Data & Analytics

A review of market access for acute migraine treatments shows that under the pharmacy benefit, about 47% of the lives under commercial formularies are covered with utilization management restrictions. Around 41% of the lives under Medicare formularies are not covered for at least one of the drugs.

Most of the health plans ranked by the National Committee for Quality Assurance received an overall rating of 3.5 stars or higher, according to the NCQA’s 2023 health plan ratings.

Of the rated plans, only two out of the 1,095 plans listed received five stars this year: Kaiser Foundation Health Plan of the Mid-Atlantic States and Independent Health Association, Inc. In the 2022 ratings, six out of 1,048 health plans earned five stars. Commercial health plans had a higher overall rating compared to Medicaid and Medicare health plans.

A review of market access for treatments of adults with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) shows that under the pharmacy benefit, about 48% of the lives under commercial formularies are covered with utilization management restrictions. Around 38% of the lives under Medicare formularies are not covered for at least one of the drugs.

Here’s how major health insurers’ stock performed in August 2023. UnitedHealth Group had the highest closing stock price among major commercial insurers as of August 31, 2023, at $476.58. Humana Inc. had the highest closing stock price among major Medicare insurers at $461.63.

One-third of political appointees to HHS between 2004 and 2020 later exited to work for the private sector, according to a recent study published in Health Affairs.

Based on an analysis of employment histories for 766 appointees, the researchers found that more than half of appointees at the Centers for Disease Control and Prevention, CMS and the Office of the Deputy Secretary at HHS went straight to private industry after their government employment.

Meanwhile, about 15% of people appointed to HHS during the study period were employed in the private sector immediately before joining the government. A greater share of people appointed by a Republican president came from the industry compared with a Democratic president, yet net rates of exit to industry remained similar.

A review of market access for non-small cell lung cancer systemic therapy treatments shows that under the pharmacy benefit, about 38% of the lives under commercial formularies are covered with utilization management restrictions. Around 67% of the lives under Medicare formularies are not covered for at least one of the drugs.

Annual health care costs for a hypothetical American family of four covered by an employer-sponsored preferred provider plan (PPO) are estimated to reach $31,065 in 2023, an increase of 5.6% year over year, according to the 2023 Milliman Medical Index (MMI).

On average, annual health care costs per person covered by a PPO plan will grow from $6,472 in 2021 to $7,221 in 2023, the actuarial and consulting firm predicted. Approximately 36% of those total expenses are attributed to inpatient and outpatient hospital services, while professional services alone will account for 30% of total spending in 2023.

A review of market access for ulcerative colitis treatments shows that under the pharmacy benefit, about 54% of the lives under commercial formularies are covered with utilization management restrictions. Around 32% of the lives under Medicare formularies are not covered for at least one of the drugs.

A review of market access for Duchenne muscular dystrophy treatments shows that under the pharmacy benefit, about 44% of the lives under commercial formularies are covered with utilization management restrictions. Around 35% of the lives under health exchange formularies are not covered for at least one of the drugs.

Health care breaches have exposed more than 343 million patient records since 2009, according to the HHS Office for Civil Rights. In the first half of 2023 alone, the health care sector saw 436 breaches of 500 or more records: 25 of them are now solved while the rest are under investigation.

As the health care sector has increasingly adopted digital services and moved to electronic record keeping, the number of data breaches has been rising since 2015. The median number of patients affected in each breach, which indicates the size of each breach, also increased from 2,300 in 2018 to 7,140 in 2022.

In recent years, some of the biggest breaches targeted health care providers and business associates, such as third-party administrators that assist plans with claims processing or consultants that perform utilization reviews for hospitals. Last year was the first year that business associates suffered more data breaches than any other type of health care entities.