Chris Boerner, CEO of Bristol Myers, on IRA

HHello, and happy Thursday from Boston at the STAT Summit! For those of you following along virtually, this afternoon my co-author Sarah Owermohle interviews Atul Gawande, deputy administrator for global health at USAID, and Bob Herman interviews former CMS administrator Don Berwick about the future of Medicare. Submit news tips and your biggest unanswered election questions [email protected].

Medicare Advantage insurers have increased their 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 adopting predictive technologies to automate coverage decisions, STAT’s Bob Herman and Casey Ross report.

The report cites STAT’s series last year examining the use of algorithms and artificial intelligence in Medicare Advantage plans.

The Senate investigation released this morning shows that denials were largely focused on seniors seeking care in nursing homes, residential rehabilitation facilities and long-term hospitals. It shows that UnitedHealth, CVS and Humana, the three largest MA insurers, all used AI and algorithmic tools to issue denials. According to the report, UnitedHealth’s denial rate for post-acute services increased 172% between 2019 and 2022, reaching a peak of 22.7%.

Bob and Casey summarized the full results, including an internal presentation from CVS.

Joe Grogan on the GOP’s strategy for fights over drug prices and the ACA

Former Trump White House official Joe Grogan said at the STAT summit that while Republicans don’t plan to repeal the entire Affordable Care Act, they should still grapple with tough questions about drug pricing and the ACA’s premium subsidies.

He argued that the restructuring of Medicare Part D through the Inflation Reduction Act had destabilized the program to the point that it was in a “death spiral,” and said that lawmakers would not make any changes to the law or the Part D program further down the line Senses should be considered if this is the case Trends continue.

Grogan, who believes the GOP should not extend the additional ACA premium subsidies passed under the Biden administration, dismissed concerns that many of the people benefiting from the subsidies live in Republican-led states. He said there was an “unbearable” level of fraud in the program.

Read more, including his assessment of Republicans’ potential chance to reform public health agencies.

Califf takes obesity medication

In an interview with STAT, FDA Commissioner Robert Califf appeared to be torn about what he saw as new anti-obesity drugs 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 on other disease areas was “significant.” At the same time, he emphasized that Americans do not pay attention to the causes of disease.

“I have a recurring thought that my great-grandchildren will read that there was once a country called the USA where we created a hugely obese population through overwhelming food and advertising manipulation. And our solution was to invent a class of drugs that cost $20,000 a year to address that,” he said. “And they said, ‘What kind of country is this? Why didn’t you just eat good food from the start and not end up like this?'”

Read STAT cardiovascular health reporter Liz Cooney’s full interview with Califf about why Americans’ cardiovascular health is so poor and what needs to be done to improve it.

Pharma managers comment on the election

STAT’s Matthew Herper interviewed Bristol Myers Squibb CEO Chris Boerner at the STAT Summit about all things related to the Inflation Reduction Act and the upcoming election. Some highlights from their conversation:

• Boerner said the worst part of his first year as CEO was the “unexpected opportunity” to testify before Sen. Bernie Sanders’ HELP committee.
• Boerner said BMS will be “at the forefront” of encouraging pharmaceutical companies to offer patient support under the Medicare program.
• In the first round of Medicare drug pricing negotiations, Boerner said he was “proud of the way the team handled CMS” and that Eliquis was indeed the type of drug the system should incentivize: relatively inexpensive, widely available , and could help prevent hospitalizations in the future.
• On the election, Boerner said BMS is a global company that operates on both sides of the aisle, and he stuck to those talking points even when asked which presidential candidate would be better for his company. “Our focus as a company doesn’t really change depending on who is in the White House or controls Congress,” Boerner said.

Bayer and Sandoz executives also recently wrote first opinion pieces outlining their priorities for the post-election world. Bayer calls on both parties to “resist” price controls and Sandoz warns against protectionism.

A look inside UnitedHealth’s strategy to put pressure on doctors

In the latest installment of STAT’s investigation into UnitedHealth Group’s business practices, the team behind Health Care’s “Colossus” examines how the company’s managers pushed doctors to see more patients and make more money.

Doctors who scheduled more appointments were offered additional bonuses, and the company launched a program to offer patients gift cards if they completed a checkup. UnitedHealth shared with practice physicians a dashboard that compared the percentage of chronic conditions they found in their Medicare Advantage patients to other practices within the company.

The full article is based on internal documents from a UnitedHealth practice and should not be missed.

STAT’s surprising reckoning with prodigy

There are many truly exceptional young professionals who won the STAT Wunderkind Award this year. Erin Duffy is one of them.

Among other things, Duffy is a leading expert on surprise medical bills and debt at the USC Schaeffer Center for Health Policy & Economics. She recently co-published a Secret Shopper study that highlights the difficulties people face in obtaining payment schedule estimates for scheduled procedures.

Her work on major policy failures began with her job as a refugee case manager at Catholic Charities in Boston. She was struck by how often they faced the same preventable problems—home loss, eviction, disenrollment from public programs, bed bugs. (Duffy often helped with laundry.)

So she returned to school to study health policy and eventually focused on her doctoral dissertation. Working on medical bills.

What we read

• Ahead of public meeting, FDA signals flexibility in evaluating smoking cessation treatments, STAT
• Trump causes a stir when he declares himself the “father of IVF,” according to the New York Times
• Is it time to freak out about bird flu?, STAT
• Walz reveals Harris’ plan for rural voters as campaign aims to rein in Trump, Associated Press
• First Opinion: Mark Cuban has no doubt he can disrupt healthcare, STAT