Industry Briefing #9

Healthcare media highlights

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1 min
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The Briefing
Published date
April 29, 2024

The Briefing keeps consultants ahead by unpacking essential trends and emerging questions they can answer through market research.

On this week’s issue: Healthcare providers are struggling after the Change Healthcare cyberattack. The Biden administration and CMS are updating Medicare and Medicaid regulations, requiring adjustments. Reproductive health legislation changes are under review. Financial challenges are causing layoffs in large healthcare organizations, while health tech startups are attracting institutional investors.

Many healthcare providers are still struggling with finances and operations after the Change Healthcare cyberattack. 

The Biden administration and CMS are making changes to Medicare and Medicaid regulations, and providers will need to adjust. 

Both the Biden administration and SCOTUS are assessing changes to controversial reproductive health legislation. 

Some large healthcare organizations are laying off staff as a response to a challenging financial climate. 

Many health tech startups have attracted the attention of institutional investors. 

Two months later, healthcare providers across the US are still dealing with the fallout from the Change Healthcare cyberattack.

In late February, UnitedHealth Group subsidiary Change Healthcare was targeted by a large-scale cyberattack that sent ripples through the entire healthcare industry. The attack exposed patients’ personal and health data on a large scale and temporarily shut down payment processing services throughout the country. 

UnitedHealth Group is conducting an in-depth analysis on the attack. They recently announced that the patient data exposed “could cover a substantial portion of people in America”. They’ve also recently confirmed that screenshots of stolen files were posted on the dark web for about one week, and that they did pay the attackers a ransom in exchange for the return of their data. 

Many healthcare providers are still struggling with operations in the wake of the attack, and small practices have been hit particularly hard. While UnitedHealth Group has given affected providers over $7 billion in financial support, that hasn’t always been enough to keep things afloat. 

Since Change Healthcare’s systems remain offline, some insurance providers have been mailing manual claims forms. Processing these forms requires extra time and labor that many practices don’t have. Without an efficient way to receive reimbursement from insurers, many practices are struggling to pay their staff.

A survey from the American Medical Association indicates that 31% of physician respondents have struggled to make payroll since the attack.

Many have taken out loans or even dipped into their personal funds to cover the difference. 

Due to the scale of the attack, the US Justice Department is conducting an ongoing investigation into Change Healthcare. CEO Andrew Witty is set to testify for both House and Senate subcommittees in early May. 

Recent changes to Medicare and Medicaid have been met with mixed responses. 

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The federal government has recently released proposed changes to the Medicare and Medicaid system, which provides healthcare coverage for millions of people throughout the US. The Centers for Medicare & Medicaid Services, or CMS, have also made adjustments to the program, many of which have already been enacted. 

One of the most controversial proposals is one that would raise the Medicare eligibility age from 65 to 67. Another proposal would put work requirements in place for Medicaid. Both of these proposals stem from Republican congressional leaders and have been heavily criticized. While these proposals could help reduce government expenses, they could also leave patients vulnerable during a time when they need healthcare the most. 

The Biden administration also recently released a mandate that would require nursing homes to provide each resident with 3.48 hours of care per day, which is a significant increase from previous standards. While this legislation is intended to improve the quality of care available for patients, critics worry that it could exacerbate severe staffing shortages and even lead some nursing homes to close. 

CMS has yet to address this latest change from the White House, they have recently announced a new rule that would require a minimum of 80% of Medicaid payments for in-home care services to go toward provider wages.

This new ruling is intended to help prevent staffing turnover for individuals who need access to in-home care the most.

This is just one part of the broader changes that CMS has made to the Medicaid program. Enrollment in Medicaid increased dramatically during the COVID-19 pandemic, with a peak of one in four Americans on the program in 2021. Many of those people have remained on Medicaid post-pandemic. Given the influx of enrollees, CMS’s Medicaid changes are focused on creating more transparency by requiring states to create better websites for Medicaid plans and to release how much they spend on Medical costs each year. 

The US government is assessing changes to controversial reproductive healthcare laws. 

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On April 23rd, the Biden administration released a new ruling that will improve reproductive healthcare privacy for patients nationwide. This rule prevents all providers covered by HIPAA from disclosing protected health information related to reproductive care. 

This ruling will help prevent this information from being used to investigate abortions. Many states have banned abortion on some level since the Supreme Court overturned the Roe vs. Wade ruling in 2022. The new ruling protects patients who travel outside their home state to a state where abortion is legal to receive care. 

The US Supreme Court is also set to hear a case regarding emergency access to abortion care at the end of April. Since 2022, many states have been criticized for putting abortion bans in place without provisions to provide access to emergency healthcare for pregnant women. This case will focus on the Emergency Medical Treatment and Active Labor Act of 1986, which states that hospitals cannot turn away patients experiencing life-threatening emergencies. 

The case will determine whether EMTALA pre-empts Idaho’s current abortion ban. This ruling could also affect access to care for pregnant women in 22 other states with abortion bans. 

Many large healthcare organizations are facing layoffs and financial cuts in the months to come. 

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Finances are tightening across the healthcare industry, and many healthcare organizations have announced they will be making layoffs soon. These layoffs will primarily affect staff working in administrative roles rather than doctors or other clinical staff. 

One of the largest organizations laying off employees is Optum, a healthcare tech and pharmacy services provider. Optum is a subsidiary of UnitedHealth Group and has already laid off 114 employees in its NaviHealth division. Optum claims that the layoffs are part of a broader restructuring. 

Humana is a major national insurance provider that already laid off over 1,000 people earlier this year. The company recently released their finances for the first quarter, which indicated declining profit margins and will require substantial cuts to benefits and plans. While there are no more layoffs announced at this time, these financials are indicative of broader industry challenges as regulations and patient needs change.

UPMC recently announced a layoff of approximately 1,000 employees due to recent financial losses.

UMPC is one of the largest health systems in the Pittsburgh area. In addition to the layoffs, UMPC will also be cutting open positions.

Health tech companies are attracting attention from institutional investors. 

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Investors are looking toward the future with a focus on healthcare technology. In particular, many telehealth companies have gotten significant funding deals as part of shifting care models in a post-pandemic world. Many AI-powered technologies have also secured funding due to increased focus on automation across industries. 

For example, Summer Health recently raised $12 million in its Series A funding round. Summer Health is a text-based telehealth service focused on pediatric care.

$10 million Alaffia Health also raised $10 million in its Series A round.

Alaffia Health uses generative AI tools to help insurance providers process claims efficiently. 

These are just two examples in a broader trend of funding healthcare technology, both of which are very timely. High healthcare costs in the US often deter people from seeking in-person medical care, but telehealth services can bridge that gap. Many medical providers are also overworked and struggle to manage operations, but AI technology could help make operations more efficient. 

Questions to Stay One Step Ahead

From financial challenges to new regulations to patient privacy concerns, healthcare consultants have many factors to consider when developing solutions. Many organizations are looking to technology to fill in care gaps and address some of the biggest problems in the healthcare industry right now.

Cybersecurity and regulatory compliance remain as important as ever as many organizations struggle to stay afloat in challenging times. Innovation will be necessary to break out of this cycle of struggle. Questions to consider include: 

  • Cybersecurity and operations: Will the Change Healthcare attack leave providers cautious about working with third parties? 
  • Reproductive care: Reproductive care laws have shifted as federal politics have changed. How are providers preparing themselves for changing regulations moving forward? 
  • Healthcare tech: Many health tech startups are conducting successful investment rounds. What are investors assessing when looking into funding large-scale payers and providers? 

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