On February 27, 2024, the Wall Street Journal (WSJ) reported that the Department of Justice (DOJ) has launched an antitrust investigation into UnitedHealth Group (UHG), the owner of the biggest health insurer in the U.S. and the leading manager of drug benefits and one of the largest networks of physician groups. This investigation comes as the Biden administration’s antitrust enforcers have ramped up investigations into some of the biggest U.S. companies, including Amazon, Apple, and Google. This Health Capital Topics article reviews the reported government investigation. (Read more...)
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On March 5, 2024, the White House announced plans to launch an interagency strike force to lower costs across the U.S. economy. The Strike Force on Unfair and Illegal Pricing will be co-chaired by the Federal Trade Commission (FTC) and the Department of Justice (DOJ) and aims to strengthen the agencies’ efforts to stop illegal corporate behavior that increases prices for Americans through deceptive, anti-competitive, unfair, and fraudulent business practices. (Read more...)
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Beginning January 1, 2024, the Centers for Medicare and Medicaid Services (CMS) updated its Medicare Advantage (MA) Capitation Rates, as well as Part C and Part D Payment Policies, which finalized the switch to a revised CMS-Hierarchical Condition Category (HCC) risk-adjustment model, Version 28 (V28). The last version of the CMS-HCC risk-adjustment model, Version 24 (V24), was released in 2020. The changes in the CMS-HCC risk-adjustment model V28 impact multiple programs, including MA, the Medicare Shared Savings Program (MSSP), and the Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH) Model. This Health Capital Topics article discusses the various changes and updates included in the recently-enacted version of the risk-adjustment model. (Read more...)
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The U.S. government is the largest payor of medical costs, through Medicare and Medicaid, and has a strong influence on physician reimbursement. In 2021, Medicare and Medicaid accounted for an estimated $900.8 billion and $734.0 billion in healthcare spending, respectively. The prevalence of these public payors in the healthcare marketplace often results in their acting as a price setter, and being used as a benchmark for private reimbursement rates. This third installment in a five-part series on the valuation of diagnostic imaging centers will discuss the reimbursement environment in which these centers operate. (Read more...)
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Congratulations to HCC Senior Financial Analyst Janvi Shah, for successfully completing the certification process through the National Association of Certified Valuators and Analysts (NACVA) to earn her Certified Valuation Analyst (CVA) credential. The CVA credential is granted only to qualified individuals with considerable professional experience in the field of business valuation. Keep up the excellent work Janvi!
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