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THCB Reader - Medicare Advantage tidbits & a ton of articles & interviews


THCB Reader

March 28 · Issue #144 · View online

Everything you always wanted to know about the health care system. But were afraid to ask.

THCB Reader has some catching up to do. Since our last email, David Warmlash does a takedown of Robert Malone’s appearance on the Rogan podcast, spreading vaccine misinformation (part 1 + part 2), Brian Klepper discusses where health care value can lead, Kim Bellard considers what crypto could mean for our healthcare system, and Mike Magee reflects on Ukraine. Jeff Goldsmith and Ian Morrison talk about Hospital Systems as a Framework for Maximizing Social Benefit; Kim Bellard reflects on ARPHA-H; Rosemarie Day celebrates the 12th anniversary of the Affordable Care Act and considers its relevance during the pandemic; and Eric Perakslis contemplates health data rights as civil rights.
Scroll down for lots of interviews. I have some quickbite interviews from the ViVE conference with 1UpHealth, Cecelia Health, Lark, and Luma Health. Jess DaMassa on WTF Health has (deep breath) Glen Tullman of Transcarent, Zane Burke from Quantum Health, and CEOs from Flume Health, Homeward, and Clarify Health Solutions. She also interviews Cricket Health CEO Bobby Sepucha, about the merger of Cricket Health, Fresenius Health, and InterWell Health. Bobby disagrees with my cynical assessment of the merger (as well he might!).
Jess and I have done five episodes of Health Tech Deals in the last two weeks: deals include Doctolib, House Rx, SmithRx, Synapse Medicine, Kintsugi, Clarify, Embedded Healthcare, Wildflower, Vivante Health, Gravie, Nice, Elemy, Health Gorilla, M_disrupt, Flume, Homeward Health, Embold Health, Canopy, Vira Health, Woebot, Huma, Cricket Health, Afterlife, Timedoc Health, Avive, and Antidote Health.
Two #THCBGangs. The first features double trouble futurists Ian Morrison (@seccurve) & Jeff Goldsmith; Vince Kuraitis (@VinceKuraitis), and Principal of Worksite Health Advisors Brian Klepper (@bklepper1). That one has a lot about platforms and whether health care is ready for them! On the second #THCBGang it’s Casey Quinlan (@MightyCasey); Michael Millenson (@MLMillenson); Kim Bellard (@kimbbellard); and back from his travels in Mexico, Mike Magee (@drmikemagee). Special guest was population health expert Ines Vigil, from Clarify Health solutions, the author of Population Health Analytics. We dived deep into what population health means, what we need to do to make it work, and whether it’s real or not!
Don’t forget that to listen any time—you can subscribe to #THCBGang and #HealthTechDeals podcasts with an easy click on Apple or Spotify.

For my health care tidbits this week, the controversy about Medicare Advantage is getting louder and louder. There’s no question that it results in lower out of pocket payments for its members than traditional FFS Medicare. Medicare Advantage members use fewer services, and their care appears to be better “managed” –then again FFS Medicare’s “members” are barely managed at all. 
But the big question is, Does Medicare Advantage save the government money? Critics (notably ex CMS veterans Berwick & Gilfillan) claim that risk adjustment games played by the private plans who run Medicare Advantage have cost up to $200bn over 10 years. Medpac (the independent body that advises Congress) estimates that “Medicare spends 4 percent more for MA enrollees than it would have spent if those enrollees remained in FFS Medicare” and go on to say “In aggregate, for the entire duration of their Medicare participation, private plans have never produced savings for Medicare”. However data from the Medicare Trustees and other research from ACHP & the trade group Better Medicare Alliance suggests that Medpac’s analysis is incorrect and that Medicare Advantage saves the government about 9% per enrollee"
THCB ran a long piece (pt 1, pt 2) about Medicare Advantage from former Kaiser Permanente CEO George Halvorson earlier this year, and a related one from current Permanente Federation CEO Richard Isaacs. But it’s much more nuanced than that. J Michael McWilliams has long piece on Health Affairs Forefront trying to capture the various strands of the argument. His conclusion?  “The substantial subsidies MA receives are largely responsible for the extra benefits and have more than offset savings from any efficiencies, posing a net cost to Medicare and complicating assessments of MA’s added value.”
Meanwhile CMS has just changed the most controversial aspect of risk adjustment (which is the most controversial part of Medicare Advantage) by banning the plans from doing it, and only allowing providers to be involved.
Whether any of this is going to change CMS regulations or wider government policy regarding MA payments is less certain. CMS is currently dealing with its replacement for the even more controversial Direct Contracting (now called ACO REACH). But Medicare Advantage is the most profitable part of private health insurance and has many knock on effects for care services and technology. So I’ll be watching this space and you should too!
Follow me on Twitter @boltyboy and THCB at @thcbstaff for more similar insights/nonsense (and even the occasional sensible idea)! Enjoy! – Matthew Holt
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From Jess DaMassa & WTF Health...
Past the Talking Points: Glen Tullman on Affordable Insulin, Payment Model Reform & Transcarent
Clarify Health Solutions’ CEO on Data Analytics Startup’s Next Trick: Value-Based Payments Tech
BREAKING at ViVE: Jenny Schneider on Launch of New Biz Homeward
“There Isn’t One Health Plan to Save Them All”: Flume Health’s CEO on New Build-A-Plan Biz
Livongo's Former CEO Zane Burke on New Gig Leading Healthcare Navigator Biz Quantum Health
Will ‘DoorDash for Lab Draws’ Startup Sprinter Health Be What Speeds Up Virtual Care’s Growth?
THCB Spotlights Quickbite Interviews: Lark, Luma Health, 1UpHealth & Cecelia Health
Julia Hu, CEO, Lark
Adnan Iqbal, CEO, Luma Health
Joe Gagnon, CEO, 1upHealth
Mark Clermont, CEO, Cecelia Health
#HealthTechDeals Episode 14: Elemy, Health Gorilla, M_disrupt; Flume; and Homeward Health
#HealthTechDeals Episode 15 | Clarify, Embedded Healthcare, Wildflower, Vivante Health, Gravie, Nice
#HealthTechDeals Episode 16: Doctolib, House Rx, SmithRx, Synapse Medicine, and Kintsugi
#HealthTechDeals Episode 17: Cricket Health, Embold Health, Canopy, Vira Health, and Woebot
#HealthTechDeals Episode 18: Huma, Afterlife, Timedoc Health Avive, Antidote Health
Matthew Holt
Matthew Holt
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