UnitedHealth is the nation’s largest health insurance conglomerate. ProPublica obtained what is effectively the company’s internal playbook for limiting and cutting therapy costs. Here’s what we found. propublica.org/article/unite…

I love that @MorePerfectUS is highlighting the downsides of healthcare consolidation. This is a bipartisan issue. Let’s fix it: Site neutral payments, 340B reform, CON repeal, stark reform, and roll back the physician owned hospital ban.

For all its faults, at least a person in the USA doesn’t have to wait until it’s to late for life saving care.

.@RepJasonSmith nails it: Large hospital systems “manipulate the 340B drug pricing program to keep steep drug discounts for themselves instead of passing the savings to low-income patients.” Patients and taxpayers deserve transparency, not hospital systems exploiting a safety-net program while costs keep rising.

The IRS test for tax exemption is “community benefit.” Median nonprofit hospital spends 2.3% of revenue on charity care. For-profit competitors spend 3.8%.

We need patients in this. Plain and simple. Patients Rising has put together a sign-on letter to HRSA about the 340B program, and it comes down to something that shouldn’t be this hard to answer. If your prescription is part of a program generating billions in discounted drug revenue, you should be able to see where that value goes and how it actually reaches you. Right now, you can’t. That’s the gap this letter is calling out. It pushes for transparency patients can actually understand, real proof that patients benefit, and accountability for how the program is being run behind the scenes. If you’ve ever dealt with the healthcare costs and thought, “something about this doesn’t add up,” this is exactly where that frustration belongs. ✔️ Sign the letter ✔️ Tag someone in this post to sign on. It’s being submitted to HRSA THIS AFTERNOON as part of the official record, and it should reflect the people it’s supposed to serve. Sign the letter here: hubs.ly/Q04cGr-70

Health care costs are high, but no one knows exactly why. What we do know is that normal market forces don't drive down insurance prices because the costs for medical procedures and medicine are negotiated behind closed doors. There's no price transparency by design.

We price oil to the penny in real time across 195 countries. But nobody on earth can tell you what a knee replacement costs before you get one. That’s not complexity. That’s a cartel.

The one debt you can’t ever pay off ? Your insurance premiums. You literally will pay an insurance premium monthly, till you die. But we don’t look at it like it’s a debt paid to an insurance company that will do all it possibly can never spend it on your care. We are working on a non -insurance solution. The day HSAs no longer require an insurance policy, it all will change. finance.yahoo.com/sectors/he…

Health Savings Accounts (HSAs) should be part of the solution in fixing American healthcare. (They are not everything, but they could be an important part.) youtube.com/shorts/1ea02VlxU… via @YouTube

I am the Senior Vice President of Claims Optimization at Cigna. I built PXDX. PXDX stands for Procedure-to-Diagnosis. It is a list. It matches a billing code to a diagnosis code. If the procedure doesn't match an approved diagnosis on the list, the claim is denied. Automatically. In an average of 1.2 seconds. 1.2 seconds. That's faster than a doctor can read the patient's name. In two months last year, our medical directors denied over 300,000 claims through PXDX. One doctor denied 121,000 in that stretch. Her name is on every letter. She did not open a single patient file. She clicked a button that approved batches of fifty at a time. That's oversight. PXDX is not a complex algorithm. It is a lookup table. A procedure either matches a diagnosis or it doesn't. There is no clinical judgment. There is no context. There is no patient. There is a code, and the code says no. That's the system. Before we added autonomic nervous system testing to the PXDX list, we were paying 100% of those claims. After, we denied 17,800 a year. Saved $2.4 million annually. On one test. That's a correction. Patients can appeal. The appeal process takes 40 to 60 days. The denial took 1.2 seconds. We call this "access to recourse." Our own internal documents estimate that only 5% of patients will appeal. Of those, most give up after the second round of paperwork. We know this. We planned for it. That's engagement. I received the 2024 Cigna Catalyst Award for Operational Excellence. The plaque says "Transforming Member Outcomes Through Intelligent Automation." It's mounted in the lobby of our Bloomfield, Connecticut, office, next to the mission statement that puts patients first. No one has asked me to take it down. 1.2 seconds per claim. A doctor's signature on a letter she never read. An appeal window designed around the statistical probability that you won't use it. A lookup table that has never met a patient and never will. The system doesn't deny claims. It denies the premise that claims should be reviewed. I am PXDX. I am the 1.2 seconds. I am the doctor's name at the bottom of a letter no doctor wrote. The system works.