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Walmart's Decision to Close Health Centers Reflects Widespread Financial Constraints in U.S. Healthcare

"The decision eliminates an option that was geared toward bringing primary care to residents of underserved markets.... For the strategy to succeed, ... Walmart would have had to overcome recent systemic trends.... Legacy providers are dealing with the same headwinds but generally have more margin for error."

How Specialty Drugs Are Remaking Healthcare and Driving Up Costs

"Accelerating healthcare costs have less to do with hospital and physician services than with surging drug spending ... [Data suggests] advanced therapies increasingly are taking the place of procedure-based care. For example, whereas GLP-1 use increased by more than 700% during a recent five-year period, bariatric surgery rates were flat to declining. Similarly, SGLT2 inhibitor patients more than tripled, while cardiac catheterization volumes declined slightly."

Senate HELP Committee Eyes Healthcare Reform to Enhance Affordability

"[H]ospitals, insurers and pharmacy benefit managers (PBMs) all are under scrutiny by Congress in efforts to curb the growth in healthcare costs. The Senate Health, Labor Education and Pensions (HELP) Committee held a July 31 hearing to examine ways to make healthcare more affordable for consumers and other purchasers, and the discussion focused on various stakeholder groups."

Healthcare Price Transparency Initiatives May Fall Flat Due to Systemic Factors

"The biggest impediments to establishing an efficient pricing system ... stem from expecting consumers to navigate such a complex industry and shop for healthcare with a transactional mindset ... [T]he biggest beneficiaries of improved transparency will be employers that can 'leverage the information to demand better deals from their insurers and third-party administrators.' "

Cyberattack on Change Healthcare Brings Turmoil to Healthcare Operations Nationwide

"On its incident page, Optum listed more than 100 Change Healthcare services that were affected. Among various other core functions being impacted are benefits verification, claims submission and status updates, remittance information transmittal and prior authorization. As of Feb. 25, Optum had not offered new information about the attack nor a timeline for when Change Healthcare's systems will be up and running."

How Price Transparency Can Lower Healthcare Costs

"Drug prices are expected to increase by 9.9 percent this year ... One of the main causes of frustration among consumers is in their inability to see a clear rationale for why prices are rising and what exactly they are paying for.... With the changing climate in healthcare policy, price transparency has come to the forefront as people consider how to manage their medical spending. Price transparency can help drive down healthcare costs in by increasing pressure on providers to control costs and ensure that patients receive the highest quality of care possible for the price they pay."

How AI Is About to Change Healthcare

"Using [a large language model (LLM)] that can comb a patient record and sense keywords through prompts that a business leader would be able to identify, the provider can drive the coders to the information that's going to be most useful to them to generate the codes and get the claims out the door ... [A] hospital that can't recruit and retain enough staff to perform claims follow-up ... may benefit from [robotic process automation (RPA)] that checks payer portals for claim payment status[.]"

Supreme Court Agrees to Review the Vaccine Mandate for Healthcare Workers in Upcoming Weeks

"The Supreme Court is set to provide a measure of clarity on the Biden administration's COVID-19 vaccine mandate for healthcare workers after establishing a deadline of Dec. 30 for challenger-states to file briefs. The court's eventual ruling may eliminate the potential for the country to be temporarily split between states in which the mandate is in place and those in which injunctions prevent enforcement."

New Federal Rule Means Big Changes in Coverage of Behavioral Healthcare

"For health plans offering benefits that cover mental-health and SUD conditions, the final rule calls for ensuring the benefits are meaningful as determined by whether the benefits are comparable to medical/surgical benefits in the same classification and cover at least one core treatment in each classification.... Compliance with the rule will be monitored via results of a comparative self-analysis conducted by plans ... The departments can then review a plan's analysis, with plans required to submit the analysis within 10 business days of the request."

The Burden of Healthcare Costs in the Pandemic Era

"CMS actuaries reported that healthcare spending accelerated dramatically during the first year of the COVID-19 pandemic. Vastly higher federal spending was the big driver of the rise in spending growth. The growth in spending on hospital services was virtually flat. Significant numbers of Americans continue to report having trouble with healthcare costs[.]"