Now Available

Comagine Health | Aug 31st, 2022

Online ordering has resumed for free COVID-19 home tests for blind and low-vision users.

Officials ask those who order the Ellume COVID home tests only make the request if they do not have a way to use the other types of tests, such as assistive technology or a trusted family member or friend who can assist.

The tests will be available until supplies run out and can be ordered through a dedicated webpage or by calling 1-800-232-0233.

If you are able to use the other COVID-19 at-home tests and have not placed a third order, you can order online through the main ordering page or by calling 1-800-232-0233. This program will be suspended on Sept. 2.


Omicron-Specific Covid Booster Shots Are Just Weeks Away. Here’s Who Will—and Won’t—Be Eligible

CNBC / By Annika Kim Constantino

Newly updated Covid booster shots designed to target omicron’s BA.5 subvariant should be available within in the next three weeks. That begs an important question: Who’s going to be eligible to get them?

The short answer: anyone ages 12 and up who has completed a primary vaccination series, a Centers for Disease Control and Prevention spokesperson tells CNBC Make It. It’s unlikely to matter whether you’ve received any other booster doses or not before, the spokesperson says — but if you’re unvaccinated, you won’t be eligible for the updated formula until you complete a primary series with the existing Covid vaccines.

The longer answer is somewhat more complex, because it depends on which booster shots get approved and when.

Pfizer’s “bivalent” shot, which targets both the original Covid strain and omicron’s BA.5 subvariant, is expected to be authorized first. The CDC says it’ll likely come with a wide eligibility swath: the full group of vaccinated Americans ages 12 and up.

Moderna’s bivalent shot is expected to follow suit later, most likely in October. It’ll come with a somewhat narrower range of eligibility, at least at first: vaccinated people ages 18 and older. For both shots, younger pediatric age groups could become eligible later, the CDC says.

Those projections are tentative, at least for now. A person familiar with the matter told NBC News on Wednesday that it’ll hinge on how much supply Pfizer and Moderna are able to manufacture and roll out by next month. If that supply is limited, the shots could first be available to those most at risk, such as the elderly and immunocompromised.

Federal health officials believe the shots will provide the best level of protection against the highly transmissible BA.5 subvariant to date, especially in the fall and winter when a large wave of Covid infections is projected to hit the U.S.

“It’s going to be really important that people this fall and winter get the new shot. It’s designed for the virus that’s out there,” Dr. Ashish Jha, the White House’s Covid response coordinator, said at a virtual event hosted by the U.S. Chamber of Commerce Foundation on Tuesday.

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