Healthcare - USAFacts

Our nation, in numbers:

Government data from over 70 sources organized to show how the money flows, the impact, and who "the people" are.

From health insurance to prescription drug prices, the cost of healthcare has been a political issue for decades. There’s a good reason for that: In 2018, $3.7 trillion was spent on healthcare-related goods and services, 18% of the nation’s gross domestic product. The issue encompasses several government programs, with Medicare (which primarily serves the 65+ population) and Medicaid (for low-income people) being the best known. Beyond government healthcare programs, private insurance is also an important aspect of this issue.

Covered by public or private health insurance

(%)National spending on healthcare goods and services

Healthcare Expenditures as % of GDP

Share of uninsured Americans increases for the first time since ACA went into effect, Census data shows

The number of uninsured Americans increased by 1.8 million between 2017 to 2018, increasing the percentage of Americans without health insurance by 0.6 percentage points.

The uptick represents the first increase in the percentage of uninsured Americans since 2014, when the bulk of the provisions of the Affordable Care Act went into effect.

The data was released by the Census Bureau Tuesday in its annual Health Insurance Coverage in the United States report.

How Americans get insurance

The individual mandate, a provision of the Affordable Care Act, was still in effect in 2018 requiring health insurance in lieu of paying a tax penalty. For 2019, the tax penalty was lowered to $0, effectively ending the individual mandate.

At the state level, 25 states had a higher share of uninsured in 2018 compared with 2017, with Hawaii and Idaho experiencing increases by more than 1 percentage point.

The share of those uninsured increased across age groups, excluding slight decreases for those 26 to 34 years old and those 65 and older.

The share of those uninsured, by age

Age group	% uninsured in 2016	% uninsured in 2017
Under 65	9.2%	10.0%
Under 19	5.0%	5.5%
19 to 64	11.0%	11.7%
19 to 25	13.7%	14.3%
26 to 34	14.0%	13.9%
35 to 44	11.4%	12.5%
45 to 64	8.3%	9.3%
65 and over	1.0%	0.9%

How does the census compile health insurance data

The US Census Bureau releases data on health insurance rates using two different measures. Its Current Population Survey Annual Social and Economic Supplement (CPS ASEC) is conducted between every February and April, asking respondents if they had health insurance at any point during the previous calendar year. Data used in this report from prior to 2016 had a different data processing approach to the post-2017 statistics.

The agency also asks about health insurance coverage in its American Community Survey. Unlike the CPS ASEC, that survey asks respondents if they are covered at the time of questioning. This data is used to provide estimates at the state and local levels.




Healthcare - USAFacts:

How to Choose Your Primary Care Physician

How-does-one-select-the right-physician-as-patient ?

This is not an easy thing to do..However, there is a plan which can help you decide.  If you are well established in the community you may or may not have your own physician and you can ask a friend or a fellow employee who their physician is and if they like them?  If it is for a general physical examination when you are well some experts feel the annual physical examination is almost useless.  There are recommendations for screening tests, such as mammograms, EKG, stress testing. Your family history also is important for diseases that can now be suspected with genetic testing. Breast cancer is one where a gene BCRA can be found. History is very important. Heart disease has no specific genetic markers, but testing for lipid disorders helps and can reveal increased risk factors. Other diseases are recommended for colon cancer (colonoscopy).

Here are 10 tips on how to choose the right primary care doctor for you.

1. Ask around.

The first step to finding a great doctor: Talk to your family and friends about their great doctors. A recommendation from someone you trust is a great way to identify a highly-skilled, helpful physician. But remember: Every person is different. Just because a doctor was perfect for your neighbor or your best friend doesn’t mean that he or she is right for you.

2. Map it out.

Since you’ll be visiting your primary care doctor for everyday health needs, it’s important that he or she be located somewhere convenient to you. You won’t want to travel very far when you’re not feeling good. And if your doctor’s office is conveniently located, you’ll be more inclined to keep appointments for physicals and other preventive care when you’re healthy. If you’re enrolled in a Medicare Advantage plan, check if it offers transportation benefits, which can come in handy if you need help getting to and from your doctor appointments.

3. Make sure you’ve got coverage.

Once you’ve identified some possible candidates, check whether they work with your health plan. If you have traditional Medicare, call the doctor’s office and ask if he or she accepts Medicare patients. If you have a Medicare Advantage plan, call your insurance provider or check your plan’s website to see if the doctor is in your plan’s network. Most plans charge more if you see a doctor outside the network, and some won’t cover out-of-network care at all, so it’s important to take this step before scheduling an appointment.

4. Do a quality check.

Chances are you wouldn’t hire someone to make repairs in your home without doing a little research into the quality of their work. So why would you choose a doctor without doing the same?

If you have a Medicare Advantage plan, check with your insurance company to see if they have any information about the quality ratings of specific primary care doctors in your network. You can also use the Physician Compare tool on Medicare.gov to see if your doctor has participated in any activities that indicate he or she provides high-quality care.

Finally, check to see whether your doctor is board-certified through the Certification Matters site, which the American Board of Medical Specialties maintains. Board-certified primary care doctors have not only met the licensing requirements of their states, but also passed comprehensive exams in internal medicine. Doctors also have to keep up with the latest developments in their fields to maintain their certification, so you can be sure they’re giving you up-to-date advice.

5. Place a cold call.

Castillo advises that patients call a potential doctor’s office for a first impression of the practice.

“You can tell a lot by the phone etiquette of the office staff,” Castillo said. “Ask if they’re taking new patients and see how they answer. If they say, ‘The next appointment is in 90 days, have a great day,’ that’s a lot different than saying, ‘He’s really busy, and we always make time for existing patients, so it might take us some time to fit a new patient in.’”

6. Ask about logistics…and consider scheduling an in-person meeting.

Castillo recommends asking questions during that initial call that provide a sense of how the office runs. How does the office handle prescription refills? How do they let you know about test results? Can you email your doctor or schedule appointments online? Will the office call to remind you if you’re overdue for an annual screening or a flu shot?

When Castillo was in practice, some patients would ask for quick in-person conversations before making an appointment. Not all doctors will be able to accommodate such requests, but it doesn’t hurt to ask.

7. Keep your needs in mind.

Every person has unique health needs, and those needs change as people age. Castillo suggests asking your doctor about his or her specialties or areas of interest.

“Some primary care doctors are really good at sports medicine, but if you’re not a serious athlete in your senior years, that may not be helpful to you,” Castillo said. “Some doctors, on the other hand, may have a special interest in diabetes care or have a large population of diabetics in their practice. Those are things to ask when you call.”

And if you have multiple complex medical issues, you may benefit from seeing a geriatrician, Castillo said. Geriatricians specialize in the care of older patients.

8. Look at the bigger picture.

At the first visit, it’s important to make sure your doctor’s philosophy of care lines up with your own. Consider asking these questions: Why did the doctor decide to go into primary care? What is his or her favorite thing about being a doctor? What does he or she wish more patients would do after they leave his or her office? If your doctor’s outlook on patient care meshes nicely with your preferences, you’ll be more likely to follow his or her recommendations in between appointments. So take this information into consideration when deciding whether to stick with a doctor following your first appointment.

9. Avoid culture shock.

Every culture has its own customs, ideas, and taboos about medical care, so find a doctor who not only speaks your language but is sensitive to your cultural and religious convictions.

“In some cultures, it’s very easy to joke around, and in other cultures, that is just not the way you do things,” Castillo said. “It’s important that your doctor is culturally aware.”

10. Trust your gut.

Your primary care doctor is going to be a problem-solver and an important advocate for your health. It’s critical that you trust him or her and feel comfortable asking questions.

The American Academy of Family Physicians recommends that after your first appointment, you ask yourself the following questions:

• Do you feel at ease with this doctor?

• Did you have enough time to ask questions?

• Did he or she answer all your questions?

• Did he or she explain things in a way you understood?

If something seems off, trust your instincts and look for a new doctor, Castillo advised.

“You should be comfortable with your primary care doctor,” Castillo said. “It’s really about what you expect and need. It’s OK to say, ‘This person is not the right fit for me.’”

Plans are insured through UnitedHealthcare Insurance Company or one of

There are four categories to evaluate in a primary care physician (Family doc, or GP)

Accessibility
Affability
Affordability
Advocacy

What to do

You can also ask the doctor what journals he reads and how often. If he questions why you want to know...tell him it is important to you to know he continues his medical education. Medicine is a profession that requires continuing medical education. Trust your gut reaction.  How do you react emotionally to a doctor?  Does he listen more than he talks? Or does he have a fast answer?  Good doctors pause and ask more questions.
If you are fortunate enough to live near a School of Medicine, check with them. Physicians in a university setting are well-vetted and work closely with specialists. The U.S. News publishes a list of best hospitals for specific diseases. The hospitals do not pay to be on this list.

What not to do

Avoid 'Best Doctors in America"
Avoid doctors who advertise on TV, Radio, Newspapers and even the Internet.
Avoid 'health screening' fairs". 

Listen to the Podcast from Peter Attia M.D.  If you like it subscribe to it.




























http://hwcdn.libsyn.com/p/8/1/1/81103f841778d345/Q109P_-_How_does_one_select_the_right_physician_as_a_patient_FINAL.mp3?c_id=62504492&cs_id=62504492&expiration=1581874559&hwt=6c02351ba930fc8ba5e40f00930b13b3

How Much Are Health Systems Spending on Social Determinants?

 A new study found that health systems are making sizable investments in social determinants of health programs, with more addressing housing insecurity.

Hospitals and medical groups now realize the significant impact upon health,  chronic illnesses, outcomes and a reduction of readmissions.  This may be due to Medicare's quality measure for rates of readmission. CMS penalizes hospitals for increased readmission rates. Thorough discharge planning can make a difference. Although skilled nursing facilities (SNF) make a difference they are not always necessary if alternative non-medical housing can make a difference.


California, with Los Angeles and San Francisco and Seattle, WA.  high on the list for homelessness. State governments are now reacting to crisis planning on significant amounts of money to help correct the problem.  The rate of homelessness in Medi-Cal beneficiaries increases the cost of health care to taxpayers.  In the long run, ameliorating the homeless can offset or decrease health expenditures. If you are homeless there is no access to mail, no street address, probably no transportation unless you live in a car or van. Homelessness is a bad place, with poor hygiene

Health systems are making significant investments in programs that address social determinants of health, such as housing, employment, and food security, according to a new study published in Health Affairs.

Dig Deeper

Social Determinants of Health Impact Hospital Readmission Rates

How Addressing Social Determinants of Health Cuts Healthcare Costs

Social Determinants of Health Key to Value-Based Purchasing Success

Ridesharing can overcome missed appointments when hospitals share cost or contract with Uber or Lyft to provide transportation.  Missed appointments contribute to deterioration and lower ED visits. Transportation is a key social determinant impacting patient outcomes. Without access to reliable, affordable, and convenient transportation, patients miss appointments and end up costing providers.

Missed appointments and care delays cost the healthcare industry $150 billion each year, and individual organizations lose revenue for every patient who does not show up for a scheduled appointment.

Patients without transportation are also less likely to adhere to medication regimes. One study found that 65 percent of patients felt transportation assistance would enable them to fill prescriptions after discharge. Other research has also shown that Medicaid reimbursement restrictions for transportation payments resulted in fewer prescription refills.

“There is a strong business case for hospitals and health systems to address transportation needs since individuals experiencing these issues are more likely to miss appointments or not fill prescriptions, leading to delays in care and potentially to disease progression and complications or readmissions,”  To recoup revenue and improve care quality, some health systems like MedStar Health and Denver Health Medical Center are teaming up with Uber, Lyft,

In the analysis of public announcements of new social determinants of health programs operated by US health systems from Jan. 1, 2017, to Nov. 30, 2019, researchers from New York University uncovered at least a $2.5 billion in investments from 57 health systems that collectively included 917 hospitals. The health system funds were allocated to 78 unique programs launched during that time.

About two-thirds of the total investment ($1.6 billion) was specifically committed to housing-focused efforts, followed by employment (28 programs, $1.1 billion), education (14 programs, $476.4 million), food security (25 programs, $294.2 million), social and community context (13 programs, $253.1 million), and transportation (6 programs, $32 million).

“Historically, hospitals have tended to provide community benefit through uncompensated or subsidized care rather than through investment in activities not directly related to health,” they wrote in the study. But now, health systems have found a new strategy to improve outcomes and lower costs outside the walls of their organization.

Announcing a New Format and Theme for Health Train Express

I was reviewing statistics for the blog.  I began writing Health Train Express in 2005-2006. I wanted to review how many articles I published since then.  All told 2360 made it to the worldwide web.  I found  152 in my unpublished vault.  Thank you Ms. Blogger.  You are not the fanciest blogging tool nor the most popular. Each time I was unfaithful to you I would wander over to others, such as WordPress, and many others. They each have their own charm, some difficult to resist. However, I always returned to my first love.  She has been a 'keeper'.

Even fickle Google has been faithful to it's the affair, never downgrading her, despite many mergers, and acquisitions,  through it all...Google +, Google Hangouts, Alphabet, Google Health, Google Glass, Feedburner, and 50 other Google Fails. I am set in my ways, I like things simple....they don't break.  Blogger has never broken on me...no weird messages, except when I use a google extension named add-to-any. It gives me a 'whoops, there is something wrong with the URL". Apparently, there is a limit on the number of characters it can forward.  No matter, I did a workaround (or I guess a hack as my grandchildren tell me). I use a tiny URL that works just fine.

So don't get me wrong I am not a Luddite and have always been a certifiable nerd, going all the way back to 8th grade.

Three years ago I caved in and bought a smartphone, An android Galaxy S8+, followed in six months with a Galaxy S8 Note.  My brother had one, and I thought the pen was cool. It was an impulse buy, I bought it because my fingers twitch and my left hand has a tremor.  It does make dialing my phone easier.  Google Assistant has taken over most of my tasks. "Call......Test.....Open......(almost whatever you want).  I have programmed my phone to ask Alexa different questions....they talk all-day.

This post has gone way off target....I think dementia may play a part.

So enjoy the new format.  It is easy to skip around to any post since 2005.

Physicians, No need for Burnout

In the past year, there has been increased attention to stress on physicians that lead to burnout. In a recent article in the Journal of the American Association, several factors can immunize doctors against burnout.

Sara Berg
Senior News Writer
American Medical Association

Physician burnout is a multifactorial problem that is not easily solved. A systems approach is recommended to reduce physician burnout and foster professional well-being says a report from the National Academy of Medicine. But as system-level solutions continue to be developed, what helps some physicians avoid burnout?

Committed to making physician burnout a thing of the past, the AMA has studied and is currently addressing issues causing and fueling physician burnout—including time constraints, technology, and regulations—to better understand and reduce the challenges physicians face. By focusing on factors causing burnout at the system-level, the AMA assesses an organization’s well-being and offers guidance and targeted solutions to support physician well-being and satisfaction. 

Authors of the consensus study report published by the National Academy of Medicine, Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being, call for immediate action from the health care system to combat physician burnout and improve professional well-being. The book can be bought or downloaded (free) by clicking on the above link.

Work system factors continue to contribute to physician burnout and professional well-being. But here are four individual factors that may help doctors prevent the development of burnout.

Physician burnout: 4 types of interventions and how they can help

Here are four steps to take when creating an effective physician well-being program in your organization or school.

Identify existing goals and processes. This first step is divided into two parts. In step A it is important for teams to identify existing goals and processes. “For us that was doing an environmental scan of the Canadian medical schools—what’s already been offered over there?” said Hastings-Truelove. “So, what does our starting point look like?”

And the second part of this step involves identifying target processes and goals. This is where experts compile their “wish list of what standard physician wellness would look like—where do we want to get to?” she said.

Look at system interaction. “We started thinking about the different levels involved in physician wellness, so the individual, the organization and the culture,” said Hastings-Truelove. “So, what are the interactions between these three levels?” Understanding that will help organizations figure out where to begin.

Discover transition interactions. Part of this is identifying the difficulty in making this change for an organization. “There’s lots of evidence that’s available,” she said. “Lots of people are doing different things with physician wellness, but it hasn’t really been compiled into one place.” With so many pilot programs, part of this is bringing together the wealth of evidence. While people and organizations are working on improving physician burnout through well-being initiatives, what works?

Survey the stakeholders. Hearing from experts in the field is an important step. For example, Hastings-Truelove’s team scheduled a workshop and invited key stakeholders to join them and contribute their voice to recommendations.

“Our target goal is to create a culture where each level reinforces the next. So, the individual has a responsibility to know what resources are available to make personal choices that contribute to wellness,” said Hastings-Truelove. “The organization has a responsibility to measure wellness and provide clear policies around support and accommodations that include flexibility.


Burnout’s mounting price tag: What it’s costing your organization

Physician burnout is costing the U.S. about $4.6 billion annually when you conservatively estimate the costs related to physician turnover and reduced clinical hours, according to a new study co-written by Christine Sinsky, MD, the AMA’s vice president of professional satisfaction.

How burnout in physicians compares to other professional degrees

Does whether you have a medical, doctor of philosophy (Ph.D.) or Juris Doctor (JD) degree, play a role in your risk for professional burnout? It does.  “Burnout among physicians is higher than burnout among other professionals who have also invested many additional years in their training,” said AMA Vice President of Professional Satisfaction Christine Sinsky, MD, a general internist and a co-author of the letter.  “In fact, having higher levels of training protects against burnout in professions outside of medicine, whereas it does not in medicine,” she added. 

“There is a shared responsibility among many organizations that impact physicians’ work lives to consider how decisions within their realm impact the do-ability of the work and the well-being of the physician workforce,” she added.

The burnout statistics are high enough that groups should consider a mandatory medical education program for their physicians, and perhaps a mandatory CME program for licensure in each state. This type, of course, may even impact the number of impaired physicians and decrease license probations and/or suspension.

https://tinyurl.com/qqd33x7

One Defensive Strategy Against Surprise Medical Bills: Set Your Own Terms |

 By writing in payment limits when signing hospital forms, patients might have leverage in negotiations over disputes that arise from surprise medical bills.

When you sign into a hospital next time, read all those pages that require a signature. For the discussion here we will limit comments to the agreement to pay all charges. Often patients are asked to sign on a computer signature line. You can also ask for a printed paper signature page.

There some things you can do to limit excessive balance billings.  Patients should be proactive and not be frightened by a threat of admission being refused.  

Take These Passes With You​
​
Save Quizzify's helpful passes to your Apple Wallet to avoid surprise medical bills and ask doctors the right questions.

You don’t have to remember these questions, because, in the immortal words of the great philosopher Yogi Berra, we’ve done the remembering for you. (He didn’t actually say that, but he could have.) All you need to remember is that you’ve got them in your AppleWallet.

If you do not have an Apple iPhone you can use this link on an Android smartphone.  In any case if all else fails you can have this pass on a smartphone.

When Stacey Richter’s husband recently landed in a New Jersey emergency room, fearing a heart attack, she had an additional reason for alarm: a potential big bill from the hospital if the ER wasn’t in his insurer’s network.

So she took an unusual step. Instead of simply signing the hospital’s financial and treatment consent form, Richter first crossed out sections calling for her to pay whatever amount the hospital charged. She wrote in her own payment rate of a “maximum of two times” what the federal government would pay under Medicare, which is in the ballpark, experts said, of what hospitals might consider an acceptable rate.

“And then I signed it, took a picture of it and handed it back to them,” said Richter, co-president of the consultancy Aventria Health Group.

The U.S. Congress has also considered legislation regarding excessive balance billing. The legislation contains specific requirements in regard to timely billing as well as excessive charges. Section 202, and 302

One Defensive Strategy Against Surprise Medical Bills: Set Your Own Terms | California Healthline:

Social Security Disability Insurance: A Bedrock of Security for American Workers

Social Security Disability Insurance provides vital protection to nearly all American workers and their families in case of life-changing disability or illness.

Imagine that tomorrow, while cleaning out your gutters, you fall off a ladder. You suffer a traumatic brain injury and spinal cord damage, leaving you paralyzed, unable to speak, and with significantly impaired short- and long-term memory. Unable to work for the foreseeable future, you have no idea how you are going to support your family. Now imagine your relief when you realize an insurance policy you have been paying into all your working life will help keep you and your family afloat by replacing a portion of your lost wages. Fortunately, there is no need to conjure up the source of your relief: it is our Social Security system.

Social Security Disability Insurance is coverage that workers earn

For a young worker with a spouse, two children, and average earnings, the value of the coverage that Disability Insurance provides is equivalent to a $580,000 insurance policy, and many estimates suggest that the real value of the protection it offers is much higher. Both workers and employers pay for Social Security through payroll tax contributions. Workers currently pay 6.2 percent of the first $118,500 of their earnings each year, and employers pay the same amount up to the same cap. Of that 6.2 percent, 5.3 percent currently goes to the Old-Age and Survivors Insurance, or OASI, trust fund, and 0.9 percent to the Disability Insurance trust fund. Due to the interrelatedness of the Social Security programs, the two funds are typically considered together, although they are technically separate. The portion of payroll tax contributions that goes into each trust fund has changed several times throughout the years to account for demographic shifts and the funds’ respective projected solvency. 

Many patients misunderstand this benefit and do not apply because they consider it charity. Not so, it is an insurance policy.

Eligibility criteria are stringent and most applicants are denied

Social Security Disability Insurance is reserved for workers whose disabilities or illnesses are so debilitating that they cannot support themselves through work. Under the Social Security Act, the eligibility standard requires that a disabled worker be “unable to engage in substantial gainful activity”—defined as earning $1,090 per month, for 2015—“by reason of any medically determinable physical or mental impairment which can be expected to result in death or last for a continuous period of not less than 12 months.” In order to meet this rigorous standard, a worker must not only be unable to do his or her past jobs, but also—considering his or her age, education, and experience—any other job that exists in significant numbers in the national economy at a level where he or she could earn even $270 per week.

A worker must also have earned coverage in order to be protected by Disability Insurance. A worker must have worked at least one-fourth of his or her adult years, including at least 5 of the 10 years before the disability began in order to be “insured.” The typically disabled worker beneficiary worked 22 years before needing to turn to benefits.

Applying for Disability

In practice, proving medical eligibility for Disability Insurance requires extensive medical evidence from one or more “acceptable medical sources”—licensed physicians, specialists, or other approved medical providers—documenting the applicant’s severe impairment, or impairments, and resulting symptoms. Evidence from other providers, such as nurse practitioners or clinical social workers, is not enough to document a worker’s medical condition. Statements from friend's loved ones and the applicant is not considered medical evidence and is not sufficient to establish eligibility. Past medical records are essential. It will require your active participation, telephone calls to past doctors, for testing results.

Don't expect to be approved on your first try. Records will be incomplete or missing. If you are repeatedly denied get an experienced Disability attorney to take your case.  They are paid out of whatever you are awarded.  Remember too that all benefits are retroactive to the first date of your application.  In some cases, this can be any number of years.  That amount would be paid to you in a lump sum.

Fewer than 4 in 10 claims for Disability Insurance are approved under this stringent standard, even after all levels of appeal. Underscoring the strictness of the disability standard, thousands of applicants die each year while waiting for benefits. And one in five males and nearly one in six female beneficiaries die within five years of being approved for benefits. Disability Insurance beneficiaries have death rates three to six times higher than other people their age.

Social Security Disability Insurance: A Bedrock of Security for American Workers - Center for American Progress:

CVS swings to $6.6B profit in 2019, buoyed by Aetna Acquisition

Despite rising pharmaceutical prices there are economic pressures for mergers between industries in the healthcare sector.  This one is between retail outlets, and health insurance (plan).

• CVS Health slightly topped Wall Street expectations for the fourth quarter of 2019 on both earnings and revenue, which clocked in at $66.9 billion, up almost 23% year over year.
• The Aetna integration, along with higher volume in both the pharmacy benefit management business Caremark and the retail segment, drove revenue growth in the quarter and in 2019 overall. For the year, its first as a combined company, CVS saw total revenue of $256.8 billion, up 32% from 2018.
• The Woonsocket, Rhode Island-based health giant reported a profit of $1.7 billion in the quarter, up from a loss of $421 million in the prior-year period. CVS raked in a profit of $6.6 billion for the full year, up from a loss in 2018 of $596 million, it said in results announced premarket Wednesday.

Dive Insight:

The ubiquitous drugstore giant, which overcame an unprecedented judicial hold-up of its acquisition with payer Aetna in September, reported its highest year-over-year earnings growth in the first three quarters of last year due to the results of the Aetna buy.

While the fourth quarter didn't include the impact of share dilution and interest expense from the transaction, CVS still saw earnings growth higher than financial analysts and its own internal expectations, according to top leadership.

Continued price compression in pharmacy services, retail reimbursement pressure and an increased generic dispensing rate all slightly tamped down revenue, both for the quarter and the full year. However, CVS benefited from a lower tax rate than anticipated.

The company reported operating income of $3 billion in the fourth quarter and $12 billion for the full year, up 269% and 198%, respectively. Adjusted operating income, which factors out the impact of the acquisition, of $3.8 billion in the quarter and $15.3 billion for the year, was up 1.3% and 36.2%, respectively.

Caremark and CVS' retail segment both saw their revenue tick up slightly in the fourth quarter to $37 billion and $22.6 billion, respectively. For the PBM, claims processed increased more than 10% to 534 million, mostly due to new business and retention of a large portion of a contract with Centene, extended through 2022.

For the 2021 selling season, Caremark has completed for 65% of contract renewals to date, including the extension of the Blue Cross Blue Shield's federal employee program contract through 2021 and renewal of Wellcare's contract through 2023.​

Aetna spurred revenue in CVS' healthcare benefits business to almost triple in the quarter to $17.2 billion. Revenue in the segment was $69.6 billion for 2019, up 677% from 2018, pre-Aetna. CVS had almost 23 million beneficiaries in its Aetna and Medicare Part D plans in 2019, up 3.6% year over year, and a medical loss ratio of 85.7%.

The payer saw growth in government services. Its Medicare Advantage business grew over three times the industry average in 2019, CEO Larry Merlo said Wednesday, and Medicaid growth was oiled both organically and through M&A, including the December acquisition of Illinicare from Centene.

Along with the results, CVS also announced a leadership shuffle. EVP Alan Lotvin, who previously helmed CVS' transformation efforts, is replacing Derica Rice as president of Caremark and Jonathan Mayhew, ex-SVP for Aetna markets, will replace Lotvin in managing the transformation product portfolio.

As a result of the earnings, CVS bumped up its guidance for 2020, expecting operating income to ring in between $12.8 billion and $13 billion and diluted earnings per share of $5.47 to $5.60.

It remains to be seen whether this will be a patient-centered experience or a boon for stockholders. Perhaps it will be both and the efficiency of one organization integrating health insurance coverage and retail pharmacy will be interesting. The initial quarterly financial statement may be a figment of a profit and loss statement.  Let's give it a year or two to unwind.

CVS swings to $6.6B profit in 2019, buoyed by Aetna | Healthcare Dive: