Medicare advantage

Let’s MA-ke a deal

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Within the next week, we will know how the Biden administration is approaching next year’s Medicare Advantage plans — and whether it is willing to meet the health insurance industry’s demands and deposit more money into the bank accounts of insurers.

In February, the government proposed a modest cut to the average benchmark payment for 2025 MA plans. Billions of dollars are on the line for a program that still has not saved a dime for taxpayers, despite promises that it would.

Over the past several weeks, 42,000 comments flooded into the federal government’s inbox over those proposals. Many independent health policy experts supported the government’s proposals to temper how much money MA companies receive next year, with some saying the government could have gone further to rein in overpayments. But there is still a lot of pressure coming from insurance companies and their lobbying groups to raise next year’s payment rates. Read the story to understand what the points of contention are.

private equity

The money behind methadone clinics

Obtaining methadone, a drug that helps cut the risk of opioid overdose death, is notoriously difficult for people looking to recover from their opioid addiction. The deep-pocketed private equity industry is in no rush to change that because PE-backed methadone clinics don’t want to lose the wave of profits associated with that process, my colleague Lev Facher reports in the third part of his War on Recovery series.

Private equity firms have acquired stakes in nearly one-third of all methadone clinics in recent years, according to a new analysis from Lev. And in the past two years, large clinic chains backed by private equity firms have launched a lobbying blitz aimed at preserving their exclusive right to dispense methadone.

Methadone clinics say it’s not a matter of protecting their financial moat; it’s about safely dispensing a drug that is, itself, an opioid. But advocates and lawmakers in the U.S. point out these barriers to methadone don’t exist overseas, and they are frustrated the PE-backed clinics are derailing attempts to make it easier to get methadone outside of a specialized clinic. I highly recommend you read all of Lev’s story.

hospitals

Meet me in the float room

Golf simulators, skating treadmills, “brain gyms,” and “float rooms” — welcome to the world of sports performance, a service line that hospitals are building for the affluent who are willing to pay for it, my colleague Liz Cooney reports.

There’s an important distinction between sports medicine and sports performance. Sports medicine is a more traditional discipline that gets people healthy after an injury and is associated with orthopedics, rehabilitative medicine, and physical therapy. Sports performance is more about preventing injuries and getting people to peak athleticism through “non-medical” means. As a result, sports medicine is typically covered by insurance, while people pay out of pocket for sports performance services.

There are still relatively few sports performance programs, and they aren’t really money-makers for hospitals. But they could be an entry point for athletes who inevitably get hurt and need the hospital’s higher-margin sports medicine or orthopedic surgery. Read more from Liz.