CareDx Q4, Full-Year Revenues Rise on Back of Cash Collections, Test Volumes

 CareDx reported after the close of the market on Monday year-over-year revenue gains of 4 percent for the fourth quarter of 2022 and 9 percent for the full year.

The Brisbane, California-based company finished the three months ended Dec. 31 with $82.4 million in revenues compared to $79.2 million for the same quarter in 2021, narrowly beating analysts' average estimate of $81.7 million. Shares in CareDx were up approximately 20 percent, to $17.65 per share, in Tuesday morning trading on the Nasdaq.

The firm attributed much of the increase to cash collection, which amounted to 110 percent of testing service revenues in the quarter, representing an approximately 10 percent year-over-year rise. The company also said that it provided approximately 47,700 AlloMap and AlloSure patient results in Q4, up 14 percent from the prior-year quarter. Fourth quarter test volume also included 2,300 AlloSure Lung tests.

Testing services revenue for the fourth quarter of 2021 fell 5 percent to $65.4 million from $68.7 million in the same period of 2021. At the same time, fourth quarter product revenues rose 12 percent year-over-year to $8.6 million from $7.7 million. Revenue from patient and digital solutions nearly tripled in Q4 to $8.4 million from $2.9 million.

In a conference call with investors, CareDx President and CEO Reg Seeto commented on the potential for further growth in test revenue, noting that during the fourth quarter, the International Society for Heart and Lung Transplantation announced new guidelines that support expanded use of AlloMap and AlloSure in routine monitoring of heart transplant patients.

"This inclusion in ISHL guidelines should lead to increased reimbursement over time," he said.

Seeto also noted that the company is working with Palmetto's MolDx program to acquire Medicare coverage for AlloSure Lung.

"This potential improvement in coverage represents the single greatest opportunity for the company," he stated.

CareDx's Q4 R&D spending rose 7 percent to $23.6 million from $22.0 million a year ago, while its SG&A expenses grew 7 percent to $48.5 million from $45.5 million a year ago.

Fourth quarter net loss increased to $18.3 million, or $.34 per share, from $16.2 million, or $.31 per share, in the same quarter a year ago. CareDx reported an adjusted loss per share of $.07, bettering the Wall Street expectation of a loss per share of $.09.

CareDx reported $321.8 million in total revenues for 2022, up 9 percent from $296.4 million in 2021. Annual te

sting service revenue rose 2 percent year-over-year to $263.7 million from $259.3 million. Similarly, product revenue rose 9 percent to $29.3 million from $26.8 million in the prior year. Full-year revenue from patient and digital solutions again nearly tripled to $28.8 million in 2022 from $10.3 million a year ago.

The company said that its full-year AlloMap and AlloSure testing volumes grew 19 percent to approximately 182,000 tests.

The company's full-year R&D spending shot up 18 percent to $90.4 million from $76.5 million in 2021, while its SG&A expenses ballooned 29 percent to $196.4 million from $152.2 million a year earlier.

CareDx CFO Abhishek Jain attributed part of the spending spike to clinical study payments and to a partnership-related milestone payment made to an undisclosed entity.

Full-year net loss rose to $76.6 million, or $1.44 per share, from $30.7 million, or $.59 per share in 2021. Adjusted loss per share was $.39, bettering analysts' average expectation of a loss per share of $.41.

Seeto noted that fourth quarter transplant volumes only grew by 2 percent sequentially, part of a downward sequential trend that has continued into 2023, with current quarterly data for the first seven weeks showing a 3 percent decline across all organs.

"One of the key reasons behind this trend is that living donor kidney transplants remain below the pre-COVID levels and staffing shortages [are] continuing in the transplant hospital centers," he said.

However, Seeto stated that the firm sees potential for volumes to double in the next five to 10 years.

CareDx finished the year with $89.9 million in cash and cash equivalents and $203.2 million in marketable securities.

The company said it anticipates full-year 2023 revenue within the range of $328 million to $338 million.

https://www.genomeweb.com/business-news/caredx-q4-full-year-revenues-rise-back-cash-collections-test-volumes

Optum report: Alzheimer's drugs key for payers to watch in Q1

 Payers should be keeping a close eye on developments in the drug pipeline for Alzheimer's disease therapies—and how the Centers for Medicare & Medicaid Services (CMS) responds to those developments, according to a new report from Optum.

Optum released its latest quarterly Drug Pipeline Report, which highlights products coming through the pipeline that payers should be watching. In this edition, the report includes two monoclonal antibody drugs that target beta-amyloid plaques to treat Alzheimer's: lecanemab and donanemab.

This class of drugs has been controversial since the first therapy, Aduhelm, secured accelerated Food and Drug Administration approval in the summer of 2021. Clinical experts had expressed concern about the drug's efficacy and the high price tag.

As a result, CMS issued a restrictive national coverage decision that limits coverage to patients in clinical trials in the absence of full FDA approval. Patient advocates have pushed the agency for greater access.

Optum's report notes that lecanemab, developed by Biogen and Eisai, secured accelerated approval from the FDA in January, while Eli Lilly's donanemab was rejected. Biogen and Eisai have already filed for traditional FDA approval, and Eli Lilly expects to have the data necessary to follow suit in the second quarter of this year, according to the report.

Just how successful the data are for either drug will be critical to watch for insurers making decisions about coverage, Arash Sadeghi, a clinical pharmacist at OptumRx, told Fierce Healthcare.

"What CMS ends up doing in terms of revisiting that policy based on some of this phase 3 trial data is really going to shape how successful these drugs are," he said.

While CMS said it is awaiting those additional data, or a full FDA approval, to take another look at the coverage decision, patient advocates have argued that it should adjust more quickly to allow people with Alzheimer's to access the drug sooner.

In addition to the emerging therapies for Alzheimer's , the report highlights two more drugs of interest in the early part of this year: Roctavian, a gene therapy for hemophilia, and fezolinetant, which treats moderate to severe vasomotor symptoms associated with menopause.

An FDA decision on Roctavian is expected March 31, though it could slip into the second quarter should an additional phase 3 analysis be added to the application, according to the report. Like other gene therapies, if approved Roctavian could carry a hefty, multimillion-dollar price tag.

Sadeghi said payers can prepare now for these pricey therapies to come to market by examining their member populations and identifying the likely areas of greatest need. Using Roctavian as an example, he said that some 30,000 people in the U.S. have hemophilia, but they won't all immediately need to transition to a gene therapy.

The goal is to avoid "payers getting caught off guard" by mounting costs, though the price of these therapies isn't necessarily a shock as more come to market, he said.

The final drug in the report, fezolinetant, would enter a market where it could see significant demand, as between 60% and 80% of women experience vasomotor symptoms either during or after menopause. The front-line treatment for these symptoms is hormone therapy, which may not work as an option for patients with risk of breast cancer, heart disease and stroke.

The drug, produced by Astellas Pharma, could also face future competition from another therapy in the pipeline, developed by Bayer, according to the report.

While fezolinetant could prove an appealing option for some patients, there is a lack of data comparing its efficacy head-to-head with established treatments, many of which are offered as generics, the report said.

https://www.fiercehealthcare.com/payers/optum-report-alzheimers-drugs-key-payers-watch-q1

CMS instructs some billing arbitration decisions to resume following court-ordered pause

 Following the issue of a court-ordered pause to out-of-network payment dispute arbitration, the Centers for Medicare & Medicaid Services is now instructing arbitrators to resume determinations for care that occurred prior to Oct. 25, 2022. 

The notice, published Friday, tells Independent Dispute Resolution (IDR) entities to refer to instructions laid out in CMS' October 2021 interim final rules. That guidance has now been "revised" following early February's decision from the U.S. District Court for the Eastern District of Texas and a prior ruling from July 2022, CMS said. 

CMS had instructed arbitrators earlier this month to hold off on most decisions as the agency worked to interpret the court's ruling (see below the break). 

"Disputes involving items or services furnished before October 25, 2022, are not affected by the February 6, 2023 opinion and order in Texas Medical Association, et al. v. United States Department of Health and Human Services et al.," CMS wrote in the notice.

"Certified IDR entities will continue to hold issuance of payment determinations that involve items or services furnished on or after October 25, 2022 until the Departments issue further guidance. The Departments are working diligently to complete necessary guidance and system updates in order to allow certified IDR entities to resume processing payment determinations for these disputes," CMS wrote.

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Feb. 13, 2023

The Centers for Medicare & Medicaid Services have instructed arbitrators for out-of-network payment disputes to pause and recall certain payment determinations due to a recent court decision striking down key parts of the agency’s surprise billing regulations.

CMS said in a Feb. 10 notice that its departments “are in the process of evaluating and updating” implementation of the Federal Independent Dispute Resolution process to be consistent with a Feb. 6 ruling from the U.S. District Court for the Eastern District of Texas.

The court agreed with the provider plaintiff, the Texas Medical Association, that CMS once again went against the congressional intent of 2020’s No Surprises Act.

The law banning surprise medical bills went into effect at the top of 2022, though CMS has now been forced to amend arbitration—its process for settling payment disputes between providers and payers—for a second time.

Specifically, rules released by CMS outlining how an independent third party should choose between the amounts proposed by each side were successfully contested in court by providers for too heavily weighing on the qualified payment amount, which favors payers.

“[CMS’ final rule released in Aug. 2022] continues to place a thumb on the scale for the QPA by requiring arbitrators to begin with the QPA and then imposing restrictions on the non-QPA factors that appear nowhere in the statute,” Judge Jeremy Kernodle wrote in last week’s decision.

The summary judgment granted by Kernodle vacated certain portions of the rule and remanded it back to CMS.

As a result, CMS instructed arbitrators on Friday to immediately stop issuing new payment determinations until further guidance is available. Further, arbitrators should recall any payment determinations that were issued after Feb. 6, the date of Kernodle’s decision, CMS wrote.

Other parts of the dispute resolution process remain fair game for arbitrators as they await additional direction from CMS, the agency wrote.

The court’s decision to send back arbitration guidelines for a second time was welcomed by the hospital industry. Melinda Hatton, general counsel for the American Hospital Association, said in a statement last week that her group hopes CMS will now “work with hospitals and health systems to implement the fair process Congress intended.”

The Texas Medical Association, meanwhile, has other issues with the administration’s implementation of the No Surprises Act, having recently filed another lawsuit challenging increases to the administrative fees charged when a provider or payer initiates an arbitration dispute.

https://www.fiercehealthcare.com/providers/cms-halts-recalls-billing-arbitration-decisions-after-texas-court-vacates-guidance

DEA's proposed telehealth rules pull back COVID-era remote prescribing flexibilities

 Telehealth providers and advocates are balking at proposed telemedicine rules released by the Drug Enforcement Administration (DEA) late Friday. If made permanent, the rules would be a marked change from the suspension of the  Ryan Haight Online Pharmacy Consumer Protection Act, which propelled a telepsychiatry boom during the COVID-19 pandemic.

Under the proposed rule released by the DEA, developed in concert with the U.S. Department of Health and Human Services (HHS) and in coordination with the U.S. Department of Veterans Affairs, some medications would require an in-person doctor’s visit. Controlled substances (PDF) including stimulants like Adderall and opioids such as oxycodone and buprenorphine used to treat opioid use disorder (OUD) would require at least one in-person visit.

The American Telemedicine Association (ATA) is one of many groups calling the new rule more restrictive than warranted.

“Our concern lies with the potential public health crisis this could cause for individuals needing access to clinically appropriate prescriptions of controlled substances for a wide variety of medical circumstances, including for mental health and substance use disorders,” Kyle Zebley, the ATA’s senior vice president of public policy, said in a press release. “The continuity of care for countless Americans will be severed, potentially leaving these patients to fall through the cracks of our healthcare system without access to needed medications.”

Under the proposed rule, Schedule II medications or narcotics would require (PDF) an in-person prescription. Schedule III or higher medications, including buprenorphine, can be prescribed for 30 days via telehealth but would require an in-person visit before a refill. Non-narcotic drugs like Ambien, Valium, Xanax and ketamine also fall into this category. If a patient is referred to a provider, an in-person appointment is not required as long as one took place with the referring physician.

If a telemedicine relationship was established during the COVID-19 public health emergency, the DEA will extend the in-person exam waiver an additional 180 days.

According to the administration, the new rule seeks to provide safeguards to prevent online over-prescribing of controlled medications. Teleprescribing has been touted as a robust tool for bringing medications for opioid use disorder (MOUDs) to rural areas in the ongoing treatment of the opioid epidemic. 

HHS Secretary Xavier Becerra backed the ruling by emphasizing its leniency compared to pre-pandemic regulations.

“Improved access to mental health and substance use disorder services through expanded telemedicine flexibilities will save lives,” Becerra said in a press release. “We still have millions of Americans, particularly those living in rural communities, who face difficulties accessing a doctor or health care provider in-person. At HHS, we are committed to working with our federal partners and stakeholders to advance proven technologies and lifesaving care for the benefit of all Americans.”

Some have argued that without in-person requirements, companies facilitating the prescribing of Adderall or ketamine have not conducted adequate screenings or follow-up appointments.

In the text (PDF) of the proposed ruling, the DEA emphasized the initial impetus for the Ryan Haight Act, referencing the internet “pill mills” of the early 2000s that led to the death of a California high school student. The text seemed to imply that the “ease of access to the Internet, combined with the lack of medical supervision” could lead to future tragedies if not carefully corralled.

Nathaniel Lacktman, partner at law firm Foley and Lardner LLP, said the proposed rules were both “complex and more restrictive” than regulations for remote prescribing over the last three years.

“For the last year, there have been repeated assurances by HHS, DEA, SAMHSA, ONDCP and the White House that these buprenorphine patients will not fall off the telehealth cliff,” Lacktman wrote in the firm’s blog. “Unless the proposed rule is changed, stakeholders are left to ask: Will DEA’s decision to end telemedicine-only buprenorphine help, or will it harm patients struggling with opioid use disorder and trigger more overdoses and diversion?”

Advocates for remote prescribing have urged the DEA to create a special registration process to avoid a potential disruption in medication. Congress mandated the DEA to craft the process after the passing of the Ryan Haight Act in 2008, but the administration has yet to do so.

“The DEA’s proposed rules are not the special registration process that Congress mandated and could gravely disrupt millions of patients’ treatments and care regimens,” Talkiatry co-founder and CEO Robert Krayn said in a press release. “Instead of taking inspiration from more modern state-level prescribing policy already introduced in Connecticut and Florida, the rules reinstate obsolete and counterproductive in-person requirements under the guise of novelty. There is nothing novel about sending vulnerable patients back into the dark ages of care delivery.”

Talkiatry is one of many companies with a business model that relies on remote prescribing. The telepsychiatry company released a report in January stating that 14,700 of its patients would lose access to their treatment if COVID-era exemptions were to end.

The expanded use of telehealth services during the pandemic was shown to reduce the risk of opioid overdoses, according to a 2022 study published in JAMA Psychiatry. The study, conducted by the National Institute on Drug Abuse, followed 175,000 Medicaid beneficiaries and found that telehealth services led to an increase in OUD treatment access and adherence.

Bicycle Health is a MOUD telepsychiatry company. The company flew psychiatrists to Alabama in July 2022 when the state passed a bill requiring providers to perform one annual in-person visit. Bicycle Health's CEO and founder Ankit Gupta told Fierce Healthcare earlier this month that the company is prepared to take drastic efforts again if necessary.

“Every piece of research we’ve seen shows that teleOUD leads to increased access to lifesaving medications and decreases overdoses—with no evidence of an increase in drug diversion,” Gupta said in a press release. “This rulemaking unnecessarily limits access at a time when it’s needed the most and puts thousands of lives at risk. We plan to work with the DEA during the public comment period toward common sense revisions.”

The proposed changes will now enter a 30-day public comment period.

https://www.fiercehealthcare.com/telehealth/deas-proposed-telehealth-rules-tighten-covid-era-remote-prescribing-regulations

As SNAP benefits wane, 'food-as-medicine' horns in

 The end of COVID-era food and nutrition benefits is bringing an ebb to the Supplemental Nutrition Assistance Program (SNAP) in 32 states as of March 1. With a quickly approaching cliff and 18 states already having lost emergency benefits, digital food-as-medicine programs are bringing resources to the table.

Historically called food stamps, 41 million Americans receive the benefit that expanded at the beginning of the pandemic. At the end of the month, it is estimated that 16 million Americans will receive about $90 less a month. Some beneficiaries with the greatest need will lose up to $258 monthly, and further cuts are being proposed by Republican lawmakers who want more stringent eligibility requirements for the federal program.

Food-as-medicine programs have long been seen as a niche corner of healthcare. However, some even consider SNAP benefits as a food-as-medicine program. As value-based care gains traction, social determinants of health moves from a buzzword to common healthcare scaffolding and SNAP benefits get clipped, organizations like Instacart, FarmboxRx and About Fresh are expanding their reach.

“Our goal is to put more food on the table for more families,” said Instacart Chief Corporate Affairs Officer Dani Dudeck in a press release. “As grocery budgets tighten for millions of SNAP recipients and lines stretch longer at food banks across the country, accessing affordable, nutritious food has never been harder. At Instacart, we’re committed to finding more ways to support food banks nationwide so they can continue to serve their communities and feed more families.”

Instacart announced a Community Carts campaign along with an extension of its discounted Instacart+ membership for SNAP recipients. Anyone using an Electronic Benefit Transfer SNAP card to buy groceries on Instacart will continue to be eligible for a membership at half the standard price for one year.

By expanding its Community Carts initiative, the grocery tech company is hoping to drive donations to food banks. Starting March 1, food items can be donated via Instacart to over 120 food banks in 47 states with delivery service fees being waived.

Instacart’s food-as-medicine pillar includes various alliances such as Good Measures and its partner WellCare of Kentucky. The collaboration makes food prescription programs available to Medicaid members who have been screened for high blood pressure.

Currently, traditional Medicare is barred from covering food whether it be medically-tailored meals or produce prescriptions.

“While $90 a month may not seem like much to some people, it's a massive blow to the overall budgets of those who rely on SNAP to survive, especially during a period of record-high inflation,” FarmboxRx founder and CEO Ashley Tyrner told Fierce Healthcare in an email. “Dramatic cuts like this to SNAP budgets without alternative safety nets in place for those who have come to rely on these programs will trickle down to hit already over-burdened Medicare and Medicaid budgets.”

While food-as-medicine is still not covered by most insurers, reimbursement strategies are taking shape.

FarmboxRx is a food delivery service partnering with Medicaid and Medicare programs as an Advantage Benefit. Recipients may use an Over the Counter Card benefit or a Healthy Food Card benefit to purchase healthy food through the platform. People with private plans like Commonwealth Care Alliance and Health Partners Plans can also be reimbursed for medically tailored recipe boxes or produce.

Food-as-medicine programs have seen growing interest since September when the White House hosted the first Conference on Hunger, Nutrition and Health in 50 years. At the conference, private and public sector commitments totaled $8 billion for health and nutrition programs and research endeavors. Kaiser Permanente pledged $50 million to address key areas including coordinating with publicly funded programs to support members experiencing food and nutrition insecurity or diet-related diseases.

The Rockefeller Foundation and the American Heart Association along with inaugural partners including Kroger announced a $50 million plan to build a national Food is Medicine Research Initiative. Many experts in the field feel that what has been lacking is concrete evidence supporting the movement, a gap in knowledge the research initiative is hoping to fill.

About Fresh, a food-as-medicine startup, began addressing nutrition insecurity by turning school buses into grocery stores. When the nonprofit launched, Bostonians paid for produce with grant-funded coupons. Now, About Fresh provides a prepaid debit card.

About Fresh integrates its HIPAA-compliant platform into provider workflows including electronic health records and third-party referral platforms. Through integration with FIS, an IT service management company, cards can be used at Walmart, Kroger stores and Albertsons.

Founder and CEO Josh Trautwein has seen food-as-medicine gain traction as About Fresh has evolved with the movement. He sees a future where, like in the early stages of drug development, About Fresh functions as a nonprofit research laboratory. Only through this data collection can health systems learn prescription dosage, outcomes and limitations, Trautwein told Fierce Healthcare.

In December, the Rockefeller Foundation granted About Fresh nearly $900,000 to begin a “large-scale food is medicine demonstration project” with the VA. While the exact dimensions of the study have yet to take shape, Trautwein thinks it’s a first step to large-scale healthcare and government buy-in to addressing nutrition insecurity.

“It's almost more important than expanding our program because we want to contribute to the system's change in healthcare,” Trautwein said. “That's going to create the context for healthcare investment in food as medicine.”

Seana Weaver, Fresh Truck managing director at About Fresh, told Fierce Healthcare that "the end of the SNAP Emergency Allotments will create a huge strain for household food budgets throughout the country, especially those with children." She added that in Boston, the company's Fresh Truck Mobile Markets "are a place for families to stretch their SNAP dollars by using the Healthy Incentive Program to purchase fresh fruits and vegetables."

Policymakers face their own looming deadline with a federal law, known as the farm bill, authorizing agricultural subsidies and nutrition programs including SNAP set to expire at the end of September.

SNAP EBT cards themselves have also been a hot topic with recent waves of benefits being stolen. Unlike a debit or credit card which might warn of fraud, SNAP benefits have not always been historically protected. A lawsuit on behalf of New York state residents was filed this week against the Department of Agriculture to require the replacement of stolen funds.

https://www.fiercehealthcare.com/digital-health/snap-benefits-wane-food-medicine-platforms-carve-out-niche-healthcare

UHS: Wait until H2 for margin growth

 Universal Health Services executives are warning investors that it'll likely take until the second half of 2023 for revenue and volume recovery to catch up with labor rate increases and other rising expenses that have hammered providers' finances over the past year. 

Speaking in UHS' Tuesday morning earnings call, President and CEO Marc Miller described 2023 as "a year of continued transition into a post-pandemic world."

The acute hospital and behavioral health facility operator expects it will be able to cut down its premium pay expenses by a third from 2022's elevated levels, representing roughly $150 million to $160 million in reduced spending. Hiring rates and worker turnover should also improve in the coming year, Miller said, and the behavioral health segment in particular has shown "encouraging" operating indicators during the first several weeks of the year. 

Still, the resulting margin improvement will likely be "incremental" and are being offset by inflation and labor shortage-fueled wage pressures, executives said.

"Where we're at in both businesses is that ... even though revenues are recovering particularly on the behavioral side, salary expense or wage expense is still outpacing the growth in revenues," Steve Filton, executive vice president and chief financial officer, told investors. "We believe that by the second half of 2023 that begins to sort of stabilize and we start to get to a more normalized historical pattern of revenue growth exceeding salary growth. But in the first half of the year that's not the case and, again, I think that's probably the main driver of the margin pressure next year."

Filton told investors that UHS expects that the second half of 2023 should resemble the same period in 2019 and that "unless there is some unforeseen development, [2024] begins to look like a really true post-pandemic year."

UHS capped off 2022 with a quarterly net income of $174.8 million ($2.43 per diluted share) and a full-year net income of $675.6 million ($9.14 per diluted share), the company announced in earnings results posted Monday after market close.

The fourth-quarter and annual performances fell below 2021’s respective $239.1 million ($3 per diluted share) and $991.6 million ($11.82 per diluted share).

While the quarter's numbers were slightly above consensus market estimates as recorded by Seeking Alpha, the company's conservative projections for 2023 led UHS stock price to drop roughly 10% by midday Tuesday.

Net revenues for the quarter increased 5.2% year over year to $3.45 billion, again beating the consensus market estimate by about $50 million. Operating expenses grew 7.5% to $3.19 billion, leaving operating income at $261.3 million in the fourth quarter (down 16.7% year over year).

Across the year, net revenue rose 6% to $13.4 billion. Operating expenses grew 9.9% to $12.4 billion, with operating income landing at $1 billion (down 26.4% year over year).

UHS highlighted a 5.5% year-over-year increase in quarterly adjusted admissions and a 1.6% increase in adjusted patient days, though net revenue per adjusted admission fell 3.8% and net revenue per adjusted patient day dipped by 0.2% . Full-year volumes saw a 3.1% increase in adjusted admissions, a 0.9% increase in adjusted patient days, a 0.3% dip in net revenue per adjusted admission and a 1.9% increase in net revenue per adjusted patient day.

Speaking to investors, Miller and Filton said that the acute care business's softer per-job revenues the result of lower case acuity. This was due in part to a drop in the number of COVID-19 inpatients and the ongoing shift to outpatient care—Filton, for instance, noted that fourth quarter surgical volumes were up "3% or 4%" from the same time in 2019, with outpatient procedures up "probably 7% or 8%" and inpatient procedures "sort of flattish."

In the behavioral health segment, adjusted admissions for the quarter rose 0.7% year over year, adjusted patient days grew 2%. Net revenue per adjusted admission increased by 3.4% as net revenue per adjusted patient day rise by 2.2%. For the year, adjusted admissions were up 0.7%, adjusted patient days grew by 1.2%, net revenue per adjusted admission rose 4% and net revenue per adjusted patient day increased by 3.5%.

Here the winding down of COVID-19 has been an unconditional boon for UHS, namely due to the greater supply of labor that allowed behavioral hospitals to cut down the number of capped beds to "a few hundred ... we would consider capped on most days," Filton said.  

UHS’ $174.8 million net income for the quarter includes after-tax commercial insurance proceeds of $19.6 million tied to business interruption and property damage at one of its facilities and an IT incident. The quarter also includes a $42.3 million after-tax hit that largely came from a Las Vegas hospital’s asset value write-down.

Looking ahead, UHS forecasted 2023 full-year net revenues between $14.04 billion and $14.31 billion. It expects adjusted EBITDA net of non-controlling interests in the range of $1.55 billion and $1.75 billion, translating to $9.50 to $10.50 adjusted earnings per diluted share. The company plans capital expenditures between $725 million and $875 million.

King of Prussia, Pennsylvania-based UHS operates 28 inpatient acute care hospitals, 331 inpatient behavioral health facilities, 39 outpatient facilities and other locations across 39 states. It employs nearly 94,000 people.

https://www.fiercehealthcare.com/providers/uhs-beats-street-profits-175m-q4-6756m-across-2022

Clover Health slims losses in Q4 as it puts focus on profitability

 Medicare Advantage insurtech Clover Health posted an $84 million loss in the fourth quarter, shrinking its losses year over year, according to the company's earnings report released Tuesday.

By comparison, Clover reported a $187.2 million loss in the fourth quarter of 2021. For the full year 2022, Clover posted a $338.8 million loss, down from the $587.8 million loss reported for the full year 2021.

Revenues grew substantially year over year, according to the report. Clover reported $898.8 million in revenue for the fourth quarter and $3.5 billion in revenue for the full year 2022. By comparison, it brought in $432 million in revenue during the fourth quarter of 2021 and $1.5 billion for the full year, according to the report.

Clover's top brass said in the company's earnings release that a major focus heading into 2023 will be on reaching profitability.

"In 2023, accelerating our path to profitability is our top priority, and I am excited by Clover Assistant's role in helping physicians identify and manage chronic diseases earlier, which improves care for Medicare beneficiaries," CEO Andrew Toy said in the release (PDF).

Clover Health's insurance membership grew to 88,627 people at the end of 2022, up from 68,120 the year prior. Members in its non-insurance products grew by an even wider margin, reaching 164,887 at the end of December compared to 61,876 on Dec. 31, 2021.

In its outlook for 2023, Toy said the insurer priced its products with that profitability focus at the forefront. The company expects between $1.15 billion and $1.2 billion in insurance revenue as well as between $750 million and $800 million in revenue from its non-insurance product lines, according to the report.

Clover expects its insurance medical cost ration to land at between 89% and 91% for 2023.

"I'm pleased we are achieving real momentum towards profitability," Toy said. "We intentionally priced our Insurance plans for 2023 with profitability in mind while still expecting to grow our top-line Insurance revenue. We believe this, coupled with a maturing membership base and increased reimbursements based on our improved star ratings, will enable us to achieve continued meaningful improvement in our Insurance MCR in 2023,"

https://www.fiercehealthcare.com/payers/clover-health-slims-losses-q4-it-puts-focus-profitability