Healthcare Economics & Policy

The U.S. Department of Justice (DOJ) can move forward with a lawsuit alleging UnitedHealth Group wrongly collected more than $1 billion through Medicare Advantage by finding conditions to increase a patient’s risk adjustment payment from CMS.

The proposed merger between Downers Grove, Illinois-based Advocate Health Care and Milwaukee’s Aurora Health Care now has the blessing of the Federal Trade Commission and regulators in Illinois, leaving regulatory approval in Wisconsin as the final hurdle for creating the 10th largest nonprofit health system in the U.S.

The growth in health expenditures nationwide is expected to average 5.5 percent annually through 2026, with the aging population driving more rapid annual growth in Medicare.

Between 1996 and 2015, the number of emergency department (ED) visits per individual paid for by Medicare increased at a greater rate than those paid for by private insurance or Medicaid. The annual increases in per-visit expenditures, however, were greater for private insurance than either of the federal programs.

An era of low inflation in healthcare prices may be winding down, judging by the results of Altarum’s latest health sector economic indicator reports, which said hospital prices grew by 2.2 percent in December 2017, the fastest growth rate in four years.

CVS Health president and CEO Larry Merlo downplayed the threat to its pending $69 billion acquisition of Aetna from the recently announced healthcare partnership between Amazon, JPMorgan Chase and Berkshire Hathaway, saying “what that group aspires to is what we're going to deliver.”

Just one day after announcing a name change from Carolinas HealthCare System, Charlotte, North Carolina-based Atrium Health has signed a letter of intent to merge with another system, Navicent Health, based in Macon, Georgia.

CMS has outlined which alternative payment models (APMs) qualify as Advanced APM under the Quality Payment Program (QPP) this year, thus giving participating providers a 5 percent payment bonus.

In a proxy statement filed with the U.S. Securities and Exchange Commission, Louisville, Kentucky-based Kindred Healthcare urged its shareholders to follow the recommendation of Kindred board members and vote yes on the proposed $4.1 billion sale of the company to insurer Humana and two private equity firms.

The $69 billion proposed acquisition of Aetna by CVS Health remains under review by the Department of Justice (DOJ), which requested the companies provide more information on their merger agreement.

Between July 1, 2018, and June 30, 2019, health systems should expect pharmaceutical prices to jump up by 7.35 percent, a slightly lower increase than in recent years as fewer products see “exorbitant” price hikes and costs moderate for high-priced hepatitis C drugs.

The merger of Wellmont Health System and Mountain States Health Alliance (MSHA) cleared its last hurdle on Jan. 31, as the Tennessee Department of Health issued the Certificate of Public Advantage (COPA) allowing the deal to be completed.