Morning Briefing
Summaries of health policy coverage from major news organizations
'The Storm Is Here': Lower ACA Uptake, Higher Healthcare Costs Hurting Americans, Analysis Shows
The affordability crisis for many people who have health insurance under the Affordable Care Act came into sharper focus Tuesday, with a new analysis projecting that higher premiums will cause millions more people to lose insurance this year. Another sign of economic distress: Average deductibles for policyholders are now the highest ever, a result of people switching to the exchange鈥檚 cheapest 鈥渂ronze plans鈥 in response to premium hikes, according to the report released Tuesday by KFF, a health policy research organization. (Rowland, 5/19)
More about the high cost of healthcare 鈥
When health insurers contract with providers, they agree on prices for all kinds of procedures. For a lumbar laminectomy, a common spine surgery for ailments like herniated discs or arthritis, the median price is $1,400.聽Out-of-network providers, those that don鈥檛 contract with health insurers, are getting 24 times that amount for the same surgery at the median 鈥 nearly $34,000 鈥 through the No Surprises Act鈥檚 arbitration process. Some are even getting north of $100,000. (Bannow, 5/19)
Below are the adjusted expenses per inpatient day in 2024 for nonprofit, for-profit and government hospitals in every U.S. state, based on the latest estimates provided by Kaiser State Health Facts. The figures are based on information from the 2024 American Hospital Association Annual Survey. They are an estimate of the expenses incurred in a day of inpatient care and have been adjusted upward to reflect an estimate of outpatient service volumes, according to the KFF. (Gamble, 5/19)
Elevance Health is expanding a policy that penalizes hospitals making out-of-network referrals 鈥 and providers aren鈥檛 having it. Hospital associations say the insurer鈥檚 policy, which applies to Elevance鈥檚 Anthem Blue Cross Blue Shield commercial plans, is another attempt to shortchange hospitals. The insurer argues the policy will help control rising care costs and limit exorbitant reimbursement requests. (Hudson, 5/19)
More news about the healthcare industry 鈥
Millions of dollars are on the way to HCMC, Minnesota's largest trauma center, now that the state legislative session has ended and lawmakers approved a healthcare bill. The safety-net hospital serves more low-income and uninsured patients than any other facility in Minnesota and is expected to lose more than $1 billion in the next decade. (Bright and Levin, 5/19)
Global Healthcare Opportunities and CBC Group have agreed to combine to create a healthcare investment firm with more than $21 billion of assets under management, according to a statement Wednesday. The firm will have over 200 employees in 13 offices in North America, Europe and Asia Pacific, which account for about 90% of global healthcare research and development spending, Singapore-based CBC said, adding that it will be the world鈥檚 biggest healthcare investment manager. GHO is based in London. (Cao, 5/20)
The University of Kansas Hospital Authority has settled six lawsuits alleging that a contaminated device used during open-heart surgeries led to serious and sometimes fatal infections in patients. (Thomas, 5/19)
Health systems are revamping their operating rooms to protect a key revenue driver as demand for surgeries increases and reimbursement declines. Providers are deploying new technology, redesigning surgical suites, reorganizing scheduling models and strengthening oversight as part of broader operating room overhauls. Even modest efficiency gains can significantly increase health system margins as they treat more patients, direct the most complex procedures to hospitals and reduce costs. (Kacik, 5/19)
It took some time for Jasmine Jones to absorb the news that doctors wanted to replace four of her organs at once. She had been through so much already because of cystic fibrosis, a genetic disease that can damage the lungs and other organs. The 28-year-old South Side woman had become almost numb to the situation. (Schencker, 5/20)
On AI in healthcare 鈥
OpenEvidence rode the wave of early enthusiasm for large language models by building a free chatbot for doctors. Physicians, especially trainees, have flocked to the platform to help make patient care decisions; the company claims that about 650,000 U.S. physicians use it actively. (Palmer, 5/20)
Artificial intelligence has shown promise in flagging sepsis cases in hospitals, and new AI models are focusing on earlier detection of the condition responsible for one in three deaths of hospitalized patients. Detecting sepsis is a compelling use case for AI because it can present differently depending on the patient, creating diagnostic uncertainty. Sepsis occurs when the body has an adverse response to an infection. In the U.S., 1.7 million adults develop sepsis annually, according to data from the Centers for Medicare and Medicaid Services. (Famakinwa, 5/19)
In the first, tenuous weeks of her life, Jorie Kraus and her parents faced her possible death repeatedly. Muscles throughout her tiny body simply didn鈥檛 work properly. Her heart. Her legs. Her larynx. Even the involuntary action of breathing was labored, and constantly faltering. (Ross, 5/19)
23andMe plans to give its customers the capacity to import their medical records, allowing what it calls 鈥渁 360-degree view of their personal health.鈥 The offering will include an AI-written 23andMe Health Summary, which the company said is in development and will be available to some beta testers.聽(Herper, 5/19)