CONGRESS
Medicare Advantage insurers ramped up use of technology to deny claims
An investigation by the U.S. Senate Permanent Subcommittee on Investigations found that Medicare Advantage insurers denied more claims after they adopted predictive technologies designed to automate coverage decisions, STAT's Bob Herman and Casey Ross report.
The report cites STAT's series last year that investigated the use of algorithms and artificial intelligence within Medicare Advantage plans.
The Senate investigation, released this morning, shows that denials were concentrated among seniors who were requesting care in nursing homes, inpatient rehab, and long-term hospitals. It shows that UnitedHealth, CVS, and Humana, the three largest MA insurers, all used AI and algorithmic tools to aid in issuing denials. UnitedHealth's rate of denials for post-acute services jumped 172% between 2019 and 2022, topping out at 22.7%, according to the report.
Bob and Casey summarized the full findings, including an internal presentation from CVS.
election 2024
Joe Grogan on the GOP's strategy for fights over drug pricing and the ACA
Former Trump White House official Joe Grogan said at the STAT Summit that while Republicans don't have plans to repeal the entire Affordable Care Act, they should still grapple with tough issues on drug pricing and the ACA's premium subsidies.
He argued that the Inflation Reduction Act's restructuring of Medicare Part D has destabilized the program to the point that it's in a "death spiral," and said that lawmakers should consider changes to the law, or the Part D program more broadly, if the current trends continue.
Grogan, who maintains that the GOP should not extend additional ACA premium subsidies passed under the Biden administration, dismissed concerns that many of the people who benefit from the subsidies live in Republican-led states. He said that there is an "intolerable" amount of fraud in the program.
Read more, including his take on what could be Republicans' chance to reform public health agencies.
Q&A
Califf on obesity drugs
In an interview with STAT, FDA Commissioner Robert Califf seemed torn over what he thought of new anti-obesity medications as a long-term solution to the United States' obesity problem.
He called the evidence for the drugs "overwhelmingly good," and said the potential for impact in other disease areas is "profound." At the same time, he emphasized that Americans aren't paying attention to the root causes of disease.
"I have this recurrent thought that my great-grandkids will read that there was once a country called the U.S.A. where we used overwhelming manipulation of food and advertising to create an enormously obese population. And our solution to it was to invent a class of drugs that cost $20,000 a year to try to counteract it," he said. "And they would say, 'What kind of country is that? Why didn't you just eat good food to start with and not end up like that?'"
Read STAT cardiovascular health reporter Liz Cooney's full interview with Califf on why Americans' cardiovascular health is so bad, and what needs to be done to improve it.
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