The CVS-Aetna hearing is on the move–finally

June 5, 2019 | by

The train that is the CVS-Aetna hearing, in the courtroom presided over by Judge Richard Leon of the US District Court for the District of Columbia, is at long last chugging down the tracks. And Pauline is still tied up. Tuesday 4 June was Day 1 of this hearing. Early reports are just being filed. The issue is whether Judge Leon will authorize the Department of Justice’s approval of the merger or dissolve a closed merger, based on his authority under the Tunney Act and his own repeated intent to search for harm that the merger might do to the public. 

Today’s hearing focused on Aetna’s divestiture of its Medicare Part D business as a prelude to the merger, and whether it was quite enough. Much of the discussion was on the relative strength of the buyer, WellCare (itself in the early stages of being acquired), and whether it could be truly competitive in the Part D market. The other factor is that CVS as a dominant pharmacy benefits manager (PBM) could undermine WellCare in several ways. PBMs operate opaquely and are highly concentrated, with CVS, Optum (UnitedHealthcare), and Cigna-Express Scripts accounting for 70 percent of the market. Modern Healthcare

Other issues for Days 2 and 3 will cover the effects on competition in health insurance, retail pharmacy and specialty pharmacy.

Healthcare Dive discusses how these hearings are already setting precedent on how Tunney Act hearings are conducted, their scope (Judge Leon has ruled against every attempt by CVS-Aetna to limit it), and the unprecedented live testimony.  There is the good possibility that Judge Leon will decide to dissolve the merger for competitive reasons, which DOJ likely would appeal. Add to this the cost of the delayed integration and the precedent set by the District Court on scrutiny of any healthcare merger, and this tedious hearing along with Judge Leon’s actions leading to it hold major consequences.

Soapbox: JPM’s Dimon takes the 50,000 foot view on the JP Morgan Chase-Berkshire Hathaway-Amazon health joint venture

April 10, 2018 | by

Mr. Jamie Dimon, the chairman and CEO of JP Morgan Chase, had a few thoughts about the JPM-Berkshire Hathaway-Amazon healthcare JV for all three companies. You’ll have to fill up the tea or coffee mug (make it a small pot) for it’s an exceedingly prolix Annual Shareholder Letter you’ll have to sled through to find those comments. Your Editor has taken her punishment to find them, towards the end of the letter in ‘Public Policy’. 

They demonstrate what this Editor suspected–an headache-inducing mix of generalities and overreach, versus starting modestly and over-delivering.

  • Point #1 sets up what has gone wrong. Among several, “Our nation’s healthcare costs are twice the amount per person compared with most developed nations.” Under point 2 on how poor public policy happened, an admission that Obamacare fixed little:

Here’s another example: We all know that the U.S. healthcare system needs to be reformed. Many have advocated getting on the path to universal healthcare for all Americans. The creation of Obamacare, while a step in the right moral direction, was not well done. America has 290 million people who have insurance — 180 million through private enterprise and 110 million through Medicare and Medicaid. Obamacare slightly expanded both and created exchanges that insure 10 million people. But it did very little to fix our broken healthcare system and has, in fact, torn up the body politic over 10 years — and this tumult may go on for another 10 years.

  • Point #7 is about fixing the deficit and the ill effects if we don’t. In Mr. Dimon’s view, healthcare is a major part of this through the uncontrolled growth of entitlements, with Medicare, Medicaid and Social Security leading the pack–skipping over the fact that nearly all Americans pay into Medicare and SSI well in advance of any entitlement collection. Healthcare is also an offender through unnecessary costs such as administrative and fraud (25-40 percent),  and six mainly chronic conditions accounting for 75 percent of spending.
  • The experts–specifically, their experts–will fix it! “While we don’t know the exact fix to this problem, we do know the process that will help us fix it. We need to form a bipartisan group of experts whose direct charge is to fix our healthcare system. I am convinced that this can be done, and if done properly, it will actually improve the outcomes and satisfaction of all American citizens.”
  • The generalities continue with
    • The JV “will help improve the satisfaction of our healthcare services for our employees (that could be in terms of costs and outcomes) and possibly help inform public policy for the country.” 
    • Aligning incentives systemwide ‘because we’re getting what we incentivize’
    • “Studying the extraordinary amount of money spent on waste, administration and fraud costs.”
    • “Empowering employees to make better choices and have the best options available by owning their own healthcare data with access to excellent telemedicine options, where more consumer-driven health initiatives can help.”
    • “Developing better wellness programs, particularly around obesity and smoking — they account for approximately 25% of chronic diseases (e.g., cancer, stroke, heart disease and depression).”
    • “Determining why costly and specialized medicine and pharmaceuticals are frequently over- and under-utilized.”
    • “Examining the extraordinary amount of money spent on end-of-life care, often unwanted.”
    • “To attack these issues, we will be using top management, big data, virtual technology, better customer engagement and the improved creation of customer choice (high deductibles have barely worked”).

This Editor has observed from the vantage of the health tech, analytics, payer, and care model businesses that nearly every company has addressed or is addressing all these concerns. So what’s new here? Perhaps the scale, but will they tap into the knowledge base those businesses represent or reinvent the wheel? 

A bad sign is Mr. Dimon’s inclusion of ‘end of life care’. This last point is a prime example of overreach–how many of the JV’s employees are in this situation? The ‘attack’ tactics? We’ve seen, heard, and many of us have been part of similar efforts.

Prediction: This JV may be stuck at the 50,000 foot view. It will take a long time, if ever, to descend and produce the concrete, broadly applicable results that it eagerly promises to its million-plus employees, much less the polity. 

2016: will telehealth catch on or stagnate, due to factors out of control?

November 25, 2015 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/11/Robert-Graham-Center-logo.jpg” thumb_width=”150″ /]Updated. Reviewing the Robert Graham Center study summarized by Editor Chrys last week, René Quashie of Epstein Becker Green, perhaps the leading law firm in the health tech area, opines that despite the great progress made by telehealth (telemedicine/virtual consults, but also remote patient monitoring), “state legal and regulatory issues, reimbursement, and provider training and education continue to be serious barriers to wider adoption of telehealth. And until the landscape evolves to address these barriers, telehealth adoption is likely to stagnate despite the great promise of telehealth holds as a tool to improve quality and access.” Yes, that old FBQ* (actually the top two) continues to be as true now as five years ago. While in closing Mr Quashie puts his trust in the ‘pull’ factor of consumers and patients “who will continue to demand better access and more innovative delivery models outside the conventional office visit,” this Editor is far less sanguine, despite having used a virtual consult app recently. It was turned to more out of sheer frustration–time pressure (work, travel), being unable to secure a timely visit with a specialist (no one seems to be taking new patients!) despite good (non-Obamacare) medical coverage, and a condition which was eminently photographable (plus $40 at hand). National Law Review  * The Five Big Questions (FBQs)–who pays, how much, who’s looking at the data, who’s actioning it, how data is integrated into patient records.

Then again, if you read Health Populi and believe Gallup’s polling (based on a slightly skewed question), a majority of Americans aren’t thinking about delivery models or telehealth at all. They’re unhappy, and would like to hand the whole hot mess over to the government when asked if “government is responsible for ensuring that people have health insurance.” Yet the Affordable Care Act, now two years in, was supposed to do exactly that by forcing everyone to pay for a healthcare policy or else pay a punitive tax. Too many did the math; the tax penalty was cheaper, especially for those Young ‘n’ Healthy Invincibles with slim purses and other things to spend on. They were the ones who were expected to pony up premiums, use few services and generally prop up the system.

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/11/shockedshocked.jpg” thumb_width=”150″ /]Now the American populace are shocked, shocked to find that out-of-pocket costs are way up and access is down. The same Health Populi article cites Fair Health’s spring 2015 consumer survey, finding that 33 percent of American patients felt that their out-of-pocket costs were ‘much more than expected’, with an additional 17 percent in the ‘somewhat’ category–a total of 50 percent. The contradiction of government control versus spending (and actuarial) reality is, in this Editor’s opinion, not going to be solved easily or well.

As to the wisdom of government involvement, there’s another developing and embarrassing ACA Big Fail.  (more…)

Driverless cars will cut insurance costs – is there a parallel with mHealth?

May 26, 2015 | by | 1 Comment

This article in the Telegraph last week has stimulated Prof Mike Short to ask whether if driverless cars can eliminate bad driving and so reduce insurance costs, mHealth can do the same for those with either or both life assurance and health insurance.

There’s little doubt in the mHealth community that technology will cut costs, and already there are (at least a few) solid examples. The big question is, can the insurance world – both life assurers & health insurers – be convinced? We know in the UK for example that BUPA is working hard on mHealth solutions, and that Aviva has tied up with Babylon (who recently won the recent AXA ‘Most Innovative Provider’ award)…and doubtless there is much more too. Obviously the situation is much further ahead in countries such as the US where health insurance is the norm.

Mike suggests that we run an insurance led event to look at techniques of prevention as well as cure/care. This could have an interesting policy dimension if the health insurers were willing to think about new measurement policies and indicate where they wish to go with data driven policies – eHealth as an opener for new policies and forms of funding? As he says, apps/wearables/connectivity are just enablers to this wider story, for which the insurance systems and their objectives need to be understood too.

DHACA is happy to participate, broker or organise such an event – we’d really welcome view from readers though first – would you be interested in taking an active part in what might just change the face of health insurance in the UK, and promote mHealth at the same time?

Forced to wear a fitness tracker for insurance? (US)

August 28, 2014 | by

For those covered by corporate health policies, the day is not far away where employee health insurance programs will require wearing a fitness tracker and meeting certain metrics, such as walking a million steps or sleep quality. Already some programs have the employee log food, exercise, blood glucose, heart rate and other vital signs to qualify for a discount. The trajectory is much like BYOD–once unheard of, now it is expected to be the norm in 50 percent of US companies by 2017, with a concomitant loss of personal security and privacy. CVS Caremark and other companies have already made the stick, not the carrot, the norm of employee wellness programs [TTA 12 April 2013]. Writer Adrian Kingsley-Hughes asks: “How much access do we want our employers to have to our medical data? How much access to our daily activities do we want our employers and insurers having?” And what about spoofing those Fitbits and Jawbones? His ZDNet article notes the interest that Apple (plus Samsung and Google, despite Sergey’s and Larry’s vapors–Ed.) has in health, then takes it out a few more yards with Wearables and health insurance: A health bar over everyone’s head (and do check out the comments.)

Health kiosks, insurers–perfect together?

January 7, 2014 | by

The real revenue stream of health kiosks revealed? The business model of free health kiosks placed in places like Wal-Mart and sibling Sam’s Club has to date been advertiser-dependent. Now SoloHealth [TTA 27 Feb 13]is adding an agreement in California with insurer Anthem Blue Cross to solicit name, email and phone number of individual users who want more information on insurance. They must opt in to add this, but it is not disclosed by the friendly animation (a doctor, no less) that a broker will be contacting them; to find out, the user has to hit a blue button–not the one that ONC has designed for personal health record access–to read two pages of disclosure, or wait till after they supply information. In addition, SoloHealth collects even more qualitative user information during its exams for blood pressure, vision and BMI. Here is the real gold mine in ‘dem der kiosks’–a fat database which can be sold as deidentified data without violating current privacy regulations. (Did anyone think otherwise? And what about all that fitness data being gathered by Fitbit, Pebble, Shine, Jawbone?) KQED’s California Report gears up into high dudgeon on the privacy issues.

The train, plane and car wreck that is Healthcare.gov and Obamacare

November 8, 2013 | by

If the ACA and Healthcare.gov were Boeing or Airbus aircraft–they would have been grounded on 3 October.

Wherever you reside in the over 150 countries TTA is read in, if you need more convincing that the US Government is unable to be successful (and Editor Donna is being restrained and charitable) at 99 percent of everything contained in this misbegotten Act, all one needs to do is read our previous coverage and this latest update in the Daily Mail along with their links to their own previous coverage. Are you sure it’s going to be fixed within weeks, Mr. President? This is Obamacare website riddled with garbled messages today

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Except in the minds of White House and HHS planners, the obvious solution would be to STOP: halt the enrollment process, suspend the ACA implementation, restore the right to current coverage for the millions who have been blocked from renewing their current individual coverage and take the entire website down. Rethink all the elements including the coverage structure and the website, send it back to Congress for relegislating and implement a program that works sometime in 2015 IF a way can be found. But no, Americans get piecemeal fixes on a website and system that increase the vulnerability of personal information to hackers and identity theft–and coverage they cannot afford. (And this is only in the individual and small group market. Wait till it applies to large employers–other than unions which have been exempted.) (more…)