February 14, 2024

Happy Wednesday. Today, we have new reporting by Axios' Caitlin Owens, who's going deeper on the big trends transforming health care. Pro readers got an advance look at it this week — click here to learn more about our policy subscription.

Today's newsletter is 980 words or a 3.5-minute read.

1 big thing: The appeal of dual eligibles

Illustration: Tiffany Herring/Axios

People who are eligible for both Medicare and Medicaid — a group that is generally low-income with complex health needs — are expected to generate billions in profit for health insurers in the coming years, despite being a group that typically racks up expensive health care bills.

Why it matters: This is part of a major shift in how insurers make their money, with profits increasingly coming from their provision of government plans like Medicare Advantage and Medicaid managed care, Caitlin writes.

Driving the news: A recent McKinsey report projected that earnings before interest, taxes, depreciation, and amortization — a measure of profitability — from covering the "dual eligibles" population will see a growth rate of greater than 10% between 2022 and 2027, and profits will grow from $7 billion in 2022 to $12 billion in 2027.

  • "Reimbursement tends to be higher for, in the insurance lingo, the riskier population," said Shahed Al-Haque, a partner at McKinsey. "Because [plans are] getting a higher level of reimbursement and the cost does not necessarily scale at the same level of reimbursement, they're able to achieve profitability."
  • Plans for dual eligibles had some of the highest profit margins among private Medicare Advantage plans in 2021, according to MedPAC.
  • The profitability of insurance plans' government segment is expected to be 65% higher than the commercial segment by 2027, per McKinsey.

Between 12 million and 13 million people receive health coverage from both Medicare and Medicaid, with about half enrolled in Medicare Advantage in 2020.

Yes, but: It's unclear how well most of these private plans are coordinating enrollees' care between Medicare and Medicaid, experts say, and insurers may be attracting some of the less costly dual patients.

  • "Yes, they are the sickest and most disabled and most vulnerable, but within them you have people who are extremely high need and some who are not very high need," said Arielle Mir, vice president of health care at Arnold Ventures.

Go deeper

2. Demand for Alzheimer's drug picking up

Photo: John Tlumacki/The Boston Globe via Getty Images

An uptick in demand for the Alzheimer's drug Leqembi provided a bright spot for Biogen on Tuesday as the biotech missed Wall Street expectations, Axios' Adriel Bettelheim writes.

Why it matters: Biogen continues to feel a financial drag from the withdrawal of its earlier controversial Alzheimer's drug Aduhelm and is trying to affect a turnaround by focusing on newer treatments like Leqembi, which it developed with Japanese drugmaker Eisai.

Details: The company estimated there were 3,800 patients prescribed or close to being prescribed Leqembi as of last week — an increase of about 56% from December, according to an Alzheimer's Association patient registry, per Reuters.

  • But analysts don't expect Leqembi, which in July became the first drug altering Alzheimer's progression to win full approval, to hit a target of 10,000 patients by next month.

Read here

3. EMS care quality varies

Photo: Daniel Acker/Bloomberg via Getty Images

The level of care patients receive in a medical emergency varies widely based on where they're dialing 911.

Why it matters: A first-of-its-kind study of emergency medical service systems' performance across the country points to opportunities to improve patient care when the pressure is on.

What they did: Researchers at the Icahn School of Medicine at Mount Sinai reviewed more than 26 million responses from nearly 9,700 EMS agencies in 2019.

  • They assessed how those agencies performed on safety and clinical quality measures that had been outlined by a nonprofit industry organization that year.
  • The researchers said it's a shift from looking primarily at response times to determine performance, which they say is an imprecise metric for most calls.

What they found: Agencies largely responding in rural areas were less likely to treat low blood sugar or improve trauma patients' pain, researchers found.

  • They were also more likely to use lights and sirens unnecessarily, which other studies have found raises the risk of crashes.
  • Delivery of time-sensitive treatment also varied during EMS calls. For instance, 4 in 10 kids with wheezing or asthma attacks didn't get breathing treatment, and about 1 in 3 suspected stroke patients didn't have a stroke assessment documented.

What they're saying: "We have to move away from solely looking at response times and start looking at performance that directly impacts the people we are meant to treat," said lead author Michael Redlener, an associate professor of emergency medicine.

4. United States of medical debt

Share of adults with medical debt
Data: Peterson-KFF; Map: Tory Lysik/Axios Visuals

About 1 in 12 U.S. adults have unpaid medical bills of at least $250, with people in the South and rural areas reporting the greatest burden of medical debt, according to a study from the Peterson Center on Healthcare and KFF.

The big picture: Medical debt remains a big problem, even for insured patients who struggle to afford co-pays and deductibles. People in poor health, those with lower incomes and those lacking insurance are more likely to struggle to pay medical bills.

Zoom in: South Dakota (17.7%), Mississippi (15.2%), North Carolina (13.4%), West Virginia (13.3%) and Georgia (12.7%) had the highest shares of adults with medical debt on average between 2019-2021.

  • During that time, West Virginia was the only one of those states with expanded Medicaid coverage for low-income adults. (South Dakota and North Carolina have since joined the Affordable Care Act expansion.)
  • Hawaii (2.3%), Washington, D.C. (2.7%) and California (3.9%) had the lowest shares of adults reporting medical debt.

Of note: Though it's hard to pin down exact numbers on medical debt, the report estimates that Americans owed at least $220 billion at the end of 2021.

5. Catch up quick

🩺 Early prenatal tests are becoming more common amid strict state abortion laws. (Associated Press)

🚀 President Biden's cancer moonshot is boosting startups that help patients navigate the health care system. (Modern Healthcare)

🧠 Most employees think it's OK to talk about mental health at work, but some still aren't comfortable with the idea. (CNN)

🦠 Why the bubonic plague is still a thing. (Washington Post)

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