| A new report from a federal watchdog found that three of the nation’s largest Medicare Advantage insurers routinely denied requests for post-acute care services, which could intensify scrutiny of prior authorization practices in the rapidly growing program. The Office of Inspector General for the Department of Health and Human Services examined more than 2,000 prior authorization decisions made in June 2024 by Aetna, UnitedHealthcare and Humana. → That’s the subject of the latest report from The Post’s Christopher Rowland. - The OIG focused on services often needed after a hospital stay, including long-term acute care hospitals and inpatient rehabilitation facilities. Delays or denials can leave patients stuck in hospitals longer than necessary or without access to specialized recovery services.
- The report found denial rates for long-term acute care hospitals ranged from 70 percent to 80 percent, while denials for inpatient rehabilitation services exceeded 50 percent across all three insurers.
Why it matters: More than half of Medicare beneficiaries — roughly 35 million people — are now enrolled in Medicare Advantage plans, giving a handful of insurers enormous influence over access to care. “As enrollment in Medicare Advantage continues to grow, so does the urgency and importance of ensuring that [insurance companies] are delivering on the value that the federal government pays them to provide,” the OIG report said. Complaints about Medicare Advantage coverage denials are nothing new, but the report underscores the potential impact they can have. The Centers for Medicare and Medicaid Services, which oversees the Medicare Advantage program, has been working with insurers over the last year to scale back their use of prior authorization. What to watch: The report could add fuel to several legislative proposals on Capitol Hill that would require insurers to submit more information about claim denial rates and, for Medicare Advantage plans specifically, additional encounter data related to patient care. - The OIG report found for-profit Medicare Advantage organizations denied coverage more frequently than nonprofit plans, a pattern investigators said suggests financial incentives may play a role in utilization management decisions.
→ But the report’s data predates pledges that private insurers have made to decrease use of the practice for all consumers. Companies have reported early progress in reducing prior authorization for many services. “This report reflects data from 2024. Since then, health plans have voluntarily eliminated roughly 6.5 million prior authorizations across markets — including more than 15 percent in Medicare Advantage,” said Mary Beth Donahue, president and CEO of the Better Medicare Alliance. Insurers also pointed to previous findings, including ones from the HHS watchdog in 2018, that raised concerns about whether many inpatient rehab facilities met Medicare’s standards or were providing unnecessary care that ultimately harmed patients. “The reports ignore serious, well-documented concerns about wide variations in the cost and quality of post-acute care and skilled nursing facilities,” said Chris Bond, a spokesperson for insurance industry group AHIP. BUT WAIT, THERE’S MORE → A companion report issued by the OIG also renews scrutiny of insurers’ use of contractors to conduct prior authorization reviews. Investigators found a UnitedHealth Group subsidiary, formerly known as NaviHealth, denied nursing home care more frequently than insurers themselves or other vendors. - The subsidiary, which rebranded to Home & Community Care in 2024, has allegedly used an algorithm to determine care needs. The OIG report doesn’t mention the reported algorithm usage.
- UnitedHealth Group has maintained that coverage decisions are always made by a human, thereby rejecting claims that the algorithms led to improperly denied care.
- However, the claims are at the center of an ongoing lawsuit filed by the families of deceased Medicare Advantage patients.
The inspector general is urging CMS to take action to ensure plans are not improperly denying care. CMS officials told Christopher the agency is examining insurance denials by collecting data through a pilot program and conducting audits. The agency added that it “will continue using its full range of oversight and enforcement tools to identify potential issues, hold plans accountable and strengthen program integrity while protecting beneficiary access to care.” Read the full story: “Seniors needed long-term care and rehab. Their private Medicare plans said no.” 48 percent That’s the percentage of independent voters who said they have less trust in health recommendations that come from the Trump administration’s leadership of health agencies than they did before Trump took office. Just 15 percent of independent voters said they trusted new health agency leadership more. The figures come from a recent poll published by the Harvard T.H. Chan School of Public Health and the de Beaumont Foundation’s Public Health Listening Lab. Why it matters: While President Donald Trump won’t be on the ballot in November, sentiment about his administration could influence how voters react at the polls. While the extent to which trust in the administration’s health leadership will impact individual races largely depends on the specific state, the national perception gap still matters because voters have been pointing to health care ranks as a top concern. Those concerns could ultimately shape broader views about Republicans, which could prove to be a crucial metric for those in competitive races who need to sway independent voters. → Another new analysis, released on Wednesday, found that nearly half of Americans ages 18 to 64 reported that they struggled to pay for their health care last year. For about 35 percent, unaffordability meant they or someone in their family put off receiving needed care, according to the survey by the Robert Wood Johnson Foundation and the Urban Institute. When talking about Trump administration policies that could impact voter sentiment, two major themes have emerged — public health and policies involving vaccines, and the rhetoric around transforming what Americans eat. There’s been much ink spilled about how administration officials are trying to focus more on food-related health initiatives than changes to the immunization schedule, which tend to be less popular with voters. The Harvard T.H. Chan School of Public Health and the de Beaumont Foundation poll adds additional data points supporting that strategy, while also suggesting trust in vaccines may be wavering. VACCINES - Vaccine safety: Overall views on vaccine safety remain high — even among varying political parties — with almost all Republicans (85 percent) and Democrats (96 percent) saying they trust vaccine safety.
- However, the amount of people who believe that childhood shots are “very safe” is on the decline: Fifty-seven percent of Americans reported that childhood vaccines are very safe, compared to 63 percent who said so last year. The figure matches pre-pandemic levels in 2019, when 54 percent said vaccines were “very safe.”
- Childhood vaccination requirements: Seventy-seven percent of Americans expressed support for a requirement that children receive routine shots before being able to attend school, including 91 percent of Democrats and 65 percent of Republicans. Last year, 79 percent of Americans supported the requirements and, in 2022, 74 percent supported them.
DIETARY GUIDELINES - Sentiment of new dietary advice: More than 80 percent of respondents agreed that the guidelines contain “advice that is widely agreed on, like eating whole, ‘real food,’” and 73 percent agreed that the updated guidelines have a “common-sense approach that makes them easier to understand.”
However, half of the respondents — including 36 percent of Republicans — said the guidance had been “influenced too much by ‘big agriculture’ like the beef or dairy industry.” | “It is an extraordinary number. … What specialties do they represent? Why so many?” Jonathan Reiner, a longtime cardiologist for former vice president Dick Cheney | | | | That quote comes from a story from The Post’s Dan Diamond and Isaac Arnsdorf, who found in Trump’s medical disclosures that 22 specialists had evaluated his health during the president’s most recent checkup. → The disclosure, revealing that Trump appears to have been evaluated by more clinicians in a single visit than his modern predecessors, has spurred questions from outside physicians who said they were already skeptical of the White House’s disclosures around the nearly 80-year-old Trump’s health. White House officials told my colleagues that the number was commensurate with the need to perform a “complete and preventive evaluation” of the president. Sean Barbabella, the president’s physician, said the assessment found that Trump was in “excellent health.” “The involvement of multiple specialists reflects a comprehensive, multidisciplinary evaluation consistent with best practices for executive-level medical care,” the White House said in a statement. A White House official told The Post that some generalist physicians were included in the administration’s count of 22 specialists. Read more: “Trump sees 22 medical specialists, appearing to set new bar for presidents.” | “We continue to believe this is going to be a big tent.” Neerja Balachander, vice president of U.S. clinical development at Boehringer Ingelheim | | | | The quote is a snapshot of how the pharmaceutical industry believes the GLP-1 market boom isn’t slowing down. It comes from a story from Christopher about how companies are trying to innovate additional drugs in the category. While Eli Lilly and Novo Nordisk have so far dominated the market with their blockbuster offerings — Mounjaro and Wegovy, respectively — companies including Amgen, Pfizer and Roche are tweaking these medicines to lessen negative side effects, among other improvements. Boehringer Ingelheim, in particular, has a GLP-1 medication in development that it says has been shown in studies to target “visceral” fat, which is in the ab | 
