Hospital IT Teams Still Working to Resolve CrowdStrike-Related Outage Issues

By David Raths - As health system IT teams reported steady progress in bringing computer systems and EHR access back online after Friday’s global outage, the U.S Cybersecurity and Infrastructure Security Agency (CISA) warned that cyber threat actors continue to leverage the outage to conduct malicious activity, including phishing attempts. Read Full Article…

HVBA Article Summary

1. Impact and Response to the Outage: The widespread outage caused by a faulty software update from CrowdStrike affected approximately 8.5 million Windows devices, including many hospital systems, leading to scheduling delays and operational challenges. Microsoft has published a recovery tool to aid impacted systems, and CISA is actively monitoring for any emerging malicious activity. Health systems such as RWJBarnabas Health and Corewell Health praised their IT teams for managing the crisis effectively, emphasizing the importance of aggressive and effective management to prevent significant disruptions.

2. Guidance and Recovery Efforts: The American Hospital Association (AHA) issued recommendations for hospital IT teams to manage the impact of the outage, including assessing the effect of CrowdStrike on their networks, reviewing business and clinical continuity procedures, and testing cyber incident response plans. AHA highlighted the ongoing recovery efforts and the responsiveness of both Microsoft and CrowdStrike in addressing the operational, financial, and clinical impacts on hospitals. The association also advised hospitals to be vigilant against increased phishing attempts related to the disruption.

3. Public and Institutional Reactions: The outage prompted widespread reports from healthcare workers and institutions. Nursing website nurse.org reported extensive feedback from nurses nationwide, detailing system failures and a reversion to paper charting. Major health systems like Providence and Corewell Health continued efforts to restore normal operations while ensuring patient care remained uninterrupted. Providence advised patients not to delay emergency or urgent care, and Corewell Health acknowledged the patience and understanding of their patients during the delays caused by the global technology issue.

Why Millions Are Trying FDA-Authorized Alternatives to Big Pharma’s Weight Loss Drugs

By Arthur Allen - Pharmacist Mark Mikhael has lost 50 pounds over the past 12 months. He no longer has diabetes and finds himself “at my ideal body weight,” with his cholesterol below 200 for the first time in 20 years. “I feel fantastic,” he said. Read Full Article…

HVBA Article Summary

1. The Role and Controversy of Compounded Semaglutide and Tirzepatide: Mikhael, CEO of Olympia Pharmaceuticals, uses his company's compounded versions of weight loss drugs instead of branded ones like Wegovy or Zepbound. This practice is common among several large compounding pharmacies that supply millions of Americans with these drugs. Novo Nordisk and Eli Lilly, the original manufacturers, oppose this compounding business, citing safety concerns and legal disputes, despite the FDA allowing compounding in cases of drug shortages.

2. FDA and Industry Perspectives on Drug Safety and Supply: While compounding pharmacies are regulated and required to maintain high standards of purity and consistency, the raw materials used might differ from those of the original manufacturers. Despite concerns, reports of adverse effects from compounded versions have not raised significant alarms. However, past incidents like the 2012 New England Compounding Center tragedy highlight the potential risks, emphasizing the need for stringent oversight and quality control.

3. Economic and Healthcare Impact of Compounded Drugs: Compounded semaglutide and tirzepatide are significantly cheaper than their branded counterparts, making them more accessible to patients. This accessibility is crucial as the original manufacturers struggle to meet the high demand. However, the potential removal of these drugs from the FDA shortage list could disrupt supply and impact patients relying on affordable alternatives, highlighting the ongoing tension between pharmaceutical companies, compounding pharmacies, and regulatory bodies.

CrowdStrike: What to tell clients when a cyber event affects them

By Lloyd Lofton- The CrowdStrike outage was a worldwide event, and the impact is still being felt. You received the calls, maybe you were affected personally or someone you care about was affected. What do you say? How do you advise them? Here are one advisor’s story and tips. Read Full Article…

HVBA Article Summary

1. Emphasize Calm and Informed Decision-Making: In the face of market disruptions, it's crucial to stay calm and informed. As a financial advisor, I reassure my clients by providing clear and accurate information about the situation. For example, during the CrowdStrike incident, I explained the technical issues and their widespread impact, emphasizing the importance of not making hasty decisions based on fear or speculation. This approach helps clients understand the context and make rational choices, maintaining their focus on long-term financial goals.

2. Promote Diversification and Regular Portfolio Reviews: I highlight the significance of diversification in mitigating risk. Ensuring that clients' portfolios include a mix of asset classes, sectors, and geographic regions helps cushion the impact of disruptions in any single area. Regular portfolio reviews are essential to ensure alignment with clients' goals and risk tolerance. For instance, during the CrowdStrike disruption, I reminded clients like John and Lisa of their diversified investments and encouraged them to review their portfolios without making drastic changes based on short-term events.

3. Encourage Long-Term Focus and Ongoing Consultation: Maintaining a long-term investment strategy is vital, especially during market volatility. I advise clients to stay focused on their financial objectives and avoid overreacting to temporary market fluctuations. During crises like the CrowdStrike incident, I schedule webinars and virtual meetings to address collective concerns, provide updates, and offer strategic guidance. Regular consultations with clients ensure they feel supported and confident in their financial plans, reinforcing the value of staying the course despite market disruptions.

South Park Tackles Prior Authorization. It Would be Funny if It Wasn't so Damn Deadly.

By Wendell Potter - I’m writing today to praise the boys of South Park for helping us understand how futile it has become to get a health insurance company to do the right thing. Read Full Article…

HVBA Article Summary

1. Navigating the U.S. Healthcare System: The South Park episode humorously showcases Kyle and Cartman's futile attempt to get Cartman's weight-loss meds covered by insurance, highlighting the complexities and frustrations of the U.S. healthcare system. Their journey reflects the real-life struggles many Americans face, discovering that their expensive insurance often falls short when it comes to actual medical needs.

2. The Hidden Realities of Prior Authorization: The episode subtly critiques the insurance industry's use of prior authorization, a process designed to limit treatments and medications without mentioning it explicitly. This barrier, meant to control costs and maximize profits, is a significant contributor to physician burnout, high healthcare costs, and negative patient outcomes. The AMA reports that prior authorization often leads to patients abandoning necessary treatments due to the bureaucratic hurdles involved.

3. Exposing Insurance Company Practices: Through satire, the episode brings attention to the insidious practices of insurance companies, such as denying claims and using prior authorization to delay or prevent care. The segment emphasizes how these practices contribute to the immense profits of insurance companies, exemplified by UnitedHealth's $16 billion profit in six months. Viewers are urged to understand the real impact of these policies and advocate for change, as highlighted by various reports and experts in the field.

US drug industry middlemen defend business model amid accusations of raising patient costs

By Amina Niasse and Bhanvi Satja - U.S. pharmaceutical industry middlemen defended their role in the healthcare system during a Congressional hearing on Tuesday after committee members accused them of pushing patients toward expensive treatments even when lower-cost options are available. Read Full Article…

HVBA Article Summary

1. Pharmacy Benefit Managers (PBMs) and Rebates: A House Committee on Oversight and Accountability report revealed that pharmacy benefit managers (PBMs) require drugmakers to pay rebates for prioritizing their branded drugs on insurance-covered medication lists. Executives from top PBMs, including UnitedHealth's OptumRx, Cigna's ExpressScripts, and CVS Health's Caremark, testified that their business models save money for health plan members, but they blamed drug manufacturers' "patent abuses" and high launch prices for increased consumer costs.

2. Pharmaceutical Executives' Response: Pharmaceutical executives argue that PBMs are responsible for high prescription drug costs. CVS Caremark President David Joyner highlighted the high prices of new drugs, citing a median annual price of $300,000 for newly marketed drugs. He pointed out that medications like Humira, Ozempic, and Stelara cost more than all generic drugs combined and described the potential costs of GLP-1 drugs for weight loss as "overwhelming," with projected annual costs exceeding $1.2 trillion if prescribed to all obese individuals.

3. Committee's Findings and Accusations: The House Committee's report accused the largest PBMs of enacting anti-competitive policies and protecting their profits by controlling 80% of prescription drugs dispensed in the U.S. The report also alleged that PBMs share patient data to steer patients toward their own pharmacies and have moved some operations abroad to avoid transparency and proposed reforms. Committee Chair James Comer criticized PBMs for shifting drug pricing blame onto manufacturers, contrary to feedback from doctors and pharmacists across the country.

The obesity drug race is being fought on the manufacturing floor as GLP-1 rivals make plans to catch leaders

By Anna Brown - Ever since the weight loss drug craze created near-unprecedented demand, the first two companies to market have been doing everything they can to meet it by investing in old facilities, building new ones and even rationing doses. Read Full Article…

HVBA Article Summary

1. Intensified Manufacturing Investments: Eli Lilly and Novo Nordisk are aggressively investing in expanding their manufacturing capabilities to meet the soaring demand for their GLP-1 drugs. With significant capital allocations—Novo earmarking $6.5 billion and Lilly spending over $5.3 billion—they are building new facilities and acquiring existing ones to bolster production. This strategy highlights the critical role of manufacturing in sustaining market leadership amid high demand and competitive pressures.

2. Emerging Competitors: Despite Lilly and Novo's current dominance, competition is on the horizon with companies like Boehringer Ingelheim, Zealand Pharma, Roche, and Amgen advancing their own GLP-1 candidates. These competitors are leveraging both internal manufacturing expertise and third-party partnerships to expedite market entry. The competitive landscape is poised to shift as these new entrants progress through clinical trials and prepare for commercialization.

3. Outsourcing and Capacity Challenges: The GLP-1 market faces significant capacity challenges, leading companies to consider outsourcing to contract manufacturers. However, outsourcing comes with risks, as evidenced by Catalent's past production issues with Novo's Wegovy. The ongoing shortages of GLP-1 drugs underscore the need for expanded manufacturing capacity, whether through internal builds or strategic partnerships. Both Lilly and Novo are navigating these challenges by balancing in-house production with outsourced solutions to meet global demand.

Spine groups see insurers rescind payments

By Laura Dydra - Spine and orthopedic groups are strengthening their revenue cycle teams and clinical documentation improvement programs to stay ahead of insurance coverage policy changes, several leaders said during the Becker's 21st Annual Spine, Orthopaedic & Pain Management-Driven ASC Conference in June. Read Full Article…

HVBA Article Summary

1. Enforcement of Prior Authorizations and Coverage Denials: Insurance companies are increasingly leveraging prior authorizations and coverage denials to delay or avoid payments. This practice places significant administrative burdens on healthcare providers, necessitating robust clinical documentation improvement programs to meet payer requirements and prevent billing errors. Shannon Cameron, COO of billing operations for Harvard Medical Faculty Physicians, highlights that their program has been vital in avoiding such issues.

2. Intensified Post-Authorization Clawbacks: Healthcare providers are experiencing intensified post-authorization clawbacks where insurers request medical records months after a procedure to reassess and potentially rescind payments. Adam Bruggeman, MD, of Texas Spine Center, notes that despite having prior authorization, insurers are increasingly questioning and denying claims retroactively, stressing the need for meticulous documentation and proactive education of physicians.

3. Large-Scale Retroactive Denials: Insurance companies are conducting large-scale reviews to retroactively deny payments for procedures performed months prior, leading to significant administrative and financial strains on healthcare organizations. Andrew Lovewell, CEO of Columbia Orthopaedic Group, mentions that one payer requested information on 6,000 joint surgeries, employing third-party auditors to reassess claims, causing a substantial nuisance and resource drain for the group.

Harris' chance to forge a new Dem health agenda

By Caitin Owens - Vice President Kamala Harris is expected to pick up President Biden's policy torch as the presumptive Democratic presidential nominee, but the reality is that she's stepping into a role leading the party at a time when it's biggest long-term health care goals have to some extent been realized. Read Full Article…

HVBA Article Summary

1. Policy Continuity and Strategic Focus: If Kamala Harris clinches the nomination, she is expected to largely adopt Joe Biden's "finish the job" health care agenda. This includes extending Medicare's price negotiations with pharmaceutical companies, reducing the uninsured rate, and renewing Affordable Care Act subsidies. Health care consultant Chris Jennings notes that Harris will likely prioritize personal goals within this framework, building on the current administration's successful record rather than introducing a new, broad vision.

2. Emerging Health Care Challenges: Harris's leadership will coincide with several pressing health care crises. These include an aging population, workforce shortages, lack of rural health care providers, worsening drug-overdose epidemic, and a youth mental health crisis. Additionally, the high cost of care continues to make health insurance less meaningful for many Americans, even as coverage expands. A wave of new scientific and technological innovations will further challenge existing regulatory and payment systems, presenting an opportunity for Harris to develop and champion new goals.

3. Potential for Progressive Shifts and Immediate Impact Areas: Harris could leverage her record and experiences to introduce progressive health care initiatives. Her past support for Bernie Sanders' Medicare for All bill and advocacy for using "march-in rights" to reduce drug prices highlight this potential. Furthermore, Harris's strong stance on abortion rights, marked by her "Fight for Reproductive Freedoms" tour, indicates an area where she may differentiate herself. Her background in antitrust health care cases, such as the Sutter Health consolidation case and blocking the Anthem-Cigna merger, could also inform policies aimed at reducing health care costs and addressing market consolidation.

Hospital mergers kill jobs, and workers: Economists

By Allison Bell - Hospital mergers kill workers, a team of economists concludes in a new working paper published by the National Bureau of Economic Research. Read Full Article…

HVBA Article Summary

1. Economic Impact of Hospital Mergers: The analysis of 304 U.S. hospital mergers between 2010 and 2015, involving hospitals within 50 miles of each other, revealed that these mergers led to a 1.2% increase in healthcare prices within two years. This price hike resulted in a 0.4% reduction in payroll and employment outside the health sector for every 1% increase in healthcare prices, and a corresponding 0.1 percentage point rise in unemployment.

2. Social Consequences and Mortality: The study highlighted severe social consequences, estimating that about 1 in 140 workers who lost their jobs due to increased healthcare costs died from suicide or drug overdose within a year of starting unemployment benefits. The 125 most anticompetitive mergers caused more than a 5% increase in prices, an average loss of 203 jobs, and 1 to 2 deaths from despair per merger.

3. Regulatory Recommendations and Broader Implications: The economists argued for stronger regulatory measures to identify and block hospital mergers that significantly raise prices. They emphasized that rising healthcare costs have broad macroeconomic and social impacts, including increased labor costs, reduced business dynamism, higher federal budget pressures, and exacerbated income inequality. The paper underscores the need for concrete steps to address healthcare price growth to prevent further economic and social harm.