FEDS REPORTEDLY OPEN ANTITRUST INVESTIGATION INTO UNITEDHEALTH
The Department of Justice (DOJ) has launched an antitrust investigation into UnitedHealth, one of the largest health insurers in the country, according to the Wall Street Journal and The Examiner News. Sources told the media outlets that investigators are looking into relationships between UnitedHealthcare’s insurance unit and its Optum arm, which owns physician groups, surgery centers, health data and technology units, and one of the largest pharmacy benefit managers. The Wall Street Journal reported that while UnitedHealth and the DOJ declined to comment, sources told the media outlets that investigators are looking into Optum’s acquisitions of the physician groups and how the ownership of physician and health plan units affect competition. They are also examining the company’s Medicare billing practices.
REPORT: MA ADVANCE NOTICE COULD LEAD TO REDUCED VALUE FOR MEMBERS
A new report by Berkeley Research Group, LLC (BRG), a global consulting firm, finds that Medicare Advantage (MA) payment per month per beneficiary could drop by an estimated 1.0 percent in 2025 if the Centers for Medicare & Medicaid Services (CMS) finalizes policies it proposed in its Advance Notice. The analysis, funded by Better Medicare Alliance, determined that MA medical cost inflation will increase by 4 percent to 6 percent in 2025. When payments from CMS drop relative to expected medical costs, the value of supplemental benefits and reductions to premiums and cost sharing tends to fall. Click here to read the full report.
CMS REPORT REVEALS DROP IN HEALTH CARE QUALITY DURING COVID-19
A triennial report that assesses the quality and efficiency impact of the use of 26 quality measures in CMS programs found that patient safety suffered during the first two years of the pandemic. Indeed, in many cases, progress that organizations made prior to COVID-19 were reversed once the pandemic hit and patients delayed care.
Prior to the public health emergency, 88 percent of the analyzed measures improved or were stable, according to the report. But during the pandemic, CMS found that performance on 38 percent of the measures were worse than expected in 2020 and 47 percent worse in 2021. Among the more dramatic decreases in performance: A measure of central line-associated bloodstream infections in acute care hospitals was 94 percent worse than expected and methicillin resistant Staphylococcus aureus (MRSA) was 55 percent worse than expected.
However, some measures improved. The report found that comprehensive assessment at admission (overall treatment) for hospice and palliative care patients increased and 1.1 million more assessments were completed. Nearly two million more Medicare enrollees with Part D in the medication therapy management program completed a comprehensive medication review.
The 69-page report captures quality measurement data from a unique moment in history, the onset of the COVID-19 PHE, and includes lessons learned during the pandemic and best practices to prepare for future public health emergencies. Data for the 2027 report will examine measures performance post pandemic and which scores have returned to pre-pandemic trends.
HHS TAKES STEPS TO STRENGTHEN DIRECT CARE WORKFORCE FOR SENIORS, PEOPLE WITH DISABILITIES
The Department of Health and Human Services (HHS), through the Administration for Community Living (ACL), announced several new initiatives and resources from ACL’s Direct Care Workforce (DCW) Strategies Center to address the shortage of professionals who provide services that many older adults and people with disabilities need to live in the community. Two programs aim to help states strengthen their systems for recruiting, retailing, and developing direct care workers: a national hub featuring best practices and resources and a webinar series for states on a range of direct care workplace topics.
“Urgent action is needed to address the shortage of direct care professionals, which is threatening to reverse decades of progress in community living,” said Alison Barkoff, who leads the Administration for Community Living, in the announcement. “The DCW Strategies Center was created to strengthen collaboration across state agencies, direct care professionals, people receiving services, and other stakeholders in order to improve recruitment, retention, and development of this critical workforce. The initiatives announced today are an exciting step forward toward this goal.”
The shortage of workers reached crisis levels during the COVID-19 pandemic and continues today, HHS said in the announcement. As a result, more than three-quarters of service providers decline new participants and more than half have cut services. This has left people who need assistance to move to a nursing home or other institution. Without urgent action, HHS said the program will only continue to get worse.
OIG OFFERS LESSONS LEARNED DURING COVID TO IMPROVE NURSING HOME CARE
A new report produced by the Office of Inspector General (OIG) examines the impact of COVID-19 on nursing home residents and staff and offers steps to better protect them during future outbreaks. The report is based on firsthand accounts from 25 nursing home administrators about the challenges they had with staffing and infection control practices.
Nursing homes were hit with ongoing staffing challenges during the pandemic and turned to outside staffing agencies to fill gaps. They also struggled with costs, testing protocols, personal protective equipment compliance, and vaccination rates.
“Significant change is needed to better protect the health and safety of residents, and this change will require broad collaboration with partners and stakeholders across government, the nursing home sector, and the broader health care industry,” OIG wrote in the report.
Although OIG noted that the issues can’t be resolved by CMS alone, the watchdog suggests that CMS expand its policy and programs to strengthen the nursing home workforce, reassess nurse aide training and certification requirements, update nursing home requirements for infection control, provide guidance on how to comply with these updated requirements, and share strategies and information to help nursing homes overcome challenges and improve care.